Lack of synergism between long-term poor glycaemic control and three gene polymorphisms of the renin angiotensin system on risk of developing diabetic nephropathy in type I diabetic patients

DEFF Research Database (Denmark)

Tarnow, L; Kjeld, T; Knudsen, E

2000-01-01

AIMS/HYPOTHESIS: Reports on a putative synergism between poor glycaemic control and carriage of the angiotensin II type 1 receptor (AGTR1) C1166-allele and risk of diabetic nephropathy have been conflicting. Therefore, we investigated the interaction between long-term glycaemic control and three...... studied Caucasian patients with Type I (insulin-dependent) diabetes mellitus and nephropathy (120 men 74 women, age 41.1 +/- 9.6 years, diabetes duration 28 +/- 8 years) and long-standing Type I diabetic patients with persistent normoalbuminuria (112 men 69 women, age 42.5 +/- 10.0 years, diabetes...... duration 27 +/- 9 years). Genotyping was PCR-based and metabolic control estimated from all measurements of HbA1c done in each patient [average (range) n = 31 (6-74)]. The median observation time (range) was 13.5 (2-14) years. RESULTS: Type I diabetic patients with a history of poor glycaemic control (HbA1...

Improvement in C-reactive protein and advanced glycosylation end-products in poorly controlled diabetics is independent of glucose control.

Science.gov (United States)

Md Isa, S H; Najihah, I; Nazaimoon, W M Wan; Kamarudin, N A; Umar, N A; Mat, N H; Khalid, B A K

2006-04-01

We studied the efficacy of four different treatment regimens (sulphonylurea and metformin+/-acarbose versus glimepiride and rosiglitazone versus glimepiride and bedtime NPH insulin versus multiple actrapid and NPH insulin injections) in poorly controlled type 2 diabetes subjects on hs-CRP, VCAM-1 and AGE at 4, 8 and 12 weeks of treatment. Multiple insulin injections rapidly improved HbA(1c) by 0.6+/-0.9% (pimprovement in blood glucose. AGE improved in all groups irrespective of type of treatment, glycaemic control and CRP levels. Our data indicate rapid glycaemic control alone does not necessarily result in improvement in markers of inflammation in type 2 diabetes patients.

Impact of poor glycemic control of type 2 diabetes mellitus on serum prostate-specific antigen concentrations in men.

Science.gov (United States)

Atalay, Hasan Anıl; Akarsu, Murat; Canat, Lutfi; Ülker, Volkan; Alkan, İlter; Ozkuvancı, Unsal

2017-09-01

To evaluate the impact of poor glycemic control of type 2 diabetes mellitus (T2DM) on serum prostate-specific antigen (PSA) concentrations in men. We performed a prospective analysis of 215 consecutive patients affected by erectile dysfunction (ED). ED was evaluated using the IIEF-5 questionnaire and the poor glycemic control (PGC) of T2DM was assessed according to the HbA1c criteria (International Diabetes Federation). Patients were divided into PGC group (HbA1c ≥ 7%) and control group (CG) (HbA1c men ranging from 44 to 81 years of age, lower PSA concentrations were observed in men with PGC (PGC mean PSA: 0.9 ng/dl, CG mean PSA: 2.1 ng/dl, p men with PGC compared with men with CG (PGC mean prostate volume: 26 ml, CG prostate volume: 43 ml, p strong negative correlation was found between serum HbA1c levels and serum PSA (p men with PGC. We also found at the multivariate logistic regression model that PSA, prostate volume and peak systolic velocity were independent predictors of PGC. Our results suggest that there is significant impact of PGC on serum PSA levels in T2DM. Poor glycemic control of type 2 diabetes was associated with lower serum PSA levels and smaller prostate volumes.

Gender, diabetes education, and psychosocial factors are associated with persistent poor glycemic control in patients with type 2 diabetes in the Joint Asia Diabetes Evaluation (JADE) program.

Science.gov (United States)

Yin, Junmei; Yeung, Roseanne; Luk, Andrea; Tutino, Greg; Zhang, Yuying; Kong, Alice; Chung, Harriet; Wong, Rebecca; Ozaki, Risa; Ma, Ronald; Tsang, Chiu-Chi; Tong, Peter; So, Wingyee; Chan, Juliana

2016-01-01

Factors associated with persistent poor glycemic control were explored in patients with type 2 diabetes under the Joint Asia Diabetes Evaluation (JADE) program. Chinese adults enrolled in JADE with HbA1c ≥8% at initial comprehensive assessment (CA1) and repeat assessment were analyzed. The improved group was defined as those with a ≥1% absolute reduction in HbA1c, and the unimproved group was those with patients with HbA1c ≥8% at baseline, 1450 underwent repeat CA. After a median interval of 1.7 years (interquartile range[IQR] 1.1-2.2) between CA1 and CA2, the unimproved group (n = 677) had a mean 0.4% (95% confidence interval [CI] 0.3%, 0.5%) increase in HbA1c compared with a mean 2.8% reduction (95% CI -2.9, -2.6%) in the improved group (n = 773). The unimproved group had a female preponderance with lower education level, and was more likely to be insulin treated. Patients in the improved group received more diabetes education between CAs with improved self-care behaviors, whereas the unimproved group had worsening of health-related quality of life at CA2. Apart from female gender, long disease duration, low educational level, obesity, retinopathy, history of hypoglycemia, and insulin use, lack of education from diabetes nurses between CAs had the strongest association for persistent poor glycemic control. These results highlight the multidimensional nature of glycemic control, and the importance of diabetes education and optimizing diabetes care by considering psychosocial factors. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

Late-night-dinner is associated with poor glycemic control in people with type 2 diabetes: The KAMOGAWA-DM cohort study.

Science.gov (United States)

Sakai, Ryosuke; Hashimoto, Yoshitaka; Ushigome, Emi; Miki, Akane; Okamura, Takuro; Matsugasumi, Masako; Fukuda, Takuya; Majima, Saori; Matsumoto, Shinobu; Senmaru, Takafumi; Hamaguchi, Masahide; Tanaka, Muhei; Asano, Mai; Yamazaki, Masahiro; Oda, Yohei; Fukui, Michiaki

2018-04-26

Skipping breakfast or irregular breakfast is associated with poor glycemic control. However, a relationship between the timing of dinner and glycemic control in people with type 2 diabetes remains indefinite. Therefore, we investigated the relationship between late-night-dinner and glycemic control in people with type 2 diabetes. We performed questionnaire survey for lifestyle factors in this cross-sectional study. We defined having dinner later than eight pm as late-night-dinner. We examined the differences in clinical and metabolic parameters between those who have late-night-dinner and those who do not have. We also examined the relationship between late-night-dinner and HbA1c, using multiple regression analysis. Ninety-five people (23.2%) had a late-night-dinner, among 409 people with type 2 diabetes. Metabolic parameters (mean (SD) or median (interquartile range)) of people with late-night-dinner were worse than those of without, including body mass index (BMI) (24.4 (4.0) vs. 23.2 (3.4) kg/m 2 , p = 0.006), triglycerides (1.5 (1.1-2.1) vs. 1.2 (0.8-1.7) mmol/L, p dinner (standardized regression coefficient = 0.13, p = 0.028) was associated with hemoglobin A1c after adjusting for age, BMI, sex, duration of diabetes, smoking, exercise, alcohol, snacking after dinner, nighttime sleep duration, time from dinner to bedtime, skipping breakfast, and medication for diabetes. Late-night-dinner is independently associated with poor glycemic control in people with type 2 diabetes.

Population pharmacokinetic modeling of glibenclamide in poorly controlled South African type 2 diabetic subjects

Directory of Open Access Journals (Sweden)

Rambiritch V

2016-07-01

Full Text Available Virendra Rambiritch,1 Poobalan Naidoo,2 Breminand Maharaj,1 Goonaseelan Pillai3 1University of KwaZulu-Natal, Durban, 2Department of Internal Medicine, RK Khan Regional Hospital, Chatsworth, South Africa; 3Novartis Pharma AG, Basel, Switzerland Aim: The aim of this study was to describe the pharmacokinetics (PK of glibenclamide in poorly controlled South African type 2 diabetic subjects using noncompartmental and model-based methods. Methods: A total of 24 subjects with type 2 diabetes were administered increasing doses (0 mg/d, 2.5 mg/d, 5 mg/d, 10 mg/d, and 20 mg/d of glibenclamide daily at 2-week intervals. Plasma glibenclamide, glucose, and insulin determinations were performed. Blood sampling times were 0 minute, 30 minutes, 60 minutes, 90 minutes, and 120 minutes (post breakfast sampling and 240 minutes, 270 minutes, 300 minutes, 330 minutes, 360 minutes, and 420 minutes (post lunch sampling on days 14, 28, 42, 56, and 70 for doses of 0 mg, 2.5 mg, 5.0 mg, 10 mg, and 20 mg, respectively. Blood sampling was performed after the steady state was reached.  A total of 24 individuals in the data set contributed to a total of 841 observation records. The PK was analyzed using noncompartmental analysis methods, which were implemented in WinNonLin®, and population PK analysis using NONMEM®. Glibenclamide concentration data were log transformed prior to fitting. Results: A two-compartmental disposition model was selected after evaluating one-, two-, and three-compartmental models to describe the time course of glibenclamide plasma concentration data. The one-compartment model adequately described the data; however, the two-compartment model provided a better fit. The three-compartment model failed to achieve successful convergence. A more complex model, to account for enterohepatic recirculation that was observed in the data, was unsuccessful. Conclusion: In South African diabetic subjects, glibenclamide demonstrates linear PK and was best

The poor children of the poor: Coping with diabetes control in a ...

African Journals Online (AJOL)

[1,2]. Many children over the age of 10 years administer their own insulin injections,[3] although some authorities ... Patients attending the paediatric diabetes clinic were interviewed by ..... review and meta-analysis of randomized control trials.

Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings.

LENUS (Irish Health Repository)

Murphy, Mark E

2017-08-04

Poorly controlled type 2 diabetes mellitus (T2DM) is a major international health problem. Our aim was to assess the effectiveness of healthcare interventions, specifically targeting patients with poorly controlled T2DM, which seek to improve glycaemic control and cardiovascular risk in primary care settings.

Life-threatening emphysematous liver abscess associated with poorly controlled diabetes mellitus: a case report.

Science.gov (United States)

Takano, Yuichi; Hayashi, Masafumi; Niiya, Fumitaka; Nakanishi, Toru; Hanamura, Shotaro; Asonuma, Kunio; Yamamura, Eiichi; Gomi, Kuniyo; Kuroki, Yuichiro; Maruoka, Naotaka; Inoue, Kazuaki; Nagahama, Masatsugu

2017-03-06

Emphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care. The patient was a 69-year-old Japanese man with type 2 diabetes. He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks. Abdominal computed tomography revealed an abscess 5 cm in diameter accompanied by gas formation in the right hepatic lobe. Markedly impaired glucose tolerance was observed with a blood sugar level of 571 mg/dL and a glycated hemoglobin level of 14.6%. The patient underwent emergency percutaneous abscess drainage, and intensive care was subsequently initiated. Klebsiella pneumoniae was detected in both the abscess cavity and blood cultures. The drain was removed 3 weeks later, and the patient was discharged. Emphysematous liver abscesses are often observed in patients with poorly controlled diabetes, and the fatality rate is extremely high. Fever and malaise occasionally mask life-threatening infections in diabetic patients, necessitating careful examination.

Long-term tolerability of inhaled human insulin (Exubera) in patients with poorly controlled type 2 diabetes

DEFF Research Database (Denmark)

Barnett, A H; Lange, P; Dreyer, M

2007-01-01

OBJECTIVE: Inhaled human insulin (Exubera; EXU) has shown encouraging tolerability in short-term trials. We evaluated the safety profile of EXU after long-term exposure. DESIGN: In two, open-label, 2-year studies patients poorly controlled on a sulphonylurea were randomised to adjunctive EXU...... or metformin (study 1) and patients poorly controlled on metformin were randomised to adjunctive EXU or the sulphonylurea, glibenclamide (study 2). PATIENTS: The studies included 446 (study 1) and 476 (study 2) patients with type 2 diabetes, no clinically significant respiratory disease and glycosylated....... There was no discernable effect of long-term EXU therapy on pulmonary gas exchange. Insulin antibody binding reached a plateau at 6 months and did not correlate with HbA(1c) or lung function changes. Glycaemic control was maintained over 2 years. CONCLUSIONS: Exubera was well tolerated during long-term use. Pulmonary...

Salivary function and glycemic control in older persons with diabetes.

Science.gov (United States)

Chavez, E M; Taylor, G W; Borrell, L N; Ship, J A

2000-03-01

There is no consensus on the possible association between diabetes and salivary dysfunction in older persons with diabetes. This study's purpose was to investigate the effect of diabetes and glycemic control on salivary function in an older population. Twenty nine persons with type 2 diabetes and 23 nondiabetic control subjects participated (age range, 54-90 years). Diabetic status was determined by a glycosylated hemoglobin (HbA(1c)) test and a 2-hour glucose tolerance test. Poor glycemic control was defined as HbA(1c) >9%. Unstimulated whole saliva, unstimulated parotid, and stimulated parotid flow rates were measured, and subjects completed a standardized xerostomia questionnaire. Persons with poorly controlled diabetes had lower (P =.01) stimulated parotid flow rates than persons with well-controlled diabetes and nondiabetic control subjects. There were no significant differences in xerostomic complaints based on diabetic or glycemic control status or salivary flow rates. These results provide some evidence that poorly controlled diabetes may be associated with salivary dysfunction in older adults who have no concomitant complaints of xerostomia.

Serum GGT activity and hsCRP level in patients with type 2 diabetes mellitus with good and poor glycemic control: An evidence linking oxidative stress, inflammation and glycemic control.

Science.gov (United States)

Gohel, Mukesh G; Chacko, Anusha N

2013-12-20

Diabetes is undoubtedly one of the most challenging health problems in 21st century. Understanding the pathogenesis and preventing long term complications have been major goals of research in diabetes mellitus (DM). Research in the past few years has linked oxidative stress and inflammation to beta cell dysfunction. Aim of this study is to evaluate serum gamma-glutamyl transferase (GGT) activity (marker of oxidative stress) and high sensitivity C reactive protein (hsCRP) level (an inflammatory marker) in type 2 DM subjects with good and poor glycemic control. Further, we investigated correlation between serum GGT and hsCRP level with glycemic control (FBS, PP2BS, HbA1c) in subjects. A cross sectional study consists of 150 patients out of them 50 patients having type 2 DM with good control (Group II), 50 patients with type 2 DM with poor control (Group III) and 50 normal healthy control (Group I) were selected. Serum GGT, serum hsCRP, FBS, PP2BS, HbA1c, and other biochemical investigations include serum liver enzymes and lipids were measured. Mean serum GGT and hsCRP concentration were statistically significantly higher in group III patients compared to group I and group II subjects as well as increased in group II compared to group I (p stress and inflammation appears to be a key component and also associated with poor glycemic control and further pathogenesis of diabetes and its complications. All our finding suggesting a link between oxidative stress, inflammation and glycemic control in patient with type 2 diabetes mellitus.

Short-term poor glycemic control and retinal microvascular changes in pediatric Type 1 Diabetes patients in Singapore: a pilot study.

Science.gov (United States)

Li, Ling-Jun; Lamoureux, Ecosse; Wong, Tien Yin; Lek, Ngee

2017-06-15

Poor glycemic control in Type 1 Diabetes (T1D) patients is strongly associated with an increased risk of diabetes-related microvascular complications later in life, but it is unclear whether short period of poor glycemic control in children with T1D can cause evident microvascular morphological changes long before any pathological manifestation. Our study aimed to investigate the longitudinal association between poor glycemic control and subsequent changes in retinal microvasculature, in a pilot study of 55 pediatric T1D patients from Singapore after a one-year follow-up. This is a hospital-based, exposure-matched and retrospective longitudinal study. A total of 55 T1D patients were included from Singapore KK Women's and Children Hospital, 28 of whom had poor glycemic control (average glycated hemoglobin [HbA1c] ≥8% during the year) while the other 27 age- and gender-matched subjects had good glycemic control (HbA1c Singapore I Vessel Assessment [SIVA], version 4.0, Singapore Eye Research Institute, Singapore) and a spectrum of retinal vascular parameters (e.g. caliber, tortuosity, branching angle and fractal dimension) were measured quantitatively from 0.5 to 2.0 disc diameters. There was no significant difference in ethnicity, duration of T1D, blood pressure, body mass index (BMI) and low-density cholesterol lipoprotein (LDL) between the two groups. Retinal imaging was obtained at the end of 1 year of glycemic control assessment. In multiple linear regression adjusting for ethnicity, BMI, LDL and duration of T1D, patients with poor glycemic control tended to have marginally wider retinal arteriolar caliber (6.0 μm, 95% CI: -0.9, 12.8) and had significantly larger retinal arteriolar branching angle (10.1 degrees, 95% CI: 1.4, 18.9) compared with their age- and gender- matched counterparts with good glycemic control. Our findings showed that abnormal retinal microvascular morphology was evident in pediatric patients with T1D after one-year's poor glycemic

Behavioral health care for adolescents with poorly controlled diabetes via Skype: does working alliance remain intact?

Science.gov (United States)

Freeman, Kurt A; Duke, Danny C; Harris, Michael A

2013-05-01

Increasingly various technologies are being tested to deliver behavioral health care. Delivering services via videoconferencing shows promise. Given that the patient-provider relationship is a strong predictor of patient adherence to medical regimens, addressing relationship quality when services are not delivered face-to-face is critical. To that end, we compared the therapeutic alliance when behavioral health care was delivered to youth with poorly controlled type 1 diabetes mellitus (T1DM) and their caregivers in-clinic with the same services delivered via Internet-based videoconferencing (i.e., Skype™). Seventy-one adolescents with poorly controlled T1DM (hemoglobin A1c ≥9%) and one of their caregivers received up to 10 sessions of a family-based behavioral health intervention previously shown to improve adherence to diabetes regimens and family functioning; 32 were randomized to the Skype condition. Youth and caregivers completed the working alliance inventory (WAI), a 36-item measure of therapeutic alliance, at the end of treatment. Additionally, the number of behavioral health sessions completed was tracked. No significant differences in WAI scores were found for those receiving behavioral health care via Skype versus in-clinic. Youth WAI goal and total scores were significantly associated with the number of sessions completed for those in the clinic group. Behavioral health can be delivered to youth with T1DM via Internet-based videoconferencing without significantly impacting the therapeutic relationship. Thus, for those adolescents with T1DM who require specialized behavioral health care that targets T1DM management, Internet-based teleconferencing represents a viable alternative to clinic-based care. © 2013 Diabetes Technology Society.

Blood glucose control and compliance of diabetic children

Directory of Open Access Journals (Sweden)

F. P. R. de Villiers

1997-03-01

Full Text Available Non-compliance is an important factor hindering good control in diabetics. The aim of this study was to identify areas of poor compliance with the diabetes management regimen in the children attending our clinic. A questionnaire was administered to 57 patients who attend the Paediatric Diabetes Clinic. It was designed to elicit socio-demographic data and information about the diabetic regimen. Prior to the administration of the questionnaire, patients were classified as being well, satisfactorily or poorly controlled, based on their average glycosylated Haemoglobin results over the past year.

High Prevalence of Autoimmune Diabetes and Poor Glycaemic Control among Adults in Madagascar: A Brief Report from a Humanitarian Health Campaign in Ambanja

Directory of Open Access Journals (Sweden)

Ernesto Maddaloni

2017-01-01

Full Text Available Madagascar is a geographically isolated country considered a biodiversity hotspot with unique genomics. Both the low-income and the geographical isolation represent risk factors for the development of diabetes. During a humanitarian health campaign conducted in Ambanja, a rural city in the northern part of Madagascar, we identified 42 adult subjects with diabetes and compared their features to 24 randomly enrolled healthy controls. 42.9% (n=18 of diabetic subjects showed HbA1c values ≥ 9.0%. Unexpectedly, waist circumference and BMI were similar in people with diabetes and controls. Different from the healthy controls, diabetic subjects showed a low prevalence of obesity (5.7% versus 30%, p=0.02. Accordingly, we found a high prevalence of autoimmune diabetes as 12% of people with diabetes showed positivity for the autoantibody against glutamic acid decarboxylase. Diabetic subjects with positive autoantibody had higher HbA1c values (11.3 ± 4.1% versus 8.3 ± 2.6%, p=0.03 compared to diabetic subjects with negative autoantibody. In conclusion, here we describe the presence of diabetes and its features in a rural area of Northern Madagascar, documenting poor glycaemic control and a high prevalence of autoimmune diabetes. These data highlight that the diabetes epidemic involves every corner of the world possibly with different patterns and features.

Young patients with type 1 diabetes poorly controlled and poorly compliant with self-monitoring of blood glucose: can technology help? Results of the i-NewTrend randomized clinical trial.

Science.gov (United States)

Di Bartolo, Paolo; Nicolucci, Antonio; Cherubini, Valentino; Iafusco, Diario; Scardapane, Marco; Rossi, Maria Chiara

2017-04-01

To compare iBGStar™ + DMApp (experimental meter + telemedicine system) (iBGStar) with a traditional glucose meter (Control) in type 1 diabetes adolescents/young adults. i-NewTrend was a multicenter, open-label, randomized trial involving subjects aged 14-24 years, on basal-bolus insulin, HbA1c ≥ 8.0%, and poorly compliant with SMBG (i.e., technologies effective and acceptable to patients is an option to improve adherence to diabetes care. The trial was registered at ClinicalTrials.gov (registration number NCT02073188).

Study protocol of the Diabetes and Depression Study (DAD): a multi-center randomized controlled trial to compare the efficacy of a diabetes-specific cognitive behavioral group therapy versus sertraline in patients with major depression and poorly controlled diabetes mellitus.

Science.gov (United States)

Petrak, Frank; Herpertz, Stephan; Albus, Christian; Hermanns, Norbert; Hiemke, Christoph; Hiller, Wolfgang; Kronfeld, Kai; Kruse, Johannes; Kulzer, Bernd; Ruckes, Christian; Müller, Matthias J

2013-08-06

Depression is common in diabetes and associated with hyperglycemia, diabetes related complications and mortality. No single intervention has been identified that consistently leads to simultaneous improvement of depression and glycemic control. Our aim is to analyze the efficacy of a diabetes-specific cognitive behavioral group therapy (CBT) compared to sertraline (SER) in adults with depression and poorly controlled diabetes. This study is a multi-center parallel arm randomized controlled trial currently in its data analysis phase. We included 251 patients in 70 secondary care centers across Germany. Key inclusion criteria were: type 1 or 2 diabetes, major depression (diagnosed with the Structured Clinical Interview for DSM-IV, SCID) and hemoglobin A1C >7.5% despite current insulin therapy. During the initial phase, patients received either 50-200 mg/d sertraline or 10 CBT sessions aiming at the remission of depression and enhanced adherence to diabetes treatment and coping with diabetes. Both groups received diabetes treatment as usual. After 12 weeks of this initial open-label therapy, only the treatment-responders (50% depression symptoms reduction, Hamilton Depression Rating Scale, 17-item version [HAMD]) were included in the subsequent one year study phase and represented the primary analysis population. CBT-responders received no further treatment, while SER-responders obtained a continuous, flexible-dose SER regimen as relapse prevention. Adherence to treatment was analyzed using therapeutic drug monitoring (measurement of sertraline and N-desmethylsertraline concentrations in blood serum) and by counting the numbers of CBT sessions received. Outcome assessments were conducted by trained psychologists blinded to group assignment. Group differences in HbA1c (primary outcome) and depression (HAMD, secondary outcome) between 1-year follow-up and baseline will be analyzed by ANCOVA controlling for baseline values. As primary hypothesis we expect that CBT

Twelve-Week Treatment With Liraglutide as Add-on to Insulin in Normal-Weight Patients With Poorly Controlled Type 1 Diabetes

DEFF Research Database (Denmark)

Frandsen, Christian S; Dejgaard, Thomas F; Holst, Jens J

2015-01-01

OBJECTIVE: This study investigated the efficacy and safety of once-daily liraglutide 1.2 mg versus placebo as add-on to insulin treatment in normal-weight patients with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS: In a randomized (1:1), double-blind, placebo-controlled design, 40...... patients with type 1 diabetes (HbA1c ≥8% [64 mmol/mol]) received once-daily liraglutide 1.2 mg or placebo for 12 weeks. Continuous glucose monitoring was performed before and at the end of treatment. The primary end point was change in HbA1c. Secondary end points included change in insulin dose, weight...... was more frequently associated with gastrointestinal adverse effects. The incidence of hypoglycemia did not differ between groups. CONCLUSIONS: Liraglutide significantly reduces body weight and insulin requirements but has no additional effect on HbA1c in normal-weight patients with type 1 diabetes...

Study methodology and diabetes control in patients from the non-English diabetes management project (NEDMP).

Science.gov (United States)

Dirani, Mohamed; Dang, Trung M; Xie, Jing; Gnanasekaran, Sivashanth; Nicolaou, Theona; Rees, Gwyneth; Fenwick, Eva; Lamoureux, Ecosse L

2017-03-01

To describe the clinical characteristics of non-English speaking patients from the Diabetes Management Project (NEDMP), and compare their diabetes management and severity of diabetic retinopathy (DR) with the English-speaking DMP sample (EDMP). A prospective study was conducted on non-English speaking adults with diabetes who attended the Royal Victorian Eye and Ear Hospital. 136 (90.1%) non-English speaking adults were assessed, with a mean age of 72.2 years (range: 50-88 years); 74 (54.4%) were male. Participants completed interviewer-administered questionnaires and underwent visual acuity, fundus photography, optical coherence tomography, biochemistry and anthropometric measurements. The EDMP assessed 609 patients in 2009 using a similar protocol. Type and duration of diabetes, diabetes control and diabetic retinopathy. A total of 127 (93.4%) and 8 (5.9%) participants reported having type 2 and type 1 diabetes, respectively, with a median (IQR) duration of 17 (14) years. The proportion of patients with poor diabetes control (HbA1c ≥ 7%) in the NEDMP was similar to the EDMP (64.0% and 68.2%, respectively; P = 0.411). A significantly higher proportion of patients with DR in the NEDMP were found to have poor diabetes control (HbA1c ≥ 7%) compared to those without DR (80.9% vs. 50.0%, P = 0.003). Almost two-thirds of NEDMP patients (74/118) had DR and 23% (27/115) had diabetic macular edema. The prevalence of DR was similar between the NEDMP and EDMP studies, ranging from 25-30% and 28-29%. The clinical characteristics, diabetes control, and DR severity of English and non-English-speaking patients were similar. The high proportion of poor diabetes management in non-English speaking patients with DR suggests educational and behavioural interventions to improve glycaemic control are warranted. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

Pregnancy outcomes in type 2 diabetic patients as compared with type 1 diabetic patients and nondiabetic controls.

Science.gov (United States)

Knight, Kristin M; Thornburg, Loralei L; Pressman, Eva K

2012-01-01

To characterize the neonatal and maternal outcomes of type 2 diabetic patients as compared with type 1 diabetic patients and nondiabetic controls. We performed a retrospective cohort study reviewing perinatal outcomes of type 1 and type 2 diabetic patients and nondiabetic controls from July 2000 to August 2006. Analysis of variance, t testing and chi2 analysis were used to compare groups. Post hoc power analysis indicated 80% power was necessary to detect a 15% difference in composite poor neonatal outcomes. A total of 64 type 2 and 64 type 1 diabetic patients were compared with 256 controls. Type 1 diabetic patients had higher incidences of composite poor neonatal outcome and congenital anomalies than did type 2 diabetic and control patients. Both diabetic groups had similarly higher incidences of cesarean delivery, preeclampsia, preterm delivery, polyhydramnios and macrosomia than did controls. Type 2 diabetic patients have a decreased incidence of adverse neonatal outcomes when compared with that of type 1 diabetic patients. No difference was observed between the diabetic groups in the incidence of a majority of the adverse maternal outcomes examined, however both diabetic groups had overall worse outcomes that did nondiabetic controls.

Dietary compliance and its association with glycemic control among poorly controlled type 2 diabetic outpatients in Hospital Universiti Sains Malaysia.

Science.gov (United States)

Tan, S L; Juliana, S; Sakinah, H

2011-12-01

Compliance with medical nutrition therapy is important to improve patient outcomes. The purpose of this study was to determine dietary compliance and its association with glycemic control among outpatients with poorly controlled type 2 diabetes mellitus (T2DM) in Hospital Universiti Sains Malaysia (HUSM). In this cross-sectional study, patients who had a glycosylated hemoglobin (HbA1c) level of at least 6.5%, after attending a diet counseling session at the Outpatient Dietetic Clinic, HUSM, were enrolled. Out of 150 diabetic patients reviewed between 2006 and 2008, 61 adults (32 men and 29 women) agreed to participate in this study. A questionnaire-based interview was used to collect socio-demographic, clinical and diabetes self-care data. The patient's dietary compliance rate was determined by the Summary of Diabetes Self-Care Activities (SDSCA) measure. Anthropometric and biological measurements were also taken. Only 16.4% of the respondents adhered to the dietary regimen provided by dietitians. Among the 7 dietary self-care behaviours, item number 6 (eat lots of food high in dietary fibre such as vegetable or oats) had the highest compliant rate (54.1%); whereas item number 3 (eat five or more servings of fruits and vegetables per day) had the lowest compliant rate (23.0%). There was a significant association between gender (p = 0.037) and fasting blood sugar (FBS) (p = 0.007) with the compliance status. Dietary non-compliance is still common among T2DM patients. Dietitians need to improve their skills and use more effective intervention approaches in providing dietary counseling to patients.

Leisure-time physical activity and risk of type 2 diabetes in patients with established vascular disease or poorly controlled vascular risk factors

NARCIS (Netherlands)

Brouwer, B.G.; Graaf, van der Y.; Soedamah-Muthu, S.S.; Wassink, A.M.J.; Visseren, F.L.J.

2010-01-01

AIM: To investigate the effect of leisure-time physical activity on the incidence of type 2 diabetes (T2DM) in patients with manifest arterial disease, or poorly controlled risk factors. METHODS: We examined 3940 patients with manifest arterial disease, hypertension or hyperlipidemia, aged

Musculoskeletal morbidity: the growing burden of shoulder pain and disability and poor quality of life in diabetic outpatients.

Science.gov (United States)

Laslett, L L; Burnet, S P; Jones, J A; Redmond, C L; McNeil, J D

2007-01-01

To investigate shoulder pain and disability and quality of life (QoL) over 12 months in patients with diabetes and in a non-diabetic control group. Cross-sectional study with 12-month follow-up in diabetic (n=189) and medical (n=99) outpatients employing the Shoulder Pain and Disability Index (SPADI) and SF-36 version 2. The results were analysed using restricted maximum likelihood (REML). The prevalence of current shoulder symptoms was 35% in diabetics and 17% in controls. Shoulder pain and disability as calculated by the SPADI were independently associated with diabetes (vs controls) and current shoulder symptoms, and worsened over 12 months. Disability scores worsened with age in diabetics, and pain scores were higher in diabetics than controls among patients reporting current shoulder symptoms. Poor physical QoL worsened over time in patients with diabetes and was worse in patients with current shoulder symptoms, whether they had diabetes or not. Mental QoL was worse only in patients with current shoulder symptoms. Shoulder symptoms are common, affecting 1 in every 3 diabetic patients and 1 in every 6 control patients. In this study shoulder pain, disability and physical QoL were poorer among diabetics and patients reporting current shoulder symptoms, and worsened over time. Mental QoL was worse in patients reporting current shoulder symptoms and was independent of diabetes. Therefore, shoulder symptoms are common, are associated with poor physical and mental QoL in addition to shoulder pain and disability, and are worse in patients with diabetes, even in a population with relatively moderate shoulder pain and disability.

Artificial Neural Networks in Diabetes Control

OpenAIRE

Fernandes, Filipe; Vicente, Henrique; Abelha, António; Machado, José; Novais, Paulo; Neves, José

2015-01-01

Diabetes Mellitus is now a prevalent disease in both developed and underdeveloped countries, being a major cause of morbidity and mortality. Overweight/obesity and hypertension are potentially modifiable risk factors for diabetes mellitus, and persist during the course of the disease. Despite the evidence from large controlled trials establishing the benefit of intensive diabetes management in reducing microvasculars and macrovasculars complications, high proportions of patients remain poorly...

Explanatory models of diabetes in urban poor communities in Accra, Ghana.

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de-Graft Aikins, Ama; Awuah, Raphael Baffour; Pera, Tuula Anneli; Mendez, Montserrat; Ogedegbe, Gbenga

2015-01-01

The objective of the study was to examine explanatory models of diabetes and diabetes complications among urban poor Ghanaians living with diabetes and implications for developing secondary prevention strategies. Twenty adults with type 2 diabetes were recruited from three poor communities in Accra. Qualitative data were obtained using interviews that run between 40 and 90 minutes. The interviews were audio-taped, transcribed and analysed thematically, informed by the 'explanatory model of disease' concept. Respondents associated diabetes and its complications with diet, family history, lifestyle factors (smoking, excessive alcohol consumption and physical inactivity), psychological stress and supernatural factors (witchcraft and sorcery). These associations were informed by biomedical and cultural models of diabetes and disease. Subjective experience, through a process of 'body-listening,' constituted a third model on which respondents drew to theorise diabetes complications. Poverty was an important mediator of poor self-care practices, including treatment non-adherence. The biomedical model of diabetes was a major source of legitimate information for self-care practices. However, this was understood and applied through a complex framework of cultural theories of chronic disease, the biopsychological impact of everyday illness experience and the disempowering effects of poverty. An integrated biopsychosocial approach is proposed for diabetes intervention in this research community.

Can Fetuin-A Be a Marker for Insulin Resistance and Poor Glycemic Control in Children with Type 1 Diabetes Mellitus?

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Şiraz, Ülkü Gül; Doğan, Murat; Hatipoğlu, Nihal; Muhtaroğlu, Sabahattin; Kurtoğlu, Selim

2017-12-15

Metabolic impairment in type 1 diabetes mellitus (T1DM) with poor glycemic control causes insulin resistance, non-alcoholic fatty liver disease (NAFLD), atherosclerosis, and increased carotid intima-media thickness (CIMT). Fetuin-A has a protective effect in cardiovascular disorders and is increased in hepatosteatosis. We aimed to investigate the reliability of fetuin-A levels in early detection of diabetic complications in children with T1DM and to identify a cut-off value that may show poor metabolic control. The study included 80 patients who had T1DM for at least 5 years and who had no chronic complications or an auto-immune disorder. Blood samples were drawn to measure hemoglobin A1c (HbA1c), biochemical parameters, and fetuin-A levels. Anthropometric parameters were also measured. Percent body fat was calculated. Hepatosteatosis and CIMT were assessed by sonography. Mean age of the patients was 13.5 years. Grade 1 hepatosteatosis was detected in 10%. Patients were stratified into 2 groups based on presence of NAFLD. Fetuin-A level was increased in patients with NAFLD. We identified a fetuin-A cut-off value (514.28 ng/mL; sensitivity: 47.34; specificity: 96.72) that may predict NAFLD. HbA1c and total cholesterol levels were found to be higher in patients with fetuin-A levels above higher the cut-off value. Fetuin-A is a reliable parameter in the prediction of complications and poor glycemic control in patients with T1DM.

Long-term tolerability of inhaled human insulin (Exubera) in patients with poorly controlled type 2 diabetes

DEFF Research Database (Denmark)

Barnett, A H; Lange, P; Dreyer, M

2007-01-01

or metformin (study 1) and patients poorly controlled on metformin were randomised to adjunctive EXU or the sulphonylurea, glibenclamide (study 2). PATIENTS: The studies included 446 (study 1) and 476 (study 2) patients with type 2 diabetes, no clinically significant respiratory disease and glycosylated....... There was no discernable effect of long-term EXU therapy on pulmonary gas exchange. Insulin antibody binding reached a plateau at 6 months and did not correlate with HbA(1c) or lung function changes. Glycaemic control was maintained over 2 years. CONCLUSIONS: Exubera was well tolerated during long-term use. Pulmonary...... function changes compared with comparator groups were small, non-progressive and reversed upon treatment discontinuation. Importantly, rates of lung function change were indistinguishable between EXU and comparator after 6 months of therapy. Udgivelsesdato: 2007-Oct...

Metformin in gestational diabetes mellitus: predictors of poor response.

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Gante, Inês; Melo, Luís; Dores, Jorge; Ruas, Luísa; Almeida, Maria do Céu

2018-01-01

Metformin can be regarded as a first-line treatment in gestational diabetes mellitus (GDM) due to its safety and effectiveness. However, a proportion of women do not achieve adequate glycemic control with metformin alone. We aim to identify predictors of this poor response to metformin. Retrospective multicentre cohort study of women with GDM who started metformin as first-line treatment. The assessed cohort was divided into a metformin group and metformin plus insulin group. Biometric and demographic characteristics, glycemic control data, obstetric, neonatal and postpartum outcomes were compared between groups and analysed in order to identify predictors of poor response to metformin. Data were analysed using STATA, version 13.1. Of the 388 women enrolled in the study, 135 (34.8%) required additional insulin therapy to achieve the glycemic targets. Higher age (aOR: 1.08 (1.03-1.13), P  = 0.003), higher pre-pregnancy body mass index (BMI) (1.06 (1.02-1.10), P  = 0.003) and earlier introduction of metformin (0.89 (0.85-0.94), P  metformin, insulin supplementation was not associated with poor neonatal outcomes. Higher age, higher pre-pregnancy BMI and earlier introduction of metformin could be used as predictors of poor response to metformin. © 2018 European Society of Endocrinology.

Pre-diabetes and well-controlled diabetes are not associated with periodontal disease: the SHIP Trend Study.

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Kowall, Bernd; Holtfreter, Birte; Völzke, Henry; Schipf, Sabine; Mundt, Torsten; Rathmann, Wolfgang; Kocher, Thomas

2015-05-01

To examine associations of pre-diabetes and well-controlled diabetes with periodontitis. The Study of Health in Pomerania (SHIP)-Trend is a cross-sectional survey in North-Eastern Germany including 3086 participants (49.4% men; age 20-82 years). Clinical attachment loss (CAL) and periodontal probing depth (PPD) were assessed applying a random half-mouth protocol. The number of teeth was determined. Pre-diabetes comprised impaired fasting glucose and impaired glucose tolerance. Previously known diabetes was defined as well controlled if glycated haemoglobin (HbA1c) was diabetes, newly detected type 2 diabetes (T2DM), known T2DM with HbA1cdiabetes was neither associated with mean CAL and PPD in multivariable adjusted linear regression models nor with edentulism (OR = 1.09 (95%-CI: 0.69-1.71)) and number of teeth (OR = 0.96 (95%-CI: 0.75-1.22), lowest quartile versus higher quartiles) in logistic regression models. Associations with mean CAL and edentulism were stronger in poorly controlled previously known diabetes than in well-controlled previously known diabetes (for edentulism: OR = 2.19 (95%-CI: 1.18-4.05), and OR = 1.40 (95%-CI: 0.82-2.38), respectively, for comparison with NGT). Periodontitis and edentulism were associated with poorly controlled T2DM, but not with pre-diabetes and well-controlled diabetes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Higher body mass index and lower intake of dairy products predict poor glycaemic control among Type 2 Diabetes patients in Malaysia.

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Shu, Ping Soon; Chan, Yoke Mun; Huang, Soo Lee

2017-01-01

This cross-sectional study was designed to determine factors contributing to glyceamic control in order to provide better understanding of diabetes management among Type 2 Diabetes patients. A pre-tested structured questionnaire was used to obtain information on socio-demographic and medical history. As a proxy measure for glycaemic control, glycosylated haemoglobin (HbA1c) was obtained as secondary data from the medical reports. Perceived self-care barrier on diabetes management, diet knowledge and skills, and diet quality were assessed using pretested instruments. With a response rate of 80.3%, 155 subjects were recruited for the study. Mean HbA1c level of the subjects was 9.02 ± 2.25% with more than 70% not able to achieve acceptable level in accordance to WHO recommendation. Diet quality of the subjects was unsatisfactory especially for vegetables, fruits, fish and legumes as well as from the milk and dairy products group. Higher body mass index (BMI), poorer medication compliance, lower diet knowledge and skill scores and lower intake of milk and dairy products contributed significantly on poor glycaemic control. In conclusion, while perceived self-care barriers and diet quality failed to predict HbA1c, good knowledge and skill ability, together with appropriate BMI and adequate intake of dairy products should be emphasized to optimize glycaemic control among type 2 diabetes patients.

Higher body mass index and lower intake of dairy products predict poor glycaemic control among Type 2 Diabetes patients in Malaysia.

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Ping Soon Shu

Full Text Available This cross-sectional study was designed to determine factors contributing to glyceamic control in order to provide better understanding of diabetes management among Type 2 Diabetes patients. A pre-tested structured questionnaire was used to obtain information on socio-demographic and medical history. As a proxy measure for glycaemic control, glycosylated haemoglobin (HbA1c was obtained as secondary data from the medical reports. Perceived self-care barrier on diabetes management, diet knowledge and skills, and diet quality were assessed using pretested instruments. With a response rate of 80.3%, 155 subjects were recruited for the study. Mean HbA1c level of the subjects was 9.02 ± 2.25% with more than 70% not able to achieve acceptable level in accordance to WHO recommendation. Diet quality of the subjects was unsatisfactory especially for vegetables, fruits, fish and legumes as well as from the milk and dairy products group. Higher body mass index (BMI, poorer medication compliance, lower diet knowledge and skill scores and lower intake of milk and dairy products contributed significantly on poor glycaemic control. In conclusion, while perceived self-care barriers and diet quality failed to predict HbA1c, good knowledge and skill ability, together with appropriate BMI and adequate intake of dairy products should be emphasized to optimize glycaemic control among type 2 diabetes patients.

A model of poorly controlled type 1 Diabetes Mellitus and its treatment with aerobic exercise training.

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Melling, C W J; Grisé, K N; Hasilo, C P; Fier, B; Milne, K J; Karmazyn, M; Noble, E G

2013-05-01

Modern exogenous insulin therapy can improve the quality of life of Type 1 Diabetic Mellitus (T1DM) patients, although maintenance of normal glycaemic levels is often a challenge given the variety of factors that alter it. A number of studies have examined the effect of exercise in T1DM; however, the majority of experimental studies have utilized diabetic rodents with severe hyperglycaemia. Given that T1DM patients are likely to refrain from hyperglycaemia, studies examining the effects of regular exercise in which blood glucose is poorly controlled would better represent the T1DM population. The current study examined the ability of a ten-week aerobic exercise training program to modify markers of cardiovascular function and bone health in STZ-induced diabetic rodents maintained in the 9-15 mM glycaemic range through insulin therapy. Moderate hyperglycaemia, when prolonged, leads to significant changes in cardiac structure, bone health, and glucose handling capacity. Ten weeks of exercise was able to alleviate many of these deleterious events as no significant cardiovascular functional alterations were evident except a reduction in resting heart rate and an increase in stroke volume index. Further, despite changes in cardiac dimensions, exercise was able to elevate cardiac output index and increase the E/A ratio of exercising diabetic animals which would be indicative of improvements of cardiac function. Together, this study demonstrates that despite moderate hyperglycaemia, the combined role of a ten-week exercise training program coupled with insulin therapy is able to alleviate many of the well-known complications associated with diabetes progression. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Depressive symptoms and diabetes control in African Americans.

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Wagner, Julie A; Abbott, Gina L; Heapy, Alicia; Yong, Lynne

2009-02-01

This study of African Americans with diabetes investigated: (1) the relationship between depressive symptoms and glycemic control; (2) the relationship between depressive symptoms and long-term diabetes complications; (3) the relationship between depressive symptoms and medication usage; and (4) the effects of demographic and diabetes variables on these relationships. One-hundred twenty five African American diabetic adults who were attending health fairs reported demographic and medical history and provided blood samples for A1c assessment of glycemic control. They also completed the Centers for Epidemiological Studies Depression questionnaire, and the Diabetes Self-Care Inventory. After controlling for confounders, higher depressive symptoms were associated with higher A1c, more long-term diabetes complications, and more diabetes medications. Diabetes self-care did not fully account for these relationships. The relationship between depression and poor diabetes control exists in African Americans as it does in Whites. Providers are encouraged to attend to depression in their African American patients with diabetes.

Factors associated with glycemic control among diabetic adult out-patients in Northeast Ethiopia.

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Fiseha, Temesgen; Alemayehu, Ermiyas; Kassahun, Wongelawit; Adamu, Aderaw; Gebreweld, Angesom

2018-05-18

The aim of this study was to determine the status of glycemic control and identify factors associated with poor glycemic control among diabetic out-patients. A hospital based cross-sectional study was conducted among randomly selected 384 (126 type 1 and 258 type 2) diabetic adults attending a hospital in Northeast Ethiopia from January 1 to April 30, 2017. Of the total participants, 70.8% had poor status of glycemic control (defined as mean fasting blood glucose level above 130 mg/dl). In the multivariate analysis, rural residence (AOR = 2.61, 95% CI 1.37-4.96), low educational level (AOR = 7.10, 95% CI 2.94-17.17) and longer duration of diabetes (AOR = 2.20, 95% CI 1.18-4.08) were significantly associated with increased odds of poor glycemic control. Moreover, merchants (AOR = 3.39, 95% CI 1.16-9.96) were significantly more likely to have poor glycemic control compared to government employee. Diabetic patients receiving oral anti-diabetics (AOR = 5.12, 95% CI 2.10-12.52) or insulin (AOR = 3.26, 95% CI 1.26-8.48) were more likely to be poorly controlled. These results highlight the needed for appropriate management of patients focusing on associated factors identified for poor glycemic control to maintain good glycemic control and improve adverse outcomes of the disease in this study setting.

Single, community-based blood glucose readings may be a viable alternative for community surveillance of HbA1c and poor glycaemic control in people with known diabetes in resource-poor settings

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Daniel D. Reidpath

2016-08-01

Full Text Available Background: The term HbA1c (glycated haemoglobin is commonly used in relation to diabetes mellitus. The measure gives an indication of the average blood sugar levels over a period of weeks or months prior to testing. For most low- and middle-income countries HbA1c measurement in community surveillance is prohibitively expensive. A question arises about the possibility of using a single blood glucose measure for estimating HbA1c and therefore identifying poor glycaemic control in resource-poor settings. Design: Using data from the 2011–2012 US National Health and Nutrition Examination Surveys, we examined the relationship between HbA1c and a single fasting measure of blood glucose in a non-clinical population of people with known diabetes (n=333. A linear equation for estimating HbA1c from blood glucose was developed. Appropriate blood glucose cut-off values were set for poor glycaemic control (HbA1c≥69.4 mmol/mol. Results: The HbA1c and blood glucose measures were well correlated (r=0.7. Three blood glucose cut-off values were considered for classifying poor glycaemic control: 8.0, 8.9, and 11.4 mmol/L. A blood glucose of 11.4 had a specificity of 1, but poor sensitivity (0.37; 8.9 had high specificity (0.94 and moderate sensitivity (0.7; 8.0 was associated with good specificity (0.81 and sensitivity (0.75. Conclusions: Where HbA1c measurement is too expensive for community surveillance, a single blood glucose measure may be a reasonable alternative. Generalising the specific results from these US data to low resource settings may not be appropriate, but the general approach is worthy of further investigation.

Glycaemic Control amongst Persons with Diabetes Mellitus in Benin ...

African Journals Online (AJOL)

Conclusion: This study has shown that poor glycaemic control is common amongst persons with diabetes mellitus in Benin City. Studies have shown that good glycaemic control prevents and delays the complications of diabetes mellitus. We therefore recommend that health education on the benefits of good glycaemic ...

Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors

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Polonsky WH

2016-07-01

Full Text Available William H Polonsky,1,2 Robert R Henry2,3 1Behavioral Diabetes Institute, San Diego, 2University of California, San Diego, 3Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA, USA Abstract: At least 45% of patients with type 2 diabetes (T2D fail to achieve adequate glycemic control (HbA1c <7%. One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals, patient demographic factors (eg, young age, low education level, and low income level, critical patient beliefs about their medications (eg, perceived treatment inefficacy, and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia. Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative medication beliefs of patients. Solutions to these problems would require behavioral innovations as well as new methods and modes of drug delivery. Keywords: glycemic control, HbA1c, hypoglycemia, medication adherence, psychosocial, type 2 diabetes

Optimal cut?off value of alanine aminotransferase level to precisely estimate the presence of fatty liver in patients with poorly controlled type?2 diabetes

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Tanabe, Akihito; Tatsumi, Fuminori; Okauchi, Seizo; Yabe, Hiroki; Tsuda, Tomohiro; Okutani, Kazuma; Yamashita, Kazuki; Nakashima, Koji; Kaku, Kohei; Kaneto, Hideaki

2016-01-01

Optimal cut?off value of ALT level to precisely estimate the presence of fatty liver was as low as 28.0?U/L. We should consider the possibility of fatty liver even when ALT level is within normal range in subjects with poorly controlled type 2 diabetes.

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya.

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Ashur, Sana Taher; Shah, Shamsul Azhar; Bosseri, Soad; Fah, Tong Seng; Shamsuddin, Khadijah

2016-01-01

Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8(©)), while glycaemic control status was based on the HbA1c level. Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94). The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

An open, randomized, parallel-group study to compare the efficacy and safety profile of inhaled human insulin (Exubera) with glibenclamide as adjunctive therapy in patients with type 2 diabetes poorly controlled on metformin

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Barnett, AH; Dreyer, M; Lange, Peter

2006-01-01

OBJECTIVE: To compare the efficacy and safety profile of adding inhaled human insulin (INH) (Exubera) or glibenclamide to metformin monotherapy in patients with poorly controlled type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted an open-label, parallel, 24-week multicenter trial. Patients...... associated clinical manifestations. CONCLUSIONS: In patients with type 2 diabetes poorly controlled on metformin, adding INH or glibenclamide was similarly effective in improving glycemic control, and both were well tolerated. A predefined subgroup with very high A1C (>9.5%) was more effectively treated...

Glycemic control and diabetes-related health care costs in type 2 diabetes; retrospective analysis based on clinical and administrative databases.

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Degli Esposti, Luca; Saragoni, Stefania; Buda, Stefano; Sturani, Alessandra; Degli Esposti, Ezio

2013-01-01

Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases. A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups. Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population). Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost per person associated with the groups with good control, fair control, poor control, and very poor control was €219.28, €264.65, €513.18, and €564.79, respectively. Many patients showed suboptimal glycemic control. Lower levels of glycated hemoglobin were associated with lower diabetes

Glycemic control and diabetes-related health care costs in type 2 diabetes; retrospective analysis based on clinical and administrative databases

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Degli Esposti L

2013-05-01

Full Text Available Luca Degli Esposti,1 Stefania Saragoni,1 Stefano Buda,1 Alessandra Sturani,2 Ezio Degli Esposti11CliCon Srl, Health, Economics and Outcomes Research, Ravenna, Italy; 2Nephrology and Dialysis Unit, Santa Maria delle Croci Hospital, Ravenna, ItalyBackground: Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases.Methods: A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups.Results: Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population. Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost

Glycemic control in type 2 diabetes mellitus prevents coronary arterial wall infection

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Morteza Izadi

2014-05-01

Full Text Available BACKGROUND: Diabetes mellitus (DM is a very well-known risk factor for development of atherosclerosis, and it has been hypothesized that poor glycemic control and hyperglycemia plays a major role in this process. In the current study, we aimed to evaluate the associates of poor glycemic control in Iranian patients who have already undergone coronary artery bypass grafting (CABG, with especial focus on the inhabitation of infectious agents within the coronary arterial wall. METHODS: In January 2010, 52 consecutive patients with type 2 DM who undergone CABG at the Department of Cardiovascular Surgery of Baqiyatallah University of Medical Sciences (Tehran, Iran were included into this cross-sectional study and biopsy specimens from their coronary plaques were taken and analyzed by polymerase chain reaction (PCR methods for detecting Helicobacter species, cytomegalovirus (CMV and Chlamydia pneumoniae, and their potential relation to the glycemic control status in these patients. RESULTS: Compared to that in diabetic patients with mean fasting blood sugar (FBS levels FBS < 126, atherosclerotic lesions in type 2 diabetic patients with poor glycemic control (FBS > 126 were significantly more likely to be positive for CMV PCR test (41% vs. 9%, respectively; P = 0.05. In laboratorial test results, mean triglyceride level was significantly higher among patients of poor glycemic control (168 ± 89 vs. 222 ± 125 mg/dl, respectively; P = 0.033. Hypertension was also significantly more prevalent in this population (73% vs. 36%, respectively; P = 0.034. CONCLUSION: Type 2 diabetic patients with poor glycemic control can be at higher risk for developing CMV infection in their coronary arterial wall, which can promote atherosclerosis formation process in this patient population. According to the findings of this study, we recommend better control of serum glucose levels in type 2 diabetic patients to prevent formation/progression of atherosclerosis.   Keywords

Glycemic Control, Hand Activity, and Complexity of Biological Signals in Diabetes Mellitus

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Hsien-Tsai Wu

2017-01-01

Full Text Available Both glycemic control and handgrip strength affect microvascular function. Multiscale entropy (MSE of photoplethysmographic (PPG pulse amplitudes may differ by diabetes status and hand activity. Of a middle-to-old aged and right-handed cohort without clinical cardiovascular disease, we controlled age, sex, and weight to select the unaffected (no type 2 diabetes, n=36, the well-controlled diabetes (HbA1c < 8%, n=22, and the poorly controlled diabetes (HbA1c ≥ 8%, n=22 groups. MSEs were calculated from consecutive 1,500 PPG pulse amplitudes of bilateral index fingertips. The small-,  medium-, and large-scale MSEs were defined as the average of scale 1 (MSE1, scales 2–4 (MSE2–4, and scales 5–10 (MSE5–10, respectively. Intra- and intergroups were compared by one- and two-sample t-tests, respectively. The dominant hand MSE5–10 was lower in the poorly controlled diabetes group than the well-controlled diabetes and the unaffected (1.28 versus 1.52 and 1.56, p=0.019 and 0.001, resp. groups, whereas the nondominant hand MSE5–10 was lower in the well- and poorly controlled diabetes groups than the unaffected group (1.35 and 1.29 versus 1.58, p=0.008 and 0.005, resp.. The MSE1 of dominant hand was higher than that of nondominant hand in the well-controlled diabetes (1.35 versus 1.10, p=0.048. In conclusion, diabetes status and hand dominance may affect the MSE of PPG pulse amplitudes.

Flexible guided self-determination intervention for younger adults with poorly controlled Type 1 diabetes, decreased HbA1c and psychosocial distress in women but not in men

DEFF Research Database (Denmark)

Zoffmann, V; Vistisen, D; Due-Christensen, M

2015-01-01

AIM: To report results from an 18-month randomized controlled trial (RCT) testing the effectiveness of a flexible guided self-determination (GSD) intervention on glycaemic control and psychosocial distress in younger adults with poorly controlled Type 1 diabetes. METHODS: Between January 2010 and...

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya

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Sana Taher Ashur

2016-03-01

Full Text Available Background: Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. Methods: A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA and the eight-item Morisky Medication Adherence Scale (MMAS-8©, while glycaemic control status was based on the HbA1c level. Results: Mean HbA1c was 8.9 (±2.1, and of the 523 patients, only 114 (21.8% attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03–2.91, patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05–3.54, patients on insulin (OR=3.14, 95% CI=1.66–6.03, and low-medication adherents (OR=2.25, 95% CI=1.36–3.73 were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77–0.94. Conclusion: The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

The Influence of Diabetes, Glycemic Control, and Diabetes-Related Comorbidities on Pulmonary Tuberculosis

Science.gov (United States)

Chiang, Chen Yuan; Bai, Kuan Jen; Lin, Hsien Ho; Chien, Shun Tien; Lee, Jen Jyh; Enarson, Donald A.; Lee, Ting-I; Yu, Ming-Chih

2015-01-01

Background To assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB). Methodology/Principal Findings Culture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005–2010 were investigated. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C) and diabetic patients were categorized into 3 groups: HbA1C9%. 1,473 (705 with DM and 768 without DM) patients were enrolled. Of the 705 diabetic patients, 82 (11.6%) had pretreatment HbA1C9%, and 195 (27.7%) had no information of HbA1C. The proportions of patients with any symptom, cough, hemoptysis, tiredness and weight loss were all highest in diabetic patients with HbA1C>9%. In multivariate analysis adjusted for age, sex, smoking, and drug resistance, diabetic patients with HbA1C>9% (adjOR 3.55, 95% CI 2.40–5.25) and HbA1C 7–9% (adjOR 1.62, 95% CI 1.07–2.44) were significantly more likely to be smear positive as compared with non-diabetic patients, but not those with HbA1C<7% (adjOR 1.16, 95% CI 0.70–1.92). The influence of DM on outcome of TB treatment was not proportionately related to HbA1C, but mainly mediated through diabetes-related comorbidities. Patients with diabetes-related comorbidities had an increased risk of unfavorable outcome (adjOR 3.38, 95% CI 2.19–5.22, p<0.001) and one year mortality (adjOR 2.80, 95% CI 1.89–4.16). However, diabetes was not associated with amplification of resistance to isoniazid (p = 0.363) or to rifampicin (p = 0.344). Conclusions/Significance Poor glycemic control is associated with poor TB treatment outcome and improved glycemic control may reduce the influence of diabetes on TB. PMID:25822974

Dose pre-infarction diabetic control affect the outcome of acute myocardial infarction

International Nuclear Information System (INIS)

Shah, S.F.A.; Hifizullah, M.; Mufti, T.A.; Hadi, A.; Shah, S.T.

2012-01-01

Objectives: The aim of this study was to see the effect of glycemic control on the outcome of acute myocardial infarction (AMI), in well controlled and poorly controlled diabetic patients by measuring fructosamine levels. Methodology: This prospective observational study was done in Department of Cardiology, Lady Reading Hospital, Peshawar, from May 2008 to December 2008. Both diabetic and nondiabetic patients having first AMI were included. Patients having stroke, advanced renal failure or COPD were excluded. Diabetic control was assessed on the basis of serum fructosamine level. Patients having fructosamine level <285 micro mol/l were considered to have good control of diabetes. All patients had standard medical treatment during their stay in hospital. One month later patients were evaluated for effort tolerance on treadmill. Results: A total of 230 patients were studied. More diabetics were obese (36% vs. 14%, p= 0.001), hypertensive (34% vs. 14%, p=0.001) and had evidence of heart failure i.e. Killip class II and III (62% vs. 24%, p=0.001), IV (11% vs. 8%, p=0.04). Diabetic patients also had higher serum fructosamine level (475 +-115 vs. 230 +- 50 micro mol/l, p =0.002), triglyceride level (232 +- 19 vs. 160 +- 25 mg%, p=0.001) and had slightly higher mortality (14% vs. 6%, p=0.19). Diabetes was well controlled in 30 patients with fructosamine (248 +- 26 vs. 470 +- 152 micro mol/l, p=0.001). Heart failure was more common in patients with poorly controlled diabetes (85% vs. 47%, p=0.001). Conclusion: Poor Diabetic status is associated with higher morbidity following acute myocardial infarction. (author)

[Prospective observational study of insulin detemir in patients with poorly controlled type 2 diabetes mellitus initiating insulin therapy for the first time (SOLVE Study)].

Science.gov (United States)

Orozco-Beltrán, Domingo; Artola-Menéndez, Sara

2016-02-01

Describe the experience in the primary care setting with insulin detemir in patients with poorly controlled type2 diabetes mellitus that need to add-on insulin to their oral antidiabetic drug therapy. Prospective observational study of 6 months of follow up, performed in 10 countries. In Spain, participating sites were only from the primary care setting. Eligible patients were those with poorly controlled type2 diabetes mellitus adding-on once-daily insulin detemir to their existing oral antidiabetic therapy in the month prior to their enrollment. The change of Hb1Ac and of weight at the end of the study and the incidence of hypoglycemia and adverse reactions, were analyzed. We report the results obtained in the Spanish cohort. Overall 17,374 patients were included, 973 in Spain [mean age 64.8 years (SE 12); duration of diabetes 9.4 years (SE 6.2); Hb1Ac 8.9% (DE 1.4)]. In the sample analyzed for efficacy (n=474) the mean change of Hb1Ac was -1.6% (95%CI: -1.75 to -1.42; P<.001), mean change of weight was -2.9 kg (95%CI: -3.72 to -2.08; P<.001). Only one episode of severe hypoglycemia was reported, which was also the only serious adverse reaction reported in the study. The incidence rate of non-severe hypoglycemia was 2.44 events/patient-year. In this cohort of patients with type 2 diabetes mellitus receiving newly initiated insulin therapy, once-daily detemir improved the glycemic control, with low incidence of hypoglycemia and a significant reduction of the weight. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Factors Associated with Long-Term Control of Type 2 Diabetes Mellitus.

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Badedi, Mohammed; Solan, Yahiya; Darraj, Hussain; Sabai, Abdullah; Mahfouz, Mohamed; Alamodi, Saleh; Alsabaani, Abdullah

2016-01-01

Aims. This study assessed factors associated with glycemic control among Saudi patients with Type 2 diabetes mellitus (T2DM). Methods. We conducted an analytical cross-sectional study, which included a random sample of 288 patients with T2DM proportional to the diabetes population of each primary health care center in Jazan city, Kingdom of Saudi Arabia. Results. More than two-thirds (74%) of patients had poor glycemic control. Lack of education, polypharmacy, and duration of diabetes ≥ 7 years were significantly associated with higher glycated hemoglobin (HbA1c). Moreover, patients who were smoker or divorced were significantly more likely to have higher HbA1c. The patients who did not comply with diet or take their medications as prescribed had poor glycemic control. The study found lower HbA1c levels among patients who received family support or had close relationship with their physicians. Similarly, knowledgeable patients towards diabetes or those with greater confidence in ability to manage self-care behaviors had a lower HbA1c. In contrast, risk factors such as depression or stress were significantly correlated with poorer glycemic control. Conclusion. The majority of T2DM patients had poor glycemic control. The study identified several factors associated with glycemic control. Effective and tailored interventions are needed to mitigate exposure to these risk factors. This would improve glycemic control and reduce the risks inherent to diabetes complications.

Factors Associated with Long-Term Control of Type 2 Diabetes Mellitus

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Mohammed Badedi

2016-01-01

Full Text Available Aims. This study assessed factors associated with glycemic control among Saudi patients with Type 2 diabetes mellitus (T2DM. Methods. We conducted an analytical cross-sectional study, which included a random sample of 288 patients with T2DM proportional to the diabetes population of each primary health care center in Jazan city, Kingdom of Saudi Arabia. Results. More than two-thirds (74% of patients had poor glycemic control. Lack of education, polypharmacy, and duration of diabetes ≥ 7 years were significantly associated with higher glycated hemoglobin (HbA1c. Moreover, patients who were smoker or divorced were significantly more likely to have higher HbA1c. The patients who did not comply with diet or take their medications as prescribed had poor glycemic control. The study found lower HbA1c levels among patients who received family support or had close relationship with their physicians. Similarly, knowledgeable patients towards diabetes or those with greater confidence in ability to manage self-care behaviors had a lower HbA1c. In contrast, risk factors such as depression or stress were significantly correlated with poorer glycemic control. Conclusion. The majority of T2DM patients had poor glycemic control. The study identified several factors associated with glycemic control. Effective and tailored interventions are needed to mitigate exposure to these risk factors. This would improve glycemic control and reduce the risks inherent to diabetes complications.

quality of glycaemic control in ambulatory diabetics at the out-patient

African Journals Online (AJOL)

hi-tech

2003-08-08

Aug 8, 2003 ... Conclusion: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin ...

The management of diabetes among the rural poor in South Africa ...

African Journals Online (AJOL)

The management of diabetes among the rural poor in South Africa. ... have been found to lead to a diet that has very high carbohydrate, high in saturated fatty acids, ... to facilitate good self-management of diabetes among the rural people.

Technology-Intensified Diabetes Education Study (TIDES) in African Americans with type 2 diabetes: study protocol for a randomized controlled trial.

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Williams, Joni S; Lynch, Cheryl P; Knapp, Rebecca G; Egede, Leonard E

2014-11-25

Compared to American Whites, African Americans have a higher prevalence of type 2 diabetes mellitus (T2DM), experiencing poorer metabolic control and greater risks for complications and death. Patient-level factors, such as diabetes knowledge, self-management skills, empowerment, and perceived control, account for >90% of the variance observed in outcomes between these racial groups. There is strong evidence that self-management interventions that include telephone-delivered diabetes education and skills training are effective at improving metabolic control in diabetes. Web-based home telemonitoring systems in conjunction with active care management are also effective ways to lower glycosylated hemoglobin A1c values when compared to standard care, and provide feedback to patients; however, there are no studies in African Americans with poorly controlled T2DM that examine the use of technology-based feedback to tailor or augment diabetes education and skills training. This study provides a unique opportunity to address this gap in the literature. We describe an ongoing 4-year randomized clinical trial, which will test the efficacy of a technology-intensified diabetes education and skills training (TIDES) intervention in African Americans with poorly controlled T2DM. Two hundred male and female AfricanAmerican participants, 21 years of age or older and with a glycosylated hemoglobin A1c level ≥ 8%, will be randomized into one of two groups for 12 weeks of telephone interventions: (1) TIDES intervention group or (2) a usual-care group. Participants will be followed for 12 months to ascertain the effect of the interventions on glycemic control. Our primary hypothesis is that, among African Americans with poorly controlled T2DM, patients randomized to the TIDES intervention will have significantly greater reduction in glycosylated hemoglobin A1c at 12 months of follow-up compared to the usual-care group. Results from this study will add to the current literature

Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus

International Nuclear Information System (INIS)

Sarac, K.; Alkan, A.; Baysal, T.; Akinci, A.; Aslan, M.; Oezcan, C.

2005-01-01

The metabolite changes in the brains of children with poorly controlled type 1 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9±3.4 (8.2-19.4). The average number of keto-acidosis episodes was 1.9±2.2 (0-9) and the average number of daily insulin injections was 2.8±0.97 (2-4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled type 1 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover. (orig.)

Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus

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Sarac, K.; Alkan, A.; Baysal, T. [Inonu University School of Medicine, Department of Radiology, Malatya (Turkey); Akinci, A.; Aslan, M. [Inonu University School of Medicine, Department of Paediatric Endocrinology, Malatya (Turkey); Oezcan, C. [Inonu University School of Medicine, Department of Neurology, Malatya (Turkey)

2005-07-01

The metabolite changes in the brains of children with poorly controlled type 1 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9{+-}3.4 (8.2-19.4). The average number of keto-acidosis episodes was 1.9{+-}2.2 (0-9) and the average number of daily insulin injections was 2.8{+-}0.97 (2-4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled type 1 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover. (orig.)

Association between poor glycemic control, impaired sleep quality, and increased arterial thickening in type 2 diabetic patients.

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Koichiro Yoda

Full Text Available Poor sleep quality is an independent predictor of cardiovascular events. However, little is known about the association between glycemic control and objective sleep architecture and its influence on arteriosclerosis in patients with type-2 diabetes mellitus (DM. The present study examined the association of objective sleep architecture with both glycemic control and arteriosclerosis in type-2 DM patients.Cross-sectional study in vascular laboratory.The subjects were 63 type-2 DM inpatients (M/F, 32/31; age, 57.5±13.1 without taking any sleeping promoting drug and chronic kidney disease. We examined objective sleep architecture by single-channel electroencephalography and arteriosclerosis by carotid-artery intima-media thickness (CA-IMT.HbA1c was associated significantly in a negative manner with REM sleep latency (interval between sleep-onset and the first REM period (β=-0.280, p=0.033, but not with other measurements of sleep quality. REM sleep latency associated significantly in a positive manner with log delta power (the marker of deep sleep during that period (β=0.544, p=0.001. In the model including variables univariately correlated with CA-IMT (REM sleep latency, age, DM duration, systolic blood pressure, and HbA1c as independent variables, REM sleep latency (β=-0.232, p=0.038, but not HbA1c were significantly associated with CA-IMT. When log delta power was included in place of REM sleep latency, log delta power (β=-0.257, p=0.023 emerged as a significant factor associated with CA-IMT.In type-2 DM patients, poor glycemic control was independently associated with poor quality of sleep as represented by decrease of REM sleep latency which might be responsible for increased CA-IMT, a relevant marker for arterial wall thickening.

Poor glycemic control of diabetes mellitus is associated with higher risk of prostate cancer detection in a biopsy population.

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Juhyun Park

Full Text Available To evaluate the impact of glycemic control of diabetes mellitus (DM on prostate cancer detection in a biopsy population.We retrospectively reviewed the records of 1,368 men who underwent prostate biopsy at our institution. We divided our biopsy population into three groups according to their history of DM, and their Hemoglobin A1c (HbA1c level: a no-DM (DM- group; a good glycemic control (DM+GC group (HbA1c <6.5%; and a poor glycemic control (DM+PC group (HbA1c ≥6.5%. For sub-analyses, the DM+PC group was divided into a moderately poor glycemic control (DM+mPC group (6.5≤ HbA1c <7.5% and a severely poor glycemic control (DM+sPC group (HbA1c ≥7.5%.Among 1,368 men, 338 (24.7% had a history of DM, and 393 (28.7% had a positive biopsy. There was a significant difference in prostatic specific antigen density (PSAD (P = 0.037 and the frequency of abnormal DRE findings (P = 0.031 among three groups. The occurrence rate of overall prostate cancer (P<0.001 and high-grade prostate cancer (P = 0.016 also presented with a significantly difference. In the multivariate analysis, the DM+PC group was significantly associated with a higher rate of overall prostate cancer detection in biopsy subjects compared to the DM- group (OR = 2.313, P = 0.001 but the DM+PC group was not associated with a higher rate of high-grade (Gleason score ≥7 diseases detected during the biopsy (OR = 1.297, P = 0.376. However, in subgroup analysis, DM+sPC group was significantly related to a higher risk of high-grade diseases compared to the DM- group (OR = 2.446, P = 0.048.Poor glycemic control of DM was associated with a higher risk of prostate cancer detection, including high-grade disease, in the biopsy population.

An open, randomized, parallel-group study to compare the efficacy and safety profile of inhaled human insulin (exubera) with meformin as adjunctive therapy in patients with type 2 diabetes poorly controlled on a sulfonylurea: response to mikhail and cope

DEFF Research Database (Denmark)

Barnett, Anthony H.; Dreyer, Manfred; Lange, Peter

2006-01-01

OBJECTIVE: To compare the efficacy and safety profile of adding inhaled human insulin (INH; Exubera) or metformin to sulfonylurea monotherapy in patients with poorly controlled type 2 diabetes. RESEARCH DESIGN AND METHODS: We performed an open-label, parallel, 24-week, multicenter trial. At week -1......: In patients with type 2 diabetes poorly controlled on a sulfonylurea (A1C >9.5%), the addition of premeal INH significantly improves glycemic control compared with adjunctive metformin and is well tolerated....

[Analysis of population survey for determining the factors associated with the control diabetes mellitus in Mexico].

Science.gov (United States)

Hernández-Romieu, Alfonso Claudio; Elnecavé-Olaiz, Alejandro; Huerta-Uribe, Nidia; Reynoso-Noverón, Nancy

2011-01-01

Determine the influence of nutritional counseling, exercise, access to social healthcare and drugs, and the quality of medical care on the control of diabetics. The information and blood samples were obtained in 2005. Glycemic control was defined as good if HbA1c was ≤7.0%, poor from 7.01%-9.50% and very poor if HbA1c >9.5%. Binary logistic regression models were used to determine the association of these factors with HbA1c>9.5%. Thirty percent of the patients with a medical diagnosis of diabetes had adequate metabolic control. Nutritional guidance was associated with an increase in the degree of control. A majority of diabetics have poor or very poor glycemic control. Strengthening the quality of and access to medical care for these patients is urgently needed.

Potential risk factors for diabetic neuropathy: a case control study

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Nooraei Mahdi

2005-12-01

Full Text Available Abstract Background Diabetes mellitus type II afflicts at least 2 million people in Iran. Neuropathy is one of the most common complications of diabetes and lowers the patient's quality of life. Since neuropathy often leads to ulceration and amputation, we have tried to elucidate the factors that can affect its progression. Methods In this case-control study, 110 diabetic patients were selected from the Shariati Hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS was used to differentiate cases from controls. The diagnosis of neuropathy was confirmed by nerve conduction studies (nerve conduction velocity and electromyography. The multiple factors compared between the two groups included consumption of angiotensin converting enzyme inhibitors (ACEI, blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality. Results Statistically significant relationships were found between neuropathy and age, gender, quality of diabetes control and duration of disease (P values in the order: 0.04, 0.04, Conclusion In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control reduces the incidence of neuropathy, slows its progression and improves the diabetic patient's quality of life. More attention must be paid to elderly male diabetic patients with poor diabetes control with regard to regular foot examinations and more practical education.

Blood pressure control among type 2 diabetics

International Nuclear Information System (INIS)

Al-Shehri, Ahmed M.

2008-01-01

Objective was to assess blood pressure BP control in patients with diabetes mellitus type 2 DM type treated in primary health care. A cross-sectional study was conducted in primary health care at King Fahd Military Complex Hospital in Dhahran, Kingdom of Saudi Arabia, between August 2003 and February 2004, to assess blood control in type 2 diabetics. A sample of 403 medical records of type 2 diabetic patients was selected using systematic random sampling after ordering the medical record numbers. The data were collected through the pre-coded checklist. Hypertension was found in 57.8% of diabetic patients with no statistically significant difference between males and females. The mean age of diabetic patients was significantly highly in hypertensive than non-hypertensive p=0.001. The mean duration of hypertension was significantly higher in females p=0.02. There were only 14.2% of hypertensive diabetic patients in whom blood pressure was controlled. Poor control was significantly associated with obesity and a high rate of complications. Blood pressure control correlated positively and significantly with the age of patients and negatively with duration of diabetes and hypertension. The most commonly prescribed antihypertensive were angiotensin converting enzyme inhibitors in 29.3%, followed by angiotensin receptors blockers in 24.1%, and the least prescribed drug was thiazide diuretic. Blood pressure in diabetic patients needs to be given particular attention from all health care professionals, especially primary care family physicians, who should follow the new guideline for better control of blood pressure, and fewer complications. Patient's awareness should be increased, through continuous health education with different modalities. (author)

Glycemic control in diabetic children and adolescents after attending diabetic camp

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Erwin P. Soenggono

2011-10-01

Conclusion Glycemic control in T1DM children and adolescents was significantly improved 3 months after attending diabetic camp compared to that before attending camp. According to subjects’ self-assessment by PedsQL questionnaire, no subjects indicated a poor quality of life for the duration of their illness. [Paediatr Indones. 2011;51:294-7].

Predictors of glycemic control in children with Type 1 diabetes mellitus in Assiut-Egypt

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Hanaa A Mohammad

2012-01-01

Full Text Available Background : Type 1 diabetes mellitus (T1DM may lead to severe long-term health consequences, such as renal failure, blindness, as well as heart and cerebrovascular disease. Although a direct relationship between blood glucose control and diabetes complications remains to be established beyond doubt, most diabetologists aim to achieve the best possible glucose control in their patients with T1DM. The aim of this study was to detect the predictors of glycemic control among children with T1DM in Assiut Governorate-Egypt. Materials and Methods : We enrolled 415 children aged 2 to 18 years with type 1 diabetes of >1-year duration. They were subjected to full history including demographic factors and disease-related factors. Examination was done with determination of the body mass index, and assessment of stage of maturity. Investigations included hemoglobin A1c (HbA1c and lipid profile. Patients with HbA1c above the recommended values for age by the American Diabetes Association were considered as poor glycemic control group. Results : Of the studied cases, 190 cases (45.8% were of poor glycemic control. Patients with poor control had significantly higher mean age (16.83 ± 3.3 vs 9.77 ± 3.7, P<0.000. Girls aged 15 years or more had significantly higher prevalence of poor glycemic control than males of the same age group. As regard the disease-related factors, patients with poor control had significantly longer duration of disease (7.94 ± 2.6 vs 2.40 ± 2.0, P<0.000 and were older in age at onset of disease. Insulin regimen which consists of basal bolus insulin plus three injections of regular insulin was associated with more frequency of good glycemic control than other regimens. Patients with poor control had significantly higher mean of cholesterol, triglyceride (TG, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol than patients with good control. Adjusting for other variables, age of the patients, duration of

The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial.

Science.gov (United States)

Thom, David H; Willard-Grace, Rachel; Hessler, Danielle; DeVore, Denise; Prado, Camille; Bodenheimer, Thomas; Chen, Ellen

2015-01-01

Lack of concordance between medications listed in the medical record and taken by the patient contributes to poor outcomes. We sought to determine whether patients who received health coaching by medical assistants improved their medication concordance and adherence. This was a nonblinded, randomized, controlled, pragmatic intervention trial. English- or Spanish-speaking patients, age 18 to 75 years, with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were enrolled from 2 urban safety net clinics and randomized to receive 12 months of health coaching versus usual care. Outcomes included concordance between medications documented in the medical record and those reported by the patient and adherence based on the patient-reported number of days (of the last 7) on which patient took all prescribed medications. The proportion of medications completely concordant increased in the coached group versus the usual care group (difference in change, 10%; P = .05). The proportion of medications listed in the chart but not taken significantly decreased in the coached group compared with the usual care group (difference in change, 17%; P = .013). The mean number of adherent days increased in the coached but not in the usual care group (difference in change, 1.08; P coaching by medical assistants significantly increases medication concordance and adherence. © Copyright 2015 by the American Board of Family Medicine.

A longitudinal analysis of salivary flow in control subjects and older adults with type 2 diabetes.

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Chávez, E M; Borrell, L N; Taylor, G W; Ship, J A

2001-02-01

Many diabetics complain of xerostomia, a condition that can affect oral health, nutritional status, and diet selection. This study's purposes were (1) to investigate the effect on salivary flow of type 2 diabetes and change in glycemic control in a group of older adults over time and (2) to compare flow rates with subjective complaints of xerostomia. A total of 39 older adults, 24 with type 2 diabetes and 15 who were nondiabetic (controls), aged 54-90 years, participated in a 1-year follow-up study. Diabetic status was determined by means of glycosylated hemoglobin (HbA1c) levels and 2-hour glucose tolerance tests. Poor glycemic control was defined as HbA1c > 9%. Unstimulated whole, unstimulated parotid, and stimulated parotid saliva flow rates were measured for all subjects by a single examiner at baseline and 1 year later. Each subject completed a standardized xerostomia questionnaire at every visit. Age, sex, and duration of diabetes did not adversely affect salivary flow rates. Subjects with poorly controlled diabetes had significantly lower stimulated parotid saliva flow rates at both visits. There were no significant changes in flow rates over time on the basis of diabetic status or glycemic control. Subjects with diabetes reported significantly more complaints of thirst but not of xerostomia at 1 year. These results suggest that older adults with poorly controlled diabetes may have impaired salivary flow in comparison with subjects with better controlled diabetes and nondiabetic subjects, yet they may not have concomitant xerostomic complaints. There were no significant changes in salivary flow rates or glycemic control over the 1-year period.

Effects of glycemic control on saliva flow rates and protein composition in non-insulin-dependent diabetes mellitus.

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Dodds, M W; Dodds, A P

1997-04-01

The objective of this study was to determine whether improvements in the level of diabetic control in a group of subjects with poorly controlled non-insulin-dependent diabetes mellitus influence salivary output and composition. Repeated whole unstimulated and stimulated parotid saliva samples were collected from diabetic patients attending an outpatient diabetes education program and a matched nondiabetic control group. Saliva was analyzed for flow rates, parotid protein concentration and composition, and amylase activity. Subjective responses to questions about salivary hypofunction were tested. There were no significant differences in whole unstimulated and stimulated parotid flow rates or stimulated parotid protein concentration and composition between diabetics and the control group. Amylase activity was higher in diabetics and decreased with improved glycemic control. Subjects reporting taste alterations had higher mean blood glucose levels than subjects with normal taste sensation. Poorly controlled non-insulin-dependent diabetes mellitus has no influence on saliva output, although amylase activity may be elevated, and there may be taste alterations.

Nutritional status, glycemic control and its associated risk factors among a sample of type 2 diabetic individuals, a pilot study.

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Firouzi, Somayyeh; Barakatun-Nisak, Mohd Yusof; Azmi, Kamaruddin Nor

2015-01-01

The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control. A total of 104 type 2 diabetic patients were recruited and completed a questionnaire covering socio-demographic status, 3-day diet records, and physical activity. Anthropometry and glycemic control parameters, lipid profile and blood pressure were also measured. Subjects were on average 56.7±9.9 years old with a mean duration of diabetes of 6.5 ± 5.0 years. The mean hemoglobin A1c of the subjects was 7.6% ± 1.4%, with only 20.2% achieving the target goal of 10.6% of the subjects exercised daily. The proportions of macronutrients relative to total energy intake were consistent with the recommendations of most diabetes associations. The adjusted odds of having poor glycemic control were 3.235 (1.043-10.397) (P types of oral anti-diabetic drugs had 19.9 (2.959-87.391) (P 1) and 14.3 (2.647-77.500) (P 1) higher odds of poor glycemic control respectively compared to those who were being treated by diet alone. Poor glycemic control was prevalent among Malaysian diabetic patients, and this could be associated with low levels of HDL and being treated with oral anti-diabetes agents.

Increased length of inpatient stay and poor clinical coding: audit of patients with diabetes.

Science.gov (United States)

Daultrey, Harriet; Gooday, Catherine; Dhatariya, Ketan

2011-11-01

People with diabetes stay in hospital for longer than those without diabetes for similar conditions. Clinical coding is poor across all specialties. Inpatients with diabetes often have unrecognized foot problems. We wanted to look at the relationships between these factors. A single day audit, looking at the prevalence of diabetes in all adult inpatients. Also looking at their feet to find out how many were high-risk or had existing problems. A 998-bed university teaching hospital. All adult inpatients. (a) To see if patients with diabetes and foot problems were in hospital for longer than the national average length of stay compared with national data; (b) to see if there were people in hospital with acute foot problems who were not known to the specialist diabetic foot team; and (c) to assess the accuracy of clinical coding. We identified 110 people with diabetes. However, discharge coding data for inpatients on that day showed 119 people with diabetes. Length of stay (LOS) was substantially higher for those with diabetes compared to those without (± SD) at 22.39 (22.26) days, vs. 11.68 (6.46) (P coding was poor with some people who had been identified as having diabetes on the audit, who were not coded as such on discharge. Clinical coding - which is dependent on discharge summaries - poorly reflects diagnoses. Additionally, length of stay is significantly longer than previous estimates. The discrepancy between coding and diagnosis needs addressing by increasing the levels of awareness and education of coders and physicians. We suggest that our data be used by healthcare planners when deciding on future tariffs.

Remnant cholesterol predicts periprocedural myocardial injury following percutaneous coronary intervention in poorly-controlled type 2 diabetes.

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Zeng, Rui-Xiang; Li, Sha; Zhang, Min-Zhou; Li, Xiao-Lin; Zhu, Cheng-Gang; Guo, Yuan-Lin; Zhang, Yan; Li, Jian-Jun

2017-08-01

Remnant cholesterol (RC) is receiving increasing attention regarding its relation to cardiovascular risk. Whether RC is associated with periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) in type 2 diabetes (T2D) is currently unknown. We prospectively enrolled 1182 consecutive T2D patients who were scheduled for PCI but with baseline normal preprocedural cardiac troponin I (cTnI). Patients were divided according to their glycemic control status: group A [glycated hemoglobin (HbA1c)cholesterol ratio (RC/HDL-C) with PMI were investigated. The associations of RC and RC/HDL-C with PMI were observed in group B (both p0.05). Patients in group B, a 1-SD increase of RC produced 30% and 32% increased risk for postprocedural cTnI>3× upper limit of normal (ULN) and >5×ULN, respectively. The odds ratios for RC/HDL-C were the highest compared with any cholesterol fractions including total cholesterol (TC)/HDL-C, low density lipoprotein cholesterol (LDL-C)/HDL-C, nonHDL-C/HDL-C, and triglyceride/HDL-C with 1.43 [95% confidence interval (CI): 1.10-1.88] for >3× ULN and 1.49 (95% CI: 1.13-1.97) for >5× ULN. However, no such associations were found in group A. Furthermore, patients with RC >27.46mg/dL (third tertile) [RC≤14.15mg/dL (first tertile) as reference] were associated with a 1.57-fold and 2-fold increased risk for >3× ULN and >5× ULN in group B, respectively. RC and RC/HDL-C might be valuable, independent predictors for PMI in poorly-controlled diabetic patients undergoing PCI. Copyright © 2017. Published by Elsevier Ltd.

Effect of glycemic control on diabetic dyslipidemia

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Ahmed, W.; Arshad, A.R.

2010-01-01

To determine whether good glycemic control has an effect on lipid profile in diabetics After taking relevant history and physical examination, serum urea, creatinine, thyroid stimulating hormone, bilirubin, alanine transaminase and HbA1c were measured. Blood samples for determination of fasting plasma glucose, serum total cholesterol, triglycerides, HDL and LDL levels were collected in a fasting state. Patients were divided into two groups based on HbA1c levels. They were compared using SPSS 13. 42 patients had good glycemic control and 58 had poor control. The two groups were age and weight matched. 43 patients had abnormal lipid profiles. Serum total cholesterol and triglycerides were lower and HDL levels higher in the good control group but serum LDL levels were equal. Conclusion: Good glycemic control improves lipid profile in patients with type 2 diabetes mellitus. (author)

Effect of glycemic control on diabetic dyslipidemia

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Ahmed, W [Military Hospital Rawalpindi, Rawalpindi (Pakistan); Arshad, A R [Combined Military Hospital, Lahore (Pakistan)

2010-03-15

To determine whether good glycemic control has an effect on lipid profile in diabetics After taking relevant history and physical examination, serum urea, creatinine, thyroid stimulating hormone, bilirubin, alanine transaminase and HbA1c were measured. Blood samples for determination of fasting plasma glucose, serum total cholesterol, triglycerides, HDL and LDL levels were collected in a fasting state. Patients were divided into two groups based on HbA1c levels. They were compared using SPSS 13. 42 patients had good glycemic control and 58 had poor control. The two groups were age and weight matched. 43 patients had abnormal lipid profiles. Serum total cholesterol and triglycerides were lower and HDL levels higher in the good control group but serum LDL levels were equal. Conclusion: Good glycemic control improves lipid profile in patients with type 2 diabetes mellitus. (author)

Diabetes with poor glycaemic control does not promote atherosclerosis in genetically modified hypercholesterolaemic minipigs

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Al-Mashhadi, Rozh H; Bjørklund, Martin M; Mortensen, Martin B

2015-01-01

atherogenesis in a novel pig model of atherosclerosis, the D374Y-PCSK9 (+) transgenic minipig. METHODS: Nineteen minipigs were fed a cholesterol-enriched, high-fat diet; ten of these pigs were injected with streptozotocin to generate a model of diabetes. Restricted feeding was implemented to control the pigs......' weight gain and cholesterol intake. After 49 weeks of high-fat feeding, the major arteries were harvested for a detailed analysis of the plaque burden and histological plaque type. RESULTS: Stable hyperglycaemia was achieved in the diabetic minipigs, while the plasma total and LDL......-cholesterol and creatinine levels were unaffected. Diabetes failed to increase atherosclerosis in any of the vessels examined. The plaque burden in the aorta and right coronary artery was comparable between the groups, and was even reduced in the left anterior descending (LAD) coronary and iliofemoral arteries...

Effect of sitagliptin on blood glucose control in patients with type 2 diabetes mellitus who are treatment naive or poorly responsive to existing antidiabetic drugs: the JAMP study.

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Sakura, Hiroshi; Hashimoto, Naotake; Sasamoto, Kazuo; Ohashi, Hiroshi; Hasumi, Sumiko; Ujihara, Noriko; Kasahara, Tadasu; Tomonaga, Osamu; Nunome, Hideo; Honda, Masashi; Iwamoto, Yasuhiko

2016-12-01

To investigate the ameliorating effect of sitagliptin, a dipeptidyl peptidase-4 inhibitor, on blood glucose control in patients with type 2 diabetes mellitus who were previously untreated with or who have a poor responsive to existing antidiabetic drugs. Sitagliptin (50 mg/day) was added on to the pre-existing therapy for type 2 diabetes and changes in the glycated hemoglobin (HbA1c) level after 3 months of treatment were compared with the baseline and performed exploratory analysis. HbA1c levels were significantly decreased after 1 month of treatment compared to baseline, with a mean change in HbA1c level from baseline of -0.73% (range, -0.80 to -0.67) in the entire study population at 3 months. Patients who received a medium dose of glimepiride showed the least improvement in HbA1c levels. The percentage of patients who achieved an HbA1c level of blood glucose level of type 2 diabetes mellitus who were previously untreated with, or poorly responsive to, existing antidiabetic drugs. Thus, sitagliptin is expected to be useful in this patient group. However, the additional administration of sitagliptin in patients treated with medium-dose glimepiride only slightly improved blood glucose control when corrected for baseline HbA1c level.

Health system challenges in organizing quality diabetes care for urban poor in South India.

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Bhojani, Upendra; Devedasan, Narayanan; Mishra, Arima; De Henauw, Stefaan; Kolsteren, Patrick; Criel, Bart

2014-01-01

Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.

Health system challenges in organizing quality diabetes care for urban poor in South India.

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Upendra Bhojani

Full Text Available BACKGROUND: Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. METHODS: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. RESULT: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. CONCLUSIONS: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes

Quality of glycaemic control in ambulatory diabetics at the out-patient clinic of Kenyatta National Hospital, Nairobi.

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Otieno, C F; Kariuki, M; Ng'ang'a, L

2003-08-01

Treatment of diabetes mellitus is based on the evidence that lowering blood glucose as close to normal range as possible is a primary strategy for reducing or preventing complications or early mortality from diabetes. This suggests poorer glycaemic control would be associated with excess of diabetes-related morbidity and mortality. This presumption is suspected to reach high proportions in developing countries where endemic poverty abets poor glycaemic control. There is no study published on Kenyan patients with diabetes mellitus about their glycaemic control as an audit of diabetes care. To determine the glycaemic control of ambulatory diabetic patients. Cross-sectional study on each clinic day of a randomly selected sample of both type 1 and 2 diabetic patients. Kenyatta National Hospital. Over a period of six months, January 1998 to June 1998. During routine diabetes care in the clinic, mid morning random blood sugar and glycated haemoglobin (HbA1c) were obtained. A total of 305 diabetic patients were included, 52.8% were females and 47.2% were males. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2% on OHA and insulin and 4.6% on diet only. 39.5% had mean HbA1c or = 8%. Patients on diet-only therapy had the best mean HbA1c = 7.04% while patients on OHA-only had the worst mean HbA1c = 9.06%. This difference was significant (p=0.01). The former group, likely, had better endogenous insulin production. The influence of age, gender and duration of diabetes on the level of glycaemic control observed did not attain statistically significant proportions. The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin production. Poor glycaemic control was presumed to be due to sub-optimal medication and

Nutritional status, glycemic control and its associated risk factors among a sample of type 2 diabetic individuals, a pilot study

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Firouzi, Somayyeh; Barakatun-Nisak, Mohd Yusof; Azmi, Kamaruddin Nor

2015-01-01

Background: The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control. Materials and Methods: A total of 104 type 2 diabetic patients were recruited and completed a questionnaire covering socio-demographic status, 3-day diet records, and physical activity. Anthropometry and glycemic control parameters, lipid profile and blood pressure were also measured. Results: Subjects were on average 56.7±9.9 years old with a mean duration of diabetes of 6.5 ± 5.0 years. The mean hemoglobin A1c of the subjects was 7.6% ± 1.4%, with only 20.2% achieving the target goal of exercised daily. The proportions of macronutrients relative to total energy intake were consistent with the recommendations of most diabetes associations. The adjusted odds of having poor glycemic control were 3.235 (1.043-10.397) (P < 0.05) higher among those who had high density lipoprotein cholesterol levels below the normal range. Those taking one or two types of oral anti-diabetic drugs had 19.9 (2.959-87.391) (P < 0.01) and 14.3 (2.647-77.500) (P < 0.01) higher odds of poor glycemic control respectively compared to those who were being treated by diet alone. Conclusion: Poor glycemic control was prevalent among Malaysian diabetic patients, and this could be associated with low levels of HDL and being treated with oral anti-diabetes agents. PMID:25767521

Elevated Fasting Blood Glucose Is Predictive of Poor Outcome in Non-Diabetic Stroke Patients: A Sub-Group Analysis of SMART.

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Ming Yao

Full Text Available Although increasing evidence suggests that hyperglycemia following acute stroke adversely affects clinical outcome, whether the association between glycaemia and functional outcome varies between stroke patients with\\without pre-diagnosed diabetes remains controversial. We aimed to investigate the relationship between the fasting blood glucose (FBG and the 6-month functional outcome in a subgroup of SMART cohort and further to assess whether this association varied based on the status of pre-diagnosed diabetes.Data of 2862 patients with acute ischemic stroke (629 with pre-diagnosed diabetics enrolled from SMART cohort were analyzed. Functional outcome at 6-month post-stroke was measured by modified Rankin Scale (mRS and categorized as favorable (mRS:0-2 or poor (mRS:3-5. Binary logistic regression model, adjusting for age, gender, educational level, history of hypertension and stroke, baseline NIHSS and treatment group, was used in the whole cohort to evaluate the association between admission FBG and functional outcome. Stratified logistic regression analyses were further performed based on the presence/absence of pre-diabetes history.In the whole cohort, multivariable logistical regression showed that poor functional outcome was associated with elevated FBG (OR1.21 (95%CI 1.07-1.37, p = 0.002, older age (OR1.64 (95% CI1.38-1.94, p<0.001, higher NIHSS (OR2.90 (95%CI 2.52-3.33, p<0.001 and hypertension (OR1.42 (95%CI 1.13-1.98, p = 0.04. Stratified logistical regression analysis showed that the association between FBG and functional outcome remained significant only in patients without pre-diagnosed diabetes (OR1.26 (95%CI 1.03-1.55, p = 0.023, but not in those with premorbid diagnosis of diabetes (p = 0.885.The present results demonstrate a significant association between elevated FBG after stroke and poor functional outcome in patients without pre-diagnosed diabetes, but not in diabetics. This finding confirms the importance of glycemic

Metabolic control targets in Sudanese adults with type 1 diabetes: A population-based study

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Ahmed O Almobarak

2017-01-01

Full Text Available Background: Type 1 diabetes is a challenging metabolic disorder for health authorities in Sudan. The objective of this study was to assess the level of glycemic control and to determine the prevalence of dyslipidemia and complications among individuals with type 1 diabetes in Sudan. Materials and Methods: Individuals with type 1 diabetes, who were having the disease for at least 1 year, were invited to participate in this study. Data were collected from two diabetes centers, in the Capital Khartoum and Atbara City, North of Sudan. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic data, and life style characteristics. Blood pressure, body mass index, and waist circumference were measured. Blood samples were taken for measurement of lipid profile and glycosylated hemoglobin. Results: A total of eighty individuals with type 1 diabetes volunteered to participate in this study, 37.5% of males and 62.5% of females. Majority of the patients were aged between 40 and 70 years old. There was poor glycemic control (glycosylated hemoglobin> 7%, in 83.8%. Age and sex were significant factors associated with poor glycemic control in this cohort. High cholesterol, triglyceride, and low density lipoprotein were seen in 76.2%, 27.5%, and 48.8% of participants, respectively. Low high density lipoprotein was seen in 33.8%. Hypertension was determined in 21.3%. Peripheral neuropathy, visual impairment, diabetic foot, and myocardial infarction were seen in 50%, 48.8%, 18.8%, and 2.5% of patients, respectively. Conclusion: Sudanese adults with type 1 diabetes have poor glycemic control, high prevalence of dyslipidemia, and long-term complications.

Is glycemic control in patients with type-2 diabetes in Rawalpindi improving

International Nuclear Information System (INIS)

Khan, D.A.; Saeed, M.; Khan, F.A.

2009-01-01

Glycaemic control is critical for managing diabetes and related complications. Considering high prevalence of Diabetes in Pakistan, our study aimed to assess the status of glycaemic control in Type-II Diabetics by measurement of HbA1c from 2005-2007 at Rawalpindi. We also evaluated changes in its trends in relation with sex and age. It was a retrospective analysis of data from Clinical Pathology Laboratory, Army Medical College, Rawalpindi during 2005-2007. A total of 2875 patients, aged 24-70 years, taking oral hypoglycaemic agents, were included. HbA1c was measured by using Human kit. International Diabetes Federation guidelines, 6.5%, 6.6%-8.4% and 8.5% were used to classify patients into good, fair and poor control categories. The number of patients (n=2875) tested for HbAlc increased from 904,974 to 997 during 2005-2007. The patients had an age of 48+-13 years and comprised of 54% males and 46% females. Improvement in patient's glycaemic control among the three categories during 2005 to 2007 was as follows: good (41% vs. 47%), fair (38% vs. 40%) and poor (21% vs. 13%) respectively. The average HbA1c values improved from 7.25 % in 2005 to 6.69% in 2007 (p<0.05). Overall, males (45%) and youngest age group (53%) patients had good diabetic control. Glycaemic control improved in diabetic patients from 41% to 47% during 2005-2007 at Rawalpindi. Males, especially the youngest patients comprised majority of good control population. For effective disease management and optimal HbA1c values, a combined effort by the patient and physician is required. (author)

Glycemic control in diabetes in three Danish counties.

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Jørgensen, Lone G M; Petersen, Per Hyltoft; Heickendorff, Lene; Møller, Holger Jon; Hendel, Jørn; Christensen, Cramer; Schmitz, Anita; Reinholdt, Birgitte; Lund, Erik D; Christensen, Niels J; Hansen, Erik Kjaersgaard; Hastrup, Jens; Skjødt, Hanne; Eriksen, Ebbe Wendel; Brandslund, Ivan

2005-01-01

Hemoglobin A1c (HbA1c) is a proxy measure for glycemic control in diabetes. We investigated the trend for glycemic control in patients from three Danish counties using HbA1c measurements. We studied 2454 patients from a population of 807,000 inhabitants for whom routine monitoring of diabetes using HbA1c-DCCT aligned was initiated in 2001. We estimated the incidence of monitored patients in the population. The progress in patients with originally diabetic HbA1c levels was investigated by cumulative probability plots, and the individual trend in clinical outcome was investigated by a modified difference plot. The age-standardized incidence of monitored patients was or=6.62% HbA1c) showed on average 15% improved glycemic control in the first year. Further improvement was limited. The overall percentage above the treatment target (>or=6.62% HbA1c) was 51% in 2003 compared to 59% in 2001, and the percentage with poor glycemic control (>or=10.0% HbA1c) was reduced from 19% to 4%. Of patients with originally diabetic HbA1c levels, 15% showed progress in glycemic control, and 28% reached treatment targets. In patients with originally normal HbA1c, 75% showed an upward trend in HbA1c levels, which reached diabetic concentrations in 17%. Patients with diabetic first HbA1c concentrations (>or=6.62% HbA1c) showed on average 15% improved glycemic control in the first year. Further improvement was limited. In individual patients, 75% with originally diabetic HbA1c levels showed improved glycemic control after 3 years, while 78% with originally normal concentrations showed an upward trend in HbA1c levels.

Is poor glycaemic control in diabetic patients a risk factor of myopia?

DEFF Research Database (Denmark)

Jacobsen, N.; Jensen, H.; Lund-Andersen, H.

2008-01-01

haemoglobin (HbA(1c)), insulin dosage and myopia in diabetic patients. Methods: All type 1 diabetic patients aged 16-26 years [mean age 22.0, standard deviation (SD) 2.9] attending the eye clinic at Steno Diabetes Center, Copenhagen, in 1995-1997 were included in the study (n = 393). The following data were...... collected from the medical records from baseline to 2005: age at diabetes onset, age at baseline, sex, weight, HbA(1c), insulin dosage, refractive error, visual acuity and ocular diabetes complications. Results: The prevalence of myopia [spherical equivalent (SE) 0.5 D] was 53.3% [95% confidence...

Status of glycemic control in patients of type 2 diabetes mellitus

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Khan, A.U.; Fakhr, A.; Khan, Z.A.; Nadeem, M.; Bangash, R.Y.

2013-01-01

Objective: To determine the status of glycemic control in patients of type 2 diabetes mellitus. Design: Cross sectional descriptive study. Place and Duration of Study: Medical out-patient/ in -patient departments at Military Hospital Rawalpindi from January 2011 to December 2012. Methods: Six hundred and fifty patients of type 2 DM fulfilling the required criteria were included in the study. Glycemic control of these patients was determined by estimation of blood glucose (fasting and random) and glycosylated haemoglobin (HbA1c). The patients were grouped in three categories good, fair and poor diabetic control having their HbA1c values of being 6-7%, 7.1-8% and more than 8.1% respectively. Statistical package for social sciences (SPSS) version 15 was used for analysis. Results: Out of 650 patients 377 (58%) had poor glycemic control with mean HbA1c of 9.5% +- 0.95, 78 (12%) patients had fair control of glycemic control with mean HbA1c of 7.8 +- 0.25, and 195 (30%) patients had good glycemic control with mean HbA1c of 6.4 +- 0.17. Conclusion: Majority of patients had poor control of their glycemic status which is an important indicator and predictor of both micro and macrovascular complications. (author)

Nutritional status, glycemic control and its associated risk factors among a sample of type 2 diabetic individuals, a pilot study

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Somayyeh Firouzi

2015-01-01

Full Text Available Background: The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control. Materials and Methods: A total of 104 type 2 diabetic patients were recruited and completed a questionnaire covering socio-demographic status, 3-day diet records, and physical activity. Anthropometry and glycemic control parameters, lipid profile and blood pressure were also measured. Results: Subjects were on average 56.7±9.9 years old with a mean duration of diabetes of 6.5 ± 5.0 years. The mean hemoglobin A1c of the subjects was 7.6% ± 1.4%, with only 20.2% achieving the target goal of <6.5% with no significant differences between genders. The mean body mass index was 26.9 ± 4.7 kg/m 2 , with 86.5% either were overweight or obese. Only 10.6% of the subjects exercised daily. The proportions of macronutrients relative to total energy intake were consistent with the recommendations of most diabetes associations. The adjusted odds of having poor glycemic control were 3.235 (1.043-10.397 (P < 0.05 higher among those who had high density lipoprotein cholesterol levels below the normal range. Those taking one or two types of oral anti-diabetic drugs had 19.9 (2.959-87.391 (P < 0.01 and 14.3 (2.647-77.500 (P < 0.01 higher odds of poor glycemic control respectively compared to those who were being treated by diet alone. Conclusion: Poor glycemic control was prevalent among Malaysian diabetic patients, and this could be associated with low levels of HDL and being treated with oral anti-diabetes agents.

Risk factors for periodontal diseases among Yemeni type II diabetic patients. A case-control study.

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Anas Shamala

2017-08-01

Full Text Available Background: Chronic periodontal diseases are one of diabetes mellitus complications. The present study aims to compare the periodontal status of type II diabetic patients to a control group and assess the role of risk factors in both groups. Materials and methods: A case-control study was conducted of 270 individuals (132 type II diabetics and 138 non-diabetics. Full mouth periodontal examination including plaque index, gingival bleeding, gingival recession, clinical attachment loss (CAL, tooth mobility, furcation involvement and the number of missing teeth. The case group was subdivided according to glycosylated hemoglobin (HbA1c status (poorly controlled HbA1c >8 and well controlled HbA1c≤8 Likewise, the duration of diabetes mellitus as short or long duration (DM≤10 or >10. The diabetic group was also subdivided according to smoking and Khat chewing habits. Result: The severity of periodontal disease among type II diabetic patients were significantly higher compared to the control group regarding the plaque index 2.6 (1.6-4.3, bleeding on probing 3.5 (2.3-13.0, gingival recession 2.0 (1.2-3.4, furcation involvement 4.0 (2.3-6.7, clinical attachment loss 5.7 (3.1-10.5, tooth mobility 2.0 (1.2-3.4, and number of missing teeth 4.4 (2.3-8.5. In addition, poorly controlled type II DM and long duration had higher CAL and number of missing teeth than well-controlled DM and short duration. No significant differences were found between smokers/nonsmokers and Khat chewers/non-chewers among the diabetic group. Conclusion: Type II diabetic patients have severe periodontal destruction and tooth loss compared to non-diabetic people and there were no differences within the diabetic group in regards to smoking and Khat chewing habits.

[Insulin and diabetes control in Argentina].

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Gagliardino, Juan J; Costa Gil, José E; Faingold, María C; Litwak, León; Fuente, Graciela V

2013-01-01

As in the rest of the world, there is a significant gap between scientific knowledge regarding diabetes mellitus and the daily practice outcome, in Argentina. Inadequate diabetes control combined with associated cardiovascular risk factors are responsible for an elevated morbid-mortality incidence and the consequent raise in the socioeconomic burden. Some of the factors leading to this situation are the late diagnosis of the disease, the clinical "inertia" (reluctance to prescribe insulin) and the poor education given to the health care team as well as the persons with diabetes. The implementation of a national diabetologic education program targeting health care providers, the persons with diabetes and their families, could contribute to optimize the appropriate insulin prescription, and consequently improve their life quality, while reducing the disease socioeconomic burden. In order to optimize the education program's strategy outcome, insulinization cabinets should be incorporated, the participation of all health systems (public health, social security and private health insurance companies), the media, health sciences, schools and the pharmaceutical industry are needed.

Poor pregnancy outcome in women with type 2 diabetes

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Clausen, Tine D; Mathiesen, Elisabeth; Ekbom, Pia

2005-01-01

. Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996-2000, the background population, and pregnant women with type 2 diabetes during 1980-1992 from the same department. RESULTS: The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.......6%) was increased four- and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2...... diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA(1c) at admission and type 2 diabetes were independently associated with a serious adverse fetal outcome...

Periodontal disease in type 2 diabetes mellitus

International Nuclear Information System (INIS)

Haseeb, M.; Khawaja, K.I.; Ataullah, K.; Munir, M.B.; Fatima, A.

2012-01-01

Objective: To determine the periodontal status in well controlled and poorly controlled type 2 diabetic patients compared with normal healthy individuals. Methodology: Forty well controlled and forty poorly controlled type 2 diabetic subjects having good oral hygiene (scored according to simplified oral hygiene index) were compared with a control group of forty normal healthy individuals. Probing depth (PD), gingival recession (GR), and attachment loss (AL) were recorded to obtain the periodontal status of each tooth, using a Michigan probe '0' with Williams marking. Glycemic control was evaluated by glycated Hb value. Using ANOVA and independent sample t-test, mean probing depth and attachment loss in each tooth type (incisors, canines, premolars and molars) were compared. Results: Mean age of diabetic subjects was 58.86 +- 6.21 years and that of control group was 56.92 +- 6.91 years; 60% were females. Probing depth was greater in patients with poorly controlled diabetes compared to well controlled diabetic patients and non-diabetic controls (4.21 mm vs. 3.72 mm and 2.93 mm respectively, p 0.05). Number of sites and mean percentage of sites with attachment loss of greater or equal to 4 and greater or equal to 6 mm was also significantly higher in poorly controlled diabetes compared to the control group (p < 0.05 and p < 0.001 respectively). Conclusion: Periodontal status as estimated by probing depth and degree of attachment loss deteriorates significantly with poor glycemic control in diabetes. (author)

Bridging glycated hemoglobin with quality of life and health state; a randomized case-control study among type 2 diabetes patients.

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Gillani, Syed Wasif; Ansari, Irfan Altaf; Zaghloul, Hisham A; Abdul, Mohi Iqbal Mohammad; Sulaiman, Syed Azhar Syed; Baig, Mirza R

2018-01-01

The aim of this study was to explore the predictors of QOL and health state and examine the relationship with glycemic control among type 2 diabetes mellitus (T2DM) patients. A randomized cross-sectional case-control study was conducted among n = 600 T2DM patients of Malaysia. Study population was distributed into three groups as: controls: patients with HbA1c ≤ 7 (n = 199), cases arm 1: with HbA1c 7-7.9 (n = 204) and cases arm 2 (n = 197): with HbA1c ≥ 8 consecutively last 3 times. Participants with diabetes history > 10 years exhibits higher mean QOL score among all the three groups. In contrast mean health status score significantly ( p  diabetes both within and intergroup assessment that participants with poor glycemic control (arm 2) had significantly higher mean QOL score with knowledge and self-care dimensions as compared to others, however mean health state scores were significantly ( p  self-care activities, comorbidities, ability of positive management and BMI were significant predictors to health state for consistent glycemic control (controls) as compared to poor glycemic control (arm 2) participants. This study suggested that poor glycemic index reported low self-care behavior, increase barriers to daily living activities and poor ability to manage diabetes positively, which cause poor QOL and decrease health state.

Predictors of glycemic control among patients with Type 2 diabetes: A longitudinal study

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Philis-Tsimikas Athena

2005-04-01

Full Text Available Abstract Background Diabetes is the sixth leading cause of death and results in significant morbidity. The purpose of this study is to determine what demographic, health status, treatment, access/quality of care, and behavioral factors are associated with poor glycemic control in a Type 2 diabetic, low-income, minority, San Diego population. Methods Longitudinal observational data was collected on patients with Type 2 diabetes from Project Dulce, a program in San Diego County designed to care for an underserved diabetic population. The study sample included 573 patients with a racial/ethnic mix of 53% Hispanic, 7% black, 18% Asian, 20% white, and 2% other. We utilized mixed effects models to determine the factors associated with poor glycemic control using hemoglobin A1C (A1C as the outcome of interest. A multi-step model building process was used resulting in a final parsimonious model with main effects and interaction terms. Results Patients had a mean age of 55 years, 69% were female, the mean duration of diabetes was 7.1 years, 31% were treated with insulin, and 57% were obese. American Diabetes Association (ADA recommendations for blood pressure and total cholesterol were met by 71% and 68%, respectively. Results of the mixed effects model showed that patients who were uninsured, had diabetes for a longer period of time, used insulin or multiple oral agents, or had high cholesterol had higher A1C values over time indicating poorer glycemic control. The younger subjects also had poorer control. Conclusion This study provides factors that predict glycemic control in a specific low-income, multiethnic, Type 2 diabetic population. With this information, subgroups with high risk of disease morbidity were identified. Barriers that prevent these patients from meeting their goals must be explored to improve health outcomes.

Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus.

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Tang, Yunzhao; Meng, Lingling; Li, Daiqing; Yang, Min; Zhu, Yanjuan; Li, Chenguang; Jiang, Zhenhuan; Yu, Ping; Li, Zhu; Song, Hongna; Ni, Changlin

2014-01-01

Copious evidence from epidemiological and laboratory studies has revealed that sleep status is associated with glucose intolerance, insulin resistance, thus increasing the risk of developing type 2 diabetes. The aim of this study was to reveal the interaction of sleep quality and sleep quantity on glycemic control in patients with type 2 diabetes mellitus. From May 2013 to May 2014, a total of 551 type 2 diabetes patients in Tianjin Metabolic Diseases Hospital were enrolled. Blood samples were taken to measure glycosylated hemoglobin (HbA1c), and all the patients completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep status. "Good sleep quality" was defined as PQSI quality" was defined as PQSI 6-8, and "poor sleep quality" was defined as PQSI >8. Poor glycemic control was defined as HbA1c ≥7%. Sleep quantity was categorized as 8 hours/night. Short sleep time was defined as sleep duration quality in poor glycemic control group was much greater than that in the average control group (χ(2) = 9.79, P = 0.007). After adjusted by gender, age, body mass index, and disease duration, the adjusted PSQI score's OR was 1.048 (95% CI 1.007-1.092, P = 0.023) for HbA1c level. The sleep duration's OR was 0.464 (95% CI 0.236-0.912, P = 0.026) for HbA1c level. One-way analysis of variance showed that the poor sleep quality group had the highest homeostasis model assessment-insulin resistance (P quality and quantity, should be regarded as a plausible risk factor for glycemic control in type 2 diabetes. Poor sleep might bring much more serious insulin resistance and could be the reason for bad glycemic control. A good night's sleep should be seen as a critical health component tool in the prevention and treatment of type 2 diabetes. It is important for clinicians to target the root causes of short sleep duration and/or poor sleep quality.

Role of parenting style in achieving metabolic control in adolescents with type 1 diabetes.

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Shorer, Maayan; David, Ravit; Schoenberg-Taz, Michal; Levavi-Lavi, Ifat; Phillip, Moshe; Meyerovitch, Joseph

2011-08-01

To examine the role of parenting style in achieving metabolic control and treatment adherence in adolescents with type 1 diabetes. Parents of 100 adolescents with type 1 diabetes completed assessments of their parenting style and sense of helplessness. Parents and patients rated patient adherence to the treatment regimen. Glycemic control was evaluated by HbA(1c) values. An authoritative paternal parenting style predicted better glycemic control and adherence in the child; a permissive maternal parenting style predicted poor adherence. A higher sense of helplessness in both parents predicted worse glycemic control and lesser adherence to treatment. Parental sense of helplessness was a significant predictor of diabetes control after correcting for other confounders (patient age, sex, and treatment method). An authoritative nonhelpless parenting style is associated with better diabetes control in adolescents. Paternal involvement is important in adolescent diabetes management. These results have implications for psychological interventions.

Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis.

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Hudson, Joanna L; Bundy, Chris; Coventry, Peter A; Dickens, Chris

2014-04-01

Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated. Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r=±0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also. Associations between cognitive illness representations and poor emotional health were in the expected direction - negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways. Copyright © 2014 Elsevier Inc. All rights reserved.

Poor hypertension control in Greek patients with diabetes in rural areas. The VANK study in primary care.

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Skliros, E; Sotiropoulos, A; Vasibossis, A; Xipnitos, C; Chronopoulos, I; Razis, N; Merkouris, Panagiotis

2007-01-01

This study aimed to determine hypertension prevalence and levels of awareness, treatment and control of hypertension among diabetic patients using data from the VANK study. The sample consisted of 221 men and women (122/99) diagnosed with type 2 diabetes. Semi-structured interviews were conducted with all participants. Controlled hypertension definition was based on having a systolic blood pressure (BP) of hypertension was 194/221 (87.7%). In total, 34.1% of patients (66/194) were not aware of having hypertension. Of those who were aware of having hypertension (n = 128, 65.9%), all were treated. Among those treated, only 11 persons (11/194, 5.6%) had systolic BP hypertensive patients (n = 128) received antihypertensive drug therapy, in only 8.6% (11/128) the treatment was effective (BP hypertension from primary care physicians, as well as regular surveillance to detect developing hypertension in diabetic patients.

Food insecurity is related to glycemic control deterioration in patients with type 2 diabetes.

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Bawadi, Hiba Ahmad; Ammari, Fawaz; Abu-Jamous, Dima; Khader, Yousef Saleh; Bataineh, Safa'a; Tayyem, Reema Fayez

2012-04-01

Poor glycemic control has been shown to play a major role in the development and progression of diabetes complications. This cross-sectional study tested the hypothesis that food insecurity may deteriorate glycemic control in patients with type 2 diabetes. The objectives of this study were to assess the prevalence of food insecurity among type 2 diabetics in a major hospital that serves the area of northern Jordan, and to investigate its relation to glycemic control. A sample of 843 patients diagnosed with type 2 diabetes participated in the study. Socioeconomic and health data were collected by interview-based questionnaire. Weight and height were measured by a trained nutritionist. Dietary assessment was done using food frequency questionnaire. Dietary data were processed using food processor software. Food insecurity was assessed by the short form of the U.S. food security survey module. Glycemic control was assessed by measuring glycosyated hemoglobin (HbA1c). Statistical procedures used to analyze the data were chi-square, and post-hoc analysis of variance. About 22% of the tested sample were food secure (FS); 51% were moderately food insecure (MFIS); and 27% were severely food insecure (SFIS). Higher BMI was associated with SFIS patients. After adjusting for age, gender, income, education, and duration of diabetes, body mass index, and caloric consumption; moderate and severe food insecurity were associated with poor glycemic control (p = 0.04). food insecurity may be associated with glycemic control deterioration in patients with type 2 diabetes. Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Regional, geographic, and racial/ethnic variation in glycemic control in a national sample of veterans with diabetes.

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Egede, Leonard E; Gebregziabher, Mulugeta; Hunt, Kelly J; Axon, Robert N; Echols, Carrae; Gilbert, Gregory E; Mauldin, Patrick D

2011-04-01

We performed a retrospective analysis of a national cohort of veterans with diabetes to better understand regional, geographic, and racial/ethnic variation in diabetes control as measured by HbA(1c). A retrospective cohort study was conducted in a national cohort of 690,968 veterans with diabetes receiving prescriptions for insulin or oral hypoglycemic agents in 2002 that were followed over a 5-year period. The main outcome measures were HbA(1c) levels (as continuous and dichotomized at ≥8.0%). Relative to non-Hispanic whites (NHWs), HbA(1c) levels remained 0.25% higher in non-Hispanic blacks (NHBs), 0.31% higher in Hispanics, and 0.14% higher in individuals with other/unknown/missing racial/ethnic group after controlling for demographics, type of medication used, medication adherence, and comorbidities. Small but statistically significant geographic differences were also noted with HbA(1c) being lowest in the South and highest in the Mid-Atlantic. Rural/urban location of residence was not associated with HbA(1c) levels. For the dichotomous outcome poor control, results were similar with race/ethnic group being strongly associated with poor control (i.e., odds ratios of 1.33 [95% CI 1.31-1.35] and 1.57 [1.54-1.61] for NHBs and Hispanics vs. NHWs, respectively), geographic region being weakly associated with poor control, and rural/urban residence being negligibly associated with poor control. In a national longitudinal cohort of veterans with diabetes, we found racial/ethnic disparities in HbA(1c) levels and HbA(1c) control; however, these disparities were largely, but not completely, explained by adjustment for demographic characteristics, medication adherence, type of medication used to treat diabetes, and comorbidities.

Control to goal of cardiometabolic risk factors among Nigerians living with type 2 diabetes mellitus.

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Okafor, C I; Ofoegbu, E N

2012-01-01

Cardiovascular risk factors contribute to morbidity and mortality among diabetic patients. National and international guidelines on management of diabetes therefore emphasize control to goals of blood glucose, blood pressure, dyslipidemia, and obesity so as to minimize the development of complications and enhance the patients' quality of life. To evaluate the status of control to goals of cardiometabolic risk factors among the diabetic patients attending the Diabetes clinic of University of Nigeria Teaching Hospital, Enugu. A survey of 233 type 2 diabetic patients recruited from the Diabetes clinic of our hospital was carried out. Standard procedures as described in the WHO STEP instrument were used to determine the waist circumference, weight, height, and systolic and diastolic blood pressure. Fasting blood glucose and lipid profiles were also assessed. Therapeutic goals used to define risk or poor control were values adopted by expert groups such as American diabetes association (ADA), National cholesterol education program (NCEP), American association of clinical endocrinologist (AACE) and International diabetes federation (IDF). There were 98 males and 135 females with mean (SD) duration of diabetes mellitus (DM) of 6.7 (6.3) years. Suboptimal glycemic, blood pressure control and dyslipidemia were observed in 65.7%, 51.9%, 97.1% of the subjects respectively while 60.1% of the subjects were found to be overweight/obese. Comparing the mean indices of risk factors with the recommended therapeutic goals, status of control was optimal for HDL-cholesterol, waist circumference and triglycerides. All the other risk factors were suboptimal. Control to goals of cardiovascular risk factors is poor among the patients. There is the need to identify and tackle the possible contributing factors so as to reduce the morbidity and mortality in these patients.

Impact of a diabetes disease management program on diabetes control and patient quality of life.

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Rasekaba, Tshepo Mokuedi; Graco, Marnie; Risteski, Chrissie; Jasper, Andrea; Berlowitz, David J; Hawthorne, Graeme; Hutchinson, Anastasia

2012-02-01

The worldwide burden of diabetes is projected to be 5.4% of the adult population by the year 2025. Diabetes is associated with multiple medical complications that both decrease health-related quality of life (HR-QOL) and contribute to earlier mortality. There is growing evidence for the effectiveness of multidisciplinary disease management programs that incorporate self-management principles in improving patients' long-term outcomes. The aim of this project was to evaluate the effectiveness of this approach in improving: (1) glycemic control measured by HbA1c, and (2) HR-QOL measured by the Assessment of Quality of Life (AQOL), at enrollment and at 12-months follow-up. Between 2004 and 2008, a total of 967 patients were enrolled in the program; 545 (56%) of these patients had HbA1c data available at baseline and at 12 months. Mean HbA1c at enrollment was 8.6% (SD 1.9) versus 7.3% (SD 1.2) at 12 months (Pmanagement program for patients with poorly controlled type 2 diabetes can improve both glycemic control and HR-QOL.

[Relationship between brachial-ankle pulse wave velocity and glycemic control of type 2 diabetes mellitus patients in Beijing community population].

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Sun, Ke-xin; Liu, Zhi-ke; Cao, Ya-ying; Juan, Juan; Xiang, Xiao; Yang, Cheng; Huang, Shao-ping; Liu, Xiao-fen; Li, Na; Tang, Xun; Li, Jin; Wu, Tao; Chen, Da-fang; Hu, Yong-hua

2015-06-18

To explore the correlation between glycemic control of type 2 diabetes mellitus (T2DM) patients and brachial-ankle pulse velocity (baPWV). A community-based cross-sectional study was conducted in Beijing, China. Every subject underwent physical examinations, glycated hemoglobin (HbA1c), blood lipid and baPWV measurements and completed a standardized questionnaire. T2DM patients were divided into well controlled and poorly controlled groups according to HbA1c levels. The correlation between glycemic control of T2DM patients and baPWV was analyzed. In this study, 1 341 subjects were recruited, including 733 T2DM patients and 608 non-diabetes subjects. Compared with non-diabetes subjects, abnormal baPWV (baPWV≥1 700 cm/s) rate for T2DM patients was higher (40.8% vs. 26.8%, Pcontrol in T2DM patients, the abnormal baPWV rates for non-diabetes subjects, well controlled and poorly controlled T2DM patients were significantly different (non-diabetes vs. HbA1ccontrol status of T2DM patients was associated with abnormal baPWV. Compared with non-diabetes subjects, the ORs for abnormal baPWV in HbA1ccontrol status of T2DM patients from communities is significantly associated with baPWV. Poor glycemic control is a risk factor for abnormal baPWV. Keeping HbA1c under control might lower the risk of cardiovascular diseases in T2DM patients.

Treatment non-adherence among patients with poorly controlled ...

African Journals Online (AJOL)

2014-03-01

Mar 1, 2014 ... Background: Poor adherence to prescribed therapy among patients with chronic diseases is a growing concern which un- dermines the ... consent was obtained from individual patient to signi- .... and SRMAS in binary categories of adherence versus ..... United Kingdom Prospective Diabetes Study Group.

Diabetes knowledge among Greek Type 2 Diabetes Mellitus patients.

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Poulimeneas, Dimitrios; Grammatikopoulou, Maria G; Bougioukli, Vasiliki; Iosifidou, Parthena; Vasiloglou, Maria F; Gerama, Maria-Assimina; Mitsos, Dimitrios; Chrysanthakopoulou, Ioanna; Tsigga, Maria; Kazakos, Kyriakos

2016-01-01

Diabetes knowledge has been shown to improve glycemic control and associate with several demographic parameters. In Greece, a country with high obesity rates, disease knowledge has never been evaluated in diabetic patients. This cross sectional study aimed to assess diabetes knowledge and its associations between social and demographic parameters, among Greek type 2 diabetes mellitus (T2DM) patients. One hundred fifty nine patients with T2DM were recruited from an urban and a rural clinic in Greece. Diabetes knowledge was assessed with the Brief Diabetes Knowledge Test (DKT). Basic anthropometry was performed. Data regarding glycemic control and sociodemographic characteristics were collected from the patients' medical files. Greek T2DM patients demonstrated poor disease knowledge (mean DKT score 8.3±2.2/14.0 and mean DKT as a percent of correct answers 59.6±15.8%). No differences were observed between sex, place of residence, or glycemic control, among subjects. Patients with higher education demonstrated greater diabetes knowledge. Simple obesity with concurrent central obesity or suboptimal glycemic control decreased diabetes knowledge among participants. Additionally, waist circumference was inversely correlated to diabetes knowledge. Based on the DKT, Greek patients exhibit poor diabetes knowledge. This study provides evidence for the need for better diabetes education in order to ameliorate disease outcome. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

Ischaemic heart disease and glycaemic control in type-2 diabetes mellitus by questionnaire method

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Yathish, T.R.; Annamalai, N.; Shankar, V.

2010-01-01

Background: Various tests like Echocardiogram, Nuclear scan, Electron-beam computed tomography, Coronary angiography, and magnetic resonance angiography are available for diagnosis of ischemic heart disease (IHD). But most of these are expensive, invasive and cannot be afforded in developing countries. An attempt was made to study sensitivity, specificity, and predictive value of non-invasive technique like questionnaire method and compared with traditional clinical evaluation. This study compared diagnosis of angina made with the Rose uestionnaire to diagnosis by physician in type-2 diabetes mellitus and the effect of glycaemic control. Methods: A cross-sectional study was done from March 2005 to March 2006. Cases were collected from outpatients and inpatients visiting RL Jalappa hospital and SNR Hospital attached to Sri Devraj Urs Medical College Kolar, Karnataka, India. Glycosylated haemoglobin levels were estimated. Data on Rose questionnaire angina and physician diagnosed angina were collected and compared between groups of well controlled diabetics, poorly controlled diabetics and controls. The 12 lead Electrocardiogram was used to confirm the diagnosis. Results: The Rose questionnaire had 63.63% sensitivity, 97.5% specificity, 73% positive predictive value, and 96% negative predictive value. This study also showed the occurrence of IHD was higher in the poorly controlled diabetics (16.3%) as compared to well controlled diabetic patients (6%) and controls (5%) which were significant. Conclusions: The questionnaire diagnosis showed good sensitivity and high specificity as compared with diagnosis by physicians. The questionnaire method can be frequently used and incorporated in cardiovascular risk assessment and epidemiologic screening programs. (author)

Differentiating Approaches to Diabetes Self-Management of Multi-Ethnic Rural Older Adults at the Extremes of Glycemic Control

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Brewer-Lowry, Aleshia Nichol; Arcury, Thomas A.; Bell, Ronny A.; Quandt, Sara A.

2010-01-01

Purpose of the Study: This study identified approaches to diabetes self-management that differentiate persons with well-controlled from poorly controlled diabetes. Previous research has focused largely on persons participating in self-management interventions. Design and Methods: In-depth qualitative interviews were conducted with 48 adults, drawn…

Association between depression and glycemic control among type 2 diabetes patients in Lima, Peru.

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Crispín-Trebejo, Brenda; Robles-Cuadros, María Cristina; Bernabé-Ortiz, Antonio

2015-12-01

There is limited and controversial information regarding the potential impact of depression on glycemic control. This study aims to evaluate the association between depression and poor glycemic control. In addition, the prevalence of depression and rates of poor glycemic control were determined. Cross-sectional study performed in the endocrinology unit of two hospitals of ESSALUD in Peru. The outcome of interest was poor glycemic control, evaluated by glycated hemoglobin (HbA1c: diabetes patients. Our results suggest that early detection of depression might be important to facilitate appropriate glycemic control and avoid further metabolic complications. © 2015 Wiley Publishing Asia Pty Ltd.

An evaluation of Birmingham Own Health® telephone care management service among patients with poorly controlled diabetes. a retrospective comparison with the General Practice Research Database

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Adab Peymané

2011-09-01

Full Text Available Abstract Background Telephone-based care management programmes have been shown to improve health outcomes in some chronic diseases. Birmingham Own Health® is a telephone-based care service (nurse-delivered motivational coaching and support for self-management and lifestyle change for patients with poorly controlled diabetes, delivered in Birmingham, UK. We used a novel method to evaluate its effectiveness in a real-life setting. Methods Retrospective cohort study in the UK. 473 patients aged ≥ 18 years with diabetes enrolled onto Birmingham Own Health® (intervention cohort and with > 90 days follow-up, were each matched by age and sex to up to 50 patients with diabetes registered with the General Practice Research Database (GPRD to create a pool of 21,052 controls (control cohort. Controls were further selected from the main control cohort, matching as close as possible to the cases for baseline test levels, followed by as close as possible length of follow-up (within +/-30 days limits and within +/-90 days baseline test date. The aim was to identify a control group with as similar distribution of prognostic factors to the cases as possible. Effect sizes were computed using linear regression analysis adjusting for age, sex, deprivation quintile, length of follow-up and baseline test levels. Results After adjusting for baseline values and other potential confounders, the intervention showed significant mean reductions among people with diabetes of 0.3% (95%CI 0.1, 0.4% in HbA1c; 3.5 mmHg (1.5, 5.5 in systolic blood pressure, 1.6 mmHg (0.4, 2.7 in diastolic blood pressure and 0.7 unit reduction (0.3, 1.0 in BMI, over a mean follow-up of around 10 months. Only small effects were seen on average on serum cholesterol levels (0.1 mmol/l reduction (0.1, 0.2. More marked effects were seen for each clinical outcome among patients with worse baseline levels. Conclusions Despite the limitations of the study design, the results are consistent with the

Diabetes, glycemic control, and urinary incontinence in women

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Wang, Rui; Lefevre, Roger; Hacker, Michele R.; Golen, Toni H.

2015-01-01

OBJECTIVES To estimate the association between urinary incontinence and glycemic control in women ages 20 to 85. METHODS We included 7,270 women from the 2005–2010 National Health and Nutrition Examination Survey, stratified into three groups of glycemic control defined by hemoglobin A1c (HbA1c): i) those below the diagnostic threshold (HbA1c8.5%) to allow for a different relationship between glycemic control and urinary incontinence within each group. The primary outcomes were the presence of any, only stress, only urgency, and mixed urinary incontinence. We calculated adjusted risk ratios using Poisson regressions with robust variance estimates. RESULTS The survey-weighted prevalence was 52.9% for any, 27.2% for only stress, 9.9% for only urgency, and 15.8% for mixed urinary incontinence. Among women with relatively controlled diabetes, each one-unit increase in HbA1c was associated with a 13% (95% CI: 1.03–1.25) increase for any urinary incontinence and a 34% (95% CI 1.06–1.69) increase in risk for only stress incontinence but was not significantly associated with only urgency and mixed incontinence. Other risk factors included body mass index, hormone replacement therapy, smoking, and physical activity. CONCLUSIONS Worsening glycemic control is associated with an increased risk for stress incontinence for women with relatively controlled diabetes. For those either below the diagnostic threshold or with poorly controlled diabetes, the risk may be driven by other factors. Further prospective investigation of HbA1c as a modifiable risk factor may motivate measures to improve continence in women with diabetes. PMID:26313496

Poor Vitamin C Status Late in Pregnancy Is Associated with Increased Risk of Complications in Type 1 Diabetic Women: A Cross-Sectional Study

DEFF Research Database (Denmark)

Juhl, Bente; Lauszus, Finn Friis; Lykkesfeldt, Jens

2017-01-01

Vitamin C (vitC) is essential for normal pregnancy and fetal development and poor vitC status has been related to complications of pregnancy. We have previously shown lower vitC status in diabetic women throughout pregnancy compared to that of non-diabetic controls. Here, we evaluate...... the relationship between vitC status late in diabetic pregnancy in relation to fetal outcome, complications of pregnancy, diabetic characteristics, and glycemic control based on data of 47 women from the same cohort. We found a significant relationship between the maternal vitC level > or ≤ the 50% percentile...... of 26.6 μmol/L, respectively, and the umbilical cord blood vitC level (mean (SD)): 101.0 μmol/L (16.6) versus 78.5 μmol/L (27.8), p = 0.02; n = 12/16), while no relation to birth weight or Apgar score was observed. Diabetic women with complications of pregnancy had significantly lower vitC levels...

"Control Your Diabetes. For Life."

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... this page please turn Javascript on. Feature: Diabetes "Control Your Diabetes. For Life." Past Issues / Fall 2009 Table of Contents For information about "Control Your Diabetes. For Life" campaign, visit www.YourDiabetesInfo. ...

Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score.

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Bihan, Hélène; Laurent, Silvana; Sass, Catherine; Nguyen, Gérard; Huot, Caroline; Moulin, Jean Jacques; Guegen, René; Le Toumelin, Philippe; Le Clésiau, Hervé; La Rosa, Emilio; Reach, Gérard; Cohen, Régis

2005-11-01

Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé (Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation. We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41 +/- 13.2 years [mean +/- SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed. HbA(1c) level was significantly correlated with the EPICES score (r = 0.366, P < 0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (beta = 1.984 [SE 0.477], P < 0.001), neuropathy (odds ratio 2.39 [95% CI 1.05-5.43], P = 0.037), retinopathy (3.66 [1.39-9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14-0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors. Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and economic burden of deprived patients is high.

COMPARISON OF RNFL THICKNESS AND VISUAL FIELD CHANGES BETWEEN DIABETIC WITHOUT RETINOPATHY AND NONDIABETIC CONTROLS- A CROSS-SECTIONAL STUDY

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Soumya Swarup Chattopadhyay

2017-10-01

Full Text Available BACKGROUND Diabetes mellitus is one of the major component of metabolic syndrome and a leading cause of ocular morbidity in modern era and India will be considered to be the diabetes capital of the world. Before the onset of diabetic retinopathy, other structural and functional changes may predict the visual diminution of the individual. MATERIALS AND METHODS In this cross-sectional study in a tertiary care hospital, after inclusion and exclusion, the age-gender matched groups (diagnosed type 2 diabetes patients without diabetic retinopathy and controls without diabetes were thoroughly examined clinically and by noninvasive and invasive examination (after proper counselling of the patient and informed consent. Then, they are tested for functional loss of retina by Humphrey FDT, GDx VCC. Comparison done between cases and controls as well as poorly-controlled and well-controlled diabetic groups. RESULTS It was found that the average RNFL thickness was significantly reduced in diabetics (mean 53.48, SD 2.69 compared to controls (mean 60.21, SD 1.87 (p7%, the RNFL thickness was significantly reduced (mean 52.23, SD 1.31 compared to diabetics with good metabolic control (mean 56.38, SD 2.92 (p<0.05. In retinal functional testing, it was found that the Humphrey FDT mean deviation (FDT MD and pattern standard deviation (FDT PSD were significantly worse in diabetics (FDT MD- 1.478, SD 0.386, (FDT PSD- 3.485, SD 0.403 compared to normal controls (FDT MD- 0.442, SD 0.536, (FDT PSD- 1.438, SD 0.404. The parameters were also found to be significantly worse in uncontrolled diabetics (p<0.05. CONCLUSION To conclude, without diabetic retinopathy, functional and structural loss in retina in diabetes patients compared to age-sex matched individual and especially in poorly-controlled diabetes should be of concern as there are no detectable vasculopathy. So, early diagnosis and control of diabetes is advocated to control this functional loss

Efficacy and safety comparison between liraglutide as add-on therapy to insulin and insulin dose-increase in Chinese subjects with poorly controlled type 2 diabetes and abdominal obesity

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Li Chun-jun

2012-11-01

Full Text Available Abstract Objective To assess the efficacy and safety of adding liraglutide to established insulin therapy in poorly controlled Chinese subjects with type 2 diabetes and abdominal obesity compared with increasing insulin dose. Methods A 12-week, randomized, parallel-group study was carried out. A total of 84 patients completed the trial who had been randomly assigned to either the liraglutide-added group or the insulin-increasing group while continuing current insulin based treatment. Insulin dose was reduced by 0-30% upon the initiation of liraglutide. Insulin doses were subsequently adjusted to optimized glycemic control. Glycosylated hemoglobin (HbA1c values, blood glucose, total daily insulin dose, body weight, waist circumference, and the number of hypoglycemic events and adverse events were evaluated. Results At the end of study, the mean reduction in HbA1c between the liraglutide-added group and the insulin-increasing group was not significantly different (1.9% vs. 1.77%, p>0.05. However, the percentage of subjects reaching the composite endpoint of HbA1c ≤ 7.0% with no weight gain and no hypoglycemia, was significantly higher in the liraglutide-added group than in the insulin-increasing group (67% vs. 19%, p2, p Conclusions Addition of liraglutide to abdominally obese, insulin-treated patients led to improvement in glycemic control similar to that achieved by increasing insulin dosage, but with a lower daily dose of insulin and fewer hypoglycemic events. Adding liraglutide to insulin also induced a significant reduction in body weight and waist circumference. Liraglutide combined with insulin may be the best treatment option for poorly controlled type 2 diabetes and abdominal obesity.

Association of reduced zinc status with poor glycemic control in individuals with type 2 diabetes mellitus.

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Bandeira, Verônica da Silva; Pires, Liliane Viana; Hashimoto, Leila Leiko; Alencar, Luciane Luca de; Almondes, Kaluce Gonçalves Sousa; Lottenberg, Simão Augusto; Cozzolino, Silvia Maria Franciscato

2017-12-01

This study evaluated the relationship between the zinc-related nutritional status and glycemic and insulinemic markers in individuals with type 2 diabetes mellitus (T2DM). A total of 82 individuals with T2DM aged between 29 and 59 years were evaluated. The concentration of zinc in the plasma, erythrocytes, and urine was determined by the flame atomic absorption spectrometry method. Dietary intake was assessed using a 3-day 24-h recall. In addition, concentrations of serum glucose, glycated hemoglobin percentage, total cholesterol and fractions, triglycerides, and serum insulin were determined. The insulin resistance index (HOMA-IR) and β-cell function (HOMA- β) were calculated. The markers of zinc status (plasma: 83.3±11.9μg/dL, erythrocytes: 30.1±4.6μg/g Hb, urine: 899.1±622.4μg Zn/24h, and dietary: 9.9±0.8mg/day) were classified in tertiles and compared to insulinemic and glycemic markers. The results showed that lower zinc concentrations in plasma and erythrocytes, as well as its high urinary excretion, were associated with higher percentages of glycated hemoglobin, reflecting a worse glycemic control in individuals with T2DM (pzinc levels and glycated hemoglobin percentage (r=-0.325, p=0.003), and a positive correlation between urinary zinc excretion and glycemia (r=0.269, p=0.016), glycated hemoglobin percentage (r=0.318, p=0.004) and HOMA-IR (r=0.289, p=0.009). According to our study results, conclude that T2DM individuals with reduced zinc status exhibited poor glycemic control. Copyright © 2017 Elsevier GmbH. All rights reserved.

Hba1c, Blood Pressure, and Lipid Control in People with Diabetes: Japan Epidemiology Collaboration on Occupational Health Study.

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Huanhuan Hu

Full Text Available The control of blood glucose levels, blood pressure (BP, and low-density lipoprotein cholesterol (LDL-C levels reduces the risk of diabetes complications; however, data are scarce on control status of these factors among workers with diabetes. The present study aimed to estimate the prevalence of participants with diabetes who meet glycated hemoglobin (HbA1c, BP, and LDL-C recommendations, and to investigate correlates of poor glycemic control in a large working population in Japan.The Japan Epidemiology Collaboration on Occupational Health (J-ECOH Study is an ongoing cohort investigation, consisting mainly of employees in large manufacturing companies. We conducted a cross-sectional analysis of 3,070 employees with diabetes (2,854 men and 216 women aged 20-69 years who attended periodic health examinations. BP was measured and recorded using different company protocols. Risk factor targets were defined using both American Diabetes Association (ADA guidelines (HbA1c < 7.0%, BP < 140/90 mmHg, and LDL-C < 100 mg/dL and Japan Diabetes Society (JDS guidelines (HbA1c < 7.0%, BP < 130/80 mmHg, and LDL-C < 120 mg/dL. Logistic regression models were used to explore correlates of poor glycemic control (defined as HbA1c ≥ 8.0%.The percentages of participants who met ADA (and JDS targets were 44.9% (44.9% for HbA1c, 76.6% (36.3% for BP, 27.1% (56.2% for LDL-C, and 11.2% (10.8% for simultaneous control of all three risk factors. Younger age, obesity, smoking, and uncontrolled dyslipidemia were associated with poor glycemic control. The adjusted odds ratio of poor glycemic control was 0.58 (95% confidence interval, 0.46-0.73 for participants with treated but uncontrolled hypertension, and 0.47 (0.33-0.66 for participants with treated and controlled hypertension, as compared with participants without hypertension. There was no significant difference in HbA1c levels between participants with treated but uncontrolled hypertension and those with treated and

Significance of family and peer support for metabolic control of type 1 diabetes in adolescents

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Đurović Dušanka

2009-01-01

Full Text Available The aim of the paper was to explore the significance of family and peer support for metabolic control of Type 1 diabetes in adolescents. Metabolic control refers to maintenance of acceptable blood glucose level thus diminishing risk for chronic complications. It involves regular insulin shots, measuring blood glucose and keeping diary, as the daily based self-control. Regular visits to endocrinologist and screening for chronic complications are compulsory. The sample comprised 79 adolescents age 10-17 years with diagnose of Type 1 diabetes and properly treated at the institute. The sample was divided in two groups - with good (N=40 and poor (N=39 metabolic control. A criterium for good metabolic control was glycosilated hemoglobin less than 7,6%. Social support was measured by Social Support Scale consisting of two parts - the first for estimation of registered family support (based upon modified Perceived Social Support Family Scale and the second for estimation of registered friends' support (modified Perceived Social Support Friend Scale. Adolescents with good metabolic control referred statistically more significant social support in the family, unlike the group with poor metabolic control. Considering peer social support, there was no statistically significant difference. Positive family history for diabetes also appeared to be directly linked to good metabolic control.

Periodontal disease and type I diabetes mellitus: Associations with glycemic control and complications

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Ajita Meenawat

2013-01-01

Full Text Available Objective: The aim of the study was to evaluate periodontal health status in patients diagnosed with type 1 diabetes mellitus (DM1 and to establish a correlation between metabolic control and periodontal health status. Materials and Methods: Periodontal health parameters namely plaque index (PI, gingival index (GI, probing pocket depth (PPD and clinical attachment loss (CAL were recorded in 28 patients diagnosed with type 1 diabetes mellitus (DM1 and 20 healthy controls. Diabetes history was recorded based on the information provided by the physician and it included date of diagnosis, duration, age of diagnosis, latest values of glycosylated haemoglobin and existing diabetic complications. Statistical analysis was performed to evaluate the relationship between periodontal parameters and degree of metabolic control, the duration of the disease and the appearance of complications. Results: The periodontal health in the diabetic group was compromised and they had greater bleeding index (P < 0.001, probing pocket depth (P < 0.001 and clinical attachment level (P = 0.001. Patients diagnosed for diabetes for shorter duration of time (4-7 years showed bleeding index-disease severity correlation to be 1.760 ΁ 0.434. Conclusion: Periodontal disease was more evident in type 1 diabetes mellitus patients and periodontal inflammation is greatly increased in subjects with longer disease course, poor metabolic control and diabetic complications.

[Association between central diabetes insipidus and type 2 diabetes mellitus].

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Palumbo, Claudia; Nicolaci, Nora; La Manna, Andrés A; Branek, Natalia; Pissano, María N

2018-01-01

Central diabetes insipidus is a rare disease of the hypothalamus and neurohypophysis. It is very unusually found in the adult with type 2 diabetes mellitus. It is manifested by a polydipsic polyuric syndrome, which must be distinguished from the poorly controlled type 2 diabetes mellitus. Given the similarity of both entities and the unusual nature of their coexistence, their suspicion is difficult. The case of a 72-year-old male with type 2 diabetes mellitus with poor insulin control (fasting hyperglycemia greater than 180 mg/dl) who had a long-standing polyuric syndrome is here presented. Hypernatremia and plasma osmolality elevated together with a low urinary osmolality led to the suspicion of diabetes insipidus, which was subsequently confirmed by the dehydration test and the administration of desmopressin sc. With 61% increase in the calculated urinary osmolarity one hour post desmopressin s.c., diabetes insipidus of central type was diagnosed. Nuclear Magnetic Resonance showed a bright spot with normal neurohypophysis, contributing to the diagnosis of the idiopathic form.

Vulnerability to stress, anxiety and depressive symptoms and metabolic control in Type 2 diabetes

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Gois Carlos

2012-06-01

Full Text Available Abstract Background Vulnerability to stress has been associated to distress, emotional distress symptoms and metabolic control in type 2 diabetes mellitus (T2DM patients as well. Furthermore some conflicting results were noticed. We aimed to evaluate the effect over metabolic control in what concerns vulnerability to stress beyond depressive and anxiety symptoms. Findings This cross-sectional study assessed 273 T2DM patients with depressive and anxiety symptoms using the Hospital Anxiety Depression Scale (HADS and the 23 Questions to assess Vulnerability to Stress (23QVS, along with demographic and clinical diabetes-related variables. Hierarchical logistic regression models were used to investigate predictors of poor glycemic control. The results showed an association of depressive symptoms (odds ratio = 1.12, 95%CI = 1.01-1.24, P = 0.030 with increased risk of poor glycemic control. Anxiety symptoms and vulnerability to stress on their own were not predictive of metabolic control, respectively (odds ratio = 0.92, 95%CI = 0.84-1.00, P = 0.187 and odds ratio = 0.98, 95%CI = 0.95-1.01, P = 0.282. Conclusions Our data suggested that vulnerability to stress was not predictive of poor glycemic control in T2DM, but depressive symptoms were.

The effectiveness of peer health coaching in improving glycemic control among low-income patients with diabetes: protocol for a randomized controlled trial

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Chen Ellen

2011-04-01

Full Text Available Abstract Background Although self-management support improves diabetes outcomes, it is not consistently provided in health care settings strained for time and resources. One proposed solution to personnel and funding shortages is to utilize peer coaches, patients trained to provide diabetes education and support to other patients. Coaches share similar experiences about living with diabetes and are able to reach patients within and beyond the health care setting. Given the limited body of evidence that demonstrates peer coaching significantly improves chronic disease care, this present study examines the impact of peer coaching delivered in a primary care setting on diabetes outcomes. Methods/Design The aim of this multicenter, randomized control trial is to evaluate the effectiveness of utilizing peer coaches to improve clinical outcomes and self-management skills in low-income patients with poorly controlled diabetes. A total of 400 patients from six primary health centers based in San Francisco that serve primarily low-income populations will be randomized to receive peer coaching (n = 200 or usual care (n = 200 over 6 months. Patients in the peer coach group receive coaching from patients with diabetes who are trained and mentored as peer coaches. The primary outcome is change in HbA1c. Secondary outcomes include change in: systolic blood pressure, body mass index (BMI, LDL cholesterol, diabetes self-care activities, medication adherence, diabetes-related quality of life, diabetes self-efficacy, and depression. Clinical values (HbA1c, LDL cholesterol and blood pressure and self-reported diabetes self-efficacy and self-care activities are measured at baseline and after 6 months for patients and coaches. Peer coaches are also assessed at 12 months. Discussion Patients with diabetes, who are trained as peer health coaches, are uniquely poised to provide diabetes self management support and education to patients. This study is designed to

Tight glycaemic control is a key factor in wound healing enhancement strategies in an experimental diabetes mellitus model.

LENUS (Irish Health Repository)

O'Sullivan, J B

2012-02-01

BACKGROUND: Diabetes mellitus is a leading cause of impaired wound healing. The aim of this study was to establish a glucose-controlled diabetic wound healing model. METHOD: Sprague-Dawley rats were divided into three groups: Control group (C), Diabetic Non-glucose Controlled group (DNC) and Diabetic glucose Controlled group (DC). RESULTS: Glucose control was achieved using Insulman Rapid (average daily glucose level <10 mmol\\/L). 18 Sprague-Dawley rats underwent a dorsal skin wound incision and 10 days later were killed. Fresh and fixed wound tensile strength, hydroxyproline and transforming growth factor beta-1 levels were improved in the DC group when compared to the DNC group. The quantity of fibroblasts present was similar in each group. CONCLUSION: This study demonstrates the impact that diabetes has on acute wound healing and suggests that wound modulating agents must be tested in both the tightly glucose-controlled as well as the poorly glucose-controlled diabetic animal models prior to proceeding with translational clinical studies.

Treatment of Type 2 diabetes mellitus in Chongqing of China: unaffordable care for the poor.

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Long, Q; He, M; Tang, X; Allotey, P; Tang, S

2017-01-01

This study aims to investigate the medical expenditure of people with Type 2 diabetes mellitus in Chongqing, China; to explore factors that contribute to the expenditure; and to examine the financial burden placed on households, particularly poor households. A cross sectional survey was conducted with a sample of people diagnosed with Type 2 diabetes mellitus in 2014. Of the 664 people eligible, 76% were interviewed. Descriptive statistics and log-linear regression were used to examine respondents' age, sex and level education, location of residence, income and type of health insurance associated with out-of-pocket expenditure on accessing diabetes mellitus care. In a year, average out-of-pocket expenditure on the purchase of drugs from pharmacies and having outpatient care were US $333 and US $310, respectively. The average out-of-pocket expenditure on accessing inpatient care was 3.7 times (US $1159) that of accessing outpatient care. After adjusting for age and sex, out-of-pocket expenditure on diabetes care was significantly higher for people covered by the Urban Employee Basic Medical Insurance programme and those enrolled in the identified priority diseases reimbursement programme, which provided higher reimbursement rates for outpatient and (or) inpatient care. Out-of-pocket expenditures on the purchase of drugs from pharmacies, having outpatient and inpatient care, respectively, were 9.8%, 16.2% and 62.6% of annual household income in low-income group. Even with health insurance coverage, poor people with Type 2 diabetes mellitus suffered from significant financial hardship. This has significant implications for models of care and healthcare financing in China with the growing burden of diabetes. © 2016 Diabetes UK.

Monitoring of Individual Needs in Diabetes (MIND)-2

DEFF Research Database (Denmark)

Snoek, Frank J; Kersch, Nancy Y A; Eldrup, Ebbe

2012-01-01

To test the effects of implementing computer-assisted Monitoring of Individual Needs in Diabetes (MIND) in routine diabetes care on psychological status and glycemic control, identify predictors of poor psychological outcomes, and evaluate care providers' experiences.......To test the effects of implementing computer-assisted Monitoring of Individual Needs in Diabetes (MIND) in routine diabetes care on psychological status and glycemic control, identify predictors of poor psychological outcomes, and evaluate care providers' experiences....

Evaluation of glycemic control in patients with type 2 diabetes mellitus in Chinese communities: a cross-sectional study.

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Shan, Shan; Gu, Liubao; Lou, Qinglin; Ouyang, Xiaojun; Yu, Yun; Wu, Haidi; Bian, Rongwen

2017-02-01

This study aimed to evaluate the glycemic levels in Chinese patients with type 2 diabetes mellitus (T2DM) and to explore the factors related to the results of glycemic control. A total of 2454 T2DM patients from 11 communities were examined for glycosylated hemoglobin levels and glycemic control options. Potential factors related to the results of glycemic control were analyzed using logistic regression. Of all the patients, 55.3 % achieved the glycemic control target of HbA1c 1.345, 95 % CI 1.022-1.769; P = 0.034), higher levels of fasting blood glucose (OR 1.954, 95 % CI 1.778-2.147; P 1), and low-density lipoprotein cholesterol (OR 1.181, 95 % CI 1.020-1.367; P = 0.026) were significantly associated with poor glycemic control. The complexity of antidiabetics was also associated with poor glycemic control (P insulin injection was most strongly associated with poor glycemic control (OR 6.210, 95 % CI 4.054-9.514; P 1). Male patients with higher levels of total cholesterol, lower levels of high-density lipoprotein cholesterol, or longer diabetic durations showed poor glycemic control, which was not found in female patients. Glycemic control was not satisfactory in T2DM patients of Nanjing communities. Various factors are associated with poor results of glycemic control.

Penile gangrene in diabetes mellitus with renal failure: A poor prognostic sign of systemic vascular calciphylaxis

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Mayank Mohan Agarwal

2007-01-01

Full Text Available Penile gangrene associated with chronic renal failure is very uncommon. A 52-year-old man with diabetes mellitus, diffuse atherosclerosis, ischemic cardiomyopathy and end-stage renal disease presented with blackening of distal penis for 10 days. His general condition was poor and gangrene of prepuce and glans was noted. Doppler and magnetic-resonance angiography revealed bilateral internal iliac artery obstruction. He underwent trocar suprapubic cystostomy and was planned for partial penectomy. But he died of severe diabetic complications in the interim period. Penile gangrene is a manifestation of widespread vascular calcifications associated with end-stage renal disease and is a marker of poor prognosis.

One too many diabetes: the combination of hyperglycaemic hyperosmolar state and central diabetes insipidus.

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Burmazovic, Snezana; Henzen, Christoph; Brander, Lukas; Cioccari, Luca

2018-01-01

The combination of hyperosmolar hyperglycaemic state and central diabetes insipidus is unusual and poses unique diagnostic and therapeutic challenges for clinicians. In a patient with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology that is considered, and achieving glycaemic control remains the first course of action. However, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and urine osmolality suggest concurrent symptomatic diabetes insipidus. We report a rare case of concurrent manifestation of hyperosmolar hyperglycaemic state and central diabetes insipidus in a patient with a history of craniopharyngioma. In patients with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology to be considered.However, a history of craniopharyngioma, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and osmolality provide evidence of concurrent diabetes insipidus.Therefore, if a patient with diabetes mellitus presents with severe hypernatraemia, hyperglycaemia, a low or low normal urinary-specific gravity and worsening polyuria despite correction of hyperglycaemia, concurrent diabetes insipidus should be sought.

Prevalence and Risk Factors of Diabetic Nephropathy in Omani Type 2 Diabetics in Al-Dakhiliyah Region

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Abdulhakeem Hamood Alrawahi

2012-05-01

Full Text Available Objective: To assess the prevalence and risk factors of diabetic nephropathy among Omani type 2 diabetics in Al-Dakhiliyah region of the Sultanate of Oman.Methods: A cross-sectional and a case control study designs were used to assess the prevalence and risk factors respectively. For the prevalence study a sample of 699 diabetic subjects were selected randomly from two polyclinics in Al-Dakhiliyah region; Sumail and Nizwa polyclinics. For the case control study, a sample consisting of 215 cases and 358 controls were randomly selected from those who were included in the cross-sectional study. A well designed questionnaire has been used to collect data regarding the disease and risk factors. Data was analyzed using SPSS19 statistical program.Results: Total prevalence of diabetic nephropathy was calculated as 42.5% (95% C.I: 38.83% - 46.15%. The difference in the prevalence in the two polyclinic catchment area was not significant. The prevalence was significantly higher among males (51.6% compared to females (36.5%. Crude analysis of the risk factors showed significant association between diabetic nephropathy and the following factors; male gender, decreased literacy, long duration of diabetes mellitus, hypertension, retinopathy, neuropathy, family history of diabetic nephropathy, poor glycemic control (high HbA1c, and hypertriglyceridemia. Multivariate analysis showed the following factors to be independent risk factors; male gender, decreased literacy, long duration of diabetes, family history of diabetic nephropathy and poor glycaemic control (high HbA1c.Conclusion: The prevalence of diabetic nephropathy in this study was 42.5% and the significant risk factors associated with it included male gender, decreased literacy, long duration of diabetes, family history of diabetic nephropathy and poor glycemic control (high HbA1c.

A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients.

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Eissa, Iman M; Khalil, Noha M; El-Gendy, Heba A

2016-01-01

Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P = 0.002), with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability. Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

Prevalence, awareness, treatment and control of diabetes mellitus in rural China: results from Shandong Province.

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Yang, F; Qian, D; Chen, J; Hu, D; Hou, M; Chen, S; Wang, P

2016-04-01

To estimate the prevalence, awareness, treatment and control of diabetes in rural areas in Shandong Province, China. The Luxemburg-WHO-Shandong Project on Rural Health Personnel Training and Chronic Disease Control, a cross-sectional study, examined 16 375 rural residents aged 25 years and over using multistage cluster sampling in April 2007. An overnight fasting blood specimen was collected to measure plasma glucose and a 2-h 75-g oral glucose tolerance test was conducted among people with a fasting blood glucose of ≥ 6.1 mmol/l. Information on the history of diabetes and hypoglycaemic medication was obtained using a standard questionnaire. Diabetes and prediabetes were defined according to the 1999 World Health Organization diagnostic criteria. Overall, the prevalence rates for diabetes, prediabetes and previously diagnosed diabetes in the rural population were estimated to be 3.5%, 6.0% and 1.2%, respectively. Among those with diabetes, only 34.8% were aware of their condition, 30.6% were currently undergoing medication treatment, and 11.5% achieved glycaemic control. These results indicate that diabetes has become a public health problem in poor rural areas of China and the rates of awareness, treatment and control of diabetes were relatively low. There is an urgent need for strategies aimed at the prevention and treatment of diabetes in the rural population in Shandong Province, China. © 2015 Diabetes UK.

Glycaemic Control and Associated Self-Management Behaviours in Diabetic Outpatients: A Hospital Based Observation Study in Lusaka, Zambia

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Emmanuel Mwila Musenge

2016-01-01

Full Text Available Background. The control of diabetes mellitus depends on several factors that also include individual lifestyles. We assessed glycaemic control status and self-management behaviours that may influence glycaemic control among diabetic outpatients. Methods. This cross-sectional study among 198 consenting randomly selected patients was conducted at the University Teaching Hospital diabetic clinic between September and December 2013 in Lusaka, Zambia. A structured interview schedule was used to collect data on demographic characteristics, self-management behaviours, and laboratory measurements. Binary logistic regression analysis using IBM SPSS for Windows version 20.0 was carried out to predict behaviours that were associated with glycaemic control status. Results. The proportion of patients that had good glycaemic control status (HbA1c≤ 48 mmol/mol was 38.7% compared to 61.3% that had poor glycaemic control status (HbA1c≥ 49 mmol/mol. Adherence to antidiabetic treatment and fasting plasma glucose predicted glycaemic control status of the patients. However, self-blood glucose monitoring, self-blood glucose monitoring means and exercise did not predict glycaemic control status of the patients.  Conclusion. We find evidence of poor glycaemic control status among most diabetic patients suggesting that health promotion messages need to take into account both individual and community factors to promote behaviours likely to reduce nonadherence.

Viscoelasticity as a measurement of clot structure in poorly controlled type 2 diabetes patients: towards a precision and personalized medicine approach.

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Pretorius, Etheresia; Bester, Janette

2016-08-09

Type 2 diabetes patients (T2D) have a considerably higher cardiovascular risk, which is closely associated with systemic inflammation, and an accompanying pathologic coagulation system. Due to the complexity of the diabetic profile, we suggest that we need to look at each patient individually and particularly at his or her clotting profile; as the healthiness of the coagulation system gives us an indication of the success of clinical intervention. T2D coagulability varied markedly, although there were no clear difference in medication use and the standards of HbA1c levels. Our sample consisted of 90 poorly controlled T2D and 71 healthy individuals. We investigated the medication use and standards of HbA1c levels of T2D and we used thromboelastography (TEG) and scanning electron microscopy (SEM) to study their clot formation. The latest NIH guidelines suggest that clinical medicine should focus on precision medicine, and the current broad understanding is that precision medicine may in future, provide personalized targets for preventative and therapeutic interventions. Here we suggest a practical example where TEG can be used as an easily accessible point-of-care tool to establish a comprehensive clotting profile analysis for T2D patients; and additionally may provide valuable information that may be used in the envisaged precision medicine approach. Only by closely following each individual patient's progress and healthiness and thereby managing systemic inflammation, will we be able to reduce this pandemic.

Rationale and design of the Miami Healthy Heart Initiative: a randomized controlled study of a community health worker intervention among Latino patients with poorly controlled diabetes

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Carrasquillo O

2014-02-01

Full Text Available Olveen Carrasquillo,1,2 Elizabeth Patberg,1 Yisel Alonzo,1 Hua Li,2 Sonjia Kenya1 1Department of Medicine, 2Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA Background: Type 2 diabetes mellitus disproportionately affects the Latino community. Latinos with diabetes are also less likely to have adequate control of cardiovascular risk factors such as cholesterol and blood pressure. Community health workers (CHWs are increasingly being used to address various health disparity conditions, including diabetes. However, evidence of their effectiveness from randomized controlled trials is limited. Methods: The Miami Health Heart Initiative is a randomized controlled trial of 300 Latino patients with diabetes. Patients with hemoglobin A1c (HbA1c ≥8.0% were recruited from Miami-Dade's public hospital system. At baseline, all patients underwent phlebotomy, physical examination, and a structured 90-minute research interview. They were then randomized to either usual care or a CHW intervention called Cariño. For participants in the Cariño arm of the study, CHW services included assistance with nonmedical social services, health education, and patient navigation in which the CHWs serve as a bridge between patients and the health care system. These services were delivered through home visits, phone calls, and group visits. At 12 months, all subjects had a follow-up examination. The primary outcomes at 1 year are changes in systolic blood pressure, low-density lipoprotein, and HbA1c. Secondary outcomes include medication adherence, medication intensification, diabetes self-efficacy, physical activity, and self-reported fruit and vegetable intake. Discussion: The Miami Healthy Heart Initiative is one of the first rigorously conducted randomized controlled trials to provide evidence on the impact of CHWs on diabetes intermediate outcomes among Latinos. If the data support our primary hypotheses, the study would lend added

[Metabolic parameters in patients with steatosis non alcoholic liver and controlled diabetes type 2 versus uncontrolled diabetes type 2].

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Miranda Manrique, Gonzalo

2016-01-01

Non-alcoholic fatty liver (NASH) is widely distributed around the world and is more common in subjects with dyslipidemia, metabolic syndrome obese and DM2 (34-74%). However, the prevalence of cirrhosis by NASH in general population is unknown which is still subject of research. To determine if there are significant differences between metabolic parameters of non-alcoholic fatty liver in controlled versus uncontrolled diabetes type 2 of recent diagnosis. retrospective case-control study, performed in the Hospital Guillermo Almenara Irigoyen, Lima, Peru from November 2014 to February 2015.This study included 231 patients: 147 patients (NASH with DM2 of recent diagnosis and poor control) and 84 patients (NASH with DM2 ofrecent diagnosis and adequate control). Levene test for evaluating homogeneity of variances intra groups and parametric test for independent samples. After applying Levene test of homogeneity and student test, significant metabolic parameters were the triglycerides, HbA1C level, metformin dose and gender. It is important in diabetic patients to diagnose NASH early for a tighter control, not only of glucose but other metabolic parameters mainly triglycerides which strongly supports existing concept of "multiple hits" which considers NASH affects glucose homeostasis, and it could be the starting point of new research to improve interventions for decreasing progression from to cirrhosis in diabetic patients and also to delay progression of diabetes mellitus in patients with non alcoholic steatohepatitis.

Association between central diabetes insipidus and type 2 diabetes mellitus

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Claudia Palumbo

2018-04-01

Full Text Available Central diabetes insipidus is a rare disease of the hypothalamus and neurohypophysis. It is very unusually found in the adult with type 2 diabetes mellitus. It is manifested by a polydipsic polyuric syndrome, which must be distinguished from the poorly controlled type 2 diabetes mellitus. Given the similarity of both entities and the unusual nature of their coexistence, their suspicion is difficult. The case of a 72-year-old male with type 2 diabetes mellitus with poor insulin control (fasting hyperglycemia greater than 180 mg/dl who had a long-standing polyuric syndrome is here presented. Hypernatremia and plasma osmolality elevated together with a low urinary osmolality led to the suspicion of diabetes insipidus, which was subsequently confirmed by the dehydration test and the administration of desmopressin sc. With 61% increase in the calculated urinary osmolarity one hour post desmopressin s.c., diabetes insipidus of central type was diagnosed. Nuclear Magnetic Resonance showed a bright spot with normal neurohypophysis, contributing to the diagnosis of the idiopathic form.

Comorbidity of Depression and Anxiety: Association with Poor Quality of Life in Type 1 and 2 Diabetic Patients

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de Ornelas Maia, Ana Claudia C.; Braga, Arthur de Azevedo; Paes, Flávia; Machado, Sergio; Carta, Mauro Giovanni; Nardi, Antonio Egidio; Silva, Adriana Cardoso

2013-01-01

Background: Diabetes is associates with depression and impairment in Quality of Life (QoL). Objective: The objective is to define the frequencies of depressive and anxiety symptoms in a sample of patients diagnosed with type 1 and 2 diabetes, the amount of impairment of QoL and the weight of depression and anxiety in determining the QoL in such of patients. Methods: A total of 210 patients were divided into two groups (type 1 and type 2). Patients completed the HADS and WHOQoL-bref. Results: Groups showed a high prevalence of anxiety (type 1 = 60%, type 2 = 43.8%) and depression (type 1 = 52.4%, type 2 = 38.1%), both measures were significantly higher (p < 0.05) in diabetes type 1 patients. Type 1 patients also showed a QoL in the overall assessment and the physical, psychological and social relations domains. In both Type 1 and 2 diabetes poor QoL was found associated by anxiety and depression comorbidity. Conclusion: In overall diabetes patients depression and anxiety seems to be a determinant of poor QoL. PMID:23935696

Self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control.

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Tan, Ming Yeong; Magarey, Judy

2008-08-01

To investigate the self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. Using a one-to-one interviewing approach, data were collected from 126 diabetic adults from four settings. A 75-item questionnaire was used to assess diabetes-related knowledge and self-care practices regarding, diet, medication, physical activity and self-monitoring of blood glucose (SMBG). Most subjects had received advice on the importance of self-care in the management of their diabetes and recognised its importance. Sixty-seven subjects (53%) scored below 50% in their diabetes-related knowledge. Subjects who consumed more meals per day (80%), or who did not include their regular sweetened food intakes in their daily meal plan (80%), or who were inactive in daily life (54%), had higher mean fasting blood glucose levels (p=0.04). Subjects with medication non-adherence (46%) also tended to have higher fasting blood glucose levels. Only 15% of the subjects practiced SMBG. Predictors of knowledge deficit and poor self-care were low level of education (p = <0.01), older subjects (p=0.04) and Type 2 diabetes subjects on oral anti-hyperglycaemic medication (p = <0.01). There were diabetes-related knowledge deficits and inadequate self-care practices among the majority of diabetic patients with sub-optimal glycaemic control. This study should contribute to the development of effective education strategies to promote health for adults with sub-optimal diabetes control.

Type 2 diabetes detection and management among insured adults.

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Dall, Timothy M; Yang, Weyna; Halder, Pragna; Franz, Jerry; Byrne, Erin; Semilla, April P; Chakrabarti, Ritashree; Stuart, Bruce

2016-01-01

The Centers for Disease Control and Prevention estimates that 28.9 million adults had diabetes in 2012 in the US, though many patients are undiagnosed or not managing their condition. This study provides US national and state estimates of insured adults with type 2 diabetes who are diagnosed, receiving exams and medication, managing glycemic levels, with diabetes complications, and their health expenditures. Such information can be used for benchmarking and to identify gaps in diabetes detection and management. The study combines analysis of survey data with medical claims analysis for the commercially insured, Medicare, and Medicaid populations to estimate the number of adults with diagnosed type 2 diabetes and undiagnosed diabetes by insurance type, age, and sex. Medical claims analysis used the 2012 de-identified Normative Health Information database covering a nationally representative commercially insured population, the 2011 Medicare 5% Sample, and the 2008 Medicaid Mini-Max. Among insured adults in 2012, approximately 16.9 million had diagnosed type 2 diabetes, 1.45 million had diagnosed type 1 diabetes, and 6.9 million had undiagnosed diabetes. Of those with diagnosed type 2, approximately 13.0 million (77%) received diabetes medication-ranging from 70% in New Jersey to 82% in Utah. Suboptimal percentages had claims indicating recommended exams were performed. Of those receiving diabetes medication, 43% (5.6 million) had medical claims indicating poorly controlled diabetes-ranging from 29% with poor control in Minnesota and Iowa to 53% in Texas. Poor control was correlated with higher prevalence of neurological complications (+14%), renal complications (+14%), and peripheral vascular disease (+11%). Patients with poor control averaged $4,860 higher average annual health care expenditures-ranging from $6,680 for commercially insured patients to $4,360 for Medicaid and $3,430 for Medicare patients. This study highlights the large number of insured adults with

How best to use partial meal replacement in managing overweight or obese patients with poorly controlled type 2 diabetes.

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Leader, Natasha J; Ryan, Lynne; Molyneaux, Lynda; Yue, Dennis K

2013-02-01

To compare patient compliance and benefits, over 12 months, of 1 versus 2 partial meal replacement (PMR) for the management of overweight/obese subjects with inadequately controlled type 2 diabetes. Thirty-six overweight patients with inadequately controlled type 2 diabetes (BMI > 27 kg/m(2) and HbA1c > 7.5% [58 mmol/mol]) were randomized to receive 1 or 2 PMR/day, while maintaining usual lifestyle. Subjects were seen monthly and adjustment of medications was made to prevent hypoglycemia. Compliance was assessed by counting unused sachets. Patients on 2 PMR/day lost almost 4 kg compared with only 0.5 kg in the 1 PMR/day group. This difference was statistically significant (P meal replacement. Reductions in weight, waist, and HbA1c were better in the 2 PMR/day group while patient dropout and compliance were not worse over a 12-month period. PMR provides a further management option for overweight/obese individuals with type 2 diabetes. The initial recommendation should be 2 PMR/day. Copyright © 2012 The Obesity Society.

Musculoskeletal manifestations in type 2 diabetes mellitus

OpenAIRE

Deepti P. Deshmukh; Asmita G. Akarte

2017-01-01

Background: Musculoskeletal complications of diabetes have been generally ignored and poorly treated as compared to other complications. Hence we carried out this study to find the prevalence of musculoskeletal manifestations in type II diabetes mellitus and its correlation with age, BMI, duration of diabetes, and control of diabetes. Methods: 100 consecutive patients of type II diabetes were studied. Duration of diabetes, control of diabetes, and any musculoskeletal complaints were noted....

A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients

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Iman M. Eissa

2016-01-01

Full Text Available Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P=0.002, with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability. Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

Diabetes: Models, Signals and control

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Cobelli, C.

2010-07-01

Diabetes and its complications impose significant economic consequences on individuals, families, health systems, and countries. The control of diabetes is an interdisciplinary endeavor, which includes significant components of modeling, signal processing and control. Models: first, I will discuss the minimal (coarse) models which describe the key components of the system functionality and are capable of measuring crucial processes of glucose metabolism and insulin control in health and diabetes; then, the maximal (fine-grain) models which include comprehensively all available knowledge about system functionality and are capable to simulate the glucose-insulin system in diabetes, thus making it possible to create simulation scenarios whereby cost effective experiments can be conducted in silico to assess the efficacy of various treatment strategies - in particular I will focus on the first in silico simulation model accepted by FDA as a substitute to animal trials in the quest for optimal diabetes control. Signals: I will review metabolic monitoring, with a particular emphasis on the new continuous glucose sensors, on the crucial role of models to enhance the interpretation of their time-series signals, and on the opportunities that they present for automation of diabetes control. Control: I will review control strategies that have been successfully employed in vivo or in silico, presenting a promise for the development of a future artificial pancreas and, in particular, I will discuss a modular architecture for building closed-loop control systems, including insulin delivery and patient safety supervision layers.

Glycemic control and alveolar bone loss progression in type 2 diabetes.

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Taylor, G W; Burt, B A; Becker, M P; Genco, R J; Shlossman, M

1998-07-01

This study tested the hypothesis that the risk for alveolar bone loss is greater, and bone loss progression more severe, for subjects with poorly controlled (PC) type 2 diabetes mellitus (type 2 DM) compared to those without type 2 DM or with better controlled (BC) type 2 DM. The PC group had glycosylated hemoglobin (HbA1) > or = 9%; the BC group had HbA1 or = 75% were used to identify the worst bone score (WBS) in the dentition. Change in worst bone score at follow-up, the outcome, was specified on a 4-category ordinal scale as no change, or a 1-, 2-, 3-, or 4-category increase over baseline WBS (WBS1). Poorly controlled diabetes, age, calculus, time to follow-up examination, and WBS1 were statistically significant explanatory variables in ordinal logistic regression models. Poorly controlled type 2 DM was positively associated with greater risk for a change in bone score (compared to subjects without type 2 DM) when the covariates were included in the model. The cumulative odds ratio (COR) at each threshold of the ordered response was 11.4 (95% CI = 2.5, 53.3). When contrasted with subjects with BC type 2 DM, the COR for those in the PC group was 5.3 (95% CI = 0.8, 53.3). The COR for subjects with BC type 2 DM was 2.2 (95% CI = 0.7, 6.5), when contrasted to those without type 2 DM. These results suggest that poorer glycemic control leads to both an increased risk for alveolar bone loss and more severe progression over those without type 2 DM, and that there may be a gradient, with the risk for bone loss progression for those with better controlled type 2 DM intermediate to the other 2 groups.

Presence of neuropathic pain may explain poor performances on olfactory testing in diabetes mellitus patients.

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Brady, Shauna; Lalli, Paul; Midha, Nisha; Chan, Ayechen; Garven, Alexandra; Chan, Cynthia; Toth, Cory

2013-07-01

Olfactory dysfunction in neurodegenerative conditions such as Parkinson's syndrome and Alzheimer's disease can hallmark disease onset. We hypothesized that patients with diabetes mellitus, a condition featuring peripheral and central neurodegeneration, would have decreased olfaction abilities. We examined participants with diabetic peripheral neuropathy, participants with diabetes without diabetic peripheral neuropathy, and control participants in blinded fashion using standardized Sniffin' Sticks. Diabetic peripheral neuropathy severity was quantified using the Utah Early Neuropathy Scale. Further subcategorization of diabetic peripheral neuropathy based on presence of neuropathic pain was performed with Douleur Neuropathique 4 Questionnaires. Participants with diabetes had decreased olfactory sensitivity, impaired olfactory discrimination abilities, and reduced odor identification skills when compared with controls. However, loss of olfaction ability was, at least partially, attributed to presence of neuropathic pain on subcategory assessment, although pain severity was not associated with dysfunction. Those participants with diabetes without diabetic peripheral neuropathy and those with diabetic peripheral neuropathy without neuropathic pain had similar olfactory function as controls in general. The presence of neuropathic pain, associated with limited attention and concentration, may explain at least a portion of the olfactory dysfunction witnessed in the diabetic patient population.

Dental caries and salivary status in children with type 1 diabetes mellitus, related to the metabolic control of the disease.

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Siudikiene, Jolanta; Machiulskiene, Vita; Nyvad, Bente; Tenovuo, Jorma; Nedzelskiene, Irena

2006-02-01

The aim of this study was to investigate the relationship among type 1 diabetes mellitus, dental caries, and salivary status in children. The study comprised 68, 10-15-yr-old diabetics, and 68, age- and gender-matched non-diabetic controls. Diabetics were categorized into well-to-moderately controlled (HbA1c or= 9.0%) groups. Caries was recorded by assessing lesion activity at non-cavitated and cavity levels. Teeth were examined visually for the presence of dental plaque. Saliva was analyzed for unstimulated and stimulated flow rates, buffer effect, mutans streptococci, lactobacilli, and yeasts. Diabetics had fewer caries and plaque, lower salivary flow rates and buffer effect, and more frequent growth of yeasts than their non-diabetic controls. Well-to-moderately controlled diabetics had fewer decayed surfaces and lower counts of mutans streptococci and yeasts than poorly controlled diabetics, but the level of metabolic control of diabetes had no influence on salivary flow rates and buffer effect. High caries levels in diabetics were significantly associated with age, plaque score, and decreased unstimulated salivary flow rate, but were not associated with the level of metabolic control of diabetes. High caries experience in this study population could be related to plaque accumulation and/or to changes in saliva induced by diabetes mellitus.

Monthly use of a real-time continuous glucose monitoring system as an educational and motivational tool for poorly controlled type 1 diabetes adolescents.

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Głowińska-Olszewska, B; Tobiaszewska, M; Łuczyński, W; Bossowski, A

2013-01-01

Experience with the use of real-time continuous glucose monitoring systems (RT-CGMS) in teenagers with type 1 diabetes mellitus (T1DM) is limited. We aimed to assess the possibility of glycaemic control improvement and to characterize the group of adolescents, who may gain long-term benefits from the use of the RT-CGMS. Forty T1DM patients, aged 14.6 ± 2.1 years, with diabetes duration 7.4 ± 3.6 years and initial HbA₁c 9.3 ± 1.5% were recruited. The analysis was based on one-month glucose sensors use, combined with the thorough family support. Patients were analysed in groups according to baseline HbA₁c: below and above 7.5%, and 10.0%. Comparison between patients with or without improvement in HbA₁c after 3-month follow-up was also performed. Patients' satisfaction based on the questionnaire was assessed. HbA₁c level in entire study group decreased after three months, from 9.3 ± 1.0% to 8.8 ± 1.6% (P10% did not achieve significant improvement: 11.2 ± 0.5% vs. 10.9 ± 1.1 (P=0.06). In satisfaction questionnaire the lowest scores (negative opinion) were reported by group of patients with initial HbA₁c above 10%, while the highest scores (positive opinion) were found in the group with improvement of HbA₁c after 3 month follow-up. Short-term use of CGMS RT, united with satisfaction questionnaire, performed in poorly controlled teenagers with T1DM, can be useful in defining the group of young patients, who can benefit from long-term CGMS RT use in metabolic control improvement.

Glycaemic control and quality of life among ethnically diverse Malaysian diabetic patients.

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Daher, Aqil Mohammad; AlMashoor, Syed Ahmad H; Winn, Than

2015-04-01

To assess the relationship between glycaemic control and quality of life (QoL) among a sample of Malaysians with type 2 diabetes mellitus. This study is a cross-sectional hospital-based study involving 256 patients from three major ethnic groups in Malaysia. Data about QoL were collected with the 18-item Audit of Diabetes Dependent QoL questionnaire. Other data about putative predictors of QoL including personal characteristics and disease-related factors were also collected. Hierarchical multiple linear regression was used to determine factors associated with QoL and to control for confounding variables. The mean age of participants was 56.79 years. Participants were mostly women, employed and married and had attained secondary education. More than a third of the patients had a disease duration of more than 10 years, and about two-thirds had HbA1c ≥ 6.5 %. Those with desired glycaemic control had poorer QoL than those with less than desired glycaemic control moderated by the use of insulin. Hierarchical multiple linear regression showed that desired glycaemic control (HbA1c), diabetes worry, use of insulin, more than 10 years' duration of diabetes, neuropathy and retinopathy were associated with poor QoL, whereas being satisfied with waiting time for consultation was associated with better QoL. The results of this study show that diabetes was associated with negative impact on quality of life. The use of insulin to achieve desired glycaemic control was particularly associated with negative impact on QoL.

Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners.

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Paul, Christine L; Piterman, Leon; Shaw, Jonathan E; Kirby, Catherine; Forshaw, Kristy L; Robinson, Jennifer; Thepwongsa, Isaraporn; Sanson-Fisher, Robert W

2017-03-23

In Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control. Trial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period. Eleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued. There is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented. Australian New Zealand Clinical Trials

Drug Non-Adherence in Type 2 Diabetes Mellitus: Predictors and Associations

International Nuclear Information System (INIS)

Shams, N.; Ahmed, W.; Kumar, N.; Saleem, F.

2016-01-01

Background: Diabetes being a serious health issue faced by developing countries with drug adherence having pivot role for recommended glycaemic target. This study aims to determine drug non-adherence in type 2 diabetics and its predictors and associations. Methods: This cross sectional study was conducted after ethical approval at Medicine Dept. Rawal Institute of Health Sciences Islamabad over 10 months duration. Demographic details, duration of diabetes, education, socioeconomic class, glycaemic control, mode of anti-diabetic therapy, number of medications and other modes of therapy documented. Michigan Diabetes Knowledge Questionnaire applied with outcome as good, acceptable and poor knowledge. Drug adherence was assessed by Morisky Medication Adherence Scale (non-adherence at <6 points). Data analysed via SPSS version 17 with significant p-value <0.05. Results: Among 183 diabetics there were 43 (23.5 percent) males and 140 (76.5 percent) females. Mean age was 56.6±10.6 years and mean duration of diabetes 8.4±6.57 years. One hundred and fourteen (62 percent) cases were non-adherent. Diabetes knowledge was poor in 76 (41.5 percent), acceptable in 76 (41.5 percent) and good in 31 (16.9 percent). Un-satisfactory glycaemic control present in 149 (81.4 percent). Non-adherence was found to be associated with poor glycaemic control, poor dietary adherence, poly-pharmacy, illiteracy, practicing other modes of therapy and poor diabetes knowledge (p<0.05). Conclusion: Non-adherence to medication in type 2 diabetics needs to be addressed. Suggested contributory factors are illiteracy, practicing other modes of therapy, poor diabetes knowledge and poly-pharmacy. Public awareness programs, self-monitoring of blood sugars, regular follow-up visits with focus at patient education may improve glycaemic control and diabetes related complications. (author)

Islamic Fasting and Diabetes

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Fereidoun Azizi

2013-07-01

Full Text Available The aim of this article is to review health-related aspects of Ramadan fasting in normal individuals and diabetics. During fasting days of Ramadan, glucose homeostasis is maintained by meal taken bepore dawn and by liver glycogen stores. Changes in serum lipids are variable and defend on the quality and quantity of food consumption and changes in weight. Compliant, well controlled type 2 diabetics may observe Ramadan fasting; but fasting is not recommended for type 1, non complaint, poorly controlled and pregnant diabetics. Although Ramadan fasting is safe for all healthy individuals and well controlled diabetics, those with uncontrolled diabetics and diabetics with complications should consult physicians and follow scientific recommendations.

Outcomes of glycemic control in Hispanic geriatric diabetic patients admitted to a general ward community hospital in Puerto Rico.

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Maldonado-Rodríguez, Miguel; Pérez-López, Shirley; Torres-Torres, Nancy; Torres-Semprit, Erick; Millán-Aponte, Ismenio

2012-01-01

Diabetes mellitus is one of the most prevalent medical conditions among the Hispanic population. Although studies with patients in intensive care units have shown poor outcomes among those with uncontrolled glucose, more recent data have shown increased mortality associated with a tighter inpatient glucose control. In view of the lack of information regarding geriatric Hispanic patients with diabetes this study evaluated the effect of glucose control in the outcomes of this population in a community hospital in Puerto Rico. Through analysis of data from a previous study we evaluated 502 admissions of Hispanic geriatric patients with diabetes as comorbidity, for glucose control, management of diabetes and outcome. Data was stratified by age groups (65-74 years, 75-84 years and > or = 85 years) and outcomes were compared between the groups using chi-square and odds ratio. The most common admission diagnosis was pneumonia. Hypoglycemia was the most common complication and was associated with tighter glucose control in the age group of 75-84 years. An increased risk of having an acute coronary syndrome/acute myocardial infarction among uncontrolled patients was observed in the 75-84 year old group. Finally, although we found a high prevalence of uncontrolled blood glucose, only 54% of the patients received interventions for their glucose control. Poor glucose control seems to be associated with a tendency for decreased risk of hypoglycemia and higher risk of acute coronary syndrome/acute myocardial infarction as complications among geriatric patients with diabetes admitted to a general ward.

A randomized controlled study to evaluate the effect of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among type 2 diabetes patients: A consort compliant study protocol.

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Bukhsh, Allah; Nawaz, Muhammad Sarfraz; Ahmed, Hafiz Sajjad; Khan, Tahir Mehmood

2018-03-01

Diabetes self-care activities, like, healthy diet, regular exercise, self-monitoring of blood glucose, and rational use of medicines are considered to play a vital role in establishing euglycemia. Health literacy among type 2 diabetes mellitus (T2DM) patients in Pakistan is very low, which is the most likely cause for poor clinical outcomes. This study is designed to investigate the impact of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among T2DM patients in Pakistan. In this randomized controlled trail, effectiveness of a 6-month pharmacist-led educational intervention will be examined on glycemic control, diabetes self-care activities and disease knowledge of 80 adult T2DM patients (age >30 years) with poorly controlled T2DM (HbA1c> 7%), after randomizing them into intervention and control groups, at diabetes care clinic of Capital Hospital Islamabad, Pakistan. The primary outcome is change in patients' HbA1c, whereas, changes in self-care activities and patients' disease knowledge are the secondary outcomes. After baseline assessment of their self-care activities and disease knowledge by using validated Urdu versions of Diabetes Self-management Questionnaire (DSMQ) and Diabetes Knowledge Questionnaire (DKQ), respectively, interventional group patients will be supplemented with a face-to-face pharmacist-led educational intervention, whereas, the control group will receive usual care. Intervention arm patients will be educated successively at their first follow-up visit (12th week) and telephonically after every 4 weeks. All assessments will be made at baseline and end of trail for both intervention and control groups. Multivariate general linear model will be applied to analyze the effects of the intervention. Glycemic control in T2DM patients requires optimum self-care activities. This study is an attempt to improve self-care behaviors among poorly controlled T2DM patients who are at higher risk of

Glycaemic control and associated factors among patients with diabetes at public health clinics in Johor, Malaysia.

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Mahmood, M I; Daud, Faiz; Ismail, Aniza

2016-06-01

To determine the prevalence of glycaemic control and factors associated with poor glycaemic control [glycosylated haemoglobin (HbA1c) ≥6.5%] among patients with type 2 diabetes treated in public health clinics in Johor, Malaysia. Cross-sectional study. A review of all patients aged over 18 years and with a diagnosis of type 2 diabetes for >1 year. The National Diabetic Registry was used as the database for attendees at public health clinics in Johor Bahru between January and December 2013. A required sample of 660 was calculated, and a random sampling method was applied to acquire patient information across the 13 public health clinics in Johor Bahru. All relevant information (e.g. HbA1c, type of treatment and other parameters for glycaemic control) were abstracted from the registry. Sixty-eight percent of 706 patients had HbA1c >6.5%, and mean HbA1c was 7.8%. Younger patients (72.3%) had poorer glycaemic control than older patients (63.0%), and most patients with poor glycaemic control were obese (79.2%). Approximately 31.7% of patients did not achieve the target blood pressure 5 years), body mass index (obese), type of treatment (diet therapy vs combination therapy) and abnormal lipid profile were significantly associated with increased odds of HbA1C >6.5%. More than half (68%) of the patients with diabetes had HbA1c >6.5%. This highlights the importance of providing organized care to manage patients with diabetes in the primary care setting, such as weight reduction programmes, proper prescribing treatment, and age- and gender-specific groups to ensure good glycaemic control. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Weight control behaviors in overweight/obese U.S. adults with diagnosed hypertension and diabetes

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Li Chaoyang

2009-03-01

Full Text Available Abstract Background Obesity is a major risk factor for development and progression of hypertension and diabetes, which often coexist in obese patients. Losing weight by means of energy restriction and physical activity has been effective in preventing and managing these diseases. However, weight control behaviors among overweight/obese adults with these conditions are poorly understood. Methods Using self-reported data from 143,386 overweight/obese participants (aged ≥ 18 years in the 2003 Behavioral Risk Factor Surveillance System, we examined the proportion of overweight/obese adults who tried to lose weight and their weight control strategies by hypertension and/or diabetes status. Results Among all participants, 58% of those with hypertension, 60% of those with diabetes, and 72% of those with both diseases tried to lose weight, significantly higher than the 50% of those with neither condition (Bonferroni corrected P Conclusion The proportion of overweight/obese patients with diagnosed hypertension and/or diabetes who attempted to lose weight remains suboptimal and the weight control strategies varied significantly among these patients.

Menstruation and control of diabetes.

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Walsh, C H; Malins, J M

1977-01-01

Seventy per cent of the patients aged 45 years or under and suffering from diabetic ketoacidosis who were seen in one diabetic clinic over five years were women. The association of menstruation with ketoacidosis was assessed over two and a half years, and it was found that menstruation was associated with ketoacidosis more often than would be expected by chance (P less than 0-01). Two hundred women were interviewed and 76 observed that menstruation changed their diabetic control. Fifty-three found that control deteriorated and hyperglycaemia occurred, while 23 found that control improved and hypoglycaemia was a common problem. Menstruation appears to be an important factor in influencing control of diabetes. The mechanism of the changes observed has not yet been determined, but it seems to be a subject worthy of further investigation. PMID:406008

Managing the diabetic foot in resource-poor settings: challenges and solutions

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Abbas ZG

2017-10-01

Full Text Available Zulfiqarali G Abbas1,2 1Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Internal Medicine, Abbas Medical Centre, Dar es Salaam, Tanzania Abstract: Diabetes mellitus is one of the most common noncommunicable diseases globally. In Africa, rates of diabetes are increasing, so there is a parallel increase of foot complications. Peripheral neuropathy is the main risk factor for foot ulceration in people with diabetes in developing nations, but peripheral arterial disease is also increasing in number owing to the change in lifestyle and increasing urbanization. Ulceration arising from peripheral neuropathy, peripheral arterial disease, and trauma are highly susceptible to secondary infection and gangrene, and are hence associated with increased morbidity and mortality. Government funding is very limited in many developing countries, and diabetes and its complications impose a heavy burden on health services. In particular, the outcomes of foot complications are often poor, and this is the result of various factors including lack of awareness of the need for foot care among patients, relatives, and health care providers; relatively few professionals with an interest in the diabetic foot and with the training to provide specialist treatment; nonexistent podiatry services; long distances for patients to travel to the clinic; delays among patients in seeking medical care, or the late referral of patients for specialist opinion; and lack of the awareness of the importance of a team approach to care, and the lack of training programs for health care professionals. Many of these can, however, potentially be tackled without exorbitant spending of financial resources. Cost-effective educational efforts should be targeted at both health care workers and patients. These include implementation of sustainable training programs for health care professionals with a special interest in foot

Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA1c and spikes of high glucose values in the third trimester

DEFF Research Database (Denmark)

Damm, Peter; Mersebach, Henriette; Råstam, Jacob

2014-01-01

OBJECTIVE: To analyse data from a randomised, controlled study of prandial insulin aspart versus human insulin, both with NPH insulin, in pregnant women with type 1 diabetes for potential factors predicting poor pregnancy outcomes. RESEARCH DESIGN/METHOD: Post hoc analysis including 91 subjects r...

Self-perceived oral health and salivary proteins in children with type 1 diabetes.

Science.gov (United States)

Javed, F; Sundin, U; Altamash, M; Klinge, B; Engström, P-E

2009-01-01

The aim was to validate self-perceived oral health with salivary IgG as an inflammatory parameter in children with type 1 diabetes. Unstimulated whole saliva samples were collected from 36 children with well controlled and 12 with poorly controlled type 1 diabetes and 40 non-diabetic children (Controls). Salivary flow rate, random blood glucose level, salivary protein concentration and immunoglobulin A and G levels were recorded using standard techniques. Data concerning oral health and diabetes status were collected. Self-perceived gingival bleeding (bleeding gums), bad breath and dry mouth were higher in diabetic children when compared with those in controls (P diabetes (P diabetes (P Salivary flow rate was lower in the diabetic children compared to controls (P diabetes. Salivary IgG per mg protein concentration was higher in the diabetics when compared with the control group (P diabetes (P diabetes. Self-perceived gingival bleeding and salivary IgG per mg protein concentration were increased in children with type 1 diabetes compared with controls. These variables were also increased in children with poorly controlled compared with well-controlled type 1 diabetes.

Effectiveness of behavioral change techniques employed in eHealth interventions designed to improve glycemic control in persons with poorly controlled type 2 diabetes: a systematic review and meta-analysis protocol

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Mihiretu Kebede

2017-10-01

Full Text Available Abstract Background The incorporation of Behavioral Change Techniques (BCTs in eHealth interventions for the management of non-communicable diseases (NCDs, such as type 2 diabetes mellitus (T2DM, might be a promising approach to improve clinical and behavioral outcomes of NCDs in the long run. This 3paper reports a protocol for a systematic review that aims to (a identify the effects of individual BCTs in eHealth interventions for lowering glycated hemoglobin levels (HbA1c and (b investigate which additional intervention features (duration of intervention, tailoring, theory-base, and mode of delivery affect levels of HbA1c in this population. The protocol follows the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P 2015 guideline. Methods/design To identify eligible studies, an extensive systematic database search (PubMed, Web of Science, and PsycINFO using keywords will be conducted. This review will include randomized controlled trials examining the effects of eHealth interventions on HbA1c in persons with poorly controlled T2DM over a minimum follow-up period of 3 months. Relevant data will be extracted from the included studies using Microsoft Excel. The content of the interventions will be extracted from the description of interventions and will be classified according to the BCT taxonomy v1 tool. The quality of studies will be independently assessed by two reviewers using the Cochrane risk of bias tool. If the studies have adequate homogeneity, meta-analysis will be considered. The effect sizes of each BCT will be calculated using the random effect model. The quality of the synthesized evidence will be evaluated employing the Grading of the Recommendations Assessment, Development and Evaluation (GRADE criteria. Discussion This systematic review is one of the firsts to appraise the effectiveness of eHealth interventions employing BCTs which aimed at improving glycemic control in persons with poorly

Differential effect of race, education, gender, and language discrimination on glycemic control in adults with type 2 diabetes.

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Reynolds, D Brice; Walker, Rebekah J; Campbell, Jennifer A; Egede, Leonard E

2015-04-01

Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes. Six hundred two patients with type 2 diabetes from two adult primary care clinics in the southeastern United States completed validated questionnaires. Questions included perceived discrimination because of race/ethnicity, level of education, sex/gender, or language. A multiple linear regression model assessed the differential effect of each type of perceived discrimination on glycemic control while adjusting for relevant covariates, including race, site, gender, marital status, duration of diabetes, number of years in school, number of hours worked per week, income, and health status. The mean age was 61.5 years, and the mean duration of diabetes was 12.3 years. Of the sample, 61.6% were men, and 64.9% were non-Hispanic black. In adjusted models, education discrimination remained significantly associated with glycemic control (β=0.47; 95% confidence interval, 0.03, 0.92). Race, gender and language discrimination were not significantly associated with poor glycemic control in either unadjusted or adjusted analyses. Discrimination based on education was found to be significantly associated with poor glycemic control. The findings suggest that education discrimination may be an important social determinant to consider when providing care to patients with type 2 diabetes and should be assessed separate from other types of discrimination, such as that based on race.

Risk factors for diabetic retinopathy in Kuwaiti type 2 diabetic patients

International Nuclear Information System (INIS)

Al-Adsani, Afaf M.S.

2007-01-01

To determine the risk factors associated with diabetic retinopathy in Kuwaiti subjects with type 2 diabetes. Kuwaiti subjects with type 2 diabetes (n=165) attending the Diabetic Clinic at Al-sabah Hospital, Kuwait between October 2000 and March 2005 were screened for diabetic retinopathy. Any diabetic retinopathy was found in 40% while 20.6% had sight threatening retinopathy. Mild NPDR was present in 21.2%, moderate to severe non-proliferative diabetic retinopathy (NPDR) in 7.9%, and proliferative diabetic retinopathy in 3.0%. Maculopathy was present in 10.3% and 7.9 % pf patients were photocoagulated. Compared to those without retinopathy, diabetic patients with any retinopathy were significantly older (51.7+-10.3 versus 47.2+-9.5 years; p<0.005), had longer duration of diabetes (13.1+-6.3 versus 4.7 +-5.4 years; p<0.0001), higher systolic blood pressure (142.9+-23.0 versus 130.3+-20.2; p<0.0001) and poor glycemic control (Hemoglobin A1c=10.1+-2.4 versus 8.9+-2.3; p<0.005). The prevalence of hypertension and nephropathy was significantly higher in patients with any retinopathy than those without retinopathy (70.8% versus 49.5%; p<0.01 and 64.4% versus 30.8%; p<0.0001) respectively. Longer duration of diabetes and presence of nephropathy was the most significant independent factors associated with any retinopathy and sight-threatening retinopathy. Treatment with sulphonylurea or insulin, and poor glycemic control were other significant independent factors associated with any retinopathy. Longer duration of diabetes, presence of nephropathy, glycemic control and mode of treatment were the most significant independent factors of diabetic retinopathy. However, population-based study is warranted to identify the risk factors, as well as the prevalence of diabetic retinopathy. (author)

Erectile dysfunction is a strong predictor of poor quality of life in men with Type 2 diabetes mellitus.

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Malavige, L S; Jayaratne, S D; Kathriarachchi, S T; Sivayogan, S; Ranasinghe, P; Levy, J C

2014-06-01

To identify predictors of poor quality of life among men with diabetes from a comprehensive set of sexual, clinical, socio-economic and lifestyle variables. This was a cross-sectional observational-study of 253 men with Type 2 diabetes, randomly selected from a clinic in Colombo, Sri Lanka. Erectile dysfunction was assessed using the five-item International Index of Erectile Function and quality of life was assessed using the Sri Lankan version of the 36-item short form health survey questionnaire and the disease-specific Psychological Impact of Erectile Dysfunction scale. The presence of premature ejaculation, reduced libido, socio-demographic and lifestyle data was obtained using an interviewer-administered questionnaire. Significant predictors of quality of life were identified by stepwise multivariate linear regression models for short form-36 subscales, summary scales and two scales of Psychological Impact of Erectile Dysfunction. Significant predictors on the physical summary scale of the 36-item short form were erectile dysfunction (β = 7.93, 95% CI 3.70-12.17, P 27.5 kg/m(2) (β = 9.12, 95% CI 1.38-17.44, P strong predictor of poor generic and disease-specific quality of life among other sexual and clinical variables in men with diabetes. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

Association between oral health status and type 2 diabetes mellitus among Sudanese adults: a matched case-control study.

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Hasaan G Mohamed

Full Text Available AIM: The purpose of this study was to compare the clinical and subjective oral health indicators of type 2 diabetic patients (T2DM with age and gender matched non-diabetic controls. A second aim was to identify clinical and subjective oral health indicators that discriminate between well-controlled and poorly controlled T2DM patients as well as between patients with long and short duration of the disease. METHODS: A total of 457 individuals participated in the study (154 T2DM cases and 303 non-diabetic controls. The T2DM group was sub-divided according to metabolic control [(well-controlled: glycosylated haemoglobin test 8%, (poorly controlled: glycosylated haemoglobin test > 8%] and according to duration of T2DM [(long duration: >10 years, (short duration: 10 years]. Participants were interviewed using a structured questionnaire including socio-demographics, lifestyle and oral health related quality of life factors. The clinical examination comprised full mouth probing depths, plaque index, tooth mobility index, furcation involvement and coronal and root surface caries. RESULTS: The T2DM patients presented with more probing depths 4 mm, furcation involvement, tooth mobility, missing teeth, and oral impacts on daily performance (OIDP. The corresponding adjusted odds ratios and their 95% confidence intervals were 4.07 (1.74-9.49, 2.96 (1.36-6.45, 5.90 (2.26-15.39, 0.23 (0.08-0.63 and 3.46 (1.61-7.42, respectively. Moreover, the odds ratio was 2.60 (1.21-5.55 for the poorly controlled T2DM patients to have high levels of mobility index and 2.94 (1.24-6.94 for those with long duration of T2DM to have high decayed, missed and filled teeth (DMFT values. CONCLUSION: This study revealed that chronic periodontitis, tooth mobility, furcation involvement and OIDP were more prevalent among T2DM patients compared to their non-diabetic controls.

Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control.

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Armour, Carol L; Lemay, Kate; Saini, Bandana; Reddel, Helen K; Bosnic-Anticevich, Sinthia Z; Smith, Lorraine D; Burton, Deborah; Song, Yun Ju Christine; Alles, Marie Chehani; Stewart, Kay; Emmerton, Lynne; Krass, Ines

2011-11-01

Although asthma can be well controlled by appropriate medication delivered in an appropriate way at an appropriate time, there is evidence that management is often suboptimal. This results in poor asthma control, poor quality of life, and significant morbidity. The objective of this study was to describe a population recruited in community pharmacy identified by trained community pharmacists as being at risk for poor asthma outcomes and to identify factors associated with poor asthma control. It used a cross-sectional design in 96 pharmacies in metropolitan and regional New South Wales, Victoria, Queensland, and Australian Capital Territory in Australia. Community pharmacists with specialized asthma training enrolled 570 patients aged ≥18 years with doctor-diagnosed asthma who were considered at risk of poor asthma outcomes and then conducted a comprehensive asthma assessment. In this assessment, asthma control was classified using a symptom and activity tool based on self-reported frequency of symptoms during the previous month and categorized as poor, fair, or good. Asthma history was discussed, and lung function and inhaler technique were also assessed by the pharmacist. Medication use/adherence was recorded from both pharmacy records and the Brief Medication Questionnaire (BMQ). The symptom and activity tool identified that 437 (77%) recruited patients had poor asthma control. Of the 570 patients, 117 (21%) smoked, 108 (19%) had an action plan, 372 (69%) used combination of inhaled corticosteroid (ICS)/long-acting β(2)-agonist (LABA) medications, and only 17-28% (depending on device) used their inhaler device correctly. In terms of adherence, 90% had their ICS or ICS/LABA dispensed <6 times in the previous 6 months, which is inconsistent with regular use; this low adherence was confirmed from the BMQ scores. A logistic regression model showed that patients who smoked had incorrect inhaler technique or low adherence (assessed by either dispensing history or

Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India.

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Bhojani, Upendra; Kolsteren, Patrick; Criel, Bart; De Henauw, Stefaan; Beerenahally, Thriveni S; Verstraeten, Roos; Devadasan, Narayanan

2015-01-01

Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n=163 diabetes patients) and the four matched facilities served as control (n=154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard

Role of metabolic control on diabetic nephropathy

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Macedo Célia Sperandéo

2002-01-01

Full Text Available OBJECTIVE: The aim of this investigation was studying the influence of glucose metabolic control on diabetic nephropathy. The authors observed the effect of acarbose, insulin, and both drugs on the metabolic control and development of mesangial enlargement of kidney glomeruli in alloxan-diabetic rats. METHODS: Five groups of Wistar rats were used: normal rats (N, non-treated alloxan-diabetic rats (D, alloxan-diabetic rats treated with acarbose (AD, alloxan-diabetic rats treated with insulin (ID, and alloxan-diabetic rats treated with insulin plus acarbose (IAD. The following parameters were evaluated: body weight; water and food intake; diuresis; blood and urine glucose levels; and the kidney lesions: mesangial enlargement and tubule cell vacuolization. Renal lesions were analysed using a semi-quantitative score 1, 3, 6, 9, and 12 months after diabetes induction. RESULTS: Diabetic rats showed a marked increase of glycemia, urinary glucose levels, diuresis, water and food intake, and weight loss, while the treated diabetic rats showed significant decreased levels of these parameters. The most satisfactory metabolic control was that of diabetic rats treated with acarbose + insulin. There was a significant mesangial enlargement in diabetic rats compared to normal rats from the third up to the 12th month after diabetes induction, with a significant difference between the animals treated with acarbose + insulin and non-treated diabetic rats. A difference between the animals treated with acarbose or insulin alone and non-treated diabetics rats was not seen. CONCLUSIONS: The authors discuss the results stressing the role of diabetic metabolic control in the prevention of diabetic nephropathy.

Effectiveness of a structured educational intervention using psychological delivery methods in children and adolescents with poorly controlled type 1 diabetes: a cluster-randomized controlled trial of the CASCADE intervention.

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Christie, Deborah; Thompson, Rebecca; Sawtell, Mary; Allen, Elizabeth; Cairns, John; Smith, Felicity; Jamieson, Elizabeth; Hargreaves, Katrina; Ingold, Anne; Brooks, Lucy; Wiggins, Meg; Oliver, Sandy; Jones, Rebecca; Elbourne, Diana; Santos, Andreia; Wong, Ian C K; O'Neil, Simon; Strange, Vicki; Hindmarsh, Peter; Annan, Francesca; Viner, Russell M

2016-01-01

Type 1 diabetes (T1D) in children and adolescents is increasing worldwide with a particular increase in children life and psychosocial functioning in children and adolescents with T1D. 28 pediatric diabetes services were randomized to deliver the intervention or standard care. 362 children (8-16 years) with HbA1c≥8.5% were recruited. Outcomes were HbA1c at 12 and 24 months, hypoglycemia, admissions, self-management skills, intervention compliance, emotional and behavioral adjustment, and quality of life. A process evaluation collected data from key stakeholder groups in order to evaluate the feasibility of delivering the intervention. 298/362 patients (82.3%) provided HbA1c at 12 months and 284/362 (78.5%) at 24 months. The intervention did not improve HbA1c at 12 months (intervention effect 0.11, 95% CI -0.28 to 0.50, p=0.584), or 24 months (intervention effect 0.03, 95% CI -0.36 to 0.41, p=0.891). There were no significant changes in remaining outcomes. 96/180 (53%) families in the intervention arm attended at least 1 module. The number of modules attended did not affect outcome. Reasons for low uptake included difficulties organizing groups and work and school commitments. Those with highest HbA1cs were less likely to attend. Mean cost of the intervention was £683 per child. Significant challenges in the delivery of a structured education intervention using psychological techniques to enhance engagement and behavior change delivered by diabetes nurses and dietitians in routine clinical practice were found. The intervention did not improve HbA1c in children and adolescents with poor control. ISRCTN52537669, results.

Self-reported type 2 diabetes Mellitus is associated with abdominal obesity and poor perception of health in shift workers

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Carine FRÖHLICH

Full Text Available ABSTRACT Objective: To investigate factors that are associated with type 2 diabetes Mellitus in shift workers of a slaughterhouse in Southern Brazil. Methods: This cross-sectional study included 1,194 18- to 50-year-old workers of both sexes. The presence of type 2 diabetes Mellitus was self-reported and confirmed by the use of hypoglycemic drugs or insulin. The independent variables were sex, age, skin color, marital status, education level, family income, leisure time physical activity, smoking, and self-reported health and nutritional status (body mass index and waist circumference. Multivariate analysis was performed from an a priori conceptual model. Results: The prevalence of diabetes was 1.3% (95%CI=0.6-1.9. Type 2 diabetes Mellitus was associated with poor or regular self-reported health (OR=3.72; 95%CI=1.28-10.78 and level II abdominal obesity ³102 for men and ³88 for women (OR=5.76; 95%CI=1.07-29.10. Conclusion: The prevalence of type 2 diabetes Mellitus was low. Moreover, the study evidenced the importance of using waist circumference to surveil and screen for metabolic diseases, such as type 2 diabetes Mellitus, and to monitor the low quality of life in the study individuals given the poor self-perceived health of workers with the said disease.

Mobile diabetes intervention study: testing a personalized treatment/behavioral communication intervention for blood glucose control.

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Quinn, Charlene C; Gruber-Baldini, Ann L; Shardell, Michelle; Weed, Kelly; Clough, Suzanne S; Peeples, Malinda; Terrin, Michael; Bronich-Hall, Lauren; Barr, Erik; Lender, Dan

2009-07-01

National data find glycemic control is within target (A1ccommunication system, using mobile phones and patient/physician portals to allow patient-specific treatment and communication. All physicians receive American Diabetes Association (ADA) Guidelines for diabetes care. Patients with poor diabetes control (A1c> or =7.5%) at baseline (n=260) are enrolled in study groups based on PCP randomization. All study patients receive blood glucose (BG) meters and a year's supply of testing materials. Patients in three treatment groups select one of two mobile phone models, receive one-year unlimited mobile phone data and service plan, register on the web-based individual patient portal and receive study treatment phone software based on study assignment. Control group patients receive usual care from their PCP. The primary outcome is mean change in A1c over a 12-month intervention period. Traditional methods of disease management have not achieved adequate control for BG and other conditions important to persons with diabetes. Tools to improve communication between patients and PCPs may improve patient outcomes and be satisfactory to patients and physicians. This RCT is ongoing.

The Impact of Antidepressant Therapy on Glycemic Control in Canadian Primary Care Patients With Diabetes Mellitus

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Justin Gagnon

2018-06-01

Full Text Available Context: Depression is common in people with diabetes and is associated with poor glycemic control. Evidence suggests that certain antidepressants (AD increase the risk of poor control. Few population-based studies have examined the impact of individual ADs on glycemic control. This study's objective is to measure the impact of Citalopram, Amitriptyline, Venlafaxine, Trazodone and Escitalopram on glycated hemoglobin (HbA1c in Canadian primary care patients with diabetes.Methods: A retrospective study of electronic medical records (EMR from 115 primary care practices across Canada was undertaken. Data were obtained from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN. The sample population comprised 1,084 diabetic patients with 1,127 prescriptions of one of the five selected ADs and with baseline and post-exposure HbA1c measurements. Generalized linear mixed models were computed to estimate the effect of the ADs on HbA1c.Results: Mean HbA1c ratios for Amitriptyline, Venlafaxine, Trazodone and Escitalopram were all numerically lower than Citalopram. The confidence intervals included the minimum detectable effect, however the differences were not statistically significant. The lowest clinically relevant HbA1c ratios, relative to Citalopram, were found in patients prescribed Trazodone and Escitalopram. Accounting for the prescription of Trazodone for indications other than depression, this research suggests that Escitalopram may be safer than Citalopram for people with diabetes and depression, in terms of its effect on blood glucose.Conclusion: This study can inform future research examining the relationship between ADs and blood glucose and provides insight into the limitations pertaining to the use of health data in health research. Future research should seek to control for, across multiple time points: depression symptoms, depression severity, depression duration, weight, diabetes medication, tobacco and alcohol consumption and

Comparative analysis of diabetic nephropathy and non-diabetic nephropathy disease.

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Chen, Qiuxiang; Zhu, Aimin; Wang, Junsheng; Huan, Xuelai

2017-12-01

Clinical symptoms of diabetic nephropathy patients and non-diabetic nephropathy are compared and analyzed, hemodialysis effect and quality of life of two kinds of nephrotic patients are analyzed. Respectively extract 1300 cases of diabetic nephropathy and non-diabetic nephropathy patients admitted to different hospitals during December 2011-December 2014. Based on whether the patient suffers from diabetes, they were divided into diabetic group and control group. Hemodialysis of two groups of patients were followed up to observe effectiveness of blood treatment, and complications were observed after one year of follow-up. Hematodialysis effectiveness of diabetic nephropathy patients is significantly lower than that of non-diabetic nephropathy group. After 1 year's follow-up, it can be found that survival rate of diabetic nephropathy patients is much lower than that of control group. In statistical comparison of data involved in the two groups of patients, P diabetic nephropathy patients is relatively poor compared to that of non-diabetic patients. In clinics, management and prevention of diabetic patients should be strengthened to avoid complication of nephropathy which brings serious injury to patients.

Guided self-determination improves life skills with Type 1 diabetes and A1C in randomized controlled trial

DEFF Research Database (Denmark)

Zoffmann, Vibeke; Lauritzen, Torsten

2006-01-01

Objective To report 1-year results of newly developed method, guided self-determination (GSD), applied in group training (GSD-GT) for Type 1 diabetes patients with persistent poor glycaemic control. Methods GSD was designed on the basis of qualitative research to help patients develop life skills...... is a worthy candidate for further research. We consider it adjustable to people with type 2 diabetes and other chronic conditions....

Identification of metformin poor responders, requiring supplemental insulin, during randomization of metformin versus insulin for the control of gestational diabetes mellitus.

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Ashoush, Sherif; El-Said, Mourrad; Fathi, Hisham; Abdelnaby, Mohamed

2016-06-01

To evaluate glycemic control among women with gestational diabetes mellitus (GDM) under insulin versus metformin (with or without insulin supplementation), and to identify metformin poor responders requiring supplemental insulin. In Ain Shams University Hospital, mothers with 26-32-week GDM pregnancies, failing diet control, were randomized to receive metformin (n = 47) or insulin (n = 48). The primary outcome was glycemic control. Secondary outcomes included maternal weight, parameters predicting successful metformin monotherapy, neonatal hypoglycemia, and birthweight. Women using metformin (23.4% needing supplemental insulin) gained less weight (P metformin group was related to initial body mass index, HbA1c, oral glucose tolerance test (GTT), and first week mean glucose level. The 1-h glucose level during initial GTT (Hr1-GTT) and the mean fasting glucose level during the first week of therapy (Wk1-mFG) were the two independent parameters associated with requiring supplemental insulin. Women with Hr1-GTT >212 mg/dL and Wk1-mFG >95 mg/dL had a risk ratio of 58.6 (95%CI: 3.68-933.35, P = 0.004) and 11.5 (95%CI: 2.77-47.34,= 0.0008), respectively for needing supplemental insulin during the course of the study compared with women without. Metformin is an effective and safe alternative to insulin in GDM. Women using metformin (± supplemental insulin) had similar glycemic control, less weight gain, and similar rates of side-effects as those on insulin monotherapy. Insulin supplementation to metformin therapy was more likely with elevated Hr1-GTT and Wk1-mFG. © 2016 Japan Society of Obstetrics and Gynecology.

The influence of aspirin dose and glycemic control on platelet inhibition in patients with type 2 diabetes mellitus

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Lemkes, B. A.; Bahler, L.; Kamphuisen, P. W.; Stroobants, A. K.; van den Dool, E. J.; Hoekstra, J. B.; Nieuwland, R.; Gerdes, V. E.; Holleman, F.

Background: Low-dose aspirin seems to offer no benefit in the primary prevention of cardiovascular disease in type 2 diabetes mellitus (DM2). The anti-platelet effect may be diminished by poor glycemic control or inadequate dosing of aspirin. Objectives: To study the effects of both glycemic control

Effect of metabolic control on parathyroid hormone secretion in diabetic patients

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Paula F.J.A.

2001-01-01

Full Text Available The metabolic derangement caused by diabetes mellitus may potentially affect bone mineral metabolism. In the present study we evaluated the effect of diabetes metabolic control on parathyroid hormone (PTH secretion during stimulation with EDTA infusion. The study was conducted on 24 individuals, 8 of them normal subjects (group N: glycated hemoglobin - HbA1C = 4.2 ± 0.2%; range = 3.5-5.0%, 8 patients with good and regular metabolic control (group G-R: HbA1C = 7.3 ± 0.4%; range = 6.0-8.5%, and 8 patients with poor metabolic control (group P: HbA1C = 12.5 ± 1.0%; range: 10.0-18.8%. Blood samples were collected at 10-min intervals throughout the study (a basal period of 30 min and a 2-h period of EDTA infusion, 30 mg/kg body weight and used for the determination of ionized calcium, magnesium, glucose and intact PTH. Basal ionized calcium levels were slightly lower in group P (1.19 ± 0.01 mmol/l than in group N (1.21 ± 0.01 mmol/l and group G-R (1.22 ± 0.01 mmol/l. After EDTA infusion, the three groups presented a significant fall in calcium, but with no significant difference among them at any time. Basal magnesium levels and levels determined during EDTA infusion were significantly lower (P<0.01 in group P than in group N. The induction of hypocalcemia caused an elevation in PTH which was similar in groups N and G-R but significantly higher than in group P throughout the infusion period (+110 min, N = 11.9 ± 2.1 vs G-R = 13.7 ± 1.6 vs P = 7.5 ± 0.7 pmol/l; P<0.05 for P vs N and G-R. The present results show that PTH secretion is impaired in patients with poorly controlled diabetes.

Poor structural social support is associated with an increased risk of Type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study.

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Altevers, J; Lukaschek, K; Baumert, J; Kruse, J; Meisinger, C; Emeny, R T; Ladwig, K H

2016-01-01

Several psychosocial factors have been shown to increase the risk of Type 2 diabetes mellitus. This study investigated the association between structural social support and incidence of Type 2 diabetes mellitus in men and women. Data were derived from three population-based MONICA/KORA surveys conducted in 1984-1995 in the Augsburg region (southern Germany) and followed up by 2009. The study population comprised 8952 participants (4669 men/4283 women) aged 30-74 years without diabetes at baseline. Structural social support was assessed using the Social Network Index. Sex-specific hazard ratios were estimated from Cox proportional hazard models. Within follow-up, 904 incident Type 2 diabetes mellitus cases (558 men, 346 women) were observed. Crude incidence rates for Type 2 diabetes mellitus per 10 000 person-years were substantially higher in poor compared with good structural social support (men: 94 vs. 69, women: 58 vs. 43). After adjustment for age, survey, parental history of diabetes, smoking status, alcohol intake, physical activity, hypertension, dyslipidaemia, BMI, education, sleep complaints and depressed mood, risk of Type 2 diabetes mellitus for participants with poor compared with good structural social support was 1.31 [95% confidence interval (CI) = 1.11-1.55] in men and 1.10 (95% CI = 0.88-1.37) in women. Stratified analyses revealed a hazard ratio of 1.50 (95% CI = 1.23-1.83) in men with a low level of education and 0.87 (95% CI = 0.62-1.22) in men with a high level of education (P for interaction: 0.0082). Poor structural social support is associated with Type 2 diabetes mellitus in men. This association is independent of risk factors at baseline and is particularly pronounced in men with a low level of education. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

One too many diabetes: the combination of hyperglycaemic hyperosmolar state and central diabetes insipidus

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Snezana Burmazovic

2018-04-01

Full Text Available The combination of hyperosmolar hyperglycaemic state and central diabetes insipidus is unusual and poses unique diagnostic and therapeutic challenges for clinicians. In a patient with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology that is considered, and achieving glycaemic control remains the first course of action. However, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and urine osmolality suggest concurrent symptomatic diabetes insipidus. We report a rare case of concurrent manifestation of hyperosmolar hyperglycaemic state and central diabetes insipidus in a patient with a history of craniopharyngioma.

Occurrence and predictors of depression and poor quality of life among patients with Type-2 diabetes: A Northern India perspective

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Prerna Bahety

2017-01-01

Full Text Available Background and Aims: Globally, depression has been linked to Type-2 diabetes mellitus (T2DM. However, similar data from India are scant. This study evaluated the occurrence and predictors of depression and health-related quality of life (QOL in patients with T2DM as compared to healthy controls.Materials and Methods: One hundred adults with T2DM without prior diagnosis of depression and 100 matched controls were evaluated. Depression was assessed using Patient Health Questionnaire-9. World Health Organization QOL Brief (WHO-QOL-BREF was used to assess QOL. Demography, anthropometry, biochemical parameters of diabetes control, and microvascular and macrovascular complications in patients were recorded. Results: Depression was significantly more common in T2DM (63% as compared to controls (48% (odds ratio [OR] - 1.84 [1.04, 3.24]; P = 0.03. In T2DM, depression was higher in patients with disease duration> 5 years (OR = 2.66; P = 0.02, glycated hemoglobin> 7% (OR = 3.45; P = 0.004, retinopathy (OR - 3.56; P = 0.03, and nephropathy (OR - 4.11; P = 0.07. Occurrence of depression was significantly higher among the patients with macrovascular complications, namely, coronary artery disease (17.4%; P = 0.000006, cerebrovascular disease (14.2%; P = 0.0006, and peripheral vascular disease (7.9%; P = 0.05. Insulin users had higher depression as compared to patients using only oral antihyperglycemic medications (P = 0.034. Patient with depression had significantly low QOL. The WHO-QOL for all the domains was significantly lower in T2DM with microvascular and macrovascular complications, as compared to those without. Conclusion: Indian T2DM had higher prevalence of depression and lower QOL as compared to controls, which was associated with poor glycemic control and higher end-organ damage. Public health measures are required to create more awareness for managing depression in diabetes.

Constraints faced by urban poor in managing diabetes care: patients’ perspectives from South India

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Upendra Bhojani

2013-10-01

Full Text Available Background: Four out of five adults with diabetes live in low- and middle-income countries (LMIC. India has the second highest number of diabetes patients in the world. Despite a huge burden, diabetes care remains suboptimal. While patients (and families play an important role in managing chronic conditions, there is a dearth of studies in LMIC and virtually none in India capturing perspectives and experiences of patients in regard to diabetes care. Objective: The objective of this study was to better understand constraints faced by patients from urban slums in managing care for type 2 diabetes in India. Design: We conducted in-depth interviews, using a phenomenological approach, with 16 type 2- diabetes patients from a poor urban neighbourhood in South India. These patients were selected with the help of four community health workers (CHWs and were interviewed by two trained researchers exploring patients’ experiences of living with and seeking care for diabetes. The sampling followed the principle of saturation. Data were initially coded using the NVivo software. Emerging themes were periodically discussed among the researchers and were refined over time through an iterative process using a mind-mapping tool. Results: Despite an abundance of healthcare facilities in the vicinity, diabetes patients faced several constraints in accessing healthcare such as financial hardship, negative attitudes and inadequate communication by healthcare providers and a fragmented healthcare service system offering inadequate care. Strongly defined gender-based family roles disadvantaged women by restricting their mobility and autonomy to access healthcare. The prevailing nuclear family structure and inter-generational conflicts limited support and care for elderly adults. Conclusions: There is a need to strengthen primary care services with a special focus on improving the availability and integration of health services for diabetes at the community level

The role of primary health care in patient education for diabetes control.

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Koura, M R; Khairy, A E; Abdel-Aal, N M; Mohamed, H F; Amin, G A; Sabra, A Y

2001-01-01

patients had poor knowledge about diabetes and its management (85.7%) and a negative attitude towards self-management (61.6%) and only 23.6% of them were satisfied with the services provided by the PHC facilities for diabetes control. They were mainly dissatisfied with the role of PHC physicians in patient education. Some misconceptions and false beliefs were also recognized among diabetic patients. Many of them considered diabetes a contagious disease or primarily caused by stress. They didn't know the importance of regular exercise in diabetes control. They also believed in the efficacy of herbal therapy in diabetes control; that vitamins are essential for all people with diabetes; that water intake should be decreased when passing large amounts of urine, that anti-diabetic drugs should be stopped during associated illnesses and that patients on insulin treatment can't be shifted to oral drugs. Moreover, they believed that the amount of carbohydrates in diet should be reduced or even restricted and that the amount of proteins should not be reduced. They also refused the use of artificial sweeteners as sugar substitutes. Thus, it may be concluded that there is a serious gap in the provision of basic educational services to the majority of diabetic patients attending PHC facilities in Alexandria.

Diabetes Control: Why It's Important (For Kids)

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... to feel good, be healthy, and stay healthy. What Can Make Blood Sugar Levels Be Out of Control? Managing diabetes is like a three-way balancing ... Do I Know if My Diabetes Is Under Control? Your doctor or diabetes health care team will tell you what your blood sugar levels should be. They may ...

Patient-Related Determinants of Glycaemic Control in People with Type 2 Diabetes in the Gulf Cooperation Council Countries: A Systematic Review.

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Alramadan, Mohammed J; Afroz, Afsana; Hussain, Sultana Monira; Batais, Mohammed Ali; Almigbal, Turky H; Al-Humrani, Hassan Ahmad; Albaloshi, Ahmed; Romero, Lorena; Magliano, Dianna J; Billah, Baki

2018-01-01

The aim of this systematic review is to assess patient-related factors affecting glycaemic control among people with type 2 diabetes in the Arabian Gulf Council countries. MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL databases were searched from their date of inception to May 2016. Two researchers independently identified eligible studies and assessed the risk of bias. A total of 13 studies met the inclusion criteria. One study was population based, six recruited participants from multiple centres, and the remaining were single centred. The majority of the studies were of low to moderate quality. Factors associated with poor glycaemic control include longer duration of diabetes, low level of education, poor compliance to diet and medication, poor attitude towards the disease, poor self-management behaviour, anxiety, depression, renal impairment, hypertension, and dyslipidaemia. Healthcare providers should be aware of these factors and provide appropriate education and care especially for those who have poor glycaemic control. Innovative educational programs should be implemented in the healthcare systems to improve patient compliance and practices. A variation in the results of the included studies was observed, and some potentially important risk factors such as dietary habits, physical activity, family support, and cognitive function were not adequately addressed. Further research is needed in this area.

Diabetes in children and adolescents from ethnic minorities: barriers to education, treatment and good metabolic control

DEFF Research Database (Denmark)

Povlsen, Lene; Olsen, Birthe; Ladelund, Steen

2005-01-01

AIM: This paper reports an investigation to establish whether metabolic control is different in children and adolescents from ethnic minorities with type 1 diabetes compared with young Danish patients, and to learn about factors affecting their opportunities to achieve good metabolic control....... BACKGROUND: The prevalence of diabetes in children and adolescents from ethnic minorities in Denmark is increasing. Having a different ethnic background has frequently been described as a risk factor for poor metabolic control, but whether the risk is represented by the ethnicity and immigration itself...... the centres provided limited specialized knowledge and support. The questionnaires completed by the parents revealed limited schooling, lack of professional education and a major need for interpreters; these characteristics were especially prevalent among the mothers. CONCLUSIONS: Young patients from ethnic...

Poor blood pressure control and its associated factors among older people with hypertension: A cross-sectional study in six public primary care clinics in Malaysia.

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Cheong, A T; Sazlina, S G; Tong, S F; Azah, A S; Salmiah, S

2015-01-01

Hypertension is highly prevalent in the older people. Chronic disease care is a major burden in the public primary care clinics in Malaysia. Good blood pressure (BP) control is needed to reduce the morbidity and mortality of cardiovascular disease (CVD). This study aimed to determine the status of BP control and its associated factors among older people with hypertension in public primary care clinics. A cross-sectional study on hypertensive patients aged 18 years and above was conducted in six public primary care clinics in Federal Territory, Malaysia. A total of 1107 patients were selected via systematic random sampling. Data from 441 (39.8%) patients aged 60 years and more were used in this analysis. BP control was determined from the average of two BP readings measured twice at an interval of 5 min. For patients without diabetes, poor BP control was defined as BP of ≥140/90 mm Hg and ≥150/90 for the patients aged 80 years and more. For patients with diabetes, poor control was defined as BP of ≥140/80 mm Hg. A total of 51.7% (n = 228) of older patients had poor BP control. The factors associated with BP control were education level (p = 0.003), presence of comorbidities (p = 0.015), number of antihypertensive agents (p = 0.001) and number of total medications used (p = 0.002). Patients with lower education (less than secondary education) (OR = 1.7, p = 0.008) and the use of three or more antihypertensive agents (OR = 2.0, p = 0.020) were associated with poor BP control. Among older people with hypertension, those having lower education level, or using three or more antihypertensive agents would require more attention on their BP control.

Poor control and management of type 2 diabetes mellitus at an ...

African Journals Online (AJOL)

Romona Devi Govender

However, this one-year chart review showed that glycaemia was poorly managed at this ... setting in South Africa. To the best of our knowledge, no studies ..... morbid conditions is more necessary now than ever before in order to change ...

The Impact of Patient Education on Anthropometric, Lipidemic, and Glycemic Parameters Among Patients With Poorly Controlled Type II Diabetes Mellitus: A 3-Month Prospective Single-Center Turkish Study.

Science.gov (United States)

Cander, Soner; Gul, Ozen Oz; Gul, Cuma B; Keles, Saadet B; Yavas, Sibel; Ersoy, Canan

2014-12-01

This study evaluated the impact of patient education on adherence to a diabetes care plan (e.g., anthropometric, lipidemic, and glycemic parameters) among adults with type II diabetes mellitus without adequate glycemic control. A total of 61 ambulatory adults with type II diabetes mellitus (mean age: 53.6 ± 8.2 years, 70.5% female) were evaluated for anthropometrics, duration of diabetes mellitus, type of anti-diabetic treatment, blood biochemistry, and glycemic parameters in this 3-month prospective observational single-center study. During the course of the study, participants demonstrated a significant decrease in body weight and fat percentage and HbA1c (p diabetes mellitus who received education on adherence to routine self-monitoring of blood glucose, standard diabetic diet, and an exercise program delivered by certified diabetes educators had better glycemic control and significant decrease in body weight and fat percentage over a 3-month monitoring period. Copyright 2014, SLACK Incorporated.

Role of footcare education in diabetic foot status and glycaemic ...

African Journals Online (AJOL)

Background: Prevalence of type 2 diabetes among the adult population is rising globally. As the case detection rates of diabetes increase in adult Nigerians, managing the attendant (foot) complications has become an important health challenge. Poor practice of foot care and poor glycaemic control is potential risk for ...

Control of type 2 diabetes mellitus among general practitioners in private practice in nine countries of Latin America.

Science.gov (United States)

Lopez Stewart, Gloria; Tambascia, Marcos; Rosas Guzmán, Juan; Etchegoyen, Federico; Ortega Carrión, Jorge; Artemenko, Sofia

2007-07-01

To better understand how diabetes care and control are being administered by general practitioners/nonspecialists in private practice in nine countries of Latin America, and to identify the most significant patient- and physician-related barriers to care. A multicenter, cross-sectional, epidemiological survey was conducted in nine countries in Latin America: Argentina, Brazil, Chile, Costa Rica, Ecuador, Guatemala, Mexico, Peru, and Venezuela. General practitioners in private practice were asked to provide care and control data for patients 18 to 75 years of age with type 2 diabetes mellitus (T2DM), including demographics, medical and medication history, laboratory exams, and information on the challenges of patient management. Of the 3 592 patient questionnaires returned by 377 physicians, 60% of the patients had a family history of diabetes, 58% followed a poor diet, 71% were sedentary, and 79% were obese or overweight. Poor glycemic control (fasting blood glucose >or= 110 mg/dL) was observed in 78% of patients. The number of patients with HbA1c 15 years). Considering the differences between private and public health care in Latin America, especially regarding the quality of care and access to medication, further studies are called for in the public setting. Overall, a more efficient and intensive program of T2DM control is required, including effective patient education programs, adjusted to the realities of Latin America.

Gaps and barriers in the control of blood glucose in people with type 2 diabetes.

Science.gov (United States)

Blonde, Lawrence; Aschner, Pablo; Bailey, Clifford; Ji, Linong; Leiter, Lawrence A; Matthaei, Stephan

2017-05-01

Glycaemic control is suboptimal in a large proportion of people with type 2 diabetes who are consequently at an increased and avoidable risk of potentially severe complications. We sought to explore attitudes and practices among healthcare professionals that may contribute to suboptimal glycaemic control through a review of recent relevant publications in the scientific literature. An electronic search of the PubMed database was performed to identify relevant publications from January 2011 to July 2015. The electronic search was complemented by a manual search of abstracts from key diabetes conferences in 2014/2015 available online. Recently published data indicate that glycaemic control is suboptimal in a substantial proportion (typically 40%-60%) of people with diabetes. This is the case across geographic regions and in both low- and higher-income countries. Therapeutic inertia appears to be an important contributor to poor glycaemic control in up to half of people with type 2 diabetes. In particular, prescribers are often willing to tolerate extended periods of 'mild' hyperglycaemia as well as having low expectations for their patients. There are often delays of 3 years or longer in initiating or intensifying glucose-lowering therapy when needed. Many people with type 2 diabetes are failed by current management, with approximately half not achieving or maintaining appropriate target blood glucose levels, leaving these patients at increased and avoidable risk of serious complications. Review criteria: The methodology of this review article is detailed in the 'Methods' section.

Diabetes diagnosis and management among insured adults across metropolitan areas in the U.S.

Directory of Open Access Journals (Sweden)

Wenya Yang

2018-06-01

Full Text Available This study provides diabetes-related metrics for the 50 largest metropolitan areas in the U.S. in 2012—including prevalence of diagnosed and undiagnosed diabetes, insurance status of the population with diabetes, diabetes medication use, and prevalence of poorly controlled diabetes.Diabetes prevalence estimates were calculated using cross-sectional data combining the Behavioral Risk Factor Surveillance System, American Community Survey, National Nursing Home Survey, Census population files, and National Health and Nutrition Examination Survey. Analysis of medical claims files (2012 de-identified Normative Health Information database, 2011 Medicare Standard Analytical Files, and 2008 Medicaid Analytic eXtract produced information on treatment and poorly controlled diabetes by geographic location, insurance type, sex, and age group.Among insured adults with diagnosed type 2 diabetes in 2012, the proportion receiving diabetes medications ranged from 83% in Oklahoma City, Oklahoma, to 65% in West Palm Beach, Florida. The proportion of treated patients with medical claims indicating poorly controlled diabetes was lowest in Minneapolis, Minnesota (36% and highest in Texas metropolitan areas of Austin (51%, San Antonio (51%, and Houston (50%.Estimates of diabetes detection and management across metropolitan areas often differ from state and national estimates. Local metrics of diabetes management can be helpful for tracking improvements in communities over time. Keywords: Diabetes, Management

Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials.

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Effie Viguiliouk

Full Text Available Tree nut consumption has been associated with reduced diabetes risk, however, results from randomized trials on glycemic control have been inconsistent.To provide better evidence for diabetes guidelines development, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of tree nuts on markers of glycemic control in individuals with diabetes.MEDLINE, EMBASE, CINAHL, and Cochrane databases through 6 April 2014.Randomized controlled trials ≥3 weeks conducted in individuals with diabetes that compare the effect of diets emphasizing tree nuts to isocaloric diets without tree nuts on HbA1c, fasting glucose, fasting insulin, and HOMA-IR.Two independent reviewer's extracted relevant data and assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD with 95% CI's. Heterogeneity was assessed (Cochran Q-statistic and quantified (I2.Twelve trials (n = 450 were included. Diets emphasizing tree nuts at a median dose of 56 g/d significantly lowered HbA1c (MD = -0.07% [95% CI:-0.10, -0.03%]; P = 0.0003 and fasting glucose (MD = -0.15 mmol/L [95% CI: -0.27, -0.02 mmol/L]; P = 0.03 compared with control diets. No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts.Majority of trials were of short duration and poor quality.Pooled analyses show that tree nuts improve glycemic control in individuals with type 2 diabetes, supporting their inclusion in a healthy diet. Owing to the uncertainties in our analyses there is a need for longer, higher quality trials with a focus on using nuts to displace high-glycemic index carbohydrates.ClinicalTrials.gov NCT01630980.

Análisis de una encuesta poblacional para determinar los factores asociados al control de la diabetes mellitus en México Analysis of population survey for determining the factors associated with the control diabetes mellitus in Mexico

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Alfonso Claudio Hernández-Romieu

2011-02-01

Full Text Available OBJETIVO: Explorar la asociación entre recomendaciones dietéticas, ejercicio, acceso a seguridad social y medicamentos, y calidad de la atención médica con el grado de control glucémico en pacientes diabéticos. MATERIAL Y MÉTODOS: La información y muestras sanguíneas se obtuvieron en 2005. Se analizó la proporción de pacientes que se encontraban en buen control (9.5%, de acuerdo con su HbA1c. Fueron empleados modelos de regresión logística binaria para determinar la asociación entre los factores y niveles de glucemia. RESULTADOS: El 30% de los pacientes diabéticos se encontraban en buen control. CONCLUSIONES: Recibir consulta con un nutriólogo disminuye la posibilidad de descontrol severo. Un alto porcentaje de los pacientes diabéticos se encuentra en alto grado de descontrol, por lo que es urgente reforzar el acceso y calidad de la atención ofrecida a estos pacientes.OBJECTIVE: Determine the influence of nutritional counseling, exercise, access to social healthcare and drugs, and the quality of medical care on the control of diabetics. MATERIAL AND METHODS: The information and blood samples were obtained in 2005. Glycemic control was defined as good if HbA1c was 9.5%. Binary logistic regression models were used to determine the association of these factors with HbA1c>9.5%. RESULTS: Thirty percent of the patients with a medical diagnosis of diabetes had adequate metabolic control. CONCLUSIONS: Nutritional guidance was associated with an increase in the degree of control. A majority of diabetics have poor or very poor glycemic control. Strengthening the quality of and access to medical care for these patients is urgently needed.

Oxidative stress in diabetic patients with retinopathy | Kundu ...

African Journals Online (AJOL)

Background: Diabetes mellitus (DM) is known to induce oxidative stress along with deranging various metabolisms; one of the late complications of diabetes mellitus is diabetic retinopathy, which is a leading cause of acquired blindness. Poor glycemic control and oxidative stress have been attributed to the development of ...

Management of a Dog with Poorly Regulated Diabetes Mellitus, Chronic Pancreatitis, and Suspected Atopy with Cyclosporine

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Jörg M. Steiner

2012-01-01

Full Text Available A 3-year-and-9-months old male neutered Bichon Frise was presented for a second opinion for diabetes mellitus, weight loss, pruritus, and loss of hair. During further work-up, the dog was diagnosed with uncontrolled diabetes mellitus and concurrent diagnoses of pancreatitis and atopy were also suspected. Multiple adjustments of insulin therapy did not improve control of diabetes mellitus. Also, a variety of different treatments failed to improve pruritus. The dog was seen by a veterinary dermatologist who further suspected atopy and started treatment with cyclosporine. Pruritus improved and coincidentally serum Spec cPL and fructosamine concentrations normalized after therapy, suggesting the possibility that cyclosporine may have controlled pancreatic inflammation and improved control of diabetes mellitus. This case report would suggest that further research into autoimmunity in dogs with chronic pancreatitis is warranted. Also, a controlled study is needed and in progress before the use of cyclosporine in dogs with chronic pancreatitis or a subgroup thereof can be advocated.

Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia.

Science.gov (United States)

Pimazoni-Netto, Augusto; Zanella, Maria Teresa

2014-11-01

Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. The same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. The main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases.

Evaluation of the difference in caries experience in diabetic and non-diabetic children-A case control study.

Directory of Open Access Journals (Sweden)

Stefano Lai

Full Text Available To evaluate the caries prevalence and related variables in Type 1 diabetic and non-diabetic children and among the diabetic children according to their metabolic status.Sixty-eight diabetic and 136 non-diabetic children, matching by gender and age (4-14 years were enrolled. The diabetic children were divided: a 20 children in good metabolic control (Hb1ac≤7.5 and b 48 children in bad metabolic control (Hb1ac>7.5. Dietary and oral hygiene habits were investigated. Caries status was registered using the International Caries Detection and Assessment System. Oral microflora was analysed using the checkerboard DNA-DNA hybridisation method. Plaque acidogenicity was recorded after a sucrose rinse.Sugared beverage and snack intake was higher in diabetic group compared to non-diabetic group (p = 0.03 and p = 0.04, respectively and in subjects in bad metabolic control (p = 0.03 and p<0.01, respectively. Oral hygiene habits were similar, except for the use of fluoridated adjuvants, higher in non-diabetic children (p = 0.04. No statistically significant differences were observed regarding caries figures, but a higher number of caries free subjects was found in diabetic subjects in good metabolic control (p<0.01. Significant difference for the main cariogenic bacteria was found between diabetic and non-diabetic subjects (p<0.05. The pH values showed statistically significant differences between diabetic and non-diabetic subjects and between diabetic subjects in good and bad metabolic control (p<0.01.Diabetic children in good metabolic control might even be considered at low caries risk, while those in bad metabolic control showed an oral environment prone to a high caries risk.

Diabetes in Hispanic American Youth

Science.gov (United States)

Lawrence, Jean M.; Mayer-Davis, Elizabeth J.; Reynolds, Kristi; Beyer, Jennifer; Pettitt, David J.; D'Agostino, Ralph B.; Marcovina, Santica M.; Imperatore, Giuseppina; Hamman, Richard F.

2009-01-01

OBJECTIVE—To report the 2001 prevalence and 2002–2005 incidence of type 1 and type 2 diabetes in Hispanic American youth and to describe the demographic, clinical, and behavioral characteristics of these youth. RESEARCH DESIGN AND METHODS—Data from the SEARCH for Diabetes in Youth Study, a population-based multicenter observational study of youth aged 0–19 years with physician-diagnosed diabetes, were used to estimate the prevalence and incidence of type 1 and type 2 diabetes. Information obtained by questionnaire, physical examination, and blood and urine collection was analyzed to describe the characteristics of youth who completed a study visit. RESULTS—Among Hispanic American youth, type 1 diabetes was more prevalent than type 2 diabetes, including in youth aged 10–19 years. There were no significant sex differences in type 1 or type 2 diabetes prevalence. The incidence of type 2 diabetes for female subjects aged 10–14 years was twice that of male subjects (P < 0.005), while among youth aged 15–19 years the incidence of type 2 diabetes exceeded that of type 1 diabetes for female subjects (P < 0.05) but not for male subjects. Poor glycemic control, defined as A1C ≥9.5%, as well as high LDL cholesterol and triglycerides were common among youth aged ≥15 years with either type of diabetes. Forty-four percent of youth with type 1 diabetes were overweight or obese. CONCLUSIONS—Factors such as poor glycemic control, elevated lipids, and a high prevalence of overweight and obesity may put Hispanic youth with type 1 and type 2 diabetes at risk for future diabetes-related complications. PMID:19246577

Clinical study of diabetic dermoangiopathy

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MPS Sawhney

1990-01-01

Full Text Available One hundred and twenty three diabetic patients and 100 non- diabetic controls were examined for lesions of diabetic dermoangiopathy. Twenty two (17.9% lesions, while simildr lesions were found in only 2 (2% controls. Age of the patients with opathy was sipifirandy higher than those derm without dermopathy, and it was more common in the fifth to the seventh decade. No statistically siicant relationship could be established with the sex, type, serverity control or duration of diabetes, diatetic neuropathy, larize vessel disease like CAD, PVD or CVA or with metabolic complications of diabetes. However, a higher percentage (59.1% of patients with dermopathy were found to have a poor control of their diabetes as compared to those without microangiopathy (50.7%. Dermopathy was also more common (23% 9 the duration of diabetes was more than 5 years, than if it was less than 5 years (14.1%. The percentage (33.3% of patients with retinopathy having dermopathy. Rubeosis was seen in 4 (3.2% patients.

Correlates of Nocturia and Relationships of Nocturia With Sleep Quality and Glycemic Control in Women With Type 2 Diabetes.

Science.gov (United States)

Chang, Chun-Jen; Pei, Dee; Wu, Chien-Chih; Palmer, Mary H; Su, Ching-Chieh; Kuo, Shu-Fen; Liao, Yuan-Mei

2017-07-01

To explore correlates of nocturia, compare sleep quality and glycemic control for women with and without nocturia, and examine relationships of nocturia with sleep quality and glycemic control in women with diabetes. This study was a cross-sectional, correlational study with data collected from 275 women with type 2 diabetes. Data were collected using a structured questionnaire. Multivariate logistic regression analyses were used to identify correlates. Chi-squared tests were used to identify candidate variables for the first logistic regression model. A one-way analysis of variance was used to compare sleep quality and glycemic control for women with and those without nocturia. Pearson correlations were used to examine the relationships of nocturia with sleep quality and glycemic control. Of the 275 participants, 124 (45.1%) had experienced nocturia (at least two voids per night). Waist circumference, parity, time since diagnosis of diabetes, sleep quality, and increased daytime urinary frequency were correlated with nocturia after adjusting for age. Compared to women without nocturia, women who had nocturia reported poorer sleep quality. A significant correlation was found between the number of nocturnal episodes and sleep quality. Nocturia and poor sleep are common among women with diabetes. The multifactorial nature of nocturia supports the delivered management and treatments being targeted to underlying etiologies in order to optimize women's symptom management. Interventions aimed at modifiable correlates may include maintaining a normal body weight and regular physical exercise for maintaining a normal waist circumference, and decreasing caffeine consumption, implementing feasible modifications in sleeping environments and maintaining sleep hygiene to improve sleep quality. Healthcare professionals should screen for nocturia and poor sleep and offer appropriate nonpharmacological lifestyle management, behavioral interventions, or pharmacotherapy for women

Bilateral Diabetic Papillopathy and Metabolic Control

DEFF Research Database (Denmark)

Ostri, Christoffer; Lund-Andersen, Henrik; Sander, Birgit

2010-01-01

OBJECTIVE: The pathogenesis of diabetic papillopathy largely is unknown, but case reports suggest that it may follow rapidly improved metabolic control. The present study was designed to investigate this hypothesis. DESIGN: Retrospective case-control study. PARTICIPANTS: Two thousand sixty......-six patients with type 1 diabetes. METHODS: Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008. MAIN OUTCOME MEASURES: Simultaneous, bilateral diabetic papillopathy. RESULTS: The mean follow-up was 4.9 years. During 10 020...... patient-years of observation, bilateral diabetic papillopathy developed in 5 patients. During the year preceding this incident, all 5 patients had experienced a decrease in glycosylated hemoglobin A(1c) (HbA(1C)) at a maximum rate of -2.5 (mean) percentage points per quarter year, which was significantly...

Evaluation of the difference in caries experience in diabetic and non-diabetic children-A case control study.

Science.gov (United States)

Lai, Stefano; Cagetti, Maria Grazia; Cocco, Fabio; Cossellu, Dina; Meloni, Gianfranco; Campus, Guglielmo; Lingström, Peter

2017-01-01

To evaluate the caries prevalence and related variables in Type 1 diabetic and non-diabetic children and among the diabetic children according to their metabolic status. Sixty-eight diabetic and 136 non-diabetic children, matching by gender and age (4-14 years) were enrolled. The diabetic children were divided: a) 20 children in good metabolic control (Hb1ac≤7.5) and b) 48 children in bad metabolic control (Hb1ac>7.5). Dietary and oral hygiene habits were investigated. Caries status was registered using the International Caries Detection and Assessment System. Oral microflora was analysed using the checkerboard DNA-DNA hybridisation method. Plaque acidogenicity was recorded after a sucrose rinse. Sugared beverage and snack intake was higher in diabetic group compared to non-diabetic group (p = 0.03 and p = 0.04, respectively) and in subjects in bad metabolic control (p = 0.03 and pgood metabolic control (pgood and bad metabolic control (pgood metabolic control might even be considered at low caries risk, while those in bad metabolic control showed an oral environment prone to a high caries risk.

Breaking down patient and physician barriers to optimize glycemic control in type 2 diabetes.

Science.gov (United States)

Ross, Stuart A

2013-09-01

Approximately half of patients with type 2 diabetes (T2D) do not achieve globally recognized blood glucose targets, despite the availability of a wide range of effective glucose-lowering therapies. Failure to maintain good glycemic control increases the risk of diabetes-related complications and long-term health care costs. Patients must be brought under glycemic control to improve treatment outcomes, but existing barriers to optimizing glycemic control must first be overcome, including patient nonadherence to treatment, the failure of physicians to intensify therapy in a timely manner, and inadequacies in the health care system itself. The reasons for such barriers include treatment side effects, complex treatment regimens, needle anxiety, poor patient education, and the absence of an adequate patient care plan; however, newer therapies and devices, combined with comprehensive care plans involving adequate patient education, can help to minimize barriers and improve treatment outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

Work ability among Finnish workers with type 1 diabetes.

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Hakkarainen, P; Moilanen, L; Hänninen, V; Heikkinen, J; Räsänen, K

2016-08-01

Work ability represents the balance between individual resources, health status and job demands. As far as we are aware, these issues have not been examined in working people with type 1 diabetes (T1D). To examine how work-related and diabetes-related factors are associated with work ability among male and female workers. Questionnaires were mailed to a random sample of 2500 people with T1D from the Medication Reimbursement Register of The Social Insurance Institution of Finland. The associations of the predictors of poor work ability were examined in a logistic regression analysis. The final sample comprised 767 working people aged 18-64 with T1D; overall response rate 49%. One in every three working men and women with T1D had poor work ability. High job demands and low job control were associated with poor work ability in both genders. Physical work and low worktime control were significantly associated with poor work ability in men but not in women with T1D. A self-reported high value of glycosylated haemoglobin was the only diabetes-related variable associated with poor work ability in both men and women. Work-related factors and poor glycaemic control were associated with poor work ability in individuals with T1D. Thus, job control and worktime control should be taken into account in supporting the work ability of workers with T1D. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Glycemic control and the outcomes of Hispanic patients with diabetes admitted to the general ward of a community hospital in Puerto Rico.

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Torres-Torres, Nancy; Maldonado-Rodríguez, Miguel A; Pérez-López, Shirley; Sierra-Martínez, Kassandra; García, Astrid J

2011-06-01

Uncontrolled glucose, present in 40% of diabetic patients admitted to United States hospitals, has been associated with prolonged length of stay and poorer general outcomes in critically ill and surgical patients. However, past studies of general ward patients have shown there to be no consistent benefits of strict glucose control, and the Hispanic population has been underrepresented in such studies. This work evaluated the association between glycemic control and the outcomes of hospitalized Hispanics with diabetes and to describe physicians' interventions in the treatment of diabetes. This is a retrospective chart review of all patients with diabetes admitted over a period of six months in the general ward of a community hospital in Puerto Rico. We evaluated glucose levels during the first 72 hours, length of stay, and reported complications during admission. Outcomes were evaluated with crude odds ratios and multivariate logistic regression. Uncontrolled blood glucose was observed in 59.1% of the 875 patients whose records were revised; of that 59.1%, treatment modification was not prescribed for 43.2%. Patients with poorly controlled glucose were more likely to develop acute coronary syndrome (corrected OR: 11.46; 95% CI = 1.48-88.50) as a complication and less likely to develop hypoglycemia (corrected OR: 0.57; 95% = CI 0.37-0.88). Our results suggest that hospitalized but non-critically ill Hispanic patients with diabetes are prone to poor outcomes secondary to uncontrolled glucose levels; in addition, those results support the creation of standardized protocols for the management of diabetes in this population.

The effect of metformin in overweight patients with type 1 diabetes and poor metabolic control

DEFF Research Database (Denmark)

Jacobsen, Iben Brock; Henriksen, Jan Erik; Beck-Nielsen, Henning

2009-01-01

Metformin as adjunct to intensive insulin therapy may improve glucose metabolism and thereby prevent the development of cardiovascular risk factors in patients with type 1 diabetes. Double-blinded intervention with 2000 mg metformin or placebo daily in 24 type 1 diabetic patients as adjunct...... to intensive insulin therapy. Primary endpoint was HbA1c, while secondary endpoints were body weight, frequency of hypoglycaemia, blood pressure, lipids, insulin dosage and self-monitored blood glucose profiles were measured. After 24 weeks, no difference in HbA1c was seen between the metformin and placebo...

[Cardiovascular risk factor control in a population with longstanding diabetes attending endocrinology departments].

Science.gov (United States)

Comi-Diaz, Cristina; Miralles-García, José M; Cabrerizo, Lucio; Pérez, María; Masramon, Xavier; De Pablos-Velasco, Pedro

2010-12-01

To determine the degree of control of cardiovascular risk factors (CVRF) in a sample of patients with diabetes mellitus (DM) attending Endocrinology and Nutrition Departments in Spain. An epidemiological, cross-sectional, multicenter and observational study involving 41 Departments of Endocrinology and Nutrition in Spain. Each department selected patients with DM with over 10 years of evolution, which were treated in outpatient settings. Demographic, anthropometric, clinical and biochemical data, including medication, were collected for each participant. 1159 patients who met the inclusion criteria were recruited. 52% of the participants were patients with type 2 DM. The mean duration of DM was 19.6 years. A proportion of 37%, 44%, 27.6% and 25.5% had good control of their blood pressure (BP), low density cholesterol (LDLc), lipids and glucose, respectively, and only 4.3% did well in all factors evaluated. The percentage of poorly controlled BP was four times higher in type 2 than in type 1 DM. Obesity, low cultural level and aggregation of cardiovascular risk factors were associated with poorer control. The degree of control of CVRF in diabetic patients with long disease duration is insufficient. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.

Increased ratio of serum matrix metalloproteinase-9 against TIMP-1 predicts poor wound healing in diabetic foot ulcers.

Science.gov (United States)

Li, Zhihong; Guo, Shuqin; Yao, Fang; Zhang, Yunliang; Li, Tingting

2013-01-01

Little is known about serum concentrations of Matrix Metalloproteinase-9 (MMP-9), MMP-2, TIMP-1 and TIMP-2 in diabetic patients with foot ulcers. This study demonstrates their relationship with wound healing. Ninety-four patients with diabetic foot ulcers were recruited in the study. Serum MMP-9, MMP-2, TIMP-1 and TIMP-2 were measured at the first clinic visit and the end of 4-week treatment and followed up till 12 weeks. According to the decreasing rate of ulcer healing area at the fourth week, we divided those cases into good and poor healers. Through analyses, we explore the possible relationship among those factors and degree of wound healing. The median level of serum MMP-9 in good healers was lower than poor healers at first visit (124.2 μg/L vs 374.6 μg/L, phealing than MMP-9 alone before therapy and after 4 week treatment (r = -0.6475 vs -0.3251, r = -0.7096 vs -0.1231, respectively). Receiver Operator Curve (ROC) showed that the cutoff for MMP-9/TIMP-1 ratio at healing and might provide a novel target for the future therapy in diabetic foot ulcers. Copyright © 2013 Elsevier Inc. All rights reserved.

Knowledge, Attitude, and Practice Related to Diabetes Mellitus Among Diabetics and Nondiabetics Visiting Homeopathic Hospitals in West Bengal, India.

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Koley, Munmun; Saha, Subhranil; Arya, Jogendra Singh; Choubey, Gurudev; Ghosh, Shubhamoy; Chattopadhyay, Rajat; Das, Kaushik Deb; Ghosh, Aloke; Hait, Himangsu; Mukherjee, Rajarshi; Banerjee, Tanapa

2016-01-01

High prevalence of undiagnosed cases of diabetes mellitus and poor knowledge, awareness, and practice has increased premature death, costly complications, and financial burden. A cross-sectional survey was conducted in November 2014 on 273 diabetics and 355 nondiabetics in 3 government homeopathic hospitals in West Bengal, India. A self-administered questionnaire assessing knowledge, awareness, and practice related to diabetes was used. A total of 17.5% to 29.3% of the participants were aware of the normal blood sugar level. Lack of insulin, frequent urination, hypertension, and poor wound healing were identified most frequently as the cause, symptom, association, and complications. A total of 35.5% to 46.5% said that diabetes was preventable; 14.1% to 31.9% knew that diabetes was controllable rather than curable. Consumption of planned diet, avoiding sugar, and testing blood sugar were the most frequently identified components of healthy lifestyle, diabetic diet, and diagnostic domain. Diabetics had higher knowledge and awareness than nondiabetics (P diabetes. © The Author(s) 2015.

Mother-father informant discrepancies regarding diabetes management: associations with diabetes-specific family conflict and glycemic control.

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Sood, Erica D; Pendley, Jennifer Shroff; Delamater, Alan M; Rohan, Jennifer M; Pulgaron, Elizabeth R; Drotar, Dennis

2012-09-01

To examine the relationship of mother-father informant discrepancies regarding diabetes management to diabetes-specific family conflict and glycemic control. One hundred thirty-six mothers and fathers of youth with Type 1 diabetes reported on the youth's diabetes management, diabetes-specific family conflict, and amount of paternal involvement in diabetes care. Glycosylated hemoglobin A1c (HbA1c) was used to measure glycemic control. As hypothesized, mother-father discrepancies regarding diabetes management were positively associated with frequency of diabetes-specific family conflict. Contrary to hypotheses, mother-father discrepancies regarding diabetes management predicted poorer glycemic control for youth with less involved fathers only. Results highlight the importance of caregivers being consistent about pediatric illness management and support the idea that informant discrepancies represent an important window into the functioning of the family system. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Quality of life and glycemic control in adolescents with type 1 diabetes and the impact of an education intervention

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et al

2011-02-01

Full Text Available Mostafa A Abolfotouh1,*, Mofida M Kamal2,*, Mohamed D El-Bourgy2,*, Sherine G Mohamed2,*1King Abdullah International Medical Research Center (KAIMRC, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS, Riyadh, Kingdom of Saudi Arabia; 2Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria, Egypt; *All authors contributed equally to this workObjective: To assess quality of life (QoL and glycemic control in adolescents with type 1 diabetes and to investigate the impact of an educational program.Methods: A quasiexperimental study with nonrandomized experimental and control groups was conducted in which a total of 503 adolescents with type 1 diabetes completed a questionnaire using the Diabetes Quality of Life Instrument for Youth. Adolescents were then assigned to experimental and control groups. The experimental group was subjected to four 120-minute sessions of an educational program over a period of 4 months. Extracted medical chart data included the duration of diabetes, insulin dosage, and most recent hemoglobin A1c levels. Analysis of covariance was used to detect the impact of intervention.Results: The overall mean QoL score (% was 76.51 ± 9.79, with good QoL in 38% of all adolescents. Poorer QoL was significantly associated with older age (P < 0.001, more hospital admissions in the last 6 months (P = 0.006, higher levels of depression (P < 0.001, poor self-esteem (P < 0.001, and poor self-efficacy (P < 0.001. There was significant deterioration in all domains of QoL in the experimental group after intervention. However, this deterioration was significantly less severe than in the control group. Between-group effects on total knowledge, adherence to exercise, glucose monitoring, treatment, self-efficacy, family contribution to management, glycemic control, and satisfaction with life were significantly in favor of the experimental group

Glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with renal complications

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Huri HZ

2015-08-01

Full Text Available Hasniza Zaman Huri,1,2 Lay Peng Lim,1 Soo Kun Lim3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, 2Clinical Investigation Centre, University Malaya Medical Centre, 3Renal Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Background: Good glycemic control can delay the progression of kidney diseases in type 2 diabetes mellitus (T2DM patients with renal complications. To date, the association between antidiabetic agents and glycemic control in this specific patient population is not well established.Purpose: This study aimed to identify antidiabetic regimens as well as other factors that associated with glycemic control in T2DM patients with different stages of chronic kidney disease (CKD.Patients and methods: This retrospective, cross-sectional study involved 242 T2DM inpatients and outpatients with renal complications from January 2009 to March 2014 and was conducted in a tertiary teaching hospital in Malaysia. Glycated hemoglobin (A1C was used as main parameter to assess patients’ glycemic status. Patients were classified to have good (A1C <7% or poor glycemic control (A1C ≥7% based on the recommendations of the American Diabetes Association.Results: Majority of the patients presented with CKD stage 4 (43.4%. Approximately 55.4% of patients were categorized to have poor glycemic control. Insulin (57.9% was the most commonly prescribed antidiabetic medication, followed by sulfonylureas (43%. Of all antidiabetic regimens, sulfonylureas monotherapy (P<0.001, insulin therapy (P=0.005, and combination of biguanides with insulin (P=0.038 were found to be significantly associated with glycemic control. Other factors including duration of T2DM (P=0.004, comorbidities such as anemia (P=0.024 and retinopathy (P=0.033, concurrent medications such as erythropoietin therapy (P=0.047, a-blockers (P=0.033, and antigouts (P=0.003 were also correlated with A1C.Conclusion: Identification of

Effectiveness of basal-supported oral therapy (BOT) using insulin glargine in patients with poorly controlled type 2 diabetes.

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Suzuki, Daisuke; Umezono, Tomoya; Miyauchi, Masaaki; Kimura, Moritsugu; Yamamoto, Naoyuki; Tanaka, Eitaro; Kuriyama, Yusuke; Sato, Hiroki; Miyatake, Han; Kondo, Masumi; Toyoda, Masao; Fukagawa, Masafumi

2012-07-20

To determine the clinical usefulness of basal-supported oral therapy (BOT) using insulin glargine in Japanese patients with type 2 diabetes. We compared HbA1c levels, body weight, and insulin doses before the introduction of BOT and in the final month of the observation period in 122 patients with type 2 diabetes who received BOT with insulin glargine between October 2007 and July 2009. To exclude the possible effects of seasonal changes in glycemic control, 57 of the 122 patients were followed-up for one year and examined for changes in HbA1c levels, body weight, and insulin dose. Examination of all cases (n=122) showed a significant decrease in HbA1c (before BOT: 8.7±1.8, after: 7.1±1.1%), but no significant change in body weight (before: 63.1±16.1, after: 63.8±17.0 kg). The mean observation period was 10.5±6.4 months. Insulin doses were significantly increased during the study. HbA1c levels improved significantly in patients on non-insulin-secreting drugs (biguanide, α-glucosidase inhibitor and thiazolidine derivatives) than those on insulin-secreting drugs (SU agents and glinides). BOT with insulin glargine is a useful strategy that can achieve good glycemic control in clinical practice without causing serious hypoglycemia. The introduction of BOT before exhaustion of pancreatic β cells may increase its effectiveness.

Ethnic differences in glycaemic control and complications: the adult diabetes control and management (ADCM), Malaysia.

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Chew, B H; Mastura, I; Lee, P Y; Wahyu, T Sri; Cheong, A T; Zaiton, A

2011-08-01

Ethnicity is an important factor in diabetes care. The understanding of its effect in this country may help to improve diabetes care, glycaemic control and diabetic complication rates. This study was to determine the diabetes control profile in relation to complication rates between the three main ethnics group in Malaysia. This nested cross-sectional study was part of the Audit of Diabetes Control and Management (ADCM), an ongoing cohort patient registry focused on diabetes control and management in the primary care setting in Malaysia. This registry registers all diabetes patients aged 18 years old and above. Demographic data, diabetes duration, treatment modalities, as well as various risk factors and diabetes complications are reported. Data was handled by statisticians using STATA version 9. A total of 20330 patients from 54 health centers were registered at the time of this report. The majority were type 2 diabetics (99.1%) of whom 56.6% were female. The mean age was 57.9 years (SD 11.58). Malay accounted for 56.3%, Chinese 19.5% and Indian 22.5%. There were 30.3% who attained HbA1c profiles. The Chinese diabetics suffer as many diabetes-related complications despite better glycaemic control. Further studies will need to look into other socio-genetic factors in order to provide a more personalized effective diabetes care.

Pancreatic scintigraphy in diabetes mellitus

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Shio, Hiroshi; Ueki, Jyuichi; Nomura, Kozi; Nakamura, Yoshifumi

1983-01-01

Pancreatic scintigraphy was performed on 67 diabetic patients (42 males and 25 females) in order to study exocrine pancreatic functions in primary diabetes. Relationships between visualization and the onset age, sex, morbid period, presence or absence of retinitis, good or poor control of blood glucose control and the therapeutic modality of diabetes were examined. Abnormality was detected in 34 cases (50.7%), being frequent among male patients in their 50s. The more serious the diabetes, i.e., with a longer morbid period, poorer blood glucose control and worse retinitis, the higher was the frequency of abnormality in pancreatic visualization. The frequency of abnormality was high in association with insulin treatment, oral tablets and single dietary treatment in that order. The more severe the hypoinsulinism, the higher was the frequency of abnormality. This technique can be used as a screening means for exocrine pancreatic function tests on diabetics. (Chiba, N.)

The Relationship Between Perceived Family Climate and Glycemic Control in Type 1 Diabetes Mellitus Adolescent Patients.

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Eray, Şafak; Uçar, Halit Necmi; Çetinkaya, Fatma; Eren, Erdal; Vural, Pınar

2017-09-01

Type 1 diabetes mellitus (T1DM) is a chronic disease which ranks third in children under age 16 years. Expressed emotion (EE) is a term that indicates a specific family climate including lack of emotional support (LES), irritability, and emotional over-involvement. It is known that the family environment is highly important for glycemic control in diabetic adolescents. In this study, the relationship between perceived EE and glycemic control in adolescents diagnosed with T1DM not accompanied by psychopathology were investigated. The study included 49 adolescents with T1DM and 50 adolescents as a control group. Adolescents with psychopathology and intellectual disability were excluded from the study. Perceived EE was measured by the Shortened Level of Expressed Emotion Scale (SLEES) and blood sugar regulation was assessed by HbA1c levels. The adolescents with T1DM showed a significant difference in perceived EE (p=0.020) and LES (p=0.014) when compared with the control group. When diabetic adolescents were compared among themselves, the diabetic adolescents with poor glycemic control perceived greater EE (p=0.033) and less emotional support (p=0.049). In regression analyses, the predictive power of mother's educational level, the employment status of mothers and the subscale "LES" of SLEES combined to explain HbA1c level was determined to be 37.8%. The strong relationship between perceived EE and glycemic control showed us that perceived EE can hinder treatment compliance without causing psychopathology. For this reason, it is recommended that not only patients with psychopathology, but all diabetic adolescents receive psychosocial support and family interventions.

Poor Vitamin C Status Late in Pregnancy Is Associated with Increased Risk of Complications in Type 1 Diabetic Women: A Cross-Sectional Study

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Bente Juhl

2017-02-01

Full Text Available Vitamin C (vitC is essential for normal pregnancy and fetal development and poor vitC status has been related to complications of pregnancy. We have previously shown lower vitC status in diabetic women throughout pregnancy compared to that of non-diabetic controls. Here, we evaluate the relationship between vitC status late in diabetic pregnancy in relation to fetal outcome, complications of pregnancy, diabetic characteristics, and glycemic control based on data of 47 women from the same cohort. We found a significant relationship between the maternal vitC level > or ≤ the 50% percentile of 26.6 μmol/L, respectively, and the umbilical cord blood vitC level (mean (SD: 101.0 μmol/L (16.6 versus 78.5 μmol/L (27.8, p = 0.02; n = 12/16, while no relation to birth weight or Apgar score was observed. Diabetic women with complications of pregnancy had significantly lower vitC levels compared to the women without complications (mean (SD: 24.2 μmol/L (10.6 vs. 34.6 μmol/L (14.4, p = 0.01; n = 19 and 28, respectively and the subgroup of women (about 28% characterized by hypovitaminosis C (<23 μmol/L had an increased relative risk of complications of pregnancy that was 2.4 fold higher than the one found in the group of women with a vitC status above this level (p = 0.02, 95% confidence interval 1.2–4.4. No correlation between diabetic characteristics of the pregnant women and vitC status was observed, while a negative association of maternal vitC with HbA1c at delivery was found at regression analysis (r = −0.39, p < 0.01, n = 46. In conclusion, our results may suggest that hypovitaminosis C in diabetic women is associated with increased risk of complications of pregnancy.

Relative risk of hypertension and coronary artery disease in diabetes mellitus

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Chaudhary, G.M.D.

2001-01-01

During the year 1996-1997, 3275 diabetic patients, registered in Diabetic Clinic of Jinnah Hospital, Lahore, were studied to note the effect of various variables of diabetes mellitus (DM) on hypertension (HTN) and coronary artery diseases (CAD). Out of these 1402 (42.8%) were hypertensive patients. HTN was observed more frequently in obese, older age, longer duration of DM, poor glycemic control and dyslipidemia with p<0.0001. The relative risk (RR) of HTN was significantly increased (p<0.001) in obese (M2.53, F7.77 times), older age (M 3.69,F 9.64 times), longer duration of Dm (2.3 times for both sexes), poor glycemic control (M 2.89, F 4.75 times) and dyslipedemia (M 1.62-5.27, F2.56-9.53 times). While the RR of CAD due to HTN was 4.6 times (M5.4, F4.2 times) (p<0.0001) as compared to normotensive diabetic patients. The risk of developing HTN is more in female diabetics and of CAD in male hypertensive diabetic patients. It is concluded that obesity, older age, poor glycemic control, longer duration of DM and dyslipidemia increases the risk of HTN 2-9.5 times and HTN increases the risk of CAD by 4-5 times, hence requiring aggressive and comprehensive treatment of the diabetes mellitus syndrome. (author)

Relative risk of hypertension and coronary artery disease in diabetes mellitus

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Chaudhary, G M.D. [Nishter Medical Coll., Multan (Pakistan). Dept. of Medicine

2001-03-01

During the year 1996-1997, 3275 diabetic patients, registered in Diabetic Clinic of Jinnah Hospital, Lahore, were studied to note the effect of various variables of diabetes mellitus (DM) on hypertension (HTN) and coronary artery diseases (CAD). Out of these 1402 (42.8%) were hypertensive patients. HTN was observed more frequently in obese, older age, longer duration of DM, poor glycemic control and dyslipidemia with p<0.0001. The relative risk (RR) of HTN was significantly increased (p<0.001) in obese (M2.53, F7.77 times), older age (M 3.69,F 9.64 times), longer duration of Dm (2.3 times for both sexes), poor glycemic control (M 2.89, F 4.75 times) and dyslipedemia (M 1.62-5.27, F2.56-9.53 times). While the RR of CAD due to HTN was 4.6 times (M5.4, F4.2 times) (p<0.0001) as compared to normotensive diabetic patients. The risk of developing HTN is more in female diabetics and of CAD in male hypertensive diabetic patients. It is concluded that obesity, older age, poor glycemic control, longer duration of DM and dyslipidemia increases the risk of HTN 2-9.5 times and HTN increases the risk of CAD by 4-5 times, hence requiring aggressive and comprehensive treatment of the diabetes mellitus syndrome. (author)

Identifying barriers to glycemic control in patients with type 2 diabetes after completion of an accredited education program.

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Gildea, Chris M; Lantaff, Wendy M; Olenik, Nicole L

The objective of this study was to identify patient-perceived barriers to achieving A1C targets after receiving instruction in an accredited diabetes education program. Qualitative research using semistructured interviews and thematic analyses. One pharmacist-run diabetes center located within an independent community pharmacy in a suburban region of southern Indiana. A total of 17 participants between the ages of 41-78 were interviewed in March and April 2016. Not applicable. Patient-perceived barriers to attaining glycemic control after completion of a pharmacist-taught diabetes self-management education (DSME) program accredited by the American Association of Diabetes Educators. Participants reported a variety of perceived barriers to glycemic control subsequent to the receipt of structured education. Seven major themes emerged: 1) health care provider factors; 2) self-identified indiscretions; 3) psychological barriers and poor social support; 4) knowledge deficits; 5) personal injury or adverse drug events; 6) time constraints and competing life demands; and 7) financial constraints. Participants reported a variety of perceived barriers to achieving A1C targets after completing DSME. Incorporation of solutions and coping mechanisms to these barriers into diabetes education programs may help patients attain glycemic control. Other factors may require individualized attention outside of DSME in follow-up episodes of diabetes care. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

A Participatory Randomized Controlled Trial in Knowledge Translation (KT) to Promote the Adoption of Self-Monitoring of Blood Glucose for Type 2 Diabetes Mellitus Patients in An Urban District of Thailand.

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Suriyawongpaisal, Paibul; Tansirisithikul, Rassamee; Sakulpipat, Thida; Charoensuk, Phikul; Aekplakorn, Wichai

2016-02-01

To examine effectiveness of self-monitoring of blood glucose (SMBG) in glycemic control for poor control diabetes patients, and test whether the glycemic outcome for those with the 7-point SMBG was better than those with 5-point SMBG or usual care. Randomized-controlled trial (RCT) of patients with type 2 diabetes mellitus aged 30 years or older HbA1c > 7. Patients were randomly allocated to one of three groups; 7-point SMBG 5-point SBMG and control group. Differences in HbA1c at 6 months and baseline were compared among groups. A total of 191 patients with poor control of diabetes were included. Compared with baseline, at 6 months, average change in HbAlc among control, 7-point, and 5-point SMBG were -0.38, -0.87, and -0.99 (p = 0.04), respectively. The corresponding percentages of patients with reduced HbA1c were 57.1%, 77.6% and 75.5%, respectively (p = 0.03). Using different cut-off values for HbA1c (patients among the 3 groups, yet the differences were not statistically significant. Reductions in body weight were observed in both SMBG groups but not in the control group. Using RCT on participatory basis, SMBG with individual dietary counseling was effective in short term. Further engagement with the provider team, the patients/care takers and the health care financing agency to integrate SMBG in the care protocol for poor control diabetes should be considered.

Diabetic Myonecrosis: An Atypical Presentation

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José Hernán Martínez

2013-01-01

Full Text Available Diabetic myonecrosis is a frequently unrecognized complication of longstanding and poorly controlled diabetes mellitus. The clinical presentation is swelling, pain, and tenderness of the involved muscle, most commonly the thigh muscles. Management consists of conservative measures including analgesia and rest. Short-term prognosis is good, but long-term prognosis is poor with most patients dying within 5 years. Failure to properly identify this condition will expose the patient to aggressive measures that could result in increased morbidity. To our knowledge this is the first case reported in which there was involvement of multiple muscle groups including upper and lower limbs.

Comparison of glycemic control and variability in patients with type 2 and posttransplantation diabetes mellitus.

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Werzowa, Johannes; Pacini, Giovanni; Hecking, Manfred; Fidler, Catharina; Haidinger, Michael; Brath, Helmut; Thomas, Andreas; Säemann, Marcus D; Tura, Andrea

2015-01-01

Posttransplantation diabetes mellitus (PTDM) is a common complication after renal transplantation leading to increased cardiovascular morbidity and mortality. In subjects with type 2 diabetes (T2DM) increased glycemic variability and poor glycemic control have been associated with cardiovascular complications. We therefore aimed at determining glycemic variability and glycemic control in subjects with PTDM in comparison to T2DM subjects. In this observational study we analyzed 10 transplanted subjects without diabetes (Control), 10 transplanted subjects with PTDM, and 8 non-transplanted T2DM subjects using Continuous Glucose Monitoring (CGM). Several indices of glycemic control quality and variability were computed. Many indices of both glycemic control quality and variability were different between control and PTDM subjects, with worse values in PTDM. The indices of glycemic control, such as glucose mean, GRADE and M-value, were similar in PTDM and T2DM, but some indices of glycemic variability, that is CONGA, lability index and shape index, showed a markedly higher (i.e., worse) value in T2DM than in PTDM (P value range: 0.001-0.035). Although PTDM and T2DM subjects showed similar glycemic control quality, glycemic variability was significantly higher in T2DM. These data underscore potential important pathophysiological differences between T2DM and PTDM indicating that increased glycemic variability may not be a key factor for the excess cardiovascular mortality in patients with PTDM. Copyright © 2015 Elsevier Inc. All rights reserved.

Worldwide increase in diabetes: implications for tuberculosis control

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Fisher-Hoch SP

2014-07-01

Full Text Available Susan P Fisher-HochDivision of Epidemiology, Human Genetics and Environmental Science, University of Texas School of Public Health, Brownsville Campus, Brownsville, TX, USAAbstract: Diabetes presents a greater threat to global tuberculosis (TB control than previously appreciated, with risk of reversing the achievements of several decades. An estimated 382 million people worldwide currently have diabetes, half of whom are undiagnosed. Most live in low- and middle-income countries alongside many of the two billion individuals infected with TB. Though the frequency of TB in type 1 diabetes was known for centuries, only recently have we observed the tripling of TB in type 2 diabetes, most significantly in high-burden TB populations such as in Peru, Russia, and the People's Republic of China. In India diabetes is estimated to have increased TB cases by 46% between 1998 and 2008. Diabetes is a greater long-term threat to TB control than human immunodeficiency virus (HIV/acquired immunodeficiency syndrome (AIDS since ten-fold more people are affected by diabetes than HIV/AIDS in larger geographic areas. Diabetes in TB increases drug resistance, treatment failure, and mortality, and may increase the spread of drug-resistant strains. Delayed or missed diagnosis fuels transmission of TB and hinders control of diabetes. Tailored treatment for diabetes patients requires well-designed clinical trials. The World Health Organization (WHO framework for care and control of diabetes and TB needs improved screening strategies. Determination of how best to establish bi-directional screening is hampered by lack of affordable and reliable methods. Recommendations include education of health care providers, patients, and communities. Structured diabetes programs with registries and effective follow-up could be modeled on and communicate with existing TB programs. Vital research should address new diagnostic tools, lowering cost and evaluation of intervention

Association between metabolic control and oral health in adolescents with type 1 diabetes mellitus.

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Saes Busato, Ivana Maria; Bittencourt, Mônica Sommer; Machado, Maria Angela Naval; Grégio, Ana Maria Trindade; Azevedo-Alanis, Luciana Reis

2010-03-01

The aim of this study was to evaluate the association between metabolic control and oral health of adolescents with type 1 diabetes mellitus (DM1). A case-control epidemiologic study was performed on adolescents allocated between 2 groups: DM1 group composed of 51 with DM1, and control group composed of 51 without diabetes. In the DM1 group, metabolic control data were observed (glycosylated hemoglobin (GHb) and capillary glucose), whereby GHb 8.0% poor metabolic control (DM1-B). Oral mucosal abnormalites, Community Periodontal Index (CPI), and decayed, missing, and filled (DMF) index were documented. Salivary flow was evaluated by means of stimulated saliva collection (SSFR). Glycosylated hemoglobin values of 8.0% (DM1-B) in 34 (76%) of the subjects. The average DMF indexes were 1.5 (control) and 3.3 (DM1-group) (P < or = .05). The average CPIs were 0.2 (control), 1.4 (DM1-A), and 2.0 (DM1-B) (P < or = .05). Average SSFRs were 0.997 (DM1-A), 0.903 (DM1-B), and 1.224 (control) mL/min. Oral health of adolescents with DM1 was impaired regardless of metabolic control. Copyright 2010 Mosby, Inc. All rights reserved.

Text message-based diabetes self-management support (SMS4BG): study protocol for a randomised controlled trial.

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Dobson, Rosie; Whittaker, Robyn; Jiang, Yannan; Shepherd, Matthew; Maddison, Ralph; Carter, Karen; Cutfield, Richard; McNamara, Catherine; Khanolkar, Manish; Murphy, Rinki

2016-04-02

Addressing the increasing prevalence, and associated disease burden, of diabetes is a priority of health services internationally. Interventions to support patients to effectively self-manage their condition have the potential to reduce the risk of costly and debilitating complications. The utilisation of mobile phones to deliver self-management support allows for patient-centred care at the frequency and intensity that patients desire from outside the clinic environment. Self-Management Support for Blood Glucose (SMS4BG) is a novel text message-based intervention for supporting people with diabetes to improve self-management behaviours and achieve better glycaemic control and is tailored to individual patient preferences, demographics, clinical characteristics, and culture. This study aims to assess whether SMS4BG can improve glycaemic control in adults with poorly controlled diabetes. This paper outlines the rationale and methods of the trial. A two-arm, parallel, randomised controlled trial will be conducted across New Zealand health districts. One thousand participants will be randomised at a 1:1 ratio to receive SMS4BG, a theoretically based and individually tailored automated text message-based diabetes self-management support programme (intervention) in addition to usual care, or usual care alone (control). The primary outcome is change in glycaemic control (HbA1c) at 9 months. Secondary outcomes include glycaemic control at 3 and 6 months, self-efficacy, self-care behaviours, diabetes distress, health-related quality of life, perceived social support, and illness perceptions. Cost information and healthcare utilisation will also be collected as well as intervention satisfaction and interaction. This study will provide information on the effectiveness of a text message-based self-management support tool for people with diabetes. If found to be effective it has the potential to provide individualised support to people with diabetes across New Zealand (and

Type 2 diabetes: how do Thai Buddhist people with diabetes practise self-management?

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Lundberg, Pranee C; Thrakul, Supunnee

2012-03-01

This paper is a report of a study of how Thai Buddhist people with type 2 diabetes practice self-management. The importance of diabetes self-management is recognized in the literature. However, research on self-care management in Thailand, in particular concerning Buddhist people with type 2 diabetes, is scarce. A descriptive qualitative study was conducted. Purposive convenience sampling was used, and thirty men and women with diabetes, aged 28-79 years, participated. Data were collected from June to August 2009 and analysed by use of manifest and latent content analysis. Five themes of self-management among Thai Buddhist people with type 2 diabetes were identified: cultural influence on disease control, Buddhism and Thai culture, struggle for disease control, family support and economy a high priority. Even though the Buddhist people with diabetes had certain self-management capabilities, many had poor control of their blood sugar levels and needed assistance. Reference to Buddhist moderation can be an effective means of helping the people with diabetes better manage their disease and change their lifestyles. In addition to cultural and religious traditions, family, economy and social environment should be taken into account both in the care and in interventions aimed at helping people with diabetes cope and empowering them to control their disease. © 2011 Blackwell Publishing Ltd.

Psychological aspects of diabetes management

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Snoek, Frank J.; Skinner, T. Chas

2006-01-01

Diabetes is a largely self-managed disease. Consequently, if the patient is unwilling or unable to self-manage his or her diabetes on a day-to-day basis, outcomes will be poor, regardless of how advanced the treatment technology is. Cognitive, emotional, behavioural and social factors have a vital...... role in diabetes management. More so, as co-morbid depression and other psychological problems are prevalent and negatively impact on well-being and metabolic outcomes. There is more to diabetes than glucose control; it requires a biopsychosocial approach. Motivational counselling and behaviour change...... and 'diabetes burnout'. Integrating psychology in diabetes management can help to effectively tailor care to the patient's individual needs and improve outcomes....

Adherence to a diabetic care plan provides better glycemic control in ambulatory patients with type 2 diabetes.

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Chiu, Yi-Wen; Chang, Jer-Ming; Lin, Li-Ing; Chang, Pi-Yu; Lo, Wan-Ching; Wu, Ling-Chu; Chen, Tun-Chieh; Hwang, Shang-Jyh

2009-04-01

Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3-4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c) levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: -2.5 +/- 1.8% vs. -1.1 +/- 1.7%, p decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05). Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.

Adherence to A Diabetic Care Plan Provides Better Glycemic Control in Ambulatory Patients With Type 2 Diabetes

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Yi-Wen Chiu

2009-04-01

Full Text Available Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3–4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: −2.5 ± 1.8% vs. −1.1 ± 1.7%, p < 0.01. The maximal HbA1c decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05. Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.

Development of a Group Intervention for Teens with Type 1 Diabetes

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Cespedes-Knadle, Yolanda M.; Munoz, Cynthia E.

2011-01-01

Adolescents with Type 1 diabetes (DM1) are at significant risk for depression compared to their non-diabetic counterparts and frequently demonstrate poor glycemic control. Comorbid depression may further exacerbate inadequate metabolic control by creating emotional barriers to effective adherence. Caregiver response to the diagnosis and management…

Adolescents developing life skills for managing type 1 diabetes

DEFF Research Database (Denmark)

Husted, Gitte R; Esbensen, Bente Appel; Hommel, Eva

2014-01-01

AIM: To explore and illustrate how the Guided Self-Determination-Youth method influences the development of life skills in adolescents with type 1 diabetes supported by their parents and healthcare providers. BACKGROUND: Evidence-based methods that accomplish constructive cooperation between...... adolescents with poorly controlled type 1 diabetes, their parents and healthcare providers are needed. We adjusted an adult life skills intervention comprising reflection sheets and advanced communication for use by adolescent-parent-professional triads in outpatient visits. DESIGN: A qualitative realistic...... with type 1 diabetes for ≥1 year and having poor glycaemic control participated together with 17 parents and eight healthcare providers. Data were collected from December 2009-March 2012 and consisted of digitally recorded outpatient Guide Self-Determination-Youth visits collected during the intervention...

Monitoring of Individual Needs in Diabetes (MIND)-2 Follow-up data from the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) MIND study

NARCIS (Netherlands)

Snoek, F.J.; Kersch, N.Y.A.; Eldrup, E.; Harman-Boehm, I.; Hermanns, N.; Kokoszka, A.; Matthews, D.R.; McGuire, B.E.; Pibernik-Okanovic, M.; Singer, J.; de Wit, M.; Skovlund, S.E.

2012-01-01

OBJECTIVE - To test the effects of implementing computer-assisted Monitoring of Individual Needs in Diabetes (MIND) in routine diabetes care on psychological status and glycemic control, identify predictors of poor psychological outcomes, and evaluate care providers' experiences. RESEARCH DESIGN AND

Decreased Retinal Thickness in Type 1 Diabetic Children with Signs of Nonproliferative Diabetic Retinopathy

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P. Ruiz-Ocaña

2018-01-01

Full Text Available The retina functions as a neurovascular unit. How early vascular alterations affect neuronal layers remains controversial; early vascular failure could lead to edema increasing retinal thicknesses, but alternatively neuronal loss could lead to reduced retinal thickness. Objective. To evaluate retinal thickness in a cohort of pediatric patients with type 1 diabetes mellitus (PwT1DM and to analyze differences according to the presence or absence of nonproliferative diabetic retinopathy (NPDR, poor metabolic control, and diabetes duration. Patients and Methods. We performed retinographies and optical coherence tomography (OCT (TOPCON 3D1000® to PwT1DM followed at our center and healthy controls. Measurements of the control group served to calculate reference values. Results. 59 PwT1DM (age 12.51 ± 2.59 and 22 healthy controls (age 10.66 ± 2.51 volunteered. Only two PwT1DM, both adolescents with poor metabolic control, presented NPRD. Both showed decreased thicknesses and retinal volumes. The odds ratio of having decreased retinal thickness when signs of NPDR were present was 11.72 (95% IC 1.16–118.28; p=0.036. Conclusions. PwT1DM with NPDR have increased odds of decreased retinal thicknesses and volumes. Whether these changes are reversible by improving metabolic control or not remains to be elucidated.

Relationship between patients' perception of the importance of diabetes and metabolic control and pursuing chronic complications of disease

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Mohammad Ebrahim Khamseh

2011-04-01

Full Text Available Introduction: Type II diabetes is a metabolic disorder. Environmental factors and patient awareness have major roles on chronic complications. The purpose of this study was to determine the association of patients' perception of t the importance of diabetes and metabolic- control and pursuing of chronic complications. Material and Methods: 194 patients with diabetes enrolled from diabetes clinic of Institute Endocrinology & Metabolism in a cross-sectional study, from February to March 2010. Data were collected using a questionnaire to assess the personal demographics, individual approach in pursuit of complications, and glycemic control, as well as patient perception and attitude toward the importance of disease process and follow-up. Level of perceptions was determined as well, moderate and weak. Results: Out of 194 patients, 77(39.7% were male and 117(60.3% female. Mean age was 52.18±10.17years. 69.2% did not know what the glycosylated hemoglobin was. In 71.4%, willing to participate in decisions making on medical treatment was good and they knew that with initiation of insulin therapy, they would have better metabolic control. 68.9% of patients had regular follow-up for eye complications, and 51% for cardiac complications. Follow-up for diabetic foot complication was poor. Patients with good perception had regular follow-up regarding cardiac, eye and renal complications. Conclusion: These results indicate that better perception of diabetic patients might improve their compliance for regular follow- up regarding the pursuit of chronic complications, especially cardiac, eye and renal problems. Although, the metabolic- control of patients had not the association with patient perception about the importance of diabetes

Metabolic Control, Nutrition Knowledge, Attitude and Practice in Non-Insulin-dependent Diabetic Patients from Kohgiluyeh and Boyer-Ahmad Province, South-West of Iran

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Janmohamad Malekzadeh

2016-07-01

Full Text Available Background and Objectives: Diabetes mellitus is among the most common causes of mortality in the world and an important risk factor for chronic kidney disease, foot amputation, ischemic heart disease and blindness among older adults. Diabetic patients mostly develop hyperlipidemia, which can result in cardiovascular diseases. Patient’s knowledge, attitude and practices toward diet are the core center for diabetes control and affect their metabolic control and complications. In the present study, we measured nutritional knowledge, attitude and practices and their relations to serum lipids, HbA1C, and fasting blood glucose in diabetic patients of Boirahmad County, southwest of Iran, where many people encounter increasing prevalence of diabetes. Materials and Methods: 198 IDDM patients from the rural and urban areas of Boirahmad County were invited to the health centers to be checked for their fasting blood glucose, serum total cholesterol, serum HDL cholesterol, serum triglyceride and also serum glycosylated hemoglobin. Their knowledge, attitude, and practices toward the diabetic diet were assessed using a validated questionnaire. The obtained scores were classified into three categories (Poor, average, and Good to show their knowledge, attitude and practice levels, and the serum parameters were compared between the levels to show the relevancies. Results: Our data showed that the patients’ knowledge and attitude on diabetic nutrition are mostly at the average level (79.3% and 47.1%, respectively but their practice scores are mostly at the poor level (43.8%, and just a minor proportion of the patients are at the appropriate levels (15.3, 33, and 23.1% of knowledge, attitude and practices, respectively. In addition, we found a significant reverse relationship between the patients’ nutritional knowledge and  serum HbA1C (p=0.003, and also between their attitude and serum triglyceride (p<0.05. Conclusions: Our data suggest that the knowledge

SERUM magnesium levels as an indicator of status of Diabetes Mellitus type 2.

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Ramadass, S; Basu, Sharbari; Srinivasan, A R

2015-01-01

Magnesium deficiency is commonly associated with endocrine and metabolic disorders, especially with Diabetes Mellitus type 2 though the mechanism of hypomagnesemia in Diabetes Mellitus is not completely known. There is a close association between metabolic control of Diabetes Mellitus and impaired magnesium balance. To estimate the serum levels of magnesium in patients of with Diabetes Mellitus type 2 and to find a correlation if any, with the duration and control (by estimating HbA1c) of Diabetes Mellitus type 2. Fifty patients of Diabetes Mellitus type 2 were included in the study. Blood samples were analyzed for fasting and post prandial glucose, HbA1c and magnesium. The patients were grouped into three categories based upon their HbA1c levels into those with good control, need intervention and poor control. The three groups were compared with reference to their mean levels of blood glucose and magnesium. Association of serum magnesium levels with HbA1c, Fasting and postprandial blood glucose and duration of Diabetes Mellitus was also done. Serum magnesium levels were found to decline with rise in HbA1c levels and with duration of Diabetes Mellitus type 2. Hypomagnesemia is linked to poor control of Diabetes Mellitus type 2 and depletion of serum magnesium occurs exponentially with duration of disease. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Clinical, behavioural and social indicators for poor glycaemic control around the time of transfer to adult care: a longitudinal study of 126 young people with diabetes

DEFF Research Database (Denmark)

Castensøe-Seidenfaden, P.; Jensen, A. K.; Smedegaard, H.

2017-01-01

participants aged 14–22 years from 2 years before to 2 years after transfer from paediatric to adult care. Changes in glycaemic control were calculated using repeated measurements. We adjusted for gender, age at diabetes onset, age at transfer, duration of diabetes at transfer, gap (amount of time) between...... levels and thereby reduce hospitalization rates....

Symptoms of depression and diabetes-specific emotional distress are associated with a negative appraisal of insulin therapy in insulin-naïve patients with Type 2 diabetes mellitus. A study from the European Depression in Diabetes [EDID] Research Consortium

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Makine, Ceylan; Karşidağ, C; Kadioğlu, P

2009-01-01

AIMS: A meta-analysis concluded that depression is associated with poor glycaemic control in Type 2 diabetes (DM2). In DM2 patients with deteriorating glycaemic control, the initiation of insulin therapy is often postponed. The aim of the present study was to determine whether symptoms of depress......AIMS: A meta-analysis concluded that depression is associated with poor glycaemic control in Type 2 diabetes (DM2). In DM2 patients with deteriorating glycaemic control, the initiation of insulin therapy is often postponed. The aim of the present study was to determine whether symptoms...... of depression and diabetes-specific emotional distress are associated with a more negative appraisal of insulin therapy. METHODS: We collected cross-sectional data in two outpatient university clinics in Istanbul, Turkey. The study sample consisted of 154 insulin-naïve patients with DM2. A self...... scores. Multiple regression analyses showed that a negative appraisal of insulin therapy was significantly associated with higher depression and diabetes-distress scores and low education, but not with sex, age or duration of diabetes. CONCLUSIONS: Our results suggest that in insulin-naïve Type 2...

A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control Among Clients In Three States.

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Seligman, Hilary K; Lyles, Courtney; Marshall, Michelle B; Prendergast, Kimberly; Smith, Morgan C; Headings, Amy; Bradshaw, Georgiana; Rosenmoss, Sophie; Waxman, Elaine

2015-11-01

Food insecurity--defined as not having adequate quantity and quality of food at all times for all household members to have an active, healthy life--is a risk factor for poor diabetes control, yet few diabetes interventions address this important factor. Food pantries, which receive food from food banks and distribute it to clients in need, may be ideal sites for diabetes self-management support because they can provide free diabetes-appropriate food to people in low-income communities. Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in three states in a six-month pilot intervention that provided them with diabetes-appropriate food, blood sugar monitoring, primary care referral, and self-management support. Improvements were seen in pre-post analyses of glycemic control (hemoglobin A1c decreased from 8.11 percent to 7.96 percent), fruit and vegetable intake (which increased from 2.8 to 3.1 servings per day), self-efficacy, and medication adherence. Among participants with elevated HbA1c (at least 7.5 percent) at baseline, HbA1c improved from 9.52 percent to 9.04 percent. Although food pantries are nontraditional settings for diabetes support, this pilot study suggests a promising health promotion model for vulnerable populations. Policies supporting such interventions may be particularly effective because of food pantries' food access and distribution capacity. Project HOPE—The People-to-People Health Foundation, Inc.

Insufficient insulin administration to diabetic rats increases substrate utilization and maintains lactate production in the kidney

DEFF Research Database (Denmark)

Laustsen, Christoffer; Lipsø, Hans Kasper Wigh; Østergaard, Jakob Appel

2014-01-01

with insulin, resulting in poor glycemic control, has an additional effect on progression of late diabetic complications, than poor glycemic control on its own. We therefore compared renal metabolic alterations during conditions of poor glycemic control with and without suboptimal insulin administration, which...... administration increased pyruvate utilization and metabolic flux via both anaerobic and aerobic pathways in diabetic rats even though insulin did not affect kidney oxygen availability, HbA1c, or oxidative stress. These results imply direct effects of insulin in the regulation of cellular substrate utilization...... and metabolic fluxes during conditions of poor glycemic control. The study demonstrates that poor glycemic control in combination with suboptimal insulin administration accelerates metabolic alterations by increasing both anaerobic and aerobic metabolism resulting in increased utilization of energy substrates...

Existence and characterization of optimal control in mathematics model of diabetics population

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Permatasari, A. H.; Tjahjana, R. H.; Udjiani, T.

2018-03-01

Diabetes is a chronic disease with a huge burden affecting individuals and the whole society. In this paper, we constructed the optimal control mathematical model by applying a strategy to control the development of diabetic population. The constructed mathematical model considers the dynamics of disabled people due to diabetes. Moreover, an optimal control approach is proposed in order to reduce the burden of pre-diabetes. Implementation of control is done by preventing the pre-diabetes develop into diabetics with and without complications. The existence of optimal control and characterization of optimal control is discussed in this paper. Optimal control is characterized by applying the Pontryagin minimum principle. The results indicate that there is an optimal control in optimization problem in mathematics model of diabetic population. The effect of the optimal control variable (prevention) is strongly affected by the number of healthy people.

Diabetic retinopathy in acromegaly

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Said Azzoug

2014-01-01

Full Text Available Introduction: Although growth hormone (GH has been implicated in the pathogenesis of diabetic retinopathy (DR, DR is deemed to be rare in patients with GH excess. Our aim was to study its prevalence in subjects with acromegaly suffering from diabetes mellitus (DM, to analyze its characteristics, and to look for predictive factors such as age at diagnosis, GH concentration and duration, DM duration, DM control, and family background. Materials and Methods: Forty patients with acromegaly and DM (21 males, 19 females, median age = 50 years, underwent a systematic ophthalmological examination with dilated funduscopy to seek diabetic retinopathy. Results: Among this population, 05 (12.5% had DR. It was at an early stage or background retinopathy in 3 cases and at a more advanced stage or proliferative retinopathy in 2 cases. We did not find any correlation with age at diagnosis, GH levels and duration, DM duration and family history of DM, but poor glycemic control seems to play a role although statistical analysis showed borderline significance. Conclusion: From this study, we conclude that prevalence of DR in patients with acromegaly is 12.5%, and it is slight or moderate. Among studied factors, only poor glycemic control seems to be implicated in its development.

The "rule of halves" does not apply in Peru: awareness, treatment, and control of hypertension and diabetes in rural, urban, and rural-to-urban migrants.

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Lerner, Alana G; Bernabe-Ortiz, Antonio; Gilman, Robert H; Smeeth, Liam; Miranda, J Jaime

2013-06-01

To determine the awareness, treatment, and control of hypertension and diabetes by migration status. Cross-sectional study, secondary analyses of the PERU MIGRANT study. Rural, rural-to-urban migrants, and urban participants. Awareness, treatment, and control of hypertension and diabetes mellitus were calculated using weights to account for participant's group size. Of 205 of the 987 (weighted prevalence 24.1%, 95% confidence interval: 21.1%-27.1%) participants identified as hypertensive, 48.3% were aware of their diagnosis, 40% of them were receiving treatment, and 30.4% of those receiving treatment were controlled. Diabetes was present in 33 of the 987 (weighted prevalence 4.6%, 95% confidence interval: 3.1%-6%), and diabetes awareness, treatment, and control were 71.1%, 40.6%, and 7.7%, respectively. Suboptimal control rates, defined as those not meeting blood pressure or glycaemia targets among those with the condition, were 95.1% for hypertension and 97% for diabetes. Higher awareness, treatment, and control rates, for both hypertension and diabetes, were observed in rural-to-urban migrants and urban participants compared with rural participants. However, treatment rates were much lower among migrants compared with the urban group. These results identify major unmet needs in awareness, treatment, and control of hypertension and diabetes. Particular challenges are lack of awareness of both hypertension and diabetes in rural areas, and poor levels of treatment and control among people who have migrated from rural into urban areas.

Effectiveness of a group diabetes education programme in underserved communities in South Africa: pragmatic cluster randomized control trial.

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Mash, Bob; Levitt, Naomi; Steyn, Krisela; Zwarenstein, Merrick; Rollnick, Stephen

2012-12-24

Diabetes is an important contributor to the burden of disease in South Africa and prevalence rates as high as 33% have been recorded in Cape Town. Previous studies show that quality of care and health outcomes are poor. The development of an effective education programme should impact on self-care, lifestyle change and adherence to medication; and lead to better control of diabetes, fewer complications and better quality of life. Pragmatic cluster randomized controlled trialParticipants: Type 2 diabetic patients attending 45 public sector community health centres in Cape TownInterventions: The intervention group will receive 4 sessions of group diabetes education delivered by a health promotion officer in a guiding style. The control group will receive usual care which consists of ad hoc advice during consultations and occasional educational talks in the waiting room. To evaluate the effectiveness of the group diabetes education programmeOutcomes: diabetes self-care activities, 5% weight loss, 1% reduction in HbA1c. self-efficacy, locus of control, mean blood pressure, mean weight loss, mean waist circumference, mean HbA1c, mean total cholesterol, quality of lifeRandomisation: Computer generated random numbersBlinding: Patients, health promoters and research assistants could not be blinded to the health centre's allocationNumbers randomized: Seventeen health centres (34 in total) will be randomly assigned to either control or intervention groups. A sample size of 1360 patients in 34 clusters of 40 patients will give a power of 80% to detect the primary outcomes with 5% precision. Altogether 720 patients were recruited in the intervention arm and 850 in the control arm giving a total of 1570. The study will inform policy makers and managers of the district health system, particularly in low to middle income countries, if this programme can be implemented more widely. Pan African Clinical Trial Registry PACTR201205000380384.

Effects of diabetes-related family stress on glycemic control in young patients with type 1 diabetes: Systematic review.

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Tsiouli, Elina; Alexopoulos, Evangelos C; Stefanaki, Charikleia; Darviri, Christina; Chrousos, George P

2013-02-01

To investigate the way that family stress influences glycemic control among patients with diabetes who are younger than 18 years of age. PubMed and Scopus were searched for relevant studies published since 1990 using the following key words: diabetes type 1, glycemic control, family stress, family conflict, and family function. In total, 1478 papers were identified in the initial search. The final review included 6 cohort studies, 3 cross-sectional studies, and 1 qualitative review in which family stress was assessed using specific diabetes-related conflict measurement instruments, and glycemic control was evaluated by glycosylated hemoglobin measurement. In most studies family stress was negatively correlated with patients' glycemic control. Family function was strongly related to patients' glycemic control, while family conflict was adversely associated with glycemic control. Families of low socioeconomic status, those of adolescents with diabetes, and those of single parents were more prone to diabetes-related stress and thus more susceptible to worse glycemic control. Therapeutic psychological interventions and educational programs can help alleviate family diabetes-related stress and will likely improve glycemic control.

The Value of Urine Specific Gravity in Detecting Diabetes Insipidus in a Patient with Uncontrolled Diabetes Mellitus: Urine Specific Gravity in Differential Diagnosis

OpenAIRE

Akarsu, Ersin; Buyukhatipoglu, Hakan; Aktaran, Sebnem; Geyik, Ramazan

2006-01-01

When a patient with diabetes mellitus presents with worsening polyuria and polydipsia, what is a sensible, cost-effective approach? We report the unique coincidence of type 2 diabetes mellitus and diabetes insipidus. A 46-year-old woman with poorly controlled type 2 diabetes complained of polyuria with a daily output of 5 L. Although urinalysis demonstrated significant glucosuria, diabetes insipidus was suspected owing to a low urine specific gravity (1.008). The low specific gravity persiste...

The Value of Urine Specific Gravity in Detecting Diabetes Insipidus in a Patient with Uncontrolled Diabetes Mellitus

Science.gov (United States)

Akarsu, Ersin; Buyukhatipoglu, Hakan; Aktaran, Sebnem; Geyik, Ramazan

2006-01-01

When a patient with diabetes mellitus presents with worsening polyuria and polydipsia, what is a sensible, cost-effective approach? We report the unique coincidence of type 2 diabetes mellitus and diabetes insipidus. A 46-year-old woman with poorly controlled type 2 diabetes complained of polyuria with a daily output of 5 L. Although urinalysis demonstrated significant glucosuria, diabetes insipidus was suspected owing to a low urine specific gravity (1.008). The low specific gravity persisted during a water deprivation test. Ultimately, diabetes insipidus was confirmed when urine specific gravity and urine osmolality normalized following desmopressin administration. This case emphasizes the importance of accurately interpreting the urine specific gravity in patients with polyuria and diabetes mellitus to detect diabetes insipidus. PMID:17026722

MANAGEMENT OF DIABETES MELLITUS IN DIABETIC PATIENTS: ISFAHAN. 1999

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P ABAZARI

2001-06-01

Full Text Available Introduction. Diabetic control and its acute and chronic complications needed to investigate the characteristics medical and self care in diabetics. This evaluation can detect conflicts in this field and provide the possibility of better planning to arrive the ideal control of diabetes. Methods. This study was a cross sectional survey. Samples were 344 diabetic patients who were living in Isfahan. Data was collected by a questionnaire described diabetics contextual characteristics, position of medical services use, position of diabetic education, self blood glucose monitoring (SMBG, attendance to diet regimen and so on. Questionnaires were cmpeleted through interview. Results. Mean age of patients was 56.5±13.6 years. More than fifty percent (57.7 percent were female. More than one third (57.6 percent were illiterate. Patients had 1 to 40 years history of diabetes. More than one forth (27.4 percent did not seek medical advice and 61.2 percent had referred to physician only when they were encountering with a problem for example lack of insulin or oral hypoglycemic agents. Over eighty percent never had foot examination by their physicians. Only 7.4 percent, had heared about glycosylated hemoglubine. This test had not been accomplished for 95.9 percent of patients. 46.2 percent had not performed self foot examination till study time. More than eighty percent of interviewers had reported their lost blood glucose value above 130 mg/dl. Only ten percent of the study population had performed 5MBG. About fifty percent (45.3 percent, did not educated about diabetes. Only 26.8 percent reported that they always follow their dietary regimen. Discussion. Results of this survey showed irregular calls to physicians, poor blood glucose control, high rate of hospitalization due to acute and chronic diabetes complications, irregular blood glucose monitoring. Diabetes management needs more attention in our city.

The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study

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Erku DA

2017-09-01

Full Text Available Background: Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients. Objective: This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus. Methods: A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65 received the usual care while patients in the intervention group (n=62 received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6‐months with medication adherence (using Morisky medication adherence scale and number of hospital admissions as the main outcome variables. Results: A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value<0.01. Furthermore, at the 6-month follow-up, only 23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (p< 0.001. Conclusions: The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes.

Efficacy of insulin lispro in improving glycemic control in gestational diabetes

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M C Deepaklal

2014-01-01

Full Text Available Aim: To assess the safety and efficacy of insulin lispro in improving glycemic control in patients with gestational diabetes. Materials and Methods: A retrospective observational study was conducted at a single center on 201 gestational women with diabetes. Subjects who received insulin lispro performed blood glucose self-monitoring and recorded the readings in the fasting state and 1 h after each meal. At each contact (in person or telephonic contact, the insulin dose was adjusted based on the readings measured. A total of 53 subjects also recorded glucose levels post-partum. Pregnancy and post-delivery glucose level and insulin requirements of these 53 patients were compared. Results: Analysis of glucose levels both fasting and post-prandial glucose levels revealed that after using insulin lispro, the number of episodes of post-prandial hyperglycemia (1 h plasma glucose >120 mg/dL was minimal and so was the incidence of hypoglycemia. Hypoglycemia was defined as a blood sugar value of. There was neither any congenital abnormality except for a poorly formed pinna in the right ear of one baby nor any post-partum complications of note. Conclusion: Insulin lispro is an effective and safe treatment option in gestational diabetes.

Life versus disease in difficult diabetes care

DEFF Research Database (Denmark)

Knudsen, Vibeke Zoffmann

2005-01-01

Conflicts in problem solving are known from diabetes research on patients with good glycemic control but have rarely been studied in the care of patients with poor glycemic control. Equally, the different perspectives of health care providers and patients have not been a focus in previous studies....... The authors studied the interactions between health care providers and 11 diabetes patients with poor glycemic control in a grounded theory study at a Danish university hospital. Keeping Life and Disease Apart was identified as a core category. It involved a pattern of conflicts both between and within...... patients and health professionals, which disempowered them in problem solving. Three approaches to problem solving were identified: A compliance-expecting approach kept the pattern unchanged, a failure-expecting approach deadlocked the pattern, and a mutuality-expecting approach appeared to neutralize...

Discovering successful strategies for diabetic self-management: a qualitative comparative study.

Science.gov (United States)

Weller, Susan C; Baer, Roberta; Nash, Anita; Perez, Noe

2017-01-01

This project explored lifestyles of patients in good and poor control to identify naturally occurring practices and strategies that result in successful diabetes management. Semistructured interviews with adult patients with type 2 diabetes explored diet, food preparation, physical activity, medication use and glucose monitoring. Patients (n=56) were classified into good (A1C 8.0%) control groups and matched across groups on diabetes duration (±5 years) and medication modality (none, oral, insulin±oral) to control for non-lifestyle factors. A qualitative comparative analysis identified practices that distinguished glycemic groups. Good control patients were more likely to test their glucose two or more times a day and reduce their sodium intake, as well as increase fruits and vegetables and limit portion sizes, some attaining good control without exercise. Fair control patients discussed several dietary strategies including limiting sweets, drinking non-caloric beverages, reducing carbs, 'cheating' (eating only a few sweets/limiting carbs in one meal to have more in another meal) and tested their glucose once a day. Poor control patients were more likely to skip antidiabetic medications and not test their glucose. Although clinical trials indicate most self-management practices have limited effectiveness over time, increased glucose monitoring is a valuable component in daily management. Research is needed on effectiveness of dietary strategies that emphasize sodium monitoring and allow some degree of cheating. Reoffering diabetes education classes and providing pill boxes as memory aids may help improve poor control.

The population perspective on quality of life among Americans with diabetes.

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Smith, David W

2004-10-01

Quality of life (QOL) among Americans with diabetes was compared to Americans without diabetes using the Behavioral Risk Factor Surveillance System for 1996 through 2000. QOL was measured in terms of days in the last month of limited activity, poor physical health, poor mental health, pain, depression, stress, poor sleep, and high energy and perceived general health. Each of 42,154 diabetics was matched with one non-diabetic (control) respondent on age, sex, race, and ethnicity. Additional statistical adjustments were made for socio-economic status, marital status, and access to health care. Respondents with diabetes averaged more statistically adjusted impaired days than controls: 3.11 days (SE = 0.07) for physical health, 0.92 (SE = 0.06) for mental health, 1.69 (SE = 0.06) for limited activity, 1.86 (SE = 0.16) for pain, 1.14 (SE = 0.14) for depression, 1.11 (SE = 0.16) for stress, 1.47 (SE = 0.18) for inadequate rest or sleep, and 3.54 (SE = 0.21) fewer for high energy. General health was also lower. Diabetes compromised QOL a substantial proportion of time on every dimension tested. Across the board, lower education, being unable to work, unemployed, or retired and lacking funds to pay for needed medical care were associated with greater impairments among persons with diabetes.

Diabetes screening: a pending issue in hypertense/obese patients.

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Sepehri, Armina; Palazón-Bru, Antonio; Gil-Guillén, Vicente Francisco; Ramírez-Prado, Dolores; Navarro-Cremades, Felipe; Cortés, Ernesto; Rizo-Baeza, María Mercedes

2015-01-01

The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003-2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted.

The ‘rule of halves’ does not apply in Peru: Awareness, treatment, and control of hypertension and diabetes in rural, urban and rural-to-urban migrants

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Lerner, Alana G.; Bernabe-Ortiz, Antonio; Gilman, Robert H.; Smeeth, Liam; Miranda, J. Jaime

2015-01-01

Objective To determine the awareness, treatment, and control of hypertension and diabetes by migration status. Design Cross-sectional study, secondary analyses of the PERU MIGRANT study. Patients Rural, rural-to-urban migrants, and urban participants. Main outcome measures Awareness, treatment and control of hypertension and diabetes mellitus were calculated using weights to account for participant’s group size. Results Of the 205/987 (weighted prevalence 24.1%, 95%CI: 21.1%–27.1%) participants identified as hypertensive 48.3% were aware of their diagnosis, 40% of them were receiving treatment, and 30.4% of those receiving treatment were controlled. Diabetes was present in 33/987 (weighted prevalence 4.6%, 95%CI: 3.1%–6%) and diabetes awareness, treatment and control were 71.1%, 40.6%, and 7.7%, respectively. Sub-optimal control rates, defined as those not meeting blood pressure or glycaemia targets among those with the condition, were 95.1% for hypertension and 97% for diabetes. Higher awareness, treatment and control rates, for both hypertension and diabetes, were observed in rural-to-urban migrants and urban participants compared to rural participants. However, treatment rates were much lower among migrants compared to the urban group. Conclusions These results identify major unmet needs in awareness, treatment, and control of hypertension and diabetes. Particular challenges are lack of awareness of both hypertension and diabetes in rural areas, and poor levels of treatment and control among people who have migrated from rural into urban areas. PMID:23680809

A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control.

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Sato, Junko; Kanazawa, Akio; Makita, Sumiko; Hatae, Chie; Komiya, Koji; Shimizu, Tomoaki; Ikeda, Fuki; Tamura, Yoshifumi; Ogihara, Takeshi; Mita, Tomoya; Goto, Hiromasa; Uchida, Toyoyoshi; Miyatsuka, Takeshi; Takeno, Kageumi; Shimada, Satoshi; Ohmura, Chie; Watanabe, Takehito; Kobayashi, Kiyoe; Miura, Yoshiko; Iwaoka, Manami; Hirashima, Nao; Fujitani, Yoshio; Watada, Hirotaka

2017-08-01

The usefulness of low-carbohydrate diet (LCD) for Japanese patients with type 2 diabetes mellitus (T2DM) has not been fully investigated. Therefore, we compared the effectiveness and safety of LCD with calorie restricted diet (CRD). This prospective, randomized, open-label, comparative study included 66 T2DM patients with HbA1c >7.5% even after receiving repeated education programs on CRD. They were randomly allocated to either the 130g/day LCD group (n = 33) or CRD group (n = 33). Patients received personal nutrition education of CRD or LCD for 30 min at baseline, 1, 2, 4, and 6 months. Patients of the CRD group were advised to maintain the intake of calories and balance of macronutrients (28× ideal body weight calories per day). Patients of the LCD group were advised to maintain the intake of 130 g/day carbohydrate without other specific restrictions. Several parameters were assessed at baseline and 6 months after each intervention. The primary endpoint was a change in HbA1c level from baseline to the end of the study. At baseline, BMI and HbA1c were 26.5 (24.6-30.1) and 8.3 (8.0-9.3), and 26.7 (25.0-30.0) kg/m 2 and 8.0 (7.6-8.9) %, in the CRD and LCD, respectively. At the end of the study, HbA1c decreased by -0.65 (-1.53 to -0.10) % in the LCD group, compared with 0.00 (-0.68 to 0.40) % in the CRD group (p 1). Also, the decrease in BMI in the LCD group [-0.58 (-1.51 to -0.16) kg/m 2 ] exceeded that observed in the CRD group (p = 0.03). Our study demonstrated that 6-month 130 g/day LCD reduced HbA1c and BMI in poorly controlled Japanese patients with T2DM. LCD is a potentially useful nutrition therapy for Japanese patients who cannot adhere to CRD. This trial was registered at http://www.umin.ac.jp/english/ (University Hospital Medical Information Network: study ID number 000010663). Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Salivary IgA concentration in diabetic patients compared to healthy controls

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Farimah Sardari

2015-01-01

Full Text Available Introduction: The alterations in salivary flow rate and its compositions could affect the development, symptoms, and severity of oral changes in diabetic patients. The aim of this study was to assess the concentration of salivary IgA in type I in comparison with type II diabetic patients and healthy controls. Materials and Methods: In this cross-sectional study, 25 patients with type I diabetes, 25 patients with type II diabetes, and 25 control subjects (12 subjects for the type I and 13 subjects for the type II were enrolled. Unstimulated saliva samples were collected by spitting method and the concentration of salivary IgA was measured byenzyme-linked immunosorbent assay (ELISA method. Results: The mean of salivary IgA in type I diabetic patients was 148.3 ± 38.7 μg/ml and in their controls was 65.8 ± 17.4 μg/ml (P < 0.001. In type II diabetic patients the mean of salivary IgA was 67.3 ± 20.6 μg/ml and in their controls was 63.3 ± 15.2 μg/ml. There was no significant difference between patients with type II diabetes and controls (P = 0.54. The mean of salivary IgA in patients with type I diabetes was significantly higher than in patients with type II diabetes (148.3 ± 38.7 versus 67.3 ± 20.6 μg/ml, respectively, P < 0.001. Conclusions: Level of salivary IgA in type II diabetic patients in comparison with their healthy control did not show any significant difference, but in type I diabetic patients was higher than that of healthy controls and type II diabetic patients.

How the impact of median neuropathy on sensorimotor control capability of hands for diabetes: an achievable assessment from functional perspectives.

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Haw-Yen Chiu

Full Text Available To comprehend the sensorimotor control ability in diabetic hands, this study investigated the sensation, motor function and precision pinch performances derived from a pinch-holding-up activity (PHUA test of the hands of diabetic patients and healthy subjects. The precision, sensitivity and specificity of the PHUA test in the measurements of diabetic patients were also analyzed. We hypothesized that the diabetic hands would have impacts on the sensorimotor functions of the hand performances under functionally quantitative measurements. One hundred and fifty-nine patients with clinically defined diabetes mellitus (DM and 95 age- and gender-matched healthy controls were included. Semmes-Weinstein monofilament (SWM, static and moving two-point discrimination (S2PD and M2PD, maximal pinch strength and precision pinch performance tests were conducted to evaluate the sensation, motor and sensorimotor status of the recruited hands. The results showed that there were significant differences (all p<0.05 in SWM, S2PD, M2PD and maximum pinch strength between the DM and control groups. A higher force ratio in the DM patients than in the controls (p<0.001 revealed a poor ability of pinch force adjustment in the DM patients. The percentage of maximal pinch strength was also significantly different (p<0.001 between the DM and control groups. The sensitivity, specificity and area under the receiver operating characteristic curve were 0.85, 0.51, and 0.724, respectively, for the PHUA test. Statistically significant degradations in sensory and motor functions and sensorimotor control ability were observed in the hands of the diabetic patients. The PHUA test could be feasibly used as a clinical tool to determine the sensorimotor function of the hands of diabetic patients from a functional perspective.

Control of glycemia and other cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: data from the Adult Diabetes Control and Management.

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Sazlina, Shariff-Ghazali; Mastura, Ismail; Ahmad, Zaiton; Cheong, Ai-Theng; Adam, Bujang-Mohamad; Jamaiyah, Haniff; Lee, Ping-Yein; Syed-Alwi, Syed-Abdul-Rahman; Chew, Boon-How; Sriwahyu, Taher

2014-01-01

The aims of the present study were to assess the control of glycemia and other cardiovascular disease risk factors, and the association between age and these controls among older adults with type 2 diabetes in Malaysia. A cross-sectional study was carried out using cases notified to the Adult Diabetes Control and Management database between 1 January and 31 December 2009. A total of 10 363 people aged over 60 years with type 2 diabetes mellitus were included in the analyses. A standard online case report form was used to record demographic data, clinical factors (diabetes duration, comorbid condition and treatment modalities), cardiovascular disease risk factors, diabetes complications and laboratory assessments. The cardiovascular disease risk factors controls assessed included glycosylated hemoglobin (HbA(1c)) control of cardiovascular disease risk factors was suboptimal in older adults with type 2 diabetes. The oldest elderly were more likely to achieve target HbA(1c) (<7.0%) and triglycerides (<1.7 mmol/L) than older adults aged 60-69 years. © 2013 Japan Geriatrics Society.

Lansoprazole for children with poorly controlled asthma: a randomized controlled trial.

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Holbrook, Janet T; Wise, Robert A; Gold, Benjamin D; Blake, Kathryn; Brown, Ellen D; Castro, Mario; Dozor, Allen J; Lima, John J; Mastronarde, John G; Sockrider, Marianna M; Teague, W Gerald

2012-01-25

Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma. Untreated GER has been postulated to be a cause of inadequate asthma control in children despite inhaled corticosteroid treatment, but it is not known whether treatment with proton pump inhibitors improves asthma control. To determine whether lansoprazole is effective in reducing asthma symptoms in children without overt GER. The Study of Acid Reflux in Children With Asthma, a randomized, masked, placebo-controlled, parallel clinical trial that compared lansoprazole with placebo in children with poor asthma control who were receiving inhaled corticosteroid treatment. Three hundred six participants enrolled from April 2007 to September 2010 at 19 US academic clinical centers were followed up for 24 weeks. A subgroup had an esophageal pH study before randomization. Participating children were randomly assigned to receive either lansoprazole, 15 mg/d if weighing less than 30 kg or 30 mg/d if weighing 30 kg or more (n = 149), or placebo (n = 157). The primary outcome measure was change in Asthma Control Questionnaire (ACQ) score (range, 0-6; a 0.5-unit change is considered clinically meaningful). Secondary outcome measures included lung function measures, asthma-related quality of life, and episodes of poor asthma control. The mean age was 11 years (SD, 3 years). The mean difference in change (lansoprazole minus placebo) in the ACQ score was 0.2 units (95% CI, 0.0-0.3 units). There were no statistically significant differences in the mean difference in change for the secondary outcomes of forced expiratory volume in the first second (0.0 L; 95% CI, -0.1 to 0.1 L), asthma-related quality of life (-0.1; 95% CI, -0.3 to 0.1), or rate of episodes of poor asthma control (relative risk, 1.2; 95% CI, 0.9-1.5). Among the 115 children with esophageal pH studies, the prevalence of GER was 43%. In the subgroup with a positive pH study, no treatment effect for lansoprazole vs placebo was observed for

Predictors of mortality in insulin dependent diabetes

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Rossing, P; Hougaard, P; Borch-Johnsen, K

1996-01-01

OBJECTIVE: To evaluate the prognostic significance of microalbuminuria and overt diabetic nephropathy and other putative risk factors for cardiovascular and all cause mortality in insulin dependent diabetes. DESIGN: Ten year observational follow up study. SETTING: Outpatient diabetic clinic...... in a tertiary referral centre. SUBJECTS: All 939 adults with insulin dependent diabetes (duration of diabetes five years or more) attending the clinic in 1984; 593 had normal urinary albumin excretion ( or = 300 mg...... and other potentially modifiable risk factors such as hypertension, smoking, poor glycaemic control, and social class predict increased mortality in insulin dependent diabetes. Microalbuminuria by itself confers only a small increase in mortality. The prognosis of patients with overt diabetic nephropathy...

[Psychological factors associated to patient's treatment compliance in Chilean diabetic teenagers].

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Ortiz, Manuel; Ortiz, Eugenia

2005-03-01

Treatment compliance among patients with type 1 diabetes mellitus, is low in 50% of diabetic teenagers, becoming a social and medical problem. To determine psycho-social factors associated to treatment compliance among Chilean diabetic type 1 teenagers. A non experimental study of 61 diabetic teenagers (age 14.9+/-1.9 years, 37 male). The number of blood glucose determinations, socioeconomic level and practice of sports was measured. Psychological tests were applied to analyze self-efficiency, motivation of achievement, self-esteem and knowledge of the illness and its treatment. As a measure of patient compliance, glycosilated hemoglobin (HB1Ac) was measured. Six patients had a good control of diabetes (HB1Ac <7%), 24 had HB1Ac values between 7 and 8.9, and 31 (51%) had values of 9% or more, considered as a poor diabetes control. The intensified insulin treatment scheme, the knowledge of the illness and its treatment and the sense of self-efficiency, were the factors associated with a better compliance with treatment. Teenagers of higher socio-economical levels had a better compliance with treatment. Fifty percent of Chilean diabetic teenagers in this sample had a poor control of the disease and the variable knowledge about the disease is the better predictor of patient compliance.

Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections into the Subacromial Space of the Shoulder.

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Aleem, Alexander W; Syed, Usman Ali M; Nicholson, Thema; Getz, Charles L; Namdari, Surena; Beredjiklian, Pedro K; Abboud, Joseph A

2017-09-01

Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on blood glucose levels in diabetic patients with shoulder pathology. Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to confirm their fasting morning glucose level for 10 days post-injection. Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of patients' glucose levels returned to near baseline levels around post-injection day 8, while poorly controlled patients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fasting glucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients ( P patients with well-controlled diabetes experience smaller elevations and faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood glucose elevation while maintaining therapeutic benefit.

The Spoken Knowledge in Low Literacy in Diabetes scale: a diabetes knowledge scale for vulnerable patients.

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Rothman, Russell L; Malone, Robb; Bryant, Betsy; Wolfe, Catherine; Padgett, Penelope; DeWalt, Darren A; Weinberger, Morris; Pignone, Michael

2005-01-01

The purpose of this study was to develop and validate a new knowledge scale for patients with type 2 diabetes and poor literacy: the Spoken Knowledge in Low Literacy patients with Diabetes (SKILLD). The authors evaluated the 10-item SKILLD among 217 patients with type 2 diabetes and poor glycemic control at an academic general medicine clinic. Internal reliability was measured using the Kuder-Richardson coefficient. Performance on the SKILLD was compared to patient socioeconomic status, literacy level, duration of diabetes, and glycated hemoglobin (A1C). Respondents' mean age was 55 years, and they had diabetes for an average of 8.4 years; 38% had less than a sixth-grade literacy level. The average score on the SKILLD was 49%. Less than one third of patients knew the signs of hypoglycemia or the normal fasting blood glucose range. The internal reliability of the SKILLD was good (0.72). Higher performance on the SKILLD was significantly correlated with higher income (r = 0.22), education level (r = 0.36), literacy status (r = 0.33), duration of diabetes (r = 0.30), and lower A1C (r = -0.16). When dichotomized, patients with low SKILLD scores (< or = 50%) had significantly higher A1C (11.2% vs 10.3%, P < .01). This difference remained significant when adjusted for covariates. The SKILLD demonstrated good internal consistency and validity. It revealed significant knowledge deficits and was associated with glycemic control. The SKILLD represents a practical scale for patients with diabetes and low literacy.

Blood glucose control in diabetes patients seen in primary health care centers Controle glicêmico em pacientes diabéticos atendidos em centros de atenção primária à saúde

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Maria Cecília F Assunção

2005-04-01

Full Text Available OBJECTIVE: To identify factors associated to poor glycemic control among diabetic patients seen at primary health care centers. METHODS: A cross-sectional study was carried out in a sample of 372 diabetic patients attending 32 primary health care centers in southern Brazil. Data on three hierarchical levels of health unit infrastructure, medical care and patient characteristics were collected. RESULTS: The frequency of poor glycemic control was 50.5%. Multivariate analysis (multilevel method showed that patients with body mass indexes below 27 kg/m², patients on oral hypoglycemic agents or insulin, and patients diagnosed as diabetic over five years prior to the interview were more likely to present poor glycemic control when compared to their counterparts. CONCLUSIONS: Given the hierarchical data structuring, all associations found suggest that factors associated to hyperglycemia are related to patient-level characteristics.OBJETIVO: Identificar fatores associados à falta de controle glicêmico em pacientes diabéticos atendidos em centros de atenção primária à saúde. MÉTODOS: Estudo transversal em amostra de 372 pacientes diabéticos atendidos nos 32 centros de atenção primária de uma cidade do sul do Brasil. Foram coletados dados ordenados em três níveis hierárquicos: estrutura das unidades de saúde, características do processo do cuidado médico e pacientes diabéticos. RESULTADOS: A freqüência de falta de controle glicêmico foi de 50,5%. A análise multivariada (método multinível mostrou que pacientes com Índice de Massa Corporal abaixo de 27 kg/m², em tratamento medicamentoso e com mais de cinco anos de diagnóstico de diabetes, tiveram maior probabilidade de apresentar hiperglicemia quando comparados a seus pares. CONCLUSÕES: Considerando a estrutura hierárquica dos dados, todas as associações encontradas sugerem que os fatores associados à hiperglicemia são relacionados a características dos pacientes.

Effects of Intensive Control of Glycemia on Clinical Kidney Outcomes in Type 2 Diabetes Patients Compared with Standard Control: A Meta-Analysis

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Francisco Herrera-Gómez

2017-11-01

Full Text Available Background: Association between poor control of glycemia and the onset of microvascular complications in type 2 diabetes mellitus (T2DM patients is a hard issue. However, it seems that the impact of pharmacological treatment is important only in early stages of diabetic nephropathy. We sought to examine whether intensive glycemic control is associated with improvement of clinical Chronic Kidney Disease (CKD outcomes compared to standard glycemic control.Methods: Meta-analysis of published and unpublished randomized controlled trials (RCT and post-hoc analysis of RCTs comparing anti-diabetic drugs and/or insulin (intensive control vs. dietary measures (standard control for relevant outcomes related to progression of CKD clinically manifest was undertaken. Summary estimates obtained by random effects model and funnel plots for assessing reporting bias are presented.Results: Our analysis was based on four RCTs representing 27,391 adult T2DM patients with CKD from around the world. The pooled OR for the outcomes of doubling of serum creatinine and need of dialysis were, respectively, of 0.98 with 95% confidence interval (95% CI 0.81–1.19, and 0.84 with 95% CI 0.69–1.02. The pooled OR for the outcome of death from kidney failure was 0.62 with 95% CI 0.39–0.98. Clinical differences between studies were not translated in statistical heterogeneity. Reporting bias may be present.Conclusions: Intensive glycemic control has an effect on death from kidney failure compared to standard glycemic control. Better comprehension of glycemic control effects on both T2DM patients with and without CKD is important for individualization of these two treatment modalities.

Poor pregnancy outcome in women with type 2 diabetes

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Clausen, Tine Dalsgaard; Mathiesen, Elisabeth Reinhardt; Ekbom, Pia

2005-01-01

To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001.......To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001....

DIABEO App Software and Telemedicine Versus Usual Follow-Up in the Treatment of Diabetic Patients: Protocol for the TELESAGE Randomized Controlled Trial.

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Jeandidier, Nathalie; Chaillous, Lucy; Franc, Sylvia; Benhamou, Pierre-Yves; Schaepelynck, Pauline; Hanaire, Hélène; Catargi, Bogdan; Farret, Anne; Fontaine, Pierre; Guerci, Bruno; Reznik, Yves; Penfornis, Alfred; Borot, Sophie; Serusclat, Pierre; Kherbachi, Yacine; D'Orsay, Geneviève; Detournay, Bruno; Simon, Pierre; Charpentier, Guillaume

2018-04-19

Self-management of diabetes minimizes the risk of macrovascular and microvascular complications, but understanding and/or adherence to self-management recommendations is often suboptimal. DIABEO is a smartphone app (downloaded via the internet) used to calculate bolus insulin doses. A previous study (TELEDIAB 1) showed that the use of DIABEO was associated with a significant improvement in glycemic control in patients with poorly controlled type 1 diabetes mellitus, particularly when combined with teleconsultations with physicians. Here, we present the protocol for a new study (Suivi A Grande Echelle d'une cohorte de diabétiques de type 1 et de type 2 sous schéma insulinique basal bolus par la TELEmédecine; abbreviated TELESAGE), conducted in a larger population of diabetic patients with poorly controlled basal-bolus insulin levels. TELESAGE is a multicenter, double-randomized, open-label, three parallel-arms study, conducted in approximately 100 centers in France. The study will compare a control group (arm 1: usual follow-up) with two DIABEO telemedicine systems: (1) physician-assisted telemedicine (arm 2), and (2) nurse-assisted telemonitoring and teleconsultations by a diabetologist's task delegation (arm 3). Initial randomization will allocate the study arms in 12 French regions. A second randomization will assign patients in the groups allocated to each studied region. The primary objective of TELESAGE will be to investigate the effect of the DIABEO telemedicine system versus usual follow-up, with respect to improvements in the glycated hemoglobin levels of approximately 696 diabetic patients with poorly controlled basal-bolus insulin levels. The TELESAGE study is sponsored by Sanofi (Gentilly, France). A primary completion date is expected in June 2018, and publication of results is expected within 6 months of work completion. The TELESAGE study is expected to confirm the previous results of the TELEDIAB 1 study using a larger sample of diabetic patients

Effects of Sleep Disorders on Hemoglobin A1c Levels in Type 2 Diabetic Patients

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Ahmet Keskin

2015-01-01

Full Text Available Background: Studies have reported the presence of sleep disorders in approximately 50-70% of diabetic patients, and these may contribute to poor glycemic control, diabetic neuropathy, and overnight hypoglycemia. The aim of this study was to determine the frequency of sleep disorders in diabetic patients, and to investigate possible relationships between scores of these sleep disorders and obstructive sleep apnea syndrome (OSAS and diabetic parameters (fasting blood glucose, glycated hemoglobin A1c [HbA1c], and lipid levels. Methods: We used the Berlin questionnaire (BQ for OSAS, the Epworth Sleepiness Scale (ESS, and the Pittsburgh Sleep Quality Index (PSQI to determine the frequency of sleep disorders and their possible relationships with fasting blood glucose, HbA1c, and lipid levels. Results: The study included 585 type 2 diabetic patients admitted to family medicine clinics between October and December 2014. Sleep, sleep quality, and sleep scores were used as the dependent variables in the analysis. The ESS scores showed that 54.40% of patients experienced excessive daytime sleepiness, and according to the PSQI, 64.30% experienced poor-quality sleep. The BQ results indicated that 50.20% of patients were at high-risk of OSAS. HbA1c levels correlated significantly with the ESS and PSQI results (r = 0.23, P < 0.001 and r = 0.14, P = 0.001, respectively, and were significantly higher in those with high-risk of OSAS as defined by the BQ (P < 0.001. These results showed that HbA1c levels were related to sleep disorders. Conclusions: Sleep disorders are common in diabetic patients and negatively affect the control of diabetes. Conversely, poor diabetes control is an important factor disturbing sleep quality. Addressing sleep disturbances in patients who have difficulty controlling their blood glucose has dual benefits: Preventing diabetic complications caused by sleep disturbance and improving diabetes control.

Stigma and Its Association With Glycemic Control and Hypoglycemia in Adolescents and Young Adults With Type 1 Diabetes: Cross-Sectional Study.

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Brazeau, Anne-Sophie; Nakhla, Meranda; Wright, Michael; Henderson, Mélanie; Panagiotopoulos, Constadina; Pacaud, Daniele; Kearns, Patricia; Rahme, Elham; Da Costa, Deborah; Dasgupta, Kaberi

2018-04-20

Qualitative studies in type 1 diabetes indicate that visibility of diabetes supplies, self-care, and hypoglycemia symptoms are associated with stigma and suboptimal management. This may be particularly salient in youth who face concurrent challenges such as establishing autonomy and making vocational choices. The aim of the study was to estimate stigma prevalence in youth (aged 14-24 years) with type 1 diabetes and its associations with glycemic control. Participants, recruited largely through social media, were asked to complete a Web-based survey and to send via mail capillary blood samples for glycated hemoglobin (HbA 1c ) measurement. The primary definition of stigma required endorsement of one or more of 3 stigma-specific items of the Barriers to Diabetes Adherence questionnaire. These addressed avoidance of diabetes management with friends present, difficulty telling others about diabetes diagnosis, and embarrassment in performing diabetes care with others present. Poor glycemic control was defined as HbA 1c >9% (ie, >75 mmol/mol; measured value when available, else self-report) and/or ≥1 severe hypoglycemic episode in the previous year (reported requiring assistance from someone else during the episode). Stigma prevalence was computed (95% CI), and associations with glycemic control were evaluated (multivariate logistic regression models). Among the 380 respondents, stigma prevalence was 65.5% (95% CI 60.7-70.3). Stigma was associated with a 2-fold higher odds of poor glycemic control overall (odds ratio [OR] 2.25, 95% CI 1.33-3.80; adjusted for age, sex, and type of treatment). There were specific associations with both HbA 1c >9% (75 mmol/mol; OR 3.05, 95% CI 1.36-6.86) and severe hypoglycemia in the previous year (OR 1.86, 95% CI 1.05-3.31). There is a high prevalence of stigma in youth with type 1 diabetes that is associated with both elevated HbA 1c levels and severe hypoglycemia. Targeted strategies to address stigma are needed. Clinical

Brief Computer-Delivered Intervention to Increase Parental Monitoring in Families of African American Adolescents with Type 1 Diabetes: A Randomized Controlled Trial.

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Ellis, Deborah A; Idalski Carcone, April; Ondersma, Steven J; Naar-King, Sylvie; Dekelbab, Bassem; Moltz, Kathleen

2017-06-01

African American adolescents with type 1 diabetes (T1D) are at elevated risk for poor diabetes management and metabolic control. Parental supervision and monitoring of adolescent diabetes management have been shown to promote better diabetes management among adolescents, but parents typically decrease their oversight during the transition to independent diabetes care. The purpose of the study was to conduct a randomized clinical trial to test the feasibility and efficacy of a three-session, computer-delivered motivational intervention (The 3Ms) to promote increased parental monitoring among primary caregivers of young African American adolescents with T1D. The intervention was brief and optimized for delivery during routine diabetes clinic visits. Sixty-seven adolescents with T1D aged 11-14 and their primary caregiver were randomly assigned to one of three arms: adolescent and parent motivational intervention (Arm 1), adolescent control and parent motivational intervention (Arm 2), or adolescent and parent control (Arm 3). Intervention effects were assessed 1 month after intervention completion. Parents in Arm 1 and Arm 2 had significant increases in knowledge of the importance of monitoring adolescents' diabetes care. Parents in Arm 2 also had trend to significant increases in direct observation and monitoring of adolescent diabetes care, and adolescents in Arm 2 had significant improvements in glycemic control. Findings from the present study provide preliminary support for the efficacy of a brief, computer-delivered parenting intervention for improving family management practices and adolescent health outcomes among African American adolescents with T1D and their caregivers.

Trace elements and oxidative stress in children with type 1 diabetes mellitus

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Alghobashy AA

2018-03-01

Full Text Available Ashgan Abdalla Alghobashy,1 Usama M Alkholy,1 Mohamed A Talat,1 Nermin Abdalmonem,1 Ahmed Zaki,2 Ihab A Ahmed,1 Randa H Mohamed3 1Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 2Department of Pediatrics, Faculty of Medicine, Mansura University, Mansura, Egypt; 3Department of Biochemistry, Faculty of Medicine, Zagazig University, Zagazig, Egypt Background: The early imbalances of trace elements in type 1 diabetes (T1D may cause disturbance of glucose metabolism and more oxidative stress that may enhance the development of insulin resistance and diabetic complications. We aim to evaluate the serum level of selenium (Se, zinc (Zn, magnesium (Mg, and copper (Cu, the degree of oxidative stress and evaluate their relations to glycemic control in children with T1D. Methods: A case–control study which included 100 diabetic children and 40 healthy children age, sex, and ethnicity-matched as a control group. The diabetic children were divided into poor and good controlled patients according to glycosylated hemoglobin (A1c %. Studied children underwent history taking, clinical examination and laboratory measurement of serum Se, Zn, Mg, and Cu levels, erythrocyte reduced glutathione (GSH and peroxidase enzyme activity (GPx. Results: Serum Se, Zn, Mg, Cu, erythrocyte GSH, and GPx were significantly lower in the diabetic group in comparison to the control group (P<0.05 and their levels were lower in poorly controlled patients compared to good controlled patients (P<0.05. The serum Se, Zn, Mg, erythrocyte GSH, and GPx showed a negative correlation with A1c %. The serum Se showed a positive correlation with erythrocyte GSH and GPx ([r=0.56, P<0.001], [r=0.78, P<0.001], respectively. Conclusion: Children with T1D, especially poorly controlled cases, had low serum Se, Zn, Mg, Cu, GSH, and GPx. Low serum Se in diabetic children may affect the erythrocyte GSH-GPx system. Keywords: oxidative stress; type 1 diabetes; trace

Emotional dysfunction associated with diabetes in Mexican adolescents and young adults with type-1 diabetes

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Lerman-Garber Israel

2003-01-01

Full Text Available OBJECTIVE: To assess the emotional dysfunction associated with diabetes in Mexican young individuals with type-1 diabetes. MATERIAL AND METHODS: A cross-sectional survey was conducted to perform a complete clinical and psychosocial evaluation of 93 consecutive type-1 diabetes patients, aged 14 to 30 years. RESULTS: Adolescents had higher scores of emotional dysfunction related to diabetes and a diminished knowledge in diabetes-related areas. A multivariate logistic regression model showed that an inadequate emotional response to diabetes (high problem areas in diabetes or PAID scores was mainly associated with a poor glycemic control (OR=2.9, 95% CI 0.9-9.7, p=0.09. Apprehension about the future and the possibility of serious complications had the highest mean PAID score in all age groups. CONCLUSIONS: New strategies should be developed to improve the routine care and support of young individuals with type-1 diabetes.

Glycemic control among patients with type 2 diabetes at a primary health care center in Oman.

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Al Balushi, Khalid A; Al-Haddabi, Mahmod; Al-Zakwani, Ibrahim; Al Za'abi, Mohammed

2014-10-01

To determine the status of blood sugar control by using fasting blood sugar (FBS) of ≤6.1 mmol/l and glycosyted hemoglobin A1c (HbAc1) of Oman. The overall mean age of the cohort was 53±12 years (range: 24-91) with females representing 60% (n=106) of the study sample. The study found that only 9.6% (n=17) and 35% (n=62) of the patients attained optimal FBS and HbAc1 levels, respectively. Higher HbA1c was significantly associated with higher diastolic BP (84 versus 80 mm Hg; p=0.006), higher total cholesterol (5.2 versus 4.7 mmol/l; p=0.002) and higher low-density lipoprotein cholesterol (3.8 versus 3.0 mmol/l; p=0.034). The results demonstrated poor glycemic control in Oman type 2 diabetic patients comparable to local and global studies especially in those hypertensive and dyslipidemic patients. Implementation of early and aggressive management of diabetes mellitus at the primary care setting is warranted. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Tumor necrosis factor-alpha and interleukin -6 as diagnostic markers of diabetic complications in children with type I diabetes mellitus

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El-Nashar, N.A.; Moawad, A.T.; Nassar, E.M.

2010-01-01

This study aimed to determine the role of cellular auto immunity and its humoral mediators in pathogenesis and following up of type I diabetes mellitus (TIDM). Therefore, serum concentrations of tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), glycemic control, body mass index, duration of the disease and microalbuminuria in children with TIDM were evaluated. This study was conducted on 30 patients suffered from type I diabetes mellitus (TIDM), 14 males and 16 females with mean age of 11.40 ±3.67 years and 20 apparently healthy children served as control (10 male and 10 female). Children with TIDM were classified according to duration: diabetic children for 5 years or less duration (n= 15, duration means: 2.74 ± 1.34 years) and diabetic children > 5 years (n=15, duration means: 7.35 ± 1.49 years); according to glycemic control: children with good glycemic control (n=16, HbAIc: 7.82 ± 2.70) and diabetic children with poor glycemic control (n=14, HbAIc: 10.49 ± 2.72) and according to complication: diabetic children without complications (n= 20) and diabetic children with microvascular or neurological complications (n= 10, nephritic, retinal or neurological complications). Patients and controls were subjected to careful history, clinical examination and laboratory investigations. The following investigations were done for all children; random blood glucose, Glycated hemoglobin (HbAIc %), microalbuminuria and kidney function tests. Serum tumour necrosis factor-alpha (TNF-alpha) and serum interleukin-6 (IL-6) were measured using immuno-enzymometric assay (ELISA). Patients with TIDM with duration more than 5 years, with poor glycemic control and with complications had higher serum glucose levels, higher HbAIc%, higher level of blood urea nitrogen (BUN), serum creatinine, microalbuminuria and elevated serum TNF-alpha (p<0.0001) and IL-6 (p<0.0001) in comparison to the same diabetic patients with 5 years duration or less, with good glycemic control

Potential effect of opium consumption on controlling diabetes and some cardiovascular risk factors in diabetic patients.

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Rahimi, Najmeh; Gozashti, Mohamad Hossain; Najafipour, Hamid; Shokoohi, Mostafa; Marefati, Hamid

2014-01-01

Due to this belief that opium may have beneficial effects on diabetes or cardiovascular risk factors, the present study aimed to assess the potential and possible effects of opium consumption on diabetes control and some cardiovascular risk factors in diabetic patients. This study enrolled 374 diabetic subjects from diabetes care centers in Kerman, Iran, including opium user group (n = 179) and a non-opium user group (n = 195). The data were collected through a questionnaire completed by interviewing, physical examination and laboratory assessment. Opium did not show any statistically significant effect on blood glucose, glycated hemoglobin (HbA1C), fasting blood sugar (FBS), low-density lipoprotein (LDL) and diastolic blood pressure. However, systolic blood pressure (SBP) and prevalence of high SBP were significantly higher in opium user group (P opium user group (P opium does not seem to have beneficial effects on diabetes control or cardiovascular risk factors. Therefore, it would not be advisable to consume opium as an anti-diabetes or cardioprotective agent.

Diabetes mellitus: Trends in northern India

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Manish Gutch

2014-01-01

Full Text Available Diabetes mellitus is becoming a global health issue with more than 80% diabetics living in developing countries. India accounts for 62.4 million diabetics (2011. Indian Council of Medical Research India Diabetes Study (ICMR-INDIAB study showed highest weighted prevalence rate in the north India among all studied regions. Diabetes in north India has many peculiarities in all aspects from risk factors to control programmers. North Indians are becoming more prone for diabetes and dyslipidemia because rapid westernization of living style and diet due rapid migration to metropolitan cities for employment. North Indian diabetes is plagued with gender bias against females, poor quality of health services, myths, and lack of disease awareness compounded with small number of prevention and awareness programmers that too are immature to counteract the growing pandemic.

Diabetic muscle infarction: two cases: one with recurrent and bilateral lesions and one with usual unilateral involvement.

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Arroyave, Jorge A; Aljure, Dahyana Cadavid; Cañas, Carlos A; Vélez, Juan D; Abadía, Fabio Bonilla

2013-04-01

Diabetic muscle infarction is a rare complication of diabetes. We describe 2 cases of diabetic muscle infarction, each one of them with a particular form of clinical presentation: recurrence, bilateral engagement, and unilateral compromise. Both cases had history of poorly controlled diabetes mellitus and diabetic nephropathy. The diagnosis was based on clinical, imaging, and anatomopathological features. The treatment was with a close control of diabetes mellitus, analgesics, short-term immobilization, and physical therapy.

Comorbidity and glycemia control among patients with type 2 diabetes in primary care

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Catherine Hudon

2008-11-01

Full Text Available Catherine Hudon1,3, Martin Fortin1,3, Marie-France Dubois2, José Almirall31Department of Family Medicine, 2Department of Community Health Sciences, Sherbrooke University, Sherbrooke, Quebec, Canada; 3Centre de Santé et de Services Sociaux de Chicoutimi, Quebec, CanadaAbstract: Reports on the relationship between comorbidity and glycemia control in diabetic patients are conflicting and the method of measuring comorbidity varies widely among studies. The aim of the present study was to evaluate the relationship between diabetes control and comorbidity, taking into account all comorbidities and their severity, in a primary care setting. We performed a retrospective descriptive study based on chart review of 96 randomly selected type 2 diabetic patients. Comorbidity was measured with the cumulative illness rating scale (CIRS, an exhaustive comorbidity index. Diabetes was considered as controlled if the mean value of two measurements of glycosylated hemoglobin A (HbA1c was less than 7%. Taking diabetes control as the dependent variable, its relationship with the CIRS score, age, sex, diabetes duration, and diabetes-related complications was explored. Diabetes control was not significantly related with the CIRS score, age, sex or diabetes severity. Diabetes duration was the only variable significantly related to diabetes control. Our study suggests that comorbidity measured with the CIRS in patients with type 2 diabetes is not a factor that prevents the achievement of a good glycemia control.Keywords: glycemia control, type 2 diabetes mellitus, comorbidity, primary care

Glycemic control paradox: Poor glycemic control associated with higher one-year and eight-year risks of all-cause hospitalization but lower one-year risk of hypoglycemia in patients with type 2 diabetes.

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Li, Tsai-Chung; Kardia, Sharon L R; Li, Chia-Ing; Chen, Ching-Chu; Liu, Chiu-Shong; Yang, Sing-Yu; Muo, Chin-Shin; Peyser, Patricia A; Lin, Cheng-Chieh

2015-09-01

The relationship between glycemic control and adverse outcomes found in a population with diabetes has seldom been evaluated in patients with type 2 diabetes. We explored the association between hemoglobin A1c (HbA1c) and hospitalization risks within one-year and eight-year follow-up periods. We conducted a retrospective cohort study on 57,061 patients with type 2 diabetes from National Diabetes Case Management Program during 2002-2004 in Taiwan. HbA1c at baseline and in-hospital mortality, all-cause and cause-specific hospitalization over one year and eight years were analyzed. After multivariate adjustment, one-year risk was higher for cases with HbA1c level risk of hypoglycemia hospitalization (0.81, 95% CI: 0.74-0.88). For eight-year risk, subjects with HbA1c level risks of all-cause and diabetes-related hospitalization (1.04, 1.03-1.05, and 1.15, 1.14-1.17, respectively). Higher HbA1c level correlated with lower one-year risk due to hypoglycemia hospitalization but increased one-year and eight-year risks due to all-cause and diabetes-specific hospitalization among Chinese people with type 2 diabetes in Taiwan. Future study must ascertain how to meet HbA1c targets and improve outcome without risk to this population. Copyright © 2015 Elsevier Inc. All rights reserved.

Family Food Choices: A Guide to Weight and Diabetes Control.

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Indian Health Service (PHS/HSA), Rockville, MD.

Written for American Indians who have diabetes, this folder explains diabetes and outlines a weight control program and diet. The folder discusses the five things diabetics can do to help control their disease: lose weight, watch the amount and kind of fat eaten, eat more food with fiber, avoid sugar, and avoid alcohol. Charts for foods containing…

Diabetes and Cause-Specific Mortality in Mexico City.

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Alegre-Díaz, Jesus; Herrington, William; López-Cervantes, Malaquías; Gnatiuc, Louisa; Ramirez, Raul; Hill, Michael; Baigent, Colin; McCarthy, Mark I; Lewington, Sarah; Collins, Rory; Whitlock, Gary; Tapia-Conyer, Roberto; Peto, Richard; Kuri-Morales, Pablo; Emberson, Jonathan R

2016-11-17

Most large, prospective studies of the effects of diabetes on mortality have focused on high-income countries where patients have access to reasonably good medical care and can receive treatments to establish and maintain good glycemic control. In those countries, diabetes less than doubles the rate of death from any cause. Few large, prospective studies have been conducted in middle-income countries where obesity and diabetes have become common and glycemic control may be poor. From 1998 through 2004, we recruited approximately 50,000 men and 100,000 women 35 years of age or older into a prospective study in Mexico City, Mexico. We recorded the presence or absence of previously diagnosed diabetes, obtained and stored blood samples, and tracked 12-year disease-specific deaths through January 1, 2014. We accepted diabetes as the underlying cause of death only for deaths that were due to acute diabetic crises. We estimated rate ratios for death among participants who had diabetes at recruitment versus those who did not have diabetes at recruitment; data from participants who had chronic diseases other than diabetes were excluded from the main analysis. At the time of recruitment, obesity was common and the prevalence of diabetes rose steeply with age (3% at 35 to 39 years of age and >20% by 60 years of age). Participants who had diabetes had poor glycemic control (mean [±SD] glycated hemoglobin level, 9.0±2.4%), and the rates of use of other vasoprotective medications were low (e.g., 30% of participants with diabetes were receiving antihypertensive medication at recruitment and 1% were receiving lipid-lowering medication). Previously diagnosed diabetes was associated with rate ratios for death from any cause of 5.4 (95% confidence interval [CI], 5.0 to 6.0) at 35 to 59 years of age, 3.1 (95% CI, 2.9 to 3.3) at 60 to 74 years of age, and 1.9 (95% CI, 1.8 to 2.1) at 75 to 84 years of age. Between 35 and 74 years of age, the excess mortality associated with previously

Proposed cut-off value of CA19-9 for detecting pancreatic cancer in patients with diabetes: a case-control study.

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Murakami, Mariko; Nagai, Yoshio; Tenjin, Ayumi; Tanaka, Yasushi

2018-04-11

Pancreatic cancer is a highly lethal malignancy. CA19-9 is a well-known marker for diagnosis of pancreatic cancer, but the serum CA19-9 level is reported to be elevated in patients with poorly controlled diabetes. This study evaluated the sensitivity, specificity, and cut-off value of serum CA19-9 for detection of pancreatic cancer in patients with diabetes. A case-control study of 236 patients was performed. The case group was selected from diabetic patients with pancreatic cancer, while one control was selected for each case from among diabetic patients without pancreatic cancer during the same period. The case group (n = 118) and the control group (n = 118) were matched for age, sex, and pancreatic cancer risk factors. Receiver operating characteristic (ROC) curves were plotted to determine the serum CA19-9 level that predicted pancreatic cancer. Then the sensitivity and specificity of CA19-9 were calculated for the threshold value. There were no significant differences of age, sex, BMI, smoking, alcohol intake, and HbA1c between the case and control groups. According to ROC analysis, a serum CA19-9 level of 75 U/mL had the maximum sensitivity and specificity for separating diabetic patients with or without pancreatic cancer. Using this cut-off value, the sensitivity and specificity of CA19-9 for pancreatic cancer was 69.5% and 98.2%, respectively, while the area under the ROC curve was 0.875 [95%CI: 0.826-0.924]. We propose that a serum CA19-9 level of 75 U/mL should be used as the cut-off value when screening patients with diabetes for pancreatic cancer.

Self-monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes (The SMBG Study): study protocol for a randomised controlled trial.

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Parsons, Sharon; Luzio, Stephen; Bain, Stephen; Harvey, John; McKenna, Jillian; Khan, Atir; Rice, Sam; Watkins, Alan; Owens, David R

2017-01-26

The benefit of Self-monitoring of Blood Glucose (SMBG) in people with non-insulin treated type 2 diabetes remains unclear with inconsistent evidence from randomised controlled trials fuelling the continued debate. Lack of a consistent finding has been attributed to variations in study population and design, including the SMBG intervention. There is a growing consensus that structured SMBG, whereby the person with diabetes and health care provider are educated to detect patterns of glycaemic abnormality and take appropriate action according to the blood glucose profiles, can prove beneficial in terms of lowering HbA1c and improving overall well-being. Despite this, many national health agencies continue to issue guidelines restricting the use of SMBG in non-insulin treated type 2 diabetes. The SMBG Study is a 12 month, multi-centre, randomised controlled trial in people with type 2 diabetes not on insulin therapy who have poor glycaemic control (HbA1c ≥58 mmol/mol / 7.5%). The participants will be randomised into three comparative groups: Group 1 will act as a control group and receive their usual diabetes care; Group 2 will undertake structured SMBG with clinical review every 3 months; Group 3 will undertake structured SMBG with additional monthly telecare support from a trained study nurse. A total of 450 participants will be recruited from 16 primary and secondary care sites across Wales and England. The primary outcome measure will be HbA1c at 12 months with secondary measures to include weight, BMI, total cholesterol and HbA1c levels at 3, 6, 9 and 12 months. Participant well-being and attitude towards SMBG will be monitored throughout the course of the study. Recruitment began in December 2012 with the last participant visit due in September 2016. This study will attempt to answer the question of whether structured SMBG provides any benefits to people with poorly controlled type 2 diabetes who are not being treated with insulin. The data will also

Comparison of atherogenic risk factors among poorly controlled and well-controlled adolescent phenylketonuria patients.

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Gündüz, Mehmet; Çakar, Sevim; Kuyum, Pınar; Makay, Balahan; Arslan, Nur

2016-06-01

Previous studies investigating the known risk factors of atherosclerosis in phenylketonuria patients have shown conflicting results. The primary aim of our study was to investigate the serum atherogenic markers in adolescent classical phenylketonuria patients and compare these parameters with healthy peers. The secondary aim was to compare these atherogenic markers in well-controlled and poorly controlled patients. A total of 59 patients (median age: 12.6 years, range: 11-17 years) and 44 healthy controls (median age: 12.0 years, range: 11-15 years) were enrolled in our study. Phenylketonuria patients were divided into two groups: well-controlled (serum phenylalanine levels below 360 µmol/L; 24 patients) and poorly controlled patients (serum phenylalanine levels higher than 360 µmol/L). The mean high-density lipoprotein cholesterol levels of well-controlled patients (1.0±0.2 mmol/L) were significantly lower compared with poorly controlled patients and controls (1.1±0.2 mmol/L, p=0.011 and 1.4±0.2 mmol/L, pphenylketonuria patients. In particular, these changes were more prominent in well-controlled patients. We conclude that phenylketonuria patients might be at risk for atherosclerosis, and therefore screening for atherosclerotic risk factors should be included in the phenylketonuria therapy and follow-up in addition to other parameters.

Influence of glycemic control on some real-time biomarkers of free radical formation in type 2 diabetic patients: An EPR study.

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Gadjeva, Veselina Georgieva; Goycheva, Petia; Nikolova, Galina; Zheleva, Antoaneta

2017-11-01

The pathology of diabetes is associated with several mechanisms, one of which is oxidative stress (OS). The relationship between OS and diabetic complications has been extensively investigated. OS has been suggested to be involved in the genesis of both macroand microangiopathy. In contrast, the relationship between OS and insulin action is a neglected research area. The aim of this study is to elucidate the effect of glycemic control in type 2 diabetic patients by following the serum levels of some real-time oxidative stress biomarkers. The study group consisted of 53 type 2 diabetic patients (31 with poor glycemic control and 22 with good glycemic control) and 24 healthy control subjects. The oxidative stress biomarkers (ROS, Asc• and •NO) were measured by using electron paramagnetic resonance spectroscopy (EPR) methods and compared with clinical parameters. The statistically significantly higher levels of ROS products and •NO in type 2 diabetic patients in both groups compared to controls mean that the oxidation processes take place at the time the survey is performed. Free radical overproduction persists after the normalization of the glucose levels, and oxidative stress may be involved in the "metabolic memory" effect. This is confirmed by the positive correlation between ROS levels/•NO and average blood glucose levels, triglycerides, and total cholesterol. Furthermore, the low level of the ascorbate radical in both diabetes groups compared to controls confirmed an increase in oxidation processes. Higher levels of real-time biomarkers show that intensive insulin treatment does not lead to the expected decrease in oxidative processes involving ROS and •NO, probably due to "metabolic memory".

167: CRITICALLY APPRAISE OF THE REPORTING QUALITY OF RANDOMIZED CONTROLLED TRIALS ARTICLES IN THE FIELD OF DIABETES IN MEDICAL GUIDELINES IN IRAN

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Aletaha, Azadeh; Baradaran, Hamid Reza; Soltani, Akbar; Ramezani, Amir

2017-01-01

Background and aims To determine the quality of randomized controlled clinical trial reports in diabetes research in Iran and their presence in domestic and foreign credible guidelines which can imply whether randomized controlled trial articles in the field of diabetes are of good quality or not with respect to their high level of received citations, quality and credibility. Method We included RCTs conducted on Diabetes mellitus in Iran. Animal studies, educational, interventions, and non-randomized trials were excluded. This was a bibliographic study examining published journal articles involving RCTs in diabetes research from Iranian authors. A systematic search of ten databases(ISI Web of science, Scopus, PubMed, Science Direct, The Cochrane Library, Taylor & Francis Online, Biomed Central, EBSCO, ProQuest and OVID)were undertaken from July 2004–2014. We excluded duplicated publications reporting the same groups of participants and intervention two independent reviewers identify all eligible articles specifically designed data extraction form. Two reviewers assessed the quality of reporting by CONSORT 2010 (Consolidated Standards of Reporting Trials) checklist statement and also evaluate each article with Scientometry tools in 260 valid English diabetes guidelines. Result Overall, we included 185 RCTs on diabetes mellitus, One hundred and eight five (185) studies were included and appraised. Half of them (55.7%) were published in Iranian journals. Most (89.7%) were parallel RCTs, and being performed on type2 diabetic patients (77.8%). Less than half of the CONSORT items (43.2%) were reported in studies, totally. The reporting of randomization and blinding were poor. A few studies 15.1% mentioned the method of random sequence generation and strategy of allocation concealment. And only 34.8% of trials report how blinding was applied. From 185 articles, twelve articles (10%) are presented in 260 Guidelines. Conclusion The reporting quality of abstracts of RCTs

Influence of Language and Culture in the Primary Care of Spanish-Speaking Latino Adults with Poorly Controlled Diabetes: A Qualitative Study.

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Zamudio, Cindy D; Sanchez, Gabriela; Altschuler, Andrea; Grant, Richard W

2017-01-01

We examined the role of language and culture in the interactions between Spanish-speaking Latino patients with poorly controlled diabetes - a fast-growing population in the United States - and their primary care providers. We conducted four focus groups with 36 non-US born Spanish-speaking patients with elevated HbA1c. Participants were insured health plan members with either English-speaking (2 groups) or Spanish-speaking (2 groups) primary care providers. Moderated discussions focused on visit preparation, communication during visit, and role of other care team members. Key themes derived from these discussions were then linked to corresponding Latino cultural constructs. Patients had a mean age of 57.9 (±11.2) years and last measured HbA1c was 8.6% (1.5%). Two communication-related themes (reluctance to switch providers and use of intermediaries) and two visit-related themes (provider-driven visit agendas and problem-based visits) emerged from our analyses. These themes reflected the cultural constructs of confianza (trust), familismo (family), respeto (deference), and simpatía (harmonious relationship). Trust in the patient-provider relationship led many participants to remain with English-speaking providers who treated them well. Patients with either language concordant and discordant providers reported reliance on family or other intermediaries to close communication gaps. Deference to physician expertise and authority led to visit expectations that it is the doctor's job to know what to ask and that visits were intended to address specific, often symptom-driven problems. Spanish-speaking Latino patients' cultural expectations play an important role in framing their primary care interactions. Recognizing culturally influenced visit expectations is an important step toward improving patient-provider communication.

Vasculogenesis and Diabetic Erectile Dysfunction: How Relevant Is Glycemic Control?

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Castela, Angela; Gomes, Pedro; Silvestre, Ricardo; Guardão, Luísa; Leite, Liliana; Chilro, Rui; Rodrigues, Ilda; Vendeira, Pedro; Virag, Ronald; Costa, Carla

2017-01-01

Erectile dysfunction (ED) is a complication of diabetes, condition responsible for causing endothelial dysfunction (EDys) and hampering repair mechanisms. However, scarce information is available linking vasculogenesis mediated by Endothelial Progenitor Cells (EPCs) and diabetes-associated ED. Furthermore, it remains to be elucidated if glycemic control plays a role on EPCs functions, EPCs modulators, and penile vascular health. We evaluated the effects of diabetes and insulin therapy on bone marrow (BM) and circulating EPCs, testosterone, and systemic/penile Stromal Derived Factor-1 alpha (SDF-1α) expression. Male Wistar rats were divided into groups: age-matched controls, 8-weeks streptozotocin-induced type 1 diabetics, and insulin-treated 8-weeks diabetics. EPCs were identified by flow cytometry for CD34/CD133/VEGFR2/CXCR4 antigens. Systemic SDF-1α and testosterone levels were evaluated by ELISA. Penile SDF-1α protein expression was assessed, in experimental and human diabetic cavernosal samples, by immunohistochemical techniques. Diabetic animals presented a reduction of BM-derived EPCs and an increase in putative circulating endothelial cells (CECs) sloughed from vessels wall. These alterations were rescued by insulin therapy. In addition, glycemic control promoted an increase in systemic testosterone and SDF-1α levels, which were significantly decreased in animals with diabetes. SDF-1α protein expression was reduced in experimental and human cavernosal diabetic samples, an effect prevented by insulin in treated animals. Insulin administration rescued the effects of diabetes on BM function, CECs levels, testosterone, and plasmatic/penile SDF-1α protein expression. This emphasizes the importance of glycemic control in the prevention of diabetes-induced systemic and penile EDys, by the amelioration of endothelial damage, and increase in protective pathways. J. Cell. Biochem. 118: 82-91, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Effectiveness of a group diabetes education programme in underserved communities in South Africa: pragmatic cluster randomized control trial

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Mash Bob

2012-12-01

Full Text Available Abstract Background Diabetes is an important contributor to the burden of disease in South Africa and prevalence rates as high as 33% have been recorded in Cape Town. Previous studies show that quality of care and health outcomes are poor. The development of an effective education programme should impact on self-care, lifestyle change and adherence to medication; and lead to better control of diabetes, fewer complications and better quality of life. Methods Trial design: Pragmatic cluster randomized controlled trial Participants: Type 2 diabetic patients attending 45 public sector community health centres in Cape Town Interventions: The intervention group will receive 4 sessions of group diabetes education delivered by a health promotion officer in a guiding style. The control group will receive usual care which consists of ad hoc advice during consultations and occasional educational talks in the waiting room. Objective: To evaluate the effectiveness of the group diabetes education programme Outcomes: Primary outcomes: diabetes self-care activities, 5% weight loss, 1% reduction in HbA1c. Secondary outcomes: self-efficacy, locus of control, mean blood pressure, mean weight loss, mean waist circumference, mean HbA1c, mean total cholesterol, quality of life Randomisation: Computer generated random numbers Blinding: Patients, health promoters and research assistants could not be blinded to the health centre’s allocation Numbers randomized: Seventeen health centres (34 in total will be randomly assigned to either control or intervention groups. A sample size of 1360 patients in 34 clusters of 40 patients will give a power of 80% to detect the primary outcomes with 5% precision. Altogether 720 patients were recruited in the intervention arm and 850 in the control arm giving a total of 1570. Discussion The study will inform policy makers and managers of the district health system, particularly in low to middle income countries, if this programme can

A Team-Based Online Game Improves Blood Glucose Control in Veterans With Type 2 Diabetes: A Randomized Controlled Trial.

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Kerfoot, B Price; Gagnon, David R; McMahon, Graham T; Orlander, Jay D; Kurgansky, Katherine E; Conlin, Paul R

2017-09-01

Rigorous evidence is lacking whether online games can improve patients' longer-term health outcomes. We investigated whether an online team-based game delivering diabetes self-management education (DSME) to patients via e-mail or mobile application (app) can generate longer-term improvements in hemoglobin A 1c (HbA 1c ). Patients ( n = 456) on oral diabetes medications with HbA 1c ≥58 mmol/mol were randomly assigned between a DSME game (with a civics booklet) and a civics game (with a DSME booklet). The 6-month games sent two questions twice weekly via e-mail or mobile app. Participants accrued points based on performance, with scores posted on leaderboards. Winning teams and individuals received modest financial rewards. Our primary outcome measure was HbA 1c change over 12 months. DSME game patients had significantly greater HbA 1c reductions over 12 months than civics game patients (-8 mmol/mol [95% CI -10 to -7] and -5 mmol/mol [95% CI -7 to -3], respectively; P = 0.048). HbA 1c reductions were greater among patients with baseline HbA 1c >75 mmol/mol: -16 mmol/mol [95% CI -21 to -12] and -9 mmol/mol [95% CI -14 to -5] for DSME and civics game patients, respectively; P = 0.031. Patients with diabetes who were randomized to an online game delivering DSME demonstrated sustained and meaningful HbA 1c improvements. Among patients with poorly controlled diabetes, the DSME game reduced HbA 1c by a magnitude comparable to starting a new diabetes medication. Online games may be a scalable approach to improve outcomes among geographically dispersed patients with diabetes and other chronic diseases. © 2017 by the American Diabetes Association.

Glimepiride versus pioglitazone combination therapy in subjects with type 2 diabetes inadequately controlled on metformin monotherapy: results of a randomized clinical trial.

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Umpierrez, Guillermo; Issa, Maher; Vlajnic, Aleksandra

2006-04-01

To compare the effect of add-on glimepiride or pioglitazone in subjects with type 2 diabetes inadequately controlled on metformin monotherapy. Multicenter, randomized, parallel-group, open-label, forcedtitration study involving 203 adults with poorly controlled type 2 diabetes (A1C 7.5-10%) on metformin monotherapy. Subjects were randomized to receive glimepiride or pioglitazone, titrated to the maximum dose for 26 weeks. Subjects were evaluated for A1C changes, fasting plasma glucose (FPG), insulin, C-peptide, and lipid levels. Safety outcomes and diabetes-related healthcare resource utilization were also evaluated. Both treatment groups achieved similar and significant mean decreases from baseline to endpoint (week 26) in A1C (p = 0.0001) and FPG (p use of fasting C-peptide concentration > or = 0.27 nmol/L in the inclusion criteria was a potential limitation as it may have included those patients with an improved probability for glimepiride or pioglitazone response. In addition, a larger patient population would have provided a greater degree of data applicability. In patients with type 2 diabetes inadequately controlled on metformin monotherapy, add-on glimepiride or pioglitazone results in similar overall improvements in glycemic control. Compared with pioglitazone, glimepiride is associated with faster glycemic control, lower total and LDL cholesterol levels and reduced short-term healthcare costs.

Understanding the Relationship between Type 2 Diabetes Mellitus and Falls in Older Adults: A Prospective Cohort Study

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Roman de Mettelinge, Tine; Cambier, Dirk; Calders, Patrick; Van Den Noortgate, Nele; Delbaere, Kim

2013-01-01

Background Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls. Methods 199 older adults (104 with diabetes and 95 healthy controls) underwent a medical screening. Gait (GAITRite®), balance (AccuGait® force plate), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. Results Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants (42 diabetes vs. 22 controls) reported at least one injurious fall or two non-injurious falls (“fallers”). Univariate logistic regression identified diabetes as a risk factor for future falls (Odds Ratio 2.25, 95%CI 1.21–4.15, p = 0.010). Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability. Conclusions Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes. PMID:23825617

The Prevention of WEight Regain in diabetes type 2 (POWER) study: the effectiveness of adding a combined psychological intervention to a very low calorie diet, design and pilot data of a randomized controlled trial

NARCIS (Netherlands)

K.A.C. Berk (Kirsten); H. Buijks (Hanneke); B. Özcan (Behiye); A. van 't Spijker (Adriaan); J.J. van Busschbach (Jan); E.J.G. Sijbrands (Eric)

2012-01-01

markdownabstract__Background:__ Obesity is of major pathogenetic importance to type 2 diabetes, it contributes to poor glycemic control and increases the risk of cardiovascular disease. Over 80% of patients with diabetes type 2 are overweight. To achieve a more favourable risk profile, changes in

Clinical and laboratory parameters in adult diabetics with and without calcific shoulder periarthritis.

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Mavrikakis, M E; Sfikakis, P P; Kontoyannis, S A; Antoniades, L G; Kontoyannis, D A; Moulopoulou, D S

1991-10-01

The clinical and laboratory parameters of calcific shoulder periarthritis (CSP) were examined in 900 patients with type II diabetes mellitus as well as in 350 age- and sex-matched control subjects. A threefold increased prevalence of CSP in diabetics compared with the control group was associated with the presence of longstanding and poorly controlled diabetes, hypercholesterolemia, and hypertriglyceridemia suggesting pronounced diabetic angiopathy, as well as with minor trauma and hypomagnesemia. Aging and serum calcium concentrations were not related to the presence of CSP. Thirty-two percent of diabetics with CSP were symptomatic; 15% of them presented with severe pain and restriction of shoulder movement. These findings confirm a close pathogenetic interrelation between CSP and diabetes mellitus.

Blood pressure control among patients with hypertension and newly diagnosed diabetes.

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Choma, N N; Griffin, M R; Kaltenbach, L A; Greevy, R A; Roumie, C L

2012-09-01

To determine the proportion of patients who achieved blood pressure control during the 2 years following new diabetes diagnosis. A retrospective cohort of veterans ≥ 18 years with hypertension who initiated a diabetes medication from 2000 to 2007 in the Veterans Administration Mid-South Network was assembled. Blood pressure control at diabetes treatment initiation (baseline) was compared with blood pressure control 6, 12, 18 and 24 months later. The Veterans Affairs and American Diabetes Association definitions of control, ≤ 140/90 and ≤ 130/80 mmHg, respectively, were primary and secondary outcomes. At baseline, 59.5% of 16,182 patients had controlled blood pressure according to the Veterans Affairs guideline (31.5% using American Diabetes Association definition). Six months following initiation of diabetes treatment, 65.7% had their blood pressure controlled (P < 0.001). Blood pressure control was sustained but not further improved between 6 months and 2 years, with 66.5% controlled at 2 years following baseline. Higher initial systolic blood pressure, black race and hospitalization in the previous year were associated with higher likelihood of uncontrolled blood pressure at 6 months; whereas baseline cardiovascular disease, baseline dementia and later year of cohort entry were associated with lower likelihood of uncontrolled blood pressure. We found an increase in blood pressure control in the 6 months following initiation of diabetes treatment. However, overall blood pressure control remained suboptimal and with no further improvement over the next 18 months. Published 2011. This article is a US Government work and is in the public domain in the USA.

A socioeconomic and behavioral survey of patients with difficult-to-control type 2 diabetes mellitus reveals an association between diabetic retinopathy and educational attainment

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Emoto N

2016-10-01

Full Text Available Naoya Emoto,1,2 Fumitaka Okajima,1,2 Hitoshi Sugihara,2 Rei Goto3 1Department of Endocrinology, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, 2Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, 3Graduate School of Business Administration, Keio University, Kanagawa, Japan Background: We have recently reported that the attitude of patients toward risk could be a factor in the progression of diabetic complications. In general, risk preference is closely related to socioeconomic status (SES, which includes factors such as age, sex, income, and educational attainment.Objective: We aimed to determine the effect of SES and behavioral propensity on the progress of diabetic complications in patients with type 2 diabetes mellitus (T2DM.Methods: We conducted a survey of 238 patients with difficult-to-control T2DM treated at a hospital in Japan using a modified behavioral economics questionnaire that included questions related to SES. The patients had been referred by general practitioners or other departments in the hospital because of poor metabolic control or unstable complications.Results: Educational attainment was significantly associated with progression of retinopathy in patients <65 years of age. Educational attainment of a high school diploma (12 years of education or lower was a significant risk factor, but there were no differences among levels of attainment beyond high school (13–16 years or more of education. Behavioral propensities were also weakly associated with complications, but not as much as educational attainment. Personal income level and economic status did not show an association with the retinopathy levels.Conclusion: Lower educational attainment is a strong risk factor for diabetic retinopathy, and it is independent of the economic status. The result suggests that cognitive function may play an important role in the progression of diabetic retinopathy in

Diabetes-specific emotional distress mediates the association between depressive symptoms and glycaemic control in Type 1 and Type 2 diabetes

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van Bastelaar, Kim M P; Pouwer, F; Geelhoed-Duijvestijn, P H L M

2010-01-01

and diabetes-specific emotional distress respectively. Linear regression was performed to examine the mediating effect of diabetes-distress. RESULTS: Complete data were available for 627 outpatients with Type 1 (n = 280) and Type 2 (n = 347) diabetes. Analyses showed that diabetes-distress mediated......OBJECTIVES: To investigate whether diabetes-specific emotional distress mediates the relationship between depression and glycaemic control in patients with Type 1 and Type 2 diabetes. RESEARCH DESIGN AND METHODS: Data were derived from the baseline assessment of a depression in diabetes screening...... and glycaemic control, diabetes-specific emotional distress appears to be an important mediator. Addressing diabetes-specific emotional problems as part of depression treatment in diabetes patients may help improve glycaemic outcomes....

Potential Effect of Opium Consumption on Controlling Diabetes and Some Cardiovascular Risk Factors in Diabetic Patients

OpenAIRE

Rahimi, Najmeh; Gozashti, Mohamad Hossain; Najafipour, Hamid; Shokoohi, Mostafa; Marefati, Hamid

2014-01-01

Background Due to this belief that opium may have beneficial effects on diabetes or cardiovascular risk factors, the present study aimed to assess the potential and possible effects of opium consumption on diabetes control and some cardiovascular risk factors in diabetic patients. Methods This study enrolled 374 diabetic subjects from diabetes care centers in Kerman, Iran, including opium user group (n = 179) and a non-opium user group (n = 195). The data were collected through a questionnair...

Type D Personality Predicts Poor Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus: A Six-Month Follow-Up Study.

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Xuemei Li

Full Text Available Type D personality and medication nonadherence have been shown to be associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease, myocardial infarction, and heart failure. However, the relationship between type D personality and medication adherence in patients with Type 2 Diabetes Mellitus (T2DM remains unknown. This study aims to examine whether type D personality was associated with medication adherence in patients with T2DM.A follow-up study was conducted in general hospital of the People's Liberation Army in Beijing.412 T2DM patients (205 females, who were recruited by circular systematic random sampling, provided demographic and baseline data about medical information and completed measures of Type D personality. Then, 330 patients went on to complete a self-report measure of medication adherence at the sixth month after baseline data collection. Chi-square test, t tests, and hierarchical multiple regression analyses were conducted, as needed.Patients with type D personality were significantly more likely to have poor medication adherence (p<0.001. Type D personality predicts poor medication adherence before and after controlling for covariates when it was analyzed as a categorical variable. However, the dimensional construct of type D personality was not associated with medication adherence when analyzed as a continuous variable.Although, as a dimensional construct, type D personality may not reflect the components of the personality associated with poor medication adherence in patients with T2DM, screening for type D personality may help to identify those who are at higher risk of poor medication adherence. Interventions, aiming to improve medication adherence, should be launched for these high-risk patients.

Glycemic Control and Urinary Tract Infections in Women with Type 1 Diabetes: Results from the DCCT/EDIC.

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Lenherr, Sara M; Clemens, J Quentin; Braffett, Barbara H; Cleary, Patricia A; Dunn, Rodney L; Hotaling, James M; Jacobson, Alan M; Kim, Catherine; Herman, William; Brown, Jeanette S; Wessells, Hunter; Sarma, Aruna V

2016-10-01

We examined the relationship between glycemic control and urinary tract infections in women with type 1 diabetes mellitus. Women enrolled in the Epidemiology of Diabetes Interventions and Complications study, the observational followup of the Diabetes Control and Complications Trial, were surveyed to assess the rate of physician diagnosed urinary tract infections in the preceding 12 months. The relationship between glycated hemoglobin levels and number of urinary tract infections in the previous 12 months was assessed using a multivariable Poisson regression model. A total of 572 women were evaluated at year 17. Mean age was 50.7 ± 7.2 years, mean body mass index was 28.6 ± 5.9 kg/m(2), mean type 1 diabetes duration was 29.8 ± 5.0 years and mean glycated hemoglobin was 8.0% ± 0.9%. Of these women 86 (15.0%) reported at least 1 physician diagnosed urinary tract infection during the last 12 months. Higher glycated hemoglobin levels were significantly associated with number of urinary tract infections such that for every unit increase (1%) in recent glycated hemoglobin level, there was a 21% (p=0.02) increase in urinary tract infection frequency in the previous 12 months after adjusting for race, hysterectomy status, urinary incontinence, sexual activity in the last 12 months, peripheral and autonomic neuropathy, and nephropathy. The frequency of urinary tract infections increases with poor glycemic control in women with type 1 diabetes. This relationship is independent of other well described predictors of urinary tract infections and suggests that factors directly related to glycemic control may influence the risk of lower urinary tract infections. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Impact of postprandial glucose control on diabetes-related complications

DEFF Research Database (Denmark)

Madsbad, Sten

2016-01-01

Conflicting findings in the literature and lack of long-term definitive outcome studies have led to difficulty in drawing conclusions about the role of postprandial hyperglycemia in diabetes and its complications. Recent scientific publications support the role of postprandial glucose (PPG......) as a key contributor to overall glucose control and a predictor of microvascular and macrovascular events. However, the need remains for definitive evidence to support the precise relationship between PPG excursions and the development and progression of cardiovascular complications of diabetes. Drawing...... complications is unclarified and is one of the remaining unanswered questions in diabetes. Nevertheless, current evidence supports PPG control as an important strategy to consider in the comprehensive management plan of individuals with diabetes....

Scleredema Diabeticorum in a Patient with Type 2 Diabetes Mellitus

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C. Martín

2011-01-01

Full Text Available Background. Scleredema adultorum, a connective tissue disorder of unknown aetiology, is characterized by a thickening of the reticular dermis in the upper back of the body that may decrease the mobility of the affected tissues. It has been reported in diabetic patients with poor metabolic control. Therapeutic options are limited with generally poor results. Case Report. 53-year-old white male with type 2 diabetes mellitus was referred to our department for evaluation of incipient nephropathy and retinopathy. On examination, he presented erythematous, indurated, painless and ill-defined plaque on the skin of the upper back with limited movement of shoulders. A biopsy was done revealing scleredema. PUVA treatment and physiotherapy were started with the amelioration of mobility and acquiring some elasticity of the upper back. Discussion. The development of scleredema in diabetic patients has been related to prolonged exposure to chronic hyperglycaemia. Our patient has had diabetes for 20 years with an acceptable glucose control, however he developed the scleredema 10 years ago. Conclusions. Scleredema is a rare connective disorder that seems to appear most frequently in diabetic subjects. Good metabolic control seems not to preclude its development. PUVA treatment and physiotherapy are therapeutic options that seem to be of some help.

H. pylori seroprevalence and risk of diabetes: An ancillary case-control study nested in the diabetes prevention program.

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Alzahrani, Saud; Nelson, Jason; Moss, Steven F; Paulus, Jessica K; Knowler, William C; Pittas, Anastassios G

2017-10-01

To determine the association between H. pylori infection and risk of incident diabetes in adults at high risk for diabetes who participated in the Diabetes Prevention Program (DPP) study. In a nested case-control study conducted among 421 adults with newly diagnosed diabetes and 421 matched controls, we examined the association between serological status of H. pylori at baseline and risk of incident diabetes over a mean follow-up period of 2.6years. Using data from the baseline visit of the DPP, we also examined the cross-sectional association between presence of H. pylori antibodies and insulin sensitivity, insulin secretion and the disposition index-like measure after a 75-g oral glucose tolerance test (OGTT). At baseline, H. pylori antibodies were present in 40% of participants who developed diabetes and 39% of controls. After adjusting for matching factors, there was no association between exposure to H. pylori and incident diabetes (odds ratio [OR] of 1.04 (95% CI, 0.77 to 1.40). In cross-sectional analyses, H. pylori status was not significantly associated with insulin sensitivity and disposition index-like measure from OGTT. In adults at high risk for diabetes, H. pylori seropositivity was not associated with risk of developing diabetes. Copyright © 2017 Elsevier Inc. All rights reserved.

The Prevention of WEight Regain in diabetes type 2 (POWER) study : The effectiveness of adding a combined psychological intervention to a very low calorie diet, design and pilot data of a randomized controlled trial

NARCIS (Netherlands)

K.A.C. Berk (Kirsten); H. Buijks (Hanneke); B. Özcan (Behiye); A. van 't Spijker (Adriaan); J.J. van Busschbach (Jan); E.J.G. Sijbrands (Eric)