XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

D iabetes mellitus is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. Specifically titled sections of the standards address children with diabetes, pregnant women, and people with prediabetes. These standards are not intended to preclude clinical judgment or more extensive evaluation and management of the patient by other specialists as needed. For more detailed information about management of diabetes, refer to references 1–3. The recommendations included are screening, diagnostic, and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A large number of these interventions have been shown to be cost-effective (4). A grading system (Table 1), developed by the American Diabetes Association (ADA) andmodeled after existingmethods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. These standards of care are revised annually by the ADA’s multidisciplinary Professional Practice Committee, incorporating new evidence. For the current revision, committee members systematically searched Medline for human studies related to each subsection and published since 1 January 2010. Recommendations (bulleted at the beginning of each subsection and also listed in the “Executive Summary: Standards of Medical Care in Diabetesd2012”) were revised based on new evidence or, in some cases, to clarify the prior recommendation or match the strength of the wording to the strength of the evidence. A table linking the changes in recommendations to new evidence can be reviewed at http:// professional.diabetes.org/CPR_Search. aspx. Subsequently, as is the case for all Position Statements, the standards of care were reviewed and approved by the ExecutiveCommittee of ADA’s Board ofDirectors, which includes health care professionals, scientists, and lay people. Feedback from the larger clinical community was valuable for the 2012 revision of the standards. Readers who wish to comment on the “Standards of Medical Care in Diabetesd2012” are invited to do so at http://professional.diabetes.org/ CPR_Search.aspx. Members of the Professional Practice Committee disclose all potential financial conflicts of interest with industry. These disclosures were discussed at the onset of the standards revisionmeeting. Members of the committee, their employer, and their disclosed conflicts of interest are listed in the “Professional PracticeCommitteeMembers” table (see pg. S109). The AmericanDiabetes Association funds development of the standards and all its position statements out of its general revenues and does not utilize industry support for these purposes.

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Standards of Medical Care in Diabetes—2012

D iabetes is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude clinical judgment or more extensive evaluation and management of the patient by other specialists as needed. For more detailed information about management of diabetes, refer to references 1–3. The recommendations included are screening, diagnostic, and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was used to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. These standards of care are revised annually by the ADA multidisciplinary Professional Practice Committee, and new evidence is incorporated. Members of the Professional Practice Committee and their disclosed conflicts of interest are listed in the Introduction. Subsequently, as with all position statements, the standards of care are reviewed and approved by the Executive Committee of ADA’s Board of Directors.

Standards of Medical Care in Diabetes—2010

How we Think

https://www.scienceopen.com/document_file/57689460-a74a-45be-b1a0-a3e9cd0c5d62/PubMedCentral/57689460-a74a-45be-b1a0-a3e9cd0c5d62.pdf

Standards of Medical Care in Diabetes—2013

Objectives: To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes. Design: Randomised design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending “delayed DAFNE” training 6 months later. Setting: Secondary care diabetes clinics in three English health districts. Participants: 169 adults with type 1 diabetes and moderate or poor glycaemic control. Main outcome measures: Glycated haemoglobin (HbA1c), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL). Results: At 6 months, HbA1c was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t=6.1, P Conclusion: Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.

Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes : dose adjustment for normal eating (DAFNE) randomised controlled trial

The Government's recent commitment to inclusive education aligns En- glish policy in special needs education with the international inclusion movement. One of the founding assumptions of that movement is that mainstream schools can and should develop structures and practices which will allow them to respond more fully to the diversity of their pupil populations. This article reports a study of four comprehensive schools seeking to develop in this more inclusive direction. It finds, however, that their attempts were beset by difficulties and ambiguities which call for an explanation. It considers, and finds inadequate, accounts within the literature in terms of theories of educational change, theories of inclusive schools and micro-political theories. These accounts, it argues, need to be supplemented by a perspective which sees responses to diversity as being beset by dilemmas arising from contradictory imperatives within mass education systems. Such a dilemmatic perspective suggests that movement towards inclusive schooling is likely to be more problematic and more complex than we have supposed.

Theories of Inclusion, Theories of Schools: deconstructing and reconstructing the ‘inclusive school’

This conceptual paper explores the notion of higher education (HE) internationalization and its potential to lead to transformational institutional change. Internationalization is generally regarded as a process that involves increasing the range of international activities within universities and between universities and other educational institutions and the numbers of international students and academic staff. Much of the literature on ‘internationalization’ focuses on incoming international students and the challenges for teaching and learning associated with the increasing diversity of the student population. Forward thinking institutions are responding by attempting to make the curriculum (both formal and informal) more relevant and engaging for international students and by considering ‘internationalization at home’ to prepare all students for life and work in a global economy. Other studies explore the opportunities arising from international research collaboration, for knowledge-transfer and soci...

Internationalization: a transformative agenda for higher education?

1. The Globalization of Higher Education: Concepts and Contexts 2. An International Institution 3. Internationalization: The Challenges 4. International Students 5. International Curriculum, Teaching and Assessment 6. Supporting the Learning Process 7. Managing the Process: Strategic and Management Issues 8. Internationalization, University Teachers and Academic Development References and Selected Bibliography Index.

Internationalizing the University

This special issue follows on from a special call for contributions to the ECER 2016 conference in Dublin on the need to rethink and reconceptualise internationalisation in higher education (HE). The papers in this special issue contribute to a critically reflective interdisciplinary discussion on the phenomena of internationalisation in terms of the evolution of the structures, systems, and functions of HE institutions. They critique the phenomena from social, educational and spatial perspectives, highlighting the complexity of this field and a common concern regarding the effects of predominantly economic drivers for internationalisation. The papers provide insights into some of the drivers and rationales for internationalisation and the ways in which policies and power relationships steer the direction and development of internationalisation at an institutional, programme or personal level. They illustrate the complex and interdependent nature of the positive and less positive dimensions of int...

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Sue Robson

Papers

Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes : dose adjustment for normal eating (DAFNE) randomised controlled trial

Theories of Inclusion, Theories of Schools: deconstructing and reconstructing the ‘inclusive school’

Internationalization: a transformative agenda for higher education?

Internationalizing the University

Internationalisation of higher education: drivers, rationales, priorities, values and impacts