Showing papers on "Diabetes management published in 1992"

Major developments in behavioral diabetes research.

Abstract: Over the past decade, there has been a major increase in behavioral diabetes research. This review focuses on 6 areas: self-treatment, psychosocial impact, diabetes-specific assessment, psychological stress, weight loss intervention, and neuropsychological effects. There has been great progress in identifying factors that predict self-treatment behaviors and psychological adjustment. This research has produced a number of diabetes-specific assessment tools. Psychological stress appears to affect both the etiology and the control of diabetes, but underlying mechanisms remain unclear. Weight loss studies demonstrate the potential benefits of behavioral interventions for diabetes management. Both acute and chronic abnormalities in diabetic blood glucose cause neuropsychological impairments and may cause permanent deficits. The challenge for the next decade is to translate these findings into interventions that improve quality of life and physical well-being for individuals with diabetes.

Evaluating Diabetes Education: Are we measuring the most important outcomes?

Abstract: This article reviews the published literature on diabetes education evaluations and makes recommendations for outcome measures to be used in future research. We conclude that program evaluations to date have focused too narrowly on assessing knowledge and GHb outcomes to the exclusion of other important variables. To reflect the changing emphasis and conceptual basis of diabetes education, we recommend that future evaluations do the following: 1) report on the program's target population, recruitment methods, and representativeness of participants; 2) collect measures of self-efficacy and patient-provider interaction; 3) include quality of life and patient-functioning outcomes; and 4) use more standardized and objective measures of diabetes management behaviors. We close by providing practical examples of feasible collection measures for most settings and references to studies that have done so.

General practice based diabetes surveillance: the views of patients.

Abstract: Forty three patients with non-insulin dependent diabetes registered at two suburban practices were interviewed at least one year after the introduction of an organized general practice based system of diabetic surveillance and the results compared with data gathered from interviews administered before the introduction of the system. Structured data from the two interviews were compared in relation to the importance which patients attached to diabetes and its medical review, patients' preference for place of future review and the health professionals from whom they wished to receive diabetes care. Patients' ratings of the performance of health professionals on various aspects of care were compared with the ratings given before the introduction of the new service. At the follow-up interviews the reasons behind patients' responses to the structured questions were explored using a qualitative method. The introduction of a general practice based diabetes service was marked by an improvement in attendance for diabetes monitoring (56% before introduction, 98% in the year following introduction). This was associated with an increase in the importance which patients attached to diabetes and its medical review. After experience of diabetes care in general practice, patients remained enthusiastic about general practice involvement and confident in their general practitioners' knowledge about diabetes management. In spite of an improvement in the patients' ratings of hospital doctors' communication skills, they continued to rate general practitioners significantly more highly in these skills (P < 0.01) and in terms of convenience and accessibility (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical application of two computerized diabetes management systems: comparison with the log-book method.

Abstract: In two consecutive studies the clinical application and suitability of two computer-assisted data management systems (Camit and Cadmo) were evaluated in a prospective manner. In each study nineteen long-standing, stable insulin-dependent patients were randomly assigned to one of two groups. In study I assessment of metabolic control and insulin dose adjustments were based either on the Camit S1 data analysis or on the conventional log-book method, whereas in study II the Camit S2 and the Cadmo simulation programs were evaluated. HbA1c values decreased significantly in both studies (p < 0.05). A clear decline in hypoglycemic events as well as a significant reduction of the percentage of glucose values below 4.0 mmol/l (p < 0.005) and a marked increase (p < 0.05) in the percentage of glucose levels in the target range (4.0-10.0 mmol/l) were observed. We found both computerized assessment systems to be reliable and suitable for the assessment of blood glucose control and for insulin dose finding. The graphical and statistical presentation of the numerous glucose and insulin data allowed a better summary of blood glucose control and metabolic trends. More time could be spent for problem solving, which proved to be much less exhausting with the computer for the attending physician. Further studies should address the educational potential of computerized systems for the patient as well as for the physician.

Effects of a social support group, as an adjunct to diabetes training, on metabolic control and psychosocial outcomes.

Abstract: The purpose of this present study was to evaluate a social support group as an adjunct to an intensive outpatient diabetes training program. Insulin-treated and non-insulin-treated patients (n = 204) were randomized into two groups: the control group received the training program only, whereas the experimental group was offered the same program plus eight support group meetings. At the 7-month follow-up, patients in both groups showed improved metabolic control, diabetes knowledge, frequency of practicing recommended diabetes management behaviors, and emotional adjustment. Although no additional improvement was seen in those outcome measures in patients who attended support group meetings, results of a subjective evaluation of the support group showed that patients experienced positive feelings in the groups that may contribute to patient health. A better understanding of the possible contribution of support groups to health is necessary before such groups are routinely recommended to patients.

Understanding Insulin Dependent Diabetes

Abstract: Understanding Insulin Dependent Diabetesis the seventh edition of the diabetes instructional manual written by H. Peter Chase, MD, and used at the Barbara Davis Center for Childhood Diabetes. It is meant to explain to parents of a child newly diagnosed the pathophysiology of diabetes and the techniques necessary to manage a child with diabetes. Dr Chase has written his teaching tool clearly, so that most high school students and adults can understand the information. He includes the many technological advances in diabetes management of the 1980s. He emphasizes home glucose monitoring and consistency in food management and clearly outlines the American Diabetic Association's recommendations for the standard of care for children with insulin-dependent diabetes. The seventh edition includes a much stronger look at the social and psychological aspects of being a child with diabetes. The author discusses age-appropriate expectations for children with diabetes, and children are not expected in

The Death of a Child With Diabetes from Neglect: A Case Study

Abstract: This case report of a child with insulin-dependent diabetes mellitus (IDDM) describes a naturally occurring ABABCA design. The A condition represents poor diabetes management provided in the home setting, and the B and C conditions represent improved diabetes management in residential treatment (condition B) or foster care (condition C). The A condition was consistently associated with episodes of diabetic ketoacidosis, high glycosylated hemoglobin percentage, and school failure. In contrast, the B/C conditions were consistently associated with improved health status and school performance. On two occasions, the child was returned to condition A by the state's protective service agency (HRS) in direct conflict with the recommendations of the child's psychological and medical treatment staff. During her last condition A placement, the youngster died. Chronically ill children who are neglected may not receive the protection they need because of lack of awareness about the psychosomatic aspects of their problem.

Care of Diabetic Pregnant Women by Primary-Care Physicians: Reported Strategies for Managing Pregestational and Gestational Diabetes

Abstract: Objective —To ascertain the strategies used by primary-care physicians for treating pregestational and gestational diabetes mellitus (GDM) during pregnancy, because many women with pregnancies complicated by these types of diabetes are treated by physicians who have no special training in intensive diabetes management. Research Design and Methods —Two hundred twenty-four family-practice (FP) physicians and 184 obstetrics/gynecology (OB/GYN) physicians were surveyed by mail. Results —When compared with OB/GYNs, FPs were less likely to screen all pregnant women for GDM ( P = 0.03), use multiple-injection insulin regimens ( P = 0.004) or self-monitoring of blood glucose (SMBG) ( P = 0.01) for Pre-GDM patients, and refer these patients to a specialist for medical ( P = 0.01) or ophthalmologic (P P = 0.003), SMBG ( P = 0.02), and examine eyes for retinopathy (P Conclusions —These data show that there are considerable discrepancies between the strategies used by FPs and OB/GYNs and also suggest that physicians in both groups are under-utilizing recommended treatment strategies described in publications targeted specifically to primary-care physicians. Increased exposure to and dissemination of guidelines for diabetes management and additional medical school and postgraduate education programs are recommended as methods to improve utilization of these strategies.

HEMORHEOlOGIC THERAPY TO CONTROL DIABETIC VASCULAR DISEASE

Abstract: Chronic diabetes mellitus is associated with difficulties that have in common a disturbance of the circulation. A clearly defined hemorheologic burden antedates and is cross-sectionally related to the diabetic circulatory complications, suggesting that blood flow plays a role in damaging diabetic blood vessels. This concept has led to the development of hemorheologic models for both micro- and macroangiopathy. Intensive insulin therapy appears to benefit the diabetic hemorheologic burden, but it has limits that make it unable to normalize blood's flow properties. Other interventions can be identified, based both on drugs and on changes in health habits. They have little or no effect on blood glucose levels but decrease the hemorheologic burden; fourteen means to improve diabetic blood flow are identified and discussed. Four non-drug managements are already often used in treatment. Ten types of pharmacologic agent have clear potential for reducing or preventing diabetic vascular problems. The strength of evidence for their effects and their possible mechanisms of action are discussed. Establishing a more effective role for these agents in diabetes management will require more sophisticated interventional studies that incorporate modern hemorheologic assessment into their design. Such evaluations are important in examlnlng both established and new drugs if we are to further improve the prognosis for individuals with established diabetes.

Work-load and outcomes of diabetes care in general practice.

Abstract: The effect of starting a general practice diabetes clinic on practice work-load and intermediate outcome measures was studied retrospectively using patient records. The 35 diabetic patients included had been diagnosed greater than 4 years before the diabetes clinic started and were followed for 6 years in the clinic, together with a group of age- and sex-matched controls. There was a significant rise in the consultation rates of the diabetic patients, due to an increase in diabetes-related consultations, from 3.9 consultations yr-1 to 6.7 consultations yr-1 (p less than 0.001). There was a fall in HbA1c level of 0.22 (99% CI 0.13, 0.32) %Hb yr-1 over the 6 years and in body mass index of 0.37 (99% CI 0.22, 0.52) kg m-2 yr-1, suggesting an improvement in diabetes management.

Intensive insulin therapy: Part I. Basic principles.

Abstract: Intensive insulin therapy is a complete program of diabetes management. A multicomponent insulin regimen is just one element of this approach. Intensive insulin therapy does not necessarily strive for euglycemia, since patients require individualized glycemic goals. When prescribing insulin, the family physician should be familiar with several important pharmacokinetic issues. Insulin species, insulin absorption, injection site and timing of premeal insulin all affect glycemia. The relationship between diabetic complications and blood glucose control is also important. Although many previous studies have been flawed, evidence suggests that meticulous diabetes control decreases the risk of microvascular complications and neuropathy. Unfortunately, studies have shown no improvement in advanced retinopathy or advanced nephropathy with improved glycemic control. The major cost of improved glycemic control is an increased risk of hypoglycemia.

Problems in Diabetes Management Part I. The Diabetic needing Surgery and the Addington Protocol

Abstract: This is Part I of the Diabetes Management, and describes why the Addington Protocol was developed and what it is. Of the 1,2 million diabetics in the RSA, half of them will require surgery at least once in their lifetime, and there is no standard method which has been successful in regulating all the surgical diabetic - patients because both surgical procedures and patients' physical states, vary too much. Even the indispensable "sliding scale", which junior consultants carry with them as part of their survival-kit, is doomed to fail. This need for a more predictable, Logical and scientific method of maintaining glycaemic control in surgical patients (and in other diabetic complications) was identified, and met by the author, who developed this Addington Protocol to be used in the Addington Hospital in Durban. The protocol is explained, giving clear step-wise guidelines to the nursing staff, and looking at emergency surgery in diabetics. It concludes with the finding that, with adequate management during surgery, the mortality rate for patients with diabetes approximates that of the non-diabetic population.