Showing papers on "Diabetes management published in 1995"

I Get by with a Little Help from my Family and Friends: Adolescents' Support for Diabetes Care

Abstract: Evaluated and compared the support provided by family members and friends for adolescents' diabetes care. Family and friend support also were examined in relation to other measures of social support, to demographic variables (age, gender, duration of diabetes) and to adherence. Using a structured interview, 74 adolescents with diabetes described the ways that family members and friends provided support for diabetes management (insulin shots, blood glucose monitoring, eating proper meals, exercise), and for helping them to "feel good about their diabetes." Families provided more support than friends for three management tasks (insulin injections, blood glucose monitoring, meals); this support was largely instrumental. In contrast, friends provided more emotional support for diabetes than families. Greater family support was related to younger age, shorter disease duration, and better treatment adherence. Implications of the findings include encouraging parents to remain involved in adolescents' treatment management, and involving peers as supportive companions for meals and exercise.

Parents' perceptions of caring for an infant or toddler with diabetes.

Abstract: Although the incidence rate of diabetes in children under the age of 3 years is increasing dramatically, no previous studies provide information about the day-to-day experience of caring for these infants and toddlers. Because a young child with diabetes is dependent on the parent for his/her very existence, the purpose of this phenomenological study was to gain knowledge and understanding of the parents' experiences so that appropriate interventions could be developed and implemented to support parental care for this unique population. Findings revealed three distinct phases in the parents' experiences: the diagnosis and child's hospitalization; adjusting to care at home; and long-term adaptation. Within these phases, parents described inordinate amounts of stress exacerbated by the child's young age and the complex, intrusive nature of diabetes management. On the basis of these findings, implications for practice are discussed.

A Practical Model of Diabetes Management and Education

Abstract: This article discusses an evolving conceptual model of diabetes self-management and patient education. The model contains three primary levels or stages: 1) social environment and contextual factors, which have received little research attention; 2) patient-health care provider interactions, self-management behaviors, and short-term physiological outcomes, which constitute an ongoing cycle of care feedback system; and 3) longer term health and quality-of-life outcomes, which include the major societal costs of treating diabetes complications. The assessment and intervention implications of factors within each of these levels are discussed, with emphasis on both low-cost system-wide activities appropriate for all patients and higher cost activities and resources (e.g., intensive management a la the Diabetes Control and Complications Trial) for appropriately targeted or higher risk patients. I hope that such a systems approach to diabetes management can help reduce victim blaming (whether the victim is the noncompliant patient or the insensitive provider). Such conceptual models, if practically oriented, may help accelerate the development, evaluation, and dissemination of programs that facilitate both patient and health care team adherence to recommended guidelines for diabetes care.

Diabetes in urban African-Americans. I. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis.

Abstract: OBJECTIVE To identify the causes of diabetic ketoacidosis (DKA) in a large urban hospital. RESEARCH DESIGN AND METHODS Consecutive patients admitted during a 3-month period with a primary diagnosis of DKA and who had moderate-to-severe illness as shown by serum glucose >13.9 mmol/l (>250 mg/dl), bicarbonate RESULTS There were 56 episodes of DKA, and 75% of the episodes were in patients with known diabetes. In the known diabetic patients, the most common cause of DKA was stopping insulin therapy, which occurred in 67% of episodes. Half of the patients (50%) stopped insulin because of reported lack of money to buy insulin from an outside pharmacy or get transportation to the hospital; 21% stopped insulin because of lack of appetite; 14% stopped insulin because of behavioral or psychological reasons; and 14% did so because they did not know how to manage diabetes on sick days. Of the known diabetic patients, >80% recalled having been instructed as to blood glucose testing and acute and chronic complications, but fewer patients recalled having been instructed as to insulin dose adjustment (28%) or sick day management (35%). Symptoms of decompensated diabetes were recognized in 55% of the 42 episodes of DKA in patients with known diabetes. However, only 5% of patients contacted the Diabetes Unit when they became ill; the majority (95%) went directly to the emergency room. CONCLUSIONS DKA occurred most often in patients with known diabetes who stopped insulin therapy because of reported lack of money for purchasing insulin or for transportation to the hospital and limited self-care skills in diabetes management. In urban African-American populations, up to two-thirds of the episodes of DKA may be preventable by improving patient education and access to care.

Developing and Implementing a Pharmaceutical Care Model in an Ambulatory Care Setting for Patients With Diabetes

Abstract: This study evaluated pharmaceutical care as an adjunct to an existing, coordinated-care program at a Regional Diabetes Center. The progress of a control group receiving the standard pharmacist instruction was compared with two treatment groups receiving additional small group or individual supplementary education for a 2-month period. Outcome evaluation included assessment of individual diabetes management through blood glucose monitoring and responses on a pretest and posttest questionnaire. Patients in the treatment groups demonstrated significantly lower average weekly blood glucose levels and a decreased incidence of hyperglycemic episodes compared with the control group. Questionnaire data for both treatment groups demonstrated a significant increase in patient understanding of diabetes medications and medications for associated illnesses, an increase in knowledge about blood glucose monitoring, and a positive difference in perceptions/attitudes toward diabetes and communication with the pharmacist. ...

A brief office-based intervention to facilitate diabetes dietary self-management

Abstract: There is a pressing need for brief, practical interventions that address diabetes management. We have developed an office-based intervention to prompt both patients and providers to focus on behavioral issues relevant to dietary self-management that is being evaluated in a randomized trial. The intervention is designed to be broadly applicable to the majority of adult diabetes outpatients during medical visits; uses touchscreen computer assessment to provide immediate feedback on key issues to patients and providers just prior to their interaction; and provides goal setting and problem-solving assistance to patients following their meeting with the physician. Follow-up components include phone calls and videotape or interactive video instruction as needed. The program is described, and demographic and behavioral characteristics of participants are presented for the first 95 patients randomized. Initial process results suggest success in producing modest, targeted behavior changes among a broad cross-section of patients. If the long-term results are equally positive, this intervention could provide a prototype for a feasible, cost-effective way to integrate patient views and behavioral management into office-based care for diabetes.

Perinatal complications and cognitive development in 2- to 5-year-old children of diabetic mothers

Abstract: Objective: Our purpose was to assess whether perinatal complications contribute to lower intellectual attainment in offspring of diabetic mothers, independent of antepartum metabolic disregulation. Study Design: Subjects were 223 pregnant women and their singleton offspring. Eighty-nine women had pregestational diabetes mellitus, 99 had gestational diabetes mellitus, and 35 had normal gestational glucose metabolism. Perinatal complications were prospectively recorded on an examination checklist. The intelligence quotient of the child was assessed with the Bayley Scales of Infant Development at age 2 years and the Stanford-Binet Intelligence Scale at age 3 to 5 years. Results: No significant correlations emerged between either measure of child's intelligence quotient and any prevalent perinatal complication, after statistical correction for socioeconomic status, race or ethnic origin, patient group, and antepartum metabolic control. Conclusions: Given prevailing practices in diabetes management and obstetric and neonatal care, the effects of prevalent perinatal complications on the intellectual development of offspring of diabetic mothers appear minimal.

Monitoring Behavioral Changes in Diabetes Care With the Diabetes Self-Management Record

Abstract: An evaluation instrument called the diabetes self-management record has been developed to better document the positive behavioral changes associated with diabetes education programming. This record is a simple behavior monitoring system that awards points for positive behaviors associated with exercise, glucose monitoring, and nutrition management. A group of 39 adults with diabetes monitored their behaviors with the record prior to, immediately after; and 4 to 6 weeks following a diabetes education programming course. Overall diabetes management scores were higher (mean ± SEM=56.2 ± 3.5 vs 66.3 ± 2.9) following the educational intervention, as well as specific behavioral scores for exercise, glucose monitoring, fat consumption, refined sugar/carbohydrate consumption, and eating behavior. These behaviors were maintained for at least 4 to 6 weeks postprogramming. The diabetes self-management record can be used as an adjunct to diabetes education programming, as an evaluator of the educational intervention,...

Occupational Therapy and the Person With Diabetes and Vision Impairment

Abstract: Diabetes affects 5.2% of the population; many of those persons experience loss of vision as one complication of the disease. Occupational therapists are treating these persons, often for other resulting complications (such as stroke or amputations), or are being asked to adapt techniques or equipment (such as insulin-drawing devices) needed for diabetes management. Because no guidelines exist for occupational therapy with persons with diabetes or vision loss or both, occupational therapists may be unsure of appropriate treatment approaches. Among the approaches described in the occupational therapy literature, common ones include collaboration with other professionals and incorporation of one or more aspects of the diabetes regimen into the person's life-style. When addressing persons who have both diabetes and vision loss, therapists consider their own knowledge base as well as the persons' needs in managing their diabetes. Treatment ideas include enhancing the visual environment or incorporating tactile and auditory feedback with self-management tasks such as testing blood glucose levels. Collaboration with and referral to diabetes and low-vision professionals are adjuncts to therapy and ensure a comprehensive and ongoing diabetes management program.

Diagnosis and Management of Insulin Resistance in Dogs and Cats With Diabetes Mellitus

Abstract: Both dogs and cats with diabetes occasionally develop resistance to the action of insulin during treatment. Clinical insulin resistance should be suspected in any animal in which marked hyperglycemia persists throughout the day despite insulin doses of greater than 1.5 U/kg per injection. In a clinical setting it may be difficult to determine the underlying cause for insulin resistance, which makes management difficult. This article reviews the known causes for insulin resistance and outlines recommendations for diagnosis and management of diabetic dogs and cats.

Symptoms, hormones, and glucose fluxes during a gradual hypoglycaemia induced by intraperitoneal vs venous insulin infusion in Type I diabetes.

Abstract: Intraperitoneal (IP) insulin infusion with programmable implantable pumps is associated with a reduction in hypoglycaemic events when compared to intensive diabetes management with subcutaneous insulin in patients with Type 1 diabetes mellitus. The mechanism may involve more physiological insulin kinetics, lower peripheral insulin levels or a specific hepatic action of portal insulin on hypoglycaemic counter regulation. To investigate the latter two hypotheses, we performed two hypoglycaemic clamps (controlled blood glucose decrement to 2.2 mmol l-1) in random order in 12 Type 1 diabetic patients. Insulin was infused either IP or IV for 150 min, at rates chosen to generate similar peripheral insulin levels (1 mU/kg-1 min-1 IV or 2 mU/kg-1 min-1 IP, n = 6) to evaluate direct hepatic action, or at similar rates (1 mU/kg-1 min-1 IV and IP, n = 6) to evaluate IP indirect effects via lower peripheral insulinaemia. Hepatic glucose production and glucose utilization were measured by [6.6 2H] glucose dilution technique. Glucose production was lower (1.7 +/- 0.4 vs 0.5 +/- 0.4 mg kg-1 min-1, p < 0.05), and utilization was similar at the end of the matched-insulinaemia IV and IP clamps, respectively. By contrast, glucose production was higher (1.7 +/- 0.5 IV vs 2.7 +/- 0.3 IP mg kg-1 min-1, p < 0.01) and glucose utilization lower (4.4 +/- 1.0 IV vs 3.3 +/- 0.2 IP mg kg-1 min-1, p < 0.05) with IP delivery at the end of the matched-dose clamps. Counterregulatory hormones and hypoglycaemic symptoms increased similarly in all clamps. In summary, IP insulin, when compared to IV insulin at similar delivery rates, but not at similar insulinaemia, is associated with a less negative glucose balance (glucose production-glucose utilization) during hypoglycaemia. Such a mechanism may play a role in the reduced hypoglycaemic risk seen with IP implantable pumps.

Intensified diabetes management: lessons from the diabetes control and complications trial.

Abstract: The results of the multicenter diabetes control and complications trial are examined and methods for the implementation of the findings for individuals with type I and type II diabetes are discussed. More than a decade ago the question was raised of whether tight glycemic control would prevent or slow the progression of microvascular complications. In 1993, having studied 1441 individuals with type I diabetes randomized to either intensive glycemic control (HbA1c 9%), it was concluded that a reduction in risk of retinopathy, neuropathy and nephropathy could be realized if near normal glycemic control were achieved. Some questions remained, however. For example, could intensive treatment be achieved in routine practice under the auspices of primary care physicians? Are the findings in this study applicable to individuals with type II diabetes? These questions are addressed through the introduction of staged diabetes management (SDM), an innovative approach to the treatment of diabetes and the prevention of its complications. SDM is designed as a data-based systematic approach to diabetes treatment that targets blood glucose control. Studied in 40 clinical sites throughout the United States and evaluated in 30 sites worldwide, SDM promises to provide appropriate clinical guidance to both primary care and specialist physicians seeking to alter current practice patterns by adopting a systematic approach to diabetes management.

Nutrition and Health Practices of Diabetic and Nondiabetic Men and Women from Two Southeastern New England Communities

Abstract: Diabetes occurs in at least 13 million persons in the United States and is a major cause of morbidity and premature mortality. Diet is the cornerstone of diabetes management, and the purpose of this investigation was to examine dietary intakes and health practices among diabetic and nondiabetic individuals from a recently surveyed population-based sample from two communities in southeastern New England. Data were collected during cross-sectional home health surveys conducted in random population samples of two New England communities during 1987-1988, 1989-1990, and 1992-1993. A food frequency questionnaire was completed by 1,897 of 2,077 eligible respondents who made up our study sample. Statistical analyses suggest that diabetic individuals do not appear to be adhering to measures known to improve metabolic control (i.e., weight reduction and physical activity). Furthermore, both diabetic and nondiabetic individuals alike should be targeted for educational programs aimed at improving dietary intakes which lead to a reduction in consumption of total and saturated fatty acid.

Structured public health quality circle on the topic of diabetes management in general practice

Abstract: The efficacy of quality circles has not yet been evaluated in controlled studies in Germany. The Central Research Institute for Ambulatory Health Care in Germany conducted a prospective controlled trial in order to evaluate the effects of structured quality circles on the process of quality ambulatory care for diabetic patients. Following a training for moderators (two for each quality circle) two quality circles undertook five sessions. In a representative random sample (25 diabetic patients per practice), the quality of diabetes care was evaluated before and after participation in the quality circles and was compared to the results of a control group without peer review. The participation in a quality circle resulted in a significant and relevant improvement of the quality concerning the detection of diabetes related complications.

Diabetes and Vascular Disease: A Common Association

Abstract: Diabetes is a chronic metabolic disorder with a characteristic hyperglycemia. This elevated blood glucose causes the frequent complications of diabetes that often involve the vascular system. Macrovascular involvement includes coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Diabetic nephropathy and retinopathy are serious microvascular disturbances. There is no cure for diabetes, so early detection and intervention are necessary to limit progression of diabetes and its complications. The advanced nurse practitioner has a vital role in directing care for chronic conditions through education and a holistic approach to the patient as they are key to diabetes management. Standards of practice for diabetes have been defined by the American Diabetes Association. Balancing cost containment with maintenance of these standards is a challenge for health care.

Pharmacologic Management of Hyperglycemia in Diabetes Mellitus: Implications for Physical Therapy

Abstract: Diabetes mellitus is a costly, chronic disease that affects millions of Americans each year. The classic triad of diabetes management includes diet, exercise, and pharmacological intervention. A variety of complications may result due to this chronic disease, and manipulation of the triad of treatment factors may be necessary in order to effectively treat the individual patient. Physical therapists are consulted in both the primary care of patients with diabetes and in the case of complications; therefore, an understanding of the various forms of the disease, the complications, and the treatment approaches is necessary for comprehensive patient management. The purposes of this article are to give an overview of the disease and its common complications and to discuss the various treatment approaches with emphasis on the pharmacological interventions and physical therapy concerns.

Pancreatic transplantation and its future role in diabetes management.

Abstract: The first attempt to implant insulin-producing tissue (pieces of sheep pancreas) into an insulin-dependent patient dates back to the last century long before the discovery of insulin. Since 1966 when the first pancreatic allograft was performed, more than 6800 pancreas transplantations have been registered. Improved surgical techniques, more effective immunosuppression, and optimal perioperative and postoperative care have led to impressive results collected in the International Pancreas Transplant Registry;' (1 year patient survival 91 %-75'/0 and 65% functioning grafts at 1 and 5 years, respectively). Despite these positive results which are comparable to graft survival rates of other solid organs and despite the fact that none of the treatment modalities in I D D M diabetic patients is more effective in controlling diabetic metabolism, pancreatic grafting i s st i l l c ~ n t r o v e r s i a l . ~ ~ The arguments against pancreatic transplantation are manifold: it is not a life-saving procedure, it may lead to a higher postoperative morbidity, chronic immunosuppression is required, and the life-prolonging effect as well as benefit on macrovascular morbidity are still not conclusive. in addition, it i s an expensive alternative to insulin replacement, especially in times and regions which are short of health care funds. However, those arguing against pancreatic grafting forget that I D D M i s an ever-demanding disease especially for the patient, who has many daily burdens, like glucose monitoring, multiple insulin injections, restrictions in life-style and social and professional discrimination. Moreover there is the danger and fear of acute metabolic derangements and chronic secondary complications. In recent years, the prognosis of insulin-dependent diabetes has improved, life expectancy has increased by more than 20 years and the incidence of secondary complications decreased dramatically with the introduction of structured diabetes education, self-control and preventive measures like opththalmological, neurological and vascular screening and treatment programmes for early d iabetes-specific and d ia betes-associated lesions. One example i s the dramatic reduction of nephropathy by 30-40%.5 Prospective studies have demonstrated that there is a clear relation between glycaemic control and the incidence and reduction of early diabetic lesion^.^,^ The threshold for the non-linear development of retinopathy and nephropathy seem to be at a glycosolated haemoglobin of around 8%.\" Although extraordinary efforts and successes have been made to improve patient care and empowerment, the reality i s that for many reasons many patients do not profit from these achievements and develop secondary complications. Who then might profit from pancreatic transplantation? There is increasing evidence that pancreatic grafting

The Diabetes Control and Complications Trial: new challenges for the school nurse.

Abstract: Results from the recently concluded Diabetes Control and Complications Trial confirm previously held beliefs regarding the relationships between hyperglycemia and the development of retinopathy, nephropathy, and neuropathy in insulin-dependent diabetes mellitus. Intensive therapy, now recommended for all patients 13 years and over, requires diabetes management throughout the school day and the active participation of the school nurse as a member of the child's health care team.

Tool Chest: Teaching Component Skills for Diabetes Management to a Low-Functioning Child

Abstract: sometimes are not adequately addressed. For example, children typically are taught the intricate steps necessary for self-injecting insulin, testing blood glucose, levels, and responding appropriately to blood glucose levels. However, less attention is paid to component skills such as reading ability and the interpretation of output from a blood glucose monitoring device. What follows is a case report on an 11-yearold female with IDDM who presented with deficient component skills which were identified over the course of treat-

Pharmaceutical intervention in diabetes management.

Abstract: Insulins and oral agents should be prescribed based on the assessed needs and physical status of the patient. They are most effective when combined with a diabetes management plan which will include 1) an individualized nutrition plan, 2) an exercise plan based on the assessed physical need and capabilities of the patient, 3) consistent self-blood glucose testing, and 4) patient understanding of correct medication/insulin administration, effect, and side effects. All aspects of communication between the health team and the patient need to be clear and concise if the patient is to reach self actualization in diabetes management.