Showing papers on "Diabetes management published in 1997"

A Randomized Controlled Trial of Weight Reduction and Exercise for Diabetes Management in Older African-American Subjects

Abstract: OBJECTIVE To evaluate a weight loss and exercise program designed to improve diabetes management in older African-Americans. RESEARCH DESIGN AND METHODS Overweight African-Americans ( n = 64) ages 55–79 years with NIDDM were randomized to either an intervention (12 weekly group sessions, 1 individual session, and 6 biweekly group sessions) or usual care (1 class and 2 informational mailings). Clinical and behavioral variables were assessed at 0, 3, and 6 months of treatment. RESULTS Significant net differences in the intervention versus usual care were observed for weight (−2.0 kg, P = 0.006), physical activity, and dietary intake of fat, saturated fat, cholesterol, and nutrition knowledge at 3 months (all P 0.10) mmHg systolic, respectively. Blood lipid profiles improved more in intervention than usual care participants, but not significantly. CONCLUSIONS The intervention program was effective in improving glycemic and blood pressure control. The decrease in HbA1c values was generally independent of the relatively modest changes in dietary intake, weight, and activity and may reflect indirect program effects on other aspects of self-care.

Diabetes Self-Management: Self-reported recommendations and patterns in a large population

Abstract: OBJECTIVE Diabetes self-management is the cornerstone of overall diabetes management. Yet many questions concerning self-management remain unanswered. The current study was designed to examine several questions about diabetes self-management: 1) What do individuals report being told to do? 2) What are their self-reported levels and patterns of self-care? 3) Are there differences on self-reported self-management recommendations and levels across various subgroups? RESEARCH DESIGN AND METHODS Mailed surveys were returned by 2,056 individuals (73.4% response rate). Of the total, 13.8% had IDDM and the remainder had NIDDM, with 65% of the NIDDM group using insulin. RESULTS The levels and patterns of self-management were consistent with those found in previous studies, i.e., individuals most regularly followed their prescribed medication regimen and least regularly followed recommendations for lifestyle changes of diet and exercise. There were significant differences on reported self-management recommendations across different subgroups. Comparisons on level of self-management across diabetes type revealed significant differences for diet and glucose testing. Differences were also found on self-management levels for a number of individual characteristics, including age, working status, and type of insurance, along with knowledge of the Diabetes Control and Complications Trial findings. CONCLUSIONS These findings provide important information on perceived self-management recommendations and the specific self-management levels and patterns in individuals with diabetes. The current findings may help health professionals better understand the levels and correlates of diabetes self-management and direct future research.

Device for diabetes management

Abstract: A device for management of diabetes using a programmable microprocessor based unit having a display, keyboard, and memory The keyboard is for inputting information concerning carbohydrates ingested by a user The microprocessor is programmed to determine an amount of insulin to be used by a user based upon the carbohydrates ingested and the display is for displaying the amount of insulin to be used

Diabetes in Urban African-Americans. IX. Provider Adherence to Management Protocols

Abstract: OBJECTIVE Staged diabetes management should permit glycemic goals to be attained in a timely manner, but the success of such an approach requires conformity by health care providers. To test performance, we analyzed the adherence of practitioners to a protocol for staged management of NIDDM patients. RESEARCH DESIGN AND METHODS Records of patients treated at the Grady Memorial Hospital Diabetes Clinic were reviewed retrospectively over a 3-year period. For each patient, intensification of therapy was indicated if fasting plasma glucose was > 7.8 mmol/l and a prior HbA 1c was > 7.0%. Protocols dictated a progression from dietary therapy alone to increasing dosages of sulfonylureas to increasing dosages of insulin. Patients were seen at bimonthly intervals. RESULTS During the 3-year period, 1,051 patient visits met protocol criteria for intensification. Adherence to the protocol improved significantly in the 3rd year compared with the first 2 years (30, 31, and 47% adherence in the 1st, 2nd, and 3rd years, respectively). Patients treated with diet alone were significantly less likely to have their therapy intensified than patients on sulfonylureas or insulin (intensification rates 25, 41, and 47%, respectively). In the management of patients treated with diet alone, practitioners were reluctant to intensify therapy at early visits, but were more likely to do so later, 19% of patients beyond goal range at the 2-month visit were started on pharmacological therapy vs. 28% at the 4-month visit, and 39% at the 6-month visit ( P 1c . Age did not appear to be a significant factor in the decision to intensify. CONCLUSIONS Although staged management protocols constitute critical tools to achieve glycemic goals, the adherence of health care providers may be suboptimal. Special efforts may be needed to assure compliance.

Perceived competence and actual level of knowledge of diabetes mellitus among nurses.

Abstract: Staff nurses were surveyed on their perceived and actual level of knowledge of diabetes mellitus. Staff nurses (n = 32) employed at a rural 62-bed acute care hospital in the southeastern United States constituted a convenience sample. The Diabetes Self-Report Tool was used to assess staff nurses' perceptions of knowledge of diabetes mellitus. Using a Likert-type scale a mean score of 88% was obtained concerning perceived knowledge. The Diabetes Basic Knowledge Test was used to measure the actual level of knowledge of diabetes mellitus. A mean score of 75% was obtained on the Diabetes Basic Knowledge Test. Nurses' perception of knowledge was not related to actual knowledge scores. Study findings raise questions for the nurse involved in staff development concerning the adequacy of nursing competency validation in the area of diabetes management.

Moving diabetes management from clinic to community: development of a prototype based on automated voice messaging.

Abstract: The purpose of this study is twofold. First, it provides a review of the literature supporting the development of a new service to help patients with diabetes and their providers manage their care. This service, automated voice messaging (A VM) with nurse follow-up, allows for systematic and intensive patient monitoring and diabetes education as well as a means of focusing clinical resources where they are most needed. Second, it provides a description of a prototype AVM-based diabetes management service that has been developed as part of two ongoing, randomized, controlled trials to test the efficacy of AVM care for patients with Type 2 diabetes. Preliminary findings from implementing this service in two large public healthcare systems suggest that AVM-supported care is feasible, desirable by clinicians and patients with diabetes, and may identify serious health problems that otherwise would go unnoted through standard means of clinic-based patient care.

Overcoming social and cultural barriers to care for patients with diabetes.

Abstract: We attempted to develop a culturally sensitive alternative approach to diabetes management in a multiethnic, socially disadvantaged community (Waianae, Hawaii). The aims of this 3.5-year demonstration project were to establish regular community-based medical contact with diabetic patients who had a history of nonadherence to treatment regimens and to determine whether this strategy would lead to better health care (particularly improved self-management) in these patients. This community-based, culturally sensitive outreach system of medical follow up dramatically improved the amount and quality of medical care provided to this high-risk subpopulation of patients with diabetes.

Diabetes Care in India --- Patient's Perceptions, Attitudes and Practices

Abstract: Diabetes is a major health care problem in India. There are an estimated 30 million persons with diabetes, majority living in urban areas. Over 98% are believed to have Type 2 diabetes. There are no reliable figures on how many are diagnosed and how many treated. Based on sales of anti-diabetic pharmaceuticals, we estimate that a meagre 10-12% receive modern pharmacological treatment. All involved with diabetes care agree that patients play a major role in the successful management of diabetes. To be able to provide comprehensive care including appropriate education and advice it is essential to understand perceptions, attitudes and practices amongst patients with diabetes. Such studies are rarely conducted, and if conducted rarely reported. Physician’s often decide on what is good for the patient based on their better knowledge of the disease and their assumptions are at best empirical. The treatment of diabetes, particular Type 2 requires constant review and change as the disease progresses. Initial treatment with diet and exercise, gives way to oral medications and further - to insulin, as has been known for long[1, 2, 3] and is now documented in UKPD study. Hesitation of patients to insulin therapy is well known and recognised but rarely researched and reported. Preliminary results from the UKPD study[4] indicate that 27% of the 676 patients assigned to insulin refused it initially, but does not examine the issue further. A recent study [5] examined NIDDM patients’ fears and hopes about insulin therapy and recommended that health care providers examine their patient’s perceptions, actively elicit and respond to patient needs to avoid unwitting promotion of negative attitudes toward diabetes management. In a separate paper we will report on physician’s perceptions, attitudes and practice (DIPPAP-2 study) [6] and how these can influence patient attitudes. In this study we report from a survey on 475 persons with diabetes living in urban India, their attitudes, perceptions and practices.

Quality of life and social environment as reported by Chinese immigrants with non-insulin-dependent diabetes mellitus.

Abstract: Non-insulin-dependent diabetes mellitus (NIDDM) has been associated with stressful events such as immigration. The purpose of this paper is to report a pilot study that tested translated and back-translated instruments to ascertain factors related to diabetes management in a group of Chinese immigrants with diabetes. The descriptive, cross-sectional design included a convenience sample of 30 Chinese immigrants who had been diagnosed with NIDDM for at least 1 year. Consenting participants completed paper- and-pencil questionnaires (Diabetes Family-Behavior Checklist II, Diabetes Quality of Life, and MDRTC Knowledge Test) that had been translated and back-translated into Chinese and returned them in stamped, self-addressed envelopes. Results indicated that most of the scale and subscale reliabilities were similar to those published previously. Study participants had received limited diabetes education, reported many problems managing diabetes, especially in terms of social and vocational issues, and reported dissatisfaction with their quality of life. Diabetes-related family supportive behaviors were rated positively indicating the importance of including family members in educational programs.

Acceptance of Diabetes Regimens in Adults

Abstract: Diabetes affected an estimated 14 million people in the United States as of 1993 (American Diabetes Association [ADA], 1993a). There are several types of diabetes. As a group, they raise virtually all the issues of prevention, management, and adjustment dealt with in health psychology (Fisher, Delamater, Bertelson, & Kirkley, 1982), and they raise these issues across the life span, from a family’s reaction to a young child’s diagnosis with a lifelong, life-threatening disease to blindness and amputations among adults. Parallel with the complexity of the disease and the diversity of its effects, acceptance in diabetes is complex, entailing a number of skills and tasks. Acceptance is also influenced by a wide range of factors, from the economic and cultural to the personal. This complexity of acceptance and the multiple influences on it are a theme of this chapter.

Method and device for the individual-specific adaption of a simultion model for the determination of the daily profiles of blood sugar concentration, the insulin effect and the food absorption

Abstract: of EP0834825A process for measuring blood sugar concentrations in individual patients over a fixed time period, usually twenty-four hours, allows determination of specific patient profiles. The effect of the administration of a sub-cutaneous insulin and of foodstuff resorption can then be measured based on a mathematical model of the glucose/insulin/substance change through a differential equalising system. By the use of this simple process and algorithm the individual diabetic's blood sugar and insulin dynamics can be defined. Variations from this usual profile can then be more easily detected, leading to better diabetes management.

consenso Consenso Sobre Diabetes Gestacional e Diabetes Pré-Gestacional

Abstract: Clinical guidelines for the management of gestational diabetes andpregestational diabetes were prepared by the Diabetes and PregnancyWorking Group, during the XI Brazilian Diabetes Congress, held in 1997.Selective screening of pregnant women based on the presence of riskfactors is advised beginning at the 20th week of gestation, using a fast-ing plasma glucose. Cut points of 85mg/dl or 90mg/dl are used to classi-fy a positive screening. A 75g oral glucose tolerance test is performed ifthe screening test is positive. Diagnostic cut points suggested by theWorld Health Organization are endorsed (fasting plasma glucose³126mg/dl or 2h plasma glucose ³140mg/dl). Endocrine and obstetricmanagement of gestational diabetes as well as a review on pre-gesta-tional diabetes management are also presented.Keywords: gestational diabetes, diabetes and pregnancy, screening,diagnosis, treatment DIABETES GESTACIONAL ConceitoE A INTOLERÂNCIA AOS CARBOIDRATOS, d e graus variados de intensidade,diagnosticada pela primeira vez durante a gestacao, podendo ou naopersistir apos o parto (1, 2).Fatores de risco• Idade superior a 25 anos• Obesidade ou ganho excessivo de peso na gravidez atual• Deposicao central excessiva de gordura corporal• Historia familiar de diabetes em parentes de 1

Nursing Management of Diabetes Mellitus: A Guide to the Pattern Approach

Abstract: Definition, facts and statistics diagnoses, physiology of glucose metabolism child young and middle adult the older adult meal plan insulin oral hypoglycaemic agents psychosocial considerations self-monitoring of blood glucose hygiene exercise acute complications stress and diabetes management effects on sexual function pregnancy surgery drugs and alcohol development of an education programme assessment of patient's education.

Resource utilization and work or school loss reported by patients with diabetes: experience in diabetes training programs.

Abstract: Diabetes exerts a major economic impact on healthcare in the United States both in terms of direct and indirect costs. Diabetes management and education programs designed to assist patients in achieving more optimal glycemic control represent a potential mechanism for reducing the morbidity and costs associated with diabetes. The relationship between HbA1c and patient hospitalizations and between HbA1c and days lost from work or school related to diabetes within the past year were evaluated. A cohort of 2359 patients with diabetes (188 type I, 2171 type II) referred to a comprehensive diabetes self-management training program was included in the analyses. Overall, 350 (14.8%) patients reported hospitalization, and 212 (9.0%) reported days lost from work or school. Patients with type I diabetes reported more hospitalizations (26.1% vs 13.9% and days lost (19.2% vs 8.1%) than type II patients. For the hospitalization outcome, the multivariate analyses indicated that younger age, the number of co-morbidities, and the duration of diabetes exerted a greater influence on the reported numbers of hospitalization than glycemic control. For the days lost outcome, the multivariate analyses indicated that there was a marginally significant association between patients with poor glycemic control and reported work or school loss related to diabetes (odds ratio = 1.5; 95% confidence interval, 1.0-2.2). These data suggest that interventions that improve glycemic control may decrease indirect costs related to diabetes.

Management of Insulin-Dependent Diabetes mellitus in Adolescents

Abstract: There are many reasons for a specific management plan for adolescents with insulin-dependent diabetes mellitus (IDDM). Although most new patients can be managed initially on an outpatient basis, as they reach their teenage years, blood glucose control deteriorates and insulin requirements increase. Eating disorders, missing insulin injections, excess of alcohol all contribute to poor glycaemic control. Teenagers who have had diabetes for a number of years may have developed microvascular complications and disturbances of growth can occur, more often in girls than in boys. The transition to adult care continues to be a significant problem both for paediatricians and patients. Diabetes management during adolescence requires a team effort involving nurse educator, dietitian, paediatric diabetologist and, possibly, a social worker, with referral to specialists if necessary. Organizing this type of care requires a Regional Paediatric Diabetes Centre.

Management of diabetes in pregnancy.

Abstract: A team approach to diabetes management optimizes pregnancy outcomes for mother and baby. Patients with preexisting diabetes require intensive insulin therapy before conception and during pregnancy. Glucose self-monitoring assists in achieving near-normal glucose levels during pregnancy, with the goal of maintaining fasting glucose levels from 60 to 105 mg per dL (3.3 to 5.8 mmol per L) and postprandial levels less than 120 mg per dL (6.7 mmol per L). Universal screening at 24 to 28 weeks of gestation identifies women with gestational diabetes. Dietary measures are used initially in the management of gestational diabetes, with the addition of insulin therapy if glucose levels exceed 105 mg per dL (5.8 mmol per L) in a fasting state or 120 mg per dL (6.7 mmol per L) two hours postprandial. Self-monitoring of blood glucose levels four or more times a day guides insulin and dietary modifications. Women with gestational diabetes have a higher risk of developing non-insulin-dependent diabetes later in life and, thus, warrant long-term follow-up.

Psychosocial Aspects of Diabetes: The Diabetologists' Perspective.

Abstract: Diabetes mellitus is a multisystem disorder characterized by abnormalities in glucose, fat, and protein metabolism. The long-term microvascular complications of diabetes such as retinopathy, nephropathy, and neuropathy are the same in both forms of the disease. In both types of the disease, diabetes education, frequent monitoring of blood glucose, and regular screening to detect and treat complications at an early stage are an integral part of diabetes management. Patients have to emotionally accept the diagnosis of diabetes and also face the fact that they may already have potentially debilitating complications. Lack of compliance by patients may be a sign of frustration; it signals that goals of treatment and the approach to therapy should be reevaluated. This evaluation should include attention to possible social and psychological issues that may not be immediately apparent. These issues include fear of diabetes and its complications, stress with family or in the workplace and underlying psychiatric conditions. Conversely, both hyperglycemia and hypoglycemia can be very stressful. The relationship between stress and blood glucose control is further complicated by the fact that patients under psychological stress often change their behavior in ways that impact on glucose control. Despite the tremendous progress already made in our understanding of pathophysiology of diabetes and treatment of hyperglycemia, one thing remains unchanged. Life with diabetes continues to be a significant effort and often an overwhelming burden. The disease is complicated, treatments can be complex and prescriptions for patient regimens are often confusing. Diabetes treatment is dependent to a large extent on the individual's ability to practice adequate daily self care, a skill that requires critical support by the health care team. A multidisciplinary approach that includes professionals experienced in psychosocial problems is invaluable in helping these patients.

The clinical usefulness of glucated haemoglobin in diabetes care evaluated by use of a medical technology assessment strategy.

Abstract: With the introduction of measurements of glycated haemoglobin in a single blood sample as an index of long-term blood glucose control, the clinically usefulness of these measurements was questioned. The aim of this study was to evaluate measurements of glycated haemoglobin as a new test for metabolic regulation in diabetes management by use of a medical technology assessment strategy. Technology assessment in medicine has been defined as "the art and science of evaluating medical practices", but the strategy has to be adjusted to the medical technology in question always including the following three stages: (a) problem definition and identification of medical technology, (b) analysis by testing the technology with consideration to its benefit and harm, its costs, and its social consequences, and (c) synthesis of the accumulated knowledge about the technology. Based on the out-put from the problem definition we found it necessary to investigate some of the identified problems ourselves before implementation of routine measurements of glycated haemoglobin. Several studies were accomplished to validate the laboratory technology in terms of analytical reliability and its clinical usefulness. We wanted to (1) define goals of analytical quality of assays of glycated haemoglobin based on clinical goals, (2) establish a laboratory method for measurements of glycated haemoglobin fulfilling the defined goals, (3) investigate the ability of measurements of glycated haemoglobin to characterize impaired glucose tolerance, (4) evaluate the clinical usefulness of measurements of glycated haemoglobin in the assessment of metabolic regulation in non-insulin-dependent diabetes mellitus (NIDDM), (5) compare physicians' assessment of metabolic control in insulin-dependent diabetes mellitus (IDDM) with measurements of glycated haemoglobin and determine whether knowledge of glycated haemoglobin values would result in improved metabolic control, and (6) evaluate the organizational and economical consequences of introducing regular measurements of glycated haemoglobin. The analysis required a multi-disciplinary approach. Based on our own studies and the available data information we found that measurements of glycated haemoglobin should be regarded the most clinically appropriate test of long-term glycemia and should be introduced into routine management of adult patients with IDDM and NIDDM with the following guidelines concerning methodologies, clinical utility, organizational consequences. The individual laboratory has to establish and secure its own method since at present we are still without an internationally accepted reference method or reference material. The method should measure HbA1c without measuring the labile intermediate pre-HbA1c and provide separate detection of haemoglobin variants. We investigated the analytical goals for the performance characteristics of assays based on biological variation and on the clinical significance of a certain change in concentrations in the individual. Different strategies lead to different analytical goals of CVA between 2-4%. An oral glucose tolerance test is still required to establish the diagnosis of diabetes. Measurements of glycated haemoglobin have been suggested as an alternative but a considerable overlap between the WHO-defined groups of normal and impaired glucose tolerance was observed. In patients with IDDM our studies demonstrated the limitations of traditional clinical judgement and the laboratory procedures in providing an accurate assessment of blood glucose control and that knowledge of HbA1c values allowed the clinician to identify patients in poor glycemic control and lead to improvement in glycemic control. In patients with NIDDM our study showed that measurements of HbA1c provided information that was otherwise not obtainable in the usual clinical setting in primary health care. Measurements of glycated haemoglobin were easily accepted by patients with diabetes. (ABSTRACT TRUNCA

Diabetes and Exercise: The Role of the Athletic Trainer

Abstract: Objective: To identify the role that exercise plays in the management of diabetes mellitus and to provide the reader with guidelines for preventing and treating exercise-related complications. Data Sources: MEDLINE was searched from 1985 to 1996 using the key words “diabetes,” “exercise,” “Type I diabetes,” and “athlete.” Data Synthesis: Diabetes mellitus is a chronic metabolic disorder characterized by an abnormally elevated blood glucose level. It is a disease that has long-term ramifications for the body's organ systems. The primary goal of diabetes management is to normalize the blood glucose level. Exercise, along with dietary modifications and insulin, is an important component of the management scheme. While exercise is not consistently associated with improvements in long-term blood glucose control, it does lead to other benefits that may reduce the severity and number of diabetes-related complications. Conclusions/Recommendations: The athletic trainer can help athletes with diabetes to compete safely by understanding their unique physiologic responses to exercise, as well as the risks and benefits of exercise.

Hypertension Education: An Important and Neglected Part of the Diabetes Education Curriculum?

Abstract: This review highlights the important role of hypertension education in reducing the impact of hypertension on the development and progression of diabetes-related complications. Hypertension is commonly associated with diabetes mellitus and can significantly affect the progression of the complications of diabetes. Lifestyle changes similar to those recommended for diabetes management can result in a lowering of blood pressure and can be maintained on a long- term basis to benefit patients with diabetes and mild hypertension. Recently, a team approach in a hypertension clinic model similar to the team approach for diabetes treatment was shown to be effective in diabetes management. Increased awareness of hypertension education may contribute greatly to reducing the complications of diabetes. Hypertension education should be an important component of the diabetes education curriculum.