Showing papers on "Diabetes management published in 2013"

Importance of family/social support and impact on adherence to diabetic therapy.

Abstract: Diabetes mellitus affects 24 million individuals in the US. In order to manage their diabetes successfully, patients must adhere to treatment regimens that include dietary restrictions, physical activity goals, and self-monitoring of glucose levels. Numerous factors affect patients’ ability to adhere properly, eg, self-efficacy, treatment expectations, health beliefs, and lack of social support. Consequently, diabetes management can be quite complex, requiring lifelong commitment and drastic changes to the patient’s lifestyle. Empirical studies have shown positive and significant relationships between social support and treatment adherence among patients with diabetes. Social support from family provides patients with practical help and can buffer the stresses of living with illness. However, the exact mechanism by which social support affects patient adherence is not yet completely understood. Further research is needed to address how the differences in types of support, such as functional or emotional support, are linked to outcomes for patients. The purpose of this review is to summarize what is known of the impact of social and family support on treatment adherence in patients with diabetes and to explore the current methods and interventions used to facilitate family support for diabetic patients.

Continuous Glucose Monitoring Systems: A Review

Abstract: There have been continuous advances in the field of glucose monitoring during the last four decades, which have led to the development of highly evolved blood glucose meters, non-invasive glucose monitoring (NGM) devices and continuous glucose monitoring systems (CGMS). Glucose monitoring is an integral part of diabetes management, and the maintenance of physiological blood glucose concentration is the only way for a diabetic to avoid life-threatening diabetic complications. CGMS have led to tremendous improvements in diabetic management, as shown by the significant lowering of glycated hemoglobin (HbA1c) in adults with type I diabetes. Most of the CGMS have been minimally-invasive, although the more recent ones are based on NGM techniques. This manuscript reviews the advances in CGMS for diabetes management along with the future prospects and the challenges involved.

Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy.

Abstract: Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future.

Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management

Abstract: OBJECTIVE Current guidelines for intensive treatment of type 1diabetes base the mealtime insulin bolus calculation exclusively on carbohydrate counting. There is strong evidence that free fatty acids impair insulin sensitivity. We hypothesized that patients with type 1 diabetes would require more insulin coverage for higher-fat meals than lower-fat meals with identical carbohydrate content. RESEARCH DESIGN AND METHODS We used a crossover design comparing two 18-h periods of closed-loop glucose control after high-fat (HF) dinner compared with low-fat (LF) dinner. Each dinner had identical carbohydrate and protein content, but different fat content (60 vs. 10 g). RESULTS Seven patients with type 1 diabetes (age, 55 ± 12 years; A1C 7.2 ± 0.8%) successfully completed the protocol. HF dinner required more insulin than LF dinner (12.6 ± 1.9 units vs. 9.0 ± 1.3 units; P = 0.01) and, despite the additional insulin, caused more hyperglycemia (area under the curve >120 mg/dL = 16,967 ± 2,778 vs. 8,350 ± 1,907 mg/dL⋅min; P < 0001). Carbohydrate-to-insulin ratio for HF dinner was significantly lower (9 ± 2 vs. 13 ± 3 g/unit; P = 0.01). There were marked interindividual differences in the effect of dietary fat on insulin requirements (percent increase significantly correlated with daily insulin requirement; R 2 = 0.64; P = 0.03). CONCLUSION This evidence that dietary fat increases glucose levels and insulin requirements highlights the limitations of the current carbohydrate-based approach to bolus dose calculation. These findings point to the need for alternative insulin dosing algorithms for higher-fat meals and suggest that dietary fat intake is an important nutritional consideration for glycemic control in individuals with type 1 diabetes.

Challenges in diabetes management in Indonesia: a literature review.

Abstract: The expanding diabetes epidemic worldwide could have potentially devastating effects on the development of healthcare systems and economies in emerging countries, both in terms of direct health care costs and loss of working time and disability. This study aims to review evidence on the burden, expenditure, complications, treatment, and outcomes of diabetes in Indonesia and its implications on the current health system developments. We conducted a comprehensive literature review together with a review of unpublished data from the Ministry of Health and a public health insurer (Askes). Studies presenting evidence on prevalence, incidence, mortality, costs, complications and cost of complications, treatment, and outcomes were included in the analysis. A limited number of international, national and local studies on the burden and cost of diabetes in Indonesia were identified. National survey data suggests that in 2007 the prevalence of diabetes was 5.7%, of which more than 70% of cases were undiagnosed. This estimate hides large intracountry variation. There was very limited data available on direct costs and no data on indirect costs. The most commonly-identified complication was diabetic neuropathy. There were a number of limitations in the data retrieved including the paucity of data representative at the national level, lack of a clear reference date, lack of data from primary care, and lack of data from certain regions of the country. If left unaddressed, the growing prevalence of diabetes in the country will pose a tremendous challenge to the Indonesian healthcare system, particularly in view of the Government’s 2010 mandate to achieve universal health coverage by 2014. Essential steps to address this issue would include: placing diabetes and non-communicable diseases high on the Government agenda and creating a national plan; identifying disparities and priority areas for Indonesia; developing a framework for coordinated actions between all relevant stakeholders.

Interrelation Between Adult Persons With Diabetes and Their Family A Systematic Review of the Literature

Abstract: Diabetes mellitus is a common chronic disease all over the world. Self-management plays a crucial role in diabetes management. The purpose of this systematic review was to summarize what is known about the interactions between adult persons with diabetes, their family, and diabetes self-management. MEDLINE, CINAHL, PSYCHINFO, LINDA, and MEDIC databases were searched for the years 2000 to 2011 and for English language articles, and the reference lists of the studies included were reviewed to capture additional studies. The findings indicate that family members have influence on the self-management of adult persons with diabetes. The support from family members plays a crucial role in maintaining lifestyle changes and optimizing diabetes management. Diabetes and its treatment also affect the life of family members in several ways, causing, for example, different types of psychological distress. More attention should be paid to family factors in diabetes management among adult persons.

The use of technology to promote physical activity in Type 2 diabetes management: A systematic review

Abstract: With increasing evidence available on the importance of physical activity in the management of Type 2 diabetes, there has been an increase in technology-based interventions. This review provides a systematic and descriptive assessment of the effectiveness of technology to promote physical activity in people with Type 2 diabetes. For this review, technology included mobile phones and text messages, websites, CD-ROMs and computer-learning-based technology, and excluded telephone calls. A systematic literature search was conducted to retrieve articles from January 2001 to March 2013 using the following databases: the Cochrane Library, EMBASE, MEDLINE, PsycINFO and PubMed. Articles had to describe an intervention that used technology to promote physical activity in people with Type 2 diabetes. A methodological quality assessment of the studies was conducted and data synthesis was performed. In total, 15 articles were eligible for review: web-based (9), mobile phone (3), CD-ROM (2) and computer based (1). All studies found an increase in physical activity but only nine were significant. The use of a personal coach, logbooks and reinforcement strategies such as phone calls and email counselling were found to be effective components for behaviour change. No studies were ranked as low in terms of methodological quality. Technology-based interventions to promote physical activity are effective; using further methods to promote participant adherence is associated with greater benefit. Further research should look into strategies to enhance adherence and sustainability in order to increase the effectiveness of technology-based physical activity intervention in diabetes care.

What’s distressing about having type 1 diabetes? A qualitative study of young adults’ perspectives

Abstract: Diabetes distress is a general term that refers to the emotional burdens, anxieties, frustrations, stressors and worries that stem from managing a severe, complex condition like Type 1 diabetes. To date there has been limited research on diabetes-related distress in younger people with Type 1 diabetes. This qualitative study aimed to identify causes of diabetes distress in a sample of young adults with Type 1 diabetes. Semi-structured interviews with 35 individuals with Type 1 diabetes (23–30 years of age). This study found diabetes related-distress to be common in a sample of young adults with Type 1 diabetes in the second phase of young adulthood (23–30 years of age). Diabetes distress was triggered by multiple factors, the most common of which were: self-consciousness/stigma, day-to-day diabetes management difficulties, having to fight the healthcare system, concerns about the future and apprehension about pregnancy. A number of factors appeared to moderate distress in this group, including having opportunities to talk to healthcare professionals, attending diabetes education programmes and joining peer support groups. Young adults felt that having opportunities to talk to healthcare professionals about diabetes distress should be a component of standard diabetes care. Some aspects of living with diabetes frequently distress young adults with Type 1 diabetes who are in their twenties. Clinicians should facilitate young adults’ attendance at diabetes education programmes, provide them with opportunities to talk about their diabetes-related frustrations and difficulties and, where possible, assist in the development of peer-support networks for young adults with diabetes.

Internet Psycho-Education Programs Improve Outcomes in Youth With Type 1 Diabetes

Abstract: OBJECTIVE The purpose of this study was to determine the efficacy of two internet-based psycho-educational programs designed to improve outcomes for youth with type 1 diabetes transitioning to adolescence. RESEARCH DESIGN AND METHODS The study was a multisite clinical trial of 320 youth (age 11–14 years; 37% minority; 55% female) randomized to one of two internet-based interventions: TeenCope or Managing Diabetes. Primary outcomes were HbA 1c and quality of life (QOL). Secondary outcomes included coping, self-efficacy, social competence, self-management, and family conflict. Data were collected at baseline and after 3, 6, and 12 months online. Youth were invited to cross over to the other program after 12 months, and follow-up data were collected at 18 months. Analyses were based on mixed models using intent-to-treat and per-protocol procedures. RESULTS Youth in both groups had stable QOL and minimal increases in HbA 1c levels over 12 months, but there were no significant differences between the groups in primary outcomes. After 18 months, youth who completed both programs had lower HbA 1c ( P = 0.04); higher QOL ( P = 0.02), social acceptance ( P = 0.01), and self-efficacy ( P = 0.03) and lower perceived stress ( P = 0.02) and diabetes family conflict ( P = 0.02) compared with those who completed only one program. CONCLUSIONS Internet interventions for youth with type 1 diabetes transitioning to adolescence result in improved outcomes, but completion of both programs was better than only one, suggesting that these youth need both diabetes management education and behavioral interventions. Delivering these programs via the internet represents an efficient way to reach youth and improve outcomes.

A critical review of diabetes, glycemic control, and dental implant therapy

Abstract: Objectives—To systematically examine the evidence guiding the use of implant therapy relative to glycemic control for patients with diabetes and to consider the potential for both implant therapy to support diabetes management and hyperglycemia to compromise implant integration. Material and Methods—A systematic approach was used to identify and review clinical investigations directly assessing implant survival or failure for patients with diabetes. A MEDLINE (PubMED) database search identified potential articles for inclusion using the search strategy: (dental implants OR oral implants) AND (diabetes OR diabetic). Inclusion in this review required longitudinal assessments including at least 10 patients, with included articles assessed relative to documentation of glycemic status for patients. Results—The initial search identified 129 publications, reduced to 16 for inclusion. Reported implant failures rates for diabetic patients ranged from 0–14.3%. The identification and reporting of glycemic control was insufficient or lacking in 13 of the 16 studies with 11 of these enrolling only patients deemed as having acceptable glycemic control, limiting interpretation of findings relative to glycemic control. Three of the 16 studies having interpretable information on glycemic control failed to demonstrate a significant relationship between glycemic control and implant failure, with failure rates ranging from 0–2.9%. Conclusions—Clinical evidence is lacking for the association of glycemic control with implant failure while support is emerging for implant therapy in diabetes patients with appropriate accommodations for delays in implant integration based on glycemic control. The role for implants to improve oral function in diabetes management and the effects of hyperglycemia on implant integration remains to be determined.

Improving Depression Screening for Adolescents With Type 1 Diabetes

Abstract: OBJECTIVE: Depression is common among adolescents, but rates increase significantly in the presence of chronic health conditions. Outpatient screening for depression is recommended but rarely formally conducted due to barriers of implementation. METHODS: To provide a model for depression screening of youth with chronic health conditions, a standard process using a self-administered electronic version of the Children’s Depression Inventory (CDI) was developed. Quality improvement methodology and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients 13 to 17 years of age with type 1 diabetes. RESULTS: Of the 528 eligible adolescents, 509 (96%) received at least 1 depression screen during the first year. The process was tested and refined in over 1200 patient encounters, which resulted in an increase in depression screening rates from <5% to a median of 85% over the initial 12 months. Both patients and staff reported acceptance of screening on qualitative surveys. Elevated CDI scores (≥16) were found in 8% of the sample; moderate scores (10–15) in 12% of the sample. Low risk scores were found in 80% of the sample. Higher CDI scores correlated with lower blood glucose monitoring frequency and higher hemoglobin A1c, confirming the link between more depression symptoms and poorer diabetes management and control. Suicidal ideation was endorsed in 7% of the population. CONCLUSIONS: Systematic depression screening in adolescents with type 1 diabetes can be reliably implemented with clinically significant results. A systematic approach, such as described in this study, can serve as a model for other chronic health conditions. * Abbreviations: BGM — : blood glucose monitoring CDI — : Children’s Depression Inventory EMR — : electronic medical record HbA1c — : hemoglobin A1c QI — : quality improvement PDSA — : plan, do, study, act

Use of Behavioral Change Techniques in Web-Based Self-Management Programs for Type 2 Diabetes Patients: Systematic Review

Abstract: Background: Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic metabolic disease characterized by hyperglycemia and cardiovascular risks. Without proper treatment, T2DM can lead to long-term complications. Diabetes self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs for T2DM patients can help to successfully improve patient health behaviors and health-related outcomes. Theories can help to specify key determinants of the target behaviors and behavior change strategies required to arrive at the desired health outcomes, which can then be translated into specific behavioral techniques or strategies that patients can learn to apply in their daily life. From previous reviews of a wide range of online diabetes self-management tools and programs, it appears that it is still unclear which behavioral change techniques (BCTs) are primarily used and are most effective when it comes to improving diabetes self-management behaviors and related health outcomes. Objective: We set out to identify which BCTs are being applied in online self-management programs for T2DM and whether there is indication of their effectiveness in relation to predefined health outcomes. Methods: Articles were systematically searched and screened on the mentioned use of 40 BCTs, which were then linked to reported statistically significant improvements in study outcomes. Results: We found 13 randomized controlled trials reporting on 8 online self-management interventions for T2DM. The BCTs used were feedback on performance, providing information on consequences of behavior, barrier identification/problem solving, and self-monitoring of behavior. These BCTs were also linked to positive outcomes for health behavior change, psychological well-being, or clinical parameters. Conclusions: A relatively small number of theory-based online self-management support programs for T2DM have been reported using only a select number of BCTs. The development of future online self-management interventions should be based on the use of theories and BCTs and should be reported accurately.

Impact of communicative and critical health literacy on understanding of diabetes care and self-efficacy in diabetes management: a cross-sectional study of primary care in Japan

Abstract: Background: The role of a patient’s functional health literacy (HL) has received much attention in the context of diabetes education, but researchers have not fully investigated the roles of communicative and critical HL, especially in primary care. Communicative HL is the skill to extract health information and derive meaning from different forms of communication, and to apply this information to changing circumstances. Critical HL allows the patient to critically analyze information and to use this information to achieve greater control over life events and situations. We examined how HL, particularly communicative and critical HL, is related to the patient’s understanding of diabetes care and self-efficacy for diabetes management in primary care settings. We also examined the impact of patient–physician communication factors on these outcomes, taking HL into account. Methods: We conducted a cross-sectional observational study of 326 patients with type 2 diabetes who were seen at 17 primary care clinics in Japan. The patients completed a self-administered questionnaire that assessed their HL (functional, communicative, and critical), understanding of diabetes care, and self-efficacy for diabetes management. We also examined the perceived clarity of the physician’s explanation to assess patient–physician communication. Multivariate regression analyses were performed to determine whether HL and patient–physician communication were associated with understanding of diabetes care and self-efficacy. Results: A total of 269 questionnaires were analyzed. Communicative and critical HL were positively associated with understanding of diabetes care (β = 0.558, 0.451, p < 0.001) and self-efficacy (β = 0.365, 0.369, p < 0.001), respectively. The clarity of physician’s explanation was associated with understanding of diabetes care (β = 0.272, p < 0.001) and self-efficacy (β = 0.255, p < 0.001). In multivariate regression models, HL and perceived clarity of the physician’s explanation were independently associated with understanding of diabetes care and self-efficacy. Conclusions: Communicative and critical HL and clear patient–physician communication were independently associated with the patient’s understanding of diabetes care and self-efficacy. The potential impact of communicative and critical HL should be considered in communications with, and the education of, patients with diabetes in primary care settings.

1,5-Anhydroglucitol in diabetes mellitus

Abstract: The measure of glycated hemoglobin (HbA1c) concentration is the gold standard of glycemic control index in diabetes management and is well known as a marker for diabetes complications. However, HbA1c level neither accurately reflect glucose fluctuations, nor does it provide a clear indication of glycemic control in recent days or weeks. HbA1c concentration measurement can be confounded in patients with anemia, hemoglobinopathy, liver disease, or renal impairment. 1,5-Anhydroglucitol (1,5-AG) structurally resembles glucose. It can be influenced by diet or medication, gender and race, especially severe renal disease and various pathological conditions. Most notably, 1,5-AG level is reflective of short-term glucose status, postprandial hyperglycemia, and glycemic variability which are not captured by HbA1c assay. 1,5-AG may suggest an alternative index of subtypes of diabetes and a warning sign of diabetes complications. This review provides an overview of our current understanding of the role of 1,5-AG marker in diabetes. However, further investigations on the associations between this glycemic marker and diabetes complications are needed.

Mobile phone health apps for diabetes management: Current evidence and future developments

Abstract: Can an app help manage diabetes? We discuss how the advent of mobile health apps in connecting patients to providers is creating new opportunities for the management of diabetes. Although there are promising outcomes, there is still much to be learned about how such technology could be fully exploited.

Differences in the Management of Type 1 Diabetes Among Adults Under Excellent Control Compared With Those Under Poor Control in the T1D Exchange Clinic Registry

Abstract: OBJECTIVE Optimizing glycemic control in type 1 diabetes is important to minimize the risk of complications. We used the large T1D Exchange Clinic Registry database to identify characteristics and diabetes management techniques in adults with type 1 diabetes, differentiating those under excellent glycemic control from those with poorer control. RESEARCH DESIGN AND METHODS The cross-sectional analysis included 627 participants with HbA 1c 1c ≥8.5% (fair/poor control) at enrollment who were ≥26 years of age (mean ± SD 45.9 ± 13.2 years), were not using continuous glucose monitoring, and had type 1 diabetes for ≥2 years (22.8 ± 13.0 years). RESULTS Compared with the fair/poor control group, participants in the excellent control group had higher socioeconomic status, were more likely to be older and married, were less likely to be overweight, were more likely to exercise frequently, and had lower total daily insulin dose per kilogram ( P P CONCLUSIONS Diabetes self-management related to insulin delivery, glucose monitoring, and lifestyle tends to differ among adults with type 1 diabetes under excellent control compared with those under poorer control. Future studies should focus on modifying diabetes management skills in adult type 1 diabetes patients with suboptimal glycemic control.

Diabetes management in Thailand: a literature review of the burden, costs, and outcomes.

Abstract: Management of diabetes represents an enormous challenge for health systems at every level of development. The latter are tested for their ability to continuously deliver high quality care to patients from the day they are diagnosed throughout their life. In this study, we review the status of diabetes management in Thailand and try to identify the key challenges the country needs to address to reduce the current (and future) medical and economic burden caused by the disease. We conducted a literature review on the burden, costs, and outcomes of diabetes in Thailand. This information was complemented by personal communication with senior officials in the Thai Ministry of Health. We identified the following priorities for the future management of diabetes in Thailand. First, increasing screening of diabetes in high risk population and promoting annual screening of diabetes complications in all diabetic patients. Second, identifying and addressing factors affecting poor treatment outcomes. Third, policy should specify clear targets and provide and use a monitoring framework to track progress. Fourth, efforts are needed to further improve data availability. Up-to-date data on the medical and economic burden of diabetes representative at the national level and at least the regional level are essential to identify needs and monitor progress towards established targets. Fifth, promotion of a healthy lifestyle for prevention of diabetes through education and quality information delivered to the public.

Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options.

Abstract: This review is focused on the prevalence of eating disorders and disordered eating behaviors in individuals with type 1 diabetes. Recent research indicates higher prevalence rates of eating disorders among people with type 1 diabetes compared with their peers without diabetes. Eating disorders and disordered eating behaviors—especially insulin omission—are associated with poorer glycemic control and serious risk for increased morbidity and mortality. Screening should begin in pre-adolescence and continue through early adulthood, as many disordered eating behaviors begin during the transition to adolescence and may persist for years. Available screening tools and treatment options are reviewed. Given the complexity of diabetes management in combination with eating disorder treatment, it is imperative to screen early and often, in order to identify those most vulnerable and begin appropriate treatment in a timely manner.

National recommendations: Psychosocial management of diabetes in India.

Abstract: Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.

Disentangling the roles of parental monitoring and family conflict in adolescents' management of type 1 diabetes.

Abstract: Type 1 diabetes is a chronic condition that impacts two of every 1000 youth in the United States (Liese et al., 2006). The complex, demanding regimen for diabetes self-care requires frequent blood glucose (BG) monitoring and management of insulin, nutritional intake, and physical activity (Silverstein et al., 2005). Common declines in adolescents’ self-care and disease control (Helgeson, Siminerio, Escobar, & Becker, 2009; Luyckx, Seiffge-Krenke, & Hampson, 2010) elevate the risk for complications, lead to greater healthcare utilization, and result in higher medical costs (Menzin, Langley-Hawthorne, Friedman, Boulanger, & Cavanaugh, 2001; Wagner et al., 2001). Ideally, youth with diabetes and their parents complete diabetes management jointly (Anderson, 2004; Silverstein et al., 2005), and family interactions related to diabetes can impact youths’ diabetes self-care and glycemic outcomes (Anderson, Ho, Brackett, Finkelstein, & Laffel, 1997). Parental involvement in diabetes management can take the form of parental responsibility, in which parents complete particular tasks for youth, or of parental monitoring, in which parents supervise youths’ independent completion of self-care tasks. Both forms of involvement are associated with better glycemic control via their beneficial impact on adolescents’ self-care (Anderson et al., 1997; Ellis et al., 2007). In early adolescence, increasing autonomy is typical (Beyers, Goossens, Vansant, & Moors, 2003) and parents’ expectations for teens’ diabetes self-care tend to increase while their direct participation in diabetes management often decreases (Palmer et al., 2004; Wysocki et al., 1996). During this period, parental involvement may begin to transition from responsibility to monitoring. The shift in disease management responsibility from parents to youth is one factor associated with the common deterioration in diabetes outcomes in adolescence (Holmes et al., 2006; Grey, Boland, Yu, Sullivan-Bolyai, & Tamborlane, 1998; Palmer et al., 2004), although greater parental monitoring appears to minimize this risk (Ellis et al., 2007). Conflict between teens and their parents about diabetes is another factor associated with worsening diabetes outcomes in adolescence. Diabetes-related conflict is of significant concern given that even minimally elevated conflict can negatively impact glycemic control (Hood, Anderson, Butler, & Laffel, 2007), in part by detracting from diabetes self-care (Hilliard, Guilfoyle, Dolan, & Hood, 2011). For example, some adolescents who are distressed, angry, or frustrated about family conflict may be less inclined or less able to complete diabetes tasks. Others might limit their completion of diabetes self-care tasks to avoid arguments (e.g., related to BG values). While previous studies have identified family conflict and lower parental monitoring as independent risk factors for suboptimal self-care and ultimately poorer glycemic outcomes (Ellis et al., 2007; Hilliard et al., 2011), it remains unclear how these two important family characteristics are related to one another in the context of diabetes management and glycemic control. There are likely reciprocal relations between them, such that the amount and nature of parental monitoring may impact family conflict, and family conflict may impact how much and in what ways parents are involved in adolescents’ daily diabetes self-care. Greater parental responsibility for and monitoring of diabetes self-care often are encouraged to improve adolescents’ diabetes management and glycemic outcomes (Anderson et al., 1997; Ellis et al., 2007). Yet, clinically it is apparent that some aspects of parent involvement in adolescents’ diabetes self-care, including parental monitoring, may inadvertently foster conflict. For example, frequent reminders or questions about diabetes self-care might irritate teens and lead to or exacerbate conflict. Among youth without diabetes, those with more family conflict want less parental supervision (Laird, Pettit, Dodge, & Bates, 2003) and this preference likely is mirrored in teens with diabetes, who often want less frequent or less intrusive parental involvement in their diabetes self-care (Hanna & Guthrie, 2001; Weinger, O’Donnell, & Ritholz, 2001). Conflict also may detract from diabetes management and glycemic control through its impact on the amount and ways that parents participate in their adolescents’ self-care (Weinger et al., 2001). For example, in order to avoid conflict some parents might decrease their monitoring or oversight of diabetes management (Palmer et al., 2004). Parents who argue frequently with their teens about diabetes may refrain from asking questions or be hesitant to offer assistance with diabetes tasks. Other parents may increase or become more persistent in their monitoring to ensure their teens follow directions. Additionally, adolescents themselves may avoid discussions about diabetes with their parents as a means to avoid conflict. Any of these scenarios could detract from self-care and negatively impact glycemic control. Given the developmentally normative changes in parent-youth relationships at the entry to adolescence and their potential impact on diabetes self-care and glycemic control, a better understanding of how family conflict and parental monitoring relate to each other and to diabetes self-care and glycemic outcomes is valuable. Thus, this paper aims to examine the associations among family conflict, parental monitoring, diabetes self-care, and glycemic control. More family conflict and less parental monitoring were hypothesized to be correlated and to each have a direct association with poorer glycemic control. Given previous evidence of self-care as a mediator of the separate relations of parental monitoring (Ellis et al., 2007) and family conflict (Hilliard et al., 2011) with glycemic control, poorer self-care was hypothesized to mediate these associations. Confirmation of this model would indicate that interventions to improve adolescents’ glycemic control should address multiple aspects of the parent-adolescent relationship related to diabetes and directly address teens’ diabetes self-care behaviors.

The non-fatal disease burden caused by type 2 diabetes in South Africa, 2009

Abstract: Background : Increasing urbanisation and rising unhealthy lifestyle risk factors are contributing to a growing diabetes epidemic in South Africa. In 2000, a study estimated diabetes prevalence to be 5.5% in those aged over 30. Accurate, up-to-date information on the epidemiology and burden of disease due to diabetes and its sequelae is essential in the planning of health services for diabetes management. Objective : To calculate the non-fatal burden of disease in Years Lost due to Disability (YLD) due to diabetes and selected sequelae in South Africa in 2009. YLD measures the equivalent loss of life due to ill-health. Methods : A series of systematic literature reviews identified data on the epidemiology of diabetes and its sequelae in South Africa. The data identified were then applied to Global Burden of Disease (GBD) methodology to calculate the burden attributable to diabetes. Results : Prevalence of type 2 diabetes in South Africa in 2009 is estimated at 9.0% in people aged 30 and older, representing approximately 2 million cases of diabetes. We modelled 8,000 new cases of blindness and 2,000 new amputations annually caused by diabetes. There are 78,900 YLD attributed to diabetes, with 64% coming from diabetes alone, 24% from retinopathy, 6% from amputations, 9% from attributable stroke disability, and 7% from attributable ischemic heart disease disability. Conclusions : We estimate that the prevalence of diabetes is increasing in South Africa. Significant disability associated with diabetes is demonstrated. Some of the attributed burden can be prevented through early detection and treatment. Keywords : burden of disease; diabetes; South Africa; developing country; epidemiology (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 19244 - http://dx.doi.org/10.3402/gha.v6i0.19244 Access the supplementary material to this article – see Supplementary files under Article Tools online.

Evaluation of a community health worker pilot intervention to improve diabetes management in Bangladeshi immigrants with type 2 diabetes in New York City.

Abstract: PurposeThe purpose of this study is to explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve diabetes management among Bangladeshi-American individuals...

Self-monitoring of blood glucose in type 2 diabetes: recent studies.

Abstract: The increasing role for structured and personalized self-monitoring of blood glucose (SMBG) in management of type 2 diabetes has been underlined by randomized and prospective clinical trials. These include Structured Testing Program (or STeP), St. Carlos, Role of Self-Monitoring of Blood Glucose and Intensive Education in Patients with Type 2 Diabetes Not Receiving Insulin, and Retrolective Study Self-Monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes (or ROSSO)-in-praxi follow-up. The evidence for the benefit of SMBG both in insulin-treated and non-insulin-treated patients with diabetes is also supported by published reviews, meta-analyses, and guidelines. A Cochrane review reported an overall effect of SMBG on glycemic control up to 6 months after initiation, which was considered to subside after 12 months. Particularly, the 12-month analysis has been criticized for the inclusion of a small number of studies and the conclusions drawn. The aim of this article is to review key publications on SMBG and also to put them into perspective with regard to results of the Cochrane review and current aspects of diabetes management.