Showing papers on "Diabetes management published in 2015"

International textbook of diabetes mellitus

Abstract: Diagnosis, Epidemiology and Aetiology of Diabetes Biochemistry and Pathophysiology of Diabetes Management of Diabetes Monitoring of Therapy Special Problems in Management Acute Disturbances of Diabetes Chronic Complications of Diabetes Diabetes and Public Health.

Glycemic Variability: How Do We Measure It and Why Is It Important?

Abstract: Chronic hyperglycemia is the primary risk factor for the development of complications in diabetes mellitus (DM); however, it is believed that frequent or large glucose fluctuations may independently contribute to diabetes-related complications. Postprandial spikes in blood glucose, as well as hypoglycemic events, are blamed for increased cardiovascular events in DM. Glycemic variability (GV) includes both of these events; hence, minimizing GV can prevent future cardiovascular events. Correcting GV emerges as a target to be pursued in clinical practice to safely reduce the mean blood glucose and to determine its direct effects on vascular complications in diabetes. Modern diabetes management modalities, including glucagon-related peptide-1-based therapy, newer insulins, modern insulin pumps and bariatric surgery, significantly reduce GV. However, defining GV remains a challenge primarily due to the difficulty of measuring it and the lack of consensus regarding the optimal approach for its management. The purpose of this manuscript was not only to review the most recent evidence on GV but also to help readers better understand the available measurement options and how the various definitions relate differently to the development of diabetic complications.

Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era

Abstract: BACKGROUND Continuous glucose monitoring highlights the complexity of postprandial glucose patterns present in type 1 diabetes and points to the limitations of current approaches to mealtime insulin dosing based primarily on carbohydrate counting. METHODS A systematic review of all relevant biomedical databases, including MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, was conducted to identify research on the effects of dietary fat, protein, and glycemic index (GI) on acute postprandial glucose control in type 1 diabetes and prandial insulin dosing strategies for these dietary factors. RESULTS All studies examining the effect of fat ( n = 7), protein ( n = 7), and GI ( n = 7) indicated that these dietary factors modify postprandial glycemia. Late postprandial hyperglycemia was the predominant effect of dietary fat; however, in some studies, glucose concentrations were reduced in the first 2–3 h, possibly due to delayed gastric emptying. Ten studies examining insulin bolus dose and delivery patterns required for high-fat and/or high-protein meals were identified. Because of methodological differences and limitations in experimental design, study findings were inconsistent regarding optimal bolus delivery pattern; however, the studies indicated that high-fat/protein meals require more insulin than lower-fat/protein meals with identical carbohydrate content. CONCLUSIONS These studies have important implications for clinical practice and patient education and point to the need for research focused on the development of new insulin dosing algorithms based on meal composition rather than on carbohydrate content alone.

Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes

Abstract: BACKGROUND AND OBJECTIVES: Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry. METHODS: The cohort included 10 704 participants aged RESULTS: Insulin pump use was higher in white participants than in black or Hispanic participants (61% vs 26% and 39%, respectively) after adjusting for gender, age, diabetes duration, and SES (P CONCLUSIONS: Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups.

Barriers and Facilitators for Type-2 Diabetes Management in South Asians: A Systematic Review.

Abstract: Objective Although South Asian populations have among the highest burden of type 2 diabetes in the world, their diabetes management remains poor. We systematically reviewed studies on South Asian patient’s perspectives on the barriers and facilitators to diabetes management.

Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control.

Abstract: The rising prevalence of type 2 diabetes represents a significant challenge for population health in the US and internationally. Although it is well established that reductions in hemoglobin A1c (A1C), a key index of glycemic control in diabetes, can substantially reduce the risk of diabetes complications (United Kingdom Prospective Diabetes Study, 1998; Nathan et al., 2005), about half of US adults with diabetes are not at goal for A1C (Stark Casagrande et al., 2013) and many report nonadherence to prescribed medications (DiMatteo, 2004; Rubin, 2005). Nonadherence is associated with poor control of A1C, blood pressure and lipids, and increased risk of hospitalization and mortality (e.g., Ho et al., 2006); it is also linked to less effective care – providers are less likely to intensify treatment when indicated for nonadherent patients (Grant et al., 2007). Thus, identification of factors associated with diabetes treatment nonadherence is important and could guide interventions to improve health outcomes. Among patient-level factors, depressive symptoms have been consistently related to treatment nonadherence across a variety of chronic illnesses (DiMatteo, Lepper, Croghan, 2000). A meta-analysis of 47 independent samples showed that higher levels of depressive symptom severity are consistently associated with problematic diabetes self-management across various behavioral domains, including medication adherence (Gonzalez et al., 2008a). Beyond their consistent association with poorer diabetes self-management, depressive symptoms are also related to important diabetes health outcomes over time, such as development of complications (Lin et al., 2010; Black, Markides & Ray, 2003) and mortality (Park, Katon & Wolf, 2013). However, it is important to note that these relationships do not appear to be limited to cases of clinical depression, such as major depressive disorder (MDD). Indeed, depressive symptoms that fall well below MDD diagnostic thresholds are associated with worse self-management both cross-sectionally (Gonzalez et al., 2007) and longitudinally (Gonzalez et al. 2008b); they also predict complications and mortality (Black et al., 2003). Evidence suggests that these ‘subclinical’ depressive symptoms may often represent emotional distress specific to the burdens of living with diabetes rather than a co-morbid depressive mood disorder (Fisher et al., 2007). The need to differentiate diabetes-related emotional distress from depression has led to the development of widely used measures of ‘diabetes distress’ (Polonsky et al., 1995; Polonsky et al., 2005) and of behavioral interventions to directly target diabetes distress (Fisher et al., 2013). Greater precision in distinguishing between depression and diabetes distress could guide the selection of appropriate interventions for patients (Gonzalez, Fisher & Polonsky, 2011). Both diabetes distress and depressive symptoms have been independently associated with medication nonadherence, cross-sectionally and longitudinally, in adults treated for type 2 diabetes (Fisher et al., 2010; Gonzalez et al., 2007; Gonzalez et al., 2008b; Gonzalez, Delahanty, Safren, Meigs & Grant, 2008c; Aikens, 2012). However, the conceptual and measurement overlap between these constructs contributes to inconsistencies in the literature (Gonzalez, Fisher & Polonsky, 2011; Fisher, Gonzalez, & Polonsky, 2014). For example, although early studies showed consistent associations between depressive symptoms and glycemic control (Lustman et al., 2000), more recent studies examining change over time have failed to demonstrate this relationship (e.g., Georgiades et al., 2007; Fisher et al., 2010; Aikens, Perkins, Lipton & Piette, 2009; Aikens, 2012) and suggest that diabetes distress is more closely associated with glycemic control (Aikens, 2012; Fisher et al., 2010). Thus, although emotional distress is clearly implicated in sub-optimal diabetes treatment adherence and outcomes, there is inconsistency in these relationships. Some of this inconsistency may result from an over-reliance on self-report measures of depressive symptoms, which are often more reflective of general distress than clinical depression (Coyne, 1994) and may be particularly vulnerable to overlap with diabetes distress (Gonzalez et al., 2011). Despite the size of the literature on the relationship between emotional distress and diabetes self-management, little research is available to shed light on how distress is linked to diabetes self-management. Social-cognitive variables may play an important role. Negative mood states are known to have a direct influence on self-efficacy, generally reducing perceived ability to carry out activities across various domains (e.g., Kavanagh & Bower, 1985; Salovey & Birnbaum, 1989). Thus, one mechanism linking emotional distress with poor diabetes treatment adherence and health outcomes may involve self-efficacy. Several studies have reported evidence to support self-efficacy as a mediator of the relationship between depressive symptoms and type 2 diabetes self-management (Chao, Nau, Aikens, Taylor, 2005;Wagner, Tennen, Osborn, 2010). Evidence has also been reported for self-efficacy for diabetes management as a mediator of the relationship between depressive symptoms and glycemic control among males with type 2 diabetes (Cherrington, Wallston, Rothman, 2010). Although there is a rich literature that links perceptions of self-efficacy for specific activities to the amount of effort and persistence expended on these activities (Bandura, 1982), these perceptions should be distinguished from one’s perceived ability to meaningfully affect an outcome of interest, or perceived control (Bandura & Wood, 1989; Skinner, 1996). Bandura viewed self-efficacy and perceived control as linked through reciprocal causation (Bandura & Wood, 1989) and described perceived control as a precondition to the optimal execution of efficacious behaviors – “if people approach situations as largely uncontrollable, they are likely to exercise their efficacy weakly and abortively,” whereas, “when people believe the environment is controllable…they are motivated to exercise fully their personal efficacy” (Bandura & Wood, 1989, p.806). Individuals with type 2 diabetes and elevated depressive symptoms report less perceived control over diabetes (Egede & Ellis, 2008; Macrodimitris & Endler, 2001) and greater perceived control is consistently associated with lower A1C (Egede & Ellis, 2008; Macrodimitris & Endler, 2001; Sharry, Moss-Morris, Kendrick, 2011). This relationship may be mediated through improved adherence, as perceived control has also been consistently associated with better diabetes self-management (e.g., Hampson Glasgow, & Toobert, 1990; Skinner & Hampson, 2001). Thus, although evidence supports self-efficacy and perceived control as potential mediators of the distress – diabetes self-management relationship, prior studies have not examined their independent effects. We sought to advance our understanding of the relationships among emotional distress, diabetes treatment adherence, and glycemic control in adults with treated type 2 diabetes by examining direct and indirect pathways linking these variables. We used measures of depressive symptoms and diabetes distress as indicators of emotional distress and evaluated perceived control and self-efficacy as sequential mediators of the relationships between emotional distress, medication adherence and glycemic control.

Type 1 Diabetes in Young Adulthood

Abstract: Type 1 diabetes has traditionally been studied as a chronic illness of childhood. However, young adulthood is a critical time for the development and integration of lifelong diabetes management skills, and research is starting to identify unique challenges faced by youth with diabetes as they age into adulthood. Most young adults experience multiple transitions during this unstable developmental period, including changes in lifestyle (e.g., education, occupation, living situation), changes in health care, and shifting relationships with family members, friends, and intimate others. Young adults with type 1 diabetes must navigate these transitions while also assuming increasing responsibility for their diabetes care and overall health. Despite these critical health and psychosocial concerns, there is a notable lack of evidence-based clinical services and supports for young adults with type 1 diabetes. We review relevant evolving concerns for young adults with type 1 diabetes, including lifestyle considerations, health care transitions, psychosocial needs, and changes in supportive networks, and how type 1 diabetes impacts and is impacted by these key developmental considerations. Specific avenues for intervention and future research are offered.

Hypoglycemia in Type 2 Diabetes - More Common Than You Think A Continuous Glucose Monitoring Study

Abstract: Background:Hypoglycemia is often the limiting factor for intensive glucose control in diabetes management, however its actual prevalence in type 2 diabetes (T2DM) is not well documented.Methodology...

The Use of Videogames, Gamification, and Virtual Environments in the Self-Management of Diabetes: A Systematic Review of Evidence

Abstract: The use of videogames in healthcare interventions is gaining popularity, but there is still a gap in the understanding on how these types of interventions are used for the management of diabetes. The purpose of this review is to examine published research on the use of videogames for diabetes management. With the increased use of mobile technology, the review was expanded to understand whether games, gamification, and virtual environments can be used for diabetes self-management. Out of the 307 articles identified, only 10 articles met the inclusion criteria of the study. The duration of most studies was short, with small sample sizes. All interventions targeted behavioral changes examining risk reduction of diabetes-related risk and promotion of healthy behavior among study participants. Videogames appeared to be helpful tools for education in some interventions, whereas gamification and virtual environments increased extrinsic motivation and provided positive reinforcement. This review concludes by discussing the potential of using videogames and gamification for the self-management of diabetes.

The changing face of diabetes in youth: lessons learned from studies of type 2 diabetes

Abstract: The incidence of youth type 2 diabetes (T2D), linked with obesity and declining physical activity in high-risk populations, is increasing. Recent multicenter studies have led to a number of advances in our understanding of the epidemiology, pathophysiology, diagnosis, treatment, and complications of this disease. As in adult T2D, youth T2D is associated with insulin resistance, together with progressive deterioration in β cell function and relative insulin deficiency in the absence of diabetes-related immune markers. In contrast to adult T2D, the decline in β cell function in youth T2D is three- to fourfold faster, and therapeutic failure rates are significantly higher in youth than in adults. Whether the more aggressive nature of youth T2D is driven by genetic heterogeneity or physiology/metabolic maladaptation is yet unknown. Besides metformin, the lack of approved pharmacotherapeutic agents for youth T2D that target the pathophysiological mechanisms is a major barrier to optimal diabetes management. There is a significant need for effective therapeutic options, in addition to increased prevention, to halt the projected fourfold increase in youth T2D by 2050 and the consequences of heightened diabetes-related morbidity and mortality at younger ages.

Internet delivered diabetes self-management education: a review.

Abstract: Background: Diabetes self-management education is a cornerstone of successful diabetes management. Various methods have been used to reach the increasing numbers of patients with diabetes, including Internet-based education. The purpose of this article is to review various delivery methods of Internet diabetes education that have been evaluated, as well as their effectiveness in improving diabetes-related outcomes. Materials and Methods: Literature was identified in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Medline, EBSCO, the Cochrane Library, and the Web of Science databases through searches using the following terms: “type 2 diabetes AND internet/web based AND education” and “type 2 diabetes AND diabetes self-management education (DSME) AND web-based/internet OR technology assisted education.” The search was limited to English language articles published in the last 10 years. The search yielded 111 articles; of these, 14 met criteria for inclusion in this r...

Technology and diabetes self-management: An integrative review

Abstract: Technology can be used to supplement healthcare provider diabetes care by providing both educational and motivational support. Education can be provided using technology allowing patients to learn new practices and routines related to diabetes management. Technology can support daily diabetes self-management activities including blood glucose monitoring, exercising, healthy eating, taking medication, monitoring for complications, and problem-solving. This article describes an integrative review conducted to evaluate the types of technology being used to facilitate diabetes self-management and the effect of that technology on self-management and diabetes outcomes for adults living with type 2 diabetes mellitus. A literature review was conducted by searching Medline, PubMed, and Psych INFO databases using the search terms: diabetes self-management, technology, type 2 diabetes, smartphones, cell phones, and diabetes mellitus covering the years from 2008-2013. Articles relying on secondary data (editorials, systematic reviews) and articles describing study protocol only were excluded. Fourteen studies including qualitative, quasi-experimental, and randomized controlled trial designs were identified and included in the review. The review found that technological interventions had positive impacts on diabetes outcomes including improvements in hemoglobin A1C levels, diabetes self-management behaviors, and diabetes self-efficacy. Results indicate that technological interventions can benefit people living with diabetes when used in conjunction with diabetes care delivered by healthcare providers.

Factors influencing the acceptance of telemedicine for diabetes management

Abstract: Telemedicine service is effective intervention in blood glucose management and reducing the progression of diabetic complications. While telemedicine service for the enhanced management of diabetes has been known for its usefulness, there is little understanding regarding which factors should be considered when diabetic patients accept telemedicine. Thus, this study aimed to examine the factors that influence the acceptance of telemedicine service for the enhanced management of diabetes mellitus based on the Unified Theory of Acceptance and Use of Technolog (UTAUT) model. Data were collected from a paper-based survey of 116 diabetic patients who were outpatients in six different university hospitals. This study used partial least squares regression to determine the causal relationship between the five variables. Demographic variables, such as age and gender, as moderating variables for behavioral intention to use were analyzed. The results indicate that facilitating factors have effects on the behavioral intention to use telemedicine service through the performance expectancy ( $$p<0.05$$ p < 0.05 ). In addition, facilitating factors have effects on the behavioral intention to use telemedicine service through the effort expectancy ( $$p<0.05$$ p < 0.05 ). This study also found that performance expectancy, effort expectancy and social influence have positive effects on behavioral intentions to use telemedicine service, as predicted using the UTAUT model ( $$p<0.05$$ p < 0.05 ). Finally, gender and age were found to be moderators between PE and behavioral intention to use telemedicine service as predicted using the UTAUT model. Our results showed that telemedicine service for diabetes mellitus management should facilitate infrastructure methods such as continuous assistance service and service guideline education. Therefore, the capacity of telemedicine service providers is more important for telemedicine success than the competence of the individuals receiving telemedicine service care. In addition, performance expectancy, effort expectancy and social influence are influencing factors for the acceptance of telemedicine service for diabetes management. Accordingly, in order to raise service usage, telemedicine service providers' variety support is important.

Overcoming Clinical Inertia: A Randomized Clinical Trial of a Telehealth Remote Monitoring Intervention Using Paired Glucose Testing in Adults With Type 2 Diabetes

Abstract: Background: Type 2 diabetes mellitus is a worldwide challenge. Practice guidelines promote structured self-monitoring of blood glucose (SMBG) for informing health care providers about glycemic control and providing patient feedback to increase knowledge, self-efficacy, and behavior change. Paired glucose testing—pairs of glucose results obtained before and after a meal or physical activity—is a method of structured SMBG. However, frequent access to glucose data to interpret values and recommend actions is challenging. A complete feedback loop—data collection and interpretation combined with feedback to modify treatment—has been associated with improved outcomes, yet there remains limited integration of SMBG feedback in diabetes management. Incorporating telehealth remote monitoring and asynchronous electronic health record (EHR) feedback from certified diabetes educators (CDEs)—specialists in glucose pattern management—employ the complete feedback loop to improve outcomes. Objective: The purpose of this study was to evaluate a telehealth remote monitoring intervention using paired glucose testing and asynchronous data analysis in adults with type 2 diabetes. The primary aim was change in glycated hemoglobin (A 1c )—a measure of overall glucose management—between groups after 6 months. The secondary aims were change in self-reported Summary of Diabetes Self-Care Activities (SDSCA), Diabetes Empowerment Scale, and Diabetes Knowledge Test. Methods: A 2-group randomized clinical trial was conducted comparing usual care to telehealth remote monitoring with paired glucose testing and asynchronous virtual visits. Participants were aged 30-70 years, not using insulin with A 1c levels between 7.5% and 10.9% (58-96 mmol/mol). The telehealth remote monitoring tablet computer transmitted glucose data and facilitated a complete feedback loop to educate participants, analyze actionable glucose data, and provide feedback. Data from paired glucose testing were analyzed asynchronously using computer-assisted pattern analysis and were shared with patients via the EHR weekly. CDEs called participants monthly to discuss paired glucose testing trends and treatment changes. Separate mixed-effects models were used to analyze data. Results: Participants (N=90) were primarily white (64%, 56/87), mean age 58 (SD 11) years, mean body mass index 34.1 (SD 6.7) kg/m2, with diabetes for mean 8.2 (SD 5.4) years, and a mean A 1c of 8.3% (SD 1.1; 67 mmol/mol). Both groups lowered A 1c with an estimated average decrease of 0.70 percentage points in usual care group and 1.11 percentage points in the treatment group with a significant difference of 0.41 percentage points at 6 months (SE 0.08, t 159 =–2.87, P =.005). Change in medication (SE 0.21, t 157 =–3.37, P =.009) was significantly associated with lower A 1c level. The treatment group significantly improved on the SDSCA subscales carbohydrate spacing ( P =.04), monitoring glucose ( P =.001), and foot care ( P =.02). Conclusions: An eHealth model incorporating a complete feedback loop with telehealth remote monitoring and paired glucose testing with asynchronous data analysis significantly improved A 1c levels compared to usual care. Trial Registration: Clinicaltrials.gov NCT01715649; https://www.clinicaltrials.gov/ct2/show/NCT01715649 (Archived by WebCite at http://www.webcitation.org/6ZinLl8D0). [J Med Internet Res 2015;17(7):e178]

Awareness, treatment, and control of diabetes in Bangladesh: a nationwide population-based study.

Abstract: Objectives To examine awareness, treatment, and control of diabetes mellitus among the adult population in Bangladesh. Methods The study used data from the 2011 nationally representative Bangladesh Demographic and Health Survey (BDHS). The BDHS sample is comprised of 7,786 adults aged 35 years or older. The primary outcome variables were fasting blood glucose, diagnosis, treatment, and control of diabetes. Multilevel logistic regression models were used to identify the risk factors for diabetes awareness. Results Overall, age-standardized prevalence of diabetes was 9.2%. Among subjects with diabetes, 41.2% were aware of their condition, 36.9% were treated, and 14.2% controlled their condition. A significant inequality in diabetes management was found from poor to wealthy households: 18.2% to 63.2% (awareness), 15.8% to 56.6% (treatment), and 8.2% to 18.4% (control). Multilevel models suggested that participants who had a lower education and lower economic condition were less likely to be aware of their diabetes. Poor management was observed among non-educated, low-income groups, and those who lived in the northwestern region. Conclusions Diabetes has become a national health concern in Bangladesh; however, treatment and control are quite low. Improving detection, awareness, and treatment strategies is urgently needed to prevent the growing burden associated with diabetes.

Diabetes care in the school setting: a position statement of the American Diabetes Association.

Abstract: Diabetes is one of the most common chronic diseases of childhood (1). There are approximately 200,000 individuals <20 years of age with diabetes in the U.S. (2). The SEARCH for Diabetes in Youth (SEARCH) study recently reported that 1.93 per 1,000 (aged <20 years) were diagnosed with type 1 diabetes, an increase of 21% from 2001 to 2009. Increases in the prevalence of type 1 diabetes were seen in all ethnic groups, but non-Hispanic whites were disproportionately affected. Because type 2 diabetes rarely occurs in younger children, its prevalence in the population aged <20 years is not readily available. For type 2 diabetes in youth between 10 and 20 years of age, the SEARCH study reported a prevalence of 0.46 per 1,000 youth of all ethnicities, an increase of 31% from 2001 to 2009 (3). These statistics demonstrate the rising prevalence of diabetes in children and the increased need for diabetes management. The majority of young people with diabetes spend many hours at school and/or in some type of child care program. Trained and knowledgeable staff are essential to provide a safe school and child care environment for children with diabetes. This includes the provision of care during the school day, field trips, and all school-sponsored activities in the school setting and in preschool, day care, and camp programs in the child care setting. Staff play a critical role in helping to reduce the risk of short- and long-term complications of diabetes and ensuring that children are well-positioned for academic success and normal growth and development. The child’s parents/guardians and health care provider(s) should work together to provide school systems and child care providers with the information necessary to enable children with diabetes to participate fully and safely in the school and child care setting experiences (4–6). …

Effects of Mobile Phone SMS to Improve Glycemic Control Among Patients With Type 2 Diabetes in Bangladesh: A Prospective, Parallel-Group, Randomized Controlled Trial.

Abstract: Mobile phone technologies have emerged as an essential tool for strengthening health systems and improving disease outcomes in many countries (1). In recent years, the government of Bangladesh and the World Health Organization have adopted information technologies for health in their strategic plans. However, data to support a successful model of mobile phone short message service (SMS) in diabetes management are scarce. In this trial, we assessed whether the addition of an automated SMS service to standard diabetes care would improve glycemic control in patients with type 2 diabetes. A total of 236 adult patients with type 2 diabetes (diagnosed within the previous 5 years) on oral medication therapy with access to SMS and attending the outpatient department of the Bangladesh Institute of Health Sciences in Dhaka, Bangladesh, were recruited (September 2013–August 2014) and randomly assigned 1:1 to SMS intervention and standard care groups. Data were collected through face-to-face interviews with a structured questionnaire, anthropometric measurements, and blood tests for …

A Review of Emerging Technologies for the Management of Diabetes Mellitus

Abstract: Objective : High prevalence of diabetes mellitus (DM) along with the poor health outcomes and the escalated costs of treatment and care poses the need to focus on prevention, early detection and improved management of the disease. The aim of this paper is to present and discuss the latest accomplishments in sensors for glucose and lifestyle monitoring along with clinical decision support systems (CDSSs) facilitating self-disease management and supporting healthcare professionals in decision making. Methods : A critical literature review analysis is conducted focusing on advances in: 1) sensors for physiological and lifestyle monitoring, 2) models and molecular biomarkers for predicting the onset and assessing the progress of DM, and 3) modeling and control methods for regulating glucose levels. Results : Glucose and lifestyle sensing technologies are continuously evolving with current research focusing on the development of noninvasive sensors for accurate glucose monitoring. A wide range of modeling, classification, clustering, and control approaches have been deployed for the development of the CDSS for diabetes management. Sophisticated multiscale, multilevel modeling frameworks taking into account information from behavioral down to molecular level are necessary to reveal correlations and patterns indicating the onset and evolution of DM. Conclusion : Integration of data originating from sensor-based systems and electronic health records combined with smart data analytics methods and powerful user centered approaches enable the shift toward preventive, predictive, personalized, and participatory diabetes care. Significance : The potential of sensing and predictive modeling approaches toward improving diabetes management is highlighted and related challenges are identified.

Effect of mediterranean diet in diabetes control and cardiovascular risk modification: a systematic review.

Abstract: Background: Over the past few years, there has been a worldwide significant increase in the incidence of type II diabetes (T2DM) with both increase in morbidity and mortality. Controlling diabetes through life style modifications, including diet and exercise has always been the cornerstone in diabetes management. As a matter of fact, a number of studies addressed the potential protective role of Mediterranean diet in diabetic patients. Increasing evidence suggests that the Mediterranean diet could be of benefit in diseases associated with chronic inflammation, including metabolic syndrome, diabetes, obesity as well as atherosclerosis, cancer, pulmonary diseases, and cognition disorders. Methods: A systematic review was conducted on the effect of Mediterranean diet in diabetes control and cardiovascular risk modification as well as the possible mechanism through which this diet might exhibit its beneficial role. We did a comprehensive search of multiple electronic databases such as Medline, Google Scholars, PubMed, and the Cochrane central register data until May 2014. We included cross-sectional, prospective and controlled clinical trials that looked at the associations between Mediterranean diet and indices of diabetes control such HbA1c, fasting glucose, and HOMA, in addition to cardiovascular and peripheral vascular outcomes. Outcome/Conclusion: Most of the studies showed favorable effects of Mediterranean diet on glycemic control and CVD, although a certain degree of controversy remains regarding some issues, such as obesity. Important methodological differences and limitations in the studies make it difficult to compare results, thus further longer term studies are needed to evaluate the long-term efficacy of the Mediterranean diet along with the possibility of explaining its mechanism.

The Emerging Diabetes Online Community

Abstract: Background: Diabetes self-management is complex and demanding, and isolation and burnout are common experiences. The Internet provides opportunities for people with diabetes to connect with one another to address these challenges. The aims of this paper are to introduce readers to the platforms on which Diabetes Online Community (DOC) participants interact, to discuss reasons for and risks associated with diabetes-related online activity, and to review research related to the potential impact of DOC participation on diabetes outcomes. Methods: Research and online content related to diabetes online activity is reviewed, and DOC writing excerpts are used to illustrate key themes. Guidelines for meaningful participation in DOC activities for people with diabetes, families, health care providers, and industry are provided. Results: Common themes around DOC participation include peer support, advocacy, self-expression, seeking and sharing diabetes information, improving approaches to diabetes data management, and humor. Potential risks include access to misinformation and threats to individuals’ privacy, though there are limited data on negative outcomes resulting from such activities. Likewise, few data are available regarding the impact of DOC involvement on glycemic outcomes, but initial research suggests a positive impact on emotional experiences, attitudes toward diabetes, and engagement in diabetes management behaviors. Conclusion: The range of DOC participants, activities, and platforms is growing rapidly. The Internet provides opportunities to strengthen communication and support among individuals with diabetes, their families, health care providers, the health care industry, policy makers, and the general public. Research is needed to investigate the impact of DOC participation on self-management, quality of life, and glycemic control, and to design and evaluate strategies to maximize its positive impact.

The Empirical Evidence for the Telemedicine Intervention in Diabetes Management

Abstract: Objective: The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and diabetic r...

Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy.

Abstract: Background Increasing diabetes prevalence affects a substantial number of pregnant women in the United States. Our aims were to evaluate health outcomes, medical costs, risks and types of complications associated with diabetes in pregnancy for mothers and newborns. Methods In this retrospective claims analysis, patients were identified from the Truven Health MarketScan® database (2004–2011 inclusive). Participants were aged 18–45 years, with ascertainable diabetes status [Yes/No], date of birth event >2005 and continuous health plan enrolment ≥21 months before and 3 months after the birth. Results In total, 839 792 pregnancies were identified, and 66 041 (7.86%) were associated with diabetes mellitus [type 1 (T1DM), 0.13%; type 2 (T2DM), 1.21%; gestational (GDM), 6.29%; and GDM progressing to T2DM (patients without prior diabetes who had a T2DM diagnosis after the birth event), 0.23%]. Relative risk (RR) of stillbirth (2.51), miscarriage (1.28) and Caesarean section (C-section) (1.77) was significantly greater with T2DM versus non-diabetes. Risk of C-section was also significantly greater for other diabetes types [RR 1.92 (T1DM); 1.37 (GDM); 1.63 (GDM progressing to T2DM)]. Risk of overall major congenital (RR ≥ 1.17), major congenital circulatory (RR ≥ 1.19) or major congenital heart (RR ≥ 1.18) complications was greater in newborns of mothers with diabetes versus without. Mothers with T2DM had significantly higher risk (RR ≥ 1.36) of anaemia, depression, hypertension, infection, migraine, or cardiac, obstetrical or respiratory complications than non-diabetes patients. Mean medical costs were higher with all diabetes types, particularly T1DM ($27 531), than non-diabetes ($14 355). Conclusions Complications and costs of healthcare were greater with diabetes, highlighting the need to optimize diabetes management in pregnancy. © 2015 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons, Ltd.

Impact of community based peer support in type 2 diabetes: a cluster randomised controlled trial of individual and/or group approaches.

Abstract: Background Diabetes peer support, where one person with diabetes helps guide and support others, has been proposed as a way to improve diabetes management. We have tested whether different diabetes peer support strategies can improve metabolic and/or psychological outcomes. Methods People with type 2 diabetes (n = 1,299) were invited to participate as either 'peer' or 'peer support facilitator' (PSF) in a 2x2 factorial randomised cluster controlled trial across rural communities (130 clusters) in England. Peer support was delivered over 8-12 months by trained PSFs, supported by monthly meetings with a diabetes educator. Primary end point was HbA1c. Secondary outcomes included quality of life, diabetes distress, blood pressure, waist, total cholesterol and weight. Outcome assessors and investigators were masked to arm allocation. Main factors were 1:1 or group intervention. Analysis was by intention-to-treat adjusting for baseline. Results The 4 arms were well matched (Group n = 330, 1:1(individual) n = 325, combined n = 322, control n = 322); 1035 (79·7%) completed the mid-point postal questionnaire and 1064 (81·9%) had a final HbA1c. A limitation was that although 92.6% PSFs and peers were in telephone contact, only 61.4% of intervention participants attended a face to face session. Mean baseline HbA1c was 57 mmol/mol (7·4%), with no significant change across arms. Follow up systolic blood pressure was 2·3 mm Hg (0.6 to 4.0) lower among those allocated group peer-support and 3·0 mm Hg (1.1 to 5.0) lower if the group support was attended at least once. There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication. Conclusions Group diabetes peer support over 8-12 months was associated with a small improvement in blood pressure but no other significant outcomes. Long term benefits should be investigated. Trial registration ISRCTN.com ISRCTN6696362166963621.

Utility of different glycemic control metrics for optimizing management of diabetes

Abstract: The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin (HbA1c). Despite its importance as an indicator for the development of diabetic complications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between HbA1c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to HbA1c in routine diabetes care is self-monitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize glucose dynamics. Several continuous glucose monitoring (CGM) systems, which have shown usefulness in clinical practice, are presently on the market. They can broadly be divided into systems providing retrospective or real-time information on glucose patterns. The widespread clinical application of CGM is still hampered by the lack of generally accepted measures for assessment of glucose profiles and standardized reporting of glucose data. In this article, we will discuss advantages and limitations of various metrics for glycemic control as well as possibilities for evaluation of glucose data with the special focus on glycemic variability and application of CGM to improve individual diabetes management.

The adherence to medications in diabetic patients in rural Kerala, India.

Abstract: We conducted a study to determine medications adherence and factors associated with poor adherence in community-dwelling adults with diabetes in southern India. A cross-sectional survey was conducted among 346 diabetes patients selected using multistage cluster sampling. The 8-item Morisky Medication Adherence Scale was used to collect information on adherence. Prevalence of poor adherence was 74% (95% confidence interval = 69.2-78.3). Multiple regression analysis showed that patients using oral hypoglycemic agents, who had lower per capita monthly expenditure, those with irregular blood sugar monitoring, who received limited diabetes management instructions from health professionals, who resorted to only symptomatic management, and those who did not receive family member's help to remember medications were more likely to report poor adherence compared with their counterparts. Interventions for patients using oral hypoglycemic agents, with lower expenditure, with irregular blood sugar monitoring, and which focus on better education and enhanced family support, are likely to enhance adherence in this population.

Evaluating the Association between Diabetes, Cognitive Decline and Dementia.

Abstract: The aim of this article is to review the association between diabetes mellitus, cognitive decline and dementia, including the effects of cognitive decline and dementia on self management of diabetes. This is a literature review of primary research articles. A number of contemporary research articles that met the inclusion criteria were selected for this review paper. These articles were selected using a number of search strategies and electronic databases, such as EBSCOhost Research and SwetsWise databases. The duration of diabetes, glycated haemoglobin levels and glycaemic fluctuations were associated with cognitive decline and dementia. Similarly, hypoglycaemia was significantly related to increased risk of developing cognitive decline and dementia. Furthermore, cognitive decline and dementia were associated with poorer diabetes management. There is evidence of the association between diabetes, cognitive decline and dementia including the shared pathogenesis between diabetes and Alzheimer’s disease. In addition, the self management of diabetes is affected by dementia and cognitive decline. It could be suggested that the association between diabetes and dementia is bidirectional with the potential to proceed to a vicious cycle. Further studies are needed in order to fully establish the relationship between diabetes, cognitive decline and dementia. Patients who have diabetes and dementia could benefit from structured education strategies, which should involve empowerment programmes and lifestyle changes. The detection of cognitive decline should highlight the need for education strategies.