Diabetes management

About: Diabetes management is a research topic. Over the lifetime, 6060 publications have been published within this topic receiving 164670 citations.

Staged diabetes management. Toward an integrated model of diabetes care.

Abstract: This paper introduces a new and innovative approach to diabetes management in the primary-care setting. Staged diabetes management (SDM) represents a four-year effort to develop and test a data-based approach to diabetes management that could be easily adapted to a variety of health-care settings in which diabetes management is principally under the direction of primary-care physicians was limited access to specialists. After testing under controlled circumstances at the International Diabetes Center (Minneapolis, MN), SDM was subjected to substantial field trials under conditions that represent the scope and variety of primary-care practices in diabetes. The following represents the work of several investigators who independently undertook a review of SDM.

Optimized Mealtime Insulin Dosing for Fat and Protein in Type 1 Diabetes: Application of a Model-Based Approach to Derive Insulin Doses for Open-Loop Diabetes Management.

Abstract: OBJECTIVE To determine insulin dose adjustments required for coverage of high-fat, high-protein (HFHP) meals in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Ten adults with T1D received low-fat, low-protein (LFLP) and HFHP meals with identical carbohydrate content, covered with identical insulin doses. On subsequent occasions, subjects repeated the HFHP meal with an adaptive model-predictive insulin bolus until target postprandial glycemic control was achieved. RESULTS With the same insulin dose, the HFHP increased the glucose incremental area under the curve over twofold (13,320 ± 2,960 vs. 27,092 ± 1,709 mg/dL ⋅ min; P = 0.0013). To achieve target glucose control following the HFHP, 65% more insulin was required (range 17%–124%) with a 30%/70% split over 2.4 h. CONCLUSIONS This study demonstrates that insulin dose calculations need to consider meal composition in addition to carbohydrate content and provides the foundation for new insulin-dosing algorithms to cover meals of varying macronutrient composition.

Adherence patterns in patients with type 2 diabetes on basal insulin analogues: missed, mistimed and reduced doses

Abstract: OBJECTIVE To describe basal insulin analogue dosing irregularities, the effect of these events on patient functioning, well-being and diabetes management, and the identification of patients most at risk. RESEARCH DESIGN AND METHODS The GAPP2 (Global Attitude of Patients and Physicians 2) study was an online multinational cross-sectional study of patients with type 2 diabetes currently treated with basal insulin, and healthcare professionals (HCPs) involved in the care of such patients. Basal insulin adherence patterns were evaluated with respect to three types of dosing irregularity: missed, mistimed [± 2 hours from prescribed time], and reduced dose over the last 30 days. RESULTS A total of 3042 patients treated with basal insulin analogues and 1222 prescribers completed the full survey; 38% of patients reported any type of basal insulin dosing irregularity in the last 30 days. Patients reported missing (22% on 3 ± 0.16 occasions), mistiming (24% on 4.2 ± 0.21 occasions) or reducing (14% on 4.2 ± 0.24 occasions) basal insulin doses, with 15% of patients reporting multiple types of dosing irregularities. For most patients, missed (83%) and mistimed doses (82%) were unintentional, whereas the majority (87%) of patients reducing doses did so intentionally. Patients who intentionally missed or reduced a dose of basal insulin were significantly more likely to have performed this dosing irregularity on multiple occasions. Fifty-three percent of patients increased the frequency of blood glucose monitoring, and 17% of patients extended the duration of more frequent blood glucose monitoring by one or more days as a result of unintentional missed doses. Reduced dosing was highest in a subset of patients reporting self-treated hypoglycaemia. CONCLUSIONS Basal insulin dosing irregularities including missed, mistimed and reduced doses are common. A significant proportion of patients also report undertaking these irregular dosing behaviours at a frequency that would be considered by prescribers to negatively impact diabetes management. This is despite the potential under-reporting due to recall or social bias that may be a limitation of a self-reported survey around these behaviours.

The Why WAIT program: improving clinical outcomes through weight management in type 2 diabetes.

Abstract: Targeting body weight, as an alternative model to targeting hemoglobin A(1c), is emerging as a viable and potentially cost-effective approach to diabetes management in clinical practice. Why WAIT (Weight Achievement and Intensive Treatment) is a 12-week multidisciplinary program for weight control and intensive diabetes management specifically designed for application in routine diabetes practice. The program, which is generally covered by insurance, is followed by continuous support aimed at long-term maintenance of weight loss and diabetes control. This model was effective in improving key metabolic abnormalities observed in diabetic patients. Eighty-two percent of participants achieved the target hemoglobin A(1c) of less than 7% on less diabetes medications. The achieved weight reduction after 12 weeks of intervention was maintained for an additional year. Future dissemination of this intervention model in routine clinical practice may require wider endorsement by third-party payers and support of governmental health care agencies to halt the progression of the epidemic of obesity and diabetes in the United States.