Diabetes management

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

Heterogeneity of Pre-diabetes and Type 2 Diabetes: Implications for Prediction, Prevention and Treatment Responsiveness.

Abstract: Type 2 diabetes is a heterogeneous disease with large variation in the relative contributions of insulin resistance and beta cell dysfunction between subgroups and individuals. Some of these differences are reflected in the way people are diagnosed. However, differences in glucose regulation exist among individuals even in those with comparable diagnostic glucose levels. In this review we address the heterogeneity of pre-diabetes and type 2 diabetes with special emphasis on differences in the pathophysiology and treatment responses related to the diagnostic criteria. We also discuss whether novel glycaemic markers of diabetes risk can provide additional information to the established diagnostic criteria. A better understanding of the underlying mechanisms responsible for elevated fasting versus postprandial glucose concentration, as well as knowledge about the expected responsiveness to treatment in individuals with different clinical characteristics at diagnosis, may contribute to optimising strategies for management of hyperglycaemia in both pre-diabetes and type 2 diabetes.

Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

Abstract: Background Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control. Methods and findings A protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals. Conclusions This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.

A Shared Decision-Making Primary Care Intervention for Type 2 Diabetes

Abstract: PURPOSE The purpose of this study is to test the feasibility of a brief shared decision-making (SDM) goal-setting intervention among individuals with type 2 diabetes. METHODS A convenience sample of 58 patients from the University Internal Medicine Resident Clinic was recruited to participate in the study. Outcomes were tested through a pilot test of the intervention and ongoing conversations with clinic nursing staff and physicians. Patient outcomes included preintervention and postintervention hemoglobin A1C (HbA1c), weight and blood pressure levels, preintervention and postintervention patient survey questionnaires, and documented diabetes goals. RESULTS Most providers indicated that the SDM intervention did not impose major demands. Patient-centered interviewing and an SDM approach to goal setting led to 75.9% of patients having at least 1 diabetes management goal documented in their medical record after intervention. HbA1c level, weight, and diabetes empowerment score showed a trend toward improvement, as did patient ratings of "life disruption from having diabetes." Postintervention perceived knowledge of diabetes and treatments increased significantly (P = .001), as did the mean numbers of documented diabetes management goals (P < .001). CONCLUSIONS An SDM intervention for individuals with type 2 diabetes appears to be feasible and may improve major diabetes outcomes in primary care. SDM workbooks and activities can encourage patients to identify realistic diabetes goals with primary care providers. These results are encouraging. Future randomized trials with larger samples are warranted.

Role of the pharmacist in diabetes management.

Abstract: The role of pharmacists in diabetes management, including patient identification, assessment, education, referral, and monitoring, is described. Pharmacists can help identify patients with diabetes through screening and should target patients at high risk, people with a family history of the disease, and women with a history of gestational diabetes or who delivered a baby weighing more than nine pounds. Patient education should be provided immediately after diagnosis, at a second stage at which time a patient assessment can be performed, and at a third stage during which patients can receive continuing education to reinforce concepts and a motivational boost. One of the pharmacist's most important roles is the referral of patients to other members of the diabetes care team. Although the role of the pharmacist in monitoring diabetes is not well defined, it might include such things as ascertaining whether physician visits and testing to assess long-term glycemic control. Obtaining certification as a diabetes educator is recommended. This process requires at least 1000 hours of experience in providing disease-state management for patients with diabetes and successful completion of an examination. Implementing diabetes management services requires a commitment of time, effort, and resources and may necessitate training of staff and changes in work patterns. The pharmacist can play an important role in diabetes care by screening patients at high risk for diabetes, assessing patient health status and adherence to standards of care, educating patients to empower them to care for themselves, referring patients to other health care professionals as appropriate, and monitoring outcomes. Providing diabetes management services requires market savvy, communication skills, and a commitment of time, effort, and resources. Pharmacists who obtain training in diabetes management reap rewards in professional satisfaction and financial reimbursement.

Type 2 diabetes in family practice. Room for improvement.

Abstract: OBJECTIVE To further knowledge of diabetes management in family practice. DESIGN Retrospective, observational chart audit study. SETTNG: Southwestern Ontario. PARTICIPANT A random sample of non-academic family physicians and a random selection of their patients with type 2 diabetes mellitus. MAIN OUTCOME MEASURES Glycemic control as measured by HbA1c and adherence to recommendations in clinical practice guidelines (CPGs). RESULTS Eighty-four percent of patients had at least one HbA1c test ordered in the previous year. Overall mean HbA1c was 0.079 and half-the patients had levels deemed acceptable by 1992 CPGs. Screening for microvascular complications was disappointing; only 28% were tested for microalbuminuria, and 15% were examined for diabetes-related foot conditions. Screening for macrovascular complications was more comprehensive; blood pressure was measured in 88%, and lipid profiles documented in 48%, of patient charts. CONCLUSION Management of glycemic control and screening for microvascular and macrovascular disease in family practice can be improved.