Diabetes management

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

Continuous glucose monitoring time series and hypo/hyperglycemia prevention: requirements, methods, open problems.

Abstract: A clinically important task in diabetes management is the prevention of hypo/hyperglycemic events. The availability of continuous glucose monitoring (CGM) devices allow to develop new strategies, but new problems have also emerged. In this contribution, we discuss three major challenges which, in practical real time CGM applications, should be dealt with: filtering to enhance the signal-to-noise ratio, ahead-of-time prediction of glucose concentration, and generation of hypo/hyper-alerts. For all these challenges, some techniques, with a different degree of sophistication, have been proposed recently in the literature, but several issues remain open.

Parental persuasive strategies in the face of daily problems in adolescent type 1 diabetes management.

Abstract: Objective: The study examined (1) whether daily diabetes problems that adolescents experience were associated with parental persuasive strategies (e.g., persuading the adolescent to do more to manage diabetes), (2) whether this association was mediated through greater parental worry and lower confidence in adolescents’ abilities, and (3) how parental persuasive strategies may provide corrections for subsequent blood glucose control but reduce adolescent confidence for adolescents high in self-efficacy. Method: Adolescents with Type 1 diabetes (N 180, ages 10.50–15.58 years) and their mothers (N 176) and fathers (N 139) completed diaries for 14 days reporting on problems experienced with diabetes, maternal and paternal use of persuasive strategies, and confidence in adolescents’ ability to manage diabetes. Parents reported their daily worry about diabetes, adolescents reported their general self-efficacy for diabetes management, and blood glucose was downloaded from glucometers. Results: Across reporters, multilevel modeling revealed that parents used more persuasive strategies on days when more diabetes problems were experienced. This association was mediated through parents’ greater worry and lower confidence in adolescents’ ability to manage diabetes. Lagged analyses revealed that adolescents’ perceptions of maternal persuasive strategies were associated with improvements in next-day blood glucose, but also with reductions in adolescents’ daily confidence for those high in self-efficacy. Conclusions: Parental persuasive strategies appear responsive to daily problems that adolescents experience in diabetes management. Mothers’ persuasive strategies may have the dual effects of correcting blood glucose levels but reducing the more self-efficacious adolescents’ confidence in their own ability to manage diabetes.

The validity of the patient health Questionnaire-9 to screen for depression in patients with type-2 diabetes mellitus in non-communicable diseases clinics in Malawi

Abstract: Depression is a global problem, affecting populations worldwide, but is too often under-diagnosed. The identification of depression among patients with diabetes is important because depression is prevalent in this group and can complicate diabetes management. The aim of the study was to determine the sensitivity and specificity of the PHQ-9 in the detection of depression among patients with type-2 diabetes mellitus attending non-communicable diseases (NCD) clinics in Malawi. We conducted a validation study of the Patient Health Questionnaire (PHQ-9) among 323 patients with type-2 diabetes mellitus who attended two NCD clinics in one of the 28 districts of Malawi. The participants were screened consecutively using the nine-item PHQ-9 in Chichewa by a research assistant and completed a diagnostic interview using the Structured Clinical Interview for DSM-IV (SCID) for depression with a mental health clinician. We evaluated both content validity based on expert judgement and criterion validity of the Patient Health Questionnaire (PHQ-9) based on performance against the SCID. The PHQ-9 cutpoint that maximized sensitivity plus specificity was selected to report test characteristics. Using the SCID for depression, the prevalence of minor or major depression was 41% (133/323). The internal consistency estimate for the PHQ-9 was 0.83, with an area under the receiver operator curve (AUC) of 0.93 (95% CI, [0.91–0.96]). Using the optimal cut-point of ≥9, the PHQ-9 had a sensitivity of 64% and a specificity of 94% in detecting both minor and major depression, with likelihood ratio-positive = 10.1 and likelihood ratio negative =0.4 as well as overall correct classification (OCC) rate of 81%. This is the first validation study of the PHQ-9 in NCD clinics in Malawi. Depression was highly prevalent in this sample. The PHQ-9 demonstrated reasonable accuracy in identifying cases of depression and is a useful screening tool in this setting. Health care workers in NCD clinics can use the PHQ-9 to identify depression among their patients with those having a positive screen followed up by additional diagnostic assessment to confirm diagnosis. PACTR201807135104799 . Retrospectively registered on 12 July 2018.

How Does Provider and Patient Awareness of High-Risk Status for Lower-Extremity Amputation Influence Foot-Care Practice?

Abstract: OBJECTIVE To assess whether patients with diabetes at high risk for lower extremity amputation received more intensive medical care or self-care instruction and to determine the association between foot care and risk of lower-extremity amputation. RESEARCH DESIGN AND METHODS Patients with diabetes were seen at the Seattle Veterans Affairs Medical Center (VAMC) between October 1984 and April 1987; 67 patients were seen for initial non-traumatic amputation, and 236 consecutive control subjects were seen for non-traumatic but medically necessary surgery unrelated to diabetes. Data collection included patient interview and medical record review. High-risk status, defined as presence of peripheral neuropathy, peripheral vascular disease, or prior foot ulcer, was temporally fixed at 2 years before study enrollment. RESULTS Peripheral neuropathy, peripheral vascular disease, and prior foot ulcer were independently associated with risk of lower-extremity amputation: peripheral neuropathy odds ratio (OR) = 1.4 (95% confidence interval (CI) 0.7-2.7), peripheral vascular disease OR = 2.6 (95% CI 1.5-4.5), and prior foot ulcer OR = 10.9 (95% CI 4.6-25.5). Patients with a prior foot ulcer were significantly more likely to have seen a podiatrist and to have received outpatient diabetes education at the Seattle VAMC; their providers were more likely to prescribe clipping toenails, regular foot washing, and elevating feet during the day ( X 1 2 for proportions P x 1 2 for proportions P > 0.20). CONCLUSIONS When clinicians were aware of a patient9s very elevated risk for lower-extremity amputation (evidenced by prior history of foot ulcer), they were more likely to prescribe preventive foot-care behaviors, but awareness of other risk factors (peripheral neuropathy or peripheral vascular disease) did not necessarily increase preventive care. Physicians and patients should receive periodic education and reinforcement of diabetes management skills to modify care delivered to individuals at highest risk for lower-extremity amputation.

Validity and reliability of the DMSES UK: a measure of self-efficacy for type 2 diabetes self-management

Abstract: Objectives Self-efficacy is an important outcome measure of self-management interventions. We aimed to establish UK validity and reliability of the diabetes management self-efficacy scale (DMSES). Methods The 20 item DMSES was available for Dutch and US populations. Consultation with people with type 2 diabetes and health professionals established UK content and face validity resulting in item reduction to 15. Participants were adults with type 2 diabetes enrolled in a randomised controlled trial (RCT) of the diabetes manual, a self-management education intervention, with an HbA1c over 7% and who understood English. Baseline trial data and follow-up control group data were used. Results A total of 175 participants completed all 15 items. Pearson’s correlation coefficient of −0.46 (P 0.30. Cronbach’s alpha was 0.89 over all items. Conclusion This evaluation demonstrates that the scale has good internal reliability, internal consistency, construct validity, criterion validity, and test-retest reliability. Practice Implications The 15 item DMSES UK is suitable for use in research and clinical settings to measure the self-efficacy of people living with type 2 diabetes in managing their diabetes.