Diabetes management

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

A randomized trial of three diabetes registry implementation strategies in a community internal medicine practice.

Abstract: Article-at-a-Glance Background Disease registries are powerful tools with the potential to transform the way chronic diseases are managed. To date, however, little work has been done to determine how to optimize the implementation of a chronic disease registry in practice. Methods Twenty-nine physicians and their nurse teams in a large community internal medicine practice participated in this 6-month prospective randomized trial in 2000. Teams were assigned to one of three implementation strategies using information from a diabetes registry. Process and outcome measures for diabetes management were analyzed. Process measures included the percentage of patients completing glycosylated hemoglobin (Hgb) testing within 6 months and low-density lipoprotein (LDL) testing within 12 months. Outcome measures included the percentage of patients with a glycosylated Hgb > 9.3% (equivalent to a HgbA1c > 8.0%), the percentage of patients with an LDL cholesterol > 130mg/dl, and the percentage of patients with controlled blood pressure, defined as Results Teams randomized to an intervention strategy that included direct letters to patients showed significant improvement across a number of measures. The improvement was most apparent among patients without recent testing or with poorly controlled disease. The two interventions that did not include direct patient letters resulted in limited improvement. Discussion Disease registries can be used to improve outcomes in the management of diabetes and other chronic diseases. Better outcomes were seen in patients who received letters based on registrygenerated data. This strategy should be included as part of a comprehensive chronic disease management plan. Further refinements in the use of registries should result in further incremental improvement.

Exploring the Challenges and Opportunities of Health Mobile Apps for Individuals with Type 2 Diabetes Living in Rural Communities.

Abstract: Background: Many adults with type 2 diabetes (T2D), living in rural communities, are not optimally managing the disease through their diet and physical activities. Mobile apps have the potential to facilitate self-management activities, such as providing educational content, assisting with problem solving, and self-regulation. The goal of this study was to understand the perceived barriers, benefits, and facilitators among rural adults with T2D regarding the use of free mobile apps available in Apple App store or Google Play store for diabetes management or behavior monitoring. Materials and Methods: Four focus groups were conducted with 18 participants with T2D who owned a smartphone (age: M = 54.4, SD = 12.7; 27.8% male). The participants were asked about their general app and health-specific app usage. They were then shown features of four apps related to diabetes self-management (Glucose Buddy, mySugr, MyFitnessPal, and MapMyWalk) and prompted to provide feedback. The focus groups were audio ...

Navigating the health system: diabetes care in Georgia

Abstract: Background Effective delivery of diabetes care requires integration across specialist teams delivering recognized interventions, a reliable pharmaceutical supply, and promoting self-management. Drawing on a framework incorporating physical, human, intellectual and social resources, the paper examines how these challenges are managed in diabetes care in Georgia. Methods The rapid appraisal study triangulated data from interviews with users, providers and key informants from various institutions in four regions of Georgia; data on clinical and social outcomes from diabetes; legislative and policy documents. Results Diabetes-related mortality in Georgia is among the worst in Europe and Central Asia, in a context of conflict, economic collapse and weak institutions. Essential inputs for diabetes care are in place (free insulin, training for primary care physicians, financed package of care), but constraints within the system hamper the delivery of accessible and affordable care. There are no evidence-based guidelines on diabetes management, formal support and quality assurance. The scope of work of primary care practitioners is limited and they rarely diagnose and manage diabetes, which instead takes place within the vertical system. Access to insulin is problematic in rural areas. Obtaining syringes, supplies and hypoglycemic drugs and self-monitoring equipment remains difficult everywhere. Prevention and effective management of complications is limited, increasing adverse outcomes. Diagnosis and treatment of diabetes complications involve hospital admission and unaffordable out-of-pocket payments. The complexity of pathways to key stages of care obstructs continuous care. There are poor linkages between primary and secondary care and ineffective patient follow-up or monitoring of outcomes. There is little effort to promote self-care, adherence to drug regimens and appropriate lifestyle, or to empower patients. Conclusions Improving diabetes outcomes will involve simplifying pathways to care and drugs, reassessing staff roles and insulin distribution systems. This would require better co-ordination of the inputs into the system and development of an integrated and patient-centred model.

Patient Navigators Connecting Patients to Community Resources to Improve Diabetes Outcomes

Abstract: Background: Despite the recognized importance of lifestyle modification in reducing risk of developing type 2 diabetes and in diabetes management, the use of available community resources by both patients and their primary care providers (PCPs) remains low. The patient navigator model, widely used in cancer care, may have the potential to link PCPs and community resources for reduction of risk and control of type 2 diabetes. In this study we tested the feasibility and acceptability of telephone-based nonprofessional patient navigation to promote linkages between the PCP office and community programs for patients with or at risk for diabetes. Methods: This was a mixed-methods interventional prospective cohort study conducted between November 2012 and August 2013. We included adult patients with and at risk for type 2 diabetes from six primary care practices. Patient-level measures of glycemic control, diabetes care, and self-efficacy from medical records, and qualitative interview data on acceptability and feasibility, were used. Results: A total of 179 patients participated in the study. Two patient navigators provided services over the phone, using motivational interviewing techniques. Patient navigators provided regular feedback to PCPs and followed up with the patients through phone calls. The patient navigators made 1028 calls, with an average of 6 calls per patient. At follow-up, reduction in HbA1c (7.8 ± 1.9% vs 7.2 ± 1.3%; P = .001) and improvement in patient self-efficacy (3.1 ± 0.8 vs 3.6 ± 0.7; P Conclusions: The patient navigator model is a promising and acceptable strategy to link patient, PCP, and community resources for promoting lifestyle modification in people living with or at risk for type 2 diabetes.