Diabetes management

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

The impact of diabetes and associated cardiometabolic risk factors on members: strategies for optimizing outcomes.

Abstract: BACKGROUND In the past decade, the prevalence of obesity, diabetes, and metabolic syndrome has increased exponentially. Estimated national spending on direct costs related to these conditions exceeds $90 billion for overweight and obesity, $90 billion for diabetes, and $250 billion for cardiovascular disease (CVD). Spending on prescription drugs that are used to modify cardiometabolic risk (CMR) is both a major component of all spending on prescription drugs and a leading cause of the increase in such spending. Also, spending on antihyperglycemic agents is projected to become the largest single component of all spending on prescription drugs in the near future. As the use of antihyperglycemic agents continues to increase, there is a growing need to evaluate the relative and comparative cost-effectiveness of these products. As new antihyperglycemic agents appear, physicians and health plans may begin differentiating products in this category not only on the basis of their use in achieving glycemic control, but also in the context of their effect on global CMR factor modification. OBJECTIVE To describe the effect of overall CMR on clinical outcomes and costs in patients with diabetes. SUMMARY Metabolic syndrome is defined as a clustering of risk factors that identify those at increased risk of CVD and diabetes. Although the exact definition and clinical use of the term "metabolic syndrome" are debated, the clinical community is united in identifying its individual risk factors as important contributors to the development of cardiometabolic disease. Two of the most important points of consensus are that diabetes significantly increases the risk of CVD and that the CVD risk associated with metabolic syndrome is greater than the sum of its measured risk factors. Therefore, it is increasingly recognized that the risk of CVD is greater in patients with diabetes and other CMR factors than in those with diabetes alone. Diabetes treatment goals extend beyond glycemic control to include other risk factor modifications, such as blood pressure control, lipid management, weight management, and smoking cessation. However, a significant percentage of patients do not reach their treatment targets. To improve the quality of diabetes care, treatment algorithms have been developed to provide specific recommendations for each line of treatment and to suggest prompt reevaluation. Also, new antihyperglycemic agents, such as incretin-related therapies, have the potential to address the unmet needs associated with conventional antihyperglycemic agents, including the improvement of glycemic control with either weight maintenance or weight loss and the modification of CMR factors. Economic analyses demonstrate that CMR modification in patients with diabetes can reduce the costs of complications. Among chronic complications of diabetes, CVD treatment generates the greatest expenses, particularly in the early stages of disease progression. Health plan spending related to diabetes can be affected by a number of patient attributes, including age, glycemic control, complications, and CMR. It has also been shown that diabetes spending increases substantially in the presence of various CMR factors (e.g., obesity, hypertension, and dyslipidemia), independent of the presence of other chronic complications. Increasing differences among antihyperglycemic agents have made apparent the need for models in cost-effectiveness analysis. Pharmacoeconomic models have been developed and validated that simulate the treatment benefits not just of glycemic control, but of comprehensive diabetes management. These models can assist in demonstrating the importance of CMR modification in patients with diabetes. CONCLUSION Growing evidence indicates that the evaluation of diabetes treatment strategies should incorporate considerations of their effect on global CMR. Macrovascular disease is one of the major factors in diabetes costs and resource use, both medical and pharmaceutical. Various economic analyses indicate that global CMR should be reduced to control costs in this population. Newer antihyperglycemic agents with a favorable overall metabolic profile may offer a cost-effective approach to managing diabetes.

Impact of Information Technology on the Therapy of Type-1 Diabetes: A Case Study of Children and Adolescents in Germany

Abstract: Being able to manage and adjust insulin doses is a key part of managing type-1 diabetes. Children and adolescents with type-1 diabetes mellitus often have serious difficulties with this dosage adjustment. Therefore, this paper aims to investigate the impact of using novel mobile, web and communication technologies in assisting their therapy and treatment. A trial was conducted in the north-eastern part of Germany to evaluate the impact of the “Mobil Diab”, a mobile diabetes management system, on the clinical outcome. 68 subjects aged between 8 and 18 years, divided randomly into control and intervention groups, were included into the study. Metrics such as changes in the quality of metabolic control, changes in psychological parameters, usability and acceptance of the technology were used for evaluation purpose. Metabolic control was mainly assessed by the mean HbAlc. Analysis showed a good acceptance of the proposed system. An overall improvement in mean levels of HbA1c was observed, however further studies will be conducted to prove evidence of the weight and BMI improvements. Moreover, initial indications of positive impact on the improvement in psychological parameters were presumed based on the result of the conducted study. The system appeared to be an efficient and time saving tool in diabetes management.

Glycated albumin is the preferred marker for assessing glycaemic control in advanced chronic kidney disease.

Abstract: Diabetic nephropathy is the most common aetiology of end-stage kidney disease (ESKD). Strict glycaemic control reduces the development and progression of diabetes-related complications, and there is evidence that improved metabolic control improves outcomes in diabetic subjects with advanced chronic kidney disease (CKD). Glycaemic control in people with kidney disease is complex. Changes in glucose and insulin homeostasis may occur as a consequence of loss of kidney function and dialysis. The reliability of measures of long-term glycaemic control is affected by CKD and the accuracy of glycated haemoglobin (HbA1c) in the setting of CKD and ESKD is questioned. Despite the altered character of diabetes in CKD, current guidelines for diabetes management are not specifically adjusted to this patient group. The validity of indicators of longer term glycaemic control has been the focus of increased recent research. This review discusses the current understanding of commonly used indicators of metabolic control (HbA1c, fructosamine, glycated albumin) in the setting of advanced CKD (Stages 4 and 5, glomerular filtration rate <30 mL/min/1.73m2).

Pregnancy and Diabetes Management: Advances and Controversies

Abstract: BACKGROUND: The treatment of diabetes in pregnancy has potentially far-reaching benefits for both pregnant women with diabetes and their children and may provide a cost-effective approach to the prevention of obesity, type 2 diabetes mellitus, and metabolic syndrome. Early and accurate diagnosis of diabetes in pregnancy is necessary for optimizing maternal and fetal outcomes. CONTENT: Optimal control of diabetes in pregnancy requires achieving normoglycemia at all stages of a woman's pregnancy, including preconception and the postpartum period. In this review we focus on new universal guidelines for the screening and diagnosis of diabetes in pregnancy, including the 75-g oral glucose tolerance test, as well as the controversy surrounding the guidelines. We review the best diagnostic and treatment strategies for the pregestational and intrapartum periods, labor and delivery, and the postpartum period, and discuss management algorithms as well as the safety and efficacy of diabetic medications for use in pregnancy. SUMMARY: Global guidelines for screening, diagnosis, and classification have been established, and offer the potential to stop the cycle of diabetes and obesity caused by hyperglycemia in pregnancy. Normoglycemia is the goal in all aspects of pregnancy and offers the benefits of decreased short-term and long-term complications of diabetes.