Diabetes management

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

Barriers to appropriate diabetes management among homeless people in Toronto

Abstract: Background: Homeless people are more likely to have chronic medical conditions and to encounter barriers to health care than the general population. In this study we identify barriers to appropriate disease management among homeless adults with diabetes mellitus in Toronto. Methods: People with diabetes were surveyed at homeless shelters in Toronto. Information was obtained on demographic characteristics, diabetes history, access to health care, substance abuse and mental illness. Participants’ descriptions of the difficulties they experienced in managing their diabetes were analysed qualitatively. Hemoglobin A1c levels were used to assess adequacy of glycemic control. Results: Fifty people completed the survey (response rate 83%). Of the respondents 82% were male and 64% were white. Type 2 diabetes had been diagnosed in 86%, with 62% of all participants taking oral agents alone and 28% taking insulin alone. Overall, 72% of the participants reported experiencing difficulties managing their diabetes: the most common were related to diet (type of food at shelters and inability to make dietary choices, reported by 64%) and scheduling and logistics (inability to get insulin and diabetic supplies when needed and inability to coordinate medications with meals, reported by 18%). Although alcohol use, cocaine use and mental health problems were common, few respondents cited these issues as barriers to diabetes management. According to Canadian Diabetes Association guidelines, glycemic control was inadequate in 44% of the people tested. Interpretation: In Toronto, most homeless adults with diabetes report difficulties managing their disease, and poor glycemic control is common.

Caring for Poorly Controlled Diabetes Mellitus: A Randomized Pharmacist Intervention

Abstract: BACKGROUND:There is limited information from randomized controlled studies about the influence of pharmacist interventions on diabetes control.OBJECTIVE:To evaluate the effect of a pharmacist intervention on improving diabetes control; secondary endpoints were medication appropriateness and self-reported adherence.METHODS:A randomized, controlled, multi-clinic trial was conducted in the University of Washington Medicine Neighborhood Clinics. Seventy-seven subjects, ⩾18 years old with a hemoglobin (Hb) A1c ⩾9% at baseline and taking at least one oral diabetes medication, were randomized to receive a pharmacist intervention (n = 43) or usual care (n = 34) for 6 months followed by a 6-month usual-care observation period for both groups. Subjects met with a clinical pharmacist to establish and initiate a diabetes care plan followed by weekly visits or telephone calls to facilitate diabetes management and adherence. HbA1c, medication appropriateness, and self-reported adherence were assessed at baseline, 6 mon...

Glycemic Control and Health Disparities in Older Ethnically Diverse Underserved Adults With Diabetes: Five-year results from the Informatics for Diabetes Education and Telemedicine (IDEATel) study

Abstract: OBJECTIVE The Informatics for Diabetes Education and Telemedicine (IDEATel) project randomized ethnically diverse underserved older adults with diabetes to a telemedicine intervention or usual care. Intervention participants had lower A1C levels over 5 years. New analyses were performed to help better understand this difference. RESEARCH DESIGN AND METHODS IDEATel randomized Medicare beneficiaries with diabetes ( n = 1,665) to receive home video visits with a diabetes educator and upload glucose levels every 4–6 weeks or usual care (2000–2007). Annual measurements included BMI, A1C (primary outcome), and completion of questionnaires. Mixed-model analyses were performed using random effects to adjust for clustering within primary care physicians. RESULTS At baseline, A1C levels (mean ± SD) were 7.02 ± 1.25% in non-Hispanic whites ( n = 821), 7.58 ± 1.78% in non-Hispanic blacks ( n = 248), and 7.79 ± 1.68% in Hispanics ( n = 585). Over time, lower A1C levels were associated with more glucose uploads ( P = 0.02) and female sex ( P = 0.002). Blacks, Hispanics, and insulin-users had higher A1C levels than non-Hispanic whites ( P < 0.0001). BMI was not associated with A1C levels. Blacks and Hispanics had significantly fewer uploads than non-Hispanic whites over time. Hispanics had the highest baseline A1C levels and showed the greatest improvement in the intervention, but, unlike non-Hispanic whites, Hispanics did not achieve A1C levels <7.0% at 5 years. CONCLUSIONS Racial/ethnic disparities were observed in this cohort of underserved older adults with diabetes. The IDEATel telemedicine intervention was associated with improvement in glycemic control, particularly in Hispanics, who had the highest baseline A1C levels, suggesting that telemedicine has the potential to help reduce disparities in diabetes management.

Behavioral interventions for adolescents with type 1 diabetes: how effective are they?

Abstract: OBJECTIVE: To evaluate the effectiveness of behavioral interventions for adolescents with type 1 diabetes based on a systematic review of the literature. RESEARCH DESIGN AND METHODS: The literature was identified by searching 11 electronic databases, hand-searching 3 journals from their start dates, and contacting individual researchers. Only articles that reported evaluations of behavioral (including educational and psychosocial) interventions for adolescents (age range 9-21 years) with type 1 diabetes that included a control group were included in the present review. Data summarizing the key features of the interventions and their effects were extracted from each article. Where possible, effect sizes for the randomized control trials (RCTs) were calculated. RESULTS: The search process identified 64 reports of empirical studies. Of these, 35 studies included a control group, and 24 were RCTs. Effect sizes could be calculated for 18 interventions. The overall mean effect size calculated across all outcomes was 0.33 (median 0.21), indicating that these interventions have a small- to medium-sized beneficial effect on diabetes management. Interventions that were theoretically based were significantly more effective than those that were not (P<0.05, 1-tailed). CONCLUSIONS: Research to date indicates that these interventions are moderately effective. Several methodological weaknesses to be avoided in future studies are noted. It is also recommended that investigators use the reach, efficacy, adoption, implementation, and maintenance (RE-AIM) framework to guide the design of future studies, which should result in more disseminable interventions. RE-AIM assesses the intervention's reach, or percent or representativeness of patients willing to participate; efficacy across a range of outcomes; adoption, or the percent and representativeness of settings willing to implement the intervention; implementation, or the consistency of the delivery of the intervention as intended; and maintenance, or the extent to which delivery of the intervention becomes a routine part of health care in the medical setting.

The relationship between literacy and glycemic control in a diabetes disease-management program.

Abstract: Purpose This study examined the role of literacy in patients with poorly controlled diabetes who were participating in a diabetes management program that included low-literacy-oriented interventions. Methods A before-after analysis was performed of a pharmacist-led diabetes management program for 159 patients with type 2 diabetes and poor glycemic control (hemoglobin A1c [A1C] > or = 8.0%). Clinic-based pharmacists offered one-to-one education and medication management for these patients using techniques that did not require high literacy. Literacy was measured by the Rapid Estimate of Adult Literacy in Medicine (REALM) test and dichotomized at the 6th-grade level. The A1C values were collected prior to enrollment, at enrollment, and approximately 6 months after enrollment. Results Of the 111 patients with follow-up data, 55% had literacy levels at the 6th-grade level or below. Lower literacy was more common among African Americans, older patients, and patients who required medication assistance. There was no significant relationship between literacy status and A1C prior to enrollment or at enrollment. Over the 6-month study period, patients with low and high literacy had similar improvements in A1C. Conclusions This diabetes care program, which used individualized teaching with low-literacy techniques, significantly improved A1C values independent of literacy status.