Diabetes management

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

What’s distressing about having type 1 diabetes? A qualitative study of young adults’ perspectives

Abstract: Diabetes distress is a general term that refers to the emotional burdens, anxieties, frustrations, stressors and worries that stem from managing a severe, complex condition like Type 1 diabetes. To date there has been limited research on diabetes-related distress in younger people with Type 1 diabetes. This qualitative study aimed to identify causes of diabetes distress in a sample of young adults with Type 1 diabetes. Semi-structured interviews with 35 individuals with Type 1 diabetes (23–30 years of age). This study found diabetes related-distress to be common in a sample of young adults with Type 1 diabetes in the second phase of young adulthood (23–30 years of age). Diabetes distress was triggered by multiple factors, the most common of which were: self-consciousness/stigma, day-to-day diabetes management difficulties, having to fight the healthcare system, concerns about the future and apprehension about pregnancy. A number of factors appeared to moderate distress in this group, including having opportunities to talk to healthcare professionals, attending diabetes education programmes and joining peer support groups. Young adults felt that having opportunities to talk to healthcare professionals about diabetes distress should be a component of standard diabetes care. Some aspects of living with diabetes frequently distress young adults with Type 1 diabetes who are in their twenties. Clinicians should facilitate young adults’ attendance at diabetes education programmes, provide them with opportunities to talk about their diabetes-related frustrations and difficulties and, where possible, assist in the development of peer-support networks for young adults with diabetes.

Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters.

Abstract: We review clinical instances in which A1C should not be used and reflect on the use of other glucose metrics that can be used, in substitution of or in combination with A1C and SMBG, to tailor an individualized approach that will result in better outcomes and patient empowerment

Emotional and quality-of-life aspects of diabetes management

Abstract: Patients with diabetes commonly feel overwhelmed, frustrated, or "burned out" by the daily hassles of disease management and by the unending, often burdensome self-care demands. Many report feeling angry, guilty, or frightened about the disease, and often are unmotivated to complete diabetes self-care tasks. The toll of short- and long-term complications can make the disease even more burdensome. Not surprisingly, it is a consistent finding across studies that diabetes is associated with impaired health-related quality of life (HRQOL), measured in a variety of different ways. Importantly, the relationship between HRQOL and diabetes appears to be bidirectional. Both medical and psychosocial aspects of diabetes may negatively affect HRQOL; in turn, impaired HRQOL may negatively influence diabetes self-management. Unfortunately, the concept of HRQOL in diabetes remains unclear, making precise evaluation and intervention difficult. There is growing agreement that the focus of HRQOL assessment should be on the subjective burden of symptoms, not merely on the presence of objectively identifiable problems. Proper evaluation should include both generic and diabetes-specific elements of HRQOL. In this article, a comprehensive multidimensional model of HRQOL in diabetes involving six major components is introduced and described. Representative self-report questionnaires that may be valuable in assessing these components are also presented. Once the patient's most important HRQOL issues have been identified and prioritized, appropriate intervention becomes possible. The good news is that there are now a growing number of research-based interventions available for addressing almost all of the HRQOL impairments that may occur.

Association of Patient-Physician Language Concordance and Glycemic Control for Limited-English Proficiency Latinos With Type 2 Diabetes.

Abstract: Importance Providing culturally competent care to the growing number of limited–English proficiency (LEP) Latinos with diabetes in the United States is challenging. Objective To evaluate changes in risk factor control among LEP Latinos with diabetes who switched from language-discordant (English-only) primary care physicians (PCPs) to language-concordant (Spanish-speaking) PCPs or vice versa. Design, Setting, and Participants This pre-post, difference-in-differences study selected 1605 adult patients with diabetes who self-identified as Latino, whose preferred language was Spanish, and who switched PCPs between January 1, 2007, and December 31, 2013. Study participants were members of the Kaiser Permanente Northern California health care system (an integrated health care delivery system with access to bilingual PCPs and/or professional interpreter services). Spanish-speaking and English-only PCPs were identified by self-report or utilization data. Exposures Change in patient-PCP language concordance after switching PCPs. Main Outcomes and Measures Glycemic control (glycated hemoglobin [HbA 1c ] 1c > 9%), low-density-lipoprotein (LDL) control (LDL Results Overall, 1605 LEP Latino adults with diabetes (mean [SD] age, 60.5 [13.1] years) were included in this study, and there was a significant net improvement in glycemic and LDL control among patients who switched from language-discordant PCPs to concordant PCPs relative to those who switched from one discordant PCP to another discordant PCP. After adjustment and accounting for secular trends, the prevalence of glycemic control increased by 10% (95% CI, 2% to 17%; P = .01), poor glycemic control decreased by 4% (95% CI, −10% to 2%; P = .16) and LDL control increased by 9% (95% CI, 1% to 17%; P = .03). No significant changes were observed in SBP control. Prevalence of LDL control increased 15% (95% CI, 7% to 24%; P Conclusions and Relevance We observed significant improvements in glycemic control among LEP Latino patients with diabetes who switched from language-discordant to concordant PCPs. Facilitating language-concordant care may be a strategy for diabetes management among LEP Latinos.

Inhaled Insulin Using the AERx Insulin Diabetes Management System in Healthy and Asthmatic Subjects

Abstract: OBJECTIVE —The AERx insulin Diabetes Management System (AERx iDMS) (Aradigm, Hayward, CA) delivers an aerosol of liquid human insulin to the deep lung for systemic absorption. This study examined the effects on pulmonary function, pharmacokinetics, and pharmacodynamics of inhaled insulin in asthmatic and nonasthmatic subjects without diabetes. RESEARCH DESIGN AND METHODS —A total of 28 healthy and 17 asthmatic (forced expiratory volume during the first second [ FEV 1 ] 50–80% of predicted value) subjects were enrolled in a two-part, open-label trial. To assess insulin pharmacokinetics and pharmacodynamics, a single inhalation dose of 1.57 mg (45 IU) was given on each of the 2 dosing days in part 1. A dose of 4.7 mg (135 IU) of insulin was inhaled in part 2 to assess effects on pulmonary function. RESULTS —Inhaled insulin showed area under the curve (AUC) (0–360 min) values that were significantly greater for healthy subjects than for asthmatic subjects ( P = 0.013), whereas no difference was observed for maximum concentration (C max ) in the two groups. A greater reduction of serum glucose as indicated by area over the curve (AOC) (0–360 min) was observed in healthy subjects ( P = 0.007). Asthmatic subjects had greater intrasubject variations in insulin AUC (0–360 min) and C max values than healthy subjects, but similar variations in glucose AOC (0–360 min) . No significant changes in FEV 1 , forced vital capacity (FVC), and FEV 1 /FVC were observed from pre- to postdose times, and there were no observed safety issues. CONCLUSIONS —After inhaling insulin using the AERx iDMS, asthmatic subjects absorbed less insulin than healthy subjects, resulting in less reduction of serum glucose. No effects on airway reactivity were observed. Diabetic patients with asthma may need to inhale more insulin than patients with normal respiratory function in order to achieve similar glycemic control.