Diabetes management

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

German Diabetes Management Programs Improve Quality Of Care And Curb Costs

Abstract: This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management. After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care.

Medical Care for Patients with Diabetes: Epidemiologic Aspects

Abstract: Objective : To describe the epidemiologic characteristics of physician care and self-care for adults with diabetes in the U.S. population. Design and Subjects : Data are drawn from the 1989 National Health Interview Survey, in which a personal household interview was administered to a representative sample of U.S. adults aged 18 years or older. The response rate was 96% (n = 84 572). All subjects identified as having diabetes previously diagnosed by a physician were asked a series of questions about their diabetes. Response rate for this representative sample of U.S. diabetic patients was 95% (n = 2405). Measurements : Self-reported information was obtained about various aspects of diabetes care, including care by physicians and self-care practices of the diabetic persons. Sociodemographic and clinical factors that may influence diabetes care were also determined. Results : More than 90% of diabetic adults had one physician for the usual care of their diabetes, but 32% made fewer than four visits to this physician each year. Most physician visits by diabetic patients were not made to diabetes specialists, and the visit rate to other health care professionals such as ophthalmologists, podiatrists, and nutritionists was low. About half of insulin-treated diabetic subjects used multiple daily insulin injections ; and 40% of patients with insulin-dependent diabetes mellitus, 26% of those with non-insulin-dependent diabetes mellitus (NIDDM) who were taking insulin, and 5% of those with NIDDM who were not taking insulin monitored their blood glucose level daily. Diabetes patient education classes had been attended by 35% of diabetic adults. Conclusions : These and other data indicate that medical care for diabetic patients and their self-care practices may not be optimal for prevention of diabetes complications. The Diabetes Control and Complications Trial showed that achieving and maintaining near-normal glycemia, with a concomitant 50% to 70% reduction in diabetes complications, may require close monitoring and ongoing support from a health care team, ample financial resources, and advanced patient knowledge and motivation. Providing this level of diabetes management to all diabetic persons may require major changes in the health care system and in patient self-care practices.

Inhaled insulin for diabetes mellitus

Abstract: Purpose. Pharmacokinetic and safety data related to the use of inhaled insulin for the management of diabetes mellitus are discussed. The various pulmonary insulin delivery systems under development are also reviewed. Summary. Several pharmaceutical companies are developing pulmonary insulin delivery systems. These products fall into two main groups: solution and drug powder formulations, which are delivered through different patented inhaler systems. Exubera, a rapid-acting insulin in powder form, has been studied extensively in patients with type 1 and type 2 diabetes mellitus. The AERx Insulin Diabetes Management System delivers a liquid form of human insulin. Preliminary data indicate that patients converting from insulin injections to this system showed higher compliance to therapy, demonstrated by improved glycemic control. Other pulmonary insulin delivery systems, including ProMaxx, AIR, Spiros, and Technosphere, are also under investigation. In humans, inhaled regular insulin is more rapidly absorbed than insulin from the subcutaneous injection site. The efficiency of inhaled insulin is lower than that of subcutaneous injection because pulmonary delivery of insulin involves some loss of drug within the inhaler or mouth during inhalation. A concern of many clinicians is the possibility of long-term effects from the intraalveolar deposition of insulin within the lung, since insulin is known to have growth-promoting properties. The long-term safety of these products has not been established. Conclusion. Several inhaled insulin products are under development. If these products receive marketing approval, the pulmonary delivery of insulin may offer patients with diabetes an alternative to repeated insulin injections.

Social support and diabetes management in childhood and adolescence: influence of parents and friends.

Abstract: This paper reviews the empirical research literature on the role of social support in children and adolescents with diabetes. Studies on the role of parental involvement in diabetes management suggest that premature withdrawal of parental involvement is associated with poor diabetes outcomes, whereas continued parental support and monitoring is associated with better outcomes among adolescents. Research on social support from friends suggests that friends can be a unique source of support that complements parents' involvement and improves adolescents' diabetes management.

"They care but don't understand": family support of African American women with type 2 diabetes.

Abstract: PURPOSE This study evaluated the relationship between perceived social support among African American women with type 2 diabetes and diabetes self-management. METHODS The sample included 12 African American female patients at a diabetes clinic in the southeastern United States. Focus group participants responded to questions related to social support and its influence on diabetes management. RESULTS Support comes particularly from family, but also friends and/or healthcare providers. The dual challenges of diabetes management and multicaregiving were an expected theme from the sessions. A unique emerging theme, however, was the women's perception of a lack of understanding of their needs by members of their social networks. Participants believed that those who provide support claim they care and try to be helpful but provide minimal physical assistance or emotional understanding of their needs, which could vary daily. Those who provide informational support seem to care but misunderstand the type of information actually needed and how best to deliver it. CONCLUSIONS Healthcare providers can help improve communication with these women by actively seeking to meet their support needs and educating families so that provisional support is more meaningful and diabetes management more attainable.