Diabetes management

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

Current status of management, control, complications and psychosocial aspects of patients with diabetes in India: Results from the DiabCare India 2011 Study

Abstract: Objectives: DiabCare India 2011 was a cross-sectional study in patients with diabetes mellitus, undertaken to investigate the relationship between diabetes control, management and complications in a subset of urban Indian diabetes patients treated at referral diabetes care centres in India. Materials and Methods: This was a cross-sectional, multicentre (330 centres) survey in 6168 diabetes patients treated at general hospitals, diabetes clinics and referral clinics across India. Patient data, including medical and clinical examination reports during the past year were collected during their routine visit. The patients' and physicians' perceptions about diabetes management were recorded using a questionnaire. Results: A total of 6168 subjects with diabetes (95.8% type 2), mean age 51.9 ± 12.4 years and mean duration of diabetes, 6.9 ± 6.4 years were included. Mean HbA1c was 8.9 ± 2.1% and the mean fasting (FPG), post prandial (PPG) and random (RBG) plasma glucose levels were 148 ± 50 mg/dl 205 ± 66 mg/dl and 193 ± 68mg/dl respectively. Neuropathy was the most common complication (41.4%); other complications were: Foot (32.7%), eye (19.7%), cardiovascular (6.8%) and nephropathy (6.2%). The number of diabetic complications increased with mean duration of diabetes. Most (93.2%) of the patients were on oral anti-diabetic drugs (OADs) and 35.2% were on insulin (±OADs). More than 15% physicians felt that the greatest barrier to insulin therapy from patient's perspective were pain and fear of using injectable modality; 5.2% felt that the greatest barrier to insulin therapy from physician's perspective was the treatment cost; 4.8% felt that the major barriers to achieve optimum diabetic care in practice was loss to follow-up followed by lack of counselling (3.9%) and treatment compliance (3.6%). Conclusion: DiabCare India 2011 has shown that type 2 diabetes sets in early in Indians and glycaemic control is often sub-optimal in these patients. These results indicate a need for more structured intervention at an early stage of the disease and need for increased awareness on benefits of good glycaemic control. It cannot be overemphasized that the status of diabetes care in India needs to be further improved. (ClinTrials.gov identifier: NCT01351922)

Evaluation of a Theory-based Nutrition Intervention for Older Adults With Diabetes Mellitus

Abstract: Objective To evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus. Design A randomized pretest-posttest control group design was used. Subjects/setting Participants (48 experimental, 50 control) were aged 65 years and older with type 2 diabetes for 1 year or longer; 93 participants (95%) completed the study, conducted in an outpatient setting. Intervention The intervention included 10 weekly group sessions led by a dietitian. Information processing, learning theory, and Social Cognitive Theory principles were used in program development and evaluation. Main outcome measures Participants' knowledge, outcome expectations (expected results of behavior), self-efficacy, and decision-making skills were assessed. Instrument validity and reliability were established before program evaluation. Statistical analyses performed Factor analysis identified underlying factor structures. Analysis of covariance with pretest score as covariate was used to compare groups at posttest. Paired t tests compared results within groups. Results Two factors were identified for outcome expectations (positive and negative) and for self-efficacy (promoters of and barriers to diabetes management). The experimental group had greater improvement in total knowledge scores (mean±standard error of the mean: 7.8±0.7) than the control group (0.2±0.7) ( P P =.01), promoters of diabetes management (0.83±0.12 vs −0.09±0.18, P P P Applications/conclusions Older adults with diabetes can benefit from nutrition education designed to improve knowledge and skills necessary for diabetes management. J Am Diet Assoc. 2002;102:1069–1074,1079–1081 .

Improving Depression Screening for Adolescents With Type 1 Diabetes

Abstract: OBJECTIVE: Depression is common among adolescents, but rates increase significantly in the presence of chronic health conditions. Outpatient screening for depression is recommended but rarely formally conducted due to barriers of implementation. METHODS: To provide a model for depression screening of youth with chronic health conditions, a standard process using a self-administered electronic version of the Children’s Depression Inventory (CDI) was developed. Quality improvement methodology and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients 13 to 17 years of age with type 1 diabetes. RESULTS: Of the 528 eligible adolescents, 509 (96%) received at least 1 depression screen during the first year. The process was tested and refined in over 1200 patient encounters, which resulted in an increase in depression screening rates from <5% to a median of 85% over the initial 12 months. Both patients and staff reported acceptance of screening on qualitative surveys. Elevated CDI scores (≥16) were found in 8% of the sample; moderate scores (10–15) in 12% of the sample. Low risk scores were found in 80% of the sample. Higher CDI scores correlated with lower blood glucose monitoring frequency and higher hemoglobin A1c, confirming the link between more depression symptoms and poorer diabetes management and control. Suicidal ideation was endorsed in 7% of the population. CONCLUSIONS: Systematic depression screening in adolescents with type 1 diabetes can be reliably implemented with clinically significant results. A systematic approach, such as described in this study, can serve as a model for other chronic health conditions. * Abbreviations: BGM — : blood glucose monitoring CDI — : Children’s Depression Inventory EMR — : electronic medical record HbA1c — : hemoglobin A1c QI — : quality improvement PDSA — : plan, do, study, act

Dose-response relation of liquid aerosol inhaled insulin in type I diabetic patients.

Abstract: Aims/hypothesis. The AERx insulin Diabetes Management System (AERx iDMS) is a liquid aerosol device that enables insulin to be administered to the peripheral parts of the lung. This study aimed to compare the pharmacokinetic and pharmacodynamic properties of insulin which is inhaled using AERx iDMS with insulin which is subcutaneously administered. Methods. In total, 18 C-peptide negative patients with Type I (insulin-dependent) diabetes mellitus participated in this randomised, open-label, 5-period cross-over trial. Human regular insulin was administered subcutaneously (0.12 U/kg body weight) or inhaled by means of the AERx iDMS (dosages 0.3, 0.6, 1.2, and 1.8 U/kg body weight). Thereafter plasma glucose was kept constant at 7.2 mmol/l for a 10-h period (glucose clamp technique). Results. Inhaled insulin provided a dose-response relation that was close to linear for both pharmacokinetic (AUC-Ins(0–10 h); Cmax-Ins) and pharmacodynamic (AUC-GIR(0–10 h); GIRmax) parameters. Time to maximum insulin concentration (Tmax-Ins) and time to maximum glucose infusion rate (TGIRmax) were shorter with inhaled insulin than with subcutaneous administration. The pharmacodynamic system efficiency of inhaled insulin (AUC-GIR(0–6 h)) was 12.7 % (95 % C. I.: 10.2–15.6). Conclusion/interpretation. The inhalation of soluble human insulin using the AERx iDMS is feasible and provides a clear dose response. Further long-term studies are required to investigate safety aspects, HbA1 c values, incidence of hypoglycaemic events and the quality of life. [Diabetologia (2001) 44: 305–308]