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Diabetes management

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


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TL;DR: Project Dulce was effective in improving clinical outcomes for control of diabetes and related conditions in a medically indigent, culturally diverse population and the finding of reduced hospital expenditures, although statistically insignificant, is clinically and economically important.
Abstract: BACKGROUND:Diabetes mellitus is a common and costly chronic disease that increasingly affects minority populations; however, there is little evidence regarding the clinical effectiveness and costs of culturally appropriate disease management programs.OBJECTIVE:To determine the clinical outcomes and costs of Project Dulce, a combined stepped-care diabetes nurse case management program and culturally oriented peer-led self-empowerment training program.METHODS:Pre—post clinical outcome and cost analysis of Project Dulce participants were compared with a cohort of historical controls over a one-year period. Subjects included 348 persons with diabetes with coverage under County Medical Services who were receiving services in community health centers in San Diego, CA. Generalized regression models were used to estimate changes in clinical outcomes (hemoglobin [Hb] A1c, blood pressure, cholesterol level) and costs associated with participation in Project Dulce.RESULTS:Project Dulce participants had significant r...

79 citations

Journal ArticleDOI
TL;DR: This review synthesizes research regarding the involvement of caregivers—primarily mothers and fathers— of youth with T1D with a focus on biopsychosocial outcomes and provides recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with type 1 diabetes.
Abstract: Sustained parental involvement in diabetes management has been generally advised to counteract the deteriorating adherence and glycemic control often seen during adolescence, yet until recently, little attention has been given to the optimal amount, type, and quality of parental involvement to promote the best health outcomes for adolescents with type 1 diabetes (T1D). This review synthesizes research regarding the involvement of caregivers-primarily mothers and fathers-of youth with T1D, with a focus on biopsychosocial outcomes. The recent literature on parental involvement in diabetes management highlights a shift in focus from not only amount but also the types (e.g., monitoring, problem-solving) and quality (e.g., warm, critical) of involvement in both mothers and fathers. We provide recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with T1D.

79 citations

Journal ArticleDOI
TL;DR: Diabetes self-care was evaluated as a mediator of the associations among parental monitoring, family conflict, and glycemic control in early adolescents with type 1 diabetes.
Abstract: Type 1 diabetes is a chronic condition that impacts two of every 1000 youth in the United States (Liese et al., 2006). The complex, demanding regimen for diabetes self-care requires frequent blood glucose (BG) monitoring and management of insulin, nutritional intake, and physical activity (Silverstein et al., 2005). Common declines in adolescents’ self-care and disease control (Helgeson, Siminerio, Escobar, & Becker, 2009; Luyckx, Seiffge-Krenke, & Hampson, 2010) elevate the risk for complications, lead to greater healthcare utilization, and result in higher medical costs (Menzin, Langley-Hawthorne, Friedman, Boulanger, & Cavanaugh, 2001; Wagner et al., 2001). Ideally, youth with diabetes and their parents complete diabetes management jointly (Anderson, 2004; Silverstein et al., 2005), and family interactions related to diabetes can impact youths’ diabetes self-care and glycemic outcomes (Anderson, Ho, Brackett, Finkelstein, & Laffel, 1997). Parental involvement in diabetes management can take the form of parental responsibility, in which parents complete particular tasks for youth, or of parental monitoring, in which parents supervise youths’ independent completion of self-care tasks. Both forms of involvement are associated with better glycemic control via their beneficial impact on adolescents’ self-care (Anderson et al., 1997; Ellis et al., 2007). In early adolescence, increasing autonomy is typical (Beyers, Goossens, Vansant, & Moors, 2003) and parents’ expectations for teens’ diabetes self-care tend to increase while their direct participation in diabetes management often decreases (Palmer et al., 2004; Wysocki et al., 1996). During this period, parental involvement may begin to transition from responsibility to monitoring. The shift in disease management responsibility from parents to youth is one factor associated with the common deterioration in diabetes outcomes in adolescence (Holmes et al., 2006; Grey, Boland, Yu, Sullivan-Bolyai, & Tamborlane, 1998; Palmer et al., 2004), although greater parental monitoring appears to minimize this risk (Ellis et al., 2007). Conflict between teens and their parents about diabetes is another factor associated with worsening diabetes outcomes in adolescence. Diabetes-related conflict is of significant concern given that even minimally elevated conflict can negatively impact glycemic control (Hood, Anderson, Butler, & Laffel, 2007), in part by detracting from diabetes self-care (Hilliard, Guilfoyle, Dolan, & Hood, 2011). For example, some adolescents who are distressed, angry, or frustrated about family conflict may be less inclined or less able to complete diabetes tasks. Others might limit their completion of diabetes self-care tasks to avoid arguments (e.g., related to BG values). While previous studies have identified family conflict and lower parental monitoring as independent risk factors for suboptimal self-care and ultimately poorer glycemic outcomes (Ellis et al., 2007; Hilliard et al., 2011), it remains unclear how these two important family characteristics are related to one another in the context of diabetes management and glycemic control. There are likely reciprocal relations between them, such that the amount and nature of parental monitoring may impact family conflict, and family conflict may impact how much and in what ways parents are involved in adolescents’ daily diabetes self-care. Greater parental responsibility for and monitoring of diabetes self-care often are encouraged to improve adolescents’ diabetes management and glycemic outcomes (Anderson et al., 1997; Ellis et al., 2007). Yet, clinically it is apparent that some aspects of parent involvement in adolescents’ diabetes self-care, including parental monitoring, may inadvertently foster conflict. For example, frequent reminders or questions about diabetes self-care might irritate teens and lead to or exacerbate conflict. Among youth without diabetes, those with more family conflict want less parental supervision (Laird, Pettit, Dodge, & Bates, 2003) and this preference likely is mirrored in teens with diabetes, who often want less frequent or less intrusive parental involvement in their diabetes self-care (Hanna & Guthrie, 2001; Weinger, O’Donnell, & Ritholz, 2001). Conflict also may detract from diabetes management and glycemic control through its impact on the amount and ways that parents participate in their adolescents’ self-care (Weinger et al., 2001). For example, in order to avoid conflict some parents might decrease their monitoring or oversight of diabetes management (Palmer et al., 2004). Parents who argue frequently with their teens about diabetes may refrain from asking questions or be hesitant to offer assistance with diabetes tasks. Other parents may increase or become more persistent in their monitoring to ensure their teens follow directions. Additionally, adolescents themselves may avoid discussions about diabetes with their parents as a means to avoid conflict. Any of these scenarios could detract from self-care and negatively impact glycemic control. Given the developmentally normative changes in parent-youth relationships at the entry to adolescence and their potential impact on diabetes self-care and glycemic control, a better understanding of how family conflict and parental monitoring relate to each other and to diabetes self-care and glycemic outcomes is valuable. Thus, this paper aims to examine the associations among family conflict, parental monitoring, diabetes self-care, and glycemic control. More family conflict and less parental monitoring were hypothesized to be correlated and to each have a direct association with poorer glycemic control. Given previous evidence of self-care as a mediator of the separate relations of parental monitoring (Ellis et al., 2007) and family conflict (Hilliard et al., 2011) with glycemic control, poorer self-care was hypothesized to mediate these associations. Confirmation of this model would indicate that interventions to improve adolescents’ glycemic control should address multiple aspects of the parent-adolescent relationship related to diabetes and directly address teens’ diabetes self-care behaviors.

79 citations

Journal ArticleDOI
TL;DR: It is estimated that the prevalence of diabetes is increasing in South Africa, representing approximately 2 million cases of diabetes and its sequelae in 2009, and some of the attributed burden can be prevented through early detection and treatment.
Abstract: Background : Increasing urbanisation and rising unhealthy lifestyle risk factors are contributing to a growing diabetes epidemic in South Africa. In 2000, a study estimated diabetes prevalence to be 5.5% in those aged over 30. Accurate, up-to-date information on the epidemiology and burden of disease due to diabetes and its sequelae is essential in the planning of health services for diabetes management. Objective : To calculate the non-fatal burden of disease in Years Lost due to Disability (YLD) due to diabetes and selected sequelae in South Africa in 2009. YLD measures the equivalent loss of life due to ill-health. Methods : A series of systematic literature reviews identified data on the epidemiology of diabetes and its sequelae in South Africa. The data identified were then applied to Global Burden of Disease (GBD) methodology to calculate the burden attributable to diabetes. Results : Prevalence of type 2 diabetes in South Africa in 2009 is estimated at 9.0% in people aged 30 and older, representing approximately 2 million cases of diabetes. We modelled 8,000 new cases of blindness and 2,000 new amputations annually caused by diabetes. There are 78,900 YLD attributed to diabetes, with 64% coming from diabetes alone, 24% from retinopathy, 6% from amputations, 9% from attributable stroke disability, and 7% from attributable ischemic heart disease disability. Conclusions : We estimate that the prevalence of diabetes is increasing in South Africa. Significant disability associated with diabetes is demonstrated. Some of the attributed burden can be prevented through early detection and treatment. Keywords : burden of disease; diabetes; South Africa; developing country; epidemiology (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 19244 - http://dx.doi.org/10.3402/gha.v6i0.19244 Access the supplementary material to this article – see Supplementary files under Article Tools online.

79 citations

Journal ArticleDOI
TL;DR: This low-cost self-instructional program can potentially empower young women with type 1 diabetes to make well-informed reproductive health choices, adding little time burden or cost to their diabetes management.
Abstract: Objective- To evaluate the impact of a preconception counseling (PC) program tailored for teens with type-1-diabetes on cognitive, psychosocial, and behavioral outcomes and to assess its cost-effectiveness. Research design and methods- Eighty-eight teens with type-1-diabetes from 2-sites were randomized into the “READY-Girls” (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) intervention (IG) (n=43) or standard care (SC) (n=45) groups. During 3 diabetes clinic visits, IG subjects viewed a two-part CD-ROM, read a book, and met with a nurse. Program effectiveness was measured by knowledge, attitudes, intentions and behaviors regarding diabetes, pregnancy, sexuality, and PC. Assessments occurred at baseline, before and after viewing program materials, and at 9-months. Economic analyses included an assessment of resource utilization, direct medical costs, and a break-even cost analysis. Results- Age range was 13.2-19.7 years(mean=16.7±s.d 1.7 years); 6 (n=5) were African American and 24%(n=21) were sexually active. Compared to baseline and SC subjects, IG subjects demonstrated a significant group-by-time interaction for benefit and knowledge of PC and reproductive-health: increasing immediately after the first visit (p READY-Girls were low. Conclusion- READY-Girls was beneficial and effects were sustained for at least 9-months. This low-cost self-instructional program can potentially empower young women with type-1-diabetes to make well informed reproductive-health choices, adding little time burden or cost to their diabetes management.

79 citations


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Performance
Metrics
No. of papers in the topic in previous years
YearPapers
2023168
2022331
2021480
2020511
2019405
2018386