Dental hygienists and their knowledge about the management of diabetic patients

Simple SummaryDiabetes mellitus is a common disease in patients with cancer. It is a risk factor for certain cancers such as pancreatic, liver, colon, breast, and endometrial cancer. Furthermore, several new cancer treatments or the use of steroids may unmask underlying diabetes or aggravate preexisting diabetes. Evidence suggests that patients with cancer and diabetes have higher cancer-related mortality. Moreover, concurrent complications associated with diabetes in patients with cancer may influence the choice of cancer therapy. This review highlights the relationship between diabetes and cancer and various aspects of the management of diabetes in patients with cancer.Background: Diabetes mellitus and cancer are commonly coexisting illnesses, and the global incidence and prevalence of both are rising. Cancer patients with diabetes face unique challenges. This review highlights the relationship between diabetes and cancer and various aspects of the management of diabetes in cancer patients. Methods: A literature search using keywords in PubMed was performed. Studies that were published in English prior to July 2021 were assessed and an overview of epidemiology, cancer risk, outcomes, treatment-related hyperglycemia and management of diabetes in cancer patients is provided. Results: Overall, 8–18% of cancer patients have diabetes as a comorbid medical condition. Diabetes is a risk factor for certain solid malignancies, such as pancreatic, liver, colon, breast, and endometrial cancer. Several novel targeted compounds and immunotherapies can cause hyperglycemia. Nevertheless, most patients undergoing cancer therapy can be managed with an appropriate glucose lowering agent without the need for discontinuation of cancer treatment. Evidence suggests that cancer patients with diabetes have higher cancer-related mortality; therefore, a multidisciplinary approach is important in the management of patients with diabetes and cancer for a better outcome. Conclusions: Future studies are required to better understand the underlying mechanism between the risk of cancer and diabetes. Furthermore, high-quality prospective studies evaluating management of diabetes in cancer patients using innovative tools are needed. A patient-centered approach is important in cancer patients with diabetes to avoid adverse outcomes.

Hypertension management in outpatient visits by diabetic patients

The impact of hand strength in consideration of sedentary behaviour on diabetes management in patients with type 2 diabetes mellitus (T2DM) is unclear. The purpose of this study was to examine the impact of hand strength on HbA1c, body mass index (BMI) and body composition by group according to the duration of sedentary behaviour in Japanese patients with T2DM. In this retrospective, cross-sectional, single-centre study, hand strength standardised by bodyweight (GS) and sedentary time (ST), were obtained and analysed in a total of 270 Japanese T2DM outpatients in 2021. After dividing the patients into four categories of median values (high and low GS, and long and short ST), odds ratios (ORs) for good control of HbA1c, BMI, waist circumference (WC) and intra-abdominal fat (IAF) were investigated using logistic regression models. The high GS/short ST group was found to have a significantly higher (OR = 2.01; 95% CI: 1.00, 4.03; P = 0.049) for controlled HbA1c compared with that of the low GS/long ST group. The high GS/short ST and the high GS/long ST groups had significantly higher ORs for controlled BMI, WC and IAF compared with the OR of the low GS/long ST group. In addition, the ORs were significantly increased with a positive trend in order from low GS/long ST, low GS/short ST, high GS/long ST, to high GS/short ST in all models (P < 0.001 for trend). Hand strength, with modest effects from sedentary behaviour, could be helpful for diabetes management in T2DM patients.

Introduction: With advances in medicine, more systemic patients seek dental treatment. On the other hand, oral health care is an essential part of pregnancyand diabetes mellitus health care. The aim of this study was to assess dentist’s awareness about dental management of pregnant and diabetic patients. Materials & Methods: This study was conducted on 106 out of 204 dentists attending in oral medicine congresses and continuous education programs from June 2009 to June 2010. A self-established questionnaire with approved validity and reliability was used. Along with demographic data, some multiple choice questions about dental management of diabetic and pregnant patients were asked. Totally 20 points were assigned to questions and awareness was classified to excellent (18-20 points), good (14-Results: The mean awareness score (MAS) was moderate (10.5±2.5). The MAS for pregnancy was (3.5±1.78) of 10 and for diabetes mellitus were (7±1.32) of 10. MAS were higher in women especially about diabetes mellitus but it was not significantly different. The University of Graduation and years of career were not significantly related to awareness status. Education and treatment attitude for pregnant patients were not related to awareness but women had a higher attitude in treatment of pregnant patients (P<0.05). The lowest awareness was about indications of consultation in diabetic patients and the highest awareness was about administration of suitable antibiotic and analgesic during pregnancy. Conclusion: The awareness level of dentists studied here was moderate and low about dental management in pregnancy and diabetes mellitus which should be improved via continuous education programs.

Dietary management in diabetic patients is affected by psychosocial factors and the social-environmental context. Ecological momentary assessment (EMA) allows patients to consistently report their experiences in real-time over a certain period and across different contexts. Despite the importance of dietary management, only a few EMA studies have been conducted on dietary management and psychosocial factors in patients with type 2 diabetes; further evidence must be gathered. Therefore, this study examined dietary management and psychosocial factors using EMA, comparing type 2 diabetes patients with healthy adults. A total of 20 patients with type 2 diabetes and 16 healthy adults underwent EMA. Relying on event-contingent recordings, this study evaluated the participants' mood (e.g., anxiety, anger, vigor), appetite (hunger, craving), meal types (e.g., breakfast), location (e.g., eating out), companions (e.g., family), and dietary lapses (e.g., I ate a larger portion of a meal or snack than I intended) before and after meals. Dietary lapse recording after meals was paired with psychosocial data before meals. Only the type 2 diabetes patients used a sensor-based glucose monitoring system (Freestyle Libre Pro, Abbot) and wearable activity monitors (GT3X-BT, ActiGraph). The EMA produced a total of 4,254 responses. Dietary lapse predicted two-hour postprandial glucose through a sensor-based glucose monitoring system. Multilevel logistic regression analyses were performed. For diabetes patients, dietary lapse was affected by vigor, fatigue, and cravings before eating. Meanwhile, for healthy adults, only fatigue before meals affected dietary lapse, and increased vigor from dietary intake was associated with dietary lapse. In both type 2 diabetes patients and healthy adults, eating-out situations were linked to dietary lapse. The results suggest differences in psychosocial factors influencing dietary lapse between patients with type 2 diabetes and healthy adults. EMA is well suited to assess psychosocial factors that drive dietary management in diabetic patients. This study further discussed the possibility of individual approaches using EMA data.

The circadian time structure of serum 25 (OH) vitamin D (25-OHD), calcium (Ca) and phosphorus (P) may prove to be helpful in prevention, efficacy and management of diabetes mellitus. Ten newly diagnosed patients with type-2 diabetes mellitus (6 men and 4 women), 30-65 years of age, and 10 age-matched clinically healthy volunteers (7 men and 3 women) were synchronized for one week with diurnal activity from about 06:00 to about 22:00 and nocturnal rest. Breakfast was served around 08:00, lunch around 13:30 and dinner around 20:00. Drugs/nutraceuticals known to affect the vitamin D-calcium metabolism and status were not taken. Blood samples were collected at 6-h intervals for 24 h under standardized, 24-h synchronized conditions. Serum 25-OHD, Ca, P, Ca-P product and Ca-P ratio were determined. A marked circadian variation was demonstrated for 25-OHD in healthy volunteers (p = 0.030) and of borderline statistical significance in the diabetic patients (p = 0.083) by population-mean cosinor analysis. Similarly, healthy volunteers showed borderline significance for serum Ca, P and Ca-P ratio. The circadian acrophase of Ca occurred later in the patients as compared to healthy controls. Mapping the circadian rhythm (an important component of the broader time structure or chronome, which includes a.o., trends with age and extra-circadian components) of vitamin D and calcium is needed for exploring their role as markers in the treatment and management of diabetic patients.

Background: Self-care behavior and diabetic management in patients with diabetes mellitus (DM) tends to be low, especially during the COVID-19 pandemic. Various studies have found the influence of knowledge with self-care behavior diabetic management, as well as attitudes, motivation, family support and self-efficacy, but research analyzing the most dominant factors that play a role in influencing diabetic patients in self-care behavior and diabetic management is still limited.Purposes: Analyzing the factors that influence self-care behavior and diabetic management in diabetic patients. This study also analyzes the factor that play the most dominant role to influence self-care behavior and diabetic management in diabetic patients.Methods: This type of research is observational analytic with cross-sectional design. Patients of type 2 diabetes were the population in this study, with a sample size of 312 selected by convenience sampling. Factors of knowledge, attitude, motivation, family support and self-efficacy were observed in the study which were thought to be factors affecting self-care behavior diabetic management. The data were analyzed by chi square test and logistic regression.Results: The factors of knowledge, family support, and motivation significantly influence self-care behavior and diabetic management (p&lt;0.05). The motivation factor is the most dominant factor affecting it (AOR 2.760; p&lt;0.001).Conclusion: Good knowledge about diabetes management plus optimal family support and high motivation will improve self-care behavior and diabetic management in diabetic patients.

Peri-operative environments are a hazardous setting for diabetes patients. A systematic review of literature regarding the management of diabetes patients across the peri-operative pathway has been undertaken to assess if the management of patients within this pathway is suitable and effective for patients. Methods A database search of Google Scholar, CINAHAL, Embase, OVID, Cochrane Library, Joanna Briggs institute and PUBMED was undertaken from 15 th of March 2019 to 30 th of March 2019. A total of 57 papers were found and reduced down to 11 final papers that answered the review question and met the inclusion and exclusion criteria. Inclusion criteria were: Full text, English language, human subjects, adult patients only and studies that focused on diabetes care in a section of the peri-operative pathway. Exclusion criteria: children or adults and children, studies that looked a one particular intervention or type of surgery. No date limit was set. PICO tool was used to frame the study question. Results Three main themes emerged from the literature. 1. Poor patient outcomes; 2. Longer length of stay (LOS); 3. Lack of adherence to guidance and or protocols and glycaemic control. Elective patients had advantageous outcomes compared to emergency surgical patients. Hyperglycaemia still remained a problem with an increase in other medical complications for diabetes patients. LOS in hospital was found to have increased due to medical complications. Adherence to protocols and guidance was found to be beneficial in monitoring and managing hyperglycaemia. However, this review found that best practice guidance and hospital protocol is not always adhered to. A liberal approach to glycaemic control is beneficial. Conclusion This systematic review investigated the management of diabetes patients across the peri-operative pathway. Three main themes emerged from the literature: poor patient outcomes; length of stay; and lack of adherence to guidance and or protocols and glycaemic control. We concluded the peri-operative environment is a hazardous setting for a diabetes patients. Elective patients had slightly more advantageous outcomes than emergency patients. Hyperglycaemia still remains a problem which leads to poor patient outcomes and longer LOS. Adherence to protocols and guidance was found to be beneficial in monitoring and managing hyperglycaemia.

An increasing amount of evidence confirms that abnormalities in glucose metabolism are associated with cardiovascular morbidity and mortality in acute coronary syndromes (ACS). The in-hospital management of hyperglycemic diabetic patients with ACS is complex, and the traditional clinical-organizational approaches show a high degree of heterogeneity nationwide in Italy. The current survey (March 2016-January 2017), carried out through the Delphi method, was focused on some management issues to verify the modalities/possibilities of resolution in daily clinical practice. In addition to the 12 members of the Board, who defined the web-based questionnaire and coordinated the various stages of the process, 66 specialists, cardiologists or diabetologists, were involved in 6 Italian Regions (Lombardy, Tuscany, Lazio, Friuli-Venezia Giulia, Puglia and Sicily). Three iterative rounds of evaluation of the 24 statements included in the questionnaire were scheduled. For each statement, the median evaluation value and the degree of convergence of the Panel of specialists were determined. The final analysis reveals two key aspects with a broad convergence of opinions: (i) the need, since admission to hospital, of a close collaboration between cardiologists and diabetologists in the assistance of high-risk patients; and (ii) the opportunity of a specific diagnostic therapeutic care pathway extended to post-discharge management, where the role of the general practitioner should be adequately emphasized.

Non-communicable diseases (NCDs) stand as a formidable global public health challenge, casting a shadow over populations and contributing significantly to global mortality rates. Among the primary culprits in this health crisis are cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer. This study zeroes in on a critical facet of this challenge - the staff capacity and management of diabetic patients at Mnazi Mmoja Hospital in the Urban District of Unguja, Zanzibar. The urgency of this research is accentuated by the staggering statistic that approximately 415 million people worldwide are grappling with diabetes, catapulting it into the forefront of global health emergencies in the twenty-first century. In response to this pressing need, 205 questionnaires were distributed among diabetes health workers at Mnazi Mmoja Hospital, creating a comprehensive foundation for analysis. Employing statistical techniques with SPSS version 26, the study sought to unravel the intricate landscape of staff knowledge and the challenges faced in managing diabetic patients.&#x0D; The findings of the study paint a nuanced picture, revealing that 38.6% of the staff possessed specialized knowledge in managing diabetic patients, while 61.4% had general knowledge. Alarmingly, only 36.3% of diabetic health workers were available for the management of diabetic patients. The study sheds light on the multifaceted challenges faced by the staff, with issues related to equipment, drugs, support from relatives, psychotherapy treatment, and drug adherence and compliance all surfacing as significant concerns, reported by varying percentages. In the face of these challenges, the study underscores a compelling message: the critical importance of hospital management in recruiting staff with expertise in diabetic treatment and care. This strategic hiring approach is seen as a linchpin for ensuring the efficient and effective management of diabetic patients. Moreover, the study advocates for ensuring the availability of adequate equipment, medical supplies, and materials essential for investigating diabetes and its complications, such as diabetic foot, renal failure, and cardiovascular diseases. This comprehensive approach is deemed crucial for providing holistic care to patients grappling with the complexities of diabetes.

We measured and contrasted general dentists' and periodontists' involvement in 3 areas of managing diabetic patients-assessment of health status, discussion of pertinent issues, and active management of patients--and identified and contrasted predictors of active management of diabetic patients. We conducted a cross-sectional mail survey of random samples of general dentists and periodontists in the northeastern United States during fall 2002, using lists from the 2001 American Dental Directory and the 2002 American Academy of Periodontology Directory. Responses were received from 105 of 132 eligible general dentists (response rate=80%) and from 103 of 142 eligible periodontists (response rate=73%). Confidence, involvement with colleagues and medical experts, and professional responsibility were influential predictors of active management for periodontists (R2=0.46, P<.001). Variables pertaining to patient relations were significant predictors for general dentists (R2=0.55, P<.001). Our findings permitted us to assess and compare general dentists' and periodontists' behavior in 3 realms--assessment of diabetic patients' health status, discussion of pertinent issues, and active management of diabetic patients--and to identify components of potentially effective targeted interventions aimed at increasing specialists' and generalist dentists' involvement in the active management of diabetic patients.

Diabetes management in patients with cancer has critical aspects. This study aims to assess the quality of life (QoL) and self-perceived impact of the management of diabetes on the overall situation of a group of subjects referred to a center dedicated to the management of diabetes in the oncological setting. The study evaluated a sample of 23 consecutive cancer patients with diabetes referred to a tertiary hospital between June and December 2017. All patients were asked to fill in a dedicated questionnaire with 11 items assessing the improvement of typical symptoms of glycemic imbalance after starting anti-diabetic therapy, impact of diabetes self-management on their global situation, improvement of their self-perceived QoL, and perceived utility of a dedicated center for the integrated management between oncologists and endocrinologists. The responses to the questionnaire showed a partial/high improvement of all symptoms, especially in patients suffering from fatigue (68%), decreased appetite (78%), or reduced overall well-being (78%). In 26% of patients, diabetes self-management had a considerable impact on daily routine. However, a notable improvement of the QoL was reported in 74% of cases, despite the higher commitment due to self-monitoring of blood glucose and to insulin therapy. All of the patients reported the perceived utility of a dedicated center for the integrated management between oncologists and endocrinologists. Diabetes management in patients with cancer is often complicated. A well-structured and individualized educational program may reduce the impact of diabetes on the patient’s daily routine and improve QoL.

Management and short-term outcome of diabetic patients hospitalized for acute myocardial infarction: results of a nationwide French survey

Introduction Diabetes and cancer are prevalent diseases whose incidence is globally increasing. Type 2 diabetes mellitus is an independent risk factor for the development of several different types of cancer, including that of the colon and pancreas both in men and women, breast cancer in women and cancer of the liver and bladder in men. Nutritional assessment is an essential step in the global management of diabetic cancer patients. Malnutrition occurs due to a variety of mechanisms, involving the tumour, the host response to the tumour and anticancer therapies (surgery, radiotherapy and chemotherapy). In diabetic patients with cancer, malnutrition is a significant cause of morbidity, with high rate of toxicities during chemotherapy and radiotherapy, increased hospital length of stay, increased treatment costs and altered quality of life. Further, in diabetic cancer people, anorexia and cachexia can co-exist to determine the anorexia–cachexia syndrome, which acts synergistically to impact patients’ morbidity and mortality. Indeed, the concurrence of diabetes and cancer results in profound changes in the protein, lipid and glucose metabolism, in turn causing inefficient use of the energy and plastic substrates. The aim of this paper was to discuss nutrition in diabetic people with cancer. Conclusion The best way to treat cancer cachexia is to cure the cancer, although unfortunately this remains an infrequent achievement among adults with advanced solid tumours. Introduction Diabetes and cancer are prevalent diseases whose incidence is globally increasing1. Epidemiologic evidence suggests that type 2 diabetes mellitus (T2DM) is an independent risk factor for the development of several different types of cancer including that of the colon and pancreas both in men and women, breast cancer in women and cancer of the liver and bladder in men. The link between T2DM and certain types of cancer was first postulated many years ago and it was believed that the relationship could be entirely attributable to the direct effects of diabetes, such as hyperglycemia1,2. Current thinking suggests that diabetes is a possible marker of altered cancer risk due to changes in underlying metabolic conditions, including insulin resistance, hyperinsulinaemia and hyperglycaemia, via their influence on neoplastic processes2. Nutritional assessment is an essential step in the global management of diabetic cancer patients, in order to distinguish malnourished and non-malnourished patients3. The American Society for Parenteral and Enteral Nutrition guidelines defined malnutrition as an involuntary loss or gain of > 10% of usual body weight in 6 months or > 5% in one month4. Malnutrition occurs due to a variety of mechanisms, involving the tumour, the host response to the tumour and anticancer therapies (surgery, radiotherapy, chemotherapy)5. In diabetic patients with cancer, malnutrition is a significant cause of morbidity, with high rate toxicities during chemotherapy and radiotherapy, increased hospital length of stay, increased treatment costs, decreased performance status and altered quality of life6. Cachexia is more common in elderly patients and becomes more pronounced as the disease progresses. The prevalence of cachexia increases from 50% to more than 80% before death and in more than 20% of patients, cachexia is the main cause of death7. In diabetic cancer patients, anorexia and cachexia can co-exist to determine the ‘anorexia–cachexia syndrome’8 that acts synergistically to impact patients’ morbidity, mortality and quality of life9. The presence and severity of anorexia–cachexia syndrome reduce overall survival, contribute to the occurrence of postoperative complications, increase the toxicity induced by radio-chemotherapy, while reducing the sensitivity of tumour cells to antineoplastic treatment. In addition, it lowers the immune response and ultimately becomes the source of psychological stress for the patient and family. This paper discusses the management of diabetic cancer patients including the attempt to address and possibly solve typical diabetes and tumour metabolic changes, reduced caloric intake secondary to the presence of cancer anorexia and specific nutritional requirements by the tumour itself. Discussion The ‘anorexia–cachexia syndrome’ in diabetic cancer patients For a long time, the nutritional problems of diabetic cancer patients * Corresponding author Email: ottavio.giampietro@med.unipi.it Clinical Nutrition Unit, Department of Clinical and Experimental Medicine, University of Pisa

Peri-operative management of diabetes: the need for a lead.