Blood Sugar Management Research Articles

당뇨병 질환자의 의료이용 및 직접의료비 연구

This study was aimed to make data how much spent money of medical utilization and direct medical cost. In order to research we were using Korea Health panel 2012 Statistics which data contained Diabetes mellitus client 812 people in age 19. The method of this study was emergency cost, admission medical cost, out patient department cost(client own due, National Health insurance service due, not insurance fee). The result of this study, Diabete Mellitus client were using 198 times during 1 year per 100, total medical direct cost were 859,942 won, 447,359 won, 363,255,508. And admission times were 5.6 times per year, total direct cost was 772,240 won, 4,061,982 won, and 3,298,329,384 won, and out patient clinic using number was 10 times, medical cost total direct cost containing total direct cost was 11,978 won, 26,020 won, and 21,129,240 won. From this research we conclusion that the occurrence of diabetes mellitus can be increased medical cost and direct medical cost and it can be huge burden to client including their family and quality of life in the future. We suggest that in order to prevention and management of diabetes mellitus healthy diet, activity, blood sugar, and blood management should be encouragement.

G561(P) Safe use of insulin

Context The project involves all paediatric inpatients with type 1 diabetes on a general paediatric ward in a district general hospital. The staff involved include paediatric specialist nurses, ward nurses, ward-based doctors, the ward pharmacist and the clinical lead for diabetes. Problem Errors were occurring with prescribing and administration of insulin, including dosing errors, type of insulin, missed doses and untimely doses. This was leading to poor blood sugar management significant risk to patient safety. Parents were reporting to the diabetes specialist nurses that they lacked confidence in the ward staff’s abilities to understand glycaemic control and one teenage patient self-discharged as he felt unsafe. Assessment of problem and analysis of its causes Construct a process map from a multidisciplinary discussion to diagnose the variations in care during the patient journey. The discussion helped determine: Problems with the prescription chart, e.g. insulin prescribed on different pages; text boxes too small with inappropriate subheadings; not suitable for variable doses. Lack of staff understanding, compounded by high turnover of medical staff sometimes with no paediatric experience and lack of exposure due to low admission rates of diabetics. The lack of clarity of the prescription was leading to an unnecessary step of the nurse calling the doctor to check the quantity of insulin required based on each blood sugar result. Patient engagement: contact with recent inpatients/their carers to discuss perception of care. Intervention A search was conducted to see how other departments are approaching this problem and then critically appraise whether these methods would be suitable in our setting. As a starting point we introduced a separate specific insulin prescription chart securely attached to ward drug chart. The chart allowed sufficient space for each type of insulin prescribed, with prompts to guide staff in decision-making regarding dose and to encourage appropriate timing of administration of doses. Study design Due to the low admission rate of diabetic patients and high risk of harm from drug errors, analysis using real patients would delay the implementation of the safer prescription chart. Therefore initial tests of the chart’s suitability were carried out with simulation exercises and repeatedly tested on groups of doctors and nurses, who provided feedback on the charts. The feedback and charts were then analysed by the author along with the ward pharmacist. Strategy for change The new drug chart will be kept in the same place as the standard drug charts. Use of the chart will be incorporated into the diabetes study day for the nursing staff and the doctors’ departmental induction. Measurement of improvement Run charts of the number of errors found on charts tested out on doctors and nurses with the dummy patients. Simultaneous analysis of confidence of prescribing and interpretation of prescriptions by nurses. Once the chart has been through the trust’s clinical governance systems and is implemented for real patient use, the incidence of drug errors will be monitored using the incident reporting system and feedback from the ward pharmacist. Effects of changes It is hoped that there will be a reduction in drug errors and an improvement in the timely, accurate administration of the correct insulin type. It is expected that as a result of improved confidence of the staff and consistency of prescriptions that patient confidence will improve. Lessons learnt By standardising part of the pathway we predict a reduction in treatment variation. Message for others Safe insulin prescribing is now mandatory training throughout the NHS. This chart allows this training to be incorporated into best practice.

Narrative Therapy for Diabetic Patients

Diabetic patients undergo psychosocial difficulties, including anger, because of their chronic disease, anxiousness of complications, and stress resulting from the need for self-management. These difficulties often lead to depression and other negative emotions. Thus, management of these emotions is needed. Narrative therapy can help patients discover their identity, including their own capabilities, values, and hopes. Through the process of narrative therapy, which includes externalization conversation, reauthoring conversation, re-membering conversation and definition ceremony, diabetic patients can achieve emotional stability. Furthermore, it can be helpful in blood sugar management.

Low perfusion index affects the difference in glucose level between capillary and venous blood.

AimIn emergency cases, finger stick testing is primarily used to check the blood glucose value of patients since it takes longer to obtain the venous value. In critical patients, under conditions that cause an increase in metabolic state and level of stress, there occurs considerable difference in glucose levels between capillary and venous measurements. This study aimed to investigate the comparability of capillary and venous glucose values, according to the perfusion index level obtained with the Masimo Radical-7® device, in critical patients aged 18 years and over.MethodWe conducted this prospective and observational study in the emergency department of the Eskisehir Osmangazi University hospital between November 3, 2008 and February 2, 2009.ResultsThe blood glucose of 300 critical patients was checked by finger stick in the emergency unit. The participants with normal vital signs had perfusion index between 0 and 5; the results obtained by the two methods were more consistent for perfusion index values of 6 and over. The results were most consistent in aged participants with normal vital sign findings and low perfusion index and in young patients with high perfusion index. In the cases where at least one of the vital signs was abnormal, the glucose values obtained by the two methods were more consistent when the perfusion index was 6 or over. In this group, independently from the perfusion index value, the consistency was higher in younger patients compared with aged patients.ConclusionIn the emergency department, perfusion index value measured by Masimo Radical-7 and capillary blood glucose levels can serve in blood sugar management in critically ill patients.

Blood sugar management of pancreatic diabetes in the postoperative of total pancreatectomy

Blood sugar management of pancreatic diabetes in the postoperative of total pancreatectomy

Glycemic control in diabetic kidney disease patients

Type 1 and type 2 diabetes mellitus with long duration leads to nephropathy. Since population diabetes is increasing, mainly type 2 and so the people suffering from nephropathy. It is well-documented from clinical studies that early management of nephropathy reduces the development of end-stage renal disease. Blood sugar management in chronic kidney disease (CKD) is important because good glycemic control reduces the mortality in diabetic patients. Various options are available to treat high blood sugar, in mild to moderate renal failure cases patients can be treated with oral hypoglycemic agents while insulin is indicated in patients with moderate to severe CKD. Patients with CKD require frequent monitoring of blood sugar especially home monitoring. Blood sugar should be maintained in normal range with avoiding hypoglycemia.

Audit of blood sugar management in diabetic pregnancies

BackgroundDiabetes is the commonest medical disorder affecting pregnancy in the UK, affecting 1 in 250 pregnancies. Our aim in managing diabetic pregnancies should be to achieve a pregnancy outcome that...

Late‐evening snack with branched‐chain amino acids improves liver function after radiofrequency ablation for hepatocellular carcinoma

This prospective study was designed to examine whether consumption of a branched-chain amino acid (BCAA)-enriched nutrient mixture as a late-evening snack (LES) helps maintain and/or improve liver functioning in liver cirrhosis (LC) patients who have undergone radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). An equal number (10) of 30 LC patients who had undergone RFA for HCC was randomly assigned to a standard diet group (control) group, a morning BCAA (M-BCAA) administration group, or a LES with BCAA (LES-BCAA) administration group. Liver function testing was performed and Child-Pugh scores (CPS) calculated for each group to assess the improvement at 1, 4 and 12 weeks post-RFA. Compared to the control and M-BCAA groups, the LES-BCAA group experienced a rapid and significant improvement in albumin and total serum bilirubin levels and in CPS that began during the initial post-RFA period. These results indicate that LES with BCAA supplementation significantly improved the CPS of the LES-BCAA group at 4 and 12 weeks post-RFA. Although no patients experienced serious adverse effects, two patients who had been diagnosed with diabetes mellitus before undergoing RFA required blood sugar management to improve glycemic control and one subject withdrew due to supplement-induced vomiting. LES with BCAA supplementation significantly and rapidly improves liver functioning and CPS in LC patients who have undergone RFA for HCC. Control of blood sugar levels is necessary when calorie-containing BCAA is administrated to LC patients with impaired glucose tolerance.

The theory of music, mood and movement to improve health outcomes

This paper presents a discussion of the development of a middle-range nursing theory of the effects of music on physical activity and improved health outcomes. Due to the high rate of physical inactivity and the associated negative health outcomes worldwide, nurses need new evidence-based theories and interventions to increase physical activity. The theory of music, mood and movement (MMM) was developed from physical activity guidelines and music theory using the principles of statement and theory synthesis. The concepts of music, physical activity and health outcomes were searched using the CINAHL, MEDLINE, ProQuest Nursing and Allied Health Source, PsycINFO and Cochrane Library databases covering the years 1975-2008. The theory of MMM was synthesized by combining the psychological and physiological responses of music to increase physical activity and improve health outcomes. It proposes that music alters mood, is a cue for movement, and makes physical activity more enjoyable leading to improved health outcomes of weight, blood pressure, blood sugar and cardiovascular risk factor management, and improved quality of life. As it was developed from the physical activity guidelines, the middle-range theory is prescriptive, produces testable hypotheses, and can guide nursing research and practice. The middle-range theory needs to be tested to determine its usefulness for nurses to develop physical activity programmes to improve health outcomes across various cultures.

S8-3 From CHS to ACE: Chinese Cardiologists are Taking Their Responsibilities in the Management of Blood Sugar

S8-3 From CHS to ACE: Chinese Cardiologists are Taking Their Responsibilities in the Management of Blood Sugar

Management of blood sugar for prevention hypoglycemia at colonoscopy

Management of blood sugar for prevention hypoglycemia at colonoscopy

Cardiologists and the management of blood sugar: a Chinese perspective

Cardiologists and the management of blood sugar: a Chinese perspective

A Minimally Invasive Device for Continuous Glucose Monitoring in Infants

Blood sugar management is particularly critical in the neonatal intensive care unit where the incidence of hypoglycemia is high and patients run the risk of brain damage. The staff at most hospitals obtain glucose levels in infants by drawing blood from the heel, which is a cause for recurrent pain. Some infants undergo this procedure every 1–3hours for up to a few months. Our goal is to design a minimally invasive device that allows for real-time glucose monitoring in very low birth weight infants in the neonatal intensive care unit (NICU). This glucose monitor will reduce the amount of pain and physiological stress on the infants, decrease the risk of hypoglycemia in neonates and reduce the workload on hospital staff. There is currently much room for emerging technologies in this market as it trends towards less pain and faster responses. The device should only slightly hinder the infant’s motion, be as painless as possible, and all materials used in contact with the body need to be biologically inert and cause no irritation or allergic reaction. The device will utilize a microneedle array to extract interstitial fluid and draw it through a hydrophilic polyurethane membrane and into a polarimetry chamber. Circularly polarized light will be passed through the chamber and the differential absorbance of left and right polarized light will be used to calculate the glucose concentration. A literature and patent review showed that each separate portion could be used in an effective device for minimally invasive, continuous glucose monitoring.

Surgical Site Infection: The Host Factor

More than 30 million surgical procedures are performed annually in the United States, and surgical site infections (SSIs) remain a major postoperative complication. Although bacteria contaminate all surgical wounds, not all wounds become infected. In most cases, the host response eradicates the microbes. The patient's (ie, host's) responsiveness, therefore, is an important variable in the equation of factors that influence the rate of infection. Optimizing the patient's physiological condition can help prevent SSIs. Initiatives that show promise in reducing SSI rates include use of supplemental oxygen, maintenance of core body temperature, and rigorous management of blood sugar. Perioperative nurses play an important role as the patient's infection control advocate.

Poster 027: A Case of Deep Neck Abscess by Which Ring Enhancement of the External Jugular Vein Became an Indicator of the Diagnosis

It is well known that contrast-enhanced CT is useful for diagnosis of deep neck abscess. The characteristic findings are: (1) single cystic or multiloculated low-density findings; (2) contrast enhancement of the abscess wall; (3) edema surrounding the abscess; (4) anatomical boundaries that fit the fascial spaces; and (5) air and/or fluid at the center of the abscess. However, little is known about the nature of the inflammatory reaction. Herein, we report an abnormal case of deep neck abscess developing from odontogenic infection. In this case, rapid spread of the inflammation was demonstrated and there was a lack of characteristic CT findings to suggest the formation of abscess. The patient was a 46-year-old woman with swelling in the right parotid region complicated by right inferior alveolar neuroparalysis. The patient’s medical history included diabetes (HbA1C 12%). Although the patient reported oppressive pain in the right parotid region at the first medical examination, the range of swelling was ambiguous because the neck was thick and short. It was only the intraoral view that showed slight redness in the right mandibular first-molar region. The right parotid gland showed diffuse swelling on contrast-enhanced CT, but there were no signs of a clear abscess. However, there was ring enhancement of the right external jugular vein extending for about 11cm from the inferior pole of the parotid gland, and circumferential edema was also noted. The WBC was 15100/ul and CRP was 25 mg/dl. She was given a diagnosis of right mandibular osteomyelitis and cervical cellulites caused by an odontogenic infection of the right mandibular first-molar. Although antimicrobial therapy and blood sugar management were started under hospitalization, there was no reduction of inflammation. Based on the range of ring enhancement of the right external jugular vein, the region was incised and pus was drained from the superficial layer of the cervical fascia. This experience suggests that ring enhancement of the vein was an indicator of abscess on contrast-enhanced CT.

Experts call for better management of blood glucose in hospitalized patients

Hospitalized patients deserve good glucose control, and institutional barriers to achieving it, as well as misconceptions about inpatient blood sugar management, must be addressed now, diabetes experts concluded at a January 30–31 conference in Washington, D.C. “Achieving glycemic targets is critical for the welfare of our patients,” said Nathaniel Clark, an American Diabetes Association (ADA) vice president, at a February 1 press conference. The event followed a two-day meeting on inpatient glycemic control convened by ADA, the American Association of Clinical Endocrinologists (AACE), and other stakeholders. A consensus statement released by the groups describes the growing body of clinical evidence that tight glucose control in critical care settings leads to better outcomes. “Blood glucose control reduces complications and infections, saves lives, shortens [the] length of hospital stays and reduces costs,” the consensus team announced in a press release. And, the experts advised, these potential benefits should be extended throughout the hospital setting, so that all patients with elevated blood glucose are identified and receive proper care.

Primary diabetes care: yesterday, today and tomorrow

AbstractStarting in the early 1970s general practitioners (GPs) in the United Kingdom developed diabetes clinics in their practice. Momentum was initially slow, but following the 1990 GP contract and the St Vincent Declaration, GPs were encouraged to take more responsibility for diabetes care. The 1997 contract provided further impetus for this, and primary care organisations were developed. Throughout this time there was a realisation that it was important to apply best evidence to primary diabetes care. The United Kingdom Prospective Diabetes Study was an impetus for GPs to improve care and changed the emphasis of care from solely blood sugar management to a wider cardiovascular risk assessment in people with diabetes.At the beginning of this decade the Scottish Intercollegiate Guideline Network, National Institute for Clinical Excellence and American Diabetes Association guidelines for diabetes management were published setting out best practice. Each of the four nations in the United Kingdom then published national service framework (NSF) documents outlining best practice. In 2003, GPs voted for a new General Medical Services contract. This will introduce formalised payments for quality work in practice and will encourage GPs and their practice nurses to follow protocols adapted from these guidelines and NSFs and apply best evidence to their patients.In the future, the numbers of patients with diabetes will increase as will the workload. Further innovative measures will have to be adopted to cope with this epidemic. Primary care will remain vital for information gathering, follow up, management and probable screening for diabetes, with patients encouraged to be empowered to understand and manage their condition. Copyright © 2004 John Wiley & Sons, Ltd.

Good Blood Sugar Control Keeps Patients Healthier for Years.

HomeCirculationVol. 101, No. 9Good Blood Sugar Control Keeps Patients Healthier for Years Free AccessOtherDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherDownload EPUBGood Blood Sugar Control Keeps Patients Healthier for Years Ruth SoRelle Ruth SoRelleRuth SoRelle Search for more papers by this author Originally published7 Mar 2000https://doi.org/10.1161/01.CIR.101.9.e9013Circulation. 2000;101:e9013The benefits of intensive blood sugar control last for years, according to a national consortium of researchers in a study published in the New England Journal of Medicine (2000;342:381–389).A study of patients with type 1 diabetes who participated in the Diabetes Control and Complications Trial showed that those who worked hard (intensive treatment) to control their blood sugar had fewer problems with diabetic retinopathy, neuropathy, and related kidney disease than those who used less intensive blood sugar management. The multicenter study of 1441 people with type 1 diabetes compared intensive treatment with conventional treatment. Patients on intensive treatment kept glucose levels as close to normal as possible with ≥3 insulin injections a day or an insulin pump and frequent self-monitoring of blood glucose. Conventional treatment consisted of 1 or 2 insulin injections a day, with once-a-day urine or blood glucose testing. As expected, those who practiced the intensive management kept their blood sugar closer to normal than those who received conventional treatment. After the study, the conventional group received training in maintaining good blood sugar control and were encouraged to follow that plan. Researchers continued to follow the 2 groups.The striking new finding is that people who received intensive therapy during the study continued to have a lower risk of eye and kidney disease than those who had been on conventional treatment 4 years after the study ended and both groups went on intensive treatment. “Intensive management, with the aim of keeping blood glucose levels as close to normal as possible, is extremely effective at reducing the complications of diabetes,” said David Nathan, MD, of Massachusetts General Hospital, who co-chaired the research group. “Now we know that the benefits of intensive control continue for years.”About 16 million people in the United States have diabetes, which is the most common cause of blindness, kidney failure, and amputations in adults. About 10 percent, or 1.6 million, have type 1 diabetes. Previous Back to top Next FiguresReferencesRelatedDetails March 7, 2000Vol 101, Issue 9 Advertisement Article InformationMetrics Copyright © 2000 by American Heart Associationhttps://doi.org/10.1161/01.CIR.101.9.e9013 Originally publishedMarch 7, 2000 Advertisement