Care Of Diabetic Patients Research Articles

Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study

BackgroundRecent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data.ObjectiveTo measure the association between physician-hospital integration and both spending and quality using patient-level data and explicit physician-hospital contracting information.DesignRetrospective review of claims data from 2014 through 2016. Adjustments were made for patient, physician, and regional characteristics.PatientsPatients aged 19 to 64 enrolled in a Blue Cross Blue Shield Texas Preferred Provider Organization in the four largest metropolitan areas in Texas who could be attributed to a physician practice based on claims.Main Outcomes and MeasuresAnnual spending per patient was compared for patients treated by a physician practice that is billing through a hospital, versus billing through an independent physician practice; spending was also subdivided by BETOS category, by site and type of care, and percent of patients with positive spending by subcategory. Quality measures included readmission within 30 days of discharge for hospitalized patients, appropriate care for diabetic patients, and screening mammography for women ages 50–64.ResultsEstimates suggest that patients in a preferred provider organization incur spending which is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices (95% CI 1.7 to 9.9; p = 0.006). Spending is significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care. The spending difference appears attributable to greater service utilization rather than higher prices. There was no consistent difference in care quality for hospital-owned versus physician-owned practices.Conclusions and RelevanceWe find that financial integration between physicians and hospitals raises patient spending, but not care quality. Given that higher spending raises the price of health insurance, policy makers should carefully consider policies that limit consolidation of hospitals and physicians.

A pilot program of integration of preventive foot care into comprehensive care of diabetic hemodialysis patients

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

How Recent Advances in Genomics Improve Precision Diagnosis and Personalized Care of Maturity-Onset Diabetes of the Young.

Non-autoimmune monogenic diabetes (MD) in young people shows a broad spectrum of clinical presentations, which is largely explained by multiple genetic etiologies. This review discusses how the application of state-of-the-art genomics research to precision diagnosis of MD, particularly the various subtypes of maturity-onset diabetes of the young (MODY), has increasingly informed diabetes precision medicine and patient care throughout life. Due to extended genetic and clinical heterogeneity of MODY, diagnosis approaches based on next-generation sequencing have been worthwhile to better ascribe a specific subtype to each patient with young-onset diabetes. This guides the best appropriate treatment and clinical follow-up. Early etiological diagnosis of MD and individualized treatment are essential for achieving metabolic targets and avoiding long-term diabetes complications, as well as for drastically decreasing the financial and societal burden of diabetes-related healthcare. Genomic medicine-based practices help to optimize long-term clinical follow-up and patient care management.

Bitter gourd (Momordica charantia) possess developmental toxicity as revealed by screening the seeds and fruit extracts in zebrafish embryos

BackgroundBitter gourd (Momordica charantia) has attracted the focus of researchers owing to its excellent anti-diabetic action. The beneficial effect of Momordica charantia on heart has been reported by in vitro and in vivo studies. However the developmental toxicity or potential risk of M. charantia on fetus heart development is largely unknown. Hence this study was designed to find out the developmental toxicity of M. charantia using zebrafish (Danio rerio) embryos.MethodsThe crude extracts were prepared from fruit and seeds of M. charantia. The Zebrafish embryos were exposed to serial dilution of each of the crude extract. The biologically active fractions were fractionated by C18 column using high pressure liquid chromatography. Fourier-transform infrared spectroscopy and gas chromatography coupled with mass spectrophotometry was done to identify chemical constituents in fruit and seed extract of M. charantia.ResultsThe seed extract of M. charantia was lethal with LD50 values of 50 μg/ml to zebrafish embryos and multiple anomalies were observed in zebrafish embryos at sub-lethal concentration. However, the fruit extract was much safe and exposing the zebrafish embryos even to 200 μg/ml did not result any lethality. The fruit extract induced severe cardiac hypertrophy in treated embryos. The time window treatment showed that M. charantia perturbed the cardiac myoblast specification process in treated zebrafish embryos. The Fourier-transform infrared spectroscopy analyses revealed diverse chemical group in the active fruit fraction and five new type of compounds were identified in the crude seeds extract of M. charantia by gas chromatography and mass spectrophotometry.ConclusionThe teratogenicity of seeds extract and cardiac toxicity by the fruit extract of M. charantia warned that the supplementation made from the fruit and seeds of M. charantia should be used with much care in pregnant diabetic patients to avoid possible damage to developing fetus.

The Impact of Simulation on Knowledge and Performance Gain Regarding Diabetic Patient Care

BackgroundIt is essential that nurses be prepared to provide quality care for patients with diabetes, a common condition today. The purpose of this study was to evaluate the impact of a high-fidelity simulation on traditional prelicensure nursing students' knowledge and performance related to care of the diabetic patient. MethodsThis multisite, multimeasure study used a purposive, quasiexperimental pretest-posttest design. ResultsSimulation positively impacted performance change scores. Pretest scores were positively associated with simulation scores and posttest scores. ConclusionsThe findings from this study support the use of high-fidelity simulation to improve care of the diabetic patient.

糖尿病患者への予防的フットケア─フットケアとセルフケア支援の実際（事例を含む）─

糖尿病患者への予防的フットケア─フットケアとセルフケア支援の実際（事例を含む）─

1263-P: Diabetes Care Network: A Paradigm Shift in Diabetes Care Delivery Utilizing Collaborative Care Pathway

Diabetes Care Network is a telemedicine based collaborative care pathway with team-based approach to improve diabetes care and scale the endocrine expertise. Veterans with poorly controlled type 2 diabetes were identified from electronic database, consultation completed via E-consult, and continuity care collaborated with primary care liaisons. We studied the efficacy and sustainability of our approach in improving diabetes care over 12 months. Methods: Means (+/-SD), frequencies and percentages were presented, and Spearman correlations were assessed. Statistical significance set at p<0.05. Cohort (n=87) was predominantly white (90.8%) males (97.7%), with a mean age 67.2 (8.9), and had an average of 3.3 co-morbid conditions, 0.7 macro and 1.3 micro-vascular complications. Significant decline in A1C occurred from baseline A1C of 10.2% (1.4), to 8.1% (0.99) at 3 months, 7.6% (0.96) at 6 months, and 7.5 % (0.86) at 12 months (all p<0.0001). Proportion of patients out of 87 who achieved A1C of <8 were 38 (43.6%), 56 (64%), and 56 (64%) and those who achieved A1C <7 were 10 (11.4%), 21(24.1%), and 23 (26.4%) at 3, 6, and 12 months respectively. Non-significant improvements were noted in Weight {229.3 lbs (48.1) to 228.4 lbs (46.9)}, LDL {89.0 mg/dl (36.4) to 79.5 mg/dl (32.5)}, systolic BP {130.5 mmHg (16.1) to 123.9 mmHg (17.5)}, and triglycerides {226.9 mg/dl (195.3) to 159.3 (97.4)}. Compared to 12 months pre-enrollment period, no difference in healthcare utilization (ER visits or admissions) was noted in study period. From baseline to completion, non-significant improvement was noted in the use of anti-platelet agents, ACE/ARB, moderate to high-intensity statins and, in the frequency of Urine micro albumin measurements, annual foot and retinal exams. Conclusion: A paradigm shift in diabetes care delivery is urgently needed. Use of telehealth technologies based collaborative pathways can scale the endocrine expertise and help attain better care for diabetic patients. Disclosure A. Bandi: None. M.J. Larson: None. S.J. Lutz-McCain: None. A.M. Summerville: None. B.K. Lumley: Employee; Spouse/Partner; Quest Diagnostics. M.Y. Boudreaux-Kelly: None.

681-P: Survey of Medical Staff on Use of Glucagon Injection in the Event of Serious Hypoglycemia in Japanese Diabetic Patients—Reason for Poor Spread of Glucagon Use in Japan

Glucagon injection is effective in the event of serious hypoglycemia, especially in unconscious patients who cannot swallow their medications. However, recent surveys in Japan found that only 15.9% of patients have glucagon injections in their possession, and both the adoption rate and the level of awareness in Japan lag behind those of Western countries. This suggests that the medical care and education system for diabetes patients in Japan should deal with this issue not only with patients and their families, but also with healthcare professionals engaged in patient guidance. We carried out a questionnaire survey of the staff at our hospital to determine the state of awareness and provision of glucagon injections by the medical staff in the event of serious hypoglycemia. A questionnaire was distributed to 100 medical staff at our hospital who were engaged in treatment of diabetes, requesting information about the state of knowledge and awareness on glucagon injections. All physicians and about 30% of nurses provided guidance on glucagon injection. In contrast, only a few nutritionists, pharmacists, clinical technologists, and other professionals, who were Certified Diabetes Educators of Japan, had ever done so. We concluded that the lack of knowledge among the medical staff about the technique of glucagon injection and related specific instructions may be one reason for the low rate of glucagon possession and use among the Japanese diabetics. The results suggested that the medical staff have poor knowledge about the technique of injection of glucagon and related instructions, and that a procedure has yet to be established for collection of expired unused dispensed glucagon vials and for re-prescription. Our results highlighted the need for educational programs for a sizeable proportion of healthcare professionals who are involved in the management of diabetes but lack specific information on glucagon injection. Disclosure N. Saito: None. M. Toyoda: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kyowa Hakko Kirin Co., Ltd., Medtronic Japan Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. M. Kimura: None. M. Fukagawa: Research Support; Self; Kyowa Hakko Kirin Co., Ltd. Speaker's Bureau; Self; Bayer Yakuhin, Ltd., Kissei Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Torii Pharmaceutical Co., Ltd.

Effectiveness of pro-active organizational models in primary care for diabetes patients

BackgroundDemographic changes and chronicity are posing new challenges to health care systems. Our study aimed to examine how effectively the three different types of proactive primary care models adopted by three different regional health care systems in Italy were improving the quality of diabetes management by general practitioners. MethodsA coordinated Italian nationwide project to compare systematically the new proactive organizational models implemented at regional and local level (the MEDINA Project) involved several regions and their local health units (LHUs). A quasi-experimental study was conducted on a large dataset obtained by processing administrative databases. A combined indicator was developed to assess the quality of care delivered by primary care physicians, based on adherence to recommendations concerning patient monitoring and treatment. ResultThe study concerned 602 Italian general practitioners (GPs), 174 of them female, who were caring for a total of 753,366 patients (47,575 of them diabetic). Analyzing a total score, representing global adherence to a quality management of patients with diabetes, confirmed that GPs who had adopted the new model of care for their diabetic patients obtained better results than those who had not, so the new policy was generally effective. ConclusionOur study showed that introducing new, proactive primary care models could sustain efforts made around the world to guarantee good-quality chronic disease management in the primary care setting.

Quality indicators in type 2 diabetes patient care: analysis per care-complexity level

BackgroundThis study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population.MethodsThis was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%).ResultsIn the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered.ConclusionsOur results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.

Relationship Among Diabetes Distress, Decisional Conflict, Quality of Life, and Patient Perception of Chronic Illness Care in a Cohort of Patients With Type 2 Diabetes and Other Comorbidities.

The primary outcome is to evaluate the relationship between diabetes distress and decisional conflict regarding diabetes care in patients with diabetes and two or more comorbidities. Secondary outcomes include the relationships between diabetes distress and quality of life and patient perception of chronic illness care and decisional conflict. This was a cross-sectional study of 192 patients, ≥18 years of age, with type 2 diabetes and two or more comorbidities, recruited from primary care practices in the Greater Toronto Area. Baseline questionnaires were completed using validated scales: Diabetes Distress Scale (DDS), Decisional Conflict Scale (DCS), Short-Form Survey 12 (SF-12), and Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression models evaluated associations between summary scores and subscores, adjusting for age, education, income, employment, duration of diabetes, and social support. Most participants were >65 years old (65%). DCS was significantly and positively associated with DDS (β = 0.0139; CI 0.00374-0.0246; P = 0.00780). DDS-emotional burden subscore was significantly and negatively associated with SF-12-mental subscore (β =-3.34; CI -4.91 to -1.77; P < 0.0001). Lastly, DCS was significantly and negatively associated with PACIC (β = -6.70; CI -9.10 to -4.32; P < 0.0001). We identified a new positive relationship between diabetes distress and decisional conflict. Moreover, we identified negative associations between emotional burden and mental quality of life and patient perception of chronic illness care and decisional conflict. Understanding these associations will provide valuable insights in the development of targeted interventions to improve quality of life in patients with diabetes.

SUN-166 Insulin Dose Calculator in a Pediatric Hospital

Background: To decrease delays in inpatient insulin ordering and administration, our children’s hospital implemented an insulin-dose-calculator (IDC) imbedded in the electronic health record. A multidisciplinary team developed the IDC, modeling it after a similar tool in place at another children’s hospital. 1 This calculator provides an innovative approach to the complex and time-consuming process of dosing, ordering, and administering rapid-acting insulin in the inpatient setting. Prior to implementation of the IDC, rapid acting insulin dosing, ordering, and administration required 7-steps with 6 identified areas of delay. The IDC streamlined this into a 4-step process, eliminating 5 out of 6 areas of delay. Here, we describe the benefits of an insulin dose calculator in terms of efficiency, safety, and overall streamlining of inpatient care of insulin-dependent diabetic patients. Methods: This pre- and post- implementation cohort study measured delays between (1) point-of-care (POC) glucose testing and insulin ordering and (2) between POC glucose testing and insulin administration. The pre-implementation cohort included pediatric patients receiving insulin admitted to our hospital between 2011 and 2017 (n=644). Those who received insulin via the IDC will be included in the post-implementation cohort. Pre- and post-implementation delays were compared to determine the impact of the tool on patient care and hospital efficiency. Additionally, pre- and post-implementations surveys were completed by the pediatric nursing staff to capture data on nursing and patient satisfaction. Finally, insulin-related safety events were collected pre-and post-implementation. Results: Prior to implementation of the IDC, the average delay between POC glucose testing and insulin ordering was 22 minutes. The average delay between POC glucose testing and insulin administration was 37 minutes. Preliminary data at the time of this abstract submission supports a decrease in the delay between POC glucose testing and insulin administration after implementation of the IDC tool. Results from the pre-implementation nursing survey revealed that 75% of nurses were dissatisfied with the previous process and that they perceived most patients were dissatisfied as well. Conclusion: Implementation of an IDC tool will minimize delays in ordering and administering of rapid-acting insulin, as well as increase nursing satisfaction, while maintaining a safe system for insulin dosing. 1. Aiyagari R, Moran C, Singer K, Ateya M. Insulin Bolus Calculator in a Pediatric Hospital. Applied Clinical Informatics. 2017;08(02):529-540. doi:10.4338/aci-2016-11-ra-0187.

Establishing Expert, Multi-Disciplinary, Peer-Reviewed Consensus to Lead a Paradigm Shift in Optimal Blood Glucose Management.

IntroductionThe National Health Service (NHS) in the UK appears unclear on how blood glucose monitoring (BGM) should be used to support diabetes patient care and empowerment, and local interpretation of NICE guidance on the availability of devices varies widely. An expert group of clinicians and commissioners considered BGM in terms of access, guidance, resources, data integration, patient education, and patient choice.MethodsThe group generated a series of questions on BGM into a 38-statement questionnaire using Delphi methodology. This was circulated to clinicians involved in diabetes management across the UK, receiving 222 responses.ResultsFrom the questionnaire, 35 of the 38 statement responses showed > 66% consensus, with 26 of these achieving > 90% agreement.ConclusionThe expert group reviewed the responses and made recommendations based on the clear professional consensus demonstrated. These included the need to use new technology and data integration and that wider factors, including patient choice rather than cost alone, should inform formulary inclusion of BGM equipment.FundingLifeScan U.K. Ltd.

The role of telenursing in the management of diabetes：A systematic review and meta-analysis.

Diabetes is a common chronic disease that requires a long-term regimen. However, the management of diabetes by telenursing is limited and inconclusive. To determine the effectiveness of telenursing on control in diabetes. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched electronic databases, including PubMed, Embase, Web of Science and Cochrane Library. Studies comparing telenursing with usual care in diabetes patients were included. A total of 17 randomized controlled trials were identified. Glycated hemoglobin (HbA1c) dates were pooled using a random effects meta-analysis method, followed by subgroup analyses to examine heterogeneity. The meta-analysis showed that the use of telenursing (vs. usual care) was associated with a significant reduction in HbA1c levels compared to usual care, with a pooled 0.68% (95% CI: 0.33-1.03, p=0.0001; I2 =95%). For the secondary outcome, the SMD of body mass index (BMI) was -0.25% (95% CI: -0.81 to 0.32%, p=0.39), with no statistically significant change; the fasting blood sugar (FBS) SMD was -0.19% (95% CI: 0.20 to 1.01, p=0.003), with a statistically significant change; the total cholesterol (TC) SMD was -0.09% (95% CI: -0.03 to 0.21, p=0.12), with no statistically significant change. Telenursing, as a useful tool for patient education and behavioral interventions, can help diabetes patients to improve their glycemic control. However, more studies on up-to-date and cost-effective technologies are needed.

Multidisciplinary clinics reduce treatment costs and improve patient outcomes in diabetic foot disease

ObjectiveDiabetic foot disease poses a significant and rising financial burden on health care systems worldwide. This study investigated the effect of a new multidisciplinary diabetic foot clinic (MDDFC) in a large tertiary hospital on patient outcomes and treatment cost. MethodsPatients' records were retrospectively reviewed to identify all patients who had been managed in a new MDDFC between July 2014 and July 2017. The wound episode—the period from initial presentation to the achievement of a final wound outcome—was identified, and all relevant inpatient and outpatient costs were extracted using a fully absorbed activity-based costing methodology. Risk factor, treatment, outcome, and costing data for this cohort were compared with a group of patients with diabetic foot wounds who had been managed in the same hospital before the advent of the MDDFC using a generalized linear mixed model. ResultsThe MDDFC and pre-MDDFC cohorts included 73 patients with 80 wound episodes and 225 patients with 265 wound episodes, respectively. Compared with the pre-MDDFC cohort, the MDDFC group had fewer inpatient admissions (1.56 vs 2.64; P ≤ .001). MDDFC patients had a lower major amputation rate (3.8% vs 27.5%; P ≤ .001), a lower mortality rate (7.5% vs 19.2%; P ≤ .05), and a higher rate of minor amputation (53.8% vs 31.7%; P ≤ .01). No statistically significant difference was noted in the rate of excisional débridement, skin graft, and open or endovascular revascularization. In the MDDFC cohort, the median total cost, inpatient cost, and outpatient cost per wound episode was New Zealand dollars (NZD) 22,407.465 (U.S. dollars [USD] 17,253.74), NZD 21,638.93 (USD 16,661.97), and NZD 691.915 (USD 532.77), respectively. The MDDFC to pre-MDDFC wound episode total cost ratio was 0.7586 (P < .001). ConclusionsThis study is the first to compare the cost and treatment outcomes of diabetic foot patients treated in a large tertiary hospital before and after the introduction of an MDDFC. The results show that an MDDFC improves patient outcomes and reduces the cost of treatment. MDDFCs should be adopted as the standard of care for diabetic foot patients.

Abstract P070: Hemoglobin A1c Trajectories and Two-year Mortality in Individuals With Diabetes After Cardiac Catheterization

Background: Guidelines advise relaxing glycemic control goals in diabetes patients with coronary artery disease (CAD). However, the hemoglobin A1c (HbA1c) trajectories that occur in routine clinical care in diabetes patients with objectively assessed CAD have not been described, and their association with mortality is unknown. Methods: We studied 7780 individuals with diabetes using data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, a registry of US Veterans who have undergone coronary angiography since 2005. We used HbA1c values from the measurement closest in time preceding catheterization and all values during two years of follow-up to fit longitudinal latent class models. We determined optimal trajectory model fit by Bayes Information Criteria, varying the functional form of time and the numbers of HbA1c trajectory classes. We then fit a joint latent class longitudinal mixed model to estimate associations between HbA1c trajectory class and two-year mortality, adjusting for clinical and demographic covariates, including an interaction term between HbA1c trajectory and CAD burden (no, non-obstructive, or obstructive), and with an autoregressive correlation structure for repeated HbA1c measurements. Results: Three trajectory classes best fit the data: individuals with stable glycemia after catheterization (class 1; 89%, 6934 of 7780), those with a decline in HbA1c after catheterization (class 2; 4.7%, 364 of 7780), and those with an increase in HbA1c after catheterization (class 3; 6.2%, 482 of 7780). Class 1 participants were older, more likely to be white, less likely to have congestive heart failure, and more likely to be adherent to cardioprotective medications. In multivariable joint mixed models, two-year mortality was 4.3% in class 1, 4.7% in class 2, and 5.0% in class 3 and differed significantly across HbA1c trajectory classes (p=0.047). In pairwise comparisons, two-year mortality differed significantly between individuals in classes 1 and 3 (p=0.03), but not between those in classes 1 and 2 (p=0.9) or between those in classes 2 and 3 (p=0.5). The interaction between trajectory class and CAD burden was non-significant (p=0.1), but limited by the number of participants with no or non-obstructive CAD. In individuals with obstructive CAD, we observed a significant association between HbA1c trajectory and mortality (p=0.04), driven by a difference between classes 1 and 3 (p=0.04) as in the full cohort. Conclusions: Distinct HbA1c trajectories were evident within 6 months after cardiac catheterization in patients with diabetes and were associated with two-year mortality. Serial HbA1c measurements in outpatient follow-up after cardiac catheterization could classify individuals with diabetes based on HbA1c trajectory; these trajectories may inform mortality risk stratification, especially in those with obstructive CAD.

3483 Glycemic Control and Diabetic Peripheral Neuropathy Among Patients on Prescription Opioid Pain Medications in Western New York: Using Data Analytics for Quality Assessment

OBJECTIVES/SPECIFIC AIMS: I would like to make clinicians aware about prescription opioid use and glycemic control among patients with diabetes. This is a quality of care issue that increases the disease burden for two conditions opioid dependence and diabetic complications. Big data analytics can bring out this quality of care issue and help in changing clinical practice through precision medicine METHODS/STUDY POPULATION: This is a population health study of patients on prescription opioid pain medications in Erie county medical center and local out patient clinic. The electronic data from the hospital records and Outpatient were collected, merged and de identified. The database was saved in a protected environment and made accessible to researchers through a secure login. The data was queried for the number of patients with diabetes. The glycohemoglobin levels were collected and then the analysis was made RESULTS/ANTICIPATED RESULTS: It was found that only 63 of the 89 patients with DPN and 156 of the 570 patients without DPN had any measurement of HbA1c in our data. It was found that 86 out of 156 patients without DPN had suboptimal glycemic control with a glycohemoglobin level &gt; 7% while 36 out of 63 patients with DPN had a glycohemoglobin &gt; 6.7%. The odds of patients with DPN having poor glycemic control is 0.57 while the odds of having poor glycemic control without DPN is.55. The relative risk being 1.03. DISCUSSION/SIGNIFICANCE OF IMPACT: Our population study revealed suboptimal glycemic control among a large set of patients in Western New York with a diagnosis of diabetes mellitus and a concurrent prescription for an opioid pain medication. A significant percentage of patients in our study population with a diagnosis of DPN might benefit in terms of decreased painful symptoms of neuropathy from monitoring and attempting to improve glycemic control. Additionally, in our patient population, there were no patients with diabetic peripheral neuropathy prescribed pregabalin or duloxetine, the first-line FDA-approved medications for painful DPN, Based on our population study, the quality of care for diabetic patients with DPN who are prescribed opioid pain medications should be monitored closely. First-line, FDA approved anticonvulsants and antidepressants should be considered for the treatment of painful symptoms when necessary. Attention should be directed towards monitoring and improving glycemic control in patients without DPN receiving opioid pain medications to attempt to prevent or delay the microvascular complications of diabetes, including the onset of painful peripheral neuropathy.

What Are the Experiences and Training Needs of Home-Based Carers in Dealing With Diabetes in a Rural Village in South Africa? An Explorative Study

Type 2 Diabetes Mellitus is a difficult chronic condition associated with morbidity, mortality and loss of quality of life. In Sub-Saharan African countries, HBC (Home-Based Carers) play an important role in the care of people diagnosed with chronic illnesses like diabetes. However, home-based carers seem to lack knowledge to care of people with diabetes because they have not been not formally trained. The aim of this study is to explore and describe the practices, knowledge and learning needs of Home-Based Carers (HBCs) of people with diabetes. A qualitative explorative approach was taken, holding interviews with 15 HBCs at the 4 clinics in the Ga-Dikgale village. The purposive sampling method was used to select participants for this study. Four themes are described: activities performed by HBCs during the care of diabetes patients, existing structures and sources of information for HBCs on the management of diabetic patients, challenges experienced by HBCs during the provision of care to diabetes patients and the learning needs of HBCs, based on how they want their training to be organised. HBCs execute various activities during the care of PWD (patients with diabetes) including providing nutritional advice, medication support, helping with household chores, accompanying patients to healthcare services and dressing their wounds. However, they lack knowledge of issues related to the care of PWD, which makes their role very difficult and challenging.

Clinical Application of Nightingale's Theory

This Paper is based on the Florence Nightingale theory and application of her theory on clinical grounds for the improvement of nursing practice. A careful step by step approach is being adopted to discuss case scenario, main concepts of theory, analysis, hypothesis and conclusion. Since, diabetes mellitus is becomes a major cause of morbidity and mortality throughout the world. Unavailability of better nursing services, petty management, poor personal cleanliness and congested environment is one of the reasons of compromised care of diabetic patients. Therefore, the paper focusing on a lot of things which could be better while providing care to a diabetic patient to modify the environment and to make the patient feel better by implementing Florence nightingale theory principles. This paper would enable the readers to identify all environmental factors which can exaggerate any patient's health conditions and propose different strategies and ways to correct them in order to gain level of recovery and satisfaction among patients.

Readiness to use telemonitoring in diabetes care: a cross-sectional study among Austrian practitioners

BackgroundTelemonitoring services could dramatically improve the care of diabetes patients by enhancing their quality of life while decreasing healthcare expenditures. However, the potential for implementing innovative treatment options in the Austrian public and private health system is not known yet. Thus, we analyzed the readiness to use telemonitoring in diabetes care among Austrian practitioners.MethodsWe conducted an online survey among a purposive sample of Austrian practitioners (n = 41) using an adapted German version of the practitioner telehealth readiness assessment tool. We assessed three readiness domains for telemonitoring in the context of diabetes care, i.e. core readiness, engagement readiness, and structural readiness, and validated the German tool using principal components analysis.ResultsStudy subjects perceived themselves as open to innovations and also expressed optimistic attitudes towards telemonitoring in general and offering telemonitoring-based services for their patients. Participants achieved a medium average readiness level for telemonitoring (58.2, 95% CI 53.9–62.5) and were thus in a good position to use telemonitoring, although some arguments may adversely affected its use. The top three perceived benefits of telemonitoring were enhanced quality of treatment, better therapy adjustment, and reduced travel and waiting times for patients. The top three barriers were reduced personal communication, practitioner time expenditure and equally placed poor financial compensation as well as data security and privacy issues.ConclusionOur data revealed that Austrian practitioners showed a quite moderate readiness to use telemonitoring in diabetes care. To further advance telemonitoring readiness among all pillars of diabetes care in Austria, joint efforts among healthcare stakeholders are required to overcome existing financial, organizational, and technical obstacles.