Diabetes Mellitus Care Research Articles

Relationship among chrononutrition, sleep, and glycemic control in women with gestational diabetes mellitus: a randomized controlled trial

BACKGROUNDGestational diabetes mellitus is associated with an increased risk of maternal, fetal, and neonatal morbidities. Chronobiological disorders have recently been identified as risk factors for those morbidities. The disorders include chrononutritional disorders related to meal frequency and content according to the sleep-wake cycle, sleep disorders related to sleep quality, and chrono-obesity disorders, such as abnormal weight gain because of sleep deprivation and time of eating. OBJECTIVEThis study aimed to assess whether a chrononutritional and sleep hygiene intervention can improve maternal glycemic control and reduce the proportion of large-for-gestational-age newborns among women with gestational diabetes mellitus. STUDY DESIGNThis randomized controlled trial included 103 women with gestational diabetes mellitus who were carrying a singleton fetus and assigned to either the intervention group (n=33) or the control group (n=70). The intervention group was assigned to a chrononutrition and sleep hygiene program, in addition to the usual care for gestational diabetes mellitus, from the time of diabetes mellitus diagnosis to birth, whereas the control group received the usual gestational diabetes mellitus care. RESULTSThe chrononutritional and sleep hygiene intervention significantly reduced the proportion of women with suboptimal glycemic control (<80% of the plasma glucose values at target), after adjustment for maternal age, prepregnancy body mass index, gravidity, history of gestational diabetes mellitus, and large for gestational age (relative risk, 0.28; 95% confidence interval, 0.18–0.81). The effect of the intervention on balancing maternal glycemic control was mainly because of the decreased carbohydrate intake in the evening interval of the day (relative risk, 0.8; 95% confidence interval, 0.64–0.99). However, the intervention had no effect on the proportion of large-for-gestational-age newborns. CONCLUSIONThe chrononutritional and sleep hygiene intervention can improve maternal glycemic control.

The Effects of Exercise Habit on Albuminuria and Metabolic Indices in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Background and Objectives: Diabetes mellitus (DM) can cause macrovascular and microvascular complications, potentially resulting in further life-threatening complications. In general, the global prevalence of type 2 DM is increasing. To date, the care of DM comprises three aspects: diet, medication and exercise; among them, exercise is the most economical. Albuminuria is associated with renal injury and the progress of chronic kidney disease (CKD). The effects of habitual exercise in patients with new onset of diabetic kidney disease (DKD) have not been generally recognized. Our aim was to conduct an observational study regarding the effects of regular exercise on proteinuria and associated metabolic indices in patients with newly diagnosed type 2 DM. To investigate the effects of an exercise habit on albuminuria and the metabolic indices including renal function, blood glucose, and plasma lipids among patients with newly diagnosed type 2 DM. Materials and Methods: A cross-sectional study was conducted on newly diagnosed DM patients in two teaching hospitals in Taiwan from 1 June to 31 December 2020. The DM patients participated in the Diabetes Shared Care Network. According to the DM care mode, the patients’ blood biochemical results were analysed. Based on exercise duration, the patients were divided into two groups, i.e., the exercise group (≥150 min per week) and the non-exercise group (<150 min per week). Clinical demographic features and laboratory examination including blood and urine biochemistries were determined. Results: A total of 229 patients including 99 males (43.2%) and 130 females (56.8%) participated in the study. The proportion of DM patients with normoalbuminuria was higher (p < 0.05) in the exercise group (69.8%) than in the non-exercise group (53.7%), and the proportion of DM patients with micro or macroalbuminuria was lower in the exercise group (30.2%) than in the non-exercise group (46.3%). Levels of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), triglycerides (TG) and high-density lipoprotein (HDL) were significantly different in both groups. Compared with the non-exercise group, lower HbA1c (6.89 ± 0.69 vs. 7.16 ± 1.05%) (p < 0.05), lower FPG (121.9 ± 25.7 vs. 140.5 ± 42.4 mg/dL) (p < 0.05), lower TG (115.6 ± 53.6 vs. 150.2 ± 15.4 mg/dL) (p < 0.05), and higher HDL (50.3 ± 11.4 vs. 44.1 ± 9.26 mg/dL) (p < 0.05) levels were noted in the exercise group. Conclusions: Regular exercise remains imperative and may bear an impact on albuminuria, blood glucose, and plasma lipids among type 2 DM patients. Therefore, medical staff and healthcare providers should encourage patients to maintain an exercise duration ≥150 min per week for preventing and controlling DM progression.

Effect of inadequate care on diabetes complications and healthcare resource utilization during management of type 2 diabetes in the United States

ABSTRACT Objective To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors. Methods The most recently available (years 2016–2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes-related complications, and total days absent from school or work change from baseline. Results 1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes-related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes-related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization. Conclusion Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes-related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.

IDF21-0231 Effect of multidisciplinary for improves diabetes outcomes: Diabetes Education, Awareness and Lifestyle modification

Background: There is a global pandemic of type2 diabetes mellitus (T2DM), mainly in Asia. Thailand has a prevalence of T2DM at 9.6%, which is higher than the world average of 8.9%. Multiple studies have shown that multidisciplinary, team-based, coordinated care has been associated with improved measures of quality care and reduced healthcare utilization. Patients with poor glycemic control and nephropathy are at the highest risk of developing cardiovascular complications and renal failure. Aim: In this study, we aimed to explore the impact of intensive multidisciplinary diabetes mellitus care with patient empowerment versus routine clinical care on the rate of progression of micro and macro vascular complications and peripheral atherosclerotic burden, as measured by change in arterial blood Index (ABI) in patients with persistently elevated HbA1c and nephropathy. Method: The study is randomized controlled trial (RCT) of intensive diabetes mellitus care with patient empowerment versus routine clinical care. Patient in the intensive arm will receive care from a multidisciplinary team consisting of an endocrinologist, diabetes nurse educator, dietitian, renal pharmacist and social worker for counseling. In addition, patients will be provided with tools for self-care empowerment such as glucometers, blood pressure monitors and calendar record to facilitate care, monitoring and education. Patients in the routine clinical care will receive standard clinical care. Follow up (FU) will be 2 years. Primary outcomes include cardiovascular events, rate of progression of nephropathy and development of end-stage renal disease. Secondary endpoints include the proportions of patients with documented improved control of cardiovascular risk factors (HbA1c, blood pressure, low density lipoprotein-(LDL-C), reduction in body weight), frequency of hypoglycemia, hospitalization days and change in ABI. We will also examine the prevalence of peripheral atherosclerosis and the predictive value and usability of lower extremity arterial ultrasound to predict cardio-cerebrovascular events, amputation and peripheral intervention. Results: The cumulative incidence of all events (DM-related complications and all-cause mortality) was 21.2% in the Trial-DM group and 40.6% in the usual care group. Trail-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 52.6% (95% CI 50.5, 54.6), micro vascular complications by 10.9% (95% CI 6.8, 14.6), mortality by 65.1% (95% CI 61.3, 62.9), specialist attendance by 31.0% (95% CI 30.6, 32.4), emergency attendance by 39.2% (95% CI 36.8, 40.5), and hospitalizations by 53.5% (95% CI 53.2, 56.7). Patients with low baseline CVD risks benefitted the most from Trail-DM, which decreased CVD and mortality risk by 58.4% (95% CI 50.8, 64.5) and 79.6% (95% CI 72.3, 81.0), respectively. Discussion: Diabetes mellitus carries significant health care cost. Patients with poorly glycemic control and nephropathy are at highest risk of developing cardiovascular complications and renal failure. Intensive diabetes mellitus care with patient empowerment may lead to sustained glycemic control, reduction of clinical complications and progression of nephropathy, and incidence of cardiovascular complications.

Text Message Intervention for Latino Adults to Improve Diabetes Outcomes.

Introduction: Determine the effectiveness of a diabetes text message intervention to improve diabetes outcomes in Latino adults at a free clinic in the southeastern United States. Methods: A pre-post, one-group design was used with a convenience sample (n = 24) of Latino adults with type 2 diabetes and A1C ≥ 7 who consented to participate. Over 8 weeks, participants were sent 23 educational and motivational text messages that were based on the American Association of Diabetes Educators (AADE) 7 self-care tasks and the American Diabetes Association (ADA) Standards of Medical Care in Diabetes Mellitus (DM). Diabetes knowledge, self-efficacy, self-care, and A1C were measured. Results: Diabetes knowledge, self-efficacy, self-care, and A1C improved after 8 weeks. Statistically significant results (p < .05) were seen in two of the four evaluation instruments administered (Spoken Knowledge in Low Literacy in Diabetes Scale [SKILLD], p = .001, Diabetes Self-Efficacy Scale [DSES], p = .000). A1C improvements were significant (0.86 or 10 mmol/mol) from the pre-intervention (M = 9.06 [76 mmol/mol], SD = 1.49) to the post-intervention (M = 8.20 [66 mmol/mol], SD = 1.27, t [23] = 3.02, p = .006). Conclusion: Personalized communication, education, and follow-up via text messages improved diabetes knowledge, self-efficacy, self-care, and A1C among pilot project participants. Text messages are a useful tool for diabetes management.

Where can Tanzania health system integrate clinical management of patients with dual tuberculosis and diabetes mellitus? A cross-sectional survey at varying levels of health facilities

ObjectiveTo assess the current Tanzania health facilities readiness in integrating clinical management of dual Tuberculosis (TB) and Diabetes Mellitus (DM) by using the Service Availability and Readiness Assessment (SARA) manual of the World Health Organization prior to implementing an integrated service model. Study designCross-sectional study. MethodsA needs assessment survey was conducted at varying levels of health care facilities. The SARA manual evaluated the service delivery outcomes in terms of availability of guidelines, medicines and diagnostic equipment, training of healthcare workers in providing TB and DM care, and patient record review. Data were analyzed using Statistical Package for Social Science version 26. ResultsAmong 29 health facilities selected, three were regional referral hospitals, eight were district hospitals and eighteen were health centers. Baseline investigations revealed that GeneXpert MTB/RIF machines were present in 10 (34.5%) facilities, and glycated hemoglobin devices were present in two (6.9%) facilities, while all health facilities had a glucometer. The presence of an attending medical doctor in 19 (65.5%) facilities and the presence of operating biochemistry analyzers in 15 (51.7%) facilities were two mandatory variables used to assess readiness. Among the various guidelines observed, none of the facilities had the 2016 DM guidelines. Overall, 15 (51.7%) health facilities were ready to integrate dual TB and DM services. ConclusionIntegrative TB/DM screening and management activities can be achieved only if integration initiatives are prioritized at all levels of health facilities and among health policy makers in Tanzania. At least half of the health facilities were prepared to integrate the management of dual TB/DM. However, there is an urgent need to mobilize significant resources to improve the integration in these facilities, such as management guidelines and diagnostics..

Progress of Polyaniline Glucose Sensors for Diabetes Mellitus Management Utilizing Enzymatic and Non-Enzymatic Detection.

Glucose measurement is a fundamental tool in the daily care of Diabetes Mellitus (DM) patients and healthcare professionals. While there is an established market for glucose sensors, the rising number of DM cases has promoted intensive research to provide accurate systems for glucose monitoring. Polyaniline (PAni) is a conductive polymer with a linear conjugated backbone with sequences of single C–C and double C=C bonds. This unique structure produces attractive features for the design of sensing systems such as conductivity, biocompatibility, environmental stability, tunable electrochemical properties, and antibacterial activity. PAni-based glucose sensors (PBGS) were actively developed in past years, using either enzymatic or non-enzymatic principles. In these devices, PAni played roles as a conductive material for electron transfer, biocompatible matrix for enzymatic immobilization, or sensitive layer for detection. In this review, we covered the development of PBGS from 2015 to the present, and it is not even exhaustive; it provides an overview of advances and achievements for enzymatic and non-enzymatic PBGB PBGS for self-monitoring and continuous blood glucose monitoring. Additionally, the limitations of PBGB PBGS to advance into robust and stable technology and the challenges associated with their implementation are presented and discussed.

A New Learning Approach to Improve Nurses' Knowledge of and Skills in Diabetes Care

Patients' knowledge of how to care for their diabetes mellitus (DM) is critically influenced by health education, which is mostly provided by nurses. Therefore, effectively increasing nurses' knowledge of and skills in diabetes care is crucial. The aim of this study was to explore the effectiveness of the Diabetes Conversation Map™ Program (DCMP) in improving nurses' knowledge of DM care and skills in insulin injection. A quasi-experimental design was adopted that used a pre-test and a posttest. A total of 18 nurses were included in the intervention group, while 19 nurses were in the control group receiving conventional teaching. A structured questionnaire regarding knowledge of and skills in DM care was administered before the program and then one month after. Knowledge of DM and skills in insulin injection improved significantly in the intervention group compared to the control group (p < .001 vs. p < .01). The DCMP can be used to increase nurses' knowledge of DM and their skills in caring for DM. It leads to more effective learning than conventional teaching. [J Contin Educ Nurs. 2022;53(2):90-96.].

Global accessibility of therapeutics for diabetes mellitus.

Diabetes mellitus is a global health issue, yet huge regional disparities exist in its care, including in access to basic necessities such as insulin. In this Viewpoint, six experts from different regions discuss differences in access to insulin and other diabetes mellitus therapies as well as the key barriers in diabetes mellitus care accessibility and potential solutions.

Bidirectional screening and treatment outcomes of diabetes mellitus (DM) and Tuberculosis (TB) patients in hospitals with measures to integrate care of DM and TB and those without integration measures in Malawi

IntroductionThere are efforts in low and middle-income countries (LMICs) to integrate Tuberculosis (TB) and Diabetes mellitus (DM) healthcare services, as encouraged by WHO and other international health organizations. However, evidence on actual effect of different integration measures on bidirectional screening coverages and or treatment outcomes for both diseases in LMICs is scarce.Objectives and methodsRetrospective chart review analysis was conducted to determine effects of integrated care on bidirectional screening and treatment outcomes for both TB patients and people with DM (PWD) recruited in eight Malawian hospitals. Data of ≥ 15 years old patients registered between 2016 to August 2019 were collected and analysed.Results557 PWDs (mean age 54) and 987 TB patients (mean age 41) were recruited. 64/557 (11.5%) PWDs and 105/987 (10.6%) of TB patients were from an integrating hospital. 36/64 (56.3%) PWDs were screened for TB in integrated healthcare as compared to 5/493 (1.0%) in non-integrated care; Risk Difference (RD) 55.2%, (95%CI 43.0, 67.4), P < 0.001, while 10/105 (9.5%) TB patients were screened for DM in integrated healthcare as compared to 43/882 (4.9%) in non-integrated care; RD 4.6%, (95%CI − 1.1, 10.4), P = 0.065. Of the PWDs screened, 5/41 (12.2%) were diagnosed with TB, while 5/53 (9.4%) TB patients were diagnosed with DM. On TB treatment outcomes, 71/508 (14.8%) were lost to follow up in non-integrated care and none in integrated care were lost to follow-up; RD − 14.0%, (95%CI: − 17.0,-11.0), p < 0.001. Among PWDs, 40/493 (8.1%) in non-integrated care and 2/64 (3.1%) were lost to follow up in integrated care; RD − 5.0%, (95%CI:-10.0, − 0.0); P = 0.046. After ≥ 2 years of follow up, 62.5% PWDs in integrated and 41.8% PWDs in non-integrated care were retained in care, RD 20.7, (95%CI: 8.1, 33.4), P = 0.001.ConclusionWe found higher bidirectional screening coverage and less loss to follow-up in one centre that made more efforts to implement integrated measures for TB and DM care than in 7 others that did not make these efforts. Decisions on local programs to integrate TB/DM care should be taken considering currently rather weak evidence and barriers faced in the local context as well as existing guidelines.

Intensive Case Finding of Tuberculosis and Diabetes Mellitus-Bidirectional Screening of Patients Attending a Tertiary Teaching Hospital in Rural Telangana, India

Introduction: Tuberculosis (TB) is a communicable disease of global public health threat. Poor and vulnerable populations are mainly affected with it. In association with Diabetes Mellitus (DM), TB may get worsen as increased relapse rates, delayed sputum culture conversion, increase in the case fatality rates etc. Conversely, TB may increase the incidence of DM, and worsen glycaemic control in diabetes patients. Aim: To study the effectiveness of bidirectional screening for TB and DM in rural hospital. Materials and Methods: A cross-sectional cohort study conducted at Medicine and Pulmonology department of MediCiti Institute of Medical Sciences (MIMS) for a period of nine months in June 2019-February 2020. All TB patients were screened for DM and vice versa. All TB patients were followed-up for treatment outcome of TB and all DM patients were followed-up for glycaemic control. Relative risk was calculated using incidence of outcome or control of disease in TB with DM patients to TB patients and DM with TB patients to DM patients. Results: Of 256 TB patients, 38 (14.8%) were TB with DM cases. All 256 patients were followed-up for TB treatment outcome, 100% TB patients without DM had recovery, whereas 97.3% TB patients with DM had recovery after two months of therapy. Relative risk of DM on TB outcome was 0.97. Of 256 DM patients screened, 9 (3.5%) had been newly diagnosed with TB. All 256 people were followed-up for impact on glycaemic control. Relative risk of TB on glycemic control was 1.87. Conclusion: Bidirectional screening would potentially improve care and prevention of TB and DM.

The association between diabetes mellitus and incidence of depressive episodes is different based on sex: insights from ELSA-Brasil.

Objective:To investigate the association between diabetes mellitus (DM) and incidence of depressive episodes among men and women.Methods:Data were used from 12,730 participants (5866 men and 6864 women) at baseline (2008–2010) and follow-up 1 (2012–2014) of the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort of Brazilian civil servants. Participants were classified for diabetes using self-reported and clinical information, and evaluated for presence of depressive episodes by the Clinical Interview Schedule–Revised (CIS-R). Associations were estimated by means of logistic regression models (crude and adjusted for socio-demographic variables).Results:Women classified as with DM prior to the baseline were at 48% greater risk (95% confidence interval (CI) = 1.03–2.07) of depressive episodes in the crude model and 54% greater risk (95% CI = 1.06–2.19) in the final adjusted model compared to women classified as non-DM. No significant associations were observed for men. The regression models for duration of DM and incidence of depressive episodes (n = 2143 participants; 1160 men and 983 women) returned no significant associations.Conclusion:In women classified as with prior DM, the greater risk of depressive episodes suggests that more frequent screening for depression may be beneficial as part of a multi-factorial approach to care for DM.

Comparison of Group Prenatal Care versus Standard Prenatal Care for Patients with Diabetes in Pregnancy

Group prenatal care has demonstrated positive pregnancy outcomes. In individuals with diabetes mellitus (DM) in pregnancy, group care could coordinate services to improve patient education, provide social support while maintaining the risk screening and physical assessment of individual prenatal care. We sought to determine if this method of prenatal care will increase compliance with blood sugar monitoring. A retrospective cohort study from 2014-2020 at a single tertiary care center. Group care was led by a provider, social worker, and diabetes educator allowing for more time and attention to be spent on education compared to the traditional model of one provider per patient. Data collection was completed on patients who participated in standard and group care. Data was extracted via chart review on glucose monitoring, delivery information, and postpartum visit. Primary outcome was measured by percentage of visits that an individual brought their blood sugar log. Data was analyzed with median and range for continuous variables (data was not normally distributed) and percentage with number for categorical variables. P< 0.05 was considered significant. A total of 107 patients met inclusion criteria with 42 in group care and 65 in standard care. There was no difference in our primary outcome of compliance with producing blood sugar log to appointments (group: 61.9% (range=0-100%) vs. standard: 50.0% (range=0-100%); p=0.429) (Table 1). Individuals in group care were more likely to attend more prenatal visits from DM diagnosis to delivery (group: 7 visits (range 1-16) vs. standard: 5 visits (range 3-17); p=0.026) (Table 1). There were also no differences in delivery outcomes. Of note, individuals with group care were more likely to complete their 2-hour oral glucose tolerance test to test for type 2 DM at their postpartum visit (group: 53.3% vs. standard: 20.5%; p=0.003) (Table 2). Group prenatal care for DM does not change compliance with blood sugar reporting or delivery outcomes but may enhance education to demonstrate the importance of postpartum screening.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Virtual visits and the use of continuous glucose monitoring for diabetes care in the era of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in virtual care utilization for patients with diabetes mellitus (DM). Virtual DM care requires both providers and patients to become familiar with new technology that supports home health monitoring. Continuous glucose monitoring (CGM) is a DM technology that provides 24-hr glucose monitoring and is associated with improved clinical outcomes, including decreased rates of hypoglycemia and lower hemoglobin A1c (A1c). Continuous glucose monitoring use has increased due to ease of use and its ability to allow patients to share data with providers during virtual visits. Although the clinical benefits of CGM use are clear, many providers are overwhelmed by the various options available and large influx of data received. The purpose of this clinical case review is to provide an overview of CGM use in the virtual care setting. Various types of CGMs will be defined and an overview of the patient characteristics shown to benefit most from CGM use will be provided. Further, recommendations for improving clinic workflow when using CGM will be outlined, including strategies to handle the influx of large datasets, outlining the role of the nurse practitioner (NP) and other providers in the clinic, and organizing data for efficient and improved clinical decision making. Continuous glucose monitoring use is hallmarked to revolutionize DM care for many patients, particularly during and after the COVID-19 pandemic. It is important that clinicians understand the nuances of CGM use and organize their virtual clinics to efficiently manage CGM users, leading to improved clinical decisions and patient outcomes.

Readiness of health facilities and determinants to manage diabetes mellitus: evidence from the nationwide Service Provision Assessment survey of Afghanistan, Bangladesh and Nepal

ObjectivesUsing nationally representative surveys, the study’s aims were to: (1) evaluate healthcare facilities’ readiness to provide diabetes mellitus (DM) services and (2) identify the factors that affect DM service readiness.Data...

A nurse-led conceptual model to inform patient-centred, type 2 diabetes mellitus management in public clinical settings.

BackgroundGlobally, there is an increased need to provide patient-centred care for people diagnosed with type 2 diabetes mellitus. In Nigeria, a poorly financed health system has worsened the difficulties associated with managing type 2 diabetes mellitus in clinical settings, causing a detrimental effect on patient-centred care.AimsWe aimed to develop a conceptual model to promote patient-centred type 2 diabetes mellitus care in clinical settings. We explored nurses’ contextual perceptions of clinical practices and operations in light of type 2 diabetes mellitus management across public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to care optimisation for people diagnosed with type 2 diabetes mellitus.MethodsWe adopted a qualitative approach. Using the constant comparison method and semi-structured questions and interviewed practice nurses, with over one year’s experience and who were working in public hospitals across Lagos, Nigeria. The framework method was used to analyse the data obtained.ResultsNurses provided insight into four areas of patient-centred type 2 diabetes mellitus management in clinical settings: empowering collaboration; empowering flexibility; empowering approach; and empowering practice. Nurses discussed an empowering pathway through which health settings could provide patient-centred care to individuals diagnosed with type 2 diabetes mellitus. The pathway entailed the integration of macro, meso and micro levels for patient management. Nurses’ accounts have informed the development of a conceptual model for the optimisation of patient care.ConclusionsThe model developed from this research sits within the patient-centred care model of healthcare delivery. The research sits within the patient-centred care model of healthcare delivery. inform patient-centred care, not only in countries with poorly financed healthcare systems, but in developed countries with comparatively better healthcare.

Hibiscus sabdariffa Linn fruit derivatives as alternative agents for diabetes mellitus care: A basic insight

This study discusses the effectiveness of methanolic extract and fractions (butanol, ethyl acetate, and n-hexane) of H. sabdariffa Linn fruit towards antidiabetic activities (in vitro). In order to test the efficacy, toxicity and insulin secretion capacity of rat pancreatic β-cell lines (BRIN-BD11) were tested with the methanolic extract and fractions. The outcomes showed that both the extract and the fractions demonstrated significantly lower levels of cytotoxic activities. Furthermore, the methanolic extract and fractions displayed varied sensitivity levels towards insulin release after an incubation period of 30 min. The methanolic extract, at a concentration of 300 µg/mL, significantly stimulated secretion of insulin by 2.85-fold (p&lt;0.001). In addition, butanol, ethyl acetate, and n-hexane fractions revealed a gradual increase in insulin secretion. The stimulated insulin secretion for these fractions had been recorded at 2-fold (p&lt;0.01), 2.67-fold, and 2.31-fold (p&lt;0.001), respectively, at the highest concentrations. The methanolic extract and fractions also appeared to stimulate secretion of insulin with all modulators present, for example, potassium chloride (KCl), insulin secretion inhibitor (verapamil and diazoxide), as well as insulin secretagogue (tolbutamide and isobutylmethylxanthine (IBMX)). These results indicate that H. sabdariffa Linn fruit methanolic extract and fractions could indeed be beneficial for future development of antidiabetic drugs.

Diabetic Self-Management Education – Effect on Self-Management Care of Type-2 Diabetic Patients

A common problem of a person with diabetes mellitus was the lack of discipline in implementation of their daily self-care management. Diabetes Self-Management Education (DSME) was a system to help diabetes patients manage their activities to improve their health. DSME is the process which can improve the knowledge, skill, and ability of diabetes self-care. This study aimed to determine the effect of using diabetes self-management education (DSME) intervention and how it affected patients’ self-care management. This research was quasi experiment with one group pretest-posttest among patients with type-2 diabetes. There were 30 participants assigned by using purposive sampling into DSME intervention. Four sessions of DSME were conducted to the participants using illustrative media/fliers. The data were collected by questionnaires of Diabetes Self-Care Management. Then, it was analyzed by using paired t-test. The results showed that self-care management of the respondents before the intervention was 28.8 and it increased to 35.3 after the intervention (mean different=6.5). There were differences in the self-care score before and after the intervention (p=0.001). This study has limited time to do DSME. But, in four sessions, we have tried to explain more about diabetes interactively. Then, better to assess the type-2 diabetes patients with qualitative method or mixed with more participants included for the future researchers. This research was adopting a DSME to found significant improvements in the self-care management in type-2 diabetes mellitus patient. This demonstrates that DSME intervention can be such clinical importance in care of type-2 diabetes mellitus patient.Keywords: Diabetes self-management education, self-care management, type-2 diabetes patients.

Application Research of Target Management of Visceral Fat in the Care of Overweight or Obese Diabetes Mellitus

Application Research of Target Management of Visceral Fat in the Care of Overweight or Obese Diabetes Mellitus

Interpreting Absolute and Relative Risk Reduction in the Context of Recent Cardiovascular Outcome Trials in Patients with Type 2 Diabetes.

The cardiovascular benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) have increased the focus of type 2 diabetes mellitus (T2DM) care on comprehensive cardiovascular risk reduction. Herein, we review the results of the cardiovascular outcomes trials of SGLT2i and GLP-1 RA, discuss the concepts of relative vs. absolute risk reduction in the context of these trials, and highlight the importance of individualized risk assessment when applying trial results to clinical practice. To enable personalized treatment approaches, multiple clinical risk scores have been developed to assess risk of atherosclerotic cardiovascular disease (ASCVD) outcomes and hospitalization for heart failure (HHF) in patients with T2DM. In addition, circulating biomarkers of myocardial injury (cardiac troponin) and hemodynamic stress (natriuretic peptides) have been shown to further refine risk prediction of these clinically important cardiovascular complications. When making decisions about whether to initiate SGLT2i and GLP-1 RA, clinicians should consider the anticipated relative and absolute treatment benefits from these antihyperglycemic therapies. Clinicians can use available clinical and biomarker-based risk tools when counseling patients about their individual cardiovascular risk profiles and when estimating absolute treatment benefits from SGLT2i and GLP-1 RA.