Diabetes Mellitus Care Research Articles

A histological and immunohistochemical investigation to assess the therapeutic role of metformin nanoemulsion against metformin in a diabetic retinopathy model

ABSTRACT The fundamental concept of diabetes research is the restoration of normal glycemic status. Nowadays, nanoemulsion medication delivery technologies provide effective approaches to the second type of diabetes mellitus care. This study aimed to investigate the potential of metformin nanoemulsion (MTF-NE) in treating streptozotocin (STZ)-induced diabetic retinopathy in rats. Histopathological examinations, including hematoxylin and eosin, anti-F-actin, anti-CD57, and anti-S100 immunostains, were performed after 8 weeks. Many alterations in the STZ group as slight disorganization of retinal layers, loss of some photoreceptor processes, and focal widening of intercellular spaces between small darkly stained nuclear cells in inner and outer nuclear layers, focal areas of disruption of outer plexiform layer, pyknotic nuclei of ganglion cells, and dilated congested blood capillaries with vascular leakage in the ganglion cell layer, decreased F-actin, increased CD75 and S100 immunohistochemical expression. Rats treated with metformin nanoemulsion have substantial improvements in retinal organization, histopathology, and immunohistochemical markers compared to those treated with metformin. The study suggests that metformin nanoemulsion holds promise for alleviating diabetic retinopathy in rats on a histological and immunohistochemical basis.

Diabetes mellitus and hard braking events in older adult drivers

BackgroundDiabetes mellitus (DM) can impair driving safety due to hypoglycemia, hyperglycemia, diabetic peripheral neuropathy, and diabetic eye diseases. However, few studies have examined the association between DM and driving safety in older adults based on naturalistic driving data.MethodsData for this study came from a multisite naturalistic driving study of drivers aged 65–79 years at baseline. Driving data for the study participants were recorded by in-vehicle recording devices for up to 44 months. We used multivariable negative binomial modeling to estimate adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs) of hard braking events (HBEs, defined as maneuvers with deceleration rates ≥ 0.4 g) associated with DM.ResultsOf the 2856 study participants eligible for this analysis, 482 (16.9%) reported having DM at baseline, including 354 (12.4%) insulin non-users and 128 (4.5%) insulin users. The incidence rates of HBEs per 1000 miles were 1.13 for drivers without DM, 1.15 for drivers with DM not using insulin, and 1.77 for drivers with DM using insulin. Compared to drivers without DM, the risk of HBEs was 48% higher for drivers with DM using insulin (aIRR 1.48; 95% CI: 1.43, 1.53).ConclusionOlder adult drivers with DM using insulin appear to be at increased proneness to vehicular crashes. Driving safety should be taken into consideration in DM care and management.

Instrument for assessing the performance of nursing professionals in primary health care of Diabetes Mellitus

Introduction: According to the WHO, diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or the body does not effectively use the insulin it produces. Objective: Design an instrument that allows for the assessment of nursing performance in Diabetes Mellitus in primary care. Method: Research with a quantitative approach, experimental, descriptive, and transversal design. Development of an instrument to determine its reliability and content validity. The sample used for the evaluation of internal reliability was made up of 10 patients diagnosed with diabetes mellitus who are treated in the health centers of zone 3 belonging to the Pelileo Canton, Province of Tungurahua, who agreed to collaborate with the research, to check the understanding of the questions and the operation of the instrument. Internal consistency was determined by calculating Cronbach's Alpha coefficient. Results: Expert professionals in diabetes mellitus assessed the pertinence, relevance, and clarity of the 20 items divided into four dimensions, qualifying them as applicable. The internal consistency of Cronbach's Alpha was 0.97, which demonstrates that the formulation of the items is reasonable, satisfactorily defined, and suitable in the presence of the questionnaire. Conclusions. The results obtained to evaluate the instrument and the application of the pilot test were adequate. This valid and reliable instrument justifies its use in the research field. The instrument is easy and quick to apply, allowing us to know the perception of patients with Diabetes Mellitus about the care received by the nursing staff in the PHC.

Health-Care Utilization and Outcomes in Young Adults With Type 1 and Type 2 Diabetes

Abstract Young adulthood can be a challenging time for individuals with diabetes mellitus (DM) as they experience increasing independence and life transitions, which can make it difficult to engage in DM self care. Compared to older adults, young adults are more likely to have higher glycated hemoglobin A1c (HbA1c). They also often have lower adherence to standards of care in DM, and higher utilization of emergency department (ED) visits and hospitalizations for diabetic ketoacidosis. This review describes health-care utilization and explores factors that may contribute to high HbA1c among young adults with DM. In addition, it discusses the unique health-care needs of young adults with DM, examines the role of technology in their DM care, and analyzes the effects of social determinants of health on their health-care utilization.

Glucose to Complications: Understanding Secondary Effects in Diabetes Mellitus

Diabetes Mellitus (DM) is a complex metabolic disorder characterized by persistent hyperglycemia, impacting millions globally. While glucose control is central to its management, understanding secondary complications is crucial for comprehensive care. This paper explores the intricate relationship "From Glucose to Complications" in DM, elucidating the pathophysiological mechanisms and organ system involvement. Hyperglycemia-induced damage, driven by glycation and oxidative stress, underpins the cascade of complications. Microvascular complications encompass diabetic retinopathy, nephropathy, and neuropathy, each posing significant morbidity and mortality risks. Macrovascular complications, including atherosclerosis and stroke, contribute substantially to cardiovascular morbidity in diabetic individuals. Metabolic derangements such as dyslipidemia and obesity further exacerbate the risk profile. Endocrine disturbances, neurological sequelae, and cognitive impairments represent additional burdens in DM management. This paper emphasizes preventive strategies and holistic management approaches to mitigate complications. Glycemic control remains paramount, supported by lifestyle interventions emphasizing diet, exercise, and weight management. Pharmacological therapies targeting secondary complications, alongside emerging therapies, hold promise in improving outcomes. Furthermore, addressing comorbidities and mental health concerns is integral to comprehensive care in DM. In conclusion, effective management of Diabetes Mellitus (DM) and its associated complications necessitates a multifaceted approach encompassing glycemic control, lifestyle interventions, and pharmacological therapies.

Current Perspectives, Practices, and Barriers Faced by Community Pharmacists Regarding Pharmaceutical Care Services for Diabetes Mellitus in the United Arab Emirates.

Providing accurate and sufficient information is a crucial requirement for delivering effective diabetes care, making it essential for community pharmacists to possess adequate knowledge of diabetes mellitus (DM) and its management. To investigate community pharmacists' level of expertise and engagement in providing counseling and health promotion services for individuals with DM in the United Arab Emirates (UAE). A cross-sectional study design was used. The community Pharmacies were chosen via random sampling and researchers then conducted face-to-face interviews with them using the structured questionnaire. The questionnaire included demographic data, 14 questions on the knowledge and 9 questions about the practice concerning pharmaceutical care for Diabetes Mellitus. The average age ± SD was 31 ± 6.3. Of the total 516 community pharmacists recruited in the study, 37.2% (n=192) were male and 62.8% (n=324) were female. The average knowledge score about DM prevention and management was 9.7 with a 95% confidence interval (CI) [9.5, 9.9] and the average practice score about DM prevention and management was 7.1 with a 95% confidence interval (CI) [6.9, 7.2]. Better knowledge scores were observed in chief pharmacists (OR 1.29; 95% CI 1.08-1.56), pharmacists with 6-10 Years of experience (OR 6.92; 95% CI 3.43-8.86), pharmacist with > 10 years of experience (OR 1.99; 95% CI 1.67-2.36), when the number of patients the pharmacist serve is 5-10 (OR 1.27; 95% CI 1.06-1.53) and being trained on DM prevention and management (OR 2.18; 95% CI 1.92-2.47). Similarly, better practice scores were observed in older participants (OR1.02; 95% CI 1.001-1.03), chain pharmacies (OR 1.42; 95% CI 1.20-1.68), chief pharmacists (OR 1.56; 95% CI 1.18-2.06), when the number of patients the pharmacists serve was 5-10 (OR 12.26; 95% CI 7.26-16.19), when the number of patients the pharmacists serve was 11-20 (OR 4.23; 95% CI 3.54-5.06) and being trained on DM prevention and management (OR 1.33; 95% CI 1.11-1.59). The most commonly reported barriers to providing counseling and health promotion services for diabetes mellitus (DM) in community pharmacies include a lack of coordination with other healthcare professionals (77%) and insufficient knowledge or clinical skills (68.7%). Our study revealed that community pharmacy staff members displayed a noteworthy level of involvement in providing pharmaceutical care services for patients with diabetes mellitus. Based on these findings, it is recommended to enhance pharmacy education by incorporating more advanced, evidence-based training and curricula focusing on disease management and appropriate therapies, particularly for diabetes.

Gestational diabetes mellitus care re‐imagined: women's experiences of a major model of care change at a large metropolitan hospital

Abstract Background: A gestational diabetes mellitus (GDM) pregnancy has significant psychological, time and resource impacts. In 2020–21, a digitally‐supported radical GDM service redesign was undertaken at a Brisbane tertiary centre, producing substantial cost savings without compromising clinical outcomes.Aims: To describe women's experiences within this new model of care (MOC), specifically the app user experience (MOC) (post), compared with a traditional MOC (pre).Methods: The new MOC was evaluated using a pre–post study design. This MOC included a smartphone app‐to‐clinician blood glucose communication platform. A convenience sample of women were surveyed about care experiences and app use pre‐ and post‐implementation. An additional survey queried user app experience at four weeks’ postpartum.Results: Within the service, 34% (n=24) and 22% (n=48) of women were surveyed pre and post MOC introduction, respectively. Pre‐implementation, 50% (n=12) of women missed work to attend appointments and 75% spent 30–120 minutes at the hospital. Questions regarding understanding GDM, initial dietary changes and glucometer use received similar or slightly lower ratings, pre‐ to post‐implementation. Nearly a quarter of women in the app‐experiences survey (24.2%; n=177) showed high levels of satisfaction with care received (91.5%) and with the app for managing GDM (87.1%). Two experience themes that emerged were Enhanced GDM management and Usability issues.Conclusions: The new MOC reduced time impositions associated with attending appointments. Despite the removal of face‐to‐face visits in the new MOC, women still established a connection with their treating team and maintained their understanding of their GDM management. Copyright © 2024 John Wiley & Sons.

Interplay Between Diabetes Mellitus and the Occurrence of Osteoarthritis and Associated Conditions in Women of Menopausal Age.

Osteoarthritis (OA) and diabetes mellitus (DM) have long-term deleterious chronic effects and are among the most prevalent chronic disorders. DM and its associated factors, such as hyperglycemia, have a significant contribution to the pathophysiology of OA, particularly in post-menopausal women. Women who have uncontrolled diabetes (DM) are more prone to develop osteoarthritis (OA), which may be exacerbated by poor glycemic control. Furthermore, this category of female patients with DM has an increased risk of developing fractures, even in those with initially normal bone density scores, further illustrating the correlation between DM and bone health. Additionally, multiple risk factors, including obesity, metabolic syndrome, hypertension, estrogen-based hormone therapy, and hyperuricemia, in menopausal women can lead to the development and exacerbation of OA. It is discovered that these variables have a direct or indirect impact, frequently causing inflammation and hormonal changes, which contribute to the intricate interaction between DM and OA. The management of OA and DM in womenthus calls for a multi-faceted management plan including glycemic control, weight control, exercise, and specialized pain management methods catering to the specific requirements of the patients. Regularly screening for OA should be implemented for menopausal women with DM and utmost care should be provided by healthcare professionals. Regular monitoring of joint health and early management, encouraging interdisciplinary cooperation, putting preventative measures into place, and creating individualized treatment programs are essential. A thorough understanding of the link between DM and OA will ultimately lead to improved health outcomes and a better future for these individuals.

Relationships between the Structural Characteristics of General Medical Practices and the Socioeconomic Status of Patients with Diabetes-Related Performance Indicators in Primary Care.

The implementation of monitoring for general medical practice (GMP) can contribute to improving the quality of diabetes mellitus (DM) care. Our study aimed to describe the associations of DM care performance indicators with the structural characteristics of GMPs and the socioeconomic status (SES) of patients. Using data from 2018 covering the whole country, GMP-specific indicators standardized by patient age, sex, and eligibility for exemption certificates were computed for adults. Linear regression models were applied to evaluate the relationships between GMP-specific parameters (list size, residence type, geographical location, general practitioner (GP) vacancy and their age) and patient SES (education, employment, proportion of Roma adults, housing density) and DM care indicators. Patients received 58.64% of the required medical interventions. A lower level of education (hemoglobin A1c test: β = -0.108; ophthalmic examination: β = -0.100; serum creatinine test: β = -0.103; and serum lipid status test: β = -0.108) and large GMP size (hemoglobin A1c test: β = -0.068; ophthalmological examination β = -0.031; serum creatinine measurement β = -0.053; influenza immunization β = -0.040; and serum lipid status test β = -0.068) were associated with poor indicators. A GP age older than 65 years was associated with lower indicators (hemoglobin A1c test: β = -0.082; serum creatinine measurement: β = -0.086; serum lipid status test: β = -0.082; and influenza immunization: β = -0.032). Overall, the GMP-level DM care indicators were significantly influenced by GMP characteristics and patient SES. Therefore, proper diabetes care monitoring for the personal achievements of GPs should involve the application of adjusted performance indicators.

The Impact of Parental Electronic Health Literacy on Disease Management and Outcomes in Pediatric Type 1 Diabetes Mellitus: Cross-Sectional Clinical Study.

Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents' skills to deal with electronic health information sources. We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children's outcomes. A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents' electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children's treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c. Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents' average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children's treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=-0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children's HbA1c (r=-0.143; P=.08), PedsQL Diab (r=-0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=-0.13; P=.12). Regression analysis revealed significant associations of the child's HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=-0.66; P=.03; pump + sensor: β=-0.93; P=.007), and parents' self-efficacy (PSESDM; β=-0.08; P=.001). Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents' diabetes management attitude but not with the child's glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged.

Longitudinal Medical Student Collaborative Care in Primary Care Patients With Type 2 Diabetes.

The Education-Centered Medical Home (ECMH) is a longitudinal clerkship that emphasizes continuity and quality improvement in primary care. We aimed to evaluate our ECMH's ability to improve type 2 diabetes mellitus (T2DM) care through a systematic chart audit and care planning process. The effect of this intervention was measured by adherence to process and outcome measures. From November 2015 to March 2017, medical students were educated on and performed monthly chart audits of guideline-based quality metrics: hemoglobin A1c systolic blood pressure; lipid and microalbuminuria evaluation; annual ophthalmic and foot examinations; flu, hepatitis, and pneumonia vaccination; and statin therapy. Patients were included if they had a diagnosis of T2DM and were seen by the ECMH clinic before and after the audits started. Students shared audit logs, using them to plan patient appointments. We assessed changes in proportion of patients meeting each guideline with Fisher's exact test. The project included 11 patients with T2DM. ECMH adherence to the annual eye exam increased significantly 1 year postintervention, compared to preintervention (73% vs 55%; P=.03) and 6 months (73% vs 46%, P=.01). The metric with significant improvement during the chart audit, annual eye exam, is a process measure requiring advance planning. This small study suggests that a formal, regular audit process can improve student adherence to evidence-based care guidelines, particularly for tasks that require advance planning or action by the care team outside the day of a patient visit.

Knowledge and practices on diabetic care among the caregivers of children with type 1 diabetes mellitus: A cross sectional study

Background: Diabetes mellitus care in children requires parental support and involvement as young children cannot independently handle all of their diabetes cares; the diabetic cares given to these children entirely depend on the knowledge and skills of the care givers. This study was conducted to determine the knowledge and practices on diabetic care and associated factors among the caregivers of children with type 1 diabetes mellitus attending the follow-up clinic at Jimma Medical Center, Southwest Ethiopia. &#x0D; Methods: Institution-based prospective cross-sectional study was conducted from July 10 to October 10, 2022. Data was collected using a structured questionnaire and analyzed using statistical packages for social sciences software Version 25.0. Bivariate and stepwise multivariate analysis was performed to test associations between the dependent and independent variables. &#x0D; Results: One hundred fifty-eight caregivers of children with type 1 diabetes mellitus participated in the study; over half of the participants (93, 58.9%) were females. Over half of caregivers have a poor level of knowledge (56.3%) and practice (58.6%) about diabetes cares. Participants residing in the urban area are found to have better knowledge (p&lt;0.001; 95%CI:1.81-6.86), whereas being female caregiver (p=0.03; 95%CI:1.04-4.22), attending diabetic education sessions (p=0.035; 95%CI:1.17-79.66) and, those who had good diabetes knowledge (p=0.04; 95%CI:1.03-4.04 ) were found to have a better practice. &#x0D; Conclusion: The knowledge and practices of caregivers regarding diabetic care among caregivers of children with type 1 diabetes mellitus were found to be low. Structured diabetes care education should be given to all caregivers to improve their knowledge and practices.

Patient Characteristics Associated with Telemedicine Use for Diabetes Mellitus Care: Experience of a University Health System.

The objective was to understand the characteristics of patients who used telemedicine for diabetes management to inform future implementation of telemedicine. We examined patient characteristics associated with telemedicine use for diabetes mellitus (DM) care between March 1, 2020 and April 1, 2021 (the coronavirus disease 2019 pandemic period) in a large university health system when telemedicine visits increased rapidly. Logistic regression models assessed patient characteristics associated with telemedicine visits and delays in DM process measures (hemoglobin A1c checks, nephropathy, and retinopathy evaluations) during the pandemic period after adjusting for potential confounders and corresponding values before the pandemic period (March 1, 2019-February 29, 2020). A total of 45,159 patients were seen from 987,791 visits during the pandemic period. The number of visits averaged one visit less during the pandemic period than before the pandemic period. Approximately 5.4% of patients used telemedicine during the pandemic period from 42,750 visits. The mean (standard deviation) telemedicine visit was 1.28 (0.91). Men, Asian, Black, and other race (vs White), having Medicare or uninsured (vs private insurance), were less likely to use telemedicine. Patients with more visits before the pandemic period were more likely to use telemedicine and less likely to experience a delay in DM process measures during the pandemic period. Telemedicine users were 18% less likely to experience a delay in nephropathy visits than nonusers, but without difference for other process measures. Race, sex, insurance, and prepandemic in-person visits were associated with telemedicine use for DM management in a large health system. Telemedicine use was not associated with delays in hemoglobin A1c testing, nephropathy, and retinopathy assessments. Understanding reasons for not using telemedicine is important to be able to deliver equitable DM care.

Seeking and receiving hypertension and diabetes mellitus care in Tanzania.

The rapid increase in chronic non-communicable diseases (NCDs) poses a major challenge to already strained health systems in sub-Saharan Africa. This study investigates the factors associated with seeking and receiving NCD services in Tanzania, using a household survey and client exit interview data from Kilombero and Same districts. Both districts are predominantly rural, with one semi-urban area called Ifakara town and Same town. Of the 784 household survey respondents, 317 (40.4%), 37 (4.7%), and 20 (2.5%) were diagnosed with hypertension, diabetes mellitus, and other NCDs, respectively, of whom 69% had sought care in the past six months. After controlling for covariates, those enrolled in the National Health Insurance Fund (NHIF) and those who received a user fees waiver were more likely to use health services. However, even when NCD patients managed to access the care they needed, they were likely to receive incomplete services. The main reason for not receiving all services at the health facility visited on the day of the survey was drug stock-outs. Among health care users, those registered with the improved Community Health Funds (iCHF) were less likely to receive all prescribed services at the health facility visited than uninsured patients. The findings of this study highlight the need to strengthen both primary care and social health protection systems to improve access to needed care for NCD patients.

1123 The Value of Extending Maternal Care of Diabetes Mellitus After Delivery in Underserved Areas

1123 The Value of Extending Maternal Care of Diabetes Mellitus After Delivery in Underserved Areas

Health and Racial Disparities in Diabetes Mellitus Prevalence, Management, Policies, and Outcomes in the United States.

Diabetes Mellitus (DM) is a severe and chronic metabolic disorder characterized by hyperglycaemia and various complications, including cardiovascular disease. It is diagnosed when fasting plasma glucose (FPG) level is126 mg/dL (7.0 mmol/L) or higher [1]. Notable differences in DM prevalence are evident among populations in the United States. While DM affects 13% of the general adult population, specific groups, including American Indians/Alaska Natives (14.7%), Hispanics (12.5%), and non-Hispanic Blacks (11.7%), experience disproportionately higher rates. Conversely, lower prevalence rates are observed among non-Hispanic Asians (9.2%) and non-Hispanic Whites (7.5%). Black Americans are twice as likely to succumb to diabetes-related mortality compared to Whites [2]. The overall objective of this review article is to comprehensively address racial disparities in DM within the United States, emphasizing prevalence rates, management strategies, and health outcomes across diverse ethnic groups. To achieve this objective, we conducted a systematic review and meta-analysis utilizing data from nationally representative surveys, healthcare databases, and published literature spanning from 2014 to 2023. Our findings highlight significant racial disparities in DM prevalence, with minority populations, including African Americans, Hispanics, and Native Americans, consistently exhibiting higher rates than their Caucasian counterparts. Beyond prevalence, disparities extend to access to healthcare resources, diabetes education, and preventive measures. Additionally, challenges in DM management, including access to optimal treatment modalities, medication adherence, and diabetes self-management education, are identified among minority populations. Socioeconomic factors, particularly income and education, significantly contribute to these disparities. This review article contributes to the growing body of evidence guiding policymakers, healthcare professionals, and researchers in developing targeted strategies to achieve health equity in diabetes management and prevention. Addressing these disparities is crucial for fostering an inclusive and practical approach to DM care within diverse ethnic populations.

Assessment of Quality of Life in Gestational Diabetes Mellitus Care-Study Protocol of the GDM-QOL Project.

In recent years, the concept of quality of life (QoL) has gained significant importance within health care and clinical research, e.g., as in patient-reported outcomes. In gestational diabetes mellitus (GDM) care, enhancing QoL through reasonable interventions is considered equally important as achieving metabolic control and preventing complications in the treatment process, leading to the suggestion that QoL assessment should be implemented as a clinical standard in GDM care. Although a considerable number of questionnaires for the measurement of general as well as health-related and diabetes-specific QoL are frequently used in GDM research, a validated QoL questionnaire tailored to women with GDM does not exist in German-speaking countries. To develop and test such an instrument, we plan to conduct the following steps: (a) translate the Persian questionnaire GDMQ-36, the only GDM-specific questionnaire to date; (b) conduct expert ratings as well as pretests featuring cognitive debriefings and structured interviews with women suffering from GDM for evaluating comprehensibility, face and content validity; (c) pilot and validate the preliminary questionnaire in terms of testing its psychometric performance (e.g., via confirmatory factor analysis). The resulting GDM-specific questionnaire will facilitate a broader perspective of the pregnant women's expectations, needs, impairments, and burdens related to their disease, and its treatment. This enables physicians and other health professionals to establish an individualized treatment plan and to provide customized information, support, and psychological counseling, which helps to optimize the provided care.

Nursing care for diabetes mellitus

Background. Due to the global rise in diabetes patients, nurses of all specialties and positions are increasingly caring for these individuals on a daily basis. The purpose of this study was to examine the latest re­commendations and individual studies on diabetes management and to determine the place of nurses in a multidisciplinary team. Materials and methods. The article used descriptive methods and methods of comparative analysis to determine the characteristics of nursing practice in the management of patients with diabetes. Results. From the information studied, it became clear that nurses should be prepared to receive quality education associated with ongoing support and care in the community, primary health care institutions or in hospitals for such patients. Education in self-management and psychosocial problem solving are key elements of diabetes care and nursing. The Diabetes Self-Management Education and Support program is a crucial tool for patient-nurse communication, involving ongoing psychological support through educational techniques to address questions and concerns from individuals with diabetes and their families. Conclusions. Trained nurses can also perform screening for mental disorders and diabetes complications in order to timely diagnose or prevent their development. Regardless of new technologies or treatments, nurses must never lose their role as advocates for patients’ rights.

Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey

AbstractBackgroundDiabetes mellitus (DM) is a major public health concern in India, and entails a severe burden in terms of disability, death, and economic cost. This study examined the out‐of‐pocket health expenditure (OOPE) and financial burden associated with DM care in India.MethodsThe study used data from the latest round of the National Sample Survey on health, which covered 555,115 individuals from 113,823 households in India. In the present study, data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed.ResultsIn India, 10.04 per 1000 persons reported having DM during the last 15 days before the survey date, varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas. Nearly 38% of Indian households with diabetic members experienced catastrophic health expenditure (at the 10% threshold) and approximately 10% of DM‐affected households were pushed below the poverty line because of OOPE, irrespective of the type of care sought. 48.5% of households used distressed sources to finance the inpatient costs of DM. Medicines constituted one of the largest proportion of total health expenditure, regardless of the type of care sought or type of healthcare facility visited. The average monthly OOPE was over 4.5‐fold and 2.5‐fold higher for households who sought inpatient and outpatient care, respectively, from private health facilities, compared with those treated at public facilities. Notably, the financial burden was more severe for households residing in rural areas, those in lower economic quintiles, those belonging to marginalised social groups, and those using private health facilities.ConclusionThe burden of DM and its associated financial ramifications necessitate policy measures, such as prioritising health promotion and disease prevention strategies, strengthening public healthcare facilities, improved regulation of private healthcare providers, and bringing outpatient services under the purview of health insurance, to manage the diabetes epidemic and mitigate its financial impact.

Practical therapeutic approach in the management of diabetes mellitus secondary to Cushing's syndrome, acromegaly and neuroendocrine tumours.

Cushing's syndrome, acromegaly and neuroendocrine disorders are characterized by an excess of counterregulatory hormones, able to induce insulin resistance and glucose metabolism disorders at variable degrees and requiring immediate treatment, until patients are ready to undergo surgery. This review focuses on the management of diabetes mellitus in endocrine disorders related to an excess of counterregulatory hormones. Currently, the landscape of approved agents for treatment of diabetes is dynamic and is mainly patient-centred and not glycaemia-centred. In addition, personalized medicine is more and more required to provide a precise approach to the patient's disease. For this reason, we aimed to define a practical therapeutic algorithm for management of diabetes mellitus in patients with glucagonoma, pheochromocytoma, Cushing's syndrome and acromegaly, based on our practical experience and on the physiopathology of the specific endocrine disease taken into account. This document is addressed to all specialists who approach patients with diabetes mellitus secondary to endocrine disorders characterized by an excess of counterregulatory hormones, in order to take better care of these patients. Care and control of diabetes mellitus should be one of the primary goals in patients with an excess of counterregulatory hormones requiring immediate and aggressive treatment.