Complexity Of Diabetes Management Research Articles

Diabetes care in times of armed conflict

Recent events in Ukraine emphasise the danger and uncertainty faced by people who are caught in armed conflict. Those living with diabetes face an additional crisis: the complexity of diabetes management during war. This editorial describes the challenges of caring for people with diabetes in this scenario, including the impact on healthcare systems, mass displacement, refocused priorities of wider healthcare, fiscal challenges, and disruption to supply lines, storage of medicines and communications. We consider the effects on people living with diabetes and suggest some strategies for healthcare workers providing care during conflict, including equipping healthcare providers to deal with diabetes emergencies, and adaptation of technological innovations.

Lessons Learned: Barriers to Hemoglobin A1c Monitoring in Rural Northern Tanzania

In sub-Saharan countries, Non-communicable Chronic Diseases (NCDs), including diabetes, are on the rise. Glycated hemoglobin (HbA1c) is a Point Of Care (POC) diagnostic tool for diabetic monitoring that is unavailable in many resource-constrained environments worldwide. Theoretically, HbA1c measurement is practical in these settings because fasting is not required, the test is not generally repeated before 120 days and travel time for multiple appointments is reduced. To improve diabetes management of patients and the provider’s ability to manage chronic diabetes, two HbA1c monitoring machines were used to determine the effectiveness and feasibility of HbA1c in diabetes management in two hospital locations in Tanzania. A follow-up team returned to the sites to determine the use of the HbA1c machines in the treatment of diabetes and introduced the use of Point Of Care (POC) HbA1c machines. Interviews were conducted with diabetic participants (n = 4) regarding their diabetes management experiences. Though short-term change had mixed success, the long-term impact on the management of diabetes is unknown. Cultural influences and access issues had a significant impact on the usefulness of the HbA1c machines for monitoring diabetes in rural northern Tanzania. A greater understanding of these factors is needed in order to creatively address these barriers. The Tanzania HbA1c project functions as a case study at a population level through which to examine the complexities of diabetes management in a resource-constrained environment.

Academic and Government Partnerships to Address Diabetes in the USA: a Narrative Review.

Multi-sector partnerships are broadly considered to be of value for diabetes prevention and management. The purpose of this article is to summarize academic and government collaborations focused on diabetes prevention and management. Using a narrative review approach, we identified 17 articles describing 10 academic and government partnerships for diabetes management and surveillance. Challenges and gaps in the literature include complexity of diabetes management vis a vis current healthcare infrastructure; a paucity of racial/ethnic diversity in translational efforts; and the time/effort needed to maintain strong relationships across partner institutions. Academic and government partnerships are of value for diabetes prevention and management activities. Acknowledgment that the key priorities of government programming are often costs and feasibility is critical for collaborations to be successful. Future translational efforts of diabetes prevention and management programs should focus on the following: (1) expansion of partnerships between academia and local health departments; (2) increased utilization of implementation science for enhanced and efficient implementation and dissemination; and (3) harnessing of technological advances for data analysis, patient communication, and report generation.

Exploring diabetes management amongst immigrant Sikhs in the Greater Toronto Area: a qualitative study

ABSTRACTObjectives. This study describes the ethnocultural influences associated with managing diabetes (Type 2) in a small sample of older Sikh immigrants in Toronto, Canada. The South Asian community, which includes Sikhs, is the fastest growing immigrant population, the second largest visible minority in Canada, and is five times more likely to have diabetes than their Canadian counterparts. The relationship between culture, immigration, and management of diabetes has been recognized, but research of how these areas intersect in the Sikh community is sparse.Design. Data were collected using qualitative semi-structured interviews, and participants were recruited via purposive and snowball sampling techniques. Data were analysed using constant comparative methods.Results. The complexities of diabetes management are organized in this study as the (1) external (2) internal and (3) actualized experiences participants faced navigating cultural dynamics, understanding their diagnosis, and interacting with health resources.Conclusion. An individual's diabetes diagnosis and treatment plan interacts with layers beyond the health system which must be understood in order to provide health care that is truly an empowering resource.

Abstract LB-183: Metformin use does not increase survival of pancreatic cancer patients: A cautionary lesson

Abstract Background: Epidemiologic studies have suggested that metformin use is associated with cancer death reduction. The results for pancreatic ductal adenocarcinoma (PDAC) are inconsistent. Retrospective studies of cancer survival may potentially have unintended biases; due to complexities of diabetes management, metformin use exposure is commonly categorized as simply “yes/no.” Nevertheless, in part based on epidemiologic studies, there are at least 20 open cancer clinical trials that include metformin in a treatment arm. We aimed to study metformin use and survival of patients with PDAC, addressing potential inherent biases. Methods: A retrospective cohort study for the years 2000-2011 was conducted using the patient database of the Mayo Clinic Specialized Programs of Research Excellence (SPORE) in Pancreatic Cancer. 1,360 PDAC patients (59% male; mean age 67) with diabetes were studied; overall survival was the primary outcome. Initiation and duration of metformin use was carefully abstracted from medical records. Patients were categorized into 5 groups based on metformin initiation: (A) Never used, n = 908 (reference group); (B) Metformin started >1 year prior to PDAC diagnosis, n = 84; (C) Metformin started within 1 year prior to PDAC diagnosis, n = 212; (D) Metformin started <30 days post-PDAC diagnosis, n = 104; (E) Metformin started >30 days post PDAC diagnosis, n = 34. Hazard ratios (HR) and 95% confidence intervals (C.I.) for survival differences between groups were computed using Cox proportional hazards models, adjusting for age, sex, disease stage, body mass index, and diagnosis year group. Results: Median survival of patients in Groups B-E was 292 days compared to 308 for Group A; this was not significantly different. However, among 413 resectable patients, metformin users appeared to survive longer than non-users (782 vs. 612 days, p = 0.07). Survival in each group was 308, 245, 249, 243 and 818 days, respectively. Because Group E had already survived >30 days, a bias existed. With Group E excluded, there was no survival difference among the other 4 groups (p = 0.18). Compared to Group A, HR and 95% C.I. for metformin use were 1.08 (0.85-1.37), 0.99 (0.85-1.17), 1.04 (0.83-1.31) and 0.49 (0.33-0.74), for Group B-E, respectively. Conclusions: Our thorough analysis suggests that metformin use does not improve survival of patients with PDAC. The benefit of metformin was observed only in patients who started metformin post-PDAC diagnosis; however, there is an inherent survival bias in this group of patients. Studies of medication exposure and cancer survival warrant very careful and detailed data collection. Researchers should exercise caution when initiating clinical trials based on retrospective epidemiologic studies. Citation Format: Roongruedee Chaiteerakij, David B. Zhen, Patrick A. Burch, Kari G. Chaffee, William R. Bamlet, Ann L. Oberg, Lewis R. Roberts, Gloria M. Petersen. Metformin use does not increase survival of pancreatic cancer patients: A cautionary lesson. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-183. doi:10.1158/1538-7445.AM2015-LB-183

A Review of Advances in Collaborative Pharmacy Practice to Improve Adherence to Standards of Care in Diabetes Management

The prevalence of diabetes in the United States is increasing and so is the need to provide diabetes care. Given the time commitment and complexity of diabetes management, an interdisciplinary approach is recommended. Pharmacists are integral members of the diabetes care team because of their accessibility and expertise in medication management. Pharmacists are receiving specialized training and becoming more involved in direct patient care through collaborative practice opportunities such as medication therapy management and collaborative drug therapy management. These collaborative practice models increase patient access to care and allow pharmacists to optimize drug therapy and provide important education to promote diabetes self-management. Studies show pharmacists practicing in a variety of outpatient environments can reduce HbA1c, LDL and BP as well as improve adherence to recommended American Diabetes Association guidelines (yearly monofilament exams, dilated eye exams, microalbumin screening, etc). Pharmacists working as part of the health care team can ensure optimal diabetes management.

Characterization of Type 2 Diabetes Mellitus Burden by Age and Ethnic Groups Based on a Nationwide Survey

BackgroundType 2 diabetes mellitus (T2DM) is the most common form of diabetes. Risk factors for its development include older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. ObjectiveThe purpose of this study was to characterize T2DM burden, from a patient perspective, with respect to age and race/ethnicity. MethodsAdults aged ≥18 years with T2DM from a large, Internet-based, nationwide survey were retrospectively analyzed. Demographic and clinical characteristics (glycemic control, body mass index [BMI], comorbidities, and diabetes-related complications), hypoglycemic episodes, and medication adherence were used to assess diabetes burden. Degree of burden was compared across age (18–64, 65–74, and ≥75 years) and racial/ethnic (white, African American, Hispanic, Asian, and American Indian) groups. ResultsAn apparent association was found between glycemic control and medication adherence. Hispanics had the lowest percentage of participants with a hemoglobin A1c (HbA1c) level <7.0% (24.4%) and the highest percentage of those not knowing their HbA1c levels (55.4%) but also had the poorest medication adherence among racial/ethnic groups. Conversely, American Indians and whites had the best glycemic control, HbA1c knowledge, and medication adherence. The 18- to 64-year age group had the poorest glycemic control (28.8%), the most with unknown HbA1c levels (46.3%), and the poorest medication adherence of the age groups. Mean BMIs were high (>30 mg/kg2) for all racial/ethnic groups other than the Asian group (28.9 mg/kg2). Approximately 71% of Asians were obese or overweight compared with ≥90% in the other racial/ethnic groups. Mean BMIs decreased with increasing age group (34.5, 32.6, and 29.8 kg/m2 for the age groups of 18–64, 65–74, and ≥75 years, respectively). Regarding diabetes-related comorbidities, the Asian group had the lowest percentages of those with hypertension (39.1%) and hypercholesterolemia (46.6%). The Asian group had the lowest mean Charlson Comorbidity Index (CCI) score (score of 1.4); the American Indian group had the highest CCI score (score of 1.8). Of the age groups, the 65- to 74-year group had the highest percentages of those with hypertension (69.0%) and hypercholesterolemia (67.4%). The mean CCI scores in the 65- to 74-year and ≥75-year age groups (scores of 1.8 for both) were significantly higher than in the 18- to 64-year age group. The Asian group had the lowest percentage of participants reporting hypoglycemia (37.3%). The 18- to 64-year age group had the highest percentage of participants reporting hypoglycemia (52.7%). Limitations of this study include selection bias (Internet-based survey), recall bias, missing values, and descriptive analyses without adjustment for multiplicity. ConclusionThere are many factors that contribute to diabetes burden and the complexity of diabetes management. The results of this study provide insight from a patient perspective regarding how these factors vary across age and race/ethnicity to aid in the individualization of diabetes treatment.

Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options.

This review is focused on the prevalence of eating disorders and disordered eating behaviors in individuals with type 1 diabetes. Recent research indicates higher prevalence rates of eating disorders among people with type 1 diabetes compared with their peers without diabetes. Eating disorders and disordered eating behaviors-especially insulin omission-are associated with poorer glycemic control and serious risk for increased morbidity and mortality. Screening should begin in pre-adolescence and continue through early adulthood, as many disordered eating behaviors begin during the transition to adolescence and may persist for years. Available screening tools and treatment options are reviewed. Given the complexity of diabetes management in combination with eating disorder treatment, it is imperative to screen early and often, in order to identify those most vulnerable and begin appropriate treatment in a timely manner.

An algorithm for the treatment of type 2 diabetes in Latin America

Diabetes is a principal and growing health concern in Latin America, accounting for significant mortality and morbidities. Large, randomized, prospective trials of various interventional therapies in patients with both type 1 and type 2 diabetes have demonstrated that reductions in hyperglycaemia and management of diabetes-related risk factors can significantly reduce the micro- and macrovascular complications of diabetes. Therefore, patients with type 2 diabetes will benefit from more aggressive treatment regimens to help decrease the occurrence and rate of progression of diabetic complications. Given the many complexities of diabetes management, it is often difficult for general practice physicians to stay abreast of emerging treatment strategies and therapies. Owing to the high prevalence of type 2 diabetes in Latin America, the majority of patients with diabetes are treated by generalists rather than specialists. This article was intended to assist physicians and other healthcare professionals in developing and using effective treatment strategies to stem the growing epidemic of diabetes and its complications in Latin America.

Heuristic model linking contextual processes to self-management in African American adults with type 2 diabetes.

This article examines the influence of various environmental factors on the diabetes self-care practices of African American adults with type 2 diabetes. A heuristic model was developed that considers how community barriers and supports, availability and use of insurance, diabetes education, medical provider-patient relationships, extended family processes, and psychological functioning may indirectly affect metabolic control through the patient's ability to regulate diabetes. The proposed model offers a framework to demonstrate the complexity of diabetes management that may be unique to the African American experience. A comprehensive view of the environmental context will lead to new and more effective approaches in diabetes education and counseling for African American adults with type 2 diabetes.

The elderly type II diabetic: a treatment challenge.

Type II or noninsulin dependent diabetes mellitus is the predominant type of diabetes in the elderly. Complexities of diabetes management with elderly patients are discussed, including differences in presenting signs and symptoms of the disease, treatment complications that occur with concomitant illnesses or age-related physiological changes, and drug interactions that can lead to either hypo- or hyperglycemia. The goals of treatment are discussed. Standard therapies, including diet, exercise, and medications, are reviewed with the special considerations of the geriatric patient in mind.