Care Diabetes Clinic Research Articles

High prevalence in Malawi of sight-threatening retinopathy and visual impairment caused by diabetes: identification of population-specific targets for intervention.

AimsTo report the prevalence of all grades of diabetic retinopathy and associations with demographic, clinical and biochemical variables in people with diabetes in Southern Malawi.MethodsWe report baseline data from a 24-month prospective cohort study. Subjects were systematically sampled from two hospital-based, primary care diabetes clinics. Visual acuity, glycaemic control, systolic blood pressure, HIV status, urine albumin–creatinine ratio, and haemoglobin and serum lipid levels were assessed. Retinopathy was graded at an accredited reading centre using modified Wisconsin grading of four-field mydriatic photographs.ResultsA total of 357 subjects were studied. Of these, 13.4% subjects were HIV-positive and 15.1% had anaemia. The overall prevalence rates of any retinopathy, sight-threatening diabetic retinopathy and proliferative retinopathy were 50.1% (95% CI 44.9–55.3), 29.4% (95% CI 24.7–34.1) and 7.3% (95% CI 4.6–10.0), respectively. In multivariate logistic analysis the presence of sight-threatening retinopathy was associated with duration of diabetes (odds ratio 1.11, 95% CI 1.05–1.17), HbA1c (odds ratio 1.31, 95% CI 1.13–1.50), systolic blood pressure (odds ratio 1.03, 95% CI 1.01–1.04), haemoglobin (odds ratio 0.98, 95% CI 0.96–0.99) and LDL cholesterol (odds ratio 1.63, 95% CI 1.18–2.25). No significant association with HIV status was observed. In all, 3.6 and 1.4% of people in our study cohort had visual acuity worse than 6/18 and 6/60 in the better eye, respectively.ConclusionsThe present study found a prevalence of sight-threatening retinopathy in diabetes clinics in one Sub-Saharan African country of approximately four times that reported in recent European studies and a prevalence of proliferative retinopathy approximately 10 times higher. The association of sight-threatening retinopathy with lower haemoglobin level is a new finding. Our results highlight the urgent need for provision of services for retinopathy detection and management to avoid a large burden of vision loss.

Influence of foot ulceration on cause-specific mortality in patients with diabetes mellitus

The purpose of this study was to assess the odds of all-cause mortality in individuals with diabetic foot ulceration (DFU) compared with those with diabetes and no history of DFU. In addition, we sought to determine the strength of association of DFU with cardiovascular and nonvascular mortality. We obtained data for a cohort of patients who attended a secondary care diabetic foot clinic or a general diabetes clinic between 2009 and 2010. A clinic cohort of patients with diabetes and no history of DFU provided a control group. Cause-specific mortality was recorded during a median follow-up duration of 3.6years (interquartile range, 3.3-4.2years). The association between DFU and all-cause mortality was evaluated by Cox regression. The association between DFU and cardiovascular mortality was determined by competing risk modeling. We recorded 145 events of all-cause mortality and 27 events of cardiovascular mortality among 869 patients with diabetes. After adjustment for potential confounders, DFU was associated with both cardiovascular disease (hazard ratio, 2.53; 95% confidence interval, 0.98-6.49; P= .05) and all-cause mortality (hazard ratio, 3.98; 95% confidence interval, 2.55-6.21; P< .001). The proportion of deaths attributable to cardiovascular disease was similar between the groups (18% with diabetes only and 19% with DFU; P= .91). DFU is associated with premature death from vascular and nonvascular causes.

Diabetes care and control: the effect of frequent visits to diabetes care center.

BACKGROUND AND OBJECTIVESFrequent visits to diabetes care clinics linked with better control of diabetes mellitus (DM), but debates exist about how frequently visits should be done. The objective of this study was to assess the effect of frequent visits on diabetes care and control.DESIGN AND SETTINGSA prospective study of 100 diabetic patients attending Prince Abdul-Aziz Bin-Majed Diabetes Care Centre (PAMDCC), Al Madinah Al Munawwarah, Saudi Arabia, during the period from March 2011 through December 2012.METHODSDemographics, lifestyle, and diabetes data were obtained at the index visit. At that and subsequent visits, glycosated hemoglobin (HBA1c), blood pressure (BP) and low-density lipoprotein (LDL) were measured. All these data together with visit number and gap were recorded. Statistical analysis including linear regression analysis was done.RESULTSA significant reduction in the mean of diabetic control parameters was observed at the last visit. The highest mean changes were observed in patients with >6 visits, visit gap ≤1 month, and visit-month index ≥8. Adjusted linear regression showed that each visit significantly lowered HBA1c by 0.25%, BP by 2.1/0.7 mm Hg and 0.2 mmol/L for LDL. The number of visits needed to get HBA1c <7% and BP <130/85 was 8 and 5 visits with a visit-month index of 14 and 5, respectively.CONCLUSIONThe study suggests that frequent visits at short intervals may lead to better diabetes control. Other prospective clinical trial studies are needed to confirm these findings and to outline the appropriate cost-effective intervals and visit gaps.

Patient Perception of Midlevel Providers in Pediatric Diabetes Care

The purpose of this study was to evaluate perceptions of the role of midlevel providers among pediatric type 1 diabetes patients. The study population was a convenience sample of 82 youth with type 1 diabetes who were enrolled in the SEARCH for Diabetes in Youth Study, Carolina site, and attended either baseline (n = 22) or follow-up (n = 60) visits between May 25, 2012, and October 3, 2012. Self-administered surveys queried participants' understanding of providers' roles and perceived employment at clinics and whether participants had seen providers since diagnosis. Midlevel providers of interest included dietitians, nurse practitioners, physician assistants, and medical social workers. Mean proportions for each provider were compared to dietitians (referent) via a t test. Fisher exact tests were used to determine associations between survey responses. Baseline participants reported seeing a dietitian since diagnosis more often than they reported seeing an nurse practitioner, physician assistant, or medical social worker. Baseline and follow-up participants both reported understanding the role of dietitians significantly more than the role of other providers. Dietitians were reported by all participants to be employed at clinics more frequently than physician assistants or medical social workers. Seeing the provider was associated with patients' self-reported understanding of providers and their employment at diabetes care clinics. The survey population reported a high understanding of dietitian roles. However, the roles of other midlevel providers were not as well understood by youth with type 1 diabetes and their parents, which could represent a missed opportunity for care.

HLA alleles may serve as a tool to discriminate atypical type 2 diabetic patients.

To investigate whether the presence of human leukocyte antigen (HLA) marker could add new information to discriminated atypical diabetic type 2 patients. We analyzed 199 patients initially diagnosed as type 2 diabetes who are treated in special care diabetes clinics (3(rd) level). This population was classified in "atypical" (sample A) and "classic" (sample B) according to HLA typing. We consider "classic patient" when has absence of type 1 diabetes associated HLA alleles and no difficulties in their diagnosis and treatments. By the other hand, we considered "atypical patient" when show type 1 diabetes associated HLA alleles and difficulties in their diagnosis and treatments. The standard protocol Asociacion Latinoamericana de Diabetes 2006 was used for patients follow up. To analyze differences between both populations in paraclinical parameters we used unpaired t tests and contingence tables. Bivariate and multivariate analyses were carried out using the SPSS software program. In all studies we assume differences statistically significant, with a P-value < 0.05 corrected and 95%CI. The typing HLA in the "atypical" populations show that 92.47% patients presented at list one type 1 diabetes associated HLA alleles (DQB1*0201-0302 and DR 3-4) and 7.53% had two of its. The results showed for categorical variables (family history, presence or absence of hypertension and/or dyslipidemia, reason for initial consultation) the only difference found was at dyslipidemia (OR = 0.45, 0.243 < OD < 0.822 (P < 0.001). In relation to continuous variables we found significant differences between atypical vs classic only in cholesterol (5.07 ± 1.1 vs 5.56 ± 1.5, P < 0.05), high density lipoproteins (1.23 ± 0.3 vs 1.33 ± 0.3, P < 0.05) and low density lipoproteins (2.86 ± 0.9 vs 3.38 ± 1.7, P < 0.01). None of the variables had discriminating power when logistic regression was done. We propose an algorithm including HLA genotyping as a tool to discriminate atypical patients, complementing international treatment guidelines for complex patients.

PHP55 - The Hybrid Purchaser-Provider Split in England: Should Europe Follow Suit?

Developed countries have embraced the purchaser-provider split as a mechanism to improve health resource allocation and outcomes. With the emergence of Clinical Commissioning Groups (CCGs) as both buyers and providers of health services a hybrid purchaser-provider model is being explored. This research explored the opportunities and challenges of this model and analysed the implications for NHS England and Europe. Eighty influential regional and national payers involved in the NHS England reforms took part in 1-hour tele-depth interviews to better understand the changes and uncertainties before the reforms were implemented. This research was re-visited three months post implementation in an advisory board setting to externally validate our findings and identify case studies for further analysis. NHS payers stated that they were still ‘broadly optimistic’ about the re-allocation of purchaser responsibilities to CCGs. One case study illustrated that greater clinician involvement provided opportunities to redesign services like respiratory care and allocate funding more efficiently between acute and primary care. Initial success stories include the creation of primary care diabetes clinics and Pharma-NHS local partnerships to help reduce hospital activity. Within the advisory board, payers voiced concerns with this hybrid model. Questions raised from the meeting included: 1) How do we equip GP commissioners with the right skill set to draft and negotiate hospital contracts? 2) How can we help GP commissioners and GP providers to help minimise potential conflicts of interest? The purchaser-provider model implemented in England presents a new way to tackle reduced financial budgets and need to improve health outcomes. The results of this research suggest that the purchaser-provider model has the potential to make a difference for patient care. A number of challenges appear to still be present and it will be important to address these in order for the UK and other countries to further explore its benefits.

Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management

To prospectively use a non-invasive algorithm to identify asymptomatic, advanced non-alcoholic fatty liver disease (NAFLD) in a secondary care diabetes clinic and to determine the short-term effect of a multi-disciplinary team (MDT) approach in a liver clinic. NAFLD Fibrosis Score (NFS) was calculated in 64 asymptomatic patients with type 2 diabetes. Advanced fibrosis was identified using transient elastography and confirmed with liver biopsy. In a subsequent retrospective study, 95 patients newly referred to the NAFLD MDT clinic were investigated and the impact of the MDT approach assessed. 25/64 (39.0%) of patients with diabetes had a low NFS (<-1.455). 39/64 (61.0%) patients had a high or indeterminate NFS and were referred for review in the NAFLD MDT clinic, of which 23/39 attended for assessment. 19/23 (82.6%) were diagnosed with NAFLD, of which 6/19 (31.6%) patients had a positive transient elastography (≥8 kPa). Liver biopsy confirmed advanced fibrosis in 5/6 cases, with moderate fibrosis in 1 case. In the retrospective study, 65/95 (68.4%) new referrals to the NAFLD MDT clinic had a diagnosis of NAFLD. Over a median 98 days (IQR 70-182) follow-up, there was a significant improvement in weight (-0.8 kg; P = 0.024), total cholesterol (-0.2 mmol/L; P = 0.044), ALT (alanine transmaminase, -12.5 IU/L; P < 0.001) and GGT (gammu-glutamyl transferase, -13.0 IU/L; P < 0.0001). 7/28 (25%) of patients with diabetes achieved >5% weight loss. A significant proportion of asymptomatic patients attending type 2 diabetes clinics have undiagnosed advanced NAFLD fibrosis. An MDT approach to NAFLD results in short-term improvements in metabolic and liver parameters.

Costs of Recalled and Recommended Diets for Pregnant Women with Type 1, Type 2 and Gestational Diabetes

The costs associated with nutritious foods may be a barrier to healthy dietary choices and of particular concern to pregnancies complicated by diabetes. Therefore, a survey was conducted in a tertiary care diabetes and pregnancy clinic to compare the associated costs of actual food choices versus the cost of a constructed recommended diet. Women with types 1, 2 and gestational diabetes mellitus (GDM) completed 24-hour dietary recalls under the supervision of the research coordinator (Actual Diet). A Recommended Diet for this population was constructed independent of participant responses. Actual and Recommended Diets were standardized per 2000 kcal, priced and compared for content and cost. Seventy-five women participated: 27 with GDM, 29 with type 1 diabetes and 19 with type 2 diabetes. There were no significant cost differences between Recommended and Actual Diets food choices expressed per 2000 kcal: Recommended Diet $10.14±3.72; Actual Diet GDM: $11.30±3.88; Actual Diet type 1 diabetes: $9.00±3.16; Actual Diet type 2 diabetes: $10.24±3.92. Percentage of fibre intake was lower for Actual Diets than Recommended Diet for all groups, while percentage of protein intake was lower in Actual than Recommended Diet for women with type 1 diabetes. Clinical recommendations for healthy food choices may not be more expensive than actual choices made by pregnant women with diabetes.

PP32 Are there Socio-Inequalities Associated With Type 2 Diabetes Care?

BackgroundThere has been increasing research interest in the adverse effects of public health interventions; notably concern that processes in the planning or delivery of an intervention may create or exacerbate...

Into the abyss: diabetes process of care indicators and outcomes of defaulters from a Canadian tertiary care multidisciplinary diabetes clinic

BackgroundContinuity of care is essential for good quality diabetes management. We recently found that 46% of patients defaulted from care (had no contact with the clinic for 18 months after a follow-up appointment was ordered) in a Canadian multidisciplinary tertiary care diabetes clinic. The primary aim was to compare characteristics, diabetes processes of care, and outcomes from referral to within 1 year after leaving clinic or to the end of the follow-up period among those patients who defaulted, were discharged or were retained in the clinic.MethodsRetrospective cohort study of 193 patients referred to the Foustanellas Endocrine and Diabetes Center (FEDC) for type 2 diabetes from January 1, 2005 to June 30, 2005. The FEDC is the primary academic referral centre for the Ottawa Region and provides multidisciplinary diabetes management. Defaulters (mean age 58.5 ± 12.5 year, 60% M) were compared to patients who were retained in the clinic (mean age 61.4 ± 10.47 years, 49% M) and those who were formally discharged (mean age 61.5 ± 13.2 years, 53.3% M). The chart audit population was then individually linked on an individual patient basis for laboratory testing, physician visits billed through OHIP, hospitalizations and emergency room visits using Ontario health card numbers to health administrative data from the Ministry of Health and Long-Term Care at the Institute for Clinical and Evaluative Sciences (ICES).ResultsRetained and defaulted patients had significantly longer duration of diabetes, more microvascular complications, were more likely to be on insulin and less likely to have a HbA1c < 7.0% than patients discharged from clinic. A significantly lower proportion of patients who defaulted from tertiary care received recommended monitoring for their diabetes (HbA1c measurements, lipid measurements, and periodic eye examinations), despite no difference in median number of visits to a primary care provider (PCP). Emergency room visits were numerically higher in the defaulters group.ConclusionsPatients defaulting from a tertiary care diabetes hospital do not receive the recommended monitoring for their diabetes management despite attending PCP appointments. Efforts should be made to minimize defaulting in this group of individuals.

Population‐based screening for the prevention of lower extremity complications in diabetes

Diabetes-related foot disease is a major health problem leading to significant morbidity and cost. If high-risk populations could be identified and treated before they develop complications, a significant reduction in the burden of foot disease and number of amputations might be expected. We examined the evidence to support population-based screening programs. MEDLINE and EMBASE databases were searched from January 1970 to February 2012 to identify studies assessing the impact of screening on lower limb complications in diabetes. Foot screening was defined as combined risk stratification and intervention to prevent foot complications in a population of people with diabetes mellitus. Articles reporting singularly on stratification of risk factors to predict subsequent complications but not reporting effect on minor, major and/or combined major and minor (total) amputation were excluded. Two randomized control trials were identified. These demonstrated patient benefit from screening in the setting of a general secondary care diabetes clinic and renal dialysis unit. Four before and after studies suggested benefit from primary care or regional screening. One study tried to address confounding from general improvements in the provision of diabetes foot care separately from screening. All the observational studies were prone to confounding. The evidence base for formal national primary care-based foot screening of all patients with diabetes is weak. Focused research is needed to confirm that general population-based screening in the community is effective and cost-effective. Limited evidence suggests that screening of high-risk populations of patients may be justified.

Content validity of the illness perceptions questionnaire – revised among people with type 2 diabetes: A think-aloud study

Objectives : to access the cognitions of adults with type 2 diabetes whilst completing items on the Illness Perceptions Questionnaire – Revised (IPQ-R). To determine whether these cognitions are congruent with the meaning of items and subscales as interpreted by researchers and clinicians using the IPQ-R and to identify the nature and extent of problems that individuals experience when completing the IPQ-R. Design : participants (n = 36) were recruited from a primary care diabetes clinic and a hospital diabetes clinic. They were asked to complete the IPQ-R using a ‘think-aloud’ methodology. Main outcome measures : transcripts were analysed to identify instances where participants expressed problems with item completion, or where there was inconsistency between verbal and written responses. Results : the most problematic subscales were those of ‘personal control’ and ‘consequences’. Conclusion : generally, participants found the IPQ-R unproblematic. However, participants had problems with the concept of ‘cure’ and ‘symptoms’ in the context of type 2 diabetes, and with the negative phrasing used in some items. These findings have important implications for the interpretation of IPQ-R scores, particularly when the IPQ-R is used as the basis for individualised interventions among people with type 2 diabetes.

The relationship between physical activity, restless legs syndrome, and health-related quality of life in type 2 diabetes

To evaluate the relationship between physical activity with co morbidities and health-related quality of life in type 2 diabetic patients with and without restless legs syndrome (RLS). This is an observational study, set at tertiary care diabetic outpatient clinic, where 200 consecutive type 2 diabetic patients and 47 controls participated. Physical activity level was established by the International Physical Activity Questionnaire (IPAQ) and RLS diagnosis and RLS severity were established using the criteria defined by the International Restless Legs Syndrome Study Group; excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale, quality of sleep by the Pittsburgh Sleep Quality Index and Health-Related Quality of Life by the Short-Form Health Survey (SF-36). Depressive symptoms were investigated by Beck Depression Inventory (BDI- II). Among all diabetic patients (58 % women, mean age 52.7 ± 5.7), disease duration varied from 1 to 30 years (11.7 ± 7.5). Diabetic patients had more hypertension (76 %), peripheral neuropathy (65 %), and depressive symptoms (31 %) than controls; no gender differences were found between cases with and without depressive symptoms. RLS patients (72 % female) had worse quality of sleep. With regards to the quality of life domains, more active RLS diabetic patients had better perception of functional capacity, physical limitation, pain, and general health state (p < 0.05). RLS symptom severity did not vary according to physical activity (IPAQ level). This study shows that the physical activity is associated with a better perception of functional capacity, physical limitation, and pain in diabetic patients with RLS; thus a more active lifestyle should be encouraged.

Insulin-dependent diabetic patients with macrovascular complications suffer from many geriatric conditions

BackgroundCurrent diabetic care guidelines focus mainly on managing metabolic control and macro- and microvascular comorbidities. This focus may be too narrow given the number of geriatric conditions present in these often aged patients. MethodsWe studied the prevalence of multimorbidity, (undiagnosed) geriatric conditions and disabilities in diabetic patients with macrovascular complications. ResultsOne hundred forty-three community dwelling, insulin-dependent diabetic patients with macrovascular complications, aged 55years and above, who were concurrently enrolled in the diabetes care clinic in a university hospital in the Netherlands, participated. Data on healthcare utilization, activities of daily living, geriatric conditions and quality of life were self-reported using a systematic diagnostic questionnaire. Mean age was 66.9years (8.5years), 62% were male and 22% were of Surinamese-South Asian descent. Loneliness was reported by 47%. The majority rated their quality of life (QoL) from ‘reasonable’ (45%) to ‘good’ (31%). In patients without ADL impairments, 60% were in need of assistance, compared to 95% among those with more than one impairment (p<0.01). In total, 19% had cognitive impairment, and 63% perceived pain. 84% of patients with impairments experienced social problems compared to 32% of patients in the other group. ConclusionsThis study demonstrates that the current focus of diabetes care may be too restricted given the high number of geriatric conditions that these patients present.

Diabetic Foot Problems in Tertiary Care Diabetic Clinic in Thailand

Foot problems in patients with diabetes cause substantial morbidity and may lead to lower extremity amputations. These risks may be reduced by appropriate screening and intervention measures. Effective screening assigns the patient to a risk category and dictates both the type and frequency of appropriate foot interventions. Less than half of diabetic patients in tertiary care hospital in Thailand received annual foot examination and there are limited data available on the nature of foot problems in such setting. This study reported a cross-sectional data of 438 diabetic patients attend tertiary diabetic clinic in the university hospital in Northern Thailand. Neuropathy manifestations as skin dryness, limitation of joint mobility and insensate to monofilament was the most common manifestation of diabetic foot problems in this setting. Most patients were not protected by proper footwear. More effort is needed to educate diabetic patients about foot care and improve their choice and selection of footwear.

Survey of transitional care service for patients with type 1 diabetes mellitus

<h3>Aim</h3> To assess patient satisfaction with the transitional care service in type 1 diabetes. <h3>Methods</h3> An anonymous questionnaire was retrospectively sent to 37 patients who had attended the diabetic transitional care clinics over a period of 2 years from 2009- 2011. The patients were aged 16-19 years at the time of the survey. The questionnaire addressed various aspects of the service including the information given before transition, clinic environment, education provided and the communication with and within the diabetic team. <h3>Results</h3> 11 out of 37 (30%) patients responded to the questionnaire. The median age was 18 years. 91% felt that sufficient notice was given for the transitional care service. 55% felt well informed about what to expect from the service. 64% were made aware of the professionals the patient would meet when attending the clinic. 27% felt that written information would be helpful before the clinic. Only 36% felt that the appointment times were convenient. 73% felt that they had the opportunity to ask questions and express concerns during the appointment. 60% were educated about diabetes and alcohol whilst only 13% received information about safe sex and contraception. 29-36% received information about diabetes and university education, leaving home and driving licence. 45% felt that the clinic environment was suitable for a young adult. 64% felt that they had the opportunity to meet the staff they had expected to see. 73% said that the diabetic team communicated well with each other about the patients needs. 73% felt the team was easily approachable. 83% felt that it was easy to contact the diabetic team out side the clinic hours. 60% felt that the service was helpful in transition to adult care. 80% felt confident to transfer to adult care after attending the clinics. <h3>Conclusion</h3> Transitional care service has been shown to be beneficial in ensuring smooth transition of adolescents to adult service and our data supports this. This survey has highlighted that adequate education in various important aspects of adolescence needs to be addressed in these clinics.

Reasons for non-attendance: audit findings from a nurse-led clinic

Evidence has shown that non-attendance at clinics occurs for a variety of reasons and impacts negatively on client outcomes and effective use of clinic resources. This paper reports an audit of non-attendance at Care Plus and diabetes clinics undertaken between October 2007 and October 2008, in a large general practice in the Wellington region. A retrospective and prospective audit of the non-attendance rate at nurse-led wellness clinics was completed using the Query Builder function in Medtech32, collecting data from 142 people who did not attend a scheduled appointment. Thirty-three people were unable to be contacted about their reason for not attending. Of those contacted, 68 did not attend because they were unaware of the appointment, confused regarding the appointment time, or simply forgot. Eighty-four people were aged between 18 and 65 years, yet of those contacted, only four cited work had prevented their attendance at the clinic. Difficulty with transport was reported by only two people. The audit highlighted the importance of administration processes for scheduling routine appointments and reminding patients about appointments. It provided evidence that administrative support for nurse-led clinics is necessary. Involvement in clinical audit was a new experience for many of the staff and the usefulness of the findings led to more positive views about how audit can be used. The importance of appropriate administrative support was highlighted. Lessons learned for future audits included the importance of a complete data set and consistent use of codes for data entry.

Short-term outcomes of an employer-sponsored diabetes management program at an ambulatory care pharmacy clinic

The impact of a collaborative, employer-sponsored diabetes management program on glycemic control and other clinical endpoints over 6-12 months is reported. In a retrospective, chart-based evaluation, glycosylated hemoglobin (HbA(1c)) and related health status indicators were assessed among first-year enrollees in the Healthy Outcome Partnership for Employees (HOPE) with Diabetes Program, an ongoing program sponsored by the Wake Forest Baptist Health (WFBH) system. Diabetes management services were provided by pharmacists in collaboration with providers inside and outside the WFBH system. The primary endpoint was the mean change in HbA(1c) during follow-up averaging 8.2 months; secondary endpoints included changes in blood pressure, cholesterol, and triglyceride levels. Among the 98 patients included in the data analysis (75.5% women, 72.4% Caucasian), the mean HbA(1c) value decreased significantly during the study period (from 7.8% to 7.1%, p < 0.01); the proportion of patients at the recommended goal of an HbA(1c) of ≤7.0% rose from 40.8% to 56.1% (p < 0.01). HOPE Program enrollees also experienced significant improvements in mean triglyceride, total cholesterol, and blood pressure values (p < 0.05 for all). A subgroup of patients with initially poor glycemic control (HbA(1c) of ≥8.0%) had a mean HbA(1c) reduction of 1.7 percentage points during the study (p < 0.01), suggesting that the greatest benefits occurred in the highest-risk patients. Among patients seen for at least six months at an employer-sponsored ambulatory care diabetes clinic managed by pharmacists, significant improvements from baseline in clinical end-points including HbA(1c) and blood pressure were demonstrated.

Prevalence of diabetic retinopathy, cataract and visual impairment in patients with diabetes in sub-Saharan Africa

Background/aimsThere are few published data on the prevalence of diabetic retinopathy in sub-Saharan Africa. We report the prevalence of all grades of retinopathy and associations with systemic parameters in patients...

Prevalence and Correlates of Dietary Supplement Use in Individuals With Diabetes Mellitus at an Academic Diabetes Care Clinic

This study sought to describe the prevalence of supplement use by those with diabetes mellitus receiving care at an academic outpatient diabetes care center and to identify any association of supplement use with glycemic control. This study is based on a retrospective audit of provider-verified and patient-self-reported medication and supplement use by adults with diabetes at the University of Washington Diabetes Care Center during four 2-week periods from fall 2006 through summer 2007 (1 period per season). Verified medication and supplement histories for 459 adults demonstrated a per-person average use of 7 ± 4.1 prescription medicines and 0.4 ± 0.9 over-the-counter medicines daily, with 55% using some form of vitamin, mineral, or nonvitamin-nonmineral supplement on a daily basis. The rate of nonvitamin-nonmineral use was nearly twice that for type 2 diabetes mellitus as for type 1 diabetes mellitus (39.3% vs 20.3%), and A1c was lower in those using any supplement compared to those not using supplements. Vitamin use was associated with reduced A1c; however, this relationship did not hold at A1c < 7.0%. The findings highlight the prevalence of supplement use in diabetes mellitus and association of supplement use with improved glycemic control. Findings are limited by the retrospective design.