Diabetes Care Team Research Articles

Diabetes Care Network: A Novel Model to Disseminate Team-Based Diabetes Specialty Care in a Rural Population.

The purpose of the study was to examine the impact of a novel approach to provide diabetes specialty team care to rural patients with type 2 diabetes (T2DM) on clinical outcomes and processes of care. Diabetes Care Network (DCN) provides Veterans with T2DM and elevated A1C an initial 6-week period of remote self-management education and support and medication management by a centrally located team of diabetes specialists. Participants are then comanaged by remote liaisons embedded in rural primary care facilities for the remainder of the 12-month intervention. In this pre-post intervention study, 87 Veterans enrolled in DCN from 2 different clinical sites had baseline and 12-month postenrollment A1C, systolic blood pressure, weight, and LDL cholesterol levels collected and compared using paired t tests. Participants were mostly male and White with elevated baseline A1C. Participants from both sites had significant improvement in A1C over the 12-month intervention period compared to an increase in the 12 months prior to enrollment. There were also significant improvements in LDL and systolic blood pressure at 1 site, with no significant change in weight at either site. DCN participants had significant improvement in A1C after not meeting similar goals previously in a robust primary care setting. A technology-enabled collaborative partnership between centrally located diabetes care teams and local liaisons is a feasible approach to enhance access to diabetes specialty care for rural populations.

Current and Emerging Trends in Diabetes Care and Education: 2021 National Practice and Workforce Survey.

The purpose of the National Practice Survey is to understand current trends related to the diabetes care and education specialist's integration into the full care team beyond formal diabetes self-management education and support services. The 2021 National Practice Survey (NPS2021) contained 61 questions for all respondents with an additional 56 questions pertaining to specific diabetes care and education segments. An anonymous survey was administered online to respondents who are diabetes care and education specialists or a part of the diabetes care team. Email lists were obtained from the Association of Diabetes Care & Education Specialists (ADCES) and the Certification Board for Diabetes Care and Education (CBDCE). Approximately 39,258 emails were sent, and 3357 were undeliverable, with 3797 surveys completed between February 9 to April 6, 2021, resulting in an 11% response rate. The response rate may have been affected by the COVID-19 public health emergency. Diabetes care and education specialists represent an interprofessional specialty of nurses, dietitians, physicians, pharmacists, health educators, and others. Many respondents reported holding either certification as a Certified Diabetes Care and Education Specialist (CDCES) or being Board Certified in Advanced Diabetes Management (BC-ADM). In addition, there appears to be a slight increase in those trained as a Lifestyle Coach to provide the National Diabetes Prevention Program (CDC Recognized National DPP) compared to NPS2017. Most respondents reported being Caucasian/White (84%), followed by Hispanic or Latinx (7%) and African American/Black and Asian/Asian American (at 4% each), like in previous surveys. Respondents reported diverse care delivery models, including traditional and nontraditional services, and expanded models of care such as population health/risk stratification models, the Chronic Care Model, Accountable Care Organizations, managed care, and others. The NPS2021 describes DCES workforce opportunities and challenges. Identifying and addressing those that impact the specialty's sustainability, diversity, and growth will guide strategies for the future workforce and their practice settings. Opportunities identified include embracing diabetes community care coordinators for person-centered delivery of care and education services and supporting frontline health care team members to increase competence and expertise in the prevention of type 2 diabetes, diabetes care, and education/support for related chronic diseases. In addition, as health care evolves, it creates opportunities for the DCESs to demonstrate a broader, key role as part of the diabetes care team.

Health care organization and use of technological devices in people with diabetes in Italy: Results from a survey of the Working Group on Diabetes and Technology

Background and aimThe use of technology offers recognized benefits to persons with diabetes. The aim of this study was to evaluate the organization of healthcare facilities, the composition of the diabetes team, and the use of Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in Italy. Methods and resultsDiabetes care centers were asked to complete a web survey based on information collected in 2018. Sixty-one pediatric and 243 adult centers participated in the survey, accounting for 507,386 patients, mostly with type 2 diabetes (86.4%). Fifty-three percent of pediatric centers and 11% of adult centers reported a team composed of diabetologists, nurses, and psychologists. Overall, 13,204 patients (2.6%) were using CSII (95% with type 1 diabetes), and 28,936 (5.7%), were using CGM (74% with type 1 diabetes). When stratifying for the type of diabetes, 24% and 40.8% of patients with type 1 were using CSII and CGM, respectively, whereas low use of technology was reported for patients with type 2 and women with gestational diabetes. The percentage of adult and pediatric patients with type 1 diabetes on CSII and CGM was respectively 21% and 32%, and 35% and 57%. ConclusionsThe spread of CGM and CSII increased in Italy between 2013 and 2018. However, the percentage of users is still lower than what is expected based on clinical indications for use of technology. The inadequate number of professionals in the diabetes care team and insufficient economic resources are relevant barriers to disseminating technology for diabetes management.

A qualitative analysis of the needs and wishes of people with type 2 diabetes and healthcare professionals for optimal diabetes care.

AimGlobally, type 2 diabetes care is often fragmented and still organised in a provider‐centred way, resulting in suboptimal care for many individuals. As healthcare systems seek to implement digital care innovations, it is timely to reassess stakeholders' priorities to guide the redesign of diabetes care. This study aimed to identify the needs and wishes of people with type 2 diabetes, and specialist and primary care teams regarding optimal diabetes care to explore how to better support people with diabetes in a metropolitan healthcare service in Australia.MethodsOur project was guided by a Participatory Design approach and this paper reports part of the first step, identification of needs. We conducted four focus groups and 16 interviews (November 2019–January 2020) with 17 adults with type 2 diabetes and seven specialist clinicians from a diabetes outpatient clinic in Brisbane, Australia, and seven primary care professionals from different clinics in Brisbane. Data were analysed using reflexive thematic analysis, building on the Capability, Opportunity, Motivation and Behaviour model.ResultsPeople with diabetes expressed the wish to be equipped, supported and recognised for their efforts in a holistic way, receive personalised care at the right time and improved access to connected services. Healthcare professionals agreed and expressed their own burden regarding their challenging work. Overall, both groups desired holistic, personalised, supportive, proactive and coordinated care pathways.ConclusionsWe conclude that there is an alignment of the perceived needs and wishes for improved diabetes care among key stakeholders, however, important gaps remain in the healthcare system.

Adherence to Contraceptive Use Guidelines and Preconception Advice in a Diabetes Clinic

Background: Women with diabetes have more complications during pregnancy. Contraceptive advice to prevent unplanned pregnancy is of utmost importance for them. Maintenance of strict glycaemic control is essential to have a positive outcome in pregnancy and proper care. Preconception care and counselling to help pregnancy planning is thus essential. Aim: To assess whether proper education regarding importance of contraceptive use, preconception care and advice is being imparted to female diabetics according to NICE guidelines Method: This is a proposed monocentric retrospective clinical audit to evaluate adherence of a diabetes clinic to NICE guidelines regarding education and advice on contraceptive use and preconception care. The three criteria being assessed include documentation of patient’s intentions regarding contraceptive use and pregnancy at each visit with the diabetes care team; offering patients intending to get pregnant a structured education programme as soon as possible; and preconception care and advice being imparted to patients wanting to try for pregnancy before discontinuing contraception. Two patient cohorts, each consisting of 50 patients who meet the inclusion and exclusion parameters for the respective criteria will be made. Data collection will be done by the diabetologist, the diabetes specialist nurse and the practice nurse at St. June’s Diabetes Clinic. Data will be collected by accessing previous records of patients from 01 January 2021 to 31 December 2021. Data will be compiled as a percentage and compared with the standard. Conclusion: Improved patient-staff communication is the key point to improve compliance with NICE guidelines regarding these standards.

Physical Activity Behavior During the COVID-19 Outbreak in Individuals with Type 2 Diabetes: Role of Social Support and Other Covariates.

ObjectivesThis study was performed to investigate whether social support and other psychological predictors were associated with physical activity during the prolonged social isolation due to the coronavirus disease 2019 outbreak in Iran.MethodsThis cross-sectional study was performed on 494 individuals with type 2 diabetes (T2D) in a diabetes specialty clinic. The questionnaire package comprised five parts, including sociodemographic and clinical characteristics, physical activity level, diabetes-specific social support, feelings of isolation, and diabetes-related distress. Clinical and hemoglobin A1c data were obtained from electronic medical records. Descriptive statistics, Pearson’s chi-square test, and multivariable logistic regressions were conducted to analyze the data.ResultsApproximately 71% of the participants participated in low/insufficient levels of physical activity. The participants who received support from family/friends (odds ratio [OR] = 1.77; 95% confidence interval [CI]: 1.47 - 2.74), diabetes care team (OR = 1.42; 95% CI: 1.15 - 1.77), and neighbors (OR = 1.53; 95% CI: 1.20 - 2.08) were more likely to have sufficient physical activity than those who did not receive these supports. There was also an association between physical activity behavior with feelings of isolation and diabetes distress.ConclusionsThis study points to the importance of social support as an amplifier mechanism for the maintenance of physical activity behavior in individuals with T2D during critical times.

Health-Care Disparities in the Use of Diabetes Technologies in the UK

Health inequalities have been a longstanding challenge for decades with widening disparities in recent years. Much focus is rightly placed on inequalities based on race/ethnicity, but it is clear that racial disparities and socioeconomic deprivation are interlinked. The connection between systematic and personal bias against individuals from the most deprived groups, irrespective of ethnicity, clearly exists. Socioeconomic deprivation appears to be an influential factor driving health disparities, with implicit bias directed against individuals living in poverty. This is reflected in access to diabetes technologies such as insulin pump therapy, continuous glucose monitoring systems, and automated insulin delivery where those from ethnic minority backgrounds and those in areas of highest deprivation are least able to access or benefit from such technological advancements. Inequalities are further reinforced by government cuts in spending. Between 2009 and 2020, net expenditure per person in local authorities in the 10% most deprived areas fell by 31% compared with a 16% decrease in the least deprived areas. These regressive cuts included a failure of health-care spending to rise in accord with historical patterns. Compounding the challenges were cuts to public health funding and reductions in welfare payments to families most in need. These widening health inequalities are unacceptable and unfair within a national health system where all individuals are entitled to the same level of care. Improved access to specialist diabetes care teams and to life-enhancing technologies could improve the health of all people with diabetes and reduce its human and financial cost.

Continuous Glucose Monitoring Data Sharing in Older Adults With Type 1 Diabetes: Pilot Intervention Study.

BackgroundFamily members or friends (care partners [CPs]) of older adults with type 1 diabetes (T1DM) regularly become part of the diabetes care team, but they often lack knowledge about how to become involved to prevent hypo- and hyperglycemia. Continuous glucose monitoring (CGM) allows a person with diabetes to see their glucose levels continuously and to receive predictive alerts. A smartphone data-sharing app called the Follow app allows the person with diabetes to share continuous glucose numbers with others and to receive predictive alerts of impending hypo- and hyperglycemia. However, there are barriers to sharing this continuous glucose level data with CPs.ObjectiveThis study aimed to address the barriers to sharing CGM data. Our objective was to examine the feasibility of using CGM with the Follow app and a data-sharing intervention called SHARE plus in older adults with T1DM and their CPs. SHARE plus includes dyadic communication strategies, problem-solving strategies, and action planning to facilitate CGM data sharing.MethodsOlder adults with T1DM (n=20) and their CPs (n=20) received the SHARE plus intervention at baseline. People with diabetes wore the CGM for 12 weeks while sharing their glucose data using the Follow app with CPs. Feasibility data were analyzed using descriptive statistics.ResultsThe SHARE plus intervention was feasible and was associated with high self-reported satisfaction for people with diabetes and their CPs as well as high adherence to CGM (mean 96%, SD 6.8%). Broad improvements were shown in the diabetes-related quality of life through the use of CGM in people with diabetes and their CPs. Although the majority of people with diabetes (11/20, 55%) were willing to share hyperglycemia data, several chose not to. The majority of people with diabetes (14/20, 70%) were willing to talk about glucose numbers with a CP.ConclusionsOlder adults with T1DM and their CPs identified having someone else aware of glucose levels and working together with a partner on diabetes self-management as positive aspects of the use of the SHARE plus intervention. Clinicians can use these results to provide data sharing coaching in older adults and their CPs.

Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country.

There has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care; (2) referral system for patients across transitions of care between different health professionals of the diabetes care team; (3) tools for the provision of collaborative care and documentation of care; (4) diabetes education and counselling by trained diabetes educators; and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country.

SHARE plus: Delivering a Telehealth CGM Data-Sharing Intervention to Older Adults and Their Care Partners.

Care partners of older adults with type 1 diabetes often become part of the diabetes care team but lack knowledge of how to become involved with glucose management. This article describes a study confirming the feasibility of SHARE plus, a telehealth intervention involving continuous glucose monitoring and data-sharing to assist these individuals in working together on diabetes management. The intervention provides a strategy for increasing remote patient monitoring and facilitating care partner involvement in diabetes management.

Effects of a low-carbohydrate diet in adults with type 1 diabetes: an interventional study protocol

<p><strong>Background:</strong> Type 1 diabetes (T1D) is an autoimmune condition characterised by pancreatic beta cell destruction and absolute insulin deficiency. The varying impact of dietary factors on blood glucose levels is well-known, yet there remains a lack of consensus surrounding the optimal dietary approaches to achieve glycaemic control in T1D. The aim of this research is to assess the efficacy of a low-carbohydrate (LC) diet in adults with T1D. We will set out to determine whether significant differences in T1D management outcomes exist between a LC diet and habitual diets higher in carbohydrate. Our primary hypothesis is that a LC diet will result in improved T1D management compared to habitual diets higher in carbohydrates. <strong></strong></p><p><strong>Methods:</strong> This is a 28-week single arm within-participant intervention study involving a 4-week control period, a 12-week intervention period and a 12-week follow-up. We plan to recruit 20 adults (18-60 years) with T1D (duration ≥6 months) who have suboptimal glycaemic control (HbA1c>7.0%). The primary outcome is haemoglobin A1c (HbA1c) and secondary outcomes include glycaemic variability, frequency of hypoglycaemia, total daily insulin, and quality of life. This LC diet will start at 50 g of digestible carbohydrate per day and then there will be opportunity to increase or decrease within a broader range of 25-75 g/day according to individual blood glucose levels and personal preference. Participants will meet individually with the study dietitian for a total of six fortnightly sessions to receive dietary instruction, strategies, and education. Participants will continue to work with a member of their usual diabetes care team for specific advice regarding insulin management.</p><p><strong>Conclusions:</strong><em> </em>Current dietary management strategies for T1D appear to be lacking in effect and additional dietary therapies, including LC diets, require urgent consideration. Therefore, an interventional study investigating a patient-led LC dietary approach will be of important clinical relevance for healthcare practitioners and may help to better inform clinical practice guidelines for T1D management.</p><p><strong>Trial Registration<em>: </em></strong>https://www.anzctr.org.au/ACTRN12621000764831.aspx <em></em></p>

COVID-19-specific diabetes worries amongst diabetic patients: The role of social support and other co-variates

BackgroundThe COVID-19 pandemic has impacted every individual’s life. It has been shown that mortality in people with underlying diseases including diabetes has been very high. The present study aimed to measure diabetes related worries (outcome) and their associations with social support and lifestyle (exposures) amongst people with diabetes during the COVID-19 pandemic. MethodsAn online cross-sectional survey was completed by 928 respondents (>18 years) between 15-11-2020 and 12-12-2020. The questionnaire comprised four sections: socio-demographic details, diabetic-related worries, social support, and behavioral changes due to COVID-19. Descriptive statistics, correlations and hierarchical regression analysis were performed in the study. ResultsData from 928 respondents (51.61% male; mean age = 52.48 [SD = 11.76]; age range = 18–86 years) were analyzed. The mean score for COVID-19 specific diabetes worries was 3.13 out of 8. Hierarchical regression analysis showed that the mean COVID-19-specific diabetes worries score was significantly associated with lower age, cigarette smoking, perceived poor health status, presence of other diabetic complications. Lack of social support from family, friends, work colleagues and diabetes care team and also eating more than usual were also significantly associated with COVID-19 specific diabetes worry. ConclusionsDiabetes related worries were strongly associated with a lack of social support during the COVID-19 pandemic. The findings suggest the need of social support as well as improving knowledge and guidelines is important for people with diabetes during the COVID-19 pandemic.

924-P: A Latent Class Analysis of Adolescent Preferences on Social Media Use by Diabetes Care Teams to Support Type 1 Diabetes Management

Objective: To identify latent classes of adolescents with type 1 diabetes (T1D) based on their interest in receiving diabetes management support from their diabetes care team via social media (SM). Methods: 227 adolescents with T1D (13-18 years old) in Seattle, WA completed a survey about their interest in communicating with their care team over SM. Latent class analysis was used to identify latent groups based on their stated preferences. Results: A 3-class solution was identified that minimized AIC (2042.1), BIC (2131.1), and maximized entropy (0.88) and the value of log-likelihood (-995.0). Over half the sample (n=114, 50.2%) belonged to Class 1, which was defined by a positive view of using SM to support diabetes management and a strong preference for using direct messaging options to communicate over social media (see Figure). Adolescents in Class 2 (n=47, 20.7%) had a similar outlook with respect to impact on communication but reported a preference for private social media communication options. Class 3 (n=66, 29.1%) accounted for adolescents not interested in communicating over SM. Conclusions: The majority of adolescents with T1D endorsed the use of SM communication tools to support diabetes management. Findings from this latent class analysis can be used to provide tailored strategies to meet adolescent preferences for SM use with the diabetes care team. Disclosure F. Malik: None. A. M. Ellyson: None. D. Christakis: None. R. Mangione-smith: None. C. Pihoker: None. M. A. Moreno: None. Funding National Institutes of Health (K23DK119465)

932-P: Impact of Insurance Source on Health Care Transition Progress in College Youth with Type 1 Diabetes

Background: The transition from pediatric to adult models of care can be challenging for adolescents with chronic diseases, like type 1 diabetes (T1D). Among the challenges they often face is the issue of health insurance, which can be difficult to navigate, and which may affect access to effective transitional care. In this study, we examined the impact of insurance source on healthcare transition (HCT) progress in college youth with T1D. Methods: Data are from 138 respondents to a multi-national, web-based study of college youth with T1D recruited via social media platforms and direct outreach. Participants were asked to report their health insurance source and answer questions about the HCT process and their diabetes care team. Descriptive statistics and multivariable regression were used to evaluate HCT measures as a function of sociodemographic variables, adjusting for confounders. Results: Participants were from 85 universities across 30 states and Canada, and 87.0% were covered on a parent’s insurance plan. Those not covered on a parent’s insurance plan were more likely to list a general adult practitioner as their main diabetes care provider (22.2% vs. 8.3%, p=0.067) but were less likely to have received help with finding an adult provider than their counterparts (44.4% vs. 76.3%, p=0.042). Participants not covered on a parent’s insurance plan (vs. those who were) also were more likely to have discussed obtaining health insurance with their provider (61.1% vs. 25.0%, p=0.002). These differences persisted after adjustment. Conclusion: College youth with T1D demonstrate differences in indicators of HCT progress according to insurance source. Lack of parental insurance may instigate independent - though not necessarily smooth - transitions, potentially leaving an increasing number of adolescents with dependent coverage vulnerable to a prolonged HCT. Efforts to improve the HCT process should consider insurance source to advance HCT preparation for all college youth with T1D. Disclosure R. K. Tsevat: None. E. R. Weitzman: None. L. E. Wisk: None. Funding Boston Children’s Hospital (FP01017994)

Exploring support needs of people living with diabetes during the coronavirus COVID-19 pandemic: insights from a UK survey

IntroductionThe coronavirus COVID-19 pandemic has radically compromised healthcare for people living with chronic conditions such as diabetes. Government-imposed restrictions to contain the spread of the virus have forced people to...

70-LB: Continuous Glucose Monitoring Data Sharing in Older Adults with Type 1 Diabetes and Their Care Partners

Background: Family members of older adults with type 1 diabetes (T1D) regularly become part of the diabetes care team yet often lack knowledge about how to become involved to prevent hypo- and hyperglycemia. Real-time continuous glucose monitoring (RT-CGM) with data sharing could facilitate diabetes management among older adults with T1D and their family members. Methods: Older adults with T1D (n=20) and their care partners (n=20) received a RT-CGM data sharing intervention called SHARE. SHARE included dyadic communication strategies, problem-solving strategies, and action planning. People with diabetes (PWD) wore the RT-CGM for 12 weeks while sharing their glucose data with a care partner. Feasibility data were obtained on intervention dose, implementation processes, satisfaction, and diabetes-related quality of life using RT-CGM. Descriptive statistics were used to examine feasibility, satisfaction, and demographic data. Results: The SHARE intervention was feasible, had high self-reported satisfaction for PWD and their care partner, and high adherence (96±6.8%) with wearing the RT-CGM. We found broad improvements in diabetes-related quality of life using RT-CGM in PWD and their care partners. Although the majority of PWD were willing to share hyperglycemia data (55%), several chose not to. The majority of PWD were willing to talk about glucose numbers with a care partner (n=70%). For this feasibility study, the SHARE intervention was not targeted at improving glucose levels but rather on communication and problem-solving strategies. There were no significant trends in the RT-CGM data (e.g., time in range) between baseline and 12 weeks. Conclusion: Older adults with T1D diabetes and their care partners identified the positives of RT-CGM with SHARE as having someone else aware of glucose levels and working together with a partner on diabetes self-management. SHARE may improve dyadic communication and problem-solving around glucose management in older adults. Disclosure N. A. Allen: Research Support; Self; Dexcom, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes. J. Chamberlain: Speaker’s Bureau; Self; Abbott Diabetes, Dexcom, Inc. E. Grigorian: None. E. Iacob: None. C. Berg: None. Funding University of Utah Center on Aging; University of Utah One U Caregiving Initiative; Dexcom, Inc.

Perceptions and Understanding of Diabetes Mellitus Technology in Adults with Type 1 or Type 2 DM: A Pilot Survey from Pakistan.

Diabetes mellitus technology (DMT) is increasingly used for routine management in developed countries, yet its uptake in developing countries is not as consistent. Multiple factors may influence this, including country specific patient perception regarding DMT. We conducted a pilot study in Pakistan to understand this important question which has not been studied yet. A cross-sectional pilot study was conducted in Pakistan. An anonymous survey exploring perceptions of diabetes technology was circulated on social media platforms, collecting responses over 2 weeks. Target population included adults (≥18 years) living in Pakistan, with DM1 or 2. A total of 40 responses were received. The majority (36/40) reported using conventional glucometers. Nine used continuous glucose monitoring (CGM). Thirty-two of 40 patients believed DMT improved diabetes care, 22 felt it helped decreased risk of Diabetes-related complications. 15/40 stated that DMT results in increased cost of care. Sixteen reported their diabetes care teams had never discussed wearable DMT options whereas 11 disliked them because they did not want a device on their self. In our pilot study we have identified broad themes of opportunity and challenges to DMT use in Pakistan. Patients' perceptions regarding DMT were generally positive but significant barriers to its acceptance included high cost, lack of discussion between doctor and patient about available technology and personal hesitation. Limitations of our study include sampling bias (online survey) and small sample size, but this data can help inform larger studies, to look at this important topic in greater detail.

Risk factors in acute diabetic foot syndrome: analysis of 75 consecutive patients referred to a tertiary center in Modena, Italy

Aim: Diabetic foot syndrome (DFS) is a complication of diabetes in which the presence of infections, ulceration and/or destruction of deep tissue associated with neuropathy, peripheral atherosclerosis and comorbidity affect the prognosis, the need for limb amputation and quality of life. Purpose of the present study is to report the features of patients with acute DFS admitted to our Diabetic Foot Unit tertiary Center in 2019. Methods: In all patients admitted, the approach was performed through a multidisciplinary team (Diabetic Foot Care Team) and described in a specific diagnostic-therapeutic-assistance program. Criteria of inclusion were presence of sepsis and/or suspected osteomyelitis and/or critical limb ischemia. Clinical features and interventions performed were registered. Primary endpoints were mortality and amputation (major, minor). Secondary endpoints were length of hospitalization, type of revascularization and duration of antibiotic therapy. Results: Among 75 consecutive patients (mean age 70.9 years) enrolled, prevalence of acute DFS was higher among men (M/F 3:1). Poor glycemic control [mean hemoglobin A1c (HbA1c) 67.9 ± 22.3 mmol/mol], long duration of diabetes (mean 19 ± 16.3 years), high low-density lipoprotein-cholesterol (mean 89.5 ± 45.1 mg/ dL) and obesity (mean Body Mass Index 30.2 ± 7.6 kg/m2) were common. Diabetes-related complications as peripheral arterial disease (PAD) (76%), ischemic heart disease (48%), retinopathy (40.5%), hepatic steatosis (50%), heart failure (17.8%) were present. During hospitalization, 21 subjects (28.4%) underwent lower limb amputations (overall rate of major amputation 4%), and 41.3% underwent percutaneous angioplasty. Long period of hospitalization (18.4 ± 7.9 days) and prolonged antibiotic therapy (23.9 ± 15.9 days) were observed. Major amputation was associated with C-reactive protein > 6.5 mg/dL (P = 0.03), osteomyelitis (P = 0.001), prior insulin therapy (P = 0.015). Conclusions: Male sex, co-morbidity, PAD, systemic inflammation and poor glycemic control are major features of acute hospitalized DFS. An approach through a multidisciplinary team is recommended in order to treat vascular and extra-vascular complications aimed at reducing mortality and at improving quality of life.

Risk factors in acute diabetic foot syndrome: analysis of 75 consecutive patients referred to a tertiary center in Modena, Italy

Aim: Diabetic foot syndrome (DFS) is a complication of diabetes in which the presence of infections, ulceration and/or destruction of deep tissue associated with neuropathy, peripheral atherosclerosis and comorbidity affect the prognosis, the need for limb amputation and quality of life. Purpose of the present study is to report the features of patients with acute DFS admitted to our Diabetic Foot Unit tertiary Center in 2019. Methods: In all patients admitted, the approach was performed through a multidisciplinary team (Diabetic Foot Care Team) and described in a specific diagnostic-therapeutic-assistance program. Criteria of inclusion were presence of sepsis and/or suspected osteomyelitis and/or critical limb ischemia. Clinical features and interventions performed were registered. Primary endpoints were mortality and amputation (major, minor). Secondary endpoints were length of hospitalization, type of revascularization and duration of antibiotic therapy. Results: Among 75 consecutive patients (mean age 70.9 years) enrolled, prevalence of acute DFS was higher among men (M/F 3:1). Poor glycemic control [mean hemoglobin A1c (HbA1c) 67.9 ± 22.3 mmol/mol], long duration of diabetes (mean 19 ± 16.3 years), high low-density lipoprotein-cholesterol (mean 89.5 ± 45.1 mg/ dL) and obesity (mean Body Mass Index 30.2 ± 7.6 kg/m2) were common. Diabetes-related complications as peripheral arterial disease (PAD) (76%), ischemic heart disease (48%), retinopathy (40.5%), hepatic steatosis (50%), heart failure (17.8%) were present. During hospitalization, 21 subjects (28.4%) underwent lower limb amputations (overall rate of major amputation 4%), and 41.3% underwent percutaneous angioplasty. Long period of hospitalization (18.4 ± 7.9 days) and prolonged antibiotic therapy (23.9 ± 15.9 days) were observed. Major amputation was associated with C-reactive protein > 6.5 mg/dL (P = 0.03), osteomyelitis (P = 0.001), prior insulin therapy (P = 0.015). Conclusions: Male sex, co-morbidity, PAD, systemic inflammation and poor glycemic control are major features of acute hospitalized DFS. An approach through a multidisciplinary team is recommended in order to treat vascular and extra-vascular complications aimed at reducing mortality and at improving quality of life.

Diabetic foot care course: a quasi-experimental study on E-learning versus interactive workshop.

Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prevention and management. Regarding the increasing use of e-learning educational courses as the new learning strategy with potential benefits among health care providers, this study attempted to evaluate the educational effects of an e-learning course on DFC compared to that of an interactive workshop in the related knowledge attainment. This was a quasi-experimental study compared two non-randomized groups consisting of nurses who attended an e-learning course (intervention group) and a face-to-face interactive workshop (control group) on DFC using a pre- and post-test design. The eligible nurses enrolled by convenience sampling. All five e-modules on DF prevention and care were the same for both groups. A P value of <0.05 was considered as significant. The study findings indicated that both e-learning course and interactive workshop increased DFC knowledge among nurses. There is a significant difference between the learning level (after training) in the intervention and control groups (P < 0.01). The findings suggest that the e-learning course of DF could be as effective as conventional educational methods. However, considering the time, cost savings and providing an opportunity to learn anytime and anywhere, of the e-learning course, it is recommend for the future and required that more health care providers be trained to use of distance learning.