Diabetes Management Practices Research Articles

Changes in diabetes care and management practices during the COVID-19 pandemic

Abstract Background We examined changes in diabetes care and management practices before and during the COVID-19 pandemic. Methods Population-based data regarding four diabetes-related healthcare engagement and four self-management indicators were obtained from adults with diabetes surveyed in 19 US States and Washington DC through the Behavioral Risk Factor Surveillance System. Using logistic regression, we estimated changes in the prevalence of each indicator, overall and by sociodemographic subgroups in 2019 (before the pandemic) and 2021 (during the pandemic). Results Between 2019 and 2021, the prevalence of biannual HbA1c tests reduced by 2.6 percentage points (pp; 95% confidence interval: −4.8, −0.4), from 75.4% to 73.1%, and prevalence of annual eye exams fell by 4.0 pp (−6.2, −2.8), from 72.2% to 68.7%. The composite indicator of engagement with healthcare for diabetes control fell by 3.5 pp (−5.9, −1.1), from 44.9% to 41.9%. Of self-management behaviors, avoidance of smoking increased by 2.0 pp (0.4, 3.6) from 84.7% to 87.1%. Conclusions The findings suggest a deterioration of the uptake of evidence-based, preventive health services requiring laboratory services and clinical examination for diabetes control during the pandemic. On the other hand, smoking rates decreased, suggesting potential positive impacts of the pandemic on health behaviors in people with diabetes.

Physician’s perceived barriers to millet-based diet in clinical practice: A cross-sectional survey

Objectives: This study aimed to investigate the perceived barriers faced by physicians in Maharashtra when recommending a millet-based diet for diabetic patients. The objectives were to identify the challenges physicians encounter in promoting millet consumption, assess their knowledge and beliefs about millet-based diets, and evaluate the current resources and practices used in dietary counseling for diabetes management. Methods: A cross-sectional survey was conducted among 68 physicians specializing in diabetes care in Maharashtra. Participants were recruited using snowball sampling and met the inclusion criteria of having over 10 years of clinical practice and significant experience in diabetes management. Data collection was performed through a pre-tested survey tool distributed through email and Google Forms. The survey included questions on the effectiveness of millet-based diets, patient characteristics influencing dietary recommendations, barriers to providing millet-based food education, and current and desired resources for promoting such diets. Ethical approval was obtained, and informed consent was secured from all participants. Results: The survey revealed that 70.59% of physicians considered a millet-based diet significantly effective for lowering blood sugar levels. However, several barriers were identified, including high comorbidities (82.35%) and low income (54.41%) among patients, which hindered dietary recommendations. In addition, physicians reported a lack of formal training in millet-based nutrition (73.53%), personal skepticism toward millet-based diets (63.23%), and insufficient patient educational resources (55.89%). Current resources used for dietary counseling were primarily verbal education (100%) and electronic resources (97.06%). Conclusion: Despite recognizing the potential benefits of millet-based diets, physicians face substantial barriers in recommending them to diabetic patients. These barriers include factors such as lack of training, time, and educational resources. To overcome these challenges, there is a need for enhanced educational programs for physicians, increased availability of patient-friendly educational materials, and access to trained dietitians. Implementing these measures could improve dietary management strategies and health outcomes for diabetic patients.

Knowledge and Awareness of Type 2 Diabetes Complications in Conflict-Affected Regions: A Cross-Sectional Study in Homs, Syria.

Background Diabetes mellitus is a significant global health problem characterized by high blood sugar levels due to either a lack of insulin or insensitivity to it. Concerns about diabetes complications are growing both globally and locally, making effective preventive measures crucial to tackle these complications. This research aimed to determine the level of knowledge and awareness regarding type 2 diabetes complications among patients in Homs, Syria, during the ongoing conflict. Methods A cross-sectional study was conducted among 1016 diabetic patients aged 16 years and above attending internal medicine and diabetes clinics in Homs City through a structured questionnaire administered via social media, telephone interviews, and paper forms. The data collected were analyzed using SPSS version 23.0 (IBM Corp., Armonk, USA). Descriptive statistics were used to summarize the demographic characteristics. In contrast, inferential statistics such as the chi-square test were used to test for associations between different variables with p-value < 0.05 as the significance level. Results The study found that 478 (47.1%) of participants were male, and 538 (53%) were female. The majority 652 (64.2%) were between 46 and 70 years old, and 422 (41.5%) had primary-level education. Most were married 750 (73.8%) and lived in urban areas 856 (84.2%). Diabetes knowledge varied significantly by age, education, occupation, and residence. Housewives and those with lower education levels had the least knowledge, while urban residents and those with 1-5 years since diagnosis had better awareness. Individuals with relatives in the medical field had higher knowledge levels.Results indicate that gender did not significantly influence diabetes knowledge (p = 0.19), while younger adults showed poorer awareness compared to older age groups (p < 0.05). Higher education levels were associated with better knowledge (p < 0.05), and a family history of diabetes correlated with greater awareness of complications. Occupation significantly impacted knowledge, with employed individuals and urban residents demonstrating higher awareness levels (p < 0.05). Diabetes knowledge peaked during the 6-10 year disease duration (p < 0.05). Conclusion This study assesses diabetes knowledge and management practices among 1016 participants in Homs, Syria, focusing on demographic and socioeconomic factors. Our findings underscore the need for targeted educational initiatives to improve diabetes management, particularly among younger, less educated, and rural populations in Homs.The analysis reveals significant knowledge gaps about diabetes across different demographics in Homs, highlighting the need for targeted educational programs, especially for younger individuals, the less educated, and rural residents. The study emphasizes the importance of education and medical practice in understanding diabetes, particularly in conflict-affected areas.

Patient-reported outcomes and treatment adherence in type 2 diabetes using natural language processing: Wave 8 of the Observational International Diabetes Management Practices Study.

We analyzed patient-reported outcomes of people with type 2 diabetes to better understand perceptions and experiences contributing to treatment adherence. In the ongoing International Diabetes Management Practices Study, we collected patient-reported outcomes data from structured questionnaires (chronic treatment acceptance questionnaire and Diabetes Self-Management Questionnaire) and free-text answers to open-ended questions to assess perceptions of treatment value and side-effects, as well as barriers to, and enablers for, adherence and self-management. Free-text answers were analyzed by natural language processing. In 2018-2020, we recruited 2,475 patients with type 2 diabetes (43.3% insulin-treated, glycated hemoglobin (HbA1c) 8.0 ± 1.8%; 30.9% with HbA1c <7%) from 13 countries across Africa, the Middle East, Europe, Latin America and Asia. Mean ± standard deviation scores of chronic treatment acceptance questionnaire (acceptance of medication, rated out of 100) and Diabetes Self-Management Questionnaire (self-management, rated out of 10) were 87.8 ± 24.5 and 3.3 ± 0.9, respectively. Based on free-text analysis and coded responses, one in three patients reported treatment non-adherence. Overall, although most patients accepted treatment values and side-effects, self-management was suboptimal. Treatment duration, regimen complexity and disruption of daily routines were major barriers to adherence, whereas habit formation was a key enabler. Treatment-adherent patients were older (60 ± 11.6 vs 55 ± 11.7 years, P < 0.001), and more likely to have longer disease duration (12 ± 8.6 vs 10 ± 7.7 years, P < 0.001), exposure to diabetes education (73.1% vs 67.8%, P < 0.05), lower HbA1c (7.9 ± 1.8% vs 8.3 ± 1.9%, P < 0.001) and attainment of HbA1c <7% (29.7% vs 23.3%, P < 0.01). Patient perceptions/experiences influence treatment adherence and self-management. Patient-centered education and support programs that consider patient-reported outcomes aimed at promoting empowerment and developing new routines might improve glycemic control.

The Prevalence and Management of Diabetes Mellitus Among Educated and Uneducated Populations in Pakistan. A comparative study

Background: Diabetes mellitus (DM) is a growing public health challenge globally, particularly in developing countries like Pakistan. Education plays a crucial role in DM management and awareness. Objective: The aim of this work was to compare the rate and the treatment of diabetes mellitus (DM) in educated and uneducated people of Pakistan. Methodology: This comparative study was conducted on 500 participants out of which 300 has been given formal education that is at least secondary education whereas 200 has no formal education that is they have dropped out at least at primary level. Diabetes prevalence, awareness, and management and lifestyle practices data were collected using structured questionnaires and blood glucose measurements. Data analysis was done with SPSS v 25.0, where chi-squared tests and logistic regression were used to assess the relationship of educational status with DM prevalence and its management. Results: The result showed that DM was higher among the uneducated group which was 32% compare to the educated group which was 18%. The participants who were educated had better understanding of DM, better compliance with the prescribed drug regimen and improved life style changes. On the other hand, the uneducated group had poor disease knowledge and worst management hence poor management of their disease condition. Conclusion: Education has a great effect on the incidence and control of DM. The study implies that there is a significant lack of knowledge about DM among the uneducated population hence the need to conduct health education to create awareness and ensure proper management of DM.

Undesirable Levels of Practice Behaviours and Associated Knowledge amongst Community Health Workers in Rural South India Responsible for Type 2 Diabetes Screening and Management.

Type 2 diabetes (T2DM) poses an enormous global health care challenge, especially among rural communities. Healthcare in these areas can be inadequate and inaccessible due to socio-demographic barriers. To overcome this situation, many low- and middle-income countries are resorting to task shifting, using community health workers (CHWs) for diabetes management. However, its successful implementation depends on the practice behaviours and knowledge of these workers. This cross-sectional study aimed to evaluate the proficiency of CHWs involved in diabetes screening and management in rural South India by identifying the existing practice behaviours and knowledge gaps. Employing a customised questionnaire, developed through inputs from experts and government officials, we assessed practice behaviours and the corresponding knowledge base of 275 CHWs. Analytical methodologies consisted of descriptive statistics, logistic regression, and mosaic plots for comprehensive data interpretation. The study showcased significant deficiencies in both practice behaviours (97%) and knowledge (95%) with current mean levels ranging from 48 to 50%, respectively, among the participants. The identified areas of insufficiency were broadly representative of the core competencies required for effective diabetes management, encompassing diabetes diagnosis and referral, HbA1c testing, diabetes diet, diabetes type and self-management, microvascular complications and their screening, peripheral neuropathy management, and diabetes risk assessment. In several areas, correct practice behaviour was reported by a relatively large number of CHWs despite incorrect answers to the related knowledge questions such as referral to the health centres, self-management, and calculation of diabetes risk assessment. This study highlights widespread deficiencies (97% CHWs) in diabetes management practices and knowledge (95% CHWs). To overcome these deficiencies, a thorough needs assessments is vital for effective CHW training. Training of CHWs should not only identify prior knowledge and/or behaviour but also their interrelationship to help create a robust and flexible set of practice behaviours.

The Rate of Insulin use and Suboptimal Glycemic Control among Egyptian Patients with T2DM: Cohort Analysis of Eighth Wave of the International Diabetes Management Practices Study (IDMPS).

The International Diabetes Management Practices Study (IDMPS) is an international annual survey aiming to study and characterize the current standards of care for managing DM in developing countries. In Egypt, DM represents a substantial burden on the healthcare system, with an estimated 10.9 million patients, ranking it 10th amongst countries with the highest prevalence of DM. Previous studies showed that to maintain safety and achieve treatment goals among diabetic patients, optimal insulin therapy should be selected individually based on the patient's needs. We reported the proportion of Egyptian T2DM patients on insulin therapy who participated in the eighth wave of the IDMPS. The 2018 IDMPS wave consisted of cross-sectional and longitudinal phases and aimed to evaluate the proportion of T2DM who were on insulin therapy in 13 countries from four regions. In Egypt, 17 physicians agreed to participate in the present study and were required to include at least one patient. A total of 180 T2DM patients were included in the cross-section phase. At the end of the ninth month of follow-up, data from 170 T2DM patients were available. A total of 39 T2DM patients (21.7%) were on insulin therapy, with a mean duration of 32.4 ± 36.6 months. More than half of the patients (n = 22; 56.4%) were on basal insulin, mainly long-acting (n = 20; 90.9%). The mean basal insulin daily dose was 0.3 ± 0.1 IU/Kg. Notably, 28.2% of the patients received insulin via vials, and 46.2% stated that they were adjusting the insulin dose by themselves. On the other hand, 60.2% of the study population was on oral antidiabetic drugs at the cross-sectional phase. Nearly 17.4% and 27% of the patients in the cross-sectional phase achieved the glycemic target per recommendations of international guidelines and the treating physicians, respectively. At the end of the longitudinal phase, the percentage of T2DM patients who achieved glycemic targets increased to 38.4% and 77.4% as per recommendations of international guidelines and the treating physicians, respectively. Overall, 38.3% of T2DM patients received diabetes education, and 28.9% were involved in an educational program provided by the physician or their clinical staff. Besides, 85.5% of T2DM patients followed their diabetes medication dosage and frequency strictly as prescribed. The proportion of insulin use in patients with T2DM aligned with the previous studies from different countries; however, it is still inadequate to achieve the targeted glycemic control. Nearly one-third of Egyptian patients received diabetes education, highlighting the need for adopting a national educational program. Nonetheless, the level of adherence among T2DM from Egypt appears to be high.

The prevalence of sleep disorders among children with type-1 diabetes mellitus in the Southern Region of Saudi Arabia

Objective: This study aimed to investigate the prevalence of sleep disorders and their associations with sociodemographic variables and diabetes management practices among children with type-1 diabetes mellitus (T1DM) in the Southern region of Saudi Arabia. Methods: A total of 198 children aged 6 to 18 years with a confirmed diagnosis of T1DM were recruited for the study. Data were collected using structured questionnaires and medical records. Results: The findings indicated a significant prevalence of sleep disorders among the participants, with insomnia, narcolepsy, restless legs syndrome, and sleep apnea affecting a considerable proportion of the population. Sleep disorders were associated with several variables, including parental education, diabetes management frequency, family history of diabetes, sleep duration, hours of physical activity per week, nighttime awakenings, caffeinated beverage consumption, and hemoglobin A1c levels. Conclusion: Recognizing and addressing sleep disorders in children with T1DM is important. Tailored interventions and comprehensive care strategies that consider sociodemographic factors and diabetes management practices are vital for enhancing the overall health and quality of life of these youngsters. This study underscores the multifaceted nature of the relationship between T1DM and sleep disorders and calls for further research to examine the underlying mechanisms and necessary interventions.

Collaborative practice in type 2 diabetes management in a developing country: A qualitative study of perceptions and attitudes of key stakeholders.

To explore collaborative practice and perceptions and attitudes of key stakeholders on collaboration in type 2 diabetes management in a tertiary care setting. Understanding collaborative practice in diabetes care in developing countries helps to design and provide patient-centred and cost-effective care. An exploratory qualitative study. Interviews were undertaken with 30 patients and 18 health professionals and policymakers. Thematic data analysis was undertaken to explore collaborative practice and examine participant perspectives on collaboration in diabetes management. We compared the findings with D'Amour's Collaboration Framework to determine the level of collaboration. Most participants reported a lack of collaborative practice in diabetes management, while they appreciated its importance in improving care. Perceptions varied with respect to what constituted collaborative practice. Three themes were identified: (1) perspectives of key stakeholders on current practice of collaboration; (2) impediments to collaborative practice; (3) strategies to improve collaborative practice. Analyses of the themes using D'Amour's Collaboration Framework indicated a low level of collaboration among physicians, nurses, pharmacists and policymakers, which was attributed to workload and time pressures on health professionals, power dynamics and lack of role clarity of all actors in collaborative action. Participants commented on the need to improve collaboration by establishing strong leadership and governance at different healthcare structure levels, which is committed to coordinating collaboration and developing collaborative frameworks and policies that guide collaborative undertaking. Perceived shortcomings of collaboration were attributed to inadequate resources, power dynamics, a lack of strong team functioning and policies. Participants' positive perceptions provide an opportunity to improve collaborative practice through incorporation of collaborative frameworks and policies. The findings in this study inform development of tailored and patient-centred diabetes care in tertiary care settings in sub-Saharan Africa. The study was reported in accordance with the COREQ checklist. Patients or the public were not involved in the design, analysis or interpretation of the data in this study. However, patients and healthcare providers participated in pilot interviews, which helped refine the interview guides. The summary of the findings of the study was also discussed with patients and healthcare providers, where they provided feedback.

Saudi Arabian Physical Therapists' Knowledge, Attitudes, and Clinical Practice in Diabetes Prevention and Management.

This study explores physical therapists' current knowledge, attitudes, and practice toward the management and prevention of diabetes in Saudi Arabia. A cross-sectional survey was distributed among physical therapists in Saudi Arabia. The questionnaire included several sections concerning their knowledge, attitude, and current practice toward diabetic management. A total of 301 physical therapists (32% female) participated in our study. The results suggest that only half of the participants agreed that diabetes management and prevention were within physical therapy's scope of service. However, approximately 30% of the participants did not regularly check or ask about the glucose levels of their patients with diabetes. Only 55% of the participants correctly answered the knowledge test questions. This study found that physical therapists in Saudi Arabia have a modest level of diabetes knowledge. The findings indicate that physical therapy educational programs should address diabetes management. Furthermore, continued education is required for current practicing physical therapists in Saudi Arabia.

Striving for Excellence in Diabetes Management Research and Practice

The research articles featured in this issue represent the pioneering efforts of scientists, clinicians, and researchers who strive to unravel the intricacies of diabetes. These studies shed light on novel therapeutic approaches, elucidate the underlying mechanisms of the disease, and explore the impact of lifestyle interventions on diabetes management. Through rigorous study design, meticulous data analysis, and robust conclusions, these research contributions form the foundation for evidence-based practice and inform clinical decision-making.

1433-P: Relationships between HbA1c Levels and Diabetes Management Practices—NHANES Data, 2007–2018

Objective: To evaluate the relationships between HbA1c levels and the recommended diabetes management practices captured in the National Health and Nutrition Examination Survey (NHAHES) datasets between 2007 and 2018 in adults with diabetes. Methods: This study utilized a cross-sectional approach. Logistic regression models were created, adjusting for covariates while examining the relationships between diabetes management practices and HbA1c levels. Results: The study included 4,623 individuals with an average age of 62 years (SD 0.19). Of these individuals, 33.8% were non-Hispanic Whites, 26.9% non-Hispanic Blacks, 17.4% Mexican Americans, 10.7% other Hispanics, and 11.3% other races. The following table summarizes these relationships' odds ratios, 95% confidence intervals, and p-values. Conclusion: From 2007 to 2018, participants who saw a diabetes specialist once or less per month were less likely to have a lower A1c level (&amp;lt; 9%). Those who reported checking their feet, reducing fat/calories in their diet, and taking Insulin were significantly more likely to have a lower A1c level than their counterparts. These significant findings confirm the importance of the recommended diabetes management (e.g., nutrition and medication) at the national level, reinforcing the ongoing large-scale public health campaigns that are warranted to support the existing messages to patients with diabetes. Disclosure C.F.Young: Other Relationship; Abbott Diabetes. C.Myung: None.

837-P: Improved Outcomes across Socioeconomically Advantaged and Disadvantaged Communities—A Real-World Study

Socioeconomic conditions of one's community have been attributed to disparities in diabetes outcomes and management practices. Among a random sample (n=19955) of people with type 2 diabetes receiving care at a nationwide telemedicine clinic utilizing a carbohydrate restricted nutritional approach and continuous remote care model (CR-CRCM), we explored A1c and medication utilization by area deprivation index quintile (Q). Upon enrollment, patients residing in more disadvantaged areas (Q4, Q5) had higher A1c compared to the least disadvantaged area (Q1; 7.8% vs 7.7%, p&amp;lt;0.01), and insulin (INS) and sulfonylureas (SU), but not other medication classes, were prescribed to a greater proportion of patients living in Q5 (25% INS, 23% SU) compared to Q1 (18% INS, 18% SU) and Q2 (21% INS, 19% SU) after accounting for differences in age, sex, baseline BMI, baseline INS use (when appropriate), and race and ethnicity (p&amp;lt;0.05). After one year in clinic, no differences in the prescription of medication classes between Q were observed, except for INS, where greater use remained only in Q5 than Q1 (14% vs 10%, p=0.011); among those remaining on INS, dose was reduced by 49-58% across all Q (p&amp;lt;0.001). Differences in SU use were no longer present; 77-83% fewer SU were prescribed across Q. Differences in A1c between Q4 (6.6%) and Q5 (6.7%) vs Q1 (6.5%) remained (p&amp;lt;0.001), though all groups achieved significant reductions in A1c of 1.1-1.2% (all p&amp;lt;0.001) concurrent with reduced prescription of all diabetes medication (from 1.7-1.8 to 1.1-1.2 medication classes per person). Across all levels of socioeconomic disadvantage, patients achieved clinically and statistically meaningful reductions in A1c and medication. Higher rates of SU use among patients residing in more disadvantaged areas were mitigated through a CR-CRCM to improve glycemia. Further, these data suggest a CR-CRCM may overcome financial barriers to optimal diabetes management through reduced need for medication. Disclosure A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.J.Athinarayanan: Employee; Virta Health Corp.

Type 1 diabetes patient experiences and management practices during the COVID-19 pandemic in rural Uganda.

The COVID-19 pandemic has impacted various aspects of the lives of persons with chronic diseases, including type 1 diabetes (T1D). However, the diabetes care experiences and practices adopted by persons living with T1D after the declaration of the COVID-19 pandemic in Uganda have not been well documented. We investigated diabetes management practices and experiences of persons with T1D during the COVID-19 pandemic lockdown in a rural district of southwestern Uganda. Using interactive sequential explanatory mixed methods, we conducted a cross-sectional study of persons with T1D aged 18-25 years, their caregivers and health workers. Quantitative data was exclusively collected from patients with T1D using Kobo Toolbox™ and analysed with SPSS™ version26; qualitative interviews were used to elicit responses from purposively selected patients with T1D, plus caregivers and health workers that were analysed using a thematic framework approach. The study enrolled 51 (24 males) patients with T1D; diabetes duration (mean ± SD) 6.6 ± 5 years. Access to insulin syringes significantly worsened in 19.6% of participants (p = 0.03). Insulin injection frequency (p = 0.01), blood glucose monitoring (p = 0.001) and meal frequency (p = 0.0001) significantly decreased. Qualitative interviews highlighted COVID-19 restriction measures had reduced household income, frequency of clinic visits, and access to food, diabetes support and social services. Experiences and practices were consistent with decisions to prioritise survival, even with known risks around metabolic control. The online version contains supplementary material available at 10.1007/s40200-023-01222-4.

A provider survey of cystic fibrosis related diabetes screening and management practices at North American CF centers.

Cystic Fibrosis Foundation (CFF) Guidelines recommend annual screening for cystic fibrosis related diabetes (CFRD) with an oral glucose tolerance test (OGTT). However, screening rates remain consistently low. We conducted surveys of 1) US CF center directors and 2) Endocrinologists affiliated with the CFF-sponsored EnVision program to characterize CFRD screening practices, describe provider perceived barriers to screening, and identify strategies for improving screening. The surveys queried OGTT protocols, alternate screening strategies, and perceived barriers to screening. CF center characteristics and procedures for coordinating OGTTs were compared between centers achieving ≥50% versus <50% OGTT completion. Endocrinologists received additional questions regarding OGTT interpretation and management. The survey response rate was 18% (51/290) from CF Centers and 63% (25/40) from Endocrinologists. The majority (57%) of CF centers utilized 2 OGTT timepoints (0,120 min). The majority (72%) of Endocrinologists utilized 3 timepoints (0,60,120 min). Four percent of CF centers and 8% of Endocrinologists utilized other timepoints. Forty-nine percent of CF centers reported ≥50% OGTT completion in the past year. Completion of ≥50% OGTT was 5 times more likely when patient reminders were consistently provided (p = 0.017). Both CF Centers and Endocrinologists employed alternative screening strategies including HbA1c (64%, 92%), fasting plasma glucose (49%, 67%), continuous glucose monitoring (30%, 58%), and home fingerstick monitoring (55%, 50%). OGTT is the gold standard screening method for CFRD, but completion rates remain suboptimal, practice variation exists, and many providers utilize alternate screening strategies. Systematic reminders may improve completion rates. Studies to improve our approach to CFRD screening are urgently needed.

Nurses’ knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus

BackgroundThe prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses’ role in nutritional management of diabetes. This study aimed to evaluate nurses’ knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes.MethodsThis cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses’ KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis.ResultsThe mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses’ attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008).ConclusionNurses’ knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.

The present study was aimed to assess the Knowledge, Attitude and Practice on management of Diabetes among diabetic patients in selected settings of Mysuru

Background: Diabetes commonly affects individuals the world over. In India, it affects all the parts of the country irrespective of age, gender, ethnicity, andrace. According to International Diabetic Federation, diabetes affects more females than males. The rate of incidence is rising every day. Therefore, it is important to assessthe knowledge of management of diabetes among diabetic patients. Objectives: To assess the knowledge and attitude, practice of diabetes management among diabetic patients in selected settings inMysuru and also to determine the association between the levels of the knowledge, attitude, practice on diabetes with theirselectedpersonnel variable. Methodology: Research Approach: Descriptive research approach was used for this study. Research Design: Descriptive research design was selected for this study. Setting: Setting refers to the area where thestudy was conducted. This study was conducted in Nadanahalli rural areas of Varuna PHC, Mysuru. Population: The target population for the study included Diabetes patients from Nadanahalli village, rural areas of Varuna PHC, Mysuru. Sample: Diabetes patients from Nadanahalli village, rural areas of Varuna PHC, Mysuru. Participants: Thirty diabetic patients Sampling Techniques: Convenience sampling technique was used to select the sample. Result: The majority of diabetic patients demonstrated moderate knowledge on diabetes. Only a few diabetic patients had adequate knowledge. The overall mea knowledge scores of the diabetic patients were 23.16 with SD4. Majority of them is having neutral attitude i.e. 28.17 with SD of 3.09 with mean value of 79.57.and the practice score is 29.18 with SD 5.04. related to association Out of many variables, age, gender, education were found to be significant with the knowledge of 0.05levels. andage, occupation and education significant with attitude gender and education were found to have significant association with practice 0.05 level.

A Nanotechnology-Based Approach to Biosensor Application in Current Diabetes Management Practices

Diabetes mellitus is linked to both short-term and long-term health problems. Therefore, its detection at a very basic stage is of utmost importance. Research institutes and medical organizations are increasingly using cost-effective biosensors to monitor human biological processes and provide precise health diagnoses. Biosensors aid in accurate diabetes diagnosis and monitoring for efficient treatment and management. Recent attention to nanotechnology in the fast-evolving area of biosensing has facilitated the advancement of new sensors and sensing processes and improved the performance and sensitivity of current biosensors. Nanotechnology biosensors detect disease and track therapy response. Clinically efficient biosensors are user-friendly, efficient, cheap, and scalable in nanomaterial-based production processes and thus can transform diabetes outcomes. This article is more focused on biosensors and their substantial medical applications. The highlights of the article consist of the different types of biosensing units, the role of biosensors in diabetes, the evolution of glucose sensors, and printed biosensors and biosensing systems. Later on, we were engrossed in the glucose sensors based on biofluids, employing minimally invasive, invasive, and noninvasive technologies to find out the impact of nanotechnology on the biosensors to produce a novel device as a nano-biosensor. In this approach, this article documents major advances in nanotechnology-based biosensors for medical applications, as well as the hurdles they must overcome in clinical practice.

Safe Travel Practices and Awareness among Diabetic Patients.

To measure the knowledge of Saudi patients with diabetes in coping with their condition and to assess their practice of disease control during travels. Study Design. Cross-sectional study using a self-administered questionnaire. This study was conducted between September 2018 and May 2019 at a University hospital in Riyadh, Saudi Arabia. The questions were adopted from guidelines and advices provided by the CDC, American Diabetic Association, and other references. Bivariate and multivariate analyses were used to identify factors associated with diabetic control during travels. From the included 242 patients, 33.6% showed the good practice of diabetic control during travels. 23.7% of patients were communicated by their doctors about the importance of consultations before traveling and 20.7% encountered complications during travels. Factors associated with doctors' consultation before travel are patients' concerns about travel duration and possible risks during trip. (OR = 2.588, 95% CI = 5.308-1.261), (OR = 3.525, 95% CI = 8.152-1.525); respectively. Patient awareness and education about the importance of proper diabetic self-monitoring and control during travels is crucial as the study showed suboptimal diabetes management practice. Practice Implications. Physicians should proactively educate patients about the importance of seeking advice before their travels.

ISPAD Clinical Practice Consensus Guidelines 2022: Ramadan and other religious fasting by young people with diabetes.

ISPAD Clinical Practice Consensus Guidelines 2022: Ramadan and other religious fasting by young people with diabetes.