Outpatient Diabetes Research Articles

Factors Associated with Oral Health Literacy among Patients with Type 2 Diabetes Mellitus Attending Hospital Universiti Sains Malaysia

Objective: To determine the oral health literacy (OHL) level and its associated factors among patients with type 2 diabetes mellitus attending Hospital Universiti Sains Malaysia (USM). Material and Methods: This cross-sectional study involved 135 diabetic patients with a mean age of 62.6 years old (SD=9.05) who attended the Diabetes Outpatient Clinic at Hospital USM, a teaching hospital in the north-eastern corner of Peninsular Malaysia. The Malay version of the Oral Health Literacy Instrument (OHLI-M) was used to assess the level of OHL among respondents. An additional self-administered questionnaire was used to obtain other variables of interest. Systematic random sampling was applied in this study. The data were analyzed using an independent t-test and ANOVA to determine factors associated with oral health literacy among respondents. Results: Most respondents have at least one oral health problem (62.2%). The most common problem was cavitated tooth (42.2%). Other problems include toothache (17.8%), mobile tooth (17.8%), and swollen gums (16.3%). OHL level for most respondents (40.7%) was inadequate. The mean total OHLI-M score was 67.9 (SD=17.74). The OHL score was significantly lower in respondents with the following characteristics: female, no formal education or had primary education, unemployed, lower income group, never visited a dentist, and had swollen gums. Conclusion: The OHL of most patients with type 2 diabetes mellitus attending the Diabetes Outpatient Clinic, Hospital USM still need to be improved. Oral health problems were common in patients with type 2 diabetes mellitus in this study. This study also highlighted the link between OHL and socio-demographic factors. Improving the OHL of patients may increase their capability to obtain and understand oral health messages needed to take appropriate actions that will eventually prevent oral diseases associated with diabetes mellitus.

Assessing Outpatients' Knowledge, Attitude, and Practice Toward Managing Diabetes in Saudi Arabia.

Introduction: When it comes to non-communicable diseases like diabetes, inadequate knowledge, attitude, and practice are often linked to poor health outcomes. This study aims to assess the patients’ knowledge, attitude, and practice (KAP) of diabetes in the outpatient department of a university teaching hospital in Saudi Arabia. Methodology: In this cross-sectional study, diabetes type 2 patients attending outpatient departments at a university teaching hospital, Riyadh, were assessed regarding their knowledge, attitude, and practice toward diabetes using a validated KAP scale. Descriptive and inferential analysis was done to determine the factors associated with KAP score using SPSS version 26.0 software (SPSS Inc., Chicago, IL, U.S.). Results: Males made up 69.7% of the sample (n = 165), while 56.9% were between the ages of 41 and 75. The level of knowledge and practice had “good” in 37.6%, and 47.9%, respectively, but level of attitude had “positive” in 30.9% of patients. The association between knowledge tier and gender (p0.014) and insurance status (p0.008), respectively, was shown to be significant. However, the attitude tier was only significantly associated with gender (P = .003). The practice tier also showed a significant age association (P = .049). As regards, the mean scores for diabetes-related knowledge were higher only among insured participants (P = .03) than for other participants’ sociodemographic factors. Meanwhile, the mean attitude scores were also higher among males (P = .006) than for other sociodemographic characteristics. A comparison of the participants’ sociodemographic characteristics found no statistically significant variations in practice scores. Conclusion: Unfortunately, this study found that outpatient diabetes patients had insufficient knowledge, practice, and a negative attitude toward diabetes type 2. This imposes a great burden on healthcare workers and hence the healthcare system to improve patient scores via diabetes education programs or pharmacist-led patient counseling initiatives.

POSB420 Diabetes Treatment Cost in KSA Using a Real-World Dataset from Private Payer

Diabetes is a prevalent non-communicable disease worldwide associated with high morbidity, mortality and a lower quality of life. KSA ranks 7th in the rate of diabetes worldwide with an estimated disease prevalence of around 24%. The Kingdom is witnessing a worsening pattern of diabetes with 10-fold increase over the past 30 years resulting in significant financial burden on payers. The aim of the study is to determine the cost of in-patient and out-patient diabetes pharmacotherapy in KSA.

POSA419 Diabetes Treatment Cost in Lebanon Using a Real-World Dataset from Private Payer

Diabetes is a high burden non communicable disease worldwide. In Lebanon, the estimated prevalence of diabetes is around 12%. Earlier studies in the country have shown deficiencies in diabetes management. The aim of the study is to determine the cost of in-patient and out-patient diabetes treatment in Lebanon.

Serum PCSK9 Correlates with PTX3 and Apolipoproteins B, A1, and C3 Concentrations in Patients with Type 2 Diabetes.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is involved in the regulation of LDL metabolism. There is evidence that circulating PCSK9 is a cardiovascular risk factor. In this study, we determined factors associated with circulating PCSK9 in a group of patients with type 2 diabetes mellitus (DM2). Material included 116 consecutive patients with DM2 from outpatient diabetes clinic. Circulating PCSK9, PTX3, apolipoprotein (apo) B100, apo B48, and apo C3 levels were determined by ELISA, apo A1 by immunoturbidimetry. The mean (sd) age of patients was 59.1 (11.1) years, the mean (sd) values of serum PCSK9 were 255.4 (106.97) ng/ml. Circulating PCSK9 correlated negatively with age (r = −0.21, p < 0.05) and HbA1c (r = −0.21, p < 0.05) and positively with BMI (r = 0.21, p < 0.05), total cholesterol (r = 0.59), LDL-cholesterol (r = 0.50), triglyceride (r = 0.35), apo B100 (r = 0.43), apo A1 (r = 0.43) (p < 0.001 for all), apo C3 (r = 0.29, p < 0.01), and apo B48 (r = 0.25, p < 0.01) concentration and FLI (r = 0.26, p < 0.01). Strong correlation between PTX3 and PCSK9 levels was observed (r = 0.47, p < 0.001). Multiple stepwise backward regression analysis with PCSK9 as dependent variable revealed that PTX3, apo B100, apo A1, apo B48, and BMI were significantly positive and the presence of NAFLD and HbA1c negatively associated with PCSK9 concentrations. These variables together explain 57% of PCSK9 variability; the strongest relationship was observed between PCSK9 and PTX3 and apo B100. Our results indicate that circulating PCSK9 is significantly associated with inflammation marker PTX3 as well as atherogenic lipids and apolipoproteins C3, B100, and B48, which might be of value in understanding interactions between development of atherosclerosis and inflammatory state in DM2 patients.

Poor glycemic control and its associated factors among diabetes patients attending public hospitals in West Shewa Zone, Oromia, Ethiopia: An Institutional based cross-sectional study

PurposeDiabetes mellitus (DM) is increasing at an alarming rate throughout the world and its complications of has become a major public health concern in all countries. Glycemic control is the most important predictor for DM related complications and deaths. However information on glycemic control remains scarce in Ethiopia including our study area. Hence, the aim of this study was to assess the magnitude and factors associated with poor glycemic control among diabetic outpatients at West Shewa public Hospitals, Ethiopia. MethodsA facility-based cross-sectional study was conducted from June 01 to September 30, 2020. Poor glycemic control was assessed by glycated hemoglobin level and a systematic random sampling method was employed to select participants. An interviewer-administered structured questionnaire was used and the data entered into Epi data version 3.1 and exported into SPSS version 22 for analysis. Logistic regression was conducted to identify predictors of poor glycemic control. A p-value of <0.05 was considered statistically significant. ResultsA total of 390 participants were involved in the study with mean age of 46.45 (±15.6) years. The study finding showed that the prevalence of poor glycemic control was found to be 63.8%. Age of ≥50 years (AOR = 2.77; 95% CI: 0.15,0.85), being single (AOR = 2.55; 95% CI: 0.179,.857), having high low-density lipoprotein cholesterol (AOR = 3.44; 95% CI: 1.65, 7.12), being female gender (AOR = 2.4; 95%CI: 0.31,0.816), alcohol intake (AOR = 1.88; 95% CI: 1.135, 3.1) and presence of diabetic peripheral neuropathy (AOR = 1.24; 1.1,1.39) were associated with poor glycemic control. ConclusionAbout two-thirds of participants had poor blood glucose control. Increased age, high low-density lipoprotein cholesterol, family history of diabetes, being single, being female, diabetic peripheral neuropathy and alcohol intake were associated with poor glycemic control. Hence, effort should be made towards reducing these factors among DM patients by the concerned body.

Implementation of App-Based Diabetes Medication Management: Outpatient and Perioperative Clinical Decision Support.

Outpatient and perioperative therapeutic decision making for patients with diabetes involves increasingly complex medical-decision making due to rapid advances in knowledge and treatment modalities. We sought to review mobile decision support tools available to clinicians for this essential and increasingly difficult task, and to highlight the development and implementation of novel mobile applications for these purposes. We found 211 mobile applications related to diabetes from the search, but only five were found to provide clinical decision support for outpatient diabetes management and none for perioperative decision support. We found a dearth of tools for clinicians to navigate these tasks. We highlight key aspects for effective development of future diabetes decision support. These include just-in-time availability, respect for the five rights of clinical decision support, and integration with clinical workflows including the electronic medical record.

Utilisation of telehealth for outpatient diabetes management during COVID-19 pandemic: how did the patients fare?

BackgroundDuring the Coronavirus disease 2019 (COVID‐19) pandemic, many outpatient services at public hospitals, including diabetes services, had adopted telehealth appointments for their clinic patients. There was concern that patients' glycaemic control may worsen during the pandemic.AimTo assess glycaemic control of patients with diabetes attending telehealth consultations in 2020, compared to face‐to‐face reviews prior to pandemic.MethodsWe conducted a retrospective review of patients with diabetes managed by telehealth consultations over 5 months at two metropolitan hospitals in Sydney. Their attendance rate, glycaemic control and unplanned admissions to hospital were assessed, and these were compared with the same period 12 months prior when patients were reviewed via face‐to‐face appointments.ResultsBetween April and September 2020, the attendance rate for telehealth consultation at the diabetes services at the two hospitals was 88.9% (884 out of 994), which was higher than in 2019 (85.2%; 818 out of 959; P = 0.016) when patients attended via face‐to‐face appointments. Of the 629 patients reviewed via telehealth in 2020 and who had been with our service for over 12 months, glycaemic control was better in 2020 (HbA1c 7.8 ± 1.4% (62 ± 15 mmol/mol)) compared with 12 months earlier (8.2 ± 1.7% (66 ± 19 mmol/mol); P < 0.001). There was no difference in the number of unplanned admissions for this cohort in 2020 (n = 58; 9.2%) compared with 2019 (n = 75; 11.9%; P = 0.100).ConclusionsThe present study showed that for patients with diabetes who received care via telehealth consultations during the COVID‐19 lockdown, their glycaemic control was slightly better, and unplanned admission rates were not higher compared with those in the pre‐COVID‐19 period. Telehealth consultation offers an important care delivery option in the management of patients with diabetes under these circumstances.

Analysis of pregnant women with the diagnosis of gestational diabetes mellitus without oral glucose tolerance test confirmation in early pregnancy

Purpose: The aim of this analysis was to determine the proportion of pregnant women referred by gynaecologists to the outpatient diabetes clinic of the University Medical Centre Maribor with a diagnosis of gestational diabetes mellitus (GDM) based on inappropriately measured fasting plasma glucose (FPG). Additionally, we wanted to compare pregnancy outcomes in subgroups diagnosed later as having GDM vs. no–GDM with oral glucose tolerance testing (OGTT) in the 24th to 28th week of pregnancy, but declared as “probably not having GDM” in early pregnancy.&#x0D; Methods: We reviewed retrospectively data on 81 pregnancies referred to our centre, from August 2013 to July 2014, with a diagnosis of early GDM that we did not con-firm with OGTT retesting. After retesting, women were followed up routinely by a gynaecologist, but those with a diagnostic OGTT, performed in the 24th to 28th week, were referred back to a diabetologist.&#x0D; Results: The age of the entire cohort was 30.5±4.7 years, and 91% were ≥25 years old; 40% were overweight before pregnancy. The period of fasting before FPG measurement was less than 8 hours in 36%. When comparing the GDM vs. no–GDM subgroups, a higher proportion of women with GDM were fasted for less than 8 hours before FPG measurement (75% vs. 32%; p=0.022), and birth weight was higher for women with GDM (3778±588 g vs. 3316±618 g; p=0.048). There were no differences in macrosomia, eclampsia, Caesarean delivery and birth trauma.&#x0D; Conclusion: The accuracy of the diagnosis of early pregnancy GDM can be improved by following the FPG measurement protocol. When a single FPG in early pregnancy is near normal we suggest retesting with an OGTT. This approach probably has no adverse effect on pregnancy outcomes.

Abstract 12791: Facility Characteristics Associated With High-Performing Outpatient Diabetes and Cardiovascular Disease Risk Factor Program Awardees

Background: The American Heart Association (AHA) developed an outpatient recognition program centered around the care of patients with type 2 diabetes as part of the Know Diabetes by Heart initiative. The program offers two levels of recognition, Participant and Gold. With over 500 outpatient organizations in the program, specific facility characteristics and component protocols were analyzed to determine what variables increased a site’s likelihood of being a Gold awardee. Methods: The AHA Quality and Analytics team examined multiple data sets from 470 (203 Gold, 267 Participant) award winning facilities. 2020 recognition level was based on aggregate patient data from the 2019 calendar year and self-identified facility characteristics. Univariate regression modeling was carried out to determine facility characteristics that contributed to a site achieving Gold or Participant Target: Type 2 Diabetes award which are displayed in table 1. Results: Higher percentage of Gold-level recipients implemented more treatment plans and protocols for their patients compared to Participant-level recipients. This trend also exists in activities that elevated standard of care for all patients such as assessing for comorbidities, lifestyle modification, and motivation and depression. Conclusion: Facilities characterized as having multiple components in treatment protocols in T2D patients, diabetes self-management and education (DSME), and defined protocols for use of pharmacologic therapy had higher likelihood of achieving Gold award status. In contrast, smaller, non-academic, and high minority population organization were less likely to achieve Gold status, highlighting the care disparities that still need to be addressed. Resources focused on assisting facilities to adopt these evidence-based protocols could help organizations further elevate their T2D management practices, achieve improved patient outcomes and award levels for all organization types.

Feasibility and Acceptability of a Digital Patient-Reported Outcome Tool in Routine Outpatient Diabetes Care: Mixed Methods Formative Pilot Study.

BackgroundImprovements in the digital capabilities of health systems provide new opportunities for the integration of patient-reported outcome (PRO) solutions in routine care, which can facilitate the delivery of person-centered diabetes care. We undertook this study as part of our development of a new digital PRO diabetes questionnaire and clinical dialog support tool for use by people with diabetes and their health care professionals (HCPs) to improve person-centered diabetes care quality and outcomes.ObjectiveThis study evaluates the feasibility, acceptability, and perceived benefits and impacts of using a digital PRO diabetes tool, DiaProfil, in routine outpatient diabetes care.MethodsOverall, 12 people with diabetes scheduled for routine medical diabetes visits at the outpatient clinic were recruited. Purposive sampling was used to optimize heterogeneity regarding age, gender, duration, type of diabetes, treatment modality, and disease severity. Participants filled out a PRO diabetes questionnaire 2 to 5 days before their visit. During the visit, HCPs used a digital PRO tool to review PRO data with the person with diabetes for collaborative care planning. Participants completed evaluation forms before and after the visit and were interviewed for 30 to 45 minutes after the visit. HCPs completed the evaluation questionnaires after each visit. All visits were audio-recorded and transcribed for analysis. Data were analyzed using quantitative, qualitative, and mixed methods analyses.ResultsPeople with diabetes found the PRO diabetes questionnaire to be relevant, acceptable, and feasible to complete from home. People with diabetes and HCPs found the digital PRO tool to be feasible and acceptable for use during the diabetes visit and would like to continue using it. HCPs were able to use the tool in a person-centered manner, as intended. For several people with diabetes, completion of the questionnaire facilitated positive reflection and better preparation for the visit. The use of the PRO tool primarily improved the quality of the dialog by improving the identification and focus on the issues most important to the person with diabetes. People with diabetes did not report any negative aspects of the PRO tool, whereas HCPs highlighted that it was demanding when the person with diabetes had many PRO issues that required attention within the predefined time allocated for a visit.ConclusionsThe Danish PRO diabetes questionnaire and the digital tool, DiaProfil, are feasible and acceptable solutions for routine diabetes visits, and this tool may generate important benefits related to advancement of person-centered care. Further research is now required to corroborate and expand these formative insights on a larger scale and in diverse health care settings. The results of this study are therefore being used to define research hypotheses and finalize real-world PRO evaluation tools for a forthcoming large-scale multisector implementation study in Denmark.

Managing type 1 diabetes during the COVID-19 pandemic is a team effort: a qualitative study of the experiences of young people and their parents

ObjectiveTo explore the experiences of young people with type 1 diabetes mellitus (T1DM) and their parents in accessing integrated family-centred care in the Australian Capital Territory during the COVID-19 pandemic.Methods...

Serum adipokine levels in patients with type 1 diabetes are associated with degree of obesity but only resistin is independently associated with atherosclerosis markers.

The role of adipokines in causing inflammation and insulin resistance in normal weight and obese patients is generally well studied. However, there are often conflicting results regarding their levels in type 1 diabetes mellitus (T1DM) patients and their relationship to micro- and macrovascular disease. We therefore investigated which serum adipokine levels are independently associated with markers of early atherosclerosis and microvascular complications in patients with T1DM. A cross-sectional study was performed in the Diabetes Outpatient Clinic of Hippokrateion General Hospital, Thessaloniki, Greece. Sixty T1DM patients (30 females, mean age 38.8 ± 10.6years, mean diabetes duration 17.4 ± 9.9years) were included. Plasma adiponectin, leptin, and resistin, carotid artery intima media thickness (cIMT), and arterial stiffness (pulse wave velocity, PWV/SpygmoCor CP System and Mobil-O-Graph 24h PWA) were assessed. Leptin and resistin levels were significantly higher in overweight and obese patients (p = 0.002 and p = 0.039, respectively). Adiponectin was the only adipokine negatively correlated with BMI (rs = - 0.41, p = 0.001). We report a bivariate association between serum adiponectin levels and retinopathy (p = 0.007). Resistin was the only adipokine that showed significant correlation with systolic (rs = 0.42, p = 0.001) and diastolic (rs = 0.29, p = 0.024) hypertension and PWV (p = 0.035). Serum adipokine levels demonstrate similar bivariate associations with anthropometric variables in patients with T1DM to those in normal weight subjects. Although microvascular complications are associated with serum adipokine levels by bivariate analysis, only resistin, an inflammatory marker, is independently associated with arterial stiffness in patients with T1DM.

Intensification of Diabetes Medications at Hospital Discharge and Clinical Outcomes in Older Adults in the Veterans Administration Health System

Transient elevations of blood glucose levels are common in hospitalized older adults with diabetes and may lead clinicians to discharge patients with more intensive diabetes medications than they were using before hospitalization. To investigate outcomes associated with intensification of outpatient diabetes medications at discharge. This retrospective cohort study assessed patients 65 years and older with diabetes not taking insulin who were hospitalized in the Veterans Health Administration Health System between January 1, 2011, and September 28, 2016, for common medical conditions. Data analysis was performed from January 1, 2020, to March 31, 2021. Discharge with intensified diabetes medications, defined as filling a prescription at hospital discharge for a new or higher-dose medication than was being used before hospitalization. Propensity scores were used to construct a matched cohort of patients who did and did not receive diabetes medication intensifications. Coprimary outcomes of severe hypoglycemia and severe hyperglycemia were assessed at 30 and 365 days using competing risk regressions. Secondary outcomes included all-cause readmissions, mortality, change in hemoglobin A1c (HbA1c) level, and persistent use of intensified medications at 1 year after discharge. The propensity-matched cohort included 5296 older adults with diabetes (mean [SD] age, 73.7 [7.7] years; 5212 [98.4%] male; and 867 [16.4%] Black, 47 [0.9%] Hispanic, 4138 [78.1%] White), equally split between those who did and did not receive diabetes medication intensifications at hospital discharge. Within 30 days, patients who received medication intensifications had a higher risk of severe hypoglycemia (hazard ratio [HR], 2.17; 95% CI, 1.10-4.28), no difference in risk of severe hyperglycemia (HR, 1.00; 95% CI, 0.33-3.08), and a lower risk of death (HR, 0.55; 95% CI, 0.33-0.92). At 1 year, no differences were found in the risk of severe hypoglycemia events, severe hyperglycemia events, or death and no difference in change in HbA1c level was found among those who did vs did not receive intensifications (mean postdischarge HbA1c, 7.72% vs 7.70%; difference-in-differences, 0.02%; 95% CI, -0.12% to 0.16%). At 1 year, 48.0% (591 of 1231) of new oral diabetes medications and 38.5% (548 of 1423) of new insulin prescriptions filled at discharge were no longer being filled. In this national cohort study, among older adults hospitalized for common medical conditions, discharge with intensified diabetes medications was associated with an increased short-term risk of severe hypoglycemia events but was not associated with reduced severe hyperglycemia events or improve HbA1c control. These findings indicate that short-term hospitalization may not be an effective time to intervene in long-term diabetes management.

Video Consultation for Parents with a Child Newly Diagnosed with Type 1 Diabetes: A Qualitative Study.

With the exception of the coronavirus pandemic, video consultations have not been a part of the standard care for children with diabetes in Germany. The "Virtual Diabetes Outpatient Clinic for Children and Adolescents 2.0" (VIDIKI 2.0) study investigated the effect of monthly and supplementary video consultations on standard care over one year. The qualitative substudy investigated the experiences of families with a child newly diagnosed with type 1 diabetes mellitus (T1DM) who received at least four weekly supplementary video consultations. Guideline-based qualitative interviews were conducted with seven families with children under the age of eight and T1DM onset shortly before study entry. The answers were analyzed using a qualitative content analysis approach, particularly inductive category formation. Families of patients with T1DM onset have questions, almost daily, concerning various aspects of insulin therapy. The offer of high-frequency video consultations can reduce the number of trips to the diabetes team, facilitate the organization of daily life and increase the sense of security. Video consultations as a supplementary offer of health care, especially after diabetes onset, were considered very helpful by the affected families. High-frequency video consultations may provide a tool to overcome existing deficiencies in specialized diabetes care.

79: A patient satisfaction survey regarding the use of telemedicine for outpatient CF endocrinology and diabetes care during the COVID-19 pandemic

79: A patient satisfaction survey regarding the use of telemedicine for outpatient CF endocrinology and diabetes care during the COVID-19 pandemic

Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis

BackgroundLow- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines.MethodsOutpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate.ResultsBeneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government.ConclusionsAdditional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.

Effect of Diabetes Self-Management Education (DSME) with and without Motivational Interviewing (MI) on Glycemic Control among Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

Background: Type 1 diabetes mellitus (T1DM) is a chronic disease that is difficult to control. Motivational interviewing (MI) is a collaborative style of communication that was designed to strengthen a person’s motivation and commitment to change and improve. We hypothesized that applying MI to diabetes care would lead to improved glycemic control and improved diabetes self-care behavior.&#x0D; Methods: Subjects were T1DM patients aged 10-18 years with HbA1C ≥8% that were recruited from the Outpatient Diabetes Clinic during October 2016 - March 2017. Subjects were randomized into the diabetes self-management education (DSME) or DSME plus MI groups. HbA1C levels, diabetes knowledge test, and diabetes self-care behavioral questionnaire were performed.&#x0D; Results: Thirty-five patients (17 DSME, 18 DSME + MI) completed the study. Baseline HbA1C was not significantly different between groups. At the end of the study, HbA1C levels were not significantly different within or between groups. From pre-intervention to post-intervention, diabetes knowledge scores were significantly increased, and self-care behavioral scores were significantly increased for dietary control and medical taking. Transition to the stages of change action stage was increased from 0 to 12 persons.&#x0D; Conclusions: The effectiveness of MI on glycemic control was not found to be statistically significant at 6 months. However, continuation of DSME in T1DM patients is necessary for improving diabetes knowledge and care. Further study in a larger sample size with longer duration of MI and follow-up is needed to conclusively establish the value of MI on glycemic control in pediatric T1DM.

Screening for Depression in Adolescents with Type 1 Diabetes Mellitus

Abstract Introduction Type 1 diabetes (T1DM) is one of the most frequent chronic metabolic diseases in childhood and adolescence. Depression is common among adolescents and its occurrence is higher in people with diabetes mellitus. Objectives The aim of the study is to detect depression disorder among adolescents with type 1 Diabetes Mellitus and determine the risk factors and relation to the glycemic control. Patients and Methods This cross-sectional study was carried out on 100 adolescents with type 1 diabetes. Patients were recruited from the outpatient diabetes specialized clinic, pediatric hospital at Ain Shams University. Patients were subjected to: (1) an interview Pre structured questionnaire which included the following: Personal history, socio economic level, medical history: Duration of diabetes, frequency of hospital admission, presence of diabetic complication, BMI and HbA1C measurement at time of study. (2) Psychiatric screening for the major depressive disorders by using the Arabic version of PHQ-A "modified PHQ-9 for adolescents". (3) Essential examination &amp; investigations to detect presence of diabetic complications. Results The current study reveals that 89% of the patients have depression, while 11% of them don't have. Additionally; there is a statistically significant relationship between the depression score and age, sex, socioeconomic level, HbA1c as well as obesity. Conclusions Adolescents with type 1 diabetes mellitus are at increased risk for depression specially those with poor diabetic control.

THE EFFECT OF SMARTPHONE APPS AND TECHNOLOGY COMPATIBILITY ON DIABETES CONTROL IN DIABETIC PATIENTS USING INSULIN

Objective: This study was done to determine the need for technological systems in diabetes patients using insulin in Turkey, and to investigate the relationship between diabetes control and their smartphone apps. Material and Methods: This descriptive cross-sectional type of study was carried out with 506 diabetic patients using insulin who were followed up at the Diabetes Outpatient Clinics within the Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, between March and September 2017. The data were obtained with a face-to-face interview of the physician using the data collection form. Results: The mean age of the participants was 54.23±15.23 (18-89) years. The investigation of distribution in accordance with age showed that 71 patients (14%) were in the 18-34 age group, 302 (59.7%) in the 35-64 age group, and 133 (26.3%) were aged 65 years and above. The rate of those with Type 1 diabetes was 22.9% (n=116) and the rate of those with Type 2 diabetes was 77.1% (n=390). Four-hundred and sixty-four (92.5%) of the patients stated that a patient follow-up system specific to our country would be useful in increasing the quality of life for diabetic patients. Three-hundred and twenty-one (63.4%) of the patients stated they have been using applications on - technological and telecommunication devices, and 185 patients (36.6%) stated they did not use the applications. In the model that examined the factors affecting the use of smartphone applications (Nagelkerke R2=44.6%, sensitivity=82.9% specificity=69.2%), it showed that higher education students’ rate of using smartphone applications was 14.7 times higher than those with lower education; and those with an income level between 2 and 4 times above minimum wage were found to be 2.5 times higher than those with an income level of or below minimum wage. Conclusion: It is anticipated that a system specific to our country will be needed for diabetic patients using insulin and that educated young patients with middle income will be highly interested in this system.