Eligible Diabetic Patients Research Articles

Feature selection and risk prediction for diabetic patients with ketoacidosis based on MIMIC-IV.

Diabetic ketoacidosis (DKA) is a frequent acute complication of diabetes mellitus (DM). It develops quickly, produces severe symptoms, and greatly affects the lives and health of individuals with DM.This article utilizes machine learning methods to examine the baseline characteristics that significantly contribute to the development of DKA. Its goal is to identify and prevent DKA in a targeted and early manner. This study selected 2382 eligible diabetic patients from the MIMIC-IV dataset, including 1193 DM patients with ketoacidosis and 1186 DM patients without ketoacidosis. A total of 42 baseline characteristics were included in this research. The research process was as follows: Firstly, important features were selected through Pearson correlation analysis and random forest to identify the relevant physiological indicators associated with DKA. Next, logistic regression was used to individually predict DKA based on the 42 baseline characteristics, analyzing the impact of different physiological indicators on the experimental results. Finally, the prediction of ketoacidosis was performed by combining feature selection with machine learning models include logistic regression, XGBoost, decision tree, random forest, support vector machine, and k-nearest neighbors classifier. Based on the importance analysis conducted using different feature selection methods, the top five features in terms of importance were identified as mean hematocrit (haematocrit_mean), mean hemoglobin (haemoglobin_mean), mean anion gap (aniongap_mean), age, and Charlson comorbidity index (charlson_comorbidity_index). These features were found to have significant relevance in predicting DKA. In the individual prediction using logistic regression, these five features have been proven to be effective, with F1 scores of 1.000 for hematocrit mean, 0.978 for haemoglobin_mean, 0.747 for age, 0.692 for aniongap_mean and 0.666 for charlson_comorbidity_index. These F1 scores indicate the effectiveness of each feature in predicting DKA, with the highest score achieved by mean hematocrit. In the prediction of DKA using machine learning models, including logistic regression, XGBoost, decision tree, and random forest demonstrated excellent results, achieving an F1 score of 1.000. Additionally, by applying feature selection techniques, noticeable improvements were observed in the experimental performance of the support vector machine and k-nearest neighbors classifier. The study found that hematocrit, hemoglobin, anion gap, age, and Charlson comorbidity index are closely associated with ketoacidosis. In clinical practice, these five baseline characteristics should be given with the special attention to achieve early detection and treatment, thus reducing the incidence of the disease.

Fruit and vegetable consumption in diabetics patients: Effect of pender health promotion model (HPM) intervention.

This study was aimed to investigate the effect of the intervention based on Pender's health promotion model (Pender's HPM) to improve the consumption of fruits and vegetables in diabetic patients. The present study was quasi-experiment community-based research conducted on 112 diabetic patients in Sirjan City. Eligible diabetic patients were randomly divided into two experimental and control groups. The data were collected by two questionnaires, Behavioral Risk Factor Surveillance System and the researcher-made based on Pender's HPM. In order to compare qualitative variables between two groups, Chi-square test was performed. P value <0.05 was considered significant. The findings showed that there is a significant difference in the consumption of fruit juice in men and women (P value = 0.016). In this study, the perceived obstacles structure and interpersonal influences structure was effective on the consumption of vegetables and salad in diabetic patients before and after the educational intervention. Perceived benefits and interpersonal and situational influencers are effective on the consumption of fruits and vegetables in diabetic people and health planners should design educational interventions in order to increase the consumption of fruits and vegetables in the target group by considering these effective determinants.

A study of the feasibility, ability and acceptability of self-testing of HbA1c before consultation (FLASH) in primary care setting

Background: HbA1c test is the most-ordered laboratory test in public primary care clinics, accounting for 17% of laboratory services. In recent years, there has been growing adoption of self-service technology in taking clinical measurements. However, there are currently no on-site self-testing HbA1c facilities. This study assessed patients’ acceptability and ability to perform self-testing of HbA1c levels and the feasibility of implementation in primary care setting. Methods: A total of 30 eligible diabetic patients were recruited in Tampines Polyclinic. Participants were shown a demonstration video before self-testing with a Point-of-Care HbA1c analyzer and completed a questionnaire after self-testing. The usability of the system was assessed using System Usability Scale (SUS). Acceptance and ability were assessed using either a five or six point-Likert Scale for the 7-step procedure. Fisher’s exact test was used to test for association with SUS score. Results: The study population comprises mainly males (60.0%), Chinese (50.0%), had highest qualification of secondary education and beyond (80.0%), with a mean age of 61.4 ± 8.3 years. The mean SUS score was 66.5 ± 13.3 and the average time taken to complete the HbA1c self-testing was 11.8 ± 4.5 min. No significant association was observed between demographics and SUS score. Although 40.0% of participants experienced some difficulty in inserting the cartridge into the analyzer, all were able to understand and follow the video and were willing to perform self-testing in the future. Conclusion: There is high level of acceptance and ability among diabetic patients to adopt HbA1c self-testing. It is feasible for use in primary care.

Effectiveness of stingless bee (Kelulut) honey versus conventional gel dressing in diabetic wound bed preparation: A randomized controlled trial

PurposeKelulut honey contains trehalulose and has high antioxidant content, such as phenolic and flavonoid substances, which can promote wound healing. This study evaluated the effectiveness of Kelulut honey in diabetic wound healing compared to a commercially available conventional gel dressing (Intrasite gel). MethodsA prospective, randomized, single-blinded control trial was performed on eligible diabetic patients with full-thickness cavity wounds. Patients’ demographics, size and site of wounds, and baseline routine blood investigations were recorded. The wounds were dressed every other day with Kelulut honey for the intervention group or gel for the control group. The wound size reduction and granulation tissue formation percentage were calculated every 6 days for 1 month. ResultsSeventy-one patients were randomized. After 30 days of follow-up, 62 participants were available for analysis: 30 from the control group and 32 from the treatment group. The control group had increased granulation tissue at baseline and more wounds on the lower limb and posterior trunk. Both groups showed an increasing mean and median percentage of wound epithelialization and granulation tissue over time, with significantly higher values at every timepoint in the honey group (p < 0.05). However, repeated measures analysis of variance and analysis of covariance revealed no significant interaction effect between the different treatments and time, with F (2.02, 121.28) = 0.88, p = 0.417 and F (1.60, 93.95) = 0.79, p = 0.431, respectively. ConclusionThis study revealed that Kelulut honey was comparable to and as effective as the conventional gel in treating diabetic wounds in terms of promoting epithelialization and granulation tissue formation.

Prevalence of diabetes foot ulcers and associated factors among adult diabetic patients in three referral hospitals in Mogadishu, Somalia.

Diabetes mellitus (DM) causes significant morbidity and mortality in sub-Saharan Africa (SSA), including Somalia. Among diabetic patients, diabetic foot ulcers (DFUs) constitute the largest proportion of admissions, amputations, and mortality. The aim of this study is to assess the prevalence of diabetic foot ulcers and subsequently determine factors associated with it among diabetic patients at three major hospitals in Somalia. An institutional-based cross-sectional study was conducted among 193 diabetic patients between August and November 2022. All eligible diabetes patients who were attending De Martini Hospital, Madina General Hospital, and Deynile General Hospital during the study period were included in the study. Patients were interviewed using a structured questionnaire. We collected demographic, clinical, and behavioral variables from all participants. A bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. An odds ratio with a 95% confidence interval was computed to determine the level of significance. The mean age of the study's participants was 50.9 ± 13.6 years. The prevalence of diabetic foot ulcer was 15%. Patients who were either overweight or obese (OR 4.63, CI: 2.08-10.30), had a lack of family support in managing diabetes (OR 3.33, CI: 1.74-6.36), and did not check their feet regularly were more likely to develop DFU (OR 1.99, CI:1.08-3.66). Increased body mass index, lack of family support, and not checking feet regularly were associated with DFUs. The high prevalence of DFUs and the plethora of needs of people with DFUs pose challenges for health care. A coordinated health care system is necessary to meet the needs of diabetic patients and prevent DFUs.

Psychiatric morbidities among patients with type-2 diabetes mellitus attending outpatient department in a rural area of North India.

Both diabetes mellitus and psychiatric morbidities are widely prevalent diseases which show a discerning upward trend globally. Coexistence of diabetes and psychiatric morbidities usually manifests as impaired quality of life and poor treatment adherence. The study aimed to estimate the prevalence of psychiatric morbidities among rural diabetic patients and to determine their association with different variables. The present cross-sectional study was conducted in CHC of Rural Health Block attached with PG Department of Community Medicine GMC (Government Medical College) Jammu. The eligible diabetic patients attending medical outpatient department services were enrolled using a consecutive sampling method. DAS scale was used to assess psychiatric morbidity among the study subjects. The findings revealed that the prevalence of psychiatric morbidity in the study participants was 38.9%, 68.5% and 25.64% for depression, anxiety and stress, respectively. Psychiatric morbidities were slightly higher in female patients and were significantly associated with age, marital status, sedentary lifestyle, history of substance abuse, duration of diabetes, presence of complications and underlying morbidities (P < 0.05). The prevalence of anxiety and depression among rural diabetic patients was found to be quite high. Diabetic patients need thorough screening for psychiatric evaluation, and there is an urgent need for psychiatric counselling at regular intervals.

The COVID-19 Vaccination Behavior and Correlates in Diabetic Patients: A Health Belief Model Theory-Based Cross-Sectional Study in China, 2021.

The population with diabetes is more susceptible to severe acute respiratory syndrome-associated coronavirus (SARS-CoV)-2, and have a significantly higher coronavirus disease-2019 (COVID-19) mortality rate. Previous studies have shown low willingness for the COVID-19 vaccination, and there are limited reports on the behavior and relevance of the COVID-19 vaccination. This study aimed to determine the uptake behavior and associated factors of the COVID-19 vaccine. In our cross-sectional questionnaire-based clinical study, 645 diabetes patients affiliated with two affiliated hospitals of Changzhi Medical College completed the questionnaire between June to October 2021. The health belief model (HBM) was used in examining factors influencing vaccination behavior. After adjusting for covariates with significant differences in social background characteristics, a multivariable logistic regression was used to determine predictors related to uptake in COVID-19 vaccination. A total of 162 vaccinated and 483 unvaccinated eligible diabetic patients were recruited. Patients who believed that the COVID-19 syndrome is severe (aOR3.67, 95%CI 1.88–7.17; p < 0.001), believe that vaccination can significantly reduce the risk of SARS-Cov-2 infection (aOR3.48, 95%CI 1.80–6.73; p < 0.001), believe that vaccination is beneficial to themselves and others (aOR 4.53, 95%CI 1.71–11.99; p = 0.002), think that relatives’ vaccination status has a positive impact on their vaccination behavior (aOR 5.68, 95%CI 2.83–11.39; p < 0.001), and were more likely to be vaccinated; worrying about the adverse health effects of COVID-19 vaccination (aOR 0.18, 95%CI 0.09–0.35; p < 0.001) was negatively correlated with COVID-19 vaccination behavior. Health care workers should provide targeted informative interventions based on the safety and protective effects theory of HBM to improve vaccination behavior in patients with diabetes.

The Relationship Between Health Literacy and Health Promoting Behaviors in Patients with Type2 Diabetes

Background and Objective: Health literacy and health-promoting behaviors are the main factors in field of health promotion and education and play an important effect to prevent diabetes type II complications and reduce its health care costs. Therefore, this study aimed to find the relationship between health literacy and health-promoting behaviors in patients with type II diabetes.Materials and Methods: This correlational study was conducted on 175 diabetic patients (20 to 65 years) from April 2020 to October 2020. Convenience sampling was used to select eligible diabetic patients who were referred to governmental diabetes clinics in Ganjavian Hospital where located in Dezful city, Iran. Data were collected by diabetic patients’ health-promoting behaviors questionnaire and health literacy questionnaire. Data were analyzed using SPSS 22, descriptive statistics, and Pearson’s correlation coefficient.Results: The mean scores for health literacy and health-promoting behaviors were 113.54 ± 25.66 and 171.7 ± 33.69, respectively. The highest scores in health-promoting behaviors belonged to blood sugar control and foot control and the lowest score belonged to physical activity. There was a significant relationship between all dimensions of health promoting behaviors and health literacy (P = 0.000, r = 0.444).Conclusion: Since there is a positive relationship between health literacy and health-promoting behaviors, there is a need for more efforts in teaching health-promoting behaviors and publicizing self-care. Further, adding these concepts into course plans may lead to the health improvement of community members.

Predictors of extrapulmonary tuberculosis among diabetic patients at Debre Markos compressive specialized hospital, Ethiopia, 2021: A retrospective cohort study

BackgroundExtrapulmonary tuberculosis is an emerging public health problem among diabetic patients. Diabetes, which causes immunosuppression, is increasingly being recognized as an independent risk factor for tuberculosis, and the two often coexist and impact each other. Therefore, this study aimed to investigate the incidence and predictors of extra pulmonary tuberculosis among diabetic patients at Debre Markos referral hospital, Northwest Ethiopia. MethodsThis institutionally-based retrospective cohort study was undertaken among 433 diabetic patients of Debre Markos compressive specialized hospital between January 2016 to December 2020. All eligible diabetic patients who full filled the inclusion criteria were included in the study. Data were entered using Epi-data Version 3.1 and analyzed using STATA Version 14. The survival time of diabetic patients was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables was compared using the log rank test. Both bi-variable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of tuberculosis among diabetic patients. ResultsAmong a cohort of 433 diabetic patients at Debre Markos compressive specialized hospital, 17(3.9%) developed extra pulmonary tuberculosis during the follow-up time. The total time allotted to follow up the study participants was 1101.5 person-years (PY). The overall extra pulmonary tuberculosis incidence rate was 1.5 per 100 PY with 95% CI. Using the multivariable Cox-regression analysis, age (AIR 4.8 (95% CI (1.2–20.7), 0.03), diabetic medication (AIR 1.4 (95% CI(1.24–16), 0.03), having past history of PTB before diabetic follow up initiation (AID 1.5(95% CI (3.2–6.9),0.01) and having history of alcohol (AIR (95%CI (4(1.2–13),0.02) were significantly increased the risk of extra pulmonary tuberculosis while BMI (18.5–25) AIR(95% CI (0.22 (0.06–0.76), 0.02) was associated with a rate reduction for the incidence of extra pulmonary tuberculosis. ConclusionsIn this study, we found a high rate of extra pulmonary tuberculosis among diabetic patients. Factors significantly linked with increased risk of extra pulmonary tuberculosis included: age, using insulin as hypoglycemic medication, having past history of PTB before diabetic follow up initiation and alcoholic history while BMI was associated with a rate reduction of EPTB. Early screening and treatment for extra pulmonary tuberculosis is highly recommended at diabetes mellitus follow up for patients with the above risk factors.

Prevalence of diabetic retinopathy: A tertiary care centre based study

Diabetes has become a global epidemic. Diabetic retinopathy (DR) is a leading cause of loss of vision in diabetics. Since the global prevalence of diabetes is estimated to rise exponentially, the prevalence of DR is also bound to rise. Consequently, a large population will be at risk by DR in near future. A cross sectional observational study was conducted on eligible diabetic patients. Demographic data and history was noted. A complete ophthalmic examination in which fundus was examined by +90 D and +20D lenses. Statistical analysis was performed. Out of 291 eligible patients, 159 (55%)were males. 76 (26.11%) had DR of which 43 (27.04%)were males. For duration of diabetes (years) &amp;#60;5, 5-10 and &amp;#62;10, DR was found in 5 (6.57%), 30 (39.47%) and 41 (53.94%) respectively. DR in age groups (years) of &amp;#60;40,40-60,60-80 and &amp;#62;80,was 1(2%),32(25%),44(30%) and 9(100%) respectively. Mild, moderate, severe NPDR and PDR were found in 39(51.31%), 17(22.36%), 13 (17.1%) and 7 (9.2%) patients respectively. The prevalence of DR is very high in Indian population. Diabetic patients are unaware of development of DR in early stages. The severity of DR rises with increase in duration of diabetes.

PUK7 Budget Impact Of A New Mobile Application Reimbursement Strategy For Diabetic Patients In Andhra Pradesh (India)

In Andhra Pradesh, ApeRx app is a mobile application previously used for reimbursement of tuberculosis drugs under World Health Organisation's strategy to eliminate this disease. Due to the chronic nature of diabetes, out of pocket spending to purchase drugs aggravates the problem leading to low compliance to dosage schedule and also economic impoverishment. So, the current study evaluates the budget impact of reimbursement of a basket of generic drugs for diabetes directly to the bank account of private pharmacists through the ApeRx app from a Andhra government perspective. A cohort-based budget impact model was used to calculate the incremental cost of introducing the basket of generic medicines for diabetes (glibenclamide 5mg, glimepride 1 mg, glimepride 2mg, metformin 500 mg) for a short time horizon of one year. The analysis compared two scenarios: treatment options excluding or including this strategy. Market shares were derived from sales data of private pharmacies and epidemiological data was derived from the literature. Acquisition costs were based on wholesale acquisition costs and costs for diagnosis of diabetes, drug administration and monitoring, and relevant adverse events were included. With an estimated 11,42,810 eligible diabetic patients for the scheme, the budget impact for this strategy was calculated to be 19.02 crores (approx $2.6 M), corresponding to a budget impact of only 166 per treated member. In the state of Andhra Pradesh, use of this new mobile application reimbursement strategy may increase access to life saving drugs for the poor diabetes patients.

Validation of the 3-item What Engagement Looks Like (WELL) scale in patients with diabetes

BackgroundPatients’ behaviors play a key role in chronic disease management, but how effective they are may depend on how engaged they feel. The objective was to develop a short measure of how much patients felt engaged in self-managing a chronic condition. Online test of a three-question series followed by a survey of physicians and their eligible diabetic patients. Physicians answered: 1) how well the physician thought the patient was managing his/her diabetes, and 2) how much effort the physician thought the patient was putting in. Each patient was mailed a survey that included three questions on self-management. Six hundred six patients from a national online consumer panel with diabetes or obesity, and 35 physicians from 3 primary care practices and a sample of 243 of their diabetic patients. Respondents were asked three questions about how much they thought their behavior could affect their health condition, how confident they were that they could do what was needed, and how involved they were in decisions about managing their condition. These items were summed to create a WELL score. Descriptive statistics and correlation coefficients were used to describe item relationships. Generalized Estimating Equations were used to predict how well the physician thought the patient was managing their diabetes and patient effort.ResultsCorrelations among the three patient-reported items ranged from − 0.01 to 0.45. The WELL score was correlated with an existing measure of patient activation commitment (r = .43, p < 0.001) and found to be a significant predictor of physicians’ ratings of how much effort patients devoted to condition management (b = 0.02, p = 0.001, OR = 1.02) after adjusting for confounders. The WELL score didn’t predict physicians’ ratings of how effective patients were (b = 0.003, p = .526, OR = 1.004) after their A1c score had been taken into account.ConclusionPatients’ WELL scores predicted physicians’ ratings of patient effort in diabetes self-management.

Incidence and Predictors of Tuberculosis among Adult Diabetic Patients, Debre Markos Referral Hospital, Northwest Ethiopia, 2018: A Retrospective Cohort Study.

BackgroundTuberculosis remains a serious global public health problem. It mainly affects the lungs, and occurs in every part of the world. The link between tuberculosis and diabetes mellitus is essential to inform programs and policies, yet there is a scarcity of information in our study area. Therefore, this study aimed to investigate the incidence and predictors of tuberculosis among diabetic patients at Debre Markos Referral Hospital, northwest Ethiopia.MethodsThis institutionally based retrospective cohort study was undertaken among 433 diabetic patients of Debre Markos Referral Hospital between January 2013 and December 2017. All eligible diabetic patients who met the inclusion criteria were included in the study. Data were entered using EpiData version 3.1 and analyzed using Stata version 14. The survival time of diabetic patients was estimated using Kaplan–Meier survival curves, and survival time among different categorical variables compared using the log-rank test. Both bivariate and multivariate Coxproportional-hazard regression models were fitted to identify independent predictors of tuberculosis among diabetic patients.ResultsAmong the cohort of 43326 (6%) developed tuberculosis during follow-up. The overall tuberculosis-incidence rate was 2.4 per 100 with 95% CI. The total time allotted to follow up the study participants was 1,101.5 person-years. Using multivariate Cox regression analysis, history of alcohol consumption (adjusted incidence ratio 4, 95% CI 1.2–13; P=0.02) and history of tuberculosis (12, 95% CI 3–39; P=0.01) significantly increased the risk of tuberculosis, but normal body-mass index and above (≥18.5 kg/m2) was associated with a rate reduction (0.34, 95% CI 0.14; P=0.80; 0.03) forincidence of tuberculosis.ConclusionIn this study, we found a high rate of tuberculosis among diabetic patients. Factors significantly linked with increased risk of tuberculosis included history of alcohol consumption, history of tuberculosis, and low body-mass index. Early screening and treatment for tuberculosis is highly recommended at diabetes mellitus follow-up for patients with these risk factors.

Hyperbaric Oxygen Therapy in the Treatment of Ischaemic Lower Extremity Ulcers in Patients with Diabetes: Results of the Damocles Multicentre Randomised Clinical Trial

Introduction - Conflicting evidence exists on the effects of hyperbaric oxygen therapy (HBOT) in the treatment of chronic ischaemic leg ulcers. The aim of this multicentre trial was to investigate whether HBOT, as an adjunct to revascularisation and standard wound care, can improve wound healing and reduce major amputation rates in patients with diabetes and ischaemic lower extremity ulcers. Methods - The DAMOCLES study was designed as a multicentre, randomised, parallel-group, superiority trial. In total, 120 patients were randomised to standard care without (SC) or with HBOT (SC+HBOT). Eligible diabetic patients had a Wagner grade 2-4 ulcer present for at least 4 weeks and concomitant limb ischaemia with or without revascularisation options. Primary outcomes were limb salvage and complete wound healing after 12 months of follow-up, as well as time to wound healing. Other endpoints were amputation-free survival (AFS) and mortality. Results - Both groups contained 60 patients. Limb salvage was achieved in 47 patients (78%) in the SC group vs. 53 (88%) patients in the SC+HBOT group (risk difference [RD] 0.10, 95% CI -0.04 to 0.23). After 12 months, 28 index wounds were healed in the SC group vs. 30 in the SC+HBOT group (RD 0.03, 95% CI -0.14 to 0.21). AFS was achieved in 41 patients in the SC group and 49 patients in the SC+HBOT group (RD 0.13, 95% CI -0.02 to 0.28). In the SC+HBOT group 21 patients (35%) were unable to complete the HBOT-protocol as initially planned. Those who did had significantly less major amputations and higher AFS (RD 0.26, 95% CI 0.10 to 0.38). Conclusion - Additional HBOT did not significantly improve complete wound healing and limb salvage in patients with diabetes and lower limb ischaemia. However, a trend was seen towards a better amputation-free survival among HBOT-treated patients. The potential efficacy of HBOT may not be realised because a considerable number of patients is unable to complete a full HBOT-regimen.

Personalized diabetes management recommendations at hospital discharge based on a computerized, pre-hospitalization clinical profile analysis: A prospective, electronic health records-based study.

While glycemic control of hospitalized diabetic patients is straightforward, personalization of management at discharge is challenging. Treatment guidelines base recommendations on the clinical profile of patients. We checked the feasibility of implementing discharge recommendations, based on the clinical profile in the patients' electronic health records (EHR). A decision-making algorithm was devised according to current guidelines. It was incorporated into the EHR. A prospective follow-up of eligible diabetes patients was done. During 15 months, 835 patients (HbA1c was 6.9% [6.2%-7.8%]) met our inclusion criteria. The rate of HbA1c acquisition increased from 55% during Q1 to 85%, 86%, 88%, and 87% thereafter. Also, the rate of incorporating personalized management recommendations to discharge letters increased: from 14.9% during Q1 to 42.9%, 43.0%, 47.2%, and 53.4% thereafter. Fifty-eight (17.3%) of patients who got personalized recommendations upon discharge were found to have HbA1c values that were over 1% deviating from suggested target HbA1c. They got the most stringent recommendations. Twenty-nine (50%) of them had available follow-up HbA1c values showing a significant drop in HbA1c: from 9.1% (8.4%-10.2%) to 8.5% (7.4%-9.5%), P = .03. Personalized, EHR algorithm-based, management recommendations for diabetes upon discharge from hospitalization are feasible and beneficial.

Safety and Efficacy of Placenta-Derived Mesenchymal Stem Cell Treatment for Diabetic Patients with Critical Limb Ischemia: A Pilot Study.

Diabetic foot has become the main cause of non-traumatic amputation. Stem cell therapy, especially mesenchymal stem cells (MSCs), holds a great promise as a therapy for diabetic foot with ischemia limb arterial disease. The aim of this pilot study is to evaluate the safety and efficacy of placenta-derived MSCs (P-MSCs) treatment for diabetic patients with critical limb ischemia (CLI). Four eligible diabetic patients with CLI were consecutively enrolled in this pilot study. On the base of the standard-of-care treatment, these patients accepted P-MSCs treatment by intramuscular injection for successive 3 times at an interval of 4 weeks, and the safety and efficacy of placenta-derived MSCs (P-MSCs) treatment were evaluated. There were no serious adverse events during the period of P-MSCs injection and the 24-weeks follow-up period. The clinical ischemic features of patients were improved 24 weeks after P-MSCs treatment. The scores of resting pain and limb coldness significantly decreased, and pain-free walking distance significantly increased from baseline to 24 weeks after P-MSCs therapy. The resting ankle brachial index increased, but no statistically significant difference was found. The findings of magnetic resonance angiography showed the increase of collateral vessel formation in one patient, but there were no significant changes observed in the other patients. The data in this pilot study indicated that multiple intramuscular P-MSCs injections may be a safe and effective alternative therapy for diabetic patients with CLI, and larger, placebo-controlled, perspective studies are needed to prove these results.

Abstract 174: Healthcare Provider Compliance with the 2013 ACC/AHA Blood Cholesterol Guidelines for Statin Therapy for Diabetic Patients of Ages 40 to 75

Introduction: On the basis of documented outcome benefit in randomized clinical trials, 2013 ACC/AHA blood cholesterol guidelines advocate use of moderate to high intensity statin therapy in all diabetic patients ages 40 -75. Recent published observations suggest variable provider compliance with this recommendation. This study investigates provider adherence to this recommendation and the predictors of such decision-making at a single academic tertiary care center. Methods: We retrospectively reviewed all diabetic patients, ages of 40-75, who were evaluated at our institution in the outpatient setting in 2015. Patient characteristics including demographics, cardiovascular co-morbidities and statin use were obtained from the electronic medical records. Statin prescribing frequency was analyzed by age group, gender and indication, whether primary or secondary prevention. Correlation and regression analyses were done to determine the effect of patient characteristics on statin prescription and the predictors of prescribing statins, respectively. Results: Of the 18,389 patients with diabetes, 10,338 (56.2%) were on statin therapy of any dose. Of those treated, 94.9% were on appropriate statin intensity. In the multivariate model, independent predictors of failure to prescribe statins were: Absence of diagnosis of hyperlipidemia (OR 3.60, 95% CI 3.31-3.92, p&lt;0.0005), absence of hypertension (OR 1.42, 95% CI 1.30-1.56, p&lt;0.0005), absence of atherosclerotic cardiovascular disease (coronary, cerebral or peripheral arterial disease) (OR1.41, 95% CI 1.16-1.70, p=0.001), age less than 60 (OR 1.35, 95% CI 1.24-1.46, p&lt;0.0005), and female gender (OR 1.27, 95% CI 1.17-1.38, p=0.037). Absence of coronary artery disease (46.7% vs 29.9%, p&lt;0.0005), absence of stroke history (44.0% vs 36.9%, p=0.003), BMI less than 30 (45.3% vs 43.3%, p=0.027) and lack of a cardiologist provider (44.3% vs 41.9%, p=0.009) were associated with failure to prescribe statins, but were not independent predictors. Conclusions: Only 56.2% of patients in an outpatient setting in our study who have an indication for statin use on the basis of diabetes received a prescription for statin therapy. Independent predictors of failure to prescribe statins were: absence of hyperlipidemia, absence of hypertension, absence of ischemic vascular disease, age less than 60, and female gender. Future educational interventions should focus on these predictors in order to improve provider compliance with initiation of statin therapy in eligible diabetic patients.

Prevalence of Psychiatric Comorbidity among Patients of Type 2 Diabetes Mellitus in a Hilly State of North India.

Background:Psychiatric comorbidity with diabetes mellitus is common. Comorbidity of diabetes and psychiatric disorders can present in different patterns, which are associated with impaired quality of life, increased cost of care, poor treatment adherence, poor glycaemia control and increased emergency room visits. The present study was planned to assess the psychiatric comorbidity in type 2 diabetic patients at tertiary care hospital in a hilly state of North India.Objectives:To study the prevalence of psychiatric comorbidity among patients of type 2 diabetes mellitus and to study the association between psychiatric comorbidity, sociodemographic and clinical variables in such patients.Materials and Methods:A cross-sectional study was conducted after enrolling the eligible diabetic patients attending outpatient department services of medicine department, Indira Gandhi Medical College, Shimla. The Brief Illness Perception Questionnaire was used to assess the cognitive and emotional aspects of illness, Hamilton Depression Rating Scale for assessment of depression, Hamilton Anxiety Rating Scale for assessing severity of anxiety and Mini-International Neuropsychiatric Interview 6.0 for screening all major Axis I disorders.Results:Out of 320 patients of type 2 diabetes mellitus screened, 202 eligible patients were enrolled. Depression was the most common psychiatric comorbid illness present in (41.9%) patients. Depression was slightly higher in female patients and persons aged >50 years. Greater prevalence of depressive episodes was there in people with longer duration of diabetes.Conclusion:There were a significant percentage of diabetic patients having psychiatric illnesses. Their attitude towards these comorbidities may be changed by psychiatric counselling at regular intervals.

The Relationship between Health Literacy and Health Promoting Behaviors in Patients with Type 2 Diabetes.

Health promoting behaviors are known to be a key factor in managing type 2 diabetes and improving the quality of life in diabetic patients. However, there is little known about the factors influencing these behaviors in diabetic patients. This study aimed to find the relationship between the health literacy and health promoting behaviors in patients with type II diabetes. This correlational study was conducted from August to September 2016 on 175 eligible diabetic patients (20 to 65 year-old) who referred to the selected centers of diabetes control in Ahvaz City. Patients were chosen using convenience non-probable sampling. Data were collected by diabetic patients' health promoting behaviors' questionnaire and health literacy questionnaire. Data were analyzed using SPSS 22, descriptive statistics and Pearson's correlation coefficient. The mean scores for health promoting behaviors and health literacy were determined 100.45±19.82 and 76.14±15.26, respectively. The highest and lowest scores in health promoting behaviors belonged to nutrition (26.11±6.85) and physical activity (6.70±2.75), respectively. There was a significant relationship between all dimensions of health promoting behaviors and health literacy (P<0.05). Since health literacy has a positive relationship with health promoting behaviors in diabetic patients, health care providers need to concentrate on increasing the health literacy of their patients rather than solely concentrating on increasing their knowledge, thereby facilitating the development of health promoting behaviors in patients.

NHS England to fund flash glucose monitoring devices for all eligible diabetes patients

NHS England to fund flash glucose monitoring devices for all eligible diabetes patients