Level Of Diabetes Control Research Articles

Relationship of Mean Platelet Volume and HbA1c in Predicting the Level of Diabetes Control in Type 2 Diabetes Mellitus

Background: MPV is an indicator of platelet size and MPV is increased in DM as compared to non-diabetics, more so in presence of complications. There are few studies evaluating the association between MPV and HbA1c and its role in predicting glycaemic control with conflicting results. The present study was planned to determine the relationship between MPV and HbA1c in predicting the level of diabetes control in type 2 DM. Methodology: Cross sectional observational study including 100 consecutive cases of type 2 DM aged between 30 to 60 years. Mean platelet volume (MPV), platelet distribution width (PDW) and platelet count were obtained from fully automated haematology analyser Sysmex KX-21. Glycosylated haemoglobin (HbA1c) was analysed by automated haemoglobin analyser. Results: The mean age among 100 type 2 DM cases was 49.58 ± 14.49 years. The mean value of MPV and HbA1c was 10.25±0.90fl and 5.66± 1.17% respectively. There was no significant correlation found between MPV and HbA1c (r=0.110, p=0.275). Similarly, there were no significant association between MPV and three levels of glycaemic control. Conclusion: MPV is not a reliable marker for determining glycaemic control in type 2 DM.

2408-PUB: Benchmarking Care Outcomes for Youth with Diabetes after Transition to Adult Care in Australia

In 2001 a model of care for transition of youth with diabetes (YWD) was implemented at Westmead Hospital and published in 2007. In 2017, Australian National Diabetes audit (ANDA) conducted a month survey of all people with diabetes attending participating centers. The Australian Diabetes Data Network (ADDN) is a newly established national database. Aim: To determine if benefits are conferred by a youth specific transition care model as compared with other Australian adult health care settings for YWD age 16-25. Methods: An audit of all T1D Westmead clinic attendees aged 16-25 in 2017 including age, duration diabetes, HbA1c, urine microalbumin/creatinine ratio in the last 12 months, BP, most recent retinal review and results compared with the ANDA outcomes for youth attending adult health care settings for management of diabetes. Subjects within 1 year diagnosis and pregnancy excluded. Results: Key: HbA1c median (25th-75th centile), [n] missing * p<0.05. HbA1c did not differ across all adult centers. In subgroup analysis only MDI treated were lower in the ANDA centers. A significantly greater proportion had urine microalbumin screening and BP screening, in the Westmead cohort. Conclusion: Similar levels of diabetes control were achieved regardless of center indicating importance of follow-up in this age group although control was suboptimal. Complications screening was more effective with a dedicated transition. Disclosure J. Holmes-Walker: None. P. Rueter: None. K. Farrell: None.

Assessment of Knowledge, attitude, and practice of dietary pattern in patients with type 2 diabetes mellitus: a locality-based perspective study

Background: Diabetes mellitus is a lifelong metabolic disease, considered often as an epidemic problem that leads to a reduction in quality and expectancy of life. There is an increasing prevalence of Diabetes Mellitus throughout the world as a result of changing dietary patterns and decreased physical activity. Providing proper education and guidance towards diabetes care among patients could result in considerable development in their glycemic control and disease treatment. The objective of this study was to assess the knowledge, attitude, and practice of dietary pattern among diabetes mellitus patients visiting primary health care center (PHC) in Al Majmaah City, Saudi Arabia Methodology: A cross-sectional study was conducted among 155 patients with type 2 diabetes that included 73 male and 82 females. Results: Mean knowledge score was 43.22±14.85. The mean attitudes score was 2.33±0.40, and regarding the practice, the majority of the patients did not follow special diet 87(56.1%), and only 24(15.5%) patients follow Diabetic diet. The majority 37(23.9%) of patients took only 1-2 serving of starch per a day, 47(30.3%) patients took less than one serving of fruits per a day, and 64(41.3%) patients only drank 4 cups of water per a day. Conclusion: In general, poor knowledge, attitudes, and practices were observed towards healthy dietary habits among type 2 diabetes mellitus in patients attending PHC in Al Majmaah city. The present study found only 15.5% among the study subjects following a strict diabetic diet which reflects the poor level of diabetic control followed in this part of the country.

Exploring how patients understand and assess their diabetes control

BackgroundPoor understanding of diabetes management targets is associated with worse disease outcomes. Patients may use different information than providers to assess their diabetes control. In this study, we identify the information patients use to gauge their current level of diabetes control and explore patient-perceived barriers to understanding the hemoglobin A1c value (HbA1c).MethodsAdults who self-reported a diagnosis of diabetes were recruited from outpatient, academically-affiliated, Internal Medicine clinics. Semi-structured interviews were conducted with participants and collected data were analyzed using thematic analysis.ResultsThe mean age of the 25 participants was 56.8 years. HbA1c was one of several types of information participants used to assess diabetes control. Other information included perceived self-efficacy and adherence to self-care, the type and amount of medications taken, the presence or absence of symptoms attributed to diabetes, and feedback from self-monitoring of blood glucose. Most participants reported familiarity with the HbA1c (22 of 25), though understanding of the value’s meaning varied significantly. Inadequate diabetes education and challenges with patient-provider communication were cited as common barriers to understanding the HbA1c.ConclusionsIn addition to the HbA1c, several categories of information influenced participants’ assessments of their diabetes control. Increased provider awareness of the factors that influence patients’ perceptions of diabetes control can inform effective, patient-centered approaches for communicating vital diabetes-related information, facilitating behavior change towards improved patient outcomes.

Lifestyle, metabolic compensation in patients with type 2 diabetes mellitus and the risk of chronic disease complications

Introduction. Poorly-controlled diabetes mellitus leads to organ-related complications of this disease and in order to prevent such complications, change of lifestyle is of essential importance. By correcting metabolic control in patients with type 2 diabetes, it is possible to slow down their progress and prevent their further development. The aim of the study was to evaluate the influence of lifestyle on metabolic control of diabetes mellitus and on chronic complications. Material and method. The study included a group of 206 patients with type 2 diabetes mellitus aged between 30 and 66 and older, with the duration of the disease up to 5 years. 183 fully completed questionnaires were finally analyzed. In the presented paper, a diagnostic survey was used as a research method, a technique which was an original questionnaire survey developed by the authors and an analysis of medical documentation. Results. The analysis of this research showed that there are no patients who would meet all the parameters of metabolic compensation. Lifestyle change after diabetes diagnosis was declared by 86.5% of the respondents; however, their confirmation does not reflect the clinical picture of the disease and the dietary habits presented by them. Diabetes complications were observed among respondents and were more common among the women (55.8%). Neuropathy was the most common of these complications. Conclusions. The respondents’ knowledge about the disease is not used in practice and does not translate into their lifestyle. The level of diabetes control among the population under examination does not significantly depend on their occupational activity, but shows slight dependence on their health behaviors. Lack of metabolic control of diabetes mellitus results in subsequent complications.

81: Group Prenatal Care Model Use in Pre-Gestational Diabetes

Pre-gestational diabetes carries an increased risk of perinatal and maternal morbidity and mortality. Recent studies show that healthy women exposed to a group prenatal care model have better pregnancy outcomes when compared to those receiving traditional care. An improvement in health also is reported in studies implementing a group care model in non-pregnant subjects with diabetes. We sought to compare the level of diabetes control and associated pregnancy outcomes in women with pre-gestational diabetes exposed to a group prenatal care model to those receiving traditional prenatal care. Randomized control trial where women with pre-gestational diabetes were assigned to an (i) enhanced group prenatal care model (enhanced group) or (ii) traditional individualized prenatal care (traditional group). All subjects were followed by Maternal-Fetal Medicine specialists and Certified Diabetic Educators. Our primary outcome was the reduction in HbA1c before delivery as a surrogate of improved diabetes control. Secondary outcomes were adverse pregnancy and neonatal outcomes associated with pre-existing diabetes. Knowledge of diabetes care was compared in both groups by traditional scoring. Chi square, student T-test and regression analyses were used when appropriate. A P-value <0.05 indicated statistical significance. Among 70 patients meeting eligibility criteria, 39 received enhanced group prenatal care and 31 traditional individual prenatal care. There was no significant difference in the average decrease in HbA1C near delivery between groups (delta 1.4 vs. 1.2, respectively; P=0.7). The traditional group had a higher incidence of fetal demise (n=3) compared to the enhanced group (n=0); P=0.1. The rate of preterm delivery was lower in the enhanced group (30% vs. 45%; P=0.7). Both groups had comparable rates of preeclampsia, cesarean delivery, breastfeeding acceptance, NICU admissions, and neonatal complications including RDS. Women in the enhanced group scored higher in diabetes knowledge at the end of pregnancy compared to those in the traditional group (24 points vs. 10 points; P = 0.02). In our cohort, enhanced group prenatal care achieved similar diabetes control and appears as a safe alternative to traditional care in women with pre-existing diabetes. An enhanced group prenatal care approach is more effective in diabetes education during pregnancy.

A study on the glycemic, lipid and blood pressure control among the type 2 diabetes patients of north Kerala, India

AimThe aim of the study was to detect the level of comprehensive diabetes control among the diabetic patients of Kerala, India. MethodsPatients (1200) were randomly selected from a diabetes care center. Their blood sugar, biochemical and anthropometric measurements were done and statistically analyzed. ResultsOnly 28.3% had their HbA1c at or below 7% and 45% above 9%. One-third of the female and one-fifth of the male patients had coronary artery disease. The prevalence of hypertension was almost equal in both sexes. However, there was a statistically significant higher systolic blood pressure (mean 162.12mmHg vs 147.49mmHg, p=0.01044) among females. The total cholesterol was above 200mg/dl in 42.1% of males and 45.61% of females. The triglyceride was >150mg/dl in 38.6% males and 50.88% females. Low high density lipoprotein (HDL) cholesterol levels were found in 20.07% of males and 41.12% of females (p=0.0445). The mean low density lipoprotein (LDL) was 121.75 (±32.29) ConclusionThe mean blood sugar values are found to be high, which will lead to a predictable increase in vascular disease, which in turn will affect the quality of health and productivity of the individual and the economic growth of the society as a whole. Studies suggest that therapeutic interventions to improve glycemic control may reduce the risk of cardiovascular disease and microvascular disease.This study shows that the level of diabetes control in Kerala is unsatisfactory. We need more medications, better strategies and more emphasis on glycemic management than we are currently able to apply.

Challenges in diagnosis and management of diabetes in the young.

The prevalence of diabetes in children and adolescents is increasing worldwide, with profound implications on the long-term health of individuals, societies, and nations. The diagnosis and management of diabetes in youth presents several unique challenges. Although type 1 diabetes is more common among children and adolescents, the incidence of type 2 diabetes in youth is also on the rise, particularly among certain ethnic groups. In addition, less common types of diabetes such as monogenic diabetes syndromes and diabetes secondary to pancreatopathy (in some parts of the world) need to be accurately identified to initiate the most appropriate treatment. A detailed patient history and physical examination usually provides clues to the diagnosis. However, specific laboratory and imaging tests are needed to confirm the diagnosis. The management of diabetes in children and adolescents is challenging in some cases due to age-specific issues and the more aggressive nature of the disease. Nonetheless, a patient-centered approach focusing on comprehensive risk factor reduction with the involvement of all concerned stakeholders (the patient, parents, peers and teachers) could help in ensuring the best possible level of diabetes control and prevention or delay of long-term complications.

Tuberculosis screening at a diabetes clinic in the Republic of the Marshall Islands

SettingTuberculosis (TB) and diabetes mellitus (DM) are prominent public health problems in the Republic of the Marshall Islands, a small island nation with high rates of tuberculosis and diabetes. ObjectiveEvaluate the rate of active and latent TB in a Pacific Island DM clinic. DesignIn one DM clinic on the island of Ebeye, 213 adult patients aged 27–86 years completed tuberculin skin testing and TB work-up between April 2010 and March 2012. ResultsScreening for TB led to the diagnosis of 77 patients with TB infection and 11 patients with TB disease. From these data, the prevalence of TB disease among DM patients in the clinic exceeded 5% (95% CI 2.2%–8.1%). All patients who completed TB screening were at high risk of TB disease, and those with DM aged ≤50 years had a higher risk of TB disease than those with DM over age 50 (RR 3.1, C.I. 1.0–9.7, p= 0.05). ConclusionThe experience at the Ebeye Diabetes Clinic demonstrates that screening DM patients for TB can identify significant rates of TB infection and TB disease, and should be considered for other settings with a high background TB incidence. Further assessment of TB risks should explore age, gender, and level of diabetes control.

A study on the glycemic, lipid and blood pressure control of type 2 diabetes patients of Kerala

AimAim of the study was to detect the level of comprehensive diabetes control among the diabetic patients of Kerala, India. MethodPatients (1200) were randomly selected from a diabetes care center. Their blood sugar and other biochemical and anthropometric measurements were done and statistically analyzed. ResultOnly 28.3% had their A1C at or below 7% and 45% above 9%. 1/3rd of the female and 1/5th of the male patients had CAD. The prevalence of hypertension was almost equal in both sexes. However, there was a statistically significant higher systolic BP (mean 162.12mm Hg vs 147.49mm Hg, p=0.01044) among females. The total Cholesterol was above 200mg/dl in 42.1% of males and 45.61% of females. The triglyceride was >150mg/dl in 38.6% males and 50.88% females. Low HDL cholesterol levels were found in 20.07% of males and 41.12% of females (p=0.0445). The mean LDL was 121.75 (±32.29247) DiscussionThe mean blood sugar values are found to be high which will lead to a predictable increase in vascular disease, which in turn will affect the quality of health and productivity of the individual and the economic growth of the society as a whole. Studies suggest that therapeutic interventions to improve glycemic control may reduce the risk of CVD and microvascular disease. ConclusionThis study shows that the level of diabetes control in Kerala is unsatisfactory. We need more medications, better strategies, and more emphasis on glycemic management than we are currently able to apply.

Comparison of Hemoglobin A1c assay performance on two different commercial systems

Introduction: Glycated hemoglobin (HbA1c) is formed by non-enzymatic binding of glucose to the free amino group of the N-terminal end of the ß-chain of hemoglobin A. HbA1c is representative of the mean blood glucose level over three months. The aim of the study was to evaluate the Hemoglobin A1c immunoturbidimetric assay performance on two different commercial systems.Methods: We evaluated the precision and trueness for determination of HbA1c in whole blood. Concentrations of total hemoglobin and HbA1c were evaluated on Dimension Xpand (Siemens) and Cobas 501 (Roche) analyzers. HbA1c was measured in a latex agglutination inhibition test. Commercial controls Liquichek Diabetes Control Level 1 and Liquichek Diabetes Control Level 2 (Bio Rad) at two levels were used for quality control. Analytical validation of HbA1c included: within-run imprecision, between-day imprecision, inaccuracy and comparison determination on the human samples on 2 systems: Dimension Xpand and Cobas 501 analyzers. Results: Within-run imprecision on the commercially controls for Level 1 is 4.5% and Level 2 is 3.2% between-day imprecision on commercially controls is 6.1% Level 1 and 5.1% Level 2 for respectively inac- curacy on commercially controls for Level 1 is 1.8% and Level 2 is 4.8%. Method comparison on human samples shows the correlation coefficient of 0.99.Conclusion: The presented results of the analytical evaluation methods for the determination of HbA1c showed an acceptable accuracy and precision.

Implementing elements of a context-adapted chronic care model to improve first-line diabetes care: effects on assessment of chronic illness care and glycaemic control among people with diabetes enrolled to the First-Line Diabetes Care (FiLDCare) Project in the Northern Philippines.

Aim The purpose of this study was to investigate the effects of implementing elements of a context-adapted chronic disease-care model (CACCM) in two local government primary healthcare units of a non-highly urbanized city and a rural municipality in the Philippines on Patients' Assessment of Chronic Illness Care (PACIC) and glycaemic control (HbA1c) of people with diabetes. Low-to-middle income countries like the Philippines are beset with rising prevalence of chronic conditions but their healthcare systems are still acute disease oriented. Attention towards improving care for chronic conditions particularly in primary healthcare is imperative and ways by which this can be done amidst resource constraints need to be explored. A chronic care model was adapted based on the context of the Philippines. Selected elements (community sensitization, decision support, minor re-organization of health services, health service delivery-system re-design, and self-management education and support) were implemented. PACIC and HbA1c were measured before and one year after the start of implementation. Findings The improvements in the PACIC (median, from 3.2 to 3.5) as well as in four of the five subsets of the PACIC were statistically significant (P-values: PACIC=0.009; 'patient activation'=0.026; 'goal setting'=0.017; 'problem solving'<0.001; 'follow-up'<0.001). The decrease in HbA1c (median, from 7.7% to 6.9%) and the level of diabetes control of the project participants (increase of optimally controlled diabetes from 37.2% to 50.6%) were likewise significant (P<0.000 and P=0.014). A significantly higher rating of the post-implementation PACIC subsets 'problem solving' (P=0.027) and 'follow-up' (P=0.025) was noted among those participants whose HbA1c improved. The quality of chronic care in general and primary diabetes care in particular may be improved, as measured through the PACIC and glycaemic control, in resource-constrained settings applying selected elements of a CACCM and without causing much strain on an already-burdened healthcare system.

In vitro and in silico antidiabetic activity of pyran ester derivative isolated from Tragia cannabina

To investigate the in vitro antidiabetic effects of isolated 4-Oxo-4H-pyran-2,6-dicarboxylic acid bis-[6-methyl-heptyl] ester from the chloroform extract of root of Tragia cannabina (T. cannabina) and AMP kinase activation property of the isolated compound. The roots of T. cannabina were collected and extracted with ethanol [95% v/v] then chromatographed over silica gel 60-120 mesh of column length 100 cm and diameter 3 cm. Elution was carried out with solvents and solvent mixtures of increasing polarities. Then the chloroform extract was used for isolation. In vitro antidiabetic activity was performed with fertile eggs of White Leghorn chicks by induction of diabetes by streptozotocin. The isolated pyran ester binds very efficiently within the active pocket of AMPK with the formation of hydrogen bond and consuming less binding energy, which is good when compared to orientation of standard drug metformin. In in vitro antidiabetic evaluation by streptozotocin treated chick embryo the administration of isolated compound at a doses of 0.5 mg/egg and 1 mg/egg produced a significant reduction in the blood glucose levels in a dose dependant manner (P<0.01). The blood glucose level of diabetic control was (244.20±12.64) mg/dL, whereas it was (207.40±2.43) mg/dL (P<0.001) for isolated compound 0.5 mg/egg and 174.800±2.410 mg/dL (P<0.001) for 1 mg/ egg of the isolated compound. The significant glucose levels were reduced (P<0.01) after administration of the pyran ester isolated from T. cannabina to streptozotocin treated chick embryo.

High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery

BackgroundDiabetes mellitus (DM) is reported to be a risk factor for surgical site infection (SSI), which is a serious complication after spinal surgery. The effect of DM on SSI after instrumented spinal surgery remains to be clarified. The aim was to elucidate perioperative risk factors for infection at the surgical site after posterior thoracic and lumbar spinal arthrodesis with instrumentation in patients with DM. MethodsConsecutive patients who underwent posterior instrumented thoracic and lumbar spinal arthrodesis during the years 2005-2011, who could be followed for at least 1 year after surgery, were included. These included 36 patients with DM (19 males and 17 females; mean age 64.3 years). The patients’ medical records were retrospectively reviewed to determine the SSI rate. The characteristics of the DM patients were examined in detail, including the levels of serum glucose and HbA1c, which indicate the level of diabetes control. ResultsPatients with DM had a higher rate of SSI (6 of 36 patients, 16.7 %) than patients without DM (10 of 309 patients, 3.2 %). Although the perioperative serum glucose level did not differ between DM patients that did or did not develop SSI, the preoperative HbA1c value was significantly higher in the patients who developed SSI (7.6 %) than in those who did not (6.9 %). SSI developed in 0.0 % of the patients with controlled diabetes (HbA1c <7.0 %) and in 35.3 % of the patients with uncontrolled diabetes (HbA1c >7.0 %). ConclusionsDM patients whose blood glucose levels were poorly controlled before surgery were at high risk for SSI. To prevent SSI in DM patients, we recommend lowering the HbAlc to <7.0 % before performing surgery.

Oral health-related quality of life in diabetic patients: comparison of the Persian version of Geriatric Oral Health Assessment Index and Oral Health Impact Profile: A descriptive-analytic study

BackgroundDiabetes mellitus is one of the systemic disease which is show important oral manifestation and influence oral health. This study describes how diabetes mellitus affects oral health and oral health-related quality of life. The aim of this study was to evaluate the oral health and oral health-related quality of life of diabetic patients and compare the discriminative capability of Persian versions of two GOHAI and OHIP-14 questionnaires in these patients.MethodsA total of 350 patients with Type II diabetes mellitus, referring to the Diabetes Clinic, were selected and data were collected by GOHAI and OHIP-14 questionnaires completed by patients and clinical examinations. Oral health parameters (CAL,BI,GI,PLI,DMFT and xerostomia) were measured, also concurrent validity and conformity of two questionnaires were assessed. In order to test Discriminant analysis capabilities of two questionnaires, ADD and SC scores of questionnaires were divided into two parts and a logistic regression model was designed, which included subjective and objective variables.ResultsMean patients age was 55 years (with 75.4% female patients). The results showed that some oral conditions such as xerostomia, clinical attachment loss, number of missing teeth and plaque index were correlated to diabetes control level (HbA1c) and type of anti-diabetic medication. ADD and SC scores of two questionnaires were at high level. However, the effect of oral problems on decreasing OHRQoL was evident. Both questionnaires had acceptable concurrent validity and conformity. Moreover, there was a strong correlation between GOHAI and OHIP-14. OHIP-14 questionnaire had a higher discriminant analysis capability compared to GOHAI and better diagnosed patients who needed dental treatments: patients with higher GI, xerostomia and those wearing partial dentures.ConclusionDiabetic patients did not show acceptable oral health status and in some extent, oral problems affected oral health-related quality of life. Psychotherapy courses and solving oral problems of the patients can improve OHRQoL. OHIP-14 had higher discriminant analysis capability and was more effective in diagnosing oral problems.

Prevalence of complications among Chinese diabetic patients in urban primary care clinics: a cross-sectional study.

BackgroundA territory-wide diabetes management program (Risk Assessment Management Program – RAMP) was recently established, providing comprehensive management for all diabetics, helping to delineate current level of control and complications prevalence among primary care diabetic patients in Hong Kong.MethodThis cross-sectional study captured anonymous clinical data from RAMP patients. Data obtained include sociodemographic details, type of diabetes, illness duration, family history, drug usage, coexisting illnesses, diabetic complications and other clinical parameters.ResultsData from 15,856 type 2 diabetic patients were analyzed. 57.1% were above 60 years old, with mean disease duration of 7.3 years. Hypertension was the commonest coexisting chronic illness (57.6%). 30.2% and 61.8% have their systolic and diastolic pressure controlled to below 130 mmHg and 80 mmHg respectively. Over half (51.5%) had an HbA1c level of less than 7.0%. 88.4% did not achieve target lipid level. 15% were on diet control alone. Only 22.2% were on statins. In patients with microalbuminuria and macroalbuminuria, 40.7% and 54.5% were on angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) respectively. 12.9%, 38.8% and 2.4% had diabetic retinopathy, nephropathy and neuropathy respectively. Overall, 37.9%, 7.3% and 0.4% had single, two and three concurrent microvascular complications respectively.ConclusionThe level of diabetic control is comparable with other developed countries. We demonstrated a high prevalence of microvascular complications among Chinese primary care patients despite achieving adequate HbA1c levels, highlighting the importance of managing all aspects of diabetes including weight, lipid and blood pressure. Efforts to improve holistic management must be tailored according to the needs of our population, with the challenges that the majority have low educational background and in the older age group.

IN VITRO AND IN SILICO ANTI DIABETIC ACTIVITY OF PHTHALIC ACID ISOLATED FROM PHYLLANTHUS RHEEDII

In folk remedies, the whole plant of Ph yllanthus rheedii is used to treat diabetes. This study aimed to investigate the in vitro and in silico antidiabetic effects of isolated Phthalic Acid 1 - (8 - Methyl - Non - 2 - Enyl) Ester 2 - Tetradecyl Ester from the chloroform extract of whole plant of Phyllanthu s rheedii and AMP kinase activation property of the isolated compound. The Phthalic acid binds very efficiently within the active pocket of AMPK with the formation of 2 hydrogen bonds which is good when compared to orientation of standard drug Metformin. I n in vitro antidiabetic evaluation of STZ treated chick embryo , the administration of isolated compound at a doses of 0.5 mg/egg and 1 mg/egg produced a significant reduction in the blood glucose levels in a dose dependan t manner (p < 0.01). The blood glucose level of diabetic control was 244.2 ± 12.64 mg%, whereas it was 207.4 ± 2.43 mg% (P < 0.001) for isolated compound at dose of 0.5 mg/egg and 174.8 ± 2.410 mg% (P < 0.001) for dose of 1 mg/egg of the isolated compound. The significant glucose levels were reduced (p < 0.01) after administration of the compound.

Development and psychometric testing of the online Adolescent Diabetes Needs Assessment Tool (ADNAT)

To report on the development and psychometric testing of the Adolescent Diabetes Needs Assessment Tool. The UK has the fifth largest paediatric diabetes population in the world, but one of the poorest levels of diabetes control, highlighting the need for intervention development. Mixed methods following recommendations for questionnaire design and validation. A total of 171 young people (12-18 years) participated between 2008- 2011. Methods included item selection using secondary framework analysis, item review, pre-testing, piloting and online transfer. Statistical tests assessed reliability using item-total correlations, interitem consistency and test-retest reliability; and validity using blood glucose (HbA1c) levels and the Self-Management of type 1 Diabetes in Adolescence questionnaire. The Adolescent Diabetes Needs Assessment Tool consists of 117 questions divided between six domains of educational and psychosocial support needs. It combines reflective questioning with needs assessment to raise self-awareness to support adolescent decision-making in relation to diabetes self-care. Thirty-six of the questions provide self-care and psychosocial health assessment scores. Face and content validity of the scoring items were all positively evaluated in terms of appropriateness and readability and tests for validity found significant correlations with Self-Management of type 1 Diabetes in Adolescence and weak correlation with HbA1c , which compared favourably with Self-Management of type 1 Diabetes in Adolescence, the only comparable (USA) tool. Item response analysis validated the use of simple additive scores. The Adolescent Diabetes Needs Assessment Tool combines reflective learning with needs assessment to support patient-centred clinical consultations.

Prediction of Patient’s Individual Blood Glucose Levels from Home Monitored Readings of Type I Diabetics

In this paper, a comparison of two different approaches that can be used in developing time series mathematical models (MM) of diabetes mellitus was carried out. The trade-off should be considered between the complexity of the model and its accuracy to predict future glucose concentration. This work is a continuation of the author’s work and results obtained previously and showed the potential and superiority of using autoregressive with exogenous terms (ARX) model in describing the dynamics of diabetes. Moreover, it is shown that despite the models are of general form but they are different depending on individuals’ regimen of diabetes management. The last fact was demonstrated by using six diabetic patients’ records, with rich information about their life style and treatment program, to derive models. In addition to that an answer is given to two main questions: how many future samples of glucose levels can be predicted with acceptable accuracy and what is the acceptable order of the model –complexity-, if the prediction horizon is specified. Both types of models were developed, tested and compared. This work emphasizes the fact that diabetes management plan should be formulated as an individualized therapeutic to achieve the desired level of diabetes control. This can be of help in improving the metabolic control of type-1diabetes patients by implementing these characteristics and models in both computerized controlled decision support system and simulation systems for educating and training of healthcare professional staff. Additionally, these MM of glucose-insulin interaction are expected to aid in reaching a generalized model.

Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings

BackgroundRelatively little is known about how depression amongst people with chronic illness is identified and managed in diverse primary health care settings. We evaluated the role of complex physical needs in influencing current practice of depression screening, documentation and antidepressant prescriptions during a 12-month period, among adults with Type 2 diabetes attending Aboriginal and Torres Strait Islander primary care health centres in Australia.MethodsWe analysed clinical audit data from 44 health centres participating in a continuous quality improvement initiative, using previously reported standard sampling and data extraction protocols. Eligible patients were those with Type 2 diabetes with health centre attendance within the past 12 months. We compared current practice in depression screening, documentation and antidepressant prescription between patients with different disease severity and co-morbidity. We used random effects multiple logistic regression models to adjust for potential confounders and for clustering by health centre.ResultsAmong the 1174 patients with diabetes included, median time since diagnosis was 7 years, 19% of patients had a co-existing diagnosis of Ischaemic Heart Disease and 1/3 had renal disease. Some 70% of patients had HbAc1>7.0%; 65% had cholesterol >4.0 mmol1-1 and 64% had blood pressure>130/80 mmHg. Documentation of screening for depression and of diagnosed depression were low overall (5% and 6% respectively) and lower for patients with renal disease (Adjusted odds ratio [AOR] 0.21; 95% confidence interval [CI] 0.14 to 0.31 and AOR 0.34; 95% CI 0.15 to 0.75), and for those with poorly controlled disease (HbA1c>7.00 (AOR 0.40; 95% CI 0.23 to 0.68 and AOR 0.51; 95% CI 0.30 to 84)). Screening for depression was lower for those on pharmaceutical treatment for glycaemic control compared to those not on such treatment. Antidepressant prescription was not associated with level of diabetes control or disease severity.ConclusionsBackground levels of depression screening and documentation were low overall and significantly lower for patients with greater disease severity. Strategies to improve depression care for vulnerable populations are urgently required. An important first step in the Australian Indigenous primary care context is to identify and address barriers to the use of current clinical guidelines for depression screening and care.