Diabetes Management Strategies Research Articles

The clinical utility of C‐peptide measurement in the care of patients with diabetes

C-peptide is produced in equal amounts to insulin and is the best measure of endogenous insulin secretion in patients with diabetes. Measurement of insulin secretion using C-peptide can be helpful in clinical practice: differences in insulin secretion are fundamental to the different treatment requirements of Type 1 and Type 2 diabetes. This article reviews the use of C-peptide measurement in the clinical management of patients with diabetes, including the interpretation and choice of C-peptide test and its use to assist diabetes classification and choice of treatment. We provide recommendations for where C-peptide should be used, choice of test and interpretation of results. With the rising incidence of Type 2 diabetes in younger patients, the discovery of monogenic diabetes and development of new therapies aimed at preserving insulin secretion, the direct measurement of insulin secretion may be increasingly important. Advances in assays have made C-peptide measurement both more reliable and inexpensive. In addition, recent work has demonstrated that C-peptide is more stable in blood than previously suggested or can be reliably measured on a spot urine sample (urine C-peptide:creatinine ratio), facilitating measurement in routine clinical practice. The key current clinical role of C-peptide is to assist classification and management of insulin-treated patients. Utility is greatest after 3–5 years from diagnosis when persistence of substantial insulin secretion suggests Type 2 or monogenic diabetes. Absent C-peptide at any time confirms absolute insulin requirement and the appropriateness of Type 1 diabetes management strategies regardless of apparent aetiology.

Guidelines for ethno-centric psychosocial management of diabetes mellitus in India: The north east consensus group statement

AbstractRecently published guidelines on Psychosocial Management of Diabetes in India provide evidence-based recommendations for the whole nation. However, they do not fully address the myriad socio-cultural issues prevalent in the North Eastern states. The eight North Eastern states of India house 45 million people, belonging to 220 ethnic groups who speak an equal number of dialects, and follow distinctly unique cultures, which impact health-related behavior. Such diversity is difficult to cover in any national guideline. This lacuna makes it necessary to have a document, which addresses the specific needs and requirements of diabetes care professionals in the North-east of India. This consensus statement aims to highlight evidence- and experience-based strategies for psychosocial management of diabetes, based upon the unique ethnographic constitution of this part of the country. It is based upon the results of a daylong focused group discussion, held at Sonapur, Assam, on 9th February 2013, involving key opinion leaders from most North-eastern states, including all geographical divisions of Assam. Recommendations are classified into three domains: General, psychological, and socio-cultural, and graded by the weight they should have in clinical practice. Eighteen recommendations of varying strength are made, to help professionals identify the psycho-socio-cultural determinants of diabetes, and to explore the role of psycho-socio-cultural interventions in devising support strategies for people with diabetes and their families. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management in the North-east and help achieve a qualitative improvement in diabetes care. The guidelines may also be useful for diabetes care professionals working with other indigenous groups across the world.

The Canadian Diabetes Association 2013 Clinical Practice Guidelines—Raising the Bar and Setting Higher Standards!

The Canadian Diabetes Association 2013 Clinical Practice Guidelines—Raising the Bar and Setting Higher Standards!

Diabetes and Mental Health

Diabetes and Mental Health

Building a Novel Inpatient Diabetes Management Mentor Program

The intent of this project was to create a formalized educational program for bedside nurses responsible for inpatient diabetes management. Bedside nurses are recruited to serve as diabetes management mentors. The mentors receive advanced education concerning teaching and learning principles, the AADE7™ Self-Care Behaviors, and diabetes management strategies. They teach their peers, advocate for patients, and facilitate referrals for outpatient Diabetes Self-Management Education (DSME) programs. The focus of these ongoing educational activities is to foster the development of diabetes management mentors and to create teaching tools that mentors can use with peers to address practice gaps or skill deficiencies. The diabetes management mentor is integral in enhancing the care of patients with diabetes in the hospital. The empowerment of bedside nurses as mentors for their peers and their patients is an invaluable asset that helps nurses take ownership of their practice. This role could be applied to other complex disease entities, helping nurses to develop specific management skills to improve patient outcomes and enhance patient satisfaction.

Self-management, health service use and information seeking for diabetes care among recent immigrants in Toronto

Our objective was to explore self-management practices, health services use and information-seeking for type 2 diabetes care among adult men and women from four recent immigrant communities in Toronto. A structured questionnaire was adapted for the Canadian context and translated into 4 languages. A total of 184 participants with type 2 diabetes-130 recent immigrants and 54 Canadian-born-were recruited in both community and hospital settings. Recent immigrants were significantly less likely than the Canadian-born group to perform regular blood glucose and foot checks and significantly more likely than the Canadian-born group to be non-smokers, participate in regular physical activity and reduce dietary fat. Recent immigrants were significantly less likely than the Canadian-born group to use a specialist, alternative provider and dietician and less likely to report using dieticians, nurses and diabetes organizations as sources of diabetes-related information. Important differences were observed by sex and country of origin. Findings suggest that diabetes prevention and management strategies for recent immigrants must address linguistic, financial, informational and systemic barriers to information and care.

Personal and Cultural Influences on Diabetes Self-Care Behaviors Among Older Hispanics Born in the U.S. and Mexico

Older Hispanics are disproportionately affected by diabetes, but little is known about predictors of diabetes self-care among this group. This study compared the magnitude of three self-care behaviors (diet, physical activity (PA), and glucose monitoring) among older Hispanics with type 2 diabetes born in the United States (n = 59) to those born in Mexico (n = 179), and investigated the influence of personal and health indicators on each self-care behavior. Findings were based on data drawn from convenience sample data collected with a questionnaire. Self-care behaviors were moderately practiced (39.5-45.8 %) with no significant differences by nativity. Mexico-born seniors were less linguistically acculturated (P < 0.001). Being female (OR = 2.41) and PA levels (OR = 2.62) were significantly associated with diet. Being female (OR = 3.24), more educated (OR = 3.73), U.S.-born (OR = 2.84), and receiving diabetes education (OR = 3.67) were associated with PA. Diabetes education (OR = 2.41) was associated with glucose monitoring. Although acculturation influenced only PA and no other behaviors, personal and cultural factors require further investigation to design diabetes management strategies for Hispanic seniors at the border region.

Reframing Diabetes in American Indian Communities: A Social Determinants of Health Perspective

American Indians and Alaska Natives (AI/ANs) experience some of the greatest health inequities of any group within the United States. AI/ANs are diagnosed with diabetes more than twice as often as non-Hispanic white Americans. Diabetes is a chronic preventable disease often associated with individual risk factors and behaviors that indicate what interventions are needed to prevent or manage the disease. Individual ameliorative strategies in diabetes prevention and management do not fully address the fundamental causes and complexity of diabetes in American Indian communities. Through the application of a social determinants of health paradigm, social work has the opportunity to reframe diabetes and begin to understand it as a product of and a response to unjust conditions and environments, rather than as a disease rooted solely in individual pathology and responsibility.

Angiogenesis in Diabetes. Unraveling the Angiogenic Paradox

Angiogenesis can be regarded as a double-edged sword given its useful actions in repairing tissues, and secondly due to its effects in enhancing tissue damage. Angiogenesis is actually involved in the pathogenesis of disorders in which the inflammatory component is a major contributor for disease progression, such as diabetes. It is now stated that angiogenesis together with vasculogenesis partake to neovascular development. A peculiar characteristic of diabetes is the co-existence of vascular impairment and excessive angiogenesis in distinct organs. But despite this knowledge, many questions remain unanswered. Due to the importance of these systems in diabetes-associated complications, a better understanding of the molecular and cellular processes may open new mechanism-based therapeutic options. Accordingly, the available treatment strategies for diabetes management are not completely efficient, as highlighted by the elevated mortality and morbidity rates associated with this condition. Diabetic nephropathy, which may evolve to end-stage renal failure, and diabetic retinopathy that may progress to blindness are important causes of morbidity. Additionally, chronic nonhealing skin ulceration greatly impairs the quality of life of diabetic patients, resulting often in limb amputation. Cardiovascular events, in turn, are responsible for a significant number of deaths in diabetes. This review aims at highlighting the state-of-the-art in diabetic vascular complications, and comprehends the characterization of neovascular system alterations. The elucidation of the diabetic-associated angiogenic paradox is fundamental for prospecting novel therapeutic interventions.

Towards more effective strategies for management of diabetes in Mauritius

Over the past 2 decades, the prevalence of diabetes in Mauritius has remained one of the highest in the world with no recent significant improvement. Mauritius ranked 2nd in 2002 and 4th in the world in 2009 with nearly one in five of its adult population above the age of 30 years being affected. Nearly half of those affected do not know that they have the disease and this adversely influences quality of life, risks of complications as well as morbidity and mortality. Despite the availability of free health services, over 50% of diabetes patients are poorly controlled and the risk of complications from diabetes such as cardiovascular diseases, renal failure, blindness, peripheral vascular and neurological diseases leading to lower limb amputations, remain very high. Despite continued efforts from the Ministry of Health and Quality of Life (MOH & QOL) to provide easily accessible diabetes care to all patients, the outcome remains poor. Most of the outpatients and primary health care centres are overcrowded and the set-up does not provide optimal care and attention. Diabetes care is very much medical-orientated and the health promotion campaigns have had little impact so far. Prevention and control of diabetes must become a priority. There is an urgent need for enhanced heath promotion and education, as evidence suggests that a change in diet and lifestyle can bring about significant improvement in the incidence and prevalence of diabetes. This paper examines some of the key actions/ proposals with respect to: evaluation of actions taken, health promotion campaigns, attitude and behavioural change, focused leadership and commitment, marketing strategies, effective segmentation and targeting.

Adolescent Build Plotting on Body Composition Chart and the Type of Diabetes Mellitus

Although the prevalence of type 2 diabetes is increasing, there are cases difficult to categorize into certain type in pediatric diabetic patients. The aims of this study were to detect and choose a proper treatment modality for atypical cases of diabetes mellitus, using the body composition chart. We conducted a retrospective study from August 2005 to 2012 with patients who visited Konkuk University Medical Center, and were diagnosed with diabetes mellitus. The medical records were reviewed for the anthropometric data and indices of body composition. The subjects were grouped by the type of diabetes and gender. We constructed a body composition chart plotting fat free mass index and fat mass index (FMI). Body mass index and all body composition indices were higher in type 2 diabetes, in each gender in analysis with Mann-Whitney test. Significant determinant of diabetes type was revealed as FMI and contributing factors on FMI were analyzed with regression analysis. Six atypical cases were identified by a body composition chart including non-obese type 2 diabetes showing suboptimal growth with lower BMI related to relatively lower insulin secretion and type 1 diabetes with insulin resistance resulted from obesity. Body composition chart analysis might be useful in characterization of diabetes type and detection of atypical cases and early adjustment of diabetes management strategy.

Thiazolidinediones and metformin associated with improved survival of diabetic prostate cancer patients

BackgroundThe association between antidiabetic medications and the prognosis of human prostate cancer has not been explored. This study examined the impact of these drugs on the outcomes of diabetic patients with prostate cancer to provide a basis for diabetes management strategy in these patients. Patients and methodsRecords of consecutive prostate cancer patients with coexisting diabetes mellitus type 2 who were treated at the study institution between 15 July 1999 and 31 December 2008 were reviewed. The survival, cancer pathological grade, stage at the time of diagnosis, and antidiabetic pharmacotherapy of the patients were analyzed. ResultsA total of 233 consecutive cases were analyzed. In Kaplan–Meier analysis, thiazolidinedione (log-rank, P = 0.005) and metformin (log-rank, P = 0.035) usage were significant predictors of improved overall survival, while insulin and insulin secretagogue usage were not significant predictors. Multivariate Cox regression analysis showed that thiazolidinedione {hazard ratio [HR] = 0.454 [95% confidence interval (CI) 0.213–0.965], P = 0.040} and metformin [HR = 0.550 (95% CI 0.315–0.960), P = 0.035] usage remained as significant predictors of favorable survival after controlling for variables including age, race, Gleason grade, and stage. ConclusionsThiazolidinediones and metformin appear to be associated with improved overall survival of diabetic prostate cancer patients. The choice of antidiabetic pharmacotherapy may influence overall survival of these patients.

Geoenvironmental Diabetology

Many reports have documented the negative health consequences that environmental stressors can have on patients with diabetes. Studies examining the interaction between the environment and a patient with diabetes can be unified under a single discipline termed "geoenvironmental diabetology." Geoenvironmental diabetology is defined more specifically as the study of how geophysical phenomena impact a patient with diabetes, to include effects on metabolic control, ancillary equipment (e.g., glucometers and insulin pumps), medications, supplies, access to care, and influences on the adaptive strategies employed by patients to care for their diabetes under extreme circumstances. Geological events such as natural disasters (e.g., earthquakes) or extreme weather (e.g., heat waves) are examples of stressors that can affect patients with diabetes and that can be included under the heading of geoenvironmental diabetology. As proposed here, geoenvironmental diabetology refers to how events in the physical world affect those with diagnosed diabetes, rather than how environmental factors might trigger development of disease. As the global prevalence of diabetes continues to increase, including in parts of the world that are especially vulnerable to disasters and climate change, further discussion is warranted on how to best prepare for management of diabetes under conditions of extreme geological and weather events and a changing climate. An overview is presented of various studies that have detailed how geoenvironmental phenomena can adversely affect patients with diabetes and concludes with a discussion of requirements for developing strategies for geoenvironmental diabetes management.

Effect of natural products on commercial oral antidiabetic drugs in enhancing 2-deoxyglucose uptake by 3T3-L1 adipocytes

The management of diabetes with insulin and synthetic oral hypoglycemic drugs (OHDs) can produce serious side effects and in addition fails to prevent diabetes-related complications in many patients. A new diabetes management strategy is needed that is more effective and has fewer side effects. This paper analyzes the dose- and time-dependent effect of three phytochemicals: berberine, arecoline and vanillic acid, and two antidiabetic drugs: 2,4-thiazolidinedione (TZD) and metformin, on the uptake of 2-deoxyglucose (2DG) by 3T3-L1 adipocytes. The interactions of the phytochemicals with the OHDs were analyzed with isobolograms and the combination index. TZD and berberine increased 2DG uptake by 3.3-fold (with respect to control) at 15 μM and 25 μM, respectively. The same concentrations of arecoline and vanillic acid increased 2DG uptake by 3.2-and 2.9-fold, respectively, when compared with the basal level. Berberine and arecoline acted synergistically with both the OHDs, whereas vanillic acid had an additive interaction with TZD and an antagonistic interaction with metformin. Arecoline significantly increased the translocation of GLUT4 via the PPAR(γ) pathway, whereas berberine and vanillic acid did this via the AMPK-dependent pathway. These phytochemicals significantly reduced the expression of the enzymes involved in fatty acid and cholesterol synthesis, indicating that they might help prevent the secondary complications of diabetes. The current study suggests that berberine and arecoline could allow dosage reduction of OHDs, which could also lead to a reduction in the toxicity and side effects caused by OHDs.

Clinical Management of the Physically Active Patient with Type 1 Diabetes

The prevalence and incidence of type 1 diabetes continues to increase worldwide. Most patients with type 1 diabetes are young at the time of diagnosis and wish to continue leading a physically active life. Although regular exercise, insulin therapy, and proper nutrition are the cornerstone of treatment, there are considerable challenges in managing the active individual with type 1 diabetes. The current recommendation for diabetes management is intensive glycemic control for all patients when possible to help prevent secondary complications. Both insulin pump therapy and multiple daily injections are beneficial treatment options to lower average glucose levels; however, without continuous glucose monitoring, these treatment options typically increase the risk of hypoglycemia. In active patients with type 1 diabetes, the challenges of maintaining good glycemia are complicated by the inability to regulate insulin concentrations during and after exercise. Physiological and psychosocial factors during growth and maturation also provide additional challenges. This article highlights challenges and key strategies for diabetes management in the active individual with type 1 diabetes, including the application of the most recent diabetes technologies.

Treatment of Type 2 Diabetes in Youth

Type 2 diabetes is becoming more common among youth, in parallel with the increasing prevalence of obesity in pediatrics. Despite this, therapeutic modalities remain extremely limited, with scanty data regarding appropriate treatment, desired glycemic targets, and management of associated comorbidities and complications. Management of type 2 diabetes in youth, both acute and long term, should occur in specialty tertiary care pediatric centers. Health care providers should address the pathophysiological components of insulin resistance and decline in β-cell function, aiming to preserve the latter while improving the former. Addressing comorbidities, namely hypertension and dyslipidemia, which are currently inadequately addressed, should be properly assessed and tracked. Further research is critical to establish treatment goals and develop effective diabetes management strategies that will not only enhance adherence to treatment recommendations, but also effectively manage comorbidities and prevent micro- and macrovascular complications. With the escalating rates of obesity, type 2 diabetes is increasing (1,2), not only in adults but also in youth. In the SEARCH for Diabetes in Youth study, it is estimated that the number of adolescents per year diagnosed with type 2 diabetes is ~3,700 and increasing (2,3). Despite this, there is a dearth of approved therapeutic options. The UK Prospective Diabetes Study showed that intensive glucose therapy for adults with newly diagnosed type 2 diabetes was associated with a decreased risk of microvascular complications and, among individuals who were >120% above their ideal body weight, with a decreased risk of myocardial infarction and death from any cause (4). In patients diagnosed with type 2 diabetes at a younger age, there may be more aggressive development of diabetes complications, including myocardial infarction and microalbuminuria (5). Given these considerations, it is critical to have treatment options for adolescents with type 2 diabetes that optimize diabetes control and reduce complications. …

Estimation of the impact of diabetes-related complications on health utilities for patients with type 2 diabetes in Ontario, Canada

The goal of this study was to analyze health-related quality of life (HRQL) data from a Canadian population with type 2 diabetes in order to estimate the disutility associated with experiencing a diabetes-related complication. The EQ-5D, a standardized instrument for use as a measure of health outcome, was administered to 1,147 patients in Hamilton, Ontario, with type 2 diabetes. After controlling for age, gender, and duration of diabetes, changes in utility values were estimated by regressing the EQ-5D scores onto binary indicators for the presence of an event. The primary method of analysis was Ordinary Least Squares (OLS) and due to concerns over non-Normality, bootstrap standard errors (SE) were calculated. The analysis included 1,143 participants. Based on the OLS model, reductions in HRQL were associated with duration of diabetes (-0.0015, SE=0.0006), experiencing a myocardial infarction (MI) (-0.059, SE=0.017), amputation (-0.063, SE=0.059), stroke (-0.046, SE=0.023), and kidney failure (-0.102, SE=0.047). This study estimated the reductions in HRQL associated with several important complications commonly experienced in patients with diabetes. The greatest impacts on HRQL were associated with kidney failure and MI. The utility values calculated here can be used to assess the outcome of interventions that reduce these diabetes-related complications and will have a useful impact on future economic evaluations of diabetes management strategies in Canada.

Students’ experiences of managing type 1 diabetes

To explore the experiences of young people managing their type 1 diabetes at college or university. A convenience sample of 23 students, aged 17-19 years, with type 1 diabetes participated in semi-structured telephone interviews. Thematic data analysis identified four main themes: balancing diabetes and further education; adverse diabetes management strategies at college or university; reduced quality of life with regard to participation in social events; and problematic transition from paediatric to adult diabetes clinics. Young people often face difficulties in their diabetes self-management at college or university because of psychosocial issues, and may experience barriers when changing from paediatric to adult diabetes clinics.

Diabetes pathophysiology and disease management

Diabetes is a disease that presents in many different forms, but diabetes mellitus is the most common form seen in dogs and cats. Insulin dependent diabetes mellitus is more common in dogs than cats and non-insulin dependent diabetes mellitus is more common in cats than dogs. The incidence of diabetes varies depending on the species, age, physical attributes, genetic make up and gender of the animal. Clinical signs almost always include polyuria and polydipsia, but can also include polyphagia, weakness, weight loss, unkempt haircoat and changes in behaviour, among others. There are a number of successful treatment strategies that can enable the diabetic dog or cat to lead a long fulfilling life. Many of these treatment plans require careful monitoring of blood glucose, daily insulin injections and modifications in diet and lifestyle habits. A veterinary nurse who has a good foundation on diabetes disease pathophysiology, treatments and management strategies is not only essential in caring for hospitalized diabetic patients, but is also critical for helping to alleviate pressure on clients who must bear the responsibility of managing their diabetic pet at home.

Online Social Networking by Patients with Diabetes: A Qualitative Evaluation of Communication with Facebook

Several disease-specific information exchanges now exist on Facebook and other online social networking sites. These new sources of knowledge, support, and engagement have become important for patients living with chronic disease, yet the quality and content of the information provided in these digital arenas are poorly understood. To qualitatively evaluate the content of communication in Facebook communities dedicated to diabetes. We identified the 15 largest Facebook groups focused on diabetes management. For each group, we downloaded the 15 most recent "wall posts" and the 15 most recent discussion topics from the 10 largest groups. Four hundred eighty unique users were identified in a series of 690 comments from wall posts and discussion topics. Posts were abstracted and aggregated into a database. Two investigators evaluated the posts, developed a thematic coding scheme, and applied codes to the data. Patients with diabetes, family members, and their friends use Facebook to share personal clinical information, to request disease-specific guidance and feedback, and to receive emotional support. Approximately two-thirds of posts included unsolicited sharing of diabetes management strategies, over 13% of posts provided specific feedback to information requested by other users, and almost 29% of posts featured an effort by the poster to provide emotional support to others as members of a community. Approximately 27% of posts featured some type of promotional activity, generally presented as testimonials advertising non-FDA approved, "natural" products. Clinically inaccurate recommendations were infrequent, but were usually associated with promotion of a specific product or service. Thirteen percent of posts contained requests for personal information from Facebook participants. Facebook provides a forum for reporting personal experiences, asking questions, and receiving direct feedback for people living with diabetes. However, promotional activity and personal data collection are also common, with no accountability or checks for authenticity.