Patientswith Diabetes Research Articles

Use of diabetes data management software reports by health care providers, patients with diabetes, and caregivers improves accuracy and efficiency of data analysis and interpretation compared with traditional logbook data: first results of the Accu-Chek Connect Reports Utility and Efficiency Study (ACCRUES).

We assessed users' proficiency and efficiency in identifying and interpreting self-monitored blood glucose (SMBG), insulin, and carbohydrate intake data using data management software reports compared with standard logbooks. This prospective, self-controlled, randomized study enrolled insulin-treated patients with diabetes (PWDs) (continuous subcutaneous insulin infusion [CSII] and multiple daily insulin injection [MDI] therapy), patient caregivers [CGVs]) and health care providers (HCPs) who were naïve to diabetes data management computer software. Six paired clinical cases (3 CSII, 3 MDI) and associated multiple-choice questions/answers were reviewed by diabetes specialists and presented to participants via a web portal in both software report (SR) and traditional logbook (TL) formats. Participant response time and accuracy were documented and assessed. Participants completed a preference questionnaire at study completion. All participants (54 PWDs, 24 CGVs, 33 HCPs) completed the cases. Participants achieved greater accuracy (assessed by percentage of accurate answers) using the SR versus TL formats: PWDs, 80.3 (13.2)% versus 63.7 (15.0)%, P < .0001; CGVs, 84.6 (8.9)% versus 63.6 (14.4)%, P < .0001; HCPs, 89.5 (8.0)% versus 66.4 (12.3)%, P < .0001. Participants spent less time (minutes) with each case using the SR versus TL formats: PWDs, 8.6 (4.3) versus 19.9 (12.2), P < .0001; CGVs, 7.0 (3.5) versus 15.5 (11.8), P = .0005; HCPs, 6.7 (2.9) versus 16.0 (12.0), P < .0001. The majority of participants preferred using the software reports versus logbook data. Use of the Accu-Chek Connect Online software reports enabled PWDs, CGVs, and HCPs, naïve to diabetes data management software, to identify and utilize key diabetes information with significantly greater accuracy and efficiency compared with traditional logbook information. Use of SRs was preferred over logbooks.

Statins and diabetes mellitus: price of collaboration

It is now well established that clinical use of statins for primary and secondary prevention of cardiovascular complications in patientswith diabetes mellitus (DM) increases life expectancy. At the same time, meta-analysis of major randomized trials shows statins to increaseglycemic levels and incidence of diabetic symptoms, especially in patients at risk for developing glycemic disorders. However,comparison of positive and negative effects of statins suggests prevalence of clinically beneficial factors.

Endothelial dysfunction in development of cerebrovascular disorders in patients with diabetes mellitus

Endothelial dysfunction and aberrations of haemostasis play an important part in development of cerebrovascular disorders in patientswith diabetes mellitus. Such factors as hyper- and hypoglycemia, hyperinsulinism, insulin resistance and excessive weight affect progressionof microcirculation deficiency and cerebral ischemia. Transcranial Doppler ultrasound examination is useful as a noninvasivemethod of hemodynamic assessment.

Interventional cardiology and diabetes mellitus: age of effective coronary heart disease treatment

Introduction into clinical practice of coronary angioplasty has provided new possibilities for treatment of coronary heart disease (CHD) in patientswith diabetes mellitus. The indications for endovascular interventions and principles of coronary stenting in such patients are described in this article.

Uticaj dužine trajanja diabetes mellitus-a na razvoj dijabetesne retinopatije

Objective: Diabetes retinopathy is one of the most common and earliest complications of diabetes mellitus. Blindness is 25 times more common at the diabetics than in common population and its incidence in Europe amounts to 60-65 at the population of 100.000 diabetics, yearly. The aim of this study is to analyse causality of the diabetes retinopathy with the sex, age, family predisposition, time of duration and type of the diabetes mellitus. Method: Research was conducted at the Institute for the the workers health care, in Kragujevac, for period from 15th November 2009. to 15th November 2010. and involved 135 patients. Experimental group had 90 patients with progressive diabetes retinopathy and the other, control one, involved 45 patientswith diabetes mellitus without progressive diabetes retinopathy. Results: In both examined groups men make two thirds of patients. Positive family predisposition was found in 68 patients (50,4%), from wich 47 (69,1%) were from experimental group. Most of patients were 51-60 years old, and average oldness is 57,5 years in control group and 60,1 years in experimental group. The average duration of diabetes in control group was 11,7 years and 14,4 years in experimental group. Conclusion: Researching show that the sex and family predisposition don't influence to the manifestation and progress of the diabetes retinopathy. The age of the patients also doesn't influence to the manifestation of this complication. Time of duration diabetes mellitus influences to the appearance of diabetes retinopathy. If the time of illness duration is prolonged for one year, chance for appearance diabetes retinopathy is increased for 1,068 time, more exactly 6,8%.

Relationship between diet, exercise habits, and health status among patients with diabetes

Background The American Diabetes Association recommends that people with diabetes should engage in physical activity and healthy eating. Similarly, diets rich in fruits or vegetables (5-13 servings) have been found to lower the risk of stroke, cardiovascular conditions, cancer, and diabetes. Objectives To examine the associations between eating fruits and vegetables and exercising on physical/mental health among diabetes patients. A secondary objective was to describe the relationship between socioeconomic status and physical/mental health. Finally, we used the Health Belief Model (HBM) to help providers understand how they can work best with their patients to implement healthy lifestyle. Methods The 2005 Centers for Disease Control's Behavioral Risk Factor Surveillance System was used to determine the relationship between eating fruits/vegetables and exercise on physical and mental health. The sample was restricted to individuals who self-reported being diagnosed with diabetes (N = 33,320) in 2005. Eating fruits and vegetables was categorized by the number of fruit and vegetable servings consumed daily (0, 1-2, 3-4, and ≥5). Poisson regression was used to assess these associations. Results Only 26% of individuals ate 5 or more servings of fruits and vegetables, whereas only 33% met exercise recommendations. Individuals who ate 5 or more servings of fruits and vegetables reported better mental health but poor physical health. Compared with meeting exercise recommendations, no exercise was associated with more days of poor physical/mental health. Conclusions Reinforcement of daily exercise is helpful to patients with diabetes (PWDS); meeting exercise recommendations was associated with better outcomes of physical and mental health. Pharmacists and other public health providers should focus on interventions that incorporate the promotion of healthy lifestyles. The HBM can be used to improve health behavior among PWDS. Pharmacists are in a unique position to advocate change with consistent access to care.

Service delivery by nurse prescribers for diabetes care

The overall aim of the research was to provide a national evaluation of Nurse Independent and Nurse Supplementary Prescribing in diabetes in the UK. A key component was to examine service provision by nurse prescribers for patients with diabetes.The NMC database was used to randomly select and distribute questionnaires to 1992 registered Nurse Independent/Nurse Supplementary Prescribers. 1400 questionnaires were returned. Medicines for patients withdiabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The majority (63%) of nurses worked in general practice. Over 90% of services were provided to patients in the community. Over 30% made treatment alterations over the telephone to patients they had not met. Nurses with specialist training in diabetes viewed themselves as more competent than nurses without (P=0.000). Nurses who reported higher levels of competence were more likely to make treatment alterations over the telephone (P=0.000). Nurse independent and nurse supplementary prescribers working in a variety of roles are actively involved in the delivery of services to patients with diabetes. This care is predominantly provided in the community. It is evident from our findings that nurse's competence affects their scope of professional practice in the management of these patients.

Control of hypertension in Nigerians with Diabetes Mellitus: A report of the Ibadan Diabetic / Kidney Disease Study Group.

The prevalence of high blood pressure (BP) is high among Nigerians with diabetes mellitus. This study of Nigerian patientswith diabetes examines the adequacy of BP control and antihypertensive therapy as a baseline for establishing conformitywith current guidelines. A total of 256 patients with diabetes, aged between 21 and 83 years (mean 59.1 + 12.8 years)attending the Diabetes/Endocrine Clinic of the University College Hospital Ibadan, Nigeria were involved in the study. Fiftyseven per cent had co-existing hypertension and 15.5% of these patients were not receiving any antihypertensive agent. Therewas a significantly higher systolic BP among females compared to males (p < 0.05). Diabetic patients with hypertension weresignificantly older than those with diabetes alone (p < 0.001). The body mass index (BMI) was higher than 25 in 66% ofpatients with both diabetes and hypertension compared to 48% in those with diabetes alone ( p <0.005). A satisfactory meansystolic (<130 mmHg) and diastolic BP (<80 mmHg) BP was obtained in only 38.5% and 42.2% of all patients respectively.The association between BMI and blood pressure was found to be significant only for the diastolic pressure (p <0.05). Only52% of the patients with hypertension were receiving angiotensin converting enzyme inhibitors as part of their treatment.The high prevalence and poor control of high BP among Nigerians with diabetes pose an increased risk of future developmentof nephropathy. There is need for a more intense awareness programme for doctors in developing countries regarding currentblood pressure management guidelines and the need for adhering to them.

Plantar and digital dermatoglyphic patterns in Malawian patients with diabetes, hypertension and diabetes with hypertension

In this study we examined the dermatoglyphic features of 99 Malawian patients with diabetes,hypertension and diabetes with hypertension, attending the outpatient clinic at Lilongwe and QueenElizabeth Central Hospitals. Plantar and digital pattern types were determined and their variabilitywas calculated using Dankmeijer’s (DI) and pattern intensity (PII) indices. The results showed thatthe soles of all patients had more loops than arches and more arches than whorls, which wererestricted to the distal zones. In hypertension, whorls were found in zones I, II and III whereas inpatients with diabetes and hypertension, the whorls were seen in zones I, III and IV. In digits themost predominant ridge pattern were arches in all patients, followed by loops and whorls were absent.In the first digit, diabetic patients had no arches but women hypertensives showed arches. In patientswith diabetes and hypertension, arches were present in both sexes but in men it was confined to theright foot. Loops were only found in the first digit in all patients. The frequency of loops was highestin diabetic patients, high in diabetics with hypertension and least in patients with hypertension alone.Using PII and DI indices, there were significant differences between patients and healthy Malawiansubjects (P < 0.001), and between the sexes (P < 0.01), but PII did not show significant differenceswith sex (P > 0.5) in hypertensives. Diabetic patients had the lowest mean DI when compared to theother groups. In conclusion, this study has demonstrated plantar and digital dermatoglyphicdifferences between patients and healthy Malawians, differences that were exhibited more in digitalthan in plantar ridge patterns. The disease conditions were indicated better by whorls intopographical zones IV of the sole and by the presence and frequency of loops in the first digit.

The Unreliability of Individual Physician “Report Cards” for Assessing the Costs and Quality of Care of a Chronic Disease

HOFER, TIMOTHY P.; HAYWARD, RODNEY A.; GREENFIELD, SHELDON; WAGNER, EDWARD H.; KAPLAN, SHERRIE H.; MANNING, WILLARD G. Author Information

Course of Peripheral Occlusive Arterial Disease in Diabetes: Vascular Laboratory Assessment

To determine comparative rates of development and progression of peripheral occlusive arterial disease, 110 healthy nondiabetic control subjects, 112 patients with peripheral occlusive arterial disease (POAD), 240 patients with diabetes mellitus (DM), and 100 patients with diabetes mellitus and peripheral occlusive arterial disease (DM + POAD) were studied over 4 yr with noninvasive techniques. The presence of peripheral occlusive arterial disease was determined by postexercise ankle-brachial index (ABI) values; progression of peripheral occlusive arterial disease was determined by the rate of change in postexercise ABI. Patients who underwent peripheral arterial reconstructive surgery or amputation were also classified as having progression of their peripheral occlusive arterial disease. On this basis, follow-up revealed that peripheral occlusive arterial disease developed and therefore progressed in 1 (1%) of the control group and 22 (9%) of the DM. Peripheral occlusive arterial disease progressed in 31 (28%) of the POAD and 26 (26%) of the DM + POAD. The presence of peripheral occlusive arterial disease predisposes to progression of disease, and peripheral occlusive arterial disease is more likely to develop in diabetic patients who do not have peripheral occlusive arterial disease than in nondiabetic control subjects. However, the presence of diabetes mellitus in patients with peripheral occlusive arterial disease does not seem to increase the risk of progression.