Diabetes Care Practices Research Articles

Infection and Foot Care in Diabetics Seeking Treatment in a Tertiary Care Hospital, Bhubaneswar, Odisha State, India

Diabetes mellitus is a major public health problem that can cause a number of serious complications. Foot ulceration is one of its most common complications. Poor foot care knowledge and practices are important risk factors for foot problems among diabetics. The present study was undertaken in the diabetes outpatient department of a tertiary care hospital to assess the practices regarding foot care in diabetes, find out the determinants of foot ulcer in diabetics, and offer suggestions to improve care. After informed consent, a total of 124 diabetics were interviewed to collect all relevant information. The diabetic foot care practice responses were converted into scores and for the sake of analysis were inferred as poor (0–5), fair (6-7), and good (>7) practices. Of the study population, 68.5% (85/124) consisted of men. The disease was diagnosed within the last 5 years for 66% (81/124) of the study participants. Of the study subjects, 83% (103/124) were on oral hypoglycemic agents (OHAs), 15.3% (19) on insulin, and 2 on diet control only. Among them about 18.5% had a history of foot ulcer. 37.9% reported using special slippers, 12% diabetics used slippers indoors, and 66.9% used slippers while using toilet. Of the study subjects, 67.8% said that feet should be inspected daily. 27.4% said they regularly applied oil/moisturizer on their feet. There is a need on part of the primary or secondary physician and an active participation of the patient to receive education about foot care as well as awareness regarding risk factors, recognition, clinical evaluation, and thus prevention of the complications of diabetes.

Knowledge and Practice of Diabetic Foot Care in an In- Patient Setting at a Tertiary Medical Center.

Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputation. This study is conducted to assess patients' knowledge and compliance of diabetic foot care. A cross sectional study performed on patients who were admitted to HSNZ from the 1st September 2013 to 30th April 2014 for diabetic foot infections. They were interviewed with a questionnaire of 15 'yes' or 'no' questions on foot care knowledge and practice. Score of 1 was given for each 'yes' answer. The level of knowledge and practice, whether good or poor, was determined based on the median score of each category. The result was tested using a chi-square test in SPSS version 17. A total of 157 patients were included in this study with a mean age of 56.33 years (31-77). There were 72 male (45.9%) and 85 female (54.1%) patients with the majority of them being Malays (154 patients, 98.1%). Majority of the patients (58%) had poor foot care knowledge while 97 patients (61.8%) had poor diabetic foot care practice as compared to the median score. Based on the chi square test of relatedness, there was no significant association between knowledge and practice with any of the variables. In conclusion, the majority of patients admitted for diabetic foot infections had poor knowledge and practice of diabetic foot care. Education regarding foot care strategies should be emphasized and empowered within the diabetic population.

Emerging trends in diabetes care practice and policy in The Netherlands: a key informants study.

BackgroundEffective self-management is viewed as the cornerstone of diabetes care. Many interventions and policies are available to support self-management, but challenges remain regarding reaching specific subgroups and effectively changing lifestyles. Here, our aim was to identify emerging policies and practices regarding diabetes care in The Netherlands.MethodsStudy with a purposeful sample of key informants, covering a range of stakeholders. They were individually interviewed, using a flexible and semi-structured approach. A thematic analysis was done, guided by an international framework, which resulted in 28 themes.ResultsAfter a decade of investing in diabetes care in The Netherlands, stakeholders seem to have shifted their focus towards a view that effective self-management is expected in most people. The expectation is that individuals’ personal networks, community organizations and emerging information technologies will facilitate this. If support of self-management is required, this has to be provided by local coalitions of health and social care organizations, with involvement of municipalities. Poor reach in specific subgroups of the population, such as economically deprived people, is recognized but has not led to targeted policies.ConclusionsThe role of healthcare providers in supporting patients’ self-management in diabetes care seems to be changing in The Netherlands.

Second clinical congress of the gulf chapter of the american association of clinical endocrinologists, october, 23rd-25th 2014, Abu Dhabi, United Arab Emirates

These are the advance abstracts of the second clinical congress of the Gulf Chapter of the American Association of Clinical Endocrinologists to be held on 23-25 of October 2014. The declared educational objectives of the congress is to give a “state of the art in endocrine practice”. To this end, the organizing committee invited international and regional key opinion leaders to meet the objectives of the congress. We present the abstracts of the congress as submitted by the authors after minimal restyling and editing to suit the publication requirements of the journal. Many major issues and topical themes with wide interests in the profession were addressed in 5 plenary lectures. A clinical practice debate was included to highlight the pros and cons of the recently published lipid lower guidelines from both sides of the Atlantic. More focused issues were included in 12 clinical practice symposia to suite the specific educational needs of the target audience subgroups. Practical issues were addressed in “Meet the Expert”-type of interactive workshops. A selection of free communications from abstracts submitted by delegates, reflecting mostly the regional epidemiology and clinical practice in diabetes care and endocrinology, were selected for presentation as either oral or poster presentations.We hope that by publishing them in this journal we extend the benefit to those who could not make it to the live presentations. The focus of this year's congress included bone health, molecular endocrinology, pituitary and adrenal disease, new advances in diabetes care, nuclear medicine in endocrinology and select topical issues in addition to many other day to day concerns in diabetes care and clinical endocrinology.

Evaluating Diabetes Outcomes and Costs Within an Ambulatory Setting: A Strategic Approach Utilizing a Clinical Decision Support System.

Diabetes affects 22.3 million people in the United States.1 It is a major cause of heart disease and stroke and is the seventh leading cause of death.2 Patients with diabetes are at two to four times greater risk of myocardial infarction (MI) than those without diabetes, and diabetes is the primary reason for renal failure, blindness, and nontraumatic limb amputations.3 Preventive care practices can reduce the development of severe vision loss by 50–60%, reduce foot amputations by 45–85%, and lower blood pressure to reduce proteinuria, a risk factor for developing kidney disease, by ~ 35%.2 Despite evidence that complications related to diabetes are preventable,4,5 only 52% of individuals with diabetes meet guidelines targeting an A1C of < 7.0%, and only 18% meet combined glycemic, lipid, and blood pressure goals.6 In addition to significant morbidity, diabetes has a substantial financial impact. Medical expenses for people with diabetes are more than two times higher than for those without diabetes.2 Total national health care and related costs for the treatment of all people with diabetes total ~ $245 billion.1 Complications from diabetes, such as chronic kidney disease, can cost health care organizations $33 billion per year.2 Most diabetes care is provided in the community in the primary care setting,3 and diabetes is the fourth most frequent reason for ambulatory physician visits.7 A gap exists between optimal and actual care, constituting a wide “quality chasm,”8 which underscores the need for innovative approaches to change the current practice of diabetes care. Clinical decision support systems (CDSSs) have been suggested as a viable solution to these pressing issues.9 CDSSs have been defined as systems providing an automated process for comparing patient-specific characteristics against a computerized knowledge base, with resulting recommendations or …

Predictors of physical inactivity in men and women with type 2 diabetes from the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study.

The purpose of this secondary analysis was to determine changes in physical inactivity from baseline to 5 years and to identify factors associated with and predictive of physical inactivity among individuals with type 2 diabetes enrolled in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. DIAD was a prospective randomized screening trial that assessed the prevalence of silent ischemia in asymptomatic patients with type 2 diabetes. Subjects were recruited from diabetes and primary care practices at 14 centers throughout the United States and Canada. This is a secondary data analysis of the physical activity data (type and hours/week) collected. No intervention was conducted. In all subjects, physical inactivity rose from 24% at baseline to 33% at 5 years (S = 28.93; P < .0001). This change was significant in both men (S = 11.44; P < .0001), increasing from 23% to 31%, and women (S = 18.05; P < .0001), increasing from 25% to 36%. Gender differences were noted in several factors associated with baseline physical inactivity as well as in factors predictive of physical inactivity at 5 years. Important factors associated at both time points included lower level of education, current employment, presence of peripheral and autonomic neuropathy, and indicators of overweight/obesity. Baseline physical inactivity was strongly predictive of physical inactivity at 5 years (odds ratio, 3.27; 95% confidence interval, 2.36-4.54; P < .0001). Gender-related differences were noted in factors associated with and predictive of physical inactivity.

Prevalence and Factors Influencing Diabetic Foot Ulcer among Diabetic Patients Attending Arbaminch Hospital, South Ethiopia

Background: Diabetic foot ulcer is one of the long standing complications of diabetic mellitus with the life time risk up to 25%. In Africa in general, particularly in Ethiopia, there are limited epidemiological studies related to diabetic foot ulcer. Objective: The main objective of this study is to assess prevalence and factors influencing diabetic foot ulcer among diabetic patients attending Arbaminch hospital. Methods: A cross sectional study was conducted on 216 diabetic clients attending Arbaminch hospital from Feb10, 2013 to April 10, 2013. Subjects were identified using simple random sampling and data was collected by four trained diploma level nurses using interviewer administered questioner, record review check list and observation check lists. The data was coded and entered to Epidata version 3.1 and exported to SPSS version 16.0 for analysis. Descriptive analysis was done for sociodemographic variables, diabetic knowledge, diabetes self care practice and attitude and clinical factors. Binary logistic regression analysis was also done to identify independent factors associated with diabetic foot ulcer and significant factors was declared at p<0.05 with 95% confidence interval. Finally data was presented with explanatory statements, tables and graphs. Result: All of the study subjects were interviewed which gives 100% response rate with the mean ± SD age of 50.72 ± 13.39 years. Out of the total 216 study subjects , about 32(14.8%) has diabetic foot ulcer, 129(59.7%) were male, 61(28.2%) from rural, 132(61.11%) were overweight, 97(44.5%) have poor diabetic foot self care practice and 80(37%) of them have secondary education. rural residence (AOR=4.074, 95% CI 1.262-13.151), absence of co-morbidity (AOR=0.611, 95% CI 0.131-0.955), mean arterial blood pressure greater than 90(AOR=5.113, 95% CI 1.285-20.347), duration of diabetes for more than 10years (AOR=8.452, 95% CI 2.365-30.994), are independent factor associated with DFU. Conclusions and recommendations: Significant proportion of patients with diabetes developed diabetic foot ulcer. Rural residence; presence of co-morbidity; duration of diabetes, mean arterial blood pressure and occupation are factors associated with diabetic foot ulcer. In addition to regular diabetic care emphasis should be given on enhancing diabetic patient’s knowledge of self care practice and regular diabetic foot evaluation

Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India

Background:The burden of diabetes and its foot complications is increasing in India. Prevention of these complications through foot care education should be explored. The objective of our study was to assess the risk factors of poor diabetic foot care and to find the effectiveness of health education in improving foot care practice among diabetes patients.Materials and Methods:A structured pre-tested questionnaire was administered to the outpatients of a rural health center with type 2 diabetes. Awareness regarding diabetes, care of diabetes and foot care practice ware assessed and scored. Individual and group health education focusing on foot care was performed. Foot care practice was reassessed after 2 weeks of education.Results:Only 54% were aware that diabetes could lead to reduced foot sensation and foot ulcers. Nearly 53% and 41% of the patients had good diabetes awareness and good diabetes care respectively. Only 22% of the patients had their feet examined by a health worker or doctor. The patients with poor, satisfactory and good practice scores were 44.7%, 35.9% and 19.4% respectively. Low education status, old age and low awareness regarding diabetes were the risk factors for poor practice of foot care. Average score for practice of foot care improved from 5.90 ± 1.82 to 8.0 ± 1.30 after 2 weeks of health education. Practice related to toe space examination, foot inspection and foot wear inspection improved maximally.Conclusion:Foot care education for diabetics in a primary care setting improves their foot care practice and is likely to be effective in reducing the burden of diabetic foot ulcer.

Prevalence and Factors Influencing Diabetic Foot Ulcer among Diabetic Patients Attending Arbaminch Hospital, South Ethiopia

Background: Diabetic foot ulcer is one of the long standing complications of diabetic mellitus with the life time risk up to 25%. In Africa in general, particularly in Ethiopia, there are limited epidemiological studies related to diabetic foot ulcer. Objective: The main objective of this study is to assess prevalence and factors influencing diabetic foot ulcer among diabetic patients attending Arbaminch hospital. Methods: A cross sectional study was conducted on 216 diabetic clients attending Arbaminch hospital from Feb10, 2013 to April 10, 2013. Subjects were identified using simple random sampling and data was collected by four trained diploma level nurses using interviewer administered questioner, record review check list and observation check lists. The data was coded and entered to Epidata version 3.1 and exported to SPSS version 16.0 for analysis. Descriptive analysis was done for sociodemographic variables, diabetic knowledge, diabetes self care practice and attitude and clinical factors. Binary logistic regression analysis was also done to identify independent factors associated with diabetic foot ulcer and significant factors was declared at p<0.05 with 95% confidence interval. Finally data was presented with explanatory statements, tables and graphs. Result: All of the study subjects were interviewed which gives 100% response rate with the mean ± SD age of 50.72 ± 13.39 years. Out of the total 216 study subjects , about 32(14.8%) has diabetic foot ulcer, 129(59.7%) were male, 61(28.2%) from rural, 132(61.11%) were overweight, 97(44.5%) have poor diabetic foot self care practice and 80(37%) of them have secondary education. rural residence (AOR=4.074, 95% CI 1.262-13.151), absence of co-morbidity (AOR=0.611, 95% CI 0.131-0.955), mean arterial blood pressure greater than 90(AOR=5.113, 95% CI 1.285-20.347), duration of diabetes for more than 10years (AOR=8.452, 95% CI 2.365-30.994), are independent factor associated with DFU. Conclusions and recommendations: Significant proportion of patients with diabetes developed diabetic foot ulcer. Rural residence; presence of co-morbidity; duration of diabetes, mean arterial blood pressure and occupation are factors associated with diabetic foot ulcer. In addition to regular diabetic care emphasis should be given on enhancing diabetic patient’s knowledge of self care practice and regular diabetic foot evaluation

Changes in adiponectin level and fat distribution in patients with type 2 diabetes

The aim of this study was to assess the impact of standard hypoglycaemic treatment strategies on adiponectin levels and fat distribution in patients with newly diagnosed type 2 diabetes mellitus (T2DM). This was a prospective observational study of 50 women with newly diagnosed T2DM, aged 64·6±7·9years and treated for 12months with lifestyle modification alone (n=24) or in combination with metformin (n=26), according to current standards of diabetic care and clinical practice guidelines. None of the patients required insulin therapy during the entire study period. Total (BF), abdominal (android) and hip (gynoid) fat were measured by dual-energy X-ray absorptiometry at the baseline and after 12months of treatment. Total adiponectin, glycated haemoglobin (HbA1c) and fasting glucose were measured in 3-month intervals. Baseline adiponectin level was low (9·37±2·81μg/mL). Lifestyle modifications and metformin produced comparable changes in adiponectin levels, which were not associated with changes in BF, HbA1c, glucose and regional fat depots. Baseline adiponectin was inversely correlated with triglycerides (R=-0·441; P=0·0007) and the android/gynoid ratio (R=-0·272; P=0·042). Treatment with metformin was associated with a significant weight reduction (P=0·033), which resulted from a decrease in BF% (P=0·044) but was not associated with changes in android and gynoid depots. In postmenopausal women with newly diagnosed T2DM, lifestyle modifications alone or combined with metformin produced comparable changes in adiponectin levels. Weight reduction in patients treated with metformin was associated with significant decrease in %BF but not in regional fat depots.

The first clinical congress of the gulf chapter of the American association of clinical endocrinologists, october, 3rd-5th 2013, St Regis Hotel, Abu Dhabi, United Arab Emirates

The first clinical congress of the Gulf Chapter of the American Association of Clinical Endocrinologists was held in October 2013. The declared educational objective of the congress is to give a “state of the art in endocrine practice”. To this end, the organizing committee invited international and regional key opinion leaders to meet the objectives of the congress. In this article, we present the abstracts of the congress as submitted by the authors after minimal restyling and editing to suit the publication requirements of the journal. Major issues and topical themes with wide interests in the profession were addressed in 6 plenary lectures. More focused issues were included in several parallel symposia to suite the specific educational needs of the target audience subgroups. Practical issues were addressed in “Meet the Expert” type of interactive workshops. A selection of free communications from abstracts submitted by delegates, reflecting mostly the regional epidemiology and clinical practice in diabetes care and endocrinology, were presented as either oral or poster presentations. The abstracts are presented under their relevant groups. We hope that by publishing them in this journal we extend the benefit to those who could not make it to the live presentations.

Intuitive practice and skill development in diabetes care

Anne Phillips evaluates the importance of intuition during decision-making in nursing practice and patient communication. She investigates how the quality of care provided by practice nurses may benefit from it

Management of diabetes mellitus and associated cardiovascular risk factors in Brazil – the Brazilian study on the practice of diabetes care

BackgroundThe Brazilian Study on the Practice of Diabetes Care main objective was to provide an epidemiological profile of individuals with type 1 and 2 diabetes mellitus (DM) in Brazil, concerning therapy and adherence to international guidelines in the medical practice.MethodsThis observational, cross-sectional, multicenter study collected and analyzed data from individuals with type 1 and 2 DM attending public or private clinics in Brazil. Each investigator included the first 10 patients with type 2 DM who visited his/her office, and the first 5 patients with type 1 DM.ResultsA total of 1,358 patients were analyzed; 375 (27.6%) had type 1 and 983 (72.4%) had type 2 DM. Most individuals were women, Caucasian, and private health care users. High prevalence rates of hypertension, dyslipidemia and central obesity were observed, particularly in type 2 DM. Only 7.3% and 5.1% of the individuals with types 1 and 2 DM, respectively, had optimal control of blood pressure, plasma glucose and lipids. The absence of hypertension and female sex were associated with better control of type 1 DM and other cardiovascular risk factors. In type 2 DM, older age was also associated with better control.ConclusionsFemale sex, older age, and absence of hypertension were associated with better metabolic control. An optimal control of plasma glucose and other cardiovascular risk factors are obtained only in a minority of individuals with diabetes. Local numbers, compared to those from other countries are worse.

Adherence to Diabetes Self-Management Practices among Type Ii Diabetic Patients in Ethiopia; A Cross Sectional Study

Background: Diabetes is a group of metabolic disorders that affect the body’s ability to process and use sugar (glucose) for energy. Type II diabetes mellitus resulting from the combination of resistance to insulin action and inadequate insulin secretion. The success of long-term maintenance therapy for diabetes depends largely on the patients’ adherence with self managements practices. Objective: The aim of this study was to assess adherence to diabetes self management practices and its associated factors among type II diabetic patients in Ethiopia. Method: institutional based cross sectional study was employed and 320 study subjects were selected using systematic random sampling technique. And the data was collected using interviewer administered structured questionnaire; data was analyzed and cleaned using SPSS version 16. Scoring method was employed to classify patients’ self-care management practices level. The study period was from sept.2011 to May 30, 2012. Results: Of all respondents, 167 (52.2%) were female. Mean age of the respondents was 55.03 ± 10.7 years with minimum age of 30 and maximum age of 85. The mean duration of diabetes was 12.3+ 7.6 years with minimum of 6 months and maximum of 41 years. From the total respondents, one hundred and seventy (53.1%) were reported to have adhered to physical activities. Two hundred and thirteen (66.6%) respondents were reported to have adhered to the recommended diabetic foot care practices. Overall diabetes self- managements practices were reported as adhered in 178 (55.6%) respondents. Marital status, level of education, monthly income and diabetes complication were showed that association with their adherence condition to physical activity [P=0.047, AOR (95% CI)=2.99 (1.015-8.837) and P=0.006, AOR(95%CI)= 2.79(1.942-5.832)], [P=0.011, AOR (95% CI) = 2.74(1.069-7.064) and P=0.016, AOR (95%CI) = 1.79(1.1182.888)]. Gender and age were found to have association with adherence to diabetic foot care management practices [P=<0.001, AOR (95% CI) =2.03(1.256-3.297)] and [P=0.040, AOR (95% CI) =1.45(0.524-4.060)]. Gender, level of education, diabetes complication and age were showed that association with adherence level to overall diabetes self management practices [P=0.003, AOR (95% CI) =2.37 (1.353- 4.167) and P=0.009, AOR (95%CI) =3.69(1.390-9.830)], [P=<0.001, AOR (95% CI) =2.509 (1.535-4.104)], [P=0.013, AOR (95% CI) =0.46 (0.241-0.879)] Conclusion: findings of this study showed that Almost half of the respondents were adhered to physical activity regimen, diabetes foot care and over all diabetes self managements practices. Marital status, level of education, monthly income, presence or absence of diabetes complication, age were the factors affecting to those diabetes self managements practices

Changing diabetes® barometer: A global quality monitoring framework for improving patient outcomes

This article has a global perspective and includes examples from several continents i.e. Latin America, Africa, Asia and Europe. The Changing Diabetes® Barometer (CDB) is a Novo Nordisk initiative that works as a worldwide quality monitoring system for diabetes management to measure the gains made in the fight against diabetes focusing on quality of care and patient outcomes. CDB provides a platform for countries to share local diabetes data and good practices. In doing so it aims to disseminate improved practices of care. CDB is conceptualised as a framework that can help change diabetes. Its three cornerstones are “Measure, Share, Improve” (MSI):• MEASURE the quality of diabetes care through patient outcomes and care processes.• SHARE data on the quality of diabetes care and good practices with all relevant stakeholders.• IMPROVE the quality of diabetes care by identifying and actively spreading good practices in diabetes care and inspire others to adopt and follow best practice examples.Italy and Algeria both constitute best practice examples of CDB initiatives. In Italy a registry solution is already solidly implemented and improvements in patient outcomes have been documented. The initiative in Algeria has recently been initiated including establishment of IT equipment in participating clinics to ensure all relevant measurements. This will enable transparency on current level of quality of diabetes care. Both initiatives have the common goal of driving improvements in quality of care and patient outcomes across clinics. India is another good example where data is collected through the CDB aimed at driving improvement of diabetes care in order to improve quality of life for people with diabetes. CDB in India is implemented in five states (Goa, Bihar, Gujarat, Puducherry and Andhra Pradesh) and is planned to be expanded to five additional states.

Changing diabetes®barometer: A global quality monitoring framework for improving patient outcomes

This article has a global perspective and includes examples from several continents i.e. Latin America, Africa, Asia and Europe. The Changing Diabetes ® Barometer (CDB) is a Novo Nordisk initiative that works as a worldwide quality monitoring system for diabetes management to measure the gains made in the fight against diabetes focusing on quality of care and patient outcomes. CDB provides a platform for countries to share local diabetes data and good practices. In doing so it aims to disseminate improved practices of care. CDB is conceptualised as a framework that can help change diabetes. Its three cornerstones are Measure, Share, Improve (MSI): MEASURE the quality of diabetes care through patient outcomes and care processes. SHARE data on the quality of diabetes care and good practices with all relevant stakeholders. IMPROVE the quality of diabetes care by identifying and actively spreading good practices in diabetes care and inspire others to adopt and follow best practice examples. Italy and Algeria both constitute best practice examples of CDB initiatives. In Italy a registry solution is already solidly implemented and improvements in patient outcomes have been documented. The initiative in Algeria has recently been initiated including establishment of IT equipment in participating clinics to ensure all relevant measurements. This will enable transparency on current level of quality of diabetes care. Both initiatives have the common goal of driving improvements in quality of care and patient outcomes across clinics. India is another good example where data is collected through the CDB aimed at driving improvement of diabetes care in order to improve quality of life for people with diabetes. CDB in India is implemented in five states (Goa, Bihar, Gujarat, Puducherry and Andhra Pradesh) and is planned to be expanded to five additional states.

Do Healthcare Workers Adhere to Diabetes Clinical Care Guidelines? A Study at a National Hospital, Kenya

Background: The incidence of diabetes mellitus is rapidly increasing worldwide and over 366 million people have diabetes and according to the Kenyan Ministry of Health over 2 million Kenyans are affected by diabetes. In Kenya about 60% and 50% of patients with renal and cardiac complications respectively are as a result of diabetes, and about three quarter of these patients attend the diabetes clinic. It is therefore critical to examine the care provided especially the healthcare practitioner’s adherence to diabetes care guidelines. Such guidelines offer a practical way of ensuring standardized care for diabetics and reduce morbidity. Methods: A retrospective study based on a record review of 377 outpatient files to assess diabetes care practices at Kenyatta National Hospital. The sample consisted of diabetics who have utilised the diabetes clinic for a period of two years. A structured questionnaire and checklist were used to collect data. Randomly selected patient files were reviewed to collect information on the diabetes care practices recommended by the national guidelines. Data was analyzed using SPSS to establish the health care professionals’ adherence to National Diabetes Care Guidelines. Results: Despite almost all patients having an initial evaluation done and management goals were stated in 99.5% in the files, 24.7% and 10.8% of patients were referred for medical nutrition therapy and diabetes self-management education respectively showing that preventive measure were poorly executed. Yearly risk assessment surveillance was poor with only 30.2% and 47.2% patients referred for micro albuminuria, and lipid assessment respectively. Conclusion: Adherence to diabetes guidelines by healthcare professionals at the hospital was poor and this worsen during patients’ subsequent visits. There was also poor adherence to annual risk assessment. Together, these deficiencies represent a lost opportunity for early detection of preventable complications that are major contributors to care costs and poor quality of life.

Diabetic Retinopathy Screening by General Practitioners Using Non- Mydriatic Retinography

Diabetic retinopathy (DR) is the leading cause of visual loss in people aged 30 to 69 years. Most authorities recommend screening of the ocular fundus to prevent severe visual loss. The increasing incidence of diabetes mellitus and fewer ophthalmologists in many countries is leading to inadequate screening. Establishing an adequate system for DR screening is a complex issue and represents a challenge for most health authorities. To alleviate the burden of DR screening for most health systems, some investigators have suggested that general practitioners (GPs) perform the initial screenings. The aim of this article was to review the current status of DR screening performed by GPs using non-mydriatic retinography. The five studies analyzed in this review indicated that after adequate training GPs can be effective and reliable screeners of DR using non-mydriatic retinography. Including GPs in the screening model would be a useful way to alleviate the increasing demands of ophthalmic care resulting from the increased prevalence of diabetes mellitus. In addition, GPs would have full control of the diabetic process, which could bolster their motivation and confidence in other areas of diabetes care and medical practice.

PHP113 Utilization of FPG, HbA1C and Self-Monitoring of Blood Glucose (SMBG) in Community Health Centers in the Shanghai Area

Utilization of fasting plasma glucose (FPG), HbA1c and SMBG are considered core components of diabetes therapy. They support a safe and effective drug therapy and they provide feedback on the quality of glycemic control. In 2011 a Chinese guideline on SMBG was published. SMBG, in contrast to most diabetes drugs, is not reimbursed in China. This study aims to assess the level of SMBG usage with patients on different diabetes therapies in community health centers (primary care). In 2012 a survey was conducted in community health centers in 6 districts of Shanghai. 935 random diabetes cases were documented in a standardized format. Subsequent explorative analysis were performed. SMBG usage was analyzed by therapy-subgroups: oral diabetes therapy only (OAD 84%), any therapy involving insulin (INSULIN 14%) and OTHERS (2%). 99% were patients with type 2 diabetes. FPG levels were available for 86% and 89% in OAD/INSULIN respectively, HbA1c levels were available for 32.0% and 19.4% respectively. For 124 patients (13.3%) SMBG usage was reported, for 111 of them actual test frequencies were available. Shares of testers by therapies (OAD/INSULIN) were 10.0% and 21.8%. Physicians recommended an average of 5.9 tests per week, patients performed 2.8 (47.5%). For OAD/INSULIN test-frequencies were 2.8 and 2.2. Doctors rated the SMBG adherence as good or very good in 43% of cases. In community centers the vast majority of patients have type 2 diabetes. FPG values were broadly documented, but the therapy quality marker HbA1 is only available for the minority of patients. SMBG was more common with insulin users, but clearly below guideline recommendations. It needs to be determined which measures could potentially improve the current practice in diabetes care in order to strengthen the role of community health centers in managing the diabetes epidemic in China.

Diabetic Retinopathy Screening by General Practitioners Using Non- Mydriatic Retinography

Diabetic retinopathy (DR) is the leading cause of visual loss in people aged 30 to 69 years. Most authorities recommend screening of the ocular fundus to prevent severe visual loss. The increasing incidence of diabetes mellitus and fewer ophthalmologists in many countries is leading to inadequate screening. Establishing an adequate system for DR screening is a complex issue and represents a challenge for most health authorities. To alleviate the burden of DR screening for most health systems, some investigators have suggested that general practitioners (GPs) perform the initial screenings. The aim of this article was to review the current status of DR screening performed by GPs using non-mydriatic retinography. The five studies analyzed in this review indicated that after adequate training GPs can be effective and reliable screeners of DR using non-mydriatic retinography. Including GPs in the screening model would be a useful way to alleviate the increasing demands of ophthalmic care resulting from the increased prevalence of diabetes mellitus. In addition, GPs would have full control of the diabetic process, which could bolster their motivation and confidence in other areas of diabetes care and medical practice.