Risk Of Diabetes-related Complications Research Articles

Original Research: Knowledge of Diabetes and Hypertension Care among Health Care Workers in Southwest Nigeria

Background: There has been a progressive increase in diabetes among Nigerians. A major problem with diabetes care in the sub-Saharan African region is the inadequate training of health care workers, leading to insufficient knowledge of diabetes and other chronic diseases. Aim: To assess health care workers' knowledge on various aspects of diabetes and hypertension management based on recommended guidelines. Materials and Methods: A questionnaire assessing knowledge of diabetes and hypertension care was administered among health care workers at the beginning of a workshop on diabetes education. The responses were analyzed using SPSS statistical software version 10.0. Results: A total of 184 subjects responded. One hundred four (56.5%) were male and 80 (43.5%) were female. Medical practitioners constituted 76 (41.8%) while nurses and other categories of health care workers constituted 46 (25.2%) and 60 (33%), respectively. Twenty-eight (26.9%) of these worked in primary health institutions, 46 (44.2%) in secondary health institutions, while 30 (28.9%) worked in tertiary health institutions. One hundred eighteen (64.1%) respondents gave a correct response of 5 to 6 mmol/L (90–108 mg/L) as the blood glucose target level for diabetic patients. Similarly, 118 (64.1%) respondents gave a correct response of ≤ 130/85 mm Hg as the recommended target blood pressure for diabetic patients. The ideal serum cholesterol of 5.0 mmol/L and glycated hemoglobin were correctly indicated by 42 (22.8%) and 56 (30.4%) of the respondents, respectively. The majority of the subjects (89.1%) were aware of the fact that tight blood glucose control reduces the risk of diabetes-related complications. The variables that correlated with increased knowledge include treating more than 50 patients per month (X2 4.124, P = 0.042) and working in a tertiary center (X2 5.714, P = 0.047). Most of the health care facilities (61.7%) where the respondents work do not deliver protocol-driven care for diabetics. Conclusion: A large number of health care workers in southwest Nigeria do not seem to be familiar with the current practice guidelines for the management of diabetes. There is a need to introduce protocol-driven diabetes care in our health care facilities and improve the knowledge base of practitioners.

The role of new basal insulin analogues in the initiation and optimisation of insulin therapy in type 2 diabetes

Intensive insulin therapy aimed at achieving normoglycaemia is becoming increasingly accepted in the treatment of type 2 diabetes (T2DM) to reduce the risk of diabetes-related complications. Insulin therapy is increasingly combined with oral antidiabetic drugs (OADs) to moderate insulin dosage, reduce weight gain and confer cardiovascular protection. However, traditional insulins are associated with limitations that may act as barriers to initiation, and intensive use of insulin therapy. The advent of newer, longer-acting, basal insulin analogues, such as insulin glargine (glargine) and insulin detemir (detemir), offer improved pharmacokinetic and pharmacodynamic profiles compared with neutral protamine Hagedorn insulin (NPH). This potentially provides concomitant improvements in safety, efficacy and variability of glycaemic control. This paper reviews the properties of these new long-acting, basal insulin analogues and their potential roles in facilitating the initiation and optimisation of insulin therapy. Studies that reported the use of insulin and insulin analogues for the treatment of T2DM were identified using Medline. Key search terms included: 'insulin glargine', 'insulin detemir', 'NPH insulin', 'basal insulin', 'long-acting insulin', 'insulin analogue', 'pharmacokinetics', 'pharmacodynamics', 'dose titration', 'algorithms' and 'type 2 diabetes'. Abstracts presented at the American Diabetes Association and the European Association for the Study of Diabetes annual congresses were also searched. The data show that the long-acting insulin analogues glargine and detemir both offer a low risk of hypoglycaemia and improved glycaemic control. Aggressive dose titration with glargine and detemir facilitates attainment of glycaemic control targets. The goal of achieving good glycaemic control with a low risk of hypoglycaemia may be more feasible with newer insulin therapies as part of a simple basal insulin regimen with continued OADs.

Good glycaemic control: an international perspective on bridging the gap between theory and practice in type 2 diabetes

ABSTRACTBackground: Good glycaemic control is crucial in reducing the risk of diabetes-related complications. Despite the availability of evidence-based treatment guidelines, glycaemic control appears to remain suboptimal in most countries.Objectives: In this commentary we outline the extent to which diabetes guideline targets on HbA1c are being met in clinical practice and – where targets are being missed – to identify potential reasons for this shortfall. Furthermore, we discuss possible actions that may improve glycaemic control.Methods: A literature search of MEDLINE using 20 core terms was conducted to help assess the state of glycaemic control in patients with type 2 diabetes worldwide.Results: Despite clinical guidelines, evidence suggests that glycaemic control is suboptimal in most parts of the world, with average HbA1c values varying from 7.0% to 12.6% and thus above virtually all HbA1c recommendations. The potential reasons for this shortfall are numerous. However, lack of diabetes education and awareness of HbA1c appear to be particularly important. A number of education initiatives from around the world have been shown to improve HbA1c levels significantly and thus improve standards of care.Conclusions: Poor glycaemic control in patients with type 2 diabetes appears to be a worldwide problem. As the global rise in diabetes (and its complications) seems destined to affect many less affluent countries, it is essential that appropriate steps are taken to address the barriers to good glycaemic control and ultimately improve outcomes for all people with type 2 diabetes.

Themed Review: Lifestyle Interventions Across the Continuum of Type 2 Diabetes: Reducing the Risks of Diabetes

Type 2 diabetes is a progressive disease that results from defects in insulin action (insulin resistance), insulin secretion (insulin deficiency), or both. The progressive decline in β-c ell function requires that medical therapy progress from lifestyle interventions for prevention of diabetes to medical nutrition therapy (MNT) alone for diabetes management to MNT in combination with glucose-lowering medications that target the multiple pathophysiologic aspects of diabetes to MNT with insulin. MNT also progresses from prevention of obesity or weight gain to improving insulin resistance to contributing to improved metabolic control of glucose, lipids, and blood pressure; however, MNT is important throughout the continuum of diabetes and its medical management. Early diagnosis and aggressive therapy decrease the risk of diabetes-related complications.

Continuous glucose monitoring: a stepping stone in the journey towards a cure for diabetes

Probably the most important advance in the field of diabetes and pregnancy since the discovery of insulin in 1921 is self-monitoring of blood glucose. Within the past 30 years, home monitoring of blood glucose has introduced a more efficient means of tracking patient progress. The advent of continuousglucos e monitoring hasbroadened the horizonsfor improving patient care. Barriersto intensive therapy such as standard methods of monitoring blood glucose, the risk of hypoglycemia, the limitations of present therapy and inadequate patient education must be overcome in order to improve diabetesmanagement. Thispaper discussesmethodsof blood glucose monitoring and its aimsat bringing the abovementioned barriersto a minimum in order to maintain normoglycemia, to reduce risks of diabetes-related complications and to optimize the possibility for pregnant women with diabetesof delivering healthy babies.

Autonomy or non-compliance in adolescent diabetes?

Many physical, psychological, social and cognitive changes take place in adolescence. Emerging personal values and beliefs, an acute awareness of body image and a desire for peer conformity and increasing independence can make the transition to adulthood troublesome. For teenagers with diabetes, usual adolescent needs and concerns are complicated by the demands of a complex treatment regimen. This can result in non-adherence to the recommended programme of care and, consequently, poor glycaemic control, which increases the risks for diabetes-related complications in later life. This situation poses a major problem for healthcare professionals. Teenagers, however, are frequently preoccupied with the present, and are unable to perceive, or will ignore, their vulnerability to long-term health problems. This article discusses these difficult issues and, taking into account the increasing need for autonomy and independence in adolescence, makes recommendations for nursing practice.