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Diabetes Management (diabetes + management)
Kinds of Diabetes Management Selected AbstractsHEALTH BENEFITS OF APPLE PHENOLICS FROM POSTHARVEST STAGES FOR POTENTIAL TYPE 2 DIABETES MANAGEMENT USING IN VITRO MODELSJOURNAL OF FOOD BIOCHEMISTRY, Issue 1 2010I. ADYANTHAYA ABSTRACT An increasing number of studies indicate that regular intake of fruits and vegetables have clear links to reduced risk of chronic diseases like diabetes and cardiovascular disease. The beneficial effects in many cases have been attributed to the phenolic and antioxidant content of the fruits and vegetables. Apples are a major source of fiber and contain good dietary phenolics with antioxidant function. Previous epidemiological studies have indicated that intake of apples reduces the risk of developing type 2 diabetes. Our studies indicate that this reduced risk is potentially because of the modulation of postprandial glucose increase by phenolics present in apples via inhibition of, -glucosidase. Phenolic content was evaluated during 3 months of postharvest storage of four varieties of apples and results indicated positive linkage to enhanced postharvest preservation and, -glucosidase inhibition. These in vitro results along with existing epidemiological studies provide strong biochemical rationale for further animal or human clinical studies. PRACTICAL APPLICATIONS The understanding of phenolic-linked antioxidant enzyme responses during postharvest storage of apples has implications for using the same phenolic functional ingredients toward health benefits such as ,-glucosidase inhibition linked to glycemic index control associated with type 2 diabetes. Therefore strategies to understand phenolic-linked postharvest preservation and natural treatments to extend this preservation in selected varieties, such as McIntosh and Cortland in this study, can be basis for food ingredient design for health benefits. These strategies can then be extended to prolong postharvest preservation and enhance phenolic linked human health benefits of a wide variety of fruits and vegetables. [source] TOWARD CASE-BASED REASONING FOR DIABETES MANAGEMENT: A PRELIMINARY CLINICAL STUDY AND DECISION SUPPORT SYSTEM PROTOTYPECOMPUTATIONAL INTELLIGENCE, Issue 3 2009Cindy Marling This paper presents a case-based decision support system prototype to assist patients with Type 1 diabetes on insulin pump therapy. These patients must vigilantly maintain blood glucose levels within prescribed target ranges to prevent serious disease complications, including blindness, neuropathy, and heart failure. Case-based reasoning (CBR) was selected for this domain because (a) existing guidelines for managing diabetes are general and must be tailored to individual patient needs; (b) physical and lifestyle factors combine to influence blood glucose levels; and (c) CBR has been successfully applied to the management of other long-term medical conditions. An institutional review board (IRB) approved preliminary clinical study, involving 20 patients, was conducted to assess the feasibility of providing case-based decision support for these patients. Fifty cases were compiled in a case library, situation assessment routines were encoded to detect common problems in blood glucose control, and retrieval metrics were developed to find the most relevant past cases for solving current problems. Preliminary results encourage continued research and work toward development of a practical tool for patients. [source] Staged Diabetes Management, 2nd EditionDIABETIC MEDICINE, Issue 7 2005A. Kilvert No abstract is available for this article. [source] Diabetes management in the new millennium using insulin pump therapyDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2002Bruce W. Bode Abstract Current goals of therapy of type 1 and 2 diabetes are to achieve near normal glycemia, minimize the risk of severe hypoglycemia, limit excessive weight gain, improve quality of life and delay or prevent late vascular complications. As discussed in this review, insulin pump or continuous subcutaneous insulin infusion (CSII) therapy provides a treatment option that can dramatically aid in achieving all of these goals. In comparison to multiple daily injections (MDI), CSII uses only rapid-acting insulin, provides greater flexibility in timing of meals and snacks, has programmable basal rates to optimize overnight glycemic control, can reduce the risk of exercise-induced hypoglycemia, and enhances patients' ability to control their own diabetes. Most important, in adults and adolescents with type 1 diabetes, CSII has been shown to lower HbA1c levels, reduce the frequency of severe hypoglycemia and limit excessive weight gain versus MDI without increasing the risk of diabetic ketoacidosis. Similarly positive results are being seen with CSII in adults with type 2 diabetes. The effectiveness of CSII and improvements in pump technology have fueled a dramatic increase in the use of this therapy. Practical guidelines are presented for selection of patients, initiation of treatment, patient education, follow-up assessments and troubleshooting. The recent introduction of methods for continuous glucose monitoring provides a new means to optimize the basal and bolus capabilities of CSII and offers the hope of the development of a feedback-controlled artificial pancreas. Copyright © 2002 John Wiley & Sons, Ltd. [source] Hospital in-patients with diabetes: increasing prevalence and management problemsDIABETIC MEDICINE, Issue 1 2005M. E. Wallymahmed Abstract Aims To re-assess the prevalence, management problems, clinical outcomes and discharge summaries of hospital in-patients with diabetes. Methods Case records of all patients occupying in-patient beds were audited on a single weekday in 2003 in a large urban hospital and repeated after 3 months. Data was compared with an identical audit 12 years previously. Results Over 12 years the number of beds available for admission (1191) had reduced by 25% with a bed occupancy of 97%. Diabetes prevalence had increased from 7.0% to 11.1% (P < 0.01) (97% Type 2). Diabetes management was considered inappropriate in 29%, more than in 1991 (20%). After 3 months, discharge summaries had been completed on 75% of patients but diabetes was mentioned in only 53%. Conclusion The prevalence of in-patient diabetes (11.1%) was over 50% greater and diabetes management was suboptimal in more patients than in 1991. In many length of stay was prolonged and almost half of the discharge summaries did not mention diabetes. These findings have major implications for service delivery and resource planning. [source] Integrating educational and technological interventions to improve pregnancy outcomes in women with diabetesDIABETES OBESITY & METABOLISM, Issue 2 2010Helen R. MurphyArticle first published online: 5 NOV 200 A gap currently exists between our expectations of tight blood glucose control and the reality of safely achieving it before and during pregnancy. Technological and pharmaceutical advances will not in isolation prevent poor pregnancy outcomes without recognising the social, cultural and behavioural context of the women living with diabetes. Neither will behavioural and/or educational programmes completely overcome the fundamentally disordered metabolic pathways and physiological challenges of pregnancy. Improved integration of the technological, behavioural and educational aspects of diabetes care will pave the way for truly personalized, interdisciplinary diabetes management and ultimately improved pregnancy outcomes for women with diabetes and their infants. [source] Mid- and high-ratio premix insulin analogues: potential treatment options for patients with type 2 diabetes in need of greater postprandial blood glucose controlDIABETES OBESITY & METABOLISM, Issue 2 2010J. S. Christiansen Some patients with type 2 diabetes continue to have high postprandial blood glucose levels on twice-daily regimens of ,low-ratio' premix insulin formulations (up to 30% rapid-acting, with 70% protracted insulin). These patients require intensified insulin therapy, which can be provided by a twice- or thrice-daily regimen of mid-ratio (50% rapid-acting and 50% protaminated intermediate-acting insulin , human or analogue) or high-ratio (70% rapid-acting and 30% protaminated insulin , analogue only) premix insulin. Alternatively, a third daily injection of low-ratio premix insulin can be added to the regimen, with the option of incorporating one or more injections of mid- or high-ratio premix as required, and as an alternative to basal,bolus therapy. How these mid- and high-ratio formulations differ from the low-ratio premix insulins is reviewed here, with the aim of identifying the role of these formulations in diabetes management. Glucose clamp studies have shown that premix analogues give serum insulin levels proportional to their percentage of rapid-acting uncomplexed insulin: the higher the proportion, the greater the maximum level reached. Other pharmacokinetic parameters were not always significantly different between the mid- and high-ratio formulations. In clinical trials, postprandial plasma glucose and glycated haemoglobin A1c (HbA1c) levels were significantly reduced with thrice-daily mid- /high-ratio premix analogue when compared with twice-daily low-ratio biphasic human insulin (BHI) 30/70 or once-daily insulin glargine. Moreover, glycaemic control with mid-/high-ratio premix analogue was found to be similar to that with a basal,bolus therapy. Mid- and high-ratio premix regimens are generally well tolerated. The frequency of minor hypoglycaemia was reportedly higher with mid- /high-ratio premix analogues than with BHI 30, but nocturnal hypoglycaemia was less frequent. Although there is little evidence that clinical outcomes with mid-ratio premix analogues are different from those with high-ratio, they are useful additions to the low-ratio formulations for the management of diabetes, and addressing postprandial hyperglycaemia in particular. [source] ,Lipoproteins, glycoxidation and diabetic angiopathy'DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2004Alicia J. Jenkins Abstract The chronic vascular complications of diabetes (nephropathy, retinopathy and accelerated atherosclerosis) are a major cause of morbidity and premature mortality. In spite of the more widespread availability of intensive diabetes management, approximately one in three people with diabetes develop aggressive complications and over 70% die of atherosclerosis-related diseases. Genetic and acquired factors are likely to be contributory. Potential mediators of vascular damage may include the interrelated processes of lipoprotein abnormalities, glycation, oxidation and endothelial dysfunction. Lipoprotein abnormalities encompass alterations in lipid concentrations, lipoprotein composition and subclass distribution and lipoprotein-related enzymes. Nonenzymatic glycation and oxidative damage to lipoproteins, other proteins and to vascular structures may also be deleterious. As atherosclerosis is a chronic condition commencing in youth, and because clinical events may be silent in diabetes, surrogate measures of vascular disease are important for early identification of diabetic patients with or at high risk of vascular damage, and for monitoring efficacy of interventions. The increasing array of biochemical assays for markers and mediators of vascular damage, noninvasive measures of vascular health, and therapeutic options should enable a reduction in the excessive personal and economic burden of vascular disease in type 1 and type 2 diabetes. Copyright © 2004 John Wiley & Sons, Ltd. [source] Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectivenessDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 3 2004Régis Pierre Radermecker Abstract Portable insulin infusion devices are effective and safe insulin delivery systems for managing diabetes mellitus, especially type 1 diabetes. Rapidly absorbed insulin analogues, such as insulin lispro or insulin aspart, may offer an advantage over regular human insulin for insulin pumps. Several open-label randomised crossover trials demonstrated that continuous subcutaneous insulin infusion (CSII) with insulin lispro provided a better control of postprandial hyperglycaemia and a slightly but significantly lower glycated haemoglobin level, with lower daily insulin requirement and similar or even less hypoglycaemic episodes. A CSII study comparing insulin lispro and insulin aspart demonstrated similar results with the two analogues, and better results than those with regular insulin. Because these analogues have a quicker onset and a shorter duration of action than regular insulin, one might expect an earlier and greater metabolic deterioration in case of CSII interruption, but a more rapid correction of metabolic abnormalities after insulin boluses when reactivating the pump. These expectations were confirmed in randomised protocols comparing the metabolic changes occurring during and after CSII interruption of various durations when the pump infused either insulin lispro or regular insulin. The extra cost resulting from the use of CSII and insulin analogues in diabetes management should be compensated for by better metabolic control and quality of life. In conclusion, CSII delivering fast-acting insulin analogues may be considered as one of the best methods to replace insulin in a physiological manner by mimicking meal and basal insulin requirements, without higher risk of hypoglycaemia or ketoacidosis in well-educated diabetic patients. Copyright © 2004 John Wiley & Sons, Ltd. [source] Evidence for a vicious cycle of exercise and hypoglycemia in type 1 diabetes mellitusDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 2 2004A. C. Ertl Abstract Exercise is a cornerstone of diabetes management as it aids in glycemic control, weight management, reducing blood pressure, and improving the quality of life of patients. Unfortunately, owing to the complexity and difficulties of regulating exogenous insulin in a physiologic manner during exercise, physical activity often results in hypoglycemia in patients with type 1 diabetes mellitus (type 1 DM). When glucose levels fall below threshold glycemic levels, neuroendocrine, autonomic nervous system (ANS), and metabolic glucose counterregulatory mechanisms are activated. These hypoglycemic counterregulatory mechanisms in type 1 DM can be blunted irreversibly by disease duration or by acute episodes of prior stress. These reduced (or absent) counterregulatory responses result in a threefold increase in severe hypoglycemia when intensive glycemic control is implemented in type 1 DM 1. Much recent work has been focused on determining the in vivo mechanisms responsible for causing the increased incidence of severe hypoglycemia in type 1 DM. Studies from several laboratories have demonstrated the role played by episodes of antecedent hypoglycemia in producing blunted glucose counterregulatory responses during subsequent exposures of hypoglycemia. Until recently, the mechanisms responsible for exercise related hypoglycemia in type 1 DM have been attributed to relative or absolute increases of insulin levels or incomplete glycogen repletion after physical activity. Owing to the qualitative similarity of neuroendocrine, ANS, and metabolic responses to hypoglycemia and exercise, we have hypothesized that neuroendocrine and ANS counterregulatory dysfunction may also play an important role in the pathogenesis of exercise-related hypoglycemia in type 1 DM. Vicious cycles can be created in type 1 DM, where an episode of hypoglycemia or exercise can feed forward to downregulate neuroendocrine and ANS responses to a subsequent episode of either stress, thereby creating further hypoglycemia (Figure 1). This article will review the recent work that has studied the contribution of counterregulatory dysfunction to exercise-induced hypoglycemia in type 1 DM. Copyright © 2004 John Wiley & Sons, Ltd. 1. Reciprocal vicious cycles may be created in type 1 diabetes mellitus (type 1 DM), whereby an episode of hypoglycemia or exercise can feed forward to downregulate neuroendocrine and autonomic nervous system responses to a subsequent episode of either stress, thereby creating further hypoglycemia [source] Assessment of different techniques for subcutaneous glucose monitoring in Type 1 diabetic patients during ,real-life' glucose excursionsDIABETIC MEDICINE, Issue 3 2010J. K. Mader Diabet. Med. 27, 332,338 (2010) Abstract Aims, To compare the accuracy of two marketed subcutaneous glucose monitoring devices (Guardian RT, GRT; GlucoDay S, GDS) and standard microdialysis (CMA60; MD) in Type 1 diabetic patients. Methods, Seven male Type diabetic patients were investigated over a period of 26 h simulating real-life meal glucose excursions. Catheters of the three systems were inserted into subcutaneous adipose tissue of the abdominal region. For MD, interstitial fluid was sampled at 30- to 60-min intervals for offline glucose determination. Reference samples were taken at 15- to 60-min intervals. All three systems were prospectively calibrated to reference. Median differences, median absolute relative differences (MARD), median absolute differences (MAD), Bland,Altman plot and Clark Error Grid were used to determine accuracy. Results, Bland,Altman analysis indicated a mean glucose difference (2 standard deviations) between reference and interstitial glucose of ,10.5 (41.8) % for GRT, 20.2 (55.9) % for GDS and 6.5 (35.2) % for MD, respectively. Overall MAD (interquartile range) was 1.07 (0.39; 2.04) mmol/l for GRT, 1.59 (0.54; 3.08) mmol/l for GDS and 0.76 (0.26; 1.58) mmol/l for MD. Overall MARD was 15.0 (5.6; 23.4) % (GRT), 19.7 (6.1; 37.6) % (GDS) and 8.7 (4.1; 18.3) % (MD), respectively. Total sensor failure occurred in two subjects using GRT and one subject using GDS. Conclusions, The three investigated technologies had comparable performance. Whereas GRT underestimated actual blood glucose, GDS and MD overestimated blood glucose. Considerable deviations during daily life meal glucose excursions from reference glucose were observed for all three investigated technologies. Present technologies may require further improvement until individual data can lead to direct and automated generation of therapeutic advice in diabetes management. [source] Understanding and beliefs of diabetes in the UK Bangladeshi populationDIABETIC MEDICINE, Issue 6 2009S. M. Choudhury Abstract Aims, To examine the understanding and beliefs of people with diabetes from the Bangladeshi community living in the UK. Methods, Structured interviews were carried out with 14 people invited to a peer educational programme. All interviews were on a one-to-one basis and were in Sylheti or in English. Interviews were transcribed and analysed by two independent researchers. Results, The majority of participants did not know what caused diabetes. Knowledge of the management of diabetes was linked to controlling sugar intake and a number of participants reported eating bitter foods such as bitter gourd to control their diabetes. There was little access to information as many participants did not speak English and did not have a Bengali-speaking doctor. The majority of participants felt that education classes should teach them what the doctor thought was important and that these classes would best be advertised by word of mouth. Therefore, participants were quite passive about their own self management and relied very strongly on the doctor's views and recommendations. Conclusions, Findings from this study can be used to help health professionals working with Bangladeshi people. There is a need for improved information for Bangladeshi people and much of this information might need to come from health professionals. In addition, there is a need for increased awareness by health professionals of practices used by Bangladeshi people, such as eating bitter gourd (which may enhance the effects of rosiglitazone), and the influence these practices could have on the individual's diabetes management. [source] ,-cell preservation: a potential role for thiazolidinediones to improve clinical care in Type 2 diabetesDIABETIC MEDICINE, Issue 8 2005L. A. Leiter Abstract Type 2 diabetes is caused by progressively increasing insulin resistance coupled with deteriorating ,-cell function, and there is a growing body of evidence to suggest that both of these defects precede hyperglycaemia by many years. Several studies have demonstrated the importance of maintaining ,-cell function in patients with Type 2 diabetes. This review explores parameters used to indicate ,-cell dysfunction, in Type 2 diabetes and in individuals with a predisposition to the disease. A genetic element undoubtedly underlies ,-cell dysfunction; however, a number of modifiable components are also associated with ,-cell deterioration, such as chronic hyperglycaemia and elevated free fatty acids. There is also evidence for a link between pro-inflammatory cytokines and impairment of insulin-signalling pathways in the ,-cell, and the potential role of islet amyloid deposition in ,-cell deterioration continues to be a subject for debate. The thiazolidinediones are a class of agents that have demonstrated clinical improvements in indices of ,-cell dysfunction and have the potential to improve ,-cell function. Data are accumulating to show that this therapeutic group offers a number of advantages over traditionally employed oral agents, and these data demonstrate the growing importance of thiazolidinediones in Type 2 diabetes management. [source] Hospital in-patients with diabetes: increasing prevalence and management problemsDIABETIC MEDICINE, Issue 1 2005M. E. Wallymahmed Abstract Aims To re-assess the prevalence, management problems, clinical outcomes and discharge summaries of hospital in-patients with diabetes. Methods Case records of all patients occupying in-patient beds were audited on a single weekday in 2003 in a large urban hospital and repeated after 3 months. Data was compared with an identical audit 12 years previously. Results Over 12 years the number of beds available for admission (1191) had reduced by 25% with a bed occupancy of 97%. Diabetes prevalence had increased from 7.0% to 11.1% (P < 0.01) (97% Type 2). Diabetes management was considered inappropriate in 29%, more than in 1991 (20%). After 3 months, discharge summaries had been completed on 75% of patients but diabetes was mentioned in only 53%. Conclusion The prevalence of in-patient diabetes (11.1%) was over 50% greater and diabetes management was suboptimal in more patients than in 1991. In many length of stay was prolonged and almost half of the discharge summaries did not mention diabetes. These findings have major implications for service delivery and resource planning. [source] In-patient management of diabetes mellitus and patient satisfactionDIABETIC MEDICINE, Issue 5 2002A. Bhattacharyya Abstract Aims To devise a system for assessing in-patient glycaemic control and care satisfaction in diabetic patients admitted to hospital for reasons other than their diabetes. Methods Consecutive January to March 2001 case-notes were reviewed. Admissions with acute metabolic complications, acute myocardial infarction and pregestational or gestational diabetes were excluded. Glycaemic control, frequency of blood monitoring and management of hyperglycaemia were recorded. The diabetes treatment satisfaction questionnaire was used to assess preadmission satisfaction with care. Post-admission a 12-stem questionnaire was used to assess satisfaction with in-patient diabetes management. Results Hypoglycaemia was common. Although none developed a hyperglycaemic emergency, high blood glucose was prevalent and, frequently, persistent hyperglycaemia or recurrent hypoglycaemia was not acted on appropriately. The overall score for in-patient satisfaction with treatment was fair (4.1 ± 1.8 on a six-point scale; 6 = very satisfied and 1 = very dissatisfied). Scores were higher among patients on surgical wards than on medical wards (P = 0.008), but satisfaction did not vary when patients were stratified according to sex, age and mode of treatment. Conclusion Current systems are not achieving satisfactory in-patient glycaemic control and there is poor satisfaction with medical in-patient diabetes care. Following changes intended to produce improvements, this assessment system can be used recurrently to monitor in-patient care and satisfaction. [source] Survey of dietetic provision for patients with diabetesDIABETIC MEDICINE, Issue 8 2000M. Nelson SUMMARY Aims To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes. Methods A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded. Results Nationally the median provision of dietetic care for diabetes reported was 10.7 h per 100 000 general population per week, but the provision was uneven ranging from 2.0 to 27.6 h per 100 000. Eighty-five per cent of dietitians worked in areas where the provision was less than 22 h per 100 000 general population per week (the current recommended minimum standard). Dietetic provision was greater in secondary care (median 9.1 h per 100 000 general population per week) than in general practice, residential homes and other locations (median 4.4 h per 100 000 general population per week). Provision was greater in those areas in which a designated dietitian had responsibility for co-ordinating the dietetic service for diabetes than in areas where the co-ordinator was not a dietitian or where there was no co-ordinator. Over 90% of dietitians reported following British Diabetic Association (BDA) recommendations regarding advice on carbohydrate, sugar, fat and fibre consumption, but only one-third routinely advised on salt restriction. Of the 17% of dietitians who continue to use carbohydrate exchanges, all combine this method with other approaches. Of the recommendations made by the Clinical Standards Group, only 69% of dietitians reported seeing more than half of newly diagnosd adult patients within four weeks, and less than 50% reported offering half or more of their patients an annual review. Amongst the literature in current use, 98% of dietitians use BDA literature for teaching patients and 90% use BDA publications in their own education. Seventy-six per cent of dietitians believed that there was a role for commercial slimming organizations in weight management of people with diabetes Conclusions Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK. [source] Monogenic diabetes: information seeking and genetic testing access via e-mailEUROPEAN DIABETES NURSING, Issue 2 2010M Shepherd RGN, PhD Honorary Clinical Senior Lecturer Abstract Background: Confirmation of monogenic diabetes by molecular genetic testing has allowed many patients, often previously assumed to have type 1 diabetes, to transfer from insulin injections to sulphonylurea tablets, with improvements in glycaemic control and quality of life: www.diabetesgenes.org provides information about monogenic diabetes and genetic testing. Aim: To investigate key issues raised by individuals who e-mailed the monogenic diabetes team about genetic testing and monogenic diabetes management. Methods: Sixty e-mail enquiries, received over a six-month period from patients and professionals worldwide, were analysed using a qualitative thematic content approach. Results: Five themes emerged: 1. Accessing genetic technology: patients and professionals both enquired about access to testing; 2. Presentation of evidence: medical facts presented by patients and professionals included characteristics specifically relevant to diagnosing monogenic diabetes; 3. Experiences of healthcare: patients often researched their condition online and some felt dissatisfied with routine consultations; 4. Seeking specialist advice regarding treatment: specific information was sought relating to management of neonatal diabetes or monogenic diabetes and pregnancy; 5. Searching for a cure through genetic technology: patients questioned whether genetic advances would lead to a cure for diabetes. Conclusion: This project offers the first insights into use of e-mail as a means of gaining access to a specialist monogenic team and information about genetic testing. Although providing advice via e-mail can prove complicated, particularly when received from patients under the care of other clinicians, it is an efficient means of communicating specialist knowledge. Study findings will aid development of a ,frequently asked questions' section of www.diabetesgenes.org. Copyright © 2010 FEND [source] Practice nurses' role and knowledge about diabetes management within rural and remote Australian general practicesEUROPEAN DIABETES NURSING, Issue 2 2010District Nurse, MRCNA, R Livingston RN Abstract Background: The increasing prevalence of diabetes and obesity represents a significant disease burden in Australia. Practice nurses (PNs) play an important role in diabetes education and management. Aim: To explore PNs' roles, knowledge and beliefs about diabetes education and management in rural and remote general practice in Australia. Method: Exploratory study undertaken in three phases: 1) Pilot study to test the performance of the questionnaire; 2) One-shot cross-sectional survey using self-complete questionnaires; 3) Individual interviews. Results: Ten PNs completed the pilot test; the draft questionnaire was deemed appropriate to the study purpose. Then, 65 questionnaires were distributed to PNs and 21 responded. Fourteen respondents had worked in the role <5 years, and most PNs attended diabetes education programmes in their workplace. A minority (40%) used diabetes management guidelines regularly. Most knew obesity to be the most common risk factor for diabetes but only 50% knew that glycosylated haemoglobin indicates blood glucose levels over the preceding three months. Self-reported competency to assess patients' self-care practices and medication management practices varied. Conclusion: PNs' diabetes management was self-reported; their knowledge varied and their perceived benefits of diabetes education differed from those of patients. Copyright © 2010 FEND [source] Factors affecting uptake of an education and physical activity programme for newly diagnosed type 2 diabetesEUROPEAN DIABETES NURSING, Issue 1 2008MPH Postgraduate Research Associate, S Visram BA Hons Abstract Background: Intensive lifestyle intervention involving weight reduction and moderate physical activity has been shown to help regulate, and even prevent, type 2 diabetes. Aim: This study sought to explore factors affecting uptake of an education and physical activity programme for those diagnosed with type 2 diabetes. Method: Focus group discussions were conducted with individuals who completed the programme and semi-structured interviews were conducted with those who declined the invitation to attend. Data were analysed using a thematic framework approach and key similarities and differences between the groups were identified. Results: The 11 programme participants studied appeared to have received clearer messages about the severity of unmanaged diabetes, whereas the 10 non-attenders studied felt that co-morbidities posed greater risks to their health. There were major concerns among both groups about undertaking exercise, and strategies for diabetes management focused heavily on dietary modification. Conclusion: The findings of this study suggest that fears and lack of understanding about both diabetes and exercise can act as barriers to engaging in physical activity. These findings are supported by the literature and highlight the need for more tailored programmes of lifestyle intervention for those with type 2 diabetes. Copyright © 2008 FEND [source] Resolving Disease Management Problems in European-American and Latino Couples with Type 2 Diabetes: The Effects of Ethnicity and Patient Gender,FAMILY PROCESS, Issue 4 2000Lawrence Fisher Ph.D. The management of type 2 diabetes requires major life style changes. How patients and family members resolve disagreements about disease management affects how well the disease is managed over time. Our goal was to identify differences in how couples resolved disagreements about diabetes management based on ethnicity and patient gender. We recruited 65 Latino and 110 European-American (EA) couples in which one spouse had type 2 diabetes. Couples participated in a 10-minute videotaped, revealed differences interaction task that was evaluated with 7 reliable observer ratings: warm-engagement, hostility, avoidance, amount of conflict resolution, off-task behavior, patient dominance, and dialogue. A series of 2 × 2, Ethnicity × Sex ANOVAs indicated significant effects for Ethnicity and for the Ethnicity × Sex interaction, but not for Sex. Latino couples were rated as significantly more emotionally close, less avoidant, less hostile toward each other, and had less dominant patients than EA couples; however, Latino couples achieved significantly less problem resolution and were more frequently off-task than EA couples. These findings were qualified by patient gender. The findings highlight important differences in how couples manage diabetes based on ethnicity and patient gender, and suggest that effective family-based programs of intervention must take both characteristics into account. [source] Do researchers use pharmacists' communication as an outcome measure?INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2010A scoping review of pharmacist involvement in diabetes care Abstract Objectives, Pharmacy practice increasingly revolves around obtaining and interpreting information. We investigated whether and how pharmacy practice researchers design their studies in ways that acknowledge verbal communication between pharmacists and patients with diabetes. Methods, We conducted a scoping review of pharmacists' interventions with patients previously diagnosed as having diabetes with the aim of assessing how many used communication (quality and quantity) as an outcome measure. A scoping review identifies gaps in the literature and draws conclusions regarding the overall state of a research programme, but does not necessarily identify gaps in the quality of the studies reviewed. Quality assessment, therefore, was not conducted. MEDLINE, EMBASE, the Cochrane Library and International Pharmaceutical Abstracts were searched from 2003 to 2008 to identify relevant studies published in English. Reference lists of key studies were also scanned to identify additional studies. Randomized controlled trials and related studies of pharmacists verbal communication with diabetic patients were included. Key findings, Some 413 abstracts were identified through database and reference searching. Of these, 65 studies met abstract inclusion criteria and 16 studies met full-text inclusion criteria necessary for this review. The majority of included studies report on patients' health outcomes, beliefs about drugs, self-reported health-related quality-of-life scales or some combination of these measures as indicators of pharmacists' interventions. Nine studies included information on the duration of the initial interaction between pharmacists and patients with diabetes; 13 reported on the number of follow-up contacts with pharmacists, and seven studies indicated that pharmacists participating in interventions had received training in diabetes management or in patient-centred care. No studies included or evaluated transcripts of pharmacist,patient interactions. Summary, Results reveal a gap in the existing literature. In studies of diabetes, pharmacy practice researchers do not appear to consider the influence of pharmacists' communication skills on health outcomes. Future studies should be designed to incorporate a communication research component. [source] Perceived support from healthcare practitioners among adults with type 2 diabetesJOURNAL OF ADVANCED NURSING, Issue 7 2010Bjørg Oftedal oftedal b., karlsen b. & bru e. (2010) Perceived support from healthcare practitioners among adults with type 2 diabetes. Journal of Advanced Nursing,66(7), 1500,1509. Abstract Title.,Perceived support from healthcare practitioners among adults with type 2 diabetes. Aim., This paper is a report of a study of how adults with type 2 diabetes perceive different attributes of support provided by healthcare practitioners and how various attributes of support can influence people's motivation to self-manage their disease. Background., Motivational problems seem to be a major reason for poor diabetes management. According to well-known theories of motivation, expectations of being able to perform certain behaviours are a key element. Different attributes of support from healthcare practitioners are likely to influence such expectations. To date, no researchers have specifically examined how people with type 2 diabetes perceive different attributes of support from healthcare practitioners and how these may influence their motivation to manage their disease themselves. Methods., A descriptive/explorative qualitative design and focus groups were used to collect data. The sample consisted of 19 adults with type 2 diabetes, and the data were collected in 2007 and analysed using qualitative content analysis. Findings., Five themes were identified, reflecting perceived attributes of support from healthcare practitioners: (1) an empathetic approach, (2) practical advice and information, (3) involvement in decision-making, (4) accurate and individualized information and (5) ongoing group-based support. Conclusion., Healthcare practitioners may strengthen the self-management motivation among adults with type 2 diabetes by enhancing expectations of being able to perform the necessary diabetes care, and through the provision of empathetic, individualized, practical and ongoing group-based support. [source] Chronic sorrow in parents of children with type 1 diabetesJOURNAL OF ADVANCED NURSING, Issue 5 2009Susan Bowes Abstract Title.,Chronic sorrow in parents of children with type 1 diabetes. Aim., This paper reports on a study exploring parents' longer-term experiences of having a child with type 1 diabetes. Background., Parents of children with type 1 diabetes may experience a grief reaction at diagnosis similar to that normally associated with bereavement, but little is known about their long-term emotional adaptation. Chronic sorrow, a sustained but intermittent grief reaction, is identified in adults with diabetes but has not previously been explored in relation to parents. Methodology., In-depth interviews were conducted in 2007 with a convenience sample of 17 parents of children with type 1 diabetes 7,10 years after diagnosis. Data were explored within a theoretical framework of grief, loss, adaptation, and change. Findings., Parents had adapted to the needs of diabetes management but most had not ,come to terms' with the diagnosis. They experienced a resurgence of grief at critical times during their child's development and some, particularly mothers, became upset during their interviews, even though these took place 7,10 years after their child's diagnosis. Mothers elaborated more on their emotions than fathers, but continuing feelings associated with grief, such as anger and guilt, were expressed by both fathers and mothers. Conclusion., Greater understanding of parents' long-term emotional responses and recognition that grief may never resolve in these parents may enable healthcare professionals to provide appropriate and timely support at critical times. [source] HEALTH-RELATED FUNCTIONALITY OF PHENOLIC-ENRICHED PEA SPROUTS IN RELATION TO DIABETES AND HYPERTENSION MANAGEMENTJOURNAL OF FOOD BIOCHEMISTRY, Issue 1 2008ELIZABETH BURGUIERES ABSTRACT The rationale for this investigation is that phenolic content in light-modulated pea seedlings could be enhanced by exogenous elicitors with antioxidant potential such as folic acid and vitamin C. Such phenolic-enriched extracts may have health benefits to consumers. The antioxidant-linked functional attributes of the phenolic-enriched extracts were evaluated for potential health-related benefits. Specifically, effectiveness in inhibiting ,-amylase and ,-glucosidase in relation to hyperglycemia (linked to diabetes management), as well as inhibiting angiotensin-converting enzyme I (ACE I), in relation to hypertension, was evaluated. The results show that phenolic-enriched extracts had the ability to inhibit ,-amylase and ,-glucosidase activity. On the day with the highest total phenolic content, day 8, inhibition of ,-amylase and ,-glucosidase was most prominent. Further, the same extracts showed positive benefits for potential hypertension management reflected in the inhibition of ACE I. These results taken together indicated that light-sprouted pea seedling extracts when incorporated into the diet could contribute to potential management of hyperglycemia linked to diabetes and hypertension related to cardiovascular risk. PRACTICAL APPLICATIONS In this in vitro study results show the positive effect of the different phenolic-enriched pea sprouts on hyperglycemia risk factors. It is clear that phenolic-enriched pea sprouts have high antioxidant activity, ACE 1 inhibitory activity and also good inhibitory activity on carbohydrate-modulating enzyme such as alpha-glucosidase related to glucose absorption in the intestine. The potential for managing both glucose absorption and cellular redox dysfunction for preventing postprandial hyperglycemia linked to type 2 diabetes and hyperglycemia-induced vascular complications leading to hypertension can be designed in part through food systems and therefore provides the rationale basis for further clinical studies. This strategy can be further extended to enhance phenolic-linked health benefits of a wide variety of legumes, fruits and vegetables and therefore can be the basis for food ingredient design for functional food applications. [source] INHIBITORY POTENTIAL OF WINE AND TEA AGAINST ,-AMYLASE AND ,-GLUCOSIDASE FOR MANAGEMENT OF HYPERGLYCEMIA LINKED TO TYPE 2 DIABETESJOURNAL OF FOOD BIOCHEMISTRY, Issue 1 2008YOUNG-IN KWON ABSTRACT Natural ,-amylase and ,-glucosidase inhibitors from food-grade plants offer an attractive strategy to manage postprandial hyperglycemia for type 2 diabetes management via control of starch breakdown and intestinal glucose absorption. In this study, four random sources of red and white wines as well as four types of teas were investigated for ,-amylase and ,-glucosidase inhibitory potential. Water extracts of black tea had the highest ,-glucosidase inhibitory activity, followed by white tea and oolong tea. All the randomly selected red wines had significant ,-glucosidase inhibitory activity compared to white wine. The ,-glucosidase inhibitory activity of the tea and wines correlated to the phenolic content, antioxidant activity and phenolic profile of the extracts. Further, these extracts had less or no ,-amylase inhibitory activity, indicating potential to overcome the side effects of undigested starch. This research has relevance for managing hyperglycemia and related oxidation-linked dysfunction and concurrently reducing problems of undigested starch. PRACTICAL APPLICATIONS In this study anti-diabetic-relevant potential of wines and teas were confirmed in four types of red and white wines as well as four types of commonly available teas using in vitro enzyme assays for alpha-glucosidase and alpha-amylase inhibitory activities. In vitro inhibitory activities of these enzymes provide a strong biochemical rationale for further in vivo studies and dietary management strategy for type 2 diabetes through the control of glucose absorption. Further this phenolic antioxidant-enriched dietary strategy using specific beverage combinations can generate a whole food profile that has the potential to reduce hyperglycemia-induced pathogenesis and also associated complications linked to cellular oxidation stress. [source] In Vitro,Potential of,Ascophyllum nodosum,Phenolic Antioxidant-Mediated ,-Glucosidase and ,-Amylase InhibitionJOURNAL OF FOOD SCIENCE, Issue 3 2010E. Apostolidis ABSTRACT:,Ascophyllum nodosum,is a brown seaweed that grows abundantly in the Northeast coastal region. In this study, the potential of,A. nodosum,for type 2 diabetes management through antioxidant-mediated ,-glucosidase and ,-amylase inhibition was investigated. After the initial screening of 4 locally harvested seaweeds,,A. nodosum,was chosen for its highest phenolic content and was subjected to water extraction. Among extraction ratios of 50 g to 100 to 1000 mL at room temperature, 50 g/400 mL yielded the highest phenolic content of 4.5 mg/g wet weight. For evaluation of extraction temperature ranging from 20 to 80 °C, 50 g/400 mL was chosen as a minimum amount of extractant. Among temperatures studied, extraction at 80 °C resulted in the highest total phenolic contents (4.2 mg/g wet weight). All extracts had similar levels of antioxidant activity in the range of 60% to 70% in terms of 1, 1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging activity. The 80 °C extract had the highest ,-glucosidase and ,-amylase inhibitory activity with IC50 of 0.24 and 1.34 ,g phenolics, respectively, compared to the IC50 of acarbose, reference inhibitor, being 0.37 and 0.68 ,g. The results show that fresh,A. nodosum,has strong ,-glucosidase and mild ,-amylase inhibitory activities that correlated with phenolic contents. This study suggests a nutraceutical potential of,A. nodosum,based on phytochemical antioxidant and antihyperglycemia activities. [source] Burns to persons suffering from diabetes: a systemic preventive approachJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2009MScN (edu), Ma'en Zaid Abu-Qamar Dnurs Aims. To report the findings of an investigation of patients with diabetes and burns, with emphasis on implications for practice: primary and secondary preventions. Background. Diabetes and burns are complex conditions with multi-system involvements, which worsen outcomes for patients, and their management. This research investigated outcomes for patients and diabetes management. Methods. Data on outcomes were obtained from records of patients hospitalised for foot burns in an Australian hospital from 1999,2004. A questionnaire survey design was employed to obtain information on how clinicians in burns units manage diabetes. SPSS was used to analyse data obtained from both resources. Comments written in the questionnaire were analysed using relational analysis. Results. Of the 64 patients, 12 were with diabetes and 52 were without diabetes. Those with diabetes were more likely to sustain contact foot burns (58·3% Diabetes Mellitus vs. 13·5% non Diabetes Mellitus ,2 = 11·487, p = 0·002). The duration of hospitalisation was statistically significantly longer among patients with diabetes compared with those without diabetes (U = 169, p = 0·014); although the two groups were not statistically significant different in terms of severity of burns and received treatment. Of the 29 clinical leaders, 21 (72%) indicated that they regularly provided care to patients with diabetes. Most respondents (n = 15; 58%) reported that new plans need to be initiated to accommodate the combined insult of diabetes and burns. Diabetes centres were located in all participating sites; but not always involved in the process of care. Conclusion. The co-existence of diabetes and burns worsens outcomes for patients, and complicates management plans. Optimal management can be achieved via a multidisciplinary approach starting with glycaemic control, and continued to aggressive management of diabetes and burns. Relevance to clinical practice. Preventive measures should start with tight glycaemic control, identification and avoidance of sources of trauma, early detection and treatment, and continue to aggressive inpatient management of patients with both diabetes and a burn injury. [source] School nurse perceptions of barriers and supports for children with diabetesJOURNAL OF SCHOOL HEALTH, Issue 4 2005Laura Nabors These youth often do not receive the support needed to manage their diabetes during or after school. Nurses (n = 110) from 3 states responded to a survey examining perceptions of barriers to and supports for diabetes management during school and after school activities. Results indicated that adolescents need more support at school. Support could be facilitated by education of school staff; improved communication among youth, parents, school nurses, teachers, and physicians; and more communication from adolescents to others about what they need to manage well in school. Open-ended questions allowed nurses to provide recommendations for supporting youth and ideas for addressing barriers to management at school. Future studies should address ways to enable adolescents to communicate about their diabetes and ways to educate the school team. (J Sch Health. 2005;75(4):119-124) [source] Medicinal plant species with potential antidiabetic propertiesJOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 5 2007Srinivasa Rao Mentreddy Abstract Diabetes mellitus is one of the world's major diseases. It currently affects an estimated 143 million people worldwide and the number is growing rapidly. In the USA alone, about 20.8 million or 7% of the population suffer from diabetes or related complications. The estimated direct and indirect costs of diabetes exceed US$ 132 billion annually. Plant-based medicinal products have been known since ancient times, and several medicinal plants and their products (active natural principles and crude extracts) have been used to control diabetes in the traditional medicinal systems of many cultures worldwide, including those of the Asian Indians, Chinese and South Americans. A limited number of these plant species have been studied and validated for their hypoglycaemic properties using diabetic animal models and in clinical studies using human subjects. Several oral hypoglycaemic agents are the primary forms of treatment for diabetes. However, prominent side-effects of such drugs are the main reason for an increasing number of people seeking alternative therapies that may have less severe or no side-effects. Thus plant-based herbal drugs or botanicals are emerging as the primary components of holistic approaches to diabetes management. In this review, selected species that have been validated for their hypoglycaemic or antihyperglycaemic properties using laboratory diabetic animal models and in clinical trials using human subjects, and reported in refereed journals are presented. Copyright © 2007 Society of Chemical Industry [source] "Actually, I Don't Feel That Bad": Managing Diabetes and the Clinical EncounterMEDICAL ANTHROPOLOGY QUARTERLY, Issue 1 2000Steve Ferzacca A major issue for persons treating and managing adult-onset diabetes (NIDDM) is the "problem of compliance." I consider the clinical encounter in the overall context of diabetes management as a punctuated experience focused on the cultivation of an ideal self whose "technologies" and "ethics of self-care" mimic a capitalist logic that links self-discipline, productivity, and health. Both clinicians and their patients share and identify with many of the cultural referents and social values that circulate through medical advice and practice. However, using individual examples, I show how this shared logic can produce idiosyncratic regimes of self-care and clinical practice that result in hybrid medical practices incorporating differing objectives and emphases concerned with a tolerable present or an ideal future. Rather than organizing principles for research and medical practice, I suggest that medical compliance and noncompliance should be considered part of the rhetoric to be explained within the regimes of a pursuit of health. [NIDDM, the clinical encounter, cultivations of self, hybridity] [source] | |||||||||||||||||||||||||||||||