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Sample records for diabetes management system

  1. A wireless diabetes management and communication system.

    PubMed

    Vigersky, Robert A; Hanson, Eric; McDonough, Edward; Rapp, Timothy; Pajak, John; Galen, Robert S

    2003-01-01

    Current diabetes management requires the collection of a large volume of data by the patient for analysis by his or her provider. There are numerous practical and technical barriers to doing this effectively and efficiently. In addition, the calculation of the correct insulin dose is complex because it requires considering anticipated carbohydrate consumption and exercise in addition to the current blood glucose level. A Diabetes Management and Communication System (DMCS) has been developed using a Compaq iPAQ Pocket PC with a Sprint PCS wireless AirCard. This system circumvents the problem of multiple proprietary programs for each brand of meter and permits the accurate determination of the proper insulin dose. Privacy is maintained by using only the iPAQ serial number as the patient identifier with access to the website protected by unique patient and provider passwords. The iPAQ was programmed with formulas that included: insulin sensitivity factor, current glucose level, amount of carbohydrates, appropriate carbohydrate:insulin ratio for that meal, and duration/intensity of exercise. Once the information is entered, an insulin dose is calculated, although an alternative dose can be selected. The data are downloaded to http://www.HealthSentry.net, where they are displayed in both tabular and graphic form. The patient may view the glucose data in both tabular and graphic form on the iPAQ. Thus a DMCS has been developed to assist patients and providers in improving glycemic control. A proof-of-concept study is underway to determine the effectiveness of the DMCS in patients with Type 1 diabetes mellitus who are currently using insulin pumps. PMID:14511424

  2. Complication Reducing Effect of the Information Technology-Based Diabetes Management System on Subjects with Type 2 Diabetes

    PubMed Central

    Cho, Jae-Hyoung; Lee, Jin-Hee; Oh, Jeong-Ah; Kang, Mi-Ja; Choi, Yoon-Hee; Kwon, Hyuk-Sang; Chang, Sang-Ah; Cha, Bong-Yun; Son, Ho-Young; Yoon, Kun-Ho

    2008-01-01

    Objective We introduced a new information technology-based diabetes management system, called the Internet-based glucose monitoring system (IBGMS), and demonstrated its short-term and long-term favorable effects. However, there has been no report on clinical effects of such a new diabetes management system on the development of diabetic complications so far. This study was used to simulate the complication reducing effect of the IBGMS, given in addition to existing treatments in patients with type 2 diabetes. Research Design and Methods The CORE Diabetes Model, a peer-reviewed, published, validated computer simulation model, was used to project long-term clinical outcomes in type 2 diabetes patients receiving the IBGMS in addition to their existing treatment. The model combined standard Markov submodels to simulate the incidence and progression of diabetes-related complications. Results The addition of IBGMS was associated with improvements in reducing diabetic complications, mainly microangiopathic complications, including diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and diabetic foot ulcer. The IBGMS also delayed the development of all diabetic complications for more than 1 year. Conclusions This study demonstrated that the simulated IBGMS, compared to existing treatment, was associated with a reduction of diabetic complications. As a result, it provides valuable evidence for practical application to the public in the world. PMID:19885180

  3. Help Teens Manage Diabetes

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues Help Teens Manage Diabetes Past Issues / Spring 2008 Table of ... diabetes management. Its aim is to improve diabetic teens' coping and communication skills, healthy behaviors, and conflict ...

  4. New trends in diabetes management: mobile telemedicine closed-loop system.

    PubMed

    Hernando, M Elena; Gómez, Enrique J; Gili, Antonio; Gómez, Mónica; García, Gema; del Pozo, Francisco

    2004-01-01

    The rapid growth and development of information technologies over recent years, in the areas of mobile and wireless technologies is shaping a new technological scenario of telemedicine in diabetes. This telemedicine scenario can play an important role for further acceptance by diabetic patients of the existing continuous glucose monitoring systems and insulin pumps with the final goal of improving current therapeutic procedures. This paper describes a Personal Smart Assistant integrated in a multi-access telemedicine architecture for the implementation of a mobile telemedicine closed-loop system for diabetes management. The system is being evaluated within the European Union project named INCA ("Intelligent Control Assistant for Diabetes"). PMID:15718596

  5. Diabetes update: population management.

    PubMed

    Erlich, Deborah R; Slawson, David C; Shaughnessy, Allen

    2013-05-01

    To optimally care for diabetes patients, physicians must adopt a systematic approach to managing the entire panel. At the heart of excellent care is a multidisciplinary health care team working in a patient-centered environment. Options to supplement traditional office visits include shared medical appointments (ie, group visits), patient self-management education, and social media for patient support and education. Educating patients about diabetes is associated with more frequent recommended screening, improved objective measures, cost savings, and improved short-term quality of life, especially when behavioral goal setting is incorporated. Participation in a nurse-led diabetes management program or an outreach program is associated with reduced health care costs and increased receipt of recommended screening and testing for patients with diabetes; implementation of an electronic database or registry system also is associated with these benefits. Some studies show that these interventions are associated with improvements in A1c; however, outcomes data are limited. Formats for group visits vary. Evidence suggests that patients with diabetes who participate in a group education program have lower A1c levels, improved lipid profiles, higher quality of life scores, and improved knowledge about diabetes and problem-solving ability. PMID:23690376

  6. Help Teens Manage Diabetes

    MedlinePlus

    ... Training (CST) as a part of routine diabetes management. Its aim is to improve diabetic teens' coping and communication skills, healthy behaviors, and conflict resolution. The CST training helps diabetic teens to make good decisions when it comes to managing food choices, making ...

  7. Lessons from implementing a combined workflow-informatics system for diabetes management.

    PubMed

    Zai, Adrian H; Grant, Richard W; Estey, Greg; Lester, William T; Andrews, Carl T; Yee, Ronnie; Mort, Elizabeth; Chueh, Henry C

    2008-01-01

    Shortcomings surrounding the care of patients with diabetes have been attributed largely to a fragmented, disorganized, and duplicative health care system that focuses more on acute conditions and complications than on managing chronic disease. To address these shortcomings, we developed a diabetes registry population management application to change the way our staff manages patients with diabetes. Use of this new application has helped us coordinate the responsibilities for intervening and monitoring patients in the registry among different users. Our experiences using this combined workflow-informatics intervention system suggest that integrating a chronic disease registry into clinical workflow for the treatment of chronic conditions creates a useful and efficient tool for managing disease. PMID:18436907

  8. A Web-based system for the intelligent management of diabetic patients.

    PubMed

    Riva, A; Bellazzi, R; Stefanelli, M

    1997-01-01

    We describe the design and implementation of a distributed computer-based system for the management of insulin-dependent diabetes mellitus. The goal of the system is to support the normal activities of the physicians and patients involved in the care of diabetes by providing them with a set of automated services ranging from data collection and transmission to data analysis and decision support. The system is highly integrated with current practices in the management of diabetes, and it uses Internet technology to achieve high availability and ease of use. In particular, the user interaction takes place through dynamically generated World Wide Web pages, so that all the system's functions share an intuitive graphic user interface. PMID:9308344

  9. Management of Diabetic Neuropathy

    PubMed Central

    Ali, Raymond Azman

    2003-01-01

    Diabetes mellitus is the commonest cause of neuropathy worldwide. Diabetic neuropathy (DN) develops in about 4–10% of diabetic patients after 5 years and in 15% after 20 years. Four main mechanisms have been postulated to underlie the pathogenesis of DN. Diabetic neuropathy can be divided into symmetrical and asymmetrical neuropathies. Diabetic Autonomic Neuropathy (DAN) parallels the severity of DSN, and affects primarily the cardiovascular, gastrointestinal, genitourinary and integumentary systems. The cornerstone of treatment of diabetic neuropathy is optimization of glycaemic control. Future treatments for diabetic neuropathy should address the underlying pathogenesis. PMID:23386794

  10. Postpartum management of diabetes pregnancy.

    PubMed

    Hossain, Nazli

    2016-09-01

    Diabetes mellitus has assumed the role of an epidemic. Previously considered a disease of affluent developed countries, it has become more common in developing countries. Pakistan is included among the countries with a high prevalence of diabetes. In this scenario, postpartum management of a woman with diabetes mellitus becomes more important as in this period counseling and educating a woman is essential. Counselling includes life style modifications to prevent future risks involving all the systems of the body. This review article discusses management of diabetes mellitus in postpartum period, guidelines for postpartum screening of women with gestational diabetes mellitus, risks involved in future life and stresses upon the need of local population based studies. Primary care providers and gynaecologists must realize the importance of postpartum screening for diabetes mellitus and provide relevant information to women as well. PMID:27582163

  11. Performance assessment of a closed-loop system for diabetes management.

    PubMed

    Martinez-Millana, A; Fico, G; Fernández-Llatas, C; Traver, V

    2015-12-01

    Telemedicine systems can play an important role in the management of diabetes, a chronic condition that is increasing worldwide. Evaluations on the consistency of information across these systems and on their performance in a real situation are still missing. This paper presents a remote monitoring system for diabetes management based on physiological sensors, mobile technologies and patient/doctor applications over a service-oriented architecture that has been evaluated in an international trial (83,905 operation records). The proposed system integrates three types of running environments and data engines in a single service-oriented architecture. This feature is used to assess key performance indicators comparing them with other type of architectures. Data sustainability across the applications has been evaluated showing better outcomes for full integrated sensors. At the same time, runtime performance of clients has been assessed spotting no differences regarding the operative environment. PMID:25667016

  12. Ubiquitous Diabetes Management System via Interactive Communication Based on Information Technologies: Clinical Effects and Perspectives

    PubMed Central

    Cho, Jae-Hyoung; Kim, Hun-Sung; Han, Jae-Hoon; Lee, Jin-Hee; Oh, Jeong-Ah; Choi, Yoon-Hee

    2010-01-01

    New diabetes management systems based on interactive communication have been introduced recently, accompanying rapid advances in information technology; these systems are referred to as "ubiquitous diabetes management systems." In such ubiquitous systems, patients and medical teams can communicate via Internet or telecommunications, with patients uploading their glucose data and personal information, and medical teams sending optimal feedback. Clinical evidence from both long-term and short-term trials has been reported by some researchers. Such systems appear to be effective not only in reducing the levels of HbA1c but also in stabilizing glucose control. However, most notably, evidence for the cost-effectiveness of such a system should be demonstrated before it can be propagated out to the general population in actual clinical practice. To establish a cost-effective model, various types of clinical decision supporting software designed to reduce the labor time of physicians must first be developed. A number of sensors and devices for monitoring patients' data are expected to be available in the near future; thus, methods for automatic interconnections between devices and web charts were also developed. Further investigations to demonstrate the clinical outcomes of such a system should be conducted, hopefully leading to a new paradigm of diabetes management. PMID:21076573

  13. Managing hyperglycemia and diabetes in patients receiving enteral feedings: A health system approach.

    PubMed

    Mabrey, Melanie E; Barton, Anna Beth; Corsino, Leonor; Freeman, Susan B; Davis, Ellen D; Bell, Elizabeth L; Setji, Tracy L

    2015-01-01

    Evidence of poor outcomes in hospitalized patients with hyperglycemia has led to new and revised guidelines for inpatient management of diabetes. As providers become more aware of the need for better blood glucose control, they are finding limited guidance in the management of patients receiving enteral nutrition. To address the lack of guidelines in this population, Duke University Health System has developed a consistent practice for managing such patients. Here, we present our practice strategies for insulin use in patients receiving enteral nutrition. Essential factors include assessing the patients' history of diabetes, hyperglycemia, or hypoglycemia and timing and type of feedings. Insulin practices are then designed to address these issues keeping in mind patient safety in the event of abrupt cessation of nutrition. The outcome of the process is a consistent and safe method for glucose control with enteral nutrition. PMID:25744356

  14. Developing Framework for Agent- Based Diabetes Disease Management System: User Perspective

    PubMed Central

    Mohammadzadeh, Niloofar; Safdari, Reza; Rahimi, Azin

    2014-01-01

    Background: One of the characteristics of agents is mobility which makes them very suitable for remote electronic health and tele medicine. The aim of this study is developing a framework for agent based diabetes information management at national level through identifying required agents. Methods: The main tool is a questioner that is designed in three sections based on studying library resources, performance of major organizations in the field of diabetes in and out of the country and interviews with experts in the medical, health information management and software fields. Questionnaires based on Delphi methods were distributed among 20 experts. In order to design and identify agents required in health information management for the prevention and appropriate and rapid treatment of diabetes, the results were analyzed using SPSS 17 and Results were plotted with FREEPLANE mind map software. Results: Access to data technology in proposed framework in order of priority is: mobile (mean 1/80), SMS, EMAIL (mean 2/80), internet, web (mean 3/30), phone (mean 3/60), WIFI (mean 4/60). Conclusions: In delivering health care to diabetic patients, considering social and human aspects is essential. Having a systematic view for implementation of agent systems and paying attention to all aspects such as feedbacks, user acceptance, budget, motivation, hierarchy, useful standards, affordability of individuals, identifying barriers and opportunities and so on, are necessary. PMID:24757407

  15. Computerized Automated Reminder Diabetes System (CARDS): E-Mail and SMS Cell Phone Text Messaging Reminders to Support Diabetes Management

    PubMed Central

    Hanauer, David A.; Wentzell, Katherine; Laffel, Nikki

    2009-01-01

    Abstract Background: Cell phone text messaging, via the Short Messaging Service (SMS), offers the promise of a highly portable, well-accepted, and inexpensive modality for engaging youth and young adults in the management of their diabetes. This pilot and feasibility study compared two-way SMS cell phone messaging with e-mail reminders that were directed at encouraging blood glucose (BG) monitoring. Methods: Forty insulin-treated adolescents and young adults with diabetes were randomized to receive electronic reminders to check their BG levels via cell phone text messaging or e-mail reminders for a 3-month pilot study. Electronic messages were automatically generated, and participant replies with BG results were processed by the locally developed Computerized Automated Reminder Diabetes System (CARDS). Participants set their schedule for reminders on the secure CARDS website where they could also enter and review BG data. Results: Of the 40 participants, 22 were randomized to receive cell phone text message reminders and 18 to receive e-mail reminders; 18 in the cell phone group and 11 in the e-mail group used the system. Compared to the e-mail group, users in the cell phone group received more reminders (180.4 vs. 106.6 per user) and responded with BG results significantly more often (30.0 vs. 6.9 per user, P=0.04). During the first month cell phone users submitted twice as many BGs as e-mail users (27.2 vs. 13.8 per user); by month 3, usage waned. Conclusions: Cell phone text messaging to promote BG monitoring is a viable and acceptable option in adolescents and young adults with diabetes. However, maintaining interest levels for prolonged intervals remains a challenge. PMID:19848576

  16. Clinical Evaluation of OneTouch Diabetes Management Software System in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Kim, Jung Min; Lee, Hey Jean; Kim, Keum Ok; Won, Jong Chul; Rhee, Byung Doo

    2016-01-01

    Background OneTouch Diabetes Management Software (OTDMS) is an efficient way to track and monitor the blood glucose level. It is possible to download data from the OneTouch Ultra via the meter's data port, and to transform the numbers of the blood glucose level into a graph, a chart, or statistics. The objectives of this study were to evaluate whether the use of OTDMS in consultation hours would improve patients' knowledge of diabetes mellitus (DM), compliance, satisfaction with doctor and medical treatment, doctor-patient reliability, and glucose control. Methods All patients were randomized into either the OTDMS group using OneTouch Ultra or the control groups not using it. Both groups had conventional DM education and only the OTDMS group used data from OTDMS as explanation materials during consultation hours. At enrollment and after 6 months, we performed a questionnaire survey consisting of the diabetes knowledge test, items for compliance of treatment, patient's satisfaction, doctor-patient reliability, and glycosylated hemoglobin (HbA1c). Results We analyzed 6-month follow-up data from 92 patients (OTDMS 42 vs. control 50). Both groups showed significant improvements in HbA1c, diabetes knowledge, compliance, reliability, and satisfaction after 6 months. However, there were no significant differences between OTDMS and control groups overall. Only "weekly frequency of checking blood glucose level" of compliance and "trying to follow doctor's order" of reliability showed better results in the OTDMS group. Conclusion Using the OTDMS system for explanation during consultation hours seems to be more helpful to improve patient's compliance and reliability, especially for checking blood glucose level and trying to follow the doctor's order. PMID:27126883

  17. An ICT-Based Diabetes Management System Tested for Health Care Delivery in the African Context

    PubMed Central

    Takenga, Claude; Berndt, Rolf-Dietrich; Musongya, Olivier; Kitero, Joël; Katoke, Remi; Molo, Kakule; Kazingufu, Basile; Meni, Malikwisha; Vikandy, Mambo; Takenga, Henri

    2014-01-01

    The demand for new healthcare services is growing rapidly. Improving accessibility of the African population to diabetes care seems to be a big challenge in most countries where the number of care centers and medical staff is reduced. Information and communication technologies (ICT) have great potential to address some of these challenges faced by several countries in providing accessible, cost-effective, and high-quality health care services. This paper presents the Mobil Diab system which is a telemedical approach proposed for the management of long-term diseases. The system applies modern mobile and web technologies which overcome geographical barriers, and increase access to health care services. The idea of the system is to involve patients in the therapy process and motivate them for an active participation. For validation of the system in African context, a trial was conducted in the Democratic Republic of Congo. 40 Subjects with diabetes divided randomly into control and intervention groups were included in the test. Results show that Mobil Diab is suitable for African countries and presents a number of benefits for the population and public health care system. It improves clinical management and delivery of diabetes care services by enhancing access, quality, motivation, reassurance, efficiency, and cost-effectiveness. PMID:25136358

  18. Diabetes Device Interoperability for Improved Diabetes Management

    PubMed Central

    Silk, Alain D.

    2015-01-01

    Scientific and technological advancements have led to the increasing availability and use of sophisticated devices for diabetes management, with corresponding improvements in public health. These devices are often capable of sharing data with a few other specific devices but are generally not broadly interoperable; they cannot work together with a wide variety of other devices. As a result of limited interoperability, benefits of modern diabetes devices and potential for development of innovative new diabetes technologies are not being fully realized. Here we discuss diabetes device interoperability in general, then focus on 4 examples that show how diabetes management could benefit from enhanced interoperability: remote monitoring and data sharing, integrating data from multiple devices to better inform diabetes management strategies, device consolidation, and artificial pancreas development. PMID:26178738

  19. Web-Based Remote Monitoring Systems for Self-Managing Type 2 Diabetes: A Systematic Review.

    PubMed

    Mushcab, Hayat; Kernohan, W George; Wallace, Jonathan; Martin, Suzanne

    2015-07-01

    This systematic review aims to evaluate evidence for viability and impact of Web-based telemonitoring for managing type 2 diabetes mellitus. A review protocol included searching Medline, EMBASE, CINAHL, AMED, the Cochrane Library, and PubMed using the following terms: telemonitoring, type 2 diabetes mellitus, self-management, and web-based Internet solutions. The technology used, trial design, quality of life measures, and the glycated hemoglobin (HbA1c) levels were extracted. This review identified 426 publications; of these, 19 met preset inclusion criteria. Ten quasi-experimental research designs were found, of which seven were pre-posttest studies, two were cohort studies, and one was an interrupted time-series study; in addition, there were nine randomized controlled trials. Web-based remote monitoring from home to hospital is a viable approach for healthcare delivery and enhances patients' quality of life. Six of these studies were conducted in South Korea, five in the United States, three in the United Kingdom, two in Taiwan, and one each in Spain, Poland, and India. The duration of the studies varied from 4 weeks to 18 months, and the participants were all adults. Fifteen studies showed positive improvement in HbA1c levels. One study showed high acceptance of the technology among participants. It remains challenging to identify clear evidence of effectiveness in the rapidly changing area of remote monitoring in diabetes care. Both the technology and its implementations are complex. The optimal design of a telemedicine system is still uncertain, and the value of the real-time blood glucose transmissions is still controversial. PMID:25830528

  20. Support systems for and barriers to diabetes management in South Asians and Whites in the UK: qualitative study of patients’ perspectives

    PubMed Central

    Singh, Harsimran; Cinnirella, Marco; Bradley, Clare

    2012-01-01

    Objectives To explore experiences of UK-based South Asian and White patients with diabetes in relation to their support systems for and barriers to diabetes management. Design Qualitative study (semistructured interviews analysed using a form of Interpretative Phenomenological Analysis). Participants 20 outpatients with diabetes (12 British South Asians and 8 British Whites) with either good or poor glycaemic control. Setting Hillingdon Hospital, Uxbridge, UK. Results Qualitative analysis revealed distinct themes for the two ethnic groups. For the South Asian participants, challenges surrounding diet management and social stigma attached to having diabetes were the two predominant barriers to effective diabetes management. Support from immediate family members was commonly reported as a strong support system for optimising diabetes management by the South Asian sample in addition to the perceived positive impact of religion (healing power of prayer), the valuable informational support from their diabetes-care team, patient leaflets and diabetes magazines. Similar to the South Asians, adhering to dietary recommendations was the most difficult aspect of diabetes management for the White participants followed by the inconveniences surrounding injecting insulin. The hospital diabetes-care team was considered as the most effective support system for diabetes management by the White sample and interestingly, this was the only dominant theme in their reported sources of support. Conclusions Both South Asian and White participants emphasised adherence to dietary recommendations as the most difficult aspect of living with diabetes. In addition, social stigma attached to diabetes was a prominent concern among South Asian participants that seemed to have a significant negative impact on their diabetes control and overall management. Given South Asian patients’ reliance on their family for the management of their condition, interventions targeting improved diabetes outcomes

  1. Performance of an Electronic Diary System for Intensive Insulin Management in Global Diabetes Clinical Trials

    PubMed Central

    Zhang, Shuyu; Mou, Jiani; Hackett, Andy P.; Raymond, Stephen A.; Chang, Annette M.

    2015-01-01

    Abstract Background: This report describes the performance of a wireless electronic diary (e-diary) system for data collection and enhanced patient–investigator interactions during intensive insulin management in diabetes clinical trials. Materials and Methods: We implemented a customized electronic communication system featuring an e-diary and a Web portal in three global, randomized, controlled Phase 3 clinical trials testing basal insulin peglispro compared with insulin glargine, both combined with prandial insulin lispro, in patients with type 1 or type 2 diabetes mellitus (T1DM and T2DM, respectively). We collected data during 28 weeks of study e-diary use for the report. Results: Patients (n=2,938) in 31 countries used e-diaries to transmit 2,439,087 blood glucose (BG) values, 96% of which were associated by the patient with a protocol time point during the 72-h response window. Of 208,192 hypoglycemia events captured, 96% had a BG value, and 95% had treatments and outcomes entered by patients within the 72-h window. Patients recorded administration of 1,964,477 insulin doses; 93% of basal insulin doses were adherent with the investigator prescription. Investigators adjusted 13 basal and 92 bolus insulin prescriptions per patient-year using the e-diary system. After 26 weeks of treatment and e-diary use in the combined study arms, hemoglobin A1c values decreased by 0.6% or 1.6% and fasting BG decreased by 7.8 or 28 mg/dL in patients with T1DM or T2DM, respectively. Conclusions: The e-diary system enabled comprehensive data collection and facilitated communication between investigators and patients for intensive insulin management in three global clinical trials testing basal insulins. PMID:25826466

  2. Does tight control of systemic factors help in the management of diabetic retinopathy?

    PubMed Central

    Rajalakshmi, Ramachandran; Prathiba, Vijayaraghavan; Mohan, Viswanathan

    2016-01-01

    Diabetic retinopathy (DR), one of the leading causes of preventable blindness, is associated with many systemic factors that contribute to the development and progression of this microvascular complication of diabetes. While the duration of diabetes is the major risk factor for the development of DR, the main modifiable systemic risk factors for development and progression of DR are hyperglycemia, hypertension, and dyslipidemia. This review article looks at the evidence that control of these systemic factors has significant benefits in delaying the onset and progression of DR. PMID:26953026

  3. Gastroretentive systems - a proposed strategy to modulate anthocyanin release and absorption for the management of diabetes.

    PubMed

    Celli, Giovana Bonat; Kalt, Wilhelmina; Brooks, Marianne Su-Ling

    2016-07-01

    Several reports have indicated a positive correlation between the consumption of anthocyanins (ACN) and biomarkers relating to the improvement of type 2 diabetes (T2D). However, the results from in vitro studies often do not translate into clinical evidence. Potential causes of these discrepancies are experimental conditions that lack physiological relevancy; extensive degradation of these compounds in vivo due to changes in pH and metabolism; and a short residence time in the absorption window in relation to the absorption rate. Here, gastroretentive systems (GRS) are proposed as a strategy to overcome the limitations in ACN delivery and to reduce the existing bench-to-subject gap. This review summarizes recent literature on the use of ACN for the management and control of T2D, followed by GRS platforms to promote a sustained release of ACN for increased health benefits. PMID:26873039

  4. Incretin manipulation in diabetes management

    PubMed Central

    Pappachan, Joseph M; Raveendran, AV; Sriraman, Rajagopalan

    2015-01-01

    Incretin-based therapies have revolutionized the medical management of type 2 diabetes mellitus (T2DM) in the 21st century. Glucagon-like peptide-1 (GLP-1) suppresses appetite and gastric motility, and has trophic effects on pancreas, cardio-protective and renal effects. GLP-1 analogues and dipeptidyl peptidase-4 inhibitors form the incretin-based therapies. Significant reduction of hemoglobin A1c when used as monotherapy and in combination regimens, favorable effects on body weight, and low risk of hypoglycemia are their unique therapeutic benefits. Their safety and tolerability are comparable to other anti-diabetic medications. Concern about elevated risk of pancreatitis has been discarded by two recent meta-analyses. This article discusses the therapeutic manipulation of incretin system for the management of T2DM. PMID:26131320

  5. Incretin manipulation in diabetes management.

    PubMed

    Pappachan, Joseph M; Raveendran, A V; Sriraman, Rajagopalan

    2015-06-25

    Incretin-based therapies have revolutionized the medical management of type 2 diabetes mellitus (T2DM) in the 21(st) century. Glucagon-like peptide-1 (GLP-1) suppresses appetite and gastric motility, and has trophic effects on pancreas, cardio-protective and renal effects. GLP-1 analogues and dipeptidyl peptidase-4 inhibitors form the incretin-based therapies. Significant reduction of hemoglobin A1c when used as monotherapy and in combination regimens, favorable effects on body weight, and low risk of hypoglycemia are their unique therapeutic benefits. Their safety and tolerability are comparable to other anti-diabetic medications. Concern about elevated risk of pancreatitis has been discarded by two recent meta-analyses. This article discusses the therapeutic manipulation of incretin system for the management of T2DM. PMID:26131320

  6. Psychosocial Predictors of Diabetes Management

    ERIC Educational Resources Information Center

    DePalma, Mary T.; Rollison, Julia; Camporese, Matthew

    2011-01-01

    Objective: To investigate whether a perception of responsibility for disease onset and self-blame might influence disease management in people with diabetes. Methods: Our survey assessed perceived responsibility for disease onset, self-blame, anger, social support, and disease management in a sample of 46 individuals with diabetes. Results: As…

  7. Improving diabetes population management efficiency with an informatics solution.

    PubMed

    Zai, Adrian; Grant, Richard; Andrews, Carl; Yee, Ronnie; Chueh, Henry

    2007-01-01

    Despite intensive resource use for diabetes management in the U.S., our care continues to fall short of evidence-based goals, partly due to system inefficiencies. Diabetes registries are increasingly being utilized as a critical tool for population level disease management by providing real-time data. Since the successful adoption of a diabetes registry depends on how well it integrates with disease management workflows, we optimized our current diabetes management workflow and designed our registry application around it. PMID:18694264

  8. Management of diabetic renal disease

    PubMed Central

    Eboh, Cecil

    2015-01-01

    Diabetic nephropathy is the leading cause of end stage renal failure (ESRF) worldwide, representing over 50% of patients on renal replacement therapy in some parts of the world. The condition is common in people with type 1 and type 2 diabetes, although the incidence appears to be declining, especially in type 1 diabetes. More than 1 in 3 people with type 2 diabetes have impaired kidney function. Advances in our understanding of the pathogenesis and natural history of the condition have enabled us to consider earlier therapy aimed at renal preservation and reduction in cardiovascular morbidity. Microalbuminuria is now established as the earliest risk marker for nephropathy in type 1 diabetes and cardiovascular disease in type 2 diabetes. This review examines the current concepts in the pathogenesis and management of diabetic nephropathy. PMID:26244141

  9. Managing diabetes in dialysis patients.

    PubMed

    O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A

    2012-03-01

    Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with

  10. Management of pancreatogenic diabetes: challenges and solutions.

    PubMed

    Makuc, Jana

    2016-01-01

    Pancreatogenic diabetes is an underdiagnosed form of secondary diabetes that is lacking official management guidelines. This paper reviews the recommended management strategies with additional data on the promising novel drugs. PMID:27601927

  11. Management of pancreatogenic diabetes: challenges and solutions

    PubMed Central

    Makuc, Jana

    2016-01-01

    Pancreatogenic diabetes is an underdiagnosed form of secondary diabetes that is lacking official management guidelines. This paper reviews the recommended management strategies with additional data on the promising novel drugs. PMID:27601927

  12. The management of gestational diabetes

    PubMed Central

    Cheung, N Wah

    2009-01-01

    The incidence of gestational diabetes is increasing. As gestational diabetes is associated with adverse pregnancy outcomes, and has long-term implications for both mother and child, it is important that it is recognized and appropriately managed. This review will examine the pharmacological options for the management of gestational diabetes, as well as the evidence for blood glucose monitoring, dietary and exercise therapy. The medical management of gestational diabetes is still evolving, and recent randomized controlled trials have added considerably to our knowledge in this area. As insulin therapy is effective and safe, it is considered the gold standard of pharmacotherapy for gestational diabetes, against which other treatments have been compared. The current experience is that the short acting insulin analogs lispro and aspart are safe, but there are only limited data to support the use of long acting insulin analogs. There are randomized controlled trials which have demonstrated efficacy of the oral agents glyburide and metformin. Whilst short-term data have not demonstrated adverse effects of glyburide and metformin on the fetus, and they are increasingly being used in pregnancy, there remain long-term concerns regarding their potential for harm. PMID:19436673

  13. Management of ischemic diabetic foot.

    PubMed

    Caravaggi, C; Ferraresi, R; Bassetti, M; Sganzaroli, A B; Galenda, P; Fattori, S; De Prisco, R; Simonetti, D; Bona, F

    2013-12-01

    Diabetic foot pathology represent the more disabling complication of diabetes. More the 1 million of diabetes patients undergo a lower limb amputation per year; 85% of these amputation are preceded by un ulcer that can be avoided by a prevention program. Critical limb ischemia (CLI), the only independent cause of major amputation in diabetic population, can be correctly treated when an early diagnosis is made. Both endoluminal and surgical revascularization procedures can be applied in diabetes with high rate of success when performed by skilled operator. Infection of diabetic foot, in particular in patients suffering from peripheral artery disease (PVD), may rapidly evolves in severe local or systemic infection putting the patient at high risk of major amputation or death. Together with an early diagnosis of infection and ischemia it is mandatory to apply a correct medical and surgical treatment protocol with the aim to control infection and to improve blood perfusion to the foot. In case of infection surgical procedure should be applied first while revascularization procedure will follow soonest. Antibiotic therapy should be chosen considering different local biological pattern and different type of infection. Reconstructive surgery, the last step in treatment of any diabetic foot lesion, must obtain a functional residual foot or a stump that will allow the patient to go back walking soonest with residual good walking capacity. PMID:24126511

  14. Common crossroads in diabetes management

    PubMed Central

    Valitutto, Michael

    2008-01-01

    The prevalence and impact of type 2 diabetes are reaching epidemic proportions in the United States. Data suggest that effective management can reduce the risk for both microvascular and macrovascular complications of diabetes. In treating patients with diabetes, physicians must be prepared not only to tailor the initial treatment to the individual and his or her disease severity but also to advance treatment as necessary and in step with disease progression. The majority of patients with diabetes are not at goal for glycated hemoglobin A1C, fasting plasma glucose, or postprandial plasma glucose levels. Although lifestyle changes based on improved diet and exercise practices are basic elements of therapy at every stage, pharmacologic therapy is usually necessary to achieve and maintain glycemic control. Oral antidiabetic agents may be effective early in the disease but, eventually, they are unable to compensate as the disease progresses. For patients unable to achieve glycemic control on 2 oral agents, current guidelines strongly urge clinicians to consider the initiation of insulin as opposed to adding a third oral agent. Recent research suggests that earlier initiation of insulin is more physiologic and may be more effective in preventing complications of diabetes. Newer, longer-lasting insulin analogs and the use of simplified treatment plans may overcome psychological resistance to insulin on the part of physicians and patients. This article summarizes the risks associated with uncontrolled fasting and postprandial hyperglycemia, briefly reviews the various treatment options currently available for type 2 diabetes, presents case vignettes to illustrate crossroads encountered when advancing treatment, and offers guidance to the osteopathic physician on the selection of appropriate treatments for the management of type 2 diabetes. PMID:18279520

  15. A Modified User-Oriented Heuristic Evaluation of a Mobile Health System for Diabetes Self-management Support

    PubMed Central

    Georgsson, Mattias; Staggers, Nancy; Weir, Charlene

    2016-01-01

    Mobile health platforms offer significant opportunities for improving diabetic self-care, but only if adequate usability exists. Expert evaluations such as heuristic evaluation can provide distinct usability information about systems. The purpose of this study was to complete a usability evaluation of a mobile health system for diabetes patients using a modified heuristic evaluation technique of (1) dual-domain experts (healthcare professionals, usability experts), (2) validated scenarios and user tasks related to patients’ self-care, and (3) in-depth severity factor ratings. Experts identified 129 usability problems with 274 heuristic violations for the system. The categories Consistency and Standards dominated at 24.1% (n = 66), followed by Match Between System and Real World at 22.3% (n = 61). Average severity ratings across system views were 2.8 (of 4), with 9.3% (n = 12) rated as catastrophic and 53.5% (n = 69) as major. The large volume of violations with severe ratings indicated clear priorities for redesign. The modified heuristic approach allowed evaluators to identify unique and important issues, including ones related to self-management and patient safety. This article provides a template for one type of expert evaluation adding to the informaticists’ toolbox when needing to conduct a fast, resource-efficient and user-oriented heuristic evaluation. PMID:26657618

  16. A Modified User-Oriented Heuristic Evaluation of a Mobile Health System for Diabetes Self-management Support.

    PubMed

    Georgsson, Mattias; Staggers, Nancy; Weir, Charlene

    2016-02-01

    Mobile health platforms offer significant opportunities for improving diabetic self-care, but only if adequate usability exists. Expert evaluations such as heuristic evaluation can provide distinct usability information about systems. The purpose of this study was to complete a usability evaluation of a mobile health system for diabetes patients using a modified heuristic evaluation technique of (1) dual-domain experts (healthcare professionals, usability experts), (2) validated scenarios and user tasks related to patients' self-care, and (3) in-depth severity factor ratings. Experts identified 129 usability problems with 274 heuristic violations for the system. The categories Consistency and Standards dominated at 24.1% (n = 66), followed by Match Between System and Real World at 22.3% (n = 61). Average severity ratings across system views were 2.8 (of 4), with 9.3% (n = 12) rated as catastrophic and 53.5% (n = 69) as major. The large volume of violations with severe ratings indicated clear priorities for redesign. The modified heuristic approach allowed evaluators to identify unique and important issues, including ones related to self-management and patient safety. This article provides a template for one type of expert evaluation adding to the informaticists' toolbox when needing to conduct a fast, resource-efficient and user-oriented heuristic evaluation. PMID:26657618

  17. Diabetic gastroparesis: diagnosis and management.

    PubMed

    Ma, Jing; Rayner, Christopher K; Jones, Karen L; Horowitz, Michael

    2009-05-29

    Gastric emptying is frequently abnormal in patients with long-standing type 1 and type 2 diabetes mellitus. Symptoms commonly associated with disordered gastric emptying include nausea, vomiting, bloating and epigastric pain, while patients are also at risk of malnutrition, weight loss, impaired drug absorption, disordered glycaemic control and poor quality of life. Although often attributed to the presence of irreversible autonomic neuropathy, acute hyperglycaemia represents a potentially reversible cause of gastric dysfunction in diabetes. Scintigraphy represents the gold standard for measuring gastric emptying. The management of diabetic gastroparesis is less than optimal, partly because the pathogenesis has not been clearly defined. Treatment approaches include dietary modification and optimization of glycaemia, and the use of prokinetic drugs, while novel therapies such as gastric electrical stimulation are the subject of ongoing investigation. PMID:19496627

  18. Design of a Decision Support System to Help Clinicians Manage Glycemia in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Rodbard, David; Vigersky, Robert A

    2011-01-01

    Objective We sought to develop a computerized clinical decision support for clinicians treating patients with type 2 diabetes mellitus (T2DM). Methods We designed, developed, and tested a computer-assisted decision support (CADS) system using statistical analyses of self-monitoring of blood glucose data, laboratory data, medical and medication history, and individualized hemoglobin A1c goals. A rule-based expert system generated recommendations for changes in therapy and accompanying explanations. Results A clinical decision support system (CADS) was developed that considers 9 classes of medications and 69 regimens with combinations of up to 4 therapeutic agents. The preferred sequences of regimens can be customized. The program is integrated with a “comprehensive diabetes management system,” electronic medical record systems, and a method for uploading data from memory glucose meters via telephone without use of a computer or the Internet. The software provides a report to the clinician regarding the overall quality of glycemic control and identifies problems, e.g., hypoglycemia, hyperglycemia, glycemic variability, and insufficient data. The program can recommend continuation of current therapy, adjustment of dosages of current medications, or change of regimen and can provide explanations for its recommendations. If the user rejects the recommendations, the program will recommend alternative approaches. The CADS also provides access to Food and Drug Administration-approved prescribing information, guidelines from professional organizations, and selections from the general medical literature. The system has been extensively tested with real and synthetic data and is ready for evaluation in multicenter clinical trials. Conclusion A clinical decision support system to assist with the management of patients with T2DM was designed, developed, tested, and found to perform well. PMID:21527112

  19. Managing diabetes in cystic fibrosis.

    PubMed

    Laguna, T A; Nathan, B M; Moran, A

    2010-10-01

    Cystic fibrosis related diabetes (CFRD) is the most common co-morbidity in persons with cystic fibrosis (CF). As the life expectancy of persons with CF continues to increase, the need to proactively diagnose and aggressively treat CFRD and its potential complications has become more apparent. CFRD negatively impacts lung function, growth and mortality, making its diagnosis and management crucial in a population already at high risk for early mortality. Compared to type 1 and type 2 diabetes, CFRD is a unique entity, requiring a thorough understanding of its unique pathophysiology to facilitate the creation and utilization of an effective medical treatment plan. The physiology of CFRD is complex, likely consisting of a combination of insulin deficiency, insulin resistance and a genetic predisposition towards the development of diabetes. However, the hallmark of CFRD is insulin deficiency, necessitating the use of exogenous insulin as the mainstay of therapy. Insulin administration, in combination with a multidisciplinary team of health professionals with expertise in the care of patients with CF and CFRD, is the cornerstone of the care for these patients. The goals of treatment of the CFRD population are to reverse protein catabolism, maintain a healthy weight, and reduce acute and chronic diabetes complications. Creating a partnership between the treatment team and the patient is the ideal way to accomplish these goals and is essential for successful diabetes care. PMID:20920037

  20. Staged diabetes management: computerizing a disease state management program.

    PubMed

    Ginsberg, B H; Tan, M H; Mazze, R; Bergelson, A

    1998-04-01

    Recently, the Diabetes Control and Complication Trial (DCCT) and other similar studies have demonstrated that near-normalization of blood glucose in diabetes will reduce complications up to 75% but translation of these results into practice has been difficult. In an attempt to help provide the best possible control of patients with diabetes, we have produced an attempt to help provide the best possible control of patients with diabetes, we have produced a new disease state management system for diabetes, called "Staged Diabetes Management" (SDM), implemented it in over 100 sites worldwide, and developed a computer program to simplify its use. SDM, designed to change the way we deal with patients with diabetes, is based upon five principles: (1) community involvement in setting care guidelines; (2) negotiation of goals with patients; (3) appropriate timelines for therapeutic success; (4) use of flowcharts for medical decisions; and (5) evaluation of the program. SDM is designed to be altered by a community to meet its needs and resources. It encourages primary care physicians to deliver better diabetes care using a team approach and to refer patients with diabetes to specialists when appropriate. It has a complete set of materials for communities, individual health care providers and patients. SDM has been tested for changes in structure, process and outcomes. A meta-analysis of seven clinical trials with over 500 patients has shown a time-weighted average fall in hemoglobin A1c of 1.7 points (equivalent to a drop in mean blood glucose of about 3.5 mM or 60 mg/dL). Preliminary pharmacoeconomic analysis demonstrates a lifetime cost saving of over $27,000 per patient. A computer program has been developed for the Microsoft Windows environment that contains a client-server database, based upon DiabCare, for the data file structure. PMID:9571514

  1. DialBetics: A Novel Smartphone-based Self-management Support System for Type 2 Diabetes Patients.

    PubMed

    Waki, Kayo; Fujita, Hideo; Uchimura, Yuji; Omae, Koji; Aramaki, Eiji; Kato, Shigeko; Lee, Hanae; Kobayashi, Haruka; Kadowaki, Takashi; Ohe, Kazuhiko

    2014-03-13

    Numerous diabetes-management systems and programs for improving glycemic control to meet guideline targets have been proposed, using IT technology. But all of them allow only limited-or no-real-time interaction between patients and the system in terms of system response to patient input; few studies have effectively assessed the systems' usability and feasibility to determine how well patients understand and can adopt the technology involved. DialBetics is composed of 4 modules: (1) data transmission module, (2) evaluation module, (3) communication module, and (4) dietary evaluation module. A 3-month randomized study was designed to assess the safety and usability of a remote health-data monitoring system, and especially its impact on modifying patient lifestyles to improve diabetes self-management and, thus, clinical outcomes. Fifty-four type 2 diabetes patients were randomly divided into 2 groups, 27 in the DialBetics group and 27 in the non-DialBetics control group. HbA1c and fasting blood sugar (FBS) values declined significantly in the DialBetics group: HbA1c decreased an average of 0.4% (from 7.1 ± 1.0% to 6.7 ± 0.7%) compared with an average increase of 0.1% in the non-DialBetics group (from 7.0 ± 0.9% to 7.1 ± 1.1%) (P = .015); The DialBetics group FBS decreased an average of 5.5 mg/dl compared with a non-DialBetics group average increase of 16.9 mg/dl (P = .019). BMI improvement-although not statistically significant because of the small sample size-was greater in the DialBetics group. DialBetics was shown to be a feasible and an effective tool for improving HbA1c by providing patients with real-time support based on their measurements and inputs. PMID:24876569

  2. Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system

    PubMed Central

    Vest, Bonnie M; Kahn, Linda S; Danzo, Andrew; Tumiel-Berhalter, Laurene; Schuster, Roseanne C; Karl, Renée; Taylor, Robert; Glaser, Kathryn; Danakas, Alexandra; Fox, Chester H

    2014-01-01

    Objectives This article reports on results of a qualitative study of social supports and institutional resources utilized by individuals living with diabetes in a high-poverty urban setting. The goal was to examine how access to social capital among low-income populations facilitates and impedes their self-efficacy in diabetes self-management. Methods Semi-structured interviews were conducted with 34 patients with diabetes from a safety net primary care practice in Buffalo, New York. Results Facilitators and barriers to successful self-management were identified in three broad areas: (1) the influence of social support networks; (2) the nature of the doctor-patient relationship; and (3) the nature of patient-health care system relationship. Patients' unmet needs were also highlighted across these three areas. Discussion Participants identified barriers to effective diabetes self-management directly related to their low-income status, such as inadequate insurance, and mistrust of the medical system. It may be necessary for patients to activate social capital from multiple social spheres to achieve the most effective diabetes management. PMID:23585634

  3. The diabetic foot management - recent advance.

    PubMed

    Sinwar, Prabhu Dayal

    2015-03-01

    Diabetic ulceration of the foot represents a major global medical, social and economic problem. It is the commonest major end-point of diabetic complications. Diabetic neuropathy and peripheral vascular disease are the main etiological factors in foot ulceration and may act alone, together, or in combination with other factors such as microvascular disease, biomechanical abnormalities, limited joint mobility and increased susceptibility to infection. In the diabetic foot, distal sensory polyneuropathy is seen most commonly. The advent of insulin overcame the acute problems of ketoacidosis and infection, but could not prevent the vascular and neurological complications. Management of diabetic neuropathic ulcer by appropriate and timely removal of callus, control of infection and reduction of weight bearing forces. Management of diabetic ischaemic foot are medical management, surgical management and percutaneous transluminal angioplasty of stenosed and occluded lower extremity arteries. Foot ulceration in persons with diabetes is the most frequent precursor to amputation. PMID:25638739

  4. Transdermal innovations in diabetes management.

    PubMed

    Rao, Rekha; Mahant, Sheefali; Chhabra, Lovely; Nanda, Sanju

    2014-01-01

    Diabetes mellitus, an endocrine disorder affecting glucose metabolism, has been crippling mankind for the past two centuries. Despite the advancements in the understanding pertaining to its pathogenesis and treatment, the currently available therapeutic options are far from satisfactory. The growing diabetic population increases the gravity of the situation. The shortcomings of the conventional drug delivery systems necessitate the need to delve into other routes. On account of its merits over other routes, the transdermal approach has drawn the interest of the researchers around the world. The transdermal drug delivery systems are aimed to achieve therapeutic concentrations of the drug through skin. These systems are designed so that the drug can be delivered at a pre-determined and controlled rate. This makes it particularly conducive to treat chronic disorders like diabetes. Correspondingly, the adverse effects and inconvenience concomitant with oral and parentral route are circumvented. This article attempts to outline the development of transdermal drug delivery systems to optimize diabetes pharmacotherapy. It not only covers the transdermal approaches adopted to fine-tune insulin delivery, but also, discusses various transdermal drug delivery systems fabricated to improve the therapeutic performance of oral hypoglycaemic agents. Such formulations include the advanced drug delivery systems, namely, transferosomal gels, microemulsions, self-dissolving micropiles, nanoparticles, insulin pumps, biphasic lipid systems, calcium carbonate nanoparticles, lecithin nanoparticles; physical techniques such as iontophoresis and microneedles and, drugs formulated as transdermal patches. In addition to this, the authors have also shed light on the future prospects and patented and commercial formulations of antidiabetic agents. PMID:25418713

  5. Diabetes Data Management in the Clinic

    PubMed Central

    Bailey, Timothy S.

    2007-01-01

    Diabetes data management using a computer has not been widely adopted, even among diabetes-focused professionals. Barriers to adoption include incompatible devices and protocols, time and effort required, and lack of specific reimbursement. A simplified approach used at our clinic to review diabetes data is presented. PMID:19885162

  6. Facilitating diabetes self-management.

    PubMed

    Wierenga, M E; Hewitt, J B

    1994-01-01

    The purpose of this study was to enhance sensitivity to and understanding of the perceptions of persons with diabetes by analyzing these individuals' unsolicited comments on structured questionnaires. Twenty of 66 adults with non-insulin-dependent diabetes mellitus (NIDDM) who participated in a study to modify their eating habits wrote a total of 122 unsolicited comments on three different questionnaires. A systematic analysis of the content of these comments resulted in seven coding categories: personal philosophy; knowledge deficit; weight or blood sugar problems; diet, exercise, or medication problems; self-care activity; stress; and success. Further analysis resulted in a trilevel schema (survival, regulation, success) depicting how individuals learn to manage their diabetes. The problem-identification and seeking-help behaviors identified in the survival level gradually changed to learning to live with the regimen in the regulation level. Respondents whose activities were in the success level demonstrated more autonomy than persons in the other two levels. A health orientation rather than a problem orientation also was seen in the success level. Consequently, teaching strategies should be tailored to the client's level of self-care, with an emphasis on assisting them toward the success level. PMID:7851227

  7. Diabetes management in OLDES project.

    PubMed

    Novak, D; Uller, M; Rousseaux, S; Mraz, M; Smrz, J; Stepankova, O; Haluzik, M; Busuoli, M

    2009-01-01

    EU project OLDES (Older People's e-services at home) develops easy to use and low cost ICT platform in order to offer a better quality of life to elderly people directly in their homes through innovative systems of tele-accompany, tele-assistance and tele-medicine. The elderly are able to access the services and send relevant medical data from their home by being connected to the central server via a low cost PC which is based on Negroponte paradigm. The OLDES platform interface uses television screens controlled through a remote control customized for the elderly. The feasibility of OLDES project is evaluated by the pilot study concentrating on compensation of diabetic patients. Compensation of diabetes is achieved by monitoring glucose glycemia level, blood pressure and weight. Moreover, the patient feeds into OLDES system daily consumption of food using interactive food scales and obtains advice if necessary. PMID:19965284

  8. Recent advances in managing and understanding diabetic nephropathy

    PubMed Central

    Tang, Sydney C.W.; Chan, Gary C.W.; Lai, Kar Neng

    2016-01-01

    Diabetic nephropathy is the commonest cause of end-stage renal disease in most developed economies. Current standard of care for diabetic nephropathy embraces stringent blood pressure control via blockade of the renin-angiotensin-aldosterone system and glycemia control. Recent understanding of the pathophysiology of diabetic nephropathy has led to the development of novel therapeutic options. This review article focuses on available data from landmark studies on the main therapeutic approaches and highlights some novel management strategies. PMID:27303648

  9. Multidisciplinary management of type 2 diabetes in children and adolescents.

    PubMed

    Bowen, Michael E; Rothman, Russell L

    2010-01-01

    Although once considered a disease of adults, the prevalence of type 2 diabetes in youth is increasing at a significant rate. Similar to adults, youth with type 2 diabetes are at increased risk for developing hypertension, lipid abnormalities, renal disease, and other diabetes-related complications. However, children and adolescents with type 2 diabetes also face many unique management challenges that are different from adults with type 2 diabetes or children with type 1 diabetes. To deliver safe, effective, high-quality, cost-effective health care to adolescents with type 2 diabetes, reorganization and redesign of health care systems are needed. Multidisciplinary health care teams, which allow individuals with specialized training to maximally utilize their skills within an organized diabetes treatment team, may increase efficiency and effectiveness and may improve outcomes in children with type 2 diabetes. This review article provides a brief review of type 2 diabetes in children and adolescents, provides an overview of multidisciplinary health care teams, and discusses the role of multidisciplinary health care management in youth with type 2 diabetes. PMID:21197360

  10. Managing type 2 diabetes in Black patients.

    PubMed

    Akindana, Adeola; Ogunedo, Chioma

    2015-09-13

    Despite many novel treatments available for managing type 2 diabetes mellitus, Black patients continue to disproportionately suffer complications associated with poor glycemic control. This article describes a comprehensive approach to managing diabetes mellitus in these patients while addressing cultural nuances that may be barriers to positive outcomes. PMID:26259037

  11. Diabetes in Older People - A Disease You Can Manage

    MedlinePlus

    ... Aging Diabetes In Older People—A Disease You Can Manage What Is Diabetes? Types Of Diabetes Pre- ... your diabetes in case of an emergency. Medicare Can Help Medicare will pay to help you learn ...

  12. Four Steps to Manage Your Diabetes for Life

    MedlinePlus

    ... Language URL Español 4 Steps to Manage Your Diabetes for Life Page Content Contents Step 1: Learn ... diabetes care each day. Step 1: Learn about diabetes. What is diabetes? There are three main types ...

  13. Long-Term Engagement With a Mobile Self-Management System for People With Type 2 Diabetes

    PubMed Central

    Årsand, Eirik; Skrøvseth, Stein Olav; Hartvigsen, Gunnar

    2013-01-01

    Background In a growing number of intervention studies, mobile phones are used to support self-management of people with Type 2 diabetes mellitus (T2DM). However, it is difficult to establish knowledge about factors associated with intervention effects, due to considerable differences in research designs and outcome measures as well as a lack of detailed information about participants’ engagement with the intervention tool. Objective To contribute toward accumulating knowledge about factors associated with usage and usability of a mobile self-management application over time through a thorough analysis of multiple types of investigation on each participant’s engagement. Methods The Few Touch application is a mobile-phone–based self-management tool for patients with T2DM. Twelve patients with T2DM who have been actively involved in the system design used the Few Touch application in a real-life setting from September 2008 until October 2009. During this period, questionnaires and semistructured interviews were conducted. Recorded data were analyzed to investigate usage trends and patterns. Transcripts from interviews were thematically analyzed, and the results were further analyzed in relation to the questionnaire answers and the usage trends and patterns. Results The Few Touch application served as a flexible learning tool for the participants, responsive to their spontaneous needs, as well as supporting regular self-monitoring. A significantly decreasing (P<.05) usage trend was observed among 10 out of the 12 participants, though the magnitude of the decrease varied widely. Having achieved a sense of mastery over diabetes and experiences of problems were identified as reasons for declining motivation to continue using the application. Some of the problems stemmed from difficulties in integrating the use of the application into each participant’s everyday life and needs, although the design concepts were developed in the process where the participants were

  14. National recommendations: Psychosocial management of diabetes in India

    PubMed Central

    Kalra, Sanjay; Sridhar, G. R.; Balhara, Yatan Pal Singh; Sahay, Rakesh Kumar; Bantwal, Ganapathy; Baruah, Manash P.; John, Mathew; Unnikrishnan, Ambika Gopalkrishnan; Madhu, K.; Verma, Komal; Sreedevi, Aswathy; Shukla, Rishi; Prasanna Kumar, K. M.

    2013-01-01

    Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges. PMID:23869293

  15. The Diabetic's Guide to the Health Care System.

    ERIC Educational Resources Information Center

    Muldoon, John F.

    1978-01-01

    The author believes that, in order to obtain the care he needs, the diabetic must assume responsibility for the treatment of his condition, in that he must understand the physical and psychological aspects of diabetes, know how the health system works, and use this knowledge in the personal management of his diabetes. (Author/PHR)

  16. Everyday Expertise in Self-Management of Diabetes in the Dominican Republic: Implications for Learning and Performance Support Systems Design

    ERIC Educational Resources Information Center

    Reyes Paulino, Lisette G.

    2012-01-01

    An epidemic such as diabetes is an extremely complex public health, economic and social problem that is difficult to solve through medical expertise alone. Evidence-based models for improving healthcare delivery systems advocate educating patients to become more active participants in their own care. This shift demands preparing chronically ill…

  17. Diabetic Neuropathy: Mechanisms to Management

    PubMed Central

    Edwards, James L.; Vincent, Andrea; Cheng, Thomas; Feldman, Eva L.

    2014-01-01

    Neuropathy is the most common and debilitating complication of diabetes and results in pain, decreased motility, and amputation. Diabetic neuropathy encompasses a variety of forms whose impact ranges from discomfort to death. Hyperglycemia induces oxidative stress in diabetic neurons and results in activation of multiple biochemical pathways. These activated pathways are a major source of damage and are potential therapeutic targets in diabetic neuropathy. Though therapies are available to alleviate the symptoms of diabetic neuropathy, few options are available to eliminate the root causes. The immense physical, psychological, and economic cost of diabetic neuropathy underscores the need for causally targeted therapies. This review covers the pathology, epidemiology, biochemical pathways, and prevention of diabetic neuropathy, as well as discusses current symptomatic and causal therapies and novel approaches to identify therapeutic targets. PMID:18616962

  18. Anxiety and diabetes: Innovative approaches to management in primary care.

    PubMed

    Bickett, Allison; Tapp, Hazel

    2016-09-01

    Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care. PMID:27390262

  19. Does audit improve diabetes care in a primary care setting? A management tool to address health system gaps

    PubMed Central

    Pruthu, T. K.; Majella, Marie Gilbert; Nair, Divya; Ramaswamy, Gomathi; Palanivel, C.; Subitha, L.; Kumar, S. Ganesh; Kar, Sitanshu Sekhar

    2015-01-01

    Introduction: Diabetes mellitus is one of the emerging epidemics. Regular clinical and biochemical monitoring of patients, adherence to treatment and counseling are cornerstones for prevention of complications. Clinical audits as a process of improving quality of patient care and outcomes by reviewing care against specific criteria and then reviewing the change can help in optimizing care. Objective: We aimed to audit the process of diabetes care using patient records and also to assess the effect of audit on process of care indicators among patients availing diabetes care from a rural health and training center in Puducherry, South India. Materials and Methods: A record based study was conducted to audit diabetes care among patients attending noncommunicable disease clinic in a rural health center of South India. Monitoring of blood pressure (BP), blood glucose, lipid profile and renal function test were considered for auditing in accordance with standard guidelines. Clinical audit cycle (CAC), a simple management tool was applied and re-audit was done after 1-year. Results: We reviewed 156 and 180 patients records during year-1 and year-2, respectively. In the audit year-1, out of 156 patients, 78 (50%), 70 (44.9%), 49 (31.4%) and 19 (12.2%) had got their BP, blood glucose, lipid profile and renal function tests done. Monitoring of blood glucose, BP, lipid profile and renal function improved significantly by 35%, 20.7%, 36.4% and 56.1% over 1-year. Conclusion: CAC improves process of diabetes care in a primary care setting with existing resources. PMID:26604621

  20. Antenatal management of pregnancy complicated by diabetes.

    PubMed

    Masood, Shabeen Naz; Masood, Yasir; Naim, Uzma; Razzak, Safina Abdul

    2016-09-01

    The prevalance of Gestational Diabetes Mellitus (GDM) is increasing worldwide. It is estimated that 21 million women develop gestational diabetes out of which 1 in 7 births are affected. Women who have been previously diagnosed as GDM are at higher risk of developing diabetes in subsequent pregnancies and Type 2 Diabetes Mellitus (T2DM) later in life. Babies born to mothers with gestational diabetes also have a higher risk of developing type 2 diabetes in their teens or early adulthood. Instead of risk stratification universal screening is essential in all pregnant women. Tight glycaemic targets are required for optimal maternal and foetal outcome. This article outlines the importance of pre-pregnancy counseling, antenatal management, screening and treatment of Hyperglycaemia in Pregnancy (HIP). PMID:27582158

  1. Neonatal management of pregnancy complicated by diabetes.

    PubMed

    Mohsin, Fauzia; Khan, Shareen; Baki, Md Abdul; Zabeen, Bedowra; Azad, Kiswhar

    2016-09-01

    Women with diabetes in pregnancy, either pre-gestational Diabetes Mellitus (Type 1 & Type 2) or Gestational Diabetes, are at increased risk for adverse pregnancy outcomes, including preterm labour and increased foetal mortality rate. Adequate glycaemic control before and during pregnancy is crucial for improving foetal and perinatal outcomes in these babies. Perinatal and neonatal morbidities and mortality rates have declined since the development of specialized maternal, foetal, and neonatal care for women with diabetes and their offspring. However, infants of diabetic mothers are at risk for developing complications as macrosomia, hypoglycaemia, perinatal asphyxia, cardiac and respiratory problems, birth injuries and congenital malformations. In this review article we describe the neonatal management of the offspring of diabetic mothers. PMID:27582162

  2. [The infected diabetic foot: diagnosis and management].

    PubMed

    Nicodème, Jean-Damien; Paulin, Emilie Nicodème; Zingg, Matthieu; Uçkay, Ilker; Malacarne, Sarah; Suva, Domizio

    2015-06-01

    Foot infections are a frequent and potentially harmful complication of diabetes mellitus. In one skin ulceration out of two, further evolution towards infection occurs and often leads to amputation increasing morbidity and health care costs. Skin disruptions, favored by the sensorimotor neuropathy and vascular disease, constitute the initial factors leading to this complication. To ensure effective care, these cases must be managed by a multidisciplinary team in a specialized center. All caretakers involved with patients suffering from diabetes mellitus must be capable of preventing and recognizing diabetic foot infections, as well as informing the patients about this complication and its management. PMID:26211284

  3. Reducing diabetes disparities through the implementation of a community health worker-led diabetes self-management education program.

    PubMed

    Walton, James W; Snead, Christine A; Collinsworth, Ashley W; Schmidt, Kathryn L

    2012-01-01

    Disparities in prevalence of type 2 diabetes and complications in underserved populations have been linked to poor quality of care including lack of access to diabetes management programs. Interventions utilizing community health workers (CHWs) to assist with diabetes management have demonstrated improvements in patient outcomes. Use of CHWs may be an effective model for providing care coordination and reducing disparities, but there is limited knowledge on how to implement this model on a large scale. This article describes how an integrated health care system implemented a CHW-led diabetes self-management education program targeting Hispanic patients and reports lessons learned from the first 18 months of operation. PMID:22367263

  4. Engaging faith-based resources to initiate and support diabetes self-management among African Americans: a collaboration of informal and formal systems of care.

    PubMed

    Johnson, Patria; Thorman Hartig, Margaret; Frazier, Renee; Clayton, Mae; Oliver, Georgia; Nelson, Belinda W; Williams-Cleaves, Beverly J

    2014-11-01

    Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network. PMID:25359253

  5. Diabetic cardiomyopathy: Pathophysiology, diagnostic evaluation and management

    PubMed Central

    Pappachan, Joseph M; Varughese, George I; Sriraman, Rajagopalan; Arunagirinathan, Ganesan

    2013-01-01

    Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population. Diabetes-related heart disease occurs in the form of coronary artery disease (CAD), cardiac autonomic neuropathy or diabetic cardiomyopathy (DbCM). The prevalence of cardiac failure is high in the diabetic population and DbCM is a common but underestimated cause of heart failure in diabetes. The pathogenesis of diabetic cardiomyopathy is yet to be clearly defined. Hyperglycemia, dyslipidemia and inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen species which are in turn implicated. The myocardial interstitium undergoes alterations resulting in abnormal contractile function noted in DbCM. In the early stages of the disease diastolic dysfunction is the only abnormality, but systolic dysfunction supervenes in the later stages with impaired left ventricular ejection fraction. Transmitral Doppler echocardiography is usually used to assess diastolic dysfunction, but tissue Doppler Imaging and Cardiac Magnetic Resonance Imaging are being increasingly used recently for early detection of DbCM. The management of DbCM involves improvement in lifestyle, control of glucose and lipid abnormalities, and treatment of hypertension and CAD, if present. The role of vasoactive drugs and antioxidants is being explored. This review discusses the pathophysiology, diagnostic evaluation and management options of DbCM. PMID:24147202

  6. Developmental issues in managing children with diabetes.

    PubMed

    Savinetti-Rose, B

    1994-01-01

    Children who are newly diagnosed with insulin dependent diabetes mellitus (IDDM) are expected to learn a substantial amount of new information within a few hospital days. It is important for nurses who design lesson plans for the child with IDDM to assess the child's developmental capabilities in relation to the necessary skills required of diabetes management and understand the family influence on the child's ability to perform self-care. PMID:8159478

  7. A simple diabetic clinic information and audit system.

    PubMed

    Mahler, R F; Greenwood, R M

    1984-11-01

    A simple method for managing the records of a diabetic clinic in a District General Hospital is described. It is based on a modified manual system in which selected items of data are recorded in a computer system. This provides a Diabetic Register, information for patient and clinical management and for research projects. It simplifies the management of the clinic, is easily used by medical staff inexperienced in the use of computers and causes minimal increase in the clinic workload. PMID:6242822

  8. Pharmacists' Role in Improving Diabetes Medication Management

    PubMed Central

    Smith, Marie

    2009-01-01

    Today there are significant gaps between reaching the goal of “optimal medication therapy” and the current state of medication use in the United States. Pharmacists are highly accessible and well-trained—yet often underutilized—key health care professionals who can move us closer toward achieving better medication therapy outcomes for patients. Diabetes medication management programs led by pharmacists are described. This is consistent with the “medical home” concept of care that promotes primary care providers working collaboratively to coordinate patient-centered care. Pharmacists utilize their clinical expertise in monitoring and managing diabetes medication plans to positively impact health outcomes and empower patients to actively manage their health. In addition, pharmacists can serve as a resource to other health care providers and payers to assure safe, appropriate, cost-effective diabetes medication use. PMID:20046662

  9. Diabetes

    MedlinePlus

    ... Diabetic retinopathy Islets of Langerhans Pancreas Insulin pump Type I diabetes Diabetic blood circulation in foot Food and insulin release ... Saunders; 2015:chap 39. Dungan KM. Management of type 2 diabetes mellitus. In: Jameson JL, De Groot LJ, de ... hyperglycemic hyperosmolar syndrome Gestational diabetes Hardening of the ...

  10. Acceptability and User Satisfaction of a Smartphone-Based, Interactive Blood Glucose Management System in Women With Gestational Diabetes Mellitus

    PubMed Central

    Mackillop, Lucy; Loerup, Lise; Kevat, Dev A.; Bartlett, Katy; Gibson, Oliver; Kenworthy, Yvonne; Levy, Jonathan C.; Tarassenko, Lionel; Farmer, Andrew

    2014-01-01

    Background: The increase in gestational diabetes mellitus (GDM) is challenging maternity services. We have developed an interactive, smartphone-based, remote blood glucose (BG) monitoring system, GDm-health. Aims: The objective was to determine women’s satisfaction with using the GDm-health system and their attitudes toward their diabetes care. Methods: In a service development program involving 52 pregnant women (September 2012 to June 2013), BG was monitored using GDm-health from diagnosis until delivery. Following birth, women completed a structured questionnaire assessing (1) general satisfaction, (2) equipment issues, and (3) relationship with the diabetes care team. Responses were scored on a 7-point Likert-type scale. Reliability and validity of the questionnaire were assessed using statistical methods. Results: Of 52 women, 49 completed the questionnaire; 32 had glucose tolerance test confirmed GDM (gestation at recruitment 29 ± 4 weeks (mean ± SD), and 17 women previous GDM recommended for BG monitoring (18 ± 6 weeks). In all, 45 of 49 women agreed their care was satisfactory and the best for them, 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively, 42 of 49 agreed GDm-health fitted into their lifestyle, and 46 of 49 agreed they had a good relationship with their care team. Written comments supported these findings, with very positive reactions from the majority of women. Cronbach’s alpha was .89 with factor analysis corresponding with question thematic trends. Conclusions: This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women. Effects on clinical and economic outcomes are currently under investigation in a randomized trial (clinicaltrials.gov NCT01916694). PMID:25361643

  11. Acceptability and user satisfaction of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus.

    PubMed

    Hirst, Jane E; Mackillop, Lucy; Loerup, Lise; Kevat, Dev A; Bartlett, Katy; Gibson, Oliver; Kenworthy, Yvonne; Levy, Jonathan C; Tarassenko, Lionel; Farmer, Andrew

    2015-01-01

    The increase in gestational diabetes mellitus (GDM) is challenging maternity services. We have developed an interactive, smartphone-based, remote blood glucose (BG) monitoring system, GDm-health. The objective was to determine women's satisfaction with using the GDm-health system and their attitudes toward their diabetes care. In a service development program involving 52 pregnant women (September 2012 to June 2013), BG was monitored using GDm-health from diagnosis until delivery. Following birth, women completed a structured questionnaire assessing (1) general satisfaction, (2) equipment issues, and (3) relationship with the diabetes care team. Responses were scored on a 7-point Likert-type scale. Reliability and validity of the questionnaire were assessed using statistical methods. Of 52 women, 49 completed the questionnaire; 32 had glucose tolerance test confirmed GDM (gestation at recruitment 29 ± 4 weeks (mean ± SD), and 17 women previous GDM recommended for BG monitoring (18 ± 6 weeks). In all, 45 of 49 women agreed their care was satisfactory and the best for them, 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively, 42 of 49 agreed GDm-health fitted into their lifestyle, and 46 of 49 agreed they had a good relationship with their care team. Written comments supported these findings, with very positive reactions from the majority of women. Cronbach's alpha was .89 with factor analysis corresponding with question thematic trends. This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women. Effects on clinical and economic outcomes are currently under investigation in a randomized trial (clinicaltrials.gov NCT01916694). PMID:25361643

  12. Screening and management of gestational diabetes.

    PubMed

    Benhalima, Katrien; Devlieger, Roland; Van Assche, André

    2015-04-01

    Gestational diabetes (GDM) is a frequent medical condition during pregnancy. It is associated with an increased risk of complications for both the mother and the baby during pregnancy and post partum. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) has proposed a new screening strategy for overt diabetes in pregnancy and screening for GDM. However, there is still a lack of international uniformity in the approach to the screening and diagnosis of GDM. Controversies include universal versus selective screening, the optimal time for screening, appropriate tests and cutoff values, and whether testing should be conducted in one or two steps. This review gives an update on screening for GDM and overt diabetes during pregnancy. We also give an overview on the medical and obstetrical management of GDM. PMID:25457858

  13. Interactive Multimedia Tailored to Improve Diabetes Self-Management.

    PubMed

    Wood, Felecia G; Alley, Elizabeth; Baer, Spencer; Johnson, Rebecca

    2015-09-01

    A pilot program was initiated to improve self-management of type 2 diabetes by rural adults. Using an iOS-based, individually tailored pre-/postintervention to improve diabetes self-management, undergraduate students developed a native mobile application to help participants effectively manage their diabetes. Brief quizzes assessed diabetes knowledge. A diabetes dictionary and physical activity assessment provided additional support to users of the app. On completion of the pilot, data analysis indicated increased diabetes knowledge and self-efficacy, and ease of use of the technology. Native app technology permits ready access to important information for those living with type 2 diabetes. PMID:26333610

  14. Management of diabetes during Ramadan: practical guidelines.

    PubMed

    Sunni, Muna; Brunzell, Carol; Nathan, Brandon; Moran, Antoinette

    2014-06-01

    Ramadan is a month-long period of heightened self-reflection about one's religion and one's relationships with others. During Ramadan, fasting during daylight hours is required. The fast is typically followed by a feast after dark. Although Muslims with certain medical conditions are allowed by Islamic law to abstain from fasting, many choose to fast during Ramadan for personal reasons. Diabetes is one of the most challenging conditions to manage during this time, and physicians and clinics with Muslim patients who have diabetes will need to be prepared if they are to support their patients who desire to fast. This article provides a general overview of Ramadan and offers practical guidance for managing adults and children with diabetes who are fasting during this important time in the Muslim calendar. PMID:25029798

  15. The management of the infected diabetic foot.

    PubMed

    Caravaggi, Carlo; Sganzaroli, Adriana; Galenda, Paolo; Bassetti, Matteo; Ferraresi, Roberto; Gabrielli, Livio

    2013-01-01

    Diabetes is a chronic disease with a worldwide increasing trend. Foot complications, closely related to neuropathy and obstructive peripheral vascular disease, are responsible for more than 1 million of leg amputations every year. Foot infection can dramatically increase the risk of amputation. Although many ulcer classification systems have been proposed to stratify the severity of the infectious process, the definition of a specific therapeutic approach still remains an unsolved problem. A Diabetic Foot Triage and an Integrated Surgical Protocol are proposed to identify a diagnostic flowchart and a step-by-step surgical protocol that can be applied in the treatment of diabetic foot infection. Considering the rapid climbing of multidrug resistant strains it is very important to rationalize the use of antibiotics utilizing them only for the treatment of true infected ulcers. PAD is widely considered the most important factor conditioning the outcome of a diabetic foot ulcer. Currently no randomized control trials are reported in the international literature directly comparing open versus endovascular revascularisation in diabetic patients with CLI. Insufficient data are available to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients. A decisional flow chart in choosing the best revascularization strategy in diabetic patients with CLI is proposed. Goals and technical aspects of emergency and elective surgical procedures in diabetic foot are analysed to evaluate critical aspects and to suggest proper surgical choices. PMID:22934545

  16. Current update in the management of diabetic nephropathy.

    PubMed

    Van Buren, Peter Noel; Toto, Robert

    2013-01-01

    Diabetic nephropathy is the leading cause of end-stage renal disease in the United States. The progression of kidney disease in patients with diabetes can take many years, and interventions such as glycemic control, blood pressure control, and inhibition of the renin-angiotensin-aldosterone system have been shown to slow this progression. Despite the implementation of these strategies, the number of patients with diabetes that ultimately develop end-stage renal disease remains high. Recent investigation has focused on the optimization of renin-angiotensin-aldosterone system blockade in patients with diabetic nephropathy using combinations of drugs that target this pathway. Additional investigation has focused on the potential of novel therapies that either target various pathways upregulated by hyperglycemia or other targets believed to promote progression of diabetic nephropathy such as the endothelin system, inflammation and vitamin D receptors. This review article addresses some of the well-established principles regarding the progression and accepted management of diabetic nephropathy and includes current updates on the most recent clinical research trials exploring novel therapeutics in this field. PMID:23167665

  17. [Management of diabetic foot infections].

    PubMed

    Esposito, Silvano; Russo, Enrico; Noviello, Silvana; Leone, Sebastiano

    2012-01-01

    All infected diabetic foot wounds require antibiotic treatment. Antibiotic treatment is influenced by the patient's features as the vascular status, the leukocyte function and the kidney activity. The initial antibiotic regimen is usually chosen empirically and it can be modified on the basis of the microbiological information obtained subsequently. The initial empiric therapy should be based, on one hand, on the grade of infected lesion and, secondly, on the epidemiological data. Almost all of the mild/moderate infected wounds can be treated with antibiotics with a spectrum of activity limited to Gram-positive cocci. Treatment with oral antibiotics is sufficient in most cases in patients with mild/moderate infections. With severe infections is more appropriate to use a broad-spectrum antibiotic therapy. Furthermore it is safer to start a parenteral therapy, possibly modifying it into an oral administration if the patient has stabilized. The most frequently pathogen observed in diabetic foot infections is Staphylococcus aureus. It is important to understand whether there are elements that may lead to the suspicion of MRSA infection in order to establish an appropriate antimicrobial therapy. PMID:22982695

  18. DMSS--a computer-based diabetes monitoring system.

    PubMed

    Zviran, M; Blow, R

    1989-10-01

    This paper describes a microcomputer-based decision support system (DSS) for diabetes monitoring. The system's basic functions include a patient management subsystem, an electronic logbook, a nutrition and exercise module, a dictionary for diabetes-related terminology, a diabetic-physician data transfer module and an on-line help capability. DMSS (Diabetes Monitoring Support System) provides a data capturing capability, trend analysis, and nutrition/exercise decision support to improve the monitoring and maintenance of diabetes. It was designed to be used by both a physician and a patient and can also serve as a useful teaching aid for a new diabetic. Its basic advantages lie in its comprehensiveness and flexibility. It is also user-friendly, easy to operate, and does not require any previous computer experience. PMID:2697741

  19. Socioeconomic factors relating to diabetes and its management in India.

    PubMed

    Shrivastava, Usha; Misra, Anoop; Gupta, Rajeev; Viswanathan, Vijay

    2016-01-01

    Diabetes is an escalating problem in India and has major socioeconomic dimensions. Rapid dietary changes coupled with decreased levels of physical activity have resulted in increases in obesity and diabetes in rural and semi-urban areas, as well as in urban-based people living in resettlement colonies. Increasing risk has also been recorded in those who suffered from poor childhood nutrition and in rural-to-urban migrants. Social inequity manifests in disparities in socioeconomic status (SES), place of residence, education, gender, and level of awareness and affects prevention, care, and management. All these population subsets have major socioeconomic challenges: low levels of awareness regarding diabetes and prevention, inadequate resources, insufficient allotment of healthcare budgets, and lack of medical reimbursement. Unawareness and delays in seeking medical help lead to complications, resulting in many-fold increased costs in diabetes care. These costs plunge individuals and households into a vicious cycle of further economic hardship, inadequate management, and premature mortality, resulting in more economic losses. At the societal level, these are massive losses to national productivity and the exchequer. Overall, there is an immediate need to strengthen the healthcare delivery system to generate awareness and for the prevention, early detection, cost-effective management, and rehabilitation of patients with diabetes, with a focus on people belonging to the lower SES and women (with a particular focus on nutrition before and during pregnancy). Because of an enhanced awareness campaign spearheaded through the National Program on Prevention of Cardiovascular Disease, Cancer, Diabetes and Stroke (NCPCDS) initiated by Government of India, it is likely that the level of awareness and early detection of diabetes may increase. PMID:26019052

  20. Diabetic Retinopathy and Systemic Factors

    PubMed Central

    Frank, Robert N.

    2015-01-01

    Diabetic retinopathy, an oculardisease, is governed by systemic as well as local ocular factors. These include primarily chronic levels of blood glucose. Individuals with chronically elevated blood glucose levels have substantially more, and more severe, retinopathy than those with lower blood glucose levels. The relationship of blood glucose to retinopathy is continuous, with no threshold although individuals with hemoglobin A1c levels (a measure of chronic glycemia) <6.5%, generally develop little or no retinopathy. Blood pressure levels have been claimed to influence retinopathy development and progression, but multiple controlled clinical trials of antihypertensive agents in diabetic subjects have produced only weak evidence of benefit from blood pressure lowering on the incidence and progression of diabetic retinopathy. Elevated blood lipids seem to play a role in the progression of retinopathy, and two trials of fenofibrate, a lipid-lowering agent that has not proved effective in preventing cardiovascular disease, have shown benefit in preventing retinopathy progression. The mechanism of this effect may not, however, be directly related to the reduction in blood lipids. Finally, there is strong, but only circumstantial, evidence for a genetic or epigenetic influence on the pathogenesis of diabetic retinopathy. Despite the power of large-scale epidemiologic studies and modern molecular biological and computational techniques, the gene or genes, which predispose or protect against the development and progression of diabetic retinopathy remain elusive. PMID:25949071

  1. Home-Based Diabetes Symptom Self-Management Education for Mexican Americans with Type 2 Diabetes

    ERIC Educational Resources Information Center

    García, Alexandra A.; Brown, Sharon A.; Horner, Sharon D.; Zuñiga, Julie; Arheart, Kristopher L.

    2015-01-01

    This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated…

  2. Diabetes Self-Management Smartphone Application for Adults With Type 1 Diabetes: Randomized Controlled Trial

    PubMed Central

    Vandelanotte, Corneel; Fenning, Andrew; Duncan, Mitch J

    2013-01-01

    Background Persistently poor glycemic control in adult type 1 diabetes patients is a common, complex, and serious problem initiating significant damage to the cardiovascular, renal, neural, and visual systems. Currently, there is a plethora of low-cost and free diabetes self-management smartphone applications available in online stores. Objective The aim of this study was to examine the effectiveness of a freely available smartphone application combined with text-message feedback from a certified diabetes educator to improve glycemic control and other diabetes-related outcomes in adult patients with type 1 diabetes in a two-group randomized controlled trial. Methods Patients were recruited through an online type 1 diabetes support group and letters mailed to adults with type 1 diabetes throughout Australia. In a 6-month intervention, followed by a three-month follow-up, patients (n=72) were randomized to usual care (control group) or usual care and the use of a smartphone application (Glucose Buddy) with weekly text-message feedback from a Certified Diabetes Educator (intervention group). All outcome measures were collected at baseline and every three months over the study period. Patients’ glycosylated hemoglobin levels (HbA1c) were measured with a blood test and diabetes-related self-efficacy, self-care activities, and quality of life were measured with online questionnaires. Results The mean age of patients was 35.20 years (SD 10.43) (28 male, 44 female), 39% (28/72) were male, and patients had been diagnosed with type 1 diabetes for a mean of 18.94 years (SD 9.66). Of the initial 72 patients, 53 completed the study (25 intervention, 28 control group). The intervention group significantly improved glycemic control (HbA1c) from baseline (mean 9.08%, SD 1.18) to 9-month follow-up (mean 7.80%, SD 0.75), compared to the control group (baseline: mean 8.47%, SD 0.86, follow-up: mean 8.58%, SD 1.16). No significant change over time was found in either group in

  3. Current management of diabetes mellitus and future directions in care.

    PubMed

    Chatterjee, Sudesna; Davies, Melanie J

    2015-11-01

    The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. Thirty years later, the first oral agents for diabetes, the biguanides and sulfonylureas, appeared and freed type 2 patients from having to inject insulin following diagnosis. Improvements in insulin formulations over the decades, including rapid-acting and long-acting insulin analogues that more closely mimic physiological insulin secretion, have increased the flexibility and efficacy of type 1 diabetes management. The last two decades have seen major advances in technology, which has manifested in more accurate glucose monitoring systems and insulin delivery devices ('insulin pump'). Increased understanding of the pathophysiological deficits underlying type 2 diabetes has led to the development of targeted therapeutic approaches such as on the small intestine (glucagon-like peptide-1 receptor analogues and dipeptidyl-peptidase IV inhibitors) and kidneys (sodium-glucose cotransporter-2 inhibitors). A patient-centred approach delivered by a multidisciplinary team is now advocated. Glycaemic targets are set according to individual circumstances, taking into account factors such as weight, hypoglycaemia risk and patient preference. Stepwise treatment guidelines devised by international diabetes organisations standardise and rationalise management. Structured education programmes and psychological support are now well-established as essential for improving patient motivation and self-empowerment. Large multicentre randomised trials have confirmed the effectiveness of intensive glycaemic control on microvascular

  4. Diabetes Technologies and Their Role in Diabetes Management

    ERIC Educational Resources Information Center

    Kollipara, Sobha; Silverstein, Janet H.; Marschilok, Katie

    2009-01-01

    The 1993 Diabetes Complications and Control Trial (DCCT) showed that controlling blood glucose prevents and delays the progression of long term complications of diabetes. New diabetes technologies can make control of diabetes possible and safer. This paper reviews these technologies used to monitor blood glucose, administer insulin and evaluate…

  5. Management of diabetic nephropathy: Recent progress and future perspective.

    PubMed

    Ahmad, Jamal

    2015-01-01

    Diabetic nephropathy (DN), a leading cause of end-stage renal disease (ESRD) affecting ∼20-30% diabetics, is associated with increased cardiovascular mortality. The progression of kidney disease in patients with diabetes can take many years. It occurs as a result of interaction between both genetic and environmental factors in individuals with both type 1 and type 2 diabetes. Hyperglycaemia, hypertension, and genetic pre-disposition are the main risk factors besides elevated serum lipids, smoking habits, and the amount of dietary proteins. Interventions such as glycaemic control, blood pressure control and inhibition of the renin-angiotensin-aldosterone system have been shown to slow this progression. Despite the implementation of these strategies, the number of patients with diabetes that ultimately develop end-stage renal disease remains high. The treatment of DN, therefore, has posed a formidable challenge besides optimization of renin-angiotensin-aldosterone system blockade in patients with DN; additional investigation has focused on the potential of novel therapies that target various pathways upregulated by hyperglycaemia or other targets believed to promote the progression of DN such as oxidative stress, inflammation, endothelin system and vitamin D receptors. This review article addresses the pathogenesis and some of the well established principles regarding the progression and accepted management of DN, and also includes the perspectives of novel anti-DN agents and the future directions for the prevention of DN. PMID:25845297

  6. Trial protocol to compare the efficacy of a smartphone-based blood glucose management system with standard clinic care in the gestational diabetic population

    PubMed Central

    Mackillop, Lucy H; Bartlett, Katy; Birks, Jacqueline; Farmer, Andrew J; Gibson, Oliver J; Kevat, Dev A; Kenworthy, Yvonne; Levy, Jonathan C; Loerup, Lise; Tarassenko, Lionel; Velardo, Carmelo; Hirst, Jane E

    2016-01-01

    Introduction The prevalence of gestational diabetes mellitus (GDM) is rising in the UK. Good glycaemic control improves maternal and neonatal outcomes. Frequent clinical review of patients with GDM by healthcare professionals is required owing to the rapidly changing physiology of pregnancy and its unpredictable course. Novel technologies that allow home blood glucose (BG) monitoring with results transmitted in real time to a healthcare professional have the potential to deliver good-quality healthcare to women more conveniently and at a lower cost to the patient and the healthcare provider compared to the conventional face-to-face or telephone-based consultation. We have developed an integrated GDm-health management system and aim to test the impact of using this system on maternal glycaemic control, costs, patient satisfaction and maternal and neonatal outcomes compared to standard clinic care in a single large publicly funded (National Health Service (NHS)) maternity unit. Methods and analysis Women with confirmed gestational diabetes in a current pregnancy are individually randomised to either the GDm-health system and half the normal clinic visits or normal clinic care. Primary outcome is mean BG in each group from recruitment to delivery calculated, with adjustments made for number of BG measurements, proportion of preprandial and postprandial readings and length of time in study, and compared between the groups. The secondary objective will be to compare the two groups for compliance to the allocated BG monitoring regime, maternal and neonatal outcomes, glycaemic control using glycated haemoglobin (HbA1c) and other BG metrics, and patient attitudes to care assessed using a questionnaire and resource use. Ethics and dissemination Thresholds for treatment, dietary advice and clinical management are the same in both groups. The results of the study will be published in a peer-reviewed journal and disseminated electronically and in print. Trial registration

  7. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services

    PubMed Central

    Riza, Anca Lelia; Pearson, Fiona; Ugarte-Gil, Cesar; Alisjahbana, Bachti; van de Vijver, Steven; Panduru, Nicolae M; Hill, Philip C; Ruslami, Rovina; Moore, David; Aarnoutse, Rob; Critchley, Julia A; van Crevel, Reinout

    2016-01-01

    Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes. PMID:25194887

  8. Outpatient Management of Pediatric Type 1 Diabetes

    PubMed Central

    Cogen, Fran R.

    2015-01-01

    The incidence of both type 1 and type 2 diabetes (T1DM and T2DM) continues to rise within the pediatric population. However, T1DM remains the most prevalent form diagnosed in children. It is critical that health-care professionals understand the types of diabetes diagnosed in pediatrics, especially the distinguishing features between T1DM and T2DM, to ensure proper treatment. Similar to all individuals with T1DM, lifelong administration of exogenous insulin is necessary for survival. However, children have very distinct needs and challenges compared to those in the adult diabetes population. Accordingly, treatment, goals, and age-appropriate requirements must be individually addressed. The main objectives for the treatment of pediatric T1DM include maintaining glucose levels as close to normal as possible, avoiding acute complications, and preventing long-term complications. In addition, unique to pediatrics, facilitating normal growth and development is important to comprehensive care. To achieve these goals, a careful balance of insulin therapy, medical nutrition therapy, and exercise or activity is necessary. Pharmacological treatment options consist of various insulin products aimed at mimicking prior endogenous insulin secretion while minimizing adverse effects. This review focuses on the management of pediatric T1DM in the outpatient environment, highlighting pharmacotherapy management strategies. PMID:26472948

  9. Diabetic foot complications: diagnosis and management.

    PubMed

    Giurini, John M; Lyons, Thomas E

    2005-09-01

    Foot complications in patients with diabetes mellitus are a challenge to the health care industry. A great deal of expenditure is due to the management of diabetic foot complications. This places a great burden on the health care industry. It also places a great burden on those diabetic patients with foot complications and their families. Therefore, their effective management in an efficient manner is crucial to our patients. To deal with these problems, a dedicated, knowledgeable, and experienced multidisciplinary team is key. Intervention at the earliest possible time yields the best outcome. Prevention is the focus for those with no ulcerations. For those with ulcerations, prompt recognition and treatment is key. The importance of classifying ulcerations according to size, depth, presence or absence of infection, and vascular status can not be overstated. Proper offloading is vital for those with neuropathic lesions. Recognition of patients with a component of ischemia and vascular intervention to increase perfusion will aid in wound healing. Of course deep infection requires immediate drainage. All efforts of those in the multidisciplinary team are directed at the restoration and maintenance of an ulcer-free foot which is important in enabling our patients to maintain their ambulatory status. PMID:16100098

  10. Management of type 2 diabetes and gestational diabetes in pregnancy.

    PubMed

    Boinpally, Tara; Jovanovic, Lois

    2009-06-01

    Although previously thought to be predominantly transient gestational diabetes, diabetes in pregnancy can be attributed more and more to type 2 diabetes today. Although all types of diabetes in pregnancy pose a threat to the health and future well-being of both the mother and child affected, undiagnosed type 2 diabetes can be significantly more devastating in complications because of effects starting from conception. This rise of type 2 diabetes thus imparts a great sense of urgency to uncover undiagnosed cases of type 2 diabetes in pregnancy and to take active measures in establishing tight glucose control. From preconception care before pregnancy to medical treatment postpartum, it is essential that immediate care be taken to help mediate the effects of diabetes in pregnancy. PMID:19421970

  11. Prevention and management of diabetic foot ulcers.

    PubMed

    Turns, Martin

    2015-03-01

    As part of an annual foot review, trained and competent personnel should examine patients' feet to detect risk factors for ulceration. Foot examination with shoes and stockings removed should include: palpation of foot pulses; testing foot sensations using 10g monofilament or vibration; inspection for significant callus or deformed nails; inspection for any structural deformity; asking about any previous ulceration; checking for signs of ulceration; asking about any pain; and inspecting footwear. Following assessment, a foot risk classification score should be given. The person with diabetes should then be informed of their risk score, with education offered regarding future foot-care management. Diabetic foot complications include ulceration, Charcot foot, painful neuropathy, gangrene and amputation. Risk factors for ulceration include non-palpable pulses, insensate foot, significant callus, deformed nails, history of previous ulcer or amputation, tissue damage or signs of ulceration, foot pain and unsuitable footwear. PMID:25757381

  12. Epidemiology, mechanisms, and management of diabetic gastroparesis.

    PubMed

    Camilleri, Michael; Bharucha, Adil E; Farrugia, Gianrico

    2011-01-01

    Recent evidence of the significant impact of gastroparesis on morbidity and mortality mandates optimized management of this condition. Gastroparesis affects nutritional state, and in diabetics it has deleterious effects on glycemic control and secondary effects on organs that increase mortality. First-line treatments include restoration of nutrition and medications (prokinetic and antiemetic). We review the epidemiology, pathophysiology, impact, natural history, time trends, and treatment of gastroparesis, focusing on diabetic gastroparesis. We discuss pros and cons of current treatment options, including metoclopramide. Second-line therapeutic approaches include surgery, venting gastrostomy or jejunostomy, and gastric electrical stimulation; most of these were developed based on results from open-label trials. New therapeutic strategies for gastroparesis include drugs that target the underlying defects, prokinetic agents such as 5-hydroxytryptamine agonists that do not appear to have cardiac or vascular effects, ghrelin agonists, approaches to pace the stomach, and stem cell therapies. PMID:20951838

  13. Understanding "masculinity" and the challenges of managing type-2 diabetes among African-American men.

    PubMed Central

    Liburd, Leandris C.; Namageyo-Funa, Apophia; Jack, Leonard

    2007-01-01

    African-American men bear a greater burden of type-2 diabetes and its associated complications. The purpose of this analysis was to explore in greater depth themes that emerged in illness narratives of a small sample of African-American men living with type-2 diabetes. The primary theme that is the focus of this article is the lived experience of black manhood and masculinity and its intersection with the challenges of diabetes self-management. In-depth interviews with 16 African-American men who had established type-2 diabetes yielded thematic analyses of four questions: (1) What do you fear most about having diabetes? (2) In what ways have people in your life treated you differently after learning you have diabetes? (3) In what ways has knowing you have diabetes affected the way you see yourself? and (4) What are some reactions when you tell people you have diabetes? This preliminary study suggests that the requirements of diabetes self-management often run counter to the traditional sex roles and learned behaviors of African-American men, and this can contribute to nonadherence to medications and poor glycemic control. Gender identity is a key cultural factor that influences health-related behaviors, including how men with type-2 diabetes engage with the healthcare system and manage their diabetes. Understanding African-American men's gender identity is an important component of cultural competency for physicians and can be consequential in patient outcomes. PMID:17534013

  14. Effects of Physical Activity on Diabetes Management and Lowering Risk for Type 2 Diabetes

    ERIC Educational Resources Information Center

    Tompkins, Connie L.; Soros, Arlette; Sothern, Melinda S.; Vargas, Alfonso

    2009-01-01

    Physical activity is a proven form of diabetes management and is considered a cornerstone in the prevention of diabetes. In children with diabetes, physical activity may improve insulin sensitivity and glucose uptake in skeletal muscle. Aerobic-based physical activity lasting 40-60 minutes daily for a minimum of four months is shown to enhance…

  15. Position statement on efficiency of technologies for diabetes management.

    PubMed

    Martín-Vaquero, Pilar; Martínez-Brocca, María Asunción; García-López, José Manuel

    2014-12-01

    Di@bet.es study results are impressive, showing that diabetes affects 13.8% of the Spanish population. Not only the statistical facts are alarming, but the increasing incidence of this disease is a major problem, as pandemic proportions of type 2 diabetes are expected. Thus, the study of diabetes represents a challenge not only for health services, but also for the Ministries of Health and Finance. Technology has become an essential tool in the quality are of patients with diabetes, as it helps in the healthcare processes to obtain an optimum metabolic balance and prevent possible complications. Insulin pumps, continuous glucose monitoring nd self-monitoring blood glucose have all proved their efficiency, and telemedicine it is making good progress. The indirect costs of diabetes in Spain are much higher than the directones, showing the importance of inverting the paradox. The optimization of resources depends not only on the ability of the physicians, but also the administration, to implant and sustain technological innovations in our system, and with that make it effective in terms of benefits. Cost-effectiveness and cost-utility analysis are needed to prioritize and allow health management services to make the correct choices for approaching this prevalent chronic disease. PMID:25453400

  16. Diabetes information technology: designing informatics systems to catalyze change in clinical care.

    PubMed

    Lester, William T; Zai, Adrian H; Chueh, Henry C; Grant, Richard W

    2008-03-01

    Current computerized reminder and decision support systems intended to improve diabetes care have had a limited effect on clinical outcomes. Increasing pressures on health care networks to meet standards of diabetes care have created an environment where information technology systems for diabetes management are often created under duress, appended to existing clinical systems, and poorly integrated into the existing workflow. After defining the components of diabetes disease management, the authors present an eight-step conceptual framework to guide the development of more effective diabetes information technology systems for translating clinical information into clinical action. PMID:19885355

  17. Diabetes Information Technology: Designing Informatics Systems to Catalyze Change in Clinical Care

    PubMed Central

    Lester, William T.; Zai, Adrian H.; Chueh, Henry C.; Grant, Richard W.

    2008-01-01

    Current computerized reminder and decision support systems intended to improve diabetes care have had a limited effect on clinical outcomes. Increasing pressures on health care networks to meet standards of diabetes care have created an environment where information technology systems for diabetes management are often created under duress, appended to existing clinical systems, and poorly integrated into the existing workflow. After defining the components of diabetes disease management, the authors present an eight-step conceptual framework to guide the development of more effective diabetes information technology systems for translating clinical information into clinical action. PMID:19885355

  18. Technology-facilitated depression care management among predominantly Latino diabetes patients within a public safety net care system: comparative effectiveness trial design.

    PubMed

    Wu, Shinyi; Ell, Kathleen; Gross-Schulman, Sandra G; Sklaroff, Laura Myerchin; Katon, Wayne J; Nezu, Art M; Lee, Pey-Jiuan; Vidyanti, Irene; Chou, Chih-Ping; Guterman, Jeffrey J

    2014-03-01

    Health disparities in minority populations are well recognized. Hispanics and Latinos constitute the largest ethnic minority group in the United States; a significant proportion receives their care via a safety net. The prevalence of diabetes mellitus and comorbid depression is high among this group, but the uptake of evidence-based collaborative depression care management has been suboptimal. The study design and baseline characteristics of the enrolled sample in the Diabetes-Depression Care-management Adoption Trial (DCAT) establishes a quasi-experimental comparative effectiveness research clinical trial aimed at accelerating the adoption of collaborative depression care in safety net clinics. The study was conducted in collaboration with the Los Angeles County Department of Health Services at eight county-operated clinics. DCAT has enrolled 1406 low-income, predominantly Hispanic/Latino patients with diabetes to test a translational model of depression care management. This three-group study compares usual care with a collaborative care team support model and a technology-facilitated depression care model that provides automated telephonic depression screening and monitoring tailored to patient conditions and preferences. Call results are integrated into a diabetes disease management registry that delivers provider notifications, generates tasks, and issues critical alerts. All subjects receive comprehensive assessments at baseline, 6, 12, and 18 months by independent English-Spanish bilingual interviewers. Study outcomes include depression outcomes, treatment adherence, satisfaction, acceptance of assessment and monitoring technology, social and economic stress reduction, diabetes self-care management, health care utilization, and care management model cost and cost-effectiveness comparisons. DCAT's goal is to optimize depression screening, treatment, follow-up, outcomes, and cost savings to reduce health disparities. PMID:24215775

  19. Diabetes foot disease: the Cinderella of Australian diabetes management?

    PubMed Central

    2012-01-01

    Diabetes is one of the greatest public health challenges to face Australia. It is already Australia’s leading cause of kidney failure, blindness (in those under 60 years) and lower limb amputation, and causes significant cardiovascular disease. Australia’s diabetes amputation rate is one of the worst in the developed world, and appears to have significantly increased in the last decade, whereas some other diabetes complication rates appear to have decreased. This paper aims to compare the national burden of disease for the four major diabetes-related complications and the availability of government funding to combat these complications, in order to determine where diabetes foot disease ranks in Australia. Our review of relevant national literature indicates foot disease ranks second overall in burden of disease and last in evidenced-based government funding to combat these diabetes complications. This suggests public funding to address foot disease in Australia is disproportionately low when compared to funding dedicated to other diabetes complications. There is ample evidence that appropriate government funding of evidence-based care improves all diabetes complication outcomes and reduces overall costs. Numerous diverse Australian peak bodies have now recommended similar diabetes foot evidence-based strategies that have reduced diabetes amputation rates and associated costs in other developed nations. It would seem intuitive that “it’s time” to fund these evidence-based strategies for diabetes foot disease in Australia as well. PMID:23021818

  20. Potential Bioactive Compounds from Seaweed for Diabetes Management.

    PubMed

    Sharifuddin, Yusrizam; Chin, Yao-Xian; Lim, Phaik-Eem; Phang, Siew-Moi

    2015-08-01

    Diabetes mellitus is a group of metabolic disorders of the endocrine system characterised by hyperglycaemia. Type II diabetes mellitus (T2DM) constitutes the majority of diabetes cases around the world and are due to unhealthy diet, sedentary lifestyle, as well as rise of obesity in the population, which warrants the search for new preventive and treatment strategies. Improved comprehension of T2DM pathophysiology provided various new agents and approaches against T2DM including via nutritional and lifestyle interventions. Seaweeds are rich in dietary fibres, unsaturated fatty acids, and polyphenolic compounds. Many of these seaweed compositions have been reported to be beneficial to human health including in managing diabetes. In this review, we discussed the diversity of seaweed composition and bioactive compounds which are potentially useful in preventing or managing T2DM by targeting various pharmacologically relevant routes including inhibition of enzymes such as α-glucosidase, α-amylase, lipase, aldose reductase, protein tyrosine phosphatase 1B (PTP1B) and dipeptidyl-peptidase-4 (DPP-4). Other mechanisms of action identified, such as anti-inflammatory, induction of hepatic antioxidant enzymes' activities, stimulation of glucose transport and incretin hormones release, as well as β-cell cytoprotection, were also discussed by taking into consideration numerous in vitro, in vivo, and human studies involving seaweed and seaweed-derived agents. PMID:26308010

  1. Potential Bioactive Compounds from Seaweed for Diabetes Management

    PubMed Central

    Sharifuddin, Yusrizam; Chin, Yao-Xian; Lim, Phaik-Eem; Phang, Siew-Moi

    2015-01-01

    Diabetes mellitus is a group of metabolic disorders of the endocrine system characterised by hyperglycaemia. Type II diabetes mellitus (T2DM) constitutes the majority of diabetes cases around the world and are due to unhealthy diet, sedentary lifestyle, as well as rise of obesity in the population, which warrants the search for new preventive and treatment strategies. Improved comprehension of T2DM pathophysiology provided various new agents and approaches against T2DM including via nutritional and lifestyle interventions. Seaweeds are rich in dietary fibres, unsaturated fatty acids, and polyphenolic compounds. Many of these seaweed compositions have been reported to be beneficial to human health including in managing diabetes. In this review, we discussed the diversity of seaweed composition and bioactive compounds which are potentially useful in preventing or managing T2DM by targeting various pharmacologically relevant routes including inhibition of enzymes such as α-glucosidase, α-amylase, lipase, aldose reductase, protein tyrosine phosphatase 1B (PTP1B) and dipeptidyl-peptidase-4 (DPP-4). Other mechanisms of action identified, such as anti-inflammatory, induction of hepatic antioxidant enzymes’ activities, stimulation of glucose transport and incretin hormones release, as well as β-cell cytoprotection, were also discussed by taking into consideration numerous in vitro, in vivo, and human studies involving seaweed and seaweed-derived agents. PMID:26308010

  2. Nurse Practitioner Management of Type 2 Diabetes

    PubMed Central

    Richardson, Gail Carr; Derouin, Anne L; Vorderstrasse, Allison A; Hipkens, James; Thompson, Julie A

    2014-01-01

    Context Multifactorial barriers prevent primary care clinicians from helping their adult patients with type 2 diabetes achieve good control of hemoglobin A1c (HbA1c) levels. Patients’ depression and low self-efficacy can complicate diabetes management by impairing tasks needed for effective disease self-management. Objectives: To evaluate whether nurse practitioners in collaborative practices with primary care clinicians are effective in helping improve control of HbA1c, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in adults with uncontrolled hyperglycemia, and to assess whether nurse practitioner-guided care affects depression and self-efficacy in these patients. Design: De-identified preintervention and postintervention data were collected from prospective review of medical charts of patients in a managed care organization’s primary care clinics. Main Outcome Measures: Preintervention and postintervention HbA1c values were evaluated as the primary outcome measure. Preintervention and postintervention values for BP, LDL-C, body weight, and depression and self-efficacy scores were secondary outcome measures. Results: After intervention, 50% of 26 patients achieved HbA1c benchmarks, 95.6% achieved systolic and diastolic BP benchmarks, and 57.8% achieved LDL-C benchmarks. Wilcoxon paired samples tests showed significantly increased self-efficacy (z = −3.42, p < 0.001) from preintervention to postintervention. Depression scores decreased slightly from preintervention (mean = 0.44, standard deviation = 1.34, median < 0.001) to postintervention values (mean = 0.18, standard deviation = 0.73, median < 0.001), but this decrease was not significant. Conclusion: Integrating nurse practitioners into primary care teams to provide innovative methods of support to adults with uncontrolled hyperglycemia improves clinical outcomes and self-efficacy for patients with type 2 diabetes. PMID:24867560

  3. Problems in diabetes mellitus management. Insulin resistance.

    PubMed

    Wolfsheimer, K J

    1990-12-01

    Insulin resistance is a cause for morning hyperglycemia seen in diabetic patients. Other reasons for morning hyperglycemia should be eliminated by performing an insulin response test. Once insulin resistance has been established as the cause of hyperglycemia, a step-by-step process should be used to establish the cause of the insulin resistance. Common causes of insulin resistance include hyperadrenocorticism, acromegaly, hyperthyroidism, and obesity. Hepatic disease, renal insufficiency, and sepsis are other causes of insulin resistance in practice. Less common causes include insulin antibodies, pregnancy, neoplasia, hyperandrogenism, and pheochromocytoma. If the underlying cause cannot be found or resolved, then increased doses of insulin are required to manage the hyperglycemia. PMID:2134077

  4. The HLA system and diabetes mellitus.

    PubMed

    Cudworth, A G; Woodrow, J C

    1977-06-01

    There is a significant positive association between insulin dependent diabetes, irrespective of age of onset, and the HLA system, whereas there is no association of HLA antigens with non-insulin dependent diabetes. There is a significant concordance value for HLA antigen frequencies in insulin dependent diabetics from three different centres, indicating that the genes (s) conferring susceptibility to this type of diabetes is possibly present in all "juvenile-onset" diabetics and is in linkage disequilibrium with all the B locus alleles. PMID:892129

  5. The Adenosinergic System in Diabetic Retinopathy

    PubMed Central

    Vindeirinho, J.; Santiago, A. R.; Cavadas, C.; Ambrósio, A. F.; Santos, P. F.

    2016-01-01

    The neurodegenerative and inflammatory environment that is prevalent in the diabetic eye is a key player in the development and progression of diabetic retinopathy. The adenosinergic system is widely regarded as a significant modulator of neurotransmission and the inflammatory response, through the actions of the four types of adenosine receptors (A1R, A2AR, A2BR, and A3R), and thus could be revealed as a potential player in the events unfolding in the early stages of diabetic retinopathy. Herein, we review the studies that explore the impact of diabetic conditions on the retinal adenosinergic system, as well as the role of the said system in ameliorating or exacerbating those conditions. The experimental results described suggest that this system is heavily affected by diabetic conditions and that the modulation of its components could reveal potential therapeutic targets for the treatment of diabetic retinopathy, particularly in the early stages of the disease. PMID:27034960

  6. Epidemiology, Mechanisms and Management of Diabetic Gastroparesis

    PubMed Central

    Camilleri, Michael; Bharucha, Adil E.; Farrugia, Gianrico

    2010-01-01

    Background Recent evidence of the significant impact of gastroparesis on morbidity and mortality mandates optimized management of this condition. Gastroparesis affects nutritional state and, in diabetics, it also has deleterious effects on glycemic control and secondary effects on organs that lead to increased mortality. First-line treatment includes restoration of nutrition and medications (prokinetic and antiemetic). Aim To review the epidemiology, pathophysiology, impact, natural history, time trends and treatment of gastroparesis with particular focus on diabetic gastroparesis. Methods The pros and cons of current treatment options including metoclopramide are discussed. Second-line approaches include surgery, venting gastrostomy or jejunostomy, and gastric electrical stimulation; most of these treatments are based on open-label treatment trials. Results/Conclusions In the future, drugs that target the underlying defects and new prokinetics such as newer 5-HT4 agonists (which appear to be devoid of cardiac or vascular effects), ghrelin agonists, new approaches to pacing the stomach, and stem cell therapies may bring more effective treatments to ameliorate the management of patients with gastroparesis. PMID:20951838

  7. Diabetes management before and after cancer diagnosis: missed opportunity

    PubMed Central

    Camacho, Fabian T.; Chukmaitov, Askar S.; Fleming, Steven T.; Anderson, Roger T.

    2015-01-01

    Background Few studies have examined the management of comorbidities in cancer patients. This study used population-based data to estimate the guideline concordance rates for diabetes management before and after cancer diagnosis and examined if diabetes management services among cancer patients was associated with characteristics of the hospital where the patient was treated. Methods We linked 2005-2009 Medicare claims data to information on 2,707 breast and colorectal cancers patients in state cancer registry files. Multivariate logistic regression models examined hospital characteristics associated with receipt of diabetes management care after cancer diagnosis. Results The rates of HbAlc testing, LDL-C testing, and retinal eye exam decreased from 72.7%, 79.6%, and 57.9% before cancer diagnosis to 58.3%, 69.5%, and 55.8% after diagnosis. The pre- and post-diagnosis diabetes management care was not significantly different by hospital characteristics in the bivariate analysis except for that the distance between residence and hospital was negatively related to retinal eye exam after diagnosis (P<0.05). The multivariate analysis did not identify any significant differences in diabetes management care after cancer diagnosis by hospital characteristics. Conclusions Cancer patients received fewer diabetes management care after diagnosis than prior to diagnosis, even for those who were treated in large comprehensive centers. This may reflect a missed opportunity to connect diabetic cancer patients to diabetes care. This study provides benchmarks to measure improvements in comorbidity management among cancer patients. PMID:25992371

  8. Antioxidant Strategies in the Management of Diabetic Neuropathy

    PubMed Central

    Oyenihi, Ayodeji Babatunde; Ayeleso, Ademola Olabode; Masola, Bubuya

    2015-01-01

    Chronic hyperglycaemia (an abnormally high glucose concentration in the blood) resulting from defects in insulin secretion/action, or both, is the major hallmark of diabetes in which it is known to be involved in the progression of the condition to different complications that include diabetic neuropathy. Diabetic neuropathy (diabetes-induced nerve damage) is the most common diabetic complication and can be devastating because it can lead to disability. There is an increasing body of evidence associating diabetic neuropathy with oxidative stress. Oxidative stress results from the production of oxygen free radicals in the body in excess of its ability to eliminate them by antioxidant activity. Antioxidants have different mechanisms and sites of actions by which they exert their biochemical effects and ameliorate nerve dysfunction in diabetes by acting directly against oxidative damage. This review will examine different strategies for managing diabetic neuropathy which rely on exogenous antioxidants. PMID:25821809

  9. Current status of managing diabetes mellitus in Korea.

    PubMed

    Ha, Kyoung Hwa; Kim, Dae Jung

    2016-09-01

    Diabetes mellitus is an increasing global health problem. Guidelines for diabetic care recommend management of lifestyle and risk factors (glucose, blood pressure, and cholesterol), as well as regular screening for complications associated with treatment of the conditions related to diabetes. The prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013. According to the diabetes fact sheet 2015, the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% from 2006 to 2013, and 49.5% of those with diabetes were being treated with lipid-lowering medications in 2013, a 1.8-fold increase since 2006. According to the 2014 Korea National Health and Nutrition Examination Survey data, 45.6% of patients with diabetes achieved a hemoglobin A1c level of < 7.0%, 72.8% achieved a blood pressure of < 140/85 mmHg, and 58.0% achieved a low density lipoprotein cholesterol level of < 100 mg/dL. Only 19.7% of patients with diabetes had good control of all three of these parameters. Despite improvements in health promotion efforts, the rates of adherence to medication and risk-factor control are low. Therefore, a systematic approach to managing diabetes, including self-management education, is needed to prevent or delay complications. The government needs to establish a long-term policy to address the growing burden of diabetes. PMID:27604796

  10. Current status of managing diabetes mellitus in Korea

    PubMed Central

    Ha, Kyoung Hwa; Kim, Dae Jung

    2016-01-01

    Diabetes mellitus is an increasing global health problem. Guidelines for diabetic care recommend management of lifestyle and risk factors (glucose, blood pressure, and cholesterol), as well as regular screening for complications associated with treatment of the conditions related to diabetes. The prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013. According to the diabetes fact sheet 2015, the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% from 2006 to 2013, and 49.5% of those with diabetes were being treated with lipid-lowering medications in 2013, a 1.8-fold increase since 2006. According to the 2014 Korea National Health and Nutrition Examination Survey data, 45.6% of patients with diabetes achieved a hemoglobin A1c level of < 7.0%, 72.8% achieved a blood pressure of < 140/85 mmHg, and 58.0% achieved a low density lipoprotein cholesterol level of < 100 mg/dL. Only 19.7% of patients with diabetes had good control of all three of these parameters. Despite improvements in health promotion efforts, the rates of adherence to medication and risk-factor control are low. Therefore, a systematic approach to managing diabetes, including self-management education, is needed to prevent or delay complications. The government needs to establish a long-term policy to address the growing burden of diabetes. PMID:27604796

  11. Standardized Glycemic Management with a Computerized Workflow and Decision Support System for Hospitalized Patients with Type 2 Diabetes on Different Wards

    PubMed Central

    Neubauer, Katharina M.; Höll, Bernhard; Aberer, Felix; Donsa, Klaus; Augustin, Thomas; Schaupp, Lukas; Spat, Stephan; Beck, Peter; Fruhwald, Friedrich M.; Schnedl, Christian; Rosenkranz, Alexander R.; Lumenta, David B.; Kamolz, Lars-Peter; Plank, Johannes; Pieber, Thomas R.

    2015-01-01

    Abstract Background: This study investigated the efficacy, safety, and usability of standardized glycemic management by a computerized decision support system for non-critically ill hospitalized patients with type 2 diabetes on four different wards. Materials and Methods: In this open, noncontrolled intervention study, glycemic management of 99 patients with type 2 diabetes (62% acute admissions; 41 females; age, 67±11 years; hemoglobin A1c, 65±21 mmol/mol; body mass index, 30.4±6.5 kg/m2) on clinical wards (Cardiology, Endocrinology, Nephrology, Plastic Surgery) of a tertiary-care hospital was guided by GlucoTab® (Joanneum Research GmbH [Graz, Austria] and Medical University of Graz [Graz, Austria]), a mobile decision support system providing automated workflow support and suggestions for insulin dosing to nurses and physicians. Results: Adherence to insulin dosing suggestions was high (96.5% bolus, 96.7% basal). The primary outcome measure, percentage of blood glucose (BG) measurements in the range of 70–140 mg/dL, occurred in 50.2±22.2% of all measurements. The overall mean BG level was 154±35 mg/dL. BG measurements in the ranges of 60–70 mg/dL, 40–60 mg/dL, and <40 mg/dL occurred in 1.4%, 0.5%, and 0.0% of all measurements, respectively. A regression analysis showed that acute admission to the Cardiology Ward (+30 mg/dL) and preexisting home insulin therapy (+26 mg/dL) had the strongest impact on mean BG. Acute admission to other wards had minor effects (+4 mg/dL). Ninety-one percent of the healthcare professionals felt confident with GlucoTab, and 89% believed in its practicality and 80% in its ability to prevent medication errors. Conclusions: An efficacious, safe, and user-accepted implementation of GlucoTab was demonstrated. However, for optimized personalized patient care, further algorithm modifications are required. PMID:26355756

  12. [The German Program for Disease Management Guidelines Type 2 Diabetes - Diabetic Foot Guideline 2006. Short review].

    PubMed

    Ollenschläger, Günter; Kopp, Ina; Thole, Henning; Lelgemann, Monika

    2007-03-15

    In Germany, the first national consensus between 14 medical scientific associations on evidence-based recommendations for prevention and therapy of foot problems in type 2 diabetes was reached in fall 2006. The recommendations' main sources are the NICE Guideline 2003 on foot problems in type 2 diabetes, as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline Type 2 Diabetes - Diabetic Foot 2006 (www.diabetes.versorgungsleitlinien.de). PMID:17345021

  13. Technophobia, prescription checking and the future of diabetes management.

    PubMed

    Albisser, A M

    2009-06-01

    Is the medical prescription the root cause of the long-term complications of diabetes mellitus? This article presents the argument for introducing prescription checking into diabetes disease management. It discusses an evidence-based need for frequent revisions of the medical prescription as the key to preventing treatment-related complications in diabetes while achieving the now mandated standards in patient care. To do this it will be prudent for diabetes healthcare providers to enrich their clinical services with new information technology-based tools. These are easily acquired by participating in professional workshops focused on advanced diabetes management. In this light, the case presented here challenges leading practitioners to become early participants in the evolution of information technology that will ultimately enhance the management of all patients with diabetes. PMID:19357829

  14. Evolving strategies in the management of diabetic retinopathy.

    PubMed

    Abu El-Asrar, Ahmed M

    2013-01-01

    Diabetic retinopathy (DR), the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Tight glycemic and blood pressure control has been shown to significantly decrease the risk of development as well as the progression of retinopathy and represents the cornerstone of medical management of DR. The two most threatening complications of DR are diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Focal/grid photocoagulation and panretinal photocoagulation are standard treatments for both DME and PDR, respectively. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with DME. Currently, most experts consider combination focal/grid laser therapy and pharmacotherapy with intravitreal antivascular endothelial growth factor agents in patients with center-involving DME. Combination therapy reduces the frequency of injections needed to control edema. Vitrectomy with removal of the posterior hyaloid seems to be effective in eyes with persistent diffuse DME, particularly in eyes with associated vitreomacular traction. Emerging therapies include fenofibrate, ruboxistaurin, renin-angiotensin system blockers, peroxisome proliferator-activated receptor gamma agonists, pharmacologic vitreolysis, and islet cell transplantation. PMID:24339676

  15. Management of diabetes in South Asian communities in the UK.

    PubMed

    Hill, Jillian

    This article discusses some of the specific challenges related to the management of diabetes in patients of South Asian origin. Communicating information that considers cultural, religious and language differences is important to promote effective self-management. The South Asian population in the UK is at greater risk of developing type 2 diabetes, and cultural practices such as fasting if not managed properly can lead to deterioration in their condition. The use of appropriate information and educators with Asian language skills and an understanding of the local population's culture are important to improve self-management of diabetes in these patients. PMID:16536399

  16. Diabetes mellitus and tuberculosis: programmatic management issues.

    PubMed

    Harries, A D; Kumar, A M V; Satyanarayana, S; Lin, Y; Zachariah, R; Lönnroth, K; Kapur, A

    2015-08-01

    In August 2011, the World Health Organization and the International Union Against Tuberculosis and Lung Disease launched the Collaborative Framework for Care and Control of Tuberculosis (TB) and diabetes mellitus (DM) to guide policy makers and implementers in combatting the epidemics of both diseases. Progress has been made, and includes identifying how best to undertake bidirectional screening for both diseases, how to provide optimal treatment and care for patients with dual disease and the most suitable framework for monitoring and evaluation. Key programmatic challenges include the following: whether screening should be directed at all patients or targeted at those with high-risk characteristics; the most suitable technologies for diagnosing TB and diabetes in routine settings; the best time to screen TB patients for DM; how to provide an integrated, coordinated approach to case management; and finally, how to persuade non-communicable disease programmes to adopt a cohort analysis approach, preferably using electronic medical records, for monitoring and evaluation. The link between DM and TB and the implementation of the collaborative framework for care and control have the potential to stimulate and strengthen the scale-up of non-communicable disease care and prevention programmes, which may help in reducing not only the global burden of DM but also the global burden of TB. PMID:26162352

  17. Self-management experiences among men and women with type 2 diabetes mellitus: a qualitative analysis

    PubMed Central

    2012-01-01

    Background The purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM). Methods 35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus groups and nine individual interviews were conducted to explore men and women's diabetes self-management experiences. Results The average age of participants was 57 years and just over half (51.4%) were female. Analyses revealed five themes: disclosure and identity as a person living with diabetes; self-monitoring of blood glucose (SMBG); diet struggles across varying contexts; utilization of diabetes resources; and social support. Women disclosed their diabetes more readily and integrated management into their daily lives, whereas men were more reluctant to tell friends and family about their diabetes and were less observant of self-management practices in social settings. Men focused on practical aspects of SMBG and experimented with various aspects of management to reduce reliance on medications whereas women focused on affective components of SMBG. Women restricted foods from their diets perceived as prohibited whereas many men moderated their intake of perceived unhealthy foods, except in social situations. Women used socially interactive resources, like education classes and support groups whereas men relied more on self-directed learning but also described wanting more guidance to help navigate the healthcare system. Finally, men and women reported wanting physician support for both affective and practical aspects of self-management. Conclusions Our findings highlight the differences in needs and challenges of diabetes self-management among men and women, which may inform gender-sensitive diabetes, care, counseling and support. PMID:23249410

  18. Diabetes management in Thailand: a literature review of the burden, costs, and outcomes

    PubMed Central

    2013-01-01

    Management of diabetes represents an enormous challenge for health systems at every level of development. The latter are tested for their ability to continuously deliver high quality care to patients from the day they are diagnosed throughout their life. In this study, we review the status of diabetes management in Thailand and try to identify the key challenges the country needs to address to reduce the current (and future) medical and economic burden caused by the disease. We conducted a literature review on the burden, costs, and outcomes of diabetes in Thailand. This information was complemented by personal communication with senior officials in the Thai Ministry of Health. We identified the following priorities for the future management of diabetes in Thailand. First, increasing screening of diabetes in high risk population and promoting annual screening of diabetes complications in all diabetic patients. Second, identifying and addressing factors affecting poor treatment outcomes. Third, policy should specify clear targets and provide and use a monitoring framework to track progress. Fourth, efforts are needed to further improve data availability. Up-to-date data on the medical and economic burden of diabetes representative at the national level and at least the regional level are essential to identify needs and monitor progress towards established targets. Fifth, promotion of a healthy lifestyle for prevention of diabetes through education and quality information delivered to the public. PMID:23497447

  19. Diabetes mellitus in patients with cirrhosis: clinical implications and management.

    PubMed

    Elkrief, Laure; Rautou, Pierre-Emmanuel; Sarin, Shiv; Valla, Dominique; Paradis, Valérie; Moreau, Richard

    2016-07-01

    Disorders of glucose metabolism, namely glucose intolerance and diabetes, are frequent in patients with chronic liver diseases. In patients with cirrhosis, diabetes can be either a classical type 2 diabetes mellitus or the so-called hepatogenous diabetes, i.e. a consequence of liver insufficiency and portal hypertension. This review article provides an overview of the possible pathophysiological mechanisms explaining diabetes in patients with cirrhosis. Cirrhosis is associated with portosystemic shunts as well as reduced hepatic mass, which can both impair insulin clearance by the liver, contributing to peripheral insulin resistance through insulin receptors down-regulation. Moreover, cirrhosis is associated with increased levels of advanced-glycation-end products and hypoxia-inducible-factors, which may play a role in the development of diabetes. This review also focuses on the clinical implications of diabetes in patients with cirrhosis. First, diabetes is an independent factor for poor prognosis in patients with cirrhosis. Specifically, diabetes is associated with the occurrence of major complications of cirrhosis, including ascites and renal dysfunction, hepatic encephalopathy and bacterial infections. Diabetes is also associated with an increased risk of hepatocellular carcinoma in patients with chronic liver diseases. Last, the management of patients with concurrent diabetes and liver disease is also addressed. Recent findings suggest a beneficial impact of metformin in patients with chronic liver diseases. Insulin is often required in patients with advanced cirrhosis. However, the favourable impact of controlling diabetes in patients with cirrhosis has not been demonstrated yet. PMID:26972930

  20. Diabetes care for emerging adults: transition from pediatric to adult diabetes care systems.

    PubMed

    Lee, Young Ah

    2013-09-01

    With the increasing prevalence of diabetes mellitus in children, transitioning patients from childhood to adulthood are increasing. High-risk behaviors and poor glycemic control during the transition period increase the risk for hypoglycemia and hyperglycemia as well as chronic microvascular and macrovascular complications. Discussions regarding complications and preparations for transition must take place before the actual transition to adult care systems. Pediatric care providers should focus on diabetes self-management skills and prepare at least 1 year prior to the transfer. Pediatric providers should also provide a written summary about previous and current glycemic control, complications and the presence of mental health problems such as disordered eating behaviors and affective disorders. Transition care should be individualized, with an emphasis on diabetes self-management to prevent acute and long-term complications. Regular screening and management of complications should proceed according to pediatric and adult guidelines. Birth control, use of alcohol, smoking and driving should also be discussed. Barriers to self-management and care must be recognized and solutions sought. The goals of transitional care are to effectively transition the diabetic patient from the pediatric to adult care system with less elapsed time in between and to improve post-transition outcome. Previous studies regarding diabetes transitional care programs including patient education programs, medical coordinators and auxiliary service systems reported promising results. However, there is a lack of evidence regarding best practices in transition care. Further studies are needed to provide evidence based transitional care programs that take both medical and psychosocial aspects of diabetes care into consideration. PMID:24904862

  1. Prevalence and Management of Diabetic Nephropathy in Western Countries

    PubMed Central

    Satirapoj, Bancha; Adler, Sharon G.

    2015-01-01

    Background Diabetic nephropathy (DN) often results in end-stage renal disease, and this is the most common reason for initiation of dialysis in the United States. Complications of diabetes, particularly renal disease, substantially increase the risk of subsequent severe illness and death. The prevalence of DN is still rising dramatically, with concomitant increases in associated mortality and cardiovascular complications. Summary Renal involvement in type 1 and type 2 diabetes reflects a complex pathogenesis. Various genetic and environmental factors determine the susceptibility and progression to advanced stages of the disease. DN should be considered in patients who have had type 1 diabetes for at least 10 years with microalbuminuria and diabetic retinopathy, as well as in patients with type 1 or type 2 diabetes with macroalbuminuria in whom other causes for proteinuria are absent. The glomerular characteristic features include mesangial expansion, thickened glomerular basement membrane, and hyalinosis of arterioles. The optimal therapy of DN continues to evolve. For all diabetic patients, practical management including blood glucose and blood pressure control with renin-angiotensin-aldosterone blockade combined with lipid control, dietary salt restriction, lowering the dietary protein intake, increased physical activity, weight reduction, and smoking cessation can reduce the rate of progression of nephropathy and cardiovascular disease. Key Message DN is a complex disease linking hemodynamic and metabolic pathways with oxidative stress, and systemic inflammation. We summarize the current evidence of epidemiology, clinical diagnosis, and the current management of DN in Western countries. Facts from East and West The prevalence of DN is increasing in Asia and Western countries alike. The deletion (D) allele of the angiotensin-converting enzyme gene is associated with progression to end-stage renal disease in Asian patients with DN, but this association is

  2. Step 3: Manage Your Diabetes | NIH MedlinePlus the Magazine

    MedlinePlus

    ... JavaScript on. Feature: Type 2 Diabetes Step 3: Manage Your Diabetes Past Issues / Fall 2014 Table of ... glucose and how to use the results to manage your diabetes. Discuss how your self-care plan ...

  3. Care Utilization Patterns and Diabetes Self-Management Education Duration.

    PubMed

    Johnson, Tammie M; Richards, Jennifer; Churilla, James R

    2015-08-01

    Objective. Previous studies have shown that receiving diabetes self-management education (DSME) is associated with increased care utilization. However, the relationship between DSME duration and care utilization patterns remains largely unexamined. Our purpose is to characterize DSME duration and examine the relationship between DSME duration and clinical- and self-care utilization patterns. Methods. The study sample included 1,446 adults who were ≥18 years of age, had diabetes, and had participated in the 2008 Florida Behavioral Risk Factor Surveillance System survey. Clinical- and self-care outcomes were derived using responses to the survey's diabetes module and were based on minimum standards of care established by the American Diabetes Association. The outcomes examined included self-monitoring of blood glucose at least once per day; receiving at least one eye exam, one foot exam, A1C tests, and an influenza vaccination in the past year; and ever receiving a pneumococcal vaccination. DSME duration was categorized as no DSME, >0 to <4 hours, 4-10 hours, and >10 hours. Results. After adjusting for sociodemographic variables, compared to those who did not receive DSME, those who had 4-10 or 10+ hours of DSME were more likely to receive two A1C tests (odds ratio [95% CI] 2.69 [1.30-5.58] and 2.63 [1.10-6.31], respectively) and have a pneumococcal vaccination (1.98 [1.03-3.80] and 1.92 [1.01-3.64], respectively). Those receiving 10+ hours of DSME were 2.2 times (95% CI 1.18-4.09) as likely to have an influenza vaccination. Conclusion. These data reveal a positive relationship between DSME duration and utilization of some diabetes clinical care services. PMID:26300613

  4. Australian Diabetes Foot Network: management of diabetes-related foot ulceration - a clinical update.

    PubMed

    Bergin, Shan M; Gurr, Joel M; Allard, Bernard P; Holland, Emma L; Horsley, Mark W; Kamp, Maarten C; Lazzarini, Peter A; Nube, Vanessa L; Sinha, Ashim K; Warnock, Jason T; Alford, Jan B; Wraight, Paul R

    2012-08-20

    Appropriate assessment and management of diabetes-related foot ulcers (DRFUs) is essential to reduce amputation risk. Management requires debridement, wound dressing, pressure off-loading, good glycaemic control and potentially antibiotic therapy and vascular intervention. As a minimum, all DRFUs should be managed by a doctor and a podiatrist and/or wound care nurse. Health professionals unable to provide appropriate care for people with DRFUs should promptly refer individuals to professionals with the requisite knowledge and skills. Indicators for immediate referral to an emergency department or multidisciplinary foot care team (MFCT) include gangrene, limb-threatening ischaemia, deep ulcers (bone, joint or tendon in the wound base), ascending cellulitis, systemic symptoms of infection and abscesses. Referral to an MFCT should occur if there is lack of wound progress after 4 weeks of appropriate treatment. PMID:22900873

  5. Alphabet Strategy for diabetes care: A multi-professional, evidence-based, outcome-directed approach to management.

    PubMed

    Lee, James D; Saravanan, Ponnusamy; Patel, Vinod

    2015-06-25

    With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work. PMID:26131328

  6. Alphabet Strategy for diabetes care: A multi-professional, evidence-based, outcome-directed approach to management

    PubMed Central

    Lee, James D; Saravanan, Ponnusamy; Patel, Vinod

    2015-01-01

    With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work. PMID:26131328

  7. Diabetic patients' willingness to use tele-technology to manage their disease – A descriptive study.

    PubMed Central

    Saddik, Basema; Al-Dulaijan, Norah

    2015-01-01

    Objectives: Diabetes mellitus is a public health concern worldwide. TeleHealth technology may be an effective tool for empowering patients in the self-management of diabetes mellitus. However despite the great impact of diabetes on healthcare in Saudi Arabia, no research has investigated diabetic patients' willingness to use this technology. This study investigates diabetic patients' willingness to use tele-technology as a tool to monitor their disease. Methods: Data were collected from diabetic patients attending the diabetes education clinic at the Ministry of National Guard Health Affairs (MNGHA) in the Eastern region of Saudi Arabia over a three month period. A survey was developed which measured patients' willingness to use tele-technology in the self-management of their diabetes as well as their perceived expectations from the technology. Results: The study found that the majority of patients were willing to use tele-technology to self- monitor their diabetes. However, a minority (11.3%) indicated willingness to use the system daily and only half indicated preference to use it once a week (53.8%). Patients who were younger, had higher education levels, were employed, had internet access and had Type II diabetes were significantly more likely to report willingness to use the technology. Conclusions: Diabetic patients could be ready to play a more active role in their care if given the opportunity. Results from this study could serve as a baseline for future studies to develop targeted interventions by trialing tele-technology on a sample of the diabetic population. Patients with diabetes need to be in charge of their own care in order to improve health outcomes across the country. PMID:26284148

  8. Management of diabetes in childhood: are children small adults?

    PubMed

    Franzese, A; Valerio, G; Spagnuolo, M I

    2004-06-01

    Diabetes in childhood is the most common chronic disease and generally fits the type 1 category, even though other forms of non-autoimmune diabetes are now emerging in this age. At variance with adults, children and adolescents undergo physiological process, which may frequently require adjustments of clinical management of diabetes. Moreover, the hormonal and psychological changes during puberty may be crucial in conditioning management. Furthermore, common illnesses frequently affecting children may also destabilise metabolic control. Consequently, education in children is the cornerstone of treatment. This review focuses on the several and peculiar aspects of practical management of diabetes in paediatric age, which require professional figures such as paediatricians, nurses, dieticians, psychologists, social assistants originally trained in paediatric area, able to deal with the age-related medical, educational, nutritional and behavioural issues of diabetes. PMID:15158292

  9. Changing trends in management of gestational diabetes mellitus

    PubMed Central

    Poomalar, Gunasekaran Kala

    2015-01-01

    Gestational diabetes mellitus (GDM) is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control than older insulins. Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control. Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes. As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high, regular assessment of these women is required in future. Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome. PMID:25789109

  10. Pharmacological Management of Bipolar Disorder in a Youth with Diabetes

    ERIC Educational Resources Information Center

    DelBello, Melissa P.; Correll, Christoph U.; Carlson, Gabrielle A.; Carlson, Harold E.; Kratochvil, Christopher J.

    2007-01-01

    In this article, four clinicians respond to the following case vignette: A 12-year-old girl with insulin-dependent diabetes presents for treatment of her newly diagnosed bipolar disorder. How would you address the bipolar disorder pharmacologically, and how would the presence of diabetes affect your selection of medication and clinical management?

  11. Use of Medicare's Diabetes Self-Management Training Benefit

    ERIC Educational Resources Information Center

    Strawbridge, Larisa M.; Lloyd, Jennifer T.; Meadow, Ann; Riley, Gerald F.; Howell, Benjamin L.

    2015-01-01

    Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to…

  12. Adolescent and parent assessments of diabetes mellitus management at school.

    PubMed

    Hayes-Bohn, Rachel; Neumark-Sztainer, Dianne; Mellin, Alison; Patterson, Joan

    2004-05-01

    This study explored opinions, concerns, and recommendations regarding care of Type 1 diabetes in schools. Thirty adolescent females and their parents participated in semi- structured, individual interviews that were audiotaped, transcribed, coded, and qualitatively analyzed. Responses emerged in three categories: knowledge/training of school staff; foods offered/available at school; and school rules. Participants expressed concerns that school personnel, particularly classroom teachers, possess limited knowledge of diabetes; that healthy food/beverage options are limited in the cafeteria, vending machines, and classrooms; and that school rules impede self-care of diabetes. Implications for enhancing diabetes management at school are noted. PMID:15283497

  13. Sick-day management in type 1 diabetes.

    PubMed

    Laffel, L

    2000-12-01

    Illness and stress are common occurrences. For the person with type 1 diabetes, these events can be triggers for counterregulation and [table: see text] subsequent metabolic deterioration if there is no attention to diabetes management tasks. Sick-day management requires increased monitoring of blood glucose and assessment for ketosis. Although urine testing for ketones has been the standard approach to sick-day management, new technology for self-monitoring of blood 3HB levels is now available. According to the American Diabetes Association, blood measurement of 3HB "may offer a useful alternative to urine ketone testing." This new technology may provide an opportunity to improve the management of uncontrolled diabetes and sick days in an attempt to reduce the human and economic burden of DKA. PMID:11149158

  14. The need for additional training for nutritional management of diabetes.

    PubMed

    Carney, Trish; Stein, Susan E; Quinlan, Jennifer J

    The purpose of this study was to investigate nurses' and nursing students'knowledge and perceived role in assisting patients with the nutritional management of diabetes. Three focus groups were conducted and the results were used to modify a previously developed survey regarding the nutritional management of diabetes. The survey was administered via an online survey tool and completed by 231 nurses and students. Over 70% of respondents agreed that nurses have an important role in reinforcing patient nutritional education. Results indicated,however, that knowledge gaps in the nutritional management of diabetes exist among nurses, including not knowing the carbohydrate content of 120ml of orange juice, a common treatment for hypoglycaemia (47.5%), not knowing where to locate carbohydrate content on a food label (60%), and not identifying the correct treatment for hypoglycaemia (47.5%). These results indicate that there may be a need to improve the nutritional education of nurses with respect to diabetes management. PMID:23752631

  15. 'Glycemic Index' May Be Too Unreliable to Manage Diabetes

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_160837.html 'Glycemic Index' May Be Too Unreliable to Manage Diabetes: Study ... 2016 WEDNESDAY, Sept. 7, 2016 (HealthDay News) -- Glycemic index values of the same foods can vary widely ...

  16. The influence of cognition on self-management of type 2 diabetes in older people.

    PubMed

    Tomlin, Ali; Sinclair, Alan

    2016-01-01

    Diabetes is a growing public health issue, increasing in prevalence, eroding quality of life, and burdening health care systems. The complications of diabetes can be avoided or delayed by maintaining good glycemic control, which is achievable through self-management and, where necessary, medication. Older people with diabetes are at increased risk for cognitive impairment. This review aims to bring together current research that has investigated both cognition and diabetes self-management together. The Cumulative Index to Nursing and Allied Health (Cinahl), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System (Medline), and Psychological Information (PsychInfo) databases were searched. Studies were included if they featured older people with type 2 diabetes and had looked for associations between at least one distinct measure of cognition and at least one distinct measure of diabetes self-management. English language publications from the year 2000 were included. Cognitive measures of executive function, memory, and low scores on tests of global cognitive functioning showed significant correlations with multiple areas of diabetes self-management, including diabetes-specific numeracy ability, diabetes knowledge, insulin adjustment skills, ability to learn to perform insulin injections, worse adherence to medications, decreased frequency of self-care activities, missed appointments, decreased frequency of diabetes monitoring, and increased inaccuracies in reporting blood glucose monitoring. The nature of the subjects studied was quite variable in terms of their disease duration, previous medical histories, associated medical comorbidities, and educational level attained prior to being diagnosed with diabetes. The majority of studies were of an associational nature and not findings confirmed by repeat testing or by the effects of an intervention, neither were the majority of studies designed to give a view or conclusion on the clinical

  17. The influence of cognition on self-management of type 2 diabetes in older people

    PubMed Central

    Tomlin, Ali; Sinclair, Alan

    2016-01-01

    Diabetes is a growing public health issue, increasing in prevalence, eroding quality of life, and burdening health care systems. The complications of diabetes can be avoided or delayed by maintaining good glycemic control, which is achievable through self-management and, where necessary, medication. Older people with diabetes are at increased risk for cognitive impairment. This review aims to bring together current research that has investigated both cognition and diabetes self-management together. The Cumulative Index to Nursing and Allied Health (Cinahl), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System (Medline), and Psychological Information (PsychInfo) databases were searched. Studies were included if they featured older people with type 2 diabetes and had looked for associations between at least one distinct measure of cognition and at least one distinct measure of diabetes self-management. English language publications from the year 2000 were included. Cognitive measures of executive function, memory, and low scores on tests of global cognitive functioning showed significant correlations with multiple areas of diabetes self-management, including diabetes-specific numeracy ability, diabetes knowledge, insulin adjustment skills, ability to learn to perform insulin injections, worse adherence to medications, decreased frequency of self-care activities, missed appointments, decreased frequency of diabetes monitoring, and increased inaccuracies in reporting blood glucose monitoring. The nature of the subjects studied was quite variable in terms of their disease duration, previous medical histories, associated medical comorbidities, and educational level attained prior to being diagnosed with diabetes. The majority of studies were of an associational nature and not findings confirmed by repeat testing or by the effects of an intervention, neither were the majority of studies designed to give a view or conclusion on the clinical

  18. Type 2 diabetes in Brazil: epidemiology and management

    PubMed Central

    de Almeida-Pititto, Bianca; Dias, Monike Lourenço; de Moraes, Ana Carolina Franco; Ferreira, Sandra RG; Franco, Denise Reis; Eliaschewitz, Freddy Goldberg

    2015-01-01

    Type 2 diabetes mellitus (T2DM) is one of the most important epidemic diseases in the world this century, and accounts for 90% of cases of diabetes globally. Brazil is one of the most important examples of the alarming picture of T2DM in emergent societies, being the country with the fourth largest number of people with diabetes. The aim of this paper is to review the literature on diabetes in Brazil, specifically looking at the epidemiology and management of T2DM. A literature search was conducted using PubMed and LILACS to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government, World Health Organization, and International Diabetes Federation were also reviewed. PMID:25609989

  19. The Utilization of a Clinical Decision Support System to Manage Adult Type 2 Diabetes: A Correlational Study

    ERIC Educational Resources Information Center

    Faught, I. Charie

    2012-01-01

    While the Institute of Medicine (2001) has promoted health information technology to improve the process of care such as compliance with clinical practice guidelines and quicker access to clinical information, diagnostic tests, and treatment results, very little was known about how a clinical decision support system can contribute to diabetes…

  20. Vegetarian and vegan diets in type 2 diabetes management.

    PubMed

    Barnard, Neal D; Katcher, Heather I; Jenkins, David J A; Cohen, Joshua; Turner-McGrievy, Gabrielle

    2009-05-01

    Vegetarian and vegan diets offer significant benefits for diabetes management. In observational studies, individuals following vegetarian diets are about half as likely to develop diabetes, compared with non-vegetarians. In clinical trials in individuals with type 2 diabetes, low-fat vegan diets improve glycemic control to a greater extent than conventional diabetes diets. Although this effect is primarily attributable to greater weight loss, evidence also suggests that reduced intake of saturated fats and high-glycemic-index foods, increased intake of dietary fiber and vegetable protein, reduced intramyocellular lipid concentrations, and decreased iron stores mediate the influence of plant-based diets on glycemia. Vegetarian and vegan diets also improve plasma lipid concentrations and have been shown to reverse atherosclerosis progression. In clinical studies, the reported acceptability of vegetarian and vegan diets is comparable to other therapeutic regimens. The presently available literature indicates that vegetarian and vegan diets present potential advantages for the management of type 2 diabetes. PMID:19386029

  1. Management of diabetic foot ulcers: evaluation of case studies.

    PubMed

    Torkington-Stokes, Rachel; Metcalf, Daniel; Bowler, Philip

    2016-08-11

    This article explores local barriers to diabetic foot ulcer healing, and describes the use of a dressing designed to manage exudate, infection and biofilm (AQUACEL® Ag+ dressing (AQAg+)) on recalcitrant diabetic foot ulcers. The authors consider four case studies that demonstrate how managing local barriers to wound healing with antimicrobial and anti-biofilm dressings in protocols of care can improve outcomes for patients. PMID:27523769

  2. Prevent Diabetes Problems: Keep Your Nervous System Healthy

    MedlinePlus

    ... Neurological Disorders and Stroke American Diabetes Association JDRF Diabetes Disease Organizations Many organizations provide support to patients ... PDF, 293 KB). Alternate Language URL Español Prevent diabetes problems: Keep your nervous system healthy Page Content ...

  3. The detection and management of diabetes distress in people with type 1 diabetes.

    PubMed

    Sturt, Jackie; Dennick, Kathryn; Due-Christensen, Mette; McCarthy, Kate

    2015-11-01

    Diabetes distress (DD) represents a significant clinical burden in which levels of DD are related to both glycated haemoglobin (HbA1c) and some self-management behaviours. DD is related to, but different from, depression. Differences in DD experienced in people with type 1 and type 2 diabetes have been observed. Commonly measured using the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS), rates of elevated DD in research study participants range from 20 to 30 %. Risk factors for elevated DD in type 1 diabetes are longer duration of diabetes, severe hypoglycaemia, younger age and being female. A systematic review of intervention studies assessing DD identified eight randomised controlled trials (RCTs) and nine pre-post design studies. Only three studies targeted DD with the intervention. Intervention types were diabetes self-management education (DSME), psychologically informed self-management and devices. DSME pre-post studies, namely the Dose Adjustment For Normal Eating (DAFNE) programme, produced more consistent improvements in DD and HbA1c at follow-up. Psychologically informed self-management was more heterogeneous, but several RCTs were effective in reducing DD. Group interventions offered the greatest benefits across intervention designs. PMID:26411924

  4. An Audit of Diabetes Self-Management Education Programs in South Africa

    PubMed Central

    Van den Broucke, Stephan; Dhoore, William; Kalweit, Kerry; Housiaux, Marie

    2015-01-01

    Background: Diabetes is a significant contributor to the burden of disease worldwide. Since its treatment requires extensive self-care, self-management education is widely recommended, particularly in resource limited settings. This study aimed to review the current state of policies and implementation of diabetes self-management education (DSME) in South Africa, with a specific focus on cultural appropriateness. Design and Methods: The audit involved a review of policy documents and semi-structured questionnaires with providers and experts in public and private health services. Forty-four respondents were interviewed. Documents were analysed with reference to the International Standards for Diabetes Education from the International Diabetes Federation. Data were entered and analysed in excel to give a description of the DSME programs and ad hoc interventions. Results: Three guidelines for Type 2 diabetes and two for chronic diseases were retrieved, but none were specifically dedicated to DSME. Five structured programs and 22 ad-hoc interventions were identified. DSME is mostly provided by doctors, nurses and dieticians and not consistently linked to other initiatives such as support groups. Health education materials are mainly in English with limited availability. Conclusions: DSME in South Africa is limited in scope, content and consistency, especially in the public services. A National curricula and materials for diabetes education need to be developed and adapted to the socio-economic context, culture and literacy levels of the target populations. It is recommended that DSME would be addressed in national policies and guidelines to guide the development and implementation of standardised programs. Significance for public health Diabetes significantly contributes to the global burden of disease. This burden is especially felt in developing countries, where resources are limited and the health system simultaneously has to deal with communicable and non

  5. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

    PubMed

    Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

    2016-02-01

    Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. PMID:26798150

  6. Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes

    PubMed Central

    Nyenwe, Ebenezer A.; Jerkins, Terri W.; Umpierrez, Guillermo E.; Kitabchi, Abbas E.

    2013-01-01

    The prevalence of type 2 diabetes continues to increase at an alarming rate around the world, with even more people being affected by prediabetes. Although the pathogenesis and long-term complications of type 2 diabetes are fairly well known, its treatment has remained challenging, with only half of the patients achieving the recommended hemoglobin A1c target. This narrative review explores the pathogenetic rationale for the treatment of type 2 diabetes, with the view of fostering better understanding of the evolving treatment modalities. The diagnostic criteria including the role of hemoglobin A1c in the diagnosis of diabetes are discussed. Due attention is given to the different therapeutic maneuvers and their utility in the management of the diabetic patient. The evidence supporting the role of exercise, medical nutrition therapy, glucose monitoring, and antiobesity measures including pharmacotherapy and bariatric surgery is discussed. The controversial subject of optimum glycemic control in hospitalized and ambulatory patients is discussed in detail. An update of the available pharmacologic options for the management of type 2 diabetes is provided with particular emphasis on newer and emerging modalities. Special attention has been given to the initiation of insulin therapy in patients with type 2 diabetes, with explanation of the pathophysiologic basis for insulin therapy in the ambulatory diabetic patient. A review of the evidence supporting the efficacy of the different preventive measures is also provided. PMID:21134520

  7. Nuts for diabetes prevention and management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Type 2 diabetes mellitus is an important preventable disease and a growing public health problem. Epidemiologic and clinical studies suggest that healthy eating, physical activity, and body weight control are the main driving forces to reduce diabetes risk. Owing to their low available carbohydrate ...

  8. Managing coeliac disease in patients with diabetes.

    PubMed

    Leonard, M M; Cureton, P A; Fasano, A

    2015-01-01

    The association between coeliac disease and type 1 diabetes has long been established. The combination of genetic susceptibility along with a potential role for gluten in the pathogenesis of autoimmunity makes defining gluten's role in type 1 diabetes extremely important. Evidence supporting the role of a gluten-free diet to improve complications associated with type 1 diabetes is not robust. However there is evidence to support improved growth, bone density and potentially the prevention of additional autoimmune diseases in patients with coeliac disease and type 1 diabetes. The gluten free diet is expensive and challenging to adhere to in people already on a modified diet. Early identification of those who have coeliac disease and would benefit from a gluten-free diet is of utmost importance to prevent complications associated with type 1 diabetes and coeliac disease. PMID:24814173

  9. 42 CFR 410.141 - Outpatient diabetes self-management training.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management...

  10. 42 CFR 410.141 - Outpatient diabetes self-management training.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management...

  11. [Empowerment approach to the management of comorbid diabetes and cancer].

    PubMed

    Ohashi, Ken

    2015-12-01

    Diabetes mellitus is a frequent comorbidity of cancer patients. Recent data show that diabetes may negatively impact both cancer risks and outcomes of treatment. It is important to identify patients at risk for complications that arise from cancer treatment in the setting of pre-existing diabetes. Additionally, underlying hyperglycemia or hidden diabetes in a patient undergoing cancer treatment such as chemotherapy including steroid administration and total parenteral nutrition should be identified and managed. Strategies for monitoring and managing hyperglycemia during the course of cancer treatment will be reviewed. The role of interdisciplinary care and empowerment approach is crucial to supporting patients and their families as they manage through the challenges of facing two life-threatening diseases. PMID:26666166

  12. Guidelines in the management of diabetic nerve pain: clinical utility of pregabalin

    PubMed Central

    Vinik, Aaron I; Casellini, Carolina M

    2013-01-01

    Diabetic peripheral neuropathy is a common complication of diabetes. It presents as a variety of syndromes for which there is no universally accepted unique classification. Sensorimotor polyneuropathy is the most common type, affecting about 30% of diabetic patients in hospital care and 25% of those in the community. Pain is the reason for 40% of patient visits in a primary care setting, and about 20% of these have had pain for greater than 6 months. Chronic pain may be nociceptive, which occurs as a result of disease or damage to tissue with no abnormality in the nervous system. In contrast, neuropathic pain is defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” Persistent neuropathic pain interferes significantly with quality of life, impairing sleep and recreation; it also significantly impacts emotional well-being, and is associated with depression, anxiety, and noncompliance with treatment. Painful diabetic peripheral neuropathy is a difficult-to-manage clinical problem, and patients with this condition are more apt to seek medical attention than those with other types of diabetic neuropathy. Early recognition of psychological problems is critical to the management of pain, and physicians need to go beyond the management of pain per se if they are to achieve success. This evidence-based review of the assessment of the patient with pain in diabetes addresses the state-of-the-art management of pain, recognizing all the conditions that produce pain in diabetes and the evidence in support of a variety of treatments currently available. A search of the full Medline database for the last 10 years was conducted in August 2012 using the terms painful diabetic peripheral neuropathy, painful diabetic peripheral polyneuropathy, painful diabetic neuropathy and pain in diabetes. In addition, recent reviews addressing this issue were adopted as necessary. In particular, reports from the American Academy of

  13. Can wireless technology enable new diabetes management tools?

    PubMed

    Hedtke, Paul A

    2008-01-01

    Mobile computing and communications technology embodied in the modern cell phone device can be employed to improve the lives of diabetes patients by giving them better tools for self-management. Several companies are working on the development of diabetes management tools that leverage the ubiquitous cell phone to bring self-management tools to the hand of the diabetes patient. Integration of blood glucose monitoring (BGM) technology with the cell phone platform adds a level of convenience for the person with diabetes, but, more importantly, allows BGM data to be automatically captured, logged, and processed in near real time in order to provide the diabetes patient with assistance in managing their blood glucose levels. Other automatic measurements can estimate physical activity, and information regarding medication events and food intake can be captured and analyzed in order to provide the diabetes patient with continual assistance in managing their therapy and behaviors in order to improve glycemic control. The path to realization of such solutions is not, however, without obstacles. PMID:19885187

  14. A Framework for the Evaluation of Internet-based Diabetes Management

    PubMed Central

    Kidd, Michael

    2002-01-01

    Background While still in its infancy, Internet-based diabetes management shows great promise for growth. However, the following aspects must be considered: what are the key metrics for the evaluation of a diabetes management site? how should these sites grow in the future and what services should they offer? Objectives To examine the needs of the patient and the health care professional in an Internet-based diabetes management solution and how these needs are translated into services offered. Methods An evaluation framework was constructed based on a literature review that identified the requirements for an Internet-based diabetes management solution. The requirements were grouped into 5 categories: Monitoring, Information, Personalization, Communication, and Technology. Two of the market leaders (myDiabetes and LifeMasters) were selected and were evaluated with the framework. The Web sites were evaluated independently by 5 raters using the evaluation framework. All evaluations were performed from November 1, 2001 through December 15, 2001. Results The agreement level between raters ranged from 60% to 100%. The multi-rater reliability (kappa) was 0.75 for myDiabetes and 0.65 for LifeMasters, indicating substantial agreement. The results of the evaluations indicate that LifeMasters is a more-complete solution than myDiabetes in all dimensions except Information, where both sites were equivalent. LifeMasters satisfied 32 evaluation criteria while myDiabetes satisfied 24 evaluation criteria, out of a possible 40 in the framework. Conclusions The framework is based on the recognition that the management of diabetes via the Internet is based on several integrated dimensions: Monitoring, Information, Personalization, Communication, and Technology. A successful diabetes management system should efficiently integrate all dimensions. The evaluation found that LifeMasters is successful in integrating the health care professional in the management of diabetes and that MyDiabetes

  15. Application of database systems in diabetes care.

    PubMed

    Kopelman, P G; Sanderson, A J

    1996-01-01

    The St Vincent Declaration includes a commitment to continuous quality improvement in diabetes care. This necessitates the collection of appropriate information to ensure that diabetes services are efficient, effective and equitable. The quantity of information, and the need for rapid access, means that this must be computer-based. The choice of architecture and the design of a database for diabetes care must take into account available equipment and operational requirements. Hardware topology may be determined by the operating system and/or netware software. An effective database system will include: user-friendliness, rapid but secure access to data, a facility for multiple selections for analysis and audit, the ability to be used as part of the patient consultation process, the ability to interface or integrate with other applications, and cost efficiency. An example of a clinical information database for diabetes care, Diamond, is described. PMID:9244825

  16. Peer support for self-management of diabetes improved outcomes in international settings.

    PubMed

    Fisher, Edwin B; Boothroyd, Renée I; Coufal, Muchieh Maggy; Baumann, Linda C; Mbanya, Jean Claude; Rotheram-Borus, Mary Jane; Sanguanprasit, Boosaba; Tanasugarn, Chanuantong

    2012-01-01

    Self-management of diabetes is essential to reducing the risks of associated disabilities. But effective self-management is often short-lived. Peers can provide the kind of ongoing support that is needed for sustained self-management of diabetes. In this context, peers are nonprofessionals who have diabetes or close familiarity with its management. Key functions of effective peer support include assistance in daily management, social and emotional support, linkage to clinical care, and ongoing availability of support. Using these four functions as a template of peer support, project teams in Cameroon, South Africa, Thailand, and Uganda developed and then evaluated peer support interventions for adults with diabetes. Our initial assessment found improvements in symptom management, diet, blood pressure, body mass index, and blood sugar levels for many of those taking part in the programs. For policy makers, the broader message is that by emphasizing the four key peer support functions, diabetes management programs can be successfully introduced across varied cultural settings and within diverse health systems. PMID:22232103

  17. Diagnosis and Management of Diabetes and the Relationship of dGlucose to Kidney Function

    PubMed Central

    Mandal, Anil K.; Hiebert, Linda

    2015-01-01

    This article reviews different glycemic parameters and is aimed to clarify the most dependable glycemic parameter that predicts renal preservation. Glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) are the most commonly ordered tests for the diagnosis of diabetes and are also used to indicate prevention of microvascular complications associated with diabetes. Some experts have concluded that HbA1c remains the only test that can predict microvascular complications but HbA1c is misleading with anemia. Other experts have reported that elevation of 2 hour postprandial glucose (2hPPG) or postprandial hyperglycemia is critical for the development of diabetic complications Measurement of parameters under fasting conditions is convenient in both clinical and research settings and are used to establish clinical guidelines for diabetes management and for rating efficacy of management. Despite the use of these diagnostic markers and a plethora of oral antidiabetic agents to treat diabetes, diabetic complications namely; cardiovascular disorders (CVD), end stage renal disease (ESRD) and amputation are on the rise. Although affirmative data on many of the complications are not available, the United States Renal Data System on ESRD is a testimonial to poor diabetes care. We have innovated dglucose (2hPPG-FBG) and found that dglucose relates significantly to renal function change measured by serum creatinine levels or estimated glomerular filtration rate. Our current study on dglucose confirms our previous finding and validates the importance of dglucose to aid in the management of diabetes and prevents diabetic complications. In conclusion, the new finding in this study is dglucose (2h-postprandial glucose-Fasting glucose) which convincingly relates to renal function changes. Since dglucose is a product of 2hPP glucose, keeping 2hPPG under tight control with intensive insulin therapy is fundamentally important. Further blood pressure control avoiding the use of

  18. Diagnosis and management of diabetes and the relationship of dglucose to kidney function.

    PubMed

    Mandal, Anil K; Hiebert, Linda

    2015-01-01

    This article reviews different glycemic parameters and is aimed to clarify the most dependable glycemic parameter that predicts renal preservation. Glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) are the most commonly ordered tests for the diagnosis of diabetes and are also used to indicate prevention of microvascular complications associated with diabetes. Some experts have concluded that HbA1c remains the only test that can predict microvascular complications but HbA1c is misleading with anemia. Other experts have reported that elevation of 2 hour postprandial glucose (2hPPG) or postprandial hyperglycemia is critical for the development of diabetic complications Measurement of parameters under fasting conditions is convenient in both clinical and research settings and are used to establish clinical guidelines for diabetes management and for rating efficacy of management. Despite the use of these diagnostic markers and a plethora of oral antidiabetic agents to treat diabetes, diabetic complications namely; cardiovascular disorders (CVD), end stage renal disease (ESRD) and amputation are on the rise. Although affirmative data on many of the complications are not available, the United States Renal Data System on ESRD is a testimonial to poor diabetes care. We have innovated dglucose (2hPPG-FBG) and found that dglucose relates significantly to renal function change measured by serum creatinine levels or estimated glomerular filtration rate. Our current study on dglucose confirms our previous finding and validates the importance of dglucose to aid in the management of diabetes and prevents diabetic complications. In conclusion, the new finding in this study is dglucose (2h-postprandial glucose-Fasting glucose) which convincingly relates to renal function changes. Since dglucose is a product of 2hPP glucose, keeping 2hPPG under tight control with intensive insulin therapy is fundamentally important. Further blood pressure control avoiding the use of

  19. Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus

    PubMed Central

    Linden, Karolina; Sparud-Lundin, Carina; Adolfsson, Annsofie; Berg, Marie

    2016-01-01

    This paper explores well-being and diabetes management in women with type 1 diabetes mellitus (DM) in early pregnancy and investigates associations among perceived well-being, diabetes management, and maternal characteristics. Questionnaires were answered by 168 Swedish women. Correlation analyses were conducted with Spearman’s correlation coefficient (rs). The women reported relatively high scores of self-efficacy in diabetes management (SWE-DES-10: 3.91 (0.51)) and self-perceived health (excellent (6.5%), very good (42.3%), good (38.7%), fair (11.3%) and poor (1.2%)). Moderate scores were reported for general well-being (WBQ-12: 22.6 (5.7)) and sense of coherence (SOC-13: 68.9 (9.7), moderate/low scores for hypoglycemia fear (SWE-HFS 26.6 (11.8)) and low scores of diabetes-distress (SWE-PAID-20 27.1 (15.9)). A higher capability of self-efficacy in diabetes management showed positive correlations with self-perceived health (rs = −0.41, p < 0.0001) and well-being (rs = 0.34, p < 0.0001) as well as negative correlations with diabetes distress (rs = −0.51, p < 0.0001) and hypoglycemia worries (rs = −0.27, p = 0.0009). Women with HbA1c levels of ≤48 mmL/mol scored higher in the subscales “goal achievement” in SWE-DES (p = 0.0028) and “comprehensibility” in SOC (p = 0.016). Well-being and diabetes management could be supported by strengthening the women’s capability to achieve glycemic goals and their comprehensibility in relation to the treatment. Further studies are needed to test this. PMID:27556476

  20. Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus.

    PubMed

    Linden, Karolina; Sparud-Lundin, Carina; Adolfsson, Annsofie; Berg, Marie

    2016-01-01

    This paper explores well-being and diabetes management in women with type 1 diabetes mellitus (DM) in early pregnancy and investigates associations among perceived well-being, diabetes management, and maternal characteristics. Questionnaires were answered by 168 Swedish women. Correlation analyses were conducted with Spearman's correlation coefficient (rs). The women reported relatively high scores of self-efficacy in diabetes management (SWE-DES-10: 3.91 (0.51)) and self-perceived health (excellent (6.5%), very good (42.3%), good (38.7%), fair (11.3%) and poor (1.2%)). Moderate scores were reported for general well-being (WBQ-12: 22.6 (5.7)) and sense of coherence (SOC-13: 68.9 (9.7), moderate/low scores for hypoglycemia fear (SWE-HFS 26.6 (11.8)) and low scores of diabetes-distress (SWE-PAID-20 27.1 (15.9)). A higher capability of self-efficacy in diabetes management showed positive correlations with self-perceived health (rs = -0.41, p < 0.0001) and well-being (rs = 0.34, p < 0.0001) as well as negative correlations with diabetes distress (rs = -0.51, p < 0.0001) and hypoglycemia worries (rs = -0.27, p = 0.0009). Women with HbA1c levels of ≤48 mmL/mol scored higher in the subscales "goal achievement" in SWE-DES (p = 0.0028) and "comprehensibility" in SOC (p = 0.016). Well-being and diabetes management could be supported by strengthening the women's capability to achieve glycemic goals and their comprehensibility in relation to the treatment. Further studies are needed to test this. PMID:27556476

  1. Conceptualizing type 2 diabetes and its management.

    PubMed

    Tsasis, Peter; Wu, Jianhong; An, Aijun; Wong, Hannah J; An, Xiandong; Mei, Zhen; Hains, Ted

    2016-01-01

    Type 2 diabetes is growing worldwide due to population growth, increased rates of obesity, unhealthy diet, and physical inactivity. Risk assessment methods can effectively evaluate the risk of diabetes, and a healthy lifestyle can significantly reduce risk or prevent complications of type 2 diabetes. However, risk assessment alone has not significantly improved poor adherence to recommended medical interventions and lifestyle changes. This paper focuses on the challenge of nonadherence and posits that improving adherence requires tailoring interventions that explicitly consider the social determinants of health. PMID:27099510

  2. Conceptualizing type 2 diabetes and its management

    PubMed Central

    Tsasis, Peter; Wu, Jianhong; An, Aijun; Wong, Hannah J; An, Xiandong; Mei, Zhen; Hains, Ted

    2016-01-01

    Type 2 diabetes is growing worldwide due to population growth, increased rates of obesity, unhealthy diet, and physical inactivity. Risk assessment methods can effectively evaluate the risk of diabetes, and a healthy lifestyle can significantly reduce risk or prevent complications of type 2 diabetes. However, risk assessment alone has not significantly improved poor adherence to recommended medical interventions and lifestyle changes. This paper focuses on the challenge of nonadherence and posits that improving adherence requires tailoring interventions that explicitly consider the social determinants of health. PMID:27099510

  3. Diabetes and the enteric nervous system.

    PubMed

    Chandrasekharan, B; Srinivasan, S

    2007-12-01

    Diabetes is associated with several changes in gastrointestinal (GI) motility and associated symptoms such as nausea, bloating, abdominal pain, diarrhoea and constipation. The pathogenesis of altered GI functions in diabetes is multifactorial and the role of the enteric nervous system (ENS) in this respect has gained significant importance. In this review, we summarize the research carried out on diabetes-related changes in the ENS. Changes in the inhibitory and excitatory enteric neurons are described highlighting the role of loss of inhibitory neurons in early diabetic enteric neuropathy. The functional consequences of these neuronal changes result in altered gastric emptying, diarrhoea or constipation. Diabetes can also affect GI motility through changes in intestinal smooth muscle or alterations in extrinsic neuronal control. Hyperglycaemia and oxidative stress play an important role in the pathophysiology of these ENS changes. Antioxidants to prevent or treat diabetic GI motility problems have therapeutic potential. Recent research on the nerve-immune interactions demonstrates inflammation-associated neurodegeneration which can lead to motility related problems in diabetes. PMID:17971027

  4. Diabetes Is Serious But Manageable | NIH MedlinePlus the Magazine

    MedlinePlus

    ... page please turn JavaScript on. Feature: Type 2 Diabetes Diabetes Type 2 Is Serious But Manageable Past Issues / ... t have to knock yourself out to prevent diabetes. The key is: small steps that lead to ...

  5. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

    PubMed Central

    Stellefson, Michael; Stopka, Christine

    2013-01-01

    Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085

  6. Modelling effective diagnosis of risk complications in gestational diabetes mellitus: an e-diabetic expert system for pregnant women

    NASA Astrophysics Data System (ADS)

    Sreedevi, E.; Vijaya Lakshmi, K.; Chaitanya Krishna, E.; Padmavathamma, M.

    2012-04-01

    Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. This paper deals with study and development of algorithm to develop an initial stage expert system to provide diagnosis to the pregnant women who are suffering from Gestational Diabetes Mellitus (GDM) by means of Oral Glucose Tolerance Test (OGTT).

  7. Diabetes in Algeria and challenges for health policy: a literature review of prevalence, cost, management and outcomes of diabetes and its complications

    PubMed Central

    2014-01-01

    Background Diabetes has become an increasingly prevalent and severe public health issue in Algeria. This article investigates the prevalence, the cost and the management of this disease. Its first objective is to better understand the burden (both from an epidemiological and economic perspective) and management of diabetes. The second objective is to understand the health policy strategy adopted by Algeria in order to respond to the disease. Methods We conducted a literature review of prevalence, costs, management and outcomes of diabetes and its complications. This was complemented by data compilations and results of expert consultations. Results The epidemiology of diabetes is continually evolving and is becoming more problematic. The national evidence suggests that the prevalence of diabetes in Algeria has increased from 6.8% in 1990 to 12.29% in 2005, but is quite higher among certain groups and areas of the country. This disease affects all population groups, especially 35–70 year olds, who constitute a large segment of the working population. There are very few estimates of the cost of diabetes. These include a 1998 study on the total cost of type 1 diabetes (USD 11.6 million, which, inflated to 2013 value, totals to USD 16.6 million), a study on the cost of complications in 2010 (at 2013 value, ranging from USD 141 for first-year treatment of peripheral vascular disease to USD 30,441 for first-year cost of renal transplantation) and the 2013 IDF estimates of total cost of type 1 and type 2 diabetes (USD 513 million). Conclusions As the prevalence of diabetes continues to increase, the financial burden will increasingly weigh heavily on social security resources and the government budget. Future priorities must focus on empowering general practitioners in treating type 2 diabetes, improving screening of diabetes and its complications, tackling the growing obesity epidemic, strengthening health information systems and implementing the national diabetes

  8. Guidelines for Perioperative Management of the Diabetic Patient.

    PubMed

    Sudhakaran, Sivakumar; Surani, Salim R

    2015-01-01

    Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. PMID:26078998

  9. Guidelines for Perioperative Management of the Diabetic Patient

    PubMed Central

    Surani, Salim R.

    2015-01-01

    Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. PMID:26078998

  10. Diabetes Management at School: Application of the Healthy Learner Model

    ERIC Educational Resources Information Center

    Bobo, Nichole; Kaup, Tara; McCarty, Patricia; Carlson, Jessie Parker

    2011-01-01

    Every child with diabetes deserves a school nurse with the capacity to effectively manage the disease at school. The school nurse needs knowledge and skills to confidently provide care and communicate with health care providers and families. The Healthy Learner Model for Chronic Condition Management provided a framework to eliminate the disjointed…

  11. Duloxetine in the management of diabetic peripheral neuropathic pain.

    PubMed

    Ormseth, Michelle J; Scholz, Beth A; Boomershine, Chad S

    2011-01-01

    Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP) is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no treatment and many treated with medications having little or no efficacy in managing DPNP. Duloxetine is one of two drugs approved by the United States Food and Drug Administration for DPNP management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) proven safe, effective, and cost-saving in reducing DPNP symptoms at a dose of 60 mg/day. Duloxetine doses greater than 60 mg/day for DPNP management are not recommended since they are no more efficacious and associated with more side effects; addition of pregabalin or gabapentin for these patients may be beneficial. Side effects of duloxetine are generally mild and typical for the SNRI class including nausea, dizziness, somnolence, fatigue, sweating, dry mouth, constipation, and diarrhea. Given its other indications, duloxetine is a particularly good choice for DPNP treatment in patients with coexisting depression, anxiety, fibromyalgia, or chronic musculoskeletal pain. Duloxetine treatment had no clinically significant effect on glycemic control and did not increase the risk of cardiovascular events in diabetes patients. However, duloxetine use should be avoided in patients with hepatic disease or severe renal impairment. Given its safety, efficacy, and tolerability, duloxetine is an excellent choice for DPNP treatment in many patients. PMID:21845034

  12. Duloxetine in the management of diabetic peripheral neuropathic pain

    PubMed Central

    Ormseth, Michelle J; Scholz, Beth A; Boomershine, Chad S

    2011-01-01

    Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP) is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no treatment and many treated with medications having little or no efficacy in managing DPNP. Duloxetine is one of two drugs approved by the United States Food and Drug Administration for DPNP management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) proven safe, effective, and cost-saving in reducing DPNP symptoms at a dose of 60 mg/day. Duloxetine doses greater than 60 mg/day for DPNP management are not recommended since they are no more efficacious and associated with more side effects; addition of pregabalin or gabapentin for these patients may be beneficial. Side effects of duloxetine are generally mild and typical for the SNRI class including nausea, dizziness, somnolence, fatigue, sweating, dry mouth, constipation, and diarrhea. Given its other indications, duloxetine is a particularly good choice for DPNP treatment in patients with coexisting depression, anxiety, fibromyalgia, or chronic musculoskeletal pain. Duloxetine treatment had no clinically significant effect on glycemic control and did not increase the risk of cardiovascular events in diabetes patients. However, duloxetine use should be avoided in patients with hepatic disease or severe renal impairment. Given its safety, efficacy, and tolerability, duloxetine is an excellent choice for DPNP treatment in many patients. PMID:21845034

  13. The Role of Pulses in the Dietary Management of Diabetes.

    PubMed

    Ramdath, Dan; Renwick, Simone; Duncan, Alison M

    2016-08-01

    Pulses are highly nutritious foods that are included as part of Canada's Food Guide to promote healthful eating, and they have established health benefits that can contribute to the dietary management of diabetes. A review of studies that have examined the effects of pulse consumption on health outcomes, integral to the management of diabetes, provides credible evidence for improvements in glycemic control, reduction of blood lipids and regulation of body weight. Results from acute feeding trials suggest that postprandial blood glucose response is significantly attenuated by a single pulse serving of between three-quarters and 1 cup. At lower doses, pulses attenuate postprandial blood glucose response more than similar amounts of starchy foods. Long-term pulse consumption of 5 cups per week appears to result consistently in improvements in glycemic control. There is high-quality evidence that supports a role for pulse consumption in the reduction of risk for cardiovascular disease; this provides a sound rationale for the regular incorporation of pulses at about two-thirds of a cup daily in the management of hyperlipidemia in persons with type 2 diabetes. Pulse consumption can contribute to improving satiety, reducing food intake and regulating body weight, which can reduce obesity risk and, in turn, improve diabetes management. Collectively, available evidence provides very good support for a role of regular pulse consumption in the prevention and management of diabetes. PMID:27497151

  14. Inadequate investment on management of diabetes education

    PubMed Central

    Abazari, Parvaneh; Vanaki, Zohreh; Mohammadi, Eesa; Amini, Massoud

    2012-01-01

    Aims: Reforming and improving the patient education process need more insight into the strengths and weaknesses of the existing education process. There is little documentation on patient education in National Diabetes Prevention and Control Program in Iran, so the present study aimed to describe patient education process in diabetes centers in one of the provinces of Iran. Materials and Methods: This is a qualitative content analysis. Twelve nurses who work as diabetes nurse educators (DNEs) and an internal medicine specialist participated in this study. Data was obtained through semi-structured face-to-face interviews, a focus group, existing documents, field notes, and multiple observations. Data analysis was guided by the conventional approach of qualitative content analysis. Results: Three main themes including unequipped trainers (insufficient knowledge and experience, lack of appropriate educational facilities, lack of time, lack of patient's interest), unstructured education (lack of educational need assessment, lack of evaluation, lack of continuing patient education), unmanaged education (lack of official planning for patient education and supervising the education process) emerged from qualitative content analysis. Conclusions: Although patient education is one of the important strategies in National Diabetes Prevention and Control Program, there however has not been necessary investment and adequate space to achieve it. Patient education was not structured and based on scientific principles. Training of diabetes nurse educators (DNEs) is neglected, and there is no supervision on patient education process. PMID:23798949

  15. Older Adult Self-Efficacy Study of Mobile Phone Diabetes Management

    PubMed Central

    Khokhar, Bilal; Weed, Kelly; Barr, Erik; Gruber-Baldini, Ann L.

    2015-01-01

    Abstract The purpose of this study was to evaluate participant self-efficacy and use of a mobile phone diabetes health intervention for older adults during a 4-week period. Participants included seven adults (mean age, 70.3 years) with type 2 diabetes cared for by community-based primary care physicians. Participants entered blood glucose data into a mobile phone and personalized patient Internet Web portal. Based on blood glucose values, participants received automatic messages and educational information to self-manage their diabetes. Study measures included prior mobile phone/Internet use, the Stanford Self-Efficacy for Diabetes Scale, the Stanford Energy/Fatigue Scale, the Short Form-36, the Patient Health Questionnaire-9 (depression), the Patient Reported Diabetes Symptom Scale, the Diabetes Stages of Change measure, and a summary of mobile system use. Participants had high self-efficacy and high readiness and confidence in their ability to monitor changes to control their diabetes. Participants demonstrated ability to use the mobile intervention and communicate with diabetes educators. PMID:25692373

  16. Managing diabetes with nanomedicine: challenges and opportunities

    PubMed Central

    Veiseh, Omid; Tang, Benjamin C.; Whitehead, Kathryn A.; Anderson, Daniel G.; Langer, Robert

    2016-01-01

    Nanotechnology-based approaches hold substantial potential for improving the care of patients with diabetes. Nanoparticles are being developed as imaging contrast agents to assist in the early diagnosis of type 1 diabetes. Glucose nanosensors are being incorporated in implantable devices that enable more accurate and patient-friendly real-time tracking of blood glucose levels, and are also providing the basis for glucose-responsive nanoparticles that better mimic the body’s physiological needs for insulin. Finally, nanotechnology is being used in non-invasive approaches to insulin delivery and to engineer more effective vaccine, cell and gene therapies for type 1 diabetes. Here, we analyse the current state of these approaches and discuss key issues for their translation to clinical practice. PMID:25430866

  17. Traditional Indian medicines used for the management of diabetes mellitus.

    PubMed

    Rizvi, Syed Ibrahim; Mishra, Neetu

    2013-01-01

    Plants have always been a source of drugs for humans since time immemorial. The Indian traditional system of medicine is replete with the use of plants for the management of diabetic conditions. According to the World Health Organization, up to 90% of population in developing countries use plants and its products as traditional medicine for primary health care. There are about 800 plants which have been reported to show antidiabetic potential. The present review is aimed at providing in-depth information about the antidiabetic potential and bioactive compounds present in Ficus religiosa, Pterocarpus marsupium, Gymnema sylvestre, Allium sativum, Eugenia jambolana, Momordica charantia, and Trigonella foenum-graecum. The review provides a starting point for future studies aimed at isolation, purification, and characterization of bioactive antidiabetic compounds present in these plants. PMID:23841105

  18. Traditional Indian Medicines Used for the Management of Diabetes Mellitus

    PubMed Central

    Mishra, Neetu

    2013-01-01

    Plants have always been a source of drugs for humans since time immemorial. The Indian traditional system of medicine is replete with the use of plants for the management of diabetic conditions. According to the World Health Organization, up to 90% of population in developing countries use plants and its products as traditional medicine for primary health care. There are about 800 plants which have been reported to show antidiabetic potential. The present review is aimed at providing in-depth information about the antidiabetic potential and bioactive compounds present in Ficus religiosa, Pterocarpus marsupium, Gymnema sylvestre, Allium sativum, Eugenia jambolana, Momordica charantia, and Trigonella foenum-graecum. The review provides a starting point for future studies aimed at isolation, purification, and characterization of bioactive antidiabetic compounds present in these plants. PMID:23841105

  19. RN Diabetes Virtual Case Management: A New Model for Providing Chronic Care Management.

    PubMed

    Brown, Nancy N; Carrara, Barbara E; Watts, Sharon A; Lucatorto, Michelle A

    2016-01-01

    The U.S. chronic disease health care system has substantial gaps in delivery of services. New models of care change traditional delivery of care and explore new settings for care. This article describes a new model of diabetes chronic care delivery: nurse-delivered care that includes protocol-based insulin titration and patient education delivered solely in a virtual environment. In phase 1, the clinical outcome of time to achievement of glycated hemoglobin (A(1C)) goals (P < .001; 95% confidence interval, 1.68-2.24) was significantly improved by registered nurse (RN) standing order intervention (n = 24) as compared with historical controls (n = 28). In phase 2, patients who were referred to an RN-managed insulin titration protocol with individualized A(1C) goals had a significant (P < .001; 95% confidence interval, 1.680-2.242) reduction in results from a mean of 9.6% at baseline to 7.7% at completion. Average patient age was 66 years, with a mean duration of 11 years diagnosed with diabetes. Safety was demonstrated by the absence of hypoglycemia related to RN protocol adjustment. There were no admissions or emergency room (ER) visits for hypoglycemia. This study demonstrates safety and efficacy of RN virtual chronic disease management for an older population of patients with long-standing diabetes. PMID:26636235

  20. Toward Automation of Insulin Delivery - Management Solutions for Type 1 Diabetes.

    PubMed

    Nimri, Revital; Phillip, Moshe

    2016-01-01

    In the past decade, the field of type 1 diabetes was characterized by the efforts to integrate technology into the daily management of diabetes. Automated insulin delivery systems have emerged followed by the improvements in technology of pumps and sensors and automated close-loop systems that were developed around the world for overnight as well as for day and night use. Initially, these closed-loop systems were tested clinically in research centers, then at diabetes camps or hotels, and recently at patients' homes. The systems were tested in a wide range of populations of patients with type 1 diabetes: children, adolescents, adults, newly diagnosed, well and suboptimally controlled patients, the critically ill and pregnant women. The extensive clinical evaluation found these close-loop systems to be safe and efficient in controlling blood glucose levels. Now is the time to take these systems from research to industry and to get a regulatory approval of convenient devices for the use at home. Automated insulin delivery systems have the potential to change the way diabetes is treated and managed for the benefit of patients. This chapter summarizes the recent advances in this field. PMID:26682752

  1. Diabetes: Christian Worldview, Medical Distrust & Self-Management

    PubMed Central

    Newlin Lew, Kelley; Arbuah, Nancy; Banach, Paul; Melkus, Gail

    2015-01-01

    To inform development of a combined diabetes prevention and self-management intervention in partnership with church communities, this study sampled African American church leaders and members (N=44) to qualitatively study religious beliefs and practices, diabetes prevention and self-management behaviors, and related community actions. Prior to commencing the study, internal review board approval was obtained. Although not required, community consent was officially provided by the church pastors. Individual consent was subsequently obtained from eligible community members who expressed an interest in participating in the study. Following a participatory action research approach, the inquiry group method was used. Qualitative data were analyzed with content analysis. Findings revealed Christian worldview, medical mistrust, and self-management as prominent themes. Findings suggest diabetes providers address religious orientation in the provision of care with attention to rebuilding trust with the African American community to improve health outcomes. PMID:25735754

  2. Diabetes: Christian worldview, medical distrust and self-management.

    PubMed

    Newlin Lew, Kelley; Arbauh, Nancy; Banach, Paul; Melkus, Gail

    2015-06-01

    To inform the development of a combined diabetes prevention and self-management intervention in partnership with church communities, this study sampled African American church leaders and members (N = 44) to qualitatively study religious beliefs and practices, diabetes prevention and self-management behaviors, and related community actions. Prior to commencing the study, internal review board approval was obtained. Although not required, community consent was officially provided by the church pastors. Individual consent was subsequently obtained from eligible community members who expressed an interest in participating in the study. Following a participatory action research approach, the inquiry group method was used. Qualitative data were analyzed with content analysis. Findings revealed Christian worldview, medical distrust and self-management as prominent themes. Findings suggest that diabetes providers address religious orientation in the provision of care with attention to rebuilding trust with the African-American community to improve health outcomes. PMID:25735754

  3. Management of hypertension and diabetes mellitus by cardiovascular and endocrine physicians: a China registry

    PubMed Central

    Song, Jie; Sheng, Chang-Sheng; Huang, Qi-Fang; Li, Li-Hua; Ma, Chang-Sheng; Guo, Xiao-Hui; Ji, Li-Nong; Wang, Ji-Guang

    2016-01-01

    Objective: We investigated hypertension and diabetes mellitus in two management settings, namely cardiology and endocrinology, and their associations with albuminuria while accounting for the management of these two diseases. Methods: Our multicentre registry included patients (≥20 years) seen for hypertension in cardiology or for diabetes mellitus in endocrinology. We administered a questionnaire and measured blood pressure, glycosylated haemoglobin A1c and albuminuria. Results: Presence of both hypertension and diabetes was observed in 32.9% of hypertensive patients in cardiology (n = 1291) and 58.9% of diabetic patients in endocrinology (n = 1168). When both diseases were present, the use of combination antihypertensive therapy [odds ratio (OR) 0.31, P < 0.0001] and inhibitors of the renin–angiotensin system (OR 0.66, P = 0.0009) was less frequent in endocrinology than cardiology, and the use of combination antidiabetic therapy (OR 0.16, P < 0.0001) was less frequent in cardiology than endocrinology. The control of hypertension and diabetes, however, was not different between the two management settings (P ≥ 0.21), regardless of the therapeutic target (SBP/DBP < 140/90 or 130/80 mmHg and glycosylated haemoglobin A1c <7.0 or 6.5%). The prevalence of albuminuria was higher (P ≤ 0.02) in the presence of both diseases (23.3%) than those with either hypertension (12.6%) or diabetes alone (15.9%). Conclusion: Hypertension and diabetes mellitus were often jointly present, especially in the setting of endocrinology. The management was insufficient on the use of combination antihypertensive therapy and inhibitors of the renin–angiotensin system in endocrinology and for combination antidiabetic therapy in cardiology, indicating a need for more intensive management and better control of both clinical conditions. PMID:27270188

  4. Pragmatic diabetes management in nursing homes: individual care plan.

    PubMed

    Benetos, Athanase; Novella, Jean-Luc; Guerci, Bruno; Blickle, Jean-Frederic; Boivin, Jean-Marc; Cuny, Pierre; Delemer, Brigitte; Gabreau, Thierry; Jan, Philippe; Louis, Jacques; Passadori, Yves; Petit, Jean-Michel; Weryha, Georges

    2013-11-01

    Although the management of diabetes as a simple entity has been extensively developed, there is a dearth of evidence in elderly, frail patients with multiple comorbidities and polymedication. This population represents a large proportion of the residents of nursing homes (NHs). As a multidisciplinary group of French experts (geriatricians, endocrinologists, diabetologists, and general practitioners) with practical experience in this area, which is growing in magnitude throughout the world, we convened to compile pragmatic, simple advice on the management of elderly, frail diabetic patients. Given demands on NH personnel (manager, medical coordinator, nurses, and, at the front line of care provision, the undertrained and overworked carers), coupled with the quasiconstant of high staff turnover, the foundation stone of a patient's diabetes management is an Individual Care Plan (ICP) expressed in layman's language. This document that is opened on the patient's admission aims to make sure that the prescriptions established at admission are followed, notably to ensure correct treatment and adapted, regular monitoring with dates and times when examinations and tests are due. This includes monitoring of the diabetes control (HbA1c and, if necessary, blood and urine glucose) and its complications (cardiovascular disease, hypoglycemia, ocular problems, foot disorders, malnutrition, peripheral neuropathy, kidney failure). A necessary corollary is the training of staff to understand the specificities of caring for a frail patient with diabetes, on what to do in a potential emergency, and how to keep the ICP up to date for consultation by doctors and nurses. PMID:24113629

  5. Diabetes

    MedlinePlus

    ... version of this page please turn Javascript on. Diabetes What is Diabetes? Too Much Glucose in the Blood Diabetes means ... high, causing pre-diabetes or diabetes. Types of Diabetes There are three main kinds of diabetes: type ...

  6. Mobile Applications for Diabetes Self-Management: Status and Potential

    PubMed Central

    El-Gayar, Omar; Timsina, Prem; Nawar, Nevine; Eid, Wael

    2013-01-01

    Background Advancements in smartphone technology coupled with the proliferation of data connectivity has resulted in increased interest and unprecedented growth in mobile applications for diabetes self-management. The objective of this article is to determine, in a systematic review, whether diabetes applications have been helping patients with type 1 or type 2 diabetes self-manage their condition and to identify issues necessary for large-scale adoption of such interventions. Methods The review covers commercial applications available on the Apple App Store (as a representative of commercially available applications) and articles published in relevant databases covering a period from January 1995 to August 2012. The review included all applications supporting any diabetes self-management task where the patient is the primary actor. Results Available applications support self-management tasks such as physical exercise, insulin dosage or medication, blood glucose testing, and diet. Other support tasks considered include decision support, notification/alert, tagging of input data, and integration with social media. The review points to the potential for mobile applications to have a positive impact on diabetes self-management. Analysis indicates that application usage is associated with improved attitudes favorable to diabetes self-management. Limitations of the applications include lack of personalized feedback; usability issues, particularly the ease of data entry; and integration with patients and electronic health records. Conclusions Research into the adoption and use of user-centered and sociotechnical design principles is needed to improve usability, perceived usefulness, and, ultimately, adoption of the technology. Proliferation and efficacy of interventions involving mobile applications will benefit from a holistic approach that takes into account patients’ expectations and providers’ needs. PMID:23439183

  7. [Guidelines for the management of diabetes mellitus type 2].

    PubMed

    Mediavilla Bravo, José Javier

    2014-09-01

    In the last few years, the publication of new studies in diabetes, together with the development of new classes of blood glucose-lowering medications, have led to updates of the most prestigious clinical practice guidelines for the treatment of diabetes. Thus, a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes on the management of hyperglycemia in type 2 diabetes was published in April 2012. An update of one of the evidence-based guidelines issued by the Canadian Diabetes Association appeared in 2013 and this year, 2014, saw the publication of the consensus document of the redGDPS, whose guidelines are those most closely followed by primary care physicians in Spain. The three guidelines highlight the need for an individualized approach to type 2 diabetes mellitus, outlining both target glycemic goals and distinct treatment regimens based on patient characteristics, disease stage and the presence of comorbidities or complications. In the treatment of the disease, the three guidelines also stress the importance of considering patients' opinions and of recommending lifestyle modifications to achieve good disease control. Metformin is identified as the first-line drug, with the addition of other glucose-lowering agents if necessary. PMID:25595348

  8. [Managing the pain linked to diabetes].

    PubMed

    Leridon, Laurence

    2016-01-01

    Chronic pain due to insulin injections and the self-monitoring of blood glucose is a daily reality for children and adolescents with diabetes. Support groups are organised by the nurse who gives personalised advice to young patients and their parents, in order to relieve the pain and overcome any difficulties. PMID:26776689

  9. Home-based diabetes symptom self-management education for Mexican Americans with type 2 diabetes.

    PubMed

    García, Alexandra A; Brown, Sharon A; Horner, Sharon D; Zuñiga, Julie; Arheart, Kristopher L

    2015-06-01

    This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated measures randomized controlled trial was conducted with 72 Mexican Americans aged 25-75 years with type 2 diabetes. Experimental condition participants received eight weekly, in-home, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing and appropriate treatments, followed by eight biweekly support telephone sessions. Wait-listed control condition participants served as comparisons at three time points. Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial, behavioral and clinical outcomes. Participants were predominantly female, middle-aged, moderately acculturated and in poor glycemic control. Experimental group participants (n = 39) significantly improved glycemic control, blood pressure, symptoms, knowledge, self-efficacy, empowerment and quality of life. Post intervention focus groups reported satisfaction with the symptom focus. Addressing symptoms led to clinical and psychosocial improvements. Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications. PMID:25953971

  10. Improving the detection and management of type 1 diabetes.

    PubMed

    Hammond, Peter

    2016-01-01

    Type 1 diabetes affects around 370,000 adults in the UK, about 10% of all those diagnosed with diabetes. In type 1 diabetes there is a lack of beta cell insulin secretion as a result of autoimmune destruction of the beta cells. However, patients are not affected by insulin resistance, and so do not routinely experience the features of metabolic syndrome that occur in type 2 diabetes. NICE recommends considering further investigation with autoantibody testing or measurement of C-peptide when: type 1 diabetes is suspected but the presentation includes atypical features (e.g. age ≥50, BMI ≥ 25 kg/m2, slow evolution of hyperglycaemia or long prodrome); type 1 diabetes has been diagnosed and treatment started but there is a clinical suspicion that the patient may have a monogenic form of diabetes, and C-peptide and/or autoantibody testing may guide the use of genetic testing; classification is uncertain, and confirming type 1 diabetes would have implications for therapy. Structured education is the cornerstone of care providing tools to allow effective self-management. Following a new diagnosis of type 1 diabetes structured education should be offered within 12 months. Newly diagnosed patients should be offered a regimen including a basal (long-acting) insulin with bolus (rapid-acting) insulin given at mealtimes. The optimal regimen, which should be offered from diagnosis, is a combination of twice daily insulin detemir and a rapid-acting analogue given at mealtimes. However, where glycaemic control is already optimised on an alternative insulin regimen this should not be discontinued. PMID:27180499

  11. The Empirical Evidence for the Telemedicine Intervention in Diabetes Management

    PubMed Central

    Shannon, Gary W.; Smith, Brian R.; Woodward, Maria A.

    2015-01-01

    Abstract Objective: The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and diabetic retinopathy. The impetus derives from the confluence of high prevalence of these diseases, increasing incidence, and rising costs, while telemedicine promises to ameliorate, if not prevent, type 2 diabetes and its complications. Materials and Methods: A purposeful review of the literature identified relevant publications from January 2005 to December 2013. These were culled to retain only credible research articles for detailed review and analysis. The search yielded approximately 17,000 articles with no date constraints. Of these, 770 appeared to be research articles within our time frame. A review of the abstracts yielded 73 articles that met the criteria for inclusion in the final analysis. Evidence is organized by research findings regarding feasibility/acceptance, intermediate outcomes (e.g., use of service, and screening compliance), and health outcomes (control of glycemic level, lipids, body weight, and physical activity.) Results: Definitions of telediabetes varied from study to study vis-à-vis diabetes subtype, setting, technology, staffing, duration, frequency, and target population. Outcome measures also varied. Despite these vagaries, sufficient evidence was obtained from a wide variety of research studies, consistently pointing to positive effects of telemonitoring and telescreening in terms of glycemic control, reduced body weight, and increased physical exercise. The major contributions point to telemedicine's potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated. Conclusions: Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2

  12. Dynamic Task Optimization in Remote Diabetes Monitoring Systems

    PubMed Central

    Suh, Myung-kyung; Woodbridge, Jonathan; Moin, Tannaz; Lan, Mars; Alshurafa, Nabil; Samy, Lauren; Mortazavi, Bobak; Ghasemzadeh, Hassan; Bui, Alex; Ahmadi, Sheila; Sarrafzadeh, Majid

    2016-01-01

    Diabetes is the seventh leading cause of death in the United States, but careful symptom monitoring can prevent adverse events. A real-time patient monitoring and feedback system is one of the solutions to help patients with diabetes and their healthcare professionals monitor health-related measurements and provide dynamic feedback. However, data-driven methods to dynamically prioritize and generate tasks are not well investigated in the domain of remote health monitoring. This paper presents a wireless health project (WANDA) that leverages sensor technology and wireless communication to monitor the health status of patients with diabetes. The WANDA dynamic task management function applies data analytics in real-time to discretize continuous features, applying data clustering and association rule mining techniques to manage a sliding window size dynamically and to prioritize required user tasks. The developed algorithm minimizes the number of daily action items required by patients with diabetes using association rules that satisfy a minimum support, confidence and conditional probability thresholds. Each of these tasks maximizes information gain, thereby improving the overall level of patient adherence and satisfaction. Experimental results from applying EM-based clustering and Apriori algorithms show that the developed algorithm can predict further events with higher confidence levels and reduce the number of user tasks by up to 76.19 %.

  13. Important aspects of self-management education in patients with diabetes.

    PubMed

    Stam, D M; Graham, J P

    1997-07-01

    The Diabetes Control and Complications Trial has shown that the long-term complication of diabetes can be decreased with intensive glycemic control. However, comprehensive patient education is required to provide the patient with the self-management skills necessary to achieve this level of glycemic control. Epidemiologic data indicate that large numbers of patients do not receive the proper care or education necessary to develop such self-management abilities. In order to convey the importance of patient education, the American Diabetes Association (ADA) has labeled self-management education as a cornerstone of therapy for patients with diabetes. Standards of care have also been defined by the ADA. Within the current U.S. health care system, however, limitations are present that may affect the quality of care and ability to provide adequate patient education. Therefore, it is the responsibility of the health care provider to improve the education process in an attempt to maintain standards of care outlined by the ADA. When developing a diabetes self-management training program, the ADA national standards can be used as a guideline. PMID:10168174

  14. Managing benefits for diabetes: changing payer strategies for changing times.

    PubMed

    Tzeel, Albert

    2013-01-01

    Just as there are many ways to treat a condition such as diabetes, there are also many ways for payers to manage the diabetes benefit. Although none of these methods is specifically right or wrong, they are grounded in a payer's philosophy and created in response to the needs of the time. Yet, just as in any other business, new ideas and, for diabetes, new scientific discoveries will surely mandate new strategies to achieve goals. As payers find themselves adapting to new political realities and new partnerships, one cannot be sure if their new strategies will succeed or not. But, in actuality, this becomes moot as the 1 point we can be sure of is that benefit management will continue to evolve. PMID:23725238

  15. Managing diabetes in people with dementia.

    PubMed

    Brown, Joe; Carson, Amanda; Waugh, Anna; Park, Douglas

    Diabetes and dementia may manifest simultaneously: one is potentially life threatening, the other causes severe, progressive loss of memory and cognitive function. Where they coexist, they present nurses with challenges such as administering life-saving interventions to patients who are unable to give informed consent. This article offers guidance on the clinical and ethical challenges involved in blood glucose monitoring and medicines administration in patients with dementia. PMID:26285437

  16. Improving diabetes management with electronic health records and patients' health records.

    PubMed

    Benhamou, P-Y

    2011-12-01

    The lack of patient engagement and clinical inertia both contribute to suboptimal diabetes care. However, both obstacles are amenable to informatics- and Internet-based interventions. The use of electronic medical records (EMRs) is now established as being useful for improving diabetes care. Intelligent records that integrate computerized decision-support systems are now able to recommend care protocols tailored to risk levels. Web-based personal health record (PHR) systems, shared with healthcare providers, could also provide added value by promoting self-management of the behaviours related to diabetes. These Web-based programmes include patients' access to EMRs, uploading of glucose monitoring results, a glucose diary, secure e-mail with providers, manual or automated feedback on blood glucose readings and other risk factors, an educational website, and an online diary for entering personal information on exercise, diet and medication. The integration of Web-based patients' systems into the EMR used by physicians is the next frontier. In addition, the input from "smartphones" that are able to provide real-time support to patients could contribute to the reorganization of diabetes care. Convincing data on HbA(1c) improvements with such systems are available for type 2 diabetes, but are still equivocal for type 1 diabetes. Obstacles include patients' compliance with the technology, their ergonomic design and the need to reimburse providers for their care. Designing appropriate electronic tools and tailoring them to the conditions in France merits our attention. PMID:22208711

  17. 42 CFR 414.63 - Payment for outpatient diabetes self-management training.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for outpatient diabetes self-management... SERVICES Physicians and Other Practitioners § 414.63 Payment for outpatient diabetes self-management..., payment for outpatient diabetes self-management training is made under the physician fee schedule...

  18. 42 CFR 414.63 - Payment for outpatient diabetes self-management training.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for outpatient diabetes self-management... SERVICES Physicians and Other Practitioners § 414.63 Payment for outpatient diabetes self-management..., payment for outpatient diabetes self-management training is made under the physician fee schedule...

  19. Children's Roles in Parents’ Diabetes Self-Management

    PubMed Central

    Laroche, Helena H.; Davis, Matthew M.; Forman, Jane; Palmisano, Gloria; Reisinger, Heather Schacht; Tannas, Cheryl; Spencer, Michael; Heisler, Michele

    2010-01-01

    Background Family support is important in diabetes self-management. However, children as providers of support have received little attention. This study examines the role of children in their parents’ diabetes self-management, diet, and exercise. Methods This research used community-based participatory research principles. Researchers conducted semi-structured parallel interviews of 24 Latino and African-American adults with diabetes and with a child (age 10–17 years) in their home (2004–06). Interviews were transcribed, coded, and analyzed for themes (2004–07). Results Adults and children perceived that children play many roles related to adults’ diabetes self-management. Parents described children as monitoring parents’ dietary intake and reminding them what they should not be eating. Some children helped with shopping and meal preparation. Families described children reminding parents to exercise and exercising with their parent. Children reminded parents about medications and assisted with tasks such as checking blood sugar. Parents and children perceived that children played a role in tempting parents to stray from their diabetes diet, because children's diets included food that parents desired but tried to avoid. Conclusion Children and parents perceived that children have many roles in both supporting and undermining adults’ diabetes self-management. There is more to learn about the bidirectional relationships between adults and children in this setting and the most beneficial roles children can play. Health-care providers should encourage family lifestyle change, strengthen social support for families and direct children toward roles that are beneficial for both parent and child and do not place an unreasonable level of responsibility on the child. PMID:19896027

  20. Glycemic control and diabetes management in hospitalized patients in Brazil

    PubMed Central

    2013-01-01

    Background The importance of tight blood glucose control among outpatients with diabetes mellitus is well established, however, the management of diabetes in the hospital setting is generally considered secondary in importance. This study sought to assess glycemic control and diabetes management in adult patients admitted to hospitals in Brazil. Methods A cross-sectional and nationwide survey was conducted from July 2010 to January 2012. Eligible cases were 18 years of age or older, had a diagnosis of diabetes and a hospitalization length of stay ≥72 hours. Socio-demographic information, hospitalization details, and data on diabetes diagnosis, management and treatment were collected for all patients by chart review. Information on all blood glucose (BG) readings for a maximum of 20 consecutive days of hospitalization was recorded for each patient. Results Overall, 2,399 patients were surveyed in 24 hospitals located in 13 cities from all five Brazilian regions. The prevalence of patients presenting hyperglycemic (BG >180 mg/dL) or hypoglycemic (BG <70 mg/dL) events was 89.4% and 30.9% in patients in general wards, and 88.2% and 27.7% in those in Intensive Care Units (ICUs), respectively. In addition, a BG measure >180 mg/dL was recorded in two-thirds of the patient-days. A high proportion of patients were treated with sliding-scale insulin regimen alone in the general wards (52.0%) and in the ICUs (69.2%), and only 35.7% and 3.9% received appropriate insulin therapy in general wards (basal + bolus insulin) and in ICUs (continuous IV insulin), respectively. Conclusions Inpatient glycemic control and diabetes management needs improvement. Opportunities to improve care in Brazilian hospitals include expanded use of intravenous insulin and subcutaneous basal-bolus insulin protocols, avoiding use of sliding-scale insulin alone, increased frequency of blood glucose monitoring, and institution wide quality improvement efforts targeting both physician and nursing

  1. Sleep in Adolescents and Young Adults with Type 1 Diabetes: Associations with Diabetes Management and Glycemic Control

    PubMed Central

    Jaser, Sarah S.; Ellis, Deborah

    2016-01-01

    Objective To describe sleep in adolescents and young adults with type 1 diabetes and explore the association between sleep disturbances, diabetes management and glycemic control. Methods Adolescents with type 1 diabetes (n = 159, mean age = 16.4, 43% female, 69% white, mean A1C = 9.3%) completed the Pittsburgh Sleep Quality Index to assess sleep quantity and quality and sleep disturbances. Frequency of blood glucose monitoring (meter downloads) was used as a measure of diabetes management. Results Average sleep duration was 7.4 hours, below the recommended duration for this age. Adolescents using insulin pumps reported fewer sleep disturbances and longer sleep duration than those on injections, and older adolescents reported less sleep than younger adolescents. Poorer sleep duration was related to poorer diabetes management and better self-reported sleep quality was associated with better glycemic control for males but not for females. Conclusions Assessing for and treating sleep disturbances in adolescents may improve diabetes management. PMID:27081578

  2. Diabetes insipidus uncovered during conservative management of complicated acute appendicitis.

    PubMed

    Mamtani, Anita; Odom, Stephen R; Butler, Kathryn L

    2016-05-01

    Diabetes insipidus (DI) arises from impaired function of antidiuretic hormone, characterized by hypovolemia, hypernatremia, polyuria, and polydipsia. This case is a reminder of the rare but challenging obstacle that undiagnosed DI poses in fasting surgical patients, requiring prompt recognition and vigilant management of marked homeostatic imbalances. PMID:27190614

  3. Routine management and special problems of diabetic children.

    PubMed

    MacDonald, M J

    1983-12-01

    Guidelines for the prescription, initiation, and adjustment of insulin plans in diabetic children are outlined, with an emphasis on patient education and active participation in the treatment regimen. The management of special situations--sick days, surgery, noncompliance, and travel--is also discussed. PMID:6371862

  4. Diabetes Management and Hypoglycemia in Safety Sensitive Jobs

    PubMed Central

    Koh, David; Chui, Winnie KL; Sum, Chee-Fang

    2011-01-01

    The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs. PMID:22953182

  5. Gestational Diabetes Mellitus: Risks and Management during and after Pregnancy

    PubMed Central

    Buchanan, Thomas A.; Xiang, Anny H.; Page, Kathleen A.

    2015-01-01

    Gestational diabetes mellitus (GDM) represents glucose levels in the high end of the population distribution during pregnancy. GDM carries a small but potentially important risk of adverse perinatal outcomes and a longer-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements compliment maternal glucose measurements in identifying pregnancies that need such intensification. Glucose testing shortly after pregnancy can stratify the near-term diabetes risk in mothers, Thereafter, annual glucose and HbA1C testing can detect deteriorating glycaemic control, a harbinger of future diabetes, usually type 2. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning allows optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity. PMID:22751341

  6. Diabetes management: optimizing roles for nurses in insulin initiation.

    PubMed

    Levich, Bridget R

    2011-01-01

    Type 2 diabetes is a major public health concern. Screening and early diagnosis followed by prompt and aggressive treatment interventions can help control progression of diabetes and its complications. Nurses are often the first healthcare team members to interact with patients and are being called on to apply their specialized knowledge, training, and skills to educate and motivate patients with diabetes about insulin use and practical ways to achieve treatment goals. Clinical nurse specialists possess specific training and skills to provide this level of care, while staff or office-based nurses may be trained by physicians to fulfill a task-specific role. This manuscript reviews the benefits of intensive glycemic control in type 2 diabetes, therapeutic goals and guidelines, advances in insulin therapy, and contribution of nurses in overcoming barriers to insulin initiation and related aspects of diabetes care. Nurses are particularly well positioned to fill the gap and improve efficiency in diabetes-related healthcare by assisting patients with insulin initiation and other aspects of glycemic self-management. PMID:21468244

  7. Recommendations for management of diabetes during Ramadan: update 2015

    PubMed Central

    Ibrahim, Mahmoud; Abu Al Magd, Megahed; Annabi, Firas A; Assaad-Khalil, Samir; Ba-Essa, Ebtesam M; Fahdil, Ibtihal; Karadeniz, Sehnaz; Meriden, Terry; Misha'l, Aly A; Pozzilli, Paolo; Shera, Samad; Thomas, Abraham; Bahijri, Suhad; Tuomilehto, Jaakko; Yilmaz, Temel; Umpierrez, Guillermo E

    2015-01-01

    Since the first ADA working group report on the recommendations for management of diabetes during Ramadan in 2005 and our update in 2010, we received many inquiries asking for regular updates on information regarding education, nutritional habits and new oral and injectable agents that may be useful for the management of patients with diabetes during Ramadan. Patients can be stratified into their risk of hypoglycemia and/or complications prior to the start of the fasting period of Ramadan. Those at high risk of hypoglycemia and with multiple diabetic complications should be advised against prolonged fasting. Even in the lower hypoglycemia risk group, adverse effects may still occur. In order to minimize adverse side effects during fasting in patients with diabetes and improve or maintain glucose control, education and discussion of glucose monitoring and treatment regimens should occur several weeks prior to Ramadan. Agents such as metformin, thiazolidinediones and dipeptidyl peptidase-4 inhibitors appear to be safe and do not need dose adjustment. Most sulfonylureas may not be used safely during Ramadan except with extreme caution; besides, older agents, such as chlorpropamide or glyburide, should not be used. Reduction of the dosage of sulfonylurea is needed depending on the degree of control prior to fasting. Misconceptions and local habits should be addressed and dealt with in any educational intervention and therapeutic planning with patients with diabetes. In this regard, efforts are still needed for controlled prospective studies in the field of efficacy and safety of the different interventions during the Ramadan Fast. PMID:26113983

  8. Health Technologies for Monitoring and Managing Diabetes: A Systematic Review

    PubMed Central

    Russell-Minda, Elizabeth; Jutai, Jeffrey; Speechley, Mark; Bradley, Kaitlin; Chudyk, Anna; Petrella, Robert

    2009-01-01

    Background The primary objective of this review was to determine the strength of evidence for the effectiveness of self-monitoring devices and technologies for individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on specific health-related outcome measures. Self-monitoring devices included those that assist patients with managing diabetes and preventing cardiovascular complications (CVCs). A secondary objective was to explore issues of feasibility, usability, and compliance among patients and providers. Methods Study criteria included individuals ≥14 years and youth (7–14 years) with T1DM or T2DM, intervention with a self-monitoring device, assessment of clinical outcomes with the device, literature in English, and ≥10 participants. Relevant published literature was searched from 1985 to 2008. Randomized controlled trials and observational studies were included. Data were extracted for clinical outcomes, feasibility and compliance methods, and results. Selected studies were independently evaluated with a validated instrument for assessing methodological quality. Results Eighteen trials were selected. Predominant types of device interventions included self-monitoring of blood glucose, pedometers, and cell phone or wireless technologies. Feasibility and compliance were measured in the majority of studies. Conclusions Self-monitoring of blood glucose continues to be an effective tool for the management of diabetes. Wireless technologies can improve diabetes self-care, and pedometers are effective lifestyle modification tools. The results of this review indicate a need for additional controlled trial research on existing and novel technologies for diabetes self-monitoring, on health outcomes associated with diabetes and CVCs, and device feasibility and compliance. PMID:20144402

  9. Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study

    PubMed Central

    2013-01-01

    Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. Methods/design This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. Discussion This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries

  10. [Management of children and adolescents with diabetes mellitus: personal experience].

    PubMed

    Dorchy, H

    2005-09-01

    The increasing prevalence of type 2 diabetes in the USA has closely paralleled the increase in childhood obesity noted there, but now across the Western world and therefore in Belgium. (Pre)type 2 diabetes is preceded by insulin resistance which must be diagnosed and treated. In Belgium, type 1 diabetes is the predominant (97%) form of diabetes in young people (< 2,000 cases under the age of 18 years). Type 1 diabetes is an auto-immune disease which is more aggressive in younger children. At onset, the key-symptoms are : polyuria, polydipsia, weight loss, asthenia. Diagnosis is confirmed with 2 strips measuring glycaemia and glycosuria. Treatment and diabetes education for self-management should be initiated immediately in paediatric clinics of diabetology with a specialised multidisciplinary team. Thanks to the Belgian Social medicine, medical consultations and material necessary for treatment are nearly without cost. The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications by maintaining blood glucose concentrations close to the normal range and an HbA1c level under 7%. The number of daily insulin injections, 2 or > or = 4, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycaemic control in young patients depends mainly on the quality and intensity of diabetes education. Any dogmatism must be avoided. Dietary recommendations issued over the last few years are the same for diabetic and non-diabetic individuals in order to avoid degenerative diseases. In the twice-daily injection regimen, the allocation of carbohydrates throughout the day is essential. Due to their pharmakokinetic characteristics, rapid-acting and long-acting insulin analogues have specific indications in both the twice

  11. Diabetes Self-Management Education in the Home

    PubMed Central

    Zeitoun, Joanah; Stern, Marianne; Butkiewicz, Elise; Wegner, Elfie; Reinisch, Courtney

    2016-01-01

    Purpose Diabetes self-management education and home visits have been found to improve clinical outcomes in individuals living with diabetes. The purpose of this pilot project was to evaluate the feasibility and effectiveness of conducting self-management education in patients' homes. Methods Baseline biometric data was collected from a cohort of adult patients with diabetes. Home visits to 19 patients were conducted by doctoral students from Rutgers University School of Nursing. The visits included knowledge assessment, review of foods in the home, diabetes self-management education, and teaching the proper use of monitoring tools such as the glucometer and blood pressure monitor. Biomarkers were obtained post-intervention and were compared to baseline biomarkers. Descriptive lifestyle data was collected and opportunities for customized patient education were provided. Results The biomarkers improved overall during the four months after the education intervention. The mean A1C reduced 12% (p=0.0107), the mean glucose reduced 12% (p=0.0994), the mean BMI reduced 2% (p=0.1490), the systolic pressure reduced 1% (p=0.4196), and the diastolic pressure remained stable. Specific goal setting further increased the improvement in the area the individual planned to address.  Conclusions This project supports prior studies that found that in-home educational programs can improve the self-management of diabetes and lead to improvement in health indicators. The benefits of the study included personal attention in ensuring the correct use of home health monitoring devices, building self-management confidence, and identifying treatment barriers that may not be easily discerned in a clinic setting. PMID:27588231

  12. Evaluation of a Remote Monitoring System for Diabetes Control

    PubMed Central

    Katalenich, Bonnie; Shi, Lizheng; Liu, Shuqian; Shao, Hui; McDuffie, Roberta; Carpio, Gandahari; Thethi, Tina; Fonseca, Vivian

    2015-01-01

    Purpose The use of technology to implement cost-effective health care management on a large scale may be an alternative for diabetes management but needs to be evaluated in controlled trials. This study assessed the utility and cost-effectiveness of an automated Diabetes Remote Monitoring and Management System (DRMS) in glycemic control versus usual care. Methods In this randomized, controlled study, patients with uncontrolled diabetes on insulin were randomized to use of the DRMS or usual care. Participants in both groups were followed up for 6 months and had 3 clinic visits at 0, 3, and 6 months. The DRMS used text messages or phone calls to remind patients to test their blood glucose and to report results via an automated system, with no human interaction unless a patient had severely high or low blood glucose. The DRMS made adjustments to insulin dose(s) based on validated algorithms. Participants reported medication adherence through the Morisky Medication Adherence Scale-8, and diabetes-specific quality of life through the diabetes Daily Quality of Life questionnaire. A cost-effectiveness analysis was conducted based on the estimated overall costs of DRMS and usual care. Findings A total of 98 patients were enrolled (59 [60%] female; mean age, 59 years); 87 participants (89%) completed follow-up. HbA1c was similar between the DRMS and control groups at 3 months (7.60% vs 8.10%) and at 6 months (8.10% vs 7.90%). Changes from baseline to 6 months were not statistically significant for self-reported medication adherence and diabetes-specific quality of life, with the exception of the Daily Quality of Life–Social/Vocational Concerns subscale score (P = 0.04). Implications An automated system like the DRMS may improve glycemic control to the same degree as usual clinic care and may significantly improve the social/vocational aspects of quality of life. Cost-effectiveness analysis found DRMS to be cost-effective when compared to usual care and suggests DRMS has a

  13. 42 CFR 410.141 - Outpatient diabetes self-management training.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... practitioner) managing the beneficiary's diabetic condition. By signing this statement, the physician (or qualified nonphysician practitioner) certifies that he or she is managing the beneficiary's...

  14. 42 CFR 410.141 - Outpatient diabetes self-management training.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... practitioner) managing the beneficiary's diabetic condition. By signing this statement, the physician (or qualified nonphysician practitioner) certifies that he or she is managing the beneficiary's...

  15. 42 CFR 410.141 - Outpatient diabetes self-management training.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... practitioner) managing the beneficiary's diabetic condition. By signing this statement, the physician (or qualified nonphysician practitioner) certifies that he or she is managing the beneficiary's...

  16. Modern management of childhood diabetes: a role for computerized devices?

    PubMed

    Chiarelli, F; Di Ricco, L; Catino, M; Sabatino, G; Verrotti, A

    1998-08-01

    Technology is increasingly relevant in everyday life and it can be very interesting to apply it also in the field of diabetes as it can be one way of ensuring better care. In the Diabetes Control and Complications Trial, the intensively treated patients were seen fortnightly in hospital and contacted even more frequently by telephone during the day as well as at night. For these reasons, health reforms are undergoing a radical change in an attempt to reduce the spiraling costs of health care provision. Therefore, it can be useful to use information technology (IT) in diabetes care. The European Federation for Medical Informatics recently established some Special Issues to advance IT initiatives that may be able to address the problem of adjusting the insulin dose and controlling blood glucose (BG) levels, as well as assisting in the provision of modern-day diabetes care. The Special Issues can be classified under the following headings: databases, algorithms, decision support, models and education. It can be useful to develop a prototype computer system that can be applied to different areas of clinical diabetes care; computerized out-patients' clinical databases that store patients' clinical and biochemical data; statistical and graphical analysis programs that help the clinician; dietary analysis programs which examine food composition and dietary exchanges and help devise meal plans; hand-held insulin dosage adjustment computers that advise patients on a day-by-day or even meal-by-meal basis; expert systems and question and answer programs for patients' education, and finally games for children. These systems have the potential to be useful tools in many aspects of diabetes care but their utilization by the vast majority of the health care community has been extremely limited. Nonetheless, computers cannot substitute for the pediatric diabetes team, which remains the major determinant for better care of diabetes in children and adolescents. PMID:9745768

  17. Management of Pediatric and Adolescent Type 2 Diabetes

    PubMed Central

    Constantine Samaan, M.

    2013-01-01

    Type 2 diabetes (T2D) was an adult disease until recently, but the rising rates of obesity around the world have resulted in a younger age at presentation. Children who have T2D have several comorbidities and complications reminiscent of adult diabetes, but these are appearing in teens instead of midlife. In this review, we discuss the clinical presentation and management options for youth with T2D. We discuss the elements of lifestyle intervention programs and allude to pharmacotherapeutic options used in the treatment of T2D youth. We also discuss comorbidities and complications seen in T2D in children and adolescents. PMID:24260037

  18. Obesity and type 1 diabetes mellitus management.

    PubMed

    Chillarón, J J; Benaiges, D; Mañé, L; Pedro-Botet, J; Flores Le-Roux, J A

    2015-03-01

    Patients with type 1 diabetes mellitus (T1DM) traditionally had a low body mass index and microangiopathic complications were common. The Diabetes Control and Complications Trial, published in 1993, demonstrated that therapy aimed at maintaining HbA1c levels as close to normal as feasible reduced the incidence of microangiopathy. Since then, the use of intensive insulin therapy to optimise metabolic control became generalised, with two main side effects: a higher rate of severe hypoglycaemia and increased weight gain. Approximately 50% of patients with T1DM are currently obese or overweight, which reduces or nullifies the benefits of good metabolic control, and which has other negative consequences; therefore, strategies to achieve weight control in patients with T1DM are necessary. At present, treatment with GLP-1 and SGLT-2 inhibitors has yielded promising short-term results that need to be confirmed in studies with larger numbers of patients and long-term follow-up. It is possible that, in coming years, the applicability of bariatric surgery in obese patients with T1DM will be similar to that of the general population or T2DM. PMID:25413942

  19. A Portable Real-Time Ringdown Breath Acetone Analyzer: Toward Potential Diabetic Screening and Management.

    PubMed

    Jiang, Chenyu; Sun, Meixiu; Wang, Zhennan; Chen, Zhuying; Zhao, Xiaomeng; Yuan, Yuan; Li, Yingxin; Wang, Chuji

    2016-01-01

    Breath analysis has been considered a suitable tool to evaluate diseases of the respiratory system and those that involve metabolic changes, such as diabetes. Breath acetone has long been known as a biomarker for diabetes. However, the results from published data by far have been inconclusive regarding whether breath acetone is a reliable index of diabetic screening. Large variations exist among the results of different studies because there has been no "best-practice method" for breath-acetone measurements as a result of technical problems of sampling and analysis. In this mini-review, we update the current status of our development of a laser-based breath acetone analyzer toward real-time, one-line diabetic screening and a point-of-care instrument for diabetic management. An integrated standalone breath acetone analyzer based on the cavity ringdown spectroscopy technique has been developed. The instrument was validated by using the certificated gas chromatography-mass spectrometry. The linear fittings suggest that the obtained acetone concentrations via both methods are consistent. Breath samples from each individual subject under various conditions in total, 1257 breath samples were taken from 22 Type 1 diabetic (T1D) patients, 312 Type 2 diabetic (T2D) patients, which is one of the largest numbers of T2D subjects ever used in a single study, and 52 non-diabetic healthy subjects. Simultaneous blood glucose (BG) levels were also tested using a standard diabetic management BG meter. The mean breath acetone concentrations were determined to be 4.9 ± 16 ppm (22 T1D), and 1.5 ± 1.3 ppm (312 T2D), which are about 4.5 and 1.4 times of the one in the 42 non-diabetic healthy subjects, 1.1 ± 0.5 ppm, respectively. A preliminary quantitative correlation (R = 0.56, p < 0.05) between the mean individual breath acetone concentration and the mean individual BG levels does exist in 20 T1D subjects with no ketoacidosis. No direct correlation is observed in T1D subjects, T2D

  20. Hypertension Management and Microvascular Insulin Resistance in Diabetes

    PubMed Central

    Ko, Seung-Hyun; Cao, Wenhong; Liu, Zhenqi

    2011-01-01

    Type 2 diabetes is in essence a vascular disease and is frequently associated with hypertension, macrovascular events, and microvascular complications. Microvascular dysfunction, including impaired recruitment and capillary rarefaction, has been implicated in the pathogenesis of diabetic complications. Microvascular insulin resistance and renin-angiotensin system upregulation are present in diabetes, and each contributes to the development of hypertension and microvascular dysfunction. In the insulin-sensitive state, insulin increases microvascular perfusion by increasing endothelial nitric oxide production, but this effect is abolished by insulin resistance. Angiotensin II, acting via the type 1 receptors, induces inflammation and oxidative stress, leading to impaired insulin signaling, reduced nitric oxide availability, and vasoconstriction. Conversely, it acts on the type 2 receptors to cause vasodilatation. Because substrate and hormonal exchanges occur in the microvasculature, antihypertensive agents targeted to improve microvascular insulin sensitivity and function may have beneficial effects beyond their capacity to lower blood pressure in patients with diabetes. PMID:20582734

  1. A Nursing Approach to Self-Management Education for Individuals With Mental Illness and Diabetes.

    PubMed

    Lawless, Mary Ellen; Kanuch, Stephanie W; Martin, Siobhan; Kaiser, Denise; Blixen, Carol; Fuentes-Casiano, Edna; Sajatovic, Martha; Dawson, Neal V

    2016-02-01

    Patients with serious mental illness (SMI) and diabetes often seek care in primary care settings and have worse health outcomes than patients who have either illness alone. Individual, provider, and system-level barriers present challenges to addressing both psychiatric and medical comorbidities. This article describes the feasibility, acceptability, and implementation of Targeted Training and Illness Management (TTIM), a self-management intervention delivered by trained nurse educators and peer educators to groups of individuals with SMI and diabetes to improve self-management of both diseases. TTIM is intended to be delivered in a primary care setting. Findings are intended to support the future development of nurse-led programs within the primary care setting that teach self-management to individuals with concurrent SMI and diabetes. This approach supports both adaptability and flexibility in delivering the intervention. Interventions such as TTIM can provide self-management skills, accommodate people with both SMI and diabetes in primary care settings such as patient-centered medical homes, and address known barriers to access. PMID:26912962

  2. An assessment of patient education and self-management in diabetes disease management--two case studies.

    PubMed

    Fitzner, Karen; Greenwood, Deborah; Payne, Hildegarde; Thomson, John; Vukovljak, Lana; McCulloch, Amber; Specker, James E

    2008-12-01

    Diabetes affects 7.8% of Americans, nearly 24 million people, and costs $174 billion yearly. People with diabetes benefit from self-management; disease management (DM) programs are effective in managing populations with diabetes. Little has been published on the intersection of diabetes education and DM. Our hypothesis was that diabetes educators and their interventions integrate well with DM and effectively support providers' care delivery. A literature review was conducted for papers published within the past 3 years and identified using the search terms "diabetes educator" and "disease management." Those that primarily addressed community health workers or the primary care/community setting were excluded. Two case studies were conducted to augment the literature. Ten of 30 manuscripts identified in the literature review were applicable and indicate that techniques and interventions based on cognitive theories and behavioral change can be effective when coupled with diabetes DM. Better diabetes self-management through diabetes education encourages participation in DM programs and adherence to recommended care in programs offered by DM organizations or those that are provider based. Improved health outcomes and reduced cost can be achieved by blending diabetes education and DM. Diabetes educators are a critical part of the management team and, with their arsenal of goal setting and behavior change techniques, are an essential component for the success of diabetes DM programs. Additional research needs to be undertaken to identify effective ways to integrate diabetes educators and education into DM and to assess clinical, behavioral, and economic outcomes arising from such programs. PMID:19108648

  3. Risk assessment and management of post-transplant diabetes mellitus.

    PubMed

    Han, Eugene; Kim, Myoung Soo; Kim, Yu Seun; Kang, Eun Seok

    2016-10-01

    The success rate of organ transplantation has been increasing with advances in surgical and pharmacological techniques. However, the number of solid organ transplant recipients who require metabolic disease management is also growing. Post-transplant diabetes mellitus (PTDM) is a common complication after solid organ transplantation and is associated with risks of graft loss, cardiovascular morbidity, and mortality. Other risk factors for PTDM include older age, genetic background, obesity, hepatitis C virus infection, hypomagnesemia, and use of immunosuppressant agents (corticosteroids, calcineurin inhibitors, and mammalian target of rapamycin inhibitor). Management of PTDM should be started before the transplantation plan to properly screen high-risk patients. Even though PTDM management is similar to that of general type 2 diabetes, therapeutic approaches must be made with consideration of drug interactions between immunosuppressive agents, glucose-lowering medications, and graft rejection and function. PMID:27621191

  4. Literature review on the management of diabetic foot ulcer

    PubMed Central

    Yazdanpanah, Leila; Nasiri, Morteza; Adarvishi, Sara

    2015-01-01

    Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it’s suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications. PMID:25685277

  5. Technology to Optimize Pediatric Diabetes Management and Outcomes

    PubMed Central

    Harrington, Kara R.; Laffel, Lori M. B.

    2013-01-01

    Technology for diabetes management is rapidly developing and changing. With each new development, there are numerous factors to consider, including medical benefits, impact on quality of life, ease of use, and barriers to use. It is also important to consider the interaction between developmental stage and technology. This review considers a number of newer diabetes-related technologies and explores issues related to their use in the pediatric diabetes population (including young adults), with a focus on psychosocial factors. Areas include trend technology in blood glucose monitoring, continuous glucose monitoring, sensor-augmented insulin pumps and low glucose suspend functions, internet applications including videoconferencing, mobile applications (apps), including text messaging, and online gaming. PMID:24046146

  6. Predictors of Diabetes Self-Management among Type 2 Diabetes Patients

    PubMed Central

    2016-01-01

    Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak, Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06 mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1 mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness (p = 0.001), family support (p = 0.007), and self-efficacy (p = 0.027). Health care personnel must convince patients with T2DM of the effectiveness of the treatment, empower and enhance their self-efficacy, and enlist the family support so as to ensure patients sustain their DSM efforts. PMID:27563681

  7. Predictors of Diabetes Self-Management among Type 2 Diabetes Patients.

    PubMed

    Gunggu, Azylina; Thon, Chang Ching; Whye Lian, Cheah

    2016-01-01

    Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak, Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06 mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1 mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness (p = 0.001), family support (p = 0.007), and self-efficacy (p = 0.027). Health care personnel must convince patients with T2DM of the effectiveness of the treatment, empower and enhance their self-efficacy, and enlist the family support so as to ensure patients sustain their DSM efforts. PMID:27563681

  8. Patient Self-Management of Diabetes Care in the Inpatient Setting: Con.

    PubMed

    Shah, Arti D; Rushakoff, Robert J

    2015-09-01

    Self-management of diabetes by inpatients can be problematic. People with type 1 diabetes often prefer to self-manage their diabetes in the inpatient setting. We report the case of a patient admitted to the surgical service who was self-administering his home insulin, often without telling his nurse or physician. He was aiming for tight glycemic control, which resulted in life-threatening hypoglycemia. While patients can often self-manage their diabetes in the outpatient setting, inpatient management of diabetes is very different. Patients may not be familiar with common scenarios requiring adjustments of insulin therapy. Therefore, we recommend against self-management of diabetes in the hospital. However, the patients should be involved in discussions about management of their diabetes in the hospital to allay their concerns about changes made to their insulin regimens. An example of successful cooperative management is with use of protocols that allow continued use of insulin pumps in the hospital. PMID:25990293

  9. DIABETES

    PubMed Central

    Urano, Fumihiko

    2014-01-01

    Limited options for clinical management of patients with juvenile-onset diabetes mellitus call for a novel therapeutic paradigm. Two innovative studies support endoplasmic reticulum as an emerging target for combating both autoimmune and heritable forms of this disease. PMID:24393784

  10. The kallikrein-kinin system in diabetic retinopathy.

    PubMed

    Bhat, Menakshi; Pouliot, Mylène; Couture, Réjean; Vaucher, Elvire

    2014-01-01

    Diabetic retinopathy (DR) is a major microvascular complication associated with type 1 and type 2 diabetes mellitus, which can lead to visual impairment and blindness. Current treatment strategies for DR are mostly limited to laser therapies, steroids, and anti-VEGF agents, which are often associated with unwanted side effects leading to further complications. Recent evidence suggests that kinins play a primary role in the development of DR through enhanced vascular permeability, leukocytes infiltration, and other inflammatory mechanisms. These deleterious effects are mediated by kinin B1 and B2 receptors, which are expressed in diabetic human and rodent retina. Importantly, kinin B1 receptor is virtually absent in sane tissue, yet it is induced and upregulated in diabetic retina. These peptides belong to the kallikrein-kinin system (KKS), which contains two separate and independent pathways of regulated serine proteases, namely plasma kallikrein (PK) and tissue kallikrein (TK) that are involved in the biosynthesis of bradykinin (BK) and kallidin (Lys-BK), respectively. Hence, ocular inhibition of kallikreins or antagonism of kinin receptors offers new therapeutic avenues in the treatment and management of DR. Herein, we present an overview of the principal features and known inflammatory mechanisms associated with DR along with the current therapeutic approaches and put special emphasis on the KKS as a new and promising therapeutic target due to its link with key pathways directly associated with the development of DR. PMID:25130041

  11. Changes in management and outcomes for children and adolescents with type 1 diabetes over the last 50 years.

    PubMed

    Fairchild, Jan

    2015-01-01

    Over the 50 years from 1964 to 2014, outcomes for children with type 1 diabetes have improved significantly, because of both technological advancements and changes in management philosophy. For the child with type 1 diabetes in 2014, intensive management with multiple daily injections or insulin pump therapy and the support of a specialist multidisciplinary team is now standard care. The main treatment goal is no longer the avoidance of hypoglycaemia, but the minimisation of hyperglycaemia and glucose variability, thereby reducing the risk of microvascular complications. However, the inherent burden of care and diligence required by patients and families, if they are to maintain optimal diabetes control, have not changed and may even have increased. While the long sought-after cure for diabetes remains elusive, artificial pancreas or closed-loop systems hold the most promise for improving the burden of care in the near term for children and adolescents with type 1 diabetes. PMID:25529223

  12. Management of diabetes mellitus in older people with comorbidities.

    PubMed

    Huang, Elbert S

    2016-01-01

    Diabetes mellitus is a chronic disease of aging that affects more than 20% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management. PMID:27307175

  13. Managing the asymptomatic diabetic patient with silent myocardial ischaemia.

    PubMed

    Doubell, A F

    2002-01-01

    Coronary artery disease is common in diabetic patients and remains the major cause of death in these patients. However myocardial ischaemia resulting from coronary lesions does not always give rise to symptoms. The managing physician must therefore consider the benefit of screening for silent myocardial ischaemia in diabetic patients. Screening all diabetic patients is not recommended. The challenge to the physician is to select the patient subgroups likely to benefit from screening. Patients with more than one cardiac risk factor (dyslipidaemia, hypertension, smoking, family history, micro-albuminuria) in addition to diabetes, as well as patients with established macrovascular disease, e.g. peripheral vascular disease, will benefit most from screening. A standard treadmill stress ECG is the recommended screening test. A number of additional tests have been proposed to select high-risk patients for screening. Of these, testing for microalbuminuria and elevated CRP levels are most likely to influence decision-making. Once silent ischaemia has been detected in a diabetic patient, the mainstay of treatment remains the aggressive control of risk factors, improvement of glycaemic control and aspirin therapy. The use of beta-blockers and ACE-inhibitors often need consideration. The attending physician must then consider referring the patient to a cardiologist for angiography and possible intervention. This decision is based on the presence of poor prognostic signs during the stress ECG and the number of risk factors present. Microalbuminuria and elevated CRP levels are helpful in assisting with the risk stratification process. PMID:12389062

  14. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review

    PubMed Central

    2013-01-01

    Background With an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications. Methods A literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed. Results From 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed. In 2010, it was estimated that 6.3% of Brazilians aged 18 years or over had diabetes. Diabetes was estimated to be responsible for 278,778 years of potential life lost for every 100,000 people. In 2013, it is estimated that about 7% of patients with diabetes has had one or more of the following complications: diabetic foot ulcers, amputation, kidney disease, and fundus changes. The estimated annual direct cost of diabetes was USD $3.952 billion in 2000; the estimated annual indirect cost was USD $18.6 billion. The two main sources of data on diabetes are the information systems of the Ministry of Health and surveys. In the last few years, the Brazilian Ministry of Health has invested considerably in improving surveillance systems for NCDs as well as implementing specific programmes to improve diagnosis and access to treatment. Conclusions Brazil has the capacity to address and respond to NCDs due to the leadership of the Ministry of Health in NCD prevention activities, including an integrated programme currently in place for diabetes. Strengthening the surveillance of NCDs is a

  15. Challenges in diabetes management in Indonesia: a literature review

    PubMed Central

    2013-01-01

    Background and objectives The expanding diabetes epidemic worldwide could have potentially devastating effects on the development of healthcare systems and economies in emerging countries, both in terms of direct health care costs and loss of working time and disability. This study aims to review evidence on the burden, expenditure, complications, treatment, and outcomes of diabetes in Indonesia and its implications on the current health system developments. Methods We conducted a comprehensive literature review together with a review of unpublished data from the Ministry of Health and a public health insurer (Askes). Studies presenting evidence on prevalence, incidence, mortality, costs, complications and cost of complications, treatment, and outcomes were included in the analysis. Results A limited number of international, national and local studies on the burden and cost of diabetes in Indonesia were identified. National survey data suggests that in 2007 the prevalence of diabetes was 5.7%, of which more than 70% of cases were undiagnosed. This estimate hides large intracountry variation. There was very limited data available on direct costs and no data on indirect costs. The most commonly-identified complication was diabetic neuropathy. Discussion There were a number of limitations in the data retrieved including the paucity of data representative at the national level, lack of a clear reference date, lack of data from primary care, and lack of data from certain regions of the country. Conclusions If left unaddressed, the growing prevalence of diabetes in the country will pose a tremendous challenge to the Indonesian healthcare system, particularly in view of the Government’s 2010 mandate to achieve universal health coverage by 2014. Essential steps to address this issue would include: placing diabetes and non-communicable diseases high on the Government agenda and creating a national plan; identifying disparities and priority areas for Indonesia; developing

  16. Improving Diabetes Self-Management through Acceptance, Mindfulness, and Values: A Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Gregg, Jennifer A.; Callaghan, Glenn M.; Hayes, Steven C.; Glenn-Lawson, June L.

    2007-01-01

    Patients in a low-income community health center with Type 2 diabetes (N = 81) taking a one-day education workshop as part of their diabetes medical management were randomly assigned either to education alone or to a combination of education and acceptance and commitment therapy (ACT). Both groups were taught how to manage their diabetes, but…

  17. Self-Management Abilities of Diabetes in People with an Intellectual Disability Living in New Zealand

    ERIC Educational Resources Information Center

    Hale, Leigh A.; Trip, Henrietta T.; Whitehead, Lisa; Conder, Jenny

    2011-01-01

    Self-management of diabetes is encouraged; however, it is not an easy task and requires a good understanding of the disease. To determine how to improve the self-management abilities of diabetes in people with an intellectual disability (ID), this study explored the knowledge and understanding of diabetes held by a select group of adults with…

  18. Behavioural Change in Type 1 Diabetes Self-Management: Why and How?

    ERIC Educational Resources Information Center

    Wilson, Valerie L.

    2009-01-01

    Objective: To examine whether the communication process between diabetes health professionals and people intensively self-managing their type 1 diabetes influenced behavioural change. Design: Telephone interviews to provide insight into the communication process and its influence on diabetes intensive self-management behaviour. Setting:…

  19. Consultation and Collaboration on Health Self-Management for People Who Are Visually Impaired from Diabetes.

    ERIC Educational Resources Information Center

    Cleary, Margaret E.

    1993-01-01

    The expertise of rehabilitation teachers and diabetes nurse educators can complement each other in components of diabetes management for people who have become visually impaired. The role of each professional involves education; integration of diabetes self-management into a comprehensive rehabilitation program; nutrition; exercise; medication,…

  20. 42 CFR 414.63 - Payment for outpatient diabetes self-management training.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for outpatient diabetes self-management... HEALTH SERVICES Physicians and Other Practitioners § 414.63 Payment for outpatient diabetes self... this section, payment for outpatient diabetes self-management training is made under the physician...

  1. 42 CFR 414.63 - Payment for outpatient diabetes self-management training.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for outpatient diabetes self-management... HEALTH SERVICES Physicians and Other Practitioners § 414.63 Payment for outpatient diabetes self... this section, payment for outpatient diabetes self-management training is made under the physician...

  2. 42 CFR 414.63 - Payment for outpatient diabetes self-management training.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Payment for outpatient diabetes self-management... HEALTH SERVICES Physicians and Other Practitioners § 414.63 Payment for outpatient diabetes self... this section, payment for outpatient diabetes self-management training is made under the physician...

  3. Contemporary Evaluation and Management of the Diabetic Foot

    PubMed Central

    Sumpio, Bauer E.

    2012-01-01

    Foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes with prevalence as high as 25%. Ulcers are breaks in the dermal barrier with subsequent erosion of underlying subcutaneous tissue that may extend to muscle and bone, and superimposed infection is a frequent and costly complication. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Even when properly managed, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents, and negative pressure wound therapy. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field. PMID:24278695

  4. "This does my head in". Ethnographic study of self-management by people with diabetes

    PubMed Central

    2012-01-01

    Background Self-management is rarely studied 'in the wild'. We sought to produce a richer understanding of how people live with diabetes and why self-management is challenging for some. Method Ethnographic study supplemented with background documents on social context. We studied a socio-economically and ethnically diverse UK population. We sampled 30 people with diabetes (15 type 1, 15 type 2) by snowballing from patient groups, community contacts and NHS clinics. Participants (aged 5-88, from a range of ethnic and socio-economic groups) were shadowed at home and in the community for 2-4 periods of several hours (total 88 visits, 230 hours); interviewed (sometimes with a family member or carer) about their self-management efforts and support needs; and taken out for a meal. Detailed field notes were made and annotated. Data analysis was informed by structuration theory, which assumes that individuals' actions and choices depend on their dispositions and capabilities, which in turn are shaped and constrained (though not entirely determined) by wider social structures. Results Self-management comprised both practical and cognitive tasks (e.g. self-monitoring, menu planning, medication adjustment) and socio-emotional ones (e.g. coping with illness, managing relatives' input, negotiating access to services or resources). Self-management was hard work, and was enabled or constrained by economic, material and socio-cultural conditions within the family, workplace and community. Some people managed their diabetes skilfully and flexibly, drawing on personal capabilities, family and social networks and the healthcare system. For others, capacity to self-manage (including overcoming economic and socio-cultural constraints) was limited by co-morbidity, cognitive ability, psychological factors (e.g. under-confidence, denial) and social capital. The consequences of self-management efforts strongly influenced people's capacity and motivation to continue them. Conclusion Self-management

  5. Management of diabetes in Morocco: results of the International Diabetes Management Practices Study (IDMPS) – wave 5

    PubMed Central

    Chadli, Asmae; El Aziz, Siham; El Ansari, Nawal; Ajdi, Farida; Seqat, Mehdi; Latrech, Hanane; Belmejdoub, Ghizlaine

    2016-01-01

    Objectives: The International Diabetes Mellitus Practice Study (IDMPS) is a 5-year survey documenting changes in diabetes treatment practices in developing countries. The primary objective of this survey was to assess the therapeutic management of type 2 diabetes mellitus (T2DM) in real-life medical practice. The secondary objectives were to evaluate the clinical management of type 1 diabetes mellitus (T1DM) and to assess the proportion of all diabetic patients failing to reach the glycated haemoglobin (HbA1c) <7% target. Methods: Data were analysed for 738 patients (240 with T1DM and 498 with T2DM) included in wave 5 of the IDMPS in Morocco in 2011. Results: Nearly two-thirds (61%) of T2DM patients were treated with oral glucose-lowering drugs (OGLDs) alone, 13.1% were treated with insulin alone and 23.3% were treated with OGLDs plus insulin. Insulin use was less frequent, was initiated later and involved a greater use of premixes versus basal/prandial schedules compared to other populations evaluated in the IDMPS. The majority (92.5%) of T1DM patients were treated with insulin alone and the remainder received insulin plus an OGLD. Insulin protocols included basal + prandial dosing (37.5%) and premix preparations (41.3%). The recommended target of HbA1c <7% was achieved by only 22.2% of T1DM patients and 26.8% of T2DM patients. More macrovascular but fewer microvascular complications were reported in T2DM compared to T1DM patients. Late complications increased with disease duration so that 20 years after diagnosis, 75.7% of T2DM patients were found to have at least one late complication. Conclusions: The clinical burden of diabetes is high in Morocco and the majority of patients do not achieve the recommended glycaemia target, suggesting that there is a huge gap between evidence-based diabetic management and real-life practice. Better education of patients and improved compliance with international recommendations are necessary to deliver a better quality of

  6. Fluid Management System (FMS) fluid systems overview

    NASA Technical Reports Server (NTRS)

    Baird, R. S.

    1990-01-01

    Viewgraphs on fluid management system (FMS) fluid systems overview are presented. Topics addressed include: fluid management system description including system requirements (integrated nitrogen system, integrated water system, and integrated waste gas system) and physical description; and fluid management system evolution.

  7. Collaborative Depression Care Among Latino Patients in Diabetes Disease Management, Los Angeles, 2011–2013

    PubMed Central

    Wu, Brian; Jin, Haomiao; Vidyanti, Irene; Lee, Pey-Jiuan; Ell, Kathleen

    2014-01-01

    Introduction The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes–Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes. Methods A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes. Results Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment. Conclusion Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system. PMID:25167093

  8. Renal Function in Diabetic Disease Models: The Tubular System in the Pathophysiology of the Diabetic Kidney

    PubMed Central

    Vallon, Volker; Thomson, Scott C.

    2013-01-01

    Diabetes mellitus affects the kidney in stages. At the onset of diabetes mellitus, in a subset of diabetic patients the kidneys grow large, and glomerular filtration rate (GFR) becomes supranormal, which are risk factors for developing diabetic nephropathy later in life. This review outlines a pathophysiological concept that focuses on the tubular system to explain these changes. The concept includes the tubular hypothesis of glomerular filtration, which states that early tubular growth and sodium-glucose cotransport enhance proximal tubule reabsorption and make the GFR supranormal through the physiology of tubuloglomerular feedback. The diabetic milieu triggers early tubular cell proliferation, but the induction of TGF-β and cyclin-dependent kinase inhibitors causes a cell cycle arrest and a switch to tubular hypertrophy and a senescence-like phenotype. Although this growth phenotype explains unusual responses like the salt paradox of the early diabetic kidney, the activated molecular pathways may set the stage for tubulointerstitial injury and diabetic nephropathy. PMID:22335797

  9. Contingency Management Learning Systems.

    ERIC Educational Resources Information Center

    Darst, Paul W.

    Contingency management is a system focused on managing the motivation of students, and can be developed and utilized in any type of physical education environment from elementary to college levels. An analysis of two existing contingency management learning systems (one for a fifth-grade gymnastics unit and the other for a seventh- and eigth-grade…

  10. African Americans' Culturally Specific Approaches to the Management of Diabetes

    PubMed Central

    Spruill, Ida J.; Magwood, Gayenell S.; Nemeth, Lynne S.; Williams, Tiffany H.

    2016-01-01

    Spirituality is an important multidimensional cultural resource and coping strategy used by many African Americans for managing chronic diseases such as diabetes. Yet, few studies examine meaning and interpretation of colloquial terms frequently used for coping within the context of a community culture. We designed an interpretive qualitative study to gain a deeper understanding of a colloquial phrase, “I ain't claiming it,” used among Project SuGar research participants when discussing diabetes. Thematic analysis revealed two major themes, Acknowledgment and Denial, as coping mechanisms through an active or passive relationship with God. Sub-theme of acknowledgment was presented as front seat driver and sub-theme for denial of the disease presented as back seat driver. These meanings encompass a range of culturally specific coping strategies for self-management that health providers should consider and implement as part of providing patient-centered care to enhance better outcome strategies. PMID:27175439

  11. ANALYSIS: mobile phones integrated into diabetes management: a logical progression.

    PubMed

    Malasanos, Toree

    2008-01-01

    In this issue of Journal of Diabetes Science and Technology, the intervention described by D. Katz, "Novel Interactive Cell-Phone Technology for Health Enhancement," uses cell phones to provide the rapid communication necessary for the support of intensive management of diabetes. Mobile technology is widely accepted in today's society and can be an effective tool for this cause. There have been numerous interventions using various communication tools, including cell phones, to manage chronic disease, which all propose that improved communication and feedback to patients would improve health status. Dr. Katz has taken the next step by giving semiautomated, real-time, immediate feedback on each data point all transmitted by cell phone. PMID:19885192

  12. MyDiabetesMyWay: An Evolving National Data Driven Diabetes Self-Management Platform.

    PubMed

    Wake, Deborah J; He, Jinzhang; Czesak, Anna Maria; Mughal, Fezan; Cunningham, Scott G

    2016-09-01

    MyDiabetesMyWay (MDMW) is an award-wining national electronic personal health record and self-management platform for diabetes patients in Scotland. This platform links multiple national institutional and patient-recorded data sources to provide a unique resource for patient care and self-management. This review considers the current evidence for online interventions in diabetes and discusses these in the context of current and ongoing developments for MDMW. Evaluation of MDMW through patient reported outcomes demonstrates a positive impact on self-management. User feedback has highlighted barriers to uptake and has guided platform evolution from an education resource website to an electronic personal health record now encompassing remote monitoring, communication tools and personalized education links. Challenges in delivering digital interventions for long-term conditions include integration of data between institutional and personal recorded sources to perform big data analytics and facilitating technology use in those with disabilities, low digital literacy, low socioeconomic status and in minority groups. The potential for technology supported health improvement is great, but awareness and adoption by health workers and patients remains a significant barrier. PMID:27162192

  13. Management of Type 1 Diabetes in Pregnancy.

    PubMed

    Feldman, Anna Z; Brown, Florence M

    2016-08-01

    Women with type 1 diabetes (T1DM) have unique needs during the preconception, pregnancy, and postpartum periods. Preconception counseling is essential for women with T1DM to minimize pregnancy risks. The goals of preconception care should be tight glycemic control with a hemoglobin A1c (A1C) < 7 % and as close to 6 % as possible, without significant hypoglycemia. This will lower risks of congenital malformations, preeclampsia, and perinatal mortality. The safety of medications should be assessed prior to conception. Optimal control of retinopathy, hypertension, and nephropathy should be achieved. During pregnancy, the goal A1C is near-normal at <6 %, without excessive hypoglycemia. There is no clear evidence that continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) is superior in achieving the desired tight glycemic control of T1DM during pregnancy. Data regarding continuous glucose monitoring (CGM) in pregnant women with T1DM is conflicting regarding improved glycemic control. However, a recent CGM study does provide some distinct patterns of glucose levels associated with large for gestational age infants. Frequent eye exams during pregnancy are essential due to risk of progression of retinopathy during pregnancy. Chronic hypertension treatment goals are systolic blood pressure 110-129 mmHg and diastolic blood pressure 65-79 mmHg. Labor and delivery target plasma glucose levels are 80-110 mg/dl, and an insulin drip is recommended to achieve these targets during active labor. Postpartum, insulin doses must be reduced and glucoses closely monitored in women with T1DM because of the enhanced insulin sensitivity after delivery. Breastfeeding is recommended and should be highly encouraged due to maternal benefits including increased insulin sensitivity and weight loss and infant and childhood benefits including reduced prevalence of overweight. In this article, we discuss the care of pregnant patients with T1DM. PMID

  14. Optimal management of lipids in diabetes and metabolic syndrome.

    PubMed

    Brown, W Virgil; Clark, Luther; Falko, James M; Guyton, John R; Rees, Tomas J; Schonfeld, Gustav; Lopes-Virella, Maria F

    2008-10-01

    Patients with diabetes or metabolic syndrome frequently have higher triglycerides, lower high-density lipoprotein (HDL) cholesterol, and more particles containing apolipoprotein B (ApoB); this combination contributes significantly to their cardiovascular risk. Optimal management of dyslipidemia and increased atherosclerotic risk requires a fundamental understanding of diabetic dyslipidemia, the clinical evidence for different interventional strategies, and the potential benefit of achieving therapeutic targets. For this review, we considered guidelines, recent reviews, and clinical trial results. The features of dyslipidemia in type 2 diabetes and the metabolic syndrome are linked metabolically and are related to central adiposity and insulin resistance. Levels of ApoB and HDL cholesterol are particularly important markers of risk. Guidelines broadly agree that low-density lipoprotein (LDL) cholesterol should be reduced below population average levels. Additional or secondary strategies in patients with diabetes or the metabolic syndrome are to decrease non-HDL cholesterol, ApoB and/or LDL particle concentration, to increase HDL cholesterol, and to reduce triglycerides. Lifestyle changes and statins are the bedrock of treatment, although second-line treatment using fibrates or niacin will likely benefit many patients with residual risk. Ezetimibe, too, has a favorable effect on lipid profile and inflammatory biomarkers of risk. Dyslipidemia in type 2 diabetes and metabolic syndrome has a distinct profile, suggesting the need for a tailored therapy that targets the key features of lowered HDL cholesterol and raised triglycerides, in addition to the primary antiatherogenic strategy of lowering ApoB-containing lipoproteins, such as LDL. With the prominent failure of some recent intervention trials, new therapeutic strategies-particularly safe and effective means to raise HDL-are needed to manage dyslipidemia in this high-risk population. PMID:21291758

  15. Why do young adults with Type 1 diabetes find it difficult to manage diabetes in the workplace?

    PubMed

    Balfe, Myles; Brugha, Ruairi; Smith, Diarmuid; Sreenan, Seamus; Doyle, Frank; Conroy, Ronan

    2014-03-01

    This article explores how and why workplace environments impact diabetes management for adults people with Type 1 diabetes, 23-30 years of age. Interviews were conducted with 35 young adults, 29 women and 6 men. The majority of these interviewees worked in sectors such as banking, technology and administration. Young adults found it difficult to manage diabetes in the workplace for two main reasons: work-related time pressures and the non-routine nature of interviewees' work and working environment. Young adults also found it difficult to get the time to exercise both inside and outside of work. Young adults with Type 1 diabetes need to be provided with the tools and technologies that they need to manage diabetes in modern flexible workplaces. PMID:24480739

  16. Managing type 2 diabetes in men.

    PubMed

    Aguilar, Richard

    2012-06-01

    The growing epidemic of T2DM requires intervention to assist patients who have been diagnosed to better manage the disease, to reduce the risk of developing the disease in those who have not yet been diagnosed, and to manage the associated complications. In addition to individualizing interventions based on a patient's needs, concerns, and capabilities, taking gender into account is necessary. In otherwise healthy people, several independent factors appear to pose a higher risk of T2DM in men relative to women, including systolic hypertension, regular smoking, and alcohol intake ≥ 40 g/d. At the same time, men achieve greater risk reduction from moderate daily alcohol intake and a diet high in fish and seafood, low-fat dairy products, whole grains, and magnesium. Once diagnosed with T2DM, men generally fare better than women regarding the risk for CVD; they also have a better prognosis after MI and a lower risk of death overall from CVD. Possible independent risk factors for CVD in men with T2DM that are especially important may include hypertension, poor glycemic control, and low HDL-C levels. Psychosocial complications, such as depression, are less likely in men with T2DM. However, men expend less effort coping, are less likely to utilize healthcare services, and are less informed about treatment options. Although men have a lower expectation of the benefit of self-management, they find support from family and friends more helpful than do women, but they are fearful of losing control of their disease. Taking these gender differences into account should prove helpful as family care physicians work with men to reduce their risk of developing T2DM and in helping men diagnosed with T2DM to better self-manage their disease. PMID:22670243

  17. Diabetes Patients' Experiences With the Implementation of Insulin Therapy and Their Perceptions of Computer-Assisted Self-Management Systems for Insulin Therapy

    PubMed Central

    Gude, Wouter T; Holleman, Frits; Hoekstra, Joost BL; Peek, Niels

    2014-01-01

    Background Computer-assisted decision support is an emerging modality to assist patients with type 2 diabetes mellitus (T2DM) in insulin self-titration (ie, self-adjusting insulin dose according to daily blood glucose levels). Computer-assisted insulin self-titration systems mainly focus on helping patients overcome barriers related to the cognitive components of insulin titration. Yet other (eg, psychological or physical) barriers could still impede effective use of such systems. Objective Our primary aim was to identify experiences with and barriers to self-monitoring of blood glucose, insulin injection, and insulin titration among patients with T2DM. Our research team developed a computer-assisted insulin self-titration system, called PANDIT. The secondary aim of this study was to evaluate patients’ perceptions of computer-assisted insulin self-titration. We included patients who used PANDIT in a 4-week pilot study as well as patients who had never used such a system. Methods In-depth, semi-structured interviews were conducted individually with patients on insulin therapy who were randomly recruited from a university hospital and surrounding general practices in the Netherlands. The interviews were transcribed verbatim and analyzed qualitatively. To classify the textual remarks, we created a codebook during the analysis, in a bottom-up and iterative fashion. To support examination of the final coded data, we used three theories from the field of health psychology and the integrated model of user satisfaction and technology acceptance by Wixom and Todd. Results When starting insulin therapy, some patients feared a lifelong commitment to insulin therapy and disease progression. Also, many barriers arose when implementing insulin therapy (eg, some patients were embarrassed to inject insulin in public). Furthermore, patients had difficulties increasing the insulin dose because they fear hypoglycemia, they associate higher insulin doses with disease progression

  18. Diabetes in Argentina: cost and management of diabetes and its complications and challenges for health policy

    PubMed Central

    2013-01-01

    Background Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses. Aims To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes. Methodology A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina. Results Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$ 1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources

  19. SGLT2 inhibitors in the management of type 2 diabetes.

    PubMed

    Monica Reddy, R P; Inzucchi, Silvio E

    2016-08-01

    The glucose-lowering pharmacopeia continues to grow for patients with type 2 diabetes. The latest drug category, the SGLT2 inhibitors reduce glycated hemoglobin concentrations by increasing urinary excretion of glucose. They are used mainly in combination with metformin and other antihyperglycemic agents, including insulin. Their glucose-lowering potency is modest. Advantages include lack of hypoglycemia as a side effect, and mild reduction in blood pressure and body weight. Side effects include increased urinary frequency, owing to their mild diuretic action, symptoms of hypovolemia, genitourinary infections. There are also recent reports of rare cases of diabetic ketoacidosis occurring in insulin-treated patients. Recently, a large cardiovascular outcome trial reported that a specific SGLT2 inhibitor, empagliflozin, led to a reduction in the primary endpoint of major cardiovascular events. This effect was mainly the result of a surprising 38 % reduction in cardiovascular death, and the drug was also associated with nearly as large a reduction in heart failure hospitalization. These findings were notable because most drugs used in type 2 diabetes have not been shown to improve cardiovascular outcomes. Accordingly, there is growing interest in empagliflozin and the entire SGLT2 inhibitor class as drugs that could potentially change the manner in which we approach the management of hyperglycemia in patients with type 2 diabetes. PMID:27270407

  20. Managing hybrid marketing systems.

    PubMed

    Moriarty, R T; Moran, U

    1990-01-01

    As competition increases and costs become critical, companies that once went to market only one way are adding new channels and using new methods - creating hybrid marketing systems. These hybrid marketing systems hold the promise of greater coverage and reduced costs. But they are also hard to manage; they inevitably raise questions of conflict and control: conflict because marketing units compete for customers; control because new indirect channels are less subject to management authority. Hard as they are to manage, however, hybrid marketing systems promise to become the dominant design, replacing the "purebred" channel strategy in all kinds of businesses. The trick to managing the hybrid is to analyze tasks and channels within and across a marketing system. A map - the hybrid grid - can help managers make sense of their hybrid system. What the chart reveals is that channels are not the basic building blocks of a marketing system; marketing tasks are. The hybrid grid forces managers to consider various combinations of channels and tasks that will optimize both cost and coverage. Managing conflict is also an important element of a successful hybrid system. Managers should first acknowledge the inevitability of conflict. Then they should move to bound it by creating guidelines that spell out which customers to serve through which methods. Finally, a marketing and sales productivity (MSP) system, consisting of a central marketing database, can act as the central nervous system of a hybrid marketing system, helping managers create customized channels and service for specific customer segments. PMID:10107959

  1. Managing Diabetes Mellitus in Children and Adolescents: Some Guidelines for Family Physicians

    PubMed Central

    Couch, Robert M.

    1990-01-01

    Insulin-dependent diabetes mellitus is a relatively common condition affecting children and adolescents. Successful management from the time of diagnosis can help prevent chronic complications of diabetes. This article reviews initial and follow-up management of diabetes in children. Guidelines for management during the remission phase, exercise, hypoglycemia, and illness, and the problems of recurrent ketoacidosis management in adolescence are discussed. The keys to successful management of diabetes mellitus in children and adolescents are patient and family education, continued support and encouragement, and early detection of and counselling for the dysfunctional family. PMID:21234001

  2. NASA's Risk Management System

    NASA Technical Reports Server (NTRS)

    Perera, Jeevan S.

    2011-01-01

    Leadership is key to success. Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks -- risk office personnel. Each group is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk reporting and communication is an essential element of risk management and will combine both qualitative and quantitative elements. Risk informed decision making should be introduced to all levels of management. Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner. Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

  3. Utility of different glycemic control metrics for optimizing management of diabetes

    PubMed Central

    Kohnert, Klaus-Dieter; Heinke, Peter; Vogt, Lutz; Salzsieder, Eckhard

    2015-01-01

    glucose dynamics. Several continuous glucose monitoring (CGM) systems, which have shown usefulness in clinical practice, are presently on the market. They can broadly be divided into systems providing retrospective or real-time information on glucose patterns. The widespread clinical application of CGM is still hampered by the lack of generally accepted measures for assessment of glucose profiles and standardized reporting of glucose data. In this article, we will discuss advantages and limitations of various metrics for glycemic control as well as possibilities for evaluation of glucose data with the special focus on glycemic variability and application of CGM to improve individual diabetes management. PMID:25685275

  4. Definition of Information Technology Architectures for Continuous Data Management and Medical Device Integration in Diabetes

    PubMed Central

    Hernando, M. Elena; Pascual, Mario; Salvador, Carlos H.; García-Sáez, Gema; Rodríguez-Herrero, Agustín; Martínez-Sarriegui, Iñaki; Gómez, Enrique J.

    2008-01-01

    The growing availability of continuous data from medical devices in diabetes management makes it crucial to define novel information technology architectures for efficient data storage, data transmission, and data visualization. The new paradigm of care demands the sharing of information in interoperable systems as the only way to support patient care in a continuum of care scenario. The technological platforms should support all the services required by the actors involved in the care process, located in different scenarios and managing diverse information for different purposes. This article presents basic criteria for defining flexible and adaptive architectures that are capable of interoperating with external systems, and integrating medical devices and decision support tools to extract all the relevant knowledge to support diabetes care. PMID:19885276

  5. The endocannabinoid system and plant-derived cannabinoids in diabetes and diabetic complications.

    PubMed

    Horváth, Béla; Mukhopadhyay, Partha; Haskó, György; Pacher, Pál

    2012-02-01

    Oxidative stress and inflammation play critical roles in the development of diabetes and its complications. Recent studies provided compelling evidence that the newly discovered lipid signaling system (ie, the endocannabinoid system) may significantly influence reactive oxygen species production, inflammation, and subsequent tissue injury, in addition to its well-known metabolic effects and functions. The modulation of the activity of this system holds tremendous therapeutic potential in a wide range of diseases, ranging from cancer, pain, neurodegenerative, and cardiovascular diseases to obesity and metabolic syndrome, diabetes, and diabetic complications. This review focuses on the role of the endocannabinoid system in primary diabetes and its effects on various diabetic complications, such as diabetic cardiovascular dysfunction, nephropathy, retinopathy, and neuropathy, particularly highlighting the mechanisms beyond the metabolic consequences of the activation of the endocannabinoid system. The therapeutic potential of targeting the endocannabinoid system and certain plant-derived cannabinoids, such as cannabidiol and Δ9-tetrahydrocannabivarin, which are devoid of psychotropic effects and possess potent anti-inflammatory and/or antioxidant properties, in diabetes and diabetic complications is also discussed. PMID:22155112

  6. Community-based primary care: improving and assessing diabetes management.

    PubMed

    Gannon, Meghan; Qaseem, Amir; Snow, Vincenza

    2010-01-01

    Morbidity and mortality associated with diabetes make it a prime target for quality improvement research. Quality gaps and racial/gender disparities persist throughout this population of patients necessitating a sustainable improvement in the clinical management of diabetes. The authors of this study sought (1) to provide a population perspective on diabetes management, and (2) to reinforce evidence-based clinical guidelines through a Web-based educational module.The project also aimed to gain insight into working remotely with a community of rural physicians. This longitudinal pre-post intervention study involved 18 internal medicine physicians and included 3 points of medical record data abstraction over 24 months. A Web-based educational module was introduced after the baseline data abstraction. This module contained chapters on clinical education, practice tools, and self-assessment. The results showed a sustained improvement in most clinical outcomes and demonstrated the effectiveness of using Web-based mediums to reinforce clinical guidelines and change physician behavior. PMID:19786594

  7. Diabetic macular oedema: pathophysiology, management challenges and treatment resistance.

    PubMed

    Bahrami, Bobak; Zhu, Meidong; Hong, Thomas; Chang, Andrew

    2016-08-01

    Diabetic macular oedema (DMO) is the leading cause of vision loss in patients living with diabetes. DMO results from hyperglycaemia-induced activation of pathways that lead to oxidative stress and release of cytokines, impairing the inner and outer blood-retinal barriers. Improved understanding of the pathophysiological mechanisms leading to DMO have led to the development of effective therapies, including vitreoretinal surgery, laser photocoagulation, intravitreal anti-vascular endothelial growth factor drugs and corticosteroids. Advances in imaging, including fluorescein angiography and optical coherence tomography, have also enhanced diagnosis and management of the condition. Despite these advances, there remain patients who do not respond completely to therapy, reflecting the complex pathophysiology of DMO. These patients may be considered treatment-resistant. In this review, we summarise the pathophysiology of DMO, as well as the available treatments and their mechanism of action. Additionally, we focus on treatment-resistant disease and review the literature on potential options for managing this complication of diabetes. PMID:27179659

  8. Diabetes Management Using Modern Information and Communication Technologies and New Care Models

    PubMed Central

    2012-01-01

    technology and wearability, the second is related to the platform architecture, and the third to the implementation of the end-user services. The Glucose Management System, already developed within the REACTION project, is able to monitor a range of parameters from various sources including glucose levels, nutritional intakes, administered drugs, and patient’s insulin sensitivity, offering decision support for insulin dosing to professional caregivers on a mobile tablet platform that fulfills the need of the users and supports medical workflow procedures in compliance with the Medical Device Directive requirements. Conclusions Good control of diabetes, as well as increased emphasis on control of lifestyle factors, may reduce the risk profile of most complications and contribute to health improvement. The REACTION project aims to respond to these challenges by providing integrated, professional, management, and therapy services to diabetic patients in different health care regimes across Europe in an interoperable communication platform. PMID:23612026

  9. Engaging and empowering patients to manage their type 2 diabetes, Part II: Initiatives for success.

    PubMed

    Jacob, Stephan; Serrano-Gil, Manuel

    2010-10-01

    Type 2 diabetes (T2D) has reached pandemic proportions. The impact of it and its long-term sequelae represent a significant burden for many healthcare systems around the world, and a significant number of patients struggle to achieve the internationally recommended targets for the modifiable risk factors that optimize healthy outcomes. In the first part of this two-part review, the scene was set showing that there seems to be a knowledge, attitude, and practice (KAP) gap hindering successful management of T2D. Although theoretical knowledge about how T2D should be managed exists, the attitude of patients and healthcare professionals seems to influence the practicalities of implementing life-enhancing changes for patients living with diabetes. Following the chronic care model, macro-level initiatives such as Finland's national diabetes program, "The Development Programme for the Prevention and Care of Diabetes" (DEHKO), encourage a coordinated, supportive policy and financial environment for healthcare system change, and are advocated by the International Diabetes Federation. Over a 10-year period, the DEHKO program aims to demonstrate that a top-down population approach to prevention, focusing on reducing obesity, increasing physical activity, and encouraging healthier eating habits, may improve the overall health of the nation. However, the patient is the focus of day-to-day management of T2D, and innovative strategies that use a community (meso-level) approach to encourage self-management, or that embrace new technologies to access diabetes self-management education or support networks, are likely to be the way forward. Such measures may close the apparent KAP gap and bring about real and measurable benefits in quality of life and life expectancy. The second part of this review describes some of the many and varied initiatives designed to engage and empower patients to self-manage their T2D, with the aim of increasing the proportion of patients reaching health

  10. [Management of type 1 diabetes (insulin, diet, sport): "Dorchy's recipes"].

    PubMed

    Dorchy, Harry

    2010-01-01

    The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications by maintaining blood glucose concentrations close to the normal range and an HbA1c level under 7%. The number of daily insulin injections, 2 or > or = 4, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycemic control in young patients depends mainly on the quality and intensity of diabetes education. Any dogmatism must be avoided. Due to their pharmakokinetic characteristics, fast-acting and long-acting insulin analogues have specific indications in both the twice-daily injection regimen and the basal-bolus insulin therapy. They improve quality of life, without necessarily reducing HbA1c. Dietary recommendations issued over the last few years are the same for diabetic and non-diabetic individuals in order to avoid degenerative diseases. In the twice-daily free-mix regimen, the allocation of carbohydrates throughout the day is essential. There is no linear correlation between the metabolization of x grams of glucose by y units of insulin and carbohydrate counting is a piece of nonsense. Glycamic changes during exercise depend largely on blood insulin levels. In the young diabetic, during insulin deficiency, and therefore in a poor degree of metabolic control, i.e. hyperglycemic and ketotic, exercise accentuates hyperglycemia and ketosis, leading to extreme fatigue. If the insulin dosage is too high, the increase in muscular assimilation, combined with the shutdown of liver glucose production, may result in a severe hypoglycemia. During the recovery period, the repletion of muscular and hepatic glycogen stores may also provoke an hypoglycemia during hours after the cessation of muscular work. PMID:21812215

  11. A Web-Based Interactive Diabetes Registry for Health Care Management and Planning in Saudi Arabia

    PubMed Central

    Youssef, Amira M; Subhani, Shazia N; Ahmad, Najlaa A; Al-Sharqawi, Ahmad H; Ibrahim, Heba M

    2013-01-01

    Background Worldwide, eHealth is a rapidly growing technology. It provides good quality health services at lower cost and increased availability. Diabetes has reached an epidemic stage in Saudi Arabia and has a medical and economic impact at a countrywide level. Data are greatly needed to better understand and plan to prevent and manage this medical problem. Objective The Saudi National Diabetes Registry (SNDR) is an electronic medical file supported by clinical, investigational, and management data. It functions as a monitoring tool for medical, social, and cultural bases for primary and secondary prevention programs. Economic impact, in the form of direct or indirect cost, is part of the registry’s scope. The registry’s geographic information system (GIS) produces a variety of maps for diabetes and associated diseases. In addition to availability and distribution of health facilities in the Kingdom, GIS data provide health planners with the necessary information to make informed decisions. The electronic data bank serves as a research tool to help researchers for both prospective and retrospective studies. Methods A Web-based interactive GIS system was designed to serve as an electronic medical file for diabetic patients retrieving data from medical files by trained registrars. Data was audited and cleaned before it was archived in the electronic filing system. It was then used to produce epidemiologic, economic, and geographic reports. A total of 84,942 patients were registered from 2000 to 2012, growing by 10% annually. Results The SNDR reporting system for epidemiology data gives better understanding of the disease pattern, types, and gender characteristics. Part of the reporting system is to assess quality of health care using different parameters, such as HbA1c, that gives an impression of good diabetes control for each institute. Economic reports give accurate cost estimation of different services given to diabetic patients, such as the annual insulin

  12. NASA's Risk Management System

    NASA Technical Reports Server (NTRS)

    Perera, Jeevan S.

    2013-01-01

    Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks - not just risk office personnel. Each group/department is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk informed decision making should be introduced to all levels of management. ? Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner. Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

  13. Plants Used in the Management of Diabetic Complications

    PubMed Central

    Dodda, D.; Ciddi, V.

    2014-01-01

    Diabetes is a disease, which has assumed vital public health importance because of the complications associated with it. Various mechanisms including polyol pathway along with a complex integrating paradigm have been implicated in glucose-mediated complications. Though polyol pathway was established as a major mechanism, precise pathogenesis of these complications is not yet completely elucidated. Thus research focus was shifted towards key enzyme, aldose reductase in the pathway. Even though various compounds with aldose reductase inhibitory activity were synthesised, a very few compounds are under clinical use. However, studies on these compounds were always under conflicting results and an attempt has been made to review various natural substances with aldose reductase inhibitory activity and their role in management of diabetic complications. PMID:24843182

  14. South Asian women with diabetes: Psychosocial challenges and management: Consensus statement

    PubMed Central

    Bajaj, Sarita; Jawad, Fatema; Islam, Najmul; Mahtab, Hajera; Bhattarai, Jyoti; Shrestha, Dina; Wijeyaratne, Chandrika; Muthukuda, Dimuthu T.; Widanage, Niranjala Weegoda; Aye, Than Than; Aung, Moe Wint; Kalra, Bharti; Anjana, R. M.; Sreedevi, Aswathy; Verma, Komal

    2013-01-01

    in women attending diabetes clinics across South Asia. Guidelines for counselling in female sexual dysfunction, written in culturally appropriate manner for South Asia, are needed. Diabetes affects women more severely because of their unique biological, cultural and socioeconomic circumstances. Women have limited access to health care facilities because of illiteracy, ignorance and negative social customs. Transcending the gender hierarchy and inequality is a formidable challenge. Sensitising men, empowering women on self care and providing peer support maybe the answer to this challenge. It is essential for health care providers to use appropriate coping mechanism such as building psychological contact with the patient, including family and friends as part of social support and empower patient with complete process of managing diabetes. Increasing awareness through the media, seminars, posters, group discussions and education, regular monitoring and consulting the doctor, support group for women and facilities for aerobic exercises are recommended. The health care systems should consider custom-designed prevention and control programs tailored for women based on local and regional attitudes on health care, cultural beliefs, and available social support systems. Policies that empower adolescent girls and young women to take control of their metabolic management must be encouraged. Provision of gender specific diabetes education with a holistic life-cycle approach is recommended. PMID:23961469

  15. South Asian women with diabetes: Psychosocial challenges and management: Consensus statement.

    PubMed

    Bajaj, Sarita; Jawad, Fatema; Islam, Najmul; Mahtab, Hajera; Bhattarai, Jyoti; Shrestha, Dina; Wijeyaratne, Chandrika; Muthukuda, Dimuthu T; Widanage, Niranjala Weegoda; Aye, Than Than; Aung, Moe Wint; Kalra, Bharti; Anjana, R M; Sreedevi, Aswathy; Verma, Komal

    2013-07-01

    in women attending diabetes clinics across South Asia. Guidelines for counselling in female sexual dysfunction, written in culturally appropriate manner for South Asia, are needed. Diabetes affects women more severely because of their unique biological, cultural and socioeconomic circumstances. Women have limited access to health care facilities because of illiteracy, ignorance and negative social customs. Transcending the gender hierarchy and inequality is a formidable challenge. Sensitising men, empowering women on self care and providing peer support maybe the answer to this challenge. It is essential for health care providers to use appropriate coping mechanism such as building psychological contact with the patient, including family and friends as part of social support and empower patient with complete process of managing diabetes. Increasing awareness through the media, seminars, posters, group discussions and education, regular monitoring and consulting the doctor, support group for women and facilities for aerobic exercises are recommended. The health care systems should consider custom-designed prevention and control programs tailored for women based on local and regional attitudes on health care, cultural beliefs, and available social support systems. Policies that empower adolescent girls and young women to take control of their metabolic management must be encouraged. Provision of gender specific diabetes education with a holistic life-cycle approach is recommended. PMID:23961469

  16. Perspective: a systems approach to diabetes research.

    PubMed

    Kussmann, Martin; Morine, Melissa J; Hager, Jörg; Sonderegger, Bernhard; Kaput, Jim

    2013-01-01

    We review here the status of human type 2 diabetes studies from a genetic, epidemiological, and clinical (intervention) perspective. Most studies limit analyses to one or a few omic technologies providing data of components of physiological processes. Since all chronic diseases are multifactorial and arise from complex interactions between genetic makeup and environment, type 2 diabetes mellitus (T2DM) is a collection of sub-phenotypes resulting in high fasting glucose. The underlying gene-environment interactions that produce these classes of T2DM are imperfectly characterized. Based on assessments of the complexity of T2DM, we propose a systems biology approach to advance the understanding of origin, onset, development, prevention, and treatment of this complex disease. This systems-based strategy is based on new study design principles and the integrated application of omics technologies: we pursue longitudinal studies in which each subject is analyzed at both homeostasis and after (healthy and safe) challenges. Each enrolled subject functions thereby as their own case and control and this design avoids assigning the subjects a priori to case and control groups based on limited phenotyping. Analyses at different time points along this longitudinal investigation are performed with a comprehensive set of omics platforms. These data sets are generated in a biological context, rather than biochemical compound class-driven manner, which we term "systems omics." PMID:24187547

  17. Perspective: a systems approach to diabetes research

    PubMed Central

    Kussmann, Martin; Morine, Melissa J.; Hager, Jörg; Sonderegger, Bernhard; Kaput, Jim

    2013-01-01

    We review here the status of human type 2 diabetes studies from a genetic, epidemiological, and clinical (intervention) perspective. Most studies limit analyses to one or a few omic technologies providing data of components of physiological processes. Since all chronic diseases are multifactorial and arise from complex interactions between genetic makeup and environment, type 2 diabetes mellitus (T2DM) is a collection of sub-phenotypes resulting in high fasting glucose. The underlying gene–environment interactions that produce these classes of T2DM are imperfectly characterized. Based on assessments of the complexity of T2DM, we propose a systems biology approach to advance the understanding of origin, onset, development, prevention, and treatment of this complex disease. This systems-based strategy is based on new study design principles and the integrated application of omics technologies: we pursue longitudinal studies in which each subject is analyzed at both homeostasis and after (healthy and safe) challenges. Each enrolled subject functions thereby as their own case and control and this design avoids assigning the subjects a priori to case and control groups based on limited phenotyping. Analyses at different time points along this longitudinal investigation are performed with a comprehensive set of omics platforms. These data sets are generated in a biological context, rather than biochemical compound class-driven manner, which we term “systems omics.” PMID:24187547

  18. Bevacizumab for the management of diabetic macular edema

    PubMed Central

    Stefanini, Francisco Rosa; Arevalo, J Fernando; Maia, Maurício

    2013-01-01

    Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision loss and is an important public health problem. Recent studies have implicated vascular endothelial growth factor (VEGF) in DR and DME pathogenesis, as well as provided evidence of the benefits of anti-VEGF agents for the management of such conditions. Despite the benefits of intravitreal ranibizumab injection for the management of DME, the cost-effectiveness of intravitreal bevacizumab therapy has gained increasing interest in the scientific community. This review summarizes the studies examining bevacizumab for the management of DME, focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity (BCVA). There is strong evidence that intravitreal bevacizumab injection therapy has a good cost-effective profile in the management of DME and may be associated with laser photocoagulation; however, its clinical superiority in terms of the duration of DME regression and the improvement of BCVA compared with intravitreal ranibizumab and other intravitreal anti-VEGF therapies remains unclear and deserves further investigation. PMID:23593532

  19. Improving self-management of type 1 and type 2 diabetes.

    PubMed

    Phillips, Anne

    2016-01-01

    Diabetes is an increasingly common life-long condition, which has significant physical, psychological and behavioural implications for individuals. Self-management of type 1 and type 2 diabetes can be complex and challenging. A collaborative approach to care, between healthcare professionals and patients, is essential to promote self-management skills and knowledge to help patients engage in shared decision making and manage any difficulties associated with a diagnosis of diabetes. PMID:26938421

  20. Education and management of diabetes at The University of Tokyo Hospital.

    PubMed

    Iizuka, Yoko; Ohashi, Ken; Tsukamoto, Kazuhisa; Ueki, Kohjiro; Kadowaki, Takashi

    2011-06-01

    Along with reduced physical activity, increased fat intake, and intensified psychological stresses associated with work and social life, the number of diabetic patients and diabetes-related complications has increased significantly in Japan. Our aim at The University of Tokyo Hospital is to provide comprehensive diabetes treatment, including the use a diabetes handbook with guidelines for the diagnosis and treatment of diabetes consistent with evidence-based medicine. Diabetes specialists and certified diabetes educators work together to provide the best possible treatment. In addition, we have established a diabetic foot care service for outpatients, with the objective of preventing diabetes-related foot disease. The inpatients wards offer the most ideal diabetes treatments, including diet therapy, exercise therapy, guided self-monitoring of blood glucose, daily body weight measurement, and diabetes seminars. All these services provide guidelines that encourage patient self-management even after discharge from hospital. Management dietitians use food samples and a Food Exchange Table to brief patients about nutrition guidelines. Exercise therapy programs are developed according to the specific needs of each individual patient. We have also established a diabetes seminar series for the patients, to which physicians, nurses, dietitians, pharmacists, clinical laboratory technicians, and other professionals are invited to give talks on their respective areas of expertise. The aim of our ongoing efforts to implement diet and exercise therapies and improve the living habits of the patients is to achieve an ideal standard for diabetes education and management. PMID:21599864

  1. The OnTrack Diabetes Web-Based Program for Type 2 Diabetes and Dysphoria Self-Management: A Randomized Controlled Trial Protocol

    PubMed Central

    Smith, Anthony Carl; Scuffham, Paul A; Parham, Sophie

    2015-01-01

    Background The prevalence of type 2 diabetes is rising with the majority of patients practicing inadequate disease self-management. Depression, anxiety, and diabetes-specific distress present motivational challenges to adequate self-care. Health systems globally struggle to deliver routine services that are accessible to the entire population, in particular in rural areas. Web-based diabetes self-management interventions can provide frequent, accessible support regardless of time and location Objective This paper describes the protocol of an Australian national randomized controlled trial (RCT) of the OnTrack Diabetes program, an automated, interactive, self-guided Web program aimed to improve glycemic control, diabetes self-care, and dysphoria symptoms in type 2 diabetes patients. Methods A small pilot trial is conducted that primarily tests program functionality, efficacy, and user acceptability and satisfaction. This is followed by the main RCT, which compares 3 treatments: (1) delayed program access: usual diabetes care for 3 months postbaseline followed by access to the full OnTrack Diabetes program; (2) immediate program: full access to the self-guided program from baseline onward; and (3) immediate program plus therapist support via Functional Imagery Training (FIT). Measures are administered at baseline and at 3, 6, and 12 months postbaseline. Primary outcomes are diabetes self-care behaviors (physical activity participation, diet, medication adherence, and blood glucose monitoring), glycated hemoglobin A1c (HbA1c) level, and diabetes-specific distress. Secondary outcomes are depression, anxiety, self-efficacy and adherence, and quality of life. Exposure data in terms of program uptake, use, time on each page, and program completion, as well as implementation feasibility will be conducted. Results This trial is currently underway with funding support from the Wesley Research Institute in Brisbane, Australia. Conclusions This is the first known trial of an

  2. Management Information Systems.

    ERIC Educational Resources Information Center

    Crump, Kelvin

    An Australian university architect studying management information systems programs at academic institutions in the United States visited 26 universities and colleges and nine educational and professional associations, including extended visits at the University of Wisconsin and the National Center of Higher Education Management Systems. During…

  3. Management Systems in Education.

    ERIC Educational Resources Information Center

    Wagner, Ivan D.

    Management systems have been adapted for educational administration in response to the need for quality of educational opportunity, collective bargaining, school district consolidation, decreasing enrollments, accountability laws, limited financial resources, and participatory decision-making. Management systems adapted, not adopted, from business…

  4. Waste management system

    NASA Technical Reports Server (NTRS)

    Sauer, R. L.; Jorgensen, G. K.

    1975-01-01

    The function of the waste management system was to control the disposition of solid and liquid wastes and waste stowage gases. The waste management system consisting of a urine subsystem and a fecal subsystem is described in detail and its overall performance is evaluated. Recommendations for improvement are given.

  5. Metadata management staging system

    Energy Science and Technology Software Center (ESTSC)

    2013-08-01

    Django application providing a user-interface for building a file and metadata management system. An evolution of our Node.js and CouchDb metadata management system. This one focuses on server functionality and uses a well-documented, rational and REST-ful API for data access.

  6. Management Information System Project.

    ERIC Educational Resources Information Center

    Foley, Walter J.; Harr, Gordon G.

    The Management Information System (MIS) described in this report represents a plan to utilize modern management techniques to facilitate the goal of a learner-responsive school system. The MIS component is being developed to meet the need for the coordination of the resources of staff, facilities, and time with the long range planning and…

  7. Medical Information Management System

    NASA Technical Reports Server (NTRS)

    Alterescu, S.; Hipkins, K. R.; Friedman, C. A.

    1979-01-01

    On-line interactive information processing system easily and rapidly handles all aspects of data management related to patient care. General purpose system is flexible enough to be applied to other data management situations found in areas such as occupational safety data, judicial information, or personnel records.

  8. People with Mild to Moderate Intellectual Disability Talking about Their Diabetes and How They Manage

    ERIC Educational Resources Information Center

    Cardol, M.; Rijken, M.; van Schrojenstein Lantman-de Valk, H.

    2012-01-01

    Background: The prevalence of diabetes is relatively high in people with intellectual disability (ID). However, little is known about how people with ID experience having diabetes and how they manage the condition. Method: Seventeen people with mild to moderate ID who have diabetes were interviewed. A framework on illness perceptions having an…

  9. A Collaborative Approach to Diabetes Management: The Choice Made for Colorado Schools

    ERIC Educational Resources Information Center

    Bobo, Nichole; Wyckoff, Leah; Patrick, Kathleen; White, Cathy; Glass, Sue; Carlson, Jessie Parker; Perreault, Christine

    2011-01-01

    Students with diabetes deserve a school nurse who can effectively manage the disease. Tensions between the school and families sometimes emerge when a child with diabetes goes to school. To resolve these tensions in Colorado, stakeholders collaborated to implement a statewide program to meet the needs of students with diabetes. Colorado school…

  10. Racial/Ethnic Differences in Use of Health Care Services for Diabetes Management

    ERIC Educational Resources Information Center

    Chandler, Raeven Faye; Monnat, Shannon M.

    2015-01-01

    Research demonstrates consistent racial/ethnic disparities in access to and use of health care services for a variety of chronic conditions. Yet we know little about whether these disparities exist for use of health care services for diabetes management. Racial/ethnic minorities disproportionately suffer from diabetes, complications from diabetes,…

  11. Lithium battery management system

    DOEpatents

    Dougherty, Thomas J.

    2012-05-08

    Provided is a system for managing a lithium battery system having a plurality of cells. The battery system comprises a variable-resistance element electrically connected to a cell and located proximate a portion of the cell; and a device for determining, utilizing the variable-resistance element, whether the temperature of the cell has exceeded a predetermined threshold. A method of managing the temperature of a lithium battery system is also included.

  12. Blood Glucose Pattern Management in Diabetes: Creating Order from Disorder

    PubMed Central

    Choudhary, John C.; Genovese, Stefano; Reach, Gérard

    2013-01-01

    Background Self-monitoring of blood glucose (SMBG) is the most accessible way to assess glycemic patterns, and interpretation of these patterns can provide reasons for poor glycemic control and suggest management strategies. Furthermore, diabetes management based on blood glucose (BG) patterns is associated with improved patient outcomes. The aim of this review is therefore to evaluate the impact of pattern management in clinical practice. Methods We included a review of available literature, a discussion of obstacles to implementation of SMBG and pattern management, and suggestions on how clinicians and patients might work together to optimize this management feature. Results The literature review revealed eight publications specifically describing structured approaches to SMBG and pattern management. Specific information on how SMBG might be structured to detect BG patterns, however, remains limited. Barriers to pattern management include not just practical reasons, but emotional and psychological reasons as well. Conclusions Patterns are not always easy to detect or interpret, but on-meter and web-based tools can support both patients and clinicians. Ultimately, successful pattern management requires education and mutual commitment from the clinician and patient—ongoing collaboration is needed to obtain, review, and interpret SMBG values and to make changes based on the patterns. PMID:24351184

  13. Constraints faced by urban poor in managing diabetes care: patients’ perspectives from South India

    PubMed Central

    Bhojani, Upendra; Mishra, Arima; Amruthavalli, Subramani; Devadasan, Narayanan; Kolsteren, Patrick; De Henauw, Stefaan; Criel, Bart

    2013-01-01

    Background Four out of five adults with diabetes live in low- and middle-income countries (LMIC). India has the second highest number of diabetes patients in the world. Despite a huge burden, diabetes care remains suboptimal. While patients (and families) play an important role in managing chronic conditions, there is a dearth of studies in LMIC and virtually none in India capturing perspectives and experiences of patients in regard to diabetes care. Objective The objective of this study was to better understand constraints faced by patients from urban slums in managing care for type 2 diabetes in India. Design We conducted in-depth interviews, using a phenomenological approach, with 16 type 2- diabetes patients from a poor urban neighbourhood in South India. These patients were selected with the help of four community health workers (CHWs) and were interviewed by two trained researchers exploring patients’ experiences of living with and seeking care for diabetes. The sampling followed the principle of saturation. Data were initially coded using the NVivo software. Emerging themes were periodically discussed among the researchers and were refined over time through an iterative process using a mind-mapping tool. Results Despite an abundance of healthcare facilities in the vicinity, diabetes patients faced several constraints in accessing healthcare such as financial hardship, negative attitudes and inadequate communication by healthcare providers and a fragmented healthcare service system offering inadequate care. Strongly defined gender-based family roles disadvantaged women by restricting their mobility and autonomy to access healthcare. The prevailing nuclear family structure and inter-generational conflicts limited support and care for elderly adults. Conclusions There is a need to strengthen primary care services with a special focus on improving the availability and integration of health services for diabetes at the community level, enhancing patient

  14. Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project): study protocol

    PubMed Central

    2010-01-01

    Background An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. Methods/Design A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned. Discussion Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore

  15. Perceptions of barriers in managing diabetes: perspectives of Hispanic immigrant patients and family members

    PubMed Central

    Hu, Jie; Amirehsani, Karen; Wallace, Debra; Letvak, Susan

    2014-01-01

    Hispanics show poorer self-management of type 2 diabetes than non-Hispanic Whites. Although previous studies have reported socioeconomic and cultural barriers to diabetes self-management by Hispanics, little is known about perceived barriers to diabetes self-management from the perspectives of both Hispanics and their family members. Purpose The purpose of the study was to explore perceived barriers among Hispanic immigrants with diabetes and their family members. Methods A qualitative study using five focus groups was conducted. A total of 73 Hispanic immigrants with type 2 diabetes (n=36) and family members (n=37) were recruited in the southeastern United States for a family-based intervention study of diabetes-self management. Participants were asked to describe their perceptions of barriers to self-management. The five sessions were audiotaped and transcribed, translated from Spanish into English, and analyzed using standard content analysis. Demographics, hemoglobin A1C levels, blood pressure and BMI were obtained both for participants with diabetes and for their family members. Results Barriers to diabetes self-management themes identified by participants with diabetes were in three major themes categorize: suffering from diabetes, difficulties in managing the disease, and lack of resources/support. Two key themes emerged pertaining to family members: we can provide support and we lack knowledge. Conclusions Perceived barriers to diabetes self-management described by Hispanic immigrants with diabetes and family members indicate a lack of intervention strategies to meet their needs. Interventions should include culturally relevant resources, family support, and diabetes self-management skills education. PMID:23640301

  16. Hyporeninemic hypoaldosteronism and diabetes mellitus: Pathophysiology assumptions, clinical aspects and implications for management

    PubMed Central

    Sousa, André Gustavo P; Cabral, João Victor de Sousa; El-Feghaly, William Batah; de Sousa, Luísa Silva; Nunes, Adriana Bezerra

    2016-01-01

    Patients with diabetes mellitus (DM) frequently develop electrolyte disorders, including hyperkalemia. The most important causal factor of chronic hyperkalemia in patients with diabetes is the syndrome of hyporeninemic hypoaldosteronism (HH), but other conditions may also contribute. Moreover, as hyperkalemia is related to the blockage of the renin-angiotensin-aldosterone system (RAAS) and HH is most common among patients with mild to moderate renal insufficiency due to diabetic nephropathy (DN), the proper evaluation and management of these patients is quite complex. Despite its obvious relationship with diabetic nephropathy, HH is also related to other microvascular complications, such as DN, particularly the autonomic type. To confirm the diagnosis, plasma aldosterone concentration and the levels of renin and cortisol are measured when the RAAS is activated. In addition, synthetic mineralocorticoid and/or diuretics are used for the treatment of this syndrome. However, few studies on the implications of HH in the treatment of patients with DM have been conducted in recent years, and therefore little, if any, progress has been made. This comprehensive review highlights the findings regarding the epidemiology, diagnosis, and management recommendations for HH in patients with DM to clarify the diagnosis of this clinical condition, which is often neglected, and to assist in the improvement of patient care. PMID:26981183

  17. Management of Type 2 Diabetes Mellitus through Telemedicine

    PubMed Central

    Cipolla, Maurizio; Merante, Valentina; Medaglia, Valeria; Irace, Concetta; Gnasso, Agostino

    2015-01-01

    Background Type 2 diabetes mellitus T2DM has a huge and growing burden on public health, whereas new care models are not implemented into clinical practice; in fact the purpose of this study was to test the effectiveness of a program of integrated care for T2DM, compared with ordinary diligence. Methods "Progetto Diabete Calabria" is a new organizational model for the management of patients with diabetes mellitus, based on General Practitioners (GPs) empowerment and the use of a web-based electronic health record, shared in remote consultations among GPs and Hospital Consultants. One-year change in glucose and main cardiovascular risk factors control in 104 patients (Cases) following this integrated care program has been evaluated and compared with that of 208 control patients (Controls) matched for age, gender, and cardiometabolic profile, and followed in an ordinary outpatient medical management by the Consultants only. Both patient groups had Day Hospitals before and after the study period. Results The mean number of accesses to the Consultants during the study was 0.6±0.9 for Cases, and 1.3±1.5 for Controls (p<0.0001). At follow-up, glycated hemoglobin (HbA1c) significantly decreased from 58±6 to 54±8 mmol/mol in Cases only (p=0.01); LDL cholesterol decreased in both groups; body mass index decreased in Cases only, from 31.0±4.8 to 30.5±4.6 kg/m2 (p=0.03). Conclusions The present study demonstrates that a health care program based on GPs empowerment and taking care plus remote consultation with Consultants is at least as effective as standard outpatient management, in order to improve the control of T2DM. PMID:25974092

  18. Osteomyelitis in the diabetic foot: diagnosis and management.

    PubMed

    Game, Frances L

    2013-09-01

    Although osteomyelitis of the foot in diabetes remains common in specialist foot clinics across the world, the quality of published work to guide clinicians in the diagnosis and management is generally poor. Diagnosis should be based primarily on clinical signs supported by results of pathologic and radiologic investigations. Although the gold standard comes from the histologic and microbiological examination of bone, clinicians should be aware of the problems of sampling error. This lack of standardization of diagnostic criteria and of consensus on the choice of outcome measures poses further difficulties when seeking evidence to support management decisions. Experts have traditionally recommended surgical removal of infected bone but available evidence suggests that in many cases (excepting those in whom immediate surgery is required to save life or limb) a nonsurgical approach to management of osteomyelitis may be effective for many, if not most, patients with osteomyelitis of the diabetic foot. The benefits and limitations of both approaches need, however, to be established in prospective trials so that appropriate therapy can be offered to appropriate patients at the appropriate time, with the patients' views taken fully into account. PMID:23992902

  19. The current role of thiazolidinediones in diabetes management.

    PubMed

    Rizos, Christos V; Kei, Anastazia; Elisaf, Moses S

    2016-08-01

    Among the epidemics of modern time, type 2 diabetes mellitus (T2DM) is one of the main contributors to overall morbidity as well as mortality. A number of different treatment options are available for the management of diabetes. Among them thiazolidinediones (TZDs) is an interesting drug class since it does not target the result of T2DM, i.e., hyperglycemia but rather some of the core mechanisms of the disease. Indeed, glitazones increase insulin sensitivity by activating the peroxisome proliferator-activated receptor γ, which plays an important role in regulating various metabolic parameters. Although TZDs have an established efficacy in T2DM treatment, their usage during the past years was questioned following the emergence of some alarming data regarding their safety and especially the cardiovascular safety of rosiglitazone. As a result, there is often some skepticism about the current role of TZDs in T2DM management. This mainly affects rosiglitazone even leading to its withdrawal from several markets in contrast to pioglitazone, which has shown a beneficial cardiovascular profile. A comprehensive assessment of the benefit-to-risk ratio of TZDs is required in order to better understand the place of these drugs in T2DM management. PMID:27165418

  20. Operations management system

    NASA Technical Reports Server (NTRS)

    Brandli, A. E.; Eckelkamp, R. E.; Kelly, C. M.; Mccandless, W.; Rue, D. L.

    1990-01-01

    The objective of an operations management system is to provide an orderly and efficient method to operate and maintain aerospace vehicles. Concepts are described for an operations management system and the key technologies are highlighted which will be required if this capability is brought to fruition. Without this automation and decision aiding capability, the growing complexity of avionics will result in an unmanageable workload for the operator, ultimately threatening mission success or survivability of the aircraft or space system. The key technologies include expert system application to operational tasks such as replanning, equipment diagnostics and checkout, global system management, and advanced man machine interfaces. The economical development of operations management systems, which are largely software, will require advancements in other technological areas such as software engineering and computer hardware.

  1. Diabetes mellitus and renal failure: Prevention and management.

    PubMed

    Nasri, Hamid; Rafieian-Kopaei, Mahmoud

    2015-11-01

    Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD). In this paper, other than presenting the role of DM in ESRD, glucose metabolism and the management of hyperglycemia in these patients are reviewed. Although in several large studies there was no significant relationship found between tight glycemic control and the survival of ESRD patients, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of these patients to prevent damage to other organs. Glycemic control is perfect when fasting blood sugar is less than 140 mg/dL, 1-h postprandial blood glucose is less than 200 mg/dL, and glycosylated hemoglobin (HbA1c) is 6-7 in patients with type 1 diabetes and 7-8 in patients with type 2 diabetes. Administration of metformin should be avoided in chronic renal failure (CRF) because of lactic acidosis, the potentially fatal complication of metformin, but glipizide and repaglinide seem to be good choices. PMID:26941817

  2. Diabetes mellitus and renal failure: Prevention and management

    PubMed Central

    Nasri, Hamid; Rafieian-Kopaei, Mahmoud

    2015-01-01

    Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD). In this paper, other than presenting the role of DM in ESRD, glucose metabolism and the management of hyperglycemia in these patients are reviewed. Although in several large studies there was no significant relationship found between tight glycemic control and the survival of ESRD patients, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of these patients to prevent damage to other organs. Glycemic control is perfect when fasting blood sugar is less than 140 mg/dL, 1-h postprandial blood glucose is less than 200 mg/dL, and glycosylated hemoglobin (HbA1c) is 6-7 in patients with type 1 diabetes and 7-8 in patients with type 2 diabetes. Administration of metformin should be avoided in chronic renal failure (CRF) because of lactic acidosis, the potentially fatal complication of metformin, but glipizide and repaglinide seem to be good choices. PMID:26941817

  3. The Prevalence and Management of Diabetic Nephropathy in Asia

    PubMed Central

    Tomino, Yasuhiko; Gohda, Tomohito

    2015-01-01

    Background Diabetic nephropathy (DN), especially type 2 diabetes, is now increasing rapidly worldwide, also in Asian countries, and is one of the major long-term vascular complications. The pathogenesis of DN involves both genetic and environmental factors. Around 30-40% of type 2 diabetic patients develop DN despite strict blood glucose and/or blood pressure control. Although it is considered that the genetic background may influence the initiation and progression of DN, the candidate genes are still obscure. Summary To search for genes that are involved in the susceptibility of DN, a candidate gene approach was taken in the beginning before the development of genome-wide association studies. Although a candidate gene approach can detect rare genetic variants, in advance we need known or presumed pathophysiological knowledge of the specific gene. Investigations using spontaneous animal models are important to determine the pathogenesis and treatment of DN patients. There are many spontaneous animal models, such as the NOD and Akita mice for type 1 diabetes and the Ob/Ob, db/db, Tsumura Suzuki Obese Diabetics, and KK-Ay mice for type 2 diabetes. Furthermore, the toxicity of persistent hyperglycemia, the activation of reactive oxygen species, systemic and/or glomerular hypertension, microinflammation, dyslipidemia, and other factors are considered to play important roles. Diabetic patients with normoalbuminuria and normal renal function showed typical histological patterns of DN. The discovery of a specific and reliable diagnostic and prognostic biomarker other than albuminuria is urgently needed and indispensable. Since large clinical trials of oral hypoglycemic drugs in renal failure are lacking, these recommendations will need to be regularly updated after results of larger randomized trials with longer follow-up durations are available. Key Message It is necessary to summarize the basic and clinical features of DN patients in Asia and to use these for the

  4. The possible role of the ubiquitin proteasome system in the development of atherosclerosis in diabetes.

    PubMed

    Marfella, Raffaele; D' Amico, Michele; Di Filippo, Clara; Siniscalchi, Mario; Sasso, Ferdinando Carlo; Ferraraccio, Franca; Rossi, Francesco; Paolisso, Giuseppe

    2007-01-01

    We have reviewed the impact of the ubiquitin proteasome system (UPS) on atherosclerosis progression of diabetic patients. A puzzle of many pieces of evidence suggests that UPS, in addition to its role in the removal of damaged proteins, is involved in a number of biological processes including inflammation, proliferation and apoptosis, all of which constitute important characteristics of atherosclerosis. From what can be gathered from the very few studies on the UPS in diabetic cardiovascular diseases published so far, the system seems to be functionally active to a different extent in the initiation, progression, and complication stage of atherosclerosis in the diabetic people. Further evidence for this theory, however, has to be given, for instance by specifically targeted antagonism of the UPS. Nonetheless, this hypothesis may help us understand why diverse therapeutic interventions, which have in common the ability to reduce ubiquitin-proteasome activity, can impede or delay the onset of diabetes and cardiovascular diseases (CVD). People with type 2 diabetes are disproportionately affected by CVD, compared with those without diabetes 1. The prevalence, incidence, and mortality from all forms of CVD (myocardial infarction, cerebro-vascular disease and congestive heart failure) are strikingly increased in persons with diabetes compared with those withoutdiabetes 2. Furthermore, diabetic patients have not benefited by the advances in the management of obesity, dyslipidemia, and hypertension that have resulted in a decrease in mortality for coronary heart disease (CHD) patients without diabetes 3. Nevertheless, these risk factors do not fully explain the excess risk for CHD associated with diabetes 45. Thus, the determinants of progression of atherosclerosis in persons with diabetes must be elucidated. Beyond the major risk factors, several studies have demonstrated that such factors, strictly related to diabetes, as insulin-resistance, post-prandial hyperglycemia

  5. Systems engineering management plans.

    SciTech Connect

    Rodriguez, Tamara S.

    2009-10-01

    The Systems Engineering Management Plan (SEMP) is a comprehensive and effective tool used to assist in the management of systems engineering efforts. It is intended to guide the work of all those involved in the project. The SEMP is comprised of three main sections: technical project planning and control, systems engineering process, and engineering specialty integration. The contents of each section must be tailored to the specific effort. A model outline and example SEMP are provided. The target audience is those who are familiar with the systems engineering approach and who have an interest in employing the SEMP as a tool for systems management. The goal of this document is to provide the reader with an appreciation for the use and importance of the SEMP, as well as provide a framework that can be used to create the management plan.

  6. Barriers and Facilitators for Type-2 Diabetes Management in South Asians: A Systematic Review

    PubMed Central

    Sohal, Tanveer; Sohal, Parmjit; King-Shier, Kathryn M.; Khan, Nadia A.

    2015-01-01

    Objective Although South Asian populations have among the highest burden of type 2 diabetes in the world, their diabetes management remains poor. We systematically reviewed studies on South Asian patient’s perspectives on the barriers and facilitators to diabetes management. Methods We conducted a literature search using OVID, CINHAL and EMBASE (January, 1990 –February, 2014) evaluating the core components of diabetes management: interactions with health care providers, diet, exercise, and medication adherence. South Asian patients were self-reported as Indian, Pakistani, Malaysian-Indian or Bangladeshi origin. From 208 abstracts reviewed, 20 studies were included (19 qualitative including mixed methods studies, 1 questionnaire). Barriers and facilitators were extracted and combined using qualitative synthesis. Results All studies included barriers and few facilitators were identified. Language and communication discordance with the healthcare provider was a significant barrier to receiving and understanding diabetes education. There was inconsistent willingness to partake in self-management with preference for following their physician’s guidance. Barriers to adopting a diabetic diet were lack of specific details on South Asian tailored diabetic diet; social responsibilities to continue with a traditional diet, and misconceptions on the components of the diabetic diet. For exercise, South Asian patients were concerned with lack of gender specific exercise facilities and fear of injury or worsening health with exercise. Patients reported a lack of understanding about diabetes medication management, preference for folk and phytotherapy, and concerns about the long-term safety of diabetes medications. Facilitators included trust in care providers, use of culturally appropriate exercise and dietary advice and increasing family involvement. Overall themes for the barriers included lack of knowledge and misperceptions as well as lack of cultural adaptation to

  7. Development and validation of a diabetes self-management instrument for older African-Americans.

    PubMed

    McCaskill, Gina M; Bolland, Kathleen A; Burgio, Kathryn L; Leeper, James

    2016-01-01

    The objective of this study was to develop and validate a new diabetes self-management instrument for older African-Americans 65 years of age and older. The Self-Care Utility Geriatric African-American Rating (SUGAAR) was developed using the American Diabetes Association's standards for the management of type 2 diabetes in older adults and cognitive interviews with older African-Americans. The instrument underwent extensive review by a panel of experts, two rounds of cognitive interviews, and a pilot test before it was administered in an interview format to 125 community-dwelling older African-Americans. The instrument demonstrated content validity and significant, but modest, convergent validity with items from an established diabetes self-management instrument. Social workers and health care professionals can use the SUGARR to assess diabetes self-management and to identify areas for education and support for older African-Americans with type 2 diabetes. PMID:27045578

  8. Safety Management Systems.

    ERIC Educational Resources Information Center

    Fido, A. T.; Wood, D. O.

    This document discusses the issues that need to be considered by the education and training system as it responds to the changing needs of industry in Great Britain. Following a general introduction, the development of quality management ideas is traced. The underlying principles of safety and risk management are clarified and the implications of…

  9. Sick Day Management in Children and Adolescents with Type 1 Diabetes.

    PubMed

    Choudhary, Abha

    2016-06-01

    Diabetic Ketoacidosis (DKA) has high morbidity and mortality and can be prevented. It is extremely important to give clear guidance to patients and families on how to manage diabetes during intercurrent illnesses to avoid complications of ketoacidosis, dehydration,uncontrolled or symptomatic hyperglycemia and hypoglycemia. This descriptive review of clinical cases and management guidelines for sick days in children and adolescents with diabetes is provided as a resource for physicians who may take calls from parents of sick children with diabetes or manage these children in a clinic, emergency room or hospital setting. PMID:27434984

  10. Diabetes control with reciprocal peer support versus nurse care management: A randomized trial

    PubMed Central

    Heisler, Michele; Vijan, Sandeep; Makki, Fatima; Piette, John D.

    2014-01-01

    Background Many health care systems face barriers to implementing resource-intensive care management programs for patients with poorly controlled diabetes. Mobilizing patients to provide reciprocal peer support may enhance care management and improve clinical outcomes. Objective To compare the effectiveness of a reciprocal diabetes peer support program (RPS) with nurse care management (NCM) in improving glycemic control in real-world clinical settings. Design Six-month parallel randomized controlled effectiveness study from 2007–2010 (Trial Registration NCT00320112) Setting Two U.S. Veterans’Affairs (VA) health care facilities Participants 244 male diabetes patients with a hemoglobin A1c (HbA1c) in the prior 6 months of 7.5% or more. Primary Funding Source VA Health Services Research and Development (HSR&D) Measurements The primary outcome was change in HbA1c between baseline and six months. Secondary outcomes were new insulin starts and intensification, blood pressure, diabetes-specific social support, emotional distress, and medication adherence. Intervention Participants in both arms attended an initial session led by a nurse care manager to review and discuss their point-of-service HbA1c and blood pressure values, and most recent medical record cholesterol values. RPS patients then participated in a group session to set diabetes-related behavioral goals, receive brief training in peer communication skills, and be paired with another age-matched participant. Paired peer partners were encouraged to talk weekly using a telephone platform that recorded call frequency and duration and provided automated reminders promoting peer contact. Intervention participants were also offered three optional 1.5 hour patient-driven group sessions at months 1, 3, and 6 to share concerns, questions, strategies, and progress on goals. Patients in the NCM arm attended a 1.5 hour session to receive education on care manager services and diabetes educational materials and be

  11. Intranet Document Management Systems.

    ERIC Educational Resources Information Center

    Wen, H. Joseph; Yen, David C.; Lin, Binshan

    1998-01-01

    Explains how intranets facilitate documentation availability within a company at substantial cost savings. Topics include intranet document management systems (IDMS); publication costs for printed materials; hardware and software specifications; performance; and security. (Author/LRW)

  12. Advances in management of type 1 diabetes mellitus

    PubMed Central

    Aathira, Ravindranath; Jain, Vandana

    2014-01-01

    Treatment of type 1 diabetes mellitus has always posed a challenge to balance hyperglycemia control with hypoglycemia episodes. The quest for newer therapies is continuing and this review attempts to outline the recent developments. The insulin molecule itself has got moulded into different analogues by minor changes in its structure to ensure well controlled delivery, stable half-lives and lesser side effects. Insulin delivery systems have also consistently undergone advances from subcutaneous injections to continuous infusion to trials of inhalational delivery. Continuous glucose monitoring systems are also becoming more accurate and user friendly. Smartphones have also made their entry into therapy of diabetes by integrating blood glucose levels and food intake with calculated adequate insulin required. Artificial pancreas has enabled to a certain extent to close the loop between blood glucose level and insulin delivery with devices armed with meal and exercise announcements, dual hormone delivery and pramlintide infusion. Islet, pancreas-kidney and stem cells transplants are also being attempted though complete success is still a far way off. Incorporating insulin gene and secretary apparatus is another ambitious leap to achieve insulin independence though the search for the ideal vector and target cell is still continuing. Finally to stand up to the statement, prevention is better than cure, immunological methods are being investigated to be used as vaccine to prevent the onset of diabetes mellitus. PMID:25317246

  13. Automotive energy management system

    SciTech Connect

    Shiber, S.

    1980-09-23

    A hydromechanical/hydrostatic automotive energy management system is described that is comprised of two hydraulic units, the system adapted to provide: an efficient, continuously variable optimal transmission ratio, an intermittent optimal engine operation in city traffic and regenerative braking, thereby, the system is able to reduce a car's fuel consumption by as much as one half while improving drivability.

  14. Telemedicine as a tool for intensive management of diabetes: the DIABTel experience.

    PubMed

    Gómez, E J; Hernando, M E; García, A; Del Pozo, F; Cermeño, J; Corcoy, R; Brugués, E; De Leiva, A

    2002-08-01

    This paper presents the current features of the DIABTel telemedicine system and the evaluation outcomes of its use in clinical routine. This telemedicine system is designed to complement the daily care and intensive management of diabetic patients through telemonitoring and telecare services. The system comprises a patient unit (PU) used by patients in their day-to-day activities and a Medical Workstation used by physicians and nurses at hospitals. Both applications offer tools to collect, manage, view and interpret data and to exchange data and messages. The system was evaluated for usability, telemedical protocols, metabolic control and quality of life. This evaluation consisted in a 6-month cross-over pilot study with ten Type I diabetic patients. The results of the evaluation allowed assessment of the telemedicine protocols in terms of the number of communications/patient (21.6+/-7.7); days between communications (5.4+/-2.66); messages sent by physicians (118 text messages); and data and messages transmitted by patients (3524 blood glucose readings, 1649 day-to-day insulin adjustments, 24 exercise reports, ten diet modifications and 63 text messages). Physicians performed more therapeutic changes during the DIABTel period than in the control period. There was a trend towards HbA1c improvement during DIABTel use with no incidence in the number of hypoglycaemias. This pilot study demonstrates the feasibility of the DIABTel system in clinical routine use and its potential benefits for diabetes care: improving the availability of information necessary for therapy adjustments; offering new physician-patient communication tools; increasing patient empowerment and education; and showing a positive trend towards improving the metabolic control of patients. Further studies are needed to validate these findings and to promote telemedicine as an opportunity to better diabetes care. PMID:12100795

  15. The Management of Type 2 Diabetic Patients with Hypoglycaemic Agents

    PubMed Central

    Tsang, Man-Wo

    2012-01-01

    Type 2 Diabetes Mellitus (T2DM) is characterized by chronic hyperglycemia with disturbance in carbohydrate, lipid, and protein metabolism due to insulin resistance and beta cell dysfunction. Epidemiological studies have confirmed a global pandemic of T2DM, which has created an enormous burden on society, with regard to morbidity, mortality, and health care expenditures. Life style modifications are fundamental not only in early stages of disease management but need to be intensified as disease progresses. United Kingdom Prospective Diabetes Study (UKPDS) has demonstrated the progressive nature of T2DM, and as disease progresses, a combination agents—oral antidiabetic drugs (OAD) and insulin—are needed in order to maintain good sugar control. The general consensus of HbA1c target for most patients is less than 7%, and various guidelines and algorithms have provided guidance in patient management to keep patient at goal. As our understanding of pathophysiological defects advances, targeting treatment at underlying defects not only enables us to achieve HbA1c goal but also reduces morbidities, mortalities, and progression of the disease. Traditional oral agents like metformin and sulfonylureas have failed to arrest the progression of T2DM. New agents such as TZD, DPP-4 inhibitor, and SGLT-2 may increase our armamentariums against T2DM. PMID:22645689

  16. Effectiveness of a Culturally Tailored Diabetes Self-Management Program for Chinese Americans

    PubMed Central

    Sun, Angela C.; Tsoh, Janice Y.; Saw, Anne; Chan, Joanne L.; Cheng, Joyce W.

    2016-01-01

    Purpose The purpose of the study was to test the feasibility and efficacy of a diabetes self-management and education program for Chinese Americans in a support group format. The rationale for the study was to create culturally appropriate diabetes education and management programs in response to the growing diabetes prevalence among Chinese Americans. The investigators hypothesized that participants will have improved diabetes knowledge and practices, hemoglobin A1C, and social support. The study objectives were at least: 50% will have significant improvements in diabetes knowledge and practice activities, 30% of participants will have significant improvements in A1C, and 50% will report a gain in emotional support. Methods The program consisted of 12 90-minute diabetes education and support group sessions offered in a medical office setting. The sample included 23 Chinese Americans with either type 1 or type 2 diabetes. Using a single-group, pre-post test design, A1C and diabetes knowledge were assessed at baseline and 6 months. Data were collected through clinical assessments and written questionnaires. Results The results indicated high attendance and statistically significant increases in glycemic control and diabetes knowledge. Statistically insignificant differences were shown in diabetes management practices. Secondary outcomes assessed participants’ perceived diabetes management and emotional and social support. Conclusions Diabetes Self-Management: A Cultural Approach (DSMCA) support group model demonstrates that a culturally tailored support group utilizing a community-based participatory research approach is an effective format to improve diabetes self-management skills among Chinese Americans. The program can be adapted for other ethnic populations. The efficacy of the intervention can be further tested in larger randomized trials. PMID:22722610

  17. Heart failure in the diabetic population – pathophysiology, diagnosis and management

    PubMed Central

    Drzewoski, Jozef

    2014-01-01

    Evidence from clinical trials repeatedly confirms the association of diabetes with heart failure, independent of hypertension, atherosclerosis, coronary artery disease and valvular heart disease. However, the importance of coexistence of diabetes and heart failure is not universally recognized, despite the fact that it may significantly contribute to morbidity and mortality of the diabetic population. It seems that prevention of heart failure, early diagnosis, and appropriate management could improve the outcome. Unfortunately, the etiology of heart failure in diabetic patients is still to be elucidated. It is multifactorial in nature and several cellular, molecular and metabolic factors are implicated. Additionally, there are still no definite guidelines on either the diagnosis and treatment of heart failure in diabetic patients or on the therapy of diabetes in subjects with heart failure. This review focuses on the pathophysiology, diagnosis, and prevention of heart failure in the diabetic population as well as management of both comorbidities. PMID:25097587

  18. Self-management support interventions that are clinically linked and technology enabled: can they successfully prevent and treat diabetes?

    PubMed

    Kaufman, Neal D; Woodley, Paula D Patnoe

    2011-05-01

    Patients with diabetes need a complex set of services and supports. The challenge of integrating these services into the diabetes regimen can be successfully overcome through self-management support interventions that are clinically linked and technology enabled: self-management support because patients need help mastering the knowledge, attitudes, skills, and behaviors so necessary for good outcomes; interventions because comprehensive theory-based, evidence-proven, long-term, longitudinal interventions work better than direct-to-consumer or nonplanned health promotion approaches; clinically linked because patients are more likely to adopt new behaviors when the approach is in the context of a trusted therapeutic relationship and within an effective medical care system; and technology enabled because capitalizing on the amazing power of information technology leads to the delivery of cost-effective, scalable, engaging solutions that prevent and manage diabetes. PMID:21722596

  19. The management of type 1 diabetes in primary school: review of the literature.

    PubMed

    Marks, Anne; Wilson, Valerie; Crisp, Jackie

    2013-01-01

    Type 1 diabetes is one of the most common chronic health conditions in childhood. The introduction of intensive insulin therapy and the rising prevalence of diabetes in younger children has increased the need for involvement of diabetes educators and school personnel in school diabetes care. School encompasses a significant proportion of a child's day, therefore diabetes treatment at school needs to be optimal or the child will have poor metabolic control. The aim of this literature review is to examine diabetes management in the early primary school setting. The main areas of diabetes management explored are: type, provision, and location of treatment, the impact on the child, and the role of the credentialed diabetes educator. The review identifies that the majority of children are not receiving intensive diabetes treatment at school. Younger children require more assistance with care and may be disadvantaged due to lack of appropriate school staff support. Most schools do not have nurses to assist with diabetes care, therefore teaching and administration staff are utilized. The use of insulin pump therapy may increase access to insulin at school, as children and teaching staff appear more confident with this method of delivery than injections. Treatment is frequently performed away from the classroom and can impact on class attendance, metabolic control, and emergencies. Diabetes educators need to work in collaboration with children, parents, and school personnel to ensure diabetes care is fully integrated into the school day. PMID:23597278

  20. Database Management System

    NASA Technical Reports Server (NTRS)

    1990-01-01

    In 1981 Wayne Erickson founded Microrim, Inc, a company originally focused on marketing a microcomputer version of RIM (Relational Information Manager). Dennis Comfort joined the firm and is now vice president, development. The team developed an advanced spinoff from the NASA system they had originally created, a microcomputer database management system known as R:BASE 4000. Microrim added many enhancements and developed a series of R:BASE products for various environments. R:BASE is now the second largest selling line of microcomputer database management software in the world.

  1. [The German program for disease management guidelines: type 2 diabetes--diabetic retinopathy/maculopathy guideline 2006. Short review].

    PubMed

    Ollenschläger, Günter; Kopp, Ina; Thole, Henning; Lelgemann, Monika

    2007-02-15

    In Germany, the first national consensus between six medical scientific associations on evidence-based recommendations for prevention and therapy of retinopathy/maculopathy in type 2 diabetes was reached in fall 2006. The recommendations' main sources are the NICE Retinopathy Guideline 2002, and existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline Type 2 Diabetes-Retinopathy/Maculopathy 2006 (www.diabetes.versorgungsleitlinien.de). PMID:17323022

  2. Oil field management system

    DOEpatents

    Fincke, James R.

    2003-09-23

    Oil field management systems and methods for managing operation of one or more wells producing a high void fraction multiphase flow. The system includes a differential pressure flow meter which samples pressure readings at various points of interest throughout the system and uses pressure differentials derived from the pressure readings to determine gas and liquid phase mass flow rates of the high void fraction multiphase flow. One or both of the gas and liquid phase mass flow rates are then compared with predetermined criteria. In the event such mass flow rates satisfy the predetermined criteria, a well control system implements a correlating adjustment action respecting the multiphase flow. In this way, various parameters regarding the high void fraction multiphase flow are used as control inputs to the well control system and thus facilitate management of well operations.

  3. Integrated work management system.

    SciTech Connect

    Williams, Edward J., Jr.; Henry, Karen Lynne

    2010-06-01

    Sandia National Laboratories develops technologies to: (1) sustain, modernize, and protect our nuclear arsenal (2) Prevent the spread of weapons of mass destruction; (3) Provide new capabilities to our armed forces; (4) Protect our national infrastructure; (5) Ensure the stability of our nation's energy and water supplies; and (6) Defend our nation against terrorist threats. We identified the need for a single overarching Integrated Workplace Management System (IWMS) that would enable us to focus on customer missions and improve FMOC processes. Our team selected highly configurable commercial-off-the-shelf (COTS) software with out-of-the-box workflow processes that integrate strategic planning, project management, facility assessments, and space management, and can interface with existing systems, such as Oracle, PeopleSoft, Maximo, Bentley, and FileNet. We selected the Integrated Workplace Management System (IWMS) from Tririga, Inc. Facility Management System (FMS) Benefits are: (1) Create a single reliable source for facility data; (2) Improve transparency with oversight organizations; (3) Streamline FMOC business processes with a single, integrated facility-management tool; (4) Give customers simple tools and real-time information; (5) Reduce indirect costs; (6) Replace approximately 30 FMOC systems and 60 homegrown tools (such as Microsoft Access databases); and (7) Integrate with FIMS.

  4. Diabetes Nurse Case Management and Motivational Interviewing for Change (DYNAMIC): Study Design and Baseline Characteristics in the Chronic Care Model for Type 2 Diabetes

    PubMed Central

    Stuckey, Heather L.; Dellasega, Cheryl; Graber, Nora J.; Mauger, David T.; Lendel, Irina; Gabbay, Robert A.

    2009-01-01

    Background Despite evidence that diabetes is costly and devastating, the health care system is poorly equipped to meet the challenges of chronic disease care. The Penn State Institute of Diabetes & Obesity is evaluating a model of managing Type 2 DM which includes nurse case management (NCM) and motivational interviewing (MI) to foster behavior change. The primary care intervention is designed to improve patients' self care and to reduce clinical inertia through provider use of standardized clinical guidelines to achieve better diabetes outcomes. Methods This RCT tests the efficacy of an enhanced NCM intervention on Type 2 DM (n=549) patient outcomes mediated by changes in self-care behavior and diabetes management. Outcome measures include: (a) effect on clinical parameters such as HbA1c (<7), BP (<130/80), and LDL (<100), depression scores and weight; (b) process measures such as complication screening; (c) patient psychological and behavioral outcomes as measured by emotional distress (PAID), diabetes-specific quality of life (ADDQoL), patient satisfaction (DTSQ), self-care activities (SDSCA); and (d) physician satisfaction and cost-effectiveness of the intervention. Conclusions Baseline includes (mean) age = 58; BMI = 34.4; 57% females; 47% Caucasian, and 39% Hispanic. Patients had elevated HbA1c (8.4), BP (137/77) and LDL (114). Overall, patients were depressed (CES-D = 21.6) and had an extremely negative quality of life (ADDQoL = -1.58). We believe that enhanced NCM will both improve self-care and reduce emotional distress for patients with diabetes. If proven effective, enhanced NCM may be translated to other chronic illnesses. PMID:19328244

  5. Understanding diabetes self-management behaviors among Hispanics in New York City.

    PubMed

    Aponte, Judith; Campos-Dominguez, Giselle; Jaramillo, Diana

    2015-01-01

    Diabetes mellitus is a public health concern disproportionately affecting Hispanics. Because Hispanics are greatly affected by a high prevalence of diabetes, a qualitative study was conducted, which explored how Hispanics understand, perceive, and experience behavioral change and how they maintain such change while managing their diabetes. Twenty Caribbean (Dominican and Puerto Rican) Hispanic adults with diabetes, who were either English- or Spanish-speaking, participated in the study. Twenty individual interviews were conducted, audiotaped, and transcribed and translated. Structured questions were used in the interviews which covered the meaning of certain terms (e.g., healthy eating, exercise), motivators and barriers to changing behaviors related to diabetes management, and a question to explore ways nurses can assist them in changing behaviors. Content analysis was used to analyze the text of the interviews. Three themes (diabetes management, behavior change, and nurse's role) emerged from the data, including apparent gaps in the participants' perception of adapting their cultural foods into healthier dietary habits. PMID:25741930

  6. Building a Virtual Environment for Diabetes Self-Management Education and Support

    PubMed Central

    Johnson, Constance; Feenan, Kevin; Setliff, Glenn; Pereira, Katherine; Hassell, Nancy; Beresford, Henry F.; Epps, Shelly; Nicollerat, Janet; Tatum, William; Feinglos, Mark; Vorderstrasse, Allison

    2015-01-01

    The authors developed an immersive diabetes community to provide diabetes self-management education and support for adults with type 2 diabetes. In this article the authors describe the procedures used to develop this virtual environment (VE). Second Life Impacts Diabetes Education & Self-Management (SLIDES), the VE for our diabetes community was built in Second Life. Social Cognitive Theory, behavioral principles and key aspects of virtual environments related to usability were applied in the development in this VE. Collaboration between researchers, clinicians and information technology (IT) specialists occurred throughout the development process. An interactive community was successfully built and utilized to provide diabetes self-management education and support. VEs for health applications may be innovative and enticing, yet it must be kept in mind that there are substantial effort, expertise, and usability factors that must be considered in the development of these environments for health care consumers. PMID:25699133

  7. Automated RTOP Management System

    NASA Technical Reports Server (NTRS)

    Hayes, P.

    1984-01-01

    The structure of NASA's Office of Aeronautics and Space Technology electronic information system network from 1983 to 1985 is illustrated. The RTOP automated system takes advantage of existing hardware, software, and expertise, and provides: (1) computerized cover sheet and resources forms; (2) electronic signature and transmission; (3) a data-based information system; (4) graphics; (5) intercenter communications; (6) management information; and (7) text editing. The system is coordinated with Headquarters efforts in codes R,E, and T.

  8. Development of a diabetes care management curriculum in a family practice residency program.

    PubMed

    Nuovo, Jim; Balsbaugh, Thomas; Barton, Sue; Davidson, Ellen; Fox-Garcia, Jane; Gandolfo, Angela; Levich, Bridget; Seibles, Joann

    2004-01-01

    Improving the quality of care for patients with chronic illness has become a high priority. Implementing training programs in disease management (DM) so the next generation of physicians can manage chronic illness more effectively is challenging. Residency training programs have no specific mandate to implement DM training. Additional barriers at the training facility include: 1) lack of a population-based perspective for service delivery; 2) weak support for self-management of illness; 3) incomplete implementation due to physician resistance or inertia; and 4) few incentives to change practices and behaviors. In order to overcome these barriers, training programs must take the initiative to implement DM training that addresses each of these issues. We report the implementation of a chronic illness management curriculum based on the Improving Chronic Illness Care (ICIC) Model. Features of this process included both patient care and learner objectives. These were: development of a multidisciplinary diabetes DM team; development of a patient registry; development of diabetes teaching clinics in the family practice center (nutrition, general management classes, and one-on-one teaching); development of a group visit model; and training the residents in the elements of the ICIC Model, ie, the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. Barriers to implementing these curricular changes were: the development of a patient registry; buy-in from faculty, residents, clinic leadership, staff, and patients for the chronic care model; the ability to bill for services and maintain clinical productivity; and support from the health system key stakeholders for sustainability. Unique features of each training site will dictate differences in emphasis and structure; however, the core principles of the ICIC Model in enhancing self-management may be generalized to all sites. PMID:15671788

  9. Management of hyperglycemia in geriatric patients with diabetes mellitus: South Asian consensus guidelines

    PubMed Central

    Baruah, Manash P.; Kalra, Sanjay; Unnikrishnan, Ambika Gopalkrishnan; Raza, Syed Abbas; Somasundaram, Noel; John, Mathew; Katulanda, Prasad; Shrestha, Dina; Bantwal, Ganpathy; Sahay, Rakesh; Latt, Tint Swe; Pathan, Faruque

    2011-01-01

    Asia is home to four of the world's five largest diabetic populations, two of them being South Asian nations, namely, India and Pakistan. This problem is compounded by a substantial rise in the elderly population in Asian countries. On the other hand, the heterogeneous health condition and multiple co-morbidities make the care of chronic disease in the elderly a challenging task. The aim of the South Asian Consensus Guidelines is to provide evidence-based recommendations to assist healthcare providers in the rational management of type 2 diabetes mellitus in the elderly population. Current Guidelines used systematic reviews of available evidence to form its key recommendations. No evidence grading was done for the purpose of this manuscript. The clinical questions of the guidelines, the methodology of literature search, and medical writing strategy were finalized by consultations in person and through mail. The South Asian Consensus guideline emphasizes tailoring of glycemic goals for patients based on age, co-morbid conditions especially that of cardiovascular system, risk of hypoglycemia, and life expectancy. It also recommends cautious use of available pharmacotherapy in geriatric patients with diabetes. The primary principle of diabetes therapy should be to achieve euglycemia, without causing hypoglycemia. Appropriate use of modern insulins and oral drugs, including incretin mimetics will help physicians achieve this aim. PMID:21731863

  10. Psychosocial issues in diabetes self-management: strategies for healthcare providers.

    PubMed

    Sabourin, Brigitte C; Pursley, Shannon

    2013-02-01

    Education and training for diabetes mellitus self-management is widely available and an essential part of many diabetes centres. Nonetheless, the majority of individuals with diabetes do not adhere to optimal self-management recommendations. It is believed that psychosocial issues play an important role in individuals' ability to undertake the extensive behavioural demands involved in managing diabetes. The goal of the present article is to provide an overview of psychosocial issues and suggest strategies for healthcare providers in supporting patients with the challenges of diabetes self-management. First, motivational enhancement strategies have the potential to augment patients' own motivation to engage in health behaviours. Second, behavior modification principles can increase patients' self-efficacy and their experiences of success. Third, managing distressing emotions, including anxiety, depression, distress specifically related to diabetes care, and fear of hypoglycemia, can facilitate motivation and ability to undertake diabetes self-management efforts. Recognizing and addressing psychosocial challenges allows healthcare providers to better support their patients in the demanding tasks of diabetes self-management. PMID:24070746

  11. Decision support system for diabetic retinopathy using discrete wavelet transform.

    PubMed

    Noronha, K; Acharya, U R; Nayak, K P; Kamath, S; Bhandary, S V

    2013-03-01

    Prolonged duration of the diabetes may affect the tiny blood vessels of the retina causing diabetic retinopathy. Routine eye screening of patients with diabetes helps to detect diabetic retinopathy at the early stage. It is very laborious and time-consuming for the doctors to go through many fundus images continuously. Therefore, decision support system for diabetic retinopathy detection can reduce the burden of the ophthalmologists. In this work, we have used discrete wavelet transform and support vector machine classifier for automated detection of normal and diabetic retinopathy classes. The wavelet-based decomposition was performed up to the second level, and eight energy features were extracted. Two energy features from the approximation coefficients of two levels and six energy values from the details in three orientations (horizontal, vertical and diagonal) were evaluated. These features were fed to the support vector machine classifier with various kernel functions (linear, radial basis function, polynomial of orders 2 and 3) to evaluate the highest classification accuracy. We obtained the highest average classification accuracy, sensitivity and specificity of more than 99% with support vector machine classifier (polynomial kernel of order 3) using three discrete wavelet transform features. We have also proposed an integrated index called Diabetic Retinopathy Risk Index using clinically significant wavelet energy features to identify normal and diabetic retinopathy classes using just one number. We believe that this (Diabetic Retinopathy Risk Index) can be used as an adjunct tool by the doctors during the eye screening to cross-check their diagnosis. PMID:23662341

  12. Data Grid Management Systems

    NASA Technical Reports Server (NTRS)

    Moore, Reagan W.; Jagatheesan, Arun; Rajasekar, Arcot; Wan, Michael; Schroeder, Wayne

    2004-01-01

    The "Grid" is an emerging infrastructure for coordinating access across autonomous organizations to distributed, heterogeneous computation and data resources. Data grids are being built around the world as the next generation data handling systems for sharing, publishing, and preserving data residing on storage systems located in multiple administrative domains. A data grid provides logical namespaces for users, digital entities and storage resources to create persistent identifiers for controlling access, enabling discovery, and managing wide area latencies. This paper introduces data grids and describes data grid use cases. The relevance of data grids to digital libraries and persistent archives is demonstrated, and research issues in data grids and grid dataflow management systems are discussed.

  13. Management of hyperosmolar hyperglycaemic state in adults with diabetes.

    PubMed

    Scott, A R

    2015-06-01

    Hyperglycaemic hyperosmolar state (HHS) is a medical emergency, which differs from diabetic ketoacidosis (DKA) and requires a different approach. The present article summarizes the recent guidance on HHS that has been produced by the Joint British Diabetes Societies for Inpatient Care, available in full at http://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_HHS_Adults.pdf. HHS has a higher mortality rate than DKA and may be complicated by myocardial infarction, stroke, seizures, cerebral oedema and central pontine myelinolysis and there is some evidence that rapid changes in osmolality during treatment may be the precipitant of central pontine myelinolysis. Whilst DKA presents within hours of onset, HHS comes on over many days, and the dehydration and metabolic disturbances are more extreme. The key points in these HHS guidelines include: (1) monitoring of the response to treatment: (i) measure or calculate the serum osmolality regularly to monitor the response to treatment and (ii) aim to reduce osmolality by 3-8 mOsm/kg/h; (2) fluid and insulin administration: (i) use i.v. 0.9% sodium chloride solution as the principal fluid to restore circulating volume and reverse dehydration, (ii) fluid replacement alone will cause a fall in blood glucose (BG) level, (iii) withhold insulin until the BG level is no longer falling with i.v. fluids alone (unless ketonaemic), (iv) an initial rise in sodium level is expected and is not itself an indication for hypotonic fluids and (v) early use of insulin (before fluids) may be detrimental; and (3) delivery of care: (i) The diabetes specialist team should be involved as soon as possible and (ii) patients should be nursed in areas where staff are experienced in the management of HHS. PMID:25980647

  14. Purge water management system

    DOEpatents

    Cardoso-Neto, J.E.; Williams, D.W.

    1995-01-01

    A purge water management system is described for effectively eliminating the production of purge water when obtaining a groundwater sample from a monitoring well. In its preferred embodiment, the purge water management system comprises an expandable container, a transportation system, and a return system. The purge water management system is connected to a wellhead sampling configuration, typically permanently installed at the well site. A pump, positioned with the monitoring well, pumps groundwater through the transportation system into the expandable container, which expands in direct proportion with volume of groundwater introduced, usually three or four well volumes, yet prevents the groundwater from coming into contact with the oxygen in the air. After this quantity of groundwater has been removed from the well, a sample is taken from a sampling port, after which the groundwater in the expandable container can be returned to the monitoring well through the return system. The purge water management system prevents the purge water from coming in contact with the outside environment, especially oxygen, which might cause the constituents of the groundwater to oxidize. Therefore, by introducing the purge water back into the monitoring well, the necessity of dealing with the purge water as a hazardous waste under the Resource Conservation and Recovery Act is eliminated.

  15. Purge water management system

    DOEpatents

    Cardoso-Neto, Joao E.; Williams, Daniel W.

    1996-01-01

    A purge water management system for effectively eliminating the production of purge water when obtaining a groundwater sample from a monitoring well. In its preferred embodiment, the purge water management system comprises an expandable container, a transportation system, and a return system. The purge water management system is connected to a wellhead sampling configuration, typically permanently installed at the well site. A pump, positioned with the monitoring well, pumps groundwater through the transportation system into the expandable container, which expands in direct proportion with volume of groundwater introduced, usually three or four well volumes, yet prevents the groundwater from coming into contact with the oxygen in the air. After this quantity of groundwater has been removed from the well, a sample is taken from a sampling port, after which the groundwater in the expandable container can be returned to the monitoring well through the return system. The purge water management system prevents the purge water from coming in contact with the outside environment, especially oxygen, which might cause the constituents of the groundwater to oxidize. Therefore, by introducing the purge water back into the monitoring well, the necessity of dealing with the purge water as a hazardous waste under the Resource Conservation and Recovery Act is eliminated.

  16. Computer memory management system

    DOEpatents

    Kirk, III, Whitson John

    2002-01-01

    A computer memory management system utilizing a memory structure system of "intelligent" pointers in which information related to the use status of the memory structure is designed into the pointer. Through this pointer system, The present invention provides essentially automatic memory management (often referred to as garbage collection) by allowing relationships between objects to have definite memory management behavior by use of coding protocol which describes when relationships should be maintained and when the relationships should be broken. In one aspect, the present invention system allows automatic breaking of strong links to facilitate object garbage collection, coupled with relationship adjectives which define deletion of associated objects. In another aspect, The present invention includes simple-to-use infinite undo/redo functionality in that it has the capability, through a simple function call, to undo all of the changes made to a data model since the previous `valid state` was noted.

  17. Healthy Changes™ for Living with Diabetes: An Evidence-Based Community Diabetes Self-Management Program

    PubMed Central

    Klug, Cindy; Toobert, Deborah J.; Fogerty, Michaela

    2016-01-01

    Purpose This article addresses the gap between research and practice by describing the feasibility and outcomes of an evidence-based diabetes self-management health education program. The Healthy Changes™ program used a peer-led group format to promote physical activity and healthful eating practices, employing culturally relevant materials and measures. Methods Older adults (mean age = 69.2 years; SD = 10.7) with type 2 diabetes (N = 243) were recruited from nine communities to participate in the Healthy Changes™ program. Components included goal setting, problem solving, group support, and interactive lectures from experts. Measures of eating patterns, physical activity, body weight, community resources, self-rated health, and self-efficacy were administered at baseline, and at 4, 8, and 12 months. Results Participants attended on average 13 weekly sessions, and showed improvements in health behaviors, supportive resources, and self-efficacy at 4, 8, and 12 months. Conclusion The Healthy Changes™ program can be successfully translated into community settings and led by trained peer leaders, yielding health improvements similar to those reported in efficacy trials. Trained peer leaders are key to effective program implementation. Peer-led groups enhance goal attainment by giving participants a venue to discuss obstacles and strategize solutions. PMID:19075087

  18. Materials management information systems.

    PubMed

    1996-01-01

    The hospital materials management function--ensuring that goods and services get from a source to an end user--encompasses many areas of the hospital and can significantly affect hospital costs. Performing this function in a manner that will keep costs down and ensure adequate cash flow requires effective management of a large amount of information from a variety of sources. To effectively coordinate such information, most hospitals have implemented some form of materials management information system (MMIS). These systems can be used to automate or facilitate functions such as purchasing, accounting, inventory management, and patient supply charges. In this study, we evaluated seven MMISs from seven vendors, focusing on the functional capabilities of each system and the quality of the service and support provided by the vendor. This Evaluation is intended to (1) assist hospitals purchasing an MMIS by educating materials managers about the capabilities, benefits, and limitations of MMISs and (2) educate clinical engineers and information system managers about the scope of materials management within a healthcare facility. Because software products cannot be evaluated in the same manner as most devices typically included in Health Devices Evaluations, our standard Evaluation protocol was not applicable for this technology. Instead, we based our ratings on our observations (e.g., during site visits), interviews we conducted with current users of each system, and information provided by the vendor (e.g., in response to a request for information [RFI]). We divided the Evaluation into the following sections: Section 1. Responsibilities and Information Requirements of Materials Management: Provides an overview of typical materials management functions and describes the capabilities, benefits, and limitations of MMISs. Also includes the supplementary article, "Inventory Cost and Reimbursement Issues" and the glossary, "Materials Management Terminology." Section 2. The

  19. Management Information System

    NASA Technical Reports Server (NTRS)

    1984-01-01

    New Automated Management Information Center (AMIC) employs innovative microcomputer techniques to create color charts, viewgraphs, or other data displays in a fraction of the time formerly required. Developed under Kennedy Space Center's contract by Boeing Services International Inc., Seattle, WA, AMIC can produce an entirely new informational chart in 30 minutes, or an updated chart in only five minutes. AMIC also has considerable potential as a management system for business firms.

  20. Management Observation System (MOS)

    SciTech Connect

    Michael Baker; Robert Bryant; Teresa Childs

    2006-01-01

    The Management Observation System (MOS) was developed at Oak Ridge National Laboratory (ORNL) to improve the overall safety of the Laboratory. The MOS provides a tool to document management observations, records time spent in the field conducting observations, and the results of those observations. It also documents if there are lessons learned from a particular observation or if follow-up actions are needed to correct issues or deficiencies identified. Management has found this a very useful tool to use as a proactive approach to identifying and/or correcting potential problems before they become safety related issues.

  1. Racial/Ethnic Differences in Use of Health Care Services for Diabetes Management

    PubMed Central

    Chandler, Raeven Faye; Monnat, Shannon M.

    2015-01-01

    Research demonstrates consistent racial/ethnic disparities in access to and use of health care services for a variety of chronic conditions. Yet we know little about whether these disparities exist for use of health care services for diabetes management. Racial/ethnic minorities disproportionately suffer from diabetes, complications from diabetes, and diabetes-related mortality. Proper diabetes management can reduce the risk of complications and premature mortality. Using a large national data set (N=37,705) of white, black, Hispanic, Asian, and Native American U.S. adults aged 65 and older who have been diagnosed with diabetes, we examine three specific types of health care provider use for diabetes management: number of times seen by a healthcare professional for diabetes, number of times feet have been checked by a health care professional, and number of visits for a glycosylated hemoglobin check. We found that net of controls for a variety of demographic and socioeconomic characteristics, blacks and Hispanics had significantly more visits to a health care provider (HCP) for their diabetes and significantly more glycosylated hemoglobin checks than whites, and blacks and Native Americans had significantly more HCP feet checks than whites. Our results suggest that the reduced access to health care services traditionally found among racial/ethnic minorities does not hold for access to health care services for diabetes management, where racial/ethnic minority diabetics are actually more likely to use care than are white diabetics. Future research should examine whether higher use of health care services for diabetes among racial/ethnic minorities is due to greater disease severity among racial/ethnic minorities than among non-Hispanic whites. PMID:25842386

  2. Racial/Ethnic Differences in Use of Health Care Services for Diabetes Management.

    PubMed

    Chandler, Raeven Faye; Monnat, Shannon M

    2015-12-01

    Research demonstrates consistent racial/ethnic disparities in access to and use of health care services for a variety of chronic conditions. Yet we know little about whether these disparities exist for use of health care services for diabetes management. Racial/ethnic minorities disproportionately suffer from diabetes, complications from diabetes, and diabetes-related mortality. Proper diabetes management can reduce the risk of complications and premature mortality. Using a large national data set (N = 37,705) of White, Black, Hispanic, Asian, and Native American U.S. adults aged 65 years and older who have been diagnosed with diabetes, we examine three specific types of health care provider (HCP) use for diabetes management: number of times seen by a health care professional for diabetes, number of times feet have been checked by a health care professional, and number of visits for a glycosylated hemoglobin check. We found that net of controls for a variety of demographic and socioeconomic characteristics, Blacks and Hispanics had significantly more visits to a HCP for their diabetes and significantly more glycosylated hemoglobin checks than Whites, and Blacks and Native Americans had significantly more HCP feet checks than Whites. Our results suggest that the reduced access to health care services traditionally found among racial/ethnic minorities does not hold for access to health care services for diabetes management, where racial/ethnic minority diabetics are actually more likely to use care than are White diabetics. Future research should examine whether higher use of health care services for diabetes among racial/ethnic minorities is due to greater disease severity among racial/ethnic minorities than among non-Hispanic Whites. PMID:25842386

  3. Diabetes Case Management in Primary Care: The New Brunswick Experience and Expanding the Practice of the Certified Diabetes Educator Nurse into Primary Care.

    PubMed

    Jones, Shelley L

    2015-08-01

    The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions. PMID:25797113

  4. Developing a Manualized Occupational Therapy Diabetes Management Intervention: Resilient, Empowered, Active Living With Diabetes.

    PubMed

    Pyatak, Elizabeth A; Carandang, Kristine; Davis, Shain

    2015-07-01

    This article reports on the development of a manualized occupational therapy intervention for diabetes management. An initial theoretical framework and core content areas for a Stage I intervention manual were developed based on an in-depth needs assessment and review of existing literature. After evaluation by a panel of experts and completion of a feasibility study, the intervention was revised into a Stage 2 manual in preparation for a randomized study evaluating the intervention's efficacy. In developing the initial manual, we delineated core theoretical principles to allow for flexible application and tailoring of the intervention's content areas. Expert panel feedback and feasibility study results led to changes to the intervention structure and content as we developed the Stage 2 manual. Through describing this process, we illustrate the dynamic evolution of intervention manuals, which undergo revisions due to both theoretical and practical considerations at each stage of the research-to-clinical practice pipeline. PMID:26594741

  5. Design and development of a web-based application for diabetes patient data management.

    PubMed

    Deo, S S; Deobagkar, D N; Deobagkar, Deepti D

    2005-01-01

    A web-based database management system developed for collecting, managing and analysing information of diabetes patients is described here. It is a searchable, client-server, relational database application, developed on the Windows platform using Oracle, Active Server Pages (ASP), Visual Basic Script (VB Script) and Java Script. The software is menu-driven and allows authorized healthcare providers to access, enter, update and analyse patient information. Graphical representation of data can be generated by the system using bar charts and pie charts. An interactive web interface allows users to query the database and generate reports. Alpha- and beta-testing of the system was carried out and the system at present holds records of 500 diabetes patients and is found useful in diagnosis and treatment. In addition to providing patient data on a continuous basis in a simple format, the system is used in population and comparative analysis. It has proved to be of significant advantage to the healthcare provider as compared to the paper-based system. PMID:15949173

  6. Aloesin as a medical food ingredient for systemic oxidative stress of diabetes

    PubMed Central

    Yimam, Mesfin; Brownell, Lidia; Jia, Qi

    2015-01-01

    Diabetes is a chronic disease that requires a long term management where oxidative stress plays a pivotal role in disease progression and intensifying secondary complications. In spite of all the research on diabetes and recent advances in diabetes treatments, the reality is that there is no cure for diabetes and its devastating complications. While currently available anti-diabetic therapies are effective in reducing blood glucose level, they are not without associated side effects when they are used for a long term applications. As a result, physicians and patients are inclining more towards to a safer therapy with less serious side effects in the form of medicinal foods and botanical alternatives that are suitable for chronic usage. Aloesin, an Aloe chromone, has previously been formulated with an aloe polysaccharide to give a composition called Loesyn, where it showed significant impact in reducing glycosylated hemoglobin, fasting blood glucose, fructosamine and plasma insulin level in humans. Radical scavenging activities of chromones and polysaccharides from Aloe have also been reported. Here we rationalize the relevance of use of Aloesin alone or in a standardized blend with Aloe polysaccharides, as a potential medical food to manage systemic oxidative stress and/or high blood glucose of diabetes. PMID:26265996

  7. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys

    PubMed Central

    Mallinger, Leslie; Abbott-Klafter, Jesse; Guerrero, Ramiro; Villalpando, Salvador; Ridaura, Ruy Lopez; Aekplakorn, Wichai; Naghavi, Mohsen; Lim, Stephen; Lozano, Rafael; Murray, Christopher JL

    2011-01-01

    Abstract Objective To examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socioeconomic factors. Methods We used nationally representative health examination surveys from Colombia, England, the Islamic Republic of Iran, Mexico, Scotland, Thailand and the United States of America to obtain data on diagnosis, treatment and control of hyperglycaemia, arterial hypertension and hypercholesterolaemia among individuals with diabetes. Using logistic regression, we explored the socioeconomic determinants of diagnosis and effective case management. Findings A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries. The figures range from 24% of the women in Scotland and the USA to 62% of the men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure and serum cholesterol was very low, ranging from 1% of male patients in Mexico to about 12% in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States. Conclusion There are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia. While no large socioeconomic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management. PMID:21379413

  8. Priority management system

    SciTech Connect

    Simpson, W.A.

    1990-12-18

    Westinghouse Idaho Nuclear Company (WINCO) operates the Idaho Chemical Processing Plant (ICPP) for the US Department of Energy at the Idaho National Engineering Laboratory (INEL). This plant recovers Uranium-235 and rare gases from spent nuclear fuel. Improved fuel processing and waste management methods are also developed at this site. Facilities at ICPP include spent fuel storage and reprocessing areas, a waste solidification facility and related waste storage bins, remote analytical laboratories, and a coal-fired steam generation plant. Maintaining and modernizing a plant of this complexity presents difficult, but not unique problems in scheduling and resource management. WINCO accomplishes the many tasks inherent in any maintenance and construction program by using a Priority Management System. This system allows WINCO to provide integrated and systematic review of all aspects of design and construction, thus meeting customer requirements. This paper provides an overview of the priority setting process and necessary actions to fully implement the system.

  9. Coronary artery disease and diabetes - Management during Ramadan.

    PubMed

    Khan, Idris Ahmed

    2015-05-01

    Ramadan is the Islamic holy month of fasting and practiced by all adult Muslims all over the world at the same time simultaneously. Although people who are ill or diabetics with coronary heart disease are exempted from fasting, they still desire to fast and this is a challenge to themselves and the treating physician. We performed a systematic review of the available Medline English literature on the subject from January 1982 to December 2014 so as to help guide physicians in managing these patients. The results revealed that although the metabolic parameters change during Ramadan fasting, but this does not lead to any significant increase in the incidence of acute coronary events. Most adults with stable coronary artery disease can fast without significant complications, but those with unstable disease or recent or pending revascularization procedures should generally refrain from fasting. Regular monitoring by the physician is mandatory along with adjustment of the dosages. PMID:26013792

  10. Climate data management system

    SciTech Connect

    Drach, R

    1999-07-13

    The Climate Data Management System is an object-oriented data management system, specialized for organizing multidimensional, gridded data used in climate analysis and simulation. The building blocks of CDMS are variables, container classes, structural classes, and links. All gridded data stored in CDMS is associated with variables. The container objects group variables and structural objects. Variables are defined in terms of structural objects. Most CDMS objects can have attributes, which are scalar or one-dimensional metadata items. Attributes which are stored in the database, that is are persistent, are called external attributes. Some attributes are internal; they are associated with an object but do not appear explicitly in the database.

  11. Supporting self-management of type 2 diabetes: is there a role for the community pharmacist?

    PubMed Central

    Dhippayom, Teerapon; Krass, Ines

    2015-01-01

    Background Evidence supports the efficacy of pharmacy services in type 2 diabetes (T2D). However, little is known about consumer perspectives on the role of community pharmacists in diabetes care. The objectives of this study were to identify potential unmet needs and explore preferences for pharmacist-delivered support for T2D. Methods A qualitative study using focus groups was conducted in Sydney, Australia. Patients with T2D who were members of the Australian Diabetes Council in Sydney, Australia, were recruited through a survey on medication use in T2D. Five focus groups with a total of 32 consumers with T2D were recorded, transcribed, and thematically analyzed. Results The key themes were 1) the experiences of diabetes services received, 2) the potential to deliver self-management services, and 3) the suggested role of pharmacist in supporting diabetes management. Gaps in understanding and some degree of nonadherence to self-management signaled a potential for self-management support delivered by pharmacists. However, consumers still perceive that the main role of pharmacists in diabetes care centers on drug management services, with some enhancements to support adherence and continuity of supply. Barriers to diabetes care services included time constraints and a perceived lack of interest by pharmacists. Conclusion Given the unmet needs in diabetes self-management, opportunities exist for pharmacists to be involved in diabetes care. The challenge is for pharmacists to upgrade their diabetes knowledge and skills, organize their workflow, and become proactive in delivering diabetes care support. PMID:26257514

  12. Metabolic surgery: A paradigm shift in type 2 diabetes management

    PubMed Central

    Pappachan, Joseph M; Viswanath, Ananth K

    2015-01-01

    Obesity and type 2 diabetes mellitus (T2DM) are major public health issues globally over the past few decades. Despite dietary interventions, lifestyle modifications and the availability of several pharmaceutical agents, management of T2DM with obesity is a major challenge to clinicians. Metabolic surgery is emerging as a promising treatment option for the management of T2DM in the obese population in recent years. Several observational studies and a few randomised controlled trials have shown clear benefits of various bariatric procedures in obese individuals in terms of improvement or remission of T2DM and multiple other health benefits such as improvement of hypertension, obstructive sleep apnoea, osteoarthritis and non-alcoholic fatty liver disease. Uncertainties about the long-term implications of metabolic surgery such as relapse of T2DM after initial remission, nutritional and psychosocial complications and the optimal body mass index for different ethnic groups exist. The article discusses the major paradigm shift in recent years in the management of T2DM after the introduction of metabolic surgery. PMID:26240695

  13. Spousal Support in Diabetes Self-Management among Korean Immigrant Older Adults

    PubMed Central

    Lee, Jennifer J.; Park, Jenny J.; Sarkisian, Catherine A.

    2015-01-01

    We investigated domains of spousal support among diabetic Korean seniors and their spouses. We conducted two focus groups with diabetic participants and three with their spouses from the greater Los Angeles Korean community asking participants to describe the spousal support given or received for diabetes self-management. Each group was composed of 4–9 participants. Focus groups were audiotaped, transcribed, translated; two independent coders identified domains of spousal support. Content analysis identified six domains: diet, exercise, emotional support, medical regimen, communication with clinicians, and information. Diet was the most frequently described domain across all groups. Gender differences were noted in domains of information, communication, and treatment among diabetic participants. Both diabetic and spouse participants identified individualizing spousal support and recognizing diabetes management as teamwork as important elements of successful spousal support. Spousal support education for Korean seniors might have the greatest impact by incorporating these six domains, addressing gender differences, providing tips on individualizing support, and cultivating teamwork. PMID:25420183

  14. [Geriatric aspects for the management of diabetes mellitus].

    PubMed

    Huber, Joakim; Smeikal, Michael; Lechleitner, Monika; Fasching, Peter

    2016-04-01

    There is a high prevalence of diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence. PMID:27052230

  15. Management control system description

    SciTech Connect

    Bence, P. J.

    1990-10-01

    This Management Control System (MCS) description describes the processes used to manage the cost and schedule of work performed by Westinghouse Hanford Company (Westinghouse Hanford) for the US Department of Energy, Richland Operations Office (DOE-RL), Richland, Washington. Westinghouse Hanford will maintain and use formal cost and schedule management control systems, as presented in this document, in performing work for the DOE-RL. This MCS description is a controlled document and will be modified or updated as required. This document must be approved by the DOE-RL; thereafter, any significant change will require DOE-RL concurrence. Westinghouse Hanford is the DOE-RL operations and engineering contractor at the Hanford Site. Activities associated with this contract (DE-AC06-87RL10930) include operating existing plant facilities, managing defined projects and programs, and planning future enhancements. This document is designed to comply with Section I-13 of the contract by providing a description of Westinghouse Hanford's cost and schedule control systems used in managing the above activities. 5 refs., 22 figs., 1 tab.

  16. Building a novel inpatient diabetes management mentor program: a blueprint for success.

    PubMed

    Modic, Mary Beth; Sauvey, Rebecca; Canfield, Christina; Kukla, Aniko; Kaser, Nancy; Modic, Joselyn; Yager, Christina

    2013-01-01

    The intent of this project was to create a formalized educational program for bedside nurses responsible for inpatient diabetes management. Bedside nurses are recruited to serve as diabetes management mentors. The mentors receive advanced education concerning teaching and learning principles, the AADE7™ Self-Care Behaviors, and diabetes management strategies. They teach their peers, advocate for patients, and facilitate referrals for outpatient Diabetes Self-Management Education (DSME) programs. The focus of these ongoing educational activities is to foster the development of diabetes management mentors and to create teaching tools that mentors can use with peers to address practice gaps or skill deficiencies. The diabetes management mentor is integral in enhancing the care of patients with diabetes in the hospital. The empowerment of bedside nurses as mentors for their peers and their patients is an invaluable asset that helps nurses take ownership of their practice. This role could be applied to other complex disease entities, helping nurses to develop specific management skills to improve patient outcomes and enhance patient satisfaction. PMID:23493577

  17. Management of Type 1 Diabetes in Schools: Whose Responsibility?

    ERIC Educational Resources Information Center

    Mandali, Swarna L.; Gordon, Theresa A.

    2009-01-01

    The Centers for Disease Control and Prevention (2008) reports that approximately 0.2% of all persons under the age of 20 have been diagnosed with either type 1 or type 2 diabetes. This represents 186,300 children and young adults. Type 1 diabetes has traditionally been a disease of children and adolescents. Although type 2 diabetes has in the past…

  18. Protein tyrosine phosphatase 1B inhibitors: a molecular level legitimate approach for the management of diabetes mellitus.

    PubMed

    Thareja, Suresh; Aggarwal, Saurabh; Bhardwaj, T R; Kumar, Manoj

    2012-05-01

    Diabetes mellitus is a systemic disease responsible for morbidity in the western world and is gradually becoming prevalent in developing countries too. The prevalence of diabetes is rapidly increasing in industrialized countries and type 2 diabetes accounts for 90% of the disease. Insulin resistance is a major pathophysiological factor in the development of type 2 diabetes, occurring mainly in muscle, adipose tissues, and liver leading to reduced glucose uptake and utilization and increased glucose production. The prevalence and rising incidence of diabetes emphasized the need to explore new molecular targets and strategies to develop novel antihyperglycemic agents. Protein Tyrosine Phosphatase 1B (PTP 1B) has recently emerged as a promising molecular level legitimate therapeutic target in the effective management of type 2 diabetes. PTP 1B, a cytosolic nonreceptor PTPase, has been implicated as a negative regulator of insulin signal transduction. Therefore, PTP 1B inhibitors would increase insulin sensitivity by blocking the PTP 1B-mediated negative insulin signaling pathway and might be an attractive target for type 2 diabetes mellitus and obesity. With X-ray crystallography and NMR-based fragment screening, the binding interactions of several classes of inhibitors have been elucidated, which could help the design of future PTP 1B inhibitors. The drug discovery research in PTP 1B is a challenging area to work with and many pharmaceutical organizations and academic research laboratories are focusing their research toward the development of potential PTP 1B inhibitors which would prove to be a milestone for the management of diabetes. PMID:20814956

  19. Software Management System

    NASA Technical Reports Server (NTRS)

    1994-01-01

    A software management system, originally developed for Goddard Space Flight Center (GSFC) by Century Computing, Inc. has evolved from a menu and command oriented system to a state-of-the art user interface development system supporting high resolution graphics workstations. Transportable Applications Environment (TAE) was initially distributed through COSMIC and backed by a TAE support office at GSFC. In 1993, Century Computing assumed the support and distribution functions and began marketing TAE Plus, the system's latest version. The software is easy to use and does not require programming experience.

  20. Content Management Systems

    ERIC Educational Resources Information Center

    Wisniewski, Jeff; Stenstrom, Cheryl

    2007-01-01

    In this article, the authors provide a guide in acquiring content management system. They conducted a vendor survey that covers four areas: (1) general information about the product (including standards supported); (2) administration of the product; (3) functionality; and (4) contact information for readers who want to know more. A list of product…

  1. Management Information Systems.

    ERIC Educational Resources Information Center

    Finlayson, Jean, Ed.

    1989-01-01

    This collection of papers addresses key questions facing college managers and others choosing, introducing, and living with big, complex computer-based systems. "What Use the User Requirement?" (Tony Coles) stresses the importance of an information strategy driven by corporate objectives, not technology. "Process of Selecting a Computerised MIS in…

  2. Advanced Distribution Management System

    NASA Astrophysics Data System (ADS)

    Avazov, Artur R.; Sobinova, Liubov A.

    2016-02-01

    This article describes the advisability of using advanced distribution management systems in the electricity distribution networks area and considers premises of implementing ADMS within the Smart Grid era. Also, it gives the big picture of ADMS and discusses the ADMS advantages and functionalities.

  3. Managing Complex Dynamical Systems

    ERIC Educational Resources Information Center

    Cox, John C.; Webster, Robert L.; Curry, Jeanie A.; Hammond, Kevin L.

    2011-01-01

    Management commonly engages in a variety of research designed to provide insight into the motivation and relationships of individuals, departments, organizations, etc. This paper demonstrates how the application of concepts associated with the analysis of complex systems applied to such data sets can yield enhanced insights for managerial action.

  4. Is it possible to predict improved diabetes outcomes following diabetes self-management education: a mixed-methods longitudinal design

    PubMed Central

    Huxley, Caroline; Sturt, Jackie; Dale, Jeremy; Walker, Rosie; Caramlau, Isabela; O'Hare, Joseph P; Griffiths, Frances

    2015-01-01

    Objective To predict the diabetes-related outcomes of people undertaking a type 2 Diabetes Self-Management Education (DSME) programme from their baseline data. Design A mixed-methods longitudinal experimental study. 6 practice nurses and 2 clinical academics undertook blind assessments of all baseline and process data to predict clinical, behavioural and psychological outcomes at 6 months post-DSME programme. Setting Primary care. Participants –31 people with type 2 diabetes who had not previously undertaken DSME. Intervention All participants undertook the Diabetes Manual 1:1 self-directed learning 12-week DSME programme supported by practice nurses trained as Diabetes Manual facilitators. Outcome variables Glycated haemoglobin (HbA1c), diabetes knowledge, physical activity, waist circumference, self-efficacy, diabetes distress, anxiety, depression, demographics, change talk and treatment satisfaction. These variables were chosen because they are known to influence self-management behaviour or to have been influenced by a DSME programme in empirical evidence. Results Baseline and 6-month follow-up data were available for 27 participants of which 13 (48%) were male, 22 (82%) white British, mean age 59 years and mean duration of type 2 diabetes 9.1 years. Significant reductions were found in HbA1c t(26)=2.35, p=0.03, and diabetes distress t(26)=2.30, p=0.03, and a significant increase in knowledge t(26)=−2.06, p=0.05 between baseline and 6 months. No significant changes were found in waist circumference, physical activity, anxiety, depression or self-efficacy. Accuracy of predictions varied little between clinical academics and practice nurses but greatly between outcome (0–100%). The median and mode accuracy of predicted outcome was 66.67%. Accuracy of prediction for the key outcome of HbA1c was 44.44%. Diabetes distress had the highest prediction accuracy (81.48%). Conclusions Clinicians in this small study were unable to identify individuals likely

  5. Analytical Services Management System

    SciTech Connect

    Church, Shane; Nigbor, Mike; Hillman, Daniel

    2005-03-30

    Analytical Services Management System (ASMS) provides sample management services. Sample management includes sample planning for analytical requests, sample tracking for shipping and receiving by the laboratory, receipt of the analytical data deliverable, processing the deliverable and payment of the laboratory conducting the analyses. ASMS is a web based application that provides the ability to manage these activities at multiple locations for different customers. ASMS provides for the assignment of single to multiple samples for standard chemical and radiochemical analyses. ASMS is a flexible system which allows the users to request analyses by line item code. Line item codes are selected based on the Basic Ordering Agreement (BOA) format for contracting with participating laboratories. ASMS also allows contracting with non-BOA laboratories using a similar line item code contracting format for their services. ASMS allows sample and analysis tracking from sample planning and collection in the field through sample shipment, laboratory sample receipt, laboratory analysis and submittal of the requested analyses, electronic data transfer, and payment of the laboratories for the completed analyses. The software when in operation contains business sensitive material that is used as a principal portion of the Kaiser Analytical Management Services business model. The software version provided is the most recent version, however the copy of the application does not contain business sensitive data from the associated Oracle tables such as contract information or price per line item code.

  6. Analytical Services Management System

    Energy Science and Technology Software Center (ESTSC)

    2005-03-30

    Analytical Services Management System (ASMS) provides sample management services. Sample management includes sample planning for analytical requests, sample tracking for shipping and receiving by the laboratory, receipt of the analytical data deliverable, processing the deliverable and payment of the laboratory conducting the analyses. ASMS is a web based application that provides the ability to manage these activities at multiple locations for different customers. ASMS provides for the assignment of single to multiple samples for standardmore » chemical and radiochemical analyses. ASMS is a flexible system which allows the users to request analyses by line item code. Line item codes are selected based on the Basic Ordering Agreement (BOA) format for contracting with participating laboratories. ASMS also allows contracting with non-BOA laboratories using a similar line item code contracting format for their services. ASMS allows sample and analysis tracking from sample planning and collection in the field through sample shipment, laboratory sample receipt, laboratory analysis and submittal of the requested analyses, electronic data transfer, and payment of the laboratories for the completed analyses. The software when in operation contains business sensitive material that is used as a principal portion of the Kaiser Analytical Management Services business model. The software version provided is the most recent version, however the copy of the application does not contain business sensitive data from the associated Oracle tables such as contract information or price per line item code.« less

  7. Use of Gaming in Self-Management of Diabetes in Teens.

    PubMed

    Swartwout, Ellen; El-Zein, Ashley; Deyo, Patricia; Sweenie, Rachel; Streisand, Randi

    2016-07-01

    With the growing prevalence of diabetes in teens and frequent concomitant problems with adherence, adolescents are a frequent target for diabetes self-management support and education. Due to widespread use of technology among teens in general, the use of serious games, games used for purposes beyond entertainment with the intention to educate and support health behavior for teens with diabetes self-management, is an emerging and promising practice. This report explores games intended for teens with diabetes, how the use of games may enhance clinical practice, and provides suggestions for future research and better utilization of these technologies. Current research on the use of gaming for promoting diabetes management in teens is fairly limited, with some initial support for improvements in both behavioral and clinical outcomes among teens. More research is clearly needed in order to further determine how gaming can best be utilized to impact health outcomes in these teens, as well as potential mechanisms of change. PMID:27155609

  8. Managing Conflict in Temporary Management Systems

    ERIC Educational Resources Information Center

    Wilemon, David L.

    1973-01-01

    As organizational tasks have grown more complex, several innovative temporary management systems such as matrix management have been developed. The Apollo space program has been an important contribution to the development of matrix management techniques. Discusses the role of conflict within the matrix, its determinants, and the process of…

  9. Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments

    PubMed Central

    Hasan, Muhammed Y.; Teo, Rachel; Nather, Aziz

    2015-01-01

    Negative-pressure wound therapy (NPWT) plays an important role in the treatment of complex wounds. Its effect on limb salvage in the management of the diabetic foot is well described in the literature. However, a successful outcome in this subgroup of diabetic patients requires a multidisciplinary approach with careful patient selection, appropriate surgical debridement, targeted antibiotic therapy, and optimization of healing markers. Evolving NPWT technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications. This review article summarizes current knowledge about the role of NPWT in the management of the diabetic foot and its mode of action, clinical applications, and recent developments. PMID:26140663

  10. Medicare reimbursement and diabetes self-management training: national survey results.

    PubMed

    Pearson, Jan; Mensing, Carolé; Anderson, Robyn

    2004-01-01

    The AADE and ADA are committed to using these survey results to address the issues identified concerning Medicare reimbursement of diabetes self-management training programs. As a result, the following Web-based conferences have been conducted: Reimbursement Update 2003 (ADA) and Achieving and Maintaining Education Program Recognition (ADA). There were many registrants for these conferences, and their positive evaluations indicated that online continuing education programs were well received. Multiple education opportunities continue to be provided at local and national meetings. For example, programs were presented at the ADA Southern Regional Conference in May and the AADE Annual Meeting in August 2004. In addition, the AADE Annual Meeting offered workshops on reimbursement issues, including one conducted by a director from the CMS. An excellent desktop reference for questions regarding reimbursement is the manual, The Guide to Reimbursement. Organizations need to maintain strong volunteer and organization commitment to assure that DSMT is not only valued but also compensated for services rendered. The AADE and ADA volunteers continue to join together to advocate for adequate reimbursement for DSMT. To accomplish this goal, all affected organizations need to continue to partner and seek funding to promote legislative activities and education of health professionals regarding reimbursement and billing processes. Today diabetes education is revered as integral to diabetes care and management. The results gained from this national survey are a platform for enhancing the fiscal viability of the programs that provide this service. The survey data suggest that professionals need ongoing education on the fiscal considerations regarding DSMT programs, including the need for accurate documentation, awareness of current reimbursement status, processes for monitoring billing and appealing claims, establishing working relationships with billing services, implementing the use

  11. Sensor Monitoring of Physical Activity to Improve Glucose Management in Diabetic Patients: A Review

    PubMed Central

    Ding, Sandrine; Schumacher, Michael

    2016-01-01

    Diabetic individuals need to tightly control their blood glucose concentration. Several methods have been developed for this purpose, such as the finger-prick or continuous glucose monitoring systems (CGMs). However, these methods present the disadvantage of being invasive. Moreover, CGMs have limited accuracy, notably to detect hypoglycemia. It is also known that physical exercise, and even daily activity, disrupt glucose dynamics and can generate problems with blood glucose regulation during and after exercise. In order to deal with these challenges, devices for monitoring patients’ physical activity are currently under development. This review focuses on non-invasive sensors using physiological parameters related to physical exercise that were used to improve glucose monitoring in type 1 diabetes (T1DM) patients. These devices are promising for diabetes management. Indeed they permit to estimate glucose concentration either based solely on physical activity parameters or in conjunction with CGM or non-invasive CGM (NI-CGM) systems. In these last cases, the vital signals are used to modulate glucose estimations provided by the CGM and NI-CGM devices. Finally, this review indicates possible limitations of these new biosensors and outlines directions for future technologic developments. PMID:27120602

  12. Nurse-patient communication in primary care diabetes management: an exploratory study

    PubMed Central

    2013-01-01

    Background Diabetes is a major health issue for individuals and for health services. There is a considerable literature on the management of diabetes and also on communication in primary care consultations. However, few studies combine these two topics and specifically in relation to nurse communication. This paper describes the nature of nurse-patient communication in diabetes management. Methods Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as part of a larger multi-site study tracking health care interactions between health professionals and patients who were newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the 6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography and interaction analysis. In addition to analysis of the recorded consultations and interviews, the number of consultations for each patient and total time spent with nurses and other health professionals were quantified and compared. Results This study showed that initial consultations with nurses often incorporated completion of extensive checklists, physical examination, referral to other health professionals and distribution of written material, and were typically longer than consultations with other health professionals. The consultations were driven more by the nurses’ clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed that protocols and checklists both help and hinder the communication process. This contradictory outcome was also evident at a health systems level: although organisational targets may have been met, the patient did not always feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed arising from the sheer volume of information exchanged along with a mismatch in expectations. Conclusions Conscientious nursing work was

  13. Clinical evaluation of the DIABETES expert system for decision support by multiple regimen insulin dose adjustment.

    PubMed

    Ambrosiadou, B V; Goulis, D G; Pappas, C

    1996-01-01

    A performance evaluation of the DIABETES rule-based expert system prototype for clinical decision making is presented. The system facilitates multiple insulin regimen and dose adjustment of insulin dependent Type I or II diabetic patients. The study was performed on 600 subjects from two diabetological centres and three diabetological offices of Greek hospitals. The responses of the attendant medical doctors were compared with those of the DIABETES system, with the aid of a specifically devised valuation range (0-5 degrees, 0 indicating full agreement and 5 full disagreement). The capabilities and the weakness of the system in terms of its practicality for decision support in assisting therapy of diabetes mellitus by blood glucose monitoring and subsequent insulin dose adjustment are discussed. The potential benefits of decision support systems for diabetic patient management are seen to be the cost saving they provide in terms of man-hours of verbal instruction by medical experts, the support in terms of objective and consistent decision making, as well as the recording of medical knowledge in the ill-defined field of insulin administration, thus aiding the education and training of medical personnel. PMID:8646833

  14. Teneligliptin in management of type 2 diabetes mellitus

    PubMed Central

    Sharma, Surendra Kumar; Panneerselvam, A; Singh, KP; Parmar, Girish; Gadge, Pradeep; Swami, Onkar C

    2016-01-01

    Teneligliptin is a recently developed oral dipeptidyl peptidase 4 inhibitor indicated for the management of type 2 diabetes mellitus (T2DM) in adults along with diet and exercise. Teneligliptin has been recently available in Japan (Teneria®), Argentina (Teneglucon®), and India (Tenepure; Teneza) at relatively affordable price. This is a positive step toward the management of T2DM in developing countries, where the cost of medicine is out-of-pocket expenditure and is a limiting factor for health care. This review evaluates the efficacy and safety of teneligliptin in the management of T2DM. Teneligliptin has been systematically evaluated in T2DM as monotherapy with diet and exercise and in combination with metformin, glimepiride, pioglitazone, and insulin in short-term (12 weeks) and long-term (52 weeks) studies. These studies have reported a reduction in HbA1c of 0.8%–0.9% within 12 weeks of therapy. Two 52-week studies reported sustained improvement in glycemic control with teneligliptin. Teneligliptin has been found to be well tolerated, and the safety profile is similar to other dipeptidyl peptidase 4 inhibitors. Hypoglycemia and constipation are the main adverse events. Teneligliptin can be administered safely to patients with mild, moderate, or severe renal impairment or end-stage renal disease without dose adjustment. Similarly, it can be used in patients with mild-to-moderate hepatic impairment. Teneligliptin is effective and well tolerated and may have an important role in the management of T2DM. PMID:27574456

  15. Teneligliptin in management of type 2 diabetes mellitus.

    PubMed

    Sharma, Surendra Kumar; Panneerselvam, A; Singh, K P; Parmar, Girish; Gadge, Pradeep; Swami, Onkar C

    2016-01-01

    Teneligliptin is a recently developed oral dipeptidyl peptidase 4 inhibitor indicated for the management of type 2 diabetes mellitus (T2DM) in adults along with diet and exercise. Teneligliptin has been recently available in Japan (Teneria(®)), Argentina (Teneglucon(®)), and India (Tenepure; Teneza) at relatively affordable price. This is a positive step toward the management of T2DM in developing countries, where the cost of medicine is out-of-pocket expenditure and is a limiting factor for health care. This review evaluates the efficacy and safety of teneligliptin in the management of T2DM. Teneligliptin has been systematically evaluated in T2DM as monotherapy with diet and exercise and in combination with metformin, glimepiride, pioglitazone, and insulin in short-term (12 weeks) and long-term (52 weeks) studies. These studies have reported a reduction in HbA1c of 0.8%-0.9% within 12 weeks of therapy. Two 52-week studies reported sustained improvement in glycemic control with teneligliptin. Teneligliptin has been found to be well tolerated, and the safety profile is similar to other dipeptidyl peptidase 4 inhibitors. Hypoglycemia and constipation are the main adverse events. Teneligliptin can be administered safely to patients with mild, moderate, or severe renal impairment or end-stage renal disease without dose adjustment. Similarly, it can be used in patients with mild-to-moderate hepatic impairment. Teneligliptin is effective and well tolerated and may have an important role in the management of T2DM. PMID:27574456

  16. Air System Information Management

    NASA Technical Reports Server (NTRS)

    Filman, Robert E.

    2004-01-01

    I flew to Washington last week, a trip rich in distributed information management. Buying tickets, at the gate, in flight, landing and at the baggage claim, myriad messages about my reservation, the weather, our flight plans, gates, bags and so forth flew among a variety of travel agency, airline and Federal Aviation Administration (FAA) computers and personnel. By and large, each kind of information ran on a particular application, often specialized to own data formats and communications network. I went to Washington to attend an FAA meeting on System-Wide Information Management (SWIM) for the National Airspace System (NAS) (http://www.nasarchitecture.faa.gov/Tutorials/NAS101.cfm). NAS (and its information infrastructure, SWIM) is an attempt to bring greater regularity, efficiency and uniformity to the collection of stovepipe applications now used to manage air traffic. Current systems hold information about flight plans, flight trajectories, weather, air turbulence, current and forecast weather, radar summaries, hazardous condition warnings, airport and airspace capacity constraints, temporary flight restrictions, and so forth. Information moving among these stovepipe systems is usually mediated by people (for example, air traffic controllers) or single-purpose applications. People, whose intelligence is critical for difficult tasks and unusual circumstances, are not as efficient as computers for tasks that can be automated. Better information sharing can lead to higher system capacity, more efficient utilization and safer operations. Better information sharing through greater automation is possible though not necessarily easy.

  17. Smart energy management system

    NASA Astrophysics Data System (ADS)

    Desai, Aniruddha; Singh, Jugdutt

    2010-04-01

    Peak and average energy usage in domestic and industrial environments is growing rapidly and absence of detailed energy consumption metrics is making systematic reduction of energy usage very difficult. Smart energy management system aims at providing a cost-effective solution for managing soaring energy consumption and its impact on green house gas emissions and climate change. The solution is based on seamless integration of existing wired and wireless communication technologies combined with smart context-aware software which offers a complete solution for automation of energy measurement and device control. The persuasive software presents users with easy-to-assimilate visual cues identifying problem areas and time periods and encourages a behavioural change to conserve energy. The system allows analysis of real-time/statistical consumption data with the ability to drill down into detailed analysis of power consumption, CO2 emissions and cost. The system generates intelligent projections and suggests potential methods (e.g. reducing standby, tuning heating/cooling temperature, etc.) of reducing energy consumption. The user interface is accessible using web enabled devices such as PDAs, PCs, etc. or using SMS, email, and instant messaging. Successful real-world trial of the system has demonstrated the potential to save 20 to 30% energy consumption on an average. Low cost of deployment and the ability to easily manage consumption from various web enabled devices offers gives this system a high penetration and impact capability offering a sustainable solution to act on climate change today.

  18. Using Behavioral Interventions to Assist Children with Type 1 Diabetes Manage Blood Glucose Levels

    ERIC Educational Resources Information Center

    Lasecki, Kim; Olympia, Daniel; Clark, Elaine; Jenson, William; Heathfield, Lora Tuesday

    2008-01-01

    Treatment and management of chronic disease processes on children occurs across multiple settings, placing demands for consultation and expertise on school personnel, including school psychologists. One such chronic condition in children is type I diabetes. Children with type I insulin dependent diabetes mellitus exhibit high rates of…

  19. Multidisciplinary Teaming To Promote Effective Management of Type 1 Diabetes for Adolescents.

    ERIC Educational Resources Information Center

    Strawhacker, MaryAnn Tapper

    2001-01-01

    By facilitating active participation in treatment, coordinating services, and maximizing community resources, schools can help adolescents build a strong foundation for lifelong diabetes management. This paper presents an overview of intensive diabetes therapy, psychosocial implications of chronic illness in adolescence, the effects of chronic…

  20. Diabetes Self-Management Education Enhanced by the Low Vision Professional

    ERIC Educational Resources Information Center

    Sokol-McKay, Debra A.

    2007-01-01

    Diabetes currently affects 20.8 million people in the United States and is the leading cause of blindness in people between the ages of 20 and 74 years. The author uses a fictional but typical example to explain the ways in which low vision specialists can improve the diabetes self-management program of a person with low vision and demonstrates…

  1. Self-Care Management among Patients with Type 2 Diabetes in East Jerusalem

    ERIC Educational Resources Information Center

    Daoud, Nihaya; Osman, Amira; Hart, Trevor A.; Berry, Elliott M.; Adler, Bella

    2015-01-01

    Objective: Little research exists on diabetes self-care management (DSCM) in Arab populations. We examined the contribution of health belief constructs, socioeconomic position (SEP) and clinical factors (glycated haemoglobin [HbA1C] level, type of diabetes treatments, and receiving professional guidance) to DSCM among Arab patients in East…

  2. Evaluation of Online Education about Diabetes Management in the School Setting

    ERIC Educational Resources Information Center

    Bachman, Jean A.; Hsueh, Kuei-Hsiang

    2008-01-01

    There are a variety of initiatives to provide education to improve the quality of care for children with diabetes in the school setting. This study piloted and evaluated an online continuing education program for school nurses about diabetes management for children in schools using current practice principles. The evaluation determined if…

  3. Field of Dreams Program Evaluation: Empowering the Latino Population in Type2 Diabetes Self-Management

    ERIC Educational Resources Information Center

    Urteaga, Edie

    2011-01-01

    Adult onset, type2 diabetes affects Latino families at a higher rate than other ethnicities and negatively impacting their quality of life, ability to financially succeed, and ultimately impacting our overall economy. Multiple resources are available in the country to help people learn how to prevent, control, and manage diabetes. However, the…

  4. Improving outpatient diabetes management through a collaboration of six competing, capitated Medicare managed care plans.

    PubMed

    Marshall, C L; Bluestein, M; Briere, E; Chapin, C; Darling, B; Davis, K; Davis, T; Gersten, J; Harris, C; Hodgin, A; Larsen, W; Mabb, D; Rigberg, H; Watson, D; Krishnaswami, V

    2000-01-01

    This report addresses diabetes care in the managed care setting and improvement in care brought about by collaboration between 6 Medicare managed care plans (MCPs) and a Peer Review Organization (PRO). The objective was to improve the quality of care of outpatient diabetes patients provided by primary care physicians through the mutual collaboration of 6 Medicare managed care plans and a Medicare Peer Review Organization. The design involved pre-post intervention trial based on 2 random samples, a baseline sample drawn in 1995 and a remeasurement sample drawn in 1996. Medical records of patients in both samples were reviewed by the PRO to determine provision of 14 quality indicator services over a 1-year period. The setting was 6 Arizona Medicare managed care plans comprising approximately 40% of the Arizona Medicare population. Two random samples were drawn from type 2 diabetes patients continuously enrolled in the same managed care plan for at least 1 year. The intervention was comparative feedback of baseline data by the PRO, enabling each plan to compare itself to any other plan on any or all indicators. Each plan developed and implemented its own intervention in response to the 1995 baseline results. The main outcome measures were mean HbA1c, the proportion of HbA1c values below 8%, and positive change in provision of 14 quality indicator services. At postintervention remeasurement, mean HbA1c values fell from 8.9 +/- 2.2 to 7.9% +/- 2.1, and the proportion of patients with HbA1c values below 8.0% rose from 40% to 61.6%. The proportion of the 14 indicator services provided to patients rose from 35% to 55%. The mean number of physician office visits fell 13% and the number of services provided per visit doubled. We conclude that improving the process of care improves glycemic control. Better outpatient diabetes management in competing, capitated managed care plans is an attainable goal when mediated through a neutral third party such as a PRO. PMID:10763220

  5. Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin?

    PubMed Central

    Abdelsalam, Walid A.; Mowafy, Hala E.; Abd ElHameid, Azza A.

    2016-01-01

    Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies. Blood glucose control improves perinatal outcomes. Medical nutrition therapy is the foundation in management. Aim of This Study. To evaluate efficacy of metformin in comparison to insulin for managing GDM. Methods. In prospective randomized comparative study, 150 antenatal women whose pregnancies had been complicated by GDM and did not respond to diet alone were recruited from antenatal clinics at Obstetrics Department in Zagazig University Hospitals from November 2012 to December 2014. They were divided randomly into two groups, 75 patients in each, and were subjected to either insulin or metformin medication. Outcomes were comparing the effects of both medications on maternal glycemic control, antenatal complications, and neonatal outcome. Results. No significant difference in controlling high blood sugar in GDM with the use of metformin or insulin (P = 0.95, 0.15). Maternal complications in both groups had no significant difference and fetal outcomes were as well similar except the fact that the hypoglycemia occurred more in insulin group with P value 0.01. Conclusion. Glycaemic control in GDM can be achieved by using metformin orally without increasing risk of maternal hypoglycemia with satisfying neonatal outcome. PMID:27597988

  6. An analysis of data management tools for diabetes self-management: can smart phone technology keep up?

    PubMed

    Ciemins, Elizabeth; Coon, Patricia; Sorli, Christopher

    2010-07-01

    In this issue of Journal of Diabetes Science and Technology, Rao and colleagues present a comparison of three iPhone diabetes data management applications: the Diamedic Diabetes Logbook, Blood Sugar Diabetes Control, and WaveSense Diabetes Manager. These applications provide patients the ability to enter blood glucose readings manually, view graphs and simple statistics, and email data to health care providers. While these applications show promise, they are limited in their current forms. All require manual data entry and none convert insulin-to-carbohydrate ratios to insulin dose. Future development of these types of technology should consider integration with blood glucose meters and expanded calculation capabilities, as well as monitoring of other risk factors, e.g., blood pressure and lipids, and tracking of preventive examinations, e.g., eye, foot, and renal. PMID:20663462

  7. An Analysis of Data Management Tools for Diabetes Self-Management: Can Smart Phone Technology Keep Up?

    PubMed Central

    Ciemins, Elizabeth; Coon, Patricia; Sorli, Christopher

    2010-01-01

    In this issue of Journal of Diabetes Science and Technology, Rao and colleagues present a comparison of three iPhone diabetes data management applications: the Diamedic Diabetes Logbook, Blood Sugar Diabetes Control, and WaveSense Diabetes Manager. These applications provide patients the ability to enter blood glucose readings manually, view graphs and simple statistics, and email data to health care providers. While these applications show promise, they are limited in their current forms. All require manual data entry and none convert insulin-to-carbohydrate ratios to insulin dose. Future development of these types of technology should consider integration with blood glucose meters and expanded calculation capabilities, as well as monitoring of other risk factors, e.g., blood pressure and lipids, and tracking of preventive examinations, e.g., eye, foot, and renal. PMID:20663462

  8. Power management system

    DOEpatents

    Algrain, Marcelo C.; Johnson, Kris W.; Akasam, Sivaprasad; Hoff, Brian D.

    2007-10-02

    A method of managing power resources for an electrical system of a vehicle may include identifying enabled power sources from among a plurality of power sources in electrical communication with the electrical system and calculating a threshold power value for the enabled power sources. A total power load placed on the electrical system by one or more power consumers may be measured. If the total power load exceeds the threshold power value, then a determination may be made as to whether one or more additional power sources is available from among the plurality of power sources. At least one of the one or more additional power sources may be enabled, if available.

  9. Alternative therapies useful in the management of diabetes: A systematic review

    PubMed Central

    Pandey, Awanish; Tripathi, Poonam; Pandey, Rishabh; Srivatava, Rashmi; Goswami, Shambaditya

    2011-01-01

    Diabetes mellitus is a metabolic disorder in the endocrine system. This dreadful disease is found in all parts of the world and becoming a serious threat of mankind health. There are lots of chemical agents available to control and to treat diabetic patients, but total recovery from diabetes has not been reported up to this date. In addition to adverse effects, drug treatments are not always satisfactory in maintaining euglycemia and avoiding late stage diabetic complications. Alternative to these synthetic agents, plants provided a potential source of hypoglycemic drugs and are widely used in several traditional systems of medicine to prevent diabetes. Several medicinal plants have been investigated for their beneficial effect in different type of diabetes. Other alternative therapies such as dietary supplements, acupuncture, hydrotherapy, and yoga therapies less likely to have the side effects of conventional approaches for diabetes. PMID:22219583

  10. Factors Influencing Self-Management in Chinese Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis

    PubMed Central

    Luo, Xiaoping; Liu, Tingting; Yuan, Xiaojing; Ge, Song; Yang, Jing; Li, Changwei; Sun, Wenjie

    2015-01-01

    Diabetes is a major public health problem in China. Diabetes self-management is critical for patients to achieved better health outcomes, however, previous studies have shown suboptimal diabetes self-management performance. We conducted a systematic review and meta-analysis to identify factors associated with diabetes self-management in Chinese adults. The results showed that confrontation, resignation, overall health beliefs, perceived susceptibility, perceived barriers, and self-efficacy were factors associated with overall diabetes self-management performance and six aspects of diabetes self-management behaviors. There is some limited evidence to suggest that provider-patient communication, married individuals, higher educational level, and higher household income level may also be linked to better diabetes self-management practice. Having healthcare insurance and utilizing chronic illness resources generally appeared to have a favorable effect on diabetes self-management performance. In addition, there were a number of factors for which the evidence is too limited to be able to ascertain its strength of association with diabetes self-management practice. The findings of this review suggest that diabetes self-management behaviors are affected by a wide range of personal and environmental factors, which allow health care providers to develop theory-based strategies to improve diabetes-self-management behaviors in this population. PMID:26378555

  11. Factors Influencing Self-Management in Chinese Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis.

    PubMed

    Luo, Xiaoping; Liu, Tingting; Yuan, Xiaojing; Ge, Song; Yang, Jing; Li, Changwei; Sun, Wenjie

    2015-09-01

    Diabetes is a major public health problem in China. Diabetes self-management is critical for patients to achieved better health outcomes, however, previous studies have shown suboptimal diabetes self-management performance. We conducted a systematic review and meta-analysis to identify factors associated with diabetes self-management in Chinese adults. The results showed that confrontation, resignation, overall health beliefs, perceived susceptibility, perceived barriers, and self-efficacy were factors associated with overall diabetes self-management performance and six aspects of diabetes self-management behaviors. There is some limited evidence to suggest that provider-patient communication, married individuals, higher educational level, and higher household income level may also be linked to better diabetes self-management practice. Having healthcare insurance and utilizing chronic illness resources generally appeared to have a favorable effect on diabetes self-management performance. In addition, there were a number of factors for which the evidence is too limited to be able to ascertain its strength of association with diabetes self-management practice. The findings of this review suggest that diabetes self-management behaviors are affected by a wide range of personal and environmental factors, which allow health care providers to develop theory-based strategies to improve diabetes-self-management behaviors in this population. PMID:26378555

  12. Mastering the management system.

    PubMed

    Kaplan, Robert S; Norton, David P

    2008-01-01

    Companies have always found it hard to balance pressing operational concerns with long-term strategic priorities. The tension is critical: World-class processes won't lead to success without the right strategic direction, and the best strategy in the world will get nowhere without strong operations to execute it. In this article, Kaplan, of Harvard Business School, and Norton, founder and director of the Palladium Group, explain how to effectively manage both strategy and operations by linking them tightly in a closed-loop management system. The system comprises five stages, beginning with strategy development, which springs from a company's mission, vision, and value statements, and from an analysis of its strengths, weaknesses, and competitive environment. In the next stage, managers translate the strategy into objectives and initiatives with strategy maps, which organize objectives by themes, and balanced scorecards, which link objectives to performance metrics. Stage three involves creating an operational plan to accomplish the objectives and initiatives; it includes targeting process improvements and preparing sales, resource, and capacity plans and dynamic budgets. Managers then put plans into action, monitoring their effectiveness in stage four. They review operational, environmental, and competitive data; assess progress; and identify barriers to execution. In the final stage, they test the strategy, analyzing cost, profitability, and correlations between strategy and performance. If their underlying assumptions appear faulty, they update the strategy, beginning another loop. The authors present not only a comprehensive blueprint for successful strategy execution but also a managerial tool kit, illustrated with examples from HSBC Rail, Cigna Property and Casualty, and Store 24. The kit incorporates leading management experts' frameworks, outlining where they fit into the management cycle. PMID:18271319

  13. Automatic messaging for improving patients engagement in diabetes management: an exploratory study.

    PubMed

    Fioravanti, Alessio; Fico, Giuseppe; Salvi, Dario; García-Betances, Rebeca I; Arredondo, Maria Teresa

    2015-12-01

    Mobile health systems aiming to promote adherence may cost-effectively improve the self-management of chronic diseases like diabetes, enhancing the compliance to the medical prescription, encouraging and stimulating patients to adopt healthy life styles and promoting empowerment. This paper presents a strategy for m-health applications in diabetes self-management that is based on automatic generation of feedback messages. A feedback assistant, representing the core of architecture, delivers dynamic and automatically updated text messages set up on clinical guideline and patient's lifestyle. Based on this strategy, an m-health adherence system was designed, developed and tested in a small-scale exploratory study with T1DM and T2DM patients. The results indicate that the system could be feasible and well accepted and that its usage increased along with adherence to prescriptions during the 4 weeks of the study. A more extensive research is pending to corroborate these outcomes and to establish a clear benefit of the proposed solution. PMID:25564181

  14. A hybrid knowledge based system for therapy adjustment in gestational diabetes.

    PubMed

    Hernando, M E; Gómez, E J; Corcoy, R; del Pozo, F; Arredondo, M T

    1994-01-01

    This poster describes a system to analyze self-monitoring data of gestational diabetic patients, for obtaining an assessment of their metabolic control with the final goal of supporting decision-making in therapy adjustment. The system is able to manage incomplete data and to make temporal reasoning under uncertainty, the two most important constraints when analyzing ambulatory monitoring data. Two different formalism have been used to represent and manage the knowledge: a dynamic Bayesian network and a production system based on rules. The outcomes provided by the whole system are: information on possible patient transgressions of the prescribed treatment and recommendations of treatment adjustments. PMID:7950077

  15. ''Buddy system'' of peer mentors may help control diabetes.

    PubMed

    Long, Judith A

    2012-03-01

    Type 2 diabetes is more prevalent and severe among African Americans. Even within the Veterans Health Administration, which is thought to have minimized barriers in access to care, racial disparities in glucose control and outcomes persist. This Issue Brief summarizes work testing two novel interventions--one-on-one peer mentoring (a "buddy system") and financial incentives--designed to help patients with consistently poor diabetes control achieve better results. In this case, a telephone buddy makes a big difference. PMID:22451999

  16. Data Management System

    NASA Technical Reports Server (NTRS)

    1997-01-01

    CENTRA 2000 Inc., a wholly owned subsidiary of Auto-trol technology, obtained permission to use software originally developed at Johnson Space Center for the Space Shuttle and early Space Station projects. To support their enormous information-handling needs, a product data management, electronic document management and work-flow system was designed. Initially, just 33 database tables comprised the original software, which was later expanded to about 100 tables. This system, now called CENTRA 2000, is designed for quick implementation and supports the engineering process from preliminary design through release-to-production. CENTRA 2000 can also handle audit histories and provides a means to ensure new information is distributed. The product has 30 production sites worldwide.

  17. A guideline management system.

    PubMed

    Ciccarese, Paolo; Caffi, Ezio; Boiocchi, Lorenzo; Quaglini, Silvana; Stefanelli, Mario

    2004-01-01

    This paper describes the architecture of NewGuide, a guide-line management system for handling the whole life cycle of a computerized clinical practice guideline. NewGuide components are organized in a distributed architecture: an editor to formalize guidelines, a repository to store them, an inference engine to implement guidelines instances in a multi-user environment, and a reporting system storing the guidelines logs in order to be able to completely trace any individual physician guideline-based decision process. There is a system "central level" that maintains official versions of the guidelines, and local Healthcare Organizations may download and implement them according to their needs. The architecture has been implemented using the Java 2 Enterprise Edition (J2EE) platform. Simple Object Access Protocol (SOAP) and a set of con-tracts are the key factors for the integration of NewGuide with healthcare legacy systems. They allow maintaining unchanged legacy user interfaces and connecting the system with what-ever electronic patient record. The system functionality will be illustrated in three different contexts: homecare-based pressure ulcer prevention, acute ischemic stroke treatment and heart failure management by general practitioners. PMID:15360768

  18. Training Management Information System

    SciTech Connect

    Rackley, M.P.

    1989-01-01

    The Training Management Information System (TMIS) is an integrated information system for all training related activities. TMIS is at the leading edge of training information systems used in the nuclear industry. The database contains all the necessary records to confirm the department's adherence to accreditation criteria and houses all test questions, student records and information needed to evaluate the training process. The key to the TMIS system is that the impact of any change (i.e., procedure change, new equipment, safety incident in the commercial nuclear industry, etc.) can be tracked throughout the training process. This ensures the best training can be performed that meets the needs of the employees. TMIS is comprised of six functional areas: Job and Task Analysis, Training Materials Design and Development, Exam Management, Student Records/Scheduling, Evaluation, and Commitment Tracking. The system consists of a VAX 6320 Cluster with IBM and MacIntosh computers tied into an ethernet with the VAX. Other peripherals are also tied into the system: Exam Generation Stations to include mark sense readers for test grading, Production PC's for Desk-Top Publishing of Training Material, and PC Image Workstations. 5 figs.

  19. The role of patient education in the prevention and management of type 2 diabetes: an overview.

    PubMed

    Coppola, Adriana; Sasso, Loredana; Bagnasco, Annamaria; Giustina, Andrea; Gazzaruso, Carmine

    2016-07-01

    The management of type 2 diabetes mellitus includes ability and empowerment of the patient to change lifestyle, maintain an adequate diet and physical activity, manage the disease, and follow a specific program of periodic medical checks and education sessions. In addition, the patient should be able to correctly identify and adequately solve problems related to the disease and actively collaborate with the healthcare system. To obtain these goals, therapeutic patient education (TPE) is now considered a crucial element not only in the treatment but also in the prevention of type 2 diabetes. Several trials showed that TPE is able to improve clinical, lifestyle, and psycho-social outcomes. Nevertheless, studies have not clarified the ideal characteristics of a comprehensive patient education program in clinical practice. Other work is needed to answer open questions regarding the type of PTE (individual or group education), themes, frequency and number of education sessions, contact time between educator and patient, background of educators, use of new technologies, and barriers to self-management. The present review discusses these points on the basis of the most recent data of the literature. PMID:26494579

  20. Managing type 1 diabetes in school: Recommendations for policy and practice

    PubMed Central

    Lawrence, Sarah E; Cummings, Elizabeth A; Pacaud, Danièle; Lynk, Andrew; Metzger, Daniel L

    2015-01-01

    Diabetes requiring insulin is increasingly common and likely to impact students in most, if not all, schools. Diabetes and its complications have major personal, social and economic impact, and improved diabetes control reduces the risk of both short- and long-term complications. Evidence shows that more intensive management of diabetes – through frequent blood glucose monitoring, insulin administration with injections and/or insulin pumps, and careful attention to diet and exercise – leads to better control. Since children spend 30 to 35 hours per week at school, effectively managing their diabetes while there is integral to their short- and long-term health. The Canadian Paediatric Society and the Canadian Pediatric Endocrine Group recommend that minimum standards for supervision and care be established across Canada to support children and youth with type 1 diabetes in schools. These recommendations are derived from evidence-based clinical practice guidelines, with input from diabetes care providers from across Canada, and are consistent with the Canadian Diabetes Association’s Guidelines for the Care of Students Living with Diabetes at School. PMID:25722642

  1. The introduction of self-management in Type 2 Diabetes care: A narrative review

    PubMed Central

    Baghbanian, Abdolvahab; Tol, Azar

    2012-01-01

    Type 2 diabetes is one of the most life-threatening public health challenges in the world. It causes a high disease burden including increased disability, reduced life expectancy and ever-increasing costs of care in almost every country. The growing burden of diabetes along with rapid cultural changes, aging population, increasing urbanization, changes in nutritional habits, reduced physical activity, and improper lifestyle and behavior patterns would inexorably drive increased health care costs and demands. Several models of education have been proposed to reduce the complications of chronic diseases including diabetes. However, it is widely known and acknowledged that adopting self-care and self-management behaviors play a fundamental role in diabetes control and treatment. A non-systematic (narrative) search strategy was used to collect necessary data. Several models of diabetes care such as compliance-based or curative models exist. Neither the curative model nor the compliance/adherence model is rigorously effective in diabetes care. The model of self-empowerment – based on the three fundamental aspects of chronic illness care: choices, control, and consequences – is much more applicable in the management of diabetes. This point to an approach which recognizes that patients are responsible for their diabetes care. Self-empowerment model has the potential to place diabetes care into context – a context which is based on active involvement of patients and informed, proactive healthcare professionals in the process of care. PMID:23555138

  2. Use of technology to track program outcomes in a diabetes self-management program.

    PubMed

    Chima, Cinda S; Farmer-Dziak, Nancy; Cardwell, Pat; Snow, Sara

    2005-12-01

    The Diabetes Self-Management Education Program at MetroHealth Medical Center in Cleveland, OH, uses widely available technology to facilitate outcomes tracking and market the diabetes program. Baseline assessment data are entered directly into an Access database form (Microsoft, Inc, Seattle, WA). Quarterly, updated weight and lab data are downloaded into the database from the Epicare electronic medical record (Epic Systems Corp, Madison, WI). This system has enabled staff to track outcomes of program participants on an ongoing basis. To date, 438 patients have been entered into the program database, though complete clinical data are not available for all patients. Mean (+/-standard deviation) baseline body mass index of program participants was 35.8+/-9.1 (range 18.0 to 70.0, n=261). Mean (+/-standard deviation) baseline hemoglobin A1c (HbA1c) for all patients was 9.5%+/-2.5%, range 4.5% to 18.3% (n=332). Median baseline HbA1c was 9.1%, and the median last available postprogram HbA1c was 7.5% (P<.001, n=216; patients ranged from 90 days to more than 3 years postprogram entry). Weight change was not significant. In patients 1-year postprogram (n=72), mean baseline HbA1c was 9.9%+/-2.9% and the mean 1-year HbA1c value was 7.4%+/-1.7%, P<.001. At 1 year, 75% of patients had HbA1c < or = 8%. In response to these outcomes, an alert was implemented in the outpatient charting system triggered by an HbA1c > 8.5% and recommending referral to the Diabetes Self-Management Education Program. Since implementation of the prompt, referrals to the program have increased 40%. PMID:16321600

  3. Chemical Management System

    Energy Science and Technology Software Center (ESTSC)

    1998-10-30

    CMS provides an inventory of all chemicals on order or being held in the laboratory, to provide a specific location for all chemical containers, to ensure that health and safety regulatory codes are being upheld, and to provide PNNL staff with hazardous chemical information to better manage their inventories. CMS is comprised of five major modules: 1) chemical purchasing, 2) chemical inventory, 3) chemical names, properties, and hazard groups, 4) reporting, and 5) system administration.

  4. Management systems research study

    NASA Technical Reports Server (NTRS)

    Bruno, A. V.

    1975-01-01

    The development of a Monte Carlo simulation of procurement activities at the NASA Ames Research Center is described. Data cover: simulation of the procurement cycle, construction of a performance evaluation model, examination of employee development, procedures and review of evaluation criteria for divisional and individual performance evaluation. Determination of the influences and apparent impact of contract type and structure and development of a management control system for planning and controlling manpower requirements.

  5. Diabetes

    MedlinePlus

    ... glucose or pre-diabetes. These levels are risk factors for type 2 diabetes. Hemoglobin A1c (A1C) test: Normal is less than 5.7%; prediabetes is 5.7 to 6.4%; and diabetes is 6.5% or higher. Oral ...

  6. Long-Term Engagement with Health-Management Technology: a Dynamic Process in Diabetes

    PubMed Central

    Klasnja, Predrag; Kendall, Logan; Pratt, Wanda; Blondon, Katherine

    2015-01-01

    Diabetes management is a complex, dynamic process that is largely incumbent on patient choices and behavior. We explore how health-management needs—and the needs for technological support—change over time for individuals with diabetes. Through interviews and a focus group, we found that after initial diagnosis, individuals face acute information needs and chiefly turn to mobile applications and Internet resources to help understand the diabetes-specific factors that affect their health. Over time their focus shifts from highly regimented routines to more flexible ones that enable them to maintain a quality of life. Our results suggest that long-term engagement with health technology does not necessarily require continuous, sustained use: routine disease management could lead to a decrease in use, until a new event occurs. Our findings point to a need for tools that help patients with diabetes to effectively manage their health as their bodies, treatment and circumstances change over time. PMID:26958211

  7. Interventions to Promote Diabetes Self-Management in Children and Youth: A Scoping Review.

    PubMed

    Cahill, Susan M; Polo, Katie M; Egan, Brad E; Marasti, Nadia

    2016-01-01

    As children and youth with diabetes grow up, they become increasingly responsible for controlling and monitoring their condition. We conducted a scoping review to explore the research literature on self-management interventions for children and youth with diabetes. Eleven studies met the inclusion criteria. Some of the studies reviewed combined the participant population so that children with Type 1 as well as children with Type 2 diabetes were included. The majority of the studies focused on children age 14 yr or older and provided self-management education, self-management support, or both. Parent involvement was a key component of the majority of the interventions, and the use of technology was evident in 3 studies. The findings highlight factors that occupational therapy practitioners should consider when working with pediatric diabetes teams to select self-management interventions. PMID:27548858

  8. New technologies and therapeutic approaches for the management of pediatric diabetes.

    PubMed

    Lawlor, M T; Laffel, L M

    2001-08-01

    Evolving trends in technology and therapeutic strategies create a very exciting time for the management of diabetes. Technology, like the internet, helps us to keep up with this fast-paced, changing world of diabetes. New therapies most often begin with adult clinical trials; once safety and efficacy are demonstrated, practice recommendations follow for the pediatric population. The Diabetes Research Working Group has defined potentially important new directions and technologies for diabetes research. The group has recommended the creation of regional centers of technologic excellence, if contemporary diabetes research is to succeed. An overview of recent advances in diabetes technology follows covering five main areas: monitoring, telemedicine, insulin analogues, insulin delivery devices, and islet cell transplantation. PMID:12762958

  9. Therapeutic Targets for Management of Periodontitis and Diabetes

    PubMed Central

    Sima, Corneliu; Van Dyke, Thomas E.

    2016-01-01

    The increasing incidence of diabetes mellitus (DM) and chronic periodontitis (CP) worldwide imposes a rethinking of individualized therapy for patients with both conditions. Central to bidirectional links between DM and CP is deregulated systemic inflammation and dysfunctional immune responses to altered-self and non-self. Control of blood glucose levels and metabolic imbalances associated with hyperglycemia in DM, and disruption of pathogenic subgingival biofilms in CP are currently the main therapeutic approaches for these conditions. Mounting evidence suggests the need to integrate immune modulatory therapeutics in treatment regimens that address the unresolved inflammation associated with DM and CP. The current review discusses the pathogenesis of DM and CP with emphasis on deregulated inflammation, current therapeutic approaches and the novel pro-resolution lipid mediators derived from n-3 polyunsaturated fatty acids. PMID:26881443

  10. An Internet-Based Diabetes Management Platform Improves Team Care and Outcomes in an Urban Latino Population

    PubMed Central

    Zagarins, Sofija E.; Santiago-Kelly, Paula; Rodriguez, Zoraida; Bursell, Sven-Erik; Rosal, Milagros C.; Gabbay, Robert A.

    2015-01-01

    OBJECTIVE To compare usual diabetes care (UDC) to a comprehensive diabetes care intervention condition (IC) involving an Internet-based “diabetes dashboard” management tool used by clinicians. RESEARCH DESIGN AND METHODS We used a parallel-group randomized design. Diabetes nurses, diabetes dietitians, and providers used the diabetes dashboard as a clinical decision support system to deliver a five-visit, 6-month intervention to 199 poorly controlled (HbA1c >7.5% [58 mmol/mol]) Latino type 2 diabetic (T2D) patients (mean age 55 years, 60% female) at urban community health centers. We compared this intervention to an established, in-house UDC program (n = 200) for its impact on blood glucose control and psychosocial outcomes. RESULTS Recruitment and retention rates were 79.0 and 88.5%, respectively. Compared with UDC, more IC patients reached HbA1c targets of <7% (53 mmol/mol; 15.8 vs. 7.0%, respectively, P < 0.01) and <8% (64 mmol/mol; 45.2 vs. 25.3%, respectively, P < 0.001). In multiple linear regression adjusting for baseline HbA1c, adjusted mean ± SE HbA1c at follow-up was significantly lower in the IC compared with the UDC group (P < 0.001; IC 8.4 ± 0.10%; UDC 9.2 ± 0.10%). The results showed lower diabetes distress at follow-up for IC patients (40.4 ± 2.1) as compared with UDC patients (48.3 ± 2.0) (P < 0.01), and also lower social distress (32.2 ± 1.3 vs. 27.2 ± 1.4, P < 0.01). There was a similar, statistically significant (P < 0.01) improvement for both groups in the proportion of patients moving from depressed status at baseline to nondepressed at follow-up (41.8 vs. 40%; no significance between groups). CONCLUSIONS The diabetes dashboard intervention significantly improved diabetes-related outcomes among Latinos with poorly controlled T2D compared with a similar diabetes team condition without access to the diabetes dashboard. PMID:25633661

  11. Veterans Affairs Research on Health Information Technologies for Diabetes Self-Management Support

    PubMed Central

    Piette, John D.; Kerr, Eve; Richardson, Caroline; Heisler, Michele

    2008-01-01

    Background Like many patients with diabetes, Department of Veterans Affairs (VA) patients frequently fall short of self-management goals and experience multiple barriers to self-care. Health information technologies (HITs) may provide the tools that patients need to manage their illness under the direction of their primary care team. Methods We describe several ongoing projects focused on HIT resources for self-management in VA. VA researchers are developing HITs that seek to bolster a variety of potential avenues for self-management support, including patients′ relationships with other patients, connections with their informal care networks, and communication with their health care teams. Results Veterans Affairs HIT research projects are developing services that can address the needs of patients with multiple challenges to disease self-care, including multimorbidity, health literacy deficits, and limited treatment access. These services include patient-to-patient interactive voice response (IVR) calling systems, IVR assessments with feedback to informal caregivers, novel information supports for clinical pharmacists based on medication refill data, and enhanced pedometers. Conclusion Large health care systems such as the VA can play a critical role in developing HITs for diabetes self-care. To be truly effective, these efforts should include a continuum of studies: observational research to identify barriers to self-management, developmental studies (e.g., usability testing), efficacy trials, and implementation studies to evaluate utility in real-world settings. VA HIT researchers partner with operations to promote the dissemination of efficacious services, and such relationships will be critical to move HIT innovations into practice. PMID:19885173

  12. Resources Management System

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Delta Data Systems, Inc. was originally formed by NASA and industry engineers to produce a line of products that evolved from ELAS, a NASA-developed computer program. The company has built on that experience, using ELAS as the basis for other remote sensing products. One of these is AGIS, a computer package for geographic and land information systems. AGIS simultaneously processes remotely sensed and map data. The software is designed to operate on a low cost microcomputer, putting resource management tools within reach of small operators.

  13. The Impact of Technology on Current Diabetes Management.

    PubMed

    Garvey, Katharine; Wolfsdorf, Joseph I

    2015-08-01

    Technological innovations have revolutionized the treatment of type 1 diabetes. Although technological advances can potentially improve diabetes outcomes, maintenance of target glycemic control, at the present time, remains largely dependent on patient and family motivation, competence, and adherence to daily diabetes care requirements. Trials of closed loop or "artificial pancreas" technology show great promise to automate insulin delivery and achieve near normal glucose control and reduced hypoglycemia with minimal patient intervention. PMID:26210622

  14. A Worksite Occupational Health Clinic-Based Diabetes Mellitus Management Program.

    PubMed

    Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; Erickson, Denise; McCluskey, Maureen; Schultz, Alyssa

    2015-12-01

    This study is an analysis of a workplace diabetes management program offered to employees of a Fortune 100 financial services corporation located in the United States. The 12-month worksite-based educational program was for employees who were at risk for diabetes, had prediabetes, or were diagnosed with diabetes. This employed population, with health benefits, generally had acceptable control of their diabetes at the start of the program. They statistically improved most self-efficacy measures, but improvement in biometric tests at 6 and 12 months were not significantly different from baseline. Mean hemoglobin A1c at baseline, 6 months, and 12 months was 7.2%, 7.2%, and 7.3%, respectively. At 12 months, about 40% of preprogram survey participants completed all screenings and the post-program questionnaire. Disease management programs at the workplace can be an important component in helping employees enhance their knowledge of diabetes and maintain and improve their health. PMID:26091060

  15. A system management methodology for building successful resource management systems

    NASA Technical Reports Server (NTRS)

    Hornstein, Rhoda Shaller; Willoughby, John K.

    1989-01-01

    This paper presents a system management methodology for building successful resource management systems that possess lifecycle effectiveness. This methodology is based on an analysis of the traditional practice of Systems Engineering Management as it applies to the development of resource management systems. The analysis produced fifteen significant findings presented as recommended adaptations to the traditional practice of Systems Engineering Management to accommodate system development when the requirements are incomplete, unquantifiable, ambiguous and dynamic. Ten recommended adaptations to achieve operational effectiveness when requirements are incomplete, unquantifiable or ambiguous are presented and discussed. Five recommended adaptations to achieve system extensibility when requirements are dynamic are also presented and discussed. The authors conclude that the recommended adaptations to the traditional practice of Systems Engineering Management should be implemented for future resource management systems and that the technology exists to build these systems extensibly.

  16. DiabCare survey of diabetes management and complications in the Gulf countries

    PubMed Central

    Omar, Muhamed Shahed; Khudada, Khaled; Safarini, Saher; Mehanna, Sherif; Nafach, Jalal

    2016-01-01

    Aim: To describe the status of diabetes control and complications, and the quality of diabetes management in Saudi Arabia, Kuwait, and the United Arab Emirates, and to obtain an insight into the relationship between these factors. Methods: Patients with diabetes for>12 months were enrolled from specialist clinics and general hospitals. All available data from the patients’ medical files including patient demographics; glycemic, lipid, and blood pressure status; diabetes-related complications; and diabetes management were recorded in data collection forms and analyzed. Results: Overall, 1290 patients with diabetes were enrolled with a mean (±standard deviation) age of 49.4 ± 12.3 years and duration of diabetes of 8.7 ± 5.9 years. Glycemic control was poor: Mean glycated hemoglobin A1c of 8.3 ± 2.0%, fasting and postprandial plasma glucose levels of 155.9 ± 57.1 mg/dL (8.7 ± 3.2 mmol/L), and 218.2 ± 87.4 mg/dL (12.1 ± 4.9 mmol/L), respectively. Diabetes-related complications such as neuropathy (34.9% of patients), background retinopathy (29.9%), and cataract (14.1%) were common. Cardiovascular complications were reported in <10% of patients, and microalbuminuria was detected in 34.4% of patients. Oral antidiabetic drug (OAD) monotherapy (43.3%) was the most common treatment, followed by insulin + OADs (39.3%) and insulin monotherapy (17.6%). Conclusion: The status of diabetes care was found to be suboptimal. Further improvements in diabetes management are necessary to prevent or delay the development of diabetes-related complications. PMID:27042419

  17. Lifestyle Intervention for Diabetes and Weight Management in Psychosis

    ClinicalTrials.gov

    2015-01-08

    Type 2 Diabetes Mellitus; Schizophrenia; Schizoaffective Disorder; Schizophreniform Disorder; Bipolar I Disorder; Major Depression With Psychotic Features; Substance-induced Psychosis; Psychosis Not Otherwise Specified

  18. Obstetrical data management systems.

    PubMed

    1997-03-01

    Obstetrical data management systems (OBDMSs) are computer systems designed to interface with fetal and maternal monitors. This allows monitoring and charting records to be created and maintained electronically and to be viewed from centralized workstations. In theory, these systems could eliminate paper record keeping from the obstetrics department altogether, although currently at least some paper documentation, such as fetal monitoring strips, is being kept. We evaluated five OBDMSs, one of which is no longer on the market and which we did not rate. Of the remaining systems, three were rated Acceptable; the fourth was rated Acceptable-Not Recommended because it lacks several important features and functions. This Evaluation also includes a Technology Overview, in which we discuss how OBDMSs function. The Overview incorporates a supplementary article, "Obstetrical Care Monitoring and Documentation," describing the monitoring and documentation typically performed during a pregnancy. And in the Selection and Use Guide, we discuss issues involved in choosing, purchasing, and implementing an OBDMS. PMID:9067726

  19. Effects of Diabetic Case Management on Knowledge, Self-Management Abilities, Health Behaviors, and Health Service Utilization for Diabetes in Korea

    PubMed Central

    Shin, Soon Ae; Lee, Kunsei; Lin, Vivian; Liu, George; Shin, Eunyoung

    2015-01-01

    Purpose This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. Materials and Methods The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. Results The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. Conclusion This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program. PMID:25510771

  20. Integrative gaming: a framework for sustainable game-based diabetes management.

    PubMed

    Kahol, Kanav

    2011-03-01

    Obesity and diabetes have reached epidemic proportions in both developing and developed nations. While doctors and caregivers stress the importance of physical exercise in maintaining a healthy lifestyle, many people have difficulty subscribing to a healthy lifestyle. Virtual reality games offer a potentially exciting aid in accelerating and sustaining behavior change. However, care needs to be taken to develop sustainable models of employing games for the management of diabetes and obesity. In this article, we propose an integrative gaming paradigm designed to combine multiple activities involving physical exercises and cognitive skills through a game-based storyline. The persuasive story acts as a motivational binder that enables a user to perform multiple activities such as running, cycling, and problem solving. These activities guide a virtual character through different stages of the game. While performing the activities in the games, users wear sensors that can measure movement (accelerometers, gyrometers, magnetometers) and sense physiological measures (heart rate, pulse oximeter oxygen saturation). These measures drive the game and are stored and analyzed on a cloud computing platform. A prototype integrative gaming system is described and design considerations are discussed. The system is highly configurable and allows researchers to build games for the system with ease and drive the games with different types of activities. The capabilities of the system allow for engaging and motivating the user in the long term. Clinicians can employ the system to collect clinically relevant data in a seamless manner. PMID:21527096

  1. Integrative Gaming: A Framework for Sustainable Game-Based Diabetes Management

    PubMed Central

    Kahol, Kanav

    2011-01-01

    Obesity and diabetes have reached epidemic proportions in both developing and developed nations. While doctors and caregivers stress the importance of physical exercise in maintaining a healthy lifestyle, many people have difficulty subscribing to a healthy lifestyle. Virtual reality games offer a potentially exciting aid in accelerating and sustaining behavior change. However, care needs to be taken to develop sustainable models of employing games for the management of diabetes and obesity. In this article, we propose an integrative gaming paradigm designed to combine multiple activities involving physical exercises and cognitive skills through a game-based storyline. The persuasive story acts as a motivational binder that enables a user to perform multiple activities such as running, cycling, and problem solving. These activities guide a virtual character through different stages of the game. While performing the activities in the games, users wear sensors that can measure movement (accelerometers, gyrometers, magnetometers) and sense physiological measures (heart rate, pulse oximeter oxygen saturation). These measures drive the game and are stored and analyzed on a cloud computing platform. A prototype integrative gaming system is described and design considerations are discussed. The system is highly configurable and allows researchers to build games for the system with ease and drive the games with different types of activities. The capabilities of the system allow for engaging and motivating the user in the long term. Clinicians can employ the system to collect clinically relevant data in a seamless manner. PMID:21527096

  2. Chronic complications of diabetes mellitus related to the respiratory system.

    PubMed

    Vojtková, Jarmila; Ciljaková, Miriam; Michnová, Zuzana; Turčan, Tomá

    2012-01-01

    The quality of life in patients with diabetes mellitus is mainly determined by chronic diabetic complications which may affect all organ tissues including respiratory system. Microangiopathy of pulmonary capillaries, autonomic neuropathy, myopathy of respiratory muscles or changes in collagen belong to supposed pathophysiological pathways. This paper brings brief review about reported functional consequences in subjects with diabetes - decreased vital lung capacity and pulmonary volumes, decreased diffuse lung capacity for carbon monoxide, lower basal bronchial tone, lower cough reflex sensitivity, increased incidence of sleep obstructive apnea, increase in respiratory infections, disorders in respiratory muscles or phrenical nerve. Examination of pulmonary functions may serve for early detection of chronic complications in patients with diabetes. PMID:23146790

  3. Effectiveness of self-management promotion educational program among diabetic patients based on health belief model

    PubMed Central

    Jalilian, Farzad; Motlagh, Fazel Zinat; Solhi, Mahnaz; Gharibnavaz, Hasan

    2014-01-01

    Introduction: Diabetes is a chronic disease; it can cause serious complications. Diabetes self-management is essential for prevention of disease complications. This study was conducted to evaluate self-management promotion educational program intervention efficiency among diabetic patients in Iran and health belief model (HBM) was applied as a theoretical framework. Materials and Methods: Overall, 120 Type 2 diabetic patients referred to rural health centers in Gachsaran, Iran participated in this study as randomly divided into intervention and control group. This was a longitudinal randomized pre- and post-test series control group design panel study to implement a behavior modification based intervention to promotion self-management among diabetic patients. Cross-tabulation and t-test by using SPSS statistical package, version 16 was used for the statistical analysis. Results: Mean age was 55.07 years (SD = 9.94, range: 30-70). Our result shows significant improvements in average response for susceptibility, severity, benefit and self-management among intervention group. Additionally, after intervention, average response of the barrier to self-management was decreased among intervention group. Conclusion: Our result showed education program based on HBM was improve of self-management and seems implementing these programs can be effective in the and prevention of diabetes complications. PMID:24741654

  4. Evaluation of the Role of Enteral Nutrition in Managing Patients with Diabetes: A Systematic Review

    PubMed Central

    Ojo, Omorogieva; Brooke, Joanne

    2014-01-01

    The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF) with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed. PMID:25412151

  5. Environmental Compliance Management System

    SciTech Connect

    Brownson, L.W.; Krsul, T.; Peralta, R.A. ); Knudson, D.A.; Rosignolo, C.L. )

    1992-01-01

    Argonne National Laboratory (ANL) is developing the Environmental Compliance Management System (ECMS) as a comprehensive, cost-effective tool to ensure (1) that the Laboratory complies with all applicable federal and state environmental laws and regulations, (2) that environmental issues and concerns are recognized and considered in the early phases of projects; and (3) that Laboratory personnel conduct Laboratory operations in the most environmentally acceptable manner. The ECMS is an expert computer system which is designed to allow project engineers to perform an environmental evaluation of their projects. The system includes a Master Program which collects basic project information, provide utility functions, and access the environmental expert modules, environmental expert system modules for each federal and state environmental law which allows the user to obtain specific information on how an individual law may affect his project; and site-specific databases which contain information necessary for effective management of the site under environmental regulations. The ECMS will have the capability to complete and print many of the necessary environmental forms required by federal and state agencies, including the Department of Energy.

  6. Environmental Compliance Management System

    SciTech Connect

    Brownson, L.W.; Krsul, T.; Peralta, R.A.; Knudson, D.A.; Rosignolo, C.L.

    1992-09-01

    Argonne National Laboratory (ANL) is developing the Environmental Compliance Management System (ECMS) as a comprehensive, cost-effective tool to ensure (1) that the Laboratory complies with all applicable federal and state environmental laws and regulations, (2) that environmental issues and concerns are recognized and considered in the early phases of projects; and (3) that Laboratory personnel conduct Laboratory operations in the most environmentally acceptable manner. The ECMS is an expert computer system which is designed to allow project engineers to perform an environmental evaluation of their projects. The system includes a Master Program which collects basic project information, provide utility functions, and access the environmental expert modules, environmental expert system modules for each federal and state environmental law which allows the user to obtain specific information on how an individual law may affect his project; and site-specific databases which contain information necessary for effective management of the site under environmental regulations. The ECMS will have the capability to complete and print many of the necessary environmental forms required by federal and state agencies, including the Department of Energy.

  7. Tips for Teens with Diabetes: What Is Diabetes?

    MedlinePlus

    Tips for Teens with Diabetes What is Diabetes? National Diabetes Education Program Learn about diabetes and how to manage it. styaoyfuyodarooiatumdrbaTecebadhhtlkeoieoecsoaii… cncdlteehams, gyr, ealauwbkncoeeedofishgayceeohch. attue, ...

  8. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

    PubMed Central

    Arnold, Mark; Bakris, George L.; Bruns, David E.; Horvath, Andrea Rita; Kirkman, M. Sue; Lernmark, Ake; Metzger, Boyd E.; Nathan, David M.

    2011-01-01

    BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A1c (HbA1c) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended. PMID:21617108

  9. [Support of diabetes dietary management and self-management using mobile applications].

    PubMed

    Szálka, Brigitta; Kósa, István; Vassányi, István; Mák, Erzsébet

    2016-07-01

    The key components of successful diabetes therapy are pharmacotherapy, hospital care and lifestyle education. Lifestyle education, self-management, and composing the right diet can be effectively supported with mobile applications. In this paper Hungarian mobile applications are reviewed and compared to some international competitors. Besides plenty of useful functions some deficiencies are identified, based on dietary recommendations. The related improvements together with clinical trials validating effectiveness and reliability can strengthen medical evidence as well as the penetration of such mobile applications. Orv. Hetil., 2016, 157(29), 1147-1153. PMID:27426463

  10. Diabetes Management in the School Setting. Position Statement

    ERIC Educational Resources Information Center

    Butler, Sarah; Fekaris, Nina; Pontius, Deborah; Zacharski, Susan

    2012-01-01

    It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as school nurse) is the only school staff member who has the skills, knowledge base, and statutory authority to fully meet the healthcare needs of students with diabetes in the school setting. Diabetes management…

  11. Managing Type 1 Diabetes at School: An Integrative Review

    ERIC Educational Resources Information Center

    Tolbert, Rebecca

    2009-01-01

    This integrative literature review examines research studies that describe the care of the student with type 1 diabetes at school and interventions to improve care. Participants of the studies include school nurses, counselors, staff, administrators, parents, and students with diabetes. The studies reviewed use a descriptive approach in examining…

  12. Assessing Empathy and Self-Efficacy Levels of Pharmacy Students in an Elective Diabetes Management Course

    PubMed Central

    Stahnke, Amanda M.; Behnen, Erin M.

    2015-01-01

    Objective. To assess the impact of a 6-week patient/provider interaction simulation on empathy and self-efficacy levels of diabetes management skills in third-year pharmacy students. Design. Pharmacy students enrolled in a diabetes elective course were paired to act as a patient with diabetes or as a provider assisting in the management of that patient during a 6-week simulation activity. After 3 weeks, students switched roles. The simulation was designed with activities to build empathy. Assessment. The Jefferson Scale of Empathy (JSE) and a self-efficacy survey were administered to assess change in empathy and confidence levels from baseline to the end of the activity. Completion of the activity resulted in significant improvement in total JSE scores. Additionally, significant improvements in overall self-efficacy scores regarding diabetes management were noted. Conclusion. The 6-week patient/provider interaction simulation improved empathy and self-efficacy levels in third-year pharmacy students. PMID:25995517

  13. A systematic review of the role of renin angiotensin aldosterone system genes in diabetes mellitus, diabetic retinopathy and diabetic neuropathy

    PubMed Central

    Rahimi, Zohreh; Moradi, Mahmoudreza; Nasri, Hamid

    2014-01-01

    Background: The renin angiotensin aldosterone system (RAAS) plays a vital role in regulating glucose metabolism and blood pressure, electrolyte and fluid homeostasis. The aim of this systematic review is to assess the association of the RAAS genes with diabetes mellitus (DM) and its complications of retinopathy, neuropathy and cardiovascular disease (CVD). Materials and Methods: The relevant English-language studies were identified using the key words of DM, type 1 diabetes mellitus (T1DM), T2DM, renin angiotensin aldosterone polymorphisms or genotypes and RAAS from the search engines of MEDLINE/PubMed, and Scopus from January 1, 1995 to July 30, 2014. Inclusion criteria for selecting relevant studies were reporting the role of RAAS gene variants in the pathogenesis of T1DM or T2DM, diabetic retinopathy (DR), diabetic neuropathy and cardiovascular complication of DM. Results: The reviewers identified 204 studies of which 73 were eligible for inclusion in the present systematic review. The review indicates the angiotensinogen (AGT) M235T polymorphism might not affect the risk of DM. The role of angiotensin converting enzyme insertion/deletion (ACE I/D) and angiotensin II type 1 receptor gene (AT1R) A1166C polymorphisms in the pathogenesis of DM could not be established. Studies indicate the absence of an association between three polymorphisms of AGT M235T, ACE I/D and AT1R A1166C and DR in DM patients. A protective role for ACE II genotype against diabetic peripheral neuropathy has been suggested. Also, the ACE I/D polymorphism might be associated with the risk of CVD in DM patients. Conclusion: More studies with adequate sample size that investigate the influence of all RAAS gene variants together on the risk of DM and its complications are necessary to provide a more clear picture of the RAAS genes polymorphisms involvement in the pathogenesis of DM and its complications. PMID:25657757

  14. Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes--United States, 2011-2012.

    PubMed

    Li, Rui; Shrestha, Sundar S; Lipman, Ruth; Burrows, Nilka R; Kolb, Leslie E; Rutledge, Stephanie

    2014-11-21

    Diabetes is a complex chronic disease that requires active involvement of patients in its management. Diabetes self-management education and training (DSMT), "the ongoing process of facilitating the knowledge, skill, and ability necessary for prediabetes and diabetes self-care," is an important component of integrated diabetes care. It is an intervention in which patients learn about diabetes and how to implement the self-management that is imperative to control the disease. The curriculum of DSMT often includes the diabetes disease process and treatment options; healthy lifestyle; blood glucose monitoring; preventing, detecting and treating diabetes complications; and developing personalized strategies for decision making. The American Diabetes Association recommends providing DSMT to those with newly diagnosed diabetes, because data suggest that when diabetes is first diagnosed is the time when patients are most receptive to such engagement. However, little is known about the proportion of persons with newly diagnosed diabetes participating in DSMT. CDC analyzed data from the Marketscan Commercial Claims and Encounters database (Truven Health Analytics) for the period 2009-2012 to estimate the claim-based proportion of privately insured adults (aged 18-64 years) with newly diagnosed diabetes who participated in DSMT during the first year after diagnosis. During 2011-2012, an estimated 6.8% of privately insured, newly diagnosed adults participated in DSMT during the first year after diagnosis of diabetes. These data suggest that there is a large gap between the recommended guideline and current practice, and that there is both an opportunity and a need to enhance rates of DSMT participation among persons newly diagnosed with diabetes. PMID:25412060

  15. Environmental management system.

    SciTech Connect

    Salinas, Stephanie A.

    2010-08-01

    The purpose of the Sandia National Laboratories/New Mexico (SNL/NM) Environmental Management System (EMS) is identification of environmental consequences from SNL/NM activities, products, and/or services to develop objectives and measurable targets for mitigation of any potential impacts to the environment. This Source Document discusses the annual EMS process for analysis of environmental aspects and impacts and also provides the fiscal year (FY) 2010 analysis. Further information on the EMS structure, processes, and procedures are described within the programmatic EMS Manual (PG470222).

  16. Adherence to evidence-based guidelines among diabetes self-management apps.

    PubMed

    Breland, Jessica Y; Yeh, Vivian M; Yu, Jessica

    2013-09-01

    Smartphone apps can provide real-time, interactive self-management aid to individuals with diabetes. It is currently unclear whether existing diabetes self-management apps follow evidence-based guidelines. The purpose of this study was to evaluate the extent to which existing diabetes self-management apps address the seven self-management behaviors recommended by the American Association of Diabetes Educators (the AADE7™). The term "diabetes" identified relevant self-management apps via the Apple App Store search engine in March 2012. Ratings were based on app descriptions and downloads. Chi-square analyses assessed differences in apps based on developer type. Apps promoted a median of two AADE7™ skills. Overall reliability between description and download ratings was good (kappa = .66). Reliability of individual skills was variable (kappa = .25 to .91). Most diabetes apps do not conform to evidence-based recommendations, and future app reviews would benefit from testing app performance. Future apps may also benefit from theory-based designs. PMID:24073179

  17. National Athletic Trainers' Association Position Statement: Management of the Athlete With Type 1 Diabetes Mellitus

    PubMed Central

    Jimenez, Carolyn C; Corcoran, Matthew H; Crawley, James T; Guyton Hornsby, W; Peer, Kimberly S; Philbin, Rick D; Riddell, Michael C

    2007-01-01

    Objective: To present recommendations for the certified athletic trainer in the management of type 1 diabetes in the athlete. Background: In managing diabetes, the most important goal is to keep blood glucose levels at or as close to normal levels as possible without causing hypoglycemia. This goal requires the maintenance of a delicate balance among hypoglycemia, euglycemia, and hyperglycemia, which is often more challenging in the athlete due to the demands of physical activity and competition. However, effectively managing blood glucose, lipid, and blood pressure levels is necessary to ensuring the long-term health and well-being of the athlete with diabetes. Recommendations: These recommendations are intended to provide the certified athletic trainer participating in the management of an athlete with type 1 diabetes mellitus with the specific knowledge and problem-solving skills needed. Athletic trainers have more contact with the athlete with diabetes than most members of the diabetes management team do and so must be prepared to assist the athlete as required. PMID:18176622

  18. Primary Care Providers' Knowledge and Practices of Diabetes Management During Ramadan.

    PubMed

    Ali, Mujtaba; Adams, Alexandra; Hossain, Md Anwar; Sutin, David; Han, Benjamin Hyun

    2016-01-01

    There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan. PMID:26294052

  19. Evidence-based review of diabetic macular edema management: Consensus statement on Indian treatment guidelines

    PubMed Central

    Das, Taraprasad; Aurora, Ajay; Chhablani, Jay; Giridhar, Anantharaman; Kumar, Atul; Raman, Rajiv; Nagpal, Manish; Narayanan, Raja; Natarajan, Sundaram; Ramasamay, Kim; Tyagi, Mudit; Verma, Lalit

    2016-01-01

    The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians. PMID:26953019

  20. Current nanotechnology approaches for the treatment and management of diabetic retinopathy.

    PubMed

    Fangueiro, Joana F; Silva, Amélia M; Garcia, Maria L; Souto, Eliana B

    2015-09-01

    Diabetic retinopathy (DR) is a consequence of diabetes mellitus at the ocular level, leading to vision loss, and contributing to the decrease of patient's life quality. The biochemical and anatomic abnormalities that occur in DR are discussed in this review to better understand and manage the development of new therapeutic strategies. The use of new drug delivery systems based on nanoparticles (e.g. liposomes, dendrimers, cationic nanoemulsions, lipid and polymeric nanoparticles) is discussed along with the current traditional treatments, pointing out the advantages of the proposed nanomedicines to target this ocular disease. Despite the multifactorial nature of DR, which is not entirely understood, some strategies based on nanoparticles are being exploited for a more efficient drug delivery to the posterior segment of the eye. On the other hand, the use of some nanoparticles also seems to contribute to the development of DR symptoms (e.g. retinal neovascularization), which are also discussed in light of an efficient management of this ocular chronic disease. PMID:25536109

  1. Honey: A Potential Therapeutic Agent for Managing Diabetic Wounds

    PubMed Central

    Islam, Md. Asiful; Gan, Siew Hua; Khalil, Md. Ibrahim

    2014-01-01

    Diabetic wounds are unlike typical wounds in that they are slower to heal, making treatment with conventional topical medications an uphill process. Among several different alternative therapies, honey is an effective choice because it provides comparatively rapid wound healing. Although honey has been used as an alternative medicine for wound healing since ancient times, the application of honey to diabetic wounds has only recently been revived. Because honey has some unique natural features as a wound healer, it works even more effectively on diabetic wounds than on normal wounds. In addition, honey is known as an “all in one” remedy for diabetic wound healing because it can combat many microorganisms that are involved in the wound process and because it possesses antioxidant activity and controls inflammation. In this review, the potential role of honey's antibacterial activity on diabetic wound-related microorganisms and honey's clinical effectiveness in treating diabetic wounds based on the most recent studies is described. Additionally, ways in which honey can be used as a safer, faster, and effective healing agent for diabetic wounds in comparison with other synthetic medications in terms of microbial resistance and treatment costs are also described to support its traditional claims. PMID:25386217

  2. Discrepancy Reporting Management System

    NASA Technical Reports Server (NTRS)

    Cooper, Tonja M.; Lin, James C.; Chatillon, Mark L.

    2004-01-01

    Discrepancy Reporting Management System (DRMS) is a computer program designed for use in the stations of NASA's Deep Space Network (DSN) to help establish the operational history of equipment items; acquire data on the quality of service provided to DSN customers; enable measurement of service performance; provide early insight into the need to improve processes, procedures, and interfaces; and enable the tracing of a data outage to a change in software or hardware. DRMS is a Web-based software system designed to include a distributed database and replication feature to achieve location-specific autonomy while maintaining a consistent high quality of data. DRMS incorporates commercial Web and database software. DRMS collects, processes, replicates, communicates, and manages information on spacecraft data discrepancies, equipment resets, and physical equipment status, and maintains an internal station log. All discrepancy reports (DRs), Master discrepancy reports (MDRs), and Reset data are replicated to a master server at NASA's Jet Propulsion Laboratory; Master DR data are replicated to all the DSN sites; and Station Logs are internal to each of the DSN sites and are not replicated. Data are validated according to several logical mathematical criteria. Queries can be performed on any combination of data.

  3. Peer Support for Achieving Independence in Diabetes (Peer-AID): Design, methods and baseline characteristics of a randomized controlled trial of community health worker assisted diabetes self-management support

    PubMed Central

    Nelson, Karin; Drain, Nathan; Robinson, June; Kapp, Janet; Hebert, Paul; Taylor, Leslie; Silverman, Julie; Kiefer, Meghan; Lessler, Dan; Krieger, James

    2014-01-01

    Background & Objectives Community health workers (CHWs) may be an important mechanism to provide diabetes self-management to disadvantaged populations. We describe the design and baseline results of a trial evaluating a home-based CHW intervention. Methods & Research Design Peer Support for Achieving Independence in Diabetes (Peer-AID) is a randomized, controlled trial evaluating a home-based CHW-delivered diabetes self-management intervention versus usual care. The study recruited participants from 3 health systems. Change in A1c measured at 12 months is the primary outcome. Change in blood pressure, lipids, health care utilization, health-related quality of life, self-efficacy and diabetes self-management behaviors at 12 months are secondary outcomes. Results A total of 1,438 patients were identified by medical record review as potentially eligible, 445 patients were screened by telephone for eligibility and 287 were randomized. Groups were comparable at baseline on socio-demographic and clinical characteristics. All participants were low-income and were from diverse racial and ethnic backgrounds. The mean A1c was 8.9%, mean BMI was above the obese range, and non-adherence to diabetes medications was high. The cohort had high rates of co-morbid disease and low self-reported health status. Although one-third reported no health insurance, the mean number of visits to a physician in the past year was 5.7. Trial results are pending. Conclusions Peer-AID recruited and enrolled a diverse group of low income participants with poorly controlled type 2 diabetes and delivered a home-based diabetes self-management program. If effective, replication of the Peer-AID intervention in community based settings could contribute to improved control of diabetes in vulnerable populations. PMID:24956324

  4. The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes: Implications for Intensive Diabetes Management.

    PubMed

    Paterson, Megan; Bell, Kirstine J; O'Connell, Susan M; Smart, Carmel E; Shafat, Amir; King, Bruce

    2015-09-01

    A primary focus of the management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. However, even with the introduction of more flexible intensive insulin regimes, people with type 1 diabetes still struggle to achieve optimal glycaemic control. More recently, dietary fat and protein have been recognised as having a significant impact on postprandial blood glucose levels. Fat and protein independently increase the postprandial glucose excursions and together their effect is additive. This article reviews how the fat and protein in a meal impact the postprandial glycaemic response and discusses practical approaches to managing this in clinical practice. These insights have significant implications for patient education, mealtime insulin dose calculations and dosing strategies. PMID:26202844

  5. Integration of Personalized Healthcare Pathways in an ICT Platform for Diabetes Managements: A Small-Scale Exploratory Study.

    PubMed

    Fico, Giuseppe; Fioravanti, Alessio; Arredondo, Maria Teresa; Gorman, Joe; Diazzi, Chiara; Arcuri, Giovanni; Conti, Claudio; Pirini, Giampiero

    2016-01-01

    The availability of new tools able to support patient monitoring and personalized care may substantially improve the quality of chronic disease management. A personalized healthcare pathway (PHP) has been developed for diabetes disease management and integrated into an information and communication technology system to accomplish a shift from organization-centered care to patient-centered care. A small-scale exploratory study was conducted to test the platform. Preliminary results are presented that shed light on how the PHP influences system usage and performance outcomes. PMID:25389246

  6. Improving preparedness of medical students and junior doctors to manage patients with diabetes

    PubMed Central

    Kelly, Narcie A A; Brandom, Kevin G; Mattick, Karen L

    2015-01-01

    Objective New medical graduates are the front-line staff in many hospital settings and manage patients with diabetes frequently. Prescribing is an area of concern for junior doctors, however, with insulin prescribing reported as a particular weakness. This study aimed to produce an educational intervention which aimed to improve preparedness to manage patients with diabetes and evaluate it using a mixed methods approach. Research design and methods An e-resource (http://www.diabetesscenariosforjuniordoctors.co.uk) was created to contain commonplace and authentic diabetes decision-making scenarios. –32 junior doctors (n=20) and year 5 students (n=12) in South West England worked through the scenarios while ‘thinking aloud’ and then undertook a semistructured interview. Qualitative data were transcribed verbatim and analyzed thematically. Participant confidence to manage patients with diabetes before, immediately after, and 6 weeks after the educational intervention was also measured using a self-rating scale. Results Participants reported that patients with diabetes were daunting to manage because of the wide array of insulin products, their lack of confidence with chronic disease management and the difficulty of applying theory to practice. The e-resource was described as authentic, practical, and appropriate for the target audience. Junior doctors’ self-rated confidence to manage patients with diabetes increased from 4.7 (of 10) before using the e-resource, to 6.4 immediately afterwards, and 6.8 6 weeks later. Medical students’ confidence increased from 5.1 before, to 6.4 immediately afterwards, and 6.4 6 weeks later. Conclusions Providing opportunities to work with authentic scenarios in a safe environment can help to ameliorate junior doctors’ lack of confidence to manage patients with diabetes. PMID:26435838

  7. Role of guar and dietary fibre in the management of diabetes mellitus.

    PubMed

    Cohen, M; Leong, V W; Salmon, E; Martin, F I

    1980-01-26

    High-fibre diets, particularly with the addition of guar gum, have been reported to improve control of blood glucose concentration in diabetics. These studies are reviewed, and the results of a study of 22 obese, poorly controlled, poorly compliant diabetic outpatients are presented. In a random, single-blind controlled trial, either guar, or bran, or placebo were added to the previous diet. Over a three-month period, there were no changes in weight, fasting blood glucose levels, or random blood glucose levels. Problems of tolerance were experienced with guar gum. Therefore, supplementation of the diet of such patients with guar gum or bran does not produce long-term improvements in diabetic control in a clinical context. The use of naturally occurring high-fibre foods may slightly improve diabetic control in motivated patients, but further long-term trials are required to establish whether dietary fibre will have any significant role in the practical management of diabetes. PMID:7360088

  8. Quality systems and environmental management

    SciTech Connect

    Wenmonth, B.A.

    1994-11-01

    The increasing prominence of quality management in the past decade has been closely paralleled by an increasing awareness of the need to protect and manage the environment. This paper explains the basic premises of quality management and explores how these can be integrated with environmental management systems and how they might apply to the role of environmental health and health protection officers.

  9. H2RM: A Hybrid Rough Set Reasoning Model for Prediction and Management of Diabetes Mellitus

    PubMed Central

    Ali, Rahman; Hussain, Jamil; Siddiqi, Muhammad Hameed; Hussain, Maqbool; Lee, Sungyoung

    2015-01-01

    Diabetes is a chronic disease characterized by high blood glucose level that results either from a deficiency of insulin produced by the body, or the body’s resistance to the effects of insulin. Accurate and precise reasoning and prediction models greatly help physicians to improve diagnosis, prognosis and treatment procedures of different diseases. Though numerous models have been proposed to solve issues of diagnosis and management of diabetes, they have the following drawbacks: (1) restricted one type of diabetes; (2) lack understandability and explanatory power of the techniques and decision; (3) limited either to prediction purpose or management over the structured contents; and (4) lack competence for dimensionality and vagueness of patient’s data. To overcome these issues, this paper proposes a novel hybrid rough set reasoning model (H2RM) that resolves problems of inaccurate prediction and management of type-1 diabetes mellitus (T1DM) and type-2 diabetes mellitus (T2DM). For verification of the proposed model, experimental data from fifty patients, acquired from a local hospital in semi-structured format, is used. First, the data is transformed into structured format and then used for mining prediction rules. Rough set theory (RST) based techniques and algorithms are used to mine the prediction rules. During the online execution phase of the model, these rules are used to predict T1DM and T2DM for new patients. Furthermore, the proposed model assists physicians to manage diabetes using knowledge extracted from online diabetes guidelines. Correlation-based trend analysis techniques are used to manage diabetic observations. Experimental results demonstrate that the proposed model outperforms the existing methods with 95.9% average and balanced accuracies. PMID:26151207

  10. H2RM: A Hybrid Rough Set Reasoning Model for Prediction and Management of Diabetes Mellitus.

    PubMed

    Ali, Rahman; Hussain, Jamil; Siddiqi, Muhammad Hameed; Hussain, Maqbool; Lee, Sungyoung

    2015-01-01

    Diabetes is a chronic disease characterized by high blood glucose level that results either from a deficiency of insulin produced by the body, or the body's resistance to the effects of insulin. Accurate and precise reasoning and prediction models greatly help physicians to improve diagnosis, prognosis and treatment procedures of different diseases. Though numerous models have been proposed to solve issues of diagnosis and management of diabetes, they have the following drawbacks: (1) restricted one type of diabetes; (2) lack understandability and explanatory power of the techniques and decision; (3) limited either to prediction purpose or management over the structured contents; and (4) lack competence for dimensionality and vagueness of patient's data. To overcome these issues, this paper proposes a novel hybrid rough set reasoning model (H2RM) that resolves problems of inaccurate prediction and management of type-1 diabetes mellitus (T1DM) and type-2 diabetes mellitus (T2DM). For verification of the proposed model, experimental data from fifty patients, acquired from a local hospital in semi-structured format, is used. First, the data is transformed into structured format and then used for mining prediction rules. Rough set theory (RST) based techniques and algorithms are used to mine the prediction rules. During the online execution phase of the model, these rules are used to predict T1DM and T2DM for new patients. Furthermore, the proposed model assists physicians to manage diabetes using knowledge extracted from online diabetes guidelines. Correlation-based trend analysis techniques are used to manage diabetic observations. Experimental results demonstrate that the proposed model outperforms the existing methods with 95.9% average and balanced accuracies. PMID:26151207

  11. Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy

    PubMed Central

    2013-01-01

    Background Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. Method We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. Results There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. Conclusions The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future. PMID:23374611

  12. Environmental Management System Plan

    SciTech Connect

    Fox, Robert; Thorson, Patrick; Horst, Blair; Speros, John; Rothermich, Nancy; Hatayama, Howard

    2009-03-24

    Executive Order 13423, Strengthening Federal Environmental, Energy, and Transportation Management establishes the policy that Federal agencies conduct their environmental, transportation, and energy-related activities in a manner that is environmentally, economically and fiscally sound, integrated, continually improving, efficient, and sustainable. The Department of Energy (DOE) has approved DOE Order 450.1A, Environmental Protection Program and DOE Order 430.2B, Departmental Energy, Renewable Energy and Transportation Management as the means of achieving the provisions of this Executive Order. DOE Order 450.1A mandates the development of Environmental Management Systems (EMS) to implement sustainable environmental stewardship practices that: (1) Protect the air, water, land, and other natural and cultural resources potentially impacted by facility operations; (2) Meet or exceed applicable environmental, public health, and resource protection laws and regulations; and (3) Implement cost-effective business practices. In addition, the DOE Order 450.1A mandates that the EMS must be integrated with a facility's Integrated Safety Management System (ISMS) established pursuant to DOE P 450.4, 'Safety Management System Policy'. DOE Order 430.2B mandates an energy management program that considers energy use and renewable energy, water, new and renovated buildings, and vehicle fleet activities. The Order incorporates the provisions of the Energy Policy Act of 2005 and Energy Independence and Security Act of 2007. The Order also includes the DOE's Transformational Energy Action Management initiative, which assures compliance is achieved through an Executable Plan that is prepared and updated annually by Lawrence Berkeley National Laboratory (LBNL, Berkeley Lab, or the Laboratory) and then approved by the DOE Berkeley Site Office. At the time of this revision to the EMS plan, the 'FY2009 LBNL Sustainability Executable Plan' represented the most current Executable Plan. These

  13. Virginia's traffic management system

    SciTech Connect

    Morris, J.; Marber, S. )

    1992-07-01

    This paper reports that Northern Virginia, like most other urban areas, faces the challenge of moving more and more vehicles on roads that are already overloaded. Traffic in Northern Virginia is continually increasing, but the development surrounding Interstate 395, 495, and 66 makes little room available for roadway expansion. Even if land were unlimited, the strict requirement of the Clean Air Act make building roads difficult. This paper reports that ensuring the most efficient use of the interstate highways is the goal of the Virginia Department of Transportation's (VDOT's) traffic management system (TMS). TMS is a computerized highway surveillance and control system that monitors 30 interstate miles on I-395, I-495, and I-66. The system helps squeeze the most use from these interstates by detecting and helping clear accidents or disabled vehicles and by smoothing traffic flow. TMS spots and helps clear an average of two incidents a day and prevents accidents caused by erratic traffic flow from ramps onto the main line. For motorists, these TMS functions translate into decreased travel time, vehicle operating costs, and air pollution. VDOT's TMS is the foundation for the intelligent vehicle-highway systems of tomorrow. It employs several elements that work together to improve traffic flow.

  14. Evaluation and management of diabetic and non-diabetic hypoglycemia in end-stage renal disease.

    PubMed

    Gosmanov, Aidar R; Gosmanova, Elvira O; Kovesdy, Csaba P

    2016-01-01

    Patients with end-stage renal disease (ESRD) regardless of diabetes status are at increased risk of hypoglycemia with a resultant array of adverse clinical outcomes. Therefore, hypoglycemia should be thoroughly evaluated in ESRD patients. In diabetic dialysis patients, hypoglycemic agents and nutritional alterations can trigger hypoglycemia in the background of diminished gluconeogenesis, reduced insulin clearance by the kidney and improved insulin sensitivity following initiation of renal replacement therapy. Detailed evaluation of antidiabetic regimen and nutritional patterns, patient education on self-monitoring of blood glucose and/or referral to a diabetes specialist may reduce risk of subsequent hypoglycemia. In certain situations, it is important to recognize the possibility of non-diabetic causes of hypoglycemia in patients with diabetes and to avoid treating pseudo-hyperglycemia caused by glucose- non-specific glucometers in patients utilizing icodextrin-based solutions for peritoneal dialysis. Adrenal insufficiency, certain medications, malnutrition and/or infection are among the most common causes of hypoglycemia in non-diabetic ESRD patients, and they should be suspected after exclusion of inadvertent use of hypoglycemic agents. The goal of this review article is to summarize approaches and recommendations for the work up and treatment of hypoglycemia in ESRD. PMID:26152404

  15. [Management of Type 2 Diabetes: a Practical Approach].

    PubMed

    Donath, Marc

    2016-06-01

    Over the last years, the therapeutic aims for patients with type 2 diabetes have changed and several novel drugs have been introduced. In this Mini-Review we discuss these aims and how to achieve them. PMID:27269776

  16. Co-Managing Patients with Type 1 Diabetes and Cancer.

    PubMed

    Best, Conor J; Thosani, Sonali; Ortiz, Marjorie; Levesque, Celia; Varghese, Sigi S; Lavis, Victor R

    2016-08-01

    The life expectancy of people with type 1 diabetes is improving and now approaches that of those without diabetes. As this population ages, a growing number will be diagnosed with and treated for cancer. Cancer treatments can drastically affect insulin requirement and glycemic control through multiple mechanisms including high doses of glucocorticoids and targeted therapies that directly interfere with cellular pathways involved in the action of insulin. Patients with cancer frequently also have alterations in gastrointestinal motility or appetite and require supplemental enteral or parenteral nutrition. Few studies have evaluated these patients directly, but data on patients with and without diabetes suggest that glycemic control may play a larger role in cancer outcomes than is often recognized. Collaboration between the treating oncologist and diabetologist allows people with diabetes to receive the most effective therapies for their cancers without undue risk of hypoglycemia or adverse outcomes due to hyperglycemia. PMID:27319323

  17. Assessing the Impact of a Quality Improvement Intervention on Diabetes Self- Management Education Services Provided by Local Health Departments

    PubMed Central

    Dearinger, Angela T.; Ingram, Richard C.; Pendley, Robin P.; Wilding, Sarah

    2015-01-01

    Background As the burden of diabetes continues to overwhelm the public health system, there is increased demand on local health departments (LHDs) to improve public health services. Quality improvement (QI) techniques have been shown to be an effective means to improve the delivery of services by LHDs. Purpose To evaluate the extent to which the adoption of organizational quality improvement (QI) strategies influences the delivery and outreach of Diabetes Self- Management Education (DSME) services provided by LHDs. Methods A change facilitation model which included QI team development and on- site QI training and facilitation was delivered to 6 LHDs who provide DSME during 2010-2011. After training, each LHD developed and implemented a QI project to improve the outreach and delivery of DSME services. Pre- and post- intervention surveys were administered to evaluate the extent of change in DSME outreach and delivery. Results The number of individuals who completed an entire course of DSME increased by > 100%, and 14% more diabetics attended DSME on a monthly basis. Half of LHDs reported receiving increased numbers of referrals per month, and 15% more healthcare providers referred diabetic patients to the LHD for DSME. Conclusions Participation in COACH 4 DM led to improvements in the LHD QI infrastructure, and in the outreach and delivery of services to diabetic patients. The techniques used during COACH-4 DM are applicable to a wide variety of contexts and may be an effective tool to improve the delivery of other clinical and community preventive services. PMID:24237923

  18. Potential role of TRAIL in the management of autoimmune diabetes mellitus.

    PubMed

    Bernardi, Stella; Norcio, Alessia; Toffoli, Barbara; Zauli, Giorgio; Secchiero, Paola

    2012-01-01

    Type 1 diabetes mellitus (T1DM) is an autoimmune disease, due to the immune-mediated destruction of pancreatic β-cells, whose incidence has been steadily increasing during the last decades. Insulin replacement therapy can treat T1DM, which, however, is still associated with substantial morbidity and mortality. For this reason, great effort is being put into developing strategies that could eventually prevent and/or cure this disease. These strategies are mainly focused on blocking the immune system from attacking β-cells together with functional islet restoration either by regeneration or transplantation. Recent experimental evidences suggest that TNFrelated apoptosis-inducing ligand (TRAIL), which is an immune system modulator protein, could represent an interesting candidate for the cure for T1DM and/or its complications. Here we review the evidences on the potential role of TRAIL in the management of T1DM. PMID:22726118

  19. Proposing an Acceptance and Commitment Therapy Intervention to Promote Improved Diabetes Management in Adolescents: A Treatment Conceptualization

    ERIC Educational Resources Information Center

    Hadlandsmyth, Katherine; White, Kamila S.; Nesin, April E.; Greco, Laurie A.

    2013-01-01

    Pediatric diabetes is linked with adverse medical outcomes, the risks of which increase with poor or intermittent adherence (Diabetes Control and Complications Trial Research Group, 1994). Further, during adolescence, diabetes management tends to deteriorate (Anderson & Laffel, 1996; Bryden et al., 2001; Insabella, Grey, Knafl, &…

  20. Updates on the management of diabetes in dialysis patients.

    PubMed

    Rhee, Connie M; Leung, Angela M; Kovesdy, Csaba P; Lynch, Katherine E; Brent, Gregory A; Kalantar-Zadeh, Kamyar

    2014-03-01

    Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the U.S. and many countries globally. The role of improved glycemic control in ameliorating the exceedingly high mortality risk of diabetic dialysis patients is unclear. The treatment of diabetes in ESRD patients is challenging, given changes in glucose homeostasis, the unclear accuracy of glycemic control metrics, and the altered pharmacokinetics of glucose-lowering drugs by kidney dysfunction, the uremic milieu, and dialysis therapy. Up to one-third of diabetic dialysis patients may experience spontaneous resolution of hyperglycemia with hemoglobin A1c (HbA1c) levels <6%, a phenomenon known as "Burnt-Out Diabetes," which remains with unclear biologic plausibility and undetermined clinical implications. Conventional methods of glycemic control assessment are confounded by the laboratory abnormalities and comorbidities associated with ESRD. Similar to more recent approaches in the general population, there is concern that glucose normalization may be harmful in ESRD patients. There is uncertainty surrounding the optimal glycemic target in this population, although recent epidemiologic data suggest that HbA1c ranges of 6% to 8%, as well as 7% to 9%, are associated with increased survival rates among diabetic dialysis patients. Lastly, many glucose-lowering drugs and their active metabolites are renally metabolized and excreted, and hence, require dose adjustment or avoidance in dialysis patients. PMID:24588802

  1. Updates on the Management of Diabetes in Dialysis Patients

    PubMed Central

    Rhee, Connie M.; Leung, Angela M.; Kovesdy, Csaba P.; Lynch, Katherine E.; Brent, Gregory A.; Kalantar-Zadeh, Kamyar

    2014-01-01

    Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the U.S. and many countries globally. The role of improved glycemic control in ameliorating the exceedingly high mortality risk of diabetic dialysis patients is unclear. The treatment of diabetes in ESRD patients is challenging, given changes in glucose homeostasis, the unclear accuracy of glycemic control metrics, and the altered pharmacokinetics of glucose-lowering drugs by kidney dysfunction, the uremic milieu, and dialysis therapy. Up to one-third of diabetic dialysis patients may experience spontaneous resolution of hyperglycemia with hemoglobin A1c (HbA1c) levels <6%, a phenomenon known as “Burnt-Out Diabetes,” which remains with unclear biologic plausibility and undetermined clinical implications. Conventional methods of glycemic control assessment are confounded by the laboratory abnormalities and comorbidities associated with ESRD. Similar to more recent approaches in the general population, there is concern that glucose normalization may be harmful in ESRD patients. There is uncertainty surrounding the optimal glycemic target in this population, although recent epidemiologic data suggest that HbA1c ranges of 6% to 8%, as well as 7 to 9%, are associated with increased survival rates among diabetic dialysis patients. Lastly, many glucose-lowering drugs and their active metabolites are renally metabolized and excreted, and hence, require dose adjustment or avoidance in dialysis patients. PMID:24588802

  2. Factors contributing to attrition behavior in diabetes self-management programs: A mixed method approach

    PubMed Central

    Gucciardi, Enza; DeMelo, Margaret; Offenheim, Ana; Stewart, Donna E

    2008-01-01

    Background Diabetes self-management education is a critical component in diabetes care. Despite worldwide efforts to develop efficacious DSME programs, high attrition rates are often reported in clinical practice. The objective of this study was to examine factors that may contribute to attrition behavior in diabetes self-management programs. Methods We conducted telephone interviews with individuals who had Type 2 diabetes (n = 267) and attended a diabetes education centre. Multivariable logistic regression was performed to identify factors associated with attrition behavior. Forty-four percent of participants (n = 118) withdrew prematurely from the program and were asked an open-ended question regarding their discontinuation of services. We used content analysis to code and generate themes, which were then organized under the Behavioral Model of Health Service Utilization. Results Working full and part-time, being over 65 years of age, having a regular primary care physician or fewer diabetes symptoms were contributing factors to attrition behaviour in our multivariable logistic regression. The most common reasons given by participants for attrition from the program were conflict between their work schedules and the centre's hours of operation, patients' confidence in their own knowledge and ability when managing their diabetes, apathy towards diabetes education, distance to the centre, forgetfulness, regular physician consultation, low perceived seriousness of diabetes, and lack of familiarity with the centre and its services. There was considerable overlap between our quantitative and qualitative results. Conclusion Reducing attrition behaviour requires a range of strategies targeted towards delivering convenient and accessible services, familiarizing individuals with these services, increasing communication between centres and their patients, and creating better partnerships between centres and primary care physicians. PMID:18248673

  3. Cryptographic Key Management System

    SciTech Connect

    No, author

    2014-02-21

    This report summarizes the outcome of U.S. Department of Energy (DOE) contract DE-OE0000543, requesting the design of a Cryptographic Key Management System (CKMS) for the secure management of cryptographic keys for the energy sector infrastructure. Prime contractor Sypris Electronics, in collaboration with Oak Ridge National Laboratories (ORNL), Electric Power Research Institute (EPRI), Valicore Technologies, and Purdue University's Center for Education and Research in Information Assurance and Security (CERIAS) and Smart Meter Integration Laboratory (SMIL), has designed, developed and evaluated the CKMS solution. We provide an overview of the project in Section 3, review the core contributions of all contractors in Section 4, and discuss bene ts to the DOE in Section 5. In Section 6 we describe the technical construction of the CKMS solution, and review its key contributions in Section 6.9. Section 7 describes the evaluation and demonstration of the CKMS solution in different environments. We summarize the key project objectives in Section 8, list publications resulting from the project in Section 9, and conclude with a discussion on commercialization in Section 10 and future work in Section 11.

  4. Database management system for instrument data management

    SciTech Connect

    Tatum, C.P.

    1990-01-01

    Data from many measuring devices throughout the Savannah River Site (SRS) is transmitted to a central location for processing as a vital component in the SRS emergency preparedness and response program. The data processing is currently accomplished using VAX-based FORTRAN programs with the data stored in Digital's Record Management System (RMS) files which is shared using global COMMON. A program is underway to store and process this data using a Structured Query Language (SQL)-based Database Management System (DBMS). The advantages of replacing the current system with one using an SQL-based DBMS are discussed.

  5. EMPOWER--pathways for supporting the self-management of diabetes patients.

    PubMed

    Plößnig, Manuela; Kabak, Yildiray; Lamprinos, Ilias; Pabst, Alexander; Hildebrand, Claudia; Mantwill, Sarah

    2015-01-01

    Diabetes is a serious world-wide medical challenge and there is a recognised need for improved diabetes care outcomes. This paper describes results of the EMPOWER project, to foster the self-management of diabetes patients by integration of existing and new services offered to patients after having been diagnosed with diabetes. The Self-Management Pathway described in this paper helps patients in the specification of personalized activities based on medical recommendations and personal goals, as well as self-monitoring of the results. The whole process is supported by innovative ICT services that motivate patients to change their lifestyle and adhere to defined medication and activity plans. We describe the approach and present the findings of the validation phase in Germany and Turkey. PMID:26063272

  6. Good cop, bad cop: quality of parental involvement in type 1 diabetes management in youth.

    PubMed

    Young, Mackenzie T; Lord, Jadienne H; Patel, Niral J; Gruhn, Meredith A; Jaser, Sarah S

    2014-01-01

    Sustained parental involvement in diabetes management has been generally advised to counteract the deteriorating adherence and glycemic control often seen during adolescence, yet until recently, little attention has been given to the optimal amount, type, and quality of parental involvement to promote the best health outcomes for adolescents with type 1 diabetes (T1D). This review synthesizes research regarding the involvement of caregivers-primarily mothers and fathers-of youth with T1D, with a focus on biopsychosocial outcomes. The recent literature on parental involvement in diabetes management highlights a shift in focus from not only amount but also the types (e.g., monitoring, problem-solving) and quality (e.g., warm, critical) of involvement in both mothers and fathers. We provide recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with T1D. PMID:25212099

  7. The management of autonomy in adolescent diabetes: a case study of triadic medical interaction.

    PubMed

    Buchbinder, Mara

    2009-03-01

    The transfer of responsibility for diabetes management from parent to child has been seen as a central challenge for the clinical care of adolescents with Type 1 diabetes. Research is needed to better understand how clinicians, patients, and families handle the delicate balance between parental involvement and adolescent responsibility for diabetes management. The aim of this study is to investigate the interactional processes by which an adolescent's autonomy is facilitated and constrained in a clinical interaction between a nurse practitioner (NP), a 13-year-old diabetes patient, and the patient's mother. Integrating psychological perspectives on adolescent autonomy and responsibility with conversation analytic approaches to participation, I examine participation frameworks and shifting alignments to illuminate the negotiation of adolescent autonomy within a single clinical encounter. The analysis demonstrates that the patient's autonomy is emphasized while identifying problems, yet restricted when considering solutions. Clinical implications are discussed. PMID:19228827

  8. Prevention and Management of Type 2 Diabetes: Dietary Components and Nutritional Strategies

    PubMed Central

    Ley, Sylvia H.; Hamdy, Osama; Mohan, V.; Hu, Frank B.

    2016-01-01

    Summary In the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than the quantity of these macronutrients. Diets rich in whole grains, fruits, vegetables, legumes, nuts, moderate in alcohol consumption, and lower in refined grains, red/processed meats, and sugar-sweetened beverages have demonstrated to reduce diabetes risk and improve glycemic control and blood lipids in patients with diabetes. Several healthful dietary patterns emphasizing the overall diet quality can be adapted to appropriate personal and cultural food preferences and calorie needs for weight control and diabetes prevention and management. Although considerable progress has been made in developing and implementing evidence-based nutrition recommendations in developed countries, concerted global efforts and policies are warranted to alleviate regional disparities. PMID:24910231

  9. Computerized training management system

    DOEpatents

    Rice, H.B.; McNair, R.C.; White, K.; Maugeri, T.

    1998-08-04

    A Computerized Training Management System (CTMS) is disclosed for providing a procedurally defined process that is employed to develop accreditable performance based training programs for job classifications that are sensitive to documented regulations and technical information. CTMS is a database that links information needed to maintain a five-phase approach to training-analysis, design, development, implementation, and evaluation independent of training program design. CTMS is designed using R-Base{trademark}, an-SQL compliant software platform. Information is logically entered and linked in CTMS. Each task is linked directly to a performance objective, which, in turn, is linked directly to a learning objective; then, each enabling objective is linked to its respective test items. In addition, tasks, performance objectives, enabling objectives, and test items are linked to their associated reference documents. CTMS keeps all information up to date since it automatically sorts, files and links all data; CTMS includes key word and reference document searches. 18 figs.

  10. Computerized training management system

    DOEpatents

    Rice, Harold B.; McNair, Robert C.; White, Kenneth; Maugeri, Terry

    1998-08-04

    A Computerized Training Management System (CTMS) for providing a procedurally defined process that is employed to develop accreditable performance based training programs for job classifications that are sensitive to documented regulations and technical information. CTMS is a database that links information needed to maintain a five-phase approach to training-analysis, design, development, implementation, and evaluation independent of training program design. CTMS is designed using R-Base.RTM., an-SQL compliant software platform. Information is logically entered and linked in CTMS. Each task is linked directly to a performance objective, which, in turn, is linked directly to a learning objective; then, each enabling objective is linked to its respective test items. In addition, tasks, performance objectives, enabling objectives, and test items are linked to their associated reference documents. CTMS keeps all information up to date since it automatically sorts, files and links all data; CTMS includes key word and reference document searches.

  11. Current Status of Management in Type 2 Diabetes Mellitus at General Hospitals in South Korea

    PubMed Central

    Jung, Jin-Hee; Lee, Jung-Hwa; Noh, Jin-Won; Park, Jeong-Eun; Kim, Hee-Sook; Yoo, Joo-Wha; Song, Bok-Rye; Lee, Jeong-rim; Hong, Myeong-Hee; Jang, Hyang-Mi; Na, Young; Lee, Hyun-Joo; Lee, Jeong-Mi; Kang, Yang-Gyo; Kim, Sun-Young

    2015-01-01

    Background In Korea, the prevalence, complications, and mortality rate of diabetes are rapidly increasing. However, investigations on the actual condition of diabetes management are very limited due to lack of nation-wide research or multicenter study. Hence, we have minutely inquired the current status of diabetes management and achievement of glucose target goal in general hospital offering education program. That way, we are able to furnish data for policy making of diabetes education and draw up guideline which may allow us to reduce the morbidity and mortality of diabetes. Methods The subjects consisted of 2,610 patients with type 2 diabetes who visited the 13 general hospital in Seoul or Gyeonggi region from March 19 to May 29, 2013. General characteristics, associated diseases, complications, and management status were investigated. Results The mean age was 61.0±11.6 years, body mass index was 25.0±3.3 kg/m2, and family history of diabetes was 50.5%. The mean duration of diabetes was 10.7±7.9 years and 53% received education about diabetes. The prevalence of hypertension and dyslipidemia were 59.2% and 65.5%, respectively, and 18.3% of the subjects were accompanied by liver disease. Diabetic retinopathy appeared in 31.6%, nephropathy in 28.1%, and neuropathy in 19.9% of the subjects. The mean glycosylated hemoglobin (HbA1c) level was 7.3%±1.3% and the achieving rate based on Korean Diabetes Association guideline (HbA1c <6.5%) was 24.8%, blood pressure (130/80 mm Hg or less) was 49.4%, and low density lipoprotein cholesterol (<100 mg/dL) was 63.6%. The reaching rate to the target level in four parameters (blood glucose, blood pressure, lipids, and body weight) was 7.8%. Conclusion The blood glucose control rate was lower than other parameters, and the implementation rate of diabetes education was only 53%. Thus more appropriate glucose control and systematic diabetes education are imperative. PMID:26301192

  12. Supplier Management System

    NASA Technical Reports Server (NTRS)

    Ramirez, Eric; Gutheinz, Sandy; Brison, James; Ho, Anita; Allen, James; Ceritelli, Olga; Tobar, Claudia; Nguyen, Thuykien; Crenshaw, Harrel; Santos, Roxann

    2008-01-01

    Supplier Management System (SMS) allows for a consistent, agency-wide performance rating system for suppliers used by NASA. This version (2.0) combines separate databases into one central database that allows for the sharing of supplier data. Information extracted from the NBS/Oracle database can be used to generate ratings. Also, supplier ratings can now be generated in the areas of cost, product quality, delivery, and audit data. Supplier data can be charted based on real-time user input. Based on these individual ratings, an overall rating can be generated. Data that normally would be stored in multiple databases, each requiring its own log-in, is now readily available and easily accessible with only one log-in required. Additionally, the database can accommodate the storage and display of quality-related data that can be analyzed and used in the supplier procurement decision-making process. Moreover, the software allows for a Closed-Loop System (supplier feedback), as well as the capability to communicate with other federal agencies.

  13. Use of integrated care delivery to improve the quality of diabetes management among African Americans.

    PubMed

    Bray, Paul; Cummings, Doyle M; Thompson, Debra K

    2011-01-01

    The prevalence of type 2 diabetes is increasing, and racial disparities in that prevalence persist. Reimbursement policies do not match the innovative care delivery systems that have been developed. One key policy goal involves reimbursement for diabetes care delivered by physician and nonphysician health care professionals on the same day. Our evidence suggests that this integrated care improves outcomes among patients. PMID:22416520

  14. Advances in Energy Management Systems

    SciTech Connect

    Horton, J.S.; Prince, B.; Sasson, A.M.; Wynne, W.T.; Trefny, F.; Cleveland, F.

    1986-08-01

    This paper is one of the series prepared for a special session to be held at PICA 85. The objective is to review the advances that have been made in Energy Management Systems and to obtain a more common agreement as to the usefulness and future of such systems. The paper contains a summary of five discussions of Energy Management Systems. These discussions focus on the major components of an Energy Management System and address important questions as to the usefulness, past developments, the current state-of-the-art, and needs in Energy Management Systems. Each author provides a different perspective of these systems. The discussions are intended to provide insight into Energy Management Systems, to solicit discussions, and to provide a forum for discussions of Energy Management System's developments and future needs.

  15. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control

    PubMed Central

    Betônico, Carolina C R; Titan, Silvia M O; Correa-Giannella, Maria Lúcia C; Nery, Márcia; Queiroz, Márcia

    2016-01-01

    The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: “diabetes kidney disease” and “renal failure” in combination with “diabetes treatment” and “oral antidiabetic drugs” or “oral hypoglycemic agents.” The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population. PMID:26872083

  16. Weight management in type 2 diabetes: current and emerging approaches to treatment.

    PubMed

    Van Gaal, Luc; Scheen, André

    2015-06-01

    Diabetes is a growing global health concern, as is obesity. Diabetes and obesity are intrinsically linked: obesity increases the risk of diabetes and also contributes to disease progression and cardiovascular disease. Although the benefits of weight loss in the prevention of diabetes and as a critical component of managing the condition are well established, weight reduction remains challenging for individuals with type 2 diabetes due to a host of metabolic and psychological factors. For many patients, lifestyle intervention is not enough to achieve weight loss, and alternative options, such as pharmacotherapy, need to be considered. However, many traditional glucose-lowering medications may lead to weight gain. This article focuses on the potential of currently available pharmacological strategies and on emerging approaches in development to support the glycemic and weight-loss goals of individuals with type 2 diabetes. Two pharmacotherapy types are considered: those developed primarily for blood glucose control that have a favorable effect on body weight and those developed primarily to induce weight loss that have a favorable effect on blood glucose control. Finally, the potential of combination therapies for the management of obese patients with type 2 diabetes is discussed. PMID:25998297

  17. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control.

    PubMed

    Betônico, Carolina C R; Titan, Silvia M O; Correa-Giannella, Maria Lúcia C; Nery, Márcia; Queiroz, Márcia

    2016-01-01

    The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: "diabetes kidney disease" and "renal failure" in combination with "diabetes treatment" and "oral antidiabetic drugs" or "oral hypoglycemic agents." The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population. PMID:26872083

  18. Ethnic disparities in type 2 diabetes: pathophysiology and implications for prevention and management.

    PubMed Central

    Dagogo-Jack, Samuel

    2003-01-01

    Based on 2000 census data, ethnic minorities constitute approximately 25% of the overall population of the United States, and the population of minority groups has been increasing at a faster rate than the general U.S. population. Compared with caucasians, persons from minority ethnic groups suffer disproportionately from type 2 diabetes and its long-term complications. Acute complications of diabetes occur with varying frequencies in the different demographic groups, but there are indications that the rate of hospitalization for diabetic ketoacidosis and nonketotic coma may be higher among certain minority populations. Genetic and lifestyle factors likely account for the increased prevalence of type 2 diabetes among ethnic minorities. However, the increase in morbidity and mortality from diabetes may be the result, in part, of socioeconomic factors. Pathophysiologically, several studies have documented a higher prevalence of insulin resistance in minority groups, even after correction for obesity and lifestyle factors. These findings underscore the need for a more aggressive approach to diabetes management in high-risk populations. Behavioral and pharmacologic interventions that reduce insulin resistance have profound beneficial effects in African-American patients and subjects with diabetes from other ethnic groups. Indeed, much of the ethnic difference in morbidity from diabetic complications disappears when caucasians and non-caucasians are treated to identical degrees of glycemic control. PMID:14527045

  19. An evaluation of diabetes self-management applications for Android smartphones.

    PubMed

    Demidowich, Andrew P; Lu, Kevin; Tamler, Ronald; Bloomgarden, Zachary

    2012-06-01

    We reviewed diabetes apps for Android smartphones. We compiled a list of free and paid apps in April 2011 by searching the Android Market for apps which could track self-monitoring of blood glucose (SMBG), diabetes medications or calculate prandial insulin dosages. Two reviewers independently evaluated six features per app, using a five-point Likert scale. The sum of the six ratings was the composite usability score, and the mean score of an app's features was the average usability score. Of the 80 Android diabetes apps identified, 42 unique apps were eligible for the study. SMBG recording was present in 36 (86%) of the apps, a tool to track insulin or oral diabetic medications was found in 19 (45%) apps, and a prandial insulin dose calculator existed for 11 (26%) apps. Eighteen apps were free of charge and the other 24 apps had a mean purchase price of $2.86 (range 0.99-6.99). The mean composite usability score was 11.3 out of a possible 30. The mean average usability score was 3.0 out of a possible 5.0. Only four of the 42 apps had a composite usability score above 20 and none offered direct data input from glucometers, suggesting that few provided a comprehensive method of diabetes management. The apps Glucool Diabetes, OnTrack Diabetes, Dbees and Track3 Diabetes Planner were the highest rated. Clinicians may find it useful to recommend these apps. PMID:22604278

  20. Management of type 2 diabetes mellitus by lifestyle, diet and medicinal plants.

    PubMed

    Haque, N; Salma, U; Nurunnabi, T R; Uddin, M J; Jahangir, M F K; Islam, S M Z; Kamruzzaman, M

    2011-01-01

    Globally, the prevalence of chronic, noncommunicable diseases is increasing at an alarming rate and diabetes is one of them. If diabetes is not controlled then a lot of complication like coronary artery disease, cerebrovascular disease, peripheral vascular disease, retinopathy, nephropathy and neuropathy arise in diabetic patients and causes morbidity and/or mortality. Diabetes is increasing at an epidemic form and in near future the largest increases will take place in the regions dominated by developing economies. So, it will be a great social and economical burden to developing countries as well as the developed. But if we be aware about our diet and lifestyle and take proper medication we may prevent and reduce the prevalence of diabetes. Oral medicine plays an important role in management of diabetes. But most of the oral drugs are costly and have a lot of side effects. For this it is also necessary to take medicines with fewer or no side effects. And antidiabetic medicinal plants may play an important role in this case. In this article we have tried to describe how diet and lifestyle with using medicinal plants may help to prevent or maintain diabetes and help to reduce the mortality and morbidity due to diabetes or complication related to it. PMID:21913493

  1. Social Ecological Model of Illness Management in High-Risk Youths with Type 1 Diabetes

    ERIC Educational Resources Information Center

    Naar-King, Sylvie; Podolski, Cheryl-Lynn; Ellis, Deborah A.; Frey, Maureen A.; Templin, Thomas

    2006-01-01

    In this study, the authors tested a social ecological model of illness management in high-risk, urban adolescents with Type 1 diabetes. It was hypothesized that management behaviors would be associated with individual adolescent characteristics as well as family, peer, and provider relationships. Questionnaires were collected from 96 adolescents…

  2. Manpower management information system /MIS/

    NASA Technical Reports Server (NTRS)

    Gravette, M. C.; King, W. L.

    1971-01-01

    System of programs capable of building and maintaining data bank provides all levels of management with regular manpower evaluation reports and data source for special management exercises on manpower.

  3. Use of unripe plantain (Musa paradisiaca) in the management of diabetes and hepatic dysfunction in streptozotocin induced diabetes in rats

    PubMed Central

    Okafor, Polycarp

    2015-01-01

    Aim This study aims to investigate the effect of unripe plantain (Musa paradisiaca) on markers of hepatic dysfunction in streptozotocin induced diabetic rats. Methods Blood glucose; relative liver weight (RLW); relative kidney weight (RKW); relative heart weight (RHW); relative pancreatic weight (RPW); serum and hepatic serum aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP); serum amylase, lipase, total, and conjugated bilirubin; and chemical analysis of the test feed were determined using standard techniques. Results The diabetic rats had significant alteration (P < 0.05) of blood glucose; RLW; RKW; RPW; serum and hepatic AST, ALT, and ALP; serum total and conjugated bilirubin; and serum lipase activities compared with nondiabetic while these parameters were significantly improved (P < 0.05) in the rats fed unripe plantain. There were no significant differences (P > 0.05) in the RHW of the rats in the three groups, as well as significant decreases (P < 0.05) in the amylase levels of the diabetic rats compared with the nondiabetic, but there was nonsignificant increase (P > 0.05) in the amylase levels of the rats fed unripe plantain compared with the nondiabetic rats. The test and standard rat feeds contained considerable amount of proteins, carbohydrates, fats, phenols, and crude fiber. Conclusion Amelioration of acute pancreatitis by unripe plantain could play a key role in its management of diabetes and related complications. PMID:25838921

  4. Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care

    PubMed Central

    van Olmen, Josefien; Schellevis, François; Van Damme, Wim; Kegels, Guy; Rasschaert, Freya

    2012-01-01

    There is growing attention for chronic diseases in sub-Saharan Africa (SSA) and for bridges between the management of HIV/AIDS and other (noncommunicable) chronic diseases. This becomes more urgent with increasing numbers of people living with both HIV/AIDS and other chronic conditions. This paper discusses the commonalities between chronic diseases by reviewing models of care, focusing on the two most dominant ones, diabetes mellitus type 2 (DM2) and HIV/AIDS. We argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care. We developed a “chronic dimension framework,” which analyses the “disease dimension,” the “health provider dimension,” the patient or “person dimension,” and the “environment dimension” of chronic diseases. Applying this framework to HIV/AIDS and DM2 shows that it is useful to think about management of both in tandem, comparing care delivery platforms and self-management strategies. A literature review on care delivery models for diabetes and HIV/AIDS in SSA revealed potential elements for cross-fertilisation: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support, and self-management strategies; and strengthening health services. PMID:23209477

  5. Patients' management of type 2 diabetes in Middle Eastern countries: review of studies.

    PubMed

    Alsairafi, Zahra Khalil; Taylor, Kevin Michael Geoffrey; Smith, Felicity J; Alattar, Abdulnabi T

    2016-01-01

    The increased prevalence of diabetes in Middle Eastern countries is a health policy priority. Important risk factors for diabetes have been identified. Lifestyle interventions and adherence to medications are central to disease prevention and management. This review focuses on the management of type 2 diabetes mellitus in Middle Eastern countries. The aim is to identify the ways in which knowledge, health beliefs, and social and cultural factors influence adherence to medication and lifestyle measures. Thirty-four studies were identified following a systematic search of the literature. The studies describe the influence of knowledge, health beliefs, culture, and lifestyle on the management of type 2 diabetes mellitus in the Middle East. Findings indicate a lack of health knowledge about diabetes among populations, which has implications for health behaviors, medication adherence, and treatment outcomes. Many identified health beliefs and cultural lifestyle factors, such as religious beliefs, beliefs about fasting during Ramadan, and sedentary lifestyles played a role in patients' decisions. For better management of this disease, a collaborative approach between patients, their families, health care professionals, and governments should be adopted. Implementing behavioral strategies and psychological interventions that incorporate all health care professionals in the management process have been shown to be effective methods. Such services help patients change their behavior. However, the utilization of such services and interventions is still limited in Arabian countries. Physicians in the Middle East are the health care professionals most involved in the care process. PMID:27354775

  6. Patients’ management of type 2 diabetes in Middle Eastern countries: review of studies

    PubMed Central

    Alsairafi, Zahra Khalil; Taylor, Kevin Michael Geoffrey; Smith, Felicity J; Alattar, Abdulnabi T

    2016-01-01

    The increased prevalence of diabetes in Middle Eastern countries is a health policy priority. Important risk factors for diabetes have been identified. Lifestyle interventions and adherence to medications are central to disease prevention and management. This review focuses on the management of type 2 diabetes mellitus in Middle Eastern countries. The aim is to identify the ways in which knowledge, health beliefs, and social and cultural factors influence adherence to medication and lifestyle measures. Thirty-four studies were identified following a systematic search of the literature. The studies describe the influence of knowledge, health beliefs, culture, and lifestyle on the management of type 2 diabetes mellitus in the Middle East. Findings indicate a lack of health knowledge about diabetes among populations, which has implications for health behaviors, medication adherence, and treatment outcomes. Many identified health beliefs and cultural lifestyle factors, such as religious beliefs, beliefs about fasting during Ramadan, and sedentary lifestyles played a role in patients’ decisions. For better management of this disease, a collaborative approach between patients, their families, health care professionals, and governments should be adopted. Implementing behavioral strategies and psychological interventions that incorporate all health care professionals in the management process have been shown to be effective methods. Such services help patients change their behavior. However, the utilization of such services and interventions is still limited in Arabian countries. Physicians in the Middle East are the health care professionals most involved in the care process. PMID:27354775

  7. ASCOT data base management system

    SciTech Connect

    Barbieri, J.; Nyholm, R.; Castro, C.; Hill, K.

    1980-07-01

    The ASCOT data base management system is designed to handle the data produced by both the experimental and theoretical efforts of the DOE Atmospheric Studies in Complex Terrain (ASCOT) project. The data base envisioned is hierarchically structured, sparse, and compact. Information concerning any given data file is stored in a directory file. The data base management system uses a relational data management approach. Presently three management schema are being developed for use with the data base. 5 figures.

  8. Evaluating the "Healthy Diabetes" Caribbean Food Plate and Website Portal for Diabetes Prevention and Management: Results of an Online Study and Implications for Reducing Health Disparities

    ERIC Educational Resources Information Center

    Thomas, Nigel M.

    2013-01-01

    Given the challenge of cooking traditional Caribbean meals so they are consistent with the goals of diabetes prevention and management, the researcher created and evaluated a new website portal as e-health tailored to be culturally appropriate and teach the following: how to cook and prepare "Healthy Diabetes" Caribbean Plates. A social…

  9. Antiobesity pharmacotherapy for patients with type 2 diabetes: focus on long-term management.

    PubMed

    Jeon, Won Seon; Park, Cheol Young

    2014-12-29

    Type 2 diabetes and obesity have a complex relationship; obesity is linked to insulin resistance, the precursor to type 2 diabetes. The management of obesity is an important method to delay onset of diabetes and improve the glycemic durability of antidiabetic agents. However, insulin and some of the oral hypoglycemic agents used to treat diabetes cause significant weight gain, and it is difficult for patients with diabetes to reduce and maintain their weight by life-style changes alone. Thus, antiobesity medications or bariatric surgery may be a necessary adjunct for certain obese patients with diabetes. In 2012, the U.S. Food and Drug Administration (FDA) approved lorcaserin and phentermine/topiramate extended-release for the management of chronic weight, and approval for naltrexone/bupropion sustained-release as an adjunct to exercise and reduced caloric intake followed in 2014. Liraglutide is pending FDA approval for antiobesity drug. Here we review the efficacy of approved and new promising drugs for the management of obesity. PMID:25559569

  10. Antiobesity Pharmacotherapy for Patients with Type 2 Diabetes: Focus on Long-Term Management

    PubMed Central

    Jeon, Won Seon

    2014-01-01

    Type 2 diabetes and obesity have a complex relationship; obesity is linked to insulin resistance, the precursor to type 2 diabetes. The management of obesity is an important method to delay onset of diabetes and improve the glycemic durability of antidiabetic agents. However, insulin and some of the oral hypoglycemic agents used to treat diabetes cause significant weight gain, and it is difficult for patients with diabetes to reduce and maintain their weight by life-style changes alone. Thus, antiobesity medications or bariatric surgery may be a necessary adjunct for certain obese patients with diabetes. In 2012, the U.S. Food and Drug Administration (FDA) approved lorcaserin and phentermine/topiramate extended-release for the management of chronic weight, and approval for naltrexone/bupropion sustained-release as an adjunct to exercise and reduced caloric intake followed in 2014. Liraglutide is pending FDA approval for antiobesity drug. Here we review the efficacy of approved and new promising drugs for the management of obesity. PMID:25559569

  11. Using Electronic Health Record Systems in Diabetes Care: Emerging Practices.

    PubMed

    Veinot, Tiffany C; Zheng, Kai; Lowery, Julie C; Souden, Maria; Keith, Rosalind

    2010-01-01

    While there has been considerable attention devoted to the deployment of electronic health record (EHR) systems, there has been far less attention given to their appropriation for use in clinical encounters - particularly in the context of complex, chronic illness. The Department of Veterans' Affairs (VA) has been at the forefront of EHR adoption and, as such, provides a unique opportunity to examine a mature EHR system in widespread use. Moreover, with a high prevalence of diabetes in its patient population, the VA provides a useful platform for examining EHR use in the context of chronic disease care. We conducted a sequential, exploratory qualitative study at two VA Medical Centers in the Midwest. First, we conducted observations of 64 clinical consultations with diabetes patients. These observations involved 31 different health care providers. Second, using insights from these observations, we conducted in-depth, semi-structured interviews with 39 health care providers focusing on their use of information in diabetes patient care. Field notes and interview transcripts were analyzed using a grounded theory approach. Our analysis generated several categories of EHR use in clinical encounters: priming, structuring, assessing, informing, and continuing. We also outline some mismatches between EHR system design and VA diabetes care practices. We conclude by discussing implications of these emergent system uses for improving the software design of EHRs to better support chronic disease care, as well as for our understanding of the integration of technologies in health care. PMID:25264545

  12. Self-Management in Early Adolescence and Differences by Age at Diagnosis and Duration of Type 1 Diabetes

    PubMed Central

    Chao, Ariana; Whittemore, Robin; Minges, Karl E.; Murphy, Kathryn M.; Grey, Margaret

    2014-01-01

    Purpose The purpose of the study was to describe the frequency of diabetes self-management activities, processes, and goals among early adolescents. In addition, differences in self-management by age at diagnosis and duration of diabetes were explored. Methods A cross-sectional design was used to analyze baseline data from 320 adolescents with T1DM enrolled in a multisite clinical trial. Participants completed questionnaires on demographic/clinical characteristics and self-management. Results There was a transitional pattern of self-management with a high frequency of diabetes care activities, problem solving, and goals and variable amounts of collaboration with parents. After controlling for therapy type and age, youth with short diabetes duration reported performing significantly more diabetes care activities than individuals with a longer duration. Individuals with short diabetes duration had more frequent communication than individuals with a longer duration, which was associated with diagnosis in adolescence. Among those diagnosed as school age children, those with short diabetes duration reported significantly more diabetes goals than those with a longer duration. Conclusions A more specific understanding of self-management may help clinicians provide more targeted education and support. Adolescents with a long duration of diabetes need additional self-management support, particularly for diabetes care activities and communication. PMID:24470042

  13. A review and critical analysis of professional societies' guidelines for pharmacologic management of type 2 diabetes mellitus.

    PubMed

    Vigersky, Robert A

    2012-06-01

    The development of clinical practice guidelines (CPGs), which are promulgated by various sponsoring organizations to provide direction to clinicians for management of complex problems, generally adhere to a set of key principles. To reassure the users of their scientific and ethical validity, these include the use of a system to rate the quality of evidence on which the guideline is based and the divulgence of any conflicts of interest (COI) among members of the panel developing the guidelines. I analyzed the CPGs for pharmacologic management of patients with type 2 diabetes written by the two US professional societies that developed such guidelines (American Association of Clinical Endocrinologists [AACE] and the American Diabetes Association/European Association for the Study of Diabetes [ADA/EASD]) to assess their adherence to these principles of guideline development and to compare them with regard to simplicity, consideration of costs, and peer review status. To put the existence of COIs in these guidelines into context, I also reviewed the COIs from government-sponsored panels that developed diabetes CPGs. The results of this analysis suggest that both the AACE and ADA/EASD guidelines should be regarded as consensus documents rather than true CPGs, since neither guideline employed evidence grading. COI was extremely common among the members of both CPG panels from professional organizations, as well in the CPG panels with government sponsorship. In addition, the nature and extent of external peer review of these guidelines is unclear. Given these limitations, the AACE and ADA/EASD CPGs for diabetes management should be regarded as advisory at best, rather than prescriptive or authoritative, especially in view of their noncompliance with key principles of guideline development. PMID:22422437

  14. Systems management techniques and problems

    NASA Technical Reports Server (NTRS)

    1971-01-01

    Report is reviewed which discusses history and trends of systems management, its basic principles, and nature of problems that lend themselves to systems approach. Report discusses systems engineering as applied to weapons acquisition, ecology, patient monitoring, and retail merchandise operations.

  15. Integrated Management Tracking System

    Energy Science and Technology Software Center (ESTSC)

    2000-03-30

    The Integrated Management Tracking System (IMTS) is a "Web Enabled" Client/Server Business application that provides for the Identification and Resolution of commitments, situations, events and problems. The IMTS engine is written with Microsoft Active Server Pages (ASP) for IIS4. The system provides for reporting, entering, editing, closing and administration over a Intranet, Extranet or Internet. This Application facilitates: Electronic assignment, acceptance and tracking to completion. Email notifications of assigned action. Establishment of Due Dates. Electronicmore » search and retrieval based on keywords in combination with user specified database parameters (Document Type, Date Ranges, etc.). Coded for Trending and Reporting. User selected reports. Various levels of access for reports and administration. The "Server" side of this application consists of a Microsoft Access database running on a NT Server with Internet Information Server (IIS). As the "Client" side of the application runs on any Web browser, this solution is a cost effective, user friendly application that lends itself to organizations not physically colocated in one location providing information immediately available to everyone at once.« less

  16. Integrated Management Tracking System

    SciTech Connect

    Garrett, Terrance

    2000-03-30

    The Integrated Management Tracking System (IMTS) is a "Web Enabled" Client/Server Business application that provides for the Identification and Resolution of commitments, situations, events and problems. The IMTS engine is written with Microsoft Active Server Pages (ASP) for IIS4. The system provides for reporting, entering, editing, closing and administration over a Intranet, Extranet or Internet. This Application facilitates: Electronic assignment, acceptance and tracking to completion. Email notifications of assigned action. Establishment of Due Dates. Electronic search and retrieval based on keywords in combination with user specified database parameters (Document Type, Date Ranges, etc.). Coded for Trending and Reporting. User selected reports. Various levels of access for reports and administration. The "Server" side of this application consists of a Microsoft Access database running on a NT Server with Internet Information Server (IIS). As the "Client" side of the application runs on any Web browser, this solution is a cost effective, user friendly application that lends itself to organizations not physically colocated in one location providing information immediately available to everyone at once.

  17. Management of limited joint mobility in diabetic patients

    PubMed Central

    Abate, Michele; Schiavone, Cosima; Salini, Vincenzo; Andia, Isabel

    2013-01-01

    Several rheumatologic manifestations are more pronounced in subjects with diabetes, ie, frozen shoulder, rotator cuff tears, Dupuytren’s contracture, trigger finger, cheiroarthropathy in the upper limb, and Achilles tendinopathy and plantar fasciitis in the lower limb. These conditions can limit the range of motion of the affected joint, thereby impairing function and ability to perform activities of daily living. This review provides a short description of diabetes-related joint diseases, the specific pathogenetic mechanisms involved, and the role of inflammation, overuse, and genetics, each of which activates a complex sequence of biochemical alterations. Diabetes is a causative factor in tendon diseases and amplifies the damage induced by other agents as well. According to an accepted hypothesis, damaged joint tissue in diabetes is caused by an excess of advanced glycation end products, which forms covalent cross-links within collagen fibers and alters their structure and function. Moreover, they interact with a variety of cell surface receptors, activating a number of effects, including pro-oxidant and proinflammatory events. Adiposity and advanced age, commonly associated with type 2 diabetes mellitus, are further pathogenetic factors. Prevention and strict control of this metabolic disorder is essential, because it has been demonstrated that limited joint motion is related to duration of the disease and hyperglycemia. Several treatments are used in clinical practice, but their mechanisms of action are not completely understood, and their efficacy is also debated. PMID:23690694

  18. Barriers to Self-Management of Serious Mental Illness and Diabetes

    PubMed Central

    Blixen, Carol E.; Kanuch, Stephanie; Perzynski, Adam T.; Thomas, Charles; Dawson, Neal V.; Sajatovic, Martha

    2016-01-01

    Objectives Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices. Methods In-depth interviews were conducted with 20 subjects who had diagnoses of both SMI and DM. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. Results Transcript-based analysis generated 3 major domains of barriers to disease self-management among patients with both DM and SMI: (1) personal level barriers (stress, isolation, stigma); (2) family and community level barriers (lack of support from family and friends); and (3) provider and health care system level barriers (poor relationships and communication with providers, fragmentation of care). Conclusions Care approaches that provide social support, help in managing stress, optimize communication with providers, and reduce compartmentalization of medical and psychiatric care, are needed to help these vulnerable individuals avoid health complications and premature mortality. PMID:26931751

  19. Using Simulation Technology to Teach Diabetes Care Management Skills to Resident Physicians

    PubMed Central

    Sperl-Hillen, John; O’Connor, Patrick; Ekstrom, Heidi; Rush, William; Asche, Stephen; Fernandes, Omar; Appana, Deepika; Amundson, Gerald; Johnson, Paul

    2013-01-01

    Background Simulation is widely used to teach medical procedures. Our goal was to develop and implement an innovative virtual model to teach resident physicians the cognitive skills of type 1 and type 2 diabetes management. Methods A diabetes educational activity was developed consisting of (a) a curriculum using 18 explicit virtual cases, (b) a web-based interactive interface, (c) a simulation model to calculate physiologic outcomes of resident actions, and (d) a library of programmed feedback to critique and guide resident actions between virtual encounters. Primary care residents in 10 U.S. residency programs received the educational activity. Satisfaction and changes in knowledge and confidence in managing diabetes were analyzed with mixed quantitative and qualitative methods. Results Pre- and post-education surveys were completed by 92/142 (65%) of residents. Likert scale (five-point) responses were favorably higher than neutral for general satisfaction (94%), recommending to colleagues (91%), training adequacy (91%), and navigation ease (92%). Finding time to complete cases was difficult for 50% of residents. Mean ratings of knowledge (on a five-point scale) posteducational activity improved by +0.5 (p < .01) for use of all available drug classes, +0.9 (p < .01) for how to start and adjust insulin, +0.8 (p < .01) for interpreting blood glucose values, +0.8 (p < .01) for individualizing treatment goals, and +0.7 (p < .01) for confidence in managing diabetes patients. Conclusions A virtual diabetes educational activity to teach cognitive skills to manage diabetes to primary care residents was successfully developed, implemented, and well liked. It significantly improved self-assessed knowledge and confidence in diabetes management. PMID:24124951

  20. [The management of diabetic retinopathy and diabetic macular edema; joint forces fight for sight].

    PubMed

    Chronopoulos, Argyrios; Roquelaure, Daniel; Jacquier, Paul; Souteyrand, Georges; Matter, Michel; Thumann, Gabriele

    2015-12-16

    Despite the considerable progress in prevention and treatement options since the first big epidemiologic studies in the 80's, diabetic retinopathy still represents the primary cause of blindness in the working age population. The intensified prevention efforts that took place recentyears did show hopeful results as the incidence of diabetic retinopathy seems to decline. However a still considerable number of patients does not meet metabolic or treatment recommandations. In the aftermath of an ongoing globalisation and growing urbanisation of the society, there is an even bigger need of understanding the disease as well as improving prevention and treatment guidelines. PMID:26852554