The management of type 1 diabetes: more than just glycaemic control? (original) (raw)
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Clinical science: Type 1 diabetes
Diabetic Medicine
In the short term, continuous subcutaneous insulin infusion (CSII) has been associated with improved glycaemic control, reduced hypoglycaemia and improved quality of life (QOL). However, there limited data available on the long-term benefits. We aimed to assess the long-term impact of CSII use at Derby Teaching Hospitals on long term outcomes. Method: Patient-level data were obtained from the hospital electronic records for 258 CSII users at the Royal Derby Hospital. Patient-confidence and satisfaction questionnaires were sent by post. A likert scale was used to assess confidence in aspects of selfmanagement and quality of life. STATA v.13 was used for data analysis. Descriptive and comparative statistics were conducted to explore clinical outcomes using Pearson's Chi-square and student t-tests. Results: The mean age was 43.9 AE 13.4 years, baseline: HbA1c 9.2 AE 2.0%. There was a significant overall reduction in HbA1c from 9.3 AE 2.0% at baseline, to 8.5 AE 1.3% and 8.2 AE 1.3% at six month and six years respectively (mean diff:-0.87%; 95% CI:-1.12 to-0.61; p < 0.0001 at six years). Majority (75.6%) of the CSII users had a baseline HbA1c > 8.5%. This subgroup experienced greater reduction in HbA1c (mean diff:-1.39%; 95% CI:-1.66 to-1.11; p < 0.0001). A total pf 119 (46%) responded to the survey and 94.2% (114) reported an improved QOL; reduction in the frequency of hypoglycaemia (n = 95; 79.8%) and general satisfaction with the quality of care received in the insulin pump service (85.7%, n = 102). Conclusion: CSII therapy led to a sustained long-term improvement in glycaemic control in addition to improved quality of life and reduced self-reported hypoglycaemia in our centre.
Diabetes Care: "Taking It to the Limit One More Time
Diabetes care, 2017
With this January 2017 issue, our editorial team celebrates its 5-year anniversary at the helm of Diabetes Care. In 2012, when we accepted the assignment to oversee the scientific aspects of the journal, we envisioned that the editorial for this January 2017 issue would be our opportunity to thank the American Diabetes Association (ADA) for allowing us to lead this effort, to thank our reviewers and associate editors for their tireless efforts, and to thank the readers for their valuable suggestions and ideas. However, we are now writing to inform you that those plans have been put on hold. Our editorial team has been given the opportunity to continue to guide Diabetes Care for another 2-year period. We have accepted the invitation primarily because our "team" (including the editorial committee, editorial office, and publications staff) feels we still have creative ideas to make the journal better and considerable energy to bring these ideas to fruition. Therefore, suffice it to say, we remain honored to continue to lead Diabetes Care for this extended period. It has been our custom to summarize our productivity and achievements in both the January and June issues of each year. This year we believe the trajectory of quality continues to rise. We hope you will also agree when reading the summary presented in this narrative. We feel each year's monthly issues have surpassed the prior year's work, and year 2016 is no exception! As we described in July of 2016, we aim to provide the readers with lagniapped"a little something extra"! (1). This past year the editorial team took our initiative to another level devoting several monthly issues to specific clinical or research topics. A current summary of all thematic monthly issues can be found in our Diabetes Care Online Collections (http://care.diabetesjournals.org/content/diabetes-care-online-collections). In the past year alone, we have published collections of articles on six particular topics. The January 2016 issue focused on gestational diabetes mellitus, the May issue on diabetes and cardiovascular disease, the July issue on the artificial pancreas, and the November issue on precision medicine. Two monthly special issues were particularly noteworthy as they provided a "first" in each particular field. The December 2016 issue of Diabetes Care presented nine articles on a broad spectrum of behavioral and psychosocial issues that can influence treatment success and quality of life for people living with diabetes (2). Central to this topic, and serving as the cornerstone of that issue, was the first Position Statement from the ADA for the psychosocial care of people with diabetes (3). Another "first" was presented in the June issue, which featured 12 articles supporting bariatric/metabolic surgery as a new treatment option in the management of type 2 diabetes (4). The centerpiece of this collection was a contribution from Rubino et al. (5), writing on behalf of 48 voting delegates from the 2nd Diabetes Surgery Summit (DSS-II). This international consensus conference, organized in collaboration with major diabetes organizations, proposed new evidence-based guidelines for surgical treatment of type 2 diabetes, the first in over 20 years of experience. The report summarized a large body of evidence demonstrating that several gastrointestinal operations, originally designed to promote weight loss, improved glucose homeostasis more effectively than any current pharmaceutical or behavioral approach and led to sustained improvement of glycemic control in many patients with type 2 diabetes (5). Diabetes Care was honored to be the journal chosen to disseminate these important and new treatment guidelines, which promise to help medical providers and patients alike in assessing treatment options!
Diabetic patients served at a regional level hospital-what is their clinical picture?
We describe the demographics, diabetic characteristics, diabetic control and complications in the diabetes service in Edendale Regional Hospital, Pietermaritzburg, in this study. Diabetes mellitus, together with its complications, is increasing at an alarming rate worldwide. Good glycaemic control translates into lower long-term complications and longer life expectancy. Previous studies performed in both the public and the private sectors have demonstrated that there is suboptimal diabetic control in South Africa.
Madridge Journal of Nursing, 2017
Diabetes has been among the leading causes of mortality, morbidity and disability around the world. Literature indicates that patient education is vital for diabetes control and management. However, research has shown that nurses' (who are at the forefront of care) knowledge of diabetes is variable and not sufficient in the researched populations. This study sought to identify and describe the level of diabetes knowledge and the management of hypoglycaemia and hyperglycaemiaamong nursing staff of a tertiary teaching hospital in South Australia. A descriptive study design was used with structured observation to gather data on blood glucose monitoring practice and a survey to obtain information on the level of knowledge of diabetes as data collection methods. A convenience sample of nurses, who were directly involved in the provision of care for diabetic patients was observed during blood glucose monitoring and were given a questionnaire to be completed. Approval for the study was gained from the hospital's Research Ethics Committee. The observation checklist and the survey questionnaire were scored by hand and entered into SPSS and reviewed for data entry accuracy. Descriptive statistics were used to summarize the data. Non-parametric statistics were used to compare the knowledge scores between the mentioned groups since the data were not normally distributed. Pearson product-moment coefficient was used to describe the strength and direction of correlation between selected variables. Twenty nurses completed the questionnaire and 32 nurses were observed during their practice. The results of this study showed that the demographic data were not correlated with higher knowledge scores or higher observation scores. However, a statistically significant, positive correlation was found between hospital accreditation for blood glucose monitoring and practices score. It is recommended that this study be replicated in other units of the hospital to see whether the same results could be achieved.