scholarly journals Breaking Therapeutic Inertia in Type 2 Diabetes: Active Detection of In-Patient Cases Allows Improvement of Metabolic Control at Midterm

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Anna M. Lucas Martín ◽  
Elena Guanyabens ◽  
R. Zavala-Arauco ◽  
Joaquín Chamorro ◽  
Maria Luisa Granada ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Metabolic Control ◽  
Hospitalized Patients ◽  
Therapeutic Inertia ◽  
Therapeutic Algorithm ◽  
Fasting Glycaemia ◽  
Active Detection

Type 2 diabetes (T2D) exists in 25–40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittanceHbA1cwas 7.7 ± 1.5%; 47% (189) hadHbA1c≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their currentHbA1c. Ninety-four of the 189 SCGC patients were evaluated 3–6 months later. TheirHbA1cbefore in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P<0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia.

scholarly journals Improving Glycaemic Control in Patients with Type 2 Diabetes Mellitus through A Peer Support Instant Messaging Service Intervention (Diabpeers): Study Protocol for a Randomized Controlled Trial

2021 ◽  
Author(s):  
Elisabeth Höld ◽  
Johanna Grüblbauer ◽  
Martin Wiesholzer ◽  
Daniela Wewerka-Kreimel ◽  
Stefan Stieger ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycaemic Control ◽  
Standard Therapy ◽  
Instant Messaging ◽  
Self Management ◽  
Diabetes Therapy

Abstract Background: the context and purpose of the studyDiabetes mellitus is one of the four priority non-communicable diseases worldwide. It can lead to serious long-term complications and produces significant costs. Due to the chronicle character of the disease, it requires continuous medical treatment and good therapy adherence of those suffering. Therefore, diabetes self-management education (DSME) (and support DSMES) plays a significant role to increase patient’s self-management capacity and improve diabetes therapy. Research indicates that these outcomes might be difficult to maintain. Consequently, effective strategies to preserve the positive effects of DSMES are needed. Preliminary results show that peer support, which means support from a person who has experiential knowledge of a specific behaviour or stressor and similar characteristics as the target population, is associated with better outcomes in terms of HbA1c, cardiovascular disease risk factors or self-efficacy at lower cost compared to standard therapy. Peer-supported instant messaging services (IMS) approaches have significant potential for diabetes management because support can be provided easily and prompt, is inexpensive, and needs less effort to attend compared to standard therapy. The major objective of the study is to analyse the impact of a peer-supported IMS intervention in addition to a standard diabetes therapy on the glycaemic control of type 2 diabetic patients. Methods: how the study will be performedA total of 205 participants with type 2 diabetes mellitus will be included and randomly assigned to intervention or control group. Both groups will receive standard therapy, but the intervention group will participate in the peer-supported IMS intervention, additionally. The duration of the intervention will last for seven months, followed by a follow-up of seven months. Biochemical, behavioural and psychosocial parameters will be measured before, in the middle, and after the intervention as well as after the follow-up.Discussion: a brief summary and potential implicationsDiabetes mellitus type 2 and other non-communicable diseases put healthcare systems worldwide to the test. Peer-supported IMS interventions in addition to standard therapy might be part of new and cost-effective approaches to support patients independent from time and place.Trial registration: If your article reports the results of a health care intervention on human participants, it must be registered in an appropriate registry and the registration number and date of registration should be in stated in this section. If it was not registered prospectively (before enrollment of the first participant), you should include the words 'retrospectively registered'. See our editorial policies for more information on trial registration.ClinicalTrials.gov Identifier: NCT04797429Date of registration: 15 March 2021

scholarly journals Depression and microvascular complications predict poor goal achievement among Colombian patients with type 2 diabetes

2017 ◽  
Vol 3 (2) ◽  
pp. 36-47
Author(s):  
Catalina Sanmiguel ◽  
María C. Luna ◽  
William Kattah ◽  
Carlos O. Mendivil
Keyword(s):  
Type 2 Diabetes ◽  
Metabolic Control ◽  
Latin American ◽  
Diabetes Management ◽  
Microvascular Complications ◽  
Good Control ◽  
Therapeutic Success ◽  
Poor Metabolic Control

Aims: Many patients with type 2 diabetes (DM2) in Latin American countries remain insufficiently controlled. We aimed to identify factors associated with persistent poor metabolic control in Colombian patients with DM2.Methods: Retrospective one-year follow-up cohort study of adult patients with DM2. The primary outcome was persistent poor metabolic control (PPMC): HbA1c level >8% in all measurements during follow-up. Secondary outcomes were intermittent poor metabolic control (IPMC) and good control (GC: simultaneous achievement of HbA1c, blood pressure and LDL cholesterol goals). Multiple demographic, clinical and laboratory variables were predictors in multivariable logistical models. Results: Of 399 patients included, 50 had the primary endpoint during follow-up. Older age was negatively associated with PPMC (OR 0.40, 95%CI 0.17-0.92 for extreme quartiles), even after multivariate adjustment. Depression and the presence of multiple microvascular complications were strongly associated with the secondary endpoint IPMC (multivariate OR respectively 4.2, 95%CI 1.08-16.4 for depression; 5.61, 95%CI 1.03-30.6 for microvascular complications). Being unemployed was associated with significantly less odds of achieving GC (multivariate OR 0.19, 95%CI 0.04-0.95). Conclusions: Age, depression, the presence of microvascular complications and employment status were associated with the success or failure of diabetes management. These factors were better correlates of therapeutic success than the pharmacological agent employed.

scholarly journals Achievement of Target Glucose Level among Newly Diagnosed Type 2 Diabetes Mellitus Patients in Public Teaching Hospitals in Addis Ababa, Ethiopia: a retrospective chart review

2021 ◽  
Author(s):  
Tigist Workneh Leulseged
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Chart Review ◽  
Addis Ababa ◽  
Retrospective Chart Review ◽  
Teaching Hospitals ◽  
Target Glucose

Abstract Background Diabetes is a chronic illness that requires continuous medical care to reach target glycaemic level to prevent complications. Most studies around the world have showed that glycaemic control among type 2 diabetes mellitus (T2DM) patients is poor using measurements taken at one point and including all patients irrespective of the duration of illness. This study aimed to assess achievement of optimal glycaemic control at different points in time in relation to the time of diagnosis and initiation of treatment and to identify associated factors among T2DM patients attending diabetes clinic of public teaching hospitals in Addis Ababa, Ethiopia. Methods A retrospective chart review was conducted from May to July 2018 among randomly selected 685 medical charts of patients who were on follow-up from January, 2013 to December, 2017. Association was assessed using Binary logistic regression, where 95% CIs for odds ratio and P-values were used for testing significance and interpretation of results. Results The prevalence of optimal glycaemic control among T2DM patients at the end of 3 months, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years of diagnosis and treatment were 1.9%, 44.7%, 52.8%, 66.3%, 69.2%, 70.2% and 70.5% respectively. The significant factors were age group and type of treatment regimen. Conclusions Achievement of optimal glycaemic control increases as the follow-up duration increases; it was only 1.9% at the third month and 70.5% at the fifth year of observation. Close to one third of patients (29.5%) did not achieve target glucose even after five years and were at the verge of increased risk for diabetes related complications and death. Attention should be given to the time when patients achieve target glucoses level instead of just measuring the number of individuals who achieved glycaemic control in a short observation period.

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