scholarly journals Evaluation of the Association of CGM Metrics with Antihyperglycemic Drugs in Insulin-Treated Diabetics

2021 ◽  
pp. 1-6
Author(s):  
Toshiyuki Horiuchi ◽  
Junichiro Adachi ◽  
Yoshihiro Sekiguchi ◽  
Akiko Kanamaru
Keyword(s):  
Insulin Therapy ◽  
Combined Therapy ◽  
Insulin Dose ◽  
Multivariable Analysis ◽  
Glucose Monitoring ◽  
Density Lipoprotein ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Diabetic Type ◽  
Logistic Analysis

<b><i>Introduction:</i></b> Intermittent flash glucose monitoring (FGM) and real-time continuous glucose monitoring (CGM) are used to monitor glycemic excursions for 14 days and can demonstrate time in range (TIR), time above range (TAR), and time below range (TBR). The utility of CGM metrics, such as TIR, TBR, and TAR, in diabetics treated with insulin combined with antihyperglycemic drugs is uncertain. <b><i>Methods:</i></b> In a cross-sectional and retrospective study, we investigated the relationship between target metrics from CGM/FGM and HbA1c or glucose variabilities in 80 type 1 and 2 diabetic patients receiving insulin treatment with ≥1 injections per day. The proportions of TIR, TAR, and TBR from FGM in relation to HbA1c and coefficient of variation (CV)% in types 1 and 2 diabetics were analyzed. Multivariable analyses were performed regarding the associations of TIR with biochemical factors and glycemic variabilities. TBR was also examined in relation to antidiabetic agents and diabetic type in multiple regression analyses. Finally, the association of retinopathy with FGM-CGM metrics was examined using a logistic analysis. <b><i>Results:</i></b> When patients were grouped by sex and diabetic type, significant differences in age, TIR, TBR, high-density lipoprotein cholesterol (HDLC), and insulin dose were detected using Kruskal-Wallis analyses. HbA1c significantly correlated with TIR (<i>p</i> &#x3c; 0.001) and TAR (<i>p</i> &#x3c; 0.001) using Pearson’s correlation analysis. TBR significantly correlated with CV% (<i>p</i> &#x3c; 0.001). Multivariable analysis of TIR showed a significant negative association with HbA1c (<i>p</i> = 0.02). Incretin combined with insulin therapy reduced the TBR proportion significantly according to the multivariate analysis. Retinopathy tended to be related to HbA1c (<i>p</i> = 0.059) and duration (<i>p</i> = 0.078) but not TIR (<i>p</i> = 0.891), according to the logistic analysis. <b><i>Conclusions:</i></b> These results demonstrate that CGM metrics reflect glucose control for 2 weeks using TIR. In addition, combined therapy with incretin and insulin therapy is superior for reducing hypoglycemia, based on TBR. Thus, TBR is also useful for monitoring hypoglycemia. However, FGM/CGM metrics do not predict retinopathy accurately.

scholarly journals Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals

2018 ◽  
Vol 35 (1) ◽  
Author(s):  
Iqra Arshad ◽  
Sara Mohsin ◽  
Sana Iftikhar ◽  
Tahseen Kazmi ◽  
Luqman F. Nagi
Keyword(s):  
Insulin Therapy ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Early Initiation ◽  
P Value ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Creative Commons ◽  
Oral Medications ◽  
Tertiary Care Hospitals

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic. Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17. Results: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years). Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe. How to cite this:Arshad I, Mohsin S, Iftikhar S, Kazmi T, Nagi LF. Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.237 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals The relationship between high-density lipoprotein cholesterol (HDL-C) and glycosylated hemoglobin in diabetic patients aged 20 or above: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rui Huang ◽  
Li Yan ◽  
Yuhua Lei
Keyword(s):  
Glycemic Control ◽  
Interaction Analysis ◽  
Glycosylated Hemoglobin ◽  
Density Lipoprotein ◽  
Cross Sectional Study ◽  
Cerebrovascular Diseases ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Race Ethnicity ◽  
The Relationship

Abstract Aim The incidence rate of diabetes is increasing year by year, seriously threatening human health. As a predictor of glycemic control, glycated hemoglobin is reported to be related to various complications and prognoses of diabetes. Besides, HDL-C dyslipidemia is a component of metabolic syndrome and may be related to various cardiovascular and cerebrovascular diseases. The principal objective of this project was to investigate the relationship between HDL-C and glycosylated hemoglobin in adult diabetic patients. Methods A total of 3171 adult diabetic patients aged 20 years and above were included in the present study from the National Health and Nutrition Examination Survey (NHANES). HDL-C and glycosylated hemoglobin were regarded as independent and dependent variables, respectively. EmpowerStats software and R (version 3.4.3) were used to examine the association between HDL-C and glycosylated hemoglobin. Results HDL-C was inversely associated with glycohemoglobin after adjusting for other covariates (β = − 0.004, 95% CI:− 0.008 to − 0.000, p = 0.044). Race/ethnicity and age were considered the most prominent interactive factors that affect the relationship between HDL and glycosylated hemoglobin by the interaction analysis. A U-shaped association was detected between HDL-C and glycosylated hemoglobin for people of other race/ethnicity or aged 60 and above, which had an inflection point of HDL-C at 60 mg/dL. In contrast, we observed an inverted U-shaped distribution between HDL-C and glycosylated hemoglobin in people under 40 with point of inflection located at 60 mg/dL as well. Conclusions HDL-C in diabetic patients is inversely associated with glycosylated hemoglobin and may be relevant to glycemic control. However, a U-shaped relationship was also observed in a certain kind of people, which implied that, though HDL-C is considered as metabolism and anti-atherogenic property, for diabetics, it is not the higher, the better.

scholarly journals Clinical Presentation and Biochemical Abnormalities in Patients Presented with Diabetic Ketoacidosis in BIRDEM Hospital

2017 ◽  
Vol 5 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Suraiya Nazneen ◽  
Fatema Ahmed ◽  
SM Ashrafuzzaman ◽  
Khwaja Nazim Uddin ◽  
ASM Areef Ahsan ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Clinical Presentation ◽  
Insulin Dose ◽  
Respiratory Pattern ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Severe Hyponatraemia ◽  
Age Range ◽  
Time Of Admission ◽  
Biochemical Abnormalities

Objective: To see the clinical presentation and biochemical abnormalities in hospitalized patients of Diabetic ketoacidosis.Methodology: This cross sectional observational study was carried enrolling 55 subjects with Diabetic ketoacidosis, in the Department of Medicine, BIRDEM General Hospital, Dhaka, over a period of six months starting from April 2013 to September 2013.Results: The mean age was 48.35±16.76 with age range from 30 to 68 years. Infection (pneumonia, urinary tract infection, cellulitis) 22(40%), omission of insulin or drugs 14 (25.4%), myocardial infarction 5(9.0%), and reduction of insulin dose 3(5.4%) worked as precipitating cause.Most patients had drowsiness 16(29.0%), moderate dehydration 30(55.5%), signs of infection 22(40%). About 13(23.56%) had Kussmaul’s type of respiratory pattern. Other signs were less obvious. Majority of the subjects 40(72.7%) had 3+ ketonuria at the time of admission in hospital. About 32(58.1%) of the known diabetic patients were on insulin from the beginning of their diagnosis.19 (34.4%) were initially on OHA followed by insulin and 14 (25.4%) patients took OHA alone.7 patients were on dietary modification and exercise without any drugs. Majority 52 (96.46%) patients had blood sugar level between 21-34 mmol/l and mean HbA1c was 12.31(SD±2.50).About 4(7.2%) patients had severe hyponatraemia and 22(40%) patients had hypokalaemia. Eight (14.5%) patients had severe acidosis while 18(32.7%) patients had only mild acidosis. Most of the subjects 29(52.7%) had moderate acidosis. Complete cure from DKA was observed in 53(96.3%) subjects. Only 2(3.6%) subjects developed cerebral oedema. It took 4 to 5 days in mild group, 6 to 8 days in moderate DKA and more than 9 days in severe DKA for recovery.Conclusion: From the study result it could be concluded that infection control and regular administration of insulin or control of diabetes and proper Diabetes Self Management Education (DSME) can prevent diabetic ketoacidosis.Bangladesh Crit Care J March 2017; 5(1): 7-10

scholarly journals Predictive Value of Oxidized Low-Density Lipoprotein/β2-Glycoprotein-I Complexes (oxLDL/β2GPI) in Nonautoimmune Atherothrombosis

2018 ◽  
Vol 24 (7) ◽  
pp. 1050-1055
Author(s):  
Paul R. J. Ames ◽  
Giuseppe Di Girolamo ◽  
Giovanna D’Andrea ◽  
Luis R. Lopez ◽  
Giovanni Gaeta ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Multivariable Analysis ◽  
Density Lipoprotein ◽  
Cell Types ◽  
Low Density ◽  
Oxidized Low Density Lipoprotein ◽  
Cross Sectional ◽  
Lipid Status ◽  
Glycoprotein I ◽  
Fourth Quartile

Introduction: Lipid oxidation is a definite feature of atherosclerosis, and oxidized low-density lipoprotein (oxLDL) is not only highly immunogenic but toxic to several cell types. Beta-2-glycoprotein-I (β2GPI) dampens oxLDL toxicity by forming binary oxLDL/β2GPI complexes. We evaluated whether circulating oxLDL/β2GPI complexes are associated to atherosclerosis-related events (ARE) and to venous thromboembolism (VTE). Methods: In a cross-sectional case–control study, cases were (a) 57 consecutive patients (male/female [M/F] 33/24, mean age 57 [10] years) attending a thrombosis unit for ARE (myocardial infarction [MI] n = 20, peripheral vascular disease n = 7, and ischemic strokes n = 30); (b) 52 consecutive patients (M/F 22/30, mean age 55 [17] years) attending the same unit for unprovoked (VTE); (c) normal controls comprised 90 participants (M/F 35/55, mean age 41 [15] years); and (d) oxLDL/β2GPI complexes were measured by immunoassay and resulting levels divided into quartiles. Results: The odds ratio (OR) of ARE was greater in the fourth and second quartiles than in the first quartile (8.5 and 6.0, respectively); the OR of developing MI was greatest in the fourth quartile (17.8). By multivariable analysis with age, sex, smoking, lipid status, statin, and ARE phenotypes as independent variables and oxLDL/β2GPI as the dependent variable, only MI predicted oxLDL/β2GPI ( P < .0001). Conclusions: OxLDL/β2GPI may be regarded as a marker of ARE, in particular of MI.

scholarly journals Comparison of ox-LDL Levels in Diabetic Patients with Normo-, Micro-, and Macroalbuminuria with Their First Degree Relatives and the Healthy Control Group

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Parisa Behzadi ◽  
Firouzeh Torabi ◽  
Massoud Amini ◽  
Ashraf Aminorroaya
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cross Sectional Study ◽  
Control Group ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
First Degree Relatives ◽  
Significant Difference ◽  
Healthy Control ◽  
And Control

Oxidized low density lipoprotein (ox-LDL) is a product of oxidative stress. In this cross-sectional study, we compared the ox-LDL concentrations in diabetic patients with normoalbuminuria (n=28), microalbuminuria (n=28), and macroalbuminuria (n=28) with their first degree relatives (n=28) and healthy control people (n=31). They were selected by consecutive patient selection method. The ox-LDL level was assayed using ELISA. We measured blood pressure, lipid profile, fasting plasma glucose (FPG), and HbA1c in all groups. There was no significant difference in ox-LDL concentrations among normoalbuminuric, microalbuminuric, and macroalbuminuric diabetic groups. In diabetic patients with micro- and macroalbuminuria, ox-LDL concentration was higher than their first degree relatives (P=0.04andP=0.03) and control group (P=0.001andP=0.03, resp.). In normoalbuminuric diabetic persons, ox-LDL concentration was just higher than that of healthy people (P=0.02). There was no statistically significant difference in ox-LDL levels between normoalbuminuric diabetic patients and their first degree relatives. In conclusion, the presence and progression of albuminuria in diabetic patients are not related to ox-LDL concentration and genetic predisposition influences the plasma OX-LDL level. Larger sample size is needed to confirm this conclusion in future studies.

scholarly journals Study of awareness of insulin usage in diabetics attending NRI Medical College and General Hospital

2017 ◽  
Vol 7 (1) ◽  
pp. 59
Author(s):  
Jagadeesh A. ◽  
Ravi Shankar K. ◽  
Krishnakanth K.
Keyword(s):  
Insulin Therapy ◽  
Tertiary Care ◽  
Disease Process ◽  
Type Ii Diabetes Mellitus ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Diabetes Treatment ◽  
Cross Sectional ◽  
High Blood Glucose ◽  
Family History Of Diabetes

Background: India had 69.2 million diabetic patients. Insulin is an important part of diabetes treatment, but one-third of patients fail to take their insulin as prescribed, and many adults intentionally skip their doses. Since, diabetes treatment continues for lifetime, there is a need to assess the knowledge and understanding of patients in relation to their disease process and its management.Methods: A cross sectional, observational, knowledge and attitude survey were carried on patients with type II diabetes mellitus who are taking insulin therapy and attended medicine diabetes OPD in tertiary care Hospital during the period of April 2017 to Dec 2017. 200 diabetic patients’ ≥18 years of age who were willing to respond to the study questionnaire were interviewed.Results: Total of 200 study participants were interviewed using structured questionnaires, almost 75 (37.5%) of the respondents were age group of 41 - 50 years. 109 (54.5 %) male, 67 (33.5%)Hindus, 121 (60.5 %) married,79 (39.5%) were primary school, 120 (73.8%) were family history of diabetes, duration of treatment1-3 years 72 (31.5 %), 160 (63%) of the study subjects know about diabetes is high blood glucose, 119(59.5%)of subjects know complications of diabetes, 165(82.5%) were know about insulin used for diabetes, 115 (57.5%) of patients know other substitute for insulin, 94 (47%) of the study subjects have knowledge of complications of insulin therapy, 85 (42.5) were know different types of insulin preparations, 141 (70.5%) were know insulin is mandatory in some patients,159 (79.5%) were understood the route of administration of insulin.Conclusions: The finding of present study showed that, diabetes patients had average knowledge and less favourable attitude among diabetic patients toward insulin therapy.

scholarly journals PERBANDINGAN ANTARA KADAR KALIUM SERUM DENGAN ATAU TANPA TERAPI INSULIN PADA PASIEN DIABETES MELLITUS TIPE 2

2018 ◽  
Vol 15 (3) ◽  
pp. 95
Author(s):  
Andi Syamsudduha ◽  
S. V Sembiring ◽  
R DN Pakasi
Keyword(s):  
Serum Level ◽  
Insulin Therapy ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Fisher Exact Test ◽  
Diabetic Mellitus ◽  
Cross Sectional ◽  
Exact Test ◽  
Type 2 Dm

Diabetic patients can suffer from hipokalemia because of prolonged osmotic diuretic and management diabetic mellitus with insulinif does not associate with kalium intake. The aimed of this study was to evaluate kalium serum level on type 2 DM, and comparisonof kalium serum level on type 2 DM patients with or without insulin therapy. A cross-sectional study was done on 33 patiens type 2diabetic mellitus that admission on Stella Maris Hospital who examined kalium serum level. The data were colected from Medical Recordperiode January to December 2007. Data were analyzed with Fisher Exact test using SPSS versi 11.5. From 33 samples found normalkalium level 9 samples (27.3%) and decreased 6 samples (18.2%) and without insulin therapy found decresed 3 samples (9.1%) andnormal Kalium level 15 samples (45.5%). Comparison of Kalium serum level of type 2 DM patiens with or without insulin therapydid not statistically significant with P = 0.135. Kalium serum level of type 2 DM patiens with or without insulin therapy commonly inreference value.

scholarly journals Association of the Monocyte–to–High-Density Lipoprotein Cholesterol Ratio With Diabetic Retinopathy

2021 ◽  
Vol 8 ◽  
Author(s):  
Xixiang Tang ◽  
Ying Tan ◽  
Yi Yang ◽  
Mei Li ◽  
Xuemin He ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Macular Oedema ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Diabetic Patients ◽  
Healthy Controls ◽  
Cross Sectional

Background: Chronic inflammation in type 2 diabetes mellitus (T2DM) is an essential contributor to the development of diabetic retinopathy (DR). The monocyte–to–high-density lipoprotein cholesterol (HDL-C) ratio (MHR) is a novel and simple measure related to inflammatory and oxidative stress status. However, little is known regarding the role of the MHR in evaluating the development of DR.Methods: A total of 771 patients with T2DM and 607 healthy controls were enrolled in this cross-sectional study. MHR determination and eye examination were performed. The association of MHR with the prevalence of DR in T2DM patients was analyzed.Results: The MHR in patients with DR was significantly higher than that in both non-DR diabetic patients (P &lt; 0.05) and healthy controls (P &lt; 0.01). No significance was observed in the MHR of different DR severity grades. Moreover, the MHR was similar between patients with non-macular oedema and those with macular oedema. Logistic regression analysis demonstrated that MHR was independently associated with the prevalence of DR in diabetic patients [odds ratio (OR) = 1.438, 95% confidence interval (CI): 1.249–1.655, P &lt; 0.01]. After additional stratification by HbA1c level and diabetic duration, the MHR was still independently associated with the prevalence of DR.Conclusions: Our study suggests that the MHR can be used as a marker to indicate the prevalence of DR in patients with T2DM.

scholarly journals Association of high density lipoprotein levels with advancing age in type 2 diabetes patients in Tertiary Hospital.

2019 ◽  
Vol 26 (09) ◽  
pp. 1471-1476
Author(s):  
Shahzad Alam Khan ◽  
Iqra Imtiaz
Keyword(s):  
Type 2 Diabetes ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
P Value ◽  
Diabetic Patients ◽  
Adverse Cardiovascular Event ◽  
Type 2 Diabetic Patients ◽  
Cross Sectional ◽  
Low Hdl

Background: HDL particles have several biological functions. Low levels of HDL-cholesterol are responsible for atherosclerotic disease. Type 2 diabetes is a metabolic disease of chronic etiology and low HDL‐cholesterol is frequent finding in diabetics. Levels of HDL with advancing age are inconsistent, few study show decline in HDL with increasing age while others show vice versa results. Objectives: Objective of this study was to establish an association between low HDL levels with advancing age in type 2 diabetic patients. Study Design: Cross sectional descriptive study. Setting: Diabetes Outpatient Department Nishtar Hospital Multan. Period: 6 months extending from March 2018 to August 2018. Materials and Methods: 145 patients with newly or previously diagnosed type 2 diabetes mellitus, age >35 years were considered for the study. Those diabetics who had family history of dyslipidemias (to rule out familial hyperlipidemias) were excluded. Study was started after acquiring permission from ethical committee. All the patients were evaluated for the HDL levels by getting a fasting lipid assay. Results: Out of 145 cases 78 (53.6%) were males while remaining 67 (46.4%) were female. Mean age of the patients was 57.27 + 6.91 years. Mean HDL level was 37.82 + 8.42. It was seen that HDL is low in 116/145 (80%) patients. Those diabetic patients who were < 60 (91 cases), HDL was noticed to be low in 67/91(73.62%) patients. Among patients >60 years (54 cases), HDL was identified to be low in 49/54(90.7%) patients. P-value was found out to be 0.012 Conclusion: Due to falling levels of HDL with advancing age in diabetic patients, there is increase in cardiovascular events in elderly diabetic patients. So the measures which tend to increase HDL level will also give protection against adverse cardiovascular event in elderly diabetics.

scholarly journals Evaluations of knowledge, skills and practices of insulin storage and injection handling techniques of diabetic patients in Ethiopian primary hospitals

2020 ◽  
Author(s):  
Adeladlew Kassie Netere ◽  
Eyayaw Ashete ◽  
Eyob Alemayehu Gebreyohannes ◽  
Sewunet Admasu Belachew
Keyword(s):  
Insulin Therapy ◽  
Injection Site ◽  
Insulin Delivery ◽  
Cross Sectional Study ◽  
Injection Technique ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Duration Of Diabetes ◽  
Knowledge Levels ◽  
Insulin Storage

Abstract Background: Insulin is an effective therapeutic agent in the management of diabetes but it is also sensitive to external environment. Consequently, diabetic patients’ adherence to insulin delivery recommendations is critical to its effectiveness. Lack of knowledge, skill, and irrational practices on appropriate insulin delivery techniques can result in therapeutic failure and increased costs of therapy. The aim of this study was to evaluate the knowledge, skills, and practices of insulin storage and injection technique of patients. Methods : An interview-based cross-sectional study was conducted in conveniently selected participants in Northwest Ethiopian primary hospitals from March 1 to May 30, 2019. Knowledge levels were assessed with right or wrong responses and practice was measured by administering a 4-point Likert scale structured questionnaire through face-to-face interviews. Finally, a five-point observational (demonstration) techniques checklist assessed patients’ skills. Results: Among 194 patients approached, 166 participants completed the survey with a response rate of 85.6 %. From these participants, 54.8% were males and the mean age was 38.46±13.8 years . The overall patients’ median knowledge and practice levels on insulin storage and handling techniques were moderately adequate (64.3%) and fair (55.4%), respectively. In patients’ skill assessments, 94.6% showed injection sites, 70% indicated injection site rotations, and 60.75% practiced injection site rotations. Education (p<0.001), duration of insulin therapy (p=0.008) and duration of diabetes (p=0.014) had a significant effect on patients’ knowledge level. Education (p<0.001), occupation (p<0.001), duration of insulin therapy (p=0.001), duration of diabetes (p=0.036) and patients’ knowledge levels (p<0.001) were found to have a significant effects on the patients’ practice level. A Mann-Whitney U test also disclosed that residency, ways to get insulin and mocked injection technique during first training had significant effects on patients’ knowledge levels. Conclusion: The current study revealed that patients had moderately adequate knowledge and fair practice levels on insulin storage and handling techniques. Moreover, patients missed important insulin administration skills. Healthcare professionals and stakeholders can play important roles in educating patients thereby improving the knowledge, practice, and administration techniques of patients.

Sign in / Sign up

Export Citation Format

Share Document