The overtreatment of type 2 diabetes in frail older people

2020 ◽  
Vol 2 (9) ◽  
pp. 496-502
Author(s):  
Hannah Syed
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Older People ◽  
Diabetes Management ◽  
Holistic Approach ◽  
Protective Effects ◽  
Frail Older People ◽  
Good Glycaemic Control

Intensive treatment with insulin and sulfonylureas in older people with low HbA1c (<53mmol/mol) can increase the risk of hypoglycaemia, morbidity and mortality. Older people, particularly those with frailty and/or comorbidities are less likely to benefit from the long-term protective effects of good glycaemic control and are often at risk of inappropriate polypharmacy. A person-centred holistic approach to diabetes management must be adapted for older people living with diabetes.

The overtreatment of type 2 diabetes in frail older people

2020 ◽  
Vol 31 (6) ◽  
pp. 240-244
Author(s):  
Hannah Syed
Keyword(s):  
Older People ◽  
Diabetes Management ◽  
Holistic Approach ◽  
Protective Effects ◽  
Frail Older People ◽  
Good Glycaemic Control ◽  
Increased Risk ◽  
Holistic Method

With older patients at an increased risk of hypoglyceamia from intensive treatments of insulin and sulfonylureas, Hannah Syed examines how a patient-centred holistic method must be undertaken for older people living with diabetes Intensive treatment with insulin and sulfonylureas in older people with low HbA1c (<53mmol/mol) can increase the risk of hypoglycaemia, morbidity and mortality. Older people, particularly those with frailty and/or comorbidities are less likely to benefit from the long-term protective effects of good glycaemic control and are often at risk of inappropriate polypharmacy. A person-centred holistic approach to diabetes management must be adapted for older people living with diabetes.

scholarly journals Type 2 diabetes in women of reproductive age

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Donna M. Williams ◽  
Kathryn Evans Kreider
Keyword(s):  
Type 2 Diabetes ◽  
Nurse Practitioners ◽  
Diabetes Management ◽  
Reproductive Age ◽  
Current Evidence ◽  
Evidence Based ◽  
Women Of Reproductive Age

The prevalence of type 2 diabetes in women of reproductive age ranges from 3% to 7%. Due to the common nature of this condition, it is imperative for nurse practitioners who care for women to understand evidence-based methods of diabetes management. The aim of this article is to describe current screening and diagnostic criteria for type 2 diabetes, discuss current evidence-based management and patient education necessary to prevent long-term complications, and provide the tools for a healthy reproductive plan in women with type 2 diabetes from puberty until menopause. Diabetes management extends well beyond glucose control, and nurse practitioners should be attuned to all factors that can impact cardiovascular risk and quality of life.

scholarly journals Low and reduced carbohydrate diets: challenges and opportunities for type 2 diabetes management and prevention

2020 ◽  
Vol 79 (4) ◽  
pp. 498-513 ◽  
Author(s):  
Chaitong Churuangsuk ◽  
Michael E. J. Lean ◽  
Emilie Combet
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Weight Control ◽  
Diabetes Management ◽  
Food Selection ◽  
Food Sources ◽  
Micronutrient Deficiencies ◽  
Clinical Endpoints

Low-carbohydrate diets (LCD) have been promoted for weight control and type 2 diabetes (T2D) management, based on an emerging body of evidence, including meta-analyses with an indication of publication bias. Proposed definitions vary between 50 and 130 g/d, or <10 and <40 % of energy from carbohydrate, with no consensus on LCD compositional criteria. LCD are usually followed with limited consideration for other macronutrients in the overall diet composition, introducing variance in the constituent foods and in metabolic responses. For weight management, extensive evidence supports LCD as a valid weight loss treatment, up to 1–2 years. Solely lowering carbohydrate intake does not, in the medium/long term, reduce HbA1c for T2D prevention or treatment, as many mechanisms interplay. Under controlled feeding conditions, LCD are not physiologically or clinically superior to diets with higher carbohydrates for weight-loss, fat loss, energy expenditure or glycaemic outcomes; indeed, all metabolic improvements require weight loss. Long-term evidence also links the LCD pattern to increased CVD risks and mortality. LCD can lead to micronutrient deficiencies and increased LDL-cholesterol, depending on food selection to replace carbohydrates. Evidence is limited but promising regarding food choices/sources to replace high-carbohydrate foods that may alleviate the negative effects of LCD, demanding further insight into the dietary practice of medium to long term LCD followers. Long-term, high-quality studies of LCD with different food sources (animal and/or plant origins) are needed, aiming for clinical endpoints (T2D incidence and remission, cardiovascular events, mortality). Ensuring micronutrient adequacy by food selection or supplementation should be considered for people who wish to pursue long-term LCD.

scholarly journals Association of long-term glycaemic control on tear break-up times and dry eye symptoms in Chinese patients with type 2 diabetes

2018 ◽  
Vol 46 (6) ◽  
pp. 608-615 ◽  
Author(s):  
Andre Ma ◽  
Martin SY Mak ◽  
Kendrick Co Shih ◽  
Claudia KY Tsui ◽  
Rachel KY Cheung ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Dry Eye ◽  
Chinese Patients ◽  
Eye Symptoms ◽  
Break Up ◽  
Dry Eye Symptoms

scholarly journals Quality improvement project for improving inpatient glycaemic control in non-critically ill patients admitted on medical floor with type 2 diabetes mellitus

2020 ◽  
Vol 9 (3) ◽  
pp. e000982
Author(s):  
Adeel Ahmad Khan ◽  
Aamir Shahzad ◽  
Samman Rose ◽  
Dabia Hamad S H Al Mohanadi ◽  
Muhammad Zahid
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Diabetes Management ◽  
Oral Intake ◽  
Improvement Project ◽  
Type 2 Dm ◽  
Management Protocol ◽  
Patients With Diabetes

A significant number of patients admitted to the medical floor have type 2 diabetes mellitus (DM). Lack of a standardised inpatient hyperglycaemia management protocol leads to improper glycaemic control adding to morbidity in such patients. American Diabetes Association, in its 2019 guidelines, recommends initiation of a regimen consisting of basal insulin (long-acting insulin) or basal plus correctional insulin for non-critically ill hospitalised patients with poor or no oral intake. A combination of basal insulin, bolus (short-acting premeal or prandial) insulin and correctional scale insulin is recommended for inpatient hyperglycaemia management in non-critical patients with type 2 DM who have proper oral intake. Baseline data of 100 patients with diabetes admitted to Hamad General Hospital Doha, Qatar, showed that although insulin was used in the majority of patients, there was lack of uniformity in the initiation of insulin regimen. Adequate glycaemic control (7.8–10 mmol/L) was achieved in 45% of patients. Using Plan–Do–Study–Act (PDSA) model of improvement, a quality improvement project was initiated with the introduction of a standardised inpatient hyperglycaemia management protocol aiming to achieve 50% compliance to protocol and improvement in inpatient glycaemic control from baseline of 45% to 70%. Interventions for change included development of a standardised inpatient hyperglycaemia management protocol and its provision to medical trainees, teaching sessions for trainees and nurses, active involvement of medical consultants for supervision of trainees to address the fear of hypoglycaemia, regular reminders/feedbacks to trainees and nurses about glycaemic control of their patients and education about goals of diabetes management during hospitalisation for patients with diabetes. Overall, glycaemic control improved significantly with target glycaemic control of 70% achieved in 4 of the 10 PDSA cycles without an increase in the number of hypoglycaemic episodes. We conclude that development of a standardised inpatient insulin prescribing protocol, educational sessions for medical trainees and nurses about goals of diabetes management during hospitalisation, regular reminders to healthcare professionals and patient education are some of the measures that can improve glycaemic control of patients with type 2 DM during inpatient stay.

scholarly journals Self-Care Adherence And Barriers To Good Glycaemic Control In Nepalese Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study

2019 ◽  
Vol Volume 12 ◽  
pp. 817-826 ◽  
Author(s):  
Sushant Pokhrel ◽  
Sneha Shrestha ◽  
Alaska Timilsina ◽  
Manisha Sapkota ◽  
Mahendra Prasad Bhatt ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycaemic Control ◽  
Self Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Good Glycaemic Control

Maintenance of good glycaemic control is challenging – A cohort study of type 2 diabetes patient in North Karelia, Finland

2019 ◽  
Vol 73 (4) ◽  
pp. e13313 ◽  
Author(s):  
Nazma Akter Nazu ◽  
Jaana Lindström ◽  
Päivi Rautiainen ◽  
Hilkka Tirkkonen ◽  
Katja Wikström ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Glycaemic Control ◽  
Diabetes Patient ◽  
Good Glycaemic Control
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