Pharmacist Impact on Physician Practices Related to Diabetes Management

To examine the impact of a pharmacist’s physical presence on (1) the achievement of individual and combined targets for hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) (composite target), and (2) physician practices in relation to the American Diabetes Association (ADA) standards of medical care. Methods A retrospective, comparative study of randomly selected diabetic patients seen within an underserved primary care setting at least twice annually between June 1, 2018- December 31, 2019. Patients were allocated by whether they had received care in one of the physician-pharmacist clinics (Group A) or the physician-only clinic (Group B). Study outcomes included the proportion of patients achieving the composite and individual treatment targets for A1C, BP, and LDL-C. Results A total of 394 patients were included; Majority were underserved African Americans. The composite target was attained by 20% of participants in Group A and 13% in Group B (p=0.09). There were no statistically significant differences in achievement of individual targets between groups. A significantly higher proportion of participants in Group A achieved better control of diastolic blood pressure control (85% vs. 74%), had microalbuminuria tested (50% vs. 12%), were prescribed aspirin (43% vs. 32%), and had lower utilization of non-insulin glucose-lowering agents relative to those in Group B. Conclusion The impact of a pharmacist’s physical presence on physician practice demonstrated a general trend towards improvement in clinical outcomes related to diabetes management. Future studies are needed to further characterize the impact provided by the physician-pharmacist relationship.

Download Full-text

Impact of Use Frequency of a Mobile Diabetes Management App on Blood Glucose Control: Evaluation Study (Preprint)

10.2196/preprints.11933 ◽

2018 ◽

Author(s):

Josep Vehi ◽

Jordi Regincós Isern ◽

Adrià Parcerisas ◽

Remei Calm ◽

Ivan Contreras

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Diabetes Management ◽

Blood Glucose Control ◽

Evaluation Study ◽

High Blood Glucose ◽

Group A ◽

Control Evaluation ◽

Group B ◽

The Impact

BACKGROUND Technology has long been used to carry out self-management as well as to improve adherence to treatment in people with diabetes. However, most technology-based apps do not meet the basic requirements for engaging patients. OBJECTIVE This study aimed to evaluate the effect of use frequency of a diabetes management app on glycemic control. METHODS Overall, 2 analyses were performed. The first consisted of an examination of the reduction of blood glucose (BG) mean, using a randomly selected group of 211 users of the SocialDiabetes app (SDA). BG levels at baseline, month 3, and month 6 were calculated using the intercept of a regression model based on data from months 1, 4, and 7, respectively. In the second analysis, the impact of low and high BG risk was examined. A total of 2692 users logging SDA ≥5 days/month for ≥6 months were analyzed. The highest quartile regarding low blood glucose index (LBGI) and high blood glucose index (HBGI) at baseline (t1) was selected (n=74 for group A; n=440 for group B). Changes in HBGI and LBGI at month 6 (t2) were analyzed. RESULTS For analysis 1, baseline BG results for type 1 diabetes mellitus (T1DM) groups A and B were 213.61 (SD 31.57) mg/dL and 206.43 (SD 18.65) mg/dL, respectively, which decreased at month 6 to 175.15 (SD 37.88) mg/dL and 180.6 (SD 40.47) mg/dL, respectively. For type 2 diabetes mellitus (T2DM), baseline BG was 218.77 (SD 40.18) mg/dL and 232.55 (SD 46.78) mg/dL, respectively, which decreased at month 6 to 160.51 (SD 39.32) mg/dL and 173.14 (SD 52.81) mg/dL for groups A and B, respectively. This represents a reduction of estimated A1c (eA1c) of approximately 1.3% (P<.001) and 0.9% (P=.001) for T1DM groups A and B, respectively, and 2% (P<.001) for both A and B T2DM groups, respectively. For analysis 2, T1DM baseline LBGI values for groups A and B were 5.2 (SD 3.9) and 4.4 (SD 2.3), respectively, which decreased at t2 to 3.4 (SD 3.3) and 3.4 (SD 1.9), respectively; this was a reduction of 34.6% (P=.005) and 22.7% (P=.02), respectively. Baseline HBGI values for groups A and B were 12.6 (SD 4.3) and 10.6 (SD 4.03), respectively, which decreased at t2 to 9.0 (SD 6.5) and 8.6 (SD 4.7), respectively; this was a reduction of 30% (P=.001) and 22% (P=.003), respectively. CONCLUSIONS A significant reduction in BG was found in all groups, independent of the use frequency of the app. Better outcomes were found for T2DM patients. A significant reduction in LBGI and HBGI was found in all groups, regardless of the use frequency of the app. LBGI and HBGI indices of both groups tend to have similar values after 6 months of app use.

Download Full-text

Comparison the Effect of Niacin Treatment with and without Atorvastatin on Lipid Profile in Type 2 Diabetic Patients

Iranian journal of diabetes and obesity ◽

10.18502/ijdo.v12i3.4446 ◽

2020 ◽

Author(s):

Mohammad Afkhami-Ardekani ◽

Mahmoo Emami-Meibodi ◽

Naimeh Mostafae ◽

Arezoo Afkhami-Ardekani ◽

Boshra Najafi

Keyword(s):

Blood Pressure ◽

Diabetic Patient ◽

Lipid Profile ◽

High Density Lipoproteins ◽

P Value ◽

Diabetic Patients ◽

Diabetes Research ◽

Type 2 Diabetic Patients ◽

Group A ◽

Group B

Objective: The risk of cardiovascular disease increased in diabetic patients due to lipoprotein metabolism disorder and insulin resistance. There is different type of dyslipidemia in diabetic patient. The nicotinic acid (niacin) is categorized as vitamin B family and decreases low-density lipoproteins (LDL) and triglyceride (TG) level and increases high-density lipoproteins (HDL). The aim of this study was to compare the effect of niacin treatment with and without atorvastatin on lipid profile on diabetic patient. Materials and Methods: This study is cross over clinical trial on 30 diabetic patients (9 men, 21women) referred to diabetes research center of Yazd (IRAN). At initiation of study administered atorvastatin alone (20 mg/day) for 6 weeks (protocol A), and after 3 weeks washout period, started atorvastatin (20 mg/day) with niacin (50 mg/day) for 6 weeks (protocol B). Statistical analysis was accomplished by using SPSS for windows, version 11.50 and kappa and paired T-test. Results: Patients on protocol B had statistically significant more increase of HDL-C (P-value= 0.08) and decrease of TG than profile A (P-value= 0.024). Also, 2 hours post prandial blood sugar and HbA1c changes in two groups were not significant A (P-value= 0.226), B (P-value= 0.918). Patient in group B had statistically significant decrease in systolic blood pressure and diastolic blood pressure than group A (P-value= 0.010, P-value= 0.015). Conclusion: This study showed decrease of TG, LDL-C and total cholesterol and increase of HDL in both groups. There are significant changes in HDL-C and TG in group B that used niacin with atorvastatin than group A.

Download Full-text

Effect of Intradialytic Change in Plasma Volume on Blood Pressure in Patients Undergoing Maintenance Hemodialysis

Journal of Laboratory Physicians ◽

10.4103/0974-2727.72151 ◽

2010 ◽

Vol 2 (02) ◽

pp. 066-069 ◽

Cited By ~ 1

Author(s):

Ali-Reza Khalaj ◽

Suzan Sanavi ◽

Reza Afshar ◽

Muhammad-Reza Rajabi

Keyword(s):

Blood Pressure ◽

Body Weight ◽

Plasma Volume ◽

Calculated Data ◽

Study Groups ◽

Maintenance Hemodialysis ◽

Blood Levels ◽

Diabetic Patients ◽

Group A ◽

Group B

ABSTRACT Background: Hypervolemia is a common complication in patients on hemodialysis (HD). To determine the effect of volume change on blood pressure in HD population, this cohort was conducted. Materials and Methods: The study population was composed of 60 non-diabetic patients on maintenance HD, with mean age of 59.95±15.28 years. They were divided into hypertensive group A (n=26) and normotensive group B (n=34). Data were collected by a questionnaire. Pre and post-dialysis blood levels of urea, sodium, total protein, and hemoglobin were measured and intradialytic change of plasma volume were calculated. Data analyses were performed by the SPSS v.16. Results: Out of 60 patients, 58.3% were male and 41.7% female. Post-dialysis systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly lower than pre-dialysis values in both groups (P=0.001, each). No correlation was found between intradialytic change in plasma volume or body weight and alterations of SBP or DBP during HD in the study groups (P>0.05, each). Intradialytic changes of body weight did not correlate to intradialytic changes of plasma volume (P=0.15). Conclusion: HD effectively reduces blood pressure and volume expansion, however, intradialytic changes of plasma volume and body weight do not influence on SBP and DBP.

Download Full-text

Bioinformatics Study on Serum Triglyceride Levels for Analysis of a Potential Risk Factor Affecting Blood Pressure Variability

Current Bioinformatics ◽

10.2174/1574893614666190109152809 ◽

2019 ◽

Vol 14 (5) ◽

pp. 376-385 ◽

Cited By ~ 2

Author(s):

Lin Xu ◽

Jiangming Huang ◽

Zhe Zhang ◽

Jian Qiu ◽

Yan Guo ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Blood Pressure Variability ◽

Partial Correlation ◽

Pearson Correlation ◽

Target Organ Damage ◽

Serum Triglyceride ◽

Hypertensive Patients ◽

Group A ◽

Group B

Objective: The purpose of this study was to establish whether Triglycerides (TGs) are related to Blood Pressure (BP) variability and whether controlling TG levels leads to better BP variability management and prevents Cardiovascular Disease (CVD). Methods: In this study, we enrolled 106 hypertensive patients and 80 non-hypertensive patients. Pearson correlation and partial correlation analyses were used to define the relationships between TG levels and BP variability in all subjects. Patients with hypertension were divided into two subgroups according to TG level: Group A (TG<1.7 mmol/L) and Group B (TG>=1.7 mmol/L). The heterogeneity between the two subgroups was compared using t tests and covariance analysis. Results: TG levels and BP variability were significantly different between the hypertensive and non-hypertensive patients. Two-tailed Pearson correlation tests showed that TG levels are positively associated with many BP variability measures in all subjects. After reducing other confounding factors, the partial correlation analysis revealed that TG levels are still related to the Standard Deviation (SD), Coefficient of Variation (CV) of nighttime systolic blood pressure and CV of nighttime diastolic blood pressure, respectively (each p<0.05). In the subgroups, group A had a lower SD of nighttime Systolic Blood Pressure (SBP_night_SD; 11.39±3.80 and 13.39±4.16, p=0.011), CV of nighttime systolic blood pressure (SBP_night_CV; 0.09±0.03 and 0.11±0.03, p=0.014) and average real variability of nighttime systolic blood pressure (SBP_night_ARV; 10.99±3.98 and 12.6±3.95, p=0.024) compared with group B, even after adjusting for age and other lipid indicators. Conclusion: TG levels are significantly associated with BP variability and hypertriglyceridemia, which affects blood pressure variability before causing target organ damage.

Download Full-text

The Effect of Prophylactic Ephedrine on Systemic Hypotension Caused by Induction of Anaesthesia with Propofol and Sufentanil in Elderly Hypertensive Patients: A Prospective Randomized, Double-blind Placebo-controlled Clinical Trial

10.22514/sv.2020.16.0081 ◽

2020 ◽

Keyword(s):

Blood Pressure ◽

General Anesthesia ◽

Normal Saline ◽

Saline Group ◽

Normal Saline Group ◽

Hypertensive Patients ◽

Group A ◽

Elderly Hypertensive ◽

Elderly Hypertensive Patients ◽

Group B

Objective: To study the effectiveness of prophylactic ephedrine to prevent hypotension caused by induction of anesthesia with propofol and sufentanil in elderly hypertensive patients. Methodology: 70 elderly ASA grade II-III hypertensive patients undergoing elective general anesthesia were randomized into two groups to receive either intravenous ephedrine,100 ug/kg in 5ml normal saline (Group B), or an equal volume of normal saline (Group A) before induction. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were recorded at T0 (after entry to the operating room), T1 (1 min after induction), T2 (2 min after induction), T3 ( 3 min after induction), T4 (4 min after induction), T5 (when intubated), T6 (2 min after intubation), and T7 (at the start of the procedure), as well as the incidence of hypotension and bradycardia. Results: SBP, DBP and HR were not significantly different at T0 and were significantly different at T1 to T7 after anesthesia induction. There were statistically significant effect on hypotension and bradycardia between the two groups and group B have a lower risk of hypotension and bradycardia relative to group A. SBP and DBP decreased significantly after induction in both groups. HR decreased significantly in group A while increased in group B. Conclusion: Ephedrine pretreatment can minimize hypotension and bradycardia caused by propofol and sufentanil during the induction of general anesthesia in elderly patients with hypertension.

Download Full-text

The Impact of Left Atrial Size in Catheter Ablation of Atrial Fibrillation Using Remote Magnetic Navigation

Cardiology Research and Practice ◽

10.1155/2018/3096261 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Xiao-yu Liu ◽

Hai-feng Shi ◽

Jie Zheng ◽

Ku-lin Li ◽

Xiao-xi Zhao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Magnetic Navigation ◽

Remote Magnetic Navigation ◽

X Ray ◽

Group A ◽

Group B ◽

The Impact

Objective. The objective of this study was to investigate the impact of left atrial (LA) size for the ablation of atrial fibrillation (AF) using remote magnetic navigation (RMN). Methods. A total of 165 patients with AF who underwent catheter ablation using RMN were included. The patients were divided into two groups based on LA diameter. Eighty-three patients had small LA (diameter <40 mm; Group A), and 82 patients had a large LA (diameter ≥40 mm; Group B). Results. During mapping and ablation, X-ray time (37.0 (99.0) s vs. 12 (30.1) s, P<0.001) and X-ray dose (1.4 (2.7) gy·cm2 vs. 0.7 (2.1) gy·cm2, P=0.013) were significantly higher in Group A. No serious complications occurred in any of the patients. There was no statistical difference in the rate of first anatomical attempt of pulmonary vein isolation between the two groups (71.1% vs. 57.3%, P=0.065). However, compared with Group B, the rate of sinus rhythm was higher (77.1% vs. 58.5%, P<0.001) during the follow-up period. More patients in Group A required a sheath adjustment (47/83 vs. 21/82, P<0.001), presumably due to less magnets positioned outside of the sheath. In vitro experiments with the RMN catheter demonstrated that only one magnet exposed created the sheath affects which influenced the flexibility of the catheter. Conclusions. AF ablation using RMN is safe and effective in both small and large LA patients. Patients with small LA may pose a greater difficulty when using RMN which may be attributed to the fewer magnets beyond the sheath. As a result, the exposure of radiation was increased. This study found that having at least two magnets of the catheter positioned outside of the sheath can ensure an appropriate flexibility of the catheter.

Download Full-text

The Influence of the Physiotherapeutic Program on Selected Static and Dynamic Foot Indicators and the Balance of Elderly Women Depending on the Ground Stability

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094660 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4660

Author(s):

Joanna Matla ◽

Katarzyna Filar-Mierzwa ◽

Anna Ścisłowska-Czarnecka ◽

Agnieszka Jankowicz-Szymańska ◽

Aneta Bac

Keyword(s):

Elderly Women ◽

Statistical Significance ◽

Exercise Program ◽

Control Group ◽

Balance Assessment ◽

Motor Functions ◽

Static Test ◽

Group A ◽

Group B ◽

The Impact

Seniors are a constantly growing group of people in many societies. It is necessary to develop physiotherapeutic programs to improve their mobility. The aim of this study was to assess the impact of the physiotherapeutic program conducted unstable ground on selected indicators of motor functions of elderly women. Sixty women (60–80 years) participated in the research. Group A (N = 20) underwent a 12-week physiotherapeutic program on stable ground, group B (N = 20) followed an exercise program on unstable ground, and group C (N = 20) (control group) had no therapeutic intervention. The effects of the therapy were assessed by using a FreeMed platform (foot load analysis) and a Biosway balance system. The results were compared using ANOVA (the one-way analysis), the Kruskal–Wallis test and also the post hoc tests (Tukey’s test and the multiple comparison test). In group A, a statistically significant change was observed in the static test and balance assessment, in group B this was observed in the static and dynamic foot tests and balance assessment, in group C, no statistical significance was achieved. The authors’ physiotherapeutic program had a statistically significant effect on changes in the balance and selected indicators of the motor functions of the examined people. Comparing the results before and after the therapy more improvement changes were noted in women training on an unstable ground compared to women training on a stable ground.

Download Full-text

Blind Comparative study between Silver nanoparticles dressings and Standard Moist Wound Dressings (SMWD) in management of diabetic foot ulcers

QJM ◽

10.1093/qjmed/hcab097.040 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Amr Abdelaal ◽

Mostafa Soliman ◽

Hany Rafik ◽

Mohamed Emam ◽

Mohamed Mahmoud Mohamed Elsadek

Keyword(s):

Silver Nanoparticles ◽

Diabetic Foot ◽

Wound Dressing ◽

Treatment Modalities ◽

Controlled Study ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Group A ◽

Group B

Abstract Background Diabetic foot ulcers (DFUs) are the main cause of hospitalization in diabetic patients and they are considered a major worldwide health problem. Thus, there is a need to evaluate various treatment modalities. In this study we will assess the clinical efficacy of Silver nanoparticles dressing vs Standard Moist Wound Dressing (SMWD) in management of diabetic foot ulcers. Objective To compare wound outcome, limb salvage, healing time of diabetes related foot ulcers and cost effectiveness in terms of duration of hospital stay between Silver nanotechnology dressings and Standard moist wound therapy (SMWT) in management of diabetic foot ulcers. Patients and Methods This is a prospective randomized controlled study involving 34 patients with active diabetic foot ulcers, in a high volume tertiary referral vascular center. They were divided into 2 groups: 17 patients (group A) were prescribed SMWD and the other 17 patients (group B) received Silver nanoparticles wound dressing. Results Our study correlates with the study conducted by K.Suhas et al. which had observed that Silver nanoparticles wound dressing was safe and effective treatment for complex diabetic foot wounds and could lead to higher proportion of healed wounds and faster healing rates. At the end of the study, group B promised a better outcome as compared to group A. Conclusion The role of Silver nanoparticles wound dressing in healing of diabetic foot ulcers has been proposed as a novel method of manipulating the chronic wound environment in a way that it reduces bacterial burden and chronic interstitial wound fluid, increases vascularity and cytokine expression and to an extent mechanically exploiting the viscoelasticity of peri wound tissues.

Download Full-text

Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽

10.1515/med-2018-0048 ◽

2018 ◽

Vol 13 (1) ◽

pp. 304-323 ◽

Cited By ~ 3

Author(s):

Hernando Vargas-Uricoechea ◽

Manuel Felipe Cáceres-Acosta

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Angiotensin Receptor Blockers ◽

Pharmacological Therapy ◽

Current Evidence ◽

Diabetic Patients ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Patients With Diabetes ◽

The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

Download Full-text

Maintenance treatment of diabetic patients, associating arterial obstructive tibio-peroneal disease

Sao Paulo Medical Journal ◽

10.1590/s1516-31801995000100007 ◽

1995 ◽

Vol 113 (1) ◽

pp. 701-705

Author(s):

Nelson Wolosker ◽

Ruben Miguel Ayzin Rosoky ◽

Baptista Muraco Neto ◽

Berilo Langer

Keyword(s):

Maintenance Treatment ◽

Diabetic Patients ◽

Type I ◽

Group I ◽

Significant Difference ◽

Therapeutic Procedures ◽

Arterial Pulsation ◽

Group A ◽

Group B ◽

Better Than

When a melito-diabetic patient presents trophic infected injury on the limb, it is essential an evaluation of the circulatory conditions for therapeutic procedures orientation. In some circumstances, although arterial pulsation is absent, there is no ischemia of tissues. In these cases, the maintenance treatment, with eventual resection of the necrosed and infected tissues may be adopted. Evolution of 70 diabetic patients with trophic injuries on extremities were submitted to a maintenance treatment. Age of patients varied from 28 to 88 years, with an average of 56.8. The most occurrence was verified in women, with 42 cases. Diabetes non-dependant on insuline (type II) was observed in 64 patients (91.5%), being the remaining 6 patients of type I. Diabetic retinopathy was observed in 14 (20%) of the patients, neuropathy in 22 (31%) and nephropathy in 8 patients (11.4%). All the patients presented arterial pulsation until the popliteal region. They were divided in 2 groups, considering trunk arteries of legs: Group I, pervial legs arteries, composed by 48 patients; Group II, occluded legs arteries, with 22 patients. In what refers to the anatomic local of the injuries, patients were classified in three groups: Group A, formed by 32 patients (45.7%), presenting injuries in one or two toes only, without affecting the metatarsic region; Group B, formed by 16 patients (22.9%), trophic injuries affecting the metatarsic region and Group C, formed by 22 patients (31.4%), injuries affecting the calcaneous region. Injuries in both of the groups were caused by mechanical traumatism. Duration of the injury in the inferior member varied from 7 to 48 days, resulting in a 12 days average. Analyzing pervicacity in trunk arterias and evolution of patients, it may be observed that there has been a significantly better result in those with all the pulses present (81.3% x 45.5%)(p<0,01). Studying the injury locals associated to the evaluation of the cases, we may observe that for injuries in the extreme digital, result is significantly better than in locals more nearly. When distal pulses are absent, there is no significant difference in the result of the treatment, being performed in distal injuries or in the more near ones (p>0,05)(Table IV).

Download Full-text