scholarly journals The Status of Metabolic Control in Patients With Diabetes Attending Primary Care Clinics in Madinah, Saudi Arabia

2021 ◽  
Author(s):  
Eman Mohammed ALFADHLI ◽  
Ghada Mohamed SOBHY ◽  
Ruqaya Saleh MASOUD ◽  
Yaseera Ali GADI ◽  
Amal Mohammed Surrati ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Saudi Arabia ◽  
Glycemic Control ◽  
Metabolic Control ◽  
Diabetes Management ◽  
Diabetes Duration ◽  
Diabetic Patients ◽  
Primary Care Clinics ◽  
Patients With Diabetes

Abstract OBJECTIVE: Comprehensive control of diabetes and its related comorbidities is essential to avoid diabetes complications and reduce diabetes care expenses. Nevertheless, several reports have uncovered the gap in diabetes management and confirmed the suboptimal glycemic control globally. This study aims to assess the metabolic control among patients with diabetes attending primary care clinics (PCCs) in Madinah, Saudi Arabia. METHODS: A cross-sectional study was conducted at 15 PCCS in Madinah, Saudi Arabia. Consecutive 692 adult diabetic patients who attended the clinics between January 2016 to December 2017 were included. The primary outcome measures were achieving blood glucose, blood pressure, and lipids goals. The achievement of adequate metabolic control followed the American diabetes association (ADA) guidelines. RESULT: Majority (98%) of the patients had type 2 diabetes (T2DM) with a mean age of 55.1±11.6 years and a mean diabetes duration of 11.02±7.8 years. The mean HbA1c was 8.39±1.7, and glycemic goals (HbA1C < 7%) were achieved in 15.7%. Achievement of LDL, triglyceride, and HDL goals were as follow; 46.4%. 53.3%, 70.8%, respectively. 66.3% of subjects achieved systolic blood pressure, and 88.7% achieved diastolic blood pressure goals. Younger age, longer diabetes duration, and higher LDL levels were associated with poor glycemic control. CONCLUSION: Glycemic control is inadequate among patients with diabetes following at the PCCs in Madinah, Saudi Arabia. A patient-centered approach and individualized management plan considering all risk factors are required.

Cognitive functions and glycemic control in children and adolescents with type 1 diabetes

2009 ◽  
Vol 40 (1) ◽  
pp. 95-103 ◽  
Author(s):  
S. Ohmann ◽  
C. Popow ◽  
B. Rami ◽  
M. König ◽  
S. Blaas ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Metabolic Control ◽  
Child Behavior Checklist ◽  
Diabetes Management ◽  
Social Activity ◽  
Self Report ◽  
Patients With Diabetes

BackgroundThe relationship between metabolic control and cognitive function in adolescents with type 1 diabetes (DM type 1) is not clear. We compared the quality of glycemic control (GC) and cognitive measures in adolescents with DM type 1 to find out if the quality of diabetes management is related to cognitive impairment.MethodWe assessed executive functions (EFs) and other neuropsychological and psychosocial variables in 70 adolescent patients with DM type 1 and 20 age-matched controls. Patients were divided into two groups according to their last hemoglobin A1c (HbA1c): acceptable (HbA1c 5.9–8.0%, mean 6.9%, 36 patients, mean age 14 years) and non-optimal (HbA1c 8.2–11.6%, mean 9.3%, 34 patients, mean age 15.6 years).ResultsWe found impaired EFs, mainly problems of concept formation (p=0.038), cognitive flexibility (p=0.011) and anticipation (p=0.000), in the patients with DM type 1. Both groups did not differ in intelligence, most assessed EFs and adjustment to chronic illness (Youth Self-Report; YSR). Younger patients (<15 years) were cognitively less flexible. GC was worse in older patients and in patients with longer duration of the disease. We also found significant differences between patients with diabetes and controls concerning somatic complaints, internalizing problems (Child Behavior Checklist; CBCL) and social activity (CBCL and YSR).ConclusionsDM type 1 is associated with cognitive deficits in adolescents independent of the quality of metabolic control and the duration of the disease. These deficits are probably related to the disease, especially in patients with early-onset diabetes.

scholarly journals Impact of Pharmacist-Led Diabetes Management in Primary Care Clinics

2018 ◽  
Vol 9 (2) ◽  
pp. 17
Author(s):  
Benjamin Pontefract ◽  
Benjamin S. King ◽  
Cynthia A. King ◽  
David M Gothard
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Usual Care ◽  
Diabetes Management ◽  
Intervention Group ◽  
Control Group ◽  
Original Research ◽  
Diabetic Patients ◽  
Primary Care Clinics ◽  
The Impact

Purpose: Current literature supports that pharmacists effectively lower hemoglobin A1c (HbA1c) in diabetic patients. Little data exists on pharmacists’ effects on comorbidity management, patient satisfaction, or financial viability of these positions. This study looked to assess the impact of pharmacists on diabetes management compared to usual care. Methods: This multi-site, two-part study includes a retrospective chart review of patients referred to the pharmacist versus usual care within a large academic health system. The pharmacists collaborated under a consult agreement with primary care physicians. The second part of the study assessed patient satisfaction through an abbreviated CG-CAHPS survey. Results:A total of 206 patients with diabetes for an average of 12 years were included. The average patient age was 62 years with 60% of patients identifying as female and 81% as African-American. Patients were enrolled in a 2:1 fashion with 138 patients in the intervention group. Average baseline HbA1c was 10.1% in the intervention group and 9.3% in the control group (p= 0.0125). At 6 months, the mean change in HbA1c was -2.17% and 0.48% for the intervention and control groups respectively (p Conclusion: Pharmacists are effective at lowering HbA1c in primary care clinics, and patients were highly satisfied with these services. While direct revenue from this service did not meet cost, the pharmacist did positively affect outcomes that contribute to reimbursement. Treatment of Human Subjects: IRB review/approval required and obtained   Type: Original Research

Prevalence of Inter Arm Blood Pressure Difference among Type 2 Diabetics in Primary Care

2018 ◽  
Vol 3 (09) ◽  
Author(s):  
Dr. Amal Al Balushi ◽  
Dr Firdous Jahan ◽  
Dr. Maiya Al Jahdhami ◽  
Dr. Kamlesh Bhargava
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Pressure Difference ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Blood Pressure Difference ◽  
Type 2 Diabetics ◽  
Patients With Diabetes

Hypertension in patients with diabetes is a common problem; it increases the risk of cardiovascular, renal and ophthalmologic complications. Appropriate measurement of blood pressure is important, as the readings are the target of all pharmacological and non-pharmacological treatment. The aim of the present study was to observe the prev-alence of significant difference in blood pressure in the arms in type 2 Diabetics and to establish if there is association between inter-arm blood pressure difference (IAD) and cardiovascular risk. A cross sectional study conducted in 5 primary care health centers. BP measurements were done by automatic Omron 7 machine; the measure-ments were done two times with interchanging the instruments between two arms. Da-ta collection included demographic data (including, age, sex, body mass index (BMI), waist circumferences, duration of Diabetes, history of HTN, and smoking status).The data collection form also included entry of last biochemical investigations done in-cluding total cholesterol, LDL, HDL, triglyceride, glycosylated hemoglobin (HbA1c) and Cardiovascular risk (CV risk ) calculated by UKPDS engine version 2.0. Data was analyzed with SPSS (version 19). A total of 155 patients were studied. Mean age of patients was 55yrs. 22 participants (14.2, 95% CI=9.1-20.7) had systolic IAD >10 mmHg, 51 (33%, 95% CI=25.6-40.9) had a diastolic IAD >5 mmHg and 9 (5.8 %, 95% CI=2.7-10.7) had a diastolic difference >10 mmHg. In addition, the results showed statistically significant correlation between systolic interarm BP difference and duration of diabetes (P=0.025).There is significant diastolic interarm blood pres-sure difference in diabetic patients. Hence it is important to measure the blood pres-sure in both arms for patients with diabetes to treat hypertension in diabetics appropri-ately.

Effects of wearable technology on patients with diabetes: A systematic review and meta-analysis (Preprint)

2020 ◽  
Author(s):  
Dongjun Wu ◽  
Nicholas Buys ◽  
Guandong Xu ◽  
Jing Sun
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Relapse Prevention ◽  
Diabetes Management ◽  
Meta Analysis ◽  
Intervention Group ◽  
Wearable Technologies ◽  
Patients With Diabetes ◽  
Hba1c Levels

UNSTRUCTURED Aims: This systematic review and meta-analysis aimed to evaluate the effects of wearable technologies on HbA1c, blood pressure, body mass index (BMI), and fastening blood glucose (FBG) in patients with diabetes. Methods: We searched PubMed, Scopus, Embase, the Cochrane database, and the Chinese CNKI database from last 15 years until August 2021. The quality of the 16 included studies was assessed using the PEDro scale, and random effect models were used to estimate outcomes, with I2 used for heterogeneity testing. Results: A significant reduction in HbA1c (-0.475% [95% CI -0.692 to -0.257, P<0.001]) was found following telemonitoring. However, the results of the meta-analysis did not show significant changes in blood pressure, BMI, and glucose, in the intervention group (P>0.05), although the effect size for systolic blood pressure (0.389) and diastolic blood pressure may indicate a significant effect. Subgroup analysis revealed statistically significant effects of wearable technologies on HbA1c when supported by dietetic interventions (P<0.001), medication monitoring (P<0.001), and relapse prevention (P<0.001). Online messages and telephone interventions significantly affected HbA1c levels (P<0.001). Trials with additional online face-to-face interventions showed greater reductions in HbA1c levels. Remote interventions including dietetic advice (P<0.001), medication (P<0.001), and relapse prevention (P<0.001) during telemonitoring showed a significant effect on HbA1c, particularly in patients attending ten or more intervention sessions (P<0.001). Conclusion: Wearable technologies can improve diabetes management by simplifying self-monitoring, allowing patients to upload their live measurement results frequently and thereby improving the quality of telemedicine. Wearable technologies also facilitate remote medication management, dietetic interventions, and relapse prevention.

scholarly journals A preliminary study on diabetes self-management education and glycemic control among patients with diabetes mellitus

2019 ◽  
Vol 9 (9) ◽  
pp. 98 ◽  
Author(s):  
Kisokanth G. ◽  
Indrakumar J. ◽  
Prathapan S. ◽  
Joseph J. ◽  
Ilankoon I.M.P.S.
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Management Education ◽  
Self Management ◽  
Rank Test ◽  
Diabetic Patients ◽  
Effective Measure ◽  
Before And After ◽  
Patients With Diabetes ◽  
Preliminary Study

This study was aimed to assess the effectiveness of diabetes self-management education (DSME) in the improvement of glycemic control among patients with type 2 Diabetes Mellitus (T2DM) in Batticaloa District, Sri Lanka. The study was a prospective interventional study and conducted as a preliminary study at medical clinic, Base hospital, Kaluwanchikudy, Batticaloa. Thirty patients with T2DM were included based on inclusion and exclusion criteria. A structured individual diabetes self-management education for 10 hours (one hour per week) was delivered to diabetic patients by the trained Nurse Health Educator. Glycosylate hemoglobin (HbA1c) was assessed as a main outcome measure and Fasting Blood Sugar (FBS), Body Mass Index (BMI) of each patient were also measured and recorded before and after the intervention. The respondent rate was 96.7% (n = 29). Majority of them were females (n = 25, 86.2%). A Wilcoxon signed rank test showed that DSME had a statistically significant reduction in HbA1c [8.60 (IQR 2.60) vs. 7.40 (IQR 2.10), p = .000] and FBS level [159.00 (IQR 77.50) vs. 134.00 (IQR 40.50), p = .002] at 3 months of intervention. The mean BMI at baseline was higher compared to 3 months of intervention [24.88 (SD ± 3.06) vs. 24.19 (SD ± 2.79)] which was statistically significant (p = .000). Majority of participants (n = 22, 75.9%) had improved their HbA1c level by ≥ 0.5% in 3 months. The diabetes self-management education is an effective measure in improving glycemic control and other clinical parameters among patients with T2DM. Thus, DSME needs to be implemented among clinic patients with T2DM for the better outcome and the preventions of complications.

scholarly journals Diabetes and Frail Older Patients: Glycemic Control and Prescription Profile in Real Life

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 115
Author(s):  
Anne-Sophie Mangé ◽  
Arnaud Pagès ◽  
Sandrine Sourdet ◽  
Philippe Cestac ◽  
Cécile McCambridge
Keyword(s):  
Glycemic Control ◽  
Older Patients ◽  
Diabetes Management ◽  
Real Life ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Frailty Status ◽  
Frail Patients ◽  
Patients With Diabetes ◽  
Hba1c Target

(1) Background: The latest recommendations for diabetes management adapt the objectives of glycemic control to the frailty profile in older patients. The purpose of this study was to evaluate the proportion of older patients with diabetes whose treatment deviates from the recommendations. (2) Methods: This cross-sectional observational study was conducted in older adults with known diabetes who underwent an outpatient frailty assessment in 2016. Glycated hemoglobin (HbA1c) target is between 6% and 7% for nonfrail patients and between 7% and 8% for frail patients. Frailty was evaluated using the Fried criteria. Prescriptions of glucose-lowering drugs were analyzed based on explicit and implicit criteria. (3) Results: Of 110 people with diabetes with an average age of 81.7 years, 67.3% were frail. They had a mean HbA1c of 7.11%. Of these patients, 60.9% had at least one drug therapy problem in their diabetes management and 40.9% were potentially overtreated. The HbA1c distribution in relation to the targets varied depending on frailty status (p < 0.002), with overly strict control in frail patients (p < 0.001). (4) Conclusions: Glycemic control does not seem to be routinely adjusted to the health of frail patients. Several factors can lead to overtreatment of these patients.

Assesment of nutrition care provided to patients with diabetes in primary-care clinics

1992 ◽  
Vol 92 (7) ◽  
pp. 854-856
Author(s):  
WYLIE-ROSETT JUDITH ◽  
CYPRESS MARJORIE ◽  
WALKER ELIZABETH ◽  
ENGEL SAMUEL ◽  
ENGEL SAMUEL ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinics ◽  
Nutrition Care ◽  
Patients With Diabetes

Pharmacist Impact on Physician Practices Related to Diabetes Management

2021 ◽  
Vol 8 (4) ◽  
pp. 560-575
Author(s):  
Amina Ammar ◽  
Lindsay M. Darghali ◽  
Wassim Tarraf ◽  
Helen D. Berlie ◽  
Linda A. Jaber
Keyword(s):  
Blood Pressure ◽  
Diabetes Management ◽  
Individual Treatment ◽  
Diabetic Patients ◽  
Composite Target ◽  
Physician Practices ◽  
Physical Presence ◽  
Group A ◽  
Group B ◽  
The Impact

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.

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