Type 2 Diabetes in Women-Different and Difficult

Background: Lifestyle modification along with medication have improved the quality of life of patients with type 2 diabetes (T2D), but treatment of diabetes in women still lacks a gender-centric approach. Methods: Expert opinions to improve diabetes management in women were collated from the open discussion forum organized by the sixth Jothydev’s Professional Education Forum Diabetes Convention which included global diabetes care experts and general public The review is also based on the studies published in electronic databases such as PubMed and Google Scholar that discussed the problems and challenges faced by the Indian diabetes care sector in treating women with diabetes. Results: The complex interplay of biological, socioeconomic, psychosocial and physiological factors in women with type 2 diabetes has not been well addressed till date. Biological factors such as neurohumoral pathways, sex hormones, genetic predisposition as well as gender based environmental and behavioural differences must be considered for modern personalized diabetes treatment. Most importantly, pregnant woman with diabetes deserves special attention, as this vulnerable phase have a marked impact on the future health of both mother and offspring. Conclusion: The review provides an overview of the challenges and issues existing in the clinical management of diabetes and its complications among women in India. Women-centric clinical approaches should be encouraged for the effective management of diabetes in Indian women.

Download Full-text

Involvement of dietitians in diabetes care, results from a secondary care hospital in Greece

Proceedings of The Nutrition Society ◽

10.1017/s002966512000155x ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Zoe Pafili ◽

Sophia Samara ◽

Charilaos Dimosthenopoulos ◽

Olga Gkortzi

Keyword(s):

Type 2 Diabetes ◽

Diabetes Care ◽

Secondary Care ◽

Diabetes Management ◽

Nutrition Therapy ◽

Dietary Advice ◽

Diabetes Diagnosis ◽

Diabetes Patients

AbstractIntroductionAccording to diabetes care standards nutrition therapy should be an integral part of diabetes management, and all individuals with diabetes should be referred to a registered dietitian for nutrition therapy at—or soon after—diagnosis and for ongoing follow-up. There is limited international data that indicate that a large percentage of people with diabetes have not received structured diabetes education and have not visited a dietitian. The aim of this study was to assess the involvement of dietitians in diabetes care in Greece.Materials and MethodsAll adult diabetic patients admitted to a secondary care general hospital in Greece during 30 consecutive days were included in the study. Patients admitted in the ICU, CICU, day clinics and hemodialysis patients were excluded. Data were obtained by personal interviews using a 40 item questionnaire which included 10 questions regarding number of visits to dietitians for diabetes management, whether patients were referred by their doctors or sought dietary advice by their own, reasons for visiting a dietitian, goal achievement and patient satisfaction.ResultsIn total 124 patients (68 males and 56 females) with diabetes were admitted to the hospital during the study period (4 type 1, 114 type 2 and 6 pregnancy diabetes). Data were obtained from 3 (22.8 ± 6 yrs, 26.1 ± 5.7kg/m2,8.3 ± 5.9 yrs with diabetes),105 (76.6 ± 11.3 yrs, 28.0 ± 5.3 kg/m2, 12.8 ± 9.3 yrs with diabetes), and 5 (32.6 ± 4.4 yrs, 28.5 ± 4.0 kg/m2) patients with type 1, type 2 and pregnancy diabetes respectively. Two out of 3 type 1 diabetes and 1 out of 5 patients with pregnancy diabetes interviewed reported to have been referred to a dietitian by their doctor. Only 5.7% (6 patients) of type 2 diabetes patients reported to have been referred to a dietitian by their doctor and another 5.7% have visited a dietitian on their own initiative. Five out of 6 referrals were at diabetes diagnosis. The number of encounters with a dietitian ranged from 1 to 24 with patients seeking to loose weight having the greater number of encounters. Of type 2 diabetes patients 94.3% did not receive lifestyle advice before commencing diabetes medication whereas 25% did not receive any dietary advice by any health professional even after starting medication.ConclusionsIn our cohort the majority of diabetes patients had not received dietary counseling by a dietitian, whereas about one fourth of type 2 diabetes patients had not received any dietary advice.

Download Full-text

Integrated personalized diabetes management goes Europe: A multi-disciplinary approach to innovating type 2 diabetes care in Europe

Primary Care Diabetes ◽

10.1016/j.pcd.2020.10.008 ◽

2020 ◽

Author(s):

Allan Jones ◽

Jakob Eyvind Bardram ◽

Per Bækgaard ◽

Claus Lundgaard Cramer-Petersen ◽

Timothy Skinner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetes Care ◽

Diabetes Management

Download Full-text

Therapy in type 2 diabetes: A logical empiricism - based approach

Journal of Social Health and Diabetes ◽

10.4103/2321-0656.130804 ◽

2014 ◽

Vol 02 (02) ◽

pp. 109-111

Author(s):

Sanjay Kalra ◽

Yashdeep Gupta

Keyword(s):

Type 2 Diabetes ◽

Diabetes Care ◽

Diabetes Management ◽

Logical Empiricism ◽

Ongoing Debate ◽

The Family ◽

Important People

AbstractThere is ongoing debate about the relevance of the ‘guideline approach,” vis-a-vis the “pathophysiologic approach” in the management of diabetes. However, it is disheartening to note that both these stands neglects the most important people involved in diabetes management: The person with diabetes, the family, and the treating physician. We discuss a logical empiricism based approach for diabetes care in this brief communication.

Download Full-text

Comment on Tay et al. A Very Low-Carbohydrate, Low–Saturated Fat Diet for Type 2 Diabetes Management: A Randomized Trial. Diabetes Care 2014;37:2909–2918

Diabetes Care ◽

10.2337/dc14-2713 ◽

2015 ◽

Vol 38 (4) ◽

pp. e64-e64

Author(s):

Maria Ida Maiorino ◽

Michela Petrizzo ◽

Giuseppe Bellastella ◽

Dario Giugliano ◽

Katherine Esposito

Keyword(s):

Type 2 Diabetes ◽

Randomized Trial ◽

Diabetes Care ◽

Diabetes Management ◽

Saturated Fat ◽

Low Carbohydrate

Download Full-text

Use of Complementary and Alternative Medicine among People with Type 2 Diabetes in Taiwan: A Cross-Sectional Survey

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2011/983792 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 18

Author(s):

Hsiao-yun Annie Chang ◽

Marianne Wallis ◽

Evelin Tiralongo

Keyword(s):

Type 2 Diabetes ◽

Professional Education ◽

Healthcare Professionals ◽

Diabetes Management ◽

Self Administration ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Before And After ◽

Cam Use

Research into CAM use by people with diabetes is limited. This study explored CAM use among patients who attend diabetic clinics for followup treatment. Special attention was paid to patients' changing patterns of CAM use before and after diagnosis with Type 2 diabetes, their experience of CAM use, and their management of CAM use with conventional medicines. A retrospective cross-sectional survey () was undertaken in three census regions in Taiwan, including metropolitan, urban, and rural areas in 2006-7 (87.4% response rate). Participants reported extensive use of CAM with conventional medicines. The prevalence of CAM use was 22.7% before and 61.0% after diagnosis with Type 2 diabetes with nutritional supplements being the most commonly used CAM before and after diagnosis. However, the disclosure rate of CAM use to healthcare professionals remained low (24.6%), and lack of knowledge about CAM ingredients was common (63.4%). Awareness of the widespread use of CAM by people with Type 2 diabetes is crucial for healthcare professionals. The self-administration of both conventional medicines and CAM without disclosure of CAM use to healthcare professionals may result in ineffective diabetes management and adverse effects. CAM information needs to be incorporated into clinical practice and patient and professional education.

Download Full-text

An Expert Opinion on “Glycemic Happiness”: Delineating the Concept and Determinant Factors for Persons with Type 2 Diabetes Mellitus

Clinics and Practice ◽

10.3390/clinpract11030071 ◽

2021 ◽

Vol 11 (3) ◽

pp. 543-560 ◽

Cited By ~ 1

Author(s):

Sanjay Kalra ◽

Ashok Kumar Das ◽

Gagan Priya ◽

Ameya Joshi ◽

Hitesh Punyani ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Expert Opinion ◽

Diabetes Care ◽

Diabetes Management ◽

Psychological Impact ◽

Psychological Outcomes ◽

Psychosocial Burden

The importance of the psychological impact of diabetes is globally well-documented. Evidence suggests that there is a high level of psychosocial burden of diabetes in India. Moreover, there is a lack of relevant knowledge among the patients and caregivers regarding the psychological impact of diabetes and how to cope with it, as compared to the majority of other countries. “Happiness of the patient” is an essential component of diabetes management, which potentially affects the treatment outcome, treatment adherence, self-care, and lifelong management of diabetes. Although several validated tools and scales exist for measuring psychological outcomes both in patients and physicians, tools to assess “happiness in diabetes care” are still lacking. With this background, an expert group meeting was held in India in September 2019, involving nine expert diabetologists and endocrinologists across the country to discuss the concept of “glycemic happiness”. This article summarizes the expert opinion on the factors affecting psychological outcomes in diabetes, introduces the concept of glycemic happiness, describes available scales and tools to measure general happiness, and delineates the five sets of questionnaires developed with questions that may help correlate with “glycemic happiness”. The questionnaires are based on a five-point Likert method. The experts also discussed and decided upon the study design for a proposed observational survey to assess glycemic happiness of persons with type 2 diabetes mellitus (T2DM) based on the developed five sets of questionnaires. Given the huge burden of diabetes in India, the introduction of the concept of glycemic happiness will help in the optimization of diabetes care in the country.

Download Full-text

Effects of benchmarking on the quality of type 2 diabetes care: results of the OPTIMISE (Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment) study in Greece

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018815592803 ◽

2015 ◽

Vol 6 (5) ◽

pp. 199-209 ◽

Cited By ~ 2

Author(s):

Vasilis Tsimihodimos ◽

Michael S. Kostapanos ◽

Alexandros Moulis ◽

Nikos Nikas ◽

Moses S. Elisaf

Keyword(s):

Type 2 Diabetes ◽

Diabetes Care ◽

Standard Treatment ◽

Diabetes Management ◽

Optimal Type

Download Full-text

Overview of In-Hospital Diabetes Management: Audit of Patients Attending a Rural Hospital in Queensland, Australia

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.875 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A429-A429

Author(s):

Sarah X M Goh ◽

Jun Kwei Ng ◽

On Sze Yun ◽

Holly Gibbons ◽

Anis Zand Irani

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Diabetes Care ◽

Diabetes Management ◽

Diabetes Type 2 ◽

Diabetes Type ◽

Australian Institute ◽

Clinical Records ◽

Improve Diabetes Care

Abstract Context: The Australian Institute of Health and Welfare (AIHW) health survey in 2018 demonstrated that mortality rates from diabetes in remote and very remote areas were twice as high compared to those in the urban regions. Moreover, diabetic patients in the lowest socioeconomic areas were more than twice as likely to die from the disease and its associated complications than those living in the highest socioeconomic areas (77 and 33 per 10,000 respectively) [1]. These health disparities prompted a closer look into the quality of local inpatient diabetes management in order to identify the changes required to improve diabetes care in a rural community. Methods: A retrospective audit assessing all adult patients (aged over 18) with diabetes between August and October 2019 who attended treatment in one rural health centre in Queensland, Australia was conducted. Information was obtained from paper based patient records, especially the state-wide insulin subcutaneous order and blood glucose chart. Results: There were 122 diabetic inpatients during the study period. 9 were excluded due to poor documentation on the details of diabetes or insulin management. Men comprised 62% (n = 75) of the patients and the chronicity of diabetes in the majority of the patients was either unknown or undocumented (n = 90). Type 2 diabetes represented 87% (n = 106) of the hospitalisations. There were 64 hospitalisations with diabetes or diabetic related complications as the principal diagnoses. Among these, 7% (n = 8) were due to diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) or severe hyperglycaemia with ketosis, while 2 patients (1.7%) presented with hypoglycaemia. The majority (32%, n = 36) of the diabetic related complications were due to an underlying infection. Throughout inpatient stay, half (50.4%, n = 57) of the patients experienced one or more hyperglycaemic episodes and 14% (n = 16) experienced at least one hypoglycaemic events. The prevalence of inappropriate management of hyperglycaemia during this period was observed to be 21%. This was due to prescription errors i.e. usual insulin not prescribed (n = 7), erroneous insulin type (n = 3) and unsigned order (n = 4). Persistent hyperglycaemia, defined locally by blood glucose level (BGL) > 12 mmol/L was not managed ideally in 10 patients due to either lack of communication between staffs and physicians or failure to make changes when notifications were relayed. Patients were followed up until the discharge phase. Nearly half (41.8%, n = 51) of the patients were found to have no clearly documented follow up plans albeit the limitations of paper based clinical records should be taken into account. Conclusion: The management of diabetes in the rural communities can be challenging. Communication between the different layers of healthcare providers is imperative to ensure hyperglycaemia among hospitalised patients is not mismanaged. Clear documentation of insulin doses and BGL levels on paper records as well as regular education and shared clinical experience on insulin titration in response to abnormal BGL levels by clinicians are strategies to improve diabetes care. Reference: 1. Australian Institute of Health and Welfare. 2021. Diabetes, Type 2 Diabetes - Australian Institute Of Health And Welfare. [online] Available at: <https://www.aihw.gov.au/reports/diabetes/diabetes/contents/hospital-care-for-diabetes/type-2-diabetes> [Accessed 6 January 2021].

Download Full-text

Client perceptions of group education in the management of type 2 diabetes mellitus in South Australia

Australian Journal of Primary Health ◽

10.1071/py15008 ◽

2016 ◽

Vol 22 (4) ◽

pp. 360 ◽

Cited By ~ 8

Author(s):

Cynthia Smith ◽

Darlene A. McNaughton ◽

Samantha Meyer

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetes Management ◽

Diabetes Education ◽

Self Management ◽

Systematic Observation ◽

Future Health ◽

Group Education

Type 2 diabetes mellitus (T2DM) is a progressive chronic disease that requires significant self-surveillance and adherence to the treatment protocols for successful management and future health. There is a growing body of evidence suggesting that diabetes education is beneficial for patient outcomes. However, there is some debate about how best to deliver diabetes education, whether individually or in groups. Although several studies have investigated the role of group education in improving the management of T2DM, few studies have examined this issue from the client’s perspective. It is here that this study makes a contribution to understanding diabetes management. Drawing on systematic observation of group education sessions provided by diabetic resource nurses and in-depth interviews with clients, this paper describes the experiences, perspectives and significance of these sessions to clients. Our results suggest that group education sessions were seen as valuable to the clients for: the opportunity they provided to meet others living with diabetes; to improve motivation for managing the disease; and to enhance knowledge of diabetes, its management and long-term implications. In short, this study demonstrates that the clients value group education sessions for the social contact, increasing knowledge about the disease for self-management and support they provide; factors recognised as important to maintaining health. In addition, group education sessions appear to be a cost-effective method for diabetes self-management that funders need to consider.

Download Full-text