How much do diabetic patients know about diabetes mellitus and its complications?
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INTRODUCTION: A Singapore study reported that 99% of diabetics had received some diabetes mellitus (DM) education. Another study reported that the Singapore public is generally well-informed about DM but whether diabetics are well-informed is not known. The objectives of this study were to determine DM knowledge of diabetics visiting the Emergency Department (ED) and to determine the diabetics' knowledge versus practice gap. MATERIALS AND METHODS: A pretested questionnaire was used to survey a convenient sample of ED patients and visitors. The respondents were required to answer 43 questions on areas including "Risk Factors", "Treatment and Management" and "Monitoring". A point was awarded for each correct response. Diabetics were asked if they practised the items described in "Treatment and Management" and "Monitoring" sections. RESULTS: There were 95 diabetics and 91 non-diabetics surveyed, with no difference in the mean age or the proportion of men. There was no difference (P = 0.51) between the diabetics' mean score of 29.2/43 (68.1%) and the non-diabetics' 28.3/43 (65.9%). The younger diabetics tended to score higher with those <54.99 years obtaining the highest score of 34.2/43 (79.5%) in the study. More than 50% of diabetics practised what they knew of self-care but 25% were ignorant of key aspects like need for home glucose monitoring and regular ophthalmic reviews. Only 21.2% diabetics performed home glucose monitoring though another 42.1% knew they should but were not doing it. CONCLUSION: In this study, knowledge of DM was similar between diabetics and non-diabetics even though younger diabetics obtained higher scores. Diabetes education resulted in better-informed diabetics and changed practices but 25% were ignorant of some key aspects. Among the informed diabetics, various issues need to be addressed to close the gaps between knowledge and practice. (+info)
Overcoming obstacles: new management options.
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The outlook for patients with type 2 diabetes looks set to improve with the availability of new diabetes management options that provide more comprehensive control of blood glucose levels and/or encourage better patient compliance than previous alternatives. New insulin analogues, such as insulin lispro, aspart and glargine, allow more physiological insulin replacement and greater freedom in the timing and content of meals, compared with regular insulin preparations. The development of novel non-invasive routes of insulin administration promises to further improve diabetes management. Many barriers to initiating insulin relate to the need for frequent insulin injections, fears that insulin injections will be painful and difficult to administer, and concerns about hypoglycaemia and weight gain. Thus, each measure that reduces these barriers will help to prevent inappropriate delays in starting insulin therapy as well as to promote better compliance with therapy. The output from continuous glucose monitoring devices will assist accurate insulin replacement, which is difficult using point-estimates of blood glucose. Such devices will hopefully also circumvent the need for finger stick tests. There are several novel therapies in development that will further expand the portfolio of treatment options for patients with type 2 diabetes. Improved quality and choice of diabetes management options will provide doctors with the tools they require to develop tailored treatment plans, increase the probability that treatment goals are achieved and thereby reduce the risk of patients developing late-stage diabetes-related complications. (+info)
Practical aspect of monitoring hypertension based on self-measured blood pressure at home.
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Devices for home blood pressure (BP) measurement are produced worldwide at a rate of more than 10 million a year and 30 million such devices have already been distributed in Japan. The clinical significance of home BP measurement is obvious; patients can recognize the effects of antihypertensive treatment. Home BP measurements encourage medication compliance, follow-up clinic visits, and active participation in the medical treatment, thus resulting in improved management of hypertension. Home BP measurements more accurately reflect damage to target organs and the prognosis of cardiovascular diseases. The purpose of home BP measurements is to obtain information on the patient's inherent BP pattern using longterm, repetitive measurement under controlled conditions. Since home BP is measured under controlled condition, values are reproducible, and thus, useful in the diagnosis and treatment of hypertension. Blood pressures measured under standardized condition are indispensable when comparing data among individuals, among groups and among institutes. Working Group of Japanese Society of Hypertension (JSH) established JSH Guidelines for Self-Monitoring of Blood Pressure at Home in 2003. Standardization of the measurement procedure may elevate the position of home BP measurements for the purpose of diagnosing and treating hypertension. As a result, home BP measurements may improve the accuracy of screening for hypertension and assessment of BP control during treatment and encourage drug compliance. Home BP measurements, under such controlled conditions, should have a beneficial effect on the economics of diagnosing and treating hypertension. (+info)
The lower pole of the earlobe is an alternative site for painless blood sampling in the self-assessment of blood glucose concentrations.
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OBJECTIVES: Measurement of blood glucose is essential for better control of diabetes mellitus. The pain associated with repeated blood sampling is a significant problem, and a less painful technique would be advantageous. This study was conducted to establish a less painful method of blood sampling for monitoring of blood glucose concentrations. METHODS: Fourteen healthy doctors and nurses at the age of 22 to 32 years were enrolled into this study. The earlobe was divided into 20 areas. Each area was punctured with a fine needle and the pain was assessed by the visual analog scale (VAS). Then, localized cooling or warming was applied before puncture and the pain was assessed by the VAS. RESULTS: The VAS tended to be lower toward the lower part of the earlobe. The VAS in the uppermost area was 53.1 +/- 19.1 mm and 28.9 +/- 16.8 mm in the lowest part of the earlobe. The VAS was higher in the uppermost area than in the lowest area in six of the seven volunteers (p=0.028). We did not find significant differences in the VAS and blood glucose levels between the control sampling and the warming, or cooling sampling. The localized warming shortens the time to obtain blood by 4.4 seconds (p=0.0426). CONCLUSION: The area of the ear, but not localized cooling or warming, significantly affects the pain in sampling blood from the earlobe. Blood sampling for glucose tests are recommended to be obtained at the lower pole of the earlobe. (+info)
A case study of type 2 diabetes self-management.
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BACKGROUND: It has been established that careful diabetes self-management is essential in avoiding chronic complications that compromise health. Disciplined diet control and regular exercise are the keys for the type 2 diabetes self-management. An ability to maintain one's blood glucose at a relatively flat level, not fluctuating wildly with meals and hypoglycemic medical intervention, would be the goal for self-management. Hemoglobin A1c (HbA1c or simply A1c) is a measure of a long-term blood plasma glucose average, a reliable index to reflect one's diabetic condition. A simple regimen that could reduce the elevated A1c levels without altering much of type 2 diabetic patients' daily routine denotes a successful self-management strategy. METHODS: A relatively simple model that relates the food impact on blood glucose excursions for type 2 diabetes was studied. Meal is treated as a bolus injection of glucose. Medical intervention of hypoglycaemic drug or injection, if any, is lumped with secreted insulin as a damping factor. Lunch was used for test meals. The recovery period of a blood glucose excursion returning to the pre-prandial level, the maximal reach, and the area under the excursion curve were used to characterize one's ability to regulate glucose metabolism. A case study is presented here to illustrate the possibility of devising an individual-based self-management regimen. RESULTS: Results of the lunch study for a type 2 diabetic subject indicate that the recovery time of the post-prandial blood glucose level can be adjusted to 4 hours, which is comparable to the typical time interval for non-diabetics: 3 to 4 hours. A moderate lifestyle adjustment of light supper coupled with morning swimming of 20 laps in a 25 m pool for 40 minutes enabled the subject to reduce his A1c level from 6.7 to 6.0 in six months and to maintain this level for the subsequent six months. CONCLUSIONS: The preliminary result of this case study is encouraging. An individual life-style adjustment can be structured from the extracted characteristics of the post-prandial blood glucose excursions. Additional studies are certainly required to draw general applicable guidelines for lifestyle adjustments of type 2 diabetic patients. (+info)
Advances in diabetes for the millennium: insulin treatment and glucose monitoring.
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Newer insulins and easier blood glucose monitoring have greatly improved the ability to obtain excellent control of blood glucose levels with less risk of hypoglycemia. In type 1 diabetes, insulin pump therapy remains the optimal approach with the most flexibility, especially with the ultra-fast-acting analogs lispro or aspart. Otherwise, once- or twice-daily dosing with the long-acting analog glargine provides excellent basal coverage, and lispro or aspart at meals provides bolus coverage, all in the attempt to mimic physiological insulin secretion. For type 2 diabetes, although oral agents continue to be a mainstay of therapy, it is clear that many patients require insulin to attain the goal A1c of < 6.5%. Once-daily glargine is now used more commonly after 1-2 oral agents have failed, and it typically takes the place of sulfonylureas. The future will likely have better systems for continuous glucose monitoring and novel therapies to control glucose through agents that affect gut hormones. (+info)
How and when to use an alternative site in self-monitoring of blood glucose.
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Taking care of diabetic patients has considerably been improved for approximately fifty years both in the therapeutic field and in the glycaemia monitoring field. Prospective studies conducted on large cohorts have clearly shown the importance of taking optimal care of such patients in order to prevent the occurrence or aggravation of chronic diabetes-associated complications. However, despite the simplification of self-monitoring of blood glucose through technological developments, drawbacks, some of which are linked to the sampling site, the fingertip, still slow down the patients' compliance. The use of an alternative site seems to be one of the solutions to offer in order to improve their monitoring and hence, their metabolic control. The development of such a monitoring mode has been slowed down after revealing, in some studies, a probably physiological delay in the detection of glycaemia variations, at the level of the alternative sites. Despite such conflicting observations, interest of using such alternative sites is to be defined in self-monitoring. Beside fast glycaemia variations, it proved to be reliable. (+info)
What are capillary blood ketone levels in type 1 diabetic patients using CSII in normal conditions of insulin delivery?
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OBJECTIVE: The aim of the study was to determine the normal level of capillary ketonemia in type 1 diabetic patients on continuous subcutaneous insulin infusion (CSII). RESEARCH DESIGN AND METHODS: A total of 36 type 1 diabetic patients treated by external pump were studied for 2 to 3 weeks. Patients were instructed to self monitor capillary glucose and capillary ketone bodies at least 4 times per day with a handheld Medisense Optium meter and check for urinary ketone bodies in the morning and when blood glucose exceeded 2.5 g/l with a semiquantitative test. Data were collected and analysed for each period of time defined as the time interval between two changes of the infusion site. A period was considered "normal" when no problem causing any impairment in insulin delivery was detected. RESULTS: 186 periods of 2.1 +/- 0.9 days were recorded; 119 were considered normal. 1281 coupled values of glucose and betahydroxybutyrate were analysed during the so called normal periods. Mean percentage of ketonemia of 0, 0.1, 0.2, > or =0.3 mmole/l were 81.3%, 13%, 3.7% and 2% respectively whereas mean glucose level (g/l) was 1.49 +/- 0.7, 1.48 +/- 0.7, 1.59 +/- 0.8 and 1.89 +/- 0.9 respectively. Only 0.9% of betahydroxybutyrate values were > or =0.3 mmole/l when blood glucose exceeded 2.5 g/l. CONCLUSION: Our study indicates that ketonemia self monitoring can be a valuable tool to screen insulin deficiency in patients on CSII with a low risk of false positive if we consider a threshold of 0.3 mmole/l for ketone bodies. (+info)