Compliance with follow-up in patients with diabetic macular edema: Eye care center vs. diabetes care center

Purpose: The study was conducted to compare the compliance to intravitreal injection treatment and follow?up in patients with center?involving diabetic macular edema (CI?DME) and treatment outcomes between a tertiary eye care facility and a tertiary diabetes care center. Methods: A retrospective review was conducted on treatment naïve DME patients who had received intravitreal anti?vascular endothelial growth factor (anti?VEGF) injections in 2019. Participants were people with type 2 diabetes who were under regular care at the eye care center or the diabetes care center in Chennai. The outcome measures were noted at months 1, 2, 3, 6, and 12. Results: A review of 136 patients treated for CI?DME (72 from the eye care center and 64 from a diabetes care center) was carried out. The severity of diabetic retinopathy (DR) was similar in both centers. There was no statistically significant (P > 0.05) difference in the choice of initial intravitreal drug in the two centers. At 12?month follow?up, only 29.16% came for a follow?up in the eye center vs. 76.56% in a diabetes care center (P = 0.000). The multivariate logistic regression showed increasing age was associated with non?compliance in both the groups (eye care center: odds ratio [OR] 0.91; 95% confidence interval [CI] 0.82–1.21; P = 0.044) and diabetes care center (OR 1.15; 95% CI 1.02–1.29; P = 0.020). Conclusion: The follow?up rate between eye care and diabetic care center with DME showed a significant disparity. By providing comprehensive diabetes care for all complications under one roof, compliance with follow?up can be improved in people with DME

Heart Smart Diabetes Care

The world is growing smarter day by day, and so is health care. In spite of innumerable inventions and tech-tools, however, we struggle to contain chronic illnesses like diabetes and heart disease. We need to work together and design a rational, scientific and socially sustainable Heart Smart diabetes care ecosystem, with Heart Smart management strategies, to ensure happiness and harmony in persons who live with diabetes.

Heart Smart Diabetes Care

The world is growing smarter day by day, and so is health care. In spite of innumerable inventions and tech-tools, however, we struggle to contain chronic illnesses like diabetes and heart disease. We need to work together and design a rational, scientific and socially sustainable Heart Smart diabetes care ecosystem, with Heart Smart management strategies, to ensure happiness and harmony in persons who live with diabetes.

Reliability and validity of the Filipino-translated diabetes self-management questionnaire and its correlation with HbA1c

Background@#Diabetes self-management is a fundamental aspect of diabetes care and has a significant impact on diabetes- related mortality and morbidity. Assessment of self-care management is thus essential for clinicians and educators seeking better outcomes. However, there are no Filipino-validated tools to objectively measure this.@*Methodology@#A cross-sectional analytic study was done among adult Type 2 diabetic mellitus (T2DM) patients at the Ilocos Training and Regional Medical Center (ITRMC) Department of Internal Medicine outpatient clinic and three private diabetes clinics to determine the reliability and validity of the Filipino-translated Diabetes Self-Management Questionnaire (DSMQ) and its association with glycemic control as measured using glycosylated hemoglobin (HbA1c) values and categorized into good (< 7%), moderate (7-8.9%) and poor (> 9%) control. The English version of the DSMQ was translated to Filipino using forward-backward translation. The pre-tested Filipino translated questionnaire was then distributed to the participants and the responses were analyzed using Cronbach’s alpha, Pearson’s coefficient, and one–way analyses of variance.@*Results@#There were a total of 78 respondents. The test-retest reliability showed a statistically significant correlation (p < 0.05). All the items showed a high difficulty index. Known group validity was computed based on categorized HbA1c values. DSMQ sum scores and subscales showed no significant differences among the three categories of glycemic control.@*Conclusion@#The Filipino-translated DSMQ is a reliable tool for measuring the self-care of Filipinos with type 2 diabetes mellitus. Future research using it with a larger sample size and analysis for other factors affecting diabetes control may be better able to demonstrate its association with glycemic control.

Nurse-Led Diabetes Clinic (NLDC) for a comprehensive diabetes care management

@#Chronic disease is rapidly becoming a greater burden in the world and the leading cause of mortality because of epidemiological transformation. Diabetes is one; with 6.7 million deaths registered in 2021. In the Philippines, a report by the International Diabetes Foundation (IDF) projects the number of patients with Diabetes in 2030 to reach 5.4 million and 7.5 million by 2045. Diabetes treatment in the Philippines is poor and challenging in terms of resources, government support, and economy. The national health insurance system does not have comprehensive diabetes care coverage and private insurance companies offer limited diabetes coverage. As a result, patients rely on "out-of-pocket" expenses for their laboratory testing and medications, and consequently, nonadherence to therapy. There is a need for an intervention in diabetes care management as Diabetes Mellitus (DM) prevalence posts an upward trend. This paper recommends the following policy statements to strengthen DM care management in a comprehensive, integrated, and coordinated nurse-led care system through “3Rs”: “Reactivating” the health promotion activities; “Rephrasing” the existing care provisions; and “Re-establishing” care models that will boost the DM management care among the Filipinos.

La imperiosa necesidad de telemedicina en la atención de diabetes durante la pandemia de COVID-19. Un estudio de abordaje integral / The imperious need for telemedicine for the care of diabetes during the COVID-19 pandemic. A comprehensive approach study

Resumen Introducción: Los pacientes con diabetes experimentan dificultades para mantener el control glucémico durante el confinamiento por la pandemia de COVID-19, con el riesgo de presentar complicaciones crónicas de la diabetes y COVID-19 grave. Objetivo: El propósito de este estudio fue evaluar la conversión de un centro de atención primaria presencial de diabetes a un servicio de telemedicina por llamada telefónica. Métodos: Se realizaron consultas médicas por llamada telefónica durante la etapa inicial del confinamiento (abril a junio de 2020), para continuar el seguimiento de pacientes ingresados a un programa de atención multicomponente en diabetes. Resultados: Se realizaron 1118 consultas por llamada telefónica para continuar el seguimiento de 192 pacientes con diabetes tipo 2. Participaron diferentes profesionales de distintas áreas de la salud: atención médica, educación en diabetes, nutrición, psicología y podología. Conclusiones: La atención multicomponente en diabetes se transformó con éxito de un esquema de atención presencial a un servicio de telemedicina. Numerosos pacientes de atención primaria pueden ser candidatos a telemedicina. Se debe considerar un rediseño del modelo de atención que incorpore la telemedicina para mitigar la carga de morbimortalidad en enfermedades crónicas impuesta por la pandemia de COVID-19, pero también para la era pos-COVID-19.

Abstract Introduction: Patients with diabetes experience difficulties to maintain glycemic control during the confinement due to the COVID-19 pandemic, with the risk of developing diabetes chronic complications and severe COVID-19. Objective: The purpose of this study was to evaluate the conversion of an outpatient diabetes primary care center from a face-to-face care modality to a telemedicine care service by telephone. Methods: Medical consultations were made by telephone during the initial phase of confinement (April to June 2020), to then continue the follow-up of patients admitted to a multicomponent diabetes care program. Results: A total of 1,118 consultations were made by telephone and follow-up was subsequently continued in 192 patients with type 2 diabetes. Different professionals from different health areas participated, including medical care, diabetes education, nutrition, psychology and podiatry. Conclusions: Multicomponent diabetes care was successfully transformed from a face-to-face care modality to a telemedicine service. Many primary care patients may be candidates for telemedicine. A redesign of the care model that incorporates telemedicine should be considered to mitigate chronic diseases burden of morbidity and mortality imposed by COVID-19 pandemic, but also for the post-COVID-19 era.

Role of comprehensive diabetes care in known diabetes patients from western Mumbai region: an observational study

Background: The occurrence of Diabetes Mellitus (DM) has been creating a havoc since past few decades on a global platform. As per available literature, prevalence of DM in Mumbai is around 10%. Comprehensive Diabetes Care (CDC) is a form of Ayurvedic therapy which combines panchkarma and diet management. The present study was planned to evaluate the effectiveness of CDC in patients of DM by analysing changes in body mass index (BMI), body weight, OGTT, HbA1c, etc.Methods: The present study was of retrospective design, conducted at Madhavbaug clinics in western Mumbai. The duration of study was of one year, conducted from October 2018 to September 2019. It included patients diagnosed with type 2 DM i.e. HbA1c>6.5%, who were given CDC therapy.Results: In the present study, out of 183 type 2 diabetic patients, 99 were males (52%), while 84 were females (48%), thus male: female ratio was 1.17:1. On analysing the results of HbA1c in patients who had completed 12 weeks of CDC therapy, it was found that controlled DM status was seen in 109 patients (59%), while uncontrolled DM status was noted in 33 patients (19%) as compared to 102 patients (58%) at baseline.Conclusions: From the findings of the present study, it is clear that CDC is effective in the form of increasing number of euglycemic patients at the end of study period, as well as reduction in all glycaemic and anthropometric parameters, and reducing dependency on conventional medicines.

Barriers to Diabetes Care in a Developing Country: Exploratory Evidence from Diabetes Healthcare Providers

Aims: The morbidities and mortalities associated with diabetes are disproportionately high in low and middle income countries. This study aimed to explore important barriers and facilitators to diabetes care in Nigeria from the perspectives of diabetes healthcare providers (DHPs).Study Design:A nationwide descriptive survey Place and Duration:Onsite (Calabar, Nigeria) and online surveys conducted between September 2016 and March 2017. Methodology:A validated self-administered questionnaire was used to assess barriers to diabetes care and strategies to improve care among DHPs in Nigeria.Results:A total of 129 subjects with mean ± SD age and mean ± SD duration of practice of 42.4 ± 7.6 years and 8.5 ± 5.4 years respectively were surveyed. About 84.5% of the respondents perceived diabetes care in Nigeria as being remarkably challenging. The most common barriers identified include: poverty, low diabetes awareness, shortage of trained diabetes care specialists, poor diabetes care knowledge among primary care doctors, and poor knowledge of diabetes self care among patients and other institutional, cultural and religious barriers. To improve care, respondents recommended, among other strategies, increasing healthcare funding, expansion of national health insurance coverage, introduction of government subsidy on diabetes medications, encouraging local production of diabetes medicines and supplies, increasing public diabetes awareness, periodic training of general practitioners and strict regulation of alternative medicine practitioners and faith healing centers.Conclusion:This survey identified several barriers to diabetes care in Nigeria and proffered some useful and implementable strategies to improve care. In order to reduce the burden of diabetes in Nigeria and perhaps other countries in SSA, these expert opinions should form the basis for a blue print by major diabetes stakeholders and health policy makers

Depression and diabetes: A tendency or demon of darkness among diabetics? A cross-sectional study among type 2 diabetes mellitus patients attending an “integrated diabetes and gestational diabetes clinic” of Eastern India

Background: Depression is a common comorbid condition found in chronic medical illnesses in general and diabetes mellitus (DM) in particular. Worldwide, more than 365 million people are estimated to have Type 2 DM (T2DM), and almost 300 million people have major depression. Depression can be viewed as a Modifiable independent risk factor for the development of T2DM and for progression of complications from either type 1 or T2DM. Objectives: The aim of the study was to find out the distribution and determinants of depression among T2DM patients attending an integrated diabetes and gestational diabetes clinic (IDGDC) of a tertiary care hospital of West Bengal, East India. Materials and Methods: This cross-sectional, observational study was conducted among T2DM patients who attended IDGDC during May 2017–June 2017. Public Health Questionnaire-9 was used to assess depression and its severity. A total of 196 study subjects participated in the study. Results: The prevalence of depression was found to be 54.6%. About 28.1% of the study subjects had mild depression, 17.9%, 6.1%, and 2.6% subjects had moderate, moderately severe, and severe depression, respectively. Women gender, increasing age, rural residence, low literacy, longer duration of diabetes, and overweight/obesity were significantly associated with high frequency of depression. Addiction was significantly higher among depressed T2DM patients. Mean hemoglobin A1c level was significantly lower among non-depressed T2DM patients. Conclusion: More than half of the T2DM patients are suffering from depression of varying severity. There should be a dedicated counselor in diabetes clinics for routine screening of depression among all T2DM patients to identify the high-risk patients requiring urgent psychiatrist consultation.

The BDFOOT- IDGDC study: Burden of diabetic foot ulcers and its determinants among type 2 diabetes patients attending an “Integrated Diabetes and Gestational Diabetes Clinic” of Eastern India

Background: Globally, about 425 million people are suffering from diabetes mellitus (DM) which will be about 629 million by 2045. India is popularly known as “World Diabetes Capital” and is presently home of about 72.9 million diabetes patients. Poorly managed DM will increase the burden of both microvascular and macrovascular complications. One of the most common complications among them is diabetic foot ulcer (DFU) which affects about 7%–24% of DM patients. Aims and Objectives: This study was planned to determine the burden of DFU and its determinants among Type 2 diabetes mellitus (T2DM) patients attending integrated diabetes and gestational diabetes clinic. Materials and Methods: An institution-based, observational, cross-sectional study was conducted from July to September 2018. A pre-designed, pre-tested, semi-structured schedule was used to collect clinicosocial data. Blood pressure of the study subjects was measured and classified as per Joint National Committee-8 guidelines. Peripheral vascular assessment of the feet was done by calculating “ankle-brachial index (ABI)” in both lower limbs using “Diabetik Foot Care India Pvt. Limited” vascular Doppler instrument having 8 MHz transducer. ABI ≤0.9 and absence of pulse in dorsalis pedis and/or posterior tibial arteries were considered as peripheral artery disease (PAD). Vibration perception threshold for peripheral sensory neuropathy was tested with the help of Diabetik Foot Care Pvt. Limited Digital Biothesiometer using 50 Hz frequency. Results: Data were collected from 338 study participants. The frequency of DFU was found to be 9.5%. Increasing age, longer duration of diabetes, poor educational status, overweight/obesity, poor glycemic control, treatment with insulin, PAD, diabetic peripheral neuropathy, hypertension, ischemic heart disease, and hypothyroidism were significantly associated with DFU. Conclusion: There is high frequency of DFU among T2DM patients. Most of the risk factors are modifiable and if taken care of the occurrence of DFU can be prevented and/or delayed.

Gender differences and barriers women face in relation to accessing type 2 diabetes care: A systematic review

The objectives of this systematic review were to find out whether gender differences exist in the domain of access to type 2 diabetes care and to identify the barriers faced by women in accessing type 2 diabetes care. A PubMed search was conducted for English articles published between January 01, 2005, and April 30, 2017, that looked into the above-mentioned topics. The search showed 219 articles, which were scrutinized and 21 articles were chosen for final review. Five articles dealt with gender differences, 14 articles dealt with barriers faced by women in accessing type 2 diabetes care and two articles dealt with both aspects. To accomplish the first objective, major areas studied by articles dealing with gender differences in accessing type 2 diabetes care were identified. In each of those areas, articles which reported gender differences were noted. Six out of these seven articles which dealt with gender differences (87%) reported that gender differences were present in the areas of type 2 diabetes care they studied. These articles also reported that women faced more difficulty in accessing type 2 diabetes care. To accomplish the second objective, data from articles dealing with barriers faced by women in accessing type 2 diabetes care were carefully analyzed and potential themes and theme categories were identified. Results showed that women faced personal, sociocultural, health system, economic, psychological, and geographical barriers in accessing type 2 diabetes care. Since this systematic review could identify only limited studies, evidence from more studies would help to confirm and generalize our findings.

Artificial Intelligence Applications in Type 2 Diabetes Mellitus Care: Focus on Machine Learning Methods / 대한의료정보학회지

OBJECTIVES: The incidence of type 2 diabetes mellitus has increased significantly in recent years. With the development of artificial intelligence applications in healthcare, they are used for diagnosis, therapeutic decision making, and outcome prediction, especially in type 2 diabetes mellitus. This study aimed to identify the artificial intelligence (AI) applications for type 2 diabetes mellitus care. METHODS: This is a review conducted in 2018. We searched the PubMed, Web of Science, and Embase scientific databases, based on a combination of related mesh terms. The article selection process was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Finally, 31 articles were selected after inclusion and exclusion criteria were applied. Data gathering was done by using a data extraction form. Data were summarized and reported based on the study objectives. RESULTS: The main applications of AI for type 2 diabetes mellitus care were screening and diagnosis in different stages. Among all of the reviewed AI methods, machine learning methods with 71% (n = 22) were the most commonly applied techniques. Many applications were in multi method forms (23%). Among the machine learning algorithms applications, support vector machine (21%) and naive Bayesian (19%) were the most commonly used methods. The most important variables that were used in the selected studies were body mass index, fasting blood sugar, blood pressure, HbA1c, triglycerides, low-density lipoprotein, high-density lipoprotein, and demographic variables. CONCLUSIONS: It is recommended to select optimal algorithms by testing various techniques. Support vector machine and naive Bayesian might achieve better performance than other applications due to the type of variables and targets in diabetes-related outcomes classification.

To Study Efficacy Of Comprehensive Diabetes Care (cdc) Management Program In Type Ii Diabetic Obese Patients: An Observational Study

Context: Diabetes mellitus (DM) contributes to a major chunk of morbidity, mortality, and healthcare cost on a global level. The prevalence of DM is rising alarmingly, worldwide and India. Comprehensive Diabetes Care (CDC) is a combination of Panchakarma and diet management. Aims: This study was conducted to evaluate the effect of CDC on Glycosylated hemoglobin (HbA1c), body mass index (BMI), body weight, abdominal girth and dependency on conventional therapy in DM Patients. Setting and Design: This observational study was conducted in July 2017, wherein the data of obese Type II DM patients (HbA1c >6.5%) who attended out-patient departments (OPDs) at Madhavbaug clinics in Maharashtra, India were identified. Materials and Methods: Data of patients who were administered CDC (60-75 minutes) with minimum 6 sittings over 90 days (± 15 days) were considered. Variables were compared between day 1 and day 90 of CDC. Results: Out of 27 patients, 22 were included for analysis, out of which 10 were males while 12 females. CDC showed significant improvement in HbA1c 1.1% (from 8.80 ± 0.93 to 6.98 ± 1.73; p<0.001), BMI by 2.66 (from 33.79 ± 3.80 to 31.13 ± 3.91, p< 0.001), weight by 6.56 kg (from 83.67 ± 11.28 to 77.11 ± 12.27, p<0.001). Abdominal girth (from 104.34 ± 9.74 to 96.97 ± 11.93; p<0.001), also showed significant reduction. Dependency on concomitant medicines was reduced, with the number of patients on no concomitant medicines increasing from 27% to 41%. Conclusion: Comprehensive Diabetes Care Management Program found to be efficacious; by reducing HbA1c, as well as reducing dependency on allopathic medications.

Effect of home diabetes care platform based on internet and family fixed partner on the continuous care of diabetes patients outside the hospital / 中国实用护理杂志

Objective To investigate the effect of home diabetes care platform based on internet and family fixed partner on the continuous care of diabetes patients outside the hospital.Methods A total of 150 out-patients with diabetes were collected from June 2016 to November 2016,divided into family fixed partner group(group A),smart phone APP home diabetes care platform group(group B),family fixed partner combination with smart phone APP home diabetes care platform group(group C)with 50 cases each by random digits table method.The three groups received the same health education during their stay in hospital,patients in group A and group C were required to have family fixed partners,patients in group B and group C were required to receive the home diabetes care platform for smart phones APP after they left the hospital,the intervention time was six months,and the indexes of blood glucose metabolism,self-management ability of diabetes were assessed at the end of six months after intervention and before intervention.Results Fasting blood glucose and postprandial blood glucose and glycosylated hemoglobin values of the three groups after intervention were lower than those before intervention.The postprandial blood glucose and glycosylated hemoglobin values was(9.96±4.23)mmol/L,(7.16±1.47)%in group C,(13.78±3.34),(11.46±4.85)mmol/L and(8.46±2.21)%,(8.07±2.45)%in group A and B,the difference was significant(F=10.57,3.92,P＜0.05).The scores of self-management ability of diabetes of the three groups after intervention were all higher than those before intervention.The score of self-management ability of diabetes of item 1-6 was(6.45±1.65),(4.87±2.23),(6.17±2.12),(5.24±1.65),(4.67±2.13),(6.27±2.02)points in group C,(5.78±1.96),(3.63±2.14),(5.25±2.34),(4.12±1.97),(3.65±1.34),(5.26±2.21)points in group B,(5.04±1.78),(3.37±1.64),(4.63±1.87),(4.03±2.17),(3.32±1.74),(5.30±1.97)points in group A,the difference was statistically significant(F=3.82-7.94,P＜0.05).Conclusions Home diabetes care platform based on internet,combined with family fixed partner education,are more conductive to patient blood sugar control,and enhance self-management ability and account ability.

Diabetes care in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

@#The global burden of diabetes and its accompanying risk factors is upon us. Asia is the focus of this burden, owing to huge population numbers and increasing prevalence rates. The Philippines National Health and Nutrition Survey (NNHeS) of 2013, has provided the latest health and disease score with prevalence rates of the major risk factors among adults >20 years of age: diabetes (5.4%), hypertension (22.3%), dyslipidemia, low HDL (71.3%), obesity, BMI >25 kg/m2 (31.1%), and smoking (25.4%). Metabolic syndrome as of the 2008 survey reports a 27% prevalence rate (unpublished data). Efforts have to be directed to achieve improvement in prevention, survival, and quality of life for all diabetics. The health infrastructure under the leadership of the Department of Health, in partnership with governmental and non-governmental organizations has to provide a cohesive plan engaging all partners in various aspects of care. Strategies to enhance outcomes include: 1) a national screening program, 2) implementation of practice guidelines that will elevate the quality of care for all, 3) access to healthcare, medications, 4) development of an environment for research in institutions to allow a better understanding of these conditions among Filipino patients and 5) enhancement of training, education and service to benefit the Filipino diabetic. Indeed, the challenge is upon all of us as a nation, and we need to stand up and move forward with an organized and accessible system of care, as we aim to combat the epidemic of diabetes and its complications.

Myanmar diabetes care model: Bridging the gap between urban and rural healthcare delivery / Journal of the ASEAN Federation of Endocrine Societies

@#There has been significant magnitude of problems of diabetes in Myanmar, according to the estimates of International Diabetes Federation (IDF) and the recent National Survey on the prevalence of diabetes. There has been a wide gap of equity between the urban and rural healthcare delivery for diabetes. Myanmar Diabetes Care Model (MMDCM) aims to deliver equitable diabetes care throughout the country, to stem the tide of rising burden of diabetes and also to facilitate to achieve the targets of the Global Action Plan for the Prevention and Control of NCDs (2013-2020). It is aimed to deliver standard of care for diabetes through the health system strengthening at all level. MMDCM was developed based on the available health system, resources and the country's need. Implementation for the model was also discussed.

Diabetes care model in Malaysia / Journal of the ASEAN Federation of Endocrine Societies

@#With the highest prevalence of diabetes in the region, Malaysia faces a massive task ahead to care for its people afflicted with the disorder. For a successful Diabetes Care model to work, it requires a well-established functioning multidisciplinary team comprising Endocrinologists/Physicians/Family Medicine Specialist Physicians, Diabetes Nurse Educators, Dietitians, Pharmacists, and others such as Podiatrists are needed to provide broad ranging services. Although we have many such individuals trained and working independently, these services are fragmented. What is required is coordination and integration of these services to enable patients’ access in a timely manner. The Disease Control Division, Ministry of Health continues to play a central role – coordinating and funding these initiatives. What is desperately needed are more certified Diabetes Nurse Educators to manage the overall care of the patients as well as to provide key diabetes education that enable patient-empowerment to improve self-care, compliance, and ultimately result in better lives.

Factors Associated with Diabetic Retinopathy and Nephropathy Screening in Korea: The Third and Fourth Korea National Health and Nutrition Examination Survey (KNHANES III and IV)

This cross-sectional study was done to identify and determine the socio-demographic and health-related factors associated with diabetic retinopathy and nephropathy screening in Korea. Participants included 2,660 adults, aged 40 or older, with diabetes. Of the 2,660 adults, 998 (37%) and 1,226 (46.1%) had received a diabetic retinopathy and a nephropathy screening within one year, respectively. Regarding retinopathy, subjects older than 65, living in urban areas, with high educational levels, and with self-reported "unhealthy" status were likely to receive annual screening. Subjects living in urban areas, with higher educational levels, with self-reported "fair" or "unhealthy" status, and with 1 to 2 co-morbidities were likely to receive annual nephropathy screening. The Korea Composite Stock Price Index (KOSPI) continued to rise until 2007 when it started to decline over the subsequent years, following the same curve as the diabetic retinopathy and nephropathy screening rates during that time. Together with the financial matter, lack of patient education proved to be a hindrance to diabetes-related screening. The relatively low screening rates in Korea compared to the Western countries are likely to be due to the difference in the health system, economic situations and national demographics.

Factors Associated with Screening for Diabetic Retinopathy in Diabetic Patients Aged > or = 40 Years Using the KNHANES IV

PURPOSE: To identify factors associated with care of diabetic retinopathy. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) is a nationwide survey. This survey included 1, 257 people aged 40 years and older with a history of diabetic mellitus who answered questions, "Within one year, have you ever received eye examination (fundus photography) for screening diabetic retinopathy?" Factors that affect care of diabetic retinopathy were identified using multiple logistic regression analysis. RESULTS: Among the 1,257 people aged 40 years and older, 464 (36.9%) received screening for diabetic retinopathy. People aged 65 years and older (aOR = 0.7, 95% CI: 0.51-0.85) with university education (aOR = 0.5, 95% CI: 0.32-0.74) were more likely to undergo screening for diabetic retinopathy compared to those in the reference category (40-64 years old and those who had elementary school or lower education). People living in rural areas were less likely to undergo screening for diabetic retinopathy compared to those living in urban areas (aOR = 1.7, 95% CI: 1.32-2.24). Diabetic retinopathy screening was also associated with self-reported health status (ref: unhealthy [aOR = 1], fair [aOR = 1.7, 95% CI: 1.25-2.23], and healthy [aOR = 1.8, 95% CI: 1.30-2.44]). CONCLUSIONS: To increase nationwide screening rates for diabetic retinopathy, more attention should be given to underserved groups, particularly people aged between 40 and 64 years, those with a low education level, those living in rural areas, and those with a positive attitude toward self-reported health status. These issues highlight the need for a new emphasis in health education and public health policies aimed towards these underserved groups.

The Development of a Multimedia Interactive Learning (MIL) Program in Diabetes Care for Health Care Professionals in Northeastern Thailand.

Objective: This paper reports the development of a multimedia interactive learning (MIL) program in diabetes care for health care professionals in northeastern Thailand. It aims to be a supplementary tool for health care professionals to enhance their knowledge and skills in diabetes treatment. Methods: The program was developed via software called “Authorware Professional 7.1Ò”. Additionally, audio and video clips were implemented into the program as part of the multimedia interactive functions. The program covers different aspects of diabetes care including; basic knowledge of diabetes, available treatments (e.g., oral medications, insulin, non-medication treatments), patient monitoring (e.g., diet, exercise, blood glucose check up), case studies (e.g., patient cases), and assessments (e.g., multiple choice questions). Moreover, the insulin injection techniques were demonstrated via video clips. Interestingly, the program itself will be running via a mouse-clicking with automatic audio sounds. After the completion of the program, an attitude survey towards a MIL program was conducted next. Results: The overall results were positively favorable. Some changes were made into the program based on the recommendations. A further evaluation of the effectiveness of the program with the health care professionals needs to be conducted via a well designed study. More surveys regarding the attitudes toward the program will be continually performed. Conclusion: a multimedia interactive learning (MIL) program was completely developed. The usefulness of the program in diabetes care management via health care professionals is still needed. Further evaluations of attitudes toward to the program need to be done.