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Objective To understand the status of type 2 diabetes mellitus (T2DM) patients′ trust in their family physicians, and to explore the role of the trust on patients′ medication adherence. Methods A total of 1078 patients with T2DM were recruited by cluster and systematic sampling method, from ten rural communities in Sanlong township in Yancheng city and five rural communities of Pingchao township in Nantong city, during February to April in 2018. The survey covered their trust behavior and attitude scale (PTBAS), and an 8-item Morisky medication adherence scale ( MMAS-8). Both measurement data and enumeration data were subject to descriptive analysis by mean ± SD and proportion respectively. Multiple linear regression was employed to explore the determinants of trust in physicians. Ordered logistic regression analysis was used to explore the relationship between patient-physician trust and medication adherence. Results The mean scoring of patients′ trust and medication adherence was 20. 16 ± 2. 13, 7. 07 ± 1. 54 respectively. 55. 40 percent of the patients had high medication compliance, 28. 53 percent of them had medium compliance and 16. 07 percent had poor compliance. Multiple linear regression analysis showed that the patient′s occupation, course of disease, self-reported health status and mental health status influenced their trust behavior (P < 0. 05). Ordered logistic regression analysis showed that each 1 point increase in patient′s trust in physicians, the medication compliance increased by 11. 0％ (OR = 1. 110, P < 0. 001). Medication adherence is also affected by age, employment status, course of illness, and mental health status. Conclusions Diabetes patients′ trust in their family physicians improves their medication adherence.
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India has the large number of diabetic patients, and the number is expected to raise to 69.9 million by 2025. “Quality of life (QOL)” evaluation has emerged as an important outcome measure for chronic disease management. In diabetes, psychosocial factors have an important impact on self-care, acceptance of therapeutic regimens, treatment success, and QOL. Aims and Objectives: The aim of the study was to find out the QOL among the diabetic patients attending the outpatient department of tertiary care hospital in Bagalkot city. Methodology: It is a cross-sectional descriptive study, which was undertaken at a tertiary care hospital in Bagalkot city. The duration of the study was from August 10, 2016 to October 25, 2016. A sample size of 180 was obtained after considering the prevalence of diabetes in Karnataka as 10.22%. Patients attending the hospital for outpatient services were interviewed in their own language after obtaining the consent. QOL instrument for Indian Diabetes Patients questionnaire was used it is a reliable, valid, and sensitive tool for the assessment of diabetes-specific QOL in Indian subjects. Statistical analysis was done using Microsoft Excel 2010 and SPSS 20.1 trial version. Chi-square and Fisher’s exact test was used. Results: The mean age of study participants was 58.14 ± 13.46 years. 31.8% of the study participants were on insulin therapy. 52.3% of the males in the study had good QOL. The patients who were obese had poorer QOL than the patients with overweight and normal body mass index; this was statistically significant. Married participants had better QOL. In participants with comorbidities, QOL was poorer when compared to those without comorbidities; this difference was statistically significant.
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Objective To evaluate the intervention effects of peer support education mode for type 2 diabetes control in rural residents.Methods A random cluster sampling method has been used,including 300 rural residents aged above 18 years old from three villages (184 in control group,116 in intervention group),in order to proceed the physical check-up and health education programs.Unchanged rate,transfer rate of patients,rate of impaired glucose tolerance,turn normal rate and other biochemical indicators of patients and people with impaired glucose tolerance from control group and intervention group were analyzed,to evaluate the intervention effects of peer support education mode.Results The glycemic control rate of intervention group for patients and people with impaired glucose tolerance (72.2％ and 71.4％) were higher than control group (43.6％ and 26.7％),but the unchanged rate of intervention group (13.9％ and 0.0％) were lower than control group (42.3％ and 73.3％).Patients with diabetes or glucose intolerance in the education group improved significantly in waist-to-hip ratio,uric acid,total cholesterol and HDL-C.Glycemic hemoglobin level also improved significantly in diabetes patients of the education group.Conclusion Peer support for education intervention seemed beneficial for diabetic control.The combination of education and effect evaluation was important in the evaluation of diabetes prevention and control.Peer support education also benefited the blood glucose control in general population.
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Objective To evaluate the intervention effects of peer support education mode for type 2 diabetes control in rural residents.Methods A random cluster sampling method has been used,including 300 rural residents aged above 18 years old from three villages (184 in control group,116 in intervention group),in order to proceed the physical check-up and health education programs.Unchanged rate,transfer rate of patients,rate of impaired glucose tolerance,turn normal rate and other biochemical indicators of patients and people with impaired glucose tolerance from control group and intervention group were analyzed,to evaluate the intervention effects of peer support education mode.Results The glycemic control rate of intervention group for patients and people with impaired glucose tolerance (72.2％ and 71.4％) were higher than control group (43.6％ and 26.7％),but the unchanged rate of intervention group (13.9％ and 0.0％) were lower than control group (42.3％ and 73.3％).Patients with diabetes or glucose intolerance in the education group improved significantly in waist-to-hip ratio,uric acid,total cholesterol and HDL-C.Glycemic hemoglobin level also improved significantly in diabetes patients of the education group.Conclusion Peer support for education intervention seemed beneficial for diabetic control.The combination of education and effect evaluation was important in the evaluation of diabetes prevention and control.Peer support education also benefited the blood glucose control in general population.
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[Objective]To investigate the molecular mechanism of abnormal platelet activation induced by platelet O2 ·- and H2O2 levels in type 2 diabetes mellitus.[Methods]The platelet parameters in patients with type 2 diabetic patients and normal controls were measured;Immunofluorescence technique was used to observe the platelet morphology changing;Flow cytometry was used to detect platelet intracellular O2 ·- and H2O2 content in two groups,then with platelets in normal controls treated with NADH/PMS system and H2O2 respectively,platelet activation positive percentage was observed. Standard Western blot analysis protocols were used to detect expression difference of Catalase and type 2 super-oxide dismutase(Mn-SOD)in platelets.[Results]The MPV in the group of type 2 diabetic patients was significantly higher than in the normal control group(P < 0.001),but there was no statisticdifference in PLT,PDW,PCT between two groups. Immunofluorescence results showed that morphology of platelets in type 2 diabetic patients changed contrast to normal group. Through flowcytometry detection,the content of mitochondrial O2·-and H2O2 of platelet in type 2 diabetic patients were obviously higher than in normal group(P<0.05),whereas no significant difference in cytoplasmic O2·-. We adopted NADH/PMS system and H2O2 to treat platelets of normal group,heightened activated positive percentage were observed which described O2 ·- and H2O2 can significantly promote platelet activation(P<0.01). Western blot results showed that expression of Catalase in platelet of type 2diabetes patients decreased,while the expression and activity of Mn-SOD had no difference.[Conclusion]It is diabetic platelet Catalase expression decreased that may lead to Diabetic platelet mitochondrial O 2 ·- and H2O2 level increased ,thus regulating aberrant activation of diabetic platelet.
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Objective:To investigate the characteristics of seeking behavior and medical expense of outpatients in the New Rural Cooperative Scheme,and provide suggestions and theoretical basis for the implementation and pro-motion of hierarchical medical policy systems.Methods:In this study,13 counties in the eastern part of China were selected.By using data about diabetes mellitus distribution and medical expense of outpatient service reimbursement database in Beijing New Rural Cooperative Medical Scheme from 2009 to 2013,the diabetes mellitus were divided in-to two groups:with complications and without complications; the number of visits and proportion of the first-class, secondary-and tertiary-level medical institutions and the average annual growth rate of the five-year were calculated and the total expense,the average cost,the individual burden and the annual growth rate of the two types of diabetes mellitus were statistically analyzed.Results:The visits in the tertiary medical institutions of diabetes mellitus without complications decreased from 1895 to 661 and the proportion decreased from 3.05% to 0.6% from 2009 to 2013, while the visits in the tertiary medical institutions of diabetes mellitus with complications increased year by year and the proportion increased from 3.27%~4.24% since 2010.Outpatient medical expenses varied widely between pa-tients with and without complications and the higher the level,the greater the difference between the two.At the first-class,secondary-and tertiary-level institutions,the average expenses per time of diabetes mellitus with complications were 2.50,3.34 and 3.75 times higher than the diabetes mellitus without complications and the average out-of-pock-et expenses per time were 2.62,3.66 and 3.96 times higher than the latter respectively.Conclusions:From 2009 to 2013,the utilization of primary outpatient service in the region achieved some success while there were still some problems including unreasonable outpatient distribution, and more diabetic patients with complications went to the tertiary-level institutions than those without complications.Compared with outpatients without complications,patients with complications face up to a larger direct-economic burden of disease.The construction and the ability to prevent and control diabetes mellitus of basic medical institutions should be further strengthened,and the distribution of pa-tient needs to be reasonably led to enhance the service quality and ability of preventing,treating and controlling dia-betes and complications,and to guide patients with diabetes to seek medical treatment in primary healthcare institu-tions.
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BACKGROUND: Glycemic control is an effective way to reduce the cardiovascular complications of diabetes, but more than half of the adults with diabetes in Korea are improperly controlling their glycemic levels. The purpose of this study is to identify the factors associated with poor glycemic control in type 2 diabetes patients. METHODS: This study analyzed 1,261 subjects ≥30 years old diagnosed with type 2 diabetes who participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012). Poor glycemic control rates were defined as hemoglobin A1c (HbA1c) level ≥7%. To shed light on the causes of poor glycemic control, socio-demographics, diabetes severity, health status, and health behavior factors were adjusted and logistic regression was done. RESULTS: Of the total 1,261 patients, 53.0% of patients with type 2 diabetes had HbA1c ≥7%. After running a logistic regression model, the odds ratio of poor glycemic control was higher in high school graduates than elementary school graduates; in people living in Chungcheong and Jeolla/Jeju than those living in Seoul; in the group with diabetes for over 5 years had diabetes less than 5 years; in a group with insulin and oral hypoglycemic agent treatment than non-treatment; in a group with hypertriglyceridemia than without hypertriglyceridemia; and in the group with slept less than 6 hours slept 7-8 hours. CONCLUSION: We need a comprehensive public health policy to reduce the poor glycemic control rates in type 2 diabetes patients. We should recognize the education levels, duration of diabetes, diabetes treatment, hypertriglyceridemia, and sleep duration were associated with poor glycemic control.
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Adult , Humans , Diabetes Mellitus, Type 2 , Education , Health Behavior , Hypertriglyceridemia , Insulin , Korea , Logistic Models , Nutrition Surveys , Odds Ratio , Public Health , Running , SeoulABSTRACT
Diabetes patients in China is large in number, low level of health literacy, and their self management mainly relies on community doctor's health propaganda and education, as a result, it is very important to train community healthcare professionals to improve their communication skills with patients.Guided by the Social Cognitive Theory (SCT), the researchers developed a literacy-addressing training model specifically through: 1) low literacy healthcare education materials written in plain language, simple text, maximal white space, and behavior-oriented images or pictograms;2) a standardized health communication curriculum to promote simple communication with decreased jargon usage, teach teach back, and enhance shared goal-setting;3) use of standardized patients to enhance doctor-patient communication training;and 4) MOOC and a series of videos demonstrating doctor-patient communication scenarios.The novel training model can be used in continuing medical education through traditional on-site classes or by E-learning platform.It is expected to improve the communication skills of community doctors and patients, improve the satisfaction of both doctors and patients, and the effect of patients' self-management.
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Objective To understand the awareness status of diabetic nephropathy( DN)and its influence factors among diabetes patients. Methods A total of 1236 cases of diabetes were investigated on the awareness of DN and Logistic regression was used to analyze its influence factors. Results The awareness rate of DN was 77. 67% and its influence factors were age,education level,monthly household income and available diabetic health education( OR=1. 15,1. 80, 1. 41and 0. 98 respectively,all P< 0. 05). Moreover,the awareness status of DN prevention was at a low level. Among the 9 methods to prevent DN,only had 4 methods the awareness rate of which was over 80%. Conclusion Health education on DN control and prevention among diabetes patients should be emphasized.
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This study was aimed to observe the curative effect and safety of Danzhi Jiangtang Capsule ( DJC ) combined with atorvastatin on carotid artery intima-media thickness (IMT) in diabetes patients without hyper-tension . A total of 196 diabetes patients without hypertension with incrassate carotid artery IMT were randomly divided into the control group ( 98 cases ) and the treatment group ( 98 cases ) . The conventional diabetes thera-py was given to both groups . The atorvastatin of 20 mg/night was given to the control group . And the atorvas-tatin 20 mg/night added with DJC 9 . 0 g/night were given to the treatment group . The treatment course was 12 months . Carotid artery IMT , carotid atherosclerotic plaque area , FPG , FIns , HOMA-IR , HbA1c , blood lipids , hepatorenal function and etc . were examined before and after the treatment respectively . The results showed that there was a significant positive correlation between carotid artery IMT and FIns , HOMA-IR , HbAlc , LDL-C . After 12-month treatment , the total effectiveness is 85 . 87% in the treatment group . And there was significant difference compared with the control group ( P < 0 . 05 ) . The levels of FPG , FIns , HOMA-IR , HbAlc of the treatment group had no difference compared with the control group . Compared with the control group, TC and LDL-C of the treatment group was obviously decreased (P < 0.05). And HDL-C was significantly increased ( P < 0 . 05 ) . The carotid artery IMT of the treatment group decreased from ( 0 . 11 ±0 . 01 ) cm to ( 0 . 08 ± 0 . 01 ) cm . And compared with the control group , there was statistical significance ( P <0 . 05 ) . The carotid atherosclerotic plaque area of 58 cases in the treatment group decreased from ( 0 . 37 ±0.56) cm2 to (0.21 ± 0.25) cm2. However, there was no statistical significance compared to the control group. There were 5 adverse events in the control group and 9 adverse events in the treatment group . And there was no difference between two groups. It was concluded that DJC combined with atorvastatin can regulate lipid metabolism and reduce carotid artery IMT .
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One of the major characteristics of diabetes is that the compliance to self-management considerably affects the prognosis of the disease. Therefore, the diabetes educator is required to evaluate the patients from a psychosocial aspect to gain a comprehensive understanding and enhance their ability to adapt self-management activities. From the perspective of "Person In Environment," psychosocial evaluation refers to the holistic understanding of the patient, including family relationships, emotional status, financial affordability, social background, problem-solving skills and coping ability. With the psychosocial evaluation, the diabetes educator can practically help the patients set their goals of self management, improve their behavior patterns and maximize their locus of control.
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Humans , Compliance , Family Relations , Internal-External Control , Prognosis , Self CareABSTRACT
Los anticuerpos antitiroperoxidasa (AcTPO) y antitransglutaminasa (ATGt) son útiles marcadores de enfermedad tiroidea autoinmune y enfermedad celíaca, respectivamente. Su presencia en familiares de primer grado de personas con diabetes tipo 1 no se ha descrito en Cuba. Objetivo: determinar las frecuencias de los AcTPO y ATGt en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas. En un grupo de 285 sujetos se realizó la medición del AcTPO y en 262 individuos la de ATGt. Se incluyeron casos entre los 2 y 65 años de edad. Se registraron datos sobre edad, sexo, color de la piel, antecedentes personales, historia familiar de obesidad, diabetes tipo 2, enfermedad tiroidea y enfermedad celíaca. Se interrogaron síntomas y exploraron signos clínicos de enfermedad celíaca y enfermedad tiroidea autoinmune. Se determinó glucemia, insulinemia, AcTPO, ATGt y autoanticuerpos asociados a diabetes tipo 1 (AGAD y AIA-2), así como la resistencia a la insulina mediante el índice HOMA-IR. RESULTADOS: las frecuencias de AcTPO y ATGt positivos fueron 5,3 y 1,9 por ciento, respectivamente. La historia familiar de enfermedad tiroidea, el temblor muscular fino y el exoftalmos se relacionaron con la presencia de AcTPO. Malabsorción intestinal, diarrea persistente, dolor abdominal recurrente y antecedente personal de hepatopatía se asociaron con la presencia de ATGt. Se encontró asociación entre los ATGt y el AIA-2. La resistencia a la insulina no se asoció con la presencia de AcTPO ni de ATGt. En los familiares de primer grado de personas con diabetes tipo 1 las frecuencias de AcTPO y ATGt son bajas. Algunos antecedentes, síntomas y signos vinculados con enfermedad celíaca y enfermedad tiroidea autoinmune pueden ser indicadores prácticos previos a la indicación de estos autoanticuerpos(AU)
The antithyroperoxidase (TPOAb) and antitransglutaminase (tTGAb) antibodies are useful markers of autoimmune thyroid disease and celiac disease, respectively. Its presence in first-degree relatives of type 1 diabetes patients has not been described in Cuba. Objetive: to determine the TPOAb and tTGAb frequencies in first-degree relatives of type 1 diabetes patients and its relation to some clinical, biochemical and immunological features. In a group of 285 subjects we measured TPOAb and in 262 subjects we measured tTGAb. The cases included aged between 2 and 65. Data were registered on age, sex, skin color, personal backgrounds, and a family history of obesity, type 2 diabetes, thyroid disease and celiac disease. Symptoms were look for and clinical signs of celiac disease and autoimmune thyroid disease were explored. Fasting glucose, fasting insulin, TPOAb, tTGAb and type 1 diabetes associated autoantibodies (AGAD and AIA-2) were determined as well as the insulin resistance according the HOMA-IR index. RESULTS: the frequencies of positive TPOAb and tTGAb were of 5,3 and 1,9 percent, respectively. The family history of thyroid disease, slight muscular tremor and exophthalmos are related to presence of TPOAb. Intestinal malabsorption, persistent diarrhea, recurrent abdominal pain and personal background of liver disease were associated with presence of tTGAb. There was an association between tTGAb and AIA-2. Insulin resistance was not associated with the presence of both antibodies. In first-degree relatives of type 1 diabetes patients, frequencies of TPOAb and tTGAb are low. Some backgrounds, symptoms and signs linked to celiac disease and autoimmune thyroid disease may be practical indicators previous to perform these autoantibodies(AU)
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Animals , Autoantibodies/therapeutic use , Thyroiditis, Autoimmune/epidemiology , Diabetes Mellitus, Type 1/etiology , Medical History Taking/methods , Celiac Disease/pathology , Autoantibodies/immunologyABSTRACT
Objective To compare the clinical effects and safety of treating newly diagnosed type 2 diabetes patients by combining Glargine insulin with Metformin or/and Acarbose. Methods 84 patients with newly diagnosed type 2 diabetes ,who have a history of weight loss, body mass index( BMI )23 ～ 28kg/m2 and poorly controlled blood glucose in Metformin at least a month ,were randomly divided into three groups. Glargine insulin plus Mefformin were used in group A. Glargine insulin plus Acarbose(without mefformin)were used in group B, Glargine insulin, Acarbos and metformin were used in Group C. All three groups were given a 12-week follow-up. Results FBG,2hBG and HbA1c levels were lower in the patients after treatment( P ＜0. 05 ). HbA1c of patients was partly up to the standard in group A and group B,but HbA1c of patients was all up to the standard in group C. The effects in group C were better than those in group A and group B. It had the shortest time to achieve the target and the smallest dose of insulin in group C. BMI in group A and B did not change but decreased in group C(P＞0.05).The incidence of low blood sugar in all three groups was low and no significant difference observed among three groups (P＞0.05). And in all three groups no severe hypoglycemia occurred. Conclusion The method of combining Glargine insulin with Mefformin or/and Acarbose could effectively control blood sugar had little impact on body weight of the newly diagnosed type 2 diabetes patients, and moreover, the incidence of low blood sugar in the newly diagnosed type 2 diabetes patients was lower. It would be the ideal method to treat newly diagnosed type 2 diabetes patients considering the general safety and effectiveness and convenience.