A study on diabetes-related self-care plan and its determinants among diabetes patients in a Warangal region, Telangana, India

Abstract The prevalence of epidemiological diseases, including diabetes, has continued to increase because of the adaption of Western culture and the lack of self-care activities among patients with diabetes. Therefore, in this cross-sectional study, we aimed to assess self-care plans and determinants among diabetes outpatients in Warangal. We conducted a prospective observational study among diabetes outpatient clinic in Warangal, India over 6 months from October 2019 to March 2020. We used the expanded Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. A P value of less than < 0.05 was considered statistically significant. Respondents (mean age, 52.3 (standard deviation (SD), 11.01) years) had an overall SDSCA score of 49.18 ± 3.57 (SD). Mean scores for the diet, physical activity, foot care, medication adherence, and blood sugar testing scales were 12.79 (SD, 1.61), 10.24 (SD, 1.77), 15.67 (SD, 1.5), 5.66 (SD, 1.17), and 4.80 (SD, 0.68), respectively. Patients' age, education, disease duration and hemoglobin A1C (HbA1C) levels of <7.5% (P < 0.001)) had significantly higher mean scores for blood sugar testing, diet, physical activity, and adherence (P < 0.001). The employment status is associated with all the domains of Summary of Diabetes Self-Care Activities (P < 0.001). Taken together, our results revealed that patients with diabetes in Warangal had poor self-care planning, highlighting the need for strengthening initiatives that generate awareness regarding diabetes and improving related self-care practices

Practices for diabetes mellitus in doctors

Background: Doctors know everything about cause, diagnosis, treatment and care to be taken for diabetes mellitus. This study was carried out to evaluate awareness, attitude and practices of diabetes in doctors.Methods: A cross sectional study was conducted among 100 male and 100 female doctors of various subjects who attended a conference at Mangaluru 25th to 27th October 2018.Results: Prevalence of diabetes mellitus was 12% in male doctors while it was 8% in female doctors. 11 (91.66%) male doctors and 8 (100%) female doctors were taking medicines for diabetes regularly, 8 (66.66%) male doctors and 7 (87.5%) female doctors were doing blood sugar regularly, 7 (58.33%) male doctors and 5 (62.5%) female doctors were doing diet control, 7 (58.33%) male doctors and 5 (62.5%) female doctors were doing exercise regularly, 9 (75%) male doctors and 8 (100%) female doctors were using footwear while 6 (50%) male doctors and 4 (50%) female doctors were taking proper dental care.Conclusions: In present study, doctors were aware of causes, diagnosis, treatment & care to be taken in diabetes. Still, routine check-up was not seen in 100%. After diagnosis, doctors were taking medicines quite regularly but regular follow up for diabetes & cardiovascular risk was seen in less numbers.

Study on the Effects of Treatment Compliance on Short-term Clinical Outcome among Community Patients with Type 2 Dia- betes Mellitus in China / 中国药房

OBJECTIVE： To provide reference for improving the treatment compliance and therapeutic effect of patients with type 2 diabetes mellitus （T2DM） in China. METHODS： The follow-up data was from the issue of Pharmacoeconomic Study of Diabetic Drugs in China， which was conducted by China Center for Health Economic Research （CCHER） of Peking University. Using follow-up endpoint HbA1c level as clinical output indicator， univariate analysis and multivariable regression analysis of binary and numerical variables were performed to evaluate the effect of treatment compliance on short-term clinical outcomes. RESULTS： Totally 2 236 community T2DM patients were included for the analysis. The patients with good and poor medication compliance accounted for 23.48％ and 76.52％； the patients with good and poor blood glucose monitoring compliance accounted for 7.02％ and 93.98％； 66.3％， 23.5％ and 10.2％ of the patients had good， medium and poor diet control compliance， respectively. Univariate analysis showed that there was a significant difference in the “good control” group of blood glucose and the “poor control” group of blood glucose in terms of patient age， body mass index， education level， duration of disease， exercise， and eating habits，etc （P＜0.05）. Similar results were obtained in the analysis of multiple Logistic regression and multivariate loglinear regression models， that is， blood glucose monitoring compliance and diet control compliance had significant positive effects on end-point HbA1c （P＜0.05）， but drug compliance had no significant effect （P＞0.05）. CONCLUSIONS： The treatment compliance among community patients with T2DM in China was generally poor. After controlling for other variables， patients’ treatment compliance has a positive effect on end-point HbA1c， especially better blood glucose monitoring compliance and diet control compliance contribute to blood glucose control， but medication compliance has no significantly effect.

Acupuncture Treatment of Polycystic Ovarian Syndrome Patients with Abdominal Obesity by Regulating Dai Meridian: A Randomized Controlled Clinical Trial / 针刺研究

OBJECTIVE: To explore the therapeutic effect of acupuncture in the treatment of polycystic ovarian syndrome (PCOS) patients with abdominal obesity by regulating glucose metabolism, insulin resistance, sex hormones, etc. METHODS: Eligible PCOS volunteers were randomly divided into treatment group(n=30) and control group(n=28). The treatment group received acupuncture therapy three times a week combined with diet control and exercise. EA (2 Hz/100 Hz, 4-8 mA) was applied to bilateral Daimai (GB 26)and Tianshu (ST 25) for 20 min/time, and bilateral Daheng (SP 15), Shenshu (BL 23), Ciliao (BL 32), Guilai (ST 29), Zulinqi (GB 41) and Waiguan (SJ 5) were stimulated with filiform needles, with the needles retained for 20 min. Patients of the control group were asked to restrict intake of dietary calories (low fat, appropriate proteins, and high carbohydrate) and aerobic exercise (>40 min/time), 3 times/week. The treatment duration lasted 12 weeks. Before and after the treatment, serum fasting insulin (FINS), fasting blood-glucose (FBG), Testosterone (T), luteinizing hormone (LH) and follicle stimulating hormone (FSH) contents were assayed using immuno-fluorometry, the homeostasis model assessment of insulin resistance (HOMA -IR) and ratio of LH/FSH were calculated, and body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) were measured, separately. RESULTS: Comparison with their own individual pre-treatment, the levels of FINS, HOMA -IR, T, LH, LH/FSH, BMI, WC and WHR (not FBG) in both control and treatment groups were significantly decreased (P0.05). CONCLUSION: Acupuncture can effectively reduce FINS, HOMA-IR and WC levels in PCOS patients with abdominal obesity, down-regulating insulin resistance, which is significantly superior to simple diet control plus exercise.

The Effect of Diet Control on the Leptin Levels in Diabetic Pregnant Women

Leptin is an adipokine that has strong correlation with the body mass index (BMI). Gestational diabetes mellitus (GDM) is a common medical complication associated with pregnancy. Leptin may lose its correlation with the body mass index (BMI) during diabetes due to hormonal rearrangement. Diet control is the first line management in GDM. Leptin reported to increase in pregnancy and further increases in diabetic patients during GDM screening. There is paucity in the reports concerning Leptin levels in GDM patients on diet control. The present study was aimed to evaluate the changes in maternal leptin in pregnancy complicated by GDM on diet control compared to the normal pregnancy in the 3rd trimesters by comparing the means and to find the correlation of Leptin with the body mass index in both groups. Methods: The study included 2 groups: normal pregnancy (n = 40) and pregnancy with GDM under diet control (n = 60) both groups are at 38-40 weeks of gestation. Leptin concentration in serum was measured in both groups and statistically tested using student t test. The BMI were measured and correlated with the Leptin level in test groups. Results: the results indicated that Leptin will nearly triple in the third trimester (38±30 ng/ml) of pregnancy compared to the standard normal non-pregnant. Leptin level was significantly lower in diabetic women on diet control (28±16 ng/ ml) when compared with the non-diabetics (38±30 ng/ml). The hormone has no correlation with the age of the patients but have a positive correlation with the body mass index before and during pregnancy in both groups. Conclusion: Leptin is increasing in pregnancy as part of the physiological changes. Dieting can decrease Leptin level in diabetics’ pregnant women. Diet can restore the hormonal dysregulation of Leptin. Assessment of Leptin level might be used as an indicator for good diet control during pregnancy.

Does Protein Distribution Affect Blood Glucose in Type I Diabetes Mellitus? A Case Report

Introduction: Type I diabetes mellitus patients often complain of hunger and suboptimal blood glucose levels. Proper protein distribution might help to improve glucose control and ultimately, carbohydrate distribution. Case presentation: A nine-year-old boy (herein the patient) newly diagnosed with Type I diabetes mellitus with diabetic ketoacidosis, presented nocturia, polydipsia, loss of weight and lethargy. During admission, the patient was dehydrated and had decompensate metabolic acidosis with glycated hemoglobin (HbA1c) 14.5%, random blood sugar 26.2 mmol/dL, and ketone 3.2 mmol/dL. The patient was started on insulin therapy and referred to a dietitian on the 2nd day of admission. Although patient complied with the dietitian's plan, his glucose level remained suboptimal and he complained of hunger immediately after meals. Insulin dose and activity level remained same at this moment. Whilst keeping the protein intake constant, protein exchanges were redistributed into snacks and main meals. The patient felt satiety and his blood glucose started to optimise. Pairing protein-rich foods with carbohydrates can help to slow the rise in blood glucose because protein causes slower stomach emptying and helps prevent sharp spikes in blood glucose and takes the edge off hunger. Conclusion: This reported case showed proper protein distribution with even carbohydrate distribution can help to improve glucose control and satiety in type I diabetic mellitus. It is recommended that further investigations be conducted to provide more concrete evidence on the role of protein distribution in blood glucose control of type I diabetes mellitus.

Application of the Health Action Process Approach on the behavior of diet control in patients with obesity type polycystic ovarian syndrome / 中国实用护理杂志

Objective To explore the effect of HAPA theory based intervention on diet control behavior of patients with polycystic ovary syndrome (PCOS).Methods 64 obese PCOS patients were randomly divided into the intervention group and the control group,32 cases in each group.The control group received routine health education,while the patients in the intervention group received HAPA theory based intervention.The diet control behavior and clinical monitoring indexes of patients were investigated before and 1 and 6 months after intervention.Results The behavior level of the intervention group on 1 month and 6 month after intervention was significant higher than that of the control group.The levels of BMI,FT,blood glucose level two hours after OGTT,follicle number of the intervention group after intervention were significantly lower than those of the control group.Conclusions The HAPA theory based intervention can improve the diet control behavior of PCOS patients,improve the effect of clinical treatment.

Application of continuous glucose monitoring system in the gestational patients with impaired glucose regulation / 中华临床营养杂志

Objective To evaluate the value of continuous glucose monitoring system (CGMS) in the gestational patients with impaired glucose regulation. Methods The glucose level in the subcutaneous tissue was monitored by CGMS for 3 days in 6 patients with gestational diabetes mellitus (GDM) and 6 patients with gestational impaired glucose tolerance (GIGT). The fluctuation coefficient of blood glucose, percentage of hyperglycemic time, and percentage of hypoglycemic time were calculated. Results As shown by CGMS, the fluctuation coefficient of blood glucose, mean glucose level, percentage of hyperglycemic time, percentage of hypoglycemic time, mean fasting blood glucose, and mean postprandial blood glucose (PBG) levels were not significantly different between GDM group and GIGT group (P ＞ 0. 05). The time for reaching the peak PBG level ranged 90-120minutes in both two groups (P ＞ 0. 05). No sensor-related adverse events were noted. Conclusions It is safe to apply CGMS sensor in pregnant women. The blood glucose profiles are comparable between GDM and GIGT patients by CGMS; therefore, control of blood glucose should be equally strict in patients with GIGT as those with GDM.

EFFECTS OF DIETARY INTERVENTION COMBINED WITH EXERCISE ON BLOOD LIPIDS SUGAR,AND PRESSURE IN OVERWEIGHT SUBJECTS / 营养学报

Objective To observe the effect of diet control combined with exercise on hyperlipi-demia,hyperglycemia and high blood pressure in overweight subjects. Method One hundred and four subjects (75 men and 29 women )were chosen from 6789 persons for medical examinations at health administration centre of our hospital from August to December in 2005. All of them met the following requirements: age 35-60,BMI value 24—28,high blood lipids ,high blood glucose or high blood pressure ,never using any drugs and excluding diseases with defects of heart ,liver or renal function and osteoarthritis diseases affecting physical activities. They were required to follow the plan of diet control and exercise for 24 w. The changes of their body weights (BW) ,body mass index (BMI),waist-hip ratio (WHR),total cholesterol (TC),total triglyceride (TG),high-density lipoprotein (HDL-C),low-density lipoprotein (LDL-C),fasting plasma glucose(FPG),2 hours plasma glucose (2 hPG),glycosylated haemoglobin (HbA1c),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed . Results After 24 w intervention by diet control and exercise ,the BW ,BMI,FPG,2hPG ,HbAlc ,TC ,TG,LDL-C and SBP of the subjects studied were decreased drastically. HDL-C and DBP were not changed. Conclusion Scientific and reasonable diet pattern and rational exercise can lower the hyperlipidemia ,hyperglycemia and hypertension in overweight subjects.