Self monitoring of blood glucose combined with digital diabetes management to improve clinical relevant indicators in type 2 diabetes / 重庆医学

Objective To compare the influence between self-monitoring of blood gluocose(SMBG)combined with digital diabetes management and traditional management mode on the related clinical indexes in the patients with type 2 diabetes mellitus(T2DM).Methods A total of 100 patients with T2DM treated in the endocrinology and metabolism outpatient department of this hospital from January 2022 to June 2022 and meeting the inclusion criteria of this study were successively included.They were divided into the experimental group and control group.The experimental group was managed by SMBG combined with digital diabetes man-agement mode,while the control group adopted the traditional management mode,the outpatient clinic follow up once a month.After 6 months of follow-up,fasting blood glucose,glycosylated hemoglobin(HbA1c),low density lipoprotein cholesterol(LDL-C)and urinary microalbumin/creatinine ratio(UACR)were compared between the two groups.Results The FBG,HbA1c,LDL-C,and UACR of the experimental group decreased after intervention when compared with baseline.Compared with the control group,the FBG[8.7(7.7,9.2)mmol/L vs.10.8(8.8,12.7)mmol/L,Z=-4.660,P＜0.001],HbA1c[6.3％(5.3,7.8)％vs.8.5％(7.2,10.0)％,Z=-5.130,P＜0.001],LDL-C[2.6(1.8,3.1)mmol/L vs.3.3(2.6,4.0)mmol/L,Z=-4.112,P＜0.001],UACR[16.1(3.5,46.5)mg/g vs.58.4(11.9,108.0)mg/g,Z=-2.220,P=0.026]for patients in the expriemental group after intervention were significantly decreased.Conclusion SMBG combined with digital diabetes management model can significantly improve the clinical indicators of patients.

Studies on the Intention Use of Diabetes Personal Management Application and Related Factors / 昆明医科大学学报

Objective To understand the intention of the community diabetes management application and analyze the related factors.Methods Diabetes patients in the community were selected as the research objects,and the diabetes management application intention scale,diabetes electronic health literacy scale,diabetes self-management ability scale and general information questionnaire were randomly conducted for the investigation.Results The score of 286 cases of community diabetes management application intention was 44.38±8.56,the qualification rate was 67.4%,the score of diabetes e-health literacy score was 22.38±7.56,the qualification rate was 28.2%,and the score of diabetes self-management ability score was 43.41±7.96.Through the analysis,it was found that diabetes management application intention,e-health literacy,and self-management ability were affected by patients'education,age,and income.The analysis of related factors showed that the intention to use the diabetes management application was positively related to the electronic health literacy and self-management ability of patients P<0.05.Conclusion The intention to use community diabetes management application is affected by income,education level,age,e-health literacy and self-management ability.The overall level of e-health literacy and self-management ability of diabetes patients is low.It is necessary to improve the e-health literacy and self-management level of diabetes patients.

Design of remote diabetes management system based on dynamic blood glucose monitoring / 医疗卫生装备

Objective To design a remote diabetes management system based on dynamic blood glucose monitoring to solve the problems of traditional diabetes patient management in glucose data manual collection,unidirectional information flow and out-hospital glucose management.Methods A remote diabetes management system was developed with Java EE distributed microservices-based architecture and front-end and back-end separation mode,which used Vue for the front-end user interface design and IntelliJ IDEA development tools supporting Java language for the backend.The system developed was composed of a doctor App,a patient App and a background management terminal.The doctor App had three modules for user management,data viewing and intervention follow-up,the patient App had three modules for data monitoring,event recording and doctor-patient communication and the background management terminal had three modules for user management,data management and device management.Results The system developed realized individualized intervention and long-term glucose control based on real-time data acquisition of patient glucose fluctuation,diet,medication,exercise and other conditions.Conclusion The system developed can be used for the centralized online and offline management for in-hospital and out-hospital diabetes patients,which reduces the incidence of adverse events due to high or low blood glucose and improves the efficiency of medical staffs.[Chinese Medical Equipment Journal,2023,44(9):42-48]

Research progress on minimally invasive and non-invasive blood glucose detection methods / 生物医学工程学杂志

Blood glucose monitoring has become the weakest point in the overall management of diabetes in China. Long-term monitoring of blood glucose levels in diabetic patients has become an important means of controlling the development of diabetes and its complications, so that technological innovations in blood glucose testing methods have far-reaching implications for accurate blood glucose testing. This article discusses the basic principles of minimally invasive and non-invasive blood glucose testing assays, including urine glucose assays, tear assays, methods of extravasation of tissue fluid, and optical detection methods, etc., focuses on the advantages of minimally invasive and non-invasive blood glucose testing methods and the latest relevant results, and summarizes the current problems of various testing methods and prospects for future development trends.

Research hotspots of diabetes management in China / 预防医学

Objective@#To analyze the research status,research hotspots and its changing trends of diabetes management in China. @*Methods@#We searched the databases of CNKI,Wanfang and VIP to collect literature about diabetes management until December 7th of 2019;counted the number of published articles and journals;plotted the co-occurrence maps of authors and institutions,and time zone map of keywords by CiteSpace software,so as to analyze the research status,research hotspots and its changing trends of diabetes management.@*Results @#A total of 8 435 articles were included,and the number of the articles was increasing year by year. The largest number,8 141 (96.51%) of published articles lay in the period from 2009 to 2019. The articles published in 826 journals,13 of which were in the core area. Diabetes New World published the largest number,419 (4.97%) of articles. Lou Qingqing was the author with the most articles published (26,accounting for 0.31%). Shanghai Jiao Tong University,West China Hospital of Sichuan University and the First Affiliated Hospital of Jinan University ranked the top three in articles published,with 70 articles accounting for 0.83%. The keywords that appeared more frequently were self-management,health education,blood glucose management,gestational diabetes,health management,community management and nursing management. The more centralized keywords were self-management,health education,gestational diabetes and community management. Self-management and health education had always been research hotspots. Family doctors and mobile health were new directions in recent years.@*Conclusions@#The volume of domestic articles on diabetes management has been increasing. Self-management and health education has always been hotspots,meanwhile,family doctor and mobile health have become new hotspots of diabetes management research.

Intention and influencing factors of medical staff in community diabetes management to recommend influenza vaccination / 预防医学

Objeetive@#To understand the intention and influencing factors of medical staff in community diabetes management to recommend influenza vaccination,so as to provide reference for promotion of influenza vaccination recommendation.@*Methods @#The Doctors, nurses and managers from 8 community health service centers（hospitals）in Jiangbei District of Ningbo,who provided diabetes management services,were recruited to collect their demographic features,job satisfaction and intention to recommend influenza vaccination. Logistic regression model was used to analyze the influencing factors for the intention to recommend. @*Results@#Totally 412 questionnaires were distributed and 399（96.84%）valid questionnaires were recovered. There were 178 general practitioners,161 nurses,20 managers and 40 other staffs,accounting for 44.61%,40.35%,5.01% and 10.03%, respectively. Among them,281 had the intention to recommend influenza vaccination,accounting for 70.43%. The results of multivariate logistic regression analysis showed that the medical staff who aged 30 to 39 years（OR=0.332,95%CI：0.118-0.932）,worked for more than 20 years（OR=0.136,95%CI：0.044-0.425）, concerned about medical disputes（OR=0.170,95%CI：0.074-0.392）and negative medical opinion（OR=0.336,95%CI：0.141-0.803）were less likely to recommend influenza vaccination;while the medical staff who were general practitioners（OR=3.664,95%CI：1.513-8.869）,managers（OR=14.695,95%CI：2.494-86.591）,and who were satisfied with professional training opportunities（OR=5.041,95%CI：1.686-15.072）,financial or moral rewards（OR=8.216,95%CI：3.213-21.011）,personal accomplishment（OR=3.955,95%CI：1.517-10.310）and interest in work（OR=6.669,95%CI：2.667-16.679）were more likely to recommend influenza vaccination.@*Conclusion@#Age,post,working age,medical dispute concern,negative medical opinion,professional training opportunities,financial or moral rewards,personal accomplishment and interest in work are associated with the intention to recommend influenza vaccination of the medical staff in community diabetes management.

Diabetes self-management education program (DSME) among adolescents with type 1 diabetes mellitus

@#<p style="text-align: justify;">The DSME program is aimed to educate adolescents about diabetes mellitus: disease process, survival skills, exercise management, drug management, diet management, prevent acute and chronic complications and optimize quality of life. This study utilized the quasi experimental pre and post-test design involving 15 adolescent patients with Type 1 Diabetes Mellitus. The DSME materials were composed of five modules that included topics in diabetes awareness, survival skills, exercise, drug and diet management. Knowledge, Fasting Blood Sugar (FBS), Random Blood Sugar (RBS) and waist and hip ratio (WHR) were tested. The Intervention phase was implemented in three months where each module was completed by patients in two weeks. Pre and post-test examinations were done after each module. Participants have very satisfactory knowledge in diabetes awareness, survival skills, exercise, drug management before and after the DSME program. However, participants knowledge in diet management were unsatisfactory before and after the DSME program. FBS were high but RBS levels and WHR were in normal levels before, during and after the DSME program. Knowledge scores were significantly different before and after the implementation of all the modules (Module 1 to Module 5) to the participants. RBS results were significantly different after the implementation of the Module 1- DM awareness and Module 5- diet management. However, no significant differences were obtained in the RBS results of the participants after the implementation of Module 2, 3, 4, and 5. No significant differences were also obtained in the WHR parameters of the participants in each of the implementation of DSME. No significant differences in the FBS results were obtained after the implementation of the DSME modules. The module type DSME is effective in increasing knowledge of the adolescent patients in diabetes and its management. The content of the diet management module needs to be strengthened and be tested again for its effectiveness in increasing knowledge of adolescent patients.</p>

Assessment of knowledge and skills of barangay health workers: Basis for diabetes education program for lay persons

@#This study aimed to determine the level of knowledge and skills of the barangay health workers (BHW) about diabetes management. A descriptive correlational design that included 121 BHWs in Bustos, Bulacan was utilized in the study. A test and skill demonstration checklist was utilized to determine the knowledge and skills of BHWs about diabetes management. Categorical variables such as the respondents' profile were described using frequencies and percentages. Continuous variables such as level of knowledge and skills were summarized using central tendency measures (mean) with standard deviation. Pearson correlation test for association was used to test for relationship between level of knowledge and skills. Pearson Chi square was used to test association between demographic variables and level of knowledge and skills. Ap value of <0.05 was considered significant in the analysis of the results. Results showed that the overall level of knowledge of the BHWs was satisfactory but varied in many aspects of diabetes management. The BHWs level of knowledge in determining signs and symptoms and diagnosis of diabetes was high but low in determining types of diabetes mellitus. The level of skills of the BHWs was high in blood pressure measurement but low in blood glucose monitoring. BHWs have varied knowledge and skills in diabetes care management. There is a need to train the BHWs further to develop their knowledge and skills. The nurse diabetes educators must provide diabetes education program for BHWs that are focused on competencies to deliver safe and appropriate health teaching activities utilizing the basic concepts and principles of diabetes management

Effect of intervention programs regarding community "5+1" staged diabetes target management on patients with type 2 diabetes mellitus / 中华流行病学杂志

Objective: To analyze the effect of intervention programs and influencing factors regarding the community "5+1" staged diabetes target management on patients with type 2 diabetes mellitus (T2DM) and to provide evidence for improving the quality of life (QOL). Methods: A total of 12 community health service centers from Shanxi province, Jiangsu province, and Ningxia Hui autonomous region were selected as intervention group and control group, by stratified cluster sampling method. "5+1" model was used in intervention groups and basic public health services model was applied in control groups for this two-year follow-up. Data was collected through a questionnaire on demographic and disease-related information, while the QOL was measured with SF-36. Multiple linear regression and conducted by SAS 9.4. Results: A total of 2 467 subjects were included at baseline and 1 924 had completed a two-year-long management service. After intervention programs being implemented, the net effect of PCS score between the intervention and the control groups was 13.6, with the net effect of MCS score as 29.8. Results from the multiple linear regression showed that the main factors affecting PCS scores included age, type of medical insurance, baseline PCS score and regions of residency. Main factors related to MCS score included age, type of medical insurance, baseline MCS score, hypertension, and region of residency. Conclusion: Community "5+1" staged diabetes target management model presented favorable effect of improving the QOL on T2DM patients.

Effect of diabetic management modes on diabetic nephropathy: a prospective study / 中华危重病急救医学

Objective@#To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions.@*Methods@#Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor blocker (ACEI/ARB) were collected.@*Results@#A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L): -1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L): -1.85±0.88 vs. -1.53±0.68, HbA1c: -0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g): -0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9% (16/18) vs. 22.2% (4/18), 95.8% (23/24) vs. 29.2% (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9% (16/18) vs. 95.8% (23/24), P > 0.05].@*Conclusion@#Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.

Effect of intervention programs regarding community “5 + 1” staged diabetes target management on patients with type 2 diabetes mellitus / 中华流行病学杂志

Objective To analyze the effect of intervention programs and influencing factors regarding the community “5 + 1” staged diabetes target management on patients with type 2 diabetes mellitus (T2DM) and to provide evidence for improving the quality of life (QOL).Methods A total of 12 community health service centers from Shanxi province,Jiangsu province,and Ningxia Hui autonomous region were selected as intervention group and control group,by stratified cluster sampling method.“5 + 1” model was used in intervention groups and basic public health services model was applied in control groups for this two-year follow-up.Data was collected through a questionnaire on demographic and disease-related information,while the QOL was measured with SF-36.Multiple linear regression and conducted by SAS 9.4.Results A total of 2 467 subjects were included at baseline and 1 924 had completed a two-year-long management service.After intervention programs being implemented,the net effect of PCS score between the intervention and the control groups was 13.6,with the net effect of MCS score as 29.8.Results from the multiple linear regression showed that the main factors affecting PCS scores included age,type of medical insurance,baseline PCS score and regions of residency.Main factors related to MCS score included age,type of medical insurance,baseline MCS score,hypertension,and region of residency.Conclusion Community “5 + 1” staged diabetes target management model presented favorable effect of improving the QOL on T2DM patients.

Effect of diabetic management modes on diabetic nephropathy: a prospective study / 中华危重病急救医学

Objective To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions. Methods Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor blocker (ACEI/ARB) were collected. Results A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L):-1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L):-1.85±0.88 vs. -1.53±0.68, HbA1c:-0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g):-0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9％ (16/18) vs. 22.2％ (4/18), 95.8％ (23/24) vs. 29.2％ (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9％ (16/18) vs. 95.8％ (23/24), P > 0.05]. Conclusion Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.

Applied research on diabetes management system based on Android system platform / 中国医学装备

Objective: To research a intelligent mobile APP information platform is used to carry out remote diagnosis and treatment services for the patients with diabetes so as to improve the medical experience and treatment compliance of the patients with diabetes. Methods: The patient's physiological information data that were obtained from home wearable medical devices were collected through the Bluetooth technique by using wireless mobile network. And the APP system was used to carry out remote online multi-channel communication between doctor and patient, and was applied to establish relevant health records. Results: The control rate of blood sugar, blood pressure, blood lipid and other indicators of patients with diabetics have been increased from 33% to 70%, and the filing rate of health records of patients also has been increased from 29% to 85%. Conclusion: The application of multi-channel multimedia interconnect platform and the integration of health data of patients with diabetes can ensure patients to complete treatment in least process, and it can provided convenient communication in real time for doctor and patients. And it also can greatly enhance the efficiency for the management of diabetes, improve satisfaction of patient, reduce the risk of hypoglycemia and the complications of diabetes.

Promote the nurse diabetes health education as the core management mode / 中国实用护理杂志

[abstract] Objective To study the health education on diabetes nurse diabetes management mode at the core of application in the patients with follow-up effect. Methods Our hospital endocrinology in October 2015,participate in blood sugar management company research project(namely,doctors,nurses and patients ofthree Eonline and offline (O2O) integration management system).The project is the specialist education nurses,doctors and patients of organic whole,to form a closed-loop management.Use of the project with mobile tablet (PAD),SMS platform on the first base into a group of patients with type 2 diabetes insulin for 5 minutes on education and baseline data collection,and in the next 15 weeks of diabetes health education nurses via text message and phone tracking in the form of blood sugar and insulin dose data,at the same time for more than three months of education,guidance and management,to help patients with initial foundation of insulin self management knowledge and skills,promote the blood glucose control is at target. Results In 12 weeks of the completion of this project and follow-up,425 patients of FPG success rate is 82.6%. Conclusion Nurse diabetes health education as the core of diabetes management model is feasible in patients with type 2 diabetes, the effect is good,that greatly arouse the subjective initiative of patients;Improve the patients′self-management ability,improving according to the medical behavior;Improved treatment adherence to standard prompt patients FPG.

Knowledge, Attitude, and Practice of Iranian Internists Regarding Diabetes: A Cross Sectional Study

BACKGROUND: A number of studies investigated the general practitioners' and family physicians' knowledge, attitude, and practice (KAP) on diabetes. However, studies on internists' KAP on diabetes management are limited. This study aimed to investigate the Iranian internists' KAP on diabetes mellitus and its management. METHODS: A cross-sectional study was conducted on a random sample of internists who participated in the 26th annual congress of internists in Tehran, Iran. The level of KAP and affecting factor was evaluated by a validated instrument. RESULTS: One-hundred internists with the mean age of 41.98±9.26 years were evaluated. Totally, the physicians possessed 66.29%±19.5%, 50.44%±19.39%, and 64.5%±15.3% of the scores in KAP, respectively. The time since graduation in general medicine had significant negative correlation with their knowledge and practice, that was along with the subjects' age (P0.05). Attitude, and practice scores were significantly higher in physicians who were working at diabetes clinic (P<0.05), and attitude was more in physicians working at teaching hospitals compared to those who were not working (57.82 vs. 47.72, P=0.020). CONCLUSION: According to our results, subjects' age and time since graduation in general medicine and specialty were inversely correlated by knowledge and practice. So internists with older age seems to be in priority for educational programs. And holding CME programs in current forms seems to be not suitable to increase the KAP regarding diabetes.

Características generales y esquemas de tratamiento en pacientes con diabetes tipo 2, participantes en el estudio IDMPS (International Diabetes Management Practice Study) en Costa Rica / Basic characteristics and treatment regimens in people with type 2 diabetes who participated in the International Diabetes Management Practices Study in Costa Rica

Antecedentes: el International Diabetes Management Practice Study es un estudio mundial, observacional, que tiene como propósito determinar el estándar de tratamiento de los pacientes con diabetes mellitus en las diferentes regiones del mundo, y la adherencia a las guías internacionales con respecto al abordaje y manejo de estos pacientes. A nivel mundial, 15016 pacientes con diabetes tipo 2 participaron en el estudio, previamente publicado por Ringborg et al. en la revista International Journal of Clinical Practice, en 2009. La siguiente publicación corresponde a la segunda etapa del estudio que analizó a los pacientes participantes de Costa Rica. Resultados: en Costa Rica se valoró 49 pacientes de la consulta privada de 5 médicos endocrinólogos, en un periodo que comprendió del 22 de marzo al 24 de abril de 2007. El valor promedio de la glicemia en ayunas para los pacientes fue de 140,45mg/dL ± 56,3. Con respecto al control glicémico, el estudio encontró que el 60% de los participantes presentó una HbA1c > 7%, y el 17,5% de los pacientes presentó HbA1c mayor al 9%. Todos los pacientes valorados estaban recibiendo algún tipo de terapia farmacológica: el 63,6% de los pacientes con hipoglicemiantes orales, y el 45,5% de los pacientes tratados con insulina alcanzó la meta de HbA1c < 7%. Solo el 22,2% de los pacientes tratados con la combinación de hipoglicemiantes orales más insulina, llegó a la meta. Conclusión: el estudio muestra como la mayoría de los pacientes (60%) no logra alcanzar la meta de un adecuado control glicémico (HbA1c < 7%), aunque se ha establecido que un adecuado control glicémico reduce la incidencia de complicaciones micro y macrovasculares. Debe haber un mayor énfasis en la atención intensiva para mejorar el manejo de los pacientes con diabetes tipo 2 en Costa Rica.

Background: The International Diabetes Management Practice Study was a worldwide observational study with the aim to determine the standard of care of diabetic patients in different regions around the world and the adherence to the international guidelines regarding diabetic care and management. Around the world 15,016 patients with type 2 diabetes were enrolled in this study, published previously by Ringborg et al, in the International Journal of Clinical Practice in 2009. The following study corresponds to the sub study which analyzed the patients who participated in Costa Rica. Results: In Costa Rica 49 type 2 diabetic patients were recruited from the private practice of 5 endocrinologists from March 22nd to April 24th, 2007. The mean fasting blood sugar value of the patients studied was of 140.45mg/dL ± 56.3. With respect to glycemic control, the study showed that 60% of patients had an HbA1c > 7% and 17.5% of them had a value greater than 9%. All the patients who were evaluated had some type of pharmacologic agent in their therapeutic regimen. Around sixty-three percent (63.6%) of the patients who were treated with oral antidiabetic agents and 45.5% with insulin alone reached the target of an HbA1c < 7%, respectively. To a lesser extent (22.2%) patients who were treated with both types of medications reached that goal. Conclusion: In this study the majority of patients (60%), did not meet criteria for an adequate glycemic control (HbA1c < 7%) despite the broad scientific evidence available which demonstrates that an adequate glycemic control effectively reduces micro and macrovascular complications. More emphasis needs to be added to improve treatment for patients with type 2 diabetes in Costa Rica.

Current status of managing diabetes mellitus in Korea

Diabetes mellitus is an increasing global health problem. Guidelines for diabetic care recommend management of lifestyle and risk factors (glucose, blood pressure, and cholesterol), as well as regular screening for complications associated with treatment of the conditions related to diabetes. The prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013. According to the diabetes fact sheet 2015, the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% from 2006 to 2013, and 49.5% of those with diabetes were being treated with lipid-lowering medications in 2013, a 1.8-fold increase since 2006. According to the 2014 Korea National Health and Nutrition Examination Survey data, 45.6% of patients with diabetes achieved a hemoglobin A1c level of < 7.0%, 72.8% achieved a blood pressure of < 140/85 mmHg, and 58.0% achieved a low density lipoprotein cholesterol level of < 100 mg/dL. Only 19.7% of patients with diabetes had good control of all three of these parameters. Despite improvements in health promotion efforts, the rates of adherence to medication and risk-factor control are low. Therefore, a systematic approach to managing diabetes, including self-management education, is needed to prevent or delay complications. The government needs to establish a long-term policy to address the growing burden of diabetes.

Evaluation of Oral Health Promotion Program Connected with Hypertension and Diabetes Management Programs: Use of a Logical Model / 치위생과학회지

This study aimed to design and operate a complementary integrated health management program based on the connection between the hypertension and diabetes management programs and the oral health programs at a public health center. It also proposed to suggest the phased evaluation indicators. In this study, 48 adults registered in the hypertension and diabetes management program were selected from the Gangneung public health center. The clinic-specific programs were led by dental hygienists and operated for visitors twice every two weeks. The programs were designed based on the logical model, and indicators for evaluating the structure, process, and outcome were presented and applied to the input, process, output, and outcome. The evaluation indices consisted of quantitative and qualitative indicators, and the planning and operation, goal achievement, and effect of each program were assessed. The process evaluations were assessed by the appropriateness of the managers and the operating fidelity of the programs. Indicators for evaluating the outcomes were gingival bleeding, oral health knowledge, oral health awareness, and the satisfaction of the participant and the manager. The clinic-specific programs resulted in positive changes in the evaluated outcomes. The integrated health management of visitors to the hypertension and diabetes management program is important as the general and oral health has common risk factors. Furthermore, long-term operation and continuous monitoring of oral health programs are necessary to evaluate the common factors in chronic disease management.

Diabetes Management through Care Communities / 임상당뇨병

The prevalence of diabetes has increased consistently throughout recent decades. Among patients, 70.7% are aware of their disease, and 63% receive treatment. However, less than 20% of those treated maintain their blood sugar level (glycosylated hemoglobin > 6.5%), indicating that most diabetic patients do not receive appropriate treatment. Diabetes management requires consistent treatment and self-management, but elderly patients who lack social or family support and patients from socially disadvantaged classes tend to have less access to medical care and often stop treatment due to economic hardship. While public health centers, Diabetes registration and management center and home nursing services are available to support vulnerable diabetic patients, many are still neglected by our health care system. To improve patient quality of life, a free service providing information and consistent care based on community should be established. Also, when diabetic education team, patients, and their family's, community organizations connection is firmly formation, in the community can be used to effectively manage diabetes.

Economic Evaluation of Diabetes Education / 임상당뇨병

BACKGROUND: Diabetes education, also known as diabetes self-management training or diabetes selfmanagement education, is effective in helping patients with diabetes control their illness and maximize their health. However, there is no established institutional strategy in South Korea because economic evaluations of the benefits and costs of diabetes education have been limited. The purpose of this study is two-fold: (1) describe economic evaluation methodologies, one of the tools available to help choose wisely from a range of alternatives and implement effective resources; and (2) suggest applications of economic evaluation in terms of diabetes education. METHODS: There are three types of commonly used economic evaluations in diabetes education: cost benefit analysis, cost effective analysis, and cost utility analysis. RESULTS: The understanding of the economic value of diabetes education for people with diabetes has a number of uses: to provide empirical evidence to influence policy-making in diabetes education, to offer proof of the benefits of diabetes self-management, to improve awareness of the importance and necessity of diabetes education, to reduce costs of diabetes management, and to enhance healthcare quality. CONCLUSION: Further research is needed to evaluate the economic benefits and costs associated with diabetes education.