Which information resources are used by general practitioners for updating knowledge regarding diabetes?

Little is known about the degree of utilization of information resources on diabetes by general practitioners [GPs] and its impact on their clinical behavior in developing countries. Such information is vital if GPs' diabetes knowledge is to be improved. This cross-sectional study recruited 319 GPs in the summer of 2008. Questions were about the updates on diabetes knowledge in the previous two years, utilization of information resources [domestic and foreign journals, congresses, the Internet, reference books, mass media, and peers], attitude toward the importance of each resource, and impact of each resource on clinical behavior. A total of 62% of GPs had used information resources for improving their knowledge on diabetes in the previous two years. Domestic journals accounted for the highest utilization [30%] and the highest importance score [83 points from 100]; with the importance score not being affected by sex, years elapsed after graduation, and numbers of diabetic visits. Clinical behavior was not influenced by the information resources listed; whereas knowledge upgrade, irrespective of the sources utilized, had a significantly positive correlation with clinical behavior. Domestic journals constituted the main information resource utilized by the GPs; this resource, however, in tandem with the other information resources on diabetes exerted no significant impact on the GPs' clinical behavior. In contrast to the developed countries, clinical guidelines do not have any place as a source of information and or practice. Indubitably, the improvement of diabetes knowledge transfer requires serious interventions to improve information resources as well as the structure of scientific gatherings and collaborations

[Prevention and public approach to diabetic foot]

Diabetes among Eastern Mediterranean [EM] population above age of 20 years is around 10.5% and is ranked among the leading causes of blindness, renal failure and lower limb amputation. While 50% of EM people with diabetes will die of cardiovascular diseases. This means that in our region, there are pandemic trends in prevalence of diabetes and associated complications. Globally, people with diabetes are 25 times more likely to have a leg amputated than those without the condition, and up to 70% of all leg amputations happen to people with diabetes. Somewhere in the world, a leg is lost to diabetes every 30 seconds. Foot ulcer is the most common single precursor to lower extremity amputations among diabetics. Hyperglycemia, impaired immunologic responses, neuropathy, and peripheral arterial disease are the major predisposing factors leading to limb-threatening diabetic foot infections. Diabetic foot represents a health problem and economic burden among majority of EM Countries. Infection in a diabetic foot is limb-threatening and must be treated empirically and aggressively. Treatment of infected foot wounds is the most common reason for diabetes- related hospitalization. The good news is that up to 85 percent of diabetic amputations can be prevented. As to above challenge, the best approach for EMR is education, community awareness and prevention of diabetic foot. The public approach and education that emphasize on proper footwear and foot care are best preventive and cost-effective modalities that can be easily implemented among EM Countries. EM Countries need to strengthen national health services that promote the concept of prevention and tight control of diabetes in order to prevention diabetes complications. This also necessitates building/strengthening diabetes registry and complications

Comparison of desmopressin [DDAVP] tablet and intranasal spray in the treatment of central diabetes insipidus

Desmoperssin is the drug of choice for treatment of central diabetes insipidus and most commonly it is used as intranasal spray. In this study, efficacy and side effects of oral desmopressin was compared with the intranasal spray. This study was before -after clinical trial on 14 outpatients [9 F, 5 M, age 14 -50 Y] with central diabetes insipidus who had been treated with intranasal spray of desmopressin previously. Weight, pulse rate and blood pressure [sitting -standing], biochemical profile, serum electrolytes, 24h urine volume, specific gravity of urine and LFT was measured before and after 1 month study. Starting dose for each patient was one oral tablet of DDAVP [0.1 mg] per 8 hours. Paired Samples T-Test was used for data analysis. No clinically significant changes were found as regard to weight, pulse rate, blood pressure, blood chemistry, electrolyte and urinalysis. Single reported adverse effect was headache [43%] in tablet group and dyspnea [7%] in spray group. Both dosage forms were able to control diurnal polyuria and nocturnal polyuria. The antidiuretic dose - equivalence ratio for intranasal to oral desmopressin was 1: 18. Spray was superior in terms of rapid onset of action and duration of antidiuretic action in 100% and 78% of cases [not significant], respectively. Tablets were more available and much more easily consumed as reported by patients, in 86% [P=0.0006]. Treatment with tablets offers a good alternative to the intranasal route, especially in patients with chronic rhinitis or common cold and similar conditions

[ effect of combination therapy with gliclazide and metformin in control of blood glucose of type 2 diabetics]

Background: gliclazide is a second generation sulfonylurea which its efficacy and safety in the treatment of diabetes has been established. Diamicron MR [30 mg] is a new formulation of gliclazide with modified release which offer once daily dosage administration. This study was designed to assess the effect of combination therapy with diamicron and metformin in the treatment of type 2 diabetes

Methods: 16 patients with type 2 diabetes [2 males, 14 females] more than 35 years old who despite treatment with glibenclamide and metformin had poor diabetes control participated in this clinical trial.HbA1c, lipid profile, liver and renal function tests at the end of study were compared with before

Results: no significant changes was found in FBS, BS2hpp, lipid profile and renal and liver function tests at the end of study. Patients' weight was stable during the study

Conclusion: regardless of well efficacy of diamicron in the treatment of new diabetics cases, it is not recommended for patients with poor diabetes control despite of combination therapy with metformin and glibenclamide