The effect of diabetes self-management education with frequent follow-up on the health outcomes of African American men.

PURPOSE: This study was conducted to determine whether objective clinical, patient performance, quality-of-life, and subjective outcomes are significantly different among African American men with type 2 diabetes who received follow-up at either monthly or 3-month intervals after participating in a structured diabetes self-management education program. METHODS: Prior to the diabetes self-management education program, 30 African American men with type 2 diabetes were randomly assigned to 2 groups to receive telephone follow-up at either monthly or 3-month intervals over a 6-month period. Information obtained at follow-up contact included HbA1c level, perception of general health, and present diabetes knowledge. In addition, daily foot care, dietary, exercise, and medication compliance measures were assessed postprogram. RESULTS: There were no significant differences between the participants who received follow-up at monthly and 3-month intervals on any measures of the selected clinical, patient performance, quality-of-life, and subjective outcomes. CONCLUSIONS: This cross-sectional study showed that telephone follow-up at 3-month intervals following a structured program of diabetes self-management education may be just as effective in contributing to favorable diabetes health outcomes as monthly follow-up.

The Diabetes Day Treatment experiment: a preliminary report on what we learned.

PURPOSE: This paper presents data on the efficacy of a diabetes day treatment program to modify the healthcare behavior of elderly African Americans with diabetes. METHODS: African American patients with Type 1 or Type 2 diabetes who were referred by their certified diabetes educator were eligible to participate in the day treatment program. The program was designed to serve eight patients for 4 hours 1 day a week over 9 months. Participants engaged in informal discussions, low-impact armchair exercises, and discussions of various diabetes issues. A flow sheet was initiated and maintained by the investigators to record information pertaining to each participant's blood pressure, blood sugar, and weight at each session. Attendance and reasons for not attending sessions were recorded. To obtain more in-depth information, the group leaders used a technique known as participant observation. RESULTS: Having CDEs administer a blood sugar test, take blood pressure, and weigh each patient at each clinic visit promotes patient adherence to the diabetes treatment regimen. Memory loss was observed to be especially prevalent among the subjects. CONCLUSIONS: The Diabetes Day Treatment Program may be used as a model for working with elderly persons with diabetes from different ethnic groups.

Suppression of experimental abdominal aortic aneurysms by systemic treatment with a hydroxamate-based matrix metalloproteinase inhibitor (RS 132908).

BACKGROUND: Abdominal aortic aneurysms (AAAs) are associated with chronic inflammation, disruption of medial elastin, and increased local production of elastolytic matrix metalloproteinases (MMPs). The purpose of this study was to investigate how treatment with a hydroxamate-based MMP antagonist (RS 132908) might affect the development of experimental AAAs. METHODS: Male Wistar rats underwent intraluminal perfusion of the abdominal aorta with 50 units of porcine pancreatic elastase followed by treatment for 14 days with RS 132908 (100 mg/kg/day subcutaneously; n = 8) or with vehicle alone (n = 6). The external aortic diameter (AD) was measured in millimeters before elastase perfusion and at death, with AAA defined as an increase in AD (DeltaAD) of at least 100%. Aortic wall elastin and collagen concentrations were measured with assays for desmosine and hydroxyproline, and fixed aortic tissues were examined by light microscopy. RESULTS: AAAs developed in all vehicle-treated rats, with a mean AD (+/- SE) that increased from 1.60 +/- 0.03 mm before perfusion to 5.98 +/- 1.02 mm on day 14 (DeltaAD = 276.4 +/- 67.7%). AAAs developed in only five of eight animals (62.5%) after MMP inhibition, with a mean AD that increased from 1.56 +/- 0.05 mm to 3.59 +/- 0.34 mm (DeltaAD = 128.1 +/- 18.7%; P <.05, vs vehicle). The overall inhibition of aortic dilatation attributable to RS 132908 was 53.6 +/- 6.8%. Aortic wall desmosine fell by 85.4% in the vehicle-treated rats (1210.6 +/- 87.8 pmol/sample to 176.7 +/- 33.4 pmol/sample; P <.05) but only by 65.6% in the animals treated with RS 312908 (416.2 +/- 120.5 pmol/sample). In contrast, hydroxyproline was not significantly affected by either elastase perfusion or drug treatment. Microscopic examination revealed the preservation of pericellular elastin and a greater degree of fibrocollagenous wall thickening after MMP inhibition, with no detectable difference in the extent of inflammation. CONCLUSIONS: Systemic MMP inhibition suppresses aneurysmal dilatation in the elastase-induced rodent model of AAA. Consistent with its direct inhibitory effect on various MMPs, RS 132908 promotes the preservation of aortic elastin and appears to enhance a profibrotic response within the aortic wall. Hydroxamate-based MMP antagonists may therefore be useful in the development of pharmacologic approaches to the suppression of AAAs.

Crystal structures of MMP-1 and -13 reveal the structural basis for selectivity of collagenase inhibitors.

The X-ray crystal structures of the catalytic domain of human collagenase-3 (MMP-13) and collagenase-1 (MMP-1) with bound inhibitors provides a basis for understanding the selectivity profile of a novel series of matrix metalloprotease (MMP) inhibitors. Differences in the relative size and shape of the MMP S1' pockets suggest that this pocket is a critical determinant of MMP inhibitor selectivity. The collagenase-3 S1' pocket is long and open, easily accommodating large P1' groups, such as diphenylether. In contrast, the collagenase-1 S1' pocket must undergo a conformational change to accommodate comparable P1' groups. The selectivity of the diphenylether series of inhibitors for collagenase-3 is largely determined by their affinity for the preformed S1' pocket of collagenase-3, as compared to the induced fit in collagenase-1.

Making a case for the CDE's role in outsourcing diabetes services to a freestanding outpatient diabetes disease state management center.

Outsourcing of diabetes disease state management services by MCOs is a good thing for enrollees with diabetes. It is a good mechanism for MCOs that are striving to cut the costs of diabetes care, and it is a trend that the authors expect to see continue in an accelerated way, given the new diagnostic guidelines released by the American Diabetes Association and the epidemic of diabetes among older persons. Through a partnership with a quality, freestanding, outpatient diabetes disease state management center staffed by CDEs, MCOs with a vision can expect to profit now and pay less later for devastating, expensive diabetes complications that lead to increased hospitalizations.

Greatest fears of type 1 and type 2 patients about having diabetes: implications for diabetes educators.

This exploratory study was undertaken to describe the differences in the greatest fears about having diabetes between type 1 and type 2 patients. Frequency distributions, measures of central tendency, and nonparametric statistics were employed to examine the traits of the sample and to make comparisons between type 1 and type 2 patients. Content analysis was used to describe and analyze the subjects' responses to the question, What is your greatest fear about having diabetes? Subjects' answers to this question were categorized and scored as representing fear of either a long-term or acute complication based on the clinical judgment of the authors. Results revealed that both type 1 and type 2 patients were likely to have given responses that were suggestive of fear of long-term complications. The major fears concerned amputation, cardiovascular disease, nephropathy, neuropathy, retinopathy, and stroke. The findings of the present investigation suggest that diabetes educators may need to address patients' fears of long-term complications directly and effectively. Several areas of research that grew out of this exploratory study were recommended for future consideration.

Diabetes in minority populations.

The prevalence and incidence of diabetes are higher in several ethnic minority populations in the US, including Hispanic, Asian, African, and Native Americans. Nurse practitioners will encounter increasing numbers of patients from these population groups in the future. Of major concern is the high prevalence of additional risk factors, such as smoking, obesity, hypertension, hyperlipidemia, and low socioeconomic status, which contribute to the increased rate of complications of this disease in these groups. Emphasis must be placed on screening and risk reduction, and diabetes management in these groups must be culturally sensitive and relevant.