Impact of a Cooking Intervention on the Cooking Skills of Adult Individuals with Type 2 Diabetes Mellitus: A Pilot Study.

OBJECTIVE: To investigate the impact of the Nutrition and Culinary in the Kitchen (NCK) Program on the cooking skills of Brazilian individuals with type 2 diabetes mellitus (T2DM). METHODS: A randomized controlled intervention study was performed, with intervention and control groups. The intervention group participated in weekly sessions of the NCK Program for six weeks (including two in-person practical cooking and three online cooking workshops). The cooking recipes were adapted by replacing high glycemic index ingredients with low and medium glycemic index alternatives. Of note, the recipes did not contain added sugars or sweeteners, were based on the use of fresh or minimally processed foods, herbs, and spices, and were sensorially tested by individuals with T2DM before use in the intervention. The study outcomes were participant score changes on the seven scales. A validated online instrument was administered to the control and intervention groups at baseline (T1) and post-intervention (T2). Parametric and non-parametric tests were used to assess the differences between the T1 and T2 parameters. RESULTS: Of the 60 individuals enrolled, 44 answered the questionnaire at both times. The findings revealed a 45.37% ± 93.57% increase in Knowledge of Cooking Terms in the intervention group, whereas the control group showed a 3.82% ± 16.17% reduction (p = 0.008). There was an increase in all the other cooking skills and healthy eating scales from T1 to T2 in the intervention group, but the differences were not significant. CONCLUSIONS: The development of cooking skills can contribute to increasing culinary knowledge and the availability of time to cook at home. The results contribute to the planning of health actions aimed at individuals with DM2 through culinary interventions and public food and nutrition policies.

Usability evaluation of the educational website "understanding my diabetes" for Mexican patients with type 2 diabetes.

Background: Diabetes education is an integral part of the treatment for the metabolic control of patients with diabetes. The use of the Internet as a tool for diabetes education, as well as its acceptance, is still under study. Aim: To assess the usability of the educational website "I understand my diabetes" designed for patients with type 2 diabetes attending primary care clinics. Material and method: A cross-sectional study was done in 110 patients with type 2 diabetes from two family medicine clinics, each of whom was assigned a user account on the educational website "Entiendo mi diabetes." The web site assigned a user name and password to each patient. They were able to access the educational website at home. After a 15-day review period, participants were asked to evaluate usability using the Computer System Usability Questionnaire. Additionally, we developed an eight-item questionnaire usability focusing on diabetes care. Sociodemographic data, blood pressure, and anthropometric measurements were recorded. Glucose levels and lipid profiles were also measured. Results: The patients with diabetes had a mean age of 52.7 years and a median of 5 years since they were diagnosed with diabetes. The website received a good usability rating from 89.1% of participants, with favorable assessments in all three dimensions: 87.3% for information, 85.5% for quality, and 88.2% for interface. Regarding usability specifically for diabetes care, 98.2% rated it as having good usability. Conclusion: The website for education about the disease in patients "I understand my diabetes" had an adequate usability evaluation by patients, so they also considered it very useful for diabetes care. The diabetes care instrument had adequate usability and reliability.

Analysis of Self-Care Activities in Type 2 Diabetes in Brazil: Protocol for a Scoping Review.

BACKGROUND: Diabetes mellitus is a chronic disease that is growing worldwide. It is estimated that 15.7 million people aged between 20 and 79 years live with diabetes in Brazil, and the majority of cases are type 2 diabetes (T2D). To successfully manage diabetes, the patient needs to develop self-care activities. However, there is limited understanding of what self-care activities are performed by people with T2D in Brazil. OBJECTIVE: This study aims to identify and map studies that evaluate self-care activities in T2D in Brazil. METHODS: This is a scoping review protocol structured according to the methodological guidelines of the Joanna Briggs Institute. Six databases and gray literature were used. The process of searching, identifying, and evaluating the papers was carried out by 2 independent reviewers, guided by the assumptions established by the Joanna Briggs Institute. We sought to answer the following guiding question: How are self-care activities for people with T2D evaluated in Brazil? We included papers and publications in any language, from public and private domains, and with different methodological approaches. RESULTS: Initial database searches produced a total of 681 results. These papers will be critically analyzed, and relevant information will be extracted. Quantitative and qualitative results of the papers reviewed will be presented to respond to the study's objective. We intend to publish the scoping review in the first half of 2024. CONCLUSIONS: The protocol for this scoping review will evaluate the main self-care activities carried out by adults and older people with T2D in Brazil. The results may help identify knowledge gaps and contribute to future research and diabetes education interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49105.

Insulin settings and their association with time in range in patients with type 1 diabetes users of predictive low glucose suspend (PLGS) augmented insulin pumps in Santiago, Chile.

AIMS: Sensor augmented insulin pumps have become a powerful tool for managing type 1 diabetes (T1D). This study aimed to analyze the insulin pump configuration in users of predictive insulin suspension technology (PLGS). METHODS: T1D patients on insulin pumps with PLGS (Medtronic 640G®) were enrolled. Data was obtained from medical records and pump data was downloaded for 30 days. Basal insulin, bolus calculator parameters, and PLGS operation parameters were analyzed and compared with Time in Range, Time Below Range, and Time Above Range. RESULTS: 112 patients were included, with average TIR of 73,96 % and HbA1c 7,0 % and 25 months of follow-up. Basal insulin remained similar to initial doses, with an increase of 27 % for the Dawn phenomenon. The Carbohydrate ratio was slightly more aggressive. Insulin sensitivity was 17 % less stringent than initially programmed. No differences were observed in Time in Rage according to the number of basal, ratio, and sensitivity segments. Time of insulin suspension correlated directly with Time Bellow Range. CONCLUSIONS: Patients with good metabolic control have basal insulin programming similar to their initiation doses with less aggressive sensitivity factors. Excessive suspension time determined by PLGS could be an expression of excess insulin and increased hypoglycemia risk.

Six-Month Glycemic Control with a Hybrid Closed-Loop System in Type 1 Diabetes Patients in a Latin American Country.

The goal of this study was to assess the 6-month effectiveness of hybrid closed loop on glycemic control in type 1 diabetes (T1D) patients in Latin America. An exploratory analysis of data prospectively collected from non-selected consecutive patients with T1D who initiated treatment with the MiniMed™ 670G system in Argentina was conducted. Baseline and follow-up visits at days 7, 28, 90, and 180 were carried out and data were downloaded at each visit. A total of 30 patients (age range 9-57 years, female 63.3%), 73.3% (n = 22) of whom previously used sensor augmented pump-predictive low glucose management (SAP-PLGM), with baseline glycated hemoglobin 7.4% ± 1% were included. Time in range between 70 and 180 mg/dL significantly increased from 65.1% at baseline to 77.3%, 76.2%, 75.7%, and 75.2% at days 7, 28, 90 and 180, respectively. Time above range (>180 mg/dL) significantly decreased from 33% to 22.5% (P < 0.001), while time below range (<70 mg/dL) did not change. Mean glucose levels were reduced from 163.5 mg/dL at baseline to 150.9 mg/dL (P = 0.001) at last visit. The Auto Mode feature was used > 90% of the time. Virtual training was successfully completed with a Net Promoter Score® (NPS®) of 87%. This analysis confirms that MiniMed 670G system use allowed successful achievement of glycemic control within recommended targets in a non-selected Latin American patient population who underwent virtual system training.

Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus. / La adherencia al tratamiento no farmacológico se asocia con metas de control cardiovascular y mejores hábitos dietéticos en pacientes mexicanos con diabetes mellitus tipo 2.

OBJECTIVE: To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. METHODS: Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus¼ (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. RESULTS: Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). CONCLUSION: Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

Lower versus standard sucrose dose for treating hypoglycemia in patients with type 1 diabetes mellitus in therapy with predictive low glucose suspend (PLGS) augmented insulin pumps: A randomized crossover trial in Santiago, Chile.

BACKGROUND AND AIMS: Recommended hypoglycemia treatment in adults with T1D consists of 15 g of rapid absorption carbohydrates. We aimed to evaluate the response to fewer carbohydrates for treating hypoglycemia in patients with T1D on insulin pumps with predictive suspension technology (PLGS). METHODS: T1D patients on insulin pumps with PLGS were randomized to receive 10 or 15 g of sucrose per hypoglycemia for two weeks (S10 and S15 groups, respectively) when capillary blood glucose (BG) was <70 mg/dL, with crossover after two weeks. Evolution of capillary BG, active insulin, and suspension time were assessed. RESULTS: 59 hypoglycemic episodes were analyzed, 33 in S10 and 26 in S15. Baseline BG in S10 was 54.3 ± 7.7 mg/dL versus 56.9 ± 8.8 in S15 (p = 0,239). Active insulin, present in 85% of the episodes, and PLGS suspension time were similar between groups. BG at 15 min was 77 mg/dL in S10 and 95 mg/dL in S15 (p = 0.0007). In S10, 21% of the episodes required to repeat the treatment after 15 min compared with none on S15, with a RR of 0,79 (95% CI 0.66, 0.940, p = 0,014) for successfully treating the episode. Sensor glucose was significantly different from BG at the moment of the hypoglycemia and control 15 min after treatment. No severe hypoglycemia and no rebound hyperglycemia occurred in neither group. CONCLUSIONS: A hypoglycemia treatment protocol with a lower dose of sucrose might be insufficient despite PLGS technology. Our data suggest that standard doses of sucrose should still be recommended.

A Fun Way to Learn About Diabetes: Using Therapeutic Play in a Brazilian Camp.

PURPOSE: Understanding disease mechanisms inside the body is crucial to engage youth with type 1 diabetes (T1D) in self-care behaviors. This study describes how Instructional Therapeutic Play (ITP) group sessions held by nurses in a Brazilian camp can enhance youth's understanding about T1D. DESIGN AND METHODS: Youth with T1D participated in video recorded ITP group sessions guided by the Sensitive Creative Method. First, participants were asked to create an artistic production based upon the query "What happens in the body of a young person who has diabetes?". They described their drawings and shared information, providing opportunities to discuss T1D pathophysiology. Second, campers were told a story about a child who had T1D onset using a rag doll and illustrative figures. Participants were asked to create a second artistic production based upon the same initial query. Finally, campers had another presentation of the drawings, discussion, and sharing through the question "How did the story told help you understand your diabetes?" Transcriptions of ITP sessions were submitted to thematic analysis. RESULTS: Twenty participants (9-17yo) were assigned to age/gender matched groups. Four themes were built: Designing insulin production; Experiencing the glycemic vigilance in diabetes management; The ITP session as a safe space to share challenges with nurses and peers; and Unraveling the myths of diabetes with the ITP session. CONCLUSION: Therapeutic play sessions enhanced youth's knowledge and unraveled myths of T1D pathophysiology. PRACTICE IMPLICATIONS: ITP sessions can be developed by nurses in order to deliver age-appropriate diabetes education to pediatric patients.

Time in range and HbA1C after 6 months with a multidisciplinary program for children and adolescents with diabetes mellitus, real world data from Mexico City.

BACKGROUND: Multidisciplinary interventions may be useful for children and adolescents with diabetes mellitus (DM), especially in areas where new blood glucose monitoring and control technologies are difficult to access. METHODS: PAANDA, a care program for adolescents and children with diabetes, was implemented in patients aged 0 to 18 years and 11 months. The effect of the intervention was determined by self-blood glucose monitoring (SBGM) and glycosylated hemoglobin (HbA1C ) levels at start and after 6 months. RESULTS: A total of 121 patients with DM were evaluated, mean age of 14.27 years (SD: 4.60 years). Blood glucose measurements in range (70-120 mg/dL pre-prandial or 70-180 mg/dL post-prandial) increased by 20.67% before breakfast, 8.14% after breakfast (both P-value <.001), 5.02% before lunch (P-value = .02), 8.66% after lunch (P-value <.001), 11.50% before dinner (P-value <.001), 11.87% after dinner (P-value <.001), and 8.00% at dawn (P-value = .001). This change was accompanied by fewer values in the hyperglycemic category (-19.49% before breakfast, -7.73% after breakfast, both P-value <.001) and hypoglycemia (-1.18%). HbA1C levels decreased significantly 1.8% (P-value = .018). Multivariate logistic regression analysis showed an increase in glycemic control associated with each month after the intervention time in the PAANDA program (P-value <.001 for all the time points evaluated) and a significant decrease in glycemic variability. CONCLUSIONS: The multidisciplinary PAANDA intervention had a beneficial effect on glycemic control, with an improved time in range in a population of children and adolescents with DM.

Does knowledge on diabetes management influence glycemic control? A nationwide study in patients with type 1 diabetes in Brazil.

OBJECTIVE: The purpose of this study is to establish demographic and clinical data associated with the knowledge on diabetes management and its influence on glycemic control in patients with type 1 diabetes. METHODS: This was a retrospective, observational, multicenter study conducted with 1,760 patients between August 2011 and August 2014 in 10 cities of Brazil. RESULTS: Overall, 1,190 (67.6%) patients knew what glycated hemoglobin (HbA1c) means. These patients were older, had longer disease duration, longer follow-up in each center, reported lower frequency of self-reported hypoglycemia, and were more frequently Caucasians and at glycemic goal. Multivariate analysis showed that knowledge on what HbA1c means was related to more years of school attendance, self-reported ethnicity (Caucasians), severe hypoglycemia, economic status, follow-up time in each center, and participation on diabetes educational programs. Good glycemic control was related to older age, more years of school attendance, higher frequency of daily self-monitoring of blood glucose, higher adherence to diet, and knowledge on what HbA1c means. CONCLUSION: Patients with a knowledge on what HbA1c means had a better chance of reaching an adequate glycemic control that was not found in the majority of our patients. Diabetes care teams should rethink the approaches to patients and change them to more proactive schedules, reinforcing education, patients' skills, and empowerment to have positive attitudes toward reaching and maintaining a better glycemic control. Finally, the glucocentric approach to diabetes management should be changed to actions that include patients' psychosocial aspects aiming to reduce the stress of living with diabetes, improving glycemic control, and avoiding adverse outcomes.

Educación nutricional en diabetes: una estrategia emergente en venezuela / Nutritional Diabetes Education: an emerging strategy in Venezuela

La Educación Terapéutica en Diabetes constituye una parte fundamental para el control adecuado de la diabetes, y dentro de esta la educación nutricional en Diabetes es fundamental, ya que permite el empoderamiento de los pacientes con herramientas nutricionales que le permitan de forma sencilla y agradable realizar cambios en el estilo de vida para controlar los niveles de glicemia y alcanzar los objetivos metabólicos. En Venezuela aún no se reconoce en las instituciones universitarias ni de salud a la Educación en Diabetes como una carrera profesional, pero varios grupos trabajan en conjunto para promover las herramientas y competencias educativas, en especial las relativas a la alimentación y nutrición. En este trabajo se presenta una perspectiva de los hallazgos más relevantes que sientan los principios nutricionales y educativos de la estrategia de Educación Nutricional en Diabetes en Venezuela, con el fin de que se pueda aplicar cada día más en el país a través de los educadores en diabetes, nutricionistas-dietistas y el resto de los profesionales de la salud(AU)

Therapeutic Education in Diabetes is a fundamental part for the adequate management of diabetes, and diabetes nutritional education is also fundamental, this allows the empowerment of patients with nutritional tools that allow them in a simple and pleasant way to make changes in lifestyle to control blood glucose levels and achieve metabolic goals. In Venezuela, Diabetes Education is still not recognized in the university or health institutions as a professional career, but several groups work together to promote educational tools and competencies, especially those related to food and nutrition. This paper presents a perspective of the most relevant findings that establish the nutritional and educational principles of the strategy of nutrition education in diabetes in Venezuela, so that it can be applied every day more in the country through educators in diabetes, Nutritionists-Dietitians and the rest of health professional(AU)

Efectividad de una estrategia educativa dirigida a adultos mayores diabéticos tipo 2 y proveedores de salud / Effectiveness of an educational strategy aimed at older adults suffering from type 2 diabetes and at health providers

Objetivo: Evaluar la efectividad de la estrategia educativa dirigida a adultos mayores diabéticos tipo 2 y proveedores de salud. Métodos: Investigación cuasi experimental que evaluó un antes-después con grupo control. El universo de estudio estuvo constituido por adultos mayores diabéticos dispensarizados en los policlínicos Hermanos Cruz (U= 1 369) y Pedro Borrás (U= 1 528), del primero se seleccionó el grupo experimental y en el segundo el grupo control, ambos del municipio y provincia Pinar del Río. Para determinar la muestra se utilizó un Muestreo por Conglomerados Bietápico con probabilidades proporcionales al tamaño de las Unidades de Primera Etapa quedando conformada para ambos grupos por 123 adultos mayores diabéticos tipo 2. Se trabajó con el universo de prestadores del GBT uno (U= 84) del policlínico Hermanos Cruz. La estrategia fue aplicada en el grupo experimental, y evaluada de forma inmediata, a los seis meses y al año. Resultados: Las comparaciones de los grupos en los momentos relacionados con la aplicación de la estrategia estuvieron dentro de lo esperado, generalmente se produjeron cambios significativos en los adultos mayores diabéticos tipo 2 en cuanto a los resultados globales y en cada una de las preguntas examinadas a favor del grupo experimental e igualmente en los proveedores de salud. Conclusiones: La mejoría detectada en los resultados de las variables de respuesta principal y secundarias, en el grupo experimental, dan una medida de la efectividad de la estrategia. Al mismo tiempo su estabilidad a los seis meses y al año considerado como horizonte temporal de evaluación, avalan su sostenibilidad(AU)

Objective: To evaluate the effectiveness of the educational strategy aimed at type 2 diabetic older adults and at health providers. Method: A quasi experimental research study to evaluate the situation before and after the application of this strategy in a control group. The study population consisted of diabetic old patients recruited at Hermanos Cruz (U= 1 369) and Pedro Borrás Astorga (U= 1 528) polyclinics. The experimental group was chosen from the first group and the control group from the second one, both in Pinar del Río municipality in Pinar del Rio province. A two-staged cluster was used with proportional probabilities according to the size of the first stage units and the final sample was 123 type 2 diabetic older adults for both groups. All the basic working team health providers from Hermanos Cruz polyclinics were involved in the study. The strategy was applied in the experimental group and immediately evaluated after six months and after a year. Results: The comparisons of the groups made at the time of the implementation of the strategy were within the expectations; there were significant changes in type 2 diabetics in terms of overall outcomes and each of the analyzed questions, which favored the experimental group along with the health providers. Conclusions: The improvement observed in the results of the answer variables of the experimental group shows the strategy effectiveness. At the same time, the stability of results after six months and a year endorses the strategy sustainability(AU))

Decreased Prevalence of Diabetes Mellitus in Jamaica.

The purpose of this paper is to report the dramatic changes in the point prevalence of diabetes mellitus in the adult population of Jamaica following education intervention. The initial prevalence in the 15-and-over age group was determined by a two-stage stratified random sampling design in 1993. In 1997, the University of the West Indies Diabetes Outreach Project thru its public service arm, the Diabetes Association of Jamaica, developed and implemented a Peer Facilitators Diabetes Education Programme. This effort has realized an increased patient and public education as well as concomitant increased patient compliance and a reduction in related complications. The Jamaica Health and Lifestyle Survey 2008 examined, using a stratified, random, two-stage cluster sample survey, and a nationally representative sample of 2848 Jamaicans aged 15-74. The most dramatic outcome is the decrease in the prevalence from 17.9% to 7.9% in the adult population, age 15+.

Intervención educativa con participación comunitaria dirigida a adultos mayores diabéticos tipo 2 / Educational intervention with community participation aimed at type 2 diabetic old-age people

Introducción: una de las formas más factibles para identificar problemas, y buscar soluciones es la investigación-acción-participativa como dimensión de la Educación Popular. Objetivo: promover la participación comunitaria en la dilucidación de problemas, en la toma de decisiones y en las medidas iniciadas para transformar los factores de riesgo y pronósticos de complicaciones crónicas de la diabetes mellitus tipo 2 en el adulto mayor. Métodos: la investigación clasifica como desarrollo tecnológico, al brindar la metodología utilizada en la intervención educativa comunitaria. El estudio se realizó en el policlínico Hermanos Cruz de Pinar del Río en el período de 2011-2014. Como universo se consideró la totalidad de población adulta mayor con diabetes mellitus tipo 2 (U= 1369), del policlínico para el año 2012. La muestra por conglomerados bietápico quedó conformada por 123 pacientes. En la primera etapa se hizo un estudio descriptivo. A partir de estos resultados, se desarrolló la metodología educativa, donde se plantearon diferentes acciones reflejadas en el plan de acciones comunitarias Renacer a la Vida. Resultados: se verificó la responsabilidad de la comunidad junto al médico y la enfermera de la familia, para que las personas adultas mayores con diabetes modifiquen sus opiniones, hábitos y conocimientos. Igualmente se confirmó que en la comunidad se pueden hacer muchas acciones con las organizaciones políticas y de masas, además de actividades deportivas y culturales para trabajar la importancia de la educación al diabético. Conclusiones: el nivel primario de atención es excelente para establecer programas educativos con participación comunitaria dirigidos a adultos mayores diabéticos tipo 2(AU)

Introduction: One of the most feasible ways to identify problems and find solutions is through the participative-action research as a dimension of what is known as Popular Education. Objective: To promote community participation in the elucidation of problems, decision-making and the steps taken to transform risk factors and the prognosis of chronic complications of type 2 diabetes mellitus in the elderly. Methods: This research classifies as technological development by providing the methodology used in the community educational intervention. The study was conducted at Hermanos Cruz polyclinic of Pinar del Río during 2011-2014. The target group comprised the entire elderly population with type-2 diabetes mellitus (U= 1369) during 2012. The two-stage cluster sample was composed of 123 patients. A descriptive study was carried out in the first stage. From these results, an educational methodology was established, reflecting the different actions developed in the community; which is known as Renacer a la Vida. Results: Community's responsibility was verified by the doctor and family nurse, for old-people suffering from diabetes modify their view points, habits and knowledge. It was also confirmed that several activities can be planned in the community supported on the political and mass organizations; such as sport and cultural activities emphasizing the importance of education for diabetic population. Conclusions: Primary health care is an excellent context to establish educational programs involving the community, with the aim of educating type-2 diabetic old-age people(AU)

Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data.

BACKGROUND: Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina). METHODS: MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed. RESULTS: A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198). CONCLUSION: MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers. Trial Registration NCT01400971.

The Contribution of Diabetes Education in the Treatment of People with Type 2 Diabetes and Risk of Cardiovascular Disease.

Diabetes has caused 5.1 million deaths, primarily from cardiovascular disease. Large clinical studies have proven the importance of intensive control of diabetes from diagnosis to prevent microvascular and macrovascular complications of the disease in the long term. Diabetes education conducted by an interdisciplinary team of doctors, nurses, nutritionists, psychologists, and others is a necessary tool to ensure effective behavioral change and help overcome the obstacles that may hinder self care. Several studies have been analyzed in this review, in which we find a variety of results. Diabetes education has proven to be essential to patient compliance with their T2DM treatment; the main objective is to prevent acute and chronic complications, especially cardiovascular ones, which are the main causes of mortality.

Educación terapéutica en diabetes en pacientes con una primera amputación por pie diabético / Therapeutic education on diabetes for patients with first amputation caused by diabetic foot

Introducción: la educación diabetológica es la base del tratamiento para las personas con diabetes, la falta de conocimientos sobre la enfermedad favorece la aparición de complicaciones. Objetivos: identificar las principales causas que provocaron una primera amputación por pie diabético, describir el seguimiento ambulatorio de estos pacientes y explorar los conocimientos sobre su autocuidado. Métodos: estudio descriptivo, de corte transversal en 110 pacientes diabéticos hospitalizados en el Instituto Nacional de Angiología por pie diabético sometidos a una primera amputación. Se analizaron variables demográficas y de salud, así como las características del seguimiento ambulatorio, los conocimientos de los pacientes sobre la enfermedad y las principales causas de la lesión desencadenante. Resultados: la edad promedio fue de 61 años; y 15,4 años de evolución de la enfermedad. El 70,8 por ciento de los pacientes no tenían un seguimiento ambulatorio periódico, menos del 32 por ciento recibió cursos de educación diabetológica. Solo un tercio acudía periódicamente a los servicios de podología. Muy pocos pacientes pudieron expresar de forma precisa y concreta los cuidados de los pies. Entre las principales causas comentadas por los pacientes, que desencadenaron la lesión y que terminó en una primera amputación estuvieron "los pinchazos" y "el rebajar callosidades". Conclusiones: la mayoría de los diabéticos con una primera amputación no tenían un seguimiento periódico ni especializado para su enfermedad, insuficientes conocimientos sobre su autocuidado lo que probablemente generó que las conductas inapropiadas identificadas causaran una lesión complicada que requirió una amputación. Se impone la necesidad de un proceso educativo que sea eficiente para todas las personas con diabetes y así reducir las amputaciones(AU)

Introduction: diabetes education is the mainstay of treatment for people with diabetes since lack of knowledge about the disease favors the occurrence of complications. Objectives: to identify the main causes that led to a first diabetic foot amputation, to describe outpatient monitoring of these patients and to explore their knowledge about self diabetic foot care. Methods: descriptive and cross-sectional study conducted in 110 diabetic patients hospitalized at the National Institute of Angiology due to first diabetic foot amputation. The demographic and health variables as well as the characteristics of patient follow-up, patients' knowledge about the disease and the leading cause of the triggering injury were all taken into consideration. Results: it was found that the average age was 61 years, and 15.4 years of disease progression. In the study group, 70.8 percent of patients had no regular outpatient follow-up, less than 32 percent had received education courses on diabetes. Only one third of them came regularly to podiatric services. Very few patients were able to clearly say the aspects of foot care. The main causes stated by patients, which triggered the injury and led to a first amputation, were "punctures" and "reducing calluses". Conclusions: most diabetics with a first amputation did not have a either systematic or specialized monitoring for disease, with insufficient knowledge about self diabetic foot care, which probably led to identified inappropriate behaviors that caused complications and finally amputation. It is necessary to implement an effective educational process for all the diabetic persons and thus reduce amputations(AU)

Frequency of self-monitoring blood glucose and attainment of HbA1c target values.

AIMS: Test strips for self-monitoring of blood glucose (SMBG) represent in Argentina, around 50 % of diabetes treatment cost; the frequency of their use is closely associated with hyperglycemia treatment. However, the favorable impact of SMBG on attainment of HbA1c goal in different treatment conditions remains controversial. We therefore attempted to estimate the relationship between use of SMBG test strips and degree of attainment of metabolic control in an institution of our social security subsector (SSS) in which provision is fully covered and submitted to a regular audit system. METHODS: Observational retrospective study using information of 657 patients with T2DM (period 2009-2010) from the database of the Diabetes and Other Cardiovascular Risk Factors Program (DICARO) of one institution of our SSS. DICARO provides-with an audit system-100 % coverage for all drugs and keeps records of clinical, metabolic and treatment data from every patient. RESULTS: The average monthly test strips/patient used for SMBG increased as a function of treatment intensification: Monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. In every condition, the number was larger in people with target HbA1c levels. Test strips represented the larger percentage of total prescription cost. CONCLUSIONS: In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG; in every condition tested, targeted HbA1c values were associated with greater strip use. Patient education and prescription audit may optimize its use and treatment outcomes.

Evaluación del programa de educación en diabetes en el adulto mayor / Assessment of Diabetes Education Program in the Elderly at Hermanos Cruz Polyclinic

Introducción: la Educación para la Salud es esencial en el abordaje terapéutico del diabético. No podemos introducir la dieta, el ejercicio y la medicación sin informar al paciente sobre su importancia y sin motivarlo para que adquiera protagonismo en el control de su enfermedad. Objetivo: evaluar tácticamente el programa de educación en diabetes a nivel del Consultorio Médico de la Familia. Métodos: estudio en el campo de la investigación en sistemas y servicios de salud, en el policlínico "Hermanos Cruz" durante el año 2012. Se utilizaron los criterios evaluativos elaborados en una investigación anterior por los autores según datos de estructura, proceso y resultado; así como indicadores y estándares. Resultados: la evaluación táctica de los componentes de estructura, proceso y resultados, resultó evaluada de no satisfactoria. Con el diseño y la aplicación de la evaluación se demostró que existen dificultades en el cumplimiento del programa de educación en diabetes en el área de salud estudiada, el nivel de satisfacción de los servicios en usuarios internos y externos es desfavorable. Conclusiones: las discrepancias detectadas entre el cumplimiento del programa de educación en diabetes y los estándares sirvieron de base para una estrategia encaminada a su perfeccionamiento(AU)

Introduction: Health Education is essential in diabetic therapeutic approach. We cannot introduce diet; exercising and medication without informing the patient of its importance, without motivatingpatient in controlling their disease. Objective: Tactically assess the diabetes education program at family doctor practice. Methods: A study in the field of research in health systems and services was conducted at HermanosCruzpolyclinic in 2012. Evaluative criteria were used by the authors. These criteria weredeveloped in previous research according to data structure, process and outcome; as well as indicators and standards. Results: The tactical evaluation of structure, process and results components proved unsatisfactory evaluated. There are difficulties in implementing the program of diabetes education in the health area studied showed by the design and implementation of this evaluation, the level of satisfaction of services in internal and external users is unfavorable. Conclusions: The discrepancies detected between program implementation and diabetes education standards were the basis for a strategy for its further development(AU)