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Diabetes in primary care

Carla Assaf-Balut, Nuria García de la Torre, Alejandra Duran, Manuel Fuentes, Elena Bordiú, Laura Del Valle, Cristina Familiar, Johanna Valerio, Inés Jiménez, Miguel A Herraiz, Nuria Izquierdo, María J Torrejon, Maria Ángeles Cuadrado, Isabel Ortega, Francisco J Illana, Isabelle Runkle, Paz de Miguel, Inmaculada Moraga, Carmen Montañez, Ana Barabash, Martín Cuesta, Miguel A Rubio, Alfonso L Calle-Pascual
AIMS: The aim of the study was to evaluate the effect of a Mediterranean diet (MedDiet), enhanced with extra virgin olive oil (EVOO) and nuts, on a composite of adverse maternofoetal outcomes of women with normoglycemia during pregnancy. METHODS: This was a sub-analysis of the St Carlos gestational diabetes mellitus Prevention Study. Only normoglycemic women were analysed (697). They were randomized (at 8-12th gestational weeks) to: standard-care control group (337), where fat consumption was limited to 30% of total caloric intake; or intervention group (360), where a MedDiet, enhanced with EVOO and pistachios (40-42% fats of total caloric intake) was recommended...
December 14, 2018: Annals of Nutrition & Metabolism
Joseph Tibaldi, Martin Hadley-Brown, Andreas Liebl, Steffen Haldrup, Viktor Sandberg, Michael Lyng Wolden, Helena W Rodbard
AIMS: To compare the real-world effectiveness of insulin degludec (degludec) and glargine 300 units/mL (glargine U300) in insulin-naïve adult patients with type 2 diabetes in routine US clinical practice. MATERIALS AND METHODS: CONFIRM is a non-interventional comparative effectiveness study following US patients across the continuum of care, through electronic medical records from multiple health systems and integrated delivery networks. Propensity-score matching controlled for confounding...
December 15, 2018: Diabetes, Obesity & Metabolism
Lindsay S Mayberry, John D Piette, Aaron A Lee, James E Aikens
Adults with type 2 diabetes mellitus (T2DM) often receive self-management support from adult children, siblings or close friends residing outside of their home. However, the role of out-of-home support in patients' self-management and well-being is unclear. Patients (N = 313) with HbA1c > 7.5% were recruited from community primary care clinics for a mobile health intervention trial and identified an out-of-home informal support person, herein called a CarePartner; 38% also had an in-home supporter...
December 14, 2018: Journal of Behavioral Medicine
Mireille Captieux, Gemma Pearce, Hannah L Parke, Eleni Epiphaniou, Sarah Wild, Stephanie J C Taylor, Hilary Pinnock
OBJECTIVES: Self-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about the effectiveness of self-management support strategies for people with type 2 diabetes, and which interventions work best and for whom. DESIGN: A meta-review of systematic reviews of randomised controlled trials (RCTs) was performed adapting Cochrane methodology...
December 14, 2018: BMJ Open
Susanne Buhse, Nadine Kuniss, Kathrin Liethmann, Ulrich Alfons Müller, Thomas Lehmann, Ingrid Mühlhauser
OBJECTIVE: To translate an informed shared decision-making programme (ISDM-P) for patients with type 2 diabetes from a specialised diabetes centre to the primary care setting. DESIGN: Patient-blinded, two-arm multicentre, cluster randomised controlled trial of 6 months follow-up; concealed randomisation of practices after patient recruitment and acquisition of baseline data. SETTING: 22 general practices providing care according to the German Disease Management Programme (DMP) for type 2 diabetes...
December 14, 2018: BMJ Open
Vanessa Selak, Tereki Stewart, Yannan Jiang, Jennifer Reid, Taria Tane, Peter Carswell, Matire Harwood
INTRODUCTION: Type 2 diabetes mellitus (T2DM) and its complications are more common among Māori and Pacific people compared with other ethnic groups in New Zealand. Comprehensive and sustained approaches that address social determinants of health are required to address this condition, including culturally specific interventions. Currently, New Zealand has no comprehensive T2DM management programme for Māori or Pacific people. METHODS AND ANALYSIS: The Mana Tū programme was developed by a Māori-led collaborative of primary healthcare workers and researchers, and codesigned with whānau (patients and their families) in order to address this gap...
December 14, 2018: BMJ Open
Laura E Britton, Jon M Hussey, Diane C Berry, Jamie L Crandell, Jada L Brooks, Amy G Bryant
INTRODUCTION: Although elevated blood glucose is associated with adverse maternal and fetal health outcomes, evidence suggests that women with diabetes may not be receiving comprehensive reproductive health care, including family planning and preconception care. Using a population-based sample, we evaluated the relationship between contraceptive use and biomarker-identified diabetes. METHODS: This cross-sectional study used data from 5548 women in the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) from 2007 to 2009...
December 12, 2018: Journal of Midwifery & Women's Health
Brian Chan, Samuel T Edwards, Meg Devoe, Richard Gil, Matthew Mitchell, Honora Englander, Christina Nicolaidis, Devan Kansagara, Somnath Saha, P Todd Korthuis
BACKGROUND: Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research...
December 14, 2018: Addiction Science & Clinical Practice
Rebecka Husdal, Eva Thors Adolfsson, Janeth Leksell, Björn Eliasson, Stefan Jansson, Lars Jerdén, Jan Stålhammar, Lars Steen, Thorne Wallman, Ann-Marie Svensson, Andreas Rosenblad
AIMS: To describe and analyse the associations between primary health care centres' (PHCCs') quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM). METHODS: This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs. RESULTS: Of the participants, 56% had controlled (≤52mmol/mol), 31...
December 10, 2018: Primary Care Diabetes
J C Romero Vigara, J L Llisterri Caro, M Turégano Yedro, S Cinza Sanjurjo, L Muñoz González, Y A Silvero, A Segura Fragoso, J Santianes Patiño, J I García García, J Benítez Rivero
OBJECTIVE: To describe the clinical and socio-sanitary characteristics of adults older than 65 years attended in a Primary Care setting. MATERIAL AND METHODS: The PYCAF study (Prevalence and Characteristics of the Fragile Elderly) is a descriptive, cross-sectional and multicentre study, in which patients older than 65 years attended in clinical practice in Primary Care in Spain were consecutively included. RESULTS: A total of 2,461 patients (mean age 76...
December 9, 2018: Semergen
Nithya Sukumar, Helen Dallosso, Ponnusamy Saravanan, Tom Yates, Carol Telling, Karen Shorthose, Alison Northern, Sally Schreder, Christopher Brough, Laura J Gray, Melanie J Davies, Kamlesh Khunti
BACKGROUND: A diagnosis of gestational diabetes (GDM) is associated with an over sevenfold increase in the risk of developing type 2 diabetes (T2D), while among parous women with T2D, up to 30% have a history of GDM. Lifestyle interventions have been shown to reduce the risk of incident T2D in adults with impaired glucose tolerance, including in women with a history of GDM. The aim of this study is to establish whether a group self-management education programme, supported by a mobile web application, can improve levels of physical activity at 12 months in women who have had GDM...
December 12, 2018: Trials
Jaime Gallegos Salazar, William O'Brien, Judith M Strymish, Kamal Itani, Westyn Branch-Elliman, Kalpana Gupta
Importance: Limited data suggest that screening for asymptomatic bacteriuria (ASB) prior to nonurologic procedures is not useful. However, high-quality evidence to support consensus recommendations and influence clinical practice is lacking. Objective: To characterize the association between detection and treatment of preoperative ASB and postoperative outcomes. Design, Setting, and Participants: This retrospective cohort study involved patients, predominantly male veterans, who underwent surgical procedures in 109 US facilities within the US Department of Veterans Affairs health care system from October 1, 2008, to September 30, 2013...
December 12, 2018: JAMA Surgery
Elen Ferraz Teston, Dandara Novakowski Spigolon, Edilaine Maran, Aliny de Lima Santos, Laura Misue Matsuda, Sonia Silva Marcon
OBJECTIVE: to grasp the perspective of nurses on health education in the process of caring for people with Diabetes Mellitus in Primary Care. METHOD: a descriptive study of a qualitative nature carried out with 13 nurses from the Family Health Strategy in Southern Brazil. The data were collected in November and December of 2017, through recorded interviews, which were submitted to content analysis, thematic modality. RESULTS: three categories emerged, which show from the perspective of nurses, the influence of structural and assistance characteristics in the development of educational actions; outcomes of these actions, and possibilities to increase their quality as central to the nursing action...
2018: Revista Brasileira de Enfermagem
Rasha Elamoshy, Yelena Bird, Lilian Ulrica Thorpe, John Moraros
Background: Diabetes is a prevalent chronic condition that has been linked to depression and suicidal behavior. The Aboriginal peoples of Canada are known to suffer from significant health disparities and higher burden of physical and mental illnesses. The purpose of this study was to assess whether diabetes is associated with higher depressive symptoms and lifetime suicidal ideation among Aboriginal Canadian peoples living off-reserve. Methods: Data were obtained from the Aboriginal Peoples Survey, 2012...
2018: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
Ashruta Patel, Gary Daniels
BACKGROUND: Factitious disorder causing hypoglycemia is a psychiatric condition in which patients deliberately use blood sugar lowering medications to cause severe symptoms for the purposes of hospitalization or other primary gains. CASE PRESENTATION: We report a case of factitious hypoglycemia in a 19-year-old foster care adolescent female who presented to the Emergency Department with recurrent hypoglycemic episodes, to the degree that the patient required large amounts of dextrose and further management by intensive care unit hospitalization...
December 11, 2018: BMC Emergency Medicine
Graham R McClure, Emilie P Belley-Cote, John Harlock, Andre Lamy, Michael Stacey, P J Devereaux, Richard P Whitlock
PURPOSE: Postoperative infection, particularly in cardiac surgery, results in significant morbidity, mortality, and healthcare cost. Identification of novel predictors of postoperative infection can target high-risk populations for prophylactic intervention. METHODS: Steroids in cardiac surgery (SIRS) was a multi-centre randomized-controlled trial assessing intraoperative administration of methylprednisone during cardiac surgery, which enrolled 7,507 patients across 80 centres in 18 countries...
December 10, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Yogarabindranath Swarna Nantha, Shamsul Haque, Hemanath Swarna Nantha
Background: There has been a shift in worldwide disease burden from infections to non-communicable diseases, especially type 2 diabetes (T2D). Behavioural change and self-management are key to optimal T2D control. Several universal models of diabetic care have been proposed to help explain the dimensions of T2D self-care such as medication adherence, physical activity, diet and patient-doctor interaction. These models do not allow an objective and quantifiable measurement of the problems faced by patients in terms of medication compliance...
December 10, 2018: Family Practice
Alex Jones, Manuel Gallegos, Ignacio Díaz, Rodrigo Donoso
BACKGROUND: Primary care units of ophtalmology (UAPO) were incorporated in 2003 into the healthcare system of the Ministry of Health, in response to the high demand for hospital care. Three of these primary care units were incorporated to provide a network care with the ophthalmology service of a tertiary care hospital. AIM: To report the public health impact of networking. MATERIAL AND METHODS: A descriptive-prospective study was carried out analyzing all the healthcare attentions carried out between June and August 2016...
August 2018: Revista Médica de Chile
Sanjay Basu, Ryan G Wagner, Ronel Sewpaul, Priscilla Reddy, Justine Davies
BACKGROUND: Cardiovascular diseases and their risk factors-particularly hypertension, dyslipidaemia, and diabetes-have become an increasing concern for middle-income countries. Using newly available, nationally representative data, we assessed how cardiovascular risk factors are distributed across subpopulations within South Africa and identified which cardiovascular treatments should be prioritised. METHODS: We created a demographically representative simulated population for South Africa and used data from 17 743 respondents aged 15 years or older of the 2012 South African National Health and Nutrition Examination Survey (SANHANES) to assign information on cardiovascular risk factors to each member of the simulated population...
December 6, 2018: Lancet Global Health
Nicholas W Carris, Ronald R Magness, Arthur J Labovitz
Cardiovascular disease is a leading cause of death in patients with diabetes. Consequently, as antidiabetic medications have demonstrated cardiovascular benefit, cardiologists have been asked to weigh in regarding antidiabetic therapy. The cardiologist's role will continue to grow as antidiabetic agents with cardiovascular benefit are being studied in prediabetes as part of an evolving clinical environment. Still, current guidelines primarily recommend high-intensity lifestyle intervention or metformin for diabetes prevention...
November 6, 2018: American Journal of Cardiology
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