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diabetic care pathways

Peter Rijnbeek
Massive numbers of electronic health records are currently being collected globally, including structured data in the form of diagnoses, medications, laboratory test results, and unstructured data contained in clinical narratives. This opens unprecedented possibilities for research and ultimately patient care. However, actual use of these databases in a multi-center study is severely hampered by a variety of challenges, e.g., each database has a different database structure and uses different terminology systems...
September 2016: Journal of Hypertension
Christopher C Asuzu, Rebekah J Walker, Joni Strom Williams, Leonard E Egede
BACKGROUND: The aim of this study was to examine the mechanism by which depressive symptoms, diabetes distress, and diabetes fatalism together influence diabetes outcomes using structured equation modeling. METHODS: 615 adults with type 2 diabetes were recruited from two primary care clinics in the southeastern United States. Psychosocial factors found to be associated with diabetes outcomes were measured using validated questionnaires. Structured equation modeling (SEM) was used to investigate the relationship between diabetes fatalism, depressive symptoms, diabetes distress, self-care and glycemic control...
September 30, 2016: Journal of Diabetes and its Complications
Geir Bjørklund, Salvatore Chirumbolo
Diet may be defined as a complex process that should involve a deeper comprehension of metabolism, energy balance, and the molecular pathways involved in cellular stress response and survival, gut microflora genetics, enzymatic polymorphism within the human population, and the role of plant-derived polyphenols in this context. Metabolic syndrome, encompassing pathologies with a relatively high morbidity, such as type 2 diabetes, obesity, and cardiovascular disease, is a bullet point of the big concern about how daily dietary habits should promote health and prevent metabolic impairments to prevent hospitalization and the need for health care...
August 8, 2016: Nutrition
Eleanor R Gunn, Benjamin B Albert, Paul L Hofman, Wayne S Cutfield, Alistair J Gunn, Craig A Jefferies
BACKGROUND: There has been little change in the incidence of diabetic ketoacidosis (DKA) in newly diagnosed type 1 diabetes mellitus (T1DM) in children and adolescents in most developed countries. OBJECTIVES: To assess potentially modifiable antecedents of DKA in children <15 years of age with new onset T1DM. METHODS: Retrospective review of prospectively collected data from a complete regional cohort of children with T1DM in Auckland (New Zealand) from 2010 to 2014...
October 11, 2016: Pediatric Diabetes
Ariana Singh, Kamran Ahmed, Abdullatif Aydin, Muhammad Shamim Khan, Prokar Dasgupta
INTRODUCTION AND HYPOTHESIS: Fournier's gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier's gangrene with emphasis on early diagnosis and management...
October 5, 2016: Archivio Italiano di Urologia, Andrologia
Wenying Yang, Zhaojun Yang, Jing Zhao, Hai Lu, Tianhong Luo
BACKGROUND: A large proportion of patients with T2DM in China do not meet accepted HbA1c targets despite the availability of guidelines that describe a treatment pathway for achieving glycemic control. The aim of this study is to identify the fasting plasma glucose (FPG) target that will provide the highest control rate of HbA1c <7 % in Chinese patients with T2DM treated with an insulin glargine-based regimen as an adjunct to an established OAD regimen. This information will support improvements in diabetes care management in China...
September 26, 2016: Trials
Peter Rijnbeek
Massive numbers of electronic health records are currently being collected globally, including structured data in the form of diagnoses, medications, laboratory test results, and unstructured data contained in clinical narratives. This opens unprecedented possibilities for research and ultimately patient care. However, actual use of these databases in a multi-center study is severely hampered by a variety of challenges, e.g., each database has a different database structure and uses different terminology systems...
September 2016: Journal of Hypertension
Preeti Datta-Nemdharry, Andrew Thomson, Julie Beynon, Katherine Donegan
PURPOSE: The purpose of this study is to characterise how Type 2 Diabetes Mellitus (T2DM) is treated in England and Wales and whether this adheres to 2009 National Institute for Health and Care Excellence (NICE) guidance on management of T2DM. METHODS: Data for T2DM patients aged 18+ years prescribed at least one anti-diabetic drug between 01/01/2000-30/06/2012 were extracted from the Clinical Practice Research Datalink. We examined the sequences in which anti-diabetic drugs were prescribed and, for patients on the most common anti-diabetic drug pathways, evaluated average HbA1c values at treatment initiation and at progression to a second or third-line anti-diabetic drug class, including insulin...
September 19, 2016: Pharmacoepidemiology and Drug Safety
Chia-Ying Chen, Fu-Sung Lo, Bai-Hsiun Chen, Ming-Huei Lu, Yu-Mei Hsin, Ruey-Hsia Wang
BACKGROUND: Adolescents with type 1 diabetes mellitus (T1DM) need to adapt physically and psychologically to the impact of diabetes. PURPOSE: The purpose of this study was to examine the pathways of emotional autonomy, depressive symptoms, and self-care behaviors to glycosylated hemoglobin (HbA1c) levels and quality of life (QoL) in adolescents with T1DM. METHODS: Cross-sectional design was used in this study. Self-reported questionnaires and medical records were used to collect data from 265 adolescents with T1DM by convenience sampling in Taiwan...
August 19, 2016: Nursing Outlook
Inger J Bakken, Kari Tveito, Kari M Aaberg, Sara Ghaderi, Nina Gunnes, Lill Trogstad, Per Magnus, Camilla Stoltenberg, Siri E Håberg
BACKGROUND: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a complex condition. Causal factors are not established, although underlying psychological or immunological susceptibility has been proposed. We studied primary care diagnoses for children with CFS/ME, with children with another hospital diagnosis (type 1 diabetes mellitus [T1DM]) and the general child population as comparison groups. METHODS: All Norwegian children born 1992-2012 constituted the study sample...
2016: BMC Family Practice
Jihae Han, Hye Yeon Choi, Ahmed Abdal Dayem, Kyeongseok Kim, Gwangmo Yang, Jihye Won, Sun Hee Do, Jin-Hoi Kim, Kyu-Shik Jeong, Ssang-Goo Cho
Studies on adipogenesis may be important for regulating human and/or animal obesity, which causes several complications such as, type II diabetes, hypertension, and cardiovascular disease, thus giving rise to increased economic burden in many countries. Previous reports revealed that various flavonoids have anti-apoptotic, antioxidant, and cell differentiation-regulating activities with a number of physiological benefits, including protection from cardiovascular disease, cancers, and oxidative stress. As we found that the hydroxylation patterns of the flavonoid B ring are known to play a critical role in their function, we screened several flavonoids containing different numbers and positions of OH substitutions in B ring for their modulatory property on adipogenesis...
August 31, 2016: Journal of Cellular Biochemistry
Hilde Smith-Strøm, Marjolein M Iversen, Marit Graue, Svein Skeie, Marit Kirkevold
INTRODUCTION: Diabetic foot ulcers are a feared complication of diabetes. Care delivered via telemedicine is suggested to be a more integrated care pathway to manage diabetic foot ulcers than traditionally delivered healthcare. Our aim was to explore patients' experiences with telemedicine follow-up care as compared to traditional care. METHODS: Interpretive description was used as an analysis strategy. Data were collected using individual semi-structured interviews in the context of a larger ongoing clustered randomized controlled trial...
October 2016: International Journal of Medical Informatics
Ruth A Hackett, Andrew Steptoe
Type 2 diabetes is a chronic disease that is increasing in prevalence globally. Cardiovascular disease is a major cause of mortality and morbidity in diabetes, and lifestyle and clinical risk factors do not fully account for the link between the conditions. This article provides an overview of the evidence concerning the role of psychosocial stress factors in diabetes risk, as well as in cardiovascular complications in people with existing diabetes. Several types of psychosocial factors are discussed including depression, other types of emotional distress, exposure to stressful conditions, and personality traits...
October 2016: Current Cardiology Reports
Andrzej Śliwczynski, Ewa Orlewska
Precision medicine (PM) is an important modern paradigm for combining new types of metrics with big medical datasets to create prediction models for prevention, diagnosis, and specific therapy of chronic diseases. The aim of this paper was to differentiate PM from personalized medicine, to show potential benefits of PM for managing chronic diseases, and to define problems with implementation of PM into clinical practice. PM strategies in chronic airway diseases, diabetes, and cardiovascular diseases show that the key to developing PM is the addition of big datasets to the course of individually profiling diseases and patients...
August 18, 2016: Polskie Archiwum Medycyny Wewnętrznej
Shaunak S Adkar, Ryan S Turley, Ehsan Benrashid, Sandhya Lagoo, Cynthia K Shortell, Leila Mureebe
OBJECTIVE: The initiation of bundled payment for care improvement (BPCI) by Centers for Medicare & Medicaid Services (CMS) has led to increased financial and performance accountability. As the majority of vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multi-disciplinary pathway for the elderly vascular patient, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity arterial bypass (LEB)...
August 12, 2016: Annals of Vascular Surgery
Fliss E M Murtagh, Aine Burns, Olivier Moranne, Rachael L Morton, Saraladevi Naicker
Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not)...
August 10, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Gavin S Tan, Ning Cheung, Rafael Simó, Gemmy C M Cheung, Tien Yin Wong
Diabetic macular oedema, characterised by exudative fluid accumulation in the macula, is the most common form of sight-threatening retinopathy in people with diabetes. It affects one in 15 people with diabetes resulting in more than 20 million cases worldwide. Few epidemiological studies have been done to specifically investigate risk factors for diabetic macular oedema, although poor glycaemic and blood pressure control are associated with the presence and development of the disorder. The pathophysiological processes begin with chronic hyperglycaemia, and interplay between vascular endothelial growth factor (VEGF) and inflammatory mediators...
August 2, 2016: Lancet Diabetes & Endocrinology
Lonneke A van Vught, Brendon P Scicluna, Arie J Hoogendijk, Maryse A Wiewel, Peter M C Klein Klouwenberg, Olaf L Cremer, Janneke Horn, Peter Nürnberg, Marc M J Bonten, Marcus J Schultz, Tom van der Poll
BACKGROUND: Diabetes is associated with chronic inflammation and activation of the vascular endothelium and the coagulation system, which in a more acute manner are also observed in sepsis. Insulin and metformin exert immune modulatory effects. In this study, we aimed to determine the association of diabetes and preadmission insulin and metformin use with sepsis outcome and host response. METHODS: We evaluated 1104 patients with sepsis, admitted to the intensive care unit and stratified according to the presence or absence of diabetes mellitus...
2016: Critical Care: the Official Journal of the Critical Care Forum
Kris English, Emily Pajevic
In 2007, the World Health Organization published a set of International Classification of Functioning, Disability and Health (ICF) codes designed for children and youth (ICF-CY version). The ICF-CY considers typical developmental changes associated with childhood while describing health status and the effects of intervention. In this article we will describe how a specific intervention (transition planning for adolescents) can be documented with the ICF-CY. Transition planning in health care prepares adolescents and their families for the transfer from pediatric to adult health services and has been demonstrated to be an effective practice for adolescents with many types of chronic health conditions (e...
August 2016: Seminars in Hearing
Noriko Satoh-Asahara, Hiroto Ito, Tomoyuki Akashi, Hajime Yamakage, Kazuhiko Kotani, Daisuke Nagata, Kazuyuki Nakagome, Mitsuhiko Noda
PURPOSE: Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. METHOD: We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. RESULTS: Eight sets of PHRs were found for people with diabetes...
2016: Japanese Clinical Medicine
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