强化健康认知护理对高血压合并糖尿病患者生活质量的改善作用

目的探究强化健康认知护理对高血压合并糖尿病患者生活质量的改善效果。方法选取该院2018年1—12月收治的高血压合并糖尿病患者94例,采用摸球法分为研究组和常规组,各47例。研究组采用强化健康认知护理,常规组采用常规护理。护理2个月开展随访,观察健康认知程度评分、生活质量评分及空腹血糖、糖化血红蛋白、收缩压、舒张压变化。结果研究组健康认知程度评分、生活质量评分均高于常规组,对比差异有统计学意义(P<0.05)。研究组空腹血糖、糖化血红蛋白等血糖指标及收缩压、舒张压等血压指标均低于常规组,对比差异有统计学意义(P<0.05)。结论强化健康认知护理在高血压合并糖尿病患者中具有显著效果,可改善患者认知及生活质量,有效控制血压、血糖,值得临床推广。     

Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians

DESCRIPTION: The American College of Physicians (ACP) developed this guideline to present the evidence for the link between the use of intensive insulin therapy to achieve different glycemic targets and health outcomes in hospitalized patients with or without diabetes mellitus. METHODS: Published literature on this topic was identified by using MEDLINE and the Cochrane Library. Additional articles were obtained from systematic reviews and the reference lists of pertinent studies, reviews, and editorials, as well as by consulting experts; unpublished studies on ClinicalTrials.gov were also identified. The literature search included studies published from 1950 through March 2009. Searches were limited to English-language publications. The primary outcomes of interest were short-term mortality and hypoglycemia. This guideline grades the evidence and recommendations by using the ACP clinical practice guidelines grading system. RECOMMENDATION 1: ACP recommends not using intensive insulin therapy to strictly control blood glucose in non-surgical intensive care unit (SICU)/medical intensive care unit (MICU) patients with or without diabetes mellitus (Grade: strong recommendation, moderate-quality evidence). RECOMMENDATION 2: ACP recommends not using intensive insulin therapy to normalize blood glucose in SICU/MICU patients with or without diabetes mellitus (Grade: strong recommendation, high-quality evidence). RECOMMENDATION 3: ACP recommends a target blood glucose level of 7.8 to 11.1 mmol/L (140 to 200 mg/dL) if insulin therapy is used in SICU/MICU patients (Grade: weak recommendation, moderate-quality evidence).     

A Digital Ecosystem of Diabetes Data and Technology: Services,Systems, and Tools Enabled by Wearables,Sensors, and Apps

The management of type 1 diabetes (T1D) ideally involves regimented measurement of various health signals; constant interpretation of diverse kinds of data; and consistent cohesion between patients, caregivers, and health care professionals (HCPs). In the context of myriad factors that influence blood glucose dynamics for each individual patient (eg, medication, activity, diet, stress, sleep quality, hormones, environment), such coordination of self-management and clinical care is a great challenge, amplified by the routine unavailability of many types of data thought to be useful in diabetes decision-making. While much remains to be understood about the physiology of diabetes and blood glucose dynamics at the level of the individual, recent and emerging medical and consumer technologies are helping the diabetes community to take great strides toward truly personalized, real-time, data-driven management of this chronic disease. This review describes “connected” technologies—such as smartphone apps, and wearable devices and sensors—which comprise part of a new digital ecosystem of data-driven tools that can link patients and their care teams for precision management of diabetes. These connected technologies are rich sources of physiologic, behavioral, and contextual data that can be integrated and analyzed in “the cloud” for research into personal models of glycemic dynamics, and employed in a multitude of applications for mobile health (mHealth) and telemedicine in diabetes care.     

The Role of Nursing Home Admission and Dementia Status on Care for Diabetes Mellitus

OBJECTIVES: To study the role of nursing home (NH) admission and dementia status on the provision of five procedures related to diabetes mellitus.
DESIGN: Retrospective cohort study using data from a large prospective study in which an expert panel determined the prevalence of dementia.
SETTING: Fifty-nine Maryland NHs.
PARTICIPANTS: Three hundred ninety-nine new admission NH patients with diabetes mellitus.
MEASUREMENTS: Medicare administrative claims records matched to the NH medical record data were used to measure procedures related to diabetes mellitus received in the year before NH admission and up to a year after admission (and before discharge). Procedures included glycosylated hemoglobin, fasting blood glucose, dilated eye examination, lipid profile, and serum creatinine.
RESULTS: For all but dilated eye examinations, higher rates of procedures related to diabetes mellitus were seen in the year after NH admission than in the year before. Residents without dementia received more procedures than those with dementia, although this was somewhat attenuated after controlling for demographic, health, and healthcare utilization variables. Persons without dementia experience greater increases in procedure rates after admission than those with dementia.
CONCLUSION: The structured environment of care provided by the NH may positively affect monitoring procedures provided to elderly persons with diabetes mellitus, especially those without dementia. Medical decisions related to the risks and benefits of intensive treatment for diabetes mellitus to patients of varying frailty and expected longevity may lead to lower rates of procedures for residents with dementia.     

糖尿病前期人群综合强化干预两年后的转归及影响因素

目的 采用2003年美国糖尿病学会(ADA)标准分析综合强化干预2年后糖尿病前期人群的转归及影响因素.方法 将北京地区中老年人群流行病学调奁筛查出的连续2年均为糖尿病前期的患者,随机分为常规治疗组(对照组)和综合强化治疗组(强化组).对照组仅给予生活方式指导,强化组在生活方式干预同时分别给予二甲双胍或阿卡波糖,并且建议根据病情选用降压及调脂药物,服用阿司匹林.随访2年,分析转归及影响因素.结果 2年后综合强化干预组的血糖、血压、体重指数、甘油三酯达标率显著高于对照组(P<0.05).强化组无1例进展为糖尿病,而对照组共8例(9.3%)进展为糖尿病;强化组逆转为正常糖耐量(NGT)的比例稍高于对照组(29.5% vs 22.1%,P>0.05).Logistic逐步回归分析,发现腰围及收缩压的增加与糖尿病的发生呈独立正相关关系,而胰岛功能的改善与糖尿病的发生呈独立负相关关系.结论 综合强化干预可显著降低糖尿病前期人群的糖尿病发生率,增加NGT的逆转率.腰围及收缩压的增加、胰岛β细胞功能的衰退是糖尿病前期人群进展为糖尿病的重要影响因素.     

Telediabetologie

Type 2 diabetes mellitus affects 8?C9% of the German population. Due to elevated blood glucose levels, acute and chronic complications occur that can only be prevented by consistent control and therapy. Lifestyle changes and patient autonomy play an important role. Furthermore, the percentage of in-patients affected by diabetes mellitus has grown dramatically. Hyperglycemia during operations is associated with wound infections and other complications. In the medical system a consistent glucose monitoring is not possible. Telediabetology is a new special field that allows a close-meshed and valid control of relevant health parameters and is a reasonable complementation to conventional therapy. Alterations in diabetes metabolism can be responded to fast and objectively. Moreover, patients receive an efficient health support and motivation for self-management. In addition telediabetological care can offer a systematic monitoring of stationary patients. In this review recent publications in the field of telediabetology and projects in Germany will be presented.     

Professional flash glucose monitoring and health service utilisation in type 2 diabetes: A secondary analysis of the GP-OSMOTIC study

AimProfessional flash glucose monitoring involves people with diabetes wearing a glucose monitor for up to two weeks, with the data downloaded by their health professional, and the information used to help guide treatment. This study describes if professional flash glucose monitoring was associated with a change in health services utilisation.MethodsAdministrative claims data from three data sources were linked to 288 participants from the GP-OSMOTIC study, a randomised controlled trial evaluating the use of professional flash glucose monitoring versus usual care in people with type 2 diabetes in primary care. Generalised linear models with the Poisson family speci?ed and log link function were used to compare general practice consultations between the intervention and control groups at 0?6- and 6?12-month time points, with adjustment for baseline health services utilisation.ResultsGP consultations increased in the flash glucose monitoring group in the 6 months following initial flash glucose monitoring sensor application from a median (IQR) 6 (4,9) to 8 (5,11); (P < 0.001). Participants in the professional FGM group were 1.2 times (95 % CI 1.1–1.4 (P = 0.0014)) more likely at 6?12 months to have GP consultation visits.ConclusionsAdministrative claims data identified changes in health services utilisation associated with professional flash glucose monitoring, despite minimal changes in glycaemic control.     

Continuous Glucose Monitoring Awaits Its ��Killer App��

Continuous glucose monitoring (CGM) could drive a paradigm shift in diabetes care, but realization of this promise awaits a complementary shift in the way CGM data is used. The most exciting use for CGM is as the input for automated, closed-loop glucose control. Although first generation CGM devices leave much room for improvement, closed-loop control does not have to wait. Algorithms should target blood glucose levels above the normal range for safety in the setting of imperfect CGM measurements. If the mean glucose under closed-loop control is sufficiently close to the chosen target, hemoglobin A1c goals could be met while minimizing risk of hypoglycemia. CGM may also improve the care of intensive care unit patients treated with intensive insulin therapy and the large numbers of diabetic patients in general hospital wards.     

强化血糖控制在2型糖尿病患者卒中预防中的作用

糖尿病是缺血性卒中的独市危险因素.流行病学研究表明,强化血糖控制能降低2型糖尿病患者的卒中风险.然而,目前的前瞻性临床试验却未能证实二者之间存在明确的因果关系.文章针对2型糖尿病患者强化血糖控制在卒中一级顶防和二级预防中作用的临床试验进行了综述.     

Prevalence of undiagnosed Type-2-diabetes mellitus and impaired fasting glucose in German primary care: data from the German Metabolic and Cardiovascular Risk Project (GEMCAS).

AIMS: Primary care physicians are gatekeepers of the healthcare system and thus responsible for screening, prevention and treatment of diabetes. Little is known about the prevalence of diabetes, impaired fasting glucose and factors that are associated with the risk of future development of diabetes and subsequent cardiovascular disease in unselected patients presenting to general practitioners. RESEARCH DESIGN AND METHODS: A nationwide sample of 35,869 primary care patients screened in 2005 was used to estimate the prevalence of detected and undetected diabetes as well as of impaired fasting glucose. Logistic regressions were used to assess the prevalence, cardiovascular morbidity and the factors associated with undetected diabetes and impaired fasting glucose. RESULTS: 1) Using a blood glucose screening algorithm the prevalence of known type 1 and type 2 diabetes mellitus was found to be 0.6 and 12.2%, respectively. Another 2.9% (23% of the diagnosed) had either undiagnosed diabetes (0.9%) or impaired fasting glucose (2.0%). 2) Undiagnosed patients had a more unfavourable cardiovascular risk profile compared to non-diabetic patients. 3) Moreover, higher age, male gender, low HDL-cholesterol and elevated triglycerides as well as a family history of diabetes were associated with unknown diabetes or impaired fasting glucose. CONCLUSIONS: Approximately 15.7% of individuals in Germany consulting a primary care physician are affected from either diabetes (known and unknown) or impaired fasting glucose and face a substantially elevated cardiovascular risk score. This study demonstrated that using a simplified blood glucose screening algorithm considering risk markers like higher age, male gender, low HDL-cholesterol, high triglycerides and a family history of diabetes may well serve as a suitable screening approach for undiagnosed diabetes and impaired fasting glucose in primary care practice.     

Self-monitoring in Type 2 diabetes mellitus: a meta-analysis.

AIMS: Self-monitoring of blood or urine glucose is widely used by subjects with Type 2 diabetes mellitus. This study evaluated the effectiveness of the technique at improving blood glucose control through a systematic review and meta-analysis. METHODS: Randomized controlled trials were identified that compared the effects of blood or urine glucose monitoring with no self-monitoring, or blood glucose self-monitoring with urine glucose self-monitoring, on glycated haemoglobin as primary outcome in Type 2 diabetes. RESULTS: Eight reports were identified. These were rated for quality and data were abstracted. The mean (SD) quality score was 15.0 (1.69) on a scale ranging from 0 to 28. No study had sufficient power to detect differences in glycated haemoglobin (GHb) of less than 0.5%. One study was excluded because it was a cluster randomized trial of a complex intervention and one because fructosamine was used as the outcome measure. A meta-analysis was performed using data from four studies that compared blood or urine monitoring with no regular monitoring. The estimated reduction in GHb from monitoring was -0.25% (95% confidence interval -0.61 to 0.10%). Three studies that compared blood glucose monitoring with urine glucose monitoring were also combined. The estimated reduction in GHb from monitoring blood glucose rather than urine glucose was -0.03% (-0.52 to 0.47%). CONCLUSIONS: The results do not provide evidence for clinical effectiveness of an item of care with appreciable costs. Further work is needed to evaluate self-monitoring so that resources for diabetes care can be used more efficiently.     

Factors associated with therapeutic target achievement in the control of complications in consequence of diabetes: A hospital-based study in west of Iran

Background and aimThe goal of diabetes management is to enhance the performance of the surveillance system to perpetuate optimal blood sugar, blood pressure and cholesterol levels in the normal values. This paper aimed to identify factors associated with therapeutic target achievement in the control of complications in consequence of diabetes.MethodsIn this cross-sectional study, a secondary analysis was performed on data obtained in the surveillance center of patients referred to in Makoo city, West Azerbaijan Province. The main interested variables included Fasting Blood Sugar (FBS), HbA1c, triglycerides, cholesterol, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) diastolic and systolic blood pressure, duration of diabetes, family history of diabetes, early and late complications of diabetes, treatment received, history of smoking.ResultsAverage age of the patients with diabetes mellitus, insulin-dependent was 35.43 (SD = 17.25) and in patients of diabetes mellitus 53.37 (SD = 10.89), which was significantly different (p-value = 0.001). Frequency amount of fasting blood sugar in diabetes mellitus, insulin-dependent and diabetes mellitus, type II was 64.30% and 66.0%, respectively. Only 19.0% of patients with diabetes mellitus, insulin-dependent and 13.90% of diabetes mellitus, type II breached to the optimum level of blood glucose control.ConclusionsThis study found that a considerable proportion of subjects with diabetes mellitus, insulin-dependent and diabetes mellitus, type II did not achieve the goals of care guidelines of Iran on secondary prevention of complications related to diabetes, especially vascular complication.     

Barriers to the effective use of capillary blood glucose monitoring in extended care facilities

Elderly residents of extended care facilities have an increased prevalence of diabetes compared with age-matched individuals living in the community, and are more prone to uncontrolled hyperglycemia and hypoglycemia. Capillary blood glucose monitoring can provide essential data for managing patients with diabetes, yet blood glucose monitoring is not used consistently by many institutions that provide long-term care. Among the barriers to its use are a perceived lack of validity, a perceived or actual lack of reliability, a failure by staff to use monitoring results consistently, a belief that good control is not necessary for the elderly, and the cost. Educational programs need to be offered to extended care facilities emphasizing the significance of glucose monitoring in the management of diabetes in elderly patients.     

Recommendations for Standardizing Glucose Reporting and Analysis to Optimize Clinical Decision Making in Diabetes: The Ambulatory Glucose Profile

Underutilization of glucose data and lack of easy and standardized glucose data collection, analysis, visualization, and guided clinical decision making are key contributors to poor glycemic control among individuals with type 1 diabetes mellitus. An expert panel of diabetes specialists, facilitated by the International Diabetes Center and sponsored by the Helmsley Charitable Trust, met in 2012 to discuss recommendations for standardizing the analysis and presentation of glucose monitoring data, with the initial focus on data derived from continuous glucose monitoring systems. The panel members were introduced to a universal software report, the Ambulatory Glucose Profile, and asked to provide feedback on its content and functionality, both as a research tool and in clinical settings. This article provides a summary of the topics and issues discussed during the meeting and presents recommendations from the expert panel regarding the need to standardize glucose profile summary metrics and the value of a uniform glucose report to aid clinicians, researchers, and patients.     

代谢性疾病作为胰腺癌危险因素的回顾性研究

目的 分析血糖、血压及体重与胰腺癌(PC)发生间关系,探讨胰腺癌发生的代谢相关的危险因素.方法 采用回顾性分析的方法,收集上海交通大学医学院附属瑞金医院2002年12月-2009年2月间收治的548例术后病理确诊的PC病例,分析PC与血糖、血压、体重等代谢因素间的关系.结果 使用主成分归因分析可知,血糖、血压、体重指数(BMI)增高、代谢综合征(MS)与PC密切相关,其贡献率分别为33.614%、25.236%、15.418%和12.918%.单因素统计分析发现,新发糖尿病(DM,病程≤2年)与PC的关联显著高于长期DM患者.平素血糖控制良好而近期血糖控制不佳的长期DM患者发生PC人数显著多于非PC患者(44.6%比5.6%,P<0.05),且这部分PC患者的空腹血糖[(13.87±3.49)mmol/L]显著高于新发DM和其他长期DM者,OR为13.46(95%CI为4.560,39.731).BMI增高是PC的危险因素,但危险度与增高程度差异无统计学意义.上述代谢性疾病是PC的危险因素,但对PC的病理、部位、分期方面的差异无统计学意义.结论 MS及其包括的DM、BMI增高、高血压等代谢性疾病是发生PC的危险因素.其中新发DM及近期血糖控制不良的长期DM需警惕发生胰腺癌的可能.早期治疗密切随访代谢性疾病对于PC的早期诊断及预后可能有益.     

Kosten in der Früh- und Spätphase des Diabetes mellitus

The costs of diabetes mellitus type 2 in Germany are underestimated due to incomplete data. Especially in the first few years of the disease, the costs are significantly higher in diabetics than in persons without diabetes or other diabetes patients. The cost driver is inpatient treatment of diabetes complications. Glucose-lowering medications play a minor role. According to recent studies (CODE-2, CoDiM), the basic cost structure remains similar in later diabetes stages. For patients with complex complications, the costs are more than four times higher than in persons without diabetes. The enormous direct costs of diabetes account for 14.2% of total health care costs in Germany. Therapy for high blood pressure and blood glucose seem to be cost effective; data for modern lipid-lowering therapies are unclear. Thus, it is advisable to treat patients according to current guidelines and ethical considerations.     

Automated Glycemic Pattern Analysis: Overcoming Diabetes Clinical Inertia

The OneTouch® Verio™ IQ Meter with PatternAlert™ Technology has been approved by the U.S. Food and Drug Administration as the first self-glucose monitor that can automatically determine glycemic patterns [high and low pre-meal blood glucose (BG)] for health care providers (HCPs) and patients. In this issue of Journal of Diabetes Science and Technology, Katz and coauthors demonstrate that this device was more accurate and quicker in detecting abnormal glucose patterns than the review by HCPs of 30-day handwritten BG logs and that its interpretations were positively accepted by the HCPs. Continued development of automated pattern analysis and decision-support software to overcome the “data-overload” associated with intensive glucose monitoring and diabetes management will reduce clinical inertia and could dramatically improve diabetes outcomes.     

Home blood glucose monitoring

Objective: To determine whether home blood glucose monitoring as used by non-insulin-dependent diabetes mellitus patients followed in primary care nonresearch clinics improves glycemic control or reduces utilization of the outpatient laboratory. Design: A retrospective chart reviewfor 229 patients receiving outpatient supplies for home testing of either blood or urine. Setting: A variety of nonresearch clinics at a Veterans Affairs Medical Center, a teaching hospital affiliated with an academic university medical center. Patients: Outpatient veterans followed in diabetes, primary care, internal medicine, or endocrine clinics. Interventions: None. Measurements and main results: The mean glycosylated hemoglobin for an unselected group monitoring glycemic control by urine testing only was 11.32% and for those using blood monitoring was 11.37%. Frequency and duration of monitoring had no apparent impact on glucose control. There was no decrease in the utilization of the laboratory among those patients practicing home blood glucose monitoring. Conclusions: For non-insulin-dependent diabetic patients followed in a nonresearch clinic setting, the benefits of home blood glucose monitoring remain to be proven.     

Cost-utility analyses of intensive blood glucose and tight blood pressure control in type 2 diabetes (UKPDS 72)

Aims/hypothesis This study estimated the economic efficiency (1) of intensive blood glucose control and tight blood pressure control in patients with type 2 diabetes who also had hypertension, and (2) of metformin therapy in type 2 diabetic patients who were overweight.Methods We conducted cost-utility analysis based on patient-level data from a randomised clinical controlled trial involving 4,209 patients with newly diagnosed type 2 diabetes conducted in 23 hospital-based clinics in England, Scotland and Northern Ireland as part of the UK Prospective Diabetes Study (UKPDS). Three different policies were evaluated: intensive blood glucose control with sulphonylurea/insulin; intensive blood glucose control with metformin for overweight patients; and tight blood pressure control of hypertensive patients. Incremental cost : effectiveness ratios were calculated based on the net cost of healthcare resources associated with these policies and on effectiveness in terms of quality-adjusted life years gained, estimated over a lifetime from within-trial effects using the UKPDS Outcomes Model.Results The incremental cost per quality-adjusted life years gained (in year 2004 UK prices) for intensive blood glucose control was £6,028, and for blood pressure control was £369. Metformin therapy was cost-saving and increased quality-adjusted life expectancy.Conclusions/interpretation Each of the three policies evaluated has a lower cost per quality-adjusted life year gained than that of many other accepted uses of healthcare resources. The results provide an economic rationale for ensuring that care of patients with type 2 diabetes corresponds at least to the levels of these interventions.     

Blood glucose measurements in critically ill patients

Studies on tight glycemic control by intensive insulin therapy abruptly changed the climate of limited interest in the problem of hyperglycemia in critically ill patients and reopened the discussion on accuracy and reliability of glucose sensor devices. This article describes important components of blood glucose measurements and their interferences with the focus on the intensive care unit setting. Typical methodologies, organized from analytical accuracy to clinical accuracy, to assess imprecision and bias of a glucose sensor are also discussed. Finally, a list of recommendations and requirements to be considered when evaluating (time-discrete) glucose sensor devices is given.