护理干预对2型糖尿病患者自护行为的影响

目的探讨护理干预对2型糖尿病患者自护行为的影响，帮助患者建立长期性良好的自护行为，以提高患者的生活质量。方法随机抽取2006年7月-2008年1月在我院门诊就诊和住院确诊的2型糖尿病患者在监测与控制血糖、饮食控制、规律运动、遵医服药、足部护理、高低血糖预防与处理等自护行为进行健康教育和指导，并进行干预前和干预后6个月评价。结果患者对糖尿病相关知识掌握率明显提高（P〈0．01），其自护行为明显改善（P〈0．01），血糖异常率明显下降（P〈0．01）。结论对2型糖尿病患者自护行为进行护理干预，可提高患者的自我保健意识，建立长期性良好的白护行为，以提高患者的生活质量。     

Improving the Health Status of US Working Adults with Type 2 Diabetes Mellitus

Diabetes mellitus is the seventh leading cause of death (sixth leading cause of death by disease) in the US. Approximately 5.9% of the US population has diabetes and one-third of those with diabetes are unaware that they have the condition. Diabetes is the leading cause of adult blindness, end-stage renal disease, and non-traumatic lower extremity amputation.The annual per-capita incremental cost of diabetes among employees compared with individuals without diabetes has been estimated at $US4410 (1998 values). Furthermore, more than 30% of the costs associated with diabetic employees are attributable to medically related work absences and disability, and this is estimated to cause a one-third reduction in earnings due to reduced workforce participation.The incidence of diabetes and long term medical complications could be reduced through more effective diabetes education and patient self-management. Intensive management of diabetes can help workers remain productive, decrease costs associated with complications, and reduce associated costs for overtime. Policy complications from this review encourage employers and Medicare/Medicaid to invest in diabetes education and Wellness programs.     

Depression among Korean Adults with Type 2 Diabetes Mellitus: Ansan-Community-Based Epidemiological Study

Objectives

There are an increasing number of studies being carried out on depression in patients with diabetes. Individuals with diabetes have been reported as having a higher prevalence of depression compared to those without diabetes. However, only a few studies involving Korean patients have been conducted. The aims of this study were to examine the prevalence of depression and to find various risk factors according to the degree of depression among Korean patients with Type 2 diabetes mellitus (T2DM).

Methods

An Ansan-community-based epidemiological study was conducted from 2005 to 2012. The total number of participants in this study was 3,540, from which patients with diabetes (n = 753) have been selected. The presence of depression was evaluated using the Beck Depression Inventory total score.

Results

The prevalence of depression was 28.8%. The mean age of participants was 55.5 ± 8.2 years. We divided the participants into three groups (without-depression, moderate-depression, and severe-depression groups) to examine the depression prevalence among Korean T2DM patients. The unemployed participants had 2.40 [95% confidence interval (CI) 1.21–4.76], the low-income participants had 2.57 (95% CI 1.52–4.35), the participants using an oral diabetes medicine or insulin had 2.03 (95% CI 1.25–3.32), the participants who are currently smoking had 2.03 (95% CI 1.10–3.73), and those without regular exercise had 1.91 (95% CI 1.17–3.14) times higher odds of depression in the severe-depression group, compared with the without-depression group.

Conclusion

There was a significant association between depression prevalence and diabetes, and we found various risk factors according to the degree of depression in Korean patients with T2DM.     

Physical Activity Related Information Sources Predict Physical Activity Behaviors in Adults with Type 2 Diabetes

Physical activity (PA) is a key management strategy for type 2 diabetes. Despite the known benefits, PA levels are low. Whether the low level of PA is related to lack of knowledge or support is not fully understood. This study was conducted to describe where and how often adults with type 2 diabetes receive and seek information related to PA and examine the relationships between the source and quality of PA information with PA behaviors. A series of questions related to the source and quality of PA information were added to a baseline survey distributed to the participants (N = 244) of the Canadian Aerobic and Resistance Training in Diabetes (CARED) study. Physicians and television were found to be the main sources of PA-related information. In our cross-sectional model, sources of PA-related information other than that from health care professionals explained 14% (p = .05) and 16% (p < .05) of the variance for aerobic-based and resistance training behaviors and 22% (p < .01) and 15% (p < .05) for these behaviors in our longitudinal model. Physical activity (PA)-related information is widely available to adults with type 2 diabetes. Neither the quantity nor the quality of the PA information provided by health care professionals predicted PA behavior. These data provide further insight into the modes with which PA can be promoted to adults with type 2 diabetes.     

Evaluation of Self-Care Practices and Emotional Distress Among People with Type 2 Diabetes Mellitus in Dar Es Salaam,Tanzania

This study was conducted to determine self-care practices and diabetes related emotional distress among people with Type 2 diabetes mellitus in Dar es Salaam, Tanzania. A cross sectional survey-involving 121 Types 2 diabetics was conducted in 4 diabetic clinics located in Dar es Salaam. Anthropometric and biomedical measurements namely weight, height, waist, hip, mid-upper arm circumference, blood pressure and fasting blood glucose were measured. Self-care practices and diabetic related emotion distress were evaluated by using validated instruments. Results revealed that, the average fasting plasma glucose was 11.2 ± 5.5 mmol/l, blood pressure was 134.7/86.1 mm/Hg and the mean BMI for males and females were 25.0 ± 4.3 and 27.0 ± 5.1 kg/m², respectively. Subject's self-care score for general diet, specific diet, physical exercise, foot-care and medication were 4.6 ± 2.4, 3.7 ± 1.5, 3.4 ± 1.8, 3.6 ± 2.8 and 5.5 ± 2.8 days per week, respectively. Self-monitoring of blood glucose was irregular and only 46.3% of the subjects tested their levels of blood glucose at least once in between the appointments (90 days). Low income was the major limitation for complying with the self-care practices related to diet, blood glucose testing and medication. It is recommended that, the Government of Tanzania should in the short run subsidize the prices of diabetes drugs, remove all taxes on the glucose test kits and establish a national diabetes program that would coordinate and oversee provision of the basic services such as screening, glucose testing, medication, counseling and management of the condition. In the long run, the government should establish a preventive public health program in order to curtail the escalation of diabetes. Further research should be conducted to determine how factors such as socio-cultural and demographic, self-care, and psychosocial distress interact to determine biomedical outcomes such as blood pressure, blood glucose and body mass index.     

Management of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a progressive disease with an insidious onset. It is thought to affect up to 10% of European and North American populations with a significantly higher incidence in non-White than in White populations. Complications of the disease are associated with considerable morbidity and mortality and their management consumes significant healthcare resources.Data from the United Kingdom Prospective Diabetes Study have shown that intensive glycemic control reduces the microvascular complications of type 2 disease and that intensive management of fasting plasma glucose (FPG) levels is insufficient over time to provide such control. Recent studies have demonstrated that lowering postprandial plasma (PPG) glucose levels provides some additional glycemic control and recent epidemiologic data suggest reducing PPG levels may be associated with a reduction in mortality.In patients with type 2 diabetes mellitus inadequately controlled by diet and exercise, nateglinide significantly improved glycemic control compared with placebo; a beneficial effect on both FPG and PPG levels was observed. In active comparator studies, nateglinide has been shown to be as effective as metformin (in pharmacotherapy-naïve patients), acarbose and troglitazone in reducing glycosylated hemoglobin (HbA_1c) levels.When used in combination with metformin (in patients inadequately controlled on maximum dosages of metformin monotherapy) nateglinide significantly improves glycemic control compared with placebo. In addition, nateglinide has been shown to display pronounced additive effects when added to troglitazone or metformin in patients inadequately controlled by diet and exercise alone.Nateglinide was generally well tolerated in clinical trials. The most common adverse event was hypoglycemia, although the incidence was low in comparison with sulfonylureas. The incidence of hypoglycemia was increased in patients using nateglinide in combination with metformin.By controlling HbA_1c and PPG, nateglinide has the potential to provide substantial health and quality-of-life benefits; however, long-term outcome data and validated quality-of-life assessments are lacking. In economic modelling studies, the estimated cost-effectiveness ratios observed with nateglinide were well within the range for therapies considered to be cost-effective.In conclusion, nateglinide is a useful addition to the available treatments for type 2 diabetes mellitus. It significantly improved glycemic control in pharmacotherapy-naïve patients as well as in patients not adequately controlled by metformin alone; however, until long-term clinical data become available, nateglinide can only be considered as an adjunct to metformin in patients inadequately controlled on metformin alone in whom PPG levels are elevated. Nateglinide is well tolerated and has low potential to cause hypoglycemia and bodyweight gain.     

Insulin Therapy in Patients with Type 2 Diabetes Mellitus

Objective: To support policy-making for patients with diabetes mellitus we compared the costs and effectiveness of initiation of insulin therapy in patients with type 2 diabetes mellitus in 2 settings in The Netherlands. Design: Retrospective cohort study. Setting: A shared-care setting and an outpatient care setting of a university hospital. Both settings are located in Amsterdam, The Netherlands. Patients: All patients with type 2 diabetes mellitus above 40 years of age who were transferred to insulin therapy in 1993 in both settings. Intervention: Initiation and monitoring of insulin therapy in patients with type 2 diabetes mellitus. Study perspective: Healthcare sector. Main outcome measures: Baseline and 12 months glycosylated hemoglobin (HbA_1c) values and fasting blood glucose levels, and direct healthcare costs of insulin therapy. Costs were expressed in 1996 Dutch guilders (NLG) [NLG1 = 0.5 US dollars ($US)]. Results: In the shared-care setting (n = 57) the per patient healthcare costs during 1 year of follow-up averaged NLG2467. In the secondary care setting (n = 45) healthcare costs averaged NLG2740. A sensitivity analysis demonstrated that healthcare costs per patient were in the same range in both settings, ranging from NLG2000 to about NLG3400 ($US1000 to $US1700). Mean HbA_1c values fell from 9.1 to 7.9% (shared-care setting; p < 0.05) and from 10.2 to 8.2% (secondary care setting; p < 0.05). The percentage of patients with poor glycemic control (HbA_1c >8.5%) decreased from 56 to 30% (shared-care setting) and from 76 to 36% (secondary care setting). The percentage of patients with good glycemic control (HbA_1c <7%) increased from 4 to 23% (shared-care setting) and from 2 to 18% (secondary care setting). Conclusions: The study shows that in the first year of insulin therapy in patients with type 2 diabetes mellitus, acceptable glycemic control (HbA_1c >8.5%) can be attained in the majority of patients in both a shared-care and a secondary care setting, at comparable low average costs per patient.     

慈溪市成年人2型糖尿病患病率及危险因素研究

目的 了解慈溪市18周岁及以上居民2型糖尿病患病情况及相关危险因素.方法 采用多阶段分层随机整群抽样的方法,对慈溪市4个镇18周岁及以上居民1147人进行横断面调查.结果 慈溪市18岁及以上居民2型糖尿病患病率为9.15％,标化率为6.84％;男性和女性粗患病率分别为7.72％和10.57％,标化率为5.40％和8.19％,男性和女性糖尿病患病率差异无统计学意义(P＞0.05).单因素分析结果,年龄、文化程度、饮酒、高血压、血脂异常、糖尿病家族史、冠心病、体重指数、TC值和TG值与人群2型糖尿病患病有关.多因素非条件Logistic回归分析显示,2型糖尿病的危险因素为糖尿病家族史(OR=86.225)、BMI(OR =9.840)和年龄(OR =21.254).结论 慈溪市居民2型糖尿病患病率处于较高水平,有糖尿病家族史、肥胖的中老年人群需要重点防治.     

Initiatives to Promote Effective Self-Care Skills in Children and Adolescents with Diabetes Mellitus

Intensive management of type 1 diabetes mellitus (T1DM) is increasingly becoming the ‘ideal’ standard of care for pediatric patients at diabetes centers across the world. This ‘ideal’ standard is based on two landmark studies that documented that keeping blood glucose levels as close to normal as possible and achieving this as early as possible in the disease course helps to prevent or delay the devastating long-term complications of T1DM. Simultaneously, initiatives supplemental to the medical care of young patients with diabetes that are attempting to improve the self-care behavior and glycemic control of young patients with diabetes have been implemented. There is consensus among recent meta-analyses and critical reviews of these interventions that their overall impact on glycemic control is modest to moderate at best. Because of the need for healthcare cost containment and allocation of resources, we have attempted to identify the components of these different initiatives that have the potential to be practical, cost saving, and integrated into the routine clinical care of diabetes. Interventions based on coping-skills training, motivational interviewing, behavioral family systems therapy, and multisystemic therapy models require the expertise of a highly trained mental healthcare professional. Moreover, none of these interventions has yet been implemented or evaluated within the ongoing context of routine ambulatory diabetes care. Finally, each of these interventions requires additional time commitments from young patients with diabetes and their families.The Care Ambassador intervention and programs based on the Family Teamwork intervention do not require highly trained, expensive staff for delivery and have been successfully integrated into routine pediatric diabetes-care settings. Moreover, the Care Ambassador model has also been shown to reduce expensive adverse outcomes across a broad spectrum of youth with diabetes. Finally, telehealth interventions for youth with diabetes may hold great potential as a lower-cost intervention to supplement routine diabetes care and to optimize glycemic control for pediatric patients; however, we await the rigorous evaluation of the application of telehealth interventions across a range of outpatient pediatric diabetes-care settings. Pediatric diabetes care requires an environment of supportive, collaborative communication grounded in realistic expectations for youths. Thus, ongoing evaluations of outcomes of these various interventions are needed within multiple healthcare settings.     

2型糖尿病的社区筛查

2型糖尿病是一种代谢疾病,近年来其患病率在世界范围内呈上升趋势,严重影响人类健康,给个人、家庭和社会带来沉重的负担.通过社区筛查,可以早期发现高危人群并进行适当地干预,早期诊断糖尿病患者并促使患者及时接受治疗,减少并发证的发生,从而改善糖尿病患者的健康结局.     

老年2型糖尿病患者的社区管理效果评价

目的探讨老年2型糖尿病患者社区管理的效果。方法选取沈阳市铁西区9个社区的老年2型糖尿病患者70人，采用健康教育、量化饮食疗法、量化运动疗法、合理用药、定期监测等健康改善措施，评价1年的干预效果。结果干预后，患者的糖尿病知识知晓率、行为控制等指标明显改善（P〈O．05），空腹血糖及餐后2h血糖水平均显著降低（P〈0．05）；糖化血红蛋白平均值及达标率明显改善（P〈O．01）。结论将高等医学院校的技术资源与社区的卫生资源相结合，提供个性化治疗方案，对社区老年2型糖尿病患者的病情控制具有显著效果。     

Reducing the Incidence of Type 2 Diabetes Mellitus

The evidence base derived from the research literature has clearly established that type 2 diabetes mellitus may be prevented or delayed through pharmacological interventions and, most efficaciously, through lifestyle interventions. Unfortunately, efforts to translate the research results into programs that may be applied to the clinical or healthcare system setting are lacking. The purpose of this article is 3-fold: (i) to briefly review the results of the major trials conducted in the area of type 2 diabetes; (ii) to outline an approach that may guide the design and development of type 2 diabetes prevention programs for clinical care; and (iii) to present a protocol that may support the process of implementation in the practice setting.The literature review clearly delineates critical type 2 diabetes prevention program outcomes, i.e. modest weight loss, dietary changes, an increase in physical activity level and, in the case of pharmacological interventions, good adherence to medication regimens. Guided by evidence-informed approaches to translation, this article outlines a set of critical program design principles that guide the development of type 2 diabetes prevention programs, and are systematically included and recognized in the programs; these principles are termed the ‘4Ss’: (i) effect size; (ii) program scope; (iii) scalability; and (iv) long-term sustainability in the real-world setting.Based on additional literature that addresses operational feasibility and principles of design and evaluation, this paper describes a protocol that may help healthcare systems and care delivery settings design such prevention programs and successfully document desired impacts that are meaningful to their customers. The protocol is designed to include the total membership of a healthcare system and it systematically allows for the identification and stratification of the risk of developing type 2 diabetes. Individuals are assigned to one of three risk strata: (i) low risk of developing type 2 diabetes; (ii) high risk of developing type 2 diabetes; or (iii) active disease (already diagnosed with type 2 diabetes). The high-risk group is subsequently invited to participate in risk-reduction strategies that are designed to reduce the incidence of type 2 diabetes.     

肥胖和2型糖尿病患者脂肪细胞素的变化

目的了解脂肪细胞素在肥胖及2型糖尿病(T2DM)患者血浆中的水平,探讨脂肪细胞素对肥胖及T2DM发生发展的作用。方法选择在沈阳医学院附属沈洲医院体检科、内分泌科门诊及住院患者作为研究对象:单纯肥胖组50名、肥胖合并T2DM组50名、对照组50名。检测其血浆脂肪细胞素水平,同时进行体格检查及血脂、血糖、血清胰岛素检测,并计算胰岛素抵抗指数。结果 3组受检者体质指数、血脂、血糖及血清胰岛素水平的差异均有统计学意义(P<0.05)。与对照组比较,单纯肥胖组血浆中脂肪细胞素水平及胰岛素抵抗指数升高,差异有统计学意义(P<0.01);与对照组及单纯肥胖组比较,肥胖合并T2DM组血浆中脂肪细胞素水平及胰岛素抵抗指数升高,差异有统计学意义(P<0.05)。血浆中脂肪细胞素与体质指数、甘油三酯、血糖、血清胰岛素及胰岛素抵抗指数呈正相关(P<0.05)。多元逐步回归分析显示,体质指数、甘油三酯、口服葡萄糖耐量试验2h血糖、血清胰岛素及胰岛素抵抗指数是脂肪细胞素的独立危险因素。结论血浆中脂肪细胞素水平的升高可能与肥胖和2型糖尿病的发病机制有关。     

2型糖尿病合并脑卒中的临床观察

目的探讨糖尿病脑卒中患者的临床特点、病因、危险因素及预后情况,从而有效指导该病的防治。方法对2型糖尿病脑卒中患者195例及非2型糖尿病脑卒中患者642例的发病类型,病情及治疗转归进行比较,观察其临床特点。结果糖尿病脑卒中患者酗酒、抽烟、高血压、总胆固醇、低密度脂蛋白、糖化血红蛋白、高密度脂蛋白、C反应蛋白、大动脉粥样硬化、小动脉闭塞以及预后较非糖尿病脑卒中有统计学差异(P<0.05或P<0.01)。结论糖尿病脑卒中患者与抽烟、酗酒、高血压、高血脂以及高血糖、血脂紊乱以及CRP增加等危险密切相关,在糖尿病脑卒中以大动脉粥样硬化性卒中、基底节区最常见。血糖升高会加重脑卒中的病情。     

2型糖尿病的遗传流行病学研究

目的 探讨遗传因素在2型糖尿病发生中的作用及其一般遗传模式。方法 对21个2型糖尿病先证者进行家系调查，应用Falconer同归法估算遗传度，Penrose’s法、Li-Mantel-Gait法及江三多的阈值模型理论估计2型糖尿病分离比、遗传模式等。结果 2型糖尿病先证者一级亲属患病率为7．6％，高于一般人群患病率；2型糖尿病遗传度为46．8％；Penrose’s法计算同胞患病率（s）/人群患病率（q）为3．312，接近1／q^1/2；简单分离分析结果显示，分离率P为0．131，低于0．25；阈值模型理论推算出2型糖尿病一级亲属的理论发病率为8．0％，实际发病率为7．6％。结论 2型糖尿病有明显遗传倾向，但不符合单基因遗传模式，具有多基因遗传特征。     

2型糖尿病合并脑卒中的临床观察

目的探讨糖尿病脑卒中患者的临床特点、病因、危险因素及预后情况,从而有效指导该病的防治。方法对2型糖尿病脑卒中患者195例a．al~2型糖尿病脑卒中患者642例的发病类型,病情及治疗转归进行比较,观察其临床特点。结果糖尿病脑卒中患者酗酒、抽烟、高血压、总胆固醇、低密度脂蛋白、糖化血红蛋白、高密度脂蛋白、c反应蛋白、大动脉粥样硬化、小动脉闭塞以及预后较非糖尿病脑卒中有统计学差异（P〈0．05或P〈0．01）。结论糖尿病脑卒中患者与抽烟、酗酒、高血压、高血脂以及高血糖、血脂紊乱以及CRP增加等危险密切相关,在糖尿病脑卒中以大动脉粥样硬化性卒中、基底节区最常见。血糖升高会加重脑卒中的病情。     

Sexual Dysfunction and Depression in Turkish Women with Type 2 Diabetes Mellitus

The aim of this study is to examine sexual dysfunction (SD) and depression in Turkish women with type 2 diabetes mellitus (DM). Forty-five women were included in the sampling. The study inclusion criteria were: literate, 18 years or older, able to speak, understand and communicate verbally in Turkish, not pregnant, having active sexual life, agreed to participate in the study. Patients had been diagnosed with DM at least 6 months before conducting the study. The instrument included questions about demographic variables. In addition, Female Sexual Function Index (FSFI) and Beck Depression Inventory were used. It was determined that the women between the ages 22 and over 50, primary school graduates, unemployed and those living in large family, those suffering from diabetes for more than 10 years were more SD and had higher level of depression than the other groups. A significant positive correlation was found between SD and depression. It was also found that as the level of depression of the patients increased, the mean subtotal and total FSFI scores decreased.     

Sexual Dysfunction in Turkish Men and Women with Type 2 Diabetes Mellitus

Sexual dysfunction (SD) is a common health problem for many men and women all over the world. This study was conducted to determine sexual dysfunction among Turkish men and women with type 2 diabetes mellitus (DM). Eighty men and eighty women were included in the sampling. This study inclusion criterion were: awareness of the illness, literate, married, the age range of the diabetic women 18–45, and not pregnant, the age range of the diabetic men 18–65 years, DM diagnosed at least 1 year, able to read the Turkish language, agreed to participate in the study. The data was completed using a questionnaire form, the index of female sexual function (IFSF), and the international index of erectile function (IIEF). The prevalence of male sexual dysfunction was 65.0 %; the prevalence of female sexual dysfunction was 68.8 %. The scores obtained from the subscale of the IFSF were lower for women with SD. There were also significant differences between the two groups in all domains (lubrication, sexual desire, intercourse satisfaction, clitoral sensation, overall satisfaction) except for the orgasmic function domain (p = 0.000). Scores obtained from the subscale of the IIEF were lower in men with SD, and between the two groups significant differences were found in the domains of erectile function (p = 0.000) and sexual desire (p = 0.010). We also found statistically significant differences between the income level (p = 0.003), family size (p = 0.002), therapy (p = 0.017) and SD in women. Differences for men were found between the age and SD (p = 0.018).     

2型糖尿病视网膜病变的视网膜厚度检测

在糖尿病视网膜病变,视网膜内外屏障的破坏导致液体积聚黄斑水肿是引起视力下降的一个重要原因.眼底检查和荧光素血管造影可以观察到黄斑水肿和血管渗漏,视网膜厚度分析仪(Retinal Thickness Analyzer,RTA)是一种激光扫描的可以快速无创获得后极部视网膜的厚度信息的仪器.     

Self-Care and Glycemic Control in Adolescents With Type I Diabetes

This study assesses the concurrence of adolescent- and parent-reported adherence to the medical regimen among youth with type 1 diabetes. Relationships between diabetes self-care and metabolic control were also examined. Adolescents' (n = 111) and their mothers' reports of adolescents' self-management of the diabetes regimen were examined for prediction to glycosylated hemoglobin (HgbA1c) levels obtained at concurrent and subsequent clinic visits. Adolescents' and parents' reports were correlated with each other, and correlations with HgbA_1c were as high as .41. Self- and parent-reported adherence to more complex aspects of the regimen (i.e., keeping blood glucose at appropriate levels) was the strongest correlate of HgbA_1c. In multivariate analyses, adolescent report predicted 30% and parent report explained 19% of the variance in concurrent HgbA1c. Self- and parent report of the adolescents' self-management may be show reliable indicators of the adolescents' self-care behaviors. As such they may be useful as indices for assessing the effectiveness of interventions to improve the management of the diabetic regimen among adolescents. In addition, aspects of diabetes management that involve higher level cognitive skills appear to be more effective in maintaining good HgbA_1c than variables that involve simply complying with physician directives. These findings emphasize the importance of education and graded practice with complex tasks and decision making in relation to diabetes management.