Glycemic control and the psychosocial benefits gained by patients with type 1 diabetes mellitus attending the diabetes camp

OBJECTIVE: The aim of this study was to evaluate the effectiveness of diabetes camp on glycemic control, knowledge, and psychosocial benefits among patients with type 1 diabetes (T1D). Glycemic control among patients with infrequent and frequent self-monitoring of blood glucose (SMBG) was also compared. METHODS: During a 5-day camp, 60 patients were taught diabetes self-management education (DSME). After camp, patients were divided into two groups based on frequency of SMBG (<3 versus 3-4 times/day) and were followed up until 6-month post-camp. Patients' HbA1c levels and knowledge were assessed at baseline, 3- and 6-month post-camp. Patients' impressions towards camp were assessed. RESULTS: In both SMBG groups, HbA1c levels decreased significantly at 3-month post-camp but did not sustain at 6-month monitoring. The patients with frequent SMBG had a lower mean HbA1c level. A significant improvement in knowledge was noted and sustained up to 6-month post-camp. The patients found diabetes camp of benefit and felt they could better cope with diabetes. CONCLUSIONS: Although the effect of the diabetes camp on glycemic control was short-lived, an improvement in knowledge and a better attitude towards having diabetes were seen among participants. PRACTICE IMPLICATIONS: The psychosocial benefits and knowledge gained by patients attending diabetes camp underline the importance of including a camp in a diabetes management plan. To improve patients' long-term glycemic control, a continuous education is required.     

Self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control

OBJECTIVE: To investigate the self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. METHODS: Using a one-to-one interviewing approach, data were collected from 126 diabetic adults from four settings. A 75-item questionnaire was used to assess diabetes-related knowledge and self-care practices regarding, diet, medication, physical activity and self-monitoring of blood glucose (SMBG). RESULTS: Most subjects had received advice on the importance of self-care in the management of their diabetes and recognised its importance. Sixty-seven subjects (53%) scored below 50% in their diabetes-related knowledge. Subjects who consumed more meals per day (80%), or who did not include their regular sweetened food intakes in their daily meal plan (80%), or who were inactive in daily life (54%), had higher mean fasting blood glucose levels (p=0.04). Subjects with medication non-adherence (46%) also tended to have higher fasting blood glucose levels. Only 15% of the subjects practiced SMBG. Predictors of knowledge deficit and poor self-care were low level of education (p = <0.01), older subjects (p=0.04) and Type 2 diabetes subjects on oral anti-hyperglycaemic medication (p = <0.01). CONCLUSION: There were diabetes-related knowledge deficits and inadequate self-care practices among the majority of diabetic patients with sub-optimal glycaemic control. PRACTICE IMPLICATIONS: This study should contribute to the development of effective education strategies to promote health for adults with sub-optimal diabetes control.     

Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: A national survey of the considerations and beliefs of GPs,ID physicians and care staff

Objective

This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID).

Methods

A survey questionnaire covering decision making about potentially burdensome medical interventions was sent to nationally representative samples of 294 ID care staff-members, 273 ID physicians and 1000 GPs.

Results

Professionals predominantly believed that considerations about quality of life are most important. Quality of life and wellbeing were also frequently considered in both decisions to start/continue an intervention and decisions to forgo/withdraw an intervention. Seventy percent believed that people with ID should always be informed about interventions, and 61% would respect a refusal by the person. The family's wishes were explicitly considered more often than the wishes of the person with ID.

Conclusion

Although respondents agree that the quality of life is highly important, the wishes of people with ID (especially of those with severe/profound ID) were often not considered in decisions about potentially burdensome medical interventions.

Practice implications

To enhance the active involvement of people with ID in decision making we recommend that professionals integrate collaborative principles in decision making and make use of pictorial and easy reading resources.     

Role in decision making among congestive heart failure patients and its association with patient outcomes: a baseline analysis of the SCOPAH study

ObjectiveWe investigated the predictors of patient-experienced and preferred roles for decision making, and the association between patient-experienced role in decision making and patient outcomes among congestive heart failure (HF) patients in a multi-ethnic Asian population.MethodsWe surveyed 246 HF patients classified as New York Heart Association class 3/4. Multivariable regressions were used to analyse the associations between patient-experienced roles and patient outcomes.ResultsPatients who were male, attained higher education, and had a higher cognitive score were more likely to experience and prefer active roles in decision making. Younger patients and patients with lower symptom burden were more likely, while married patients were less likely to prefer leading decision making. Patients with collaborative (family and/or physician) decision making reported higher emotional well-being and sense of meaning/peace. Collaborative and patient-led decision making were associated with higher perceived control over illness. Those who were led by others or made decisions alone reported lower quality of physician communication.ConclusionCollaborative decision making was associated with higher emotional well-being, sense of meaning/peace, and higher perceived control over illness among HF patients.Practice ImplicationsPhysicians should explain the benefits of shared decision making and encourage patients to participate in treatment decisions.     

Association of glucose control and stages of change for multiple self-management behaviors in patients with diabetes: A latent profile analysis

ObjectiveTo determine whether the joint use of the transtheoretical model and latent profile analysis could help us better understand the shared characteristics of patients with diabetes and explore the association of patients’ latent classes and glucose control.MethodsFive hundred twenty-three (523) patients with diabetes were included in the study. The questionnaire evaluated patients’ stages of change for medication-taking, diet control, exercise, and glucose-monitoring. Latent profile analysis was performed based on the four indicators.ResultsPatients were classified into four latent groups and defined as follows: good medication-taking/good lifestyle (GM/GL, 41.7%), poor medication-taking/poor lifestyle (PM/PL, 27.7%), good medication-taking/poor lifestyle (GM/PL, 21.6%), and poor medication-taking/good lifestyle (PM/GL, 9.0%). Patients in the PM/PL group were generally younger and better educated while those in the GM/GL group exhibited the opposite pattern. Compared with patients in the PM/PL group, those in the PM/GL and GM/GL groups had significantly lower HbA1c values (PM/GL: standardized β = -0.694, P = 0.007; GM/GL: standardized β = -0.499, P = 0.003).ConclusionWith the help of the transtheoretical model and latent profile analysis, future study could cluster homogeneous patients before the initiation of intervention and provide tailored instructions to different types of patients accordingly.Practice implicationsA combination of the transtheoretical model and latent profile analysis could shed some light into future diabetic interventions.     

2型糖尿病合并急性脑梗死患者血糖水平及血糖漂移对神经功能缺损的影响

目的：观察血糖水平及血糖漂移对2型糖尿病(type 2 diabetes mellitus,T2DM)合并急性脑梗死(acute cerebral infarction,ACI)患者神经功能缺损的影响。方法：选取2014年3月至2015年6月在我院治疗的ACI患者作为观察对象,根据其是否合并2型糖尿病史,将其分为2组：合并2型糖尿病组(DMCI组,42例)和不合并2型糖尿病组(NDMCI组,45例)。比较两组患者平均血糖水平(mean blood glucose,MBG)、血糖水平标准差(standard deviation of blood glucose,SDBG)、血糖波动频数(number of effective glucose excursions,NEGE)、最大血糖波动幅度(largest amplitude of glycemic excursions,LAGE)以及平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)的差异;观察两组患者神经功能缺损评分的差异,分析血糖水平及血糖漂移与神经功能缺损的相关性。结果：DMCI组患者神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)明显高于NDMCI组,差异具有统计学意义(P<0.05);DMCI组患者MBG、SDBG、NEGE、LAGE和MAGE水平均明显高于NDMCI组,差异具有统计学意义(P<0.05);NIHSS评分与MBG、SDBG、NEGE、LAGE和MAGE水平均明显正相关(r=0.356、0.412、0.389、0.435和0.397,P<0.05)。结论：血糖及血糖漂移的高水平可加重T2DM合并ACI患者的神经功能缺损程度。     

Comparison of the efficacy of an education program for people with diabetes and insulin pump treatment (INPUT) in a randomized controlled trial setting and the effectiveness in a routine care setting: Results of a comparative effectiveness study

ObjectiveTo compare the efficacy of an education program for people with diabetes and insulin pump treatment (INPUT) in a randomized controlled trial (RCT) to the effectiveness in an implementation trial (IT).Methods135 people with diabetes on insulin pump treatment (CSII) underwent structured education with INPUT under RCT-conditions, 191 people with diabetes on CSII underwent structured education with INPUT under IT-conditions. Baseline characteristics and treatment outcomes at the 6-month follow-up were compared.ResultsAt baseline, RCT-participants were younger (42.7 ± 14.2 vs. 47.2 ± 14.1 years, p = 0.005), had higher HbA1c-values (8.3 ± 0.8% vs. 7.8 ± 1.2%, p = 0.001) and had more diabetes-related distress (27.8 ± 16.4 vs 22.4 ± 14.4, p = 0.002). At follow-up, INPUT results were comparable under the RCT and IT settings. After adjustment for baseline HbA1c, reduction of HbA1c in the IT was significantly greater than in the RCT (Δ0.17%; 95% CI 0.023–0.319%, p = 0.024). Participants with higher HbA1c-levels, more diabetes-related distress and more hypoglycemia problems were most likely to benefit from INPUT regardless of the trial setting.ConclusionsEfficacy of the INPUT program for people with CSII was demonstrated under RCT- and routine care conditions.Practice implicationsEducation with the INPUT program is effective not only under standardized RCT conditions but also under conditions of routine care.     

心理护理在糖尿病肾病患者透析中负性情绪的应用效果

目的：探究心理护理在糖尿病肾病患者透析中的负性情绪的应用效果。方法：选取本院从2014年5月至2015年5月的90例老年早期糖尿病肾病患者,将入组的患者按随机数表法随机分为两组,观察组和对照组,每组分别为45例,对照组实施持续质量改进模式,观察组实施持续质量改进模式联合心理护理,共进行2周。观察记录两组患者透析过程中不同时间段患者发生低血糖的例数;观察记录两组患者透析过程中不同时间点的血糖水平;观察记录两组患者护理前后负性情绪情况,负性情绪包括抑郁、焦虑情绪。结果：比较两组患者透析过程中不同时间段患者发生低血糖例数,观察组1、2、4 h的低血糖患者例数分别为5、9、7例,对照组1、2、4 h低血糖患者例数分别为12、21、13例,观察组在1、2、4 h时患者发生低血糖的例数明显少于对照组,差异具有统计学意义(P<0.05);比较两组患者透析过程中不同时间点患者血糖水平,观察组透析开始时、透析2 h时、透析结束时患者血糖水平分别为(6.68±3.23)、(2.35±1.23)、(5.95±3.43) mmol/L,对照组透析开始时、透析2 h时、透析结束时患者血糖水平分别为(6.67±3.21)、(1.98±1.25)、(3.85±2.09) mmol/L,透析开始前两组患者血糖水平差异不大,无统计学意义(P>0.05),透析2 h时两组患者血糖水平下降,对照组患者血糖水平低于观察组患者,差异明显,具有统计学意义(P<0.05),透析结束时两组患者血糖水平均提高,观察组患者血糖水平提高,与对照组差异明显,具有统计学意义(P<0.05);护理后观察组SDS、SAS评分分别降为(36.43±5.33)、(39.45±5.22)分,对照组SDS、SAS评分分别降为(54.52±6.11)、(56.45±5.53)分,心理护理后两组患者的SDS评分、SAS评分均降低,且观察组患者SDS评分、SAS评分均明显低于对照组患者,差异明显,具有统计学意义(P<0.05)。结论：心理护理在糖尿病肾病患者应用能够有效改善抑郁、焦虑负性情绪,促进患者健康恢复。     

Differential effect of hyperglycaemia on the immune response in an experimental model of diabetes in BALB/cByJ and C57Bl/6J mice: participation of oxidative stress

Diabetes is associated with an increased risk of death from infectious disease. Hyperglycaemia has been identified as the main factor contributing to the development of diseases associated with diabetes mellitus. However, experimental evidence indicates individual susceptibility to develop complications of diabetes. In this context, the aim of this work was to study the immune response in a streptozotocin‐induced type 1 diabetes in two mouse strains: BALB/cByJ and C57Bl/6J. The participation of hyperglycaemia and oxidative stress was also analysed. Diabetic BALB/cByJ mice showed a decrease in both the in‐vivo and in‐vitro immune responses, whereas diabetic C57Bl/6J mice had higher blood glucose but exhibited no impairment of the immune response. The influence of hyperglycaemia over the immune response was evaluated by preincubation of lymphocytes from normal mice in a high glucose‐containing medium. T and B cells from BALB/cByJ mice showed a decrease in cell viability and mitogen‐stimulated proliferation and an increase in apoptosis induction. An increase in oxidative stress was implicated in this deleterious effect. These parameters were not affected in the T and B lymphocytes from C57Bl/6J mice. In conclusion, BALB/cByJ mice were sensitive to the deleterious effect of hyperglycaemia, while C57BL/6J were resistant. Although an extrapolation of these results to clinical conditions must be handled with caution, these results highlight the need to contemplate the genetic background to establish models to study the deleterious effect of diabetes in order to understand phenotypical variations that are of clinical importance in the treatment of patients.     

Effects of an educational intervention on heart failure knowledge,self-care behaviors,and health-related quality of life of patients with heart failure: Exploring the role of depression

ObjectivesTo test effects of an educational intervention on patient-reported outcomes among rural heart failure (HF) patients and to examine whether effects differed between patients with and without depression.MethodsPatients (N = 614) were randomized to usual care (UC) or 1 of 2 intervention groups. Both intervention groups received face-to-face education, followed by either 2 phone calls (LITE) or biweekly calls until they demonstrated content competency (PLUS). Follow-up lasted 24 months. Statistical analyses included linear mixed models and subgroup analyses by depression status.ResultsBoth intervention groups showed improvement in HF knowledge at 3 months (LITE–UC, p = 0.003; PLUS–UC, p < 0.001). Improvement lasted 24 months only in the PLUS group. Compared to UC, both intervention groups exhibited better self-care at 3 months (LITE–UC, p < 0.001; PLUS–UC, p < 0.001) and 12 months (LITE–UC, p = 0.001; PLUS–UC, p = 0.002). There were no differences in health-related quality of life (HRQOL) among groups. In subgroup analyses, similar effects were found among non-depressed, but not among depressed patients.ConclusionThe educational intervention improved HF knowledge and self-care, but not HRQOL. No intervention effects were observed in patients with depressive symptoms.Practice ImplicationsThe simple educational intervention is promising to improve HF knowledge and self-care. Additional strategies are needed for depressed patients.     

Common gastric and colon (GC) carcinoma with an anomaly in the GC amylase (AMY) gene and good prognosis: clinical findings of common GC carcinoma

The common causes and clinical features of gastric and colon (GC) carcinomas were investigated in 218 Japanese patients who underwent gastrectomy and 138 Japanese patients who underwent colectomy over a period of 2.9 years. One characteristic feature of common GC carcinoma was high levels of saliva-type serum amylase (S-Amy). High serum amylase of >400 IU/l, which was secreted from GC carcinoma, was identified in 9% to 12% of the patients immediately after surgery. Besides the high S-Amy, liver (bile duct) and/or kidney cysts and diabetes mellitus (DM) or borderline DM were found in 61–70% and 36–37%, respectively, of these GC carcinoma patients. The liver (bile duct) or kidney cysts may have been induced by a gene anomaly related to GC carcinoma. DM with low levels of insulin could also be connected to GC carcinoma. The pancreatic carcinoma markers, carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA), increased when GC carcinoma had metastasized to the lungs and/or liver. Seven (3%) patients with gastric carcinoma had liver metastasis, but none had lung metastasis. Colon carcinomas, which had better pathological findings than gastric carcinomas, metastasized more frequently with higher CEA levels. Both lung and liver metastases were found in four (3%) patients, lung metastasis in three (2%) patients, and only liver metastasis in five (4%) patients. Early stage metastases via lymph-vascular or large vascular vessels, but not small vein vessels, with a good prognosis of 3–4% mortality rates, were also characteristic findings of GC carcinomas. Some nodules of the metastases fell into necrosis in the metastatic organs. It was concluded that, among the GC carcinoma patients admitted to our hospital, at least 70% of GC carcinomas may be common GC carcinomas, which must have abnormal GC salivary AMY gene promoters.     

Deletion mapping of chromosome 13q in head and neck squamous cell carcinoma in Indian patients: correlation with prognosis of the tumour

Deletions in chromosome (chr.) 13q occur frequently in head and neck squamous cell carcinoma (HNSCC). Previous studies failed to identify common deleted regions in chr.13q, though several candidate tumour suppressor genes (TSGs) loci, e.g. BRCA2, RB1 and BRCAX have been localized in this chromosome, as well as no prognostic significance of the deletion has been reported. Thus, in the present study, deletion mapping of chr. 13q has been done in 55 primary HNSCC samples of Indian patients using 11 highly polymorphic microsatellite markers of which three were intragenic to BRCA2 gene, one intragenic to RB1 gene and another from BRCAX locus. The deletion in chr.13q was significantly associated with progression of HNSCC. High frequencies (27-39%) of loss of heterozygosity were found in 13q13.1 (BRCA2), 13q14.2 (RB1), 13q21.2-22.1 (BRCAX) and 13q31.1 regions. Deletions in the BRCA2 and RB1 regions were significantly correlated. The four highly deleted regions were associated with clinical stage and histological grades of the tumour as well as poor patient outcome. Deletion in the 13q31.1 region was only found to be associated with HPV infection. High frequencies (11-23%) of microsatellite size alteration (MA) were seen to overlap with the highly deleted regions. Forty per cent of the samples showed rare biallelic alteration whereas loss of normal copy of chromosome 13q was seen in five tumours. Thus, it seems that the putative TSGs located in the BRCAX and 13q31.1 regions as well as the BRCA2 and RB1 genes may have some cumulative effect in progression and poor prognosis of HNSCC. Significant association between deletion in BRCA2 and RB1 gene loci may indicate functional relationship between the genes in this tumour progression.     

Preoperative diagnostic accuracy of fine-needle aspiration in the management of breast lesions: Comparison of specificity and sensitivity with clinical examination,mammography, echography,and thermography in 249 patients

Two hundred and forty-nine women suffering from breast problems underwent a complete series of tests including clinical examination, mammography, echography, thermography, and fine-needle aspiration (FNA). Ninety-four of these patients were shown to be positive or to have suspected malignancy. Accordingly, they underwent surgical excision followed by histologic examination, while the remaining patients were re-examined after 12 to 18 mo in order to exclude false negatives. The analysis of specificity and sensitivity of every single procedure showed that FNA describes the best degree of sensitivity and specificity but no procedure allows, by itself, the detection of all carcinomas. When considered in combination, clinical examination, mammography, and fine-needle aspiration have a sensitivity of 100% and a specificity of 49%, and are the best diagnostic tests for a correct assessment of mammary lesions. Thermography and echography showed a low degree of sensitivity and should not be included in the routine diagnostic procedure of breast lesions. Diagn Cytopathol 1994; 11:4–8. © 1994 Wiley-Liss, Inc.     

Liver abscesses in adult patients with and without diabetes mellitus: an analysis of the clinical characteristics,features of the causative pathogens,outcomes and predictors of fatality: a report based on a large population,retrospective study in China

In China, there are four types of liver abscesses (LAs) that meet the clinical criteria. Pyogenic liver abscesses (PLAs) and amoebic liver abscesses (ALAs) are two of the most common types of abscesses, followed by fungal liver abscesses (FLAs) and hydatid secondary liver abscesses (HsLAs). Diabetes mellitus (DM) is associated with the development of PLAs. However, there is a lack of population-based studies that have evaluated the underlying relationship between LAs (mainly PLAs and FLAs) and DM. We conducted a retrospective study based on a large population to identify the potential differences and factors that affect the mortality of PLA patients in DM and non-DM groups. Our results revealed that the prevalence of DM is 44.3% (158/357) in PLA patients and 35.3% (18/51) in FLA patients. Compared with the non-DM patients, statistically significant differences were found in DM patients according to symptomatology, clinical manifestations, laboratory findings, microbiological characteristics, antimicrobial resistance, clinical treatments and outcomes in relation to mortality. In addition, the status of antibiotic resistance to E. coli and K. pneumoniae, which were isolated from the patient samples, is severe in the area in which the study was conducted. Regarding the treatment of PLAs, our study indicated that broad-spectrum antimicrobial therapy and drug combinations should be recommended and initiated before the pathogens are cultured and identified. In the clinic, therapies that combine percutaneous drainage with antibiotics and surgery with antibiotics are the two most useful strategies for treating an LA. These two combined treatments resulted in satisfactory cure rates. In the DM and non-DM groups, the cure rates for percutaneous drainage with antibiotics were 90.3% and 92.0%, respectively, and the cure rates for surgery with antibiotics were 93.9% and 95.2%, respectively.     

Interleukin 10 gene single nucleotide polymorphisms in Polish patients with chronic hepatitis C: Analysis of association with severity of disease and treatment outcome

It is suggested that interleukin 10 (IL-10), as a modulator of immune response, is likely to influence the elimination of hepatitis C virus (HCV), the progression of chronic hepatitis C (CHC) and the response to interferon-based therapy in CHC patients. The aim of the study was to analyze the association of single nucleotide polymorphisms (SNPs) of IL-10 gene with severity of liver disease (degree of inflammation and stage of fibrosis) and outcome of pegylated interferon alpha and ribavirin combined therapy (sustained virological response (SVR) and relapse) in 196 Polish CHC patients infected with HCV genotype 1. The analysis included IL-10 promoter SNPs: ?1082(A/G) rs1800896, ?819(C/T) rs1800871, ?592(C/A) rs1800872 and SNP in the 3′ UTR of IL-10 gene: +4529(A/G) rs3024498. Genotyping was performed using PCR-RFLP and HRM analysis. It was demonstrated that the ?592C allele is associated with mild hepatic inflammation. Moreover, it was found that the ?819C allele might be associated with SVR and that the ACCA haplotype and intermediate IL-10 producer ACC haplotype are associated with SVR and non-relapse. It can be concluded that IL-10 SNPs are associated with severity of disease and response to therapy and may be considered as potential prognostic and predictive markers in CHC.     

Prevalence and risk factors for endogenous fungal endophthalmitis in adult patients with candidemia at a tertiary care hospital in the Republic of Korea over 13 years

BackgroundEndogenous fungal endophthalmitis (EFE) is a critical complication of candidemia. We conducted a study to investigate the prevalence and risk factors for EFE.MethodsAdult candidemia patients ≥ 19 years who underwent an ophthalmological examination at a tertiary care hospital in the Republic of Korea from 2006 to 2018 were enrolled.ResultsThere was a total of 152 adult candidemia patients analyzed. EFE was found in 29 patients (19.1%). Patients were categorized into two groups (Non-endophthalmitis [NE] and endophthalmitis [E]). Between the two groups, there was no significant difference in terms of age, sex, and underlying comorbidities. However, there were more Candida albicans candidemia, abnormal alanine aminotransferase (ALT) at the time of candidemia diagnosis, receipt of antifungal treatment ≥ 48 hours after onset of candidemia symptoms and blood culture sample (AOCS), and candidemia clearance ≥ 5 days after initiation of antifungal treatment (AIAT) in the E group. A predictive model for the E was created, which had an area of 0.811 under the receiver operating characteristics curve. In a multivariate logistic regression analysis, C. albicans candidemia, ALT at the time of candidemia diagnosis, receipt of antifungal treatment ≥ 48 hours AOCS, and candidemia clearance ≥ 5 days AIAT were significantly associated with EFE.ConclusionEFE occurred in 19% of adult patients with candidemia. Adult candidemia patients with C. albicans candidemia, abnormal ALT, receipt of antifungal treatment ≥ 48 hours AOCS, and candidemia clearance ≥ 5 days AIAT need to be closely monitored for the possibility of EFE.