Dominant Western health care: type 2 diabetes mellitus.

Diabetes is a major public health problem with serious complications. In 2002, the Centers for Disease Control estimated that 18.2 million people in the United States had diabetes. One in every 400 to 500 adolescents is diagnosed with type 1 diabetes mellitus (T1DM), and pediatric type 2 diabetes mellitus (T2DM) represents an emerging public health concern. The Children's Hospital of Philadelphia (CHOP) identified 337 children with T2DM through 2004. These children were mostly female and obese with a strong family history of T2DM. One patient's course of treatment for 1.5 years after initial presentation is described. Nineteen percent of the patients at CHOP were diagnosed with a neuropsychiatric illness before T2DM onset, further complicating their treatment. There is an imperative need for large-scale studies investigating the pathophysiology, treatment, and complications of T2DM in adolescents and youth.     

诺和锐治疗2型糖尿病病人的护理

诺和锐（Novorapid）是近年新上市的超短效人胰岛素类似物，其作用特点、疗效和注射方法均与普通短效胰岛素不同。现将有关诺和锐临床治疗试验中的护理报告如下。     

诺和锐治疗2型糖尿病病人的护理

诺和锐(Novorapid)是近年新上市的超短效人胰岛素类似物,其作用特点、疗效和注射方法均与普通短效胰岛素不同。现将有关诺和锐临床治疗试验中的护理报告如下。1临床资料均为我院门诊和住院的2型糖尿病病人,其中男9例,女12例,平均年龄56.1岁,糖尿病病程10.8年±5.3年,体重指数(2     

2型糖尿病住院患者慢性并发症危险因素分析

目的:分析大连地区2型糖尿病住院患者糖尿病慢性并发症的相关危险因素。方法:①收集2005-01/2006-12大连医科大学附属第二医院内分泌科住院2型糖尿病患者579例。符合1999年世界卫生组织糖尿病诊断标准,且对检测项目知情同意。②收集个人资料,测量体脂测量参数(体质量指数、腰围、臀围、股围)以及实验室检查指标(血糖、血脂、24h尿白蛋白、胰岛素敏感相关指标)。根据国际临床分类法,24h尿白蛋白情况,神经肌电图,彩超检查、头部CT、心电图以及酶学诊断糖尿病视网膜病变、糖尿病肾脏病变、糖尿病周围神经病变、糖尿病大血管并发症。③使用Logistic逐步回归分析各危险因子对糖尿病并发症的贡献大小。结果:糖尿病患者579例均进入结果分析,其中42.3%合并糖尿病视网膜病变,其中4.5%为增殖型视网膜病变;63.2%合并糖尿病周围神经病变;37.0%合并糖尿病肾脏病变;56.6%合并糖尿病大血管并发症。多因素Logistic回归分析结果:①糖尿病病程、收缩压、糖化血红蛋白、腰股比为糖尿病肾脏病变独立危险因素(偏回归系数分别为0.005,0.019,0.069,6.693,P<0.05￣0.01)。②糖尿病病程、糖化血红蛋白、空腹血糖、血总胆固醇、24h尿白蛋白为糖尿病视网膜病变独立危险因素(偏回归系数分别为0.014,0.158,0.536,0.039,0.006,P<0.05￣0.01)。③糖尿病病程、年龄、血总胆固醇、空腹血糖为糖尿病周围神经病变独立危险因素(偏回归系数分别为0.016,0.039,0.608,0.433,P<0.05￣0.01)。④年龄、体质量指数、胰岛素抵抗指数、空腹血糖、总胆固醇、24h尿白蛋白为糖尿病大血管并发症独立危险因素(偏回归系数分别为0.085,0.092,0.248,1.153,0.937,0.002,P<0.05￣0.01)。高密度脂蛋白胆固醇为糖尿病大血管并发症独立保护因素(偏回归系数为0.992,P<0.05)。结论:腰股比是糖尿病肾脏病变的主要危险因素,糖化血红蛋白、空腹血糖是糖尿病视网膜病变的主要危险因素,空腹血糖、总胆固醇是糖尿病大血管并发症和糖尿病周围神经病变的主要危险因素。     

2型糖尿病健康教育的研究进展

从2型糖尿病健康教育团队的组成、教育模式、教育内容(2型糖尿病的危害、预防、饮食、运动、心理、药物及血糖监测的护理)及效果评价概括2型糖尿病健康教育的研究进展,归纳总结出2型糖尿病健康教育中存在的不足,并提出相关对策,以提高2型糖尿病健康教育的质量。     

2型糖尿病健康教育的研究进展

从2型糖尿病健康教育团队的组成、教育模式、教育内容（2型糖尿病的危害、预防、饮食、运动、心理、药物及血糖监测的护理）及效果评价概括2型糖尿病健康教育的研究进展，归纳总结出2型糖尿病健康教育中存在的不足，并提出相关对策，以提高2型糖尿病健康教育的质量。     

Knowledge and attitudes of patients with diabetes mellitus in a primary health care system

The objective of this study was to characterize patients with type 2 diabetes mellitus, according to sociodemographic and clinical variables, and to analyze scores of knowledge and attitudes regarding the disease. Participants were 79 users who received care in a primary health care service, in 2008. The Diabetes Mellitus Knowledge (DKN-A) and Attitude (ATT-19) questionnaires were used for data collection. The population was formed by adults and elderly adults, who were between 30 and 80 years old. Most were literate (96.3%); married (63.3%); female (63.3%) and classified as class-2 obesity. As to the knowledge about the disease, subjects obtained scores lower than 8, indicating unsatisfactory results on self-care. Scores obtained regarding attitudes show difficulties to cope with the disease. Results evidence the need to adopt a Diabetes Education Program at the studied unit.     

Long-term complications in newly diagnosed Sri Lankan patients with type 2 diabetes mellitus

We screened 597 newly-diagnosed diabetic patients (201 women) mean +/- SD age 42.3 +/- 6.2 years to determine the prevalence of diabetic complications; 22% presented because of symptoms of diabetes, 27% were diagnosed when hyperglycaemia was discovered at a health screening, and 36% were diagnosed while being treated for intercurrent illness. Neuropathy was present in 25.1%, nephropathy in 29%, retinopathy in 15%, coronary vascular disease in 21%, stroke in 5.6%, peripheral vascular disease in 4.8%, hypertension in 23%, obesity in 16%, central obesity in 21.3%, hypercholesterolaemia in 11%, hypertriglyceridaemia in 14%, and low high-density lipoprotein cholesterol in 12%. The prevalence of coronary vascular disease, hypertension, stroke, neuropathy and retinopathy at the time of diagnosis were higher in our patients than in Caucasian and Indo-Asian patients in the UK. Both a genetic predisposition to develop complications, and exposure to a longer duration of asymptomatic hyperglycaemia due to poor access to adequate health care, may contribute to the high frequency of complications at diagnosis. Since complications are already present at diagnosis, there is a case for implementing primary prevention programmes combined with screening for diabetes in high-risk groups.      

Incidence and prevalence of pulmonary tuberculosis among patients with type 2 diabetes mellitus: a systematic review and meta-analysis

BackgroundThe epidemic of type 2 diabetes mellitus (T2DM) poses a great challenge to pulmonary tuberculosis (PTB) control. However, the incidence and prevalence of PTB among T2DM patients has not been fully determined. This meta-analysis aimed to provide the estimation on the global incidence and prevalence of PTB among T2DM patients (T2DM-PTB).MethodsOnline databases including Web of Science, PubMed, China National Knowledge Infrastructure and Cochrane Library were searched for all relevant studies that reported the incidence or prevalence of T2DM-PTB through 31 January 2022. Pooled incidence and prevalence of T2DM-PTB with 95% confidence interval (CI) was estimated by the random-effect model. All statistical analyses were performed using R software.ResultsA total of 24 studies (14 cohort studies, 10 cross-sectional studies) were included. The pooled incidence and prevalence of T2DM-PTB were 129.89 per 100,000 person-years (95% confidence interval (CI): 97.55–172.95) and 511.19 per 100,000 (95% CI: 375.94–695.09), respectively. Subgroup analyses identified that the incidence of T2DM-PTB was significantly higher in Asia (187.20 per 100,000 person-years, 95% CI: 147.76–237.17), in countries with a high TB burden (172.04 per 100,000 person-years, 95% CI: 122.98–240.68) and in studies whose data collection ended before 2011 (219.81 per 100,000 person-years, 95% CI: 176.15–274.28), but lower in studies using International Classification of Diseases-10 codes (73.75 per 100,000 person-years, 95% CI: 40.92–132.91). The prevalence of T2DM-PTB was significantly higher in countries with a high TB burden (692.15 per 100,000, 95% CI: 468.75–1022.04), but lower in Europe (105.01 per 100,000, 95% CI: 72.55–151.98).ConclusionsThis systematic review and meta-analysis suggests high global incidence and prevalence of PTB among T2DM patients, underlining the necessity of more preventive interventions among T2DM patients especially in countries with a high TB-burden.

Key messages

• A total of 24 studies (14 cohort studies, 10 cross-sectional studies) containing 2,569,451 T2DM patients were included in this meta-analysis.
• The pooled incidence and prevalence of T2DM-PTB are 129.89 per 100,000 person-years (95% CI: 97.55–172.95) and 511.19 per 100,000 (95% CI: 375.94–695.09) respectively.
• The incidence of T2DM-PTB was significantly higher in Asia, in countries with a high TB burden and in studies whose data collection ended before 2011, but lower in studies using International Classification of Diseases-10 codes.
• The prevalence of T2DM-PTB was significantly higher in countries with a high TB-burden, but lower in Europe.

     

Medical costs of managed care in patients with type 2 diabetes mellitus

The main objective of this study was to analyze the principal treatment cost drivers in patients with type 2 diabetes mellitus in a managed care setting. The study used retrospective integrated (linked) medical and pharmacy claims data for the calendar year 1995. The data were obtained from, and in cooperation with, the Hawaii Medical Service Association, Honolulu, Hawaii. The medical claims data included paid claims for services and procedures for diabetes and commonly associated comorbidities. Claims and associated costs for pharmacotherapy administered to the patient population were recorded in the pharmacy data. Patients aged > or =65 years were excluded because Medicare claims were unavailable for the type 2 diabetic population. The sample used in this study included 5171 patients. An ordinary least squares regression model was employed to identify principal cost drivers among the identified cohort to the managed care system. Independent variables in the analysis consisted of the presence or absence of a number of commonly observed comorbidities associated with diabetes mellitus (hypertension, hyperlipidemia, cardiovascular diseases, congestive heart failure, renal disorders, retinopathy, neurologic disorders, and any cardiac or noncardiac comorbidity combinations), pharmacologic therapy variables (insulin, oral medication, or both), a number of significant events (hospitalization, dialysis, hemoglobin A1c testing, and eye examination), patient enrollment category (fee-for-service vs a capitated system), and patient age and sex. The dependent variable was the natural logarithm of total medical costs of treatment for diabetes and commonly observed comorbidities. Results showed that among comorbidity variables, the 3 largest treatment cost drivers for patients with type 2 diabetes were the presence of neurologic disorders, renal disorders, and any comorbidity combination (cardiac or noncardiac or both), in decreasing order of significance. Similarly, higher costs of treatment were associated with episodes of hospitalization, use of antidiabetic medication, dialysis services, and hemoglobin A1c testing. Whether the patient was being treated under a capitated provider payment system or a fee-for-service system did not have any significant impact on the medical costs of diabetes-related treatment. Age was positively associated with these costs, indicating that older patients were more likely to incur higher costs to the system. The overall explanatory power of the model was 40%. In summary, unless diabetes is properly managed and glucose levels monitored, some component of an integrated health system (hospital vs pharmacy) necessarily bears financial risk. An understanding of the underlying cost distribution for a chronic disease could help in targeting interventions, integrating disease-management services, and managing the formal structure of the health plan being considered.     

Incidence of diabetes mellitus by clinical type

The incidence of diabetes mellitus by clinical type was determined for the community of Rochester, Minnesota, 1945-69. Overall adjusted incidence rates per 100,000 person-years were 8.4 for IDDM, 80.1 for obese NIDDM, 45.6 for nonobese NIDDM, and 3.6 for secondary diabetes, using our definitions. Strict use of National Diabetes Data Group criteria would have reduced the apparent incidence of all diabetes by about 20% through the deletion of NIDDM cases. The National Diabetes Data Group classification improved the clinical homogeneity of IDDM patients compared with "juvenile-onset" diabetes but had little effect on NIDDM relative to "maturity-onset" diabetes, since essentially the same patients were included in both groups. Separation of NIDDM into obese and nonobese subcategories accomplished little in the way of defining two more homogeneous subgroups.     

Promoting health in type 2 diabetes: nurse-physician collaboration in primary care

The purpose of this study is to examine effects of a nurse-physician collaborative approach to care of patients with type 2 diabetes and to determine possible effect sizes for use in computing sample sizes for a larger study. Forty patients from a family practice clinic with type 2 diabetes were randomly assigned to control or experimental groups. The control group received standard care, whereas the experimental group received standard care plus home visits from a nurse, as well as consultation with an exercise specialist and/or nutritionist. Follow-up continued for 3 months. Clinical end points included standard measures of diabetes activity as well as quality-of-life indicators. Focus group interviews were used to explore patients' responses to the program. Although findings were not statistically significant, a trend toward small to moderate positive effect sizes was found in glycosylated hemoglobin and blood pressure. Quality of life measures also showed a trend toward small to moderate, but nonsignificant, improvements in physical functioning, bodily pain, vitality, social and global functioning, energy, impact of diabetes, and health distress. Focus group interviews indicated a very positive response from patients, who expressed feelings of empowerment. In this study, patients treated with nurse-physician collaboration demonstrated small, but nonsignificant, improvements in blood chemistry after only 3 months. Physical and social functioning, energy, and bodily pain also showed a small improvement. Changes in awareness of effects of diabetes on health and an expressed sense of self-efficacy suggest that effects could be sustainable over the longer term.     

2型糖尿病患者血清皮质醇与慢性并发症的关系

目的分析2型糖尿病患者血清皮质醇水平的变化情况,探讨糖尿病患者慢性并发症的发生与其体内血清皮质醇水平的关系。方法收集190例患者的一般资料和临床信息,其中2型糖尿病患者139例、非糖尿病患者51例,比较2组皮质醇分泌水平的差异;通过多因素Logistic回归分析了解糖尿病患者体内皮质醇水平升高与其慢性并发症的相关性。结果与非糖尿病患者相比,2型糖尿病患者8时、16时、0时血清皮质醇及24 h尿皮质醇均升高(P均<0.05)。发生慢性并发症的糖尿病患者的午夜皮质醇水平高于未发生者(P <0.05)。胰岛素抵抗指数高、男性、病程5～10年及病程超过10年以上、GHbA_1c是糖尿病患者发生慢性并发症的危险因素(OR分别为2.671、2.696、3.313、10.523、1.291,P均<0.05)。结论糖尿病患者存在下丘脑-垂体-肾上腺轴功能异常,出现慢性并发症的糖尿病患者的午夜皮质醇水平明显高于未出现慢性并发症的患者,午夜皮质醇水平升高可能与慢性并发症相关。胰岛素抵抗程度高、男性及病程长是糖尿病患者出现并发症的危险因素。     

2型糖尿病患者社区健康教育干预的效果评价

目的 探讨糖尿病社区健康教育干预在2型糖尿病综合治疗中的作用.方法 将120例社区2型糖尿病患者随机分为干预组55例和对照组65例.前者进行系统化糖尿病知识教育后,针对每一例患者进行个体化强化教育,后者则仅进行一般的糖尿病教育.于教育前和教育后6个月分别采用自我护理能力测定量表进行评价,并监测血糖、尿糖、糖化血红蛋白、血脂,进行组内教育前后及同期组间教育效果的比较.结果 开展教育后6个月末,干预组与对照组自我护理能力、自我护理技能、自护责任感和健康知识水平均比教育前明显改善,但干预组自我护理能力、自我护理技能、自护责任感和健康知识水平均明显高于对照组.开展教育后6个月末,干预组与对照组HbAlc和TC、TG均比教育前明显改善,但干预组HbAlc和TC、TG水平均明显低于对照组.结论 社区健康教育干预可以更有效地提高自我护理能力、自我护理技能、自护责任感和健康知识水平,改善糖尿病患者的糖脂代谢水平.     

个性化健康教育在2型糖尿病患者中的应用研究

目的 观察个性化健康教育对2型糖尿病患者代谢指标的影响,探索改变患者生活方式的有效措施.方法 由糖尿病专科护士对58例2型糖尿病患者一对一制定个性化健康教育计划,并观察实施计划后患者BMI、空腹血糖(FPG)、餐后2h血糖(2 hPG)、糖化血红蛋白(HbAlc)等代谢指标的变化.结果 健康教育实施6,12个月后患者BMI、FPG、2hPG、HbAlc等代谢指标均较基线值有所下降,差异均有统计学意义,90％以上的患者能自觉坚持饮食和运动治疗.结论 个性化健康教育能更好地改善2型糖尿病患者的代谢指标.对糖尿病患者进行个性化健康教育,能增强其有效性,并自觉养成良好的生活习惯,从而延缓糖尿病患者慢性并发症的发生和发展.     

2型糖尿病患者出院后远程管理模式选择的调查分析

目的：了解住院2型糖尿病患者出院后对延续护理服务——以网络为媒介的远程管理模式的接受程度及其选择与否的原因。方法：对106位在我院住院的2型糖尿病患者进行调查。让患者自由选择“门诊随诊结合远程管理…门诊随诊结合电话随访”或“仅门诊随诊”方式中的一种，同时询问其选择原因。结果：20．75％的患者选择远程管理模式；选择不同模式患者的年龄、文化程度、人住科室、糖化血红蛋白（HbA1c）值及人院时随机血糖水平的差异有统计学意义（P〈0．05）。结论：目前我院糖尿病患者对远程管理模式接受程度不高，不熟悉上网操作或家中不具备上网条件是患者不选择网络远程管理的主要原因。因此，可将三种管理方式结合，制定适合患者个体的管理模式。     

2型糖尿病患者家庭主要照顾者照顾负担与应对方式的相关性研究

目的 描述2型糖尿病患者家庭主要照顾者(以下简称照顾者)照顾负担与应对方式的现状,并探讨二者的相关性。方法 采用疾病负担量表和应对方式量表,对82例2型糖尿病患者及其照顾者进行问卷调查,分析2型糖尿病患者家庭照顾者照顾负担的发生情况及影响因素,并采用Spearman相关分析法探讨照顾者负担与应对方式之间的相关性。结果 照顾者照顾负担的发生率为87.8%；照顾者采用最多的应对方式为“尽量看到事情好的一面”(2(1,2))；照顾者负担与积极应对方式呈正相关(r_s=0.294,p＜0.01),与消极应对方式不相关(p＞0.05)。结论 2型糖尿病患者家庭主要照顾者具有中重度的照顾负担,照顾者的照顾负担越多,采纳的积极应对方式也越多。医务工作者将照顾者纳入到患者的日常健康教育中,提供其更多的积极应对方式的方法,减轻照顾负担。     

Low incidence of vascular complications in patients with diabetes mellitus associated with liver cirrhosis as compared with type 2 diabetes mellitus

We compared clinical features and vascular complications of patients with diabetes mellitus associated with liver cirrhosis versus patients with type 2 diabetes mellitus. Subjects were 19 patients (LC-DM group) in whom diabetes was diagnosed after development of liver cirrhosis. Control consisted of 38 patients with type 2 diabetes (T2DM group) matched for sex, age, duration of diabetes, body mass index, treatment, and degree of glycemic control, which was determined by glycoalbumin. The LC-DM group had significantly more smokers, higher serum insulin levels, more insulin resistance calculated by homeostasis model assessment, lower blood counts (white and red blood cells, hemoglobin, and platelets), and lower serum levels of total cholesterol, triglyceride, low density lipoprotein cholesterol and lipoprotein (Lp)(a) than the T2DM group. The incidence of diabetic retinopathy and cerebrovascular disease was significantly lower in the LC-DM group compared to the T2DM group. Logistic regression analysis indicated that Lp(a) and the diabetes duration were significant predictors for the retinopathy, while Lp(a) was a significant predictor for the cerebrovascular complication. In diabetes associated with liver cirrhosis, the incidence of diabetic retinopathy and cerebrovascular disease is lower than in type 2 diabetes mellitus in this study, probably because of lower levels of serum Lp(a).