Foot nursing of patients with diabetes

Incidence of atherosclerosis was higher in patients with diabetes.Atherosclerosis of peripheral limbs mainly affect artery of lower limbs and abnormal feeling of foot and intermittent limping was the manifestation.To explore nursing methods of foot in patients with diabetes.     

Are spouses of patients with type 2 diabetes at increased risk of developing diabetes?

OBJECTIVE: To determine whether spouses of patients with type 2 diabetes have an increased risk of diabetes compared with spouses of subjects with normal glucose tolerance. RESEARCH DESIGN AND METHODS: A random sample of spouses of patients with type 2 diabetes (group 1S) attending a general practice diabetes clinic was compared with spouses of nondiabetic subjects (as determined by oral glucose tolerance test [OGTT]) (group 2S). Spouses in both groups underwent OGTT, fasting lipid profile, and blood pressure (BP) measurements. RESULTS: A total of 245 subjects in group 1S and 234 subjects in group 2S underwent OGTT. Group 1S had a significantly higher incidence of fasting glucose, impaired glucose tolerance, or type 2 diabetes (19.1 vs. 9.4%). Group 1S also had higher fasting glucose and triglyceride levels, higher BMI, and a trend toward higher BP. Multivariate logistic regression analysis, adjusted for BMI and age, showed the risk of diabetes in the spouse of a patient with diabetes was 2.11 (95% CI 1.74-5.1), as compared with the spouse of a subject with normal glucose tolerance. Similarly, the risk of any degree of glucose intolerance in a spouse of a patient with type 2 diabetes was 2.32 (1.87-3.98), as compared with a spouse of a subject with normal glucose tolerance. CONCLUSIONS: Spouses of patients with type 2 diabetes have a significantly increased risk of glucose intolerance and type 2 diabetes, and they should be classified as high risk for diabetes. This finding has implications for screening programs, which should include spouses of subjects with diabetes.     

Infectious risk factors analysis to senile patients with diabetes

INTRODUCTIONIncidenceofdiabetescombinedwithinfectionwasveryhigh,dis-easeconditionwasserious,courseofdiseasewaslongwhichmadetreatmentverydifficult犤1-3犦.Senilediabetesweremoreeasytobeinfectedbecauseofbadcontroleffectofbloodglucoseandde-creasedimmunefunctionandtheinfectionwasdifficulttocon-trol.Correspondingriskfactorsaboutsenilediabetescombinedwithinfectionwereanalyzedinthisarticletomaketimelydiagnosisandtreatment.MATERIALSANDMETHODSMaterials338inpatientswithsenilediabetesindepartm…     

Metabolic syndrome and type 2 diabetes: can we stop the weight gain with diabetes?

Many patients with type 2 diabetes also have the metabolic syndrome with its cardinal features of central adiposity, insulin resistance, dyslipidemia, and hypertension. Although there is strong evidence for the importance of tight glycemic control in minimizing the microvascular complications of diabetes, many of the current therapies used for optimizing glycemic control also cause weight gain. With this treatment-induced weight gain, there is a risk of worsening the patient's insulin resistance. Physicians need to be aware of this vicious cycle in their overweight type 2 diabetic patients. This article reviews the strategies currently available to achieve glycemic control while at the same time minimizing weight gain and the associated complications.     

Are there advantages with U-Albumin/U-Creatinine ratios compared with U-Albumin in monitoring diabetes?

Management of hypertension and diabetes mellitus in primary health care requires occasional assessment of kidney function. Monitoring the urinary albumin excretion every 24 h is often used as a diagnostic gold standard but measurement of U-Albumin concentrations in morning urine either alone or together with U-Creatinine is a well-established surrogate measure. We compared the ratio U-Albumin/U-Creatinine and U-Albumin concentrations measured by commonly used POC (Point of care) instruments with those obtained in a central laboratory and estimated the uncertainty of the results after establishing an uncertainty budget. It is concluded that the presentation of ratios or concentrations on an ordinal scale is less satisfactory than reporting U-Albumin concentration on a ratio scale. Moreover the latter will have the advantage of allowing the physician to adjust the diagnostic sensitivity and specificity to local needs. The present report is a methodological study and does not consider the diagnostic performance of the studied properties per se.     

Effect of health education on self nursing of patient with diabetes

Background:Diabetesneedsalongself-nursingtimeandthedeficiencyofknowledgeaboutdiabeteswilldirectlyinfluencepa-tients'healthylife.Healtheducationindiabetesistheimportantcontentofnursinginfact.Objective:Toinvestigatetheeffectofhealtheducationonself-nursingofpatientwithdiabetes.Unit:ShenyangGeneralHospitalofPLA.Subjects:FromJanuary2001toSeptember200186casesdia-betestreatedwithinsulinwereinvestigated,including54males,32females.Allcasesweredividedintotreatmentgroup(n=44)andcontrolgroup(n=42).I…     

Is there a role for screening asymptomatic patients with diabetes?

Coronary artery disease (CAD) remains a leading cause of death among patients with diabetes mellitus. However, many patients with diabetes and CAD are asymptomatic and may sustain a myocardial infarction as their presenting symptom of CAD. Non-invasive cardiovascular imaging offers an opportunity to detect the presence and severity of CAD, or its hemodynamic consequences. The Detection of Ischemia in Asymptomatic Diabetics study and the FACTOR-64 study examined the utility of non-invasive imaging tests to evaluate asymptomatic individuals with diabetes mellitus. The results of these trials may have been negative with regard to promoting CAD screening of asymptomatic diabetic patients, but they do strengthen the position of optimal medical management in reducing cardiovascular events. However, performing a trial to include true high-risk patients who have CAD and are more likely to have silent ischemia could lead to prognostically beneficial coronary revascularizations.     

Do patients with diabetes wear shoes of the correct size?

BACKGROUND: Fifteen per cent of patients with diabetes will develop a foot ulcer at some point in their life. Ill-fitting footwear frequently contributes to foot ulceration. A good fitting shoe is an essential component in the management of the diabetic foot. The objective of this study was to assess the feet and footwear of patients with diabetes to determine whether they are wearing the correct-sized shoes. METHODS: One-hundred patients with diabetes who were attending the general diabetic clinic had their foot length measured using a 'Clarks' shoe shop device and foot width using a pair of callipers. Measurements were taken whilst seated and standing. Shoe dimensions were also assessed by recording the manufactured shoe length and using callipers to assess shoe width. A calibrated measuring stick standardised shoe lengths. Neurovascular status and the presence of deformities in the foot were also recorded. RESULTS: One-third of diabetic patients were wearing the correct shoes on either foot whilst seated or whilst standing. However, only 24% of patients were wearing shoes that were of the correct length and width for both feet whilst seated and 20% upon standing. Seventeen per cent of patients appeared in both groups. No significance was found between any other variables, such as sensory neuropathy. CONCLUSIONS: Many patients with diabetes wear shoes that do not fit, particularly, shoes that are too narrow for their foot width. Assessing the appropriateness of footwear maybe an important part of foot examination.     

Is physician gender associated with the quality of diabetes care?

OBJECTIVE: This study examines the association between physician gender and diabetes quality of care. RESEARCH DESIGN AND METHODS: We examined the association between the gender of primary care physicians (n = 1,686) and the quality of diabetes care they provided to their patients participating in the Translating Research Into Action for Diabetes (TRIAD) study. Main outcome measures were diabetes processes of care including receipt of dilated retinal exams, urine microalbumin/protein testing, foot exams, lipid and HbA(1c) (A1C) testing, recommendation to take aspirin, and influenza vaccination over 1 year. Intermediate outcomes included blood pressure, A1C, LDL levels, and patient satisfaction. Hierarchical regression models accounted for clustering within provider groups and health plans and adjusted for patient age, gender, race, income, education, diabetes treatment and duration, and health status, along with physician age, years of practice, and specialty. RESULTS: Compared with male physicians (n = 1,213), female physicians (n = 473) were younger, had more recently completed training, and were more often internists. Patients of female physicians (n = 4,585) were more often women and younger than patients of male physicians (n = 1,783). In adjusted analyses, patients of female physicians were slightly more likely to receive lipid measurements (predicted probability 1.09 [95% CI 1.02-1.15]) and A1C measurements (1.02 [1.00-1.05]) and were slightly more likely to have an LDL <130 mg/dl (1.05 [1.00-1.10]). CONCLUSIONS: Patients of female physicians received similar quality of care compared with patients of male physicians.     

Experts’ opinion on manual wheelchair adjustments for adults with diabetes

Diabetes is a global health concern that can lead to mobility limitations necessitating a wheelchair. However, there are currently no guidelines for wheelchair adjustments tailored to the diabetic population.

Purpose: To describe relevant manual wheelchair adjustments for adults with diabetes, and to explore how these adjustments apply to populations living in less-resourced countries.

Methods: Semi-structured interviews were conducted with 13 wheelchair experts from five different countries working with adult with diabetes. Interviews were analyzed using the constant comparison method.

Results: The most frequently mentioned wheelchair adjustments were related to neuropathies, skin integrity, decreased strength and amputations. Air cushions were preferred for managing seat sores. Lightweight wheelchairs could be advantageous for people with decreased strength and endurance. In less-resourced settings, wheelchair adjustment decisions prioritized durability and low maintenance.

Discussion: The recommendation of lightweight wheelchairs for adults with diabetes may be limited by the lack of adjustment possibilities compared to regular weight wheelchairs. In less-resourced settings, prioritizing durability and low maintenance may limit prevention and management of conditions associated to diabetes.

Conclusion: This study represents a first step towards the development of guidelines for manual wheelchair adjustments specifically tailored to adults with diabetes, in a global health context.

• Implications of rehabilitation

• When prescribing manual wheelchairs to persons with diabetes, expert clinicians agree that skin integrity, neuropathies and decreased strength are their primary concerns.

• Compromises are often necessary when adjusting a wheelchair for a person with diabetes, due to the complexity of their symptoms: same modification can be indicated for one symptom but contraindicated for another.

• Diabetes prevalence is high in less-resourced settings. There is a need for increased availability of affordable wheelchair equipment that is durable, reliable and adapted to persons with diabetes.