Specialist and Generalist Care for Type 1 Diabetes Mellitus

The incidence of diabetes mellitus (both type 1 and type 2) is growing to epidemic proportions, with an expected combined worldwide prevalence of 220 million by the year 2010. A subsequent increase in the incidence of diabetes complications is likely to follow if present trends continue, placing an increased burden on already troubled healthcare systems. While there are many identified biologic mechanisms for the development of diabetes complications, there has been little exploration of healthcare provider issues and their contribution to these outcomes. One area of research with few data is the influence of diabetes specialty care on outcomes in type 1 diabetic patients. Evidence demonstrates that both process delivery and outcomes are better in individuals with typel diabetes who are cared for by diabetes specialists compared with generalists. For example, those receiving care from diabetes specialists were more likely to receive diabetes education, to be treated with intensive insulin therapy (>2 injections/day), and to receive an eye examination compared with those receiving generalist care. Additionally, lower rates of proliferative retinopathy were observed in those receiving specialist care. Recent evidence also demonstrates that there are lower incidences of neuropathy, overt nephropathy, and coronary artery disease in those patients who spend a higher proportion of the duration of their diabetes in specialist care. Based on these observations, it is recommended that attempts be made to replicate the favorable characteristics of specialty care in the primary care setting. Healthcare systems should ensure the availability of access to diabetes specialists, as well as ancillary healthcare professionals including diabetes educators, with increased emphasis placed on coordinated care.     

肺癌合并糖尿病的围手术期护理

目的总结肺癌合并糖尿病患者的围手术期护理方法。方法重视肺癌合并糖尿病患者的术前血糖控制,心理疏导及营养教育,术后加强生命体征观察及血糖监测,加强管道护理及提高术后患者合并症,并发症的护理水平。结果 47例患者应用综合性护理措施降低了手术风险,减少并发症的发生,无1例患者围手术期死亡。结论加强肺癌合并糖尿病患者的围手术期护理可促使患者顺利康复,提高其生活质量。     

Assessing Diabetes Care Disparities with Ambulatory Care Quality Measures

ObjectiveTo identify and describe racial/ethnic disparities in overall diabetes management.ConclusionsAlthough this health system has above-average diabetes care quality, significant disparities by race/ethnicity were identified. This underscores the importance of stratifying quality measures to improve care and outcomes for all.     

Thiazolidinediones for Diabetes Mellitus

Thiazolidinediones (TZDs), including pioglitazone and rosiglitazone, have been prescribed for a number of years as monotherapy or combination therapy for glycemic control of type 2 diabetes mellitus. It has been hypothesized that the clinical advantages offered by TZDs compared with other commonly used oral hypoglycemic agents (OHAs) [i.e. improved glycemic control, improved lipid profiles, and low rates of hypoglycemic events] should lead to improvements in long-term outcomes, such as decreased incidence of micro- and macrovascular disease, leading in turn to improvements in life expectancy and quality-adjusted life expectancy. While the acquisition costs of TZDs are generally higher than other alternatives, such as metformin or sulfonylureas, it has been postulated that the higher initial acquisition costs of the medications should be offset by decreased costs of treating complications. As such, TZDs could represent an efficient form of treatment for type 2 diabetes.In order to provide an overview of studies performed to date, we have reviewed the available literature on the cost effectiveness of TZDs as a treatment in type 2 diabetes. An extensive literature search of major databases of indexed studies and proceedings of diabetes and health economics-related international conferences was performed to identify studies reporting health-economic outcomes for pioglitazone or rosiglitazone. Very few health-economics studies of TZDs have been published in peer-reviewed journals to date. A total of 16 studies (3 peer-reviewed international journal publications, 13 abstracts) were identified. These studies used various economic-simulation models to estimate the cost effectiveness of rosiglitazone or pioglitazone compared with other commonly prescribed OHAs, such as metformin, sulfonylureas, or acarbose, used either as monotherapy or in combination therapy for the treatment of type 2 diabetes. The studies demonstrated that the short-term clinical advantages of using TZDs translated into decreased incidence and progression of micro- and macrovascular complications, leading to improvements in life expectancy and quality-adjusted life expectancy. The short-term increase in costs due to the higher acquisition prices of the TZDs were partially offset by the long-term avoidance of complication costs. In Japan, pioglitazone was shown to lead to overall cost savings compared with other commonly used OHAs. While bearing in mind the issues of publication bias and other limitations outlined, the cost-effectiveness analyses identified and discussed in this paper lend support to the hypothesis that TZDs can be cost-effective therapies when compared with other commonly prescribed OHAs. Future clinical and health-economics studies must make direct head-to-head comparisons between pioglitazone and rosiglitazone to identify which TZD offers the best value for money. Furthermore, the more recently discovered renoprotective properties of TZDs must be factored into future analyses and are likely to have an important impact on their long-term cost effectiveness.     

延续护理在肺结核合并糖尿病患者中的应用

目的探讨延续护理在肺结核合并糖尿病患者中的临床效果。方法选择2012年5月至2013年5月在我院住院治疗的60例肺结核合并糖尿病患者,随机分为对照组和实验组各30例,其中对照组患者仅给予常规护理,实验组患者在常规护理的基础上给予延续护理。对两组患者的临床疗效、舒适度及满意度进行比较。结果实验组患者肺结核治愈情况及血糖控制情况较对照组患者均明显提高,两组间差异具有统计学意义(P<0.05);实验组患者满意度及舒适度较对照组患者均明显提高,两组间差异具有统计学意义(P<0.05)。结论针对肺结核合并糖尿病患者运用延续护理,可以取得良好的护理效果,在提高治疗效果同时提高患者的舒适度、满意度,临床值得推广。     

Diabetes Mellitus

Because of the extensive burden that diabetes mellitus imposes on individuals and healthcare systems, this disease state is frequently on the priority lists of managed-care organisations for improving quality of care while controlling costs. This article explains diabetes disease management concepts and interventions aimed at improving clinical outcomes illustrated with details of the Lovelace Health Systems Diabetes Episodes of Care® programme.The effectiveness of diabetes disease management programmes can best be evaluated by the clinical outcome of haemoglobin A_1c measures. Process measurements include diabetes education access, annual eye examinations and documentation of annual clinical evaluations of feet. Short term cost reductions are frequently unrealistic expectations of diabetes disease management programmes because of the complex, chronic nature of the disease. Coordination of previously fragmented services, eventual reduction of long term complications and meeting regulatory standards are potential achievements of these programmes.     

妊娠期糖尿病95例护理体会

目的探讨妊娠期糖尿病护理方法。方法回顾我院2009年1月-2012年12月期间收治的95例妊娠期糖尿病患者的临床资料,对其诊断及护理措施进行分析及观察,同时进行归纳总结。结果95例妊娠期糖尿病患者经积极的治疗与精心的护理,产前与产后血糖基本控制在正常范围,并健康出院。结论妊娠期糖尿病需要早发现、早诊断、早处理,孕期及产后加强监护,提供优质的护理服务,是减少母、婴并发症的重要环节,值得推广和应用。     

糖尿病合并股骨颈骨折患者的围手术期护理

目的分析糖尿病合并股骨颈骨折患者围手术期护理方法。方法回顾性分析80倒糖尿病合并股骨颈骨折患者11手术期护理措施。结果本组80倒病倒,均无死亡病例,无因糖尿病导致手术失败病例,无因护理不当导致并发症发生病例。结论加强糖尿病患者固手术期护理,能提高患者对治疗的顺应性和依从性,促进疾病康复。     

糖尿病合并股骨颈骨折患者的围手术期护理

目的分析糖尿病合并股骨颈骨折患者围手术期护理方法。方法回顾性分析80例糖尿病合并股骨颈骨折患者围手术期护理措施。结果本组80例病例,均无死亡病例,无因糖尿病导致手术失败病例,无因护理不当导致并发症发生病例。结论加强糖尿病患者围手术期护理,能提高患者对治疗的顺应性和依从性,促进疾病康复。     

Joslin's Diabetes Mellitus

Because of its traditional responsibility to care for dependents as well as troops, the military medical corps provides health services for nearly 10 million men, women, and children, making for a physician-patient ratio of only about 117 per 100,000. The attractions of a military career are cited; they include scholarships for medical students, internships and residencies, and substantial salary and pension benefits.     

Psychosocial Correlates of Health Care Utilization for Children and Adolescents With Type 1 Diabetes Mellitus

Our objective was to examine the relation of self-reported depressive symptomatology to health care utilization (HCU) in families with a child with Type 1 diabetes mellitus (DM1). Data were obtained from a community sample (N = 88) being followed in 2 private outpatient diabetes clinics. Children and adolescents completed measures of depressive symptomatology. Mothers provided demographic information and completed measures of HCU and depressive symptomatology. Physicians provided measures of glycosylated hemoglobin (HbA1c) and illness severity. Hierarchical regression analyses indicated that higher levels of child depressive symptomatology were associated with increased HCU for children with DM1 above and beyond demographic and illness variables. However, no significant relationship was found between either adolescent or maternal depressive symptomatology and HCU. These findings suggest self-reported depressive symptomatology in children with DM1 is a salient correlate of HCU even after statistically controlling for the influence of demographics and illness parameters. The possibility that children with DM1 with symptoms of depression may have higher utilization of health services supports the need to target psychosocial variables for intervention.     

Interrupting the Pathway from Gestational Diabetes Mellitus to Type 2 Diabetes: The Role of Primary Care

ObjectiveOur objective was to describe patient-, provider-, and health systems-level factors associated with likelihood of obtaining guideline-recommended follow-up to prevent or mitigate early-onset type 2 diabetes after a birth complicated by gestational diabetes mellitus (GDM).MethodsThis study presents a retrospective cohort analysis of de-identified demographic and health care system characteristics, and clinical claims data for 12,622 women with GDM who were continuously enrolled in a large, national U.S. health plan from January 31, 2006, to September 30, 2012. Data were obtained from the OptumLabs Data Warehouse. We extracted 1) known predictors of follow-up (age, race, education, comorbidities, GDM severity); 2) novel factors that had potential as predictors (prepregnancy use of preventive measures and primary care, delivery hospital size); and 3) outcome variables (glucose testing within 1 and 3 years and primary care visit within 3 years after delivery).ResultsAsian ethnicity, higher education, GDM severity, and delivery in a larger hospital predicted greater likelihood of post-GDM follow-up. Women with a prepregnancy primary care visit of any type were two to three times more likely to receive postpartum glucose testing and primary care at 1 year, and 3.5 times more likely to have obtained testing and primary care at 3 years after delivery.ConclusionsA history of use of primary care services before a pregnancy complicated by GDM seems to enhance the likelihood of postdelivery surveillance and preventive care, and thus reduce the risk of undetected early-onset type 2 diabetes. An emphasis on promoting early primary care connections for women in their early reproductive years, in addition to its overall value, is a promising strategy for ensuring follow-up testing and care for women after complicated pregnancies that forewarn risk for later chronic illness. Health systems should focus on models of care that connect primary and reproductive/maternity care before, during, and long after pregnancies occur.     

2型糖尿病危险因素的统计学分析及护理对策

目的探讨2型糖尿病的危险因素,并提出相应的护理对策。方法随机抽取2型糖尿病患者65例,以1∶1配比原则选取非糖尿病对照组共60例,采用多元逐步Logistic回归方法筛选关系较为密切的危险因素进行定量分析。结果文化程度、体重指数、家族史、吸烟、食量、三酰甘油、高密度脂蛋白均与2型糖尿病相关(P<0.05)。其中,文化程度和高密度脂蛋白是2型糖尿病的保护因素,其他5个因素都是危险因素,且吸烟、食量和三酰甘油是非常危险的因素。结论对糖尿病患者进行有针对性的健康教育,应重点从控制食量、加强锻炼、戒烟和控制体重等方面进行治疗和护理。