糖尿病患者行为方式与血糖控制关系

目的 了解糖尿病患者的饮食控制、运动情况和医学应对方式与血糖控制的关系,探索提高糖尿病患者身心健康水平的措施。方法 抽取2015年9月-2016年6月在黑龙江省某三甲医院住院治疗的459例糖尿病患者作为调查对象,采用自编问卷和医学应对方式问卷对糖尿病患者进行问卷调查,并对患者的空腹血糖值等生化指标进行评定。结果 糖尿病患者空腹血糖值平均浓度为（8.77±3.04）mmol/L,不同性别、年龄、居住地、文化程度的糖尿病患者空腹血糖浓度差异无统计学意义;相关分析结果显示,糖尿病患者每次运动的时间量与血糖浓度呈负相关（r=-0.171,P<0.05）,饮食方式、回避应对方式和屈服应对方式与血糖浓度正相关（r=0.144、0.128、0.106,P<0.05）。结论 饮食和运动习惯以及应对方式与糖尿病患者的血糖控制密切相关,医护工作者可以从改变行为方式的角度出发,探索提高糖尿病患者生活质量的方法。     

Point of care testing to improve glycemic control

PURPOSE: The purpose of this paper is to pilot-test the feasibility and impact of protocol-driven point-of-care HbAlc testing on levels of glycemic control and on rates of diabetic regimen intensification in an urban community health center serving low-income patients. DESIGN/METHODOLOGY/APPROACH: The paper suggests a primary care process re-design, using point of care finger-stick HbA1c testing under a standing order protocol that provided test results to the provider at patient visit. FINDINGS: The paper finds that the protocol was well received by both nurses and physicians. HbA1c testing rates increased from 73.6 percent to 86.8 percent (p = 0.40, n = 106). For the 69 patients who had both pre- and post-intervention results, HbAlc levels decreased significantly from 8.55 to 7.84 (p = 0.004, n = 69). At baseline, the health center as a system was relatively ineffective in responding to elevated HbA1c levels. An opportunity to intensify, i.e. a face-to-face visit with lab results available, occurred for only 68.6 percent of elevated HbAlc levels before the intervention, vs. 100 percent post-intervention (p < 0.001). Only 28.6 percent of patients with HbAlc levels >8.0 had their regimens intensified in the pre-intervention phase, compared with 53.8 percent in the post-intervention phase (p = 0.03). RESEARCH LIMITATIONS/IMPLICATIONS: This was a pilot-study in one urban health center. Larger group-randomized controlled trials are needed. PRACTICAL IMPLICATIONS: The health center's performance as a system, improved significantly as a way of intensifying diabetic regimens thereby achieving improved glycemic control. ORIGINALITY/VALUE: This intervention is feasible, replicable and scalable and does not rely on changing physician behaviors to improve primary care diabetic outcomes.     

社区糖尿病患者血糖控制的相关因素分析

目的 探讨影响社区糖尿病患者血糖控制理想的相关因素,为基层医疗机构开展糖尿病健康管理提供基础数据。 方法 随机抽取福州市6个城区各1家基层医疗机构,对抽中机构在2020年所有参与体检和随访并登记建档的2型糖尿病患者8 653例均纳入分析,根据空腹血糖（FPG）水平分成控糖理想组（4 868例）与控糖非理想组（3 785例）,比较两组一般情况、体检指标、生化指标等。运用SPSS 20.0统计学软件进行分析,计量资料的组间比较用t检验,计数资料的比较χ²检验。以FPG水平为因变量,社会人口学特征、生化指标等为自变量进行logistic回归分析。结果 控糖非理想组男性比例、中心性肥胖检出率、收缩压≥130 mm Hg和舒张压≥80 mm Hg检出率、吸烟率、超重检出率、服药率、丙氨酸氨基转移酶（ALT≥40 U/L）检出率、天冬氨酸氨基转移酶（AST≥40 U/L）检出率、总胆红素（Tbil≥17.10 μmol/L）检出率、血尿素氮（BUN≥7.5 mmol/L）检出率、甘油三酯（TG≥1.7 mmol/L）检出率和高密度脂蛋白胆固醇（HDL - C,男≤1.0,女≤1.3）检出率均明显高于控糖理想组（t/χ² = 4.817, 24.340, 115.841, 53.839, 3.984, 17.425, 158.991, 69.284, 28.750, 6.702, 24.506, 9.442, 69.528, 均P＜0.05/P＜0.001）,病程明显长于控糖理想组（t = 5.381, P＜0.001）,而控糖非理想组尿酸（UA,男≥420,女≥360）检出率明显低于控糖理想组（χ²= 15.518, P＜0.001）,差异均有统计学意义。多因素logistic回归模型筛选出11个影响因素有统计学意义,未使用降糖药（OR = 0.468,95%CI: 0.404～0.542）、UA男性≥420 μmol/L或者女性≥360 μmol/L（OR = 0.757,95%CI: 0.688～0.833）与糖尿病患者控糖非理想均呈负相关,中心性肥胖（OR = 1.314,95%CI: 1.159～1.492）、收缩压≥130 mm Hg（OR = 1.415,95%CI: 1.289～1.553）、舒张压≥80 mm Hg（OR = 1.369,95%CI: 1.199～1.528）、病程≥10年（OR = 1.740,95%CI: 1.585～1.909）、ALT≥40 U/L（OR = 1.647,95%CI: 1.397～1.942）、TBil≥17.10 μmol/L（OR = 1.207,95%CI: 1.061～1.373）、BUN≥7.5 mmol/L（OR = 1.441,95%CI: 1.213～1.713）、TG≥1.7 mmol/L（OR = 1.109,95%CI: 1.013～1.214）、HDL - C男性≤1.0 mmol/L或女性≤1.3 mmol/L（OR = 1.473,95%CI: 1.334～1.627）与糖尿病患者控糖非理想均呈正相关。结论 本调查筛选出11个影响血糖达标的因素,应加强对患者这些因素的监测,并精准干预,以降低合并症和并发症的风险。     

老年糖尿病患者运动状况及血糖控制情况研究

目的 研究老年糖尿病患者运动状况及血糖控制情况。方法 以2020年1月至2021年12月商丘市某医院诊治的老年糖尿病患者为研究对象,自制调查问卷获取患者的基本资料（包括性别、年龄、文化程度、居住地、病程、糖尿病并发症和其他基础疾病）,采用老年糖尿病患者运动锻炼评估量表评估运动状况,采用血生化指标检测评估血糖控制达标情况,分析老年糖尿病患者运动状况、血糖控制达标情况及其影响因素。结果 共纳入有效研究对象1 173例,其中男645例（54.99%）,年龄60～84岁,以60～69岁为主（45.69%）,文化程度以初中及以下为主（51.66%）,居住地以农村为主（56.61%）,病程以<5年为主（65.47%）,无糖尿病并发症者占90.88%,无其他基础疾病者占79.71%。血糖控制达标389例,达标率33.16%。运动状况总分（114.39±20.53）分,血糖未达标患者的运动状况总分及运动知识、运动行为、专业支持维度评分均显著低于血糖达标患者（均P<0.01）。多因素Logistic回归分析结果显示,病程（OR=0.689）、糖尿病并发症（OR=0.498）、其他基础疾病（O...     

Cost-effectiveness of the screening and treatment of diabetic retinopathy. What are the costs of underutilization?

Diabetic retinal disease remains a leading cause of visual disability among those of working age. Controlled trials have demonstrated that timely diagnosis and photocoagulation treatment can reduce significantly the likelihood of visual impairment in affected diabetic patients. Using a prospective simulation model, we show that an annual screening and treatment program saves thousands of years of vision and reduces medical expenditures over the lifetime of a cohort of Swedish Type I diabetic patients.     

糖尿病视网膜病变防治重点目标人群的调查研究

目的:为了解糖尿病人群相关危险因素对糖尿病视网膜病变(DR)发病的影响,从而为开展DR的防治工作提供对策和依据。方法:收集588例2型糖尿病患者的眼底检查情况及其它临床资料。根据眼底检查结果将患者分为糖尿病无视网膜病变(NDR)组398例及糖尿病视网膜病变(DR)组190例,并检测相关生化指标。结果:两组间比较,DR组病程较长,且收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后2 h血糖(P2BG)、糖化血红蛋白(HbAlc)均高于NDR组(P<0.05)。结论:应加强DR防治知识的普及,尤其是病程较长,SBP、DBP、FPG、P2BG和HbA1c较高的糖尿病患者应作为重点目标人群。     

糖尿病患者自我管理能力及与血糖控制状况的相关性

目的 了解社区糖尿病患者的糖尿病自我管理能力水平及与血糖控制状况的相关性.方法 选取南京市江北新区6家社区卫生服务中心纳入自我管理项目的2型糖尿病患者1 104例作为研究对象,分析不同特征人群的自我管理能力水平,采用多因素非条件logistic回归模型,分析自我管理水平与血糖控制状况相关性.结果 1 104例糖尿病患者...     

Determinants of glycemic control in female diabetic patients: a study from Iran

Background  

Since microvascular and macrovascular complications are reduced through strict glycemic control, this study carried out to identify the factors that affect glycemic control.     

Gravidity and diabetic retinopathy

The relationship between gravidity and severity of diabetic retinopathy was investigated in a population-based sample of diabetic patients. All of these women had had diabetes diagnosed before 30 years of age and were taking insulin. All received their primary medical care in an 11-county region of southwestern Wisconsin (Health Service Area 1). Each participant had an ophthalmologic examination which included stereoscopic fundus photography of seven standard fields in each eye. Photos were graded according to a standard protocol. Of the 397 women, 197 had never been pregnant, 88 had been pregnant once, 56 had been pregnant twice, and 56 had been pregnant three or more times after diabetes was diagnosed. The number of pregnancies was positively associated with the severity of retinopathy. However, after controlling for duration of diabetes, this relationship was no longer apparent. Using an ordinal regression model, duration of diabetes, diastolic blood pressure and glycosylated hemoglobin were significant predictors of the severity of diabetic retinopathy.     

Ramadan fasting ameliorates oxidative stress and improves glycemic control and lipid profile in diabetic patients

Purpose

The effects of Ramadan fasting on public health are important. The present study characterized the metabolic effects of Ramadan fasting and evaluated its influence on oxidative stress in diabetic patients.

Methods

The current study was carried out in the city of Benha, Egypt, during the period from July 12, 2012 to October 4, 2012. This corresponds to 22 Shaban 1433 to 18 Dhul Al-Qi’dah 1433 in the Islamic Calendar. Two equal, sex- and age-matched groups (n = 40 each; age 55 ± 5 years) of non-diabetic subjects (ND group) and diabetic patients (D group) were recruited for this study. Parameters of glycemic control, lipid profile, and oxidative stress were measured pre-, during and post-fasting.

Results

Ramadan fasting reduced fasting blood glucose (FBG) insignificantly by 5.8 % and significantly by 23.0 % in the (ND) and (D) groups, respectively. Serum triglycerides (TG) and malondialdehyde (MDA) were lowered significantly by: TG (22.8, 22.1 %), MDA (54.3, 46.6 %), and total cholesterol (TC) and low-density lipoproteins (LDL) insignificantly by: TC: (4.7, 6.1 %), LDL: (4.0, 5.1 %), whereas high-density lipoproteins (HDL) were raised significantly by 6.7 % and insignificantly by 2.2 %, and blood glutathione (GSH) significantly by 52.6 and 59.4 %, in the (ND) and (D) groups, respectively. At 6 weeks post-fasting FBG, TG, TC, HDL, and LDL returned to levels indistinguishable from their baseline values in both groups, while MDA was maintained significantly lower by (25.7, 22.7 %), and GSH significantly higher by (26.3, 31.3 %), in the (ND) and (D) groups, respectively.

Conclusions

Ramadan fasting improves glycemic control and lipids profile and alleviates oxidative stress in diabetics.     

Cost-effectiveness of primary care

This article is intended only as an introduction to the use of cost-effectiveness analysis in primary care. The goals are to provide a clear understanding of the difference between the cost of a treatment and its cost-effectiveness; consider what is generally a socially acceptable range for cost-effectiveness; provide some basic criteria for critically evaluating cost-effectiveness analyses in the medical literature; give some examples of the cost-effectiveness of various treatments in primary care; and provide for comparison some examples of cost-effectiveness in the world of specialty care. For those interested in more detail, excellent books and reviews are available, including the report of a US. Public Health Service-appointed expert panel.     

Epidemiology of diabetic retinopathy

Diabetic retinopathy is associated with a number of systemic risk factors, namely hyperglycaemia, elevated blood pressure and dyslipidaemia. Patients with diabetes should be vigorously treated for these modifiable risk factors to prevent the development and progression of diabetic retinopathy.     

Plasma carotenoids and diabetic retinopathy

Diabetic retinopathy increases with duration of diabetes and may be associated with carotenoid status. Carotenoids alter the pro-oxidation/antioxidation balance, and circulating levels depend largely on dietary intake. Lower levels have been reported in diabetes and age-related macular degeneration; however, little is known of the relationship between carotenoids and diabetic complications. Consequently, the purpose of the present study was to evaluate the relationship between plasma carotenoids and diabetic retinopathy. We assessed the carotenoid-retinopathy relationship in 111 individuals with type 2 diabetes in a community-based, cross-sectional study. We photodocumented retinal status and used HPLC to measure plasma carotenoid concentrations. Data for clinical and demographic variables and risk factors for diabetic retinopathy were obtained from 24 h urine and fasting blood samples, and an interviewer-assisted lifestyle questionnaire. We found that the combined lycopene and lutein/zeaxanthin (non-pro-vitamin A (non-PVA) carotenoid) concentration when compared with the pro-vitamin A (PVA) carotenoids (alpha-carotene, beta-carotene and beta-cryptoxanthin) was significantly lower in the retinopathy than non-retinopathy group (OR 1.2 (95% CI 1.0, 1.4) v. 1.6 (95% CI 1.4, 1.7), respectively; P=0.009). A higher non-PVA:PVA ratio also predicted a lower risk of diabetic retinopathy, after adjustment for potential confounders (OR 0.33 (95% CI 0.12, 0.95); P=0.039). Finally, a higher concentration of PVA carotenoids was associated with greater odds of diabetic retinopathy, after adjustment for risk factors (P=0.049). We suggest synergies between carotenoids are implicated in diabetic retinopathy, independent of established risk factors. Importantly, our observations indicate dietary modulation of retinopathy risk may be possible by increasing intakes of lutein- and lycopene-rich foods.     

Multi-state models and diabetic retinopathy

This paper discusses the application of a multi-state model to diabetic retinopathy under the assumption that a continuous time Markov process determines the transition times between disease stages. The multi-state model consists of three transient states that represent the early stages of retinopathy, and one final absorbing state that represent the irreversible stage of retinopathy. By using a model with covariables, we explore the effects of factors that influence the onset, progression, and regression of diabetic retinopathy among subjects with insulin-dependent diabetes mellitus. We can also introduce time-dependent covariables in the model by assuming that the covariables remain constant between two observations. We can also obtain survival-type curves from each stage of the disease and for any combination of patient risk factors.     

Accuracy of primary care clinicians in screening for diabetic retinopathy using single-image retinal photography

PURPOSE Diabetic patients with limited access to ophthalmologists have low screening rates for diabetic retinopathy. We evaluated a diabetic retinopathy screening program in a community health center using single images taken with a nonmydriatic retinal camera and primary care clinicians trained to read retinal images.