Long term effect of a structured inpatient diabetes teaching and treatment programme in type 2 diabetic patients: influence of mode of follow-up

Inpatient multidisciplinary care can prevent deterioration of renal function in patients with chronic kidney disease: a nationwide cohort study

Background

Multidisciplinary care is necessary to prevent worsening renal function and all-cause mortality in patients with chronic kidney disease (CKD) but has mostly been investigated in the outpatient setting. In this study, we evaluated the outcome of multidisciplinary care for CKD according to whether it was provided in an outpatient or inpatient setting.

Methods

This nationwide, multicenter, retrospective, observational study included 2954 Japanese patients with CKD stage 3-5 who received multidisciplinary care in 2015-2019. Patients were divided into two groups: an inpatient group and an outpatient group, according to the delivery of multidisciplinary care. The primary composite endpoint was the initiation of renal replacement therapy (RRT) and all-cause mortality, and the secondary endpoints were the annual decline in the estimated glomerular filtration rate (ΔeGFR) and the changes in proteinuria between the two groups.

Results

Multidisciplinary care was provided on an inpatient basis in 59.7% and on an outpatient basis in 40.3%. The mean number of health care professionals involved in multidisciplinary care was 4.5 in the inpatient group and 2.6 in the outpatient group (P < 0.0001). After adjustment for confounders, the hazard ratio of the primary composite endpoint was significantly lower in the inpatient group than in the outpatient group (0.71, 95% confidence interval 0.60-0.85, P = 0.0001). In both groups, the mean annual ΔeGFR was significantly improved, and proteinuria significantly decreased 24 months after the initiation of multidisciplinary care.

Conclusion

Multidisciplinary care may significantly slow deterioration of eGFR and reduce proteinuria in patients with CKD and be more effective in terms of reducing initiation of RRT and all-cause mortality when provided on an inpatient basis.

A 7 day inpatient diabetes education program improves quality of life and glycemic control 12 months after discharge

AIMS

For long-term management of diabetes, patients with type 2 diabetes mellitus require a high level of treatment adherence, which is associated with treatment satisfaction and their quality of life (QOL). To achieve it, patient education about diabetes self-management is essential. We routinely conduct a 7 day inpatient diabetes education program and administer the diabetes treatment-related (DTR)-QOL questionnaire to all participants, both before admission and at discharge. Here, we investigated whether our program improves QOL and post-discharge glycemic control.

MATERIALS AND METHODS

This retrospective study utilized data from patients with type 2 diabetes mellitus who participated in our program between July 2017 and March 2020 and who had been treated in our outpatient department for more than 1 year. We evaluated the relationship between at admission and at discharge diabetes treatment-related quality of life scores and glycemic control after discharge.

RESULTS

Data from 140 patients were analyzed in this study, which showed a significant improvement in the total, 'Anxiety and dissatisfaction with treatment', and 'Satisfaction-with-treatment' scores. A significant improvement was evident in HbA1c at 12 months after discharge. Multiple regression analysis showed that HbA1c after 12 months was independently associated with gender, duration of diabetes, and HbA1c at admission.

CONCLUSIONS

Our program effectively improves quality of life and post-discharge glycemic control in patients with type 2 diabetes mellitus. It is particularly effective in patients of the male gender, with a shorter duration of diabetes mellitus and higher HbA1c at admission.

Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery

Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.

An inpatient educational program for chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is a significant health problem in Japan, and prevention programs to slow disease progression are necessary. In this study, we evaluated the effectiveness of a 1-week inpatient education program, delivered during the predialysis stage of CKD, in slowing the deterioration in renal function over the subsequent 2 years, and identified factors influencing the program's effectiveness.

METHODS

We retrospectively evaluated the estimated glomerular filtration rate (eGFR) of 105 consecutive patients who completed the program, at the following time points: 6 months prior to program initiation, at program initiation and, at 6, 12, 18, and 24 months after the program. To identify factors predictive of program effectiveness, we classified patients into a Responder and Non-responder group.

RESULTS

In comparison with the rate of deterioration in renal function (mL/min/1.73 m²/year) before admission, the rate slowed at 6, 12, 18 and 24 months after discharge (all p < 0.01). A urinary protein (UP) level <0.5 g/gCr and CKD stages 4-5 were predictive of a slowing of CKD progression after the education program.

CONCLUSIONS

Although the effectiveness of our program declined over time, it did produce an overall slowing in the rate of renal function deterioration over the 2-year period of observation after discharge. This slowing of CKD progression was more pronounced in patients with low UP levels, indicating that education programs should be considered while these levels are still low. Furthermore, the program still offers benefits to patients with CKD stages 4-5.

WITHDRAWN: Group based diabetes self-management education compared to routine treatment, waiting list control or no intervention for people with type 2 diabetes mellitus

The review authors of this review update are unable to continue with their work. The Cochrane Metabolic and Endocrine Disorders Review Group is seeking very experienced new authors to perform an update on this complex intervention review.

At June 2015, this review has been withdrawn. This review is out of date although it is correct as the date of publication. The latest version is available in the 'Other versions' tab on the Cochrane Library, and may still be useful to readers.

The editorial group responsible for this previously published document have withdrawn it from publication.

The level and determinants of diabetes knowledge in Kuwaiti adults with type 2 diabetes

AIM

To investigate the level of diabetes knowledge in a population with type 2 diabetes (T2D) and a high prevalence of illiteracy, to identify the main gaps in the knowledge and to study the determinants of the knowledge score.

METHODS

This cross-sectional survey involved 24 diabetes clinics and Kuwaiti adults with T2D (n=5114), and used the Michigan Diabetes Knowledge Test.

RESULTS

The participants' mean age (+/-S.D.) was 55.6+/-10.4 years; 68.2% were women, 45.0% were illiterate, 52.2% reported a family income equivalent to 1200 to 2400 euros per month and only 28.6% performed glucose monitoring. Mean+/-S.D. HbA(1c) was 8.76+/-2.3%. Their mean score for the total knowledge test was 58.9%. Knowledge deficits were apparent in the questions related to diet and self-care. Participants who were older, and with lower educational levels, limited family income, negative family history of diabetes or were smokers had significantly lower knowledge scores. The scores were also lower in those who had shorter disease duration and fewer complications, were taking insulin, had less frequent insulin injections, performed less glucose monitoring and had lower HbA(1c) levels. Education, family income, glucose monitoring and presence of complications were independent determinants of the knowledge score.

CONCLUSION

Knowledge of diabetes in a T2D population with a high prevalence of illiteracy was poor. Limited family income and lack of self-care are other predictors of knowledge deficits. Efforts need to be focused on educational programmes with strategies to assist T2D patients of limited education and income to manage their disease more effectively.

The effects of home monitoring by public health nurse on individuals' diabetes control

Diabetes is an important health problem that changes the lifestyle of individuals. The ability of individuals to control their disease is directly related to their adaptation to the disease and self-care. The purpose of this study was to determine the effect of home monitoring of individuals with diabetes for the purpose of developing their self-care and their adaptation to diabetes. The research used a quasi-experimental (time series) design study. A convenient sample of 34 patients receiving outpatient diabetes care at Hacettepe University Adult Hospital Endocrinology Clinic participated in the study on a voluntary basis. After being seen for the first time in the clinic, they were followed up for a 6-month period in their homes. At the end of the home monitoring period, these patients with diabetes had a statistically significant decrease in HbA(1c) (glycated hemoglobin; p = .000), fasting blood glucose (p = .001), postmeal blood glucose (p = .000), and systolic blood pressure (p = .007) measurements. Diabetes is a quite frequently seen chronic and progressive disease. Nursing monitoring is important to develop an individual's skills in self-care and to support compliance to diabetes. This study supports the finding that the home monitoring of individuals with diabetes by community health nurse improves diabetic control. It is recommended that individuals with diabetes be monitored not only in the hospital but also in their homes for a comprehensive evaluation.

Group based training for self-management strategies in people with type 2 diabetes mellitus

BACKGROUND

It has been recognised that adoption of self-management skills by the person with diabetes is necessary in order to manage their diabetes. However, the most effective method for delivering education and teaching self-management skills is unclear.

OBJECTIVES

To assess the effects of group-based, patient-centred training on clinical, lifestyle and psychosocial outcomes in people with type 2 diabetes.

SEARCH STRATEGY

Studies were obtained from computerised searches of multiple electronic bibliographic databases, supplemented by hand searches of reference lists of articles, conference proceedings and consultation with experts in the field. Date of last search was February 2003.

SELECTION CRITERIA

Randomised controlled and controlled clinical trials which evaluated group-based education programmes for adults with type 2 diabetes compared with routine treatment, waiting list control or no intervention. Studies were only included if the length of follow-up was six months or more and the intervention was at least one session with the minimum of six participants.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed study quality. A meta-analysis was performed if there were enough homogeneous studies reporting an outcome at either four to six months, 12-14 months, or two years, otherwise the studies were summarised in a descriptive manner.

MAIN RESULTS

Fourteen publications describing 11 studies were included involving 1532 participants. The results of the meta-analyses in favour of group-based diabetes education programmes were reduced glycated haemoglobin at four to six months (1.4%; 95% confidence interval (CI) 0.8 to 1.9; P < 0.00001), at 12-14 months (0.8%; 95% CI 0.7 to 1.0; P < 0.00001) and two years (1.0%; 95% CI 0.5 to 1.4; P < 0.00001); reduced fasting blood glucose levels at 12 months (1.2 mmol/L; 95% CI 0.7 to 1.6; P < 0.00001); reduced body weight at 12-14 months (1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02); improved diabetes knowledge at 12-14 months (SMD 1.0; 95% CI 0.7 to 1.2; P < 0.00001) and reduced systolic blood pressure at four to six months (5 mmHg: 95% CI 1 to 10; P = 0.01). There was also a reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; P < 0.00001; RD = 0.2; NNT = 5). Therefore, for every five patients attending a group-based education programme we could expect one patient to reduce diabetes medication.

AUTHORS' CONCLUSIONS

Group-based training for self-management strategies in people with type 2 diabetes is effective by improving fasting blood glucose levels, glycated haemoglobin and diabetes knowledge and reducing systolic blood pressure levels, body weight and the requirement for diabetes medication.

Fear and other disturbances of severe hypoglycaemia in children and adolescents with type 1 diabetes mellitus

OBJECTIVE

To study perceived occurrence and magnitude of fear and other disturbances of severe hypoglycaemia in children and adolescents with type 1 diabetes mellitus (DM) receiving intensive treatment with active education and psychosocial support.

PATIENTS AND METHODS

Out of a geographic population of 112 patients <19 years of age and their families, with a DM duration >1 year, HbA1c mean+/-SD 6.7+/-0.9 (method 1.15% below DCCT level), 74 responded to a questionnaire. Visual analogue scales, 5-graded Likert scales and open questions were used.

RESULTS

Global quality of life was high, but lower among patients with severe hypoglycaemia within the last year (p = 0.0114). Worse perceived health was correlated to higher HbA1c year mean (r = 0.32, p = 0.0227). Patients and parents regard severe hypoglycaemia more as a problem (p <0.0001) and the risk of it more disturbing than mild hypoglycaemia (p <0.0001), insulin injections (p <0.0001) or blood glucose determinations (p <0.0001). The disturbance is higher during exercise, disco/party and in travel situations. Severe hypoglycaemia with unconsciousness causes more fear than severe hypoglycaemia needing assistance but without unconsciousness (p = 0.0001) or the potential late complications of DM (p = 0.0014). Severe hypoglycaemia needing assistance but without unconsciousness causes more fear than mild hypoglycaemia (p = 0.0001) and diabetic ketoacidosis (p <0.0001) but less than the potential late complications of DM (p = 0.0034).

CONCLUSIONS

Severe hypoglycaemia frequently causes fear and various disturbances in spite of active education and psychosocial support. There is a potential for increased quality of life from interventions targeted at the prevention of severe hypoglycaemia. Further research and improved strategies for the prevention of severe hypoglycaemia are needed.