Association of Cycling With All-Cause and Cardiovascular Disease Mortality Among Persons With Diabetes: The European Prospective Investigation Into Cancer and Nutrition (EPIC) Study

Importance

Premature death from all causes and cardiovascular disease (CVD) causes is higher among persons with diabetes.

Objective

To investigate the association between time spent cycling and all-cause and CVD mortality among persons with diabetes, as well as to evaluate the association between change in time spent cycling and risk of all-cause and CVD mortality.

Design, Setting, and Participants

This prospective cohort study included 7459 adults with diabetes from the European Prospective Investigation into Cancer and Nutrition study. Questionnaires regarding medical history, sociodemographic, and lifestyle information were administered in 10 Western European countries from 1992 through 2000 (baseline examination) and at a second examination 5 years after baseline. A total of 5423 participants with diabetes completed both examinations. The final updated primary analysis was conducted on November 13, 2020.

Exposures

The primary exposure was self-reported time spent cycling per week at the baseline examination. The secondary exposure was change in cycling status from baseline to the second examination.

Main Outcomes and Measures

The primary and secondary outcomes were all-cause and CVD mortality, respectively, adjusted for other physical activity modalities, diabetes duration, and sociodemographic and lifestyle factors.

Results

Of the 7459 adults with diabetes included in the analysis, the mean (SD) age was 55.9 (7.7) years, and 3924 (52.6%) were female. During 110 944 person-years of follow-up, 1673 deaths from all causes were registered. Compared with the reference group of people who reported no cycling at baseline (0 min/wk), the multivariable-adjusted hazard ratios for all-cause mortality were 0.78 (95% CI, 0.61-0.99), 0.76 (95% CI, 0.65-0.88), 0.68 (95% CI, 0.57-0.82), and 0.76 (95% CI, 0.63-0.91) for cycling 1 to 59, 60 to 149, 150 to 299, and 300 or more min/wk, respectively. In an analysis of change in time spent cycling with 57 802 person-years of follow-up, a total of 975 deaths from all causes were recorded. Compared with people who reported no cycling at both examinations, the multivariable-adjusted hazard ratios for all-cause mortality were 0.90 (95% CI, 0.71-1.14) in those who cycled and then stopped, 0.65 (95% CI, 0.46-0.92) in initial noncyclists who started cycling, and 0.65 (95% CI, 0.53-0.80) for people who reported cycling at both examinations. Similar results were observed for CVD mortality.

Conclusion and Relevance

In this cohort study, cycling was associated with lower all-cause and CVD mortality risk among people with diabetes independent of practicing other types of physical activity. Participants who took up cycling between the baseline and second examination had a considerably lower risk of both all-cause and CVD mortality compared with consistent noncyclists.

Sarcopenia Is Associated With Reduced Function on Admission to Rehabilitation in Patients With Diabetes

OBJECTIVE

This work aims to estimate the prevalence of sarcopenia and to investigate the association between sarcopenia and functional performance in patients with and without diabetes admitted for inpatient rehabilitation.

MATERIALS AND METHODS

Consecutive patients admitted to the subacute inpatient rehabilitation unit at St Vincent's Hospital Melbourne, Australia (November 2016 to March 2020) were prospectively recruited into this cross-sectional study. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People 2018 algorithm. Participants' functional performance was measured by the total Functional Independence Measure, motor Functional Independence Measure, and the Short Physical Performance Battery. The association between sarcopenia and functional performance was investigated using quantile regression.

RESULTS

Of 300 participants, 49 (16%) had a history of diabetes and 44 (14.7%) were diagnosed with sarcopenia. No significant difference in the prevalence of sarcopenia between patients with or without diabetes was identified (11/49, 22.5% vs 33/251, 13.2%, P = .12). In patients with diabetes, those with sarcopenia had significantly reduced functional performance compared to those without sarcopenia on Functional Independence Measure, motor Functional Independence Measure, and the Short Physical Performance Battery, whereas in patients without diabetes no significant difference between patients with and without sarcopenia were identified for either functional performance measure (all P values for interaction < .005).

CONCLUSIONS

The diagnosis of sarcopenia was associated with a reduced functional performance on admission to inpatient rehabilitation in patients with diabetes, but not in those without diabetes. Further investigation is needed into the progress of patients with dual diagnoses of diabetes and sarcopenia in inpatient rehabilitation.

Global Mapping of Interventions to Improve Quality of Life of People with Diabetes in 1990-2018

Improving the quality of life (QOL) of people living with diabetes is the ultimate goal of diabetes care. This study provides a quantitative overview of global research on interventions aiming to improve QOL among people with diabetes. A total of 700 English peer-reviewed papers published during 1990-2018 were collected and extracted from the Web of Science databases. Latent Dirichlet Allocation (LDA) analysis was undertaken to categorize papers by topic or theme. Results showed an increase in interventions to improve the QOL of patients with diabetes across the time period, with major contributions from high-income countries. Community- and family-based interventions, including those focused on lifestyle and utilizing digital technologies, were common approaches. Interventions that addressed comorbidities in people with diabetes also increased. Our findings emphasize the necessity of translating the evidence from clinical interventions to community interventions. In addition, they underline the importance of developing collaborative research between developed and developing countries.

The mixed model for repeated measures for cluster randomized trials: a simulation study investigating bias and type I error with missing continuous data

BACKGROUND

Cluster randomized trials (CRTs) are a design used to test interventions where individual randomization is not appropriate. The mixed model for repeated measures (MMRM) is a popular choice for individually randomized trials with longitudinal continuous outcomes. This model's appeal is due to avoidance of model misspecification and its unbiasedness for data missing completely at random or at random.

METHODS

We extended the MMRM to cluster randomized trials by adding a random intercept for the cluster and undertook a simulation experiment to investigate statistical properties when data are missing at random. We simulated cluster randomized trial data where the outcome was continuous and measured at baseline and three post-intervention time points. We varied the number of clusters, the cluster size, the intra-cluster correlation, missingness and the data-generation models. We demonstrate the MMRM-CRT with an example of a cluster randomized trial on cardiovascular disease prevention among diabetics.

RESULTS

When simulating a treatment effect at the final time point we found that estimates were unbiased when data were complete and when data were missing at random. Variance components were also largely unbiased. When simulating under the null, we found that type I error was largely nominal, although for a few specific cases it was as high as 0.081.

CONCLUSIONS

Although there have been assertions that this model is inappropriate when there are more than two repeated measures on subjects, we found evidence to the contrary. We conclude that the MMRM for CRTs is a good analytic choice for cluster randomized trials with a continuous outcome measured longitudinally.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02804698.

Monitoring and Intervention Technologies to Manage Diabetic Older Persons: The CAPACITY Case-A Pilot Study

Diabetes Mellitus is a chronic disease with a high prevalence among older people, and it is related to an increased risk of functional and cognitive decline, in addition to classic micro and macrovascular disease and a moderate increase in the risk of death. Technology aimed to improve elder care and quality of life needs to focus in the early detection of decline, monitoring the functional evolution of the individuals and providing ways to foster physical activity, to recommend adequate nutritional habits and to control polypharmacy. But apart from all these core features, some other elements or modules covering disease-specific needs should be added to complement care. In the case of diabetes these functionalities could include control mechanisms for blood glucose and cardiovascular risk factors, specific nutritional recommendations, suited physical activity programs, diabetes-specific educational contents, and self-care recommendations. This research work focuses on those core aspects of the technology, leaving out disease-specific modules. These central technological components have been developed within the scope of two research and innovation projects (FACET and POSITIVE, funded by the EIT-Health), that revolve around the provision of integrated, continuous and coordinated care to frail older population, who are at a high risk of functional decline. Obtained results indicate that a geriatric multimodal intervention is effective for preventing functional decline and for reducing the use of healthcare resources if administered to diabetic pre-frail and frail older persons. And if such intervention is supported by the CAPACITY technological ecosystem, it becomes more efficient.

The effect of self-management education through weblogs on the quality of life of diabetic patients

BACKGROUND

Self-management education of diabetes which is one of the most important noncommunicable diseases worldwide involves facilitating knowledge, skills, and ability required for self-care in these patients. Concerning the progressive growth of use of Internet for educating patients and absence of different studies about education through use of weblogs in patients with diabetes in Iran, the present study was conducted with the aim of determining the effect of self-management education through weblogs on the quality of life of affect the patients.

METHODS

This study was performed as intervention on patients referring to diabetes clinic of Talghani hospital in Kermanshah in winter 2018 and spring 2019. The samples consisted of 98 patients with diabetes chosen through available sampling and randomly assigned into study and control groups. For data collection, diabetes quality of life (DQOL) short form clinical questionnaire, Persian version, was used. The intervention involved training self-management conducted through 60 sessions via a designed weblog. The obtained information was introduced into SPSS 21, and analyzed through Mann-Whitney, t-test, and paired t-test.

RESULTS

According to the results of this study, the mean age of the examined patients was 32.1 ± 4.9 years, where the major participants were male (n = 52 in the test group, 52.5%). The results showed that after the intervention, the test and control groups were different in terms of anthropometric variables and metabolic indicators; the mean waist circumference in the test and control groups was 98.6 ± 9.8 and 101.5 ± 7.8, respectively; the mean FBS following the intervention in the test and control groups was 131.08 ± 16.04 and 238.2 ± 40, respectively; and the mean BMI postintervention in the test and control groups was obtained as 27.3 ± 3.4 and 30.1 ± 3.8 respectively, where these differences were significant according to independent t-test (p < 0.05). The mean score of quality of life postintervention in the test and control groups was obtained as 56.1 and 49.9 respectively; according to Mann-Whitney test, the difference between the two groups was significant (p < 0.05).

CONCLUSION

The results of the present study revealed the positive effect of weblog based self-management on the quality of life of patients with diabetes following the intervention. Further, reduced levels of FBS, BMI, as well as systolic and diastolic blood pressure were also observed, which could be due to increased awareness of patients about their abilities, its risks, as well as the ways to control and treat it.

Real-world impact of ongoing regular exercise in overweight and obese US adults with diabetes on health care utilization and expenses

AIMS

To assess the effect of regular exercise on health care utilization patterns and expenses in a real-world national sample of overweight and obese US adults with diabetes.

METHODS

Medical Expenditure Panel Survey data (2010-2015) identified adults with diabetes and a body mass index (kg/m²) ≥25. Two groups were created: exercise (moderate or vigorous physical activity >30min at least five times weekly) and non-exercise groups.

OUTCOMES MEASURED

average total health care expenses (per-person per-annum) and the likelihood of hospitalization.

RESULTS

Among 5140 overweight and obese adults with diabetes, 49.1% reported exercising at least five times weekly. The exercise group showed lower medical care and prescription drug utilization than the non-exercise group (p<0.001). Total unadjusted health expenses in the exercise group were $5651 lower than the non-exercise group (p<0.001). After controlling for socioeconomic and health-related variables, regular exercise reduced total health care expenses by 22.1% (p<0.001) and the likelihood of hospitalization by 28% (p=0.001).

CONCLUSIONS

Reduced hospitalization and health care expenses were associated with regular exercise (≥30min at least five times weekly) in overweight and obese adults with diabetes.

A systematic review and meta-analysis of adherence to physical activity interventions among three chronic conditions: cancer, cardiovascular disease, and diabetes

BACKGROUND

Physical activity is effective for the prevention and treatment of chronic disease, yet insufficient evidence is available to make comparisons regarding adherence to aerobic physical activity interventions among chronic disease populations, or across different settings. The purpose of this review is to investigate and provide a quantitative summary of adherence rates to the aerobic physical activity guidelines among people with chronic conditions, as physical activity is an effective form of treatment and prevention of chronic disease.

METHODS

Randomized controlled (RCTs) trials where aerobic physical activity was the primary intervention were selected from PsychInfo, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Clinical Key, and SCOPUS from 2000 to 2018. Studies were included if the program prescription aligned with the 2008 aerobic physical activity guidelines, were at least 12 weeks in length, and included adult participants living with one of three chronic diseases. The data was extracted by hand and the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines were used to evaluate risk-of-bias and quality of evidence. Data were pooled using random-effect models. The primary outcome measure was program adherence and the secondary outcome measures were dropout and setting (e.g. home vs. clinic-based). Pooled effect sizes and 95% CiIs (confidence intervals) were calculated using random-effect models.

RESULTS

The literature search identified 1616 potentially eligible studies, of which 30 studies (published between 2000 and 2018, including 3,721 participants) met the inclusion criteria. Three clinical populations were targeted: cancer (n = 14), cardiovascular disease (n = 7), and diabetes (n = 9). Although not statistically significant, adherence rates varied across samples (65, 90, and 80%, respectively) whereas dropout rates were relatively low and consistent across samples (5, 4, and 3%). The average adherence rate, regardless of condition, is 77% (95% CI = 0.68, 0.84) of their prescribed physical activity treatment. The pooled adherence rates for clinic-based and home-based programs did not differ (74% [95% CI, 0.65, 0.82] and 80% [95% CI, 0.65, 0.91], respectively).

CONCLUSIONS

The current evidence suggests that people with chronic conditions are capable of sustaining aerobic physical activity for 3+ months, as a form of treatment. Moreover, home-based programs may be just as feasible as supervised, clinic-based physical activity programs.

Managing people with diabetes during the cancer palliation in the era of simultaneous care

Managing people with diabetes and cancer during palliation constitutes a daunting challenge. Cancer, diabetes and treatment toxicity could be seen as a "Bermuda Triangle" for physician and health care professionals in general. Based on literature review, the present paper stresses the distinctive aspects that diabetes and cancer together involve and bring out. Considering the simultaneous care approach as the basement of our perspective, we explore the areas of palliative intervention for which the specific features of persons with diabetes and cancer emerge: pain manifestation and treatment, response to opioids, psychosocial and communication aspects, infection-related susceptibility and complications. The overall impact of suffering that these two diseases in association involve requires new awareness and a cultural attitude towards new network based approaches in order to strengthen the person-centered health care in this field.

The Role of Physical Exercise in Obesity and Diabetes

The prevalence of obesity is increasing world-wide. Obesity is associated with a plethora of metabolic and clinical constraints, which result in a higher risk for the development of cardiovascular complications and metabolic disease, particularly insulin resistance and type 2 diabetes. Obesity is an acknowledged determinant of glycemic control in patients with type 1 diabetes and accounts for the majority of premature death due to cardiovascular events. Physical exercise is generally recommended in patients with diabetes in order to prevent the development of or reduce existing obesity, as adopted by every international treatment guideline so far. Regular physical exercise has a beneficial impact on body composition, cardiovascular integrity, insulin sensitivity and quality of life. However, only a minority of patients participates in regular physical exercise, due to individual or disease-related barriers. In type 2 diabetes, there is robust evidence for beneficial effects of physical exercise on glycemic control, cardiovascular health and the development of diabetes-related long-term complications. In type 1 diabetes and patients treated with insulin, a higher risk for exercise-related hypoglycemia has to be considered, which requires certain prerequisites and adequate adaptions of insulin dosing. Current treatment guidelines do only incompletely address the development of exercise-related hypoglycemia. However, every patient with diabetes should participate in regular physical exercise in order to support and enable sufficient treatment and optimal glycemic control.

Considerations for developing chronic care system for traumatic brain injury based on comparisons of cancer survivorship and diabetes management care

Experts in traumatic brain injury (TBI) rehabilitation recently proposed the framing of TBI as a chronic disease rather than a discrete event. Within the framework of the Chronic Care Model (CCM), a systematic comparison of three diseases - cancer survivorship, diabetes management and TBI chronic care - was conducted regarding chronic needs and the management of those needs. In addition, comparisons of these conditions require comparative evaluations of disease management characteristics and the survivor concept. The analysis found diabetes is more established within the CCM, where care is integrated across specialists and primary care providers. No single comparison provides a full analogue for understanding the chronic care health delivery system for TBI, indicating the need for a separate model to address needs and resources for TBI survivors. The findings from this research can provide practitioners with a context to develop a robust continued care health system for TBI. Practitioner Summary: We examine development of a chronic care system for traumatic brain injury. We conducted a systematic comparison of Chronic Care Model elements of decision and information support. Development of capabilities using a benchmark of diabetes care, with additional insights from cancer care, provides insights for implementing TBI chronic care systems.

Fasting plasma glucose and lipid profiles of diabetic patients improve with aerobic exercise training

OBJECTIVE

This study presents the effects of aerobic exercise training on fasting plasma glucose and lipid profiles (FPG/LP) of diabetic patients in Kumasi.

DESIGN

A randomised experimental with control design.

SETTING

The study was conducted at the diabetic unit of KATH in Kumasi, Ghana.

PARTICIPANTS

Twelve diabetic patients [grouped into intervention (IG) and control (CG)] attending the diabetic unit of KATH with diabetes diagnosis durations less than fifty years, ambulant status/age of 20-68years, sedentary and free from complications.

INTERVENTIONS

Eight weeks aerobic exercise training between August 2015 and March 2016.

MAIN OUTCOME MEASURES

Body weight (BW), Body mass index (BMI), fasting plasma glucose (FPG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (T) and total cholesterol (TC).

RESULTS

Body weight (4.85kg, 7.0%), body mass index (4.08kg/m2, 7.3%), FPG (5.28mmol/L, 43.5%), LDL-C (.33mmol/l, 11.9%), TC (.47 mmol/l, 5.3%) and T (.48mmol/l, 29.4%) profiles of the patients in IG declined while HDL-C (.11mmol/l, 7.1%) increased. IG patients improved significantly in FPG [6.27 ± 0.91 < 8.00 ± 0.96; t=-52.00, P = 0.000], BW [58.60 ± 15.34 < 75.35 ± 22.00; t= 3.29, P = 0.040] and BMI [23.45 ±5.03<27.04 ±4.78, t=4.24, P = .050] compared to CG.

CONCLUSION

Patients in IG, in addition to conventional care, experienced non-significant decline in LDL-C, TC, T, increase in HDL-C and significant reduction in FPG, BW, and BMI over those receiving conventional care only. Exercise Scientists are recommended to handle exercise sessions for healthcare prevention and management routines of diabetic patients.

FUNDING

Not declared.

The Robert Wood Johnson Foundation Diabetes Initiative

PURPOSE

The purpose of the Diabetes Initiative of the Robert Wood Johnson Foundation is to demonstrate feasible and sustainable approaches to promoting diabetes self-management in primary care and community settings.

METHODS

The Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and frontier settings around the United States. This report describes the Initiative, its ecological perspective on self-management, and implications for program development, sustainability, and dissemination.

RESULTS

Ecological perspectives stress varied levels of influence ranging from individuals to communities and policies. Based on this, the Initiative has identified key resources and supports for self-management (individualized assessment, collaborative goal setting, enhancing skills, follow-up and support, community resources, and continuity of quality clinical care). Lessons learned include the central roles of community health workers, integration of healthy coping and attention to negative emotion and depression in self-management, community partnerships, approaches to ongoing follow-up and support, organizational factors in sustaining programs, and the utility of a collaborative learning network for program development. Sustainability stresses organizational and policy supports for the program. Dissemination of lessons learned will stress collaboration among interested parties, stimulating consumer understanding and demand for self-management services as central to diabetes care.

CONCLUSIONS

The Diabetes Initiative demonstrates that effective self-management programs and supports can be implemented in real-world clinical and community settings, providing models of worthwhile, sustainable programs.

Integration of a Promotora-Led Self-Management Program Into a System of Care

PURPOSE

The purpose of this article is to describe the integration of a promotora-led self-management component into a system of care and assess the influence of this program on indicators of metabolic control over time.

METHODS

Gateway Community Health Center is a federally qualified health center in Laredo, Texas, that serves a predominantly Hispanic population. Gateway integrated self-management support into care for people with diabetes by incorporating promotora-led self-management services into the clinic structure, operations, and patient visits. The self-management program included education, goal setting, depression screening with symptom follow-up, and support groups after course end. Indicators of metabolic control, HbA1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were compared at baseline and at 12 months.

RESULTS

The integration of promotora-led self-management services into the system of care allowed for continual improvements of self-management services in response to patient needs. Patients enrolled in the self-management course showed improved indicators of metabolic control that were sustained over time, and they reported a high level of goal achievement.

CONCLUSIONS

The integration of the promotora-led self-management program into diabetes care at Gateway generated a system of referral, follow-up, feedback, and documentation that produced consistently high-quality clinical care.

Move More Diabetes

PURPOSE

The purpose of this article is to describe Move More Diabetes (MMD), which is used by Lay Health Educators (LHEs) to promote physical activity and improve diabetes self-management among individuals with type 2 diabetes.

METHODS

Move More Diabetes used social marketing strategies to choose and segment the target audience, develop messages, and determine message delivery. Based on market research results, MMD chose natural peer support from LHEs as the main intervention strategy.

RESULTS

Move More Diabetes built a sustainable volunteer network of 35 LHEs who recorded 1500 contacts with enrollees from 2004 to 2006. Participation improved when the program was not specific for diabetes.

CONCLUSION

The MMD program demonstrated benefits of partnership and natural peer support and the utility of social marketing in planning and implementing a community-based chronic disease self-management and physical activity promotion program. This low-cost program can serve as a model for other rural communities interested in increasing physical activity to address chronic disease.

A Community-Based Program to Encourage Patients’ Attention to Their Own Diabetes Care

Purpose

The authors evaluated the ability of a brief educational program to enhance patients’ self-care behavior and their familiarity with the meaning and utility of 5 of the major clinical tests in diabetes (A1C, blood pressure, low-density lipoprotein [LDL] cholesterol, microalbumin, and the dilated eye examination).

Methods

Adults with type 1 or type 2 diabetes were invited to attend a free, 90-minute, small-group workshop about diabetes care, which included on-site metabolic testing that provided patients with immediate results and personalized feedback to understand those results. In total, 221 individuals with diabetes participated and completed baseline and 3-month follow-up questionnaires.

Results

From baseline to 3 months, participants reported significant improvement in following recommendations for meal planning (P < .001), regular exercise (P < .002), and blood glucose monitoring (P < .05) and a significant rise in test awareness for A1C, blood pressure, LDL cholesterol, and microalbumin (in all cases, P < .001).

Conclusions

A brief educational intervention appeared effective in encouraging patients toward better self-management and more regular metabolic testing and to become more aware of their own test results. Future research should aim to replicate and extend these findings in a randomized controlled trial.

Choosing and Using Theories in Diabetes Education Research

Diabetes educators use theories all the time, even if they are not aware of it. To teach, one must have some assumptions about how people learn and what constitutes effective teaching. The purpose of this article is to help diabetes educators interested in research and evaluation choose appropriate theories. The article will review the 4 purposes of theories, that is, description, explanation, prediction, and control, as well as the degree to which a theory has been articulated and elaborated. The importance of a theory’s personal resonance, its explanatory power, and its utility will also be examined. The article will also review how to use 1 or more theories at each stage of a research or evaluation project.

The Impact of Promotoras on Social Support and Glycemic Control Among Members of a Farmworker Community on the US-Mexico Border

PURPOSE

The purpose of this study is to describe the effect of a promotora-driven intervention to build social support as a means to affect self-management behaviors and clinical outcomes in a farmworker community on the US-Mexico border.

METHODS

Promotoras implemented a community-based intervention that included support groups, home/hospital visits, telephone support, and advocacy to people with diabetes. A 12-month pre/post study design was used to investigate the relationship between promotora contact, perceived support, and clinical outcomes. Clinical data were gathered from 70 participants during routine physician visits. A pre/post questionnaire was used to measure perceived support and self-management practices.

RESULTS

Glycosylated hemoglobin (HbA1c) levels decreased 1% among high-risk participants. Improved HbA1c level was associated with promotora advocacy and participation in promotora-led support groups. Participants reported increased support from family and friends and more comfort speaking about diabetes (la enfermedad) with family and friends.

CONCLUSIONS

These findings document improvement in both clinical and social health indicators for Mexican Americans in a farmworker community when a promotora model is used to provide and facilitate culturally relevant support for diabetes self-management practices.

Characteristics of Organizational Resources and Supports for Self Management in Primary Care

PURPOSE

The purpose of this article is to describe components of organizational support for self-management in primary care and provide illustrations of each of these components from the Diabetes Initiative's Advancing Diabetes Self Management (ADSM) projects.

METHODS

Elements of organizational resources and supports for diabetes self-management in primary care were developed from the experience of the ADSM projects and in collaboration with Diabetes Initiative staff and experts.

RESULTS

Eight elements of organizational support for self-management were identified: (1) the establishment of patient care teams, (2) continuity of care, (3) coordination of referrals, (4) documentation of self-management support, (5) ongoing quality improvement, (6) patient input, (7) staff training and education, and (8) integration of self-management into primary care.

CONCLUSION

Establishing a comprehensive system of care for people with diabetes is enabled by an infrastructure of organizational resources and supports for self-management in primary care settings. These components of organizational support provide guidance for integrating diabetes self-management services into primary care settings.

Patient Perceptions of Satisfaction Following Diabetes Education

PURPOSE

The purpose of this study was to test the conceptual congruency of scores from the Mastery of Stress Instrument (MSI) with qualitative data in an effort to identify patients for whom a specific educational intervention was sufficient.

METHODS

A convenience sample of patients with diverse age and educational backgrounds was recruited from those who registered for a 4-session diabetes educational experience as new or refresher patients. All 57 patients completed the MSI before and after diabetes educational experiences, and half participated in before and after audiotaped interviews. All patients responded to a query about their perceptions of the educational experience. MSI scores were analyzed by demographic variables as well as compared to qualitative interviews for greater insights and explanation.

RESULTS

Consistency was noted between the MSI scores and the information revealed in the interviews. Additional support for the use of the MSI to identify patients at risk and in need of additional educational interventions was realized.

CONCLUSIONS

Further research to explore the use of the MSI with persons with different educational experiences and to standardize the MSI scores for adult persons taking diabetes or other patient education classes is needed before generalization can be achieved.

The AADE National Diabetes Education Practice Survey: Diabetes Education in the United States—Who, What, Where, and How

This article describes the first comprehensive survey of diabetes self-management education programs and practice in the United States. The American Association of Diabetes Educators (AADE), through environmental scanning of members and the external health care environment, identified significant changes in the practice of diabetes education in 2004. In an effort to more completely understand the current state of practice, the association administered the National Diabetes Education Practice Survey (NPS) to the membership in 2005 and 2006. The survey was structured to elicit information about the structure, process, and outcomes of diabetes education practice from both program managers and diabetes educators. Through this baseline description of diabetes education practice and program design, opportunities were identified for broadening the patient referral base, enhancing cost-effectiveness and educator productivity activities, improving program access to all populations, developing innovative delivery methods, improving patient outcomes, and striving for sustainable funding sources. The association will continue to administer the survey annually and report on changes and trends in diabetes education programs and practice.

Training Effective Interpreters for Diabetes Care and Education

PURPOSE

This article describes a pilot project to improve knowledge, attitudes, and skills of ad hoc interpreters working with Native American diabetes patients with limited English proficiency.

METHODS

Case-based studies reflecting clinical situations were developed. Key concepts and terms from the cases were translated into the Navajo language and carefully back translated using the newly standardized Navajo diabetes terminology. Twenty-two health care workers from 2 Indian Health Service facilities were recruited for a pilot study to compare the performance of interpreters trained in a formal workshop using the case studies with that of interpreters who independently reviewed a video made from the training.

RESULTS

Workshop participants noted significant improvements in their knowledge and comfort level in interpretation of diabetes concepts but not about unrelated topics; the independent study group perceived less improvement.

CONCLUSION

Formal training for interpreters working with diabetes patients should be considered by diabetes educators working in settings where medical interpreters are needed. Diabetes educators should encourage back translation of key diabetes concepts to understand exactly what is being said to patients. Those working with multiple interpreters should make sure there are opportunities for interpreters to discuss translations of key concepts with each other and the educators so that translations are accurate and consistent among interpreters. Independent study did not appear to be an effective way to improve the ability of interpreters to translate current diabetes concepts accurately.

Use of the Transtheoretical Model to Enhance Resources and Supports for Diabetes Self Management

PURPOSE

The purpose of this article is to describe how Resources and Supports for Self Management (RSSM) and strategies of the transtheoretical model (TTM) intersect to produce a comprehensive approach resulting in cutting-edge diabetes programs.

METHODS

Specific components of RSSM, especially individualized assessment, collaborative goal setting, and enhancing skills, are reviewed in terms of contributions to the TTM.

RESULTS

Specific examples from the Diabetes Initiative of using TTM constructs from 5 projects are shown to illustrate the first 3 RSSM constructs: individualized assessment, collaborative goal setting, and skill building.

CONCLUSION

Diabetes Initiative grantees have demonstrated that the TTM enhances RSSM and facilitates the adoption of good diabetes self-management behaviors.

Self-management in African American Women With Diabetes

Purpose

This study describes demographic and medical characteristics, self-efficacy, locus of control, self-managementd defined by functional status, hemoglobin HbA1c outcomes, and the relationships among these variables based on age group differences (25-44 years, 45-64 years, and 65-84 years) in African American women with type 2 diabetes.

Methods

Subjects (n = 75) in community medical practices were interviewed to complete a demographic and medical form, the Diabetes Self-efficacy Outcomes Expectancy Questionnaire (DSEQ), the Diabetes Locus of Control Scale, and the Medical Outcomes–Short Form 36 (SF-36). A venous blood sample was taken following the interview. Data were analyzed for the total sample and separately for age groups.

Results

Scores on the self efficacy (DSEQ) and the locus of control (LOC) were above average for all 3 groups. Significant correlations were found among subscales of the LOC, SF-36, and HbA1c. HbA1c scores were abnormally high across groups. Significant group differences were found in duration of diabetes and number of medications used.

Conclusions

Despite high levels of internal locus of control and self-efficacy and scores indicating good mental, physical, emotional, and social health, self-management amongthe women was inadequate, as indicated by abnormally high HbA1c levels.

Use of an Assessment Tool to Enhance Diabetes Educators' Ability to Identify Erectile Dysfunction

An assessment tool to identify erectile dysfunction is useful to diabetes educators in recognizing patients with sexual dysfunction requiring further counseling, education, and treatment. Use of an assessment tool serves as a first step in creating dialogue between diabetes educators and patients living with undiagnosed erectile dysfunction. The assessment tool helps identify underlying causes of erectile dysfunction, its impact on psychological wellbeing, and identification of treatment and referral needs. The purpose of this article is to discuss the value of assessing erectile dysfunction as a component of comprehensive diabetes care. An example of an erectile dysfunction assessment tool developed in 1991 is presented.

Facilitating Diabetes Self-Management Goal Setting in a Real-World Primary Care Center

PURPOSE

The purpose of this article is to present a model for implementing self-management goal setting in a primary care setting.

METHODS

A train-the-trainer model for training staff nurses to facilitate self-management goals with people with type 2 diabetes.

RESULTS

Fourteen staff nurses in 6 primary care sites were trained. In 2 sites that received consistent mentoring, the number and quality of self-management goals increased. Training staff nurses allowed the health center to facilitate self-management goals with patients who did not seek the services of a certified diabetes educator or who obtained care in a site without a certified diabetes educator.

CONCLUSIONS

Self-management goal setting can be implemented in primary care settings in an efficient and economical manner.

Feasibility and Effectiveness of System Redesign for Diabetes Care Management in Rural Areas

Purpose

Redesigning the system of care for the management of patients with type 2 diabetes mellitus has not been well studied in rural communities with a significant minority population and limited health care resources. This study assesses the feasibility and potential for cost-effectiveness of restructuring care in rural fee-for-service practices for predominantly minority patients with diabetes mellitus.

Methods

This was a feasibility study of implementing case management, group visits, and electronic registry in 5 solo or small group primary care practices in rural North Carolina. The subjects were 314 patients with type 2 diabetes mellitus (mean age = 61 years; 72% African American; 54% female). An advanced practice nurse visited each practice weekly for 12 months, provided intensive diabetes case management, and facilitated a 4-session group visit educational program. An electronic diabetes registry and visit reminder systems were implemented.

Results

There was an improvement in the percentage of patients achieving diabetes management goals and an improvement in productivity and billable encounters. The percentage of patients with a documented self-management goal increased from 0% to 42%, a currently documented lipid panel from 55% to 76%, currently documented aspirin use from 25% to 37%, and currently documented foot examination from 12% to 54%. The average daily encounter rate improved from 20.17 to 31.55 on intervention days.

Conclusions

A redesigned care delivery system that uses case management with structured group visits and an electronic registry can be successfully incorporated into rural primary care practices and appears to significantly improve both care processes and practice productivity.

Patient-Centered

PURPOSE

The purpose of this article is to describe the process of collaborative goal setting as a means to improve diabetes self-management in primary care.

METHODS

The Self-Management Goal Cycle framework illustrates a model of care for patients with diabetes. The Big Bad Sugar War is an approach to patient counseling that includes background, barriers, successes, willingness to change, action plan, and reinforcement.

RESULTS

Planned visits occur when a medical assistant performs routine health checks and laboratory tests prior to traditional individual appointments. Mini-group medical visits occur when a provider and medical assistant meet with 3 patients at one time. Open office group visits occur when 7 to 12 patients attend 2-hour sessions staffed by a provider.

DISCUSSION

Collaborative goal setting is a valuable tool for improving self-management skills among patients with diabetes. By implementing goal setting techniques, members of the patient care team are better equipped to help patients manage their chronic conditions by making them valued partners of the health care team.

Clinical Benefits of Training Patients to Voluntarily Increase Peripheral Blood Flow

The purpose of this article is to introduce a training pro- gram that can help diabetes educators get a fresh approach to assist their clients with the diabetes complication of limited peripheral blood flow. Biofeedback-assisted relaxation training is an educational and integrative intervention that supplements traditional medical care. Biofeedback-assisted relaxation training can be taught to the patient in a single setting. The relaxation training allows peripheral blood vessels to widen, providing enhanced circulation to peripheral tissues, including nerves. The training includes an explanation of relaxation and its effects on the patient, after which the technique is practiced with the assistance of thermal biofeedback. Biofeedback is an effective physiological training modality that teaches the patient what is going on in his or her own body. As the patient relaxes correctly, peripheral blood vessels dilate and blood flow improves, resulting in increased skin temperature. The change in skin temperature is measured with a small alcohol thermometer. Consistent relaxation yields significant outcomes such as improved peripheral blood flow, a reduction in peripheral pain, enhanced healing, improved ambulation, and increased coping skills in the patient's life.

Diabetes Nurse Educators' Prioritized Elder Foot Care Behaviors

Purpose

The purpose of this study was to identify diabetes nurse educators' perceptions of the most important foot care behaviors for elderly people to enact in daily care.

Methods

A structured, open-ended questionnaire was mailed to a regionally stratified random sample of 90 diabetes nurse educators. Subjects were asked to identify and rank order 8 foot care behaviors perceived important for elderly people with diabetes to enact daily. Data were transcribed and coded into categories and domains using descriptive content analysis.

Results

Forty-seven diabetes nurse educators responded with a total of 346 foot care behaviors perceived important for elders. Twenty-one major foot care behavior content categories were grouped into 4 domains of descending importance: foot/nail care, footwear/shoes, general health, and foot emergencies.

Conclusions

Diabetes nurse educators generated a range of baseline data for developing a reliable, valid, and patient foot care knowledge outcome measure to support national diabetes patient education and self-management program guidelines.

Contributions of Children to the Care of Adults With Diabetes

PURPOSE

The purpose of this study was to determine the occurrence of child caregivers among adults with diabetes and the type of assistance they provide.

METHODS

In this exploratory descriptive study, 51 diverse adults with diabetes from 9 clinics in 3 states completed a survey in English or Spanish about themselves and their child caregivers. Topics addressed in the survey were the duration and types of assistance, the children's education about diabetes, and the impact of children's caregiving on attendance at school and work.

RESULTS

The occurrence of child caregiving for adults with diabetes was 15.7%, and greatest for Hispanics. Most adults and caregivers were female; 14 adults reported more than 1 child caregiver. The children ranged in age from 5 to 18 years and began caregiving at a mean age of 11. Children provided from 1 to 10 services, including planning meals, drawing up or administering medications, testing blood glucose, interpreting results, and transporting. Most children provided care several times a week, and nearly half had no education about diabetes care.

CONCLUSIONS

Children of both sexes and 4 racial/ethnic groups provided a broad range of services to adults with diabetes with little preparation. Diabetes educators should consider if and how they can assess and include child caregivers in diabetes education.

Depression Increases Diabetes Symptoms by Complicating Patients’ Self-Care Adherence

PURPOSE

This study evaluated whether diabetes patients with depressive symptoms are more likely than other diabetes patients to report symptoms of glucose dysregulation, and whether this relationship is mediated by the impact of depressive symptoms on patients' adherence to their diabetes self-care regimen.

METHODS

Participants were English- and Spanish-speaking adults with type 2 diabetes. Interviewers assessed participants' depressive symptoms and diabetes-related symptoms at baseline. Self-care behaviors and diabetes symptoms were measured at a 1-year follow-up. Structural equation models were used to determine whether depression affected diabetes symptoms by limiting patients' ability to adhere to self-care recommendations.

RESULTS

An initial model identified direct effects of baseline depressive symptoms on self-care and diabetes symptoms at follow-up. The relationship between self-care behaviors and physical symptoms of poor glycemic control were assessed using a second model. Results explained the relationship between depressive symptoms at baseline and diabetes symptoms at 1 year.

CONCLUSIONS

Depressive symptoms impact subsequent physical symptoms of poor glucose control by influencing patients' ability to adhere to their self-care regimen. More aggressive management of depression among patients with diabetes may improve their physical health as well as their mental health.

Quality Diabetes Self-Management Education: Achieving and Maintaining ADA Education Program Recognition

PURPOSE

The purpose of this article is to describe the ADA Education Recognition Program Review Criteria for the National Standards for DSME and to help ADA-Recognized programs be prepared in the event of a random audit.

METHODS

A multidisciplinary committee defined the Review Criteria and Indicators to demonstrate implementation of the 10 National Standards. Tips for completing the application as well as the 2 types of audits, random paper and onsite, are described.

RESULTS

Five percent of all ADA-Recognized education programs will receive an onsite review conducted by 2 trained auditors. Detailed steps (based on over 100 audits that have been conducted) are outlined describing what happens prior to and during an audit so education programs can more fully understand the process and be prepared. The most common reasons that applications and/or audits fail are described.

CONCLUSIONS

The Education Recognition Program of the ADA aims to ensure that diabetes education programs that meet quality standards will reach as many patients as possible. The lessons learned from other program applications and audits help to strengthen all diabetes education services to ensure that educators are doing the best for their patients.

Cardiovascular Risk Reduction and Diabetes Education: What Are We Telling Our Patients?

PURPOSE

The purpose of this study was to determine the extent to which diabetes education encounters include evidence-based content aimed at reducing the risk of cardiovascular disease.

METHODS

During a 2-week period in November 2001, 3 certified diabetes educators (CDEs) listed the statements they made while teaching patients. These statements/comments were then assigned to the 7 outcome areas identified by the Diabetes Self-Management Assessment Report Tool (D-SMART). All educational encounters completed during that same month by 21 educators were reviewed for content areas or modules consistent with the American Diabetes Association National Standards.

RESULTS

Of all statements made by the 3 CDEs, 63% were about glycemic control while only 5% were directly relevant to cardiovascular risk reduction. There were 1043 educational encounters in November 2001, of which only 10% targeted cardiovascular risk. Educators focused most of their educational efforts (62%) on glycemic control.

CONCLUSIONS

Despite its potential impact and strong evidence base, diabetes education gives little attention to the reduction of cardiovascular risk. Diabetes educators should emphasize interventions that are most likely to be effective in reducing cardiovascular morbidity and mortality in patients with diabetes.

Social Cognitive Theory in Diabetes Exercise Research: An Integrative Literature Review

PURPOSE

This integrative review critically examined the literature on diabetes research using Social Cognitive Theory (SCT) to determine its predictive ability in explaining exercise behavior and to identify key interventions that enhance exercise initiation and maintenance.

METHODS

Literature published between 1985 and 2002 was searched using the following keywords: SCT, self-efficacy, diabetes mellitus, non-insulin-dependent diabetes mellitus, insulin-dependent diabetes mellitus, physical activity, and exercise. The databases searched were CINAHL, Medline, and PsychInfo. Of the 38 articles retrieved from databases, 13 were reviewed.

RESULTS

A statistically significant relationship between self-efficacy and exercise behavior was found in correlational studies. Results from the predictive study support the predictability of self-efficacy for exercise behavior. Mixed results were found for the predictive ability of outcome expectancies for exercise behavior. Self-efficacy was predictive of exercise initiation and maintenance over time. The evidence for successful interventions to increase self-efficacy and exercise behavior over time was inconclusive.

CONCLUSIONS

To better understand exercise behavior and to develop effective exercise interventions, a microanalytic, theory-driven approach to studying exercise behavior is needed. Several suggestions are offered to strengthen exercise self-efficacy.

Are diabetes camps effective?

In the present article data about Diabetes Camps (DC) from all continents were reviewed in order to answer the title question "are diabetes camps effective?". Articles from peer reviewed journals and abstracts published in international conferences proceedings were raised. The effectiveness was considered in terms of knowledge acquisition, and psychosocial and physiological changes. Even though expected improvements were not found in all studies, in a deeper and wider analysis the aspects that influence the most toward gains are identified. Among them are: number of participations in a DC, post-camp educational opportunities, staff training, and program oriented toward campers' autonomy. To conclude, practical recommendations are addressed intending to amplify DC's potential.

Developing a Manualized Occupational Therapy Diabetes Management Intervention: Resilient, Empowered, Active Living With Diabetes

This article reports on the development of a manualized occupational therapy intervention for diabetes management. An initial theoretical framework and core content areas for a Stage I intervention manual were developed based on an in-depth needs assessment and review of existing literature. After evaluation by a panel of experts and completion of a feasibility study, the intervention was revised into a Stage 2 manual in preparation for a randomized study evaluating the intervention's efficacy. In developing the initial manual, we delineated core theoretical principles to allow for flexible application and tailoring of the intervention's content areas. Expert panel feedback and feasibility study results led to changes to the intervention structure and content as we developed the Stage 2 manual. Through describing this process, we illustrate the dynamic evolution of intervention manuals, which undergo revisions due to both theoretical and practical considerations at each stage of the research-to-clinical practice pipeline.

Diabetes, race, and functional limitations in older U.S. men and women

AIMS

The presence of diabetes is associated with increased odds of difficulties in functional tasks but it remains unclear if the burden is similar by race.

METHODS

Our study included 122,004 non-Hispanic Black (NHB) and non-Hispanic White (NHW) adults ≥50 years from the U.S. National Health Interview Survey (2001-2012). Diabetes was defined as self-reported diagnosis or medication use. Functional limitations were defined as any self-reported difficulty in performing mobility tasks, general physical activities (GPA), or leisure and social activities (LSA). Logistic regression models were created to investigate the relationship of race with functional limitations accounting for key covariates, among men and women, by diabetes status.

RESULTS

Among older U.S. adults, NHB versus NHW women without diabetes had a higher odds of limitations in mobility (OR=1.39, 1.30-1.49) and LSA (OR=1.13, 1.05-1.23) without diabetes but a similar odds of these limitations with diabetes by race, after adjusting for age, income, education, obesity, arthritis, heart disease, stroke, COPD, and cancer. Interestingly, NHB versus NHW women had significantly lower odds of GPA, irrespective of diabetes status. However, NHB versus NHW men with diabetes had a persistently higher odds for mobility and LSA limitations with diabetes as follows: mobility (OR=1.30, 1.12-1.51) and LSA limitations (OR=1.07, 1.06-1.34). The interaction of race and diabetes was significant among women for mobility limitations (p<0.01), but not men.

CONCLUSIONS

The burden of functional limitations differs by race among both men and women with diabetes. Future studies should examine mechanisms underlying these differences to prevent progression to disability in older adults with diabetes.

Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life

In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.

Exercise patterns and behaviour in Asian Indians: data from the baseline survey of the Diabetes Community Lifestyle Improvement Program (D-CLIP)

AIMS

This paper attempts to describe the patterns of exercise and the perceived benefits and barriers to exercise in an urban south Indian population.

METHODS

Study participants were recruited from the baseline survey of the D-CLIP (Diabetes Community Lifestyle Improvement Program). Frequency, duration, type and location of exercise were assessed using a questionnaire, while a Likert type scale was used to assess perceived benefits of and barriers to exercise. Quality of life was measured using the EQ-5D.

RESULTS

Out of 1281 participants (63.7% males), 24.1% reported doing ≥150min of exercise/week ("exercisers") compared to 75.9% "non-exercisers". Exercisers were significantly older (47 vs. 43 years), better educated (68.8% vs. 60%), had a higher monthly income (41% vs. 29.2%), consumed more fruits (38.2% vs. 25.6%) and vegetables (84.1% vs. 77.7%) and had better perceived state of health (81.1% vs. 76.8%), compared to non-exercisers. Exercisers had significantly lower HOMA-IR, higher Matsuda index and lower prevalence of low HDL cholesterol compared to non-exercisers. However, there were no significant differences in cardio-metabolic risk factors like diabetes, hypertension and obesity between the two groups. Walking was the most common type of exercise. Both exercisers and non-exercisers perceived the benefits of exercising, but barriers weighed more heavily on exercise behaviour.

CONCLUSIONS

Urgent steps are needed to improve overall exercise levels in India by addressing barriers and improving the quality of exercise performed so as to enhance overall metabolic health.

A pilot study: the development of a culturally tailored Malaysian Diabetes Education Module (MY-DEMO) based on the Health Belief Model

BACKGROUND

Diabetes education and self-care remains the cornerstone of diabetes management. There are many structured diabetes modules available in the United Kingdom, Europe and United States of America. Contrastingly, few structured and validated diabetes modules are available in Malaysia. This pilot study aims to develop and validate diabetes education material suitable and tailored for a multicultural society like Malaysia.

METHODS

The theoretical framework of this module was founded from the Health Belief Model (HBM). The participants were assessed using 6-item pre- and post-test questionnaires that measured some of the known HBM constructs namely cues to action, perceived severity and perceived benefit. Data was analysed using PASW Statistics 18.0.

RESULTS

The pre- and post-test questionnaires were administered to 88 participants (31 males). In general, there was a significant increase in the total score in post-test (97.34 ± 6.13%) compared to pre-test (92.80 ± 12.83%) (p < 0.05) and a significant increase in excellent score (>85%) at post-test (84.1%) compared to pre-test (70.5%) (p < 0.05). There was an improvement in post-test score in 4 of 6 items tested. The remaining 2 items which measured the perceived severity and cues to action had poorer post-test score.

CONCLUSIONS

The preliminary results from this pilot study suggest contextualised content material embedded within MY DEMO maybe suitable for integration with the existing diabetes education programmes. This was the first known validated diabetes education programme available in the Malay language.

Integrating diabetes self-management interventions for mexican-americans into the catholic church setting

Churches provide an innovative and underutilized setting for diabetes self-management programs for Latinos. This study sought to formulate a conceptual framework for designing church-based programs that are tailored to the needs of the Latino community and that utilize church strengths and resources. To inform this model, we conducted six focus groups with mostly Mexican-American Catholic adults with diabetes and their family members (N = 37) and found that participants were interested in church-based diabetes programs that emphasized information sharing, skills building, and social networking. Our model demonstrates that many of these requested components can be integrated into the current structure and function of the church. However, additional mechanisms to facilitate access to medical care may be necessary to support community members' diabetes care.

[The epidemiologic characteristic of diabetes mellitus and its complications]

The article presents dynamics of prevalence, mortality and disability due to diabetes mellitus at the territory of Perm kraiy during last 10 years. The rate of diseases' complications and mean life interval are also considered. The materials of analysis made it possible to evaluate the epidemiological situation in kraiy and to develop activities to change it.

Changes in diastolic function after exercise training in patients with and without diabetes mellitus after coronary artery bypass surgery. A randomized controlled trial

BACKGROUND

Left ventricular diastolic dysfunction and diabetes were associated with prognosis after coronary artery bypass surgery (CABG).

AIM

This study investigated whether short-term exercise improves diastolic function in patients with and without diabetes mellitus (DM) after CABG and examined the relationship of these changes to exercise capacity.

DESIGN

RCT SETTING: Outpatient.

POPULATION

Patients with left ventricular ejection fraction ≥50% after CABG were included in this study.

METHODS

Participants were randomly assigned to a control (N.=33) or exercise (N.=28) group. The exercise group participated in three-month treadmill exercise training. We evaluated all participants on diastolic function, peak oxygen uptake (VO(2peak)), and concomitant stroke volume.

RESULTS

Exercise significantly enhanced VO(2peak) to a similar extent in all patients (P<0.05). Patients with DM improved in arteriovenous oxygen difference ([a-v] O(2) diff) after training (p=0.016), whereas those without DM improved in deceleration time of early filling (p=0.031) with exercise training. The magnitude of improvement in VO(2peak) correlated with the change in (a-v) O(2) diff in patients regardless of DM (r=0.442~0.542) and with baseline (a-v) O(2) diff only in patients with DM (r=-0.480).

CONCLUSION

After CABG, all patients showed similar improvements in VO(2peak) with exercise training, mainly through increased (a-v) O(2) diff, but those without DM showed greater improvements in deceleration time.

CLINICAL REHABILITATION IMPACT

Exercise training is beneficial for improving exercise capacity associated with restorations of peripheral oxygen utilization in both patients with and without DM.