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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A computerized health records system has facilitated an analysis of the correlated illness of a segment of population afflicted with a chronic disease. Taking the existence of clinical diabetes as a starting point, the total illness experience of 635 diabetics, as shown by clinic utilization data, has been compared with an age-sex-geographically matched control population. The comparisons show that, overall, diabetics cause a caseload rate more than double that of nondiabetics. In 17 out of 22 broad health problem areas, the diagnosis caseload rates for diabetics varied from 1.3 to 3.7 times greater than the rate for matched, non-diabetic controls. Workload (physician visit and hospital days) comparisons showed even greater disparity. Some of the comparisons confirm statistically the clinical impressions of diabetologists over the past years. Some of the findings are not reflections of orthodox clinical opinion. The results contribute to further elucidation of the natural history of this disease. They also indicate the need for the development of comprehensive clinical management programs for groups of interrelated conditions found in persons with chronic disease such as diabetes.
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PMID:Epidemiological definition of the cohort of diseases associated with diabetes in Southwestern American Indians. 111 55

A practical method of ambulatory management of childhood diabetes is described. The patient and his parents must realize that diabetes is a chronic disease which needs lifelong management. Adequate instruction should include the following principles of management and control: urine testing, diabetic diet, administration of insulin, intensive motor activity, recognition and treatment of hypoglycemic episodes. Hospitalisation of diabetic children should be avoided as much as possible. A proper ambulatory management of diabetic children ensures normal growth and development, that differs in no way from that of nondiabetic children.
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PMID:[Ambulatory management of the diabetic child (author's transl)]. 117 53

This study analyses data from two nationwide prospective diabetes registries now covering about 3400 cases from 19 million person-years of follow-up in the age group 0-34 years. The risk of developing insulin-dependent diabetes mellitus (IDDM) per 100,000 individuals before 15 years was 386 (95% confidence intervals (CI): 362-410) for boys and 391 (95% CI: 367-415) for girls and by 35 years 701 (95% CI: 671-731) for men and 562 (95% CI: 534-690) for women. The incidence rate showed a maximum for both boys and girls in early puberty. After pubertal years a sharp increase in the male to female incidence ratio of IDDM was notable. At 10-14 years it was 0.94, at 15-19 years 1.59 and at 20-24 years 2.08. A Cox regression model was used to analyse the effects on age at onset of sex, population density and climatological factors as measured by north-south area of residence and season at onset. The effect of sex was confirmed (P less than 0.001). A significant effect (P = 0.004) of season was shown when the four seasons were classified according to a four stage scale related to mean temperature. When dividing Sweden into 11 regions according to north-south gradient (Latitude 55 degrees, 56 degrees, 57 degrees, ..., 65 degrees) a significant effect (P = 0.038) was also found. However, no effects of population density or living near the coast versus in the interior were found. It is concluded that a large proportion of the young are at risk of developing this chronic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Risk of developing insulin-dependent diabetes mellitus (IDDM) before 35 years of age: indications of climatological determinants for age at onset. 142 92

Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes mellitus that can be life threatening. Although DKA is often preventable, approximately 84,000 DKA-associated hospitalizations and 1800 DKA-associated deaths occurred in the United States during 1988. The Washington Department of Health (WDH) monitors DKA-associated hospitalizations to assist its chronic disease programs in preventing DKA-associated hospitalizations and deaths. This report summarizes surveillance of DKA hospitalizations among Washington state residents from 1987 through 1989.
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PMID:Hospitalizations for diabetic ketoacidosis--Washington State, 1987-1989. 143 70

Concerning a revision about the mutual influence between the diabetes, the diabetic and his family, the author reviews the literature about the psychosocial area of the Family Physician content's work. It is also confirmed the high prevalency of the chronic disease and the importance of the family ecosystem, not only as support but also as problem to the bearing person of such type of disease. Studies of chronic disease indicate that family dysfunction is associated with poor health outcomes. The areas which more and better have been studied in this scope are reviewed. Thus, having as backdrop the diabetes management, the family's diabetic influence in general is reviewed, as well as the parental attitudes, the family organization and the family life events. Finally, the health care team role is reviewed and particulary the role of the family physician in the management of this type of patients. It is pointed out, as example of the Family Medicine specific contribution, the improving cooperation with medical treatment from the diabetic.
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PMID:[Chronic disease, the chronic patient and his family. Psychosocial impact of diabetes mellitus]. 144 84

There is little data on the advantages and disadvantages of using desktop analysers in general practice. This prospective trial compared four of the analysers available in the United Kingdom, in six urban general practices, over a six month period. Of the 2619 tests where the time was noted, 55.8% were performed outside the hours when routine transport to a hospital laboratory was possible (after 12.00 hours). Of the 3530 tests performed the commonest were measurements of cholesterol (14.4 tests per 5000 patients per 30 days), glucose (6.0 tests) and haemoglobin (5.6 tests). Less than 5% of the tests were performed as an emergency despite the speed at which results are available. The main reasons for requesting the tests were screening or case finding (56.9%), with the remainder for monitoring chronic disease, especially diabetes and hypercholesterolaemia. There was evidence that the use of the machines in the four practices reduced requests for hospital laboratory blood tests by 24-40% of pre-study levels. However, there was a considerable increase in testing for cholesterol (three fold) and haemoglobin (eight fold) on the desktop analysers, compared with the number of laboratory tests requested before the study. The cost per test of using such machines is closely related to the level of activity and probably does not compete favourably with hospital testing unless several tests are performed each day. Quality control tests were within the specified limits on at least 98% of occasions, however these tests also identified the need for laboratory back up where a problem was found.
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PMID:Comparison of the use of four desktop analysers in six urban general practices. 145 51

Diabetes mellitus is the most frequent chronic disease associated with secondary magnesium deficit. Hypomagnesaemia is a central feature of the deficit, which is often reported in experimental and clinical forms of the disease. In diabetic rats as in man, plasma magnesium concentrations may correlate inversely with the degree of hyperglycaemia. The duration of the disease also appears to be relevant. The hypomagnesaemia of diabetes might be expected to affect intracellular concentrations of the ion. However, although some animal and clinical studies have reported subnormal magnesium concentrations in blood cells, bone, and soft tissues of diabetics, the relationship between plasma magnesium concentration and intracellular level of the ion is inconsistent. Clinical studies have speculated on a potential link between the magnesium deficit of diabetes and several diabetic complications, including cardiovascular problems and retinopathy. Recent experimental studies are largely supportive of such a link; myocardial disorders associated with magnesium deficiency have been reported in diabetic mice and rabbits. It is possible that a common mechanism involving magnesium may be responsible for some of the diverse complications of diabetes. The aetiology of hypomagnesaemia in diabetes is complex. Nevertheless, plasma magnesium concentrations are ultimately determined by four processes: intake, gastrointestinal absorption, redistribution within body pools, and urinary excretion. This review considers in turn the potential role of each of these processes in the development of diabetic hypomagnesaemia. Both experimental and clinical studies suggest that hypermagnesiuria may be the major factor involved. Recent animal studies have described a specific renal tubular magnesium defect in diabetes, which, together with the osmotic diuresis, is responsible for large magnesium losses. The precise cause of the defect is unknown, but it may relate to the prolonged hyperglycaemia, insulinopenia, disturbance of phosphate metabolism, or other hormonal changes which characterize the disease.
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PMID:New experimental data on the relationship between diabetes mellitus and magnesium. 146 58

Individual variation in susceptibility to chemical toxicity may be due to differences in toxicokinetic patterns or effect modification. Well-documented interspecies genetic differences in susceptibility to chemicals had lead to studies of such variation also within species. Epidemiological evidence now suggests that common variations, particularly in the P-450 enzymes, may play a major role in determining individual susceptibility to chemically-induced disease. Physiologic factors are involved in the particular susceptibility of the fetus, the newborn, and the old. Constitutional susceptibility is also affected by acquired conditions, including chronic disease, such as diabetes mellitus. Perhaps the most complex area relates to the increase in vulnerability caused by previous or contemporary exposure to other factors, thus eliciting, e.g., synergistic effects. Although amply demonstrated by experimental studies, epidemiological or clinical confirmation is generally lacking. One hypothesis suggests that a chemical exposure may affect the reserve capacity of the body, though not resulting in any immediate adverse effect. Subsequently, the body becomes unable to compensate for an additional stress, and toxicity then develops. Epidemiological approaches are available and need to be expanded. Research in this area has potential ethical implications which should be dealt with in an open, informed forum.
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PMID:Individual susceptibility to toxicity. 147 Nov 95

Despite the increasing potential of computers for educational use, experience shows that few Computer Assisted Instruction (CAI) programs for patient education have been accepted into routine use by health care providers. A CAI program on hypoglycemia for insulin dependent diabetics, which was developed by the authors and has been widely used in Europe for over 6 years, is described and is used to illustrate some specific difficulties and possible solutions when using computers for patient education. We hope to show that patients suffering from a chronic disease, such as diabetes, require specific skills which are very different in nature from the theoretic knowledge they usually receive from different sources, including health care providers. In order to be really useful, a CAI program for patients must help them to cope with their disease and take into account patients' concerns, fears, and misconceptions as far as possible. Far beyond a detailed knowledge of the domain, a deep experience in patient education is mandatory to understand patients' needs.
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PMID:Designing computer assisted instruction programs for diabetic patients: how can we make them really useful? 148 70

Examined research on peer relations of children with chronic illness. In general, scant attention has been devoted to this topic. A recent review (La Greca, 1990) highlighted this oversight and suggested several avenues for further research and clinical endeavors. This paper updates the earlier review, and provides examples from current literature regarding the role of peer relations in adjustment to chronic disease. Data are presented from an ongoing investigation of the ways in which friends and family members provide support for adolescents with diabetes. Adolescents' friends were more oriented toward companionship support than were family members; both family and friends were reported to provide emotional support for diabetes care, although the types of emotional support varied. Findings are discussed in the context of the important and varied role that peers play in youngsters' disease adaptation.
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PMID:Peer influences in pediatric chronic illness: an update. 148 38


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