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

This study compared an activation intervention to passive education in a randomized attention-control trial of 232 patients with type 2 diabetes. The activation intervention was based on Expanding Patient Involvement in Care (EPIC) trials, and was compared to time-matched passive education viewing of ADA video-tapes. Patient demographics and clinical characteristics of their diabetes were assessed with questionnaires, active involvement was assessed via ratings of taped interactions between patients and providers, and serum samples were analyzed for HbA1c. Patients in the activation condition were rated as more actively involved in discussions of diabetes self-management, and rated active involvement was predictive of improvement in glycemic control. No effect of the activation intervention was found on HbA1c. Thus, the activation intervention increased the active involvement of patients with type 2 diabetes in visits with practitioners, and active involvement led to improved glycemic control. However, the activation intervention did not improve glycemic control directly.
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PMID:Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention. 1559 Feb 20

In order to determine whether the variations in the calpain-10 gene constitutes risk of type 2 diabetes (T2DM) in Chinese, the frequency of UCSNP-43, 44 in 268 adults newly diagnosed with T2DM (according to the 1999 ADA criteria) and 153 non-diabetic control subjects was investigated. For all subjects, the height, weight, waist-to-hip ratio (W/H) and blood pressure, as well as following parameters were measured: (1) 75-g oral glucose tolerance test with insulin, C-peptide, HbA1c and blood lipid profiles; (2) Genomic DNA extracted from peripheral blood lymphocytes was genotyped for UCSNP-43 (calpain-10-g. 4852 G/A) and UCSNP-44 (calpain-10-g. 4841 T/C) by sequencing a polymerase chain reaction (PCR)-amplified fragment. PCR product was selected by single strand conformation polymorphism (SSCP) and then sequenced. The results showed that there was significant difference between T2DM group and normal control group in allele frequencies, haplotype frequencies, or haplotype combinations of UCSNP-43 and -44 either. But in newly diagnosed T2DM group, it was found that the individuals with the genotype UCSNP-44 T/C + C/C had significantly increased fasting and post-challenge insulin levels (Fins and P2hIns), consistent with reduced insulin sensitivity. In the BMI> 25 subgroup, the differences were even more significant. It was demonstrated that the Calpain-10 gene polymorphism UCSNP-44 was associated with insulin sensitivity and Fins and P2hIns in newly diagnosed T2DM, although Calpain-10 doesn't appear as a major diabetes susceptible gene in this population.
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PMID:Relationship between calpain-10 gene polymorphism and insulin resistance phenotypes in Chinese. 1564 90

A rising prevalence of Type 2 diabetes and impaired fasting glucose/glycaemia (IFG) was recently reported in the urban areas of Nepal by Singh and Bhattarai [D.L. Singh, M.D. Bhattarai, High prevalence of diabetes and impaired fasting glycaemia in urban Nepal, Diabet. Med. 20 (2003) 170-171] in the first population-based study based on the revised diagnostic criteria of ADA-1997 and WHO-1998. In comparison with our community-based survey done in 1990 in suburban and rural areas of Nepal, the current data show a surprisingly rapid increase in the prevalence of diabetes in the Nepalese population. In our 1990 study, diabetes and IFG, respectively, were present in 1.4 and 2.5% of people > or =20 years old in suburban village (Bhadrakali) compared with 0.3 and 0.7% in a rural village (Kotyang). In a short communication, Singh and Bhattarai found the rates to be 14.6 and 9.1% in urban areas, and 2.5 and 1.3% in rural areas. This phenomena appears to have been influenced more by rapid urbanization and changes in lifestyles after the ongoing democratic movements that have taken place since 1990 in Nepal. Moreover, our new analysis of the data provide baseline features for the planning of health care policy and establishment of medical priorities in modern day Nepal.
Diabetes Res Clin Pract 2005 Feb
PMID:The prevalence of diabetes mellitus and impaired fasting glucose/glycaemia (IFG) in suburban and rural Nepal-the communities--based cross-sectional study during the democratic movements in 1990. 1564 77

This study examined diabetes-related health disparities in a Latino population in terms of prevalence of the disease, and the extent to which practice-based interventions improve health care and health for the Latinos who have diabetes. Previous research has shown that Latinos, overall, are at greater risk for diabetes, but less is known for those of Puerto Rican and Dominican origin. Two interventions were implemented in a large primary care practice: an ADA-recognized Diabetes Self Management Education program, and clinical information feedback loops to providers regarding adherence to the Massachusetts Guidelines for the Care of Diabetes. The study identified the prevalence of diabetes to be 13.7% among Puerto Ricans, and 9.1% among Dominicans, rates 2-to-3 times that for the general population. Latino patients (N=567) who participated in a Diabetes Self Management Education Program maintained lower Hb A1c values than did a comparison group (N=432). For a random sample of Latinos with diabetes (N=98) in this study, 6 measures of health care improved significantly from 2001 to 2003. Areas of improvement among healthcare providers were: ordering a microalbumin level measurement when appropriate, prescribing ACE inhibitors as needed, providing pneumococcal and influenza vaccines, reviewing activity status and exercise, identifying smoking status, and prescribing lipid-lowering agents, as appropriate. Body mass index (BMI) for the 98 patients remained the same for both measurement periods at 32.8. Although this initial study spanned only 2 years, improvements in health care and health indices for the population are encouraging. Further study is underway to expand on these gains.
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PMID:Practice-based interventions to improve health care for Latinos with diabetes. 1568 80

The aim of this cross-sectional study was to describe the prevalence of total, known and unknown diabetes mellitus and impaired fasting glucose (IFG) in the population of Murcia (SE Spain), a Mediterranean area with a high prevalence of obesity. Therefore, 2562 subjects (>or=20 years) were selected by stratified random sampling and a survey was carried out by telephone, together with a physical examination and biochemical determinations. The ADA-1997 diagnostic criteria were used. The crude prevalence of total diabetes was 11% (9.5-12.6%), known diabetes 7.8% (6.5-9.2%), unknown diabetes 3.2% (2.4-4.2%) and IFG 4.9% (3.9-6.1%). Both total diabetes and IFG were higher in men than in women, with prevalence rates increasing with age. People with diabetes and IFG had higher BMI, blood pressure, total cholesterol, LDL-cholesterol and triglyceride values than the rest of the population. No difference in the prevalence of diabetes was observed between the rural and urban populations. The prevalence of diabetes in Murcia is high compared to the rest of Spain and the world, suggesting that the possible benefits attributed to some characteristics of the diet of this Mediterranean population are not sufficient to counteract the risk factors associated with the disease.
Diabetes Res Clin Pract 2006 Feb
PMID:Prevalence of diabetes in Murcia (Spain): a Mediterranean area characterised by obesity. 1610 90

The objective of the study was to determine the clinical characteristics and mortality of patients with hyperglycaemic hyperosmolar syndrome (HHS) and diabetic ketoacidosis (DKA) at a Jamaican tertiary care hospital. In a retrospective study of 1560 admissions for diabetes during the period 1998-2002, 980 dockets were reviewed and 164 individuals met the ADA diagnostic criteria for DKA or HHS. Patients with HHS were older than DKA patients (64.5 years [95% CI: 60.7-68.4] versus 35.9 years [95% CI: 30.2-41.6]), but were not more likely to be non-compliant with medications, infected, or male. Overall, 24% had a mixed DKA/HHS syndrome. Most DKA patients had type 2 diabetes (62%). Only 2% of HHS and 6% of DKA/HHS patients had type 1 diabetes. Syndrome specific mortality was: DKA 6.7%, HHS 20.3%, and DKA/HHS 25% (p for trend=0.013). Mortality increased significantly with age, especially in patients > or =50 years. Significant univariate predictors of mortality were altered mental status on admission, co-existing medical disease, increasing age, older age at onset of diabetes, acute stressors, and DKA/HHS. In multivariate models, only altered mental status was significant (OR=3.59; 95% CI: 1.24-10.41). Hence, hyperglycaemic crises in a Jamaican tertiary care hospital are associated with significant mortality especially in patients who are older or with altered mental status.
Diabetes Res Clin Pract 2006 Aug
PMID:Predictors of hyperglycaemic crises and their associated mortality in Jamaica. 1645 89

Patients with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) have been designated by American Diabetes Association (ADA, 2004) as having 'prediabetes', which indicates the higher risk of developing the disease in these patients. Prediabetes is important to recognise because of at least 2 major implications: increased risk for future diabetes and for atherosclerotic cardiovascular diseases. Pharmacotherapy in prediabetes should therefore be directed at preventing or, at least, delaying the onset of the disease as well as reducing the morbidity and mortality from atherosclerotic complications. Several drugs having different mechanisms of action, such as metformin, glitazones, acarbose, orlistat, nateglinide, glicazide, angiotensin-converting enzymes, angiotensin receptor blockers have been found to be effective in prediabetes to improve the glycaemic status, though they are still not recommended by any professional organisation.
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PMID:Drug therapy in prediabetes. 1657 Jul 65

The nutrition community is divided over de rol of de Glycemic Index (GI) or Glycemic Load (GL) in the dietetic management of Diabetes Mellitus (DM) and in the prevention of chronic diseases as DM, Obesity, Insulin Resistance (IR), Cardiovascular diseases and Cancer. The concept of GI and GL of food and diet is defined. Methodological problem are analyzed: poor standardization, bad reproducibility and high variability. The factors that determines the food glycemic index and the causes of it variability are analyzed. Recent and qualified clinical and epidemiological evidences about the relation between the GI and GL of food and diet, on the management of DM, and prevention of Obesity, DM, RI, Cardiovascular disease and Cancer, are discussed. Is concluded that there are insufficient evidences of clinical efficacy in the use of this concept for the prevention of Obesity, IR, Cardiovascular diseases and Cancer. In relation to the treatment of DM, ADA states that the most important dietetic tool is the reduction of the total amount of carbohydrates, but accepts that the use of the GI could give additional benefits. Although de GI has the potential to be a valuable clinical tool. For now consumers should focus on eating a diet plant-based, with a variety of vegetables, fruits, whole grain and legumes. At the moment we must be caution in making dietary changes based solely in this concept.
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PMID:The glycemic index. A current controversy. 1677 Oct 73

New diagnostic criteria for diabetes mellitus proposed by the American Diabetes Association in 1997 and the World Heath Organization Consultation Report in 1998 recommend lowering of the fasting plasma glucose (FPG) to 7.0 mmol/L. This change in the diagnostic FPG cut-off point was based on the results of well-documented epidemiological studies showing that increased risk of microangiopathy starts at values closer to 7.0 than 7.8 mmol/L used in the past. To facilitate the diagnosis, ADA Expert Committee recommends using FPG as the main diagnostic tool and eliminating OGTT from routine clinical practice. In contrast to ADA, WHO Consultation Group strongly recommended keeping OGTT in routine use. Due to the inconvenience, poor reproducibility, non-physiological character and labour-intensiveness of OGTT, an alternative test has been sought. The aim of this study was to determine whether fasting capillary glucose (FCG) along with fructosamine and glycated haemoglobin (HbA(1c)) perform better for the detection of glucose tolerance abnormalities than FCG alone. OGTT was performed in 1528 patients. Serum fructosamine was determined in 480 and glycated haemoglobin in 234 of these patients. To assess the value of FCG, fructosamine and glycated haemoglobin in predicting post-load glycaemia and detecting glucose tolerance abnormalities, multiple linear regression analysis and Receiver Operating Characteristics analysis were done. Fructosamine correlated stronger with 2h-postload glucose concentrations than with fasting glucose. HbA(1c) correlated stronger with FCG than with 2h-postload glucose. Combined use of fructosamine and FCG predicted 2h-postload glucose better than combined use of FCG and HbA(1c). Receiver Operating Characteristics curve analysis showed that FCG was the best criterion in discriminating diabetes. Combined use of FCG and fructosamine slightly improved the ability to discriminate glucose tolerance abnormalities from normal glucose tolerance. The following conclusions were drawn: (1) FCG is the most effective predictor of 2h-postload glucose and the best criterion for discriminating diabetes and other glucose tolerance abnormalities from normal glucose tolerance. (2) Because of the limited sensitivity and specificity of fasting glucose, fructosamine and glycated haemoglobin tests, OGTT is irreplaceable in the identification of patients with glucose tolerance abnormalities. Nevertheless, fructosamine is a potentially useful post-load glycaemia index.
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PMID:[Diagnostic value of fasting glucose, fructosamine, and glycated haemoglobin HbA(1c) with regard to ADA 1997 and who 1998 criteria for detecting diabetes and other glucose tolerance abnormalities]. 1687 52

The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indian environment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommends that as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oral glucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one step procedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible. Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA are applicable. A team approach is ideal for managing women with GDM. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring, diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are still controversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when the fetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintain normoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcome depends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A short term intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in the offspring, as the preventive medicine starts before birth.
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PMID:Gestational diabetes mellitus--guidelines. 1694 93


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