Hemoglobin A1c (HbA1c) levels are indicators for managing Diabetes Mellitus. This study investigated the effectiveness of Diabetes Mellitus education classes based on participants’ HbA1c levels. The HbA1c and body mass index (BMI) values were analyzed using t-tests to determine significant (P ≤ 0.05) differences between baseline (N = 46) levels compared to three months, six months, and 12 months after class participation and reported as means ± standard deviations. The study was not able to track all participants as some did not attend all follow-up sessions. Mean HbA1c levels were lower at three months (8.1% ± 2.1, P = 0.002, n = 31), six months (8.11% ± 2.6, P = 0.001, n = 39), and 12 months (8.7% ±± 2.3, P = 0.050, n = 29) compared to baseline (9.5% ± 2.4). The baseline BMI was 36.7kg/m2 ± 9.7 with similar (P > 0.05) values after class attendance.

Bakgrund: Ny teknik förändrar förutsättningar för hur information sprids och används i samhället. Den enskilde individen kan i stor utsträckning samla data om sig själv och sin omgivning. I vården kan denna förändring medföra en förskjutning av roller där patienten intar en roll som söker partnerskap och delaktighet snarare än undervisning och riktade beslut. Parallellt med en snabb teknisk utveckling har idag även livsstils relaterade sjukdomar växt fram, däribland diabetes.  Sjukdomen kräver en hög grad av egenvård och information. Stöd för patienten erbjuds idag via ett flertal mobila applikationer, specifikt riktade till patienter med Diabetes. Syfte: Syftet med studien var att beskriva likheter och skillnader mellan mobila egenvårdsstöd för patienter med diabetes. Fokus riktades även mot förändring av HBA1c (metabol balans) knutet till användandet av mobila egenvårdstöd. Metod: Litteraturstudie, där åtta vetenskapliga artiklar med kvantitativ ansats granskades. Databaserna CINAHL, PubMed och PsychInfo användes. Resultat: Analysen resulterade i två kategorier och två sub-kategorier. Den första kategorin var Likheter och skillnader mellan applikationer och den andra var HbA1c. Konklusion: Forskning pekar på positiva trender gällande metabol balans vid användning av mobila applikationer vid diabetes. Dock saknar dessa applikationer ofta viktiga komponenter. Mer studier krävs inom området då forskningen inom fältet är begränsad.

Der Diabetes mellitus zählt zu den Hauptursachen einer terminalen Niereninsuffizienz. Aufgrund der veränderten Erythropoiese ist die Verwendung des HbA1c für die Beurteilung der Stoffwechseleinstellung bei Diabetikern mit einer chronischen Nierenerkrankung im Stadium 5 nach KDOQI immer noch in Frage gestellt. Die vorliegende Arbeit untersuchte die HbA1c-Variabilität in Abhängigkeit der ESA-Dosis und des ESA-Präparates bei Hämodialysepatienten. Zum Einsatz kamen entweder das klassische Epoetin-Analogon Erythropoietin α oder ein Wirkstoff der neueren Generation Methoxy-Polyethylenglycol-Epoetin beta. Es wurden 102 Hämodialysepatienten, darunter 41 Diabetiker und 61 Nicht-Diabetiker, über einen Zeitraum von neun Monaten beobachtet. Von den Untersuchungsteilnehmern erhielten 48 Patienten Epoetin α und 54 Patienten Methoxy-Polyethylenglycol-Epoetin beta. Unsere Daten konnten zeigen, dass es zu einer Beeinflussung des HbA1c durch die Therapie mit ESA-Präparaten kommt. Das als alternativer Stoffwechselparameter fungierende Fructosamin unterlag keiner derartigen Beeinflussung, korrelierte jedoch nur ungenügend mit den höheren Blutzuckerwerten, sodass seine Anwendbarkeit bei Diabetikern ebenfalls erheblich einschränkt ist. In der Gegenüberstellung der beiden ESA-Präparate erzielten beide Wirkstoffe vergleichbare Ergebnisse bezüglich des Erreichens der Hämoglobin-Zielwerte. Methoxy-Polyethylenglycol-Epoetin beta zeigte im Gegensatz zu Epoetin α eine seltener notwendige Dosisanpassung und längere Applikationsintervalle. Aus der vorliegenden Arbeit geht hervor, dass bei Hämodialysepatienten das HbA1c kritisch und mit Bedacht auf mögliche Einflussfaktoren interpretiert werden sollte. Es ist dennoch derzeit der konstanteste Parameter in der Stoffwechselverlaufskontrolle bei Diabetes mellitus.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-09-04T19:21:42Z No. of bitstreams: 1 Zaira Onofre Nunes Avaliação do controle glicêmico e seus determinantes em pacientes com diabetes mellitus....pdf: 1394652 bytes, checksum: 56dba13366982abd621882b5e8bfad9c (MD5) / Made available in DSpace on 2012-09-04T19:21:42Z (GMT). No. of bitstreams: 1 Zaira Onofre Nunes Avaliação do controle glicêmico e seus determinantes em pacientes com diabetes mellitus....pdf: 1394652 bytes, checksum: 56dba13366982abd621882b5e8bfad9c (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / O Diabetes Mellitus (DM) é uma doença metabólica crônica caracterizada por hiperglicemia persistente devido a deficiência na secreção e/ou na ação da insulina. Geralmente, está associada a complicações micro e macrovasculares devido a persistência de valores altos de glicemia. Por conta da maior industrialização, mudança na qualidade e nos hábitos de vida, maus hábitos alimentares, maior expectativa de vida, dentre outros, o DM vem atingindo proporções epidêmicas no mundo. Este crescimento atinge tanto países desenvolvidos quanto em desenvolvimento constituindo, assim, um problema de saúde pública. Os dados sobre a epidemiologia do diabetes na Venezuela são escassos e limitados. Estima-se que a prevalência de DM neste país varie de 3.8 a 7.3% e acredita-se estar em crescimento. Informações sobre o controle glicêmico e fatores de risco para o controle inadequado do diabetes são importantes para o planejamento de programas de saúde que contribuam na melhoria do atendimento ao paciente diabético. Este trabalho teve como objetivo estimar a prevalência de controle glicêmico inadequado em pacientes diabéticos de acordo com o tipo e duração da doença, determinar fatores associados ao mau controle glicêmico e identificar informações úteis para programas de melhoria do controle glicêmico em pacientes com diabetes. Este estudo é um inquérito de corte-transversal, conduzido de janeiro a junho de 2007, onde a população em estudo foi composta por pacientes diabéticos atendidos regularmente em serviços e centros médicos em oito regiões da Venezuela. O controle glicêmico foi avaliado através da dosagem de HbA1c pelo método de HPLC (High-Performance Liquid Chromatography). O ponto de corte para determinar controle adequado foi HbA1c <7.0%. No total foram avaliados 4.075 indivíduos, sendo 349 (9%) portadores de DM tipo 1 (DM1) e 3.726 (91%) com DM tipo 2 (DM2). A prevalência de controle glicêmico inadequado foi de 76%; ao estratificarmos por tipo de diabetes, o pacientes com DM1 apresentaram 87% de controle inadequado e aqueles com DM2 75%. Na avaliação da regressão linear, das variáveis analisadas mostraram associação com o pior controle glicêmico para o DM1, o baixo nível de escolaridade e a pior auto-percepção do controle glicêmico. Já para o DM2 mostraram associação com pior controle glicêmico menor idade, tipo de tratamento, menor nível de escolaridade, maior duração da doença, aderência ruim a dieta, a participação em grupos de educação para o diabetes e a pior auto-percepção do controle. Apesar das evidências clinicas que apóiam o controle rigoroso da glicemia, constatamos que poucos pacientes diabéticos na Venezuela alcançaram as metas de controle glicêmico recomendadas. Isso pode contribuir para o aumento das taxas de complicações micro e macrovasculares e podem impactar em aumento nos custos dos cuidados de saúde. / Diabetes Mellitus (DM) is a chronic metabolic disease characterized by persistent hyperglycemia due to deficiency in the secretion and / or insulin action. Generally is associated with macrovascular and microvascular complications due to persistent high levels of blood glucose. Due to the increased industrialization, changes in quality and lifestyle, poor eating habits, higher life expectancy, among others, the DM is reaching epidemic proportions in the world. This increase affects both developed and developing countries and thus constitutes a public health problem. Data on the epidemiology of diabetes in Venezuela is scarce and limited. It is estimated that the prevalence of DM in this country ranges from 3.8 to 7.3% and is believed to be growing. Information on glycemic control and risk factors for inadequate control of diabetes are important for planning health programs that contribute to the improvement of care for diabetic patients. This study aimed to estimate the prevalence of inadequate glycemic control in diabetic patients according to the type and duration of disease, determine factors associated with poor glycemic control and to identify useful information for programs to improve glycemic control in patients with diabetes. This study is a cross-sectional survey, conducted from January to June 2007, which the study population was composed of diabetic patients seen regularly at services and medical centers in eight regions of Venezuela. Glycemic control was assessed by measurement of HbA1c by HPLC (High-Performance Liquid Chromatography). The cutoff point for determining appropriate control was HbA1c <7.0%. Overall 4.075 individuals were evaluated, 349 (9%) patients with type 1 DM (T1DM) and 3.726 (91%) with type 2 DM (T2DM). The prevalence of poor glycemic control was 76%; when stratified by type of diabetes, patients with T1DM were 87% of inadequately controlled and those with T2DM 75%. In the evaluation of linear regression, the variables showed association with poor glycemic control for type 1 diabetes, the low level of education and worse self-perception of glycemic control. As for DM2 were associated with poor glycemic control variables younger age, type of treatment, lower education level, longer disease duration, poor adherence to diet, group education for diabetes and worse self-perception of control. Despite the clinical evidence supporting tight control of diabetes, we found that few diabetic patients in Venezuela met the recommended glycemic control targets. This may contribute to increased rates of macrovascular and microvascular complications and which may impact on rising costs of health care.

Class of 2014 Abstract / Specific Aims: To assess the effect of aerobic exercise dose has on diabetes control monitoring parameter of HbA1c and BMI. Methods: Studies were found from previous studies and through a search of PubMed. These studies were screened for eligibility and data was extracted using a data extraction tool. The outcomes of HbA1c and BMI were analyzed using Comprehensive Meta-Analysis software and standardized mean difference (SMD) was used to assess the impact of different doses of exercise on the outcome measures. Variability was measured using the I2 statistic and publication bias was assessed. Main Results: Nineteen studies met inclusion criteria and were analyzed. Moderate dose aerobic exercise was found to have moderate effect in reducing HbA1c and BMI (p = 0.00 & 0.03 respectively). Low dose and high dose aerobic exercise were not to reduce HbA1c (p = 0.07 & 0.13) or BMI (p = 0.61 & 0.25). There was excess variation found in both the HbA1c analysis and the BMI analysis (I2 = 72.28 & 84.04 respectively). There was no publication bias found (Kendall’s tau = 0.809). Conclusion: Moderate dose aerobic exercise was effective in reducing HbA1c and BMI, while low dose and high dose aerobic exercise were not found to have a statistically significant effect on either HbA1c or BMI.

Aim: The aim of this study was to compare how patients with diabetes type 2 self-estimate their self-consciousness, problem identification, stress management and the willingness to change before and after a daycare week. The aim was also to compare if the value on HbA1c have changed after the daycare week compared to before. Method: A total of 60 patients who recived offer to participate in a daycare week at a clinic on a university hospital in Sweden. Patients replied a form (SWE-DES-SF-10) before (n=60) and three months after (n=35) the daycare week. They also left a blood sample for HbA1c before (n=60) and three months after (n=42) the daycare week. The forms and HbA1c-values were analyzed using wilcoxon´s signed-rank test and paired t-test.   Results: After the daycare week estimated the participating patiens their self-consciousness and problem identification higher than before the daycare week. The value on HbA1c had reduced after the daycare week compared to before.   Conclusions: A daycare week for patients with diabetes type 2 may affect patients´ self-consciousness and their ability to identify problems and therefore increase their ability to manage their disease.

Bakgrund: Förekomsten av diabetes typ 2 ökar kraftigt i Sverige liksom i världen. Diabetesbehandlingens övergripande syfte är att hjälpa patienten att bibehålla en god livskvalitet alternativt att förbättra nedsatt livskvalitet. Den största delen i diabetesbehandlingen utgörs av egenvård. Behandlingens syfte är att patienten ska kunna ta större kontroll över sjukdomen och på så vis förbättra hälsan. Syfte: Att undersöka vilken typ av kost och kostutbildning som kan ha hälsofrämjande effekt och gynna egenvården hos patienter med diabetes typ 2. Metod: Litteraturstudie baserad på 18 vetenskapliga artiklar med kvantitativ ansats vilka analyserats och sammanställts. Resultat: Medelhavskost, fettsnål kost, låg kolhydratskost, fettsnål vegankost samt kostfiber har hälsofrämjande effekt vid diabetes typ 2. Låg fettkost och låg kolhydratkost kan ha gynnsam effekt på patienters egenvård vid diabetes typ 2. Intensiv kostutbildning, enskild alternativt inom ramen för en livsstilsutbildning, påverkar egenvården positivt hos patienter med diabetes typ 2. Slutsats: Egenvård är centralt vid behandlingen av diabetes typ 2. Hälsofrämjande kost och kostutbildning kan gynna patienters egenvård och hälsa. För att ytterligare kunna förbättra diabetesbehandlingen samt förebygga komplikationer och följdsjukdomar hos patienterna krävs ytterligare forskning och utveckling knutet till kost, kostutbildning och livsstilsutbildning.

Adherence to the health care advice is essential to prevent or minimize acute and long term conditions. Non-adherence to medical advice among people with diabetes is a common problem in every community. This study examined the diabetes knowledge (DKT), self-efficacy (CIDS) and other factors that enhance adherence to treatment and management of the condition in Libya. The study revealed that many Libyans with diabetes showed a low level of diabetes knowledge and did not generally adhere to their diabetes self-care regimen except for the medication regimen of taking tablets and/or insulin. The thesis concludes that various factors may explain poor adherence and the lower level of HbA1c level in this study. These include: self-efficacy about the management of the condition; duration of illness; type of treatment; cognitive factors; culture and social support; economic factors; stressful lifestyle; and health care services delivery. This study points to a need to improve health care services for diabetes, particularly health education, with more focus placed on socio-cultural and psychological aspects.

Class of 2013 Abstract / Specific Aims: To assess the impact that exercise-type has on diabetes control through improvement in monitoring parameters such as hemoglobin A1c and fasting blood glucose. Methods: Studies were selected using a study inclusion tool and then data was extracted using the data extraction tool. The primary outcomes assessed were BMI and HbA1c. The standardized mean difference (SMD) was the main summary measure and the I2 statistic ¬¬¬¬¬¬was used to assess variability among the studies. Main Results: Ten studies met inclusion criteria (Total N = 1,787). The age range of patients was 40-66 years old with equal amounts of male and female participants. Aerobic and resistance exercise were effective (p < 0.01) in reducing A1c; Tai Chi was not (p = 0.50). Aerobic exercise did not have a significant effect on BMI (p = 0.07), however Tai Chi and Resistance exercise did (p<0.04). Conclusion: Aerobic and resistance exercise produced a significant reduction in HbA1c, whereas Tai Chi did not. The non-significant impact aerobic exercise had on BMI was probably due to large variation between the studies. No significant differences were found between the different forms of exercise and their overall impact on diabetes control. Based upon the data incorporated in this meta-analysis, it is reasonable for patients with diabetes mellitus type 2 to use aerobic or resistance exercise to improve their HbA1C. However, it remains to be seen whether recommending specific exercise types over others will provide increased benefit.

Background: Type 2 Diabetes is a chronic metabolic condition which occurs as a result of insufficient insulin production and insulin resistance. This results in less glucose uptake by muscle and fat cells, allowing blood glucose levels to rise in the body. Higher blood glucose levels place patients at an increased risk of diabetes-related complications. The treatment is characterised by the initiation, switching and intensification of antidiabetic medications. The goal for patients with diabetes is to maintain glycaemic control, with blood glucose levels (HbA1c) between 6.5-7.0%(48-53mmol/mol). International guidelines recommend prescribing of metformin at initiation but there is no consensus on optimal agents in a combination regimen. The aim of this thesis was to assess the drug utilisation patterns of first-line therapies and the impact of this pathway on second-line regimens. This entailed: (i.) observing the prescribing of the first-line therapy, (ii.) characterising the medication-taking process of the first-line therapy and effectiveness of the regimens, and (iii.) determining the most effective second-line regimen in delaying the onset of microvascular complications. Methods: Patients with type 2 diabetes, prescribed a first-line antidiabetic regimen, were identified from the Clinical Practice Research Datalink (a large UK anonymised primary care database) between 01/01/05 and 31/12/09, were followed-up until 31/12/12. A multinomial logistic regression model was used to assess the relationship between patient characteristics and the choice of first-line agent. Adherence to first-line therapy was estimated using the Medication Possession Ratio calculation, expressing the percentage of days covered by a drug supply. To assess the factors influencing achievement of glycaemic goals from the first-line therapy, a logistic regression analysis was performed. To investigate second-line regimens, a Marginal Structural Cox model was implemented to explore the causal relationships between the time to development of microvascular complications and the second-line regimens. Results: Of the 72,429 individuals diagnosed with type 2 diabetes, 44,838 started therapy with an antidiabetic medication regimen. Metformin and sulphonylureas were the most frequently prescribed agents at initiation (82.9% and 9.8%,respectively). Deviations from metformin were associated with patients presenting with higher HbA1c levels, lower BMI values and had concurrent prescriptions (immunosuppressants and oral corticosteroids). Achieving glycaemic control, to the target of 6.5% (48mmol/mol), was only met in 22.7% of patients. Characteristics of the patient, choice of first-line agent and medical support influenced the effectiveness of the treatments. Patients at the greatest risk of failing to achieve the target glycaemic goal from therapy had HbA1c levels>8.0% (64mmol/mol) and a BMI≥25kg/m2. Adherence was significantly associated with greater lowering of HbA1c levels but these reductions did not guarantee reaching the ideal glycaemic target. Intensification of the monotherapy to a dual therapy regimen was observed in 30.2% of patients in a mean time of 2 years. The most frequently prescribed second-line regimens consisted of metformin/sulphonylurea (SU) (74.5%), metformin/thiazolidinediones(TZD) (11.3%) and metformin/DPP-4 inhibitors (14.2%). Metformin/SU was the most effective dual therapy regimen for delaying the onset of microvascular diagnoses. The rate of development of these events was significantly higher for the DPP-4 combination in comparison to the SU combination with a hazard ratio of 1.85 (95% CI: 1.53,2.24). A TZD combination resulted in a non-significant increase of 19% in the rate of development compared to the SU combination (HR 1.19; 95% CI: 0.98,1.47). Metformin/SU resulted in the greatest lowering in HbA1c levels (-3.3%; 12mmol/mol) in comparison to the DPP-4 and TZD regimens. Conclusions: It is unlikely that patients starting first-line therapy with high HbA1c levels will be able to reduce blood glucose levels sufficiently on a monotherapy regimen. It is important for practitioners to consider a faster uptake of a dual therapy regimen (metformin/SU) to prevent sustained suboptimal glycaemic control and reduce the risk of future complications. Other important considerations in the optimal treatment pathway would be to provide more frequent support from health professionals; this may help to highlight inadequate drug regimens, offer management of risk factors and provide education. These aspects may help patients to achieve better control of their condition, with the aim of reducing the risk of diabetes-related complications; which, severely impact patient quality of life and NHS costs and resources.