This prospective study investigated many compliance-related aspects involving a population of Type II (non-insulin-dependent) diabetics, who attended the out-patients' clinic of a District General hospital. The investigations were undertaken from both qualitative and quantitative perspectives; activities within the clinic were observed and knowledge levels concerning diabetes mellitus were measured. A teaching programme was constructed, drawing on general educational principles; each stage was subjected to analysis and evaluation. Information, teaching and counselling skills were incorporated and a quality assurance model described. Two groups of subjects - one diagnosed less than one year (n=20), the other diagnosed more than one year (n=18) - were entered into a teaching programme; weight change was chosen as the study variable. Three interventions were planned for each subject. No statistically significant differences were found between the study groups and an historical control group, but clinically significant trends towards the target weight were recorded. Following the intervention study, a clinic-specific video was made, which was positively evaluated by subjects after it was viewed in their own homes. An innovative method of analysis was applied to health belief attributes, including vulnerability and social support-dynamic concept analysis (Kontiainen, 1973) - and models were constructed to determine whether there were common patterns of interview response from which prediction of compliance with clinical advice could be deduced. From the analysis it was concluded that computerised models could be constructed, which would be used in the clinic setting to predict, and subsequently monitor and guide, the behaviour required of individuals with NIDDM. The home viewing of clinic-specific videos would provide an adjunct to effective management through the dissemination of information outside the immediate physician-patient interaction. The main aim of Type II diabetes management is control of body weight. A means of depicting movement out of the obesity grading (Garrow and Webster, 1985) was devised, which could be utilised in a collaborative way by the health care professional and the diabetic person. From this longitudinal study it was concluded that the unique educational needs of individuals must be met by a range of inter-linked skills, methods and materials, if a solution to the non-compliance problem is to be found.

Thesis (MSc.(Med.)(Pharmacy))--University of Limpopo, 2010. / Diabetes Mellitus (DM) is a self -managed condition and it is essential for patients to have the relevant knowledge, skills and attitudes needed for successful diabetes management. Follow-up and proper counselling are major components in diabetes management as these will improve adherence and optimise diabetes management. The aim of this study was to compare the knowledge, understanding and outcome of the disease management in four health institutions ; a dedicated institution, a semi-dedicated institution and two non-dedicated institution. The study objectives were: To describe the level of knowledge and understanding of diabetic patients in the management of their condition at the different institutions , to describe the outcome of diabetes management at the different institutions , to describe consulting and dispensing times for diabetic patients at the different institutions , and to obtain patients’ perceptions on the quality of the health care services pertaining to the treatment of their diabetes. A total of 120 patients were interviewed, 30 per institution. A questionnaire was used to collect data for the different objectives. Prospective and retrospective data were collected. Knowledge of DM was assessed in ten patients from each institution. Patients were asked to explain their understanding on five aspects of the condition. Median scores for patients from the two non-dedicated institutions were compared using Wilcoxon two-sample test, and were found not to differ significantly for any of the questions or the overall score. The groups did not differ significantly in their understanding of whether there was a cure for diabetes mellitus and in their understanding of hypoglycaemia and its management. Patients at the dedicated clinic were significantly more knowledgeable of the condition, it’s causes and their overall understanding of the questions asked. Hyperglycaemia and its management were understood significantly better by the patients at the dedicated iv institution than those at the non-dedicated institutions , with patients at the semi-dedicated institution not differing significantly from either group. The outcome of diabetes management was recorded from the patients file for a six month period. The proportions of elevated blood pressure results recorded at the three institution types differed significantly. The semi-dedicated institution had a significantly higher proportion of uncontrolled blood pressure results (33 of 55 results recorded, or 60%) than the non-dedicated institutions (32 of 91, 35%) or the dedicated institution (9 of 36, 25%,). None of the ten patients at the semi-dedicated institution had all their values within the controlled range, as compared to six of 20 at the non-dedicated and six of ten at the dedicated institution. The glucose control was least achieved in patients at the semidedicated institution, where only one of ten (10%) of patients had no recorded value outside the controlled range, as opposed to four of ten (40%) at the dedicated institution and nine of eighteen (50%) at the non-dedicated institutions. Median visit times differed between all types of institutions. Time spent on consulting and dispensing was the shortest at the non-dedicated (median=7min), it took longer at the semi-dedicated (median=9), and longest at the dedicated institution (median=18min). The patient’s perception on the quality of care was recorded for patients. They were asked whether they were satisfied with the amount of time that they spent with the healthcare worker. Patient satisfaction with visit time was not linked to the duration of the visit. Actual visit time did appear to be linked to patients’ perception of whether they got enough time to ask questions. As for perceived quality of service, fewer patients were informed about their progress at the non-dedicated institution than at the others. Family members of fewer patients were educated at the dedicated than at the other institutions. More patients at the dedicated institution than at the other institutions were informed of treatment changes. Suggestions for improvement of patient care were made by 18% of v patients attending non-dedicated institutions , 23% of patients at the semi-dedicated institution and 63% at the dedicated institution. The conclusion based on the results is that the more dedicated a service is, the better the diabetic care of patients. Patients at the dedicated clinic had more time with the health worker during consultation and dispensing of treatment. They were informed about treatment changes more than the patients at other institutions. Patients at the dedicated clinic also showed a better knowledge and understanding of their condition than patients in other institutions. They also had higher affirmative responses in terms of lifestyle modification as compared to the other institutions.

One in four adults over the age of 60 suffers from diabetes. Around 85%-90% of individuals who have diabetes suffer from Type II diabetes. The prevalence of individuals with diabetes is expected to increase. This paper addresses the influence spousal support, friend support, and religion all have on diabetes mellitus. Gender difference in relation to spousal support benefits has also received limited attention. The limited amount of studies that have examined gender differences in relation to spousal support and diabetes management indicate that diabetic men benefit the most from spousal support due to their wives active involvement in meal preparation and grocery shopping. The results showed that neither spousal support nor religious salience was significantly related to diabetes management. There were observed gender differences in religious salience (males = 4.84, females = 5.36, p < .001) and positive spousal support (males = 3.19, females = 3.02, p <.001), but none of the major hypotheses were supported.

Trata-se de um estudo quase-experimental, prospectivo, comparativo, do tipo antes e depois, realizado no Centro Educativo de Enfermagem para Adultos e Idosos. Objetivo geral: avaliar o impacto do Protocolo Staged Diabetes Management no controle metabólico dos pacientes diabéticos do Centro Educativo de Enfermagem para Adultos e Idosos da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Objetivos específicos: caracterizar a população do estudo, segundo variáveis sociodemográficas — sexo e idade — e clínicas — tipo de diabetes, tempo de diagnóstico e co-morbidade —; descrever a evolução do tratamento e dos sinais e sintomas dos pacientes estudados; descrever e comparar o índice de massa corporal (IMC), perfil glicêmico, lipídico e da pressão arterial dos pacientes diabéticos, antes e depois da implementação do Protocolo SDM; avaliar o conhecimento dos pacientes diabéticos acerca de sua doença, antes e depois da implementação do Protocolo SDM e descrever a satisfação dos pacientes, depois da implementação do Protocolo SDM. A população foi constituída por 54 pacientes diabéticos do tipo 1 e do tipo 2, que atenderam aos critérios de inclusão e exclusão, de agosto de 2003 a abril de 2005. Para a coleta de dados, foram utilizados formulários, questionários, fichas de registros e exames laboratoriais, em três pontos denominados P0 — inicio do estudo; P6 — seis meses após o início do estudo, e P12 — o final do estudo. Na análise dos dados, utilizou-se o programa estatístico SPSS-11.5. Para a apresentação dos dados, os pacientes foram subdivididos em dois grupos G1 e G2. No grupo G1, foram alocados os pacientes diabéticos que encontravam-se no P0 em bom controle metabólico para cada um dos parâmetros clínicos, e no G2 os que estavam fora dos valores considerados como bom controle metabólico. Os resultados mostraram que a população do estudo caracterizou-se por pacientes adultos e idosos, com idade entre 29 e 78 anos, com mediana de 60 anos; com predomínio do sexo feminino, 74,1%. Quanto ao tipo de diabetes, a maioria, 96,3% é do tipo 2; o tempo de diagnóstico cuja mediana foi de 6,0, as co-morbidades mais freqüentes foram hipertensão, obesidade, dislipidemia e problemas vasculares. Quanto ao IMC, observou-se uma redução que não foi significativa para os grupos G1IMC e G2IMC. No que se refere a Hemoglobina A1c, houve redução significativa no G2HbA1c (p&#8776;0) de 1%, sendo que a redução foi de 8,8±1,2% para 7,8 ±1,1%. No G1, em relação ao perfil lipídico, houve aumento significativo do LDL (p&#8776;0) de 88,3±19,9 mg/dl para 111,4±24,4 mg/dl, e redução significativa do HDL (p&#8776;0), de 56,2±10,9 mg/dl para 44,4±9,2 mg/dl. Quanto ao colesterol total e os triglicerídeos, não houve diferença significativa. No grupo G2, houve redução significativa do colesterol total (p&#8776;0) de 229,9±20,2 mg/dl para 207,9±48,3 mg/dl e aumento significativo do HDL (p&#8776;0) de 34,5±2,3 mg/dl para 41,0 ±14,5 mg/dl. Não houve diferença significativa para os triglicerídeos. No que se refere à pressão arterial sistólica, no G1PAS, não houve diferença significativa. No G2PAS, houve redução significativa (p&#8776;0) de 146,0±8,8 mmHg para 128,8±9,9 mmHg. Quanto à pressão arterial diastólica, no G1PAD, não houve diferença significativa. No G2PAD, houve redução significativa (p&#8776;0) de 89,5±7,6 mmHg para 72,2±6,5 mmHg. Quanto ao conhecimento dos pacientes acerca dos cuidados para o controle metabólico, houve aumento significativo (p&#8776;0), com destaque para os tópicos referentes a diabetes mellitus: conceito, fisiopatologia e tratamento; atividade física e alimentação. Conclui-se que a implementação de um atendimento ao paciente diabético por equipe multiprofissional, contribuiu para melhorar o seu controle metabólico e a satisfação dos pacientes. / It is an almost-experimental study, prospective, comparative, with a model of before and after, performed in the Nursing Educational Center for Adults and Elders. General Objective: evaluate the impact of using the Staged Diabetes Management Protocol in controlling the diabetics patients metabolism, in the Nursing Educational Center for Adults and Elders at the Nursing School of the University of Sao Paulo, in Ribeirao Preto, Brazil. Specific Objectives: to characterize, the studied population, according to social-demographics variables – sex and age –, to clinical variables – diabetes type, time of diagnosis and co-morbidity –; to describe the evolution of treatment and of the signals and symptoms of the studied patients; to describe and to compare the IMC, the glicemic profile, the lipid profile and the arterial blood pressure, of the diabetic patients, before and after implementing the SDM Protocol; to evaluate de knowledge, that the diabetic patients have, before and after implementing the SDM Protocol and to describe the satisfaction of the patients, before and after implementing the SDM Protocol. The population was constituted by 54 diabetics patients types 1 and 2, which met the inclusion and exclusion criteria from August 2003 to April 2005. Data was collected with forms, questionnaires, register cards and lab exams, in three points denominated P0-beginning of the study; P6–six months after the beginning, and P12–at the end of the study. The data was analyzed with the statistical program SPSS-11.5. The patients were divided into two groups G1 and G2. In G1, were allocated diabetics patients that, at P0 had a good metabolic control for each of the clinic parameters; and in the group G2, the patients that did not present laboratory values in ranges considered as good metabolic control. The results showed that the studied population, was typified by adults and elderly patients, with ages between 29 and 78 years, median of 60 years; predominance of the female sex, 74,1%. Most of the studied population were diabetics type 2, 96,3%; the median of diagnostic time was of 6 years. The most frequent co-morbidities were hypertension, obesity, dislipedimia an vascular problems. The reduction in the body mass index was not a significant, between groups G1IMC e G2IMC. The A1c hemoglobin had a significant reduction in the group G2HbA1c (p&#8776;0) of 1%, from 8,8±1,2 to 7,8 ±1,1. In the group G1, the lipid profile had a significant increase of LDL (p&#8776;0), from 88,3±19,9 mg/dl to 111,4±24,4 mg/dl, and a significant reduction of HDL (p&#8776;0), from 56,2±10,9 mg/dl to 44,4±9,2 mg/dl. The total cholesterol and the triglycerides levels did not show a significant change. In group G2, there was a significant reduction of total cholesterol (p&#8776;0) from 229,9±20,2 mg/dl to 207,9±48,3 mg/dl and a significant increase of HDL (p&#8776;0) from 34,5±2,3 mg/dl to 41,0±14,5 mg/dl. There was not found a significant difference for triglycerides. The systolic arterial pressure, in G1PAS, did not show a significant difference; but in G2PAS, occurred a significant reduction (p&#8776;0) from 146,0±8,8 mmHg to 128,8±9,9 mmHg. The systolic arterial pressure, in G1PAD, did not present a significant difference; but in G2PAD, there was a significant reduction (p&#8776;0) from 89,5±7,6 mmHg to 72,2±6,5 mmHg. The patient’s knowledge about the procedures for metabolic control, increased significantly (p&#8776;0); with relevance for the topics referred to diabetes mellitus: concepts, physiopathology and treatments; physical activity and nutrition. In conclusion the implementation of the program for diabetics patients, involving a multi-professional team, contributed to improve the metabolic control and the satisfaction of the patients.

Trata-se de um estudo quase-experimental, prospectivo, comparativo, do tipo antes e depois, realizado no Centro Educativo de Enfermagem para Adultos e Idosos. Objetivo geral: avaliar o impacto do Protocolo Staged Diabetes Management no controle metabólico dos pacientes diabéticos do Centro Educativo de Enfermagem para Adultos e Idosos da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Objetivos específicos: caracterizar a população do estudo, segundo variáveis sociodemográficas — sexo e idade — e clínicas — tipo de diabetes, tempo de diagnóstico e co-morbidade —; descrever a evolução do tratamento e dos sinais e sintomas dos pacientes estudados; descrever e comparar o índice de massa corporal (IMC), perfil glicêmico, lipídico e da pressão arterial dos pacientes diabéticos, antes e depois da implementação do Protocolo SDM; avaliar o conhecimento dos pacientes diabéticos acerca de sua doença, antes e depois da implementação do Protocolo SDM e descrever a satisfação dos pacientes, depois da implementação do Protocolo SDM. A população foi constituída por 54 pacientes diabéticos do tipo 1 e do tipo 2, que atenderam aos critérios de inclusão e exclusão, de agosto de 2003 a abril de 2005. Para a coleta de dados, foram utilizados formulários, questionários, fichas de registros e exames laboratoriais, em três pontos denominados P0 — inicio do estudo; P6 — seis meses após o início do estudo, e P12 — o final do estudo. Na análise dos dados, utilizou-se o programa estatístico SPSS-11.5. Para a apresentação dos dados, os pacientes foram subdivididos em dois grupos G1 e G2. No grupo G1, foram alocados os pacientes diabéticos que encontravam-se no P0 em bom controle metabólico para cada um dos parâmetros clínicos, e no G2 os que estavam fora dos valores considerados como bom controle metabólico. Os resultados mostraram que a população do estudo caracterizou-se por pacientes adultos e idosos, com idade entre 29 e 78 anos, com mediana de 60 anos; com predomínio do sexo feminino, 74,1%. Quanto ao tipo de diabetes, a maioria, 96,3% é do tipo 2; o tempo de diagnóstico cuja mediana foi de 6,0, as co-morbidades mais freqüentes foram hipertensão, obesidade, dislipidemia e problemas vasculares. Quanto ao IMC, observou-se uma redução que não foi significativa para os grupos G1IMC e G2IMC. No que se refere a Hemoglobina A1c, houve redução significativa no G2HbA1c (p&#8776;0) de 1%, sendo que a redução foi de 8,8±1,2% para 7,8 ±1,1%. No G1, em relação ao perfil lipídico, houve aumento significativo do LDL (p&#8776;0) de 88,3±19,9 mg/dl para 111,4±24,4 mg/dl, e redução significativa do HDL (p&#8776;0), de 56,2±10,9 mg/dl para 44,4±9,2 mg/dl. Quanto ao colesterol total e os triglicerídeos, não houve diferença significativa. No grupo G2, houve redução significativa do colesterol total (p&#8776;0) de 229,9±20,2 mg/dl para 207,9±48,3 mg/dl e aumento significativo do HDL (p&#8776;0) de 34,5±2,3 mg/dl para 41,0 ±14,5 mg/dl. Não houve diferença significativa para os triglicerídeos. No que se refere à pressão arterial sistólica, no G1PAS, não houve diferença significativa. No G2PAS, houve redução significativa (p&#8776;0) de 146,0±8,8 mmHg para 128,8±9,9 mmHg. Quanto à pressão arterial diastólica, no G1PAD, não houve diferença significativa. No G2PAD, houve redução significativa (p&#8776;0) de 89,5±7,6 mmHg para 72,2±6,5 mmHg. Quanto ao conhecimento dos pacientes acerca dos cuidados para o controle metabólico, houve aumento significativo (p&#8776;0), com destaque para os tópicos referentes a diabetes mellitus: conceito, fisiopatologia e tratamento; atividade física e alimentação. Conclui-se que a implementação de um atendimento ao paciente diabético por equipe multiprofissional, contribuiu para melhorar o seu controle metabólico e a satisfação dos pacientes. / It is an almost-experimental study, prospective, comparative, with a model of before and after, performed in the Nursing Educational Center for Adults and Elders. General Objective: evaluate the impact of using the Staged Diabetes Management Protocol in controlling the diabetics patients metabolism, in the Nursing Educational Center for Adults and Elders at the Nursing School of the University of Sao Paulo, in Ribeirao Preto, Brazil. Specific Objectives: to characterize, the studied population, according to social-demographics variables – sex and age –, to clinical variables – diabetes type, time of diagnosis and co-morbidity –; to describe the evolution of treatment and of the signals and symptoms of the studied patients; to describe and to compare the IMC, the glicemic profile, the lipid profile and the arterial blood pressure, of the diabetic patients, before and after implementing the SDM Protocol; to evaluate de knowledge, that the diabetic patients have, before and after implementing the SDM Protocol and to describe the satisfaction of the patients, before and after implementing the SDM Protocol. The population was constituted by 54 diabetics patients types 1 and 2, which met the inclusion and exclusion criteria from August 2003 to April 2005. Data was collected with forms, questionnaires, register cards and lab exams, in three points denominated P0-beginning of the study; P6–six months after the beginning, and P12–at the end of the study. The data was analyzed with the statistical program SPSS-11.5. The patients were divided into two groups G1 and G2. In G1, were allocated diabetics patients that, at P0 had a good metabolic control for each of the clinic parameters; and in the group G2, the patients that did not present laboratory values in ranges considered as good metabolic control. The results showed that the studied population, was typified by adults and elderly patients, with ages between 29 and 78 years, median of 60 years; predominance of the female sex, 74,1%. Most of the studied population were diabetics type 2, 96,3%; the median of diagnostic time was of 6 years. The most frequent co-morbidities were hypertension, obesity, dislipedimia an vascular problems. The reduction in the body mass index was not a significant, between groups G1IMC e G2IMC. The A1c hemoglobin had a significant reduction in the group G2HbA1c (p&#8776;0) of 1%, from 8,8±1,2 to 7,8 ±1,1. In the group G1, the lipid profile had a significant increase of LDL (p&#8776;0), from 88,3±19,9 mg/dl to 111,4±24,4 mg/dl, and a significant reduction of HDL (p&#8776;0), from 56,2±10,9 mg/dl to 44,4±9,2 mg/dl. The total cholesterol and the triglycerides levels did not show a significant change. In group G2, there was a significant reduction of total cholesterol (p&#8776;0) from 229,9±20,2 mg/dl to 207,9±48,3 mg/dl and a significant increase of HDL (p&#8776;0) from 34,5±2,3 mg/dl to 41,0±14,5 mg/dl. There was not found a significant difference for triglycerides. The systolic arterial pressure, in G1PAS, did not show a significant difference; but in G2PAS, occurred a significant reduction (p&#8776;0) from 146,0±8,8 mmHg to 128,8±9,9 mmHg. The systolic arterial pressure, in G1PAD, did not present a significant difference; but in G2PAD, there was a significant reduction (p&#8776;0) from 89,5±7,6 mmHg to 72,2±6,5 mmHg. The patient’s knowledge about the procedures for metabolic control, increased significantly (p&#8776;0); with relevance for the topics referred to diabetes mellitus: concepts, physiopathology and treatments; physical activity and nutrition. In conclusion the implementation of the program for diabetics patients, involving a multi-professional team, contributed to improve the metabolic control and the satisfaction of the patients.

No description available.

No description available.

Diabetes type 1 is an autoimmune, incurable disease which requires careful monitoring and treatment to not result in life threatening complications. Managing the disease is to a great extent made by the patients themselves, implying the disease needs to be constantly taken into consideration when doing even the most simple and regular everyday tasks and activities.This study aims to examine the use of AI in everyday treatment for patients with diabetes type 1. The study investigated what areas AI is already used in diabetes care management, and where there is room for development. The purpose is to give an indication of what role AI has and potentially can have in making the life for patients with diabetes type 1 easier. The research was conducted by a combined literature review and a cross sectional multiple case-study, with semi-structured interviews with people diagnosed with diabetes type 1. The gathered data were analyzed in relation to the triangle of diabetes management and technology acceptance model 2. The first indicates what factors are of highest relevance to not create dangerous situations for a diabetic, and the second relates to whether users would accept the use of a complex technology. The result suggested wide current and further potential use of AI in creating functionality in treatment and everyday management of the disease. Further, it became evident that technological tools simplify the lives of diabetics but there are several areas where AI could be further implemented in order to improve it even further.

Diabetes mellitus (DM) is a highly prevalent chronic disease that affects 29 million people in the United States including over 2 million veterans who receive care through the Veterans Administration. Patient-aligned care teams (PACTs) are an interprofessional teamwork system designed to improve outcomes of chronic illness, but empirical explorations of the efficacy of the PACTs have been insufficient. Utilizing the chronic care model, the purpose of this retrospective study was to determine if PACTs have been efficient in the diabetic management of veterans receiving care through a Southeastern VA. Medical records for 114 veterans with type 2 DM were randomly selected. A 1-way ANOVA was used to analyze outcomes for 5 evidence-based standards (SBP, DBP, BGL, A1C, & LDL) among 6 outpatient clinics. A repeated measures ANOVA was used for the same 5 evidence-based standards for the clinics to assess if there were any changes from FY2014 to FY2016. Results revealed that blood pressure readings and LDL levels met evidence-based standards, while A1C and BGL levels did not. No significant differences over the 3-year period were noted nor were there significant differences in patterns of performance between the clinics. The findings provide an essential basis for initiating a discussion on the potential of PACTs for the delivery of quality healthcare to U.S. veterans with diabetes and other chronic diseases. Positive social change can result from improving the delivery of healthcare using the PACT model to decrease morbidity, improve clinical outcomes, and increase the quality of life of U.S. veterans with type 2 DM. Future research that examines perceptions of clinical team members, team stability, and the delivery of shared care is warranted.

Introduction: The management of type 1 diabetes through the use of Continuous Subcutaneous Insulin Infusion (CSII); also known as insulin pump therapy, has become an increasingly popular option for children and adolescents. A systematic review of studies that measured Quality of Life (QoL) in children associated with CSII was conducted. Eighteen studies were reviewed, and the results showed insufficient evidence to conclude that CSII improves QoL in children and adolescents with type 1 diabetes. The current study aimed to address the gap in the literature by exploring children and parents’ perspectives on the use of CSII for managing diabetes. Method: Data were gathered from five children aged 8 – 14 years (and five parents), using one to one semi-structured interviews. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Results: Five super-ordinate themes were identified for parents: ‘Parenting a Child with Diabetes’; ‘Worth the Hard Work’; ‘Strive for Normality’; The Pump as an Enabler’; and ‘An eye on the Future’. Three Super-ordinate themes were identified for children ‘Feeling Different’; Grappling for Control’; and ‘Better…’ which were associated with a central theme of ‘Developing a Relationship with the Pump’. Children’s data is presented separately within a journal article format. Discussion: Findings suggest that parents value the insulin pump, despite acknowledging the challenges, particularly the hard work required to manage it. Children seemed to have an ambivalent but developing relationship with the insulin pump. They experience a number of benefits and drawbacks associated with the use of CSII and it seems to affect their identity and their locus of control. Conclusion: This research provides a greater insight into the lived experience of CSII for children and their parents. The benefits of CSII seemed to outweigh the challenges involved particularly for parents; and children seemed to be developing a relationship with the pump within the realms of their relationship with diabetes.