ABSTRACT The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) estimates the prevalence of Type 2 Diabetes Mellitus in South Africa to be approximately 13% in the Indian, 3% in the European and 4.8-8% in the African population group. Morbidity from diabetes is a consequence of both macrovascular and microvascular disease. Over the last decade, a fundamental transformation of the principles of management of type 2 diabetes has occurred. This was driven by a large number of multicentre randomized clinical trials documenting improved outcomes associated not only with glycaemic control, but also with use of antihypertensive, lipid lowering and anti-platelet therapy. The objective of this research report was to ‘revisit’ our diabetes clinics to ascertain how many diabetic patients are reaching the lipid, blood pressure, body mass index, waist circumference and glucose targets as recommended by the SEMDSA guidelines and to ascertain if there has been any improvement since a previous study conducted a decade ago. Study design included a sample of 150 patients. Body mass indices (BMI), fasting lipograms, glycated haemoglobin (HbA1c), waist measurements and blood pressure were determined in patients with type 2 diabetes mellitus who were on oral agents or insulin (Protaphane), or a combination thereof, and who were age 35 years or older. Results showed that, out of the 150 patients, 98 were females and 52 were males. Black patients constituted 68%, White 12,7%, Indian 10,7% and Coloured 8,7%. The mean age was 59 years. The mean HbA1c was 8,7% with HbA1c being more than 8% in 83 patients (55%). Obesity was present in 37,3% of the patients; it was class I (BMI 30-34,9 kg/m2) in 22%, class II (BMI 35-39,9) in 10% and class III (BMI >40) in 5,3%. Hypercholesterolaemia (total cholesterol > 5,0 mmol/l) was present in 29,3%, hypertriglyceridaemia (total triglycerides > 1,5 mmol/l) in 45,3% of the patients. Waist circumference was greater or equal than 80cm in 98% of the females and greater or equal than 94cm in 69% of males. In the whole cohort of 150 patients, 127 were hypertensive (84,67%). 78,74% of patients with hypertension had systolic blood pressure above or equal to 130 mmHg and 59,84% had diastolic blood pressure above or equal to 80 mmHg. Out of the 150 patients, 43% did not engage in regular exercise, 6% smoked cigarettes and 51% were on aspirin. In conclusion these findings are similar to those from a previous study conducted in 1996 and show little improvement in the holistic care of patients with type 2 diabetes.

Diabetes is the 7th leading cause of death in the United States and is the main cause of chronic kidney failure, nontraumatic limb amputations, blindness, myocardial infarction, and stroke. Many patients with diabetes do not meet goals for at least 1 control measure of blood sugar, blood pressure, or cholesterol. The purpose of the project was to implement a template for documentation--a toolkit for patient care management-to improve blood glucose and blood pressure levels in a rural health clinic in central Texas for 33 patients with diabetes during a 6- to 8-week timeframe. The practice-focused question asked whether management of patients with diabetes would be improved if documentation on a standard template were used by all providers at the site. Models used in this doctoral project included the chronic care model and the Institute for Healthcare Improvement breakthrough series collaborative model. Sources of evidence included published outcomes and research from a systematic review of the literature, archival and operational data collected from the rural health clinic, and evidence from the project. Glycosalated hemoglobin levels improved from a mean of 8.9 mg to 7.6 mg in 31 of 33 participants (t = 2.684, 30 df, p = .012). Systolic and diastolic blood pressures were reduced slightly, but changes were not statistically significant. Potential implications for positive change in nursing practice include improvements in clinical management, implementation of evidence-based practice, and improved outcomes for patients with diabetes. Incorporating evidence-based practice provides scientific justification for actions that will improve clinical outcomes for patients, which leads to healthier patients, families, and communities and contributes to positive social change.

Cukrinis diabetas (CD) yra valdoma liga, kuriai būtina ne tik tinkama ir atitinkanti gydymo standartus medikų teikiama diabeto priežiūra, bet ir sergančiųjų šia liga savipriežiūra. Darbo tikslas. Įvertinti ir palyginti Kauno miesto ir rajono pirminės sveikatos priežiūros centrų pacientų, sergančių CD, požiūrį į diabeto priežiūrą. Uždaviniai: 1) įvertinti ir palyginti Kauno miesto ir rajono pirminės sveikatos priežiūros centrų (PSPC) pacientų, sergančių CD, demografines socialines, gyvensenos ir CD charakteristikas; 2) įvertinti ir palyginti Kauno miesto ir rajono PSPC sergančių CD, požiūrį į savipriežiūrą bei CD priežiūros prieinamumą; 3) įvertinti Kauno miesto ir rajono PSPC pacientų, sergančių CD, pasitenkinimą cukrinio diabeto priežiūra. Tyrimo metodika. Tirti suaugę Kauno miesto privataus PSPC (n=104) ir Kauno rajono privataus PSPC pacientai (n=151), sergantys CD. Anoniminė anketinė apklausa vyko nuo 2009-10-05 iki 2010-02-10, naudojant tyrėjų sudarytą klausimyną. Duomenys analizuojami standartiniais statistiniais metodais (SPSS 13,0), skaičiuojant vidurkius, vertinant požymių priklausomybę pagal Pirsono (χ2) kriterijų, veiksnių pasireiškimo palyginimui skaičiuota šansų santykiai, veiksnių įtakai nustatyti atlikta logistinė regresija. Rezultatai. Miesto sergančiųjų CD tarpe, lyginant su rajono, buvo keturis kartus daugiau neturinčių jokių diabeto komplikacijų, bet du kartus dažniau besigydančių dėl CD problemų ligoninėje, taip pat daugiau įgijusių aukštesnį išsilavinimą... [toliau žr. visą tekstą] / Diabetes mellitus (DM) is a manageable disease, but it requires suitable and adequate care according treatment standards as well as self-management of the disease. The aim of the study: To assess and compare the attitudes towards diabetes care of patients with DM of Primary Health Care Centres in Kaunas city and Kaunas rural area. The objectives of the study: 1) to assess and compare demographic, social, lifestyle and disease characteristics of patients with DM of Primary Health Care Centres in Kaunas city and rural area; 2) to assess and compare the attitudes towards self-management of DM and medical care accessibility of Primary Health Care Centres in Kaunas city and rural area; 3) to assess and compare satisfaction with diabetes care of patients of Primary Health Care Centres in Kaunas city and rural area. Methods: Adult patients with DM from Kaunas city Primary Health Care centre (n =104) and from Kaunas rural area Primary Health Care centre (n=151), were involved in the survey. Anonymous questionnaire survey was carried out since 2009-10-05 until 2010-02-10 using the questionnaire developed by researchers. Statistical analysis package (SPSS 13,0) was used to analyse the data. Dependence of symptoms was researched by the use of Pirson test (χ²). Odds ratio was computed for comparison of factor manifestation. Logistic regression was performed in order to determine the influence of factors. The results: Among the patients with DM in the city, comparing to the rural area... [to full text]

Increasing rates of adult-onset diabetes in low- to middle-income countries (LMICs) present a growing healthcare concern that requires a regulatory approach and local community engagement. Cross-sector collaboration (CSC) is an effective strategy for improving community health. CSC is not effectively used to manage adult-onset diabetes in LMICs, nor is there public policy advocating CSC in the management of diabetes. This qualitative exploratory case study explored how leadership and resources affect the use of CSC to assist in managing the adult-onset of diabetes in a CSC in Cameroon. A purposeful sampling strategy was used to identify participants for semistructured interviews of 10 executives involved in the CSC. CSC theory provided a theoretical framework. Collected data were organized by audio recording, transcribing, translating, member checking, and thematically coding data using NVivo 12 software. Data from a review of documents and researcher observations were triangulated with interview data. Findings revealed that poverty, access to health care, and rising diabetes prevalence contributed to environmental turbulence. Goal-setting and objectives, intersectoral-communication, fostering trust and respect, and sharing data and motivating people presented leadership effectiveness challenges. The following resource challenges emerged in the CSC: public policy, money, skills and expertise, equipment and supplies, and connection to the target population. This increased scientific understanding could help government policy-makers and nongovernmental organizations expand public policy leading to a decrease in the prevalence and burden of adult-onset diabetes.

Un problème préoccupant du suivi des patients diabétiques en République Démocratique du Congo (RDC) demeure ceux perdus de vue qui ne cessent d’augmenter. En effet, beaucoup de patients négligent la gestion de leur maladie pour plusieurs raisons, parmi lesquelles les croyances religieuses. En général, les religions promeuvent la vie et consolident sa protection. Certaines croyances religieuses, cependant, confortent des comportements démissionnaires et irresponsables au regard de la santé. La présente recherche vise à comprendre le rôle des connaissances et des facteurs religieux sur l’autogestion du diabète. Une enquête qualitative descriptive par entretiens semi-dirigés a été réalisée à Kinshasa auprès de 23 fidèles diabétiques et ainsi qu’au moyen de trois groupes de discussion impliquant des leaders religieux de ces églises. Cette étude a démontré une connaissance erronée et insuffisante de la maladie et à l’influence des croyances religieuses sur la gestion du diabète. Les participants identifiaient le diabète comme une maladie grave, curable par des prières et par des plantes traditionnelles dictées par Dieu. Ils manifestaient un déni de la maladie, ce qui influençait leurs habitudes de vie (c’est-à-dire leur régime alimentaire et leur activité physique). Se disant détenir le pouvoir de guérison, les chefs religieux pouvaient interrompre le traitement médical et acceptaient que leurs fidèles diabétiques se rendent à l’hôpital uniquement pour vérifier leur taux de glycémie. Notre étude implique que les réseaux d’affiliation religieuse et d’entraide devraient être ciblés par les stratégies de sensibilisation contre la désinformation, afin de réduire les complications et les décès dus au diabète à Kinshasa en particulier et en République Démocratique du Congo en général. / An important problem in the follow-up of diabetic patients in the Democratic Republic of Congo (DRC) remains the lost to follow-up which continues to increase. Many patients neglect the management of their disease for several reasons including religious beliefs. In general, religions promote life and consolidate its protection. Certain religious beliefs, however, reinforce resigning and irresponsible behaviors regarding health. The current research aims to understand the role of knowledge and religious factors in the self-management of diabetes. A descriptive qualitative study by semi-structured interviews was carried out in Kinshasa among 23 diabetic patients and three focus groups of religious leaders from prophetic churches. This study suggests an incorrect and insufficient knowledge of the disease, and the influence of religious beliefs on diabetes management. Participants identified diabetes as a serious disease that was curable by prayers and by traditional plants dictated by God. They displayed a denial of the disease which influenced their lifestyle (i.e., diet and physical activity). Claiming to have the ability to heal, religious leaders could interrupt medical treatment and only allowed their diabetic patients to go to the hospital to check their blood sugar levels. Our study implies that religious affiliation and mutual aid networks should be targeted by advocacy strategies against disinformation to reduce complications and deaths from diabetes in Kinshasa and in the Democratic Republic of Congo.