CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / O diabetes mellitus tipo 2 à uma doenÃa de importÃncia crescente na saÃde pÃblica, jà que sua incidÃncia e prevalÃncia tÃm avanÃado de forma assustadora, sendo causada por uma combinaÃÃo de fatores genÃticos e estilo de vida. Em face disso, a saÃde pÃblica indica a prevenÃÃo primÃria para identificar os fatores de risco para DM2 e traÃar estratÃgias com vistas a evitar a exposiÃÃo ao risco, retardando ou impedindo o aparecimento da doenÃa. Objetivou-se avaliar o risco para o desenvolvimento do DM2 entre adultos de Itapipoca-CE. Trata-se de pesquisa quantitativa, com delineamento transversal e observacional, realizada no perÃodo de janeiro a marÃo de 2010, com 419 usuÃrios da EstratÃgia SaÃde da FamÃlia do municÃpio de Itapipoca-CE, com idades entre 20 e 59 anos. Para a coleta de dados aplicou-se um formulÃrio no qual se registraram dados sociodemogrÃficos e clÃnicos e o Finnish Diabetes Risk Score. Os dados foram armazenados no Excel, sendo processados no Statistical Package for Science Social versÃo 18.0. O estudo foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do Cearà sob protocolo 346/09. Dos 419 usuÃrios participantes, 88,1% eram do sexo feminino; a mÃdia de idade foi de 37 anos; 60,4% eram casados ou mantinham uniÃo estÃvel; 39,4% cursaram atà o ensino fundamental incompleto e 58,2% pertenciam Ãs classes econÃmicas D/E. Em relaÃÃo aos fatores de risco para DM2, 25,3% tinham idade ≥ 45 anos; 59,7% estavam com excesso de peso; 84% foram classificados em risco cardiovascular; 83,3% eram sedentÃrios; 53,7% relataram nÃo comer frutas e/ou verduras diariamente; 12,9% tomavam anti-hipertensivos; 5,3% mencionaram histÃria prÃvia de glicose alta e 47% histÃria familiar de DM2. Segundo observou-se, 5,2% da amostra foram classificados com hipertensÃo e apenas 0,7% com provÃvel diabetes. Quanto ao grau de risco para DM2, 24,6% estavam em baixo risco; 63% em risco moderado e 11,7% em alto risco. Entre os participantes com alto risco, 12,0% eram homens; 30,2% tinham idades ≥ 45 anos; 37,4 estavam com excesso de peso; 21,1% estavam em risco cardiovascular aumentado; 12,9% eram sedentÃrios; 14,7% nÃo comiam frutas/verduras diariamente; 31,5% tomavam anti-hipertensivos; 81,8% relataram histÃria de glicose alta e 23,9% histÃria familiar de DM2. Esse estudo abre portas para uma posterior pesquisa de intervenÃÃo no municÃpio, na qual os indivÃduos com alto risco para DM2 seriam acompanhados pelos profissionais de saÃde da ESF e dos NÃcleos de Apoio à SaÃde da FamÃlia, com orientaÃÃes quanto Ãs mudanÃas no estilo de vida, e com intervenÃÃes nos fatores de risco potenciais encontrados, objetivando reduzir ou retardar o aparecimento da doenÃa. / The type 2 diabetes mellitus is a disease of increasing importance in public health, since its incidence and prevalence have dauntingly advanced, and has been caused by a combination of genetic factors and lifestyle. In this view, public health indicates primary prevention to identify risk factors for T2DM and strategize in order to avoid exposure to risk by delaying or preventing the onset of the disease. The objective was to evaluate the risk for the development of T2DM among adults in Itapipoca town-CearÃ. It is a quantitative research with cross-sectional observational study conducted from January to March 2010, with 419 users of EstratÃgia SaÃde da FamÃlia (ESF) in Itapipoca town-CearÃ, the participants aged between 20 and 59 years. To collect data we applied a form in which demographic and clinical data and Finnish Diabetes Risk Score were registered. The data were stored in Excel, and processed in the Statistical Package for Social Science 18.0. The study was approved by the Ethics Committee of the Federal University of CearÃ, under protocol 346/09. Out of the 419 participating users, 88.1% were female and the average age was 37 years, 60.4% were married or had common law-marriage, 39.4% attended to part of primary school and 58.2% belonged to lower social classes. Regarding risk factors for T2DM, 25.3% were aged ≥ 45 years, 59.7% were overweight, 84% were classified as cardiovascular risk, 83.3% were sedentary, 53.7% reported not eating fruit and / or vegetables daily, 12.9% were taking anti-hypertensive, 5.3% reported a previous history of high glucose and 47% had family history of T2DM. As observed, 5.2% of the sample were classified as having hypertension, and only 0.7% with probable diabetes. As for the risk levels for T2DM, 24.6% were at low risk, 63% in moderate risk and 11.7% at high risk. Amongst participants with high risk, 12.0% were men, 30.2% were aged ≥ 45 years, 37.4% were overweight, 21.1% were at increased cardiovascular risk, 12.9% were sedentary; 14.7% did not eat fruit / vegetables daily, 31.5% took antihypertensive drugs, 81.8% reported a history of high glucose and 23.9% had family history of T2DM. This study opens doors for further intervention research in the town, in which individuals at high risk for T2DM would be accompanied by health professionals from the ESF and the NÃcleos de Apoio à SaÃde da FamÃlia. With the aim to reduce or delay the onset of the disease, the individuals would be given guidance as to changes in lifestyle and interventions on potential risk factors found.

Human immunodeficiency virus (HIV) is one of the largest public health problems internationally today and southern Africa is the part of the world that is most affected. Successful research has led to new improved antiretroviral drugs. Even if these drugs are improved and more successful, they bring along side effects. Research studies have shown that treatment of HIV entails metabolic changes and increases the risk for developing diabetes. This side effect can have a large impact on the patient’s quality of life and the affected patients often have to make lifestyle changes. To be able to develop the care around this group of patients, it is important to understand the complexity of nursing them. The aim with our study is to look into how nurses in Namibia experience caring for patients with HIV who also has type 2 diabetes as a side effect from antiretroviral drugs. Our study is a qualitative study based on interviews with six nurses working at Katutura hospital in Windhoek, Namibia. We did the interviews at Katutura hospital and the interviews were recorded. We transcribed the interviews and used Lundman & Hallgren Granheims (2012) method for analyzing the collected data. The result showed that health education raises awareness and through that, the prevention of HIV increases and the risk of failure for already infected persons is reduced. Overall shall openness be a leading influencer in every aspect around the patient, the nurses, the community and the family’s treatment. The discussion brings up the importance of educating people both in the community and inside the healthcare spectra. It also brings up the importance of openness, both from the patients and nurses.

Background: Diabetes is a growing chronic disease that affects more than 29 million adults in the United States and 422 million adults globally. Women with a history of gestational diabetes (GDM) are identified to be at higher risk for developing subsequent type 2 diabetes mellitus (T2DM). The prevalence of GDM varies based on the data collection method, response rate, and diagnostic criteria. The aim of this study is to examine the association between history of GDM diagnosis and current T2DM status and how the relationship differs based on the participant’s age, race, and BMI. Methods: Data from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys (NHANES) were analyzed to conduct a cross-sectional study of 4,006 U.S. non-pregnant women ages 20 years and older with a history of prior pregnancy. The race/ethnicity of the participants include non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, non-Hispanic Asians, and "Other" variables. Univariate and multivariate logistic regression analyses were used to determine the association between history of GDM and current T2DM status stratified by age, race, and BMI. Results: Three hundred and fifteen subjects from a sample size of 4006 were found to have a history of GDM. Of the 315 participants with GDM, 111 (35.2%) were found to develop T2DM. After controlling for age, race, and body mass index (BMI), women with a history of GDM were found to be at greater odds of T2DM (OR=4.71; 95% CI: 3.52-6.28) compared to women without a history of GDM. A multivariate analysis was performed adjusting for other covariates such as age, race, BMI, and cholesterol. When stratified by participant age, women between the ages of 20-44 years with a history of GDM were linked with an increased risk of T2DM (OR= 3.02; 95% CI: 1.88-4.85). Overweight and obese women with a history of GDM have a 2.5-fold risk of developing T2DM (OR=2.51; 95% CI: 1.49-4.23). Discussion: This study provides further understanding and awareness on the role of GDM during the subsequent risk for T2DM. Our study shows women between the ages of 20 and 44 years and with elevated BMIs (25 ≥ kg/m2) are at increased risk of developing subsequent T2DM. Findings suggest the need for health promotion and prevention efforts towards the populations at risk. Early intervention post-pregnancy and education may help prevent women with a history of GDM from developing T2DM.

Class of 2005 Abstract / Objectives: The purpose was to describe the glycemic control of hospitalized patients treated with sliding scale insulin (SSI) and correlate glycemic episodes to other factors. Methods: The records of 315 patients admitted to a private, 166-bed hospital between August 25 and November 30, 2004 were identified from orders for antidiabetic medications then screened for inclusion and exclusion criteria. 135 of these patients met the criteria for inclusion in this study and their charts were reviewed for demographic data, medical history, medication regimens, blood glucose measurements and SSI use during hospitalization. Hypoglycemia was defined as less than or equal to 50 mg/dL and hyperglycemia greater than 250 mg/dL. Results: Orders for SSI were written for 93% of diabetic patients admitted. 2,904 blood glucose fingerstick measurements were recorded: 15.9% were greater than 250 mg/dL and 0.689% were under 50 mg/dL. The only statistically significant result was the correlation between increased numbers of hyperglycemic episodes and the consumption of the hospital’s “diabetic diet,” p<0.001. The small group of patients admitted for cellulitis (N=6) also experienced more hyperglycemic episodes. There was a trend approaching significance, p=0.055, for an increased number of hyperglycemic episodes in patients with admission blood glucose value over 200 mg/dL. Results based upon the hospital’s standard SSI regimen were not significantly different from other variations of SSI. Implications: SSI was almost always prescribed for hospitalized patients with type 2 diabetes and this regimen resulted in poor glucose control in approximately 17% of fingerstick measurements.

Class of 2005 Abstract / Objectives: The purpose of the study was to evaluate if rosiglitazone was being used in full compliance with the SAVA consensus criteria for appropriate use of thiazolinediones. Methods: A retrospective chart review was performed on 50 SAVA patients selected at random from a list of patients that were on rosiglitazone treatment as of March 15, 2005. Results: The percent of patients who met all of the criteria set forth by the SAVA when initiating therapy was 44%. Rosiglitazone treatment should not have been started in 28 out of the 50 patients. Once initiated on rosiglitazone, patients’ follow-up ALT was only obtained in 16% of patients. Once rosiglitazone has been prescribed for 3 months, HbA1c should decrease. Twenty percent of the patients showed an increase in HbA1c from baseline and were continued on the medication despite the criteria. Implications: Once therapy was initiated, the majority of patients studied failed to meet the SAVA guidelines for the appropriate use of rosiglitazone. In addition, a majority failed to follow the aspects of the guideline regarding initiation of rosiglitazone therapy.

Class of 2005 Abstract / Objective: To determine the effect that a pharmacist run diabetes mellitus (DM) care clinic has on glycemic control, as measured by glycosylated hemoglobin (HbA1c) levels. The baseline comparison group is the current standard of care consisting of physician only treated DM patients. Methods: This project is a retrospective cohort analysis of clinical data obtained from patient charts, patients were matched on age. The pharmacist treated group, from a community health center clinic with a collaborative care agreement for the treatment of DM (Group 1), provided comprehensive DM treatment based upon a prearranged treatment protocol with clinic physicians. The physician treated group, is from an outpatient clinic situated at a community hospital (Group 2). The primary outcome was change in HbA1c over at least a 6 month period of time. Patients from both groups were diagnosed with type 2 diabetes mellitus, >18 years of age, and enrolled in an Arizona Health Care Cost Containment System (AHCCCS) Medicaid insurance program. Patients could be treated with oral antidiabetic medication, an insulin product, or a combination of both. Results: A total of 321 patients were included in the study, Group 1 n=161, Group 2 n=160. Ages were similar, mean age=57.7 (SD=12.2) for Group1 and mean age=57.4 (SD=12.3) for Group 2. Gender (male=33.5% and 37.5% respectively) and ethnicity were also similar (p>0.45). The average HbA1c levels at baseline and at the end of treatment were as follows; Group 1 (9.8 and 7.8), and Group 2 (8.8 and 8.9) p<0.001 for post treatment comparison. Implications: This study indicates that physician pharmacist collaborative care improves glycemic control, as shown by significantly lower HbA1c levels than the physician treated group.

Type 2 diabetes mellitus (T2DM) continues to be a national challenge for Canadians. African and Caribbean Immigrants are among the most affected groups and those at risk of developing comorbidities and related complications. It continues to prove challenging to treat T2DM for the affected individuals. Effectively treating the disease can help mitigate risk factors for related comorbidities and complications while improving the quality of life for those affected. There is increasing research, outside of Canada, showing the evidence for the effectiveness of culturally sensitive and adapted interventions to immigrant patients affected with T2DM. In light of the effectiveness of such interventions in many industrialized nations, a systematic review (SR) can offer the best evidence for the scope and consideration of such treatment approaches in Canada. This SR aimed to determine whether community-based diabetic interventions in Canada, are culturally sensitive to African and Caribbean minorities living with type II diabetes. A narrative synthesis was employed to report the effect of interventions seeking to affect outcomes of T2DM patients in Canada. Of the 63 articles included for full review, 60 were excluded for not meeting the criteria of having the target population explicitly identified and also not having any mention of cultural sensitivity. Three articles were included for the final review because the target population was explicitly identified. The final results showed that all interventions were found not to be culturally sensitive to African and Caribbean T2DM patients in Canada. Our results suggest a lack in Canadian literature. To the best of our knowledge, this is the very first systematic review on this subject matter in Canada. This review provides dependable information and recommendations to researchers, educators, clinicians, and policy makers for future research with T2DM African and Caribbean patients in Canada. RÉSUMÉ Le diabète de type 2 demeure un défi national pour les Canadiens. Les immigrants d’origine d’Afrique et des Caraïbes sont parmi les groupes les plus frappés et l'un des plus à risque de développer des troubles comorbides et de complications liées au diabète. Traiter le diabète continue à poser un défi chez les personnes affectées. Traiter efficacement cette maladie peut contribuer à réduire des principaux facteurs de risque quant aux troubles comorbides et complications, tout en améliorant la qualité de vie chez les personnes affectées. Un nombre grandissant de recherche, hors du Canada, démontrent avec des preuves concluantes que les interventions sensibles et culturellement adaptées aux immigrants affectés par le diabète sont efficaces. Étant donné l'efficacité de ces interventions dans nombreux pays industrialisés, une revue systématique peut nous offrir la meilleure preuve pour l'envergure relative à ce genre de traitement au Canada. La présente étude méthodique vise à déterminer si les interventions contre le diabète, en milieu communautaires au Canada, sont culturellement adaptées aux minorités ethniques d’origines d’Afrique et des Caraïbes souffrant de diabète de type II. Une synthèse narrative a été utilisée afin de signaler les effets des interventions par rapport aux résultats des patients souffrant du diabète de type 2. Parmi les 63 articles considérés pour une évaluation complète, 60 ont été exclus car ni la population cible ou la mention de la sensibilité culturelle n’a été explicitement identifiée. Trois articles ont été inclus pour l’évaluation finale car la population cible fut explicitement identifiée. Aucune des interventions n’est culturellement sensible aux patients Africains et Caribéen affecté par le diabète de type 2. Nos résultats démontrent un écart dans la littérature Canadienne. A ce que nous sachons, cette revue systématique est la première qui touche à cette question au Canada. Cette revue fournie des données fiables et recommandations qui permettront aux chercheurs, enseignants, cliniciens, et aux décideurs en matière de politiques de santé pour des recherches futures auprès des patients Africains et Caribéen souffrants du diabète de type 2 au Canada.

Class of 2008 Abstract / Objectives: To determine the cost-effectiveness of adding a thiazolidinedione (TZD) versus insulin glargine (glargine) as a triple regimen for treatment of Type 2 diabetes mellitus for patients not controlled with metformin and a sulfonylurea. Methods: A decision analytic model was developed to compare the clinical outcomes and costs of triple therapy with either a TZD or glargine. Published literature was used to determine treatment efficacy and the frequency of clinically important adverse effects. Cost data were obtained from the 2007 Physician Fee Reference and North Carolina Industrial Commission website. The decision tree was built using TreeAge software. Clinical outcome measures included HgA1c (A1C) control, hypoglycemia frequency, and the development of edema associated with the use of these medications. A Monte Carlo probabilistic sensitivity analysis was conducted to determine the mean and 95% CIs for both treatment efficacy and costs. Results: There was no statistically significant difference in the efficacy of adding either a TZD or glargine in achieving a goal A1C ≤ 7%. However, glargine triple therapy was estimated to be significantly less costly than TZD triple therapy ($3,161/yr; 95% CI $3,116 to $3,356 versus $3,769/yr; 95% CI $3,667 to $3,902, respectively). Conclusions: Most patients requiring triple therapy for the management of T2DM should receive glargine rather than a TZD due to the significantly lower cost producing similar clinical efficacy.

Introduction: The global burden of diabetes can be minimised by interventions focusing on the control of glucose levels. Effective self-management and quality of care have improved diabetes outcomes such as glycaemic levels. However, few studies directly evaluate the relative importance of individual aspects of self-management and quality of care on glycaemic control. Therefore, I evaluated the individual contribution and relative importance of specific aspects of self-management and quality of care on the glycaemic control of Mexican patients with type 2 diabetes. Methods: A longitudinal cohort study was conducted. Consecutive patients were recruited from the waiting rooms in five primary care practices in the city of Aguascalientes, Mexico (from December 2009 to April 2010). These practices are part of the largest social security institution in Mexico (the Mexican Institute for Social Security). Predictors of glycaemic control were measured from medical records and interviews with patients at baseline. Self-management was measured using four questionnaires: the Diabetes Knowledge Questionnaire (DKQ-24), the Medical Prescription Knowledge Questionnaire (MPKQ), the Summary of Diabetes Self-Care Activities (SDSCA), and the Diabetes Self Efficacy Scale. Quality of care was measured using three questionnaires and by extracting data from medical records to evaluate an index of continuity of care (MMCI) and treatment intensification. The questionnaires used were the continuity of care scale from the General Practice Assessment Questionnaire (GPAQ), the Patient–Doctor Communication Scale (PDCS), and the Patient Satisfaction with Diabetes Care scale (PSDC). Glycaemic control (HbA1c levels) was measured at two time points: baseline and six month follow-up. The main analysis was a multivariate regression model with HbA1c at six-month follow-up as the dependent variable and with self-management and quality of care as predictors and demographic and clinical factors as covariates. A secondary analysis considered the interaction between self-management and quality of care in the prediction of HbA1c at six-month follow-up using a multivariate regression model including HbA1c at baseline in the model. Results: The multivariate linear regression model, that included all variables, was significant and explained 36 % of the variance (P <0.01). Patients had lower HbA1c at follow-up if they had lower levels of HbA1c at baseline, received care at one particular practice in the city, had diabetes of shorter duration, and were prescribed monotherapy. When HbA1c at baseline was removed from the model it explained 14% of the variance (P <0.01). Practice and medical prescription remained significant. In addition, lower levels of HbA1c at follow-up were related to the patient undergoing appropriate treatment intensification by their general practitioner. In the secondary analysis, the interaction showed that if treatment was not intensified, good self-managers had lower HbA1c (P <0.01) but if treatment was intensified, the level of self-management had no effect. Conclusions: Treatment intensification was the main predictor of lower HbA1c levels at follow-up. Although none of the self-management predictors was significantly related to HbA1c, an exploratory analysis of self-management/quality of care interactions showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: To describe and compare attitudes, lifestyle behaviors, and cardiometabolic risk factors between individuals with and without a relative with type 2 diabetes mellitus (T2DM) living in the same household. Methods: A secondary analysis of baseline data from an implementation study in Peru was conducted. The outcomes were attitudes towards changing lifestyle behaviors (e.g. intentions towards losing weight, increasing physical activity, reducing salt consumption, etc), profiles of health lifestyle behaviors (e.g. daily smoking, heavy drinking, and physical activity), and cardiometabolic risk factors (e.g., overweight [body mass index ≥25 kg/m2] and hypertension); whereas the exposure was the presence of at least one relative with known diagnosis of T2DM living in the same household. Multilevel logistic mixed effect regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Results: A total of 2298 records, 1134 (49.4%) males, mean age 43.3 (SD: 17.2) years, were analyzed. There was no evidence of a difference in lifestyle-changing attitudes, smoking, alcohol drinking, physical activity levels, and hypertension between individuals with and without relatives with T2DM. Overweight was 63% more common among individuals having a relative with a T2DM in multivariable model (OR = 1.63; 95% CI: 1.03–2.61). Conclusions: Individuals with relatives with T2DM have higher probabilities of being overweight compared to those who did not have relatives with T2DM in the same household. The absence of differences on lifestyle-related attitudes and behaviors highlight the need of involving relatives of patients with T2DM on intervention strategies to further enhance diabetes prevention and management efforts. / National Heart, Lung, and Blood Institute / Revisión por pares / Revisión por pares