Using an Electronic Health Record Alert System to Screen and Manage patients with Diabetes Mellitus Type 2 in a Rural Primary Care Setting

Diabetes Mellitus type 2 is the 7th leading cause of death and affects nearly 10% of the US population. Early detection of this condition leads to the initiation of treatment and lowers the risk for complications and better outcomes. Frequent testing of hemoglobin A1Cs in those already diagnosed also leads to better management, glycemic control and improves health outcomes. This project utilized a feature in the electronic health record system of a rural primary care clinic to remind providers to screen at-risk patients and retest those who were either due or overdue for hemoglobin A1C testing. Hemoglobin A1C readings were compared three months prior to implementation and three months post implementation. The overall number of screening and monitoring hemoglobin A1C readings ordered increased and newly identified cases rose nearly 4%. There was an overall decrease in the number of hemoglobin A1C readings above 7%. This clinic enjoyed success with a reminder system and has incorporated it into daily practice. This reminder system can be streamlined to work more efficiently and expanded to other primary care settings to lead to better outcomes for patients with diabetes Mellitus type 2

Formation of a system of target indicators for rating and integral evaluation of the efficiency of the organization of the provision of medical care to patients with diabetes mellitus in the Russian Federation regions

AIM: Formation of a system of target indicators for rating and integral assessment of the effectiveness and efficiency of the organization of medical care for patients with diabetes mellitus in the Russian Federation regions.MATERIALS AND METHODS: The study was an expert survey in the form of a structured interview. At the first stage, we performed the primary selection of indicators. At the second stage, the selection of experts took place in accordance with the inclusion criteria, and the assessment of the level of expert competence was assessed based on a self-assessment survey. Further, criteria we formulated for expert evaluation of the significance of the selected indicators in accordance with the principles used in the development of national and federal projects. The indicators were divided into two groups: additional (process) and main (outcome). To quantify the degree of agreement between the experts’ answers, Kendall’s concordance coefficient (W) was calculated. The significance of differences was assessed using the nonparametric Friedman test.RESULTS: Only indicators with a high degree of agreement between experts and the presence of statistical significance in terms of the concordance coefficient are recommended as target indicators. The following main and additional indicators satisfy these requirements: mortality from cardiovascular complications of type 2 diabetes (people per 100,000 population); the proportion of patients with type 1 and 2 diabetes mellitus provided with medical devices out of the total number of patients with type 1 and 2 diabetes mellitus (percentage); the proportion of patients with type 1 and 2 diabetes mellitus with high amputations of all patients with type 1 and 2 diabetes mellitus with any amputations (percentage); and other indicators.CONCLUSION: We selected indicators that can be used both for the integral rating of the constituent entities of the Russian Federation, and in the formation of federal projects or departmental target programs. The results of the study can also be used to organize a system for monitoring the effectiveness of the implementation of these projects and programs

Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study

OBJECTIVE: To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. STUDY DESIGN: This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated. RESULTS: There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease

Cuidado farmacêutico a pacientes com diabetes mellitus tipo 2 no Brasil : uma revisão narrativa da literatura

O diabetes mellitus é uma das doenças crônicas não transmissíveis mais prevalentes no mundo, no qual o diabetes mellitus do tipo 2 corresponde a maioria dos casos de diabetes já diagnosticados. Essa condição de saúde demanda do sistema de saúde a realização do rastreamento, diagnóstico, tratamento, monitorização da evolução e manejo das complicações que podem ser desenvolvidas. Com a aplicação do Cuidado Farmacêutico, é possível a realização de serviços farmacêuticos e também do estreitamento da relação com o paciente, sua família e a comunidade. O tratamento farmacológico e não farmacológico da diabetes mellitus do tipo 2 é contínuo, dificultando a adesão do paciente. O desenvolvimento do seguimento farmacoterapêutico, possibilita a identificação de problemas relacionados a medicamentos e, a partir dessa identificação, a realização de intervenções para obter resultados clínicos efetivos, com a finalidade de melhorar a qualidade de vida do paciente. Utilizou-se artigos de 2011 até 2022 relacionados ao Cuidado Farmacêutico a pacientes com diabetes mellitus do tipo 2 no Brasil. Resultados positivos foram identificados com a participação ativa do farmacêutico na linha de cuidado, como a diminuição de hemoglobina glicada e a glicemia em jejum, por exemplo.Diabetes mellitus is one of the most prevalent chronic not transmissible diseases in the world, in which type 2 diabetes mellitus corresponds to most cases of diabetes already diagnosed. This health condition requires the health system to carry out screening, diagnosis, treatment, monitoring of the evolution and management of complications that may develop. With the application of Pharmaceutical Care, it is possible to carry out pharmaceutical services and also to strengthen the relationship with the patient, his family and the community. The pharmacological and non-pharmacological treatment of type 2 diabetes mellitus is continuous, making it difficult for the patient to adhere. The development of pharmacotherapeutic follow-up makes it possible to identify drug-related problems and, based on this identification, carry out interventions to obtain effective clinical results, with the aim of improving the patient's quality of life. Articles from 2011 to 2022 related to Pharmaceutical Care for patients with type 2 diabetes mellitus in Brazil were used. Positive results were identified with the active participation of the pharmacist in the care line, such as a decrease in glycated hemoglobin and fasting blood glucose, for example

The experiences of patients with diabetes and strategies for their management during the frst COVID-19 lockdown: a qualitative study

Background: During the pandemic, primary care systems prioritised attention to COVID-19 patients; chronically ill patients, such as people with Type 2 Diabetes were obliged to take more responsibility for their own care. We aimed to analyse the experiences of patients with Type 2 Diabetes Mellitus during the stay-at-home order that was in place during the first wave of the COVID-19 pandemic and identify the strategies and resources used in managing their care. Method: We conducted a qualitative descriptive study. The participants were ten patients with type 2 Diabetes Mellitus who experienced strict lockdown during the first wave of the COVID-19 pandemic in Catalonia, Spain, selected using intentional sampling. We recorded semi-structured interviews with the participants and conducted thematic analysis. Results: We identified 14 subthemes, which we then grouped into three overarching themes: 1) anxiety, fear, and vulnerability (anxiety, fear, vulnerability, rethinking life, loneliness, sadness), 2) insufficient diabetes monitoring by the health system (health care received, glycaemic control, view of treatment by health providers) and proactive self-care (changes in daily routine, diet, physical activity, medication, personal protective equipment & social distancing). Conclusion: Despite the exceptional nature of the situation and the stress, worry, and changes in their daily lives, many respondents reported that they had successfully modified their lifestyles. Self-care was effective during confinement and was based on a process of adaptation using the resources available, without face-to-face contact with primary care health staff. Relevance to clinical practice: These results can help to guide the design and implementation of self-care-focused strategies and also to explore new ways of empowering patients without access to health care personnel

Multimodal optical measurement for study of lower limb tissue viability in patients with diabetes mellitus

According to the International Diabetes Federation, the challenge of early stage diagnosis and treatment effectiveness monitoring in diabetes is currently one of the highest priorities in modern healthcare. The potential of combined measurements of skin fluorescence and blood perfusion by the laser Doppler flowmetry method in diagnostics of low limb diabetes complications was evaluated. Using Monte Carlo probabilistic modeling, the diagnostic volume and depth of the diagnosis were evaluated. The experimental study involved 76 patients with type 2 diabetes mellitus. These patients were divided into two groups depending on the degree of complications. The control group consisted of 48 healthy volunteers. The local thermal stimulation was selected as a stimulus on the blood microcirculation system. The experimental studies have shown that diabetic patients have elevated values of normalized fluorescence amplitudes, as well as a lower perfusion response to local heating. In the group of people with diabetes with trophic ulcers, these parameters also significantly differ from the control and diabetes only groups. Thus, the intensity of skin fluorescence and level of tissue blood perfusion can act as markers for various degrees of complications from the beginning of diabetes to the formation of trophic ulcers

Comparison of glycemic excursion in patients with new onset type 2 diabetes mellitus before and after treatment with repaglinide

Due to industrialization and sedentary life, incidence of type 2 diabetes (DM2) is increasing seriously. Repaglinide is a glucose reducing agent that predominantly reduces post-prandial glucose. Continuous glucose monitoring system (CGMS) monitors blood glucose excursions over a 3-day period. CGMS can be used as a therapeutic and diagnostic instrument in diabetics. There are not enough studies about using CGMS in DM2. The aim of this study was to determine the blood glucose excursions in patients with new onset of DM2. 10 patients with new onset of DM2 were entered to this study. As the first therapeutic management, patients received diabetic diet and moderate exercise for 3-weeks, if they did not achieve blood glucose goal (Fasting blood glucoser (FBG) <120mg/dl, 2-hour postprandial blood glucose (2hpp) <180mg/dl), were considered to undergo 3-days CGMS at baseline and after 4-weeks on Repaglinide (0.5mg three times before meals). Mean excursions of blood glucose were not different at the onset and at the end of treatment (6±4.05 VS 7.6±5.2 episodes, P=0.49). There were also no significant differences between mean duration of hypoglycemic episodes (zero VS 5.1±14.1 hours, P =0.28) and hyperglycemic episodes before and after therapy (7.6±5.2 VS 5.7±4.1, P=0.42), but mean hyperglycemia duration was significantly reduced at the end of therapy (21±26.17 VS 57.7±35.3, P=0.001). Patients experienced a mean of 0.3±0.67 episodes of hypoglycemia after therapy showed no significant difference before it (P =0.19). Mean FBG (with CGMS) was significantly lower after therapy than before it (142.9±54.31 VS 222.9±82.6, P <0.001). This study showed the usefulness of CGMS not only as a diagnostic but also as an educational and therapeutic tool that in combination with Repaglinide (with the lowest effective dose and duration) can significantly reduce FBG and glycemic excursions in DM2 patients and hypoglycemic events are low. © Hezarkhani et al

Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan.

Objective  To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services. Method  A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic. Results  There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10-20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations. Conclusion  Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases

The Diabetic Dog as a Translational Model for Human Islet Transplantation.

The dog model has served as the primary method for early development of many diabetes therapies, including pancreatic islet transplantation techniques and immunosuppressive protocols. Recent trends towards the use of monoclonal antibody therapies for immunosuppression in human islet transplantation have led to the increasing use of primate models with induced diabetes. In addition to induced-disease models in large animals, scientists in many fields are considering the use of naturally-occurring disease models in client-owned pets. This article will review the applicability of naturally-occurring diabetes in dogs as a translational model for developing islet transplantation in the human diabetic patient