Patient education: interpretation of medical terms as a key part of diabetes mellitus treatment

Background: Only a little percent of chronically ill patients was found to follow physicians’ prescriptions. One of the reasons for this issue is misunderstanding of recommendations due to inappropriate interpretation of medical terms, contained in medical advice. Aims: The study is aimed to evaluate the quality of patient interpretation of the most frequently used medical terms in diabetes mellitus field (DM) and to evaluate the impact of misunderstanding on diabetes control. Materials and methods: 13 endocrinologists composed 2 lists of the most frequently used terms – one list for DM type 1 and one for DM type 2. We selected 10 terms for DM type 1 and 10 terms for DM type 2, mentioned by the most of participated doctors, and created 2 kinds of questionnaire for patients. Patients were to explain the terms in written if they were aware of terms’ meaning. Three independent researchers evaluated every answer according to a 0 to 10 scale, where 0 was for totally incorrect or no answer, and 10 was for a completely correct answer. Patients also filled in the forms about their social and demographic parameters. Statistical analysis was conducted with the use of Wilcoxon Test and linear regression model. Results: 89 patients with DM type 1 (27% men, HbA1c (mean±SD) 7,95±1,77%) and 86 patients with DM type 2 (27% men, HbA1c (mean±SD) 8,11±1,91%) were included into the study. Patients with type 1 DM received a greater overall score for understanding the terms than those with type 2 DM (p <0.0001) – 57.84±22.66 and 39.33±22.02 from 100, respectively. 38 (42.7%) participants with DM type 1 reported that they know all 10 terms, but only 15 (16.8%) respondents understand terms correctly. In the group of type 2 DM patients 9 (10.5%) of all answered yes for all the terms, but really know terms only 2 (2.3%) participants. In both groups, the total score of the terms knowledge did not correlate with the HbA1c level (р=0.698 and р=0.319 for type 1 and type 2 DM groups, respectively). Conclusion: The most of patients with DM do not understand relevant medical terms properly. Some patients are in the wrong belief that they have no misunderstandings with their consulting doctors. However, terms understanding does not influence on glycemic control (HbA1c level). During the medical consultation, endocrinologists should check if a patient understands their advice properly to improve understanding and compliance of patients

Free-living use of artificial pancreas for children with type 1 diabetes: systematic review

BACKGRAUND: A closed-loop glucose control system or artificial pancreas consists of three components a Continuous Glucose Monitor (CGM), infusion pumps to deliver hormone(s) and a sophisticated dosing algorithm to control hormone delivery. In the past years, numerous studies with closed-loop system devices were conducted with gradual shift to out-of-hospital environment and with lengthening study duration. AIMS: To compare efficacy and safety of closed-loop insulin pump use in children with type 1 diabetes mellitus in compare with conventional insulin treatment (continuous subcutaneous insulin infusion (CSII) with our without CGM) based on randomized control trials data (RCT). METHODS: In the systematic review we have include 28 randomized controlled trials results indexed in PubMed, Medline databases published till 15 June 2017. The efficacy on metabolic control in this study evaluated by the proportion of time within target range (preferably 70 to 180 mg/dl if reported) and mean (median) glucose based on sensor measurements, and the safety evaluated by time in hypoglycemia (below 70 mg/dl if reported). RESULTS: Increased time in range in the night period was observed in all RCT. Only 3 RCT showed decrease of the time in range within 24 h evaluation period. In one RCT the significant positive differences have been shown in the time in range for dual hormone closed-loop glucose control system in compare with insulin-only artificial pancreas. Mean glycaemia and glucose variability changes were not in the same manner in different RCT, both in the night only and in 24 h estimation period. Night hypoglycemia duration decreased in most RCT with closed-loop control in compare with CSII, and increased only in 2 RCT. When all-day estimation period the time in hypoglycemia changed not in the same manner in different RCT. Valuable methodology differences of the glycaemic control estimation within observed RCT brought significant complications in the data analysis and made impossible the results quantitative estimation to prepare a metaanalysis. CONCLUSIONS: Much work has been done to develop effective and safe artificial pancreas, but not all RCTs confirmed advantages of closed-loop glucose control in compare with CSII in children and adolescents in real life. More research with prospective randomized control design required to prove benefits of closed-loop glucose control. Further RCTs should have an uniform methodology for glycemic control assessment and long duration that will allow to use cumulative measures in a closed-loop efficacy estimation (HbA1c)

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Metabolicheskaya regulyatsiya i tsAMF-zavisimaya proteinkinaza (AMRK): vrag ili soyuznik?

Общеизвестным фактом является высокая распро страненность и растущая частота сахарного диабета 2 типа (СД2), ожирения, сопутствующих им заболеваний. При всей очевидности терапевтических подходов, достижение целей лечения далеко не всегда успешно. Эти факты привели к необходимости углубления наших фундаментальных знаний о контроле энергетического гомеостаза

Programma skrininga sakharnogo diabeta 2 tipa v Sankt-Peterburge

Статья отражает результаты применения программы скринингового обследования населения Санкт-Петербурга на сахарный диабет, которая показала высокую клиническую эффективность мероприятий по раннему выявлению заболевания, а, следовательно, и его осложнений. Это определяет экономическую целесообразность проведения скрининга, поскольку экономит материальные ресурсы, которые потребовались бы на лечение поздно диагностированных осложнений диабета при рутинном выявлении заболевания

Otsenka effektivnosti standartizovannogo lecheniya i nablyudeniya bol'nykh sakharnym diabetom v Sankt-Peterburge: rezul'taty mnogotsentrovogo otkrytogo kontroliruemogo randomizirovannogo issledovaniya

Цель. Оценка эффективности внедрения алгоритмов лечения больных СД в условиях сложившейся системы медицинской помощи пациентам в Санкт-Петербурге (программа "Диастандарт"). Материалы и методы. В исследование включено 50 больных диабетом 1 типа (СД1) и 60 пациентов с СД 2 типа (СД2). Согласно процедуре рандомизации центров пациенты были разделены на 2 группы: основная ? лечение по алгоритмам "Диастандарта" - 80 больных; контрольная ? "традиционное" наблюдение больных диспансерной группы ? 30 больных. Лечение пациентов основной группы регламентировалось разработанными алгоритмами терапии СД "Диастандарт". Период включения продолжался с ноября 1999 г. по январь 2000 г. Продолжительность исследования 6 мес. Результаты. Гликемия натощак и после еды в обеих группах достоверно не различалась, уровень HbAl в основной группе был выше, чем в контрольной (8,3 и 7,8). Средний уровень АД по группам был удовлетворительным. В обеих группах получено достоверное снижение постпрандиальной гликемии и гликемии натощак. Тяжелых гипогликемии отмечено не было. Динамика уровня HbAl в группах свидетельствовала об улучшении состояния углеводного обмена у больных, получавших лечение по алгоритмам "Диастандарта", в то время как у пациентов контрольной группы таких изменений не было. Не было выявлено статистически значимых изменений индекса массы тела, биохимических показателей, случаев прогрессирования диабетической ретинопатии. При СД1 интенсивность наблюдения больных, получавших лечение по алгоритмам "Диастандарта", оказалась выше, чем в контрольной группе (7,3 визита/1 больной/6 мес. и 5,2 визита/1 больной/6 мес). У больных СД2, получавших традиционную терапию, наблюдение было более интенсивным: в основной группе ? 6,8 визита/1 больной/6 мес , в контрольной ? 7,6 визита/1 больной/6 мес. Наибольшее снижение гликемии в обеих группах произошло в первые 3 мес. лечения. Выводы. В данной работе эффективность "традиционной" тактики ведения больных СД на амбулаторном этапе сравнивали с лечением по алгоритмам (стандартизованное лечение) в открытом исследовании с рандомизацией центров. Показано преимущество стандартизованного лечения перед традиционным подходом, которое выражалось в положительной динамике уровня НвА1 в этой группе по сравнению с контрольной. Стандартизованное лечение не сопровождается существенной интенсификацией наблюдения. Улучшение показателей углеводного обмена при применении алгоритмов лечения не сопровождается значимым увеличением дозы инсулина и пероральных сахароснижающих препаратов. Целесообразно внедрение стандартизованного лечения в клиническую практику с предварительной адаптацией к местным условиям

Fear of hypoglycaemia in patients with type 1 diabetes

Independently of causes and risk factors of hypoglycaemia, its manifestations are always unfavourable and evoke fear and other negative emotions that lead to negative consequences connected with quality of diabetes control. The fear of hypoglycaemia creates an internal conflict by diminishing patients? motivation to adhere to intensive treatment regimes. In addition to the severity of hypoglycaemia and its negative consequences, quality of life is one of the main criteria for evaluating the physical, psychological and social components of patient's life as a whole. Fear of hypoglycaemia is one of the most important factors; it either directly or indirectly affects quality of life and influences all aspects of the patient's life. Fear of hypoglycaemia is also a source of anxiety for the patient's relatives, causing damage to their familial and social relations. The negative consequences of hypoglycaemia can affect the relationship between spouses, as well as between parents and children with type 1 diabetes. The qualitative and quantitative data demonstrate that non-severe nocturnal hypoglycaemia causes more anxiety and fear in patients than daytime hypoglycaemia does. To quantify the fear of hypoglycaemia in adults with type 1 diabetes, the hypoglycaemia fear scale (HFS) was developed and still is the most commonly used instrument. To assess the fear of hypoglycaemia in children and their parents, the HFS scale was adapted to be used in the paediatric population: HFS for parents (PHFS) and HFS for children (CHFS). From a clinical point of view, these scales for measuring the level of fear of hypoglycaemia may be useful for monitoring adult patients and families who may need additional support, training or assistance in dealing with issues related to hypoglycaemia. The methods for regulating the fear of hypoglycaemia range from behavioural to pharmaceutical and surgical ones, and include a broad range of activities. Nevertheless, the problem remains quite relevant today and an integral approach for solving this problem, both by the physician and by the patient, should be used. Proper assessment of the patient's level of anxiety, impact of the fear of hypoglycaemia on his or her social life, awareness of the possible psychological consequences of this problem may positively affect both the behaviour and mood of the patient, and the opportunity to achieve better glycaemic control

Generik atorvastatina Tulip? v lechenii dislipidemii u bol'nykh s sakharnym diabetom 2 tipa

Цель. Оценка эффективности и безопасности применения нового генерика аторвастатина ? препарата Тулип (ЛЕК, Словения) у больных СД 2 типа и дислипидемией. Материалы и методы. В открытое проспективное контролируемое исследование эффекта препарата Тулип были включены 20 пациентов. Для сравнения была выбрана группа пациентов (n=20), сопоставимая по демографическим характеристикам, также не получавшая ранее терапию липидснижающими препаратами. Протокол обследования включал стандартный опрос, осмотр, антропометрическое обследование. Лабораторные исследования проводили в сыворотке венозной крови, взятой утром натощак после 12-часового голодания. Для оценки степени компенсации СД определяли уровни холестерина, ЛПНП, ЛПВП, триглицеридов, АЛТ, АСТ в сыворотке (визит 1?3). Уровни HbA1c, холестерина, ЛПНП, ЛПВП, триглицеридов исследовали и в конце наблюдения. Результаты. В основной группе за время наблюдения обнаружено снижение уровня ЛПНП. Увеличение дозы препарата Тулип до 20 мг/день требовалось 9 пациентам. Все больные этой группы отмечали хорошую переносимость препарата. Выводы. Генерик аторвастатина Тулип? Лек, Словения, является эффективным препаратом с высоким уровнем без опасности для лечения дислипидемии у пациентов с СД 2 типа. Улучшение гликемического профиля у больных СД 2 типа не сопровождается спонтанной нормализацией липидного спектра и требует медикаментозной коррекции нарушений липидного обмена

Diabetes mellitus and driving a motor vehicle

Diabetes mellitus is a chronic disease that not only affects the lives of patients but also influences their social interactions, including driving. Driving a motor vehicle is a complex process, requiring good visuospatial function, rapid information processing, vigilance and high decision-making skills. Potential causes of driving impairment associated with diabetes include hypoglycemia and its effects on unawareness, retinopathy, neuropathy and ischemic heart disease. The effects of hypoglycemia can lead to dangerous and life-threatening events for both the driver and others on the road. Research data confirm that impairments from hypoglycemia affect driving performance. Many trials and meta-analyses have revealed that not all drivers follow precautions such as measuring blood glucose levels before driving; therefore, this problem remains quite relevant. In Russian Federation, the process of a person with diabetes obtaining a driver’s license is not uniformly regulated, even though this issue is related to road safety

Psychosocial factors in young patients with type 1 diabetes mellitus ? a practical approach

Psychosocial factors play a significant role in the management of young type 1 diabetes mellitus (T1DM) patients who may have difficulties in coping with their condition. DM can lead to discrimination and changes in social relationships. It may also have a negative impact on academic and professional performance. We aimed to highlight the influence of psychosocial factors on metabolic control and health of the patient as a whole, and to attract the attention of medical professionals to the variety of psychosocial problems existing in young patients with T1DM. This article reviews the results of recent clinical studies and discusses methods of psychological screening