A longitudinal study into the new and long-term use of self-monitoring blood glucose strips in the UK

Aims To determine the impact of self-monitoring blood glucose (SMBG) strip use in patients with type 2 diabetes in the UK. Methods The study period was April 1, 2004 to July 31, 2005. Data from primary care was extracted from The Health Improvement Network database. Patients identified with diabetes and matching the inclusion criteria were defined as new users of SMBG, prevalent users, or non-users. Patients were also defined as treated with insulin, with oral agents (OA), or not pharmacologically treated. Change in glycosylated hemoglobin (HbA1c) at baseline and after 12 months was compared. Results 2559 patients met the inclusion criteria. For new users, HbA1c fell by 0.59% (P=0.399) for those treated with insulin, 1.52% (P<0.001) for those treated with OA, and 0.51% (P<0.001) for no treatment. In prevalent users, changes were 0.31% (P<0.001), 0.34% (P<0.001), and 0.09% (P=0.456), respectively. In non-users, changes were 0.28% (P=0.618), 0.42% (P<0.001), and an increase of 0.05% (P=0.043), respectively. A significant decrease in mean HbA1c was associated with increasing strip use in OA patients newly initiated on strips. Conclusion This observational study showed a significant decrease in HbA1c for new users of SMBG treated either non-pharmacologically or with OA, and for prevalent users treated with insulin or OA. Reduced HbA1c with increasing strip use was observed but was only significant for OA-treated new users. This suggests that SMBG use has a role in the treatment of non-insulin treated patients with type 2 diabetes

Distress, the 6(th) vital sign in cancer care Caring for patients’ emotional needs: what does this mean and what helps?

Distress has been endorsed as the 6(th) Vital Sign by the International Psycho-Oncology Society (IPOS) in 2009 with Screening for Distress as a proposed IPOS strategy in 2010. The need for skilled psychological care is well-recognized as a necessary, integral part of oncology care. There has been significant development of this field over the last two decades in the area now commonly labelled “psycho-oncology”. Given the advances in psycho-oncology, it is helpful to overview the approaches to provision of psychological care, so we can better understand how to care for the emotional needs of cancer patients, their partners and families. The focus here is on patients with high and enduring levels of need in terms of emotional functioning and the formal therapies that are available to help patients and their families manage these needs

Nutrition screening of older people in a community general practice, using the MNA-SF

Background: Objective The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition.Design Cross-sectional study of nutritional risk screen conducted over a six month period.Participants and setting Patients attending a general practice clinic in Victoria, Australia, who attended for the &ldquo;75 plus&rdquo; health assessment check.Measurements The Mini Nutritional Assessment Short Form (MNA&reg;-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA&reg;-SF score recorded.Results Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA&reg;-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 &plusmn; 0.8 (SEM) vs 27.4 &plusmn; 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category.Conclusion In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.<br /