Redesigning treatment strategies in type 2 diabetes by treatment intensification and patient education

Type 2 diabetes is a complex disease that is characterized by insufficient insulin production or utilization. Type 2 diabetes is associated with complications such as diabetic neuropathy, diabetic nephropathy, diabetic retinopathy, atherosclerosis, peripheral artery disease and coronary heart disease. Three important risk factors for complications are hyperglycemia, hypertension and dyslipidemia. Effective diabetes care involves self-management of the disease with proper nutrition, physical exercise and pharmacological agents that can control levels of glucose, cholesterol and blood pressure. With the rise in the prevalence of diabetes and often ineffective treatment intensification it is necessary to consider new treatment strategies. Patient centered approaches along with treatment intensification and diabetes education can be one such strategy to improve diabetes care. Diabetes education can be helpful as it helps in promoting healthy behaviors and appropriate diabetes self-management. The objective of this study was to evaluate the effectiveness of providing patient education and intensifying treatment in patients with Type 2 diabetes and determine if there were significant changes observed in HbA1c, LDLc, blood pressure and adherence. This study specifically reported changes in patients at the 3 month follow up. The study was a prospective, cluster randomized controlled trial. There were a total of 240 patients enrolled in the study: 175 were in the intervention group and 65 were in the control group. Treatment was intensified according to pre-approved protocols and diabetes education was provided to patients in the intervention group. There was significant decrease in HbA1c and LDLc levels within the intervention group but the difference was not significant within the control group. There was no decrease in blood pressure within the intervention or the control group. HbA1c, systolic blood pressure and diastolic blood pressure was significantly different in between the groups at baseline but not during 3 month follow up. There was no statistically significant difference between the underlying distributions of the adherence scores of protocol and the adherence scores of control at baseline or 3 month follow up. The results from the 3 month follow up strongly indicated that treatment intensification along with patient education can be an effective way to treat diabetes. These results also emphasized the importance of a patient centered approach and diabetes education. The public health significance of this study is that it can be very helpful to optimize treatment strategies in diabetes while addressing behavioral and psychological needs of a patient. This can improve self-management of diabetes, which is one of the very important aspects of diabetes care

A case study of the disappearance of Arius tenuispinis (marine catfish) in the vicinity of Visakhapatnam due to mechanised fishing

Visakhapatnam is on the eastern sea board of India (17 degree 40' N and 83 degree 15' E) having a continental shelf of 45 km width which is provided with a polychaete rich, silty clay sea floor to a distance of 15 km and beyond, from the shore. Repeated trawling by a large number of trawlers over an area of 900 sq.km (30 x 30) resulted in the hardening of the substratum to the extent of making it uninhabitable to the polychaetes and polychaete feeding fish. The shoaling and strictly demersal marine catfish, Arius tenuispinis, which is a prolific polychaete feeder on the fishing grounds off Visakhapatnam, has been on the decline since 1979. The catch rate of fish dropped from 9.7 kg/boat per day in 1979 to 2.6 kg by 1985-86. In the bottomset gillnets, the catch per net dwindled from 4.4 kg in 1973 to 0.04 kg by 1985-86. The species has virtually disappeared from the fishing grounds off Visakhapatnam and further north, as a results of the cumulative effect of overfishing with trawlnets and bottomset gillnets. It is further aggravated by the hardening of the sea floor on these grounds due to repeated trawling over a narrow zone

Contribution of Anaerobic Digestion Coupled with Algal System towards Zero Waste

Global environmental protection is of immediate concern and it can only be achieved by avoiding the use of fossil fuels. In addition, waste disposal and management could be made remunerative through the generation of renewable energy so that sustainable development is ensured. India is an agriculture-based country, and paddy residues such as rice straw and rice husk are the largest agricultural wastes in India. Currently, the common practice to dispose paddy residues is through field burning, but this has adverse effects on the air quality and consequently on people’s health. However, utilization of lignocellulosic and non-food agricultural residues such as paddy residue for biogas generation by solid-stated anaerobic digestion (AD) is promising and this can substitute fossil fuels. Paddy residues for biogas production via AD has not been widely adopted because of its complex cell wall structure making it resistant to digestion by microbial attack. In addition, sequestration of carbon dioxide from biogas by algal biomass cultivated in an integrated algal bioreactor could be a promising option for biogas enrichment due to its unmatched advantages. This chapter presents the overview on utilization of non-edible residues for biogas production and its enrichment via algal biomass by means of circular bioeconomy

A Visual Guide to Essay Writing

Dr Valli Rao, Associate Professor Kate Chanock, and Dr Lakshmi Krishnan use a visual approach to walk students through the most important processes in essay writing for university: formulating, refining, and expressing academic argument

Awareness about adverse drug reaction monitoring and pharmacovigilance among final year medical students in tertiary care teaching hospital in Andhra Pradesh: a cross sectional study

Background: Adverse drug reaction (ADR) is an unwanted, undesirable effect of a drug that occurs during clinical use. ADRs will occur daily in health care institutions and can unfavourably affect a patient's quality of life, frequently causing considerable morbidity and mortality. Pharmacovigilance is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.Methods: It was a non-interventional study was done among hundred final year medical students at Kurnool Medical College, Kurnool, Andhra Pradesh. The study instrument was a predesigned questionnaire was structured by following the precedence, which was set by parallel studies. The participants were given forty-five minutes to answer the questionnaire; the questionnaires were then analyzed by grading the respondents into three categories: poor, unsatisfactory and satisfactory.Results: This study showed satisfactory results about awareness, knowledge and methods of application of pharmacovigilance among final year medical students 55%, 47%, 54% respectively and positive correlation between awareness, knowledge and methods of application of pharmacovigilance among final year medical students significantly (<0.0001) correlated.Conclusions: The present study revealed that the final year medical students were satisfactory in awareness and knowledge and methods of application of pharmacovigilance. The correlations told that the higher the awareness, the more was the knowledge and better were the methods of application. Likewise, the knowledge and practices were significantly and positively related to a correlation

Therapeutic implications of recombinant human erythropoietin in anaemic related clinical manifestations

The introduction of recombinant human erythropoietin (RHUEPO) has revolutionised the treatment strategies for patients suffering with anaemia of chronic renal disease and chronic heart failure. Clinicalstudies and several observational evidences have demonstrated that RHUEPO is also useful in various non-uraemic conditions including haematological and oncological disorders, prematurity, HIV infectionand preoperative therapies. The successful treatment of all the anaemic related malfunctions with recombinant human erythropoietin (RHUEPO) has become a standard treatment tool for dialysis patients and as an interesting therapeutic option for several forms of non-renal anaemia. As a conesquence of both, RHUEPO has achieved the highest annual sales worldwide and the potential of it increases its scope in the future prospective also

Cutaneous Metaplastic Synovial Cyst

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