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Aim: To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus (T2DM) in non-controlled studies ("real-world conditions") on quality of care, resource consumption and conditions of employment., Methods: This cross-sectional study and longitudinal follow-up describe the data (demographic and socioeconomic profiles, clinical characteristics, treatment of hyperglycaemia and associated cardiovascular risk factors, resource consumption) collected during the second phase (2006) of the International Diabetes Management Practices Study (IDMPS). Patients received diabetes education directly from the practice nurse, dietitian or educator, or were referred to ad hoc group-education programmes; all programmes emphasized healthy lifestyle changes, self-care and active participation in disease control and treatment. Educated vs non-educated T2DM patients (n=5692 in each group), paired by age, gender and diabetes duration, were randomly recruited for the IDMPS by participating primary-care physicians from 27 countries in Eastern Europe, Asia, Latin America and Africa. Outcome measures included clinical (body weight, height, waist circumference, blood pressure, foot evaluation), metabolic (HbA(1c) levels, blood lipid profile) and biochemical control measures. Treatment goals were defined according to American Diabetes Association guidelines., Results: T2DM patients' education significantly improved the percentage of patients achieving target values set by international guidelines. Educated patients increased their insulin use and self-care performance, had a lower rate of chronic complications and a modest increase in cost of care, and probably higher salaries and slightly better productivity., Conclusion: Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: To address whether type 1 diabetic patients with type 2 diabetic first degree relatives are different from others in terms of cardiovascular risk factors, insulin resistance and daily insulin dosage., Methods: We studied 18 type 1 diabetic patients with type 2 diabetic first degree relatives and 36 type 1 diabetic patients without such relatives. Patients with diabetic complications (including microalbuminuria) were excluded. The groups were similar in terms of baseline characteristics. We measured systolic and diastolic blood pressures, body mass index, waist circumference, total cholesterol, triglycerides, LDL, VLDL, HDL, daily insulin dosage and insulin sensitivity. Insulin sensitivity was tested using insulin tolerance test., Results: Type 1 diabetic patients having first degree relatives with type 2 diabetes had significantly higher systolic and diastolic blood pressures (although within the normal range) than others (p < 0.001). They were more insulin resistant according to insulin tolerance test and were using higher daily insulin dosages. In this group, waist circumference, triglyceride and VLDL levels also tended to be higher, but differences were not significant statistically. Total cholesterol, LDL and HDL levels were similar in both groups., Conclusion: Family history of type 2 diabetes increases blood pressure and decreases insulin sensitivity in type 1 diabetic patients. Thus such patients should be treated more aggressively in terms of both cardiovascular risk factors and glucose control.

Background: Coping is defined as the behavioral and cognitive efforts used in an attempt to deal with stressful events. The objective of this study was to explore the relationship between coping with diabetes and the following outcome variables in type 1 and insulin treated type 2 diabetes mellitus: glycemic control, microangiopathic complications, adherence to self monitoring of blood glucose, adherence to insulin injections, and adherence to diet., Methods: Subjects were 196 insulin treated adult diabetes patients visiting an outpatient clinic at a government university hospital in Istanbul, Turkey. Coping with disease was measured with the Turkish version of the Diabetes Coping Measure and adherence to treatment regimen was measured with a questionnaire adapted from the subscales of the Summary of Diabetes Self-Care Activities Questionnaire. Data on patients' HbA(1c) levels and severity of microangiopathic complications were obtained from their medical records., Results: Partial correlations controlling for background variables suggested that coping was a good predictor of outcome for both type 1 and insulin treated type 2 diabetes mellitus. These associations were more pronounced for type 1 patients when compared to type 2 patients. Regressing the outcome variables on the two second-order coping factors (obtained by a factor analysis) also supported the hypothesis that coping is an important construct in explaining the outcome variables. Finally, the effect of coping on HbA(1c) was only partially mediated by adherence., Conclusion: Coping with diabetes-related issues is an important factor in both types of diabetes, with type 1 patients showing slightly stronger associations. Therefore, training and education programs for diabetic adults might benefit from including a component that is aimed at improving coping with issues specific to diabetes.