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Aim To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements. Methods We developed narrative vignettes describing clinical scenarios of patients receiving basal insulin therapy. For each vignette, the respondents were asked to indicate whether they would advise a change in insulin dose. A total of 520 paper questionnaires were distributed among physicians and nurses in primary and secondary care in the Netherlands. Multivariate linear and logistic regression analyses were performed to identify factors associated with dosing decisions. Results A total of 190 (37%) questionnaires were returned. In cases of a severe rather than mild hypoglycaemic event, care providers were nearly five times more likely to decrease the dose (odds ratio 4.77, 95% CI 1.65-13.75). Care providers were six times more likely to increase the dose when the patient's current dose was low (30 units) rather than high (90 units) (odds ratio 6.38, 95% CI 3.04-13.37). The plasma glucose concentration during a hypoglycaemic event and a known history of cardiovascular disease did not influence the care providers' dosing decisions. Conclusion Evidence regarding the optimum insulin titration is not always translated into clinical practice. When formulating guidelines, misconceptions should be identified and addressed. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 404-409 (2012) Abstract Aims To investigate validity of waist circumference measurements obtained by self-report and self-measurement with non-verbal pictorial instructions among a multi-ethnic population. Methods Five hundred and twenty-six individuals aged 40-75 years (91 South Asian, 430 White European and five other), who attended a screening programme for Type 2 diabetes, estimated their waist circumference and measured their waist with a paper tape measure. Participants were also provided with simple pictorial instructions for measurement of waist circumference in their preferred language and remeasured their waist circumference. We calculated 95% limits of agreement with measures undertaken by a healthcare professional unaware of prior measures. Results Mean age was 56.8 years ( sd 9.0), mean BMI 30.0 kg/m2 ( sd 5.6) and mean waist circumference 98.4 cm ( sd 14.1). Seventy-nine per cent had high waist circumference according to International Diabetes Federation criteria. The mean of participants' self-reported value was 6.8 cm lower than the healthcare professional measure ( sd 8.8; 95% limits of agreement −10.4 to 24.0 cm), with significant differences by sex and ethnicity (South Asian men 7.5 cm, South Asian women 0.1 cm, White European men 7.8 cm, White European women 7.0 cm, P < 0.001). Compared with healthcare professional measures, mean self-measured waist circumference was very similar, both with instructions (0.4 cm higher; sd 5.5 cm; −11.1 to 10.4 cm) and without instructions (0.5 cm lower; sd 5.6; −10.4 to 11.4 cm), but with significant differences by sex and ethnicity ( P < 0.001). Conclusions There was systematic underestimation of self-reported waist circumference in this multi-ethnic UK population. The magnitude of underestimation might reduce the performance of risk scores; however, this can be corrected through self-measurement with pictorial instructions. [ABSTRACT FROM AUTHOR]

Aims The burden of diabetes is considerable for racial and ethnic minority populations in many places in the USA and worldwide, often disproportionately affecting immigrant communities. This paper reports findings from a community-based participatory research study that described diabetes risk and awareness, assessed the association between perceived and actual risk (high, two or more diabetes risk factors; low, fewer than two risk factors) and identified factors associated with disease risk among Chinese and Hispanic / Latino immigrant populations in Portland, OR, USA. Methods Cross-sectional, self-reported data were collected from a purposive sample of 324 Chinese (n = 159) and Hispanic / Latino (n = 165) adults, aged 18-86 years [mean (SD) age, 45.2(17.9) years; 50.7% women). Analyses described differences in variable distributions. Logistic regression estimated odds ratios and 95%confidence intervals in pooled and ethnic group-specific samples. Results Approximately 43% of participants were at high risk for diabetes, regardless of ethnicity or age. Of those unaware of their risk, or who perceived themselves not to be at risk, 25-53%had two or more risk factors (high risk); these patterns varied by ethnicity. The proportion of participants who reported two or more risk factors and were unaware of their risk status (31.8% Hispanic / Latino; 17% Chinese) or self-identified as not at risk (12.5% Hispanic / Latino; 13.0% Chinese) was substantial. Factors associated with diabetes risk also varied by ethnicity. Conclusions This study assessed the degree and determinants of diabetes risk and awareness among local Hispanic / Latino and Chinese communities and identified significant variation between groups. The results are important because they highlight substantial diabetes risk among persons who misestimate or are unaware of their risk status, regardless of ethnicity, and, in the USA, the Chinese immigrant population commonly is not considered a high-risk group for Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims To assess the effect of mobile phone intervention on glycaemic control in diabetes self-management. Methods We searched three electronic databases (PubMed, EMBASE and Cochrane Library) using the following terms: diabetes or diabetes mellitus and mobile phone or cellular phone, or text message.We also manually searched reference lists of relevant papers to identify additional studies. Clinical studies that used mobile phone intervention and reported changes in glycosylated haemoglobin (HbA1c) values in patients with diabetes were reviewed. The study design, intervention methods, sample size and clinical outcomes were extracted from each trial. The results of the HbA1c change in the trials were pooled using meta-analysis methods. Results A total of 22 trials were selected for the review. Meta-analysis among 1657 participants showed that mobile phone interventions for diabetes self-management reduced HbA1c values by amean of 0.5% [6 mmol / mol; 95% confidence interval, 0.3-0.7% (4-8 mmol/ mol)] over a median of 6 months follow-up duration. In subgroup analysis, 11 studies among Type 2 diabetes patients reported significantly greater reduction in HbA1c than studies among Type 1 diabetes patients [0.8 (9 mmol/ mol) vs. 0.3% (3 mmol / mol); P = 0.02]. The effect of mobile phone intervention did not significantly differ by other participant characteristics or intervention strategies. Conclusions Results pooled from the included trials provided strong evidence that mobile phone intervention led to statistically significant improvement in glycaemic control and self-management in diabetes care, especially for Type 2 diabetes patients. [ABSTRACT FROM AUTHOR]