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Introduction: Patients undergoing surgery require a thorough assessment preoperatively. Hyperglycemia is associated with poor outcomes, and stability of glucose levels is an important factor in preoperative management. Diabetes presents a particular challenge since patients are often on multiple medications encompassing glycemic management and cardiovascular therapies. Areas Covered: A PubMed search of published data and reviews on preoperative approaches in diabetes was conducted. Consensus opinion drives most of the guidelines and recommendations for management of diabetes in surgical patients. Pathophysiology is often complex with varying levels of glucose and surgical stress. Establishing well-controlled diabetes prior to surgical intervention should be standard practice in non-emergent procedures. We review the best practices for implementing preoperative assessment, with diabetes with a focus on diabetes medications. Expert opinion: The management of a patient preoperatively varies by region and country. Institutions differ in approaches to preoperative evaluation and the establishment of consistent approaches would provide a platform for monitoring patient outcomes. Multidisciplinary teams and pre-assessment clinics for preoperative evaluation can enhance patient care for those undergoing surgery. [ABSTRACT FROM AUTHOR]

Background: Group medical visits (GMV) effectively improve patient care and outcomes through interactive education, increased patient contact, and facilitated social support. This quality improvement research examined if patient activation and quality of life correlate with weight, blood pressure (BP), and hemoglobin A1c (A1C) through GMV interventions. Methods: Participants were enrolled in GMV Lighten Up for weight management or GMV Diabetes. At pre- and post-intervention, patients completed the Patient Activation Measure (PAM) and the healthrelated quality of life measure, the SF-12; and were assessed for weight, blood pressure (BP), and hemoglobin A1c (A1C). Results: Weight and PAM scores significantly improved regardless of group. For patients in GMV Diabetes, A1C significantly decreased. GMV Lighten Up participants had statistically significant declines in diastolic BP. Both groups improved patient activation, but statistically significantly so only in GMV Diabetes participants. SF-12 scores did not statistically significantly improve. There were no predictors of A1C and PAM score change for the Diabetes GMV. However, age, SBP and SF-12 scores predicted PAM score changes in GMV Lighten up participants. Conclusions: Participants in this study showed overall improvement in biomarkers and patient activation. Thus, GMV continue to be a viable method for healthcare delivery. [ABSTRACT FROM AUTHOR]

Objective: Patients with diabetes must navigate multiple components of care to self-manage their disease. Group Medical Visits (GMVs) are a forum for patients to see a provider as well as actively participate in education and care management with other patients with diabetes. The objective is to describe GMV implementation and resident involvement in a primary care setting. Methods: We adapted and implemented a GMV model into a primary care practice with a residency program. Residents attend GMV sessions that provide a continuity experience in addition to their regular clinic schedules. A cohort of patients enroll in a series of eight GMVs occurring over of 4 months. Each patient and resident complete surveys evaluating the visits. Results: There have been 14 GMV groups totaling 70 participants. GMV groups (N = 67) mean A1C for reduction was 0.53 ± 1.60 from baseline to 3- to 6-month post-GMV follow-up. Resident and patient feedback show an overall positive experience. Conclusion: The GMV model offers patients the setting to interact and exchange experiences with each other as well as to receive feedback from providers and the health-care team. The incorporation of the GMV program into residency training provides a continuity group care experience and an alternative practice model. [ABSTRACT FROM AUTHOR]

Introduction: Reducing symptom burden is often secondary to risk factor control in diabetes. Symptom burden with comorbid medical conditions and the need for symptom palliation are not well defined. Although neuropathy is one of the most frequent occurring comorbidities of diabetes, patient experience is inconsistent. Using in-depth interview, we assessed patients' perspectives of pain experienced through neuropathy and the impact on type 2 diabetes management. Areas covered: Participants completed a structured telephone interview during which perspectives on diabetes and its management occurred. Data were analyzed iteratively using content analysis and extracted themes came from reduced data. Interview data were triangulated with clinical data from electronic health records. Expert opinion: During interviews, 41% of patients reported pain interfered with their lives. Three pain-related themes emerged from interviews, augmented by descriptions of how people experience and cope with pain. Themes included: (1) people know what neuropathy is and attribute their pain to it; (2) neuropathic pain seems insurmountable at times; and (3) pain can lead to feeling down or hopeless. Pain, a common comorbidity in diabetes, is a primary driver of patient suffering. Understanding how patients experience pain paves the way for creative interventions to manage it better among those living with diabetes. [ABSTRACT FROM AUTHOR]

Views and clinical practice on hormone replacement therapy (HRT) for postmenopausal women have varied widely over the last several decades. The 1990s showed a dramatic decline in prescribing and only recently are prescription rates increasing again. Use of HRT is first line for women suffering from the symptoms of menopause. For a certain population of postmenopausal women, HRT is recommended for prevention of fracture. More consideration is being given to patient risk factors, side effects, and formulations available. Transdermal patch estrogen formulations have been on the market for many years and are becoming more common although many physicians are less familiar with the various options. Transdermal preparations are worth consideration with regard to less adverse effects as there is the avoidance of liver metabolism and accumulation of metabolites with antiestrogenic activity. Data suggests that transdermal patch estrogen preparations are both safer and potentially more efficacious than oral estrogen therapy. Guidelines recommend the addition of progesterone for women who have not had a hysterectomy. Transdermal patch estrogen has a role for women as a choice for individualized therapy and providers need to be familiar with the formulations as well as unique challenges and advantages. [ABSTRACT FROM PUBLISHER]

The “dual effects” hypothesis argues that social control can be effective in promoting positive health-related behavior change, but it can also jeopardize the targeted individual's well-being. This hypothesis is tested using hemoglobin A1C as an objective indicator of behavioral compliance with diabetes self-management behavior and depressive symptoms. Differences in the effects of social control on A1C and depressive symptoms by sex and ethnicity are tested. Cross-sectional data were obtained from a multi-ethnic sample of older adults with diabetes (N = 593). Greater social control was associated with poorer rather than better odds of achieving glucose control, and with greater depressive symptoms. There was no evidence that social control has differential effects on either glucose control or depressive symptoms by sex or ethnicity. Active use of social control attempts by family members and friends, especially if they are coercive or punitive in nature, are likely counterproductive for maintaining the physical and mental health of older adults with diabetes. [ABSTRACT FROM AUTHOR]

The article reflects on Self-monitoring of blood glucose, a tool for management of diabetes mellitus, for detecting hyperglycemia and hypoglycemia. Article refers that Randomized controlled trials (RCTs) are conducted to assess the impact of SMBG on glucose control. The International Diabetes Federation Clinical Guidelines Taskforce in conjunction with the SMBG International Working Group has developed a 'Guideline on Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes.

The article discusses why minority populations with diabetes have poorer glycemic control than non-Hispanic white patients in the U.S. It is stated that the evidence from literature continues to develop data to support the assumption that there are disparities among minority populations with diabetes compared with the non-Hispanic white population. As a result, ethnic minorities are disproportionately affected by the burden of diabetes and related complications.