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OBJECTIVE — The role of general practice and diabetes clinics in the management of diabetes is still a matter of debate. Methodological flaws in previous studies may have led to inaccurate conclusions when comparing the care provided in these different settings. We compared the care provided to type 2 diabetic patients attending diabetes outpatient clinics (DOCs) or being treated by a general practitioner (GP) using appropriate statistical methods to adjust for patient case mix and physician-level clustering. RESEARCH DESIGN AND METHODS — We prospectively evaluated the process and intermediate outcome measures over 2 years in a sample of 3,437 patients recruited by 212 physicians with different specialties practicing in 125 DOCs and 103 general practice offices. Process measures included frequency of HbA1c, lipids, microalbuminuria, and serum creatinine measurements and frequency of foot and eye examinations. Outcome measures included HbA1c, blood pressure, and total and LDL cholesterol levels. RESULTS — Differences for most process measures were statistically significantly in favor of DOCs. The differences were more marked for patients who were always treated by the same physician within a DOC and if that physician had a specialty in diabetology. Less consistent differences in process measures were detected when patients followed by GPs were compared with those followed by physicians with a specialty other than diabetology. As for the outcomes considered, patients attending DOCs attained better total cholesterol levels, whereas no major differences emerged in terms of metabolic control and blood pressure levels between DOCs and GPs. Physicians' specialties were not independently related to patient outcomes. CONCLUSIONS — Being followed always by the same physician in a DOC, particularly if the physician had a specialty in diabetes, ensured better quality of care in terms of process measures. In the short term, care provided by DOCs was also associated with better intermediate outcome measures, such as total cholesterol levels. [ABSTRACT FROM AUTHOR]

Provides information on a study which assessed the prevalence of self-reported erectile dysfunction (ED) and evaluated its impact on quality of life (QOL) in type 2 diabetic patients. Research design and methods of the study; QOL frequency scale scores according to ED frequency; Β-parameters associated with ED in multiple regression analyses with each dimension of QOL as dependent variable.

Deals with a study which investigated the frequency of self-monitoring of blood glucose and its association with metabolic control and quality of life among type 2 diabetics. Research design and methods; Results; Conclusions.

Objective: To investigate the relationship between beliefs of physicians relative to intensive metabolic control in type 2 diabetes and levels of HbA1c obtained in a sample of their patients.Research Design and Methods: Physicians' beliefs were investigated through a questionnaire sent to a sample of self-selected clinicians participating in a nationwide initiative aimed at assessing the relationship between the quality of care delivered to patients with type 2 diabetes and their outcomes. At the same time, physicians were asked to collect clinical data on a random sample of their patients, stratified by age (<65 vs. > or = 65 years). Mean HbA1c levels in the study population were thus evaluated according to target fasting blood glucose (FBG) used by their physicians.Results: Of 456 physicians, 342 (75%) returned the questionnaire. Among the responders, 200 diabetologists and 99 general practitioners (GPs) recruited 3,297 patients; 2,003 of whom were always followed by the same physician and 1,294 of whom were seen by different physicians in the same structure on different occasions. Only 14% of the respondents used target FBG levels < or = 6.1 mmol/l, whereas 38% pursued values >7.8 mmol/l, with no statistically significant difference between diabetologists and GPs. The analysis of the relationship between FBG targets and metabolic control, restricted to those patients always seen by the same physician, showed a strong linear association, with mean HbA1c values of 7.0 +/- 1.6 for patients in the charge of physicians pursuing FBG levels < or = 6.1 mmol/l and 7.8 +/- 1.8 for those followed by physicians who used target values >7.8 mmol/l. After adjusting for patients' and physicians' characteristics, the risk of having HbA1c values > 7.0% was highly correlated with physicians' beliefs. Patients followed by different physicians in the same unit showed a risk of inadequate metabolic control similar to that of patients followed by physicians adopting a nonaggressive policy.Conclusions: Doctors adopt extremely heterogeneous target FBG levels in patients with type 2 diabetes, which in turn represent an important independent predictor of metabolic control. To improve patient outcomes, physicians-centered educational activities aimed at increasing the awareness of the potential benefits of a tight metabolic control in patients with type 2 diabetes are urgently needed. [ABSTRACT FROM AUTHOR]

Investigates aspects related to foot care in patients with type two diabetes enrolled in outpatient clinics by general practitioners in the U.S. Prevalence of lower limb complications; Percentage of the patients who received education on foot care; Role of physicians in orientation of patient practices.

Aims/Hypothesis:Diabetes treatments were related with either an increased or reduced risk of cancer. There is ongoing debate about a potential protective action of metformin. To summarize evidence on the association between metformin and risk of cancer and cancer mortality in patients with diabetes. Methods:Data source: MEDLINE and EMBASE (January 1966-April 2012). We selected randomized studies comparing metformin and other hypoglycaemic agents and observational studies exploring the association between exposure to metformin and cancer. Outcomes were cancer mortality, all malignancies and site-specific cancers. Results:Of 25307 citations identified, 12 randomized controlled trials (21,595 patients) and 41 observational studies (1,029,389 patients) met the inclusion criteria. In observational studies there was a significant association of exposure to metformin with the risk of cancer death [6 studies, 24,410 patients, OR:0.65, 95%CI: 0.53-0.80], all malignancies [18 studies, 561,836 patients, OR:0.73, 95%CI: 0.61-0.88], liver [8 studies, 312,742 patients, OR:0.34; 95%CI: 0.19-0.60] colorectal [12 studies, 871,365 patients, OR:0.83, 95%CI: 0.74–0.92], pancreas [9 studies, 847,248 patients, OR:0.56, 95%CI: 0.36–0.86], stomach [2 studies, 100701 patients, OR:0.83, 95%CI: 0.76–0.91], and esophagus cancer [2 studies, 100694 patients, OR:0.90, 95%CI: 0.83–0.98]. No significant difference of risk was observed in randomized trials. Metformin was not associated with the risk of: breast cancer, lung cancer, ovarian cancer, uterus cancer, prostate cancer, bladder cancer, kidney cancer, and melanoma. Conclusions/Interpretation:Results suggest that Metformin might be associated with a significant reduction in the risk of cancer and cancer-related mortality. Randomized trials specifically designed to evaluate the efficacy of metformin as an anticancer agent are warranted. [ABSTRACT FROM AUTHOR]

The trials comparing Continuous Subcutaneous Insulin Injection (CSII) with Multiple Daily Injections (MDI) in adults with type 1 diabetes (T1DM) have been mainly focused on easily measurable outcomes such as glycated haemoglobin. Nevertheless, their relative benefits in terms of flexibility of lifestyle and quality of life (QoL) have been seldom investigated. Aim of this ease-control study was to compare QoL and treatment satisfaction in a large sample of patients treated with either CSII or MDI. On the occasion of a routine visit, patients completed the Diabetes-Specific Quality-of-Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire, and the SF-36 Health Survey. All the scores ranged between 0 and 100, with higher scores indicating better QoL/higher satisfaction. Overall, 62 diabetes clinics enrolled 1341 patients, of whom 481 treated with CSII (cases) and 860 treated with MDI (controls). The prevalence of females was higher among cases than controls (57% vs. 46%; p<0.0001). The former also had a longer diabetes duration (18±10 years vs. 15±10 years; p<0.0001) and suffered more often from eye complications (32% vs. 22%; p<0.0001) and renal complications (11% vs. 6%; p=0.0007). No difference emerged in terms of age, school education, occupation, and HbA1c levels. At multivariate analysis, after adjusting for socioeconomic and clinical characteristics, cases showed significantly higher scores than controls in the following areas of the DSQOLS: diet restrictions (β=9.96; p<0.0001), daily hassles (β=3.57; p=0.01), fears about hypoglicemia (β=3.88; p=0.006), and preference-weighted treatment satisfaction score (β=0.87; p=0.0025). Treatment with CSII was also associated with a markedly higher DTSQ score (β=11.5; p<0.0001) as compared with MDI. Finally, the DTSQ score of patients treated with CSII was significantly higher than that of patients treated with MDI including insuline glargine or NPH (p<0.0001 for both comparisons). In conclusion, patients treated with CSII have a lower perception of burdens and restrictions and a substantially higher treatment satisfaction than patients treated with MDI. [ABSTRACT FROM AUTHOR]