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Objective: Although diabetes is one of the leading causes of death among Korean Americans, the levels and predictors of diabetes knowledge in this group have not been sufficiently reported. This study aimed to (1) describe the level of diabetes knowledge of Korean immigrant women in the U.S. and (2) examine whether there is an interaction effect between social support and education on diabetes knowledge. Design: This study conducted a cross-sectional survey design. The sample included 227 Korean immigrant women living in the southeast region of the U.S. The fourteen items of the Diabetes Knowledge Test were used to assess the diabetes knowledge level of Korean American women. A multiple linear regression analysis was conducted to examine the interaction effect between social support and education on diabetes knowledge. Results: Only 6% of the participants presented a good diabetes knowledge level, 12.5% had a poor level, and the majority (81.5%) had a moderate level. We found a significant interaction effect between social support and education on diabetes knowledge. The highest diabetes knowledge was observed when individuals with a lower education level had higher social support. Conclusion: Future health practices and policies may focus on increasing knowledge among Korean American women with lower education levels and lower social support. Implementing peer-led initiatives can enhance diabetes knowledge and encourage better self-care practices within the community. [ABSTRACT FROM AUTHOR]

Local problem: Variations in nursing practice were observed across our hospital, a 520-bed acute care teaching facility in the northeast United States, regarding the timing and frequency of insulin administration in adult patients with diabetes. Chart audits noted that RNs administered insulin more than one hour after blood glucose results were obtained 97% of the time. In addition, insulin was given at bedtime only 37% of the time. Purpose: The purpose of this quality improvement (QI) project was to improve the care of inpatients requiring insulin by implementing protocols and adjusting practice to align with best practice recommendations. Methods: The clinical nurse education specialist met with a team of staff nurses, providers, nurse leaders, and patient care technicians (PCTs) to formulate protocols and design interventions to ensure improvements in the quality of care for inpatients with diabetes. A sequence of education sessions and an online learning module were developed and assigned to nurses and PCTs to address knowledge gaps, specifically in the pharmacodynamics and safe administration of insulin, as well as how best to provide care to patients with diabetes. Monthly adherence data were disseminated to nurse leaders and educators and reviewed with clinical staff at daily safety huddles and staff meetings. Additional interventions to enhance nursing practice in caring for patients with diabetes included ensuring both bedtime insulin administration and timely insulin delivery. This project began in May 2017 and ended five years later. Results: Two weeks after initial education sessions began in May and June 2017, the frequency of giving bedtime insulin based on the order set and according to the patient's blood glucose levels rose from 37% to 82%, and adherence to best practice protocols continued until final chart audits were performed in May 2022. The frequency of giving insulin less than one hour after obtaining blood glucose results improved from 3% to 64% between October and December 2019, and increased to a sustained level above the project's 92% goal two years later. Conclusion: Protocol development, targeted education, and audits with feedback led to improved care delivery for patients requiring insulin and increased nursing confidence. [ABSTRACT FROM AUTHOR]

Background: For older adults with type 2 diabetes (T2D) treated with insulin or sulfonylureas, Endocrine Society guideline recommends HbA1c between 7% to <7.5% for those in good health, 7.5% to <8% for those in intermediate health, and 8% to <8.5% for those in poor health. Our aim was to examine associations between attained HbA1c below, within (reference), or above recommended target range and risk of complication or mortality. Methods: Retrospective cohort study of adults ≥65 years old with T2D treated with insulin or sulfonylureas from an integrated healthcare delivery system. Cox proportional hazards models of complications during 2019 were adjusted for sociodemographic and clinical variables. Primary outcome was a combined outcome of any microvascular or macrovascular event, severe hypoglycemia, or mortality during 12‐month follow‐up. Results: Among 63,429 patients (mean age: 74.2 years, 46.8% women), 8773 (13.8%) experienced a complication. Complication risk was significantly elevated for patients in good health (n = 16,895) whose HbA1c was above (HR 1.97, 95% CI 1.62–2.41) or below (HR 1.29, 95% CI 1.02–1.63) compared to within recommended range. Among those in intermediate health (n = 30,129), complication risk was increased for those whose HbA1c was above (HR 1.45, 95% CI 1.30–1.60) but not those below the recommended range (HR 0.99, 95% CI 0.89–1.09). Among those in poor health (n = 16,405), complication risk was not significantly different for those whose HbA1c was below (HR 0.98, 95% CI 0.89–1.09) or above (HR 0.96, 95% CI 0.88–1.06) recommended range. Conclusions: For older adults with T2D in good health, HbA1c below or above the recommended range was associated with significantly elevated complication risk. However, for those in poor health, achieving specific HbA1c levels may not be helpful in reducing the risk of complications. See related editorial by Green and Lee in this issue. [ABSTRACT FROM AUTHOR]

Objective: There has been a trend toward hospital systems and insurers acquiring privately owned physician practices and subsequently converting them into vertically integrated practices. The purpose of this study is to observe whether this change in ownership of a medical practice influences adherence to clinical guidelines for the management of type 1 and type 2 diabetes., Methods: This is an observational study using pooled cross-sectional data (2014-2016 and 2018-2019) from the National Ambulatory Medical Care Survey, a nationally representative probability sample of US office-based physician visits. A total of 7499 chronic routine follow ups and preventative care visits to non-integrated (solo and group physician practices) and integrated practices were analyzed to see whether guideline concordant care was provided. Measures included 7 services that are recommended annually for individuals with type 1 and type 2 diabetes (HbA1c, lipid panel, serum creatinine, depression screening, influenza immunization, foot examination, and BMI)., Results: Compared to non-integrated physician practices, vertically integrated practices had higher rates of hemoglobin A1C testing (odds ratio 1.58 [95% CI 1.07-2.33], P  < .05), serum creatine testing (odds ratio 1.53 [95% CI 1.02-2.29], P  < .05), foot examinations (odds ratio 2.03 [95% CI 0.98-4.22], P  = .058), and BMI measuring (odds ratio 1.54 [95% CI 0.99-2.39], P  = .054). There was no significant difference in lipid panel testing, depression screenings, or influenza immunizations., Conclusions: Our results show that integrated medical practices have a higher adherence to diabetes practice guidelines than non-integrated practices. However, rates of services provided regardless of ownership were low., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Currently, there is limited knowledge of the healthcare resources and time needed to intensify patients with type 2 diabetes (T2D) treated with basal insulin to more complex treatment regimens. The purpose of the study was to investigate physicians' perspectives on the time and healthcare resources required for post-basal insulin intensification to basal–bolus and to basal in combination with a glucagon-like peptide-1 receptor agonist (GLP-1) regimens. The study also examined referrals to specialists for intensification and patient challenges with intensification. Methods: A web-based survey of physicians was conducted in the United Kingdom (UK) and the United States (USA). Results: A total of 458 physicians completed the survey, including general practitioners (58.5%) and specialists (endocrinologists/diabetologists; 41.5%). On average, 7.0 healthcare provider (HCP) visits (SD 3.7) over 30.1 weeks (SD 17.4) were required to intensify to a basal–bolus regimen, while 5.7 HCP visits (SD 3.8) over 23.5 weeks (SD 15.2) were needed to intensify to basal insulin in combination with GLP-1. Referral to a specialist for intensification required on average an additional 8 weeks of wait time before intensification. Physicians reported that the complexity of the basal–bolus regimen and frequent injections were key challenges for T2D patients intensifying to basal–bolus, while frequent injections and side effects were key challenges for those intensifying with GLP-1. Conclusion: Less complex regimens for intensification following basal insulin may help reduce the time and healthcare resources required for intensification and address some of the challenges T2D patients face when intensifying to basal–bolus or basal with GLP-1. Funding: Novo Nordisk, A/S. [ABSTRACT FROM AUTHOR]

The number of Americans affected by diabetes continues to increase but the number of endocrinologists with specialty training to treat this population has not kept up with demand. Primary care outpatient visits can also not meet the projected diabetes population demands or the needs for other complex diabetes management issues. Treatments for diabetes including both medications and technologies continue to expand and become more complex. In response to these challenges there have been primary care physicians seeking specialized training to become diabetologists. This can fill some of the gaps left by a lack of resources in the U.S. healthcare system. [ABSTRACT FROM AUTHOR]

In light of a marked increase in the incidence and prevalence of diabetes in the United States in recent years with associated health costs totaling $245 billion for 2012, diabetes has become a major health and fiscal concern. Haitian Americans as a cultural group have unique obstacles to effective treatment and management of diabetes. This paper analyzes recent studies relevant to these challenges in anticipation of new research pertaining to this population. Although medication compliance is generally referred to as adherence, it is a complex concept and key challenge in diabetes care. Accordingly, this paper will further define adherence by describing its relevance in effective treatment and management. It will also analyze key theoretical perspectives in diabetes care, summarize recent research, and make recommendations for effective future research on the impact of diabetes education in Haitian Americans. [ABSTRACT FROM AUTHOR]

Objective: Despite the increased popularity of newer, fast-acting bolus insulin treatment options that allow for more flexibility in the timing of bolus insulin dosing in recent years, relatively little is known about people with diabetes who administer bolus insulin at differing times in relation to their meals. The purpose of this study was to investigate bolus insulin dose timing in relation to meals among people with type 1 (T1D) and type 2 (T2D) diabetes, as well as to better understand the characteristics and experiences of people who bolus dose at differing times.Methods: A web-based survey of adults with T1D and T2D treated with bolus insulin therapy in Germany, the UK, and USA was conducted.Results: A total of 906 respondents completed the survey (39% T1D; 61% T2D). A majority of respondents reported bolus dosing before meals in the previous week (57.0%), followed by after meals (18.9%), with meals (12.7%), and at varying times (11.5%). Compared to respondents who dosed with or after meals, those who dosed before meals were significantly less likely to experience hypoglycemia (before, 55.7%; with, 72.8%; after, 68.7%; p < .001) in the previous week. Respondents who bolus dosed before meals were significantly more likely to perceive bolus dose timing as flexible (45.5%) compared to those who dosed with (27.8%) or after (35.7%) meals (p < .001).Conclusion: Results show that many people with T1D and T2D dose their bolus insulin with or after meals. Key limitations of all self-report surveys include potential bias in responses and generalizability of findings. However, the study was designed to help mitigate these limitations. The findings have implications for clinicians and suggest opportunities for improving diabetes education and care. [ABSTRACT FROM AUTHOR]

Objective: This consensus statement provides (1) visual guidance in concise graphic algorithms to assist with clinical decision-making of health care professionals in the management of persons with type 2 diabetes mellitus to improve patient care and (2) a summary of details to support the visual guidance found in each algorithm., Methods: The American Association of Clinical Endocrinology (AACE) selected a task force of medical experts who updated the 2020 AACE Comprehensive Type 2 Diabetes Management Algorithm based on the 2022 AACE Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan and consensus of task force authors., Results: This algorithm for management of persons with type 2 diabetes includes 11 distinct sections: (1) Principles for the Management of Type 2 Diabetes; (2) Complications-Centric Model for the Care of Persons with Overweight/Obesity; (3) Prediabetes Algorithm; (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Complications-Centric Algorithm for Glycemic Control; (7) Glucose-Centric Algorithm for Glycemic Control; (8) Algorithm for Adding/Intensifying Insulin; (9) Profiles of Antihyperglycemic Medications; (10) Profiles of Weight-Loss Medications (new); and (11) Vaccine Recommendations for Persons with Diabetes Mellitus (new), which summarizes recommendations from the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention., Conclusions: Aligning with the 2022 AACE diabetes guideline update, this 2023 diabetes algorithm update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and diabetes mellitus and highlights the importance of appropriate management of atherosclerotic risk factors of dyslipidemia and hypertension. One notable new theme is an emphasis on a complication-centric approach, beyond glucose levels, to frame decisions regarding first-line pharmacologic choices for the treatment of persons with diabetes. The algorithm also includes access/cost of medications as factors related to health equity to consider in clinical decision-making., Competing Interests: Disclosures The Task Force was empaneled in accordance with the AACE Conflict of Interest (COI) Policy and approved by the AACE COI Subcommittee, Clinical Practice Guidelines Oversight Committee, and AACE executive leadership. All members of the expert Task Force completed disclosures related to commercial and direct financial relationships within the preceding 12 months with companies that develop products connected with endocrine disorders. Categories for disclosure included employment, stock or other ownership, direct financial relationships (eg, speaker or consultant), research funding, authorship or panel involvement on a guideline or white paper related to an overlapping topic, or other situations related to a perceived COI. The AACE COI Subcommittee reviewed disclosures of potential authors against an AACE-approved list of affected companies related to the topic of this consensus statement and made recommendations regarding who could serve on the Task Force in the nonconflicted majority, those who could serve in the conflicted minority with management strategy, and those who were disqualified from serving on the Task Force. Members of this Task Force were reminded throughout development to update potential disclosures if any new relationships/potential COI arose during their appointments and to verify currency of disclosures. AACE made every effort to minimize the potential for COI that could influence guidance provided in this consensus statement. S.L.S. is a member of the AACE Board of Directors and Executive Committee and has received research support to Mayo Clinic from Corcept, served on a steering committee, and been a national or overall principal investigator from Chiasma and Novartis, and is ABIM Chair, Longitudinal Knowledge Assessment Approval Committee for Endocrinology, Diabetes, and Metabolism. P.V. is a consultant for Takeda Pharmaceutical Company and has been a national or overall principal investigator for National Institutes of Health grant K23 DK 11324-01A1. L.B. is a consultant, with payment to Ochsner Health, for Corcept Therapeutics, Merck, Novo Nordisk, Salix Pharmaceuticals, and Sanofi. E.A.C. received research support to company from Abbott and AbbVie; is a consultant for Ascendis, Boehringer Ingelheim, and Novo Nordisk; is a speaker for Amryt, AstraZeneca, Bayer, Corcept, Eli Lilly, Boehringer Ingelheim, and Novo Nordisk; designed study protocol and is a national principal investigator for the GLITTER1 diabetes mellitus trial funded by Gan & Lee pharmaceuticals; is owner of Endocrinology Associates, Inc; and is part-owner of MediZen. R.J.G. is or has been a consultant for Bayer, Boehringer Ingelheim, Eli Lilly and Company, Novo Nordisk, Pfizer, Sanofi, and Weight Watchers; has received research support to Emory University for investigator-initiated studies and been a national or overall principal investigator for Dexcom, Eli Lilly and Company, and Novo Nordisk; and has been partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Numbers P30DK111024-04S, 1K23DK123384. I.B.H. is on the advisory boards of Abbott, Bigfoot, GWave, and Roche; received research support from Beta Bionics, Insulet, and Medtronic Diabetes Care; participated in development of a consensus report on the Management of Type 1 Diabetes in Adults for the American Diabetes Association and European Association for the Study of Diabetes and an Endocrine Society guideline on inpatient diabetes management. S.D.I. is a member of the AACE Board of Directors and Executive Committee and is a consultant (without pay) for Myovant Sciences, Madrigal Pharmaceuticals, Siemens, and Novo Nordisk. K.E.I. is a member of the AACE Board of Directors and has received research support from Novo Nordisk and is on the board of the Nevada Clinical Endocrinologists Association. C.C.L. receives research support to Jaeb Coordinating Center and the University of Colorado for investigator-initiated studies from Dexcom, Inc, is treasurer of the American College of Diabetology, secretary of the Clinical Diabetes and Endocrine Institute, and chair of the Advisory Committee for the FDA on Endocrinologic and Metabolic Drugs, whose views are not represented herein. G.E.U. has received research support and been a national or overall principal investigator for AstraZeneca, Dexcom, and Novo Nordisk; serves as president, Medicine & Science, for the American Diabetes Association; and participated in development of the Endocrine Society guideline on hospital diabetes and Society of Critical Care guideline on ICU diabetes. W.M.V. and C.L.T. have no conflicts of interest to disclose., (Copyright © 2023 AACE. Published by Elsevier Inc. All rights reserved.)

Student run free health clinics (SRFCs) provide medical care to vulnerable populations in communities throughout the United States. The COVID-19 pandemic had a significant impact on the delivery of healthcare services and demanded a rapid adjustment in care delivery methods in both resource-rich and resource-poor settings. The aim of this study is to evaluate the impact of the pandemic on the management of chronic disease, specifically diabetes. Patients with diabetes who received care continuously throughout the pre-pandemic (face-to-face) and pandemic (telehealth) study periods at MedZou Community Health Center, a SRFC located in central Missouri, were evaluated. This sample of patients (n = 29) was evaluated on six quality measures including annual eye exams, blood pressure, hemoglobin A1c, chronic kidney disease monitoring, flu vaccination, and statin therapy. Overall diabetes care, as measured by the number of quality measures met per patient, decreased by 0.37 after the onset of the pandemic. The median COVID-era ranks were not statistically significantly different than the pre-pandemic ranks (z = 1.65, P = 0.099). Fewer patients received an influenza vaccination the year following the onset of the pandemic (10.3%) compared to the year before the pandemic (37.9%; difference in proportions 0.276, 95% CI 0.079, 0.473; p = 0.005). No other individual measures of diabetes care statistically differed significantly in the year after the pandemic began. Twenty-six (90%) patients received diabetes care using telehealth after the onset of the pandemic. Diabetes care using telehealth in a SRFC may be an acceptable alternative model when face-to-face visits are not feasible. Observed decreases in diabetes-related clinical quality measure performance warrant further study., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: There is strong evidence on the efficacy of behavioral modification and treatment for reducing diabetes incidence and diabetes-related morbidity and mortality in persons with pre-diabetes and diabetes. But the extent to which the evidence has translated into gains in health in these population sub-groups in the US is unclear. Monitoring national diabetes-related mortality levels over time is important for evaluating the effectiveness of the US health system response to diabetes. Methods: We identified individuals with pre-diabetes and diabetes using Hemoglobin A1c. Two consecutive periods for investigating differences in mortality according to categories of glycemia were derived using nationally representative survey data on US adults ages 35-74 from subsequent rounds of the National Health and Nutrition Examination Survey (1988-1994 and 1999-2002). Age-standardized mortality rates were calculated for individuals with pre-diabetes and diabetes and proportional hazards models were used to assess change in the relative risks of dysglycemia (pre-diabetes and diabetes) adjusting for multiple confounding factors. Results: Age-standardized mortality rates in individuals with pre-diabetes and diabetes showed no statistically significant change between 1988-2001 and 1999-2006. In individuals with pre-diabetes, mortality rates were 11.19 and 14.02 deaths per 1,000 person-years in the early and later period, respectively. The corresponding values for individuals with diabetes were 20.34 and 20.82 deaths per 1,000 person-years. In contrast, the absolute level of mortality in the normo-glycemic population declined significantly between 1988-2001 and 1999-2006 (7.81 to 6.04; p for difference < 0.05). Adjusting for social and demographic variables, smoking and body mass index in a multivariate analysis, the hazard ratio of dysglycemia increased from 1.62 (95% CI: 1.36-1.93) in 1988-2001 to 2.36 (95% CI: 1.70-3.27) in 1999-2006 (p for difference < 0.05). Conclusions: We find no evidence of declines in excess mortality in persons with dysglycemia between 1988-2001 and 1999-2006, a result that was robust to adjustment for social and demographic variables, smoking and body mass index. In the context of long-term secular declines in mortality in the US population, our findings suggest that individuals with pre-diabetes and diabetes should be an important focus of future interventions aimed at improving population health in the US. [ABSTRACT FROM AUTHOR]

Children with type 1 diabetes need to monitor their blood glucose and food intake, administer insulin, and participate in physical activity during school hours. School concerns for this group include school personnel, the medical directive plan, classmates, school lunches, and physical education classes. Nurse practitioners should take an active role in advocating for improved T1DM management in schools by talking with patients and their parents about experiences in school, identifying challenges and discussing possible solutions for improving diabetes management during school hours, and accessing online resources to assist patients, parents, and school personnel. [ABSTRACT FROM AUTHOR]

In the United States, diabetes has reached epidemic proportions. Thanks to science and technology, we are undergoing a rapid expansion of treatment tools including new drugs, continuous glucose monitoring devices as well as insulin pumps among other gadgets, aimed to help patients with diabetes take control over this disease. Unfortunately, people affected with diabetes face multiple barriers and cannot take advantage of these. This article uncovers multiple educational and financial resources that are often underutilized and not very well known by those providers responsible of taking care of this vulnerable population., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Diabetes mellitus is a major public health concern for the U.S. population because of its high prevalence and longterm health implications. The purpose of this study was to apply the Theory of Planned Behavior (TPB) to assess dental faculty member and student willingness to provide diabetes education and counseling to patients in a dental school. A survey was administered to dental students (n= 101 respondents) and faculty members (n=39 respondents), and summary scores for seven diabetic educational activities and TPB constructs were calculated and analyzed. Participants were most willing to refer a patient to a physician for treatment and provide basic information about diabetes and oral health, and they were least willing to provide basic information about diabetic medications. Importance, self-efficacy, and barriers constructs predicted willingness to perform diabetic educational or counseling activities. Our findings suggest that, when developing innovative approaches to expand diabetic education and counseling in our dental education environment, programs should demonstrate how diabetic counseling can improve patients' health and should include diabetic management skills-building in the curriculum. [ABSTRACT FROM AUTHOR]

Abstract: This study examines how acculturation affects type 2 diabetes management and perceived health for Chinese American immigrants in the U.S. Acculturation experiences or cultural adaptation experiences affecting diabetes management and health were solicited from an informant group of immigrant patients and their spouses (N = 40) during group, couple and individual interviews conducted from 2005 to 2008. A separate respondent group of immigrant patients and their spouses (N = 19) meeting inclusion criteria reviewed and confirmed themes generated by the informant group. Using interpretive phenomenology, three key themes in patients’ and spouses’ acculturation experiences were identified: a) utilizing health care, b) maintaining family relations and roles, and c) establishing community ties and groundedness in the U.S. Acculturation experiences reflecting these themes were broad in scope and not fully captured by current self-report and proxy acculturation measures. In the current study, shifting family roles and evaluations of diabetes care and physical environment in the U.S. significantly affected diabetes management and health, yet are overlooked in acculturation and health investigations. Furthermore, the salience and impact of specific acculturation experiences respective to diabetes management and perceived health varied across participants due to individual, family, developmental, and environmental factors. In regards to salience, maintaining filial and interdependent family relations in the U.S. was of particular concern for older participants and coping with inadequate health insurance in the U.S. was especially distressing for self-described lower-middle to middle-class participants. In terms of impact, family separation and relocating to ethnically similar neighborhoods in the U.S. differentially affected diabetes management and health due to participants’ varied family relations and pre-migration family support levels and diverse cultural and linguistic backgrounds, respectively. Implications for expanding current conceptualizations and measures of acculturation to better comprehend its dynamic and multidimensional properties and complex effects on health are discussed. Additionally, implications for developing culturally-appropriate diabetes management recommendations for Chinese immigrants and their families are outlined. [Copyright &y& Elsevier]

Objective: To examine trends in diabetes management, by race and sex, in the southeast United States. Design: Population-based survey. Setting: Southeast United States (ie, Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee). Participants: Whites and Blacks surveyed through the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System between 2000 and 2007 in the southeast United States. Main Outcome Measures: Total diabetes management included personal factors (checking blood glucose and feet), healthcare provider factors (visiting a doctor, checking hemoglobin A1c, checking feet) and vaccinations (influenza, pneumonia). Results: Vaccination levels were low throughout the study period, and a racial disparity in vaccination rates developed because trends in prevalence increased more rapidly in Whites relative to Blacks. Personal diabetes management increased significantly in all race/sex groups with greater increases in Black than White men, resulting in White men having lower point estimates of prevalence than Black men. Healthcare provider diabetes management increased significantly in all race/sex groups with the exception of Black men. Considering vaccinations together with personal and provider diabetes management criteria, diabetes management improved significantly in all race/sex groups, but remained low in 2007 (ie, 8.8%, Black women; 14.0%, White women; 11.5%, Black men; 12.8% White men). Conclusion: Emphasis should be placed on improving vaccination levels, diabetes patient self-management and provider-management in the southeast United States. Although diabetes management improved over the study time period, in 2007 the percent of individuals meeting all of the diabetes management criteria examined remained very low ranging from 8.8% in Black women to 14.0% in White women. [ABSTRACT FROM AUTHOR]

This study explored the perception of older adults with diabetes regarding the areas of service considered helpful to their daily activities and routines. A survey questionnaire was designed and given to 52 community-dwelling older adults with diabetes. Results showed that cholesterol control, managing blood sugar, foot care, fatigue management and pacing, and pain management/reduction were the areas of most concern that deserve services. The findings suggest that, in providing holistic client-centered interventions to individuals with diabetes, occupational therapists need to be able to prioritize clients' concerns and help them incorporate diabetes management into their routines and lifestyle. [ABSTRACT FROM AUTHOR]

The article discusses medical approaches to diabetes. Type 2 diabetes is strongly correlated with overweight and obesity. The disease is responsible for substantial morbidity and mortality in the U.S. The American Diabetes Association recommends that all diabetes patients should maintain tight glycemic control, healthy blood pressure and beneficial lipid levels.

Purpose: To examine the association between weight loss and type 2 diabetes remission among vulnerable populations living in medically underserved areas of the Mid-Southern United States., Design: Quantitative, retrospective cohort study., Setting: 114 ambulatory sites and 5 adults' hospitals in the Mid-South participating in a regional diabetes registry., Participants: 9,900 adult patients with type 2 diabetes, stratified by remission status, with 1 year of baseline electronic medical record data, and 1 year of follow-up data for the 2015-2018 study period., Measures: The outcomes were diabetes remissions, categorized as any remission, partial remission, and complete remission based on the guidelines of the American Diabetes Association. The exposure was weight loss, calculated by the change in the Body Mass Index (BMI) as a proxy measure., Analysis: χ 2 tests, Fisher's exact tests, and the Mann-Whitney U-test were used to examine the differences in patient characteristics by remission status across the 3 remission categories, as appropriate. Multiple multivariable logistic regressions adjusting for confounders were performed to estimate the adjusted odds ratios (aORs) for the associations between weight loss and diabetes remission., Results: Among 9,900 patients identified, a reduction of 0.3 kg/m 2 (standard deviation: 2.5) in the average BMI from the baseline to the follow-up was observed. 10.8% achieved any type of remission, with 9.8% for partial and 1.0% for complete remissions. Greater weight loss was significantly associated with an increased likelihood of any (aOR = 1.07, 95% confidence interval (CI), 1.06-1.08), partial (aOR 1.06, 95% CI, 1.04-1.07), and complete diabetes remission (aOR 1.10, 95% CI, 1.07-1.13)., Conclusions: Weight loss is significantly associated with diabetes remission among patients living in medically underserved areas, but complete remission is rare.

Background: Type 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management., Objective: The aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A 1c (HbA 1c ) levels, diabetes care adherence, and quality of life, and (2) the adolescents' overall satisfaction with this intervention., Methods: This pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA 1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses., Results: The final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t 21 =-2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t 24 =2.48, P=.01, d=0.32). HbA 1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t 24 =0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t 23 =0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA 1c levels (F 1,20 =9.74, P<.005; R 2 =0.33). Overall, the adolescents were satisfied with the app intervention., Conclusions: In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects., Trial Registration: ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628., (©Bree Holtz, Katharine M Mitchell, Amanda J Holmstrom, Shelia R Cotten, Julie K Dunneback, Jose Jimenez-Vega, Deborah A Ellis, Michael A Wood. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 14.09.2021.)

The Integrated Pharmacy Skills laboratory is a laboratory-based approach to many different aspects of pharmacy education. As diabetes is one of the most common disease states in the United States, it is a primary focus of the educational experience at South University School of Pharmacy. The laboratory experience at South University School of Pharmacy includes the application of diabetes management in a hospital setting, a community setting, and a clinic setting. The class has been developed for the first professional year of a 3-year professional curriculum. Laboratory exercises include calculations, case studies, intravenous preparation, assessment tools, and patient-counseling exercises. The Integrated Pharmacy Skills laboratory provides a practical experience for teaching our future pharmacists about diabetes and diabetes management. [ABSTRACT FROM AUTHOR]

To estimate and compare the management of diabetes among Arab, Asian, non-Hispanic Black, and non-Hispanic Whites attending a large health system in metropolitan Detroit. Data were electronically abstracted for 6622 adult patients with diabetes. Dependent variables were uptake of A1c testing and results, LDL-C testing and results, and eye examination frequency. The independent variable was race/ethnicity. Logistic regression models were used to examine the association between Arab Americans and non-Hispanic Whites for each of the dependent variables while controlling for confounders. Arab Americans were 38% more likely than non-Hispanic Whites to report an A1c > 7% (OR 1.38; 95% CI 1.03, 1.87). Arab Americans were 62% less likely to receive an eye exam compared to non-Hispanic Whites (OR 1.62; 95% CI 1.21, 2.17). Population based studies about diabetes management among Arab Americans will facilitate tailored interventions aimed at preventing/delaying diabetes complications and reducing premature mortality due to diabetes.

Background: Recent emphasis on value based care and population management, such as Accountable Care Organizations in the United States, promote patient navigation to improve the quality of care and reduce costs. Evidence supporting the efficacy of patient navigation for chronic disease care is limited. The objective of this study was to evaluate the effect of a patient navigation program on medical and administrative outcomes among patients with diabetes in an urban, safety-net hospital clinic setting., Methods: A retrospective cohort study with pre- and post-intervention periods was conducted. Eligible patients were those with A1C ≥ 8.5% and at least one appointment no-show in the previous 12 months. The intervention and reference groups were balanced on observed characteristics and baseline outcome levels using propensity score matching. The effect of patient navigation was isolated using the difference-in-differences approach. Primary outcomes were A1C, low-density lipoprotein cholesterol, triglycerides, random urine microalbumin, the number of scheduled appointments, clinic visits, emergency visits, and inpatient stays, and the percentage of arrivals, cancellations, and no-shows to scheduled appointments., Results: Of 797 eligible patients, 328 entered the navigation program. Matching reduced the sample size to 392 individuals (196 in each group). Patient navigation resulted in improved A1C (-1.1 percentage points; p < .001), more scheduled appointments (+ 5.3 per year; p < .001), more clinic visits (+6.4 per year; p < .001), more arrivals to scheduled appointments (+7.4 percentage points; p = .009) and fewer no-shows (-9.8 percentage points; p < .001)., Conclusions: Navigation was associated with improved glycemic control and better clinic engagement among patients with diabetes. Further research is important to identify what features of navigation in diabetes care are critical to achieving success and to understand navigators' role in other settings.

Cardiovascular disease (CVD) is common in patients with diabetes. For these patients, clinicians should seek diabetes treatment that is beneficial rather than harmful in relation to CVD. Until recently, there have been many treatments for hyperglycemia, whose impact on CVD has been controversial. The aims of this review are to evaluate the effectiveness of antihyperglycemic medications on risk factors for CVD and to examine the impact of these drugs on CVD in cardiovascular (CV) outcome trials. In this article, we summarize current knowledge about the impacts of these drugs on various risk factors as well as CV outcomes. We identify the recent emergence of trials with antihyperglycemic agents showing newly discovered CV benefits as well as past trials with antihyperglycemic agents not showing much benefit on CV events. Rather than focusing on treatment strategies, we review the effects of individual drug classes on CV outcomes. We also briefly review goal-driven glycemia reduction and its impact on CVD. We conclude that antihyperglycemic agents are associated with improvement in CV risk factors in patients with diabetes and insulin resistance; in fact, a few drugs reduced CV events in randomized CV outcome trials. Therefore, the use of these drugs is appropriate for reducing glucose and decreasing CV event risk in a select subpopulation.

Background and Objectives: Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry., Methods: The cohort included 10 704 participants aged <18 years with type 1 diabetes for ≥1 year (48% female; mean age: 11.9 ± 3.6 years; diabetes duration: 5.2 ± 3.5 years). Diabetes management and clinical outcomes were compared among 8841 non-Hispanic white (white) (83%), 697 non-Hispanic black (black) (7%), and 1166 Hispanic (11%) participants. The population included 214 high-income black and Hispanic families., Results: Insulin pump use was higher in white participants than in black or Hispanic participants (61% vs 26% and 39%, respectively) after adjusting for gender, age, diabetes duration, and SES (P < .001). Mean hemoglobin A1c was higher (adjusted P < .001) in black participants than in white or Hispanic participants (9.6%, 8.4%, and 8.7%). More black participants experienced diabetic ketoacidosis and severe hypoglycemic events in the previous year than white or Hispanic participants (both, P < .001). There were no significant differences in hemoglobin A1c, diabetic ketoacidosis, or severe hypoglycemia between white and Hispanic participants after adjustment for SES., Conclusions: Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups., (Copyright © 2015 by the American Academy of Pediatrics.)

Type 2 diabetes is considered a public health crisis, particularly among people of Mexican descent in the United States. Clinical approaches to diabetes management increasingly emphasize self-care, which places responsibility for illness on individuals and mandates self-regulation. Using narrative and free-list data from a two-phase study of low-income first- and second-generation Mexican immigrants living with diabetes, we present evidence that self-care among our participants involves emotion regulation as well as maintenance of and care for family. These findings suggest, in turn, that the ideology of selfhood on which these practices are based does not correspond with the ideology of selfhood cultivated in the U.S. clinical sphere. Divergence between these ideologies may lead to self-conflict for patients and the experience of moral blame. We argue that our participants use their explanations of diabetes causality and control as a form of self-making, which both resists such blame and asserts an alternative form of selfhood that may align more closely with the values held by our Mexican-American participants., (© 2014 by the American Anthropological Association.)

Background: Uninsured patients with diabetes are at increased risk for poor outcomes and often have limited access to health and prescription services necessary to manage diabetes. Hamilton Health Center, a federally qualified community health center, with support from the Highmark Foundation, implemented a Diabetes Healthy Outcomes Program (DHOP) for uninsured patients., Purpose: To evaluate the effectiveness of DHOP that is designed to provide health care and supportive services for uninsured diabetic patients at a federally qualified community health center., Methods: Mixed quantitative and qualitative analyses of participant outcomes and satisfaction were used to assess program effectiveness., Results: A total of 189 participants enrolled in DHOP over 2 years. Thirty-four (18%) participants had adequate glycemic control with hemoglobin A1c (HbA1c) ≤ 7%. Overall, 105 participants received prescription drugs, 101 participants received eye care services, 23 participants received dental services, 45 received podiatry services, 37 received nutrition services, and 28 patients engaged in an exercise program. More participants (38%, 34) had controlled diabetes mellitus at study start than at the end (28%, 25). However, 30% versus 17% of participants with 2 HbA1c measurements achieved or maintained HbA1c ≤ 7% by the end of the program compared with the start. Participants who accessed more services were more likely to achieve glycemic control as measured by HbA1c (P > .01)., Conclusion: Although 30% of participants improved or maintained glycemic control over 2 years, more were uncontrolled at the end than at study start. Participants who accessed more primary and specialty care services were more likely to achieve glycemic control. Multidisciplinary care may improve diabetes control in low-income patients.