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Background: Patient satisfaction is one of the desired outcomes of health care, as it is not only an indicator of quality of care but also plays a vital role in the management of chronic patients such as Diabetes mellitus because it promotes adherence to advice and treatment, utilization of health care services, and the establishment of the doctor-patient relationship. Aims and Objectives: This study aims to assess diabetic patients' level of satisfaction attending the Central Diabetes Clinics in primary health care. Additionally, this study aims to determine whether patient satisfaction is related to individual characteristics such as sociodemographic parameters and disease-related factors. Materials and Methods: A cross-sectional study was conducted in the Central Diabetes Clinics of Primary Health Care from February 6th to February 17th, 2022. The data was collected via a selfadministered questionnaire. It was divided into two sections: the first part contained the patient's characteristics, and the second included 16 items obtained from the short form of the Patient Satisfaction Questionnaire (PSQ-18). Results: The study included 369 diabetes patients in total. Most participants (85.9%) were Bahrainis between the ages of 51 and 70 (70.5%). The overall satisfaction mean score was 69.4 (86.75%, SD = 8.9). Patients were most satisfied with the interpersonal manners, while they were dissatisfied with the waiting time for emergency services. A significant association was found between overall satisfaction and education level, as well as with the duration of treatment. Lower educational levels and a duration of Diabetes of 5-10 years were associated with higher satisfaction. No significant association was found between overall satisfaction and other factors such as sex, age, nationality, marital status, employment status, monthly income, the presence of other chronic conditions, the presence of diabetes-related complications, or the treatment type. Conclusion: This study concluded that most diabetic patients who visit Central Diabetes Clinics are generally satisfied with the quality of healthcare services. [ABSTRACT FROM AUTHOR]

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic. Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17. Results: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years). Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe. [ABSTRACT FROM AUTHOR]

Objective: To determine patterns of blood glucose monitoring in children and adolescents with type 1 diabetes (T1D) before and after routine T1D clinic visits.Methods: Blood glucose monitoring data were downloaded at four consecutive routine clinic visits from children and adolescents aged 5-18 years. Linear mixed models were used to analyze patterns of blood glucose monitoring in patients who had at least 28 days of data stored in their blood glucose monitors.Results: In general, the frequency of blood glucose monitoring decreased across visits, and younger children engaged in more frequent blood glucose monitoring. Blood glucose monitoring increased before the T1D clinic visits in younger children, but not in adolescents. It declined after the visit regardless of age.Conclusions: Members of the T1D care team need to consider that a T1D clinic visit may prompt an increase in blood glucose monitoring when making treatment changes and recommendations. Tailored interventions are needed to maintain that higher level of adherence across time. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda. Research design and methods: A facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs) at the 95% confidence interval (CI) were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0. Results: The overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78), being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71), being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14) and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27), taking three or less tests of blood glucose per day (APRR: 0.63; 95% CI: 0.42, 0.95), and having a caretaker with poor knowledge about diabetes (APRR: 0.49; 95% CI: 0.43, 0.57) and who is inactive in supervision of insulin injections (APRR: 0.58; 95% CI: 0.56, 0.60) were associated with adherence to type 1 diabetes care recommendations. Conclusion: Adherence to type 1 diabetes care recommendations is still low among this population. The results suggest that reinforcing caretaker involvement could be vital in improving adherence to diabetes care recommendations in this population. [ABSTRACT FROM AUTHOR]

Background: Healthcare industry in India is growing at a tremendous pace owing to its strengthening coverage, services, and increasing expenditure by public as well as private players. Healthcare outfits as organizations pretty much depend on patient admissions. So ultimately, this brings emphasis on importance of the healthcare consumers and impact of their behavior on hospital's performance. This paper seeks to find out (1) impact of socioeconomic profile of the patients on service quality perception, (2) impact of service quality perception on patient's behavior, and (3) assess the usability of such impact to formulate healthcare strategy. This study is basically an exploratory cum causal research, which attempts to explore certain relationships between socioeconomic characteristics versus behavioral characteristics of patients. The data were collected from 800 small and medium private clinics where competition is stringent. The resultant data assumed to be related to three constructs viz. socioeconomic profile, service quality perception, and patient's behavior. There are 13 variables in the dataset. Study used reliability analysis to evaluate the internal consistency in the data. Factor analysis together with structural equation modeling was used to evaluate study constructs. Certain socioeconomic characteristics are significant towards certain service quality dimensions. There is also certain level of evidence in support of study proposition that patient's satisfaction and attitude depends on their perception of service quality. The hospitals as healthcare organizations can make use of the impact of socioeconomic profile of patients while strategizing care so that it impacts patient's service quality perception. More specifically, while strategizing patient's perception of accuracy, the hospitals can make use of entire socioeconomic makeup as a single construct. [ABSTRACT FROM AUTHOR]

Introduction Depression and diabetes are highly prevalent worldwide and often co-exist, worsening outcomes for each condition. Barriers to diagnosis and treatment are exacerbated in low and middle-income countries with limited health infrastructure and access to mental health treatment. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study tests the sustained effectiveness and cost-effectiveness of a multi-component care model for individuals with poorly-controlled diabetes and depression in diabetes clinics in India. Materials and methods Adults with diabetes, depressive symptoms (Patient Health Questionnaire-9 score ≥ 10), and ≥ 1 poorly-controlled cardiometabolic indicator (either HbA1c ≥ 8.0%, SBP ≥ 140 mm Hg, and/or LDL ≥ 130 mg/dl) were enrolled and randomized to the intervention or usual care. The intervention combined collaborative care, decision-support, and population health management. The primary outcome is the between-arm difference in the proportion of participants achieving combined depression response (≥ 50% reduction in Symptom Checklist score from baseline) AND one or more of: ≥ 0.5% reduction in HbA1c, ≥ 5 mm Hg reduction in SBP, or ≥ 10 mg/dl reduction in LDL-c at 24 months (12-month intervention; 12-month observational follow-up). Other outcomes include control of individual parameters, patient-centered measures (i.e. treatment satisfaction), and cost-effectiveness. Results The study trained seven care coordinators. Participant recruitment is complete – 940 adults were screened, with 483 eligible, and 404 randomized (196 to intervention; 208 to usual care). Randomization was balanced across clinic sites. Conclusions The INDEPENDENT model aims to increase access to mental health care and improve depression and cardiometabolic disease outcomes among complex patients with diabetes by leveraging the care provided in diabetes clinics in India ( clinicaltrials.gov number: NCT02022111 ). [ABSTRACT FROM AUTHOR]

Aims: Diabetes care is principally applied in the primary care setting whereby we examined trends in glycaemic levels and goals and estimated avoidable glycaemic burden.Methods: We retrieved glycated haemoglobin (HbA1C) results and glucose-lowering prescription records from a patient-based medical database during 2005-2013. There were 275,480 available HbA1C measurements from 76,341 individuals managed by 960 general practitioners from 321 clinics across Australia. Change in mean levels and glycaemic control over time were assessed according to sex, age and glucose-lowering therapy. The time that HbA1C levels exceeded 7% (53mmol/mol) in untreated (n=4888), non-insulin (n=11,534) and insulin treated (n=4049) patients was calculated as area under the curve (AUC) and months above threshold.Results: Average age of patients was 62.1±15.1years (47.1% women). HbA1C levels decreased from 7.1% (54mmol/mol) in 2005 to 6.6% (49mmol/mol) in 2013 and the proportion of patients who achieved a HbA1C target of <7% improved by 16% in men (53-69%) and 21% in women (55-76%). HbA1C levels decreased with advancing age in men and increased with insulin treatment; correspondingly, HbA1C goal attainment increased and decreased, respectively. Avoidable glycaemic burden was 9.3±17.7months in untreated, 16.2±25.2months in non-insulin, and 26.8±34.6months in insulin-treated patients.Conclusions: Amid considerable improvements, many treated patients still do not attain HbA1C levels ≤7% and time spent above this threshold was delayed. Earlier and more vigorously intensified management may reduce lengthy periods of uncontrolled hyperglycaemia in primary care. [ABSTRACT FROM AUTHOR]

Aims: We evaluated a theoretically-derived family-oriented intervention aimed to improve self-efficacy, self-management, glycemic control and quality of life in individuals living with Type 2 diabetes in Thailand.Methods: In a single-blinded randomized controlled trial, 140 volunteer individuals with Type 2 diabetes, recruited from a diabetes clinic in rural Thailand, were randomly allocated to intervention and control arms. Those in the intervention arm received routine care plus a family-oriented program that included education classes, group discussions, a home visit, and a telephone follow-up while the control arm only received routine care. Improvement in outcomes over time (baseline, Week 3, and Week 13 following intervention) was evaluated using Generalized Estimating Equations multivariable analyses.Results: Except for age, no between-group significant differences were observed in all other baseline characteristics. Diabetes self-efficacy, self-management, and quality of life improved in the intervention arm but no improvement was observed in the controls. In the risk-adjusted multivariable models, compared to the controls, the intervention arm had significantly better self-efficacy, self-management, outcome expectations, and diabetes knowledge (p<0.001, in each). Participation in the intervention increased the diabetes self-management score by 14.3 points (β=14.3, (95% CI 10.7-17.9), p<0.001). Self-management was better in leaner patients and in females. No between-group differences were seen in quality of life or glycemic control, however, in the risk-adjusted multivariable models, higher self-management scores were associated with significantly decreased HbA1c levels (p<0.001) and improved patient quality of life (p<0.05) (irrespective of group membership).Conclusions: Our family-oriented program improved patients' self-efficacy and self-management, which in turn could decrease HbA1c levels. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. Results: The prevalence of high/very high stress was 35% among DM patients. Age 30-40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. Conclusions: This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity. [ABSTRACT FROM AUTHOR]

Aim: The present study was undertaken to assess the cost-effectiveness of good glycemic control in a population of Bangladeshi people with type 2 diabetes mellitus (T2DM).Methods: A cross-sectional study was conducted among 496 registered patients with >1year duration of diabetes. Glycated hemoglobin A1c level <7% was judged as the cut-off value for good glycemic control. All treatment-related records from the last year were collected from patients' guide books and all cost components were calculated.Results: Among patients, 31% had good glycemic control. The average annual cost was US$ 314 per patient. Patients with poor glycemic control were significantly more likely to have complications [(p=0.049) OR 1.5] and comorbidities [(p=0.02) OR 1.5]. The annual cost increased rapidly with complications/comorbidities. In multivariable logistic regression analysis, gender (p=0.003) and cost of care (p=0.006) were significantly associated with glycemic control, and the presence of any comorbidities/complications was associated with 1.8-fold higher odds of poor glycemic control (p=0.013 95% CI: 1.131-2.786).Conclusion: Good glycemic control can lead to substantial cost saving through prevention and control of complications. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus places an enormous burden upon both patients and countries' health systems. Integral to achieving control is patients assuming responsibility for their condition. Self-monitoring of blood glucose (SMBG) can serve as a powerful tool modifying lifestyle behaviour and can aid in achieving optimal control. Methods: This study assessed the effect on diabetes control in patients who received glucometers and education over 12 months. This data was analysed at baseline, 6 and 12 months. Results: Glycaemic control improved significantly between baseline, 6 and 12 months (HbA1c% 12.29 ± 3.17 vs. 11.16 ± 3.09 vs. ±10.68 ± 3.10, respectively). The number of patients achieving target glycaemic control increased substantially while the number of patients achieving target total cholesterol and triglyceride levels improved at six months. Mean HDL cholesterol increased significantly between baseline and 12 months (1.20 ± 0.42 vs. 1.31 ± 0.40, respectively; p-value 0.0095). The mean BMI of male patients in the study increased between 6 and 121 months (27.59 ± 6.42 vs. 31.90 ± 8.85, respectively, p = 0.0012) and between baseline and 12 months (27.64 ± 6.13 vs. 31.90 ± 8.85, respectively, p = 0.0012). Conclusion: This study demonstrated that the introduction of SMBG and patient education, within this resource-limited clinic setting, had beneficial effects on diabetes control; however, obesity remains an obstacle to optimal control. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate management approach and outcome in two endocrinologist-managed clinics using data on treatment adherence, diabetes-specific parameters, prescribed medications and self-management practices among ambulatory type 2 diabetes patients. Opinion on cause(s) and perceived fear about diabetes were also explored. Design: A cross-sectional prospective study using semi-structured interview among consented patients for eightweek, and a review of participants' case notes at 3-month post-interactive contact for details of diabetes-specific parameters and antidiabetes medications Settings: The University College Hospital (UCH) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in southwestern Nigeria. Participants: Adult patients with type 2 diabetes, on therapies for >3-month and who had average fasting blood glucose (FBG)>6.0mmol/L were enrolled. All patients with type 1 diabetes, and type 2 diabetes who decline participation were excluded. Out of 185 participants who were approached, 176(95.1%) consented and completed the study including 113(64.2%) from UCH and 63(35.8%) in OAUTHC. Results: Mean FBG for patients were 9.6mmol/L in UCH and 11.0mmol/L in OAUTHC (p=0.03). Medication adherence among patients was 47(46.5%) in UCH and 31(52.5%) in OAUTHC (p=0.46). Prescribed antidiabetes medications between the clinics significantly differ. Practice of self-monitoring of blood glucose among participants was 26(23.0%) in UCH and 13(20.6%) in OAUTHC (p=0.72). Thirty-two participants (29.4%) in UCH and 33(43.4%) from OAUTHC (p=0.02) mentioned complications as perceived fear about type 2 diabetes. Conclusion: There are differences and similarities between the diabetes-specialty clinics with respect to diabetes management and outcome. This underscores the necessity for a protocol-driven treatment approach in ensuring improved diabetes care and outcome. [ABSTRACT FROM AUTHOR]

Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources. Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA. Method. We have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The team consisted of highly trained nurses. The model effectiveness is measured by comparing the rate of hospital admission for DKA over 4-year period to the baseline year prior to implementing the model. Results. There were 158 admissions for DKA over a 5-year period. Number of patients followed up in the outpatient diabetes clinics increased from 37 to 331 patients at the start and the end of the study years. Admission rate showed a downward trend over the five-year period. Percentage of admission for DKA is reduced from 210% to 1.8% (P 0.001). Conclusion. Diabetes educator care model is an effective and a sustainable measure to reduce hospital admission for DKA in children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus, frequently associated with comorbid depression, contributes to the double burden of individual patients and community. Depression remains undiagnosed in as many as 50%-75% of diabetes cases. This study aimed to determine the prevalence and associated factors of depression among diabetic patients attending the University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted from March to May 2014 among 422 sampled diabetic patients attending the University of Gondar Hospital Diabetic Clinic. The participants were selected using systematic random sampling. Data were collected by face-to-face interview using a standardized and pretested questionnaire linked with patient record review. Depression was assessed using the Patient Health Questionnaire-9. Data were entered to EPI INFO version 7 and analyzed by SPSS version 20 software. Binary logistic regression analysis was performed to identify factors associated with depression. Results: A total of 415 diabetic patients participated in the study with a response rate of 98.3%. The prevalence of depression among diabetic patients was found to be 15.4% (95% confidence interval (CI): 11.7-19.2). Only religion (adjusted odds ratio [AOR] =2.65 and 95% CI: 1.1-6.0) and duration of diabetes (AOR =0.27 and 95% CI: 0.07-0.92) were the factors associated with depression among diabetic patients. Conclusion: The prevalence of depression was low as compared to other similar studies elsewhere. Disease (diabetes) duration of 10 years and above and being a Muslim religion follower (as compared to Christian) were the factors significantly associated with depression. Early screening of depression and treating depression as a routine component of diabetes care are recommended. Further research with a large sample size, wider geographical coverage, and segregation of type of diabetes mellitus is recommended. [ABSTRACT FROM AUTHOR]

Background: India has the second largest population of persons with diabetes and a significant proportion has poor glycemic control and inadequate awareness of management of diabetes. Objectives: Determine the level of awareness regarding management of diabetes and its complications and diabetic care practices in India. Methods: The cross-sectional, hospital-based survey was conducted in 11 cities where public and private providers of diabetic care were identified. At each diabetic care facility, 4-6 persons with diabetes were administered a structured questionnaire in the local language. Results: Two hundred and eighty-five persons with diabetes were interviewed. The mean duration since diagnosis of diabetes was 8.1 years (standard deviation ± 7.3). Half of the participants reported a family history of diabetes and 41.7% were hypertensive. Almost 62.1% stated that they received information on diabetes and its management through interpersonal channels. Family history (36.1%), increasing age (25.3%), and stress (22.8%) were the commonest causes of diabetes reported. Only 29.1% stated that they monitored their blood sugar levels at home using a glucometer. The commonest challenges reported in managing diabetes were dietary modifications (67.4%), compliance with medicines (20.5%), and cost of medicines (17.9%). Around 76.5% were aware of complications of diabetes. Kidney failure (79.8%), blindness/vision loss (79.3%), and heart attack (56.4%) were the commonest complications mentioned. Almost 67.7% of the respondents stated that they had had an eye examination earlier. Conclusions: The findings have significant implications for the organization of diabetes services in India for early detection and management of complications, including eye complications. [ABSTRACT FROM AUTHOR]

For normal function, the human body requires a constant supply of energy intake is achieved through food principles (Jensen et al. 2012). Being a body warm-blooded, that lacks the storage capacity of the heat and the possibility of transforming other forms of external energy source unique and indispensable to the survival of human remains energy produced by dissolution of chemical bonds in the structure of food health of each individual, often measured by what is called an optimal nutritional status derived from balance achieved between supply and nutritional intake (Camina-Martin et al. 2015). The existence of a state of optimal nutrition promotes the growth and development of the organism, maintain health, enable work daily and participates protect the body from various diseases assaults (Elmadfa and Meyer 2014). [ABSTRACT FROM AUTHOR]

Objective To assess tuberculosis infection control measures in diabetes mellitus ( DM) clinics in China. Method An evaluation questionnaire was developed based on the measures outlined in the WHO policy on TB infection control in healthcare facilities and congregate settings. Ten selected hospitals were assessed between September 2014 and February 2015. Results All hospitals had an infection control committee, an action plan and training, but there was no focus on activities to prevent airborne transmission of infection, especially from tuberculosis. All DM clinics had natural or artificial ventilation, but at the time of the evaluation half had all windows closed. While all the hospitals provided surgical masks for hospital staff, none had N95-specific respiratory masks and only three provided masks for patients with a cough. There were no policies on identifying DM patients with TB symptoms, minimising the time spent by these patients in the clinics or developing health educational material on diabetes and tuberculosis. Conclusion Infection control measures to prevent airborne transmission in DM clinics are inadequate. More work is needed to better understand and determine the risk of TB infection in DM clinics and to improve their TB infection control practices. [ABSTRACT FROM AUTHOR]

Background: Growing attention is being paid to the importance of trust, and its corollaries such as mistrust and distrust, in health service and the central place they have in assessments of quality of care. Although initially focussing on doctor-patient relationships, more recent literature has broadened its remit to include trust held in more abstract entities, such as organisations and institutions. There has consequently been growing interest to develop rigorous and universal measures of trust. Methods: Drawing on illustrative ethnographic material from observational research in a UK diabetes clinic, this paper supports an approach that foregrounds social practice and resists conceiving trust as solely a psychological state that can be divorced from its context. Beyond exploring the less-than-conscious nature of trust, the interpretations attend to the extent to which trust practices are distributed across a range of actors. Results: Data from clinical encounters reveal the extent to which matters of trust can emerge from the relationships between people, and sometimes people and things, as a result of a wide range of pragmatic concerns, and hence can usefully be conceived of as an extended property of a situation rather than a person. Trust is rarely explicitly articulated, but remains a subtle feature of experience that is frequently ineffable. Conclusions: A practice approach highlights some of the problems with adopting a general psychological or intellectualist conception of trust. In particular, assuming it is a sufficiently stable internal state that can be stored or measured not only transforms a diffuse and often ephemeral quality into a durable thing, but ultimately presents it as a generic state that has meaning independent of the specific relationships and context that achieve it. Emphasising the context-specific nature of trust practices does not dismiss the potential of matters of trust, when they emerge, to be transposed to other contexts. But it does highlight how, on each occasion, trust as a relational quality is ways 'done' or 'achieved' anew. [ABSTRACT FROM AUTHOR]

Adherence to the treatment of diabetic patients is always a challenge. Hence the study was carried out to find out the effectiveness of the diabetic clinic, in improving the adherence of patients. Study subjects: Patients with known DM attending Diabetic clinic of Medical College Hospital, Sangli. Study design: Cross Sectional study. Study duration: 6 months. Study Tools: Pre tested proforma with written consent of the DM patient. Sampling techniques: all the patients attending diabetic clinic were interviewed once. Sample size: 282. Adherence to pharmacological treatment was 93.3 %, while adherence to non pharmacological treatment, was 78.3 % and 95 % respectively. Statistically highly significant difference was found for the adherence to advice like reducing sugar consumption, in rural and urban patients. Similarly the observed difference was found to be highly significant for the adherence to advice like carrying out daily exercise compared between male and female. Unaffordable drug price was one of the main causes of non-adherence. Adherence to treatment of diabetic patients can be improved with effective and efficient diabetic clinic. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine diabetic patients in Jeddah, Saudi Arabia, regarding their general diabetic and oral health-related awareness and practices, their awareness of the association of diabetes with periodontal disease, and their sources of diabetes-related information. Methods: Diabetic patients (n=454) who were receiving care at the diabetes clinic in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from October 2013 to May 2014, completed a six-part questionnaire assessing their sociodemographic characteristics, general and oral health awareness and practices, and sources of diabetes-related information. Descriptive statistics were used to report the results. Results: The responses indicated inadequate health-related practices in the surveyed group: 22.2% brushed their teeth twice daily, 73.6% never flossed their teeth, and while 80.2% visited a physician in the past year, only 12.6% visited a dentist during the same year. Of the respondents, 94.8% reported that they had never received advice on oral hygiene tasks in relation to diabetes from a health professional. Awareness about the diabetes and periodontal disease association was limited: 46.7% knew that diabetics have gum problems more often if their blood sugar stays very high, and only 21.8% knew that gum disease makes it harder to control blood sugar in diabetic patients. A significant association (P<0.05) was found between a higher level of education and greater general and oral awareness, as well as a significant association (P<0.05) between longer duration of disease, regular exercise, and regular visits to the physician and awareness about diabetes mellitus. Additionally, a significant association (P<0.05) was found between regular dental visits and both periodontal disease and diabetes awareness. Family and friends were the main source of diabetes-related information, and the Internet was the least likely source. Conclusion: Customized educational programs should be planned for diabetic patients according to community needs. [ABSTRACT FROM AUTHOR]

Research on the routines of doctor-patient consultations has been conducted in language and culture concordant dyads and in dyads where either doctor or patient uses a foreign language; yet there is an absence of scholarly engagement with consultations where both participants are using a foreign language. In seeking to address this gap, this article reports on four doctor-patient consultations involving the use of English as a lingua franca. The data form part of a larger empirical study of communication in an Irish diabetes clinic. Microanalysis, informed by Interactional Sociolinguistics, Pragmatics and Conversation Analysis, reveals a range of interactive challenges rooted in language and cultural assumptions which impact on the management of the consultation routines. The findings emphasize the strength of the doctors' professional socialization and the challenges this poses for non-native-speaker patients. [ABSTRACT FROM AUTHOR]

Background: Foot complications are a serious and costly complication of Diabetes Mellitus. With about one third of Tanzanian diabetic patients likely to require hospitalization due to limb complications, with its high mortality, which can be prevented or decreased by proper limb assessment? This study aimed at determining the practice of foot assessment of diabetic patients and factors hindering it at the diabetic clinic in a Rural Tanzanian hospital. Methods: A hospital based descriptive cross-sectional study was carried out in the diabetic clinic of Shinyanga regional hospital. A patient knowledge assessment tool was developed and used for exit survey, and a separate provider tool adopted from National Diabetic association of Australia was also used on the last day of the study. Results: A total of 268 patients were interviewed of whom 45% had poor knowledge on footcare. Only one third of patients had their feet assessed in spite of good knowledge mean score of health workers as regards diabetic footcare. Work overload was cited as the hindrance factor. Conclusion: Poor quality of diabetic care still exists even after efforts to establish special clinics. A chronic care model should be developed and disseminated to all HCWs offering care to diabetic patients. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the Diabetic Foot Symposium held in Karachi, Pakistan in August 2014. Topics covered include the speakers during the event, including Professor Abdul Basit, executive director of the Baqai Institute of Diabetes and Endocrinology (BIDE), and Dr. Fatema Jawad, chief editor of the "Journal of Pakistan Medical Association" (JPMA), and issues raised by speakers, such as public awareness about diabetes and problems faced by diabetic foot clinics.

Introduction: Diabetes mellitus in Malta has been an established major health problem for years. It has been linked with cultural, geographical, historical, genetic as well and a change from a Mediterranean diet to a Westernized diet. This diabetes burden has lead to establishment of diabetes clinics both in the central general hospital, as well as in the community. Over the past 50 years, there have been two major epidemiological diabetes studies conducted to evaluate diabetes in the Maltese population. Diabetes in Malta: To date, there is no established national diabetes plan or diabetes register in Malta, although there has been the formation of a governmental diabetes focus group. The time is right for an updated prevalence study to look at the current Maltese generation and their changing determinants including diabetes risk factors and genetics, followed by the development of preventative strategies and policies. Conclusion: Over the years, diabetes burden has increased and become a public health and national financial concern. It is of utmost importance to address this national disease. An updated prevalence study would provide the evidence-based backbone for the development of diabetes preventive strategies and policies. The combination of which will enable the Maltese health services to be improved and better equipped to come to grips with this epidemic. [ABSTRACT FROM AUTHOR]

Abstract: Fetal Growth Restriction (FGR) is a leading cause for long term morbidity. The Cohen diabetic sensitive rats (CDs), originating from Wistar, develop overt diabetes when fed high sucrose low copper diet (HSD) while the original outbred Sabra strain do not. HSD induced FGR and fetal oxidative stress, more prominent in the CDs, that was alleviated more effectively by copper than by the anti-oxidant vitamins C and E. Our aim was to evaluate the impact of copper or the anti-oxidant Tempol on placental size, protein content, oxidative stress, apoptosis and total DNA methylation. Animals were mated following one month of HSD or regular chow diet and supplemented throughout pregnancy with either 0, 1 or 2ppm of copper sulfate or Tempol in their drinking water. Placental weight on the 21st day of pregnancy decreased in dams fed HSD and improved upon copper supplementation. Placental/fetal weight ratio increased among the CDs. Protein content decreased in Sabra but increased in CDs fed HSD. Oxidative stress biochemical markers improved upon copper supplementation; immunohistochemistry for oxidative stress markers was similar between strains and diets. Caspase 3 was positive in more placentae of dams fed HSD than those fed RD. Placental global DNA methylation was decreased only among the CDs dams fed HSD. We conclude that FGR in this model is associated with smaller placentae, reduced DNA placental methylation, and increased oxidative stress that normalized with copper supplementation. DNA hypomethylation makes our model a unique method for investigating genes associated with growth, oxidative stress, hypoxia and copper. [Copyright &y& Elsevier]

We examined the diagnostic utility of the indicator test Neuropad in the assessment of overall and small fibre dysfunction in 1 010 patients with type 2 diabetes mellitus (T2DM) (608 men, mean age 63.9 ± 10.3 years) from 5 diabetes clinics. Sudomotor function was diagnosed by the Neuropad ® test. Overall and small nerve fibre dysfunction was diagnosed through clinical examination and symptoms. Patients were divided into Groups A (441 patients with sudomotor dysfunction) and B (569 patients without sudomotor dysfunction). The former were older (p < 0.05) and had longer T2DM duration (p < 0.05) than the latter. For overall nerve fibre dysfunction, abnormal Neuropad defined as patchy/ blue had 94.9 % sensitivity, 70.2 % specificity and 98.1 % negative predictive value (NPV), while for small fibre dysfunction the corresponding values were 85.6 %, 71.2 % and 93.3 %. For overall nerve fibre dysfunction, abnormal Neuropad defined as blue had 64 % sensitivity, 96 % specificity and 91 % NPV, while for small fibre dysfunction the corresponding values were 52 %, 96 % and 85 %. The odds ratios (ORs) of Neuropad patchy/blue for overall and for small fibre dysfunction were 43.7 and 14.7, respectively. The ORs of Neuropad blue for overall and for small fibre dysfunction were 45.7 and 24.9, respectively. In conclusion, Neuropad patchy/blue response exhibited better diagnostic performance both for overall and small nerve fibre dysfunction. Its very high NPV renders it an excellent screening tool primarily to exclude neuropathy in T2DM. [ABSTRACT FROM AUTHOR]

Background To investigate the relationship between elevated serum uric acid levels and the presence of diabetic foot ulcer ( DFU) in Chinese patients with type 2 diabetes ( T2D). Methods A retrospective study was performed on 829 outpatients with T2D (478 men, 351 women) who visited the Diabetes Clinic ( Nanfang Hospital, Southern Medical University) from January 2007 to December 2009. Information regarding their clinical history, anthropometric measurements, and laboratory data were collected. Potential confounding variables with P < 0.10 were adjusted for in multivariate logistic regression analysis. Results In univariate analyses, there was a significant difference in serum uric acid levels between female patients with and without DFU (370 ± 128 vs. 313 ± 107 μmol/L, respectively; P < 0.05), but not between male patients with and without DFU (317 ± 100 vs. 348 ± 111 μmol/L, respectively; P = 0.643). The prevalence of DFU among quintiles of uric acid levels (from 1-20% to 80-100%) was 5.3%, 3.9%, 7.7%, 5.5%, and 16.7%, respectively. Using uric acid level as a continuous variable, the multivariate-adjusted odds ratio for diabetic foot ulcer in female patients was 1.004 (95% confidence interval 1.001-1.008; P < 0.05). Conclusions Elevated uric acid levels are a significant and independent risk factor for diabetic foot ulcer in female Chinese patients with T2D. Whether serum uric acid is involved in the pathogenesis of DFU in female patients remains to be investigated. [ABSTRACT FROM AUTHOR]

The article discusses the medical case of a 39-year-old overweight man with type 1 diabetes. An overview of the patient's blood glucose control is provided. Some methods that the patients tried to achieve glycemic control are intensified insulin-injection therapy, regular visits to a diabetes clinic and input from diabetes nurse educators. The clinical problem and the mechanism of the benefit of insulin-pump therapy are discussed. The author's clinical recommendations are provided.

Introduction: The aim of this study is to clarify the relationship of erectile dysfunction (ED) and diabetes mellitus (DM) parameters (referred to with '1'), including peripheral neuropathy (referred to with '2'). Methods: (1) The DM parameters including age, serum levels of blood sugar, hemoglobin A1c, duration of DM and number of DM complications were obtained from 145 patients at a general DM clinic. (2) The peripheral neuropathy examinations by vibration perception threshold (VPT) and Achilles tendon reflex were performed in 97 DM patients. Erectile functions in DM patients were evaluated by the International Index of Erectile Function (IIEF 5). The DM patients' parameters were compared with the IIEF 5 scores. Results: (1) The data showed IIEF 5 scores were significantly correlated with patient age, duration of DM and number of DM complications. (2) IIEF 5 scores were significantly correlated with VPT time. Furthermore, multiple regression analysis revealed that patient age and VPT time were independent risk factors for predicting ED in DM patients. Conclusions: The severity of ED in DM patients depended on age, duration of DM, number of DM complications and VPT. Significantly, the age of DM patients and the measurement of VPT are considered to be simple and useful indicators to diagnose ED in DM patients. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: To determine the long-term (20 years from presentation) outcome of brittle type 1 diabetes characterized by recurrent episodes of ketoacidosis (DKA).Methods: The cohort studied was a group of brittle diabetic patients from various parts of UK originally identified between 1979 and 1985. Patients were traced, where possible, via their diabetic clinics and/or general practitioners. Data on survival or otherwise were obtained from hospital case notes and information from diabetes care team members. For survivors, clinical and demographic information obtained included complication status and whether they still had brittle characteristics. They were also compared with a matched case–control group of type 1 patients with no history of brittle behaviour.Results: The original cohort comprised 33 patients— all female and mean ± SD, aged 18 ± 5 years and diabetes duration 8 ± 4 years. Thirteen were not traceable and 10 of the remaining 20 (50%) had died during the mean 22 years of follow-up. Deaths occurred evenly throughout the period, and causes were chronic renal failure (3), DKA (3), hypoglycaemia (2), subarachnoid haemorrhage (1) and uncertain (1). Age at death ranged from 27 to 45 years. Of the 10 survivors, none remained brittle, but they had a substantial burden of complications. Compared with the non-brittle control group, there was a significant excess of nephropathy and autonomic neuropathy.Conclusions: We conclude that brittle diabetes characterized by recurrent DKA has high long-term outcome mortality. These deaths were premature and almost all diabetes related. Those who survived had resolution of brittleness, but suffered a significant complication burden. [ABSTRACT FROM AUTHOR]

Objective: To find out prevalence of various myths regarding diet of diabetics in local population. Methodology: This was a cross sectional study conducted at diabetic clinic and medical OPD in Civil Hospital Karachi from January 2008 to December 2008. A total of 409 diabetic patients of either gender, age 18 or above who had given the consent were randomly selected. A pretested semi structured questionnaire regarding sociodemographic profile and various dietary myths regarding diabetes were used to get information from the study group. Result: Out of 409 diabetic subjects 207(50.6%) were male. Average age was 51.6 ±10.4 years. Most of the participant 397(97.1%) were type 2 diabetics. Large number of subjects 83(20.3%) were either illiterate or had had primary schooling 112 (27.4%). Most of the participants 256 (62.6%) never received any diabetic education. Majority of study subjects 348(85%) believed in special diet for control of blood sugar level while large proportion of study population 335 (81.9%) did not use underground vegetables and same number of participants had strong belief in bitter vegetables as natural remedy. Forty one percent study subjects had myths regarding fruits while 301(73.5 %) said that rice is prohibited. Study population who believed in special diet showed significant p-value (<0.005) when compared with those who did not. Similarly the group that had received diabetic education showed significant p-value when compared with those who did not. Conclusions: A large number of diabetic patients especially those who never received any diabetic education have strong dietary misconceptions. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to analyze patients' knowledge about therapeutic goals for diabetic patients and factors associated with good knowledge. Methods: A total of 266 diabetic patients were randomly selected from 6 diabetes clinics in Kuwait to be included in a cross-sectional patient survey. Data were collected via face-to-face structured interviews using a pretested questionnaire. Descriptive and logistic regression analysis was used in data analysis. Results: The response rate was 93% (n = 247). The percentages [95% confidence interval (CI)] of patients who reported knowing their recent levels of low-density lipoprotein cholesterol (LDL-C), blood pressure (BP), and glycosylated hemoglobin (HbA1c) were 5% (2-8), 54% (48-60), and 8% (5-11), respectively. The percentages (95% CI) of patients who admitted knowing the target goals for LDL-C, BP, HbA1c, fasting, and postprandial blood glucose levels were 3% (1-6), 49% (43-55), 6% (3-9), 62% (56-68) and 55% (49-61), respectively. Correct target goals for LDL-C, BP, HbA1c, fasting, and postprandial blood glucose levels were reported by 2% (1-4), 43% (37-49), 5% (2-8), 60% (54-66), and 47% (41-53), respectively. Those with a high education (OR = 4.76; 95% CI 2.34-9.68) and those with a family history of diabetes (OR = 3.05; 95% CI 1.50-6.19) had good knowledge about correct targets. Conclusion: The current findings revealed that lack of knowledge about recent levels of BP, LDL-C and HbA1c and therapeutic goals was alarmingly high, which highlights the need for the implementation of an effective multidisciplinary team approach to encourage patient education and self-care. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia. Subjects and Methods: A prospective observational study was performed on 320 patients (174 males and 146 females) attending the diabetic clinic. A detailed dermatological examination was carried out by a consultant dermatologist and the cutaneous findings were recorded. Results: The overall prevalence of skin manifestations was 91.2%. Cutaneous lesions were seen in 12 patients (34.3%) of type 1 diabetes mellitus (DM) and 280 (98.2%) of type 2 diabetics. There was a statistically significant difference (p < 0.001) in skin manifestations between type 1 and type 2 DM patients. For those patients having diabetes of less than 5 years' duration, the incidence of skin manifestations was 80.6%; for those having had diabetes for more than 5 years, the incidence was 98%. This difference was statistically significant (p < 0.001). The skin manifestations that had a statistically significant difference (p < 0.05) in prevalence between the 2 durational groups were gangrene, diabetic dermopathy, paresthesia, diabetic feet, diabetic bullae and fungal infections. Conclusion: Diabetics had a greater prevalence of skin manifestations in type 2 than type 1, and as the duration of diabetes increased, the likelihood of developing skin manifestations also increased. Early referral to the dermatologist may help to detect complications of the skin in diabetes at an early stage and may prevent disability caused by these complications. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the role of mother's knowledge and socioeconomic status (SES) of the family on glycemic control in diabetic children. Our sample was taken from successive admissions to the outpatient's diabetes clinics in Tuzla, Bosnia and Herzegovina. Diabetes knowledge was assessed using the Michigan Diabetes Research and Training Center Diabetes Knowledge Test. Glycemic control was assessed by glycosylated hemoglobin (HbA(1C)). The mother's demographics were obtained by self-report. To categorize families' SES, parents' level of education, and current employment were recorded and analyzed using the Hollingshed two-factor index of social position. As expected, higher mother's knowledge was significantly associated with lower HbA(1C) (r = -0.2861705, p = 0.0442). Also, a significant correlation was found between the families' SES and HbA(1C) levels (r = 0.4401921; p = 0.0015). Mothers with more knowledge have children with better metabolic control, and low SES is significantly associated with higher levels of HbA1c. Improvement of mothers' knowledge and family SES may improve glycemic control and ultimately decrease acute and chronic complications of diabetes in children. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this descriptive pilot study was to evaluate physiological and behavioral outcomes among veterans with type 2 diabetes attending an advanced practice nurse-managed diabetes clinic. Participants completed baseline and follow-up interviews approximately 6 weeks apart, and physiological data were obtained from medical records after each interview. Physiological outcomes did not change significantly from baseline to follow-up; however, some behavioral outcomes improved significantly. Although further research is warranted, this study provided insight into the beliefs of patients with type 2 diabetes, which may inform the treatment and education of such patients in primary care. [Copyright &y& Elsevier]

To assess the effect of L-carnitine administration as an additional useful supplement, its modulating effect on glycaemic state, and its effect on certain parameters of renal function in type 2 diabetics with or without nephropathy. Patients and Methods: Fifty-four patients (32 males, 22 females) with type 2 diabetes mellitus who were attending Al-Waffa Diabetic Clinic, Mosul, Iraq; during the period from 1st October 2005 to 31st March 2006 were included in this study. Lcarnitine was given to each of these diabetics for 45 days in a dose of 550 mg, in form of tablets in two doses orally, in addition to their other hypoglycaemic drugs. Blood samples were taken from each patient for the measurement of fasting plasma glucose (FPG), HbA1c, serum creatinine and urea before the first administration of L-carnitine, then after 15, 30 and 45 days from the commencement of the study. Mean FPG showed significant decrease (p<0.001) between the four intervals with a mean of 11.15 mmol/L before starting carnitine administration, 8.55 mmol/L after 15 days, 8.30 mmol/L after 30 days and 7.85 mmol/L after 45 days from the administration of carnitine. This study also shows a significant decrease in mean HbA1 and HbA1c when compared to that before administration (p<0.001) with mean of 8.99% and 6.78% respectively before starting administration, and 7.65% and 5.71% respectively 45 days after carnitine administration. Serum creatinine showed a significant decrease (p<0.001) with a mean of 114.9 μmol/L and 100.6 μmol/L before and 45 day from starting carnitine administration respectively. Serum urea showed also a significant decrease (p<0.01) from a mean of 6.61 mmol/L before carnitine administration and 6.03 mmol/L 45 days from starting carnitine administration. L-carnitine can be useful as an additional dietary supplement and pharmaceutical agent that complement other hypoglycaemic drugs for the management of type 2 diabetics. It has a lowering effect on fasting plasma glucose and blood HbA1c as well as its effect on improving renal function. [ABSTRACT FROM AUTHOR]

Abstract: Exenatide use in type 2 diabetes is limited in routine clinical practice. We examined a cross-section of 90 patients. Mean weight and HBA1c were 114.9±20.6kg, 10.3±2.1% at initiation; 108.0±15.3kg (p <0.0001), 9.0±2.1% (p <0.001) at 3 months; 109.2±18.2kg (p <0.0001), 9.5±2.3% (p =0.08) at 6 months. Exenatide appears effective in reducing HBA1c and weight. [Copyright &y& Elsevier]

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paterson bl, charlton p & richard s (2010) Journal of Nursing and Healthcare of Chronic Illness 2, 63–74 Non-attendance in chronic disease clinics: a matter of non-compliance? Aim. To identify the personal, contextual and mediating factors that influence non-attendance in specialty chronic disease clinics. Background. Non-attendance in chronic disease clinics is an ongoing problem that can increase patients’ vulnerability to serious complications, affect continuity of care, contribute to long wait times, engender negative patient–provider relationships, and increase costs to the health system. Methods. Literature for this review was obtained by an extensive search of health and social science computerised bibliographic databases using the search terms participation, attendance, non-attendance, attrition, dropout, missed appointment, no show with diabetes, chronic disease and chronic illness care. Results. Twenty-eight research studies met our criteria for inclusion in the review. Analyses revealed that non-attendance at chronic disease clinics is influenced by a myriad of factors encompassed as personal and clinical factors, and factors pertaining to the nature and operations of the clinic. Conclusions. The factors that influence attendance are complex and multifactoral. A range of strategies are needed to address the myriad of patient-related and health-system factors to increase attendance rates and ultimately improve health outcomes. Relevance to clinical practice. A critical analysis of factors that affect attendance is important to begin to develop a greater awareness and understanding among health providers of the implications and reasons for missed appointments. The results can help to improve patient–provider relationships and deliver services that better meet patients’ needs and expectations. [ABSTRACT FROM AUTHOR]

Abstract: Methods: The most recent nationally recognised guidelines for type 2 diabetes from eight European countries (Belgium, England/Wales, France, Germany, Ireland, Italy, the Netherlands and Sweden) were compared. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was used for quality assessment. Details of recommendations for key process and outcome indicators were also extracted. Appraisal and data extraction were conducted independently by two researchers. Results: AGREE domain scores varied between guidelines, including a range of 31–95% for rigour of development. The highest mean domain scores were for Scope and Purpose (81%) and Clarity and Presentation (85%); the lowest was for Stakeholder Involvement (49%). Specific recommendations, including targets relating to intermediate outcomes, were broadly similar. However, at detailed level, there were variations, particularly in terms of the level of information provided, for example, only two countries’ guidelines provided cut-off points in relation to risk associated with waist circumference. Implications: Our findings suggest that there are some areas of good practice relating to guideline development where more attention is needed. Despite a substantial degree of consensus for specified targets, observed differences at detailed level suggest a lack of consistency in relation to some aspects of the information provided to clinicians across Europe. [Copyright &y& Elsevier]

Abstract: Background and aims: Since there is no agreement on regimens of self-monitoring of blood glucose (SMBG) in type 2 diabetes not on insulin, we evaluated the effects of a simple SMBG policy taking into account compliance. Methods and results: 273 type 2 diabetic patients not on insulin with HbA1c >7% attending our Diabetes Clinic and already using SMBG were randomized as follows: Group A, one BG profile/month with fasting and post-prandial values; Group B, one BG profile every 2 weeks with pre- and post-prandial values. Patients were followed-up by the same team every 3 months with the same education and treatment policies. At 3 and 6 months, SMBG profiles were evaluated and HbA1c measured. SMBG was carried out as recommended by 73% of Group A and 44% of Group B patients. In compliant patients, HbA1c and BG were unchanged in Group A whereas in Group B fasting, pre-prandial and two out of three post-prandial BG values were reduced and HbA1c decreased from 8.09±0.84% to 7.60±0.73% (p <0.001). The influence on BG control was similar for the two policies when compliance was not considered. Conclusions: The more intensive SMBG policy considered is associated with improvements in glycaemic control in compliant subjects. [Copyright &y& Elsevier]