Our meta-analysis shows that overall, HITs have favorable impact on glycemic control of patients with type 2 diabetes. On average, mobile-based interventions produce larger effects compared to other forms of approaches under review (Current Diabetes Reports)
Diabetes News
Category: Management
Management of Hyperglycemia in Type 2 Diabetes, 2018
A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Standards of Medical Care in Diabetes—2018
16 sections (Diabetes Care)
NICE impact diabetes
This report considers how NICE’s evidence-based guidance can contribute to improvements in the prevention and management of diabetes
Inpatient hypoglycaemia; should we should we focus on the guidelines, the targets or our tools?
These guidelines suggest using lower limits of glucose targets varying from 4.0 to 6.0 mmol/l [2–4]. Levy et al. propose a lower glucose limit of 5 mmol/l with the catchphrase ‘stop at 5 and keep the inpatient alive’ (Diabetic Medicine)
Effect of a Remotely Delivered Tailored Multicomponent Approach to Enhance Medication Taking for Patients With Hyperlipidemia, Hypertension, and Diabetes
A remotely delivered multicomponent behaviorally tailored intervention resulted in a statistically significant increase in medication adherence but did not change clinical outcomes (JAMA Internal Medicine)
Nurse-led psychological intervention for type 2 diabetes: a cluster randomised controlled trial (Diabetes-6 study) in primary care
Training nurses in MI and basic CBT to support self-management did not lead to improvements in glycaemic control or other secondary outcomes in people with T2D at 18 months. It was also unlikely to be cost-effective. Furthermore, the increased contact with standard-care nurses did not improve glycaemic control (British Journal of General Practice)
Glycaemic control and mortality in older people with type 2 diabetes: The Fremantle Diabetes Study Phase II
Tight glycaemic control may be hazardous in older people with type 2 diabetes when achieved with pharmacotherapy with metformin, and especially with insulin or sulphonylureas. These data confirm that overtreatment is likely to be an important clinical problems in this vulnerable population (Diabetes, Obesity and Metabolism)
SGLT2 Inhibitors in Combination Therapy: From Mechanisms to Clinical Considerations in Type 2 Diabetes Management
With guidelines moving away from a one-size-fits-all approach toward setting patient-centered goals and allowing flexibility in choosing a second-/third-line drug from the growing number of U.S. Food and Drug Administration–approved glucose-lowering agents, keen personalized management in T2D has become a challenge for health care providers in daily practice (Diabetes Care)
Young people’s experiences of managing Type 1 diabetes at university: a national study of UK university students
The study quantifies the high level of risk experienced by students with Type 1 diabetes during the transition to university, in particular, female students and those moving to a new university healthcare provider (Diabetic Medicine)
A retrospective observational study of people with Type 1 diabetes with self‐reported severe hypoglycaemia reveals high level of ambulance attendance but low levels of therapy change and specialist intervention
We observed a high level of ambulance service intervention but surprisingly low levels of hypoglycaemia follow‐up, therapy change and specialist intervention in people self‐reporting severe hypoglycaemia. These results suggest there may be important gaps in care pathways for people with Type 1 diabetes self‐reporting severe hypoglycaemia (Diabetic Medicine)
Effectiveness of text message based, diabetes self management support programme (SMS4BG)
A tailored, text message based, self management support programme resulted in modest improvements in glycaemic control in adults with poorly controlled diabetes. Although the clinical significance of these results is unclear, the findings support further investigation into the use of SMS4BG and other text message based support for this patient population (BMJ)
Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty.
We present a framework for the assessment of older adults and guidelines for the management of this population according to their frailty status, with the intention of reducing complications and improving quality of life for these people (Diabetic Medicine)
Pathophysiology‐based phenotyping in type 2 diabetes: A clinical classification tool
Patients clinically diagnosed with type 2 diabetes are a heterogeneous group. In the future, targeted treatment based on pathophysiological characteristics rather than the current “one size fits all” approach may improve patient prognosis (Diabetes/Metabolism Research and Reviews)
Treatment Intensification in Type 2 Diabetes: A Real-World Study of 2-OAD Regimens, GLP-1 RAs, or Basal Insulin
Despite robust HbA1c lowering following treatment initiation, many patients did not achieve HbA1c < 7.0%. Basal insulin, generally prescribed for patients with high baseline HbA1c, was associated with a large reduction in HbA1c and with higher costs. Therapy intensification at an appropriate time could lead to clinical and economic benefits and should be investigated further (Diabetes Therapy)
Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study
Both low and high levels of glycaemic control were associated with an increased mortality risk, and the level of variability also seems to be an important factor, suggesting that a stable glycaemic level in the middle range is associated with lower risk (The Lancet Diabetes & Endocrinology)
How Does Diabetes Affect Daily Life? A Beyond-A1C Perspective on Unmet Needs
Patients across cultures and countries report negative experiences from diabetes, not only with regard to glycemia, but also regarding physical, emotional, social, and financial health metrics. Diabetes is a 24/7 unwanted job with no vacations, breaks, or set-it-and-forget-it phone apps (Clinical Diabetes)
Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes
A health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial. Our analysis of the REPOSE data suggests that routine use of pumps in adults without an immediate clinical need for a pump, as identified by National Institute for Health and Care Excellence, would not be cost-effective (BMJ Open)
Long-term outcomes associated with triple-goal achievement in patients with type 2 diabetes mellitus
Achievement of triple-goal was associated with better health outcomes among veterans with T2DM compared to those that did not, while LDL-C has more weight of influence. Multi-faceted treatment strategies targeting hypertension, hyperglycemia and hyperlipidemia may improve health outcome in veterans with T2DM (Diabetes Research and Clinical Practice)
Young Adult Diabetes: Engaging to improve; outcomes of the young adult clinic restructure
Using results of local audits and feedback from a subsequent multi-disciplinary team (MDT) and patient focus group meeting, the young adult diabetes clinic was re-designed with a vision to have a structured, patient-led, flexible clinic service with specific aims and objectives, to be achieved within 12 months (December 2016) (NICE)
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