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Retrospective assessment of the quality of diabetes care in a rural diabetes clinic in Western Kenya

Retrospective assessment of the quality of diabetes care in a rural diabetes clinic in Western Kenya

We conducted a retrospective study in the diabetes clinic of Webuye District Hospital (WDH), a secondary care hospital in rural Western Kenya. The clinic was established in 2009 and serves a low-income population that primarily relies on an agriculture-based economy and job market. The clinic is regularly staffed by clinical officers (diploma level providers equivalent to physician assistants in other settings), nutrition counselors, and a social work team. Clinical officers manage stable pa- tients, defined as patients with well controlled diabetes and low risk for complications, while family medicine residents and consultant physicians review newly en- rolled patients. In addition, the physicians, family medi- cine residents and clinical pharmacists provide care decision support for complicated cases. Patients are scheduled for follow up anytime between one week and three months depending on the patient’s clinical needs. The clinic is able to provide both insulin therapy, oral hypoglycemic agents (sulfonylureas), and metformin, as well as routine tests such as point-of-care blood glucose (Abbott Optimum Xceed ® ), and glycated hemoglobin (HbA1C, Siemens DCA Vantage®) at the clinic. The hos- pital lab provides urea, creatinine, electrolyte measure- ments, urinalysis, and complete blood count testing, when needed. Insulin dependent patients and/or those at increased risk of diabetes related complications are eligible for inclusion within an intensive self-monitored blood glucose (SMBG) program where patients are pro- vided with glucose monitoring devices and test strips for twice daily SMBG checks and relay them to the clinic once a week via phone calls for dose adjustments by the clinic staff [14]. Patients with additional diagnostic tests or treatment requirements beyond the hospital ’ s capacity are referred to higher levels of care or private facilities. Clinic and phone based patient encounters are recorded using paper based forms that are transcribed into an electronic database. [11].

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An Internal Audit of Diabetes Care for Type 2 Diabetic Patients in a Public Hospital Diabetes Clinic in Malaysia

An Internal Audit of Diabetes Care for Type 2 Diabetic Patients in a Public Hospital Diabetes Clinic in Malaysia

The audit was conducted in the diabetes clinic in Sibu Hospital, a district hospital with major specialists. The hospital's Research Review Committee accepted this research work as a hospital-based internal audit, due to the use of depersonalised clinical data and achievements. This 630-bed public hospital not only services a direct population of 278,300 from Sibu, but is also a referral centre for the central zone of Sarawak, including Sarikei, Mukah and Kapit divisions, which have an additional combined population of up to 421,000. The diabetes clinic runs once a week every Wednesday afternoon and receives referrals of difficult diabetes cases, providing treatment and follow-up for diabetes and associated medical illnesses. In 2014, the clinic registered about 550 patients, who attended every three to four months on average. Each clinic was run by four resident medical officers and one general physician. There are two diabetic educators providing a counselling service to an average of five to six patients every session, as well as two pharmacists offering medication counselling for up to six patients per session. For individuals who require dietary counselling, a dietitian referral is made and a separate appointment provided. There is no podiatrist at Sibu Hospital.

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Charcot osteoarthropathy in type 2 diabetes persons presenting to specialist diabetes clinic at a tertiary care hospital

Charcot osteoarthropathy in type 2 diabetes persons presenting to specialist diabetes clinic at a tertiary care hospital

It was a cross sectional study including a total of 1931 (mean age 50.72 ± 10.66) type 2 diabetes persons including both male and female presenting in Sakina Institute of Diabetes & Endocrine Research (SiDER) which is a spe- cialist diabetes clinic at Shalamar Institute of Health Sci- ences, Lahore, Pakistan, over period of one year from Sept 2012 to August 2013. The cognitive impaired subjects were excluded from the study. The demographic informa- tion (name, age, sex, address, education, duration of dia- betes) was collected from customized designed hospital based software. Data entry was done by a trained doctor proficient in using the software. The maintenance of data and software was done by hospital IT department. The Ethical Review Committee of Shalamar Institute of Health Sciences reviewed and approved the study. The diabetic condition was confirmed by review of medical record, pre- vious laboratory tests. The patients having fasting blood glucose ≥126 mg/dl were considered as diabetic. The writ- ten informed consent was taken after explaining the na- ture of the study to the patients.

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Cardiovascular disease among patients attending a specialist diabetes clinic in Jamaica

Cardiovascular disease among patients attending a specialist diabetes clinic in Jamaica

In this study we found that 35% of patients with diabetes attend- ing a specialist diabetes clinic had at least one major CVD. Although PVD had the highest prevalence (26%) of the three categories of CVD studied, a significant proportion of partici- pants reported CHD (7%) and cerebrovascular disease (16%). There were no gender differences in the prevalence of CVD in this study. Prevalence of CVD was higher among persons $50 years, those with high blood pressure, central obesity, or high total cholesterol, and among persons with a diabetes duration $20 years. In multivariable models, duration of dia- betes was the most consistent factor associated with prevalent CVD, while having a blood pressure at goal of ,130/80 mmHg and engaging in three or more physical activity sessions per week were associated with lower odds of CVD.

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Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda – a descriptive retrospective study

Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda – a descriptive retrospective study

Methods: We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out- patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients ’ registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients ’ LTFU rates in hazard ratios (HRs).

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Association Between Diabetes Control and Visits to a Multidisciplinary Pediatric Diabetes Clinic

Association Between Diabetes Control and Visits to a Multidisciplinary Pediatric Diabetes Clinic

These 3-year data show that subjects who had 3 to 4 visits per year to the diabetes clinic, during which they were assessed and treated by a multidisci- plinary team, had significantly lower mean HbA1C levels compared with subjects seen only 1 to 2 times per year. The number of visits was a significant predictor of HbA1C even after controlling for age, duration, adherence, and knowledge. Therefore, fre- quent multidisciplinary visits addressing diabetes self-care issues and assessing adherence to diabetes- specific guidelines for the patient and family ap- peared to be beneficial and predictive toward im- proved outcome over a 3-year time period. In the changing climate of health care delivery, it would appear reasonable to assume that quarterly visits with a multidisciplinary team should be a covered benefit, particularly for the pediatric population.

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Managing diabetes at high altitude: personal experience with support from a Multidisciplinary Physical Activity and Diabetes Clinic

Managing diabetes at high altitude: personal experience with support from a Multidisciplinary Physical Activity and Diabetes Clinic

We have established a Multidisciplinary Physical Activity and Diabetes Clinic, aiming to empower, educate and enable people with diabetes to undertake sports, activity and exercise unimpeded by glycaemic variability and injuries. The clin- ical team include a diabetologist, diabetes dietitian, diabetes specialist nurse and consultant in sports and exercise medicine. In 2016, a 42-year-old man (GM) who had had type 1 diabetes for 30 years attended with the intention of climbing Mont Blanc (4800 m) in the summer and trekking to Everest Base Camp (5300 m) then summiting Kala Patthar (5600 m) in Nepal during the autumn. To facilitate this, he assiduously prepared for these trips and we provided real-time continuous glucose monitoring (CGM) (Dexcom G4, San Diego, California) to support blood glucose self- management. In addition, we synthesised the available research information into a reference document/factsheet designed to support his preparation and planning (box 1). His pre-trek insulin regimen was insulin glargine (Lantus, Sanofi, USA) 22 units in the morning and 15 units in the evening;

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“Having diabetes shouldn’t stop them”: healthcare professionals’ perceptions of physical activity in children with Type 1 diabetes

“Having diabetes shouldn’t stop them”: healthcare professionals’ perceptions of physical activity in children with Type 1 diabetes

Methods: Semi-structured interviews with 11 HCPs involved in the care of children with T1DM in the UK were conducted. Interviews were recorded, transcribed verbatim and data were analysed using thematic analysis. Results: The factors perceived to influence participation in physical activity are presented as five major themes and eleven sub-themes. Themes included the positive influence of social support, the child ’ s motivation to be active, the potential for formal organisations such as school and diabetes clinic to support physical activity, the challenges faced by those who have T1DM and the perceived barriers to HCPs fulfilling their role of promoting physical activity. Conclusions: Healthcare professionals recognised their role in helping children with T1DM and their parents to incorporate physical activity into diabetes management and everyday life, but perceived barriers to the successful fulfilment of this role. The findings highlight the potential for clinical and non-clinical supportive systems to be sensitive to these challenges and facilitate children ’ s regular participation in physical activity.

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Igumbor

Igumbor

The study adopted clinical observational approach, as well as questionnaire survey method. Clinical observation was based on free monthly diabetes clinic program, which was set to establish diabetes mellitus and heart disease register in the study location. The survey employed two standard questionnaires including one adopted from the UK (Figure 1); and the health literacy questionnaire in part 1 of this series. The descriptive cross-sectional method evaluated „how glycaemic control among diabetes patients was assessed and the prevalence of common metabolic syndrome factors‟.

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51ST SEMDSA Congress - Abstracts

51ST SEMDSA Congress - Abstracts

Methods: This was a cross-sectional observational study among men with T2DM attending the adult diabetes clinic at IALCH. Information collected from patients included smoking and medication history, clinical examination and laboratory tests. Blood tests included serum total testosterone (TT), sex-hormone binding globulin (SHBG), calculated free-testosterone (fT) and free-androgen index, leutinising hormone (LH), HbA1c, fructosamine, lipid profile, full blood count, urea and electrolytes and liver function tests. Symptoms were assessed using the Ageing Male’s Symptom Scale (AMS) questionnaire. TT, SHBG and fT levels were also measured in male control subjects with no history of diabetes. Low testosterone level was defined as a free testosterone <180 pmol/l.

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Diabetic patients served at a regional level hospital: what is their clinical picture?

Diabetic patients served at a regional level hospital: what is their clinical picture?

This data-capturing system was implemented in September 2012. In order to create a baseline for the assessment of our patients to guide the implementation of strategies to improve patient care going forward, the data it rendered were analysed for the period from 1 October 2012 to 30 September 2013. The level of control and the complications seen in this regional public sector diabetes clinic in Edendale Hospital, Pietermaritzburg, KwaZulu-Natal, are described in this paper. The patients seen in our clinic are predominantly black South Africans. Common complications of diabetes, such as neuropathy, retinopathy and nephropathy, were investigated. The data was analaysed to find out whether or not there was an association between the duration of diabetes and the mean HbA 1c and control in the three different treatment groups viz. oral antidiabetic drugs (OADs), insulin monotherapy and a combination of OADs and insulin. Obesity is one of the major risk factors for insulin resistance and poor diabetic control, hence we examined obesity rates in this group of patients. 13,14

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“Having diabetes shouldn’t stop them”: healthcare professionals’ perceptions of physical activity in children with Type 1 diabetes

“Having diabetes shouldn’t stop them”: healthcare professionals’ perceptions of physical activity in children with Type 1 diabetes

Methods: Semi-structured interviews with 11 HCPs involved in the care of children with T1DM in the UK were conducted. Interviews were recorded, transcribed verbatim and data were analysed using thematic analysis. Results: The factors perceived to influence participation in physical activity are presented as five major themes and eleven sub-themes. Themes included the positive influence of social support, the child ’ s motivation to be active, the potential for formal organisations such as school and diabetes clinic to support physical activity, the challenges faced by those who have T1DM and the perceived barriers to HCPs fulfilling their role of promoting physical activity. Conclusions: Healthcare professionals recognised their role in helping children with T1DM and their parents to incorporate physical activity into diabetes management and everyday life, but perceived barriers to the successful fulfilment of this role. The findings highlight the potential for clinical and non-clinical supportive systems to be sensitive to these challenges and facilitate children ’ s regular participation in physical activity.

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The Effectiveness of Self-Compassion Group Training on Raising Hope in Diabetics

The Effectiveness of Self-Compassion Group Training on Raising Hope in Diabetics

Method: The present experimental study had a pre-test post-test design with a control group. The statistical population included patients with type 2 diabetes who had referred to the Diabetes Clinic of Kermanshah in 2017.Among them, 32 were selected by convenience sampling method and were determined according to the inclusion criteria; and 20 patients were randomly assigned to two experimental and control groups (each group with 10 samples). The self-compassion training was provided for the experimental group during 8 sessions (90 minutes per session), but the control group did not receive any training. Data was collected by Miller Hope Scale (MHS); and the univariate analysis of covariance with SPSS 21were utilized for data analysis.

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Stakeholder perspectives on the development of a virtual clinic for diabetes care : qualitative study

Stakeholder perspectives on the development of a virtual clinic for diabetes care : qualitative study

development of a complex intervention, yet all too often their views are only gathered in later stages. Stakeholders have clear and relevant views on what such a system should provide, and these views can be captured and synthesized with relative ease. In this case, we identified 6 themes that are supported by findings from previous studies on the perceived convenience of an asynchronous messaging system [16,17] and the importance and value of peer-to-peer support [5,19,20]. The themes also contribute to debate about who is likely to use Internet-based systems and suggest that patients are eminently capable of assessing advice posted by peers on a discussion board and relating it to their personal situation. By basing the focus groups and interviews in an existing diabetes clinic, the research was able to suggest that an Internet-based system is likely to fit well with existing care provision as well as to explore the likely impact on health professionals’ time. The main strength of this study is the involvement of a diverse range of stakeholders in detailed consultation during the development stage of an Internet-based intervention. The diverse range of methods used to involve these stakeholders (ie, interviews, focus groups, email consensus gathering, and an expert workshop) is also a key strength. In particular, the use

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<p>Pattern of Obesity Among Patients with Type 2 Diabetes at a Tertiary Healthcare Center in Northern Nigeria</p>

<p>Pattern of Obesity Among Patients with Type 2 Diabetes at a Tertiary Healthcare Center in Northern Nigeria</p>

older age, sedentary living and rising rates of obesity. 1–3 Migration from rural to urban areas is associated with changes in lifestyle characterized by unhealthy eating habits (consumption of fat-laden and energy-dense foods) coupled with reduced physical activity due to the avail- ability of alternative modes of transportation. Thus, urban living promotes the development of obesity. Obesity increases the risk of DM 7-fold compared to normal- weight individuals. 4 Traditionally, obesity is classi fi ed into generalized obesity, as measured by body mass index (BMI) and central obesity or adiposity, de fi ned by abnormal waist circumference (WC), waist-to-hip ratio (WHR) or waist-to-height ratio (WhtR). Diabetes has a stronger association with central obesity than with gen- eralized obesity. 5 The prevalence of generalized obesity among patients with type 2 diabetes across Nigeria ranges from 5.0% in Zaria, 6 in the Northwest to 40% in Lagos 7 in the Southwestern part of the country. Similarly, the rates for central adiposity ranged between 72%, using WC in Uyo, 8 South-South Nigeria to 95% using WHR in Zaria, Northwestern Nigeria. 6 However, none of the studies cited utilized WhtR as a measure of central obesity. We there- fore set out to determine the pattern of obesity, using established anthropometric indices, including WhtR among patients with type 2 diabetes at the diabetes clinic of Aminu Kano Teaching Hospital (AKTH), Kano, Northwestern Nigeria.

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Negative effects of diabetes–related distress on health-related quality of life: an evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia

Negative effects of diabetes–related distress on health-related quality of life: an evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia

possible that these men were almost inherently the bread-winners of their families and were required to be out-and-about, and were less likely to complain or per- ceive themselves to be in need of basic help (just like men in most cultures). Hence, there was no association between these men and the physical domain of HRQoL [57]. In relation to men’s emotional ability [58], it was noted that they experienced the poorest SRQOL that re- quired emotional skills for interpersonal relationships and the management of emotions. These findings were in contrast to the men with T2D from multi-ethnic backgrounds (non-Hispanic whites, African-Americans, Asian-Indians, and Hispanics) in Texas, United States (US) who were reported to have better diabetes-specific HRQoL compared to the women [55]. In another study, women who perceived living with diabetes as predomin- antly stressful intermingled with depressive feelings were required to be constantly vigilant about healthy eating, self-concern, and fatigue [3]. In this study, it was noted that HRQoL was better perceived by women because T2D had more adverse impacts on men, or the men’s perception could be limited by their emotional ability [58]. However, future studies are needed to confirm this and to examine the causes of low HRQoL among men with T2D.

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Evaluation of a Type 2 Diabetes Screening Protocol in an Urban Pediatric Clinic

Evaluation of a Type 2 Diabetes Screening Protocol in an Urban Pediatric Clinic

subsequent visits, thus not meeting the criteria for screening. Overall, there was a low rate of recogni- tion of hypertension in this clinic, with only 12% of subjects with elevated blood pressure having docu- mentation of such in their medical records. The most likely reason for this poor recognition is the lack of a quick method for identifying elevated blood pres- sure in a busy clinical practice. This clinic did not have charts or graphs to evaluate blood pressure percentiles readily available for the medical provid- ers; these could be added to the medical records or made available as a reference in the clinic. However, given the low rate of BMI plotting in this setting, an electronic linkage between the blood pressure cuff and a computerized system that provides age-based interpretation might be a preferable option.

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Availability and accessibility of diabetes clinics on Trinidad: An analysis using proximity tools in a GIS environment

Availability and accessibility of diabetes clinics on Trinidad: An analysis using proximity tools in a GIS environment

Non-communicable diseases (NCDs), account for a growing number of deaths worldwide. The English-speaking Caribbean has the highest per capita burden of NCDs in the region of the Americas [1]. This paper presents an overview of availability and accessibility based on clinic hours and physician fulltime equivalents (FTE) on the island of Trinidad devoted to diabetes and wound care. The project integrates a Geo- graphic Information System (GIS) with epidemi- ologic and bio-statistical data to provide a nec- essary spatial analysis not otherwise possible. It examines the island’s ability to effectively de- liver treatment to residents with diabetes by pro- viding a geographic perspective to data pub- lished on the internet by the Trinidad-Tobago Ministry of Health and the Central Statistical Of- fice. Results indicate a significant regional vari- ability in both numbers of physicians and office hours devoted to diabetes treatment.

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Complementary alternative medicine use among patients with diabetes coming to the geriatric clinic at tertiary care hospital in chandigarh, india

Complementary alternative medicine use among patients with diabetes coming to the geriatric clinic at tertiary care hospital in chandigarh, india

Type 2 Diabetes Mellitus (T2DM) is an important public health concern despite advancement in its management. It causes substantial morbidity, complications and mortality, thereby effects patients and their families. Mainstay management of diabetes remains insulin if not control with oral antidiabeticdrugs. Living with diabetes is a challenge as it requires considerable dedication to a life-long treatment imposed by its chronic nature 1 . In addition, many factors linked to management makes difficult to achieve control of diabetes. The factors include lifestyle changes viz. modifying eating habits, exercising regularly, maintaining optimal body weight, and self-monitoring of blood sugar 2 . Non-compliance with management of diabetes may adversely effects health systems in terms of compromised health benefits and serious economic consequences due to wasted time, money and uncured disease 3 . As a result of the complexities of treatment plans, the prolonged course of the disease, and the debilitation due to complications, many patients with diabetes start use of complementary and alternative medicine (CAM) therapies instead of allopathic treatment 2 .Complementary alternative

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“Pharmacoeconomic Evaluation of Anti Diabetic Treatment at Ayder Referral Hospital, Mekelle, Ethiopia” by Behaylu Assefa, Abrham Wondimu, Solomon Abrha, Subas Chandra Dinda, Birhanu Demeke, Naod Gebre-Samuel, Admassu Assen, Fantahun Molla, Zewdu Yilma, Et

“Pharmacoeconomic Evaluation of Anti Diabetic Treatment at Ayder Referral Hospital, Mekelle, Ethiopia” by Behaylu Assefa, Abrham Wondimu, Solomon Abrha, Subas Chandra Dinda, Birhanu Demeke, Naod Gebre-Samuel, Admassu Assen, Fantahun Molla, Zewdu Yilma, Ethiopia.

The treatment profile and clinical characteristics of the DM patients is presented in Table 2. Seventy (53.8%) and 60 (46.2%) patients were found to have type-1 and type-2 diabetes, respectively. The mean duration of the disease was 4.76 ± 4.93 years. Ninety-two patients (70.78%) had DM for 1-5 years; and the current fasting blood sugar level of sixty patients (46.15%) were >180 mg/dl. The number of patients’ visits to the DM clinic in the year 2012 varied; for instance, 52.31%, 43.08%, 3.08%, 1.54% of patients visited the clinic 3-6 times, 7-11 times, 1-2 times and more than 12 times, respectively. The table also shows that 17.69% of the study participants had co- morbidity and 25.38% of the study participants developed one or more diabetic complications.

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