Changing health policy: From study to national policy
Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer in Textbook of Diabetes and Pregnancy, 2018
CHS runs a comprehensive diabetes community program since 1997. Most people with diabetes are managed by their primary practitioners and other community healthcare providers, including nurses, pharmacists, dietitians, and physiotherapists. Patients are referred to consultant diabetes specialist in case of uncontrolled diabetes or severe diabetic complications. CHS developed its own diabetes practice guidelines, endorsing international standards, and being regularly reviewed and revised every 2–3 years. The diabetes disease management program within the primary care setup in CHS addresses also other comorbidities and risk factors that are associated with diabetes, e.g., hypertension, dyslipidemia, and cardiovascular disease. The comprehensive care provided is culturally sensitive, addressing the ethnic diversity of the insured population. As a result, more than 55% of people with diabetes have HbA1C level of less than 7%, and more than 70% have their HbA1c level within their personally adapted target; more than 60% of the diabetic patients have LDL cholesterol levels lower than 100 mg/dL, and more than 75% of the patients with diabetes have LDL cholesterol level of less than 130 mg/dL. As a result of the comprehensive diabetes care provided to people with diabetes, there has been a significant decline in the rate of nontraumatic amputations, invasive procedures for coronary reperfusion and blindness due to diabetic retinopathy. As a result, the costs of the person with diabetes decreased by about 40%, from the provider perspective.
Diabetes Self-Management Education and the Diabetes Team
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Diabetes nurse clinician: Provides care, management, and instructional services. The title implies specialized training, although it may be on-the- job-training. Most clinicians have at least an undergraduate degree. Diabetes nurse specialist or diabetes clinical specialist: Advanced level of practitioner. These individuals have at least Master of Science degree in a specialized area of study. They have the training, expertise, and autonomy to provide most clinical management responsibilities, including patient and professional education. Certified Diabetes Educator: Diabetes educators who pass a certification examination become a certified diabetes educator (CDE). CDE is then added after their name and degree. Certified diabetes educators must pass a certification examination every 5 years to maintain certification. CDE implies a minimal standard of knowledge, expertise, and skills in all aspects of diabetes education.
Bariatric and metabolic surgery
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Obesity is becoming the plague of the 21st century. With overweight becoming the norm in most western countries and newly resource-rich countries, two-thirds of adults are overweight or obese (Table64.1). Every clinician faces the condition and its associated diseases, such as type 2 diabetes, as part of their practice. Obesity and lack of physical activity have the second largest public health impact after smoking. Severe obesity increases the risk of cancer, is associated with multiple other diseases, affects quality of life and reduces life expectancy by 5-20 years. Obese people will more often be of lower social class, unemployed and/or on state benefits. Obesity runs in families and social networks and very few obese people have an identifiable genetic, hormonal basis such as Prader-Willi syndrome. Surgeons encounter the problem of obesity on a daily basis as it affects the treatment of nearly every abdominal pathology in terms of approach and outcomes.
The necessary evolution of diabetes fellowships in the United States
Published in Postgraduate Medicine, 2021
Amber Healy, Jay Shubrook, Howard Feinberg, Sumera Ahmed
Primary care diabetology is an underrecognized specialty in the United States, albeit a known specialty in other countries. Diabetology provides specialized training for primary care physicians to be able to serve as diabetes experts. There are currently six diabetology fellowship programs in the United States, and to date there have been 50 graduates of those programs since 2005 [4]. The concept of diabetology is not completely new. Elliot Joslin, MD started the first diabetology fellowship in the country, and this program remained a 1-year program for at least 30 years. In 1955 the first physician requested a certificate of completion for the program as postgraduate medical education was not formalized until after World War II and by the 1980s the 1-year diabetes program merged into a 2-year endocrinology program [4]. More recently, the concept of a diabetology fellowship reemerged in the U.S. In 2004, diabetology fellowship programs were simultaneously started at East Carolina Brody School of Medicine and Ohio University Heritage College of Osteopathic Medicine [4,5]. They both saw an opportunity to train primary care physicians to serve in areas where an endocrinologist might not be available. Since that time there have been 4 more programs created. The 6 programs are: Duke Southern Regional AHEC, East Carolina University, Ohio University Heritage College of Osteopathic Medicine, Touro University California College of Osteopathic Medicine, University of Colorado, and University of Pennsylvania [5].
Relationship between the triglyceride–glucose index and coronary artery calcification in asymptomatic, non-diabetic patients undergoing maintenance hemodialysis
Published in Renal Failure, 2023
Hong Ding, Jinhua Zhu, Ying Tian, Li Xu, Lei Song, Ying Shi, Dongxing Mu, Ruoxin Chen, Hong Liu, Bicheng Liu
This was a cross-sectional, observational study. Patients who were undergoing regular hemodialysis at People’s Hospital of Yangzhong city were selected as study participants (Figure 1). The inclusion criteria were as follows: (a) age ≥18 years; (b) stable hemodialysis for >3 months; (c) regular hemodialysis 3 times/week for 4 h each time; (d) no history of CAD, cardiac pacemaker or defibrillator implantation, or suspected symptoms, such as chest pain and heart palpitations; and (e) agreement to undergo chest CT examination. The exclusion criteria were as follows: (a) diagnosis of diabetes mellitus by a doctor; (b) elevated triglyceride levels (≥ 500 mg/dL); (c) presence of malignant tumors, acute severe infection, connective tissue disease, severe metabolic diseases, decompensated chronic liver disease, hematologic diseases, or use of hormones in the past 3 months; (d) presence of severe cognitive impairment or mental illness; (e) pregnancy or lactation; and (f) lack of complete data.
Extracellular vesicles in type 2 diabetes mellitus: key roles in pathogenesis, complications, and therapy
Published in Journal of Extracellular Vesicles, 2019
Yongwei Xiao, Lei Zheng, Xiaofeng Zou, Jigang Wang, Jianing Zhong, Tianyu Zhong
Diabetes mellitus is a group of metabolic disorders characterized by high blood sugar levels over a prolonged period [1]. It occurs either when the pancreas does not produce sufficient insulin or when the body cannot effectively use the insulin produced. Generally, the symptoms of patients with diabetes mellitus include polyuria, polydipsia, constant hunger, and weight loss. Diabetes mellitus, if not well controlled, will cause serious complications including heart attack, kidney failure, unhealed wounds, vision loss, and nerve damage [2–6]. In addition, diabetes is also a risk factor for the prevalence of cancer [7]. Currently, the number of patients with diabetes mellitus has reached more than 422 million worldwide and has been increasing rapidly [8]. This disease has become an important public health problem. Notably, this figure was predicted to increase to 693 million by 2045 [9].
Related Knowledge Centers
- Blurred Vision
- Diabetic Nephropathy
- Diabetic Neuropathy
- Diabetic Retinopathy
- Endocrine Disease
- Hyperglycemia
- Pancreas
- Cardiovascular Disease
- Polyuria
- Insulin