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Primary Diabetes

Types Of Diabetes Mellitus

Types Of Diabetes Mellitus

Diabetes mellitus (or diabetes) is a chronic, lifelong condition that affects your body's ability to use the energy found in food. There are three major types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes. All types of diabetes mellitus have something in common. Normally, your body breaks down the sugars and carbohydrates you eat into a special sugar called glucose. Glucose fuels the cells in your body. But the cells need insulin, a hormone, in your bloodstream in order to take in the glucose and use it for energy. With diabetes mellitus, either your body doesn't make enough insulin, it can't use the insulin it does produce, or a combination of both. Since the cells can't take in the glucose, it builds up in your blood. High levels of blood glucose can damage the tiny blood vessels in your kidneys, heart, eyes, or nervous system. That's why diabetes -- especially if left untreated -- can eventually cause heart disease, stroke, kidney disease, blindness, and nerve damage to nerves in the feet. Type 1 diabetes is also called insulin-dependent diabetes. It used to be called juvenile-onset diabetes, because it often begins in childhood. Type 1 diabetes is an autoimmune condition. It's caused by the body attacking its own pancreas with antibodies. In people with type 1 diabetes, the damaged pancreas doesn't make insulin. This type of diabetes may be caused by a genetic predisposition. It could also be the result of faulty beta cells in the pancreas that normally produce insulin. A number of medical risks are associated with type 1 diabetes. Many of them stem from damage to the tiny blood vessels in your eyes (called diabetic retinopathy), nerves (diabetic neuropathy), and kidneys (diabetic nephropathy). Even more serious is the increased risk of hea Continue reading >>

Managing Diabetes In Primary Care: 2016 Recommendations From Ada

Managing Diabetes In Primary Care: 2016 Recommendations From Ada

Managing diabetes in primary care: 2016 recommendations from ADA Managing diabetes in primary care: 2016 recommendations from ADA The American Diabetes Association (ADA) has released a summary of its 2016 recommendations that focus on managing patients with diabetes inprimary care, as published March 1 in the Annals of Internal Medicine. A synopsis of the 2016 Standards of Medical Care in Diabetes highlights 8 key areas for primary care providers: diagnosis, glycemic targets, medical management, hypoglycemia, cardiovascular risk factor management, microvascular disease screening and management, and inpatient diabetes management. To create the 2016 Standards, the ADA Professional Practice Committee (PPC) searched on MEDLINE to find and grade new evidence from January 1, 2015, through December 7, 2015. Recommendations are assigned an A, B, or C rating based on evidence quality. Some expert opinions are given an E rating to indicate that there is no evidence from clinical trials, clinical trials may be impractical, or existing evidence is conflicting. The 2016 ADA Standards diagnostic criteria for prediabetes and diabetes are outlined in Table 1. Table 1. Criteria for the diagnosis of prediabetes and diabetes1 * 2-h plasma glucose level after a 75-g oral glucose tolerance test ** In the absence of unequivocal hyperglycemia, results should be confirmed by repeated testing. *** Only diagnostic in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis. Distinguishing whether a patient has type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) is important, as their diagnosis affects management. T1DM is characterized by the presence of 1 or more autoimmune markers. Pregnant women with no history of diabetes should be screened for gestational diab Continue reading >>

Acp: Ecp - A Population-based Approach To Diabetes Management...

Acp: Ecp - A Population-based Approach To Diabetes Management...

A Population-Based Approach to Diabetes Management in a Primary Care Setting: Early Results and Lessons Learned David K. McCullough, MD, Martha J. Price, DNSc, Mike Hindmarsh, MA, Edward H. Wagner, MD, MPH OBJECTIVE. To determine the effect of a multifaceted program of support on the ability of primary care teams to deliver population-based diabetes care. DESIGN. Ongoing evaluation of a population-based intervention. SETTING/PARTICIPANTS. Group Health Cooperative of Puget Sound, a staff model HMO in which more than 200 primary care providers treat approximately 15 000 diabetic patients. INTERVENTION. A program of support to improve the ability of primary care teams to deliver population-based diabetes care was implemented. The elements of the program are based on an integrated model of well-validated components of delivery of effective care to chronically ill populations. These elements have been introduced since the beginning of 1995, and some aspects of the program were pilot-tested in a few practice sites before being implemented throughout the organization. The program elements include 1) a continually updated on-line registry of diabetic patients; 2) evidence-based guidelines on retinal screening, foot care, screening for microalbuminuria, and glycemic management; 3) improved support for patient self-management; 4) practice redesign to encourage group visits for diabetic patients in the primary care setting; and 5) decentralized expertise through a diabetes expert care team (a diabetologist and a nurse certified diabetes educator) seeing patients jointly with primary care teams. MAIN OUTCOME MEASURES. Patient and provider satisfaction through existing system-wide measurement processes; process measures, health outcomes, and costs are tracked continuously. RESULTS. Continue reading >>

Guidelines

Guidelines

There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those living with the condition. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefit. Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are part of the process which seeks to address those problems. IDF has produced a series of guidelines on different aspects of diabetes management, prevention and care. IDF Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care The new IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care seek to summarise current evidence around optimal management of people with type 2 diabetes. It is intended to be a decision support tool for general practitioners, hospital based clinicians and other primary health care clinicians working in diabetes. Continue reading >>

Primary Diabetes Mellitus

Primary Diabetes Mellitus

This site is intended for healthcare professionals The common primary diabetes mellitus syndromes are: insulin dependent diabetes mellitus (IDDM) (Type I Diabetes) non-insulin dependent diabetes mellitus (NIDDM) (Type II Diabetes) The distinction between IDDM and NIDDM is clinical: if insulin therapy is required to prevent ketoacidosis the the patient has IDDM if insulin therapy is not required to prevent ketoacidosis then the patient has NIDDM if the patient has NIDDM but insulin is required to maintain acceptable glycaemic control then the patient has insulin-treated NIDDM Maturity onset diabetes of the young (MODY) is a rare primary diabetes mellitus syndrome. The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2016 Oxbridge Solutions Ltd. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions Ltd receives funding from advertising but maintains editorial independence. GPnotebook stores small data files on your computer called cookies so that we can recognise you and provide you with the best service. If you do not want to receive cookies please do not use GPnotebook. Continue reading >>

Primary Care Diabetes

Primary Care Diabetes

Enter your login details below. If you do not already have an account you will need to register here . Check the status of your submitted manuscript in EES: Once production of your article has started, you can track the status of your article via Track Your Accepted Article. CiteScore: 1.65 CiteScore measures the average citations received per document published in this title. CiteScore values are based on citation counts in a given year (e.g. 2015) to documents published in three previous calendar years (e.g. 2012 14), divided by the number of documents in these three previous years (e.g. 2012 14). The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years. 2017 Journal Citation Reports (Clarivate Analytics, 2018) 5-Year Impact Factor: 1.583 Five-Year Impact Factor: To calculate the five year Impact Factor, citations are counted in 2016 to the previous five years and divided by the source items published in the previous five years. 2017 Journal Citation Reports (Clarivate Analytics, 2018) Source Normalized Impact per Paper (SNIP): 0.856 Source Normalized Impact per Paper (SNIP): SNIP measures contextual citation impact by weighting citations based on the total number of citations in a subject field. SCImago Journal Rank (SJR): 0.584 SCImago Journal Rank (SJR): SJR is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and a qualitative measure of the journals impact. Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

"Diabetes" redirects here. For other uses, see Diabetes (disambiguation). Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.[7] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.[2] If left untreated, diabetes can cause many complications.[2] Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.[3] Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.[2] Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.[8] There are three main types of diabetes mellitus:[2] Type 1 DM results from the pancreas's failure to produce enough insulin.[2] This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".[2] The cause is unknown.[2] Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[2] As the disease progresses a lack of insulin may also develop.[9] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes".[2] The most common cause is excessive body weight and insufficient exercise.[2] Gestational diabetes is the third main form, and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.[2] Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with t Continue reading >>

Transition From Specialist To Primary Diabetes Care: A Qualitative Study Of Perspectives Of Primary Care Physicians

Transition From Specialist To Primary Diabetes Care: A Qualitative Study Of Perspectives Of Primary Care Physicians

Abstract The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP) perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents Continue reading >>

Balancing Primary Diabetes Care Quality And Services

Balancing Primary Diabetes Care Quality And Services

Balancing Primary Diabetes Care Quality and Services From University of Minnesota, Minneapolis, Minnesota. Author, Article, and Disclosure Information This article was published at Annals.org on 13 December 2016. From University of Minnesota, Minneapolis, Minnesota. Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2768 . Requests for Single Reprints: Kevin A. Peterson, MD, MPH, University of Minnesota, Mayo Memorial Building, Suite A674-2, 420 Delaware Street SE, MMC 381, Minneapolis, MN 55455; e-mail, [email protected] . Cheung and colleagues' study uses a remarkable collection of data from Ontario, Canada, to evaluate the association between patient volume and process measures among primary care physicians (PCPs) ( 1 ). The authors analyzed a retrospective cohort of 1203721 patients with diabetes from several linked administrative data sets; the final cohort captures patient-based quality measures and diabetes-related emergency department (ED) visits for adults aged 20 to 104 years assigned to 9014 Canadian PCPs. The study provides valuable insight into how measures of quality are influenced by the number of patient visits per day and the total number of patients with diabetes seen by a provider. This is an important step in understanding the relationship between delivery of primary care services and quality. Continue reading >>

Diabetes Primary And Community Care

Diabetes Primary And Community Care

With rising demand for services and a shift towards providing care closer to home, primary and community care is increasingly at the forefront of delivering diabetes care. Use the following resources and tools to improve primary and community care for people with diabetes. My diabetes, my care: people's experience of community diabetes care and the support they are provided to self-manage their condition, Care Quality Commission website (September 2016) This review considers how well care services work together to deliver high-quality diabetes care. It also makes a number of recommendations for how health and social care commissioners, providers and professionals should work together to improve diabetes care and prevention. Building the right workforce for diabetes care: a toolkit for healthcare professionals, London Strategic Clinical Networks website (January 2016) This toolkit presents the case for improving education and training for community based healthcare professionals. The toolkitincludes the keycompetencies necessary for delivering care,documenting the currently available education and training programmes for diabetes care. It also considers ways to maintain knowledge and enhance skills through continuous professional development, with examples from case studies. Improving quality in general practice, The Health Foundation website (November 2014) This evidence scan explores how quality could be defined in general practice. It summarises the evidence on what features patients think are important and brings together evidence about interventions that have been tested to improve quality. This guide offers new, practical and cost effective ways to increase the opportunities for self-management for people with long-term conditions by engaging local non-traditional Continue reading >>

Harvard Cme | Diabetes & Cardiometabolic Syndrome In Primary Care

Harvard Cme | Diabetes & Cardiometabolic Syndrome In Primary Care

Diabetes & Cardiometabolic Syndrome in Primary Care Boston Marriott Cambridge Nov 9 - 11, 2018 Updates, Guidance, and Best Practices to Optimize Care for Patients with Diabetes Anyone who provides care for people with (or at risk for) diabetes knows that these patients often have a myriad of comorbidities and complications, and that optimizing their care is frequently complex and challenging. It is with these challenges in mind that Harvard Medical School faculty have developed this CME program, Diabetes and Cardiometabolic Syndrome in Primary Care. This program provides comprehensive updates, practice recommendations, and the newest evidence-based strategies for the treatment and care of the person with or at risk for diabetes. By attending, you can ensure that you are current with state-of-the-art approaches to: Pharmacological management of diabetes, including insulin and non-insulin treatments The latest advances in insulin deliveryand glucose monitoring Treating complications and comorbidities, including dyslipidemia, hypertension, peripheral vascular disease, cardiovascular disease, kidney disease, and the diabetic foot Integrating emerging concepts and therapies into day-to-day practice EDUCATION TO OPTIMIZE PATIENT CARE AND OUTCOMES Education is focused on optimized patient care and outcomes and improving skills in the following areas: Using insulin: when to start, which insulins to choose, and how to intensify treatment Treating people with type 2 diabetes who are not achieving their therapeutic goals Office-based assessment and treatment of comorbidities and complications Individualizing multifaceted approaches to lifestyle and weight management Assessing the severity and optimizing management of non-alcoholic steatohepatitis(NASH) Personalizing nutrition pla Continue reading >>

Type 2 Diabetes Mellitus: Practical Approaches For Primary Care Physicians | The Journal Of The American Osteopathic Association

Type 2 Diabetes Mellitus: Practical Approaches For Primary Care Physicians | The Journal Of The American Osteopathic Association

Type 2 Diabetes Mellitus: Practical Approaches for Primary Care Physicians James R. Gavin, III, MD, PhD ; Jeffrey S. Freeman, DO ; Jay H. Shubrook, Jr, DO ; Frank Lavernia, MD From Healing Our Village, Inc, in Lanham, Maryland, and Emory University School of Medicine in Atlanta, Georgia (Dr Gavin); from Philadelphia College of Osteopathic Medicine, in Pennsylvania (Dr Freeman); from Cornwell Center for Diabetes and Cardiovascular Care, in Athens, Georgia (Dr Shubrook); and from private practice in Coconut Creek, Florida (Dr Lavernia). Address correspondence to James R. Gavin III, MD, PhD, Healing Our Village, Inc, 10104 Senate Dr, Suite 210, Lanham, MD 20706-4393.E-mail: [email protected] Type 2 Diabetes Mellitus: Practical Approaches for Primary Care Physicians The Journal of the American Osteopathic Association, May 2011, Vol. 111, S3-S12. doi: The Journal of the American Osteopathic Association, May 2011, Vol. 111, S3-S12. doi: Gavin JR, Freeman JS, Shubrook JH, Lavernia F. Type 2 Diabetes Mellitus: Practical Approaches for Primary Care Physicians. J Am Osteopath Assoc 2011;111(5_suppl_4):S3S12. doi: . Type 2 Diabetes Mellitus: Practical Approaches for Primary Care Physicians You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account The incidence and prevalence of type 2 diabetes mellitus (T2DM) have reached epidemic proportions in the United States. In addition to growing numbers of individuals in whom T2DM has been diagnosed, in numerous others T2DM or prediabetes remains undiagnosed or is likely to develop in the near future. Identification of individuals at risk for T2DM, as well as those who may already have the disease but in whom it has not yet been dia Continue reading >>

Other Types Of Diabetes Mellitus

Other Types Of Diabetes Mellitus

In most cases of diabetes, referred to as type 1 and type 2, no specific cause can be identified. This is referred to as primary or idiopathic diabetes. A small minority of cases, estimated at about 2%, arise as the consequence of some other well-defined disease or predisposing factor such as pancreatitis or steroid excess. This is called 'secondary diabetes'. Secondary diabetes can be sub-divided into single-gene disorders affecting insulin secretion or resistance, damage to the exocrine pancreas, other endocrine disease, drug-induced diabetes, uncommon manifestations of autoimmune diabetes, and genetic syndromes associated with diabetes. Gestational diabetes (diabetes arising for the first time in pregnancy) has a diagnostic category all to itself, but is included in this section for convenience. Secondary diabetes is often (but not always) associated with a relatively mild metabolic disturbance, but may nonetheless result in typical long-term complications such as retinopathy. Although it is relatively uncommon, the possibility of secondary diabetes should always be considered, since it may be a pointer to other disease, often requires a different approach to therapy, and is sometimes reversible. Background The common denominator of all the forms of diabetes discussed here is that something sets them apart from type 1 and type 2 diabetes. Since type 2 diabetes is hard to define, this implies that for most forms of diabetes in this category there is a pointer to a different pathophysiological explanation! The current WHO classification of diabetes, adopted and regularly updated by the American Diabetes Association, identifies four main categories of diabetes, and secondary diabetes is clssified under 'other specific types' (see figures). The common categories of secon Continue reading >>

Primary Care Diabetes Support Program

Primary Care Diabetes Support Program

Location: St. Josephs Family Medical and Dental Centre (get directions) Located at the St. Josephs Family Medical and Dental Centre, the Primary Care Diabetes Support Program provides diabetes support and managementfor individuals diagnosed with type 2 diabetes who don't have a family doctor.The program also supports those dealing with various challenges that make managing diabetes more difficult, such as economic hardship, language barriers, and anyissues or illnesses that can make navigating the health care system difficult. Our multidisciplinary team assists patients to become diabetes self-managers and helps them access the resources they need to manage their diabetes effectively.We also assists family physicians in London and the surrounding area to build capacity for diabetes care in their own practices.Our team includesphysicians,nurse practitioners, dietitians, nurses, support worker and specialized diabetic care providers. The Primary Care Diabetes Support Program is part of St. Josephs Centre for Diabetes, Endocrinology and Metabolism, the primary regional centre for diabetes and endocrine disease management in Southwestern Ontario. Continue reading >>

Secondary Diabetes

Secondary Diabetes

Tweet Secondary diabetes is diabetes that results as a consequence of another medical condition. Because the cause of diabetes ranges between different conditions, the way in which blood glucose levels are controlled can also vary. Secondary diabetes will often be permanent but for some forms, it may be possible to reverse or eradicate the effects of hyperglycemia. Which conditions can lead to secondary diabetes? Health conditions which can cause diabetes include: Cystic fibrosis Hemochromatosis Chronic pancreatitis Polycystic ovary syndrome (PCOS) Cushing's syndrome Pancreatic cancer Pancreatectomy Drug induced diabetes includes diabetes that results from taking certain medications. Medications which may bring on diabetes include corticosteroids, beta-blockers and thiazide diuretics. Read more on drug induced diabetes Managing secondary diabetes How secondary diabetes is managed can vary quite significantly depending on which condition has caused it. Insulin resistance Some medical conditions listed will result in insulin resistance, which is where the body is not able to adequately respond to insulin. This forces the body to release more insulin in an attempt to keep blood glucose levels under control. Insulin resistance is a characteristic of type 2 diabetes. Insulin resistance is a feature of diabetes caused by Cushing’s syndrome and PCOS. Lifestyle changes are an important part of treatment. If medication is required to control blood glucose levels, metformin is commonly prescribed with stronger medication, including insulin, available if blood glucose levels remain elevated. Loss of pancreatic function Some forms of secondary diabetes, such as diabetes as a result of pancreatitis, cystic fibrosis or hemochromatosis, may result in a loss of pancreatitic function; Continue reading >>

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