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When Goals Are Not Met In Diabetes Care

When Goals Are Not Met in Diabetes Care

When Goals Are Not Met in Diabetes Care

A presentation at the fall live meeting of the ACO & Emerging Healthcare Delivery Coalition® focused on the clinical and economic consequences of not meeting glycemic goals in patients with type 2 diabetes.
Clinical and economic burdens are placed on the US healthcare system when target goals are not met in diabetes care. In 2012, total costs (direct and indirect) associated with diabetes in the United States were $245 billion dollars.1 In a presentation at the 2017 Fall ACO & Emerging Healthcare Delivery Coalition®, hosted by The American Journal of Managed Care® on October 26th, 2017, Kari Uusinarkaus, MD, discussed the economic impact of type 2 diabetes (T2D). This presentation focused on the prevalence, costs, and consequences of not meeting glycemic goals in patients with T2D.
Approximately 16.5 million people in the United States have T2D.2 The majority of adult patients (90%-95%) with diabetes have T2D.1 Risk factors associated with the occurrence of T2DM include ethnicity (eg, American Indians, African Americans, Hispanics/Latinos, Asians, Native Hawaiians, Pacific Islanders), male gender, older age, obesity, family history, gestational diabetes, impaired glucose metabolism, and physical inactivity.
Diabetes increases the risk of developing complications (eg, neurological, peripheral vascular, cardiovascular, renal, endocrine/metabolic, ophthalmic).3 More than 60% of patients with T2D die from cardiovascular disease.4 From 1998 to 2011, the overall death rate among patients with T2D was 38.64 per 1000 person-years.5 The risk of death in patients with T2D increase Continue reading

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Diabetes life expectancy 'improving'

Diabetes life expectancy 'improving'

Life expectancy for diabetes patients in Scotland has improved, a Dundee University study has found.
A major study carried out by the university and the Scottish Diabetes Research Network showed that people with type 1 diabetes die significantly younger than the general population.
Men with the condition live about 11 years less than those without it, while women live about 13 years less.
However, previous research had reported a gap of between 15 and 27 years.
Major advances have occurred in the treatment of type 1 diabetes over the last 30 years, and scientists said the life expectancy study could help future care plans and in the setting of insurance premiums.
Diabetes is an incurable condition which leaves the body unable to control blood sugar levels, with type 1 causing the pancreas to stop producing insulin, a hormone which regulates the amount of glucose in blood.
Diabetes charities such as Diabetes UK generally cite losses of life expectancy of between 15 and 20 years for type 1 patients, while estimates from the United States in the 1970s reported a loss of 27 years.
However, the study run by Prof Helen Colhoun and Shona Livingstone at the university, shows contemporary life expectancy has improved.
Life expectancy
They studied the cases of more than 24,000 individuals with type 1 diabetes who were aged 20 or older between 2008 and 2010.
They found that 47% of men and 55% of women with the condition survived to age 70, compared to 76% of men and 83% of women without it.
On average, men with diabetes lived for 46.2 further years after turning 20, compared to 57.3 y Continue reading

Understanding Diabetes and Blood Sugar Control

Understanding Diabetes and Blood Sugar Control

Imagine this scene. Your doctor tells you that you have diabetes. You are afraid as you are not too sure what it all means. You start hearing new terms such as blood glucose, insulin, hemoglobin A1c, fasting blood glucose, fasting blood sugars and it seems overwhelming. So let’s take a minute to break it down. Understanding your disease is the first step in maintaining your health.
So what exactly does it mean to have diabetes?
When a person eats, whether they have diabetes or not, the glucose level in their blood rises. The term “blood glucose level” is commonly referred to as “blood sugar”. A rise in blood glucose levels after eating is normal, and it’s how the body nourishes the cells. When a person does not have diabetes, the pancreas produces insulin, whose job it is to bring down glucose levels in the blood stream before it rises to a dangerous level. Insulin equalizes blood glucose levels to safe levels. But when a person has diabetes, their pancreas does not produce enough insulin, if any at all, or the insulin they produce is not working properly. Therefore, when a person has diabetes, the blood glucose rises unimpeded, causing damage to the organs. If uncontrolled and levels rise dangerously high, it could cause coma or death.
Chances are you may have family members and friends who have diabetes. As a matter of fact, 6 percent of Americans have diabetes. November 14th is designated as World Diabetes Day.
What causes glucose levels to rise?
Blood sugars in our blood stream rise naturally when we eat, in order to feed our cells. But not all foods cause a Continue reading

Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study

Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study

Abstract
Regular physical activity is a cornerstone of diabetes management. We conducted a study to evaluate whether specifying the timing of walking in relation to meals enhances the benefits conferred by current physical activity guidelines.
A total of 41 adults with type 2 diabetes mellitus (mean ± SD age 60 ± 9.9 years; mean diabetes duration 10 years) participated in this randomised, crossover study. Randomisation was by a computer-generated protocol. For periods of 2 weeks, advice to walk 30 min each day was compared with advice to walk for 10 min after each main meal. Both sets of advice met current physical activity guidelines for people with type 2 diabetes mellitus. Physical activity was measured by accelerometry over the full intervention, and glycaemia was measured using continuous glucose monitoring in 5 min intervals over 7 days. The primary outcome of postprandial glycaemia was assessed during the 3 h after a meal by the incremental area under the blood glucose curve (iAUC).
The iAUC was significantly lower when participants walked after meals compared with on a single daily occasion (ratio of geometric means 0.88, 95% CI 0.78, 0.99). The improvement was particularly striking after the evening meal (0.78, 95% CI 0.67, 0.91) when the most carbohydrate was consumed and sedentary behaviours were highest. One participant died during the 30 day washout period between interventions, but participation in this study was not judged to contribute to this unfortunate event.
The benefits relating to physical activity following meals suggest that current guidelines shou Continue reading

Beating type 2 diabetes into remission

Beating type 2 diabetes into remission

Recognising and accurately coding reversal of type 2 diabetes is key to improving outcomes and reducing healthcare costs, argue Louise McCombie and colleagues
Type 2 diabetes, generally perceived as progressive and incurable, now affects 5-10% of the population, about 3.2 million people in the UK.1 Until complications develop, most patients are managed entirely within primary care, with diabetes comprising a major part of general practice activity. About 10% of total UK NHS expenditure goes on treating diabetes, and international figures suggest that medical costs for people with diabetes are twofold to threefold greater than the average for age and sex matched people without diabetes.1
Application of current clinical guidelines to reduce glycated haemoglobin (HbA1c) levels and cardiovascular risks, primarily with drugs and generic lifestyle advice, has improved clinical outcomes, but many patients still develop vascular complications, and life expectancy remains up to six years shorter than in people without diabetes.2 The diagnosis carries important social and financial penalties for individuals, as well as poor health prospects.
Remission of diabetes (no longer having diabetes, at least for a period) is clearly attainable for some, possibly many, patients but is currently very rarely achieved or recorded. Greater awareness, documentation, and surveillance of remissions should improve health outcomes and reduce healthcare costs.
Changing management
In keeping with trends in most medical specialties, diabetes management is beginning to focus on reversible underlying diseas Continue reading

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