Diabetic medicine : a journal of the British Diabetic Association
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Identifying patients' beliefs about taking medication can inform interventions to support medication taking, and their evaluation. We set out to establish the range of these beliefs, and measure the frequency of commonly held beliefs and their correlation with intention to take medication and self-reported medication adherence. ⋯ Use of a theoretical model to elicit and identify common beliefs about taking medication regularly underscores the importance of exploring weight-gain concerns and how to keep taking tablets when routines change. Beliefs associated with intention and taking medication will inform intervention development, implementation and evaluation in randomized controlled studies.
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Randomized Controlled Trial
Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysis.
Economic evaluations of diabetes interventions do not usually include analyses on effects and cost of implementation strategies. This leads to optimistic cost-effectiveness estimates. This study reports empirical findings on the cost-effectiveness of two implementation strategies compared with usual hospital outpatient care. It includes both patient-related and intervention-related cost. ⋯ Both guideline implementation strategies in secondary care are cost-effective compared with current care, by Dutch standards, for these patients. Additional annual costs per patient using patient passports are low. This analysis supports patient involvement in diabetes in the Netherlands, and probably also in other Western European settings.
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To examine patient- and provider-reported psychosocial problems and barriers to effective self-care and resources for dealing with those barriers. ⋯ Psychosocial problems appear to be common among diabetic patients worldwide. Addressing these problems may improve diabetes outcomes, but providers often lack critical resources for doing so, particularly skill, time and adequate referral sources.
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Lactic acidosis is a known adverse risk of metformin treatment. We report two cases in whom fulminant lactic acidosis developed during treatment. There were no contraindications to metformin treatment and both were admitted with abdominal discomfort for some days, causing dehydration. ⋯ One patient died and the other survived but is severely disabled. We suggest, in both cases, that acute renal failure developed as a result of dehydration, causing metformin accumulation and lactic acidosis. We recommend that all patients on metformin should consider discontinuation of metformin treatment in the event of a severe medical condition causing dehydration.
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Obesity, the strongest risk factor for Type 2 diabetes mellitus, is less prevalent in Japanese than in other populations. We investigated the effects of body mass index (BMI, kg/m(2)) on the incidence of diabetes mellitus in a Japanese population. ⋯ BMI, even within the non-obese level, is a dose-dependent risk factor for diabetes mellitus in middle-aged Japanese. Increases in BMI of 1 kg/m(2) (= body-weight gain of 2.4-2.9 kg) may raise the risk by about 25%.