Journal of diabetes and its complications
-
Digital toe amputation is a relatively minor surgical procedure but there is a historical view that it is the "first stage in a predictable clinical course" leading to eventual limb loss. There is a paucity of contemporaneous data on the long-term outcomes of patients undergoing toe amputation. We aim to study the experience from our institution, focussing on the risk factors for progression to future limb loss, by conducting a retrospective review of our practice. ⋯ Toe amputation is a significant predictor of future limb loss. Our study identified that patients with diabetes are significantly less likely to progress to further limb loss than those with the disease. We hypothesise that this difference is due to the more intensive, multi-disciplinary foot care follow-up that diabetic patients receive. These results highlight the significance of toe amputation and contribute to the evidence for a more intensive out-patient service for these high risk patients.
-
J. Diabetes Complicat. · Mar 2012
Predictive value of admission blood glucose level on short-term mortality in acute cerebral ischemia.
Admission hyperglycemia increases the risk of death in patients with acute stroke. However, the most appropriate cut-off of glucose level indicating an increased risk of short-term mortality remains unknown. ⋯ Admission hyperglycemia (≥143mg/dL) is a strong and an independent predictor for 72-hour fatality, especially in patients with no prior history of diabetes mellitus.
-
J. Diabetes Complicat. · Jan 2012
Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus.
The objective was to evaluate the relationships between diabetes management self-efficacy and diabetes self-management behaviors and glycemic control. ⋯ The majority of subjects did not have their diabetes controlled; their self-efficacy was low, and they had suboptimal self-management behaviors. Therefore, strategies to enhance and promote self-efficacy and self-management behaviors for patients are essential components of diabetes education programs. Furthermore, behavioral counseling and skill-building interventions are critical for the patients to become confident and be able to manage their diabetes.
-
J. Diabetes Complicat. · Nov 2011
Disparities in diabetes self-management and quality of care in rural versus urban veterans.
There are distinct geographic differences in diabetes-related morbidity and mortality; however, data regarding self-management and clinical outcomes are limited. This study examined diabetes care among veterans residing in rural versus urban areas. ⋯ Diabetes self-foot care was significantly better among rural veterans than their urban counterparts, but quality of care was equivalent. This suggests that clinical diabetes care among veterans is uniform; however, greater efforts for patient education and support in diabetes self-management are needed to improve outcomes.
-
J. Diabetes Complicat. · May 2011
ReviewThe importance of glycemic control: how low should we go with HbA1c? Start early, go safe, go low.
Epidemiologic data indicate a continuous relationship between hemoglobin A1c (HbA1c) and risk for microvascular and macrovascular complications of diabetes. Intensive glycemic control reduces risk of microvascular complications in Type 1 and Type 2 diabetes, and long-term treatment and follow-up studies have shown that initial intensive control is associated with reduced cardiovascular risk. Recent intervention trials in older, high-risk patients with Type 2 diabetes have not shown a benefit of intensive control in reducing cardiovascular risk over a rather short-term follow-up period of up to 5 years, with some data indicating that intensive control accompanied by hypoglycemia is detrimental in patients with high cardiovascular risk. ⋯ Still, the goal in treating both Type 1 and Type 2 diabetes should be to safely get HbA1c as close to normal as possible. In Type 2 diabetes, this goal should be tempered for the time being in patients with shorter life expectancy or co-existing cardiovascular disease or other co-morbidities, in whom a target of 7.0-7.5% may be advisable until we can demonstrate that lower targets in such patients can be safely achieved. Newer agents with lower risk of hypoglycemia--e.g., insulin analogues, incretin mimetics and incretin enhancers-may form an integral component of strategies for safely achieving lower HbA1c levels.