1,721,110 research outputs found
Quality of Care of Outcomes in Type 2 Diabetic Patients A comparison between general practice and diabetic clinics
No full textOBJECTIVE— The role of general practice and diabetes clinics in the management of diabetes
is still a matter of debate. Methodological flaws in previous studies may have led to
inaccurate conclusions when comparing the care provided in these different settings. We compared
the care provided to type 2 diabetic patients attending diabetes outpatient clinics (DOCs)
or being treated by a general practitioner (GP) using appropriate statistical methods to adjust for
patient case mix and physician-level clustering.
RESEARCH DESIGN AND METHODS— We prospectively evaluated the process and
intermediate outcome measures over 2 years in a sample of 3,437 patients recruited by 212
physicians with different specialties practicing in 125 DOCs and 103 general practice offices.
Process measures included frequency of HbA1c, lipids, microalbuminuria, and serum creatinine
measurements and frequency of foot and eye examinations. Outcome measures included HbA1c,
blood pressure, and total and LDL cholesterol levels.
RESULTS— Differences for most process measures were statistically significantly in favor of
DOCs. The differences were more marked for patients who were always treated by the same
physician within a DOC and if that physician had a specialty in diabetology. Less consistent
differences in process measures were detected when patients followed by GPs were compared
with those followed by physicians with a specialty other than diabetology. As for the outcomes
considered, patients attending DOCs attained better total cholesterol levels, whereas no major
differences emerged in terms of metabolic control and blood pressure levels between DOCs and
GPs. Physicians’ specialties were not independently related to patient outcomes.
CONCLUSIONS— Being followed always by the same physician in a DOC, particularly if
the physician had a specialty in diabetes, ensured better quality of care in terms of process
measures. In the short term, care provided by DOCs was also associated with better intermediate
outcome measures, such as total cholesterol levels
Una esperienza di pianificazione urbanistica transattiva al Sud
No full textVIII Giornata di Studi INU - Istituto Nazionale di Urbanistica “Una politica per le città italiane”;Sessione XIII - Specificità della città del sud;
Pg. 13-17; Progressivo pagine 990-994
A standardized protocol for continuous subcutaneous insulin infusion in the peripartum period in women with type 1 diabetes
No full textObjectives and methods. Metabolic control must be optimized to prevent maternal-neonatal complications during and after delivery. The primary aim of this study was to provide a standardized protocol for continuous subcutaneous insulin infusion (CSII), with or without real-time continuous glucose monitoring (RT-CGM), during delivery in pregnant type 1 diabetic women. This procedure was based on a retrospective multicenter observational study in which CSII was used around the time of delivery by women already instructed on its use during pregnancy. Three basal insulin rates were established, depending on the capillary blood glucose level (CBG): profile A, last basal rate in use before delivery; profile B, half of profile A; profile C, 0.1-0.2 U/h, for CBG < 70 mg/dl, activated just before anesthesia or at the beginning of active labor. An alternative intravenous insulin protocol (IVP) was applied in case of complications or sudden metabolic deterioration. Primary outcomes were CBG in the target range (70-140 mg/dl) throughout delivery and the percentages of women managed with the IVP. Results. The study comprised 65 pregnant women with diabetes: 56 (86%) had cesarean section, 9 (14%) spontaneous/ induced vaginal delivery. Mean CBG was 102 ± 31 mg/dl at time 0; 109 ± 42 mg/dl at 30 min; 120 ± 48 mg/dl at 60 min; 99 ± 34 mg/dl at 24 h. Mean basal rate during delivery was 0.6 ± 0.4 U/h (profile B). Mean CBG was lower in the RT-CGM group than with CSII alone: 80 ± 14 mg/dl vs 111 ± 32 mg/dl at 0 min (p < 0.01); 79 ± 11 mg/dl vs 109 ± 42 mg/dl at 30 min (p < 0.02); 98 ± 20 mg/dl vs 125 ± 51 mg/dl at 60 min (p = ns). There were 11 cases (17%) of neonatal hypoglycemia, 9 of them transient. No women had to switch to IVP. No major differences were observed in relation to the delivery procedure. Conclusions. CSII is feasible and safe during delivery in selected women who have been appropriately instructed. RT-CGM can help achieve better maternal peripartu
Il parto della donna con diabete
No full textIl diabete in gravidanza rappresenta una condizione di rischio per esiti avversi materni, perinatali e neonatali. Gli esiti materni, perinatali e neonatali sono influenzati dalla durata del diabete e dal controllo glicemico prima e durante la gravidanza. Il rischio di molte di queste complicanze, come crescita fetale aumentata o ridotta, nascita pretermine, ipertensione/preeclampsia, morte neonatale, ipoglicemia neonatale e il ricovero in terapia intensiva neonatale, ha un impatto diretto sulla decisione dei tempi e della modalità del parto (1). Comunque, il diabete ben controllato, in assenza di altre condizioni associate, può essere gestito per quanto riguarda tempi e modalità del parto in maniera simile ad una gravidanza fisiologica. L’ottimizzazione del controllo glicemico durante le fasi del travaglio e del parto è condizione indispensabile per il benessere della madre e del neonato. La comparsa di ipoglicemie, come anche di iperglicemie materne 4-6 ore prima del parto, è associata ad ipoglicemia transitoria e/o ipossia nel neonato (2). Il parto sia che avvenga per via vaginale che con taglio cesareo, è caratterizzato da una grande instabilità glicemica che impegna il clinico e la donna soprattutto in caso di diabete pregestazionale di tipo 1. Il trattamento del diabete durante il parto deve tener conto della fisiologia del parto stesso. Il travaglio attivo di parto (Figura 1) è una forma di esercizio fisico ad elevato turnover di glucosio con richiesta energetica aumentata di circa il 40%, da cui deriva un aumentato e continuo fabbisogno di glucosio. Tale fabbisogno è pari a circa 2.5 mg/kg/minuto (3). Il taglio cesareo, considerato come intervento chirurgico in elezione, necessita di una correzione della spesa energetica con un aumento stimato di circa il 10-20% del metabolismo basale (4). Il diabetologo deve offrire un appropriato “counseling” sul trattamento del diabete durante il travaglio, il parto e l’immediato post partum, già dall’inizio del terzo trimestre così che la paziente possa comprenderne appieno le strategie. Inoltre, le strategie devono essere condivise con gli altri specialisti della sala parto, laddove questo non avvenga istituzionalmente. Pertanto, le sale parto degli ospedali dovrebbero disporre di semplici protocolli atti a raggiungere la normoglicemia ed evitarne pericolose fluttuazioni
Gestational diabetes in multiple pregnancies
No full textrelazioni reciproche fra diabete gestazionale e gravidanza gemellare
Use of repaglinide during the first weeks of pregnancy in two type 2 diabetic women
No full textImpact Factor 7,8
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