Gestational diabetes (GDM) is one of the most common complications in pregnancy, with a prevalence that continues to rise. At the time of the COVID-19 epidemic, immediate reorganisation and ...adjustment of the system was needed. Telemedicine support was offered in order to provide high-quality treatment to pregnant women. However, the success of the treatment is unknown. We therefore aimed to evaluate COVID-19 epidemic effects on pregnancy outcomes in GDM.
The maternal outcomes (insulin treatment, gestational weight gain, caesarean section, hypertensive disorders) and perinatal outcomes (rates of large and small for gestational age, preterm birth and a composite child outcome) of women visiting a university hospital diabetes clinic from March to December 2020 were compared with those treated in the same period in 2019.
Women diagnosed with GDM during the COVID-19 epidemic (n=417), were diagnosed earlier (23.9 11.7-26.0 vs. 25.1 21.8-26.7 gestational week), had higher fasting glucose (5.2 5.0-5.4 vs. 5.1 4.8-5.3 mmol/l) and earlier pharmacological therapy initiation, and had achieved lower HbA1c by the end of followup (5.1% (32.2 mmol/mol) 4.9% (30.1 mmol/mol)-5.4% (35.0 mmol/mol) vs. 5.2% (33.3 mmol/mol) 5.0% (31.1 mmol/mol) - 5.4%·(35.5 mmol/mol), p<0.001) compared to a year before (n=430). No significant differences in perinatal outcomes were found.
Although GDM was diagnosed at an earlier gestational age and higher fasting glucose concentration was present at the time of diagnosis, the COVID-19 epidemic did not result in worse glucose control during pregnancy or worse pregnancy outcomes in Slovenia.
Long-term exposure to outdoor air pollution is a serious and common public health concern associated with growing morbidity and mortality worldwide. There are many published studies about the ...pathophysiological mechanisms involved in response of the body tissues to outdoor air pollution exposure. The aim of our review was to investigate the problem of outdoor air pollution and health effects of pathological mechanisms, with specific goal to point out public health intervention strategies based upon a clearer understanding of pathophysiological mechanisms of outdoor air pollution. A systematic literature review was carried out in two bibliographic databases, Science Direct and PubMed, in the period from January 1995 to December 2015. We conducted a systematic analysis of 95 studies, 43 of them being review studies and 52 original studies. The systematic analysis was done in three steps, for each body tissue separately (respiratory diseases, cardiovascular diseases, neurologic diseases and diabetes mellitus). This insight into literature review may help foster more effective preventive measures at the public health level as well as potential intervention strategies based upon a clearer understanding of the involved pathways.
Hypoglycaemia is the major barrier for glycaemic target achievement in patients treated with insulin. The aim of the present study was to investigate real-world incidence and predictors of ...hypoglycaemia in insulin-treated patients.
More than 300 consecutive patients with type 1 or type 2 diabetes treated with insulin were enrolled during regular out-patient visits from 36 diabetes practices throughout the whole country. They completed a comprehensive questionnaire on hypoglycaemia knowledge, awareness, and incidence in the last month and last six months. In addition, in the prospective part, patients recorded incidence of hypoglycaemic events using a special diary prospectively on a daily basis, through 4 weeks.
At least one hypoglycaemic event was self-reported in 84.1%, and 56.4% of patients with type 1 and type 2 diabetes, respectively, during the prospective period of 4 weeks. 43.4% and 26.2% of patients with type 1 and type 2 diabetes, respectively, experienced a nocturnal hypoglycaemic event. In the same time-period, severe hypoglycaemia was experienced by 15.9% and 7.1% of patients with type 1 and type 2 diabetes, respectively. Lower glycated haemoglobin was not a significant predictor of hypoglycaemia.
Rates of self-reported hypoglycaemia in patients treated with insulin in the largest and most comprehensive study in Slovenia so far are higher than reported from randomised control trials, but comparable to data from observational studies. Hypoglycaemia incidence was high even with high glycated haemoglobin values.
Pojavnost kardiometabolnih bolezni je dosegla pandemične razsežnosti, zato se čedalje večja pozornost posveča tudi z življenjskim slogom pogojenemu zdravju prebivalstva, še posebej načinu ...prehranjevanja in vnosu določenih skupin živil. Številne epidemiološke raziskave so dokazale, da je uživanje pijač z dodanim sladkorjem povezano z nastankom debelosti, sladkorne bolezni in srčno-žilnih bolezni, dodatno je tudi dober pokazatelj posameznikovega nezdravega življenjskega sloga. Pijače z dodanim sladkorjem so vir tako imenovanih »praznih kalorij«, ki nimajo hranilne vrednosti in predstavljajo največji dodatni vir energije in vnosa dodanih sladkorjev, še posebej fruktoze. Zmanjšanje vnosa pijač z dodanim sladkorjem dokazano vodi v znižanje telesne mase in zmanjšanje tveganja za nastanek kardiometabolnih bolezni. Uživanje pijač z dodanim sladkorjem je uvrščeno kar med 15 najpogostejših dejavnikov tveganja med kazalci nezdravega življenjskega sloga. Posledično je smiselno intenzivno ozaveščanje o pomembnosti opustitve uživanja pijač z dodanim sladkorjem, še posebej pri osebah s povečanim tveganjem za presnovne bolezni in mladih z nezdravim življenjskim slogom. V prispevku so opredeljene pijače z dodanim sladkorjem, opisana je njihova povezava z debelostjo, sladkorno boleznijo in srčno-žilnimi boleznimi ter možni zdravi nadomestki.
The aim of this literature review was to explore the views of parents and children with type 1 diabetes mellitus regarding having a school nurse.
Six databases were selected for the analysis. The ...research strategy was based on the PICO model. The research participants were children with type 1 diabetes mellitus and/or their parents.
The present review of research papers includes 12 publications. The majority of works deal with the perspectives of children with type 1 diabetes and their parents on various aspects related to the role of a school nurse in the care of a child with type 1 diabetes:the presence of a school nurse;the role of a school nurse in the prevention and treatment of hypoglycaemia, in performing the measurements of blood glucose, and in insulin therapy;the role of a nurse in improving metabolic control of children with type 1 diabetes;a nurse as an educator for children with type 1 diabetes, classmates, teachers, teacher's assistants, principals, administrators, cafeteria workers, coaches, gym teachers, bus drivers, and school office staff;a nurse as an organiser of the care for children with type 1 diabetes.
According to parents and children with type 1 diabetes mellitus, various forms of school nurse support (i.e., checking blood glucose, giving insulin, giving glucagon, treating low and high blood glucose levels, carbohydrate counting) are consistently effective and should have an impact on the condition, improvement of metabolic control, school activity and safety at school.
Telemonitoring and web-based interventions are increasingly used in primary-care practices in many countries for more effective management of patients with diabetes mellitus (DM). A new approach in ...treating patients with diabetes mellitus in family practices, based on ICT use and nurse practitioners, has been introduced and evaluated in this study.
Fifteen Slovene family practices enrolled 120 DM patients treated only with a diet regime and/or tablets into the study. 58 of them were included into the interventional group, and the other 62 DM patients into the control group, within one-year-long interventional, randomised controlled trial. Patients in the control group had conventional care for DM according to Slovenian professional guidelines, while the patients in the interventional group were using also the eDiabetes application. Patients were randomised through a balanced randomisation process.
Significant reductions of glycated haemoglobin (HbA1c) values were found after 6 and 12 months among patients using this eDiabetes application (p<0.05). Among these patients, a significant correlation was also found between self-monitored blood pressure and the final HbA1c values. Diabetic patients' involvement in web-based intervention had only transient impact on their functional health status.
This eDiabetes application was confirmed to be an innovative approach for better self-management of DM type 2 patients not using insulin. Both a significant reduction of HbA1c values and a significant correlation between the average self-measured blood pressure and the final HbA1c values in the interventional group were found. Nurse practitioners - as diabetes care coordinators - could contribute to better adherence in diabetes e-care.
A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of ...registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices.
A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared.
The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort.
The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.
A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article ...was to assess the quality of diabetes and hypertension management.
We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators.
Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices.
First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.
Navezanost je vedenjski in fiziološki sistem, ki posamezniku omogoča dinamično prilagajanje na okolje. Navezanost se razvija pri sovplivu med dojenčkom in materjo, igra pomembno vlogo pri razvoju ...otrokovih možgan in vpliva na kvaliteto posameznikovih socialnih odnosov vse življenje.
Pediatrična endokrinologija je začela s svojim neodvisnim razvojem zgodaj v splošnem razvoju te specilanosti, z izrazitim poudarkom na raziskovalnemu delu in klinični odličnosti. Slovenska ...pediatrična endokrinologija je bila že od začetkov evropske pediatrične endokrinologije njen sestavni del, še posebej kot soustanoviteljica prve mednarodne skupine ‘International Study Group for Diabetes in Children and Adolescents’. Po pionirskem delu prof. dr. Leva Matajca je prof. dr. Ciril Kržišnik KO za endokrinologijo, diabetes in bolezni presnove Pediatrične klinike v Ljubljani trdno vpel v mednarodno znanstveno skupnost. V zadnjem desetletju KO sodeluje pri vrhunskem raziskovalnem delu in zagotavlja klinično oskrbo po najvišjih mednarodnih standardih.
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