The global prevalence of type 2 diabetes mellitus (T2DM) has increased significantly in recent decades. Despite numerous studies and systematic reviews, there is a gap in comprehensive and up-to-date ...evaluations in this rapidly evolving field.CONTEXTThe global prevalence of type 2 diabetes mellitus (T2DM) has increased significantly in recent decades. Despite numerous studies and systematic reviews, there is a gap in comprehensive and up-to-date evaluations in this rapidly evolving field.This review provides a comprehensive and current overview of the efficacy of Traditional Chinese Medicine (TCM) in treating T2DM.OBJECTIVEThis review provides a comprehensive and current overview of the efficacy of Traditional Chinese Medicine (TCM) in treating T2DM.A systematic review was conducted using PubMed, Web of Science, Wanfang Data, CNKI, and Medline databases, with a search timeframe extending up to November 2023. The search strategy involved a combination of subject terms and free words in English, including 'Diabetes,' 'Traditional Chinese Medicine,' 'TCM,' 'Hypoglycemic Effect,' 'Clinical Trial,' and 'Randomized Controlled Trial.' The studies were rigorously screened by two investigators, with a third investigator reviewing and approving the final selection based on inclusion and exclusion criteria.METHODSA systematic review was conducted using PubMed, Web of Science, Wanfang Data, CNKI, and Medline databases, with a search timeframe extending up to November 2023. The search strategy involved a combination of subject terms and free words in English, including 'Diabetes,' 'Traditional Chinese Medicine,' 'TCM,' 'Hypoglycemic Effect,' 'Clinical Trial,' and 'Randomized Controlled Trial.' The studies were rigorously screened by two investigators, with a third investigator reviewing and approving the final selection based on inclusion and exclusion criteria.A total of 108 relevant papers were systematically reviewed. The findings suggest that TCMs not only demonstrate clinical efficacy comparable to existing Western medications in managing hypoglycemia but also offer fewer adverse effects and a multitarget therapeutic approach. Five main biological mechanisms through which TCM treats diabetes were identified: improving glucose transport and utilization, improving glycogen metabolism, promoting GLP-1 release, protecting pancreatic islets from damage, and improving intestinal flora.RESULTSA total of 108 relevant papers were systematically reviewed. The findings suggest that TCMs not only demonstrate clinical efficacy comparable to existing Western medications in managing hypoglycemia but also offer fewer adverse effects and a multitarget therapeutic approach. Five main biological mechanisms through which TCM treats diabetes were identified: improving glucose transport and utilization, improving glycogen metabolism, promoting GLP-1 release, protecting pancreatic islets from damage, and improving intestinal flora.TCM has demonstrated significant protective effects against diabetes and presents a viable option for the prevention and treatment of T2DM. These findings support the further exploration and integration of TCM into broader diabetes management strategies.CONCLUSIONSTCM has demonstrated significant protective effects against diabetes and presents a viable option for the prevention and treatment of T2DM. These findings support the further exploration and integration of TCM into broader diabetes management strategies.
Background: Gestational diabetes is type 1 or 2. Preconception treatment reduces problems, while poor blood glucose management increases congenital deformity risk. Diet, insulin, or oral medications ...are essential for blood sugar control, including insulin transition during pregnancy. Substandard care of diabetic women contributes to maternal and fetal morbidity and mortality. Objectives: Evaluate diabetes care in pregnancy at Qena University Hospital, as compared to NICE recommendations. Patients and methods: This Study conducted at South Valley University, covering pregnant diabetics from Jan 2019 to Dec 2020. Diabetes management during pregnancy was assessed in preconception, maternal, intrapartum, and postnatal stages. Patient assessment included history, physicals, and blood tests. Ultrasound determined fetal health, gestational age. Outcomes encompassed maternal glycemia, complications, preterm birth, cesarean section, neonatal issues. Results: 83.3% received pertinent information, 72.2% embarked on planned pregnancies, 5.6% underwent retinal assessment, 100% received renal assessments, and 94.4% underwent HbA1c monitoring. 17.5% had glucose monitoring, 86.0% conducted ketone testing, 22.8% underwent retinal assessments, 100% received renal assessments, 80.37% underwent anomaly scans, 54.4% monitored fetal well-being, 17.5% took measures to prevent pre-eclampsia, 19.3% received antenatal care facilitated by MDT. 52.6% had DKA attacks and 26.3% had hypoglycemic attacks. 40.4% delivered before 34 weeks of gestation, 47.4% delivered between 34-37 weeks. 77.2% required admission to the NICU. Macrosomia was in 3.51% and polyhydramnios was in 1.75%. 59.6% had cesarean section. Conclusion: Defective preconceptional and antenatal care were evident in a great proportion of patient this raise alarm for enhancing the standard of obstetric and medical management of pregnancy.
This review aimed to assess the effectiveness of interventions for type 2 diabetes (T2D) management in New Zealand on clinical outcomes, and explore the factors impacting their feasibility and ...acceptability.
Scoping review.
Three databases (PubMed, Web of Science and Scopus) were searched between January 2000 and July 2023. Reference lists of included studies were hand searched to identify additional articles.
The search yielded 550 publications, of which 11 were included in the final review. Most interventions (n = 10) focussed on education and seven were delivered by health professionals. Supporting factors for interventions included clinical/peer support (n = 8) and whānau (family) involvement (n = 6). Hindering factors included non-adherence (n = 4) and high drop-out (n = 4). Most studies reported modest improvement in HbA1c and weight at six months, but minimal change in HbA1c, weight, lipids, renal profile, and blood pressure by two years.
Future interventions should involve culturally appropriate approaches to improve engagement and acceptability while addressing lifestyle and medication adherence for T2D management. T2D interventions not widely disseminated via academic channels need to be further identified.
•Microneedle patches can be used for drug delivery and disease monitoring.•They allow synchronous drug delivery and ISF biomarker monitoring.•Their use has been reported to result in significantly ...reduced pain.•Their use in tissue biopsy has recently been tested with promising results.
Microneedle (MN) patches are composed of micron-sized needles organised in arrays and attached to the backing of a patch. The most common type is the transdermal patch, designed to uniformly penetrate the stratum corneum to reach the dermis of the skin. Recent advances in 3D printing technology have allowed the development of reproducible, efficient methods to create microneedles on a large scale, which had previously been a factor in the limited clinical uptake. In comparison to conventional drug delivery methods, MN patches have been shown to significantly reduce pain and scar generation while maintaining effective and reliable delivery of vaccines, immunotherapies, and slow-release drug therapies. The MN design has also been investigated as an alternative to conventional tissue biopsy, with positive results. Synchronous delivery of medications while monitoring biomarkers in dermal interstitial fluid (ISF) is also a promising clinical development with wide-reaching benefits. MNs are diverse in design and material composition, and with developments in fabrication technology, transdermal drug delivery has been applied to many clinical fields, including chronic illnesses such as arthritis or diabetes, cancer, immunotherapies, epidemic disease prevention and ocular treatments. While the majority of MN patch applications are still in the pre-clinical testing phase in animal models, further translation of this technology to the clinic could aid in medication and vaccine compliance, improve treatment access in rural and remote communities, improve targeted therapy applications and provide financial cost savings to the public health sector. This review evaluates the designs and applications of current transdermal MN patches for drug delivery, biomarker monitoring and diagnostic biopsies compared to conventional needle-based methods.
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ObjectiveDiabetes management requires ongoing monitoring of diabetes care from primary care, specialist care and laboratory testing. COVID-19 led to changes in access to in-person care. The purpose ...of this research was to assess changes in the management of diabetes during the COVID-19 pandemic using population-linked datasets and population segmentation.
ApproachWe identified over 1.4 Million Ontarians with diabetes (approximately 10% of the population) with valid health insurance as of April 1, 2019 and April 1, 2020. We measured 11 indicators of diabetes management including laboratory testing for HbA1c and LDL (highlighted in this abstract). With screening indicators, we examined changes in the proportion of the population up-to-date with screening at the end of each fiscal year (March 31, 2020 and March 31, 2021) overall and according to population segments created using linked health data from primary care, home care, long term care and hospitals.
ResultsOverall screening rates that required laboratory testing for HbA1c and LDL fell substantially from 54% to 40% and 68% to 59% overall. Comparing across population segments, residents in Long Term Care facilities had the smallest changes in screening rates; individuals with low, medium and high complexity chronic conditions and end-of-life conditions had the largest changes; maternity, cancer, mental health and frail populations were in the middle. Differences according the primary care enrolment models (capitation vs fee-for-service) were relatively minor but patients who were not rostered to a primary care physician had the largest reductions in laboratory screening. Results for all 11 indicators will be shared in the presentation.
ConclusionCOVID-19 was associated with substantial reductions in laboratory-based diabetes screening. Poor diabetes management is one of the strongest risk-factors for adverse outcomes in COVID-19. Rates of diabetes management declined most for at risk patient populations amplifying the need to differentially connect with patients to ensure ongoing care during the pandemic.
Background: Access to a primary care provider is not guaranteed for many living in rural settings. Notably, rural populations experience a higher degree of burden from chronic diseases compared to ...urban-dwellers. For example, diabetes can go undiagnosed and undertreated with lack of primary care. To address these care gaps at a large, rural family medicine practice in western North Carolina, a multidisciplinary pharmacist-led diabetes clinic was developed. Objectives: This article describes the implementation, evolution, and impact of the diabetes management clinic and explores future directions for improving the experience of patients and health care providers. Practice Description and Innovation: The diabetes management clinic at Mountain Area Health Education Center (MAHEC) is a pharmacy resident-led interdisciplinary clinic incorporating nutrition and pharmacy learners to provide patient care in both telehealth and in-office settings. Since its inception in 2018, the clinic has facilitated meaningful learning opportunities for students and residents and helped patients manage their diabetes in a multifaceted approach. Evaluation Methods: A retrospective, cross-sectional study evaluated diabetes-related outcomes for 80 patients seen in the diabetes management clinic during twelve months of appointments. The primary outcome measure was change in A1c from baseline. Results: Among patients with a follow-up A1c during the study (n=64), there was a mean reduction in A1c by 0.79% from baseline. Additionally, among those with a second follow-up A1c available (n=32), there was a mean reduction from baseline in A1c of 1.42%. Conclusion: The utilization of pharmacy residents as part of an interdisciplinary diabetes management clinic can extend access to care for underserved patients. The clinic also serves as a structured teaching clinic for interdisciplinary learners, and it has contributed to positive clinical outcomes, strong interprofessional collaboration, and expansion of experiential education opportunities since its inception in 2018.
This study addresses the global challenge of effectively managing diabetes through self-care practices, including medication adherence, exercise, blood glucose monitoring, foot care, and diet. Our ...research aimed to evaluate self-care practices among type 2 diabetic patients, using the validated Summary of Diabetes Self-Care Activities scale (SDSCA), and to analyze associations with age, gender, education, and socioeconomic status. This cross-sectional study was conducted at District General Hospital Chilaw, Sri Lanka, and involved 187 participants. Data analysis employed SPSS version 25. The results highlighted suboptimal self-care behaviors and medication adherence, emphasizing the need for integrated interventions to enhance knowledge and self-care among “Type 2 Diabetes Mellitus” patients.
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