DOCSLIB.ORG

Diabetic Testing

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diabetic Testing PRE -ASSESSMENT Diabetic Testing Before CCOHTA decides to undertake a health technology assessment, a pre-assessment of the literature is performed. Pre-assessments are based on a limited literature search; they are not CCOHTA extensive, systematic reviews of the literature. They are provided here as a quick guide to important, No. 34 current assessment information on this topic. Readers are cautioned that the pre-assessments have May 2004 not been externally peer reviewed. Introduction Diabetes is prevalent in 5% of the Canadian population.1 Type 2 non-insulin dependent diabetes mellitus (NIDDM) accounts for 85% to 90% of patients with diabetes mellitus. Patients with diabetes have an increased risk for developing complications from cardiovascular (i.e., heart, cerebrovascular and peripheral vascular) disease including neuropathy (leading to limb amputation), retinopathy (leading to blindness) and nephropathy (leading to dialysis and transplant). The clinical management of diabetes ranges from surveillance and primary prevention (preventing disease occurrence) to secondary prevention and management of complications. Regular treatment and the measurement of blood lipid parameters, blood pressure and glycemia used to modify treatment plans are encouraged in patients with type 1 (insulin-dependent) or type 2 diabetes (Figure 1).1 Figure 1: Diagnosis and care of diabetes based on glycemic control Management of Diabetes Treating:Treating 1. What is the evidence that LifestyleEducation –about physical improved glycemic control nutritional,lifestyle, nutrition and and delays or leads to fewer disease knowledge complications education Diagnosis and and screening screening AntihyperglycemicAntihyperglycemic medications Glycemic Complications Type 1 control Type 1 or death or typetype 2 2 diabetes diabetes Testing:Testing GlucoseFasting in bloodplasma or plasmaglucose Fructosamine 2. What is the evidence that testing leads to HbA 1c improved glycemic control? The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) is a non-profit organization funded by the federal, provincial and territorial governments. (www.ccohta.ca) PRE-ASSESSMENT Diabetic Testing CCOHTA Tests for glycemia are supposed to help patients maintain glycemic control. These tests include fasting blood and plasma glucose measurements, glycosylated hemoglobin measurements (HbA1c) and fructosamine measurements. Traditionally, HbA1c tests are done in a laboratory and blood glucose tests at home. Point-of-care and home-based tests have been developed for HbA1c and fructosamine testing. At issue is the scientific evidence supporting glucose testing in diabetes. The necessary minimum condition for any test is that its output may cause a change in a patient’s clinical management. The test results must also decrease the probability of disease once a new 2 treatment plan is chosen. Research Questions Based on the current recommendations for the diagnosis and management of diabetes: 1) What is the scientific evidence that tests of glycemia lead to reduced or delayed complications in patients diagnosed with type 1 or type 2 diabetes? If there is evidence that testing of glycemia leads to reduced or delayed complications, what is the optimal frequency of testing? 2 a) What is the scientific evidence that testing leads to improved glycemic control? In particular, what is the evidence that self-monitoring of blood glucose (SMBG), point-of-care or self-monitoring of glycosylated hemoglobin or fructosamine monitoring in any setting will lead to better glycemic control? b) If there is evidence that testing leads to improved glycemic control, what is the optimal frequency? c) What is the evidence that testing results are used to modify lifestyle and medication therapy for persons with diabetes? 3) What is the evidence that improving glycemic control leads to reduced or delayed complications in individuals diagnosed with type 1 or type 2 diabetes? Assessment Process Literature was identified by searching MEDLINE® via PubMed (1966-11 Aug 2003), The Cochrane Library (2003 Issue 3), web sites, clinical practice guidelines and clinical trial registries, according to the Canadian Coordinating Office for Health Technology Assessment’s (HTA) checklist. The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) is a non-profit organization funded by the federal, provincial and territorial governments. (www.ccohta.ca) PRE-ASSESSMENT Diabetic Testing CCOHTA Summary of Findings Approximately 1,500 citations were captured during the electronic search. Citations describing research that focuses on the relevant clinical questions are listed in Tables 1 and 2. Trials and observational studies were captured in this preliminary search. Research question 1) What is the evidence that testing leads to reduced or delayed complications or death for individuals diagnosed with type 1 or type 2 diabetes? Response to question 1) None of the randomized controlled trials identified compared testing versus no testing and assessed its impact on complications or death. Research question 2 a) What is the evidence that testing leads to improved glycemic control? In particular, what is the evidence that SMBG, point-of-care or self-monitoring of glycosylated hemoglobin or fructosamine monitoring in any setting will lead to better glycemic control? Response to question 2 a) Several reviews, including two systematic reviews of the evidence from RCTs, were found (Table 1). The authors of one systematic review3 conducted a meta-analysis. In children or adult type 1 diabetics, blood glucose monitoring led to a detectable difference in glycosylated hemoglobin (mean difference 0.57%, 95%CI: 1.073 to 0.061) when compared to urine monitoring. On the contrary, no difference between SMBG and urine glucose was detectable from studies involving type 2 diabetics. Further to this, a significant effect on glycemic control from self-monitoring could not be detected. For type 1, we identified one new RCT and eight previously identified RCTs. Three interrupted time-series, five prospective cohort studies, nine retrospective or cross- sectional studies and three surveys were also identified (Table 2). For type 2, two new RCTs were identified (one ongoing), with eight RCTs that were previously identified. Two non-randomized studies, one interrupted time series, two prospective cohort studies, 11 retrospective or cross-sectional cohort studies and four surveys were identified (Table 3). The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) is a non-profit organization funded by the federal, provincial and territorial governments. (www.ccohta.ca) PRE-ASSESSMENT Diabetic Testing CCOHTA Table 1: Reviews identified for question 2 a) Citation Type of Report (if known) Conclusions (if known) Coster, Gulliford, et al. Systematic review 20003 conducted for NCCHTA/NICE Grimaldi & Sachon Review Prospective randomized studies are needed 20034 to confirm efficiency of SMBG in type 2 diabetes Goldstein, Little, et al. Review and guidance 20035 Court 20026 Unknown Kennedy 20017 Review Unknown Norris, Engelgau, et al. Systematic review of training 20018 (which might include SMBG) Hom 19999 Review Unknown Rindone 199810 Unclear whether this is a review Halimi 199811 Review Use of SMBG is increasingly recommended by diabetologists and general practitioners, but trials investigating effects of SMBG in NIDDM patients found no benefit for metabolic control or weight loss; we recommend a moderate use of SMBG in NIDDM patients Faas, Schellevis, et al. Efficacy of SMBG in NIDDM patients is 199712 questionable and should be tested in rigorous high-quality RCT, for which some recommendations are given Goldstein, Little, et al. Review Unknown 199513 Goldstein 199414 Review Unknown Patrick, Gill, et al. Commentary 199415 Wysocki 198916 Review Blohme 198317 Review The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) is a non-profit organization funded by the federal, provincial and territorial governments. (www.ccohta.ca) PRE-ASSESSMENT Diabetic Testing CCOHTA SMBG in type 1 diabetes: Our search revealed one new RCT. Most of the studies identified were cross-sectional cohort studies or surveys. One identified RCT evaluated continuous glucose monitoring as an addition to standard monitoring. Several prospective cohorts were identified; two suggested SMBG can lead to tighter glycemic control (Table 2). Table 2: Studies of SMBG in type 1 diabetes Citation Design and Patient Group Results Ludvigsson & Hanas RCT of children (n=27) to HbA1c decreased in unmasked arm 200318 continued glucose monitoring (7.70% to 7.31%) after 3 months but not in blind arm (7.75% to 7.65%) Adams, Mah, et al. Cross-sectional cohort study of Lower rates of SMBG associated with 19 2003 adults (n=4,565) lower HbA1c testing frequency and higher HbA1c levels in insulin-dependent Otieno, Ng'ang'a, et Cross-sectional study (n=?) in Morning random blood glucose within al. 200220 Kenyan ambulatory clinic usual therapeutic targets of 4 mmol/L to 8 mmol/L predicted good glycemic control (HbA1c≤7.8%) with high sensitivity at the range of 86.3% to 98.4% Rotchford & Cross-sectional retrospective Blood glucose monitoring not regularly 21 Rotchford 2002 design (n=253) in South Africa performed and medications rarely modified, mean HbA1c 11.3% Salardi, Zucchini, et Retrospective cohort (n=28) of CGM correlates with HbA1c (r=0.53, al. 200222 CGM users p=0.002) and decreased during OL cohort study Soumerai, Mah, et Quasi-experimental
Load more

Recommended publications
  • Management of Diabetes Mellitus Standards of Care and Clinical Practice Guidelines
    WHO-EM/DIN6/E/G MANAGEMENT OF DIABETES MELLITUS STANDARDS OF CARE AND CLINICAL PRACTICE GUIDELINES Edited by Dr A.A.S. Alwan Regional Adviser, Noncommunicable Diseases WHO Regional Office for the Eastern Mediterranean WHO-EM/DIN6/E/G INTRODUCTION Available data from many countries of the Eastern Mediterranean Region (EMR) indicate that diabetes mellitus has become a problem of great magnitude and a major public health concern. Studies have demonstrated that, in some countries, diabetes affects up to 10% of the population aged 20 years and older. This rate may be doubled if those with impaired glucose tolerance (IGT) are also included. The manifestations of diabetes cause considerable human suffering and enormous economic costs. Both acute and late diabetic complications are commonly encountered. Long-term complications represented by cardiovascular diseases, cerebrovascular accidents, end-stage renal disease, retinopathy and neuropathies are already major causes of morbidity, disability and premature death in countries of this Region. The development of long-term complications is influenced by hyperglycaernia. Poor control of diabetes accelerates their progression. Thus, to prevent complications, good control of diabetes is essential and the management of diabetes should therefore aim to improve glycaemic control beyond that required to control its symptoms. Intensified therapy and maintaining near-normal blood glucose levels can result in considerable reduction in the risk of development of retinopathy, nephropathy and neuropathy. However, despite the high prevalence of diabetes and its complications and the availability of successful prevention strategies, essential health care requirements and facilities for self-care are often inadequate in this Region. Action is needed at all levels of health care and in the various aspects of diabetes care to bridge this gap and to improve health care delivery to people with diabetes.
    [Show full text]
  • Effect of Continuous Glucose Monitoring on Hypoglycemia in Type 1 Diabetes
    Clinical Care/Education/Nutrition/Psychosocial Research ORIGINALDiabetes ARTICLE Care Publish Ahead of Print, published online February 19, 2011 Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes 1 2 TADEJ BATTELINO, MD, PHD REVITAL NIMRI, MD especially useful in patients with hypogly- 2 3 MOSHE PHILLIP, MD PER OSKARSSON, MD, PHD 1 3 cemia unawareness and/or frequent epi- NATASA BRATINA, MD, PHD JAN BOLINDER, MD, PHD sodes of hypoglycemia (18). However, the hypoglycemia preventive effect of con- tinuous glucose monitoring has not been — OBJECTIVE To assess the impact of continuous glucose monitoring on hypoglycemia in established. Therefore, we designed a ran- people with type 1 diabetes. domized, controlled, multicenter clinical RESEARCH DESIGN AND METHODS—In this randomized, controlled, multicenter trial to evaluate the effect of continuous study, 120 children and adults on intensive therapy for type 1 diabetes and a screening level of glucose monitoring on hypoglycemia in glycated HbA1c ,7.5% were randomly assigned to a control group performing conventional children and adults with type 1 diabetes. home monitoring with a blood glucose meter and wearing a masked continuous glucose monitor every second week for five days or to a group with real-time continuous glucose monitoring. The primary outcome was the time spent in hypoglycemia (interstitial glucose concentration ,63 RESEARCH DESIGN AND mg/dL) over a period of 26 weeks. Analysis was by intention to treat for all randomized patients. METHODS RESULTS—The time per day spent in hypoglycemia was significantly shorter in the contin- uous monitoring group than in the control group (mean 6 SD 0.48 6 0.57 and 0.97 6 1.55 Patients Patients aged between 10 and 65 years h/day, respectively; ratio of means 0.49; 95% CI 0.26–0.76; P = 0.03).
    [Show full text]
  • Clinical Use of Hemoglobin A1c to Improve Diabetes Management
    PRACTICAL POINTERS Clinical Use of Hemoglobin A1c to Improve Diabetes Management Alan M. Delamater, PhD, ABPP or more than 25 years, the hemo- one recent study conducted in Norway6 A1C values. Only 14% of the youths globin A1c (A1C) test has been revealed that the majority (82.6%) of were able to accurately describe the A1C Fthe most widely accepted out- 201 adult patients with type 1 diabetes test. Just 11, 7.8, and 7.8% correctly come measure for evaluating glycemic knew what their last A1C was, and most identified the A1C ranges for good, fair, control in individuals with diabetes. patients (90%) knew what a satisfactory and poor glycemic control, respectively. The test provides an index of a patient’s A1C value would be. But a significant Very few youths (1.6–3.2%) knew the average blood glucose level during the number of patients (42%) reported they blood glucose values corresponding to past 2–3 months1 and is considered to had low knowledge of A1C testing in specific A1C results. Only a small num- be the most objective and reliable general. Furthermore, 25% of patients ber of youths correctly estimated the measure of long-term metabolic con- did not think that treatment intensifica- short- and long-term risks associated trol.2,3 The Diabetes Control and tion should occur at an A1C value of with A1C values of 7 and 12%. In this Complications Trial established that 10%. sample, there was a significant lack of maintaining A1C levels as close as pos- A recent cross-sectional study knowledge concerning the meaning and sible to the normal range results in con- examined the relationship between implications of the A1C test.
    [Show full text]
  • Diabetic Neuropathy
    6 Diabetic Neuropathy Solomon Tesfaye, MD, FRCP INTRODUCTION Polyneuropathy is one of the commonest complications of the diabetes and the com- monest form of neuropathy in the developed world. Diabetic polyneuropathy encompasses several neuropathic syndromes, the most common of which is distal symmetrical neuropa- thy, the main initiating factor for foot ulceration. The epidemiology of diabetic neuropathy has recently been reviewed in reasonable detail (1). Several clinic- (2,3) and population- based studies (4,5) show surprisingly similar prevalence rates for distal symmetrical neu- ropathy, affecting about 30% of all people with diabetes. The EURODIAB prospective complications study, which involved the examination of 3250 patient with type 1 from 16 European countries, found a prevalence rate of 28% for distal symmetrical neuropathy (2). After excluding those with neuropathy at baseline, the study showed that over a 7-year period, about one-quarter of patients with type 1 diabetes developed distal symmetrical neuropathy; age, duration of diabetes, and poor glycemic control being major determinants (6). The development of neuropathy was also associated with potentially modifiable car- diovascular risk factors such as serum lipids, hypertension, body mass index, and cigaret smoking (6). Furthermore, cardiovascular disease at baseline carried a twofold risk of neu- ropathy, independent of cardiovascular risk factors (6). Based on recent epidemiological studies, correlates of diabetic neuropathy include increasing age, increasing duration of dia- betes, poor glycemic control, retinopathy, albuminuria, and vascular risk factors (1,2,4,6). The differing clinical presentation of the several neuropathic syndromes in diabetes sug- gests varied etiological factors. CLASSIFICATION Clinical classification of the various syndromes of diabetic peripheral neuropathy has proved difficult.
    [Show full text]
  • Glossary of Technical Terms
    THIS DOCUMENT IS IN DRAFT FORM, INCOMPLETE AND SUBJECT TO CHANGE AND THAT THE INFORMATION MUST BE READ IN CONJUNCTION WITH THE SECTION HEADED “WARNING” ON THE COVER OF THIS DOCUMENT. GLOSSARY OF TECHNICAL TERMS This glossary contains explanations of certain technical terms used in this Document in connection with our Company and its business. Such terminology and meanings may not correspond to standard industry meanings or usages of those terms. “acetaminophen” a non-opioid analgesic and antipyretic agent used to treat pain and fever “artificial pancreas” an integrated diabetes management system that tracks blood glucose levels using a continuous glucose monitor and automatically delivers the insulin when needed using an insulin pump according to its control algorithm “ascorbic acid” a potent reducing and antioxidant agent that functions in fighting bacterial infections, in detoxifying reactions, and in the formation of collagen in fibrous tissue, teeth, bones, connective tissue, skin, and capillaries “basal insulin” a small, continuous infusion of background insulin delivered automatically at a programmed rate, all day and night “BG Port” blood glucose strip port, the port that accepts and electrically connects a disposable blood glucose strip to the electronics “BGMS” blood glucose monitoring system “BLE” bluetooth low energy “blood glucose” blood glucose, also referred to as blood sugar, is the amount of glucose in your blood, an indicator of diabetes monitoring “bolus insulin” insulin that is taken to lower abnormally high blood glucose
    [Show full text]
  • Diabetic Peripheral Neuropathy
    PHYSICIAN REFERRAL DIABETIC PATIENT’S NAME: PERIPHERAL _________________________________ _________________________________ NEUROPATHY DIAGNOSIS: _________________________________ _________________________________ PRECAUTIONS: BACCI & GLINN _________________________________ PHYSICAL THERAPY, INC. _________________________________ For more information on this and _____ Evaluate and Treat other topics, visit our website at: “Therapy with a Difference” _____ Exercise Program (i.e. home, gym) www.bandgpt.com _____ Functional Conditioning _____ Therapeutic Exercise _____ Balance Training _____ Aquatic Therapy (Hanford only) BACCI & GLINN _____ Modalities PHYSICAL THERAPY, INC. _____ Other ______________________ COMMENTS: _____________________ 5533 West Hillsdale Avenue, Suite A Visalia, CA 93291 ________________________________ Phone: 559-733-2478 Frequency: ___ x per week for ___ weeks Fax: 559-733-2470 Signature: _________________________ 331 North 11th Avenue (Physician signature) Hanford, CA 93230 Date: __________ Phone: 559-582-1027 Fax: 559-582-8105 SAME DAY APPOINTMENTS AVAILABLE Referrals are accepted from any physician. A physician’s order and diagnosis are required for evaluation and treatment. We accept most insurances including Medicare. Johnson Designs Bacci & Glinn Physical Therapy, Inc. Hanford: 559-582-1027 Visalia: 559-733-2478 Diabetic Peripheral Neuropathy What is Diabetic Signs and Symptoms of Treatment Options Peripheral Neuropathy? Diabetic Peripheral Neuropathy There is no cure for diabetic neuropa- Diabetic neuropathy is a nerve ♦ Tingling, tightness, or burning, shooting thy. Treatment focuses on slowing the disorder commonly caused by or stabbing pain in feet, hands, or other progression of the disease. Your diabetes. High blood sugar levels parts of the body. physician will determine the best from diabetes can damage nerves ♦ Reduced feeling or numbness, most treatment for your peripheral neuropa- throughout the body. About 50% of often in the feet.
    [Show full text]
  • Blood Glucose Monitoring in Type 1 Diabetes (Adults)
    FACTSHEET | JUNE 2021 Blood Glucose Monitoring in type 1 diabetes (adults) RSS Diabetes Service Blood glucose goes up and down during the day depending on carbohydrate intake, physical activity, insulin doses, wellbeing and stressors. Blood glucose results tend to be lower before meals and higher after meals. Blood glucose monitoring guides your self-care. The first step in blood glucose monitoring is knowing your blood glucose target ranges. What are the recommended blood glucose (BG) targets For most people with type 1 diabetes, it is recommended that blood glucose be as close to normal as possible to reduce the risk of long term complications. In general, recommended blood glucose targets are: Time Target BG Fasting and before meals 4.0 – 8.0mmol/L 2 hours after meals 4.0 – 10.0mmol/L However, for some people (e.g. infants and young children, the aged, those with impaired hypoglycaemia awareness or other health conditions), blood glucose targets will need to be set higher. If you are pregnant or trying to get pregnant, your blood glucose targets will be set lower. When should I test my blood glucose (BG)? Your blood glucose levels will indicate if your diabetes is well managed or if changes are needed. Blood glucose results overnight or before breakfast tell you how well your diabetes is controlled overnight by the basal insulin. Blood glucose results before lunch, before the evening meal and at bedtime tell you if your meal time rapid acting insulin doses are correct. Extra tests are recommended if you: • feel unwell, as part of your sick day action plan • are planning some physical activity, during and after physical activity • are using machinery • are about to drive • are concerned about unstable, unexpected or unexplainable results.
    [Show full text]
  • Diabetic Neuropathy
    PRIMER Diabetic neuropathy Eva L. Feldman1*, Brian C. Callaghan1, Rodica Pop-Busui2, Douglas W. Zochodne3, Douglas E. Wright4, David L. Bennett5, Vera Bril6,7, James W. Russell8 and Vijay Viswanathan9 Abstract | The global epidemic of prediabetes and diabetes has led to a corresponding epidemic of complications of these disorders. The most prevalent complication is neuropathy , of which distal symmetric polyneuropathy (for the purpose of this Primer, referred to as diabetic neuropathy) is very common. Diabetic neuropathy is a loss of sensory function beginning distally in the lower extremities that is also characterized by pain and substantial morbidity. Over time, at least 50% of individuals with diabetes develop diabetic neuropathy. Glucose control effectively halts the progression of diabetic neuropathy in patients with type 1 diabetes mellitus, but the effects are more modest in those with type 2 diabetes mellitus. These findings have led to new efforts to understand the aetiology of diabetic neuropathy , along with new 2017 recommendations on approaches to prevent and treat this disorder that are specific for each type of diabetes. In parallel, new guidelines for the treatment of painful diabetic neuropathy using distinct classes of drugs, with an emphasis on avoiding opioid use, have been issued. Although our understanding of the complexities of diabetic neuropathy has substantially evolved over the past decade, the distinct mechanisms underlying neuropathy in type 1 and type 2 diabetes remains unknown. Future discoveries on disease pathogenesis will be crucial to successfully address all aspects of diabetic neuropathy , from prevention to treatment. The International Diabetes Federation estimates that neuropathies secondary to diabetes can occur (Fig.
    [Show full text]
  • Diabetic Neuropathy: a Position Statement by the American
    136 Diabetes Care Volume 40, January 2017 Diabetic Neuropathy: A Position Rodica Pop-Busui,1 Andrew J.M. Boulton,2 Eva L. Feldman,3 Vera Bril,4 Roy Freeman,5 Statement by the American Rayaz A. Malik,6 Jay M. Sosenko,7 and Dan Ziegler8 Diabetes Association Diabetes Care 2017;40:136–154 | DOI: 10.2337/dc16-2042 Diabetic neuropathies are the most prevalent chronic complications of diabetes. This heterogeneous group of conditions affects different parts of the nervous system and presents with diverse clinical manifestations. The early recognition and appropriate man- agement of neuropathy in the patient with diabetes is important for a number of reasons: 1. Diabetic neuropathy is a diagnosis of exclusion. Nondiabetic neuropathies may be present in patients with diabetes and may be treatable by specific measures. 2. A number of treatment options exist for symptomatic diabetic neuropathy. 3. Up to 50% of diabetic peripheral neuropathies may be asymptomatic. If not recognized and if preventive foot care is not implemented, patients are at risk for injuries to their insensate feet. 4. Recognition and treatment of autonomic neuropathy may improve symptoms, POSITION STATEMENT reduce sequelae, and improve quality of life. Among the various forms of diabetic neuropathy, distal symmetric polyneurop- athy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular au- tonomic neuropathy (CAN), are by far the most studied (1–4). There are several 1 atypical forms of diabetic neuropathy as well (1–4). Patients with prediabetes may Division of Metabolism, Endocrinology & Diabe- – tes, Department of Internal Medicine, University also develop neuropathies that are similar to diabetic neuropathies (5 10).
    [Show full text]
  • Nerve Pain in Diabetes
    Information O from Your Family Doctor Nerve Pain in Diabetes What is nerve pain in diabetes? feeling in your feet and it affects your balance, Nerve pain with diabetes is called neuropathy there are special shoes that can help. (new-ROP-uh-thee). It is common in people with uncontrolled diabetes. It usually starts in What can I expect? the feet and may go up the legs. It may cause Medicine will lessen the pain for many patients, burning pain or a loss of feeling. but most will still have some pain. It is also important to wear proper fitting shoes. And, What causes it? every time you see the doctor, have the doctor Nerves are like wires that bring feeling to your check your feet for injuries you cannot feel. brain from other parts of the body. High blood sugar levels can damage those nerves. The Where can I get more information? longer you have high blood sugar, the more Your doctor likely you are to get nerve damage. The nerves AAFP’s Patient Education Resource in your feet are usually the first to be damaged. http://familydoctor.org/familydoctor/en/diseases- Nerves in other parts of the body can be conditions/diabetic-neuropathy.html damaged, too. American Diabetes Association http://www.diabetes.org/living-with-diabetes/ How do I know if I have it? complications/neuropathy/peripheral-neuropathy.html If you have nerve damage in your feet, you will National Institutes of Health and National Institute of notice pain or loss of feeling. Your doctor can Diabetes and Digestive and Kidney Diseases do tests to be sure that is what is causing the http://www.niddk.nih.gov/health-information/health- problem.
    [Show full text]
  • Blood Glucose Monitoring
    Blood Glucose Monitoring Many people are frightened to check their blood sugar levels because they do not want to see levels that are higher or lower than their target range. However, checking your blood sugars puts you in control of your diabetes. Remember, your blood sugar levels are what they are whether you know about them or not but when you know what they are; you can make adjustments, if needed. Monitoring your blood sugar levels is the most accurate way of you seeing the effectiveness of your lifestyle changes and medications. Monitoring provides you with the ability to identify possible causes of blood sugar fluctuations. Tips for Monitoring • Wash your hands with soap in warm water before checking your blood sugar • Ensure your test strips have not expired • Remember to calibrate your meter (if your meter requires this) • Use the sides of your fingers and remember to use different fingers o Do not use alternate site testing if you think your blood sugar is very high or low – finger checks give you the most accurate result • Discuss the with your healthcare team the best times to check your blood sugar level – which may include: o Prior to your meal and / or 2 hours after the meal o Overnight o If you feel unwell • Record your results in a logbook; this will help you to identify patterns in your levels and make the required changes to get your blood sugar back to your target range; bring your blood sugar records and meter(s) to your healthcare visit - it will help you and your healthcare team to determine your diabetes management needs.
    [Show full text]
  • Diabetes Management: Directory of Provider Resources (PDF)
    DIABETES MANAGEMENT: DIRECTORY OF PROVIDER RESOURCES 2 Diabetes Management: Directory of Provider Resources ACKNOWLEDGMENTS Diabetes Management: Directory of Provider Resources was prepared with input from National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases; Centers for Medicare & Medicaid Services Advisory Panel on Outreach and Education; NORC at the University of Chicago; Jamie Murkey, MPH, PhD, Program Alignment and Partner Engagement Group 2019 summer intern; Asian Services in Action – International Community Health Center; Chinatown Public Health Center; Colorado Coalition for the Homeless; Garden City Community Health Center, Genesis Family Health; Jackson Medical Mall and Jackson Hinds Comprehensive Health Center; Montefiore Medical Center; Nash Health Care Systems; Sun Life Family Health Center; and Bryan W. Whitfield Memorial Hospital, Tombigbee Healthcare Authority. 3 Diabetes Management: Directory of Provider Resources PURPOSE The purpose of this directory is to support providers and care teams by identifying resources on the management of type 2 diabetes. It is particularly suited for providers who work with Medicare beneficiaries and vulnerable populations for whom the prevalence of type 2 diabetes and diabetes complications is higher. This directory will help the care team identify resources to improve diabetes management by promoting medication adherence. This directory also aims to equip primary care teams with tools to manage diabetes and that patients with more complex needs are appropriately referred to specialists. While some patients require care from endocrinologists, primary care teams can effectively manage many patients with prediabetes and type 2 diabetes.i Other health professionals and patients can play an important role in facilitating medication management and other diabetes self-care behaviors.
    [Show full text]