From the Family and Community Medicine Department, Prince Sultan Riyadh Military Medical City, Saudi Arabia. Approximately three-fourths of patients with T2D receive their care in primary care settings [11]. We conducted an uncontrolled quasi-experimental intervention study with pre–post assessment.
The study was conducted at Al-Wazarat Health Care Center, a large family medicine center in Riyadh, Saudi Arabia,  that hosts 32 general clinics, specialized primary care clinics, a chronic diseases center, along with support services such as pharmacy, laboratory, and radiology. The study sample included male and female adult patients older than 18 years of age with T2D who receive their diabetic care at the chronic diseases clinic. In addition to the standard diabetic care as outlined by the ADA, the care provided includes patient-based strategies to improve care. The clinical pharmacist acts as the case manager and sees the enrolled patients on a weekly basis and follows up on adherence to the agreed upon plan. The diabetic educators see all patients who need insulin titration; their job is focused on checking the injection site and the insulin dose and technique. The main study outcomes were the post-intervention changes in the levels of HbA1c, fasting blood glucose (FBG), lipid profile, and blood pressure (BP). Patients’ demographic and clinical data were described as mean and standard deviation (SD) for continuous variables and frequency and percentages for categorical ones.
The pre- and post-intervention levels of the study outcomes were analyzed as averages, highest, and last values during the corresponding periods (Table 2).
Using the standard cut-points for controlled HbA1c, FBG, serum lipids, and BP in paired assessment of pre-post-intervention changes (Table 3), no statistically significant post-intervention improvements were revealed in any of the study outcomes. The correlations between patients’ age and number of visits with study outcomes (Table 4) were weak and nonsignificant. The failure to demonstrate a statistically significant improvement in glycemic control using the standard cut-off point (HbA1c ? 7%) may be explained by the considerably high pre-intervention levels of HbA1c (median of highest levels, 11.4%), in addition to the small number of studied patients. The improvements in HbA1c and other outcome indicators likely may be attributed to the various components of the integrated care program such as frequent clinic visits, frequent glycemic monitoring, reduced time waste before referral, improved adherence, and better education, which is in congruence with previous research [19].
According to the present study results, the patients with poor diabetic control associated with renal problems experienced no benefit from the program with regard to glycemic control.
Our integrated care program had a positive impact on lipid profile, particularly total cholesterol and triglycerides. We examined the effect of an integrated care program on multiple outcomes including glycemic control and cardiovascular risk factors, studying the effect on both continuous and categorical forms of outcomes of interest, and detecting the variability in glycemic control among different patient groups. Diabetes chart- convert hba1c to equivalent blood glucose, Free printable charts and tools to better understand, track and manage your blood glucose.. A1c chart, Another difference between different diabetes testing strips is that completely different strips need different amounts of blood to browse your blood glucose levels.. A1c chart: understanding the ac1 test, A brief, yet informative article explaining the a1c test, the a1c chart and how they are used in diagnosing, managing and treating patients with diabetes. A1c chart & calculator using the dcct formula, A1c chart has a1c to bs conversion using dcct formula. A1c and average blood glucose conversion – blood sugar 101, The 2007 adag formula used in this calculator is based on cgms measurements. Printable diabetic blood sugar chart - beating, Get printable diabetic blood sugar chart get printable diabetic blood sugar chart (excel sheet) get blood sugar chart with excel chart.
Blood glucose levels: high blood sugar levels chart, A scientific study on blood glucose levels and surgery has shown that a higher than usual blood sugar level that is maintained for a certain period of time can lead. Chart blood sugar levels – beating diabetes, Chart blood sugar levels chart sugar levels control diabetes? Blood sugar - wikipedia, free encyclopedia, The blood sugar concentration blood glucose level amount glucose (sugar) present blood human animal. In Saudi Arabia, its prevalence rate among adults (20% to 27%) is about 3 times the worldwide rate (8.3%) [1,2].
Pre-intervention data were assessed by retrospectively reviewing patient charts for at least 2 visits before starting the integrated care program. All diabetic patients in our center are followed according to the American Diabetes Association (ADA) guidelines. The team includes a senior family physician, nurse, clinical pharmacist specialist, dietician, diabetic educator, health educator and social worker. These include but are not limited to providing more clinic visits, frequent monitoring of outcomes, improving interdisciplinary communication and coordination, providing additional diabetic education and dietetic advice, encouraging medication adherence, assessing the efficacy of treatment and the need for insulin titration, promoting self-management, sending patient’s reminder and making telephone calls, and providing social support [14,15,19,20]. The health educator and dietician see patients at least once a year unless they need specific education. They were between 26 and 85 years of age, with slightly more than half younger than 60 years and female (58.5%) (Table 1). Irrespective of the value used, the levels of HbA1c and FBG were significantly lower in the post-intervention stage compared with the pre-intervention stage.


However, when considering the cutoff point for HbA1c ? 8% rather than ? 7%, a statistically significant post-intervention improvement was observed, with 14 uncontrolled patients (34%) in the pre-intervention stage becoming controlled in the post-intervention stage (P = 0.001). On the other hand, the number of visits was negatively correlated with all outcomes except HDL cholesterol and body weight. Actually, the current study findings point to a trend of negative correlations between the number of visits and all outcomes, except HDL and body weight. This may be explained by the difficulty to improve glycemic control in patients with renal disease even after implementation of multidisciplinary care program [26]. The findings are in congruence with previous studies that reported control of total and LDL cholesterol [17,18]. The finding is in agreement with the results of similar multidisciplinary care programs which failed to demonstrate any significant changes in the percentage of those having controlled BP [18] or in absolute reductions in BP [17]. We acknowledge the limitations of the uncontrolled quasi-experimental design with associated bias, and the small sample size with low power to detect some of the outcomes. Al Khashan, SBFM, ABFM, MSc, Hala Al-Qahtani, MD, Adel Mishriky, MD, PhD, Ahmed Bakhiet, FRCGP, FRCP, and Noura A.
The team included a senior family physician, nurse, clinical pharmacist specialist, dietician, diabetic educator, health educator, and social worker.
Type 2 diabetes (T2D) is associated with serious complications that are associated with high morbidity and mortality, and consequently high rates of health care utilization. Single-physician approaches, infrequent visits, inadequate adherence to medication, and insufficient patient education and support are some of the challenges facing the timely management and intensification of complex diabetic care [12,13]. Post-intervention data were assessed by prospectively following the patients for at least 2 visits after joining the integrated care program (for a maximum 6 months). The team meets once or twice weekly to review the cases of uncontrolled patients to be enrolled in the program and to assess and improve the care for those already enrolled.
The implementation of the program did not require additional staff but more working hours of the present staff and more efficient use of time through time management. The case manager is also involved in managing hypoglycemia, distinguishing between true or pseudo-hypoglycemia, monitoring drug side effects, as well as ordering liver and renal function tests and referring the patient to other members of the integrated care team as needed. Moreover, each case is frequently reviewed by the manager of the center to ensure the smooth functioning of the plan agreed upon.
The majority (61.0%) of the patients were enrolled in the program because of uncontrolled diabetes without comorbidities.
Decreases in the levels of HbA1c, FBG, triglycerides, and total cholesterol were statistically significant. Although using a different multidisciplinary approach and study design, similar improvements in glycemic control were reported in several studies at primary care settings. This could be considered an indication of success since small reductions still have positive impacts on the risk of complications.
However, all these correlations, except with the level of triglycerides, are not statistically significant, probably due to the small sample size. However, this finding should be interpreted cautiously due to the small size of the studied group. However, when using ADA targets, none of these improvements reached statistical significance. In view of the study limitations, we recommend a large multicenter controlled intervention trial with longer follow-up to confirm the findings.
National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: meta-analysis of randomised controlled trials.
Evidence of suboptimal management of cardiovascular risk in patients with type 2 diabetes mellitus and symptomatic atherosclerosis.
Assessment of care for type 2 diabetic patients at the primary care clinics of a referral hospital.
The use of a multidisciplinary team care approach to improve glycemic control and quality of life by the prevention of complications among diabetic patients. Interdisciplinary team care for diabetic patients by primary care physicians, advanced practice nurses, and clinical pharmacists. Implementation and methodology of a multidisciplinary disease-state-management program for comprehensive diabetes care. The effectiveness of nurse- and pharmacist-directed care in diabetes disease management: a narrative review.


Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: a prospective, randomized study. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial.
Type 2 diabetes care and insulin intensification: is a more multidisciplinary approach needed?
Multidisciplinary care plans and diabetes–benefits for patients with poor glycaemic control.
Outcomes measured were HbA1c, fasting blood glucose (FBG), lipid profile, and blood pressure (BP). Cardiovascular diseases are 2 to 4 times more common among diabetic patients and are the largest contributor to health care utilization and related costs among this patient group [3]. A multidisciplinary rather than single-physician care approach has been suggested to overcome these challenges [14,15].
Patients had to have  at least 2 clinic visits before the start of the program (checked from the center registry system within the 12 months preceding the enrollment date) and provide informed consent to participate in the program. The case manager is also responsible for solving any problems or obstacles that can affect the implementation of the plan through coordination with the manager of the center. The median number of visits during the intervention was 13, with a wide range of 6 to 26 visits. These include clinical trials [16,21] and quality improvement observational projects [17,18]. Additionally, dynamic tailoring of the care components in response to patient’s need may have contributed to improved glycemic control. Moreover, it points to the importance of developing and testing additional interventions to deal with these patients. This may be attributed to the high percentages of patients with controlled cholesterol before the program, which was as high as 87% for total cholesterol. Although our program team had a clinical pharmacist, no such improvement was noticed, and this might be due to more endeavor given to glycemic control. There is compelling evidence that intensive glycemic control [4,5] as well as control of associated risk factors such as hypertension and dyslipidemia [5–7] can effectively delay the onset and slow the progression of cardiovascular complications among diabetic patients. Patients were referred to the integrated care program by the treating physician based on eligibility criteria. Pearson correlation tests were applied between patient’s age and the number of clinic visits with the changes in study outcomes. The levels of total cholesterol, LDL, and triglycerides also demonstrated some decreases at the post-intervention stage. This is the same increase in the percentage of patients with HbA1c ? 7% (from 28% to 40%) after implementation of a similar multidisciplinary care program by Zwar and coauthors [17]. Moreover, the presence of a clinical pharmacist in the team may have improved insulin intensification, which is rarely tackled by primary care physicians [23,24]. HDL cholesterol and BP did not show any significant changes in the post-intervention stage.
However, despite the availability of convincing evidence and clear guidelines [8], the control of cardiovascular risk factors among patients with T2D is still suboptimal [9,10].
Moreover, its implementation was successful in improving diabetic care in primary care settings [17,18]. The changes in HbA1c levels among patients with different diagnostic categories were compared using Kruskal-Wallis test. However, only the difference in the mean of total cholesterol reached statistical significance (P = 0.029).
This gains importance from the evidence that minor reductions in HbA1c are associated with major reductions in cardiovascular complications and mortality among patients with T2D. However, the current design does not allow any inference on causal relationships between these components and the improved glycemic control, which is one of the study limitations. Meanwhile, the HDL cholesterol did not benefit by the integrated care program, which was expected since exercise and lifestyle changes are needed over a long period of time.
The aim of our study was to evaluate the impact of an integrated, multidisciplinary diabetic care program on glycated hemoglobin (HbA1c), lipid profile, and blood pressure among patients with uncontrolled T2D with or without comorbidity attending the chronic disease clinics at a large primary care center. Concerning the level of HDL cholesterol, the mean level decreased at the post-intervention stage (P = 0.035), but the highest and the last levels did not show any change of statistical significance.
Thus, a 1% reduction of HbA1c is associated with a 37% reduction in microvascular complications, 14% reduction in myocardial infarction, and a 21% reduction in diabetes-related mortality [22].



Normal sugar level 6 8x8
Diabetes blood testing supplies 4u
What does low blood sugar level indicate ovulation
Diabetes sugar level hindi 720p


Comments

  1. 14.06.2014 at 19:37:55


    Mean that such a person will continue the unhealthy lifestyle of eating with gestational.

    Author: Nikotini
  2. 14.06.2014 at 14:26:36


    The most common way your medication or insulin or possibly the timing of when.

    Author: Baban_Qurban
  3. 14.06.2014 at 16:22:47


    Back to normal as in 80-120, your body which lower the spike in blood.

    Author: Dont_Danger
  4. 14.06.2014 at 22:43:21


    Not as accurate as blood testing in a laboratory receive subsequent screening for.

    Author: RamaniLi_QaQaS