scholarly journals Az inzulinkezelés elkezdésének gyakorlati akadályai 2-es típusú cukorbetegekben – a „pszichológiai inzulinrezisztencia” leküzdése

2019 ◽  
Vol 160 (3) ◽  
pp. 93-97
Author(s):  
Olivér Rácz ◽  
Marcela Linková ◽  
Krzysztof Jakubowski ◽  
Robert Link ◽  
Daniela Kuzmová
Keyword(s):  
Type 2 Diabetes ◽  
Health Care Providers ◽  
Insulin Treatment ◽  
Clinical Inertia ◽  
Diabetic Patients ◽  
Care Providers ◽  
Type 2 Diabetic Patients ◽  
Mutual Cooperation ◽  
Endogenous Insulin

Abstract: Type 2 diabetes is a progressive disease and its consequence is the gradual decrease of endogenous insulin secretion to a very low level. Beyond this point, without insulin it is not possible to achieve proper metabolic compensation. The authors are trying to explain why the insulin therapy is often delayed in type 2 diabetic patients despite existing guidelines about its initiation and continuation. The causes of delay can be divided into two groups. One is the fear and disagreement of the patients (psychological insulin resistance – PIR) arising from different cognitive, emotional and other reasons. The second is the “clinical inertia”, when the physicians are not able to explain in an effective and persuasive way the rationale and necessity of insulin treatment to their patients. The common background of both causes is the lack of sufficient knowledge about the pathogenesis of type 2 diabetes and the rationale of insulin treatment together with an insufficient level of communication between doctor and patient. The authors see the solution in the improvement of pre- and postgradual education of doctors and other health care providers (nurses, educators, psychologists), in their mutual cooperation and the translation of their knowledge towards a system of successful patient education. Orv Hetil. 2019; 160(3): 93–97.

The Relationships among the Organizational Factors of a Tertiary Healthcare Center for Type 2 Diabetic Patients in Palestine

2020 ◽  
Vol 20 ◽  
Author(s):  
Rami Mosleh ◽  
Mohammed Hawash ◽  
Yazun Jarrar
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care Providers ◽  
Organizational Factors ◽  
Patient Characteristics ◽  
Diabetic Patients ◽  
Care Providers ◽  
Type 2 Diabetic Patients ◽  
Cross Sectional

Background: Diabetes prevalence at Palestine was 10%, with a rising fund crisis, and diabetes healthcare problems. There was a limited research concerning diabetes healthcare dimensions including organizational factors and their predictors. Objectives: This study described patient characteristics and organizational factors, and assessed relationships among organizational factors of type 2 diabetes health care in Palestine. Methods: This study is retrospective cross sectional, recruited by convenience sampling method in 330 participants from a type 2 diabetes patients list. It was carried out at Ramallah, Palestine. The Statistical Package for Social Sciences (SPSS v 19) was used to analyze data on patient characteristics and organizational factors collected from personal interview and medical records review. Results: The results showed that 51.2% were males, and 88.5% had additional chronic diseases. Preventive healthcare and patient–healthcare professionals’ relationship were the most prominent organizational factors in statistically significant relationships among organizational factors. Conclusion: This study reflected the need for reviewing prescription mode, and educational programs that emphasize the diabetes self–care management and the health care providers’ role that would be of great benefit in health outcomes further.

scholarly journals Attitude and Compliance with the Onset of Insulin Therapy in Patients with Type 2 Diabetes

2020 ◽  
Vol 21 (6) ◽  
Author(s):  
Zahra Davoudi ◽  
Arezoo Chouhdari ◽  
Mahshid Mir ◽  
Fatemeh Akbarian
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Health Care Providers ◽  
Insulin Injection ◽  
Diabetic Patients ◽  
Care Providers ◽  
Type 2 Diabetic Patients ◽  
Negative Attitudes ◽  
Type 2 Diabetic

Background: Insulin therapy refusal among type 2 diabetic patients is most challenging for healthcare providers. Objectives: This study aimed to evaluate the type 2 diabetic patients’ attitude and compliance with the initiation of insulin therapy. Methods: A cross-sectional study was conducted on 100 type 2 diabetic patients at the Endocrinology Clinic of Loghman Hakim Hospital, Tehran, Iran. A questionnaire was prepared to assess the attitudes toward the onset of insulin therapy. Positive and negative attitudes toward insulin injection were compared between the two groups of accepting and rejecting insulin therapy. Results: In this study, 62% of patients with type 2 diabetes tended to start insulin therapy. There was a statistical difference between the total positive and negative attitude items toward insulin therapy (agree/disagree) and acceptance of insulin therapy (P < 0.05). The most agreements related to a positive attitude in the two groups of accepting and rejecting insulin therapy belonged to statements “Insulin injection prevents complications of diabetes (micro and macrovascular)” as 100% (P < 0.001) and “Insulin injection helps improve my diabetes” as 96.8% (P < 0.001). The most agreements related to negative attitudes in the two groups of accepting and rejecting insulin therapy belonged to statements “Insulin injection causes my dependence on it” as 72.6% (P = 0.001) and “I can control my diabetes with oral medication and diet without insulin injection” as 97.4% (P < 0.001). Conclusions: As 38% of patients with type 2 diabetes refused to initiate insulin therapy, it seems that effective communication between physicians and patients and continuous follow-ups by health care providers can increase positive attitudes toward insulin injection.

scholarly journals Effect of insulin treatment on pulsatility ratio and resistance index of the retinal artery in patients with type 2 diabetes

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254980
Author(s):  
Tsuneaki Omae ◽  
Youngseok Song ◽  
Takafumi Yoshioka ◽  
Tomofumi Tani ◽  
Akitoshi Yoshida
Keyword(s):  
Type 2 Diabetes ◽  
Blood Flow ◽  
Insulin Treatment ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Significant Difference ◽  
Retinal Artery ◽  
Type 2 Diabetic

This study aimed to evaluate whether long-term insulin treatment is associated with abnormalities in retinal circulation in type 2 diabetic patients. We evaluated 19 eyes of nondiabetic individuals and 68 eyes of type 2 diabetic patients. The eyes of diabetic patients were classified into two groups according to the presence or absence of long-term insulin therapy. We used a Doppler optical coherence tomography flowmeter to measure diameter, velocity, and blood flow in the major temporal retinal artery. The pulsatility ratio (PR) and resistance index (RI), indices of vascular rigidity, were calculated from the blood velocity profile. PR and RI were significantly elevated in type 2 diabetic patients compared with nondiabetic subjects (P < 0.05). In type 2 diabetes patients, PR and RI were significantly higher in patients receiving long-term insulin treatment than in those without (P < 0.01). There was a significant difference in velocity (P < 0.05), but not diameter and blood flow, between nondiabetic subjects and type 2 diabetes patients. No significant difference in diameter, velocity, or blood flow was observed between the groups with and without long-term insulin treatment. Long-term insulin treatment can affect PR and RI, which might be associated with vascular rigidity of the retinal artery in patients with type 2 diabetes.

scholarly journals Prevalence and determinants of psychological insulin resistance among type 2 diabetic patients in Kinshasa, Democratic Republic of Congo

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Shomba L. Rita ◽  
Fina J.-P. Lubaki ◽  
Lepira F. Bompeka ◽  
Gboyega A. Ogunbanjo ◽  
Lukanu P. Ngwala
Keyword(s):  
Insulin Resistance ◽  
Health Care Providers ◽  
Negative Impact ◽  
Therapeutic Education ◽  
Diabetic Patients ◽  
Care Providers ◽  
Type 2 Diabetic Patients ◽  
Female Ratio ◽  
Type 2 Diabetic

Background: Psychological insulin resistance (PIR) is a common but unappreciated phenomenon by health care providers with a negative impact on the control of type 2 diabetes mellitus.Aim: To determine the frequency of PIR and its determinants in patients with type 2 diabetes.Setting: This study was conducted in Kinshasa in three health centres providing management of diabetic patients.Methods: This study was a multicentric, cross-sectional study conducted from 01 November 2017 to 31 March 2018 in Kinshasa among 213 type 2 diabetic patients who were taking oral anti-diabetic drugs. A standardised questionnaire, the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ), was used for data collection.Results: The average age of participants was 59.8 ± 11.1 years with a male to female ratio of 1.5. The prevalence of PIR was 42.7%; and its main determinants were 50 years of age (odds ratios [OR] adjusted 2.05; 95% confidence interval [CI] 1.98–4.27; p = 0.045), the presence of complications (OR adjusted 3.33; 95% CI 1.68–6.60; p = 0.001), lack of knowledge about insulin therapy (OR adjusted 1.96; 95% CI 1.03–3.71; p = 0.040) and the high cost of insulin (OR adjusted 2.32; 95% CI 1.08–4.95; p = 0.030).Conclusion: The study showed that almost half of type 2 diabetic patients had PIR with the main determinant factors related to the patient and the health system. The establishment of a therapeutic education programme, improved ‘provider–patient’ communication and the development of approaches to increase access to drugs are crucial to reduce the prevalence of PIR.

scholarly journals Factors associated with therapeutic non-compliance among type 2 diabetes mellitus patients in Chidambaram, Tamilnadu, India

2017 ◽  
Vol 4 (3) ◽  
pp. 787 ◽  
Author(s):  
Manobharathi M. ◽  
Kalyani P. ◽  
John William Felix A. ◽  
Arulmani A.
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Health Care Providers ◽  
Compliance Rate ◽  
Health Centre ◽  
Diabetic Patients ◽  
Care Providers ◽  
Factors Associated

Background: Diabetes mellitus is one of the most common non-communicable diseases causing many serious complications worldwide. Therapeutic non-compliance leads to treatment failure thus making diabetes a serious problem to both the individuals and the health care providers. There are many factors which influence patient’s compliance. The aim of this study is to assess the frequency of therapeutic compliance and factors associated with therapeutic non-compliance.Methods: A descriptive cross-sectional study was conducted among type 2 diabetes mellitus patients attending the urban health centre, Chidambaram.  Compliance and factors associated with non-compliance were assessed using Morisky Medication adherence questionnaire.Results: 108 diabetic patients were enrolled. The overall compliance rate was found to be 39.8%. A statistically significant association was found between non-compliance and associated chronic diseases (p=0.007), financial problems to buy the medicines (p=0.001), reporting side effects with the prescribed medicines (p=0.049), missed at least one dose in last one week(p=0.01).Conclusions: Majority of the patients were non-compliant. This emphasizes the need of strengthening health system and improving patients knowledge through teaching programs.

scholarly journals Influence of the dynamics of body weight on the risk factors of cardiovascular disease in patients with type 2 diabetes during the first year of insulin treatment

2013 ◽  
Vol 10 (1) ◽  
pp. 22-25
Author(s):  
T S Dzhavakhishvili ◽  
T I Romantsova ◽  
O V Roik
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Insulin Treatment ◽  
Insulin Analogues ◽  
First Year ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

The aim of the present study was to investigate whether insulin treatment-induced weight gain had an adverse impact on cardiovascular risk factors in insulin-treated type 2 diabetic patients during the first year after initiating insulin therapy when insulin analogues or human insulins are used. A total of 157 patients with newly insulinized type 2 diabetes were included in the study. The patients were divided in two groups. First group consisted of subjects (mean age 57 [45; 73], duration of diabetes of 10 years [4; 16]) who had received long-acting basal (glargine, detemir), premixed (biphasic insulin aspart 30, Humalog Mix 25) or short-acting (aspart, lispro) insulin analogues. Patients from second group (mean age 59 [46; 75], duration of diabetes of 10 years [5; 15]) were treated with intermediate-acting basal (Protophane, Humulin NPH insulin), premixed (biphasic human insulin 30, Humulin M3) and regular (Actrapid, Humulin R) human insulins. Our study has shown that insulin-induced weight gain may not adversely affect cardiovascular risk factors, particularly, lipid profile, in insulin-treated type 2 diabetic patients during the first year after initiating insulin therapy. Use of insulin analogues for treatment of type 2 diabetes patients results in better glycaemic control, significant declines in blood lipid concentrations, less increase in waist circumference compared with human insulins during the first year after initiating insulin therapy.

scholarly journals Assessment of Ramadan Education and Knowledge Among Diabetic Patients

2018 ◽  
Vol 11 ◽  
pp. 117955141775161 ◽  
Author(s):  
Mussa Hussain Almalki ◽  
Ibtihal Hussen ◽  
Shawana A. Khan ◽  
Abdulrahman Almaghamsi ◽  
Fahad Alshahrani
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Health Care Providers ◽  
Diabetes Management ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Care Providers ◽  
Cross Sectional

Background: During Ramadan, Muslims fast from dawn until dusk for one lunar month every year. Most of the Muslim patients with diabetes are unaware of the potential complications that can occur while fasting, such as hypoglycemia. The aim of this study is to assess the the patient education level and patients’ overall awareness of any possible complications that could occur while fasting during Ramadan and to determine how these patients deal with these complications. Methods: We conducted a cross-sectional study and surveyed diabetic patients about their diabetes-related knowledge over a period of 4 months from the outpatient clinic at the Obesity, Endocrine, and Metabolism Center at King Fahad Medical City. Patients were included if they were ≥16 years and if they had been receiving treatment for at least 1 year before the study, irrespective of the medications used; patients were also asked about the presence or absence of complications. Results: This study included 477 patients (325 women and 152 men). Most patients (297; 62.3%) had type 2 diabetes. The patients’ mean age was 39.72 ± 15.29 years, and the mean duration of diabetes was 10.80 ± 5.88 years. During the preceding Ramadan, 76% of patients reported fasting, whereas 58% said that they monitored their blood glucose levels once per day. Hypoglycemic episodes were reported in 60.3% of cases with type 2 diabetes and in 8.3% of cases with type 1 diabetes. Among those who had hypoglycemia, 2.8% of patients with type 1 diabetes and 17.8% with type 2 diabetes broke their fast. Finally, 54% of patients reported that their health care providers offered them instructions on diabetes management during Ramadan. Conclusions: Ramadan health education in diabetes can encourage, improve, and guide patients to change their lifestyles during Ramadan while minimizing the risk of acute complications.

scholarly journals 1407Erectile dysfunction among type 2 diabetes patients and its correlates

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Vignesh Viswanath Shanmugasundaram
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Health Care Providers ◽  
Erectile Function ◽  
Demographic Factors ◽  
Lifestyle Changes ◽  
Diabetic Patients ◽  
Care Providers ◽  
Duration Of Diabetes

Abstract Background Erectile Dysfunction (ED), is a common complication in type 2 diabetic men. Present study was undertaken to investigate the association between demographic factors, metabolic parameters and medication use with ED among type 2 diabetics. Methods This was a cross-sectional study. Married men aged 20-60 years with a diagnosis of type 2 diabetes attending the outpatient unit of Department of Endocrinology at PSG Hospitals during the months of May and June 2019 were enrolled. The severity of erectile function was assessed using the validated International Index of Erectile Function (IIEF-5) questionnaire. All subjects were evaluated based on demographic factors, clinical parameters and medications used. Results Out of the 204 patients enrolled, 65 (31.86%) were found to have ED. ED was significantly associated with patients who were having less physical activity, hypertension, obesity and diabetic retinopathy. A significant increase in the prevalence of ED with duration of diabetes was observed. In patients with diabetes, for 1-5, 6-10 and 11-30 years, the prevalence was 24.1%, 27.7% and 53.1% respectively. Conclusions For type 2 diabetes, increasing duration of diabetes poses a greater risk for ED. Hypertension, less physical activity and some medications increase the prevalence of ED. Key messages Our results suggest that health care providers who address sexual dysfunction issues with their diabetic patients early may be able to reduce the severity or delay the onset of ED by implementing intensive lifestyle changes as the first step management for type 2 diabetes.

The Effect of Insulin Treatment on the Balance between Tissue Plasminogen Activator and Plasminogen Activator Inhibitor-1 in Type 2 Diabetic Patients

1992 ◽  
Vol 68 (03) ◽  
pp. 253-256 ◽  
Author(s):  
Thomas Vukovich ◽  
Sylvia Proidl ◽  
Paul Knöbl ◽  
Harald Teufelsbauer ◽  
Christoph Schnack ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Insulin Treatment ◽  
Plasminogen Activator Inhibitor ◽  
Diabetic Patients ◽  
Plasminogen Activator Inhibitor 1 ◽  
Type 2 Diabetic Patients ◽  
Glycemic Regulation ◽  
Type 2 Diabetic ◽  
Pai 1

SummaryBeside hypercoagulation and hyperactivated platelets disturbances of the fibrinolytic system towards hypofibrinolysis have been reported to be associated with both glycemic and lipidemic derangement in diabetic patients. In the present prospective follow-up study the effect of 16 weeks insulin treatment and glycemic regulation on plasma levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1), the main regulators of fibrinolysis, was investigated in 19 type-2 diabetic patients with secondary failure to sulphonylureas. A similar glycemic regulation was obtained in a control group of 10 type 2 diabetic patients with sufficient metabolic response to strict dietary treatment and continuation of sulphonylurea treatment. Compared to 27 healthy subjects levels of tPA and PAI-1 were not significantly increased in type 2 diabetic patients before metabolic intervention. Although a hypofibrinolytic state due to an increase of PAI-1 levels was previously reported in obese hyperinsulinemic patients, no effect of insulin treatment on both tPA- and PAI-1 levels was observed in the present study including patients with only slightly increased body mass index (median 26.0 kg/m2). By correlation analysis PAI-1 levels were significantly related to serum cholesterol (R = 0.52) and glycemic control (glucose R = 0.41) in the whole group of diabetic patients at entry and in both subgroups after 16 weeks of treatment (insulin group: cholesterol R = 0.46, HbA1c R = 0.51; sulphonylurea group: cholesterol R = 0.59, HbA1c R = 0.58). In healthy subjects tPA and PAI-1 was correlated to serum insulin (R = 0.54, R = 0.56) and triglycerides (R = 0.46, R = 0.40). In conclusion, our results indicate that insulin treatment associated with metabolic improvement has no adverse effect to fibrinolysis in type 2 diabetic patients.

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