Important Considerations for Clinical Decision Making: Renal Impairment in Patients with Type 2 Diabetes

2013 ◽  
Vol 19 (Supplement 1) ◽  
pp. 7-7
Author(s):  
Jaime Davidson
Keyword(s):  
Type 2 Diabetes ◽  
Decision Making ◽  
Renal Impairment ◽  
Clinical Decision Making ◽  
Clinical Decision

Virtual Simulation Improves Clinical Decision-Making in Managing Type 2 Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 688-P ◽  
Author(s):  
AMY LARKIN ◽  
KELLY L. HANLEY ◽  
MARTIN WARTERS ◽  
GWEN S. LITTMAN
Keyword(s):  
Type 2 Diabetes ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Virtual Simulation

scholarly journals Point-of-care HbA1c testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045511
Author(s):  
Jennifer A Hirst ◽  
Kirsten Bobrow ◽  
Andrew Farmer ◽  
Jennie Morgan ◽  
Naomi Levitt
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Decision Making ◽  
Blood Glucose ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Glucose Testing

IntroductionMonitoring and treatment of type 2 diabetes in South Africa usually takes place in primary care using random blood glucose testing to guide treatment decisions. This study explored the feasibility of using point-of-care haemoglobin A1c (HbA1c) testing in addition to glucose testing in a busy primary care clinic in Cape Town, South Africa.Subjects185 adults aged 19–88 years with type 2 diabetes.Materials and methodsParticipants recruited to this mixed methods cohort study received a point-of-care HbA1c test. Doctors were asked to use the point-of-care HbA1c result for clinical decision-making. Qualitative interviews were held with clinical staff.ResultsPoint-of-care HbA1c test results were obtained for 165 participants of whom 109 (65%) had poor glycaemic control (>8% HbA1c, 64 mmol/mol). Medical officers reported using a combination of HbA1c and blood glucose 77% of the time for clinical decision-making. Nurses found the analyser easy to use and doctors valued having the HbA1c result to help with decision-making.DiscussionOur results suggest that 30% of patients may have received inappropriate medication or not received necessary additional medication if random blood glucose alone had been used in routine appointments. Clinicians valued having access to the HbA1c test result to help them make treatment decisions.

scholarly journals Association of low fasting C-peptide levels with cardiovascular risk, visit-to-visit glucose variation and severe hypoglycemia in the Veterans Affairs Diabetes Trial (VADT)

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Juraj Koska ◽  
Daniel S. Nuyujukian ◽  
Gideon D. Bahn ◽  
Jin J. Zhou ◽  
Peter D. Reaven
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Decision Making ◽  
Severe Hypoglycemia ◽  
Clinical Decision ◽  
Veterans Affairs ◽  
Cvd Risk ◽  
C Peptide ◽  
Increased Risk ◽  
Control Patterns

Abstract Aims Low C-peptide levels, indicating beta-cell dysfunction, are associated with increased within-day glucose variation and hypoglycemia. In advanced type 2 diabetes, severe hypoglycemia and increased glucose variation predict cardiovascular (CVD) risk. The present study examined the association between C-peptide levels and CVD risk and whether it can be explained by visit-to-visit glucose variation and severe hypoglycemia. Materials and methods Fasting C-peptide levels at baseline, composite CVD outcome, severe hypoglycemia, and visit-to-visit fasting glucose coefficient of variation (CV) and average real variability (ARV) were assessed in 1565 Veterans Affairs Diabetes Trial participants. Results There was a U-shaped relationship between C-peptide and CVD risk with increased risk with declining levels in the low range (< 0.50 nmol/l, HR 1.30 [95%CI 1.05–1.60], p = 0.02) and with rising levels in the high range (> 1.23 nmol/l, 1.27 [1.00–1.63], p = 0.05). C-peptide levels were inversely associated with the risk of severe hypoglycemia (OR 0.68 [0.60–0.77]) and visit-to-visit glucose variation (CV, standardized beta-estimate − 0.12 [SE 0.01]; ARV, − 0.10 [0.01]) (p < 0.0001 all). The association of low C-peptide levels with CVD risk was independent of cardiometabolic risk factors (1.48 [1.17–1.87, p = 0.001) and remained associated with CVD when tested in the same model with severe hypoglycemia and glucose CV. Conclusions Low C-peptide levels were associated with increased CVD risk in advanced type 2 diabetes. The association was independent of increases in glucose variation or severe hypoglycemia. C-peptide levels may predict future glucose control patterns and CVD risk, and identify phenotypes influencing clinical decision making in advanced type 2 diabetes.

scholarly journals Association of Low Fasting C-Peptide Levels With Cardiovascular Risk, Visit-To-Visit Glucose Variation and Severe Hypoglycemia in The Veterans Affairs Diabetes Trial (VADT)

2021 ◽  
Author(s):  
Juraj Koska ◽  
Daniel S. Nuyujukian ◽  
Gideon Bahn ◽  
Jin J. Zhou ◽  
Peter D. Reaven
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Decision Making ◽  
Severe Hypoglycemia ◽  
Clinical Decision ◽  
Veterans Affairs ◽  
Cvd Risk ◽  
C Peptide ◽  
Increased Risk ◽  
Control Patterns

Abstract Aims Low C-peptide levels, indicating beta-cell dysfunction, are associated with increased within-day glucose variation and hypoglycemia. In advanced type 2 diabetes, severe hypoglycemia and increased glucose variation predict cardiovascular (CVD) risk. The present study examined the association between C-peptide levels and CVD risk and whether it can be explained by visit-to-visit glucose variation and severe hypoglycemia. Materials and Methods Fasting C-peptide levels at baseline, composite CVD outcome, severe hypoglycemia, and visit-to-visit fasting glucose coefficient of variation (CV) and average real variability (ARV) were assessed in 1565 Veterans Affairs Diabetes Trial participants. Results There was a U-shaped relationship between C-peptide and CVD risk with increased risk with declining levels in the low range (<0.50 nmol/l, HR 1.30 [95%CI 1.05-1.60], p=0.02) and with rising levels in the high range (>1.23 nmol/l, 1.27 [1.00-1.63], p=0.05). C-peptide levels were inversely associated with the risk of severe hypoglycemia (OR 0.68 [0.60-0.77]) and visit-to-visit glucose variation (CV, standardized beta-estimate -0.12 [SE 0.01]; ARV, -0.10 [0.01]) (p<0.0001 all). The association of low C-peptide levels with CVD risk was independent of cardiometabolic risk factors (1.48 [1.17-1.87, p=0.001) and remained associated with CVD when tested in the same model with severe hypoglycemia and glucose CV. Conclusions Low C-peptide levels were associated with increased CVD risk in advanced type 2 diabetes. The association was independent of increases in glucose variation or severe hypoglycemia. C-peptide levels may predict future glucose control patterns and CVD risk, and identify phenotypes influencing clinical decision making in advanced type 2 diabetes.

scholarly journals Glycated albumin is correlated with glycated hemoglobin in type 2 diabetes

2019 ◽  
Author(s):  
Dana Mihaela Ciobanu ◽  
Florina Bogdan ◽  
Cristina-Ioana Pătruț ◽  
Gabriela Roman
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Clinical Decision Making ◽  
Glycated Hemoglobin ◽  
Glycated Albumin ◽  
Clinical Decision ◽  
Adult Type ◽  
Fasting Glycemia ◽  
Clinical Centre

Background and aims. Glycated hemoglobin (HbA1c) retrospectively evaluates mean glycemia in the preceding 2-3 months and is the gold standard for assessing glycemic control, while glycated albumin (GA) is currently considered a short to intermediate term integrated glycemic control marker, since it reflects glycemic status over the last 3 weeks. We aimed to investigate the levels of GA, HbA1c and fasting glycemia in a group of patients with type 2 diabetes. Methods. The observational study included adult type 2 diabetes patients (n=135) according to inclusion and exclusion criteria, randomly selected from Clinical Centre of Diabetes, Cluj-Napoca, Romania. Fasting glycemia, GA, HbA1c and creatinine were measured using commercially available methods.  Results. Of the whole group, 62 (45.9 %) were men. Mean age was 62.1±8.6 years old, body mass index was 31.8±6.1 kg/m2 and diabetes duration was 10.0 (4.0; 15.0) years. Fasting glycemia was 162±13.7 mg/dl, GA was 28.0 (21.0; 40.0)% and HbA1c 8.9±2.3%. We found GA was significantly correlated with HbA1c (r=0.19; p=0.029) and fasting glycemia (r=0.32; p<0.001), while HbA1c was significantly correlated with fasting glycemia (r=0.40; p<0.001). Conclusions. GA was significantly correlated with both HbA1c and fasting glycemia in our patients with type 2 diabetes. While HbA1c is recognized as being the reference test for diabetes control monitoring, GA might a useful biomarker for assessing short to intermediate term glycemic control, particularly important in situations when HbA1c test cannot be reliable or earlier clinical decision making is mandatory.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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