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تعداد مقالات یافته شده: 62
ردیف عنوان نوع
1 Knowledge and behavior changes in clinician after training of partnership for Diabetes Control in Indonesia
دانش و رفتار تغییرات در پزشک پس از آموزش مشارکت برای کنترل دیابت در اندونزی-2021
Background and aims: One of the main determinants of successful diabetes management is the quality of healthcare provider including general practitioner and internist which can be increased through medical training. This study aimed to describe the changes of clinician’s knowledge and behavior of comprehensive diabetes management training program around Indonesia. Method: We conducted a three-day training program for general practitioners and internists for 3.5 years, 2013 to 2016. All clinicians invited as voluntary participant to send their patient data from medical record. Each participant was expected to submit a minimum of 25 type 2 diabetes (T2DM) set patient data before and 6 months after training program to analyze the impact of program in physician knowledge and behavior related to diabetes management. Result: 120 of 489 voluntary participants submitted completed baseline data with 4676 patient data. Meanwhile, only 32 participants that submitted completed data of 6 months before after training with 886 patient data. Most of parameters were improve before and after program. The greatest and lowest improvement were on A1c measurement (21%) and smoking assessment (2%). Conclusion: Intensive seminar and training was not enough to empower diabetes management. This research might push the creation of clinical practice program that were tailored to each care facilities and integrated within routine care aimed at continual improvement of its healthcare worker.
keywords: آموزش | دیابت | دانش | رفتار - اخلاق | Training | Diabetes | Knowledge | Behavior
مقاله انگلیسی
2 Feasibility and efficacy of a pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands
امکان سنجی و کارایی یک مدل خانواده آزمایشی مداخله خودمدیریتی دیابت در جمهوری جزایر مارشال-2021
Background: The Republic of the Marshall Islands (RMI) faces numerous health disparities, including one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. Diabetes self-management education and support (DSMES) has shown efficacy in improving glycemic control and through increases in knowledge and selfmanagement activities; however, there is limited research on DSMES in the RMI. This study evaluated the feasibility and efficacy of a culturally adapted family model of DSMES (F-DSMES) in the RMI. The F-DSME included 8 h of group educational classes delivered in churches by a community health worker.
Methods: This pilot study assessed retention and dosage rates (e.g., class attendance) among the participants with T2DM (n = 41). Efficacy was evaluated by examining pre- and post-intervention differences in HbA1c, knowledge, family support, and self-management activities among those who completed the post-intervention data collection (n = 23).
Results: The results indicate completion of post-intervention data collection and attendance were associated; 70% of participants who completed the post-intervention data collection received at least 6 h of intervention compared to 3 h for those who did not. Although the reduction in HbA1c was not statistically significant, participants demonstrated statically significant increases in knowledge, family support, and an increase in selfmanagement including in checking of blood glucose and feet.
Conclusions: This study provides important information to help address T2DM disparities in the RMI, including the feasibility and efficacy of F-DSMES. Additional research will help in understanding how to translate improvements in knowledge, family support, and self-management activities into improvements in HbA1c. This may include addressing social ecological factors that affect glycemic control.
keywords: Type 2 diabetes mellitus | Diabetes self-management education | HbA1c | Pre- and post-intervention | Marshallese
مقاله انگلیسی
3 Knowledge, attitudes and practices regarding prediabetes among general practitioners in Reunion Island
دانش، نگرش و عملکرد در مورد پیش دیابت در میان پزشکان عمومی در جزیره Reunion-2021
Background: General practitioners (GPs) are among the first health care providers to be involved in prediabetes care, and their actions can prevent patients’ transition from prediabetes to diabetes. However, data on knowledge and management of prediabetes in primary care remain scarce. Aim: To describe the knowledge, attitudes and practices of GPs towards prediabetes. Design and setting: This descriptive cross-sectional study included all private GPs working in Reunion Island.
Method: GPs were sent an electronic questionnaire that specifically sought to establish whether GPs knew the definition of prediabetes and whether their practices were in line with French guidelines for prediabetes screening and management.
Results: A total of 121 GPs completed the questionnaire. Of these, 95.0% knew the definition of impaired fasting glucose, but only 66.1% knew that of impaired glucose tolerance. Many GPs reported practices that are not recommended in guidelines. Thus, 59% of respondents declared that they monitored prediabetes with HbA1c and 10% said that they prescribed oral anti-diabetic drugs as prediabetes treatment. The risks factors associated with prediabetes were generally well known. Although 59.5% of respondents reported not having enough time to provide therapeutic education and medical follow up, only 19% referred their patients to a nutritionist or dietician. Lastly, 93.4% of respondents favoured the implementation of a local therapeutic education program targeting prediabetic individuals.
Conclusion: Prediabetes management in primary care can be made more effective by improving GPs’ knowledge of prediabetes and official guidelines, facilitating referral of prediabetic patients to lifestyle specialists and implementing local therapeutic education programs.
keywords: Prediabetes | Primary Health Care | Secondary Prevention | Health Knowledge | Attitudes | Practice | Diabetes Mellitus.
مقاله انگلیسی
4 Gestational diabetes and fetal growth in twin compared with singleton pregnancies
دیابت بارداری و رشد جنین در دوقلوها در مقایسه با بارداری های تک قلویی-2021
BACKGROUND: Gestational diabetes mellitus is associated with accelerated fetal growth in singleton pregnancies but may affect twin pregnancies differently because of the slower growth of twin fetuses during the third trimester of pregnancy and their greater predisposition to fetal growth restriction.
OBJECTIVE: This study aimed to evaluate the association of gestational diabetes mellitus with longitudinal fetal growth in twin pregnancies and to compare this association with that observed in singleton pregnancies.
STUDY DESIGN: This was a retrospective cohort study of all women with a singleton or twin pregnancy who were followed up at a single tertiary referral center between January 2011 and April 2020. Data on estimated fetal weight and individual fetal biometric indices were extracted from ultrasound examinations of eligible women. Generalized linear models were used to model and compare the change in fetal weight and individual biometric indices as a function of gestational age between women with and without gestational diabetes mellitus in twin pregnancies and between women with and without gestational diabetes mellitus in singleton pregnancies. The primary outcome was estimated fetal weight as a function of gestational age. The secondary outcomes were longitudinal growth of individual fetal biometric indices and the rate of small for gestational age and large for gestational age at birth.
RESULTS: A total of 26,651 women (94,437 ultrasound examinations) were included in the analysis: 1881 with a twin pregnancy and 24,770 with a singleton pregnancy. The rate of gestational diabetes mellitus in the twin and singleton groups was 9.6% (n¼180) and 7.6% (n¼1893), respectively. The estimated fetal weight in singleton pregnancies with gestational diabetes mellitus was significantly higher than that in pregnancies without gestational diabetes mellitus (P<.001) starting at approximately 30 weeks of gestation. The differences remained similar after adjusting for maternal age, chronic hypertension, nulliparity, and neonatal sex (P<.001). In twin pregnancies, fetal growth was similar between pregnancies with and without gestational diabetes mellitus (P¼.105 and P¼.483 for unadjusted and adjusted models, respectively). The findings were similar to the association of gestational diabetes mellitus with the risk of large for gestational fetuses and the growth of each biometric index. When stratified by type of gestational diabetes mellitus treatment, twin pregnancies with gestational diabetes mellitus was associated with accelerated fetal growth only in the subgroup of women with medically treated gestational diabetes mellitus (P<.001), which represented 12% (n¼21) of the twin pregnancy group with gestational diabetes mellitus.
CONCLUSION: In contrast to singleton pregnancies, twin pregnancies with gestational diabetes mellitus is less likely to be associated with accelerated fetal growth. This finding has raised the question of whether the diagnostic criteria for gestational diabetes mellitus and the blood glucose targets in women diagnosed with gestational diabetes mellitus should be individualized for twin pregnancies.
Key words: gestational diabetes mellitus | growth | macrosomia | large for gestational age | multifetal pregnancy | twin pregnancy
مقاله انگلیسی
5 Biometric and metabolic changes in patients with diabetes prior, during and after the holy month of Ramadan (ABCD Study)
تغییرات بیومتریک و متابولیک در بیماران مبتلا به دیابت قبل ، در و پس از ماه مبارک رمضان (مطالعه ABCD)-2021
Physiological impact of the intermittent or prolonged fasting is known from various studies on healthy subjects. However, data on impact of fasting on biochemical and biometric parameters in people with diabetes is building up. Safety of Ramadan fasting has always been assessed after Ramadan. This study looked into the immediate effect of fasting during the fasting days compared to time before and after the fasting month. Methods: This is an observational study. We looked into people with biometric and biochemical records before Ramadan, and we followed them up during and after Ramadan prospectively. We were aiming for assessing the biochemical and biometric changes for people with diabetes during Ramadan in comparison to pre-and post Ramadan. As well as the differences between these measures according to type and treatment of diabetes in those who fasted as well as in those who did not fast during Ramadan. Results: Total of 342 patients were recruited to the study. All were patients with diabetes at a mild to moderate risk of complications if fasted. Majority were males 52.3% (n = 180), while females were 47.7% (n = 162). Most of the results showed a U shape between Pre-Ramadan, During Ramadan and Post-Ramadan periods. there was a modest but significant reduction in weight but regained after Ramadan. Conclusions: Our study suggests that for many people with diabetes fasting is not associated with an increased risk to their glycemic control, their weight and/or their blood pressure. Indeed, what is seen is marginal benefit or no change in all parameters. This stratifies the ongoing recommendation that allows patients with categorized as low risk to fast Ramadan or non-Ramadan days whenever desired.
Keywords: Diabetes and Ramadan | Diabetes | Fasting | Low risk | Biochemical changes in Ramadan
مقاله انگلیسی
6 Knowledge gaps and perceptions of future research directions on management of diabetes during Ramadan fasting: An online survey of physicians
شکاف های دانش و درک دستورالعمل های تحقیقاتی آینده در مدیریت دیابت در طول روزهداری ماه رمضان: مرور آنلاین پزشکان-2021
Objectives: Current knowledge and research on diabetes and Ramadan form the basis for evidence-based clinical practice. In this context, we aimed to explore physicians’ perceptions of current knowledge gaps about research fasting (RF), barriers to, and foreseeable directions for advancement of the field.
Methods: We conducted an online survey of a convenience sample of 260 physicians from 27 countries. The survey questionnaire addressed three main domains: perceived current knowledge gaps and unmet needs in research about RF and diabetes, barriers to the conduct of research, and future directions for furthering the evidence in this field.
Results: Majority of respondents (65.7%) were senior physicians in adult endocrinology/diabetes (45.9%) working at tertiary centers (65.2%). The majority (67.3%) reported seeing an average of 20+ patients with diabetes weekly and felt ‘‘very or fairly confident” in managing diabetes during RF (67.7%). The knowledge gaps identified were the management of highrisk patients with diabetes (54.1%), such as renal impairment (59.8%), and pregnancy (61.5%). The main barriers to research were lack of adequate funding to academic centers (75.7%) and lack of interest of institutions in the subject (64.6%). Future efforts should be directed at the conduct of large epidemiological studies (49.5%) or double-blinded, placebo-controlled clinical trials (48.6%) to address the former gaps. Research findings should be widely disseminated via hands-on workshops (recommended by 70.3% of respondents) or international conferences (61.2%).
Conclusions: There is a wide agreement regarding the knowledge gaps in the management of diabetes during RF. Future efforts should focus on addressing these critical deficiencies.
keywords: روزه رمضان | ادبیات | دیابت | هیپوگلیسمی | همهگیرشناسی | کتواسیدوز دیابتی | دیدگاه های بیماران | متخصصان مراقبت های بهداشتی | ادراک | بیماران پر خطر | کودکان و نوجوانان | Ramadan fasting | Literature | Diabetes | Hypoglycaemia | Epidemiology | Diabetic ketoacidosis | Patients’ perspectives | Health Care Professionals | perceptions | High-risk patients | Children and adolescents
مقاله انگلیسی
7 How does traditional knowledge of Cassiae semen shed light on weight management? – A classical and modern literature review
دانش سنتی منی فلوس چگونه مدیریت وزن را روشن می کند؟ - بررسی ادبیات کلاسیک و مدرن-2021
Ethnopharmacological relevance: The seed of Senna obtusifolia (L.) H. S. Irwin & Barneby (Cassiae semen, CS) also known as Jue ming zi in China, has been traditionally used for weight management by purging the liver and improving the liver functions to support digestion. In the past decades, it has been used for hepatoprotection and treatment of overweight and other metabolic disorders such as hyperlipidaemia and diabetes. Aim of the review: This review aimed at providing comprehensive information on the traditional usages, phar- macology, phytochemistry and toxicology of CS and critically exploring its potential usage for clinical weight management from both traditional and modern application perspectives. Materials and methods: In order to fully understand the properties, actions and indications of CS, two sets of Chinese classical texts were searched, namely: Zhong Hua Yi Dian (Encyclopedia of Traditional Chinese Medi- cine) and Zhong Guo Ben Cao Quan Shu (Complete Collection of Traditional Texts on Chinese Materia Medica). The purpose of studying these classical texts was to determine the traditional use of CS in weight management. Comprehensive searches were also performed on seven databases for publications on original randomised clinical trials (RCT), in vivo, in vitro or in silico studies related to pharmacological effects of CS. Detailed information about the phytochemistry of CS was collected from books, encyclopedia, online databases and journal literature. Findings: In classical literature review, 89 classic texts provided information of properties, actions and indications of CS. In modern literature review, 44 studies were included for analysis, including 5 RCTs, 7 in vivo studies, 14 in vitro studies, 2 in silico studies and 16 studies of mixed types. Chinese classic literature has provided traditional evidence of the usage of CS for weight management. Contemporary studies have revealed that CS has weight loss effects and possesses some other pharmacological activities supporting weight management. Some chemical compounds of CS have been hypothesised to have a direct or indirect contribution to weight control. Conclusions: The relationships between chemical compounds and the corresponding weight-loss target proteins are not fully understood. Therefore, CS constituents should be further explored for the development of novel therapeutic or preventive agents for the treatment of overweight and obesity.
keywords: طب سنتی چینی | چاقی | اضافه وزن | ملین | لیپیدها | Traditional Chinese medicine | Senna obtusifolia | Cassia obtusifolia | Cassiae semen | Obesity | Overweight | Laxative | Lipids
مقاله انگلیسی
8 Assessment of knowledge among caregivers of diabetic patients in insulin dosage regimen and administration
ارزیابی دانش در میان مراقبان بیماران دیابتی در رژیم دوزهای انسولین و تزریق-2021
Background: Inadequate production of Insulin can lead to a complex metabolic disorder named Diabetes Mellitus that is characterized by hyperglycaemia. Diabetes is leading metabolic disease that causes major disability and increased death-rate world-wide. Diabetes can cause neuropathy, blindness, ischaemic heart disease, peripheral vascular disease, increased risk of stroke, and renal diseases. Since the management of diabetes mellitus is complex, the reliance of some patients on their caregivers has increased. In this study, a caregiver is a family member or a paid helper who is willing to provide long-term assistance to a child, an older adult, or a person with a disability.
Aim: The knowledge of caregivers about insulin doses (administration and adjustment) is determined and to study the correlation between the demographic data (age, gender, and marital status) and the knowledge of caregivers.
Methodology: This is a cross sectional type of descriptive study. A questionnaire was built based on literature review and was reviewed and validated by 17 arbitrators and modified accordingly. A pilot study was performed on 5 people of the targeted population to assess the feasibility, duration, and clarity of the data collection tool. The questionnaire was distributed online and had some extra questions to exclude non-relevant responses.
Results: A total of 819 participants filled the online questionnaire. Out of these, 83.6% were female and 16.4% were male. The good knowledge was significantly associated with caregivers who had patients diagnosed with diabetes since less than 6 months when compared with others.
Conclusion: Caregivers who reported that they do not live with the healthcare receiver had less knowledge compared with those they live, and it is statically significant association. 55% were satisfied with their level of knowledge about insulin doses management. This study indicates who lives with patient has caregiver’s knowledge on inulin dosages administration 1.766 times from who don’t have.
keywords: Diabetes Mellitus (DM) | Caregivers | Metabolic disorder | Hyperglycaemia | Demographic data | Insulin dosage
مقاله انگلیسی
9 Reinforcement learning application in diabetes blood glucose control : A systematic review
کاربرد یادگیری تقویتی در کنترل قند خون دیابت : یک بررسی سیستماتیک-2020
Background: Reinforcement learning (RL) is a computational approach to understanding and automating goaldirected learning and decision-making. It is designed for problems which include a learning agent interacting with its environment to achieve a goal. For example, blood glucose (BG) control in diabetes mellitus (DM), where the learning agent and its environment are the controller and the body of the patient respectively. RL algorithms could be used to design a fully closed-loop controller, providing a truly personalized insulin dosage regimen based exclusively on the patient’s own data. Objective: In this review we aim to evaluate state-of-the-art RL approaches to designing BG control algorithms in DM patients, reporting successfully implemented RL algorithms in closed-loop, insulin infusion, decision support and personalized feedback in the context of DM. Methods: An exhaustive literature search was performed using different online databases, analyzing the literature from 1990 to 2019. In a first stage, a set of selection criteria were established in order to select the most relevant papers according to the title, keywords and abstract. Research questions were established and answered in a second stage, using the information extracted from the articles selected during the preliminary selection. Results: The initial search using title, keywords, and abstracts resulted in a total of 404 articles. After removal of duplicates from the record, 347 articles remained. An independent analysis and screening of the records against our inclusion and exclusion criteria defined in Methods section resulted in removal of 296 articles, leaving 51 relevant articles. A full-text assessment was conducted on the remaining relevant articles, which resulted in 29 relevant articles that were critically analyzed. The inter-rater agreement was measured using Cohen Kappa test, and disagreements were resolved through discussion. Conclusions: The advances in health technologies and mobile devices have facilitated the implementation of RL algorithms for optimal glycemic regulation in diabetes. However, there exists few articles in the literature focused on the application of these algorithms to the BG regulation problem. Moreover, such algorithms are designed for control tasks as BG adjustment and their use have increased recently in the diabetes research area, therefore we foresee RL algorithms will be used more frequently for BG control in the coming years. Furthermore, in the literature there is a lack of focus on aspects that influence BG level such as meal intakes and physical activity (PA), which should be included in the control problem. Finally, there exists a need to perform clinical validation of the algorithms.
Keywords: Reinforcement learning | Blood glucose control | Artificial pancreas | Closed-loop | Insulin infusion
مقاله انگلیسی
10 Artificial Intelligence (AI) based machine learning models predict glucose variability and hypoglycaemia risk in patients with type 2 diabetes on a multiple drug regimen who fast during ramadan (The PROFAST – IT Ramadan study)
مدل های یادگیری ماشین مبتنی بر هوش مصنوعی تنوع گلوکز و خطر افت قند خون را در بیماران مبتلا به دیابت نوع 2 در یک رژیم دارویی متعدد که در ماه رمضان روزه می گیرند پیش بینی می کنند (مطالعه PROFAST - IT رمضان)-2020
Objective: To develop a machine-based algorithm from clinical and demographic data, physical activity and glucose variability to predict hyperglycaemic and hypoglycaemic excursions in patients with type 2 diabetes on multiple glucose lowering therapies who fast during Ramadan. Patients and methods: Thirteen patients (10 males and three females) with type 2 diabetes on 3 or more anti-diabetic medications were studied with a Fitbit-2 pedometer device and Freestyle Libre (Abbott Diagnostics) 2 weeks before and 2 weeks during Ramadan. Several machine learning techniques were trained to predict blood glucose levels in a regression framework utilising physical activity and contemporaneous blood glucose levels, comparing Ramadan to non-Ramadan days. Results: The median age of participants was 51 years (IQR 49–52); median BMI was 33.2 kg/ m2 (IQR 33.0–35.9) and median HbA1c was 7.3% (IQR 6.7–7.8). The optimal model using physical activity achieved an R2 of 0.548 and a mean absolute error (MAE) of 30.30. The addition of electronic health record (ehr) information increased R2 to 0.636 and reduced MAE to 26.89 and the time of the day feature further increased R2 to 0.768 and reduced MAE to 20.55. Combining all the features together resulted in an optimal XGBoost model with an R2 of 0.836 and MAE of 17.47. This model accurately estimated normal glucose levels in 2584/2715 (95.2%) readings and hyperglycaemic events in 852/1031 (82.6%) readings, but fewer hypoglycaemic events (48/172 (27.9%)). The optimal XGBoost model prioritized age gender, BMI and HbA1c followed by glucose levels and physical activity. Interestingly, the blood glucose level prediction by our model was influenced by use of SGLT2i. Conclusion: XGBoost, a machine learning AI algorithm achieves high predictive performance for normal and hyperglycaemic excursions, but has limited predictive value for hypoglycaemia in patients on multiple therapies who fast during Ramadan..
Keywords: Diabetes mellitus| Ramadan | Type-2 diabetes | Artificial intelligence | Flash glucose monitoring system | Hypoglycaemia | Hyperglycaemia
مقاله انگلیسی
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