Putting Diabetes to the Test

Abstract

A lthough the number of children and youth with type 2 diabetes is increasing, a clear case definition that describes children with type 2 diabetes at presentation remains elusive. Most initial diagnoses are decided on the clinical picture at presentation (1). Characteristics and risk factors have been outlined in several review and clinical articles (2-4). The purpose of this study was to describe the characteristics of youth presenting for an initial visit to the outpatient clinic of a large tertiary children's care center and diagnosed with type 2 diabetes.For this retrospective study, data were abstracted from a consecutive sample of 98 patients' medical records at Texas Children's Hospital starting 1 January 1998 and ending 31 October 2001. The sample's mean age at diagnosis was 13.6 years (SD 2.33; range 8.7-18.4 years). Fifty-one percent of the children were female and 49% were male (female: male ratio 1:1). For 43% race/ethnicity was not specified; the remaining participants were 28.6% African American, 22.4% Hispanic, 3.1% non-Hispanic white, and 3.1% Asian. Of those for whom data were available, a maternal history of type 2 diabetes was reported by 32.7% (18/55) and an unspecified type of diabetes by 12.7% (7/55). Twenty-seven percent (13/47) reported a father with type 2 diabetes and 21% (10/47) an unspecified type of diabetes.Mean BMI was 34.67 kg/m 2 (SD 6.91). Ninety-three percent had a BMI Ն95th percentile. All but three of the individuals had BMIs Ն85th percentile. Of those for whom data were recorded, acanthosis nigricans was identified in 94% (48/51). A Tanner stage of 3, 4, or 5 was identified in 73.2% (49/67).Blood pressure readings indicated that 49.4% (41/83) had a systolic (SBP) and 10.8% (9/83) a diastolic (DBP) Ն95th percentile for age, sex, and height (n ϭ 83). Fifty-five percent (46/83) had SBP and 19.3% (16/83) DBP readings Ն90th percentile for blood pressure. Of 72 pulse rates recorded, 2.6% were Ն95th percentile for age. Average HbA 1c was 10.38 (SD 3.52) (n ϭ 95).Of those who had symptoms documented in the medical record, 83.6% (56/ 67) reported polyuria, 83.9% (52/62) polydipsia , and 61% (36/59) polyphagia. Seventy-five percent reported both polyuria and polydipsia (46/61). Of the cases available, 46.2% (24/52) reported all three of the polys at initial presentation, 46.8% (29/62) had weight loss, and 62.5% (30/48) had ketones. Of those for whom islet cell antibody data were recorded (50/98), 49 had JDF units Ͻ5. Fifty-three percent were started on insulin, 46.3% on oral agents, and 13.7% on both insulin and oral agent (n ϭ 96). Initial mean insulin dose was 0.6 units/kg.Our sample is similar to those described in previous reports except for a more even ratio of female to male subjects, a greater percent with elevated SBP and/or DBP, and more individuals reporting weight loss. We are the first to report blood pressure by the 95th and 90th percentiles and the first to report pulse rate. These data contribute to the growing body of clinical evidence defining the characteristics of ...

Knowledge of and adherence to health advice among adults with diabetes in Libya

“…The other important factors affecting HbA 1c level was the level of diabetes knowledge which indicated that people with higher level of knowledge had also higher HbA 1c . This finding is however is different to the finding of other studies (18,19) which found that diabetes knowledge is associated with better glycemic control. The positive correlation found in this current study is, however consistent with the finding of Al-Asani et al (13).…”

Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

“…Although knowledge by itself does not necessarily lead to improved self-care behaviours or outcomes (Norris et al 2001), an understanding of the disease, its course and treatment and how all these interact are pre-requisites for effective selfcare (Golay et al 2008;Persell et al 2004). Some studies have also demonstrated a positive relationship between disease knowledge and self-care behaviours (Van den Arend et al 2001;Persell et al 2004) and glycaemic control (Colleran, Starr & Burge 2003;Persell et al 2004). This clearly demonstrates a need for improving the basic knowledge about the disease and its treatment.…”

A Validation Study of the Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLD)

“…[7][8][9][10][11][12][13][14][15][16][17][18] Higher diabetes-related knowledge (DRK) has been associated with improved glucose control 11 , lower blood pressure 11 , enhanced quality of life 10,14,19,20 , and improved selfcare behaviors such as dietary adherence 11,12,[21][22][23] , home glucose monitoring 11,12,20,21 , increased exercise 11,21 , and foot inspection 11,21 . Assessment of DRK by the validated Michigan Diabetes Knowledge Test (DKT) 24 may help determine what diabetes education is required, and to monitor knowledge educational progress over time.…”