Standards of Medical Care in Diabetes—2009

Basevi, Vittorio

doi:10.2337/dc09-s013

Cited by 1,481 publications

(525 citation statements)

References 363 publications

(306 reference statements)

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“…All of the consensus guidelines specify that an integrated package of care should be delivered by a multidisciplinary team, appropriately trained and comprising of a consultant paediatrician or paediatric endocrinologist with an interest and expertise in diabetes, a specialist nurse, a dietician and a psychologist or social worker. 2,22,23,[27][28][29][30] From the guidelines and the available evidence it is difficult to define exactly how many patients an individual team should be responsible for, and how many professionals there should be in each team. There is evidence from the UK that children attending larger clinics with more specialised consultants receive better care, 31,32 although a comparison of 207 paediatric diabetes centres in Germany and Austria did not reveal an effect of centre size on HbA1c when comparing centres with less than 50 patients to those with more than 50 patients.…”

Section: Team Structure and Centre Sizementioning

confidence: 99%

“…All six consensus guidelines suggest that, if appropriately resourced, a diabetes team should be able to offer homebased care from diagnosis if the child is well, 2,22,23,[27][28][29][30] although evidence supporting one of these processes over the other is inconclusive. 36 Facilities should be in place to test HbA1c levels two to four times per year and this should be available in the clinic.…”

Section: Ambulatory Carementioning

confidence: 99%

“…There are minor variations in the recommended screening frequency and age of testing across the world. 2,22,23,[27][28][29][30] However, whichever guideline is accepted, the delivery of that process should be monitored carefully. The national diabetes audit in England and Wales is an example of a means of monitoring how good centres are at meeting the recommendations for screening by NICE.…”

mentioning

confidence: 99%

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The best model of care for children and young people with diabetes

Williamson¹

2010

JRCPE

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introDUCtionThe incidence of diabetes in childhood has been rising by 3.9% each year in Europe in recent years.1 This has been higher in the pre-school age group, where the incidence is predicted to double by 2020 from its 2005 figure.1 Young people (defined as individuals between the ages of 11 and 18 years 2 ) with diabetes struggle to attain the standards for glycaemic control set for them.3,4 They have a high mortality, 5 develop long-term complications at a relatively early age 6 and have high rates of mental health problems. 7 These factors challenge health services to find the best way of caring for increasing numbers of children and young people with diabetes, so the best model of care needs to be clearly defined. This paper summarises the available evidence and expert opinion on the factors that may contribute to the best model of care for children and young people with diabetes. What is a 'model of care'?A clear definition of 'model of care' is hard to find in the medical literature. Examples include: 'an overarching design for the provision of a particular type of health care service that is shaped by a theoretical basis, evidence based practice and defined standards' 8 and 'a multifaceted concept, which broadly defines the way health services are delivered'. 9 The main theme of these definitions is the provision, or delivery, of healthcare. Delivery of healthcare has three components: structure, process and outcome. 10 Structural data are characteristics of personnel and hospitals or clinics. With these a framework is created from which to deliver the process. Process data are the components of the encounter between a doctor or another healthcare professional and a patient (e.g. teaching carbohydrate counting or using a particular insulin regime). The process is intended to create a beneficial effect on outcomes. Outcome data refer to the patient's subsequent health status (e.g. glycosylated haemoglobin, HbA1c, or frequency of hypoglycaemia).A simple definition of the term 'model of care' would therefore be: 'The structures of healthcare and the processes they deliver.' What models of care are used for childhood diabetes?In the UK, children with diabetes in the most part have their care delivered by specific professionals based within secondary care.11 This has been directed by consensus agreements such as the St Vincent declaration and the recommendations of the British Paediatric Association in 1990, 12,13 but it relies on the structures underpinning the secondary healthcare services, which are not specifically designed for chronic care so may have a number of shortcomings. Models of care for childhood diabetes have evolved slowly from this by adopting novel 'processes' into slowly adapting structures (e.g. implementing intensive insulin therapy, then slowly increasing the numbers of nursing staff available to deliver it), rather than making radical changes to structures to enable the most efficient delivery of the process. We therefore do not find radically different models of care for childhood d...

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Section: Team Structure and Centre Sizementioning

confidence: 99%

Section: Ambulatory Carementioning

confidence: 99%

mentioning

confidence: 99%

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The best model of care for children and young people with diabetes

Williamson¹

2010

JRCPE

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“…Exercise is important in reducing blood glucose levels especially in elderly patients with diabetes [5][6][7]. Diabetes knowledge should be undertaken in advance for effective diabetes management.…”

Section: Introductionmentioning

confidence: 99%

“…It has been reported that low-income diabetes patients have low levels of diabetes knowledge and the levels of diabetes knowledge are directly related to glucose control capabilities in this population. Therefore, developing effective strategies to provide health information and improve knowledge levels in this vulnerable population of low-income elderly patients with diabetes is necessary [5,8,9].…”

Section: Introductionmentioning

confidence: 99%

The Influence of Health Literacy and Diabetes Knowledge on Diabetes Self-care Activities in Korean Low-income Elders with Diabetes

Jihye

Park

Shin

2014

J Korean Acad Community Health Nurs

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Purpose: This study aimed to assess the levels of and relationships among health literacy, knowledge about diabetes, and self-care activities in the Korean low-income elderly with diabetes and to identify factors influencing the self-care activities of this vulnerable population. Methods: This study surveyed a total of 151 low-income elderly patients with diabetes registered at 16 Visiting Health Care Services in B City, Korea. Health literacy was measured with the Newest Vital Sign. Diabetes knowledge was measured with the Diabetes Knowledge Test. The Summary of Diabetes Self-care Activities Questionnaire was used to assess diabetes self-care activities. A stepwise multiple regression analysis was conducted to identify significant factors influencing diabetes self-care activities in these patients. Results: In the regression model, diabetes knowledge (β=.322, p<.001), exercise (β=.337, p<.001), and experiences of diabetes education (β=.241, p=.001) were significantly associated with increased diabetes self-care activities in low-income elderly patients with diabetes when gender, education, health literacy, and subjective health state were controlled. Conclusion: To improve diabetes self-care activities in the low-income elderly with diabetes, it is important to develop a customized program considering their knowledge, exercise, and diabetes education experience.

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