Diabetes and Disasters: Recent Studies and Resources for Preparedness.

PURPOSE OF REVIEW: Studies have shown that disasters may exacerbate the comorbidities in vulnerable populations such as those with a pre-existing chronic medical condition like diabetes. This article highlights recent studies that look at the impact of disasters on people with diabetes and also shows recent resources for consumers, health care providers, and policy makers to improve resiliency in people with diabetes. RECENT FINDINGS: Recent articles have looked at the short-term impact of disasters upon people with diabetes and its comorbidities such as Hurricane Sandy in 2012, the triple disaster of 2011 in Japan (earthquake, tsunami, and nuclear accident), and the 2016 Kumamoto earthquake in Japan as well as the long-term impact of disasters such as Hurricane Katrina in 2005. Several public and private partners have used the past and recent findings to develop resources that help consumers with diabetes and the people who care for them, prepare for a disaster BEFORE the event.

Team-Based Care to Improve Diabetes Management: A Community Guide Meta-analysis.

CONTEXT: Team-based care has been increasingly used to deliver care for patients with chronic conditions, but its effectiveness for managing diabetes has not been systematically assessed. EVIDENCE ACQUISITION: RCTs were identified from two sources: a high-quality, broader review comparing 11 quality improvement strategies for diabetes management (database inception to July 2010), and an updated search using the same search strategy (July 2010-October 2015). EVIDENCE SYNTHESIS: Thirty-five studies were included in the current review; a majority focused on patients with Type 2 diabetes. Teams included patients, their primary care providers, and one or two additional healthcare professionals (most often nurses or pharmacists). Random effect meta-analysis showed that, compared with controls, team-based care was associated with greater reductions in blood glucose levels (-0.5% in HbA1c, 95% CI= -0.7, -0.3) and greater improvements in blood pressure and lipid levels. Interventions also increased the proportion of patients who reached target blood glucose, blood pressure, and lipid levels, based on American Diabetes Association guidelines available at the time. Data analysis was completed in 2016. CONCLUSIONS: For patients with Type 2 diabetes, team-based care improves blood glucose, blood pressure, and lipid levels.

The Importance of Addressing Depression and Diabetes Distress in Adults with Type 2 Diabetes.

People with type 2 diabetes often experience two common mental health conditions: depression and diabetes distress. Both increase a patient's risk for mortality, poor disease management, diabetes-related complications, and poor quality of life. The American Diabetes Association and the U.S. Preventive Services Task Force recommend routine evaluations for these conditions in adults for optimal disease management and prevention of life-threatening complications. However, barriers exist within primary care and specialty settings that make screening for depression and diabetes distress challenging. Depression and diabetes distress influence diabetes self-care and diabetes control and barriers in clinical care practice that can hinder detection and management of psychosocial issues in diabetes care. This paper highlights opportunities to increase mental health screenings and provides strategies to help providers address depression and diabetes distress in patients with type 2 diabetes.

Chronic conditions and household preparedness for public health emergencies: Behavioral Risk Factor Surveillance System, 2006-2010.

INTRODUCTION: Individuals with chronic conditions often experience exacerbation of those conditions and have specialized medical needs after a disaster. Less is known about the level of disaster preparedness of this particular population and the extent to which being prepared might have an impact on the risk of disease exacerbation. The purpose of this study was to examine the association between self-reported asthma, cardiovascular disease, and diabetes and levels of household disaster preparedness. METHODS: Data were analyzed from 14 US states participating in the 2006-2010 Behavioral Risk Factor Surveillance System (BRFSS), a large state-based telephone survey. Chi-square statistics and adjusted prevalence ratios were calculated. RESULTS: After adjusting for sociodemographic characteristics, as compared to those without each condition, persons with cardiovascular disease (aPR = 1.09; 95% CI, 1.01-1.17) and diabetes (aPR = 1.13; 95% CI, 1.05-1.22) were slightly more likely to have an evacuation plan and individuals with diabetes (aPR = 1.04; 95% CI, 1.02-1.05) and asthma (aPR = 1.02; 95% CI, 1.01-1.04) were slightly more likely to have a 3-day supply of prescription medication. There were no statistically significant differences in the prevalence for all other preparedness measures (3-day supply of food and water, working radio and flashlight, willingness to leave during a mandatory evacuation) between those with and those without each chronic condition. CONCLUSION: Despite the increased morbidity and mortality associated with chronic conditions, persons with diabetes, cardiovascular disease, and asthma were generally not more prepared for natural or man-made disasters than those without each chronic condition.

Addressing diabetes and depression in the school setting; the role of school nurses.

What Can School Nurses Do to Address Diabetes and Depression in the School Setting? 1. Remember that depression and diabetes are common comorbidities. If you see signs of depression, remember to obtain the appropriate consent and approvals for students under the age of 18 before screening. 2. Remember that depression can interfere with self-management skills and may make diabetes worse--so connect students to community resources to help them reduce the risk of complications. 3. Remember that depression and risk-taking behaviors are common in adolescents with diabetes. Have educational materials ready and available to help students in need.

Advancing workplace health protection and promotion for an aging workforce.

OBJECTIVE: To explore issues related to the aging workforce, including barriers to integrating health protection and promotion programs, and provide recommendations for best practices to maximize contributions by aging workers. METHODS: Workgroups reviewed literature and case studies to develop consensus statements and recommendations for a national approach to issues related to older workers. RESULTS: Consensus statements and actions steps were identified for each of the Summit goals and call-to-action statements were developed. CONCLUSIONS: A national dialogue to build awareness of integrated health protection and promotion for the aging workforce is needed. Workers will benefit from improved health and performance; employers will realize a more engaged and productive workforce; and the nation will gain a vital, competitive workforce.

Diabetes and oral disease: implications for health professionals.

"Diabetes and Oral Disease: Implications for Health Professionals" was a one-day conference convened by the Columbia University College of Dental Medicine, the Columbia University College of Physicians and Surgeons, and the New York Academy of Sciences on May 4, 2011 in New York City. The program included an examination of the bidirectional relationship between oral disease and diabetes and the interprofessional working relationships for the care of people who have diabetes. The overall goal of the conference was to promote discussion among the healthcare professions who treat people with diabetes, encourage improved communication and collaboration among them, and, ultimately, improve patient management of the oral and overall effects of diabetes. Attracting over 150 members of the medical and dental professions from eight different countries, the conference included speakers from academia and government and was divided into four sessions. This report summarizes the scientific presentations of the event.

Integrating complementary and alternative medicine instruction into health professions education: organizational and instructional strategies.

A few years ago, the National Institutes of Health National Center for Complementary and Alternative Medicine funded a program called the Complementary and Alternative Medicine (CAM) Education Project. Grantees were 14 medical and nursing schools and the American Medical Student Association, which funded six additional medical schools. Grants were awarded in cohorts of five per year in 2000, 2001, and 2002-2003. The R25 grant recipients identified several major themes as crucial to the success of integrating CAM into health professions curricula. The rationale for integrating CAM curricula was in part to enable future health professionals to provide informed advice as patients dramatically increase the use of CAM. Success of new CAM education programs relied on leadership, including top-down support from institutions' highest administrators. Formal and informal engagement of key faculty and opinion leaders raised awareness, interest, and participation in programs. A range of faculty development efforts increased CAM-teaching capacity. The most effective strategies for integration addressed a key curriculum need and used some form of evidence-based practice framework. Most programs used a combination of instructional delivery strategies, including experiential components and online resources, to address the needs of learners while promoting a high level of ongoing interest in CAM topics. Institutions noted several benefits, including increased faculty development activities, the creation of new programs, and increased cross- and inter-university collaborations. Common challenges included the need for qualified faculty, crowded and changing curricula, a lack of defined best practices in CAM, and post-grant sustainability of programs.