Metabolic control of adults with type 2 diabetes mellitus through education and counseling.

PURPOSE: To test the efficacy of a controlled nursing intervention focused on education and counseling to improve metabolic control of adults diagnosed with diabetes mellitus type 2 in (DMT2) ambulatory care. DESIGN: A quasi-experimental design with repeated measures was selected. A sample of 45 subjects participated, of which 25 were in the experimental group, and 20 in the comparison group. Measures were taken at 0, 3, 6, 9, and 12 months, including glycosylated hemoglobin (HbAlc), psychosocial, and clinical variables. FINDINGS: Results showed a significant decrease in HbAlc in the experimental group, as well as positive effects of self-care agency, adaptation, and barriers to treatment (plus one interaction) on the HbA1c levels and on the scores of self-care actions. CONCLUSIONS: The counseling and educational model applied in the intervention was effective to improve the metabolic control of diabetic patients in the experimental group. Self-care agency, adaptation, and barriers were predictors of self-care measures and level of HbA1c.

Hypertension and diabetes mellitus - abstract

There is no doubt that the association between diabetes mellitus and hypertension represents a serious health problem all around the world. It is well-known that either one of these diseases alone increases considerably the rates of morbidity and mortality, but when they are both present at the same time, the risks of having cardiovascular or cerebro-vascular accidents are dramatically increased. On the other hand, the prevalence of hypertension is significantly higher in people with diabetes mellitus. Most epidemiological studies show a 2 - 3-fold elevation in the frequency of hypertension in people with diabetes mellitus, and the hypertension observed in patients with diabetes mellitus contributes a great deal to their mortality and morbidity; there is strong evidence that there is a link between the progression of diabetic neuropathy and high blood pressure and there is also an association between diabetic retinopathy and arterial blood pressure. There is strong evidence that the association of these two entities is not simply by chance; there are reasons to sustain that they share common physiopathological pathways, and it is very likely that hyperinsulinaemia is a common denominator for both diseases. It has been shown beyond any reasonable doubt that increased total exchangeable sodium retention and increased vascular reactivity to various vasoconstrictors are effects due to the elevated insulin levels and that these changes promote high blood pressure. The treatment of this association has been changing in the last few years. Not so long ago, it was considered the hypertension in the diabetic could be treated in the same way as in non-diabetic people. However, since several of the antihypertensive drugs have side effects that could be deleterious for people with diabetes mellitus, nowadays some modifications have to be made. The first approach to treatment should always be a non-pharmacological one that comprises:weight reduction, sodium restrictions, exercise, moderation of alcohol intake, cessation of smoking and moderation in caffeine consumption. When these measures are not enough to control the high blood pressure levels, drug treatment should be considered. Initially, one should try to control the patient with monotherapy; only in those cases that do not respond would it be necessary to use two or even three drugs at the same. Most researchers in this field agree now that the first selection should be ACE inhibitors, because they are almost exempt from side effects that could produce metabolic and undesirable changes. However, it is also true that this type of drug is not as effective in Blacks as it is in Whites, and for this reason in these cases the Calcium Channel Blockers could be used as the first choice. In case the blood pressure level is not controlled, it could be useful to add a diuretic such as Hydrochlorothiazide in small doses, daily and sometimes only every other day. In patients with very difficult control, combined therapy, using at the same time three drugs, may be necessary. It is highly recommended to read the recent report from the Canadian Hypertension Society Consensus Conference(AU)

Estudio de la eficacia y seguridad de un tratamiento a largo plazo con acipimox en hiperlipogroteinemia / Efficacy and security of a long-term treatment with acipimox in hyperlipoproteinemia

Diseño experimental: Abierto, no controlado. Número de pacientes: 117 pacientes externos (64 varones, 53 mujeres) con hiperlipoproteinemia tipo 2a, (35), 2b (38) y 4 (44). Horario de tratamiento: Los pacientes fueron instruidos para que tomaran una cápsula de 250 mg. o 400 mg. t. i. d. por un período de 6 - 24 meses. Evaluación: Mensualmente los primeros dos meses y de allí en adelante bi-mensualmente: peso corporal, ritmo cardíaco, presión sanguínea sistólica y diastólica, lípidos plasmáticos, (colesterol) total y triglicéridos). Con el mismo horario mencionado para el primer año y luego por lo menos una vez cada seis meses hemograma y bioquímica sanguínea (glicemia, uricemia, BUN, creatinina, proteínas totales, bilirrubina total, SGOT, SGPT, fosfatasa alcalina, RBC, hemoglobina, hematocrito, WBC total y diferencial, trombocitos, tiempo de protrombina), urianálisis. La electroforesis lipoproteína se hizo sólo en el momento de admisión y en algunos controles durante el estudio. Resultados: 15 pacientes interrumpieron el tratamiento: 10 debido a motivos adversos, 1 debido a enfermedad intercurrente, 1 por mejoramiento definitivo, 1 debido a empeoramiento de enfermedad concomitante y 2 se perdieron en el seguimiento. De los pacientes restantes 45, 18 y 39 completaron 6, 12 y 24 meses de tratamiento, respectivamente. Durante la prueba el peso corporal de los pacientes no cambió significativamente. a) Eficacia. Los niveles medios de triglicéridos bajaron alrededor de 57% en pacientes hiperlipoproteinémicos del tipo 4 y casi 39% en pacientes del tipo 2b con diferencias muy significativas en comparación con los valores básicos. En los pacientes del tipo 2a. la trigliceridemia bajó alrededor de 13%. Los niveles medios de colesterol total bajaron 17% en pacientes de tipo 2a y 2b y 16% en pacientes de tipo 4 con diferencias muy significativas en comparación con los valores básicos...