Evaluation of the effectiveness of an ambulatory teaching/treatment programme for non-insulin dependent (type 2) diabetic patients.

The aim of this study was to evaluate the effect of a structured teaching/treatment programme on the clinical and metabolic control of non-insulin-dependent (type 2) diabetic patients. The programme was aimed at improving the overall treatment quality in these patients through measures involving self-care, diet, exercise and weight reduction. Four theoretical-practical teaching units were given once a week to group of 5-8 ambulatory patients by previously trained general practitioners. Clinical and biochemical parameters were recorded at the beginning of the course and 1 year after its completion in 40 patients attending the programme and in 39 patients of similar clinical characteristics under conventional diabetes treatment, but receiving no structured teaching before or during the survey period (control group). The drop-out percentage in the intervention group (25%) was significantly lower than in the control group (45%, P < 0.05), suggesting an incentive toward greater compliance in the former. At the end of the 1-year follow-up, the mean differences observed in the control and in the intervention groups were: body weight loss -2.4 +/- 0.5 kg vs -0.4 +/- 0.5 (P < 0.001); haemoglobin HbA1 -0.2% +/- 0.4% vs +0.8% +/- 0.4% (NS); number of daily oral hypoglycaemic agent intake -1.4 +/- 0.2 vs +0.9 +/- 0.2 tablets (P < 0.001). Our results strongly suggest that this programme, applied through family doctors, may constitute an efficient tool to improve the compliance and clinico-metabolic control of type 2 patients at the primary health care level.

[Exercise test in exercise-induced asthma in children: study of delayed response]. / El test de esfuerzo en el asma inducido por el ejercicio en niños: estudio de la respuesta tardía.

In this study we perform the exercise broncho-provocation test according to a protocol and involving 27 children with allergic asthma to study the prevalence and distinctive traits of the late response in exercise-induced asthma (EIA). At the conclusion of the study, 20 patients (74%) were diagnosed of EIA through some of the tests employed (ergometric bicycle, free run). In the cases where both tests were negative, we reproduced in a controlled manner the exercise reported as asthmogenic on the basis of anamnesis; no positivity was observed for the test in any case. Prevalence of late asthmatic response was 40% (8/20); mean beginning time to this response was 4-6 hours, lasting less than 1 hour and with a mean intensity rate of 26.8% (measured as the percentage of PEFR drop according to the preexercise basal value). The results are discussed, comparing them with those of other authors and with the allergen provocation response pattern; in addition the methods used and therapeutic implications in view of the results are dealt with.

Evaluación de la efectividad de un programa de educación para diabéticos no insulinodependientes / Evaluation of effectiveness of an education program for non-insulin-dependent diabetic patients

En este trabajo se evaluó durante un año el impacto prospectivo de un programa educativo para diabéticos no insulinodependientes (PEDNID), sobre parámetros clínicos, bioquímicos y terapéuticos. El programa, de modalidad grupal, constaba de 4 módulos teórico-prácticos dictados semanalmente por el médico de cabecera, entrenado previamente para su desarrollo. El objetivo general fue mejorar el control metabólico del DNID por medios no farmacológicos, suprimiro atenuar los síntomas clásicos de la enfermedad y entrenar a los pacientes parala implementación de acciones de prevención y de diagnóstico precoz de las complicaciones crónicas de la enfermedad. Los objetivos particulares fueron capacitaral paciente para efectuar monitoreos glucosúricos, un plan de alimentación con reemplazos, autocuidado en piernas y pies, incremento en su actividad física y controles médicos y de laboratorio periódicos. La población consistió en pacientesasistidos en los subsectores estatal y privado en las ciudades de La Plata, Berisso, Ensenada y Magdalena. Al cabo del año se evaluaron 40 pacientes del PEDNID y 39 controles apareados por edad, sexo y antigüedad de diabetes, encontrándose estos últimos bajo tratamiento convencional de su enfermedad y sin haber recibido educación diabetológica estructurada antes o durante del período de estudio. El área congnoscitiva se evaluó en el grupo PEDNID mediante un cuestionario relevado antes y al año del curso de educación...