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Diabetes Mellitus—Current Challenges in the Pathophysiology, Diagnosis, Prevention and Management

Special Issue Editors

Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin Poland, 20-059 Lublin, Poland
Interests: obstetrics and gynecology; perinatology; molecular biology; diabetes mellitus; endocrinology; HPV-infections
Special Issues, Collections and Topics in MDPI journals
Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin Poland, 20-059 Lublin, Poland
Interests: perinatology; obesity; cardiovascular diseases; preeclampsia; life style
Special Issues, Collections and Topics in MDPI journals
Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin Poland, 20-059 Lublin, Poland
Interests: gestational diabetes mellitus; pregestational diabetes mellitus; obesity in pregnancy; pathology of pregnancy; metabolic syndrome
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Diabetes mellitus (DM) is a group of metabolic disorders characterized by a high blood glucose level over a prolonged period of time. It is classified into six categories: type 1 diabetes, type 2 diabetes, hybrid forms of diabetes, hyperglycemia first detected during pregnancy, "unclassified diabetes", and "other specific types". In 2017, 425 million people had diabetes worldwide, and that number is growing. Type 2 makes up about 90% of the cases. The WHO estimates that diabetes is the 8th leading cause of death.

We are organizing a Special Issue (SI) on the new insights in diabetes mellitus. We invite the submission of manuscripts (original research or review articles) about the pathophysiological concepts of all types of DM. In addition, we welcome critical remarks on the current criteria of diagnosis of DM. We want to include the pharmacological and non-pharmacological therapeutic options, evidence-based treatment algorithms, and novel experimental therapies. We encourage the authors to focus on prophylaxis and reducing complications strategies. In the field of environmental research, we seek papers about social, economic, and cultural changes in public health. We call for manuscripts about specific groups of patients, such as pregnant women, adolescents, older patients, and patients with comorbidities. Due to the COVID-19 pandemic, we will publish overviews and meta-analyses about the implication of the viral infection on the course of DM. The latest achievements in molecular biology, for example, assessment of gut microbiome, for this metabolic disorder are anticipated. Papers combining a high academic standard with a practical focus are especially welcome.

You may choose our Joint Special Issue in Journal of Clinical Medicine.

Prof. Dr. Anna Kwaśniewska
Dr. Aleksandra Stupak
Dr. Tomasz Gęca
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diabetes mellitus type 1
  • diabetes mellitus type 2
  • gestational diabetes mellitus
  • MODY
  • pathophysiology
  • epidemiology
  • prevention
  • education
  • diagnosis
  • treatment
  • complications
  • surgery
  • obesity
  • lifestyle
  • depression

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Published Papers (10 papers)

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Research

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16 pages, 710 KiB  
Article
Predictors of Inadequate Health Literacy among Patients with Type 2 Diabetes Mellitus: Assessment with Different Self-Reported Instruments
by Marija Levic, Natasa Bogavac-Stanojevic, Dragana Lakic and Dusanka Krajnovic
Int. J. Environ. Res. Public Health 2023, 20(6), 5190; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20065190 - 15 Mar 2023
Cited by 2 | Viewed by 1617
Abstract
Introduction: Obtaining, understanding, interpreting, and acting on health information enables people with diabetes to engage and make health decisions in various contexts. Hence, inadequate health literacy (HL) could pose a problem in making self-care decisions and in self-management for diabetes. By applying multidimensional [...] Read more.
Introduction: Obtaining, understanding, interpreting, and acting on health information enables people with diabetes to engage and make health decisions in various contexts. Hence, inadequate health literacy (HL) could pose a problem in making self-care decisions and in self-management for diabetes. By applying multidimensional instruments to assess HL, it is possible to differentiate domains of functional, communicative, and critical HL. Objectives: Primarily, this study aimed to measure the prevalence of inadequate HL among type 2 diabetes mellitus patients and to analyze the predictors influencing health literacy levels. Secondly, we analyzed if different self-reported measures, unidimensional instruments (Brief Health Literacy instruments (BRIEF-4 and abbreviated version BRIEF-3), and multidimensional instruments (Functional, Communicative and Critical health literacy instrument (FCCHL)) have the same findings. Methods: The cross-sectional study was conducted within one primary care institution in Serbia between March and September 2021. Data were collected through Serbian versions of BRIEF-4, BRIEF-3, and FCCHL-SR12. A chi-square test, Fisher’s exact test, and simple logistic regression were used to measure the association between the associated factors and health literacy level. Multivariate analyses were performed with significant predictors from univariate analyses. Results: Overall, 350 patients participated in the study. They were primarily males (55.4%) and had a mean age of 61.5 years (SD = 10.5), ranging from 31 to 82 years. The prevalence of inadequate HL was estimated to be 42.2% (FCCHL-SR12), 36.9% (BRIEF-3) and 33.8% (BRIEF-4). There are variations in the assessment of marginal and adequate HL by different instruments. The highest association was shown between BRIEF-3 and total FCCHL-SR12 score (0.204, p < 0.01). The total FCCHL-SR12 score correlates better with the abbreviated BRIEF instrument (BRIEF-3) than with BRIEF-4 (0.190, p < 0.01). All instruments indicated the highest levels for the communicative HL domain and the lowest for the functional HL domain with significant difference in functional HL between the functional HL of FCCHL-SR12 and both BRIEF-3 and BRIEF-4 (p = 0.006 and 0.008, respectively). Depending on applied instruments, we identified several variables (sociodemographic, access to health-related information, empowerment-related indicators, type of therapy, and frequency of drug administration) that could significantly predict inadequate HL. Probability of inadequate HL increased with older age, fewer children, lower education level, and higher consumption of alcohol. Only high education was associated with a lower probability of inadequate HL for all three instruments. Conclusions: The results we obtained indicate that patients in our study may have been more functionally illiterate, but differences between functional level could be observed if assessed by unidimensional and multidimensional instruments. The proportion of patients with inadequate HL is approximately similar as assessed by all three instruments. According to the association between HL and educational level in DMT2 patients we should investigate methods of further improvement. Full article
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16 pages, 808 KiB  
Article
Metabolic Control, Diabetic Complications and Drug Therapy in a Cohort of Patients with Type 1 and Type 2 Diabetes in Secondary and Tertiary Care between 2004 and 2019
by Matthias Roth, Thomas Lehmann, Christof Kloos, Sebastian Schmidt, Christiane Kellner, Gunter Wolf and Nicolle Müller
Int. J. Environ. Res. Public Health 2023, 20(3), 2631; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20032631 - 01 Feb 2023
Cited by 1 | Viewed by 1531
Abstract
This paper studies the features of metabolic parameters, diabetic complications and drug therapy of a single-centre cohort of patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) in secondary care and tertiary care over a 15-year period. Methods: Retrospective cross-sectional analysis [...] Read more.
This paper studies the features of metabolic parameters, diabetic complications and drug therapy of a single-centre cohort of patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) in secondary care and tertiary care over a 15-year period. Methods: Retrospective cross-sectional analysis of four single-centre cohorts between 2004 and 2019. All patients with T1DM or T2DM in secondary care (n = 5571) or tertiary care (n = 2001) were included. Statistical analyses were performed using linear mixed models. Results: Diabetes duration increased in both patients with T1DM and T2DM in secondary care and tertiary care (p < 0.001). Patients in secondary care consistently showed good glycaemic control, while patients in tertiary care showed inadequate glycaemic control. All four cross-sectional cohorts showed a significant increase in the prevalence of nephropathy over time and three out of four cohorts (T1DM and T2DM in secondary care and T2DM in tertiary care) showed an increase in the prevalence of neuropathy (all p < 0.001). The incidence of severe hypoglycaemia was consistently low. The use of insulin pumps and insulin analogues in the therapy of T1DM increased significantly. Conclusions: The increased prevalence of complications is likely due to older age and longer diabetes duration. Low rates of hypoglycaemia, lower limb amputations and good glycaemic control in secondary care patients indicate a good structure of patient care. Full article
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10 pages, 1340 KiB  
Article
Prevalence and Associations of Type 2 Diabetes Risk and Sociodemographic Factors in Saudi Arabia: A Web-Based Cross-Sectional Survey Study
by Reem F. Bamogaddam, Yahya Mohzari, Fahad M. Aldosari, Ahmed A. Alrashed, Abdulaziz S. Almulhim, Sawsan Kurdi, Munirah H. Alohaydib, Ohoud M. Alotaibi, Amani Z. Alotaibi and Ahmad Alamer
Int. J. Environ. Res. Public Health 2023, 20(3), 2269; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20032269 - 27 Jan 2023
Cited by 1 | Viewed by 1799
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease with ever-increasing prevalence worldwide. In our study, we evaluated the prevalence of the risk of developing T2DM in Saudi Arabia and investigated associations between that risk and various sociodemographic characteristics. To those ends, a [...] Read more.
Type 2 diabetes mellitus (T2DM) is a chronic disease with ever-increasing prevalence worldwide. In our study, we evaluated the prevalence of the risk of developing T2DM in Saudi Arabia and investigated associations between that risk and various sociodemographic characteristics. To those ends, a web-based cross-sectional survey of Saudi nationals without diabetes, all enrolled using snowball sampling, was conducted from January 2021 to January 2022. The risk of developing T2DM was evaluated using a validated risk assessment questionnaire (ARABRISK), and associations of high ARABRISK scores and sociodemographic variables were explored in multivariable logistic regression modeling. Of the 4559 participants, 88.1% were 18 to 39 years old, and 67.2% held a college or university degree. High ARABRISK scores were observed in 7.5% of the sample. Residing in a midsize city versus a large city was associated with a lower ARABRISK risk score (p = 0.007), as were having private instead of governmental insurance (p = 0.005), and being unemployed versus employed (p < 0.001). By contrast, being married (p < 0.001), divorced or widowed (p < 0.001), and/or retired (p < 0.001) were each associated with a higher ARABRISK score. A large representative study is needed to calculate the risk of T2DM among Saudi nationals. Full article
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10 pages, 315 KiB  
Article
Knowledge of School Nurses on the Basic Principles of Type 1 Diabetes Mellitus Self-Control and Treatment in Children
by Anna Stefanowicz-Bielska, Magdalena Słomion and Małgorzata Rąpała
Int. J. Environ. Res. Public Health 2022, 19(24), 16576; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192416576 - 09 Dec 2022
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Abstract
School nurses should participate in the care of children with type 1 diabetes mellitus. The aim of this study was to assess the level of knowledge of school nurses about the basic principles of self-control and the treatment of type 1 diabetes mellitus [...] Read more.
School nurses should participate in the care of children with type 1 diabetes mellitus. The aim of this study was to assess the level of knowledge of school nurses about the basic principles of self-control and the treatment of type 1 diabetes mellitus and to attempt to determine the factors that influence this level of knowledge. A cross-sectional survey was conducted among school nurses from October 2018 to November 2019 in the Pomeranian Voivodeship. The study was conducted using a self-constructed questionnaire. The survey included questions about the sociodemographic characteristics of the respondents, and a test of the knowledge and skills regarding the principles of self-control and the treatment of type 1 diabetes mellitus (16 test questions). This study included 168 Polish school nurses (mean age ± SD = 55.1 ± 8.9 years). Most of the nurses had a secondary education (81%), worked in a municipal educational institution (78.6%), and provided care to more than one student with type 1 diabetes mellitus at school (70.2%). The average level of knowledge of school nurses was 12.5 ± 2.0 points (maximum 16). The nurses working in a village school and those who worked only in one school had lower levels of knowledge. Only 85.7% of nurses reported that they could independently perform a blood glucose measurement with a glucometer, and as many as 56.5% were unable to determine the level of ketone bodies in the urine with Keto-Diastix test strips. Only 62.5% of nurses had a glucometer and glucometer strips in their nursing office. A total of 19.6% of nurses did not have glucagon (1 mg GlucaGen HypoKit®, Novo Nordisk A/S, Bagsværd, Denmark) or an ampoule with 20% glucose for an intravenous administration. The knowledge of school nurses about the principles of self-control and the treatment of type 1 diabetes mellitus is insufficient. Due to the strong increase in the incidence of type 1 diabetes mellitus among children and adolescents, it is important to organize permanent, continuous, and mandatory training on the principles of self-control and the treatment of type 1 diabetes mellitus for school nurses. The equipment in Polish school nurses’ offices should be supplemented with a working glucometer and blood glucose test strips, and the set of obligatory medications in the school nurse’s office should be supplemented with glucagon for students with type 1 diabetes mellitus. Full article
9 pages, 1682 KiB  
Article
Effect of Treatment and Nutrition on Glycemic Variability in Critically Ill Patients
by Cezary Kapłan, Alicja Kalemba, Monika Krok and Łukasz Krzych
Int. J. Environ. Res. Public Health 2022, 19(8), 4717; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084717 - 13 Apr 2022
Cited by 1 | Viewed by 1282
Abstract
Nondiabetic hyperglycemia is a dangerous metabolic phenomenon in the intensive care unit. Inattentive treatment of glycemic disorders is a serious health hazard promoting negative outcomes. The aim of our study was to assess glycemic variability and its basic determinants, and to verify its [...] Read more.
Nondiabetic hyperglycemia is a dangerous metabolic phenomenon in the intensive care unit. Inattentive treatment of glycemic disorders is a serious health hazard promoting negative outcomes. The aim of our study was to assess glycemic variability and its basic determinants, and to verify its relationship with mortality in patients hospitalized in a mixed ICU (intensive care unit). The medical records of 37 patients hospitalized 13 January–29 February 2020 were analyzed prospectively. The BG (blood glucose) variability during the stay was assessed using two definitions, i.e., the value of standard deviation (SD) from all the measurements performed and the coefficient of variation (CV). A correlation between the BG variability and insulin dose was observed (SD: R = 0.559; p < 0.01; CV: R = 0.621; p < 0.01). There was also a correlation between the BG variability and the total energy daily dose (SD: R = 0.373; p = 0.02; CV: R = 0.364; p = 0.03). Glycemic variability was higher among patients to whom treatment with adrenalin (p = 0.0218) or steroid (p = 0.0292) was applied. The BG variability, expressed using SD, was associated with ICU mortality (ROC = 0.806; 95% CI: 0.643–0.917; p = 0.0014). The BG variability in the ICU setting arises from the loss of balance between the supplied energy and the applied insulin dose and may be associated with a worse prognosis. Full article
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Review

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17 pages, 1126 KiB  
Review
Increased Risk of COVID-19 in Patients with Diabetes Mellitus—Current Challenges in Pathophysiology, Treatment and Prevention
by Tomasz Gęca, Kamila Wojtowicz, Paweł Guzik and Tomasz Góra
Int. J. Environ. Res. Public Health 2022, 19(11), 6555; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116555 - 27 May 2022
Cited by 22 | Viewed by 2418
Abstract
Coronavirus disease—COVID-19 (coronavirus disease 2019) has become the cause of the global pandemic in the last three years. Its etiological factor is SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus type 2). Patients with diabetes (DM—diabetes mellitus), in contrast to healthy people not suffering from [...] Read more.
Coronavirus disease—COVID-19 (coronavirus disease 2019) has become the cause of the global pandemic in the last three years. Its etiological factor is SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus type 2). Patients with diabetes (DM—diabetes mellitus), in contrast to healthy people not suffering from chronic diseases, are characterised by higher morbidity and mortality due to COVID-19. Patients who test positive for SARCoV-2 are at higher risk of developing hyperglycaemia. In this paper, we present, analyse and summarize the data on possible mechanisms underlying the increased susceptibility and mortality of patients with diabetes mellitus in the case of SARS-CoV-2 infection. However, further research is required to determine the optimal therapeutic management of patients with diabetes and COVID-19. Full article
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10 pages, 3132 KiB  
Review
Diabetic Mastopathy. Review of Diagnostic Methods and Therapeutic Options
by Paweł Guzik, Tomasz Gęca, Paweł Topolewski, Magdalena Harpula, Wojciech Pirowski, Krzysztof Koziełek, Marcin Żmuda, Marcin Śniadecki, Tomasz Góra, Paweł Basta and Artur Czekierdowski
Int. J. Environ. Res. Public Health 2022, 19(1), 448; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19010448 - 31 Dec 2021
Cited by 6 | Viewed by 4042
Abstract
Diabetic mastopathy is a rare breast condition that may occur in insulin-treated men and women of any age. The etiology is still unclear; however, the autoimmunological background of the disease is highly suspected. The changes in diabetic mastopathy may mimic breast cancer; therefore, [...] Read more.
Diabetic mastopathy is a rare breast condition that may occur in insulin-treated men and women of any age. The etiology is still unclear; however, the autoimmunological background of the disease is highly suspected. The changes in diabetic mastopathy may mimic breast cancer; therefore, its diagnostic process is demanding, and treatment options are not clear and limited. Lesions in DM are usually multiple; therefore, surgical removal is not fully effective. A well-done anamnesis with core-needle biopsy is essential and definitive in most cases. In this review, we summarize up-to-date knowledge of diagnostic methods and therapeutic options for diabetic mastopathy treatment and present three cases of diabetic mastopathy-type lesions in ultrasound and radiological examinations. Full article
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13 pages, 587 KiB  
Review
Comparison of Content and Quality of Caribbean, International, and High-Income Country-Specific Clinical Guidelines for Managing Type 2 Diabetes Mellitus
by Amy Latifah Nixon, Kaushik Chattopadhyay and Jo Leonardi-Bee
Int. J. Environ. Res. Public Health 2021, 18(24), 12868; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182412868 - 07 Dec 2021
Cited by 2 | Viewed by 1881
Abstract
Purpose. Type 2 diabetes mellitus (T2DM) is poorly managed in the Caribbean region; therefore, conducting an assessment on the content and quality of clinical guidelines could assist guideline developers in detecting and addressing information gaps. Hence, this study aimed to benchmark and compare [...] Read more.
Purpose. Type 2 diabetes mellitus (T2DM) is poorly managed in the Caribbean region; therefore, conducting an assessment on the content and quality of clinical guidelines could assist guideline developers in detecting and addressing information gaps. Hence, this study aimed to benchmark and compare the clinical guidelines for T2DM management from the Caribbean to guidelines developed internationally and by high-income countries. Methods. Seven T2DM management clinical guidelines were a priori selected from international and high-income country-specific clinical guidelines and then compared to the country-specific T2DM management clinical guidelines of the Caribbean region. Two reviewers independently assessed content (using a previously piloted data extraction form) and quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results. The Caribbean clinical guideline was found to contain similar levels of T2DM management topics when compared to international and high-income country-specific clinical guidelines; however, one country-specific clinical guideline from New Zealand was found to have substantially lower levels of content. The clinical guideline from the Caribbean was found to be of low quality and could not be used in practice; however, only three comparator clinical guidelines were found to be of high quality and could be recommended for use in clinical practice. A further three comparator clinical guidelines could be used in practice with minor modifications. Conclusion. Although the T2DM management clinical guidelines from the Caribbean region contained high levels of content with regards to relevant topics, it was of insufficient quality to be used in clinical practice. Therefore, an alternative high-quality clinical guideline, as identified within this study, should be adopted and used within the Caribbean region to manage T2DM until a high-quality region-specific clinical guideline can be developed. Full article

Other

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7 pages, 649 KiB  
Case Report
Non-Obese Type 2 Diabetes with a History of Being an Extremely Preterm Small-for-Gestational-Age Infant without Early Adiposity Rebound
by Nobuhiko Nagano, Chizuka Kaneko, Shoko Ohashi, Megumi Seya, Itsuro Takigawa, Ken Masunaga and Ichiro Morioka
Int. J. Environ. Res. Public Health 2022, 19(14), 8560; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19148560 - 13 Jul 2022
Cited by 3 | Viewed by 1329
Abstract
Adiposity rebound (AR), which is defined as a situation in which the body mass index (BMI) starts to increase after infancy, is a predictive marker of future development of type 2 diabetes. The patient was a 20-year-old male. He was born at 28 [...] Read more.
Adiposity rebound (AR), which is defined as a situation in which the body mass index (BMI) starts to increase after infancy, is a predictive marker of future development of type 2 diabetes. The patient was a 20-year-old male. He was born at 28 gestational weeks with a birthweight of 642 g (−3.20 standard deviation, small-for-gestational age [SGA]). AR during early childhood or obesity in later childhood was not observed. At the onset of type 2 diabetes (20 years of age), his BMI, body fat percentage, and body fat mass were within normal ranges (20.4, 18.4% and 10.8 kg, respectively). However, his muscle mass was 44.7 kg, with low muscle mass of the trunk and upper limbs, which was lower than the standard reference, indicating that myogenic insulin resistance was involved in the development of non-obese type 2 diabetes. This case report describes a patient with no presentation of AR and obesity during childhood, who was born extremely preterm SGA, developed non-obese type 2 diabetes with low muscle mass. We suggest that patients born extremely preterm SGA should be carefully observed for the development of type 2 diabetes, even if they did not have AR in early childhood or had not become obese. Full article
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9 pages, 461 KiB  
Study Protocol
Effects of Nursing Diabetes Self-Management Education on Glycemic Control and Self-Care in Type 1 Diabetes: Study Protocol
by Rocío Romero-Castillo, Manuel Pabón-Carrasco, Nerea Jiménez-Picón and José Antonio Ponce-Blandón
Int. J. Environ. Res. Public Health 2022, 19(9), 5079; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19095079 - 21 Apr 2022
Cited by 3 | Viewed by 3711
Abstract
(1) Background: Type 1 diabetes is a chronic disease that creates a high demand and responsibility for patient self-care. Patient education, self-care training and the management of derived complications are great challenges for nurses. The objective of this project is to evaluate the [...] Read more.
(1) Background: Type 1 diabetes is a chronic disease that creates a high demand and responsibility for patient self-care. Patient education, self-care training and the management of derived complications are great challenges for nurses. The objective of this project is to evaluate the efficacy of a therapeutic education program for type 1 diabetes. (2) Methods: Participants recruited to the study will be adult patients with diagnosed type 1 diabetes attending the clinic at the study site. A nurse diabetes educator will deliver a four-session education program. A two-group randomized controlled trial will be used in this study, with an intervention group and a control group. The subjects included in the experimental group will attend some health education sessions, while control group participants will receive the existing standard care provided by the endocrinology and nutrition unit of the hospital. Measurements and evaluations will be conducted at the baseline prior to the intervention and at 1 and 3 months from the intervention. (3) Conclusions: The primary outcome is improving patients’ knowledge about diet and treatment management. Secondary outcomes are improving patients’ glycemic control and mood. The findings from this study will help to determine the effect of diabetes education about self-care and treatment in patients with diabetes, as well as helping to decrease short-term and long-term complications and reduce health care costs. Full article
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