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Biomedical subjects

D G Marrero

Publications and source records attributed to D G Marrero.

34 records · Page 2Linked to original sources
PubMed1989

Management of diabetes in pediatric resident continuity clinics.

General pediatricians provide comprehensive care for many children with insulin-dependent diabetes mellitus. To assess and improve our ambulatory training program, we first evaluated diabetes-specific care behaviors by residents in their continuity clinics and then introduced a structured visit encounter form. Based on established guidelines provided to the residents, a chart audit indicated appropriate measurement of glycosylated hemoglobin 40% of the time, cholesterol 90% of the time, urine protein 50% of the time, and thyroxine 66.7% of the time. Height was plotted 23% of the time, blood pressure was noted 66% of the time, and ophthalmologic referrals were documented 60% of the time. Requests for assistance from nonphysician members of a multidisciplinary diabetes team were minimal. After introduction of the structured visit encounter form, care behaviors did not improve. New training approaches to prepare general pediatric residents to provide excellent diabetes care are needed.

Ambulatory Care Facilities↗
PubMed1989

Clinical evaluation of computer-assisted self-monitoring of blood glucose system.

The Glucometer M Diabetes Management System includes a glucose-reflectance meter with memory that can interface with a microcomputer for data manipulation and analysis. We evaluated the system in a short-term randomized control trial to determine its impact on metabolic control, self-monitoring of blood glucose (SMBG) testing behaviors, regimen self-adjustment, understanding of insulin-dependent diabetes mellitus (IDDM) treatment, attitudes about SMBG, and perceived quality of patient-physician interaction. Twenty-nine adolescent subjects (experimental) with IDDM were randomly assigned the Glucometer M system for 4 mo. Twenty-eight control subjects used meters without memory. All subjects returned twice to the clinic at 2-mo intervals during the study. At clinic visits, both groups reviewed their SMBG data with their physician. Reviews on experimental subjects were conducted with computer-generated data formats. Control subject reviews used traditional logbooks. Both groups showed a significant drop in glycosylated hemoglobin during the study period (P less than .001); however, there were no between-group differences. There were also no differences in SMBG testing behavior or self-reported regimen self-adjustment between groups or within groups compared with baseline. Compared with control subjects, experimental subjects indicated a significant increase in self-reported understanding of IDDM treatment (P = .002), perceived importance of testing (P = .006), and the quality of interaction with their physician (P less than .001). These data suggest that use of computer-assisted SMBG systems in the outpatient setting does not improve metabolic control over 4 mo. It may, however, contribute to improving communication between the patient and health-care providers.

Blood Glucose Self-Monitoring↗
PubMed1989

Pediatric endocrinologic recommendations, pediatric practice, and current pediatric training regarding care of children with diabetes.

Many pediatric diabetes patients are cared for by community-based pediatricians. Training for pediatricians in optimal diabetes care should be based on both the recommendations of pediatric endocrinologists regarding optimal care and the practices of general pediatricians. Pediatric endocrinologists, general pediatricians, and pediatric residency coordinators were surveyed to assess the consonance of current recommendations, practices, and training in pediatric diabetes care. Not surprisingly, pediatric endocrinologists recommended more subspecialty care than pediatricians reported practicing. A major difference between endocrinologists and pediatricians emerged in the area of psychosocial support. A total of 85% of endocrinologists answered that there should be a mental health diabetes team member, but only 37% of pediatricians reported often or sometimes working with one to develop care plans. Pediatricians who provide complete diabetes care for most of their patients measure frequent glycosylated hemoglobin levels, obtain yearly lipid measurements marginally less often, and use urinary glucose measurements more often than recommended by pediatric endocrinologists. According to the descriptions of most pediatric residency training programs, multidisciplinary teams include a pediatrician, an endocrinologist, and a dietician. However, 25% do not include a social worker or nurse and 70% do not include a psychologist. Although most training programs operate on the assumption that their trainees will ultimately share responsibility with a subspecialist for diabetes care, in 26% of programs residents saw no diabetics in their continuity clinics. Most residents do not participate in providing diabetes education.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1988

Improving compliance with exercise in adolescents with insulin-dependent diabetes mellitus: results of a self-motivated home exercise program.

In this project we investigated the impact of a 12-week at-home aerobic fitness program on aerobic capacity and metabolic control of ten adolescents (four girls and six boys 12 to 14 years of age) with insulin-dependent diabetes mellitus. The adolescents had no prior experience with exercise training. The 45-minute program, designed by a physical therapist, consisted of a stretching, calisthenics, and "cool-down" routine set to popular music. It was taught to the youngsters in group sessions. Each adolescent was given audio- and videocassettes of the routine for home use that emphasized self-motivation in maintaining training. The youngsters were asked to exercise three times per week and were also taught how to adjust their insulin and diet for exercise. Aerobic fitness was determined by maximal oxygen uptake following a vigorous, continuous progressive cycling test; metabolic control was measured by glycosylated hemoglobin values. All of the adolescents reported greater than 85% completion of the program. The youngsters displayed a correspondingly significant increase in aerobic fitness as measured by maximal oxygen uptake: 40.39 +/- 8.87 v 44.86 +/- 12.89 mL/kg/min. Glycosylated hemoglobin levels (mean +/- SD) for the entire group were significantly reduced after the program (11.41 +/- 4.47% v 10.01 +/- 3.21%). Results of this study indicate that nonathletic adolescents with insulin-dependent diabetes mellitus can engage in self-motivated exercise training at home. If properly designed, such programs can improve aerobic fitness and may contribute to improvement in diabetes control.

Adolescent↗
PubMed1982

Use of a glucose-controlled insulin infusion system in children and adolescents with insulin-dependent diabetes.

Seven children and adolescents (aged 8 to 23 years, mean 16 years) with poorly controlled insulin-dependent diabetes mellitus were evaluated with a glucose-controlled insulin infusion system (GCIIS) to determine whether its use could help define appropriate long-term insulin treatment regimens and increase patient understanding and compliance with such regimens. The GCIIS-derived insulin regimen was characterized by a mean insulin requirement of 1.0 +/- 0.1 units/kg/day, with 55% of the total insulin dose given in the morning and 45% in the evening. Forty-eight percent of the total insulin was short acting. Both clinical and biochemical indices of metabolic control (HbA1c levels) improved after insulin dose readjustment based on GCIIS data. The continuous documentation of blood glucose levels provided by the GCIIS was valuable in educating patients about the interrelationship between insulin, exercise, and diet. Using GCIIS data, patients were taught to apply the new regimen flexibly to variations in activity and diet. Thus, the GCIIS can aid in the management of selected children and adolescents with insulin-dependent diabetes millitus. Insulin patterns derived from its use suggest that a flexible, twice daily regimen characterized by nearly equal proportions of short- and intermediate-acting preparations may be beneficial for other pediatric patients.

Adolescent↗
PubMedDate not supplied

Primary care physicians' practice patterns and diabetic retinopathy. Current levels of care.

BACKGROUND: Diabetic retinopathy is a costly and prevalent complication of diabetes mellitus. OBJECTIVE: To assess primary care physicians' self-reported practice patterns for the screening and detection of diabetic retinopathy relative to published guidelines. PARTICIPANTS AND METHODS: All primary care physicians (defined as general internists, family practitioners, and general practitioners) in Indiana were identified and surveyed using a mailed questionnaire. Of 2390 physicians, 1508 (63%) responded and were determined to be eligible. Of these 1508 physicians, 1058 (70%) completed all or some of the eye care-related questions. For each eye care practice, physicians were asked to specify the proportion of patients to which the practice was applied and the frequency (eg, every 3 months) with which the behavior was performed, if appropriate. Physicians were also asked to distinguish between patients with type I (insulin-dependent) and type II (non-insulin-dependent) diabetes mellitus for each practice behavior. RESULTS: Physicians' responses were classified as "high," "moderate," or "low" based on the American Diabetes Association guidelines. Forty-five percent of the physicians' responses were classified as high for referring all of their patients with type I diabetes mellitus to an eye care specialist annually as were 35% of the physicians' responses for referring their patients with type II diabetes mellitus. Fewer physicians reported high levels of routine in-office funduscopic examination. No relationship was found between the extent to which physicians performed an in-office funduscopic examination and patterns of referral to eye care specialists. Logistic regression analysis suggested that recent graduates and general internists are most likely to report behavior that is considered high (P < .05). CONCLUSION: The diabetic retinopathy-related practice patterns of primary care physicians in Indiana differ significantly from published guidelines.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

Pharmaceutical care in chain pharmacies: beliefs and attitudes of pharmacists and patients.

OBJECTIVE: To discuss with pharmacists and patients with reactive airways disease their beliefs about pharmaceutical care and the pharmacist's role in health care, obstacles to providing pharmaceutical care in community pharmacies, and strategies to overcome these obstacles. DESIGN: Two focus groups of patients, two focus groups of pharmacists. PARTICIPANTS: Thirteen patients with reactive airways disease and 11 chain pharmacists. MAIN OUTCOME MEASURES: Qualitative reports on the pharmacist's role in health care delivery and obstacles to implementing pharmaceutical care programs. RESULTS: Pharmacists wished to provide pharmaceutical care, and patients were supportive of pharmacists' involvement in their health care. Both viewed counseling as an important role for pharmacists and believed that pharmacists should work with patients' physicians. Reported obstacles included lack of time, inadequate privacy, and pharmacists' lack of direct access to patients' physicians. Pharmacists and patients believed pharmacists should have access to patient-specific clinical data. CONCLUSION: Focus groups provided valuable information for designing pragmatic pharmaceutical care. The obstacles and possible solutions identified through the discussions represent fertile ground for designing innovative pharmaceutical care programs.

Asthma↗
PubMedDate not supplied

Sequencing diet and exercise programs for African American women with diabetes.

PURPOSE: This study was designed to compare the effects of 2 programs that present diet and exercise components in a different sequence. METHODS: At an urban YMCA, African American women with type 2 diabetes, aged 30 to 65, were randomly assigned to either 10 weekly sessions about healthy eating followed by 6 weekly sessions about exercise or to the reverse sequence. Sessions consisted of small group discussions and physical activity or food tasting. Primary outcomes were attendance, percent of calories consumed from fat, fruit and vegetable intake, and minutes of exercise per week. Measures were taken at baseline, and 4 and 12 months after the program. RESULTS: The only group difference found at the 12-month follow-up was in diastolic blood pressure. Time effects for both groups combined included an increase in minutes of activity, an increase in vegetable intake, and a decrease in percent of calories consumed from fat. CONCLUSIONS: This study does not provide definitive evidence of which sequence may be best to bring about behavior change. The effects of sequencing difficult behavioral changes such as diet modification and establishing an exercise habit deserve further study.

Adult↗
PubMedDate not supplied

A modified quality-of-life measure for youths: psychometric properties.

In the Diabetes Control and Complication Trial (DCCT), a Diabetes Quality of Life (DQOL) measure was developed to assess the psychosocial impact of intensified regimens. Its applicability for use with children and adolescents was limited by the exclusion criteria of the DCCT. In this study, the DQOL was modified for specific use in young diabetes populations. The result is an instrument composed of three intercorrelated scales--a Diabetes Life Satisfaction scale, a Disease Impact scale, and a Disease-Related Worries scale--with satisfactory levels of reliability. While the scale variances were independent of glycosylated hemoglobin values, they were related to adolescents' perception of their general health status. Self-perceived quality of life related to diabetes management is an important alternative outcome for diabetes education programs.

Adolescent↗
PubMedDate not supplied

Parents of children with diabetes: what are they worried about?

Parental worries, specific to having a child with diabetes, have been associated with poor diabetes control. This study addressed three questions relating to this issue: Does parental worry affect the metabolic control of the child with IDDM? What specific aspects of diabetes are the most worrisome to parents? Do these concerns change with the child's age and disease duration? Parents of 93 children with IDDM were given a modified version of the Diabetes Quality of Life measure to evaluate diabetes-specific worries. No correlation was found between parental worry and the child's metabolic control. Parents of younger children expressed the largest amount of worry, yet the kinds of things that parents were most concerned about were the same, regardless of age or duration of the child's disease.

Adolescent↗
PubMedDate not supplied

Using telecommunication technology to manage children with diabetes: the Computer-Linked Outpatient Clinic (CLOC) Study.

The purpose of this study was to evaluate the efficacy of using a telecommunication system to assist in the outpatient management of pediatric patients with insulin-dependent diabetes. Metabolic control, patients' psychosocial status, family functioning, perceived quality of life, patterns of parental/child responsibility for daily diabetes maintenance, and nursing time-on-task were evaluated. One hundred six pediatric patients (mean age = 13.3 years) were randomly assigned to an experimental or control outpatient clinic for 1 year. Experimental subjects transmitted self-monitoring blood glucose data by modem to the hospital every 2 weeks. Transmitted data were reviewed by nurse practitioners who telephoned subjects to discuss regimen adjustments. Control subjects received standard care with regimen adjustments made by physicians. There were no significant between-group differences for metabolic control, rates of hospitalization or emergency-room visits, psychological status, general family functioning, quality of life, or parent-child responsibility. A significant decrease was noted in nursing time-on-task for experimental subjects.

Adolescent↗
PubMedDate not supplied

Fear of hypoglycemia in the parents of children and adolescents with diabetes: maladaptive or healthy response?

Sixty-one parents of children with insulin-dependent diabetes mellitus completed modified versions of the Hypoglycemic Fear Survey (HFS) and the Diabetes Quality of Life (DQOL) scale. They also indicated their child's history of hypoglycemic-related seizures or loss of consciousness (SLC) events. Parental HFS scores were significantly greater if their child had ever experienced a SLC event or experienced a SLC event within the past year. Parental HFS scores were positively correlated with general parental worry about their child having diabetes. Adolescent children who experienced a SLC event during the past year reported greater HFS scores, greater general worry about diabetes, and a greater negative impact of having diabetes compared with adolescents with no such history. Despite the greater fear of hypoglycemia in parents and adolescents, there was no significant difference in HbA1 values between children with or without any history of SLC events or children with or without a SLC event within the past year.

Adaptation, Psychological↗
PubMedDate not supplied

Characteristics of adolescents with poorly controlled diabetes referred to a tertiary care center.

The medical and psychosocial findings concerning 15 adolescents with poorly controlled diabetes referred to a tertiary center are reviewed. While referring physicians usually attributed poor metabolic control to an unusual idiosyncratic pathophysiologic aspect of diabetes, all patients were managed by conventional treatment regimens. Psychosocial problems, including excessive school absence, depression, and social isolation were frequent in this population, and in eight families emotional factors appeared to contribute to the development and persistence of poor metabolic control. Eight patients accepted psychosocial intervention consisting of individual, family, and/or group counseling. Not one of the patients has been hospitalized for ketoacidosis in the subsequent 12-18-mo period, and their psychosocial functioning as adolescents is improved. Hemoglobin A1c levels remained elevated. Psychosocial factors in adolescents experiencing poor metabolic control should be addressed.

Absenteeism↗