In many American Indian communities, the rate of diabetes has increased dramatically over the past 20 years. This health problem has become a major challenge for the Indian Health Service (IHS). The Diabetes Education Program of the IHS wanted to use the National Standards to promote the best quality diabetes education programs in all IHS and tribal facilities. However, the review criteria for the National Standards had to be adapted to fit the unique needs of the Indian communities. This paper describes the process used to evaluate and modify the review criteria to implement the National Standards within IHS health care facilities.

Diabetes Mellitus, Type 2↗

PubMedDate not supplied

Comparing self-reported measures of diabetes care with similar measures from a chart audit in a well-defined population.

The objective of this study was to compare self-reported measures of diabetes care with measures derived from medical records in a well-defined population. Diabetes measures were collected through a 1997 Behavioral Risk Factor Surveillance System telephone survey of American Indians living on or near 7 Montana reservations (N = 398) and were compared with data collected from charts of a systematic sample of American Indians with diabetes seen in 1997 at Indian Health Service (IHS) facilities. Survey respondents were more likely to report a duration of diabetes > or = 10 years (44 vs 31%), annual dilated retinal exam (75 vs 59%), and an influenza immunization in the past year (73 vs 57%) compared with estimates from the chart audit. Estimates of pneumococcal immunization (88 vs 42%), annual cholesterol screening (86 vs 69%), and overweight, based on body mass index (67 vs 50%), were significantly higher from the chart audit. No significant differences were found between the survey respondents and the chart audit data for annual foot exams (65 vs 61%), annual blood pressure checks (98 vs 93%), high cholesterol (35 vs 41%), and high blood pressure (54 vs 64%). These findings suggest that self-reported data may over and underestimate specific measures of diabetes care.

Adult↗

PubMedDate not supplied

How accurate are insulin mixtures prepared by the patient?

The accuracy of mixing two types of insulin in one syringe was studied in 41 insulin-dependent diabetic patients who prepared a mixture of two fluids (saline and sterile water) with either a disposable, 1-ml plastic syringe with a fixed needle, i.e., with a small dead space, or one equipped with a separate needle. Syringes with fixed needles delivered the two components very accurately and were associated with only slight wastage of insulin of 0.011 ml per injection. The syringe with a separate needle delivered 0.033-0.065 ml more than the intended dose of the "first insulin" and correspondingly less of the intended dose of the "second insulin," since the total dose delivered was approximately correct. The magnitude of the insulin wastage of two daily injections was calculated to be 64 ml per patient annually, which could be reduced to 8 ml per patient if fixed needles were used. It is therefore recommended that patients preparing mixtures of two insulins in the same syringe abandon syringes with separate needles.

Adult↗