Anke Braun

SGS: a structured treatment and teaching programme for older patients with diabetes mellitus—a prospective randomised controlled multi-centre trial

Objectives: evaluation of the effectiveness of a new structured diabetes teaching and treatment programme (DTTP) with specific didactical approaches and topics for geriatric patients with diabetes mellitus. Design: a prospective randomised controlled multi-centre trial. Setting and participants: a total of 155 geriatric patients were randomly admitted to either the new DTTP SGS (n = 83) or the standard DTTP (n = 72) for insulin-treated patients with type 2 diabetes mellitus (HbA1c 8.0 ± 1.4%, age 76.2 ± 6.3 years). Measurements: biometrical data, metabolic control, acute complications, diabetes knowledge, self-management. Results: SGS participants showed improved levels of HbA1c 6 months after the DTTP, and less acute complications than the standard group (P<0.009). Both groups demonstrated a good capacity for diabetes self-management and improvement in diabetes knowledge after the DTTP (P<0.01). Conclusion: the new SGS diabetes education programme, focusing on the learning capabilities and the particular needs of older persons, is effective in improving metabolic control and in maintaining auto-sufficiency in geriatric patients with diabetes mellitus.

Improving care for patients with dementia hospitalized for acute somatic illness in a specialized care unit: a feasibility study.

BACKGROUND Persons with dementia hospitalized for an acute illness have a high risk of poor outcomes and add to the burden on acute care systems. We developed a segregated Special Care Unit (SCU) in a somatic hospital for patients with challenging behavior resulting from dementia and/or delirium. This pilot study evaluates the feasibility and patient outcomes. METHODS The SCU was established with environmental features that allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Daytime activities structure the day and assure additional professional presence. The staff received intensive specialized training. Feasibility criteria were: acceptance by the staff, avoidance of transfers to geriatric psychiatry, lack of serious falls and mortality. Patient outcome criteria were ADL (Barthel index), mobility scores and behavior scores (Wilcoxons, McNemar tests, pre-post design). RESULTS 332 consecutively admitted patients were enrolled. The SCU has been well received by the staff. Length of hospital stay did not differ from other hospital patients (15.3 +/- 8.3 vs. 15.0 +/- 10.3 days, p = 0.54). Six patients were transferred to geriatric psychiatry. Two patients suffered a fall-related hip fracture. The median Barthel Index improved significantly (admission 30, discharge 45, p < 0.001), with only 8.5% of patients suffering functional loss. Wandering, aggression and agitation were significantly reduced (p < 0.001). CONCLUSIONS The SCU has improved the care of patients with challenging behavior. Decline in ADL function and institutionalization occurred to a lesser degree than would be expected in this group of patients. Despite the selection of patients with behavioral problems, transfer to psychiatry was rare.

A special care unit for acutely ill patients with dementia and challenging behaviour as a model of geriatric care

ZusammenfassungDieser Artikel beschreibt die Entwicklung eines innovativen Versorgungskonzepts zu Behandlung von Menschen mit Demenz, die in einem somatischen geriatrischen Krankenhaus stationär behandelt werden. Es wurde ein halb-geschlossener geschützter Spezialbereich für Patienten mit herausforderndem Verhalten eingerichtet, welches durch eine Demenz, eine Delir oder ein Delir bei Demenz bedingt ist. Innerhalb des Bereiches sind die Patienten in ihrer Mobilität nicht eingeschränkt. Die Milieugestaltung erzeugt eine möglichst wohnliche Atmosphäre. Tagesstrukturierende Maßnahmen führen zu Aktivierung und gewährleisten zusätzliche professionelle Präsenz. Es erfolgte eine intensives Schulungsprogramm für die Mitarbeiter. GISAD ist im Krankenhaus gut angenommen und wird als eine Verbesserung der Patientenversorgung angesehen. Die psychologische Belastung der Pflegenden hat trotz Selektion dieser schwierigen Patienten im Verlauf eines Jahres nicht zugenommen.AbstractThis paper describes the development and management of a new model of care for hospitalized patients with challenging behaviour evoked by dementia and/or delirium. To ameliorate care for patients with dementia in a geriatric acute care hospital a segregated Special Care Unit for patients with challenging behaviour was created. Environmental features allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Day-time activities structure the day and assure additional professional presence in the unit. An intensive training program for the staff was provided. The SCU has been well accepted by the staff and is considered to be an improvement in care. Psychological burden of the nurses did not increase over a time period of one year in caring for these difficult patients.

Retinal vessel response to flicker light in children and adolescents with type 1 diabetes mellitus and overweight or obesity.

UNLABELLED It was the goal of the trial to assess cardiovascular risk factors in children and adolescents with type 1 diabetes mellitus or overweight/obesity. All children and adolescents (n=77 [n=45 patients with diabetes mellitus, n=32 patients with overweight/obesity]) admitted to our hospital during the period from 01/07 to 31/08/2006 were included in the trial. Socio-demographic and laboratory data (age, sex, diabetes duration, BMI, BMI-SDS, HbA1c, fasting blood glucose, oGTT in patients with overweight/obesity, lipids, CRP, TSH, creatinine, and microalbuminuria) were assessed. The diameter of a retinal arterial and a venous segment was measured continuously on-line with a Dynamic Vessel Analyzer, carotid intima-media thickness (IMT) was measured, and 24-h-blood pressure monitoring was applied. RESULTS Flicker light stimulation induces a comparable arterial dilatation in patients with type 1 diabetes and overweight/obesity. Univariate ANOVA in patients with type 1 diabetes shows an influence of diastolic blood pressure on arterial dilatation. Other factors such as BMI, age, diabetes duration, smoking, sex, HbA1c and insulin dose/kg had no effect. CONCLUSIONS In children and adolescents with diabetes or overweight/obesity retinal vascular alterations seem to be more sensitive and already present before the occurrence of classic cardiovascular markers.

Flexible intensive versus conventional insulin therapy in insulin-naive adults with type 2 diabetes: an open-label, randomized, controlled, crossover clinical trial of metabolic control and patient preference.

Improving metabolic control can reduce complications in type 2 diabetes (1–4). Conventional insulin therapy (CIT) and flexible intensive insulin therapy (FIT) are treatment options in insulin-dependent type 2 diabetic patients. In CIT, participants inject premixed human insulin (30% regular insulin, 70% NPH insulin) before breakfast and dinner and follow individually adjusted diet plans with fixed amounts of carbohydrates (5). In FIT, human regular insulin is adjusted before main meals according to current blood glucose readings and desired carbohydrate intake. When necessary, NPH insulin is added at bedtime. CIT can be easy to handle and requires less active diabetes self-management. In FIT, patients benefit from dietary freedom and improvement in quality of life (6). In pilot studies, FIT has shown good metabolic control and low risk of hypoglycemia (7). FIT may have additional advantages due to better postprandial blood glucose control (8). We tested the hypothesis that FIT and CIT in insulin-naive adults with type 2 diabetes are equally effective in regard to metabolic outcomes. We hypothesized that younger participants, in employment, would prefer FIT. The trial was designed as a clinical, prospective, randomized, open-label, single-center, crossover study. The primary end point was glycosylated hemoglobin A1c (GHb); secondary end points were mild and severe hypoglycemia, insulin dosage, blood pressure, BMI, and therapy preference. Participants started insulin therapy either with CIT (group A) or FIT (group B), randomly. Individual insulin dosage and carbohydrate intake were determined …

Cognitive Function Is Not Associated With Recurrent Foot Ulcers in Patients With Diabetes and Neuropathy

OBJECTIVE To study whether there is an association between cognitive impairment and the relapse rate of foot ulcers in diabetic patients and those with previous foot ulcers. RESEARCH DESIGN AND METHODS This single-center prospective study assessed the association of cognitive function and risk for ulcer relapse in 59 patients with diabetes (mean age 65.1 years, diabetes duration 16.5 years, and A1C 7.4%), peripheral neuropathy, and a history of foot ulceration. Premorbid and current cognitive functions were measured (multiple-choice vocabulary test [Lehrl], number-symbol test, mosaic test [HAWIE-R], and trail-making tests A and B [Reitan]). Prevalence of depression was evaluated retrospectively (diagnoses in patient files or use of antidepressive medication). Patients were re-examined after 1 year. RESULTS Three patients (5%) died during follow-up (one of sepsis and two of heart problems). The remaining 56 patients (48%) developed 27 new foot ulcerations (78% superficial ulcerations [Wagner stage 1]). Characteristics of patients with and without ulcer relapse were not different. In a binary logistic regression analysis, cognitive function is not predictive of foot reulceration. CONCLUSIONS Cognitive function is not an important determinant of foot reulceration.