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Archive - 07 - 2010
July 30, 2010 (EurekAlert) - Jennifer Dyer, MD, MPH, an endocrinologist at Nationwide Children's Hospital, has developed and completed a pilot study that uses weekly, customized text messages to remind adolescent diabetes patients about their personal treatment activities. At the conclusion of the study, Dr. Dyer found an increase in overall treatment adherence and improved blood glucose levels.
Dr. Dyer began developing this pilot study after realizing the potential of a simple reminder, in the form of a text message, which can be sent to her teenage patients. During the study, she sent personalized questions and reminders specific to diabetes adherence activities in addition to friendly, supportive messages to her patients. By asking questions about glucose testing, meal boluses and frequency of high and low glucoses, Dr. Dyer has seen an increase in teens taking their medications.
"If adolescent diabetes patients do not adhere to their treatment and medication plan, it can result in difficulty concentrating in school or functioning throughout the day," said Dr. Dyer, also an assistant professor of Pediatrics at The Ohio State University College of Medicine. "Excellent control and treatment can have a long term positive effect on a patient with diabetes."
The average teen sends about 50 texts each day while 75 percent of teen cell phone users have a cell phone plan with unlimited texting capabilities. Studies have shown that adolescent patients have a greater difficulty adhering to treatment and medication activities than adults. Thus, there is a significant correlation between increased independence and decreased treatment adherence in adolescents. The rate of medication non-adherence among adolescent recipients is approximately four times higher than that among adult recipients.
"This form of communication allows for real-time health management which is extremely valuable for patients that suffer from a chronic illness like diabetes," said Dr. Dyer, also a principal investigator in The Research Institute at Nationwide Children's Hospital.
Due to the success of this study, Dr. Dyer has applied for an internal grant in order to test an iPhone application that she has developed. This application will allow endocrinologists to send personalized, yet automated texts to multiple patients at a specific time.
July 29, 2010 (EurekAlert) - Aggressive blood sugar control does not improve survival in diabetic patients with kidney failure, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results suggest that physicians should individualize blood sugar targets for these patients and not rely on recommendations based on studies in the general population.
Uncontrolled blood sugar levels can cause serious health problems for diabetic patients with kidney failure; however, studies provide conflicting results on the benefits and risks of aggressive blood sugar control in these individuals.
By studying 24,875 dialysis patients for a maximum of three years of follow-up, Mark Williams, MD (Joslin Diabetes Center) and his colleagues found that only sustained extremeseither high or lowin blood sugar levels increased patients' risk of dying prematurely. Type 2 diabetes patients with hemoglobin A1c levels (a measure of average blood sugar levels) greater 11.0% were particularly at risk, with a 21% increased likelihood of dying during the study. In the small (5.5%) subgroup of patients with type 1 diabetes, those with hemoglobin A1c levels greater than 9% had a 52% increased risk of dying during the study.
"In the absence of randomized, controlled trials, these results suggest that aggressive [blood sugar] control cannot be routinely recommended for all diabetic hemodialysis patients on the basis of reducing mortality risk," the authors concluded. They encouraged physicians who treat diabetic patients with kidney failure to individualize blood sugar targets based on the potential risks and benefits for each patient.
Study co-authors include Eduardo Lacson Jr., MD, Weiling Wang, J. Michael Lazarus, MD, Raymond Hakim, MD, PhD (Fresenius Medical Care-North America).
In reviewing the results of this study in an accompanying editorial, Joachim Ix, MD (University of California, San Diego and Veterans Affairs San Diego Healthcare System) noted that "to date, there are no data available from randomized clinical trials targeting different hemoglobin A1c levels and powered for cardiovascular events or mortality in end-stage renal disease populations. In their absence, the marked statistical power and elegant analyses provided by these investigators provide useful insights." He agreed that individualized hemoglobin A1c targets might be more appropriate than a one-size-fits-all target.