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Differences in Diabetes Prevalence, Incidence, and Mortality Among the Elderly of Four Racial-Ethnic Groups: Whites, Blacks, Hispanics, and Asians. Diabetes Care. 27(10): 2317-2324. October 2004.

This article reports on a study undertaken to examine the prevalence and newly diagnosed cases of diabetes among Medicare elderly beneficiaries in the years 1993-2001, as well as mortality rates among individuals with diabetes. Comparisons are made between four racial or ethnic groups (whites, blacks, Hispanics, and Asians), five age-groups, and both sexes. The study was a retrospective analysis of a 5 percent random sample of Medicare fee-for-service beneficiaries older than 65 years in each of the study years. In 1993, the prevalence of diabetes among those older than 67 years of age was 145 cases per 1,000 individuals. By 2001, the prevalence in this population was 197 per 1,000, an increase of 36.0 percent. The 2001 prevalence among Hispanics (334 per 1,000) was significantly higher than among blacks (296 per 1,000), Asians (243 per 1,000), and whites (184 per 1,000). During the 7-year study period, the greatest increase in diabetes prevalence was among Asians. The mortality rate among individuals with diabetes decreased by approximately 5 percent between 1994 and 2001. No decrease in mortality was seen in the same time period among elderly individuals without diabetes. The authors conclude that the dramatic increase in the incidence and prevalence of diabetes likely reflects a combination of true increases, in addition to changes in the diagnostic criteria and increased interest in diagnosing and appropriately treating diabetes in the elderly. Improved treatment may have had an impact on mortality rates among individuals with diabetes, although they could have been influenced by the duration of diabetes before diagnosis, which has likely decreased. 1 figure. 3 tables. 38 references.

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Taking Charge of Diabetes: A Diary.

This booklet helps people newly diagnosed with diabetes to record and understand their food intake. Understanding food intake and blood glucose levels is the first step to controlling diabetes. The booklet begins with a discussion of some basics of diabetes management, including the importance of frequent blood glucose testing, high blood glucose (hyperglycemia) levels and their symptoms, how to know when symptoms consist an emergency that needs treatment, low blood glucose (hypoglycemia) symptoms and emergency care, the importance of exercise, stress reduction, the different types of meal planning (exchange lists, carbohydrate counting) that may be utilized, food labels, weight loss, and complications and how to prevent them. Most of the brochure consists of a blank food diary that covers three meals plus snacks every day for 11 weeks. Simple exchange lists are provided. The back cover of the brochure provides space for a dietitian or other health care provider to note the recommended personal meal plan. Throughout the brochure facts and practical tips are noted. The brochure is illustrated with cartoon line drawings.

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Have Your Cake and Eat It Too! Tips to Lighten-UP Your Family's Favorite Treats. Chicago, IL: American Dietetic Association. 2003. 2 p.

All types of foods, even sweets, can fit into a diabetes meal plan. This educational fact sheet helps readers newly diagnosed with diabetes understand how to include sweets and other carbohydrates in their meal planning. The fact sheet walks readers through the steps required to modify regular family recipes to be healthier: start one ingredient at a time, reduce or replace high calorie ingredients, add extra flavor and texture, and fine-tune recipes. The second page of the fact sheet includes a chart of specific suggestions for replacing common foods in baking and cooking. The fact sheet concludes with the contact information for the American Dietetic Association (www.eatright.org, 800-366-1655). 1 table.

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Identification and Management of Diabetic Nephropathy in the Diabetes Clinic. Diabetes Care. 26(6): 1806-1811. June 2003.

This article reports on a study undertaken to examine the prevalence and management of diabetic nephropathy in a diabetes clinic; the patients identified with current screening protocols were compared to those identified by a nurse-led management program. In phase I, 644 patients attended a diabetes clinic over a 6 month period. Microalbuminuria (protein in the urine) results were available for 485 patients (75 percent). A total of 115 patients were identified as having diabetic nephropathy (prevalence 17.8 percent). Of these patients, 91 percent had type 2 diabetes. During phase II, prospective analysis of urinary albumin-to-creatinine ratio was carried out in 880 patients over 8 months. A total of 174 patients were identified as having diabetic nephropathy (prevalence 20 percent). Of these, 134 patients had been identified by existing screening protocols. Forty had no previous record of microalbuminuria and were therefore newly identified by prospective screening. Systolic blood pressure guidelines were met in only 31 percent of all known patients in the study with nephropathy and 26.5 percent of newly diagnosed patients with nephropathy. Diastolic blood pressure guidelines were met in 36 percent of all known and 38 percent of newly diagnosed patients with nephropathy. The authors conclude that introduction of a nurse-led management program significantly improved detection of diabetic nephropathy. 2 figures. 4 tables. 37 references.

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Mastering Your Diabetes (Before Diabetes Masters You). Alexandria, VA: American Diabetes Association. 2003. 123 p.

This book is written for patients newly diagnosed with diabetes mellitus. Written by a diabetes health care professional who has also lived with diabetes for more than 25 years, the book covers the emotional, physical, and practical aspects of living with diabetes. Fifteen chapters cover adjusting to a diagnosis of diabetes, definition of diabetes (including the different types), the physiology of diabetes, short-term complications of high glucose levels (hyperglycemia), monitoring blood glucose levels (SMBG), medications that are used to treat diabetes, diet therapy to help manage diabetes, hypoglycemia (low blood glucose), the role of exercise, general health care recommendations, sick days, the emotional side of diabetes, long-term complications of diabetes, and how to stay motivated to maintain healthy self-care strategies. A subject index concludes the book.

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Prevalence of Diabetes Is Higher Among Female than Male Zuni Indians. Diabetes Care. 26(1): 55-60. January 2003.

This article reports on a study that tested the hypothesis that diabetes and related risk factors are more common among female than male Zuni Indians. The authors conducted a population-based, cross-sectional survey of the Zuni Indians aged greater than 5 years. The authors used households within neighborhood clusters as the sampling frame. The prevalence of previously diagnosed diabetes among Zuni Indians aged greater than 5 years (n = 1,503) was higher among female Zuni Indians (16.7 percent) than male Zuni Indians (9.7 percent). The prevalence of newly diagnosed diabetes was similar among female Zuni Indians (2.4 percent) and male Zuni Indians (2.4 percent). The prevalence of obesity was higher among female Zuni Indians (34.3 percent) than male Zuni Indians (21.5 percent). Obesity was associated with diabetes among female and male Zuni Indians. Physical inactivity was more common among female than male Zuni Indians. However, physical inactivity was not associated with diabetes among either female or male Zuni Indians. Gestational diabetes was a risk factor among female Zuni Indians. The authors conclude that the prevalence of diabetes was 57 percent higher among female than male members of the population. Cultural, traditional, and lifestyle differences may contribute to the higher prevalence of diabetes and obesity among female Zuni Indians. 4 tables. 28 references.

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Quality of Care for Patients Diagnosed with Diabetes at Screening. Diabetes Care. 26(2): 367-371. February 2003.

Screening for diabetes has the potential to be an effective intervention, especially if patients have intensive treatment of their newly diagnosed diabetes and comorbid hypertension (high blood pressure). This article reports on a study undertaken to determine the process and quality of diabetes care for patients diagnosed with diabetes by systematic screening. A total of 1,253 patients of a Veterans Affairs Medical Center aged 45 to 64 years who did not report having diabetes were screened for diabetes with an HbA1c (glycosylated hemoglobin, a measure of blood glucose levels over time) test. All subjects with an HbA1c level greater than 6.0 percent were invited for follow up blood pressure and fasting plasma glucose (FPG) measurements. A case of unrecognized diabetes was defined as HbA1c greater than 7.0 percent. For each of the 56 patients for whom a new diagnosis of diabetes was determined, the authors notified the patient's primary care provider of the diagnosis. One year after diagnosis, the authors performed follow up and review of the patient's medical records. Among patients diagnosed with diabetes at screening, 34 of 53 (64 percent) had evidence of diet or medical treatment for their diabetes, 42 of 53 (79 percent) had HbA1c measured within the year after diagnosis, 32 of 53 (60 percent) had cholesterol measured, 25 of 53 (47 percent) received foot examinations, 29 of 53 (55 percent) had eye examinations performed by an eye specialist, and 16 of 53 (30 percent) had any measure of urine protein. The mean blood pressure decline over the year after diagnosis for patients with diabetes was 2.3 mmHg; this decline was similar to that found for 183 patients in the study without diabetes. The authors conclude that patients with diabetes diagnosed at screening achieve less tight blood pressure control than similar patients without diabetes. Primary care providers do not appear to manage diabetes diagnosed at screening as intensively as long-standing diabetes and do not improve the management of hypertension given the new diagnosis of diabetes. 3 tables. 18 references.

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Cystic-Fibrosis-Related Diabetes Mellitus. Diabetes Educator. 28(5): 768, 770-771, 774-775. September-October 2002.

This article describes the care of patients with cystic-fibrosis-related diabetes mellitus (CFRD). The authors present a case report of a patient with CFRD in order to describe the patient care issues that need to be managed. The authors note that alone, cystic fibrosis requires a complicated treatment regimen. The diabetes treatment plan must complement this regimen without unnecessary burden. The authors describe the challenges of providing diabetes education for a 30 year old woman with newly diagnosed CFRD. She presented an opportunity for collaboration between pulmonologists, endocrinologists, nurses, and dietitians in the inpatient and outpatient practice settings. Topics include the patient background and history, the use of carbohydrate counting, capillary blood glucose monitoring (SMBG), insulin therapy, hypoglycemia (low blood glucose), and hospital discharge and follow up. The authors conclude that as the life expectancy for persons with CF increases, so does the likelihood of CFRD. As for all patients with diabetes, optimal glucose control is a worthwhile goal in this already high-risk population. 1 figure. 10 references.

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Diabetes Primer. Diabetes Forecast. 55(3): 63-67. March 2002.

This article helps readers newly diagnosed with diabetes to better understand their disease. The author guides readers through the maze of lifestyle changes that a diagnosis of diabetes mandates. The author emphasizes that the earlier a patient educates him or herself and applies that new knowledge to every day diabetes care, the better chance they will have of living a normal life. The author defines diabetes and explains what goes wrong in type 1 and type 2 diabetes; explains the importance of nutrition; encourages readers to incorporate exercise into their diabetes management plan; and reviews the types of medications, including insulin, that can be used to treat diabetes. Other topics are monitoring (checking one's blood glucose levels), foot care, and the need for ongoing patient education and support groups. One sidebar explains low blood sugar (hypoglycemia) and how to combat it. 1 figure.

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Hospital Admission Guidelines for Diabetes Mellitus. Diabetes Care. 25(Supplement 1): S109. January 2002.

This brief article presents the American Diabetes Association position statement on hospital admission guidelines for diabetes mellitus. Inpatient care may be appropriate in the following situations: life threatening acute metabolic complications of diabetes, newly diagnosed diabetes in children and adolescents, substantial and chronic poor metabolic control that requires close monitoring to determine cause, severe chronic complications of diabetes that require intensive treatment, other severe conditions unrelated to diabetes that significantly affect its control or are complicated by diabetes, and institution of insulin pump therapy or other intensive insulin regimens. The guidelines are outlined in detail in the position statement. The authors caution that guidelines are never a substitute for medical judgment, and each patient's total clinical and psychosocial circumstances must be considered in their application.

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