RESUMEN
OBJECTIVE: To identify barriers to appropriate dietary behavior in an urban, low-income population of patients with type 2 diabetes and to examine a new instrument in the identification of these barriers in this population. METHODS: A cross-sectional survey was developed, validated, and anonymously administered to low-income adults with type 2 diabetes in an academic family medicine physician group practice with a pharmacist-operated diabetes education and comanagement service. The survey consisted of three key subscales: determinants of food selection, importance of life challenges, and barriers to appropriate eating. RESULTS: The survey was administered to 98 patients with a mean age of 51.98 years, a mean duration of diabetes of 9.76 years, and a mean hemoglobin A1c of 7.99%. When asked to rate factors most important in food selection, the highest mean responses were taste (3.97 out of 5) and cost (score of 3.94 out of 5). Barriers that the majority of respondents agreed or strongly agreed were important included: stress causing over-eating or unhealthy food choices, difficulty resisting the temptation to eat unhealthy food, and healthy food being too expensive. The Cronbach's Alpha for the subscales of food selection, importance of life challenges, and barrier were 0.673, 0.853, and 0.786, respectively. CONCLUSIONS: In a low-income, urban, predominantly African American and Caucasian diabetic population, cost of healthy food, stress-related inappropriate eating, and the temptation to eat unhealthy food were the most frequently reported barriers to healthy eating. Diabetes education programs serving similar populations should evaluate the presence of these barriers. The survey instrument was a reliable measure of the constructs it purported to measure.
RESUMEN
INTRODUCTION: Acute hyperglycemia (blood glucose [BG] ≥400 mg/dL) is common in primary care. An outpatient protocol was developed to streamline the treatment of acute hyperglycemia. The objective was to determine if an outpatient hyperglycemia protocol could achieve a BG level of <300 mg/dL within 4 hours. METHODS: Adult diabetic patients with acute symptomatic hyperglycemia (>400 mg/dL) without acute illness were recruited. Enrolled patients were managed with a protocol that included administration of 0.15 units/kg rapid-acting insulin given subcutaneously, hydration, hourly fingerstick blood sugars (FSBS), laboratory assessment, tailored diabetes education, and follow-up within 72 hours. Independent variables for data analysis included age, baseline FSBS, sodium, potassium, chloride, blood urea nitrogen, serum creatinine, CO(2), venous glucose, and etiology (medications, diet, personal stress). RESULTS: For the 27 patients enrolled, the average initial FSBS level (n=23) was 484 mg/dL, the average final FSBS level (n=27) was 274 mg/dL, and average time to achieve BG levels of <300 mg/dL was 2.35 hours. The protocol was successful in 20 patients (74%). The causes for seven protocol failures were nonclinical in nature. The patients' weight and total time to goal were significantly associated with odds of protocol success. Personal stress significantly correlated with protocol failure. The protocol success group had a higher sodium level than the failure group (P=0.01). Weight and baseline BG showed decreased odds of protocol success (P=0.05 and P=0.04, respectively). CONCLUSIONS: Results of this pilot study suggest acute hyperglycemia without other acute illness can be managed on an outpatient basis. Outpatient interventions to addres s acute hyperglycemia need further investigation. Managing acute hyperglycemia in the outpatient setting could potentially decrease hospital admissions for hyperglycemic hyperosmolar syndrome and mild diabetic ketoacidosis.
RESUMEN
OBJECTIVES: To determine the feasibility of educating adults about their risk of prediabetes/diabetes in a community pharmacy, to determine the common risk factors for prediabetes/diabetes in adults visiting a community pharmacy, and to assess any association between risk factors and age. DESIGN: Cross sectional. SETTING: Oklahoma community pharmacies between April 1 and December 31, 2008. PARTICIPANTS: 1,852 patients aged 18 to 80 years. INTERVENTION: Student pharmacists invited adults to complete a survey to assess their risk for diabetes/prediabetes. Students reviewed participants' risk and educated them on lifestyle changes to lower diabetes risk. MAIN OUTCOME MEASURES: Patient risk factors, pharmacy identifier, and pharmacy type (independent, chain, or clinic pharmacy) and location (rural, suburban, or city). RESULTS: Diabetes risk assessment and education of 1,852 adults was performed by 110 student pharmacists in 52 community pharmacies located in 27 cities across 13 (of 77) Oklahoma counties. Obesity/overweight was the most common risk factor (57%), with positive family history, hypertension, elevated cholesterol, member of high-risk ethnic group, and sedentary lifestyle being reported by at least 20% of participants. The number of risk factors increased with age, with a significant increase occurring in participants older than 40 years of age. CONCLUSION: This project demonstrated that it is feasible to perform diabetes risk assessment and to provide education on lowering that risk through community pharmacies.