Ceriello A.,Hospital Clinic Barcelona |
Barkai L.,University of Miskolc |
Christiansen J.S.,Aarhus University Hospital |
Czupryniak L.,Medical University of Lódz |
And 12 more authors.
Diabetes Research and Clinical Practice | Year: 2012
As non-communicable or chronic diseases are a growing threat to human health and economic growth, political stakeholders are aiming to identify options for improved response to the challenges of prevention and management of non-communicable diseases. This paper is intended to contribute ideas on personalized chronic disease management which are based on experience with one major chronic disease, namely diabetes mellitus.Diabetes provides a pertinent case of chronic disease management with a particular focus on patient self-management. Despite advances in diabetes therapy, many people with diabetes still fail to achieve treatment targets thus remaining at risk of complications. Personalizing the management of diabetes according to the patient's individual profile can help in improving therapy adherence and treatment outcomes. This paper suggests using a six-step cycle for personalized diabetes (self-)management and collaborative use of structured blood glucose data. E-health solutions can be used to improve process efficiencies and allow remote access. Decision support tools and algorithms can help doctors in making therapeutic decisions based on individual patient profiles. Available evidence about the effectiveness of the cycle's constituting elements justifies expectations that the diabetes management cycle as a whole can generate medical and economic benefit. © 2012 Elsevier Ireland Ltd.
Ghafoor F.,Pakistan Medical Research Council |
Malik T.,Warwickshire General Hospital |
Naz R.,Diabetic Clinic
Iranian Journal of Diabetes and Lipid Disorders | Year: 2010
Background: Leptin, an adipokine, is considered to have a role in obesity and associated metabolic dysfunction. Serum leptin has generally been reported as lower in Caucasian subjects with diabetes. In non-caucasian groups, however, the data on leptin in subjects with diabetes is more controversial being reported as lower, similar or higher than controls. We report on serum leptin concentrations in obese Pakistani subjects with type 2 diabetes mellitus and their age and weight matched controls. Methods: We compared fasting serum leptin concentrations in 71 (11 males & 60 females) obese Pakistani subjects with type 2 diabetes attending diabetic clinic and 73 (12 male & 61 females) age and weight matched controls, from hypertensive clinic of Shaikh Zayed Hospital, Lahore, Pakistan. Results: The median ages of study cases and controls were 45.8 yrs and 40.3 yrs respectively. The median BMIs of study cases and controls were 32.4 and 33.4 kg/m2 respectively. Serum leptin concentrations in females and males with diabetes [median inter quartile range, 21.5 (14.1-28.7) and 11.7 (4.7-18.5) μg/L, respectively] were lower (P<0.005) than in their respective female and male controls [112.6 (88.6- 136.2) and 43.6 (29.2-57.2) μg/L, respectively]. Serum leptin concentrations were similar in females and males with diabetes, where as in non-diabetic females leptin concentrations were found higher than non-diabetic males (P<0.05). Conclusion: We report lower serum leptin concentrations in obese Pakistani subjects with type 2 diabetes mellitus. We suggest that this may be due either to altered fat distribution or to relative insulin deficiency in type 2 diabetes or both.