Biomedical subjects

A L Graber

Publications and source records attributed to A L Graber.

At least 19 recordsLinked to original sources

PubMed1992

Dropout and relapse during diabetes care.

OBJECTIVE: To determine factors associated with dropout and relapse during chronic diabetes care. RESEARCH DESIGN AND METHODS: Private practice outpatient treatment-education program for adult diabetes was surveyed. Retrospective analysis was done, involving 422 patients for up to 3 yr. RESULTS: Of the patients in the study, 12% dropped out after the initial visit, and 33% of the residual cohort dropped out during each subsequent 6-mo period. Factors associated with dropout included distance from home to clinic > 100 miles, lack of insulin treatment, and cigarette smoking. In patients who remained in follow-up, a significant decrease in HbA1C occurred during the first 6 mo, but 40% of the patients relapsed between 6 and 12 mo. Frequency of relapse declined as time passed. Relapse was more frequent in women. CONCLUSIONS: Dropout from treatment and relapse after temporary improvement account for a substantial amount of uncontrolled diabetes, and overcoming the obstacles of dropout and relapse has potential for significant improvement in diabetes care.

Adolescent↗

PubMed1987

Management of diabetes mellitus in the home, office and hospital.

Explore the source record for details and available documents.

Blood Glucose↗

PubMed1986

Clinical characteristics of hospitalized diabetic patients.

In an inpatient diabetes control unit established to fulfill the special needs of hospitalized diabetic patients, 29% of the admissions were for control of diabetes. In 71% the metabolic abnormalities of diabetes were incidental to the cause of admission. Of the first 232 patients, 162 had type II diabetes. The degree of hyperglycemia in the type II patients was virtually identical to that in the type I patients, as measured by hemoglobin A1C levels at admission and by mean blood glucose values in the hospital. The mean hemoglobin A1C level at admission was 9.1% in both groups (normal 3.2 to 6.1). During hospitalization the patients admitted for medical and surgical problems achieved average blood glucose levels similar to levels in those who were admitted strictly for diabetes control. Regardless of the reason for admission, hospitalization of a diabetic patient is an opportunity for improvement in metabolic control and for patient education.

Adult↗

PubMed1986

Effects of intensified practitioner-patient communication on control of diabetes mellitus.

Control of diabetes mellitus requires active participation of patients in self-care and ongoing support from medical professionals. This study examines the hypothesis that control of diabetes can be improved by more frequent communication between patients and medical professionals. We instructed 233 insulin-requiring diabetic patients to mail the results of home blood glucose monitoring to the physician's office at least every two weeks. Feedback from office nurse practitioners followed receipt of these reports, providing frequent two-way communication between regularly scheduled office appointments. In the group of patients who mailed reports more than 26 weeks during the year, the mean glycosylated hemoglobin (GHb) value was 10.4% at baseline, and there was a mean decrease in GHb of 1.0% during the succeeding year (P = .001). In patients who mailed reports less than 26 weeks during the year, mean GHb was 10.2% at baseline, and there was no significant change during the succeeding year. Since mean GHb was virtually identical in the two groups at baseline, mailing the reports of home-determined blood glucose levels and receiving feedback between office visits resulted in improved control of diabetes.

Blood Glucose↗

PubMed1978

Coordinated metabolic and obstetric management of diabetic pregnancy.

Diabetes during pregnancy is associated with insulin resistance, an increase in insulin requirement, and a greater tendency to ketosis and ketoacidosis. Increased perinatal mortality is related to maternal hyperglycemia and can be decreased dramatically with strict control of plasma glucose during pregnancy and a smooth-working obstetrician-internist-neonatologist team. Bad prognostic signs include pyelonephritis, ketoacidosis, toxemia, and poor prenatal care. Timing of delivery is no longer arbitrary at 36 or 37 weeks, but is based upon signs of fetal lung maturation and estimates of fetal risk. Abnormalities in the infant, including congenital abnormalities, biochemical abnormalities, respiratory distress syndrome, and large body weight must be managed in a well-equipped newborn intensive care unit under the care of experienced neonatologists. Strict attention to these principles has resulted in viable infants in the last 36 pregnant diabetic patients delivered at Vanderbilt University Hospital. Therefore, close medical supervision, use of modern obstetric technics, and the availability of a well-equipped and staffed neonatal intensive care unit can result in a good outcome in this group of patients. Finally, the decision for pregnancy must be carefully considered by the diabetic patient, her husband, and her physician long before pregnancy occurs.

Adolescent↗

PubMed1977

Evaluation of diabetes patient-education programs.

Patient education is generally regarded as an essential component of the clinical management of diabetes. However, analysis of the role of patient education in diabetes control has been limited. Formal patient teaching programs at several medical centers range in operation from merely providing knowledge about diabetes to integrating patient education into the chronic health care system. Improvements in knowledge about diabetes have been demonstrated with patients who have been given questionnaires before and after instruction, but changes in diabetes control and other clinical parameters have not necessarily followed. In those cases in which patient education has been a part of a comprehensive improvement in the entire clinical management of diabetes, significant decreases in rates of hospitalization and acute complications have occurred. Guidelines for future evaluations are discussed.

Diabetes Mellitus↗

PubMed1977