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The purpose of this study was to investigate diabetes self-care behaviors, stigmatization and A1C as predictors of a negative perception of insulin treatment in insulin-treated type 2 diabetic patients.

A descriptive cross-sectional and relational design was used. The study was carried out in the Diabetes Training Centre and Endocrine and Metabolism Clinic of a university hospital in the southeast of Turkey between May and October 2017. The research sample consisted of 100 type 2 diabetic patients determined by using a convenience sampling method. An introductory information form for type 2 diabetic patients, the Insulin Treatment Appraisal Scale (ITAS), Diabetes Self-Care Activities Survey (DSCAS) and Barriers to Insulin Treatment Scale (BIT) were used to collect the research data. The data were analyzed using descriptive statistics, correlations and step wise multi-linear regression.

The number of daily insulin injections, training received about insulin and stigmatization was significant predictors of a negative perception of insulin treatment.

Strategies to decrease diabetic individuals' fear of stigmatization should be utilized to minimize their negative insulin treatment perception (giving diabetic individuals training about diabetes, planning public training to inform society and using mass media tools). Diabetes educators should know that diabetic individuals' perception of the severity of the illness could influence the daily number of injections applied and decrease the negative perception regarding insulin.

This paper explores intensive self‐management of type 1 diabetes with insulin pump therapy as an enabling technology and reports barriers in the communication process with health professionals providing diabetes care who are unfamiliar with this treatment. Questionnaire responses and telephone interviews from a study conducted with 78 people using pump therapy in 2006 showed that individuals attending diabetes centres that were not pump‐trained suffered poor communication and a lack of support for intensive diabetes self‐management. As a result, some pump users did not visit their diabetes centre for care and management of the condition, preferring to communicate with the pump manufacturer and a national insulin pump therapy support organisation because they were familiar with the treatment. Nonetheless, all pump users had a strong sense of self‐efficacy concerning their mastery of the treatment technology to prevent, delay or stabilise the chronic complications of type 1 diabetes. Conclusions are linked to the Insulin Pump Services Report (Department of Health, 2007) and specific guidance on the use of pump therapy with patients by trained health professionals.

For years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.

In this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.

QALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.

This study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

Public health policy often excludes access to essential medicines. Drawing on an in-depth case study examining access to essential medicines in the context of the HIV/AIDS pandemic in South Africa, and more briefly, making reference to the U.S. diabetes epidemic, we highlight the relationship between the need for essential medicines in world populations, and the role of groups external to government in promoting access to essential medicines in public health policy. We consider how, in the context of health stratification, the activities of patient advocacy groups, and “third way” social policies of the pharmaceutical industry generate “social capital,” creating enhanced access to essential medicines for a few, and promoting the ideal of the right to access for all. The implications for the development of public health policy inclusive of essential medicines are discussed.

This interview discusses a “Blue Ocean” strategy initiative: how to introduce effective change in diabetes care into Thailand given a strong reluctance in patients, and in Thai society, to see that diabetes is not a condition to be treated by doctors alone.

An interview with Dr Thep Himathongkam, the pioneer of holistic diabetes care in Thailand.

One strategic management problem he faced was the lack of suitably trained staff. Thailand had no university courses producing the multidisciplinary personnel needed for diabetes treatment such as diabetes educators, dieticians, or foot care specialists. He address the multidisciplinary personnel shortage by training the missing specialists, getting universities on board and more recently securing funding from the World Diabetes Foundation.

The result of the diabetic foot-care training for more than 2,500 personnel, mostly from community hospitals, has been markedly successful, with a reduction in annual amputations in Thailand of 80 per cent over five years.

This interview offers a look at the multi-track problem solving required to successfully implement a Blue Ocean strategy.

This paper's aim is to identify whether community‐level socioeconomic status (SES) predicts: screening test for pre‐diabetes; actual diagnosis of pre‐diabetes; or nutritional counseling.

This is an analysis of 1,348,124 insured adults receiving medical care from Maccabi Healthcare Services (MHS) in 107 MHS clinics throughout Israel. The research population comprised 79 percent of the MHS members over 18 years of age in 2004‐2006. Area level socioeconomic data were drawn from the Israel Central Bureau of Statistics SES index for every geographical area and each MHS clinic in the study was coded from: −1.03 to 2.73 (−1.03 indicating low SES and 2.73+ high SES) according to the SES index for the location. The fasting glucose laboratory test was used for analysis. Pre‐diabetes diagnosis was based on a fasting glucose above 100 mg/dl. Nutritional counseling was defined by dietitian visits in the claims database.

The percentage of insured individuals who underwent blood glucose testing during the study increased with age from 67 percent at ages 18‐45 to 92 percent for age 65 and over. The percentage of individuals diagnosed with pre‐diabetes also increased with age, rising from 4 percent in the younger group to 14 percent in those aged 46‐65 and to 14‐16 percent of 65 and older. The percentage of individuals with pre‐diabetes who visited a dietitian was 16‐27 percent for those under 65 and 14‐17 percent for those over 65 (males and females, respectively). Individuals living in lower socioeconomic areas were less likely to have blood tests. Among tested patients, the prevalence of pre‐diabetes was higher in areas of lower SES and their dietitian visits were less frequent.

In lower SES index areas, there is a need for better identification and treatment of patients.

The paper shows that a proactive approach is needed both to detect pre‐diabetes and to encourage patients to receive nutritional treatment.

This study uses ethnographic data from two diabetes clinics to examine how some organizational features of medical settings are connected to the daily cognitive and interactional work of medical providers – specifically, the process of assessing patient adherence and using such assessments to make treatment decisions. I address continuity of care, scheduling and time constraints, team management, provider interaction, and medical recordkeeping as organizational-level issues that impact individual-level providers’ work. More than a top-down model of how “macro” influences “micro,” this study highlights how organizational influences are accounted for in terms of variation in patients’ behavior.

The purpose of this study is to examine the acute toxicity and antidiabetic activity of Asystacia gangetica leaf ethanol extract.

The study was designed as completely randomized in vivo experimental model. Where acute toxicity study was carried out using 30 albino mice, randomly assigned into six groups of five mice each. Toxicity signs and mortality were observed in the rats within a period of 24 h. The acute and sub-acute antidiabetic study was carried out using 50 rats, randomly assigned into five groups of 10 rats each. The rats’ blood glucose levels were determined and used to assess the acute and sub-acute antidiabetic activity of the extract.

Results obtained from the acute toxicity study indicated no death in any of the study groups, even at 5,000 mg/kg body weight and showed no signs of toxicity. The acute antidiabetic study showed that treatment with 400 mg/kg of the extract significantly (p = 0.01) lowered glucose level in the diabetic rats from 430.6 to 177.4 mg/dl while 800 mg/kg brought down glucose level from 370 to 144.2 mg/dl by the end of 6 h following administration when compared with the diabetic control group. It was observed that the effect of the extract mostly at 800 mg/kg also compared favorably with that of the standard drug (glibenclamide), which lowered glucose level in diabetic rats from 374.2 to 176.4 mg/dl. Furthermore, the significant reduction was evident from 4, 2 and 2 h for 400 mg/kg extract, 800 mg/kg extract and 5 mg/kg glibenclamide, respectively. At sub-acute level the blood glucose was lowered from 155.6 to 127.2 mg/dl, 137 to 124.4 mg/dl and 151.8 to 121.8 mg/dl for diabetic rats treated with 400 mg/kg, 800 mg/kg and 5 mg/kg glibenclamide, respectively, when compared to the diabetic untreated rats, which ranged from 417.6 to 358.6 mg/dl. The biochemical profile, lipid profile and hematological examination were all positively restored near to normal with the herbal treatment at the different doses. At histopathology level, the liver of the rats treated with 400 mg/kg had moderate portal inflammation without interface or lobular hepatitis while that of 800 mg/kg showed severe portal inflammation with the interface and lobular hepatitis with extensive confluents necrosis. The pancreatic cells of the treated rat showed no significant difference in the β-cells of the islets of Langerhans with hyperplasia of the acinar cell when compared to the diabetic untreated.

The record of no death and signs of toxicity implies that the extract is safe for consumption even at a high dosage of 5,000 mg/kg body weight. The significant (p = 0.01) reduction in the plasma glucose level of the treated rats as compared to the control is an indication of blood glucose-lowering potential of the extract at two different doses. The significant reduction evident of the extract at different hours and days for the two doses implies that the extract rate of lowering potentials is dose-dependent. The evidence of moderate-severe portal inflammation with the interface and lobular hepatitis at 800 mg/kg treatment is an indication that the intake of this herb at high dosage for long period is not safe for the liver tissue.

The outcome of this study suggested that the Asystacia gangetica should also be used as a vegetable in-home food preparation and food processing to use its antidiabetic effect. The herbal extract could also be incorporated into a food product and processed into herbal tea bag for convenient. The subjection of this herbal plant to heat treatment during processing could be a possible avenue to make it safe.

The economic burden and complications of diabetes mellitus management will be reduced if the practical implication of this research finding is implemented in foods as vegetable and in functional food production.

This study revealed that Asystacia gangetica leaf extract may be safe and effective for use at a low dose for acute management of diabetes mellitus. This research may be of value to those living with diabetes mellitus.

Diabetes mellitus has become a major world health problem that has unenviable impacts on health of the people including quality of life (QOL) also and in which person’s physical and psychological state, social commitments and relationships and his interaction with the environment is affected. This shows that there is an urgent need for behavior change and considerable educational strategies for proper management and rehabilitation (Reddy, 2000). This research has identified and ranked the significant factors which affect the QOL in diabetic patients in India. The paper aims to discuss these issues.

In this paper, nine factors which affect the QOL in diabetic patients in India have been identified through review of the literature and evaluated by total interpretive structural modeling (TISM) approach, i.e. an extended version of ISM. In this approach, interpretations of the interrelationship among factors have been discussed. Therefore, TISM approach has been used to develop the model and the mutual interactions among these factors.

The results of the model and MICMAC analysis indicate that diet restriction, body pain and satisfaction with treatment are the top-level factors.

Identification of the factors that have a remarkable effect on the QOL in diabetic patients is very important so that the doctors and other healthcare professionals may handle these factors efficiently and proper rehabilitation can be provided to such patients.

This paper has used an application of the TISM approach to interpret the mutual relationship by using the tool of interpretive matrix and has developed a framework to calculate the drive and the dependence power of factors using MICMAC analysis. The issues related to QOL are extremely important, as they can strongly anticipate a person’s capability to govern his lifestyle with disease like diabetes mellitus and maintain good health in the long run. This shows the urgent requirement of an optimized model which can predict and interpret the relationships among these factors. In this research, the interrelationships among these factors have been developed and interpretations of these interactions have been given to develop a comprehensive model so that QOL of diabetic patients may be improved.

The aim of this paper is to link complexity theory to the intentional change process by examining the role of emotional attraction. A research study currently underway on intentional change theory (ICT) in a healthcare context is presented.

This paper uses the concept of “attractors” from complexity theory to suggest that emotion affects the process of intentional change in different ways dependent upon whether the emotion is positive or negative. Determination of the emotion in this way proposes the existence of either a positive emotional attractor (PEA) or a negative emotional attractor (NEA). The paper discusses positive psychology's perspective on the differential impacts of positive and negative emotion. The paper also outlines an ongoing research project at a Veterans Affairs Medical Center which examines the concept of PEA and its effect on diabetes self‐management as well as its consequent role in improved health.

A review of the literature and subsequent development of hypotheses and the conceptual model, indicate education for chronically ill adults must be purposeful and directed toward a self‐perceived need for personal change; include their own disease experience; allow them to become active participants in learning; and lastly, the learning process should be considerate of individual cognitive ability.

ICT could address the needs of chronically ill patients as its focus is a self‐directed journey to personal change and learning. The potential of ICT is enormous given that diabetes is a national problem that has reached epidemic proportions.