Good drug Compliance is essentail

Drug compliance is vital thing for all DM patients

for Life

1 Fast walking
2 Low carb
3 all good drugs

The benefit of fast walking in DM patients is enhanced blood sugar and blood pressure control. Finally the optimum fast walking can reduced mortality rate more than 50% in DM patients.

The secrete for diabetes patients

1 Select the doctor if you can.
The Internal medicine or endocrine specialist is prefer.Because they can should the right drug for you.

2 Check your medicine.

• aspirin if your age over 40 or with risk factor
• statin if LDL more than 100 mg/dL
• ACEI if blood pressure more than 130/90 mm Hg
• more DM drug for better life if A1C >7.0 %

3 Fast walking 45 min every day.

• fast walking is the best way of excersie that safe and effective

4 Low carb and low fat.

This food can control your blood sugar and lipid for long life survival.

Deep change in diabetes Care

Effects of Quality Improvement Strategies for Type 2 Diabetes on Glycemic Control

A Meta-Regression Analysis

Kaveh G. Shojania, MD; Sumant R. Ranji, MD; Kathryn M. McDonald, MM; Jeremy M. Grimshaw, MBChB, PhD; Vandana Sundaram, MPH; Robert J. Rushakoff, MD; Douglas K. Owens, MD, MS

JAMA. 2006;296:427-440.

ABSTRACT

Context There have been numerous reports of interventions designed to improve the care of patients with diabetes, but the effectiveness of such interventions is unclear.

Objective To assess the impact on glycemic control of 11 distinct strategies for quality improvement (QI) in adults with type 2 diabetes.

Data Sources and Study Selection MEDLINE (1966-April 2006) and the Cochrane Collaboration's Effective Practice and Organisation of Care Group database, which covers multiple bibliographic databases. Eligible studies included randomized or quasi-randomized controlled trials and controlled before-after studies that evaluated a QI intervention targeting some aspect of clinician behavior or organizational change and reported changes in glycosylated hemoglobin (HbA1c) values.

Data Extraction Postintervention difference in HbA1c values were estimated using a meta-regression model that included baseline glycemic control and other key intervention and study features as predictors.

Data Synthesis Fifty randomized controlled trials, 3 quasi-randomized trials, and 13 controlled before-after trials met all inclusion criteria. Across these 66 trials, interventions reduced HbA1c values by a mean of 0.42% (95% confidence interval [CI], 0.29%-0.54%) over a median of 13 months of follow-up. Trials with fewer patients than the median for all included trials reported significantly greater effects than did larger trials (0.61% vs 0.27%, P = .004), strongly suggesting publication bias. Trials with mean baseline HbA1c values of 8.0% or greater also reported significantly larger effects (0.54% vs 0.20%, P = .005). Adjusting for these effects, 2 of the 11 categories of QI strategies were associated with reductions in HbA1c values of at least 0.50%: team changes (0.67%; 95% CI, 0.43%-0.91%; n = 26 trials) and case management (0.52%; 95% CI, 0.31%-0.73%; n = 26 trials); these also represented the only 2 strategies conferring significant incremental reductions in HbA1c values. Interventions involving team changes reduced values by 0.33% more (95% CI, 0.12%-0.54%; P = .004) than those without this strategy, and those involving case management reduced values by 0.22% more (95% CI, 0.00%-0.44%; P = .04) than those without case management. Interventions in which nurse or pharmacist case managers could make medication adjustments without awaiting physician authorization reduced values by 0.80% (95% CI, 0.51%-1.10%), vs only 0.32% (95% CI, 0.14%-0.49%) for all other interventions (P = .002).

Conclusions Most QI strategies produced small to modest improvements in glycemic control. Team changes and case management showed more robust improvements, especially for interventions in which case managers could adjust medications without awaiting physician approval. Estimates of the effectiveness of other specific QI strategies may have been limited by difficulty in classifying complex interventions, insufficient numbers of studies, and publication bias.

Blood Sugar Testing

Source: Defeat Diabetes Foundation, Volume IV, Issue 7
Blood Sugar Testing
Questions:
What is a good blood sugar range for a person with diabetes?How do I check my blood sugar?When should I check my blood sugar?What is my A1c Test?What do the results of the A1c mean?
Answers:
What is a good blood sugar range for a person with diabetes?
A good fasting blood sugar (before breakfast) is <110 mg/dl.*A good blood sugar before bedtime is <140 mg/dl.*
*Remember that everyone is different and their reading will vary. Check with your doctor to find out your target blood sugar range.
How do I check my blood sugar?
Wash your hands with soap and water. Use warm water to allow more blood to circulate to the fingers. Dry your hands well before you pierce your finger.
Pierce the side of your finger. The tip of the finger contains more nerve endings and will hurt more than the side of your finger when pierced.
Change which finger you pierce each time you test your blood sugar. Using the same finger will cause the skin to become tough and more difficult to stick.
If you have questions about how to use your monitor call the toll-free telephone number listed on the monitor.
When should I check my blood sugar?
You and your doctor can learn something about your control each time you test and record your blood sugar. The best times to check your sugar are:
In the morning, before breakfast.
2 hours after a meal.
Before you go to bed at night.
Before and after you exercise.
If you are sick, have a fever or diarrhea, or have had changes in your medications, check your blood sugar more often.
Keep a log of your blood sugar levels, including the date and time of measurement. Bring this record with you each time you see your doctor. This will give you and your doctor a chance to check your blood sugar control and make changes in your treatment plan.
What is my A1c Test?
Self blood sugar testing reveals your blood sugar level at a particular moment. A1c is a blood test that reveals your average blood sugar level over the past 2-to-3 months. The result of this test gives you and your doctor a bigger picture of how well your diabetes is being controlled over time.
What do the results of the A1c test mean?
The results of the A1c test are given percentages:
6% = an average blood sugar of 120 mg/dl.
7% = an average blood sugar of 150 mg/dl.
8% = an average blood sugar of 180 mg/dl.
9% = an average blood sugar of 210 mg/dl.
A good A1c reading is below 6.5%.* Studies show that blood sugar levels under 150 mg/dl and A1c readings under 6.5%* reduce the risk of health problems related to poorly controlled diabetes, such as kidney, eye, heart, blood vessel, and nerve damage.
At least once a year show your doctor or diabetes nurse educator your blood glucose monitor and talk about any questions you may have.
*Reflects the new Diabetes Screening and Mangement Guidelines set by the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE), 2001.
Question: What are the normal ranges for the hemoglobin A1c?
Answer: Remember, the hemoglobin A1c result must be compared to the normal range for each particular lab. Eventually that normal range will be standardized to a range of 4-5% but some labs still have ranges that are quite different.
To convert the A1c to average blood glucose, consider the high end of the normal range (e.g. If normal is 4-6%, then 6%) is equal to 120 mg/dl. For each change in 1% of A1c, there is a corresponding increase or decrease of approximately 30 mg/dl average plasma glucose.
Question: What is the best way to measure control?
Answer: The A1c test is the preferred standard for measuring glycemic control. The A1c test measures your average blood glucose level over the past 2-to-3 months. It's the best tool you and your healthcare provider have to assess your overall control--and your risk of developing serious complications.
AACE recommends an A1c target goal of 6.5% or less, and also suggests having an A1c test at least 4 times per year.
You and your physician should determine how often you should test.
In fact, AACE recommends talking to your physician about your A1c during every visit.
A1c testing is not substitute for regular blood glucose monitoring.
Question: If I'm measuring my A1c, is blood glucose self-monitoring also necessary?
Answer: The A1c test and blood glucose monitoring work together. The A1c test shows your average blood glucose over the past 2-to-3 months--while testing with a glucose monitor shows your glucose level at a specific point in time.
If you're not in good control, self-monitoring your A1c and blood glucose can help you better understand your diabetes and how to manage it.
Talk to your physician about self-monitoring--and if a specific monitoring plan may make sense for you.

The practical recommendations for DM patientsII

Check LDL (cholesterol) every year.Control LDL blood level below 100 mg/dL by used statin drug such as simvastatin or Lipitor.

The practical recommendations for DM patients

If you are hypertension too.

1 You should use ACEI drugs such as enalapril or ramipril.
2 You must control your blood pressure below 130/90 mmHg.

Explanation:
The advantages of ACEI drugs(enalapril 0r ramipril) is to slow progression of kidney failure , heart failure and to increase insulin sensitivity.

Why do you must be use enalapril or ramipril ?

Because its can decreased mortality and mobility rate in DM patients.
This is the next best thing you should to do if you are DM patients.

If you want to know more... see this

META-ANALYSIS:The Impact of ACE Inhibitors or Angiotensin II Type 1 Receptor Blockers on the Development of New-Onset Type 2 DiabetesEffie L. Gillespie, C. Michael White, Michael Kardas, Michael Lindberg, and Craig I. ColemanDiabetes Care, Sep 2005; 28: 2261 - 2266.