diabetes assignment introduction

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What Is Diabetes?

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Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Glucose is your body’s main source of energy. Your body can make glucose, but glucose also comes from the food you eat.

Insulin is a hormone  made by the pancreas  that helps glucose get into your cells to be used for energy. If you have diabetes, your body doesn’t make enough—or any—insulin, or doesn’t use insulin properly. Glucose then stays in your blood and doesn’t reach your cells.

Diabetes raises the risk for damage to the eyes, kidneys, nerves, and heart. Diabetes is also linked to some types of cancer. Taking steps to prevent or manage diabetes may lower your risk of developing diabetes health problems.

What are the different types of diabetes?

The most common types of diabetes are type 1, type 2, and gestational diabetes.

Type 1 diabetes

If you have type 1 diabetes , your body makes little or no insulin. Your immune system  attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes

If you have type 2 diabetes , the cells in your body don’t use insulin properly. The pancreas may be making insulin but is not making enough insulin to keep your blood glucose level in the normal range. Type 2 diabetes is the most common type of diabetes. You are more likely to develop type 2 diabetes if you have risk factors , such as overweight or obesity , and a family history of the disease. You can develop type 2 diabetes at any age, even during childhood.

You can help delay or prevent type 2 diabetes  by knowing the risk factors and taking steps toward a healthier lifestyle, such as losing weight or preventing weight gain.

Gestational diabetes

Gestational diabetes is a type of diabetes that develops during pregnancy. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a higher chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is type 2 diabetes.

Prediabetes

People with prediabetes  have blood glucose levels that are higher than normal but not high enough to be diagnosed with type 2 diabetes. If you have prediabetes, you have a higher risk of developing type 2 diabetes in the future. You also have a higher risk for heart disease than people with normal glucose levels.

Other types of diabetes

A less common type of diabetes, called monogenic diabetes , is caused by a change in a single gene . Diabetes can also come from having surgery to remove the pancreas, or from damage to the pancreas due to conditions such as cystic fibrosis or pancreatitis .

How common are diabetes and prediabetes?

More than 133 million Americans have diabetes or prediabetes. 1

As of 2019, 37.3 million people—or 11.3% of the U.S. population—had diabetes. 1 More than 1 in 4 people over the age of 65 had diabetes. Nearly 1 in 4 adults with diabetes didn’t know they had the disease. 2

About 90% to 95% of diabetes cases are type 2 diabetes. 3

In 2019, 96 million adults—38% of U.S. adults—had prediabetes. 4

What other health problems can people with diabetes develop?

Over time, high blood glucose can damage your heart , kidneys , feet , and eyes . If you have diabetes, you can take steps to lower your chances of developing diabetes health problems  by taking steps to improve your health  and learning how to manage the disease . Managing your blood glucose, blood pressure, and cholesterol levels can help prevent future health problems.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Daniel Bessesen, M.D., University of Colorado; Domenico Accili, M.D., Columbia University

Essay on Diabetes

Introduction

Diabetes is a healthcare condition that has continued to affect so many people, both young and old. Understanding more about Diabetes will help people live a healthy lifestyle by avoiding all the possible things that might cause it. In this assignment, I will assess why Diabetes is a significant health issue to individuals and the world. I will discuss the background of Diabetes, its definitions, and the types of Diabetes. Besides, I will discuss what is needed to promote individual and group health for people who have Diabetes. By the end of the assignment, one will have better knowledge about Diabetes since I will also discuss the causes and preventive measures that can be undertaken to prevent the disease. Towards the end of the assignment, I will describe three achievable health promotion goals, hence helping fight against Diabetes. I will also describe some of the interventions and roles that different people, groups, and organizations play to reduce the high cases of Diabetes in the world.

During the medieval ages, being diagnosed with Diabetes was like a death sentence. The pioneers of diabetes treatment were Thomas Willis, Sushruta, and Arataeus (Mandal, 2021). The three were Greek physicians who encouraged people to exercise on horsebacks to prevent excess urination. They also described other therapies like overfeeding and taking wine to reduce starvation and excessive loss of fluids (Mandal, 2021). On the other hand, the ancient Indians would test for Diabetes by taking ants near a person’s urine. If the human urine attracted the ants, then the person would be diagnosed with urine (Mandal, 2021). Diabetes is a disease that is the leading cause of high blood sugar levels. People who have Diabetes have bodies that cannot make enough insulin, or their bodies cannot use the insulin they have effectively (Healthline, 2021). Insulin is the hormone that moves sugars from the blood to the body cells. There are several types of Diabetes, including type 1 diabetes, type 2 diabetes, gestational diabetes, prediabetes, and Diabetes insipidus (Healthine, 2021). All these types affect our bodies differently, and they all have different effects, hence different coping strategies.

The rationale for Choosing Diabetes

Diabetes is among the most severe health issues in the world. This is the reason why I chose to discuss it to create awareness about it. The bad thing with Diabetes is that one can get it and not know that they have it. By the time they realize that they have Diabetes, the condition is worse, and the person is highly affected. According to Genesis Medical Associates (2015), one out of three adults have higher blood sugar levels; a condition referred to as prediabetes. If the persons do not change their lifestyles, the sugar levels increase, leading to other types of Diabetes (Genesis Medical Associates, 2015). Learning about Diabetes will allow people to support each other in the fight against Diabetes. This includes eating healthy meals and maintaining a healthy lifestyle through exercising (Dowshen, 2021). Another reason why I chose to discuss Diabetes is to learn more about the causes and how to manage the disease. Since most people do not know about the condition, it is crucial to educate them so that in case they feel any symptoms, and they can get the treatment as early as possible (Dowshen, 2021). It is easy to deal with Diabetes as long as the signs are detected early enough and the patient follows the given guidelines on healthy living.

Epidemiology

Diabetes is a significant health concern since it affects so many people in the world. Diabetes can affect any person. However, some ethnic groups are affected more than others. The Alaska Natives and the American Indians are more affected by Diabetes as compared to all other ethnic groups. In terms of age, more than sixty-five years are more prone to getting diabetes than young people. According to Shaikh (2021), % of the people who are more than 65 years have diabetes. However, the young people are also affected but at a meager percentage compared to the older people.

The risk factors for Type 1 diabetes are hereditary, hence easily transferred from parents to children. Type 1 diabetes primarily affects young children and teenagers. Also, white Americans are at a higher risk of getting the disease than African Americans and Latino Americans (Shaikh, 2021). Type 2 diabetes affects middle and old age persons. Also, other risk factors for type 2 diabetes include genes, being overweight, a history of gestational pregnancy, and giving birth to a baby that is more than 9lbs (Shaikh, 2021).

It is important to note that diabetes is more prone in rural areas where people do not have access to health services and education. In the United Kingdom, 28% of the people with diabetes have issues obtaining medication due to a lack of health services and knowledge on how to go about diabetes treatment (Whicher et al., 2019 p.243). Besides, most of the people who are in the rural do not go for annual health checkups; hence their conditions get worse daily.

Assessment and assessment tools for Diabetes

Different tools are used during the assessment of diabetes. Assessing diabetes is very important as it helps differentiate between different types of diabetes and the extent of the condition. The Diabetes Prevention Screening Tool helps identify the persons at risk of getting diabetes (Diabetes Education Services, 2021). Such people are encouraged to join the CDC prevention program. There is also the Risk Test for Pre Diabetes patients to understand the risks they face as pre-diabetics (Diabetes Education Services, 2021).

The Diabetes Risk calculator is a tool that is used to detect undiagnosed diabetes and prediabetes. The social Support Assessment Tool helps diabetic patients to have a support system (Diabetes Initiative, 2020). Patients who have Diabetes need a lot of support from family and friends. The support shown will help them adhere to the doctor’s instructions, hence improving the chances of being better. Another assessment is the Mental Health Progress Report. The report is filled up during the patient’s follow-up visits. The assessment involves questions determining if the patient is affected by the condition mentally (Diabetes Initiative, 2020). It helps the doctors to guide the patient on how they can cope mentally with Diabetes.

Health Promotion Goals that you will like to Achieve

One of the goals that I would like to achieve is to reduce the high number of people diagnosed with Diabetes. I will encourage people to ensure they exercise at least thirty minutes a day to become physically fit. To make this goal achievable, I will create small groups that will act as support systems. This will help push people towards healthy living, preventing them from being diagnosed with the condition (Cecelia Health, 2021). My goal is realistic since it is easy to adopt a good eating habit and exercise at least thirty minutes daily. Still, it becomes easier when these activities are done in groups so that members feel motivated. To ensure that the goal is achieved, I will set a time frame of three months. Each member must have dropped at least 10 pounds within three months and managed to exercise at least 30 minutes daily, consistently.

The second goal is to enhance a better diabetes management program. Most people who have diabetes do not know what they should avoid, while others ignore the advice given to them by the doctors. In this case, I will form a group of people of different ages who are diabetic. The group formed will be a support system that will help each other cope with Diabetes. I will encourage the group members to remain healthy by eating the right food and exercising daily (McDermott, 2020). For those that are older, they can do simple exercises like jogging and walking a few kilometers daily. After five months, I will assess each patient’s changes in sugar levels and the general healthcare status (McDermott, 2020). I expect the sugar levels to be expected or close to normal for most patients within this period. Besides, the patients will have adapted to the new lifestyle since they got used to it.

Interventions for your health promotion goals

As indicated above, the first goal is to reduce the high numbers of people diagnosed with diabetes. The first health intervention is by ensuring that people are engaging in vigorous activities and exercises. Before one retires to bed, they must ensure that they have done a bit of practice to increase the metabolic activities of their bodies (Harvard T.H CHAN, 2021). Exercising helps maintain a moderate weight; hence, the high obesity and overweight people will reduce significantly. Besides, exercise helps increase insulin sensitivity in the body. As a result, the body cells can consume the sugars that are in the bloodstream.

For this intervention to work, both individuals and groups work together. A person must know that they have a personal responsibility to ensure that they maintain healthy body weight. Besides, organizations can play a significant role by ensuring that they create team-building activities (Harvard T.H CHAN, 2021). Organizations can set a day or two per month whereby all the employees and employers are involved in various team-building activities. This will help to ensure that at least all members keep fit, even if some of the members might not be keeping fit at a personal level. Since young people are also at a very high risk of getting diabetes, schools should develop a schedule to see all the students engage in exercise activities (John Muir Health, 2021). For example, the school can decide to have a physical exercise lesson after every two days.

Another intervention that will see few people being diagnosed with diabetes is maintaining a healthy eating lifestyle. Most people, especially teenagers, eat food that is full of calories. First, one should ensure they increase the fiber intake (Science Daily, 2018). Fiber is essential as it helps to slow down the digestion of carbs and sugars. Foods that contain more fibers include legumes, vegetables, and whole grains. Too many carbs place a person at a very high risk of getting diabetes. Another healthy eating habit is taking plenty of water to stay hydrated at all times (John Muir Health, 2021). When one takes a lot of water, it also helps the kidney eliminate excess sugars through the urine (Science Daily, 2018). A well-hydrated person is at a lower risk of getting diabetes. However, one should avoid sugar-sweetened drinks as they raise the level of glucose in the blood.

Both individuals and organizations have a role to play when it comes to maintaining a healthy eating lifestyle. Families should ensure that they prepare meals that are balanced diet. As an individual, one has a choice to eat whatever they want. Following this, one should avoid taking foods with high carb content instead of increasing the intake of high fiber meals. Organizations should also participate in this intervention by preparing healthy meals for their employees (Science Daily, 2018). Communities should be encouraged to grow more fibers and take the origin foods rather than rely on ready-made foods with high calories. Also, schools can be involved by ensuring that they have a reasonable timetable for all the meals, and the fiber intake for each student should be higher than the carb intake.

The second goal is enhancing better management for people who are living with diabetes. Individuals have a tremendous responsibility to ensure that they follow the given guidelines to stabilize sugar levels efficiently. As a diabetic patient, one should know the type of diabetes they are suffering from and the measures they are supposed to take to become better (NIH, 2021). The first step that a diabetic person should take is to ensure that they are not stressed. Stress triggers sugar levels, hence raising them. To reduce stress triggers, one can listen to their favorite music, take a walk, breathing in and out, or doing their favorite activities (Diabetes UK, 2021). Also, a person needs to have a support system to reach out in case they feel stressed.

The second step that one can take to deal with diabetes is ensuring that they eat well. After being assessed by the doctor, a health care team should help the sick person come up with a meal plan (Diabetes UK, 2021). The meal plan should contain fewer calories, fewer sugars and salt, and high saturated fats. Also, a diabetic person should eat foods that have high fiber, like rice and bread. Instead of drinking sweetened juices, a diabetic person should ensure that they take plenty of clean drinking water. This helps to keep the body hydrated at all times.

Both individuals and groups have a significant role in ensuring that diabetic persons are taken care of. They have the necessary things needed for them to reduce sugar levels. Health facilities should make sure that they do follow-ups so that if a patient has forgotten to go for checkups, they can go upon being reminded. Besides, other organizations like NGOs should develop fiber for needy people who might not afford such things.

Evaluation of your Health Promotion Care

Maintaining a healthy lifestyle through exercise is not hard to achieve as long as the people involved know the benefits of exercising. Exercising is an effective strategy that will help prevent diabetes and prevent other diseases like heart attack and stroke (Diabetes UK, 2021). However, people should be allowed to choose the kind of exercise that they want to do. Instead of going for a run, one can engage in other activities like playing football, netball, or swimming (Harvard T.H CHAN, 2021). Since people are not the same, one should not be forced to go for a morning jog, yet they like swimming. If this is done, the exercises will be more effective since people will be doing them willingly. I would recommend that the government makes it paramount for organizations to have different days from engaging in other activities like swimming, running, jogging, etc. Also, schools should ensure that there are various exercises for all the students to have one or two activities that they can engage in easily.

The second promotion of care was encouraging people to eat healthy meals. From the above discussion, it is evident that people need to engage in healthy lifestyles. Whether a person has diabetes or not, engaging in a healthy lifestyle is very important (Science Daily, 2018. Following this, one should ensure that they avoid high calories and have high fibers. This healthcare plan can be effective only if the government and other non-governmental organizations are willing to provide the proper meals for the people in need. Some diabetic people do not have access to medical care; hence they cannot do follow-ups about their conditions. As a result, the health care plan will become hard to achieve if the doctors and health care workers do not follow up on their patients to ensure they have taken the right medicines and that the sugar levels are not increasing (John Muir Health, 2021. For this, I would recommend that treatment of diabetes becomes free of charge in all public healthcare institutions. This will make it easy for the poor diabetic people to go for checkups since they know they will not be asked for any money to get the services they need. During the Diabetes Awareness week in the country, the government led by the health care sector should ensure that people are educated about diabetes. This will help people learn more about it and engage in activities that will help reduce diseases.

Tannahill Health Promotion Model

The Tannahill Health Promotion Model helps in the prevention of diabetes and protection of people who have diabetes. As discussed above, diabetes can be prevented through eating the right foods and ensuring that one is physically fit. The Tannahill Health promotion strategy also suggests a good communication flow between the patient and the health care providers (Queens University Belfast, 2021). In this case, the healthcare providers should do the follow up’s for their patients. The third aspect of the Tannahill Health promotion program is that the citizens should be given health protection through the legislature, social measures, and financial measures (Queens University Belfast, 2021). This includes helping needy people eat healthy meals and ensuring that organizations and companies give their employees the proper meals. Besides, Companies, organizations, and schools should set aside specific days where each person is engaged in other activities like swimming, ring, and playing their favorite games.

Diabetes is indeed one of the most severe diseases in the world. Diabetes affects both the young and the old and people of all ages. Although people at the age of 65 and older are more prone to being diagnosed with diabetes, other factors also determine if a person is prone to getting diabetes (Healthline, 2021). For example, a child can get diabetes from their parents; hence they get hereditary diabetes. Women who have experienced gestational diabetes are also at a very high risk of contracting the disease again (Shaikh, 2021). People who are not physically fit are also prone to getting diabetes. Following this, it is evident that although some people are more prone to getting diabetes, several other factors play a significant role.

Although diabetes is a severe condition worldwide, it can be controlled and the high rates reduced. This can be achieved through two maintaining it; exercising and eating suitable meals. Since some people cannot afford the healthy diet recommended for diabetic people, the government and other non-governmental organizations can provide such meals to the people (Whicher et al., 2019 p.243. Also, ensuring that the medication services are accessible at the public hospitals will encourage most people to go for follow-ups. Exercising is easy since there are so many activities that help burn calories (Shaikh, 2021). That is why it is essential to let the person choose activities they are good at and concentrate on them. Generally, although diabetes is a serious condition, it is easy to prevent and manage it if all resources are available.

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Harvard T.H CHAN, 2021.  Simple Steps to Preventing Diabetes . [online] The Nutrition Source. Available at: <https://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention/preventing-diabetes-full-story/> [Accessed 1 June 2021].

Healthline, 2021.  Everything You Need to Know About Diabetes . [online] Healthline. Available at: <https://www.healthline.com/health/diabetes#:~:text=Diabetes%20mellitus%2C%20commonly%                                                                                 20known%20as,the%20insulin%20it%20does%20make.> [Accessed 1 June 2021].

John Muir Health, 2021.  Preventing Diabetes . [online] Johnmuirhealth.com. Available at: <https://www.johnmuirhealth.com/health-education/conditions-treatments/diabetes-articles/preventing-diabetes.html> [Accessed 1 June 2021].

Mandal, A., 2021.  History of Diabetes . [online] News Medical. Available at: <https://www.news-medical.net/health/History-of-Diabetes.aspx#:~:text=The%20term%20diabetes%20was%20probably,sweet%20taste%20of%20the%20urine.> [Accessed 1 June 2021].

McDermott, A., 2020.  7 Long-Term Goals for Better Diabetes Management . [online] Healthline. Available at: <https://www.healthline.com/health/type-2-diabetes/living-better-with-type-2-diabetes/long-term-goals-everyone-with-type-2-diabetes-should-make> [Accessed 1 June 2021].

NIH, 2021.  4 Steps to Manage Your Diabetes for Life | NIDDK . [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: <https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/4-steps> [Accessed 1 June 2021].

Queens University Belfast, 2021.  Health Promotion.  [online] Queens University Belfast. Available at  https://www.qub.ac.uk/elearning/public/HealthyEating/HealthPromotion/  [Accessed 1 June 2021]

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Whicher, C., O’Neill, S., and Holt, R., 2019. Diabetes in the UK: 2019.  Diabetic Medicine , [online] 37(2), pp.242-247. Available at: <https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.14225> [Accessed 1 June 2021].

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Introduction to Diabetes Mellitus

• First Online: 30 December 2012

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• Kirti Kaul 2 ,
• Joanna M. Tarr 2 ,
• Shamim I. Ahmad 3 ,
• Eva M. Kohner 2 &
• Rakesh Chibber 2  

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 771))

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The chronic metabolic disorder diabetes mellitus is a fast-growing global problem with huge social, health, and economic consequences. It is estimated that in 2010 there were globally 285 millionpeople (approximately 6.4% of the adult population) suffering from this disease. This number is estimated to increase to 430 million in the absence of better control or cure. An ageing population and obesity are two main reasons for the increase. Furthermore it has been shown that almost 50% of the putative diabetics are not diagnosed until 10 years after onset of the disease, hence the real prevalence of global diabetes must be astronomically high.

This chapter introduces the types of diabetes and diabetic complications such as impairment of immune system, periodontal disease, retinopathy, nephropathy, somatic and autonomic neuropathy, cardiovascular diseases and diabetic foot. Also included are the current management and treatments, and emerging therapies.

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Kirti Kaul, Joanna M. Tarr, Eva M. Kohner & Rakesh Chibber

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Kaul, K., Tarr, J.M., Ahmad, S.I., Kohner, E.M., Chibber, R. (2013). Introduction to Diabetes Mellitus. In: Ahmad, S.I. (eds) Diabetes. Advances in Experimental Medicine and Biology, vol 771. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5441-0_1

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Introduction to diabetes mellitus

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• 1 Institute of Biomedical and Clinical Science, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK.
• PMID: 23393665
• DOI: 10.1007/978-1-4614-5441-0_1

The chronic metabolic disorder diabetes mellitus is a fast-growing global problem with huge social, health, and economic consequences. It is estimated that in 2010 there were globally 285 million people (approximately 6.4% of the adult population) suffering from this disease. This number is estimated to increase to 430 million in the absence of better control or cure. An ageing population and obesity are two main reasons for the increase. Furthermore it has been shown that almost 50% of the putative diabetics are not diagnosed until 10 years after onset of the disease, hence the real prevalence of global diabetes must be astronomically high. This chapter introduces the types of diabetes and diabetic complications such as impairment of immune system, periodontal disease, retinopathy, nephropathy, somatic and autonomic neuropathy, cardiovascular diseases and diabetic foot. Also included are the current management and treatments, and emerging therapies.

Publication types

• Chronic Disease
• Diabetes Complications / drug therapy
• Diabetes Complications / physiopathology
• Diabetes Mellitus, Type 1 / drug therapy*
• Diabetes Mellitus, Type 1 / physiopathology*
• Diabetes Mellitus, Type 2 / drug therapy*
• Diabetes Mellitus, Type 2 / physiopathology*
• Hypoglycemic Agents / therapeutic use*
• Hypoglycemic Agents

• Introduction To Diabetes

Introduction to Diabetes

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In order to understand diabetes, it is necessary to first understand the role glucose plays with regard to the body, and what can happen when regulation of glucose fails and blood sugar levels become dangerously low or high.

The tissues and cells that make up the human body are living things, and require food to stay alive. The food cells eat is a type of sugar called glucose. Fixed in place as they are, the body's cells are completely dependent on the blood stream in which they are bathed to bring glucose to them. Without access to adequate glucose, the body's cells have nothing to fuel themselves with and soon die.

Human beings eat food, not glucose. Human foods get converted into glucose as a part of the normal digestion process. Once converted, glucose enters the blood stream, causing the level of dissolved glucose inside the blood to rise. The blood stream then carries the dissolved glucose to the various tissues and cells of the body.

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Though glucose may be available in the blood, nearby cells are not able to access that glucose without the aid of a chemical hormone called insulin. Insulin acts as a key to open the cells, allowing them to receive and utilize available glucose. Cells absorb glucose from the blood in the presence of insulin, and blood sugar levels drop as sugar leaves the blood and enters the cells. Insulin can be thought of as a bridge for glucose between the blood stream and cells. It is important to understand when levels of insulin increase, levels of sugar in the blood decrease (because the sugar goes into the cells to be used for energy).

The body is designed to regulate and buffer the amount of glucose dissolved in the blood to maintain a steady supply to meet cell needs. The pancreas, one of your body's many organs, produces, stores and releases insulin into the blood stream to bring glucose levels back down.

The concentration of glucose available in the blood stream at any given moment is dependent on the amount and type of foods that people eat. Refined carbohydrates, candy and sweets are easy to break down into glucose. Correspondingly, blood glucose levels rise rapidly after such foods have been eaten. In contrast, blood sugars rises gradually and slowly after eating more complex, unrefined carbohydrates (oatmeal, apples, baked potatoes, etc.) which require more digestive steps take place before glucose can be yielded. Faced with rapidly rising blood glucose concentrations, the body must react quickly by releasing large amounts of insulin all at once or risk a dangerous condition called Hyperglycemia (high blood sugar) which will be described below. The influx of insulin enables cells to utilize glucose, and glucose concentrations drop. While glucose levels can rise and fall rapidly, insulin levels change much more slowly.  When a large amount of simple sugar is eaten the bloodstream quickly becomes flooded with glucose.  Insulin is released by the pancreas in response to the increased sugar.  The glucose rapidly enters the cells but the high levels of insulin remain in the bloodstream for a period of time.  This can result in an overabundance of insulin in the blood, which can trigger feelings of hunger and even Hypoglycemia (low blood sugar), another serious condition. When blood glucose concentrations rise more gradually, there is less need for dramatic compensation. Insulin can be released in a more controlled and safer manner which requires the body experience less strain. This more gradual process will leave you feeling “full” or content for a longer period of time. For these reasons, it is best for overall health to limit the amount and frequency of sweets and refined sugars in your diet. Instead eat more complex sugars such as raw fruit, whole wheat bread and pasta, and beans. The difference between simple and complex sugars (carbohydrates) is exemplified by the difference between white (simple) and whole wheat (more complex) bread.

Insulin is the critical key to the cell's ability to use glucose. Problems with insulin production or with how insulin is recognized by the cells can easily cause the body's carefully balanced glucose metabolism system to get out of control. When either of these problems occur, Diabetes develops, blood sugar levels surge and crash and the body risks becoming damaged.

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357 Diabetes Essay Topics & Examples

When you write about the science behind nutrition, heart diseases, and alternative medicine, checking titles for diabetes research papers can be quite beneficial. Below, our experts have gathered original ideas and examples for the task.

🏆 Best Diabetes Essay Examples & Topics

⭐ most interesting diabetes research paper topics, ✅ simple & easy diabetes essay topics, 🎓 good research topics about diabetes, 💡 interesting topics to write about diabetes, 👍 good essay topics on diabetes, ❓ diabetes research question examples.

• Type 2 Diabetes The two major types of diabetes are type 1 diabetes and type 2 diabetes. Doctor: The first step in the treatment of type 2 diabetes is consumption of healthy diet.
• Adult-Onset Type 2 Diabetes: Patient’s Profile Any immediate care as well as post-discharge treatment should be explained in the best manner possible that is accessible and understandable to the patient.
• Living With a Chronic Disease: Diabetes and Asthma This paper will look at the main effects of chronic diseases in the lifestyle of the individuals and analyze the causes and the preventive measures of diabetes as a chronic disease.
• Leadership in Diabetes Management Nurses can collaborate and apply evidence-based strategies to empower their diabetic patients. The involvement of all key stakeholders is also necessary.
• Diabetes in Adults in Oxfordshire On a national level, Diabetes Research and Wellness Foundation aims to prevent the spread of the decease through research of the causes and effective treatment of diabetes 2 type.
• Case Study of Patient with DKA and Diabetes Mellitus It is manifested by a sharp increase in glucose levels and the concentration of ketone bodies in the blood, their appearance in the urine, regardless of the degree of violation of the patient’s consciousness.
• Intervention Methods for Type 2 Diabetes Mellitus An individual should maintain a regulated glycemic control using the tenets of self-management to reduce the possibility of complications related to diabetes.
• Relation Between Diabetes And Nutrition Any efforts to lessen and eliminate the risk of developing diabetes must involve the dietary habit of limiting the consumption of carbohydrates, sugar, and fats. According to Belfort-DeAguiar and Dongju, the three factors of obesity, […]
• Diabetes Mellitus: Symptoms, Types, Effects Insulin is the hormone that controls the levels of glucose in the blood, and when the pancreas releases it, immediately the high levels are controlled, like after a meal.
• Health Promotion: Diabetes Mellitus and Comorbidities This offers a unique challenge in the management of diabetes and other chronic diseases; the fragmented healthcare system that is geared towards management of short-term medical emergencies often is not well prepared for the patient […]
• Type 2 Diabetes as a Public Health Issue In recent years, a steady increase in the incidence and prevalence of diabetes is observed in almost all countries of the world.
• Diabetes Management: Case Study Type 1 and Type 2 diabetes contrast based on their definitions, the causes, and the management of the conditions. Since the CDC promotes the avoidance of saturated fat and the increase of fiber intake for […]
• Diabetes Mellitus Management in the Elderly Diabetes mellitus is a health complication involving an increase in the concentration in the concentration of blood sugar either due to a failure by cells to effectively respond to the production of insulin in the […]
• A Study of Juvenile Type 1 Diabetes in the Northwest of England The total number of children under seventeen years living with type 1 diabetes in North West England by 2009 was 2,630.
• Diabetes Prevention: The Sanofi-Aventis Leaflet Review Using the Flesh formula, it can be concluded that the leaflet has a good level of readability, but it can be improved in case it is shorter because a few sections of it are better […]
• Gestational Diabetes in a 38-Year-Old Woman The concept map, created to meet B.’s needs, considers her educational requirements and cultural and racial hurdles to recognize her risk factors and interventions to increase her adherence to the recommended course of treatment.B.said in […]
• Type 2 Diabetes Mellitus and Its Implications You call an ambulance and she is taken in to the ED. Background: Jean is still very active and works on the farm 3 days a week.
• Development of Comprehensive Inpatient and Outpatient Programs for Diabetes Overcoming the fiscal and resource utilization issues in the development of a comprehensive diabetes program is essential for the improvement of health and the reduction of treatment costs.
• Healthcare Cost Depending on Chronic Disease Management of Diabetes and Hypertension A sufficient level of process optimization and the presence of a professional treating staff in the necessary number will be able to help improve the indicators.
• Improving Glycemic Control in Black Patients with Type 2 Diabetes Information in them is critical for answering the question and supporting them with the data that might help to acquire an enhanced understanding of the issue under research. Finally, answering the PICOT question, it is […]
• Shared Decision-Making That Affects the Management of Diabetes The article by Peek et al.is a qualitative study investigating the phenomenon of shared decision-making that affects the management of diabetes. The researchers demonstrate the racial disparity that can arise in the choice of approaches […]
• Managing Obesity as a Strategy for Addressing Type 2 Diabetes When a patient, as in the case of Amanda, requires a quick solution to the existing problem, it is necessary to effectively evaluate all options in the shortest possible time.
• Tests and Screenings: Diabetes and Chronic Kidney Disease The test is offered to patients regardless of gender, while the age category is usually above 45 years. CDC1 recommends doing the test regardless of gender and is conducted once or twice to check the […]
• Obesity Management for the Treatment of Type 2 Diabetes American Diabetes Association states that for overweight and obese individuals with type 2 diabetes who are ready to lose weight, a 5% weight reduction diet, physical exercise, and behavioral counseling should be provided.
• COVID-19 and Diabetes Mellitus Lim et al, in their article, “COVID-19 and diabetes mellitus: from pathophysiology to clinical management”, explored how COVID-19 can worsen the symptoms of diabetes mellitus.
• The Importance of Physical Exercise in Diabetes II Patients The various activities help to improve blood sugar levels, reduce cardiovascular cases and promote the overall immunity of the patient. Subsequently, the aerobic part will help to promote muscle development and strengthen the bones.
• Diabetes Education Workflow Process Mapping DSN also introduces the patient to the roles of specialists involved in managing the condition, describes the patient’s actions, and offers the necessary educational materials.
• Diabetes: Treatment Complications and Adjustments One of the doctor’s main priorities is to check the compatibility of a patient’s medications. The prescriptions of other doctors need to be thoroughly checked and, if necessary, replaced with more appropriate medication.
• The Type 2 Diabetes Mellitus PICOT (Evidence-Based) Project Blood glucose levels, A1C, weight, and stress management are the parameters to indicate the adequacy of physical exercise in managing T2DM.
• Chronic Disease Cost Calculator (Diabetes) This paper aims at a thorough, detailed, and exhaustive explanation of such a chronic disease as diabetes in terms of the prevalence and cost of treatment in the United States and Maryland.
• Diabetes Mellitus Epidemiology Statistics This study entails a standard established observation order from the established starting time to an endpoint, in this case, the onset of disease, death, or the study’s end. It is crucial to state this value […]
• Epidemiology: Type II Diabetes in Hispanic Americans The prevalence of type II diabetes in Hispanic Americans is well-established, and the search for inexpensive prevention methods is in the limelight.
• Diabetes: Risk Factors and Effects Trends in improved medical care and the development of technology and medicine are certainly contributing to the reduction of the problem. All of the above indicates the seriousness of the problem of diabetes and insufficient […]
• Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes The primary role of physicians, nurses, and other healthcare team members is to provide patients with medical treatment and coordinate that care while also working to keep costs down and expand access.
• Hereditary Diabetes Prevention With Lifestyle Modification Yeast infections between the fingers and toes, beneath the breast, and in or around the genital organs are the common symptoms of type 2 diabetes.
• Health Equity Regarding Type 2 Diabetes According to Tajkarimi, the number of research reports focusing on T2D’s prevalence and characteristics in underserved minorities in the U. Adapting the program’s toolkits to rural Americans’ eating and self-management habits could also be instrumental […]
• Diabetes Mellitus: Treatment Methods Moreover, according to the multiple findings conducted by Park et al, Billeter et al, and Tsilingiris et al, bariatric surgeries have a positive rate of sending diabetes into remission.
• Diagnosing Patient with Insulin-Dependent Diabetes The possible outcomes of the issues that can be achieved are discussing the violations with the patient’s family and convincing them to follow the medical regulations; convincing the girl’s family to leave her at the […]
• Human Service for Diabetes in Late Adulthood The mission of the Georgia Diabetic Foot Care Program is to make a positive difference in the health of persons living with diabetes.
• Diabetes: Symptoms and Risk Factors In terms of the problem, according to estimates, 415 million individuals worldwide had diabetes mellitus in 2015, and it is expected to rise to 642 million by the year 2040.
• Diabetes: Types and Management Diabetes is one of the most prevalent diseases in the United States caused when the body fails to optimally metabolize food into energy.
• Type 2 Diabetes’ Impact on Australian Society Consequently, the most significant impact of the disease is the increased number of deaths among the population which puts their lives in jeopardy. Further, other opportunistic diseases are on the rise lowering the quality of […]
• Epidemiology of Diabetes and Forecasted Trends The authors note that urbanization and the rapid development of economies of different countries are the main causes of diabetes. The authors warn that current diabetes strategies are not effective since the rate of the […]
• The Aboriginal Diabetes Initiative in Canada The ADI’s goal in the CDS was to raise type 2 diabetes awareness and lower the incidence of associated consequences among Aboriginal people.
• Communicating the Issue of Diabetes The example with a CGM sensor is meant to show that doctors should focus on educating people with diabetes on how to manage their condition and what to do in extreme situations.
• Obesity and Diabetes Mellitus Type 2 The goal is to define the features of patient information to provide data on the general course of the illness and its manifestations following the criteria of age, sex, BMI, and experimental data.
• The Prevention of Diabetes and Its Consequences on the Population At the same time, these findings can also be included in educational programs for people living with diabetes to warn them of the risks of fractures and prevent them.
• Uncontrolled Type 2 Diabetes and Depression Treatment The data synthesis demonstrates that carefully chosen depression and anxiety treatment is likely to result in better A1C outcomes for the patient on the condition that the treatment is regular and convenient for the patients.
• Type 2 Diabetes: Prevention and Education Schillinger et al.came to the same conclusion; thus, their findings on the study of the Bigger Picture campaign effectiveness among youth of color are necessary to explore diabetes prevention.
• A Diabetes Quantitative Article Analysis The article “Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes” by Mathe et al.refers to the global issue of the prevention of diabetes and its complications.
• A Type 2 Diabetes Quantitative Article Critique Therefore, the main issue is the prevention of type 2 diabetes and its consequences, and this paper will examine one of the scientific studies that will be used for its exploration.
• The Diabetes Prevention Articles by Ford and Mathe The main goal of the researchers was to measure the baseline MVPA of participants and increase their activity to the recommended 150 minutes per week through their participation in the Diabetes Community Lifestyle Improvement Program.
• Type 2 Diabetes in Hispanic Americans The HP2020 objectives and the “who, where, and when” of the problem highlight the significance of developing new, focused, culturally sensitive T2D prevention programs for Hispanic Americans.
• Diabetes Mellitus as Problem in US Healthcare Simultaneously, insurance companies are interested in decreasing the incidence of diabetes to reduce the costs of testing, treatment, and provision of medicines.
• Diabetes Prevention as a Change Project All of these queries are relevant and demonstrate the importance of including people at high risk of acquiring diabetes in the intervention.
• Evidence Synthesis Assignment: Prevention of Diabetes and Its Complications The purpose of this research is to analyze and synthesize evidence of good quality from three quantitative research and three non-research sources to present the problem of diabetes and justify the intervention to address it.
• Diabetes Mellitus: Causes and Health Challenges Second, the nature of this problem is a clear indication of other medical concerns in this country, such as poor health objectives and strategies and absence of resources.
• Diabetes Mellitus (DM) Disorder Case Study Analysis Thus, informing the patient about the importance of regular medication intake, physical activity, and adherence to diet in maintaining diabetes can solve the problem.
• Diabetes Mellitus in Young Adults Thus, programs for young adults should predominantly focus on the features of the transition from adolescence to adulthood. As a consequence, educational programs on diabetes improve the physical and psychological health of young adults.
• A Healthcare Issue of Diabetes Mellitus Diabetes mellitus is seen as a primary healthcare issue that affects populations across the globe and necessitates the combination of a healthy lifestyle and medication to improve the quality of life of people who suffer […]
• Control of LDL Cholesterol Levels in Patients, Gestational Diabetes Mellitus In addition, some patients with hypercholesterolemia may have statin intolerance, which reduces adherence to therapy, limits treatment efficacy, and increases the risk of CVD.
• Exploring Glucose Tolerance and Gestational Diabetes Mellitus In the case of a glucose tolerance test for the purpose of diagnosing GDM type, the interpretation of the test results is carried out according to the norms for the overall population.
• Type 2 Diabetes Health Issue and Exercise This approach will motivate the patient to engage in exercise and achieve better results while reducing the risk of diabetes-related complications.
• Diabetes Interventions in Children The study aims to answer the PICOT Question: In children with obesity, how does the use of m-Health applications for controlling their dieting choices compare to the supervision of their parents affect children’s understanding of […]
• Diabetes Tracker Device and Its Advantages The proposed diabetes tracker is a device that combines the functionality of an electronic BGL tester and a personal assistant to help patients stick to their diet plan.
• Disease Management for Diabetes Mellitus The selection of the appropriate philosophical and theoretical basis for the lesson is essential as it allows for the use of an evidence-based method for learning about a particular disease.
• Latino People and Type 2 Diabetes The primary aim of the study is to determine the facilitators and barriers to investigating the decision-making process in the Latin population and their values associated with type 2 diabetes.
• Diabetes Self-Management Education and Support Program The choice of this topic and question is based on the fact that despite the high prevalence of diabetes among adolescents in the United States, the use of DSMES among DM patients is relatively low, […]
• Diabetes Mellitus Care Coordination The aim is to establish what medical technologies, care coordination and community resources, and standards of nursing practice contribute to the quality of care and safety of patients with diabetes.
• Healthy Lifestyle Interventions in Comorbid Asthma and Diabetes In most research, the weight loss in cases of comorbid asthma and obesity is reached through a combination of dietary interventions and physical exercise programs.
• PDSA in Diabetes Prevention The second step in the “Do” phase would be to isolate a few members of the community who are affected by diabetes voluntarily.
• Diabetes: Statistics, Disparities, Therapies The inability to produce adequate insulin or the body’s resistance to the hormone is the primary cause of diabetes. Diabetes is a serious health condition in the U.S.and the world.
• Type 2 Diabetes Prescriptions and Interventions The disadvantage is the difficulty of obtaining a universal model due to the complexity of many factors that can affect the implementation of recommendations: from the variety of demographic data to the patient’s medical history.
• Health Education for Female African Americans With Diabetes In order to address and inform the public about the challenges, nurses are required to intervene by educating the population on the issues to enhance their understanding of the risks associated with the conditions they […]
• Diabetes Risk Assessment and Prevention It is one of the factors predisposing patients suffering from diabetes to various cardiovascular diseases. With diabetes, it is important to learn how to determine the presence of carbohydrates in foods.
• Diabetes Mellitus: Preventive Measures In addition to addressing the medical specialists who will be of service in disease prevention, it will emphasize the intervention programs required to help control the spread of the illness.
• “The Diabetes Online Community” by Litchman et al. The researchers applied the method of telephone interviews to determine the results and effectiveness of the program. The study described the value of DOC in providing support and knowledge to older diabetes patients.
• Mobile App for Improved Self-Management of Type 2 Diabetes The central focus of the study was to assess the effectiveness of the BlueStar app in controlling glucose levels among the participants.
• Type 2 Diabetes in Minorities from Cultural Perspective The purpose of this paper is to examine the ethical and cultural perspectives on the issue of T2DM in minorities. Level 2: What are the ethical obstacles to treating T2DM in ethnic and cultural minorities?
• Ethics of Type 2 Diabetes Prevalence in Minorities The purpose of this article analysis is to dwell on scholarly evidence that raises the question of ethical and cultural aspects of T2DM prevalence in minorities.
• Type 2 Diabetes in Minorities: Research Questions The Level 2 research questions are: What are the pathophysiological implications of T2DM in minorities? What are the statistical implications of T2DM in minorities?
• Improving Adherence to Diabetes Treatment in Primary Care Settings Additionally, the patients from the intervention group will receive a detailed explanation of the negative consequences of low adherence to diabetes treatment.
• An Advocacy Tool for Diabetes Care in the US To ensure the implementation and consideration of my plea, I sent a copy of the letter to the government officials so it could reach the president.
• Diabetes and Allergies: A Statistical Check The current dataset allowed us to test the OR for the relationship between family history of diabetes and the presence of diabetes in a particular patient: all variables were dichotomous and discrete and could take […]
• Type 2 Diabetes in Adolescents According to a National Diabetes Statistics Report released by the Centers for Disease Control and Prevention, the estimated prevalence of the disease was 25 cases per 10,000 adolescents in 2017. A proper understanding of T2D […]
• Analysis of Diabetes and Its Huge Effects In the US, diabetes is costly to treat and has caused much physical, emotional and mental harm to the people and the families of those who have been affected by the disease.
• Nursing: Self-Management of Type II Diabetes Sandra Fernandes and Shobha Naidu’s journal illustrates the authors’ understanding of a significant topic in the nursing profession.”Promoting Participation in self-care management among patients with diabetes mellitus” article exposes readers to Peplau’s theory to understand […]
• The Impact of Vegan and Vegetarian Diets on Diabetes Vegetarian diets are popular for a variety of reasons; according to the National Health Interview Survey in the United States, about 2% of the population reported following a vegetarian dietary pattern for health reasons in […]
• “Diabetes Prevention in U.S. Hispanic Adults” by McCurley et al. This information allows for supposing that face-to-face interventions can be suitable to my practicum project that considers measures to improve access to care among African Americans with heart failure diseases. Finally, it is possible to […]
• Diabetes Disease of the First and Second Types It is a decrease in the biological response of cells to one or more effects of insulin at its average concentration in the blood. During the first type of diabetes, insulin Degludec is required together […]
• The Trend of the Higher Prevalence of Diabetes According to the CDC, while new cases of diabetes have steadily decreased over the decades, the prevalence of the disease among people aged below twenty has not.
• Person-Centered Strategy of Diabetes and Dementia Care The population of focus for this study will be Afro-American women aged between sixty and ninety who have diabetes of the second type and dementia or are likely to develop dementia in the future.
• Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services For example, during one of my interactions with the patient, I was asked whether the hospital had the policy to avoid face-to-face interaction during the pandemic with the help of video examinations.
• Diets to Prevent Heart Disease, Cancer, and Diabetes In order to prevent heart disease, cancer, and diabetes, people are required to adhere to strict routines, including in terms of diet. Additionally, people wanting to prevent heart disease, cancer, and diabetes also need to […]
• The Centers for Diabetes’ Risks Assessment In general, the business case for the Centers for Diabetes appears to be positive since the project is closely aligned with the needs of the community and the targets set by the Affordable Care Act.
• Diabetes Mellitus as Leading Cause of Disability The researchers used data from the Centers for Disease Control and Prevention, where more than 12% of older people in the US live with the condition.
• Depression in Diabetes Patients The presence of depression concomitant to diabetes mellitus prevents the adaptation of the patient and negatively affects the course of the underlying disease.
• The Relationship Between Diabetes and COVID-19 After completing the research and analyzing the articles, it is possible to suggest a best practice that may be helpful and effective in defining the relationship between diabetes and COVID-19 and providing a way to […]
• Pre-diabetes and Urinary Incontinence Most recent reports indicate that a physiotherapy procedure gives a positive result in up to 80% of patients with stage I or SUI and mixed form and 50% of patients with stage II SUI.
• Type 1 Diabetes: Recommendations for Alternative Drug Treatments Then, they have to assess the existing levels of literacy and numeracy a patient has. Tailoring educational initiatives to a person’s unique ethnic and cultural background is the basis of cultural competence in patient education.
• Type 2 Diabetes: A Pharmacologic Update Diabetes presents one of the most common diagnoses in causes of ED visits among adults and one of the leading causes of death in the United States.
• Type 2 Diabetes and Its Treatment The main difference in type 2 diabetes is the insensitivity of the body’s cells to the action of the hormone insulin and their insulin resistance.
• Diabetes: Vulnerability, Resilience, and Care In nursing care, resilience is a critical concept that shows the possibility of a person to continue functioning and meeting objectives despite the existing challenges.
• Diabetes Prevention in the United States The analysis of these policies and the other strategies provides the opportunity to understand what role they might play in the improvement of human health. NDPP policy, on the other hand, emphasizes the role of […]
• Teaching Experience: Diabetes Prevention The primary objective of the seminar is to reduce the annual number of diabetes cases and familiarize the audience with the very first signs of this disease.
• Summary of Type 2 Diabetes: A Pharmacologic Update The authors first emphasize that T2D is one of the most widespread diseases in the United States and the seventh leading cause of death.
• Insulin Effects in a Diabetes Person I will use this source to support my research because the perception of diabetes patients on insulin therapy is essential for understanding the impact they cause on the person.
• Diabetes and Medical Intervention In the research conducted by Moin et al, the authors attempted to define the scope of efficiency of such a tool as an online diabetes prevention program in the prevention of diabetes among obese/overweight population […]
• Diabetes Mellitus Type 2 and a Healthy Lifestyle Relationship The advantage of this study over the first is that the method uses a medical approach to determining the level of fasting glucose, while the dependences in the study of Ugandans were found using a […]
• Diabetes and Its Economic Effect on Healthcare For many years, there has been an active increase in the number of cases of diabetes of all types among the global population, which further aggravates the situation.
• Diabetes: Epidemiological Analysis I would like to pose the following question: how can epidemiology principles be applied to these statistics for further improvements of policies that aim to reduce the impact of diabetes on the U.S.population? The limited […]
• Pathogenesis and Prevention of Diabetes Mellitus and Hypertension The hormone is produced by the cells of the islets of Langerhans found in the pancreas. It is attributed to the variation in the lifestyle of these individuals in these two geographical zones.
• Parental Intervention on Self-Management of an Adolescent With Diabetes Diabetes development and exposure are strongly tied to lifestyle, and the increasing incidents rate emphasizes the severity of the population’s health problem.
• Addressing the Needs of Hispanic Patients With Diabetes Similarly, in the program at hand, the needs of Hispanic patients with diabetes will be considered through the prism of the key specifics of the community, as well as the cultural background of the patients.
• Diabetes Issues: Insulin Price and Unaffordability According to the forecast of researchers from Stanford University, the number of people with type 2 diabetes who need insulin-containing drugs in the world will increase by about 79 million people by 2030, which will […]
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Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes

• Léa Solh Dost   ORCID: orcid.org/0000-0001-5767-1305 1 , 2 ,
• Giacomo Gastaldi   ORCID: orcid.org/0000-0001-6327-7451 3 &
• Marie P. Schneider   ORCID: orcid.org/0000-0002-7557-9278 1 , 2  

BMC Health Services Research volume  24 , Article number:  620 ( 2024 ) Cite this article

131 Accesses

Metrics details

Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients’ perspectives of their medications from hospital to two months after discharge.

Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted.

Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence.

Conclusions

The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients’ difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients’ needs, increase their safety, and standardize physicians’, pharmacists’, and nurses’ roles and responsibilities.

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Introduction

Continuity of patient care is characterized as the collaborative engagement between the patient and their physician-led care team in the ongoing management of healthcare, with the mutual objective of delivering high-quality and cost-effective medical care [ 1 ]. Continuity of care is under great pressure during the transition of care from hospital to outpatient care, with a risk of compromising patients’ safety [ 2 , 3 ]. The early post-discharge period is a high-risk and fragile transition: once discharged, one in five patients experience at least one adverse event during the first three weeks following discharge, and more than half of these adverse events are drug-related [ 4 , 5 ]. A retrospective study examining all discharged patients showed that adverse drug events (ADEs) account for up to 20% of 30-day hospital emergency readmissions [ 6 ]. During hospitalization, patients’ medications are generally modified, with an average of nearly four medication changes per patient [ 7 ]. Information regarding medications such as medication changes, the expected effect, side effects, and instructions for use are frequently poorly communicated to patients during hospitalization and at discharge [ 8 , 9 , 10 , 11 ]. Between 20 and 60% of discharged patients lack knowledge of their medications [ 12 , 13 ]. Consideration of patients’ needs and their active engagement in decision-making during hospitalization regarding their medications are often lacking [ 11 , 14 , 15 ]. This can lead to unsafe discharge and contribute to medication adherence difficulties, such as non-implementation of newly prescribed medications [ 16 , 17 ].

Patients with multiple comorbidities and polypharmacy are at higher risk of ADE [ 18 ]. Type 2 diabetes is one of the chronic health conditions most frequently associated with comorbidities and patients with type 2 diabetes often lack care continuum [ 19 , 20 , 21 ]. The prevalence of patients hospitalized with type 2 diabetes can exceed 40% [ 22 ] and these patients are at higher risk for readmission due to their comorbidities and their medications, such as insulin and oral hypoglycemic agents [ 23 , 24 , 25 ].

Interventions and strategies to improve patient care and safety at transition have shown mixed results worldwide in reducing cost, rehospitalization, ADE, and non-adherence [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. However, interventions that are patient-centered, with a patient follow-up and led by interprofessional healthcare teams showed promising results [ 34 , 35 , 36 ]. Most of these interventions have not been implemented routinely due to the extensive time to translate research into practice and the lack of hybrid implementation studies [ 37 , 38 , 39 , 40 , 41 ]. In addition, patient-reported outcomes and perspectives have rarely been considered, yet patients’ involvement is essential for seamless and integrated care [ 42 , 43 ]. Interprofessional collaboration in which patients are full members of the interprofessional team, is still in its infancy in outpatient care [ 44 ]. Barriers and facilitators regarding medications at the transition of care have been explored in multiple qualitative studies at one given time in a given setting (e.g., at discharge, one-month post-discharge) [ 8 , 45 , 46 , 47 , 48 ]. However, few studies have adopted a holistic methodology from the hospital to the outpatient setting to explore changes in patients’ perspectives over time [ 49 , 50 , 51 ]. Finally, little is known about whether, how, and when patients return to their daily routine following hospitalization and the impact of hospitalization weeks after discharge.

In Switzerland, continuity of care after hospital discharge is still poorly documented, both in terms of contextual analysis and interventional studies, and is mainly conducted in the hospital setting [ 31 , 35 , 52 , 53 , 54 , 55 , 56 ]. The first step of an implementation science approach is to perform a contextual analysis to set up effective interventions adapted to patients’ needs and aligned to healthcare professionals’ activities in a specific context [ 41 , 57 ]. Therefore, the main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and on their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients’ perspectives of their medications from hospital to two months after discharge.

Study design

This qualitative longitudinal study, conducted from October 2020 to July 2021, used a qualitative descriptive methodology through four consecutive in-depth semi-structured interviews per participant at three, 10-, 30- and 60-days post-discharge, as illustrated in Fig.  1 . Longitudinal qualitative research is characterized by qualitative data collection at different points in time and focuses on temporality, such as time and change [ 58 , 59 ]. Qualitative descriptive studies aim to explore and describe the depth and complexity of human experiences or phenomena [ 60 , 61 , 62 ]. We focused our qualitative study on the 60 first days after discharge as this period is considered highly vulnerable and because studies often use 30- or 60-days readmission as an outcome measure [ 5 , 63 ].

This qualitative study follows the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethics committee approval was sought and granted by the Cantonal Research Ethics Commission, Geneva (CCER) (2020 − 01779).

Recruitment took place during participants’ hospitalization in the general internal medicine divisions at the Geneva University Hospitals in the canton of Geneva (500 000 inhabitants), Switzerland. Interviews took place at participants’ homes, in a private office at the University of Geneva, by telephone or by secure video call, according to participants’ preference. Informal caregivers could also participate alongside the participants.

Study flowchart

Researcher characteristics

All the researchers were trained in qualitative studies. The diabetologist and researcher (GG) who enrolled the patients in the study was involved directly or indirectly (advice asked to the Geneva University Hospital diabetes team of which he was a part) for most participants’ care during hospitalization. LS (Ph.D. student and community pharmacist) was unknown to participants and presented herself during hospitalization as a “researcher” and not as a healthcare professional to avoid any risk of influencing participants’ answers. This study was not interventional, and the interviewer (LS) invited participants to contact a healthcare professional for any questions related to their medication or medical issues.

Population and sampling strategy

Patients with type 2 diabetes were chosen as an example population to describe polypharmacy patients as these patients usually have several health issues and polypharmacy [ 20 , 22 , 25 ]. Inclusions criteria for the study were: adult patients with type 2 diabetes, with at least two other comorbidities, hospitalized for at least three days in a general internal medicine ward, with a minimum of one medication change during hospital stay, and who self-managed their medications once discharged home. Exclusion criteria were patients not reachable by telephone following discharge, unable to give consent (patients with schizophrenia, dementia, brain damage, or drug/alcohol misuse), and who could not communicate in French. A purposive sampling methodology was applied aiming to include participants with different ages, genders, types, and numbers of health conditions by listing participants’ characteristics in a double-entry table, available in Supplementary Material 1 , until thematic saturation was reached. Thematic saturation was considered achieved when no new code or theme emerged and new data repeated previously coded information [ 64 ]. The participants were identified if they were hospitalized in the ward dedicated to diabetes care or when the diabetes team was contacted for advice. The senior ward physician (GG) screened eligible patients and the interviewer (LS) obtained written consent before hospital discharge.

Data collection and instruments

Sociodemographic (age, gender, educational level, living arrangement) and clinical characteristics (reason for hospitalization, date of admission, health conditions, diabetes diagnosis, medications before and during hospitalization) were collected by interviewing participants before their discharge and by extracting participants’ data from electronic hospital files by GG and LS. Participants’ pharmacies were contacted with the participant’s consent to obtain medication records from the last three months if information regarding medications before hospitalization was missing in the hospital files.

Semi-structured interview guides for each interview (at three, 10-, 30- and 60-days post-discharge) were developed based on different theories and components of health behavior and medication adherence: the World Health Organization’s (WHO) five dimensions for adherence, the Information-Motivation-Behavioral skills model and the Social Cognitive Theory [ 65 , 66 , 67 ]. Each interview explored participants’ itinerary in the healthcare system and their perspectives on their medications. Regarding medications, the following themes were mentioned at each interview: changes in medications, patients’ understanding and implication; information on their medications, self-management of their medications, and patients’ medication adherence. Other aspects were mentioned in specific interviews: patients’ hospitalization and experience on their return home (interview 1), motivation (interviews 2 and 4), and patient’s feedback on the past two months (interview 4). Interview guides translated from French are available in Supplementary Material 2 . The participants completed self-reported and self-administrated questionnaires at different interviews to obtain descriptive information on different factors that may affect medication management and adherence: self-report questionnaires on quality of life (EQ-5D-5 L) [ 68 ], literacy (Schooling-Opinion-Support questionnaire) [ 69 ], medication adherence (Adherence Visual Analogue Scale, A-VAS) [ 70 ] and Belief in Medication Questionnaire (BMQ) [ 71 ] were administered to each participant at the end of selected interviews to address the different factors that may affect medication management and adherence as well as to determine a trend of determinants over time. The BMQ contains two subscores: Specific-Necessity and Specific-Concerns, addressing respectively their perceived needs for their medications, and their concerns about adverse consequences associated with taking their medication [ 72 ].

Data management

Informed consent forms, including consent to obtain health data, were securely stored in a private office at the University of Geneva. The participants’ identification key was protected by a password known only by MS and LS. Confidentiality was guaranteed by pseudonymization of participants’ information and audio-recordings were destroyed once analyzed. Sociodemographic and clinical characteristics, medication changes, and answers to questionnaires were securely collected by electronic case report forms (eCRFs) on RedCap®. Interviews were double audio-recorded and field notes were taken during interviews. Recorded interviews were manually transcribed verbatim in MAXQDA® (2018.2) by research assistants and LS and transcripts were validated for accuracy by LS. A random sample of 20% of questionnaires was checked for accuracy for the transcription from the paper questionnaires to the eCRFs. Recorded sequences with no link to the discussed topics were not transcribed and this was noted in the transcripts.

Data analysis

A descriptive statistical analysis of sociodemographic, clinical characteristics and self-reported questionnaire data was carried out. A thematic analysis of transcripts was performed, as described by Braun and Clarke [ 73 ], by following six steps: raw data was read, text segments related to the study objectives were identified, text segments to create new categories were identified, similar or redundant categories were reduced and a model that integrated all significant categories was created. The analysis was conducted in parallel with patient enrolment to ensure data saturation. To ensure the validity of the coding method, transcripts were double coded independently and discussed by the research team until similar themes were obtained. The research group developed and validated an analysis grid, with which LS coded systematically the transcriptions and met regularly with the research team to discuss questions on data analysis and to ensure the quality of coding. The analysis was carried out in French, and the verbatims of interest cited in the manuscript were translated and validated by a native English-speaking researcher to preserve the meaning.

In this analysis, we used the term “healthcare professionals” when more than one profession could be involved in participants’ medication management. Otherwise, when a specific healthcare professional was involved, we used the designated profession (e.g. physicians, pharmacists).

Patient and public involvement

During the development phase of the study, interview guides and questionnaires were reviewed for clarity and validity and adapted by two patient partners, with multiple health conditions and who experienced previously a hospital discharge. They are part of the HUG Patients Partners + 3P platform for research and patient and public involvement.

Interviews and participants’ descriptions

A total of 75 interviews were conducted with 21 participants. In total, 31 patients were contacted, seven refused to participate (four at the project presentation and three at consent), two did not enter the selection criteria at discharge and one was unreachable after discharge. Among the 21 participants, 15 participated in all interviews, four in three interviews, one in two interviews, and one in one interview, due to scheduling constraints. Details regarding interviews and participants characteristics are presented in Tables  1 and 2 .

The median length of time between hospital discharge and interviews 1,2,3 and 4 was 5 (IQR: 4–7), 14 (13-20), 35 (22-38), and 63 days (61-68), respectively. On average, by comparing medications at hospital admission and discharge, a median of 7 medication changes (IQR: 6–9, range:2;17) occurred per participant during hospitalization and a median of 7 changes (5–12) during the two months following discharge. Details regarding participants’ medications are described in Table  3 .

Patient self-reported adherence over the past week for their three most challenging medications are available in Supplementary Material 3 .

Qualitative analysis

We defined care transition as the period from discharge until the first medical appointment post-discharge, and outpatient care as the period starting after the first medical appointment. Data was organized into three key themes (A. Medication management, B. Medication understanding, and C. Medication adherence) divided into subthemes at three time points (1. Hospitalization, 2. Care transition and 3. Outpatient care). Figure  2 summarizes and illustrates the themes and subthemes with their influencing factors as bullet points.

Participants’ medication management, understanding and adherence during hospitalization, care transition and outpatient care

A. Medication management

A.1 medication management during hospitalization: medication management by hospital staff.

Medications during hospitalization were mainly managed by hospital healthcare professionals (i.e. nurses and physicians) with varying degrees of patient involvement: “At the hospital, they prepared the medications for me. […] I didn’t even know what the packages looked like.” Participant 22; interview 1 (P22.1) Some participants reported having therapeutic education sessions with specialized nurses and physicians, such as the explanation and demonstration of insulin injection and glucose monitoring. A patient reported that he was given the choice of several treatments and was involved in shared decision-making. Other participants had an active role in managing and optimizing dosages, such as rapid insulin, due to prior knowledge and use of medications before hospitalization.

A.2 Medication management at transition: obtaining the medication and initiating self-management

Once discharged, some participants had difficulties obtaining their medications at the pharmacy because some medications were not stored and had to be ordered, delaying medication initiation. To counter this problem upstream, a few participants were provided a 24-to-48-hour supply of medications at discharge. It was sometimes requested by the patient or suggested by the healthcare professionals but was not systematic. The transition from medication management by hospital staff to self-management was exhausting for most participants who were faced with a large amount of new information and changes in their medications: “ When I was in the hospital, I didn’t even realize all the changes. When I came back home, I took away the old medication packages and got out the new ones. And then I thought : « my God, all this…I didn’t know I had all these changes » ” P2.1 Written documentation, such as the discharge prescription or dosage labels on medication packages, was helpful in managing their medication at home. Most participants used weekly pill organizers to manage their medications, which were either already used before hospitalization or were introduced post-discharge. The help of a family caregiver in managing and obtaining medications was reported as a facilitator.

A.3 Medication management in outpatient care: daily self-management and medication burden

A couple of days or weeks after discharge, most participants had acquired a routine so that medication management was less demanding, but the medication burden varied depending on the participants. For some, medication management became a simple action well implemented in their routine (“It has become automatic” , P23.4), while for others, the number of medications and the fact that the medications reminded them of the disease was a heavy burden to bear on a daily basis (“ During the first few days after getting out of the hospital, I thought I was going to do everything right. In the end, well [laughs] it’s complicated. I ended up not always taking the medication, not monitoring the blood sugar” P12.2) To support medication self-management, some participants had written documentation such as treatment plans, medication lists, and pictures of their medication packages on their phones. Some participants had difficulties obtaining medications weeks after discharge as discharge prescriptions were not renewable and participants did not see their physician in time. Others had to visit multiple physicians to have their prescriptions updated. A few participants were faced with prescription or dispensing errors, such as prescribing or dispensing the wrong dosage, which affected medication management and decreased trust in healthcare professionals. In most cases, according to participants, the pharmacy staff worked in an interprofessional collaboration with physicians to provide new and updated prescriptions.

B. Medication understanding

B.1 medication understanding during hospitalization: new information and instructions.

The amount of information received during hospitalization varied considerably among participants with some reporting having received too much, while others saying they received too little information regarding medication changes, the reason for changes, or for introducing new medications: “They told me I had to take this medication all my life, but they didn’t tell me what the effects were or why I was taking it.” P5.3

Hospitalization was seen by some participants as a vulnerable and tiring period during which they were less receptive to information. Information and explanations were generally given verbally, making it complicated for most participants to recall it. Some participants reported that hospital staff was attentive to their needs for information and used communication techniques such as teach-back (a way of checking understanding by asking participants to say in their own words what they need to know or do about their health or medications). Some participants were willing to be proactive in the understanding of their medications while others were more passive, had no specific needs for information, and did not see how they could be engaged more.

B.2 Medication understanding at transition: facing medication changes

At hospital discharge, the most challenging difficulty for participants was to understand the changes made regarding their medications. For newly diagnosed participants, the addition of new medications was more difficult to understand, whereas, for experienced participants, changes in known medications such as dosage modification, changes within a therapeutic class, and generic substitutions were the most difficult to understand. Not having been informed about changes caused confusion and misunderstanding. Therefore, medication reconciliation done by the patient was time-consuming, especially for participants with multiple medications: “ They didn’t tell me at all that they had changed my treatment completely. They just told me : « We’ve changed a few things. But it was the whole treatment ». ” P2.3 Written information, such as the discharge prescription, the discharge report (brief letter summarizing information about the hospitalization, given to the patient at discharge), or the label on the medication box (written by the pharmacist with instructions on dosage) helped them find or recall information about their medications and diagnoses. However, technical terms were used in hospital documentations and were not always understandable. For example, this participant said: “ On the prescription of valsartan, they wrote: ‘resume in the morning once profile…’[once hypertension profile allows]… I don’t know what that means.” P8.1 In addition, some documents were incomplete, as mentioned by a patient who did not have the insulin dosage mentioned on the hospital prescription. Some participants sought help from healthcare professionals, such as pharmacists, hospital physicians, or general practitioners a few days after discharge to review medications, answer questions, or obtain additional information.

B.3 Medication understanding in the outpatient care: concerns and knowledge

Weeks after discharge, most participants had concerns about the long-term use of their medications, their usefulness, and the possible risk of interactions or side effects. Some participants also reported having some lack of knowledge regarding indications, names, or how the medication worked: “I don’t even know what Brilique® [ticagrelor, antiplatelet agent] is for. It’s for blood pressure, isn’t it?. I don’t know.” P11.4 According to participants, the main reasons for the lack of understanding were the lack of information at the time of prescribing and the large number of medications, making it difficult to search for information and remember it. Participants sought information from different healthcare professionals or by themselves, on package inserts, through the internet, or from family and friends. Others reported having had all the information needed or were not interested in having more information. In addition, participants with low medication literacy, such as non-native speakers or elderly people, struggled more with medication understanding and sought help from family caregivers or healthcare professionals, even weeks after discharge: “ I don’t understand French very well […] [The doctor] explained it very quickly…[…] I didn’t understand everything he was saying” P16.2

C. Medication adherence

C.2 medication adherence at transition: adopting new behaviors.

Medication adherence was not mentioned as a concern during hospitalization and a few participants reported difficulties in medication initiation once back home: “I have an injection of Lantus® [insulin] in the morning, but obviously, the first day [after discharge], I forgot to do it because I was not used to it.” P23.1 Participants had to quickly adopt new behaviors in the first few days after discharge, especially for participants with few medications pre-hospitalization. The use of weekly pill organizers, alarms and specific storage space were reported as facilitators to support adherence. One patient did not initiate one of his medications because he did not understand the medication indication, and another patient took her old medications because she was used to them. Moreover, most participants experienced their hospitalization as a turning point, a time when they focused on their health, thought about the importance of their medications, and discussed any new lifestyle or dietary measures that might be implemented.

C.3 Medication adherence in outpatient care: ongoing medication adherence

More medication adherence difficulties appeared a few weeks after hospital discharge when most participants reported nonadherence behaviors, such as difficulties implementing the dosage regimen, or intentionally discontinuing the medication and modifying the medication regimen on their initiative. Determinants positively influencing medication adherence were the establishment of a routine; organizing medications in weekly pill-organizers; organizing pocket doses (medications for a short period that participants take with them when away from home); seeking support from family caregivers; using alarm clocks; and using specific storage places. Reasons for nonadherence were changes in daily routine; intake times that were not convenient for the patient; the large number of medications; and poor knowledge of the medication or side effects. Healthcare professionals’ assistance for medication management, such as the help of home nurses or pharmacists for the preparation of weekly pill-organizers, was requested by participants or offered by healthcare professionals to support medication adherence: “ I needed [a home nurse] to put my pills in the pillbox. […] I felt really weak […] and I was making mistakes. So, I’m very happy [the doctor] offered me [home care]. […] I have so many medications.” P22.3 Some participants who experienced prehospitalization non-adherence were more aware of their non-adherence and implemented strategies, such as modifying the timing of intake: “I said to my doctor : « I forget one time out of two […], can I take them in the morning? » We looked it up and yes, I can take it in the morning.” P11.2 In contrast, some participants were still struggling with adherence difficulties that they had before hospitalization. Motivations for taking medications two months after discharge were to improve health, avoid complications, reduce symptoms, reduce the number of medications in the future or out of obligation: “ I force myself to take them because I want to get to the end of my diabetes, I want to reduce the number of pills as much as possible.” P14.2 After a few weeks post-hospitalization, for some participants, health and illness were no longer the priority because of other life imperatives (e.g., family or financial situation).

This longitudinal study provided a multi-faceted representation of how patients manage, understand, and adhere to their medications from hospital discharge to two months after discharge. Our findings highlighted the varying degree of participants’ involvement in managing their medications during their hospitalization, the individualized needs for information during and after hospitalization, the complicated transition from hospital to autonomous medication management, the adaptation of daily routines around medication once back home, and the adherence difficulties that surfaced in the outpatient care, with nonadherence prior to hospitalization being an indicator of the behavior after discharge. Finally, our results confirmed the lack of continuity in care and showed the lack of patient care standardization experienced by the participants during the transition from hospital to outpatient care.

This in-depth analysis of patients’ experiences reinforces common challenges identified in the existing literature such as the lack of personalized information [ 9 , 10 , 11 ], loss of autonomy during hospitalization [ 14 , 74 , 75 ], difficulties in obtaining medication at discharge [ 11 , 45 , 76 ] and challenges in understanding treatment modifications and generics substitution [ 11 , 32 , 77 , 78 ]. Some of these studies were conducted during patients’ hospitalization [ 10 , 75 , 79 ] or up to 12 months after discharge [ 80 , 81 ], but most studies focused on the few days following hospital discharge [ 9 , 11 , 14 , 82 ]. Qualitative studies on medications at transition often focused on a specific topic, such as medication information, or a specific moment in time, and often included healthcare professionals, which muted patients’ voices [ 9 , 10 , 11 , 47 , 49 ]. Our qualitative longitudinal methodology was interested in capturing the temporal dynamics, in-depth narratives, and contextual nuances of patients’ medication experiences during transitions of care [ 59 , 83 ]. This approach provided a comprehensive understanding of how patients’ perspectives and behaviors evolved over time, offering insights into the complex interactions of medication management, understanding and adherence, and turning points within their medication journeys. A qualitative longitudinal design was used by Fylan et al. to underline patients’ resilience in medication management during and after discharge, by Brandberg et al. to show the dynamic process of self-management during the 4 weeks post-discharge and by Lawton et al. to examine how patients with type 2 diabetes perceived their care after discharge over a period of four years [ 49 , 50 , 51 ]. Our study focused on the first two months following hospitalization and future studies should focus on following discharged and at-risk patients over a longer period, as “transitions of care do not comprise linear trajectories of patients’ movements, with a starting and finishing point. Instead, they are endless loops of movements” [ 47 ].

Our results provide a particularly thorough description of how participants move from a state of total dependency during hospitalization regarding their medication management to a sudden and complete autonomy after hospital discharge impacting medication management, understanding, and adherence in the first days after discharge for some participants. Several qualitative studies have described the lack of shared decision-making and the loss of patient autonomy during hospitalization, which had an impact on self-management and created conflicts with healthcare professionals [ 75 , 81 , 84 ]. Our study also highlights nuanced patient experiences, including varying levels of patient needs, involvement, and proactivity during hospitalization and outpatient care, and our results contribute to capturing different perspectives that contrast with some literature that often portrays patients as more passive recipients of care [ 14 , 15 , 74 , 75 ]. Shared decision-making and proactive medication are key elements as they contribute to a smoother transition and better outcomes for patients post-discharge [ 85 , 86 , 87 ].

Consistent with the literature, the study identifies some challenges in medication initiation post-discharge [ 16 , 17 , 88 ] but our results also describe how daily routine rapidly takes over, either solidifying adherence behavior or generating barriers to medication adherence. Participants’ nonadherence prior to hospitalization was a factor influencing participants’ adherence post-hospitalization and this association should be further investigated, as literature showed that hospitalized patients have high scores of non-adherence [ 89 ]. Mortel et al. showed that more than 20% of discharged patients stopped their medications earlier than agreed with the physician and 25% adapted their medication intake [ 90 ]. Furthermore, patients who self-managed their medications had a lower perception of the necessity of their medication than patients who received help, which could negatively impact medication adherence [ 91 ]. Although participants in our study had high BMQ scores for necessity and lower scores for concerns, some participants expressed doubts about the need for their medications and a lack of motivation a few weeks after discharge. Targeted pharmacy interventions for newly prescribed medications have been shown to improve medication adherence, and hospital discharge is an opportune moment to implement this service [ 92 , 93 ].

Many medication changes were made during the transition of care (a median number of 7 changes during hospitalization and 7 changes during the two months after discharge), especially medication additions during hospitalization and interruptions after hospitalization. While medication changes during hospitalization are well described, the many changes following discharge are less discussed [ 7 , 94 ]. A Danish study showed that approximately 65% of changes made during hospitalization were accepted by primary healthcare professionals but only 43% of new medications initiated during hospitalization were continued after discharge [ 95 ]. The numerous changes after discharge may be caused by unnecessary intensification of medications during hospitalization, delayed discharge letters, lack of standardized procedures, miscommunication, patient self-management difficulties, or in response to an acute situation [ 96 , 97 , 98 ]. During the transition of care, in our study, both new and experienced participants were faced with difficulties in managing and understanding medication changes, either for newly prescribed medication or changes in previous medications. Such difficulties corroborate the findings of the literature [ 9 , 10 , 47 ] and our results showed that the lack of understanding during hospitalization led to participants having questions about their medications, even weeks after discharge. Particular attention should be given to patients’ understanding of medication changes jointly by physicians, nurses and pharmacists during the transition of care and in the months that follow as medications are likely to undergo as many changes as during hospitalization.

Implication for practice and future research

The patients’ perspectives in this study showed, at a system level, that there was a lack of standardization in healthcare professional practices regarding medication dispensing and follow-up. For now, in Switzerland, there are no official guidelines on medication prescription and dispensation during the transition of care although some international guidelines have been developed for outpatient healthcare professionals [ 3 , 99 , 100 , 101 , 102 ]. Here are some suggestions for improvement arising from our results. Patients should be included as partners and healthcare professionals should systematically assess (i) previous medication adherence, (ii) patients’ desired level of involvement and (iii) their needs for information during hospitalization. Hospital discharge processes should be routinely implemented to standardize hospital discharge preparation, medication prescribing, and dispensing. Discharge from the hospital should be planned with community pharmacies to ensure that all medications are available and, if necessary, doses of medications should be supplied by the hospital to bridge the gap. A partnership with outpatient healthcare professionals, such as general practitioners, community pharmacists, and homecare nurses, should be set up for effective asynchronous interprofessional collaboration to consolidate patients’ medication management, knowledge, and adherence, as well as to monitor signs of deterioration or adverse drug events.

Future research should consolidate our first attempt to develop a framework to better characterize medication at the transition of care, using Fig. 2   as a starting point. Contextualized interventions, co-designed by health professionals, patients and stakeholders, should be tested in a hybrid implementation study to test the implementation and effectiveness of the intervention for the health system [ 103 ].

Limitations

This study has some limitations. First, the transcripts were validated for accuracy by the interviewer but not by a third party, which could have increased the robustness of the transcription. Nevertheless, the interviewer followed all methodological recommendations for transcription. Second, patient inclusion took place during the COVID-19 pandemic, which may have had an impact on patient care and the availability of healthcare professionals. Third, we cannot guarantee the accuracy of some participants’ medication history before hospitalization, even though we contacted the participants’ main pharmacy, as participants could have gone to different pharmacies to obtain their medications. Fourth, our findings may not be generalizable to other populations and other healthcare systems because some issues may be specific to multimorbid patients with type 2 diabetes or to the Swiss healthcare setting. Nevertheless, issues encountered by our participants regarding their medications correlate with findings in the literature. Fifth, only 15 out of 21 participants took part in all the interviews, but most participants took part in at least three interviews and data saturation was reached. Lastly, by its qualitative and longitudinal design, it is possible that the discussion during interviews and participants’ reflections between interviews influenced participants’ management, knowledge, and adherence, even though this study was observational, and no advice or recommendations were given by the interviewer during interviews.

Discharged patients are willing to take steps to better manage, understand, and adhere to their medications, yet they are also faced with difficulties in the hospital and outpatient care. Furthermore, extensive changes in medications not only occur during hospitalization but also during the two months following hospital discharge, for which healthcare professionals should give particular attention. The different degrees of patients’ involvement, needs and resources should be carefully considered to enable them to better manage, understand and adhere to their medications. At a system level, patients’ experiences revealed a lack of standardization of medication practices during the transition of care. The healthcare system should provide the ecosystem needed for healthcare professionals responsible for or involved in the management of patients’ medications during the hospital stay, discharge, and outpatient care to standardize their practices while considering the patient as an active partner.

Data availability

The anonymized quantitative survey datasets and the qualitative codes are available in French from the corresponding author on reasonable request.

Abbreviations

adverse drug events

Adherence Visual Analogue Scale

Belief in Medication Questionnaire

Consolidated Criteria for Reporting Qualitative Research

case report form

standard deviation

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Acknowledgements

The authors would like to thank all the patients who took part in this study. We would also like to thank the Geneva University Hospitals Patients Partners + 3P platform as well as Mrs. Tourane Corbière and Mr. Joël Mermoud, patient partners, who reviewed interview guides for clarity and significance. We would like to thank Samuel Fabbi, Vitcoryavarman Koh, and Pierre Repiton for the transcriptions of the audio recordings.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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LS, GG, and MS conceptualized and designed the study. LS and GG screened and recruited participants. LS conducted the interviews. LS, GG, and MS performed data analysis and interpretation. LS drafted the manuscript and LS and MS worked on the different versions. MS and GG approved the final manuscript.

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Solh Dost, L., Gastaldi, G. & Schneider, M. Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes. BMC Health Serv Res 24 , 620 (2024). https://doi.org/10.1186/s12913-024-10784-9

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DOI : https://doi.org/10.1186/s12913-024-10784-9

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• Continuity of care
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• Interprofessional collaboration
• Type 2 diabetes

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Diabetes In Practice : Case Studies with Commentary

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Diabetes In Practice : Case Studies with Commentary Edited by: Boris Draznin, MD, PhD https://doi.org/10.2337/9781580407663 ISBN (print): 978-1-58040-766-3 Publisher: American Diabetes Association

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• Notes Open the PDF Link PDF for Notes in another window
• Preface Open the PDF Link PDF for Preface in another window
• Case 1: Suspected Maturity-Onset Diabetes of the Young (MODY)-5 (MODY-HNF1B) Responding to Monotherapy With Metformin By Ana Ramirez Berlioz, MD ; Ana Ramirez Berlioz, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Richa Patel, MD ; Richa Patel, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar David Gardner, MD ; David Gardner, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar L. Romayne Kurukulasuriya, MD ; L. Romayne Kurukulasuriya, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar James Sowers, MD James Sowers, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.01 Open the PDF Link PDF for Case 1: Suspected Maturity-Onset Diabetes of the Young (MODY)-5 (MODY-HNF1B) Responding to Monotherapy With Metformin in another window
• Case 2: Maturity-Onset Diabetes of the Young (MODY)-4 Presenting as Gestational Diabetes By Ivana Sheu, MD ; Ivana Sheu, MD 1 University of California Irvine Diabetes Center and Department of Medicine, Irvine, California. Search for other works by this author on: This Site PubMed Google Scholar Yung-In Choi, MD ; Yung-In Choi, MD 1 University of California Irvine Diabetes Center and Department of Medicine, Irvine, California. Search for other works by this author on: This Site PubMed Google Scholar Samar Singh, MD ; Samar Singh, MD 1 University of California Irvine Diabetes Center and Department of Medicine, Irvine, California. Search for other works by this author on: This Site PubMed Google Scholar Ping H. Wang, MD Ping H. Wang, MD 1 University of California Irvine Diabetes Center and Department of Medicine, Irvine, California. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.02 Open the PDF Link PDF for Case 2: Maturity-Onset Diabetes of the Young (MODY)-4 Presenting as Gestational Diabetes in another window
• Case 3: Does This Patient Have Type 1 or Type 2 Diabetes? By Zubina Unjom, MD ; Zubina Unjom, MD 1 Diabetes/Endocrinology Section, Chicago Medical School, Rosalind Franklin University of Medicine and Science. Search for other works by this author on: This Site PubMed Google Scholar Janice L. Gilden, MS, MD Janice L. Gilden, MS, MD 1 Diabetes/Endocrinology Section, Chicago Medical School, Rosalind Franklin University of Medicine and Science. 2 Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.03 Open the PDF Link PDF for Case 3: Does This Patient Have Type 1 or Type 2 Diabetes? in another window
• Case 4: Is This an Unusual Type of Diabetes? By Nitish Singh Nandu, MD ; Nitish Singh Nandu, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. Search for other works by this author on: This Site PubMed Google Scholar Andriy Havrylyan, MD ; Andriy Havrylyan, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. Search for other works by this author on: This Site PubMed Google Scholar Janice L. Gilden, MS, MD ; Janice L. Gilden, MS, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. 2 Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois. Search for other works by this author on: This Site PubMed Google Scholar Bushra Osmani, MBBS Bushra Osmani, MBBS 3 Community Physicians at Froedtert and the Medical College of Wisconsin at Milwaukee, Milwaukee, Wisconsin. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.04 Open the PDF Link PDF for Case 4: Is This an Unusual Type of Diabetes? in another window
• Case 5: Challenges in the Management of Pancreatogenic (Type 3c) Diabetes By Katrina Han, MD ; Katrina Han, MD 1 Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Janet B. McGill, MD Janet B. McGill, MD 1 Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.05 Open the PDF Link PDF for Case 5: Challenges in the Management of Pancreatogenic (Type 3c) Diabetes in another window
• Case 6: New-Onset Diabetes as a Symptom of Pancreatic Adenocarcinoma By Emily Gammoh, MD ; Emily Gammoh, MD 1 University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Center for Diabetes and Endocrinology, Pittsburgh, Pennsylvania. Search for other works by this author on: This Site PubMed Google Scholar Jagdeesh Ullal, MD Jagdeesh Ullal, MD 1 University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Center for Diabetes and Endocrinology, Pittsburgh, Pennsylvania. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.06 Open the PDF Link PDF for Case 6: New-Onset Diabetes as a Symptom of Pancreatic Adenocarcinoma in another window
• Case 7: Sweet’s Syndrome in a Patient With Diabetes By Nitish Singh Nandu, MD ; Nitish Singh Nandu, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. Search for other works by this author on: This Site PubMed Google Scholar Sabah Patel, MD ; Sabah Patel, MD 2 Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois. Search for other works by this author on: This Site PubMed Google Scholar Janice L. Gilden, MS, MD Janice L. Gilden, MS, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. 2 Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.07 Open the PDF Link PDF for Case 7: Sweet’s Syndrome in a Patient With Diabetes in another window
• Case 8: Wolcott-Rallison Syndrome By Mehmet N. Özbek, MD ; Mehmet N. Özbek, MD 1 Gazi Yasargil Training and Research Hospital Clinics of Pediatric Endocrinology, Diyarbakır, Turkey. Search for other works by this author on: This Site PubMed Google Scholar Eda Cengiz, MD, MHS, FAAP Eda Cengiz, MD, MHS, FAAP 2 Division of Pediatric Endocrinology and Diabetes, Yale School of Medicine, New Haven, Connecticut. 3 Visiting Professor, Bahcesehir University, Istanbul, Turkey. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.08 Open the PDF Link PDF for Case 8: Wolcott-Rallison Syndrome in another window
• Case 9: Glucose Intolerance Associated With ACTH-Dependent Cushing’s Disease By Nitya K. Kumar, MD ; Nitya K. Kumar, MD 1 Duke University Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina. Search for other works by this author on: This Site PubMed Google Scholar Susan Spratt, MD Susan Spratt, MD 1 Duke University Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.09 Open the PDF Link PDF for Case 9: Glucose Intolerance Associated With ACTH-Dependent Cushing’s Disease in another window
• Case 10: Maturity-Onset Diabetes of the Young (MODY) Misdiagnosis as Steroid-Induced Diabetes By Ghada Elshimy, MD ; Ghada Elshimy, MD 1 Division of Endocrinology, University of Arizona College of Medicine, Phoenix, Arizona. Search for other works by this author on: This Site PubMed Google Scholar Ricardo Correa, MD, EdD, FACP, FACE, FAPCR, CMQ Ricardo Correa, MD, EdD, FACP, FACE, FAPCR, CMQ 1 Division of Endocrinology, University of Arizona College of Medicine, Phoenix, Arizona. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.10 Open the PDF Link PDF for Case 10: Maturity-Onset Diabetes of the Young (MODY) Misdiagnosis as Steroid-Induced Diabetes in another window
• Case 11: A Case of Histiocytosis-Lymphadenopathy Plus Syndrome Due to a Novel Mutation in the SLC29A3 Gene and Presentation With Diabetic Ketoacidosis By Gül Yeşiltepe-Mutlu, MD ; Gül Yeşiltepe-Mutlu, MD 1 Division of Pediatric Endocrinology and Diabetes, Koç University School of Medicine, İstanbul, Turkey. Search for other works by this author on: This Site PubMed Google Scholar Mehmet N. Özbek, MD ; Mehmet N. Özbek, MD 2 Gazi Yasargil Training and Research Hospital Clinics of Pediatric Endocrinology, Diyarbakır, Turkey. Search for other works by this author on: This Site PubMed Google Scholar Eda Cengiz, MD, MHS, FAAP Eda Cengiz, MD, MHS, FAAP 3 Division of Pediatric Endocrinology and Diabetes, Yale School of Medicine, New Haven, Connecticut. 4 Visiting Professor, Bahcesehir University, Istanbul, Turkey. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.11 Open the PDF Link PDF for Case 11: A Case of Histiocytosis-Lymphadenopathy Plus Syndrome Due to a Novel Mutation in the <em>SLC29A3</em> Gene and Presentation With Diabetic Ketoacidosis in another window
• Case 12: Acromegaly Presenting With Diabetic Ketoacidosis By Ritika Verma, MD ; Ritika Verma, MD 1 Internal Medicine, University of Missouri, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Kiet Huynh, BS ; Kiet Huynh, BS 1 Internal Medicine, University of Missouri, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Rajani Gundluru, MD ; Rajani Gundluru, MD 2 Endocrinology and Diabetes Division, University of Missouri School of Medicine, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Michael J. Gardner, MD ; Michael J. Gardner, MD 2 Endocrinology and Diabetes Division, University of Missouri School of Medicine, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar James Sowers, MD James Sowers, MD 2 Endocrinology and Diabetes Division, University of Missouri School of Medicine, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.12 Open the PDF Link PDF for Case 12: Acromegaly Presenting With Diabetic Ketoacidosis in another window
• Case 13: Rapid-Onset Type 1 Diabetes and Ketoacidosis By Deepthi Rimmalapudi, MD ; Deepthi Rimmalapudi, MD 1 Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, California. Search for other works by this author on: This Site PubMed Google Scholar Eli Ipp, MD Eli Ipp, MD 1 Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, California. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.13 Open the PDF Link PDF for Case 13: Rapid-Onset Type 1 Diabetes and Ketoacidosis in another window
• Case 14: Euglycemic Ketoacidosis in the Setting of COVID-19 Infection and Sodium–Glucose Cotransporter 2 Inhibitor Use By Olga Duchon, MD ; Olga Duchon, MD 1 Endocrinology, University of Chicago Medicine, Chicago, Illinois. Search for other works by this author on: This Site PubMed Google Scholar Celeste Thomas, MD Celeste Thomas, MD 1 Endocrinology, University of Chicago Medicine, Chicago, Illinois. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.14 Open the PDF Link PDF for Case 14: Euglycemic Ketoacidosis in the Setting of COVID-19 Infection and Sodium–Glucose Cotransporter 2 Inhibitor Use in another window
• Case 15: Euglycemic Diabetic Ketoacidosis Due to Sodium–Glucose Cotransporter 2 Inhibitor Use By Diana Soliman, MD ; Diana Soliman, MD 1 Duke University Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina. Search for other works by this author on: This Site PubMed Google Scholar Nicole Jelesoff, MD Nicole Jelesoff, MD 1 Duke University Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.15 Open the PDF Link PDF for Case 15: Euglycemic Diabetic Ketoacidosis Due to Sodium–Glucose Cotransporter 2 Inhibitor Use in another window
• Case 16: A Case of Euglycemic Diabetic Ketoacidosis After Initiation of Ketogenic Diet in a Patient With Type 2 Diabetes on a Sodium–Glucose Cotransporter 2 (SGLT2) Inhibitor By Matthew P. Gilbert, DO, MPH ; Matthew P. Gilbert, DO, MPH 1 Department of Medicine, Division of Endocrinology and Diabetes, Larner College of Medicine at The University of Vermont, Burlington, Vermont. Search for other works by this author on: This Site PubMed Google Scholar Amy Shah, DO Amy Shah, DO 1 Department of Medicine, Division of Endocrinology and Diabetes, Larner College of Medicine at The University of Vermont, Burlington, Vermont. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.16 Open the PDF Link PDF for Case 16: A Case of Euglycemic Diabetic Ketoacidosis After Initiation of Ketogenic Diet in a Patient With Type 2 Diabetes on a Sodium–Glucose Cotransporter 2 (SGLT2) Inhibitor in another window
• Case 17: Diabetic Ketoacidosis in End-Stage Renal Disease: A Unique Challenge By Vishnu Garla, MD ; Vishnu Garla, MD 1 Department of Internal Medicine, Mississippi Center for Clinical and Translational Research (MCCTR), University of Mississippi Medical Center, Jackson, Mississippi. 2 Division of Endocrinology, Metabolism, and Diabetes, University of Mississippi Medical Center, Jackson, Mississippi. Search for other works by this author on: This Site PubMed Google Scholar Angela Subauste, MD ; Angela Subauste, MD 2 Division of Endocrinology, Metabolism, and Diabetes, University of Mississippi Medical Center, Jackson, Mississippi. Search for other works by this author on: This Site PubMed Google Scholar Lillian F. Lien, MD Lillian F. Lien, MD 2 Division of Endocrinology, Metabolism, and Diabetes, University of Mississippi Medical Center, Jackson, Mississippi. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.17 Open the PDF Link PDF for Case 17: Diabetic Ketoacidosis in End-Stage Renal Disease: A Unique Challenge in another window
• Case 18: Euglycemic Diabetic Ketoacidosis in a Patient With Type 1 Diabetes Treated With a Sodium–Glucose Cotransporter 2 (SGLT2) Inhibitor While on a Ketogenic Diet By Jessica Castellanos-Diaz, MD ; Jessica Castellanos-Diaz, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Malcom Randall Veteran Hospital, Gainesville, Florida. 2 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, Florida. Search for other works by this author on: This Site PubMed Google Scholar Julio Leey-Casella, MD ; Julio Leey-Casella, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Malcom Randall Veteran Hospital, Gainesville, Florida. 2 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, Florida. Search for other works by this author on: This Site PubMed Google Scholar Kenneth Cusi, MD ; Kenneth Cusi, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Malcom Randall Veteran Hospital, Gainesville, Florida. 2 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, Florida. Search for other works by this author on: This Site PubMed Google Scholar Sushma Kadiyala, MD Sushma Kadiyala, MD 1 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Malcom Randall Veteran Hospital, Gainesville, Florida. 2 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, Florida. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.18 Open the PDF Link PDF for Case 18: Euglycemic Diabetic Ketoacidosis in a Patient With Type 1 Diabetes Treated With a Sodium–Glucose Cotransporter 2 (SGLT2) Inhibitor While on a Ketogenic Diet in another window
• Case 19: Immune Checkpoint Inhibitor–Induced Type 1 Diabetes By Halis Kaan Akturk, MD ; Halis Kaan Akturk, MD 1 Barbara Davis Center for Diabetes, University of Colorado, Aurora, Colorado. Search for other works by this author on: This Site PubMed Google Scholar Aaron W. Michels, MD Aaron W. Michels, MD 1 Barbara Davis Center for Diabetes, University of Colorado, Aurora, Colorado. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.19 Open the PDF Link PDF for Case 19: Immune Checkpoint Inhibitor–Induced Type 1 Diabetes in another window
• Case 20: Partial β-Cell Destruction: An Atypical Case of Immune Checkpoint Inhibitor Diabetes By Zoe Quandt, MD ; Zoe Quandt, MD 1 Division of Endocrinology and Metabolism. Search for other works by this author on: This Site PubMed Google Scholar Paras Mehta, MD ; Paras Mehta, MD 1 Division of Endocrinology and Metabolism. Search for other works by this author on: This Site PubMed Google Scholar Katy K. Tsai, MD ; Katy K. Tsai, MD 2 Division of Hematology/Oncology, University of California, San Francisco, California. Search for other works by this author on: This Site PubMed Google Scholar Victoria Hsiao, MD ; Victoria Hsiao, MD 1 Division of Endocrinology and Metabolism. Search for other works by this author on: This Site PubMed Google Scholar Robert J. Rushakoff, MD Robert J. Rushakoff, MD 1 Division of Endocrinology and Metabolism. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.20 Open the PDF Link PDF for Case 20: Partial β-Cell Destruction: An Atypical Case of Immune Checkpoint Inhibitor Diabetes in another window
• Case 21: Checkpoint Inhibitor–Induced Diabetes By Paras Mehta, MD ; Paras Mehta, MD 1 Division of Endocrinology and Metabolism, University of California, San Francisco, California. Search for other works by this author on: This Site PubMed Google Scholar Zoe Quandt, MD ; Zoe Quandt, MD 1 Division of Endocrinology and Metabolism, University of California, San Francisco, California. Search for other works by this author on: This Site PubMed Google Scholar Robert J. Rushakoff, MD Robert J. Rushakoff, MD 1 Division of Endocrinology and Metabolism, University of California, San Francisco, California. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.21 Open the PDF Link PDF for Case 21: Checkpoint Inhibitor–Induced Diabetes in another window
• Case 22: Alpelisib-Induced Hyperglycemia: A Case Series By Richa Patel, MD ; Richa Patel, MD 1 Department of Medicine, Division of Endocrinology and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Ana Ramirez Berlioz, MD ; Ana Ramirez Berlioz, MD 1 Department of Medicine, Division of Endocrinology and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Amber Pinson, MD ; Amber Pinson, MD 1 Department of Medicine, Division of Endocrinology and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Michael Gardner, MD Michael Gardner, MD 1 Department of Medicine, Division of Endocrinology and Metabolism, University of Missouri–Columbia, Columbia, Missouri. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.22 Open the PDF Link PDF for Case 22: Alpelisib-Induced Hyperglycemia: A Case Series in another window
• Case 23: Phosphatidylinositol 3-Kinase (PI3K) Inhibitor–Induced Hyperglycemia By Sanjita B. Chittimoju, MD ; Sanjita B. Chittimoju, MD 1 Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts. Search for other works by this author on: This Site PubMed Google Scholar Sara M. Alexanian, MD ; Sara M. Alexanian, MD 1 Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts. Search for other works by this author on: This Site PubMed Google Scholar Katherine L. Modzelewski, MD Katherine L. Modzelewski, MD 1 Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.23 Open the PDF Link PDF for Case 23: Phosphatidylinositol 3-Kinase (PI3K) Inhibitor–Induced Hyperglycemia in another window
• Case 24: Misleading Diabetes: A Case of Type B Insulin Resistance Associated With Lupus Nephritis and Autoimmune Hepatitis By Ghada Elshimy ; Ghada Elshimy 1 Division of Endocrinology, University of Arizona College of Medicine, Phoenix, Arizona. Search for other works by this author on: This Site PubMed Google Scholar Mary Esquivel ; Mary Esquivel 2 Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Search for other works by this author on: This Site PubMed Google Scholar Meredith McFarland ; Meredith McFarland 2 Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Search for other works by this author on: This Site PubMed Google Scholar Jessica Ricciuto ; Jessica Ricciuto 2 Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Search for other works by this author on: This Site PubMed Google Scholar Christopher Tessier ; Christopher Tessier 2 Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Search for other works by this author on: This Site PubMed Google Scholar Joanna Miragaya ; Joanna Miragaya 2 Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Search for other works by this author on: This Site PubMed Google Scholar Ricardo Correa, MD, EdD, FACP, FACE, FAPCR, CMQ Ricardo Correa, MD, EdD, FACP, FACE, FAPCR, CMQ 1 Division of Endocrinology, University of Arizona College of Medicine, Phoenix, Arizona. 2 Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.24 Open the PDF Link PDF for Case 24: Misleading Diabetes: A Case of Type B Insulin Resistance Associated With Lupus Nephritis and Autoimmune Hepatitis in another window
• Case 25: Latent Autoimmune Diabetes in an Adult With Insulin Allergy By Makeda Dawkins, MD ; Makeda Dawkins, MD 1 Department of Medicine, Westchester Medical Center, Valhalla, New York. Search for other works by this author on: This Site PubMed Google Scholar Alyson K. Myers, MD Alyson K. Myers, MD 2 Department of Medicine, Division of Endocrinology, North Shore University Hospital, Northwell Health, Manhasset, New York. 3 Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York. 4 Center for Health Innovations and Health Outcomes Research. 5 Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.25 Open the PDF Link PDF for Case 25: Latent Autoimmune Diabetes in an Adult With Insulin Allergy in another window
• Case 26: Onset of Autoimmune Diabetes During Pregnancy By Kaitlyn Barrett, DO ; Kaitlyn Barrett, DO 1 Department of Medicine, Division of Endocrinology and Diabetes, Larner College of Medicine at The University of Vermont, Burlington, Vermont. Search for other works by this author on: This Site PubMed Google Scholar Kelsey Sheahan, MD ; Kelsey Sheahan, MD 1 Department of Medicine, Division of Endocrinology and Diabetes, Larner College of Medicine at The University of Vermont, Burlington, Vermont. Search for other works by this author on: This Site PubMed Google Scholar Matthew P. Gilbert, DO, MPH Matthew P. Gilbert, DO, MPH 1 Department of Medicine, Division of Endocrinology and Diabetes, Larner College of Medicine at The University of Vermont, Burlington, Vermont. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.26 Open the PDF Link PDF for Case 26: Onset of Autoimmune Diabetes During Pregnancy in another window
• Case 27: Comorbidity of Diabetes and Systemic Lupus Erythematosus By Boris Mankovsky, MD ; Boris Mankovsky, MD 1 Department of Diabetology, National Medical Academy for Postgraduate Education. 2 Center for Innovative Medical Technologies, Kiev, Ukraine. Search for other works by this author on: This Site PubMed Google Scholar Yanina Saenko, MD Yanina Saenko, MD 2 Center for Innovative Medical Technologies, Kiev, Ukraine. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.27 Open the PDF Link PDF for Case 27: Comorbidity of Diabetes and Systemic Lupus Erythematosus in another window
• Case 28: Illusion of Autoimmune Diabetes By Nay Linn Aung, MD Nay Linn Aung, MD 1 St. Elizabeth Family Medicine Residency, Mohawk Valley Health System (MVHS), Utica, New York. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.28 Open the PDF Link PDF for Case 28: Illusion of Autoimmune Diabetes in another window
• Case 29: Can a Lupus Flare Cause Autoimmune Diabetes? By Andriy Havrylyan, MD ; Andriy Havrylyan, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. Search for other works by this author on: This Site PubMed Google Scholar Janice L. Gilden, MS, MD Janice L. Gilden, MS, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. 2 Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.29 Open the PDF Link PDF for Case 29: Can a Lupus Flare Cause Autoimmune Diabetes? in another window
• Case 30: Feasibility and Utility of Continuous Glucose Monitoring in an Adult With Type 1 Diabetes and Down’s Syndrome By Kristen L. Flint, MD ; Kristen L. Flint, MD 1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Search for other works by this author on: This Site PubMed Google Scholar Elena Toschi, MD Elena Toschi, MD 1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 2 Joslin Diabetes Center, Boston, Massachusetts. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.30 Open the PDF Link PDF for Case 30: Feasibility and Utility of Continuous Glucose Monitoring in an Adult With Type 1 Diabetes and Down’s Syndrome in another window
• Case 31: A Novel Approach to Achieve Target Time in Range When Using U-500 Regular Insulin in a Continuous Subcutaneous Insulin Infusion (CSII) Pump By Patricia A. Montesinos, NP, CDE ; Patricia A. Montesinos, NP, CDE 1 MedStar Diabetes Institute. Search for other works by this author on: This Site PubMed Google Scholar Michelle F. Magee, MD, MBBCh, BAO, LRCPSI Michelle F. Magee, MD, MBBCh, BAO, LRCPSI 1 MedStar Diabetes Institute. 2 Georgetown University School of Medicine, Washington, DC Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.31 Open the PDF Link PDF for Case 31: A Novel Approach to Achieve Target Time in Range When Using U-500 Regular Insulin in a Continuous Subcutaneous Insulin Infusion (CSII) Pump in another window
• Case 32: Automated Insulin Infusion System Is Useful to Control Blood Glucose Concentration During Major Stress in Patients With Type 1 Diabetes By Renzo Cordera, MD ; Renzo Cordera, MD 1 Department of Internal Medicine, University of Genova and Policlinico San Martino, Genova, Italy. Search for other works by this author on: This Site PubMed Google Scholar Davide Maggi, MD, PhD Davide Maggi, MD, PhD 1 Department of Internal Medicine, University of Genova and Policlinico San Martino, Genova, Italy. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.32 Open the PDF Link PDF for Case 32: Automated Insulin Infusion System Is Useful to Control Blood Glucose Concentration During Major Stress in Patients With Type 1 Diabetes in another window
• Case 33: Detecting Patterns in Continuous Glucose Monitoring of Glucocorticoid-Treated Patients With Diabetes By Harjyot Sandhu, MD ; Harjyot Sandhu, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. Search for other works by this author on: This Site PubMed Google Scholar Janice L. Gilden, MS, MD ; Janice L. Gilden, MS, MD 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. 2 Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois. Search for other works by this author on: This Site PubMed Google Scholar Lynne Wentz, MHS, BSN, CDCES Lynne Wentz, MHS, BSN, CDCES 1 Diabetes/Endocrinology Section, Chicago Medical School at Rosalind Franklin University of Medicine and Science. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.33 Open the PDF Link PDF for Case 33: Detecting Patterns in Continuous Glucose Monitoring of Glucocorticoid-Treated Patients With Diabetes in another window
• Case 34: Hyperinsulemic Hypoglycemia After Roux-en-Y Gastric Bypass Surgery: Both Fasting and Postprandial By Maria Magar, MD ; Maria Magar, MD 1 LAC+USC Medical Center, Los Angeles, California. Search for other works by this author on: This Site PubMed Google Scholar Anne Peters, MD ; Anne Peters, MD 2 Keck School of Medicine of the University of Southern California, Los Angeles, California. Search for other works by this author on: This Site PubMed Google Scholar Braden Barnett, MD Braden Barnett, MD 3 Keck School of Medicine of the University of Southern California, Los Angeles, California Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.34 Open the PDF Link PDF for Case 34: Hyperinsulemic Hypoglycemia After Roux-en-Y Gastric Bypass Surgery: Both Fasting and Postprandial in another window
• Case 35: Refractory Hypoglycemia Due to Massive Unintentional Insulin Overdose By Jennifer D. Merrill, MD ; Jennifer D. Merrill, MD 1 Duke University Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina. Search for other works by this author on: This Site PubMed Google Scholar Jennifer Rowell, MD Jennifer Rowell, MD 1 Duke University Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.35 Open the PDF Link PDF for Case 35: Refractory Hypoglycemia Due to Massive Unintentional Insulin Overdose in another window
• Case 36: A Case of Prolonged Hypoglycemia Due to Sulfonylurea and Concurrent Antibiotic Use By Jennifer D. Merrill, MD ; Jennifer D. Merrill, MD 1 Duke University Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC Search for other works by this author on: This Site PubMed Google Scholar Susan E. Spratt, MD Susan E. Spratt, MD 1 Duke University Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.36 Open the PDF Link PDF for Case 36: A Case of Prolonged Hypoglycemia Due to Sulfonylurea and Concurrent Antibiotic Use in another window
• Case 37: “Do I Really Need Insulin?” The Role of Insulin Therapy in Cystic Fibrosis–Related Diabetes (CFRD) By Nader Kasim, MD ; Nader Kasim, MD 1 Department of Pediatrics, Division of Endocrinology and Diabetes, Helen Devos Children’s Hospital, Spectrum Health, Michigan State University, Grand Rapids, Michigan. Search for other works by this author on: This Site PubMed Google Scholar Antoinette Moran, MD ; Antoinette Moran, MD 2 Department of Pediatrics. Search for other works by this author on: This Site PubMed Google Scholar Amir Moheet, MD Amir Moheet, MD 3 Department of Medicine, University of Minnesota, Minneapolis, Minnesota Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.37 Open the PDF Link PDF for Case 37: “Do I Really Need Insulin?” The Role of Insulin Therapy in Cystic Fibrosis–Related Diabetes (CFRD) in another window
• Case 38: Cystic Fibrosis–Related Diabetes Case Series: Effects of the CF Transmembrane Conductance Regulator (CFTR) Modulator on Glycemic Control By Jagdeesh Ullal, MD ; Jagdeesh Ullal, MD 1 University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Center for Diabetes and Endocrinology, Pittsburgh, Pennsylvania. Search for other works by this author on: This Site PubMed Google Scholar Lina Merjaneh, MD ; Lina Merjaneh, MD 2 Division of Endocrinology & Diabetes, Seattle Children’s Hospital, Seattle, Washington. Search for other works by this author on: This Site PubMed Google Scholar Kara S. Hughan, MD ; Kara S. Hughan, MD 3 Division of Endocrinology and Diabetes, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Search for other works by this author on: This Site PubMed Google Scholar Andrea Kelly, MD, MSCE Andrea Kelly, MD, MSCE 4 Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.38 Open the PDF Link PDF for Case 38: Cystic Fibrosis–Related Diabetes Case Series: Effects of the CF Transmembrane Conductance Regulator (CFTR) Modulator on Glycemic Control in another window
• Case 39: Simplifying Insulin Therapy: Transitioning from Basal-Bolus Insulin Therapy to Basal Insulin With a Glucagon-Like Peptide-1 Receptor Analog (GLP-1RA) By Sevil Aliyeva, MD ; Sevil Aliyeva, MD 1 Division of Endocrinology, Medstar Union Memorial Hospital, Baltimore, Maryland Search for other works by this author on: This Site PubMed Google Scholar Pamela Schroeder, MD, PhD ; Pamela Schroeder, MD, PhD 1 Division of Endocrinology, Medstar Union Memorial Hospital, Baltimore, Maryland Search for other works by this author on: This Site PubMed Google Scholar Paul Sack, MD Paul Sack, MD 1 Division of Endocrinology, Medstar Union Memorial Hospital, Baltimore, Maryland Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.39 Open the PDF Link PDF for Case 39: Simplifying Insulin Therapy: Transitioning from Basal-Bolus Insulin Therapy to Basal Insulin With a Glucagon-Like Peptide-1 Receptor Analog (GLP-1RA) in another window
• Case 40: Simplification of Insulin Regimen Improves Glycemic Control in Elderly Patients With Type 2 Diabetes By Maria Gracia Luzuriaga, MD ; Maria Gracia Luzuriaga, MD 1 Division of Endocrinology, Diabetes, and Metabolism, University of Miami, Miller School of Medicine, Miami, Florida Search for other works by this author on: This Site PubMed Google Scholar Rajesh Garg, MD Rajesh Garg, MD 1 Division of Endocrinology, Diabetes, and Metabolism, University of Miami, Miller School of Medicine, Miami, Florida Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.40 Open the PDF Link PDF for Case 40: Simplification of Insulin Regimen Improves Glycemic Control in Elderly Patients With Type 2 Diabetes in another window
• Case 41: Effects of Glucagon-Like Peptide-1 Receptor Agonist (GLP-1RA) in an Individual With Type 2 Diabetes on High-Dose Insulin Therapy By Basem M. Mishriky, MD ; Basem M. Mishriky, MD 1 Department of Internal Medicine. Search for other works by this author on: This Site PubMed Google Scholar Doyle M. Cummings, PharmD, FCP, FCCP ; Doyle M. Cummings, PharmD, FCP, FCCP 2 Department of Family Medicine, East Carolina University, Greenville, North Carolina. Search for other works by this author on: This Site PubMed Google Scholar Carlos E. Mendez, MD Carlos E. Mendez, MD 3 Division of Diabetes and Endocrinology, Froedtert and Medical College of Wisconsin, Milwaukee, Wisconsin Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.41 Open the PDF Link PDF for Case 41: Effects of Glucagon-Like Peptide-1 Receptor Agonist (GLP-1RA) in an Individual With Type 2 Diabetes on High-Dose Insulin Therapy in another window
• Case 42: Transient Severe Insulin Resistance in COVID-19 and Prediabetes By R. Matthew Hawkins, PA-C ; R. Matthew Hawkins, PA-C 1 University of Colorado School of Medicine, Aurora, Colorado Search for other works by this author on: This Site PubMed Google Scholar Whitney Adair, PA-C ; Whitney Adair, PA-C 1 University of Colorado School of Medicine, Aurora, Colorado Search for other works by this author on: This Site PubMed Google Scholar Joanna Gibbs, PA-C ; Joanna Gibbs, PA-C 1 University of Colorado School of Medicine, Aurora, Colorado Search for other works by this author on: This Site PubMed Google Scholar Jennifer Vinh, AGCNS-BC ; Jennifer Vinh, AGCNS-BC 1 University of Colorado School of Medicine, Aurora, Colorado Search for other works by this author on: This Site PubMed Google Scholar Cecilia C. Low Wang, MD Cecilia C. Low Wang, MD 1 University of Colorado School of Medicine, Aurora, Colorado Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.42 Open the PDF Link PDF for Case 42: Transient Severe Insulin Resistance in COVID-19 and Prediabetes in another window
• Case 43: Nondiabetic Renal Disease in Type 1 Diabetes: When to Consider a Renal Biopsy By Rong Mei Zhang, MD ; Rong Mei Zhang, MD 1 Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri; Search for other works by this author on: This Site PubMed Google Scholar Ritika Puri, MD ; Ritika Puri, MD 2 Division of Endocrinology, University of Nebraska Medical Center, Omaha, Nebraska; Search for other works by this author on: This Site PubMed Google Scholar Tingting Li, MD ; Tingting Li, MD 3 Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri Search for other works by this author on: This Site PubMed Google Scholar Janet B. McGill, MD Janet B. McGill, MD 1 Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri; Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.43 Open the PDF Link PDF for Case 43: Nondiabetic Renal Disease in Type 1 Diabetes: When to Consider a Renal Biopsy in another window
• Case 44: Severe Fetal Malformation Related to Obesity and Type 2 Diabetes By Aswathi Kumar, MD ; Aswathi Kumar, MD 1 Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri Search for other works by this author on: This Site PubMed Google Scholar Janet B. McGill, MD Janet B. McGill, MD 1 Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.44 Open the PDF Link PDF for Case 44: Severe Fetal Malformation Related to Obesity and Type 2 Diabetes in another window
• Case 45: Hyperglycemia from Oral Comfort Feeds By Nehu Parimi, MD ; Nehu Parimi, MD 1 Department of Endocrinology, University of Missouri, Columbia Search for other works by this author on: This Site PubMed Google Scholar Rajani Gundluru, MD ; Rajani Gundluru, MD 1 Department of Endocrinology, University of Missouri, Columbia Search for other works by this author on: This Site PubMed Google Scholar Michael Gardner, MD ; Michael Gardner, MD 1 Department of Endocrinology, University of Missouri, Columbia Search for other works by this author on: This Site PubMed Google Scholar James Sowers, MD James Sowers, MD 1 Department of Endocrinology, University of Missouri, Columbia Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.45 Open the PDF Link PDF for Case 45: Hyperglycemia from Oral Comfort Feeds in another window
• Case 46: Rethinking Insulin in Type 2 Diabetes By Rebecca J. Morey, MD ; Rebecca J. Morey, MD 1 Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri Search for other works by this author on: This Site PubMed Google Scholar Cynthia Herrick, MD, MPHS Cynthia Herrick, MD, MPHS 1 Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.46 Open the PDF Link PDF for Case 46: Rethinking Insulin in Type 2 Diabetes in another window
• Case 47: Coincidence or Consequence? A Case of Type 1 Diabetes With Worsening Neuropathy By Cecilia C. Low Wang, MD, FACP Cecilia C. Low Wang, MD, FACP 1 University of Colorado School of Medicine, Department of Medicine Division of Endocrinology, Metabolism and Diabetes, Anschutz Medical Campus, Aurora, Colorado Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.47 Open the PDF Link PDF for Case 47: Coincidence or Consequence? A Case of Type 1 Diabetes With Worsening Neuropathy in another window
• Case 48: Challenges to the Management of Diabetes in Patients Who Undergo Ventricular Assist Device (VAD) Implantation By Chinenye O. Usoh, MD ; Chinenye O. Usoh, MD 1 Endocrinology and Metabolism Section. Search for other works by this author on: This Site PubMed Google Scholar Donald A. McClain, MD, PhD ; Donald A. McClain, MD, PhD 1 Endocrinology and Metabolism Section. Search for other works by this author on: This Site PubMed Google Scholar Barbara A. Pisani, DO Barbara A. Pisani, DO 2 Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.48 Open the PDF Link PDF for Case 48: Challenges to the Management of Diabetes in Patients Who Undergo Ventricular Assist Device (VAD) Implantation in another window
• Case 49: Insulin and Heroin: An Unfortunate Mix in an Overlooked Population By Amro Ilaiwy, MD ; Amro Ilaiwy, MD 1 Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, North Carolina Search for other works by this author on: This Site PubMed Google Scholar Jennifer V. Rowell, MD ; Jennifer V. Rowell, MD 1 Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, North Carolina Search for other works by this author on: This Site PubMed Google Scholar Beatrice D. Hong, MD Beatrice D. Hong, MD 1 Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, North Carolina Search for other works by this author on: This Site PubMed Google Scholar Doi: https://doi.org/10.2337/9781580407663.49 Open the PDF Link PDF for Case 49: Insulin and Heroin: An Unfortunate Mix in an Overlooked Population in another window
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COVID-19 vaccination and diabetic ketoacidosis

Academic Center, Sanitation1 Medical Academic Center, Bangkok 1033300, Thailand. moc.liamtoh@boojyueb

Viroj Wiwanitkit

Community Medicine, DY Patil Vidhyapeeth, Pune 233230, India

Corresponding author: Beuy Joob, PhD, Adjunct Associate Professor, Academic Center, Sanitation1 Medical Academic Center, Bangkok 1033300, Thailand. moc.liamtoh@boojyueb

An efficient coronavirus disease 2019 (COVID-19) vaccine is urgently required to fight the pandemic due to its high transmission rate and quick dissemination. There have been numerous reports on the side effects of the COVID-19 immu-nization, with a focus on its negative effects. Clinical endocrinology is extremely interested in the endocrine issue that arises after receiving the COVID-19 vaccine. As was already mentioned, after receiving the COVID-19 vaccine, many clinical problems could occur. Additionally, there are some compelling reports on diabetes. After receiving the COVID-19 vaccine, a patient experienced hyperosmolar hyperglycemia state, a case of newly-onset type 2 diabetes. There has also been information on a potential connection between the COVID-19 vaccine and diabetic ketoacidosis. Common symptoms include thirst, polydipsia, polyuria, palpitations, a lack of appetite, and weariness. In extremely rare clinical circumstances, a COVID-19 vaccine recipient may develop diabetes complications such as hyperglycemia and ketoacidosis. In these circumstances, routine clinical care has a successful track record. It is advised to give vaccine recipients who are vulnerable to problems, such as those with type 1 diabetes as an underlying illness, extra attention.

Core Tip: There has also been information on a potential connection between the coronavirus disease 2019 (COVID-19) vaccine and diabetic ketoacidosis. Common symptoms include thirst, polydipsia, polyuria, palpitations, a lack of appetite, and weariness. In extremely rare clinical circumstances, a COVID-19 vaccine recipient may develop diabetes complications such as hyperglycemia and ketoacidosis.

INTRODUCTION

Because of the pandemic's high transmission rate, an effective coronavirus disease 2019 (COVID-19) vaccine is urgently needed[ 1 ]. The available literature indicates that both vaccines help prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, given that the vaccination is new, any potential side effects are of greater concern[ 2 - 3 ]. When a handful of novel vaccines created in response to the COVID-19 pandemic got emergency approval and were widely distributed in late 2020[ 2 ], pharmacovigilance was unwittingly thrust into the spotlight. An effective global post marketing safety surveillance system was emphasized due to the employment of cutting-edge technologies and the anticipated rapid and widespread deployment of the vaccinations. The vaccinations went through extensive clinical evaluation and regulatory authority review. Many reports on the adverse effects of the COVID-19 vaccination have focused on how diverse they are. Clinical endocrinology is quite concerned about the endocrine issue that manifests after receiving the COVID-19 vaccination. The main concern expressed by the authors of this paper is that diabetes can become a medical problem after receiving the COVID-19 vaccine. After getting the COVID-19 vaccination, numerous clinical issues could arise, as was already mentioned. There are also some interesting reports regarding diabetes. The key words are provided here with a brief explanation.

Diabetes and COVID-19 have a well-established association. There is a bidirectional causal relationship between COVID-19 and type 2 diabetes. Diabetes may exacerbate COVID-19 severity, and COVID-19 vulnerability may increase diabetes risk[ 4 ]. Diabetes patients should receive the COVID-19 vaccine, just like everyone else, to protect themselves from the disease. It is critical to discuss the risks of vaccination for those who currently have diabetes mellitus. Piccini et al [ 5 ] evaluate the likelihood of glycemic control modification, insulin dose adjustment, and adverse effects following COVID-19 vaccination in young people with type 1 diabetes who use varying degrees of technology[ 5 ]. Piccini et al [ 5 ] came to the conclusion that receiving the OVID-19 immunization did not significantly increase the risk of glycemic control disturbance in type 1 diabetes adolescents and young adults[ 5 ]. This information may be helpful clinically[ 6 ] when counseling families about the SARS-CoV-2 vaccine for young people with type 1 diabetes. In a study by D'Addio et al [ 6 ] that investigated the immunogenicity and security of SARS-CoV-2 mRNA vaccines, a cohort of individuals with type 1 diabetes took part[ 5 ]. The vaccination demonstrated both dependability and security, according to D'Addio et al [ 6 ].

Several reports claim that COVID-19 vaccine recipients have problems with their diabetes. The exacerbation of hyperglycemia in people with type 2 diabetes after receiving the COVID-19 vaccination is the first problem that needs to be addressed[ 7 ]. Mishra et al [ 7 ] claim that an early inflammatory reaction to the vaccine and a subsequent immunological response are likely to be the causes of a minor and transient rise in blood sugar levels[ 7 ]. Mishra et al [ 7 ] published a case series that substantiated the etiology of transient immuno-inflammation because all episodes of hyperglycemia were self-limited and did not require significant treatment modifications[ 7 ]. A rapid jump in blood sugar levels appears to be caused by a vaccine. The possibility of a mild to moderate rise in blood sugar levels following vaccination has been theorized[ 7 ]. One patient experienced new-onset type 2 diabetes after receiving the COVID-19 vaccine, which is known as hyperosmolar hyperglycemia state[ 8 ].

COVID-19 VACCINATION AND DIABETIC KETOACIDOSIS

Clinical diabetology has an intriguing discussion regarding the COVID-19 vaccine and diabetic ketoacidosis. As was already indicated, the immunization may cause hyperviscosity and have unintended side effects. Additionally, reports of a connection between the COVID-19 immunization and diabetic ketoacidosis have been made. Three days after the first dose of COVID-19 RNA-based vaccines, the patient typically experiences thirst, polydipsia, polyuria, palpitations, a lack of appetite, and exhaustion without a prior history of diabetes[ 9 ]. Hyperglycemia, anion gap metabolic acidosis, and ketonuria are the three main signs of classic diabetic ketoacidosis[ 9 ]. It is possible to detect insulin autoantibody positivity and latent thyroid autoimmunity[ 10 ]. Ganakumar et al [ 11 ] advised that people with diabetes, particularly those with type 1 diabetes mellitus and inadequate glycemic control, be constantly monitored for hyperglycemia and ketonemia for at least two weeks after receiving the COVID-19 vaccine[ 11 ]. Autoimmunity and genetic predisposition may have contributed to the onset of the disease, even if the precise pathophysiologic mechanisms underlying type 1 diabetes are still unknown[ 12 ].

According to Tang et al [ 12 ], vaccination could result in type 1 diabetes, irreversible islet beta cell loss, and autoimmunity in persons with susceptible genetic backgrounds[ 12 ]. The problem might be more serious and more likely to occur in situations where type 1 diabetes is already present. Yakou et al [ 13 ] advised that the immunization be cautiously administered to type 1 diabetes patients receiving strict insulin therapy and a sodium-glucose transporter[ 13 ] due to the increased risk of ketoacidosis. In the affected case, despite hyperglycemia and diabetic ketoacidosis (DKA) after SARS-CoV-2 immunization, low glycohemoglobin levels are a crucial indicator of COVID-19 vaccine-related DKA[ 14 ]. As a preventive measure, it is essential to counsel patients to continue getting insulin injections[ 13 ]. Due to the significant risk of ketoacidosis, the vaccination should be cautiously given to type 1 diabetes patients receiving rigorous insulin therapy and a sodium-glucose transporter[ 15 ]. When a patient becomes ill, it's crucial to remind them to continue taking their insulin injections and to drink enough fluids[ 13 ]. A similar preventative concern should be used in the case of the patient with poorly controlled type 2 diabetes, in addition to the patient with underlying type 1 diabetes. According to Kshetree et al [ 15 ], Type I or dysglycemia in Type 2 diabetes mellitus is becoming more frequently documented following COVID-19 vaccinations or infection[ 16 ]. The mechanisms could be autoimmunity following mRNA vaccinations, cytokine-mediated beta-cell injury, or as a component of an autoimmune syndrome brought on by vaccine adjuvants[ 15 ]. Further investigation into the negative effects of people prone to life-threatening illnesses is required, as suggested by Lin et al [ 14 ]. Also, there might be a need for postvaccination surveillance on both hyperglycemia and DKA problems[ 16 ].

Concerning the reported cases of a link between COVID-19 vaccination and diabetes ketoacidosis, an important clinical question is whether ketosis in type 1 diabetes is related to the use of sodium-glucose transport protein 2 (SGLT2) inhibitors. The clinical history of the vaccine recipients in the published articles on the clinical association usually revealed no use of SGLT2 inhibitors, which could be a clue to support the possible clinical association between COVID-19 vaccination and ketoacidosis. Last but not least, it should be noted that the mRNA COVID-19 vaccine is primarily associated with most findings on the relationship between COVID-19 immunization and diabetic ketoacidosis. There are, however, a few reports of clinical associations with other vaccination types (viral vector and inactivated COVID-19 vaccines) that have been documented[ 11 ]. The fact that the mRNA vaccination is currently the primary recommended COVID-19 vaccine may be the cause of the higher number of reported cases in the mRNA vaccine group. As previously stated, the COVID-19 vaccination may cause diabetic ketoacidosis in patients with type 1 or type 2 diabetes mellitus (Table ​ (Table1 1 ).

Table summarizing the key information of coronavirus disease-19 vaccine related diabetic ketoacidosis in recipients with background type 1 and type 2 diabetes mellitus

There are significant differences in COVD-19 vaccine-induced diabetes ketoacidosis between recipients with type 1 and type 2 diabetes. COVID-19 vaccine induced diabetes ketoacidosis usually occurs in adolescent male cases with inadequate glycemic control in cases with background type 1 diabetes mellitus[ 11 ]. This is the same pattern seen in diabetic ketoacidosis caused by COVID-19 in type 1 diabetes patients[ 17 ]. There are fewer reported cases of COVID-19 vaccine-induced diabetes ketoacidosis in people with type 2 diabetes mellitus, and the patient is usually an elderly man with a long history of diabetic illness[ 15 ]. The background hemoglobin A1C level, on the other hand, has not been identified as a risk factor for the development of COVID-19 vaccine-induced diabetic ketoacidosis[ 18 ].

In general, the COVID-19 immunization should be given to the diabetic patient because it has been proven to be effective. Generally, it has been confirmed that it is secure. In exceedingly uncommon clinical situations, a COVID-19 vaccination recipient may experience diabetes-related problems such as hyperglycemia and ketoacidosis. Routine clinical care has a history of success in some situations. Users of vaccines who are more likely to develop problems, such as those who already have type 1 diabetes as an underlying illness, are advised to receive additional attention. Because there is a possible link between the COVID vaccine and ketoacidosis, the risk diabetic case must be closely monitored. There is still a need for more clinical research on this subject because there isn't any in vivo or in vitro experimental data at this time.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Provenance and peer review: Invited article; Externally peer reviewed.

Peer-review model: Single blind

Peer-review started: December 15, 2022

First decision: January 17, 2023

Article in press: April 12, 2023

Specialty type: Endocrinology and metabolism

Country/Territory of origin: Thailand

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): B

Grade C (Good): C, C, C

Grade D (Fair): D

Grade E (Poor): 0

P-Reviewer: Cai L, United States; Dong Z, China; Moreno-Gómez-Toledano R, Spain; Wu QN, China; Zhang F, China S-Editor: Li L L-Editor: A P-Editor: Zhang XD

Contributor Information

Beuy Joob, Academic Center, Sanitation1 Medical Academic Center, Bangkok 1033300, Thailand. moc.liamtoh@boojyueb .

Viroj Wiwanitkit, Community Medicine, DY Patil Vidhyapeeth, Pune 233230, India.

Getting an Overview of the Core Terms in Margin Analysis

After completing this lesson, you will be able to:

• Get an Overview of the Core Terms in Margin Analysis

Overview of the Core Terms in Margin Analysis

https://learning.sap.com/learning-journeys/outline-cost-management-and-profitability-analysis-in-sap-s-4hana/outlining-profitability-analysis_b5b7efbb-55ea-4ff5-bc70-15d39d8a14eb

Introduction to Margin Analysis

The following video provides an overview of Margin Analysis.

Master Data

Master data in margin analysis include profitability characteristics and functional areas. Functional areas break down corporate expenditure into different functions, in line with the requirements of cost of sales accounting.

These functions can include:

• Production.
• Administration.
• Sales and Distribution.
• Research and Development.

For primary postings, the functional area is derived according to fixed rules and included in the journal entries. For secondary postings, the functional area and partner functional area are derived from the sender and receiver account assignments to reflect the flow of costs from sender to receiver.

Profitability Characteristics

Profitability characteristics represent the criteria used to analyze operating results and the sales and profit plan. Multiple profitability characteristics are combined to form profitability segments. The combination of characteristic values determines the profitability segment for which the gross margin structure can be displayed. A profitability segment corresponds to a market segment.

For example, the combination of the characteristic values North (Sales region), Electronics (Product group) and Wholesale (Customer group) determine a profitability segment for which the gross margin structure can be displayed.

True vs Attributed Account Assignments

Each activity relevant to Margin Analysis in the SAP system, such as billing, creates line items. G/L line items can carry true or attributed account assignments to profitability segments.

• Goods issue item or billing document item in a sell-from-stock scenario.
• Manual FI posting to profitability segment.
• Primary Costs or Revenue.
• Secondary Costs.
• Balance Sheet Accounts with a statistical cost element assigned.

The derivation of attributed profitability segments is based on the true account assignment object of the G/L line item. This object can be of the following types:

• Cost Center.
• Sales Order.
• Production Order (only for Engineer-to-Order process.)
• Maintenance Order.
• Service Document (service order or service contract.)

After the profitability characteristics are derived, the resulting data is mapped to the G/L line item according to specific mapping rules. An attributed profitability segment is derived to fulfill the requirement of filling as many characteristics in the item as possible to enable the maximum drilldown analysis capability.

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