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
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- 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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Two types of diabetes: Case study
While diabetes has been recognised as a severe disease since ancient times, it was only during the mid-20th century that National Health and Medical Research Council (NHMRC)-funded researchers at the Baker Heart and Diabetes Institute conclusively demonstrated that there are 2 major types of diabetes – type 2 (T2D) and type 1 (T1D) – based upon whether a person can or cannot produce their own insulin.
This finding enabled future generations of researchers and clinicians to address each type separately, leading to improved treatments and health advice for those living with diabetes.
A PDF poster version of this case study is available – see Download section below.
Diabetes mellitus is a disease associated with high levels of blood sugar, a condition that if untreated can be fatal. It can also lead to serious health problems including cardiovascular disease, nerve damage, kidney damage, eye damage and hearing impairment.
Diabetes was medically described as early as the 5th century BC, in India, 1 and by 1866 at least 2 distinct forms of the disease were recognised, requiring distinct courses of treatment. 2
In 1889, researchers discovered that the pancreas produced a substance (insulin) that helped to prevent diabetes and in 1921 insulin itself was chemically isolated. Production of insulin commenced soon after, including (in 1922) by Australia's Commonwealth Serum Laboratories. 3
In 1930, NHMRC's precursor body, the Federal Health Council, received a report from one of its members – Dr E Robertson, Chair of the Health Commission, Victoria – on 'action taken in Victoria to place the treatment by insulin and the provision of insulin for diabetics on a proper basis'.
This action was to occur within a broader 'Scheme for the reduction of the diabetic mortality in the State of Victoria', which was developed by Dr WJ Penfold of the Baker Medical Research Institute. The scheme comprised a number of steps, including determining which patients with high levels of blood sugar 'were true diabetics'.
Further understanding of this distinction between 'true' and other diabetes was provided in 1936 by the finding that people with diabetes could be divided into insulin-resistant and insulin-sensitive types. 4 However, to prove or disprove definitively that these 2 types related to insulin production, it was necessary to estimate the plasma insulin level in those with diabetes 5 and in the 1930s no method for doing so existed.
Grants and investment
NHMRC began funding medical research in 1938 and, commencing in 1939, researchers at the Baker Institute – which was established in 1926 as the biochemistry laboratory of The Alfred Hospital in Melbourne – received a succession of grants to support research on carbohydrate metabolism and diabetes. These topics had become highly significant once insulin started to become available.
The grants supported the work of a number of researchers including Charlotte Anderson, Joseph Bornstein, Arnold Ennor, GJ Lincoln, Shirley Richardson, Noel Rome and Phyliss Trewhella.
Insulin is a small protein molecule and a hormone: a chemical messenger within the body. Cells in the pancreas (beta cells) produce insulin in response to raised blood sugar levels.
In turn, insulin causes the cell membranes of muscle cells to draw in glucose, providing them with energy.
If the body has sufficient energy, insulin signals the liver and muscle cells to store glucose as glycogen and it signals the liver and the body's adipose (fat) tissues to convert glucose into triglycerides (a type of fat).
Circulating insulin also promotes protein synthesis inside body cells.
CSL and insulin
A Federal Serum Institute (later known as the Commonwealth Serum Laboratories and now CSL Ltd) was founded in 1916.
CSL established insulin production late in 1922 and treatment with this insulin was initiated in 1923. At this time, CSL was one of only 4 laboratories world-wide to produce insulin and it remains the sole manufacturer of insulin in Australia today. 3
Anderson commenced research at the Institute in 1936 by investigating the effect of the pituitary gland upon diabetes. Her work indicated that extracts of the gland reduced the effectiveness of insulin in lowering blood sugar because they also increased the transformation of glycogen (stored in the liver and elsewhere) into glucose. 6,7
Ennor recommenced work at the Institute in 1939 following completion of a Masters thesis on the effects of the adrenal gland on carbohydrate metabolism. 8 Informed by Anderson's work, he began the search for an 'anti-diabetogenic' hormone whose production was stimulated by exposure to the pituitary gland extracts. 9 His work also examined the effect of pituitary gland extracts on levels of the antioxidant glutathione in the liver. 10
Informed by the work of Anderson, Ennor, and other researchers at the Institute, Bornstein began working with Trewhella in 1947 on how to measure the concentration of insulin in human blood plasma. 11 Their approach was to create a type of rat that was unable to produce its own insulin or the pituitary and adrenal hormones that had previously been found to influence blood glucose (BG) levels and insulin uptake. 12 These rats were difficult to work with 13 because they tended to experience hypoglycemia (low BG levels) 14 but they were also extremely sensitive to insulin and would experience a measurable reduction in BG after receiving only 2 nanograms of insulin. 13,15
After being injected with both glucose and insulin, periodic measurement of BG levels in the rats would indicate how much insulin they had received. The more they had received the more their BG levels would fall. 14 If such a rat was injected with human blood plasma, and if that plasma contained insulin, then this could be measured by changes in the rat's own BG levels.
Results and translation
In 1949, Bornstein and Trewhella used their technique in a study of 19 diabetic patients and found that 'in the majority no insulin could be detected in their plasma. The minority had, however, normal insulin concentrations in the plasma, suggesting that some mechanism operates which either creates a demand for more insulin than the body can secrete or prevents insulin from operating normally.' 13 In 1950, they reported testing 17 patients of the Alfred Hospital diabetic clinic. These patients were found to fall into 2 groups and they concluded '… at least 2 forms of diabetes mellitus exist.' 16
Supported by an NHMRC fellowship 17 , Bornstein travelled to the UK in 1950 to trial the technique with Robert Lawrence, a world leader in diabetes research. They investigated the plasma insulin content of patients who, on clinical grounds, appeared to be diabetic due either to a lack of insulin or to factors other than lack of insulin, and confirmed that the first group had no measurable insulin and the second group did. 18 They concluded that they had proved 'that 2 clinical types of diabetes differ also in plasma insulin content.' 13
From Bornstein and Lawrence's 1951 paper
From these analyses of plasma insulin related to clinical cases we consider that 2 main types of human diabetes exist and can be distinguished. The first is severe and is characterized by weight loss and ketosis as well as hyperglycaemia; it occurs at any age, but mainly in the young, and their plasma contains no available insulin … They require insulin treatment to live. The second type … is distinguished by the absence of ketosis and loss of weight. Their plasma contains available insulin, roughly 70% of normal controls … Their diabetic state is easily controlled by diet alone, especially when obesity is thereby reduced. 13
Outcomes and impacts
The ability to distinguish T1D and T2D was globally significant because the 2 types are essentially separate diseases: they have different underlying molecular mechanisms and require different types of treatment.
Since insulin was first isolated, health and medical research has led to continual innovation in the treatment of diabetes and technologies have significantly improved a patient's ability to deliver the right amount of insulin. The most notable innovations include genetically-engineered synthetic 'human' insulin, insulin pumps, advances in glucose monitoring and the capacity for these technologies to interact. These new technologies have provided patients with enhanced flexibility in how and when they receive insulin and the ability to improve glucose levels, leading to better quality of life.
Recognising these benefits, the uptake of advanced technologies in Australians with T1D has increased. In 2018–19, 41% of children and 26% of adults attending hospital diabetes clinics managed their T1D with insulin pumps and 55% of children and 13% of adults newly commenced continuous glucose monitoring (CGM). 19
Diabetes remains a significant public health issue in Australia, with an estimated 1.2 million Australians (or almost 5% of the total population) living with diabetes in 2017–18. However, the prevalence of T1D diabetes is much lower than that of T2D (0.3% versus 2.2% of the total burden of disease).
In 2015 in Australia, 4.7% of the total burden of disease was attributed to high blood plasma glucose levels (which includes diabetes and pre-diabetes). In 2015–16, an estimated 2.3% ($2.7 billion) of total disease expenditure in the Australian health system was attributed to diabetes. 20
Researcher profiles
Dr charlotte anderson am.
Charlotte Morrison Anderson (1915-2002) worked at the Baker Institute from 1936 to 1941, then as registrar and research fellow at the Royal Children's Hospital, Melbourne, where she made major contributions to the treatment of cystic fibrosis, coeliac disease and sugar intolerance.
In 1968, she became the first female Professor of Paediatrics in the United Kingdom, at the University of Birmingham Medical School, a position she held until she retired in 1980.
In 1997, Anderson was appointed a Member of the Order of Australia for her service to medicine.
Sir Arnold Ennor CBE
Arnold Hughes Ennor (1912-1977) worked from 1938 to 1943 at the Baker Institute and during 1946-1947 in the Department of Biochemistry at Oxford University. He returned to Melbourne in 1948 to be Senior Biochemist at CSL but was then appointed to the Foundation Chair of Biochemistry in the newly formed John Curtin School of Medical Research at The Australian National University, a role in which he remained for nearly 2 decades. He was Permanent Head of the Australian Government Department of Education and Science and then of the Department of Science (1967-1977). He was appointed CBE in 1963 and a Knight Bachelor in 1965.
Professor Joseph Bornstein
Joseph Bornstein was a biochemist who was closely associated with The Alfred Hospital as a student. He joined the Baker Institute in 1947 then worked in The Alfred Hospital Metabolic and Diabetic Unit from its establishment in 1955 until 1961.
Bornstein was then appointed Professor of Medical Biochemistry at Monash University and the Foundation Professor of Monash’s new Department of Biochemistry.
Dr William Penfold
Dr William James Penfold (1875-1941) was recruited from the Lister Institute in London to be CSL's founding director in 1916, where he remained until he left to direct the newly formed Baker Institute in 1926, retiring in 1938.
Phyllis Trewhella B.Sc.
Phyllis Trewhella studied science at The University of Melbourne. She worked at the Baker Institute from 1949 to 1951, then worked as a teaching laboratory demonstrator at the Pharmacy College in Melbourne.
Types of diabetes
T1D often commences during childhood or young adulthood but can actually begin at any stage of life. It results from an autoimmune reaction that destroys the insulin-producing beta cells in the pancreas. Treatment for T1D involves the regular injection of insulin to manage raised blood sugar levels (hyperglycemia).
Such injections are necessary multiple times per day, with dosages adjusted to account for food intake, blood glucose levels and physical activity. Prolonged lack of insulin can result in diabetic ketoacidosis which, if untreated, can rapidly progress to loss of consciousness, coma and death.
T2D diabetes is characterised by a combination of insulin resistance (an impairment of the body's response to insulin) and a reduction in the amount of insulin that is produced. A person may have a strong genetic disposition towards T2D and their risk is greatly increased if they are overweight and inactive.
Those living with T2D can improve their blood glucose levels with regular exercise and by following a healthy diet, as well as by using a range of medications including insulin.
Gestational diabetes occurs during pregnancy and usually disappears after the baby's birth.
This case study was developed in partnership with the Baker Heart and Diabetes Institute.
The information and images from which impact case studies are produced may be obtained from a number of sources including our case study partner, NHMRC's internal records and publicly available materials.
The following sources were consulted for this case study:
- Karamanou M, Protogerou A, Tsoucalas G, Androutsos G, and Poulakou-Rebelakou E. Milestones in the history of diabetes mellitus: The main contributors. World J Diabetes. 2016 Jan 10; 7(1): 1–7
- Harley G. Diabetes: Its Various Forms and Different Treatments. London, Walton and Mabberley. 1866. p5
- Eyre F. Technology in Australia, 1788–1988: A condensed history of Australian technological innovation and adaptation during the first two hundred years. Australian Academy of Technological Sciences and Engineering. 1988. p662. Viewed online at https://www.austehc.unimelb.edu.au/tia/about.html, 25 October 2021
- Alberti KGMM. Chapter 2 The classification and diagnosis of Diabetes Mellitus, In Holt RIG, Cockram CS, Flyvbjerg A, Goldstein BJ (eds), Textbook of diabetes. pp9–12
- Aiman R, Kulkarni RD. Plasma insulin estimation and its significance in diabetes mellitus. Indian Journal of Psychology. 1958 Jul;2(3):430–6. PMID: 13586926
- The Baker Medical Research Institute. Tenth Annual Report. 1935–36
- The Baker Medical Research Institute. Eleventh Annual Report. 1936–37
- The Thomas Baker, Alice Baker, and Eleanor Shaw Medical Research Institute. Thirteenth Annual Report 1938–39
- The Thomas Baker, Alice Baker, and Eleanor Shaw Medical Research Institute. Fifteenth Annual Report 1940–41
- National Health and Medical Research Council. Report upon the work done under the Medical Research Endowment Act during the year 1939. Australian Government. 1940
- The Thomas Baker, Alice Baker, and Eleanor Shaw Medical Research Institute. Twenty-First Annual Report. 1947
- The Thomas Baker, Alice Baker, and Eleanor Shaw Medical Research Institute. Alfred Hospital, Prahran Victoria Australia. Twenty-Third Annual Report 1949 and A Retrospect 1926–1950
- Bornstein J, Lawrence RD. Plasma insulin in human diabetes mellitus. British Medical Journal. 1951 Dec 12;2(4747):1541
- Bornstein J. A technique for the assay of small quantities of insulin using alloxan diabetic, hypophysectomized, adrenalectomized rats. Aust J Exp Biol Med Sci. 1950 Jan;28(1):87–91
- Burns C, Morris T, Jones B, Koch W, Borer M, Riber U and Bristow A. Expert Committee on Biological Standardization, Expert Committee on Specifications for Pharmaceutical Preparations. Proposal to initiate a project to evaluate a candidate International Standard for Human Recombinant Insulin. World Health Organization. Geneva, 18–22 October 2010. WHO/BS/10.2143
- Bornstein J, Trewhella P. Plasma insulin levels in diabetes mellitus in man. Aust J Exp Biol Med Sci. 1950 Sep;28(5):569–72
- The Thomas Baker, Alice Baker, and Eleanor Shaw Medical Research Institute. Alfred Hospital, Prahran Victoria Australia. Twenty-Fourth Annual Report 1950
- Bornstein J, Lawrence RD. Two types of diabetes mellitus, with and without available plasma insulin. British Medical Journal. 1951 Apr 4;1(4709):732.
- Snaith JR, Holmes‐Walker DJ. Technologies in the management of type 1 diabetes. Medical Journal of Australia. 2021 Mar;214(5):202–5.
- Australian Institute of Health and Welfare 2020. Diabetes. Cat. no. CVD 82. Canberra: AIHW. Viewed 09 October 2021, https://www.aihw.gov.au/reports/diabetes/diabetes
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Case study of a patient living with diabetes mellitus
16 Case study of a patient living with diabetes mellitus Anne Claydon Chapter aims • To provide you with a case study of a patient who is living with diabetes together with the rationale for care • To encourage you to research and deepen your knowledge of diabetes Introduction This chapter provides you with an example of the nursing care that a patient with type 1 diabetes might require. The case study has been written by a diabetes nurse specialist and provides you with a patient profile to enable you to understand the context of the patient. The case study aims to guide you through the assessment, nursing action and evaluation of a patient with type 1 diabetes together with the rationale for care. Being in this community of practice has also enlightened me about diabetes as we come across many patients with diabetes. I have since learnt different ways of diabetes management. I can also give advice to patients suffering from diabetes bearing in mind that this is evidence based. (Patricia Moyo, third-year student nurse) Activity Chapter 1 gives a brief definition of diabetes and asks you to revise the normal anatomy and physiology of the endocrine system (see Montague et al 2005 ). How can diabetes affect the body and what happens within the body when a person’s blood sugars become unstable? The following paper outlines the latest guidelines for the care of patients with diabetic ketoacidosis (DKA). It would be useful to read these guidelines before you read the case study: Joint British Diabetes Societies Inpatient Care Group (2010) . The management of diabetic ketoacidosis in adults. NHS Diabetes, London. Online. Available at: http://www.bsped.org.uk/professional/guidelines/docs/DKAManagementOfDKAinAdultsMarch20101.pdf (accessed July 2011) Patient profile Lucy is an 18-year-old university student in her first year and is living in student accommodation. Lucy has had type 1 diabetes since the age of 13. Her parents are very supportive but naturally worried about her leaving home. Lucy had a take-away chicken meal 2 days ago and since then she has been vomiting and has diarrhoea. She stopped taking her insulin as she is not eating. She has been admitted with DKA. Assessment on admission Lucy is apyrexial and has not vomited for 6 hours. Her vital signs are: pulse 96 beats per minute, blood pressure 130/80 mmHg, respiratory rate slightly raised at 18 per minute. Due to her diarrhoea and vomiting, she is dehydrated. Ketones are + 2 on a standard urine stick, her blood glucose is 16 mmol/L and her venous pH is 7.2. Activity See Appendix 4 in Holland et al (2008) for possible questions to consider during the assessment stage of care planning. Lucy’s problems Based on your assessment of Lucy, the following problems should form the basis of your care plan: • Due to DKA, Lucy is dehydrated and has electrolyte imbalance. • Lucy lacks knowledge about the precipitating factors of DKA and how to prevent it. Lucy’s nursing care plan – acute stage (first hour) The most important therapeutic intervention for DKA in the acute stage is appropriate fluid replacement followed by insulin administration. Problem: Due to DKA, Lucy is dehydrated and has electrolyte imbalance. Goal: Lucy will maintain urine output > 30 mL hour. Lucy will have elastic skin turgor and moist, pink mucous membranes. Nursing action Rationale Measure and record urine output hourly Report urine output < 30 mL for 2 consecutive hours Catheterise Lucy Provide catheter care Lucy may undergo osmotic diuresis and have excessive urine output Measure fluid output accurately Maintain catheter hygiene at all time to prevent infection Administer intravenous therapy as prescribed and ensure that a cannula care plan is in place for this To prevent infection/complications around the cannula site Assess Lucy for signs of dehydration Assess Lucy’s skin turgor, mucous membranes and complaints of thirst Testing the skin; dry membranes and thirst are all signs of dehydration Continuous measurement of Lucy’s vital signs during this acute stage of DKA As Lucy has DKA and is dehydrated, compensatory mechanisms take place that may result in peripheral vasoconstriction which is characterised b a weak thready pulse, hypotension and Lucy may look pale Monitor Lucy’s neurological state Observe and document how awake Lucy is Assess how alert and orientated Lucy is to time and place Mental status in DKA can be altered due to severe volume depletion and electrolyte imbalance Monitor Lucy’s blood glucose levels every 15 minutes, then hourly as long as the insulin infusion continues Remember to wash Lucy’s hands to remove any contaminants that might alter the results Glucose levels need to be reduced gradually to prevent the risk of cerebral oedema Intravenous insulin therapy needs to continue until ketoacidosis is resolved Assess Lucy for signs of hypokalaemia, for example muscle weakness, shallow respirations, cramping and confusion DKA can cause excretion of potassium Insulin therapy results in intracellular movement of potassium resulting in low potassium levels Lucy may have signs of hyperkalaemia Assess Lucy for any weakness or irritability, ECG changes such as tall, peaked T waves, QRS and prolonged PR intervals may suggest this Potassium levels should be kept between 4 and 5 mmol/L As ketoacidosis resolves, potassium levels can rise quickly causing hyperkalaemia Ensure that the ECG leads are connected correctly and that the pads are not causing discomfort to Lucy’s skin Assess Lucy for signs of metabolic acidosis Lucy may show signs of being drowsy, she may have Kausmaul respirations, confusion and her breath may smell of pear drops Lucy may have metabolic acidosis due to a build up of ketones in her blood Measure Lucy’s serum ketone levels using a hand-held ketones meter Check ketones 4 hourly Blood glucose should be checked by a hand-held ketones meter This provides direct results for DKA to be resolved Ketonaemia has to be suppressed Lucy will need intravenous insulin during the acute stage Lucy will require fixed-rate intravenous infusion of insulin calculated on 0.1 units/kg The fixed rate of insulin may have to be adjusted in insulin resistance if the ketone concentration does not fall fast enough Aim for a reduction of blood ketone concentration by 0.5 mmol/L/hour Insulin has the following effects: • Reduction of blood glucose
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Written reflection in an eHealth intervention for adults with type 2 diabetes mellitus: a qualitative study
Silje s lie.
1 Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
Bjørg Karlsen
Christopher p niemiec.
2 Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA
Marit Graue
3 Center for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
Bjørg Oftedal
Individuals with type 2 diabetes mellitus (T2DM) are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. Many patients do not reach recommended treatment goals, and thus it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM.
The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the Guided Self-Determination (GSD) eHealth intervention and how written reflection might affect their motivation for self-management of T2DM.
We used a qualitative design in which data were collected through individual interviews. The sample consisted of 10 patients who completed the GSD eHealth intervention, and data were analyzed using qualitative content analysis.
The qualitative content analysis yielded 2 main themes. We labeled the first theme as “Written reflection affects awareness and commitment in diabetes self-management”, which reflects 2 subthemes, namely, “Writing creates space and time for autonomous reflection” and “Writing influences individuals’ focus in diabetes self-management”. We labeled the second theme as “Written reflection is perceived as inapplicable in diabetes self-management”, which reflects 2 subthemes, namely, “Responding in writing is difficult” and “The timing of the writing is inappropriate”.
Our findings indicate that written reflection in the context of the GSD eHealth intervention may be conducive to motivation for diabetes self-management for some patients. However, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. We advocate further development and examination of the GSD as a “blended” approach, especially for those who consider written reflection to be difficult or unfamiliar.
Introduction
Type 2 diabetes mellitus (T2DM) is a chronic health condition whose worldwide prevalence has increased rapidly in recent decades. 1 Individuals with T2DM are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. 2 Self-management can be defined as an “individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition”. 3 Adequate self-management of T2DM is therefore a complex process that requires motivation for managing medication as well as lifestyle changes in diet and physical activity to reach treatment goals for glycosylated hemoglobin (HbA 1c ), cholesterol, and blood pressure in order to prevent serious long-term complications. 4 , 5 Indeed, long-term complications associated with T2DM include cardiovascular disease, neuropathy, nephropathy, and periodontal disease, among others. 1 , 5 Patients have described adequate self-management of T2DM as difficult to attain because of the following reasons: cumbersomeness of lifestyle changes in diet and physical activity, and the long-term complications of T2DM and other chronic conditions. 6 Moreover, the values that people hold can conflict with the recommended behaviors for adequate self-management of T2DM, which can undermine the motivation for lifestyle changes. 7 Hence, it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM.
Indeed, eHealth interventions have been shown to have potential to support adequate self-management of T2DM, and recommendations suggest that eHealth interventions be theory-based and include “soft-touch” strategies such as personal feedback to enhance efficiency and engagement. 8 – 11 Such features enable asynchronous and flexible follow-up for each patient, which can bridge the gap between diabetes care and adequate self-management. Based on these recommendations, in the development phase of our project, we adapted the Guided Self-Determination (GSD) self-management support program to be an eHealth intervention for adults with T2DM. 12 Originally, the GSD program was developed for type 1 diabetes, and research indicates that the program is effective in facilitating the development of life skills and lowering psychosocial distress. 13 – 20
Based on self-determination theory (SDT), the GSD program is intended to enhance autonomous problem solving, goal setting, and action planning among individuals with diabetes. 21 SDT is an organismic approach to human motivation, which has been applied to health care and health behavior change, including management of T2DM. Central to SDT is the specification of 3 basic psychological needs, namely, autonomy (an experience of volition and choicefulness), competence (an experience of capability and mastery), and relatedness (an experience of support from and connection with important others); the satisfaction of these needs is necessary for optimal motivation, physical health, social integration, and psychological wellness. 22 – 24 Indeed, past research has shown that support for the basic psychological needs is associated with higher levels of autonomous motivation for diabetes self-management, medication adherence, quality of life, dietary self-care, and glucose control. 4 , 22 , 25 – 28
An important feature of the GSD program is the use of semistructured reflection sheets, which are designed to afford patients an opportunity to express their experiences and personal difficulties with diabetes, as well as to enable them to participate actively in their care process. 13 Such expression and active participation can empower patients to become self-determined and develop the skills necessary for adequate self-management of diabetes. 12 Written reflection requires the translation of emotions and experiences into words, and this cognitive process can benefit individuals in a variety of situations. 29 The use of writing as a therapeutic approach has been examined in a variety of populations, including college students who are vulnerable to depression, cancer survivors, and individuals with chronic pain and various physical diseases, and findings indicate that this approach can improve treatment outcomes and quality of life. 30 – 33 In addition, a systematic review of interventions for women with breast cancer found that expressive writing can improve their physical health. 34 To our knowledge, written reflection has not been examined in the context of eHealth interventions, and the current study was designed to fill this gap in the literature.
The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the GSD eHealth intervention, and how written reflection might affect their motivation for self-management of T2DM.
The current study, which was conducted as a pilot study, is part of a larger project that developed a complex eHealth intervention for adults with T2DM who are treated in general practices in Norway. 12 We used a qualitative design in which data were collected through individual interviews that were conducted between December 2015 and December 2016. Interviews provide valuable information on patients’ experiences and opinions, which is important when piloting clinical interventions in real-life contexts. 35
Description of the GSD eHealth intervention
Nurses who were trained in the GSD method and had experience with diabetes care delivered the GSD eHealth intervention to patients in general practices. The GSD eHealth intervention was delivered along with regular care, which for individuals with T2DM in Norway consists of structured annual consultations at general practices, regular measurement of HbA 1c , and additional consultations as per individual needs. 5 Initially, nurses and participants met face-to-face in order to establish a relationship, during which the nurse explained the aim of the GSD program, how to log on to the Web portal ( www.MinJournal.no ) and use the secure messaging system, and how to complete the reflection sheets. The Web portal requires electronic identification via BankID, which is aligned with the level of security necessary to allow for transfer of sensitive information in Norway. All participants received a comprehensive manual that described how to use the Web portal. After the initial meeting, participants received the reflection sheets in PDF format via 4 eHealth consultations. They were asked to reflect on and write about their thoughts, feelings, experiences, and difficulties related to the self-management of T2DM, as well as to formulate goals and action plans for adequate self-management of T2DM, and return the completed reflection sheets to the diabetes nurse via secure messages.
The GSD eHealth intervention was initially conducted as a “pure” eHealth intervention by recording responses to the reflection sheets in writing and communicating via secure messages. Due to a long duration (up to 35 weeks) and a large dropout rate, the approach was modified to a “blended” intervention, including 1 in-person consultation with the nurse following the third eHealth consultation. 36 The participants who were offered an additional in-person meeting completed the intervention in about 12 weeks. Figure 1 presents an overview of the GSD eHealth intervention for T2DM, along with the topics of the 13 reflection sheets and a description of the 1 additional in-person meeting.
Overview of the GSD eHealth program for adults with T2DM.
Abbreviations: GP, general practitioner; GSD, Guided Self-Determination; HbA 1c , glycosylated hemoglobin; T2DM, type 2 diabetes mellitus.
Patients and methods
Participants and procedure.
At 8 general practices in Norway, participants were recruited by their nurse or general practitioner to participate in the GSD eHealth intervention. Patients were eligible if they had been diagnosed with T2DM for >3 months, were at least 18 years of age, could read and communicate in Norwegian, had regular access to the Internet and a computer, and had a registered BankID (a secure personal electronic identification that was necessary to access the Web portal). Patients were excluded if they had severe physical or mental illness that would limit their ability to participate in the study.
A total of 25 patients (18 in the “pure” eHealth intervention, and 7 in the “blended” intervention) from southwestern Norway were invited to participate in the study. Five of the 18 patients in the “pure” eHealth intervention completed the study, and the large proportion of dropouts in this group has been described elsewhere. 36 Five of the 7 patients in the “blended” intervention completed the study. Hence, the current study included 10 participants (6 female, 4 male). After completing the intervention, participants were asked by their nurses to take part in an individual interview with an investigator at a time and place of their choosing. All 10 participants agreed to this request. Table 1 presents the characteristics of the study participants.
Characteristics of the study participants
Abbreviations: BMI, body mass index; HbA 1c , glycosylated hemoglobin.
Data collection
A semistructured interview guide was used to organize the interviews. Participants were invited to speak freely about the theme addressed in the main question, namely, “What was your overall experience with the GSD eHealth counseling program?” During the conversation, the interviewer asked supplementary questions to clarify and elaborate on participants’ responses, including “How did you experience writing your reflections on the digital reflection sheets?” and “How did writing reflections influence your motivation for diabetes self-management?” At the end of each interview, participants were asked to supplement their responses with other experiences related to the GSD eHealth intervention in order to ensure adequate representation of their perspective in the data. On average, interviews took 70 minutes to complete, and all interviews were audiotaped and transcribed verbatim. The interviews were conducted in Norwegian. Relevant meaning units were translated into English during the analysis process, and the translation has been text edited. Demographic and clinical data were collected via a questionnaire at baseline.
Ethical considerations
The Norwegian Regional Committee for Medical and Health Research Ethics (REK West, number 2015/60) approved the study protocol. Prior to the beginning of the study, participants signed a written consent form and were guaranteed anonymity and the right to withdraw from the study at any time. Anonymity was ensured by severing the link between participant names and the ID numbers and transcripts of the interviews.
Data analysis
We performed a qualitative content analysis, as described by Graneheim and Lundman, 37 which involved reading in full the unit of analysis (namely, all 10 transcribed interviews). Data from both groups of participants were analyzed together, as the theme focused on experiences with the reflection sheets and writing reflections in the context of the GSD eHealth intervention and how doing so might affect motivation for self-management of T2DM. Meaning units that corresponded to the aim of the study (namely, experiences with using reflection sheets to stimulate written reflection, and how written reflection might affect motivation for self-management of T2DM) were identified and shortened while retaining the main experience, and then labeled with codes. Codes were systematically organized according to their similarities and differences and placed in categories, which describe “what” participants talked about and represent the manifest content of the text. Revision of the codes and the names of categories occurred several times during the process of analysis. Finally, the latent content, or underlying meaning, was interpreted and represented in the subthemes and main themes, which characterize the “‘meaningful essence’ that runs through the data”. 38 Table 2 presents the themes and subthemes derived from the qualitative content analysis. Abstraction was done in collaboration with coauthors to ensure credibility and to enhance the likelihood that a probable interpretation of the text was obtained.
Themes and subthemes derived from the qualitative content analysis
The qualitative content analysis yielded 2 main themes ( Table 2 ) that describe how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the GSD eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. We labeled the first theme as “Written reflection affects awareness and commitment in diabetes self-management”, which reflects 2 subthemes, namely, “Writing creates space and time for autonomous reflection” and “Writing influences individuals’ focus in diabetes self-management”. We labeled the second theme as “Written reflection is perceived as inapplicable in diabetes self-management”, which reflects 2 subthemes, namely, “Responding in writing is difficult” and “The timing of the writing is inappropriate”. In the following sections, we describe in detail the content of these themes and subthemes using direct quotations from participants.
Written reflection affects awareness and commitment in diabetes self-management
Participants suggested that by creating space and time to express thoughts and feelings, writing affords an opportunity for reflection on what is important for them in diabetes self-management. In addition, writing creates transparency and concretizes ideas, which influences focus in diabetes self-management. Hence, written reflection affects awareness and commitment in diabetes self-management.
Writing creates space and time for autonomous reflection
Participants appreciated the opportunity for reflection in the peace and quiet of their homes, as well as the ability for written reflection without interruption. Participants also valued the opportunity to decide on the timing of their written reflection amid their busy lives, as well as the opportunity to let thoughts “simmer” for a while, which was conducive to mature and thoughtful responses.
I appreciated having the opportunity to sit and relax and fill out [the reflection sheets] in peace and quiet, and to do it when it suited me. That I had time to sit down and prioritize doing it. To sit down and be able to use the time I needed to think through my answers […]. [Participant 10]
With reflection, participants came to discover aspects of themselves and their reactions to situations of which they had not been aware previously. Participants also appreciated the intellectual stimulation represented by written reflection, through which they could focus on concrete issues and express mature thoughts.
Writing challenges you much more intellectually. That is why writing is very useful. If you just sit and talk, you may put much more emotions into things. When you sit down and write, you dispose some of the emotional, the sentimental, part. You write down your thoughts, cognitive, how you experience the situation. That is why I like to be challenged on that. [Participant 1]
Participants valued the personal nature of written reflection, which afforded an opportunity to think through their responses thoroughly rather than be interrupted with clarifying questions, as typically happens in conversations. Participants considered written reflection to be a useful clinical tool (in addition to traditional health care) because the reflection sheets focused on the psychosocial aspects of having and managing diabetes, and such experiences are important to share with the diabetes nurse.
Earlier follow-up has just been blood samples and other tests, and then finished and “good bye”. I have not had time to express thoughts and emotions, and […] That was what I appreciated, that I could finally communicate with someone about it. How I experience all of it. [Participant 2]
For some participants, written reflection sparked an interest in discussing matters related to self-management of T2DM with their family, which afforded an opportunity for enhanced openness and understanding with important others.
Writing influences individuals’ focus in diabetes self-management
Participants used reflection sheets to create focus in diabetes self-management, as their responses were “in writing”. With the opportunity for written reflection, participants created a positive commitment to their goals and action plans, which became specific, concrete, transparent, and manageable and, moreover, could be reviewed after the conclusion of the eHealth consultations.
It becomes more concrete than when it is just in your head. Maybe for some people when they have written it down, I will not say that it becomes a contract, but yet more concrete than when it is just feelings and thoughts. [Participant 4]
Yet interestingly, some participants expressed the opposite sentiment, such that written reflection can be embellished and/or forgotten after the responses are sent to the diabetes nurse. In response to the Interviewer’s question, “Would you go back and check on your goal setting?” 1 participant said, “No, there is no imminent danger of that ever occurring.”
Written reflection is perceived as inapplicable in diabetes self-management
Some participants found it difficult to understand the reflection sheets and respond in writing. Other participants perceived the questions to be repetitive or unnecessary for them. Finally, some participants thought that the timing of the writing was inappropriate, for various reasons. Hence, written reflection is perceived as inapplicable in diabetes self-management.
Responding in writing is difficult
Some participants mentioned that they struggled with writing in general, whereas others suggested that the writing would have been easier if the reflection sheets were on paper rather than digital. One participant found it difficult to comprehend the questions and, therefore, enlisted family members to help make sense of the reflection sheets. For some of the participants who were offered an in-person meeting following the third eHealth consultation, it was important to discuss the reflection sheets with the diabetes nurse.
I had some problems understanding some of the questions on the reflection sheets. So when I came to see the nurse, I had to say “I don’t know what this means”, and then she had to explain what it meant. [Participant 7]
Some participants noted the importance of further instruction on how to complete the reflection sheets. Additionally, some participants found the language of the reflection sheets to be “too academic”. Other participants found some of the reflection sheets (especially on “Work with changes” [ Figure 1 ]) to be repetitive and difficult to understand/respond to in writing.
But then there were these reflection sheets where I felt like […] first you were supposed to write about your observations, your thoughts, and feelings. I found those a little hard to separate really. Your observations […]. What do they mean with that? And then your thoughts and feelings. And then the observations. There you were supposed to write a little without thoughts and feelings? I found this difficult […]. [Participant 5]
Finally, due to the “locked-to-form” nature of the reflection sheets, some participants perceived less opportunity for elaboration of responses based on individual needs and preferences.
The timing of the writing is inappropriate
Some participants suggested that the GSD program was introduced either too early or too late in their disease trajectory for them to receive a benefit from written reflection. For some participants, written reflection conflicted with their expectations for a self-management support program. In particular, these participants viewed working with the reflection sheets as too time consuming, likely to create unnecessary problems and concerns, and inapplicable to their current life experience. Other participants focused on personal matters, such as family, relationships, and multimorbidity that undermined their perceived benefit from and opinion of written reflection. They assumed that they were supposed to deal only with specific diabetes self-management behaviors, such as diet and exercise in their written reflections and goal setting. Taken together, the timing of the writing was inappropriate for some participants.
Because you also have other things to deal with. You cannot just put all that aside and simply focus on [diabetes self-management behaviors], right. The other things are there all the time, in the back of my head. [Participant 6]
The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the GSD eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. The findings indicate that participants had diverse experiences with the digital reflection sheets and written reflection more broadly. Some participants experienced written reflection as positively affecting their awareness and commitment in diabetes self-management. On the other hand, some participants experienced difficulties in writing their reflections and perceived this as inapplicable in diabetes self-management. In the following sections, we discuss our findings in the context of previous research and SDT.
One important finding in the current study is that the writing initiated by the digital reflection sheets creates space and time for autonomous reflection, which was experienced as more positive than ordinary follow-up at the general practice. With written reflection, participants were able to identify and put into words their personal experiences and difficulties with self-management of T2DM. As the necessary behaviors for self-management of T2DM are demanding and may not have inherent interest for the individual, it is important to support autonomy in health care in order to facilitate optimal, autonomous motivation for diabetes self-management. 22 , 27 Individuals experience a sense of autonomy when their behavior is congruent with deeply held values, beliefs, and interests. 24 Written reflection in the context of the GSD eHealth intervention may be perceived as autonomy supportive, such that it engenders an experience of self-governance and volition in patients. These findings build on previous research in which adults with type 1 diabetes perceived their health care climate as more autonomy supportive after participating in the GSD intervention. 13
Another important finding is that writing influences individuals’ focus in diabetes self-management. For some participants, responding to the reflection sheets and then sending these to the diabetes nurse assist in helping to create specific goals and clear action plans, in addition to concretizing what is necessary to attain their goals. The autonomous reflection and the focus created by the writing may have facilitated healthy, autonomous goal setting in the self-management of T2DM. This is important because specific goals are much more effective than general goals for developing effective self-management behaviors. 7 , 39 Previous research has shown that active involvement in goal setting is conducive to patients’ regulating their self-management behaviors and attaining positive treatment outcomes. 23 Moreover, competence is supported when individuals pursue goals that they have an opportunity to attain, thereby experiencing a sense of achievement in reaching their goals. 24 , 27
Our findings indicate that the GSD eHealth intervention may provide support for patients’ competence – as well as autonomy. Indeed, support for competence has been associated with treatment adherence, quality of life, and glycemic control in patients with T2DM. 4 , 26 With these findings in mind, we suggest that written reflection in the context of the GSD eHealth intervention may be conducive to positive treatment outcomes because of its potential to support autonomy and competence around self-management of T2DM.
Our findings also indicate that the GSD eHealth intervention may be described as a “double-edged sword”. For some participants, written reflection may affect their awareness and commitment in diabetes self-management in a positive way, whereas for other participants, written reflection was perceived as inapplicable in diabetes self-management. Our findings suggest that responding in writing is difficult and that the timing of the writing is inappropriate for some patients, and thus participants may not value and/or benefit from written reflection in a uniform way. These findings suggest that the reflection sheets might require further adaption for adults with T2DM in an eHealth intervention.
In the current study, the reflection sheets were completed electronically, which contrasts with previous research on the GSD intervention. 13 , 14 , 18 Research on therapeutic writing has shown that the effectiveness of writing as a therapeutic tool depends on support and assistance during the writing process. 31 Moreover, in previous research showing that the GSD intervention can develop life skills and reduce psychosocial distress in individuals with type 1 diabetes, participants completed the reflection sheets on paper at home as preparation for an in-person consultation with health care personnel, which may facilitate dialogue around assistance with, explanation for, and tailoring of the intervention. 13 – 19 The fact that the written reflection and communication with health care personnel occurred primarily electronically may have undermined perceptions of support for some participants.
It is interesting to note that some participants who were offered an in-person meeting following the third eHealth consultation mentioned that their meeting with the diabetes nurse was crucial for understanding the reflection sheets. This finding underscores the importance of in-person consultation that offers assistance to participants around the GSD eHealth intervention and builds on our previous research that revealed participants’ missing of in-person consultations with the diabetes nurse as an important contributor to dropping out from the study. 36 In-person consultation with health care personnel allows for advice based on user reactions to be communicated in real time, which can facilitate engagement in eHealth interventions. Of course, additional in-person consultation can increase the cost and time required for completion of eHealth interventions, in addition to reducing reach into the population. 40 Nonetheless, we anticipate that the benefits associated with in-person consultation are likely to outweigh the costs.
Some participants considered the timing of the writing to be inappropriate, and thus this aspect of the intervention did not suit them for various reasons. Whereas some participants had a different focus and/or additional challenges in life, others were able to manage their diabetes well without much to consider in written reflection. Hence, it is important to consider the timing of eHealth interventions with regard to disease trajectory, personal needs, and anticipated strains in life. 41 Furthermore, although – ideally – the reflection sheets can be used to consider a broad range of topics in life, participants tend to focus on specific diabetes self-management activities in their goal setting, such as diet and exercise. Future research on written reflection might attempt to strike more of a balance between focusing participants on broad life issues versus specific issues relevant to diabetes self-management.
It is also interesting to consider how the concept of causality orientations within SDT 42 might affect perceptions of the timing of the writing as inappropriate. The concept of a causality orientation describes differences in how individuals initiate and regulate their behaviors over extended periods of time, and this concept has received considerable empirical attention. 24 , 43 With an autonomy orientation, individuals initiate and regulate their behavior based on personal interest, value, and choice. In contrast, with a controlled orientation, individuals initiate and regulate their behavior based on self- and/or other-imposed perceptions of pressure, coercion, and control. 42 Certainly, differences in causality orientation might affect the focus of written reflection, the self-management goals that are adopted, and the perception of the GSD eHealth intervention as appropriately timed and beneficial. It is reasonable to speculate that those participants who asserted that written reflection affects awareness and commitment in diabetes self-management (Theme 1) are more likely to have an autonomy causality orientation than those who asserted that written reflection is inapplicable in diabetes self-management (Theme 2). Indeed, individuals who score higher on the controlled causality orientation tend to benefit less from health initiatives such as the GSD program. 42 Future research on written reflection might examine whether and how the causality orientations affect the amount of benefit that participants derive from the GSD eHealth intervention.
Strengths and limitations
Several strengths and limitations deserve mention. One strength of the current study was its qualitative design with semi-structured interviews during which participants could give voice to their experience with the GSD eHealth intervention. One limitation was the small number of informants (n=10); yet it is important to note that the sample consisted of all participants who completed the GSD eHealth intervention, which precluded the possibility of further recruitment. Indeed, the fact that all participants who completed the intervention agreed to take part in our interviews is a notable strength of the current study. A second strength was that 1 investigator conducted all of the interviews in order to ensure the credibility of the data collection. Undeniably, our findings and interpretations were discussed by all coauthors during analysis and manuscript drafting, which may enhance the trustworthiness of our conclusions. That being said, because a text can have >1 meaning and interpretations are subjective, we cannot dismiss the possibility that others would have interpreted our findings in a different way. 37 , 38 A second limitation was the heterogeneity in educational status of the study participants, which might have affected how participants responded to the reflection sheets. Half of the participants in the current study had primary or secondary education as their highest level of education. That being said, we found no indication that participants with less education experienced writing as more difficult than those with more education, which may be due to the limits of our small sample size. Thus, it is important for future research with a larger sample size to examine how educational status affects responses to and benefits from written reflection, given the cognitive demands of this component of the eHealth intervention.
Written reflection stimulated by digital reflection sheets may affect awareness and commitment in diabetes self-management in a positive way by creating space and time for autonomous reflection and influencing individuals’ focus in diabetes self-management. Interpreted through the lens of SDT, it is possible that written reflection in the context of the GSD eHealth intervention can support patients’ autonomy and competence, which are conducive to autonomous (ie, optimal) motivation for diabetes self-management and positive treatment outcomes. That being said, the structured nature of written reflection in the context of the GSD eHealth intervention may be inapplicable for some participants, as responding in writing can be difficult and the timing of the writing can be inappropriate. Therefore, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. Hence, we advocate for further development and examination of the GSD as a “blended” approach, especially for those who consider written reflection to be difficult or unfamiliar.
Acknowledgments
The authors express special thanks to the participants involved in the current study. In addition, we express our gratitude to the 8 study nurses and the involved general practices for recruiting the patients and conducting the intervention.
The current study, which was conducted in collaboration between Western Norway University of Applied Sciences and the University of Stavanger, was funded by a grant from the Norwegian Research Council (project number 221065), and funds from the University of Stavanger and Western Norway University of Applied Sciences, Norway.
Author contributions
SSL, BK, MG, and BO developed the study design. The interviews, transcriptions, tentative analysis, and first draft of the article were performed by SSL. BK, CPN, MG, and BO were involved in analysis of the data, writing the manuscript, and revising the manuscript for intellectual content. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work.
The authors report no conflicts of interest in this work.
- Diabetes & Primary Care
- Vol:24 | No:06
Interactive case study: The elderly and type 2 diabetes
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Diabetes & Primary Care ’s series of interactive case studies is aimed at all healthcare professionals in primary and community care who would like to broaden their understanding of diabetes.
The care of older people with type 2 diabetes is complicated, as the prognosis and appropriate treatment goals vary greatly between individuals. The three mini-case studies developed for this issue of the journal take us through the basic considerations of managing type 2 diabetes in the elderly.
The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.
Working through the case studies will improve our knowledge and problem-solving skills in diabetes care by encouraging us to make evidence-based decisions in the context of individual cases.
Readers are invited to respond to the questions by typing in your answers. In this way, we are actively involved in the learning process, which is hopefully a much more effective way to learn.
By actively engaging with these case histories, I hope you will feel more confident and empowered to manage such presentations effectively in the future.
Marianne , who is 71 years old, has type 2 diabetes but lives a very active life, with little in the way of comorbidities. However, despite treatment with metformin 1000 mg twice daily, her glycaemic control has deteriorated in recent years.
Mike is 78 years old and has long-standing type 2 diabetes. Six years ago he suffered a myocardial infarction. He takes a range of medication to address his hyperglycaemia, hypertension and low mood. He lives alone, but uses a stick to walk and receives practical help from his daughter. Recently, he has been experiencing shakiness and sweating after gardening, and dizziness on standing. His BP is 117/58 mmHg and HbA 1c is 51 mmol/mol.
Claire is an 81-year-old who lives in a care-home. She has Alzheimer’s disease and long-standing type 2 diabetes. A stroke 4 years ago left her with unilateral weakness, and she has frequent lower urinary tract infections and episodes of urinary incontinence. For her hyperglycaemia, hypertension and various other health concerns, she is taking over a dozen medications. A review of her diabetes is due.
The health and care needs of each of these people differ greatly. By working through their case studies, we will consider the following issues, and more:
- Agreeing glycaemic targets in the elderly.
- Assessment of frailty and the importance of a holistic approach to managing diabetes in the elderly.
- Choice of medications and concerns over hypoglycaemia.
- Deintensification and simplification of medication regimens.
Click here to see the case study.
Updated guidance from the PCDS and ABCD: Managing the national GLP-1 RA shortage
Diabetes distilled: fib-4 – a diagnostic and prognostic marker for liver and cardiovascular events and mortality, at a glance factsheet: tirzepatide for management of type 2 diabetes, editorial: lipid management, tirzepatide and hybrid closed-loop: what does new nice guidance recommend, case report: pancreatic cancer – assessing diabetes in a thin elderly person, prescribing pearls: a guide to dpp-4 inhibitors (gliptins), how to conduct an extended review for people with early-onset type 2 diabetes.
Advice on selecting alternative glucose-lowering therapies when GLP-1 RAs used in the management of type 2 diabetes in adults are unavailable.
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Indications, benefits and side effects of tirzepatide, plus tips for prescribing.
With a raft of newly published NICE guidance, Jane Diggle discusses the implications for practice in primary care.
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Nursing Case Studies with Answers
Explore Nursing Case Studies with Answers and examples in Carepatron's free downloadable PDF. Enhance your nursing knowledge and prepare for exams with practical scenarios.
By Wynona Jugueta on Mar 25, 2024.
Fact Checked by Ericka Pingol.
What is a case study?
A case study in medicine is a detailed report of a patient's experience with a disease, treatment, or condition. It typically includes the patient's medical history, symptoms, diagnostic tests, treatment course, and outcome.
Some key things to know about medical case studies template . First, they delve deep into the specifics of a single case, providing a rich understanding of a particular medical situation.
Medical professionals use case studies to learn about rare diseases, unusual presentations of common conditions, and the decision-making process involved in complex cases.
Case studies can identify exciting areas for further investigation through more rigorous clinical trials. While informative, they can't be used to develop general treatment guidelines because they only focus on a single case.
Overall, medical case studies are valuable tools for medical education and research, offering insights into human health and disease complexities.
Printable Nursing Case Studies with Answers
Download this Nursing Case Studies with Answers to analyze complex clinical situations, identify priority needs, and develop effective care plans tailored to individual patients.
What is in a nursing case study?
A nursing case study is a detailed examination of a patient's health condition, treatment plan, and overall care journey, specifically from the perspective of nursing practice. These case studies are essential components of nursing education and professional development, providing valuable insights into clinical scenarios and patient care experiences.
In a case nursing study template , various elements are typically included to comprehensively understand the patient's situation. First and foremost, the case study outlines the patient's demographic information, including age, gender, medical history, and presenting symptoms. This demographic overview sets the stage for understanding the context in which healthcare interventions occur.
Moreover, nursing case studies often delve into the nursing assessment process, highlighting the initial and ongoing assessments nurses conduct to gather relevant patient health status data. These assessments involve physical examinations, vital sign monitoring, and assessment tools to identify potential health issues and risk factors.
Critical thinking skills are essential in nursing case studies, as they enable nurses to analyze complex clinical situations, identify priority needs, and develop effective care plans tailored to individual patients. Nursing students and experienced nurses use case studies as opportunities to enhance their critical thinking abilities and clinical decision-making processes.
Nursing case studies serve several vital purposes within healthcare education and professional practice, whether they are a primary care physician or a group of nursing students. Let's explore each purpose in detail:
Enhancing clinical reasoning skills
One primary purpose of nursing case studies is to enhance nursing students' and practicing nurses' clinical reasoning skills. By presenting realistic patient scenarios, case studies challenge individuals to analyze clinical data, interpret findings, and develop appropriate nursing interventions. This process promotes critical thinking and problem-solving abilities essential for effective nursing practice.
Applying theoretical knowledge to practice
Nursing case studies provide a bridge between theoretical knowledge and practical application. They allow nursing students to apply concepts learned in the classroom to real-world patient care situations. By engaging with case studies, students can integrate theoretical principles with clinical practice, gaining a deeper understanding of nursing concepts and their relevance to patient care.
Facilitating interdisciplinary collaboration
Another purpose of nursing case studies is to facilitate interdisciplinary collaboration among healthcare professionals. Nurses often collaborate with physicians, specialists, therapists, and other team members in complex patient cases to deliver comprehensive care. Case studies offer opportunities for nurses to explore collaborative decision-making processes, communication strategies, and teamwork dynamics essential for providing quality patient care.
Promoting evidence-based practice
Nursing case studies are crucial in promoting evidence-based practice (EBP) within nursing and healthcare settings. Nurses can make informed decisions about patient care interventions by analyzing patient scenarios and considering current research evidence. Case studies encourage nurses to critically evaluate research findings, clinical guidelines, and best practices to ensure the delivery of safe, effective, and patient-centered care.
Fostering professional development
Engaging with nursing case studies contributes to the ongoing professional development of nurses at all stages of their careers. For nursing students, case studies provide valuable learning experiences that help prepare them for clinical practice. For experienced nurses, case studies offer opportunities to refine clinical skills, stay updated on emerging healthcare trends, and reflect on past experiences to improve future practice.
How to write a nursing case study?
Writing a nursing case study involves several essential steps to ensure accuracy, relevance, and clarity. Let's break down the process into actionable steps:
Step 1: Select a patient case
Begin by selecting a patient case that presents a relevant and compelling healthcare scenario. Consider factors such as the patient's demographic information, medical history, presenting symptoms (e.g., joint stiffness, pain), and healthcare needs (e.g., medication administration, vital signs monitoring). Choose a case that aligns with your learning objectives and offers meaningful analysis and discussion opportunities.
Step 2: Gather relevant data
Collect comprehensive data about the selected patient case, including medical records, test results, nursing assessments, and relevant healthcare documentation. Pay close attention to details such as the patient's current health status, past medical history (e.g., diabetes), treatment plans, and any ongoing concerns or challenges. Utilize assessment tools and techniques to evaluate the patient's condition thoroughly and identify areas of clinical significance.
Step 3: Assess the patient's needs
Based on the gathered data, evaluate the patient's needs, considering physical, emotional, social, and environmental factors. Assess the patient's pain levels, mobility, vital signs, and other relevant health indicators. Identify any potential complications, risks, or areas requiring immediate attention. Consider the patient's preferences, cultural background, and individualized care requirements in your assessment.
Step 4: Formulate nursing diagnoses
Formulate nursing diagnoses that accurately reflect the patient's health needs and priorities based on your assessment findings. Identify actual and potential nursing diagnoses related to the patient's condition, considering factors such as impaired mobility, ineffective pain management, medication adherence issues, and self-care deficits. Ensure your nursing diagnoses are specific, measurable, achievable, relevant, and time-bound (SMART).
Step 5: Develop a care plan
Develop a comprehensive care plan outlining the nursing interventions and strategies to address the patient's identified needs and nursing diagnoses. Prioritize interventions based on the patient's condition, preferences, and care goals. Include evidence-based nursing interventions to promote optimal health outcomes, manage symptoms, prevent complications, and enhance the patient's overall well-being. Collaborate with other healthcare professionals as needed to ensure coordinated care delivery.
Step 6: Implement and evaluate interventions
Implement the nursing interventions outlined in the care plan while closely monitoring the patient's response to treatment. Administer medications, provide patient education, perform nursing procedures, and coordinate care activities to effectively meet the patient's needs. Continuously evaluate the effectiveness of interventions, reassessing the patient's condition and adjusting the care plan as necessary. Document all interventions, observations, and outcomes accurately and comprehensively.
Step 7: Reflect and seek assistance
Reflect on the nursing case study process, considering what worked well, areas for improvement, and lessons learned. Seek assistance from nursing instructors, preceptors, or colleagues if you encounter challenges or have concerns about the patient's care. Collaborate with interdisciplinary team members to address complex patient issues and ensure holistic care delivery. Continuously strive to enhance your nursing practice through ongoing learning and professional development.
Nursing Case Studies with Answers example (sample)
Below is an example of a nursing case study sample created by the Carepatron team. This sample illustrates a structured framework for documenting patient cases, outlining nursing interventions, and providing corresponding answers to guide learners through the analysis process. Feel free to download the PDF and use it as a reference when formulating your own nursing case studies.
Download this free Nursing Case Studies with Answers PDF example here
Why use Carepatron as your nursing software?
Carepatron stands out as a comprehensive and reliable solution for nursing professionals seeking efficient and streamlined workflows in their practice. With a range of features tailored to the needs of nurses and healthcare teams, Carepatron offers unparalleled support and functionality for managing various aspects of patient care.
Nurse scheduling software
One of the key advantages of Carepatron is its nurse scheduling software , which simplifies the process of creating and managing schedules for nursing staff. With intuitive scheduling tools and customizable options, nurses can easily coordinate shifts, manage availability, and ensure adequate staffing levels to meet patient needs effectively.
Telehealth platform
In addition, Carepatron offers a robust telehealth platform that facilitates remote patient monitoring, virtual consultations, and telemedicine services. This feature enables nurses to provide continuity of care beyond traditional healthcare settings, reaching patients in remote areas or those unable to attend in-person appointments.
Clinical documentation software
Furthermore, Carepatron's clinical documentation software streamlines the documentation process, allowing nurses to easily capture patient data, record assessments, and document interventions. The platform supports accurate and efficient documentation practices, ensuring compliance with regulatory standards and promoting continuity of care across healthcare settings.
Commonly asked questions
In clinical terms, a case study is a detailed examination of a patient's medical history, symptoms, diagnosis, treatment, and outcomes, typically used for educational or research purposes.
Case studies are essential in nursing as they provide real-life scenarios for nurses to apply theoretical knowledge, enhance critical thinking skills, and develop practical clinical reasoning and decision-making abilities.
Case studies in nursing education offer benefits such as promoting active learning, encouraging problem-solving skills, facilitating interdisciplinary collaboration, and fostering a deeper understanding of complex healthcare situations.
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Information Prescription Case studies
"The new information prescriptions developed by Diabetes UK are simple, clear and easy to understand. They are an additional resource that will allow the person with diabetes to monitor their progress, whilst supporting them to take more responsibility for their condition." Gail Pasquall, Diabetes Clinical Nurse Specialist
Information Prescriptions are a simple and practical one page document, which can be tailored to your patients. They contain the crucial information your patients need on how to better manage their diabetes and an action planning section that they agree with you, their healthcare professional. The document can be printed off and taken away by the patient.
Read the case studies below from healthcare professionals who have used the Information Prescriptions with patients. The case studies highlight:
- the ease of using the Information Prescriptions in short consultations and the benefits of goal setting.
- how Information Prescriptions change the nature of the conversation you have with patients, and
- how Information Prescriptions can be used as a tool to improve adherence and self management.
Dr Farooq Ahmad, GP, South London
A 57-year-old Asian man who has had diabetes for eight years came to see me for a minor illness. After dealing with this I saw the pop up icon on the right of the screen suggesting I could print an information prescription about his diabetes and the fact that his diabetes control was not optimum. After setting some goals himself and handing over the printed personalised sheet to him, he was really grateful and commented that in his time as a diabetic patient this was the first time anyone did some goal setting with him and gave him a personalised plan for his health. Since then this patient has greatly improved his diabetes control and become more focused about his health.
Dr Stephen Lawrence, GP, Medway
A 56-year-old woman with a six year history of Type 2 diabetes with reasonable glycaemic control but sub-optimal lipid profile and blood pressure levels. It is fair to say that over the six years since her diagnosis I, together with many other healthcare professionals, had contributed to her education regarding cardiovascular risk factors. However, it was is sobering revelation to me that, on issuing her with information prescriptions relating to her blood pressure and lipid profile to personalised interventions, she revealed to me that it was the first time that anyone had explained her results. Perhaps more accurately it was the first time that her results have been presented in the way that she could understand. I would highly recommend this tool to healthcare professionals seeking to optimise the care of their patients with diabetes.
Sandi Kendall, Practice Nurse, South London
A 42 year-old man with Type 2 diabetes diagnosed for about five years. He works night shifts at a packing factory and is currently living with his mother due to not being able to afford his own accommodation.
He has a history of poor compliance in taking his medication as he reports that he has adverse side effects with most of the medication he has been prescribed. He also finds it difficult to remember to take his medication, particularly since he has been doing night shift work.
His attendance at his six month reviews is unpredictable as he normally tends to be asleep during the day because of his job. It is difficult to contact him in order to invite to these reviews. He has a love for fizzy drinks and consumes large amounts even though he has been advised to cut down.
In the first three years of his diabetes he was treated with oral medication. Due to his rising HbA1c he agreed to start a mixed insulin to take twice daily. Due to poor compliance with the insulin regime this was discontinued after two months.
When he attended his review I gave him a copy of his Information Prescription. He was able to see in black and white how his blood glucose levels have risen over the last year. We focused on the need to comply with medication and on how keeping to a healthy diet and weight can effect blood glucose levels and cholesterol. The fact that he could actually make his own goals and write them down gave him something concrete and structured to aim for. This had more impact than just being given verbal advice. He was also able to take this home and have a reminder of the goals he had made.
This patient has started to make these small changes which have had an overall effect in improving his diabetes management, resulting in a reduction in his HbA1c from 82mmols to 65 mmols.
When people are enabled to be in the driving seat of their care they invariably make decisions that are right for them and enjoy better personal and health outcomes. Diabetes UK have developed some promising, desktop-accessible Information Prescriptions. When these are used as part of a caring therapeutic relationship, they will help promote shared decision making, goal setting and support self-management. They are likely to be a welcome tool to help people have more confidence, knowledge, understanding and skills to collaborate in their diabetes care”
Graham Kramer, GP and The Scottish Government's Clinical Lead for Self Management and Health Literacy
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© The British Diabetic Association operating as Diabetes UK, a charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136). A company limited by guarantee registered in England and Wales with (no.00339181) and registered office at Wells Lawrence House, 126 Back Church Lane London E1 1FH
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In diabetes, the role of advanced practice nurses has significantly contributed to improved outcomes in the management of type 2 diabetes,5 in specialized diabetes foot care programs,6 in the management of diabetes in pregnancy,7 and in the care of pediatric type 1 diabetic patients and their parents.8,9 Furthermore, NPs have also been ...
Type 1 diabetes accounts for approximately 6% of all cases of diabetes in adults (≥18 years of age) in the United States, 4 and 80% of these cases are diagnosed before the patient is 20 years of age. 5 Since this patient's diabetes was essentially nonprogressive over a period of at least 9 years, she most likely does not have type 1 ...
The three mini-case studies presented with this issue of the journal take you through what to consider in making an accurate diagnosis of type 2 diabetes. The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.
Open the PDF Link PDF for Case 10: Maturity-Onset Diabetes of the Young (MODY) Misdiagnosis as Steroid-Induced Diabetes in another window 2: Diabetic Ketoacidosis (DKA) and Euglycemic DKA Case 11: A Case of Histiocytosis-Lymphadenopathy Plus Syndrome Due to a Novel Mutation in the SLC29A3 Gene and Presentation With Diabetic Ketoacidosis
The 2018 Abbott Case Study Competition is run to acknowledge and reward case studies that address contemporary issues in the practice of diabetes care, diabetes education and self-management in the use of flash glucose monitoring and ambulatory glucose profile. Submitted case studies included principles of person-centred care and
A 59-year-old woman with type 1 diabetes and a 2-year history of cognitive decline presented with obtundation. There was diffuse, symmetric hypointensity in the brain on T2-weighted images and abno...
JO's family history is a concern. Both of his parents have type 2 diabetes. JO's father was forced into retirement a year after his foot was amputated because of complications from the diabetes. Two of JO's older brothers have been told to lose weight in order to reduce their risk of developing type 2 diabetes.
Diabetes mellitus currently affects 6.4% or 285 million adults worldwide, and that number is expected to increase to 7.7% or 439 million by 2030. 1 In the United States, the prevalence of diabetes in adults increased from 11.3% in 2010 to 12.3% in 2012. 2 The current type 2 diabetes mellitus (T2DM) epidemic is closely associated with a parallel obesity epidemic, with more than 85% of patients ...
Case Study: Produced by: Diabetes UK: Summary: A guide in how to prepare a practical case study about good practice in diabetes care. Also learn how to write a compelling case study showing others how good practice was achieved and how to share your case study with the right people so that it has maximum impact. Date of publication: 2015: Link
Diabetes & Primary Care 's series of interactive case studies is aimed at GPs, practice nurses and other professionals in primary and community care who would like to broaden their understanding of type 2 diabetes. The four mini-case studies created for this issue of the journal cover various aspects relating to hypoglycaemia and type 2 ...
Follow this interactive case study of diabetes and CVD and click each poster below and learn how different factors, such as medication adherence and lifestyle interventions affect Sterling's glycemic control, CVD risk management and overall outcomes. (Content accurate as of May 2023). Meet Sterling. Sterling has a new problem.
[email protected] m. Abstract. Diabetes mellitus, is a grou p of metabolic disorders that leads to high blood glucose level, resul ting in excessive urination, increased thirst, blurred vi ...
A PDF poster version of this case study is available - see Download section below. Origin. Diabetes mellitus is a disease associated with high levels of blood sugar, a condition that if untreated can be fatal. It can also lead to serious health problems including cardiovascular disease, nerve damage, kidney damage, eye damage and hearing ...
Lucy is an 18-year-old university student in her first year and is living in student accommodation. Lucy has had type 1 diabetes since the age of 13. Her parents are very supportive but naturally worried about her leaving home. Lucy had a take-away chicken meal 2 days ago and since then she has been vomiting and has diarrhoea.
A study of clinician encounters with patients with type 2 diabetes in primary care clinics supports that belief. Each additional concern raised by a patient during the course of a visit was associated with a 49% reduction in the likelihood of a change in medication. Time constraint was the biggest factor in the GP's delay in starting insulin ...
Diabetes UK's in-depth case studies provide real-life examples of good practice in diabetes care from across the country. Presented in bitesize, easy to read sections, the case studies describe what local areas have done to improve care for people with diabetes, and how the change was achieved. They also present outcomes and key lessons learned.
Results. The qualitative content analysis yielded 2 main themes. We labeled the first theme as "Written reflection affects awareness and commitment in diabetes self-management", which reflects 2 subthemes, namely, "Writing creates space and time for autonomous reflection" and "Writing influences individuals' focus in diabetes self-management".
The three mini-case studies developed for this issue of the journal take us through the basic considerations of managing type 2 diabetes in the elderly. The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.
How to write a nursing case study? Writing a nursing case study involves several essential steps to ensure accuracy, relevance, and clarity. Let's break down the process into actionable steps: ... diabetes), treatment plans, and any ongoing concerns or challenges. Utilize assessment tools and techniques to evaluate the patient's condition ...
The case studies highlight: the ease of using the Information Prescriptions in short consultations and the benefits of goal setting. how Information Prescriptions change the nature of the conversation you have with patients, and. how Information Prescriptions can be used as a tool to improve adherence and self management.