In summation, social support has been defined as an intervening factor tied directly to the coping process (Pearson, 1986). Regardless of the differences in definition, social support has been the subject of medical and behavioral research for over two decades and the universal outcome has been that social support has therapeutic value in mental and physical health. The majority of studies have been correlational, and so statements about cause and effect remain tenuous. Nevertheless, it is the consensus that social support is a key situation moderator of or buffer to the effects of psychosocial stressors (Pearson, 1986).

Social support can also serve as a salve to pains encountered along the way. It gives people the confidence to making a positive change and testing their limits when they know they have a community of support they can call upon. Social support refers to social interactions that are perceived by the recipient to facilitate coping and assist in responding to stress. Social support is thought to reduce the total amount of stress a person experience as well as to help one cope better when stressed (House, & Landis, 2003).

Social support network is defined as the people from whom an individual can reasonably expect to receive help in a time of need. Social support has been said to contain emotional, practical, and informative dimensions. Data from long-term prospective studies suggest that a lack of social relationship constitute a major risk factor for mortality (House, & Landis, 2003).

In the empowerment approach, there are both strategies that can be used by providers and strategies that can be implemented within a practice to promote patient empowerment.18-21 First and foremost, we need to listen to our patients and ask what they need to obtain from their interactions with us to better manage their diabetes.4 Patients have identified that they have many concerns and issues about living with their diabetes that are rarely addressed by their providers.22 Even patients who are achieving desired metabolic and other outcomes may struggle with the demands of a chronic illness and the uncertainty that it adds to their lives. In addition, providers can become more patient-centered and collaborative and thereby improve patient outcomes and satisfaction with their care

Depression may be a response to the psychosocial burden of living with diabetes. Psychosocial factors such as perceived health status, income, and education have been associated with depression in individuals with diabetes. From there, worsening of health status was independently associated with depression rather than the usage of insulin or medications were not associated with depression. Perceptions about the effect of diabetes on overall health rather than disease chronicity, illness severity, or type of treatment is likely to play an important role in the etiology of depression in individuals with diabetes (Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control 2007).

The notion that psychosocial factors rather than disease duration or severity plays important roles in the etiology of depression in individuals with diabetes is supported by prior work. In separate studies, perceived control of diabetes (23), intrusiveness of diabetes (24), perceived daily burden of living with diabetes (20), and perceived threat of diabetes (42) were found to be significantly associated with depression in individuals with diabetes. Therefore, future studies examining the causal relationship between diabetes and depression need to pay attention to the important role that psychosocial factors are likely to play (4).

TYPE of RECORD

Diabetes-related discharges

1st listed diagnosis

Hospital inpatient discharge

Emergency room visits

Diabetes-related discharges

1st listed diagnosis

Gender

Female

Male

Definition of Terms

During this study, the overall glycemic control of diabetic young people will be presented as being as equivalent to a Diabetes Control and Complications Trial HbAlc concentration of 8.7%, placing the majority at a high risk of the complications of diabetes in adulthood. Adjustment for these did not explain the differences between centers although factors were significantly associated with poor HbAlc.Factors not analyzed in DIABAUD2 are the determinants of HbAlc. The e style of utilization of optimum resources is the key to achieving good glycemic control (Factors Influencing Glycemic Control in Young People With Type 1 Diabetes in Scotland 2001).

Average HbAlc concentration was 9.1% (range 5.0-15.0). The following significant associations with HbAlc level were identified: age, insulin regimen, BMI, season, social circumstances, and family history. HbAlc concentrations were significantly worse in...

other ages 8.8%, P < 0.001), those using two injections per day (2/day 9.1% vs. 3/day 8.8%, P < 0.01), children without both parents at home (9.4 vs. 9.0%, P < 0.001), a sibling with diabetes (9.7% vs. no family history 9.1%, P < 0.001). HbAlc concentration ranged from 8.1 to 10.2% between centers, after adjustment for factors associated with poor HbAlc (P < 0.001). (Factors Influencing Glycemic Control in Young People With Type 1 Diabetes in Scotland 2001).
Furthermore, this study will present the role of a single measurement of HbA1c in a diabetes case finding in hospitalized patients with random hyperglycemia at admission, which includes a study of 500 people with diabetes. Fifty percent of the 500 patients met the inclusion criteria. Seventy percent completed the study, and sixty percent were diagnosed with diabetes. Patients with diabetes had higher HbA1c levels than subjects without diabetes. An HbA1c level >6.0% was 100% specific and 57% sensitive for the diagnosis of diabetes. When a lower cutoff value of HbA1c at 5.2% was used, specificity was 50% and sensitivity was 100% (Utility of HbA1c Levels for Diabetes Case Finding in Hospitalized Patients With Hyperglycemia 2003).

The cost-effectiveness of home monitoring of blood glucose (HMBG) in Type-2 diabetes was evaluated. Type-2 diabetic individuals of higher middle class to rich socio-economic status were studied. Thirty-two were allocated to conventional monthly hospital visits group-I (Gr-I) and 32 to HMBG with hospital visits at 3 monthly intervals group-II (Gr-II). In Gr-I, compared to baseline, HbA1c values decreased by 0.76% (95% CI 0.11-1.42) after 9 months and by 0.95% (95% CI 0.12-1.77) after 15 months but lost significance after 18 months follow-up. On the other hand, in Gr-II patients, HbA1c decreased significantly from baseline from 3 months and remained so at 18 months when it was decreased by 1.37% (95% CI 0.25-2.49). Hypoglycaemic episodes per patient year follow-up were significantly lower among Gr-II patients (0.172 vs. 0.354, P=0.03). Considering the cost for conveyance, wage loss, investigation, institutional cost, glucometer and test strips, the total cost per patient was quite similar in both groups. The present study suggests that HMBG with proper diabetes education may be cost-effective at least in selected groups of individuals with Type-2 diabetes, even in a developing country such as Bangladesh (Home monitoring of blood glucose (HMBG) in Type-2 Diabetes mellitus in a developing country). It can determined that diabetes care can be costly but can remain stable for the patients at a fair rate.

Conclusion

In this study, it will be presented that here are many factors at influence how patients handle the care and the managing of diabetes mellitus. Patients' ability to adhere to their treatment regimen is crucial for successful management of type 2 diabetes. However, several studies have shown difficulty maintaining optimal adherence with all aspects of therapy. For example, many diabetic patients in the United States have never monitored their own blood glucose levels, and only a minority monitor their blood glucose at least once a day.13 Ensuring that patients take oral medications as prescribed is among the most common problems encountered by primary care physicians treating patients with type 2 diabetes.14 Commonly cited reasons for nonadherence to oral medication regimens include forgetfulness and spontaneous activities.15 Furthermore, patient adherence to diet and exercise regimens is often suboptimal. In one random survey, 85% of primary care providers identified following diet regimens as a problem for people with type 2 diabetes" (Factors Influencing Patient Acceptability of Diabetes Treatment Regimens).

Chapter Two: Literature Review

2.1 Introduction

It is apparent in this study that in order to influence diabetes care with health care professionals and patients, organizational culture is a basic pattern of shared values, assumptions and beliefs considered to be the correct way of thinking about and acting on problems and opportunities facing diabetes care. In the situation of diabetes care, sometime are to many hospital visits by the patient due to the fact they are scared of having the disease."The use of a county hospital emergency room (ER) by diabetic patients was investigated by comparing ER visits for diabetes to a sample to total ER visits over a period of 1 yr. The major problems of ER use by diabetic patients were an excessive number of visits for diabetes complications, a high rate of hospital admissions from the ER, and the high cost of ER use. Approximately 20% of visits for diabetic patients were attributed to preventable complications of diabetes. The rate of hospital admissions from the ER was over four times greater for the diabetic patients than for the random sample. The median cost of an ER visit was nearly…