Diabetes

At the initial visit on entry into the program CHW will collect information and the application will guide initial treatment and referral recommendations. At this visit:
Collection of demographic information and relevant past medical history Medication history, adherence and side effects Glycemic testing, vital signs, and other anthropometric data. Screening for possible complications of diabetes Recommendations for referrals Medication recommendations and counseling

Primary visit and assessment

CHWs will meet with patients once per month to follow up on adherence and tolerance to medications, assess glycemic control, assess for complications of diabetes, refill medications (with dosing adjustments as needed for side effects, non-adherence or poor glycemic control), and provide diabetic education. These monthly visits will be facilitated by the smartphone application monthly protocol

Follow up visits

At every 3rd monthly visit, starting with the visit 3 months after enrollment, A1c will be assessed. When A1c is checked, the month 3 medication titration algorithm, is used rather than the monthly titration algorithm, which uses blood glucose. Other than checking A1c and using the A1c-based algorithm as indicated, the procedures performed at the month 3 visit are identical to those of the monthly visit.

3 month visits

The CHWs live in the same communities as the patients they will be serving. As such, the investigators recognize that patients may come to them with concerns outside of the structure of monthly visits as described above. The investigators have designed an additional module for the smartphone application that guides the CHWs through an assessment for hypoglycemia or severe hyperglycemia and possible complications of diabetes. If a patient or CHW has a concern outside of the scope of these protocols, the CHW will contact a CHW coordinator and/or the medical director for guidance

Unscheduled visits

Hospital Obras Sociales

Diabetes Treatment in Rural Guatemala

Change in mean percent of HgbA1c compared to value at baseline.

Percentage of patients meeting treatment goal for HgbA1c compared to this percentage at baseline. Treatment goal will be A1c ≤7 for most patients, A1c ≤8 for patients age 65 or older or who have 2 or more comorbidities, or other individualized goal for select patients as determined by the medical director

Mean fasting blood glucose compared to baseline value

Body mass index compared to baseline value

Waist circumference compared to baseline value

Mean systolic and mean arterial pressure compared to baseline value

Number and percentage of patients identified as potentially having the following complications: Angina,foot ulcers,eye complications,hypertension

Number of patients referred for potential complications, poor glycemic control or intolerance of diabetic medications and the number who complete referral

Prevalence of adverse effects of metformin and hypoglycemia symptoms

Community health worker adherence to recommendations provided by the application

University of Wisconsin, Madison

Stanford University

Type II Diabetes Mellitus

30 drops in 1 cup of water three times a day for 3 months

Abroma Augusta Q (mother tincture)

,Father Muller Homoeopathic Medical College, Prasanth Nivas Ashram Nmpt Hospital

Therapeutic Efficacy of "Abroma Agusta" in HbA1c % in NIDDM

Therapeutic Efficacy of Homoeopathic Mother Tincture of "Abroma Agusta" in Changing the Level of Glycated Hb (HbA1c %) in Diabetes Mellitus Type II (NIDDM

dr rita chakraborty

PROFESSOR, Head of The Department of Repertory

Fr Muller Homoeopathic Medical College

Injection of Mozobil (Plerixafor / AMD3100) in diabetic patients

Injection of Mozobil (Plerixafor / AMD3100) in non diabetic subjects

Subcutaneous injection of 0.24 mg/kg Mozobil once at 8:30am

Mozobil

Policlinico Universitario, Azienda Ospedaliera di Padova

Stem Cell Mobilization With Plerixafor in Diabetic vs Control Subjects

Mobilization Test of BM Progenitor Cells With Plerixafor / AMD3100: Controlled Parallel Group Comparison Between Diabetic and Non Diabetic Subjects

To evaluate the differences of CD34+ cells mobilization from the bone marrow to the peripheral blood induced by a single sc injection of Mozobil in diabetic patients versus non diabetic controls.
Clinical response variable: comparison of the fold change in CD34+ peripheral cell count in diabetic versus non diabetic controls after Mozobil administration (with collection of safety and tolerability data).

to evaluate whether Mozobil monotherapy is able to induce a significant CD34+ stem cells mobilization in diabetic patients (intra-group comparison).
Clinical response variable: detection of a significant fold-change in CD34+ peripheral cell count versus baseline in diabetic patients.

To evaluate the differences in mobilization of EPC (CD34+KDR+) from the bone marrow to the peripheral blood induced by a single sc injection of Mozobil in diabetic patients versus non diabetic controls (inter-group comparison).
Clinical response variable: comparison of the fold change in CD34+ KDR+ peripheral cell count in diabetic versus non diabetic controls after Mozobil administration (with collection of safety and tolerability data).

To evaluate whether Mozobil monotherapy is able to induce a significant EPC mobilization in diabetic patients (intra-group comparison).
Clinical response variable: detection of a significant fold-change in CD34+KDR+ peripheral cell count versus baseline in diabetic patients

diabetes complications/proljev

Diabetes Treatment in Rural Guatemala

Therapeutic Efficacy of "Abroma Agusta" in HbA1c % in NIDDM

Stem Cell Mobilization With Plerixafor in Diabetic vs Control Subjects

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