November 21, 2024

Structured Education in Type 2 Diabetes

Dr. Rajesh Jain August 18, 2021 123
glycemic control

glycemic control

Review of the Evidence for the Benefits of Structured Education in Type 2
Diabetes

 

INTRODUCTION

type 2 diabetes
type 2 diabetes

Globally, type 2 diabetes accounts for most deaths, sufferings, and burdens to individuals and health care services. There is a wealth of evidence to prove that high-quality structured diabetes self-management education (DSME) can significantly affect health outcomes and enhance patients’ quality of life.  This summative report aims at reviewing the evidence for the benefits of structured education in Type 2 diabetes. KNOWLEDGE DSME is the cornerstone to successful everyday diabetes management and can be transformative for individuals who have diabetes. This is evident in a systematic review of group-based education for patients with Type 2 diabetes in which 21 randomized controlled trials (RCTs) on diabetes structured education were assessed. This study revealed major improvement in participants’ knowledge about diabetes. Diabetes education is key for diabetes Prevention.

Structured education in type 2 diabetes
Structured education in type 2 diabetes

Lifestyle

See also: Diet in diabetes

People with diabetes can benefit from education about the disease and treatment, dietary changes, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.

diet for diabetes
diet for diabetes type 2

Weight loss can prevent progression from prediabetes to diabetes type 2, decrease the risk of cardiovascular disease, or result in a partial remission in people with diabetes. No single dietary pattern is best for all people with diabetes.

Healthy dietary patterns, such as the Mediterranean diet, low-carbohydrate diet, or DASH diet, are often recommended, although evidence does not support one over the others. According to the ADA, “reducing overall carbohydrate intake for individuals with diabetes has

effective weight loss
effective weight loss

demonstrated the most evidence for improving glycemia”, and for individuals with type 2 diabetes who cannot meet the glycemic targets or where reducing anti-glycemic medications is a priority, low or very-low-carbohydrate diets are a viable approach. For overweight people with type 2 diabetes, any diet that achieves weight loss is effective.

CLINICAL OUTCOME, SELF-MANAGEMENT, AND BEHAVIOR CHANGE

DSME programs have also shown major improvement in glycemic control and diabetes outcomes. Norris et al. [5] demonstrated that HbA1c levels decreased by 0.76% in participants who undertook DSME. Chala et al.  also reviewed existing literature and found similar reductions in HbA1c, with the greatest reduction of 0.88% in both individual and group settings for participants who completed
DSME. Nonetheless, in the former studies, the effect of  DSME was not sustainable long after intervention amongst participants compared to the latter.

glycemic control
glycemic control

This is quite substantial as the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that even a 0.9% decrease in HbA1c is associated with reductions in microvascular complications, diabetes-related mortality, and all-cause
mortality. In the UK, DESMOND’s (Diabetes Education and Self Management for Ongoing and Newly Diagnosed)
the intervention has yielded similar results. Khunti et al. reported a 1.49% decrease in HbA1c after 12 months and a sustained decrease after 3 years (-1.32%). However, there were no significant differences in other biomedical factors such as blood pressure and 10-year cardiovascular disease risk.

In similar terms, the reviews by DESMOND and 8 showed that greater exposure to structured education was linked to better glycemic control. An Italian-based intervention, ROMEO (Rethink Organization to iMprove Education and Outcomes), built on the efforts of these earlier studies to develop a lifestyle-change education program focusing on metabolic control, which was carried out over a longer duration of 2 years. The findings demonstrated that the participants in the ROMEO study had improved HbA1C, lipid profile, blood pressure, and BMI than in the control groups.

 

This suggests that an ongoing model of structured education may result in improvements in glycemic control and other biomedical factors, which can likely lead to fewer long-term complications.
In addition to improving health outcomes in individuals with type 2 diabetes, DESMOND’s programs also showed that structured education was beneficial in helping participants self-manage their diabetes and change health behaviors.

Structured Education
Structured Education

Examined this and found that after 12 months, the odds of having stopped smoking were up to 3.5 times higher in the intervention group than the control group. Positive results were also seen in areas of physical activities and diet change. Rygg et al., in their study, “examined the experience of participants in DSME about change in diet and physical activity and the generating learning process that facilitated this change.”

 

Their findings revealed that participants experienced a life of more confidence, security, increased control, and well-being. The participants also experienced significant improvement in their diet and physical activity 6 months after completing the DSME program. Similar findings of improved diet were reported by X-PERT programs, and a significant increase in the frequency of physical activity was reported by Davies et al. in their RCTs. X-PERT programs also showed positive results in self-management of blood glucose (SMBG),

SMBG
SMBG (Self-monitoring Blood Glucose )

although the increase in SMBG only lasted for 4 months. Results after 14 months revealed no significant difference between participants and the control group. Nevertheless, in their study, The Diabetes Equity Project (DEP) confirmed improvement in the regularity of SMBG, which lasted 12 months. SMBG and results of other activities indicated increased competence in managing their diabetes.

These education programs did not specifically measure adherence to medical treatment and care, though the positive results suggest that overall adherence improved. Van Netten et al. in their systematic review of 30 studies with 19 RCTs, revealed that DSME might have no impact in improving foot care behavior.

 SELF-DETERMINATION AND PSYCHOSOCIAL ADJUSTMENT

Khunti et al., in their research, has conclusively proven that well-structured education programs have contributed tremendously towards self-determination and mental adjustments in patients with diabetes. This is corroborated with the study from Essien et al., which indicated that DSME and social support positively affect self-efficacy and patient empowerment.

Crop unrecognizable female psychologist and patient discussing mental problems during session
patient empowerment

There are also studies suggesting that DSME has proven to promote healthy coping mechanisms and decrease diabetes-related distress and depression in their studies evidence significant improvement of quality of life for participants with diabetes-related stress after completing the DSME.

LONG-TERM OUTCOMES

Although many studies have shown that structured education can cause significant improvement in lifestyle, clinical and psychosocial outcomes, its role in preventing diabetes complications is an area of emerging research. An early study by Nicolucci et al. showed that complications such as; critical limb ischemia, amputation, chronic renal failure, dialysis treatment, proliferative retinopathy, and blindness could occur approximately 4 times more often in diabetic individuals with no education.

 

A more recent study that looked at the effects of glycemic control and incidence of cardiovascular complications showed that Patient Empowerment Programme participants were associated with lower incidence of first micro-vascular event and nephropathy.

Photo Of People Doing Handshakes
Program participants

The population-based cohort analysis study of the Patient Empowerment Programme by Wong et al. in obese type 2 diabetes patients again revealed that Patient Empowerment Programme participants had lesser incidence rates of all-cause mortality and first macro-vascular or micro-vascular disease events from diabetes.

A systematic review of literature from 2001 to 2011 by Nazar et al. revealed that diabetes complications could be minimized by developing enhanced diabetes knowledge and education to treat diabetes at the right time. This can, in turn, reduce morbidity and mortality amongst patients with diabetes.

These studies further explored that amputation rates can be reduced through DSME, which can result in huge cost savings. A long-term study with 13 years of follow-up investigated the impact gender may have on diabetes outcomes and found that structured education could reduce mortality and morbidity in women but not in men.

UTILISATION OF HEALTH CARE SERVICES

Although there is a wealth of evidence to prove that DSME can improve health outcomes and life quality for individuals with Type 2 diabetes, there is minimal recent research to prove that DSME can minimize healthcare services.

A Paramedic Woman Standing Inside the Ambulance
health care services

Norris et al., in a systematic review of five studies, only reported one study that experienced a reduction in emergency room visits four months after receiving DSME. Their findings from four other studies on admissions outcomes and hospital length of stay showed no major difference between participants who had DSME and the control group.

Greisinger et al. reviewed one study covering hospitalizations between 1993 and 2001 and concluded that patients with low income served by primary healthcare could react differently to these services than patients with highincome. There was no significant reduction in the use of eye specialist services, as reported by Norris et al.

DELIVERY MODE AND COST-EFFECTIVENESS

DSME can be delivered by nurses, physicians, specialists, and other healthcare professionals in hospitals, communities, outpatient clinics, diabetes centers, and primary care settings. DSME can be delivered as a group or one-to-one session depending on the individual’s needs. According to systematic review studies carried out by Chrvala et al. and Van Netten et al. both groups and individual education have shown significant improvements in participants‘ clinical outcomes and lifestyle changes.

Emergency Signage

According to Van Netten et al. the yearly cost for each participant without labor and admin in the X-PERT structured program was £26. On average, one medication costs £433 yearly. However, after completing the DSME with people having better outcomes, it is estimated that the cost for medication savings was £56,723 for 432 diabetic patients. Hence, over £367 million could be saved yearly if all 2.8 million patients with diabetes in the UK participated in XPERT programs.

CONCLUSION

In conclusion, this essay has examined the review of the benefits of structured education in type 2 diabetes about increasing patients’ knowledge, self-management, behavior change, clinical outcome, healthcare service utilization, long-term outcomes, psychological adjustment, and self-determination. It looked into the effectiveness of the delivery modes of type 2 diabetes structured education and discussed the cost-effectiveness and socio-economic implication of type 2 diabetes structured education.

In the studies reviewed, there is no concrete evidence that diabetes structured education may reduce healthcare services and 10-year cardiovascular risk. Nonetheless, there is substantial evidence that diabetes structured education can improve the general health outcome of individuals with type 2 diabetes, especially in areas such as physical activities, diet, medication adherence, smoke cessation, glycemic control, as well as the psychosocial well-being of the individual with type 2 diabetes. Diabetes structured education can also
reduce the huge cost on both individuals and health care services.

REFERENCES

1. International Diabetes Federation (2017) Diabetes Atlas. 8th Edn. Available at: http://www.idf.org/diabetesatlas
(Accessed: 13 May 2018).
2. Odgers-Jewell K, Ball LE, Kelly JT, Isenring EA, Reidlinger DP, et al. (2017) Effectiveness of group-based self-management education for individuals with type 2 diabetes education: A systematic review with meta-analyses and meta-regression. J Br Diabet Assoc 34: 1027-1039.
3. Skinner TC, Carey ME, Cradock S, Daly H, Davies MJ, et al. (2006) Diabetes education and self-management for on-going and newly diagnosed (DESMOND): Process modeling of a pilot study. Patient Educ Couns 64: 369-377.
4. Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey, et al. (2008) Effectiveness of the diabetes education and self-management for on-going and newly diagnosed (DESMOND) program for people with newly diagnosed type 2 diabetes: Cluster randomized controlled trial. Br Med J 336: 491-495.
5. Norris S, Lau J, Smith S, Schmid C, Engelgau M (2002a) Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care 25: 1159-1171.
6. Chrvala C, Sherr D, Lipman R (2016) Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns 99: 926-943.
7. the United Kingdom Prospective Diabetes Study (UKPDS) Group (1998) Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352: 854-865.
8. Khunti K, Gray L, Skinner T, Carey M, Realf K, et al. (2012) Effectiveness of diabetes education and self-management program (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: Three-year follow-up of a cluster randomized controlled trial in
primary care. Br Med J 344: e2333-e2333.
9. Trento M, Gamba S, Gentile L, Grassi G, Miselli V, et al. (2010) Rethink Organization to iMprove Education and Outcomes (ROMEO): A multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care 33: 745-747.
10. Rygg LO, Lohre A, Hellzen O (2017) Lifestyle changes in diet and physical activities after group education for type 2 diabetes — the active ingredient in the education: A qualitative study. Open J Nurs 7: 1181-1190.
11. Deakin TA, Cade JE, Williams R, Greenwood DC (2006) Structured patient education: The Diabetes XPERT Programme makes a difference. Diabet Med 23: 944-954.
12. van Netten JJ, Price PE, Lavery LA, Monteiro-Soares M, Rasmussen A, et al. (2016) Prevention of foot ulcers in the at-risk patients with diabetes: A systematic review. Diabetes Metab Res Rev 32: 84-98.
13. Essien O, Out A, Umoh V, Enang O, Hicks JP, et al. (2017) Intensive patient education improves glycemic control in Diabetes compared to conventional education: A randomized controlled trial in a Nigerian Tertiary Care Hospital. PLoS One 12: e0168835.
14. Tang TS, Funnell MM, Oh M (2012) Lasting effects of a 2-year diabetes self-management support intervention: Outcome at 1-year follow-up. Prevent Chronic Dis 9: E109

15. Steinsbekk KA, Rygg LQ, Lisulo M, Rise MB, Fretheim A (2012) Group-based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus: A systematic review with meta-analysis. BMC Health Serv Res, p:23.
16. Nicolucci A, Cavaliere D, Scorpiglione N, Carinci F, Capani F, et al. (1996) A comprehensive assessment of the avoidability of long-term complications of diabetes: A case-control study. SID-AMD Italian Study Group for the Implementation of the St. Vincent Declaration. Diabetes Care 19: 927-933.

17. Wong C, Wong W, Wan Y, Chan A, Chan F, et al. (2015) Patient Empowerment Programme (PEP) and risk of microvascular diseases among patients with type 2 diabetes in primary care: A population-based propensity-matched cohort study. Diabetes Care 38:
e116-e117.
18. Wong C, Wong W, Wan E, Chan A, Chan F, et al. (2016) Macrovascular and microvascular disease in obese patients with type 2 diabetes attending structured diabetes education program: A population-based propensity-matched cohort analysis of Patient
Empowerment Programme (PEP). Endocrine 53: 412-422.
19. Nazar CMJ, Bojerenu MM, Safdar M, Marwat J (2016) Effectiveness of diabetes education and awareness of diabetes mellitus in combating diabetes in the United Kingdom: A literature review. J Ethnopharmacol 5: 110-115.
20. Gazzaruso C, Fodaro M, Coppola A (2016) Structured therapeutic education in diabetes: Is it time to re-write the chapter on the prevention of diabetic complications? Endocrine 53: 347-349.
21. Krag MØ, Hasselbalch L, Siersma V, Nielsen A, Reventlow S, et al. (2015) The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: A 13-year follow-up. Diabetologia 59: 275-285.
22. He X, Li J, Wang B, Yao Q, Li L, et al. (2016) Diabetes self-management education reduces the risk of all-cause mortality in type 2 diabetes patients: A systematic review and meta-analysis. Endocrine 55: 712-731.
23. Norris SL, Engelgau MM, Narayan KM (2001) Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care 24: 561-587.
24. Greisinger AJ, Balkrishnan R, Shenolikar RA, Wehmanen OA, Muhammad S, et al. (2004) Diabetes care management participation in a primary care setting and subsequent hospitalization risk. Dis Manage 7: 325-
332.
25. Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM, et al. (2002b) Increasing diabetes self-management education in community settings – A systematic review. Am J Prev Med 22: 39-66

Citation: Jain R, Olejas S, Edwards A, Feh AR, Iqbal M, et al. (2019) Review of the Evidence for the Benefits of Structured Education in Type 2 Diabetes. Int J Diabetes Current Res, 1(2): 29-32.

Diabetes is just one of the many chronic ailments prevalent in the U.S., with millions of people suffering each year and thousands newly diagnosed by the same token.

And whether you have type 1 or 2 diabetes, making healthy lifestyle choices in the form of exercise (physical and mental), diet, and mental health management are vital for keeping this life-threatening illness at bay. to see the Complete article pls

https://www.diabetesasia.org/magazine/category/lifestyle-medicine/

About Post Author

Profile
Author's Latest Posts

Dr. Rajesh Jain

Dr. Rajesh Jain MD PG Diploma Diabetes, UK

The diabetesasia is the advocate for the people currently living with diabetes Burden & NCDs Risk. Global Diabetes Walk campaign remind us to Prevent diabetes.

See author's posts

More Stories

WDD

World Diabetes Day (WDD) Global awareness campaign dedicated to diabetes mellitus

Dr. Rajesh Jain November 9, 2024 0

Wellness Wheel: Turning Diabetes Management Into Daily Practice

Tanya Lee October 16, 2024 0
Buddha

The Noble Eightfold Path of Buddha consists of eight practices (Meditation)

Dr. Rajesh Jain July 7, 2024 0

123 thoughts on “Structured Education in Type 2 Diabetes”

  11. They are jolly personable, recollect me and pronounce to me by name. Eager to atone for any questions! I love their knowledge and experience with alternative panacea !

    Reply

  12. It was the Keeper business creme de la creme that attracted us to this relationship. We feel that this partnership determination enable us to focus on what we do best – ensuring that our clients’ and patients’ specialized needs are met with punctiliousness and consideration. In cast, http://www.azithromycintok.com provides us with a Corporate Support Center that assists with day-to-day business operations – from payroll to refund control – as well as the intensely complex interest rotate that can be so time-consuming.

    Reply

  18. I pull someone’s leg been dealing with get doctor prescription online in search over and beyond 20 years. In the beginning we lived down the street. I had small children and got to advised of Lyle Sunada graceful well as he helped commend treatments plain to a growing family. Not on the other hand did Cloverdale Pharmasave look after the ‘people’ in my family, but I was qualified to have altogether a second of pharmaceutical for my pets without the precious authenticate visit. With thanks. I appreciate this!

    Reply

  27. If the first time offender violates either treatment rules or fails to meet the probation requirements, the court may automatically issue a prison sentence. If you have had a dry summer with below-normal rainfall, you need to replenish soil moisture before preparing a seedbed. By this point your buds should be fragrant the whole grow room will likely smell like marijuana , plump and filled out After new white hairs stop growing, wait until at least 40 of the white hairs have changed color darkened and are curling in. https://weedseeds.garden

    Reply

  31. I be required to divulge, as a lot as I enjoyed reading what you had to announce ‘, I couldnt improve but be beaten induce after a while. Its as if you had a wonderful grasp on the participant puzzle, but you forgot to include your readers. As the case may be you should judge about this from immeasurably more than lone angle. Or peradventure you shouldnt generalise so considerably. Its change one’s mind if you cogitate on fro what others may make to impart preferably of very recently prevailing in return a gut feedback to the subject. Regard as about adjusting your own believed convert and giving others who may read this the fringe benefits of the doubt. https://googleh51.com

    Reply

  45. Transactional emails are the type of emails you send to a heiress to promote commercial activity. You send it following a commercial transaction or in reaction to a certain action performed nearby the recipient. An example is a confirmation email that you send to a person that ordered a by-product from your have faith; this message lets the recipient be sure that they entered into a valid transaction. Because transactional emails are required to smooth momentous transactions, businesses do not essential to obtain candid allow from the recipient to send them, far from marketing emails where agreement is required.

    Reply

  50. Китай снова преподносит сюрприз в плане технологий и новшеств.
    В этом году новшества затронули детей младшего и среднего возраста, а также их мам и пап.
    Пекинская фирма Ardokids выпустила целую линию конструкторов для всех возрастов и интересов.
    Раньше, пользователь, имея конструктор, мог сделать из него что то конкретное.
    Теперь перед хозяином конструктора распахивается гигантское количество вариантов.
    Эти конструкторы созданы по гибкой логике, что позволяет полностью самореализоваться в творчестве.
    Каждая деталь конструктора оснащена электромагнитным и электронным инжектом, который способен принимать разные умные связки с другими деталями.
    Так ребенок может сделать собственный аквапарк и даже внедрить в нем жизненный симулятор!
    Также, разобрав проект, создать кафе, гоночный трек и даже автомастерскую, конечно мини версию.
    Детали умеют реагировать на разные признаки, такие как цвет, мелодия, освещение.
    Такого рода достижение выводит их на следующую ступень развития технологий.
    Источник сведений trustorg.top

    Reply

  81. 48x5mVkNdV9f6xq6dR3YF8HtukfbnCAn
    TpJzDXWSYg7c9na8QomGRosty3pCsh4B
    bIfzH7jbnHSKKVtszuTx3XF6TaYE8Tbt
    TamXxzooA4uzQq3BCdE25Fwt7MAwZILC
    fSUfkFCVt4pl9JmXnkowuAnppnYeytvx
    lL6fGuagbnCtDEWxq9a9UbyezvKj0h32
    9fZavZqvfxY1WECtLc3WQZ96rWajYxrK
    szvYfMy3L51i4TK6SLRb7xRJBgqFxzfe

    Reply

  83. Get millions of instant leads for your organization to launch your marketing. Utilize the lists an infinite quantity of times. We have been supplying businesses and market research firms with information since 2012. Lead Generation

    Reply

  88. Bit late to this Stuart. https://context.reverso.net/ I didn’t get all my Euro tickets as was in different bookings and my mate thought the souvenir covered all your bookings for the tournament. He was led on knockout games and didn’t tick the box. Anyway I got spare Croatia, Czech, Scotland. But missing the rest 🙁

    Reply

  92. hello friends!

    I was looking for how to make the text unique, tried a lot of programs and online services, and everything is wrong((
    A friend advised an interesting and inexpensive software that can unify texts, files, and entire sites 24/7 in batches!
    The work is based on a bunch of neural networks of translators, which is essentially simple and at the same time unique.
    The program is called X-Translator, you can see the description here and get a 50% discount on the purchase
    https://www.xtranslator.ru/

    Not for advertising, I just decided to give advice, and if you know the software better, please unsubscribe in the topic!

    Good luck)

    Reply

  94. Япония и Южная Корея заявляют, что объект достиг максимальной высоты 2000000 м.
    Корея выложила снимки, сделанные во время самого мощного запуска ракеты за последние годы.
    На необычных снимках, снятых из космоса, показаны части Корейского полуострова и окрестные территории.
    В понедельник Пхеньян подтвердил, что провел испытания ракеты средней дальности (БРСД).
    Набрав полную мощность он может преодолевать огромные расстояния, оставляя в пределах досягаемости такие районы, как территория США Гуам.
    Это учение вновь подняло тревогу у мира.
    Только за последний месяц Пхеньян сделал огромное количество ракетных запусков — 7 штук — что резко осудили практически все страны мира.
    Что хочет Корея?
    Почему Северная Корея выпустила так много ракет в этом месяце?
    СК сосредоточится на экономике в 2022 году
    ООН не одобряет такие испытания баллистического и ядерного оружия и ввела строгие санкции. Но восточноазиатское государство регулярно игнорирует запрет.
    Верхушка штатов в понедельник заявили, что недавний рост активности требует возобновления переговоров с СК.
    Что произошло На испытаниях?
    Южная Корея и Япония первыми заявили о запуске в воскресенье после обнаружения его в своих мониторах.
    Они считают, что, он пролетел умеренное расстояние для такого типа ракет, преодолев расстояние около 800 км (497 миль) и набрав высоту в районе 2 тыс км, прежде чем приземлился в океани около Японии. На предельной мощи и по стандартной траектории ракета может пролететь до 4000 км.
    Для чего СК сделала запуск?
    Северокорейский аналитик Анкит Панда заявил, что отсутствие Кима и язык, который искользовался в средствах массовой информации для создания образа запуска, позволяют предположить, что это учение было предназначено для проверки того, что БРСД работает должным образом, а не для того, чтобы продемонстрировать новую силу.
    Эту новость поведало агентство новостей Агентство новостей Новостное агентство Новостное агентство Агентство новостей Top levitacia.ru

    Reply

  97. Микро изобретение сможет испускать очень интенсивный свет, который может помочь в создании портативных рентгеновских аппаратов и частичных ускорителей.
    Эти аппараты можно было бы выпускать компактней, менее затратней и быстрее, чем настоящие ускорители частиц.
    Данный свет имеет много потенциальных применений, от спектроскопии, где свет дает возможность физикам получить знания о внутренностях разных материй, до связи при помощи света.
    «В то время, как вы делаете рентген у своего врача, это огромный аппарат. Вообразите, что это можно сделать с маленьким источником света на чипе». Это даст возможность сделать процедуру рентгена крайне доступной для небольших или далеко находящихся госпиталей, а также создать ее мобильной для использования лицами, оказывающими первую помощь в катастрофах.
    Эту новость опубликовало новостное агентство Новостное агентство Новостное агентство Новостное агентство СОбытия odelburg.ru

    Reply

  104. Корея и Япония заявляют, что ракета достигла максимальной высоты 2000000 м.
    Корея выложила снимки, сделанные при самом мощном запуске ракеты за последние пять лет.
    На необычных снимках, снятых из космоса, показаны части Корейского полуострова и прилегающие районы.
    В начале рабочей недели Пхеньян заявил, что провел испытания ракеты средней дальности (БРСД).
    Набрав полную мощность он может преодолевать огромные расстояния, оставляя в пределах досягаемости такие районы, как территория США Гуам.
    Это учение вновь вызвало тревогу у международного сообщества.
    За последние несколько недель Пхеньян сделал огромное количество запусков ракет — семь пусков — интенсивная активность, которая была резко осуждена США, Южной Кореей, Японией и другими странами.
    Что хочет Корея?
    Почему Северная Корея выпустила так много ракет в этом месяце?
    Северная Корея собирается сосредоточиться на экономике в 2022 году
    ООН не одобряет такие запуски баллистического и ядерного оружия и ввела санкйии. Но Северная Корея постояно игнорирует запрет.
    Уполномоченные персоны США в понедельник сообщили, что недавний рост активности требует возобновления переговоров с Пхеньяном.
    Что же случилось На испытаниях?
    ЮК и Япония сразу же заявили об испытаниях в воскресенье после обнаружения его в своих противоракетных системах.
    Они считают, что, он прошел огромное расстояние для такого типа ракет, преодолев расстояние около 800 км (497 миль) и достигнув высоты 2000 км, перед приземлением в океани около Японии. На предельной мощи и по стандартной траектории ракета может пролететь до 4000 км.
    Почему Северная Корея запустила ракету?
    Аналитик Северной Кореи Анкит Панда предположил, что отсутствие Кима и язык, использованный в СМИ для создания образа запуска, позволяют предположить, что это испытание было предназначено чтобы проверить, что БРСД работает должным образом, а не для того, чтобы продемонстрировать новую силу.
    Эту новость опубликовало новостное агентство Агентство Агентство новостей Агентство новостей информ hypersplav.ru

    Reply

  107. DataFast Proxies, Definitive Solution in IPv6 Proxy to Solve CAPTCHA, reCAPTCHA, funCAPTCHA!
    IPv6 Proxy for XEvil 4, XEvil 5, XEvil Beta 6, CAPMONSTER 2!

    – High Speed ​​IPv6 Proxy
    – Virgin IPv6 proxy
    – Anonymous IPv6 proxy
    – Rotating IPv6 Proxy (configurable)
    – Static IPv6 proxy (configurable)
    – 24 Hour IPv6 Proxy
    – IPv6 Proxy (Uptime 99.9%)

    DataFast Proxies | Definitive Solution in IPv6 Proxy!
    https://datafastproxies.com/

    Contact:
    https://datafastproxies.com/contact/

    Reply

  116. Bermainlah di kumpulan Situs4d Gacor dengan nama situs4d slot terupdate resmi indonesia buat th 2023 – 2024 lolos uji polisi slot kelompok facebook terpercaya dalam menjaga member supaya bisa menang dengan mudah.

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *

You may have missed

WDD

World Diabetes Day (WDD) Global awareness campaign dedicated to diabetes mellitus

Dr. Rajesh Jain November 9, 2024 0

Wellness Wheel: Turning Diabetes Management Into Daily Practice

Tanya Lee October 16, 2024 0
Buddha

The Noble Eightfold Path of Buddha consists of eight practices (Meditation)

Dr. Rajesh Jain July 7, 2024 0
Vegetable oil

Health Dangers of Vegetable oil

Dr. Rajesh Jain July 2, 2024 0
adverse effects

Renal adverse effects and Diffuse Podocytopathy Associated With Semaglutide

Dr. Rajesh Jain June 10, 2024 0