Effect of ambient temperature on analytical and clinical performance of a blood glucose monitoring system: Omnitest Sensor glucose meter

The effect of ambient temperature on the analytical and clinical performance of a glucose meter was examined. A total of 114 venous whole blood samples were analysed for glucose by a reference method, and by a glucose meter at 21-22 degrees C, room temperatures, 26-27 degrees C and 33-34 degrees C. Glucose meter readings at each temperature were compared with the reference values and evaluated by analysis of variance, Spearman's correlation, the percentage of glucose meter readings within +/- 10% of the reference value and error grid analysis. Analysis of covariance was used to determine the effect of temperature on glucose meter readings. There were no significant differences in the glucose meter readings and in accuracy of the meter readings between different temperatures. Temperature was not a significant independent determinant of the glucose meter readings. For each glucose concentration, the precision of the meter and clinical performance were comparable between the different temperatures. In conclusion, ambient temperature does not affect the accuracy, precision and clinical performance of the Omnitest Sensor.

Effect of culturally appropriate health education on glycaemic control and knowledge of diabetes in British Pakistani women with type 2 diabetes mellitus

Type 2 diabetes is a growing problem in people of South Asian origin. It is associated with severe complications if it is not adequately controlled. This paper is a secondary assessment of 105 British Pakistani women within a larger randomized controlled trial of 200 Pakistani patients with diabetes. The trial used one-to-one structured diabetes health education, delivered by a linkworker with pictorial flashcards as a visual aid. Earlier published results from this study have shown that the women in the study knew less about diabetes and had poorer glycaemic control than men, which is why this assessment was performed to see what happened to them when they received appropriate health education. All patients were assessed before and 6 months after intervention by questionnaire and haemoglobin A1c blood tests to measure their overall blood sugar control. Nearly everyone improved their knowledge scores after 6 months in the intervention group, with women showing a catch-up improvement such that they equalled men. Multiple regression analysis found that glycaemic control improved in women receiving health education. Although this method of health education improved knowledge and glycaemic control in women in this sample, illiterate women did not do as well as their literate peers, continuing to score less on knowledge parameters. They also did not show an improvement in glycaemic control. Further work is needed to discover methods that will reach this sizeable subsection of the community.

Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes

OBJECTIVE

The aim of the study was to investigate the relationship between blood glucose level, measured as HbA(1c), and frequency of self-monitoring in patients with type 2 diabetes. Daily self-monitoring is believed to be important for patients treated with insulin or oral agents to detect asymptomatic hypoglycemia and to guide patient and provider behavior toward reaching blood glucose goals.

RESEARCH DESIGN AND METHODS

A national sample of patients with type 2 diabetes was studied in the third National Health and Nutrition Examination Survey. Data on therapy for diabetes, frequency of self-monitoring of blood glucose, and HbA(1c) values were obtained by structured questionnaires and by clinical and laboratory assessments.

RESULTS

According to the data, 29% of patients treated with insulin, 65% treated with oral agents, and 80% treated with diet alone had never monitored their blood glucose or monitored it less than once per month. Self-monitoring at least once per day was practiced by 39% of those taking insulin and 5-6% of those treated with oral agents or diet alone. For all patients combined, the proportion of patients who tested their blood glucose increased with an increasing HbA(1c) value. However, when examined by diabetes therapy category, there was little relationship between HbA(1c) value and the proportion testing at least once per day or the proportion testing at least once per week.

CONCLUSIONS

In this cross-sectional study of patients with type 2 diabetes, the increase in frequency of self-monitoring of blood glucose with increasing HbA(1c) value was associated with the higher proportion of insulin-treated patients in higher HbA(1c) categories. Within diabetes therapy categories, the frequency of self-monitoring was not related to glycemic control, as measured by HbA(1c) level.

Cost-effectiveness analysis of intensive blood-glucose control with metformin in overweight patients with type II diabetes (UKPDS No. 51)

AIMS/HYPOTHESIS

To estimate the economic efficiency of intensive blood-glucose control with metformin compared with conventional therapy primarily with diet in overweight patients with Type II (non-insulin-dependent) diabetes mellitus.

METHODS

Cost-effectiveness analysis based on patient level data from a randomised clinical controlled trial involving 753 overweight (> 120% ideal body weight) patients with newly diagnosed Type II diabetes conducted in 15 hospital-based clinics in England, Scotland and Northern Ireland as part of the UK Prospective Diabetes Study. Subjects were allocated at random to an intensive blood-glucose control policy with metformin (n = 342) or a conventional policy primarily with diet (n = 411). The analysis was based on the cost of health care resources associated with metformin and conventional therapy and the estimated effectiveness in terms of life expectancy gained from within-trial effects.

RESULTS

Intensive blood-glucose control with metformin produced a net saving of 258 Pounds per patient (1997 United Kingdom prices) over the trial period (median duration of 10.7 years) due to lower complication costs, and increased life expectancy by 0.4 years (costs and benefits discounted at 6%).

CONCLUSIONS/INTERPRETATION

As metformin is both cost-saving in the United Kingdom and extends life expectancy when used as first line pharmacological therapy in overweight Type II diabetic patients, its use should be attractive to clinicians and health care managers alike.

[Cost-effectiveness analysis of self-monitoring of blood glucose in type 2 diabetics]

OBJECTIVE

Compare the cost-effectiveness of self-monitoring of blood glucose (MBG) with your non-use.

DESIGN

Descriptive and retrospective study covering the period 1995-97 in the 597 type-2 diabetes patients: 286 practicing MBG on a stable basis and 311 not doing so. All are registered in seven health districts in the territorial ambit of Tortosa Primary Care. Were quantified the direct costs in relation to consumption of reagent strips for the practice of MBG, outpatients visits in your primary care center, derivations to specialist of reference and complementary test according to recommendations of the European NIDDM Policy Group in the population user of MBG and no-user; the annual cost increment, the average annual cost and the total annual cost in the population user of MBG and in the application of a ideal model of quantitative and qualitative cover according to clinical recommendations of the Gedaps; and the cost-effectiveness.

RESULTS

While the 78% of the total diabetic population satisfy some clinical indication for prescribing MBG, only the 42.5% practice the MBG. The consumption of reagent strips rising of 8% to 15% of the global cost of the diabetic population. In the application of the ideal model of cover, this cost increase up the 30% of global cost. The effectiveness obtained, an 27%, not are significantly different in the population user of MBG and no user. The cost-effectiveness in the user of MBG increased of 210.789 ptes/year to 213.148 ptes/year; and no-user of 162.019 ptes/year to 162.051 ptes/year. The application of ideal model of cover and the gain of an effectiveness near to possible level of efficiency imply an descent average of cost-effectiveness of approximately 60%: 78.904 ptes/year in user MBG and 54.682 ptes/year in no-user.

CONCLUSIONS

1. We choose in the presents conditions the option of no-user MBG. 2. The average cost-effectiveness per diabetic patient will increase by the needs of accommodate the therapy to new standards of metabolic control. 3. Are clear opportunity for the improve the management and to motivate an efficient use of technology associate to defects of public sanitary market. 4. The model of ideal cover associated to greater effectiveness are necessary for to unify the economic and clinic efficiency.

Levels of diabetes-related preventive-care practices--United States, 1997-1999

Persons with diabetes are at increased risk for serious complications (e.g., blindness, kidney failure, nontraumatic lower-extremity amputations, and cardiovascular disease) (1). Preventive-care practices, such as annual dilated eye and foot examinations, self-monitoring of blood glucose, and glycemic control, are effective in reducing both the incidence and progression of diabetes-specific complications (2-6). Despite the benefits of preventive-care practices, many persons with diabetes in the United States do not receive these services (7). The national health objectives for 2010 include increasing the proportion of persons with diabetes who 1) have an annual dilated eye examination to 75%, 2) have an annual foot examination to 75%, 3) perform self-monitoring of their blood glucose (SMBG) at least once daily to 60%, and 4) have a glycosylated hemoglobin (HbA1C) measurement at least once a year to 50%. To measure levels of preventive-care practices, CDC analyzed data from the 1997-1999 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that levels of preventive-care practices among persons with diabetes are lower than the national health objectives for 2010 (Figure 1).

Bayesian analysis of blood glucose time series from diabetes home monitoring

This paper describes the application of a novel Bayesian estimation technique to extract the structural components, i.e., trend and daily patterns, from blood glucose level time series coming from home monitoring of insulin dependent diabetes mellitus patients. The problem is formulated through a set of stochastic equations, and is solved in a Bayesian framework by using a Markov chain Monte Carlo technique. The potential of the method is illustrated by analyzing data coming from the home monitoring of a 14-year old male patient.

Blood glucose monitoring skills in children with Type I diabetes

While blood glucose monitoring has become increasingly important in diabetes care, studies have yet to address the accuracy of youngsters' performance of blood glucose testing with current reflectance meters. The present study examined testing skills and predictors of accurate testing skills in a sample of 7-14-year-old children attending a summer camp for youth with diabetes (n=266). A 15-item behavior observational skill test was used to assess accuracy of blood glucose monitoring skills with reflectance meters. Accurate performance of individual skills ranged between 14.6% and 99.6% for the sample. However, a number of children made critical errors (errors that were likely to lead to inaccurate blood glucose testing results). When duration of diabetes and metabolic control were controlled, female gender, older age, experience with a particular meter, and absence of hypoglycemia at the time of testing were positively associated with accurate skill performance. Findings suggest that younger children, children using a new blood glucose testing meter, and children suspected of having hypoglycemia should be supervised and observed when testing. Although all young children should be supervised when blood glucose testing, boys may need closer supervision until an older age than girls. This study underscores the need for health care providers to periodically observe children's blood glucose monitoring techniques to assure accurate testing habits and to correct problematic testing behaviors.

[Blood glucose self-monitoring (BGSM): an evaluation of its prescription and results in type-2 diabetes. The Research Group in Primary Care of Tortosa]

OBJECTIVES

To investigate the results of metabolic control among type-2 diabetics who practise self-monitoring of their blood glucose (MBG) and compare them with those who do not; the adequacy of MBG prescription according to clinical criteria and frequency of use; and to analyse the presence of factors predicting metabolic control.

DESIGN

Descriptive and retrospective study covering 1995, 1996 and 1997.

SETTING

The seven health districts in the territorial ambit of Tortosa Primary Care.

PATIENTS

597 type-2 diabetes patients were evaluated: 286 practising MBG, and 311 not doing so. All of them belonged to the health districts reference population. The sample was systematized and stratified by health districts in order to obtain data through a pre-designed data collection form.

MEASUREMENTS AND MAIN RESULTS

41.06% of diabetics practised MBG on a stable basis, without any significant differences showing in either HbA1c percentage, in any of the biological variables defining metabolic control in relation to the practice or otherwise of MBG, or in its frequency. An inverse relationship (p = 0.012) between the frequency of MBG and age was shown. Some clinical indication for prescribing MBG existed in 78.22% of the total diabetic population. In the diabetic population using MBG, inappropriate use of quantity was 54.89% (84.07% by too little, 15.92% in excess). Only 37.9% displayed quantitative and qualitative concordance simultaneously. The logistic model applied to the total diabetic population predicted 73.19% metabolic control with the variables of BMI (OR = 1.0542). Karnofsky index (OR = 0.9768) and presence of macroangiopathy (OR = 0.4249).

CONCLUSIONS

1. The practice of MBG is questionable, since the effectiveness found was not superior. 2. There is an imbalance between the real practice of MBG according to the clinical recommendations and consumption, which tends to be deficient. 3. The results do not seem to depend so much on MBG practice as on other linked circumstances which cannot be modified by MBG practice.

Changing the face of diabetes education and case management

Diabetes education can only work if it applies to the person's daily life. That's the premise behind two new programs that are taking education and case management services into the community, and finding a receptive audience.

[The self-measurement of blood glucose and mean glycemias in patients with diabetes mellitus]

OBJECTIVE

To assess the influence that self-measurement of capillary blood glucose (SMBG) has on glucaemia control in patients with diabetes mellitus.

DESIGN

Quasi-experimental before and after study.

SETTING

Semi-urban health centre.

PATIENTS

All diabetic patients, with at least two years of evolution, who used reactive strips for SMBG in 1996.

MEASUREMENTS AND MAIN RESULTS

Mean values of base glucaemia in the SMBG study year were compared with those of the year before in 85 patients, 33 men and 52 women, with average age 62.38. Thirteen were type 1 and 72 type 2 diabetics, with a mean 15.61 years of evolution of the disease. A drop of -11.47 mg/dl (SD 44.32) was observed, which was significant (p < 0.05, CI 95%) in the overall results. In all the subgroups, except those treated with non-pharmacological measures, there were drops, ranging between -2.17 mg/dl and -17.01 mg/dl, which were significant in women, in patients with type 2 diabetes, in those who had received health education and in those treated with non-pharmacological measures plus insulin.

CONCLUSIONS

Despite the limitations of this kind of study, our findings point towards a slightly better control of glucaemia levels in diabetic patients after SMBG. It is very doubtful whether it signifies any real improvement in managing the illness.

Clinical and statistical evaluation of self-monitoring blood glucose meters

OBJECTIVE

Our objective was to compare statistical and clinical methods for the evaluation of five self-monitoring blood glucose (SMBG) meters.

RESEARCH DESIGN AND METHODS

Two successive capillary blood glucose measurements were performed, and a simultaneous laboratory venous glucose measurement was used as the reference value. Accuracy was studied by comparing each of the two successive meter values with the reference value by 1) a Spearman's correlation test, 2) a Wilcoxon's paired test, 3) the percentage of values within the 10% interval of the reference value according to the American Diabetes Association consensus statement, and 4) the error grid analysis.

RESULTS

The first two methods did not discriminate between the SMBG systems: r was >0.92 for the five meters, and a significant difference between the meter and reference values was found for all but one meter. The two other methods allowed classification of the devices into three groups according to their accuracy: good (two meters), acceptable (two meters), and unacceptable (one meter). These two methods gave consistent results and both had a good reproducibility, because the classification was similar for the two successive measurements.

CONCLUSIONS

Both the Spearman's and Wilcoxon's paired tests, although commonly used, are inappropriate to evaluate SMBG systems. The percentage of SMBG values within the +/-10% interval and the error grid analysis are more accurate, because they consistently classified the five glucose meters tested in our study with a high degree of reproducibility.

Assessment of risk for severe hypoglycemia among adults with IDDM: validation of the low blood glucose index

OBJECTIVE

To evaluate the clinical/research utility of the low blood glucose index (LBGI), a measure of the risk of severe hypoglycemia (SH), based on self-monitoring of blood glucose (SMBG).

RESEARCH DESIGN AND METHODS

There were 96 adults with IDDM (mean age 35+/-8 years, duration of diabetes 16+/-10 years, HbA1 8.6+/-1.8%), 43 of whom had a recent history of SH (53 did not), who used memory meters for 135+/-53 SMBG readings over a month, and then for the next 6 months recorded occurrence of SH. The SMBG data were mathematically transformed, and an LBGI was computed for each patient.

RESULTS

The two patient groups did not differ with respect to HbA1, insulin units per day, average blood glucose (BG) and BG variability. Patients with history of SH demonstrated a higher LBGI (P < 0.0005) and a trend to be older with longer diabetes duration. Analysis of odds for future SH classified patients into low- (LBGI <2.5), moderate- (LBGI 2.5-5), and high- (LBGI >5) risk groups. Over the following 6 months low-, moderate-, and high-risk patients reported 0.4, 2.3, and 5.2 SH episodes, respectively (P = 0.001). The frequency of future SH was predicted by the LBGI and history of SH (R2 = 40%), while HbA1, age, duration of diabetes, and BG variability were not significant predictors.

CONCLUSIONS

LBGI provides an accurate assessment of risk of SH. In the traditional relationship history of SH-to-future SH, LBGI may be the missing link that reflects present risk. Because it is based on SMBG records automatically stored by many reflectance meters, the LBGI is an effective and clinically useful on-line indicator for SH risk.

Evaluation of Glucocard Memory 2 and Accutrend sensor blood glucose meters

The performance and practicability of 2 blood glucose meters (Glucocard Memory 2 and Accutrend sensor) were evaluated. Both glucose meters produced acceptably precise results in the hyper- and normoglycaemic concentration ranges. In the hypoglycaemic concentration range, the imprecision of Accutrend sensor was much higher than recommended by the American Diabetes Association. Within-run coefficients of variation for Glucocard Memory 2 were 6.3%, 3.9% and 2.4% at glucose concentrations of 1.7 mmol/l, 5.8 mmol/l and 11.7 mmol/l, respectively: for Accutrend sensor these were 15.2%, 5.0% and 1.2% at respective concentrations of 0.9 mmol/l, 4.2 mmol/l and 19.6 mmol/l. Between-day coefficients of variation for Glucocard Memory 2 were 4.8% and 3.5% at glucose concentrations of 3.9 mmol/l and 17.2 mmol/l, respectively and for Accutrend sensor they were 3.8% and 2.9% at glucose concentrations of 3.8 mmol/l and 18.7 mmol/l, respectively. Results were linear over a range of 1.6 mmol/l -29.7 mmol/l for Glucocard Memory 2 and 1.6 mmol/l -33.3 mmol/l for Accutrend sensor. Results of both blood glucose meters correlated closely with the hexokinase/glucose-6-phosphate dehydrogenase laboratory method. Ninety-eight percent of both Glucocard Memory 2 and Accutrend sensor results were within 20% of the comparison method values. Ninety-three percent of the Glucocard Memory 2 and 96% of the Accutrend sensor results were within 15% of the comparison method results. An inverse relation between the glucose readings and haematocrit values was observed for both blood glucose meters in the hyperglycaemic range and this effect was more pronounced for Accutrend sensor. In the normo- and hypoglycaemic ranges the effect was insignificant and absent, respectively. Minimum sample volume for Glucocard Memory 2 was 3 microliters and for Accutrend sensor it was 9 microliters. Lower sample volumes gave erroneous results. Presenting more than the required volume had no effect on results.

Reduced frequency of severe hypoglycemia and coma in well-controlled IDDM patients treated with insulin lispro. The Benelux-UK Insulin Lispro Study Group

OBJECTIVE

Several studies have suggested that use of the short-acting insulin analog, insulin lispro, in multiple injection therapy may reduce the risk of hypoglycemia in comparison with regular insulin. This effect might be more pronounced in well-controlled patients, since intensive treatment of IDDM increases the rate of severe hypoglycemic events. This study evaluated the effects of insulin lispro on glycemic control and hypoglycemia rates in well-controlled IDDM patients.

RESEARCH DESIGN AND METHODS

This was an open, randomized, 6-month crossover study of 199 IDDM patients. Glycemic control was evaluated by HbA1c, home blood glucose measurements, and rate and timing of hypoglycemic events. At the end of the study, patients completed an evaluation form regarding therapy-related quality of life.

RESULTS

HbA1c remained constant at approximately 7.3% throughout the study. Meal-related glucose excursions were significantly lower with insulin lispro compared with regular insulin (mean -0.8 +/- 1.7 vs. 1.1 +/- 1.6 mmol/l, P < 0.001), as was the within-day variability (M value 27.7 +/- 19.7 vs. 30.2 +/- 23.1, P = 0.007). The incidence of severe hypoglycemic events (58 vs. 36, P = 0.037) including coma (16 vs. 3, P = 0.004) was significantly lower with insulin lispro than with regular insulin. Patients felt that insulin lispro increased flexibility and freedom of lifestyle.

CONCLUSIONS

In well-controlled IDDM patients, insulin lispro is associated with a lower risk of severe hypoglycemia and coma.

Measurement of glucose consumption by hybridoma cells growing in hollow fiber cartridge bioreactors: use of blood glucose self-monitoring devices

Two different types of blood glucose self-monitoring device, designed for use by diabetics (Accu-Chek Advantage* and Accu-Chek III*), were evaluated for the purpose of monitoring glucose concentration in tissue culture media. The Accu-Chek Advantage* meter was found to systematically overestimate the glucose concentration in a variety of commonly used tissue culture media by 50-90%, in comparison with their formulated glucose concentration. The Accu-Chek III* meter reliably estimated glucose concentrations from 100 to 300 mg/dl and overestimated glucose concentrations above 300 mg/dl. The systematic overestimation of glucose concentration in tissue culture fluids by the Accu-Chek Advantage* meter was further investigated. A standard curve was constructed and the meter reading was found to be linearly related to the actual glucose concentration and the best linear fit was given by the formula y = -43.504 + 1.9246x, where y is the meter reading and x is the actual glucose concentration. Rearranging the equation to make x the subject gave the following algorithm x = (y + 43.504) divided by 1.9246 which could be used to correct the 'raw' meter reading. The mean corrected glucose concentrations deviated from the formulated glucose concentration by less than 3.5% in five media tested, indicating that this meter is more than adequate for monitoring glucose consumption by cells growing in hollow fiber cartridge bioreactors, when used in conjunction with this correction factor.

Patient and physician perspectives regarding treatment of diabetes: compliance with practice guidelines

BACKGROUND

Managed care organizations are focusing on how physicians manage their patients with diabetes mellitus as an indicator of physician compliance with clinical practice guidelines. Assessment of physician compliance with published guidelines may reveal areas of disagreement between physicians and guidelines or between physicians and patients and may show areas for potential improvement of care. Compliance with the diabetes care guidelines was assessed in our clinics to determine physician beliefs and performance and patients' accommodation of recommended practices.

METHODS

We interviewed 295 patients with diabetes and surveyed 47 providers at an academic family practice center to assess practices and beliefs regarding the care of patients with diabetes. We also reviewed a 1-year compilation of billing and referral records for physician use of glycosylated hemoglobin (hemoglobin A1c) testing and referral of patients for eye examinations.

RESULTS

We found that physician beliefs and practices were divergent and that provider performance of these nationally recommended activities was low. More than 75% of providers said that they recommended hemoglobin A1c testing, but only about 50% of patients had a documented test in the billing system. When questioned, one third of the patients reported that their physicians recommended this test. Similarly, nearly all physicians stated that they recommended annual eye examinations, although only 43% of patients said that their primary care physician recommended this referral.

CONCLUSIONS

Physicians can and must improve intervention and patient education in the care of diabetic patients. Patient knowledge, motivation, and practice must be augmented by physician efforts. Lack of compliance with guidelines may indicate deficiencies in physician knowledge, implementation problems, lack of belief in guidelines, or problems in patient compliance. Attention should be directed to all these areas.

Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus

OBJECTIVES

The goal of this study was to identify parental behaviors that relate to adherence and metabolic control in a population of young adolescents with insulin-dependent diabetes mellitus (IDDM), and to understand the interrelationships among the variables of parental involvement, adherence to blood glucose monitoring, and glycemic control.

STUDY DESIGN

A cross-sectional design was used to investigate parental involvement in diabetes regimen tasks in 89 youth, aged 10 to 15 years, with IDDM. Levels of parental involvement in blood glucose monitoring (BGM) and insulin administration were evaluated through interviews. Assessment of adherence was made by physicians or nurses, independent of patient or parent reports of adherence. Glycemic control was assessed with glycosylated hemoglobin (HbA1c) (reference range, 4% to 6%).

RESULTS

There were significant differences in the mean HbA1c values between the older (13 to 15 years of age) (HbA1c = 8.9% +/- 1.03%) and younger (10 to 12 years) patients (HbA1c = 8.4% +/- 1.06%) (p < 0.02). Parental involvement in BGM was significantly related to adherence to BGM (number of blood sugar concentrations checked daily) in both groups of adolescent patients. The younger patients monitored their blood glucose levels more frequently than did the older patients, 39% of the younger patients checked sugar concentrations four or more times daily compared with only 10% of the older group (p < 0.007). In a multivariate model controlling for age, gender, Tanner staging, and duration of diabetes, the frequency of BGM was a significant predictor of glycemic control (R2 = 0.19, p < 0.02). Increased frequency of BGM was associated with lower HbA1c levels. When the frequency of BGM was zero or once a day, the mean HbA1c level was 9.9% +/- 0.44 (SE); when the frequency of BGM was two or three times a day, the mean HbA1c level was 8.7% +/- 0.17; and when the frequency of BGM was four or more times daily, the mean HbA1c level was 8.3% +/- 0.22.

CONCLUSIONS

Parental involvement in BGM supports more frequent BGM in 10- to 15-year-old patients with IDDM. This increased adherence to BGM is associated with better metabolic control (i.e., lower HbA1c levels). These findings suggest that encouraging parental involvement in BGM with 10- to 15-year-old patients with IDDM may help to prevent the well-documented deterioration in glycemic control and adherence to treatment that often occurs in later adolescence.

Ambulatory medical care for non-Hispanic whites, African-Americans, and Mexican-Americans with NIDDM in the U.S

OBJECTIVE

To assess whether medical care for diabetes is different among non-Hispanic whites, African-Americans, and Mexican-Americans with NIDDM.

RESEARCH DESIGN AND METHODS

A questionnaire was administered to a representative U.S. sample of 2,170 noninstitutionalized adults with NIDDM. Information was obtained on physician visits, hyperglycemic therapy, monitoring of glycemic control, screening for and monitoring of complications, and diabetes education.

RESULTS

About 90% of subjects had a regular diabetes physician, and the physician visit rate was similar by race (median of four visits per year). African-Americans were more likely to be treated with insulin (51.9%) than non-Hispanic whites (35.9%, P < 0.0001) and Mexican-Americans (46.2%). Among insulin-treated subjects, African-Americans were less likely to use multiple daily insulin injections (35.1 vs. 53.8% of non-Hispanic whites [P < 0.0001] and 50.5% of Mexican-Americans [P = 0.027]) and were less likely to self-monitor their blood glucose at least once per day (14.0 vs. 29.8% of non-Hispanic whites [P < 0.0001] and 29.0% of Mexican-Americans). The rates of visits to specialists for diabetes complications, physician testing of blood glucose, and screening for hypertension, retinopathy, and foot problems were not substantially different among the three race/ethnic groups. A higher proportion of African-Americans (43.3%) than non-Hispanic whites (31.5%, P < 0.0001) and Mexican-Americans (25.6%, P = 0.001) had received patient education; however, the median number of hours of instruction was lower for African-Americans.

CONCLUSIONS

The frequency of diabetes care is similar among non-Hispanic whites, African-Americans, and Mexican-Americans. The major differences relate to methods of glycemic control and patient education.

Ethnic differences in diabetes care in a multiethnic community in New Zealand

Residents of two districts of South Auckland, New Zealand with a high proportion of Maori and Pacific Islands people were visited door to door to ascertain the prevalence of known diabetes and its tissue damage. The household survey canvassed 55,518 residents in 12,770 (91%) of 14,002 residences. Diabetes interviews were available for 176,214 (82%) Europeans, 286,336 (85%) Maori and 495,585 (85%) Pacific Islands diabetic patients. Europeans were older than Maori and Pacific Islands patients currently and at diagnosis. When compared with Europeans, Maori and Pacific Islands patients had a higher chance of having had their diabetes diagnosed in pregnancy, were least likely to be receiving antihypertensive or insulin therapy, were more likely to be blind, and were more likely to have received retinal photocoagulation. There were no ethnic differences in either the proportion of those receiving no ongoing care or in the proportion seen at least once by the diabetes services. Maori people were most likely to be current smokers, were most likely to have defaulted from the diabetic diet and to be dissatisfied with the diabetes service. Pacific Islands people were least likely to have neuropathic symptoms in their feet or to report a known myocardial infarction. Significant ethnic differences in diabetes and its care exist in South Auckland.

Structural time series models in medicine

Structural time series models are formulated in terms of components, such as trends, seasonals and cycles, which have a direct interpretation. This article describes such models and gives examples of how they can be applied in medicine. Univariate models are considered first, and then extended to include explanatory variables and interventions. Multivariate models are then shown to provide a framework for modelling longitudinal data and for carrying out intervention analysis with control groups. The final sections deal with data irregularities and non-Gaussian observations.

Diabetes care by primary care physicians in Minnesota and Wisconsin

BACKGROUND

The purpose of this study was to identify the characteristics of diabetes care delivered by primary care physicians.

METHODS

Twenty-seven primary care physicians recruited through the Minnesota Academy of Family Physicians Research Network and the Wisconsin Research Network recorded a sample of 240 visits for care of patients with diabetes mellitus. Information was collected concerning physician and patient demographics, practice characteristics, and patterns of delivery of diabetes care including referral and clinical outcomes.

RESULTS

Seventeen percent of the patients in this study had type I diabetes mellitus; 81% had type II. Fourteen percent of the patients with type I diabetes and 20% of patients with type II were within their target glucose range. Average hemoglobin-A1c was 10.0% +/- 3.4% and 8.9% +/- 2.3% for patients with type I and type II diabetes, respectively (normal, 4.0% to 6.1%). Two distinct patterns of referral existed for patients with newly diagnosed type I diabetes: 44% of physicians rarely referred these patients, whereas 20% almost always referred. Although distance to specialists increased as community size decreased, frequency of referral was not related to practice location. Ninety-five percent of physicians in this study were directly involved in the diabetes education of their patients, and 56% had no certified diabetes educator available.

CONCLUSIONS

Over the course of this study, patients frequently persisted with treatment regimens that failed to stabilize blood glucose values. With recent evidence that improved glucose control may delay or prevent diabetes complications, it is increasingly important for the primary care physician to optimize available resources to improve glucose control in patients with diabetes in an effort to improve long-term clinical outcomes.

[Drug consumption in diabetes mellitus (IV). The utilization of reactive material and systems for assessing blood glucose control from the viewpoint of primary care. The Group for the Study of Diabetes in Tarragona (GEDT)]

BACKGROUND

A study was performed to analyze the use of reactive material in the periodic follow up of diabetes. Likewise, the use of systems to assess glycemic control by primary care physicians was investigated.

METHODS

Analysis of the habits of use of reactive material was performed on the diabetic population of Tarragona (548,900 inhabitants) by randomized survey of prescription in 525 patients attended in 12 primary care centers. The estimation of amount was carried out by a counting of the public prescriptions made. Similarly the periodicity and the results of the applications of glucoproteins in the reference laboratories were studied.

RESULTS

A total of 253 diabetics (48%) were exclusively attended in the centers and 272 (52%) performed some type of home self-analysis; 26 (5%) in urine samples, and 246 (47%) in capillary blood. The estimated mean consumption was of 14 blood sugar strips per patient per month (168 strips/year) and 2.7 glucosuria-glucocetonuria strips (32.4 strips/year). The relative urine/blood ratio was 1/5.2. In 343 cases (65%) some glucoprotein measurement was reported within the last year, 330 (63%) corresponding to glucohemoglobin A1. The mean value was 8.3% (normal: 5-8%). The mean number of applications was 1.6 applications per patient per year.

CONCLUSIONS

An enormous increase was observed in the amount consumed at the province of reactive material in blood and in the measurement of glucoproteins as the system to assess carbohydrate control in diabetes. A significant reduction was found in the use of reactive strips in urine by the diabetic population.

[Are blood glucose controls performed with portable dosimeters valid? A comparison of the reliability and validity of 3 commonly used models]

OBJECTIVE

To evaluate and compare the reliability and validity for both normal and high glycaemia values of three models of glycaemia self-analysers: Reflolux, Glucocard and One Touch.

DESIGN

Descriptive and crossover study. Validation of a measuring appliance through its comparison with a standard appliance.

PARTICIPANTS

The sample was composed of 90 blood specimens chosen by suitability sampling.

MEASUREMENTS AND MAIN RESULTS

The glycaemia in the specimens was measured simultaneously by each one of the self-analysers and the central laboratory. There was high reliability (reproducibility) among the self-analysers, with correlation coefficients of 0.98, 0.97 and 0.98, with no statistically significant differences. As to intra-instrument reliability (repeatability), tested by analysing the variances of the differences, no statistically significant differences were found, except in the Glucocard self-analyser which lost precision at high glycaemia levels. Validity or accuracy, measured by the method of taking the average of the differences, showed a systematic bias in the Reflolux model, which had a value of 22.3 mg/dl above the reference model, and in the One Touch of -16.3 mg/dl. The Glucocard was the most accurate with a value of -1.78 mg/dl.

CONCLUSIONS

Portable glycaemia dosimeters are very useful in following up diabetic patients because of their high reliability, but are not useful in the diagnosis of diabetes because of their lack of accuracy. Before beginning to use a portable dosimeter, its characteristics in terms of reliability and validity must be known, in order to evaluate correctly its findings.