Hypoglycemia in Diabetes: Challenges and Opportunities in Care

Knowledge and Experience of Community Health Volunteer (Cadre) on Type 2 Diabetes Mellitus Management in Yogyakarta

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease that requires long-term and comprehensive management. People with T2DM play a significant role in managing their condition and day-to-day life adjustment related to T2DM. In the Indonesian context, community health volunteers (cadres) roles are imperative because the community can influence day-to-day health care. AIM: The study aimed to describe the knowledge and experience of cadre on T2DM management in Yogyakarta, Indonesia. METHODS: It was a descriptive study with a cross-sectional approach. Five primary health-care center (Puskesmas) areas in Bantul district were selected based on their high population, including Kasihan 2, Jetis 1, Sedayu 1, Jetis 2, and Imogiri 2 areas. Sixty-eight cadres from those five areas were enrolled in this study through accidental sampling. The data were collected using questionnaires and analyzed using descriptive statistics. RESULTS: The results showed that the average age of cadres was 43 years old (20–64 years), with more than half of them graduating from high school, unemployed (61.8%), and never received education about DM and its management (51.5%). Forty-two cadres (61.8%) had a moderate level of knowledge, and 64.7% had inadequate experience in T2DM management. CONCLUSION: Knowledge and experience of cadre regarding T2DM management in Yogyakarta need to be increased. Further research is needed to examine certain training programs’ effects to improve cadre’s knowledge and experience in T2DM.

A flexible enzyme-electrode sensor with cylindrical working electrode modified with a 3D nanostructure for implantable continuous glucose monitoring

A novel cylindrical flexible enzyme-electrode sensor was fabricated with a bigger working electrode (WE) surface than the traditional pin-like one for implantable continuous glucose monitoring. On the WE surface, a 3D nanostructure consisting of graphene and platinum nanoparticles was constructed to enhance the sensitivity; in conjunction with the bigger WE, this nanostructure enabled hypoglycemia detection, which is still a big challenge in clinics. The cylindrical sensor was fabricated by rotated inkjet printing which enabled direct patterning of microstructures on a curved surface, thus overcoming the restriction of the traditional planar micromachining by photolithography. Specifically, the cylindrical substrate (polyetheretherketone, PEEK) was modified by (3-aminopropyl) trimethoxysilane and (3-mercaptopropyl) trimethoxysilane to facilitate surface wettability, which discourages the coalescence of adjacent droplets, and to facilitate the adhesion of metals to PEEK in order to construct robust electrodes. A synchronous heating method was used to evaporate the solvent of the droplets quickly to prevent them from running along the cylindrical surface, which affects the formation of the printed electrode significantly. In vitro experimental results showed that the proposed sensor was able to detect the glucose concentration ranging from 0 to 570 mg dL^-1 which demonstrated its capability for physiological glucose detection. In vivo experiments were conducted with rats, and the measurement results recorded using the implanted cylindrical sensor showed great compliance to those recorded using a commercial glucometer which exhibited the viability of the proposed sensor for implantable continuous glucose monitoring, even under the hypoglycemic conditions.

Practical Approaches to Diagnosing, Treating and Preventing Hypoglycemia in Diabetes

Hypoglycemia in individuals with diabetes can increase the risk of morbidity and all-cause mortality in this patient group, particularly in the context of cardiovascular impairment, and can significantly decrease the quality of life. Hypoglycemia can present one of the most difficult aspects of diabetes management from both a patient and healthcare provider perspective. Strategies used to reduce the risk of hypoglycemia include individualizing glucose targets, selecting the appropriate medication, modifying diet and lifestyle and applying diabetes technology. Using a patient-centered care approach, the provider should work in partnership with the patient and family to prevent hypoglycemia through evidence-based management of the disease and appropriate education.