Self-monitoring of blood glucose in association with glycemic control in newly diagnosed non-insulin-treated diabetes patients: a retrospective cohort study

Comparison of laser and traditional lancing devices for capillary blood sampling in patients with diabetes mellitus and high bleeding risk

PURPOSE

Despite the importance of self-monitoring blood glucose (SMBG) for management of diabetes mellitus (DM), frequent blood sampling is discouraged by bleeding risk due to dual-antiplatelet agent therapy (DAPT) or thrombocytopenia.

METHODS

We compared the bleeding time (BT) of sampling by using a laser-lancing-device (LMT-1000) and a conventional lancet in patients with DM and thrombocytopenia or patients undergoing DAPT. BT was measured using the Duke method, and pain and satisfaction scores were assessed using numeric rating scale (NRS) and visual analog scale (VAS). The consistency in the values of glucose and glycated-hemoglobin (HbA1c) sampled using the LMT-1000 or lancet were compared.

RESULTS

The BT of sampling with the LMT-1000 was shorter than that with the lancet in patients with thrombocytopenia (60s vs. 85s, P = 0.024). The NRS was lower and the VAS was higher in laser-applied-sampling than lancet-applied sampling in the DAPT-user group (NRS: 1 vs. 2, P = 0.010; VAS: 7 vs. 6, P = 0.003), whereas the group with thrombocytopenia only showed improvement in the VAS score (8 vs. 7, P = 0.049). Glucose and HbA1c sampled by the LMT-1000 and lancet were significantly correlated in both the DAPT-user and the thrombocytopenia groups.

CONCLUSION

The LMT-1000 can promote SMBG by shortening BT in subject with thrombocytopenia and by increasing satisfaction score, as well as by showing reliable glucose and HbA1c value.

Adherence to Self-Monitoring of Blood Glucose and Its Related Factors Among Type 2 Diabetic Patients Attending Al-Ahsa Primary Health Care Centers in Saudi Arabia

BACKGROUND

Self-monitoring of blood glucose (SMBG) is a crucial component of diabetes management, but adherence remains suboptimal. This study aimed to evaluate adherence to SMBG among type 2 diabetic patients in Al-Ahsa, Saudi Arabia.

METHODS

A cross-sectional study was conducted among 398 type 2 diabetic patients attending primary healthcare centers. Data were collected through face-to-face or virtual interviews and electronic health records. Adherence levels were categorized as low, moderate, and high.

RESULTS

The majority of participants exhibited moderate adherence to SMBG (58.5%), while 27.1% had low adherence, and 14.3% were highly adherent. The use of oral hypoglycemic medications and insulin injections was associated with higher adherence (p<0.001). Comorbidities, physical exercise, diet, frequency of medical visits, and attendance at diabetes education sessions did not significantly influence adherence.

CONCLUSIONS

Suboptimal adherence to SMBG was observed among type 2 diabetic patients in Al-Ahsa. Targeted interventions addressing individual barriers and integrating technology may improve SMBG adherence and diabetes management.

The efficacy of self-monitoring of blood glucose (SMBG) intervention package through a subscription model among type-2 diabetes mellitus in Malaysia: a preliminary trial

BACKGROUND

The aim of this study was to determine the effect of a Self-Monitoring Blood Glucose (SMBG) intervention package through a subscription model in improving HbA1c and health parameters among type-2 diabetes mellitus (T2DM) individuals in Malaysia.

METHODS

This is a quasi-experimental study involving a total number of 111 individuals with T2DM (mean age 57.0 ± 11.7 years, 61% men) who were assigned to intervention (n = 51) and control (n = 60) groups. The intervention group participants were the subscribers of SugO365 program which provided a personalized care service based on self-recorded blood glucose values. Subscribers received a Contour® Plus One glucometer which can connect to Health2Sync mobile app to capture all blood glucose readings as well as physical and virtual follow up with dietitians, nutritionists, and pharmacists for 6 months. Outcome measures were body weight, body mass index (BMI), random blood glucose (RBG), glycated haemoglobin (HbA1c) and health-related quality of life (HRQoL, assessed by SF-36 questionnaire). Data were measured at baseline, third and sixth months.

RESULTS

Repeated-measure analysis of covariance showed significant improvement in HbA1c level (ƞp2 = 0.045, p = 0.008) in the intervention (baseline mean 7.7% ± 1.1%; end mean 7.3% ± 1.3%) as compared to control (baseline mean 7.7% ± 0.9%; end mean 8.1% ± 1.6%) group. Similar trend was observed for Role Emotional domain of the quality of life (ƞp2 = 0.047, p = 0.023) in the intervention (baseline mean 62.8 ± 35.1, end mean 86.3 ± 21.3) compared to control (baseline mean group 70.5 ± 33.8; end mean 78.4 ± 27.3) group. Negative association was found in HbA1c changes using Z-score and Physical Function domain (r = - 0.217, p = 0.022).

CONCLUSION

A 6 months SMBG intervention package through a subscription model improved blood glucose control as measured by HbA1c and health-related quality of life, particularly the Role Emotional domain. Elevated HbA1c levels are correlated with decreased physical function.There is a need to further examine the efficacy of SMBG intervention package using a larger sample and a longer period of intervention and to determine its cost efficacy.

Implicit HbA1c Achieving 87% Accuracy within 90 Days in Non-Invasive Fasting Blood Glucose Measurements Using Photoplethysmography

To reduce the error induced by overfitting or underfitting in predicting non-invasive fasting blood glucose (NIBG) levels using photoplethysmography (PPG) data alone, we previously demonstrated that incorporating HbA1c led to a notable 10% improvement in NIBG prediction accuracy (the ratio in zone A of Clarke's error grid). However, this enhancement came at the cost of requiring an additional HbA1c measurement, thus being unfriendly to users. In this study, the enhanced HbA1c NIBG deep learning model (blood glucose level predicted from PPG and HbA1c) was trained with 1494 measurements, and we replaced the HbA1c measurement (explicit HbA1c) with "implicit HbA1c" which is reversely derived from pretested PPG and finger-pricked blood glucose levels. The implicit HbA1c is then evaluated across intervals up to 90 days since the pretest, achieving an impressive 87% accuracy, while the remaining 13% falls near the CEG zone A boundary. The implicit HbA1c approach exhibits a remarkable 16% improvement over the explicit HbA1c method by covering personal correction items automatically. This improvement not only refines the accuracy of the model but also enhances the practicality of the previously proposed model that relied on an HbA1c input. The nonparametric Wilcoxon paired test conducted on the percentage error of implicit and explicit HbA1c prediction results reveals a substantial difference, with a p-value of 2.75 × 10-7.

Blood glucose monitoring devices: current considerations

Measuring blood glucose concentrations via capillary (fingerprick) blood glucose monitoring or continuous (interstitial) glucose monitoring is an important aspect of management for many people with diabetes. Blood glucose monitoring informs patient self-management strategies, which can improve the patient's engagement in their own care and reduce barriers to achieving recommended blood glucose targets. Blood glucose monitoring also informs clinician-guided management plans. Compared to capillary blood glucose monitoring, continuous glucose monitoring in people using insulin significantly improves glycaemic metrics and is associated with improved patient-reported outcomes. Even with good glycaemic metrics, patients using continuous glucose monitoring should still have access to capillary blood glucose monitoring for correlation of hypoglycaemic readings when accuracy may be compromised or if there is a malfunction with the continuous blood glucose monitor.

A hospital-based assessment of glycemic control and medication adherence in type 2 diabetes mellitus in Eastern Nepal

Background

Poor glycemic control in type 2 diabetes mellitus (T2DM) causes damage to various organs and leads to the development of disabling and life-threatening complications.

Objectives

To find out the prevalence of glycemic control and medication adherence (MA) and the factors affecting them.

Methods

A cross-sectional study was conducted among patients with T2DM. The patients were categorized as good glycemic control (HbA1c <7.0%) and poor glycemic control (HbA1c ≥7.0%). MA was categorized as low (score <6), medium (score 6 or 7), and high (score 8). The Statistical Package for Social Science (version 11.5) was used for statistical analysis at a P value less than 0.05.

Results

Of 129 patients, 65 (50.39%) were females. The mean age was 48.33 ± 12.86 years. The combination of metformin and glimepiride was prescribed to 37 (28.68%) patients. Diabetic knowledge was poor in 84 (65.12%) patients. Glycemic control was good in 108 (83.72%) patients. MA was medium in 72 (55.81%) patients. Patients taking regular fruit, having shorter duration of drug therapy, and having good diabetic knowledge had good glycemic control and were statistically significant (P value < 0.05). Patients having family support, nonalcoholic, taking regular fruit, being involved in daily jogging, having shorter duration of drug therapy, and having good diabetic knowledge had high MA and were statistically significant (P value < 0.05).

Conclusion

The majority of the diabetic patients had good glycemic control and medium MA. Patients taking regular fruit, being involved in daily jogging, having a shorter duration of drug therapy, and having good diabetic knowledge were identified as factors that affect both glycemic control and MA.

Risk factors for impaired quality of life in diabetic patients in Tunisia

INTRODUCTION

Quality of life preservation is crucial in the management of chronic diseases, in particular diabetes.

AIM

To identify risk factors for the impaired quality of life of Tunisian diabetic patients.

METHODS

A cross-sectional study that collected type 1 and type 2 diabetic patients, selected by convenience sampling was conducted. Diabetic patients received a self-administered questionnaire in Arabic containing general and clinical data and a validated Arabic version of the "Diabetes Health Profile -18".

RESULTS

Three hundred and thirty-three type 1 and type 2 diabetic patients, whose age was ≥ 40 years in 78.1% of cases with a sex ratio of 0.94, were collected. The answers to the questionnaire highlighted a globally impaired quality of life for the diabetic patients with an average of 30.21 (7.06). Binary regression analysis presented globally significant models reflecting impairment risk factors for diabetic patients' quality of life. Female gender (AOR= 1.7; p= 0.036), comorbidities associated with diabetes (AOR = 1.23; p<10-3), diabetes complications (AOR= 1.45; p=0.041) and irregular medical follow-up (AOR=4.19; p<10-3) were risk factors for impaired diabetic patients' quality of life.

CONCLUSION

This study underlines the major role of a holistic diabetic patient care for better identification and management of risk factors of impaired quality of life.

Association between smoking and glycemic control in men with newly diagnosed type 2 diabetes: a retrospective matched cohort study

BACKGROUND

Longitudinal data on the association between smoking and glycemic control in men with newly diagnosed type 2 diabetes (T2DM) is scarce. Therefore, this study aimed to examine the extent of the association between smoking and glycemic control in this population.

METHODS

The retrospective cohort study identified 3044 eligible men with T2DM in a medical centre in Taiwan between 2002 and 2017. Smokers (n = 757) were matched 1:1 with non-smokers using propensity score-matching. All of them were followed for one year. Glycated haemoglobin (HbA1c) levels were measured at 0, 3, 6, 9, and 12 months after enrolment. Generalised estimating equations were used to assess smoking status-by-time interaction to determine the difference in HbA1c reduction between the two cohorts. All analyses were performed in 2020.

RESULTS

The estimated maximal difference in HbA1c reduction between smokers and non-smokers was 0.33% (95% CI, 0.05-0.62%) at 3 months of follow-up. For patients with body mass index (BMI) <25 kg/m², the difference in HbA1c reduction between smokers and non-smokers was much larger (0.74%, 95% CI, 0.35-1.14%) than in those with a higher BMI.

CONCLUSIONS

Our findings show that smoking was independently associated with unfavourable glycemic control among men with newly diagnosed T2DM, and such a detrimental association could be stronger in men with a lower BMI.

What is holding back glucometer use? -A comparative study of rural and urban India

BACKGROUND

Self-monitoring of blood glucose (SMBG) is associated with better glycemic control. There have been significant technological advances in blood glucose monitoring in the recent past, but the wider acceptance of these technologies is still debatable.

AIM

This study investigates the adoption of glucometers and the extent of the use of features in rural and urban India.

METHODS

The study uses Bass Model to predict the diffusion of innovation (DOI). Mathematical modeling was used to determine the stage of adoption (using 5-stage of DOI) and the Chi-Square test was used for examining the relationship between depth of implementation (extent of use) and place of residence.

RESULTS

The result of the study suggests that glucometer diffusion of innovation has passed the initial hurdle (chasm) in the urban population and is in the late majority. However, for rural respondents, the adoption of glucometers has just passed the chasm and falls under the early majority stage. The diffusion of innovation of combined rural and urban populations has just entered the late majority zone in 2022. The study suggests that a significant number of people with diabetes are still not using a glucometer and discusses the socio-economic issue related to this phenomenon. The utilization of the potential of a glucometer in SMBG falls under the localized shallow implementation category (not using advanced features).

CONCLUSIONS

The study suggests that the adoption of glucometer has just passed the initial hurdle in rural India, where two-thirds of the Indian population lives. Furthermore, the adoption of advanced glucometers is low among users.

The Importance of Patient and Family Engagement, the Needs for Self-Monitoring of Blood Glucose (SMBG) - Our Perspectives Learned Through a Story of SMBG Assistive Devices Made by a Husband of the Patient with Diabetes

Despite some negative reports regarding the need for the self-monitoring of blood glucose (SMBG), including the issue of cost-effectiveness, there are still many users, and in diabetes treatment, which is largely dependent on the patient's self-care, SMBG remains an important tool in establishing such self-care habits, with several reports supporting this notion. In addition, devices are needed to assist in SMBG for patients with diabetes who have difficulty performing SMBG, such as the elderly or those with visual impairment. In current diabetes care, it is reported that patient-centered care that respects the preferences, needs, and values of individual patients and personalized care that consider the characteristics and comorbidities of each patient are important. Through a case study of a patient with diabetes who had difficulty performing SMBG due to visual impairment, we learned of the needs of SMBG and its assistive devices and the importance of patient and family engagement with emphasis on patient-centered and personalized care. We herein report what we learned through this case in the form of perspectives. Through this report, we hope that medical professionals involved in diabetes care will learn of the importance and needs of these issues and apply them to their actual clinical practice.