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Diabetes and Technology. Prim Care 2022; 49:327-337. [DOI: 10.1016/j.pop.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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2
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Pleus S, Freckmann G, Schauer S, Heinemann L, Ziegler R, Ji L, Mohan V, Calliari LE, Hinzmann R. Self-Monitoring of Blood Glucose as an Integral Part in the Management of People with Type 2 Diabetes Mellitus. Diabetes Ther 2022; 13:829-846. [PMID: 35416589 PMCID: PMC9076772 DOI: 10.1007/s13300-022-01254-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
For decades, self-monitoring of blood glucose (SMBG) has been considered a cornerstone of adequate diabetes management. Structured SMBG can follow different monitoring patterns, and it results in improved glycemic control, reduced hypoglycemia, and a better quality of life of people with diabetes. The technology, usability, and accuracy of SMBG systems have advanced markedly since their introduction a few decades ago. Current SMBG systems are small and easy to use, require small (capillary) blood sample volumes, and provide measurement results within seconds. In addition, devices are increasingly equipped with features such as connectivity to other devices and/or digital diaries and diabetes management tools. Although measurement quality can come close to or equal that of the glucose monitoring systems used by healthcare professionals, several available SMBG systems still do not meet internationally accepted accuracy standards, such as the International Organization for Standardization 15197 standard. Reports from China, India, and Brazil based on local experience suggest that in addition of the accuracy issues of SMBG systems, other obstacles also need to be overcome to optimize SMBG usage. Nonetheless, adequate usage of SMBG data is of high relevance for the management of people with type 2 diabetes mellitus.
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Affiliation(s)
- Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sebastian Schauer
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
| | - Linong Ji
- Peking University People's Hospital, Peking, China
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre, Chennai, India
- Madras Diabetes Research Foundation, Chennai, India
| | - Luis Eduardo Calliari
- Pediatric Endocrine Unit, Pediatric Department, Santa Casa School of Medical Department, Santa Casa School of Medical Sciences, Sao Paulo, Brazil
| | - Rolf Hinzmann
- Roche Diabetes Care GmbH, Sandhofer Straße 116, 68305, Mannheim, Germany.
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3
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Tai JCJ, Wong LZ, Richardson A. Self-Monitoring of Blood Glucose for Patients With Type 2 Diabetes in Primary Care: A Single-Centre, 10-Year Retrospective Analysis. Cureus 2021; 13:e15597. [PMID: 34277218 PMCID: PMC8272934 DOI: 10.7759/cureus.15597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/05/2022] Open
Abstract
Background While type 1 diabetics often require self-monitoring of blood glucose (SMBG), the evidence for tight blood glucose monitoring in non-insulin treated type 2 diabetes mellitus (T2DM) patients is limited. In addition to its lack of cost-effectiveness, unnecessary blood glucose monitoring may also result in anxiety and decreased quality of life. In this retrospective audit, we assessed SMBG prescribing practice at one general practice against guidelines from the National Institute for Health and Care Excellence (NICE). Methods A systematic search of T2DM patients diagnosed at a general practice in London, United Kingdom, in the last 10 years was undertaken. A total of 146 patients fulfilled these criteria, of which 100 patients were randomly selected for inclusion in this audit. Medical notes were reviewed and collated for analysis. Results Only 85% of patients with T2DM were being managed in accordance with the NICE guidelines on SMBG, while 15% were not. It was more common for patients who did not need monitoring to be inappropriately prescribed SMBG (10%) than it was for patients who needed monitoring to be under-prescribed SMBG (5%). The reasons for prescribing SMBG were often left undocumented. Conclusion Adherence to the NICE guidelines is subpar. Recommended solutions include educating healthcare professionals involved in the prescribing of SMBGs, regular reviews of the continued necessity of SMBG, and digital alerts on e-prescribing systems.
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Affiliation(s)
- Justina Cheh Juan Tai
- General Practice and Primary Care, University College London Medical School, London, GBR
| | - Liang Zhi Wong
- General Practice and Primary Care, University College London Medical School, London, GBR
| | - Adrian Richardson
- General Practice and Primary Care, NHS Haringey North Central London Clinical Commissioning Group (CCG), London, GBR
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4
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Logan AD, Jones J, Kuritzky L. Structured Blood Glucose Monitoring in Primary Care: A Practical, Evidence-Based Approach. Clin Diabetes 2020; 38:421-428. [PMID: 33384467 PMCID: PMC7755052 DOI: 10.2337/cd20-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Comprehensive care of diabetes requires satisfactory stewardship of an underutilized prescription in diabetes management: the prescription for structured blood glucose monitoring (BGM). Structured BGM is a recommended schedule of actionable blood glucose measurements taken at specific times with the intent of using the data for individualized patient education and therapeutic intervention. The utility of different BGM protocols is logically dictated by a patient's therapeutic regimen. This article reviews the prescription for structured BGM in the setting of intensive insulin, nonintensive basal insulin, and noninsulin treatment regimens. Evidence-based prescriptions of structured 5- to 7-point BGM profiles in diabetes provide essential information for productive clinician- and patient-directed therapeutic interventions. The effective implementation of structured BGM aids clinicians in achieving the desired goal of A1C reduction while bolstering patient education and empowering self-management.
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Affiliation(s)
- Aniruddha D. Logan
- University of Central Florida College of Medicine/HCA Consortium Family Medicine Residency, Gainesville, FL
| | - Jennifer Jones
- University of Central Florida College of Medicine/HCA Consortium Family Medicine Residency, Gainesville, FL
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Ray A, Esparza S, Wu D, Hanudel MR, Joung HA, Gales B, Tseng D, Salusky IB, Ozcan A. Measurement of serum phosphate levels using a mobile sensor. Analyst 2020; 145:1841-1848. [PMID: 31960836 DOI: 10.1039/c9an02215e] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The measurement of serum phosphate concentration is crucial for patients with advanced chronic kidney disease (CKD) and those on maintenance dialysis, as abnormal phosphate levels may be associated with severe health risks. It is important to monitor serum phosphate levels on a regular basis in these patients; however, such measurements are generally limited to every 0.5-3 months, depending on the severity of CKD. This is due to the fact that serum phosphate measurements can only be performed at regular clinic visits, in addition to cost considerations. Here we present a portable and cost-effective point-of-care device capable of measuring serum phosphate levels using a single drop of blood (<60 μl). This is achieved by integrating a paper-based microfluidic platform with a custom-designed smartphone reader. This mobile sensor was tested on patients undergoing dialysis, where whole blood samples were acquired before starting the hemodialysis and during the three-hour treatment. This sampling during the hemodialysis, under patient consent, allowed us to test blood samples with a wide range of phosphate concentrations, and our results showed a strong correlation with the ground truth laboratory tests performed on the same patient samples (Pearson coefficient r = 0.95 and p < 0.001). Our 3D-printed smartphone attachment weighs about 400 g and costs less than 80 USD, whereas the material cost for the disposable test is <3.5 USD (under low volume manufacturing). This low-cost and easy-to-operate system can be used to measure serum phosphate levels at the point-of-care in about 45 min and can potentially be used on a daily basis by patients at home.
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Affiliation(s)
- Aniruddha Ray
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA 90095, USA. and Department of Bioengineering, University of California, Los Angeles, CA 90095, USA and California NanoSystems Institute, University of California, Los Angeles, CA 90095, USA and Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA. and Department of Physics and Astronomy, University of Toledo, Toledo, OH 43606, USA
| | - Sarah Esparza
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| | - Dimei Wu
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| | - Mark R Hanudel
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
| | - Hyou-Arm Joung
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA 90095, USA. and Department of Bioengineering, University of California, Los Angeles, CA 90095, USA and California NanoSystems Institute, University of California, Los Angeles, CA 90095, USA
| | - Barbara Gales
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
| | - Derek Tseng
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA 90095, USA. and Department of Bioengineering, University of California, Los Angeles, CA 90095, USA and California NanoSystems Institute, University of California, Los Angeles, CA 90095, USA
| | - Isidro B Salusky
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
| | - Aydogan Ozcan
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA 90095, USA. and Department of Bioengineering, University of California, Los Angeles, CA 90095, USA and California NanoSystems Institute, University of California, Los Angeles, CA 90095, USA and Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Nikonova TV, Sukhareva OY, Pekareva EV, Ibragimova LI, Mikhina MS, Galstyan GR, Tokmakova AY, Surkova EV, Laptev DN, Kononenko IV, Egorova DN, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Gomova IS, Lipatov DV, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Klimontov VV, Mkrtumyan AM, Petunina NA, Suplotova LA, Ushakova OV, Khalimov YS, Ruyatkina LA. Diabetes mellitus type 1 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Vadim V. Klimontov
- Research Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
| | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Panuccio V, Pizzini P, Parlongo G, Caridi G, Tripepi R, Mafrica A, Cutrupi S, D'Arrigo G, Porto G, Garofalo C, Provenzano M, Tripepi G, Mallamaci F, Plebani M, Zoccali C. Urine chloride self-measurement to monitor sodium chloride intake in patients with chronic kidney disease. Clin Chem Lab Med 2020; 57:1162-1168. [PMID: 30753154 DOI: 10.1515/cclm-2018-1227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/08/2019] [Indexed: 11/15/2022]
Abstract
Background Excessive sodium intake is a risk factor for hypertension, cardiovascular disease and the risk for kidney failure in chronic kidney disease (CKD) patients. Methods We tested the diagnostic performance and the feasibility of an inexpensive method based on urine chloride strips for self-monitoring sodium intake in a series of 72 CKD patients. Results Twenty-four hour urinary chloride as measured by the reactive strips and 24 h urinary sodium were interrelated (r=0.59, p<0.001). Forty-nine out of 72 patients (78%) had a 24 h urinary sodium >100 mmol/24 h, i.e. the upper limit recommended by current CKD guidelines. The strip method had 75.5% sensitivity and 82.6% specificity to correctly classify patients with urine sodium >100 mmol/24 h. The positive and the negative predictive values were 90.2% and 61.3%, respectively. The overall accuracy (ROC curve analysis) of urine chloride self-measurement for the >100 mmol/24 h sodium threshold was 87% (95% CI: 77%-97%). The large majority of patients (97%) perceived the test as useful to help compliance with the prescribed dietary sodium and considered the test as simple and of immediate application (58%) or feasible but requiring attention (39%). Conclusions A simple and inexpensive test for urine chloride measurement has a fairly good performance for the diagnosis of excessive sodium intake. The test is feasible and it is perceived by CKD patients as helpful for enhancing compliance to the dietary sodium recommendations. The usefulness of this test for improving hypertension control in CKD patients will be tested in a clinical trial (Clinicaltrials.gov RF-2010-2314890).
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Affiliation(s)
- Vincenzo Panuccio
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Patrizia Pizzini
- Institute of Clinical Physiology (IFC), Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Giovanna Parlongo
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Graziella Caridi
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Rocco Tripepi
- Institute of Clinical Physiology (IFC), Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Angela Mafrica
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | | | | | - Gaetana Porto
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Carlo Garofalo
- Division of Nephrology, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Michele Provenzano
- Division of Nephrology, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Giovanni Tripepi
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Francesca Mallamaci
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
- Institute of Clinical Physiology (IFC), Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Carmine Zoccali
- CNR-IFC Research Unit of Reggio Calabria, c/o EUROLINE di Barillà Francesca, Via Vallone Petrara 55-57, 89124 Reggio Calabria, Italy
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Claiborne JP, Wellbeloved-Stone C, Valdez RS. Recent trends in diabetes-related consumer health information technology research. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4283-4288. [PMID: 31946815 DOI: 10.1109/embc.2019.8857052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diabetes-related consumer health information technology (CHIT) has been designed to facilitate self-management practices, and its use has improved health outcomes for many consumers. This analysis sought to identify tendencies in diabetes-related CHIT research from 2010-2015 to help researchers find novel research topics, periodicals, collaborators, and funding agencies and experts and lay consumers to find scholarly information. Six search engines encompassing computer science, engineering, and medicine yielded potential diabetes-related CHIT publications. Abstracts and full texts were screened based on inclusion and exclusion criteria. Information on year, periodical, periodical domain, keywords, author location, author institutions, authors, and funding agencies were collected from included publications. The screening process yielded 1551 publications. Studies were published in a core of twenty periodicals, commonly comprising medicine or technology domains. "Telemedicine" was the most frequently used keyword. Harvard University, Dr. Eirik Årsand, and the National Institute of Diabetes and Digestive Kidney Diseases were the most frequent author institution, author, and funding agency, respectively, associated with publications. This analysis revealed potential for novel research on the sociology and economics of diabetes-related CHIT, among other topics. A lack of collaboration between top authors in the field indicates potential for new, impactful collaborations. Ongoing bibliometric research will be necessary to assess changes in this field. The opportunity exists to inform lay consumers and researchers through bibliometric analyses of other consumer health informatics topics.
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Feller DJ, Burgermaster M, Levine ME, Smaldone A, Davidson PG, Albers DJ, Mamykina L. A visual analytics approach for pattern-recognition in patient-generated data. J Am Med Inform Assoc 2019; 25:1366-1374. [PMID: 29905826 PMCID: PMC6188507 DOI: 10.1093/jamia/ocy054] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/18/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To develop and test a visual analytics tool to help clinicians identify systematic and clinically meaningful patterns in patient-generated data (PGD) while decreasing perceived information overload. Methods Participatory design was used to develop Glucolyzer, an interactive tool featuring hierarchical clustering and a heatmap visualization to help registered dietitians (RDs) identify associative patterns between blood glucose levels and per-meal macronutrient composition for individuals with type 2 diabetes (T2DM). Ten RDs participated in a within-subjects experiment to compare Glucolyzer to a static logbook format. For each representation, participants had 25 minutes to examine 1 month of diabetes self-monitoring data captured by an individual with T2DM and identify clinically meaningful patterns. We compared the quality and accuracy of the observations generated using each representation. Results Participants generated 50% more observations when using Glucolyzer (98) than when using the logbook format (64) without any loss in accuracy (69% accuracy vs 62%, respectively, p = .17). Participants identified more observations that included ingredients other than carbohydrates using Glucolyzer (36% vs 16%, p = .027). Fewer RDs reported feelings of information overload using Glucolyzer compared to the logbook format. Study participants displayed variable acceptance of hierarchical clustering. Conclusions Visual analytics have the potential to mitigate provider concerns about the volume of self-monitoring data. Glucolyzer helped dietitians identify meaningful patterns in self-monitoring data without incurring perceived information overload. Future studies should assess whether similar tools can support clinicians in personalizing behavioral interventions that improve patient outcomes.
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Affiliation(s)
- Daniel J Feller
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Matthew E Levine
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Arlene Smaldone
- Columbia University School of Nursing and College of Dental Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - David J Albers
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
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Lee SK, Shin DH, Kim YH, Lee KS. Effect of Diabetes Education Through Pattern Management on Self-Care and Self-Efficacy in Patients with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183323. [PMID: 31505892 PMCID: PMC6765832 DOI: 10.3390/ijerph16183323] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 12/31/2022]
Abstract
This study investigated the effect of applying a customized diabetes education program through pattern management (PM), using continuous glucose monitoring system (CGMS) results, on individual self-care behaviors and self-efficacy in patients with type 2 diabetes mellitus. Patients with type 2 diabetes who had never received diabetes education, enrolled from March to September 2017, were sequentially assigned to either PM education or control groups. In the PM education group, the CGMS test was first conducted one week before diabetes education and repeated three times by PM in order to obtain data on self-care behaviors and self-efficacy. These results were then compared before and after education at three and six months. The control group received the traditional diabetes education. Self-efficacy showed statistically significant interactions between the two groups over time, indicating a significant difference in the degree of self-efficacy between the PM education and control groups. Diabetes education by PM using CGMS result analysis improved life habits with a positive influence on self-care behaviors and self-efficacy for diabetes management. Further studies are needed to further develop and apply individual diabetes education programs in order to sustain the effects of self-care behaviors and self-efficacy in patients with diabetes who experience a decrease in self-efficacy after three months of education.
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Affiliation(s)
- Sung-Kyoung Lee
- Graduate School of Public Health, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
- Department of Endocrinology Bundang Jesaeng Hospital 180 Seahyen-ro, Bundang-gu, Gyeonggido 13590, Korea.
| | - Dong-Hyun Shin
- Department of Endocrinology Bundang Jesaeng Hospital 180 Seahyen-ro, Bundang-gu, Gyeonggido 13590, Korea.
| | - Yong-Hyun Kim
- Department of Endocrinology Bundang Jesaeng Hospital 180 Seahyen-ro, Bundang-gu, Gyeonggido 13590, Korea.
| | - Kang-Sook Lee
- Graduate School of Public Health, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
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Yaron M, Roitman E, Aharon-Hananel G, Landau Z, Ganz T, Yanuv I, Rozenberg A, Karp M, Ish-Shalom M, Singer J, Wainstein J, Raz I. Effect of Flash Glucose Monitoring Technology on Glycemic Control and Treatment Satisfaction in Patients With Type 2 Diabetes. Diabetes Care 2019; 42:1178-1184. [PMID: 31036546 DOI: 10.2337/dc18-0166] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/01/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess treatment satisfaction and the effectiveness of a flash glucose monitoring (FGM) system in patients with type 2 diabetes using insulin. RESEARCH DESIGN AND METHODS A total of 101 patients with type 2 diabetes on multiple daily insulin injections (MDI) for at least 1 year were assigned randomly to the FGM intervention (n = 53) or the standard care (control) group (n = 48) and followed for 10 weeks. Both groups were instructed to adjust their insulin doses in face-to-face and telephone visits. Satisfaction with treatment, quality of life, comfort using FGM, HbA1c, and frequency of hypoglycemic events were evaluated. RESULTS The intervention group found treatment significantly more flexible (P = 0.019) and would recommend it to their counterparts (P = 0.023). Satisfaction using the FGM system was high. The changes in HbA1c were -0.82% (9 mmol/mol) vs. -0.33% (3.6 mmol/mol) in the intervention and control group, respectively (P = 0.005); in nonprespecified post hoc analysis, 68.6% of the patients in the intervention group had their HbA1c reduced by ≥0.5% (5.5 mmol/mol) compared with 30.2% in the control group (P < 0.001), and 39.2% had their HbA1c reduced by ≥1.0% (10.9 mmol/mol) vs. 18.6% in the control group (P = 0.0023) without an increased frequency of hypoglycemia. CONCLUSIONS FGM tends to improve treatment satisfaction and may lead to amelioration of glycemic control in patients with type 2 diabetes on MDI without increasing the frequency of hypoglycemia.
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Affiliation(s)
- Marianna Yaron
- Diabetes Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Zohar Landau
- Diabetes Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Tali Ganz
- Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | | | | | - Moshe Karp
- Diabetes Medical Center, Tel Aviv, Israel
| | - Maya Ish-Shalom
- Diabetes Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joelle Singer
- Diabetes Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Julio Wainstein
- Diabetes Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Itamar Raz
- Diabetes Medical Center, Tel Aviv, Israel .,Hebrew University, Jerusalem, Israel
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Slugocki M, Bialonczyk D, Özdener AE. A Review of Emerging Technologies in Diabetes Management for Multiple-Dose Insulin-Injecting Patients With Type 2 Diabetes Who Self-monitor Blood Glucose. J Pharm Technol 2019; 35:69-81. [DOI: 10.1177/8755122518813889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The management of diabetes mellitus requires a precise interpretation of blood glucose (BG) data by patients and providers and is increasingly associated with a need for medical technologies that aid in achieving patient-specific outcomes while making the process convenient. This review aims to summarize the current landscape in diabetes management technology, focusing specifically on devices that assist with pattern management in patients with type 2 diabetes (T2DM) who are on multiple-dose insulin regimens. Data Sources: The authors searched MEDLINE to identify articles from 2007 to 2018 that evaluated technologies for BG pattern management and diabetes monitoring. Additional references were generated through review of identified literature citations. Article selection was based on mutual agreement for inclusion. Data Selection and Data Extraction: Relevant articles were defined as English-language articles, describing technologies that assist with diabetes management in insulin-injecting patients with T2DM. Articles that focused exclusively on type 1 diabetes were excluded. Data Synthesis: The literature search yielded 334 articles, of which 21 were included for synthesis. The current BG monitoring practices emphasize the benefit of the structured self-monitoring of BG approach. Several randomized controlled trials conclude that the available technology aids in comprehensive data collection and facilitates communication between patients and providers. Digitally enabled “smart” devices are valuable tools that may help improve outcomes while providing a flexible, personalized approach. Conclusions: Integration of digital technology with diabetes management allows for accurate collection and analysis of data. Emergence of digital tools promotes a comprehensive, precise, and objective approach to glucose monitoring and encourages patient-provider collaborations.
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Joo EY, Lee JE, Kang HS, Park SG, Hong YH, Shin YL, Sohn M. Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes. Diabetes Metab J 2018; 42:480-487. [PMID: 30113142 PMCID: PMC6300445 DOI: 10.4093/dmj.2018.0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycosylated hemoglobin (HbA1c) levels among Korean adolescents with type 1 diabetes mellitus (T1DM). Factors affecting the SMBG frequency were analyzed in order to improve their glycemic control. METHODS Sixty-one adolescents aged 13 to 18 years with T1DM were included from one tertiary center. Clinical and biochemical variables were recorded. Factors associated with SMBG frequency were assessed using structured self-reported questionnaires. RESULTS Average total daily SMBG frequency was 3.8±2.1 and frequency during the school day was 1.3±1.2. The mean HbA1c level was 8.6%±1.4%. As the daily SMBG frequency increased, HbA1c levels declined (P=0.001). The adjusted odds of achieving the target HbA1c in participants who performed daily SMBG ≥5 significantly increased 9.87 folds (95% confidence interval [CI], 1.58 to 61.70) compared with those performed SMBG four times a day. In the subjects whose SMBG frequency <1/day during the school day, an 80% reduction in the adjusted odds ratio 0.2 (95% CI, 0.05 to 0.86) showed compared to the group with performing two SMBG measurements in the school setting. The number of SMBG testing performed at school was significantly high for individuals assisted by their friends (P=0.031) and for those who did SMBG in the classrooms (P=0.039). CONCLUSION Higher SMBG frequency was significantly associated with lower HbA1c in Korean adolescents with T1DM. It would be necessary to establish the school environments that can facilitate adequate glycemic control, including frequent SMBG.
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Affiliation(s)
- Eun Young Joo
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Ji Eun Lee
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea.
| | - Hee Sook Kang
- Diabetes Endocrinology Center, Inha University School of Medicine, Incheon, Korea
| | - Shin Goo Park
- Department of Occupational & Evironmental Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Young Lim Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Min Sohn
- Department of Nursing, Inha University College of Medicine, Incheon, Korea
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Mohan V, Mapari JA, Karnad PD, Mann JS, Maheshwari VK. Reduced Diabetes Mellitus-related Comorbidities by Regular Self-monitoring of Blood Glucose: Economic and Quality of Life Implications. Indian J Endocrinol Metab 2018; 22:461-465. [PMID: 30148089 PMCID: PMC6085947 DOI: 10.4103/ijem.ijem_216_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of the study was to understand the role of self-monitoring of blood glucose (SMBG) for better management of glycemic fluctuations, reducing the risk of complications, and the associated cost benefits for diabetes patients in India. MATERIALS AND METHODS An Excel-based Cost Impact Model was developed to analyze the impact of SMBG by calculating the savings over a 10-year time period. A literature review was undertaken to model the impact of SMBG on the risk of complications and cardiovascular morbidities. The model was developed based on inputs from previous studies. RESULTS In the base case, SMBG cohort was associated with a 10-year discounted cost of INR 718,340, resulting in an estimated saving of INR 120,173 compared to no SMBG cohort. Implementation of a once-daily SMBG protocol, for a decade, can reduce the complication-related costs. More frequent SMBG and tri-monthly hemoglobin A1c tests along with lifestyle changes can significantly reduce the financial burden on the patient over the lifespan. CONCLUSION Our study has shown that proactive management of diabetes with SMBG can improve treatment outcomes and reduce morbidity and mortality associated with this disease. Near-normal blood glucose levels can bring in cost savings in the form of reduced long-term complications and avoidance of repeated hospitalization for the management of such complications, along with an improved quality of life.
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Affiliation(s)
- Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Jayashree A. Mapari
- Ethicon Surgical Care & Diabetes Care, Johnson & Johnson Pvt. Ltd, Mumbai, Maharashtra, India
| | - Pratibha D. Karnad
- Ethicon Surgical Care & Diabetes Care, Johnson & Johnson Pvt. Ltd, Mumbai, Maharashtra, India
| | - Jasdeep S. Mann
- Lifesciences Division & Financial Analytics, SmartAnalyst Pvt. Ltd., Gurgaon, Haryana, India
| | - Vikalp K. Maheshwari
- Lifesciences Division & Financial Analytics, SmartAnalyst Pvt. Ltd., Gurgaon, Haryana, India
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15
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Rasche P, Mertens A, Miron-Shatz T, Berzon C, Schlick CM, Jahn M, Becker S. Seamless recording of glucometer measurements among older experienced diabetic patients - A study of perception and usability. PLoS One 2018; 13:e0197455. [PMID: 29799861 PMCID: PMC5969745 DOI: 10.1371/journal.pone.0197455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 05/02/2018] [Indexed: 11/19/2022] Open
Abstract
Self-measurement and documentation of blood-glucose are critical elements of diabetes management, particularly in regimes including insulin. In this study, we analyze the usability of iBG-STAR, the first blood glucose meter connectable to a smartphone. This technology records glucometer measurements, removing the burden of documentation from diabetic patients. This study assesses the potential for implementation of iBG-STAR in routine care. Twelve long-term diabetic patients (4 males; median age of 66.5 years) were enrolled in the study. N = 4/12 reported diabetic polyneuropathy. Reported subjective mental workload for all tasks related to iBG-STAR was on average lower than 12 points, corresponding to the verbal code 'nearly no effort needed'. A "Post Study System Usability Questionnaire", evaluated the glucometer at an average value of 2.06 (SD = 1.02) on a 7-Likert-scale (1 = 'I fully agree' to 7 = 'I completely disagree') for usability. These results represent a positive user-experience. Patients with polyneuropathy may experience physical difficulties in completing the tasks, thereby affecting usability. Technologically savvy patients (n = 6) with a positive outlook on diabetes assessed the product as a suitable tool for themselves and would recommend to other diabetic patients. The main barrier to regular use was treating physicians' inability to retrieve digitally recorded data. This barrier was due to a shortcoming in interoperability of mobile devices and medical information systems.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics of RWTH Aachen University, Aachen, Germany
| | - Alexander Mertens
- Institute of Industrial Engineering and Ergonomics of RWTH Aachen University, Aachen, Germany
| | - Talya Miron-Shatz
- Center for Medical Decision Making, Business School, Ono Academic College, Kiryat Ono, Israel
- Center for Medicine in the Public Interest, New York, NY, United States of America
| | - Corinne Berzon
- Center for Medical Decision Making, Business School, Ono Academic College, Kiryat Ono, Israel
| | - Christopher M. Schlick
- Institute of Industrial Engineering and Ergonomics of RWTH Aachen University, Aachen, Germany
| | - Michael Jahn
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
| | - Stefan Becker
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
- * E-mail:
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Blum JR, Rayfield EJ. AN ENDOCRINE CLINIC'S PERSPECTIVE AND EXPERIENCE WITH THE ABBOTT FREESTYLE LIBRE CGM. Endocr Pract 2018; 24:309-311. [PMID: 29547048 DOI: 10.4158/ep-2017-0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Irace C, Schweitzer MA, Tripolino C, Scavelli FB, Gnasso A. Diabetes Data Management System to Improve Glycemic Control in People With Type 1 Diabetes: Prospective Cohort Study. JMIR Mhealth Uhealth 2017; 5:e170. [PMID: 29162560 PMCID: PMC5717448 DOI: 10.2196/mhealth.8532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 09/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Smartphone and Web technology can improve the health care process, especially in chronic diseases. Objective The aim of this study was to investigate whether the use of blood glucose (BG) data management system, which enables connection to smartphones, the Web, the cloud, and downloading, can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). Methods This study was a prospective, single-arm, cohort feasibility study with 6 months of duration. T1DM subjects enrolled had experience in self-monitoring blood glucose, but were download data naïve. Fasting BG and glycated hemoglobin (HbA1c) were collected at the enrollment and at follow-up. Subjects were divided into Downloader (DL) and No-downloader (NDL). Results A total of 63 subjects were analyzed, of which 30 were classified as DL and 33 as NDL. At the end of the study, DL had significantly lower HbA1c, mean daily glucose, standard deviation, percentage of BG values above target, and pre- and postprandial (lunch and dinner) values compared with NDL (all P<.05). The percentage of BG values within treatment target was significantly higher in DL compared with NDL (47% [SD 9] vs 37% [SD 13]; P=.001). Conclusions The findings suggest that, in T1DM, downloading of BG from data management system, which enables connection to smartphones, the Web, and the cloud, might be a valuable contributor to improved glycemic control.
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Affiliation(s)
- Concetta Irace
- Metabolic Diseases Unit, Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | | | - Cesare Tripolino
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
| | - Faustina Barbara Scavelli
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
| | - Agostino Gnasso
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
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Farhan SA, Shaikh AT, Zia M, Kahara BR, Muneer R, Rehman M, Mubashir A, Sadiq H, Siddiqui DEA, Haseeb SM, Tanveer H, Siddiq K, Mujtaba SB, Mirza SA, Feroz H, Fatima K. Prevalence and Predictors of Home Use of Glucometers in Diabetic Patients. Cureus 2017; 9:e1330. [PMID: 28698830 PMCID: PMC5503458 DOI: 10.7759/cureus.1330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/09/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a critical component of diabetes care. However, it has been shown that use of glucometers in developing countries such as Pakistan is limited. The aim of this study was to determine the frequency of glucometer usage in the urban diabetic population of Karachi and to identify variables that influenced the likelihood of practice of SMBG. METHODS A cross-sectional study was conducted among 567 adult diabetic patients selected at random from the out-patient departments of multiple healthcare institutions in Karachi categorized into two settings; Government and Private. Non-diabetics, patients having gestational diabetes, diabetes insipidus and Cushing's syndrome and terminally ill patients were excluded. Pearson Chi-square and Mann-Whitney U test were applied as the primary statistical method. RESULTS Prevalence of home glucometer usage was 59% (n= 331). High socioeconomic status (p < 0.001), receiving care from private institutions (p < 0.001), higher education (p < 0.001), a family history of diabetes (p =0.001), awareness regarding diabetes (p < 0.001), having diabetes for > five years (p <0.001), and managing diabetes via pharmacological interventions (p <0.001) (versus diet and exercise) were significant positive predictors of glucometer usage. CONCLUSIONS Our study demonstrates the increasing trend in use of SMBG. Lack of awareness and cost of glucometers were reported to be the main reasons for not practicing SMBG. Given these factors are easily modifiable, government subsidized initiatives and awareness programs can result in a successful public health strategy to promote SMBG.
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Affiliation(s)
- Syed A Farhan
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Ali T Shaikh
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Maria Zia
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Bilal R Kahara
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Ramsha Muneer
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Muzna Rehman
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Ayesha Mubashir
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hassaan Sadiq
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | | | - Syed M Haseeb
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hafsa Tanveer
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Khadijah Siddiq
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Saib B Mujtaba
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Samir A Mirza
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hira Feroz
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Kaneez Fatima
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
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20
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Affiliation(s)
- Eugene E. Wright
- Department of Medicine and Community and Family Medicine, Duke Southern Regional AHEC, Fayetteville, North Carolina
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21
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Selvan C, Thukral A, Dutta D, Ghosh S, Chowdhury S. Impact of Self-monitoring of Blood Glucose Log Reliability on Long-term Glycemic Outcomes in Children with Type 1 Diabetes. Indian J Endocrinol Metab 2017; 21:382-386. [PMID: 28553591 PMCID: PMC5434719 DOI: 10.4103/ijem.ijem_342_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Logbooks of self-monitoring of blood glucose (SMBG) are useful in the modulation of insulin regimens, which aid in achieving glycemic control in type 1 diabetes mellitus (T1DM). However, discrepancies in SMBG charting may impede its utility. This study aimed to assess the accuracy of log entries and its impact on long-term glycemic control. METHODS SMBG in logbooks was compared with readings in glucometer memory and discrepancies between the two were evaluated in 101 children with T1DM. The relationship between these discrepancies and glycated hemoglobin (HbA1c) over 44 months was assessed. RESULTS Errors in glucose charting were observed in 32.67% children. The most common observed error was omission (42.42%), followed by fabrication (27.27%), erroneous (18.18%), and others (12.12%). Age was not significantly different among children having accurate versus inaccurate SMBG logs. During follow-up of 44 months, children with accurate SMBG logs consistently had lower HbA1c as compared to children having inaccurate logs, which was statistically significant at 4, 16, 20, and 28 months' follow-up. The same was reflected in the proportion of children achieving HbA1c <7% and 7%-9%. Of the 14 children who had omissions, 9 had omission of high values only, 3 patients had omission of low values only, 1 had omission of both high and low values, and 1 had omission of normal values. Among logs with fabrication, parents were responsible in 2 of 9 incidents. In the remaining 7, it was the child himself/herself. Children with fabrication consistently had the highest HbA1c values among the different types of inaccurate blood glucose chartings, which was statistically significant at 32 and 36 months of follow-up. CONCLUSIONS Reliability of SMBG logs is a significant problem among children with T1DM at our center. Children with accurate logs of SMBG readings were more likely to have better glycemic control on long-term follow-up.
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Affiliation(s)
- Chitra Selvan
- Department of Endocrinology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Anubhav Thukral
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
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Le C, Rong S, Dingyun Y, Wenlong C. Socioeconomic disparities in type 2 diabetes mellitus prevalence and self-management behaviors in rural southwest China. Diabetes Res Clin Pract 2016; 121:9-16. [PMID: 27620854 DOI: 10.1016/j.diabres.2016.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/09/2016] [Accepted: 07/16/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study examines how socioeconomic factors are associated with prevalence and self-management of diabetes among ethnic minority groups in the rural Yunnan province, which has the most ethnic minority groups per province in southwest China. METHODS A cross-sectional survey was carried out in 2014 in a rural southwest population consisting of 5532 consenting individuals aged ⩾35years. Information about participants' demographic characteristics, as well as diabetes diagnosis, treatment, and self-management behaviors, were obtained using a standard questionnaire. Fasting blood sugar levels were recorded for each individual. A socioeconomic position (SEP) index was constructed using principal component analysis. RESULTS The age-standardized prevalence of diabetes in the study population was 4.8%. In persons with diabetes, 23.1% regularly self-monitored blood glucose, 43.2% adhered to taking prescribed anti-diabetic drugs or insulin injections, and 63.1% took at least one measure to control blood glucose. Individual educational level was found to be negatively associated with the prevalence of diabetes, whereas individuals with greater household assets and higher SEP were more likely to be suffered from diabetes. Persons with diabetes with greater household assets, higher level of education, and higher SEP had a greater probability of regularly self-monitoring blood glucose, compliance to prescribed medicines, and taking measures to control diabetes. Access to medical services was positively associated with regularly self-monitoring blood glucose and compliance to prescribed medicines. CONCLUSIONS Socioeconomic disparities in diabetes prevalence and self-management do exist. Future interventions to further control diabetes and improve diabetes management must be tailored to address socioeconomic factors.
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Affiliation(s)
- Cai Le
- School of Public Health, Kunming Medical University, 1168 Yu Hua street Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Su Rong
- School of Public Health, Kunming Medical University, 1168 Yu Hua street Chun Rong Road, Cheng Gong New City, Kunming 650500, China
| | - You Dingyun
- School of Public Health, Kunming Medical University, 1168 Yu Hua street Chun Rong Road, Cheng Gong New City, Kunming 650500, China
| | - Cui Wenlong
- School of Public Health, Kunming Medical University, 1168 Yu Hua street Chun Rong Road, Cheng Gong New City, Kunming 650500, China
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Baron JS, Hirani S, Newman SP. A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes. J Telemed Telecare 2016; 23:207-216. [DOI: 10.1177/1357633x16631628] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective The objective of this research is to determine the effects of mobile telehealth (MTH) on glycosylated haemoglobin (HbA1c) and other clinical and patient-reported outcomes in insulin-requiring people with diabetes. Methods A nine-month randomised, controlled trial compared standard care to standard care supplemented with MTH (self-monitoring, mobile-phone data transmissions, graphical and nurse-initiated feedback, and educational calls). Clinical (HbA1c, blood pressure, daily insulin dose, diabetes outpatient appointments (DOAs)) and questionnaire data (health-related quality of life, depression, anxiety) were collected. Mean group changes over time were compared using hierarchical linear models and Mann-Whitney tests. Results Eighty-one participants with a baseline HbA1c of 8.98% ± 1.82 were randomised to the intervention ( n = 45) and standard care ( n = 36). The Group by Time effect revealed MTH did not significantly influence HbA1c ( p = 0.228), but p values were borderline significant for blood pressure ( p = 0.054) and mental-health related quality of life ( p = 0.057). Examination of effect sizes and 95% confidence intervals for mean group differences at nine months supported the existence of a protective effect of MTH on mental health-related quality of life as well as depression. None of the other measured outcomes were found to be affected by the MTH intervention. Conclusions Findings from this study must be interpreted with caution given the small sample size, but they do not support the widespread adoption of MTH to achieve clinically significant changes in HbA1c. MTH may, however, have positive effects on blood pressure and protective effects on some aspects of mental health.
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Affiliation(s)
- Justine S Baron
- Institute of Cardiovascular Science, University College London, United Kingdom (currently at the Ottawa Hospital Research Institute, Canada)
| | - Shashivadan Hirani
- Centre for Health Services Research, School of Health Sciences, City University London, United Kingdom
| | - Stanton P Newman
- Centre for Health Services Research, School of Health Sciences, City University London, United Kingdom
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Sutheran HL, Reynolds T. Technical and clinical accuracy of three blood glucose meters: clinical impact assessment using error grid analysis and insulin sliding scales. J Clin Pathol 2016; 69:899-905. [PMID: 26850631 DOI: 10.1136/jclinpath-2015-203339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/13/2016] [Indexed: 11/03/2022]
Abstract
AIMS Manufacturers of point-of-care testing (POCT) glucose systems must adhere to International Organisation for Standardisation (ISO) 15197 performance standards, a tightened version of which becomes mandatory in May 2016. Using methods deviating from the evaluation requirements of ISO 15197, we investigated the accuracy and clinical utility of three glucose testing systems. METHODS Whole blood glucose was measured on 62 EDTA-preserved samples with each system followed by plasma glucose determination with a laboratory hexokinase method. Technical accuracy was assessed using linear regression, Bland-Altman plots and bias. Clinical utility was evaluated using consensus error grid analysis and insulin dosing algorithms. RESULTS The correlation coefficient of the glucose measuring devices with the comparator method was between 0.979 and 0.993 (n=61). Bias against the reference method was +0.7-+4.4%. The FreeStyle Lite (0.7±4.4%) and ACCU-CHEK Aviva (1.3±7.3%) systems had the least bias to the reference. Error grid analysis depicts all meters to be clinically accurate, with all results falling within Zones A and B. CONCLUSIONS Conformité Européene-marked devices are presumed to have adequate accuracy, but postmarket evaluations are imperative to assess total system accuracy and whether regulatory targets are achieved.
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Affiliation(s)
| | - Timothy Reynolds
- Department of Clinical Chemistry, Pathology, Queen's Hospital NHS Foundation Trust, Burton-Upon-Trent, UK
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25
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Cerna L, Maresova P. Patients' attitudes to the use of modern technologies in the treatment of diabetes. Patient Prefer Adherence 2016; 10:1869-1879. [PMID: 27703334 PMCID: PMC5038572 DOI: 10.2147/ppa.s118040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The incidence of diabetes is rising across the world. This global problem significantly affects the economic and social development in the 21st century. If the disease is diagnosed in time, the number of complications as well as the costs of therapy will be lower. Modern technologies permeate all spheres of medicine, and diabetes treatment is no exception. Therefore, the aim of this article is to analyze patients' attitudes to the use of modern technologies in the treatment of diabetes (type 1 diabetes mellitus [T1DM] and type 2 diabetes mellitus [T2DM]). METHODS A total of 313 respondents from the Czech Republic in the period from June 24, 2015, to July 24, 2015, participated in a questionnaire survey. The target group was diabetics regardless of the type of illness. Collected data were analyzed using descriptive statistical methods, Z-test, and test of independence (Pearson's chi-squared test). RESULTS Although in other areas mobile applications are used to monitor patients' health condition in ~30% of cases, in the case of diabetes they are used by only 4% of respondents. Approximately 8% of participants use an application, but they do not like it. The rest of the respondents have never used any mobile application. These low figures are due to a lack of knowledge about the availability and possibilities of mobile applications. A positive correlation was proven between technical skills and methods of entering data. Gender and age show only a weak dependency of the method of writing data on their own health condition. Furthermore, the monitored parameters show that patients with T1DM control and know more about their health condition than patients with T2DM, which is reflected, for example, by more frequent blood glucose measurements or larger track of their physical activity. Conversely, the relationship between the associated complications and self-care activities has not been demonstrated. CONCLUSION Despite the current fast development of modern technologies, these technologies are not frequently used in treating patients. The principal problem lies in patients' low technological knowledge and their higher age, which makes learning new skills, including the use of modern technologies, more difficult.
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Affiliation(s)
- Lucie Cerna
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petra Maresova
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
- Correspondence: Petra Maresova, University of Hradec Kralove, Department of Economics, Rokitanskeho 62, 50003, Hradec Kralove, Czech Republic, Tel +420 737 928 745, Email
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King KR, Grazette LP, Paltoo DN, McDevitt JT, Sia SK, Barrett PM, Apple FS, Gurbel PA, Weissleder R, Leeds H, Iturriaga EJ, Rao AK, Adhikari B, Desvigne-Nickens P, Galis ZS, Libby P. Point-of-Care Technologies for Precision Cardiovascular Care and Clinical Research: National Heart, Lung, and Blood Institute Working Group. JACC Basic Transl Sci 2016; 1:73-86. [PMID: 26977455 PMCID: PMC4787294 DOI: 10.1016/j.jacbts.2016.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/20/2016] [Indexed: 12/26/2022]
Abstract
Point-of-care technologies (POC or POCT) are enabling innovative cardiovascular diagnostics that promise to improve patient care across diverse clinical settings. The National Heart, Lung, and Blood Institute convened a working group to discuss POCT in cardiovascular medicine. The multidisciplinary working group, which included clinicians, scientists, engineers, device manufacturers, regulatory officials, and program staff, reviewed the state of the POCT field; discussed opportunities for POCT to improve cardiovascular care, realize the promise of precision medicine, and advance the clinical research enterprise; and identified barriers facing translation and integration of POCT with existing clinical systems. A POCT development roadmap emerged to guide multidisciplinary teams of biomarker scientists, technologists, health care providers, and clinical trialists as they: 1) formulate needs assessments; 2) define device design specifications; 3) develop component technologies and integrated systems; 4) perform iterative pilot testing; and 5) conduct rigorous prospective clinical testing to ensure that POCT solutions have substantial effects on cardiovascular care.
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Affiliation(s)
- Kevin R. King
- Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Luanda P. Grazette
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
| | - Dina N. Paltoo
- Office of Science Policy, Office of the Director, National Institutes of Health, Bethesda, Maryland
| | - John T. McDevitt
- Departments of Bioengineering and Chemistry, Rice University, Houston, Texas
| | - Samuel K. Sia
- Department of Biomedical Engineering, Columbia University, New York, New York
| | | | - Fred S. Apple
- Hennepin County Medical Center and University of Minnesota, Department of Laboratory Medicine and Pathology, Minneapolis, Minnesota
| | - Paul A. Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Ralph Weissleder
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hilary Leeds
- Office of Science Policy, Office of the Director, National Institutes of Health, Bethesda, Maryland
| | - Erin J. Iturriaga
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Anupama K. Rao
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Bishow Adhikari
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Zorina S. Galis
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Libby
- Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Doherty ST, Greaves SP. Time-series analysis of continuously monitored blood glucose: the impacts of geographic and daily lifestyle factors. J Diabetes Res 2015; 2015:804341. [PMID: 25893201 PMCID: PMC4393908 DOI: 10.1155/2015/804341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/17/2022] Open
Abstract
Type 2 diabetes is known to be associated with environmental, behavioral, and lifestyle factors. However, the actual impacts of these factors on blood glucose (BG) variation throughout the day have remained relatively unexplored. Continuous blood glucose monitors combined with human activity tracking technologies afford new opportunities for exploration in a naturalistic setting. Data from a study of 40 patients with diabetes is utilized in this paper, including continuously monitored BG, food/medicine intake, and patient activity/location tracked using global positioning systems over a 4-day period. Standard linear regression and more disaggregated time-series analysis using autoregressive integrated moving average (ARIMA) are used to explore patient BG variation throughout the day and over space. The ARIMA models revealed a wide variety of BG correlating factors related to specific activity types, locations (especially those far from home), and travel modes, although the impacts were highly personal. Traditional variables related to food intake and medications were less often significant. Overall, the time-series analysis revealed considerable patient-by-patient variation in the effects of geographic and daily lifestyle factors. We would suggest that maps of BG spatial variation or an interactive messaging system could provide new tools to engage patients and highlight potential risk factors.
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Affiliation(s)
- Sean T. Doherty
- Department of Geography & Environmental Studies, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, Canada N2L 3C5
- *Sean T. Doherty:
| | - Stephen P. Greaves
- Institute of Transport and Logistics Studies, The University of Sydney Business School, University of Sydney, Sydney, NSW 2006, Australia
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Abstract
Monitoring of glycemic control is a key component of the diabetes treatment plan. Patients who are not meeting targets often require more intensive monitoring, ranging from frequent self-monitored glucose to continuous glucose monitoring in order to facilitate medication and lifestyle changes. However, more intensive monitoring demands more training and a structured plan for interpretation and use of the data. Better patient and provider tools to support decision-making and progress toward an artificial pancreas may help to alleviate this burden.
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Affiliation(s)
- Sara J Healy
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 5th Floor McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA
| | - Kathleen M Dungan
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 5th Floor McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA.
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Rafiei R, Habyby Z, Fouladi L, Najafi S, Asgary S, Torabi Z. Chromium level in prediction of diabetes in pre-diabetic patients. Adv Biomed Res 2014; 3:235. [PMID: 25538921 PMCID: PMC4260284 DOI: 10.4103/2277-9175.145737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/03/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Chromium supplementations (Cr) have been shown to exert beneficial effects in the management of type-2 diabetes. Prevalence of Cr deficiency in pre-diabetic patients is not well-understood, therefore, the aim of this study was to evaluate the extent of this prevalence. MATERIALS AND METHODS In this cross-sectional descriptive study, 132 pre-diabetic patients were recruited. The participants were randomly selected from those who referred to the Shariati Hospital in Isfahan, Iran. Blood samples are collected for measurement of Cr, insulin, fasting blood sugar (FBS), and two-hour post-load plasma glucose. The body mass index (BMI) was calculated. Determination of Cr was carried out by atomic absorption spectrometry. RESULTS Thirty-four (31.5%) patients had Cr deficiency and 74 (68.5%) patients had normal Cr. There was no significant difference between sex, age groups (<50 years and ≥50 years) and between patients with and without a family history of diabetes in both the groups. No significant differences in age, BMI, FBS or insulin were observed between two groups. In the group with a normal level of Cr, there was a significant reversed correlation between the Cr level and age, but no significant correlation existed between the Cr level and other factors in both groups. CONCLUSION The levels of Cr deficiency are relatively common in patients with pre-diabetes, and it is necessary to screen patients with diabetes and pre-diabetes according to the American Diabetes Association guidelines, with regard to the Cr level and action should be taken to eliminate the Cr deficiency in these patients.
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Affiliation(s)
| | | | | | - Somayeh Najafi
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sedigheh Asgary
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical, Isfahan, Iran
| | - Zahra Torabi
- Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
BACKGROUND With the increasing prevalence of systems allowing automated, real-time transmission of blood glucose data there is a need for pattern recognition techniques that can inform of deleterious patterns in glycemic control when people test. We evaluated the utility of pattern identification with a novel pattern identification system named Vigilant™ and compared it to standard pattern identification methods in diabetes. METHOD To characterize the importance of an identified pattern we evaluated the relative risk of future hypoglycemic and hyperglycemic events in diurnal periods following identification of a pattern in a data set of 536 patients with diabetes. We evaluated events 2 days, 7 days, 30 days, and 61-90 days from pattern identification, across diabetes types and cohorts of glycemic control, and also compared the system to 6 pattern identification methods consisting of deleterious event counts and percentages over 5-, 14-, and 30-day windows. RESULTS Episodes of hypoglycemia, hyperglycemia, severe hypoglycemia, and severe hyperglycemia were 120%, 46%, 123%, and 76% more likely after pattern identification, respectively, compared to periods when no pattern was identified. The system was also significantly more predictive of deleterious events than other pattern identification methods evaluated, and was persistently predictive up to 3 months after pattern identification. CONCLUSIONS The system identified patterns that are significantly predictive of deleterious glycemic events, and more so relative to many pattern identification methods used in diabetes management today. Further study will inform how improved pattern identification can lead to improved glycemic control.
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Affiliation(s)
- Erik A Otto
- InSpark Technologies, Inc, Charlottesville, VA, USA
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García-Mochón L, Olry de Labry Lima A, Espín Balbino J. Costes y efectividad de un detector de tendencias glucémicas en pacientes con diabetes mellitus. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.avdiab.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Many studies have tested clinical and behavioral approaches for improving glycemic control in people with diabetes. We reviewed studies to identify how blood glucose (BG) values have been used in patient-focused clinical research and interventions. We sought to describe the frequency that BG values have been the focus of patient education research and to characterize the different methods to integrate BG into an intervention, the approaches implemented to support patient education, and behavior change, and the nature of communication about BG values. Thirty-four eligible studies were identified that included patient education using BG values. Information regarding the study and intervention characteristics include: (1) characteristics of the study sample, (2) how BG values were obtained, (3) use of a graphical interface for BG values, (4) use of a BG log, (5) BG interpretation and regimen adjustments, (6) recommended actions to patient, (7) modality of intervention, and (8) intervention communication schedule. The review demonstrated that new BG technologies provide outstanding opportunities for greater access to BG data, and for patient support and intervention. However, it also indicated a need to improve and expand support for people with diabetes in their daily use of BG values to maintain and improve glycemic control. In order to make the most sustainable impact on behavior, generalizable skills such as problem solving need to be integrated into BG education.
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Affiliation(s)
- Yaa Kumah-Crystal
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way DOT Room 11142-C, Nashville, TN, 37232-9170, USA,
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De Melo M, de Sa E, Gucciardi E. Exploring differences in Canadian adult men and women with diabetes management: results from the Canadian Community Health Survey. BMC Public Health 2013; 13:1089. [PMID: 24262007 PMCID: PMC3890645 DOI: 10.1186/1471-2458-13-1089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 11/04/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over 2 million Canadians are known to have diabetes. In addition to the economic burden placed on the healthcare system, the human cost associated with diabetes poses a heavy burden on those living with diabetes. The literature shows that apparent differences exist in diabetes complications and diabetes management between men and women. How self-care management and utilization of health services differ by sex is not clearly understood.The purpose of this study was to explore sex differences in diabetes self-care and medical management in the Canadian population, using a nationally representative sample. METHODS Data collected from the cross-sectional, population-based Canadian Community Health Survey (2007-2008) were used in these analyses. A bootstrap variance estimation method and bootstrap weights provided by Statistics Canada were used to calculate 95% confidence intervals. Bivariate analyses identified variables of interest between females and males that were used in subsequent multivariate analyses. RESULTS A total of 131,959 respondents were surveyed for the years of 2007 and 2008, inclusive. Fully adjusted multinomial and logistic regression analyses revealed sex differences for those living with diabetes. Compared to men with diabetes, women were more likely to be in the lowest income quintiles than the highest (OR: 1.8, 95% CI: 1.3-2.6) and were more likely not to have a job in the previous week (OR: 1.8, 95% CI: 1.4-2.4). Women were also more likely to avoid foods with fats or high calories (OR: 2.1, 95% CI: 1.4-3.0 and OR: 2.2, 95% CI: 1.6-3.0, respectively), to be concerned about heart disease (OR: 1.6, 95% CI: 1.1-2.2), and to be non-smokers (OR: 2.2, 95% CI: 1.6-3.0). However, despite their increased concern, women checked their blood-glucose less frequently on a daily basis than men (μwomen = 1.7, 95% CI: 1.7-1.8; μmen = 3.1, 95% CI: 2.9-3.2). Women were more likely to have an anxiety disorder (OR: 2.3, 95% CI: 1.7-3.2) and a mood disorder (OR: 2.4, 95% CI: 1.8-3.1), and more likely to be physically inactive (OR: 1.5, 95% CI: 1.2-1.8). CONCLUSIONS Our findings underscore the importance of addressing sex differences which may interfere with diabetes self-care. In women, addressing socioeconomic and psychological barriers, as well as limitations to active living are important; in men, the benefit of more effective nutrition therapy and smoking cessation interventions are suggested. The results for this study highlight the need to further investigate and eliminate disparities between the sexes in order to optimize health outcomes among Canadians with diabetes.
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Affiliation(s)
- Margaret De Melo
- SunLife Financial Banting and Best Diabetes Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Eric de Sa
- University Health Network, Toronto, Canada
| | - Enza Gucciardi
- School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2 K3, Canada
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Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is the most accessible way to assess glycemic patterns, and interpretation of these patterns can provide reasons for poor glycemic control and suggest management strategies. Furthermore, diabetes management based on blood glucose (BG) patterns is associated with improved patient outcomes. The aim of this review is therefore to evaluate the impact of pattern management in clinical practice. METHODS We included a review of available literature, a discussion of obstacles to implementation of SMBG and pattern management, and suggestions on how clinicians and patients might work together to optimize this management feature. RESULTS The literature review revealed eight publications specifically describing structured approaches to SMBG and pattern management. Specific information on how SMBG might be structured to detect BG patterns, however, remains limited. Barriers to pattern management include not just practical reasons, but emotional and psychological reasons as well. CONCLUSIONS Patterns are not always easy to detect or interpret, but on-meter and web-based tools can support both patients and clinicians. Ultimately, successful pattern management requires education and mutual commitment from the clinician and patient--ongoing collaboration is needed to obtain, review, and interpret SMBG values and to make changes based on the patterns.
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Affiliation(s)
| | - Stefano Genovese
- Diabetes and Metabolic Diseases Unit, IRCCS Multimedica, Sesto San Giovanni (MI), Italy
| | - Gérard Reach
- Department of Endocrinology, Diabetes, and Metabolic Diseases, Avicenne Hospital Bobigny, France
- EA 3412, CRNH-IdF, University Paris 13, Sorbonne Paris Cité, Bobigny, France
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Scavini M, Bosi E, Ceriello A, Giorgino F, Porta M, Tiengo A, Vespasiani G, Bottalico D, Marino R, Parkin C, Bonizzoni E, Cucinotta D. Prospective, randomized trial on intensive SMBG management added value in non-insulin-treated T2DM patients (PRISMA): a study to determine the effect of a structured SMBG intervention. Acta Diabetol 2013; 50:663-72. [PMID: 22189755 PMCID: PMC3898142 DOI: 10.1007/s00592-011-0357-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/19/2011] [Indexed: 02/06/2023]
Abstract
Self-monitoring of blood glucose (SMBG) is a core component of diabetes management. However, the International Diabetes Federation recommends that SMBG be performed in a structured manner and that the data are accurately interpreted and used to take appropriate therapeutic actions. We designed a study to evaluate the impact of structured SMBG on glycemic control in non-insulin-treated type 2 diabetes (T2DM) patients. The Prospective, Randomized Trial on Intensive SMBG Management Added Value in Non-insulin-Treated T2DM Patients (PRISMA) is a 12-month, prospective, multicenter, open, parallel group, randomized, and controlled trial to evaluate the added value of an intensive, structured SMBG regimen in T2DM patients treated with oral agents and/or diet. One thousand patients (500 per arm) will be enrolled at 39 clinical sites in Italy. Eligible patients will be randomized to the intensive structured monitoring (ISM) group or the active control (AC) group, with a glycosylated hemoglobin (HbA1c) target of <7.0%. Intervention will comprise (1) structured SMBG (4-point daily glucose profiles on 3 days per week [ISM]; discretionary, unstructured SMBG [AC]); (2) comprehensive patient education (both groups); and (3) clinician's adjustment of diabetes medications using an algorithm targeting SMBG levels, HbA1c and hypoglycemia (ISM) or HbA1c and hypoglycemia (AC). The intervention and trial design build upon previous research by emphasizing appropriate and collaborative use of SMBG by both patients and physicians. Utilization of per protocol and intent-to-treat analyses facilitates assessment of the intervention. Inclusion of multiple dependent variables allows us to assess the broader impact of the intervention, including changes in patient and physician attitudes and behaviors.
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Affiliation(s)
- Marina Scavini
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Bosi
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
- San Raffaele Vita-Salute University, Milan, Italy
| | - Antonio Ceriello
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS) and Centro de Investigacion Biomedica en Red de Diabetes y Enfermedades Metabolicas Asociadis (CIBERDEM), Barcelona, Spain
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari School of Medicine, Bari, Italy
| | - Massimo Porta
- Department of Internal Medicine, University of Turin, Turin, Italy
| | - Antonio Tiengo
- Department of Clinical and Experimental Medicine, Division of Metabolic Diseases, University of Padova, Padua, Italy
| | - Giacomo Vespasiani
- Diabetes Unit, Ospedale Madonna del Soccorso, S. Benedetto del Tronto, Italy
| | | | - Raffaele Marino
- Medical Affairs Department Roche Diagnostics S.p.A., Monza, Italy
| | - Christopher Parkin
- Information and Education Development, CGParkin, Inc., Las Vegas, NV USA
| | - Erminio Bonizzoni
- Department of Occupational Health Clinica del Lavoro L Devoto, Section of Medical Statistics and Biometry GA Maccacaro, School of Medicine, University of Milan, Milan, Italy
| | - Domenico Cucinotta
- Department of Internal Medicine, Policlinico Universitario Gaetano Martino, Messina, Italy
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Berard LD, Blumer I, Houlden R, Miller D, Woo V. Surveillance du contrôle de la glycémie. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Blevins T. Value and utility of self-monitoring of blood glucose in non-insulin-treated patients with type 2 diabetes mellitus. Postgrad Med 2013; 125:191-204. [PMID: 23748520 DOI: 10.3810/pgm.2013.05.2668] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Self-monitoring of blood glucose (SMBG) levels provides important information regarding glycemic control for patients with diabetes, and is recommended by European and American diabetes organizations as an essential adjunct to periodic glycated hemoglobin (HbA1c) level monitoring. The benefits of SMBG in improving glycemic control in patients with type 1 diabetes and those with type 2 diabetes (T2DM) who are being treated with insulin are well recognized. In contrast, the potential role of SMBG in patients with T2DM not treated with insulin remains controversial, which may lead to underutilization of SMBG in this population. Structured SMBG, introduced as part of a treatment intervention, has been associated with modest but significant improvements in HbA1c levels in patients with T2DM who are not taking insulin as part of their management plan. Patient-obtained readings provide valuable real-time feedback on glucose responses to meals and exercise, and provide the patient with guidance on the day-to-day management of their diabetes. Studies have shown that when patients perform self-monitoring as part of their treatment interventions, support through appropriate educational initiatives is critical to ensure that patients understand the rationale for SMBG. Patients should be trained in correct testing technique and data recording for SMBG, as well as target blood glucose and goal HbA1c levels so that they will know when their SMBG readings are out of range. Technology has a potential role in facilitating SMBG-based interventions by improving patient-physician communication and optimizing glycemic control through the use of remote data uploading, data analysis tools, and, perhaps, even text messaging. This review outlines the benefits of SMBG in the management of patients with T2DM not treated with insulin, and highlights strategies for improving the effectiveness of SMBG-based treatment interventions in this population.
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Affiliation(s)
- Thomas Blevins
- Texas Diabetes and Endocrinology, Austin, TX 78731, USA.
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Grady M, Campbell D, MacLeod K, Srinivasan A. Evaluation of a blood glucose monitoring system with automatic high- and low-pattern recognition software in insulin-using patients: pattern detection and patient-reported insights. J Diabetes Sci Technol 2013; 7:970-8. [PMID: 23911178 PMCID: PMC3879761 DOI: 10.1177/193229681300700419] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to evaluate the performance of a glucose pattern recognition tool incorporated in a blood glucose monitoring system (BGMS) and its association with clinical measures, and to assess user perception and understanding of the pattern messages they receive. METHODS Participants had type 1 or type 2 diabetes mellitus and were self-adjusting insulin doses for ≥1 year. During a 4-week home testing period, participants performed ≥6 daily self-tests, adjusted their insulin regimen based on BGMS results, and recorded pattern messages in the logbook. Participants reflected on usability of the pattern tool in a questionnaire. RESULTS Study participants (n = 101) received a mean ± standard deviation of 4.5 ± 1.9 pattern messages per week (3.6 ± 1.8 high glucose patterns and 0.9 ± 1.3 low glucose patterns). Most received ≥1 high (96.5%) and/or ≥1 low (46.0%) pattern message per week. The average number of high- and low-pattern messages per week was associated with higher and lower, respectively, baseline hemoglobin A1c (p < .01) and fasting plasma glucose (p < .05). Participants found high- and low-pattern messages clear and easy to understand (84.2% and 83.2%, respectively) and considered the frequency of low (82.0%) and high (63.4%) pattern messages about right. Overall, 71.3% of participants indicated they preferred to use a meter with pattern messages. CONCLUSIONS The on-device Pattern tool identified meaningful blood glucose patterns, highlighting potential opportunities for improving glycemic control in patients who self-adjust their insulin.
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Unger J, Hinnen D, Schreiner B, Parkin C. Putting medications where they belong: Practical advice for managing type 2 diabetes in clinical practice. ACTA ACUST UNITED AC 2013; 25:65-76. [DOI: 10.1111/j.1745-7599.2012.00736.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jeff Unger
- Catalina Research Institute; Chino; California
| | | | | | - Chris Parkin
- CG Parkin Communications, Inc.; Las Vegas; Nevada
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Aghili R, Khamseh ME, Malek M, Yarahmadi S, Farshchi A. Structured self monitoring of blood glucose in Iranian people with type 2 diabetes; A cost consequence analysis. ACTA ACUST UNITED AC 2012; 20:32. [PMID: 23351493 PMCID: PMC3555770 DOI: 10.1186/2008-2231-20-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/26/2012] [Indexed: 11/10/2022]
Abstract
Background Self-Monitoring of Blood Glucose (SMBG) is considered as a key factor in management of people with diabetes which is a growing and cost demanding health problem. The purpose of this study was to investigate the effect of comprehensive patient management using structured SMBG on metabolic control as well as its cost consequence analysis. Methods Sixty subjects were recruited in an observational study for a period of 6 months. They were provided with the ACCU-CHEK 360° View tool to fill in the values of the 7-point blood glucose profiles in three consecutive days during the study on a monthly basis. Changes in metabolic control were assessed by HbA1c and lipid profile measurement at the beginning and at the end of the study. In addition, cost consequence analysis was done considering different level of health care professionals with or without insurance coverage. The Average Cost Effectiveness Ratio (ACER) as well as Cost saving analysis were calculated and compared. Results The analysis showed significant reduction in HbA1c during the 6-month period in all subjects (P = 0.000). Furthermore, a positive effect was observed on lipid profile. The cost of endocrinologist’s visit in private sector was estimated to be 265.76 USD while this figure was149.15 USD for general practitioner in public sector with insurance coverage. Total complications and mortality cost saving was 154.8 USD. The lowest ACER was calculated for intervention with general practitioner in public sector with insurance coverage. Conclusion Structured SMBG results in significant improvement of glycemic status. Moreover, it is more cost saving in public sector with insurance coverage. It seems that general practitioner visits with insurance coverage is the most affordable option for people with type 2 diabetes.
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Affiliation(s)
- Rokhsareh Aghili
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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Chatzimarkakis J. Why patients should be more empowered: a European perspective on lessons learned in the management of diabetes. J Diabetes Sci Technol 2010; 4:1570-3. [PMID: 21129355 PMCID: PMC3005070 DOI: 10.1177/193229681000400634] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient empowerment has emerged as a new paradigm that can help improve medical outcomes while lowering costs of treatment. The concept seems particularly promising in the management of chronic diseases. Diabetes may provide a blueprint for implementing patient empowerment because empowering patients has been instrumental in achieving the successes we have witnessed in the management of diabetes in recent decades. Looking at the example of diabetes, this article investigates the role and contribution of patient empowerment to therapy success and derives actions that need to be taken in order to fully leverage the potential of this concept for patients, health care professionals, and health systems.
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Abstract
Type 2 diabetes mellitus is a complicated metabolic disease affecting millions of individuals worldwide. The medications used to manage the disease are based on different pharmacologic approaches, including decreasing hepatic gluconeogenesis, stimulating pancreatic insulin production, slowing polysaccharide digestion, and increasing insulin sensitivity in muscle, liver, and fat to lower blood glucose. Incretin-based therapies, including glucagon-like peptide-1 (GLP-1) receptor agonists, mimic the effects of native GLP-1, while dipeptidyl peptidase-4 inhibitors increase circulating concentrations of endogenous GLP-1. This review focuses on means by which primary care physicians might evaluate the utility of pharmacologic agents based on their relation to the pathogenesis of type 2 diabetes. In general, patients with type 2 diabetes should be treated to their lowest targeted glycemic goals as soon as they are diagnosed, for as long as possible, as safely as possible, and as rationally as possible.
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Affiliation(s)
- Jeff Unger
- Metabolic Studies, Catalina Research Institute, Chino, CA 91710, USA.
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Abstract
Self-monitoring of blood glucose (SMBG) should be part of a regular management plan for patients with diabetes. Self-monitoring of blood glucose provides information regarding an individual's dynamic blood glucose profile. This information can help with the appropriate scheduling of food, activity, and medication. It is also required for understanding of the timing of blood glucose variations. Lack of regular SMBG predicts hospitalization for diabetes-related complications. Self-monitoring of blood glucose is an essential tool for people with diabetes who are taking insulin or for those who experience fluctuations in their blood glucose levels, especially hypoglycemia. Application of practical aspects that aid in easy management of SMBG makes the task of checking blood glucose more achievable. For patients taking insulin and adjusting their dose, SMBG is needed for self-management. For others receiving oral medication, profiling glucose trends and the confirmation of high or low blood glucose can be a useful addendum to successful management.
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Affiliation(s)
- Julienne K Kirk
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1084 , USA.
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Unger J, Parkin CG. Appropriate, timely, and rational treatment of type 2 diabetes mellitus: Meeting the challenges of primary care. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-0843(09)80029-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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