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Sun X, Zhou X, Li S, Ji L. Association between frequency of self-monitoring of blood glucose and glycemic control in patients with type 2 diabetes. Diabetes Res Clin Pract 2024; 209:111027. [PMID: 38000665 DOI: 10.1016/j.diabres.2023.111027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
AIM To determine the association between the frequency of self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes. METHODS The retrospective study analyzed data from 3,630 patients with type 2 diabetes who were enrolled between August 2020 and July 2021. 2456 non-insulin-treated patients were divided into SMBG ≤ 6 times/week and > 6 times/week groups. 1174 insulin-treated patients were divided into SMBG ≤ 9 times/week and > 9 times/week groups. Propensity score matching was used to generate groups with well-balanced covariates. Primary outcomes were changes in fasting blood glucose (FBG) and postprandial blood glucose (PBG) from baseline to 6 months. RESULTS In the non-insulin-treated group, a comparison in FBG and PBG reduction between the SMBG > 6 times/week and ≤ 6 times/week groups was statistically significant (-0.59 vs. -0.18 mmol/l, P < 0.001; -0.91 vs. -0.36 mmol/l, P < 0.001). In the insulin-treated group, there was no statistically significant reduction in FBG or PBG, patients with baseline FBG > 8 or 9 mmol/l and SMBG > 9 times/week had a significant FBG reduction than the ≤ 9 times/week group. CONCLUSION Frequent SMBG was associated with better glycemic control in non-insulin-treated patients. Insulin-treated patients with poor glycemic control may benefit from frequent SMBG.
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Affiliation(s)
- Xiaoyan Sun
- Department of Endocrinology and Metabolism, Peking University People's Hospital, 11th South Street, Xicheng District, Beijing 100044, China
| | - Xianghai Zhou
- Department of Endocrinology and Metabolism, Peking University People's Hospital, 11th South Street, Xicheng District, Beijing 100044, China
| | - Shaobo Li
- Sinocare Inc., No. 265, Guyuan Road Hi-tech Zone, Changsha, Hunan, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, 11th South Street, Xicheng District, Beijing 100044, China.
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2
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Takano M, Nagasaki S, Sakuma J, Shimabukuro M, Kotaki H, Nakata M. Association of amniotic fluid natriuretic peptide levels with ductus venosus Doppler flow in recipient twins with twin-to-twin transfusion syndrome : DV flow and NT-proBNP in TTTS recipient twins. J Med Ultrason (2001) 2022; 49:703-708. [PMID: 35841435 DOI: 10.1007/s10396-022-01241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examined the relationships between fetal quantitative Doppler parameters and amniotic fluid N-terminal prohormone brain natriuretic peptide (afNT-proBNP) levels as a biomarker of the increased cardiac load in recipient twins with twin-to-twin transfusion syndrome (TTTS). METHODS This single-center, prospective study included all monochorionic diamniotic (MD) twin pregnancies that were diagnosed with TTTS and underwent fetoscopic laser surgery. Doppler flow was used to measure the pulsatility index (PI) of the umbilical artery (UA), ductus venosus (DV), and middle cerebral artery (MCA) of each recipient and donor twins. The afNT-proBNP levels of recipient twins were examined at the time of surgery. The Spearman or Pearson correlation coefficients were used to assess the relationships between afNT-proBNP levels and Doppler parameters. RESULTS A total of 150 MD twin pregnancies were included. The afNT-proBNP levels of the recipient twins showed a stronger correlation with the DV-PI (r = 0.637; P < 0.001) of recipient twins than with the UA-PI and MCA-PI of recipient twins. The Doppler parameters of donor twins were scarcely correlated with the afNT-proBNP levels of the recipient twins. CONCLUSION A positive correlation between the DV-PI and afNT-proBNP levels of recipient twins with TTTS was observed. The recipient twin with an increased DV-PI is expected to be under a high cardiac load; therefore, DV-PI is a useful parameter for assessing increased NT-proBNP levels consecutively and noninvasively. CLINICAL TRIAL REGISTRATION This study was registered with Japanese Clinical Trial Registry "UMIN-CTR" ( http://www.umin.ac.jp/ctr/index-j.htm ; trial ID numbers UMIN000024486 and 000037702).
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Affiliation(s)
- Mayumi Takano
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Sumito Nagasaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junya Sakuma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Makiko Shimabukuro
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Hikari Kotaki
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
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3
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Winterbottom C. Diabetic leg and foot ulcers: how district nurses can promote wound healing through blood glucose control. Br J Community Nurs 2022; 27:S12-S18. [PMID: 35671195 DOI: 10.12968/bjcn.2022.27.sup6.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diabetes is a chronic and often life-long condition that is a consequence of the blood glucose level being too high (National Institute for Health and Clinical Excellence (NICE), 2019). Diabetes covers a range of conditions such as type 1 diabetes, type 2 diabetes and gestational diabetes. It has been well documented that uncontrolled blood glucose levels can lead to further circulatory damage, which impedes the wound healing process and often results in chronic wounds that do not heal. This article uses data collected from an audit and explores how district nursing teams can improve wound healing for those living at home with diabetic ulcers (DUs) by regularly monitoring blood glucose levels. This is followed by a discussion on how district nurses can support their team to adapt best practice, and the benefits of regularly checking blood glucose levels, even for service users that manage their diabetes with diet or oral medication. The article also explores how the multidisciplinary team can be accessed and used efficiently and how leadership skills can improve service user care and safety.
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Stedman M, Rea R, Duff CJ, Livingston M, McLoughlin K, Wong L, Brown S, Grady K, Gadsby R, Gibson JM, Paisley A, Fryer AA, Heald AH. The experience of blood glucose monitoring in people with type 2 diabetes mellitus (T2DM). Endocrinol Diabetes Metab 2022; 5:e00302. [PMID: 34921531 PMCID: PMC8917860 DOI: 10.1002/edm2.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Finger prick blood glucose (BG) monitoring remains a mainstay of management in people with type 2 diabetes (T2DM) who take sulphonylurea (SU) drugs or insulin. We recently examined patient experience of BG monitoring in people with type 1 diabetes (T1DM). There has not been any recent comprehensive assessment of the performance of BG monitoring strips or the patient experience of BG strips in people with T2DM in the UK. METHODS An online self-reported questionnaire containing 44 questions, prepared following consultation with clinicians and patients, was circulated to people with T2DM. 186 responders provided completed responses (25.5% return rate). Fixed responses were coded numerically (eg not confident = 0 fairly confident = 1). RESULTS Of responders, 84% were treated with insulin in addition to other agents. 75% reported having had an HbA1c check in the previous 6 months. For those with reported HbA1c ≥ 65 mmol/mol, a majority of people (70%) were concerned or really concerned about the shorter term consequences of running a high HbA1c This contrasted with those who did not know their recent HbA1c, of whom only 33% were concerned/really concerned and those with HbA1c <65 mmol/mol of whom 35% were concerned. Regarding BG monitoring/insulin adjustment, only 25% of responders reported having sufficient information with 13% believing that the accuracy and precision of their BG metre was being independently checked. Only 9% recalled discussing BG metre accuracy when their latest metre was provided and only 7% were aware of the International Standardisation Organisation (ISO) standards for BG metres. 77% did not recall discussing BG metre performance with a healthcare professional. CONCLUSION The group surveyed comprised engaged people with T2DM but even within this group there was significant variation in (a) awareness of shorter term risks, (b) confidence in their ability to implement appropriate insulin dosage (c) awareness of the limitations of BG monitoring technology. There is clearly an area where changes in education/support would benefit many.
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Affiliation(s)
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| | - Christopher J Duff
- Department of Clinical Biochemistry, North Midlands and Cheshire Pathology Service, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK.,School of Medicine, Keele University, Keele, UK
| | - Mark Livingston
- Black Country Pathology Services, Walsall Manor Hospital, Walsall, UK
| | | | | | | | | | - Roger Gadsby
- Warwick Medical School, University of Warwick, West Midlands, UK
| | - John M Gibson
- Salford Royal Hospital, Salford, UK.,The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Anthony A Fryer
- Department of Clinical Biochemistry, North Midlands and Cheshire Pathology Service, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK.,School of Medicine, Keele University, Keele, UK
| | - Adrian H Heald
- Salford Royal Hospital, Salford, UK.,The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Kim J, Hur MH. The Effects of Dietary Education Interventions on Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168439. [PMID: 34444187 PMCID: PMC8393495 DOI: 10.3390/ijerph18168439] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
As the incidence and prevalence of diabetes increases, intervention through dietary education is becoming more important for diabetes control. This systematic review examines the evidence for the efficacy of dietary education interventions on diabetes control. The study subjects were patients with type 2 diabetes, and the main outcome variable was glycosylated hemoglobin level (HbA1c). The target studies were randomized controlled trials. Thirty-six studies were included in the analysis, of which 33 were included in the meta-analysis. The effect size between dietary education and general interventions was -0.42 (n = 5639, MD = -0.42; 95% CI -0.53 to -0.31) and was significantly different (Z = 7.73, p < 0.001). When subgroup analyses were performed following the application periods, intervention methods, and intervention contents, the mean differences in 4-6-month application, individual education, and diet-exercise-psychosocial intervention were -0.51, (n = 2742, 95% CI -0.71 to -0.32), -0.63 (n = 627, 95% CI -1.00 to -0.26), and -0.51 (n = 3244, 95% CI -0.71 to -0.32), respectively. Dietary education interventions provided for at least 3 months were highly effective in controlling HbA1c levels. Regarding the education method, individualized education was more effective, and contact or non-contact education may be applied for this. Combining diet, exercise, and psychosocial intervention is more effective than diet education alone.
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Affiliation(s)
- Juri Kim
- Department of Nursing, University of Kyungmin, 545 Seobu-ro, Uijeongbu-si 11618, Korea;
| | - Myung-Haeng Hur
- College of Nursing, Eulji University, 712 Dongil-ro, Uijeongbu-si 11759, Korea
- Correspondence: ; Tel.: +82-31-951-3868
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6
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Stedman M, Rea R, Livingston M, McLoughlin K, Wong L, Brown S, Grady K, Gadsby R, Paisley A, Heald A. People with Type 2 Diabetes Mellitus (T2DM) Self-Reported Views on Their Own Condition Management Reveal a High Level of Insight into the Challenges Faced. J Diabetes Sci Technol 2021; 15:972-973. [PMID: 33998847 PMCID: PMC8252150 DOI: 10.1177/19322968211009261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS FT, Oxford
| | - Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, Walsall Manor Hospital, Walsall
- School of Medicine and Clinical Practice, Faculty of Science & Engineering, The University of Wolverhampton
| | | | | | | | | | - Roger Gadsby
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Adrian Heald
- Salford Royal Hospital, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, UK
- Adrian Heald, DM, Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK.
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Peters JL, Anderson R, Shields B, King S, Hudson M, Shepherd M, McDonald TJ, Pearson E, Hattersley A, Hyde C. Strategies to identify individuals with monogenic diabetes: results of an economic evaluation. BMJ Open 2020; 10:e034716. [PMID: 32193268 PMCID: PMC7150598 DOI: 10.1136/bmjopen-2019-034716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To evaluate and compare the lifetime costs associated with strategies to identify individuals with monogenic diabetes and change their treatment to more appropriate therapy. DESIGN A decision analytical model from the perspective of the National Health Service (NHS) in England and Wales was developed and analysed. The model was informed by the literature, routinely collected data and a clinical study conducted in parallel with the modelling. SETTING Secondary care in the UK. PARTICIPANTS Simulations based on characteristics of patients diagnosed with diabetes <30 years old. INTERVENTIONS Four test-treatment strategies to identify individuals with monogenic diabetes in a prevalent cohort of diabetics diagnosed under the age of 30 years were modelled: clinician-based genetic test referral, targeted genetic testing based on clinical prediction models, targeted genetic testing based on biomarkers, and blanket genetic testing. The results of the test-treatment strategies were compared with a strategy of no genetic testing. PRIMARY AND SECONDARY OUTCOME MEASURES Discounted lifetime costs, proportion of cases of monogenic diabetes identified. RESULTS Based on current evidence, strategies using clinical characteristics or biomarkers were estimated to save approximately £100-£200 per person with diabetes over a lifetime compared with no testing. Sensitivity analyses indicated that the prevalence of monogenic diabetes, the uptake of testing, and the frequency of home blood glucose monitoring had the largest impact on the results (ranging from savings of £400-£50 per person), but did not change the overall findings. The model is limited by many model inputs being based on very few individuals, and some long-term data informed by clinical opinion. CONCLUSIONS Costs to the NHS could be saved with targeted genetic testing based on clinical characteristics or biomarkers. More research should focus on the economic case for the use of such strategies closer to the time of diabetes diagnosis. TRIAL REGISTRATION NUMBER NCT01238380.
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Affiliation(s)
- Jaime L Peters
- Exeter Test Group, University of Exeter Medical School, Exeter, Devon, UK
- Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula), University of Exeter Medical School, Exeter, UK
| | - Rob Anderson
- ESMI (Evidence Synthesis & Modelling for Health Improvement), University of Exeter, Exeter, Devon, UK
| | - Beverley Shields
- NIHR Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Sophie King
- NIHR Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Michelle Hudson
- NIHR Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Maggie Shepherd
- NIHR Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Timothy James McDonald
- NIHR Clinical Research Facility, University of Exeter Medical School, Exeter, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Ewan Pearson
- Division of Molecular & Clinical Medicine, University of Dundee, Dundee, UK
| | - Andrew Hattersley
- NIHR Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- Exeter Test Group, University of Exeter Medical School, Exeter, Devon, UK
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Gc VS, Suhrcke M, Atkin AJ, van Sluijs E, Turner D. Cost-effectiveness of physical activity interventions in adolescents: model development and illustration using two exemplar interventions. BMJ Open 2019; 9:e027566. [PMID: 31427318 PMCID: PMC6701678 DOI: 10.1136/bmjopen-2018-027566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To develop a model to assess the long-term costs and health outcomes of physical activity interventions targeting adolescents. DESIGN A Markov cohort simulation model was constructed with the intention of being capable of estimating long-term costs and health impacts of changes in activity levels during adolescence. The model parameters were informed by published literature and the analysis took a National Health Service perspective over a lifetime horizon. Univariate and probabilistic sensitivity analyses were undertaken. SETTING School and community. PARTICIPANTS A hypothetical cohort of adolescents aged 16 years at baseline. INTERVENTIONS Two exemplar school-based: a comparatively simple, after-school intervention and a more complex multicomponent intervention compared with usual care. PRIMARY AND SECONDARY OUTCOME MEASURES Incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained. RESULTS The model gave plausible estimates of the long-term effect of changes in physical activity. The use of two exemplar interventions suggests that the model could potentially be used to evaluate a number of different physical activity interventions in adolescents. The key model driver was the degree to which intervention effects were maintained over time. CONCLUSIONS The model developed here has the potential to assess long-term value for money of physical activity interventions in adolescents. The two applications of the model indicate that complex interventions may not necessarily be the ones considered the most cost-effective when longer-term costs and consequences are taken into account.
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Affiliation(s)
- Vijay S Gc
- Centre for Health Economics, University of York, York, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
- Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Andrew J Atkin
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
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Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One 2019; 14:e0220116. [PMID: 31369582 PMCID: PMC6675068 DOI: 10.1371/journal.pone.0220116] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed. Objectives (1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting. Method A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised. Results 6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice. Conclusions These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | | | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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10
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Frías-Ordoñez JS, Pérez-Gualdrón CE. Self-monitoring of blood glucose as control tool in the different management contexts for Type 2 Diabetes Mellitus. What is its current role in non-insulin users? REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n3.69687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Self-monitoring blood glucose (SMBG) has been considered a key element in the management of Type 2 Diabetes Mellitus (T2DM). However, its role in glycemic control in non-insulin users has been long discussed.Objective: To conduct a narrative literature review of the benefits of SMBG in non-insulin-treated patients with T2DM.Materials and Methods: A scientific literature search was conducted in the following databases: Pubmed, ScienceDirect, Embase, SciELO, Cochrane and Medline. Relevant articles were selected according to the established criteria. In addition, some studies included in the references of the initially selected articles were added to the review since they were considered relevant for its objective.Results: The following records were included in the review: 14 controlled clinical trials, 13 observational studies, 10 clinical practice guidelines, 7 narrative reviews, 5 meta-analyses, and 1 systematic review.Conclusion: based on the evidence found in this review it is possible to say that the use of SMBG in patients with T2DM is beneficial and that it has a positive impact on non-insulin users in terms of achieving glycemic control and defining therapeutic changes.
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11
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Weinstock RS, Braffett BH, McGuigan P, Larkin ME, Grover NB, Walders-Abramson N, Laffel LM, Chan CL, Chang N, Schwartzman BE, Barajas RA, Celona-Jacobs N, Haymond MW. Self-Monitoring of Blood Glucose in Youth-Onset Type 2 Diabetes: Results From the TODAY Study. Diabetes Care 2019; 42:903-909. [PMID: 30833375 PMCID: PMC6489117 DOI: 10.2337/dc18-1854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/04/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether self-monitoring of blood glucose (SMBG) is associated with lower HbA1c in youth with type 2 diabetes taking oral medications only or after starting insulin for persistently elevated HbA1c. RESEARCH DESIGN AND METHODS Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study participants (n = 699) taking oral medications were asked to perform SMBG twice daily. After reaching primary outcome (PO) (HbA1c ≥8% [64 mmol/mol]) over 6 months or an inability to wean from temporary insulin because of metabolic decompensation), insulin glargine was started. HbA1c and percent of SMBG (SMBG%) (percent days when the meter was used one or more times) before and after PO were analyzed. RESULTS SMBG declined over time and was inversely related to HbA1c (P < 0.0001). Of 298 youth who reached PO and started insulin, 282 had SMBG data. At PO, mean ± SD age was 15.8 ± 2.3 years, BMI 35.5 ± 7.9 kg/m2, and HbA1c 9.6 ± 2.0% (81 ± 21.9 mmol/mol); 65.3% were female. Median SMBG% was 40% at PO, which increased to 49% after 6 months and fell to 41% after 1 year on insulin. At PO, 22% of youth checked ≥80% of days, which increased to 25% and fell to 19% after 6 and 12 months using insulin, respectively. At PO, compared with those who checked <80%, youth who checked ≥80% were younger and with a lower BMI, HbA1c, and blood pressure. SMBG ≥80% was associated with ≥1% reduction in HbA1c at 6 and 12 months after insulin initiation. CONCLUSIONS Low SMBG adherence was common and associated with higher HbA1c. Optimal SMBG frequency in youth using or not using insulin, and whether less frequent SMBG is a marker for overall worse self-care, require further study.
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Affiliation(s)
- Ruth S Weinstock
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Paul McGuigan
- Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Mary E Larkin
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, MA
| | - Nisha B Grover
- The Biostatistics Center, George Washington University, Rockville, MD
| | | | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | - Nancy Chang
- Children's Hospital of Los Angeles, Los Angeles, CA
| | | | - Rose Ann Barajas
- University of Texas Health Science Center San Antonio, San Antonio, TX
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12
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Veras VS, Filho FJFP, de Araújo MFM, de Souza Teixeira CR, Zanetti ML. The use of conversation maps in the metabolic control of diabetes in Brazilians: a randomized clinical trial. J Diabetes Metab Disord 2019; 18:25-32. [PMID: 31275871 DOI: 10.1007/s40200-019-00386-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
Objective To evaluate effects of an educative intervention over the self-monitoring of blood glucose (SMBG) at home for metabolic control. Method A total of 91 people with diabetes participated, recruited from the home capillary blood glycemia self-monitoring program. Two groups of participants were formed: one group participated in the SMBG program at home and with usual care (control group), while the other group participated in the SMBG at home and with educative intervention (intervention group). In total there were 12 meetings, three for each conversation map in the control of diabetes, during four months in 2011 and 2012. For all the analysis, a significance statistical level of 5% (p ≤ 0.05) was adopted. Results Most part of participants were females, married, with an average age of 62.1 years old and schooling from four to seven years of study. In the intervention group, an improvement was observed in the following measures: body mass index, abdominal circumference, diastolic blood pressure, fasting plasma glucose, HDL cholesterol, LDL cholesterol and triglycerides. The control group showed improvement in measures of systolic and diastolic blood pressure, fasting plasma glucose, HDL cholesterol and LDL cholesterol. Moreover, an increase on the values of glycated hemoglobin was observed in both groups. Conclusion It was observed that there was not statistical significant improvement of the metabolic control. However, it was possible to confirm that an educative intervention for SMBG at home presented a clinical significance, which in turn, resonates in a special way on the health of participants.
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Affiliation(s)
- Vivian Saraiva Veras
- University for International Integration of the Lusophony Afro Brazilian, CE 060, Km 51, S/N, Acarape, Acarape, Ceará CEP: 62785000 Brazil
| | | | - Márcio Flávio Moura de Araújo
- University for International Integration of the Lusophony Afro Brazilian, CE 060, Km 51, S/N, Acarape, Acarape, Ceará CEP: 62785000 Brazil
| | | | - Maria Lúcia Zanetti
- 4Department of General and Specialized Nursing, Ribeirão Preto School of Nursing, São Paulo University, Avenida Bandeirantes, n° 3900, Campus Universitário, Ribeirão Preto, São Paulo CEP: 1440902 Brazil
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13
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Abdulah DM, Hassan AB, Saadi FS, Mohammed AH. Impacts of self-management education on glycaemic control in patients with type 2 diabetes mellitus. Diabetes Metab Syndr 2018; 12:969-975. [PMID: 29903525 DOI: 10.1016/j.dsx.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/05/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Dietary and physical activity advice have been considered to be seminal ingredients in prevention and management of type 2 diabetes mellitus. In this regard, the impacts of a three-month self-management intervention on glycemic control in patients with type 2 diabetes were examined in the present study. STUDY DESIGN A Double-arm post-test intervention study. METHODS In the current post-test intervention study, three two-hour educational sessions on dietary habits and physical activity designed according to Health Belief Model were presented to 16 non-complicated type 2 diabetic patients and their dietary, physical activities, and biochemical outcomes were compared to a 23 patient-control arm in Iraq in 2017. The level of physical activity was measured through International Physical Activity Questionnaire (IPAQ), dietary habits through UK Diabetes and Diet Questionnaire (UKDDQ), and biochemical indicators including HbA1c were measured after three months of program completion. RESULTS The study showed that walking, taking vegetable, fruit, and bread were higher and taking full-fat cheese and full-fat spread was lower among experimental group significantly compared to control arm. In addition, the experimental group had a substantial higher albumin and lower urea, ALP-Phosphatase, and glucose levels in comparison with control patients. No substantial change was seen in HbA1C and no change in milk and fish products. CONCLUSIONS The substantial positive changes in physical activity, dietary habits, and some biochemical indicators were seen following intervention completion in the experimental arm.
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Affiliation(s)
| | - Alan Bapeer Hassan
- Basic Sciences Department, College of Nursing, University of Duhok, Iraq.
| | | | - Ary Habeeb Mohammed
- Community and Family Medicine Department, College of Medicine, University of Duhok, Iraq.
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14
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Chen CM, Hung LC, Chen YL, Yeh MC. Perspectives of patients with non-insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study. J Clin Nurs 2018; 27:1673-1683. [PMID: 29266453 DOI: 10.1111/jocn.14227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To explore experiences of self-monitoring of blood glucose among patients with non-insulin-treated type 2 diabetes. BACKGROUND Self-monitoring of blood glucose is essential to diabetes care and facilitates glycaemic control. Patients' perspectives of self-monitoring of blood glucose have seldom been discussed in the literature, and engagement in self-monitoring of blood glucose is consistently low. DESIGN The descriptive phenomenological method was used. METHODS Purposive sampling was conducted to recruit participants from the endocrinology departments of medical institutions in Taiwan based on the following criteria: (i) having a medical diagnosis of type 2 diabetes, (ii) not being treated with insulin, (iii) having engaged in self-monitoring of blood glucose at least once within the preceding 6 months, (iv) being at least 20 years old and (v) not having any major mental or cognitive disorders. Data were collected in outpatient consultation rooms, the participants' homes and other settings where the participants felt secure and comfortable. In-depth interviews were conducted to collect data from 16 patients with diabetes. RESULTS The participants perceived that lifestyle affected blood glucose levels and did not know how to handle high or low blood glucose levels. Their willingness to continue self-monitoring of blood glucose depended on whether healthcare professionals checked or discussed their blood glucose levels with them. CONCLUSIONS The patients' knowledge regarding blood glucose variation and healthcare professionals' attitudes affected the patients' self-monitoring of blood glucose behaviours. The empirical findings illustrated self-monitoring of blood glucose experiences and recommended that healthcare professionals' closely attend to patients' requirements and responses to diabetes and incorporate the self-monitoring of blood glucose into therapy plans. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should reinforce patients' knowledge on appropriate responses to high and low blood glucose levels, intervene appropriately, discuss self-monitoring of blood glucose results with patients and track these results.
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Affiliation(s)
- Chen-Mei Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Li-Chen Hung
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Mei Chang Yeh
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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15
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Clarke SF, Foster JR. A history of blood glucose meters and their role in self-monitoring of diabetes mellitus. Br J Biomed Sci 2018. [DOI: 10.1080/09674845.2012.12002443] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- S. F. Clarke
- History Committee, Institute of Biomedical Science, 12 Coldbath Square, London EC1R 5HL
| | - J. R. Foster
- History Committee, Institute of Biomedical Science, 12 Coldbath Square, London EC1R 5HL
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16
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Risso T, Furtado C. Rational use of blood glucose test strips for self-monitoring in patients with diabetes mellitus: Economic impact in the Portuguese healthcare system. Diabetes Res Clin Pract 2017; 134:161-167. [PMID: 28951334 DOI: 10.1016/j.diabres.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 04/07/2017] [Accepted: 07/03/2017] [Indexed: 11/15/2022]
Abstract
AIMS Self-monitoring of blood glucose is important for diabetes management in insulin-treated patients, but its effectiveness in patients treated with oral glucose lowering drugs only is not fully supported by current evidence. This paper aims to characterise the prescription patterns of blood glucose test strips (BGTS) in Portugal and estimate the potential cost-savings from the rational use of BGTS. METHODS A retrospective analysis of the Portuguese database of electronic medical prescriptions to assess the patterns of BGTS prescription. The database was searched for prescription, from 01 January 2016 to 31 December 2016, of insulin and other antidiabetics, as well as the associated prescriptions of BGTS. RESULTS 894,637 patients were prescribed antidiabetic medicines during 2016, 82.7% of which were prescribed oral glucose lowering drugs only. BGTS were prescribed to 456,179 patients, being more frequently prescribed in insulin-treated patients. Still, 42.8% of patients treated with oral glucose lowering drugs only were also prescribed BGTS, with large proportion of those being prescribed antidiabetic drugs with lower risk of causing hypoglycaemia and, even so, >200 BGTS/year. Several scenarios for a more rational use of BGTS were estimated to result in cost-savings of up to €9.5 million per year. CONCLUSIONS BGTS were prescribed to more than a third of patients treated with oral glucose lowering drugs only, despite accumulating evidence of their limited effectiveness in this population, resulting in substantial economic burden to the healthcare system. Given the estimated potential cost-savings, rational use of BGTS should be encouraged in Portugal.
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Affiliation(s)
- Teresa Risso
- Information and Strategic Planning Directorate, Infarmed IP - National Authority of Medicines and Health Products, IP, Lisbon, Portugal
| | - Cláudia Furtado
- Information and Strategic Planning Directorate, Infarmed IP - National Authority of Medicines and Health Products, IP, Lisbon, Portugal; National School of Public Health, Universidade NOVA de Lisboa, Portugal.
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17
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Effect of Moringa oleifera Leaf Capsules on Glycemic Control in Therapy-Naïve Type 2 Diabetes Patients: A Randomized Placebo Controlled Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:6581390. [PMID: 29317895 PMCID: PMC5727834 DOI: 10.1155/2017/6581390] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Abstract
Background Studies showed effects of Moringa oleifera (MO) on lowering blood sugar levels in animal and diabetes patients. The aims of this study were to determine the effect of MO leaf capsules on glucose control in therapy-naïve type 2 diabetes mellitus (T2DM) and to evaluate its safety. Method This was a prospective randomized placebo controlled study. Therapy-naïve T2DM was randomly assigned to receive either 8 grams per day of MO leaf capsules (MO leaf group) or placebo for 4 weeks. Clinical and laboratory characteristics were recorded at screening and at the end of 4-week study. 9-point plasma glucose was obtained before and every week during the study. Results Thirty-two T2DM patients were enrolled. The mean age was 55 years and the mean HbA1C was 7.0%. There was no significant difference in FPG and HbA1C between groups. MO leaf group had SBP reduction by 5 mmHg as compared to baseline but this difference had no statistical significance. There were no adverse effects of MO leaf. Conclusions Moringa oleifera leaf had no effect on glycemic control and no adverse effects in T2DM. Interestingly, this study demonstrated that MO leaf had a tendency on blood pressure reduction in T2DM, and this result needs further investigation.
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18
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Teljeur C, Moran PS, Walshe S, Smith SM, Cianci F, Murphy L, Harrington P, Ryan M. Economic evaluation of chronic disease self-management for people with diabetes: a systematic review. Diabet Med 2017; 34:1040-1049. [PMID: 27770591 DOI: 10.1111/dme.13281] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/17/2022]
Abstract
AIMS To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. BACKGROUND Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA1c levels in people with diabetes. METHODS Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used. RESULTS A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias. CONCLUSIONS Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.
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Affiliation(s)
- C Teljeur
- Health Information and Quality Authority, Dublin, Ireland
- Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - P S Moran
- Health Information and Quality Authority, Dublin, Ireland
| | - S Walshe
- Health Information and Quality Authority, Dublin, Ireland
| | - S M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Cianci
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - L Murphy
- Health Information and Quality Authority, Dublin, Ireland
| | - P Harrington
- Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Information and Quality Authority, Dublin, Ireland
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19
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Young LA, Buse JB, Weaver MA, Vu MB, Mitchell CM, Blakeney T, Grimm K, Rees J, Niblock F, Donahue KE. Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial. JAMA Intern Med 2017; 177:920-929. [PMID: 28600913 PMCID: PMC5818811 DOI: 10.1001/jamainternmed.2017.1233] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
IMPORTANCE The value of self-monitoring of blood glucose (SMBG) levels in patients with non-insulin-treated type 2 diabetes has been debated. OBJECTIVE To compare 3 approaches of SMBG for effects on hemoglobin A1c levels and health-related quality of life (HRQOL) among people with non-insulin-treated type 2 diabetes in primary care practice. DESIGN, SETTING, AND PARTICIPANTS The Monitor Trial study was a pragmatic, open-label randomized trial conducted in 15 primary care practices in central North Carolina. Participants were randomized between January 2014 and July 2015. Eligible patients with type 2 non-insulin-treated diabetes were: older than 30 years, established with a primary care physician at a participating practice, had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5% within the 6 months preceding screening, as obtained from the electronic medical record, and willing to comply with the results of random assignment into a study group. Of the 1032 assessed for eligibility, 450 were randomized. INTERVENTIONS No SMBG, once-daily SMBG, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the meter. MAIN OUTCOMES AND MEASURES Coprimary outcomes included hemoglobin A1c levels and HRQOL at 52 weeks. RESULTS A total of 450 patients were randomized and 418 (92.9%) completed the final visit. There were no significant differences in hemoglobin A1c levels across all 3 groups (P = .74; estimated adjusted mean hemoglobin A1c difference, SMBG with messaging vs no SMBG, -0.09%; 95% CI, -0.31% to 0.14%; SMBG vs no SMBG, -0.05%; 95% CI, -0.27% to 0.17%). There were also no significant differences found in HRQOL. There were no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation. CONCLUSIONS AND RELEVANCE In patients with non-insulin-treated type 2 diabetes, we observed no clinically or statistically significant differences at 1 year in glycemic control or HRQOL between patients who performed SMBG compared with those who did not perform SMBG. The addition of this type of tailored feedback provided through messaging via a meter did not provide any advantage in glycemic control. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02033499.
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Affiliation(s)
- Laura A Young
- Division of Endocrinology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - John B Buse
- Division of Endocrinology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Mark A Weaver
- Departments of Medicine and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Maihan B Vu
- Center for Health Promotion and Disease Prevention, UNC Chapel Hill, North Carolina
| | - C Madeline Mitchell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Tamara Blakeney
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kimberlea Grimm
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Jennifer Rees
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Franklin Niblock
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Katrina E Donahue
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill.,Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
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20
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Young LA, Buse JB, Weaver MA, Vu MB, Reese A, Mitchell CM, Blakeney T, Grimm K, Rees J, Donahue KE. Three approaches to glucose monitoring in non-insulin treated diabetes: a pragmatic randomized clinical trial protocol. BMC Health Serv Res 2017; 17:369. [PMID: 28545493 PMCID: PMC5445357 DOI: 10.1186/s12913-017-2202-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 03/30/2017] [Indexed: 11/26/2022] Open
Abstract
Background For the nearly 75% of patients living with type 2 diabetes (T2DM) that do not use insulin, decisions regarding self-monitoring of blood glucose (SMBG) can be especially problematic. While in theory SMBG holds great promise for sparking favorable behavior change, it is a resource intensive activity without firmly established patient benefits. This study describes our study protocol to assess the impact of three different SMBG testing approaches on patient-centered outcomes in patients with non-insulin treated T2DM within a community-based, clinic setting. Methods/Design Using stakeholder engagement approach, we developed and implemented a pragmatic trial of patient with non-insulin treated T2DM patients from five primary care practices randomized to one of three SMBG regimens: 1) no testing; 2) once daily testing with standard feedback consisting of glucose values being immediately reported to the patient through the glucose meter; and 3) once daily testing with enhanced patient feedback consisting of glucose values being immediately reported to the patient PLUS automated, tailored feedback messaging delivered to the patient through the glucose meter following each testing. Main outcomes assessed at 52 weeks include quality of life and glycemic control. Discussion This pragmatic trial seeks to better understand the value of SMBG in non-insulin treated patients with T2DM. This paper outlines the protocol used to implement this study in fifteen community-based primary care practices and highlights the impact of stakeholder involvement from the earliest stages of project conception and implementation. Plans for stakeholder involvement for result dissemination are also discussed. Trial registration ClinicalTrials.gov NCT02033499, January 9, 2014.
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Affiliation(s)
- Laura A Young
- Division of Endocrinology, Department of General Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, 8025 Burnett Womack Building, Campus Box # 7172 UNC-CH, Chapel Hill, NC, 27599-7170, USA. .,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - John B Buse
- Division of Endocrinology, Department of General Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, 8025 Burnett Womack Building, Campus Box # 7172 UNC-CH, Chapel Hill, NC, 27599-7170, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark A Weaver
- UNC Gillings School of Global Public Health, Chapel Hill, USA
| | - Maihan B Vu
- Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, USA
| | - April Reese
- North Carolina Division of Public Health, Chapel Hill, USA
| | - C Madeline Mitchell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tamara Blakeney
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kimberlea Grimm
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Rees
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katrina E Donahue
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Wang Y, Liu M, Pu C. 2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack. Int J Stroke 2017; 12:302-320. [PMID: 28381199 DOI: 10.1177/1747493017694391] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.
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Affiliation(s)
- Yongjun Wang
- 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Liu
- 2 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanqiang Pu
- 3 Department of Neurology, The General Hospital of Chinese People's Liberation Army, Beijing, China
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22
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Blackwell M, Wheeler BJ. Clinical review: the misreporting of logbook, download, and verbal self-measured blood glucose in adults and children with type I diabetes. Acta Diabetol 2017; 54:1-8. [PMID: 27605000 DOI: 10.1007/s00592-016-0907-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Abstract
Despite advances in technology, the frequent self-measurement of blood glucose (SMBG) remains fundamental to the management of 1 diabetes mellitus (T1DM). Once measured, SMBG results are routinely reported back to health professionals and other interested parties, either verbally, via a logbook, or electronically downloaded from a pump or meter. The misreporting of SMBG using various techniques represents a classic non-adherence behavior and carries with it both acute and chronic dangers. In addition, while this behavior appears very prevalent, many aspects remain largely unstudied. With this in mind, we aimed to summarize literature addressing the misreporting of SMBG in T1DM via a detailed literature search. This produced both recent and past literature. While most of these studies examined the prevalence of deliberate misreporting in a verbal or logbook context, others focused on the motivations behind this behavior, and alternative forms of misreporting, including deliberate manipulation of meters to produce inaccurate results and true technological errors. This timely review covers all aspects of misreporting and highlights multiple patient techniques, which are clearly adapting to advances in technology. We believe that further understanding and attention to this aspect of adherence may lead not only to improvements in glycemic control and safety, but also to the psychological well-being of those affected by type 1 diabetes.
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Affiliation(s)
- Miranda Blackwell
- Department of Women's and Children's Health, University of Otago, PO Box 913, Dunedin, 9054, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, PO Box 913, Dunedin, 9054, New Zealand.
- Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand.
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23
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Reduction in self-monitoring of blood glucose in type 2 diabetes: an observational controlled study in east London. Br J Gen Pract 2016; 65:e256-63. [PMID: 25824186 DOI: 10.3399/bjgp15x684421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) confers no benefit for many people with type 2 diabetes not being treated with insulin. It accounts for 21% of diabetes prescribing costs. AIM To improve care quality at reduced cost for type 2 diabetes by reducing unnecessary SMBG. DESIGN AND SETTING Non-randomised, observational controlled study in two intervention clinical commissioning groups (CCGs) and one control CCG in east London. METHOD In total, 19,602 people with type 2 diabetes not being treated with insulin were recruited from two intervention CCGs; 16,033 were recruited from a control CCG. The intervention (from 2010 to 2013) comprised implementation of a locally developed guideline, including IT support and peer feedback of performance. Data on practice prescribing SMBG testing strips were gathered using GP electronic health records. Information on costs were obtained via the ePACT electronic database. RESULTS Over 4 years, in all non-insulin type 2 diabetes treatment groups, use of SMBG was reduced in the two intervention CCGs from 42.8% to 16.5%, and in the control CCG from 56.4% to 47.2%. In people on metformin alone or no treatment, intervention CCGs reduced SMBG use from 29.6% to 6.0%, and in the control CCG use dropped from 47.1% to 38.7% (P<0.001). From 2009 to 2012 the total cost of all SMBG prescribing (type 1 and type 2 diabetes, including users of insulin) was reduced by 4.9% (£62,476) in the two intervention CCGs and increased in the control CCG by 5.0% (£42,607); in England, the total cost increased by 13.5% (£19.4 million). In total, 20% (3865 of 19 602) fewer patients used SMBG in the intervention CCGs. CONCLUSION This low-cost programme demonstrated a major reduction in unnecessary prescribing of SMBG, along with cost savings. If replicated nationally, this would avoid unnecessary testing in 340 000 people and prescribing costs that total £21.8 million.
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Hissa MN. Brazilian multicenter study for the evaluation of patients' satisfaction of blood glucose self-monitoring with BGStar(®) blood glucose meter in insulinized patients with diabetes mellitus type 1 and 2. Diabetol Metab Syndr 2016; 8:66. [PMID: 27625706 PMCID: PMC5020543 DOI: 10.1186/s13098-016-0180-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is considered a global epidemic, and patient self-management education and support are critical in preventing and reducing the risk of complications. Self-monitoring of blood glucose (SMBG) is essential for care of individuals with DM, helping patients to achieve and maintain target blood glucose levels. The purpose of this study is to compare the satisfaction of insulinized DM patients on SMBG with use of investigational blood glucose meter (BGM) versus their routine device. METHODS A national, multicenter, open-label, phase 4 study was conducted on patients with type 1 or 2 DM under insulin therapy regimen, who were asked to use investigational BGM instead of their usual BGM device. The study was performed in 12 centers in Brazil for 12 weeks, with an extension period of 12 weeks. The primary endpoint was to measure the variation on the patients' level of satisfaction with investigational versus routine BGM, between visits, using a Visual Analogue Scale (VAS). Secondary endpoints addressed handling aspects, satisfaction, adherence and level of functionality and safety of investigational BGM. RESULTS The study included 292 patients (36.6 % DM1 and 63.4 % DM2), mean age 50.9 years old (±17.3 years), 57.5 % females. There was statistically significant improvement in global satisfaction with investigational BGM compared with routine BGM according to VAS [mean VAS score raised from 78.8 mm (SD = 18.0) to 90.8 mm (SD = 12.2) between visits]. After 12 weeks, level of satisfaction with investigational BGM according to questionnaires was superior to routine BGM regardless of age group (p < 0.001), type of DM (p < 0.001) or insulin regimen (p < 0.001). Investigational BGM was also regarded as safe, with 10 patients (3.4 %) reporting a total of 13 adverse events during the study. CONCLUSIONS Levels of satisfaction during SMBG were higher with use of investigational BGM and the device was deemed safe and easy to handle.
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Affiliation(s)
- Miguel Nasser Hissa
- Centro de Pesquisas em Diabetes e Doenças Endócrino-metabólicas, Medical School UNICHRISTUS, Rua Canuto de Aguiar, 500/100, Meireles, Fortaleza, Ceará 60160120 Brazil
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Eborall HC, Dallosso HM, McNicol S, Speight J, Khunti K, Davies MJ, Heller SR. Explaining engagement in self-monitoring among participants of the DESMOND Self-monitoring Trial: a qualitative interview study. Fam Pract 2015; 32:596-602. [PMID: 26160892 PMCID: PMC5926453 DOI: 10.1093/fampra/cmv060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) Self-monitoring Trial reported that people with newly diagnosed type 2 diabetes attending community-based structured education and randomized to self-monitoring of blood glucose (SMBG) or urine monitoring had comparable improvements in biomedical outcomes, but differences in satisfaction with, and continued use of monitoring method, well-being and perceived threat from diabetes. OBJECTIVES To explore experiences of SMBG and urine monitoring following structured education. We specifically addressed the perceived usefulness of each monitoring method and the associated well-being. METHODS Qualitative semi-structured interviews with 18 adults with newly diagnosed type 2 diabetes participating in the DESMOND Self-monitoring Trial (SMBG, N=10; urine monitoring, N=8)~12 months into the trial. Analysis was informed by the constant comparative approach. RESULTS Interviewees reported SMBG as accurate, convenient and useful. Declining use was explained by having established a pattern of managing blood glucose with less frequent monitoring or lack of feedback or encouragement from health care professionals. Many initially positive views of urine monitoring progressively changed due to perceived inaccuracy, leading some to switch to SMBG. Perceiving diabetes as less serious was attributable to lack of symptoms, treatment with diet alone and-in the urine-monitoring group-consistently negative readings. Urine monitoring also provided less visible evidence of diabetes and of the effect of behaviour on glucose. CONCLUSIONS The findings highlight the importance for professionals of considering patients' preferences when using self-monitoring technologies, including how these change over time, when supporting the self-care behaviours of people with type 2 diabetes.
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Affiliation(s)
- Helen C Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK,
| | - Helen M Dallosso
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK, Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Sarah McNicol
- Education and Social Research Institute, Manchester Metropolitan University, Manchester, UK
| | - Jane Speight
- AHP Research, Hornchurch, UK, The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia, Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK, Diabetes Research Centre, University of Leicester, Leicester, UK and
| | - Melanie J Davies
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK, Diabetes Research Centre, University of Leicester, Leicester, UK and
| | - Simon R Heller
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
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Affiliation(s)
| | - Guang Ning
- Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.
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27
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Collins B, Capewell S, O'Flaherty M, Timpson H, Razzaq A, Cheater S, Ireland R, Bromley H. Modelling the Health Impact of an English Sugary Drinks Duty at National and Local Levels. PLoS One 2015; 10:e0130770. [PMID: 26121677 PMCID: PMC4486083 DOI: 10.1371/journal.pone.0130770] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/23/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasing evidence associates excess refined sugar intakes with obesity, Type 2 diabetes and heart disease. Worryingly, the estimated volume of sugary drinks purchased in the UK has more than doubled between 1975 and 2007, from 510 ml to 1140 ml per person per week. We aimed to estimate the potential impact of a duty on sugar sweetened beverages (SSBs) at a local level in England, hypothesising that a duty could reduce obesity and related diseases. METHODS AND FINDINGS We modelled the potential impact of a 20% sugary drinks duty on local authorities in England between 2010 and 2030. We synthesised data obtained from the British National Diet and Nutrition Survey (NDNS), drinks manufacturers, Office for National Statistics, and from previous studies. This produced a modelled population of 41 million adults in 326 lower tier local authorities in England. This analysis suggests that a 20% SSB duty could result in approximately 2,400 fewer diabetes cases, 1,700 fewer stroke and coronary heart disease cases, 400 fewer cancer cases, and gain some 41,000 Quality Adjusted Life Years (QALYs) per year across England. The duty might have the biggest impact in urban areas with young populations. CONCLUSIONS This study adds to the growing body of evidence suggesting health benefits for a duty on sugary drinks. It might also usefully provide results at an area level to inform local price interventions in England.
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Affiliation(s)
- Brendan Collins
- University of Liverpool Management School, Liverpool, United Kingdom
| | - Simon Capewell
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin O'Flaherty
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Hannah Timpson
- Centre for Public Health, Liverpool John Moores University, Liverpool, United Kingdom
| | | | | | | | - Helen Bromley
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
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Torbjørnsen A, Jenum AK, Småstuen MC, Arsand E, Holmen H, Wahl AK, Ribu L. A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH. JMIR Mhealth Uhealth 2014; 2:e52. [PMID: 25499592 PMCID: PMC4275473 DOI: 10.2196/mhealth.3535] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/26/2014] [Accepted: 09/27/2014] [Indexed: 01/11/2023] Open
Abstract
Background Self-management support for people with type 2 diabetes is essential in diabetes care. Thus, mobile health technology with or without low-intensity theory-based health counseling could become an important tool for promoting self-management. Objectives The aim was to evaluate whether the introduction of technology-supported self-management using the Few Touch Application (FTA) diabetes diary with or without health counseling improved glycated hemoglobin (HbA1c) levels, self-management, behavioral change, and health-related quality of life, and to describe the sociodemographic, clinical, and lifestyle characteristics of the participants after 4 months. Methods A 3-armed randomized controlled trial was conducted in Norway during 2011-2013. In the 2 intervention groups, participants were given a mobile phone for 1 year, which provided access to the FTA diary, a self-help tool that recorded 5 elements: blood glucose, food habits, physical activity, personal goal setting, and a look-up system for diabetes information. One of the intervention groups was also offered theory-based health counseling with a specialist diabetes nurse by telephone for 4 months from baseline. Both intervention groups and the control group were provided usual care according to the national guidelines. Adults with type 2 diabetes and HbA1c ≥7.1% were included (N=151). There were 3 assessment points: baseline, 4 months, and 1 year. We report the short-term findings after 4 months. HbA1c was the primary outcome and the secondary outcomes were self-management (Health Education Impact Questionnaire, heiQ), behavioral change (diet and physical activity), and health-related quality of life (SF-36 questionnaire). The data were analyzed using univariate methods (ANOVA), multivariate linear, and logistic regression. Results Data were analyzed from 124 individuals (attrition rate was 18%). The groups were well balanced at baseline. There were no differences in HbA1c between groups after 4 months, but there was a decline in all groups. There were changes in self-management measured using the health service navigation item in the heiQ, with improvements in the FTA group compared to the control group (P=.01) and in the FTA with health counseling group compared with both other groups (P=.04). This may indicate an improvement in the ability of patients to communicate health needs to their health care providers. Furthermore, the FTA group reported higher scores for skill and technique acquisition at relieving symptoms compared to the control group (P=.02). There were no significant changes in any of the domains of the SF-36. Conclusions The primary outcome, HbA1c, did not differ between groups after 4 months. Both of the intervention groups had significantly better scores than the control group for health service navigation and the FTA group also exhibited improved skill and technique acquisition.
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Affiliation(s)
- Astrid Torbjørnsen
- Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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Kim SK, Kim HJ, Kim T, Hur KY, Kim SW, Lee MK, Min YK, Kim KW, Chung JH, Kim JH. Effectiveness of 3-day continuous glucose monitoring for improving glucose control in type 2 diabetic patients in clinical practice. Diabetes Metab J 2014; 38:449-55. [PMID: 25541608 PMCID: PMC4273031 DOI: 10.4093/dmj.2014.38.6.449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/30/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate whether adjusting diabetic treatment regimens according to the information obtained from a continuous glucose monitoring system (CGMS) might lead to improved glycemic control in patients with type 2 diabetes. METHODS We reviewed the medical charts of 172 patients who used the CGMS for 1 year starting in December 2008 and the records of 1,500 patients who visited their regular outpatient clinics during December 2008. Of these patients, a total of 65 CGMS patients and 301 regular outpatients (control group) were enrolled in the study after propensity score matching. There were no differences in baseline glycated hemoglobin (HbA1c), age, and duration of diabetes between the CGMS and the control groups after propensity score matching. The changes in the HbA1c levels from baseline to 6 months were calculated. RESULTS The CGMS group showed a significant improvement in the HbA1c level compared to the control group at 3 months (7.9%±1.6% vs. 7.4%±1.2%, P=0.001) and at 6 months (7.4%±1.2% vs. 7.9%±1.6%, P=0.010). There were significant differences in the treatment modality changes between the CGMS group and the control group. CONCLUSION Using a 3-day CGMS was advantageous for improving glucose control in patients with type 2 diabetes and may help these patients to optimize glycemic control in clinical practice.
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Affiliation(s)
- Soo Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hye Jeong Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taehun Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Ki Min
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Won Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Morgan TO, Everett DL, Dunlop AL. How Do Interventions That Exemplify the Joint Principles of the Patient Centered Medical Home Affect Hemoglobin A1C in Patients With Diabetes: A Review. Health Serv Res Manag Epidemiol 2014; 1:2333392814556153. [PMID: 28462247 PMCID: PMC5289069 DOI: 10.1177/2333392814556153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To review the impact of the Joint Principle of the Patient Centered Medical Home (PCMH) on hemoglobin A1C (HbA1C) in primary care patients with diabetes. Methods: Systematic review of English articles using approximate terms for (1) the 7 principles of the PCMH, (2) primary care, and (3) HbA1C. We included experimental and observational studies. Three authors independently extracted data and obtained summary estimates for concepts with more than 2 high-quality studies. Results: Forty-three studies published between 1998 and 2012 met inclusion criteria, 33 randomized and 10 controlled before–after studies. A physician-directed medical practice (principle 2) lowered HbA1C values when utilizing nursing (mean difference [MD] −0.36, 95% confidence interval [CI] −0.43 to −0.28) or pharmacy care management (MD −0.76; 95% CI −0.93 to −0.59). Whole-person orientation (principle 3) also lowered HbA1C (MD −0.72, 95% CI −0.98 to −0.45). Studies of coordinated and integrated care (principle 4) and quality and safety interventions (principle 5) did not consistently lower HbA1C when reviewed in aggregate. We did not identify high-quality studies to make conclusions for personal physician (principle 1), enhanced access (principle 6), and payment (principle 7). Conclusion: Our review found individual interventions that reduced the HbA1C by up to 2.0% when they met the definitions set by of the Joint Principles of the PCMH. Two of the principles—physician-led team and whole-person orientation—consistently lowered the HbA1C. Other principles had limited data or made little to no impact. Based on current evidence, PCMH principles differentially influence the HbA1C, and there are opportunities for additional research.
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Affiliation(s)
- Toyosi O Morgan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darcie L Everett
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anne L Dunlop
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Chen CM, Chang Yeh M. The experiences of diabetics on self-monitoring of blood glucose: a qualitative metasynthesis. J Clin Nurs 2014; 24:614-26. [DOI: 10.1111/jocn.12691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Chen-Mei Chen
- Department of Nursing; Chang Gung University of Science and Technology; Taipei Taiwan
- Department of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Mei Chang Yeh
- Department of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
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Bolen SD, Chandar A, Falck-Ytter C, Tyler C, Perzynski AT, Gertz AM, Sage P, Lewis S, Cobabe M, Ye Y, Menegay M, Windish DM. Effectiveness and safety of patient activation interventions for adults with type 2 diabetes: systematic review, meta-analysis, and meta-regression. J Gen Intern Med 2014; 29:1166-76. [PMID: 24733301 PMCID: PMC4099447 DOI: 10.1007/s11606-014-2855-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/21/2014] [Accepted: 03/19/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patient activation interventions (PAIs) engage patients in care by promoting increased knowledge, confidence, and/or skills for disease self-management. However, little is known about the impact of these interventions on a wide range of outcomes for adults with type 2 diabetes (DM2), or which of these interventions, if any, have the greatest impact on glycemic control. METHODS Electronic databases were searched from inception through November 2011. Of 16,290 citations, two independent reviewers identified 138 randomized trials comparing PAIs to usual care/control groups in adults with DM2 that reported intermediate or long-term outcomes or harms. For meta-analyses of continuous outcomes, we used a random-effects model to derive pooled weighted mean differences (WMD). For all-cause mortality, we calculated the pooled odds ratio (OR) using Peto's method. We assessed statistical heterogeneity using the I (2) statistic and conducted meta-regression using a random-effects model when I (2) > 50 %. A priori meta-regression primary variables included: intervention strategies, intervention leader, baseline outcome value, quality, and study duration. RESULTS PAIs modestly reduced intermediate outcomes [A1c: WMD 0.37 %, CI 0.28-0.45 %, I (2) 83 %; SBP: WMD 2.2 mmHg, CI 1.0-3.5 mmHg, I (2) 72 %; body weight: WMD 2.3 lbs, CI 1.3-3.2 lbs, I (2) 64 %; and LDL-c: WMD 4.2 mg/dL, CI 1.5-6.9 mg/dL, I (2) 64 %]. The evidence was moderate for A1c, low/very low for other intermediate outcomes, low for long-term mortality and very low for complications. Interventions had no effect on hypoglycemia (evidence: low) or short-term mortality (evidence: moderate). Higher baseline A1c, pharmacist-led interventions, and longer follow-up were associated with larger A1c improvements. No intervention strategy outperformed any other in adjusted meta-regression. CONCLUSIONS PAIs modestly improve A1c in adults with DM2 without increasing short-term mortality. These results support integration of these interventions into primary care for adults with uncontrolled glycemia, and provide evidence to insurers who do not yet cover these programs.
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Affiliation(s)
- Shari D Bolen
- Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, USA,
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD - summary. Diab Vasc Dis Res 2014; 11:133-73. [PMID: 24800783 DOI: 10.1177/1479164114525548] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Olry de Labry Lima A, Moya Garrido MN, Espín Balbino J. Systematic review of economic evaluation studies and budget impact on ambulatory monitoring of capillary glucose in type 2 diabetics. Prim Care Diabetes 2014; 8:13-21. [PMID: 24360230 DOI: 10.1016/j.pcd.2013.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/11/2013] [Accepted: 11/21/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Realise a review of studies of economic evaluation about the ambulatory monitoring of capillary glucose (AMGC) in diabetic type II persons. METHODOLOGY A review of the literature was conducted, in MedLine, various websites, referenced paper and provided by expert's persons. RESULTS Five studies concluded that the AMGC was a cost-effective strategic, of this papers use Kaiser Permanente data base, its make that these studies could be considered a solely one study. The rest of the papers did not find difference in the AMGC use. CONCLUSIONS The use of AMGC has an uncertainty efficiency. More studies are needed.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Escuela Andaluza de Salud Pública, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
| | - María Natividad Moya Garrido
- Escuela Andaluza de Salud Pública, Granada, Spain; Departamento de Medicina preventiva y Salud Pública, Universidad de Sevilla, Spain
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Hudson JL, Bundy C, Coventry PA, Dickens C. Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis. J Psychosom Res 2014; 76:265-74. [PMID: 24630175 DOI: 10.1016/j.jpsychores.2014.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. METHODS Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated. RESULTS Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r=±0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also. CONCLUSIONS Associations between cognitive illness representations and poor emotional health were in the expected direction - negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways.
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Affiliation(s)
- Joanna L Hudson
- Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, UK; NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Chris Bundy
- NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Peter A Coventry
- NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Chris Dickens
- Mental Health Research Group, Institute of Health Research, University of Exeter Medical School, UK; The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula (PenCLAHRC), UK.
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Forjuoh SN, Bolin JN, Huber Jr JC, Vuong AM, Adepoju OE, Helduser JW, Begaye DS, Robertson A, Moudouni DM, Bonner TJ, McLeroy KR, Ory MG. Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial. BMC Public Health 2014; 14:71. [PMID: 24450992 PMCID: PMC3909304 DOI: 10.1186/1471-2458-14-71] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 12/09/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. METHODS We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. RESULTS Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants' diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. CONCLUSIONS Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01221090.
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Affiliation(s)
- Samuel N Forjuoh
- Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
- Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
- Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Jane N Bolin
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - John C Huber Jr
- Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Ann M Vuong
- Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Omolola E Adepoju
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Janet W Helduser
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Dawn S Begaye
- Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
| | - Anne Robertson
- Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
| | - Darcy M Moudouni
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Timethia J Bonner
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Kenneth R McLeroy
- Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Marcia G Ory
- Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
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Baillot A, Pelletier C, Dunbar P, Geiss L, Johnson JA, Leiter LA, Langlois MF. Profile of adults with type 2 diabetes and uptake of clinical care best practices: results from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component. Diabetes Res Clin Pract 2014; 103:11-9. [PMID: 24369983 DOI: 10.1016/j.diabres.2013.11.022] [Citation(s) in RCA: 10] [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: 04/26/2013] [Indexed: 01/02/2023]
Abstract
AIMS This study aimed to (1) describe the profile of adults with type 2 diabetes (T2D) in Canada and (2) assess the uptake of clinical care best practices, as defined by the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs). METHODS We used data from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component. Participants were aged 20 years and older, living in the 10 Canadian provinces, with self-reported T2D. Descriptive analyses present the prevalence of complications and comorbidities, as well as the level of clinical monitoring and self-monitoring/lifestyle management recommendations participants received. RESULTS We included 2335 participants with T2D, a mean age of 62.9 years, and high prevalence of complications/comorbidities and prescription medication use. Most participants reported being monitored as recommended for eye disease (73.9%), weight (81.0%), blood pressure (89.0%) and blood cholesterol levels (94.3%), but only 65.5% reported having at least two HbA1c tests during the last year and 46.5% reported an annual foot examination by a health professional. About two-thirds of the participants reported having received recommendations on weight management (59.9%) and physical activity (64.7%) from a health professional in the previous year; only 47.8% of the participants reported having received diet counseling to improve diabetes control. CONCLUSION Although the uptake of CDA CPGs for clinical and self-monitoring was high, with the majority of the participants reporting meeting most indicators, it was lower for HbA1c measurement and foot examination. Uptake of lifestyle management recommendations provided by health professionals was also significantly lower.
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Affiliation(s)
- Aurélie Baillot
- Étienne-LeBel Clinical Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Department of Medicine, Division of Endocrinology, University of Sherbrooke, Canada
| | | | - Peggy Dunbar
- Diabetes Care Program of Nova Scotia, Halifax, Nova Scotia, Canada
| | - Linda Geiss
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence A Leiter
- Division of Endocrinology & Metabolism, Keenan Research Centre in the Li KaShing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marie-France Langlois
- Étienne-LeBel Clinical Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Department of Medicine, Division of Endocrinology, University of Sherbrooke, Canada.
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Naylor RN, John PM, Winn AN, Carmody D, Greeley SAW, Philipson LH, Bell GI, Huang ES. Cost-effectiveness of MODY genetic testing: translating genomic advances into practical health applications. Diabetes Care 2014; 37:202-9. [PMID: 24026547 PMCID: PMC3867988 DOI: 10.2337/dc13-0410] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of a genetic testing policy for HNF1A-, HNF4A-, and GCK-MODY in a hypothetical cohort of type 2 diabetic patients 25-40 years old with a MODY prevalence of 2%. RESEARCH DESIGN AND METHODS We used a simulation model of type 2 diabetes complications based on UK Prospective Diabetes Study data, modified to account for the natural history of disease by genetic subtype to compare a policy of genetic testing at diabetes diagnosis versus a policy of no testing. Under the screening policy, successful sulfonylurea treatment of HNF1A-MODY and HNF4A-MODY was modeled to produce a glycosylated hemoglobin reduction of -1.5% compared with usual care. GCK-MODY received no therapy. Main outcome measures were costs and quality-adjusted life years (QALYs) based on lifetime risk of complications and treatments, expressed as the incremental cost-effectiveness ratio (ICER) (USD/QALY). RESULTS The testing policy yielded an average gain of 0.012 QALYs and resulted in an ICER of 205,000 USD. Sensitivity analysis showed that if the MODY prevalence was 6%, the ICER would be ~50,000 USD. If MODY prevalence was >30%, the testing policy was cost saving. Reducing genetic testing costs to 700 USD also resulted in an ICER of ~50,000 USD. CONCLUSIONS Our simulated model suggests that a policy of testing for MODY in selected populations is cost-effective for the U.S. based on contemporary ICER thresholds. Higher prevalence of MODY in the tested population or decreased testing costs would enhance cost-effectiveness. Our results make a compelling argument for routine coverage of genetic testing in patients with high clinical suspicion of MODY.
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Abstract
Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG) and continuous glucose monitoring system (CGMS). It also focuses on the newer concepts of blood glucose monitoring and their incorporation in routine clinical management of diabetes mellitus.
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Affiliation(s)
- Kranti Shreesh Khadilkar
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Vyankatesh Shivane
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Anurag Lila
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Nalini Shah
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Evans M, Jensen HH, Bøgelund M, Gundgaard J, Chubb B, Khunti K. Flexible insulin dosing improves health-related quality-of-life (HRQoL): a time trade-off survey. J Med Econ 2013; 16:1357-65. [PMID: 24111563 DOI: 10.3111/13696998.2013.846262] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE People with insulin-treated diabetes often face strict regimens with inflexible dose timing, frequent injections, and frequent self-measured blood glucose (SMBG) testing. The objective of this study was to estimate the health-related quality-of-life (HRQoL) impact of these aspects using time trade-off (TTO) methods. METHODS HRQoL was examined via a TTO survey in the UK, Canada, and Sweden with separate analyses of 2465 respondents from the general population, 274 people with type 1 diabetes, and 417 people with type 2 diabetes. Respondents evaluated health states with diabetes, SMBG testing, and basal injections that were once-daily time flexible, once-daily at a fixed time, and twice-daily at a fixed time in a basal or basal-bolus regimen. RESULTS Time-flexible basal injections were associated with 0.016 and 0.013 higher utility vs a fixed time of injection for basal-only and basal-bolus regimens, respectively, as evaluated by the general population. The diabetes respondents confirmed the basal-only results with 0.015 higher utility, but the difference in utility was non-significant for basal-bolus. Once-daily injections had higher utility compared with twice-daily injections for basal (0.039 and 0.042) and basal-bolus (0.022 and 0.021) regimens, as evaluated by the general population and people with diabetes, respectively. Increased frequency of SMBG negatively affected health utility. LIMITATIONS This study has the limitation that it measures hypothetical health states rather than the HRQoL of people with these health states; furthermore, it could be suggested that the web-based nature of this survey is biased towards literate respondents with internet access and IT competence. CONCLUSIONS Flexible dosing and fewer injections have a positive HRQoL impact, which potentially may enhance therapy adherence and could contribute to improved long-term outcomes. The impact of flexibility is greater in people treated with basal-only insulin regimens, and diminishes if bolus injections are part of the treatment regimen.
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Affiliation(s)
- Marc Evans
- Llandough Hospital , Penarth, Cardiff , UK
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Jones H, Berard LD, MacNeill G, Whitham D, Yu C. Éducation sur l’autogestion. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.035] [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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Schöld AK, Ylikivelä R, Lindström K, Östgren CJ, Grodzinsky E. The options of the management of self-monitoring of blood glucose in primary health care centres by the diabetes nurses and patients. Prim Care Diabetes 2013; 7:143-149. [PMID: 23415895 DOI: 10.1016/j.pcd.2012.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 03/29/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022]
Abstract
The aims of the present study were to investigate the diabetes nurse specialists (DNS) practice according to the local diabetic guideline, to study the DNSs' opinion of self-monitoring of blood glucose (SMBG) and prescription of test-strips, to investigate the patients' opinions and habits when using SMBG. Users of SMBG (n=533 patients') and all DNSs (n=25) were telephone interviewed. Only a few DNSs used local guidelines, the majority had their own prescribing strategy of SMBG. In conclusion, DNSs were aware of the guidelines but did not use them to support their decision regarding the reasons for prescribing SMBG or not. For diabetes patients, reassurance was the most important issue in having access to SMBG, despite the fact that one-third retested but did not change their behaviour and nearly 15% contacted their DNS for advice.
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Affiliation(s)
- Anna-Karin Schöld
- R&D Department of Local Health Care, County Council of Östergötland, Sweden.
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Breland JY, McAndrew LM, Burns E, Leventhal EA, Leventhal H. Using the Common Sense Model of Self-Regulation to Review the Effects of Self-Monitoring of Blood Glucose on Glycemic Control for Non–Insulin-Treated Adults With Type 2 Diabetes. DIABETES EDUCATOR 2013; 39:541-59. [DOI: 10.1177/0145721713490079] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose This systematic review examined the relationship between self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes. The Common Sense Model of Self-Regulation (CSM) served as a theoretical framework for examining how, when (mediators), and for whom (moderators) SMBG improved glycemic control. Data Sources Five databases were searched: Medline, PsychInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health Literature. Study Selection Included studies had cross-sectional, longitudinal, or randomized controlled trial designs; were published between 2007 and 2011; and included patients with type 2 diabetes at least some of whom were not taking insulin; 1318 studies were screened, 119 were reviewed in detail, and 26 were included. Data Extraction Data were collected on the relationship between SMBG and glycemic control, study design, mediators, moderators, participant characteristics, the CSM, and limitations. Data Synthesis Twenty-six studies met criteria for inclusion: 11 cross-sectional, 4 longitudinal, and 11 randomized controlled trials. The results of the cross-sectional studies were inconclusive. Results from the longitudinal studies and randomized control trials suggested that SMBG may improve glycemic control. The few studies investigating mediators or moderators reported mixed results. Few studies effectively measured the CSM. Conclusion Data suggested that SMBG may help improve glycemic control. Future trials must be designed to test hypotheses and improve our understanding of when, how, and for whom SMBG can enhance glycemic control. Rigorously controlled repetitions of current 2-arm trials will yield little new knowledge of theoretical or practical value.
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Affiliation(s)
- Jessica Y. Breland
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
| | - Lisa M. McAndrew
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
| | - Edith Burns
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
| | - Elaine A. Leventhal
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
| | - Howard Leventhal
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
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Speight J, Browne JL, Furler J. Challenging evidence and assumptions: is there a role for self-monitoring of blood glucose in people with type 2 diabetes not using insulin? Curr Med Res Opin 2013; 29:161-8. [PMID: 23259703 DOI: 10.1185/03007995.2012.761957] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is debate in the literature about the effectiveness of self-monitoring of blood glucose (SMBG) for people with type 2 diabetes (T2DM) who do not use insulin. Several recent systematic reviews and meta-analyses conclude that SMBG does not have any clinical benefit for this group. OBJECTIVE We critically appraise the available evidence, and argue whether SMBG is warranted for people with non-insulin-treated T2DM. RESULTS Considerable heterogeneity exists amongst the literature, and aspects of the methodology of some of these studies confound interpretation of results. Recent evidence demonstrates that when SMBG is 'structured', incorporated as part of a complex intervention, and embedded within education and collaborative care, improvements in average blood glucose levels result. In contrast, studies that do not apply SMBG systematically, or that assess a low frequency SMBG regimen that precludes identification and interpretation of SMBG patterns, are not clinically effective. Psychosocial outcomes, such as self-efficacy and diabetes-related distress, and other clinical outcomes, such as hypoglycaemia detection, should also be considered as important clinical endpoints. LIMITATIONS This is not a systematic literature review. The literature is limited by a lack of studies evaluating a 'structured' approach to SMBG. CONCLUSIONS It is the quality, not quantity, of SMBG that makes a difference to outcomes for people with non-insulin-treated T2DM. The benefits of 'structured' SMBG should be considered as part of a complex intervention when making decisions about policy and practice, and assumptions about the benefits of SMBG for people with non-insulin-treated T2DM should be challenged.
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Affiliation(s)
- Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia - Vic, Melbourne, Australia.
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Desroches S, Lapointe A, Ratté S, Gravel K, Légaré F, Turcotte S. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database Syst Rev 2013:CD008722. [PMID: 23450587 PMCID: PMC4900876 DOI: 10.1002/14651858.cd008722.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients, and greater adherence to dietary advice is a critical component in preventing and managing chronic diseases. OBJECTIVES To assess the effects of interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. SEARCH METHODS We searched the following electronic databases up to 29 September 2010: The Cochrane Library (issue 9 2010), PubMed, EMBASE (Embase.com), CINAHL (Ebsco) and PsycINFO (PsycNET) with no language restrictions. We also reviewed: a) recent years of relevant conferences, symposium and colloquium proceedings and abstracts; b) web-based registries of clinical trials; and c) the bibliographies of included studies. SELECTION CRITERIA We included randomized controlled trials that evaluated interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. Studies were eligible if the primary outcome was the client's adherence to dietary advice. We defined 'client' as an adult participating in a chronic disease prevention or chronic disease management study involving dietary advice. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of the studies. They also assessed the risk of bias and extracted data using a modified version of the Cochrane Consumers and Communication Review Group data extraction template. Any discrepancies in judgement were resolved by discussion and consensus, or with a third review author. Because the studies differed widely with respect to interventions, measures of diet adherence, dietary advice, nature of the chronic diseases and duration of interventions and follow-up, we conducted a qualitative analysis. We classified included studies according to the function of the intervention and present results in a narrative table using vote counting for each category of intervention. MAIN RESULTS We included 38 studies involving 9445 participants. Among studies that measured diet adherence outcomes between an intervention group and a control/usual care group, 32 out of 123 diet adherence outcomes favoured the intervention group, 4 favoured the control group whereas 62 had no significant difference between groups (assessment was impossible for 25 diet adherence outcomes since data and/or statistical analyses needed for comparison between groups were not provided). Interventions shown to improve at least one diet adherence outcome are: telephone follow-up, video, contract, feedback, nutritional tools and more complex interventions including multiple interventions. However, these interventions also shown no difference in some diet adherence outcomes compared to a control/usual care group making inconclusive results about the most effective intervention to enhance dietary advice. The majority of studies reporting a diet adherence outcome favouring the intervention group compared to the control/usual care group in the short-term also reported no significant effect at later time points. Studies investigating interventions such as a group session, individual session, reminders, restriction and behaviour change techniques reported no diet adherence outcome showing a statistically significant difference favouring the intervention group. Finally, studies were generally of short duration and low quality, and adherence measures varied widely. AUTHORS' CONCLUSIONS There is a need for further, long-term, good-quality studies using more standardized and validated measures of adherence to identify the interventions that should be used in practice to enhance adherence to dietary advice in the context of a variety of chronic diseases.
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Affiliation(s)
- Sophie Desroches
- Centre de recherche du Centre hospitalier universitaire de Québec (CHUQ), St-François d’Assise Hôpital, Québec, Canada.
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Virdi N, Daskiran M, Nigam S, Kozma C, Raja P. The association of self-monitoring of blood glucose use with medication adherence and glycemic control in patients with type 2 diabetes initiating non-insulin treatment. Diabetes Technol Ther 2012; 14:790-8. [PMID: 22775240 DOI: 10.1089/dia.2012.0047] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The value of self-monitoring of blood glucose (SMBG) for persons with type 2 diabetes who do not use insulin remains controversial. This observational study compares the likelihood of medication adherence and change in glycated hemoglobin (A1C) for non-insulin-using patients using SMBG versus those not using SMBG. The study also assessed the association between diabetes medication adherence and SMBG use. PATIENTS AND METHODS Data were extracted on 5,172 patients who began non-insulin diabetes medication between October 1, 2006, and March 31, 2009. The study assessed change in A1C associated with SMBG use and testing frequency at different categorical levels of baseline A1C. The likelihood of medication adherence for SMBG users was compared with that for non-SMBG users at different categorical levels of baseline A1C. The study further explored the interactions between SMBG use and medication adherence on change in A1C. RESULTS SMBG users had greater reductions in A1C compared with nonusers when the baseline A1C was ≥ 7%. Increasing SMBG frequency was associated with greater reductions in A1C. The study also examined the associations among SMBG use, medication adherence, and change in A1C. SMBG users had greater decreases in A1C for both medication-adherent and -nonadherent patients. As expected, medication adherence was associated with greater reductions in A1C for both SMBG nonusers and users. It is interesting that medication-nonadherent SMBG users had similar reductions in A1C compared with medication-adherent non-SMBG users. CONCLUSIONS Both SMBG use and medication adherence were associated with similar degrees of A1C reduction after controlling for baseline A1C, suggesting that both factors may be important for attaining glycemic control.
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Affiliation(s)
- Naunihal Virdi
- Medical Affairs, LifeScan, Inc, Milpitas, California 95035, USA.
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Whitmore C. Blood glucose monitoring: an overview. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2012; 21:583-7. [PMID: 22875293 DOI: 10.12968/bjon.2012.21.10.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Glucose monitoring is done to obtain information on blood glucose levels to ensure a therapeutic regimen; the aim is to maintain consistent glucose levels and avoid hypoglycaemia and hyperglycaemia. Self-management is central to diabetes control. Diabetes is individual, so self-monitoring of blood glucose (SMBG) targets and frequency of testing must be decided to meet each patient's needs. Nurses have key roles in education and advocacy. They can educate patients on what affects glucose levels, why they need to carry out SMBG, and how to interpret and act on the results. Nurses also match glucose monitoring meters to patients' needs by considering ease of use, technical features and lifestyle. Access to testing supplies is sometimes restricted through blanket policies and nurses have an advocacy role here in challenging inappropriate restrictions.
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Patients' experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study. Br J Gen Pract 2012; 62:e135-42. [PMID: 22520791 DOI: 10.3399/bjgp12x625201] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Self-management of hypertension, comprising self-monitoring of blood pressure with self-titration of medication, improves blood pressure control, but little is known regarding the views of patients undertaking it. AIM To explore patients' views of self-monitoring blood pressure and self-titration of antihypertensive medication. DESIGN AND SETTING Qualitative study embedded within the randomised controlled trial TASMINH2 (Telemonitoirng and Self Management in the Control of Hypertension) trial of patient self-management of hypertension from 24 general practices in the West Midlands. METHOD Taped and transcribed semi-structured interviews with 23 intervention patients were used. Six family members were also interviewed. Analysis was by a constant comparative method. RESULTS Patients were confident about self-monitoring and many felt their multiple home readings were more valid than single office readings taken by their GP. Although many patients self-titrated medication when required, others lacked the confidence to increase medication without reconsulting with their GP. Patients were more comfortable with titrating medication if their blood pressure readings were substantially above target, but were reluctant to implement such a change if readings were borderline. Many planned to continue self-monitoring after the study finished and report home readings to their GP, but few wished to continue with a self-management plan. CONCLUSION Participants valued the additional information and many felt confident in both self-monitoring blood pressure and self-titrating medication. The reluctance to change medication for borderline readings suggests behaviour similar to the clinical inertia seen for physicians in analogous circumstances. Additional support for those lacking in confidence to implement prearranged medication changes may allow more patients to undertake self-management.
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Evans JMM, Mackison D, Emslie-Smith A, Lawton J. Self-monitoring of blood glucose in Type 2 diabetes: cross-sectional analyses in 1993, 1999 and 2009. Diabet Med 2012; 29:792-5. [PMID: 22587406 DOI: 10.1111/j.1464-5491.2011.03567.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To characterize the numbers of reagent strips dispensed for self-monitoring of blood glucose to patients with Type 2 diabetes in Tayside, Scotland, in 1993, 1999 and 2009. METHODS A diabetes clinical information system in Tayside, record-linked to electronic dispensed prescribing records, was used to collate all dispensed prescribing records for three cross-sectional samples of patients with Type 2 diabetes in 1993 (n = 5728), 1999 (n = 8109) and at 1 January 2009 (n = 16,450). The numbers of reagent strips dispensed during the relevant calendar year were calculated and patients stratified by treatment. We also explored whether age, sex or material and social deprivation were associated with whether a patient received strips. RESULTS Proportions of people who received self-monitoring reagent strips increased from 15.5% in 1993, to 24.2% in 1999 to 29.8% in 2009, as did numbers of strips dispensed. While the proportion of diet-treated patients who received reagent strips was still very low in 2009 (5.6%), the proportion among those treated with oral agents tripled from 9.4 to 27.4% between 1993 and 2009. Over 90% of patients treated with insulin received reagent strips and, among non-insulin-treated patients, this was more common among women, younger people and less deprived groups. CONCLUSIONS The numbers of reagent strips dispensed for self-monitoring of blood glucose has increased and almost all insulin-treated patients receive strips. While few diet-treated patients receive strips, they are more extensively dispensed to those treated with oral agents. Given that self-monitoring of blood glucose is no longer routinely recommended in non-insulin treated patients, strategies to reduce unnecessary dispensing of reagent strips are needed.
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Affiliation(s)
- J M M Evans
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK.
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