Frequency Of Blood Glucose Measurement Research Articles

Relationship between mental symptoms, dietary compliance and glucose levels of diabetic patients in isolation during COVID-19 pandemic

Aim: Coronavirus disease 2019 (COVID-19, 2019-nCoV) which first appeared in Wuhan, China in December 2019 is a disease causing acute respiratory failure. Home isolation methods are used to control the disease all around the world and also in our country. In this study we planned to explain the relationship between some mental symptoms, diet compliance, frequency of blood glucose measurement and blood glucose levels in diabetic patients during home isolation. 
 Material and Method: In this study some questions about the frequency of blood glucose measurement, blood glucose levels, dietary compliance and mental states of the patients were asked on the phone and the patients were asked to give a score to the symptom severity. The notes were retrospectively screened.
 Results: It is known that social isolation triggers the anxiety and depression. Anxiety and depression can increase the secretion of some hormones which leads high blood glucose levels (respectively 54.4% of those with 200-300 mg/dl, 91.7% of those with >300 mg/dl don't follow their diets) in diabetic patients. These symptoms can reduce dietary compliance and frequency of the blood sugar measurement, therefore can make metabolic control of the diabetes difficult.
 Conclusion: In this study, we found that blood glucose levels were very high and the frequency of blood glucose measurements were very low in the patients who had some mood changes and we saw that the patients did not follow on their diets. It is important to support patients mentally during this process. Training and following up should be used with some various methods.

Feasibility and Efficiency of a Novel Bolus Calculator (IF-DIABETE) for Patients With Type 1 Diabetes: A Nonrandomized Single-Arm Pilot Study.

BackgroundThe IF-DIABETE system is an insulin bolus dose support, considered as the first bolus calculator dedicated to people with type 1 diabetes, designed in the Arabic language, and adapted to the large Arabic food culture. Our aims were to assess the proof of concept and efficiency of the IF-DIABETE system in improving clinical and metabolic outcomes in individuals with type 1 diabetes.MethodsThis is a prospective nonrandomized single-arm pilot study. Our patients used the IF-DIABETE smartphone application as a novel bolus calculator. Over six months period of the study, the primary outcome considered was hemoglobin glycated (HbA1c), and we identified hypoglycemic events, body mass index (BMI), and the frequency of blood glucose measurements as secondary outcomes.ResultsTwenty-one patients with type 1 diabetes were enrolled. The average age was 21 ± 3 years. Over a six months’ period of the study, the mean HbA1c level decreased from 8.3 ± 0.8% to 7.0 ± 0.5 % with a reduction in mild hypoglycemic events’ frequency from 5 ± 3 to 1 ± 0.7 episodes/3 months. We did not observe any change in BMI and the frequency of the blood glucose testing improved from 2 ± 0.5 to 5 ± 1 tests per day.ConclusionThe IF-DIABETE system was safe and effective to support individuals who have type 1 diabetes to improve their metabolic control. At six months, patients were able to improve their glycemic control without increasing the risk of hypoglycemic events.

Factors contributing to glycemic control in diabetes mellitus patients complying with home quarantine during the coronavirus disease 2019 (COVID-19) epidemic

AimsThis study assessed factors contributing to glycemic control among diabetes mellitus patients complying with home quarantine during the epidemic of coronavirus disease 2019 (COVID-19). MethodsWe conducted an analytical cross-sectional study by telephone with 1159 patients with type 2 diabetes mellitus (T2DM) and 96 patients with type 1 diabetes mellitus (T1DM) who were discharged from the endocrinology department of a hospital from January 1, 2019, to January 24, 2020. According to their fasting blood glucose (FBG) and 2-h postprandial BG (2hPBG) values, the patients were divided into the well-controlled BG group and the poorly controlled BG group. The main evaluation indicators included sociodemographic variables, health risk variables and adherence to self-management behaviors. ResultsIn total, 74.46% of the T2DM patients and 64.89% of the T1DM patients had poor glycemic control. T2DM patients with poor glycemic control were more likely to be older (odds ratio (OR): 1.017 [95% confidence interval (CI) 1.003–1.030]; P = 0.013), have fewer than 12 years of education (OR: 1.646 [95% CI 1.202–2.255]; P = 0.002), lack a BG meter at home (OR: 2.728 [95% CI 1.205–6.179]; P = 0.016), have a lower degree of medicationcompliance (OR: 1.627 [95% CI 1.076–2.460]; P = 0.021), and engage in less self-monitoring of BG (SMBG) per week (OR: 10.884 [95% CI 5.883–20.139]; P < 0.001). Fewer than 12 years of education (OR: 3.031 [95% CI 1.112–8.263]; P = 0.030) was a risk factor for glycemic control in T1DM. ConclusionsGlycemic control among patients with T1DM and T2DM during home quarantine amid the COVID-19 pandemic is poor. Our results showed that more eduction, a higher frequency of SMBG, and improved medication compliance may contribute to glycemic control. Therefore, diabetic patients should be advised to increase the frequency of blood glucose measurements during home quarantine and be re-educated regarding the importance of medication compliance.

Adherence to Hunger Training over 6 Months and the Effect on Weight and Eating Behaviour: Secondary Analysis of a Randomised Controlled Trial.

Monitoring blood glucose prior to eating can teach individuals to eat only when truly hungry, but how adherence to ‘hunger training’ influences weight loss and eating behaviour is uncertain. This exploratory, secondary analysis from a larger randomized controlled trial examined five indices of adherence to ‘hunger training’, chosen a priori, to examine which adherence measure best predicted weight loss over 6 months. We subsequently explored how the best measure of adherence influenced eating behavior in terms of intuitive and emotional eating. Retention was 72% (n = 36/50) at 6 months. Frequency of hunger training booklet entry most strongly predicted weight loss, followed by frequency of blood glucose measurements. Participants who completed at least 60 days of booklet entry (of recommended 63 days) lost 6.8 kg (95% CI: 2.6, 11.0; p < 0.001) more weight than those who completed fewer days. They also had significantly higher intuitive eating scores than those who completed 30 days or less of booklet entry; a difference (95% CI) of 0.73 (0.12, 1.35) in body-food choice congruence and 0.79 (0.06, 1.51) for eating for physical rather than emotional reasons. Adherent participants also reported significantly lower scores for emotional eating of −0.70 (−1.13, −0.27). Following hunger training and focusing on simply recording ratings of hunger on a regular basis can produce clinically significant weight loss and clinically relevant improvements in eating behaviour.

Attitudes, wishes, and needs of diabetes patients and their relatives: Turkish data from the DAWN2 study.

The DAWN2 (Diabetes Attitudes, Wishes, and Needs) study was conducted in order to ascertain the wishes, needs, and attitudes of diabetes patients, their relatives, and healthcare professionals. The study was conducted across 17 countries, including Turkey, and its objective was to introduce policies that could successfully meet these requirements. In this article, the needs, wishes, and attitudes of diabetes patients and their relatives in Turkey are compared with those from other countries. Eighty patients with type 1 diabetes, 426 patients with type 2 diabetes, and 126 relatives of patients with diabetes were included in the study. Depression was common in individuals suffering from diabetes and the quality of life was negatively affected. The primary concerns of diabetic individuals were general hypoglycemic attacks, nocturnal hypoglycemia, and gaining weight. Analysis of self-care activities showed that physical activity, foot care, and frequency of blood glucose measurement were below average in Turkey as compared to other countries. DAWN2 is the first study of its kind. The problems and shortcomings related to diabetes care and management in Turkey are once again revealed with this study, and important data and opportunities to improve them are presented.

Abstracts from ATTD 20158th International Conference on Advanced Technologies &amp; Treatments for DiabetesParis, France—February 18–21, 2015

Abstracts from ATTD 20158th International Conference on Advanced Technologies &amp; Treatments for DiabetesParis, France—February 18–21, 2015

Patient-reported outcomes in women with gestational diabetes: a longitudinal study.

Gestational Diabetes Mellitus (GDM) is a common health problem among pregnant women and may be associated with distress. The purpose of the study was to describe changes in patient-reported outcomes in women with GDM and identify factors associated with increased distress in these patients. The study was conducted in 205 women diagnosed with GDM. Study participants underwent a physical examination and completed a questionnaire two times during pregnancy. On average, the questionnaire was completed at 27 weeks of gestation at baseline and 36 weeks at follow-up. The questionnaire included socio-demographic and clinical variables, standardized patient-reported outcome measures, and questions about the impact of GDM on daily life, satisfaction with care, knowledge about GDM, and social and professional support. Our main outcome of interest was diabetes-related distress, measured by the Problem Areas in Diabetes (PAID) questionnaire. Data were analyzed using descriptive statistics and multivariable regression models. At baseline, 80% of the women were satisfied with their diabetes care and 58% said they managed their diabetes well. The proportion reporting little or no knowledge of GDM dropped from almost 50% at baseline to 14% at follow-up. However, the proportion reporting that GDM affected their social life increased from 26 to 35%, and the proportion reporting interference with family life increased from 14 to 26%. Insulin treatment, frequency of blood glucose measurements, lack of knowledge about GDM, and lack of support from family and health care providers were strongly and significantly associated with distress. In women with GDM, intensified treatment and lack of informational and social support are associated with distress. These aspects of GDM care appear to be appropriate targets for future research and interventions aimed at reducing the level of distress in these patients.

Comparison of the Efficacy and Safety of Two Different Insulin Infusion Protocols in the Medical Intensive Care Unit

New guidelines recommend using less intensive glycemic goals in critically ill patients receiving insulin infusions. To compare the efficacy and safety of a modified insulin infusion protocol (MIIP) with less stringent blood glucose (BG) goals to an intensive insulin infusion protocol (IIIP) in patients in a medical intensive care unit (MICU). Retrospective review of patients receiving an insulin infusion for at least 24 hours. Patients treated for hyperglycemic emergencies were excluded. The primary endpoint of the study was mean area under the BG curve (BG-AUC) at 24 and 48 hours. Other endpoints included mean BG, hours until BG at goal, rate of BG above goal, frequency of BG measurements, and rate of hypoglycemia. BG-AUC at 24 hours was similar between the groups (MIIP = 5177.7 ± 1221.3 mg/dL x h vs IIIP = 4850.3 ± 1301.7 mg/dL x h; P = .20). The mean BG level at 24 hours was 225.1 ± 91.1 mg/dL in the MIIP group and 205.7 ± 89.7 mg/dL in the IIIP group (P = .06). In the MIIP group, 61.7% of the BG levels were above goal as compared to 87.5% in the IIIP group (P < .0001). Patients were able to achieve BG goals faster with the MIIP (12.58 ± 10.5 hours vs 29.37 ± 16.8 hours; P < .001). The rate of severe hypoglycemia was lower at 24 hours in the patients following the MIIP (0% vs 0.3%; P = .01). The study showed that by having less intensive glycemic goals, goal BG levels can achieved faster and the rate of severe hypoglycemia can decrease.

Tight Glycemic Control versus Standard Care after Pediatric Cardiac Surgery

BackgroundIn some studies, tight glycemic control with insulin improved outcomes in adults undergoing cardiac surgery, but these benefits are unproven in critically ill children at risk for hyperinsulinemic hypoglycemia. We tested the hypothesis that tight glycemic control reduces morbidity after pediatric cardiac surgery.MethodsIn this two-center, prospective, randomized trial, we enrolled 980 children, 0 to 36 months of age, undergoing surgery with cardiopulmonary bypass. Patients were randomly assigned to either tight glycemic control (with the use of an insulin-dosing algorithm targeting a blood glucose level of 80 to 110 mg per deciliter [4.4 to 6.1 mmol per liter]) or standard care in the cardiac intensive care unit (ICU). Continuous glucose monitoring was used to guide the frequency of blood glucose measurement and to detect impending hypoglycemia. The primary outcome was the rate of health care–associated infections in the cardiac ICU. Secondary outcomes included mortality, length of stay, organ failure, and hypoglycemia.ResultsA total of 444 of the 490 children assigned to tight glycemic control (91%) received insulin versus 9 of 490 children assigned to standard care (2%). Although normoglycemia was achieved earlier with tight glycemic control than with standard care (6 hours vs. 16 hours, P<0.001) and was maintained for a greater proportion of the critical illness period (50% vs. 33%, P<0.001), tight glycemic control was not associated with a significantly decreased rate of health care–associated infections (8.6 vs. 9.9 per 1000 patient-days, P=0.67). Secondary outcomes did not differ significantly between groups, and tight glycemic control did not benefit high-risk subgroups. Only 3% of the patients assigned to tight glycemic control had severe hypoglycemia (blood glucose <40 mg per deciliter [2.2 mmol per liter]).ConclusionsTight glycemic control can be achieved with a low hypoglycemia rate after cardiac surgery in children, but it does not significantly change the infection rate, mortality, length of stay, or measures of organ failure, as compared with standard care. (Funded by the National Heart, Lung, and Blood Institute and others; SPECS ClinicalTrials.gov number, NCT00443599.)

Providing Diabetes Self-Management Support in Rural Primary Care Clinics With Nurse Partners

This study examined the roles and effectiveness of nurse partner-provided diabetes self-management (DSM) support in five rural primary care clinics. There were two to nine providers and one nurse partner in each clinic; nurses were licensed practical nurses (LPNs) in all but one clinic. Interviews with providers and observations of patient interactions assessed nurse roles, clinic processes, and communication patterns. Using immersion-crystallization methods, three major themes explained nurse partner role variation: "gatekeeper" role of providers, compression of time and space within clinic work flow, and nurses' educational background and experience. While nurses' education and experience were important, clinics where providers facilitated nurse participation in DSM support through focused communication and commitment of time and space most effectively integrated DSM support into their practice. Some quantitative measures improved; notably glycated hemoglobin level and patients' frequency of blood glucose measurement. Study findings provide guidance on using nurses in primary care clinics to provide DSM.

Psychosocial family factors and glycemic control among children aged 1-15 years with type 1 diabetes: a population-based survey

BackgroundBeing the parents of children with diabetes is demanding. Jay Belsky's determinants of parenting model emphasizes both the personal psychological resources, the characteristics of the child and contextual sources such as parents' work, marital relations and social network support as important determinants for parenting. To better understand the factors influencing parental functioning among parents of children with type 1 diabetes, we aimed to investigate associations between the children's glycated hemoglobin (HbA1c) and 1) variables related to the parents' psychological and contextual resources, and 2) frequency of blood glucose measurement as a marker for diabetes-related parenting behavior.MethodsMothers (n = 103) and fathers (n = 97) of 115 children younger than 16 years old participated in a population-based survey. The questionnaire comprised the Life Orientation Test, the Oslo 3-item Social Support Scale, a single question regarding perceived social limitation because of the child's diabetes, the Relationship Satisfaction Scale and demographic and clinical variables. We investigated associations by using regression analysis. Related to the second aim hypoglycemic events, child age, diabetes duration, insulin regimen and comorbid diseases were included as covariates.ResultsThe mean HbA1c was 8.1%, and 29% had HbA1c ≤ 7.5%. In multiple regression analysis, lower HbA1c was associated with higher education and stronger perceptions of social limitation among the mothers. A higher frequency of blood glucose measurement was significantly associated with lower HbA1c in bivariate analysis. Higher child age was significantly associated with higher HbA1c both in bivariate and multivariate analysis. A scatterplot indicated this association to be linear.ConclusionsMost families do not reach recommended treatment goals for their child with type 1 diabetes. Concerning contextual sources of stress and support, the families who successfully reached the treatment goals had mothers with higher education and experienced a higher degree of social limitations because of the child's diabetes. The continuous increasing HbA1c by age, also during the years before puberty, may indicate a need for further exploring the associations between child characteristics, context-related variables and parenting behavior such as factors facilitating the transfer of parents' responsibility and motivation for continued frequent treatment tasks to their growing children.

May frequency of blood glucose measurement be blurring the association between mean absolute glucose change per hour and mortality?

May frequency of blood glucose measurement be blurring the association between mean absolute glucose change per hour and mortality?

In Response

The principal concern expressed by Pitkin et al.1 is the choice of point-of-care (POC) device used to monitor blood glucose concentrations in anesthetized patients and the potential risk of undetected severe hypoglycemia. In our protocol2 we used the AccuSoft Advantage (Roche Diagnostics, Hoffman-La Roche, Laval, Quebec, Canada), a POC device routinely used in operating rooms and previous studies assessing different glycemic control protocols.3,4 In this context, while some portable blood glucometers show falsely elevated values under hypoglycemic conditions,5 Accu-Cheks tend to display lower values during hypoglycemia and anemia, thereby presumably increasing the margin of safety in the hypoglycemic range.6 We agree with Rice et al. regarding the general limitations of such POC devices, originally designed for blood glucose self-monitoring at home and the apparent lack of “regulatory framework,” proper standardization, and evaluation in critical care.7 However, none of the patients enrolled in our protocol was “critically ill” according to the definition used by the Food and Drug Administration guidance (Food and Drug Administration. Draft guidance for industry and FDA staff: total product life cycle for portable invasive blood glucose monitoring systems. Rockville, MD: Center for Devices and Radiological Health, Oct 24, 2006. Available at: http://wwwfdagov/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm079138htm), as referenced by Rice et al. Unfortunately, because of time constraints and the high frequency of blood glucose measurements, glucose–insulin therapy, as with any other algorithm aiming at tight blood glucose control in the acute care setting, depends on the results rapidly provided by POC devices rather than time-consuming central laboratory plasma glucose analysis. The relatively short 15- minute intervals between glucose measurements as dictated by our protocol and the fact that dextrose is being infused continuously, however, may be considered as an added safety feature of glucose–insulin therapy. In a recent randomized trial, completed before our investigation in patients undergoing liver surgery and designed to assess the cardioprotective effects of glucose and insulin administration while maintaining normoglycemia in 100 patients undergoing surgical coronary revascularization, we measured plasma glucose concentrations in approximately 500 arterial blood samples by using the Beckman Glucose Analyzer 2 (Beckman Instruments, Fullham, CA). We found no clinically important discrepancy between values obtained by the “gold standard” glucose-oxidase-based glucose analyzer3 and those provided by the Accu-Chek glucometer, particularly in the lower glycemic range (manuscript submitted for publication). Regardless of the protocol used or our belief in the potential benefits of strict glycemic control during and after surgery, thorough understanding of the patient's pathophysiology and the technology applied to maintain glucose homeostasis is mandatory to avoid the disastrous consequences of severe hypoglycemia.8,9 Thomas Schricker, MD, PhD George Carvalho, MD, MSc Hiroaki Sato, MD Department of Anaesthesia Royal Victoria Hospital McGill University Health Center Montreal, Quebec, Canada [email protected]

Effects of Social Demand on Reports of Self‐Monitored Blood Glucose in Adolescents with Type 1 Diabetes Mellitus

The purpose of this study was to test the hypothesis that social demand could substantially affect reports of self‐monitored blood glucose (BG) in adolescents with insulin‐dependent diabetes mellitus. Of 34 patients initially enrolled in the study, 10 were excluded because they did not bring any BG records with them to an outpatient clinic appointment. The remaining 24 patients were randomly assigned to either a low or high social demand condition that provided instructions for monitoring of BG for the week following the appointment. The subjects' BG records were quantified to provide frequency of measurement and mean reported BG for the week prior to and after the clinic visit. Five subjects did not return their BG records for the week following the intervention. The analyses were therefore based on the 19 subjects from whom complete records were obtained. The 12 subjects in the low social demand group and 7 subjects in the high social demand group were equivalent with regard to age, duration of diabetes, socioeconomic status, and glycosylated hemoglobin. Frequency of BG measurement was similar in both groups during both weeks. The mean BG value reported in the week prior to intervention was similar for the groups. However, analyses of the post‐intervention BGs revealed that subjects in the low‐demand group reported significantly higher BGs compared to pre‐intervention and to subjects in the high‐demand group. These findings suggest that self‐monitoring and reporting of BG is a social behavior that is affected by the demand characteristics of the interpersonal patient‐health provider relationship. Because optimal treatment planning for individuals with diabetes requires accurate BG records, care must be taken to interpret them in light of the social demand characteristics associated with clinical assessment.