Frequency Of Blood Glucose Testing Research Articles

Subsidized gestational diabetes mellitus screening and management program in rural China: a pragmatic multicenter, randomized controlled trial

BackgroundThe increasing prevalence of gestational diabetes mellitus (GDM) is a major challenge, particularly in rural areas of China where control rates are suboptimal. This study aimed to evaluate the effectiveness of a GDM subsidy program in promoting GDM screening and management in these underserved regions.MethodsThis multicenter, randomized controlled trial (RCT) was conducted in obstetric clinics of six rural hospitals located in three provinces in China. Eligible participants were pregnant women in 24–28 weeks’ gestation, without overt diabetes, with a singleton pregnancy, access to a telephone, and provided informed consent. Participants were randomly assigned in a 1:1 ratio to either the intervention or control groups using an internet-based, computer-generated randomization system. The intervention group received subsidized care for GDM, which included screening, blood glucose retesting, and lifestyle management, with financial assistance provided to health care providers. In contrast, the control group received usual care. The primary outcomes of this study were the combined maternal and neonatal complications associated with GDM, as defined by the occurrence of at least one pre-defined complication in either the mother or newborn. The secondary outcomes included the GDM screening rate, rates of glucose retesting for pregnant women diagnosed with GDM, dietary patterns, physical activity levels, gestational weight gain, and antenatal visit frequency for exploratory purposes. Primary and secondary outcomes were obtained for all participants with and without GDM. Binary outcomes were analyzed by the generalized linear model with a link of logistic, and odds ratios (OR) with 95% confidence intervals (CIs) were reported. Count outcomes were analyzed by Poisson regression, and incidence rate ratios with 95% CIs were reported.ResultsA total of 3294 pregnant women were randomly assigned to either the intervention group (n = 1649) or the control group (n = 1645) between 15 September 2018 and 30 September 2019. The proportion of pregnant women in the intervention group who suffered from combined maternal and/or neonatal complications was lower than in the control group with adjusted OR = 0.86 (0.80 to 0.94, P = 0.001), and a more significant difference was observed in the GDM subgroup (adjusted OR = 0.66, 95% CI 0.47 to 0.95, P = 0.025). No predefined safety or adverse events of ketosis or ketoacidosis associated with GDM management were detected in this study. Both the intervention and control groups had high GDM screening rates (intervention: 97.2% [1602/1649]; control: 94.5% [1555/1645], P < 0.001). Moreover, The intervention group showed a healthier lifestyle, with lower energy intake and more walking minutes (P values < 0.05), and more frequent blood glucose testing (1.5 vs. 0.4 visits; P = 0.001) compared to the control group.ConclusionIn rural China, a GDM care program that provided incentives for both pregnant women and healthcare providers resulted in improved maternal and neonatal health outcomes. Public health subsidy programs in China should consider incorporating GDM screening and management to further enhance reproductive health.Trial registrationChina Clinical Trials Registry ChiCTR1800017488. https://www.chictr.org.cn/

Recent advances in the precision control strategy of artificial pancreas.

The scientific diagnosis and treatment of patients with diabetes require frequent blood glucose testing and insulin delivery to normoglycemia. Therefore, an artificial pancreas with a continuous blood glucose (BG) monitoring function is an urgent research target in the medical industry. The problem of closed-loop algorithmic control of the BG with a time delay is a key and difficult issue that needs to be overcome in the development of an artificial pancreas. Firstly, the composition, structure, and control characteristics of the artificial pancreas are introduced. Subsequently, the research progress of artificial pancreas control algorithms is reviewed, and the characteristics, advantages, and disadvantages of proportional-integral-differential control, model predictive control, and artificial intelligence control are compared and analyzed to determine whether they are suitable for the practical application of the artificial pancreas. Additionally, key advancements in areas such as blood glucose data monitoring, adaptive models, wearable devices, and fully automated artificial pancreas systems are also reviewed. Finally, this review highlights that meal prediction, control safety, integration, streamlining the optimization of control algorithms, constant temperature preservation of insulin, and dual-hormone artificial pancreas are issues that require further attention in the future.

SAT142 Utilization Of Continuous Glucose Monitoring In Diagnosis And Management Of Insulinoma

Abstract Disclosure: V. Phan: None. P. kretschmer: None. A.G. Pittas: None. Background: Insulinoma is a rare condition that can cause life-threatening hypoglycemia. Its diagnosis and management are challenging due to the requirement of a prolonged fasting test and frequent blood glucose testing. Continuous glucose monitoring (CGM) is widely available in diabetes management; however, its usage in people without diabetes is limited due to lack of evidence. Here, we report an acutely ill patient where we used professional CGM to streamline and expedite the diagnosis of insulinoma, and personal CGM to titrate medical management with diazoxide. Clinical Case: An 81-year-old woman with complex past medical history was admitted for chest pain and shortness of breath, found to have non-ST-elevation myocardial infarction. During inpatient work up, she experienced several hypoglycemia episodes that resolved with oral glucose intake. She had a history of recurrent hypoglycemia and prior MRI showing pancreatic tumor; however, outside records did not reveal biochemical work-up for insulinoma. Her symptoms were unpredictable, so a professional CGM (Freestyle Libre) was placed. CGM data revealed persistent nocturnal hypoglycemia, and occasional postprandial hypoglycemia. Patient-recorded symptoms were present in less than half of the hypoglycemic periods detected by CGM, indicating hypoglycemia unawareness. Given her acute cardiac condition and knowing her nocturnal hypoglycemia pattern from CGM, we performed a modified 72-hour fasting test that started at midnight and was able to capture a hypoglycemia episode within only 2.5 hours of initiation. Her plasma glucose was 57 mg/dL, insulin was 13 uIU/mL, C-peptide was 1.33 uIU/mL, and proinsulin was 9.5 pmol/L. She had a negative screen for sulfonylurea and there was no evidence of antibodies to insulin, suggesting a diagnosis of insulinoma. While awaiting localization studies, the patient was started on diazoxide. We used the personal CGM connected to our clinic portal to monitor glycemia at home and titrate diazoxide dose and frequency. CGM data showed nocturnal hypoglycemia and minimal daytime hypoglycemia, therefore, we recommended diazoxide only at bedtime to minimize daytime side effects and hyperglycemia. On one occasion, the patient was on as short course of prednisone which typically causes hyperglycemia during the day and hypoglycemia in early morning. CGM allowed us to monitor patterns of steroid-induced hyperglycemia, and we moved the prednisone dose to bedtime which resulted in euglycemia overnight. Conclusion: CGM can be a valuable tool in diagnosing and managing people with insulinomas. The CGM provides information about hypoglycemia frequency and pattern. It also helps detect hypoglycemia unawareness. With CGM, we can choose the right timing for 72-hour fasting test to minimize the length of the procedure. As outpatient, CGM also makes monitoring response to diazoxide a seamless process. Presentation: Saturday, June 17, 2023

Diabetes Distress: The Untold Hidden Struggle of Living with Diabetes Mellitus

In recent years, the global burden of diabetes distress has increased significantly, imposing mental health issues on patients and the healthcare system. Diabetes-related distress differs from depression as it originates from the mental and emotional burden that comes from the ongoing management of diabetes. Studies have revealed that one in four individuals with type 1 diabetes has increased levels of diabetes distress, and one in five people with type 2 diabetes experiences increased levels of diabetes distress. Patients with diabetes experience psychosocial and emotional problems in response to these lengthy therapies, including worry about complications, fear of hypoglycemia, fatigue regarding poorly controlled blood glucose, worthlessness, the need for support, and access to healthcare. Psychological factors such as diabetes-related emotional distress have been linked with lower compliance to diet, exercise, frequent blood glucose testing, and medication regimens. Patients with a higher level of diabetes-specific emotional distress have been shown to have a lower health-related quality of life. Despite the increased awareness and knowledge of diabetes-related distress, patients with diabetes are not routinely screened during clinic visits. Therefore, nurses must continually observe and assess a patient's physical and emotional response to treatment and identify patterns and trends suggestive of diabetes-related distress.

Calibrating logics: How adolescents and young adults calibrate often-competing logics in their daily self-management of type 1 diabetes

Adolescents and young adults with type 1 diabetes must manage a demanding chronic condition in their daily lives, but adequate self-management remains a major challenge. In this article, we explore the logics invoked in shaping daily type 1 diabetes self-management among adolescents and young adults and propose an analytical view of self-management as a matter of ‘calibrating logics’. Drawing on Annemarie Mol’s concept of logic, our analysis of in-depth interviews with 21 adolescents and young adults with type 1 diabetes suggested that three main logics collectively shaped their self-management: biomedical, embodied and social. Biomedical logics appeared in the form of routinised insulin therapy, frequent blood glucose testing, and carbohydrate counting, all of which emphasise controlling blood glucose levels. Embodied logics emerged as refined practices such as ‘thinking insulin units’ and ‘listening’ to blood glucose fluctuations. Finally, social logics were at play when discreet or postponed self-management practices were used to adjust to social situations. While these logics may complement each other, study participants invoked how these logics often competed in daily life, generating tensions. We therefore propose viewing self-management as a matter of calibrating logics in which often-competing logics are at play. This can provide nuanced insights into the effort and challenges related to the daily self-management of type 1 diabetes for adolescents and young adults, in contrast to the prevailing dichotomy of adherence versus nonadherence to prescribed treatment regimens.

600-P: Real-Time CGM Coverage Eligibility Should Include Type 2 Diabetes Patients Treated with Less-Intensive Therapy

Use of real-time CGM (rtCGM) improves glycemic outcomes in type 2 diabetes (T2D) patients treated with intensive insulin therapy. However, rtCGM use in T2D patients treated with less intensive therapies has not been well studied. This investigator initiated, 6-month, prospective, interventional, single-arm study assessed the effects of rtCGM use in T2D patients treated with basal insulin only or non-insulin. Clinic visits occurred at baseline and every 3 months per usual care. Baseline blood glucose testing frequency was Disclosure T. Grace: Consultant; Self; Novo Nordisk, Speaker9s Bureau; Self; Dexcom, Inc., Lilly Diabetes, Sanofi US. J. Salyer: None.

Frequency of Diabetic Ketoacidosis in Patients with Type1 Diabetes Using FreeStyle Libre: A Retrospective Chart Review.

IntroductionDiabetic ketoacidosis (DKA) is an acute complication associated with poorly managed or undiagnosed diabetes. DKA is associated with significant morbidity, mortality, and healthcare costs, but can be prevented with appropriate management of diabetes. The FreeStyle Libre is flash glucose monitoring device that measures glucose levels in the interstitial subcutaneous tissue and has been shown to reduce HbA1c, time in hypoglycemia and hyperglycemia, as well as improve health-related quality of life.MethodsA retrospective chart review of patients with type 1 diabetes mellitus (T1DM) and recurrent DKA and who initiated FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) was conducted. DKA frequency and severity, glycated hemoglobin (HbA1c), and frequency of blood glucose monitoring were compared between the 2-year period before FreeStyle Libre initiation and the 2-year period after FreeStyle Libre initiation.ResultsA total of 47 patients with T1DM with recurrent DKA were included. FreeStyle Libre was associated with a reduction in the frequency of DKA events, with a mean of 0.2 (standard deviation [SD] 0.4) events per person during the 2 years after FreeStyle Libre initiation versus 2.9 (SD 0.9) during the 2 years before FreeStyle Libre initiation. Severity of DKA events was also reduced, with fewer severe (before mean 0.3 [SD 0.5] versus after 0.0 [SD 0.0]; p < 0.001) DKA events. A reduction in HbA1c (mean 7.4% [SD 0.5] after versus 9.9% [SD 1.2] before [p < 0.001]) and an increase in frequency of blood glucose testing (mean 8.1 scans/day [SD 1.7] after versus 2.2 finger-pricks/day [SD 0.7] at before [p < 0.001]) were also observed.ConclusionFreeStyle Libre is associated with a reduction in the frequency and severity of DKA events, reduction in HbA1c, and increase in frequency of blood glucose testing in patients with T1DM and recurrent DKA. The use of such a glucose monitoring tool can help to reduce the burden of morbidity, mortality, and healthcare costs associated with complications of diabetes.

Supplementation-based hypoglycemia guidelines including donor breast milk reduce NICU admission.

To study the effects of a supplementation-based hypoglycemia guideline including donor (DM) on NICU admission, exclusive breastfeeding, and blood glucose concentrations in infants at-risk for neonatal hypoglycemia (NH). We integrated DM, feeding supplementation, and reduced frequency of blood glucose testing into an NH bundle for term and late-preterm newborns. We then examined NICU admission rates and rates of exclusive breastfeeding at discharge. NICU admission rates were reduced to 6% (-10%). Exclusive breastfeeding rates increased to 55% (+22%). Median cost of DM utilization was $13.73 per patient with an average volume of 50.8 ml/infant. DM supplementation resulted in similar times to last hypoglycemic episode and greater increases in blood glucose compared to expressed breast milk or breastfeeding alone (+9.6 mg/dL, p < 0.05). A supplementation-based hypoglycemia guideline including donor milk may be an effective way to reduce NICU admissions for asymptomatic hypoglycemia and support mothers in achieving breastfeeding goals.

제 2형 당뇨병환자의 자가혈당측정, 측정결과이용, 저혈당빈도와 당대사조절의 관계

Purpose: The objective of this study is to investigate the association of Self-Monitoring of Blood glucose(SMBG), utilization of SMBG and glycemic control, hypoglycemia in patients with type 2 diabetes. Methods: A survey was conducted from November 2013 to May 2014 of 210 type 2 diabetic patients performing SMBG. Data on practice for SMBG, utilization of SMBG, self-reported episodes of hypoglycemia, and HbA1c values were obtained by questionnaires and laboratory assessments. Results: According to the data, 32.7% of patients had the complication, 38.1% of them were being treated with insulin. In frequency of blood glucose testing, 61.4% of patients monitored it less than 6 times per week. Exercise and insulin dose was frequently controlled by the result of SMBG. And three items of adjusting of oral agents dosage and records of blood glucose level and utilization of SMBG record in hospital visit were low. There were no statistically significant correlations between SMBG and glycemic control. Conclusion: In order to improve the patient’s glycemic control, it is not enough just perform SMBG. It is suggested that self-regulation by result of SMBG and communication with medical staff should be accompanied.

Assessing Diabetes Distress and Sleep Quality in Young Adults with Type 1 Diabetes Using FreeStyle Libre: A Prospective Cohort Study.

IntroductionThe burden of diabetes, its potential complications, and related self-care activities can induce negative psychosocial effects in patients with type 1 diabetes mellitus (T1DM). This prospective cohort study investigated the psychosocial benefits associated with 3 months of FreeStyle Libre (FSL) flash glucose monitoring use in young adults with T1DM in Saudi Arabia.MethodsPatients completed the Diabetes Distress Scale (DDS) and the Pittsburgh Sleep Quality Index (PSQI) questionnaires at baseline and 3 months. HbA1c, number of confirmed hypoglycemia episodes per month, and frequency of blood glucose testing were also collected at baseline and 3 months.ResultsOf 95 patients analyzed, significant reductions were observed in mean DDS (3.8 vs. 2.5; p < 0.001) and PSQI (8.7 vs. 3.9; p < 0.001) scores from baseline to 3 months. Furthermore, HbA1c and confirmed hypoglycemia episodes per month also decreased from baseline to 3 months (HbA1c 8.3 vs. 7.7% [67 vs. 61 mmol/mol], p < 0.001; hypoglycemia episodes 3.0 vs. 2.3, p < 0.001). In contrast, mean frequency of blood glucose testing per day increased from baseline to 3 months (2.5 vs. 5.2; p < 0.001).ConclusionThese data demonstrate improvements in diabetes distress and sleep quality as well as glycemic outcomes following 3 months’ FSL use in young adults with T1DM.

2181-PUB: The Patient Characteristics of Contour Diabetes App Users Worldwide

Since 2016 more than 600,000 people have been utilizing the CONTOUR®DIABETES app (CDA) in combination with connected CONTOUR® Blood Glucose Monitoring Systems (BGMSs) worldwide. The aim of this analysis was to assess demographic data of CDA users from North America (NA) 42.6%, Europe (EU) 47.9% and Asian Pacific (APAC) region 4.5%. We examined the CDA database of patients that uploaded at least one blood glucose (BG) result during September 2019. BG results were automatically synched from a BGMS to CDA via BLE (Bluetooth Low Energy) or had the capability to enter manually in the app. All other data were self-reported and included age, gender, diabetes type, therapy mode, physical activities, carbs and location. From 625,837 users 19.9% of patients recorded at least one BG result during September 2019. In all three regions the proportion of patients above 60 years old was similar (NA 26.6%, EU 23.8%, APAC 26.5%). There were slightly fewer male users in U.S. than in EU and APAC (NA 49.3%, EU 52.6%, APAC 52.8%). The proportion of T1D and T2D users was as follows in NA: T1D 12.9%, T2D 48.6%, EU :T1D 23.2%, T2D 39.4% and APAC: T1D 15.9%, T2D 48.9%. Analysis of treatment mode demonstrated that T2D patients treated by insulin alone or in combination with other glucose lowering medications (OAM) differed from region to region (NA 28.0%, EU 38.1%, APAC 14.5%). Among them daily BG testing adherence also varied (NA 25.5%, EU 33.3%, APAC 23.9%). The daily BG testing in T1D patients was also different per region (NA 30.3%, EU 33.8%, APAC 26.3%). Around 20% of patients that registered with CDA since 2016 were actively using the app. The majority of them were T2D patients across all regions. The proportion of insulin use in this population varied by region. This analysis showed that real world BG testing frequency in T2D patients treated with insulin alone or in combination with OAM as well as in T1D patients appears lower than current recommendations. Further analysis is planned to identify the profile of patients who would mostly benefit from the use of CDA. Disclosure J.M. Richardson: Employee; Self; Ascensia Diabetes Care. Employee; Spouse/Partner; Ascensia Diabetes Care. S. Pardo: Employee; Self; Ascensia Diabetes Care. R. Shaginian: Employee; Self; Ascensia Diabetes Care.

Association between mandatory health examination attendance and diabetes treatment initiation among employees being treated for hypertension.

ObjectivesIt is unclear whether mandatory health examination is effective for employees who are already being treated for chronic diseases. We focused on patients being treated for hypertension and evaluated the association between employer‐based health examination attendance and diabetes treatment initiation.MethodsUsing a database that stores health insurance claims and health examination results of subscribers enrolled in society‐managed health insurance plans in Japan, we identified employees aged 40‐59 years who were being treated for hypertension when starting diabetes treatment from April 2012 to December 2016. A case‐crossover analysis was conducted using 90, 180, and 270 days prior to diabetes treatment initiation as reference points and 90 days after the mandatory health examination as the exposure period. We conducted a subgroup analysis by hemoglobin A1c (HbA1c) level and frequency of outpatient blood glucose testing before the mandatory health examination.ResultsWe identified 1464 individuals starting treatment for diabetes while on antihypertensive drugs. The overall odds ratio for starting diabetes treatment within 90 days of the health examination was 1.89 (95% confidence interval: 1.70‐2.10). The subgroup analysis showed that this odds ratio increased as HbA1c level increased and as blood glucose testing frequency decreased.ConclusionsAmong employees starting treatment for diabetes while being treated for hypertension, employer‐based mandatory health examination attendance was associated with initiation of diabetes treatment. The health examinations may be functioning as a complement to screening in outpatient settings.

Socioeconomic Inequality in Metabolic Control Among Children With Type 1 Diabetes: A Nationwide Longitudinal Study of 4,079 Danish Children.

To examine inequality in glycemic control by maternal educational level among children with type 1 diabetes in a setting with universal access to health care. This was a longitudinal nationwide study of 4,079 Danish children with type 1 diabetes between the years 2000 and 2013. Children were divided into four groups based on mothers' education prebirth (≤high school [n = 1,643], vocational or 2-year college [n = 1,548], bachelor's degree [n = 695], ≥master's degree [n = 193]). Means of socioeconomic and treatment characteristics were compared between groups. HbA1c and the number of daily glucose tests were compared repeatedly from onset until 5 years after onset across groups. HbA1c was compared across daily blood glucose testing frequency and groups. Linear regression was used to compare HbA1c across groups with and without adjustment for socioeconomic and treatment characteristics. Large differences in HbA1c across maternal education were found. The mean level of HbA1c during follow-up was 59.7 mmol/mol (7.6%) for children of mothers with ≥master's degrees and 68.7 mmol/mol (8.4%) for children of mothers with ≤high school (difference: 9.0 mmol/mol [95% CI 7.5, 10.6]; 0.8% [95% CI 0.7, 1.0]). The associations were attenuated but remained significant after adjustment. Observable characteristics explained 41.2% of the difference in HbA1c between children of mothers with ≤high school and mothers with ≥master's degree; 22.5% of the difference was explained by more frequent blood glucose monitoring among the children with the highly educated mothers. Family background is significantly related to outcomes for children with type 1 diabetes, even with universal access to health care.

Mobile-based insulin dose adjustment for type 2 diabetes in community and rural populations: study protocol for a pilot randomized controlled trial.

Background: Insulin initiation and/or titration for type 2 diabetes (T2DM) is often delayed as it is a resource-intensive process, often requiring frequent exchange of information between a patient and their diabetes healthcare professional, such as a credentialed diabetes educator (CDE) for insulin dose adjustment (IDA). Existing models of IDA are unlikely to meet the increasing service demand unless efficiencies are increased. Mobile health (mHealth), a subset of Ehealth, has been shown to improve glycaemic control through enhanced self-management and feedback leading to improved patient satisfaction and could simultaneously reduce costs. Considering the potential benefits of mHealth, we have developed an innovative mHealth-based care model to support patients and clinicians in diabetes specialist community outreach and telehealth clinics, that is, REthinking Model of Outpatient Diabetes care utilizing EheaLth – Insulin Dose Adjustment (REMODEL-IDA). This model primarily aims to improve the glycaemic management of patients with T2DM on insulin, with the secondary aims of improving healthcare service delivery efficiency and the patients’ experience. Methods/Design: A two-arm pilot randomized controlled trial (RCT) will be conducted for 3 months with 44 participants, randomized at a 1:1 ratio to receive either the mHealth-based model of care (intervention) or routine care (control), in diabetes specialist community outreach and telehealth clinics. The intervention arm will exchange information related to blood glucose levels via the Mobile Diabetes Management System developed for outpatients with T2DM. They will receive advice on insulin titration from the CDE via the mobile-app and receive automated text-message prompts for better self-management based on their blood glucose levels and frequency of blood glucose testing. The routine care arm will be followed up via telephone calls by the CDE as per usual practice. The primary outcome is change in glycated haemoglobin, a marker of glycaemic management, at 3 months. Patient and healthcare provider satisfaction, and time required to perform IDA by healthcare providers in both arms will be collected. This pilot study will guide the conduct of a large-scale pragmatic RCT in regional Australia.

Gold nanoclusters for controlled insulin release and glucose regulation in diabetes.

Diabetes has become the third threat to public health worldwide. Traditional treatments of diabetes require frequent blood glucose testing and insulin injections, which not only bring great pain to patients but also exhibit difficulty in controlling the blood glucose accurately. In order to solve these problems, we developed a smart glucose-responsive insulin delivery system responding to the environmental glucose concentration based on gold nanoclusters (GNCs). First, we prepared GNCs as high drug-loading nanocarriers, and we decorated GNCs with phenylboronic acid molecules (4-carboxyphenylboronic acid (PBA) and 4-carboxy-3-fluorophenylboronic acid (FPBA)) as responsive ligands; then, we grafted insulin on the surface to form glucose-responsive insulin-release nanocomplexes GNC-PBA-Ins and GNC-FPBA-Ins, respectively. In the in vitro test, these complexes exhibited high sensitivity to glucose concentrations and rapidly released insulin in a hyperglycemic state. In type 1 diabetic mice in vivo, these complexes could maintain the blood glucose levels of mice in a normoglycemic range for up to 48 h without peaks of hyperglycemia or hypoglycemia, where the GNC-FPBA-Ins complex showed a better regulation of glucose than the GNC-PBA-Ins complex. These gold nanocluster systems mimic the function of the natural pancreas for blood glucose control, which has great potentials for the diagnosis and treatment of diabetes in the future.

Relationship between Frequency of Blood Glucose Testing and Reduction in HbA1c and Body Weight during Intensive Lifestyle Intervention in Patients with Type 2 Diabetes and Obesity

Self-monitoring of blood glucose (SMBG) is known to be valuable for proper diabetes management. However, the optimal frequency of SMBG has been debated. The aim of this study is to evaluate the relationship between frequency of SMBG and the degree of glycemic control and the magnitude of weight reduction in patients with type 2 diabetes (T2D) and obesity enrolled in an intensive lifestyle intervention (ILI). We evaluated 36 patients with T2D and obesity (mean age 56±9 years, 56% female) enrolled in the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week multidisciplinary ILI clinical program between May 2016 and December 2017. Participants were asked to test their blood glucose before each meal, at bed time, before and after exercise, occasionally postprandial and when needed. At baseline, average body weight was 105.7±20.9 kg, BMI 36±6 kg/m2, HbA1c 7.8±1.3%, and 41% of participants were treated with insulin. Based on their actual frequency of SMBG per day, participants were divided into tertiles. The lowest tertile tested on average 2.3±0.6 times/day (range: 1.1-2.9 times). The middle tertile tested on average 3.3±0.3 times/day (range: 3.0-3.9 times). The highest tertile tested on average 5.2±1 times/day (range: 4.0-7.7 times). HbA1c and body weight did not differ between tertiles at baseline. At 12 weeks, HbA1c changed by -0.9±0.3% (p=0.01), -1.2±0.4% (p&amp;lt;0.01) and -1.7±0.5% (p=0.001) respectively from baseline. Body weight changed by -7.6±3.2 kg (-7.13%), -9.2±6.4 kg (-8.7%), and -10.6±4.1 kg (-9.9%) respectively from baseline (p&amp;lt;0.01 for all). The reduction in HbA1c and body weight was significantly better in the highest tertile of SMBG in comparison to the lowest tertile (p&amp;lt;0.for both). In conclusion, patients with T2D and obesity who test their blood glucose more often during ILI achieve significantly better HbA1c reduction and significantly higher percentage of weight loss. Disclosure S. Tomah: None. N. Mahmoud: None. A. Mottalib: None. K. Alsibai: None. S. Ashrafzadeh: None. T. Elseaidy: None. O. Hamdy: Research Support; Self; Abbott. Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck &amp; Co., Inc.. Research Support; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Healthimation, LLC.. Consultant; Self; Sanofi-Aventis.

An Evaluation of the Diabetes Conversation Map Program—Health Outcomes and Health Care Utilization during a Four-Year Follow-Up

Background: Diabetes Conversation Map™ (Map™) is a global education program that engages patients with type 2 diabetes Mellitus (T2DM) in group-based discussions on diabetes-related topics. This study compares outcomes annually between participants and matched controls over a 4-year period. Methods: This was a retrospective cohort study of 11,053 Clalit Health Services members with T2DM who enrolled in the Map™ program between 1.1.2010 and 4.1.2016. The associations between program participation and annual laboratory test results (HbA1c, glucose and LDL levels), health behaviors (frequency of glucose and HbA1c testing), and healthcare utilization (hospital, physician and specialist visits) were assessed between cases and controls using regression analysis. Results: The Map™ group had significantly improved HbA1c, glucose, and LDL levels and more frequent blood glucose testing each year up to 36 months post-enrollment compared to matched-controls. They also had significantly fewer annual primary care visits but more annual ophthalmologist and nutritionist visits up to 24, 36, and 48 months post-enrollment, respectively, compared to matched-controls. The annual frequency of hospital admissions and length of hospital stay was lower up to 36 and 48 months post enrollment, respectively, in the Map™ group compared to matched-controls. Conclusions: Participation in the Map™ program was associated with improved clinical outcomes, behaviors, and healthcare utilization for at least 24 months, suggesting that an intervention booster may be needed beyond this time period. These findings support the significant impact of the Map™ program on the lives of patients with T2DM. Disclosure E. Srulovici: None. M. Leventer-Roberts: None. B. Curtis: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. X. He: None. M.B. Hoshen: None. M. Rotem: None. I. Gofer: None. E. Shadmi: None. C. Key: None. N. Levin-Iaina: Employee; Self; Eli Lilly and Company. A. Strizek: None. B.S. Feldman: None.

The effectiveness, reproducibility, and durability of tailored mobile coaching on diabetes management in policyholders: A randomized, controlled, open-label study

This randomized, controlled, open-label study conducted in Kangbuk Samsung Hospital evaluated the effectiveness, reproducibility, and durability of tailored mobile coaching (TMC) on diabetes management. The participants included 148 Korean adult policyholders with type 2 diabetes divided into the Intervention-Maintenance (I-M) group (n = 74) and Control-Intervention (C-I) group (n = 74). Intervention was the addition of TMC to typical diabetes care. In the 6-month phase 1, the I-M group received TMC, and the C-I group received their usual diabetes care. During the second 6-month phase 2, the C-I group received TMC, and the I-M group received only regular information messages. After the 6-month phase 1, a significant decrease (0.6%) in HbA1c levels compared with baseline values was observed in only the I-M group (from 8.1 ± 1.4% to 7.5 ± 1.1%, P < 0.001 based on a paired t-test). At the end of phase 2, HbA1c levels in the C-I group decreased by 0.6% compared with the value at 6 months (from 7.9 ± 1.5 to 7.3 ± 1.0, P < 0.001 based on a paired t-test). In the I-M group, no changes were observed. Both groups showed significant improvements in frequency of blood-glucose testing and exercise. In conclusion, addition of TMC to conventional treatment for diabetes improved glycemic control, and this effect was maintained without individualized message feedback.

Computer-determined dosage of insulin in the management of neonatal hyperglycaemia (HINT2): protocol of a randomised controlled trial

IntroductionNeonatal hyperglycaemia is frequently treated with insulin, which may increase the risk of hypoglycaemia. Computer-determined dosage of insulin (CDD) with the STAR-GRYPHON program uses a computer model to predict an...

A pain in the neck leading to hypoglycaemia

A 65-year-old man had had type 1 diabetes for six years, with meticulous attention to self-care, frequent blood glucose testing, careful carbohydrate counting and a basal bolus regimen of degludec and Novorapid. (Figure 1.) He would generally have one mild hypo which he could self-manage per fortnight, but in clinic pointed out that he had had just five hypos in two days. He wondered about the tramadol as the cause: he had started on tramadol to treat neck pain two days before the hypos. We replaced the tramadol with oramorph, and the hypos resolved. A nested case-control analysis within the UK Clinical Practice Research Datalink created a cohort of all patients newly-treated with tramadol or codeine for non-cancer pain between 1998 and 2012, and observed them for admissions for hypoglycaemia.1 Among 334 034 subjects, 1105 were hospitalised for hypoglycaemia; compared with codeine, tramadol was associated with a 50% increased risk of hypoglycaemia, particularly during the first 30 days of use. The frequency of hypoglycaemia was 7 per 10 000 users, but these were hospitalisations for hypoglycaemia, and it is likely that less severe hypos are not being recognised.2 The data also showed, not surprisingly, that the subjects with admission for hypoglycaemia were on average elderly, with multiple comorbidities and increased concomitant drug use. A French pharmacovigilance study3 compared reports of hypoglycaemia associated with tramadol, dextropropoxyphene and codeine; it was found that there were 90 reports of hypos with dextropropoxyphene, 53 with tramadol and two with codeine -- although the population at risk is not stated, it confirms the finding that hypos are more common with tramadol than codeine; also, some subjects became hypogly-caemic without being on antidiabetic agents, and hypos generally occurred during the first few days of tramadol use. It has been noted that tramadol directly reduces hepatic gluconeogenesis and enhances peripheral glucose utilisation in diabetic rats.2 Tramadol is a commonly used analgesic; it is both a mu-opioid receptor agonist and a re-uptake inhibitor of serotonin and norepinephrine. The opioid activity is due to both the parent compound and the active metabolite which is metabolised by CYP 2D6 and gives inter-individual differences in pharmacokinetics and clinical effects. Tramadol increases risk of convulsions, and should not be mixed with other opiates, psychiatric medication or drugs that raise serotonin levels.2, 4 In the linked editorial,2 Nelson and Juurlink wrote: ‘The increased prescribing of tramadol most likely reflects aggressive marketing coupled with the perception that it is a safe analgesic not prone to abuse. Whereas the drug's analgesic effects are at best moderate, its toxic effects are dangerous and merit respect, particularly when doses are escalated.’ A useful review of other drugs that are known to cause hypoglycaemia5 includes alcohol, and pentamidine with a high risk of hypoglycaemia which is possible in the absence of diabetic hypoglycaemia treatment, and other agents with a lesser risk of hypos such as chloroquine, ACE inhibitors, beta blockers, salicyclates, and fluoroquinolones such as ciprofloxacin. Recently, warfarin has been shown to increase hypoglycaemia rates in people on sulphonylureas,6 and quinine is known to cause hypoglycaemia, particularly in the setting of renal impairment causing quinine accumulation.7 The hypoglycaemic effects of these drugs occur via various mechanisms, often in the same drug, e.g. salicylate-induced hypoglycaemia may be caused by increasing insulin secretion, increasing insulin sensitivity, displacing sulphonylureas from protein-binding sites, and inhibiting renal excretion.5 Another common drug- related hypoglycaemia scenario occurs when a patient's dia-betes has been stabilised on glucocorticosteroids which are then reduced or withdrawn. I am most grateful to the patient for sending me the scan of his record book. There are no conflicts of interest. References are available online at www.practicaldiabetes.com.