Self-monitoring Of Blood Glucose Frequency Research Articles

Quality Control Circle improves self-monitoring of blood glucose in Type 2 diabetic patients

Objective: To determine the effect of quality control circle (QCC) activity on self-monitoring of blood glucose (SMBG) in type 2diabetic patients. Design: Pre-test Post-test study. Setting: Outpatient clinic of a tertiary hospital in Eastern China. Subjects: A total of 110 insulin-treated type 2 diabetic patients. Interventions: Quality control circle. Main outcome measures: Quality of self-monitoring of blood glucose and blood glucose control in patients. Results: At the end of QCC activity, the proportion of patients performing regular SMBG and the frequency of SMBG were significantly increased. The incidence of using expired test strips, incorrect timing of blood glucose monitoring, improper operation and non-calibration of meters were all significantly decreased. Consequently, the levels of glycosylated hemoglobin,one-week fasting blood glucose, and one-month incidence of hypoglycemia were significantly decreased in these patients. Conclusion: The QCC activity plays an active and beneficial role in improving SMBG and blood glucose control in patients with diabetes. This activity should be promoted in future clinical work.

Clinical efficacy of Professional Continuous Glucose Monitoring in improving glycemic control among children with Type 1 Diabetes Mellitus: An Open-label Randomized Control Trial

Frequent self-monitoring of blood glucose (SMBG) is the only accurate method available for insulin dose titration in patients with T1DM. Professional continuous glucose monitoring (p-CGM) is blinded recording of glucose trends over 5–7 days and helps physicians to guide insulin titration to patient. This study was planned to assess efficacy of insulin dose adjustments, based on p-CGM plus SMBG in improving glycemic control compared to SMBG alone. We did an open-label, parallel design, randomized control trial among children (2–10 years) having T1DM for at least 6 months. Subjects in the intervention group were placed on p-CGM (iPRO 2™ Professional CGM, Medtronic, USA) for 3–5 days along with regular SMBG. Data from p-CGM was analyzed by physician and used to guide insulin titration along with SMBG over following 3 months. Control group had only SMBG records for titrating insulin doses. Primary outcome was change in HbA1c 3 months after intervention. A total of 68 eligible children were randomized, 34 each to either arms. Thirty children in intervention group and 33 in control group completed the study and were analyzed. It was found that there was more decreased unit change in HbA1c, percentage of low sugar records and total insulin requirement per day, after 3 months follow-up, in intervention group. However, difference was not significant except for total insulin Units/kg/day (p = 0.014). In sub-group analysis of children with baseline HbA1c >7.5%, there was a significant mean fall of HbA1c by 1.27% (p = 0.045). There were no major adverse events associated with p-CGM. We conclude that addition of p-CGM along with SMBG may help in adjusting insulin dose more effectively especially in children with higher baseline HbA1c.

MON-021 Patterns of Sharps Handling and Disposal Among Insulin Using Patients with Diabetes

Background: Nearly 7 million patients with diabetes mellitus (DM) in the U.S. use insulin. Both Insulin therapy and self-monitoring of blood glucose (SMBG) have the potential to generate a large volume of biohazardous waste via use of “sharps” (needles and lancets). Unless safely disposed of these sharps could present a public health risk, placing unaware individuals at risk of needle sticks. However, there is a paucity of data on whether patients safely handle and dispose of used insulin needles and lancets. Objective: Assess patterns of sharps use and disposal among a clinic and hospital based population of DM patients on insulin therapy. Method: A survey was administered to a convenience sample of adult insulin treated DM patients recruited from an outpatient endocrinology clinic and an inpatient hospital setting. Patients were asked about patterns of sharps use (frequency of daily SMBG and insulin injections), how often sharps were used prior to disposal, sharp disposal technique, and education received regarding safe sharp disposal. Results: The survey was completed by 142 patients (94 outpatients and 48 inpatients). Mean age was 56 years, self-reported DM duration 20 years, hemoglobin A1c was 8.4%, and BMI 30.2 kg/m2; 57% were men and 75% were white. No differences in characteristics (p>0.1) were seen between outpatient and inpatient respondents. The average number of insulin injections was 3/day, and frequency of SMBG was 3.5/day. A minority (22%) used an insulin needle 2 or more times, and 32% threw the needles directly into the garbage as opposed to a sealable or red sharps container. Most (56%) respondents used a lancet 2 or more times, sometimes changing the lancet once only every few months. Around a third (35%) threw used lancets directly into the garbage; one patient flushed them down the toilet. No differences were seen between outpatients and inpatients (p> 0.3) in patterns of needle use, lancet use, or disposal method. The majority (63%) of respondents indicated they had never received instruction on safe disposal of sharps. Conclusion: In this population of both outpatients and inpatients, repeated use of the same insulin needle and lancet was noted. Moreover, nearly a third of respondents disposed of their sharps in an unsafe manner. If similar data are confirmed in broader studies, this could translate into a large number of insulin using patients improperly disposing of their sharps waste—a potentially important public health hazard. With the rising prevalence of DM and need for insulin, further study is needed to determine sharps disposal practices of these patients. Improved education is needed on both a population and patient level regarding proper handling of these biohazardous materials.

SAT-126 The Relationship of Continuous Glucose Monitoring (CGM)-Derived Time-in-Range (TIR) to Hemoglobin A1c (HbA1c)

ENDO 2019 Background The limitations of glycated hemoglobin (HbA1c) in describing both short- and long-term glycemic control have been recognized recently. Continuous glucose monitoring (CGM) provides robust short-term glycemic control data and important metrics such as time-in-range (TIR), and the TIR of 70-180 mg/dL (3.9-10 mmol/L) is now accepted as the target for patients with diabetes. The change in daily percentage of TIR is used to describe glycemic control after an intervention in clinical trials and after a treatment modification in clinical practice. Recent studies have shown that TIR has a similar association with diabetes microvascular complications as does HbA1c (1,2). The relationship of TIR to the long-standing metric of overall glycemic control (HbA1c) has not been clearly defined to date. Methods Manuscripts and publications that reported paired HbA1c and CGM-derived TIR or HbA1c and frequent self-monitoring of blood glucose (SMBG) measurements across a wide range of HbA1c levels, technologies, and subject demographics were reviewed to determine the correlation of these metrics (1, 3-17). Results There was an excellent correlation between TIR and HbA1c (R2=0.71) where TIR = -12.9*HbA1c + 157. When the results derived from frequent SMBG performed in the DCCT study (1) were excluded, a similar correlation (R² = 0.71; TIR = -12.9*HbA1c + 157) was determined. A 10% change in TIR (e.g., between 50% and 60%) was equivalent to a 0.78% and 0.74% change in HbA1c, respectively. A TIR of 100% was equivalent to an HbA1c level of 4.4%. Conclusions There is a good correlation between HbA1c and TIR, which may support the transition to TIR as a preferred metric for determining the outcome of clinical studies, predicting the risk of diabetes complications, and assessing an individual patient’s glycemic control.

Self-Monitoring of Blood Glucose in Youth-Onset Type 2 Diabetes: Results From the TODAY Study.

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. 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. 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. 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.

State of Type 1 Diabetes Care in the United States in 2016-2018 from T1D Exchange Registry Data.

State of Type 1 Diabetes Care in the United States in 2016-2018 from T1D Exchange Registry Data.

Diabetes self-management and glycemic control: The role of autonomy support from informal health supporters.

Effective diabetes self-management can prevent long-term health complications but is often complex and difficult to achieve. Health care professionals' support for patients' autonomy (autonomy support) in managing their diabetes contributes to better diabetes self-care and glycemic control. Most adults with diabetes also receive self-management support from informal health supporters. Yet, the role of autonomy support from these informal health supporters has not been explored. We examined patients' perceived autonomy support from their main health supporter (family member or friend) in relation to their diabetes distress, self-efficacy, self-monitoring of blood glucose (SMBG), medication adherence, and hemoglobin A1c (HbA1c). Three hundred twenty-six veterans with Type 2 diabetes at high risk for complications, who identified a main health supporter, were surveyed using self-report measures of social support, diabetes distress, self-efficacy, and self-care. HbA1c and prescription fill data were extracted from VA electronic records for the 12-months before and after the survey. Linear regression and linear mixed models examined the associations of autonomy support with diabetes distress, self-efficacy, SMBG, medication adherence, and glycemic control, controlling for participant-supporter relationship characteristics and patient-factors. In adjusted models, greater autonomy support was associated with lower diabetes distress (B = -.323, SE = .098, p = .001), greater self-efficacy (B = .819, SE = .148, p < .001), more frequent SMBG (B = .297, SE = .082, p < .001), and better subsequent 12-month glycemic control (B = .257, SE = .085, p = .003) but not with medication adherence (B = .001, SE = .020, p = .994). Autonomy support from main health supporters is significantly associated better diabetes related attitudes, self-care, and glycemic control after adjusting for relationship and patient characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Selfmonitoring of blood glucose practices by people living with diabetes who use their personal glucometers in Port Harcourt, Niger Delta Region, Nigeria

Self-monitoring of blood glucose (SMBG) assists persons living with diabetes with the day-to-day behavioral and therapeutic adjustments to their diabetes care. It is a cheaper and more available alternative to glycated haemoglobin (HbA1c) in Nigeria for monitoring glycaemic control. Information on SMBG practices of Nigerians living with diabetes using their personal glucometers is scanty. The aim of the study is to assess the intensity and frequency of SMBG by glucometer owners, and the extent the patients and/or the health care providers (HCP) utilize SMBG to achieve personalized treatment goals via behavioral/treatment adjustments. This was a cross sectional study carried out among persons living with diabetes that accessed diabetes care at the diabetes clinic of the University of Port Harcourt Teaching Hospital (UPTH) and using their personal glucometers. They were consecutively recruited. Data obtained by using intervieweradministered questionnaires were analyzed using SPSS version 20.0, and pvalue &lt;0.05 was considered significant. A total of 128 persons living with diabetes participated in the study of which 40 (31%) were males and 88 (69%) were females; the mean age of the subjects was 52.05 ± 11.24 years with a range of 26–70 years. The majority of the study subjects (72%) were in the active working age group (25–60years). The highest frequency of glucometer use was in the 26 subjects (20%) who checked their blood glucose every morning while 62 (48%) of the subjects checked their blood glucose any morning they felt like. Most of the subjects (60%) did not have any recording device. Glucometer owners were not just the insulin-requiring people living with diabetes as more than half of the subjects, 66 (52%) were on oral anti diabetic drugs (OAD) only. Glucometer ownership was mainly by those that were in the working age group. SMBG protocol (frequency) was variable and SMBG data were not maximally utilized.Keywords: Self-monitoring of blood glucose; Personal glucometer; Diabetes; Blood glucose

The Relationship of Hemoglobin A1C to Time-in-Range in Patients with Diabetes.

There has been recent recognition of the limitations of hemoglobin A1C (HbA1C) in describing both short- and long-term glycemic control. Continuous glucose monitoring (CGM) provides robust data about short-term glycemic control and provides metrics such as percent time-in-range (%TIR) that are now routinely reported to describe the change in glycemic control after an intervention in a clinical study or a change in therapy in a patient's care. Recent studies have shown that %TIR may have similar associations with diabetes microvascular complications as does HbA1C. The relationship of %TIR to the long-standing metric of overall glycemic control has not been clearly defined to date. Articles that report paired HbA1C and %TIR metrics (n = 1137) or HbA1C and frequent self-monitoring of blood glucose (SMBG) (n = 1440) across a wide range of HbA1Cs, technologies, and subject demographics were reviewed to determine the correlation of these metrics. Selected paired HbA1C and %TIR data from 18 articles were evaluated by linear regression analysis and Pearson's correlation coefficient. There was an excellent correlation between the two (R = -0.84; R2 = 0.71). This relationship did not change after excluding one study that used SMBG or six studies with ≤7 days of CGM. For every absolute 10% change in %TIR, there was a 0.8% (9 mmol/mol) change in HbA1C. There is a good correlation between HbA1C and %TIR that may permit the transition to %TIR as the preferred metric for determining the outcome of clinical studies, predicting of the risk of diabetes complications, and assessing of an individual patient's glycemic control.

Glycemic control and its associated factors in children and adolescents with type 1 diabetes mellitus

Objective: To explore the factors associated with glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). Methods: Subjects were enrolled from the Guangdong Type 1 Diabetes Translational Medicine Study between June 2011 and August 2017. Patients with T1DM aged less than 18 years and treated with CSII for at least 6 months were included. Demographic data and clinical information on self-monitoring of blood glucose (SMBG), glycosylated hemoglobin (HbA1c) and insulin treatment were collected. Participants were categorized based on HbA1c levels as sufficient control group (HbA1c<7.5% ) and insufficient control group ( HbA1c≥7.5%). A multivariate logistic regression model was used to examine the factors associated with glycemic control. Results: A total of 142 participants (76 females, 66 males) with a median age of 13.0 (9.9, 15.0) years and a median disease duration of 3.0 (1.6, 5.0) years were enrolled. HbA1c was (8.2±2.0)% and 41.55%(59/142) of patients achieved the target for HbA1c. The frequency of SMBG was 5.0 (2.0, 8.0) and 3.0 (1.0, 4.0) tests per day (P<0.001), and the frequency of hypoglycemia was 2.0 (0.8, 4.0) and 1.0 (0, 2.0) times per week (P=0.003) in sufficient control group and insufficient control group, respectively. Sufficient glycemic control (HbA1c <7.5%) was associated with the frequency of SMBG (OR=1.238, 95% CI: 1.088-1.409, P=0.001). Conclusion: A higher frequency of SMBG is one of the key factors to achieve sufficient glycemic control among children and adolescents with T1DM treated with CSII.

Educational Workshop using games improves self-monitoring of blood glucose among children.

ABSTRACTObjective:to evaluate the effectiveness of an educational workshop using games to improve self-monitoring of blood glucose techniques for school children with type 1 diabetes. Method:a quasi-experimental study was conducted with school children who attended two outpatient clinics of a university hospital. Data were collected by systematic observation of the self-monitoring of blood glucose (SMBG) technique before and after the intervention. Data analysis consisted of verifying changes while performing the technique, using pre- and post-intervention compliance rates using statistical tests. The sample consisted of 33 children. Each child participated in one session; 17 educational workshops were conducted in total. Results:we found an increased frequency of SMBG, changing lancets, rotation of puncture sites, as well as calibration and periodic checking of date and time of the glucose meter. Comparisons pre- and post-intervention showed that the average number of steps in accordance with the SMBG technique increased from 5.30 to 6.58, whereas the steps “Changing the lancet of the lancing device”, “Pressing the puncture site” and “Disposing of materials used in a needlestick container” showed statistically significant differences. Conclusion:the educational workshop was effective, as it improved children’s performance of the SBMG technique.

Adolescent Emotional Control Moderates Benefits of a Multicomponent Intervention to Improve Type 1 Diabetes Adherence: A Pilot Randomized Controlled Trial.

We previously tested via randomized controlled trial a novel intervention for adolescents with type 1 diabetes and above-target glycemic control that combined web-delivered incentives for self-monitoring of blood glucose (SMBG) and brief web counseling with working memory training and parental contingency contracting training. Results showed improved SMBG and decreased glycosylated hemoglobin (HbA1c) at 6- and 12-month follow-ups. However, it has not been elucidated if improvements in SMBG mediated the immediate benefits of this treatment on HbA1c nor if this intensive intervention uniquely benefited a subgroup of adolescents with higher problems in emotional control. Adolescents with type 1 diabetes and above-target glycemic control (n = 61) were randomized to receive the 6-month intervention (n = 30) or usual care (n = 31). Adolescents completed the Behavior Rating Inventory of Executive Function-Self-Report, problems with emotional control subscale at baseline, and provided meter downloads to assess frequency of SMBG and completed an HbA1c blood draw at baseline and 6 months later. At 6-month follow-up, improvements in SMBG mediated the effects of receiving the treatment on having lower average HbA1c. Further, problems in emotional control moderated the benefits of the intervention on improvements in SMBG and in turn HbA1c. Only adolescents with above average problems in emotional control evidenced improvements in SMBG in response to treatment, which then explained lower HbA1c levels at 6-month follow-up. This multicomponent, web-delivered intervention provided unique benefits for improving SMBG and lowering HbA1c in teens with higher problems in emotional control.

A Prospective Cohort Study on the Management of Young Patients with Newly Diagnosed Type 2 Diabetes Using Mobile Medical Applications.

IntroductionThe aim of this study was to evaluate the effect of using a mobile medical application (app) for self-monitoring of blood glucose (SMBG) and blood glucose control in young patients with newly diagnosed type 2 diabetes mellitus (T2DM).MethodsThis was a prospective cohort study involving young patients with newly diagnosed T2DM. On a voluntary basis, the patients chose to be included in a group in which they were followed up for 24 weeks with a mobile medical app and the changes in laboratory data and frequency of SMBG observed via the app, or in a group in which they received traditional medical treatment and follow-up. The results between the two groups were compared.ResultsA total of 126 patients signed the informed consent form and were enrolled in the study, of whom 66 chose the mobile medical group, which used the mobile medical app, and the remaining 60 patients chose the traditional medical treatment model. The differences in the physical and chemical indicators between the app-using group and the traditional medical model group were not statistically significant at baseline (p > 0.05). At 24 weeks of treatment, the levels of glycosylated hemoglobin A1c (HbA1c), total cholesterol, triglycerides, and low-density lipoprotein cholesterol were significantly reduced in all patients compared to before treatment (p < 0.05). The app-using group had a higher HbA1c compliance rate and higher frequency of both SMBG and doctor–patient communication than the traditional medical model group (p < 0.01). The HbA1c compliance rate of patients using the mobile medical app was 1.53-fold higher than that of the traditional medical model group. At 24 weeks, HbA1c was negatively correlated with the frequency of SMBG (r = − 0.208, p = 0.020) and the frequency of doctor–patient communication (r = − 0.323, p = 0.000). Additionally, there was a positive correlation between the frequency of SMBG and doctor–patient communication (r = 0.579, p = 0.000).ConclusionA mobile medical app is helpful to young patients with newly diagnosed T2DM for monitoring their blood glucose level and improving their blood glucose control to meet the standard.

Self-management practices of type 1 diabetes mellitus

The effective management of Type 1 Diabetes (T1D) involves self-management practices and education about self-monitoring of blood glucose (SMBG) and insulin therapy. Data on self-management practices in India is sparse. The aim of the study was to assess the self-management practices in young subjects with T1D. The frequency and timing of SMBG, the types of insulin used and insulin regimens, and the sites of administration and rotation patterns were analyzed in the study. This was an observational cross-sectional study carried out in young subjects with T1D using a pre designed, pretested questionnaire. Eighty (80) subjects were enrolled; age ranges from 5 to 25 years with a mean duration of T1D of 5 years. HbA1c was less than 8.5% in 47.4% of subjects. Fifty-seven percent monitored SMBG daily and majority monitored only once in the morning and once in the evening. The combination of fasting, pre-lunch, and pre-dinner was most recorded. The types of insulin used are regular, premixed, NPH, and glargine. Majority (62%) used premixed and regular insulin with a thrice-daily regimen. Site rotation was seen in 75.5% of subjects. An association between SMBG and HbA1c was observed. Eighty-six percent of the subjects with SMBG thrice or more in a day had HbA1C of less than 8.5%. The study concludes that SMBG in T1D is underused and highlights the need for educating subjects with T1D and their families further about SMBG, insulin regimens, and the importance of taking insulin diligently as advised by the doctor for better glycemic control.

Real-world use of self-monitoring of blood glucose in people with type 2 diabetes: an urgent need for improvement.

To assess use of self-monitoring of blood glucose (SMBG) in type 2 diabetes (T2DM) in the context of a continuous quality improvement initiative (AMD Annals). 14 quality-of-care indicators were developed, including frequency of SMBG, fasting blood glucose (FBG), and post-prandial glucose (PPG) levels, and hypoglycemia and hyperglycemia episodes. Clinical data and SMBG values downloaded from any glucose meter were obtained from electronic medical records. The most frequently used glucose-lowering treatment regimens were identified and the indicators were assessed separately by regimen. Overall, 21 Italian centers and 13,331 patients (accounting for 35,657 HbA1c tests and 8.44million SMBG values collected during 2014 and 2015) were included in the analysis; 11 therapeutic regimens were selected. Patients in regimens not including insulin performed 15-23 measurements per patient-month, those treated with basal insulin 32.1 tests/patient-month, and those treated with basal and short-acting insulin 53-58 tests/patient-month. In all treatment regimens, PPG measurements represented a minority of all tests; pre-breakfast measurements accounted for about 50% of all FBG values. Mean FBG levels exceeded 130mg/dl in 49.3-88.3% of the cases in the different treatment regimens, while PPG levels were over 140mg/dl in 46.7-81.0%. From 5.7 to 32.7%, patients in the different regimens had at least one episode of hypoglycemia (< 70mg/dl), while from 3.7 to 47.7% had at least one episode of hyperglycemia (> 300mg/dl). SMBG is underutilized in patients with T2DM treated or not with insulin. In all treatment groups, PPG is seldom investigated. Poor metabolic control and rates of hyper- and hypoglycemia deserve consideration in all treatment groups.

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.

Poor Adherence in Adolescents with Type 1 Diabetes Associated with Distress, Fear of Hypoglycemia, and Executive Functioning

Introduction: T1D poses unique challenges to adherence-related behavior due to complex treatment regimens. This study aimed to determine prevalence rates of adherence in adolescents on multiple daily injections (MDI) or subcutaneous insulin infusion (CSII). Additional aims included determination of whether adherence correlated to HbA1c and whether psychological factors predicted adherence. Methods: Self-monitoring of blood glucose (SMBG) and insulin delivery data were downloaded for the previous 30 days. Distress was measured using the Problem Areas in Diabetes-Teen Version, the Blood Glucose Monitoring Communication Questionnaire, and the Barriers to Diabetes Adherence survey. The Hypoglycemia Fear Survey and Behavior Rating of Executive Function were administered. Bivariate correlations and hierarchical regressions were used to determine how adherence related to HbA1c and the predictive value of psychological factors. Continuous glucose monitor (CGM) use was considered as a covariate. Results: Adolescents (N=81; 41 on MDI and 40 on CSII; 32 on CGM) aged 11 to 17 years completed the study. The mean HbA1c was 8.74% (SD=1.74%). Daily, &amp;lt;7% of participants engaged in SMBG ≥4 times; &amp;lt;7% engaged in carbohydrate entry ≥3 times, and &amp;lt;20% engaged in bolus delivery ≥3 times. Hyperglycemia readings were followed by a correction bolus in 58% of cases. HbA1c was negatively correlated with several adherence domains: frequency of SMBG (r=-0.465, p&amp;lt;.01), carbohydrate entry (r=-0.511, p&amp;lt;.01), and bolus insulin delivery (r=-0.522, p&amp;lt;.01). Distress and fear of hypoglycemia predicted adherence to correction bolusing for hyperglycemia (R2=.237, p&amp;lt;.05) in a model with child age, gender, and executive functioning. Conclusions: Findings suggest adolescents do not adequately adhere to treatment for T1D. The use of diabetes treatment technology is helpful to measure specific domains of adherence and clarify relationships with psychological factors. Disclosure S.C. Westen: None. J. Warnick: None. M. Entessari: None. A. Albanese-O'Neill: None. D. Schatz: None. M.J. Haller: None. D.M. Janicke: None.

Frequency of Flash Glucose Monitoring Scans and Hemoglobin A1c in Real Life

Introduction: In patients with type 1 diabetes mellitus (T1D) the relationship between low number of self-monitoring of blood glucose (SMBG) measurements and elevated hemoglobin A1c (HbA1c) levels has been reported. However, the optimal frequency of SMBG has not been defined. Flash glucose monitoring (FGM) is an emerging technology allowing patient with diabetes to measure interstitial glucose concentrations in a non-invasive manner, with patients obtaining more measurements than with SMBG. Materials and Methods: We collected data from 103 adult T1D patients using FGM technology in real life for at least 28 days. We recorded patients demographics, diabetes duration, type of treatment (CSII or MDI) and we downloaded FGM data to the Abbott Freestyle Libre software, which provides the number of daily FGM scans and estimates of HbA1c based on continuous glucose profile readings. The correlation between median FGM scan frequency over 28 days and the estimated HbA1c was analyzed using Spearman rho. We also computed HbA1c median levels for quintiles of scan frequency and compared them using Kruskal-Wallis test. Results: A significant correlation was found between median scan Spearman rho was -0.48 (p&amp;lt;0.0001). Moreover, median HbA1c level decreased significantly from the first (3-5) to the third (10-14) quintile of daily scan frequency [from 69 mmol/mol (IQR 62 to 78) to 54 mmol/mol (49 to 50), p#x003C0.0001] and remained unchanged thereafter, i.e., from the third to the fifth (24-50) quintile daily scan frequency [from 54 mmol/mol (49 to 50) to 53 mmol/mol (45 to 56), p=0.7638]. Conclusions: In T1D patients we confirmed that frequent measurements of interstitial glucose benefits glucose control in real life conditions. The maximum benefit in term of HbA1c decrease is obtained between 10 to 14 scans daily, a number of glucose measurements that would unlikely be sustainable with SMBG. Disclosure A. Laurenzi: Other Relationship; Self; Animas Corporation, LifeScan, Inc..A. Caretto: None.M. Barrasso: None. A. Bolla: Other Relationship; Self; Roche Diabetes Care Health and Digital Solutions. C. Molinari: Other Relationship; Self; Eli Lilly and Company, Sanofi. A. Zanardini: Other Relationship; Self; Roche Diagnostics Corporation.N.C. Dozio: None.E. Meneghini: None. E. Bosi: Consultant; Self; Abbott, AstraZeneca, Lexicon Pharmaceuticals, Inc., LifeScan, Inc.. Employee; Spouse/Partner; LifeScan, Inc.. Consultant; Self; Medtronic, Merck Sharp &amp;Dohme Corp., Novartis AG, Roche Diabetes Care Health and Digital Solutions, Sanofi. M. Scavini: Consultant; Self; Sanofi, Roche Diabetes Care Health and Digital Solutions.

Determinants of self-monitoring of blood glucose with type 2 diabetes based on 496 questionnaire surveys in China

The purpose of the study was to investigate the current status quo of self-monitoring of blood glucose (SMBG) levels and to analyze the relationship between demographics and other characteristics of SMBG among people with type 2 diabetes (T2D) in China. In this multicenter, cross-sectional study, 496 individuals with T2D from five provinces across China voluntarily participated in the study and completed a standardized questionnaire that requested information on demographic data, clinic-related information, and glucose monitoring. Data was obtained via face-to-face interviews. Negative binomial regression analysis was used to identify factors associated with SMBG. Of the total sample, 99 (20.0%) participants had never performed SMBG and/or less than once. We found that 104 participants (21.0%) had tested just once. In addition 119 people (24.0%) had tested twice, 89 (18.0%) had tested between three and six times, and 85 participants (17.1%) had tested more than seven times in a week. Univariate analysis and multivariate analysis found that the patients that had high monitoring frequencies were those with URBMI, UEBMI, and GMI insurance; those who had previously experienced complications; inpatients; and those with a knowledge of HbA1c testing. The frequency of SMBG was suboptimal, compared with the once prior to each meal recommendation by the American Diabetes Association (ADA). Several factors influenced SMBG frequency: types of health insurance, complications, impatience, and knowledge of HbA1c.

Type 1 Diabetes in Children and Adolescents.

Type 1 Diabetes in Children and Adolescents.