Self-monitoring Of Glucose Research Articles

Efficacy of a Digital Diabetes Logbook for People With Type 1, Type 2, and Gestational Diabetes: Results From a Multicenter, Open-Label, Parallel-Group, Randomized Controlled Trial.

In a randomized controlled trial, the efficacy of a digital diabetes diary regarding a reduction of diabetes distress was evaluated. A randomized controlled trial with a 12-week follow-up was conducted in 41 study sites across Germany. Key eligibility criteria were a diagnosis of type 1, type 2, or gestational diabetes and regular self-monitoring of blood glucose. Participants were randomly assigned (2:1 ratio) to either use the digital diabetes logbook (mySugr PRO), or to the control group without app use. The primary outcome was the reduction in diabetes distress at the 12-week follow-up. All analyses were based on the intention-to-treat population with all randomized participants. The trial was registered at the German Register for Clinical Studies (DRKS00022923). Between February 11, 2021, and June 24, 2022, 424 participants (50% female, 50% male) were included, with 282 being randomized to the intervention group (66.5%) and 142 to the control group (33.5%). A total of 397 participants completed the trial (drop-out rate: 6.4%). The median reduction in diabetes distress was 2.41 (interquartile range [IQR]: -2.50 to 8.11) in the intervention group and 1.25 (IQR: -5.00 to 7.50) in the control group. The model-based adjusted between-group difference was significant (-2.20, IQR: -4.02 to -0.38, P = .0182) favoring the intervention group. There were 27 adverse events, 17 (6.0%) in the intervention group, and 10 (7.0%) in the control group. The efficacy of the digital diabetes logbook was demonstrated regarding improvements in mental health in people with type 1, type 2, and gestational diabetes.

Pregnancy and delivery in an advanced cancer survivor with immune checkpoint inhibitor-induced type 1 diabetes: a case report

PurposeGiven the rarity and elderly onset of immune checkpoint inhibitor (ICI)-induced type 1 diabetes (ICI-T1DM), cases leading to delivery are rare.MethodTo our knowledge, this is the first case report of childbirth in a patient with ICI-T1DM after cancer survival. A 32-year-old woman was started on Nivolumab for metastatic parotid cancers one year after total parotidectomy.ResultThe patient developed ICI-T1DM after 43 cycles and started multiple daily insulin therapy and self-monitoring of blood glucose. Complete response was maintained for 2 years by nivolumab, and she finished nivolumab in 77 cycles to attempt pregnancy. During the follow-up period, she began using a sensor-augmented pump (SAP). She had undetectable serum and urinary C-peptide when she started SAP. Her HbA1c level decreased from 7.8 to 6.6% without increasing hypoglycemia in one year. The patient remained in complete response after ICI discontinuation, and embryo transfer was initiated. Pregnancy was confirmed after a second embryo transfer (21 months after ICI discontinuation). At 36 weeks and 6 days, an emergency cesarean section was performed due to the onset of preeclampsia. The baby had hypospadias and bifid scrotum but no other complications or neonatal intensive care unit admission.ConclusionBecause ICI discontinuation and ICI-T1DM carry risks for the patient and child, the decision regarding pregnancy warrants careful consideration. Diabetologists should collaborate with patients and other clinical departments to develop a treatment plan for childbirth.

Impact of short-term application of continuous glucose monitoring system(CGMS) on long-term glycemic profile in adolescents and adults with type 1 diabetes mellitus: An open-label randomized control cross over study

AimsThe use of Continuous Glucose Monitoring System (CGMS) improves glycemic parameters in Type 1 Diabetes Mellitus (T1D), but the cost is prohibitive. Here, we investigated the effect of short-term application of real-time and intermittently-scanned CGMS (rt and is-CGMS) in T1D individuals on change in HbA1c at the end of 3 months. MethodsT1D individuals were randomized into three groups in a ratio of 1:1:2 - Group A (rt-CGMS for 2 weeks initially, followed by is-CGMS for 2 weeks at 3 months), Group B (is-CGMS for 2 weeks initially followed by rt-CGMS for 2 weeks at 3 months) and Group C (only self-monitoring of blood glucose), respectively. HbA1c at baseline, 3, and 6 months were compared. ResultsOut of a total 68 T1D patients, HbA1c decreased significantly in groups A and B at 6 months compared to the baseline, but not in group C. HbA1c was significantly lower in Group A compared to Group C at 3 and 6 months. Fructosamine levels significantly decreased in Group B before and after cross-over. Glycemic variability indices improved significantly after cross-over from is-CGMS to rt-CGMS. ConclusionIntermittent application of CGMS for 2 weeks improves short- and long-term blood glucose control in T1D.

Effects of Switching from Degludec to Glargine U300 in Patients with Insulin-Dependent Type 1 Diabetes: A Retrospective Study.

Background and Objectives: Degludec (Deg) and glargine U300 (Gla-300) are insulin analogs with longer and smoother pharmacodynamic action than glargine U100 (Gla-100), a long-acting insulin that has been widely used for many years in type 1 and type 2 diabetes. Both improve glycemic variability (GV) and the frequency of hypoglycemia, unlike Gla-100. However, it is unclear which insulin analog affects GV and hypoglycemia better in patients with insulin-dependent type 1 diabetes. We evaluated the effects of switching from Deg to Gla-300 on the day-to-day GV and the frequency of hypoglycemia in patients with insulin-dependent type 1 diabetes treated with Deg-containing basal-bolus insulin therapy (BBT). Materials and Methods: We conducted a retrospective study on 24 patients with insulin-dependent type 1 diabetes whose treatment was switched from Deg-containing BBT to Gla-300-containing BBT. We evaluated the day-to-day GV measured as the standard deviation of fasting blood glucose levels (SD-FBG) calculated by the self-monitoring of blood glucose records, the frequency of hypoglycemia (total, severe, and nocturnal), and blood glucose levels measured as fasting plasma glucose (FPG) levels and hemoglobin A1c (HbA1c). Results: The characteristics of the patients included in the analysis with high SD-FBG had frequent hypoglycemic events, despite the use of Deg-containing BBT. For this population, SD-FBG and the frequency of nocturnal hypoglycemia decreased after the switch from Deg to Gla-300. Despite the decrease in the frequency of nocturnal hypoglycemia, the FPG and HbA1c did not worsen by the switch. The change in the SD-FBG had a negative correlation with the SD-FBG at baseline and a positive correlation with serum albumin levels. Conclusions: Switching from Deg to Gla-300 improved the SD-FBG and decreased the frequency of nocturnal hypoglycemia in insulin-dependent type 1 diabetes treated with Deg-containing BBT, especially in cases with low serum albumin levels and a high GV.

Acceptability and experiences of real-time continuous glucose monitoring in adults with type 2 diabetes using insulin: a qualitative study

AimsTo explore the lived experiences of initiating real-time continuous glucose monitoring (rt-CGM) use in individuals with type 2 diabetes using insulin.MethodsTwelve semi-structured interviews were conducted amongst individuals with type 2 diabetes taking insulin who were enrolled in the 2GO-CGM randomised controlled trial and had completed 3 months of rtCGM. Interviews were transcribed verbatim and analysed to identify common themes regarding their experiences.ResultsThe interviews revealed three key themes: i) rtCGM as a facilitator of improved health behaviours; ii) the acceptability of rtCGM systems compared to capillary blood glucose testing; and iii) barriers to the continual usage of rtCGM technology – including: connection difficulties, longevity of the sensors, and local cutaneous reactions to the sensor adhesive.ConclusionAdults on insulin with type 2 diabetes find rtCGM systems widely acceptable, and easier to engage with than traditional self-monitoring of capillary blood glucose.

Factors Associated With Diabetes Self-Care Performance in Indonesians With Type 2 Diabetes: A Cross-Sectional Study.

In Indonesia, the number of Type 2 diabetes cases is increasing rapidly, making it the third leading cause of death and among the leading noncommunicable disease healthcare expenditures in the country. Thus, there is a critical need for Indonesians with Type 2 diabetes to perform better self-care to optimize their health and prevent the onset of comorbidities. This study was designed to investigate the influence of knowledge, depression, and perceived barriers on Type 2 diabetes self-care performance in Indonesia. A cross-sectional study was conducted on 185 patients with Type 2 diabetes, with demographic, diabetes history, obesity status, diabetes knowledge, depression, perceived barriers, and self-care performance data collected. The Indonesian version of the Revised Diabetes Knowledge Test, Depression Anxiety Stress Scale, Perceived Barrier Questionnaire and Self-Care Inventory-Revised were used. Descriptive, bivariate, and multiple linear regression analyses were performed. Study participants were found to have moderate diabetes self-care performance scores. Annual eye checks, blood glucose self-monitoring, healthy diet selection, and regular exercise were the least common self-management techniques performed and were consistent with the perceived difficulties of the participants. Being illiterate or having an elementary school education (β = 4.59, p = .002), having a junior or senior high school education (β = 3.01, p = .006), having moderate depression (β = -0.92, p = .04), diabetes knowledge (β = 0.09, p = .006), and perceived barriers (β = 0.31, p < .001) were found to explain 40% of the variance in self-care performance. Educational level, depression, and perceived barriers were the strongest factors that impacted Type 2 diabetes self-care performance in this study. Nurses should not only provide diabetes education but also identify barriers to diabetes self-care early, screen for the signs and symptoms of depression, and target patients with lower levels of education.

Current status of screening and management of gestational diabetes in early pregnancy: a questionnaire survey in Japan.

Our aim is to investigate the obstetric practices in Japan regarding the screening and management of gestational diabetes mellitus (GDM) diagnosed before 20weeks of gestation (early-GDM). A web-based questionnaire survey was administered to 991 teaching hospitals between November 2021 and February 2022, and 602 responses were received (a response rate of 61%). Screening tests for all pregnant women in the first trimester were conducted in 553 (92%) hospitals, and nearly all of these hospitals (535/553 [97%]) adhered to an individual protocol, predominantly relying on random plasma glucose measurements (488/535 [91%]). A quarter (139 [26%]) implemented a risk profile assessment for GDM screening, taking into account factors such as previous gestational diabetes, prior macrosomia, and family history of diabetes. A small number (23 [4%]) targeted only women at high risk of GDM using the risk profile assessment. The majority of hospitals (501 [94%]) employed a 75g oral glucose tolerance test as a diagnostic measure, and glycemic control for early-GDM was established in most hospitals (429 [80%]). Of the 535 hospitals that maintained an individual management protocol, 356 [67%] facilitated dietary management, self-monitoring of blood glucose, and insulin administration if needed to meet glycemic targets. Our survey revealed a widespread adoption of universal screening and subsequent treatment for early-GDM in Japan.

Assessment of Health Education in The Prevention of Non-Communicable Chronic Disease Complications: Systematic Review

Objective: To evaluate the effectiveness of health education in the prevention of non-communicable chronic diseases. Method: This is a systematic literature review, guided by the question "In patients with non-communicable chronic diseases (NCDs), does health education compared to conventional clinical practice contribute to the prevention of complications?". The selected articles were extracted from the following databases: Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PUBMED), Scientific Electronic Library Online (Scielo), Regional Online Information System for Scientific Journals from Latin America, the Caribbean, Spain, and Portugal (Latindex), and Cochrane Library. Randomized clinical trials in English, Portuguese, and Spanish from the last 10 years with full-text availability were chosen as eligibility criteria, resulting in a final sample of 10 articles. Results: Positive findings were observed regarding the complications of non-communicable diseases, such as: improvement in quality of life and cardiac anxiety scores; reduction in anxiety and depression; increased therapeutic adherence, diabetic foot care, physical activity stimulation, adoption of healthy eating habits, blood glucose self-monitoring and health literacy improvement; reduction in systolic and diastolic blood pressure; improvement in self-management of Type 2 Diabetes Mellitus; overall prevention of NCDs; promotion of motivation for behavioral change in smoking patients, and improvement in renal function with a considerable decrease in serum creatinine and a stable glomerular filtration rate. Implementing educational programs can be helpful in enhancing the quality of life in chronic diseases. Conclusion: Despite the limitation resulting from the diversity of interventions, the consistency in results highlights the beneficial impact of educational approaches, calling for attention from healthcare professionals and public policymakers to expand the use of these strategies in the management of NCDs.

User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania

AimsDevelopment of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC’s attributes guiding product characteristics. However, people living with diabetes (PLWD) in...

Cost-utility of real-time continuous glucose monitoring versus self-monitoring of blood glucose in people with insulin-treated Type II diabetes in France.

Aim: Clinical trials and real-world data for Type II diabetes both show that glycated hemoglobin (HbA1c) levels and hypoglycemia occurrence can be reduced by real-time continuous glucose monitoring (rt-CGM) versus self-monitoring of blood glucose (SMBG). The present cost-utility study investigated the long-term health economic outcomes associated with using rt-CGM versus SMBG in people with insulin-treated Type II diabetes in France. Materials & methods: Effectiveness data were obtained from a real-world study, which showed rt-CGM reduced HbA1c by 0.56% (6.1mmol/mol) versus sustained SMBG. Analyses were conducted using the IQVIA Core Diabetes Model. A French payer perspective was adopted over a lifetime horizon for a cohort aged 64.5years with baseline HbA1c of 8.3% (67mmol/mol). A willingness-to-pay threshold of €147,093 was used, and future costs and outcomes were discounted at 4% annually. Results: The analysis projected quality-adjusted life expectancy was 8.50 quality-adjusted life years (QALYs) for rt-CGM versus 8.03QALYs for SMBG (difference: 0.47QALYs), while total mean lifetime costs were €93,978 for rt-CGM versus €82,834 for SMBG (difference: €11,144). This yielded an incremental cost-utility ratio (ICUR) of €23,772 per QALY gained for rt-CGM versus SMBG. Results were particularly sensitive to changes in the treatment effect (i.e., change in HbA1c), annual price and quality of life benefit associated with rt-CGM, SMBG frequency, baseline patient ageand complication costs. Conclusion: The use of rt-CGM is likely to be cost-effective versus SMBG for people with insulin-treated Type II diabetes in France.

A Real-World Prospective Study of the Effectiveness and Safety of Automated Insulin Delivery Compared With Other Modalities of Type 1 Diabetes Treatment During Ramadan Intermittent Fasting.

To compare the fasting experience and glycemic control during Ramadan among people with type 1 diabetes (PWT1D) who use automated insulin delivery (AID) versus other modalities of treatment. A total of 294 PWT1D who attempted fasting during Ramadan in 2022 were categorized on the basis of treatment modality into one of five groups: 1) AID (n = 62); 2) conventional pump + continuous glucose monitoring (CGM; n = 37); 3) pump + self-monitoring of blood glucose (SMBG; n = 8); 4) multiple daily injections (MDI) + CGM (n = 155); and 5) MDI + SMBG (n = 32). Predictors of fasting most days of Ramadan (i.e., breaking fast ≤2 days because of diabetes) were analyzed using uni- and multivariable logistic regression. The median numbers of days when fasting was broken because of diabetes were 2, 5, 3, 3.5, and 2.5 for AID, conventional pump + CGM, MDI + CGM, pump + SMBG, and MDI + SMBG users, respectively (P = 0.047). Users of AID had a significantly greater time in range (TIR) and lower glycemia risk index, time below range, and time above range compared with users of conventional pumps and MDI (both P < 0.05). Likewise, 53% of AID users attained the double target of 1) breaking fast ≤2 days because of diabetes and 2) maintaining TIR ≥70% during Ramadan compared with only 3% of the conventional pump users and 44% of the MDI + CGM users (both P < 0.05). Compared with MDI + CGM users, AID users were twice as likely to complete fasting most days of Ramadan. Use of AID is associated with the highest rates of fasting and best glycemic control during Ramadan fasting.

The role of glycemic control in the development of late complications of diabetes mellitus

The incidence of type 2 diabetes mellitus is constantly increasing throughout the world. It is known that type 2 diabetes is associated with the development of atherosclerotic cardiovascular diseases, chronic heart failure, and chronic kidney disease. Modern therapy for type 2 diabetes mellitus requires complex treatment and should be aimed not only at reducing glycemia, but also at managing the risks of cardiovascular and renal complications. The results of large scientific studies ADVANCE, ACCORD and VADT have clearly proven the role of glycemic control in the prevention of microvascular complications of diabetes. A number of studies have established that the parameters of glycemic variability are of independent importance in predicting diabetic retinopathy, nephropathy and cardiovascular complications. Hyperglycemia also plays an important role in the development of macrovascular complications. The modern approach to the management of diabetes as one of the most important methods of preventing micro-and macroangiopathies includes the need for mandatory self-monitoring of blood glucose. Self-monitoring of glycemia should be accurate, simple and convenient, allowing the patient to carry out effective and safe glucose-lowering therapy. One of the main aspects of self-monitoring of blood glucose is the choice of a glucometer. From the doctor’s point of view, the most important criterion for choosing a glucometer is compliance with accuracy standards, and from the patient’s point of view, convenience and ease of use. Thanks to the improvement of technology, the accuracy of blood glucose measurements increases, the procedure for self-monitoring of glycemia is simplified, which leads to increased adherence to treatment and the effectiveness of glucose-lowering therapy. Achieving and maintaining the target glycemic level, preventing micro-and macrovascular complications are impossible without the active full participation of the patient himself in the treatment of diabetes, self-monitoring of blood glucose using an accurate and patient-friendly glucometer, i.e., Contour Plus One.

Effects of Digitization of Self-Monitoring of Blood Glucose Records Using a Mobile App and the Cloud System on Outpatient Management of Diabetes: Single-Armed Prospective Study.

In recent years, technologies promoting the digitization of self-monitoring of blood glucose (SMBG) records including app-cloud cooperation systems have emerged. Studies combining these technological interventions with support from remote health care professionals have reported improvements in glycemic control. To assess the use of an app-cloud cooperation system linked with SMBG devices in clinical settings, we evaluated its effects on outpatient management of diabetes without remote health care professional support. In this multicenter, open-label, and single-armed prospective study, 48 patients with diabetes (including type 1 and type 2) at 3 hospitals in Japan treated with insulin or glucagon-like peptide 1 receptor agonists and performing SMBG used the app-cloud cooperation system for 24 weeks. The SMBG data were automatically uploaded to the cloud via the app. The patients could check their data, and their attending physicians reviewed the data through the cloud prior to the patients' regular visits. The primary outcome was changes in glycated hemoglobin (HbA1c) levels. Although HbA1c levels did not significantly change in all patients, the frequency of daily SMBG following applying the system was significantly increased before induction at 12 (0.60 per day, 95% CI 0.19-1.00; P=.002) and 24 weeks (0.43 per day, 95% CI 0.02-0.84; P=.04). In the subset of 21 patients whose antidiabetic medication had not been adjusted during the intervention period, a decrease in HbA1c level was observed at 12weeks (P=.02); however, this significant change disappeared at 24 weeks (P=.49). The Diabetes Treatment Satisfaction Questionnaire total score and "Q4: convenience" and "Q5: flexibility" scores significantly improved after using the system (all P<.05), and 72% (33/46) patients and 76% (35/46) physicians reported that the app-cloud cooperation system helped them adjust insulin doses. The digitization of SMBG records and sharing of the data by patients and attending physicians during face-to-face visits improved self-management in patients with diabetes. Japan Registry of Clinical Trials (jRCT) jRCTs042190057; https://jrct.niph.go.jp/en-latest-detail/jRCTs042190057.

P-26 Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: A case report

Abstract Introduction Factitious disorder (FD) is diagnosed by pretending to be sick with no abnormal examination or paraclinical study in the presence of psychiatric symptoms which also is named Munchausen's syndrome. The prevalence of the disease among hospitalized patients is approximately 9%. Clinical Case A 17-year-old girl with type 1 diabetes mellitus was referred to endocrinology clinic with uncontrolled diabetes, dizziness, abdominal pain, nausea and vomiting. She was treated with multiple daily insulin during 4 years but in last 8 months her self-monitoring of blood glucose ranges was out of control and have BG (blood glucose) different ranges of 40-560mg/dl. She was admitted to control her brittle diabetes with insulin infusion but even with high dose insulin infusion up to 20 IU/hr mostly her BS were above 400mg/dl. The notable point was that BG level was measured by laboratory was lower than glucometer. She also complained of severe abdominal pain and nausea during admission that mimics diabetic ketoacidosis in the presence of hyperglycemia despite the lack of ketonuria and metabolic acidosis. She admitted to hospital several times over the last year to control high level of BG. In psychiatric examination, she has good cooperation in response to questions. Mental Status Examination was not normal. Her mood was depressive and behavior was aggressive. Mild depressive symptoms and borderline features were seen in her Rorschach test. Finally because of high suspicion to associated psychiatric problems, to find the cause of high BG despite high insulin dose prescription, patient behaviors were monitored insensible. We found that she impregnated her finger to the date palm a few minutes before blood glucose check with glucometer devices at times when she is alone in the room. The patient had different deceptive behaviors depending on the method of treatment. But the answer to the question of why the patient was not suffering from hypoglycemia despite high doses of insulin injection is, when insulin infusion by pump was started to control high BG, intravenous cannula secretly separated from insulin infusion set and insulin thrown away. Also she secretly eats fruit juice and jam to prevent hypoglycemic attack for high-dose insulin injection. She took the water into the insulin pen instead of insulin and injected so that the nurses did not notice. Frauds were changed by switching the treatment methods. HbA1c was requested last week of hospitalization which shows 8%. Although all BGwas above 300 mg/dl during this prolonged hospitalization, it did not match with chronic hyperglycemia. Conclusion The main purpose of this article was in relation to a diabetic patient with brittle diabetes, difficulty in control BG level, discrepancies between patient symptoms and sings, factitious disorder or Munchausen syndrome should always be in our mind.

Modern methods for assessing compensation of diabetes mellitus. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes

Background. An integral part of diabetes mellitus (DM) management is its timely diagnosis. The reference method to study the quality of glycemic control is evaluating the level of glycated hemoglobin (HbA1c) as one of the most accessible and informative tools. However, the introduction of novel technologies, namely the use of continuous glucose monitoring (CGM), has given patients with DM, their relatives and healthcare professionals an access to new indicators of glycemic control such as time in range (TIR), time above range and time below range. These indicators are criteria for compensation of carbohydrate metabolism according to the 2023 American Diabetes Association guidelines. The purpose of the study was to compare the effectiveness of using glucometers and the FreeStyle Libre system for flash glucose monitoring in patients with DM. Materials and methods. An examination of 60 patients with type 2 DM who received insulin therapy was conducted. They were aged 45–65 years, with DM duration of 5 ± 2 years. All participants were divided into two equal groups of 30 people each. The first group consisted of patients with CGM devices, the second group used glucometers for daily glycemic control. Additional CGM parameters were used: glucose coefficient of variation, glucose management indicator, which shows the probable level of HbA1c. Results. When evaluating the data obtained from patients who used CGM, it is important to note their high adherence to the use of flash glucose monitoring. The use of CGM made it possible to achieve compensation of carbohydrate metabolism faster compared to patients who used glucometers to correct glycemia. Discontinuation of CGM resulted in poorer glycemic control. The obtained results prove that the compensation of patients depends primarily on their motivation, willingness to follow medical prescriptions, careful glycemic control, and compliance with medical recommendations. Conclusions. For better control of the DM course, patients should use CGM. In order to assess diabetes compensation, it is not enough to consider only TIR. Time below range indicating hypoglycemia, time above range indicating hyperglycemia, glucose management indicator should also be taken into account. Discontinuation of CGM resulted in a loss of approximately half of the initial TIR gain achieved while using CGM. CGM is more favored among patients than a 7-point self-monitoring of blood glucose.

Feasibility and performance of continuous glucose monitoring in hyperglycemia after lung transplantation.

Post-Transplant Diabetes Mellitus (PTDM) affects 20%-40% of lung transplant recipients within five years, impacting rejection, infection, cardiovascular events, and mortality. Continuous glucose monitoring (CGM) is used in diabetes but not well-studied in PTDM. This study assessed CGM performance in detecting hypoglycemia and hyperglycemia post-lung transplantation, compared to self-monitoring blood glucose. A prospective pilot study included 15 lung transplant patients (mean age 58.6 years; 53.3% men; 73.3% with pre-transplantation diabetes) managing hyperglycemia with insulin. Patients used a blinded CGM and self-monitored glucose for ten days. Data were categorized (% time in range, % high, % very high, % low, % very low) and compared using paired t-tests. CGM showed superior hyperglycemia detection. Mean differences for "% very high", "% high", and "% high and % very high" were 7.12 (95% CI, 1.8-12.4), 11.1 (95% CI, 3.5-18.8), and 18.3 (95% CI: 7.37-29.24), respectively. No significant difference was found for "% low and % very low". All patients reported a positive CGM experience. CGM use post-lung transplantation seems feasible and offers advantages in detecting hyperglycemia and in optimizing glucose management. Study limitations include a small sample size, requiring larger studies to assess glycemic control, hypoglycemia detection, and transplant outcomes.

Self-care Behaviour of Pregnant Women with Gestational Diabetes Mellitus at a Tertiary Care Hospital in Lucknow, India: A Quasi-experimental Study

Introduction: India is now the diabetes capital of the world. The rising burden of Gestational Diabetes Mellitus (GDM) adds to the existing diabetes burden. Euglycemia is achieved once the baby is delivered. The first line of management of GDM is mainly through lifestyle modification with diet and physical activity. There is a dearth of information from Lucknow city about how well pregnant women with GDM adhere to dietary changes and exercise recommendations, or how counselling helps them deal with their GDM. Aim: To assess the self-care behaviour related to diet, physical activity, and Self-Monitoring of Blood Glucose (SMBG) of pregnant women diagnosed with GDM. Materials and Methods: A total of 188 pregnant women diagnosed with GDM were selected for present quasiexperimental study. The study participants were recruited from the antenatal Outpatient Department (OPD) at the Department of Obstetrics and Gynaecology of Queen’s Mary Hospital, King George Medical University (KGMU), Lucknow, India. The total study duration was from November 2019 to November 2022. Pregnant women diagnosed with GDM according to Diabetes in Pregnancy Study Group in India (DIPSI) criteria, up to 28 weeks of gestation, who gave their written consent to participate in the study and were living within a 15-kilometer radius of the study Institute, were included in the study. One group of the study participants received one-to-one counselling, an individualised diet plan, along with usual GDM care, and the other group received usual GDM care during their antenatal visits. The summary of diabetes self-care was adapted to assess adherence to the recommended dietary and physical activity modifications, as well as self-monitoring of blood glucose. Data were analysed using R software version 4.1.1 (R Core Team, 2021). All categorical data were presented using frequency and percentages. The comparison of baseline demographic and clinical parameters of pregnant women between the two groups was done using the Chi-square test or Fisher’s-exact test for categorical observations based on the expected frequency. The independent sample t-test or Mann-whitney U test for continuous measurements was used after checking the normality assumption using the Shapiro-wilk test. The change in scores of general diet, specific diet, physical activity, and SMBG throughout all follow-ups was assessed by repeated measures Analysis of Variance (ANOVA). The change from the first follow-up visit to subsequent follow-up visit was compared using a mixed linear model with follow-up visits. The p-value was considered significant at a 5% level of significance for all comparisons. Results: The mean age of the pregnant women with GDM was 27.6±3.7 years in the intervention group and 27.9±3.9 years in the control group (p=0.451). The pregnant women with GDM in the two groups did not show significant differences in terms of socio-demographic variables such as age, religion, education, socio-economic status, occupation, type of family, and family history of diabetes mellitus. A significant difference was observed in the dietary and physical activity scores between the two groups of pregnant women with GDM. However, no difference was observed in the case of self-monitoring of blood glucose scores of the two groups. Conclusion: The study concluded that counseling plays an important role in helping pregnant women with GDM adhere to the recommended dietary modifications and physical activity.

Comparing Real-Time Continuous Glucose Monitoring to Self-Monitoring of Blood Glucose: Advantages and Limitations for Children and Adolescents With Type 1 Diabetes.

Objectives We aimed to determine the benefits and drawbacks of real-time continuous glucose monitoring (rtCGM) compared with those of self-monitoring of blood glucose (SMBG) in children and adolescents with type 1 diabetes (T1D) and their impact on glycemic control, hypo- and hyperglycemic episodes, exercise, quality of life, and psychosocial factors. Methodology This quantitative, comparative, cross-sectional study was conducted between July 2022 and March 2023 at the Pediatric Endocrine Outpatient Clinic, King Abdulaziz University Hospital, Saudi Arabia. Data were obtained via a clinical interview with children and adolescents with T1Daged 2-18 years. Results The study involved 121 participants, with 71 (58.7%)male patients and 50 (41.3%) female patients. The participants' mean age was 11.9 ± 4.4 years. Compared with patients using SMBG, patients using rtCGM demonstrated a more significant decrease in the mean glycated hemoglobin (HbA1c) level from baseline (7.79 ± 1.17 vs. 8.92 ± 1.63, P = 0.001), a reduction in the number of hypoglycemic episodes (85.7% vs. 70.6%, P = 0.028), and stable blood glucose level during exercise (97.2% vs. 76.4%, P = 0.001). Additionally, 65 (92.9%) rtCGM users had undisturbed sleep compared with 22 (43.1%) SMBG users. Approximately 64 (91.4%) rtCGM users reported that the sensor helped decrease their anxiety levels and pain sensations. Conclusions In this novel study in Saudi Arabia, rtCGM demonstrated a significantly better impact than SMBG on glycemic control, hypo- and hyperglycemic episodes, and psychosocial factors in children and adolescents with T1D.

Самоконтроль гликемии: от теории к практике (на примере пациента с сопутствующей онкологической патологией)

Self-monitoring of blood glucose (BG) levels occupies an important place in the treatment of diabetes mellitus. With an increase in the frequency of self-monitoring of BG, in patients with diabetes, carbohydrate metabolism indicators improve. Thus, self-monitoring of BG is an important factor in the prevention of acute and chronic complications of diabetes. Although new methods for measuring BG levels, such as continuous glycemic curve tracking and flash monitoring, are now widely used, they cannot completely replace BG monitoring with a glucometer. Data are presented on the dynamics of glycemia in a patient with type 1 diabetes, with a disease duration of 58 years, before and after the introduction of self-monitoring of BG.

Correlação entre tempo no alvo e hemoglobina glicada de pessoas com diabetes mellitus: revisão sistemática

Objective: to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose. Method: systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB. Results: time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (&gt;180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring. Conclusion: there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.