Home Blood Glucose Monitoring Research Articles

Roadmap to Continuous Glucose Monitoring Adoption and Improved Outcomes in Endocrinology: The 4T (Teamwork, Targets, Technology, and Tight Control) Program.

Glucose monitoring is essential for the management of type 1 diabetes and has evolved from urine glucose monitoring in the early 1900s to home blood glucose monitoring in the 1980s to continuous glucose monitoring (CGM) today. Youth with type 1 diabetes struggle to meet A1C goals; however, CGM is associated with improved A1C in these youth and is recommended as a standard of care by diabetes professional organizations. Despite their utility, expanding uptake of CGM systems has been challenging, especially in minoritized communities. The 4T (Teamwork, Targets, Technology, and Tight Control) program was developed using a team-based approach to set consistent glycemic targets and equitably initiate CGM and remote patient monitoring in all youth with new-onset type 1 diabetes. In the pilot 4T study, youth in the 4T cohort had a 0.5% improvement in A1C 12 months after diabetes diagnosis compared with those in the historical cohort. The 4T program can serve as a roadmap for other multidisciplinary pediatric type 1 diabetes clinics to increase CGM adoption and improve glycemic outcomes.

Evaluation of factors associated with beliefs about antidiabetic medicine in outpatients with type 2 diabetes at Hue University Hospital

Poor adherence to antidiabetic medication, which causes diabetes-related complications and increases medical burden, has been an important concern for both patients and physicians. Enhancing patients' beliefs about medicine can partially improve their non-adherence status to medications. To evaluate the factors associated with beliefs about antidiabetic medicine in outpatients with type 2 diabetes at Hue University Hospital. A cross-sectional study was conducted on 396 outpatients diagnosed with type 2 diabetes mellitus at the Endocrinology Clinic at Hue University Hospital. We interviewed the patients using a questionnaire based on the Vietnamese version of the Beliefs about Medicines Questionnaire (BMQ-V). The study was conducted on 396 patients with type 2 diabetes, with a median age of 66.9 ± 13.7 years. The prevalence of outpatients achieving HbA1C and glycemic targets was 18.7% and 20.7%, respectively. According to the BMQ-V questionnaire, the participants’ beliefs about medicine had a mean score of 50.3 ± 8.1. The mean value of the Specific-Concerns subscale was the highest (14.5 ± 3.8) and the Specific-Necessity subscale was the lowest (9.8 ± 3.9). Multivariate regression analysis revealed a statistically significant association between BMQ score and HbA1c control status, duration of diabetes, and home blood glucose monitoring (p < 0.05). Coordination between clinical pharmacists and physicians should be strengthened to improve their positive beliefs and gradually reduce their negative beliefs about medicines, thereby increasing medication adherence and improving treatment effectiveness.

Development of a high-performance liquid chromatographic glycated albumin assay using finger-prick blood samples.

Home blood glucose monitoring can be effective for the self-management of diabetic patients. Hemoglobin A1c (HbA1c) is a widely used marker that reflects the average blood glucose within 1-2months but does not sensitively respond to behavioral changes. Self-monitoring of blood glucose, continuous glucose monitoring, and flush glucose monitoring are sensitive; however, the cost and invasiveness of these tests prevent their widespread use. We focused on glycated albumin (GA), which reflects the average blood glucose levels over 1-2weeks, and established a GA measurement method for self-sampling, finger-prick blood, which may be submitted for testing through postal service to receive weekly results. A high-performance liquid chromatography assay was established to measure GA levels in finger-prick blood samples from 103 diabetic patients and the results were compared with venous blood measurements using an enzymatic method. Furthermore, conditions for sending blood samples by mail were evaluated. Under these conditions, samples from 27 healthy and 32 patient volunteers sent through postal service were compared with samples stored in the laboratory. GA levels were measured in samples containing>20μg albumin, which resulted in a CVless than0.3%. The correlation between the GA levels of finger-prick blood measured using HPLC and the GA levels of venous blood measured using the enzymatic method was R2=0.988 with the slope∼1.0, suggesting that the two were nearly equivalent. GA levels were stable for four days at 30°C and two days at 37°C. Mail-delivered samples exhibited a high correlation with samples that were not sent (R2>0.99). We established a method to measure GA levels in self-sampled, finger-prick blood sent through postal service in Japan. The method is applicable for weekly feedback of GA levels, which is potentially useful for motivating behavioral changes. In addition to markers such as HbA1c and blood glucose, GA can be used as a marker for assessing dietary and physical activities. This study highlighted the importance of GA monitoring by developing a suitable measurement method for weekly monitoring of GA levels.

Update information on type 1 diabetes in children/adolescents and adults.

Update information on type 1 diabetes in children/adolescents and adults.

Reducing the Cost of Diabetes Care with Telemedicine, Smartphone, and Home Monitoring.

The effect of an increasing diabetes population has resulted in escalated costs and overburdened physicians. The increase in cost is not due to the disease per se, but because of its largely preventable complications. Patient-friendly technologies are proven to significantly reduce complications and thereby cost, but seldom practised. Telemedicine is increasingly being utilized in diabetology to improve access to health care, quality of care, and clinical/psychosocial outcomes in patients with diabetes (PWD). In PWD, patient-physician interactions are essential for improving health outcomes and preventing long-term complications. Smartphones are one of the basic modalities for telemedicine application. Mobile phone messaging applications, including text messaging and multimedia message service, could offer a convenient and cost-effective way to support desirable health behaviors. There are diabetes-related mobile apps mainly focusing on self-management of diabetes, lifestyle modification, and medication adherence motivation. With the widespread availability of high-speed Internet, remote monitoring has also become popular. Home monitoring of blood glucose and blood pressure, wearable devices, and continuous glucose monitoring also play a vital role in bringing down the long‑term vascular complications of diabetes and thereby reduce the overall cost and improve the quality of life of patients. There are hundreds of tech platforms for diabetes management, of which only a few with proven efficacy and safety are recommended by physicians.

Survey of Australian clinicians' antenatal care and management practices in pregnant women with a history of bariatric surgery.

Pregnancy following bariatric surgery requires tailored care. The current Australian care provision and its alignment with consensus guidelines is unclear. Antenatal care clinicians were invited to complete a web-based survey assessing multidisciplinary referral, gestational diabetes mellitus (GDM) and micronutrient management practices. Respondents (n = 100) cared for pregnant women with a history of bariatric surgery at least monthly (63%) with most (54%) not using a specific guideline to direct care. GDM screening methods included one-week of home blood glucose monitoring (43%) or the oral glucose tolerance test (42%). Pregnancy multivitamin supplementation changes (59%) with bariatric surgery type were common. Half (54%) screened for micronutrient deficiencies every trimester and conducted additional growth ultrasounds (50%). The care clinicians report providing may not align with current international consensus guidelines. Further studies with increased obstetric clinician response may aid increased understanding of current practices. The development of workplace management guidelines for pregnancy in women with a history of bariatric surgery may assist with providing consistent evidence-based care.

Evaluation of the FreeStyle Libre, a flash glucose monitoring system, in client-owned cats with diabetes mellitus.

ObjectivesHome blood glucose monitoring using a portable blood glucose meter is important in the management of feline diabetes mellitus, but taking blood samples may be stressful for owners and cats. A flash glucose monitoring system measuring interstitial glucose, such as the FreeStyle Libre, overcomes some of these drawbacks. The aim of this study was to evaluate the practical use and analytical and clinical accuracy of the FreeStyle Libre in 41 client-owned diabetic cats.MethodsIn this prospective study, interstitial glucose concentrations were measured with the FreeStyle Libre and compared with blood glucose concentrations measured with a portable blood glucose meter (AlphaTRAK) on days 1, 7 or 8 and 14 after application of the device. Cat behaviour during application, location, skin reaction at the attachment site and owner satisfaction were assessed. Accuracy was determined by fulfilment of ISO 15197:2013 criteria, including Bland–Altman plotting and error grid analysis.ResultsPlacing the device was easy, with 70% of cats showing no reaction. Most sensors were placed on the thoracic wall. Skin reactions at the attachment site were not present or mild in almost all cats. Owners were very satisfied with the use of the FreeStyle Libre. Median functional life of the sensor was 10 days (range 1–14). Good correlation was found between interstitial and blood glucose measurements (rho[r] = 0.88, P <0.0001). Fifty-three percent of interstitial glucose concentrations were within a maximum deviation of 15% from blood glucose concentrations and 92.7% were within the safe risk zones 0 and 1 of the surveillance error grid.Conclusions and relevanceThe flash glucose monitoring system was easy to use and owners of diabetic cats were satisfied with its use. Although the device did not completely fulfil ISO requirements, it is sufficiently accurate for glucose monitoring in diabetic cats.

Non-invasive methods of home blood glucose monitoring

Diabetes is a worldwide health problem, a metabolic disorder that can lead to serious complications and damage to all vital organs. The resulting complications can be prevented with regular monitoring and maintenance of blood glucose level. The present review study aims to gather information on current methods for monitoring capillary blood glucose. Scientific articles were consulted in national and international journals, in addition to the Guidelines of the Brazilian Society of Diabetes and 9th Edition of the Diabetes Atlas of the International Diabetes Federation, American Diabetes Association, Ministry of Health and Brazilian Institute of Geography and Statistics (IBGE) data. Non-invasive methods include impedance spectroscopy, optical coherence tomography, photoacoustic spectroscopy, mid and near infrared spectroscopy, photoplethysmography. The advantages, in general, of non-invasive methods, seek ease of implementation and use, cost, accuracy in blood glucose measurement. The main disadvantages are physical parameters that can interfere with glucose measurement, as well as environmental variations. Interferences due to physiological factors can be eliminated using filtering processes, which suppress noise and increase effective information. With the present study, it is possible to conclude that there is a need to develop a non-invasive, painless, easily accessible method, without tissue damage, providing cost savings for the health system, considering quality of life, functional limitations, social and financial stress, emotional discomfort and depression in individuals with diabetes mellitus.

Multicenter Cross-Sectional Study on Perceptions and Roles of Community Pharmacists in the Prevention and Management of Cardiovascular Disorders in Northwest Ethiopia.

IntroductionCommunity pharmacy professionals are among the initial healthcare providers and could play crucial roles in preventing and managing cardiovascular disorders. This study aimed to assess perceptions and involvements of community pharmacy professionals in the prevention and management of cardiovascular disorders in Gondar city and nearby rural towns, Northwest Ethiopia.MethodsA multi-centered cross-sectional survey was conducted on community pharmacy professionals in Gondar city and the nearby rural towns from June to July 2021. Independent sample t-test and one-way ANOVA were used to show mean score differences of pharmacists towards the prevention and management of cardiovascular diseases. A 95% confidence interval with a P-value of < 0.05 in the tests was considered statistically significant.ResultsOf the 223 initial samples, 210 completed the survey and resulted in a 94.2% response rate. The average perception and involvement scores of the community pharmacy professionals towards the prevention and treatment of the cardiovascular syndromes were 4.1 and 3.8, respectively. Numerous professionals (>86%) agreed on weight reductions, alcohol consumption restrictions and physical exercises to decrease cardiovascular risks. Pharmacy professionals recruited from Gondar city had significantly higher mean scores compared with pharmacy professionals involved from rural towns (P < 0.001). A significant difference in mean involvement score was also noted in regarding the numbers of clients serving/day (P = 0.026).ConclusionCommunity pharmacy professionals had good perceptions on prevention and management of cardiovascular diseases. However, their level of involvement in measuring weight, blood pressure and glucose level, dispensing equipment for home blood pressure and glucose monitoring and keeping records of patients needs to be encouraged. Professionals might benefit from enhanced training to increase their knowledge and confidence.

Physicians’ Perspectives of Barriers to Insulin Initiation for Adults with Type 2 Diabetes Mellitus in Primary Health Care Centers (PHCCs), Tabouk Province - Kingdom of Saudi Arabia (KSA)

Aim: The goal of this study is to explore the family physicians’ perspectives of the barriers in initiating insulin for adult patients with Type 2 diabetes mellitus (T2DM) in their primary health care settings. Background: Insulin therapy often becomes necessary when oral anti-hyperglycemic agents are not enough, no longer effective or even as an initial choice. Timely insulin initiation was noticed to be a clinical problem among people with type 2 diabetes mellitus (T2DM) registered in primary health care centers (PHCCs) of Tabouk Province, KSA. Tackling this inertia or insulinophobia is a challenge in order to delay or prevent serious complications of uncontrolled diabetes. Our study and many other studies indicated that this therapeutic inertia is inappropriately due to many patient, system and physician-related factors. The present study aimed to investigate physicians’ perspectives of barriers to insulin initiation for adults with T2DM registered in PHCCs, Tabouk Province - KSA and to identify opportunities for better outcomes. Materials and Methods: This is a cross sectional study where 102 primary health care physicians (PHCPs) (58 females and 44 males) from multi PHCCs in Tabouk Health Province – Kingdom of Saudi Arabia (KSA), responded correctly to online reliable self-administered questionnaire (Cronbach alpha of 0.77344) to address their perspectives of barriers to insulin initiation for adult patients with T2DM. All participants were physicians attending PHCCs with well-equipped diabetes care clinics. Data were collected during a period from 6th – 17th June 2021. Participants included 11 (10.8%) family medicine consultants, 14 (13.7%) family medicine specialists and 77 (75.5%) general physicians. Results: 68.6 of the study participants had barriers in initiating insulin for their patients with T2DM. A significant statistical disproportional correlation was found between the level of specialty and the rate of reporting barriers to insulin initiation (P&lt;0.001). The top 10 listed barriers included the following: patients’ refusal to initiate insulin (71.4%), physicians’ fear of hypoglycemia (51.4%), inability of patients to perform home blood glucose monitoring (HMGM) (50%), physicians have no access to second opinion (44.3%), insufficient educational courses for physicians (37.1%), no family support for patients (34.3%), no clear MOH circular to support physicians’ initiation of insulin at PHCCs (28.6%) , insufficient hypoglycemic medications at PHCCs (25,7%), inability of patients to manage hypoglycemia (24.3%), and patients’ noncompliance to insulin regimen (24.3%). Conclusion: Despite the free of cost availability of all types of insulin, including the safest and peak less ultra-long (degludec) and long (Glargine), the availability of free of cost glucometers for all people with diabetes, the presence of a well-equipped diabetes clinic at every PHCC, the long list of guidelines and educational courses as well as an appointment system with electronic health information system (HIS), insulin inertia is a common problem among PHCPs working in Tabouk Health Region. Key words: Barriers, insulin initiation, insulin, primary health care, type 2 diabetes mellitus.

Comparative study on venous and capillary blood collection for estimation of glucose

ABSTRACT Diabetes is a chronic condition caused by a malfunction of the pancreas to secrete enough insulin resulting in two conditions: hyperglycemia and hypoglycemia. Glucometer is used for home blood glucose monitoring (HBGM). In the present study, out of 100 patients, the difference between venous and capillary blood glucose difference is very little i.e, 2.48 g/dl by using a glucometer. The study supports the view that venous blood glucose measurements can also be used as a substitute for capillary derived specimens in the management of non-critically ill patients. Sometimes, healthcare providers shall be cautious of pseudo-hypo/hyperglycemia where the capillary blood glucose does not correlate with venous plasma glucose. Evidence-based treatment decisions shall help diabetes management in such a scenario. Keywords: Glucose, capillary, venous, blood collection

Current Practices in Diagnosis and Management of Gestational Diabetes

Background: In the absence of international or national guidelines for the diagnosis and treatment of gestational diabetes mellitus (GDM), physicians’ current practice varies a great deal. This is particularly true for most developing countries, including Bangladesh. We have conducted a study to register the current practices related to the diagnosis and management of GDM in Bangladesh. Materials and Methods: A cross-sectional survey was conducted to obtain details regarding diagnostic criteria used, screening methods, management strategies, and postpartum follow-up of GDM using a structured questionnaire. A total of 756 physicians from 30 centers of the Diabetic Association of Bangladesh, Government and Private Hospitals located in both the capital Dhaka city and outside Dhaka participated. Results: The study found that diabetologists look after 42.5% of the GDM patients. Among the physicians participated, 44.4% preferred first antenatal care visit for the GDM screening, and 55.2% preferred two samples oral glucose tolerance test (OGTT) for screening. About 47.6% of the physicians followed the American Diabetic Association (ADA) guidelines for diagnosis. Half of the participated physicians preferred short-acting insulin and four-times home monitoring of blood glucose per day. Around 66.3% of the physicians advised OGTT 6 weeks after delivery. Conclusion: The majority of the participating physicians do not follow the recommendations for the diagnosis and management of GDM. This emphasizes the need for developing an evidence-based national guideline for GDM and necessary training to halt the rise of diabetes and safe mother and child health in Bangladesh.

240 Does the timing of gestational diabetes screening affect provider management of GDM?

A recent multicenter, randomized clinical trial (RCT) demonstrated that obese women screened early for gestational diabetes (GDM) did not have improved perinatal outcomes and required more insulin compared to women screened at the routine time. We assessed patterned blood glucose logs and medication use in early versus routine screening as a mediator of this conclusion. Secondary analysis of a multicenter RCT comparing early (14-20 weeks) to routine (24-28 weeks) GDM screening in obese gravid women with singleton, non-anomalous gestations. In this analysis, we included women diagnosed with GDM who had home blood glucose monitoring documented. Average fasting and post-prandial blood glucose levels were compared between randomization groups: weeks 1, 3, 5, and 7 after GDM diagnosis were assessed since visits are typically every two weeks. Secondly, we compared the average fasting and postprandial blood glucose levels for those visits at time of hypoglycemic agent initiation and by type of medication chosen. Groups were compared using chi-square, student’s t-test, or Wilcoxon rank sum test as appropriate. Of 114 women with GDM, 65 (57%) were screened early. Women in the early group were more likely to be White and have hypertension. At each visit (by week after diagnosis), the early screened group did not have higher fasting or postprandial blood glucose than the routine screen (Table 1). The early screening group was not initiated on a hypoglycemic agent (oral or insulin) at lower blood glucose levels than the routine screening group; in addition, the average dose of glyburide at initiation was the same for both groups (Table 2). Women in general did not receive a trial of an oral agent prior to insulin initiation (11.1% vs 50.0%, p = 0.35). The management of GDM did not vary by the timing of screening (early versus late) and differences in hypoglycemic agent use may be more related to length of time monitored rather than severity of disease.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A cross sectional study on beliefs and roles of community pharmacy professionals in preventing and managing metabolic syndrome in an Ethiopian setting.

IntroductionMetabolic syndrome (MetS) is a group of cardiovascular risk factors, and its prevalence is becoming alarmingly high in Ethiopia. Studies uncovered as community pharmacy professionals (CPPs) have not yet well integrated into public health programs and priorities. In low income setting like Ethiopia, evidence regarding the roles CPPs in preventing and management of MetS is dearth.ObjectiveThe study was aimed to assess community pharmacy professionals’(CPPs) opinions about metabolic syndrome, describe their perception level towards the effectiveness of the main interventions and explore their extent of involvement in counseling patients with the metabolic syndrome in Gondar town, Northwestern Ethiopia.MethodA descriptive, cross-sectional study was conducted among pharmacists and druggists working in community medication retail outlets (CMROs) in Gondar town, northwestern Ethiopia from April 1 to May 31, 2019. Data were collected using a self-administered pre-tested questionnaire. Descriptive statistics was used to summarize different variables, and presented in tables and figure. An independent t-test and one way ANOVA (Analysis of Variance) were used to compare mean scores. A 5% level of significance was used.ResultOut of the 75 CPPs approached, 65(40 pharmacists and 25 druggists) completed the survey giving a response rate of 86.7%. Smoking cessation practice was identified to be low. There were a statistically significant difference (t = 2.144, P = 0.036) in the involvement towards counseling patients between CPPs who claimed to work in pharmacy (mean = 3.96 out of 5 points Likert scale) and drug stores (mean = 3.80 out of 5 points Likert scale).ConclusionThe study concluded that the overall involvement of professionals in counseling patients, opinion about metabolic syndrome, and perception towards the effectiveness of the intervention was found to be more or less positive. However, the provision of services, such as monitoring therapy, selling equipment for home blood pressure and glucose monitoring and documenting patient care services needs to be encouraged. Given proper education and training, the current study hope that community pharmacists could be an important front-line contributors to contain this emerging epidemic in Gondar town as well as in the entire nation.

Metformin treatment vs a diabetes model of prenatal care in women with mild fasting hyperglycemia diagnosed in pregnancy: a feasibility study

Introduction Guidelines disagree on the diagnostic thresholds for gestational diabetes (GDM); treatment of women with mild fasting hyperglycemia may not be cost-effective and increase unnecessary intervention. Materials and methods Single-center, open-label randomized controlled feasibility trial (ISRCTN86503951). “Metformin” treatment (2 g/day) without home blood glucose monitoring (HBGM) compared to NICE “standard” diabetes prenatal care in women with fasting 5.1–5.4 mmol/L, 2H <8.5 mmol/L) at oral glucose tolerance test (OGTT). Results Process outcome: From the 173 women approached, 40/147 (27%) met the eligibility criteria and agreed to participate (non-completion n = 3). All women received dietary advice. Overall, compliance was good; with the majority of women in the treatment arm reporting missing metformin tablets less than 1–3 times/week. In the treatment arm (n = 18), median compliance (returned packets) was 65% [0–98%]; four women were unable to tolerate the full recommended dose of metformin. All women reported being satisfied with their treatment; with 9 out of 18 women (metformin arm) reporting they would choose the same treatment in a future pregnancy however 8 women reported they would want closer prenatal monitoring. Clinical outcome: Baseline characteristics and pregnancy outcomes were not different between participants and non-participants (n = 133). In women randomized to the standard care arm who performed HBGM, 15/19 were prescribed metformin based on values above target despite diet and lifestyle modifications; two women required additional insulin (10%). Data on glycemic control were available for 16/19 women; a reduction in fasting and post-prandial glucose was achieved in 15/16 from recruitment to 36 weeks. There was no change in A1C in women in the treatment arm vs the standard care arm. There was no difference in the rates of LGA between participants (n = 40) and non-participants (n = 133), although there was a reduction in the median birthweight centiles in the participants, the majority of whom received metformin treatment, compared with the non-participants (35 [IQR 12–54] vs 52 [25–78]; p = .045). Discussion Treatment with metformin in conjunction with routine care was acceptable to women with mild fasting hyperglycemia who participated in the trial, although overall recruitment to the study was low. Most women with mild fasting hyperglycemia (5.1–5.4 mmol/L) would meet the threshold for pharmacological treatment if identified as GDM based on current NICE guideline target blood glucose levels. However, given the low consent rate, it is unlikely that a future RCT comparing metformin treatment (in conjunction with routine prenatal care and without HBGM monitoring) to a diabetes prenatal clinic model of care would have the generalisability to inform the future management of this group.

Usefulness of YouTube™ videos in training patients for blood glucose self-monitoring in current coronavirus disease-19 pandemic

Objectives:During the coronavirus disease-19 pandemic, due to restricted health-care access, patients may not get hands-on training for self-monitoring of blood glucose (SMBG) from physicians. YouTube™ is a popular video-sharing web platform that can be used as a source of information for SMBG. This study aimed to assess the usefulness of YouTube™ videos on SMBG.Material and Methods:We searched the keywords “blood glucose self-monitoring,” “home blood glucose monitoring,” “blood glucose test,” and “blood sugar test” on YouTube™. The first 40 videos of each search were listed. After the two-stage screening, 49 videos were included for final data analysis. General characteristics and SMBG-specific characteristics (namely, strip handling, lancing device handling, measurement, and post- measurement action) were observed with pre-defined criteria having “yes” and “no” closed option. Data were tested statistically by the binomial test.Results:Average duration of 49 videos was 244.20 ± 72.61 s and those were online since 35.14 ± 20.52 months on YouTube™. Information about strip handling was mostly deficient, major being checking the expiry date (16.33% videos had the information). The handling of the lancing device was correct in the majority of the videos except for the disinfection of the tip of the lancing device (6.12% videos had the information). The measurement procedure was also correct in the majority of the videos except for the instruction to dry the hands (38.78% videos had the information) after washing. The post-measurement logbook entry was found in 48.98% videos.Conclusion:YouTube™ videos can be used as a potential source of information for patients’ education for SMBG. However, there are various levels of the incompleteness of the tutorials. Primary care physicians may suggest YouTube™ videos after exploring the videos and selecting the most appropriate one for their patients.

Coping with diabetes during the COVID – 19 lockdown in India: Results of an online pilot survey

AimThe management of diabetes has become a challenge due to the COVID 19 lockdown. An online-based pilot survey was conducted to study how people with diabetes were coping with their Diabetes during the COVID - 19 lockdown. MethodThe questions were designed in an online survey, Survey Monkey, to conduct this cross-sectional study. The link was generated and sent to 100 registered patients of the MV Hospital for Diabetes Royapuram who had not contacted the hospital after the lockdown announcement. The survey was done between April 1 and April 15, 2020.Oral consent was obtained through telephone before the link was sent by Whatsapp to them.The questionnaire consisted of questions on home blood glucose monitoring, regularity in doing their physical activity and dietary compliance and anxiety about the viral infection. Results92% of the participants had Type 2 diabetes. Only 28% of the participants were checking their blood glucose levels regularly. 80% of the participants mentioned that they were following regular exercise and diet control during the lockdown period. 40% of the participants were anxious about the Covid infection. ConclusionSMBG needs to be practiced on regular basis, especially among the patients with diabetes on insulin therapy. Most of the people surveyed were coping well with their Diabetes. Patients have reported that they were able to maintain proper dietary compliance and be more physically active at home during this lockdown. These findings need to be ascertained in larger sample of patients.

A Pilot Study of the Feasibility and Accuracy of Inpatient Continuous Glucose Monitoring

There are minimal data assessing the accuracy or use of continuous glucose monitoring (CGM) in hospitalized patients. Our group was interested in its use in the perioperative period, since we suspect we would identify more extremes and thus more dangerous blood glucose levels than seen with traditional bedside blood glucose monitoring. Given the lack of data for CGM use in hospitalized patients, and the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we felt this is a critical time to share our data. Use of CGM could potentially reduce the number of health care provider contacts and use of personal protective equipment. Eligible patients were adults (age ≥18 years) with diabetes who used intermittent home blood glucose monitoring and who were scheduled to undergo an elective general surgery at University of Washington Medical Center. The study protocol was approved by the University of Washington Institutional Review Board. The study was also registered as a clinical trial. Continuous intravenous insulin infusion was used per hospital algorithm (target blood glucose 100 mg/dL [5.6 mmol/L] to 180 mg/dL [10.0 mmol/L]) until oral consumption was resumed, at which time subcutaneous insulin was initiated. This …

Effect of Home Base Glucose Monitoring &amp; Self Dose Adjustment of Insulin on Glycosylated Hemoglobin

Background: Type1 Diabetes Mellitus (T1DM) is the most common endocrine metabolic disorder of childhood casing significant mortality and morbidity in childhood. Home Monitoring of Blood Glucose (HMBG) and Supplements of insulin as required depending on the blood glucose level at that time is a very important aspect of management in T1DM. The Goal of this study was to determine whether frequent checking of home base blood glucose (HMBG) levels accompanied with insulin self dose adjustment, will lead to improved metabolic control as assessed by reduction in the Glycosylated hemoglobin values (HbA1c).Subject and Method:This study was conducted in G.G.Hospital,,M.P.Shah Medical college,Jamanagar between October 2012 to September 2013 for a period of 1 year including OPD and ward patients. Retrospective analysis of clinical profile of 37patients with T1DM attending our OPD between the age group of 2 to 16 years.A detailed clinical and family history, educational level of parents and insulin regime and insulin dose was recorded. Result:Age distribution in our study showed that 62% cases in the age of more than 10 years, 32% cases in the age group 5-10years and 2 % cases falling in the age group 0-2 years, with male to female ratio of a 1:1.7. The most frequently seen symptoms were polyuria (53%), breathlessness (48%),polydipsia (46%), vomiting (29%) of cases and 82%of the patients were ketotic at the time of presentation. In family members most common associated co-morbidity is type 2 DM(21% ) , hypertension(21%) &amp; thyroid dysfunction (19%). split regimen was observed in (70%)and basal bolus regime in (30%). split mix regime 11(42%) had good(&lt;7GHb) wheaeas Basal bolus regime 6(54%) of them had good control p=0.0308(&lt;0.05). Conclusion:Regular Home monitoring of Blood glucose(HMBG) along with education on diabetes self management and regular contact with a member of a medical team for insulin dose adjustments with advice on meal planning and physical activity improve the metabolic control (as assessed by HbA1c levels) in children with T1DM.

Strategies to identify individuals with monogenic diabetes: results of an economic evaluation.

ObjectivesTo evaluate and compare the lifetime costs associated with strategies to identify individuals with monogenic diabetes and change their treatment to more appropriate therapy.DesignA decision analytical model from the perspective of the National Health Service (NHS) in England and Wales was developed and analysed. The model was informed by the literature, routinely collected data and a clinical study conducted in parallel with the modelling.SettingSecondary care in the UK.ParticipantsSimulations based on characteristics of patients diagnosed with diabetes <30 years old.InterventionsFour test-treatment strategies to identify individuals with monogenic diabetes in a prevalent cohort of diabetics diagnosed under the age of 30 years were modelled: clinician-based genetic test referral, targeted genetic testing based on clinical prediction models, targeted genetic testing based on biomarkers, and blanket genetic testing. The results of the test-treatment strategies were compared with a strategy of no genetic testing.Primary and secondary outcome measuresDiscounted lifetime costs, proportion of cases of monogenic diabetes identified.ResultsBased on current evidence, strategies using clinical characteristics or biomarkers were estimated to save approximately £100–£200 per person with diabetes over a lifetime compared with no testing. Sensitivity analyses indicated that the prevalence of monogenic diabetes, the uptake of testing, and the frequency of home blood glucose monitoring had the largest impact on the results (ranging from savings of £400–£50 per person), but did not change the overall findings. The model is limited by many model inputs being based on very few individuals, and some long-term data informed by clinical opinion.ConclusionsCosts to the NHS could be saved with targeted genetic testing based on clinical characteristics or biomarkers. More research should focus on the economic case for the use of such strategies closer to the time of diabetes diagnosis.Trial registration numberNCT01238380.