Blood Sugar Monitoring Research Articles

Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial

BackgroundOver 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Saharan African settings. In Uganda, and the majority of LMICs, management of uncontrolled hypertension remains limited in constrained health systems. Intervening at the primary care level, using CHWs to improve medical treatment outcomes has not been well studied. We aim to determine the effectiveness of a CHW-led intervention in blood pressure control among confirmed hypertensive patients and patient-related factors associated with uncontrolled hypertension.MethodsWe will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community.ConclusionThe results of this study will inform community delivered HTN management across a range of LMIC settings.Trial registrationClinicalTrials.govNCT05068505. Registered on October 6, 2021.

A Narrative Review of the Pathophysiology of Mucormycosis Infection Among COVID-19 Patients in India: Epidemiology and Clinical Implications

Background and Objective: During the second COVID-19 wave in India (April to May 2021), mucormycosis has affected the ‘recovering’ and the ‘recovered but vulnerable’ COVID-19 patients across the country. This review synthesizes information on the risk factors and pathophysiology of mucor infection among COVID-19 patients, which in turn supplements existing information from public health and clinical sciences. The study objective includes analyzing the morbidity of mucor infection and its pathophysiological mechanism, during India’s second wave of the COVID-19 pandemic. Methods: We conducted a systematic literature search of PubMed and Google Scholar databases, using the following text terms: ‘COVID-19,’ ‘SARS-CoV-2,’ ‘mucormycosis,’ and ‘zygomycosis.’ We identified 24 citations and 16 other published literature which described mucormycosis in association with COVID-19. The relevant literature was analyzed for findings on the risk factors of mucor infection and its outcome among individuals with COVID-19. Results: The risk factors for mucor infection include diabetes mellitus, immunosuppression (for example, the administration of steroids/monoclonal antibodies/broad-spectrum antibiotics), prolonged stay in the intensive care unit, co-morbidities such as malignancy or post-transplantation, and prophylactic therapy with voriconazole (generic anti-fungal). The second wave of COVID-19 in India was more severe due to the increased occurrence of systemic inflammation and coagulopathy, which can cause direct damage to the blood vessels resulting in injuries to organs such as the liver, kidney, and heart. Conclusion and Implications for Translation: The increased incidence of mucormycosis during the second wave of the COVID-19 pandemic in India (April to May 2021) was due to a combination of immunocompromising effects of corticosteroids, microangiopathy of diabetes, and peripheral microthrombi among COVID-19 patients. The indiscriminate usage of steroids for treating COVID-19 disease seems to be the likely cause, including the use of immunomodulatory drugs such as interleukin 6 inhibitors like tocilizumab (TCZ) for patients with severe COVID-19. Clinical practices should adopt a judicious approach towards the prescription of steroids and monitoring blood sugar for all COVID-19 patients admitted to the hospital as well as those isolated at home (even during the post-recovery period). The high mortality rate of mucor infection demands appropriate primary prevention measures, as well as early diagnosis and treatment modalities for improving patient survival. Copyright © 2022 Ramani et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Robust Blood Sugar Monitoring in Diabetic Patients with Timing Jitter due to Human Factors

Blood sugar monitoring in diabetic patients is commonly provided with timing jitter caused by human factors. In this paper we address the problem by developing the robust H2 optimal finite impulse response (OFIR) filter under under possible disturbances, initial errors, and measurement errors. The filter is applied to data collected daily before breakfast from diabetic patients. It is shown that the robust H2-OFIR filter improves the accuracy of the OFIR filter by the factor of less than the fractional time jitter. That is, for large fractional timing jitter of 10% the improvement would be less than 10% that is small. Otherwise, it is worth using robust estimators.

Knowledge on postpartum type-2 diabetes mellitus screening among pregnant women with gestational diabetes mellitus in Malaysia

Introduction: Despite the effectiveness of postpartum type 2 diabetes mellitus (T2DM) screening to detect and manage T2DM among women with a history of gestational diabetes mellitus (GDM), the uptake remains low, indicating the potentially low level of relevant knowledge. This study aims to identify the prevalence of postpartum T2DM screening and its associated factors. Methods: A cross-sectional study was conducted involving 116 pregnant women with GDM who attended antenatal care follow-up at government health clinics in Seremban District, Negeri Sembilan. Multistage cluster sampling was performed to recruit the respondents from 6 mukims and 10 public health clinics. The data were collected using a validated and pre-tested questionnaire, with Cronbach’s alpha values ranging from 0.81 to 0.95 for each section of the questionnaire. Data were collected through face-to-face interviews during the respondents’ routine antenatal follow-ups for blood sugar monitoring. Results: Poor knowledge on postpartum T2DM screening (55.2%) was observed, which was significantly predicted by low educational level (AOR = 6.898, 95% CI 3.62–9.055) and low self-efficacy (AOR =17.905, 95% CI 5.470–58.611). Conclusion: Most of the respondents had poor knowledge regarding postpartum T2DM screening, which was predicted by low education and self-efficacy. The findings highlight the need for continuous education and health promotion during antenatal follow-up targeting women with GDM with low self-efficacy and education level in order to ensure better adherence to screening.

Prediksi Diabetes Berdasarkan Pengukuran Mean Amplitude Glycemic Excursion (MAGE) Menggunakan Naïve Bayes

The mean amplitude of glycemic excursions (MAGE) is an important indicator in the assessment of glycemic variability (GV) which is used as a reference for continuous blood glucose control. In this case, quantitative considerations in monitoring blood sugar in diabetes are very important for diagnosis and then proceed with clinical treatment. This study focuses more on strengthening the training and testing data processing system and reducing the independent variables that occur during the classification process. To support this purpose, this study uses Cross Validation as a training and testing data processing with the number of K-Fold is 10 and Naïve Bayes as a classification method. The resulting accuracy is 93% which is an increase from previous studies with an RMSE value (error value) of 0.267. It was concluded that patients in the pre-diabetic and diabetic groups tend to have more varied blood glucose values than patients from the normal class.

Effect of sampling time jitter on robust [formula omitted] filtering estimates

In discrete-time processes, the sampling time jitter occurs naturally due to various unavoidable reasons, which make the model uncertain. Therefore, robust state estimators should be used. To find out if it is rational to design such estimators or if we can simply ignore the time jitter, in this paper we investigate its effect on the robust H2 optimal finite impulse response (OFIR) filter in a comparison with the OFIR filter. As benchmarks, we also use the maximum likelihood FIR, unbiased FIR, and Kalman filters. The robust batch H2-OFIR filter is developed for timing jitter under disturbances, initial errors, and measurement errors. For Gaussian errors, its iterative algorithm is designed using modified Kalman recursions. Numerical investigations and applications to blood sugar monitoring in diabetic patients with daily timing jitter have shown that the robust H2-OFIR filter improves the accuracy of the OFIR filter by the factor of less than the fractional time jitter. That is, for large fractional timing jitter of 10% the improvement would be less than 10% that is small. Otherwise, it is worth using robust estimators.

INFLUENCE OF HEALTH SEEKING BEHAVIOUR ON GLYCEMIC CONTROL AMONG TYPE 2 DIABETES MELLITUS FEMALE PATIENTS AGED 35-60 YEARS IN TAVETA SUB-COUNTY HOSPITAL

Purpose: The study aimed to assess the effect of the health seeking behaviour on glycemic control among type 2 diabetes mellitus female patients aged 35-60 years in Taveta sub-County Hospital.
 Methodology: A descriptive cross sectional design was adopted and systematic random sampling technique used to select 135 study subjects comprising of T2DM female patients aged 35-60 years who are registered at Taveta sub-County hospital diabetes outpatient clinic. Quantitative data was collected from informed consenting T2DM female patients using researcher administered structured questionnaire for health seeking behaviour factors, and glycemic control. The fasting blood sugar readings obtained from the patients’ self blood sugar monitoring cards was used to establish glycemic control. Quantitative data was analyzed using Statistical Package for Social Scientists (SPSS) Version 22.
 Findings: The odd of having a good glycemic control is 1.416 times higher for environment of the diabetes clinic room/area that is clean as compared to environment of the diabetes clinic room/area that is somewhat clean. The most used method to control glucose is the herbal remedies to manage diabetes.
 Unique contribution to theory, practice and policy: The patients should attend to all scheduled clinic check-ups to get the health care personnel and nutritionists counsel the patients based on the progress assessment. The patients should moreover keep the progress communicated to the health officers when there are changes in their sugar levels. The monitoring of blood sugar should be done regularly. It is recommended for an increase in scope for creation of diabetic awareness and reach out to the patients and community.

Predisposing factors of diabetic foot amputation among the diabetic patients in a tertiary care hospital

Background: Diabetes is one of the major health problems in the world. Along with multiple complications, one of those devastating complications, is diabetic foot and it can even lead to limb amputation. The objective of this study to recognize the risk factors for foot amputation among diabetic patients.Methods: This cross-sectional study was conducted at Sir Ganga Ram Hospital of Lahore. 268 diabetic patients were recruited through a set of inclusion and exclusion criteria. After taking informed consent from all patients, data was collected via a self-designed proforma. SPSS version 25 was used to analyze data. Chi-square was applied to identify any association.Results: From the total of 268 patients 72 (26.80%) were advised amputation, whereas, 196 (73.20%) patients were managed conservatively. The correlation between diabetic foot amputation and various factors which included gender (p=0.0001), educational status (p=0.0003), socioeconomic status (p=0.004), diet modification (p=0.002), blood sugar monitoring (p=0.001), life style (p=0.0003), therapy type (p=0.04), compliance with treatment (p=0.001), smoking (p=0.02), hypertension (p=0.004), ischemic heart disease (p=0.03), stroke (p=0.01), peripheral neuropathy (p=0.003), and peripheral arterial disease (p=0.001) was statistically significant, while, the correlation was not significant between diabetic foot amputation and duration of diabetes (p=0.07).Conclusions: In summary, the incidence of foot amputation among diabetic patients is quite high. The factors that lead to foot amputation are male gender, lower educational status, lower socioeconomic status, no diet modification, no blood sugar monitoring, sedentary life style, inappropriate therapy, poor compliance, history of smoking, hypertension, ischemic heart disease, stroke, peripheral neuropathy, and peripheral arterial disease.

Post surgery mucor recurrence in COVID-19 associated mucormycosis patients of a tertiary care centre

<p class="abstract"><strong>Background:</strong> Together with COVID-19 infection, we saw an outbreak of COVID associated mucormycosis (CAM). These patients were treated with antifungals, aggressive surgery, control of diabetes and other predisposing factors. But as demand increased, there was shortage of antifungals. So patients underwent relapses. The aim of study was to evaluate the causes and relevant factors predisposing to recurrence and tools used to evaluate recurrence and extent of disease in relation to primary disease.</p><p class="abstract"><strong>Methods:</strong> Prospective study of 160 CAM patients who were discharged successfully after surgery and kept under regular follow up by endoscopy, CRP, blood sugar monitoring.</p><p class="abstract"><strong>Results:</strong> Our study of 160 follow up cases of CAM in whom 21 patients had recurrence. There were 18 males and 3 females. The most common affected was between 50-60 years. 67% of recurrent cases had poor diabetic control, 81% suspicious of recurrence in endoscopy, 86% showed rising trend in CRP (>5 mg/dl). These patients were further evaluated with radiological investigations like MRI and CBCT (cone beam CT). MRI detected recurrence in 38% whereas CBCT detected 62%. Most common site of recurrence was maxilla. All recurrent cases underwent surgical debridement and were given 5 gm of liposomal amphotericin.</p><p class="abstract"><strong>Conclusions:</strong> Mucormycosis is an invasive fungal disease. COVID patients in whom immunological status are altered, diabetic or immunocompromised should be kept under surveillence by endoscopy, CRP and blood sugar monitoring. Though CAM patients are treated with surgery and antifungals, they should be under regular follow up for more than 6 months. Diabetic control helps in curbing the rapid spread of CAM. Suspected cases should undergo radiological investigations like MRI and CBCT. Recurrent/residual disease of mucormycosis can be tackled and treated successfully.</p>

Effectiveness of a nurse-led smartphone-based self-management programme for people with poorly controlled type 2 diabetes: A randomized controlled trial.

To evaluate the effectiveness of a nurse-led smartphone-based self-management programme (NSSMP) on improving self-efficacy, promoting diabetes self-care, increasing health-related quality of life (HRQoL) and decreasing HbA1c, acute complications and unplanned medical consultation for people with poorly controlled type 2 diabetes compared with a nurse-led diabetic service (NDS). A two-arm randomized controlled trial with repeated measures was conducted. Participants were recruited from June 2018 to September 2020. Eligible participants were assigned to either the intervention or control group randomly. Participants assigned to intervention group received the 6-month NSSMP, while those in the control group received existing NDS provided by the study hospital. Outcomes were measured at baseline, and at 3 and 6 months from baseline. A total of 114 participants were recruited. There were no significant interactions between group and time for all the outcomes except for blood glucose testing activities (F=4.742, p=.015). Both groups had reduced HbA1c over 6months. The intervention group had a lower HbA1c than the control group at follow-ups, but the differences were not statistically significant. None of the participants had acute diabetes complications at follow-up. Similarly, the differences in the number of unplanned medical consultation at 6-month follow-up between two groups were statistically insignificant. The NSSMP is as effective as existing NDS provided by the study hospital in improving most of the outcomes. NSSMP can liberate valuable time for nurses to provide care to critically ill patients and supports healthcare resource constraints in the current COVID-19 pandemic. The existing diabetes service is labour intensive as nurses are required to deliver education, follow-up telephone calls to trace blood sugar monitoring and provide therapeutic consultations and necessary referrals. The outbreak of COVID-19 pandemic has added further strain on the overworked professionals. NSSMP provides an alternative programme that is just as effective, to reduce nurses' workload by delegating them back to the individuals through self-management strategies. This enables nurses to increase contact time with patients, and individuals to take onus of their disease through increased self-efficacy, facilitated by technology. This study is registered under clinical registration number NCT03088475.

MUCORMYCOSIS IN COVID 19- 2ND WAVE : CLINICAL PROFILE IN CENTRAL INDIA

A sudden surge of Rhino-Orbito-Cerebral Mucormycosis (ROCM) was observed following second wave of Covid-19 in India. Diabetes mellites (DM) , steroids, hypoxia, hyperglycemia ,metabolic acidosis or Diabetic ketoacidosis, high serum iron levels, zinc supplementation, immunosuppression along with other risk factors have been found to facilitate fungal germination. Patients diagnosed with ROCM, a total of 273, were included in the study. Detailed history was noted and assessment was done. Male:Female ratio was 2.59:1. Most common presenting age group was 31 to 50 yrs (51.65%). The commonest presenting symptom was nasal obstruction (58.97%) followed by ipsilateral facial swelling (53.11%). Palatal ulceration, blood stained nasal discharge ,orbital swelling, diminution or loss of vision, headache, loosening of teeth were among other presentations. Common associated comorbidity was diabetes(84.61%), hypertension (HTN) , anemia, immunocompromised state etc. History of associated past covid infection was seen in 75.52% while 18.68% had coexisting mucor with covid. History of steroid use was in 86.81%, O2 administration by mask in 64.10%, ventilatory support in 5.12 % and tablet zinc intake in 86.45%. Covid-19 along with DM, HTN, anemia, steroid therapy and oxygen therapy are the risk factors for ROCM. Thus regular blood sugar monitoring , judicious use of corticosteroids, maintaining hygiene of mask and circuit during oxygen therapy is recommended while treating covid.

Glycemic Control in Patients with Type 2 Diabetes Mellitus: Descriptive Survey in Makassar City Hospitals

Aims: This study aims to determine the frequency distribution based on the respondent's glycemic control in the hospitals in Makassar City Methdos: This research is a non-experimental quantitative research using descriptive method. This research was conducted in hospitals in Makassar City, South Sulawesi (RSUD Kota Makassar, Bhayangkara Hospital Makassar, Pelamonia Hospital Makassar, Labuang Baji Hospital, RSUD Haji Makassar, and Ibnu Sina Hospital Makassar). The total of samples in this study amounted to 291 patients with diabetes mellitus using purposive sampling. Results: Based on the results of the our study, it was found that there were 161 (55.3%) people with diabetes mellitus with less glycemic control and 130 (44.7%) people with diabetes mellitus with good glycemic control. Conclusions: In the management of diabetes management with monitoring blood sugar levels is very important. Thus, good glycemic control will be declined diabetes complications. Consequently, it is highly recommended for people with diabetes mellitus to reduce the complications of Type 2 DM by complying with glycemic control.

Perioperative Management of a Rare Pancreatic Insulinoma Resection: Anaesthetic Challenge!

Insulinoma is a rare, mostly benign and solitary neuroendocrine tumour of the β-cells of islets of langerhans of pancreas. Clinically it presents with a classical ‘Whipple Triad’ encompassing symptomatic hypoglycemia, fasting hypoglycemia (<50 mg/dl) and immediate relief of symptoms after glucose administration. Definitive treatment is laparoscopic or open surgical excision of the tumour. We report and discuss the distinctive anaesthetic considerations and implications during perioperative period. A comprehensive approach including preoperative optimization of blood glucose levels with various drugs and dietary modifications, scrupulous hemodynamic and blood sugar monitoring with prompt initiation of dextrose infusion during surgical handling of tumour and meticulous management of rebound hyperglycemia with insulin infusion in postoperative period remains the essence for better outcome in these subset of patients.

Quality of life among those with diabetes mellitus type II attending a secondary outpatient facility in South India.

Diabetes mellitus (DM) can affect one's quality of life (QoL). Literature on the association of QoL among type II diabetics with drug compliance and diet quality among rural communities is poor. This study aimed to determine the QoL among those with type II DM attending an outpatient clinic at a secondary hospital in Tamil Nadu. A cross-sectional, interview-based study was carried out among those with type II DM. A questionnaire comprising the WHO-BREF tool, Diabetes Healthy Eating Index, Hill-Bone Medication Adherence Scale was administered to participants selected via systematic random sampling. The prevalence of good QoL was estimated to be 51.7% (n = 45, 95% CI: 41.20-62.20). There was no association between good QoL and medication compliance. None of the patients had a good diet quality. Bivariate analysis revealed significant association (p < 0.05) between good QoL and higher education (OR-2.70), those not on medication for complications (OR-2.81) and decreased frequency of general random blood sugar (GRBS) monitoring (OR-2.44). Multivariable analysis adjusting for gender, education, treatment/medication for complications, hospitalisation for DM and GRBS frequency demonstrated significant association between good QoL, lack of medication for complications/co-morbidities and decreased GRBS monitoring frequency with likelihood ratios of 3.25 and 3.44, respectively. The drop in QoL observed could be due to the aftermath of the COVID pandemic. Keeping in mind the impact of healthcare interventions on the QoL of type II DM patients, primary physicians must consider dietary and treatment plans suited to their socio-economic status.

Self Care Profile of Diabetic Patient during Covid 19 Pandemic in Manggarai Regency, East Nusa Tenggara

Diabetes mellitus (DM) is one of the comorbid diseases commonly found on COVID-19 infected individuals and causing the most death. In the pandemic era, DM patients are needful to execute the care management by themselves due to the social restriction as a part of transmission control. This study aimed to assess the self-care behavior of DM patients during the COVID-19 pandemic era in Manggarai Regency who still carry out various traditional ceremonies even during the pandemic. This study was a quantitative descriptive study. The research data get by the SDSCA (The Summary of Self-Care Activities) questionnaire developed by the General Service Administration (GSA) Regulatory Information Service Center (RISC). This study attends from January to March 2021, with 88 respondents have participated after being recruited using purposive sampling and inclusion criteria. Among the 88 respondents, the respondents were most compliant with eating restrictions on sugar-contained food such as cake, chocolate, biscuit, and ice cream diet. Respondents did not restrict themself to consume carbohydrate contained foods. Self-care behavior is most important to DM patients in the pandemic era due to the social restrictions creating the hesitancy among the patients to come to the health care facilities. Moreover, when DM patients are more prone to develop severe symptoms of covid-19. Health professionals have to improve the health education to the patients by emphasizing the importance of exercise, diabetic foot care, and routine blood sugar monitoring so that the patients are not only focused on dietary management and medicine.

Comparison of Group Prenatal Care versus Standard Prenatal Care for Patients with Diabetes in Pregnancy

Group prenatal care has demonstrated positive pregnancy outcomes. In individuals with diabetes mellitus (DM) in pregnancy, group care could coordinate services to improve patient education, provide social support while maintaining the risk screening and physical assessment of individual prenatal care. We sought to determine if this method of prenatal care will increase compliance with blood sugar monitoring. A retrospective cohort study from 2014-2020 at a single tertiary care center. Group care was led by a provider, social worker, and diabetes educator allowing for more time and attention to be spent on education compared to the traditional model of one provider per patient. Data collection was completed on patients who participated in standard and group care. Data was extracted via chart review on glucose monitoring, delivery information, and postpartum visit. Primary outcome was measured by percentage of visits that an individual brought their blood sugar log. Data was analyzed with median and range for continuous variables (data was not normally distributed) and percentage with number for categorical variables. P< 0.05 was considered significant. A total of 107 patients met inclusion criteria with 42 in group care and 65 in standard care. There was no difference in our primary outcome of compliance with producing blood sugar log to appointments (group: 61.9% (range=0-100%) vs. standard: 50.0% (range=0-100%); p=0.429) (Table 1). Individuals in group care were more likely to attend more prenatal visits from DM diagnosis to delivery (group: 7 visits (range 1-16) vs. standard: 5 visits (range 3-17); p=0.026) (Table 1). There were also no differences in delivery outcomes. Of note, individuals with group care were more likely to complete their 2-hour oral glucose tolerance test to test for type 2 DM at their postpartum visit (group: 53.3% vs. standard: 20.5%; p=0.003) (Table 2). Group prenatal care for DM does not change compliance with blood sugar reporting or delivery outcomes but may enhance education to demonstrate the importance of postpartum screening.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Resistance Exercise Reduces the Necessity for Hypoglycemic Agent (Humulin) in Overweight Women with Gestational Diabetes Mellitus

Background: Gestational Diabetes Mellitus (GDM) is currently treated with blood sugar monitoring, nutritional supplements, increased fatal police work, and hypoglycemic agent medical help PRN to achieve and maintain normoglycemia. Even though humulin therapy has been demonstrated to reduce low birth weight in women with GDM, using hypoglycemic drugs is likely challenging and may not address peripheral hypoglycemic agent resistance, which is a critical role in the development of GDM. Furthermore, the use of aggressive low blood sugar medication therapy may result in a twofold rise in the amount of small-for-gestational-age infants. The resistance exercise was used in overweight women with Gestational Diabetes Mellitus. Because resistance exercise increase the lean body muscle or decrease the body fat and Resistance exercise is an effective glycaemic management and cardio metabolic health strategy.&#x0D; Methods: Fifteen patients with physiological condition DM were arbitrarily assigned whether it's to a group that received strength training or to a group that did not receive strength training to scale back the necessity for the hypoglycaemic agent.&#x0D; Results: Despite therapy, the number of girls who required hypoglycemic agent medical care has been the same. However, a meta-analysis with only overweight girls (pre-pregnancy BMI) revealed that the exercise cluster used to have a lower rate of hypoglycemic medication use (P&lt;05) than that of the non-exercise receiving patients.&#x0D; Conclusion: Resistance exercise coaching might facilitate to avoid hypoglycaemic agent medical aid for pregnant overweight girls with physiological state diabetes

Pengalaman Pasien Diabetes Mellitus yang Tinggal Sendiri dalam Melakukan Manajemen Diri

Self-management is an important component that will be integrated into the daily activity patterns of people with Diabetes Mellitus (DM) to regulate blood glucose levels, reduce symptoms, and prevent complications. DM patient s who live alone will face challenges and self-efficacy in self-management. The purpose of this study was to explore the experience of diabetes mellitus patient living alone in self management performance . Qualitative research design, a phenomenological study was used in this study. The number of participants was six , namely solitaire DM who have been diagnosed with DM for more than 1 year , able to communicate well . The technique of taking participants was using purposive sampling according to inclusion criteria. The main instrument is the researcher himself. C ollecting data with in-depth interviews, observations and field notes. Data analysis using Colaizzi's method begins with making transcripts, determining categories, formulating sub-themes and themes. This study generate n 6 themes, namely diet management, experience of antidiabetic treatment, herbal treatment as the main choice, modification of physical activity around the house, blood sugar monitoring and personal wisdom in controlling blood sugar. proper use of antidiabetic drugs and herbal remedies . Implementation of home visits for DM sufferers who live alone can increase understanding of the use of antidiabetic drugs and appropriate herbal remedies Keywords: Diabetes Mellitus, Self Management, Solitaire

Risk Factors for Diabetic Ketoacidosis among Type 1 Diabetic Children Registered at “Heraa Diabetes Center” in Makkah Al-Mokarramah City, Saudi Arabia

Aim of Study: To assess risk factors associated with DKA among T1DM children registered at “Heraa Diabetes Center”, Makkah Al-Mokarramah City, Saudi Arabia. Patients and Methods: A retrospective hospital-based, case-control research design was followed and included 375 diabetic patients aged less than 15 years. The “Study Group” included 125 children who had a past history of diabetic ketoacidosis (DKA Group), while the “Control Group” comprised 250 diabetic children who did not have past history of DKA. A data collection sheet was designed by the researchers. Results: There was significantly more positive family history in the DKA group than the control group (78.4% and 68%, respectively, p=0.036). The mothers were the main person who injects the child. Differences between both study groups according to the person who injects the child was statistically significant (p=0.029). DKA occurred more than once in 59.2% of diabetic children, and in 46.4% of children with over-activity. The main presenting symptoms of DKA were polyuria, thirst and vomiting. The main causes and triggering factors were eating too many sweets (65.6%), missing blood sugar monitoring (57.6%), omitting the insulin dose (22.4%), or infection (12.8%). Children in the control group were significantly more compliant than those in the DKA group regarding daily measurement of blood sugar (82.8% and 71.2%, respectively, p=0.009), timely receiving treatment (96% and 82.4%, respectively, p&lt;0.001), following a healthy diet (79.6% and 65.6%, respectively, p=0.003), and receiving health education (95.2% and 88%, respectively, p=0.011). Conclusions: Risk factors for DKA include positive family history of diabetes, and less educated or employed mothers, but its incidence is lower among children of parents with health-related jobs. It can be triggered by over-activity. It is caused by eating too many sweets, missing blood sugar monitoring, omitting the insulin dose, or infection. Noncompliance is associated with higher incidence of DKA. Recommendations: All parents of diabetic children should receive health education and be trained about management of diabetes, compliance to diabetes management, continuous monitoring of glucose levels, and early manifestations of DKA. Key Words: Diabetic ketoacidosis, Type 1 diabetes, Children, Risk factors, Compliance, Saudi Arabia.

Continuous glucose monitoring systems for monitoring cystic fibrosis-related diabetes.

Cystic fibrosis(CF) is one of the most common life-shortening autosomal-recessive genetic conditions with around 100,000 people affected globally. CF mainly affects the respiratory system, but cystic fibrosis-related diabetes(CFRD) is a common extrapulmonary co-morbidity and causes excess morbidity and mortality in this population. Continuous glucose monitoring systems(CGMS) are a relatively new technology and, as yet, the impact of these on the monitoring and subsequent management of CFRD remains undetermined. To establish the impact of insulin therapy guided by continuous glucose monitoring compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 23 September 2021. We also searched the reference lists of relevant articles and reviews and online trials registries.Date of last search: 23 September 2021. Randomised controlled studies comparing insulin regimens led bydata from CGMS (including real-time or retrospective data, orboth) with insulin regimens guided by abnormal blood glucose measurements collected through other means of glycaemic data collection in people with CFRD. Studies with a cross-over design, even with a washout period between intervention arms, are not eligible for inclusion due to the potential long-term impact of each of the interventions and the potential to compromise the outcomes of the second intervention. No studies were included in the review, meaning that no data were available to be collected for analysis. Review authors screened 14 studies at the full-text stage against the review'sinclusion criteria. Consequently, seven were excluded due to the study type being ineligible (not randomised), two studies were excluded due to their cross-over design, and two studies was excluded since theintervention used was not eligible and one was a literature review. One study in participants hospitalised for a pulmonary exacerbation is ongoing. Investigators are comparing insulin dosing via insulin pump with blood sugar monitoring by a CGMS to conventional diabetes management with daily insulin injections (or on an insulin pump if already on an insulin pump in the outpatient setting) and capillary blood glucose monitoring. The participants in the control arm will wear a blinded continuous glucose monitoring system for outcome assessment. In addition to this, one further study is still awaiting classification, and will be screened to determine whether it is eligible for inclusion, or is to be excluded, in an update of this review. No studies were included in the review, indicating that there is currently insufficient evidence to determine the impact of insulin therapy guided by CGMS compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD, nor on potential adverse effects of continuous glucose monitoring in this context. Randomised controlled studies are needed to generate evidence on the efficacy and safety of continuous glucose monitoring in people with CFRD. There is one relevant ongoing study that may be eligible for inclusion in a future update of this Cochrane Review, and whose results may help answer the review question.