Regular Blood Glucose Monitoring Research Articles

Evaluation of Adherence to Therapy In Patients of Type 2 Diabetes Mellitus

Objective: To evaluate adherence to therapy and study factors associated with non-adherence in patients of type 2 diabetes mellitus (DM). Methods: A prospective, cross-sectional, questionnaire based study was conducted in a tertiary care teaching hospital. 150 patients suffering from type 2 DM since six months or more were interviewed using self-designed, semistructured questionnaire to get information about adherence to medication, diet/exercise schedule and self-monitoring of blood glucose. Morisky medication adherence questionnaire was used to calculate overall adherence. Results: Average number of medicines taken by each patient daily was 4.75 ± 1.73 (mean + SD). 70% patients reported non-adherence to medication schedule. Not buying all medicines (58.66%), not taking prescribed dose of medicines (34%), taking additional non-prescribed medicines (30%) and not taking medicines for required duration (25.33%) were common types of nonadherence. Unawareness about need of each medicine (55.66%), forgetfulness (50.66%) and high cost (43.33%) were the common causes of non-adherence. In Morisky medication adherence questionnaire high, medium and low adherence was reported by 0%, 26% and 74% of patients, respectively. Moderately positive correlation was observed between poor adherence and number of concurrent illnesses, number of medicines taken and female gender. Regular monitoring of blood glucose and diet schedule was followed by 46% and 68% patients respectively. Conclusion: Since, not buying all medicines, which was mostly due to high cost was the commonest type of non-adherence, measures to provide free medicines to non-affording patients need to be implemented. Majority of patients were not aware about need of taking each medicine, hence, creating awareness about the same is essential for improving adherence to therapy. Key words: Causes of medication non-adherence in DM, Medication non-adherence, Morisky medication adherence questionnaire, Polypharmacy in diabetes mellitus, Types of medication non-adherence in DM.

The effect of integrated health management model on the health of older adults with diabetes in a randomized controlled trial

The objective of this study was to evaluate the effect of integrated health management model on the health of older adults with diabetes. The 100 older adults with diabetes who gave informed consent were randomly allocated 1:1 into management and control groups. The integrated health management model was applied in the former while the latter was only given usual care. This model included the following components: health record establishment, health evaluation and health management (such as: diet advice, psychological aspects of health, education/skills training on health self-management, regular blood glucose monitoring, long-term diabetes drug monitoring, etc.). After 18 months, differences in three categories of variables (subjective grading items, objective measurement health indices and health service utilization) between the two groups before and after the intervention were assessed with t-test, χ2-test and mixed model analysis. The management group demonstrated improvement on the following variables: health knowledge score, self-evaluated psychological conditions, overall self-evaluated health conditions, diet score, physical activity duration per week, regular blood sugar monitoring, waist-to-hip ratio, diastolic blood pressure and fasting blood sugar, the days of hospital admissions in the preceding 6 months. Mixed model analysis showed that gender, age, self-evaluated health status, self-evaluated psychological status, education level and resident status were important factors affecting health indices. This study demonstrated that integrated health management model was effectiveness in improving the health of older adults with diabetes.

The Relationship Between Maternal Fear of Hypoglycaemia and Adherence in Children with Type-1 Diabetes

Regular blood glucose monitoring is important for children with type-1 diabetes; however, the relationship between maternal fear of hypoglycaemia and glycaemic control is not well understood. The relationship between maternal beliefs about diabetes, concerns about glycaemic control and adherence to recommended blood glucose levels in young children with type-1 diabetes were examined in this study. Seventy-one mothers with children under 13 were recruited, and a prospective design was used. Demographics, maternal self-reported hypoglycaemic fear and illness perceptions were measured at baseline. Self-report daily blood sugar levels were recorded over 1 week, and glycosylated haemoglobin (HbA1c) blood glucose levels were collected at baseline and 3 months later. High maternal fears of hypoglycaemia were predictive of suboptimal daily glycaemic control (elevated blood glucose levels), irrespective of illness duration or age at diagnosis. The results suggest that mothers who worry most about hypoglycaemia compensate by maintaining their child's blood glucose levels above recommended levels. Elevated blood glucose levels have important consequences for long-term health, and further research could explore ways to target maternal fear of hypoglycaemia.

Helicobacter pylori infection associated with high HbA1c and type 2 diabetes

Although the association between chronic Helicobacter pylori infection and type 2 diabetes has been suggested, findings have been inconsistent. This study evaluated the association between chronic H. pylori infection and glucose regulation. We evaluated H. pylori infection status of participants recruited from the gastroenterology clinic at our hospital. At baseline, we performed blood tests including fasting plasma glucose, insulin, glycated haemoglobin A1c (HbA1c) and other biochemical measurements. Insulin resistance and beta-cell function were assessed by homoeostasis model assessment (HOMA-IR and HOMA-B, respectively). A total of 2070 participants were recruited. Those who had H. pylori infections had higher serum HbA1c levels and lower HOMA-B than those who did not (5.78% vs. 5.69%, P = 0.01 and 53.85 + 38.43 vs. 60.64 + 43.40, P = 0.009, respectively). They also had a significantly higher prevalence of type 2 diabetes (8.97% vs. 5.57%, P= 0.02). Chronic H. pylori infection was significantly associated with high levels of HbA1c and type 2 diabetes in participants above 65 years old (P = 0.001) and decreased insulin secretion and sensitivity in those under 45 years (P = 0.05). Long-term H. pylori infection is significantly associated with high levels of HbA1c and decreased insulin secretion in this Chinese population. Proper screening for H. pylori infection combined with regular monitoring of blood glucose and HbA1c levels might be effective for the early detection of glucose dysregulation and prevention of type 2 diabetes.

Improving diabetes care in Sri Lankan children: the way forward

Type 1 diabetes mellitus (T1DM) is an autoimmune disease. The incidence of T1DM is on the increase worldwide. The incidence in Sri Lanka is yet to be determined but there has been a definite increase in its occurrence in the recent past. Uncontrolled diabetes gives rise to micro vascular and macrovascular complications. Various strategies are being implemented to improve care for children with T1DM worldwide. Intensive blood glucose control, regular blood glucose monitoring, screening for complications are prerequisites for better diabetes management. The diabetic care of Sri Lankan children needs to be optimised. Compared to the West we do encounter many practical difficulties. This article discusses the facilities that we have compared to other countries who have achieved good glycaemic control in children and the way forward for the Sri Lankan paediatric population. DOI: http://dx.doi.org/10.4038/sjdem.v2i1.4333 Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2012; 2 : 35-38

Multidisciplinary management of an obstetric patient with glycogen storage disease type 3

A 22-year-old primiparous woman with known glycogen storage disease type 3a presented to our hospital during her 12th week of pregnancy. Glycogen storage disease type 3 is a rare inherited disorder resulting from a deficiency of the glycogen debranching enzyme, causing the accumulation of abnormal short-chain glycogen in liver, blood cells, myocardium and striated muscle. Symptoms improve after puberty but the increased metabolism of pregnancy predisposes to hypoglycaemia, ketosis and lactic acidosis. Cardiomyopathy, distal weakness and peripheral neuropathy may present after the third decade. The patient was managed antenatally with regular cornflour feeds and was scheduled for elective caesarean delivery. She presented in early labour at 38 weeks and delivered a healthy neonate by urgent caesarean delivery under spinal anaesthesia. Intravenous dextrose infusion and regular blood glucose monitoring were used during the perinatal period to prevent hypoglycaemia. An arterial line was inserted in the operating room for frequent blood sampling and to avoid muscle cramps which could be induced by the intermittent inflation of the automated blood pressure cuff. Obstetric, anaesthetic and neonatal outcomes were uneventful.

Getting one's thoughts straight: A dialogical analysis of women's accounts of poorly controlled type 2 diabetes

Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of ‘getting one's thoughts straight’ in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.

The effect of home visits on the quality of life of children and adolescents with type 1 diabetes mellitus

The aim of the study was to analyze the impact of home and school visits and to strengthen the knowledge on diabetes education on the quality of care and life of children and adolescents with diabetes. This was a descriptive cross-sectional study of all children and adolescents (n = 16, seven males and nine females), attending a pediatric diabetes center (mean age: 11.25 yr ± 4.82, range: 5-17 yr), mean duration of diabetes being 4.6 ± 3.9 yr, range 0.5-8.4 yr. Ten patients were visited by the medical social worker at home and school, their knowledge ondiabetes education was strengthened, and intervention effect was evaluated 4 months later. Positive effects observed were that clinic visits became regular, there was notification by school of clinical status, a reduction in number of hypoglycemic episodes at school, increased acquisition of glucometers, and daily and regular (100%) self home blood glucose (BG) monitoring. The mean center HbA1c was reduced from 12.86 ± 2.5% to 9.41 ± 1.56%, the change from previsit was 3.45%. The mean center morning BG dropped from 181.60 ± 71.96 to 127.54 ± 27.54 mg/dL reflecting change from previsit BG of 54.19 mg/dL. However, these visitations had little effect on checking of BG at school. This study stressed the importance of home and school visits and diabetes education on the quality of care and life of the children and adolescents with diabetes in our region.

Successful transfer from insulin to oral sulfonylurea in a 3-year-old girl with a mutation in the KCNJ11 gene

Neonatal diabetes mellitus is considered a rare disease that is diagnosed in the first six months of life, and can be either transient or permanent. Recent advances in molecular genetics have shown that activating mutations in KCNJ11 (the gene that encodes for the Kir6.2 subunit of the KATP potassium channel of the pancreatic β-cell) is a common cause of permanent neonatal diabetes mellitus. Patients with mutations in this gene may respond to oral sulfonyureas. We describe a 3-year-old girl with permanent neonatal diabetes mellitus with a mutation in the KCNJ11 gene (R201H), who was successfully transferred from subcutaneous insulin to oral glibenclamide, with a marked improvement in glycemic control. This is the first successful switch from insulin to oral sulfonylurea in a patient with R201H mutation, in the Arabian Gulf.

Observation of effect of comprehensive community nursing on patients with diabetes mellitus

Objective To establish nursing intervention for patients with diabetes mellitus and discuss in-fluence of community nursing on rehabilitation of patients with diabetes mellitus. Methods Patients with con-finned diagnosis of type two diabetes mellitus (61 cases) were selected,individual health records were established and health education was given to them,including diet,exercises,psychological nursing,medication instruction and regular blood glucose monitoring. Patients compliance,control of fasting blood glucose and glycosylated hemoglobin were compared before and after nursing intervention. Results Patients compliance such as regular physical ex-amination,diet control,regular blood glucose monitoring and exercises treatment improved after intervention com-pared with those before community intervention (P<0.05). The control of fasting blood glucose and glycosylated hemoglobin was better after intervention compared with those before community intervention (P<0.01). Con-clusion Community nursing intervention for patients with diabetes mellitus proved to have good effect. Key words: Diabetes mellitus; Intervention; Community nursing

Glucagon as a Treatment of Severe Hypoglycemia

Over the past 2 decades, a number of different studies have demonstrated that tight metabolic control not only reduces the incidence but also delays the development of complications in people with type 1 and type 2 diabetes. Unfortunately, the intensive insulin therapy required to achieve tight glucose control is also associated with a significantly increased risk of developing hypoglycemia. Hypoglycemia can cause physical as well as psychosocial morbidity, has been associated with adverse neurological manifestations, and can sometimes result in death. It can affect daily activities such as driving, working, and studying and can result in inconvenience and embarrassment as well as cause fear for both the person with diabetes and significant others. This fear is often the biggest barrier for optimal glycemic control. With self-management education and regular monitoring of blood glucose, people with diabetes can learn to recognize their unique signs and symptoms of hypoglycemia, and with improved understanding of how insulin, food, and activity affect blood glucose levels, the patient can learn to prevent hypoglycemia. However, because managing blood glucose can be such a delicate balancing act, it is important to be prepared. An important weapon in the treatment of severe hypoglycemia is the use of glucagon, a treatment that is generally underappreciated, underevaluated, undertaught, and most certainly underutilized. The purpose of this article is to review the role of glucagon in the treatment of severe hypoglycemia and discuss how better information about and understanding of the use of glucagon might be helpful toward alleviating some of the fears surrounding hypoglycemia.

Role of recombinant human growth hormone in HIV-associated wasting and cachexia: Pathophysiology and rationale for treatment

Background: Wasting, or cachexia, is a significant, debilitating, and potentially life-threatening complication of HIV infection. It is associated with reduced strength and functional ability, reduced ability to with stand opportunistic infections, and increased risk of mortality. Although the incidence of HIV-associated wasting may have declined since the introduction of highly active antiretroviral therapy (HAART), it continues to be a concern in this patient population. Objective: This paper reviews available data on the etiology and clinical impact of HIV-associated wasting, the role of the growth hormone/insulin-like growth factor-I axis in the pathophysiology of this condition, and the rationale for its treatment with recombinant human growth hormone (rhGH). Methods: MEDLINE was searched for articles published in English through August 2007 using the terms HIV, wasting (and related terms), and growth hormone. Preference was given to clinical studies (including randomized clinical studies), meta-analyses, and guidelines. Review articles were evaluated and the bibliographies examined for additional relevant articles. The analysis was restricted to studies conducted in developed countries. Results: Alterations in the growth hormone/insulin like growth factor-I axis have been observed in patients with HIV-associated wasting, including elevated levels of the former and reduced levels of insulin-like growth factor I. In randomized, placebo-controlled studies, rhGH significantly improved lean body mass by ~3 kg compared with placebo ( P < 0.001) and total body weight by ~3 kg ( P < 0.001), and was associated with significant improvements in physical endurance and quality of life ( P < 0.001). Common adverse events with rhGH therapy include blood glucose elevations, arthralgia (36.4%), myalgia (30.4%), and peripheral edema (26.1%), but these usually respond to dose reduction or drug discontinuation. Conclusions: Physicians should be alert to the possibility of wasting in HIV-infected patients receiving HAART and should consider treatment to improve patients' stamina and quality of life. The evidence supports a role for rhGH in the treatment of patients with HIV-associated wasting. Regular blood glucose monitoring is advised when treating wasting with rhGH.

Index of Suspicion in the Nursery

Five days after birth at a private hospital, an infant is brought to another hospital because he is inactive and limp. The delivery was by outlet forceps after a supervised, normal pregnancy to consanguineous (uncle-niece) parents. His birthweight was 3.25 kg. According to his parents, he did not cry until 1 hour after birth, was limp, fed poorly, and a few hours later, had cyanosis of lips and nails and generalized tonic and clonic convulsions that were unresponsive to anticonvulsants and intravenous glucose. The parents were told that he had hypoxic brain injury and possibly an intracranial hemorrhage. The convulsions became less frequent once expressed human milk was provided through a nasogastric tube. The exact details of management at the private hospital are not available. The infant is the first child of the woman, who is well nourished and does not have diabetes. His weight on admission at 5 days of age is 3.66 kg, length is 49 cm, and head circumference is 33 cm. He is inactive and limp. His temperature is 97.8°F (36.6°C) and heart rate is 170 beats/min. His cry is feeble and response to pain is minimal. His anterior fontanelle is normal, hydration is adequate, Moro reflex is incomplete, and sucking and rooting reflexes are poor. He does not have syndromic features or acidosis. No additional findings are revealed in the remainder of the general and systemic evaluations. The results of a complete blood count; measurement of electrolytes, calcium, and bilirubin; review of the cerebrospinal fluid and urinalysis; electrocardiography and radiography of the chest and skull; and abdominal ultrasonography are normal. Cultures of blood, cerebrospinal fluid, and urine are sterile. Oxygen saturation is 98%. Blood glucose on admission is 41 mg/dL (2.28 mmol/L) and is monitored every 1 to 4 hours. Urine ketones are negative. The …

How well controlled are our type 2 diabetic patients in 2002?: An observational study in North and Central Trinidad

Objectives To determine the proportion of diabetic patients that achieved glycemic control (HbA1c £7.0%) and to explore some of the barriers to achieve this control. Design Cross-sectional, observational study. Setting Health centres in North and Central Trinidad. Patients One hundred and thirty-two type 2 diabetics attending the health centres for more than 1 year. Main outcome measures HbA1c levels and the proportion of patients who achieve glycemic control, HbA1c £7.0%. Results The patients were categorized into two groups: well controlled, HbA1c Ÿ7.0% and poorly controlled, HbA1c > 7.0%. The majority of patients were poorly controlled (55.3%), duration of diabetes impacted negatively older patients and patients attending the clinics for longer periods were less likely to be well controlled. There was no correlation between pharmacological treatment, availability of individual counselling by a dietician or regular monitoring of blood glucose and glycemic control ( p > 0.05). Conclusion A 44.7% of patients with type 2 diabetes were found to be well controlled. Old age (51–70 years) and lengthy periods of attendance seem to be barriers to achieving glycemic control. This study highlights the fact that there is a need for re-evaluation of the diabetic program since despite changes in the primary care system over the past 5 years a large proportion of diabetics are still uncontrolled.

Recent advances in the diagnosis and management of diabetic neuropathy

The World Health Organisation estimated that in the year 2000, 150 million people had diabetes mellitus, and it is predicted that this number will rise to 366 million by the year 2030.[1][1] Neuropathy is a common complication of diabetes and is characterised by a progressive loss of peripheral

Anaesthetic management of the diabetic patient

Diabetes mellitus is the most common endocrine disorder and its incidence is increasing dramatically. It affects many body systems including the cardiovascular, renal, neurological and ophthalmic systems. About 50% of diabetic patients will need surgical intervention and therefore the anaesthetist must understand the disease process, treatment and operative management. The anaesthetist should also be aware of the systemic signs and symptoms associated with the multisystem nature of diabetes and of their significance regarding administration of an anaesthetic. Diabetes is split into five diagnostic groups, of which the most common are type 1 and type 2. Anaesthetists will also encounter gestational diabetics in the labour suite. The perioperative management depends on the type of diabetes and the degree of surgery (minor or major). The key points of anaesthetic management are to avoid hypoglycaemia (and its possible fatal consequences), avoid swings in blood sugar, avoid dehydration, avoid hypokalaemia and prevent ketoacidosis. The practicalities of the anaesthetic management include simple measures such as the placement of patients first on operating lists, using regional techniques where possible, using glucose/insulin supplementation perioperatively, regular blood glucose monitoring, and careful asepsis for all invasive procedures. The anaesthetist will also be expected to provide advice on postoperative fluids and insulin supplementation until the patients are eating and back on their regular insulin regimen.

Psychosocial factors associated with poor diabetes self-care management in a specialized Center in Mexico City

To examine the relationship between demographic, clinical and psychosocial variables and diabetes self-care management in Mexican type 2 diabetic patients. Cross-sectional study of 176 consecutive patients with type 2 diabetes aged 30–75 years, attending a tertiary health-care center in Mexico City. A brief medical history and previously validated questionnaires were completed. The study group consisted of 64 males/112 females, aged 55 ± 11 years, mean diabetes duration of 12 ± 8 years and HbA1c of 9.0 ± 2.0%, 78.4% reported following the correct dose of diabetes pills or insulin, 58% ate the recommended food portions, and 44.3% did exercise three or more times per week. A good adherence to these three recommendations was observed in only 26.1% of the patients. These patients considered as a group were characterized by a greater knowledge about the disease ( P < 0.00001), regular home blood glucose monitoring ( P < 0.01), an inner perception of better diabetes control ( P = 0.007), good health ( P = 0.004) and better communication with their physician ( P < 0.02). A poor adherence to two or the three main diabetes care recommendations was associated with a depressive state (OR 2.38, 95% CI 1.1–4.9, P < 0.01) and a history of excessive alcohol intake (OR 4.03, 95% CI 1.1–21.0, P = 0.03). Poor adherence to standard diabetes care recommendations is frequently observed in patients with type 2 diabetes attending a specialized health care center in Mexico City. Depression must be identified and treated effectively.

Review: Newer antipsychotic agents, carbohydrate metabolism and cardiovascular risk

With widespread use of `atypical' antipsychotics for the treatment of psychiatric disorders, attention has focused on their association with obesity, diabetes and risk factors for cardiovascular disease. People with schizophrenia are more likely to develop diabetes than the general population, with antipsychotics appearing to add to this risk. The exact mechanism(s) by which antipsychotics cause hyperglycaemia, diabetic ketoacidosis and aggravation of pre-existing diabetes remain uncertain. Plausible mechanisms have been postulated for the promotion of obesity by these agents, with resultant insulin resistance and type 2 diabetes in some patients. Whatever the mechanism, careful consideration of potential risks and benefits is required in prescribing: people with schizophrenia are often exposed to antipsychotic agents in the long term and frequently have co-existing cardiovascular risk factors (smoking, poor diet, physical inactivity, social deprivation). Regular monitoring of body weight, blood glucose and serum lipids may help clinical management.

An evaluation of diabetic care in registered nursing homes

AbstractThis study examines current clinical practice in relationship to the care of diabetic patients in Registered Nursing Homes in Argyll and Clyde NHS Board and training needs of staff. The prevalence of diabetes was found to be 6.5% (95% CI 4.7–8.3) with 12 having type 1 and 82 having type 2 diabetes. This comprised 58 women and 42 men with a mean age of 79 years. The mean number of patients per home was 2.6 (95% CI 1.9–3.4) with a range of 0–22. Eighty‐one patients were medically cared for solely by general practice. Seventeen homes screened new patients on admission for diabetes using a variety of methods; only six homes tested blood glucose levels as part of their screening programme. Ninety‐one per cent of the sample were receiving regular blood glucose monitoring; of the patients treated with insulin 50% were having blood glucose monitoring a minimum of once per day. Forty‐seven per cent had annual retinopathy screening, with 62% being undertaken by an accredited optometrist. Ninety‐one per cent of patients had been treated by a chiropodist in the previous 12 months. A dietician had assessed 13% of patients in the previous 12 months. There was a positive response to further education on diabetes, with particular needs expressed for staff training, including blood monitoring and screening. This study has formed the basis for the development of nursing guidelines for diabetes in nursing homes and the development of an educational programme. Copyright © 2002 John Wiley &amp; Sons, Ltd.

Observations of diabetes care in long-term institutional settings with measures of cognitive function and dependency.

To document the prevalence of known diabetes and quantity of diabetes care delivered in long-term institutional settings in South Glamorgan, Wales; to measure physical and mental performance of diabetic residents; and to ascertain the level of basic diabetes knowledge of both staff and diabetic residents. A postal questionnaire survey was sent to 31 nursing or dual registered homes and 88 residential homes in South Wales to determine the prevalence of known diabetes. Medical examination and a semistructured interview of 109 diabetic and 106 age- and sex-matched nondiabetic residents was followed by assessment of dependency (Barthel Activities of Daily Living Scale [15]; Behavioral Rating Scale [16]) and cognitive performance (Mini-Mental State Exam [12]). The prevalence of known diabetes was 7.2%. Forty percent of diabetic residents were taking long-acting sulfonylureas. Only half of the residents in both homes had regular blood glucose monitoring. Less than 1 in 10 diabetic residents were being followed in a hospital-based diabetic clinic. Diabetic residents had had more hospital admissions in the preceding year than nondiabetic control subjects, and their length of stay was double that of nondiabetic control subjects (P < 0.05). Health professional input was fragmented, with involvement of community nurses and dietitians being rare. Diabetic residents had significantly higher levels of arterial disease (P < 0.05), foot ulceration (P < 0.01), and dementia (P < 0.01), and more severe cognitive impairment and higher levels of dependency (P < 0.01). Knowledge of diabetes was poor among both diabetic and nondiabetic residents and care staff. There is an important need for a reappraisal of diabetes care in institutional settings.