Blood Glucose Screening Research Articles

Extended Roles of Community Pharmacists in Addis Ababa: Extent of Use and Publics’ Perceptions

The present study was conducted to determine the extent of publics’ visit to community pharmacies and perception on their extended roles in Addis Ababa, Ethiopia. A community based cross-sectional study was conducted using semi-structured questionnaire to collect information from households. Sixty-six percent of the respondents had made at least one visit to the community pharmacies in four weeks recall period preceding the interview date. Most of the respondents visited community pharmacies for purchasing prescription and non-prescription medicines, 88.7% and 43.3%, respectively. More than a quarter of respondents reported that they visited community pharmacies seeking advice from the pharmacists. Location (85%), service quality (36%) and availability of wide range of products (37%) were identified as major contributing factors for respondents’ loyalty to a particular community pharmacy. Majority of the respondents gave approval to the possible extended roles of community pharmacists, particularly blood pressure, cholesterol and blood glucose screening; immunization, chronic disease management and related counseling services. Publics’ frequent access and acceptance of potential extended roles of community pharmacists indicate that community pharmacies could be ideal place for early detection, screening, referral and follow up stable or refill clients for chronic diseases and management of self limiting illnesses and in assisting therapeutic drug monitoring for patients with chronic conditions.Keywords: community pharmacist, community’s perception, extended roles, Addis Ababa, Ethiopia

Post-partum follow-up of women with gestational diabetes mellitus: effectiveness, determinants, and barriers

Background: Despite the recommendations for postpartum blood glucose monitoring post gestational diabetes mellitus (GDM); scientific evidence reveals that these recommendations may not be fully complied to. This study aimed to follow-up women up to 2 years post-delivery with pregnancies complicated by GDM and healthy controls to assess this fact. Methods: Women with GDM (n = 78) and normal glucose tolerant (n = 89) delivered in 2014 were followed up for 2 years. They were informed and enquired via telephone about their blood glucose screening, physical activity, postpartum complications, and current weight status of mother and baby. Results: Women with previous GDM were older and reported higher body weight 2 years post-delivery. At the 2 year follow-up, n = 11 (14.1%) participants had developed diabetes, all with previous GDM. Both weight at birth (3.8 ± 0.5 kg) and at 2-year (10.7 ± 2.3 kg) for the babies born to GDM mothers was significantly higher than the NGT group babies (2.6 ± 0.63 and 7.1 ± 1.4 kg; p < .05). Only 27 women regularly opted for T2DM screening via monitoring blood glucose or HbA1c levels postpartum. The top reason for failed screening included: believing that GDM would disappear after delivery, and being occupied with the baby. Conclusions: The high incidence of T2DM in women with previous GDM is an alarming finding. Given this trend, systematic follow-up programs are needed to reduce obesity and diabetes risk.

Impact of the Act FAST stroke campaign delivered by student pharmacists on the primary prevention of stroke

ObjectivesTo evaluate the impact of an Act FAST educational intervention performed by student pharmacists on knowledge of stroke recognition and management. DesignStroke preparedness and knowledge of primary prevention were assessed with the use of pre- and post-intervention surveys targeting community members at health fairs. The intervention was an Act FAST educational session with blood pressure and blood glucose screenings provided by student pharmacists. Act FAST is a quick tool to help recognize and respond to a stroke. The acronym FAST stands for Face, Arms, Speech, and Time. SettingCommunity health fairs in Vallejo, CA. ParticipantsCommunity members 18 years of age and older. InterventionAct FAST educational session delivered by student pharmacists. Main outcome measuresKnowledge of signs, symptoms, management, and risk factors of strokes as defined by the American Heart Association. ResultsFollowing the Act FAST educational intervention, total knowledge of signs, symptoms, and management of stroke significantly increased from moderate to high (n = 112; 95% confidence interval [CI] 1.419-2.188; P <0.0001). Total knowledge of risk factors of stroke also significantly increased following the educational intervention (n = 88; 95% CI 0.6496-1.746; P <0.0001). ConclusionThe Act FAST educational intervention delivered by student pharmacists increased knowledge of signs, symptoms, immediate management, and modifiable risk factors of stroke. This suggests that student pharmacists may have a positive impact on community members’ preparedness and knowledge of primary prevention of stroke. The Act FAST campaign may be a useful tool for all training health care professionals.

Team sugar: Blood glucose screening in acute lymphoblastic leukemia patients during induction.

57 Background: Pediatric acute lymphoblastic leukemia (ALL) protocols currently include steroids during induction therapy, which may lead to hyperglycemia. Published pediatric and adult leukemia data demonstrate increased rates of infection and mortality associated with hyperglycemia. Presently, there are no accepted recommendations for how to track blood glucose (BG) levels, so hyperglycemia may go undetected. A random review of 20 patients diagnosed with ALL during a 4-month period in 2014 at Texas Children’s Cancer Center (TXCCC) demonstrated that only 40% had BG checked throughout induction. The SMART aim of this quality improvement project was to increase BG screening rates to &gt; 95% during first week of treatment and induction days 8, 15, 22 and 29 for patients with newly diagnosed ALL at TXCCC in a 15-month period. Methods: PDSA cycle 1 involved sticker reminders on treatment roadmaps by days that required a BG check. PDSA cycle 2 entailed reminder flyers in patient care areas and no further roadmap stickers. Primary outcome measure was the percentage of successful occurrences for BG checks on days 8, 15, 22, 29. Secondary outcome measure was the percentage of patients who needed insulin therapy. Results: TXCCC had 97 new ALL patients during March 2015 to May 2016. Providers obtained 333 of 372 possible BG checks (90%) on days 8, 15, 22, 29. Thirty-nine percent of patients developed hyperglycemia ≥ 200 mg/dL. Eighteen percent patients required insulin therapy. Eighty-nine percent of patients had their peak blood glucose by day 8, and 82% of patients who required insulin were started on insulin prior to day 8. Conclusions: We improved hyperglycemia screening rates for TXCCC ALL patients in induction from 40% to 90% by implementing reminder processes for providers. The roadmap stickers were replaced with reminder flyers for sustainability. Because the peak BG was reached by 89% of patients by day 8 of therapy, our efforts are now being directed at improving screening and interventions prior to day 8. Our goal is to standardize BG screening and hyperglycemia intervention algorithms to decrease both the time-to-initiation for insulin and readmission rate for symptomatic hyperglycemia for ALL patients at TXCCC.

Developing Recommendations for Evidence-Based Clinical Preventive Services for Diverse Populations: Methods of the U.S. Preventive Services Task Force.

The U.S. Preventive Services Task Force (USPSTF) summarizes the principles and considerations that guide development of its recommendations for diverse U.S. populations. It uses these principles through each step in the evidence-based guideline process: developing the research plan, conducting the evidence review, developing the recommendation, and communicating to guideline users. Three recent recommendations provide examples of how the USPSTF has used these principles: the 2015 recommendation on screening for abnormal blood glucose and type 2 diabetes; the 2016 recommendation on screening for breast cancer; and the recommendation on screening for prostate cancer, which is currently in progress. A more comprehensive list of recommendations that includes considerations for specific populations is also provided.

Cutpoints for screening blood glucose concentrations in healthy senior cats.

Objectives The objectives of this study were to determine the reference interval for screening blood glucose in senior cats, to apply this to a population of obese senior cats, to compare screening and fasting blood glucose, to assess whether screening blood glucose is predicted by breed, body weight, body condition score (BCS), behaviour score, fasting blood glucose and/or recent carbohydrate intake and to assess its robustness to changes in methodology. Methods The study included a total of 120 clinically healthy client-owned cats aged 8 years and older of varying breeds and BCSs. Blood glucose was measured at the beginning of the consultation from an ear/paw sample using a portable glucose meter calibrated for cats, and again after physical examination from a jugular sample. Fasting blood glucose was measured after overnight hospitalisation and fasting for 18-24 h. Results The reference interval upper limit for screening blood glucose was 189 mg/dl (10.5 mmol/l). Mean screening blood glucose was greater than mean fasting glucose. Breed, body weight, BCS, behaviour score, fasting blood glucose concentration and amount of carbohydrate consumed 2-24 h before sampling collectively explained only a small proportion of the variability in screening blood glucose. Conclusions and relevance Screening blood glucose measurement represents a simple test, and cats with values from 117-189 mg/dl (6.5-10.5 mmol/l) should be retested several hours later. Cats with initial screening blood glucose >189 mg/dl (10.5 mmol/l), or a second screening blood glucose >116 mg/dl (6.4 mmol/l) several hours after the first, should have fasting glucose and glucose tolerance measured after overnight hospitalisation.

Socioeconomic and lifestyle determinants of blood glucose screening in Malaysia

Abstract Background The increase in prevalence of diabetes is a serious public health issue. It is well-documented that use of blood glucose screening can help to reduce the risk of developing diabetes. Objectives To examine the socioeconomic and lifestyle factors associated with use of blood glucose screening among Malaysian adults. Methods Nationally representative data from 2,415 survey respondents was used. The survey was a cross-sectional population-based study previously conducted by the Ministry of Health Malaysia. A logistic regression model was developed to estimate the likelihood of using blood glucose screening. Results Age, marital status, ethnicity, income, smoking, and body mass index were significantly associated with use of blood glucose screening. In particular, older individuals, married individuals, Malays, higher income earners, non-smokers, and being obese, overweight or of normal weight were correlated with a higher likelihood of using blood glucose screening. Conclusions It is important to acquire a better knowledge of the factors that can influence the decision of people to adopt preventive measures. Having better information regarding which groups of individuals use or do not use blood glucose screening can assist governments in developing appropriate intervention programs.

Inequities in Healthcare utilization: results of the Brazilian National Health Survey, 2013.

BackgroundThe Brazilian Unified Health System is a public healthcare system that has universal and equitable access among its main principles, but the continental size of the country and the complexity of the public health system complicate the task of providing equal access to all. We aim to investigate the factors associated with inequities in healthcare utilization in Brazil.MethodsWe employed data from a nationally representative cross-sectional study (2013 National Health Survey; n = 60,202). The outcome was underutilization of healthcare by adults, defined as lack of utilization of one or more of these services: physician or dentist consultation, and blood glucose or blood pressure screening. A logistic regression model, considering the complex sample, was employed (alpha = 5 %).Results0.7 % of the sample never visited a physician, 3.3 % never visited a dentist, 3 % never underwent blood pressure screening, 11.5 % never underwent blood glucose screening, and 15 % never utilized at least one of these services. Multivariate models showed a higher likelihood of underutilization of healthcare among individuals of the lowest social class “E” (AOR = 6.31, 95 % CI = 3.76–10.61), younger adults (Adjusted Odds Ratio, or AOR = 4.40, 95 % CI = 3.78–5.12), those with no formal education or incomplete primary education (AOR = 2.93, 95 % CI = 2.30–3.74), males (AOR = 2.16, 95 % CI = 1.99–2.35), and those without private health insurance (AOR = 2.11, 95 % CI = 1.83–2.44). Individuals self-classified as “white” were less likely to report underutilization (AOR = 0.82, 95 % CI = 0.75–0.90).ConclusionsDespite recent expansion of primary healthcare and oral health programs in Brazil, we observed gaps in healthcare utilization among the most vulnerable segments of the population.

Association of Material Deprivation Status, Access to Health Care Services, and Lifestyle With Screening and Prevention of Disease, Montreal, Canada, 2012.

IntroductionThe objective of this study was to provide information on the effect of disparities in material deprivation, access to health care services, and lifestyle on the likelihood of undergoing screening for disease prevention.MethodsWe used data from a probability sample (N = 10,726) of the Montreal population aged 15 years or older and assessed 6 dependent variables (screening for breast cancer, cervical cancer, colon cancer, blood glucose, and high blood pressure and receipt of the seasonal influenza vaccination), and 3 independent variables (disparities in material deprivation, access to health care services, and personal lifestyle habits). We used logistic regression to analyze data and determine associations.Results Use of preventive health services increased as material deprivation declined, access to health care improved, and lifestyle habits became healthier. The combined effect of household income, an individual measure, and the material deprivation index (consisting of quintiles representing a range from the most privileged [quintile 1: best education, employment, and income] to the most deprived [quintile 5: least education, employment, and income]) an ecological measure, showed that having a Papanicolaou test was significantly associated with high annual household income (≥$40,000) even if the woman resided in a deprived neighborhood (quintiles 4 and 5 of the material deprivation index) (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.04–1.84), whereas odds of having a mammogram or influenza vaccination were significantly associated with living in a privileged neighborhood (quintiles 1, 2, and 3 of the material deprivation index) even among people with a low annual household income (<$40,000) (mammogram: OR, 1.54; 95% CI, 1.00–2.38; influenza vaccination: OR, 1.31; 95% CI, 1.04–1.66).ConclusionIn addition to influencing lifestyle habits and access to health care services, disparities in material deprivation influence whether a person uses preventive health services. Public health professionals need to establish screening outreach programs in socioeconomically disadvantaged neighborhoods to enhance public participation in disease prevention programs and reduce disparities in health.

Physical Health Screenings Among African-American Church and Community Members.

This study sought to identify characteristics, including religiosity, related to having received health screenings among persons who attend African-American churches or receive church-based community outreach services. A sample of 602 was recruited during two phases as part of a larger project. Blood pressure, cholesterol, and blood glucose screenings were the most frequently reported screenings ever and in the last 12months. Although religiosity was significantly related to several of the health screenings in bivariate analysis, it is not a predictor of health screenings in multivariate analyses. Innovative strategies are needed to promote screenings such as church-based health fairs.

Blood glucose screening among elderly Malaysians: Who to target?

Early detection of raised blood glucose can reduce the risk of developing diabetes. Despite being a high-risk group, a significant proportion of the elderly population does not undergo blood glucose screening. The aim of the present study was to examine the factors affecting blood glucose screening among the elderly. Data from a sample of 2463 respondents in the National Health and Morbidity Survey 2011 were used. Pearson Chi-squared tests were conducted to find factors associated with screening behavior. A logit model was used to analyze the likelihood of screening. Income, age, education, ethnicity, employment status, availability of medical coverage, and smoking behavior were significantly associated with blood glucose screening. The likelihood of blood glucose screening was positively correlated with available monthly income and was higher in those aged 60-69 years, those attaining higher education, Malays, and elderly who are medically covered. The findings of the present study provide insights for health policy formulation for the elderly. As part of their efforts to reduce national health costs, governments should pay particular attention to the elderly, who are likely to be unscreened for blood glucose levels, because they face even larger risk exposure.

The Role of Untimed Blood Glucose in Screening for Gestational Diabetes Mellitus in a High Prevalent Diabetic Population.

Global prevalence increase of diabetes type 2 and gestational diabetes (GDM) has led to increased awareness and screening of pregnant women for GDM. Ideally screening for GDM should be done by an oral glucose tolerance test (oGTT), which is laborious and time consuming. A randomized glucose test incorporated with anthropomorphic characteristics may be an appropriate cost-effective combined clinical and biochemical screening protocol for clinical practice as well as cutting down on oGTTs. A retrospective observational study was performed on a randomized sample of pregnant women who required an OGTT during their pregnancy. Biochemical and anthropomorphic data along with obstetric outcomes were statistically analyzed. Backward stepwise logistic regression and receiver operating characteristics curves were used to obtain a suitable predictor for GDM without an oGTT and formulate a screening protocol. Significant GDM predictive variables were fasting blood glucose (p = 0.0001) and random blood glucose (p = 0.012). Different RBG and FBG cutoff points with anthropomorphic characteristics were compared to carbohydrate metabolic status to diagnose GDM without oGTT, leading to a screening protocol. A screening protocol incorporating IADPSG diagnostic criteria, BMI, and different RBG and FBG criteria would help predict GDM among high-risk populations earlier and reduce the need for oGTT test.

Effect of Diabetes Mellitus on Tuberculosis Treatment Outcome and Adverse Reactions in Patients Receiving Directly Observed Treatment Strategy in India: A Prospective Study.

Despite successful implementation of directly observed treatment, short course (DOTS) in India, the growing number of diabetes mellitus (DM) patients appears to be a cause in the increasing tuberculosis (TB) incidence, affecting their management. In this regard, a prospective study was conducted on DOTS patients in three primary health care centers in urban slum region of South Delhi, India, to evaluate the effect of DM on sputum conversion, treatment outcome, and adverse drug reactions (ADR) due to anti-TB treatment. Eligible TB patients underwent blood glucose screening at treatment initiation. Disease presentation, clinical outcome, and ADRs were compared between patients of TB with and without DM. Out of 316 patients, the prevalence of DM was found to be 15.8%, in which 19.4% and 9.6% were PTB and EPTB patients, respectively. DM patients have observed higher sputum positivity (OR 1.247 95% CI; 0.539–2.886) at the end of 2-month treatment and poor outcome (OR 1.176 95% CI; 0.310–4.457) at the completion of treatment compared with non DM patients. Presence of DM was significantly associated (OR 3.578 95% CI; 1.114–11.494, p = 0.032) with the development of ADRs. DM influences the treatment outcome of PTB patients in our setting and also on the ADR incidence.

Capitol Hill Health Fair: Showing Congress what pharmacy has to offer

Capitol Hill Health Fair: Showing Congress what pharmacy has to offer

Evaluation of the Activities of Community Pharmacies during the Annual Campaign with Focus on Diabetes Prevention

With its increasing incidence, diabetes is one of the major challenges of the 21th century. Against this background, the Bavarian State Ministry of Public Health and Care Services (BStMGP) started in 2014 the campaign "Diabetes moves us!". The scientific institute for prevention in health care (WIPIG) supported the activities of Bavarian pharmacies and evaluated the extent to which they might be able to contribute towards prevention. Besides additional training of pharmaceutical staff, WIPIG initiated a diabetes prevention network. Pharmacies that were members of the network had the opportunity to order a campaign package including an evaluation questionnaire and to register their activity in the calendar of events of the campaign. A total of 215 pharmacies signed up for the diabetes prevention network and registered 103 events. The WIPIG received 67 completed evaluation questionnaires. Most often (86.6%) the pharmacies conducted a blood glucose screening; 76.1% carried out screening with the diabetes risk questionnaire FINDRISC of the German Diabetes Foundation and 22.4% gave a information lecture on diabetes. During the screening 2,502 persons had their blood sugar checked and 1,765 persons filled in the FINDRISC questionnaire. Overall, 190 persons were advised to visit their physician because of a very high blood glucose level. On the basis of the FINDRISC, 80.2% were advised to change their lifestyle to prevent type 2 diabetes.

Role of pharmacist-provided point-of-care testing

APhA–APPM Patient care opportunities for pharmacists with point-of-care testing P o i n t o f c a r e (POC) testing, or “diagnostic testing performed at or near the site of patient care,” is a convenient, affordable, and reliable method for pharmacists to measure laboratory values.1,2 Currently, more than 120 POC tests waived under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) are available for use in the evaluation and management of many acute and chronic diseases.3 Pharmacists can provide these tests to patients as alternative, accessible, and impactful health care options. With more than 8 million Americans having undiagnosed diabetes and more than 35 million having uncontrolled blood pressure, pharmacists have the opportunity to play a critical role in patient care through the provision of POC testing.4,5 Blood glucose and blood pressure screenings are just two of the simple POC tests that pharmacists can provide to screen for common chronic diseases, and such tests are often provided as complementary services in the community. The addition of lipid screenings and extensive counseling present both a clinical and business opportunity for pharmacists. In general, POC test screening results may serve as a preliminary means for screening for chronic disease states and potential diagnoses. POC testing may also serve as a valuable tool for pharmacist-provided disease state management of patients diagnosed with chronic disease(s). Convenient, inexpensive, and quick POC tests enable pharmacists to deliver necessary recommendations and interventions to help patients manage their disease states in a timely and convenient manner. Common POC tests used for disease state management include glycosylated hemoglobin (A1C) and blood glucose screenings for diabetes, blood pressure measurement for hypertension, lipid panel testing for cardiovascular disease, and prothrombin time (PT)/international normalized ratio (INR) testing for anticoagulation monitoring. While communication of recommendations to physicians can be a barrier, many states allow pharmacists to practice collaborative drug therapy management (CDTM).6 POC testing is most often associated with chronic disease screening and management, but a rapidly growing area is POC testing for inRole of pharmacist-provided point-of-care testing

Summaries for Patients. Screening for Abnormal Blood Glucose and Type 2 Diabetes: U.S. Preventive Services Task Force Recommendation.

Summaries for Patients. Screening for Abnormal Blood Glucose and Type 2 Diabetes: U.S. Preventive Services Task Force Recommendation.

Redesigning the Traditional Community Health Screening Model to Provide Blood Glucose Screening and Interdisciplinary Health Education.

Community health screenings provide an opportunity for anyone to receive free or inexpensive health evaluations to help determine their risk of developing a medical condition such as diabetes. A major disadvantage to traditional health screenings is that they provide one-time data for participants but lack continuity of care. The participants are required to independently use the results from their screening to follow up with another provider. Early detection and screenings can improve patient health outcomes and reduce the costs of care. The Diabetes Prevention Program conducted by the National Institutes of Health and the U.S. Department of Health and Human Services showed that people at risk for developing diabetes could prevent or delay the onset of the disease through early detection, lifestyle modification, and medication therapy, when appropriate (1). An economic analysis by Chatterjee et al. (2) found that early detection of diabetes through health screenings provides overall health care cost savings. With these considerations in mind, the goal of this project was to redesign the community health screening model to provide regularly scheduled health screening opportunities, patient education, and early detection and to improve access to care. Recognizing the need to expand clinical screening services provided in a community setting, the College of Pharmacy at Washington State University (WSU) decided to redesign the traditional health screenings model to improve patient outcomes by providing multiple scheduled follow-up visits and to improve access by offering onsite health screenings at participants’ workplaces. A partnership developed between the College of Pharmacy and the staff of local …

Screening SSRI-users for diabetes in a general practice

Purpose – A pragmatic evaluation of the practicality of diabetes screening for users of serotonin specific reuptake inhibitors (SSRI’s). The paper aims to discuss this issue. Design/methodology/approach – This study audited the response of SSRI-users to personal invitation for diabetes screening. One-third of such patients had been screened during the past year. The remaining 217 patients were invited for fasting blood glucose tests and the improvement in screening rates measured. The rate of positive results was compared to a cohort who received fasting blood glucose screening due to physical risk factors for diabetes. Findings – Specific invitation increased the take-up of screening from 34 to 52 per cent of SSRI-users. Engagement was significantly better when patients could be contacted by telephone rather than letter. The SSRI-using cohort had a greater rate of identified diabetes than a cohort with physical risk factors for diabetes. Practical implications – SSRI-users are a difficult group to engage in medical screening and an assertive approach is of value. It is likely that the physical care of these patients would be enhanced by the active maintenance of contact by a practice healthcare professional. Screening of SSRI-users for diabetes is justified by both detection rate and the importance of establishing co-morbidity in terms of treatment decisions. Originality/value – Co-morbidity of diabetes and depression has been observed to result in a poor prognosis for the patient which can be tempered if successful engagement leads to early treatment of both conditions with a more tailored choice of medication and care.

Screening For Gestational Diabetes Mellitus

Gestational diabetes is a carbonhydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy. It is the most common metabolic disorder affecting pregnancy. Recognizing and treating diabetes or any degree of glucose intolerance in pregnancy results in lowering maternal and fetal complications. These patients present higher risk for excessive weight gain, preeclampsia, cesarean sections, a high risk of developing type 2 diabetes and cardiovascular disease in the future. Complications of infants are; higher risk for macrosomia, birth trauma, hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome, polycythemia, obesity and type 2 diabetes. Gestational diabetes mellitus (GDM) screening should be performed at 24-28 gestational weeks and followed by definitive testing in women who are labeled as high-risk population. Two strategies are used to screen for gestational diabetes. In the two-step approach, the 50-g oral glucose challenge test (OGCT) is performed between 24 and 28 weeks of gestation in a nonfasting state. Alternatively, in the one-step approach, a 75-g glucose load is administered after measuring a fasting glucose level, and the plasma glucose levels are evaluated after 1 and 2 hours of the administration. There are the other methods for screening, including HbA1C and fasting blood glucose, but an exact approach for gestational diabetes screening has not yet been established.