Self-monitoring Of Glucose Research Articles

The benefits and accuracy of real-time continuous glucose monitoring in children and adolescents with type 1 diabetes attending a summer camp.

This study evaluated the usability, satisfaction, and accuracy of a real-time continuous glucose monitoring (rt-CGM) in children and adolescents with type 1 diabetes (T1D) attending a summer camp. Seven children and adolescents with T1D (camper) and 31 of healthcare providers (HCPs) participating in a 2-day summer camp in Kumamoto, Japan were enrolled. The usability and satisfaction were evaluated by tailored questionnaire. The accuracy of rt-CGM was evaluated using self-monitoring of blood glucose (BG) and sensor glucose (SG) values before or after (off camp) and during (on camp) the camp. The score of the usefulness of rt-CGM showed 3.29 ± 0.90 in campers and 4.23 ± 0.87 in HCPs (P = 0.017). The degree of recommendation score for rt-CGM was 3.29 ± 1.11 in campers and 4.23 ± 0.79 in HCPs (P = 0.013). Time in range (TIR) off camp was 45.9% and that on camp was 57.0%. Time above range (TAR) off camp was 53.4% and that on camp was 42.4%. The mean absolute relative difference (MARD) off camp was 19.7% ± 25.2%, whereas that on camp was 16.0% ± 14.8% (P = 0.367). Clinically acceptable zones of the error grid analyses were approximately 96% in total. Rt-CGM exhibited higher usability and recommendation scores in HCPs than those in campers. This may be related to relatively lower accuracy in rt-CGM. Overall usability and recommendation are clinically satisfactory, but due to relatively low accuracy, no decision should be made based on a single, non-verified SG value alone.

The Impact of Health Literacy on Diabetes Control

Abstract Introdution People with diabetes have a significant impact on treatment outcomes through their daily decisions. Therefore, health literacy (HL) is crucial for effectively managing the disease and maintaining overall health. This study aimed to explore the relationships between different dimensions of health literacy, self-care behaviors, and Diabetes Control (HbA1c). Methods HLwas assessed using the Health Literacy Questionnaire. 706 individuals with diabetes participated in the study, the majority of whom were male (60.2%), had more than 9 years of schooling (84.7%), and over half were employed (52.4%). To examine the relationship between dimensions of HLand HbA1c, multiple linear regression analysis was conducted. Results The study revealed a significant association between higher levels of HLand lower HbA1c levels. There is a statistically significant positive linear correlation between adherence to general nutrition and HLdimensions. In terms of physical activity, a positive correlation was also found with HLdimensions, and blood glucose monitoring showed a positive correlation with health literacy. Greater adherence to nutrition was linked to a decrease in HbA1c levels, while higher adherence to self-monitoring and medication was associated with an increase in HbA1c levels Conclusions This study emphasizes the importance of HLin managing diabetes. It underscores the impact of HLin diabetes compensation. The results reveal that higher levels of feeling understood and supported by healthcare professionals, having sufficient information to manage health, actively managing health, and appraising health information among people with diabetes lead to better adherence to blood glucose self-monitoring. Based on these findings, a crucial aspect of effectively managing diabetes will involve empowering individuals with the necessary skills for self-management of their condition, overall health, and treatment regimen. Key messages • The present research reinforces the importance of health literacy for diabetes compensation and self care activies. • One critical success factor in dealing with diabetes will be investing of health literacy of people with diabetes and health care providers responsiveness.

Exploring diabetic patients’ intention to switch POCT self-monitoring glucose devices: investigating influence of perceived usefulness and perceived ease of use

Purpose The study aims to examine diabetic patients’ switching intentions toward self-monitoring blood glucose devices, incorporating perceived usefulness and perceived ease of use, with switching cost as a moderator. Design/methodology/approach A self-administered questionnaire was developed using established measuring scales. Data from 321 respondents was collected and analyzed using the partial least squares structural equation modeling approach. Findings Results indicate that perceived usefulness and perceived ease of use influence switching intention. Switching cost does not moderate the perceived usefulness, perceived ease of use and switching intention. This study reveals important information for healthcare practitioners and device manufacturers. Originality/value The significance and originality of this study stem from its pioneering investigation into the switching intentions of diabetic patients regarding self-monitoring glucose devices through the application of the technology acceptance model, thereby addressing a notable gap in the existing literature on diabetes management and technology adoption, which has lacked comprehensive examination of patients’ transition behaviors in this specific context.

Application of the Summary of Diabetes Self-Care Activities Questionnaire in Evaluating the Self-Care of People with Diabetes

Objectives: This uncontrolled open study aimed to measure the levels of self-care of patients before and after education, their initial knowledge, and their knowledge two months after interacting with healthcare providers using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. Methods: The data for this study were collected over 14 months from 396 patients with diabetes. This study was conducted in three phases: initial questionnaire testing, education, and retesting after two months. The education included specific diabetes-related topics: nutrition, exercise, self-monitoring of blood glucose, foot care, and smoking. Results: The results showed that all self-care activities between the first and second assessments were different. The initial assessment showed that the more successful the general diet, the specific diet, and physical activity were, the better the hemoglobin A1c value was. When considering the impact of gender on self-care effectiveness results, it was noted that women were more successful in foot care and specific diet in the initial testing, while men excelled in physical activity. The most successful age group in the scales of general diet, physical activity, and blood glucose testing was 31–45 years. Those with type 1 diabetes (36% of the study population) were more successful in self-care in the first and second measurements but without any differences in self-care in the retesting. Conclusions: our study observed a difference in self-care results between the two measurements of self-care activities in patients with diabetes, evaluated by the SDSCA questionnaire.

Transitioning from Self-Monitoring of Blood Glucose to Continuous Glucose Monitoring in Combination with a mHealth App Improves Glycemic Control in People with Type 1 and Type 2 Diabetes.

Introduction: Integrating mobile health (mHealth) apps into daily diabetes management allows users to monitor and track their health data, creating a comprehensive system for managing daily diabetes activities and generating valuable real-world data. This analysis investigates the impact of transitioning from traditional self-monitoring of blood glucose (SMBG) to real-time continuous glucose monitoring (rtCGM), alongside the use of a mHealth app, on users' glycemic control. Methods: Data were collected from 1271 diabetes type 1 and type 2 users of the mySugr® app who made a minimum of 50 SMBG logs 1 month before transitioning to rtCGM and then used rtCGM for at least 6 months. The mean and coefficient of variation of glucose, along with the proportions of glycemic measurements in and out of range, were compared between baseline and 1, 2, 3, and 6 months of rtCGM use. A mixed-effects linear regression model was built to quantify the specific effects of transitioning to a rtCGM sensor in different subsamples. A novel validation analysis ensured that the aggregated metrics from SMBG and rtCGM were comparable. Results: Transitioning to a rtCGM sensor significantly improved glycemic control in the entire cohort, particularly among new users of the mySugr app. Additionally, the sustainability of the change in glucose in the entire cohort was confirmed throughout the observation period. People with type 1 and type 2 diabetes exhibited distinct variations, with type 1 experiencing a greater reduction in glycemic variance, while type 2 displayed a relatively larger decrease in monthly averages.

6692 Proarrhythmic Risk Of Hypoglycemia; A Case Of Insulin-Induced Hypoglycemia Provoking Torsade De Pointes-Cardiac Arrest

Abstract Disclosure: A.M. San Hernandez: None. A. Adelkhanova: None. H. Ashraf: None. J. Aguayo Herrera: None. M.F. Siddiqui: None. Introduction: Torsade de Pointes is a life-threatening polymorphic ventricular tachycardia which is associated with QTc prolongation caused by medications, metabolic and electrolyte abnormalities. Very few cases of hypoglycemia causing QTc prolongation and Torsades de Pointes have been reported in the literature. Although the mechanism is unclear, the effects of low blood glucose have been proposed to induce a sympathetic response, hypokalemia and calcium disturbances. We report a case of an insulin-induced hypoglycemia causing Torsades de Pointes cardiac arrest, highlighting the proarrhythmic risk of hypoglycemia. Case presentation: A 57-year-old female with a history of Insulin-dependent Type 2 Diabetes Mellitus (DM) was brought in by EMS due to severe symptomatic hypoglycemia (POC blood glucose of 30 mg/dL), requiring treatment with dextrose. Patient reported reduced oral intake due to vomiting for 1 week and continued insulin administration without self-monitoring of blood glucose. Laboratory work up on presentation revealed severe hypoglycemia VBG= 55 mg/dL and mild hypomagnesemia Mg=1.4mg/dL (Ref Range 1.7-2.2mg/dl) which was treated. There was no hypokalemia or hypocalcemia. ECG showed sinus rhythm with prolonged QTc interval of 573ms and non-specific ST changes.Few hours later, patient developed torsades de pointes, requiring ACLS resuscitation. ROSC was achieved after two rounds of CPR. Patient received dextrose infusion to maintain euglycemic state. She was not taking any QTc prolonging medication. There was no history of autoimmune disease. Except for hypoglycemia, no other metabolic abnormality could be identified. Cardiac and pulmonary etiologies of cardiac arrest were ruled out. Post-ROSC ECG showed sinus tachycardia with normalization of QTc to 454ms. Thus, Insulin-induced hypoglycemia was appointed as the main culprit for her cardiac arrest, in the setting of QTc prolongation. Patient received diabetes self-management and hypoglycemia education. Conclusion: Several studies support strong correlation between hypoglycemia and arrhythmic events during bedtime in people with diabetes “The dead in bed syndrome”. Hypoglycemia causes an acquired long QT syndrome independent of other risk factors such as cardiac autonomic neuropathy. Possible mechanisms include; sympathoadrenal activation, which regulates potassium, calcium and chloride channels or altered autonomic regulation caused by hypoglycemia itself regardless of the effect of insulin or hypokalemia. QT prolongation is a risk factor for sudden cardiac death by causing torsades de pointes ventricular tachycardia (VT).People with insulin dependent diabetes are at high risk of hypoglycemia and should be cautioned about the proarrhythmic risk of hypoglycemia. Education is crucial, and Continuous glucose monitor (CGM) is a valuable tool to be use in such a patient population. Presentation: 6/3/2024

Nutrition and Glycemic Control in Children and Adolescents with Type 1 Diabetes Mellitus Attending Diabetes Camps.

Background/Objectives: Diabetes camps for children and adolescents with Type 1 Diabetes mellitus (T1DM) offer the opportunity to have a camping experience in a safe and supportive environment where they can receive diabetes skills education, such as glucose self-monitoring, insulin injections, management of hypoglycemia/hyperglycemia, and nutritional recommendations, including meal planning and carbohydrate counting. The ultimate goal of diabetes camps is to educate children to manage their condition independently, without parental involvement. Additionally, attending a diabetes camp is an excellent opportunity to meet peers and share their experiences and concerns about their condition, enhancing their confidence and reducing diabetes-related emotional distress. The aim of this review was to assess whether the nutritional planning and education offered at diabetes camps has a favorable effect on the glycemic control of attending children and adolescents. Methods: A literature search in PubMed and Scopus databases was performed. Eligible for inclusion were studies evaluating the effect of nutritional education offered in diabetes camps on glycemic control of children and adolescents with T1DM. Results: The majority of identified eligible studies supported the beneficial impact of the nutritional education offered in diabetes camps on glycemic control during and after the camp sessions. The favorable effect, though, seemed to be temporarily sustained (<6 months). Conclusions: Continuous nutritional education is required to prolong the duration of these beneficial outcomes. Further interventional studies are required to evaluate the direct effect of nutritional education provided at diabetes camps on glycemic control of children and adolescents with T1DM and the actual duration of favorable outcomes.

Efficacy of continuous glucose monitoring for finding unusual causes of hyperglycemia: a clinical case

Diabetes is a chronic condition that requires constant blood glucose self-monitoring. The carbohydrate metabolism compensation is usually assessed by the level of glycated hemoglobin. But it does not always help reveal the true cause of poor glycemic control. The devices for continuous glucose monitoring allows to assess blood glucose level in real time and find unusual causes of hyper- and hypoglycemia. Achieving target glycemic levels is influen­ced by many factors: age of patients, duration of diabetes, eating habits and eating disorders, level of education, patient’s understan­ding of the diabetes course. One of the reasons for not reaching the target levels of glycemia can be hyperphagic eating disorders, such as night eating syndrome. According to the American Psychiatric Association classification, night eating syndrome belongs to the category of “Other specified eating disorders”. Diagnostic criteria in this syndrome include consumption of &gt; 25 % of food from the daily diet after dinner or at least 2 cases per week of food consumption at night; awareness of these episodes; and at least 3 of the following: morning anorexia, uncontrollable desire to eat between dinner and sleep or at night, conviction that eating will help you fall asleep or return to sleep, insomnia and/or bad mood in the morning. The prevalence of night eating syndrome in the general population is 1.1 %, and in those who refer to metabolic surgery specialists, it is 2–20 %. The presence of night eating syndrome in diabetes adversely affects metabolic control and complicates the management of these patients, in particular, they have higher levels of HbA1c, blood pressure and body mass index compared to individuals without such eating disorder. In this case report, we describe a patient with poor glycemic control who used continuous glucose monitor and was diagnosed with night eating syndrome that helped change management and achieve normoglycemia in the evening and nighttime.

Utilization of Smart Healthcare for Gestational Diabetes Mellitus Management

Gestational diabetes mellitus (GDM) poses significant health risks to both mothers and newborns, requiring rigorous self-management and frequent medical consultations. Advances in information and communications technology (ICT) have shown promising results in reducing the number of in-person visits for GDM management. ICT enhances patient self-care engagement, with some studies reporting reductions in average blood glucose and HbA1c levels. ICT for GDM management has demonstrated benefits such as fewer in-person visits, improved adherence to self-monitoring of blood glucose, increased global user satisfaction, and maintenance of blood glucose control and perinatal outcomes. Common barriers to ICT for GDM include technological literacy, inadequate education, limited technical support, the additional burden of non-customized applications, and restricted interoperability. Further research is needed on the impact of technology on GDM management to optimize digital health solutions.

Impact of Self-Care Practices on the Prognosis of Type-2 Diabetes Mellitus in Developing Countries: A Narrative Review

Introduction: Type-2 diabetes mellitus (T2DM) is a type of diabetes with increasing prevalence in lower- and middle-income countries. Diabetes self-care practices (SCPs) are non-pharmacological treatments essential in maintaining health and well-being and improving the quality of life among DM patients. Objective: To highlight the diabetes SCPs and their impact on diabetes prognosis in developing countries. Methods: A comprehensive literature search on Africa Journals Online, PubMed, Google Scholar, and Cochrane Library, from year 2000 to 2023, using relevant keywords. Results: The review highlighted the self-care practices for adequate DM care, including physical activity, diet (healthy eating), self-monitoring of blood glucose, medication adherence, foot care, general body care, and follow-up. The review documented from previous studies that adequate SCPs positively correlated with good glycaemic control, reduction of complications, and improved quality of life among DM patients. Conclusion: Healthcare systems and policy-makers in developing countries must prioritise and support the integration of SCPs into diabetes management strategies. This will improve DM prognosis and overall well-being for individuals living with diabetes.

Real-time continuous glucose monitoring vs. self-monitoring of blood glucose: cost-utility in South Korean type 2 diabetes patients on intensive insulin

Aims This study investigated the cost-utility of real-time continuous glucose monitoring (rt-CGM) versus self-monitoring of blood glucose (SMBG) in people with type 2 diabetes (T2D) receiving intensive insulin therapy in South Korea. Methods The IQVIA Core Diabetes Model (CDM v9.5) was used, with clinical effectiveness data obtained from a large-scale real world study. Costs were obtained from South Korean sources and inflated to 2022 South Korean Won (KRW). A South Korean payer perspective was adopted over a lifetime horizon, with future costs and effects discounted at 4.5% per annum. Baseline characteristics included a mean baseline HbA1c level of 8.6% (71 mmol/mol), and a mean age of 64.4 years. A willingness-to-pay (WTP) threshold of KRW 46.0 million was used. Results Rt-CGM led to an increase of 0.683 quality-adjusted life years (QALYs) versus SMBG (7.526 QALYs for rt-CGM versus 6.843 QALYs for SMBG). An increase in costs of KRW 16.4 million (from KRW 90.4 million to KRW 106.8 million) was associated with rt-CGM. The incremental cost-utility ratio was KRW 24.0 million per QALY gained, significantly lower than the KRW 46 million threshold. Conclusions For individuals with T2D managed by intensive insulin therapy in South Korea, rt-CGM is cost-effective relative to SMBG.

Effect of low-frequency blood glucose self-monitoring on glycosylated hemoglobin levels among older adults with type 2 diabetes mellitus

Background: Reducing the frequency of self-monitoring of blood sugar, due to needle phobia, pain, stress, and costs associated with the procedure, can improve patient compliance and quality of life, provided that adequate blood sugar control is maintained. This study aimed to evaluate the effect of low-frequency blood glucose self-monitoring (LFBGSM) on glycosylated hemoglobin (HbA1C) levels among older adults living with type 2 diabetes mellitus (T2DM), treated with or without insulin. Materials and Methods: This randomized controlled trial with a parallel design was conducted on 121 older adults with T2DM in Sabzevar, Iran, between 2018 and 2020. Initially, subjects were stratified based on the type of treatment (with or without insulin) and then randomly assigned to intervention (LFBGSM) and control (no blood glucose self-monitoring [no-BGSM]) groups. HbA1C levels were measured at the beginning of the study and 3 months later for all study groups. Results: The mean age of participants treated with and without insulin was 64.3 ± 9.60 and 64.7 ± 5.01 years, respectively. The ANCOVA test revealed a significant difference in the mean HbA1C levels among the four groups 3 months postintervention (P &lt; 0.001). The HbA1C scores significantly decreased in the LFBGSM groups and increased in the no-BGSM groups at 3 months postintervention (insulin/LFBGSM, insulin/no-BGSM, noninsulin/LFBGSM, and noninsulin/no-BGSM: 7.74 ± 0.76, 8.34 ± 1.53, 7.70 ± 0.75, and 8.14 ± 1.11, respectively) compared to baseline (8.25 ± 0.67, 8.03 ± 0.64, 8.08 ± 0.69, and 7.83 ± 0.74, respectively). The least significant difference post hoc tests showed significant differences between specific groups, emphasizing subtle responses to interventions (P values ranging from 0.001 to 0.929). Conclusion: Findings suggest a significant reduction in HbA1C scores within the LFBGSM groups, while a discernible increase is observed in the no-BGSM groups over the 3 months. These findings underscore the efficacy of the interventions and emphasize the crucial role of personalized approaches in optimizing glycemic control for individuals with diabetes.

Development of a target product profile for new glucose self-monitoring technologies for use in low- and middle-income countries.

Most glucose self-monitoring devices have been developed with high-income countries in mind. We developed a target product profile (TPP) for new glucose self-monitoring technologies for users in low- and middle-income countries (LMICs). A draft TPP including 39 characteristics was developed by an expert group including diabetes specialists, device specialists, and people with diabetes, incorporating findings from qualitative research in LMICs. Each characteristic had minimal and optimal requirements for two use cases, frequent and sporadic use. Characteristics requiring refinement were identified via online survey. Characteristics with agreement level <90% for any requirement were reviewed by the expert group and amended as appropriate. One characteristic (shelf life) had agreement <75% (both requirements for both use cases). Characteristics with agreement ≥75% and <90% for the frequent use case included infrastructure level, measurement cycle, duration of use before replacement, interchangeability, and calibration (both requirements), and activity log and price per month to end payer (minimal requirement). Intended use (both requirements), accuracy, and price per month to end payer (optimal requirement) had agreement ≥75% and <90% for the sporadic use case. This TPP will inform developers on requirements for glucose self-monitoring technologies for LMICs, and support decision-makers in evaluating existing devices.

Самоконтроль уровня глюкозы у пациентов с сахарным диабетом 2-го типа

Self-monitoring of blood glucose has been considered to be a cornerstone of adequate diabetes management for decades. The structured self-monitoring leads to better compensation of carbohydrate metabolism disorders, decreased risk of hypoglycemia, and quality of life improvement in patients with DM. The technologies, as well as the glucose meter convenience and accuracy have improved considerably since the moment these were introduced several decades ago. Modern glucose meters are small and easy to use; these require small amounts of capillary blood and provide measurement results within seconds. Furthermore, glucose meters are more and more often equipped with such features, as connectivity with other devices and/or electronic diaries and instruments for diabetes management. Despite the fact that the measurement accuracy can be close to or equal to the quality level ensured by laboratory biochemical analyzers, some glucose meters continue to fall short of the internationally accepted accuracy standards, such as ISO-15197, the standard of the International Organization for Standardization. Numerous reports from the number of countries, such as Russia, China, India, and Brazil, that are based on the routine practice data suggest that in addition to the problems with the glucose meter accuracy, there are other obstacles to overcome to optimize the use of blood glucose monitoring systems. Nevertheless, the adequate use of blood glucose self-monitoring data is very important for treatment of patients with type 2 diabetes mellitus.

Digital Storytelling Intervention for Hemoglobin A1c Control Among Hispanic Adults With Type 2 Diabetes

Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking. To assess the impact of a digital storytelling intervention on glycemic control and its acceptability among Hispanic patients with poorly controlled T2D. This was a multicenter, randomized clinical trial conducted within 2 primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A1c level ≥8%). Enrollment and follow-up were conducted between February 14, 2019, and November 1, 2023. The intervention group viewed a 12-minute digital storytelling video. The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring). The control group received printed, culturally tailored T2D education materials. The primary outcome was the mean change from baseline to 3 months for hemoglobin A1c levels, adjusting for baseline hemoglobin A1c, age, gender, education, and income. Acceptability and narrative quality of the intervention were assessed through questionnaires. There were 451 study participants, with 227 (mean [SD] age, 54.3 [9.3] years; 158 [69.3%] women) randomized to the intervention group and 224 (mean [SD] age, 54.5 [9.1] years; 156 [69.3%] women) to the control group. Of these, 390 completed 3-month follow-up of the primary outcome (86% retention). There was a small improvement in the mean (SD) hemoglobin A1c level in the intervention group compared with the control group in the adjusted model (9.1% [1.7] to 8.4% [1.6] vs 9.4% [1.8] to 8.8% [2.0]; P = .04] but not in the unadjusted model. Acceptability and narrative quality of the intervention were high. In this randomized clinical trial, a digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control. This was a highly scalable intervention that may be integrated into clinical practice as part of a longitudinal diabetes self-management program for Hispanic adults. ClinicalTrials.gov Identifier: NCT03766438.

Challenges in Insulin Therapy: Perspectives of Malaysian Diabetes Educators

Background Individuals with type 2 Diabetes Mellitus (T2DM) commonly need insulin therapy as their condition advances. Healthcare providers often face difficulties in managing patients who require insulin treatment. Gaining insight into the views of healthcare professionals on the obstacles encountered by patients using insulin can aid in improving care and developing effective treatment plans. Objective This study explores the views of Malaysian diabetes educators on the barriers faced by patients in using insulin. Methods Semi-structured qualitative interviews were conducted with diabetes educators (n=8) from the northern, central, and southern regions of Malaysia who were involved in diabetes care. We used an interview guide to facilitate the in-depth interviews, which were digitally recorded, transcribed verbatim, and analyzed using a thematic approach. Results Five themes were identified: the occurrence of side effects, the need for better patient education, negative perceptions towards insulin, the financial burden, and the complexity of adherence to treatment. There is a lack of patient education on proper glucose monitoring and how to optimize insulin therapy. The cost of treatment and patient ignorance are highlighted when discussing patient self-monitoring of blood glucose. Diabetes educators recognize that the absence of an effective follow-up mechanism is a major issue, particularly for those patients who fail to maintain consistent appointment schedules. Conclusion This research highlights five significant obstacles to maximizing the effectiveness of insulin therapy. Diabetes educators who identify and address these challenges can empower patients to manage their condition effectively. To overcome systemic barriers, government involvement is needed in creating insulin follow-up initiatives, establishing multidisciplinary teams for diabetes care, empowering education strategies, and providing financial support for self-monitoring.

Continuous Glucose Monitoring for Diabetes Management During Pregnancy: Evidence, Practical Tips, and Common Pitfalls.

Continuous glucose monitoring (CGM) has the potential to revolutionize diabetes management during pregnancy by providing detailed and real-time data to patients and clinicians, overcoming many of the limitations of self-monitoring of blood glucose. Although there are limited data on the role of CGM to improve pregnancy outcomes in patients with type 2 diabetes or gestational diabetes, CGM has been shown to reduce pregnancy complications in patients with type 1 diabetes. Despite the limited data in some populations, given its ease of use and recent U.S. Food and Drug Administration approval with expanding insurance coverage, CGM has gained widespread popularity among pregnant patients with all types of diabetes. It is critical for obstetric clinicians to understand how CGM can be successfully integrated into clinical practice. We present a practical, step-wise approach to CGM data interpretation that can be incorporated into diabetes management during pregnancy and common CGM pitfalls and solutions. Although technology will continue to advance with newer-generation CGM devices and diabetes technology such as automated insulin delivery (not covered here), these key principles form a basic foundation for understanding CGM technology and its utility for pregnant people.

Self-care practice and associated factors among patients with diabetes on follow-up at Yirgalem General Hospital, Sidama, Ethiopia: a cross-sectional study

BackgroundSelf-care practice is an integral and efficient part of comprehensive diabetes management, which could be influenced by various socio-demographic, clinical, and lifestyle factors.ObjectiveThe study aimed to assess the level of diabetes self-care practice and its associated factors among patients with diabetes on follow-up at Yirgalem General Hospital, Yirgalem, Sidama, Ethiopia.MethodologyAn Institution-based cross-sectional study was conducted from February 15 to May 10, 2022, involving 298 patients with diabetes on follow-up at Yirgalem General Hospital. A pre-tested interviewer-administered questionnaire was utilized to collect data from patients. A descriptive analysis was conducted to determine the level of good self-care practice. Bivariate and multivariable binary logistics regression were performed to determine factors associated with good diabetic self-care practice. Associations with a p-value < 0.05 were considered statistically significant.ResultThe overall good diabetic self-care practice among patients was 59.4%. Regarding the specific domains of care, 15 (5%) participants had good self-glucose monitoring care, 228 (76.5%) had good exercise self-care, 268 (89.9%) had good dietary self-care, 228 (76.5%) had good foot self-care, and 260 (87.2%) had good diabetic medication adherence. Single marital status (AOR = 5.7, 95% CI: (1.418, 22.915), urban residence (AOR = 2.992, 95% CI: (1.251, 7.153)), and having a glucometer (AOR = 2.273, 95% CI: (1.083, 4.772)) were factors that were significantly associated with good diabetic self-care practice.ConclusionGood diabetic self-care practices among participants was low. Marital status, place of residence, and having a glucometer were statistically significant predictors of good diabetic self-care practices. Targeted intervention addressing those patients from rural areas to increase awareness and practice of self-care, as well as the promotion of having a glucometer at home for self-glucose monitoring is recommended.

Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis.

Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM. This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM. In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis. Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95% CI -0.33 to -0.10; P<.001; I2=35%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95% CI -0.72 to 1.80; P=.40; I2=67.8%) and the incidence of hypoglycemia (MD -0.15, 95% CI -0.57 to 0.27; P=.49; I2=70.7%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non-youth-specific quality of life (MD -0.24, 95% CI -0.45 to -0.02; P=.04; I2=0%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD -0.41, 95% CI -0.62 to -0.20; P<.001), studies that lasted <6 months (MD -0.32, 95% CI -0.48 to -0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD -0.37, 95% CI -0.53 to -0.21; P<.001), and studies with medication dose adjustment (MD -0.25, 95% CI -0.37 to -0.12; P<.001). Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life.

Adherence to Self-Monitoring of Blood Glucose and Its Related Factors Among Type 2 Diabetic Patients Attending Al-Ahsa Primary Health Care Centers in Saudi Arabia.

Self-monitoring of blood glucose (SMBG) is a crucial component of diabetes management, but adherence remains suboptimal. This study aimed to evaluate adherence to SMBG among type 2 diabetic patients in Al-Ahsa, Saudi Arabia. A cross-sectional study was conducted among 398 type 2 diabetic patients attending primary healthcare centers. Data were collected through face-to-face or virtual interviews and electronic health records. Adherence levels were categorized as low, moderate, and high. The majority of participants exhibited moderate adherence to SMBG (58.5%), while 27.1% had low adherence, and 14.3% were highly adherent.The use of oral hypoglycemic medications and insulin injections was associated with higher adherence (p<0.001). Comorbidities, physical exercise, diet, frequency of medical visits, and attendance at diabetes education sessions did not significantly influence adherence. Suboptimal adherence to SMBG was observed among type 2 diabetic patients in Al-Ahsa. Targeted interventions addressing individual barriers and integrating technology may improve SMBG adherence and diabetes management.