Self-monitoring Of Blood Glucose Levels Research Articles

Photoacoustic Resonators for Non-Invasive Blood Glucose Detection Through Photoacoustic Spectroscopy: A Systematic Review.

Diabetes mellitus is a prevalent disease with a rapidly increasing incidence projected worldwide, affecting both industrialized and developing regions. Effective diabetes management requires precise therapeutic strategies, primarily through self-monitoring of blood glucose levels to achieve tight glycemic control, thereby mitigating the risk of severe complications. In recent years, there have been significant advancements in non-invasive techniques for measuring blood glucose using photoacoustic spectroscopy (PAS), as it shows great promise for the detection of glucose using the infrared region (e.g., MIR and NIR) of light. A critical aspect of this method is the detection of the photoacoustic signal generated from blood glucose, which needs to be amplified through a photoacoustic resonator (PAR). In this work, an overview of various types of PARs used for non-invasive glucose sensing is reviewed, highlighting their operating principle, design requirements, limitations, and potential improvements needed to enhance the analysis of photoacoustic signals. The motivation behind this review is to identify and discuss main parameters crucial to the efficient design of PARs used in non-invasive glucose detection, which will be helpful for furthering the basic understanding of this technology and achieving the highly sensitive PAR required for non-invasive glucose monitoring.

Real-world Safety and Effectiveness of Insulin Glargine 300 U/mL in Participants with Type 2 Diabetes Mellitus During the Period of Ramadan in Four Countries (Egypt, Jordan, Lebanon, and Turkey): A Prospective Observational Study.

This non-interventional observational study aimed to describe the clinical outcomes of patients with T2DM treated with Gla-300 during the period of Ramadan. Type 2 diabetes mellitus (T2DM) patients who decide to fast during the holy month of Ramadan face several challenges in achieving glycemic control without increasing the risk of hypoglycemia. Insulin glargine-300 (Gla-300) has well-established safety and efficacy in improving glycemic control in multiple randomized clinical trials (RCTs). However, limited evidence is available regarding its safety and effectiveness during fasting. The objective of this study was to assess the safety and clinical outcomes of insulin glargine-300 (Gla-300) in T2DM patients before, during, and after Ramadan. We conducted a prospective, observational, non-comparative, multicenter study on patients with T2DM currently treated with Gla-300 who planned to fast and continue on Gla-300 during Ramadan in four countries (Egypt, Jordan, Lebanon, and Turkey). The study outcomes included the change in glycemic parameters and incidence of hypoglycemia before, during, and after Ramadan. One hundred and forty T2DM patients were included. Nearly 61% of the included patients had a duration of diabetes of <10 years. The mean Gla-300 daily doses during the pre-Ramadan, Ramadan, and post-Ramadan periods were 22.2 ±7.4, 20.4 ±7.5, and 22.5 ±4.7 IU, respectively. The mean change values from pre-Ramadan to Ramadan and post-Ramadan were -1.7 ±6.9 IU and 0.5 ±4.7 IU, respectively, among the included patients. The mean HbA1c decreased during the study period initiating from 7.9% ±1.4% pre-Ramadan to 6.9% ±0.4% post-Ramadan. The overall HBA1c target value was 6.9% ±0.4%, while the HbA1c target was achieved by 29 patients (21.9%). The mean fasting blood glucose (FPG) showed a reduction from baseline value in the post-Ramadan period by -0.9 ±2.3 mmol/L. Five patients (3.57%) had symptomatic documented hypoglycemia during Ramadan, and none was considered to have severe hypoglycemia. Our study showed that insulin Gla-300 maintained the glycemic control of T2DM patients who decided to fast during the holy month of Ramadan without increasing the risk of hypoglycemia. Regular self-monitoring of blood glucose levels during Ramadan is highly recommended to avoid possible complications.

Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts' consensus statement.

Pasireotide is a somatostatin analogue for the treatment of acromegaly, a chronic condition caused by excess growth hormone. Despite the therapeutic benefits of pasireotide as a second-line treatment for inadequately controlled acromegaly, a major concern is its hyperglycemic side-effect. Here, we provide guidance on how to select appropriate patients with acromegaly for treatment with pasireotide. We summarize baseline characteristics of patients at high risk for pasireotide-associated hyperglycemia and recommend a monitoring strategy based on the risk profile. Self-monitoring of blood glucose levels (SMBG), measurements of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and regular HbA1c measurements are the foundation of our proposed monitoring approach. The pathophysiology of pasireotide-induced hyperglycemia involves decreased secretion of the incretin hormones GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1). Our expert recommendations address the specific pathophysiology of pasireotide-induced hyperglycemia by recommending the incretin-based therapeutics dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in all appropriate patients as an alternative to first-line monotherapy with metformin. Furthermore, we emphasize the importance of adequate control of acromegaly, excellent diabetes education, nutrition and lifestyle guidance and advise to consult expert diabetologists in case of uncertainty in the management of patients with hyperglycemia under pasireotide.

Correlation between Serum Fructosamine and Self- Monitoring Blood Glucose in Patients with Diet-Controlled Gestational Diabetes Mellitus

Objective: To determine the correlation between serum fructosamine and self-monitoring blood glucose (SMBG) levels in gestational diabetes mellitus (GDM) patients treated by dietary control and to identify the cutoff level of serum fructosamine for determining poorly controlled GDM. Materials and Methods: A cross-sectional study conducted between October 2021 and August 2022 at Queen Savang Vadhana Memorial Hospital that included 78 singleton pregnancies diagnosed with GDM assigned to diet therapy with lifestyle modification. The daily home SMBG was performed following the standard protocol and the serum fructosamine was measured one month after starting dietary control. The correlation between serum fructosamine and means of SMBG were analyzed. The receiver operating characteristics (ROC) curve was plotted to identify the cutoff level of serum fructosamine for predicting poorly controlled GDM based on SMBG levels. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the cutoff level were calculated. Results: The correlation between serum fructosamine and SMBG were 0.436 (p&lt;0.001) and 0.618 (p&lt;0.001) in pre-prandial and post-prandial glucose levels, respectively. The poorly controlled SMBG group had serum fructosamine greater than the well-controlled group with a mean of 165.7±35 and 132.8±23 μmol/L (p&lt;0.001). The ROC curve showed that using 160 μmol/L as the optimal cutoff level to determine poorly controlled GDM had 72.7% sensitivity, 88% specificity, 50% PPV, 95.2% NPV, and 85.9% accuracy. Conclusion: The serum fructosamine was very useful for monitoring dietary control of GDM in terms of drawing blood less frequently, convenient, and more economical. An optimal cutoff point for screening a poorly controlled GDM was 160 mol/L. Keywords: Gestational diabetes mellitus; Serum fructosamine; Self-monitoring blood glucose

Efficacy and Safety of Faster Aspart in Comparison to Insulin Aspart Among Indian Women with Gestational Diabetes.

The present study aimed to compare the pregnancy outcomes, efficacy, and safety of faster aspart with insulin aspart among Indian women with gestational diabetes. In several countries, fast-acting insulin aspart (faster aspart) has been approved for use in pregnancy. There is a lack of data related to maternal glycemic control and fetal and perinatal outcomes with faster aspart in gestational diabetes among the Indian population. To compare and evaluate the efficacy and safety of faster aspart and insulin aspart in the management of gestational diabetes. This retrospective study evaluated the medical records of 60 pregnant women diagnosed with gestational diabetes and managed with faster aspart or insulin aspart at a tertiary care center, between March 2019 and September 2020. Self-monitored blood glucose levels recorded at 4 timepoints (fasting, and 1 hour post breakfast, lunch, and dinner) during 6 consecutive days any time before delivery were analyzed. Pregnancy and neonatal outcomes across both groups were compared. The mean postprandial glucose value following dinner was significantly lesser in the faster aspart group compared to the insulin aspart group (123.61 ± 2.52 mg/dL vs. 125.87 ± 2.98 mg/dL, respectively; p=0.0024). Women in the faster aspart group had significantly lower glycemic variability (fluctuations). Lesser number of hypoglycemic events were noted in the faster aspart group (10 vs. 20; p=0.0595). Faster aspart was associated with better glycemic control compared to insulin aspart among women with gestational diabetes. Further large-scale studies are needed to validate the outcomes.

Beyond Syringes and Pills: Advances in Drug Delivery Systems for Diabetes

Diabetes is a chronic disease that affects millions of people worldwide, and its prevalence is increasing. The two primary subtypes, type 1 and 2, have different causes and mechanisms, but both result in abnormal glucose metabolism. The standard of care for diabetes includes insulin therapy, oral anti-diabetic medications, diet, exercise, weight loss, and frequent self-monitoring of blood glucose levels. However, these treatments have limitations that can lead to poor patient compliance and suboptimal outcomes. Alternative insulin delivery systems such as inhalers, patches, and oral sprays offer potential benefits such as increased convenience, reduced pain, and improved adherence. Non-insulin injectables, long-acting basal insulins, and GLP-1 agonists have also shown promise in improving glycemic control and reducing the risk of complications. Nanoparticle-based systems like SLNs are a novel approach that offers several advantages for diabetic management. They allow for targeted drug delivery, controlled release, and improved biocompatibility, enhancing drug efficacy and reducing side effects. SLNs have shown potential in animal models for reducing extracellular matrix degradation, inhibiting carbohydrate digestive enzymes, and enhancing the regeneration of insulin-producing beta cells. More studies are needed to validate their safety and efficacy in humans, but the potential benefits of SLNs make them a promising option for diabetes management.

Knowledge, Attitude and Practice of Patients with Gestational Diabetes Mellitus Regarding Gestational Diabetes Mellitus: A Cross-Sectional Study.

Self-monitoring of blood glucose levels and changes in diet and lifestyle play important roles in the management of gestational diabetes mellitus (GDM). This cross-sectional study enrolled patients with GDM at Hangzhou Women's Hospital, China, between September 1, 2022, and October 26, 2022. A questionnaire was designed that included the following dimensions: demographic/clinical information, knowledge, attitude and practice. Correlations between knowledge, attitude and practice scores were evaluated using Spearman correlation analysis. Factors associated with practice score ≥14/16 were identified using multivariate logistic regression. The analysis included 499 women with GDM and a mean age of 31.22±3.89 years. The average knowledge, attitude and practice score were 11.55±3.04, 34.23±4.06 and 10.7±2.87 points, respectively. Knowledge score was positively correlated with attitude score (r=0.318, P<0.001) and practice score (r=0.351, P<0.001); attitude and practice scores were also positively correlated (r=0.209, P<0.001). Multivariate analysis identified higher knowledge score (odds ratio [OR], 1.138; 95% confidence interval [95% CI], 1.042-1.244; P=0.004) and higher attitude score (OR, 1.137; 95% CI, 1.060-1.219; P<0.001) as independently associated with good practice (ie, practice score ≥14 points). The results provide important insights into the knowledge, attitudes and practices of women with GDM in China regarding GDM and its management. These findings may facilitate the development and implementation of education and training programs to improve the self-management of GDM by women in China.

Prior Diagnosis of Diabetes but Not Its Control is Associated with Higher Depression Score Among Older Individuals.

The study assessed the relationship between prior diagnosis of diabetes and its control with depression score, differences in socioeconomic, lifestyle, health characteristics and diabetes control by adherence to treatment in population-based sample of older individuals. The analysis of the sub-sample of Polish cohort of the HAPIEE (Health, Alcohol, and Psychosocial Factors in Eastern Europe) study was conducted; 464 participants were interviewed and random first 360 (78%) underwent physical examination and blood sample tests. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The robust regression method was applied to assess the association between depression score and diabetes diagnosis as well as diabetes control. There were 97 participants (21.0%) at mean age of 73.6 years (SD=6.31 years) with prior diagnosis of diabetes. Mean HbA1c concentration was 6.65% (SD=1.0) The majority of patients (55.7%) used oral medication with diet. Nearly 20% declared the use of oral treatment alone, and 10.3% used combined treatment of oral medications, insulin, and diet. In this study, 86.6% of the participants with diabetes confirmed self-monitoring of blood glucose levels and 58.8% were on high-quality diet. No differences in socioeconomic, lifestyle, health characteristics or control of diabetes by adherence to diabetes treatment were found. After adjustment for age and gender, diagnosis of diabetes was associated with greater depressive score by about 2 points (β=2.02, 95% CI=0.16;3.88). However, no significant association between depression score and any indicator of diabetes control was found. In older individuals with diabetes, depression score was higher compared to those without diabetes, but it was not related to poorer diabetes control. No differences in socioeconomic, lifestyle, health characteristics and control of diabetes by adherence to diabetes treatment may suggest that in this age group some other, less known factors are substantial for achievement of treatment targets.

Study protocol: glycaemic outcomes in people with type 2 diabetes initiating continuous glucose monitoring: the 2GO-CGM study

PurposeImproving glycaemic control in type 2 diabetes (T2D) is essential to reducing social and health-economic burden of diabetes-related complications. Continuous glucose monitoring (CGM) has been established as beneficial in improving glycaemic control and reducing hypoglycaemia in people with type 1 diabetes, however data in T2D is limited. This study has been designed to assess the effect of initiating real-time CGM (rtCGM) on glycaemic control in a high-risk population of adults with T2D. Secondary objectives are to assess the cost-effectiveness and safety of rtCGM, and the effects of rtCGM on diet/lifestyle and the burden of diabetic complications, including cardiovascular risk.MethodsThis multicentre randomised controlled trial (RCT) will be conducted at three sites in New Zealand (Waikato, Christchurch and Dunedin). Eighty adults with T2D on insulin with suboptimal glycaemic control (HbA1c > 8.0% or 64 mmol/mol) will be randomised 1:1 to rtCGM or routine care with self-monitoring of blood glucose levels (SMBG) for three months. This intervention phase will be followed by a three-month continuation phase where SMBG group crossover to use rtCGM. Participants will then be invited to join the extension phase with continued use of rtCGM for a further 12 months. During the extension phase, both groups will independently titrate their insulin under the remote supervision of prescribing diabetes nurse specialists following an insulin titration algorithm. The primary outcome of the study is time in target glucose range (3.9–10 mmol/L or 70–180 mg/dL; TIR). Secondary outcomes include CGM metrics as per consensus statement recommendations, and HbA1c. Additional planned analyses include cardiovascular risk profile, incremental cost-effectiveness analyses, dietary patterns, and qualitative analyses.Trial registration numberThe trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000889853) on 8 July 2021 and the World Health Organisation International Clinical Trial Registry Platform (Universal Trial Number U1111–1264-5822).

Self-monitoring of blood glucose levels among pregnant individuals with gestational diabetes: a systematic review and meta-analysis.

The World Health Organization (WHO) recommends treatment and management of gestational diabetes (GD) through lifestyle changes, including diet and exercise, and self-monitoring blood glucose (SMBG) to inform timely treatment decisions. To expand the evidence base of WHO's guideline on self-care interventions, we conducted a systematic review of SMBG among pregnant individuals with GD. Following PRISMA guidelines, we searched PubMed, CINAHL, LILACS, and EMBASE for publications through November 2020 comparing SMBG with clinic-based monitoring during antenatal care (ANC) globally. We extracted data using standardized forms and summarized maternal and newborn findings using random effects meta-analysis in GRADE evidence tables. We also reviewed studies on values, preferences, and costs of SMBG. We identified 6 studies examining SMBG compared to routine ANC care, 5 studies on values and preferences, and 1 study on costs. Nearly all were conducted in Europe and North America. Moderate-certainty evidence from 3 randomized controlled trials (RCTs) showed that SMBG as part of a package of interventions for GD treatment was associated with lower rates of preeclampsia, lower mean birthweight, fewer infants born large for gestational age, fewer infants with macrosomia, and lower rates of shoulder dystocia. There was no difference between groups in self-efficacy, preterm birth, C-section, mental health, stillbirth, or respiratory distress. No studies measured placenta previa, long-term complications, device-related issues, or social harms. Most end-users supported SMBG, motivated by health benefits, convenience, ease of use, and increased confidence. Health workers acknowledged SMBG's convenience but were wary of technical problems. One study found SMBG by pregnant individuals with insulin-dependent diabetes was associated with decreased costs for hospital admission and length of stay. SMBG during pregnancy is feasible and acceptable, and when combined in a package of GD interventions, is generally associated with improved maternal and neonatal health outcomes. However, research from resource-limited settings is needed. PROSPERO CRD42021233862.

A painless fracture of a phalanx of the left hand in a patient with type 1 diabetes – case report

The aim of our study is to present a case report of a patient who, due to advanced symmetrical peripheral diabetic polyneuropathy, was unaware of the fracture of the fifth finger of the left hand and even tried to restore it to its previous position. The 53-year-old patient with type 1 diabetes at the age of 9, who, due to non-compliance with medical recommendations and poor metabolic control (over the last 15 years, HbA1c has never fallen below 8.1%, reaching 11.1% in May 2017), developed complications such as: ischemic heart disease, diabetic retinopathy, nephropathy and peripheral neuropathy. In February 2019, in the morning, when unscrewing the fuel filler cap in the car, the patient suffered a finger fracture. He remained unaware of this fact all day due to the lack of any pain symptoms. It was only in the evening that he noticed the wrong placement of the fifth finger on his left hand. On the next day, there was a slight soreness with pressure, and the swelling deepened, which prompted him to visit the emergency room. An X-ray examination was performed there, which showed a fracture of the shaft of the proximal phalanx of the fifth finger of the left hand with angular setting of the fragments. The finger was immobilized in a plaster cast and the patient was referred for further check-up in a specialist outpatient clinic. Fortunately, the attempt to set the finger on his own did not cause any significant complications, and after removing the plaster cast, the patient regained the use of the broken finger. A recent electromyographic study confirmed the existence of a very advanced peripheral neuropathy. In summary, improperly treated, poorly controlled type 1 diabetes has serious consequences. It is very important that people suffering from it conduct regular self-monitoring of blood glucose levels and lead a healthy lifestyle.

Financial, Occupational and Physical Challenges and Blood Glucose Monitoring in Type 2 Diabetes.

Blood glucose monitoring effects are changing for people living with type 2 diabetes. However, there is a lack of recent data surrounding financial, occupational, or physical stressors that affect the adherence of diabetes self-management practices. This article looks to examine specific financial, physical, and occupational challenges in adherence to blood glucose monitoring in type 2 diabetes. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 Pre-Pandemic data of adults 18+ were analyzed. These data were used to examine the relationships between insurance coverage, health status, occupation, and self-monitoring of blood glucose levels in the United States. This study found that respondents had a statistically significant association with five variables: prescription drug coverage (in-part or full), occupation status, gender, age, and three race subcategories (non-Hispanic White, Black, and Other-Multiracial) with blood glucose monitoring. This study may help certified health education specialists (CHES) and diabetes care and educator specialists (DCES) to better identify which groups of individuals are at highest risk for poor adherence to specific blood glucose monitoring in type 2 diabetes.

Da li kontinuirani monitoring glukoze možemo koristiti za postavljanje dijagnoze hiperglikemije belog mantila i potencijalno nekih drugih entiteta?

Introduction. Since 1999 continuous glucose monitoring (CGM) has been used to measure the amount of glucose in the interstitial fluid. CGM is crucial when it comes to developing the ambulatory glucose profile and giving information on time spent in range (TIR), percentage of time spent above and below range, as well as variability. Discussion. It was in 1992 that Campbell et al. first described white coat hyperglycaemia, who explained it as patients having elevated blood glucose levels in a clinician's office or laboratory and normal glucose levels obtained by self-monitoring. Prior to the introduction of CGM, white coat hyperglycaemia was described as the discrepancy in the levels of office glucose and self-monitoring blood glucose (SMBG). Nowadays, it may be said that a patient has white coat hyperglycaemia when they have elevated office levels and normal SMBG levels or TIR above 70% on CGM. Recognising white coat hyperglycaemia is of crucial importance for treatment as its intensification based on office glycaemia alone can lead to episodes of hypoglycaemia and a potentially lethal outcome. Should comparison be made with arterial hypertension and ambulatory blood pressure monitoring (ABPM), CGM may provide several other options: 1) masked hyperglycaemia; 2) isolated nocturnal hyperglycaemia. Conclusion. It seems logical that CGM can be used for diagnosing white coat hyperglycaemia and possibly some (new) entities. Nonetheless, the clinical significance of all these entities can only be discussed after conducting adequately designed randomised clinical trials, which we would strongly encourage.

Coping With Diabetes During the COVID-19 Lockdown in Saudi Arabia: Lessons Learned in the Post-pandemic Era.

Uncontrolled diabetes has appeared as one of the major risk factors for morbidity and mortality in diabetic patients with coronavirus disease 2019 (COVID-19). Alterations in dietary habits, physical inactivity, and inability to take advice from the physician are some of the contributing factors. This study aimed to assess the impact of the COVID-19 lockdown in Saudi Arabia on medication accessibility, medication adherence, lifestyle, and quality of life of diabetes patients. A cross-sectional observational study was conducted among diabetic patients using a self-reported questionnaire developed on an online platform (SurveyMonkey®). The survey was distributed through social media platforms (WhatsApp, Telegram). For those who were digitally illiterate, responses were collected by family members. The targeted population was type 1, type 2 and gestational diabetes patients. The analysis of the data was done using IBM SPSS Statistics, version 26. Four hundred forty-nine participants completed the survey. Most of the participants had type 2 diabetes (n=359; 79.8%) and were well educated (83.2%) with a high school degree and above. Complications from COVID-19 infection were reported in 12% (n=54) patients. During quarantine, 78.8% (n=354) of participants measured their blood glucose regularly. Results showed that during quarantine, 68.3% (n=311) participants skipped their scheduled follow-up whereas only 5.1% (n=23) of them took their medication inappropriately. This study reported good levels of self-monitoring of blood glucose levels, whereas patients' accessibility to seek healthcare services seemed to be interrupted. Further efforts are needed in the post-pandemic era to empower patients' self-care behaviors and utilize telehealth models to facilitate timely access to medical care.

Efecto de las intervenciones de empoderamiento de los cuidadores familiares sobre las capacidades de estos para gestionar la diabetes mellitus tipo 2 en Indonesia

ObjectiveEmpowering family caregivers is one of the strategies to increase the family caregiver's capability in T2DM self-management. The adequate capability of family caregivers in T2DM self-management can improve T2DM management, impacting people's health status with T2DM. This study aimed to examine the effect of family caregiver empowerment intervention on the family caregiver's T2DM self-management capability. MethodsThis study is an experimental study with a randomized control group pre-test post-test design. The sample size is 60 respondents by simple random sampling, which is divided into two groups randomly. The treatment group (n=30) received 10-session intervention in 10 weeks (six education and training sessions and four mentoring sessions), and the control group (n=30) received standard care. Data were collected using a questionnaire, twice, before and after the intervention (12 weeks after the last intervention session) and analysed descriptively and statistically (One way-ANOVA test, dependent t-test, and independent t-test). ResultsThe empowerment intervention significantly increased the family caregiver's T2DM self-management capability, including diet management (t=4.070; p<.001), physical activity management (t=9.493; p<.001), medication management (t=4.021; p<.001), self-monitoring blood glucose levels (t=2.789; p<.001), and foot care skills (t=6.835; p<.001). ConclusionFamily caregiver empowerment interventions can improve the capability of family caregivers in self-management of T2DM, including increasing the capability to manage diet, physical activity, medication, self-monitoring blood glucose levels, and foot care. Nurses can empower family members as family caregivers to improve self-management of T2DM.

Analysis Psychosocial Factors Affecting Behaviour of Self-Monitoring Blood Glucose in People with Type 2 Diabetes Mellitus

Introduction: Compliance with monitoring blood glucose levels is crucial to diabetes management. Self-monitoring behaviour of blood glucose levels can be influenced by psychosocial factors in people with T2DM, such as knowledge, coping, diabetes distress, family support, and nurse support. Objective: The study aimed to analyze psychosocial factors that influence the behaviour of self-monitoring of blood glucose levels in people with T2DM. Methods: The study was a descriptive-analytic study with a cross-sectional design. The sample was T2DM patients in the Jember Regency with a sample size of 138 respondents, taken using multistage random sampling. Data were collected using a questionnaire (SKILLDS, Coping Scale, DDS, HDFSS, Nurse's role perception, and the SMBG questionnaire) and analyzed using a multiple linear regression test. Results The modelling results show that psychosocial factors (knowledge, coping, diabetes distress, family support, and nurse support) have a simultaneous and significant influence on the behaviour of monitoring blood glucose levels (F = 9.292; p = 0.001 &lt; α = 0.05) with adjusted R2 = 0.232. It showed that psychosocial factors could explain the variance of behaviour monitoring blood glucose levels by 23.2%. Partially, there are three influential variables, namely coping, perception of family support, and perception of nurse support (p= 0.039; p= 0.016; and p= 0.020 &lt; α =0.05). Better coping, family support, and nurse support could improve blood glucose monitoring. Conclusion: Psychosocial factors can affect monitoring blood glucose levels in people with T2DM. The nurse can make efforts to improve the behaviour by monitoring blood glucose levels by considering the psychosocial aspects of people with T2DM through preventive promotion efforts to improve coping, family support, and nurse support to improve self-management and quality of life of people with T2DM.

Assessment of the Knowledge and Self- Care Practice on Hypoglycemia among Patients with Diabetic Mellitus Attending Medical Opd at Smch

Introduction: Hypoglycemia is a clinical emergency that needs to be recognized and treated promptly to avoid organ damage and death. Knowledge of hypoglycemia prevention is an essential step in self-care practices due to the fact knowledgeable individuals are much more likely to practice hypoglycemia prevention. Prevention of hypoglycemia relies on adequate awareness and rightself-care. Objectives: To evaluate the level of knowledge and to self - care practice of hypoglycemia with their selected demographic variables among diabetic patients. Methods: A cross sectional descriptive research design was adopted with hundred samples who met the inclusion criteria in the hospital setting. Self-structured questionnaire method was used to acquire the data. Data have been through descriptive and inferential statistics. Result: Of 100 samples, 76(76%) had adequate knowledge and 63(63%)had good self-care practice on hypoglycemia. Spearman’s correlation showed positive relationship between knowledge and self-care practice of hypoglycemia (r value = 0.720, p&lt;0.001). In respect to level of knowledge, there was a significant association noted among age, education, occupation, income, religion, marital status, family history and with regards to self-care practice along with all variables including gender is significant at p&lt;0.05. Conclusion: This study result emphasized that majority of the diabetic patients had adequate knowledge and good self-care practice on hypoglycemia. Enlightening the patients further with regular self-monitoring of blood glucose level and obtain medical guidance and support may help the patients to stay fit.

Subclinical Reactive Hypoglycemia Is Associated with Higher Eating and Snacking Frequencies in Obese or Overweight Men without Diabetes

Impacts of subclinical reactive hypoglycemia on food ingestion are not well studied. In the present study, in obese/overweight males without diabetes (n = 34), continuous glucose monitoring and eating behavior were recorded for 6 days after the 75 g glucose challenge. In 50% of subjects, the minimal sensor glucose levels within 24 h post-challenge (CGMmin) were &lt;70 mg/dL, while symptoms, if any, were subtle. Median eating and snacking frequencies were 3.45 and 0.45 times/day, respectively. In subjects with eating frequency &gt; 3 times/day, CGMmin was significantly lower than CGMmin in those without. The receiver operating characteristic curve of CGMmin for detecting eating frequency &gt; 3 times/day showed the area under the curve of 0.74 with the cutoff point of 65 mg/dL (p = 0.027). Eating frequency of subjects with CGMmin &lt; 65 mg/dL was significantly higher than that of subjects with CGMmin ≥ 65 mg/dL (3.68 vs. 3.3 times/day, p = 0.047). When it was defined as reactive hypoglycemia that either the 2 h post-load blood glucose level, the minimal self-monitored blood glucose level within the 1st day, or CGMmin, was below their respective cutoff for detecting eating frequency &gt; 3 times/day, eating frequency of subjects with the reactive hypoglycemia was significantly higher than that of the subjects without the reactive hypoglycemia (3.75 times/day vs. 3.15 times/day, p = 0.001). In addition, the median snacking frequency was 6 times higher in subjects with reactive hypoglycemia compared to those without it (0.9 times/day vs. 0.15 times/day, p &lt; 0.001). In conclusion, in obese/overweight males without diabetes, subclinical reactive hypoglycemia is significantly associated with higher eating/snacking frequencies.

163-OR: Hypoglycemia with Glimepiride vs. Insulin Glargine in the GRADE Study

Hypoglycemia limits the glycemic control that can be achieved with insulin and sulfonylureas (SUs) , but we lack evidence from head-to-head studies to guide management. In the GRADE comparative effectiveness study, 5,047 patients with type 2 diabetes (T2DM) of &amp;lt;years’ duration, on metformin monotherapy with HbA1c 6.8-8.5%, were randomized to addition of the SU glimepiride, insulin glargine U-100, sitagliptin, or liraglutide, permitting a direct comparison over 5.0 ± 1.3 (mean ± SD) years of follow-up. Glimepiride was initiated at 1-2 mg/day, glargine at 10-20 units/day, and both were titrated according to algorithms based on self-monitored blood glucose levels. Over 4 years, adjudicated severe hypoglycemia occurred in 2.3% of those randomized to glimepiride vs. 1.4% with glargine, but was less frequent with liraglutide (0.9%) and sitagliptin (0.7%) , p=0.003. During GRADE, HbA1c was measured every 3 months, and if a HbA1c &amp;gt;7.5% was confirmed, “rescue treatment” with glargine and/or aspart was added. We examined management in participants who were unable to keep HbA1c ≤7.5% - whose primary study drug was insufficient - prior to their “rescue”. At 3 mo after randomization, hypoglycemic symptoms or a measured glucose &amp;lt;70 mg/dl within the previous 30 d was reported by 33% of those using glimepiride vs. 15% with glargine (p &amp;lt;0.001) . The mean dose of glimepiride at 3 mo (n=627) and 12 mo (n=337) was 3.4 and 4.2 mg/day, respectively [a 24% increase but considerably submaximal (8 mg) ]. In contrast, the dose of glargine at 3 mo (n=487) and 12 mo (n=337) was 26 and 37 units/day, respectively (a 44% increase, p &amp;lt;0.0vs. glimepiride) . The outcome of a confirmed HbA1c &amp;gt;7.5% was reached in 50% of those using glimepiride, vs. 39% with glargine (p&amp;lt;0.001) . Conclusions: In metformin-treated patients with T2DM, there was more hypoglycemia, less increase in drug dose, and less preservation of glycemic control, with addition of the SU glimepiride compared to glargine; increases in glimepiride dose might have been limited by hypoglycemia. Disclosure L.S. Phillips: Research Support; Abbott Diabetes, AbbVie Inc., Janssen Pharmaceuticals, Inc., Janssen Scientific Affairs, LLC, Pfizer Inc. Other Relationship; Cystic Fibrosis Foundation, Diasyst Inc. E.R. Seaquist: None. C. Baker: None. R.M. Bergenstal: Advisory Panel; Hygieia, Medtronic, Roche Diabetes Care, Zealand Pharma A/S. Consultant; Abbott Diabetes, Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur SA, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, Onduo LLC, Sanofi, United HealthCare Services, Inc. Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi. N.M. Butera: None. J.P. Crandall: Research Support; Abbott. R. Goland: None. S.H. Hox: None. D.S. Hsia: None. M.L. Johnson: Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Jaeb Center for Health Research, Lilly, Medtronic, Novo Nordisk, Sanofi. P. Raskin: None. W. Valencia: None. A.H. Waltje: None. N. Younes: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (U01DK098246, U34-DK-088043)

Improving Outcomes Through Personalized Recommendations in a Remote Diabetes Monitoring Program: Observational Study.

BackgroundDiabetes management is complex, and program personalization has been identified to enhance engagement and clinical outcomes in diabetes management programs. However, 50% of individuals living with diabetes are unable to achieve glycemic control, presenting a gap in the delivery of self-management education and behavior change. Machine learning and recommender systems, which have been used within the health care setting, could be a feasible application for diabetes management programs to provide a personalized user experience and improve user engagement and outcomes.ObjectiveThis study aims to evaluate machine learning models using member-level engagements to predict improvement in estimated A1c and develop personalized action recommendations within a remote diabetes monitoring program to improve clinical outcomes.MethodsA retrospective study of Livongo for Diabetes member engagement data was analyzed within five action categories (interacting with a coach, reading education content, self-monitoring blood glucose level, tracking physical activity, and monitoring nutrition) to build a member-level model to predict if a specific type and level of engagement could lead to improved estimated A1c for members with type 2 diabetes. Engagement and improvement in estimated A1c can be correlated; therefore, the doubly robust learning method was used to model the heterogeneous treatment effect of action engagement on improvements in estimated A1c.ResultsThe treatment effect was successfully computed within the five action categories on estimated A1c reduction for each member. Results show interaction with coaches and self-monitoring blood glucose levels were the actions that resulted in the highest average decrease in estimated A1c (1.7% and 1.4%, respectively) and were the most recommended actions for 54% of the population. However, these were found to not be the optimal interventions for all members; 46% of members were predicted to have better outcomes with one of the other three interventions. Members who engaged with their recommended actions had on average a 0.8% larger reduction in estimated A1c than those who did not engage in recommended actions within the first 3 months of the program.ConclusionsPersonalized action recommendations using heterogeneous treatment effects to compute the impact of member actions can reduce estimated A1c and be a valuable tool for diabetes management programs in encouraging members toward actions to improve clinical outcomes.