Self-monitored Blood Research Articles

Changes in Patient-Reported Outcome Measures With a Technology-Supported Behavioral Lifestyle Intervention Among Patients With Type 2 Diabetes: Pilot Randomized Controlled Clinical Trial.

BackgroundIn the United States, more than one-third of the adult population is obese, and approximately 25.2% of those aged ≥65 years have type 2 diabetes (T2D), which is the seventh leading cause of death. It is important to measure patient-reported outcomes and monitor progress or challenges over time when managing T2D to understand patients’ perception of health and quantify the impact of disease processes or intervention effects. The evaluation of patient-reported outcome measures (PROMs) is especially important among patients with multiple chronic conditions in which clinical measures do not provide a complete picture of health.ObjectiveThis study examined the feasibility of collecting Patient-Reported Outcome Measurement Information System (PROMIS) measures, and preliminarily evaluated changes in PROMIS scores and compared the scores with standard scores of the general US population. The parent study is a pilot randomized controlled clinical trial testing three different modes (mobile health [mHealth], paper diary, and control) of self-monitoring in a behavioral lifestyle intervention among overweight or obese patients with T2D.MethodsPatients with comorbid overweight or obesity and a diagnosis of T2D for at least 6 months were recruited from a diabetes education program. Participants were randomized to the following three groups: mHealth, paper diary, and control (standard of care) groups. Paper diary and mHealth experimental groups received additional behavioral lifestyle intervention education sessions, as well as tools to self-monitor weight, physical activity, diet, and blood glucose. All participants completed PROMIS-57 and PROMIS-Global Health (GH) version 1.0 questionnaires during visits at baseline, 3 months, and 6 months. The PROMIS-57 includes the following seven domains: anxiety, depression, fatigue, pain interference, physical function, satisfaction with participation in social roles, and sleep disturbance. The PROMIS-GH is composed of the following two domains: global mental health and global physical health.ResultsA total of 26 patients (mHealth, 11; paper diary, 9; control, 6) were included in our analysis. The study sample was predominantly African American (68%) and female (57%), with a mean age of 54.7 years and a mean BMI of 37.5 kg/m2. All patients completed the PROMIS-57 and PROMIS-GH questionnaires, and we compared the mean scores of the three groups to investigate potential differences. No relevant differences were noted across the groups. However, positive trends were noted in both intervention (mHealth and paper diary) groups in the middle (month 3) and end (month 6) of the study.ConclusionsOur pilot study provides evidence for the feasibility of using PROMIS questionnaires to record important components of T2D-related symptoms among overweight or obese individuals. The results from our study support the use of PROMIS questionnaires to provide clinicians and researchers with a benchmark for assessing the overall need for symptom management and determining the success or challenges of an intervention.Trial RegistrationClinicalTrials.gov NCT02858648; https://clinicaltrials.gov/ct2/show/NCT02858648

Influence of Fasting Glucose Levels on Achieving Glycemic Target in Individuals with Type 2 Diabetes: a Post Hoc Analysis

FPG GOAL was a 24-week, open-label, treat-to-target randomized controlled trial which demonstrated that the optimal self-monitored fasting blood glucose (SM-FBG) target for most Chinese individuals with type2 diabetes (T2D) using insulin glargine 100IU/mL was 3.9-6.1mmol/L. Individuals who achieved lower fasting plasma glucose (FPG) levels might achieve the target HbA1c of < 7% without increasing the risk of hypoglycemia. For this post hoc analysis, individuals were redivided into three groups based on their actual laboratory FPG levels at 24weeks: level1, ≤ 5.6mmol/L; level2, > 5.6 to ≤ 6.1mmol/L; and level3, > 6.1 to ≤ 7.0mmol/L. At week24, 863 individuals with diabetes had available FPG data and 179, 122, and 179 individuals achieved FPG levels1, 2, and 3, respectively. The proportion of individuals with HbA1c < 7% or HbA1c < 7% without hypoglycemia (≤ 3.9 or ≤ 3.0mmol/L) was significantly higher in FPG levels1 (p < 0.01) and 2 (p < 0.05) than in level3. The least squares mean changes from baseline in HbA1c (- 1.77% and - 1.66% vs - 1.34%; both p < 0.001) and 2-h postprandial glucose (- 3.88mmol/L and - 3.98mmol/L vs - 3.22mmol/L; both p < 0.05) were also significantly higher in FPG levels1 and 2 compared with level3. Linear regression analysis showed a moderate relationship between FPG and HbA1c levels at 24weeks (r = 0.449). Chinese individuals with T2D who achieved lower FPG levels with insulin glargine 100IU/mL were more likely to achieve the recommended target HbA1c of < 7% compared with those with higher FPG levels. ClinicalTrials.gov identifier NCT02545842.

1096-P: Determining the Optimal Fasting Glucose Target for Patients with Type 2 Diabetes: Results of the FPG Goal Trial

Background: The optimal fasting glucose target to achieve an HbA1c &amp;lt;7.0% in patients with T2D remains controversial. Methods: This open-label RCT conducted in China (ClinicalTrials.gov, NCT02545842), randomly assigned (1:3:3) adults (aged 18-65 years) with uncontrolled T2D (HbA1c &amp;gt;7% to ≤10.5%) on 1-3 OADs to 1 of 3 self-monitored fasting blood glucose (FBG) target groups: ≤5.6 mmol/L (Group 1), ≤6.1 mmol/L (Group 2), or ≤7.0 mmol/L (Group 3). The lowest of 3 consecutive FBG values was used for insulin glargine 100 U/ml titration decisions. Primary endpoint was the proportion of patients achieving an HbA1c &amp;lt;7.0% at 24 weeks. Results: Of 947 patients randomized (Group 1, n=136; Group 2, n=405; Group 3, n=406), 914 were analyzed (mean age 53.9 years; 56.2% male; mean HbA1c 8.59%), and 885 (93.4%) completed the study. At 24 weeks, 44.4%, 46.1%, and 37.7% of patients achieved an HbA1c &amp;lt;7.0% in Group 1, 2, and 3, respectively (p=0.017; Group 2 vs. Group 3). Significantly more patients in Group 2 than in Group 3 (45.0% vs. 36.5%; p=0.014) achieved an HbA1c &amp;lt;7% without hypoglycemia (BG ≤3.0 mmol/L). Confirmed hypoglycemia (BG ≤3.9 mmol/L) was significantly more frequent in Group 1 vs. Group 3 (38.9 vs. 23.3%, p&amp;lt;0.001) but not in Group 2 vs. Group 3 (27.5% vs. 23.3%; p=0.177). Based on the lowest of 3 consecutive FBG values, the proportions of patients achieving an FBG within their target range at 24 weeks were 70.1%, 67.6% and 79.0% in Groups 1, 2 and 3, respectively. However, based on laboratory fasting plasma glucose (FPG) measurements, these proportions were 31.9%, 39.5% and 47.7%. After re-dividing by actual FPG level at 24 weeks, significantly more patients with an FPG ≤5.6 mmol/L (68.7%, p&amp;lt;0.001) and 5.6&amp;lt; FPG ≤6.1mmol/L (58.2%, p=0.013) achieved an HbA1c &amp;lt;7.0% than those with 6.1&amp;lt; FPG ≤7.0 mmol/L (43.6%). Conclusions: The optimal FBG target for the majority of patients with T2D appears to be ≤6.1 mmol/L. However, for patients at lower risk of hypoglycemia, an FBG target of ≤5.6 mmol/L may be appropriate. Disclosure W. Yang: Speaker's Bureau; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Merck Sharp &amp; Dohme Corp., Novo Nordisk Inc., Sanofi, Servier. J. Ma: None. G. Yuan: None. L. Li: None. M. Zhang: None. Y. Lu: None. X. Ye: Speaker's Bureau; Self; AstraZeneca, Merck Sharp &amp; Dohme Corp., Novo Nordisk Inc. W. Song: None. M. Liu: None. J. Wu: None. R. Chen: None. N. Cui: Employee; Self; Sanofi. Y. Li: Employee; Self; Sanofi. X. Zhang: None. J. Yang: None.

Application of the flash glucose monitoring system in children with type 1 diabetes mellitus

Objective To evaluate the usefulness, cost and side effects of flash glucose monitoring (FGM) in children with type 1 diabetes mellitus (T1DM). Methods Seven children aged 9.3-16.3 years old with T1DM (3 males, 4 females) treated with insulin in Shenzhen Children′s Hospital from May 2016 to February 2018 were enrolled, and they were performed with self-monitoring of blood glucose.All participants were subjected to FGM for 4 weeks and compared for changes in terms of hemoglobin A1c (HbA1c), episodes of hypoglycemia and hyperglycemia, frequency of self-monitoring blood glucose(SMBG) or sensor scanning, costs of glucose monitoring and side effects before and after 4-week implementation of FGM. Results The HbA1c was significantly reduced from (8.86±0.32)% before FGM to (8.10±0.14)% after implementation of FGM, and the difference was statistically significant (t=2.727, P=0.034). Both the frequency of hyperglycemia and hypoglycemia were significantly decreased after the implementation of FGM[(0.27±0.04) times/d vs.(0.62±0.05) times/d, (0.20±0.02) times/d vs.(0.37±0.05) times/d], and the differences were statistically significant(t=9.291, 2.908, P=0.001, 0.027). The average frequency of sensor scanning after the implementation of FGM was significantly higher than SMBG testing before use of FGM[(11.09±0.96) times/d vs.(4.02±0.47) times/d], and the difference was statistically significant(t=-24.398, P=0.001). The cost of FGM was a little higher than that of capillary blood glucose testing while there was no significant difference[(814.29±17.71) yuan vs.(758.89±33.42) yuan, P>0.05]. Comparing the results of the FGM and SMBG on the 1st, 7th and 13th day after FGM, there was no significant difference (all P>0.05). Also there was no significant diffe-rence among the different ranges of blood glucose (all P>0.05). The time with sensor of FGM in the arm was (13.9±0.1) days.There was no side effect to be found during 4 weeks of implementation of FGM. Conclusions FGM has the potential to increase the time of SMBG, decrease the hyperglycemia and hypoglycemia, and improve HbA1c in children with T1DM.Accuracy, safety and stability of the FreeStyle Libre System were demonstrated for the pediatric T1DM. Key words: Flash glucose monitoring system; Type 1 diabetes mellitus; Glucose; Therapy; Child

Comprehensive Evaluation of Combination Therapy with Basal Insulin and Either Lixisenatide or Vildagliptin in Japanese Patients with Type 2 Diabetes: A Randomized, Open-Label, Parallel-Group, Multicenter Study.

IntroductionWe comprehensively evaluated the effects of combination therapy with insulin glargine and the incretin-based drugs lixisenatide or vildagliptin in Japanese patients with type 2 diabetes.MethodsIn this 12-week, randomized, open-label, parallel-group, multicenter study (GLP-ONE Kobe), the incretin-based drug sitagliptin was randomly switched to lixisenatide (20 μg/day, n = 18) or vildagliptin (100 mg/day, n = 20) in patients with inadequate glycemic control despite combination therapy with insulin glargine and sitagliptin. The dose of insulin glargine was titrated after the switch to maintain fasting blood glucose at approximately 110 mg/dL. The primary end points of the study were the change in glycosylated hemoglobin (HbA1c) level between before and 12 weeks after the treatment switch, the proportion of patients achieving an HbA1c level below 7.0%, and the postprandial increase in glucose concentration as assessed by self-monitoring of blood glucose.ResultsThe change in HbA1c level from baseline to 12 weeks did not differ significantly between the lixisenatide and vildagliptin groups (− 0.6 ± 0.7% and − 0.6 ± 1.2%, respectively, P = 0.920). Neither the proportion of patients achieving an HbA1c level below 7.0% nor the postprandial increase in glucose concentration was different between two groups. Body weight and serum low density lipoprotein (LDL) cholesterol level decreased significantly in the lixisenatide and vildagliptin groups, respectively. Both drugs were associated with mild gastrointestinal symptoms but not with severe hypoglycemia. Vildagliptin was associated with elevation of serum aspartate transaminase. Treatment satisfaction as assessed with the Diabetes Treatment Satisfaction Questionnaire did not differ significantly between the two groups.ConclusionThe combinations of basal insulin and either lixisenatide or vildagliptin have similar efficacies with regard to improvement of glycemic control.Trial RegistrationThis trial has been registered with UMIN (No. 000010769).Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0505-2) contains supplementary material, which is available to authorized users.

Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus

It is difficult to use HbA(1c) as an indicator of glycaemic control in patients with neonatal diabetes mellitus (NDM) because of high levels of fetal haemoglobin (HbF) remaining in the blood. In this study, glycated albumin (GA), which is not affected by HbF, and HbA(1c) were compared to evaluate whether they reflect glycaemic control in patients with NDM. This study included five patients with NDM. Age at diagnosis was 38 ± 20 days. Insulin therapy was started in all patients, and levels of GA, HbA(1c) and HbF were measured monthly for 6 months. One-month average preprandial plasma glucose (aPPG) was calculated using self-monitoring of blood glucose. Plasma glucose and GA were elevated (29.7 ± 13.1 mmol/l [n = 5] and 33.3 ± 6.9% [n = 3], respectively) but HbA(1c) was within normal limits (5.4 ± 2.6% [35.5 ± 4.9 mmol/mol]; n = 4) at diagnosis. With diabetes treatment, aPPG (r = -0.565, p = 0.002), GA (r = -0.552, p = 0.003) and HbF (r = -0.855, p < 0.0001) decreased with age, whereas HbA(1c) increased (r = 0.449, p = 0.004). GA was strongly positively correlated with aPPG (r = 0.784, p < 0.0001), while HbA(1c) showed no correlation with aPPG (r = 0.221, p = 0.257) and was significantly inversely correlated with HbF (r = -0.539, p = 0.004). GA is a useful indicator of glycaemic control in patients with NDM, whereas HbA(1c) is influenced by age-related changes in HbF and does not accurately reflect glycaemic control.

Managment of diabetic ketoacidosis in children and adolescents in sub-Saharan Africa: A review

Diabetic ketoacidosis (DKA) is a complex metabolic state of hyperglycaemia, ketosis, and acidosis. Diabetes in sub-Saharan Africa is, in many patients a serious disease with a poor prognosis. Most deaths, however, are due to preventable causes. To improve knowledge on the management of DKA in sub-Saharan Africa. Literature review from different published sources. Health systems in sub-Saharan Africa are currently organised for the treatment of episodes of illness and not long-term conditions like diabetes. Therefore the high rates of DKA is essentially due to lack of training of health professionals, lack of facilities in most hospitals, lack of public awareness as well as lack of health education to individual patients/families. In addition erratic insulin supply coupling with infections, low parental education, poor insulin storage and lack of facilities for self monitoring of blood glucose. A complex unfavourable social and economic environment is the basis of the high prevalence of DKA in sub-Saharan Africa. Several episodes of DKA can be prevented by effective public awareness programmes and education to healthcare providers.

Evaluating the feature of hypoglycemia detected by continuous glucose monitoring system during temporary continuous subcutaneous insulin infusion in type 2 diabetes patients

To use continuous glucose monitoring system (CGMS) to investigate the features of hypoglycemia in control of hyperglycemia in T2DM patients by continuous subcutaneous insulin infusion (CSII) and to study the influencing factors of hypoglycemia. Sixty-one T2DM patients, 35 males and 26 females, age 23-88, with the disease duration of 0.5-12 years, HbA1c level of (11.1 +/- 1.6)%, and glycosylated serum protein of (32 +/- 6)%, underwent. CSII and finger blood sugar test. On the second day CGMS was used for 72 hours. Logistic regression was used to analyze the correlation among different factors. CGMS discovered 31 hypoglycemic events in 18 patients in the early stage of CSII treatment, 20 events occurring at night, a number significantly higher than that by self-monitoring of blood sugar. The C-peptide and mean blood glucose (BMG) of the patients with hypoglycemia.were significantly lower than those of the patients without hypoglycemia, and the total cholesterol, standard deviation of blood glucose (SDBG), and insulin pump basal rate of the patients with hypoglycemia were significantly higher than those of the patients without hypoglycemia (all P < 0.05). Multiple regression indicated that MBG was negatively correlated with hypoglycemia but SDBG and basal rate were positively correlated with hypoglycemia. (1) Hypoglycemia detected by CGMS occurs in about 1/3 of the type 2 diabetes patients at the early stage of CSII therapy. (2) In addition of MBG and insulin pump basal rate, glycemic excursion is related closely to hypoglycemia.

Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial

Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus.Design Prospective randomised controlled...

Quality of Care for Patients with type 2 Diabetes in Lagos University Teaching Hospital

Background/Objective: Results from clinical trials over the past decade have established a base for specific screening and prophylactic recommendations in patients with type 2 diabetes aimed at achieving optimal metabolic control and risk reduction for the development of chronic complications. We aimed to assess implementation of guidelines of diabetes care based on internationally accepted recommendations of the American Diabetes Association, in patients receiving treatment at the Diabetes clinic of the Lagos University Teaching Hospital. Methods: A cross sectional prospective study involving 114 patients from the Diabetes clinic of the Lagos University Teaching Hospital was carried out. Pre-tested questionnaires were administered. Aspects of plasma glucose, glycated haemoglobin testing, self monitoring of blood or urine glucose, and risk reduction using blood pressure measurements, foot examination, retinal examination, urine microalbumin screening, lipid assay, anti-platelet and ACE inhibitor therapy. The period the questionnaire referred to was the last 1 year of patient care. Results: A total of 63 males, 51 females were seen with type 2 diabetes with a mean age of 56.58+11.2 years. Mean duration of diabetes was 10.8±6.5years, mean BMI was 26.67+5.7kg/m2. Mean fasting plasma glucose was 162+20.4mg/dl. Only 14% of the patients had glycated haemoglobin measurement in the period under review with a mean HbA1c of 10.5+2.0%. All patients had regular blood pressure measurements during clinic visits, (average of 2-3 months) with mean blood pressure of 136.8+19.4/86.3+14.9 mmHg. 71% had foot examination during clinic visits, 48% had dilated fundoscopy, 92% had regular dipstix urinalysis during clinic visits, 50% practiced self monitoring of urine or blood glucose, 61% had regular lipid profiles, 49% were on anti-platelet aspirin therapy and 37.7% were on ACE inhibitors. Conclusion: Certain aspects of the recommendations of standards of medical care are below average. Indices of metabolic control show that the patients seen have poor glycaemic control and sub-optimal blood pressure control. Some aspects of care (glycated haemoglobin, self monitoring) possibly reflect adverse socioeconomic conditions while some possibly reflect inadequate information on the part of the attending residents or physicians. NQJHM Vol. 16 (1) 2005: pp. 6-9

A randomized pilot study in Type 1 diabetes complicated by severe hypoglycaemia, comparing rigorous hypoglycaemia avoidance with insulin analogue therapy, CSII or education alone

To determine potential for amelioration of recurrent severe hypoglycaemia without worsening in overall control in individuals with long-standing Type 1 diabetes (T1DM). Twenty-one people with T1DM characterized by altered hypoglycaemia awareness and debilitating severe hypoglycaemia were randomized in a pilot 24-week prospective study to optimized analogue therapy (ANALOGUE; lispro/glargine); continuous subcutaneous insulin infusion therapy (CSII; lispro); or re-education with relaxation of blood glucose targets on existing conventional insulin regimen (EDUCATION). Glycaemic profiles and duration of biochemical hypoglycaemia were measured by continuous subcutaneous glucose monitoring and self-monitored blood glucose. Further severe hypoglycaemia was prevented in five participants (71%) in each group (P = 0.06). Incidence of severe hypoglycaemia was: 0.6 (ANALOGUE), 0.9 (CSII), and 3.7 (EDUCATION) episodes per patient year. Restoration of hypoglycaemia awareness was confirmed by validated questionnaire in three (43%) ANALOGUE, four (57%) CSII and five (71%) EDUCATION patients. Glycated haemoglobin (HbA1c) was significantly improved in the ANALOGUE group between weeks 0 and 24 (8.6 +/- 1.1 vs. 7.6 +/- 0.8%; P = 0.04 for change). Non-significant improvement was seen in the CSII group (8.5 +/- 1.9 vs. 7.4 +/- 1.0%; P = 0.06). No change in HbA1c was seen in the EDUCATION group (8.5 +/- 1.1 vs. 8.3 +/- 1.0%; P = 0.54). There were no episodes of diabetic ketoacidosis or any other adverse events in any group. In this pilot randomized trial comparing optimized ANALOGUE, CSII or EDUCATION alone in unselected individuals with recurrent severe hypoglycaemia, we show potential for restoring hypoglycaemia awareness and preventing further severe hypoglycaemia with concomitant improvement in glycaemic control in ANALOGUE and CSII groups.

Use of complementary and alternative medicine among people living with diabetes: literature review

This paper is a report of a literature review to explore the prevalence of complementary and alternative medicine use amongst people with diabetes to inform nursing practice, education and research. Diabetes mellitus affects the entirety of a person's being and increasingly people use complementary and alternative medicine in conjunction with other medical treatments and lifestyle modifications to manage their condition and improve well-being. The CINAHL, Medline, ProQuest nursing journals and Psych INFO databases were searched for the period 1990-2006 using identified keywords. A total of 18 studies from nine countries were found. The results suggest that the prevalence of complementary and alternative medicine use among people with diabetes ranges from 17% to 72.8%. The most widely used therapies among diabetic populations are nutritional supplements, herbal medicines, nutritional advice, spiritual healing and relaxation techniques. The characteristics which influence complementary and alternative medicine use are age, duration of diabetes, degree of complications and self-monitoring of blood glucose. Although inconsistency in the definition of complementary and alternative medicine and varying research designs make estimation of usage prevalence difficult, evidence suggests that a high proportion of people with diabetes use these therapies concurrently with conventional healthcare services. Healthcare professionals need to be aware of this issue and may need to incorporate complementary and alternative medicine information into patient assessment and intervention.

Achieving fasting and postprandial blood glucose control in type 2 diabetes

Until the availability of glycated haemoglobin, laboratory fasting plasma glucose was the measurement against which insulin doses were most commonly titrated. More recently, evidence has accumulated that self-monitored postprandial blood glucose may be at least as useful in adjusting treatment.

The influence of glucose self-monitoring on glycaemic control in patients with diabetes mellitus in Sudan

Objective To investigate the influence of self-monitoring of glucose on the glycaemic control in Sudanese diabetic subjects. Subjects and methods A group of 193 consecutive type 2 and type 1 diabetic subjects (95 men, 98 women) were studied. In 104 subjects with type 2 diabetes fasting blood glucose was measured using a glucose meter and blood was obtained for serum glucose measurement in the laboratory. In the remaining 89 diabetic subjects random blood glucose was measured using the same glucose meter and a whole blood sample was drawn for laboratory assessment of HbA1c. Data on self-monitoring and other clinical and personal characteristics were recorded. Results More than 75% of either type 1 and type 2 diabetic patients never self-monitored blood or urine glucose. In type 2 diabetic subjects self-monitoring of blood or urine glucose was not related to glycaemic control. In type 1 diabetic subjects, however, self-monitoring of blood glucose was significantly associated with better glycaemic control, as assessed by HbA1c ( P = 0.02) and blood glucose at clinic visits ( P ≤ 0.0001), and similar associations were found for urine glucose self-monitoring ( P = 0.04 and 0.02) respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level. Conclusions Self-monitoring of blood glucose was not found to be associated to better glycaemic control in Sudanese subjects with type 2 diabetes. In contrast, self-monitoring of both blood and urine glucose was significantly associated with glycaemic control in subjects with type 1 diabetes. Self-monitoring of urine glucose could be useful where measurement of blood glucose is not available or affordable.

Proposal to Add an Optional Recommendations Section to Clinical Chemistry Abstracts

This journal uses a structured abstract with the topic headings Background , Methods , Results , and Conclusions . This format or a similar one is widely used by medical journals and facilitates comprehension (1). Among other possible topic headings is Recommendations . This heading would improve the effectiveness of abstracts by more clearly representing article content and by highlighting advice in the cases when it is appropriate. Conclusions are different from Recommendations . Conclusions are a concise summary of the results based on the data. Recommendations are advice given to the reader based on the conclusions. To illustrate the difference between these two terms, consider a recent article about glucose meters (2). In the abstract, the first sentence under Conclusions is a conclusion: “The analytical quality of SMBG [self-monitoring of blood …

ISPAD DECLARATION OF KOS

On September 4, 1993, on the island of Kos, the members of the International Study Group of Diabetes in Children and Adolescents (ISGD), assembled at our 19th annual international scientific meeting and in the process of transforming ISGD into the International Society of Pediatric and Adolescent Diabetes (ISPAD), renew their Hippocratic Oath by proclaiming their commitment to implement the St Vincent Declaration to promote optimal health, social welfare, and quality of life for all children and adolescents with diabetes around the world by the year 2000. We take this unique opportunity to reaffirm the commitments by diabetes specialists in the past and, in particular, unanimously pledge to work towards the following: 1. to make insulin available for all children and adolescents with diabetes; 2. to reduce the morbidity and mortality rate of acute metabolic complications or missed diagnosis related to diabetes mellitus; 3. to make age-appropriate care and education accessible to all children and adolescents with diabetes as well as to their families; 4. to increase the availability of appropriate urine and blood self-monitoring equipment for all children and adolescents with diabetes; 5. to develop and encourage research on diabetes in children and adolescents around the world; and 6. to prepare and disseminate written guidelines and standards for practical and realistic insulin treatment, monitoring, nutrition, psychosocial care and education of young patients with diabetes—and their families—emphasizing the crucial role of health care professionals—and not just physicians—in these tasks around the world.

Portable Blood Pressure Monitoring for Borderline or Mild Hypertension During Pregnancy

Several advantages are apparent in the use of self-monitored or automatic ambulatory blood pressure monitoring by pregnant patients who appear to have borderline or mild hypertension. Home recordings, combined with conventional office measurements, can give a more accurate picture of the patient's dynamic blood pressure. Blood pressures are often lower outside the physician's office, probably because of the patient's increased awareness and decreased anxiety in other settings. When blood pressures are normal at home, the patient may be able to avoid antihypertensive therapy, antepartum hospitalization, and intervention during her pregnancy. Monitoring at home or work also provides a more thorough screening for preeclampsia, especially with patients who have chronic hypertension or other predisposing conditions.

Psychological stress and blood glucose regulation in Type I diabetic patients.

Fifteen Type I diabetic patients self-monitored daily mean blood glucose levels (BGL), psychological stress, diet, exercise, and insulin injections for a period of 8 weeks. Separate multiple-regression analyses were conducted for each subject to assess the predictability of BGL from stress reports, independent of the effects of diet, exercise, and insulin self-administration. Considerable individual variability in findings was evident, with stress predicting BGL in a statistically significant manner in 7 of the 15 subjects. Stress had a significant effect on BGL independent of diet, exercise, and insulin administration for each of these 7 subjects. Discussion focused on the problems of measuring the key self-management behaviors influencing BGL and on the possibility that a subgroup of diabetic patients may be BGL stress responders.

Relation of metabolic control to complications in diabetes mellitus

Insulin-dependent diabetes mellitus is the most common endocrine-metabolic disease of childhood, with a prevalence of one in 500 children younger than 18 years and an annual incidence of approximately 16 in 100,000 population? The metabolic derangements require daily treatment with insulin, attention to nutrition, and self-monitoring of blood or urine glucose. In addition, patients face the possibility of long-term complications involving the microvasculature and macrovasculature, risk they share with the larger group of patients with non-insulin-dependent diabetes mellitus. The complications are responsible for about 5000 annual cases of blindnes~ z and an increasing number of patients requiring dialysis and renal transplantation. 3 Diabetes mellitus is the leading cause of both new cases of blindness and end-stage renal disease in adults. Although these complications appear after puberty and usually after 10 to 15 years of established diabetes, by which time most patients are no longer under the care of their pediatrician, the genesis of the complications may occur during the early years of diabetes. It has long been debated, often with more heat than light, whether the complications result from the metabolic derangements of diabetes and whether they can be related to the degree of long-term metabolic control. The issue is more than just philosophic; if complications are related to the degree of metabolic control, then pediatricians caring for children with diabetes must recommend that patients Reprint requests: Mark A. Sperling, M.D., Division of Endocrinology, Children's Hospital Research Foundation, Cincinnati, OH 45229. maintain as near normal metabolism as is feasible and provide the level of care that allows patients to reach this goal. Physicians Cannot be expected to transmit such recommendations if they are not convinced of the possible relation between metabolic control and complications, and the potential benefits of good metabolic control. In 1976 an editorial in the Journal posed two questions regarding control of diabetes mellitus: Is it achievable? Is it desirable? 4 Evidence accumulated in the ensuing interval has decidedly swung the balance in favor of an affirmative response to the second question, at least. We review the clinical evidence linking long-term microvascular compli