Difference Analysis of System Accuracy Criteria between Self-Monitoring Blood Glucose Test System and Point-of-Care Blood Glucose Monitoring Systems / 中国医疗器械杂志

According to users and places, blood glucose monitoring systems(BGMSs) can be divided into self-monitoring blood glucose test systems(SMBGs) and Point-of-Care Blood Glucose monitoring systems(POC-BGMSs). The Food and Drug Administration(FDA) believes that standards for SMBGs and POC-BGMSs should be different because of different operators, different use environments, different intendance uses and different applicable populations. Now the international standards for evaluating BGMSs include ISO 15197:2013 issued by International Organization for Standardization(ISO), two guidelines on blood glucose monitoring systems issued by FDA, and POCT12-A3 guidelines issued by the American Association for Clinical and Laboratory Standardization(CLSI), ISO standard and FDA guideline-OTC are applicable in SMBGs, CLSI guideline and FDA guideline-POCTI2-A3 are suitable for POC-BGMSs. By analyzing the accuracy evaluation processes of BGMSs based on four standard documents, it is found that the accuracy evaluation of medical BGMSs is more stringent. It is proposed that SMBGs and POC-BGMSs should be supervised separately.

Glucose monitoring for diabetes in children / 中华实用儿科临床杂志

Blood glucose monitoring is a tool to guide medical nutrition therapy,exercise intensity and time,and helps to effectively prevent hypoglycemia and adjust insulin treatment programs.It is an important part of comprehensive treatment of diabetes mellitus.Continuous glucose monitoring (CGM),as a supplement to self-monitoring blood glucose,helps to reduce the incidence of hypoglycemia and the duration of hypoglycemia in diabetic children.In addition,parents and children are satisfied with CGM,so it is increasingly used in children with diabetes mellitus.However,current research and clinical experience have shown that it is not entirely possible to rely on CGM values for treatment adjustment in children.Success with CGM requires detailed education and training in diabetes management coupled with extensive training in the use of CGM.

Glucose monitoring for diabetes in children / 中华实用儿科临床杂志

Blood glucose monitoring is a tool to guide medical nutrition therapy, exercise intensity and time, and helps to effectively prevent hypoglycemia and adjust insulin treatment programs.It is an important part of comprehensive treatment of diabetes mellitus.Continuous glucose monitoring (CGM), as a supplement to self-monitoring blood glucose, helps to reduce the incidence of hypoglycemia and the duration of hypoglycemia in diabetic children.In addition, parents and children are satisfied with CGM, so it is increasingly used in children with diabetes mellitus.However, current research and clinical experience have shown that it is not entirely possible to rely on CGM values for treatment adjustment in children.Success with CGM requires detailed education and training in diabetes management coupled with extensive training in the use of CGM.

Progress in clinical application of glycated albumin / 中华检验医学杂志

Monitoring blood glucose level timely and accurately and management of glucose level is crucial for the treatment of diabetes and the prevention of diabetic complications. Glycated albumin is one of the important biomarker to evaluate the fluctuation of blood glucose level, which has been widely used in clinic. To understand the advantages and limitations of the glycated albumin in monitoring glucose level will contribute to its better application in clinic.

Health Beliefs Predict Self-Care Practices And Glycaemic Control In Malaysian Patients With Insulin-Treated Diabetes: A Longitudinal Study

@#The practice of diabetes self-care plays an important role in achieving and maintaining good glycaemic control. However, not all patients with insulin-treated diabetes engage in their self-care activities. There is some evidence that self-care practices in patients with insulin-treated diabetes can be understood and predicted by their health beliefs, although studies are often hampered by methodological weaknesses, and the fact that less is known about adults with insulin-treated diabetes in Malaysia. This study was conducted to examine whether health beliefs (as specified in the Health Belief Model: HBM) can predict self-care practices and glycaemic control in patients with insulin-treated diabetes in Malaysia. Longitudinal design with self-reported questionnaire measures was administered at baseline (Time 1:T1) and six months later (Time 2: T2). Participants were recruited from three endocrinology clinics in Malaysia. The measures included self-care practices (diet, insulin intake, exercise and self-blood glucose monitoring: SMBG), health beliefs and diabetes knowledge. Participants’ glycaemic control was examined based on their glycated hemoglobin (HbA1c) results. Data analysis was performed at different points of the study times; T1, T1-T2 and T2. Diabetes knowledge and demographic data were controlled for in predictive statistical analyses. A total of 159 patients with insulin-treated diabetes (aged 18-40 years) completed the measures at T1. Of these, only 108 (67.9%) completed follow-up measures at T2. However, demographic characteristics were not significantly different between those who completed and dropped out of the study (p>0.05). The HBM was significantly predictive of diet self-care at T2, insulin intake practice at T1 and HbA1c at T1-T2 andT2. Of the HBM constructs, perceived benefits significantly predicted good dietary habits at T1 (OR 1.92) and T2 (OR .23) and adherence to insulin injection at T1 (OR 3.17) and T1-T2 (OR 2.68). With the exception of perceived severity, all other HBM constructs significantly predicted HbA1c [perceived susceptibility (β .169) at T1, perceived barriers (β -.206) and perceived benefits (β -.397) at T2 and cues to action (β -.233) at T1-T2]. Health beliefs predict self-care practices and glycaemic control in young to middle-aged adults with insulin-treated diabetes in Malaysia. Diabetes educators could use this knowledge in their efforts to improve diabetes self-care in this patient groupby modifying those beliefs through their diabetes education.

Practice Of Self-Monitoring Blood Glucose Among Insulin-treated Diabetic Patients In Hospital Serdang

Background: Diabetes Mellitus (DM), characterised by chronic hyperglycaemia, exposes patients to acute and chronic complications, such as hypoglycaemia and vascular complications, respectively. The latter is associated with the degree of glycaemic control. Glycated haemoglobin (HbA1c) indicates long-term glycaemic control of the preceding 2-3 months. The practice of self-monitoring blood glucose (SMBG) is essential for insulin-treated diabetic patients to achieve optimum glycaemic control and prevent hypoglycaemia. Aim: The study aimed to determine the SMBG practice and frequency and its association with HbA1c and factors in insulin-treated diabetic patients. Methods: This was a cross-sectional study of insulin-treated diabetic patients attending follow-up at the diabetic clinic of Hospital Serdang from April 2015 to August 2015. Consented eligible patients completed validated selfadministered questionnaires. Patients’ HbA1c results were obtained from the hospital information system. Results: Ninetyone of 137 (66%) patients practiced SMBG and 46 (34%) did not. Although 82% had seen diabetic nurses, 54% of patients did not alter their treatment accordingly. Neither the practice nor the frequency of SMBG was significantly associated with differences in HbA1c levels (p=0.334 and p=0.116 respectively). Ethnicity and household income significantly affected SMBG practice. The presence and frequency of hypoglycaemia significantly increased the likelihood of SMBG practice (p<0.001) and frequency (p<0.001). Conclusions: The prevalence of SMBG practice in diabetic patients on insulin was 66%. However, SMBG was not followed by proper treatment alteration in 54% of patients. There was no association between SMBG practice and frequency with good glycaemic control. Hypoglycaemia significantly affected the practice and frequency of SMBG.

Avaliação da frutosamina como parâmetro de controle glicêmico na gestante diabética / Evaluation of fructosamine as a parameter of blood glucose control in diabetic pregnant women

Objetivo Avaliar parâmetros alternativos para monitorar a glicemia em portadoras de diabetes na gestação estudando a relação entre a frutosamina e a automonitoração em gestantes portadoras de diabetes. Materiais e métodos: A frutosamina sérica e os parâmetros da automonitoração nos 14 dias que antecederam a coleta da frutosamina foram avaliados em 47 gestantes portadoras de diabetes. Resultados Setenta e uma determinações de frutosamina e 2.238 glicemias capilares (GCs) foram analisadas. A frutosamina correlacionou-se com o índice de excursões hiperglicêmicas (HBGI) e o desvio-padrão das glicemias (r = 0,28; p = 0,021 e r = 0,26; p = 0,03, respectivamente). A comparação entre as mães dos neonatos com peso adequado ou grandes ao nascer com as genitoras que tiveram neonatos pequenos para a idade gestacional (PIG) revelou que estas tiveram menor média glicêmica (105 vs. 114 e 119 mg/dL), maior índice de excursões hipoglicêmicas (5,8 vs. 1,3 e 0,7) e maior percentual de hipoglicemias (11 vs. 0 e 0%) mesmo com frutosamina dentro dos valores de referência (242 vs. 218 e 213 μmol/l). Conclusão A frutosamina pode ser utilizada como parâmetro auxiliar à automonitoração para avaliação de hiperglicemias e variabilidade glicêmica, entretanto pode subestimar hipoglicemias em gestantes com fetos PIG. .

Objective To evaluate the alternative parameters to monitor glycemia in pregnant women with diabetes studying the relationship between fructosamine testing and self monitoring of blood glucose in pregnant women with diabetes. Materials and methods Serum fructosamine levels and the self monitoring of blood glucose over 14 days before the collection of fructosamine were evaluated in 47 diabetic pregnant women. Results Seventy-one fructosamine levels and 2,238 glucose measurements (CGs) were analysed. Levels of fructosamine correlated with high blood glucose index (HBGI) and the standard deviation of glycemias (r = 0.28; p = 0.021 and r = 0.26; p = 0.03, respectively). The comparison between the mothers of the newborns with appropriated or large birthweight and those who gave birth to small newborns for their gestational age (SGA) showed that the latter had a lower glycemic mean (105 vs. 114 and 119 mg/dL), a higher low blood glucose index (5.8 vs. 1.3 and 0.7) and a higher percentage of hyperglycemias (11 vs. 0 and 0%) even when the fructosamine falls within the reference values (242 vs. 218 and 213 μmol/l). Conclusion The levels of fructosamine can be used as further parameter to aid self monitoring of blood glucose to evaluate hyperglycemias and glycemic variability, however, this can underestimate hypoglycemias in pregnant women carrying small-for-gestational age fetuses. .

Glycemic control and management of type 1 diabetes mellitus children in Beijing during 10 years / 中华实用儿科临床杂志

Objective To compare the anterior-posterior decade glycemic control with improvement of diabetes management and evaluate the influence of socioeconomic factors on glycemic control.Methods This cross-sectional clinical-based survey enrolled 158 with type 1 diabetes mellitus (T1DM) children from Sep.2011 to May 2012 (group A) in Beijing Children's Hospital of more than 1 year management and compared with 123 children with T1DM who were recruited in Asia and the West Pacific Region T1DM Study from Sep.2001 to May 2002 (Group B) in Beijing Children's Hospital.Normally distributed data were reported,linear correlation and regression analysis were performed for glycemic control.Results There was no complication in the both groups.The average of hemoglobin A1C(HbA1C) in group A was (8.50 ± 1.53) ％,better than that of group B [(9.90 ± 1.85) ％,P =0.000].The ratio of optimal and suboptimal HbA1C in group A and group B were 15.0 ％ vs 10.6％,while the ratio of suboptimal HbA1C in group A and group B were 52.5 ％ vs 25.2％,respectively,there were significantly statistical differences (all P =0.000).The ratio of insulin injection twice daily in group A and group B were 43.0％ vs 92.6％,respectively and the ratio of multiple daily injection and continuous subcutaneous insulin injection were increasing significantly 10 years after.The frequency of self-monitoring blood glucose(SMBG) between 60-120 times per month and over 120 times per month in group A was 45.5％ and 37.8％,while 0.8％,0 in group B,respectively,there was significant statistical difference (P =0.000).HbA 1C was positively correlated with age,duration,insulin dosage per day while inversely correlated with frequency of SMBG in liner correlation and regression analysis.It was showed that duration was the most important factor for HbA1C.Conclusions There were younger with T1DM in Beijing Children's Hospital.The frequency of SMBG and the ratio of multiple daily injection and continuous subcutaneous insulin injection were increasing significantly after 10 years.Duration was the most important factor for glycemic control.There was no complication in children with T1DM.Glycemic control would be better due to improvement of SMBG and increase of the frequency of insulin injection.

Estimating Average Glucose Levels from Glycated Albumin in Patients with End-Stage Renal Disease

PURPOSE: In patients with diabetic end stage renal disease (ESRD), glycated albumin (GA) reflects recent glycemic control more accurately than glycated hemoglobin (HbA1c). We evaluated the relationship between GA and average blood glucose (AG) level and developed an estimating equation for translating GA values into easier-to-understand AG levels. MATERIALS AND METHODS: A total of 185 ESRD patients, including 154 diabetic and 31 non-diabetic participants, were enrolled (108 hemodialysis, 77 peritoneal dialysis). Patients were asked to perform four-point daily self-monitoring of capillary blood glucose (SMBG) at least three consecutive days each week for four weeks. Serum levels of GA, HbA1c and other biochemical parameters were checked at baseline, as well as at 4 and 8 weeks. RESULTS: Approximately 74.3+/-7.0 SMBG readings were obtained from each participant and mean AG was 169.1+/-48.2 mg/dL. The correlation coefficient between serum GA and AG levels (r=0.70, p<0.001) was higher than that of HbA1c and AG (r=0.54, p<0.001). Linear regression analysis yielded the following equation: estimated AG (eAG) (mg/dL)=4.71xGA%+73.35, and with this formula, serum GA levels could be easily translated to eAG levels. Multivariate analysis revealed significant contributions of postprandial hyperglycemia (beta=0.25, p=0.03) and serum albumin (beta=0.17, p=0.04) in determining serum GA level, independent to other clinical parameters. CONCLUSION: Compared to HbA1c, serum GA levels were better correlated with AG levels. Using the estimating equation, an average blood glucose level of 155-160 mg/dL could be matched to a GA value of 18-19% in patients with ESRD.

Diabetes Management and Hypoglycemia in Safety Sensitive Jobs

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs.