Correlación entre tiempo en rango y hemoglobina glicosilada en personas con diabetes mellitus: revisión sistemática / Correlation between time on target and glycated hemoglobin in people with diabetes mellitus: systematic review / Correlação entre tempo no alvo e hemoglobina glicada de pessoas com diabetes mellitus: revisão sistemática

Objetivo: analizar la correlación entre el tiempo en rango y la hemoglobina glicosilada de personas que viven con diabetes mellitus y realizan la monitorización continua de la glucemia o el automonitoreo de la glucemia capilar Método: revisión sistemática de etiología y riesgo basada en las directrices del JBI e informada según los Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abarcando seis bases de datos y la literatura gris. La muestra incluyó 16 estudios y la calidad metodológica fue evaluada utilizando las herramientas del JBI. Protocolo registrado en Open Science Framework, disponible en https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tiempo en rango (70-180 mg/dl) mostró una correlación negativa con la hemoglobina glicosilada, mientras que el tiempo por encima del rango (>180 mg/dl) mostró una correlación positiva. Los coeficientes de correlación variaron entre -0,310 y -0,869 para el tiempo en rango, y entre 0,66 y 0,934 para el tiempo por encima del rango. Un estudio se realizó en una población que hacía el automonitoreo. Conclusión: hay una correlación estadísticamente significativa entre el tiempo en rango y el tiempo por encima del rango con la hemoglobina glicosilada. Cuanto mayor sea la proporción en el rango glucémico adecuado, más cerca o por debajo del 7% estará la hemoglobina glicosilada. Se necesitan más estudios que evalúen esta métrica con datos del automonitoreo de la glucemia.

Objective: to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose. Method: systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB. Results: time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (>180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring. Conclusion: there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.

Objetivo: analisar a correlação entre o tempo no alvo e a hemoglobina glicada de pessoas que vivem com diabetes mellitus e realizam a monitorização contínua da glicemia ou a automonitorização da glicemia capilar. Método: revisão sistemática de etiologia e de risco pautada nas diretrizes do JBI e reportada conforme Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abrangendo seis bases de dados e a literatura cinzenta. A amostra incluiu 16 estudos e a qualidade metodológica foi avaliada utilizando as ferramentas do JBI. Registrado protocolo no Open Science Framework, disponível em https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tempo no alvo (70-180 mg/dl) apresentou correlação negativa com a hemoglobina glicada, enquanto o tempo acima do alvo (>180 mg/dl) mostrou correlação positiva. Os coeficientes de correlação variaram entre -0,310 e -0,869 para o tempo no alvo, e entre 0,66 e 0,934 para o tempo acima do alvo. Um estudo foi efetuado com população que realizava a automonitorização. Conclusão: há correlação estatisticamente significativa entre o tempo no alvo e o tempo acima do alvo com a hemoglobina glicada. Quanto maior a proporção na faixa glicêmica adequada, mais próxima ou inferior a 7% estará a hemoglobina glicada. São necessários mais estudos que avaliem essa métrica com dados da automonitorização da glicemia.

The plasma Betatrophin level in pregnant women with gestational diabetes mellitus and its correlation with the control of blood glucose / 中国医师进修杂志

Objective:To investigate the level of plasma Betatrophin in pregnant women with gestational diabetes mellitus (GDM) and its correlation with the control of blood glucose.Methods:Forty-five pregnant women with GDM(GDM group) who received regular obstetric examinations in the Huaihua First People′s Hospital from July 2019 to January 2021 and 50 pregnant women with normal glucose tolerance (NGT) (NGT group) during the same period were enrolled in this study. Blood glucose and blood lipid indicators were collected, plasma Betatrophin level was detected, Logistic regression analysis was used to screen the influencing factors of blood glucose control effect, the pregnancy outcome was followed up, the predictive value of Betatrophin level in blood glucose control and pregnancy outcome was evaluated by receiver operating characteristic (ROC) curve.Results:The levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose (FPG), 2 h postpartum blood glucose (2 h PG), glycosylated hemoglobin (HbA 1c), fasting insulin (FINS), 2 h postprandial insulin (2 h FINS), insulin resistance index (HOMA-IR), low density lipoprotein cholesterin (LDL-C) and plasma Betatrophin in the GDM group were higher than those in the NGT group, and insulin function index (HOMA-β) and high density lipoprotein cholesterin (HDL-C) were lower than those in the NGT group ( P<0.05). Pearson correlation analysis showed that plasma Betatrophin level was positively correlated with HbA 1c and HOMA-IR in pregnant women and the GDM group ( r = 0.310, 0.314, 0.341, 0.333; P<0.05). In the GDM group, 12 patients with poor glucose control, 33 patients with good glucose control, the FPG, HbA 1c, HOMA-IR and plasma Betatrophin levels in poor glucose control patients were higher than those in good glucose control patients, HOMA-β was lower than that in the good glucose control patients: (5.82 ± 0.98)mmol/L vs. (5.04 ± 1.11) mmol/L, (9.78 ± 2.15)% vs. (8.22 ± 1.41)%, 2.71 ± 0.56 vs. 2.24 ± 0.48, (1 345.12 ± 256.32) ng/L vs. (1 165.10 ± 217.41) ng/L, 144.15 ± 22.71 vs. 158.63 ± 20.26, there were statistical differences ( P<0.05). The area under the curve of plasma Betatrophin level to predict the effect of blood glucose control was 0.775. A total of 8 pregnant women with GDM had poor pregnancy outcome, and the area under the curve predicted pregnancy outcome by plasma Betatrophin level was 0.728. Conclusions:The level of plasma Betatrophin in patients with GDM is closely related to the degree of insulin resistance and the effect of blood glucose control, and can provide some reference for clinical evaluation and therapeutic effect prediction.

Infodemiologia sobre protocolos de automonitoramento da glicemia capilar na internet brasileira / Infodemiology on capillary blood glucose self-monitoring protocols on the Brazilian internet

A Automonitoramento da Glicemia Capilar (AMGC) é importante ferramenta no controle da glicemia e no manejo do Diabetes mellitus (DM) e os protocolos de dispensação de insumos são orientados por diretrizes de tratamento e regulamentações específicas. O objetivo desse estudo infodemiológico foi analisar as publicações na internet brasileira sobre protocolos AMGC por Secretarias Municipais e/ou Estaduais de saúde disponíveis em websites brasileiros. Para a busca foi utilizada a ferramenta Google e identificadas 286 URL. A pesquisa identificou 23 protocolos disponíveis em sites governamentais, revelando sendo que 10 (43,47%) são da região Sudeste, todos os protocolos definiram o diagnóstico de Diabetes mellitus (DM) tipo 1, DM tipo 2 em uso de insulina e DM gestacional (DMG), em 11 protocolos (47.8%) o fornecimento mensal de tiras de glicemia capilar é realizado pela farmácia e a quantidade variou de 30 até 120 tiras conforme o tipo de diabetes e uso de insulina. Os protocolos analisados enfatizam a importância da educação em DM, com 60,8% deles incorporando programas educacionais. Apesar da dinamicidade da informação na internet ressaltase a necessidade de transparência nos critérios de inclusão e manutenção do fornecimento das TGC, qualificando o cuidado ao paciente com DM. A elaboração e divulgação de protocolos fortalecem a transparência do SUS, auxiliam na organização dos fluxos de documentos entre os profissionais envolvidos e o acesso equitativo aos insumos.

Self-Monitoring of Blood Glucose (SMBG) is an important tool in controlling blood glucose and managing Diabetes mellitus (DM) and input dispensing protocols are guided by treatment guidelines and specific regulations. The objective of this infodemiological study was to analyze publications on the Brazilian internet about SMBG protocols by Municipal and/or State Health Departments available on Brazilian websites. For the search, the Google tool was used and 286 URLs were identified. The research identified 23 protocols available on government websites, revealing that 10 (43.47%) are from the Southeast region, all protocols defined the diagnosis of Diabetes mellitus (DM) type 1, type 2 DM using insulin and gestational DM (GDM), in 11 protocols (47.8%) the monthly supply of capillary blood glucose test strips is provided by the pharmacy and the quantity varies from 30 to 120 strips depending on the type of diabetes and insulin use. The protocols analyzed emphasize the importance of DM education, with 60.8% of them incorporating educational programs. Despite the dynamics of information on the internet, the need for transparency in the inclusion criteria and maintenance of the supply of BGTS is highlighted, qualifying care for patients with DM. The development and dissemination of protocols strengthens the transparency of the SUS, assists in the organization of document flows between the professionals involved and equitable access to inputs.

Flash glucose monitoring system in special situations

ABSTRACT The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.

Recomendaciones para la práctica clínica sobre el manejo de la actividad física, ejercicio y deporte en niños, niñas y adolescentes con diabetes mellitus tipo 1 / Management of type 1 diabetes mellitus about physical activity, exercise and sports in children and adolescents

La presente recomendación busca brindar un marco de seguridad para la prescripción de actividad física en niños, niñas y adolescentes con diabetes mellitus tipo 1 (DM1), considerando la evaluación de las situaciones que puedan presentarse antes, durante y después de su práctica. Incluye las estrategias terapéuticas sobre el tipo de ejercicio, el control glucémico capilar (o mediante el uso de monitoreo continuo de glucosa, MCG) y la adecuación de la insulinoterapia y de la ingesta de hidratos de carbono. Se prioriza que, para optimizar los beneficios del ejercicio como parte del tratamiento de la DM1, es importante una completa y constante educación diabetológica para el paciente y sus cuidadores brindada por un equipo interdisciplinario entrenado en el manejo integral de niños, niñas y adolescentes con DM1.

These recommendations seek to provide a safety framework for the prescription of physical activity in children and adolescents with DM1, considering the evaluation of the situations that may arise before, during and after the practice of physical activity. It includes therapeutic strategies on the type of exercise, intensive capillary glycemic control or through the use of continuous glucose monitoring (CGM) and the adequacy of insulin therapy and carbohydrate intake. It is prioritized that to optimize the benefits of exercise as part of the treatment of DM1, a complete and constant diabetes education is important, provided by an interdisciplinary team trained in the comprehensive management of children and adolescents with DM1

Monitoreo continuo de glucosa durante la gestación en pacientes con diabetes mellitus tipo 2 pregestacional

La diabetes pregestacional requiere un control glicémico estricto durante el embarazo. Los dispositivos de monitoreo continuo de glucosa (MCG) miden niveles de glucosa intersticial sin necesidad de punción capilar. Se estudió 4 gestantes con diabetes mellitus tipo 2 pregestacional con la ayuda del MCG durante 2 semanas de su gestación. Ellas tuvieron sesiones nutricionales semanales y controles médicos con un endocrinólogo. El promedio de nivel de glucosa osciló entre 82 y 171 mg/dL. El MCG permitió cambios tempranos en el tratamiento de una paciente con hipoglicemia. Todas las pacientes manifestaron que el MCG les ayudó en la selección de sus alimentos. En conclusión, el MCG ayudó en el reconocimiento de carbohidratos y en el reajuste del tratamiento. El MCG tuvo buena aceptación de su uso.

Pregestational diabetes requires strict glycemic control during pregnancy. Continuous glucose monitoring (CGM) devices measure interstitial glucose levels without the need for capillary puncture. Four pregnant women with pregestational type 2 diabetes mellitus were studied with the aid of CGM during 2 weeks of their gestation. They had weekly nutritional sessions and medical controls with an endocrinologist. The average glucose level ranged from 82 to 171 mg/dL. The CGM allowed early changes in the treatment of one patient with hypoglycemia. All patients stated that the GCM helped them in their food selection. In conclusion, the GCM helped in carbohydrate recognition and treatment readjustment. The CGM was well accepted for use.

Consensus for the use of flash glucose monitoring in the Colombian adult population with type 1 and 2 diabetes mellitus / Consenso para el uso de monitoreo de glucosa flash en la población adulta colombiana con diabetes mellitus tipo 1 y 2

Abstract Introduction: in Colombia, the Clinical Practice Guidelines for the treatment of patients with type 1 (DM1) and type 2 (DM2) diabetes do not mention the use of flash glucose monitoring, as this system was not available. The objective of this study was to establish a set of recommendations for the use of intermittent flash monitoring in Colombia. Methods: the group of experts consisted of eight Colombian physicians from different cities within Colombia, with expertise in the management of patients with DM1 and DM2; a certified diabetes nurse educator; a patient with DM1; and a methodological expert. Using the Zoom Enterprise video conferencing application (Zoom Video Communications, San Jose, California), the group generated questions through the Metaplan method, then carried out a systematic literature search and evidence review. The recommendations were made according to the degree of evidence and strength of the recommendation, following the GRADE method. Results: clinical recommendations were made for: a) patients with DM1 and hypoglycemia; b) patients with DM1 and poor metabolic control; c) patients with insulin-treated DM2; d) pregestational diabetes; e) quality of life; and f) inpatient use. Conclusions: this consensus's clinical recommendations guide clinical decision making with regard to the use of intermittent flash monitoring in patients with diabetes in various clinical settings. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2239).

Resumen Introducción: en Colombia las Guías de Práctica Clínica para el manejo del paciente con diabetes tipo 1 (DM1) y tipo 2 (DM2) no mencionan el uso del monitoreo de glucosa flash dado que dicho sistema no estaba disponible. El objetivo del presente trabajo fue establecer un grupo de recomendaciones sobre el uso del monitoreo intermitente flash en Colombia. Métodos: el grupo de expertos estuvo conformado por ocho médicos colombianos expertos en el manejo de pacientes con DM1 y DM2 de diversas ciudades de Colombia, una enfermera licenciada educadora en diabetes, una paciente con diagnóstico de DM1 y un experto metodológico. A través de Zoom Enterprise versión de la aplicación de videoconferencia Zoom (Zoom Video Communications, San Jose, California) el grupo generó las preguntas con metodología Metaplan. Posteriormente, se realizó una búsqueda sistemática de la literatura y análisis de la evidencia. Las recomendaciones se generaron mediante grupo nominal según el grado de evidencia y la formaleza de la recomendación siguiendo la metodología GRADE. Resultados: se generaron recomendaciones clínicas enfocadas a: a) paciente con diagnóstico de DM1 e hipoglucemia; b) paciente con diagnóstico de DM1 y mal control metabólico, c) paciente con diagnóstico de DM tipo 2 tratado con insulina, d) diabetes pregestacional, e) calidad de vida y f) uso intrahospitalario. Conclusiones: las recomendaciones clínicas del presente consenso orientan la toma de decisiones clínicas con respecto al uso de monitoreo intermitente flash en el paciente con diagnóstico de diabetes en diferentes escenarios clínicos. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2239).

Recomendaciones para la práctica clínica sobre el manejo de la actividad física, ejercicio y deporte en niños, niñas y adolescentes con diabetes mellitus tipo 1 / Management of type 1 diabetes mellitus about physical activity, exercise and sports in children and adolescents

Resumen La presente recomendación busca brindar un marco de seguridad para la prescripción de actividad física en niños, niñas y adolescentes con diabetes mellitus tipo 1 (DM1), considerando la evaluación de las situaciones que puedan presentarse antes, durante y después de su práctica. Incluye las estrategias terapéuticas sobre el tipo de ejercicio, el control glucémico capilar(o mediante el uso de monitoreo continuo de glucosa, MCG) y la adecuación de la insulinoterapia y de la ingesta de hidratos de carbono. Se prioriza que, para optimizar los beneficios del ejercicio como parte del tratamiento de la DM1, es importante una complete y constant educación diabetológica para el paciente y sus cuidadores brindada por un equipo interdisciplinario entrenado en el manejo integral de niños, niñas y adolescentescon DM1.

Abstract These recommendations seek to provide a safety framework for the prescription of physical activity in children and adolescents with DM1, considering the evaluation of the situations that may arise before, during and after the practice of physical activity. It includes therapeutic strategies on the type of exercise, intensive capillary glycemic control or through the use of continuous glucose monitoring (CGM) and the adequacy of insulin therapy and carbohydrate intake. It is prioritized that to optimize the benefits of exercise as part of the treatment of DM1, a complete and constant diabetes education is important, provided by an interdisciplinary team trained in the comprehensive management of children and adolescents with DM1.

Psychometric properties of the portuguese self-monitoring scale: a reduced item version / Propriedades psicométricas da escala portuguesa de self-monitoring: uma versão reduzida / Propiedades psicométricas de la escala portuguesa de self-monitoring: una versión reducida

This study aimed to contribute to the adaptation of the Self-Monitoring Scale for a Portuguese sample and the examination of the possibility of reducing the scale's length. Considering the psychometric inconsistency of the scale reported in the literature, several analysis criteria to identify the number of factors to be retained were considered. The study included 791 Portuguese men and women aged 17 to 61 years. Data analysis included descriptive statistics, confirmatory factor analysis to assess construct validity, Cronbach's alpha to assess internal consistency, and fit indices (based on IRT). The results indicate a two-dimensional structure with a reduction to 9 items, which shows good values for validity and fit. This study proposes a reduced version of the self-monitoring scale for a Portuguese sample, considering that the use of this method is valuable to identify how individuals differ in the way they present themselves in social situations. (AU)

Este estudo tem como objetivo contribuir para a adaptação da Self-Monitoring Scale numa amostra Portuguesa e análise da possibilidade de reduzir o tamanho da escala. Além disso, e considerando a inconsistência psicométrica da escala relatada na literatura, foram considerados vários critérios de análise para identificar o número de fatores a reter. O estudo abrangeu 791 homens e mulheres Portugueses com idades entre os 17 e os 61 anos. A análise dos dados incluiu estatística descritiva, validade de construto (Análise Fatorial Confirmatória), consistência interna e índice de ajustamento (TRI). Os resultados apontam para uma estrutura bidimensional com uma redução para 9 itens, mostrando bons valores de validade e ajustamento. Este estudo propõe uma versão reduzida da escala de self-monitoramento para uma amostra Portuguesa, considerando que a utilização deste método é uma mais-valia para identificar como os indivíduos diferem na forma como se apresentam em situações sociais. (AU)

Este estudio tiene como objetivo contribuir a la adaptación de la Self-Monitoring Scale en una muestra portuguesa y analizar la posibilidad de reducir el tamaño de la escala. Además, teniendo en cuenta la inconsistencia psicométrica de la escala reportada en la literatura, se consideraron varios criterios de análisis para identificar el número de factores a retener. El estudio incluyó a 791 hombres y mujeres portugueses de entre 17 y 61 años. El análisis de los datos incluyó estadística descriptiva, validez del constructo (Análisis Factorial Confirmatorio), consistencia interna e índice de ajuste (TRI). Los resultados apuntan a una estructura bidimensional con una reducción a 9 ítems, mostrando buenos índices de validez y ajuste. Este estudio propone una versión reducida de la escala de automonitoramento para una muestra portuguesa, mientras que el uso de este método es particularmente valioso para identificar cómo los individuos se diferencian en la forma en que se presentan en situaciones sociales. (AU)

Research progress on blood glucose monitoring strategy of hyperglycemia during pregnancy / 中国医师杂志

Gestational hyperglycemia is increasing all over the world and leads to serious maternal and infant complications. Effective blood glucose monitoring helps to improve adverse pregnancy outcomes. Therefore, blood glucose monitoring plays a vital role in blood glucose control of patients with gestational hyperglycemia. The current blood glucose monitoring methods include self-monitoring blood glucose (SMBG), glycosylated hemoglobin (HbA 1c), glycosylated albumin (GA), continuous blood glucose monitoring (CGM) and time within glucose target range (TIR). Different blood glucose monitoring methods have their advantages and limitations. This paper reviews the latest research progress on the application value of different blood glucose monitoring methods in patients with hyperglycemia during pregnancy at home and abroad.

Analysis of correlation of glucose dosage by glycosimeter, laboratory dosage and artificial intelligence equipment / Correlação da dosagem de glicose por glicosímetro, dosagem laboratorial e de equipamento de inteligência artificial

ABSTRACT Introduction With the increasing number of cases related to Diabetes Mellitus (DM), glycemic control through laboratory methods or rapid tests is essential. Objective To analyze the correlation of three glucose determination methodologies (Glucometer, laboratory analysis and with point of care artificial intelligence equipment). Method Blood samples from the digital pulp and venous blood from the antecubital fossa were collected from 20 volunteers of different ages and sex. Blood glucose measurements were determined by the 3 methodologies mentioned above. Result Spearmans correlation analysis carried out between all types of tests shows that there is a strong and statistically significant positive correlation, indicating the compatibility of results regardless of the method applied. Conclusion The methodologies are correlated, however, the average values?? obtained by artificial intelligence were 40% higher, which can impact the clinical interpretation of results.

RESUMO Introdução Com o número crescente de casos relacionados a Diabetes Mellitus (DM), é indispensável o controle glicêmico através de métodos laboratoriais ou testes rápidos. Objetivo Analisar a correlação de três metodologias de determinação de glicose (Glicosímetro, análise laboratorial e com o equipamento com inteligência artificial de point of care). Método Foram coletadas amostras de sangue da polpa digital e sangue venoso da fossa antecubital de 20 voluntários de diferentes idades e sexo. Dosagens de glicose sanguínea foram determinadas pelas 3 metodologias acima citadas. Resultado A análise de correlação de Spearman realizada entre todos os tipos de testes mostra que há uma correlação positiva forte e estatisticamente significante, indicando a compatibilidade de resultados independentemente do método aplicado. Conclusão As metodologias apresentam correlação, no entanto, os valores médios obtidos pela inteligência artificial mostraram-se 40% mais elevada que pode impactar na interpretação clínica dos resultados.

National Institute of Mental Health Life Chart Method - Self/Prospective (NIMH-LCM-S/P™): translation and adaptation to Brazilian Portuguese

Abstract Objective The objective of this study was to translate and adapt the National Institute of Mental Health Life Chart Method - Self/Prospective (NIMH-LCM-S/P™) instrument for self-monitoring of mood into Brazilian Portuguese and provide evidence of content validity. Additionally, a user guide was prepared for the instrument and evaluated by mental health professionals. Methods The study was divided into two stages - Stage 1: Translation and cross-cultural adaptation and Stage 2: Determination of content validity index (CVI) scores. The translation and cross-cultural adaptation process involved 37 participants between translators, experts, target population, and evaluators. Results The CVI was evaluated by 15 mental health professionals. 11 (78.57%) of the items evaluated attained the maximum CVI score of 1.00, which constitutes the highest level of content validity, and no changes were suggested by participants. Only one of the items evaluated had a CVI score lower than 0.80. Conclusion The final translated and adapted version of the NIMH-LCM-S/P™ and its user guide were evaluated by the target population and the mental health professionals. Both groups displayed satisfactory comprehension levels, suggesting there is potential for using this instrument in clinical practice to assess therapeutic interventions in Brazilian settings.

Insumos para manejo do Diabetes Tipo 1 durante o distanciamento social por COVID-19 no Brasil / Supplies for Type 1 Diabetes management during COVID-19 social distancing in Brazil

O estudo analisou fatores socioeconômicos associados à aquisição de insumos para manejo da glicemia por pessoas com Diabetes Mellitus tipo 1 durante o distanciamento social pela Pandemia de COVID-19 no Brasil. Pesquisa transversal com coleta de dados realizada durante 21 dias do mês de julho de 2020, com um formulário online sobre dados socioeconômicos e aquisição de insumos para monitorização glicêmica. Foi aplicado o teste Qui-Quadrado de Pearson com análise de resíduos ajustados (p<0,05). Participaram 472 adultos de ambos os sexos. Foram encontradas associações entre o tipo de aparelho utilizado para monitorização glicêmica (glicosímetro ou sistema Flash) e renda (p<0,000), escolaridade (p=0,007), macrorregiões (p=0,049) e tipo de cidade (p=0,043); entre aquisição de insulinas e renda (p<0,000), macrorregião (p=0,027) e tipo de bairro (p=0,003); entre aquisição de fitas reagentes e renda (p<0,000); entre aquisição de lancetas e renda (p=0,001), tipo de cidade (p=0,035) e de bairro (p=0,010); entre o uso de Sistema Flash e renda (p<0,000) e tipo de bairro (p=0,006). Os resultados expõem as desigualdades sociais na aquisição de insumos para manejo da glicemia por pessoas com Diabetes Tipo 1 durante a Pandemia no Brasil.

This study analyzed socioeconomic factors related with the acquisition of supplies for blood glucose management by people with Type 1 Diabetes Mellitus during social distancing due to the COVID-19 Pandemic in Brazil. This was a cross-sectional study with data collected during 21 days in July 2020, by an online form on socioeconomic data and acquisition of supplies for glycemic monitoring. This research applied Pearson's Chi-Squared test with adjusted residual analysis (p<0.05). 472 adults of both sexes participated. Relationships were found between the type of device used for blood glucose monitoring (glucometer or Flash system) and income (p<0.000), education (p=0.007), macro-regions (p=0.049), and type of city (p=0.043); between insulin acquisition and income (p<0.000), macro-region (p=0.027) and type of neighborhood (p=0.003); between acquisition of reagent strips and income (p<0.000); between acquisition of lancets and income (p=0.001), type of city (p=0.035) and neighborhood (p=0.010); between the use of Flash System and income (p<0.000) and type of neighborhood (p=0.006). The results expose the social inequalities in the acquisition of supplies for blood glucose management by people with Type 1 Diabetes during the Pandemic in Brazil.

Autocuidado de usuários com diabetes mellitus inseridos em um programa de automonitorização da glicemia capilar / Self-care of users with diabetes mellitus entered into a program of capillary blood glucose self-monitoring / Autocuidado de los usuarios con diabetes mellitus entrado en un programa de la sangre capilar automonitorización de la glucosa

Objetivo: Avaliar o desempenho das atividades de autocuidado de usuários com diabetes mellitus inseridos em um programa de automonitorização da glicemia capilar no domicílio. Método: estudo transversal, descritivo, com abordagem quantitativa, realizado no domicílio de usuários com diabetes mellitus que realizam a automonitorização da glicemia capilar, totalizando uma amostra de 279 usuários. Na avaliação das atividades de autocuidado utilizou-se o Questionário de Atividades de Autocuidado com o Diabetes, e para coleta dos dados sociodemográficos e clínico foi aplicado um roteiro sistematizado. Resultados: os dados revelaram que as dimensões alimentação específica, atividade física e monitorização glicêmica demostra comportamento de autocuidado não desejável, enquanto adesão medicamentosa apresentou o melhor comportamento de autocuidado desejável. Conclusão: os usuários com diabetes mellitus que realizam a automonitorização da glicemia capilar no domicílio necessitam de um acompanhamento específico, acrescido de práticas educativas contínuas que estimulem a participação efetiva nas atividades de autocuidado

Objective:To evaluate the performance of self-care activities of users with diabetes mellitus entered into a program of capillary blood glucose self-monitoring at home. Method: cross-sectional study, descriptive, with a quantitative approach, held at the domicile of users with diabetes mellitus that perform capillary blood glucose self-monitoring, totaling a sample of 279 users. In the evaluation of the activities of self-care Questionnaire was used of Self-care activities with Diabetes, and to collect demographic and clinical data was applied a systematic roadmap. Results: the data revealed that the specific power supply dimensions, physical activity and monitoring Glycemic demonstrates behavior of self-care is not desirable, while drug membership presented the best self-care behavior desirable. Conclusión: users with diabetes mellitus that perform capillary blood glucose self-monitoring at home require a specific accompaniment, plus continuous educational practices that foster the effective participation in the activities of self-care

Objetivo: Evaluar el desempeño de las actividades de autocuidado de los usuarios con diabetes mellitus entró en un programa de sangre capilar glucosa autocontrol en casa. Método: estudio transversal descriptivo con enfoque cuantitativo, celebrada en el domicilio de los usuarios con diabetes mellitus que realizan sangre capilar Self-monitoring de la glucosa, por un total de una muestra de 279 usuarios. En la evaluación de las actividades de autocuidado se utilizó cuestionario de actividades de autocuidado con Diabetes, y recopilar datos demográficos y clínicos se aplicó un plan sistemático. Resultados:Los datos revelaron que la alimentación específicos dimensiones, actividad física y control glicémico demuestra comportamiento de autocuidado no es deseable, mientras que miembros de drogas presentaron el mejor comportamiento de autocuidado deseable. Conclusión: los usuarios con diabetes mellitus que realizan sangre capilar glucosa autocontrol en casa requieren de un acompañamiento específico, además de continuas prácticas educativas que fomentan la participación efectiva en las actividades de cuidados personales

Paciente adulto con diabetes mellitus tipo 1: múltiples factores para lograr un control adecuado. Reporte de caso / Adult patient with type 1 diabetes mellitus: multiple factors to achieve an adequate control

RESUMEN La diabetes mellitus tipo 1 (DM1) es una de las enfermedades crónicas más comunes de la infancia; sin embargo, un gran número de pacientes adultos viven con esta condición. La terapia con insulina es el pilar del tratamiento. Otros aspectos importantes son fomentar un estilo de vida saludable y lograr la adherencia a la medicación. Se presenta el caso de una mujer de 29 años con diagnóstico de diabetes mellitus tipo 1 hace 15 años. Describimos el manejo y evolución de los últimos 5 años y destacamos la importancia de las nuevas tecnologías, como el monitoreo continuo de glucosa, además de factores como la adherencia al tratamiento y el soporte familiar, los cuales fueron particularmente importantes para el control de la enfermedad de la paciente.

ABSTRACT Type 1 diabetes mellitus (T1DM) is one of the most common chronic childhood diseases. However, a large number of adult patients live with this condition. Insulin therapy is the cornerstone of diabetes treatment. Other important aspects are the promotion of a healthy lifestyle and the adhesion to medications. This is the case of a 29-year-old woman with a fifteen- year diagnosis of T1DM. Medical treatment and evolution over the last five years are described. The importance of new technologies such as continuous glucose monitoring and other factors such as adherence to treatment and family support were particularly important for the patient's adequate disease control.

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.

Influence of food consumption in the glycemic profile of children and adolescents with type 1 diabetes Mellitus / Influência do consumo alimentar no perfil glicêmico de crianças e adolescentes com diabetes Mellitus tipo 1

ABSTRACT Objective To review the dietary intake of children and adolescents with type 1 diabetes Mellitus and its association with the glycemic profile. Methods Longitudinal observational study. Dietary intake was measured using a three-day dietary record and the glycemic profile with a continuous glucose monitoring (range between 70 and 180mg/dL) and serum glycated hemoglobin levels (ideal <7.5%). Anthropometric data, insulin therapy, and carbohydrate counting were collected. Results The sample included 34 individuals with type 1 diabetes Mellitus aged 13.6±2.1 years. The majority of the population was eutrophic (76.4%). The entire sample used the basal-bolus insulin regimen, with mean insulin dose of 1.0±0.2U/kg/day; for 44.1% of the sample the carbohydrate counting method was used. Macronutrients intake was adequate in only 8.8% of the individuals, the highest frequency of inadequacy was related to carbohydrates (p=0.07). Inadequate glycemic control with hyperglycemia episodes and high mean glycated hemoglobin (9.7%) was observed in all individuals (61.3±18.5%). Carbohydrate counting was responsible for maintaining the percentage of time that the patient had interstitial blood glucose values within the range >40% (p<0.001) and maintaining the percentage of time in hyperglycemia <50% (p<0.001). Conclusion The majority of individuals were eutrophic, but presented inadequate dietary intake and glycemic control. The method of counting carbohydrates positively influenced the glycemic profile.

RESUMO Objetivo Analisar o consumo alimentar de crianças e de adolescentes com diabetes Mellitus tipo 1 e sua associação com o perfil glicêmico. Métodos Estudo observacional longitudinal. O consumo alimentar foi mensurado por meio de um registro alimentar de três dias, e o perfil glicêmico com um monitor contínuo de glicemia (alvo entre 70 e 180mg/dL) e de níveis séricos de hemoglobina glicada (ideal <7,5%). Foram coletados dados antropométricos, terapia insulínica e contagem de carboidratos. Resultados A amostra foi formada por 34 indivíduos com diabetes Mellitus tipo 1 com idade de 13,6±2,1 anos. A maior parte da população era eutrófica (76,4%). Toda a amostra utilizava o esquema de insulina basal-bolus, com dose média de 1,0±0,2U/kg/dia, e 44,1% realizava o método de contagem de carboidratos. O consumo dos macronutrientes estava adequado em apenas 8,8% dos indivíduos, sendo a maior frequência de inadequação nos carboidratos (p=0,07). Foram observados controle glicêmico inadequado com episódios de hiperglicemia em todos os indivíduos (61,3±18,5%) e média elevada de hemoglobina glicada (9,7%). A realização da contagem de carboidratos foi responsável por manter o percentual de tempo em que o paciente obteve valores de glicemia intersticial dentro do alvo >40% (p<0,001) e por manter o percentual de tempo em hiperglicemia <50% (p<0,001). Conclusão A maior parte dos indivíduos era eutrófica, porém apresentava consumo alimentar e controle glicêmico inadequados. O método de contagem de carboidratos influenciou positivamente o perfil glicêmico.

Aproximação dialógica às necessidades de saúde em usuários de insulina acompanhados no Programa de Automonitoramento Glicêmico / Dialogic approach to the health needs of insulin users followed up in the Glucose Self-Monitoring Program / Aproximación dialógica a las necesidades de salud en usuarios de insulina acompañados en el Programa de Automonitoreo Glucémico

O presente estudo busca caracterizar, a partir de pesquisa qualitativa, as ações de profissionais da Atenção Básica à Saúde (ABS) atuantes no Programa de Automonitoramento Glicêmico (PAMG), com vistas à troca de saberes possibilitada pelo encontro com pessoas em uso de insulina cadastradas no programa. Selecionaram-se 12 usuários para realização de rodas de conversa e foram conduzidas entrevistas semiestruturadas com os trabalhadores atuantes no PAMG, em uma Unidade Básica de Saúde (UBS) da capital paulista. Sob o enfoque dialógico, destacaram-se: a persistência do instrumentalismo biomédico pelos profissionais; o papel dos modos de vida dos usuários no seguimento terapêutico; e a emergência do PAMG enquanto espaço para o compartilhamento de experiências, lapidação da assistência e de apoio ao tratamento insulínico. Como resultado da análise, elaborou-se um guia para aproximação às necessidades de saúde dos usuários de insulina.(AU)

This study aims to characterize, through a qualitative research, actions of Primary Care professionals who work in the Glucose Self-Monitoring Program, focusing on the knowledge exchange enabled by the meeting with insulin users enrolled in the program. Twelve users were selected to participate in conversation groups and semi-structured interviews were conducted with Program workers at a Primary Care Unit in the city of São Paulo. Under the dialogic approach, the following aspects emerged, among others: the professionals' persistence in using the biomedical instrumentalism; the role of users' ways of life in the therapeutic follow-up; and the emergence of the Glucose Self-Monitoring Program as a space for sharing experiences, improving healthcare and supporting insulin therapy. As a result of the analysis, a handbook regarding insulin users' health needs was developed.(AU)

El presente estudio busca caracterizar, a partir de una encuesta cualitativa, las acciones de profesionales de la Atención Básica de la Salud actuantes en el Programa de Automonitoreo Glucémico (PAMG), con el objetivo del intercambio de saberes posibilitado por el encuentro con personas que utilizan insulina registradas en el programa. Se seleccionaron doce usuarios para la realización de rondas de conversación y se realizaron entrevistas semiestructuradas con los trabajadores actuantes en el PAMG, en una Unidad Básica de Salud de la capital del Estado de São Paulo. Bajo el enfoque dialógico, se destacaron: la persistencia del instrumentalismo biomédico por parte de los profesionales; el papel de los modos de vida de los usuarios en el acompañamiento terapéutico; y la emergencia del PAMG como espacio para la compartición de experiencias, lapidación de la asistencia y de apoyo al tratamiento con insulina. Como resultado del análisis, se elaboró una guía para la aproximación a las necesidades de salud de los usuarios de insulina.(AU)

Education in Diabetes Mellitus for blood glucose self-monitoring: a quasi-experimental study / Educación en Diabetes Mellitus para automonitorización de la glucemia: estudio cuasi-experimental / Educação em Diabetes Mellitus para automonitorização da glicemia: estudo quase-experimental

ABSTRACT Objective: to evaluate the contributions of an educational program for capillary blood glucose self-monitoring. Method: a quasi-experimental study performed in an outpatient unit of a tertiary health care service in a sample of 25 people with Type 2 Diabetes Mellitus, from July 2016 to December 2017, developed through interactive tools for care with capillary blood glucose self-monitoring. Results: among the items of capillary blood glucose self-monitoring that showed improvement after participation in the educational program, the most noteworthy are the "postprandial blood glucose values" (p=0.0039), "Interpretation of capillary blood glucose results with meals and medications" (p=0.0156), "recognition of the 'weakness' symptom for hyperglycemia" (p=0.0386) and "administration of medications correctly" for hyperglycemia prevention (p=0.0063). Conclusion: the study made it possible to recognize the main characteristics of blood glucose self-monitoring that may contribute to the care for the person with diabetes.

RESUMEN Objetivo: evaluar las contribuciones de un programa educativo para la automonitorización de la glucemia capilar. Método: el estudio cuasi-experimental, realizado en unidad ambulatoria de un servicio de atención terciaria a la salud, en muestra de 25 personas con Diabetes Mellitus tipo 2, en el período de julio de 2016 a diciembre de 2017, desarrollado por medio de herramientas interactivas para el cuidado con la automonitorización de la glucemia capilar. Resultados: entre los ítems de la automonitorización de la glucemia capilar que presentaron mejoría después de la participación en el programa educativo, se destacan los "valores de la glucemia postprandial" (p=0,0039), "Interpretación de los resultados de glucemia capilar con las comidas y medicamentos" (p=0,0156), "reconocimiento del síntoma" debilidad "para la hiperglicemia" (p=0,0386) y "administración de medicamentos correctamente" para prevenir la hiperglucemia (p=0,0063). Conclusión: el estudio posibilitó reconocer las principales características de la automonitorización de la glucemia que pueden contribuir para el cuidado a la persona portadora de la enfermedad.

RESUMO Objetivo: avaliar as contribuições de um programa educativo para a automonitorização da glicemia capilar. Método: estudo quase-experimental, realizado em unidade ambulatorial de um serviço de atenção terciária à saúde, em amostra de 25 pessoas com Diabetes Mellitus tipo 2, no período de julho de 2016 a dezembro de 2017, desenvolvido por meio de ferramentas interativas para o cuidado com a automonitorização da glicemia capilar. Resultados: entre os itens da automonitorização da glicemia capilar que apresentaram melhora após a participação no programa educativo, destacam-se os "valores da glicemia pós-prandial" (p=0,0039), "interpretação dos resultados de glicemia capilar com as refeições e medicamentos" (p=0,0156), "reconhecimento do sintoma 'fraqueza' para a hiperglicemia" (p=0,0386) e "administração de medicamentos corretamente" para prevenção da hiperglicemia (p=0,0063). Conclusão: o estudo possibilitou reconhecer as principais características da automonitorização da glicemia que poderão contribuir para o cuidado à pessoa portadora da doença.