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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.
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Background: Self-care activities are the cornerstone of diabetes care that ensures patients participation to achieve optimal glycemic control and to prevent complications. Objective: The aim of this study is to find the level of self-care activities among diabetics aged ?20 years residing in a resettlement colony in East Delhi and its association with sociodemographic factors, disease, and treatment profile. Methods: Using cross-sectional survey, 168 known diabetic patients were selected from Nand Nagri, a resettlement colony in East Delhi. Data were collected using Hindi translation of revised version-Summary of Diabetic Self Care Activities along with a pretested semi-open-ended questionnaire. Self-care was assessed on six parameters as follows: (a) general diet, (b) specific diet, (c) exercise, (d) blood sugar testing, (e) foot-care, and (f) smoking. The study period was from November 2014 to April 2016. Results: Nearly 35.1% of respondents belonged to 60� years age group. About 52.4% of respondents were female. Fifty-two diabetics (31%) reported having practised diet control on all 7 days in the past 1 week. Nearly 39.3% of patients did not perform any physical activity. The blood test was not practised by 92.3% of respondents. Foot-care was practised by only 19% of patients. There was a significant association between general diet among diabetics with family support (P = 0.020), place of diagnosis (P = 0.033), and treatment funds (P = 0.017). The exercise score among diabetics who were below the poverty line was higher than those above poverty line (P = 0.029). Younger age (P = 0.005) and treatment with insulin (P = 0.008) were positively associated with blood glucose testing. The foot-care practice was better in patients aware of complications and foot-care practices (P < 0.001). Conclusion: Self-care activities among diabetic patients were very poor. Self-management educational programs at hospitals along with information, education, and communication activities at the community level and one-to-one counseling are recommended.
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ABSTRACT Objective The aim of this study was to evaluate how different parameters of short-term glycemic control would correlate with the perception of health-related quality of life (HRQoL) in patients with type 1 diabetes mellitus (T1D). Subjects and methods A total of 50 T1D patients aged 18 to 50 years were evaluated with the questionnaires Problem Areas in Diabetes (PAID) scale and Diabetes Quality of Life (DQOL) measure after 30 days of self-monitoring of blood glucose (SMBG). Glycemic control was evaluated using glycated hemoglobin (HbA1c), mean glucose levels (MGL) in the prior month's data from SMBG (Accu-Check 360o), number of hypoglycemic episodes (< 70 mg/dL and < 50 mg/dL), and glycemic variability (GV). Results PAID correlated positively with MGL (r = 0.52; p < 0.001) and HbA1c (r = 0.36; p < 0.0097), but not with GV (r = 0.17; p = 0.23) or number of hypoglycemic episodes (r = 0.15; p = 0.17 for glucose < 70 mg/dL and r = 0.02; p = 0.85 for glucose < 50 mg/dL). After multiple linear regression, only MGL remained independently related to PAID scores. DQOL scores had a positive correlation with MGL (r = 0.45; p = 0.001), but not with HbA1c (r = 0.23; p = 0.09), GV (r = 0.20; p = 0.16), or number of hypoglycemic episodes (r = 0.06 p = 0.68). Conclusion In T1D patients, MGL, but not HbA1c or number hypoglycemic episodes, was the glycemic control parameter that best correlated with short-term perception of HRQoL.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Quality of Life/psychology , Diabetes Mellitus, Type 1/psychology , Diabetes Mellitus, Type 1/blood , Perception , Blood Glucose/analysis , Glycated Hemoglobin/analysis , Blood Glucose Self-Monitoring , Prospective Studies , Surveys and Questionnaires , Hypoglycemia/psychology , Hypoglycemia/bloodABSTRACT
Diabetes should maintain normal blood glucose through the self-management to show the progression of complications, and prevention of diabetes complications. So far, self-monitoring of blood glucose (SMBG) has been the most basic elements of self-management of diabetes. Through SMBG, it is possible for diabetes to monitor the variation of the amount and type they eat, exercise and stress. However, the patient is not easy to apply and interpret the result of the self-measured blood glucose control. It requires appropriate feedback from professional but feedback is not completed because of the constraints of time and space. This inhibitory factor was now enable interactive communication between the practitioner and the patient regardless of time and place with the development of information and communication. The mobile app makes it easier to analyze and interpret SMBG data patterns. Now mobile diabetes apps based on smartphone apps are evolving as an essential tool, not as an aid to help improve the selfmanagement of people with diabetes. Diabetes educators should be interested in developing content for mobile diabetes apps and provide professional monitoring and feedback.
Subject(s)
Humans , Blood Glucose , Diabetes Complications , Diabetes Mellitus , Mobile Applications , Self Care , SmartphoneABSTRACT
Diabetes mellitus is a metabolic disease which poses a major challenge to healthcare and is characterized by elevated blood glucose levels resulting from either an underproduction or underutilization of the insulin hormone. The actual cause of Type 1 diabetes is unknown, but it most likely results from an autoimmune mediated destruction of the insulin producing pancreatic beta cells that reduces or terminates insulin production. On the other hand, type 2 diabetes is often caused by obesity and induces a gradual desensitization of the body’s cells to insulin. Recent advances in diagnostic methods have heralded in a new era of diabetes management with improved glucose control, reduced fear of complications and better compliance with intensive therapies. Additional efforts are being made to refine these methods to allow their implementation into clinical practice and gain universal acceptance. Advances in diagnostic methods for insulin delivery and glucose monitoring are an important step forward in greatly improving the lives of diabetic patients.
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BACKGROUND: We evaluated the accuracy of the B. Braun Omnitest 5 blood glucose monitoring system (BGMS; Infopia Co. Ltd., Korea), which was recently developed for self-monitoring of blood glucose. METHODS: Precision was assessed according to Clinical and Laboratory Standards Institute guideline EP5-A3 with control materials containing low, normal, and high levels of glucose. Linearity was evaluated over the range of 52.5–548.0 mg/dL prepared from patient samples. For system accuracy, 100 capillary blood samples measured by the B. Braun Omnitest 5 BGMS were compared to plasma-equivalent blood glucose values of the fingertip blood samples measured by the YSI 2300 STAT PLUS glucose analyser (YSI Life Sciences, USA). Accuracy was evaluated according to the International Organization for Standardization (ISO) 15197: 2013 criteria. RESULTS: The range for the total coefficient of variation (%) was 1.5%–4.9% for three lots of strips. Both within-run precision and within-laboratory precision fulfilled the manufacturer's claim. ISO 15197: 2013 states that more than 95% of blood glucose measurement values must be within ±15 mg/dL for ranges below 100 mg/dL and ±15% for ranges above 100 mg/dL. Each of B. Braun Omnitest 5 lots satisfied ISO 15197: 2013, as 98.5% (197/200), 97.0% (194/200), and 99.5% (199/200) of values were within range. In consensus error grid analysis, respectively, 99.5%, 99.0%, and 100.0% of measurement values of each lot were within zone A, indicating that an average of over 99.0% of values were within zone A. CONCLUSIONS: B. Braun Omnitest 5 provided reliable results and satisfied the ISO 15197: 2013 accuracy criteria. This test is an appropriate BGMS for the self-monitoring of blood glucose.
Subject(s)
Humans , Biological Science Disciplines , Blood Glucose , Capillaries , Consensus , GlucoseABSTRACT
This retrospective study aimed to analyze the blood capillary glucose at home and the number of hypoglycemic and hyperglycemic episodes presented by persons with Diabetes Mellitus, at the start of, and at least six months after beginning to participate in, the Blood Glucose Self-Monitoring Program. A total of 97 service users with diabetes participated, from a municipality in the non-Metropolitan region of the state of São Paulo. Two spreadsheets were used for recording the blood glucose values at the start of the Program and after a minimum of six months. It was observed that there was an improvement in the postprandial blood glucose level (lunch) and in the very early morning (p<0.05). In relation to hypoglycemic episodes, there was a slight improvement in the mean, from 0.75 at the beginning to 0.49 after a minimum of six months' participation in the Program. The reduction of hyperglycemic episodes was, in the beginning, of 27.88% episodes and, at a minimum of six months' participation in the Program, of 29.15% episodes. .
Este estudio retrospectivo tuvo como objetivo analizar la glucosa en sangre capilar en casa, el número de episodios de hipoglicemia y hiperglicemia presentada por las personas con Diabetes Mellitus al inicio del estudio y por lo menos seis meses después de su participación en el programa de automonitorización de glucosa en sangre capilar en casa. Participaron 97 usuarios con diabetes, de una ciudad en el interior de São Paulo. Dos puntuaciones se utilizaron para registrar los valores de glucosa en sangre al comienzo del programa y después de al menos seis meses. Se encontró una mejoría de la glicemia posprandial (almuerzo) y durante la noche (p<0,05). En cuanto a los episodios de hipoglicemia hubo una ligera mejoría en promedio de 0,75 al inicio del estudio a 0,49 después de al menos seis meses de la participación en el Programa. La reducción de los episodios de hiperglicemia fue, al inicio, 27,88% y, al menos, seis meses de participación en el programa, de 29,15% de los episodios.
Estudo retrospectivo que teve como objetivo analisar a glicemia capilar no domicílio, o número de episódios de hipoglicemias e hiperglicemias apresentadas pelas pessoas com Diabetes Mellitus, no início e, no mínimo, após seis meses de participação no Programa de Automonitorização da Glicemia Capilar no domicílio. Participaram 97 usuários com Diabetes, oriundos de um município do interior paulista. Foram utilizadas duas planilhas para registro dos valores de glicemia capilar no início do Programa e, após, no mínimo seis meses. Constatou-se que houve uma melhora nas glicemias pós-prandial (almoço) e durante a madrugada (p<0,05). Quanto aos episódios de hipoglicemias houve uma discreta melhora na média, de 0,75 no início para 0,49 depois de no mínimo seis meses de participação no Programa. A redução dos episódios de hiperglicemia foi, no início, de 27,88% episódios e, no mínimo, seis meses de participação no Programa, de 29,15% episódios.
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Humans , Blood Glucose , Blood Glucose Self-Monitoring , Nursing , Diabetes MellitusABSTRACT
Objective To assess the impact of intervention with Insulin therapy management unit program in the poorly controlled type 2 diabetic patients in a community of Shanghai.Methods There were 55 patients with type 2 diabetes with poorly controlled hyperglycemia (HbA1C ≥ 8％) enrolled in this study.They were divided at random into 2 groups:intensive care group and standard care group.The subjects in intensive care group were provided with a glucose meter and required to monitor their blood glucose levels at least 2 or 3 times per day.Community health provider acquired information of blood glucose level,episodes of hypoglycemia,and dosage of insulin every week by cell phone.Standard care patients received diabetes care from the same provider in outpatient clinic every month.Results By the end of 6 months of intervention,the intensive care group showed a significant difference in HbA1C as compared to the standard care group (7.40％ ±0.91％ vs 8.65 ％ ± 1.28％,P＜0.01).The frequency of self-monitoring of blood glucose (SMBG) was 4 times per month in both groups at baseline.After intervention,the frequency of SMBG in intensive care group was greatly increased compared to standard care group (50times per month vs 5 times per month,P＜0.01).The frequency of self-reported hypoglycemia in intensive care group was increased compared to standard care group (3 times per month vs once per month,P＜0.01).The average daily dose of insulin in intensive care group was increased 6 units by the end of the present study(P＞0.05).Conclusion After 6 months of intervention,the glycemic control was obviously improved in type 2 diabetic patients treated with insulin and the daily dose of insulin was not increased significantly.TheInsulin therapy management unit is effective and safe.
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Objective:To analyze the important controllable factors which affect the glycemic control of diabetes. Methods:A cross-sectional study was carried out to examine the role of relevant characteristics in glycemic control by a sampling investigation of 430 diabetic patients in Hunan, China. A questionnaire was designed for personal interviews to collect data. Univariate regression analysis and multiple linear regression analysis were used to evaluate the effects of various factors on glycated hemoglobin A1c (HbA1c) control. Results:hTe level of HbA1c in 430 patients was (8.7±2.6)%, and the value in 34%patients among them was ≤7.0%. Base on univariate regression analysis some factors were associated with good HbA1c control, including age, diabetic education, self monitoring of blood glucose, knowledge of blood sugar control standard, living environment, and self-owned glucometer. However, the upgraded treatment was associated with poor control. Based on multiple linear regression analysis, the ifrst four factors mentioned above were protective factors for HbA1c while upgraded treatment was risk factor for HbA1c. Conclusion:Knowledge of blood sugar control standard, diabetic education and self monitoring of blood glucose are important controllable factors for better glycemic control of diabetes.
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We describe herein a case of life-threatening hypoglycemia due to spurious elevation of glucose concentration during the administration of ascorbic acid in a type 2 diabetic patient. A 31-year-old female was admitted for proliferative diabetic retinopathy treatment and prescribed high dose ascorbic acid. During hospitalization, she suddenly lost her consciousness and her glucose concentration was 291 mg/dL, measured using self-monitoring blood glucose (SMBG) device, while venous blood glucose concentration was 12 mg/dL. After intravenous injection of 50% glucose solution, the patient became alert. We reasoned that glucose measurement by SMBG device was interfered by ascorbic acid. Physicians should be aware of this interference; high dose ascorbic acid may cause spurious elevation of glucose concentration when measuring with SMBG devices.
Subject(s)
Adult , Female , Humans , Ascorbic Acid/administration & dosage , Blood Glucose , Blood Glucose Self-Monitoring/instrumentation , Diabetes Mellitus, Type 2/blood , Hypoglycemia/diagnosis , Renal DialysisABSTRACT
Self-monitoring of blood glucose (SMBG) and point-of-care testing are widely used in the management of diabetic outpatients. However, SMBG records are sometimes inaccurate, and may differ from glucose values measured in the hospital. Therefore, the aim of our study was to evaluate the effects of patient education regarding glucometer use on blood glucose levels and to compare the glucose values obtained by six different types of glucometers currently used in Korea. Fifty-six diabetic patients participated in the present study. Each patient visited the hospital in a fasting state. Fasting plasma glucose (FPG) levels in capillary blood samples were measured by doctors and by the patients themselves before and after patient education sessions. Then, glucose levels were measured with each of the six glucometers by doctors and by the patients themselves. The differences between FPG and glucose values measured using glucometers were compared, and their relationships with HbA1c were also assessed. There were no significant differences between glucose levels measured by patients regardless of glucometer education. We obtained similar results for differences between glucose levels measured by patients and doctors. Patient HbA1c levels were not correlated with differences in measurements between glucometers and FPG. Measurements of glucose levels by the six different glucometers did not differ significantly. Our study indicates that education about SMBG, including glucometer handling, is important to increase SMBG accuracy, but that errors in SMBG records are trivial for glucometer users and that the different glucometers used in Korea demonstrate similar accuracy.
Subject(s)
Humans , Blood Glucose , Capillaries , Fasting , Glucose , Handling, Psychological , Korea , Outpatients , Patient Education as Topic , PlasmaABSTRACT
The use of a Continuous Glucose Monitoring System (CGMS) allows diabetic patients to adjust their own insulin doses, food intakes and physical activities and to thus improve glycemic control. Even though we check the SMBG more than 4 times per day, we can't find a hidden abnormal blood glucose. CGMS have been devised to assist in the diagnosis and treatment of blood glucose changes using computer analysis. The objective of this report is to summarize the measurement principles, application and patient education of CGMS.
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Humans , Blood Glucose , Glucose , Insulin , Motor Activity , Patient Education as TopicABSTRACT
BACKGROUND: Diabetes mellitus is one of the most common chronic diseases which primary care family physician encounters. This study was performed to describe the medical care for patients with diabetes based on the Cheonan Practice-Based Research Network. METHODS: From May 2005 to July 2005, 193 patients with diabetes were assessed among the patients visiting seven family medicine clinics in Cheonan. The data were collected through a questionnaire about patient's socioeconomic characteristics, the details of medical care including screening practices of diabetic complications, self-monitoring of blood glucose and exercise. RESULTS: Among the patients with diabetes, 25.4% reported no exercise and another 29.6% reported regular exercise of more than 4 times a week. The less educated and the more elderly patients reported less exercise. Only 37.3% of patients monitored their blood glucose at home. The more educated, the more likely the patients monitored their blood glucose. Only 18.1% of patients reported having an annual 24-hour urine protein examination. The more educated and the more income they had, the more annual 24-hour urine protein examination was done. Only 32.6% of patients reported having an annual ophthalmologic examination, but there was no associated factors with having an annual ophthalmologic examination. CONCLUSION: These data indicate that the medical care for diabetic patients, including exercise, self-monitoring of blood glucose, screening of complications, may not be optimal for preventing diabetes complications, and was influenced by demographic characteristics such as age and education level. It is necessary for health care team to provide systematic education for diabetes and ongoing close monitoring of self care practices.