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.

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.

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.

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.

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.

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.

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.

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.

Self-monitoring of blood glucose as control tool in the different management contexts for Type 2 Diabetes Mellitus. What is its current role in non-insulin users? / Automonitoreo glicémico como herramienta de control en los distintos contextos de manejo para diabetes mellitus tipo 2 ¿Cuál es su rol actual en no-usuarios de insulina?

Abstract Introduction: Self-monitoring blood glucose (SMBG) has been considered a key element in the management of Type 2 Diabetes Mellitus (T2DM). However, its role in glycemic control in non-insulin users has been long discussed. Objective: To conduct a narrative literature review of the benefits of SMBG in non-insulin-treated patients with T2DM. Materials and Methods: A scientific literature search was conducted in the following databases: Pubmed, ScienceDirect, Embase, SciELO, Cochrane and Medline. Relevant articles were selected according to the established criteria. In addition, some studies included in the references of the initially selected articles were added to the review since they were considered relevant for its objective. Results: The following records were included in the review: 14 controlled clinical trials, 13 observational studies, 10 clinical practice guidelines, 7 narrative reviews, 5 meta-analyses, and 1 systematic review. Conclusion: Based on the evidence found in this review it is possible to say that the use of SMBG in patients with T2DM is beneficial and that it has a positive impact on non-insulin users in terms of achieving glycemic control and defining therapeutic changes.

Resumen Introducción. El automonitoreo glicémico es considerado un elemento clave en el manejo de la diabetes mellitus tipo 2; sin embargo, su rol en el control glicémico en pacientes no-usuarios de insulina ha sido discutido a lo largo de los años. Objetivo. Realizar una revisión narrativa de la literatura acerca de los beneficios del automonitoreo glicémico en pacientes con diabetes mellitus tipo 2 no-usuarios de insulina. Materiales y métodos. Se realizó una búsqueda de literatura científica en las bases de datos PubMed, ScienceDirect, Embase, SciELO, Cochrane y Medline. Se seleccionaron artículos pertinentes según criterio y se agregaron algunos de los mencionados en las referencias de las publicaciones seleccionadas de la búsqueda inicial que tenían utilidad para la revisión. Resultados. Se incluyeron 14 ensayos clínicos controlados, 13 estudios observacionales, 10 guías de práctica clínica, 5 metanálisis, 1 revisiones sistémicas y 7 revisiones narrativas con información relevante para el desarrollo de la presente revisión. Conclusión. La evidencia encontrada demuestra beneficios del automonitoreo glicémico en pacientes con diabetes mellitus tipo 2 y confirma su impacto positivo en no-usuarios de insulina para lograr control glicémico y definir cambios terapéuticos.

Monitoreo continuo de glucosa: Utilidad e indicaciones / Continuous glucose monitoring. Utility and indications

Un adecuado control glucémico evita o retarda la aparición y/o evolución de las complicaciones crónicas en pacientes con diabetes mellitus (DM). Para lograrlo es necesario adecuar las dosis de insulina en personas con DM tipo 1 o tipo 2 en insulinoterapia, por el tradicional automonitoreo de glucosa capilar (AGC) que presenta aún limitaciones para generar un registro adecuado de datos, es invasivo y tiene baja adherencia. En contraposición, los nuevos sistemas de monitoreo continuo de glucosa (MCG) brindan una información más completa, más dinámica y con mejor tolerancia. Están constituidos por un sensor subcutáneo que informa ininterrumpidamente los niveles de glucosa del tejido celular subcutáneo y un módulo receptor que permite su lectura y almacenamiento. Los modelos de tiempo real (MCG-RT) permiten observar continuamente los datos, mientras que los sistemas intermitentes (MCG-Flash/EI) los muestran siempre y cuando se acerque el receptor al módulo sensor, generando una lectura voluntaria e intermitente, aunque almacenan todo en la memoria. El MCG informa además las tendencias glucémicas, indicando si están en ascenso o descenso y a qué velocidad cambian. El uso del MCG vs. AGC reduce la hemoglobina glicosilada (A1c) entre 0.53 y 1.0% con disminución significativa (38%) del tiempo de exposición a hipoglucemias. Presenta además, mayor adherencia. Los objetivos de esta revisión son: describir la homeostasis glucémica, evaluar la precisión del MCG, interpretar los datos adecuadamente y finalmente, sugerir en forma práctica los cambios para incorporar a la insulinoterapia tradicional, basados en la información que aportan estos novedosos sistemas de monitoreo.

An adequate glycemic control prevents and/or delays the development and/or progression of chronic complications in patients with diabetes mellitus (DM). To achieve this control, it is necessary to adjust insulin doses, in type 1 or insulinized type 2 DM persons, based on traditional capillary glucose self-monitoring, which has limitations to generate an adequate data record, is invasive and has low adherence. In contrast, new continuous glucose monitoring (CGM) systems provide more complete and dynamic information, and better compliance. In these systems, a subcutaneous sensor continuously sends glucose values which are captured and stocked by a receptor module. Real-time models (CGM-RT) allow continuous and real-time readings of interstitial glucose, whereas CGM-Flash/EI systems require lector approach to sensor module performing intermittent scanning. CGM shows if glycemic levels are increasing or decreasing and how fast it is happening (tendency). CGM decreases glycosylated hemoglobin between 0.53% and 1.0%, as well as time in hypoglycemia by 38%, increasing the time in range of glucose levels, in patients with high adherence. The objectives of this review are to describe the glycemic homeostasis, to evaluate the accuracy of the CGM to interpret the data adequately and finally, based on the information provided by these novel monitoring systems, to suggest a practical way to be added to the traditional intensive insulin therapy.

Application of serum glycated albumin in pregnancy / 中华围产医学杂志

Hyperglycemia during pregnancy is associated with many maternal and infant complications, hence strict blood glucose control during pregnancy is of great importance. Glycosylated hemoglobin Alc (HbA1c), glycated albumin (GA), self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are four main measures to assess sugar level during pregnancy. GA level is a reflection of blood sugar level in the past 2-3 weeks and is unlikely influenced by various factors, therefore holds great potential in better control of blood glucose to help improve maternal and fetal outcomes.

Application of serum glycated albumin in pregnancy / 中华围产医学杂志

Hyperglycemia during pregnancy is associated with many maternal and infant complications,hence strict blood glucose control during pregnancy is of great importance.Glycosylated hemoglobin Alc (HbA1c),glycated albumin (GA),self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are four main measures to assess sugar level during pregnancy.GA level is a reflection of blood sugar level in the past 2-3 weeks and is unlikely influenced by various factors,therefore holds great potential in better control of blood glucose to help improve maternal and fetal outcomes.

Current status of self-management behaviors among patients with type 2 diabetes mellitus in community / 中华全科医师杂志

Two hundred and thirty nine patients with type 2 diabetes mellitus (T2DM) managed in the community health service centers of Huai'an city were selected for survey by random sampling method between January and December 2017.A self-designed questionnaire was used to assess self-management prescription.Patients received community management for 3 months.The rates of patients with not receiving diabetes health education,with healthy diet,with regular exercise,without monitoring blood glucose,with repeated hypoglycemic attacks were 44.8％ (107/239),23.0％ (55/239),46.4％ (111/239),54.8％ (131/239)and 21.3％(23/108),respectively;and 51.9％ (124/239) of the participants did not adhere to medication.The awareness rate of diabetic complications was 27.2 ％ (65/239).Only 25.1％ (60/239) and 15.1％ (36/239) of the participants apply oral hypoglycemic agents and insulin rationally.The survey results indicate that the current status of self-management in community diabetic patients is relatively poor,it is necessary to strengthen standardized management of diabetic patients in community health institutions.

Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications

By providing blood glucose (BG) concentration measurements in an almost continuous-time fashion for several consecutive days, wearable minimally-invasive continuous glucose monitoring (CGM) sensors are revolutionizing diabetes management, and are becoming an increasingly adopted technology especially for diabetic individuals requiring insulin administrations. Indeed, by providing glucose real-time insights of BG dynamics and trend, and being equipped with visual and acoustic alarms for hypo- and hyperglycemia, CGM devices have been proved to improve safety and effectiveness of diabetes therapy, reduce hypoglycemia incidence and duration, and decrease glycemic variability. Furthermore, the real-time availability of BG values has been stimulating the realization of new tools to provide patients with decision support to improve insulin dosage tuning and infusion. The aim of this paper is to offer an overview of current literature and future possible developments regarding CGM technologies and applications. In particular, first, we outline the technological evolution of CGM devices through the last 20 years. Then, we discuss about the current use of CGM sensors from patients affected by diabetes, and, we report some works proving the beneficial impact provided by the adoption of CGM. Finally, we review some recent advanced applications for diabetes treatment based on CGM sensors.

Effect of flash glucose monitoring on ambulatory glucose profile in patients with type 2 diabetes mellitus / 中国医师进修杂志

Objective To investigate the effect of flash glucose monitoring (FGM) on ambulatory glucose profile of only oral antidiabetic drugs treated patients with type 2 diabetes mellitus. Methods Twenty-eight type 2 diabetic mellitus patients with only oral antidiabetic drugs treatment from August 2017 to January 2018 were enrolled. All the patients were exposed to FGM for 14 d without changing the original treatment and encouraged to manage self-behavior by adjusting diet and activity based on the blood glucose data obtained from the real-time scanning. The changes in glucose profile during the FGM period were observed, including estimated glycated hemoglobin (HbA1c), standard deviation of blood glucose, variable coefficient of blood glucose, mean amplitude of glycemic excursions, time in range (blood glucose 3.9 to 10.0 mmol/L), area under the curve hyperglycemia (blood glucose> 10.0 mmol/L) and area under the curve hypoglycemia (blood glucose<3.9 mmol/L). The blood glucose levels on second day and thirteenth day were used as baseline and end point respectively. Results All of the 28 patients did not change their anti-diabetic drug therapy and there were no adverse events occurred. The estimated HbA1c was significantly lower than the baseline HbA1c: (6.90 ± 1.48)% vs. (7.57 ± 1.35)%, and there was statistical difference (P = 0.004). The standard deviation of blood glucose, variable coefficient of blood glucose, mean amplitude of glycemic excursions, area under the curve hyperglycemia and area under the curve hypoglycemia at end were significantly lower than those at baseline: (2.07 ± 0.86) mmol/L vs. (2.44 ± 0.86) mmol/L, 0.26 ± 0.11 vs. 0.30 ± 0.11, (5.32 ± 2.75) mmol/L vs. (6.76 ± 3.06) mmol/L, 265 (0, 1 310) vs. 351 (107, 2 177) and 0 (0, 0) vs. 0 (0, 19), the time in range at end was significantly higher than that at baseline: (1 069 ± 386) min vs. (921 ± 449) min, and there were statistical differences (P＜0.05 or＜0.01). The rate of scanning was (12.92 ± 4.87) times/d. Conclusions FGM could be applied by type 2 diabetic mellitus patients to make self-glycemic management without changing therapy, reduce the estimated HbA1c,and hypoglycemia, and improve the glucose fluctuations, which may result from real-time scanning to find abnormal glycemia and adjust daily behavior.

Teoría de rango medio: procesos familiares que predicen el descontrol glucémico en diabetes mellitus 2 / Middle range theory: family processes predicting glycemic uncontrolled in diabetes mellitus 2 / Teoria de médio alcance: processos familiares que predizem o descontrole glicêmico no diabetes mellitus 2

Objetivo: describir el desarrollo de una teoría de rango medio que contribuya en el abordaje de las perspectivas tanto del individuo como de los integrantes de la familia considerando las relaciones e interacciones que surgen en la dinámica de la vida diaria al experimentar una situación de cronicidad. Método: la teoría fue desarrollada deductivamente del modelo de la organización sistémica, un modelo empleado en la investigación y en la disciplina de enfermería para el abordaje del sistema familiar e individual. Los vínculos entre los conceptos de la teoría se desarrollan bajo los niveles de abstracción planteados por Smith y Liehr. Resultados: el desarrollo de la teoría procesos familiares e individuales y descontrol glucémico en adultos con diabetes mellitus 2 sirve para construir la ciencia de enfermería mediante la integración de la teoría de enfermería existente y el conocimiento empírico. Conclusión: esta teoría ayuda a comprender de mejor forma como se percibe y otorga el apoyo al interior de la familia y la influencia con el automanejo del integrante con diabetes mellitus 2 reflejado en el control glucémico.(AU)

Objective: to describe the development of a mid-range theory that contributes to the approach of the perspectives of both the individual and the members of the family considering the relationships and interactions that arise in the dynamics of daily life when experiencing a situation of chronicity. Method: the theory was developed deductively from the model of the systemic organization, a model used in research and in the discipline of nursing for the approach of the family and individual system. The links between the concepts of the theory are developed under the levels of abstraction proposed by Smith and Liehr. Results: the development of the theory: Family and Individual Processes and Glycemic Decontrol in adults with diabetes mellitus 2 serves to build nursing science through the integration of existing nursing theory and empirical knowledge. Conclusion: this theory helps to better understand how it is perceived and gives support to the interior of the family and the influence with the self-management of the member with diabetes mellitus 2 reflected in glycemic control.(AU)

Objetivo: descrever o desenvolvimento de uma teoria de médio alcance que contribua para abordagem das perspectivas tanto do indivíduo quanto dos membros da familia, considerando as relações e interações que surgem na dinâmica da vida diária ao experimentar uma situação de cronicidade. Método: teoria desenvolvida dedutivamente a partir do modelo de organização sistêmica, um modelo usado na investigação e disciplina de enfermagem para abordar a família e sistema individual. As ligações entre os conceitos da teoria são desenvolvidas sob os níveis de abstração levantados por Smith e Liehr. Resultados: o desenvolvimento da teoria processos familiares e individuais, e descontrole glicémico em adultos com diabetes mellitus 2 serve para construir a ciência de enfermagem mediante a integração da teoría de enfermagem existente e o conhecimento empírico. Conclusão: esta teoria ajuda a compreender de melhor forma como se percebe e fornece o apoio no interior da familia e a influência com o automanejo do integrante com diabetes mellitus 2 refletido no controle glicémico.(AU)