ABSTRACT
Introduction: During the COVID-19 pandemic lockdown, glycemic control in children with Type 1 diabetes under our care improved. One of the reasons could be due to inconsistency in the management of diabetes at school. In order to address this possibility, our unit commenced a Quality Improvement Project to improve glycemic control of children with diabetes at school. Objective(s): Our Quality Improvement Project involved developing an educational tool called AIM - Activity, Insulin, Meals, an aid to improve glycemic control at school based on insulin regime and type of glucose monitoring. AIM tool provides advice on insulin management at meal times and PE [Physical Exercise] along with a PE guide with specific advice on glycemic control around exercise. Method(s): We produced separate AIM guidance for the following groups: 1. Multiple Dose Insulin regime [MDI]using self-monitoring of blood glucose [SMBG] 2. MDI regime using CGM [Dexcom G6] 3. MDI regime using Flash Glucose scanning [Libre] 4. Continuous Subcutaneous Insulin Infusion [CSII] using SMBG 5. CSII using CGM 6. CSII using Libre A sample AIM tool [1st & last pages] for the group using MDI with CGM is inserted below. We introduced the AIM guidance to patients, parents, and school staff from mid October 2021 to end of February 2022. We are allowing 3 months to embed the guidance in the day to day management of children and young people with diabetes at school. We will then analyze the impact of the AIM educational tool on glycemic control by comparing HbA1c, time in range, average glucose, and coefficient of variability during a 6 weeks period. Post introduction data collection with start in June. Result(s): Awaiting post introduction data collection for analysis. We are likely to have 25 patients with complete pre and post introductory data. Conclusion(s): Based on the results. However we hope clear instructions using our educational tool 'AIM' will improve glycemic control in school going children and young people.
ABSTRACT
OBJECTIVES: The public, policy makers, and science communities are subject to many false, uninformed, overly optimistic, premature, or simply ridiculous health claims. The coronavirus disease 2019 (COVID-19) pandemic and its context is a paramount example for such claims. In this article, we describe why expressing the certainty in evidence to support a decision is critical and why the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach matters now, perhaps more than ever and no matter what the specific topic is in relation to COVID-19. We finally also offer suggestions for how it can be used appropriately to support decision-making at global, national, and local level when emergency, urgent or rapid responses are needed. STUDY DESIGN AND SETTING: This is an invited commentary to address the objectives above building on examples from the recent COVID-19 pandemic. This includes an iterative discussion of examples and development of guidance. RESULTS: The GRADE approach is a transparent and structured method for assessing the certainty of evidence and when developing recommendations that requires little additional time. We describe why emergency, urgent, or rapid responses do not justify omitting this critical assessment of the evidence. In situations of emergencies and urgencies, such as the COVID-19 pandemic, GRADE can similarly be used to express and convey certainty in intervention effects, test accuracy, risk and prognostic factors, consequences of public health measures, and qualitative bodies of evidence. CONCLUSIONS: Assessing and communicating the certainty of evidence during the COVID-19 pandemic is critical. Those offering evidence synthesis or making recommendations should use transparent ratings of the body of evidence supporting a claim regardless of time that is available or needed to provide this response.