Beyond HbA 1c : using continuous glucose monitoring metrics to enhance interpretation of treatment effect and improve clinical decision‐making

2019 ◽  
Vol 36 (6) ◽  
pp. 679-687 ◽  
Author(s):  
S. A. Brown ◽  
A. Basu ◽  
B. P. Kovatchev
Keyword(s):  
Decision Making ◽  
Continuous Glucose Monitoring ◽  
Treatment Effect ◽  
Clinical Decision Making ◽  
Glucose Monitoring ◽  
Clinical Decision

scholarly journals Use of continuous glucose monitoring system in patients with type 2 mellitus diabetic during hemodialysis treatment

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Marcelo Rocha Nasser Hissa ◽  
Priscilla Nogueira Gomes Hissa ◽  
Sérgio Botelho Guimarães ◽  
Miguel Nasser Hissa
Keyword(s):  
Continuous Glucose Monitoring ◽  
Clinical Decision Making ◽  
Glucose Monitoring ◽  
Clinical Decision ◽  
Relative Difference ◽  
Fluid Loss ◽  
Freestyle Libre ◽  
Stage Renal Disease ◽  
End Stage ◽  
Error Grid

Abstract Background Studies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre® is the most used in worldwide, but there is still no consensus on its use in dialysis. Method A 3-week prospective study was performed with 12 patients comparing capillary and interstitial glucose during dialysis. Results Comparing capillary and interstitial measurements, similar values were observed in pre-dialysis in the 1st week (184.1 ± 69.5 mg/dl and 173.1 ± 78.9 mg/dl, respectively, p = 0.303), in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2 mg/dl and 201.3 ± 77.0 mg/dl respectively, p = 0.466), in those dialysis fluid loss less than 2 l (185.5 ± 82.6 mg/dl and 183.1 ± 94.0 mg/dl respectively and p = 0.805) and in those with hemoglobin greater than 12 g/dl (152.0 ± 35, 5 mg/dl and 129.5 ± 47.4 mg/dl respectively, p = 0.016). In the correlation of the capillary measurement with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0%, 10.4% and 0.0% respectively and in the Parkes error grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. Conclusion The mean absolute relative difference in dialysis patients is higher than the general population without end-stage renal disease. However, clinical decision-making based on the values measured by the system can be made with a good margin based on the correlation between interstitial and capillary measurements.

scholarly journals Use of continuous glucose monitoring system in patients with type 2 mellitus diabetic during hemodialysis treatment.

2021 ◽  
Author(s):  
Marcelo Rocha Nasser Hissa ◽  
Priscilla Nogueira Gomes Hissa ◽  
Sérgio Botelho Guimarães ◽  
Miguel Nasser Hissa
Keyword(s):  
Continuous Glucose Monitoring ◽  
Clinical Decision Making ◽  
Glucose Monitoring ◽  
Clinical Decision ◽  
Relative Difference ◽  
Fluid Loss ◽  
Freestyle Libre ◽  
Stage Renal Disease ◽  
End Stage ◽  
Error Grid

Abstract Background Studies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre ® is the most used in worldwide, but there is still no consensus on its use in dialysis. Method: A 3-week prospective study was performed with 12 patients comparing capillary and interstitial glucose during dialysis. Results Comparing capillary and interstitial measurements, similar values were observed in pre-dialysis in the first week (184.1 ± 69.5 mg/dl and 173.1 ± 78.9 mg/dl, respectively, p = 0.303), in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2 mg/dl and 201.3 ± 77.0 mg/dl respectively, p = 0.466), in those dialysis fluid loss less than 2 liters (185.5 ± 82.6 mg/dl and 183.1 ± 94.0 mg/dl respectively and p = 0.805) and in those with hemoglobin greater than 12g/dl (152.0 ± 35, 5 mg/dl and 129.5 ± 47.4 mg/dl respectively, p = 0.016). In the correlation of the capillary measurement with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0 %, 10.4% and 0.0% respectively and in the Parkes Error Grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. Conclusion The mean absolute relative difference in dialysis patients is higher than the general population without end-stage renal disease. However, clinical decision-making based on the values measured by the system can be made with a good margin based on the correlation between interstitial and capillary measurements.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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