A Mobile Computerized Decision Support System to Prevent Hypoglycemia in Hospitalized Patients With Type 2 Diabetes Mellitus

Background: Diabetes management requires complex and interdisciplinary cooperation of health care professionals (HCPs). To support this complex process, IT-support is recommended by clinical guidelines. The aim of this article is to report on results from a clinical feasibility study testing the prototype of a mobile, tablet-based client-server system for computerized decision and workflow support (GlucoTab®) and to discuss its impact on hypoglycemia prevention. Methods: The system was tested in a monocentric, open, noncontrolled intervention study in 30 patients with type 2 diabetes mellitus (T2DM). The system supports HCPs in performing a basal-bolus insulin therapy. Diabetes therapy, adverse events, software errors and user feedback were documented. Safety, efficacy and user acceptance of the system were investigated. Results: Only 1.3% of blood glucose (BG) measurements were <70 mg/dl and only 2.6% were >300 mg/dl. The availability of the system (97.3%) and the rate of treatment activities documented with the system (>93.5%) were high. Only few suggestions from the system were overruled by the users (>95.7% adherence). Evaluation of the 3 anonymous questionnaires showed that confidence in the system increased over time. The majority of users believed that treatment errors could be prevented by using this system. Conclusions: Data from our feasibility study show a significant reduction of hypoglycemia by implementing a computerized system for workflow and decision support for diabetes management, compared to a paper-based process. The system was well accepted by HCPs, which is shown in the user acceptance analysis and that users adhered to the insulin dose suggestions made by the system.

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Self-monitoring of blood glucose in Black Caribbean and South Asian Canadians with non-insulin treated Type 2 diabetes mellitus: a qualitative study of patients’ perspectives

10.32920/14640246.v1 ◽

2021 ◽

Author(s):

Enza Gucciardi ◽

Mariella Fortugno ◽

Andrea Senchuk ◽

Heather Beanlands ◽

Elizabeth McCay ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

South Asian ◽

Health Care Professionals ◽

Diabetes Management ◽

Management Tool ◽

Structured Interviews ◽

Black Caribbean

Background: To examine the views and current practice of SMBG among Black Caribbean and South Asian individuals with non-insulin treated Type 2 diabetes mellitus. Methods: Twelve participants completed semi-structured interviews that were guided by the Health Belief Model and analyzed using thematic network analysis. Results: The frequency of monitoring among participants varied from several times a day to once per week. Most participants expressed similar experiences regarding their views and practices of SMBG. Minor differences across gender and culture were observed. All participants understood the benefits, but not all viewed SMBG as beneficial to their personal diabetes management. SMBG can facilitate a better understanding and maintenance of self-care behaviours. However, it can trigger both positive and negative emotional responses, such as a sense of disappointment when high readings are not anticipated, resulting in emotional distress. Health care professionals play a key role in the way SMBG is perceived and used by patients. Conclusion: While the majority of participants value SMBG as a self-management tool, barriers exist that impede its practice, particularly its cost. How individuals cope with these barriers is integral to understanding why some patients adopt SMBG more than others.

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Self-monitoring of blood glucose in Black Caribbean and South Asian Canadians with non-insulin treated Type 2 diabetes mellitus: a qualitative study of patients’ perspectives

10.32920/14640246 ◽

2021 ◽

Author(s):

Enza Gucciardi ◽

Mariella Fortugno ◽

Andrea Senchuk ◽

Heather Beanlands ◽

Elizabeth McCay ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

South Asian ◽

Health Care Professionals ◽

Diabetes Management ◽

Management Tool ◽

Structured Interviews ◽

Black Caribbean

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Management of Type 2 Diabetes Mellitus in a Patient with COVID-19: The Window of Insulin Glargine U300

Klimik Dergisi/Klimik Journal ◽

10.36519/kd.2021.3648 ◽

2021 ◽

Vol 34 (2) ◽

pp. 144-146

Author(s):

Ulaş Serkan Topaloğlu ◽

Esma Eren ◽

Yasin Şimşek

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Insulin Glargine ◽

Health Care Professionals ◽

Diabetes Management ◽

Fasting Blood Glucose ◽

Treatment And Prevention ◽

Treatment Safety

Research on pharmacological therapies for the treatment and prevention of Coronavirus Disease 2019 (COVID-19) is limited in patients with Type 2 Diabetes Mellitus (T2DM). In this case, diabetes management of a 51-year-old male patient who was followed up and treated with COVID-19 diagnosis in the pandemic clinic is presented. While metformin (2000 mg/day) oral therapy was continued, insulin glargine U100 (IGlar100) was added to the treatment subcutaneously. In addition, enoxaparin, hydroxychloroquine, azithromycin were started to be administered to the patient. During follow-up, respiratory distress and tachypnea (26 breaths/min), high fever (38.3oC), increased CRP (42 mg/dL), and decreased oxygen saturation (91%) were detected. Favipiravir was added to the treatment, and metformin was stopped due to possible lactic acidosis risk. IGlar300 treatment with more potency effect and lower risk of hypoglycaemia was initiated while IGlar100 was discontinued. In the follow-ups, titration was provided with IGlar300 to keep fasting blood glucose between 100-140 mg/dL and postprandial one between 140-180 mg/dL. In the treatment for this purpose, a maximum of 34 units/day insulin was needed. Capillary blood sugar monitoring was revised every 12 hours and then once a day. As the infection was brought under control, the required dose of IGlar300 decreased to 14 units/day. After diabetes training with a video phonecall, he was discharged with metformin and IGlar300. IGlar300 may be effective against diabetes in the COVID-19 pandemic. In addition, a significant contribution can be made both to the treatment safety of the patient in a glycemic sense and to the safety of contamination by reduced contact of health care professionals.

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Insulin Dose Adjustment Following Bariatric Surgery, a Review of Available Literature

Journal of Diabetes Science and Technology ◽

10.1177/19322968211028886 ◽

2021 ◽

pp. 193229682110288

Author(s):

Lynn E. Kassel ◽

Jessica J. Berei ◽

Jamie M. Pitlick ◽

Joel E. Rand

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Bariatric Surgery ◽

Type 2 Diabetes Mellitus ◽

Dose Adjustment ◽

Insulin Dose ◽

Appraisal Tool

Bariatric surgery is a known and effective treatment for type 2 diabetes mellitus. Patients with type 1 diabetes mellitus and exogenous insulin-requiring type 2 diabetes mellitus require adjusted insulin dosing after surgery to avoid hypoglycemia. This review describes insulin dose adjustments following a variety of bariatric procedures. After searching the available literature and assessing for eligibility, 8 articles were included. The Johns Hopkins Research Evidence Appraisal Tool for literature appraisal was used. The results of this review reveal insulin dose adjustment varies based upon surgical procedure type and time of follow-up from the procedure.

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Impact of an Advanced Practice Pharmacist Type 2 Diabetes Management Program: A Pilot Study

INNOVATIONS in pharmacy ◽

10.24926/iip.v10i4.2237 ◽

2019 ◽

Vol 10 (4) ◽

pp. 20

Author(s):

Jelena Lewis ◽

Tiffany Nguyen ◽

Hana Althobaiti ◽

Mona Alsheikh ◽

Brad Borsari ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetes Management ◽

Drug Dose ◽

Advanced Practice ◽

Dose Increase ◽

Therapeutic Decisions ◽

The Impact

Background: The purpose of this study was to describe the impact of an Advanced Practice Pharmacist (APh) on lowering hemoglobin A1c (HbA1c) in patients with type 2 diabetes within a patient centered medical home (PCMH) and to classify the types of therapeutic decisions made by the APh. Methods: This was a retrospective study using data from electronic health records. The study evaluated a partnership between Chapman University School of Pharmacy and Providence St. Joseph Heritage Healthcare that provided diabetes management by an Advanced Practice Pharmacist in a PCMH under a collaborative practice agreement. Change in the HbA1c was the primary endpoint assessed in this study. The type of therapeutic decisions made by the APh were also evaluated. Descriptive analysis and Wilcoxon signed rank test were used to analyze data. Results: The study included 35 patients with diagnosis of type 2 diabetes mellitus managed by an APh from May 2017 to December 2017. Most of the patients were 60-79 years old (68.5%), 45.7% were female, and 45.7% were of Hispanic/Latino ethnicity. The average HbA1c was 8.8%±1.4% (range=6.0%-12.4%) and 7.5%±1.4% (range=5.5%-12.4%) at the initial and final APh visit, respectively (p<0.0001). Therapeutic decisions made by the APh included drug dose increase (35.5% of visits), drug added (16.4%), drug dose decrease (6.4%), drug switch (5.5%), and drug discontinuation (1.8%). Conclusion: The Advanced Practice Pharmacist’s interventions had a significant positive impact on lowering HbA1c in patients with type 2 diabetes mellitus in a PCMH. The most common therapeutic decisions made by the APh included drug dose increase and adding a new drug. Article Type: Pharmacy Practice

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