Management of diabetes during the last days of life: attitudes of consultant diabetologists and consultant palliative care physicians in the UK

2006 ◽  
Vol 20 (3) ◽  
pp. 197-203 ◽  
Author(s):  
S Ford-Dunn ◽  
A Smith ◽  
J Quin
Keyword(s):  
Palliative Care ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Terminal Phase ◽  
Diabetic Patients ◽  
Clinical Vignettes ◽  
Dying Patients ◽  
Co Morbidity ◽  
Patients With Diabetes ◽  
The Uk

Diabetes is an increasingly common condition and hence, managing dying patients with diabetes as a co-morbidity will become a frequent challenge. It is uncertain whether there is net beneficence in preventing hyperglycaemia in diabetic patients during the terminal phase or whether the distress involved in administering therapy and blood glucose monitoring may outweigh this ordeal. Since there is no available evidence upon which to base clinical decisions, a semi-structured questionnaire based around three clinical vignettes was sent to consultants in diabetes and palliative care in the UK. There was consensus of opinion from both groups of consultants that treatment and monitoring should be stopped in patients with type 2 diabetes, once in the terminal phase. There was less consensus regarding management of type 1 diabetes. Practical issues were raised by both groups of consultants and clinical guidelines are suggested.

Hepatitis C in a Ward for Cystic Fibrosis and Diabetic Patients Possible Transmission by Spring-Loaded Finger-Stick Devices for Self-Monitoring of Capillary Blood Glucose

2001 ◽  
Vol 22 (11) ◽  
pp. 701-707 ◽  
Author(s):  
Jean-Claude Desenclos ◽  
Martine Bourdiol-Razès ◽  
Bernard Rolin ◽  
Patrick Garandeau ◽  
Jacques Ducos ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Blood Glucose ◽  
Hepatitis C ◽  
Glucose Monitoring ◽  
Capillary Blood ◽  
Blood Glucose Monitoring ◽  
Diabetic Patients ◽  
Capillary Blood Glucose ◽  
Self Monitoring ◽  
Patients With Diabetes

AbstractObjective:To identify the routes of transmission in a nosocomial outbreak of hepatitis C virus (HCV) infection.Design:Epidemiological investigation, including screening for HCV of hospitalized patients, and a retrospective cohort study, review of hygiene and medical practices, and molecular comparison of HCV isolates.Setting:A specialized care unit for cystic fibrosis (CF) and diabetic patients at an acute-care facility in the south of France.Results:Of the 57 CF patients (age in 1995: 2-28 years), 38 (66.7%) were tested and 22 (57.9%) were anti-HCV positive. Eight (50%) of 16 patients with anti-HCV antibody tested by polymerase chain reaction were viremic. No patients had received blood products or had any history of intravenous drug use. All 18 (100%) patients with CF who had ever undergone self-monitoring of capillary blood glucose in the unit were anti-HCV positive, compared to 4 (20%) of 20 who had not (relative risk, 5.0; 95% confidence interval, 2.1-12.0). Seventy (39.5%) of the patients with diabetes were screened for anti-HCV; 12 (18.8%) tested positive, with 3 (25%) positive for HCV-RNA. Patients with diabetes had routine capillary blood glucose monitoring while hospitalized and shared with CF patients the same spring-triggered devices for capillary blood glucose monitoring. The disposable platform of the devices was not changed between patient use. All HCV isolates belonged to the type 1, subtype b, and phylogenetic analysis showed a close homology by sequencing of NS5b and E2/HVR regions.Conclusion:As reported earlier for the hepatitis B virus, shared spring-triggered devices for capillary blood glucose monitoring by finger puncture may transmit HCV. Strict application of Standard Precautions procedures is warranted in any healthcare setting.

scholarly journals Problems of blood glucose self-monitoring in patients with diabetes mellitus

2022 ◽  
pp. 140-148
Author(s):  
Yu. A. Kononova ◽  
V. B. Bregovskiy ◽  
A. Yu. Babenko
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Monitoring System ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Diabetic Patients ◽  
Self Monitoring ◽  
Measurement Results ◽  
Patients With Diabetes ◽  
Blood Glucose Self Monitoring

Glycemic self-monitoring is essential in  the  treatment of  diabetes mellitus. Compliance with the  recommendations for  selfmonitoring of glycemia is an important condition for the prevention of diabetes complications. The article provides a review of the problems associated with blood glucose self-monitoring faced by diabetic patients and doctors. These include low frequency of blood glucose self-monitoring, technical errors in glucose measurements, errors in keeping a diary and errors in using measurement data to diabetes control. The blood glucose monitoring system, which includes the glucometer, test strips, application, сloud for data storage can be used for blood glucose self-monitoring in patients with diabetes mellitus. The article discusses the features and advantages of the blood glucose monitoring system. The advantages of the glucometer are the no сoding technology and the following options: аpplication of additional amount of blood to the test strip; adding meal marks, testing as the measurement results compare with targets and informing about it; storage a large number of measurement results. In addition to the standard blood glucose measurement, the glucose meter and the application offer many features to improve blood glucose self-monitoring that can help to improve diabetes management: automatic transferring measurement results to smartphone or tablet; saving notes in logbook; display of glucose trends and testing as they compare with targets; offering quick and valuable tips for critical high/low glucose values.

Indole as a new tentative marker in exhaled breath for non-invasive blood glucose monitoring of diabetic subjects

2021 ◽  
Author(s):  
Herbert Fink ◽  
Tim Maihöfer ◽  
Jeffrey Bender ◽  
Jochen Schulat
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Glucose Measurement ◽  
Diabetic Patients ◽  
Exhaled Breath ◽  
Invasive Approach ◽  
Test Strips ◽  
Non Invasive

Abstract Blood glucose monitoring (BGM) is the most important part of diabetes management. In classical BGM, glucose measurement by test strips involves invasive finger pricking. We present results of a clinical study that focused on a non-invasive approach based on volatile organic compounds (VOCs) in exhaled breath. Main objective was the discovery of markers for prediction of blood glucose levels (BGL) in diabetic patients. Exhaled breath was measured repeatedly in 60 diabetic patients (30 type 1, 30 type 2) in fasting state and after a standardized meal. Proton Transfer Reaction Time of Flight Mass Spectrometry (PTR-ToF-MS) was used to sample breath every 15 minutes for a total of six hours. BGLs were tested in parallel via BGM test strips. VOC signals were plotted against glucose trends for each subject to identify correlations. Exhaled indole (a bacterial metabolite of tryptophan) showed significant mean correlation to BGL (with negative trend) and significant individual correlation in 36 patients. The type of diabetes did not affect this result. Additional experiments of one healthy male subject by ingestion of lactulose and 13C-labeled glucose (n=3) revealed that exhaled indole does not directly originate from food digestion by intestinal microbiota. As indole has been linked to human glucose metabolism, it might be a tentative marker in breath for non-invasive BGM. Clinical studies with greater diversity are required for confirmation of such results and further investigation of metabolic pathways.

scholarly journals Prevalence of Poor Diabetes Self-Management Behaviors among Ethiopian Diabetes Mellitus Patients: A Systematic Review and Meta- Analysis

2020 ◽  
Vol 30 (4) ◽  
Author(s):  
Teshome Tesfaye Habebo ◽  
Ebrahim Jaafari Pooyan ◽  
Ali Mohammad Mosadeghrad ◽  
Getachew Ossabo Babore ◽  
Blen Kassahun Dessu
Keyword(s):  
Quality Assessment ◽  
Addis Ababa ◽  
Meta Analysis ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Self Management ◽  
Diabetic Patients ◽  
Pooled Prevalence ◽  
Meta Analyses ◽  
Management Behaviors

BACKGROUND: Diabetes has no cure so far, but appropriate self-management contributes to delay or control its progression. However, poor self-management by diabetic patients adds to disease burden. The pooled prevalence of overall, and its main components of poor self-management among Ethiopian diabetic patients remain elusive. Hence, this study aimed to determine the prevalence of poor diabetes self-management behaviors among diabetic patients in Ethiopia.METHOD: by using different combinations of search terms, we accessed articles done until February 15, 2020 through Pubmed, Scopus, Web of Science and Embase databases. Newcastle-Ottawa quality assessment scale was used for quality assessment, and STATA version 14 software along with the random-effects model was employed for statistical analyses. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA.) guideline was followed to report the results.RESULT: Twenty-one studies with 7,168 participants were included in this meta-analysis. The overall pooled prevalence of poor self-management behavior among diabetic patients in Ethiopia was 49.79% (95% CI: 43.58%, 56.01%). Based on subgroup analysis, the estimated magnitudes of poor selfmanagement by regions were 68.58% in Tigray, 55.46% in Harari, 54.74%, in Amhara, 40.90%, in SNNPRS and 37.06% in Addis Ababa. The worst (80.91%) and relatively better (24.65%) self-management components were observed on self-blood glucose monitoring and medication adherence, respectively.CONCLUSION: One in two diabetic patients in Ethiopia had poor self-management. Thus, we strongly recommend to the ministry of health and universities to train diabetes health educators, and the health facilities to deliver tailored diabetes health education.

The Impact of Fasting in Ramadan on Metabolic and Anthropometric Indices in Trained Type ΙΙ Diabetic Patients: A Prospective Observational Study

2020 ◽  
Author(s):  
Tayebe Yazdanyar ◽  
Mehrnoush Sohrab ◽  
Atena Ramezani ◽  
Zahra Kashi ◽  
Parastoo Karimi Ali Abadi ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Observational Study ◽  
Blood Sugar ◽  
Prospective Observational Study ◽  
Eating Habits ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Diabetic Patients ◽  
Anthropometric Indices ◽  
Ramadan Fasting

Abstract Background: Fasting has certain effects on metabolic and anthropometric parameters in diabetic patients. It is, therefore, necessary for patients to receive proper education related to their physical activities, eating habits, blood glucose monitoring, and medications. The aim of this study was to investigate the effects of Ramadan fasting on metabolic and anthropometric indices in type ΙΙ diabetic patients.Methods: This prospective observational study was performed during Ramadan 2018. The study population consisted of diabetic patients who desired to fast and received information on physical activity, eating habits, blood glucose monitoring, and taking their medications before Ramadan. Fasting blood sugar (FBS), blood sugar 2-hour postprandial (BS2hpp), glycosylated hemoglobin (HbA1C), and the lipids profile were assessed before and after Ramadan month. FBS and BS2hpp were also evaluated on the fifteenth day of Ramadan. The significance level for data analysis was considered p<0.05.Results: Out of 40 diabetic cases who completed the study, 6 (15%) were male and 34 (75%) were female. The mean age of participants was 55.2 ± 9.3 years. The anthropometric variables, including weight, BMI, waist, and blood pressure, decreased significantly after Ramadan fasting (p<0.05). FBS decreased significantly (125.1 ± 27.4 vs 105.2 ± 21.4, p<0.0001) and serum triglyceride increased significantly (127.5 ± 45.5 vs 166.5±53.5 mg/dl, p<0.001) after fasting compared to pre-Ramadan measurement. Other variables remained unchanged.Conclusion: The results of this study indicate that type II diabetic patients who have controlled blood sugar and received information based on clinical guidelines about their lifestyle and medications can fast safely during the holy month of Ramadan.

scholarly journals Electrochemically Activated Conductive Ni-Based MOFs for Non-enzymatic Sensors Toward Long-Term Glucose Monitoring

2020 ◽  
Vol 8 ◽  
Author(s):  
Yating Chen ◽  
Yulan Tian ◽  
Ping Zhu ◽  
Liping Du ◽  
Wei Chen ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Glucose Sensor ◽  
Glucose Monitoring ◽  
Glucose Sensors ◽  
Blood Glucose Monitoring ◽  
Diabetic Patients ◽  
Potential Range ◽  
Potential Applications ◽  
Naoh Solution

Continuous intensive monitoring of glucose is one of the most important approaches in recovering the quality of life of diabetic patients. One challenge for electrochemical enzymatic glucose sensors is their short lifespan for continuous glucose monitoring. Therefore, it is of great significance to develop non-enzymatic glucose sensors as an alternative approach for long-term glucose monitoring. This study presented a highly sensitive and selective electrochemical non-enzymatic glucose sensor using the electrochemically activated conductive Ni3(2,3,6,7,10,11-hexaiminotriphenylene)2 MOFs as sensing materials. The morphology and structure of the MOFs were investigated by scanning SEM and FTIR, respectively. The performance of the activated electrode toward the electrooxidation of glucose in alkaline solution was evaluated with cyclic voltammetry technology in the potential range from 0.2 V to 0.6 V. The electrochemical activated Ni-MOFs exhibited obvious anodic (0.46 V) and cathodic peaks (0.37 V) in the 0.1 M NaOH solution due to the Ni(II)/Ni(III) transfer. A linear relationship between the glucose concentrations (ranging from 0 to 10 mM) and anodic peak currents with R2 = 0.954 was obtained. It was found that the diffusion of glucose was the limiting step in the electrochemical reaction. The sensor exhibited good selectivity toward glucose in the presence of 10-folds uric acid and ascorbic acid. Moreover, this sensor showed good long-term stability for continuous glucose monitoring. The good selectivity, stability, and rapid response of this sensor suggests that it could have potential applications in long-term non-enzymatic blood glucose monitoring.

scholarly journals VP184 A Cost Analysis Of Flash Glucose Monitoring Systems In Veneto Region

2017 ◽  
Vol 33 (S1) ◽  
pp. 235-236
Author(s):  
Alessandro Curto ◽  
Marika Torbol ◽  
Anna Cavazzana ◽  
Margherita Andretta ◽  
Giovanna Scroccaro
Keyword(s):  
Blood Glucose ◽  
Cost Analysis ◽  
New Technology ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Diabetic Patients ◽  
Veneto Region ◽  
Glucose Levels ◽  
Medical App ◽  
The Impact

INTRODUCTION:A novel, sensor-based, factory-calibrated Flash Monitoring System (FMS) has recently proved to be an effective alternative to conventional self-monitoring of blood glucose (SMBG) in patients affected by type 1 and type 2 diabetes. The 14-days adhesive sensor, that continuously measures glucose levels in the interstitial fluid, can transfer glucose levels data to a handheld reader or a smartphone equipped with a specific medical app. The uptake of the new technology has been limited so far, because of its high costs. A cost analysis has been conducted to identify the optimal target population of introducing FSM in Veneto.METHODS:The model was designed with a 1-year time horizon for patients with diabetes using intensive insulin in Veneto region. The costs of the new technology was estimated using inputs from the two main randomized controlled trials (the IMPACT study and the REPLACE study) published in the international literature, Regional evidence-based guidelines and administrative database. Resource utilization included strips, lancets, needles, sensors, distribution and patients training. Regional unit costs were adopted.RESULTS:FSM has not shown so far relevant and statically significant benefits in terms of severe adverse events’ reduction. Estimated yearly costs for a FSM user included glucose monitoring, technology training and distribution costs, for a total of EUR1277 per patient. The new technology has been shown to be affordable in diabetic patients with i) 4years<age<18years, ii) continuous subcutaneous insulin infusion and iii) ≥5 blood glucose monitoring per day.CONCLUSIONS:The Veneto Region should carefully consider prescribing extension to other diabetic patients categories, since the high cost of the new technology. A strict prescribing monitoring is strongly recommended with the aim of ensuring appropriateness and avoiding overspending.

Design of Automatic Insulin Dosage Indicator for Diabetic Patients Using BMI

2020 ◽  
pp. 69-74
Author(s):  
Kanimozhi R ◽  
Saravanakumar S
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Blood Glucose Concentration ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Insulin Dosage ◽  
Diabetic Patients ◽  
Monitoring Methods ◽  
Invasive Techniques

Diabetes Mellitus is a serious and chronic health disease. It occurs in all age group of people, especially in adults and aged persons. It is important to measure blood glucose level frequently for the diabetes affected persons which in need to determine the appropriate insulin dosage. Along with this, the continuous glucose monitoring is vital to know whether the glucose level is in normal range. The conventional method used to measure the glucose level in blood is invasive which is infectious and a painful process. Nowadays, the non-invasive blood glucose monitoring methods are widely used. In this work, the blood glucose level is measured non-invasively using IR sensor. Besides that, the indication of insulin dosage to be taken is done by determining blood glucose concentration (non- invasively) and comparing it with Body Mass Index (BMI) of the patient. The implementation is based on the variations in the intensity of the IR LED, BMI and blood density. Themethod ismore reliable than the invasive techniques.

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