scholarly journals SUN-692 Comprehensive and Structured Care Program for Patients with Type 2 Diabetes Mellitus: A Preliminary Report from Raipur, Chhattisgarh State of India

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kalpana Dash ◽  
Surekha Tippisetty ◽  
Samba Siva Rao ◽  
Vamsi Krishna Kolukula
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Care Program ◽  
Mobile App ◽  
Phone Call ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Self Monitoring ◽  
Structured Care ◽  
Glycemic Outcomes

Abstract Aim: To assess the glycemic outcomes of T2DM patients enrolled in comprehensive structured care program at the outpatient clinic of Apollo Sugar at Raipur, India. Methods: This is a preliminary, prospective, single-center, observational study on T2DM patients from Jan 2018 to December 2018. Uncontrolled diabetes or patients with comorbid conditions with the duration of disease for more than one year and age ≥18 years and who gave consent to enroll in the program were included in the study. The structured care program is a 6 months program where patients were continuously engaged by counseling them on diabetes management- diet and exercise, self-monitoring of blood glucose, health interactions with the remote health coach through a mobile app. Baseline demographics and clinical data were collected at the time of enrollment and were followed up for 6 months. HbA1c reduction is the target measurement of this program. Descriptive statistics were used to analyze and report the data. A paired t-test is used to check the significant reduction in HbA1c from baseline to follow up Results: Total 102 patients were included in this study. Mean (SD) age was 50.7 (10.5) years, males were 78 (76%) and females were 24 (24%). The mean (SD) duration of diabetes and BMI were 7.9 (7.0) years and 27.5 (4.5) kg/m2 respectively. At the time of enrollment, patients were at mean HbA1c of 9.0(2.1)%, fasting (F) and post-prandial (PP) blood (BG) glucose was 194(68) mg/dL and 247(94) mg/dL respectively. Among these patients 38% had neuropathy and 15% had retinopathy as their complications. These patients were regularly followed up over the phone call to counsel on diabetes management with a healthy diet, exercise, self-monitoring of blood glucose, and medication compliance. After 6 months followup the HbA1c, FBG, and PPBG were 7.6 (1.5) %, 139 (50) mg/dL, and 196 (75) mg/dL, respectively with a significant mean reduction of 1.4%, 56 mg/dL, and 51 mg/dL (p <0.001). Further analysis of glycemic outcomes between these patients on oral hypoglycemic agents (OHAs) and OHAs+insulin, the reduction in HbA1c (1.5%) was not significant. Conclusion: Our study demonstrates that a structured care program might bring a clinically significant glycemic control through tight adherence to SMBG, diet, exercise, and medication. To establish these results a study in large sample is in progress.

scholarly journals Once Daily Self-Monitoring of Blood Glucose (SMBG) Improves Glycemic Control in Oral Hypoglycemic Agents (OHA)–Treated Diabetes

2015 ◽  
Vol 10 (2) ◽  
pp. 378-382 ◽  
Author(s):  
Shin-ichi Harashima ◽  
Akiko Nishimura ◽  
Kaori Ikeda ◽  
Yu Wang ◽  
Yanyan Liu ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Self Monitoring ◽  
Once Daily

"Taming the Monster aka Uncontrolled Diabetes: A Viewpoint" (Preprint)

2020 ◽  
Author(s):  
Swati Anand ◽  
Amardeep Kalsi ◽  
Jonathan Figueroa ◽  
Parag Mehta
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Positive Impact ◽  
The United States ◽  
Phone Call ◽  
Diabetic Patients ◽  
Dietary Compliance ◽  
Glucose Levels ◽  
Uncontrolled Diabetes ◽  
Number Of Patients

BACKGROUND HbA1c between 6% and 6.9% is associated with the lowest incidence of all‐cause and CVD mortality, with a stepwise increase in all‐cause and cardiovascular mortality in those with an HbA1c >7%. • There are 30 million individuals in the United States (9.4% of the population) currently living with Diabetes Mellitus. OBJECTIVE Improving HbA1C levels in patients with uncontrolled Diabetes with a focused and collaborative effort. METHODS Our baseline data for Diabetic patients attending the outpatient department from July 2018 to July 2019 in a University-affiliated hospital showed a total of 217 patients for one physician. • Of 217 patients, 17 had HbA1C 9 and above. We contacted these patients and discussed the need for tight control of their blood glucose levels. We intended to ensure them that we care and encourage them to participate in our efforts to improve their outcome. • We referred 13 patients that agreed to participate to the Diabetic educator who would schedule an appointment with the patients, discuss their diet, exercise, how to take medications, self-monitoring, and psychosocial factors. • If needed, she would refer them to the Nutritionist based on patients’ dietary compliance. • The patients were followed up in the next two weeks via telemedicine or a phone call by the PCP to confirm and reinforce the education provided by the diabetes educator. RESULTS Number of patients that showed an improvement in HbA1C values: 11 Cumulative decrease in HbA1C values for 13 patients: 25.3 The average reduction in HbA1C: 1.94 CONCLUSIONS Our initiative to exclusively target the blood glucose level with our multidisciplinary approach has made a positive impact, which is reflected in the outcome. • It leads to an improvement in patient compliance and facilitates diabetes management to reduce the risk for complications CLINICALTRIAL NA

scholarly journals A Male with Extreme Subcutaneous Insulin Resistance: A Case Report

2016 ◽  
Vol 23 (2) ◽  
pp. 209-213 ◽  
Author(s):  
Zuhayer Ahmed ◽  
Indrajit Prasad ◽  
Hafizur Rahman ◽  
Jalil Ansari ◽  
Khaled Hassan
Keyword(s):  
Insulin Resistance ◽  
Blood Glucose ◽  
Underdeveloped Country ◽  
Hypoglycemic Agents ◽  
High Dose ◽  
Subcutaneous Insulin ◽  
Oral Hypoglycemic Agents ◽  
Glucose Levels ◽  
Medical Issues ◽  
Insulin Autoantibody

AbstractIntroduction: Though insulin has no upper limit in dosage, we do not encounter very high dose requirements too often. The reported case is the first in Bangladesh to require more than 1000 international units (IU) of subcutaneous insulin per day.Case presentation: A 44-year old male diabetic patient from Bangladesh presented with unusually uncontrolled diabetes mellitus due to extreme insulin resistance. Despite dramatic increase in insulin step by step up to 1110 IU of concomitant short and intermediate acting insulin per day by subcutaneous route, his blood glucose remained over 12 mmol/L persistently, in all the fasting, pre-prandial, postprandial and random samples. He was also treated with several oral hypoglycemic agents including metformin, vildagliptin, glimepiride, pioglitazone and miglitol along with insulin but blood glucose levels remained almost unchanged. However, intravenous infusion of insulin over 4 hours caused a plummet in the glucose level. His blood test for insulin autoantibody was negative.Conclusion: This paper provides a scope to review literatures on extreme subcutaneous insulin resistance and its management. It also reveals the limitations of management due to lack of facilities in an underdeveloped country, which hinders proper exploration to many medical issues.

Evaluation of a Continuous Blood Glucose Monitor: A Novel and Non-Invasive Wearable Using Bioimpedance Technology

2021 ◽  
pp. 193229682110541
Author(s):  
Farid Sanai ◽  
Arshman S. Sahid ◽  
Jacqueline Huvanandana ◽  
Sandra Spoa ◽  
Lachlan H. Boyle ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Blood Glucose ◽  
Real World ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Self Monitoring ◽  
Non Invasive ◽  
Adult Participants ◽  
Blood Glucose Monitor

Background: Frequent blood glucose level (BGL) monitoring is essential for effective diabetes management. Poor compliance is common due to the painful finger pricking or subcutaneous lancet implantation required from existing technologies. There are currently no commercially available non-invasive devices that can effectively measure BGL. In this real-world study, a prototype non-invasive continuous glucose monitoring system (NI-CGM) developed as a wearable ring was used to collect bioimpedance data. The aim was to develop a mathematical model that could use these bioimpedance data to estimate BGL in real time. Methods: The prototype NI-CGM was worn by 14 adult participants with type 2 diabetes for 14 days in an observational clinical study. Bioimpedance data were collected alongside paired BGL measurements taken with a Food and Drug Administration (FDA)-approved self-monitoring blood glucose (SMBG) meter and an FDA-approved CGM. The SMBG meter data were used to improve CGM accuracy, and CGM data to develop the mathematical model. Results: A gradient boosted model was developed using a randomized 80-20 training-test split of data. The estimated BGL from the model had a Mean Absolute Relative Difference (MARD) of 17.9%, with the Parkes error grid (PEG) analysis showing 99% of values in clinically acceptable zones A and B. Conclusions: This study demonstrated the reliability of the prototype NI-CGM at collecting bioimpedance data in a real-world scenario. These data were used to train a model that could successfully estimate BGL with a promising MARD and clinically relevant PEG result. These results will enable continued development of the prototype NI-CGM as a wearable ring.

Prevalence of Different Brands and SMBG Frequency of Glucometer in Dakshina Kannada

2021 ◽  
Vol 11 (9) ◽  
pp. 284-288
Author(s):  
Abhishek Pradhan ◽  
Arya P P ◽  
A.R. Shabaraya
Keyword(s):  
Blood Glucose ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Diabetes Management ◽  
Essential Element ◽  
Diabetic Patients ◽  
University Graduates ◽  
Self Monitoring ◽  
Elementary School Education ◽  
The Relationship

Glucometer is helpful to find out the glucose in blood. The purpose of the study was to assess the frequency of self-monitoring of glucose and the prevalence of different brands of glucometer used by the diabetic patients. The prospective observational study was conducted among 150 patients above 18 years of age. 45.33% of participants were males and 54.67% of patients were females. The big percentage of age group belongs to 51-70 years (76.6%) followed by 71-90 years (16%) and age of 31-50 years (7.3%). Of the total, 24% has elementary school education, were 33.3% high school pass outs, and 42.6% were college/university graduates. Out of 150 patients, 54.67% used glucometer and 45.33% were not using glucometer. Among these, 30.49% used Accu-chek, 21.95% One-touch, 14.63% Gluco-one and 32.93% used other brands. Out of 54.67%, 5.33% of people were using daily, 21.33% weekly once, 28.00% were using monthly and 45.33% were not using glucometer. The present study concluded that SMBG is to help people with diabetes to improve their glycemic control. The relationship between blood glucose and SMBG frequency supported the view that SMBG is an essential element in diabetes management. The patient compliance regarding SMBG is finite. Thus, almost 60% of patients did not perform daily SMBG and above 45% did not perform routine test. Accu-chek glucometer to have an acceptable accuracy with the sensitivity of 81%, specificity 65%, PPV (positive predictive value) 74% and NPV (negative predictive value) 74%. Accu-chek was found to be the most accurate and widely used glucometer. Key words: Frequency, Glucometer brand, SMBG (Self monitoring of blood glucose).

scholarly journals Hypoglycemic Coma in a Hemodialysis Patient Receiving Blood Glucose-Lowering Therapy With the Single Agent Teneligliptin

2018 ◽  
Vol 11 ◽  
pp. 117954761876335 ◽  
Author(s):  
Takumi Minezumi ◽  
Shin-ichi Takeda ◽  
Yusuke Igarashi ◽  
Kentaro Sato ◽  
Yoshiaki Murakami ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Single Agent ◽  
Severe Hypoglycemia ◽  
Dipeptidyl Peptidase ◽  
Hypoglycemic Agents ◽  
Tolerability Profile ◽  
Oral Hypoglycemic Agents ◽  
Dipeptidyl Peptidase 4 ◽  
Hypoglycemic Coma ◽  
Dipeptidyl Peptidase 4 Inhibitors

Blood glucose management in patients undergoing dialysis is clinically challenging. In this population, most conventional oral hypoglycemic agents are contraindicated, especially from the perspective of pharmacokinetics. Dipeptidyl peptidase-4 inhibitors exert unique pharmacologic actions via glucose-dependent mechanism and have an excellent tolerability profile with a very low risk of hypoglycemia. Furthermore, the literature reports that some dipeptidyl peptidase-4 inhibitors such as teneligliptin can be administered at the usual dose, regardless of a patient’s level of renal impairment. In this article, we report a case of hypoglycemic coma with a blood glucose level of 23 mg/dL. The patient became fully conscious shortly after receiving a glucose injection; however, severe hypoglycemia recurred for approximately 1.5 days. It eventually disappeared on the discontinuation of teneligliptin, which was the only antidiabetic agent that he had received. The present case may provide deep insights into promoting the safe use of hypoglycemic agents in patients undergoing dialysis.

scholarly journals Self-monitoring of blood glucose as a basis for diabetes management

2013 ◽  
Vol 4 (1) ◽  
pp. 47-54
Author(s):  
A. Yu Mayorov ◽  
O. G Melnikova ◽  
Yu. I Filippov
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
International Organization ◽  
Diabetes Treatment ◽  
Self Monitoring ◽  
Antidiabetic Therapy ◽  
New Methods ◽  
Before And After ◽  
External Conditions

The article represents the review of issues of self-monitoring of blood glucose (SMBG) in diabetes treatment. The therapeutic purposes are considered when carrying out SMBG before and after the meals, accepted in Russia, providing an individualization depending on age, existence of severe complications and the risk of hypoglycemia. SMBG frequency is presented at various options of the antidiabetic therapy. The value of carrying out SMBG for the patient and the doctor is discussed. The principles of the work photometric and electrochemical glucometers are given. Issues of accuracy of blood glucose measuring accepted by the International organization for standardization for the systems of SMBG are presented. The reasons of errors to the system evaluation of blood glucose are connected with incorrect hand washing, improper coding of test strips, external conditions (altitude, temperature, humidity), hematocrit, acidosis, hyperlipidemia, concentration of oxygen in blood, exogenous interfering substances (some medicines). The structure and rules of maintaining the diary as the main way of the storage of results of SMBG are presented. Data of the international and Russian studies on an assessment of efficiency of SMBG are shown. The SMBG new methods are discussed in the section on continuous glucose monitoring.

scholarly journals Identification of Type 2 Diabetes Management Mobile App Features and Engagement Strategies: Modified Delphi Approach (Preprint)

2019 ◽  
Author(s):  
Hanan A Alenazi ◽  
Amr Jamal ◽  
Mohammed A Batais
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Diabetes Management ◽  
Mobile App ◽  
Patient Specific ◽  
Moderate Degree ◽  
Modified Delphi ◽  
Engagement Strategies ◽  
Delphi Approach

BACKGROUND Diabetes is a significant public health issue. Saudi Arabia has the highest prevalence of type 2 diabetes mellitus (T2DM) in the Arab world. Currently, it affects 31.6% of the general population, and the prevalence of T2DM is predicted to rise to 45.36% by 2030. Mobile health (mHealth) offers improved and cost-effective care to people with T2DM. However, the efficiency of engagement strategies and features of this technology need to be reviewed and standardized according to stakeholder and expert perspectives. OBJECTIVE The main objective of this study was to identify the most agreed-upon features for T2DM self-management mobile apps; the secondary objective was to identify the most agreed-upon strategies that prompt users to use these apps. METHODS In this study, a 4-round modified Delphi method was applied by experts in the domain of diabetes care. RESULTS In total, 11 experts with a mean age of 47.09 years (SD 11.70) consented to participate in the study. Overall, 36 app features were generated. The group of experts displayed weak agreement in their ranking of intervention components (Kendall W=0.275; <i>P</i>&lt;.001). The top 5 features included insulin dose adjustment according to carbohydrate counting and blood glucose readings (5.36), alerting a caregiver of abnormal or critical readings (6.09), nutrition education (12.45), contacts for guidance if required (12.64), and offering patient-specific education tailored to the user’s goals, needs, and blood glucose readings (12.90). In total, 21 engagement strategies were generated. Overall, the experts showed a moderate degree of consensus in their strategy rankings (Kendall W=0.454; <i>P</i>&lt;.001). The top 5 engagement strategies included a user-friendly design (educational and age-appropriate design; 2.82), a free app (3.73), allowing the user to communicate or send information/data to a health care provider (HCP; 5.36), HCPs prescribing the mobile app in the clinic and asking about patients’ app use compliance during clinical visits (6.91), and flexibility and customization (7.91). CONCLUSIONS This is the first study in the region consisting of a local panel of experts from the diabetes field gathering together. We used an iterative process to combine the experts’ opinions into a group consensus. The results of this study could thus be useful for health app developers and HCPs and inform future decision making on the topic.

Development and Usability of a Text Messaging Program for Women with Gestational Diabetes: Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Rachel A. Blair ◽  
Christine E. Horn ◽  
Jennifer M. Dias ◽  
Marie E. McDonnell ◽  
Ellen W. Seely
Keyword(s):  
Blood Glucose ◽  
Gestational Diabetes ◽  
User Experience ◽  
Text Messaging ◽  
Diabetes Management ◽  
Secondary Outcome ◽  
Program Text ◽  
Usability Study ◽  
Maternal Complications ◽  
Self Monitoring

BACKGROUND Gestational diabetes mellitus (GDM) affects 5-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. OBJECTIVE This study aimed to perform user experience testing and assess usability and acceptability of a text messaging program (Text 4 Success) for women with GDM. METHODS An automated two-way texting program was developed. It included: 1) reminders to check blood glucoses, 2) positive feedback to user-reported glucoses, 3) weekly educational messages and 4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semi-structured interviews. For women in the usability study, glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percent of recommended SMBG checks performed (a secondary outcome). RESULTS Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (>90%). In comparing the week prior to the trial to the two weeks during the trial, there was a small but statistically insignificant difference in the percentage of recommended SMBG performed (median 93% [5 to 95 percentile 82-100%] vs median 97% [83-100%]). CONCLUSIONS Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have a low adherence to self-monitoring of blood glucose at baseline. Adaptations to the program will be made based on user suggestions. Further study of text messaging to improve SMBG in GDM is needed.

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