scholarly journals Overcoming obstacles: new management options

2004 ◽  
pp. T23-T27 ◽  
Author(s):  
L Heinemann
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Diabetes Management ◽  
Treatment Options ◽  
Glucose Monitoring ◽  
Regular Insulin ◽  
Insulin Analogues ◽  
Management Options ◽  
Insulin Replacement

The outlook for patients with type 2 diabetes looks set to improve with the availability of new diabetes management options that provide more comprehensive control of blood glucose levels and/or encourage better patient compliance than previous alternatives. New insulin analogues, such as insulin lispro, aspart and glargine, allow more physiological insulin replacement and greater freedom in the timing and content of meals, compared with regular insulin preparations. The development of novel non-invasive routes of insulin administration promises to further improve diabetes management. Many barriers to initiating insulin relate to the need for frequent insulin injections, fears that insulin injections will be painful and difficult to administer, and concerns about hypoglycaemia and weight gain. Thus, each measure that reduces these barriers will help to prevent inappropriate delays in starting insulin therapy as well as to promote better compliance with therapy. The output from continuous glucose monitoring devices will assist accurate insulin replacement, which is difficult using point-estimates of blood glucose. Such devices will hopefully also circumvent the need for finger stick tests. There are several novel therapies in development that will further expand the portfolio of treatment options for patients with type 2 diabetes. Improved quality and choice of diabetes management options will provide doctors with the tools they require to develop tailored treatment plans, increase the probability that treatment goals are achieved and thereby reduce the risk of patients developing late-stage diabetes-related complications.

scholarly journals Real-time continuous glucose monitoring versus self-monitoring of blood glucose in adults with insulin-treated type 2 diabetes: a protocol for a randomised controlled single-centre trial

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040648
Author(s):  
Nanna Lind ◽  
Dorte Lindqvist Hansen ◽  
Signe Sætre Rasmussen ◽  
Kirsten Nørgaard
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Peer Support ◽  
Continuous Glucose Monitoring ◽  
Data Protection ◽  
Treatment Options ◽  
Glucose Monitoring ◽  
Single Centre ◽  
Self Monitoring

IntroductionMedical treatment options for type 2 diabetes (T2D) have increased over the last decade and enhance the possibility of individualised treatment strategies where insulin is still one of them. In spite of the advancements in treatment options, less than one-third of the population with T2D obtain their optimal glycaemic goal. In persons with type 1 diabetes, continuous glucose monitoring (CGM) has shown to be the most important driver for improvement in glycaemic control, even more than insulin-pump therapy. The use of technology in T2D has only been investigated in few studies.The overall objective of the research study is to examine the effectiveness of the use of CGM versus self-monitoring of blood glucose (SMBG) in persons with insulin-treated T2D on glycaemic variables and patient-reported outcomes on treatment satisfaction, health behaviour and well-being. The independent effect of peer support will also be studied.Methods and analysisThe study is a single centre, prospective, randomised, open-labelled, three-armed study with the randomisation 2:1:2 in group A with CGM, group B with CGM and peer support, and group C as a control group with SMBG. The participants receive a training course unique for the allocation group. The study runs for 12 months and includes 100 adult participants with insulin-treated T2D, treated at the outpatient clinic at Steno Diabetes Center Copenhagen. Primary outcome is difference in change in time in range. Recruitment begins in August 2020 and ends in July 2021. Final 12-month follow-up is anticipated to be in August 2022.Ethics and disseminationThe study will be carried out in accordance with the Helsinki Declaration and is approved by the Scientific Ethics Committee of the Capital Region (H-20000843). Data collection and handling will be performed in accordance with the General Data Protection Regulation and is approved by the Danish Data Protection Agency (J-2020-100). Dissemination will be in international peer-reviewed journals, conferences and a plain-language summary for participants.Trial registration numberClinicalTrials.gov Registry (NCT04331444).Protocol versionV.3, 11 December 2020.

Can Blood Glucose Monitoring be Simplified/Modified in Order to Achieve Better Diabetes Management—Perspectives for the Future

2010 ◽  
Vol 06 (01) ◽  
pp. 48
Author(s):  
Robert M Cuddihy ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Diabetes Management ◽  
Healthcare Providers ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Clear Understanding ◽  
Major Advance ◽  
Oral Agents

Self-monitoring of blood glucose (SMBG) with reflectance meters was heralded as a major advance in the management of diabetes and has been available to individuals with diabetes for home use since the late 1970s. This tool was put to use in the landmark Diabetes Control and Complications Trial (DCCT), which revolutionized care for individuals with type 1 diabetes, enabling these individuals to intensify their glucose control. SMBG has similar benefit in individuals with type 2 diabetes requiring insulin therapy. Its use in other individuals with type 2 diabetes treated with oral agents or non-insulin therapies is less clear. While SMBG is a potentially powerful tool to aid in the daily management of diabetes, to be used effectively, SMBG must be optimized to ensure the information derived from it can be acted on to modify physical activity, dietary intake, or medications to improve glycemic control. Recently, studies looking at this population have called into question the utility of SMBG in the management of individuals with type 2 diabetes treated with non-insulin therapies. However, these studies are lacking in the specifics of how such information was used to modify therapies. In addition to this, the lack of a universally accepted output for SMBG data significantly impedes its uptake and appropriate use by healthcare providers and patients. To maximize the effectiveness of SMBG, both patients and providers need to have a clear understanding of when and how to use SMBG data and, most importantly, act upon the data to effect a change in their diabetes management.

scholarly journals A Review of Emerging Technologies in Diabetes Management for Multiple-Dose Insulin-Injecting Patients With Type 2 Diabetes Who Self-monitor Blood Glucose

2018 ◽  
Vol 35 (2) ◽  
pp. 69-81
Author(s):  
Malgorzata Slugocki ◽  
Damian Bialonczyk ◽  
Ayşe Elif Özdener
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Multiple Dose ◽  
English Language ◽  
Diabetes Management ◽  
Data Extraction ◽  
Glucose Monitoring ◽  
Patient Specific ◽  
Smart Devices

Objective: The management of diabetes mellitus requires a precise interpretation of blood glucose (BG) data by patients and providers and is increasingly associated with a need for medical technologies that aid in achieving patient-specific outcomes while making the process convenient. This review aims to summarize the current landscape in diabetes management technology, focusing specifically on devices that assist with pattern management in patients with type 2 diabetes (T2DM) who are on multiple-dose insulin regimens. Data Sources: The authors searched MEDLINE to identify articles from 2007 to 2018 that evaluated technologies for BG pattern management and diabetes monitoring. Additional references were generated through review of identified literature citations. Article selection was based on mutual agreement for inclusion. Data Selection and Data Extraction: Relevant articles were defined as English-language articles, describing technologies that assist with diabetes management in insulin-injecting patients with T2DM. Articles that focused exclusively on type 1 diabetes were excluded. Data Synthesis: The literature search yielded 334 articles, of which 21 were included for synthesis. The current BG monitoring practices emphasize the benefit of the structured self-monitoring of BG approach. Several randomized controlled trials conclude that the available technology aids in comprehensive data collection and facilitates communication between patients and providers. Digitally enabled “smart” devices are valuable tools that may help improve outcomes while providing a flexible, personalized approach. Conclusions: Integration of digital technology with diabetes management allows for accurate collection and analysis of data. Emergence of digital tools promotes a comprehensive, precise, and objective approach to glucose monitoring and encourages patient-provider collaborations.

941-P: Frequency of Blood Glucose Monitoring in Relation to Medical Cost and Glycemic Control in Hospitalized Patients with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 941-P
Author(s):  
LEI ZHANG ◽  
YAN GU ◽  
YUXIU YANG ◽  
NA WANG ◽  
WEIGUO GAO ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Medical Cost ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Blood Glucose Monitoring

scholarly journals Glycemic variability and cardiovascular disease in patients with type 2 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002032
Author(s):  
Marcela Martinez ◽  
Jimena Santamarina ◽  
Adrian Pavesi ◽  
Carla Musso ◽  
Guillermo E Umpierrez
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycated Hemoglobin ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Cardiovascular Complications ◽  
Glucose Levels ◽  
Increased Risk ◽  
Patients With Diabetes

Glycated hemoglobin is currently the gold standard for assessment of long-term glycemic control and response to medical treatment in patients with diabetes. Glycated hemoglobin, however, does not address fluctuations in blood glucose. Glycemic variability (GV) refers to fluctuations in blood glucose levels. Recent clinical data indicate that GV is associated with increased risk of hypoglycemia, microvascular and macrovascular complications, and mortality in patients with diabetes, independently of glycated hemoglobin level. The use of continuous glucose monitoring devices has markedly improved the assessment of GV in clinical practice and facilitated the assessment of GV as well as hypoglycemia and hyperglycemia events in patients with diabetes. We review current concepts on the definition and assessment of GV and its association with cardiovascular complications in patients with type 2 diabetes.

scholarly journals Breakfast replacement with a liquid formula improves glycaemic variability in patients with type 2 diabetes: a randomised clinical trial

2019 ◽  
Vol 121 (5) ◽  
pp. 560-566 ◽  
Author(s):  
Jiahui Peng ◽  
Jingyi Lu ◽  
Xiaojing Ma ◽  
Lingwen Ying ◽  
Wei Lu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glucose Monitoring ◽  
Mean Amplitude ◽  
Randomised Clinical Trial ◽  
Postprandial Blood Glucose ◽  
Glycaemic Variability ◽  
Intervention Measures ◽  
Before And After

AbstractThere is emerging evidence that glycaemic variability (GV) plays an important role in the development of diabetic complications. The current study aimed to compare the effects of lifestyle intervention (LI) with and without partial meal replacement (MR) on GV. A total of 123 patients with newly diagnosed and untreated type 2 diabetes (T2D) were randomised to receive either LI together with breakfast replacement with a liquid formula (LI+MR) (n 62) or LI alone (n 61) for 4 weeks and completed the study. Each participant was instructed to have three main meals per d and underwent 72-h continuous glucose monitoring (CGM) both before and after intervention. Measures of GV assessed by CGM included the incremental AUC of postprandial blood glucose (AUCpp), standard deviation of blood glucose (SDBG), glucose CV and mean amplitude of glycaemic excursions (MAGE). After a 4-week intervention, the improvements in systolic blood pressure (P=0·046) and time in range (P=0·033) were more pronounced in the LI+MR group than in the LI group. Furthermore, LI+MR caused significantly greater improvements in all GV metrics including SDBG (P=0·005), CV (P=0·002), MAGE (P=0·016) and AUCpp (P<0·001) than did LI. LI+MR (v. LI) was independently associated with improvements in GV after adjustment of covariates (all P<0·05). Our study showed that LI+MR led to significantly greater improvements in GV compared with LI, suggesting that LI+MR could be an effective treatment to alleviate glucose excursions.

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