Analysis on the Effect of Metformin Hydrochloride Combined with Insulin Pump for Gestational Diabetes Mellitus

Background: U To analyze the effect of metformin hydrochloride combined with insulin pump for gestational diabetes mellitus (GDM). Methods: Overall, 216 patients with GDM in Zhangqiu Maternity and Child Care Hospital, Jinan, China from Aug 2018 to Dec 2020 were enrolled and randomized into research and control groups. Patients in the control group were treated with insulin pump, while those in the research group were treated with metformin hydrochloride combined with insulin pump. The clinical efficacy, blood glucose levels, serum Betatrophin, C reactive protein (CRP), Cystatin C (Cys-C), homocysteine (Hcy), adiponectin, tumor necrosis factor (TNF-α), interleukin-6 (IL-6) content, incidence of adverse pregnancy outcomes and incidence of adverse newborns of patients in the two groups were compared. Results: After treatment, the total clinical efficiency of the research group was 84.26%, significantly higher than that of the control group (68.52%). The levels of FPG, 2hPG, HbAlc, serum Betatrophin, CRP, CysC, Hcy, adiponectin factors, TNF-α, and IL-6 in the research group were lower than those in the control group, with statistically significant differences (P<0.05). The overall incidence of adverse pregnancy outcomes was 10.19% in the research group, and 25.93% in the control group. The comparative differences between the two groups were statistically significant (P<0.05). The overall incidence of adverse newborns was 9.26% in the research group, and 21.30% in the control group. The comparative differences between the two groups were statistically significant as well (P<0.05). Conclusion: Metformin hydrochloride combined with insulin pump for GDM can significantly reduce blood glucose level, regulate serum protein factor levels, and improve adverse outcomes for mother and child, which deserves clinical promotion.

Effects of COVID-19 Lockdown on Managing Diabetes Mellitus Among Sudanese Insulin Pump Users, A Cross-Sectional Study

Background COVID-19 lockdown has affected diabetes management among the insulin pump users by changing their life style, affected their mental health, limited diabetes and insulin pump supplies and more difficult communication with the healthcare providers Objectives The aim of this research is to study the effects of COVID-19 lockdown on managing diabetes mellitus among Sudanese insulin pump users, Sudan (March- September 2020). Methodology: This is a descriptive cross-sectional community based study which was done in contact with Shimaa medical CO. LTD. 26 insulin pump users were chosen by total coverage and the data was collected throughout phone call interviews. All statistical analyses were performed using IBM SPSS Statistics software, version 20. Results The mean age of 22 participants was 25.3 ± 17.2 years, and the majorities (63.6%) were females. The average duration of diabetes was 6.9 ± 3.9 years, and the average duration of insulin pump use was 3 ± 1 years. Of the 22 patients (90.9%) used glucometer for monitoring blood sugar. 9 (40.9%) were less subjective to depression, 9 (40.9%) had moderate susceptibility to have depression. 8 patients (36.4%) reported weight gain, 12 patients (54.5%) reported no weight changes, while 2 patients (9.1%) reported weight loss. The level of physical activity decreased in 10 patients (45.5%), and the dietary habits remained unchanged in 50%. Moreover, participants who reported a decrease in physical activity levels were more likely to report weight gain (P = 0.004) compared with those who reported an increase in physical activity levels. Most of the patients have unchanged behaviors regarding experiencing hyper and hypoglycemic symptoms 45.5%, 72.7% respectively. Most of the patients have unchanged adherence to the insulin pump behaviors, carb counting (63.6%), bolus wizard during mealtime (68.2%), and bolus wizard for hyperglycemia correction (68.2%), self-monitoring of blood glucose (40.9%). (40.9%) of the patients had scheduled phone call appointments, 5 patients (22.7%) received virtual education (VE) from the insulin pump technician. 12 patients (54.5%) reported difficulty obtaining at least one type of insulin pump supply. Conclusion COVID-19 lock down has led to the decrease in physical activity with unchanged dietary habits. Getting the insulin pump supplies was difficult for most of the patient’s, and there was shortage and increase prices for diabetes care supplies. Telemedicine should be considered seriously to ease the communication between the patients and the health care providers.

The design of an evaluation framework for diabetes self-management education and support programs delivered nationally

Background The aim of this work was to develop a National Evaluation Framework to facilitate the standardization of delivery, quality, reporting, and evaluation of diabetes education and support programs delivered throughout Australia through the National Diabetes Services Scheme (NDSS). The NDSS is funded by the Australian Government, and provides access to diabetes information, education, support, and subsidized product across diverse settings in each state and territory of Australia through seven independent service-providers. This article reports the approach undertaken to develop the Framework. Methods A participatory approach was undertaken, focused on adopting nationally consistent outcomes and indicators, nominating objectives and measurement tools, specifying evaluation processes, and developing quality standards. Existing programs were classified based on related, overarching indicators enabling the adoption of a tiered system of evaluation. Results Two outcomes (i.e., improved clinical, reduced cost) and four indicators (i.e., improved knowledge and understanding, self-management, self-determination, psychosocial adjustment) were adopted from the Eigenmann and Colagiuri national consensus position statement for diabetes education. This allowed for the identification of objectives (i.e., improved empowerment, reduced distress, autonomy supportive program delivery, consumer satisfaction) and related measurement instruments. Programs were categorized as comprehensive, topic-specific, or basic education, with comprehensive programs allocated to receive the highest-level of evaluation. Eight quality standards were developed, with existing programs tested against those standards. Based on the results of testing, two comprehensive (OzDAFNE for people with type 1 diabetes, DESMOND for people with type 2 diabetes), and eight topic-specific (CarbSmart, ShopSmart, MonitorSmart, FootSmart, MedSmart, Living with Insulin, Insulin Pump Workshop, Ready Set Go – Let’s Move) structured diabetes self-management education and support programs were nominated for national delivery. Conclusions The National Evaluation Framework has facilitated consistency of program quality, delivery, and evaluation of programs delivered by multiple service providers across diverse contexts. The Framework could be applied by other service providers who facilitate multiple diabetes education and support programs and could be adapted for use in other chronic disease populations where education and support are indicated.

The effect of visfatin genotype on insulin pump therapy on quality of life in patients with type I diabetes

Diabetes is associated with an increase in other chronic diseases and an increase in mortality. The individual differences influence the treatment of this disease in pharmacokinetics and clinical responses. One of the important factors related to individual differences includes genetic factors in transmission, metabolism, and drug function. On the other hand, this disease has a significant impact on the patients’ quality of life and their family. Therefore, this study aimed to investigate the role of single nucleotide polymorphism (rs2110385) of the visfatin gene on insulin required to maintain glucose homeostasis and to evaluate the effect of insulin pump therapy on the quality of life in type 1 diabetic patients. In this regard, this study was performed on 47 patients with type 1 diabetes. The short form of the Diabetes Quality of Life Questionnaire (DQOL) was used to record information. Laboratory tests also included FBS, HbA1C, G2h, serum levels of visfatin, insulin, and adiponectin. Insulin resistance (HOMA) and insulin sensitivity (QUICKI) indices were calculated. The polymorphism of the studied genotype was performed by the PCR-RFLP method. The results showed that the scores of both dimensions of quality of life, including patient care behaviors and satisfaction with the disease control after the intervention increased significantly (P <0.001). There was a significant and direct relationship between the patient's age and the duration of the disease with the score of increasing patients' quality of life. No significant differences were found between HbA1C, G2h, FBS levels, fasting insulin concentration, HOMA, and QUICKI indices. The insulin dose used to maintain glucose homeostasis at the same levels was significantly lower in the GG genotype than in other genotypes. In general, the present study results showed that insulin pump therapy and its dimensions could improve the life quality of patients with type 1 diabetes. Also, genetic evaluation of individuals helps to provide the correct and accurate dose of insulin with the help of the insulin pump for these patients to increase their quality of life as much as possible.

Understanding of insulin pump therapy among parents of children with type 1 diabetes

The study aimed to analyze the level of awareness among parents of children undergoing therapy using a personal insulin pump and focus specifically on those elements of treatment that create problems for caregivers.

2021 Clinical Practice Guidelines for Diabetes Mellitus in Korea

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence from real-world practice among the Korean population. The guidelines are intended for use at sites across the country by all healthcare providers (including physicians, diabetes experts, and certified diabetes educators) who treat diabetes. The recommendations for screening and antihyperglycemic agents have been revised and updated. Continuous glucose monitoring with insulin pump use and screening and treatment for non-alcoholic fatty liver disease were added in the type 2 diabetes sections. The KDA recommends active vaccination for COVID-19 in patients with diabetes. An abridgement that contains practical information for patient education and systematic clinic management was published separately.

A Position Statement of the Utilization and Support Status of Continuous Glucose Monitoring in Korea

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

Automated Bolus Calculators and Connected Insulin Pens: A Smart Combination for Multiple Daily Injection Insulin Therapy

Although automated bolus calculators (ABCs) have become a mainstay in insulin pump therapy, they have not achieved similar levels of adoption by persons with diabetes (PWD) using multiple daily injections of insulin (MDI). Only a small number of blood glucose meters (BGMs) have incorporated ABC functionality and the proliferation of unregulated ABC smartphone apps raised safety concerns and eventually led to Food and Drug Administration (FDA)–mandated regulatory oversight for these types of apps. With the recent introduction of smartphone-connected insulin pens, manufacturer-supported companion ABC apps may offer an ideal solution for PWD and health care professionals that reduces errors of mental math when calculating bolus insulin dosing, increases the quality of diabetes data reporting, and improves glycemic outcomes.