Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices

Purpose: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). Conclusions: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.

A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies

AimsMeasurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D).MethodsThe DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested.ResultsThe analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors.ConclusionsThe results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.

Allergic Reaction Following Implantation of a Blood Glucose Sensor.

Increasing incidence and onset at a younger age has changed the treatment strategy of diabetes mellitus (DM) towards prevention, delaying the onset, and minimizing disease complications. Self-monitoring blood glucose systems and continuous glucose monitoring systems are routinely preferred in diabetic children.Flash glucose monitoring system has come as an entirely new concept in glucose monitoring by providing much greater data than blood glucose testing while being more affordable than the continuous glucose monitors. The FreeStyle Libre provides ‘flash glucose monitoring’ with glucose readings by scanning a sensor rather than pricking the patient’s finger. The sensor measures interstitial tissue glucose levels every minute via a disposable round sensor with a small catheter inserted under the skin that can be worn for up to 14 days. The entire system’s on-body sensor patch worn on the back of the upper arm is disposable. However, the mild erythema may occur on the skin and disappear spontaneously after 24 hours from the detachment of the sensor. Similar skin lesions were observed in diabetic patients, and there was moderate to severe itching in 0.5% of the cases and moderate erythema in 4% of cases

The Application of Wearable Glucose Sensors in Point-of-Care Testing

Diabetes and its complications have become a worldwide concern that influences human health negatively and even leads to death. The real-time and convenient glucose detection in biofluids is urgently needed. Traditional glucose testing is detecting glucose in blood and is invasive, which cannot be continuous and results in discomfort for the users. Consequently, wearable glucose sensors toward continuous point-of-care glucose testing in biofluids have attracted great attention, and the trend of glucose testing is from invasive to non-invasive. In this review, the wearable point-of-care glucose sensors for the detection of different biofluids including blood, sweat, saliva, tears, and interstitial fluid are discussed, and the future trend of development is prospected.

How to Monitor Blood Glucose

Blood glucose testing provides important information about the effectiveness of the diabetes management plan and assists nurses to monitor the clinical situation and take appropriate action. Nurses should consider the rationale for performing a blood glucose test every time they test a patient’s blood glucose level and commit to acting on the results, including whether the results are abnormal for the patient.

Factors Influencing Adherence to Self-Care Practices Among Diabetes Patients in a Selected Tertiary Hospital, Osun State

Aims: Diabetes is a chronic non-communicable disease with many irreversible complications that can be prevented by strict adherence to self-care practice. This study aims to investigate the factors influencing adherence to self-care practices among diabetes patients Study Design: This study adopted a descriptive research design carried out among diabetes patients attending outpatient endocrinology clinic of Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State between July and September 2021. Methodology: Sample size was calculated using Cochran formula and total number of sample used were two hundred and eight (208) diabetes patients. Samples were selected using convenient sampling technique. A self-developed structured Questionnaire on knowledge of diabetes and factors influencing adherence to diabetes self-care practices with reliability index of 0.858 and 0.863 respectively. Two (2) adapted questionnaire; Diabetes self-care practices by Schmitt et al (2013) and Level of adherence to self-care practices scale by Morisky et al. (1986) with reliability index of 0.731 and 0.851 respectively were also used for data collection. Data collected were analyzed using descriptive statistics of frequency, percentage, mean and standard deviation while inferential statistics of Pearson product moment correlation and regression were used to test stated hypotheses at 0.05 level of significance. Results: The result from the study revealed good knowledge of diabetes mellitus and diabetes self-care practices among the respondents. The results also revealed high level of adherence to diabetes medication, diet, physical activity, blood glucose testing, follow-up and foot care. Factors influencing the level of adherence with diabetes self-care practices include cost of treatment, longer year of being diagnosed, good relationship between healthcare team, level of education, good family and social support. There is also a significant relationship between knowledge of diabetes mellitus and adherence with physical activity (r = 0.210; P = 0.02) and blood glucose testing (r = 0.203; P = 0.003). However, there is no significant relationship between knowledge of self-care practices and adherence to self-care practices; socio-demographic characteristics of age (r = -0.040; P = 0.568), education (r = 0.112; P = 0.107) and adherence to self-care practices. Conclusion: The study concluded that there was high level of knowledge about diabetes and diabetes self-care practices as well as adherence to diabetes self-care practices, therefore, health care providers should continue to monitor self-care practices among diabetes patients to achieve positive health outcome and reduce morbidity and mortality associated with diabetes mellitus.

How Frequently and for How Long Do Adults With Type 2 Diabetes Use Management Apps? The REALL Study

Objective: The objective of the study is to identify predictors of utilization of a type 2 diabetes (T2D) management App over time for insulin users (IUs) and noninsulin users (NIUs). Research Design and Methods: We followed over 16 weeks a national sample of unselected T2D adults who independently elected to download and pair a CONTOUR DIABETES App with their CONTOUR NEXT ONE glucose meter. App use and frequency of glucose testing were recorded. Baseline surveys recorded participant demographic, disease status, distress, medication taking, and views of technology to predict utilization. Results: Mean age was 51.6 years (108 IUs; 353 NIUs), 48% were female, time with diabetes was 6.9 years, and self-reported HbA1c was 8.1% (36.3 mmol/mol). Mean duration of App use was 85.4 days and 40% stopped using the App before 16 weeks. Continuous users were older and reported higher distress, better medication taking, and more positive attitudes toward technology (all P < .01). IUs tested more frequently than NIUs, but frequency and intensity of testing decreased markedly for both groups over time. More predictors of App use frequency and testing occurred for NIUs than IUs: older age, higher HbA1c, lower distress, more medication taking (all P < .05). Conclusions: App use and testing decreased markedly over time. Variations in the predictors of frequency of App use suggest that the utilization of mobile technologies requires a tailored approach that addresses the specific needs of individual users, compared with adopting a one-size-fits-all strategy, and that IUs and NIUs may require very different strategies of customization.

Prevalence and factors associated with diabetes mellitus among tuberculosis patients in South India—a cross-sectional analytical study

ObjectiveTo determine the prevalence and determinants of diabetes mellitus (DM) among tuberculosis (TB) patients and to assess the additional yield and number needed to screen (NNS) to obtain a newly diagnosed DM among TB patients.DesignWe undertook a cross-sectional analysis of the cohort data under Regional Prospective Observational Research for Tuberculosis-India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included. Pretested standardised questionnaires and tools were used for data collection. Prevalence of DM among TB patients was summarised as proportion with 95% CI. Type II DM was diagnosed if random blood sugar level was >200 mg/dL or if the participant had a documented history of DM. NNS by blood glucose testing to diagnose one new DM case among TB patients was also calculated.SettingThree districts of South India: Puducherry, Cuddalore and VillupuramSubjectsNewly diagnosed sputum smear positive pulmonary TB patients aged ≥16 yearsResultsIn total, 1188 TB patients were included. Prevalence of DM among TB patients was 39% (95% CI: 36.2% to 41.8%). In unadjusted analysis, elderly TB, marital status, caste, gender, higher education level, household income and obesity had a significant association with DM. However, in adjusted analysis, only marital status (currently married aPR; 3.77 (95 CI: 2.20 to 6.49), widowed/separated/divorced aPR; 3.66 (95 CI: 1.96 to 6.83)) and body mass index category (normal weight aPR; 3.26 (95 CI: 2.55 to 4.16), overweight aPR; 3.86 (95 CI: 2.69 to 5.52), obesity aPR; 4.08 (95 CI: 2.81 to 5.94)) were found to be significant determinants. The number of TB patients needed to be screened to find a new DM case was 12.ConclusionWe found that one in three TB patients had coexisting DM. The number of TB patients needed to be screened to obtain a newly diagnosed DM patients was also determined. The study supports and highlights the need of RNTCP’s effort in bidirectional screening of TB and DM.

Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

<b>Objective: </b>The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment (PPE) and reduce potential exposures during COVID-19. <p><b>Design and Methods:</b> We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII) and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 ICU.<b></b></p> <p><b>Results: </b>All nine patients required mechanical ventilation and corticosteroids. Seventy six percent of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients.</p> <p><b>Conclusions: </b>A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion. </p>

Effects of Simulated Adverse Environmental Conditions Related to Actual Conditions at Health Promoting Hospitals on the Performance of Blood Glucose Testing by Glucose Meters

Background: Annual peaks in temperature and humidity exceed manufacturers’ specifications for blood glucose test strip storage in Thailand. Health Promoting Hospitals (HPH) do not always provide the same level of health services that hospitals do since they often only turn on air-conditioning units during working hours. Methods: The blood glucose testing performance of 4 glucose meters were investigated for short and long terms stress at 5 simulated conditions. Temperature and relative humidity (RH) at 5 HPHs in different regions of Thailand were monitored for 9 weeks during April to July 2019. The use of air conditioning in storage rooms for storing test strips was surveyed at 131 HPHs using questionnaires. Results: Median-paired differences of glucose measurements with stressed test strips in 5 simulated conditions significantly differed ( P < 0.05) both in the short term (3 days) and in the long term (30 days) with 4 glucose meters when compared to unstressed test strips. The average temperature of all HPHs exceeded 30°C (86°F). The average RH was 84%. There was only one HPH that occasionally turned on its air conditioners. Most HPHs kept both opened and unopened vials of test strips in rooms without air conditioners. Further, 21.4-32.0% of HPHs kept test strips at room with air conditioners. Conclusions: This study provides evidence for poor performance of blood glucose testing by glucose meters that are affected by adverse environmental conditions. The environmental for test strips storage at HPHs should be considered to prevent analytical errors of glucose measurement.