EVALUATION OF DEVELOPMENT LEVEL OF INTEGRATED NON-COMMUNICABLE DISEASES GUIDANCE POST IN MOJOGENENG VILLAGE, JATIREJO HEALTH CENTER, MOJOKERTO REGENCY

Introduction: PTM is one of the most common causes of death in Indonesia. Based on a preliminary study of data from the Jatirejo Public Health Center in 2018, 2743 families with hypertension were found while those receiving routine treatment were 884 families. In Mojogeneng village, 163 families suffer from hypertension, but only 64 families receive regular treatment. Based on these problems, it can be said that the implementation of the PTM Posbindu in Mojogeneng Village has not run optimally, therefore it is necessary to carry out an evaluation that aims to see the level of development of the PTM Posbindu through 12 indicators according to the UKBM technical guidelines.Methods: Using a qualitative study conducted in Mojokerto Regency by involving related parties. The technique used is interview, Focus Group Discussion/FGD, observation and document review. The secondary data of the research was obtained from the results of the PTM Posbindu activities which were discussed in accordance with the research variables.Results: Variable developmental level of PTM Posbindu, Related to the implementation of activities carried out every month, 25% target obesity coverage, 35% target blood glucose, 25% target blood cholesterol, PTM counseling is carried out 3 or 4 times a year, counseling on all PTM problems, physical activity once a week 30% target, participants aged >55 years 70%, 45-55 years 55%, 35-44 years 30%, 25-35 years 15%, implementing activities 90% from the community, health financing 80% from the community , 75% independent participants, and Partnership 3 to 4 times a year.Discussion: Evaluation of the developmental level of PTM Posbindu consists of 12 indicators, the first indicator is independent category, second pratama, third middle, fourth pratama, fifth middle, sixth independent, seventh middle, eighth >55 years old and 44-55 full moon, 35-44 years old and 25-34 middle years, ninth and tenth full moons, eleventh full moons, and twelfth full moons.

Online Education Improves Knowledge and Confidence Related to CGM and the AGP

We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es) related to CGM and AGP. The CME activity was a 30-minute online video panel discussion with synchronized slides. A repeated pairs pre-/post-assessment study design and chi-square test (P <.05 is considered significant) assessed educational effect. The activity launched March 23, 2020 and data were collected through May 19, 2020. In total, 338 PCPs and 189 D/Es were included in the analysis. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: • 14% of PCPs (P=.NS) 14% of D/Es (P<.05) improved at identifying benefits of an AGP report • 20% of PCPs (P<.01) 11% of D/Es (P=.NS) improved at recognizing importance of time in range in diabetes management • 13% of PCPs (P<.05) 3% of D/Es (P=.NS) improved at recognizing target blood glucose levels for time in range • 43% of PCPs and 36% of D/Es had a measurable increase in confidence in ability to explain results from an AGP to patients Continued educational gaps: • 60% of PCPs and 47% of D/Es failed to identify benefits of an AGP report • 35% of PCPs and 12% of D/Es failed to recognize importance of time in range in diabetes management This study demonstrates the success of online 30-minute video panel discussion CME on improving knowledge and confidence of PCPs and D/Es related to CGM and the AGP. Continued gaps were identified for future educational targets.

Monitoring the Impact of Aggressive Glycemic Intervention during Critical Care after Cardiac Surgery with a Glycemic Expert System for Nurse-Implemented Euglycemia: The MAGIC GENIE Project

A novel, multi-dimensional protocol named GENIE has been in use for intensive insulin therapy (IIT, target glucose <140 mg/dL) in the surgical intensive care unit (SICU) after open heart surgery (OHS) at VA Pittsburgh since 2005. Despite concerns over increased mortality from IIT after the publication of the NICE-SUGAR Trial, it remains in use, with ongoing monitoring under the MAGIC GENIE Project showing that GENIE performance over 12 years (2005-2016) aligns with the current consensus that IIT with target blood glucose (BG) <140 mg/dL is advisable only if it does not provoke severe hypoglycemia (SH). Two studies have been conducted to monitor glucometrics and outcomes during GENIE use in the SICU. One compares GENIE ( n = 382) with a traditional IIT protocol (FORMULA, n = 289) during four years of contemporaneous use (2005-2008). The other compares GENIE’s impact overall ( n = 1404) with a cohort of patients who maintained euglycemia after OHS (euglycemic no-insulin [ENo-I], n = 111) extending across 12 years (2005-2016). GENIE performed significantly better than FORMULA during contemporaneous use, maintaining lower time-averaged glucose, provoking less frequent, severe, prolonged, or repetitive hypoglycemia, and achieving 50% lower one-year mortality, with no deaths from mediastinitis (0 of 8 cases vs 4 of 9 on FORMULA). Those benefits were sustained over the subsequent eight years of exclusive use in OHS patients, with an overall one-year mortality rate (4.2%) equivalent to the ENo-I cohort (4.5%). The results of the MAGIC GENIE Project show that GENIE can maintain tight glycemic control without provoking SH in patients undergoing OHS, and may be associated with a durable survival benefit. The results, however, await confirmation in a randomized control trial.

Management of Diabetes at the End of Life

In terminal illness careful control to avoid long-term complications is not required. Management of diabetes during terminal illness will not only depend on the type of diabetes, but also on prognosis, oral intake and the presence of co-existing disease such as renal and hepatic impairment. All dietary restrictions relating to diabetes are removed from the early stage of terminal illness. In both T1DM and T2DM, glucose monitoring should be reduced to an acceptable minimum. In the case of a patient treated with insulin, this may be 2–3 times per week and for a patient treated with oral agent’s blood glucose could be monitored 1–2 times per week., only in case of special situation frequent monitoring is advisable. This may include: hypoglycaemia, poor food intake, nausea and vomiting, enteral or parenteral feeding or corticosteroid use. The clear aim is to avoid hypoglycaemia and osmotic symptoms, so the recommendations suggest a target blood glucose range between 10 and 15 mmol/l in the early stage of terminal illness with a more liberal range of 5–20 mmol/l in the later stages. Subsequently there are no agreed, evidence-based strategies to manage diabetes at the end of life or during terminal illness. Therefore, in this review I will try to uncover some of the challenges and discuss the available guidelines associated with managing diabetes at the end of life and terminal illness from the available scientific evidence.

Evaluation of the Efficacy and Safety of an eGlycemic Management System in a Community Hospital Setting

Background: Glucommander is an eGlycemic management system (eGMS) for intravenous (IV) and subcutaneous (SQ) insulin therapy in hospitalized patients. The purpose of this study was to evaluate the efficacy and safety of Glucommander compared to previously utilized nomograms in the community hospital setting. Methods: This study was a retrospective, single-center cohort study comparing measures of efficacy and safety of IV and SQ insulin therapy via eGMS versus nomogram-driven IV insulin therapy followed by provider-ordered basal-bolus SQ insulin. The primary efficacy endpoint was percent of blood glucose (BG) readings per patient in target glycemic range. Safety objectives were percent of hyperglycemic events, hypoglycemic events, and severe hypoglycemic events after achieving target blood glucose range, and mean number of each event per patient. Results: The percentage of BG readings in range was significantly higher for eGMS patients ( n = 110) than comparison cohort patients ( n = 108, 84.6% vs 76.8%, P < .001). Hyperglycemic events occurred for significantly fewer patients in the eGMS cohort relative to the comparison cohort (81.8% vs 92.6%, P = .03). Overall, there was no significant difference between cohorts in rate of hypoglycemic events, but hypoglycemic events while on IV insulin occurred in a significantly higher percentage of eGMS cohort patients than comparison cohort patients (30.9% vs 15.7%, P < .01). There were no significant differences in incidence of severe hypoglycemic events. Conclusions: Our study found that Glucommander maintained a higher percentage of BG readings in target BG range per patient compared to previously utilized nomograms. This result was driven by an improvement in hyperglycemia, but not hypoglycemia.

Effect of Bay Leaf Extract (Syzygium polyanthum) on Blood Sugar Regulation via GLUT4 Protein Regulation in White Rat Muscle Tissue Induced Aloxan

Diabetes mellitus is a chronic condition that disturbs the body's bloodsugar regulation. Bay leaves contain entirely various secondary metabolites,where this plant is rich in flavonoids, alkaloids, terpenes and glycosides. Thisstudy aims to assess the effect of bay leaf extract (Syzygium polyanthum) onblood sugar levels and the expression of GLUT4 protein in muscle tissue. A totalof 30 white rats (Rattus norvegicus) Wistar strain obtained from the EurekaResearch Laboratory (Palembang, Indonesia) weighing between 200 - 250 grams.Bay leaf simplicia was obtained from the Tawangmangu Herbal Research Center,Karanganyar, Indonesia. After 1 week of adaptation, the mice were randomlydivided into the following six groups, each containing 5 animals: Normal controlgroup, diabetes group (negative control), diabetes + metformin group (Met; 45mg / kg), Diabetes + BLE (75 mg/kg), diabetes + BLE group (150 mg / kg) anddiabetes + BLE group (300 mg/kg). Alloxan-induced white rats showed a verysignificant increase in blood sugar levels, where the use of the drug metforminwas able to reduce blood sugar levels significantly even though they had notreached the target blood glucose target of less than 200 mg / dL. The treatmentwith bay leaf extract was able to reduce blood sugar levels significantly. Theadministration of metformin drugs or bay leaf extract showed the ability toincrease the level of GLUT4 protein. In conclusion, bay leaf extract affectsreducing blood sugar levels in diabetes mellitus white rats by increasing glucoseintake to cells and tissues.

Effect of Low Dose Insulin Therapy on Normoglycemic Critically Ill Patients in Intensive Care Units

Background Insulin has anti-inflammatory effect and vasodilatory effect via endothelial NO release in arteries, veins and capillaries. Insulin inhibits release of inflammatory mediators like IL-6, TNF-α and enhances the immune function of monocytes. Stress-induced hyperglycemia is very common in the ICU, being detected in 50–85% of critically ill patients. It is defined as a blood glucose level &gt;140 mg/dL or glycated hemoglobin (HbA1c) &gt; 6.5 without a past history of pre-existing diabetes. Aim of the Work to evaluate the effect of low dose insulin therapy on the clinical progression of organ dysfunction and on the level of C-reactive protein (CRP), procalcitonin and lipid profile in patients known to be normoglycemic complaining of systemic inflammatory response syndrome (SIRS) or sepsis in intensive care unit. Patients and Methods The study was conducted on 60 patients which were randomized into 2 groups: 30 patients received moderate insulin therapy (group 1) and 30 patients received iv infusion of placebo (normal saline 0.9% NaCl) during the course of the study (group 2). Results There was an improvement in blood pressure, heart rate and body temperature in group 1 compared to group 2 and throughout the study period in group 1. CRP and lactate levels were declined in group 1 with better creatinine values. Triglycerides were decreased in group 1 and hypoxic index was higher in group 1 compared to group 2. Conclusion Insulin therapy with target blood glucose (120-140 mg/dL) has been found in our study that it reduces the complications of SIRS and organ failure, which was expressed by the gradual improvement in heart rate, means arterial blood pressure, body temperature, serum lactate level and urine output. These results support the hypothesis that insulin has a positive inotropic effect. Recommendations Future studies are required to compare between moderate insulin therapy with target blood glucose (120 – 140 mg/dL) and intensive insulin therapy with target blood glucose (80-110 mg/dL) as regard patients' mortality and morbidity.

Evaluation of glycaemic profile variability as a basis for insulin therapy strategy in pregnant women with type 1 diabetes

BACKGROUND: Patients with any form of diabetes during pregnancy should achieve the target (close to physiological) values of glycaemia, the main condition for a safe course and outcomes of pregnancy. To accomplish this task, effective and safe methods of insulin therapy should be selected. AIM: To determine the glycaemic profile and pregnancy outcomes in women with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) and multiple insulin injections (MII). METHODS: A continuous glucose monitoring (CGM) of 100 pregnant women with type 1 diabetes treated with CSII and 100 women treated with MII was conducted to assess the effectiveness of these insulin therapy regimens in achieving target blood glucose values. RESULTS: HbA1c levels were significantly lower during the first, second, and third trimesters in patients treated with CSII than those treated with MII. Glucose variability has already improved since the second trimester of pregnancy in women treated with CSII, which was not observed in those treated with MII. The period of hyperglycaemia according to the results in pregnant women treated with CSII was 25 [13; 38] %, which was lower than those treated with MII, 41 [18; 54] %. No risk of obstetric and perinatal complications was observed with the duration of the hyperglycaemic state of 25% of the CGM time, whereas the risk of neonatal hypoglycaemia appeared with the duration of the hypoglycaemic state of a mother with type 1 diabetes of 0.2%. The relationship between glucose variability in terms of MAGE and MODD and the risk of developing macrosomia has been observed, and the dependence of glucose variability (MODD and CONGA) and the risk of neonatal hypoglycaemia and preeclampsia have also been confirmed. CONCLUSION: Comprehensive assessment of the glycaemic profile when using CSII, confirmed the advantages of using CSII in pregnant women with type 1 diabetes to achieve the target glycaemia values, to reduce glucose variability and duration of hypoglycaemic episodes, which led to decreased frequency of obstetric and perinatal complications.

Diabetes Meal Planning: Managing Your Carbohydrate Intake

If you have diabetes, maintaining a consistent carbohydrate intake throughout the day is an effective meal-planning method to help maintain your target blood glucose levels. Foods that contain carbohydrates have the greatest effect on blood glucose levels compared to foods that contain primarily protein or fat. Carbohydrates in foods that contribute to blood glucose includes sugars and starches. The amount of carbohydrate you consume is based on your diabetes treatment goals and carbohydrate tolerance. This new 3-page publication of the UF/IFAS Food Science and Human Nutrition Department, written by Nancy J. Gal and Wendy J. Dahl, provides a strategy for planning your daily menu to manage your carbohydrate intake. https://edis.ifas.ufl.edu/fs324

A comparison of bolus insulin dose errors based on results of a clinical trial of five blood glucose monitoring systems

Aim: Inaccurate blood glucose monitoring system (BGMS) results may lead to insulin dosing errors and adverse clinical outcomes. Results & methodology: This post-hoc analysis used a model to estimate the bolus insulin dose error associated with each of the five BGMSs, for a hypothetical person with diabetes (assuming a standardized meal and target blood glucose of 100 mg/dl). Differences in dose-error distribution between BGMSs were statistically tested. The 95% dose-error range for each BGMS was (insulin units): CONTOUR®PLUS, -1.1–0.7; Accu-Chek® Active, -2.4–0.7; Accu-Chek® Performa, -2.9–0.8; FreeStyle Freedom, from -5.5 to -0.5; OneTouch® SelectSimple™, -4.1−3.0. Conclusion: The CONTOUR®PLUS BGMS was associated with a statistically significantly smaller model-estimated median bolus insulin dose-error and dosing error range, compared with the other BGMSs.