Glucose Awareness to Motivate and Enable Solutions (GAMES) in diabetes mellitus using flash glucose monitoring: A clinical programme.

AIMS: This real-world observational clinical programme evaluated short and medium-term effects of intermittent flash glucose monitoring on HbA1c, glycaemic variability and lifestyle behavioural changes. METHODS: Two first-generation Libre flash glucose monitoring sensors were provided 3-4 months apart with a food, activity diary, user evaluation survey and treatment modification after each sensor wear. T-tests were used to compare glucose variables within each sensor (week 1 vs. week 2) and between sensors (1st sensor vs. 2nd sensor). EasyGV software was used to calculate glycaemic variability. RESULTS: From 42 type 1 diabetes and 120 type 2 diabetes participants, there was no statistically significant change in mean HbA1c for participants with type 1 diabetes at 3-4 months after the 1st sensor but there was a statistically significant HbA1c reduction for participants with type 2 diabetes [-4 mmol/mol (-0.4%), p = 0.008], despite no statistically significant differences in carbohydrate intake, exercise frequency and duration. Greater reduction was seen in those with baseline HbA1c> 86 mmol/mol (10%) in both type 1 [-12 mmol/mol (-1.1%), p = 0.009] and type 2 diabetes [-11 mmol/mol (-1.0%), p = 0.001). Both type 1 and type 2 diabetes showed improvements in Glucose Management Indicator and percentage time-above-range when comparing week 1 versus week 2 of the same sensor. Higher scan frequency resulted in improved glycaemic parameters and certain measures of glycaemic variability. The majority of participants (85%) agreed that flash glucose monitoring is a useful device but only 60% were keen to use it for daily monitoring. CONCLUSION: Constant feedback from flash glucose monitoring improves glycaemic parameters within the first week of wear. Intermittent use 3-4 months apart resulted in greater improvements for those with higher baseline HbA1c.

Impact of COVID-19 and partial lockdown on access to care, self-management and psychological well-being among people with diabetes: A cross-sectional study.

BACKGROUND: The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, self-care, behavioural, and psychological impact of COVID-19 and partial lockdown amongst diabetes patients in Singapore. METHODS: We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models. RESULTS: Among 301 respondents, 45.2% were women, 67.1% of Chinese ethnicity, 24.2% were aged 40 to 49 years, 68.4% have Type 2 diabetes and 42.2% on oral medications alone. During the pandemic and the lockdown, nearly all respondents were able to receive care safely from the clinics they attend (94%) and obtain their medications and diabetes equipment and supplies (97%) when needed. Respondents reported less frequent engagement in physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (ß = 9.33, P = .043), Type 1 diabetes (ß = 12.92, P = .023), number of diabetes-related comorbidities (ß = 3.16, P = .007) and Indian ethnicity (ß = 6.65, P = .034) were associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (ß = 2.49, P = .014) while ability to reach their doctor despite not going to the clinic is negatively associated with psychological distress (ß = -9.50 P = .002) and barriers to activity (ß = -7.53, P = .007). CONCLUSION: Health services access were minimally affected, but COVID-19 and lockdown had mixed impacts on self-care and management behaviours. Greater clinical care and attention should be provided to people with diabetes with multiple comorbidities and previous mental health disorders during the pandemic and lockdown.

Are English and Chinese Versions of the Audit of Diabetes-Dependent Quality of Life Equivalent? An Exploratory Study Based on the Universalist Approach.

OBJECTIVE: To translate and culturally adapt the UK English Audit of Diabetes-Dependent Quality of Life (ADDQOL) into Chinese for Singapore. METHODS: Translation was integrated into investigation of conceptual, item, semantic, and operation equivalence. Conceptual equivalence, item equivalence, and operation equivalence were assessed by literature review, expert judgment, and cognitive debriefing. Semantic equivalence was studied by using an optimized procedure including forward and backward translation, clinician review, and cognitive debriefings. Cognitive debriefings were done with five Chinese-speaking diabetic patients at polyclinics. Reliability, responsiveness, and construct validity tests were used to evaluate measurement equivalence. English- and Chinese-speaking diabetic patients by convenient sampling at a Diabetes Society of Singapore's public event were recruited for the measurement equivalence study. Mann-Whitney U tests, chi-square tests, and descriptive analyses were used for group comparisons and Spearman's correlation coefficients for construct validity tests. RESULTS: Forty-two English-speaking and 26 Chinese-speaking diabetic patients (45.5% females) with a mean age of 54.2 ± 10.07 years were recruited. Chinese-speaking respondents were more likely than the English-speaking group to be unemployed, less educated, and with poorer family functioning (P < 0.05). Conceptual equivalence, item equivalence, operation equivalence, and semantic equivalence were all demonstrated. Cronbach's alpha for internal consistency and intraclass correlation coefficient for test-retest reliability were 0.94 and 0.65, respectively. Distributions of responses were found to be similar except for some difference that can be justified by different demographic background. Convergent validity was suggested by weak to moderate correlations between "Present QOL" on the ADDQOL and EuroQol five-dimensional questionnaire (r = 0.268; P = 0.185) and six-dimensional health state short form (derived from short form 36 health survey) scores (r = 0.351; P = 0.078); divergent validity was shown by a weak correlation between ADDQOL average weighted impact (AWI) and ADDQOL "Present QOL" scores (r = 0.027, P = 0.896), a moderate correlation between ADDQOL AWI and six-dimensional health state short form (derived from short form 36 health survey) mental scores (r = 0.247; P = 0.224), and a positive correlation between ADDQOL AWI and family functioning scores (r = 0.288; P = 0.182). CONCLUSIONS: The ADDQOL has been translated and culturally adapted successfully into a Chinese version for Singapore. Our study provides justification for further research with large sample sizes among the Chinese-speaking population in Singapore.