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1.
Journal of the ASEAN Federation of Endocrine Societies ; 37:55, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2006563

RESUMO

Introduction Teleconsultation has become an increasingly important service in managing T2DM especially with the ongoing COVID-19 pandemic and is assumed to be less costly to patients compared to physical visits. This study aimed to compare patients' cost for a teleconsultation session vs physical clinic visit. Methodology This was a cross-sectional study from June 2020 to December 2021 in UMMC which included patients who had successfully participated in teleconsultation sessions. Patient interviews were conducted to collect demographics, detailed cost items (direct/ indirect cost) and a self-administered Patient Satisfaction Questionnaire Short Form (PSQ-18). HbA1c and average self-monitoring blood glucose (SMBG) records at baseline and 3-months after teleconsultation were obtained from electronic medical records (EMR). Results A total of 36 patients were recruited. The median cost of attending a physical visit was significantly higher compared to teleconsultation (RM 123.41 [54.29, 219.51] vs RM 41.41 [30.55, 49.66];p<0.001) with a median cost difference of RM 81.24 [20.20,171.69]. Indirect costs (income loss from absence) made up the majority of the cost saving with teleconsultation (teleconsultation RM 10.71 [0.00,18.45], physical visit RM95.24 [0.00,182.74];p<0.001). There was a reduction in HbA1c (9.45% [7.98, 11.38] to 8.25% [7.42, 9.49];p<0.001) and average fasting SMBG (8.11 mmol/L [6.75, 9.70] to 7.20 mmol/L [6.22, 8.71];p=0.03) after 3 months of teleconsultation. Patients reported high satisfaction levels with teleconsultation, with an overall PSQ-18 score of 78%. Conclusion Teleconsultation service in UMMC Diabetes outpatient clinic was cost saving to patients compared to physical visits without compromising blood glucose control. Teleconsultation may be a viable option of healthcare provision for many patients and may be considered as part of routine care.

2.
JACCP Journal of the American College of Clinical Pharmacy ; 5(7), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2002962

RESUMO

The proceedings contain 127 papers. The topics discussed include: utility, safety, and necessity of as needed electrolyte replacement orders: a multi-center medication use evaluation;perceptions of inpatient internal medicine pharmacists at a large quaternary academic medical center;comparative analysis of pharmacologic treatments for new onset insomnia in hospitalized adult patients;venous thromboembolism prophylaxis with enoxaparin versus unfractionated heparin in patients with low body weight;efficacy of apixaban loading doses post parenteral anticoagulation for venous thromboembolism;real-world impact of continuous glucose monitoring in non-insulin treated type 2 diabetes;expanding the scope at medication management service clinics through a patient recruitment initiative;impact of clinic-provided home blood pressure monitors during COVID-19 pandemic on blood pressure in underserved adults over 50 years old;and PCMH pharmacist impact of quality care measures for patients with uncontrolled type 2 diabetes (T2D).

4.
Clinical Diabetology ; 11(3):156-164, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1988338

RESUMO

Background: Studies of mobile diabetes applications (apps) have demonstrated improvements in glycemia, and patient-reported outcomes (PROs). In addition, shift to shorter pen needles (PN) and guidance on proper injection techniques have shown the potential for reduced glycemic variability. The purpose is to determine the impact of using a diabetes mobile app plus a novel 4 mm PN on PROs and glycemic outcomes in type 2 diabetes mellitus (T2DM) for multiple daily injection (MDI) insulin users. Materials and methods: In this 8-week prospective, parallel-group, randomized controlled trial, subjects either received (1:1) intervention (BD Diabetes Care [DC] App + BD Nano TM 2nd Gen PN) or control therapy. Controls used their current PN and did not use diabetes apps. Results: Fifty-eight subjects were randomized. Fifty-seven completed the study (intervention n = 27, control n = 30). At study end, there were no significant differences in PROs between groups, except improved medication adherence (ARMS-D) in controls. From flash glucose monitoring (fGM) data, there were no significant differences in most glycemic measures between groups except for a trend for improved glycemic variability [mean amplitude of the glycemic excursions (MAGE)] in the Intervention (p = 0.06). Controls had significantly reduced time spent in hypoglycemia but had 2 to 3-fold higher incidence at baseline. In general, Intervention subjects reported satisfaction with both the app and PN. Conclusions: This is the first BD DC App study, in combination with BD Nano TM 2nd Gen PN, to assess glycemic outcomes. This combination intervention shows promising results for reduced glycemic variability and the potential to positively impact self-management.

5.
Biosensors and Bioelectronics: X ; 10, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1977067

RESUMO

Point-of-care (POC) technology reduces the time required for diagnosis at a reduced cost to facilitate early treatment, continuous monitoring, and prevention of fatal outcomes. Biosensors are the key to the development of reliable and accurate POC devices as they are capable of detecting clinical biomarkers based on bio-recognition events. Paper-based microfluidics and lateral flow assays (LFAs) are the most commonly used techniques for the development of POC devices. Electrochemical biosensors provide high sensitivity and reproducibility in comparison to optical biosensors. Sensitivity enhancement of POC devices is imperative to lower their detection limit for improved analysis of target biomarkers at low concentrations. In this review, we have discussed the need for sensitivity enhancement in POC devices. Various sensitivity enhancement strategies such as physical, chemical, electrochemical, nanomaterial, nucleic acid, enzymatic, label-based, etc. are discussed along with numerous examples. The role of biosensors in the sensitivity enhancement of POC devices is also described herein. We have illustrated the relationship between sensitivity and the limit of detection of POC devices. Several sensitivity enhancement strategies that have been either adopted or have the potential to be realized for POC devices have been summarized in tabular form. In terms of future perspectives, the sensitivity enhancement of POC devices for the detection of important biomarkers is yet to be comprehended copiously amid the rising market for POC devices.

6.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1927737

RESUMO

Rationale: Ecuador was among the top fifth of countries affected by the COVID-19 pandemic worldwide. Intensive care units (ICUs), and health system resilience form key elements of the health system to prepare for meeting needs of its population, both during surge needs, and for postpandemic planning. There is limited evaluation of the existing ICU infrastructure, processes and protocols within ICUs. Our study sought to perform an assessment of the ICU practices across Ecuador. Methods: During December, 2020, we conducted an observational, cross-sectional study using questionnaires developed in Spanish, that were deployed in 42 Ecuadorian medical facilities, using trained physicians. The questionnaires were developed by experts, covering domains including hospital characteristics, utilization, and structural factors, such as human resources, and staffing practices. ICUs were categorized by the degree of global resource availability. The primary outcomes were availability and access to equipment, personnel, protocols, and therapies relevant to the practice of critical care. Secondary outcomes were mortality, admissions in the emergency department and ICU annually. Results: Thirty-six hospitals (85.7%) agreed to participate and were enrolled in the study. Annual average ICU mortality in 2019 was 20% (IQR: 14-30), which in 2020 increased to 40.5% (IQR 28.9-49.8), in the facilities evaluated. Annual average ICU admissions were 311 (154-404), with an average annual bed capacity of 120 (82-221.5). Sepsis, deep venous thromboprophylaxis, and glucose monitoring protocols were most commonly reported (96%), while protocols for massive transfusion (48%), targeted temperature management (41%), and palliative care (30%) were less common. In a multivariable linear regression adjusting for ICU level, annual ICU mortality was significantly lower in hospitals that reported higher use of respiratory protocols (- 3.4%, 95% CI-5.4 to -1.3;p=0.003) and sepsis protocols (-8.4%, 95% CI -14.1 to -2.7);p= 0.006). Conclusions: To our knowledge, this is the first study describing the ICU structure, process and components of different facilities across Ecuador. These may help guide decision-making policymakers, and health service communities to understand Ecuador's health system resilience, and key avenues for improvement and planning.

7.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A157, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896157

RESUMO

Background and Aims: Initiating continuous glucose monitoring (CGM) shortly after T1D diagnosis has potential glycemic and quality of life benefits for youth with T1D and their families. The COVID-19 pandemic necessitated a rapid shift to virtual delivery of CGM initiation visits. We aimed to understand parents' experiences with receiving virtual care to guide starting CGM within 30 days of diagnosis. Methods: We held focus groups and interviews with parents of T1D youth who initiated CGM over telehealth within a month of diagnosis during the COVID-19 pandemic. We used a semistructured interview guide to understand experiences of starting CGM virtually. Groups and interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Results: Participants were 16 parents (age 43±6 years;63% female) of youth (age 9±4 years;47% female;47% non-Hispanic White, 20% Hispanic, 13% Asian, 7% Black, 13% other;diabetes duration 9±3 months) who started CGM through a virtual visit within 30 days of diagnosis. Parents described multiple benefits of the virtual visit: convenience and ease of scheduling;user friendliness;and being in the comfort of home, especially for young children. Most preferred the virtual format to in-person;three parents would have preferred in-person to develop their confidence in starting CGM. Participants felt that clinics should offer families a choice of virtual and in-person for CGM initiation in the future. Conclusions: Despite initial reservations, most parents appreciated receiving telehealth CGM initiation education and felt it should be an option offered to all families. Further efforts can continue to enhance CGM initiation teaching virtually to address identified barriers.

8.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A233, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896154

RESUMO

Background and Aims: The COVID emergency has led to a reduction in the volume of care dedicated to people with Type 1 DM. The use of telemedicine can represent a means of protection. Methods: We investigated the role of FGM in 56 subjects with type 1 DM, AGP parameters were taken into consideration in the following periods: 1) October 2020 (start of the second wave in Italy), 2) May 2021 (reduction of hospitalizations due to SARS-Cov2 disease and opening of outpatient facilities) and 3) November 2021 (maintenance of dedicated COVID facilities and outpatient facilities). All subjects (ages 23.4 +/- 11.2) employed the CHO counting technique. Results: The coefficient of variation and the Glucose Management Indicator increased significantly between period 1 and 2 (37.17 vs 42.30 P = 0.03 and 8.08 vs 9.1 P = 0.005 respectively). In the second period, all the subjects were called back to the center to be re-evaluated. The opposite trend was observed for CVandGMI from the second period to date (current CV and GMI 33.10 P = 0.0002 and 7.8 P = 0.0004). TIR, TAR, TBR were not significantly different between period 1 and 2 they were significantly different from the second period to date (TIR2 55.24 vs TIR 3 65.56 P = 0.001- TAR2 40.39 vs TAR3 27.59 P = 0.001). Conclusions: Remote data control is a fundamental means of identifying those at risk of worsening glycemic control in an exponential manner and to re-propose structured training to guarantee the benefits obtained in the period prior to the pandemic.

9.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A138, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896153

RESUMO

Background and Aims: Widespread use of continuous glucose monitoring (CGM) in Type 1 Diabetes (T1D) under nationwide reimbursement, has shown an improvement in glucometrics, acute complications and patient satisfaction. Following the last phase of the reimbursement program for CGM in Catalonia (Spain), the feasibility and effectiveness of a decision tree algorithm addressed to its massive implementation was evaluated during COVID-19 pandemic. Methods: A straightforward decision tree algorithm was developed to systematically detect and categorize T1D patients from our Diabetes Unit. An administrative assistant, supported by healthcare-staff, contacted candidates and enrolled them into the program if willing to and according to: previous self-financing and digital skills. New users received information about the device, a contact number and 5 training webinars links. Patients unfamiliar with technology received a face-to-face education program. Results: Over a 3-month period, 1519 candidates were contacted by phone (52% women, mean age 43.82±15.29 years, mean HbA1c 7.71%±1.19, 19% of them were pump users). 320 (21%) self-financed CGM previously, 1045 patients (69%) initiated reimbursed CGM use, 331 (22%) declined the use of the device and we could not get in touch with 143 (9%) of patients. 292 patients (29%) joined the Diabetes educator-led webinars, while only 39 (3%) required face-to-face training. No major acute complication or relevant clinical issues were reported. Conclusions: Massive implementation of reimbursed CGMin T1D population in a short period of time is feasible, effective and safe using coordinated strategies between healthcare and nonhealthcare professionals including on-site, virtual visits and a web-site education package.

10.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A161, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896151

RESUMO

Background and Aims: Telemedicine allowed continued care during the COVID-19 epidemic. However, less is known about the role of telemedicine in women with gestational diabetes (GDM). Therefore, we aimed to evaluate whether telemedicine, compared to standard care, provides equivalent clinical outcomes. Methods: Telemedicine group was treated from home by using videoconference and glucose measurements sent daily to the telemedicine centre. The first and the last medical appointments were performed at the outpatient clinic, with medical consultation and laboratory examination. Primary outcomes were HbA1c at the first and the last medical check-up and gestational weight gain, while secondary outcome was infant's birth weight, adjusted for sex and gestational age when compared to the standard care group. Results: The telemedicine (n = 39) and the standard care group (n = 39) were equalized by age (31.6±4.1 vs. 33.0±5.3) and prepregnancy body mass index (26.4±5.3 vs. 26.0±4.7). No significant difference was found between groups in gestational weight gain (10.2±4.2 vs. 11.4±5.4). Both groups did not differ significantly in HbA1c at baseline (4.9±0.3 vs. 4.9±0.2), neither was the difference significant at the last visit (5.2±0.3 vs. 5.1±0.3). Furthermore, no difference was found between groups in the birth weight expressed in percentiles (48.0±25.7 vs. 52.6±26.7). Conclusions: Telemedicine has been shown to be a safe alternative to standard care in women with GDM, giving comparable glycemic outcomes. However, comprehensive studies on a larger sample, with a broader set of perinatal outcomes are needed.

11.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A21, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896147

RESUMO

Objectives To evaluate whether intermittently scanned continuous glucose monitoring (isCGM) with optional alarms (FreeStyle Libre 2) improves glycaemia as measured by HbA1c and sensor-based gluco-metrics, patient reported outcome measures (PROMS) and cost-effectiveness compared with selfmonitoring of blood glucose (SMBG). Design Flash UK is a multicenter, open-label, two arm, parallel, randomised controlled trial delivered in 7 specialist hospital diabetes clinics and 1 primary care centre. Participants 156 people with Type 1 diabetes, age 16 years and over treated with either multiple daily insulin injections or insulin pump therapy with HbA1c 7.5%-11% were randomised. Interventions Participants were randomised (1:1) to the FreeStyle Libre 2 (n = 72) or standard care with SMBG (n = 69). Participants were reviewed at 4, 12 and 24 weeks post-randomisation. Education and treatment optimisation was provided to both groups at randomisation, 4 and 12 weeks. Participants in the SMBG arm wore blinded glucose sensor (Freestyle Libre Pro) during the last 2 weeks of the study;all participants wore a 2-week blinded sensor prior to randomisation. All study visits were conducted either inperson or virtually owing to the COVID-19 pandemic. Main outcome measures The primary outcome was HbA1c at 24 weeks, analysed by intention to treat. Secondary outcomes included glucose time in range (3.9 to 10mmol/l), time below and above range and glucose variability. PROMS included EQ-5DL-5L, Type 1 Diabetes Distress Scale, Diabetes fear of injecting and self-testing, Diabetes Eating Problem Survey, Diabetes Treatment Satisfaction, Patient Health Questionnaire and The Glucose Monitoring Satisfaction Survey. Economic evaluation included healthcare resource use, insulin usage and Freestyle Libre 2 utilisation. Results & Conclusion Results and conclusions will be presented during the 15th International Conference on Advanced Technologies & Treatments for Diabetes, April 27 to 30th Barcelona, Spain and Online.

12.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A17, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896144

RESUMO

During the Covid pandemic, telemedicine(TM) has been more and more accepted by doctors and patients all over the world. Evidence-based research has found telemedicine-based management of type 1 diabetes efficient in delivering equivalent or better care and outcomes when compared to only face to face visits. A year before the covid, Kerala, the most literate state in India, with 96.2% literacy rate, had a community consisting of parents and children with type 1 diabetes. Almost all these parents had access to WhatsApp and were part of the type 1 diabetes community in Whatsapp. This of course doesn't include all of those with type 1 diabetes in the state but included most of those who were economically compromised and didn't have access to the premier hospitals and doctors. There were total of 4 WhatsApp groups, each consisting of 250 parents and children from all over the state of Kerala, receiving treatment from government hospitals or other private hospitals. The groups also included volunteering doctors, nurses, educators and dietitians where we were also part. Our duty was to give them directions and advices rather than to treat them. We in addition, provided the economically disadvantaged families with free supplies including insulin, glucometers, strips and injection needles based on their needs. All the communications in the group were based on updated telemedicine guidelines in India. As a team, we have been providing 24/7 advices and services free of cost to the entire community together with multiple online educational programs via the zoom. Some of these programs were with parents and children together and some other programs incorporated only parents so that counselling can be given to them to specifically address psychosocial issues of these kids. In each WhatsApp group, one of us in the team, always made sure we replied to the questions posted by the parents or grown up children, without any delay. Most frequently asked questions during Covid pandemic were related to stress and anxiety of children including abnormal/aggressive behaviour, uncontrolled glucose, reluctance with insulin injections and glucose monitoring. We also had to arrange exclusive counseling sessions with psychologist to address the multiple emotional issues of the kids/caregivers. We also created educational videos addressing different aspects of type 1 diabetes and Covid based on the frequently raised questions and concerns. MERITS 1. All their concerns are addressed even during the middle of the night. 2. Could avoid multiple episodes of DKA 3. Could successfully avert/treat multiple episodes of lifethreatening hypoglycemia 4. Dietitians in the groups could advise on diet, specific to individual requirements 5. Diabetes nurses could retrain parents and children on injection techniques whenever found essential, multiple times 6. Questions on stopping insulin or Complementary and Alternate Medicines(CAM), side effects of insulin where not only answered but also explained via videos. 6. Whoever is in short of glucometer strips or needles could get it from community itself or from us without any delay. DEMERITS 1. The patients in the WhatsApp groups are getting treated in different hospitals and not by the volunteering doctors and healthcare providers in the Whatsapp groups and hence the medical history and records are not with them. 2. Many a time, the patients with uncontrolled glucose might be on an insulin formulation or regimen not suitable for them but the team would not be able to commend on it. 3. Hundreds of parents will be messaging or calling via WhatsApp privately to doctors. However,due to legal implications, they are not replied to unless it is posted in community group. 4. Though there is no hesitancy for the type 1 diabetes community members to open up about disease in the group, there would be many concerns and questions which cannot be posted in a group. 5. Since it is an open community, whatever communications are exchanged;including lab reports are not secure or confidential. 6. The health care professionals(HCPs) will not get a remuneration and there is no funding for this activity;so those getting involved should volunteer out of their commitment to the society. 8. The HCPs may be under tremendous pressure since the patients will have easy and free access to the health care professional. The WhatsApp community of type 1 diabetes children and their parents were provided support throughout the day and night by the physicians and allied healthcare professionals in each group. This telemedicine model prevented hospital admissions which was widely appreciated by the patient community and it also reduced the overall cost and burden of treatment. However,this model is not free of demerits which may include the legal implications, the errors and mistakes, which can happen in the process of communication and implementation. This advantageous model may not be applicable in many other health systems.

13.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A137-A138, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896138

RESUMO

Background and Aims: Background: Frailty associated with older age increases the risk of complications for diabetes and its treatment, in particular hypoglycaemia. Free Style Libre is a form of flash glucose monitoring that has been commissioned for use in people living with type 1 diabetes who meet NHS criteria and can reduce hypoglycaemia. Aims: Evaluate whether patients ≥65-years-old across Birmingham Heartlands Hospital (BHH) and Solihull Hospital (SOL) are meeting AATD time in range CGM targets. Methods: BHH and SOL patients ≥65-years-old using Free-Style Libre until June 2021 were included in the study population. Patient data such as average scans per day, TIR, TAR, TBR and time <3.0mmol/L were transferred from Libreview. Demographic and HbA1c data were retrieved from electronic patient records. Results: 65 patients were identified, 44 were eligible for inclusion. 68.2% (30/44) met the TIR target of >50%, 45.5% (20/ 44) met the TAR target of <10% and 18.2% (8/44) met the TBR target of <1%. Further analysis of TBR, comparing patients to the AATD recommendation for younger people, found that 75% (33/ 44) spent <4% of time below range. 18.2% (8/44) spent <1% in hypoglycaemia (<3mmol/L) and 81.8% (36/44) spent ≥1% in hypoglycaemia. Conclusions: Despite using Free Style Libre, older patients remain at significant risk of hypoglycaemia. This risk should be managed in outpatient clinics using hypo-awareness and frailty scores. Free Style Libre data can be used as per the ABCD risk stratification criteria for triaging these patients with high risk hypoglycaemia during the COVID-19 recovery phase.

14.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A2, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896137

RESUMO

“Newer Continuous Glucose Monitoring Systems” Satish K. Garg, MD Professor of Medicine and Pediatrics, Director of adult Diabetes program, University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, Colorado. Over the past decade there have been many advances in diabetes technologies, such as Continuous Glucose Monitoring devices/systems (CGMs), insulin-delivery devices, and hybrid closed-loop systems. There have been significant advances in CGMs in the past decade. In fact, ten years ago very few people use to believe in the use of CGMs, even though they had been available for the past two decades. Many providers used to question who, why, and when will patients ever use CGMs similar to the questions asked about Self-Monitoring of Blood Glucose (SMBG) about four decades ago. At the time of this writing, more than five million people world-wide are using a CGM for their diabetes management, especially those who require insulin (all patients with Type 1 diabetes (T1D) and about 20% of patients with Type 2 diabetes (T2D)). Total sales of all CGMs now exceeds more than $7 billion and the use of SMBG is going down every day. Most of the CGMs have improved their accuracy significantly in the past two decades. I still remember doing studies on the GlucoWatch and earlier versions of Dexcom STS where mean absolute relative difference (MARD) used to be in the range of 15-26%. Now most of the CGMs (Guardian by Medtronic, G6 by Dexcom, and Libre 2 by Abbott) have single-digit MARD. In addition, the majority of the new CGMs do not require calibrations and the newer CGMs last for 10-14 days. An implantable CGM by Senseonics (Eversense®) is approved in the USA for 3 months and a different version is approved in Europe for 6 months. FDA has still not approved the 6-month version of Eversense® implantable sensor in the USA, which also has single-digit accuracy. The newer CGMs that are likely to be launched in the next 3-6 months;hopefully around the ATTD Conference, include 10.5-day Dexcom G7 (60% smaller than the existing G6), 7-day Medtronic Guardian 4, 14-day Libre 3, and 6-month Eversense®. Most of the newer CGM data can be viewed on Android or iOS/iPhone smart devices, and in many instances they have several features like predictive alarms and alerts, easy insertion, automatic initialization (in some instances down to 27 mins, Dexcom G7) with single-digit MARDs. It has also been noticed that arm insertion site might have better accuracy than abdomen or other sites like the buttock for kids. Lag time between YSI and different sensors have been reported differently, sometimes it's down to 2-3 mins;however, in many instances, it's still 15-20 mins. Diabetes effects communities of color disproportionately higher. For example, the highest prevalence of diabetes in the USA is amongst Native Americans (14.7%), which is nearly two times higher than Caucasians. African Americans and Hispanics also have higher prevalence of diabetes in the USA. It's also known that LatinX, African Americans, and Native Americans are much less likely to be offered new technologies like continuous subcutaneous insulin infusion (CSII/insulin pumps) and CGMs. Use of technology, especially CGMs, is expected to remove many of the social barriers and disparities in care for people with diabetes. A large database during the COVID-19 pandemic recently reported better Time-in-Range (TIR) in patients with diabetes irrespective of their ethnic background. However, the baseline TIR was significantly lower for minorities as compared to Caucasians. I believe the future will bring a larger increase in the use of CGMs for people with insulin-requiring diabetes (estimated at more than 100 million people globally) and those with T2D on non-insulin therapies (estimated at more than 400 million people globally). I also envision an increase in the number of pre-diabetes patients (estimated at more than 200 million people globally) using CGMs so that early medical intervention for diabetes management can be entertained. The intermittent or continuou use of CGM would depend upon the clinical needs. Needless to say, healthy individuals without diabetes (who can afford CGMs) might even use these technologies for self-evaluation of their glucose profiles after meals.

15.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A223, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896132

RESUMO

Background and Aims: People with type 1 diabetes (PWT1D) using flash glucose monitoring (FGM) showed no deleterious effect or even an improvement on glycemic control during COVID-19 lockdown. The aim is to assess the impact on glycemic control after 8 weeks and one year after lockdown. Methods: Observational retrospective study in PWT1D using FreeStyle Libre®. Glucometric data from the 2 weeks before lockdown start (PRE) were compared with data of the last 14 days after 8 weeks of consecutive lockdown (POST), and last 14 days one year after lockdown (1 YEAR POST). Results: Data from 287 patients were analyzed (median age 45,5±12,6 years, 50,2% male (n = 144), median diabetes duration 20,5±12,1 years). Median lockdown time was 53,9±4,4 days. Conclusions: PWT1D using FGM monitoring during COVID- 19 pandemic in our clinic showed an improvement in glycemic metrics which was sustained 1 year after lockdown.

16.
Diabetes Technology and Therapeutics ; 24(SUPPL 2):A9, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1895749

RESUMO

Background and Aims: Mobile health management platform is a potential way to achieving effective glycemic control in type 2 diabetesmellitus (T2DM) patients, especially during the Covid-19 pandemic. Lilly Connected Care Program (LCCP) is a smartphone-based app providing blood glucose monitoring and diabetes education services to improve diabetes management. This study aimed to evaluate the real-world effectiveness of LCCP platform in glycemic control among Chinese T2DM patients. Methods: This retrospective study included Chinese T2DM patients (age ≥18 years) from January 1, 2015, to January 31, 2020. Data was drawn from mobile app and electronic medical records. Propensity score matching (PSM) was used to match LCCP group and non-LCCP group to reduce confounding, with covariates including age, sex, duration of diabetes, baseline HbA1c, and number of oral diabetes medication classes. We analyzed HbA1c reduction within an average of 4 months and compared the proportions of patients achieving HbA1c reduction ≥0.5% or ≥1% between LCCP and non-LCCP groups. Comparisons were made using independent t-test and Chi-square test. Results: A total of 923 patients were included, among whom 303 pairs of patients were well-matched after PSM (Standardized Mean Difference of covariates <15%). The HbA1c reduction during 4-month follow-up was significantly larger in LCCP group than non-LCCP group (Mean±SD: 2.21 ± 2.37% vs. 1.65 ± 2.29%, P = 0.003). LCCP group had higher proportions of patients with HbA1c reduction ≥1% (69.0% vs. 57.4%, P = 0.003) and ≥0.5% (75.6% vs. 68.0%, P = 0.038). Conclusions: LCCP mobile platform was effective in glycemic control among Chinese T2DM patients in the real world.

17.
Diabetes Technology and Therapeutics ; 24(SUPPL 2):A21, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1895748

RESUMO

Background and Aims: The COVID 19 lockdown imposed with rigid restriction to all outdoor activities, diabetes mellitus (DM) patients visiting clinics, leading to poor glycaemic management. This study aims to understand the effectiveness of telephonic counselling with balanced nutrition, physical activity & stress management on overall glycaemia in Indian patients. Methods: In a retrospective, multi-centric study, medical records of uncontrolled DM patients digitally engaged with a smartphone-connected glucometer (SCG) who also received at least one counselling session between 25th March 2020 to 24th March 2020 (∼90 days) were assessed. The intervention included self-monitoring of blood glucose (SMBG) using SCG enabled with real-time transmission of information to BeatO's certified diabetes educators (CDE) & their corresponding counselling. Results: 4714 adults (average BG >140 mg/dl) included in this study received at least one session of counselling. The mean age of the subjects (78.2% males) was 52.8 years, BMI of 27.3 kg/m2 and 0.5% suffered with co-morbidities. Digital monitoring of BG and counselling with CDE significantly reduced the average BG levels by 16.1%, average HbA1C levels from 8.1 to 7.0 (1.1%), average premeal BG values (157.7 ± 79 to 130.2 ± 77.4 mg/dL, 18% reduction;p < 0.0001) and post meal values (162.0 ± 79.7 to 133.7 ± 70.9 mg/dL, 17.9% reduction;p < 0.0001). Majority 93.8% showed no hypoglycaemic episodes (BG <70 mg/dL) and those in fasting, pre meal and post meal periods reduced by 81.6%, 72.5% & 67.9% respectively, post counselling. Conclusions: BeatO's real time SMBG triggered CDE counselling effectively controlled overall hyperglycaemia & maintained a good target-in-range glucose levels in diabetes subjects during lockdown.

18.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1894941

RESUMO

Background: Diabetes progresses not only as a disorder but also as a public health concern and management of this condition entails continual medical care to minimize the possibility of long-term health complications. Technological advancements and the increase in internet use in the Philippines has been seen to contribute to the improvement of telemedicine delivery–specifically, in terms of access and dissemination of health information. Amid the enhanced community quarantine period, there has been an intense increase in the adoption of telemedicine practices. Aim: The researchers specifically aim to: 1. Determine the diabetes-specific characteristics of the selected persons with T2DM and the frequency of their telemedicine consultation during the COVID-19 pandemic;2. Determine the respondents’ satisfaction with their telemedicine experiences during the COVID-19 pandemic;3. Determine different barriers of telemedicine use during the COVID-19 pandemic;and 4. Determine the respondents’ self-care activities related to diabetes during the COVID-19 pandemic. Method: An online survey, which was adapted from the Diabetes Self Management Questionnaire (DSMQ) and Usefulness, Satisfaction, and Ease of use (USE), was distributed through Facebook in June 2021. The purposive sample included Luzon residents with T2DM, aged 20 and above. The gathered data was analyzed using descriptive statistics Results: The study identified that glucose management yielded the highest mean score of 6.90 among the self-care activities related to diabetes during the COVID 19 pandemic. Most of the participants only had one telemedicine consult, and the majority did not change their service provider because their current doctor uses telemedicine. The diabetes-specific characteristics, such as body mass index (BMI) and family history, may have contributed to the respondents' decision to use telemedicine. Most users–whether it is their first usage or not–had been adequately satisfied with their experience in using telemedicine consultation, but the most significant problem encountered were connectivity issues. Discussion: Conclusion: As telemedicine continues to emerge during the COVID-19 pandemic, the researchers aim to contribute to the growing body of knowledge on how a chronic illness, specifically T2DM, can be managed remotely yet effectively.

19.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1894940

RESUMO

Background: The discovery of insulin in 1921 changed the lives of people living with diabetes (PLWD). Yet, millions still lack access to insulin. Additionally, an unrecognized number of PLWD cannot access or afford the commodities needed to measure their blood glucose (BG) or safely administer insulin itself. This inconsistent access (further exacerbated by COVID) forces PLWD to ration insulin, test strips, and ration or reuse needles/syringes, leading to increased rates of severe complications, including death. This represents a huge unmet need and a call-to-action for service delivery innovation. Aim: Diabetes CarePak project aims to: • develop a human-centered “co-packaging” solution that increases access to the combination of medication and associated supplies needed for safe administration of insulin and self-care to improve quality of life and health outcomes • demonstrate health system benefits and preliminary cost savings to the Kenyan government to advocate for broader uptake. Method: We partnered with > 100 individuals, in Kenya, with lived, clinical, or work expertise in diabetes, to actualize the “care package” included in the Kenya Ministry of Health (MOH) 2018 clinical management guidelines. Utilizing human-centered design (HCD), we conducted interviews and focus groups across three counties with PLWD, health care workers (HCW), and MOH officials to co-create the CarePak prototype, and the educational and training materials for PLWD and HCWs. The CarePak prototype, which included items such as a glucometer, test strips, lancets, needles/syringes (if applicable), and educational materials was given to 23 users with Type 1 (T1D) or Type 2 (T2D) diabetes, across five facilities within the three counties, to be used daily, at home, for two months. Nine users had T1D, eight users had T2D and used insulin, and 6 users had T2D and used oral medication. Fourteen users were female and eight were from a rural area. Users completed baseline and end-line questionnaires and pre-/post-HbA1c values were documented. Usability feedback was gathered through home, clinic, and virtual visits. Results: Emerging themes included limited diabetes management/self-care knowledge (PLWD were unaware of what type of diabetes they had, incorrect insulin injection techniques were observed), limited access to personal BG monitoring (>70% of the PLWD did not own monitoring equipment), frequent reuse of needles/syringes due to cost or unreliable availability, and frequent visits to multiple facilities to get all supplies due to stockouts. Following use of the CarePak, users reported changes in individual lifestyle management (e.g. increased self-monitoring of BG, changes in diet), clinical management changes (e.g. changes in insulin regimens using BG data over time), and improved clinical outcomes (e.g. fewer sores from needle reuse, an average HbA1C improvement of 2.8% over two months). Discussion: The HCD methodology, with PLWD at the center of the co-creation process, captured key diabetes management challenges, the need for a bundle of commodities, and ensured the CarePak was usable, feasible, and valuable. CarePak iterations continue in Kenya and work is expanding to additional countries in 2022. As COVID-19 continues to stress supply chains and PLWD, we have an obligation to address all aspects of self-care, otherwise we will continue to fail PLWD globally.

20.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1894935

RESUMO

Background: Education of self-management skills in children with type 1 diabetes mellitus is essential for their care. A few studies were conducted to assess glucose control of children with type 1 diabetes during camp. Bahrain Diabetes Society (BDS) has been the pioneer in the Gulf region in diabetes camps and during COVID-19 pandemic, we transitioned the program using an online delivery method. Aim: 1. Creating a live diabetes education program for children with diabetes. 2. Assessing parents’ satisfaction of this method of delivery of diabetes education. Method: Cross-sectional study in the form of a survey that was sent to parents of children enrolled in the online diabetes education program. Data from the survey was analyzed to evaluate the satisfaction of parents with the program. Results: An invitation was sent to advertise for the program and 40 children and adolescents were enrolled. Participants were divided into two groups depending on age (7-11 years and 12-16 years). The sessions were conducted weekly as live session. The content included carbohydrate counting, techniques of insulin injection, and meetings with adults who had diabetes as children. 29 parents responded. Parents responded favorably to the format and content of the sessions and preferred 15 participants instead of 25 per session. Overall the parents provided positive comments requesting to continue such activities beyond COVID-19. Discussion: Bahrain Diabetes Society successfully conducted an online diabetes education program for children and adolescents with diabetes. This model of delivery of education and self-empowerment and motivation was appropriate during the current pandemic and can be considered in the long term as one of the options to provide such education. We intend to follow these children and adolescents and study the impact of the program on their health and glycemic profile as well.

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