Conhecimento e práticas de usuários com diabetes mellitus sobre a automonitorização da glicemia capilar no domicilio / Knowledge and practices of users with diabetes mellitus on capillary blood glucose self-monitoring at home / Conocimientos y prácticas de los usuarios con diabetes mellitus en sangre capilar glucosa autocontrol en casa

Objective:To analyze the knowledge and practices of users with Diabetes Mellitus (DM) on the capillary blood glucose self-monitoring (AMGC) held at home. Methods: descriptive-exploratory study with qualitative methodology, developed in April and May 2013, with users with DM in the public health system of an interior. The data were collected through interviews and categorial analysis verified the sample. The theme was selected by saturation of the speech totaling 12 DM users that perform AMGC at home. Results: the content analysis of data made it possible to identify three categories: realization of non-rational AMGC; The absence of educational programmes to steer on the realization of AMGC; Insufficient availability of inputs to users who perform AMGC. Conclusion: Despite advances legally reached by public policies, users with DM are unaware of the legislation and how it directly interferes in the conduct of AMGC's

Objetivo: Analisar o conhecimento e as práticas de usuários com Diabetes Mellitus (DM) acerca da Automonitorização da Glicemia Capilar (AMGC) realizada no domicílio. Métodos: Estudo descritivo-exploratório, com metodologia qualitativa, desenvolvido em abril e maio 2013, com usuários com DM atendidos pelo sistema público de saúde de um interior pernambucano. Os dados foram coletados por meio de entrevistas e verificados por análise categorial temática, a amostra foi selecionada por meio da saturação do discurso totalizando 12 usuários com DM que realizam a AMGC no domicílio. Resultados: A análise de conteúdo dos dados possibilitou identificar três categorias: Realização da AMGC de forma não racional; Ausência de programas educativos para orientar sobre a realização da AMGC; Disponibilização insuficiente de insumos aos usuários que realizam a AMGC. Conclusão: Apesar dos avanços legalmente alcançados pelas políticas públicas, os usuários com DM desconhecem a legislação e como está interfere diretamente na realização da AMGC

Objetivo: Analizar los conocimientos y prácticas de los usuarios con Diabetes Mellitus (DM) de la glucosa en sangre capilar Self-monitoring (AMGC) llevó a cabo en casa. Métodos: estudio descriptivo exploratorio con metodología cualitativa, desarrollado en abril y mayo de 2013, con usuarios con DM en el sistema de salud pública de un interior. Los datos fueron recogidos a través de entrevistas y análisis categorial verificado que el tema de la muestra fue seleccionado por la saturación del discurso por un total de 12 DM usuarios que realizan la AMGC en casa. Resultados: el análisis del contenido de los datos permitió identificar tres categorías: realización de AMGC no racional; La ausencia de programas educativos para orientar en la realización de AMGC; Disponibilidad insuficiente de insumos a los usuarios que realizan AMGC. Conclusión: A pesar de los avances alcanzados legalmente por las políticas públicas, usuarios con DM desconocen la legislación y cómo está directamente interfiere en la AMGC de conducta

Video consultations as add-on to standard care among patients with type 2 diabetes not responding to standard regimens: a randomized controlled trial.

OBJECTIVE: To examine whether video consultations preceded by measurements of blood glucose, weight and blood pressure as add-on to standard care could contribute to achieving and maintaining good diabetes control among patients with poorly regulated type 2 diabetes (T2D). DESIGN: Randomized controlled trial. METHODS: 165 patients with T2D were randomized 1:1 to telemedicine intervention as add-on to clinic-based care or control (clinic-based care). The intervention consisted of monthly video conferences with a nurse via a tablet computer and lasted for 32 weeks. Regularly self-monitored measurements of blood sugar, blood pressure and weight were uploaded and visible to patient and nurse. Both groups were followed up six months after the end of the intervention period. PRIMARY ENDPOINT: HbA1c after eight months. RESULTS: Video conferences preceded by uploads of measurements as add-on to clinic-based care led to a significant reduction of HbA1c compared to that in standard care (0.69% vs 0.18%, P = 0.022). However, at six-month follow-up, the inter-group difference in HbA1c-reduction was no longer significant. Non-completers had higher HbA1c levels at baseline and a lower degree of education. CONCLUSION: Video consultations preceded by uploading relevant measurements can lead to clinically and statistically significant improvements in glycemic control among patients who have not responded to standard regimens. However, continuing effort and attention are essential as the effect does not persist when intervention ends. Furthermore, future studies should focus on differentiation as the most vulnerable patients are at greater risk of non-adherence.

Satisfação do paciente em um programa educativo para automonitorização da glicemia capilar no domicilio / Patient satisfaction in a home-based capillary blood glucose self-monitoring educational program / Satisfacción del paciente en programa educativo de automonitoreo de glucemia capilar en domicilio

Estudo transversal que teve como objetivo avaliar a satisfação dos pacientes com diabetes mellitus após oferecimento de um programa educativo para automonitorização da glicemia capilar no domicílio. A amostra por conveniência foi constituída por 29 pacientes de duas Unidades Básicas de Saúde de uma cidade do interior paulista, em 2012. Utilizou-se um formulário contendo as variáveis sociodemográficas e um questionário para avaliar a satisfação dos pacientes em relação ao grupo de educação em diabetes. Os resultados mostraram que a maioria dos pacientes considerou o programa educativo como excelente/satisfatório. Quanto às informações recebidas, os pacientes referiram que elas atenderam às suas necessidades e que recomendariam o programa educativo a outra pessoa. Conclui-se que há necessidade de investimentos para que os programas educativos disponibilizados nos serviços de saúde às pessoas com DM sejam permanentemente avaliados e que utilizem a satisfação como um indicador de avaliação

The aim of this cross-sectional study was to assess the satisfaction of patients with diabetes mellitus (DM) after being provided with an educative program for self-monitoring capillary glucose at home. The convenience sample was made of 29 patients, from two basic health units in a city in the interior of São Paulo, in 2012. Patient satisfaction regarding the diabetes education group was assessed using a questionnaire and a form containing sociodemographic variables. Results showed that most of the patients considered the educative program to be excellent/satisfactory. Regarding the information received, the patients stated it met their needs and that they would recommend the program to other people. In conclusion, investments are needed so that the educative programs provided in health services to people with DM are permanently assessed and use satisfaction as an assessment indicator

Estudio transversal objetivando evaluar la satisfacción de pacientes con diabetes mellitus luego de ofrecérseles un programa educativo de automonitoreo de glucemia capilar en domicilio. Muestra por conveniencia constituida por 29 pacientes de dos Unidades Básicas de Salud de ciudad del interior paulista. Se utilizó un cuestionario incluyendo variable sociodemográficas y otro evaluando la satisfacción de los pacientes respecto del grupo educativo constituido. Los resultados mostraron que la mayoría de los pacientes consideró al programa educativo como excelente/satisfactorio. Respecto a las informaciones recibidas, los pacientes refirieron que las mismas atendieron sus necesidades y que recomendarían el programa educativo a otra persona. Se concluye en que existe necesidad de inversiones para que los programas educativos disponibles en los servicios de salud para personas con DM sean permanentemente evaluados y que utilicen la satisfacción como un factor indicador de la evaluación.

Sistemas de monitorización continua de la glucosa / Continuous monitoring systems of glucose

La posibilidad de obtener una lectura continua de la glucosa puede representar un gran avance y una herramienta útil para el manejo de la diabetes. Los avances tecnológicos pueden mejorar la calidad de vida y el control metabólico de las personas con diabetes, aunque esto suponga tener que aprender e incorporar nuevos conceptos técnicos, nuevos algoritmos de modificación de pauta y nuevos retos en Educación Terapéutica(AU)

The possibility of obtaining a continuous reading of glucose may represent a breakthrough and a useful tool for the management of diabetes. Technological advances can improve the quality of life and people with diabetes metabolic control, even if this means having to learn and incorporate new technical concepts, new algorithms for pattern modification and new challenges in Therapeutic Education(AU)

The options of the management of self-monitoring of blood glucose in primary health care centres by the diabetes nurses and patients.

The aims of the present study were to investigate the diabetes nurse specialists (DNS) practice according to the local diabetic guideline, to study the DNSs' opinion of self-monitoring of blood glucose (SMBG) and prescription of test-strips, to investigate the patients' opinions and habits when using SMBG. Users of SMBG (n=533 patients') and all DNSs (n=25) were telephone interviewed. Only a few DNSs used local guidelines, the majority had their own prescribing strategy of SMBG. In conclusion, DNSs were aware of the guidelines but did not use them to support their decision regarding the reasons for prescribing SMBG or not. For diabetes patients, reassurance was the most important issue in having access to SMBG, despite the fact that one-third retested but did not change their behaviour and nearly 15% contacted their DNS for advice.

Mobile phone-based video messages for diabetes self-care support.

BACKGROUND: This study examined whether mobile phone-based, one-way video messages about diabetes self-care improve hemoglobin A1c (A1C) and self-monitoring of blood glucose (SMBG). METHODS: This was a 1-year prospective randomized trial with two groups. The active intervention lasted 6 months. The study enrolled 65 people with A1C >8.0% who were established (>6 months) patients in the endocrinology clinics of the Walter Reed Health Care System. Participants were randomized to receive "usual care" or self-care video messages from their diabetes nurse practitioner. Video messages were sent daily to cell phones of study participants. Hemoglobin A1c and SMBG data were collected at 0, 3, 6, 9, and 12 months. RESULTS: Participants who received the messages had a larger rate of decline in A1C than people who received usual care (0.2% difference over 12 months, adjusting for covariates; p = .002 and p = .004 for the interaction between time and group and for the quadratic effect of time by group, respectively). Hemoglobin A1c decline was greatest among participants who received video messages and viewed >10 a month (0.6% difference over 12 months, adjusting for covariates; p < .001 for the interaction between time and group and the quadratic effect). Self-monitoring of blood glucose metrics were not related to the intervention. CONCLUSIONS: A one-way intervention using mobile phone-based video messages about diabetes self-care can improve A1C. Engagement with the technology is an important predictor of its success. This intervention is simple to implement and sustain.

Automonitorização da glicemia capilar no domicílio / Self-monitoring blood glucose at home / Automonitorización de la glucemia capilar en el domicilio

Esse estudo teve como objetivo verificar a realização de automonitorização da glicemia capilar no domicílio pelaspessoas com diabetes acompanhadas em um programa de atendimento sistematizado à pessoa diabética.Foram entrevistadas 54 pessoas com diabetes em um centro de pesquisa e extensão universitária do interiorpaulista, em 2005. Os dados obtidos na presente investigação mostram que a maioria das pessoas com diabetesnão realizam a automonitorização da glicemia capilar no domicílio. Os pacientes que a realizam aprenderam comprofissionais de saúde ou pessoas não envolvidas com o cuidado à sua saúde. O conhecimento demonstradopelas pessoas com diabetes para a interpretação dos valores da glicemia de jejum e da pós-prandial mostrou-seinsuficiente. Diante dos episódios de hipoglicemia, a conduta referida pela maioria das pessoas com diabetesmostrou-se adequada, e na presença de hiperglicemia essas pessoas apresentaram dificuldades em lidar comessa situação. A compreensão das facilidades e/ou dificuldades das pessoas com diabetes para aautomonitorização da glicemia capilar no domicílio pode oferecer aos profissionais de saúde subsídios parareorganizar a atenção à pessoa com diabetes, em atendimento aos princípios da integralidade do cuidado àsaúde.

This study aims to verify the accomplishment of self-monitoring capillary blood glucose at home by individualswith diabetes, followed in a systematic health program. Data were collected through a directed interview with 54individuals with diabetes, in a Center for Research and Extension at University of São Paulo, in 2005. The dataobtained in this research show that the majority of individuals with diabetes does not perform self-monitoringblood glucose at home. The patients who do that, learned from health professionals or people not involved withtheir health care. The knowledge shown by the individuals with diabetes for the interpretation of the values offasting and postprandial blood glucose proved to be insufficient. In the face of the episodes of hypoglycemia theconduct informed by the majority of the patients has shown to be appropriate but in the presence ofhyperglycemia they showed difficulties to deal with the situation. Understanding the facilities and/or difficulties ofindividuals with diabetes to self-monitor capillary blood glucose at home can offer subsidies to health careprofessionals to rearrange attention to the person with diabetes, in response to the principles of an ideal healthcare approach.

Este estudio tuvo como objetivo verificar la realización de automonitorización de la glucemia capilar en eldomicilio por las personas con diabetes, acompañadas en un programa de atención sistematizada a la personadiabética. Fueron entrevistadas 54 personas con diabetes, en un Centro de Investigación y ExtensiónUniversitaria del Interior Paulista, en 2005. Los datos obtenidos en esta investigación muestran que la mayoríade las personas con diabetes no realiza la automonitorización de la glucemia capilar en el domicilio. Lospacientes que la realizaron aprendieron con los profesionales de la salud o de personas que no participan en elcuidado a su salud. El conocimiento demostrado por las personas con diabetes para la interpretación de losvalores de la glucemia de ayuno y de la post prandial se demostró insuficiente. Delante de los episodios dehipoglucemia, la conducta referida por la mayoría de las personas con diabetes se mostró adecuada, y en lapresencia de hiperglucemia esas personas presentaron dificultades para lidiar con esa situación. La comprensiónde las facilidades y / o dificultades de las personas con diabetes para la automonitorización de la glucemia capilaren el domicilio, puede ofrecer a los profesionales de la salud subsidios para reorganizar la atención a la personacon diabetes, en respuesta a los principios de integridad del cuidado a la salud.

Capillary blood glucose monitoring.

This article, the first in a series of articles relating to clinical skills in nursing, outlines the procedure of capillary blood glucose monitoring. This is a convenient way of monitoring blood glucose patterns and can be a useful aid in guiding treatment changes in patients with type 1 and type 2 diabetes, especially during periods of illness or frequent hypoglycaemia.

Community nurses and self-management of blood glucose.

Self-monitoring of blood glucose (SMBG) is commonly recommended to patients with diabetes, although the rationale for this is unclear. This small research project was designed to explore the reasons why nurses working in the community recommend SMBG. Seven interviews were carried out with community nurses caring primarily for housebound patients. Those interviewed believed that a sound evidence-base supported the recommendation that patients test their blood, but not urine, for glucose levels. Though nurses believed in the importance of patient choice and empowerment, the scope for these was limited among housebound patients. There was no evidence that patients understood how to respond to test results, or that comprehensive care planning was normal practice. Although small, this study suggests that nurses working in community settings may need to update their knowledge. It also suggests that a national debate is necessary to disseminate better the evidence about SMBG, and its implications for nursing practice.