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1.
Braz J Med Biol Res ; 53(1): e8652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859911

RESUMO

Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4-10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (-0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [-2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Liraglutida/administração & dosagem , Adulto , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
3.
Zhonghua Nei Ke Za Zhi ; 58(12): 889-893, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31775451

RESUMO

Objective: To evaluate the effect of mobile application (APP) based interactive peer support on glycemic control in patients with type 1 diabetes mellitus (T1DM). Methods: The data of the present study were from the largest mobile APP platform for patients with T1DM in China, Tangtangquan. Patients with T1DM who has registered in the APP for at least 1 year and had completed data entry were recruited. According to the monthly interaction index during the first year of APP registration (including four indicators: praise, comment, posting and collection), the eligible patients were divided into the high-interaction group and the low-interaction group. The changes from baseline of self-blood glucose monitoring frequency (SMBG), glycosylated hemoglobin (HbA1c), incidence of hyperglycemia and incidence of hypoglycemia were compared between the two groups after one year of using the APP. Results: A total of 238 patients with T1DM with an age of (27±8) years were included. Among them, 77.3% (184/238) were female. The baseline SMBG [the low-interaction group (1.71±1.14) times/day vs. the high-interaction group (1.82±1.15) times/day] and HbA1c [the low-interaction group (6.72±0.99)% vs. the high-interaction group (6.76±1.04)%] were comparable between the two groups. After one year use of the APP, the frequency of SMBG in the high-interaction group was significantly higher than that in the low-interaction group [ΔSMBG (0.59+2.06) times/d vs. (0.08+1.69) times/d, t=4.280, P=0.04), and the reduction of HbA1c was more obvious in the high-interaction group [ΔHbA1c (-0.40+1.10)% vs. (-0.06+1.13)%, t=5.651, P=0.018] than in the lower-interaction group. The incidence of hyperglycemia in the high-interaction group was significantly lower than that in the low-interaction group [13.19(6.22,23.19)% vs. 17.69(10.56,30.49)%, Z=2.850, P=0.005]. There was no significant difference in the incidence of hypoglycemia between the two groups [4.62(2.14, 8.03)% vs. 4.83(2.06, 8.87)%, Z=1.276, P=0.204]. The correlation analysis showed that interaction index was significantly associated with the reduction of HbA1c and incidence of hyperglycemia. Conclusion: Participation in interactive peer education via mobile APP may be beneficent for glycemic control in patients with T1DM.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/sangue , Aplicativos Móveis , Grupo Associado , Adulto , Glicemia , China , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Hemoglobina A Glicada , Humanos , Hiperglicemia/epidemiologia , Incidência , Pessoa de Meia-Idade , Cooperação do Paciente
5.
J Clin Nurs ; 28(23-24): 4513-4524, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31430410

RESUMO

AIMS AND OBJECTIVE: To investigate the effects of a home-based nursing intervention programme established based on the Health Promotion Model on the health outcomes of adolescents with type 1 diabetes mellitus. BACKGROUND: After diagnosed with diabetes, it is necessary to ensure that nursing care is not limited to the hospital setting but continues at home. DESIGN: A quasi-experimental design with a pre- and post-test control group was used. The researchers have complied with the guidelines of TREND Checklist in presenting this study. METHOD: This study was conducted in Izmir, Turkey, with 71 adolescents (35 in an intervention group and 36 in a control group) diagnosed with type 1 diabetes mellitus who were registered at the paediatric endocrinology outpatient clinics of two hospitals and were selected using the convenience sampling method between June-December 2017. A home-based nursing intervention programme (5 week) was provided to the intervention group while standard care was provided to the control group. Data were collected at the baseline, and 3 and 6 months after a 5-week home-based nursing intervention. Multi-way and one-way analysis of variance, the Bonferroni correction, regression analysis, t test, chi-squared analysis and a structural equation model were used for data analysis of the iterative measurements. RESULTS: At the end of the home-based nursing intervention programme, the HbA1c mean scores significantly decreased, while self-efficacy perception, frequency of managing diabetes and taking responsibility in managing diabetes increased in the intervention group compared to those in the control group. Frequency of admission to the hospital and average costs were lower in the intervention group than in control group. The home-based nursing intervention programme using structural equation modelling increased the frequency of managing diabetes and taking responsibility in managing diabetes and decreased HbA1c levels. CONCLUSION: The home-based nursing intervention programme was effective in decreasing HbA1c levels, increasing the frequency of diabetes management and taking responsibility in managing diabetes, and improving the self-efficacy of the adolescents. RELEVANCE TO CLINICAL PRACTICE: The home-based nursing intervention programme can be applied by nurses to ease the transition of adolescents with type 1 diabetes mellitus and their parents to healthy daily life practices and ensure their glycemic controls after being discharged.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/enfermagem , Assistência Domiciliar/métodos , Autoeficácia , Adolescente , Aconselhamento/métodos , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Turquia
6.
Diabetes Res Clin Pract ; 155: 107814, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31421138

RESUMO

INTRODUCTION: Emerging evidence suggests us of real-time continuous glucose monitoring systems (RT-CGM), can assist to improve glucose control in Type 2 Diabetes (T2D) treatment, however the impact of these devices on patients' stress levels and behaviour is poorly understood. This study aimed to examine the effects of RT-CGM on tolerance and acceptability of device wear, stress and diabetes management and motivation to change. METHODS: Twenty adults (10 men, 10 women) with T2D (aged 60.6 ±â€¯8.4 years, BMI 34.2 ±â€¯4.7 kg/m2), were randomised to a low-carbohydrate lifestyle plan whilst wearing a RT-CGM or an 'offline-blinded' (Blinded-CGM) monitoring system continuously for 12 weeks. Outcomes were glycaemic control (HbA1c), weight (kg) perceived stress scale (PSS), CGM device intolerance, acceptability, motivation to change and diabetes management behaviour questionnaires. RESULTS: Both groups experienced significant reductions in body weight (RT-CGM -7.4 ±â€¯4.5 kg vs. Blinded-CGM -5.5 ±â€¯4.0 kg) and HbA1c (-0.67 ±â€¯0.82% vs. -0.68 ±â€¯0.74%). There were no differences between groups for perceived stress (P = 0.47) or device intolerance at week 6 or 12 (both P > 0.30). However, there was evidence of greater acceptance of CGM in the RT-CGM group at week 12 (P = 0.03), improved blood glucose monitoring behaviour in the RT-CGM group at week 6 and week 12 (P ≤ 0.01), and a significant time x group interaction (P = 0.03) demonstrating improved diabetes self-management behaviours in RT-CGM. CONCLUSION: This study provides preliminary evidence of improved behaviours that accompany RT-CGM in the context of diabetes management and glucose self-monitoring. RT-CGM may provide an alternative approach to glucose management in individuals with T2D without resulting in increased disease distress.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 2/sangue , Estilo de Vida Saudável/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
7.
Sensors (Basel) ; 19(17)2019 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-31450547

RESUMO

Even if still at an early stage of development, non-invasive continuous glucose monitoring (NI-CGM) sensors represent a promising technology for optimizing diabetes therapy. Recent studies showed that the Multisensor provides useful information about glucose dynamics with a mean absolute relative difference (MARD) of 35.4% in a fully prospective setting. Here we propose a method that, exploiting the same Multisensor measurements, but in a retrospective setting, achieves a much better accuracy. Data acquired by the Multisensor during a long-term study are retrospectively processed following a two-step procedure. First, the raw data are transformed to a blood glucose (BG) estimate by a multiple linear regression model. Then, an enhancing module is applied in cascade to the regression model to improve the accuracy of the glucose estimation by retrofitting available BG references through a time-varying linear model. MARD between the retrospectively reconstructed BG time-series and reference values is 20%. Here, 94% of values fall in zone A or B of the Clarke Error Grid. The proposed algorithm achieved a level of accuracy that could make this device a potential complementary tool for diabetes management and also for guiding prediabetic or nondiabetic users through life-style changes.


Assuntos
Técnicas Biossensoriais , Automonitorização da Glicemia/métodos , Glicemia/isolamento & purificação , Diabetes Mellitus/sangue , Algoritmos , Diabetes Mellitus/patologia , Humanos , Estudos Longitudinais , Estudos Retrospectivos
8.
Biosens Bioelectron ; 141: 111479, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31260903

RESUMO

While glucose monitoring technology is widely available, the continued prevalence of diabetes around the world coupled with its debilitating effects continues to grow. The significant limitations which exist in the current technology, instils the need for materials capable of non-invasive glucose detection. In this study a unique non-enzymatic electrochemical glucose sensor was developed, utilising a gold honeycomb-like framework upon which sharp Co3O4 needles are anchored. This composite nanomaterial demonstrates excellent sensing performance in glucose concentrations ranging between 20 µM and 4 mM, exceeding the range required for non-invasive glucose sensing. In conjunction with this high sensitivity (2.014 mA mM-1·cm-2), the material possesses excellent selectivity towards glucose for commonly interfering physiological species such as uric acid and ascorbic acid. Glucose detection in synthetic saliva was then performed showing excellent capability in the low concentration range (20 µM-1 mM) for non-invasive sensing performance. Further tests showed good selectivity of the sensor in physiological contaminants commonly found in saliva such as cortisol and dopamine. This development provides excellent scope to create next-generation non-invasive diabetes monitoring platforms, with excellent performance when detecting low glucose concentrations in complex solutions such as saliva.


Assuntos
Técnicas Biossensoriais/métodos , Cobalto/química , Glucose/análise , Ouro/química , Nanoestruturas/química , Óxidos/química , Saliva/química , Automonitorização da Glicemia/métodos , Técnicas Eletroquímicas/métodos , Humanos , Limite de Detecção , Nanoestruturas/ultraestrutura , Porosidade
9.
BJOG ; 126 Suppl 4: 27-33, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257712

RESUMO

OBJECTIVE: To compare glycaemic profiles in women with mild gestational diabetes (GDM) and those with a healthy pregnancy. DESIGN: Observational study. SETTING: Hospital-based. POPULATION: Healthy nonpregnant, healthy pregnant, and women with GDM, diagnosed by oral glucose tolerance test. METHODS: Nine nonpregnant women, 33 healthy pregnant women, 29 pregnant women with GDM between 24 and 36 weeks' gestation, received ambulatory glucose profile (AGP) monitoring for a 2-week period. AGP values were compared in the three groups: 100 days (9600 data points) for nonpregnant women, 396 days (33 792 data points) for healthy pregnant women, and 348 days (34 408 data points) for women with GDM. RESULTS: Mean glucose values for fasting and postmeals were highest in nonpregnant healthy women and lowest in healthy pregnant women (P < 0.001). Women with mild GDM had significantly higher blood glucose values than did healthy pregnant women, though still within the target range. Blood glucose values >160 mg/dl were observed in 41.4% (12/29) in the GDM group compared with 18.2% in women with a healthy pregnancy. The maximum peak of day and night time glucose was respectively 234 and 215 mg/dl in women with GDM compared with 183 and 171 mg/dL in the control group. Glycaemic variability as measured by interquartile range was higher in GDM pregnancies. CONCLUSIONS: Although the blood glucose level remained within the target levels in women with mild GDM, glycaemic variability and mean blood glucose levels were significantly higher among women with GDM than among women with a healthy pregnancy. TWEETABLE ABSTRACT: Average blood glucose levels and glycaemic variability are significantly higher in women with GDM than in women with a healthy pregnancy.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/metabolismo , Diabetes Gestacional/sangue , Índice Glicêmico , Adulto , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Projetos Piloto , Gravidez , Adulto Jovem
10.
Diabetes Res Clin Pract ; 154: 75-81, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271810

RESUMO

AIMS: To evaluate the impact of a prepregnancy care (PPC) programme, beyond HbA1c, on hypoglycaemia awareness and glycaemic variability (GV). METHODS: Prospective pilot study. We selected women with Type 1 diabetes who initiated a PPC programme with normal hypoglycaemia awareness (n = 24). Hypoglycaemia awareness, hypoglycaemic events and GV derived from masked-continuous glucose monitoring were evaluated in the first visit and within 2 weeks after pregnancy confirmation. RESULTS: The duration was 16.5 ±â€¯13.0 months. HbA1c significantly decreased (-0.8 ±â€¯0.7; p < 0.001). The Clarke score increased (0[0-1] vs. 1[0-2] points, p = 0.164), 2 out of 24 were reclassified as having impaired awareness of hypoglycaemia and 2 presented severe hypoglycaemia. GV decreased: standard deviation (p = 0.008), coefficient of variation (p = 0.021), mean amplitude of glycaemic excursions (p = 0.007), average daily risk range (p < 0.001), J-index (p = 0.010), high blood glucose index (HBGI) (p = 0.004), continuous overall net glycaemic action (CONGA) (p = 0.018), mean of daily differences (p = 0.045) and glycaemic risk assessment diabetes equation (p = 0.012). Final HbA1c was associated with baseline J-index, CONGA and HBGI (ß = 0.535, ß = 0.466, ß = 0.534, respectively; p < 0.05). CONCLUSIONS: A PPC programme improved HbA1c as well as GV with no significant impact on hypoglycaemia awareness. Moreover, GV could help to identify women less likely to achieve glycaemic targets. Larger studies are needed to confirm these results.


Assuntos
Automonitorização da Glicemia/normas , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Conhecimentos, Atitudes e Prática em Saúde , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Cuidado Pré-Concepcional/métodos , Adulto , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/sangue , Hiperglicemia/induzido quimicamente , Hiperglicemia/diagnóstico , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Projetos Piloto , Prognóstico , Estudos Prospectivos
11.
Biosens Bioelectron ; 141: 111201, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31302426

RESUMO

Diabetes mellitus is a chronic metabolic disorder lasting for the lifetime of a person. Glucose and insulin are the main indicators in the monitoring and control of this disease. Most often, various laboratory tests are used in the diagnosis and control of diabetes. Among them, the estimation of blood glucose concentration is one of the main diagnostic criteria. Proper control of the blood glucose level can delay, and to a greater extent, prevent complications. Thus, blood glucose monitoring is a requisite tool in the management of diabetes mellitus. Insulin plays a major role in glucose metabolism and its determination is of great value in the diagnosis and control of diabetes. An uncountable number of biosensors have been developed based on various mechanisms which will make sure a continuous glucose as well as insulin monitoring. Biosensors became the most sophisticated tool for the detection of glucose and insulin and they are of different types. Enzymatic, non-enzymatic, electrochemical, optical, non-invasive, and continuous monitoring biosensors are discussed in this review. In recent years, there is progress towards the development of nanobiosensors using various nanomaterials. Here, we have reviewed the fabrication, modification, and recent approaches associated with insulin and glucose biosensors for the treatment of diabetes.


Assuntos
Técnicas Biossensoriais/instrumentação , Glicemia/análise , Diabetes Mellitus/diagnóstico , Insulina/sangue , Animais , Técnicas Biossensoriais/métodos , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/métodos , Diabetes Mellitus/sangue , Glucose/análise , Humanos , Insulina/análise
12.
Sensors (Basel) ; 19(15)2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31357725

RESUMO

Diabetes patients suffer from abnormal blood glucose levels, which can cause diverse health disorders that affect their kidneys, heart and vision. Due to these conditions, diabetes patients have traditionally checked blood glucose levels through Self-Monitoring of Blood Glucose (SMBG) techniques, like pricking their fingers multiple times per day. Such techniques involve a number of drawbacks that can be solved by using a device called Continuous Glucose Monitor (CGM), which can measure blood glucose levels continuously throughout the day without having to prick the patient when carrying out every measurement. This article details the design and implementation of a system that enhances commercial CGMs by adding Internet of Things (IoT) capabilities to them that allow for monitoring patients remotely and, thus, warning them about potentially dangerous situations. The proposed system makes use of smartphones to collect blood glucose values from CGMs and then sends them either to a remote cloud or to distributed fog computing nodes. Moreover, in order to exchange reliable, trustworthy and cybersecure data with medical scientists, doctors and caretakers, the system includes the deployment of a decentralized storage system that receives, processes and stores the collected data. Furthermore, in order to motivate users to add new data to the system, an incentive system based on a digital cryptocurrency named GlucoCoin was devised. Such a system makes use of a blockchain that is able to execute smart contracts in order to automate CGM sensor purchases or to reward the users that contribute to the system by providing their own data. Thanks to all the previously mentioned technologies, the proposed system enables patient data crowdsourcing and the development of novel mobile health (mHealth) applications for diagnosing, monitoring, studying and taking public health actions that can help to advance in the control of the disease and raise global awareness on the increasing prevalence of diabetes.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/isolamento & purificação , Diabetes Mellitus/sangue , Monitorização Fisiológica , Crowdsourcing , Diabetes Mellitus/patologia , Humanos , Internet , Aplicativos Móveis , Telemedicina
13.
Diabetes Res Clin Pract ; 153: 150-156, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31150718

RESUMO

AIMS: Flash glucose monitoring (FGM)-derived markers of glucose control and variability and laboratory measured HbA1c among patients with diabetes on insulin in context of Ramadan fasting (RF) were examined and compared. METHODS: FGM data on insulin-treated patients (n = 20, age 42.3 ±â€¯11.4 years; 18 male, 2 female; 13 with type 1 and 7 with type 2 diabetes) who fasted during Ramadan were used to calculate Q-score as an indicator of glycaemia before, during and after RF. Post-hoc analysis in a group of patients (n = 12) who had HbA1c available and appropriate for these periods was performed. Other relevant data were extracted from patient records. RESULTS: Mean glucose (9.6 ±â€¯1.32 v 10.78 ±â€¯1.64 mmol/l; P < 0.0001) and Q-score increased significantly with Ramadan fasting and reduced after Ramadan. Post-hoc subgroup analysis showed a significant rise in eA1c (7.2 ±â€¯0.4%; 55.0 ±â€¯4.4 mmol/mol v 7.7 ±â€¯0.5%; 61.0 ±â€¯5.5 mmol/mol) but not in laboratory HbA1c with Ramadan fasting; eA1c reduced after Ramadan (P = 0.018). CONCLUSIONS: Ramadan fasting was associated with a deterioration in overall glucose control and time in hyperglycaemia in insulin-treated patients. FGM-derived markers are useful and a preferable alternative to HbA1c in Ramadan studies.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/terapia , Hemoglobina A Glicada/metabolismo , Adulto , Glicemia/análise , Diabetes Mellitus Tipo 2/patologia , Jejum , Feminino , Hemoglobina A Glicada/análise , Humanos , Islamismo , Masculino
14.
JMIR Mhealth Uhealth ; 7(5): e13645, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31140434

RESUMO

BACKGROUND: Hypertension is a widespread chronic disease, and its effective treatment requires self-management by patients. Health-related apps provide an effective way of supporting hypertension self-management. However, the increasing range and variety of hypertension apps available on the market, owing to the global growth in apps, creates the need for patients and health care professionals to be informed about the effectiveness of these apps and the levels of privacy and security that they provide. OBJECTIVE: This study aimed to describe and assess all available apps supporting hypertension self-management in the most popular app stores and investigate their functionalities. METHODS: In January 2018, the UK Apple and Google Play stores were scanned for all free and paid apps supporting hypertension self-management. Apps were included if they were in English, had functionality supporting hypertension self-management, and targeted adult users with hypertension. The included apps were downloaded and their functionalities were investigated. Behavior change techniques (BCTs) linked with the theoretical domain framework (TDF) underpinning potentially effective apps were independently coded by two reviewers. The data privacy and security of the apps were also independently assessed. RESULTS: A total of 186 hypertension apps that met the inclusion criteria were included in this review. The majority of these apps had only one functionality (n=108), while the remainder offered different combinations of functionalities. A small number of apps had comprehensive functionalities (n=30) that are likely to be more effective in supporting hypertension self-management. Most apps lacked a clear theoretical basis, and 24 BCTs identified in these 30 apps were mapped to 10 TDF mechanisms of actions. On an average, 18.4 BCTs were mapped to 6 TDF mechanisms of actions that may support hypertension self-management behaviors. There was a concerning absence of evidence related to the effectiveness and usability of all 186 apps, and involvement of health care professionals in the app development process was minimal. Most apps did not meet the current standards of data security and privacy. CONCLUSIONS: Despite the widespread accessibility and availability of smartphone apps with a range of combinations of functionalities that can support the self-management of hypertension, only a small number of apps are likely to be effective. Many apps lack security measures as well as a clear theoretical basis and do not provide any evidence concerning their effectiveness and usability. This raises a serious issue, as health professionals and those with hypertension have insufficient information to make decisions on which apps are safe and effective.


Assuntos
Hipertensão/terapia , Aplicativos Móveis/tendências , Autogestão/métodos , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/métodos , Humanos , Hipertensão/psicologia , Aplicativos Móveis/estatística & dados numéricos , Autogestão/estatística & dados numéricos , Telemedicina/métodos
15.
Recenti Prog Med ; 110(5): 215-220, 2019 05.
Artigo em Italiano | MEDLINE | ID: mdl-31140453

RESUMO

"Diabetes technology" is the expression used to describe the hardware, devices, and software that people with diabetes use to manage blood glucose levels, stave off diabetes complications, reduce the burden of living with diabetes, and improve quality of life. This writing is focus on continuous glucose monitoring (CGM) with the most common devices currently in use. The complexity and rapid change of the diabetes technology landscape can also be a barrier to patient and provider implementation. The almost continuous availability of glycemic data deriving from CGM could have a negative impact on the quality of life of patients due to data overload and stress for frequent alarms. Narrative medicine can be of help. Narrative medicine has been defined as medicine practiced with narrative skills of recognizing, absorbing, interpreting and being moved by stories of illness. The art of medicine has roots that lie deep in developing the biopsychosocial connection. Understanding a human body (both its physiology and pathology) along with components of emotional and spiritual cores can lead to provision of excellent medical care and better outcomes for people with diabetes.


Assuntos
Tecnologia Biomédica , Diabetes Mellitus/terapia , Qualidade de Vida , Glicemia/análise , Automonitorização da Glicemia/métodos , Complicações do Diabetes/prevenção & controle , Humanos , Medicina Narrativa/métodos
16.
BMC Endocr Disord ; 19(1): 50, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109342

RESUMO

BACKGROUND: Teenagers and young adults with type 1 diabetes (T1D) experience significant burden managing this serious chronic condition and glycaemic control is at its unhealthiest during this life stage. Flash glucose monitoring (FGM) is a new technology that reduces the burden of glucose monitoring by easily and discreetly displaying glucose information when an interstitial glucose sensor worn on the upper arm is scanned with a handheld reader, as opposed to traditional capillary glucose sampling by finger prick (otherwise known as self-monitored blood glucose, SMBG). The effectiveness of this technology and impacts of its long-term use in youth with pre-existing suboptimal glycaemic control are unknown. This study therefore aims to investigate the effectiveness of FGM in addition to standard care in young people with T1D. METHODS: This is a two phase study programme including a multi-centre randomised, parallel-group study consisting of a 6-month comparison between SMBG and FGM, with an additional 6-month continuation phase. We will enrol adolescents with T1D aged 13-20 years (inclusive), with suboptimal glycaemic control (mean glycated haemoglobin (HbA1c) in past 6 months ≥75 mmol/mol [≥9%]). Participants will be randomly allocated (1:1) to FGM (FreeStyle Libre; intervention group) or to continue SMBG with capillary blood glucose testing (usual care group). All participants will continue other aspects of standard care with the study only providing the FreeStyle Libre. At 6 months, the control group will cross over to the intervention. The primary outcome is the between group difference in changes in HbA1c at 6 months. Additional outcomes include a range of psychosocial and health economic measures as well as FGM acceptability. DISCUSSION: >If improvements are found, this will further encourage steps towards integrating FGM into regular diabetes care for youth with unhealthy glycaemic control, with the expectation it will reduce daily diabetes management burden and improve short- and long-term health outcomes in this high-risk group. TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry on 5 March 2018 ( ACTRN12618000320257p ) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1205-5784).


Assuntos
Biomarcadores/sangue , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Hipoglicemiantes/uso terapêutico , Educação de Pacientes como Assunto , Adolescente , Adulto , Glicemia/análise , Estudos de Casos e Controles , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Gerenciamento Clínico , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Autocuidado , Fatores de Tempo , Adulto Jovem
17.
Cochrane Database Syst Rev ; 5: CD009613, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31120549

RESUMO

BACKGROUND: There are a number of ways of monitoring blood glucose in women with diabetes during pregnancy, with self-monitoring of blood glucose (SMBG) recommended as a key component of the management plan. No existing systematic reviews consider the benefits/effectiveness of different techniques of blood glucose monitoring on maternal and infant outcomes among pregnant women with pre-existing diabetes. The effectiveness of the various monitoring techniques is unclear. This review is an update of a review that was first published in 2014 and subsequently updated in 2017. OBJECTIVES: To compare techniques of blood glucose monitoring and their impact on maternal and infant outcomes among pregnant women with pre-existing diabetes. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 November 2018), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs comparing techniques of blood glucose monitoring including SMBG, continuous glucose monitoring (CGM), automated telemedicine monitoring or clinic monitoring among pregnant women with pre-existing diabetes mellitus (type 1 or type 2). Trials investigating timing and frequency of monitoring were also eligible for inclusion. RCTs using a cluster-randomised design were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: This review update includes a total of 12 trials (863) women (792 women with type 1 diabetes and 152 women with type 2 diabetes). The trials took place in Europe, the USA and Canada. Three of the 12 included studies are at low risk of bias, eight studies are at moderate risk of bias, and one study is at high risk of bias. Four trials reported that they were provided with the continuous glucose monitors free of charge or at a reduced cost by the manufacturer.Continuous glucose monitoring (CGM) versus intermittent glucose monitoring, (four studies, 609 women)CGM may reduce hypertensive disorders of pregnancy (pre-eclampsia and pregnancy-induced hypertension) (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.39 to 0.85; 2 studies, 384 women; low-quality evidence), although it should be noted that only two of the four relevant studies reported data for this composite outcome. Conversely, this did not translate into a clear reduction for pre-eclampsia (RR 0.65, 95% CI 0.39 to 1.08; 4 studies, 609 women, moderate-quality evidence). There was also no clear reduction in caesarean section (average RR 0.94, 95% CI 0.75 to 1.18; 3 studies, 427 women; I2 = 41%; moderate-quality evidence) or large-for-gestational age (average RR 0.84, 95% CI 0.57 to 1.26; 3 studies, 421 women; I2 = 70%; low-quality evidence) with CGM. There was not enough evidence to assess perinatal mortality (RR 0.82, 95% CI 0.05 to 12.61, 71 infants, 1 study; low-quality evidence), or mortality or morbidity composite (RR 0.80, 95% CI 0.61 to 1.06; 1 study, 200 women) as the evidence was based on single studies of low quality. CGM appears to reduce neonatal hypoglycaemia (RR 0.66, 95% CI 0.48 to 0.93; 3 studies, 428 infants). Neurosensory disability was not reported.Other methods of glucose monitoringFor the following five comparisons, self-monitoring versus a different type of self-monitoring (two studies, 43 women); self-monitoring at home versus hospitalisation (one study, 100 women), pre-prandial versus post-prandial glucose monitoring (one study, 61 women), automated telemedicine monitoring versus conventional system (three studies, 84 women), and constant CGM versus intermittent CGM (one study, 25 women), it is uncertain whether any of the interventions has any impact on any of our GRADE outcomes (hypertensive disorders of pregnancy, caesarean section, large-for-gestational age) because the quality of the evidence was found to be very low. This was due to evidence largely being derived from single trials, with design limitations and limitations with imprecision (wide CIs, small sample sizes, and few events). There was not enough evidence to assess perinatal mortality and neonatal mortality and morbidity composite. Other important outcomes, such as neurosensory disability, were not reported in any of these comparisons. AUTHORS' CONCLUSIONS: Two new studies (406 women) have been incorporated to one of the comparisons for this update. Although the evidence suggests that CGM in comparison to intermittent glucose monitoring may reduce hypertensive disorders of pregnancy, this did not translate into a clear reduction for pre-eclampsia, and so this result should be viewed with caution. No differences were observed for other primary outcomes for this comparison. The evidence base for the effectiveness of other monitoring techniques analysed in the other five comparisons is weak and based on mainly single studies with very low-quality evidence. Additional evidence from large well-designed randomised trials is required to inform choices of other glucose monitoring techniques and to confirm the effectiveness of CGM.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Adulto , Canadá , Europa (Continente) , Feminino , Humanos , Hipertensão/prevenção & controle , Hipoglicemia/induzido quimicamente , Recém-Nascido , Mortalidade Perinatal , Pré-Eclâmpsia/prevenção & controle , Gravidez , Estados Unidos
18.
Diabetes Res Clin Pract ; 152: 111-118, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31121275

RESUMO

AIMS: In 2016 intermittently scanned continuous glucose monitoring (isCGM) became the first reimbursed CGM system in Belgium. Many children with type 1 diabetes (T1D) treated with multiple daily injections as well as with continuous subcutaneous insulin infusion (CSII) switched from self-monitoring of blood glucose to isCGM to monitor their treatment. In 2017 the Enlite® real-time CGM (rtCGM) system was reimbursed enabling its use with the Minimed® 640G insulin pump with integrated SmartGuard technology. In this study we compared the metabolic control during CSII with isCGM with that during rtCGM. Patient's satisfaction and side effects of the rtCGM system were also evaluated. METHODS: 20 children with T1D, aged 5-16 years, were included. Metabolic control during the last month of isCGM use was compared to that during the 3rd and 6th month of rtCGM. RESULTS: Three patients stopped early rtCGM mainly due to calibration burden. The HbA1c level and the mean glucose value in the other patients did not change after switching to the rtCGM system. Glucose variability was smaller (46.2% vs 38.4% and 36.4%, p = 0.000). Time in hypoglycemia (<70 mg/dl) was lower (7.4% vs 1.6% and 1.5%, p = 0.000). The main patient inconvenience was the sensor calibration. CONCLUSIONS: Our data show that during Enlite® rtCGM with the Minimed® 640G pump system glucose variability was smaller and the patients spent less time in hypoglycemia than during isCGM. The need for timely calibrations is considered as the main drawback of the system.


Assuntos
Análise Química do Sangue/métodos , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Adolescente , Bélgica , Glicemia/metabolismo , Automonitorização da Glicemia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/administração & dosagem , Injeções Subcutâneas , Masculino
19.
Diabetes Res Clin Pract ; 151: 138-145, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30959146

RESUMO

AIMS: Two medication change protocols were tested, both based on haemoglobin A1c (HbA1c), with one protocol also accounting for hypoglycaemic events. The aim was to compare the two protocols during intermittent energy restriction (5:2 diet). METHODS: Forty-two adults with type 2 diabetes (HbA1c ≥ 7% [53 mmol/mol], BMI of ≥27 kg/m2) treated with sulphonylureas and/or insulin were recruited and randomised 1:1 to fixed or adjusted medication protocols. Participants experiencing hypoglycaemia during a 2-week usual diet period then followed the 5:2 diet for 2 weeks (2 non-consecutive very-low-calorie days [500-600 kcal] and 5 habitual eating days/week), following the allocated medication protocol. The primary outcome was to determine if the adjusted protocol was superior to the fixed protocol at reducing hypoglycaemic events during the 5:2 diet. Flash glucose monitoring was used throughout to detect hypoglycaemia. RESULTS: There was a significant difference in change in the number of hypoglycaemic events between fixed and adjusted protocols (-1.0 vs. -3.5; P = 0.04). Over 60% of participants on the adjusted protocol had no hypoglycaemic events. CONCLUSIONS: This pilot study demonstrates the importance of assessing the risk of hypoglycaemia before starting a 5:2 diet and that the adjusted medication protocol is likely the best option for patients at risk. CLINICAL TRIAL REGISTRY: This study has been registered with the Australia New Zealand Clinical Trial Registry (ANZCTR) www.anzctr.org.au and given the registration number ACTRN12617000512325.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/terapia , Idoso , Restrição Calórica/efeitos adversos , Restrição Calórica/métodos , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Hipoglicemia/patologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto
20.
Ann Biol Clin (Paris) ; 77(2): 155-159, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30998195

RESUMO

The presence of hemoglobin variants can adversely affect the accuracy of some HbA1c methods depending on the variant. We examine the analytical interference from a rare Hb variant (Hb N Baltimore) with six different HbA1c methods using various method principles: two immunoassays methods (Tina-quant® HbA1c Gen et DCA Vantage), three high-performance liquid chromatography methods (G8 HPLC, Variant II Turbo A1c 2.0 et Variant II Dual kit), and one capillary-electrophoresis method (Capillarys Hb A1c kit). Hb N Baltimore can adversely affect determination of HbA1c levels. An underestimation of HbA1c level is observed with the chromatographic methods included in this study and no HbA1c result can be obtained with the capillary-electrophoresis method. Inversely, limited impact is observed with the immunoassays methods. The presence of an hemoglobin variant should be suspected when inconsistencies are observed between a patient's home blood glucose monitoring and laboratory-measured HbA1c. In these situations additional testing should be carried out using a test based on a different analytical method.


Assuntos
Hemoglobina A Glicada/análise , Testes Hematológicos/métodos , Hemoglobinas Anormais/fisiologia , Análise Química do Sangue/métodos , Glicemia/análise , Automonitorização da Glicemia/métodos , Cromatografia Líquida de Alta Pressão/métodos , Eletroforese Capilar/métodos , Testes Hematológicos/instrumentação , Hemoglobinas Anormais/análise , Humanos , Imunoensaio/métodos
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