Exploring the application of self-monitoring of blood glucose results in insulin-treated diabetes: A case study of patients, their support persons and health care practitioners

Self-monitoring of blood glucose (SMBG) can be effective in preventing poor outcomes associated with diabetes mellitus but previous research has identified that SMBG is not being undertaken in line with current recommendations. Guidance informs health professionals to educate patients on how they should self-monitor but very little is know about how patients self-monitor in the real world. In this thesis, a quantitative scoping study is first presented. This study used routine data sources to examine the levels and patterns of self-montoring in different population groups and then proceeded to a larger qualitative study to explore and question what patients are doing in practice in relation to self-monitoring, and why. This involved a qualitative multi-case study of patients, their support people, health care practitioners (HCPs) and patient diaries. Ten individuals and their nominated support people and HCPs formed ten cases among whom 21 in-depth semi-structured interviews were carried out and six patient diaries analysed. The exploratory work was framed around Stones’ version of structuration theory and uncovered a complex linkage of individual motives for monitoring, associated responses and behaviours in relation to the motive, and the underpinning attitudes and beliefs behind the motive. The following key points emerged from the analysis. People have differing relationships with their diabetes and this links with the level of engagement they have with their condition. Resistance to support people and health services was commonly observed. Experiences of diabetes reviews were important, with an identified need for them to feel more like collaboration and less like surveillance. A significant factor was the gaps and limitations in knowledge and understanding around diabetes for patients, relatives, support people and HCPs; and, finally, there was a noted maintenance of blood glucose levels higher than recommended through SMBG in several participants, which stemmed from a fear of hypoglycemic episode. The analysis concluded that although self-monitoring of blood glucose, in theory, and when considered in isolation, is a simple process to undertake, its application in the wider context of self-management and the individual is much more complicated. The process is influenced by many complex factors and generates a variety of responses and behaviours, some not in keeping with good diabetes self-management. There was a significant lack of person-centered approaches to managing diabetes which was, in part, due to existing health systems and processes. Therefore, there is a need to raise awareness of the gaps that exist in terms of such approaches as well as the gaps in knowledge and understanding of individuals with diabetes and those caring for and supporting them. In more specific terms, it is essential to develop and evaluate individual approaches to patients in relation to their self-monitoring and associated self-management in the context of their own lives, which involves the assessment of engagement and understanding around self-monitoring

Prevalence of gestational diabetes mellitus in Europe: A meta-analysis

Aims  Estimates of the prevalence of gestational diabetes vary widely. It is important to have a clear understanding of the prevalence of this condition to be able to plan interventions and health care provision. This paper describes a meta-analysis of primary research data reporting the prevalence of gestational diabetes mellitus in the general pregnant population of developed countries in Europe.  Methods  Four electronic databases were systematically searched in May 2016. English language articles reporting gestational diabetes mellitus prevalence using universal screening in general pregnant population samples from developed countries in Europe were included. All papers identified by the search were screened by one author, and then half screened independently by a second author and half by a third author. Data were extracted by one author. Values for the measures of interest were combined using a random effects model and analysis of the effects of moderator variables was carried out.  Results  A total of 3258 abstracts were screened, with 40 studies included in the review. Overall prevalence of gestational diabetes mellitus was 5.4% (3.8–7.8). Maternal age, year of data collection, country, area of Europe, week of gestation at testing, and diagnostic criteria were found to have a significant univariate effect on GDM prevalence, and area, week of gestation at testing and year of data collection remained statistically significant in multivariate analysis. Quality category was significant in multivariate but not univariate analysis.  Conclusions  This meta-analysis shows prevalence of GDM that is at the upper end of previous estimates in Europe

Patterns of self-monitoring of blood glucose (SMBG) in insulin-treated diabetes: analysis of a Scottish population over time

Analysis of a diabetes clinical information system in Tayside, Scotland, shows that a significant proportion of insulin-treated patients with diabetes are not self-monitoring blood glucose according to current clinical guidance and recommendations, with some not self-monitoring their blood glucose at all. Although there has been an increase in the numbers of reagent strips dispensed over the past decade, this increase is mainly accounted for by increased testing frequency among people with diabetes already testing.Output Type: Research Lette

Self-monitoring of blood glucose in insulin-treated diabetes: a multicase study

Objective To explore how and why self-monitoring of blood glucose (SMBG) is carried out in a real-world context. Research design and methods We conducted a multicase study among ten people with type 1 and insulin-treated type 2 diabetes mellitus in Scotland, alongside seven nominated support people and four healthcare professionals. All participants were interviewed in depth and six participants provided SMBG diaries. Stones' version of structuration theory informed the analysis. Results People with diabetes were able to provide immediate motives for SMBG at particular times, often having different motives on different occasions. We identified six such motives, including routine, in response to symptoms, associated with a diabetes review, to facilitate lifestyle, when a 'good' result was expected, and higher level motives for longer term glycemic control. These motives were influenced by underlying attitudes toward diabetes that included level of engagement and responsibility for diabetes, a desire not to be controlled by diabetes, resistance to diabetes, diabetes education and relationship with the health service, fear of hypoglycemia, and prevention of diabetes complications. Five responses to test results were identified, depending on the immediate motive and underlying attitudes. Conclusions People with insulin-treated diabetes do not necessarily self-monitor with an explicit goal of improving long-term glycemic control, but may have other motives that are important to them. An individualized understanding is therefore needed to advise people with diabetes how SMBG can be optimized for them

Health and health behaviours among a cohort of first year nursing students in Scotland: A self-report survey

The study aim was to collect data on the health and health-related behaviours of undergraduate nursing students at a Higher Education Institution in Scotland, to identify the need for potential health behaviour change interventions as part of their undergraduate course. An anonymous self-report questionnaire (with questions about physical activity, diet, sleep, alcohol, smoking, mental health) was administered to first year nursing students at a Scottish university. The response rate was 88%, with 207 respondents (26 male, 178 female, 3 other). Age ranged from 16 to 45 years (mean 24.5 years). Overall, 48 (23.1%) students rated their physical health as excellent/very good, and 100 (48.3%) their mental health as such. 157 (76.2%) students were achieving 150 min of physical activity per week. There were 48 (29%) and 30 (18.2%) overweight and obese students respectively. 129 (62.6%) students viewed a mobile device for > 30 min before sleep. 176 (86.3%) students consumed alcohol, with 32 (15.4%) reporting binge drinking. The prevalence of current smoking was 24.8%. The students’ health behaviour profile was therefore broadly similar to that of the general population in Scotland, but smoking, diet, sleep practices and binge-drinking were identified as priority areas for health education and intervention

The development of an intervention for diabetes prevention among people with impaired glucose regulation:feasibility and acceptability of an intervention component

Background As part of the design process of a low-cost minimal-contact diabetes prevention intervention, we issued a blood glucose meter to people with impaired glucose regulation (who are at high risk of type 2 diabetes). We conducted a feasibility study to assess the acceptability of this intervention component and whether and how recipients engaged with it. Methods A blood glucose meter was given to 19 people identified through primary care, who were asked to use the meter in an exploratory way during a 4-week trial period, to try to understand the effect of different foods on the body. They were advised that they could test as often or as little as they liked and were also asked to keep a food/exercise diary for at least 1 week. They were interviewed about their experiences afterwards. Results There was a high level of engagement with testing, with the total number of tests recorded ranging from 11 to 114 (median 74) among 18 participants. Fifteen participants tested almost every day during the 4-week period. The cognitive engagement was more limited. All participants commented on their own results, and most were able to relate high or low results to foods eaten and exercise taken, usually in response to prompting. However, there was limited thought or understanding beyond this in terms of longer-term patterns of diet and exercise, and testing was routine rather than experimental. Some participants were confused by conflicting or unexpected results. A few minor problems were reported by participants, such as soreness, inconvenience, and difficulty in getting blood, but never enough to discontinue testing. Several participants stated that the meter was a useful aid as a reminder that they were at high risk of diabetes and served as a prompt that needed to make and/or maintain behaviour changes. Conclusions The study suggests that blood glucose monitoring is acceptable to people with impaired glucose regulation and that they would engage with it as part of an intervention to improve their diet. The study has also uncovered potential mechanisms of action for behaviour change

Water Quality Observations from Space: A Review of Critical Issues and Challenges

Water is the basis of all life on this planet. Yet, approximately one in seven people in the world do not have access to safe water. Water can become unsafe due to contamination by various organic and inorganic compounds due to various natural and anthropogenic processes. Identifying and monitoring water quality changes in space and time remains a challenge, especially when contamination events occur over large geographic areas. This study investigates recent advances in remote sensing that allow us to detect and monitor the unique spectral characteristics of water quality events over large areas. Based on an extensive literature review, we focus on three critical water quality problems as part of this study: algal blooms, acid mine drainage, and suspended solids. We review the advances made in applications of remote sensing in each of these issues, identify the knowledge gaps and limitations of current studies, analyze the existing approaches in the context of global environmental changes, and discuss potential ways to combine multi-sensor methods and different wavelengths to develop improved approaches. Synthesizing the findings of these studies in the context of the three specific tracks will help stakeholders to utilize, share, and embed satellite-derived earth observations for monitoring and tracking the ever-evolving water quality in the earth’s limited freshwater reserves

Parks Canada’s adaptation framework and workshop approach: Lessons learned across a diverse series of adaptation workshops

In 2017, the Canadian Parks Council Climate Change Working Group, a team of federal, provincial, and territorial representatives, developed a Climate Change Adaptation Framework for Parks and Protected Areas, guiding practitioners through a simple, effective five-step adaptation process. This framework was adapted by Parks Canada into a two-day adaptation workshop approach, with 11 workshops subsequently held from September 2017 to May 2019 at Parks Canada sites in the Yukon, Quebec, Manitoba, Alberta, Nova Scotia, British Columbia, Newfoundland, and Ontario. Lessons learned from each workshop have been integrated into the approach, with the development of tools and guidance for each phase of the process, and a shareable, visual “placemat” that describes each step of the framework, acting as a map for those navigating the process

The Sun as a planet-host star : proxies from SDO images for HARPS radial-velocity variations

RDH gratefully acknowledges STFC studentship grant number ST/J500744/1, and a grant from the John Templeton Foundation. ACC and RF acknowledge support from STFC consolidated grants numbers ST/J001651/1 and ST/M001296/1. JL acknowledges support from NASA Origins of the Solar System grant No. NNX13AH79G and from STFC grant ST/M001296/1.The Sun is the only star whose surface can be directly resolved at high resolution, and therefore constitutes an excellent test case to explore the physical origin of stellar radial-velocity (RV) variability. We present HARPS observations of sunlight scattered off the bright asteroid 4/Vesta, from which we deduced the Sun's activity-driven RV variations. In parallel, the Helioseismic and Magnetic Imager instrument on board the Solar Dynamics Observatory provided us with simultaneous high spatial resolution magnetograms, Dopplergrams and continuum images of the Sun in the Fe i 6173 Å line. We determine the RV modulation arising from the suppression of granular blueshift in magnetized regions and the flux imbalance induced by dark spots and bright faculae. The rms velocity amplitudes of these contributions are 2.40 and 0.41 m s−1, respectively, which confirms that the inhibition of convection is the dominant source of activity-induced RV variations at play, in accordance with previous studies. We find the Doppler imbalances of spot and plage regions to be only weakly anticorrelated. Light curves can thus only give incomplete predictions of convective blueshift suppression. We must instead seek proxies that track the plage coverage on the visible stellar hemisphere directly. The chromospheric flux index R′HK derived from the HARPS spectra performs poorly in this respect, possibly because of the differences in limb brightening/darkening in the chromosphere and photosphere. We also find that the activity-driven RV variations of the Sun are strongly correlated with its full-disc magnetic flux density, which may become a useful proxy for activity-related RV noise.PostprintPeer reviewe