Development of a Clinical Type 1 Diabetes Metabolic System Model and in Silico Simulation Tool

Invited journal symposium paperObjectives: To develop a safe and effective protocol for the clinical control of Type 1 diabetes using conventional self-monitoring blood glucose (SMBG) measurements, and multiple daily injection (MDI) with insulin analogues. To develop an in silico simulation tool of Type 1 diabetes to predict long-term glycaemic control outcomes of clinical interventions. Methods: The virtual patient method is used to develop a simulation tool for Type 1 diabetes using data from a Type 1 diabetes patient cohort (n=40). The tool is used to test the adaptive protocol (AC) and a conventional intensive insulin therapy (CC) against results from a representative control cohort. Optimal and suboptimal basal insulin replacement are evaluated as a function of self-monitoring blood glucose (SMBG) frequency in conjunction with the (AC and CC) prandial control protocols. Results: In long-term glycaemic control, the AC protocol significantly decreases HbA1c in conditions of suboptimal basal insulin replacement for SMBG frequencies =6/day, and reduced the occurrence of mild and severe hypoglycaemia by 86-100% over controls over all SMBG frequencies in conditions of optimal basal insulin. Conclusions: A simulation tool to predict long-term glycaemic control outcomes from clinical interventions is developed to test a novel, adaptive control protocol for Type 1 diabetes. The protocol is effective and safe compared to conventional intensive insulin therapy and controls. As fear of hypoglycaemia is a large psychological barrier to glycaemic control, the AC protocol may represent the next evolution of intensive insulin therapy to deliver increased glycaemic control with increased safety. Further clinical or experimental validation is needed to fully prove the concept

Impact of Blood Glucose Monitoring Logs in Conjunction with Food Diaries in Lowering HbA1c in Adults Aged 18-89 Years with Type 2 Diabetes

Title: Impact of Blood Glucose Monitoring Logs in Conjunction with Food Diaries in Lowering HbA1c in adults aged 18-89 years with Type 2 Diabetes Mellitus Background: The risk for complications in Type 2 Diabetes Mellitus (T2D) patients has been associated with elevated glycosylated hemoglobin (HbA1c). Purpose: To integrate Self-Monitoring of Blood Glucose (SMBG) using blood glucose monitoring logs in conjunction with food diaries in the management of T2D with a goal of lowering HbA1c in adults aged 18-89 years with HbA1c \u3e 7.5% over a period of 2 months. Method: 15 adults aged 18-89 years with HbA1c \u3e 7.5% were enrolled in a primary care clinic setting. Initial HbA1c was checked. Participants were given the Johns Hopkins Patient Guide to Diabetes – Meal and Glucose Log to monitor their blood glucose and diet. Biweekly follow-ups were conducted. At the end of the second month, HbA1c was re-checked. Patient data was collected and entered in SPSS software for analysis. Results: 10 participants out of 15 returned for the second HbA1c test. Descriptive statistics (mean and standard deviation) were used for analysis. The results were categorized into 3 groups; Action 0 (did not monitor, returned for the second test), Action 1 (monitored, returned for the second test), and Action 2 (partially monitored, returned for the second test). Final mean HbA1cs (%) were 10.2 (+14%), 6.9 (-19%), and 7.5 (-2.5%) respectively. Conclusion: Consistent monitoring of blood glucose and meals showed a reduction in HbA1c. The number of participants was limited mainly due to stress factors related to the current COVID-19 pandemic

Types of Self-Care Recommendations Given for Adults with Type 2 Diabetes Mellitus, Attending a Diabetic Clinic in a Selected Teaching Hospital, Sri Lanka

Type 2 Diabetes Mellitus (T2DM) is a worldwide health problem and a significant issue in Sri Lanka. Self-care recommendations on diabetes self-care activities for patients with T2DM are vital parts of the clinical management of diabetes. There is a paucity of data regarding the types of self-care recommendations given by healthcare professionals for patients with T2DM in Sri Lanka. A descriptive cross-sectional study was conducted among purposively selected adults with T2DM (n=300)to determine the types of self-care recommendations given by healthcare professionals. Data were analyzed using descriptive statistics. Ethical approval was granted from the Ethics Review Committees of the Faculty of Medical Sciences and the Sri Jayewardenepura General Hospital. Types of self-care recommendations were assessed by using a pre-tested diabetes self- care activities questionnaire, which includes recommendations regarding diet, physical activities (PA), self-monitoring of blood glucose (SMBG) and testing urine for sugar. Out of 300 participants, the majority (68.7%) were female. From the participants, more than half (52.7%) had good glycaemia control (FBS≤ 126 mg/dl). Most of the participants (99.3%) received at least a single recommendation regarding their diet. Less than half (39%) of the adults have received all the recommendations regarding their PA from the list. Majority of the adults (73.3%) have received recommendations to get exercise such as walking and jogging daily. Of the sample, 67% received a recommendation to use a glucometer to self-monitor their blood glucose levels. Self-care recommendations were not significantly associated with glycaemia control. The health professionals need to provide more health education for adults with T2DM to maintain their self-care activities regularly. KEYWORDS: Type 2 diabetes, Self-care, Recommendations, Sri Lank

Identification of Barriers to Adherence to Prescribed Schedules for Self-Monitoring of Blood Glucose

The purpose of this descriptive study was to identify barriers to adherence to prescribed self-monitoring blood glucose (SMBG) schedules. Data were collected from a convenience sample of 40 diabetic patients from a rural northern Michigan community, ages 18-84, who completed the modified Barriers to Self-Monitoring Blood Glucose Scale (BSMBG) (Jones, Remley, & Engberg, 1996). The study’s theoretical framework was the Health Belief Model (HBM) (Rosenstock, Strecher, & Becker, 1994). The modified BSMBG scale had a reliability coefficient of 0.95 using Cronbach’s alpha. Individual barrier scores were varied indicating a need for individualized assessment of barriers to SMBG. Data analysis demonstrated significant differences between diabetes type, subject age groups, and adherence percentage compared to barrier scores. A significant negative correlation also existed between subjects’ ages and barrier scores. Findings suggested a need to assess perceived barriers to SMBG carefully in these groups to aid in intervention development aimed at improved adherence

A longitudinal study into the new and long-term use of self-monitoring blood glucose strips in the UK

Aims To determine the impact of self-monitoring blood glucose (SMBG) strip use in patients with type 2 diabetes in the UK. Methods The study period was April 1, 2004 to July 31, 2005. Data from primary care was extracted from The Health Improvement Network database. Patients identified with diabetes and matching the inclusion criteria were defined as new users of SMBG, prevalent users, or non-users. Patients were also defined as treated with insulin, with oral agents (OA), or not pharmacologically treated. Change in glycosylated hemoglobin (HbA1c) at baseline and after 12 months was compared. Results 2559 patients met the inclusion criteria. For new users, HbA1c fell by 0.59% (P=0.399) for those treated with insulin, 1.52% (P<0.001) for those treated with OA, and 0.51% (P<0.001) for no treatment. In prevalent users, changes were 0.31% (P<0.001), 0.34% (P<0.001), and 0.09% (P=0.456), respectively. In non-users, changes were 0.28% (P=0.618), 0.42% (P<0.001), and an increase of 0.05% (P=0.043), respectively. A significant decrease in mean HbA1c was associated with increasing strip use in OA patients newly initiated on strips. Conclusion This observational study showed a significant decrease in HbA1c for new users of SMBG treated either non-pharmacologically or with OA, and for prevalent users treated with insulin or OA. Reduced HbA1c with increasing strip use was observed but was only significant for OA-treated new users. This suggests that SMBG use has a role in the treatment of non-insulin treated patients with type 2 diabetes

PROFIL PENERAPAN SELF-CARE DAN STATUS DEPRESI PASIEN DIABETES MELLITUS TIPE 2 DI PUSKESMAS KALIRUNGKUT SURABAYA

Diabetes Mellitus merupakan penyakit kronis yang telah menjadi masalah global, ditandai dengan gejala hiperglikemia yang dapat menyebabkan komplikasi. Terdapat dua aspek dalam penatalaksanaan diabetes yaitu aspek farmakologis berupa penggunaan oral anti-diabetic yang dapat disertai dengan insulin dan non-farmakologis berupa self-care. Pada pasien diabetes, kejadian depresi dua kali lebih sering ditemukan dibandingkan dengan orang tanpa diabetes. Hal ini mungkin dikarenakan perasaan tertekan akibat self-care yang harus berlangsung seumur hidup. Depresi memberikan dampak negatif terhadap penerapan self-care. Tujuan dari penelitian adalah untuk mengetahui tingkat penerapan self-care, status depresi, serta tingkat penerapan self-care ditinjau dari status depresi pada pasien diabetes mellitus tipe 2 di Puskesmas Kalirungkut Surabaya. Metode penelitian adalah cross sectional dengan teknik wawancara menggunakan kuesioner Hospital Anxiety and Depression Scale-Depression dan Summary of Diabetes Self-care Activities. Hasil penelitian menunjukkan penerapan self-care 30 partisipan untuk penggunaan OAD sangat baik, diet khusus, latihan fisik, perawatan kaki cukup baik, self monitoring blood glucose sangat kurang dan terdapat 3 orang yang merokok. Berdasarkan status depresi terdapat 4 partisipan yang mengalami depresi, 2 partisipan dengan depresi ringan, dan 2 partisipan dengan depresi sedang. Tingkat penerapan self-care pada partisipan dengan depresi ringan dan sedang cenderung lebih rendah dibandingkan partisipan normal

Self-Care Adherence Experience in Patient with Diabetes Mellitus Type 2: A Systematic Review

Background: Diabetes Mellitus is a metabolic disease that cause its patient need a long life maintenance. Diabetes Mellitus management in daily life is a complex activity and need an understanding about medicines, healthy diet, physical activities, and glycemic control. All those things is a personal responsibility of patient with Diabetes Mellitus Type 2. The objective of this systematic review was to describe the self-care adherence experience in patient with Diabetes Mellitus Type 2. Method: 15 best articles were found using PECOT framework in some databases; EBSCO, Science Direct, Scopus, and Journal of Universitas Airlangga. Those articles have been chosen based on some criteria. Result: Self-care therapeutic regiment for patient with Diabetes Mellitus Type 2 are physical activities, diet, self-monitoring blood glucose (SMBG), and glycemic control. But most of respondents were disobey the therapy caused by various factors. Depression is one of the reason. Conclusion: Nursing intervention was needed to increase self-care adherence in patient with Diabetes Mellitus Type 2

Use of continuous glucose monitoring in young children with type 1 diabetes: implications for behavioral research

Patton SR, Williams LB, Eder SJ, Crawford MJ, Dolan L, Powers SW. Use of continuous glucose monitoring in young children with type 1 diabetes: implications for behavioral research.Objective: This study presents data on the use of continuous glucose monitoring (CGM) in young children with type 1 diabetes mellitus (T1DM). CGM provides moment-to-moment tracking of glucose concentrations and measures of intra- and interday variability, which are particularly salient measures in young children with T1DM.Methods: Thirty-one children (mean age = 5.0 yr ) with T1DM wore the Medtronic Minimed CGM for a mean of 66.8 h. The CGM was inserted in diabetes clinics, and parents were provided brief training.Results: Few difficulties were experienced and families cited the acceptability of CGM. Participants' CGM data are compared with self-monitoring blood glucose (SMBG) data as well as data from older children with T1DM to illustrate differences in methodology and variability present in this population. CGM data are used to calculate glucose variability, which is found to be related to diabetes variables such as history of hypoglycemic seizures.Conclusions: CGM is an acceptable research tool for obtaining glucose data in young children with T1DM and has been used previously in older children and adults. CGM may be particularly useful in young children who often experience more glucose variability. Data obtained via CGM are richer and more detailed than traditional SMBG data and allow for analyses to link blood glucose with behavior.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78635/1/j.1399-5448.2010.00649.x.pd