Showing papers on "Diabetes management published in 2023"

Evidence-based European recommendations for the dietary management of diabetes

Abstract: Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes.Graphical abstract

Evidence-based European recommendations for the dietary management of diabetes

Abstract: Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes.Graphical abstract

Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

Abstract: Continuous glucose monitoring (CGM) technology has evolved over the past decade with the integration of various devices including insulin pumps, connected insulin pens (CIPs), automated insulin delivery (AID) systems, and virtual platforms. CGM has shown consistent benefits in glycemic outcomes in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) treated with insulin. Moreover, the combined effect of CGM and education have been shown to improve glycemic outcomes more than CGM alone. Now a CIP is the expected future technology that does not need to be worn all day like insulin pumps and helps to calculate insulin doses with a built-in bolus calculator. Although only a few clinical trials have assessed the effectiveness of CIPs, they consistently show benefits in glycemic outcomes by reducing missed doses of insulin and improving problematic adherence. AID systems and virtual platforms made it possible to achieve target glycosylated hemoglobin in diabetes while minimizing hypoglycemia, which has always been challenging in T1DM. Now fully automatic AID systems and tools for diabetes decisions based on artificial intelligence are in development. These advances in technology could reduce the burden associated with insulin treatment for diabetes.

Perception of nurses on the use of mobile phone text messaging for the management of diabetes mellitus in rural Ghana

Abstract: This study aims to explore the perception of nurses on the use of mobile phone SMS for managing diabetes in rural Ghana.

Chinese diabetes datasets for data-driven machine learning

Abstract: Data of the diabetes mellitus patients is essential in the study of diabetes management, especially when employing the data-driven machine learning methods into the management. To promote and facilitate the research in diabetes management, we have developed the ShanghaiT1DM and ShanghaiT2DM Datasets and made them publicly available for research purposes. This paper describes the datasets, which was acquired on Type 1 (n = 12) and Type 2 (n = 100) diabetic patients in Shanghai, China. The acquisition has been made in real-life conditions. The datasets contain the clinical characteristics, laboratory measurements and medications of the patients. Moreover, the continuous glucose monitoring readings with 3 to 14 days as a period together with the daily dietary information are also provided. The datasets can contribute to the development of data-driven algorithms/models and diabetes monitoring/managing technologies.

Patient perceptions of insulin therapy in diabetes self-management with insulin injection devices

Abstract: Several insulin delivery systems are available to control glycemia in patients with diabetes. Recently introduced devices feature connectivity enabling data transfer to smartphone applications to provide decision support and reduce errors in dosing and timing, while reducing the cognitive burden.We conducted an online survey in Italian patients with a self-reported diagnosis of diabetes to assess patient perceptions of insulin therapy management, and their impressions of connection-enabled insulin pens compared to standard insulin pens. The Morisky Medication Adherence Scale-8 was used to assess adherence to insulin therapy.Among 223 respondents (108 with type 1 diabetes; 115 with type 2 diabetes), the most prominent unmet need was the necessity to overcome the cognitive burden of care associated with measuring, calculating, timing, and recording therapy. Only 25% of respondents had high adherence; 28% had low adherence.When asked to compare the attributes of a non-connected insulin pen with those of a new connected device, 71% of patients rated the new proposal "very useful". The cognitive burden associated with self-management of diabetes therapy may influence preferences for advanced insulin delivery systems.

Diabetes Monitoring System in Smart Health Cities Based on Big Data Intelligence

Abstract: Diabetes is a metabolic disorder in which the body is unable to properly regulate blood sugar levels. It can occur when the body does not produce enough insulin or when cells become resistant to insulin’s effects. There are two main types of diabetes, Type 1 and Type 2, which have different causes and risk factors. Early detection of diabetes allows for early intervention and management of the condition. This can help prevent or delay the development of serious complications associated with diabetes. Early diagnosis also allows for individuals to make lifestyle changes to prevent the progression of the disease. Healthcare systems play a vital role in the management and treatment of diabetes. They provide access to diabetes education, regular check-ups, and necessary medications for individuals with diabetes. They also provide monitoring and management of diabetes-related complications, such as heart disease, kidney failure, and neuropathy. Through early detection, prevention and management programs, healthcare systems can help improve the quality of life and outcomes for people with diabetes. Current initiatives in healthcare systems for diabetes may fail due to lack of access to education and resources for individuals with diabetes. There may also be inadequate follow-up and monitoring for those who have been diagnosed, leading to poor management of the disease and lack of prevention of complications. Additionally, current initiatives may not be tailored to specific cultural or demographic groups, resulting in a lack of effectiveness for certain populations. In this study, we developed a diabetes prediction system using a healthcare framework. The system employs various machine learning methods, such as K-nearest neighbors, decision tree, deep learning, SVM, random forest, AdaBoost and logistic regression. The performance of the system was evaluated using the PIMA Indians Diabetes dataset and achieved a training accuracy of 82% and validation accuracy of 80%.

Variation in the Current Use of Technology to Support Diabetes Management in UK Hospitals: Results of a Survey of Health Care Professionals

Abstract: Background: There has been a significant increase in the use of wearable diabetes technologies in the outpatient setting over recent years, but this has not consistently translated into inpatient use. Methods: An online survey was undertaken to understand the current use of technology to support inpatient diabetes care in the United Kingdom. Results: Responses were received from 42 different organizations representing 104 hospitals across the United Kingdom. Significant variation was found between organizations in the use of technology to support safe, effective inpatient diabetes care. Benefits of the use of technology were reported, and areas of good practice identified. Conclusion: Technology supports good inpatient diabetes care, but there is currently variation in its use. Guidance has been developed which should drive improvements in the use of technology and hence improvements in the safety and effectiveness of inpatient diabetes care. Key recommendations include implementation of this guidance (especially for continuous glucose monitoring), ensuring specialist support is available for the use of wearable diabetes technology in hospital, optimizing information sharing across the health care system, and making full use of data from networked glucose and ketone meters.

Prevalence, Cost, and Burden of Diabetic Ketoacidosis.

Abstract: Diabetic ketoacidosis (DKA) is a life-threatening complication, which is most common in individuals with type 1 diabetes (T1D) and is a significant risk for morbidity and mortality, and it is an economic burden on individuals, health care systems, and payers. Younger children, minority ethnic groups, and those with limited insurance are at the greatest risk for presentation of DKA at T1D diagnosis. Although monitoring ketone levels is an essential part of acute illness management and for both early detection and prevention of a DKA episode, studies have reported poor adherence to ketone monitoring. Ketone monitoring is particularly important for patients treated with sodium glucose cotransporter 2 inhibitor (SGLT2i) medications, in which DKA can present with only moderately elevated glucose levels, referred to as euglycemic DKA (euDKA). A majority of people with T1D and many with type 2 diabetes (T2D), particularly those using insulin therapy, are using continuous glucose monitoring (CGM) as their preferred method for measurement and management of glycemia. These devices provide a continuous stream of glucose data that enables users to take immediate action to mitigate and/or prevent severe hyperglycemic or hypoglycemic events. An international consensus of leading diabetes experts has recommended the development of continuous ketone monitoring systems, ideally a system that combines CGM technology with measurement of 3-β-OHB into a single sensor. In this narrative review of current literature, we report on the prevalence and burden of DKA, examine challenges to detecting and diagnosing this condition, and discuss a new monitoring option for DKA prevention.

Practical Application of Continuous Glucose Monitoring in Clinical Practice: Case Studies.

Abstract: The prevalence of diabetes continues to rise exponentially and contributes significantly to morbidity, mortality, and health care resource utilization. Individuals with diabetes have adopted continuous glucose monitoring (CGM) as their preferred method for glucose measurement. Primary care clinicians should become proficient in utilizing this technology in their practices. This case-based article provides practical guidance in CGM interpretation allowing patients to become successful partners in diabetes self-management. Our approach to data interpretation and shared decision-making is applicable to all current CGM systems.

Knowledge, attitude, and practice toward pre-diabetes among the public, patients with pre-diabetes and healthcare professionals: a systematic review

Abstract: The prevalence of pre-diabetes is increasing globally, affecting an estimated 552 million people by 2030. While lifestyle interventions are the first line of defense against progression toward diabetes, information on barriers toward pre-diabetes management and how to overcome these barriers are scarce. This systematic review describes the publics’ and healthcare professionals’ knowledge, attitude and practice (KAP) toward pre-diabetes and determines the barriers toward pre-diabetes management. A systematic search for studies examining KAP towards pre-diabetes was conducted in six databases from inception to September 2022. Studies that quantitatively assessed at least two KAP elements using questionnaires were included. The quality of studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Barriers and enablers were identified and mapped onto the Capability, Motivation, and Behaviour model to identify factors that influence behavior change. Twenty-one articles that surveyed 8876 participants were included in this review. Most of the reviews (n=13) were directed to healthcare professionals. Overall, positive attitudes toward diabetes prevention efforts were observed, although there were still knowledge deficits and poor behavior toward pre-diabetes management. Barriers and enablers were detected at patients (eg, goals and intention), healthcare professionals (eg, clinical judgement) and system (eg, access and resources) levels. The use of different survey instruments to assess KAP prevented a head-to-head comparison between studies. Most studies conducted among patients were from middle-income countries, while among healthcare professionals (HCPs) were from high-income countries, which may produce some biasness. Nevertheless, the development of pre-diabetes intervention should focus on: (1) increasing knowledge on pre-diabetes and its management; (2) imparting practical skills to manage pre-diabetes; (3) providing resources for lifestyle management; (4) improving the accessibility of lifestyle management programs; and (5) other HCPs and human support to pre-diabetes management.

Associations between insulin pump self‐management and HbA1c in type 1 diabetes

Abstract: Insulin pump self‐management is important for glycaemic outcomes. We aimed to investigate associations between self‐management factors and HbA1c.

Personalized Glycated Hemoglobin in Diabetes Management: Closing the Gap with Glucose Management Indicator.

Abstract: Glycated hemoglobin (HbA1c) has played a central role in the management of diabetes since the end of the landmark Diabetes Control and Complications Trial 30 years ago. However, it is known to be subject to distortions related to altered red blood cell (RBC) properties, including changes in cellular lifespan. On occasion, the distortion of HbA1c is associated with a clinical pathological condition affecting RBCs, however, the more frequent scenario is related to interindividual RBC variations that alter HbA1c-average glucose relationship. Clinically, these variations can potentially lead to over- or underestimating glucose exposure of the individual to the extent that may put the person at excess risk of over- or undertreatment. Furthermore, the variable association between HbA1c and glucose levels across different groups of people may become an unintentional driver of inequitable health care delivery, outcomes, and incentives. The subclinical effects within the normal expected physiological range of RBCs can be large enough to alter clinical interpretation of HbA1c and addressing this will help with individualized care and decision making. This review describes a new glycemic measure, personalized HbA1c (pA1c), that may address the clinical inaccuracies of HbA1c by taking into account interindividual variability in RBC glucose uptake and lifespan. Therefore, pA1c represents a more sophisticated understanding of glucose-HbA1c relationship at an individual level. Future use of pA1c, after adequate clinical validation, has the potential to refine glycemic management and the diagnostic criteria in diabetes.

The Evolution of Diabetes Treatment Through the Ages: From Starvation Diets to Insulin, Incretins, SGLT2-Inhibitors and Beyond

Abstract: Abstract Diabetes is an ancient disease and for centuries extreme diets and herbal remedies were used to treat diabetes symptoms. The discovery of insulin in 1921 transformed the landscape of diabetes treatment and was followed by the discovery of several new therapies which improved glycemia and increased patient life span. However, as patients with diabetes lived longer, they developed classic microvascular and macrovascular diabetes complications. In the 1990s, the DCCT and the UKPDS trials demonstrated that tight glucose control reduced the microvascular complications of diabetes, but had marginal effects on cardiovascular disease, the leading cause of death in patients with diabetes. In 2008, the FDA directed that all new diabetes medications demonstrate cardiovascular safety. From this recommendation emerged novel therapeutic classes, the GLP-1 receptor agonists and SGLT2-Inhibitors, which not only improve glycemia, but also provide robust cardio-renal protection. In parallel, developments in diabetes technology like continuous glucose monitoring systems, insulin pumps, telemedicine and precision medicine have advanced diabetes management. Remarkably, a century later, insulin remains a cornerstone of diabetes treatment. Also, diet and physical activity remain important components of any diabetes treatment. Today type 2 diabetes is preventable and long-term remission of diabetes is possible. Finally, progress continues in the field of islet transplantation, perhaps the ultimate frontier in diabetes management.

One Size Fits All Versus Individualized Medicine in Type 1 Diabetes Management.

Abstract: Diabetes is primarily a self-managed disease that requires patients to perform multiple daily tasks. However, adherence to treatment may be negatively impacted by each patient's individual physical abilities, emotional issues, and lifestyle circumstances, although the "one size fits all" was necessary due to limited treatment options. This article reviews milestones of diabetes care, provides the rationale for individualizing diabetes management, and presents a potential roadmap for utilizing current and future technologies to transition from reactive medicine to proactive disease management and prevention in the future under the umbrella of individualized care.

How Can Point-of-Care Technologies Support In-Hospital Diabetes Care?

Abstract: People with diabetes admitted to hospital are at risk of diabetes related complications including hypoglycaemia and diabetic ketoacidosis. Point-of-care (POC) tests undertaken at the patient bedside, for glucose, ketones, and other analytes, are a key component of monitoring people with diabetes, to ensure safety. POC tests implemented with a quality framework are critical to ensuring accuracy and veracity of results and preventing erroneous clinical decision making. POC results can be used for self-management of glucose levels in those well-enough and/or by healthcare professionals to identify unsafe levels. Connectivity of POC results to electronic health records further offers the possibility of utilising these results proactively to identify patients ‘at risk’ in real-time and for audit purposes. In this article, the key considerations when implementing POC tests for diabetes in-patient management are reviewed and potential to drive improvements using networked glucose and ketone measurements are discussed. In summary, new advances in POC technology should allow people with diabetes and the teams looking after them whilst in hospital to integrate to provide safe and effective care.

Continuous glucose monitoring empowers adolescents to take responsibility of diabetes management

Abstract: Background Managing diabetes is especially challenging for adolescents, and they often struggle to believe they can manage the condition. Illness perception has been widely associated with better diabetes management outcomes, but the influence of continuous glucose monitoring (CGM) on adolescents has been largely neglected. Aim The study aimed to explore the illness perception of a group of adolescents living with type 1 diabetes (T1D) using CGM. Setting The study was conducted at a medical centre that provides diabetes care services to youth living with T1D in Parktown, South Africa. Methods A qualitative research approach using semi-structured online interviews was used to gather data that was thematically analysed. Results Themes emerging from the data confirmed that CGM creates a sense of control over diabetes management as blood glucose measures were more visible. A sense of normalcy was established as CGM influences a new routine and a way of life, integrating diabetes into a young person’s identity. Despite the users’ awareness of being different due to diabetes management, CGM assisted in creating a sense of belonging, contributing to developing a better quality of life. Conclusion Findings of this study support the use of CGM as a means of empowering adolescents struggling with diabetes management to achieve better treatment outcomes. The important role of illness perception in facilitating this change was also evident. Contribution By listening to the adolescent’s voice, CGM was identified as a possible intervention to empower adolescents to improve diabetes management.

Delivering diabetes shared medical appointments in primary care: early and mid-program adaptations and implications for successful implementation

Abstract: Abstract Background Self-management is essential for good outcomes in type 2 diabetes and patients often benefit from self-management education. Shared medical appointments (SMAs) can increase self-efficacy for self management but are difficult for some primary care practices to implement. Understanding how practices adapt processes and delivery of SMAs for patients with type 2 diabetes may provide helpful strategies for other practices interested in implementing SMAs. Methods The Invested in Diabetes study was a pragmatic cluster-randomized, comparative effectiveness trial designed to compare two different models of diabetes SMAs delivered in primary care. We used a multi-method approach guided by the FRAME to assess practices’ experience with implementation, including any planned and unplanned adaptations. Data sources included interviews, practice observations and field notes from practice facilitator check-ins. Results Several findings were identified from the data: 1) Modifications and adaptations are common in implementation of SMAs, 2) while most adaptations were fidelity-consistent supporting the core components of the intervention conditions as designed, some were not, 3) Adaptations were perceived to be necessary to help SMAs meet patient and practice needs and overcome implementation challenges, and 4) Content changes in the sessions were often planned and enacted to better address the contextual circumstances such as patient needs and culture. Discussion Implementing SMAs in primary care can be challenging and adaptations of both implementation processes and content and delivery of SMAS for patients with type 2 diabetes were common in the Invested in Diabetes study. Recognizing the need for adaptations based on practice context prior to implementation may help improve fit and success with SMAs, but care needs to be given to ensure that adaptations do not weaken the impact of the intervention. Practices may be able to assess what might need to adapted for them to be successful prior to implementation but likely will continue to adapt after implementation. Conclusion Adaptations were common in the Invested in Diabetes study. Practices may benefit from understanding common challenges in implementing SMAs and adapting processes and delivery based on their own context. Trial registration This trial is registered on clinicaltrials.gov under Trial number NCT03590041, posted 18/07/2018.

Development of Smartphone-Controlled and Microneedle-Based Wearable Continuous Glucose Monitoring System for Home-Care Diabetes Management.

Abstract: Continuous glucose monitoring (CGM) can mini-invasively track blood glucose fluctuation and reduce the risk of hyperglycemia and hypoglycemia, and this is is in great demand for diabetes management. However, cost-effective manufacture of CGM systems with continuously improved convenience and performance is still the persistent goal. Herein, we developed a smartphone-controlled and microneedle (MN)-based wearable CGM system for long-term glucose monitoring. The CGM system modified with a sandwich-type enzyme immobilization strategy can satisfy the clinical requirement of interstitial fluid (ISF) glucose monitoring for 14 days with a mean absolute relative difference of 10.2% and a cost of less than $15, which correlated well with the commercial glucometer and FDA-approved CGM system FreeStyle Libre (Abbott Inc., Illinois, USA). The self-developed CGM system is demonstrated to accurately monitor glucose fluctuations and provide abundant clinical information. It is better to find the cause of individual blood glucose changes and beneficial for the guide of precise glucose control. On the whole, the intelligently wearable CGM system may provide an alternative solution for home-care diabetes management.

Continuous Glucose Monitoring Use in Older Adults for Optimal Diabetes Management.

Abstract: More than one third of U.S. adults age ≥65 years have diabetes. According to early studies, 61% of all diabetes-related costs in the United States were for individuals age ≥65 years, and more than half of these costs attributable to treating diabetes-related complications. Numerous studies have shown that use of continuous glucose monitoring (CGM) has been shown to improve glycemic control and reduce the incidence and severity of hypoglycemia in younger adults with type 1 diabetes and insulin-treated type 2 diabetes (T2D), and there is growing evidence demonstrating the same benefits in older T2D populations. However, because older adults with diabetes are a heterogeneous group with variable clinical, functional, and psychosocial milieu, clinicians must consider whether each patient can use CGM and, if so, the type of CGM device best addresses each patient's needs and capabilities. This article reviews the evidence supporting CGM in the older population, discusses the barriers and benefits of CGM use in older adults with diabetes, and provides recommendations for how different types of CGM systems can be used strategically to improve glycemic control, reduce hypoglycemia, decrease the burden of diabetes, and improve quality of life.

Nurses’ knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus

Abstract: The prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses' role in nutritional management of diabetes. This study aimed to evaluate nurses' knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes.This cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses' KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis.The mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses' attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008).Nurses' knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.

Is Continuous Glucose Monitoring a Tool, an Intervention, or Both?

Abstract: Studies that investigate use of diabetes technologies such as blood glucose monitoring (BGM) and continuous glucose monitoring (CGM) often report contradictory findings regarding efficacy and clinical utility. Whereas some studies of a given technology have shown no benefit, others have reported significant benefits. These incongruities derive from how the technology is viewed. Is it viewed as a tool, or is it an intervention? In this article, we discuss earlier studies that illustrate the contrast between use of BGM as a tool versus use as an intervention, compare and contrast the roles of BGM and CGM as tools and/or interventions in diabetes management, and suggest that CGM can function effectively as both.

Development of Smartphone-Controlled and Microneedle-Based Wearable Continuous Glucose Monitoring System for Home-Care Diabetes Management

Abstract: Continuous glucose monitoring (CGM) can mini-invasively track blood glucose fluctuation and reduce the risk of hyperglycemia and hypoglycemia, and this is is in great demand for diabetes management. However, cost-effective manufacture of CGM systems with continuously improved convenience and performance is still the persistent goal. Herein, we developed a smartphone-controlled and microneedle (MN)-based wearable CGM system for long-term glucose monitoring. The CGM system modified with a sandwich-type enzyme immobilization strategy can satisfy the clinical requirement of interstitial fluid (ISF) glucose monitoring for 14 days with a mean absolute relative difference of 10.2% and a cost of less than $15, which correlated well with the commercial glucometer and FDA-approved CGM system FreeStyle Libre (Abbott Inc., Illinois, USA). The self-developed CGM system is demonstrated to accurately monitor glucose fluctuations and provide abundant clinical information. It is better to find the cause of individual blood glucose changes and beneficial for the guide of precise glucose control. On the whole, the intelligently wearable CGM system may provide an alternative solution for home-care diabetes management.

Insight into continuous glucose monitoring: from medical basics to commercialized devices

Abstract: According to the latest statistics, more than 537 million people around the world struggle with diabetes and its adverse consequences. As well as acute risks of hypo- or hyper- glycemia, long-term vascular complications may occur, including coronary heart disease or stroke, as well as diabetic nephropathy leading to end-stage disease, neuropathy or retinopathy. Therefore, there is an urgent need to improve diabetes management to reduce the risk of complications but also to improve patient's quality life. The impact of continuous glucose monitoring (CGM) is well recognized, in this regard. The current review aims at introducing the basic principles of glucose sensing, including electrochemical and optical detection, summarizing CGM technology, its requirements, advantages, and disadvantages. The role of CGM systems in the clinical diagnostics/personal testing, difficulties in their utilization, and recommendations are also discussed. In the end, challenges and prospects in future CGM systems are discussed and non-invasive, wearable glucose biosensors are introduced. Though the scope of this review is CGMs and provides information about medical issues and analytical principles, consideration of broader use will be critical in future if the right systems are to be selected for effective diabetes management.

Technology in the Changing Management of Diabetes in Children

Abstract: Management of diabetes in children younger than 6 years of age may be difficult owing to their unpredictable eating and activity patterns, low insulin requirements, and high glycemic variability. However, tight glycemic control is necessary because unmet recommended target glucose levels may have lifelong consequences.1,2 Metabolic control can be improved with the use of a closed-loop system (also termed an “artificial pancreas”), which combines an insulin pump, a continuous glucose monitoring sensor, and a control algorithm that adjusts the amount of insulin administered in real time according to input from the sensor. Currently, all commercially available closed-loop systems are hybrid, . . .

Using Patient Profiles for Sustained Diabetes Management Among People With Type 2 Diabetes

Abstract: Introduction Our objective was to evaluate the association between patient profiles and sustained diabetes management (SDM) among patients with type 2 diabetes. Methods We collected HbA1c values recorded from 2014 through 2020 for 570 patients in a hospital in Taipei, Taiwan, and calculated a standard level based on an HbA1c level less than 7.0% to determine SDM. We used patients’ self-reported data on diabetes self-care behaviors to construct profiles. We used 8 survey items to perform a latent profile analysis with 3 groups (poor management, medication adherence, and good management). After adjusting for other determining factors, we used multiple regression analysis to explore the relationship between patient profiles and SDM. Results The good management group demonstrated better SDM than the poor management group (β = 0.183; P = .003). Using the most recent HbA1c value and the 7-year average of HbA1c values as the outcome, we found lower HbA1c values in the good management group than in the poor management group (β = −0.216 [P = .01] and −0.217 [P = .008], respectively). Conclusion By using patient profiles, we confirmed a positive relationship between optimal patient behavior in self-care management and SDM. Patients with type 2 diabetes exhibited effective self-care management behavior and engaged in more health care activities, which may have led to better SDM. In promoting patient-centered care, using patient profiles and customized health education materials could improve diabetes care.

1058-P: Pharmacist-Based Coaching within a Specialty Diabetes Center Improves Outcomes for Uncontrolled Diabetes

Abstract: Coaching programs have been shown to improve diabetes outcomes. We investigate a novel approach where pharmacists, trained in diabetes care, provide coaching for patients in poor control. Coaches addressed all aspects of diabetes care, yet the program was cost-neutral to clinical operations. The UMass Memorial Diabetes Center of Excellence clinic follows ~10,000 patients. We provide interdisciplinary team-based care by endocrinologists, NPs, CDCESs and nutritionists. Those with HbA1c ≥9% over two consecutive visits, despite best efforts by the team, were referred to the “Care Coach” program. Coaches had an initial in-person visit followed by weekly (or where appropriate less frequent) phone visits. Benefits from frequent interaction with the Coaches (Table) came from: 1) Medication management: improved medication adherence and rapid adjustments between visits; 2) Assistance with lowering drug costs; 3) Diabetes technology: greater adoption of CGM and fingerstick testing; 4) Motivational support for dietary and exercise goals; 5) Efficient modification of care plans by integrating the Coach within the care team; 6) Better patient engagement in their care plan. The program is financially self-sustaining as coaches are employed by the hospital associated Shields Health Solutions Specialty Pharmacy and funding for Coach salaries is generated via patient prescriptions and 340B program. S.Malkani: None. R.A.Haas: None. V.Shah: None. H.Sharma: None. G.Pugliese: None. C.Barry: None. L.Piz: None. W.Mcelnea: None.