Diabetes management

About: Diabetes management is a research topic. Over the lifetime, 6060 publications have been published within this topic receiving 164670 citations.

Finger-Stick Glucose Monitoring: Issues of accuracy and specificity

Abstract: Since its introduction three decades ago, self-monitoring of blood glucose (SMBG) using finger-stick blood samples, test strips, and portable meters has aided diabetes management, principally by enabling patients—particularly those treated with insulin—to become full partners along with health professionals in striving for excellent glycemic control. Over time the use of glucose meters has become easier and faster with smaller and smaller blood samples yielding results in a matter of seconds. For this reason, glucose meters are now increasingly used in hospital wards, intensive care units, and other facilities such as dialysis units and infusion centers to provide point-of-care results that would take much longer through routine laboratory channels. This technology has largely taken the guess work out of diabetes management. Without such technology, intensive glucose control such as that achieved in the Diabetes Control and Complications Trial may not have been demonstrated to prevent or decrease microvascular complications; insulin pump therapy would not really be practical; and hypoglycemia would remain an even greater source of anxiety for patients and their families than it already is. We have come to rely so much on finger-stick glucose that it is easy to forget its limitations. In considering this we will discuss accuracy, specificity, and, in light of those, inappropriate usage. ### Accuracy Although there is no universally binding standard, guidelines issued by the International Organization for Standardization (ISO) are widely acknowledged. ISO guideline 15197 suggests that for glucose levels <75 mg/dl, a meter should read within 15 mg/dl of the reference sample, and for levels ≥75 mg/dl, the reading should be within 20%. A meter also should be able to meet these targets in at least 95% of the samples tested (1). Several examples serve to illustrate the implications of this degree of imprecision. Assuming a meter does indeed meet the ISO guideline, …

Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS)

Abstract: We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional waves (2005–2017). At each wave, each physician collected data from ten consecutive participants with type 2 diabetes during a 2 week period. The primary objective of this analysis was to evaluate trends of glycaemic control over time. A total of 66,088 individuals with type 2 diabetes were recruited by 6099 physicians from 49 countries. The proportion of participants with HbA1c <53 mmol/mol (<7%) decreased from 36% in wave 1 (2005) to 30.1% in wave 7 (2017) (p < 0.0001). Compared with wave 1, the adjusted ORs of attaining HbA1c ≤64 mmol/mol (≤8%) decreased significantly in waves 2, 5, 6 and 7 (p < 0.05). Over 80% of participants received oral glucose-lowering drugs, with declining use of sulfonylureas. Insulin use increased from 32.8% (wave 1) to 41.2% (wave 7) (p < 0.0001). The corresponding time to insulin initiation (mean ± SD) changed from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6 years in wave 7, while daily insulin dosage ranged from 0.39 ± 0.21 U/kg (wave 1) to 0.33 ± 0.19 U/kg (wave 7) for basal regimen and 0.70 ± 0.34 U/kg (wave 1) to 0.77 ± 0.33 (wave 7) U/kg for basal–bolus regimen. An increasing proportion of participants had ≥2 HbA1c measurements within 12 months of enrolment (from 61.8% to 92.9%), and the proportion of participants receiving diabetes education (mainly delivered by physicians) also increased from 59.0% to 78.3%. In developing countries, glycaemic control in individuals with type 2 diabetes remained suboptimal over a 12 year period, indicating a need for system changes and better organisation of care to improve self-management and attainment of treatment goals.

An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with Type 1 Diabetes in educational settings

Abstract: Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university. Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3–25 years in educational settings. Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings. Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management. Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption. This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.

Diabetes Distress and Glycemic Control: The Buffering Effect of Autonomy Support From Important Family Members and Friends

Abstract: OBJECTIVE To examine whether autonomy support (defined as social support for an individual’s personal agency) for diabetes management from informal health supporters (family/friends) reduces the detrimental effects of diabetes distress on glycemic control. RESEARCH DESIGN AND METHODS Three hundred eight veterans with type 2 diabetes and one or more risk factors for diabetes complications completed a survey that included measures of diabetes distress and perceived autonomy support from their main informal health supporter. Hemoglobin A 1c (HbA 1c ) data from 12 months before and after the survey were extracted from electronic medical records. Linear mixed modeling examined the main effects and interaction of autonomy support and diabetes distress on repeated measures of HbA 1c over the 12 months after the survey, controlling for mean prior 12-month HbA 1c , time, insulin use, age, and race/ethnicity. RESULTS Diabetes distress ( B = 0.12 [SE 0.05]; P = 0.023) was associated with higher and autonomy support ( B = −0.16 [SE 0.07]; P = 0.032) with lower subsequent HbA 1c levels. Autonomy support moderated the relationship between diabetes distress and HbA 1c ( B = −0.13 [SE 0.06]; P = 0.027). Greater diabetes distress was associated with higher HbA 1c at low ( B = 0.21 [SE 07]; P = 0.002) but not high ( B = 0.01 [SE 0.07]; P = 0.890) levels of autonomy support. CONCLUSIONS Autonomy support from main health supporters may contribute to better glycemic control by ameliorating the effects of diabetes distress. Interventions that reduce diabetes distress and enhance the autonomy supportiveness of informal supporters may be effective approaches to improving glycemic control.

Management of diabetes using adaptive control

Abstract: The review focuses on adaptive systems for insulin treatment in type 1 diabetes. The review consists of two parts. First, adaptive approaches are described, which exploit infrequent glucose measurements (four to seven measurements per day). Second, adaptive approaches are described, which exploit frequent or continuous glucose measurements (every hour or more often). Each part is further divided into two subparts separating off-line and on-line adaptive techniques. The latter represents treatment strategies, which rely on continuous re-assessment of the glucoregulatory system. The former refers to treatment strategies, which are fixed for a day or longer and are revisited from time to time. It is concluded that the role of adaptive approaches will increase as new continuous glucose-sensing monitors reach the market. Copyright © 2004 John Wiley & Sons, Ltd.