Home About us Contact
|
Home About us Contact | ||
|
|
||
Glucose Self-monitoring (glucose + self-monitoring)
Selected AbstractsSelf-monitoring in Type 2 diabetes mellitus: a meta-analysisDIABETIC MEDICINE, Issue 11 2000S. Coster SUMMARY Aims Self-monitoring of blood or urine glucose is widely used by subjects with Type 2 diabetes mellitus. This study evaluated the effectiveness of the technique at improving blood glucose control through a systematic review and meta-analysis. Methods Randomized controlled trials were identified that compared the effects of blood or urine glucose monitoring with no self-monitoring, or blood glucose self-monitoring with urine glucose self-monitoring, on glycated haemoglobin as primary outcome in Type 2 diabetes. Results , Eight reports were identified. These were rated for quality and data were abstracted. The mean (sd) quality score was 15.0 (1.69) on a scale ranging from 0 to 28. No study had sufficient power to detect differences in glycated haemoglobin (GHb) of less than 0.5%. One study was excluded because it was a cluster randomized trial of a complex intervention and one because fructosamine was used as the outcome measure. A meta-analysis was performed using data from four studies that compared blood or urine monitoring with no regular monitoring. The estimated reduction in GHb from monitoring was ,0.25% (95% confidence interval ,0.61 to 0.10%). Three studies that compared blood glucose monitoring with urine glucose monitoring were also combined. The estimated reduction in GHb from monitoring blood glucose rather than urine glucose was ,0.03% (,0.52 to 0.47%). Conclusions The results do not provide evidence for clinical effectiveness of an item of care with appreciable costs. Further work is needed to evaluate self-monitoring so that resources for diabetes care can be used more efficiently. [source] Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapyDIABETIC MEDICINE, Issue 9 2000U. Bott SUMMARY Aims To evaluate a treatment and teaching programme including psychosocial modules for patients with Type 1 diabetes mellitus on intensified insulin therapy who failed to achieve their treatment goals despite participation in standard programmes. Methods The 5-day inpatient programme comprises small groups of 4,6 patients, focusing on individual needs and problems. Beyond the teaching lessons (most topics are deliberately chosen by the patients), the programme provides intensive group discussions and offers individual counselling concerning motivational aspects, psychosocial problems and coping strategies. Of the first consecutive 83 participants, 76 were re-examined after 17.5 ± 5.5 months (range 9,31 months). Results At follow-up, HbA1c was not improved compared to baseline (8.0 ± 1.3% vs. 8.1 ± 1.5%). However, the incidence of severe hypoglycaemia per patient/year (glucose i.v., glucagon injection) was substantially decreased: 0.62 ± 1.5 episodes at baseline compared to 0.16 ± 0.9 at follow-up (P < 0.001). Twenty-six per cent of the patients at baseline, and 4% at re-examination had experienced at least one episode of severe hypoglycaemia during the preceding year (P < 0.001). Sick leave days per patient/year decreased from 17.0 ± 38.5,7.7 ± 13.6 days (P < 0.05). Patients improved their perceptions of self-efficacy, their relationship to doctors and felt less externally controlled (P < 0.001). The majority of patients perceived an improved competence regarding diet (80.6%) and adaptation of insulin dosage (82.4%), an improved knowledge (82.2%), and a renewed motivation for the treatment (84.5%). Treatment success was significantly associated with baseline HbA1c, stability of motivation, frequency of blood glucose self-monitoring, control beliefs and change in subsequent outpatient care. Conclusions The programme improved glycaemic control mainly as a result of a substantial reduction in the incidence of severe hypoglycaemia. Patients with persistent poor glycaemic control may benefit from structured follow-up care focusing on motivational aspects of self-management and psychosocial support. [source] Continuous glucose monitoring system: an attractive support tool in diabetes educationEUROPEAN DIABETES NURSING, Issue 1 2005L Saez-de-Ibarra BSc Diabetes Specialist Nurse Abstract The study was designed to determine the usefulness of the CGMS (continuous glucose monitoring system) as a support tool in type 1 diabetes education. The CGMS is a sensor system that measures interstitial glucose levels every five minutes for three or more days, by means of a microelectrode inserted in the subcutaneous tissue. People with type 1 diabetes (n=52), who actively participated in diabetes self-management programmes, were monitored with CGMS during three to five days. Patients were selected for CGMS when unsatisfied with the glycaemic results achieved, given the effort made. Ten patients used CSII, 14 used insulin glargine plus rapid acting insulin analogue and 28 used NPH insulin plus short acting insulin. All patients used blood glucose self-monitoring, with a mean of 6.5±1.4 glucose readings per day. The CGMS register was evaluated with the patient. Mean capillary glucose during the 15 days prior to CGMS, mean capillary glucose during CGMS and mean capillary glucose during the 15 days after CGMS are compared. Discussion of the record with the patient frequently allowed detection of inappropriate solving attitudes. Mean capillary glucose dropped from 155±20mg/dL (8.60±1.11mmol/L) prior to CGMS to 143±20mg/dL (7.94±1.11mmol/L) after CGMS (p=0.000). The effectiveness of CGMS (number of patients in whom mean glucose improved) rose from 66.7% in 2001 to 70.6% in 2002, 78.9% in 2003 and 88.8% in 2004. When the patient is involved in the analysis of glucose fluctuations, CGMS is a useful tool in diabetes education that will help achieve attitude changes because of the evidence depicted by the continuous glucose record. Experience in the use of this tool by the professional will improve its effectiveness. Copyright © 2005 FEND. [source] The association between antidepressant use and hypoglycaemia in diabetic patients: a nested case,control study,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Hieronymus J. Derijks PharmD Abstract Purpose Hypoglycaemia is a limiting factor for glycaemic management of diabetes with intensive insulin and/or oral antidiabetic drug (OAD) regimen. Case reports suggest that antidepressants may interfere with blood glucose metabolism in patients with diabetes mellitus potentially increasing the risk of clinically relevant hypoglycaemia. Comorbid depression treated with antidepressants could therefore further complicate glycaemic control. We have carried out a nested case,control study among diabetic patients to assess the risk of hypoglycaemia requiring hospitalisation associated with the use of antidepressants. Methods Diabetic patients treated with insulin and/or OADs were selected from the Dutch Pharmo system. Exposure to antidepressants was the primary determinant investigated. Use of antidepressants was further subclassified based on the receptor binding profile to investigate whether specific pharmacological properties could explain a potential influence on glucose homeostasis. Conditional logistic regression was used to estimate odds ratios and to adjust for confounding factors. Results From the base cohort (40 600 patients), 549 (1.35%) cases were identified and 1897 controls were selected. Current use of any antidepressant was not associated with a significantly higher risk of hypoglycaemia requiring hospitalisation (OR: 1.36 (95%CI: 0.84,2.20)). A trend for a higher risk on hypoglycaemia was identified for antidepressants with high affinity for the serotonin reuptake transporter. The risk on severe hypoglycaemia was increased after 3 years of use (OR: 2.75 (95%CI: 1.31,5.77)). Conclusions It is important for diabetic patients using antidepressants for more than 3 years to pay attention for symptoms of hypoglycaemia and strict blood glucose self-monitoring. Copyright © 2008 John Wiley & Sons, Ltd. [source] | ||||||||||