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Zou Y, Zhao S, Li G, Zhang C. The Efficacy and Frequency of Self-monitoring of Blood Glucose in Non-insulin-Treated T2D Patients: a Systematic Review and Meta-analysis. J Gen Intern Med 2023; 38:755-764. [PMID: 36403159 PMCID: PMC9971532 DOI: 10.1007/s11606-022-07864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/21/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a useful tool in diabetes management, but its efficacy and optimal application in type 2 diabetes (T2D) patients treated without insulin have been controversial. We aimed to evaluate the efficacy of SMBG in controlling blood glucose levels in non-insulin-treated T2D patients and to determine the optimal frequency and the most appropriate population to benefit from SMBG. METHODS Eligible publications from January 2000 to April 2022 were retrieved from PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. Randomized controlled trials comparing SMBG with no SMBG or structured SMBG (S-SMBG, SMBG with defined timing and frequency of glucose measurements) were included. Meta-analyses and sub-analyses were performed to assess the efficacy, optimal frequency, and most appropriate population for SMBG. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. RESULTS Twenty-two studies involving 6204 participants were identified, including 17 comparing SMBG with no SMBG and 4 comparing SMBG with S-SMBG. SMBG reduced HbA1c (MD -0.30%, 95% CI -0.42 to -0.17) compared with no SMBG, and S-SMBG performed better than SMBG (MD -0.23%, 95% CI -0.38 to -0.07). Subgroup analyses showed that HbA1c control was better with SMBG at 8-11 times weekly (MD -0.35%, 95% CI -0.51 to -0.20) compared with other frequencies and with lifestyle adjustments (MD -0.37%, 95% CI -0.50 to -0.23) than with no adjustments. No significant differences in HbA1c were observed between baseline HbA1c subgroups (≤ 8% and > 8%, P = 0.63) and between diabetes duration subgroups (≤ 6 years and > 6 years, P = 0.72), respectively. DISCUSSION SMBG was effective for controlling HbA1c in non-insulin-treated T2D patients, although lacking detailed monitoring design. Better outcomes were seen with SMBG at 8-11 times weekly and lifestyle adjustment based on SMBG results. TRIAL REGISTRATION PROSPERO (CRD42021285604).
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Affiliation(s)
- Yue Zou
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Sixuan Zhao
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guangyao Li
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Hu Y, Zhang BY, Haque F, Ren G, Ou JZ. Plasmonic metal oxides and their biological applications. MATERIALS HORIZONS 2022; 9:2288-2324. [PMID: 35770972 DOI: 10.1039/d2mh00263a] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Metal oxides modified with dopants and defects are an emerging class of novel materials supporting the localized surface plasmon resonance across a wide range of optical wavelengths, which have attracted tremendous research interest particularly in biological applications in the past decade. Compared to conventional noble metal-based plasmonic materials, plasmonic metal oxides are particularly favored for their cost efficiency, flexible plasmonic properties, and improved biocompatibility, which can be important to accelerate their practical implementation. In this review, we first explicate the origin of plasmonics in dopant/defect-enabled metal oxides and their associated tunable localized surface plasmon resonance through the conventional Mie-Gans model. The research progress of dopant incorporation and defect generation in metal oxide hosts, including both in situ and ex situ approaches, is critically discussed. The implementation of plasmonic metal oxides in biological applications in terms of therapy, imaging, and sensing is summarized, in which the uniqueness of dopant/defect-driven plasmonics for inducing novel functionalities is particularly emphasized. This review may provide insightful guidance for developing next-generation plasmonic devices for human health monitoring, diagnosis and therapy.
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Affiliation(s)
- Yihong Hu
- School of Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.
| | - Bao Yue Zhang
- School of Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.
- School of Physics and Astronomy, Monash University, Clayton, Victoria 3800, Australia
| | - Farjana Haque
- School of Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.
| | - Guanghui Ren
- School of Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.
| | - Jian Zhen Ou
- School of Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.
- School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
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Padda J, Khalid K, Zubair U, Al Hennawi H, Khedr A, Patel V, Cooper AC, Jean-Charles G. Significance of Educational Literature and Diabetes Log Sheet on Hemoglobin A1c. Cureus 2022; 14:e21667. [PMID: 35233335 PMCID: PMC8882019 DOI: 10.7759/cureus.21667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/09/2022] Open
Abstract
Diabetes mellitus (DM) is a major cause of morbidity worldwide. The prevalence of DM has doubled over the last 35 years and is escalating. Various complications and manifestations of diabetes have caused numerous deaths worldwide, with numbers increasing every year. There have been many advances and breakthroughs over the past decade in the management of DM. The major focus of many research studies has been to evaluate effective medication combinations, preventative measures, and the way to control such morbid conditions. Our focus in this review is to discuss specific secondary prevention techniques with the diabetes log sheet and educational literature on its effectiveness in controlling diabetes. Hemoglobin A1c (HbA1c) has been accepted as a diabetes control measure in many resources worldwide. Here, we have assessed articles on the effectiveness of the diabetes log sheet and educational literature on HbA1c levels. We will begin with a few key points to acknowledge diabetes initially, followed by discussing the effectiveness of the diabetes log sheet and literature on HbA1c.
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Cheng AYY, Feig DS, Ho J, Siemens R. Blood Glucose Monitoring in Adults and Children with Diabetes: Update 2021. Can J Diabetes 2021; 45:580-587. [PMID: 34511234 DOI: 10.1016/j.jcjd.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 12/14/2022]
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Tai JCJ, Wong LZ, Richardson A. Self-Monitoring of Blood Glucose for Patients With Type 2 Diabetes in Primary Care: A Single-Centre, 10-Year Retrospective Analysis. Cureus 2021; 13:e15597. [PMID: 34277218 PMCID: PMC8272934 DOI: 10.7759/cureus.15597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/05/2022] Open
Abstract
Background While type 1 diabetics often require self-monitoring of blood glucose (SMBG), the evidence for tight blood glucose monitoring in non-insulin treated type 2 diabetes mellitus (T2DM) patients is limited. In addition to its lack of cost-effectiveness, unnecessary blood glucose monitoring may also result in anxiety and decreased quality of life. In this retrospective audit, we assessed SMBG prescribing practice at one general practice against guidelines from the National Institute for Health and Care Excellence (NICE). Methods A systematic search of T2DM patients diagnosed at a general practice in London, United Kingdom, in the last 10 years was undertaken. A total of 146 patients fulfilled these criteria, of which 100 patients were randomly selected for inclusion in this audit. Medical notes were reviewed and collated for analysis. Results Only 85% of patients with T2DM were being managed in accordance with the NICE guidelines on SMBG, while 15% were not. It was more common for patients who did not need monitoring to be inappropriately prescribed SMBG (10%) than it was for patients who needed monitoring to be under-prescribed SMBG (5%). The reasons for prescribing SMBG were often left undocumented. Conclusion Adherence to the NICE guidelines is subpar. Recommended solutions include educating healthcare professionals involved in the prescribing of SMBGs, regular reviews of the continued necessity of SMBG, and digital alerts on e-prescribing systems.
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Affiliation(s)
- Justina Cheh Juan Tai
- General Practice and Primary Care, University College London Medical School, London, GBR
| | - Liang Zhi Wong
- General Practice and Primary Care, University College London Medical School, London, GBR
| | - Adrian Richardson
- General Practice and Primary Care, NHS Haringey North Central London Clinical Commissioning Group (CCG), London, GBR
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Renskers L, Rongen-van Dartel SA, Huis AM, van Riel PL. Patients' experiences regarding self-monitoring of the disease course: an observational pilot study in patients with inflammatory rheumatic diseases at a rheumatology outpatient clinic in The Netherlands. BMJ Open 2020; 10:e033321. [PMID: 32819925 PMCID: PMC7440711 DOI: 10.1136/bmjopen-2019-033321] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Self-monitoring the disease course is a relatively new concept in the management of patients with inflammatory rheumatic diseases (IRDs). The aims of this pilot study were to obtain patients' experiences with online self-monitoring, to assess information about the agreement between the disease course assessed with patient-reported outcome measures (PROMs) and an objectively measured Disease Activity Score 28 (DAS28) by the rheumatologist, and to assess adherence to predetermined PROM frequency intervals. DESIGN Observational study using qualitative and quantitative methods. SETTING The rheumatology outpatient clinic of a teaching hospital in The Netherlands (secondary care). PARTICIPANTS 47 patients with an IRD who regularly attended the outpatient clinic. METHODS Patients completed PROMs by using an online self-monitoring program. Their experiences regarding self-monitoring were qualitatively assessed through a focus group discussion and telephone interviews using a thematic analysis approach. Adherence to the predefined PROM frequency (completed PROM assessments within the predetermined frequency) and the agreement between the DAS28 course and PROM values (Rheumatoid Arthritis Disease Activity Index-5 and the Rheumatoid Arthritis Impact of Disease (RAID)) were quantitatively assessed using descriptives. RESULTS Forty-seven patients participated, most of them diagnosed with rheumatoid arthritis (n=38, 80.9%). Three themes were identified: knowledge about and insight into the disease (activity), patient-professional interaction and functionality of the program. Mean adherence to the predetermined PROM frequency was 68.1%. The RAID showed the best agreement with the DAS28 course. Mean participation time was 350 days. CONCLUSION Patients were predominantly positive about online self-monitoring. They indicated that they gained more knowledge about their disease, felt less dependent on the healthcare professional and valued the insight into their long-term disease course. Barriers were mostly related to technical factors. Patients were able to and willing to self-monitor their disease, which could contribute to a more efficient allocation of outpatient consultations in the future.
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Affiliation(s)
- Lisanne Renskers
- IQ Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Sanne Aa Rongen-van Dartel
- IQ Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
- Rheumatology, Bernhoven Hospital Location Uden, Uden, Noord-Brabant, The Netherlands
| | - Anita Mp Huis
- IQ Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Piet Lcm van Riel
- IQ Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
- Rheumatology, Bernhoven Hospital Location Uden, Uden, Noord-Brabant, The Netherlands
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Sukhareva OY, Galstyan GR, Tokmakova AY, Nikonova TV, Surkova EV, Kononenko IV, Egorova DN, Ibragimova LI, Shestakova EA, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Bondarenko IZ, Gomova IS, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Mkrtumyan AM, Petunina NA, Ruyatkina LA, Suplotova LA, Ushakova OV, Khalimov YS. Diabetes mellitus type 2 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Shrestha M, Ng AH, Gray RJ. Association between subthreshold depression and self-care behaviours in adults with type 2 diabetes: A protocol for a cross-sectional study. J Clin Nurs 2020; 30:2453-2461. [PMID: 32415880 DOI: 10.1111/jocn.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/05/2020] [Accepted: 03/14/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the association between subthreshold depression and self-care behaviours in adults with type 2 diabetes (T2D) attending a tertiary healthcare service. BACKGROUND Diabetes is a global public health problem. Self-care behaviours are a fundamental element in managing diabetes as adherence to self-care activities is associated with improved glycaemic control. Depression in T2D is associated with decreased adherence to self-care behaviours. Adults with subthreshold depression in diabetes may have difficulties in achieving metabolic control. Further, people with subthreshold depression have an increased risk of developing major depression. Few studies have examined the association between subthreshold depression and self-care behaviours. DESIGN A cross-sectional study. METHODS The study will be conducted among 384 adults diagnosed with T2D for at least a year attending their routine outpatient appointment at Tribhuvan University Teaching Hospital in Nepal. Convenience sampling will be used to recruit study participants. Data will be collected via face-to-face interviews and a medical record review. Self-care behaviours will be assessed using the Summary of Diabetes Self-care activities and subthreshold depression will be determined using the Patient Health Questionnaire- 9. Covariates in the study include sociodemographic and clinical factors, diabetes knowledge, perceived social support and self-efficacy. This paper complies with the STROBE reporting guideline for cross-sectional studies. RESULTS We will use multiple linear regression to examine the association between subthreshold depression and each self-care behaviours (i.e. diet, physical activity, foot care, blood glucose testing and medication) and total self-care behaviour. CONCLUSIONS Effective management of diabetes requires adherence to self-care behaviours. The findings of the study will help in identifying an effective way to improve diabetes self-care. RELEVANCE TO CLINICAL PRACTICE Our observations will inform nursing research and practice by providing evidence about how subthreshold depression may influence self-care behaviours.
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Affiliation(s)
- Monika Shrestha
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Ashley H Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, Australia
| | - Richard J Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
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Wang HC, Chang FY, Tsai TM, Chen CH, Chen YY. Development and clinical trial of a smartphone-based colorimetric detection system for self-monitoring of blood glucose. BIOMEDICAL OPTICS EXPRESS 2020; 11:2166-2177. [PMID: 32341874 PMCID: PMC7173904 DOI: 10.1364/boe.389638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 05/28/2023]
Abstract
Blood glucose measurements help to guide insulin therapy, thus reducing disease severities, secondary complications, and related mortalities. Efforts are underway to allow diabetes patients to experience a more convenient way to measure blood glucose and consequently increase their adherence to regular self-monitoring of blood glucose (SMBG). This study demonstrated a new SMBG system that integrated all components of a glucometer via a smartphone's optical sensing module to detect the colorimetric blood strip and obtains the blood glucose concentration with calculations performed by an application install in the smartphone. To validate the accuracy and applicability of the new SMBG system regarding the ISO15197:2013 accuracy criteria and patient requirements, a clinical trial and usability survey involving participants from different age groups were conducted in collaboration with the China Medical University, where enrolled 120 diabetic patients were asked to operate the new SMBG system to measure their blood glucose concentration, and feedback was obtained from their user experience. The results showed that three different reagent system lots fulfilled the accuracy requirements with values of 97.4-97.5% , and all of the data were within zones A and B of the consensus error grid, which satisfies the ISO 15197:2013 requirement. The usability survey showed that 97.5% of the participants found the operations convenient, and 100% found the design easy for carrying. This new system could lead to improvements in blood glucose monitoring by people with diabetes, and thus, better management of the disease.
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Affiliation(s)
- Hung-Chih Wang
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taiwan
| | - Fuh-Yu Chang
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taiwan
| | | | - Chieh-Hsiao Chen
- iXensor Co., Ltd, Taiwan
- China Medical University and Beigang Hospital, Taiwan
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Fritzen K, Basinska K, Stautner C, Braun KF, Rubio-Almanza M, Nicolucci A, Kennon B, Vergès B, Hosny Y, Schnell O. Budget Impact of Improved Diabetes Management by Utilization of Glucose Meters With a Color-Range Indicator-Comparison of Five European Healthcare Systems. J Diabetes Sci Technol 2020; 14:262-270. [PMID: 31387385 PMCID: PMC7196878 DOI: 10.1177/1932296819864665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIM Costs for the treatment of diabetes and its comorbidities are a major international issue. A recent randomized clinical trial showed that the introduction of color range indicator (CRI)-based glucose meters (GMs) positively affects the HbA1c of patients with type 1 and type 2 diabetes, when compared to GMs without a CRI. This budget impact analysis aimed to translate this beneficial effect of CRI-based GMs, OneTouch Verio Flex and OneTouch Verio, into potential monetary impact for the healthcare systems of five European countries, Germany, Spain, Italy, France, and the United Kingdom. MATERIAL AND METHODS Data from a randomized controlled trial, evaluating the effect of CRI-based GMs, were used to estimate the ten-year risk of patients for fatal myocardial infarction (MI) as calculated by the UK Prospective Diabetes Study (UKPDS) risk engine. On the basis of assessed risks for MI, the potential monetary impact for the healthcare systems in five European countries was modeled. RESULTS Based on a mean HbA1c reduction of 0.36%, as demonstrated in a randomized controlled trial, the UKPDS risk engine estimated a reduction of 2.4% of the ten-year risk of patients for fatal MI. When applied to our economic model, substantial potential cost savings for the healthcare systems of five European countries were calculated: €547 472 (France), €9.0 million (Germany), €6.0 million (Italy), €841 799 (Spain), and €421 069 (United Kingdom) per year. CONCLUSION Improving metabolic control in patients with diabetes by the utilization of CRI-based GMs may have substantial positive effects on the expenditure of the healthcare systems of several European countries.
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Affiliation(s)
| | - Kornelia Basinska
- Sciarc GmbH, Baierbrunn, Germany
- Institute of Nursing Science, Faculty of
Medicine, University of Basel, Switzerland
| | | | - Karl F. Braun
- Klinik und Poliklinik für
Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München,
Germany
| | - Matilde Rubio-Almanza
- Endocrinology and Nutrition Department
Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La
Fe, Valencia, Spain
| | - Antonio Nicolucci
- Center for Outcomes Research and
Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Brian Kennon
- FRCP, Diabetes Centre, Queen Elizabeth
University Hospital, Glasgow, UK
| | - Bruno Vergès
- Endocrinologie, Diabétologie, Maladies
Métaboliques et Nutrition, Centre Hospitalier Universitaire Dijon Bourgogne,
France
| | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany
- Forschergruppe Diabetes e.V.,
Muenchen-Neuherberg, Germany
- Oliver Schnell, MD, Forschergruppe Diabetes
e.V., Helmholtz Zentrum Muenchen, Ingolstaedter Landstraße 1,
Muenchen-Neuherberg 85764, Germany.
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Shrestha M, Ng A, Al-Ghareeb A, Alenazi F, Gray R. Association between subthreshold depression and self-care behaviors in people with type 2 diabetes: a systematic review of observational studies. Syst Rev 2020; 9:45. [PMID: 32113485 PMCID: PMC7049390 DOI: 10.1186/s13643-020-01302-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Self-care behaviors in people living with type 2 diabetes are important to achieving optimal glycemic control. Major depression in type 2 diabetes is associated with decreased adherence to self-care behaviors. The association between subthreshold depression and self-care behaviors, however, has not previously been systematically reviewed. The objective of this review is to determine the association between subthreshold depression and self-care behaviors. METHODS A systematic search was performed in five electronic databases that included MEDLINE, EMBASE, PsycINFO, Emcare, and CINAHL. Any observational studies in adults with type 2 diabetes, investigating the association between subthreshold depression and any self-care behaviors, were included in the review. Qualitative studies, review articles, and gray literature were excluded. Two reviewers independently completed the title and abstract and full-text screening, appraised the study quality, and extracted the data. A third reviewer resolved any discrepancies between the reviewers if needed. Included articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Meta-analyses were not conducted because criteria for conducting such analyses were not met. RESULTS A total of 6408 articles were identified through the database searching. After the abstract and full-text review, two articles met the inclusion criteria. One of the included study was cross-sectional while the other was a longitudinal study. Both studies showed inconsistent findings in the association between subthreshold depression and self-care behaviors. Important risks of bias were identified in the included studies. DISCUSSION The evidence from the two included studies on a possible association between subthreshold depression and self-care behaviors in adults with type 2 diabetes was not consistent and potentially biased. Our review established a gap in knowledge and suggests that further high-quality studies are needed to examine the association between subthreshold depression and self-care behaviors in people with type 2 diabetes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018116373.
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Affiliation(s)
- Monika Shrestha
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia. .,Global Institute for Interdisciplinary Studies (GIIS), Kathmandu, Nepal.
| | - Ashley Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Australia
| | | | - Fatimah Alenazi
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,University of South Australia, Adelaide, Australia.,University of Essex, Colchester, Essex, UK
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Wang J, Wang MY, Wang H, Liu HW, Lu R, Duan TQ, Li CP, Cui Z, Liu YY, Lyu YJ, Ma J. Status of glycosylated hemoglobin and prediction of glycemic control among patients with insulin-treated type 2 diabetes in North China: a multicenter observational study. Chin Med J (Engl) 2020; 133:17-24. [PMID: 31923100 PMCID: PMC7028203 DOI: 10.1097/cm9.0000000000000585] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Blood glucose control is closely related to type 2 diabetes mellitus (T2DM) prognosis. This multicenter study aimed to investigate blood glucose control among patients with insulin-treated T2DM in North China and explore the application value of combining an elastic network (EN) with a machine-learning algorithm to predict glycemic control. METHODS Basic information, biochemical indices, and diabetes-related data were collected via questionnaire from 2787 consecutive participants recruited from 27 centers in six cities between January 2016 and December 2017. An EN regression was used to address variable collinearity. Then, three common machine learning algorithms (random forest [RF], support vector machine [SVM], and back propagation artificial neural network [BP-ANN]) were used to simulate and predict blood glucose status. Additionally, a stepwise logistic regression was performed to compare the machine learning models. RESULTS The well-controlled blood glucose rate was 45.82% in North China. The multivariable analysis found that hypertension history, atherosclerotic cardiovascular disease history, exercise, and total cholesterol were protective factors in glycosylated hemoglobin (HbA1c) control, while central adiposity, family history, T2DM duration, complications, insulin dose, blood pressure, and hypertension were risk factors for elevated HbA1c. Before the dimensional reduction in the EN, the areas under the curve of RF, SVM, and BP were 0.73, 0.61, and 0.70, respectively, while these figures increased to 0.75, 0.72, and 0.72, respectively, after dimensional reduction. Moreover, the EN and machine learning models had higher sensitivity and accuracy than the logistic regression models (the sensitivity and accuracy of logistic were 0.52 and 0.56; RF: 0.79, 0.70; SVM: 0.84, 0.73; BP-ANN: 0.78, 0.73, respectively). CONCLUSIONS More than half of T2DM patients in North China had poor glycemic control and were at a higher risk of developing diabetic complications. The EN and machine learning algorithms are alternative choices, in addition to the traditional logistic model, for building predictive models of blood glucose control in patients with T2DM.
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Affiliation(s)
- Jiao Wang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Meng-Yang Wang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Hui Wang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Hong-Wei Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Rui Lu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Tong-Qing Duan
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Chang-Ping Li
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Zhuang Cui
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yuan-Yuan Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yuan-Jun Lyu
- Department of Endocrinology, Tianjin Hospital, Tianjin 300211, China
| | - Jun Ma
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
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Meetoo D, Wong L, Ochieng B. Smart tattoo: technology for monitoring blood glucose in the future. ACTA ACUST UNITED AC 2019; 28:110-115. [PMID: 30673318 DOI: 10.12968/bjon.2019.28.2.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
New ways of measuring blood glucose bring hope of easing the burden of diabetes management for patients living with the conditions. The smart tattoo is an innovation that represents a nascent nanotechnology, which is designed to be implanted within the skin to provide continuous and reliable glucose detection for individuals diagnosed with diabetes. The potential benefits of the smart tattoo are compelling not only due to the potential of these nanodevices to prevent diabetic complications and decrease the related social costs, but also due to ease of use and relative user comfort. However, despite the advantages of the smart tattoo, it is important that health professionals, in embracing nanotechnology, understand the ethical implications of using these innovative devices.
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Affiliation(s)
- Danny Meetoo
- Programme Leader, MSc Diabetes Care, University of Salford
| | - Louise Wong
- Advanced Practitioner-Diabetes, Department of Diabetes and Endocrinology, Salford Royal Foundation (NHS) Trust
| | - Bertha Ochieng
- Professor of Integrated Health and Social Care, Faculty of Health and Life Sciences, De Montfort University, Leicester
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Dong Q, Huang J, Liu S, Yang L, Li J, Li B, Zhao X, Li Z, Wu L. A survey on glycemic control rate of type 2 diabetes mellitus with different therapies and patients' satisfaction in China. Patient Prefer Adherence 2019; 13:1303-1310. [PMID: 31534317 PMCID: PMC6682321 DOI: 10.2147/ppa.s198908] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
AIM To compare the blood glucose control of patients with type 2 diabetes mellitus (T2DM) with different treatment methods, oral hypoglycemic agents (OHA) monotherapy, insulin injection and combined therapy (OHA + insulin injection) and evaluate their satisfaction with the medical care. METHODS A total of 1512 T2DM patients were assessed, to compare the effects of different treatment methods on glycemic control in T2DM patients, the influencing factors of patients' satisfaction with medical care measures and their relationship with glycemic control. Fasting plasma glucose (FPG), 2 hrs postprandial plasma glucose (2hPG) and HbA1c were measured as the standard of the glycemic control. Satisfaction was defined using the simplified version of DAWN of chronic disease care patient scale (PACIC - DSF). RESULTS In this study, the FPG compliance rate, 2hPG compliance rate and HbA1c compliance rate were 25.5%, 22.7% and 19.5%, respectively. The differences in the glycemic control compliance rates of different treatment methods were not statistically significant. The total score of PACIC - DSF was 34.54±11.65(p>0.05), and the influencing factors included fast blood glucose (FBG) and 2hPG, 2hPG and PACIC - DSF were negatively correlated. CONCLUSIONS The T2DM glycemic control rate in China is currently low. From the score of the PACIC - DSF, there is no significant difference in general satisfaction with medical care measures in different treatments. What is more, education level, occupation and exercise of patients with type 2 diabetes had influence on PACIC - DSF score. Different treatment methods have no influence on the glycemic control of patients with T2DM. FPG value and the 2hPG value are negative correlation with the satisfaction of patients in medical care measures.
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Affiliation(s)
- Qiaoliang Dong
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
| | - Jin Huang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
| | - Shunying Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
| | - Lingfeng Yang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
| | - Juan Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
| | - Bei Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
| | - Xue Zhao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
| | - Zaizhao Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
| | - Liaofang Wu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province410011, People’s Republic of China
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Frías-Ordoñez JS, Pérez-Gualdrón CE. Self-monitoring of blood glucose as control tool in the different management contexts for Type 2 Diabetes Mellitus. What is its current role in non-insulin users? REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n3.69687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Self-monitoring blood glucose (SMBG) has been considered a key element in the management of Type 2 Diabetes Mellitus (T2DM). However, its role in glycemic control in non-insulin users has been long discussed.Objective: To conduct a narrative literature review of the benefits of SMBG in non-insulin-treated patients with T2DM.Materials and Methods: A scientific literature search was conducted in the following databases: Pubmed, ScienceDirect, Embase, SciELO, Cochrane and Medline. Relevant articles were selected according to the established criteria. In addition, some studies included in the references of the initially selected articles were added to the review since they were considered relevant for its objective.Results: The following records were included in the review: 14 controlled clinical trials, 13 observational studies, 10 clinical practice guidelines, 7 narrative reviews, 5 meta-analyses, and 1 systematic review.Conclusion: based on the evidence found in this review it is possible to say that the use of SMBG in patients with T2DM is beneficial and that it has a positive impact on non-insulin users in terms of achieving glycemic control and defining therapeutic changes.
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Xu Y, Tan DHY, Lee JYC. Evaluating the impact of self-monitoring of blood glucose frequencies on glucose control in patients with type 2 diabetes who do not use insulin: A systematic review and meta-analysis. Int J Clin Pract 2019; 73:e13357. [PMID: 31033116 DOI: 10.1111/ijcp.13357] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022] Open
Abstract
AIMS International diabetes guidelines have not established the frequencies of self-monitoring of blood glucose in patients with type 2 diabetes (T2D) who do not use insulin. The present study aimed to assess the impact of self-monitoring of blood glucose (SMBG) frequencies on the glucose control and other outcomes in non-insulin-treated patients with T2D. METHODS A literature search was performed in four databases. Randomised controlled trials with ≥6-month follow-up duration that compared the impact of different frequencies of SMBG on glycated haemoglobin A1c (HbA1c) were included. Studies with abstract only or reported effects of SMBG as a secondary outcome were excluded. RESULTS Of the 1557 studies identified, 12 RCTs with a total of 3350 patients were analysed. Overall, performing SMBG for 8 to 14 times per week was correlated with a better HbA1c control at 6 months (MD -0.46%, 95% CI -0.54 to -0.39) and 12 months (MD -0.20%, 95% CI -0.29 to -0.11). However, up to seven measurements of SMBG per week did not significantly affect glycaemic control. In addition, performing SMBG between 8 and 14 times per week was also associated with improved BMI (MD -0.46, 95% CI -0.84 to -0.08). When the results of SMBG were applied to adjust diabetes medication, a significant reduction in HbA1c levels was observed in the intervention arm compared to the control arm. CONCLUSIONS Eight to 14 measurements of SMBG per week were associated with an improved glycaemic control and a reduced BMI in patients with T2D not using insulin.
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Affiliation(s)
- Yingqi Xu
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | | | - Joyce Yu-Chia Lee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
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Parsons SN, Luzio SD, Harvey JN, Bain SC, Cheung WY, Watkins A, Owens DR. Effect of structured self-monitoring of blood glucose, with and without additional TeleCare support, on overall glycaemic control in non-insulin treated Type 2 diabetes: the SMBG Study, a 12-month randomized controlled trial. Diabet Med 2019; 36:578-590. [PMID: 30653704 PMCID: PMC6593419 DOI: 10.1111/dme.13899] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 12/20/2022]
Abstract
AIM To examine the impact of structured self-monitoring of blood glucose, with or without TeleCare support, on glycaemic control in people with sub-optimally controlled Type 2 diabetes. METHODS We conducted a 12-month, multicentre, randomized controlled trial in people with established (>1 year) Type 2 diabetes not on insulin therapy, with sub-optimal glycaemic control [HbA1c ≥58 to ≤119 mmol/mol (≥7.5% to ≤13%)]. A total of 446 participants were randomized to a control group (n =151) receiving usual diabetes care, a group using structured self-monitoring of blood glucose alone (n =147) or a group using structured self-monitoring of blood glucose with additional monthly 'TeleCare' support (n =148). The primary outcome was HbA1c at 12 months. RESULTS A total of 323 participants (72%) completed the study; 116 (77%) in the control group, 99 (67%) in the self-monitoring of blood glucose alone group and 108 (73%) in the self-monitoring of blood glucose plus TeleCare group. Compared to baseline, the mean HbA1c was lower in all groups at 12 months, with reductions of 3.3 mmol/mol (95% CI -5.71 to -0.78) or 0.3% (95% CI -0.52 to -0.07; P=0.01) in the control group, 11.4 mmol/mol (95% CI -14.11 to -8.76) or 1.1% (-1.29 to -0.81; P<0.0001) in the group using self-monitoring of blood glucose alone and 12.8 mmol/mol (95% CI -15.34 to -10.31) or 1.2% (95% CI -1.40 to -0.94; P<0.0001) in the group using self-monitoring of blood glucose plus TeleCare. This represents a reduction in HbA1c of 8.9 mmol/mol (95% CI -11.97 to -5.84) or 0.8% (95% CI -1.10 to -0.54; P≤0.0001) with structured self-monitoring of blood glucose compared to the control group. Participants with lower baseline HbA1c , shorter duration of diabetes and higher educational achievement were more likely to achieve HbA1c ≤53 mmol/mol (7.0%). CONCLUSIONS Structured self-monitoring of blood glucose provides clinical and statistical improvements in glycaemic control in Type 2 diabetes. No additional benefit, over and above the use of structured self-monitoring of blood glucose, was observed in glycaemic control with the addition of once-monthly TeleCare support. (Clinical trial registration no.: ISRCTN21390608).
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Affiliation(s)
| | - S. D. Luzio
- Diabetes Research GroupSwansea UniversitySwansea
| | - J. N. Harvey
- Diabetes CentreWrexham Maelor HospitalBetsi Cadwaladr University Health BoardBangorUK
| | - S. C. Bain
- Diabetes Research GroupSwansea UniversitySwansea
| | - W. Y. Cheung
- Diabetes Research GroupSwansea UniversitySwansea
| | - A. Watkins
- Swansea Trials UnitSwansea UniversitySwanseaUK
| | - D. R. Owens
- Diabetes Research GroupSwansea UniversitySwansea
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Wang HC, Chang FY, Tsai TM, Chen CH, Chen YY. Design, fabrication, and feasibility analysis of a colorimetric detection system with a smartphone for self-monitoring blood glucose. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-7. [PMID: 30793568 PMCID: PMC6988182 DOI: 10.1117/1.jbo.24.2.027002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/22/2019] [Indexed: 05/28/2023]
Abstract
Maintaining appropriate insulin levels is very important for diabetes patients. Effective monitoring of blood glucose can aid in maintaining the body's insulin level, and thus reduce disease severities, secondary complications, and related mortalities. However, existing blood glucose measurement devices are inconvenient to carry and involve complex procedures, reducing the willingness of diabetes patients to regularly measure blood glucose. We aim to provide a rapid, convenient, and portable meter for diabetes patients. We introduce an integrated blood glucose detection device (IBGDD) that has no electronic component and uses the optical sensing module of a smartphone to inspect colorimetric blood strips. To demonstrate accuracy conformance of the developed device to the ISO 15197:2013 standard for blood glucose measurement, 20 diabetes mellitus patients used the IBGDD with smartphones to measure their blood glucose level. The measurement results revealed an accuracy of 100%, completely satisfying the requirements of the ISO 15197:2013 standard. Overall, our specially designed IBGDD with a smartphone could achieve high accuracy and convenient usage for the measurement of blood glucose concentration. Furthermore, the device is highly portable and simple to operate. This contributes toward achieving self-monitoring of blood glucose by diabetes patients and improved mobile health in the future.
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Affiliation(s)
- Hung-Chih Wang
- National Taiwan University of Science and Technology, Department of Mechanical Engineering Taipei, Taiwan
| | - Fuh-Yu Chang
- National Taiwan University of Science and Technology, Department of Mechanical Engineering Taipei, Taiwan
| | | | - Chieh-Hsiao Chen
- iXensor Co. Ltd., Taipei, Taiwan
- China Medical University and Beigang Hospital, Taichung, Taiwan
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Tomah S, Mahmoud N, Mottalib A, Pober DM, Tasabehji MW, Ashrafzadeh S, Hamdy O. Frequency of self-monitoring of blood glucose in relation to weight loss and A1C during intensive multidisciplinary weight management in patients with type 2 diabetes and obesity. BMJ Open Diabetes Res Care 2019; 7:e000659. [PMID: 31413841 PMCID: PMC6673765 DOI: 10.1136/bmjdrc-2019-000659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/01/2019] [Accepted: 07/12/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE We evaluated the relationship between frequency of self-monitoring of blood glucose (SMBG) and body weight, A1C, and cardiovascular risk factors in patients with type 2 diabetes (T2D) and obesity enrolled in a 12-week intensive multidisciplinary weight management (IMWM) program. RESEARCH DESIGN AND METHODS We conducted a retrospective analysis of 42 patients who electronically uploaded their SMBG data over 12 weeks of an IMWM program and divided them into tertiles based on their average frequency of SMBG per day. Mean (range) SMBG frequencies were 2.3 (1.1-2.9) times/day, 3.4 (3-3.9) times/day, and 5 (4-7.7) times/day in the lowest, middle, and highest tertiles, respectively. Anthropometric and metabolic parameters were measured at baseline and after 12 weeks of intervention. RESULTS Participants in the highest tertile achieved a median change (IQR) in body weight of -10.4 kg (-7.6 to -14.4 kg) compared with -8.3 kg (-5.2 to -12.2 kg), and -6.9 kg (-4.2 to -8.9 kg) in the middle and lowest tertiles, respectively (p=0.018 for trend). Participants in the highest tertile had a median change (IQR) in A1C of -1.25% (-0.6 to -3.1%) compared with -0.8% (-0.3% to -2%) and -0.5% (-0.2% to -1.2%) in the middle and lowest tertiles, respectively (p=0.048 for trend). The association between change in body weight and SMBG frequency remained significant after adjusting for age, sex, baseline body mass index, diabetes duration, and use of insulin therapy. CONCLUSIONS Increased frequency of SMBG during IMWM is associated with significantly better weight loss and improvement of A1C in patients with T2D and obesity. These findings may suggest future clinical recommendations aimed at increasing SMBG frequency to achieve the most favorable outcomes.
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Affiliation(s)
- Shaheen Tomah
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Noor Mahmoud
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Adham Mottalib
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - David M Pober
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mhd Wael Tasabehji
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sahar Ashrafzadeh
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Osama Hamdy
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
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Nkhoma K, Norton C, Sabin C, Winston A, Merlin J, Harding R. Self-management Interventions for Pain and Physical Symptoms Among People Living With HIV: A Systematic Review of the Evidence. J Acquir Immune Defic Syndr 2018; 79:206-225. [DOI: 10.1097/qai.0000000000001785] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Machry RV, Rados DV, Gregório GRD, Rodrigues TC. Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis. Diabetes Res Clin Pract 2018; 142:173-187. [PMID: 29857093 DOI: 10.1016/j.diabres.2018.05.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 04/29/2018] [Accepted: 05/22/2018] [Indexed: 11/15/2022]
Abstract
AIMS Systematic review and meta-analysis to evaluate the effect of Self-Monitoring of Blood Glucose (SMBG) on glycemic control in patients with type 2 Diabetes (T2D). METHODS We searched the Medline, Embase, Cochrane Central, and ClinicalTrials.gov databases up to 20 July 2017. We also performed a manual search of abstracts from recent meetings of the American Diabetes Association and the European Association for the Study of Diabetes. STUDY SELECTION randomized controlled trials (RCTs) conducted in patients with T2D comparing any kind of SMBG to a control group. Two independent reviewers assessed the eligibility of references. Influence of SMBG in glycated hemoglobin (HbA1c) was aggregated as weighted mean difference accessed by direct random effect meta-analyses at 12, 24 weeks and 1 year. Sub-analyses were made to assess the effects of previous glycemic control and number of tests performed. RESULTS SMBG was associated with a reduction of HbA1c at 12 weeks (-0.31%; 95% CI: -0.57 to -0.05) and 24 weeks (-0.34%; 95%CI: -0.52 to -0.17), but no difference was found for 1 year. Subgroup analysis including studies with baseline HbA1c greater than 8% showed a higher reduction of HbA1c: -0.83% (95% CI: -1.55 to -0.11) at 12 weeks, and -0.48% (95% CI: -0.77 to -0.19) at 24 weeks, with no difference for 1 year nor for the stratification for number the tests. CONCLUSION SMBG seems to lead to a slightly better glycemic control in the short term in patients with T2D. Patients decompensated at baseline appear to have the greatest benefit. PROSPERO register: CRD42016033558.
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Affiliation(s)
- Rafael Vaz Machry
- Post Graduate Program in Medical Sciences - Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Department of Internal Medicine, Medical School, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
| | - Dimitris Varvaki Rados
- Post Graduate Program in Medical Sciences - Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Ticiana Costa Rodrigues
- Post Graduate Program in Medical Sciences - Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Biosensing Technologies for Medical Applications, Manufacturing, and Regenerative Medicine. CURRENT STEM CELL REPORTS 2018. [DOI: 10.1007/s40778-018-0123-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Affiliation(s)
- Kyung Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Song YS, Koo BK, Kim SW, Yi KH, Shin K, Moon MK. Improvement of Glycosylated Hemoglobin in Patients with Type 2 Diabetes Mellitus under Insulin Treatment by Reimbursement for Self-Monitoring of Blood Glucose. Diabetes Metab J 2018; 42:28-42. [PMID: 29199404 PMCID: PMC5842298 DOI: 10.4093/dmj.2018.42.1.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/07/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In Korea, the costs associated with self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes mellitus (T2DM) under insulin treatment have been reimbursed since November 2015. We investigated whether this new reimbursement program for SMBG has improved the glycemic control in the beneficiaries of this policy. METHODS Among all adult T2DM patients with ≥3 months of reimbursement (n=854), subjects without any changes in anti-hyperglycemic agents during the study period were selected. The improvement of glycosylated hemoglobin (HbA1c) was defined as an absolute reduction in HbA1c ≥0.6% or an HbA1c level at follow-up <7%. RESULTS HbA1c levels significantly decreased from 8.5%±1.3% to 8.2%±1.2% during the follow-up (P<0.001) in all the study subjects (n=409). Among them, 35.5% (n=145) showed a significant improvement in HbA1c. Subjects covered under the Medical Aid system showed a higher prevalence of improvement in HbA1c than those with medical insurance (52.2% vs. 33.3%, respectively, P=0.012). In the improvement group, the baseline HbA1c (P<0.001), fasting C-peptide (P=0.016), and daily dose of insulin/body weight (P=0.024) showed significant negative correlations with the degree of HbA1c change. Multivariate analysis showed that subjects in the Medical Aid system were about 2.5-fold more likely to improve in HbA1c compared to those with medical insurance (odds ratio, 2.459; 95% confidence interval, 1.138 to 5.314; P=0.022). CONCLUSION The reimbursement for SMBG resulted in a significant improvement in HbA1c in T2DM subjects using insulin, which was more prominent in subjects with poor glucose control at baseline or covered under the Medical Aid system.
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Affiliation(s)
- Young Shin Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
- Center for Medical Informatics, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Kichul Shin
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
- Center for Medical Informatics, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
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Mannucci E, Antenore A, Giorgino F, Scavini M. Effects of Structured Versus Unstructured Self-Monitoring of Blood Glucose on Glucose Control in Patients With Non-insulin-treated Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. J Diabetes Sci Technol 2018; 12:183-189. [PMID: 28697625 PMCID: PMC5761981 DOI: 10.1177/1932296817719290] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of self-monitoring of blood glucose (SMBG) in patients with non-insulin-treated type 2 diabetes is debated. Meta-analyses of randomized clinical trials (RCTs) suggest a small reduction of HbA1c in patients using SMBG, without considering potential confounders, such as SMBG regimen and use of SMBG data to adjust diabetes medications. METHODS A meta-analysis was performed including RCTs in patients with non-insulin-treated type 2 diabetes, with an intervention of ≥24 weeks and HbA1c as the primary endpoint, to verify the effect of SMBG (vs no monitoring), structured SMBG (vs unstructured), and of SMBG-driven therapy adjustments. RESULTS In RCTs (n = 8) comparing SMBG with no SMBG (1277 and 1072 patients, respectively), SMBG reduced HbA1c by -0.17% (95% CI -0.25 to -0.09%, P < .003). The reduction in HbA1c was greater in RCTs (n = 3) in which SMBG data were used to adjust diabetes medications (HbA1c decrease: -0.3% [95% CI -0.49 to -0.1%]) than in RCTs (n = 6) where SMBG data were not used for this purpose (HbA1c decrease: -0.1% [95% CI -0.2 to 0.0%]) ( P < .005). In the RCTs comparing structured and unstructured SMBG (757 and 750 patients, respectively), in which structured SMBG data were also used to adjust diabetes medications, the HbA1c difference between groups at study end was -0.27% (95% CI -0.49 to -0.04%, P < .018). CONCLUSIONS In RCTs performed in non-insulin-treated patients with type 2 diabetes, SMBG is associated with a significant, although small, reduction in HbA1c. HbA1c reduction was greater with structured SMBG and when structured SMBG data were used to adjust diabetes therapy.
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Affiliation(s)
| | | | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Marina Scavini
- Diabetes Research Institute, San Raffaele Hospital & Scientific Institute, Milan, Italy
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Young LA, Buse JB, Weaver MA, Vu MB, Mitchell CM, Blakeney T, Grimm K, Rees J, Niblock F, Donahue KE. Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial. JAMA Intern Med 2017; 177:920-929. [PMID: 28600913 PMCID: PMC5818811 DOI: 10.1001/jamainternmed.2017.1233] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
IMPORTANCE The value of self-monitoring of blood glucose (SMBG) levels in patients with non-insulin-treated type 2 diabetes has been debated. OBJECTIVE To compare 3 approaches of SMBG for effects on hemoglobin A1c levels and health-related quality of life (HRQOL) among people with non-insulin-treated type 2 diabetes in primary care practice. DESIGN, SETTING, AND PARTICIPANTS The Monitor Trial study was a pragmatic, open-label randomized trial conducted in 15 primary care practices in central North Carolina. Participants were randomized between January 2014 and July 2015. Eligible patients with type 2 non-insulin-treated diabetes were: older than 30 years, established with a primary care physician at a participating practice, had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5% within the 6 months preceding screening, as obtained from the electronic medical record, and willing to comply with the results of random assignment into a study group. Of the 1032 assessed for eligibility, 450 were randomized. INTERVENTIONS No SMBG, once-daily SMBG, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the meter. MAIN OUTCOMES AND MEASURES Coprimary outcomes included hemoglobin A1c levels and HRQOL at 52 weeks. RESULTS A total of 450 patients were randomized and 418 (92.9%) completed the final visit. There were no significant differences in hemoglobin A1c levels across all 3 groups (P = .74; estimated adjusted mean hemoglobin A1c difference, SMBG with messaging vs no SMBG, -0.09%; 95% CI, -0.31% to 0.14%; SMBG vs no SMBG, -0.05%; 95% CI, -0.27% to 0.17%). There were also no significant differences found in HRQOL. There were no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation. CONCLUSIONS AND RELEVANCE In patients with non-insulin-treated type 2 diabetes, we observed no clinically or statistically significant differences at 1 year in glycemic control or HRQOL between patients who performed SMBG compared with those who did not perform SMBG. The addition of this type of tailored feedback provided through messaging via a meter did not provide any advantage in glycemic control. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02033499.
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Affiliation(s)
- Laura A Young
- Division of Endocrinology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - John B Buse
- Division of Endocrinology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Mark A Weaver
- Departments of Medicine and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Maihan B Vu
- Center for Health Promotion and Disease Prevention, UNC Chapel Hill, North Carolina
| | - C Madeline Mitchell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Tamara Blakeney
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kimberlea Grimm
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Jennifer Rees
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Franklin Niblock
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Katrina E Donahue
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill.,Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
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Farhan SA, Shaikh AT, Zia M, Kahara BR, Muneer R, Rehman M, Mubashir A, Sadiq H, Siddiqui DEA, Haseeb SM, Tanveer H, Siddiq K, Mujtaba SB, Mirza SA, Feroz H, Fatima K. Prevalence and Predictors of Home Use of Glucometers in Diabetic Patients. Cureus 2017; 9:e1330. [PMID: 28698830 PMCID: PMC5503458 DOI: 10.7759/cureus.1330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/09/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a critical component of diabetes care. However, it has been shown that use of glucometers in developing countries such as Pakistan is limited. The aim of this study was to determine the frequency of glucometer usage in the urban diabetic population of Karachi and to identify variables that influenced the likelihood of practice of SMBG. METHODS A cross-sectional study was conducted among 567 adult diabetic patients selected at random from the out-patient departments of multiple healthcare institutions in Karachi categorized into two settings; Government and Private. Non-diabetics, patients having gestational diabetes, diabetes insipidus and Cushing's syndrome and terminally ill patients were excluded. Pearson Chi-square and Mann-Whitney U test were applied as the primary statistical method. RESULTS Prevalence of home glucometer usage was 59% (n= 331). High socioeconomic status (p < 0.001), receiving care from private institutions (p < 0.001), higher education (p < 0.001), a family history of diabetes (p =0.001), awareness regarding diabetes (p < 0.001), having diabetes for > five years (p <0.001), and managing diabetes via pharmacological interventions (p <0.001) (versus diet and exercise) were significant positive predictors of glucometer usage. CONCLUSIONS Our study demonstrates the increasing trend in use of SMBG. Lack of awareness and cost of glucometers were reported to be the main reasons for not practicing SMBG. Given these factors are easily modifiable, government subsidized initiatives and awareness programs can result in a successful public health strategy to promote SMBG.
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Affiliation(s)
- Syed A Farhan
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Ali T Shaikh
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Maria Zia
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Bilal R Kahara
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Ramsha Muneer
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Muzna Rehman
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Ayesha Mubashir
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hassaan Sadiq
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | | | - Syed M Haseeb
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hafsa Tanveer
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Khadijah Siddiq
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Saib B Mujtaba
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Samir A Mirza
- Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hira Feroz
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Kaneez Fatima
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
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Young LA, Buse JB, Weaver MA, Vu MB, Reese A, Mitchell CM, Blakeney T, Grimm K, Rees J, Donahue KE. Three approaches to glucose monitoring in non-insulin treated diabetes: a pragmatic randomized clinical trial protocol. BMC Health Serv Res 2017; 17:369. [PMID: 28545493 PMCID: PMC5445357 DOI: 10.1186/s12913-017-2202-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 03/30/2017] [Indexed: 11/26/2022] Open
Abstract
Background For the nearly 75% of patients living with type 2 diabetes (T2DM) that do not use insulin, decisions regarding self-monitoring of blood glucose (SMBG) can be especially problematic. While in theory SMBG holds great promise for sparking favorable behavior change, it is a resource intensive activity without firmly established patient benefits. This study describes our study protocol to assess the impact of three different SMBG testing approaches on patient-centered outcomes in patients with non-insulin treated T2DM within a community-based, clinic setting. Methods/Design Using stakeholder engagement approach, we developed and implemented a pragmatic trial of patient with non-insulin treated T2DM patients from five primary care practices randomized to one of three SMBG regimens: 1) no testing; 2) once daily testing with standard feedback consisting of glucose values being immediately reported to the patient through the glucose meter; and 3) once daily testing with enhanced patient feedback consisting of glucose values being immediately reported to the patient PLUS automated, tailored feedback messaging delivered to the patient through the glucose meter following each testing. Main outcomes assessed at 52 weeks include quality of life and glycemic control. Discussion This pragmatic trial seeks to better understand the value of SMBG in non-insulin treated patients with T2DM. This paper outlines the protocol used to implement this study in fifteen community-based primary care practices and highlights the impact of stakeholder involvement from the earliest stages of project conception and implementation. Plans for stakeholder involvement for result dissemination are also discussed. Trial registration ClinicalTrials.gov NCT02033499, January 9, 2014.
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Affiliation(s)
- Laura A Young
- Division of Endocrinology, Department of General Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, 8025 Burnett Womack Building, Campus Box # 7172 UNC-CH, Chapel Hill, NC, 27599-7170, USA. .,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - John B Buse
- Division of Endocrinology, Department of General Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, 8025 Burnett Womack Building, Campus Box # 7172 UNC-CH, Chapel Hill, NC, 27599-7170, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark A Weaver
- UNC Gillings School of Global Public Health, Chapel Hill, USA
| | - Maihan B Vu
- Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, USA
| | - April Reese
- North Carolina Division of Public Health, Chapel Hill, USA
| | - C Madeline Mitchell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tamara Blakeney
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kimberlea Grimm
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Rees
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katrina E Donahue
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Claude Mbanya J, Aschner P, Chan JCN, Jose Gagliardino J, Saji J. Self-monitoring of blood glucose (SMBG) and glycaemic control in Cameroon: Results of the International Diabetes Management Practices Study (IDMPS). Diabetes Res Clin Pract 2017; 126:198-201. [PMID: 28259009 DOI: 10.1016/j.diabres.2016.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/20/2022]
Abstract
This study examined the relationship between self-monitoring of blood glucose (SMBG) and glycaemic control among patients from Cameroon. A minority of patients with diabetes owned a blood glucose meter; of these patients, most performed SMBG inconsistently. The lack of SMBG may be a contributing factor to the poor glycaemic control in the country.
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Affiliation(s)
- Jean Claude Mbanya
- Faculty of Medicine and Biomedical Sciences and Laboratory for Molecular Medicine and Metabolism, The Biotechnology Centre, University of Yaoundé 1, Yaoundé, Cameroon; Health of Population in Transition Medical Research Group, P.O. Box 8046, Yaoundé, Cameroon.
| | - Pablo Aschner
- Endocrinology Unit, Javeriana University, Bogotá, Colombia.
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
| | - Juan Jose Gagliardino
- Center of Experimental and Applied Endocrinology, National Scientific and Technical Research Council, Pan American Health Organization/World Health Organization Collaborating Centre for Diabetes, School of Medicine, National University of La Plata, La Plata, Argentina.
| | - Jude Saji
- Faculty of Medicine and Biomedical Sciences and Laboratory for Molecular Medicine and Metabolism, The Biotechnology Centre, University of Yaoundé 1, Yaoundé, Cameroon.
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Zhu H, Zhu Y, Leung SW. Is self-monitoring of blood glucose effective in improving glycaemic control in type 2 diabetes without insulin treatment: a meta-analysis of randomised controlled trials. BMJ Open 2016; 6:e010524. [PMID: 27591016 PMCID: PMC5020874 DOI: 10.1136/bmjopen-2015-010524] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The present study aimed to verify the effectiveness of self-monitoring of blood glucose (SMBG) in patients with non-insulin-treated type 2 diabetes (T2D). METHODS A comprehensive literature search was conducted in PubMed, Cochrane Library, Web of Science, ScienceDirect and ClinicalTrials.gov from their respective inception dates to 26 October 2015. Eligible randomised controlled trials (RCTs) were included according to prespecified criteria. The quality of the included RCTs was evaluated according to the Cochrane risk of bias tool, and the evidence quality of meta-analyses was assessed by the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. A meta-analysis of primary and secondary outcome measures was performed. Sensitivity and subgroup analyses were carried out to evaluate the robustness and heterogeneity of the findings. Begg's and Egger's tests were used to quantify publication biases. RESULTS A total of 15 RCTs, comprising 3383 patients with non-insulin-treated T2D, met the inclusion criteria. The SMBG intervention improved glycated haemoglobin (HbA1c) (mean difference -0.33; 95% CI -0.45 to -0.22; p=3.0730e-8; n=18), body mass index (BMI; -0.65; -1.18 to -0.12; p=0.0164; n=9) and total cholesterol (TC; -0.12; -0.20 to -0.04; p=0.0034; n=8) more effectively than the control in overall effect. The sensitivity analysis revealed little difference in overall effect, indicating the robustness of the results. SMBG moderated HbA1c levels better than the control in all subgroup analyses. Most of the RCTs had high risk of bias in blinding, while the overall quality of evidence for HbA1c was moderate according to the GRADE criteria. Publication bias was moderate for BMI. CONCLUSIONS SMBG improved HbA1c levels in the short term (≤6-month follow-up) and long term (≥12-month follow-up) in patients with T2D who were not using insulin. TRIAL REGISTRATION NUMBER CRD42015019099.
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Affiliation(s)
- Hongmei Zhu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yanan Zhu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Siu-wai Leung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
- School of Informatics, University of Edinburgh, Edinburgh, UK
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The impact of self-monitoring in chronic illness on healthcare utilisation: a systematic review of reviews. BMC Health Serv Res 2015; 15:565. [PMID: 26684011 PMCID: PMC4683734 DOI: 10.1186/s12913-015-1221-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/08/2015] [Indexed: 12/11/2022] Open
Abstract
Background Self-management interventions have been found to reduce healthcare utilisation in people with long-term conditions, but further work is needed to identify which components of these interventions are most effective. Self-monitoring is one such component and is associated with significant clinical benefits. The aim of this systematic review of reviews is to assess the impact of self-monitoring interventions on healthcare utilisation across a range of chronic illnesses. Methods An overview of published systematic reviews and meta-analyses. Multiple databases were searched (MEDLINE, CINAHL, PsycINFO, EMBASE, AMED, EBM and HMIC) along with the reference lists of included reviews. A narrative synthesis was performed, accompanied by calculation of the Corrected Cover Area to understand the impact of overlapping primary research papers. Results A total of 17 systematic reviews and meta-analyses across three chronic conditions, heart failure, hypertension and chronic obstructive pulmonary disease, were included. Self-monitoring was associated with significant reductions in hospitalisation and re-admissions to hospital. Conclusions Self-monitoring has the potential to reduce the pressure placed on secondary care services, but this may lead to increase in services elsewhere in the system. Further work is needed to determine how these findings affect healthcare costs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1221-5) contains supplementary material, which is available to authorized users.
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Chen R, Ji L, Chen L, Chen L, Cai D, Feng B, Kuang H, Li H, Li Y, Liu J, Shan Z, Sun Z, Tian H, Xu Z, Xu Y, Yang Y, Yang L, Yu X, Zhu D, Zou D. Glycemic control rate of T2DM outpatients in China: a multi-center survey. Med Sci Monit 2015; 21:1440-6. [PMID: 25986070 PMCID: PMC4448594 DOI: 10.12659/msm.892246] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM)-associated mortality and morbidity are strongly dependent on glycemic control. With T2DM prevalence increasing in China, we aimed to assess glycemic control rates in Chinese T2DM outpatients. Material/Methods A total of 9065 adult T2DM outpatients (5035 men) were assessed in 26 Chinese medical centers between August 2010 and April 2012. Patients were stratified according to BMI (kg/m2): <24, 24–28, and >28. Successful glycemic control was defined as glycated hemoglobin A1c (HbA1c) ≤7% or fasting plasma glucose (FPG) <7.0 mmol/L. Results Among the participants included in this study, 2939 had BMI <24, 3361 had BMI of 24–28, and 2764 had BMI >28. The glycemic control rate was only 32.6%, and the triple control rate for glycemia, blood pressure, and lipidemia was only 11.2%. Glycemic control rates by BMI group were 33.7% (<24), 33.8% (24–28), and 30.2% (>28) (p=0.005), and corresponding incidences of cardiovascular diseases (CVD) were 12.2%, 15.7%, and 15.9% (p<0.001). Multivariate logistic regression analysis demonstrated that older age (p<0.001), higher BMI (p=0.026), larger waist circumference (p<0.001), less education (p<0.001), and recent diagnosis (p<0.001) were independent risk factors for poor glycemic control. Conclusions The T2DM glycemic control rate in China is currently low, especially in older obese patients with poor education and recent diagnosis.
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Affiliation(s)
- Rong Chen
- Department of Endocrinology, Changhai Hospital of Second Military Medical University of Chinese PLA, Shanghai, China (mainland)
| | - Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing, China (mainland)
| | - Liming Chen
- Department of Metabolic Disease, Tianjin Medical University, Tianjin, China (mainland)
| | - Li Chen
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Dehong Cai
- Department of Endocrinology, Zhujiang Hospital of First Military Medical University, Guangzhou, Guangdong, China (mainland)
| | - Bo Feng
- Department of Endocrinology, Shanghai East Hospital, Shanghai, China (mainland)
| | - Hongyu Kuang
- Department of Endocrinology, Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Hong Li
- Department of Endocrinology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Yiming Li
- Department of Endocrinology, Huashan Hospital of Fudan University, Shanghai, China (mainland)
| | - Jing Liu
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, China (mainland)
| | - Zhongyan Shan
- Department of Endocrinology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China (mainland)
| | - Haoming Tian
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Zhangrong Xu
- Department of Endocrinology, The 306th Hospital of PLA, Beijing, China (mainland)
| | - Yancheng Xu
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Yuzhi Yang
- Department of Endocrinology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China (mainland)
| | - Liyong Yang
- Department of Endocrinology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Xuefeng Yu
- Department of Endocrinology, Tongji Hospital, Wuhan, Hubei, China (mainland)
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Dajin Zou
- Department of Endocrinology, Changhai Hospital of Second Military Medical University of Chinese PLA, Shanghai, China (mainland)
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Augusto MC, Nitsche MJT, Parada CMGDL, Zanetti ML, Carvalhaes MADBL. Evaluation of the Capillary Blood Glucose Self-monitoring Program. Rev Lat Am Enfermagem 2014; 22:801-9. [PMID: 25493676 PMCID: PMC4292667 DOI: 10.1590/0104-1169.3282.2483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 08/29/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE: to evaluate the structure, process and results of the Capillary Blood Glucose
Self-monitoring Program in a Brazilian city. METHOD: epidemiological, cross-sectional study. The methodological framework of
Donabedian was used to construct indicators of structure, process and outcome. A
random sample (n = 288) of users enrolled and 96 health professionals who worked
in the program was studied. Two questionnaires were used that were constructed for
this study, one for professionals and one for users, both containing data for the
evaluation of structure, process and outcome. Anthropometric measures and
laboratory results were collected by consulting the patients' health records. The
analysis involved descriptive statistics. RESULTS: most of the professionals were not qualified to work in the program and were not
knowledgeable about the set of criteria for patient registration. None of the
patients received complete and correct orientations about the program and the
percentage with skills to perform conducts autonomously was 10%. As regards the
result indicators, 86.4% of the patients and 81.3% of the professionals evaluated
the program positively. CONCLUSION: the evaluation indicators designed revealed that one of the main objectives of
the program, self-care skills, has not been achieved.
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Affiliation(s)
| | | | | | - Maria Lúcia Zanetti
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Relationship between self-monitoring of blood glucose and glycaemic control among patients attending a specialist diabetes clinic in Jamaica. Int J Diabetes Dev Ctries 2014. [DOI: 10.1007/s13410-014-0222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Czupryniak L, Barkai L, Bolgarska S, Bronisz A, Broz J, Cypryk K, Honka M, Janez A, Krnic M, Lalic N, Martinka E, Rahelic D, Roman G, Tankova T, Várkonyi T, Wolnik B, Zherdova N. Self-monitoring of blood glucose in diabetes: from evidence to clinical reality in Central and Eastern Europe--recommendations from the international Central-Eastern European expert group. Diabetes Technol Ther 2014; 16:460-75. [PMID: 24716890 PMCID: PMC4074758 DOI: 10.1089/dia.2013.0302] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Self-monitoring of blood glucose (SMBG) is universally considered to be an integral part of type 1 diabetes management and crucial for optimizing the safety and efficacy of complex insulin regimens. This extends to type 2 diabetes patients on intensive insulin therapy, and there is also a growing body of evidence suggesting that structured SMBG is beneficial for all type 2 diabetes patients, regardless of therapy. However, access to SMBG can be limited in many countries in Central and Eastern Europe. A consensus group of diabetes experts from 10 countries in this region (with overlapping historical, political, and social environments)--Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, Slovenia, and Ukraine--was formed to discuss the role of SMBG across the spectrum of patients with diabetes. The group considered SMBG to be an essential tool that should be accessible to all patients with diabetes, including those with non-insulin-treated type 2 diabetes. The current article summarizes the evidence put forward by the consensus group and provides their recommendations for the appropriate use of SMBG as part of individualized patient management. The ultimate goal of these evidence-based recommendations is to help patients and providers in Central and Eastern Europe to make optimal use of SMBG in order to maximize the efficacy and safety of glucose-lowering therapies, to prevent complications, and to empower the patient to play a more active role in the management of their diabetes.
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Affiliation(s)
- Leszek Czupryniak
- Internal Medicine and Diabetology Department, Medical University of Lodz, Lodz, Poland
| | - László Barkai
- Postgraduate Institute of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
- Department of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
| | - Svetlana Bolgarska
- Department of Diabetology, National Medical Academy of Post-Graduate Education, Institute of Endocrinology and Metabolism of National Academy of Medical Science, Kiev, Ukraine
| | - Agata Bronisz
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Toruń, Poland
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Jan Broz
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty Hospital Motol, Prague, Czech Republic
| | - Katarzyna Cypryk
- Department of Diabetology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Marek Honka
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty Hospital Motol, Prague, Czech Republic
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center, Ljubljana, Slovenia
| | | | - Nebojsa Lalic
- Department for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emil Martinka
- National Institute for Endocrinology and Diabetology, Lubochna, Slovakia
| | - Dario Rahelic
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dubrava University Hospital, Zagreb, Croatia
| | - Gabriela Roman
- Iuliu Hatieganu University of Medicine & Pharmacy, Clinical Center of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca, Romania
| | | | - Tamás Várkonyi
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Bogumił Wolnik
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Nadia Zherdova
- Department of Diabetology, National Medical Academy of Post-Graduate Education, Institute of Endocrinology and Metabolism of National Academy of Medical Science, Kiev, Ukraine
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Efficacy of blood glucose self-monitoring on glycemic control in patients with non-insulin-treated type 2 diabetes: A meta-analysis. Int J Nurs Sci 2014. [DOI: 10.1016/j.ijnss.2014.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 2014; 2014:CD007768. [PMID: 24777444 PMCID: PMC6491214 DOI: 10.1002/14651858.cd007768.pub3] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many systematic reviews exist on interventions to improve safe and effective medicines use by consumers, but research is distributed across diseases, populations and settings. The scope and focus of such reviews also vary widely, creating challenges for decision-makers seeking to inform decisions by using the evidence on consumers' medicines use.This is an update of a 2011 overview of systematic reviews, which synthesises the evidence, irrespective of disease, medicine type, population or setting, on the effectiveness of interventions to improve consumers' medicines use. OBJECTIVES To assess the effects of interventions which target healthcare consumers to promote safe and effective medicines use, by synthesising review-level evidence. SEARCH METHODS We included systematic reviews published on the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. We identified relevant reviews by handsearching databases from their start dates to March 2012. SELECTION CRITERIA We screened and ranked reviews based on relevance to consumers' medicines use, using criteria developed for this overview. DATA COLLECTION AND ANALYSIS We used standardised forms to extract data, and assessed reviews for methodological quality using the AMSTAR tool. We used standardised language to summarise results within and across reviews; and gave bottom-line statements about intervention effectiveness. Two review authors screened and selected reviews, and extracted and analysed data. We used a taxonomy of interventions to categorise reviews and guide syntheses. MAIN RESULTS We included 75 systematic reviews of varied methodological quality. Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation and skills acquisition. No reviews aimed to promote systems-level consumer participation in medicines-related activities. Medicines adherence was the most frequently-reported outcome, but others such as knowledge, clinical and service-use outcomes were also reported. Adverse events were less commonly identified, while those associated with the interventions themselves, or costs, were rarely reported.Looking across reviews, for most outcomes, medicines self-monitoring and self-management programmes appear generally effective to improve medicines use, adherence, adverse events and clinical outcomes; and to reduce mortality in people self-managing antithrombotic therapy. However, some participants were unable to complete these interventions, suggesting they may not be suitable for everyone.Other promising interventions to improve adherence and other key medicines-use outcomes, which require further investigation to be more certain of their effects, include:· simplified dosing regimens: with positive effects on adherence;· interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).Several other strategies showed some positive effects, particularly relating to adherence, and other outcomes, but their effects were less consistent overall and so need further study. These included:· delayed antibiotic prescriptions: effective to decrease antibiotic use but with mixed effects on clinical outcomes, adverse effects and satisfaction;· practical strategies like reminders, cues and/or organisers, reminder packaging and material incentives: with positive, although somewhat mixed effects on adherence;· education delivered with self-management skills training, counselling, support, training or enhanced follow-up; information and counselling delivered together; or education/information as part of pharmacist-delivered packages of care: with positive effects on adherence, medicines use, clinical outcomes and knowledge, but with mixed effects in some studies;· financial incentives: with positive, but mixed, effects on adherence.Several strategies also showed promise in promoting immunisation uptake, but require further study to be more certain of their effects. These included organisational interventions; reminders and recall; financial incentives; home visits; free vaccination; lay health worker interventions; and facilitators working with physicians to promote immunisation uptake. Education and/or information strategies also showed some positive but even less consistent effects on immunisation uptake, and need further assessment of effectiveness and investigation of heterogeneity.There are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes, and simple interventions may be as effective as complex strategies. However, no single intervention assessed was effective to improve all medicines-use outcomes across all diseases, medicines, populations or settings.Even where interventions showed promise, the assembled evidence often only provided part of the picture: for example, simplified dosing regimens seem effective for improving adherence, but there is not yet sufficient information to identify an optimal regimen.In some instances interventions appear ineffective: for example, the evidence suggests that directly observed therapy may be generally ineffective for improving treatment completion, adherence or clinical outcomes.In other cases, interventions may have variable effects across outcomes. As an example, strategies providing information or education as single interventions appear ineffective to improve medicines adherence or clinical outcomes, but may be effective to improve knowledge; an important outcome for promoting consumers' informed medicines choices.Despite a doubling in the number of reviews included in this updated overview, uncertainty still exists about the effectiveness of many interventions, and the evidence on what works remains sparse for several populations, including children and young people, carers, and people with multimorbidity. AUTHORS' CONCLUSIONS This overview presents evidence from 75 reviews that have synthesised trials and other studies evaluating the effects of interventions to improve consumers' medicines use.Systematically assembling the evidence across reviews allows identification of effective or promising interventions to improve consumers' medicines use, as well as those for which the evidence indicates ineffectiveness or uncertainty.Decision makers faced with implementing interventions to improve consumers' medicines use can use this overview to inform decisions about which interventions may be most promising to improve particular outcomes. The intervention taxonomy may also assist people to consider the strategies available in relation to specific purposes, for example, gaining skills or being involved in decision making. Researchers and funders can use this overview to identify where more research is needed and assess its priority. The limitations of the available literature due to the lack of evidence for important outcomes and important populations, such as people with multimorbidity, should also be considered in practice and policy decisions.
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Affiliation(s)
- Rebecca Ryan
- Centre for Health Communication and Participation, School of Public Health and Human Biosciences, La Trobe University, Bundoora, VIC, Australia, 3086
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Sciacca B, Monro TM. Dip biosensor based on localized surface plasmon resonance at the tip of an optical fiber. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2014; 30:946-954. [PMID: 24397817 DOI: 10.1021/la403667q] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A dip biosensor is realized by depositing metallic nanoparticles onto the tip of a cleaved optical fiber. Light coupled into the fiber interacts with the localized surface plasmons within the nanoparticles at the tip; a portion of the scattered light recouples into the optical fiber and is analyzed by a spectrometer. Characterization of the sensor demonstrates an inverse relationship between the sensitivity and the number of particles deposited onto the surface, with smaller quantities leading to greater sensitivity. The results obtained showed also that by depositing nanoparticles with distinct localized surface plasmon resonance signatures with limited overlap, as for the case of gold and silver nanospheres, a multiplexed dip biosensor can be realized by simply functionalizing the different nanoparticles with different antibodies after the fashion of an immunoassay. In this way different localized surface plasmons resonance bands responsive to different target analytes can be separately monitored, as further presented below, requiring a minimal quantity of reagents both for the functionalization process and for the sample analysis.
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Affiliation(s)
- Beniamino Sciacca
- Institute for Photonics and Advanced Sensing and School of Chemistry and Physics, The University of Adelaide , Adelaide, South Australia 5005, Australia
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Surveillance du contrôle de la glycémie. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.03.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Effects of an internet support system to assist cancer patients in reducing symptom distress: a randomized controlled trial. Cancer Nurs 2013; 36:6-17. [PMID: 22495503 DOI: 10.1097/ncc.0b013e31824d90d4] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer patients experience many physical and psychosocial problems for which they need support. WebChoice is an Internet-based, interactive health communication application that allows cancer patients to monitor their symptoms and problems, provides individually tailored information and self-management support, e-communication with expert cancer nurses, and an e-forum for group discussion with other patients. OBJECTIVE The objective of this study was to examine the effects of WebChoice on symptom distress (primary outcome), depression, self-efficacy, health-related quality of life, and social support (secondary outcomes). METHODS In this 1-year repeated-measures randomized controlled trial, 325 breast and prostate cancer patients were randomized into 1 experimental group with access to WebChoice and 1 control group who received URLs of publicly available cancer Web sites. RESULTS Group differences on symptom distress were significant only for the global symptom distress index on the Memorial Symptom Assessment Scale (slope estimate, -0.052 [95% confidence interval, -0.101 to -0.004]; t = 4.42; P = .037). There were no significant group differences on secondary outcomes. Additional analyses showed significant within-group improvements in depression in the experimental group only. In the control group, self-efficacy and health-related quality of life deteriorated significantly over time. CONCLUSION This randomized controlled trial is one of the first to evaluate effects of an interactive health communication application to support cancer patients in illness management on symptoms. Although only 1 hypothesis was partially supported, the combined results show a clear trend toward better scores in the intervention group on most outcome measures. IMPLICATIONS FOR PRACTICE If findings can be supported with additional research, WebChoice may become an important tool to support nursing care that can equip cancer patients to better manage their illness.
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Berard LD, Blumer I, Houlden R, Miller D, Woo V. Surveillance du contrôle de la glycémie. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wang Y, Hu M. Blood‐Glucose Biosensors, Development and Challenges. DETECTION CHALLENGES IN CLINICAL DIAGNOSTICS 2013. [DOI: 10.1039/9781849737302-00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Diabetes mellitus is one of the major causes of premature illness and death worldwide. The World Health Organization estimated that by 2030, 439 million people, corresponding to 7.8% of the world adult population, will live with diabetes. With an increasing diabetic population, a Blood Glucose Monitoring System (BGMS) is becoming an ever important tool for diabetes management. The history of blood biosensor development can be traced back to 1932, when Warburg and Christian reported the “yellow enzyme” from yeast changed to colorless upon oxidizing its substrate and resumed the yellow color after its oxidation by oxygen. Since then a lot of research and development has taken place on blood glucose sensors, and the biosensor technology has gone through three generations, with the current commercially available BGMS predominantly relies on the second generation of technology. The advantages and challenges of each generation are discussed. This chapter will examine in detail topics covering the areas of electrode substrate and electrode material selection, fluid detection electrode, reaction chamber, chemistry (electrolyte, polymer, enzyme and mediator), detection method, analytical performance, regulatory requirements and the manufacturing process. The chapter will close with the clinical utility and future direction and application of glucose biosensor include a brief introduction to the Continuous Blood Glucose Monitoring System (CGMS).
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Affiliation(s)
- Yuan Wang
- Siemens HealthCare Diagnostics 511 Benedix Ave. Tarrytown, NY 10591 United States
| | - Madeleine Hu
- The College of New Jersey, 2000 Pennington Road Ewing, NJ 08628‐0718 United States
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Tambascia MA, Nery M, Gross JL, Ermetice MN, de Oliveira CP. Evidence-based clinical use of insulin premixtures. Diabetol Metab Syndr 2013; 5:50. [PMID: 24011173 PMCID: PMC4016222 DOI: 10.1186/1758-5996-5-50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 05/17/2013] [Indexed: 01/04/2023] Open
Abstract
Brazil is expected to have 19.6 million patients with diabetes by the year 2030. A key concept in the treatment of type 2 diabetes mellitus (T2DM) is establishing individualized glycemic goals based on each patient's clinical characteristics, which impact the choice of antihyperglycemic therapy. Targets for glycemic control, including fasting blood glucose, postprandial blood glucose, and glycated hemoglobin (A1C), are often not reached solely with antihyperglycemic therapy, and insulin therapy is often required. Basal insulin is considered an initial strategy; however, premixed insulins are convenient and are equally or more effective, especially for patients who require both basal and prandial control but desire a more simplified strategy involving fewer daily injections than a basal-bolus regimen. Most physicians are reluctant to transition patients to insulin treatment due to inappropriate assumptions and insufficient information. We conducted a nonsystematic review in PubMed and identified the most relevant and recently published articles that compared the use of premixed insulin versus basal insulin analogues used alone or in combination with rapid-acting insulin analogues before meals in patients with T2DM. These studies suggest that premixed insulin analogues are equally or more effective in reducing A1C compared to basal insulin analogues alone in spite of the small increase in the risk of nonsevere hypoglycemic events and nonclinically significant weight gain. Premixed insulin analogues can be used in insulin-naïve patients, in patients already on basal insulin therapy, and those using basal-bolus therapy who are noncompliant with blood glucose self-monitoring and titration of multiple insulin doses. We additionally provide practical aspects related to titration for the specific premixed insulin analogue formulations commercially available in Brazil.
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Affiliation(s)
- Marcos Antônio Tambascia
- Faculty of Medical Sciences, State University of Campinas, Brazil Rua Frei Manoel da Ressurreição 965, Campinas, SP, Brazil
| | - Márcia Nery
- Diabetes Unit - Endocrinology and Metabolism Service, Clinical Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Luiz Gross
- Department of Internal Medicine, Faculty of Medicine of Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Mariana Narbot Ermetice
- Diabetes Group, Eli Lilly do Brazil São Paulo, São Paulo, Brazil
- Currently at Novo Nordisk Brazil, São Paulo, Brazil
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Blevins T. Value and utility of self-monitoring of blood glucose in non-insulin-treated patients with type 2 diabetes mellitus. Postgrad Med 2013; 125:191-204. [PMID: 23748520 DOI: 10.3810/pgm.2013.05.2668] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Self-monitoring of blood glucose (SMBG) levels provides important information regarding glycemic control for patients with diabetes, and is recommended by European and American diabetes organizations as an essential adjunct to periodic glycated hemoglobin (HbA1c) level monitoring. The benefits of SMBG in improving glycemic control in patients with type 1 diabetes and those with type 2 diabetes (T2DM) who are being treated with insulin are well recognized. In contrast, the potential role of SMBG in patients with T2DM not treated with insulin remains controversial, which may lead to underutilization of SMBG in this population. Structured SMBG, introduced as part of a treatment intervention, has been associated with modest but significant improvements in HbA1c levels in patients with T2DM who are not taking insulin as part of their management plan. Patient-obtained readings provide valuable real-time feedback on glucose responses to meals and exercise, and provide the patient with guidance on the day-to-day management of their diabetes. Studies have shown that when patients perform self-monitoring as part of their treatment interventions, support through appropriate educational initiatives is critical to ensure that patients understand the rationale for SMBG. Patients should be trained in correct testing technique and data recording for SMBG, as well as target blood glucose and goal HbA1c levels so that they will know when their SMBG readings are out of range. Technology has a potential role in facilitating SMBG-based interventions by improving patient-physician communication and optimizing glycemic control through the use of remote data uploading, data analysis tools, and, perhaps, even text messaging. This review outlines the benefits of SMBG in the management of patients with T2DM not treated with insulin, and highlights strategies for improving the effectiveness of SMBG-based treatment interventions in this population.
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Affiliation(s)
- Thomas Blevins
- Texas Diabetes and Endocrinology, Austin, TX 78731, USA.
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Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes 2013; 11:138. [PMID: 23937988 PMCID: PMC3751743 DOI: 10.1186/1477-7525-11-138] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/12/2013] [Indexed: 02/05/2023] Open
Abstract
Background Though several questionnaires on self-care and regimen adherence have been introduced, the evaluations do not always report consistent and substantial correlations with measures of glycaemic control. Small ability to explain variance in HbA1c constitutes a significant limitation of an instrument’s use for scientific purposes as well as clinical practice. In order to assess self-care activities which can predict glycaemic control, the Diabetes Self-Management Questionnaire (DSMQ) was designed. Methods A 16 item questionnaire to assess self-care activities associated with glycaemic control was developed, based on theoretical considerations and a process of empirical improvements. Four subscales, ‘Glucose Management’ (GM), ‘Dietary Control’ (DC), ‘Physical Activity’ (PA), and ‘Health-Care Use’ (HU), as well as a ‘Sum Scale’ (SS) as a global measure of self-care were derived. To evaluate its psychometric quality, 261 patients with type 1 or 2 diabetes were assessed with the DSMQ and an established analogous scale, the Summary of Diabetes Self-Care Activities Measure (SDSCA). The DSMQ’s item and scale characteristics as well as factorial and convergent validity were analysed, and its convergence with HbA1c was compared to the SDSCA. Results The items showed appropriate characteristics (mean item-total-correlation: 0.46 ± 0.12; mean correlation with HbA1c: -0.23 ± 0.09). Overall internal consistency (Cronbach’s alpha) was good (0.84), consistencies of the subscales were acceptable (GM: 0.77; DC: 0.77; PA: 0.76; HU: 0.60). Principal component analysis indicated a four factor structure and confirmed the designed scale structure. Confirmatory factor analysis indicated appropriate fit of the four factor model. The DSMQ scales showed significant convergent correlations with their parallel SDSCA scales (GM: 0.57; DC: 0.52; PA: 0.58; HU: n/a; SS: 0.57) and HbA1c (GM: -0.39; DC: -0.30; PA: -0.15; HU: -0.22; SS: -0.40). All correlations with HbA1c were significantly stronger than those obtained with the SDSCA. Conclusions This study provides preliminary evidence that the DSMQ is a reliable and valid instrument and enables an efficient assessment of self-care behaviours associated with glycaemic control. The questionnaire should be valuable for scientific analyses as well as clinical use in both type 1 and type 2 diabetes patients.
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Affiliation(s)
- Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), German Diabetes Center Mergentheim, Theodor-Klotzbücher-Strasse 12, Bad Mergentheim, Germany.
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Breland JY, McAndrew LM, Burns E, Leventhal EA, Leventhal H. Using the Common Sense Model of Self-Regulation to Review the Effects of Self-Monitoring of Blood Glucose on Glycemic Control for Non–Insulin-Treated Adults With Type 2 Diabetes. DIABETES EDUCATOR 2013; 39:541-59. [DOI: 10.1177/0145721713490079] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose This systematic review examined the relationship between self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes. The Common Sense Model of Self-Regulation (CSM) served as a theoretical framework for examining how, when (mediators), and for whom (moderators) SMBG improved glycemic control. Data Sources Five databases were searched: Medline, PsychInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health Literature. Study Selection Included studies had cross-sectional, longitudinal, or randomized controlled trial designs; were published between 2007 and 2011; and included patients with type 2 diabetes at least some of whom were not taking insulin; 1318 studies were screened, 119 were reviewed in detail, and 26 were included. Data Extraction Data were collected on the relationship between SMBG and glycemic control, study design, mediators, moderators, participant characteristics, the CSM, and limitations. Data Synthesis Twenty-six studies met criteria for inclusion: 11 cross-sectional, 4 longitudinal, and 11 randomized controlled trials. The results of the cross-sectional studies were inconclusive. Results from the longitudinal studies and randomized control trials suggested that SMBG may improve glycemic control. The few studies investigating mediators or moderators reported mixed results. Few studies effectively measured the CSM. Conclusion Data suggested that SMBG may help improve glycemic control. Future trials must be designed to test hypotheses and improve our understanding of when, how, and for whom SMBG can enhance glycemic control. Rigorously controlled repetitions of current 2-arm trials will yield little new knowledge of theoretical or practical value.
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Affiliation(s)
- Jessica Y. Breland
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
| | - Lisa M. McAndrew
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
| | - Edith Burns
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
| | - Elaine A. Leventhal
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
| | - Howard Leventhal
- Department of Psychology and the Institute for Health, Healthcare Policy & Aging Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey (Ms Breland, Dr H. Leventhal)
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey (Dr McAndrew)
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr McAndrew)
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Burns)
- Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey (Dr EA Leventhal)
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Monitoring Glycemic Control. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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