1
|
Malandrucco I, Russo B, Picconi F, Menduni M, Frontoni S. Glycemic Status Assessment by the Latest Glucose Monitoring Technologies. Int J Mol Sci 2020; 21:E8243. [PMID: 33153229 PMCID: PMC7663245 DOI: 10.3390/ijms21218243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
The advanced and performing technologies of glucose monitoring systems provide a large amount of glucose data that needs to be properly read and interpreted by the diabetology team in order to make therapeutic decisions as close as possible to the patient's metabolic needs. For this purpose, new parameters have been developed, to allow a more integrated reading and interpretation of data by clinical professionals. The new challenge for the diabetes community consists of promoting an integrated and homogeneous reading, as well as interpretation of glucose monitoring data also by the patient himself. The purpose of this review is to offer an overview of the glycemic status assessment, opened by the current data management provided by latest glucose monitoring technologies. Furthermore, the applicability and personalization of the different glycemic monitoring devices used in specific insulin-treated diabetes mellitus patient populations will be evaluated.
Collapse
Affiliation(s)
- Ilaria Malandrucco
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
| | - Benedetta Russo
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Fabiana Picconi
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
| | - Marika Menduni
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Cameron D, Harris FM, Evans JMM. Patterns of self-monitoring of blood glucose in insulin-treated diabetes: analysis of a Scottish population over time. Diabetes Obes Metab 2016; 18:729-31. [PMID: 26990502 DOI: 10.1111/dom.12662] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/25/2016] [Accepted: 03/10/2016] [Indexed: 11/26/2022]
Abstract
Analysis of a diabetes clinical information system in Tayside, Scotland, shows that a significant proportion of insulin-treated patients with diabetes are not self-monitoring blood glucose according to current clinical guidance and recommendations, with some not self-monitoring their blood glucose at all. Although there has been an increase in the number of reagent strips dispensed over the past decade, this increase is mainly accounted for by increased testing frequency among people with diabetes already testing.
Collapse
Affiliation(s)
- D Cameron
- School of Health Sciences, University of Stirling, Stirling, UK
| | - F M Harris
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - J M M Evans
- School of Health Sciences, University of Stirling, Stirling, UK
| |
Collapse
|
4
|
Elgart JF, González L, Prestes M, Rucci E, Gagliardino JJ. Frequency of self-monitoring blood glucose and attainment of HbA1c target values. Acta Diabetol 2016; 53:57-62. [PMID: 25841589 DOI: 10.1007/s00592-015-0745-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
Abstract
AIMS Test strips for self-monitoring of blood glucose (SMBG) represent in Argentina, around 50 % of diabetes treatment cost; the frequency of their use is closely associated with hyperglycemia treatment. However, the favorable impact of SMBG on attainment of HbA1c goal in different treatment conditions remains controversial. We therefore attempted to estimate the relationship between use of SMBG test strips and degree of attainment of metabolic control in an institution of our social security subsector (SSS) in which provision is fully covered and submitted to a regular audit system. METHODS Observational retrospective study using information of 657 patients with T2DM (period 2009-2010) from the database of the Diabetes and Other Cardiovascular Risk Factors Program (DICARO) of one institution of our SSS. DICARO provides-with an audit system-100 % coverage for all drugs and keeps records of clinical, metabolic and treatment data from every patient. RESULTS The average monthly test strips/patient used for SMBG increased as a function of treatment intensification: Monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. In every condition, the number was larger in people with target HbA1c levels. Test strips represented the larger percentage of total prescription cost. CONCLUSIONS In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG; in every condition tested, targeted HbA1c values were associated with greater strip use. Patient education and prescription audit may optimize its use and treatment outcomes.
Collapse
Affiliation(s)
- Jorge F Elgart
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
| | - Lorena González
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
- Escuela de Economía de la Salud y Administración de Organizaciones de Salud, Facultad de Ciencias Económicas, Universidad Nacional de La Plata (UNLP), La Plata, Argentina.
| | - Mariana Prestes
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
| | - Enzo Rucci
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
- III-LIDI, Facultad de Informática, Universidad Nacional de La Plata (UNLP), La Plata, Argentina.
| | - Juan J Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
| |
Collapse
|
5
|
Elgart JF, González L, Rucci E, Gagliardino JJ. Self-monitoring of blood glucose: use, frequency drivers, and cost in Argentina. J Diabetes Sci Technol 2014; 8:1121-5. [PMID: 25208965 PMCID: PMC4455458 DOI: 10.1177/1932296814549993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although test strips for self-monitoring of blood glucose (SMBG) represent around 50% of diabetes treatment cost in Argentina, little is known about their current use and relationship with different types of treatment. We therefore aimed to estimate the current use of test strips and identify the major use drivers and the percentage they represent of total prescription costs in 2 entities of the social security system (SSS) of Argentina. Observational retrospective study measuring test strip prescriptions delivered by pharmacies from the province of Buenos Aires (8115 records collected during 3 months provided by the Colegio de Farmacéuticos de la Provincia de Buenos Aires) of affiliates with type 2 diabetes (T2DM) from 2 large entities of the SSS system. The average monthly test strips/patient used for SMBG was 97.5 ± 70.1. This number varied according to treatment: monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. Test strips represented a higher percentage of the total prescription cost in people under OAD monotherapy (84.6%) and lower in those with insulin analogs (46.9%). In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG and its impact on the total prescription cost depends on the kind of such treatment. Since it has been shown that patients' education and prescription audit can optimize test strip use and treatment outcomes, implementation of such strategies could appropriately support, optimize, and reduce ineffective test strip use in people with T2DM.
Collapse
Affiliation(s)
- Jorge F Elgart
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Lorena González
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Enzo Rucci
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Juan J Gagliardino
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Given JE, O'Kane MJ, Coates VE, Moore A, Bunting BP. Comparing patient generated blood glucose diary records with meter memory in type 2 diabetes. Diabetes Res Clin Pract 2014; 104:358-62. [PMID: 24690309 DOI: 10.1016/j.diabres.2014.03.003] [Citation(s) in RCA: 3] [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] [Received: 04/26/2013] [Revised: 02/24/2014] [Accepted: 03/04/2014] [Indexed: 01/15/2023]
Abstract
AIM To assess agreement between meter and diary self monitoring of blood glucose (SMBG) records, over a year, in a sample of patients with type 2 diabetes. METHODS Meter and diary records were available, for 95 individuals, who took part in the Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes study. Pearson's correlation coefficient was used to explore the relationships between the types of error. Maximum likelihood estimation was used to explore changes over time through a structural equation modelling approach. Paired samples t-tests were used to determine if the presence of errors led to a significant difference between the mean diary and meter SMBG concentrations or coefficients of variation. Multiple regression was used to explore possible predictors of the error indices. RESULTS Mean over-reporting, under-reporting, concordance and overall reliability were 8.4%, 10.0%, 83.5% and 71.3%, respectively. The first week of monitoring had significantly more under-reporting, over-reporting and less concordance and overall reliability than subsequent weeks. The majority of concordance errors were not clinically significant. Those that were, tended to occur during the first three months of monitoring. Participants' at one trial site were significantly more likely to have recording errors than those at the largest site. CONCLUSIONS Error levels were similar to those described previously in type 1 diabetes and there was a suggestion of an initial learning curve for record keeping. For some individuals diary records would not be considered acceptable if held to the same standards as blood glucose meters.
Collapse
Affiliation(s)
- J E Given
- Institute of Nursing and Health Research, University of Ulster, Coleraine Campus, Cromore Road, Coleraine, County Londonderry BT52 1SA, UK.
| | - M J O'Kane
- Department of Clinical Chemistry, Western Health and Social Care Trust, Altnagelvin Hospital, Londonderry BT47 6SB, UK
| | - V E Coates
- Institute of Nursing and Health Research, University of Ulster, Coleraine Campus, Cromore Road, Coleraine, County Londonderry BT52 1SA, UK; Nursing Directorate, Western Health and Social Care Trust, Altnagelvin Hospital, Londonderry BT47 6SB, UK
| | - A Moore
- School of Environmental Sciences, University of Ulster, Coleraine Campus, Cromore Road, Coleraine, County Londonderry BT52 1SA, UK
| | - B P Bunting
- School of Psychology, University of Ulster, Magee Campus, Londonderry BT48 7JL, UK
| |
Collapse
|
8
|
Evans JMM, Mackison D, Swanson V, Donnan PT, Emslie-Smith A, Lawton J. Self-monitoring among non-insulin treated patients with type 2 diabetes mellitus: Patients' behavioural responses to readings and associations with glycaemic control. Diabetes Res Clin Pract 2013; 100:235-42. [PMID: 23523283 DOI: 10.1016/j.diabres.2013.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/11/2013] [Accepted: 03/01/2013] [Indexed: 10/27/2022]
Abstract
AIM To investigate self-monitoring of blood glucose (SMBG) behaviour among non-insulin treated patients with type 2 diabetes mellitus, and to evaluate associations with glycaemic control. METHODS Eligible patients in 23 GP practices in Tayside, Scotland, were identified (18-75 years, no insulin treatment, SMBG reagent strips dispensed in 2009). Consenting patients were administered questionnaires addressing SMBG behaviour: these primary data were record-linked to clinical data (including HbA1c) from a validated population-based diabetes clinical information system, then anonymised. RESULTS Among 629 eligible patients, 207 were interviewed and analysed. Mean SMBG reagent strips dispensed in 12 months was 268. In response to a perceived high test result, 80 (38.8%) patients took no action or simply checked later with most of them (61.3%) indicating they did not know what action to take. Of the 126 (61.2%) patients who took some action, 101 made changes to diet, 12 increased physical activity, 10 made changes to medication and 12 mad a HCP appointment. A high score on a Diabetes Knowledge Test was a statistically significant predictor of taking action (odds ratio: 2.07). However, neither taking action nor increased SMBG frequency was associated with improved glycaemic control. CONCLUSIONS Responding to SMBG test results and increased testing frequency were not associated with improved glycaemic control in the short-term. There is a lack of knowledge surrounding SMBG in non-insulin treated patients.
Collapse
Affiliation(s)
- Josie M M Evans
- School of Nursing, Midwifery and Health, University of Stirling, Scotland, UK.
| | | | | | | | | | | |
Collapse
|
9
|
Affiliation(s)
- Satish K Garg
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, CO, USA
| | | |
Collapse
|