MyMedR

Displaying publications 1 - 20 of 41 in total

Abstract:

Sort:

Fulltext A knowledge, attitude and practice (KAP) study of diabetes mellitus among patients attending Klinik Kesihatan Seri Manjung

Ambigapathy R, Ambigapathy S, Ling HM

NCD Malaysia, 2003;2(2):6-16.

This cross sectional study describes the knowledge, attitude and practice (KAP) among 100 patients attending the diabetic clinic at Klinik Kesihatan Seri Manjung from December 2002 until January 2003. A face-to-face interview using a structured questionnaire was carried out for data collection. The results revealed that 87% of the respondents were able to answer 50% or more questions on knowledge correclty, while 98% of them had 50% or more score for the attitude questions. Ninety-nine percent of them reported 50% or more score for the questions on practice. However, only 56% of them practice all 4 of the practices that were asked - regular exercise, healthy diet, monitoring blood glucose level, and monitoring body weight. There was a significant positive correlation between knowledge and attitude (r=0.536, p<0.01), but there was no significant correlation found between attitude and practice. The results indicate that an increase in knowledge will increase the attitude, however this is not necessarily the same between attitude and practice. A better structured educational programme on diabetes and preventive measures should be conducted for all especially those with diabetes to improve their practice towards diabetes. Keywords: Diabetes Mellitus, Knowledge, Attitude and Practice (KAP)

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext Effects of social support and self-efficacy of glucose control among Malaysian type 2 diabetes mellitus patients in primary care

Aneesa Abdul Rashid, Navin Kumar Devaraj, Zuhra Hamzah, Tan Chai Eng

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):70-76.
MyJurnal

Introduction: Diabetic control depends partially on self-management. Diabetes self-care is reported to be a strong predictor of glycemic control in Type 2 Diabetes Mellitus (T2DM) patients. Factors contributing to better self-care include self-efficacy and social support. We aim to determine effects of these factors on glucose control in T2DM patients in a primary care clinic. Methods: This study utilised data from a bigger study looking into factors affecting social support and self-efficacy and their correlation in T2DM patients. This study was done among 329 T2DM pa- tients attending a primary care clinic in Selangor, Malaysia between November 2013- January 2014. Systematic ran- dom sampling was used. Instruments used were the MOS Social Support Survey and the Diabetic Management Self Efficacy Scale (DMSES). Patients’ socio-demographic data and glucose monitoring records were obtained. The asso- ciation between social support and self-efficacy with blood glucose control was determined using logistic regression. Results: The mean age of the respondents is 54.6 (+11.2), mostly female (55.3%) and Malay ethnicity (63.5%). Being older and retired were predictors for good glucose control (OR=1.05,p=0.01 and OR=2.2,p=0.023) respectively. There is also significant correlations between number of close friends/relatives with social support and self-efficacy (r=0.162,p=0.030 and r=0.190,p=0.01) respectively. The correlation of social support and self-efficacy with HbA1c levels are r= -0.044(p=0.426) and r= -0.08(p= 0.744) respectively. Conclusion: There were no correlations between social support and self-efficacy with the level of HbA1c among patients with T2DM in this study. We found older aged and retired patients to have better HbA1c levels.

Matched MeSH terms: Blood Glucose Self-Monitoring
Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya

Ashur ST, Shah SA, Bosseri S, Fah TS, Shamsuddin K

Libyan J Med, 2016 Jan;11(1):31086.
PMID: 28349838 DOI: 10.3402/ljm.v11.31086

Background Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. Methods A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8(©)), while glycaemic control status was based on the HbA1c level. Results Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94). Conclusion The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext The effects of fasting during Ramadan on glycemic excursions detected by continuous glucose monitoring system (CGMS) in patients with type 2 diabetes

Bonakdaran SH, Khajeh-Dalouie M

Med J Malaysia, 2011 Dec;66(5):447-50.
PMID: 22390099

OBJECTIVE: Safety of fasting in Ramadan for diabetic patients is not clearly known. The aim of this study was to determine the effects of fasting on glycemic excursions by continuous glucose monitoring system (CGMS).
MATERIALS AND METHODS: This pilot, observational study conducted in the Endocrine Research Center, Mashhad University of Medical Sciences, Mashhad, IRAN, in Ramadan 2008. Seventeen well controlled patients with diabetes type 2 who were taking oral agents underwent 72 hour monitoring of glycemic excursions by CGMS one month before Ramadan and during Ramadan. The extent and duration of hyperglycemic and hypoglycemic events were evaluated and compared.
RESULTS: A significant reduction in hyperglycemic events was observed during Ramadan. The extent and duration of hypoglycemic events was not significantly different between two states (Ramadan and before). A significant increase in number of hypoglycemic events in Ramadan was found in patients who take sulfonylurea compared with those who take only metformin.
CONCLUSION: Fasting in Ramadan can be safe for well controlled patients with type 2 diabetes.

Matched MeSH terms: Blood Glucose Self-Monitoring/methods*
Fulltext Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan

Bukhsh A, Goh BH, Zimbudzi E, Lo C, Zoungas S, Chan KG, et al.

Front Endocrinol (Lausanne), 2020;11:534873.
PMID: 33329377 DOI: 10.3389/fendo.2020.534873

Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.

Matched MeSH terms: Blood Glucose Self-Monitoring/psychology*
Fulltext Psychometric properties of the Diabetes Self-Management Questionnaire (DSMQ) in Urdu

Bukhsh A, Lee SWH, Pusparajah P, Schmitt A, Khan TM

Health Qual Life Outcomes, 2017 Oct 12;15(1):200.
PMID: 29025432 DOI: 10.1186/s12955-017-0776-8

BACKGROUND: Numerous study tools on diabetes self-care have been introduced; however, most existing tools do not show expectable and meaningful correlations with patients' glycaemic control. The Diabetes Self-Management Questionnaire (DSMQ) was designed to appraise self-care activities which can predict glycaemic control outcomes. However, this tool has not been validated in Pakistan. Therefore, the aim of this study was to translate and examine the psychometric properties of the Urdu version of DSMQ among type 2 diabetes patients.

METHOD: Standard forward-backward translation was used to translate the DSMQ into Urdu language. A convenience sample of 130 patients with type 2 diabetes was collected to assess the Urdu version's psychometric properties. Reliability was assessed by Cronbach's coefficient α and validity was assessed using confirmatory factor analysis and criterion-related correlations.

RESULTS: High internal consistency was found for all DSMQ scales (Sum scale: α = 0.96, Glucose Management: 0.91; Dietary Control: 0.88; Physical Activity: 0.89; Health-Care Use: 0.73). The DSMQ subscales showed significant correlations with HbA1c (Glucose Management: -0.75; Dietary Control: -0.76; Physical Activity: -0.71; Health-Care Use: -0.64; Sum Scale: -0.78; all p 0.05). Adequate fit to the data was achieved for single factor model after successively modelling all significant correlations between the items' error terms, with Chi2 = 106.6, df = 84, p = 0.049; TLI = 0.98, CFI = 0.99 and RMSEA = 0.05 (90% CI 0.01-0.07). Whereas a comparatively lower fit indices to data were observed in case of four factor model.

CONCLUSION: The findings support the Urdu version of the DSMQ as a reliable and valid instrument for assessing self-care activities associated with glycaemic control in type 2 diabetes patients.

Matched MeSH terms: Blood Glucose Self-Monitoring/methods*
Diabetes care, glycemic control, and complications in children with type 1 diabetes from Asia and the Western Pacific Region

Craig ME, Jones TW, Silink M, Ping YJ

J Diabetes Complications, 2007 Sep-Oct;21(5):280-7.
PMID: 17825751 DOI: 10.1016/j.jdiacomp.2006.04.005

AIMS: The incidence of type 1 diabetes is increasing in many parts of Asia, where resources may not enable targets for glycemic control to be achieved. The aims of this study were to describe glycemic control, diabetes care, and complications in youth with type 1 diabetes from the Western Pacific Region and to identify factors associated with glycemic control and hypoglycemia.
METHODS: A cross-sectional clinic-based study on 2312 children and adolescents (aged <18 years; 45% males) from 96 pediatric diabetes centers in Australia, China, Hong Kong, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, and Thailand was conducted. Clinical and management details were recorded, and finger-pricked blood samples were obtained for central glycated hemoglobin (HbA(1c)).
RESULTS: The median age of the patients was 12.5 years [interquartile range (IQR)=9.4-15.3 years]; diabetes duration, 4.4 years (IQR=2.5-7.2 years); and HbA(1c) level, 8.3% (IQR 7.4%-9.7%). Insulin treatment consisted of one or two daily injections in 61% of the patients (range=22%-90% by country), and home blood glucose monitoring (range=67%-100%) was practiced by 96%. HbA(1c) level was significantly associated with country, age, diabetes duration, sex, insulin dose per kilogram, insulin regimen, and frequency of home blood glucose measurement in multiple regression analysis. The incidence of severe hypoglycemia, defined as any episode requiring assistance in the previous 3 months, was 73 per 100 patient-years and was associated with country, male sex, higher HbA(1c) level, an insulin regimen with three or more injections, and more frequent home blood glucose testing. The incidence of diabetic ketoacidosis was 10 per 100 patient-years and was associated with country, higher HbA(1c) level, and higher insulin dose per kilogram.
CONCLUSIONS: There is marked variability in glycemic control, hypoglycemia, complication rates, and diabetes care among children from the Western Pacific Region. Most are not achieving adequate glycemic control, placing them at high risk of microvascular complications.

Matched MeSH terms: Blood Glucose Self-Monitoring
ISPAD Clinical Practice Consensus Guidelines: Fasting during Ramadan by young people with diabetes

Deeb A, Elbarbary N, Smart CE, Beshyah SA, Habeb A, Kalra S, et al.

Pediatr Diabetes, 2020 02;21(1):5-17.
PMID: 31659852 DOI: 10.1111/pedi.12920
Matched MeSH terms: Blood Glucose Self-Monitoring
Eco-friendly fabrication of nonenzymatic electrochemical sensor based on cobalt/polymelamine/nitrogen-doped graphitic-porous carbon nanohybrid material for glucose monitoring in human blood

Elancheziyan M, Prakasham K, Eswaran M, Duraisamy M, Ganesan S, Lee SL, et al.

Environ Res, 2023 Apr 15;223:115403.
PMID: 36754108 DOI: 10.1016/j.envres.2023.115403

The design and development of eco-friendly fabrication of cost-effective electrochemical nonenzymatic biosensors with enhanced sensitivity and selectivity are one of the emerging area in nanomaterial and analytical chemistry. In this aspect, we developed a facile fabrication of tertiary nanocomposite material based on cobalt and polymelamine/nitrogen-doped graphitic porous carbon nanohybrid composite (Co-PM-NDGPC/SPE) for the application as a nonenzymatic electrochemical sensor to quantify glucose in human blood samples. Co-PM-NDGPC/SPE nanocomposite electrode fabrication was achieved using a single-step electrodeposition method under cyclic voltammetry (CV) technique under 1 M NH4Cl solution at 20 constitutive CV cycles (sweep rate 20 mV/s). Notably, the fabricated nonenzymatic electroactive nanocomposite material exhibited excellent electrocatalytic sensing towards the quantification of glucose in 0.1 M NaOH over a wide concentration range from 0.03 to 1.071 mM with a sensitive limit of detection 7.8 μM. Moreover, the Co-PM-NDGPC nanocomposite electrode with low charge transfer resistance (Rct∼81 Ω) and high ionic diffusion indicates excellent stability, reproducibility, and high sensitivity. The fabricated nanocomposite materials exhibit a commendable sensing response toward glucose molecules present in the blood serum samples recommends its usage in real-time applications.

Matched MeSH terms: Blood Glucose Self-Monitoring
Type 2 diabetes in youth from the Western Pacific region: glycaemic control, diabetes care and complications

Eppens MC, Craig ME, Jones TW, Silink M, Ong S, Ping YJ, et al.

Curr Med Res Opin, 2006 May;22(5):1013-20.
PMID: 16709323 DOI: 10.1185/030079906X104795

OBJECTIVE: To describe the glycaemic control, diabetes care and prevalence of complications in youth with type 2 diabetes from the Western Pacific Region.
RESEARCH DESIGN AND METHODS: Cross-sectional, clinic-based audit of 331 patients aged < 18 years from 56 centres in Australia, China-Beijing, China-Shanghai, China-Hong Kong, Indonesia, Japan, South Korea, Malaysia, Philippines, Singapore, Taiwan and Thailand. Clinical and management data were recorded along with glycated haemoglobin (HbA(1c)), lipids and complication rates.
MAIN OUTCOME MEASURES: Glycaemic control, complications, diabetes management.
RESULTS: Median age was 14.9 years (interquartile range 13.2-16.4 years) and median diabetes duration 2.3 years (1.4-3.6 years). Median HbA(1c) was 7% (5.9-9.9%) and HbA(1c) was > 7.5% in 40% of patients. In multiple regression analysis, glycaemic control varied significantly between countries (p = 0.02); higher HbA(1c) was associated with fewer home blood glucose measurements (p = 0.005) and higher insulin dose/kg (p < 0.0001). Blood glucose monitoring was performed by 65% of patients (range 33-96% by country). In 25% of patients, management consisted of diet alone or no treatment (range 0-53% by country); oral anti-diabetic drugs alone were used in 49%, insulin alone in 11% and both in 15%. Microalbuminuria was found in 8% and hypertension in 24%. The risk of hypertension increased with higher BMI (OR 1.16, 95% CI 1.09-1.24, p < 0.0001); antihypertensive agents were used in 4% of patients.
CONCLUSIONS: The management of type 2 diabetes in youth from the Western Pacific Region varies widely. Hypertension and microalbuminuria were frequent, but not commonly treated. Further investigation into the natural history and risk factors for complications in youth with type 2 diabetes is required to assist in developing evidence based management guidelines.

Matched MeSH terms: Blood Glucose Self-Monitoring
Glucose tolerance: hypothesis testing on Malaysian diabetic community

Gillani SW, Sari YO, Sulaiman SA, Baig MR

Curr Diabetes Rev, 2014;10(5):311-26.
PMID: 25316148 DOI: 10.2174/1573399810666141015095004

Our study objective was to evaluate glucose tolerance and effecting factors among diabetes patients' with home care program (PHCP) in Malaysian community. A 24-week longitudinal quasi-experimental -single blind - pre/post-test study design was used to assess the effectiveness of a diabetes education program to enhance self-care practices. An attrition rate of 25% implied longitudinal design of the study in the calculation of sample size. Hence the sample size of the study was 106 subjects (53 cases and 53 focus group). The level of significance was set at 0.05. Ethical clearance had been made prior to conducting this study. Of the 109 subjects who met the study-entry criteria, 3 subjects declined to participate due to lack of time and interest. No significant parameters were revealed in the demographic and clinical characteristics of participants who completed the study. Focus group showed significant reduction in HbA1c value with mean 1.1% as compared to cases with a mean 0.06%. Similarly, hypothesis on self-care management suggest significantly improved practices among focus group [M=2.94, SD=2.25] for case group M=0.47, SD=1.36; t[127.64]=-8.23, p≤0.001] with moderate effect size [eta squared=0.06]. Total physical activity was defined as the combination of non-leisure and leisure activities. There was a statistically significant difference for increase in total physical levels between the focus [M=14.01, SD=6.41] and case groups [13.21, SD=5.22; t[148.04]=-3.15, p=0.002] with no difference in the non-leisure activity [p=0.43]. As for the case group, there was no significant difference in SMBG practices from baseline [M=0.70, SD=1.35] to follow-up [M=0.47, SD=1.36, t[72]=0.97, P=0.34] and no relationship was found between the number of blood glucose tests done with demographic or clinical variables. This study offered improved self-care practices and physical activity after PHCP but with problematic dietary care. This might be due to social and cultural habits among Malaysian population.

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext Predictors of diabetes self-management among type 2 diabetes patients

Gunggu A, Chang CT, Cheah WL

J Diabetes Res, 2016;2016:9158943.
PMID: 27563681 DOI: 10.1155/2016/9158943

Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak, Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06 mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1 mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness (p = 0.001), family support (p = 0.007), and self-efficacy (p = 0.027). Health care personnel must convince patients with T2DM of the effectiveness of the treatment, empower and enhance their self-efficacy, and enlist the family support so as to ensure patients sustain their DSM efforts.
Study site: diabetes clinics in Kuching and Samarahan Division of Sarawak, Malaysia

Matched MeSH terms: Blood Glucose Self-Monitoring/psychology*
Fulltext Usage of glucometer is associated with improved glycaemic control in type 2 diabetes mellitus patients in Malaysian public primary care clinics: an open-label, randomised controlled trial

Ismail M, Teng CL, Teng CL, Omar M, Ho BK, Kusiar Z, et al.

Singapore Med J, 2013 Jul;54(7):391-5.
PMID: 23900469

INTRODUCTION: Self-monitoring of blood glucose (SMBG) has been underutilised. We conducted an open-label, randomised controlled trial to assess the feasibility of introducing SMBG in primary care clinics in Malaysia.

METHODS: This was an open-label, randomised controlled trial conducted in five public primary care clinics in Malaysia. Patients with type 2 diabetes mellitus (age range 35-65 years) not performing SMBG at the time of the study were randomised to receive either a glucometer for SMBG or usual care. Both groups of patients received similar diabetes care from the clinics.

RESULTS: A total of 105 patients with type 2 diabetes mellitus were enrolled. Of these, 58 and 47 were randomised to intervention and control groups, respectively. After six months, the glycated haemoglobin (HbA1c) level in the intervention group showed a statistically significant improvement of 1.3% (p = 0.001; 95% confidence interval 0.6-2.0), relative to the control group that underwent usual care. The percentages of patients that reached the HbA1c treatment target of ≤ 7% were 14.0% and 32.1% in the control and intervention groups (p = 0.036), respectively.

CONCLUSION: The usage of a glucometer improved glycaemic control, possibly due to the encouragement of greater self-care in the intervention group.

Matched MeSH terms: Blood Glucose Self-Monitoring*
Use of the glucose analyser in the estimation of small bowel mucosal oligosaccharidases

Iyngkaran, N., Yadav, M., Boey, G.B., Davis, K.

Malaysian Journal of Child Health, 1991;3(1):37-39.
MyJurnal

Estimation of oligosaccharidases in the jejunal mucosa is useful in the diagnosis and evaluation of primary and secondary oligosaccharide intolerance. Until recently these enzymes have been estimated by the method of Dahlgvist.4While the method is accurate and reliable it is tedious and cumbersome. We describe here a semi quantitative method, using the glucose analyser. (Copied from article).

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care

Kalra S, Czupryniak L, Kilov G, Lamptey R, Kumar A, Unnikrishnan AG, et al.

Diabetes Ther, 2018 Dec;9(6):2185-2199.
PMID: 30390228 DOI: 10.1007/s13300-018-0521-2

Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a 'glucocentric' approach to a 'patient-centered' approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext Glycemic Patterns and Factors Associated with Post-Hemodialysis Hyperglycemia among End-Stage Renal Disease Patients undergoing Maintenance Hemodialysis

Khan AHKY, Zakaria NF, Abidin MAZ, Lim CTS, Kamaruddin NA

J ASEAN Fed Endocr Soc, 2020;35(1):68-76.
PMID: 33442172 DOI: 10.15605/jafes.035.01.12

Introduction: Chronic and post-prandial hyperglycemia are independent risk factors for diabetic complications. Glycemic patterns among hemodialysis end-stage-renal-disease (ESRD) differ as glucose metabolism changes with declining kidney function with more pronounced glycemic fluctuations. The objectives of this study are to determine glycemic patterns on hemodialysis days, the magnitude of post-hemodialysis rebound hyperglycemia (PHH) and their associated factors.
Methodology: 148 patients on hemodialysis were analysed, 91 patients had end-stage-diabetic-renal disease (DM-ESRD), and 57 patients had end-stage-non-diabetic renal disease (NDM-ESRD). Glycemic patterns and PHH data were obtained from 11-point and 7-point self-monitoring blood glucose (SMBG) profiles on hemodialysis and non-hemodialysis days. PHH and its associated factors were analysed with logistic regression.
Results: Mean blood glucose on hemodialysis days was 9.33 [SD 2.7] mmol/L in DM-ESRD patients compared to 6.07 [SD 0.85] mmol/L in those with NDM-ESRD (p<0.001). PHH occurred in 70% of patients and was more pronounced in DM-ESRD compared to NDM-ESRD patients (72.5% vs 27.5%; OR 4.5). Asymptomatic hypoglycemia was observed in 18% of patients. DM-ESRD, older age, previous IHD, obesity, high HbA1c, elevated highly-sensitive CRP and low albumin were associated with PHH.
Conclusion: DM-ESRD patients experienced significant PHH in our cohort. Other associated factors include older age, previous IHD, obesity, high HbA1c, elevated hs-CRP and low albumin.

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext Asia-Pacific consensus recommendations for application of continuous glucose monitoring in diabetes management

Kong APS, Lim S, Yoo SH, Ji L, Chen L, Bao Y, et al.

Diabetes Res Clin Pract, 2023 Jul;201:110718.
PMID: 37196707 DOI: 10.1016/j.diabres.2023.110718

Glucose monitoring has evolved from self-monitoring of blood glucose to glycated hemoglobin, and the latest continuous glucose monitoring (CGM). A key challenge to adoption of CGM for management of diabetes in Asia is the lack of regional CGM recommendations. Hence, thirteen diabetes-specialists from eight Asia-Pacific (APAC) countries/regions convened to formulate evidence-based, APAC-specific CGM recommendations for individuals with diabetes. We defined CGM metrics/targets and developed 13 guiding-statements on use of CGM in: (1) people with diabetes on intensive insulin therapy, and (2) people with type 2 diabetes on basal insulin with/without glucose lowering drugs. Continual use of CGM is recommended in individuals with diabetes on intensive insulin therapy and suboptimal glycemic control, or at high risk of problematic hypoglycemia. Continual/intermittent CGM may also be considered in individuals with type 2 diabetes on basal insulin regimen and with suboptimal glycemic control. In this paper, we provided guidance for optimizing CGM in special populations/situations, including elderly, pregnancy, Ramadan-fasting, newly diagnosed type 1 diabetes, and comorbid renal disease. Statements on remote CGM, and stepwise interpretation of CGM data were also developed. Two Delphi surveys were conducted to rate the agreement on statements. The current APAC-specific CGM recommendations provide useful guidance for optimizing use of CGM in the region.

Matched MeSH terms: Blood Glucose Self-Monitoring
Translating HbA1c measurements into estimated average glucose values in pregnant women with diabetes

Law GR, Gilthorpe MS, Secher AL, Temple R, Bilous R, Mathiesen ER, et al.

Diabetologia, 2017 04;60(4):618-624.
PMID: 28105519 DOI: 10.1007/s00125-017-4205-7

AIMS/HYPOTHESIS: This study aimed to examine the relationship between average glucose levels, assessed by continuous glucose monitoring (CGM), and HbA1clevels in pregnant women with diabetes to determine whether calculations of standard estimated average glucose (eAG) levels from HbA1c measurements are applicable to pregnant women with diabetes.
METHODS: CGM data from 117 pregnant women (89 women with type 1 diabetes; 28 women with type 2 diabetes) were analysed. Average glucose levels were calculated from 5-7 day CGM profiles (mean 1275 glucose values per profile) and paired with a corresponding (±1 week) HbA1c measure. In total, 688 average glucose-HbA1c pairs were obtained across pregnancy (mean six pairs per participant). Average glucose level was used as the dependent variable in a regression model. Covariates were gestational week, study centre and HbA1c.
RESULTS: There was a strong association between HbA1c and average glucose values in pregnancy (coefficient 0.67 [95% CI 0.57, 0.78]), i.e. a 1% (11 mmol/mol) difference in HbA1c corresponded to a 0.67 mmol/l difference in average glucose. The random effects model that included gestational week as a curvilinear (quadratic) covariate fitted best, allowing calculation of a pregnancy-specific eAG (PeAG). This showed that an HbA1c of 8.0% (64 mmol/mol) gave a PeAG of 7.4-7.7 mmol/l (depending on gestational week), compared with a standard eAG of 10.2 mmol/l. The PeAG associated with maintaining an HbA1c level of 6.0% (42 mmol/mol) during pregnancy was between 6.4 and 6.7 mmol/l, depending on gestational week.
CONCLUSIONS/INTERPRETATION: The HbA1c-average glucose relationship is altered by pregnancy. Routinely generated standard eAG values do not account for this difference between pregnant and non-pregnant individuals and, thus, should not be used during pregnancy. Instead, the PeAG values deduced in the current study are recommended for antenatal clinical care.

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext Telemonitoring in fasting individuals with type 2 diabetes mellitus during ramadan: A prospective, randomised controlled study

Lee JY, Wong CP, Tan CSS, Nasir NH, Lee SWH

Sci Rep, 2017 08 31;7(1):10119.
PMID: 28860546 DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC55790

We determined the impact of a remote blood glucose telemonitoring program with feedback in type 2 diabetes mellitus patients fasting during Ramadan compared to conventional self-monitoring method. A twelve-week cluster randomised study, with 85 participants who wish to fast for at least 15 days during Ramadan was conducted. Self-measurement and transmission of blood glucose results were performed six times daily during Ramadan. Results were transmitted to a secure website for review with feedback from case manager if necessary. The control group received usual care. The main outcome was the number of participants experiencing hypoglycaemia during Ramadan and at the end of the study. During Ramadan, the number of participants reporting hypoglycaemia was significantly lower in the telemonitoring group [Odds ratio (OR): 0.186, 95% confidence interval: 0.04-0.936; p = 0.04]. Similarly, the proportion of participants reporting symptomatic hypoglycaemia at the end of the study was significantly lower in the telemonitoring group (OR: 0.257, 95% CI: 0.07-0.89; p = 0.03). A reduction of 1.07% in glycated haemoglobin levels was observed in the telemonitoring group compared to 0.24% in the control group (p

Matched MeSH terms: Blood Glucose Self-Monitoring/methods*; Blood Glucose Self-Monitoring/standards
Fulltext Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial

Lee JY, Chan CKY, Chua SS, Ng CJ, Paraidathathu T, Lee KKC, et al.

J Gen Intern Med, 2020 Jan;35(1):87-94.
PMID: 31512187 DOI: 10.1007/s11606-019-05316-9

BACKGROUND: Connected devices that allow people with diabetes to monitor their blood glucose levels remotely with data visualization have been shown to improve self-care behavior in diabetes management. However, their effectiveness and usability for a low-middle-income, racially diverse population are unknown.
OBJECTIVE: This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes.
DESIGN: This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia.
PARTICIPANTS: People with type 2 diabetes aged 18 and above, who had hemoglobin A1c ≥ 7.5% but less than 11.0% within the past 3 months and resided in the state of Selangor.
INTERVENTION: The intervention group received home gluco-telemonitors and transmitted glucose data to a care team who could adjust therapy accordingly. The team also facilitated self-management by supporting participants to improve medication adherence, and encourage healthier lifestyle and use of resources to reduce risk factors. Usual care group received routine healthcare service.
MAIN MEASURE: The primary outcome was the change in HbA1c at 24 weeks and 52 weeks. Secondary outcomes included change in fasting plasma glucose, blood pressure, lipid levels, health-related quality of life, and diabetes self-efficacy.
RESULTS: A total of 240 participants were recruited in this study. The telemonitoring group reported larger improvements in glycemic control compared with control at the end of study (week 24, - 0.05%; 95% CI - 0.10 to 0.00%) and at follow-up (week 52, - 0.03%; - 0.07 to 0.02%, p = 0.226). Similarly, no differences in other secondary outcomes were observed, including the number of adverse events and health-related quality of life.
CONCLUSION: This study indicates that there is limited benefit of replacing telemedicine with the current practice of self-monitoring of blood glucose. Further innovative methods to improve patient engagement in diabetes care are needed.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02466880.

Matched MeSH terms: Blood Glucose Self-Monitoring

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links