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A hybrid Transformer-LSTM model apply to glucose prediction

Bian Q, As'arry A, Cong X, Rezali KABM, Raja Ahmad RMKB

PLoS One, 2024;19(9):e0310084.
PMID: 39259758 DOI: 10.1371/journal.pone.0310084

The global prevalence of diabetes is escalating, with estimates indicating that over 536.6 million individuals were afflicted by 2021, accounting for approximately 10.5% of the world's population. Effective management of diabetes, particularly monitoring and prediction of blood glucose levels, remains a significant challenge due to the severe health risks associated with inaccuracies, such as hypoglycemia and hyperglycemia. This study addresses this critical issue by employing a hybrid Transformer-LSTM (Long Short-Term Memory) model designed to enhance the accuracy of future glucose level predictions based on data from Continuous Glucose Monitoring (CGM) systems. This innovative approach aims to reduce the risk of diabetic complications and improve patient outcomes. We utilized a dataset which contain more than 32000 data points comprising CGM data from eight patients collected by Suzhou Municipal Hospital in Jiangsu Province, China. This dataset includes historical glucose readings and equipment calibration values, making it highly suitable for developing predictive models due to its richness and real-time applicability. Our findings demonstrate that the hybrid Transformer-LSTM model significantly outperforms the standard LSTM model, achieving Mean Square Error (MSE) values of 1.18, 1.70, and 2.00 at forecasting intervals of 15, 30, and 45 minutes, respectively. This research underscores the potential of advanced machine learning techniques in the proactive management of diabetes, a critical step toward mitigating its impact.

Matched MeSH terms: Blood Glucose Self-Monitoring/instrumentation; Blood Glucose Self-Monitoring/methods
Fulltext Glycaemic Changes Among Children and Adolescents With Type 1 Diabetes Mellitus Before and During Ramadan Fasting Using Continuous Glucose Monitoring

Teoh ST, Hussain S, Hong JYH

J ASEAN Fed Endocr Soc, 2022;37(2):49-59.
PMID: 36578892 DOI: 10.15605/jafes.037.02.08

OBJECTIVES: This study described and compared glycaemic changes with the use of the following Continuous Glucose Monitoring (CGM) metrics: time in range, time in hyperglycaemia and time in hypoglycaemia from retrospective CGM data among children and adolescents with Type 1 Diabetes Mellitus (T1DM), before and during Ramadan to better understand the impact of fasting during this season.
METHODOLOGY: This study was conducted in 2 tertiary centres: Hospital Putrajaya (HPJ) and Hospital Universiti Sains Malaysia (HUSM) from February to May 2020. Muslim T1DM patients between ages 8 to18 who intended to fast during Ramadan were given Ramadan-focused education. CGM iPro2® (Medtronic) was used before and during Ramadan, complemented by finger-prick glucose monitoring or self-monitoring of blood glucose (SMBG).
RESULTS: Of the 32 patients, only 24 (12 female) were analysed. Mean age was 13.6 ± 3.1 years old, mean HbAlc was 9.6 ± 1.9% and mean duration of illness was 5.4 ± 3.4 years. Majority (91.7%) were on multiple dose injections (MDI) while only 8.3% were on continuous subcutaneous insulin infusion (CSII). All fasted in Ramadan without acute complications. Retrospective CGM analysis revealed similar results in time in range (TIR), time in hyperglycaemia and time in hypoglycaemia before and during Ramadan, indicating no increased hypoglycaemic or hyperglycaemic events related to fasting. Glycaemic variability before Ramadan as measured by the LBGI, HBGI and MAG, were similar to values during Ramadan.
CONCLUSION: Ramadan fasting among T1DM children and adolescents, by itself, is not associated with short-term glycaemic deterioration. T1DM youths can fast safely in Ramadan with the provision of focused education and regular SMBG.

Matched MeSH terms: Blood Glucose Self-Monitoring/methods
Effect of ambient temperature on analytical and clinical performance of a blood glucose monitoring system: Omnitest Sensor glucose meter

Nawawi H, Sazali BS, Kamaruzaman BH, Yazid TN, Jemain AA, Ismail F, et al.

Ann. Clin. Biochem., 2001 Nov;38(Pt 6):676-83.
PMID: 11732650

The effect of ambient temperature on the analytical and clinical performance of a glucose meter was examined. A total of 114 venous whole blood samples were analysed for glucose by a reference method, and by a glucose meter at 21-22 degrees C, room temperatures, 26-27 degrees C and 33-34 degrees C. Glucose meter readings at each temperature were compared with the reference values and evaluated by analysis of variance, Spearman's correlation, the percentage of glucose meter readings within +/- 10% of the reference value and error grid analysis. Analysis of covariance was used to determine the effect of temperature on glucose meter readings. There were no significant differences in the glucose meter readings and in accuracy of the meter readings between different temperatures. Temperature was not a significant independent determinant of the glucose meter readings. For each glucose concentration, the precision of the meter and clinical performance were comparable between the different temperatures. In conclusion, ambient temperature does not affect the accuracy, precision and clinical performance of the Omnitest Sensor.

Matched MeSH terms: Blood Glucose Self-Monitoring/instrumentation*; Blood Glucose Self-Monitoring/standards; Blood Glucose Self-Monitoring/statistics & numerical data
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 Intraoperative glycaemic control in non insulin dependent diabetes mellitus: a comparison between normal saline and ringer’s lactate

Sulaiman, I.M., HS, Lee, Balan, S., Jaafar, M.Z.

Medicine & Health, 2006;1(1):20-24.
MyJurnal

Fifty Non Insulin Dependent Diabetes Mellitus (NIDDM) patients undergoing surgery under epidural anaesthesia were studied. All patients received dextrose 5% infusion at 100 ml/hr from the period of fasting until upon arrival to the operation room. Patients were randomly divided into two groups. Patients in Group 1 (n=25) received normal saline while patients in Group 2 (n=25) were given Ringer’s lactate. Both groups received their infusion throughout the operative period up to four hours postoperatively. Blood glucose level was measured at baseline, 45 minutes intra operatively and postoperatively at 30 minutes and four hours by using a glucometer. Patients in Group 2 has a larger mean increase in blood glucose level of 1.5 mmol/L between 4 hours postoperatively and baseline compared to 0.96 mmol/L in Group 1. However, this was not statistically significant. There was no difference in the increase of mean glucose level at 30 minutes when compared to baseline. There was a significant increase in mean blood glucose level in both groups in the postoperative period when compared to baseline. This study demonstrated that patients with NIDDM receiving Ringer’s lactate has a larger increase in mean blood glucose level compared to those receiving normal saline, but the magnitude is not statistically significant.

Matched MeSH terms: Blood Glucose Self-Monitoring
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
Fulltext Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study

Muhammed Elamin S, Muhamad Arshad NF, Md Redzuan A, Abdul Aziz SA, Hong J, Chua XY, et al.

BMJ Open, 2024 Apr 02;14(4):e079606.
PMID: 38569693 DOI: 10.1136/bmjopen-2023-079606

OBJECTIVE: The objective of this study is to explore the information needs related to insulin therapy in children and adolescents with type 1 diabetes mellitus (T1DM) from the children's perspectives as well as their caregivers.
DESIGN: Qualitative study; semistructured interviews. To identify emerging themes relating to information needs, open coding and thematic analysis were employed.
SETTING: Participants were recruited from a tertiary care children's hospital in Kuala Lumpur, Malaysia and a specialist hospital in Riyadh, Saudi Arabia.
PARTICIPANTS: Thirty one children with a mean age of 11.5 years (SD=1.9) and their caregivers were interviewed. Seventeen participants were from Malaysia and 14 were from Saudi Arabia.
RESULTS: Four themes of information emerged from the interviews, including information related to (1) hypoglycaemia and hyperglycaemia, (2) insulin therapy, (3) injection technique and (4) other information needs pertaining to continuous glucose monitoring, access to peer groups and future advances in insulin therapy.
CONCLUSION: This study provided valuable insights into the information needs related to T1DM and insulin therapy among children and adolescents with T1DM that should be considered by stakeholders in the development of age-appropriate education materials. Such materials will assist children and adolescents to better manage their life-long T1DM condition from adolescence until adulthood.

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext RF Remote Blood Glucose Sensor and a Microfluidic Vascular Phantom for Sensor Validation

Yunos MFAM, Manczak R, Guines C, Mansor AFM, Mak WC, Khan S, et al.

Biosensors (Basel), 2021 Dec 03;11(12).
PMID: 34940251 DOI: 10.3390/bios11120494

Diabetes has become a major health problem in society. Invasive glucometers, although precise, only provide discrete measurements at specific times and are unsuitable for long-term monitoring due to the injuries caused on skin and the prohibitive cost of disposables. Remote, continuous, self-monitoring of blood sugar levels allows for active and better management of diabetics. In this work, we present a radio frequency (RF) sensor based on a stepped impedance resonator for remote blood glucose monitoring. When placed on top of a human hand, this RF interdigital sensor allows detection of variation in blood sugar levels by monitoring the changes in the dielectric constant of the material underneath. The designed stepped impedance resonator operates at 3.528 GHz with a Q factor of 1455. A microfluidic device structure that imitates the blood veins in the human hand was fabricated in PDMS to validate that the sensor can measure changes in glucose concentrations. To test the RF sensor, glucose solutions with concentrations ranging from 0 to 240 mg/dL were injected into the fluidic channels and placed underneath the RF sensor. The shifts in the resonance frequencies of the RF sensor were measured using a network analyzer via its S11 parameters. Based on the change in resonance frequencies, the sensitivity of the biosensor was found to be 264.2 kHz/mg·dL-1 and its LOD was calculated to be 29.89 mg/dL.

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 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*
Continuous glucose monitoring results in lower HbA1c in Malaysian women with insulin-treated gestational diabetes: a randomized controlled trial

Paramasivam SS, Chinna K, Singh AKK, Ratnasingam J, Ibrahim L, Lim LL, et al.

Diabet Med, 2018 08;35(8):1118-1129.
PMID: 29663517 DOI: 10.1111/dme.13649

AIMS: To determine if therapeutic, retrospective continuous glucose monitoring (CGM) improves HbA1c with less hypoglycaemia in women with insulin-treated gestational diabetes mellitus (GDM).
METHODS: This prospective, randomized controlled, open-label trial evaluated 50 women with insulin-treated GDM randomized to either retrospective CGM (6-day sensor) at 28, 32 and 36 weeks' gestation (Group 1, CGM, n = 25) or usual antenatal care without CGM (Group 2, control, n = 25). All women performed seven-point capillary blood glucose (CBG) profiles at least 3 days per week and recorded hypoglycaemic events (symptomatic and asymptomatic CBG

Matched MeSH terms: Blood Glucose Self-Monitoring/instrumentation; Blood Glucose Self-Monitoring/methods
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 Smartphone-based laser glucometer for non-invasive measurement of glucose level of diabetic patients

Tamrin, K.F., Adilah, A.N., Hamdi, M.M., Jong, R.P.

Borneo International Journal, 2018;1(1):27-32.
MyJurnal

A glucose meter (or glucometer) is a medical device for determining the approximate concentration of glucose in the
blood by pricking a finger to draw blood sample using a sharp needle. However, diabetic patient has quite slow level in
wound healing process which causes their fingers constantly in a state of wounded and exposed to bacteria. More
importantly, two main factors for the weakness of invasive technique is a painful process and cost often because constant
monitoring of glucose level is very expensive. The main objective of this research is to design and develop a non-invasive
optical measuring technique to measure body glucose level automatically and painlessly using a laser pointer and a
smartphone. Images captured by the smartphone is analysed using a Matlab software to determine the refractive index of
the urine sample. Calibration of the system is performed by correlating the results with that of the glucometer. Both
results compare well with R-squared value of 92.9%. The system can be potentially used for remote health and patient
monitoring.

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
Internet analytics of an innovative digital educational resource of type 1 diabetes HelloType1 in local languages for people living with diabetes families and healthcare professionals in Southeast Asia

Ng SM, Malene IV, Nguyen TK, Le K, Lim YXL, Lek N, et al.

BMC Endocr Disord, 2023 Nov 16;23(1):249.
PMID: 37974071 DOI: 10.1186/s12902-023-01501-4

BACKGROUND: There is minimal data of health outcomes for Type 1 Diabetes (T1D) in Southeast Asia (SEA) where government funding of insulin and blood glucose monitoring either do not exist or is limited. The full impact of Covid-19 pandemic on the national economies of SEA remain unknown. In the midst of the pandemic, in 2021, HelloType1 was developed by Action4Diabetes (A4D), a non-government organisation charity in collaboration with Southeast Asia local healthcare professionals as an innovative digital educational resource platform of T1D in local languages. HelloType1 was launched in Cambodia, Vietnam, Thailand and Malaysia in 2021 to 2022 with Memorandums of Understandings (MOUs) signed between A4D and each country. Internet data analytics were undertaken between the 1st of January 2022 to 31st of December 2022.
AIMS: The aims of this study were to explore the usability and internet data analytics of the HelloType1 online educational platform within each country.
METHODS: The data analytics were extracted Google analytics that tracks data from the website hellotype1.com and Facebook analytics associated with the website.
RESULTS: There was a 147% increase in the number of HelloType1 users between the first 6 months versus the latter 6 months in 2022 and a 15% increase in the number of pages visited were noted. The majority of traffic source were coming from organic searches with a significant increase of 80% growth in 2022.
CONCLUSIONS: The results of the analytics provide important insights on how an innovative diabetes digital educational resource in local languages may be optimally delivered in low-middle income countries with limited resources.

Matched MeSH terms: Blood Glucose Self-Monitoring
Fulltext Self-monitoring of blood glucose among diabetes patients attending government health clinics

Mastura I, Mimi O, Piterman L, Teng CL, Wijesinha S

Med J Malaysia, 2007 Jun;62(2):147-51.
PMID: 18705449 MyJurnal

The aims of this study were (i) to determine the prevalence of self-monitoring of blood glucose (SMBG) among Type 2 diabetes patients attending government health clinics and (ii) to ascertain the factors influencing SMBG. Five hundred and fifty-six Type 2 diabetes patients from two government health clinics in Selangor and Negeri Sembilan were interviewed using a structured questionnaire. The total subjects of the study were 556 patients. Eighty-five patients (15.3%) of patients; performed SMBG. However, 170 subjects were included in the statistical analysis, 85 patients who were not self-monitoring were randomly selected and was compared with 85 patients who were self-monitoring. Among those who performed SMBG, the majority (83.5%) monitored less than once per day and only 16.5% monitored at least once a day. One-third of patients adjusted their medications based on their SMBG results. The higher patient's level of education (p= 0.024, CI 1.29 - 35.3); the higher total family income (p= 0.041, CI 1.26 - 4.79); the longer duration of diabetes (p<0.01, CI 2.22 - 7.29); and treatment regime which includes insulin (p< 0.001, CI 2.05 -9.24) were significant predictors of SMBG practice. Although SMBG is recognised to be useful and effective in achieving diabetes control, this study has found that only a minority of patients with diabetes performed SMBG. Hence healthcare personnel must increase awareness on the importance of SMBG and strongly promote the practice among diabetic patients.

Matched MeSH terms: Blood Glucose Self-Monitoring*
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*
Fulltext Accuracy, User Acceptability, and Safety Evaluation for the FreeStyle Libre Flash Glucose Monitoring System When Used by Pregnant Women with Diabetes

Scott EM, Bilous RW, Kautzky-Willer A

Diabetes Technol Ther, 2018 03;20(3):180-188.
PMID: 29470094 DOI: 10.1089/dia.2017.0386

BACKGROUND: Accuracy of the FreeStyle Libre™ Flash Glucose Monitoring System has not been evaluated in pregnant women with diabetes. The aim of this study was to determine accuracy (compared to self-monitoring of blood glucose [SMBG]), clinical safety, and acceptability of the FreeStyle Libre System when used at home by this population.
MATERIALS AND METHODS: Seventy-four participants, with type 1 (T1D, n = 24), type 2 (T2D, n = 11), or gestational (n = 39) diabetes, were enrolled across 13 sites (9 in United Kingdom, 4 in Austria). Average gestation was 26.6 ± 6.8 weeks (mean ± standard deviation), age was 30.5 ± 5.1 years, diabetes duration was 13.1 ± 7.3 years for T1D and 3.2 ± 2.5 years for T2D, and 49/74 (66.2%) used insulin to manage their diabetes. Sensors were worn for up to 14 days. Sensor glucose values (masked) were compared with capillary SMBG values (made at least 4 times/day).
RESULTS: Clinical accuracy of sensor results versus SMBG results was demonstrated, with 88.1% and 99.8% of results within Zone A and Zones A and B of the Consensus Error Grid, respectively. Overall mean absolute relative difference was 11.8%. Sensor accuracy was unaffected by the type of diabetes, the stage of pregnancy, whether insulin was used, age or body mass index. User questionnaires indicated high levels of satisfaction with sensor wear, system use, and comparison to SMBG. There were no unanticipated device-related adverse events.
CONCLUSIONS: Good agreement was demonstrated between the FreeStyle Libre System and SMBG. Accuracy of the system was unaffected by patient characteristics, indicating that the system is safe and accurate to use by pregnant women with diabetes.

Matched MeSH terms: Blood Glucose Self-Monitoring/adverse effects*
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*

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