Download or read book A Qualitative Study on Self monitoring of Blood Glucose by Patients with Type 2 Diabetes Mellitus Using Insulin in a Malaysian Hospital written by Ong Woon May and published by . This book was released on 2014 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Does Daily Self monitoring of Blood Sugar Levels Improve Blood Sugar Control and Quality of Life for Patients with Type 2 Diabetes who Do Not Use Insulin written by Laura A. Young and published by . This book was released on 2018 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: For the nearly 75% of patients living with type 2 diabetes mellitus (T2DM) who 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.OBJECTIVES: The overarching goal was to assess the impact of 3 different SMBG testing approaches on patient-centered outcomes in patients with non-insulin-treated T2DM within the real-world clinic setting.OBJECTIVE 1: Assess SMBG effectiveness on 2 primary patient-centered outcomes, glycemic control (A1c) and health-related quality of life (HRQOL), over 1 year in 450 participants with non-insulin-treated diabetes mellitus (DM) in the following 3 groups: (1) no SMBG testing, (2) once-daily SMBG testing with standard patient feedback consisting of glucose values immediately reported to the patient through the glucometer, and (3) once-daily SMBG testing with enhanced patient feedback consisting of glucose values immediately reported to the patient plus automated, tailored messaging also delivered via the glucometer. OBJECTIVE 2: Evaluate the impact of SMBG on secondary patient-centered outcomes including (1) DM-related quality of life, (2) DM self-care, (3) DM treatment satisfaction, (4) DM self-efficacy, (5) patient-provider communication, (6) hypoglycemia frequency, and (7) health care utilization. OBJECTIVE 3: Conduct qualitative assessments of the patient participant and provider experience for all 3 intervention groups. This objective supports efficient translation of study findings to real-world clinic settings by exploring such issues as patient-provider communications, use of the glucometer and accompanying reports, utility of the treatment algorithm given to providers, and practice burden. METHODS: Using a stakeholder engagement approach, we developed and implemented a pragmatic trial. We randomly assigned 450 patients with non-insulin-treated T2DM in 15 North Carolina primary care practices to 3 arms without masking of treatment assignment: (1) no SMBG, (2) once-daily testing with standard feedback consisting of glucose values being immediately reported to the patient through the glucometer, and (3) once-daily SMBG 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 glucometer following each testing. Coprimary outcomes included glycemic control (A1c) and HRQOL at 52 weeks. RESULTS: A total of 450 patients were randomized and 92.9% completed the final visit. There were no significant differences in glycemic control across all 3 groups (P = 0.74; estimated adjusted mean 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: In patients with non-insulin-treated type 2 diabetes, at 1 year we observed no clinically or statistically significant differences in glycemic control or HRQOL between patients who performed SMBG compared with those who did not perform SMBG. The addition of tailored feedback provided through messaging via a meter did not provide any advantage in glycemic control.

Download or read book Self Monitoring of Blood Glucose in Patients with Type 2 Diabetes Mellitus Meta Analysis of Effectiveness written by U. S. Department of Veterans Affairs and published by Createspace Independent Pub. This book was released on 2013-06-18 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt: According to the World Health Organization, at least 180 million people worldwide suffer from diabetes. Though prevalent throughout the world, diabetes is more common (especially type 2) in more developed countries like the United States. The National Diabetes Information Clearinghouse estimates that diabetes costs $132 billion in the United States alone every year. Given these estimates along with the projection that the worldwide incidence of diabetes will double in the next 20 years, 1 intensified research into better management of this chronic disease is paramount. Tighter control of blood glucose is advocated as a means to reduce microvascular and macrovascular complications. VA has performance measures assessing the proportion of patients meeting certain A1c goals, currently 7% and 9%. Theoretically, self-monitoring of blood glucose (SMBG) can improve compliance with recommendations on diet and exercise and medication regimens. The American Diabetes Association has recommended that the optimal frequency of SMBG for patients with type 2 diabetes should be adequate to facilitate reaching glucose goals. This hypothesis is based on the expectation that life style changes are facilitated by SMBG. Under these conditions, we should expect an improvement of glycemic control SMBG may decrease patient management costs, and because of the high prevalence of type 2 diabetes, efforts to establish the efficacy of SMBG in type 2 diabetes mellitus are of greater relevance. Methods to achieve improved glycemic control, and therefore a higher proportion of patients meeting target A1c levels, include diet, exercise, and medication. However, evidence supporting the use of SMBG for diabetics not requiring insulin is not as clear. The purpose of this review is to analyze the literature to answer four key questions given to us by VA: 1) Is regular self-monitoring of blood glucose effective in achieving target A1c levels for patients with type 2 diabetes?; 2) Is regular self-monitoring of blood glucose effective in maintaining target A1c levels for patients with type 2 diabetes?; 3) Does regular self-monitoring of blood glucose reduce the frequency of hypoglycemia in patients with type 2 diabetes?; 4) Is there evidence that different frequencies of testing result in differences in improvements in A1c?

Download or read book Systematic Review on Self Monitoring of Blood Glucose for Non Insulin Using Type 2 Diabetes Patients written by Shan Xiao and published by . This book was released on 2017-01-26 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation, "Systematic Review on Self-monitoring of Blood Glucose for Non-insulin-using Type 2 Diabetes Patients" by Shan, Xiao, 肖珊, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: The increasing prevalence causes great burden to global health. Although there is not yet an agreement on the effect of SMBG for non-insulin-treating type 2 DM patients in comprehensive management, some guidelines recommended all diabetes patients should conduct SMBG. This literature review of 5 meta-analyses and 13 randomized controlled clinical trials assessed the effectiveness of SMBG in glucose control (HbA1c), detection of hypoglycemia, non-glycemic outcomes and potential influence factors(duration of diabetes, baseline HaB1c level, SMBG frequency, SMBG duration, co-interventions) of SMBG efficacy on type 2 diabetes patients not using insulin. The method of this literature review is through a comprehensive electronic literature search of Ovid MEDLINE, EMBASE, the Cochrane Library and China Journals Full-text Database. Both English and Chinese language literatures were reviewed. All meta-analysis and randomized controlled trials of type 2 diabetes non-insulin-using patients taking SMBG to improve the glycemic control and other outcomes were included. In these studies, absolute HbA1c reduction, recognized episodes of hypoglycemia, wellbeing, QALY, DALY, complication morbidity, mortality were used as outcome measures if available. A score list based on the PRISMA Statement was used to evaluate the quality of meta-analyses. 5 meta-analysis all reported a statistical significant but clinical modest-moderate difference in HbA1c reduction between SMBG and non-SMBG group, a new published randomized controlled trial with small cohort enrolled in none of the meta- analyses did not support this conclusion. Evidence showed frequency of SMBG did not influence the efficacy of SMBG, co-interventions as education/consultation, regimen change played a positive roll on SMBG efficacy. Whether baseline HbA1c, duration of diabetes or SMBG itself have an effect on SMBG efficacy was still unknown. There is inadequate evidence of SMBG efficacy of detection of hypoglycemia of patient-oriented outcomes. No eligible Chinese article was defined to enroll in this review. This review did not support to suggest all type 2 diabetes patients not using insulin to conduct SMBG at the frequency the guidelines recommended. Carefully designed and longer-term trials are needed to obtain evidence that is more robust. Further investigation would provide more evidence of the characteristics of potential influence factors, which may help to define the specific population or optimal mode that guarantee the greatest efficacy of SMBG. DOI: 10.5353/th_b4842673 Subjects: Blood sugar monitoring Non-insulin-dependent diabetes

Download or read book The SMBG Study Structured Self monitoring of Blood Glucose in Non insulin Treated Type 2 Diabetes written by Parsons Sharon and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The SMBG Study: Structured Self-Monitoring of Blood Glucose in Non-insulin Treated Type 2 DiabetesBackground: The benefit of Self-Monitoring of Blood Glucose (SMBG) in people with non-insulin treated type 2 diabetes (T2DM) continues to be debated with inconsistent evidence from randomised controlled trials and observational studies. There is a growing consensus that structured SMBG, whereby the person with diabetes and health care provider are educated to detect patterns of glycaemic abnormality and take appropriate action according to the blood glucose profiles, can prove beneficial in terms of glycaemic control and overall well-being.Aim: To determine whether structured SMBG with or without additional telecare support, can enable poorly controlled, non-insulin treated people with T2DM to better manage their diabetes.Method: A 12 month, multi-centre, randomised controlled trial was conducted in people with established (>1 year) T2DM not on insulin therapy, with poor glycaemic control (HbA1cu22657.5% u2264 13%). A total of 666 participants were recruited from 16 primary and secondary care sites across Wales and England. 446 people were randomised into one of three groups; Group 1 (G1), a control group receiving usual diabetes care; Group 2 (G2), carried out structured SMBG with clinical review every 3 months; Group 3 (G3), carried out structured SMBG with monthly telecare support from a trained study nurse. Participants in both SMBG groups (G2 & G3) and all healthcare professionals involved in the study received standardised training including SMBG technique, glycaemic pattern recognition and the use of the clinical algorithms. The testing regimen consisted of paired testing pre and 2 hours post breakfast and main meal, 2 days each week. This was increased to recording a 7 point profile for 3 days the week prior to the 3 monthly study visit. At each study visit clinical measurements, such as weight, waist circumference and BMI were recorded, and a blood sample taken to measure HbA1c and total cholesterol. Quality of life measures were also administered at each visit along with questionnaires to gauge attitudes towards SMBG. Blood glucose management was based on SMBG results alone for those in Groups 2 & 3 with all participants and healthcare professionals involved in the study blinded to the HbA1c results taken as part of the study visit. The final HbA1c result was reported once the participant completed the study.Results: Of the 446 participants randomised, 259 were male (58%) with mean (range) age 61.7 (27 - 80)years. 267 participants (60%) had diabetes for 5 years or more with 85 (19%) having complications associated with the condition. There were no significant differences in the demographic profiles of the 3 groups. The primary outcome measure was HbA1c at 12 months and the mean (SD) HbA1c at randomisation was 8.6(1.1)%, 8.5(1.1)%, 8.6(1.2)% for Groups 1, 2 & 3 respectively. 323 participants attended the final visit at 12 months when the mean (sd) HbA1c was 8.3(1.31)% (n=116, p

Download or read book Use of Self Monitoring of Blood Glucose in Glycaemic Control of Non Insulin Treated Type 2 Diabetes Mellitus Patients written by 梁心銘 and published by Open Dissertation Press. This book was released on 2017-01-27 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation, "Use of Self Monitoring of Blood Glucose in Glycaemic Control of Non-insulin Treated Type 2 Diabetes Mellitus Patients" by 梁心銘, Sum-ming, Leung, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. DOI: 10.5353/th_b4072112 Subjects: Blood sugar monitoring Non-insulin-dependent diabetes Diabetes Mellitus

Download or read book Self monitoring Blood Glucose in Type 2 Diabetes a Continuous Improvement Initiative written by Rossi Maria Chiara and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Self-monitoring blood glucose (SMBG) is a key tool for therapeutic decision and structured patient education. Despite there is evidence that SMBG improves metabolic control both in insulin-treated and in non insulin treated patients with type 2 diabetes (T2DM), the prescription and execution of SMBG is suboptimal and heterogeneous. AIM: AMD Annals initiative aims to improve quality of diabetes care in Italy. This analysis assessed the use of SMBG in patients with T2DM to evaluate frequency of SMBG, metabolic control, and hypoglycemia in the different therapeutic schemes including or not insulin. METHOD: A specific software has been used for the standardized extraction of the information contained in the electronic medical records. Extracted data included clinical data, therapies and all SMBG values downloaded on EMR by different glucose meters routinely used by the patients. Sample was constituted by T2DM patients with at least one HbA1c value during the years 2014 and 2015 and with at least 1 available SMBG value measured in the 90 days before the HbA1c test. RESULTS: Overall 21 centers and 27,768 observations were included in the analysis. Frequency of SMBG, levels of fasting and post-prandial blood glucose (FBG and PPG), and values below 60 mg/dl were evaluated in the following treatment schemes: metformin only (N=3188); secretagogues only (N=685); metformin + secretagogues (N=2929); metformin + DPP-IV inhibitor (N=612); metformin + secretagogues + DPP-IV (N=3132); metformin + secretagogues + acarbose (N=337); GLP1RA + metformin + secretagogue (N=375); GLP1RA + metformin (N=516); basal insulin + metformin + secretagogues (N=3486); basal + short acting insulin + metformin (N=1666); basal + short acting insulin (N=6842). SMBG was frequently recommended also to patients not treated with insulin: 45.7% of observations referred to patients not treated with insulin. Frequency of SMBG was suboptimal in all treatment schemes; even patients treated with schemes including insulin monitored their glucose less than two times per day. Furthermore, 39.5% of SMBG tests could not be univocally classified as FBG or post-prandial glucose (PPG). In all treatment schemes, of those values which could be univocally classified, over 95% of SMBG tests were FBG values and less than 5% were PPG values. Pre-breakfast FBG values represented about 50% of all available FBG values in all treatment schemes. The frequency of SMBG does not substantially differed among the most common schemes with oral agents, irrespective of the use of secretagogues. The average FBG during three months was over 130 mg/dl in 38% to 84% of the cases in the different schemes, while average PPG was over 140 mg/dl in 36% to 73% of the cases. Even when looking at the most common therapeutic approaches, it emerged that substantial proportions of cases have elevated FBG and PPG, even though average HbA1c levels were often acceptable. The use of therapeutic schemes including secretagogues was associated with a two to three-fold increased risk of glycemic values

Download or read book Self monitoring of Blood Glucose in Patients with Type 2 Diabetes Mellitus written by United States. Department of Veterans Affairs. Health Services Research and Development Service and published by . This book was released on 2007 with total page 46 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Diabetes is a prevalent and costly disease in Veterans. Control of blood glucose is an important VA objective. Self-monitoring of blood glucose (SMBG) is advocated as a method to better achieve control. The Key Questions were: Key Question 1. Is regular SMBG effective in achieving target A1c levels for patients with type 2 diabetes? Key Question 2. Is regular SMBG effective in maintaining target A1c levels for patients with type 2 diabetes? Key Question 3. Does regular SMBG reduce the frequency of hypoglycemia in patients with type 2 diabetes? Key Question 4. Is there evidence that different frequencies of testing result in differences in improvements in A1c? METHODS: We searched PubMed from 2004-2006 using standard search terms. We performed an update search in July 2007. Titles, abstracts, and articles were reviewed in duplicate by physicians trained in the critical analysis of literature. Data were extracted by quantitative analysts. Pooled analyses were performed for trials with A1c outcomes at six months and 12 months or greater of follow-up. All other data were narratively summarized. RESULTS: We screened 52 titles, 14 were rejected, and we performed a more detailed review on 38 articles. From this, we identified 14 randomized controlled trials (RCTs) that measured the effect of SMBG compared to a group not receiving SMBG and monitored A1c levels with at least three months of follow-up. Four trials were excluded; one because it presented duplicate data and three because they evaluated SMBG in both the control and intervention groups, leaving 10 trials contributing to the efficacy analysis. We identified five observational studies assessing effectiveness in diabetic Veterans.

Download or read book Improving Glycaemic Control in Malaysian Patients with Type 2 Diabetes with Insulin Pump Therapy written by Abdullah Noor Rafhati Adyani and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BackgroundType 2 diabetes is a relentless progressive disease, characterized by ongoing decline in beta cell function. In advanced disease, many patients develop worsening diabetes control, unable to reach the glycaemic targets and ultimately require insulin. In addition, a growing number of insulin-treated patients require high doses of insulin. Opt2mise study demonstrated the efficacy of insulin pump therapy in long standing poorly controlled type 2 diabetes on multiple daily injections.1 In Malaysia, approximately 30% of insulin users were on premixed insulin regimen due to the cost and presumed convenience.2 Those patients who fail premixed insulin are usually intensified with multiple daily injections of insulin.AimThe purpose of this study was to evaluate the comparative efficacy of Continuous Subcutaneous Insulin Infusion(CSII) therapy versus multiple daily injections(MDI) in insulin resistant type 2 diabetes patients who were sub-optimally controlled with premixed insulin regimen.MethodologyThis was an ongoing 12 - months randomized, parallel-group, open-label trial with a single-arm cross-over in the continuation phase in subjects with Type 2 diabetes inadequately controlled with premixed insulin therapy. Participants were recruited from the Endocrine clinics and General Medical outpatient clinics, Putrajaya Hospital since January 2016. The participants were insulin-taking patients who were sub optimally controlled on premixed insulin regimen twice or three times daily(defined as having an HbA1c > 8%). The participants entered an 8-week dose optimisation run-in period and at the end of the run-in period, insulin dosage was at minimum 1.0U/kg/day. This was followed by randomisation into two interventional arms which were CSII and MDI. After 6 months, the participants on the MDI arm crossed over to CSII for another 6 months. Neither patients nor investigators were masked to treatment allocation. The primary endpoint was change in mean glycated haemoglobin between baseline and 6 months for the intention-to-treat population. The secondary endpoints were safety, metabolic profiles, total insulin dosage, within group difference in HbA1c from 6 months to 12 months and the number of self-monitoring blood glucose(SMBG)/day. This study was registered with ClinicalTrials.gov, number NCT03112538 and NMRR-15-1449-26854.ResultsThese were the results for the first 6 months. 56 patients entered the run-in period and 54 patients were randomised(29 to CSII and 25 to MDI). 25 in CSII group and 25 in MDI group completed 6 months of follow-up. The baseline demographic data were similar in both groups with the median age 52.0(IQR 14.50) and 56.0(IQR 16.50) in CSII and MDI group, respectively with mean duration of diabetes 13.8 years. Mean glycated haemoglobin at baseline was 10% in both groups. At 6 months, mean glycated haemoglobin had decreased by 2u00b71%(SD 1.17) in the CSII group and 1.2%(SD 1.74) in the MDI group, resulting in a between-group treatment diufb00erence of u20130u00b792%(95% CI -1.766, -0.816 p=0.032). After 6 months, the median total daily insulin(TDD)/kg/day was 1.0(IQR 0.37) with CSII versus 1.2(IQR 0.35) for MDI(p=0.018). The total daily insulin dose was 91.3(SD 31.38) vs 110.9(SD 35.42) (95% CI -38.59,-0.53 p=0.044) between the 2 groups. 16% vs 4% achieved HbA1c

Download or read book Preventing Chronic Diseases written by World Health Organization and published by World Health Organization. This book was released on 2005-09-28 with total page 199 pages. Available in PDF, EPUB and Kindle. Book excerpt: The major causes of premature adult deaths in all regions of the world, due to chronic diseases such as heart disease, strokes, diabetes and cancer, have been generally neglected on the international health and development agenda. Four out of every five chronic disease-related deaths in the world occur in low and middle income countries, where people tend to develop these diseases at a younger age and to die sooner. The death toll is projected to rise by a further 17 per cent in the next 10 years, whilst child obesity rates are increasing worldwide. This report examines the actual scale and severity of the problem using the most recent data available, considers the major risk factors and associated trends, and discusses the public health policy actions required to implement effective integrated chronic disease prevention and control measures.

Download or read book Self Regulation Theory and Self monitoring of Blood Glucose Behavior in Type 2 Diabetes Mellitus written by Jennifer E. F. Ward and published by . This book was released on 2014 with total page 135 pages. Available in PDF, EPUB and Kindle. Book excerpt: The present study examined self-monitoring of blood glucose (SMBG) as part of a selfregulatory process of health decision-making using the Self-Regulation Model of illness perceptions, or Common Sense Model. Participants were N=185 individuals with type 2 diabetes from a specialty diabetes clinic prescribed subcutaneous insulin or other injectable diabetes medication at least daily. Collected information included both medical chart data and self-report questionnaires completed prior receiving lab results. Self-care burden was generally high; the modal prescribed times per day of injecting insulin was 4 with modal SMBG recommendations of 3-4 times per day. Participants reported high adherence to prescribed medication regimens, varied aherence to diet recommednations, and low engagement in exercise. Specific hypotheses were developed to examine the relationship between illness coherence and illness control beliefs (IPQ), SMBG decisionmaking behavior, and outcomes including diabetes distress (PAID) and hemoglobin A1c level. These hypotheses were not supported. Supplemental analyses revealed that SMBG decision-making use was related to illness perceptions, including a positive relationship with personal control and coherence beliefs, but not treatment control, and a negative relationship with both outcome variables (A1c at baseline and PAID score). Both treatment and personal control beliefs were not associated with glucose control outcomes, suggesting that illness beliefs alone do not explain why some individuals are more successful at managing their diabetes than others. Coherence was found to differ by education level and SES and greatly vary in an otherwise relatively homogenous sample. Study findings suggest that illness perceptions play an important role in the process of SMBG use for decision-making as it relates to glucose control and diabetes distress. Results also point to possible clinical targets such as illness coherence and diabetes distress. The study provides a foundation for future research related to SMBG as a decision-making strategy.

Download or read book Self monitoring of Blood Glucose in Non insulin Treated Patients with Type 2 Diabetes written by Carine Joëlle Houriet and published by . This book was released on 2010 with total page 11 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Innovation in Diabetes Self Care Management and Interventions written by Edward Zimbudzi and published by Frontiers Media SA. This book was released on 2023-09-19 with total page 141 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Self monitoring of Blood Glucose in Patients with Type 2 Diabetes Mellitus written by United States. Department of Veterans Affairs. Health Services Research and Development Service and published by . This book was released on 2007 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book La Recherche en litt rature g n rala et compar e en France written by and published by . This book was released on 1983 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Self monitoring of Blood Glucose in Noninsulin treated Diabetes written by and published by . This book was released on 2009 with total page 18 pages. Available in PDF, EPUB and Kindle. Book excerpt: People with diabetes use test strips as a means to check their blood glucose levels. Systematic self-monitoring of blood glucose is necessary for successful insultin therapy aimed at controlling glucose. However, in patients with noninsulin-treated type 2 diabetes, the benefit of systematic self-monitoring has been called into question. This report reviews the scientific evidence for systematic self-monitoring of blood glucose with test sticks in patients with type 2 diabetes, but who are not receiving insulin therapy. The Swedish National Board of Health and Welfare commissioned the report to use as a basis for their national guidelines on diabetes care. SBU is producing three additional reports within the framework of the National Board of Health and Welfare's guidelines on diabetes -- patient education in managing diabetes, intensive glucose lowering therapy in diabetes, and dietary treatment of diabetes. Conclusions The scientific evidence does not show any benefits from systematic self-monitoring of blood glucose (SMBG) with test sticks in people with noninsulin-treated type 2 diabetes. Examples of specific situations where people with noninsulin-treated type 2 diabetes may have reason to use test sticks include symptoms of hypoglycemia, particularly in patients being treated with sulfonylurea agents and meglitinides. Self-monitoring may also be needed for other purposes, e.g., educational purposes in conjunction with changes in therapy or acute disease. A more restrictive use of test sticks in this patient group would reduce costs and would not increase medical risks.

Download or read book Evaluation of a Telehealth Intervention Combining Structured Self monitoring of Blood Glucose and Nurse Care Coordination Among People with Type 2 Diabetes Noninsulin treated written by Deborah Ann Greenwood and published by . This book was released on 2014 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation evaluates the effectiveness of a telehealth remote patient monitoring (RPM) intervention that combines structured self-monitoring of blood glucose (SMBG) and nurse care coordination (NCC) to improve outcomes in persons with type 2 diabetes. The primary aims were to compare differences between glycated hemoglobin (A1C), self-management, self-efficacy, and knowledge compared to usual care after 12 weeks. A two-group randomized clinical trial comparing usual care and RPM--with structured SMBG called paired testing--enrolled 90 people with type 2 diabetes, aged 30-70 years, not taking insulin, in NCC for 12 months with A1C between 7.5%-10.9%. The RPM system includes a computer connected to the Internet to transmit glucose data. Participants received education in paired glucose testing, glucose goals, and problem-solving. Paired testing--checking glucose before and two hours after a meal or physical activity for one week--created action plans for behavioral changes. Glucose data were analyzed weekly using pattern analysis software summarized by premeal, postmeal, and change values, with feedback via electronic health record for asynchronous communication. Nurses telephoned participants monthly to discuss goal achievement. Glucose patterns not reflecting improvement after four weeks required shared decision-making medication options. Separate mixed-effects models were used to determine if intervention or control improved over time, and if intervention showed greater improvement. Data (n = 87) included mean (SD) age 55.7 ± 10.6, mean years with diabetes 8.2 ± 5.4, body mass index 34.1 ± 6.7, and mean A1C 8.3 ± 1.1. There was a significant difference in linear rate of change in A1C indicating the treatment group had on average a faster rate of decline and a faster mean rate of improvement. The treatment group showed greater improvement in summary of diabetes self-care activities subscales of carbohydrate spacing, monitoring blood glucose, and foot care. Neither group improved knowledge or self-efficacy. This intervention shows promise for implementing a complete feedback loop to engage participants in gathering actionable data, using RPM to transmit and analyze structured data, and providing a mechanism for clinicians to virtually communicate to support timely behavior and treatment changes.