scholarly journals Evaluation of a Diabetes Remote Monitoring Program Facilitated by Connected Glucose Meters for Patients with Poorly Controlled Type 2 Diabetes: A Randomized Crossover Trial. (Preprint)

2020 ◽  
Author(s):  
Daniel J. Amante ◽  
David M. Harlan ◽  
Stephenie C. Lemon ◽  
David D. McManus ◽  
Oladapo O. Olaitan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Usual Care ◽  
Remote Monitoring ◽  
Treatment Satisfaction ◽  
Monitoring Program ◽  
Cost Of Care ◽  
Glucose Meter ◽  
Diabetes Center

BACKGROUND Patients with poorly-controlled type 2 diabetes (T2D) experience increased morbidity, mortality and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-connected devices that automatically upload SMBG data to secure cloud-based databases, allow for improved sharing and monitoring of SMBG data. Real-time monitoring of SMBG data presents opportunities to provide timely support to patients responsive to abnormal SMBG recordings. Such diabetes remote monitoring programs can provide patients with poorly-controlled T2D additional support needed to improve critical outcomes. OBJECTIVE To evaluate six months of a diabetes remote monitoring program facilitated by cellular-connected glucose meter, access to a diabetes coach and support responsive to abnormal blood glucose recordings greater than 400 mg/dL or below 50 mg/dL in adults with poorly controlled T2D. METHODS Patients (n=120) receiving care at a diabetes center of excellence participated in a two-arm, 12-month randomized crossover study. The intervention included a cellular-connected glucose meter and phone-based diabetes coaching provided by Livongo Health. The coach answered questions, assisted in goal setting, and provided support in response to abnormal glucose levels. One group received the intervention for six months before returning to usual care (IV/UC). The other group received usual care before enrolling in the intervention (UC/IV) for six months. Change in hemoglobin A1c (HbA1c) was the primary outcome and change in treatment satisfaction was the secondary outcome. RESULTS Improvements in mean HbA1c were seen in both groups during the first six months (IV/UC -1.1% (SD 1.5) vs. UC/IV -0.8% (1.5), p < 0.001). After crossover, there was no significant change in HbA1c in IV/UC (mean HbA1c change +0.2 (1.7), p=0.41); however, those in UC/IV showed further improvement (mean (SD) HbA1c change -0.4% (1.0), p < 0.01). A mixed-effects model showed no significant treatment effect (IV vs. UC) over 12 months (p=0.06). However, participants with higher baseline HbA1c and those in first time period experienced greater improvements in HbA1c. Both groups reported similar improvements in treatment satisfaction throughout the study. CONCLUSIONS Patients enrolled in the diabetes remote monitoring program intervention experienced improvements in HbA1c and treatment satisfaction similar to usual care at a specialty diabetes center. Future studies on diabetes remote monitoring program should incorporate scheduled coaching components and involve family members and caregivers. CLINICALTRIAL Study details can be found at clinicaltrials.gov with the study identifier number: NCT03124043.

scholarly journals The Effect of a Cellular-Enabled Glucose Meter on Glucose Control for Patients With Diabetes: Prospective Pre-Post Study

JMIR Diabetes ◽  
10.2196/14799 ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. e14799 ◽  
Author(s):  
Jennifer B Bollyky ◽  
Stephanie T Melton ◽  
Tong Xu ◽  
Stefanie L Painter ◽  
Brian Knox
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
The United States ◽  
South Florida ◽  
World Health ◽  
Target Range ◽  
Depression Symptoms ◽  
Diabetes Educator ◽  
Glucose Meter

Background Diabetes is a global epidemic affecting approximately 30 million people in the United States. The World Health Organization recommends using technology and telecommunications to improve health care delivery and disease management. The Livongo for Diabetes Program offers a remote monitoring technology with Certified Diabetes Educator outreach. Objective The purpose of this study was to examine health outcomes measured by changes in HbA1c, in time in target blood glucose range, and in depression symptoms for patients enrolled in a remote digital diabetes management program in a Diabetes Center of Excellence setting. Methods The impact of the Livongo for Diabetes program on hemoglobin A1c (HbA1c), blood glucose ranges, and depression screening survey results (Patient Health Questionnaire-2 [PHQ-2]) were assessed over 12 months in a prospective cohort recruited from the University of South Florida Health Diabetes Home for Healthy Living. Any patient ≥18 years old with a diagnosis of diabetes was approached for voluntary inclusion into the program. The analysis was a pre-post design for those members enrolled in the study. Data was collected at outpatient clinic visits and remotely through the Livongo glucose meter. Results A total of 86 adults were enrolled into the Livongo for Diabetes program, with 49% (42/86) female, an average age of 50 (SD 15) years, 56% (48/86) with type 2 diabetes mellitus, and 69% (59/86) with insulin use. The mean HbA1c drop amongst the group was 0.66% (P=.17), with all participants showing a decline in HbA1c at 12 months. A 17% decrease of blood glucose checks <70 mg/dL occurred concurrently. Participants with type 2 diabetes not using insulin had blood glucose values within target range (70-180 mg/dL) 89% of the time. Participants with type 2 diabetes using insulin were in target range 68% of the time, and type 1 diabetes 58% of the time. Average PHQ-2 scores decreased by 0.56 points during the study period. Conclusions Participants provided with a cellular-enabled blood glucose meter with real-time feedback and access to coaching from a certified diabetes educator in an outpatient clinical setting experienced improved mean glucose values and fewer episodes of hypoglycemia relative to the start of the program.

scholarly journals Reduction in HbA1c using professional flash glucose monitoring in insulin-treated type 2 diabetes patients managed in primary and secondary care settings: A pilot, multicentre, randomised controlled trial

2019 ◽  
Vol 16 (4) ◽  
pp. 385-395 ◽  
Author(s):  
Ramzi A Ajjan ◽  
Neil Jackson ◽  
Scott A Thomson
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Secondary Care ◽  
Treatment Satisfaction ◽  
Glucose Monitoring ◽  
Self Monitoring ◽  
Flash Glucose Monitoring ◽  
Time In Range ◽  
Diabetes Patients

Aim: Analyse the effects of professional flash glucose monitoring system (FreeStyle Libre Pro™) on glycaemic control in insulin-treated type 2 diabetes. Methods: Primary (n = 17) and secondary care centres (n = 5) randomised 148 type 2 diabetes patients into three groups: (A) self-monitoring of blood glucose (n = 52), (B) self-monitoring of blood glucose and two Libre Pro sensor wears (n = 46) or (C) self-monitoring of blood glucose and four sensor wears (n = 50). Primary endpoint was time in range (glucose 3.9–10 mmol/L) within group C comparing baseline with days 172–187. Predefined secondary endpoints included HbA1c, hypoglycaemia and quality of life measures analysed within and between groups (clinicaltrials.gov, NCT02434315). Results: In group C, time in range in the first 14 days (baseline) and days 172–187 was similar at 15.0 ± 5.0 and 14.1 ± 4.7 h/day (mean ± SD), respectively, (p = 0.1589). In contrast, HbA1c reduced from baseline to study end within group C by 4.9 ± 8.8 mmol/mol (0.44% ± 0.81%; p = 0.0003). HbA1c was also lower in group C compared with A at study end by 5.4 ± 1.79 mmol/mol (0.48% ± 0.16%; p = 0.0041, adjusted mean ± SE), without increased time in hypoglycaemia ( p = 0.1795). Treatment satisfaction scores improved in group C compared with A ( p = 0.0225) and no device-related serious adverse events were reported. Conclusions: Libre Pro can improve HbA1c and treatment satisfaction without increasing hypoglycaemic exposure in insulin-treated type 2 diabetes individuals managed in primary/secondary care centres.

scholarly journals Prevalence of Type 2 Diabetes Mellitus in Rural Adults (>_31years) in Bangladesh

2018 ◽  
Vol 13 (1) ◽  
pp. 20-23 ◽  
Author(s):  
Rajmohon Hira ◽  
Md A Wadud Miah ◽  
Devraj Hira Akash
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Adult Population ◽  
Fasting Blood Glucose ◽  
Economic Loss ◽  
Early Care ◽  
The People ◽  
High Prevalence ◽  
Glucose Meter

Diabetes is one of the most prevalent and serious non- communicable diseases all over the world. It is the leading cause of death, disability, and economic loss, and it is identified as a major threat to global development. Among the adults (age 20-79 years) with diabetes in the top five South East Asian countries, Bangladesh is in the second position. The number of people with diabetes in Bangladesh was 5.10 million in 2013, which is expected to increase to 8.20 million by 2035. Therefore, this study aimed to estimate the prevalence of type 2 diabetes in a rural population aged >_ 31 years living at a village in the district of Bagerhat, Bangladesh, and to aware the people of the area about diabetes and to detect diabetes early for early care to prevent its complications. In this study we used 'Prodigy Preferred blood Glucose Meter' for testing fasting blood glucose to diagnose diabetes. The study was conducted from 2012 to 2015. Random sampling method was used to select participants. Fasting plasma glucose of the 400 participants of >_ 31 years of age was done at a 'Free Friday Clinic' of the study area. Out of 400 participants 38 (09.50%) were diabetic. Among the participants (n=400), 45.50% were male and 54.50% were female. We found a high prevalence of DM in the rural Bangladeshi adult population (9.5%). The present study found that about one in ten Bangladeshi adults has diabetes (9.5%). This finding is consistent with many other studies from low-and middleincome countries including India (8.6%), Sri Lanka (8.0%), China (9.6%), Nauru (13.7%), and Panama (9.5%). Our study together with previous study confirms that prevalence of diabetes is increasing in Bangladesh.Faridpur Med. Coll. J. Jan 2018;13(1): 20-23

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