MOBILE SMARTPHONE INTERVENTION FOR MANAGING GLYCAEMIA CONTROL IN THE PATIENTS WITH DIABETES MELLITUS: A SYSTEMATIC REVIEW

Background: Diabetes mellitus (DM) is a chronic disease that is a global public health problem that has a social impact, economic impact, and quality of life for patients, which leads to increased morbidity and mortality. Uncontrolled blood sugar levels and long-term DM, affecting the pathophysiology of disorders including diabetic retinopathy, heart disease, kidney failure, hyperglycemia and hypoglycemia are needed interventions that can help regulate glycemic (blood sugar levels and HbA1c) (Sami & Ansari, 2015).Objective: This study aimed to identify efficacy mobile smartphone application for managing glycaemia control in the patients with diabetes mellitus.Design: This study design is a systematic review to search and review article from database and the theory underlying this study or guidance in this systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA).Data Sources: Database search for article are from Scopus, Proquest, Pubmed, Science Direct, and Springer Link is limited to the publication of the last five years from 2015 to 2020 and full text article in English.Review Methods: This review methods in a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA).Results: In this review literature, thirteen articles were found that fit the specified inclusion and exclusion criteria. The results of this review literature found that mobile smartphone impelmentation led to a decrease in HbA1c and fasting blood glucose in the patients with diabetes mellitus.Conclusion: The findings from this study help validate the efficacy of the mobile diabetes intervention for managing glycaemia control in the patients with diabetes mellitus. Keywords: Diabetes Mellitus, Glycaemia Control, Health Education, M-Health.

Frequency and risk factors of UTI and susceptibility pattern of uropathogen and impact of glycaemia control among diabetic patients.

Objectives: The present study is designed to determine the frequency and risk factor of urinary tract infection in patients with or without diabetes, and to determine antimicrobial susceptibility among type 2 subjects with controlled and uncontrolled glycemia. Study Design: Retrospective Study. Setting: Department of Microbiology, Baqai Institute of Diabetology and Endocrinology (BIDE). Period: October 2016 to September 2018. Material & Methods: Ethical approval was obtained from the institutional review board of BIDE. Total 549 patients were included in the study. Results: A total of 117 (28.96%) and 287 (35.52%) uropathogens were isolated from patients with and without diabetes respectively. Percentage of positive culture was high which was 62.30% and 38.25% in female in both patients with and without diabetes respectively. E. coli was found to be the most frequently isolated bacteria from both patients with diabetes and without diabetes, as 50.43% and 52.26% respectively. Since, Patients with diabetes have a higher prevalence of UTI than non-diabetics. Conclusion: Hence, preventive measures should be taken and patients should be properly guided about the complications of diabetes and recurrent infections.

Practice of Hyperglycaemia Control in Intensive Care Units of the Military Hospital, Sudan - Needs of a Protocol

Hyperglycaemia is a major risk factor in critically ill patients as it leads to adverse outcomes and mortality in diabetic and non-diabetic patients. The target blood glucose remained controversial; this study aimed to contribute in assessing the practice of hyperglycaemia control in intensive care units of Khartoum Military Hospital. Furthermore, it proposed a protocol for hyperglycaemia control based on findings. A hospital-based cross-sectional study assessed the awareness and practice towards hyperglycaemia management in a sample of 83 healthcare staff selected through stratified random sampling technique. In addition, 55 patients were enrolled, through quota sampling, after excluding those with diabetic ketoacidosis, hyperosmolar-hyperglycaemic state and patients < 18 years. A self-administrated questionnaire enabled to collect data from healthcare staff, patients data were extracted from medical records. SPSS 23 was used to analyse the collected data. Chi-square and ANOVA tests assessed the association among variables. All statistical tests were considered statistically significant when p < 0.05. The training on hyperglycaemia control differed statistically (p= 0.017) among healthcare staff. The target glycaemic level (140-180 mg/dl) was knew by 11.1% of the study participants. Neither the knowledge nor the practice of hyperglycaemia control methods differed among staff (p> 0.05). The use of sliding scale was 79.3% across the ICUs with a statistically significant difference (p= 0.002). 31.5% of patients had received glycaemic control based on different methods and 11.8% were in the targeted blood glucose level. Sliding scale was the prevalent method used by doctors (71.4%) and nurses (81.6%). A patient benefited from insulin infusion method, which achieved the NICE-SUGAR target. The poor knowledge and lack of awareness towards hyperglycaemia monitoring led to inappropriate implementation of glycaemia control methods across the Military Hospital ICUs. Sustained training programs on hyperglycaemia control to ICU staff and the availability of a protocol on glycaemia control are highly required.

Relationship of HbA1c Values to Retinopathy, Nephropathy, and Cardiovascular

A total of 50 patients aged 35-75 years From Al-Sader educational Hospital in Al-Najaf city was studied to determine the glycated hemoglobin risk factors with value creatinine and urea in serum and diabetic nephropathy. Diabetic patient were (35-45 years old) with HbA1c 7.9 % (60mmol/mol). Patient were (45–55 years old), glycated hemoglobin (HbA1c) andgt; 8.5 %. Patients between (55–65 years were glycated hemoglobin (HbA1c) andgt;10.5 %. HbA1c levels, lipid profile, level of Creatinine and urea in serum, family history, BMI, blood pressure, disease severity, and complications were determined. Most patients developed some grade of retinopathy (examined by an ophthalmologist) except those with HbA1c 6.7% (50mmol/mol). Diabetic patients aged (55–65 years old) with HbA1c 7.6% (60mmol/mol). Patients aged 56–75 years old of glycated hemoglobin (HbA1c) andgt;7% with poor glycaemia control ≥ 126mg/dL were assessed to classify diabetic retinopathy. HbA1c and GA are associated with nephropathy separately. Retinopathy and nephropathy may respond to different aspects of hyperglycemia. The GA found as a powerful indicator of microvascular complications same as HbA1c where long-term glycaemia is the risk factor.

Moderate intensity exercise in hypoxia increases IGF-1 bioavailability and serum irisin in individuals with type 1 diabetes

Aim: This study aimed to determine the effect of moderate intensity continuous exercise (Ex) and hypoxia (Hyp) on serum brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1) and its binding protein-3 (IGFBP-3), irisin and cytokines levels in patients with type 1 diabetes (T1D). Methods: A total of 14 individuals with T1D (age: 28.7 ± 7.3 years) and 14 healthy adults (age: 27.1 ± 3.9 years) performed 40-min continuous Ex at moderate intensity (50% lactate threshold) on a cycle ergometer in normoxia (Nor) and Hyp (FiO2 = 15.1%) Biochemical factors, glucose concentrations and physiological variables were measured at rest, immediately and up to 24 h after both Ex protocols. Results: Patients with T1D had significantly lower pre-Ex serum concentrations of BDNF ( p < 0.05, p < 0.01), and total IGF-1 ( p < 0.001, p < 0.05) and significantly higher irisin levels ( p < 0.05, p < 0.01) in Nor and Hyp, compared with healthy subjects. Ex significantly increased in T1D group serum BDNF (in Nor only p < 0.05) and total IGF-1 levels in Nor and Hyp ( p < 0.001 and p < 0.01, respectively). Immediately after Ex in Hyp, freeIGF-1 ( p < 0.05) and irisin levels ( p < 0.001) were significantly higher compared with the levels induced by Ex alone. Free IGF-1 and irisin serum levels remained elevated in 24 h post-Ex in Hyp. In T1D, significant blood glucose (BG) decrease was observed immediately after Ex in Hyp ( p < 0.001) and in 24 h recovery ( p < 0.001) compared with pre-Ex level. Conclusion: The study results suggest that moderate intensity continuous Ex has beneficial effect on BDNF and IGF-1 levels. Ex in hypoxic conditions may be more effective in increasing availability of IGF-1. The alterations in the post-Ex irisin levels and IGF-1 system may be contributing to more effective glycaemia control in patients with T1D.