The impact of limited and strategic blood glucose monitoring on metabolic control in a type 1 diabetes clinic in Central
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ORIGINAL ARTICLE
The impact of limited and strategic blood glucose monitoring on metabolic control in a type 1 diabetes clinic in Central India Caroline S. Zuijdwijk 1,2,3 & Sharad Pendsey 4 & James Ron 5 & Graham D. Ogle 6,7 & Amisha Agarwal 3 & Nick Barrowman 2,3 & Seema Chalkhore 4 & Sanket Pendsey 4 & Alexandra Ahmet 1,2,3 Received: 3 October 2019 / Accepted: 14 March 2020 # Research Society for Study of Diabetes in India 2020
Abstract Background Self-monitoring of blood glucose (SMBG) is an essential component of type 1 diabetes (T1D) management and typically involves several daily tests. However, due to high cost, SMBG supplies are often unavailable in low-resource settings. This study assessed whether the use of two SMBG tests per day improves glycemic control, measured by a change in HbA1c, in youth with T1D followed at the DREAM Trust (DT) in Nagpur, India. Methods Single-site prospective cohort study of youth ≤ 23 years of age with T1D ≥ 1 year followed by DT, who were provided with SMBG meters and two test strips per day. Patients received education regarding SMBG and how to respond to blood glucose values and trends. They were followed every 3 months with HbA1c and questionnaires for a total of 21 months. Results HbA1c declined significantly from 10.2 ± 2.5% (88 ± 4 mmol/mol) at baseline to 9.5 ± 2.4% (80 ± 3 mmol/mol) at 21 months (p < 0.001). In univariable analysis, change in HbA1c was associated with adherence to insulin dosing, number of patient education sessions, household income, and holding a below the poverty line certificate. In multivariable analysis, only adherence to insulin dosing was a significant predictor for a decrease in HbA1c. There was no increase in diabetes-related acute complications. Conclusions The use of two SMBG test strips per day for the management of T1D in a low-resource setting was safe, and over the 21 months following its introduction, there was a clinically and statistically significant decrease in HbA1c. Keywords Blood glucose self-monitoring . Diabetes mellitus, type 1 . Glycated hemoglobin A1c . Insulin . Poverty
Introduction * Caroline S. Zuijdwijk [email protected] 1
Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
2
Department of Pediatrics, University of Ottawa, Ottawa, ON K1H 8M5, Canada
3
Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
4
DREAM Trust, Nagpur, MS 440 012, India
5
Humphrey School of Public Affairs, University of Minnesota, Minneapolis, MN 55455, USA
6
Life for a Child, Glebe, NSW 2037, Australia
7
Diabetes NSW & ACT, Glebe, NSW 2037, Australia
Self-monitoring of blood glucose (SMBG) is an essential component of type 1 diabetes (T1D) management and is associated with improved glycemic control and reduced risk of both acute and long-term complications of diabetes [1]. Unfortunately, due to high cost, SMBG supplies are often unavailable in low-resource settings [2]. This has historically been the case at the Diabetes Research Educ
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