A Position Statement of the Utilization and Support Status of Continuous Glucose Monitoring in Korea

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

Effects of GYDENPHY caspules on streptozotocin-induced type 1 diabetic in Swiss mouse model

Objective: Evaluation the hypoglycemic effect of Gydenphy capsules on Streptozotocin-induced type 1 diabetic in Swiss mouse model. Methods: The type 1 diabetic model was established by intraperitoneal injections of Streptozocin 150mg/kg in Swiss mouse. Then, the Gydenphy were orally administered daily at a dose of 576 mg/kg/day or 1152 mg/kg/day in 10 days. Blood glucose concentration in the Gydenphy oral groups with that of water control group and the intraperitoneal insulin injection group was compared. Results: Blood glucose concentration in the groups using Gydenphy (dose576 mg/kg/24h and dose 1152 mg/kg/24h) significal decreased compared to the distilled water group at (p <0.05 at the time of 4 hours, 8 hours; p <0.01 at the time of 3, 10 days). The hypoglycemic effect of Gydenphy at 576mg/kg/day and 1152 mg/kg/day at 4 hours, 8 hours and 3 days were inferior to insulin 0.1 UI/kg/day for glycemic control. However, the hypoglycemic effect ofGydenphy were equivalent to insulin after 10 consecutive days on treatment. Conclusion: Gydenphy capsules have hypoglycemic effects onStreptozotocin-induced type 1 diabetes in Swiss mouse model.

A Descriptive Study to Assess the Knowledge and Attitude regarding Self Administration of Insulin Injection among Diabetes Mellitus patient in selected Hospital of Visnagar City, in view of Information Booklet

Introduction: Diabetes Mellitus is an endocrine disorder, characterized by hyperglycemia that is, high blood sugar levels. This is caused due to a relative or absolute insulin deficiency, a hormone produced by the pancreas. Lack of insulin, either relative or absolute affects metabolism or breaking down of carbohydrates, proteins, fat, water and electrolytes leading to an accumulation of glucose in the blood. Till the earlier part of this century, it was believed that there was no effective treatment for this condition, until the discovery of insulin, in 1922, by Fredrick Banting and his student, John McCleod1 Design: A descriptive survey approach was used for assessing the knowledge and attitude of Diabetes Mellitus patients regarding Self-Administration of insulin injection. Participants: The target population consisted of 60 Diabetic patients who were on Insulin Therapy within the age group of 40-70 years. Half of the patients were admitted and a few were attending the OPD services in Nootan General Hospital at visnagar. Interventions: Booklet information was given to the patients. Tool: Structure questionnaire was used to assess the level of Knowledge regarding Self-Administration of insulin injection and used Likert’s attitude scale to assess attitude regarding Self-Administration of insulin injection among diabetes mellitus patients. Results: In this study. The total 60 sample under the study were 38.3% sample 61-70 years, 20% sample 51-60 years, 20% sample 41-50 years 8.3% sample below 40 years of age. Distributed sample according to gender were 73.3% are male and 26.7% are female. Distribution of sample based on education is 1.7% graduated 3.3% had higher secondary, 21.7% completed secondary and 73.3% sample had completed primary education as regards 53.3% samples were unemployed 23% self-employed. According to family history 36.7% had family history of DM 63.3% had no family history. The level of knowledge regarding self-administration of the insulin injection were 81.7% had average knowledge, 13.3% had poor knowledge and only 5% had good knowledge regarding self-administration of insulin injection. The overall mean value of the diabetic patients knowledge regarding self-administration of insulin injection was 14.45 with a standard deviation of 3.326. This finding showed that the most of the diabetic patients were not much aware of self-administration of insulin injection. The level of attitude regarding self-administration of insulin injection was assessed were, only 18.3% had most favorable and 81.7% had a favorable attitude towards self- administration of insulin injection. It revealed the mean percentage of the positive attitude, which was 69.05 with a standard deviation of 5.585. These results showed that most of the diabetic patients were not having a most favourable attitude towards self-administration of insulin injection. Conclusion: The finding indicates that the Booklet information was a suitable and effective method of instruction for updating and enhancing the knowledge and attitude among patients.

Penerapan Pendidikan Kesehatan Diet Dengan Kepatuhan Pasien Diabetes Milletus Dilihat Dari 3 J

Diabetes mellitus control can be in the form of insulin injection, diet, exercise, and medication. Health education can also be provide to improve the knowledge and skills of people with diabetes in controlling their blood sugar. This study aims to find out how the level of knowledge and level of adherence to the diet carried out by DM sufferers is seen from the 3J (schedule, amount, and type of food). The design used in this study was a case study on 2 patients with type 2 diabetes mellitus. The instrument of this research was a questionnaire on the level of adherence to the 3J diet, a questionnaire on the level of adherence. The patient’s knowledge before and after the intervention were compared. Their dietary adherence after the intervention were also observed. The results obtained before the intervention the knowledge value of the two respondents were 60 and 53. After the intervention, the knowledge level of the two respondents became 80 and the average results of the adherence level observation of the two respondents were 86 and 84. Based on the observation data, the result of the level of dietary compliance in both clients considered complaint with the diet program. It can be concluded that health education about the 3J diet can increase the level of knowledge and dietary compliance in people with diabetes mellitus. This result can be used as a consideration for the health workers to recommend and educate DM patiens and their families to carry out implement an agreed diet program such as the 3J diet program.Keywords: Diabetes melltus, Diet, Compliance, Health education AbstrakPengendalian diabetes mellitus dapat berupa injeksi insulin, pengaturan diet, olahraga dan obat-obatan. Untuk meningkatkan pengetahuan dan keterampilan diabetisi dalam pengendalian gula darah dapat dilakukan pemberian pendidikan kesehatan. Penelitian ini bertujuan untuk mengetahui bagaimana tingkat pengetahuan dan tingkat kepatuhan akan diet yang dijalankan oleh penderita DM dilihat dari 3 J (jadwal, jumlah dan jenis makanan). Desain karya tulis ilmiah ini berupa studi kasus pada 2 penderita diabetes mellitus tipe 2. Instrument penelitian ini berupa kuesioner tingkat kepatuhan diet 3J, kuesioner tingkat pengetahuan tentang diet diabetes mellitus dan lembar observasi tingkat kepatuhan. Cara mengevaluasi dengan membandingkan nilai pengetahuan sebelum dan sesudah intervensi dan observasi nilai kepatuhan diet sesudah intervensi. Hasil yang didapat sebelum dilakukan intervensi nilai pengetahuan kedua responden adalah 60 dan 53. Setelah dilakukan intervensi nilai tingkat pengetahuan kedua responden menjadi 80 dan hasil observasi tingkat kepatuhan kedua responden rata-rata 86 dan 84. Berdasarkan data observasi didapatkan hasil tingkat kepatuhan diet pada kedua klien dianggap patuh terhadap program diet yang dilakukan. Kesimpulannya adalah pendidikan kesehatan tentang diet 3J dapat meningkatkan tingkat pengetahuan dan kepatuhan diet pada penderita diabetes mellitus. Saran bagi tenaga kesehatan hendaknya menganjurkan dan mengedukasi penderita DM dan keluarganya untuk melakukan dan melaksanakan program diet yang sudah disepakati seperti program diet 3J.Kata kunci: diabetes mellitus, diet, kepatuhan, pendidikan kesehatan

Knowledge, Practice, and Attitude of patients and physicians towards insulin therapy in Type 2 DM: a cross sectional study in TASH patients and Physician from various universities in Ethiopia

Background As type 2 DM is a growing health problem worldwide early treatment and intensification of therapy will decrease the vascular complications as evidenced by large trials. Insulin therapy is delayed in this group of patients and multiple physician and patient factors are mentioned in different settings. Methods This study is a cross-sectional, quantitative descriptive study conducted on 221patients at TASH endocrine clinic and 122 physicians working at TASH, residents visiting for detachment, and Yekatit 12 hospital. Conducted on Jul 1- Sep 30, 2020, G.C Result 76% of physicians think taking insulin at the prescribed time is difficult while only 31.5% of patients think it’s difficult. Hypoglycemia is one of the most fearful parts of having diabetes for 81.1% of patients on Insulin therapy. 87% of physicians and76.6% of patients think insulin-treated diabetes controls life while. 56% of patients therapy know nothing about insulin therapy. 23% of patients said they will not accept insulin therapy the top reason being they will be afraid of insulin injection because they think it will be painful. Conclusion Physicians tend to overestimate the difficulty of insulin injection preparation and dose adjustment fears the risk of hypoglycemia when starting insulin therapy. More than half of our patients not on insulin therapy know nothing about insulin therapy which we have to improve. Even if patients not on insulin therapy overestimate insulin needle phobia and injection pain those who are already on insulin disagree with them.

Invaluable role of histopathology in the diagnosis of cutaneous leiomyosarcoma in insulin injection site reaction

Soft tissue sarcomas (STSs) are rare and may often be misdiagnosed, resulting in delays in treatment. A 67-year-old cisgender woman with type 2 diabetes mellitus and obesity presented to her primary care physician with a mass on her left proximal arm. The clinical opinion of the attending physician was that of an insulin injection site reaction. After further evaluation from the physician, the patient was diagnosed with a lipoma without confirmatory histology. The patient continued to present with an enlarging mass, decline in health status and continued with local wound care. The patient underwent a confirmatory biopsy following which, the patient was diagnosed with leiomyosarcoma. This case report highlights the case of a person with a low or moderate income with a self-reported low health literacy living in a rural community and how STS may be misdiagnosed in medically underserved. The patient’s primary or oncology care team are not involved in the production or review of this case report.

Validity of Self-reported Diabetes Among Kurdish Population; a Large Population-based Study From Iran

Background: The aim was to assess the validity of diabetes self-reporting based on oral anti-diabetic drugs, insulin injection, or high fasting blood sugar (FBS) in a large Kurdish population of Iran.Methods: We performed a cross-sectional analytical study on 4400 subjects aged 35-70 years of the Dehgolan Prospective Cohort Study (DehPCS). The reference for having diabetes was oral hypoglycemic drug consumption, insulin injection, or high FBS representing diabetes. Self-reported diabetes status was investigated by well-trained interviewers before the identification of diabetes status based on reference criteria. The accuracy and agreement of self-reported diabetes with reference were assessed in the overall population as well as in different sociodemographic and habitual conditions. Results: Out of 4400 adults, 3996 agreed to participate in this study (participation=90.8%). The diabetes prevalence among the study population was 13.1% based on self-report and 9.7% based on reference. Of the 523 people who reported diabetes, 213 (41.28%) did not have diabetes. We found a good agreement of 92.3% concordance with a kappa value of 65.1% between self-reported diabetes and reference. Self-reported diabetes also guaranteed sensitivity of 78.5%, specificity of 93.9%, positive predictive value of 58.7%, and negative predictive value of 98.0% to identify diabetic participants. Conclusion: Self-reported diabetes is identified as a valid tool that could accurately determine the diabetes prevalence in epidemiological studies on the Kurdish population of Iran.

Hypoglycemia Among Type 1 Diabetes Patients After Insulin Use in Southwest Ethiopia

IntroductionGlycemic control is a valuable goal for people with diabetes; however, the greatest challenge to achieving tight glycemic control is hypoglycemia. Hypoglycemic events are probably common in type 1 diabetes; however, little is known about hypoglycemia in Ethiopia. Therefore, this study aimed to assess the prevalence and the associated factors of hypoglycemia among type 1 diabetes (T1D) patients after insulin use at Metu Karl Referral Hospital in southwest Ethiopia.Materials and MethodsA hospital-based cross-sectional study was conducted among 242 T1D patients at Metu Karl Referral Hospital in southwest Ethiopia. The prevalence of hypoglycemia was assessed by a structured questionnaire through a face-to-face interview in which all the possible symptoms of hypoglycemia were included. If the patients reported that they had experienced the symptoms at least two times in a month and the symptoms were relieved upon consuming sugar/candy/honey, such cases were considered to have had a hypoglycemic episode. Binary logistic regression analysis was done to identify the factors associated with the occurrence of hypoglycemia.ResultsOut of 242 T1D patients interviewed, 114 (47.1%) had self-reported hypoglycemia. The most reported symptom of hypoglycemia was sweating (91.7%), followed by dizziness and hunger and nausea with a prevalence of 24.8 and 14.5%, respectively. The study also found that educational level with reading and writing skills up to primary level [adjusted odds ratio, AOR = 0.41; 95% confidence interval, CI (0.19–0.88)] and secondary level and above [AOR = 0.32, 95% CI (0.14–0.70)], poor knowledge of diabetes [AOR = 2.26, 95% CI (1.06–4.84)], good knowledge of insulin self-administration [AOR = 0.54, 95% CI (0.30–0.99)], and duration of insulin use ≥5 years [AOR = 3.93, 95% CI (1.44–10.7)] were factors associated with hypoglycemia.ConclusionsThe prevalence of hypoglycemia was found remarkable. We can conclude that hypoglycemia is of public health importance among T1D patients. Since the study assesses hypoglycemia after insulin injection, this prevalence may be due to the poor practice of insulin injection. Therefore, imparting education on the proper technique of insulin administration should be considered at each follow-up visit.

Human Insulin (Entuzity KwikPen)

CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec. This review assesses human biosynthetic insulin (Entuzity KwikPen), 500 units/mL subcutaneous insulin injection, human biosynthetic, solution for injection Indication: Entuzity is indicated to improve glycemic control in adults and children with diabetes mellitus requiring more than 200 units of insulin per day