Rural Collaborative Model for Diabetes Prevention and Management: A Case Study.

Background: Diabetes is a major health burden in Mexican American populations, especially among those in the Lower Rio Grande Valley (LRGV) in the border region of Texas. Understanding the roles that social determinants of health (SDOH) play in diabetes management programs, both at the individual and community level, may inform future intervention strategies.Methods: This study performed a secondary data analysis on 1,568 individuals who participated in Salud y Vida (SyV), a local diabetes and chronic disease management program, between October 2013 and September 2018 recruited from a local clinic. The primary outcome was the reduction of hemoglobin A1C (HbA1C) at the last follow-up visit compared to the baseline. In addition to age, gender, insurance status, education level and marital status, we also investigated 15 community (census tract) SDOH using the American Community Survey. Because of the high correlation in the community SDOH, we developed the community-level indices representing different domains. Using Bayesian multilevel spatial models that account for the geographic dependency, we were able to simultaneously investigate the individual- and community-level SDOH that may impact HbA1C reduction.Results: After accounting for the diabetes self-management education classes taken by the participants and their length of stay in the program, we found that older age at baseline, being married (compared to being widowed or divorced) and English speaking (compared to Spanish) were significantly associated with greater HbA1C reduction. Moreover, we found that the community level SDOH were also highly associated with HbA1C reduction. With every percentile rank decrease in the socioeconomic advantage index, we estimated an additional 0.018% reduction in HbA1C [95% CI (−0.028, −0.007)]. Besides the socioeconomic advantage index, urban core opportunity and immigrant's cohesion and accessibility indices were also statistically associated with HbA1C reduction.Conclusion: To our knowledge, our study is the first to utilize Bayesian multilevel spatial models and simultaneously investigate both individual- and community-level SDOH in the context of diabetes management. Our findings suggest that community SDOH play an important role in diabetes control and management, and the need to consider community and neighborhood context in future interventions programs to maximize their overall effectiveness.

The purpose of this study was to test the effectiveness of a 6-month community-based diabetes prevention and management program in rural Gujarat, India. A community-based participatory research method was used to plan and tailor the intervention by engaging trained community health workers as change agents to provide lifestyle education, serve as community advocates, and collect data from 1638 rural Indians (81.9% response rate). Ten culturally and linguistically appropriate health education messages were provided in face-to-face individual and group sessions (demonstrations of model meals and cooking techniques). Mean age was 41.9 ± 15.9 years. Overall point prevalence of diabetes, prediabetes, obesity, and hypertension were 7.2%, 19.3%, 16.7%, and 28%, respectively, with significant differences between the low socioeconomic status (SES) participants (agricultural workers) and the high SES participants (business community) due to differing diet and activity levels. The intervention significantly reduced blood glucose levels by 5.7 and 14.9 mg/dL for individuals with prediabetes and diabetes, respectively, and systolic and diastolic blood pressure by 8 mm Hg and 4 mm Hg, respectively, in the overall population. Knowledge of diabetes and cardiovascular disease improved by 50% in the high SES group and doubled in the low SES group; general and abdominal obesity also decreased by ≤ 1%. High rates of undiagnosed hypertension (26.1%) were surprising. Among individuals with diabetes, metabolic complications such as diabetic nephropathy and chronic kidney disease were noted. Through collective engagement of the community, participatory programs can serve as a prototype for future prevention and management efforts, which are rare and underutilized in India.

Diabetes prevalence is increasing globally especially in the Asian subcontinent. It is expected that by the year 2030 there may be close to 400 million people with diabetes. All of the research in the past 25 years has clearly documented the effectiveness of improving glucose control in reducing long-term complications of diabetes, both microvascular and macrovascular. The improvement in glucose control usually requires continuous intensive diabetes management, particularly in insulin-requiring patients, which must include home self-monitoring of blood glucose (SMBG). Despite the convincing evidence, the role of SMBG in diabetes management is still being debated even though its availability in the past 35 years has revolutionised diabetes care, especially at home. The International Diabetes Federation (IDF) recently published guidelines for SMBG use in non-insulin-treated diabetic patients, recommending that SMBG should be used only when patients and/or their clinicians possess the ability, willingness and knowledge to incorporate SMBG and therapy adjustment into their diabetes care plan. The IDF also recommends that structured SMBG be performed with the choice of applying different defined blood glucose testing algorithms to patients' individual diabetes care plans. These defined blood glucose testing algorithms give SMBG a medically meaningful structure to collect high quality glucose information and are called structured SMBG. Former SMBG studies have demonstrated SMBG to be beneficial when patients receive feedback regarding the impact of their behaviours on SMBG results. Other studies which did not link SMBG results to these principal behaviours have shown no SMBG benefit. A new wave of clinical studies performed after the release of the IDF guideline have recently been published and have proved the success of the new application of SMBG. The reasons for this ongoing debate may in part be due to rising healthcare costs globally, lack of convincing data in non-insulin-requiring patients with type 2 diabetes in randomised controlled clinical trials and multiple controversial meta-analyses performed on several studies. Sometimes the decisions are extended to insulin-requiring patients, even those with type 1 diabetes. For example, last year in the state of Washington in the USA, legislators were going to stop reimbursing glucose test strips for children with type 1 diabetes. After much debate with committee members (who were not diabetologists and or endocrinologists) and law makers, not only SMBG but even in some cases continuous glucose monitoring (CGM) is now reimbursed. The issue was simply educating non-understanding but well-meaning people whose main concern is saving money. In the end, no one, even those not familiar with paediatric type 1 diabetes, can disagree about the need for SMBG in this age group. It seems to us that we should instead be spending our time and effort in advancing the field and improving diabetes management for patients through newer technologies like CGM and closed-loop systems. As discussed in the section on CGM (Chapter 2) there is ample data from both non-randomised and randomised clinical trials showing the efficacy in reducing time spent in hypoglycaemia and hyperglycaemia along with improvement in glucose control without introducing any additional medication. We hope that the future will be spent in advancing the care rather than useless meta-analyses or going back in time. It is worthwhile to review existing evidence about SMBG to learn, transfer and apply knowledge about the core requirement for good diabetes management, glucose information. Fendler W, Hogendorf A, Szadkowska A, Młynarski W Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland Pediatr Endocrinol Diabetes Metab 2011; 17 : 57–63 Background: SMBG is one of the major components of diabetes management. Aims: To evaluate the potential for miscoding of a personal glucometer, to define a target population among paediatric patients with diabetes for a non-coding glucometer and to assess the accuracy of the Contour TS non-coding system. Methods: Potential for miscoding during SMBG was evaluated by means of an anonymous questionnaire, with worst and best case scenarios evaluated depending on the response pattern. Testing of the Contour TS system was performed according to the national committee for clinical laboratory standards guidelines. Results: The estimated frequency of individuals prone to non-coding ranged from 68.21% [95% confidence interval (CI) 60.70%–75.72%] to 7.95% (95% CI 3.86%–12.31%) for the worse and best case scenarios, respectively. Factors associated with increased likelihood of non-coding were a smaller number of tests per day, a greater number of individuals involved in testing and self-testing by the patient. The Contour TS device showed intra- and inter-assay accuracy of –95%, a linear association with laboratory measurements (R2 = 0.99, p < 0.0001) and small bias of –1.12% (95% CI –3.27% to 1.02%). Clarke error grid analysis showed 4% of values within the benign error zone (B) with the other measurements yielding an acceptably accurate result (zone A). Conclusions: The Contour TS system showed sufficient accuracy to be safely used in the monitoring of paediatric patients with diabetes. Patients from families with a high throughput of test-strips or multiple individuals involved in SMBG using the same meter are candidates for clinical use of such devices due to an increased risk of calibration errors. Comment: This study further highlights the role of making SMBG simpler and easier so that patients can monitor the glucose more effectively. The current study used the Contour TS system which does not require coding by the patient and thus removes the barrier of mis-coding of SMBG. We personally think that all meters going forward must be non-coding meters. Nerhus K 1 , Rustad P 2 , Sandberg S 1,3 1 Norwegian Centre for Quality Improvement of Primary Care Laboratories, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway, 2 Norwegian Clinical Chemistry EQA-Program, Fürst Medical Laboratory, Oslo, Norway, 3 Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway Diabetes Technol Ther 2011; 13: 883–92 Background: Analytical quality of SMBG can be affected by environmental conditions. Aims: To determine the influence of a shift in the ambient temperature immediately before measurement and taking measurements in the lower and upper part of the operating temperature range. Methods: Different SMBG systems (n = 9) available on the Norwegian market were tested with heparinised venous blood (4.8 and 19.0 mmol/l). To test the effect of a shift in ambient temperature, the glucometer and strips were equilibrated for 1 h at 5 °C or 30 °C before the meter and strips were moved to room temperature, and measurements were performed after 0, 5, 10, 15 and 30 min. To test the lower and upper temperature range, measurements were performed at 10 °C and at 39 °C after 1 h for temperature equilibration of the glucometer and strips. All the measurements were compared with measurements performed simultaneously on a meter and strips kept the whole time at room temperature. Results: Six of nine SMBG systems overestimated and/or underestimated results by more than 5% after moving meters and strips from 5 °C or 30 °C to room temperature immediately before the measurements. Two systems underestimated the results at 10 °C. One system overestimated and another underestimated the results by more than 5% at 39 °C. Conclusions: A rapid shift in the ambient temperature affects analytical performance. Therefore patients need to wait at least 15 min for temperature equilibration of affected meters and strips before measuring blood glucose. Comment: This study highlights the importance of ambient temperature on analytical performance of SMBG. The study shows that rapid shift in ambient temperature may affect the accuracy and bias in SMBG measurement and highlights the need for 15 min temperature equilibration. In addition to what has been highlighted in the study, future studies also need to assess the accuracy of existing meters (especially the one using glucose oxidase) at higher altitudes (10,000 feet or higher). It is known that many of these meters do not perform well at high altitudes. McAndrew LM 1,2 , Horowitz CR 3 , Lancaster KJ 4 , Quigley KS 2,5,6 , Pogach LM 1,2 , Mora PA 7 , Leventhal H 8 1 War Related Illness and Injury Study Center and REAP Center for Healthcare Knowledge Management, Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA, 2 University of Medicine and Dentistry of New Jersey, Newark, NJ, USA, 3 Department of Health Evidence and Policy, Mount Sinai School of Medicine,New York, NY, USA, 4 Department of Nutrition, Food Studies and Public Health, New York University, New York, NY, USA, 5 Department of Veterans Affairs, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA, 6 Department of Psychology, Northeastern University, Boston, MA, USA, 7 Psychology Department, University of Texas at Arlington, Arlington, TX, USA, and 8 Institute for Health, Health Care Policy and Research, Rutgers University, New Brunswick, NJ, USA J Diabetes 2011; 3 : 147–52; Comment in J Diabetes 2011; 3 : 93–4 Background: It is unknown whether SMBG can motivate adherence to dietary recommendations. Aims: To evaluate if patients who used more SMBG would also report lower fat and greater fruit and vegetable consumption. Methods: This was a cross-sectional study of primarily minority individuals living with diabetes in East Harlem, New York (n = 401). Fat intake and fruit and vegetable consumption were measured with the Block Fruit/Vegetable/Fiber and Fat Screeners. Results: Greater frequency of SMBG was associated with lower fat intake [r(s) = –0.15; p < 0.01], but not fruit and vegetable consumption. The effects of SMBG were not moderated by insulin use. A significant interaction was found between frequency of SMBG and changing one's diet in response to SMBG on total fat intake. Conclusions: The frequency of SMBG was associated with lower fat intake. The data suggest that participants who use SMBG to guide their diet do not have to monitor multiple times a day to benefit. Comment: This study further highlights the importance of SMBG in daily lifestyle changes. Subjects with higher frequency of SMBG consumed less fat, in part related to overall education and seeing the impact from making dietary changes on SMBG levels. Kuo CY 1,2 , Hsu CT 3 , Ho CS 3 , Su TE 3 , Wu MH 4 , Wang CJ 2,5 1 Department of Clinical Laboratory, Tai-An Hospital, Taichung, Taiwan, 2 Institute of Biochemistry and Biotechnology, Chung Shan Medical University, Taichung, Taiwan, 3 Department of Core Technical Research, Bionime Corporation, Taichung, Taiwan, 4 Department of Laboratory Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan, 5 Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan Diabetes Technol Ther 2011; 13 : 596–600 Background: SMBG systems should at least meet the minimal requirement of the World Health Organization's ISO 15197:2003. For tight glycaemic control, a tighter accuracy requirement is needed. Methods: Seven SMBG systems were evaluated for accuracy and precision: Bionime Rightest™ GM550 (Bionime Corp., Dali City, Taiwan), Accu-Chek® Performa (Roche Diagnostics, Indianapolis, IN, USA), OneTouch® Ultra®2 (LifeScan Inc., Milpitas, CA, USA), MediSense® Optium™ Xceed (Abbott Diabetes Care Inc., Alameda, CA, USA), Medisafe (TERUMO Corp., Tokyo, Japan), Fora® TD4227 (Taidac Technology Corp., Wugu Township, Taiwan) and Ascensia Contour® (Bayer HealthCare LLC, Mishawaka, IN, USA). The 107 participants were 23–91 years old. The analytical results of seven SMBG systems were compared with those of plasma analysed with the hexokinase method (Olympus AU640, Olympus America Inc., Center Valley, PA, USA). Results: The imprecision of the seven blood glucose meters ranged from 1.1% to 4.7%. Three of the seven blood glucose meters (42.9%) fulfilled the minimum accuracy criterion of ISO 15197:2003. The mean absolute relative error value for each blood glucose meter was calculated and ranged from 6.5% to 12.0%. Conclusions: More than 40% of evaluated SMBG systems meet the minimal accuracy criterion requirement of ISO 15197:2003. However, considering a tighter criterion for accuracy of ±15%, only the Bionime Rightest GM550 meets this requirement. Manufacturers have to try to improve accuracy and precision and to ensure the good quality of blood glucose meters and test strips. Comment: This study further highlights the need for more accurate SMBG systems. Their data concluded that more than 40% of the evaluated SMBG systems meet the minimum ISO criteria. Since patients use blood glucose information for adjusting their insulin dose and/or treating hypoglycaemia, the accuracy of the glucose meters has to be consistent and improved. Hortensius J 1 , Slingerland RJ 2 , Kleefstra N 1,3,4 , Logtenberg SJ 1 , Groenier KH 5 , Houweling ST 3,6 , Bilo HJ 1,4 1 Diabetes Centre, Isala Clinics, Zwolle, The Netherlands, 2 Department of Clinical Chemistry, Isala Clinics, Zwolle, The Netherlands, 3 Medical Research Group, Langerhans, The Netherlands, 4 Department of Internal Medicine, University Medical Center, Groningen, The Netherlands, 5 Department of General Practice, University of Groningen, Groningen, The Netherlands, and 6 General Practice Sleeuwijk, Sleeuwijk, The Netherlands Diabetes Care 2011; 34 : 556–60 Background: There is no agreement regarding the use of the first or second drop of blood for glucose monitoring. Aims: To investigate whether capillary glucose concentrations, as measured in the first and second drops of blood, differed ≥10% compared with a control glucose concentration in different situations. Methods: Capillary glucose concentrations were measured in two consecutive drops of blood in 123 patients with diabetes in the following circumstances: without washing hands, after exposing the hands to fruit, after washing the fruit-exposed hands, and during application of different amounts of external pressure around the finger. The results were compared with control measurements. Results: Not washing hands led to a difference of ≥10% in glucose concentration in the first and in the second drops of blood in 11% and 4% of the participants, respectively. In fruit exposed fingers, these differences were found in 88% and 11% of the participants, respectively. Different external pressures led to ≥10% differences in glucose concentrations in 5%–13% of the participants. Conclusions: Washing hands with soap and water, drying them, and using the first drop of blood for SMBG is recommended. If washing hands is not possible, it is acceptable to use the second drop of blood after wiping away the first drop. External pressure may lead to unreliable readings. Comment: Over the years we have probably under-emphasised the importance of technique with SMBG. One has to wonder how much iatrogenic hypoglycaemia has occurred due to unintended exposure to glucose on the hands, and how often CGM devices are due to technique with SMBG use. 1,2 , 3 , 4 , 5 , 6 , 7 , 8 , 8 , 8 1 University of CA, USA, 2 Diabetes CA, USA, 3 University of CA, USA, 4 University Health System, USA, 5 America Diabetes USA, 6 Health IN, USA, 7 USA, and 8 Diagnostics, Indianapolis, IN, USA Diabetes Care 2011; 34 : To assess the effectiveness of structured blood glucose testing in controlled patients with type 2 diabetes without insulin Methods: A study patients with type 2 diabetes (n = and glycaemic control from 34 care in the were randomised to an control with care or a structured testing with care and at least use of structured SMBG. patients and were to use a to glucose consecutive The was measured at Results: The analysis = = showed greater in mean in the compared with the = p = analysis = = showed even greater mean in the compared with the p < more patients a at the first compared with patients, of the p < and patients significant < 0.0001) in Conclusions: use of structured SMBG glycaemic control and more changes in patients with type 2 diabetes without Comment: It is with an healthcare using a structured glucose testing can improve glucose control in non-insulin-treated Potential are of this can be in a with the more time in a care to be , 5 , 6 , 1,4 1 Department of and Laboratory Medicine, University of 2 Department of and University of 3 Department of Pediatrics, University of 4 Laboratory 5 Corporation, MA, USA, and 6 Department of Health University of J Diabetes Technol 4 : Aims: To analytical error in and glucose meters by in and Methods: The of and were tested and in with each glucose meter and with a plasma glucose method at glucose was by consecutive analysis (n = at glucose levels. analysis was used to the bias associated with the and in Results: Three meters demonstrated bias that was glucose bias on the and the of bias was on small significant on meters. of and of increased the bias and was by of total analytical the glucose meter devices of total analytical error in glucose measurement ranged from to the Conclusions: The of glucose meters to significant analytical is the analytical Comment: with to for SMBG and the research is it does not that many people the This has impact on as new guidelines for greater of are the impact on SMBG accuracy be particularly by the device should be a 1 , 1 , 2 , 3 1 Health and 2 Health, and 3 of and Department of Internal Medicine, : Aims: To evaluate the of SMBG in patients with type 2 diabetes with in Methods: In a study a of diabetes was used to from a published study of SMBG in patients with type 2 diabetes, with and with no of a time was from the of a healthcare and clinical were at Results: or times daily SMBG was associated with in which led to increased and and of diabetes complications compared with no SMBG in type 2 diabetes patients on costs increased by and in patients SMBG or times daily compared with those not using SMBG. were well at and per year respectively. Conclusions: SMBG is to be by standards in patients on in the Comment: This analysis is on a showing of and The concern of is that this analysis is not a randomised controlled and at best the data are about the efficacy of this population using this analysis is probably on controversial 1,2 , 3 , S 3 , 1 Health Research, University School of Medicine, Indianapolis, IN, USA, 2 Institute for Health Care, Indianapolis, IN, USA, 3 of University School of Medicine, Indianapolis, IN, USA, and 4 Diabetes and Center, University School of Medicine, Indianapolis, IN, USA Diabetes 2011; : To assess the and of a glucose monitoring system for with type 1 diabetes and their Methods: Patients with type 1 diabetes who been for at least 1 year in the used the system for 6 3 to and with the glucose monitoring as well as how use of the system affect quality of and diabetes management. Results: about the a number of significant that affected use of the all that the in monitoring testing was The use of the did not the quality of their of with their their of diabetes, or their glycaemic control within the time of the Conclusions: This that glucose monitoring can be used in an population to and in self-monitoring Comment: for both SMBG and CGM is clearly the future for with type 1 diabetes. The will be to how to best use this to improve in this To the is new to how best to use more studies will be to this P 1 , 2 , ST 3 , 2 , 2 , 4 , Bilo 5 , Bilo HJ 1 Department of Internal Medicine, Hospital, The Netherlands, 2 Department of Clinical Chemistry, Isala Clinics, Zwolle, The Netherlands, 3 Department of Isala Clinics, Zwolle, The Netherlands, 4 Centre for The Netherlands, 5 Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands, and 6 Department of Internal Medicine, University Medical Centre, Groningen, The Netherlands One 5 : Background: Patients with diabetes part in and thus blood glucose meters are studies bias in blood glucose measurements using different at high To evaluate if glucose are more by the lower pressure at than glucose Methods: measurements at of nine glucose glucose were compared with glucose measurement on a at and with a laboratory glucose blood of different glucose were were at a bias from glucose and from glucose mmol/l). Results: significant difference was between measurements at and for glucose or glucose as a Two glucose did not meet performance criteria. Conclusions: high all tested glucose did not influence of All for two glucose performed within criteria. are glucose concentration at high high one glucose best precision and Comment: testing for SMBG meters may be In glucose test strips should be at high altitudes. not in this it should be that patients do not this into when or 1 , J 2 , 2 , 1 , 3 , 4 , J 3 , 5 , J 6 , 7 , 7 , 8 1 Department of Health University of Health Center, USA, 2 and Health Department of Medical and University of USA, 3 Department of and Health University of USA, 4 Diabetes Care Center, Medical USA, 5 Department of University of USA, 6 Medicine Technology Center USA, 7 Department of Medicine, University of USA, and 8 Health Research USA J Aims: To assess the and of using as part of an existing system for between patients with diabetes and a care Methods: In glucose meter and two to feedback on glycaemic control were Results: glucose meter with and data feedback were the system to an and feedback system for value in the system as an to the and Conclusions: diabetes management systems may one to improve the quality of diabetes Comment: best to in a care for type 2 diabetes is still It is that there will be different of that will for different patient the use of the as a means of that device like the of in diabetes management. the now seems to be how to is a It may be that will be the only for many the of time this population 1 , 2 1 Centre for Policy Research, of Health Health Policy and Research, University of and 2 Institute for Medicine, and Health University Medical Centre 2011; : Background: the of and in Patients with 2 Diabetes a in the risk of in patients with type 2 diabetes who performed SMBG. Aims: To evaluate if these are by a that time Methods: The bias in the study was and demonstrated that it is to the effect of SMBG on Results: In the study, patients were as exposed to SMBG for their whole time if performed SMBG for at least 1 year during the study the time between and the after 1 year of self-monitoring was performed is for patients with SMBG. Patients to at least 1 year to be as exposed to this and were from The total of in the SMBG is at least of at risk After of as the relative risk from to Conclusions: The effect of SMBG on in the study is by time Comment: The study is one of the trials in the of SMBG. Study is probably a major for between the studies. Kleefstra N 1,2 , Hortensius J 1 , Logtenberg SJ 1 , 3 , Groenier K 4 , Houweling ST 2,5 , 6 , 2 , Bilo HJ 1 Diabetes Centre, Isala Clinics, Zwolle, The Netherlands, 2 Medical Research Langerhans, Zwolle, The Netherlands, 3 Department of Clinical Chemistry, Isala Clinics, Zwolle, The Netherlands, 4 Department of General Practice, University of Groningen, Groningen, The Netherlands, 5 General Practice Sleeuwijk, Sleeuwijk, The Netherlands, 6 Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands J : Background: It is not if SMBG glycaemic control in patients with type 2 diabetes. To investigate the effects of SMBG in patients with type 2 diabetes who were in glycaemic Methods: Patients years with an of using one to two blood glucose were in the Patients (n = were to receive SMBG to care or to with care for 1 A glucose value and glucose values were measured The efficacy was quality of and were using the Health the the Diabetes and the Results: in between was (95% CI to p = There were no significant changes between on the type or for the which was lower in the difference (95% CI to Conclusions: type 2 diabetes patients some of their the use of SMBG in these patients is and its use should be Comment: This is another SMBG study in non-insulin-treated type 2 the of not patients what to do with the information is one has to wonder if this at some to have some of the it is to that the in care is to more education and time than is in many of these studies. A 1 , 1 , 1 , S 2 , S 3 , A 1 , A 1 , 1 , 4 , 3 , 3 , 1 1 Department of and School of Medicine, 2 Department of School of Medicine, 3 Department of Biochemistry, School of Medicine, and 4 Department of School of Medicine, Diabetes Technol Ther : Background: glucose meters may not be accurate to Aims: of the accuracy and the capillary and venous of different Xceed (Abbott Diabetes Care, Alameda, CA, USA), Contour TS (Bayer Diabetes Care, (Roche Milpitas, CA, and Inc., in an Methods: The insulin hypoglycaemia test was performed for of mean age was measured from venous blood and capillary before and after of insulin were analysed in the laboratory by the hexokinase In tests for method and precision were also performed by the venous Results: All to hypoglycaemia to some was in error zone and was in the error zone Xceed and Contour TS and were than the other two according to error grid analysis or International for criteria. The in tests were consistent with the clinical The capillary and venous of and were than the other Not all are accurate in blood glucose levels. The patients and the should be of these of the and give more to the hypoglycaemia than the values with the These results that there is a need for the of accuracy standards of at blood glucose levels. Comment: We have the that meters are from especially at levels. patients can state a time when an The are not only for the of hypoglycaemia but also as we forward with CGM about how this about this the with the for use of the meters our clinical with patient error us that accuracy a for glucose meters at levels. has research from Inc., Corporation, Inc., and is a for Diagnostics, Diabetes Care and

Diabetes is a growing chronic disease with complications that impose a significant burden on healthcare systems worldwide. Pharmacists are readily accessible for diabetes management beyond simply dispensing medications. Consequently, they are involved in disease prevention and detection, therapy management, and patient monitoring. However, with the current escalating impact of diabetes, pharmacists must upgrade their strategies by integrating guidelines from sources like the American Diabetes Association (ADA) 2024 with pharmacy expertise. This perspective serves as a guide for pharmacists, identifying key foundations involved in diabetes management, highlighting five crucial steps for optimal disease control, ranging from prevention strategies to pharmacist-led counseling interventions. We employed PubMed, CDC, WHO guidelines, and key reference texts. Searches were performed using combinations of terms such as "pharmacist", "type 2 diabetes", "diabetes prevention", "pharmacist intervention", and "diabetes management", covering publications from January 2010 to March 2025. Studies were included if they focused on pharmacist-led prevention, intervention, or management strategies related to type 2 diabetes (T2D) and were published in English. Studies focusing exclusively on type 1 diabetes were excluded. Generative artificial intelligence was employed to order and structure information as described in the acknowledgments. Conflicting evidence was resolved by giving relevance to recent systematic reviews, randomized trials, and major guidelines. Additional insights were gained through consultations with PharmD professionals experienced in diabetes care. Evidence from selected studies suggests that pharmacist-led care models may enhance and promote the early detection of T2D, improve therapy adherence, enhance glycemic control, and increase overall treatment efficiency. This work suggests that pharmacists must play a key role in diagnosing, preventing, managing, and mitigating the consequences associated with T2D. They must contribute to early treatments with appropriate training and involvement to improve therapeutic outcomes and reduce diabetes-related complications.

Although not widely utilized, community health workers (CHWs) have been shown to enhance diabetes education and management efforts among racial/ethnic minority populations. To examine the effectiveness of CHWs on diabetes management among a population with primarily Native Hawaiian and Samoan ethnic minority participants with HbA1c greater than 10%. Descriptive study comparing HbA1c readings of participants with diabetes with and without CHW intervention. Of 116 eligible participants, 74% were either Native Hawaiian or Samoan. The mean baseline HbA1c for all eligible participants was 10.9+/-0.8%. The 80 participants who completed CHW intervention had a 2.2+/-1.8% (p.<.01, compared with baseline) mean reduction in HbA1c, compared with a 0.2+/-1.5% reduction for those without CHW intervention. Community health workers had a positive impact on diabetes management defined in terms of improved HbA1c amongst this predominantly Native Hawaiian and Samoan population.

The purpose of this study was to examine the impact of a home-based diabetes prevention and management program on high-risk American Indian youth. Together on Diabetes (TOD) was designed via a participatory approach with 4 tribal communities in the southwestern United States. A multisite pre- and postevaluation design was used to evaluate the efficacy of the TOD intervention on improving youth's psychosocial, knowledge, behavioral, and physiological outcomes at 4 time points from baseline to 12 months postenrollment. A total of 256 youth and 225 support persons were enrolled in the TOD program. At 12 months postenrollment, improvements were observed in youth's quality of life (P < .001), depressive symptoms (P < .001), knowledge related to TOD content (P < .001), standardized body mass index scores (P = .004), and hypertension (P = .026). Improvements in mean A1C were observed among diabetic youth with baseline A1C >6.5% (P = .036). The TOD program was feasible, acceptable, and effective in lowering diabetes risk among reservation-based American Indian youth. It is the first efficacious youth-focused diabetes prevention and management program developed and implemented in partnership with tribal communities.

Type 2 Diabetes Mellitus (T2DM) is turning out to be a global health crisis. Currently available literature clearly indicates an increased risk of type 2 diabetes amongst South Asian population. The objective of this narrative review is to explore the non-modifiable and modifiable risk factors of T2DM in South Asian population, including their beliefs, attitudes, socio economic and cultural barriers and also to explore the possible implications in designing culture specific diabetes prevention and management programs. This narrative review is based upon the data from individual studies and review article known to the authors. Additional relevant studies were identified through PubMed search on Englishlanguage papers published in 2000-2017 using the relevant keywords. Where appropriate, the reference lists of key papers were reviewed to identify additional studies of interest. Many genetic and environmental risk factors such as diet, physical inactivity, and sleep contribute to the increased prevalence of diabetes in the ethnic group. Providing mere knowledge about diabetes and these risk factors might not be sufficient in this particular ethnic group. It is essential to address their beliefs, attitudes and the cultural barriers faced. To overcome the health disparity in the South Asian ethnic group, various risk factors associated with diabetes, and the challenges faced are to be considered while designing future diabetes prevention and management strategies.

Background Diabetes mellitus is a major chronic illness in Africa that requires lifelong lifestyle interventions and pharmacological therapy. Lifestyle change is the most important aspect of diabetes care and includes diabetes self-management education and support, medical nutrition therapy, physical activity, smoking cessation counseling, and psychosocial care. Purpose The purpose of this project was to review published articles that investigate lifestyle and dietary pattern interventions for diabetes prevention and management in Africa. Barriers to lifestyle interventions and strategies to overcome the barriers are also reviewed in this study. Methods The article search was conducted in an electronic database search of PubMed, Google Scholar, and Cochrane Library. Studies were included if they were published between 2011 and 2019, if they were conducted in an African country, and were written in the English language. Results Articles reviewed included several that examined the basic lifestyle and dietary pattern changes for all patients diagnosed with type 2 diabetes, on self-care behavior of type 2 diabetes patients, on the cost of diabetes in Africa, and on barriers for adherence to lifestyle and dietary changes in Africa, with strategies to address those barriers. Conclusion Lifestyle interventions including regular physical exercise, weight management, and adherence to health care professionals' recommendations on a healthy diet are the cornerstone in the prevention and management of diabetes in Africa. The main barriers to adherence were both systemic (population changes, poor access, western cultural influences, and low-quality healthcare) and personal (poverty and cost, educational status, and perceptions about the disease) in nature. The strategies for the barriers include health education programs, advocacy, and capacity building.

The National Diabetes Prevention Center (NDPC) is an emerging model for public health practice and partnership. It is rooted in a "promising practices" framework, one that looks at what works for community diabetes prevention, care, and treatment practices. Working with national and local partners to explore new approaches to diabetes prevention invites us to move beyond traditional models of community public health partnerships. Traditional community partnership models emphasized the technical assistance in research, surveillance, and program development that can be provided by partners from outside the community. While not diminishing the importance of these activities, the NDPC seeks to provide an environment for meaningful language and discourse that adequately honors the innovative and culturally rich approaches to diabetes prevention already being developed within many American Indian and Alaska Native communities, which have some of the highest rates of diabetes in the world. The NDPC strives to provide common ground for the emergent discussions around the power and practice of solid evaluation frameworks, new information technologies, capacity-building philosophies, health systems, and collaborative approaches.

IntroductionNigeria's skilled health professional health workforce density is insufficient to achieve its national targets for non-communicable diseases (NCD) which include 25% reduction in the prevalence of diabetes and hypertension, particularly at the primary health care (PHC) level. This places a great demand on community health workers (CHWs) who constitute the majority of PHC workers. Traditionally, CHWs are mainly involved in infectious diseases programmes, and maternal and child health services. Their involvement with prevention and control of NCDs has been minimal. With government prioritization of PHC for combating the rising NCD burden, strengthening CHWs' skills and competencies for NCD care delivery is crucial.MethodsWe conducted a mixed methods study to explore the roles and practices of CHWs in the delivery of hypertension and diabetes care at PHC facilities in four states (two each in northern and southern regions) in Nigeria. We reviewed the National Standing Orders that guide CHWs' practices at the PHC facilities and administered a survey to 76 CHWs and conducted 13 focus groups (90 participants), and in-depth individual interviews with 13 CHWs and 7 other local and state government stakeholders.ResultsOverall, we found that despite capacity constraints, CHWs frequently delivered services beyond the scope of practice stipulated in the National Standing Orders. Such informal task-shifting practices were primarily motivated by a need to serve the community.DiscussionWhile these practices may partially support health system functions and address unmet need, they may also lead to variable care quality and safety. Several factors could mitigate these adverse impacts and strengthen CHW roles in the health system. These include a stronger enabling policy environment to support NCD task-sharing, investment in continuous capacity building for CHWs, improved guidelines that can be implemented at the point of care, and improved coordination processes between PHC and higher-level facilities.

The purpose of this study was to describe the process of implementing a diabetes prevention program provided by homecare nurses to residents of public housing communities. A cluster randomization pilot study was conducted comparing enhanced standard care (2 interactive classes on diabetes prevention) to a diabetes prevention program (7 interactive classes and behavioral support). The sample (n = 67) was primarily female (79%), nonwhite (76%), unpartnered (83%), with a mean age of 40 years, and an average of 3 children. Mixed methods were used to evaluate the implementation process. Data were collected on attendance, attrition, and protocol implementation. Interviews were conducted with nurses and community health workers who assisted with program implementation. Homecare nurses were able to implement a diabetes prevention program in public housing communities, with a protocol implementation of 83% across classes and groups. Attendance was suboptimal with 60% for the enhanced standard care group and 54% for the diabetes prevention group. Nurses and community health workers were resourceful and positive about program implementation. Linking existing resources, such as a homecare agency with a public housing community, is one approach to disseminate diabetes prevention programs.

T he U.S. Department of Health and Human Services' National Diabetes Education Program (NDEP) is the leading federal government public education program that promotes diabetes prevention and control. Based on the scientific results of the Diabetes Control and Complications Trial,1 NDEP was launched in 1997 with a mission to reduce the morbidity and mortality associated with diabetes. To fulfill that mission, NDEP translates the latest science and disseminates the message that type 2 diabetes is serious, common, and costly, yet controllable and preventable. NDEP is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention, with the support of > 200 partner organizations. Health care professionals need to know about current advances in diabetes management and prevention and require access to the most appropriate and effective tools and materials to assist them in administering the most effective care. NDEP provides a wealth of information and tools through three major campaigns: 1. Control Your Diabetes. For Life. This is a comprehensive information campaign focusing on tips and strategies for effective diabetes management. 2. Be Smart About Your Heart: Control the ABCs of Diabetes. This emphasizes the link between diabetes and cardiovascular disease. 3. Small Steps. Big Rewards. Prevent Type 2 Diabetes. This is the first national diabetes prevention effort. In view of the spiraling epidemic of diabetes in …

BackgroundThe rising prevalence of diabetes underscores the need for identifying effective prevention strategies. Recent research suggests environmental factors, particularly heavy metals like copper, significantly influence health outcomes, including diabetes, through mechanisms involving inflammation and oxidative stress. This study aims to explore how serum copper levels affect blood glucose, employing NHANES data from 2011 to 2016, to provide insights into environmental health’s role in diabetes prevention and management.MethodsThe study analyzed data from 2,318 NHANES participants across three cycles (2011–2016), focusing on those with available data on serum copper, inflammatory markers, and blood glucose levels. We utilized principal component analysis for selecting inflammatory markers, mediation analysis to examine direct and indirect effects, multiple linear regression for assessing relationships between markers and glucose levels, and weighted quantile sum regression for evaluating individual and collective marker effects, adjusting for demographic variables and serum copper.ResultsParticipants averaged 42.70 years of age, with a near-even split between genders. Average serum copper was 119.50 μg/dL, white blood cell count 6.82 × 109/L, and fasting blood glucose 107.10 mg/dL. Analyses identified significant mediation by inflammatory markers (especially white blood cells: 39.78%) in the copper-blood glucose relationship. Regression analyses highlighted a positive correlation between white blood cells (estimate: 1.077, 95% CI: 0.432 to 2.490, p = 0.013) and copper levels and a negative correlation for monocyte percentage (estimate: −1.573, 95% CI: 0.520 to −3.025, p = 0.003). Neutrophil percentage was notably influential in glucose levels. Sensitive analyses confirmed the study’s findings.ConclusionSerum copper levels significantly impact blood glucose through inflammatory marker mediation, highlighting the importance of considering environmental factors in diabetes management and prevention. These findings advocate for public health interventions and policies targeting environmental monitoring and heavy metal exposure reduction, emphasizing the potential of environmental health measures in combating diabetes incidence.

A World with Fewer People with Diabetes Noncommunicable Diseases

Diabetic Foot Ulcers (DFUs) were found to have a relatively high prevalence among type 2 diabetic patients and must never be neglected due to the high associated amputation rate. Community health workers (CHWs) showed promising strategies to combat DFUs in several countries. This study aimed to identify community perspectives on foot care intervention delivered by CHWs. Semi-structured interviews were conducted to gather the opinions of key stakeholders’ patients, their family members, CHWs, and health care professionals (HCPs) regarding the acceptability and practicality of FCI by CHWs in the Indonesian context. The recordings of all 29 interviews were transcribed and translated into English. Reflexive thematic analysis (RTA) was used to analyse the qualitative data. The opinions and perceptions of participants in delivering and receiving foot care education in the community were presented in five themes around community experiences in diabetic foot prevention, enhanced healthcare uptakes by extending CHW role, community embeddedness, CHW resources, and community training approach. Overall, the study findings supported the acceptability of CHWs delivering a FCI, albeit some barriers were identified related to the practical aspects of implementing this intervention around the community actors and healthcare policy in the community settings.