Search

Purpose: This study aims to explore the daily stressors experienced by adolescents with Type 1 diabetes (T1D) and the perceived impact of those stressors on their self‐management and psychological well‐being. Design and Methods: We conducted semistructured in‐depth telephone interviews using a qualitative descriptive approach with 20 adolescents aged 14–17 years with T1D and analyzed subsequent data using thematic analysis. Results: Participants who were non‐Hispanic white made up 85% of the sample, 75% identified as female and mean age was 15 years. The study identified two key themes: "the everyday stress of living with diabetes" and "managing stress and supporting psychological well‐being." Participants described heightened mental load, the impact of daily activities, stress associated with public diabetes management, and added stress due to COVID‐19. Primary mitigation techniques included family support, peer support networks, activity engagement, and personal acceptance of their condition. Practice Implications: We found that there is a compound effect that occurs with balancing daily disease management with normative activities of daily living. These data will help guide the design of new interventions and tailoring of existing interventions. Future intervention development may include physical exercise, mindfulness training, and stress reducing techniques. [ABSTRACT FROM AUTHOR]

Nowadays, environmentally friendly synthesis pathways for preserving the environment and minimizing waste are strongly required. Herein, we propose filter paper as a convenient scaffold for chemical reactions. To demonstrate this novel approach, Prussian Blue Nanoparticles (PBNPs) were synthesized on filter paper by utilizing few μL of its precursors without external inputs, i.e. pH, voltage, reducing agents, and without producing waste as well. The functional paper, named “Paper Blue”, is successfully applied in the sensing field, exploiting the reduction of hydrogen peroxide at low applied potential. The eco-designed “Paper Blue” was combined with wax- and screen-printing to manufacture a reagentless electrochemical point-of-care device for diabetes self-monitoring, by using glucose oxidase as the biological recognition element. Blood glucose was linearly detected for a wide concentration range up to 25 mM (450 mg/dL), demonstrating its suitability for management of diabetes and glucose-related diseases. The Paper Blue-based biosensor demonstrated a correlation coefficient of 0.987 with commercial glucose strips (Bayer Contour XT). The achieved results demonstrated the effectiveness of this approach, which is also extendible to other (bio)systems to be applied in catalysis, remediation, and diagnostics. [ABSTRACT FROM AUTHOR]

A disposable paper-based glucose biosensor with direct electron transfer (DET) of glucose oxidase (GOX) was developed through simple covalent immobilization of GOX on a carbon electrode surface using zero-length cross-linkers. This glucose biosensor exhibited a high electron transfer rate (ks, 3.363 s−1) as well as good affinity (km, 0.03 mM) for GOX while keeping innate enzymatic activities. Furthermore, the DET-based glucose detection was accomplished by employing both square wave voltammetry and chronoamperometric techniques, and it achieved a glucose detection range from 5.4 mg/dL to 900 mg/dL, which is wider than most commercially available glucometers. This low-cost DET glucose biosensor showed remarkable selectivity, and the use of the negative operating potential avoided interference from other common electroactive compounds. It has great potential to monitor different stages of diabetes from hypoglycemic to hyperglycemic states, especially for self-monitoring of blood glucose. [ABSTRACT FROM AUTHOR]

This is an executive summary of the Australasian Diabetes in Pregnancy Society (ADIPS) 2020 guideline for pre‐existing diabetes and pregnancy. The summary focuses on the main clinical practice points for the management of women with type 1 diabetes and type 2 diabetes in relation to pregnancy, including preconception, antepartum, intrapartum and postpartum care. The full guideline is available at https://doi.org/10.1111/ajo.13265. [ABSTRACT FROM AUTHOR]

The monitoring of blood glucose is a key aspect of diabetes care in limiting the negative effects of hyperglycaemia to both the microvasculature and macrovasculature. Self-monitoring of blood glucose (SMBG) gives an indication of blood glucose at a specific point in time and is recommended to be carried out four times daily. However, due to the inconvenience and associated pain of blood withdrawal, SMBG is often carried out less frequently than recommended or not at all. Extraction and subsequent determination of glucose in interstitial fluid (ISF) using microneedles (MNs) is an emerging area of research due to their minimally invasive nature and lack of associated pain. In this manuscript, a novel method for the fabrication of a hollow microneedle device is reported. The microneedle produced had a sharp bevelled edge and was 400 µm in length. Additionally, a paper backplate embedded with a colorimetric system for the rapid visual determination of glucose in simulated ISF was developed and paired with the hollow MN. This device rapidly extracted simulated ISF within five seconds and its ability to produce a glucose concentration dependent colour change within 30 s was demonstrated. Using this approach, it was possible to discriminate between glucose concentrations in normal glycaemia (4–7 mM) and hyperglycaemia (>7 mM) ranges using the naked eye. While further development is required, the results herein highlight the potential of this device to be used as a blood-free minimally invasive approach to glucose monitoring. [ABSTRACT FROM AUTHOR]

A novel low-cost, compact and sensitive paper-based platform for the accurate monitoring of glucose in biological fluids is presented. Paper-based working and reference electrodes are combined to build a whole potentiometric cell, which also fits a sampling module for simple and fast determination of glucose in a single drop of blood. The working electrode is built using a platinized filter paper coated with a Nafion membrane that entraps the enzyme glucose oxidase; the reference electrode is made by casting a polyvinylbutyral-based membrane onto a conductive paper. The system works by detecting the hydrogen peroxide generated as a result of the enzymatic reaction. Selectivity is achieved due to the permselective behaviour of Nafion, while a significant enhancement of the sensitivity is reached by exploiting the Donnan-coupled formal potential. Under optimum conditions, a sensitivity of −95.9 ± 4.8 mV per decade in the 0.3–3 mM range is obtained. Validation of the measurements has been performed against standard methods in human serum and blood. Final integration with a wireless reader allows for truly in situ measurements with a less than 2 minute procedure including a two-point calibration, washing and measurement. This low-cost analytical device opens up new prospects for rapid diagnostic results in non-laboratory settings. [ABSTRACT FROM AUTHOR]

This study aimed to develop a paper-based glucose sensor using artificial sweat and saliva samples, a non-invasive, practical, and affordable concept for measuring glucose levels. The chosen method was the colorimetric method using the Glucose Oxidase (GOx) enzyme, Horseradish Peroxidase (HRP) enzyme, and 3,3′-diaminobenzidine (DAB) chromogen. The wax stamping method was utilized on a piece of filter paper to test the glucose sensor. The test was carried out in several stages, including testing various concentrations of reagents and wax stamping sizes, fabricating the glucose sensors, and testing multiple concentrations of glucose, artificial sweat, and artificial saliva. The RGB method was used to test the resulting color. The data obtained were then validated using UV-Vis Spectrophotometry. The GOx concentration on the glucose sensor affected the color change velocity. The HRP, DAB, and wax stamping size concentration simultaneously indicated a strong correlation with changes in the color intensity that appeared on the glucose sensor. The glucose sensor in this study could measure the glucose concentration of the artificial sweat and saliva samples, respectively, from 0-3000 μM with R2 = 0.9862 and 0.9987. This study proved a strong correlation between the reagents' concentration and the color intensity on the developed glucose sensor. [ABSTRACT FROM AUTHOR]

The continuous surveillance of glucose concentration reduces short-term risks and long-term complications for people with diabetes mellitus, a disorder of glucose metabolism. As a first step towards the continuous monitoring of glucose, reagent-free transmission spectroscopy in the mid-infrared region has been carried out in vitrousing a quantum cascade laser and an optical silver halide fiber. A 30 μm gap in the fiber allowed for transmission spectroscopy of aqueous glucose solutions at a wavelength of 9.69 μm, which is specific to a molecular vibration of glucose. A noise-equivalent concentration as low as 4 mg/dL was achieved at an average power of 1.8 mW and an integration time of 50 s. This is among the most precise of glucose measurements using mid-infrared spectroscopy. Even with the very low average laser power of 0.07 mW the sensitivity of previous results (using a fiber optical evanescent field analysis) has been improved upon by almost one order of magnitude. Finally, the impact of potentially interfering substances such as other carbohydrates was analyzed. [ABSTRACT FROM AUTHOR]

• Anti HCT interference blood glucose sensors based on fiber paper-based screen-printed carbon electrode were demonstrated. • The paper-based glucose sensor can reduce HCT interference significantly with HCT range 20% to 70%. • In consensus error grid, 95% of the data points lie within zones A and B. As the number of diabetic patients increases year by year, the demand for a self-monitoring blood glucose test also increases. Additionally, more in-depth studies of blood glucose biosensors have led to increasing accuracy requirements. However, at present, most enzyme glucose sensors have difficulty solving issues related to hematocrit (HCT) interference. Most studies on anti-HCT interference in blood glucose sensing have mainly focused on correction factors, such as glucose correction, and electrical impedance or resistivity characteristics to correct the impact of HCT. In this work, we developed an anti-HCT-interference blood glucose sensor based on a fiber paper-based screen-printed carbon electrode with a mediator (potassium ferricyanide) and glucose oxidase (GOD), which were fixed through inkjet printing. When testing whole blood samples with HCT levels of 20%–70% and a fluid dropping method, the results of a consensus error grid analysis showed that 91% of the data points lied within zones A and B. The glucose sensor was exclusively designed with a 16 μL chamber in the working area of the sensor. When the testing fluid was taken in by capillary sucking, the effect of HCT was further reduced, and 95% of the data points lied within zones A and B in the consensus error grid. [ABSTRACT FROM AUTHOR]

The article presents the discussion on 19th century physician was part dispensary, part scientific laboratory. Topics include stethoscopes, bandages, syringes and medication, sat a urine testing kit—a battered leather case with vials of caustic chemicals, droppers, spirit lamps and charred test tubes; and regular use of this equipment, while the medical literature was full of letters pleading for more practical solutions.

Abstract: Diabetes mellitus (DM) is the most common endocrine disorder that can be seen in any age groups. At present, many millions of patients with this disorder can be seen around the world. A serious consequence of DM for the patients is the development of diabetic complications that can end up with death. For control of DM, diabetic complication is strongly recommended. Since poorer diabetic control means higher complication, several attempts are introduced for help control of blood sugar of the patients. Focusing on the laboratory investigation, the new concept for measurement of glycosylated hemoglobin is proposed and used at present. Based on the concept of point of care testing (POCT), several new glucometers are developed and circulated in present clinical practice. However, the problem of the “quality” of those meters must be addressed. Here, the author retrospectively appraised on the published papers that used POCT glucometers as tools for measuring hemoglobin A1C (HbA1C). Acceptability of the tool in each report is decided based on the referencing report on the quality of the POCT HbA1C analyzers. It can be seen that not all reports used reliable POCT HbA1C tools which means the doubtfulness of the results and conclusions on many published papers. [ABSTRACT FROM AUTHOR]

Background: Continuous insulin infusion is a method for maintaining blood glucose stability in critically ill patients with hyperglycemia. Many insulin infusion protocols have been applied in intensive care units. Understanding the content of these protocols can help clinical staff choose the most appropriate and convenient protocol and promote best practices in managing glucose levels in critically ill adult patients. Objective: To examine the types of insulin infusion therapies performed for blood glucose management in critically ill patients. Methods: For this scoping review, 3 Chinese-language and 8 English-language databases were searched for articles published from May 25, 2016, to October 25, 2022. Results: Twenty-one articles met the inclusion criteria. Twenty-one insulin infusion protocols were examined. Most of the insulin infusion protocols were paper protocols. Fourteen glucose management indicators were included in the 21 protocols. The glucose target range for all 21 protocols ranged from 70 to 180 mg/dL (3.9-10.0 mmol/L). Nurses were primarily responsible for protocol implementation in most protocol development processes. The roles of nurses differed in nurse-led insulin infusion protocols and non–nurse-led insulin infusion protocols. Discussion: This scoping review indicates an urgent need for more comprehensive glycemic control guidelines for patients receiving critical care. Because insulin infusion protocols are core aspects of blood glucose management guidelines, different population subgroups should also be considered. Conclusions: Nurse-led guidelines must be based on the best available evidence and should include other variables related to glucose management (eg, patient disease type, medication, and nutrition) in addition to insulin infusion. [ABSTRACT FROM AUTHOR]

Blood glucose stability in diabetic patients determines the degree of health, and changes in blood glucose levels are related to the outcome of diabetic patients. Therefore, accurate monitoring of blood glucose has a crucial role in controlling diabetes. Aiming at the problem of high volatility of blood glucose concentration in diabetic patients and the limitations of a single regression prediction model, this paper proposes a method for predicting blood glucose values based on particle swarm optimization and model fusion. First, the Kalman filtering algorithm is used to smooth and reduce the noise of the sensor current signal to reduce the effect of noise on the data. Then, the hyperparameter optimization of Extreme Gradient Boosting (XGBoost) and Light Gradient Boosting Machine (LightGBM) models is performed using particle swarm optimization algorithm. Finally, the XGBoost and LightGBM models are used as the base learner and the Bayesian regression model as the meta-learner, and the stacking model fusion method is used to achieve the prediction of blood glucose values. In order to prove the effectiveness and superiority of the method in this paper, we compared the prediction results of stacking fusion model with other 6 models. The experimental results show that the stacking fusion model proposed in this paper can accurately predict blood glucose values, and the average absolute percentage error of blood glucose prediction is 13.01%, and the prediction error of the stacking fusion model is much lower than that of the other six models. Therefore, the proposed diabetes blood glucose prediction method in this paper has superiority. [ABSTRACT FROM AUTHOR]

Wearable sweat sensors offer the possibility of continuous real-time health monitoring of an individual at a low cost without invasion. A variety of sweat glucose sensors have been developed thus far to help diabetes patients frequently monitor blood glucose levels through sweat glucose as a surrogate marker. The present study demonstrates the development and characterization of a three-dimensional paper-based microfluidic electrochemical integrated device (3D PMED) for measuring glucose concentration in sweat in real-time via simple, non-invasive, capillary-action-based sample collection. The device was selective for glucose, and it detected glucose accurately in the clinically relevant range (0~2 mM) in an off-body setup. To the best of our knowledge, this is the first time NEXAR™ has been used for biosensing applications. Further, the developed glucose sensor has acceptable sensitivity of 16.8 µA/mM/cm2. Importantly, in an on-body setup, the device achieved a significant amperometric response to sweat glucose in a very short amount of time (a few seconds). With detailed investigations, this proof-of-concept study could help further the development of sensitive and selective sweat-based glucose sensing devices for real-time glucose monitoring in diabetes patients. [ABSTRACT FROM AUTHOR]

Examines whether reagent test strip contamination affects the reliability and validity of bisected chemstrip bG for blood glucose monitoring. Intra- and interreader reliability; Pearson correlation coefficients; Analysis of variance.

Accessible Summary: What is known on the subject?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years.Effective diabetes self‐care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications.Few studies have investigated diabetes self‐care behaviours and their associations with health literacy and self‐efficacy in people diagnosed with serious mental illness. What the paper adds to existing knowledge?: Diabetes self‐care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self‐care activities were self‐monitoring of blood glucose.Factors associated with diabetes self‐care behaviours are gender, age, communicative and critical health literacy and self‐efficacy.Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. What are the implications of practice?: Mental health nurses should assess diabetes‐specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self‐care.When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes‐related distress and increase their confidence in managing comorbid diabetes. Introduction: People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim: This study investigated diabetes self‐care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods: A cross‐sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self‐report questionnaires and a chart review. Three‐step hierarchical multiple regression analysis was used to identify factors associated with diabetes self‐care behaviours. Results: Diabetes self‐care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p =.037) and self‐efficacy (β = 0.27, p =.004) significantly associated with diabetes self‐care behaviours. Discussion: Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice: Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Photoacoustic Spectroscopy (PAS) is a potential method for the noninvasive detection of blood glucose. However random blood glucose testing can help to diagnose diabetes at an early stage and is crucial for managing and preventing complications with diabetes. In order to improve the diagnosis, control, and treatment of Diabetes Mellitus, an appropriate approach of noninvasive random blood glucose is required for glucose monitoring. A polynomial kernel-based ridge regression is proposed in this paper to detect random blood glucose accurately using PAS. Additionally, we explored the impact of the biological parameter BMI on the regulation of blood glucose, as it serves as the primary source of energy for the body's cells. The kernel function plays a pivotal role in kernel ridge regression as it enables the algorithm to capture intricate non-linear associations between input and output variables. Using a Pulsed Laser source with a wavelength of 905 nm, a noninvasive portable device has been developed to collect the Photoacoustic (PA) signal from a finger. A collection of 105 individual random blood glucose samples was obtained and their accuracy was assessed using three metrics: Root Mean Square Error (RMSE), Mean Absolute Difference (MAD), and Mean Absolute Relative Difference (MARD). The respective values for these metrics were found to be 10.94 (mg/dl), 10.15 (mg/dl), and 8.86%. The performance of the readings was evaluated through Clarke Error Grid Analysis and Bland Altman Plot, demonstrating that the obtained readings outperformed the previously reported state-of-the-art approaches. To conclude the proposed IoT-based PAS random blood glucose monitoring system using kernel-based ridge regression is reported for the first time with more accuracy. [ABSTRACT FROM AUTHOR]

The article focuses on a study which tested the hypothesis that a computerized system to obtain glucose control will allow faster time to target after cardiac surgery. The study compared patients who underwent cardiac surgery between January and December 2007 whose glucose control obtained through a paper protocol with patients who underwent cardiac surgery between January and December 2008 whose glucose control was obtained with computer-driven protocol. Study authors concluded that computer-driven protocol provides excellent glycemic control.

Objective: Self-monitoring of blood glucose (SMBG) plays a vital role in the maintenance of blood glucose with type 2 diabetes mellitus(T2DM) and prediabetes patients. The study was intended to describe the current status of SMBG with T2DM and pre-diabetes patients in grassroots communities, explore the relationship between SMBG frequency and blood glucose level and apply information-motivation-behavior(IMB) model to analyze the potential influencing factors of SMBG compliance based on electronic questionnaires. Methods: A cross-sectional study was conducted with 1388 T2DM and prediabetes patients who completed electronic questionnaires composed of demographics and IMB model content. Chi-square test, Mann-Whitney U test and multivariable logistic regression model analysis were utilized to explore deeply causes of SMBG compliance. Results: The results of this study showed that among 1388 T2DM patients, only 26.2% (363/1388) patients reached SMBG standard, indicating low compliance with SMBG. Given that SMBG is one of the individual predictors of type 2 risk in prediabetes patients, this result suggests that the SMBG compliance rate needs to be improved. Patients with fixed occupation (OR=1.989, P=0.035), BMI in normal range (OR=1.336, P=0.049), smoking habit(OR=1.492, P=0.019), understanding SMBG frequency (OR=1.825, P<0.001), understanding control goal of blood glucose (OR=1.414, P<0.001), knowing all the functions of the blood glucose meter (OR=1.923, P<0.001), buying a blood glucose meter/test paper conveniently(OR=2.329, P=0.047), taking supplementary measurement when forgetting blood glucose test(OR=2.044, P=0.005), rotating all the fingers when measuring blood glucose (OR=1.616, P<0.001) and less pain at the needling site(OR=2.114, P<0.001)were independently promoting factors of adherence to SMBG. However, the lack of accessibility and convenience of blood glucose meter or heavy financial burden were blocking factors of adherence to SMBG. Moreover, there were still bottlenecks such as lack of health care knowledge and needle pricking pain. Conclusion: This study verified the practicability of applying IMB model to SMBG with T2DM and pre-diabetes patients. Adherence to SMBG still remained to improved, and putting more emphasis in improvement of individual information, motivation and behavioral skills with patients might be beneficial to maintain better adherence to SMBG in long-term routine of diabetes self-management. [ABSTRACT FROM AUTHOR]

Though monitoring blood glucose (BG) is indispensable for regulating diabetes, the frequent pricking of the finger by the commonly used fingertip blood collection causes discomfort and poses an infection risk. Since glucose levels in skin interstitial fluid (ISF) correlate with blood glucose levels, monitoring glucose in the skin ISF can be a viable alternative. With this rationale, the present study developed a biocompatible porous microneedle capable of rapid sampling, sensing, and glucose analysis in ISF in a minimally invasive manner, which can improve patient compliance and detection efficiency. The microneedles contain glucose oxidase (GOx) and horseradish peroxidase (HRP), and a colorimetric sensing layer containing 3,3′,5,5′-tetramethylbenzidine (TMB) is on the back of the microneedles. After penetrating rat skin, porous microneedles harvest ISF rapidly and smoothly via capillary action, triggering the production of hydrogen peroxide (H2O2) from glucose. In the presence of H2O2, HRP reacts with TMB contained in the filter paper on the back of microneedles, causing an easily visible color shift. Further, a smartphone analysis of the images quickly quantifies glucose levels in the 50–400 mg/dL range using the correlation between color intensity and glucose concentration. The developed microneedle-based sensing technique with minimally invasive sampling will have great implications for point-of-care clinical diagnosis and diabetic health management. [ABSTRACT FROM AUTHOR]

Objective: This study intends to understand the barriers to self-monitoring of blood glucose (SMBG) in gestational diabetes mellitus (GDM) patients. In addition, it also aims to know the factors that influence the compliance with SMBG-testing among GDM patients. Methods: The study primarily comprised a search of various databases (PubMed, EMBASE, SCOPUS, PsycINFO, PROQUEST, and CINAHL). Research papers published between March 2010 and June 2018 were searched for this review. Article types considered for this review were observational studies, experimental studies, and systemic reviews with or without meta-analysis. Using a set of eligibility criteria; initially, the papers were scrutinized by reviewing the abstracts, following which a full-text review of the selected papers was undertaken. Finally, a critical appraisal and an overall qualitative assessment of these studies were done. Results: Literature search identified 25 papers, excluding the duplicates. Six studies (two qualitative and four quasi-experimental) that matched the eligibility criteria of this study were reviewed. The barriers of SMBG in GDM patients were nonprescription of SMBG by the health-care providers, poor perception and fear of SMBG, and family history of Type 2 diabetes. Use of smartphone technology and SMBG-education improved the compliance to SMBG testing. However, most of the quasi-experimental studies did not have a pre- and post-intervention comparison of their results or comparison of their findings with any control group. Moreover, the way of determining compliance among three of these studies was not identical. Similarly, among the qualitative studies, one study does not have a clear mention of the language in which the interviews were conducted, whereas the other qualitative study does not state, if the English language translation of the verbatim transcripts was validated or not. Only one study mentioned the diagnostic criteria used to diagnose GDM. Conclusion: The recent evidence to the barriers of SMBG and the factors that influence the compliance of SMBG is weak and not generalizable. Moreover, there is a scarcity of literature that addresses the context. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the effect of an online multidisciplinary weight loss management programme. Methods: Between July 2016 and July 2017 this randomized controlled trial recruited patients in Nanjing, China who were living with type 2 diabetes mellitus and who were obese or overweight and randomized them to online versus conventional groups. All participants were managed by a multidisciplinary team. The experimental group was managed using the Why Wait WeChat Platform for Weight Reduction Management. Results: There were 55 and 52 participants in the online and conventional groups, respectively. The decreases in fasting blood glucose (−4.26 vs. −2.99 mmol/L), 2‐h postprandial blood glucose (−4.48 vs. −2.68 mmol/L) and glycated haemoglobin (−22.11 vs. −6.21 mmol/mol) were more pronounced in the online compared to conventional group (all P < 0.05). After the intervention, self‐management ability parameters, including diet control, foot care and total score, were improved in the online group compared with the conventional group, as well as all indexes of quality of life (all P < 0.05). Conclusion: The online multidisciplinary weight loss management programme improved blood glucose in obese or overweight patients living with type 2 diabetes mellitus. Self‐management ability parameters (including diet control, foot care and total score) and quality of life were improved in the online group compared with the conventional group. Summary statement: What is already known about this topic?: Multidisciplinary approaches have been introduced into weight loss management models for patients with type 2 diabetes mellitus and obese or overweight in outpatient clinics of third‐level hospitals, but their effects have not been clearly described. What this paper adds?: The online multidisciplinary weight loss management programme improved blood glucose in obese or overweight patients living with type 2 diabetes mellitus.Self‐management ability parameters (including diet control, foot care and total score) and quality of life were improved in the online group compared with the conventional group. The implications of this paper: This is the first trial of an online programme in the management of type 2 diabetes mellitus in China.Trial findings might have international applicability in the management of type 2 diabetes mellitus and could lead to improvement of prognosis. [ABSTRACT FROM AUTHOR]

The ability to perform accurate continuous glucose monitoring without blood sampling has revolutionised the management of diabetes. Newer methods that can allow measurements during longer periods are necessary to substantially improve patients' quality of life. This paper presents an alternative method for glucose monitoring which is based on electrical impedance spectroscopy. A battery-less implantable bioimpedance spectroscope was designed, built, and used in an in vivo study on pigs. After a recovery period of 14 days post surgery, a total of 236 subcutaneous bioimpedance measurements obtained from intravenous glucose tolerance tests, with glucose concentration ranges between 77.4 and 523.8 mg/dL, were analyzed. The results show that glucose concentrations estimated by subcutaneous bioimpedance measurements correlate very well to the blood glucose reference values. The pigs were clinically healthy throughout the study, and the postmortem examinations revealed no signs of adverse effects related to the sensor. The implantation of the sensor requires minor surgery. The implant, being externally powered, could in principle last indefinitely. These encouraging results demonstrate the potential of the bioimpedance method to be used in future continuous glucose monitoring systems. [ABSTRACT FROM AUTHOR]

This paper presents a miniaturized triband implantable planar antenna that covers the industrial, scientific, and medical (ISM) band and the Wireless Medical Telemetry Service (WMTS) band which can be used in a continuous blood glucose monitoring device. The antenna consists of a slotted radiating patch and a ground plane with a cross slot to miniaturize its size. The overall antenna size is only 51.35 mm3 (7.6 × 7.6 × 0.889 mm3) due to the reduced size by the slotting technique. Compared to other implantable antennas with similar performance, the proposed antenna is smaller in size, simple in construction, and easy to be fabricated. By cutting a cross slot in GND, impedance matching is improved, especially at the two higher frequency bands. We have fabricated the prototype and carried out measurements. The results show its gains are −32.2 dBi, −18.8 dBi, and −19.1 dBi at 0.9 GHz, 1.4 GHz, and 2.45 GHz, respectively. Its radiation patterns have good symmetry in the two lower operating frequency bands. In addition, the maximum SAR values comply with the IEEE standard safety guidelines (IEEE C95.1-2019). [ABSTRACT FROM AUTHOR]

We aimed to survey the findings of phenomenological studies built up in the field of diabetes care in Sweden. This is a meta-synthesis of phenomenological studies on experiences related to diabetes in Sweden focusing on learning to live with diabetes. We proceeded by reference to the seven phases of Noblit & Hare. We examined papers from seven phenomenological studies on learning to live with diabetes in Sweden. From the papers, which describe the experience of living with diabetes, three overarching themes were selected—perception and awareness of the body; integration and responsibility; and presence of others who provide support. From those describing the expert's experience, an overarching theme emerged—encouraging reflection in persons with diabetes. We interpreted each of these themes in phenomenological terms and compared them with theories in Japan. Persons with diabetes take responsibility for coping with a range of things brought on by the illness and learn to live with diabetes. Experts support these persons so they can see their world objectively and critically scrutinize it. By building a model of diabetes care in Japan that references Scandinavian human science, it will be possible to find new approaches that support learning at the existential level. [ABSTRACT FROM AUTHOR]

The current standard of diabetes management depends upon the invasive blood pricking techniques. In recent times, the availability of minimally invasive continuous glucose monitoring devices have made some improvements in the life of diabetic patients however it has its own limitations which include painful insertion, excessive cost, discomfort and an active risk due to the presence of a foreign body under the skin. Due to all these factors, the non-invasive glucose monitoring has remain a subject of research for the last two decades and multiple techniques of non-invasive glucose monitoring have been proposed. These proposed techniques have the potential to be evolved into a wearable device for non-invasive diabetes management. This paper reviews research advances and major challenges of such techniques or methods in recent years and broadly classifies them into four types based on their detection principles. These four methods are: optical spectroscopy, photoacoustic spectroscopy, electromagnetic sensing and nanomaterial based sensing. The paper primarily focuses on the evolution of non-invasive technology from bench-top equipment to smart wearable devices for personalized non-invasive continuous glucose monitoring in these four methods. With the rapid evolve of wearable technology, all these four methods of non-invasive blood glucose monitoring independently or in combination of two or more have the potential to become a reality in the near future for efficient, affordable, accurate and pain-free diabetes management. [ABSTRACT FROM AUTHOR]

The Internet of Things (IoT) is essential in innovative applications such as smart cities, smart homes, education, healthcare, transportation, and defense operations. IoT applications are particularly beneficial for providing healthcare because they enable secure and real-time remote patient monitoring to improve the quality of people's lives. This review paper explores the latest trends in healthcare-monitoring systems by implementing the role of the IoT. The work discusses the benefits of IoT-based healthcare systems with regard to their significance, and the benefits of IoT healthcare. We provide a systematic review on recent studies of IoT-based healthcare-monitoring systems through literature review. The literature review compares various systems' effectiveness, efficiency, data protection, privacy, security, and monitoring. The paper also explores wireless- and wearable-sensor-based IoT monitoring systems and provides a classification of healthcare-monitoring sensors. We also elaborate, in detail, on the challenges and open issues regarding healthcare security and privacy, and QoS. Finally, suggestions and recommendations for IoT healthcare applications are laid down at the end of the study along with future directions related to various recent technology trends. [ABSTRACT FROM AUTHOR]

The past few decades have seen ongoing development of continuous glucose monitoring (CGM) systems that are noninvasive and accurately measure blood glucose levels. The conventional finger-prick method, though accurate, is not feasible for use multiple times a day, as it is painful and test strips are expensive. Although minimally invasive and noninvasive CGM systems have been introduced into the market, they are expensive and require finger-prick calibrations. As the diabetes trend is high in low- and middle-income countries, a cost-effective and easy-to-use noninvasive glucose monitoring device is the need of the hour. This review paper briefly discusses the noninvasive glucose measuring technologies and their related research work. The technologies discussed are optical, transdermal, and enzymatic. The paper focuses on Near Infrared (NIR) technology and NIR Photoplethysmography (PPG) for blood glucose prediction. Feature extraction from PPG signals and glucose prediction with machine learning methods are discussed. The review concludes with key points and insights for future development of PPG NIR-based blood glucose monitoring systems. [ABSTRACT FROM AUTHOR]

Finger-prick blood collection process has become unrealistic for a long-term and frequent blood glucose detection. Hence, an appropriate non-invasive detection system is highly desirable to effectively address this concern. A non-invasive and intelligent dual-sensing system is forwarded in this paper. The feasibility of the proposed system has been verified using glucose solution, animal serum, and human trials. In the in vivo experiments, the detection signal exhibited a high correlation (r = 0.96) with blood glucose levels. An improved cascade convolution neural network is suggested to accurately predict the BGL. For the estimation results of BGL, the root mean squared error of 7.3217 mg dl−1 and a mean absolute relative difference of 4.7209% are achieved. The estimated results also fell by 100% in the clinically acceptable zones of the Clarke error grid analysis, indicating that the proposed system could potentially be used for clinical measurements. [ABSTRACT FROM AUTHOR]

The prevalence of diabetes is rapidly increasing worldwide and can lead to a range of severe health complications that have the potential to be life-threatening. Patients need to monitor and control blood glucose levels as it has no cure. The development of non-invasive techniques for the measurement of blood glucose based on photoacoustic spectroscopy (PAS) has advanced tremendously in the last couple of years. Among them, PAS in the mid-infrared (MIR) region shows great promise as it shows the distinct fingerprint region for glucose. However, two problems are generally encountered when it is applied to monitor real samples for in vivo measurements in this MIR spectral range: (i) low penetration depth of MIR light into the human skin, and (ii) the effect of other interfering components in blood, which affects the selectivity of the detection system. This review paper systematically describes the basics of PAS in the MIR region, along with recent developments, technical challenges, and data analysis strategies, and proposes improvements for the detection sensitivity of glucose concentration in human bodies. It also highlights the recent trends of incorporating machine learning (ML) to enhance the detection sensitivity of the overall system. With further optimization of the experimental setup and incorporation of ML, this PAS in the MIR spectral region could be a viable solution for the non-invasive measurement of blood glucose in the near future. [ABSTRACT FROM AUTHOR]

Sir, Diabetes mellitus (DM) is a global health issue, and India is among the top contributor to the global burden. There are several criteria for finding the accuracy of the devices as shown in [Table 1].[[2]],[[3]],[[4]],[[5]],[[6]],[[7]],[[8]],[[9]],[[10]],[[11]]{Table 1} In this article, we describe the method of calculation of accuracy tests without any statistical software package. In developing countries like India where test laboratories are not available in remote places, these devices can help in the management of patients suffering from DM. [Extracted from the article]

Interstitial skin fluid (ISF) is an emerging alternative source of blood samples that has attracted great interest from researchers. It is a very promising way to use microneedle patches for extracting ISF. However, the recovery of ISF still faces great challenges, such as long extraction time and low extraction volume, which may affect the analysis of biomarkers. Traditional centrifugation methods cannot completely recover ISF, which leads to inaccuracy in ISF detection. In this paper, the prepared polyvinyl alcohol/polyvinylpyrrolidone (PVA/PVP) microneedle patches had the ability to insert into the skin in a dry state; at the same time, the microneedle patches had good swelling properties and could extract ISF in a short time without any additional devices. Due to the thermal degradation of PVA, the way of gentle heating was used to recover ISF, which could greatly improve the accuracy of detection. By comparing the D -glucose content assay kit with the blood glucose concentration of rats detected using a commercial glucometer, the detection accuracy of the microneedle patches was verified. The microneedle patches can be used to sample ISF and analyze the level of biomarkers in ISF, and are expected to provide a basis for the prevention and diagnosis of clinical diseases in the future. [ABSTRACT FROM AUTHOR]

Abstract. Blood glucose level monitoring and control is of utmost importance to millions of people who have been diagnosed with diabetes or similar illnesses. One of the conventional tests for measuring how the human body breaks down glucose is IVGTT, the Intravenous Glucose Tolerance Test. The difficulty of computing the models of glucose-insulin interaction presents an issue when attempting to implement them in embedded hardware. The Metabolic P (MP), contrary to other models, does not require solving differential equations to compute, thus it could be an effective modelling approach for real-time applications. The present paper proves that MP system methodology-based IVGTT implementation in the Field Programmable Gate Arrays (FPGA) technology is reasonably precise and sufficiently flexible to be used effectively in multi-user scenarios. Presentation of the state-of-the-art focuses on glucose-insulin interaction models, glucose monitoring systems and MP system implementation techniques. Methods for MP system computations and techniques for their implementation on FPGA, together with the original unified MP system implementation technique, have been presented in this paper. The results of an elaborate investigation into the IVGTT MP systems, as well as their single and unified MP implementation techniques have also been considered. It is shown that the techniques developed are applicable to all known IVGTT MP systems, and can achieve RMSE not higher than 15% using a word length of at least 32 bits. The novel MP system combined quality metrics and its pictorial representation allow the analysis of various implementation characteristics. Compared to the unified pipelined IVGTT MP system implementation technique, the developed unified combinational technique ensures a 2-3 times higher speed. [ABSTRACT FROM AUTHOR]

Non-Invasive blood glucose monitoring using infrared (IR) light is considered to be a useful and reliable tool for measuring blood sugar levels during daily activities. IR-based glucose monitoring depends on the variant absorption levels of IR light waves by blood with high or low levels of glucose solution. This paper introduces a low-cost finger probe to measure glucose based on Arduino and embedding a Clarke error grid with fuzzy logic. An electronic blood glucose meter was designed and implemented in a non-invasive and painless manner based on an infrared sensor. The electrical signal expressing the level of glucose in the blood with a mathematical equation was used to calibrate and map the physical and electrical values. The final numerical value was validated with the Clarke error grid by implementing fuzzy logic (FL). The designed device was tested on 30 subjects with 15 diabetes subjects. The results show the high significance of results at points where the FL was able to determine an error range of less than 10% of measured glucose within the same range of the reference measurements. The proposed method of using FL with a Clarke error grid gives more confident and precise outputs in cases of this kind of portable device. [ABSTRACT FROM AUTHOR]

The article focuses on two meta-analyses related to genetic factors for body glucose regulation, insulin response and diabetes, which were conducted by the Meta-Analyses of Glucose and Insulin Related Traits Consortium (MAGIC). It discusses both papers and provides information on various gene loci associated with glucose regulation, insulin levels and Type 2 diabetes.

Aims: This study investigated self‐care activities and identified their related factors in Chinese patients with type 2 diabetes mellitus. Methods: A cross‐sectional study was conducted in Guangzhou, China, between September 2016 and February 2017, involving 202 Chinese patients with type 2 diabetes mellitus. Measures included the Summary of Diabetes Self‐Care Activities Questionnaire and Revised Illness Perception Questionnaire. Results: Self‐care activities in Chinese patients with type 2 diabetes mellitus were suboptimal overall. Foot care and blood sugar testing were the self‐care activities that were performed the least. One fifth of patients smoked. Some subscales of illness perceptions, receiving health education on diabetes, employment status, education level, body mass index, age and time since type 2 diabetes mellitus diagnosis, were related to self‐care activities in patients with type 2 diabetes mellitus. Conclusion: Health‐care providers and nurses should encourage greater engagement in self‐care activities in patients with type 2 diabetes mellitus, especially foot care and blood sugar testing. Illness perceptions may be used as a framework to guide interventions. Summary statement: What is already known about this topic? Diabetes is a global epidemic, and China has the largest number of patients with type 2 diabetes mellitus.Self‐care activities are a key factor in preventing complications and maintaining long‐term health in patients with type 2 diabetes mellitus.Illness perceptions are amendable to change by health‐care providers. What this paper adds? Self‐care activities in Chinese patients with type 2 diabetes mellitus were suboptimal; the least frequently performed self‐care activities were foot care and blood sugar testing, and one in five patients smoked.Some subscales of illness perceptions, receiving diabetes education, employment status, education level, body mass index, age and time since type 2 diabetes mellitus diagnosis, were related to self‐care activities in Chinese patients with type 2 diabetes mellitus. The implications of this paper: Illness perceptions may be used as a framework to guide interventions aimed at promoting self‐care activities in Chinese patients with type 2 diabetes mellitus.Interventions aimed at promoting self‐care activities should be tailored to the sociodemographic and clinical profiles of individual patients. [ABSTRACT FROM AUTHOR]

Aims: To explore the factors related to hospital‐to‐home transitional self‐monitoring blood glucose behaviour among patients with diabetes‐related foot ulcer. Background: The 30‐day readmission rate of patients with diabetes‐related foot ulcer can be reduced when good glycaemic control is achieved. The practice of self‐monitoring blood glucose promotes optimal glycaemic control. Design A comparative descriptive study. Methods: In this study, 200 participants, who had been hospitalized due to diabetes‐related foot ulcer, were recruited from August 2017 to July 2018. Before participants were discharged from the hospital, psychosocial factors (family support, threat belief, self‐efficacy and knowledge) and pre‐hospitalization self‐monitoring blood glucose behaviour were collected using a structured questionnaire. Then, after discharge, self‐monitoring blood glucose behaviour delivery was collected again. Results: Five variables explained 47% of the variance in the delivery of self‐monitoring of blood glucose at home. The delivery of hospital‐to‐home transitional self‐monitoring blood glucose behaviour was more likely for individuals with higher pre‐discharge self‐efficacy, higher post‐discharge self‐efficacy, more attention to pre‐hospitalization glycaemic status and post‐discharge insulin usage and those without an insensitive foot. Conclusion: Self‐monitoring blood‐glucose behaviour should be promoted among post‐discharge patients with diabetes‐related foot ulcer. The modifiable factors identified in this study can be integrated into the discharge plan. Summary statement: What is already known about this topic? Patients with diabetes‐related foot ulcer have higher 30‐day readmission rates than the general inpatient population. Such readmissions can be prevented when good glycaemic control is achieved.As a centrepiece of diabetes self‐management, self‐monitoring blood glucose practice promotes optimal glycaemic control.Although there have been several survey studies of self‐monitoring blood glucose practice among patients with diabetes, to our knowledge, no study has used longitudinal data to explore the self‐monitoring of blood glucose behaviour. In addition, no study has explored hospital‐to‐home transitional self‐monitoring of blood glucose among patients with diabetes. What this paper adds? After participants were discharged from the hospital, approximately one‐fourth did not perform self‐monitoring of blood glucose at home.The delivery of hospital‐to‐home transitional self‐monitoring blood glucose practice was more likely for individuals with higher pre‐discharge self‐efficacy, higher post‐discharge self‐efficacy, more attention to pre‐hospitalization glycaemic status and post‐discharge insulin usage as well as for those without an insensitive foot.Self‐efficacy of self‐monitoring of blood glucose is the most powerful predictor of hospital‐to‐home transitional self‐monitoring blood‐glucose practice. The implications of this paper: For patients with less attention paid to their glycaemic status previously and with impaired foot sensation, an intensive discharge plan should be provided to promote their self‐monitoring blood‐glucose practice.To promote self‐monitoring blood‐glucose practice, strategies to improve self‐efficacy related to self‐monitoring of blood glucose should be integrated into the discharge plan and subsequent follow‐up. [ABSTRACT FROM AUTHOR]

The optical scattering coefficient (μs) in the dermis layer of human skin obtained with optical coherence tomography (OCT) has shown to have a strong correlation with the blood glucose concentration (BGC), which can be used for noninvasive BGC monitoring. Unfortunately, the nonhomogeneity in the skin may cause inaccuracies for the BGC analysis. In this paper, we propose a 2D correlation analysis method to identify 2D regions in the skin with μs sensitive to BGC variations and only use data in these regions to calculate μs for minimizing the inaccuracy induced by nonhomogeneity and therefore improving the accuracy of OCT-based BGC monitoring. We demonstrate the effectiveness of the 2D method with OCT data obtained with in vivo human forearm skins of nine different human subjects. In particular, we present a 3D OCT data set in a two-dimensional (2D) map of depth vs. a lateral dimension and calculate the correlation coefficient R between the μs and the BGC in each region of the 2D map with the BGC data measured with a glucose meter using finger blood. We filter out the μs data from regions with low R values and only keep the μs data with R values sufficiently high (R-filter). The filtered μs data in all the regions are then averaged to produce an average μs data. We define a term called overall relevancy (OR) to quantify the degree of correlation between the filtered/averaged μs data and the finger-blood BGC data to determine the optimal R value for such an R-filter with the highest obtained OR. We found that the optimal R for such an R-filter has an absolute value (|R|) of 0.6 or 0.65. We further show that the R-filter obtained with the 2D correlation method yields better OR between μs and the BGC than that obtained with the previously reported 1D correlation method. We believe that the method demonstrated in this paper is important for understanding the influence of BGC on μs in human skins and therefore for improving the accuracy of OCT-based noninvasive BGC monitoring, although further studies are required to validate its effectiveness. [ABSTRACT FROM AUTHOR]

Advances of implantable medical devices (IMD) are transforming the traditional method of providing medical treatment, especially those patients under the most challenging condition. Accordingly, the IMD-enabled artificial pancreas system (APS) has now reached global market. It helped many patients suffering from chronic disease, called diabetes mellitus, in monitoring and maintaining blood glucose level conveniently. However, this advancement is accompanied by various security threats that place the life of patients at risk. Hence, protective measures, especially against yet unknown threats, are of paramount importance. This paper proposes a specification-based misbehavior detection system (SMDS) as an alternative solution to effectively mitigate security threats. Moreover, an outlier detection algorithm is also introduced to validate integrity of unprotected data transmitted by the different components. The monitor agent applies a smoothened-trust-based scheme to assess the trustworthiness of the APS. To demonstrate effectiveness of the proposed method, we first extend the UVA/Padova simulator for glucose-insulin data collection and subsequently simulate scenario with well-behave and malicious APS in MATLAB. The results show that there exists an optimal trust threshold that can achieve high specificity and sensitivity rate. Moreover, the proposed technique was compared to contemporary machine learning classifier including decision tree, support vector machine, k-nearest neighbor, and the SMDS called SMDAps. It is shown that our approach can dominate detection performance, especially to malicious behavior that manifests habitually (hidden mode). [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region. Materials and methods: The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Results: Nineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption. Conclusions: The limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate beliefs, and attitudes about health of refugees with chronic conditions such as diabetes mellitus type 2, hypertension, chronic obstructive pulmonary disease, and posttraumatic stress disorder and the consequent effects on self-care in comparison to resident populations. Design: A systematic review methodology was used. PubMed, Embase, PsycINFO and CINAHL databases were searched for relevant articles. The main terms analysed were health beliefs, chronic conditions and refugee populations. From 844 articles, 45 were retained for further assessment, and finally 5 met the inclusion criteria. Results: Differences in the health beliefs, attitudes and self-care management approaches of refugees compared to resident populations were identified in two studies. The remaining three papers did not make comparisons between the refugees and the resident population, nor did they specifically explore the refugees' health beliefs. Of the five studies, three were carried out in Sweden and two in the US. Refugees who have poorer mental and physical health as well as higher prevalence of chronic diseases than the populations among which they resettle seem to lack the knowledge about their illness, symptoms and self-management and thus are less able to control their chronic conditions. Conclusion: The findings highlighted the deficiency in the literature of studies which examine health beliefs and attitudes of minority groups such as refugees who have chronic conditions. The findings also gave insight to the need for a distinctive understanding of refugee health and the management of chronic conditions in comparison to other non-refugee migrant groups. Further research is needed to fully understand the differences between refugees and local populations in terms health beliefs, chronic disease and self-management. [ABSTRACT FROM AUTHOR]

Introduction: Tight glucose monitoring is crucial for diabetic patients by using a Continuous Glucose Monitor (CGM). The existing CGMs measure the Blood Glucose Concentration (BGC) from the interstitial fluid. These technologies are quite expensive, and most of them are invasive. Previous studies have demonstrated that hypoglycemia and hyperglycemia episodes affect the electrophysiology of the heart. However, they did not determine a cohort relationship between BGC and ECG parameters. Material and method: In this work, we propose a new method for determining the BGC using surface ECG signals. Recurrent Convolutional Neural Networks (RCNN) were applied to segment the ECG signals. Then, the extracted features were employed to determine the BGC using two mathematical equations. This method has been tested on 04 patients over multiple days from the D1namo dataset, using surface ECG signals instead of intracardiac signal. Results: We were able to segment the ECG signals with an accuracy of 94% using the RCNN algorithm. According to the results, the proposed method was able to estimate the BGC with a Mean Absolute Error (MAE) of 0.0539, and a Mean Squared Error (MSE) of 0.1604. In addition, the linear relationship between BGC and ECG features has been confirmed in this paper. Conclusion: In this paper, we propose the potential use of ECG features to determine the BGC. Additionally, we confirmed the linear relationship between BGC and ECG features. That fact will open new perspectives for further research, namely physiological models. Furthermore, the findings point to the possible application of ECG wearable devices for non-invasive continuous blood glucose monitoring via machine learning. [ABSTRACT FROM AUTHOR]

Within the past several years, a considerable body of research on adherence to diabetes regimen has emerged in public health. However, the focus of the vast majority of these studies has been on the individual traits and attitudes affecting adherence. Still little is known on the role of the social and physical context in supporting or hindering diabetes self-management, particularly from a qualitative standpoint. To address these limitations, this paper presents the findings of a Photovoice study on a sample of 10 type 2 diabetic older adults living in a deprived neighbourhood of an Italian city. The findings reveal that the possibility to engage in diet, exercise and blood sugar monitoring seems to be more affected by physical and social elements of the respondents' environment than by the interviewees' beliefs and attitudes. Both environmental barriers and social isolation emerge as barriers to lifestyle changes and self-care activities related to blood sugar monitoring. The predominance of bonding social capital, the scant level of trust and the negative perception of local health services result in a low level of social cohesion, a limited circulation of health information on diabetes management and, consequently, in poor health outcomes. [ABSTRACT FROM AUTHOR]