Diabetes Research and Clinical Practice - Volume 120 - Supplement 1 - October 2016

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PG-39
Performance comparison of average daily risk range obtained
by continuous glucose monitoring and self-monitoring of
blood glucose in diabetic outpatients
Miru KOMIYAMA 1, Yoshiro KATO 2*, Nobuhiro HIRAI2,
Mako TAKAGI 1, Kyoko YAMAGUCHI1, Shin TSUNEKAWA2,
Masaki KONDO 2, Tatsuhito HIMENO2, Hideki KAMIYA 2,
Jiro NAKAMURA 2. 1Central Clinical Laboratory, Aichi Medical
University Hospital, 2Division of Diabetes, Department of Internal
Medicine, Aichi Medical University School of Medicine, Japan
Background: Recently it has been known that postprandial
hyperglycemia and severe hypoglycemia may cause various
cardiovascular events and enhance risks for death, and
therefore monitoring of blood glucose variability is important.
As the indices for evaluating blood glucose variability, the
standard deviation of daily blood glucose levels (SD) and the
mean amplitude of glucose excursion (MAGE) have so far been
widely used, whereas there has been a problem that both of
them depend on hyperglycemic ranges but reacts insuffi-
ciently to hypoglycemic ranges. In 2006, Kovachev et al.
proposed the concept of average daily risk range (ADRR) as
the index for evaluating blood glucose variability which
sufficiently reacts to both hyper- and hypoglycemic ranges.
ADRR is converted to risk values that will be expected as the
index for prediction of risks for severe hyper- and hypogly-
cemia. Continuous glucose monitoring (CGM) is useful in
evaluating blood glucose variability. However, CGM can be
performed only in facilities which suffice the facility stan-
dards, and has problems in the possible period of glucose
sensor (the Enlite ® sensor) only for 6-day use.
Purpose: Performance comparison was conducted between
ADRR obtained by CGM (ADRRc) and ADRR obtained by SMBG
(ADRRs) using 7 points. And also, performance comparison
was conducted between ADRRc and ADRRs calculated using
only 3 points of SMBG before meal or ADRRs calculated using 3
points of SMBG before meal with 1 point of SMBG after meal.
Patients: 13 outpatients with diabetes mellitus (type1/type2:
4/9) (mean age: 59.5 years, mean HbA1c: 7.1%) were enrolled.
Methods: The study patients underwent CGM (iPro2) for 6 days
and SMBG was daily recorded 7 times (3 times before meal, 3
times 90 min after meal, and 1 time before going to sleep). In
SMBG, One Touch Ultra Vue was used. ADRRc and ADRRs were
calculated using CGM and SMBG data obtained for 6 days,
respectively.
Results: There is a strong correlation between ADRRc and
ADRRs. ADRRs calculated using only 3 points of SMBG before
meal were low compared with that calculated using 3 points of
SMBG before meal with 1 point of SMBG after meal, and the
latter approximated to ADRRc.
Conclusion: ADRRs calculated using 3 points of SMBG before
meal with 1 point of SMBG after meal correlated well with
ADRRc. Results demonstrated that ADRRs calculated using 3
points of SMBG before meal with 1 point of SMBG after meal
was the good index capable of expressing the blood glucose
variability.
PG-40
The experience of using “Steno Diabetes Dialogue Card” for
small group patient education and its effect on glycemic
control
Meng-Chun HU 1*, Szu-Tah CHEN1, Sheve-Hwa CHIOU1,
Chiu-Yueh SUN 1, Hsiao-Chuan YI1, Meng-Han SHIH 1. 1Chung-
Gung Memorial Hospital, Linkou, Taiwan
Aims: To improve the glycemic control of adult diabetic
patients, the feasibility of a self- motivated and –oriented
glycemic control program assisted by an education tool was
assessed.
Patients and methods: From 2015/06 to 2016/02, a total of 35
poorly controlled (mean diabetic duration 9.8 ± 5.61 years and
meanHbA1c 8.68 ± 1.79%) adult type 2 diabetic (T2DM) patients
(15male and 20 female, aged 62.06 ± 10.06, ranged fromaa to bb
y/o) were enrolled. After randomly subgrouped, a patient
based, problem-oriented and self-motivated interview model
was conducted by using the “Diabetes Dialogue Card corrected
from the Steno Tool ” under the guidance of an expert diabetic
educator.
Results: After a 9 months “ intervention, most of the patients
obtained better knowledge of diabetic complication and
pitfalls of diabetic control. Glycemic control was statistically
improved when the following parameters (before and after, p
value) were assessed, which include HbA1c (8.68 ± 1.79% to
7.83 ± 1.00%, p < 0. 003), body weight (64.64 ± 1.8 to 63.96 ± 10.6
kg, p < 0.025), drug compliance (4.77 ± 1.59 to 5.74 ± 0.71 days/
week, p < 0.001), frequency of exercise (2.54 ± 0.45 to 3.89 ± 1.74
days/week, p < 0.001) and frequency of self-monitoring of
blood glucose (1.66 ± 0.35 to 2.17 ± 2.06 days/week, p < 0.001).
Conclusions: Through enhancing the acknowledgement of
self-deficit in diabetic control, Diabetes Dialogue Card effect-
ively improved glycemic control of T2DM patients through a
problem-oriented, self-motivated group interview under the
guidance of expert diabetic educators.
PG-41
Scenario-based training to improve nursing staff knowledge
and competence in diabetes care
Jo Jo KWAN1*, Sau Ping Grace YEUNG1, Wai Ching LI1,
Tok Fai Vincent YEUNG1. 1Our Lady of Maryknoll Hospital,
Hongkong
Background: Currently patient with diabetes comprise up to
30% of the census of adult medical admissions in our hospital.
As there is a turnover of ward nurses each year, a structured
and tailor-made training program is essential to ensure a good
level of knowledge and competence in diabetes care so that
patient safety and quality care could be enhanced.
Method: The training module consisted of two parts,
namely scenario-based case conference and post conference
newsletter sharing. At the case conference, ward nurse would
take turn to present a case of diabetes and raise questions
regarding the management. A pre-conference quiz related to
the scenario was also given to all participants for knowledge
assessment. Interactive case discussion was guided by a
Diabetes Nurse Consultant. After the conference, all valid
learning and discussion points would be summarized in a
newsletter and posted to all related units.
Results: Three interactive case conferences were organized
and attended by a total of 49 nurses in 2015. The case-mix
selected for presentation was comprehensive, including
insulin treated diabetes with advance complications, uncon-
trolled diabetes, gestational diabetes complicated with bipolar
affective disorder, etc. Regarding the knowledge assessment,
more than 90% of the participants could recognize the actions
and side effects of traditional anti-diabetic drugs, whereas less
than 50% of them seemed not familiar with the nature of those
novel medications. All the frontline nursing colleagues could
point out the proper management for patient develop hypo-
glycemia but only a few were competent to address the
highlights when caring for gestational diabetes. Through the
interactive discussion, ward nurses could learn from real cases
that they came across and found interesting. All participants
welcomed the initiation of this program.
Conclusion: The Scenario-based training is a tailored-made
program for the ward nurses to enhance their knowledge and
competence in caring in-hospitalized patients with diabetes.
From the learning experience gained in this program, the
nurses could address patients’ need timely and grasp the
valuable teaching opportunity during their hospitalization,
thus facilitating early discharge and shorten their length of
stay. Continuous enhancement of the program would help to
fine-tune and optimize the training contents and learning
activities in future.
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211 S172