SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Blood Glucose Monitoring Devices and Digital Biomarkers in Diabetes: Effectiveness, Utilisation and Challenges: A Systematic Review(King's College London, 2024-10-09) Al Hamdan, Janah Abdullah; Lu, LeiAbstract Introduction: Diabetes management has advanced with the introduction of digital biomarkers and blood glucose monitoring (BGM) devices, offering new avenues for improving glycemic control. This systematic review evaluates the effectiveness, utilisation, and challenges of these technologies in diabetes management. Methodology: A comprehensive search was conducted in PubMed, Medline, and Embase for studies published between 2014 and 2024. Eligible studies involved adult patients (aged ≥18) with diabetes using wearable or body-mounted devices for glucose monitoring. The review included continuous glucose monitoring (CGM) systems (e.g., Dexcom, Medtronic), flash glucose monitoring (FGM) systems (e.g., Freestyle Libre), and self-monitoring of blood glucose (SMBG) devices. A total of 27 studies were included, comprising RCTs, observational studies, pilot studies, interventional studies, and quasi-experimental studies. Results: CGM systems demonstrated significant improvements in glycemic control, with reductions in HbA1c ranging from 0.6% to 1.1% and improvements in time in range (TIR) from 43% to 59%. FGM systems showed an average HbA1c reduction of 0.44% and a significant decrease in hypoglycemic events, particularly nighttime hypoglycemia (a 0.29-hour reduction, p=0.0001). While SMBG proved effective for real-time glucose monitoring, it showed lower adherence rates and a limited impact on long-term glycemic outcomes compared to CGM and FGM. Across studies, CGM outperformed FGM and SMBG in minimising glycemic variability (GV) (27% vs 29%, p=0.05) and improving patient satisfaction. However, challenges related to device cost, accessibility, and adherence, particularly for SMBG, remain prevalent. Conclusion: CGM and FGM offer substantial benefits over traditional SMBG, particularly in reducing HbA1c, improving TIR, and decreasing hypoglycemic events. While these advanced glucose monitoring systems provide significant clinical advantages, barriers such as cost and complexity must be addressed to ensure broader adoption and improved health outcomes for diabetes patients globally19 0Item Restricted Understanding Lipohypertrophy in Diabetes(King's College London, 2024) Almunif, Dina; Jha, PrashantLipohypertrophy (LH) is a significant complication of insulin therapy affecting approximately 25-41.8% of diabetes mellitus patients. This qualitative study investigates patients' and healthcare professionals' (HCPs) attitudes toward LH and insulin injection practices. Through online focus groups and interviews involving 11 patients and 10 HCPs, the research explores the prevalence and risk factors LH. Key findings reveal that modifiable risk factors, including improper injection practices like site non-rotation and needle reuse, significantly contribute to LH development. The research emphasizes the critical need for comprehensive patient education, improved HCP training, and technological advancements in insulin delivery. Recommendations include developing structured education programs, investing in advanced delivery technologies, conducting large-scale research, and creating targeted interventions for high-risk populations. This study provides crucial insights into LH management, advocating for a proactive approach to prevent complications, improve patient outcomes, and reduce healthcare system costs.19 0Item Restricted Platelet glucose metabolism-impact of diabetes(University of Leeds, 2023-12-21) Alotaibi, Reem; Naseem, KhalidGlucose metabolism is crucial for providing platelets with adequate ATP to do their functions properly. Little is known about platelet glucose uptake and the role of the first rate-limiting glycolytic enzyme, hexokinase (HK), in the regulation of platelet activation. Glucose uptake in response to platelet agonists, thrombin and convulxin (CVX), increased in a dose and time-dependent manner. Focusing on signalling downstream of glycoprotein VI (GPVI), it was found that inhibition of signalling enzymes SFKs, Syk, or PI3K linked to this receptor significantly decreased platelet glucose uptake, combined with reduced P-selectin expression. Glucose uptake was found to be independent to integrin activation, but interestingly required ADP signalling and, to a lesser extent, TxA2 signalling. Using immunoblotting and immunoprecipitation, we found that HK I and II are expressed in human and murine platelets, with HK I equally localised in cytosol and mitochondria and HK II was exclusively found in membrane fraction. Blocking HK activity with three different HK inhibitors revealed that HK plays an important role in glucose transport into platelets upon platelet activation with CVX. Functional studies have shown that HK may play a role in GPVI-mediated platelet aggregation and activation, αIIbβ3, and P-selectin expression. Platelet activation with CVX caused an increase in HK activity, which required SFKs, Syk, and PI3K/Akt pathways. These data suggest that HK plays a key, but poorly defined, role in GPVI-mediated platelet activation. Next, the effect of diabetes on platelet glucose uptake was examined. Type1 diabetes mellitus was induced in mice using Streptozotocin (STZ) injection. C57BL/6J male mice aged 8-12 weeks received STZ intraperitoneally (50 mg/kg body weight;3 days). After confirming diabetes, glucose uptake studies demonstrated that glucose uptake was basally high in diabetic mice compared to vehicle control. Further, this increase in glucose uptake was also associated with increased mitochondrial membrane potential in diabetic mice compared to vehicle group (hyperpolarisation). Correlation analysis revealed a strong positive association between fasting blood glucose levels and platelet glucose uptake upon activation in STZ mice. These data suggest that glucose metabolism is altered in diabetes. In conclusion, these studies suggest that platelet activation regulates platelet glucose metabolism by regulating GLUT3 expression and HK activity.29 0Item Restricted EXPLORING THE EFFICACY, AVAILABILITY AND PERCEPTIONS TOWARDS USING MOBILE APPLICATIONS FOR DIABETES SELF-MANAGEMENT IN SAUDI ARABIA(Saudi Digital Library, 2022-06) Abdulhakem, Alhamoudi; P, V; J, ZBackground: Many mobile and web-based applications are used to support diabetes self-management. However, up-to-date evidence of their effectiveness, availability and the attitudes of patients and healthcare professionals (HCPs) towards them is sparse. Project’s Aims and Objectives : The main aim of this project was to explore the efficacy, availability and perceptions towards using mobile applications for diabetes self-management in Saudi Arabia. To accomplish this aim, the following objectives were set: (1) To conduct a systematic review and meta-analysis aiming to explore the nature and effectiveness of mobile and web applications to support diabetes self-management; (2) To conduct a systematic review aiming to explore the knowledge and attitudes of patients and HCPs towards mobile and web applications to support diabetes self-management; (3) To conduct web-based research to explore the availability and features of mobile applications in the Google Play Store® for diabetes self-management; (4) To conduct a survey study to explore patients' beliefs, experiences, attitudes and knowledge of using mobile applications in supporting diabetes self-management; (5) To conduct a survey study to explore HCPs beliefs, experiences, attitudes and knowledge regarding the use of mobile applications in supporting diabetes self-management by patients. Methods: Based on the aims and objectives, several methods were used in this project: a systematic review, web-based content analysis and surveys. In the systematic reviews, several data synthesis approaches were used: meta-analysis, narrative synthesis and qualitative evidence synthesis. The AADE 7 Self-care Behaviour® model, the Mobile App Rating Scale (MARS) and the Technology Acceptance Model (TAM) were utilised throughout these studies. Results: In the first study, 13 studies met the inclusion criteria, of which 11 were RCTs and two were observational studies. In the second study, eight studies met the inclusion criteria. There were 402 application results from the search of the third study. Of those, 45 apps met the inclusion criteria. For the patient survey in the fourth study, there were 277 participants. Of these, only 179 were eligible. In the fifth study, 89 HCPs participated in the survey, but only 71 were eligible. Conclusion: There is no conclusive evidence about the effectiveness of mobile and web applications in supporting diabetes self-management by improving HbA1c and QoL. There could be several reasons for the lack of effectiveness. In general, qualitative evidence synthesis shows that patients and HCPs are not users, or limited users, of the currently available mobile diabetes self-management applications. They are looking for more sophisticated, interactive, smart, reliable, personalised, customisable, educational, easy-to-use and cost-effective applications. After investigating the Google app store, the number of available applications is high but are limited to supporting only some self-management tasks. Patients are required to install a variety of apps to self-manage their diabetes. The findings also suggest that patients and HCPs may find such a high number of applications overwhelming if there is no guidance or accreditation system in place. In the Saudi Arabian population, most of the study participants used mobile applications and considered them very useful and easy to use, regardless of the issues that some of them faced. However, a limited number of HCPs recommend mobile applications for their patients, despite their belief that diabetes mobile applications are useful. Finally, the general view of the final two studies was that diabetes mobile applications are useful and easy to use. This may affect future adaption positively, according to the TAM model.32 0Item Restricted Does Using Empagliflozin Reduce Hospitalization for Heart Failure and Angina in People With Diabetes? A Systematic Review(2023-05-02) Alrefaee, Manal Ibrahim; Khan, EhsanBackground Current statistics show that there are over 422 million people with diabetes around the world, and these numbers are in continuous increase (Lin et al 2020). The presence of type 2 diabetes mellitus increases the incidence of cardiovascular diseases (Leon & Thomas 2015). There is an increase trend towards using SGLT2 (Sodium Glucose Cotransporter 2) inhibitors, including empagliflozin, in the treatment of people with diabetes as the have shown beneficial effects in improving glucose control and cardiovascular events. Objectives To examine whether empagliflozin decreases hospitalizations for heart failure or unstable angina for people with type 2 diabetes mellitus (T2DM). Selection method The included studies compared using empagliflozin, 25 mg/10 mg, with placebo, no treatment. Only randomized controlled trials selected. Participants were people ≥18 years old with type 2 diabetes mellitus. Method The preferred method for conducting this systematic review was the Cochrane Handbook for Systematic Reviews (2022). The search for study was carried out through EMBASE database, PubMed, and Cochrane from 2014 to 2022. The search strategy was the PICO, (P) stands for Population, (I) Intervention, (C) Comparison, and (O) Outcome. The selected studies were assessed for quality using CASP (Critical Appraisal Skills Programme) tool. The risk of bias was also assessed using the Cochrane Risk of Bias tool (RoB2). The study search, the quality assessment and risk of bias examination all conducted by one author. Main results Four studies were retrieved for this systematic review. The studies compared using empagliflozin, 25 mg or 10 mg, with placebo, no treatment. Hospitalizations for heart failure were significantly lower in intervention groups, there is no significant difference in all-cause hospitalization, and the as no significant difference in hospitalization for unstable angina between the two groups. Conclusion Provided the notable control of diabetes status, using empagliflozin had an association with decreased hospitalization for heart failure and other cardiovascular diseases. A strong recommendation for using empagliflozin depending on the available data. The effects of empagliflozin on hospitalization for heart failure or unstable angina require more examination in the future.37 0