Lege Artis Medicinae

[The importance of continuous glucose monitoring in modern diabetes care]

KOCSIS Gyôzô 1

MAY 26, 2022

Lege Artis Medicinae - 2022;32(04-05)

DOI: https://doi.org/10.33616/lam.32.016

Review

[It is no exaggeration to say that there is a paradigm shift in the diabetes care. Since 2015, the driving force behind are primarily the widely spreading sensor technologies instead of the new insulin products and treatment regimens. The rapidly spreading sensor technologies are applied in more and more countries financially supported in type 1 diabetes since 2015. The use of Continuous Glucose Monitoring (CGM, tissue glucose sensor, simplified as sensor), which includes both real-time CGM (RT-CGM) and intermittently scanned CGM (isCGM), has grown rapidly over the past few years by improving sensor accuracy, greater convenience and ease of use, and expanding support of reimbursement. Numerous studies have demonstrated the significant clinical benefits of using CGM in diabetic patients, regardless of the type of insulin treatment. In this summary, we review the practical aspects of glucose monitoring, the optimal frequency of monitoring, the effectiveness, re­liability, and role of continuous glucose mo­­nitoring systems.]

AFFILIATIONS

  1. Semmelweis Egyetem, Belgyógyászati és Onkológiai Klinika

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Blood pressure variability and its clinical importance]

KÉKES Ede, VÁLYI Péter

[The 24-hour and longer-term (weeks, months, years) as well as seasonal, regional variations and fluctuations of blood pressure have been known for long time in both normotensive and hypertensive patients. It is also well known and established that blood pressure variability is greater in patients with more severe hypertension and in the elderly population. In the last decade and actually, the variability of blood pressure has come into new light by meticulous analysis of numerous causal factors and consequences influencing its fluctuation. The real diagnostic and prognostic value of blood pressure variability and its role in the assessment of successful antihypertensive treatment have also been favoured. In our review, we summarise the physiological and pathophysiological principles of blood pressure variability, including also the significant importance of allostasis in the new approach. We overview the methods of measuring the blood pressure variability and its real importance related to the results obtained. We analyse the importance of non-adaptive levels of blood pressure variability in asymptomatic cases and apparent conditions, further in diagnostic projections and monitoring the treatment. Based on our own experience, we also present the future options of exploring the fluctuating blood pressure.]

Lege Artis Medicinae

[Options for assessing the quality of postoperative pain relief: multidimensional measurement tools]

LOVASI Orsolya, GAÁL Péter, LÉBER Andrea, LÁM Judit

[Inadequat treatment of postoperative pain may have several adverse consequences. Its effective and efficient management requires regular pain assessments with valid and re­liable pain assessment tools. The main features of unidimensional pain assessment scales were discussed in our previous paper. Their most important disadvantage is that they measure only the pain intensity, which did not necessarily provide sufficient and re­liable basis for clinical decision making. The main goal of this paper is to review multi­dimensional measurement tools for assessment of postoperative pain, their main components, and applications based on summary of the relevant literature. While using the PICO (population, intervention, control, and outcomes) technique of systematic literature research, we identified 396 accessible and evaluable articles in total, from which we summarize the results of the most important 41 English and 4 Hungarian publications. Among the multi­dimensional pain assessment tools we discussed thoroughly the American Pain So­ciety Pa­tient Outcome Questionnaire (APS-POQ-R), the Swedish Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) questionnaire, and the characteristics of the patient outcome questionnaire of the German Quality Im­provement in Postoperative Pain Mana­ge­ment Project (QUIPS). Contrasted to unidimensional scales, multidimensional measurement tools do not evaluate only the intensity of pain, but its other dimensions, and psychosocial aspects. Thus they give a more accurate picture of its nature, however, their application of specific scales requires more time and diligence, and the scope of patients is more restricted. Consequently, unidimensional scales are more suitable for supporting the clinical practice, in cases where the multidimensional questionnaires cannot be used. In contrast, whenever the circumstances permit, multidimensional scales should be used, especially for quality improvement and research purposes.]

Lege Artis Medicinae

[The effect of COVID-19 pandemic on eating disorders]

BABUSA Bernadett, TÚRY Ferenc

[The COVID-19 pandemic increased the incidence of many mental disorders inclusive that of eating disorders as it was realised in case of anorexia nervosa, bulimia nervosa, and other eating disorders. As a result, eating disorder symptoms were worsening and the relapse rate became higher. In the back­ground the following factors may have played an important role: change in the food availability, increase of fearing weight gain, the impact of social media, some special webpages became more important in the light of social isolation, social comparison became more pronounced, exercise limitations, negative effects of stressful life events as the increase of family conflicts. The mental health consequences of pandemic highlight the importance of psychoeducation, primary and secondary prevention in the field of eating behaviours as well. ]

Lege Artis Medicinae

[The significance of recognising spinal muscular atrophy]

CSÁTI Anett, KLIVÉNYI Péter

[Spinal muscular atrophy (SMA) is a rare autosomal recessive, progressive neuromuscular disorder leading to severe proximal muscle weakness and atrophy. The spectrum of dis­ease severity ranges from early onset severe form to the slowly progressive adult-onset type. Milder and adult forms of SMA are underdiagnosed. Due to understanding the genetic background of SMA, an increasing number of disease-modifying treatment options have become available in recent years, responsible for the modification of the natural course of the disease. Updated consensus statement for standard of care is necessary. Besides the motor function alterations, health-related quality of life measurements are highlighted for estimating the impact of SMA, and the effectiveness of specific the­rapies.]

Lege Artis Medicinae

[A review of aceclofenac: Analgesic and anti-inflammatory effects on musculoskeletal disorders]

FARSANG Csaba

All articles in the issue

Related contents

Hypertension and nephrology

[Beyond the blood sugar reduction. SGLT-2 inhibitors in kidney protection]

SIMONYI Gábor

[Results of cardiovascular safety studies with SGLT-2 inhibitors have shown that in addition to their hypoglycaemic and beneficial cardiovascular effects, they are renoprotective. A number of mechanisms underlying the renoprotective effects of SGLT-2 inhibitors have been shown to reduce albuminuria and deterioration of renal function. Their nephroprotective effects extend over a very wide range of eGFR and albuminuria categories. In the DAPA-CKD study, dapagliflozin was shown to exert its nephroprotective effect regardless of the presence of diabetes and a baseline eGFR, while also having a beneficial effect on cardiovascular endpoints and mortality. Following the confirmation of favourable renal results for SGLT-2 inhibitors, it is no coincidence that they have been included in national and international recommendations for the treatment of chronic kidney disease.]

Lege Artis Medicinae

[Patient education and insulin treatment]

HIDVÉGI Tibor

[Therapeutic patient education is a lifelong educational activity. As an approach focus­ed on the needs, values and therapeutic strategies of patients, it promotes an increase in patients’ knowledge and skills according to the disease, results in a better quality of life, increased therapeutic compliance and a decrease of complications. Patients become partners and health care providers become coaches. Many type-2 diabetes patients re­fuse insulin therapy, even when this modality of treatment is indicated. This paper aims to explore diabetic patients’ reasons of accepting insulin therapy and the initial barriers to its use, as well as relat­ed education requirements.]

Ca&Bone

[Bone mineral density and diabetes mellitus - First results]

TÕKE Judit, TAMÁS GYULA, STELLA Péter, NAGY Erzsébet, NÁDASDI Ágnes, VARGA Piroska, KERÉNYI ZSUZSA

[INTRODUCTION - Data on bone mineral density (BMD) in diabetes mellitus are contradictory in the literature. Early studies described a decreased bone mineral density in type 1 diabetes mellitus (T1DM), but recent studies report no osteopenia in T1DM.The BMD may depend on the quality of treatment for diabetes mellitus and on the presence of chronic complications. In type 2 diabetes mellitus (T2DM) the BMD is not decreased, occasionally it can even be increased. PATIENTS AND METHODS - Bone mineral density was measured in 122 regularly controlled diabetic patients (T1DM: n=73, mean age: 43.6±11.1 years,T2DM: n=49, mean age: 61.8±9.8 years) by dual energy X-ray absorptiometry at the lumbar spine and at the femur. Results were compared to those of 40 metabolically healthy control persons with a mean age of 47.5±11.9 years.The patients’ carbohydrate metabolism was assessed by the average HbA1c level of the last three years.These values were 7.9±1.4 % in T1DM, and 7.5±1.7 % in T2DM. BMDs were classified based on the T-score and Z-score using the WHO criteria. RESULTS - There was no significant difference in T1DM or in T2DM compared to the reference group in the prevalence of either osteoporosis or of osteoporosis and osteopenia combined. CONCLUSION - BMD was not found to be decreased in patients with well-controlled metabolism compared to healthy controls.]

Hypertension and nephrology

[Summary of guidelines for American, European and International Companies in diabetes mellitus type 2 associated with hypertonia]

KÉKES Ede, DOLGOS Szilveszter

[The importance of hypertension in type 2 diabetes mellitus, the method of continuous blood pressure control and patient’s careas well as the forms of non-drug and drug therapy have been disclosed by presenting therapeutical recommendations from American, European scientific societies and international organizations. It has been established that the principles of care and treatment of hypertonia have basically remained unchanged in diabetes all over the world, despite the recent widespread debate over the interpretation of normal blood pressure and the consideration of the benefits of intensive or standard treatment.]

Hypertension and nephrology

[The prevalence of type 2 diabetes mellitus in the Hungarian population with hypertension]

KÉKES Ede, PÁL László, SCHANBERG Zsolt, KISS István

[Authors had found diabetes mellitus type 2 in 30% of 38 886 hypertensive patients (stadium I-III). Diabetes was more frequent in case of women under 30 years. Subsequently all age groups (from 40 to 80 years) incidence was more frequently (p<0.01-0.001) in men, above 80 years again a higher ratio was in women. Presence of diabetes was correlated to rate of BMI value and systolic, diastolic pressure as well. In women - above 140 mmHg systolic pressure - the elevation was exponential. We have found a significant correlation between fasting glucose and waist. Reaching the target blood pressure is not a simply task in hypertensive patients with diabetes. The 140/90 mmHg was reached in 34.2%, 90 mmHg diastolic blood pressure in 62.3%, but the required 80 mmHg only in 16.4% of cases. Achieve the target value was quite different in the different region of our country. The major cardiovascular complications (stroke, renal disease, myocardial infarction, peripheral artery disease) have suffered a higher rate in the hypertensives with diabetes compered to hypertensives without diabetes.]