دورية أكاديمية
Feasibility of continuous glucose monitoring in patients with type 1 diabetes at two district hospitals in Neno, Malawi: a randomised controlled trial.
| العنوان: | Feasibility of continuous glucose monitoring in patients with type 1 diabetes at two district hospitals in Neno, Malawi: a randomised controlled trial. |
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| المؤلفون: | Gomber A; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA., Valeta F; Partners In Health, Neno, Malawi., Coates MM; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA., Trujillo C; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Partners In Health, Boston, Massachusetts, USA., Ferrari G; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Partners In Health, Boston, Massachusetts, USA., Boti M; Partners In Health, Neno, Malawi., Kumwenda K; Partners In Health, Neno, Malawi., Mailosi B; Partners In Health, Neno, Malawi., Nakotwa D; Partners In Health, Neno, Malawi., Drown L; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA., Wroe EB; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Partners In Health, Boston, Massachusetts, USA.; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA., Thapa A; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA., Mithi V; Partners In Health, Neno, Malawi., Matanje B; Partners In Health, Neno, Malawi., Msekandiana A; Kamuzu Central Hospital, Lilongwe, Malawi., Park PH; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA., Kachimanga C; Partners In Health, Neno, Malawi., Bukhman G; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Partners In Health, Boston, Massachusetts, USA.; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA., Ruderman T; Partners In Health, Neno, Malawi., Adler AJ; Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA aadler2@bwh.harvard.edu.; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. |
| المصدر: | BMJ open [BMJ Open] 2024 May 06; Vol. 14 (5), pp. e075554. Date of Electronic Publication: 2024 May 06. |
| نوع المنشور: | Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Multicenter Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [London] : BMJ Publishing Group Ltd, 2011- |
| مواضيع طبية MeSH: | Continuous Glucose Monitoring* , Diabetes Mellitus, Type 1*/blood , Diabetes Mellitus, Type 1*/drug therapy, Adult ; Female ; Humans ; Male ; Middle Aged ; Blood Glucose/analysis ; Feasibility Studies ; Glycated Hemoglobin/analysis ; Hospitals, District ; Malawi ; Quality of Life ; Rural Population |
| مستخلص: | Objectives: To assess the feasibility and change in clinical outcomes associated with continuous glucose monitoring (CGM) use among a rural population in Malawi living with type 1 diabetes. Design: A 2:1 open randomised controlled feasibility trial. Setting: Two Partners In Health-supported Ministry of Health-run first-level district hospitals in Neno, Malawi. Participants: 45 people living with type 1 diabetes (PLWT1D). Interventions: Participants were randomly assigned to Dexcom G6 CGM (n=30) use or usual care (UC) (n=15) consisting of Safe-Accu glucose monitors and strips. Both arms received diabetes education. Outcomes: Primary outcomes included fidelity, appropriateness and severe adverse events. Secondary outcomes included change in haemoglobin A1c (HbA1c), acceptability, time in range (CGM arm only) SD of HbA1c and quality of life. Results: Participants tolerated CGM well but were unable to change their own sensors which resulted in increased clinic visits in the CGM arm. Despite the hot climate, skin rashes were uncommon but cut-out tape overpatches were needed to secure the sensors in place. Participants in the CGM arm had greater numbers of dose adjustments and lifestyle change suggestions than those in the UC arm. Participants in the CGM arm wore their CGM on average 63.8% of the time. Participants in the UC arm brought logbooks to clinic 75% of the time. There were three hospitalisations all in the CGM arm, but none were related to the intervention. Conclusions: This is the first randomised controlled trial conducted on CGM in a rural region of a low-income country. CGM was feasible and appropriate among PLWT1D and providers, but inability of participants to change their own sensors is a challenge. Trial Registration Number: PACTR202102832069874. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) |
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| فهرسة مساهمة: | Keywords: DIABETES & ENDOCRINOLOGY; General diabetes; International health services |
| المشرفين على المادة: | 0 (Blood Glucose) 0 (Glycated Hemoglobin) |
| تواريخ الأحداث: | Date Created: 20240508 Date Completed: 20240508 Latest Revision: 20240820 |
| رمز التحديث: | 20240820 |
| مُعرف محوري في PubMed: | PMC11086545 |
| DOI: | 10.1136/bmjopen-2023-075554 |
| PMID: | 38719319 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2044-6055 |
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| DOI: | 10.1136/bmjopen-2023-075554 |