Ronaldo J. Pineda-wieselberg, Brazil
Santa Casa de São Paulo Internal Medicine DepartmentPresenter of 3 Presentations
YOUNG LEADERS IN DIABETES TRAINING LEAD TO DECREASE OF YOUTH’S HBA1C WHILE INCREASING THEIR DIABETES KNOWLEDGE AND LEADERSHIP SKILLS
Abstract
Background and Aims
The Young Leaders in Diabetes (YLD) is a semester-long training, held since 2009. Among the leadership skills developed are: fundraising, basic and advanced management of diabetes, diabetes education, health policies and advocacy, influence, effective communication and interpersonal relationships. YLD are followed to assess their growth on the empowerment ladder, which impacts their community and the entire society. Our aim with this study was to understand how much the 6-month training impacted the HbA1c and diabetes knowledge in a subgroup of YLD.
Methods
Thirteen individuals (5 men, 22±4.5y) performed HbA1c exams and took a diabetes knowledge test of 35 questions: 32 multiple-choice and 3 open-ended questions based on IDF guidelines - twice, before starting and after concluding the training. Wilcoxon Signed Rank test was used to compare knowledge test grades and HbA1c values pre and post training; and also pre-training and current HbA1c of nine YLD.
Results
HbA1c results decreased significantly (pre: 8.0±0.5%, post: 6.9±0.3%; p=0.049); and knowledge test grades increased significantly (pre: 7.9±0.2, 8.6±0.2; p=0.012). HbA1c values continued to be significantly lower even years after concluding the training for all 9 individuals followed for 1 to 9 years post-training (current HbA1c: 7.1±0.2% p=0.035). Interestingly, none of the YLD have started pump or sensor therapy during the training, thus, these technologies were not interfering factor.
Conclusions
We attribute the HbA1c improvement and its maintenance to knowledge and skills developed by YLD during the training. In a future study, we plan to investigate the impact of starting pump and sensor on maintaining the HbA1c after YLD.
THE MICHIGAN DIABETES KNOWLEDGE TEST AND THE MICHIGAN DIABETES EMPOWERMENT SCALE SHORT VERSION USED TO QUANTIFY DEVELOPMENT OF YOUTH WHO ATTEND A DIABETES LEADERSHIP TRAINING
Abstract
Background and Aims
The Young Leaders in Diabetes (YLD) are individuals between 15 and 30 years old who complete a semester-long training. Participants develop the following skills: fundraising, basic and advanced management of diabetes, diabetes education, advocacy, leadership, communication and interpersonal relationships. YLD who stand out are invited to become tutors, responsible for supporting new candidates throughout the training to ensure that they develop leadership skills. In addition, tutors assist in leading activities, conducting group dynamics, organizing and planning training sessions. This study aims to analyze the impact of the YLD training on diabetes knowledge and empowerment.
Methods
Thirteen individuals with average age of 20.4±3.0y answered the Michigan Diabetes Knowledge Test (DKT) and the Michigan Diabetes Empowerment Scale Short Version (DES-SF). Five of them were YLD tutors-candidates (Tutors), while the other eight were the YLD-candidates. Scores between the groups were compared using the Mann-Whitney U Test.
Results
The DES-SF scores were different between the groups (p=0.043, Tutors=4.75 and Candidates=4.13), indicating that individuals who finish the YLD training and stand out are overall more empowered than the ones with no previous YLD training. Tutors scored 20 (19-21), the YLD candidates scored 19 (13-23) on the DKT (no significant difference for DKT).
Conclusions
DES-SF and DKT were useful to reveal that individuals who completed the YLD training and stood out were more empowered and displayed more knowledge - which we attribute to the training - than candidates who had not started the training.
THE USE OF FLASH GLUCOSE MONITORING (FGM) SYSTEM IN HEMOLYTIC ANEMIA (HA), A CASE REPORT
Abstract
Background and Aims
We report the case of a woman with T2DM who presented hemolytic anemia (HA). The treatment with corticosteroids led to a great variability of her BG, as well as difficulty to manage her BG and falsely low A1c. A FGM was installed to allow better evaluation of her glucose profile.
Methods
HA treatment was made with Prednisone and a pulse of 3 days of Methylprednisolone. Her BG had great variations and her A1c was falsely low. We put a FGM system to evaluate the behaviour of glucose levels in her hospitalization and compared them with the BG results.
Results
Her A1c was 4.5%, but considering HA, it was considered unreal. After 3 days with the FGM, she had an estimated A1c of 9.6% (mean glucose of 229mg/dl) and time in-range (TIR) of 37%, while the mean BG was of 253mg/dl in the same period. After 3 days of insulin management, she had an estimated A1c of 7.5% (mean glucose of 163mg/dl) and TIR of 64%, with the mean of BG of 151mg/dl.
Conclusions
The case is the first one we know in which the hemoglobinopathy was acquired and treated with corticosteroids hindering T2DM management. It is one of the few cases in which the FGM was used in hospitalar environment for optimal diabetes management. The FGM is little studied in intra-hospitalar environments, but, the success of our case suggests that further studies should be conducted in order to evaluate the feasibility of this tool to help the management of challenging cases, not only outside, but even inside the hospital.