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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Considerations to Better Meet the Needs of People Living With Diabetes While in Prison or Detention.

Diabetes spectrum : a publication of the American Diabetes Association·2024
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A Pragmatic Rethinking of Glucose Monitoring for the Incarcerated.

Rebecca E Luethy1, Renee C Lipinski1, Jennifer L West1

  • 1Centurion, Sterling, VA.

Diabetes Spectrum : a Publication of the American Diabetes Association
|August 19, 2024
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Summary

Continuous glucose monitoring (CGM) is safe and effective in prisons, improving diabetes management and A1C levels. This study found CGM enhanced patient perceptions and reduced complications compared to traditional blood glucose monitoring.

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Area of Science:

  • Diabetes management
  • Public health in carceral settings
  • Medical device implementation

Background:

  • Continuous glucose monitoring (CGM) improves diabetes outcomes but is not standard in correctional facilities.
  • Fingerstick blood glucose monitoring (BGM) remains the primary method in prisons.
  • Implementing new technologies in carceral environments presents unique challenges.

Purpose of the Study:

  • To assess the safety and patient perceptions of CGM in a prison setting.
  • To quantify changes in hemoglobin A1C (A1C) levels after CGM initiation.
  • To compare emergency department (ED) visit rates for diabetes complications between CGM and BGM users.

Main Methods:

  • A pragmatic longitudinal analysis involving a pilot program and a larger CGM implementation in men's facilities.
  • Patient surveys assessed perceptions of glucose monitoring before and after CGM use.
  • Statistical analyses included t-tests for A1C change and exact tests for ED visit rates.

Main Results:

  • CGM implementation did not disrupt security and improved patient perceptions of glucose monitoring.
  • A significant reduction in A1C levels was observed (0.60% decrease) with a medium effect size.
  • No ED visits for diabetes complications occurred among CGM users, though statistical power was low.

Conclusions:

  • Continuous glucose monitoring (CGM) is a safe and effective alternative to blood glucose monitoring (BGM) in prisons.
  • Patient engagement and appropriate security level are key for successful CGM adoption.
  • CGM can improve diabetes care and outcomes within the carceral environment.