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BACKGROUND: New technologies are changing diabetes treatment and contributing better outcomes in developed countries. To our knowledge, no previous studies have investigated the comparative effect of sensor-based monitoring on glycemic markers in developing countries like Brazil. The present study aims to evaluate the use of intermittent Continuous Glucose Measurements (iCGM) in a developing country, Brazil, regarding (i) frequency of glucose scans, (ii) its association with glycemic markers and (iii) comparison with these findings to those observed in global population data. METHODS: Glucose results were de-identified and uploaded to a dedicated database when Freestyle Libre™ readers were connected to an internet-ready computer. Data between September 2014 and Dec 2018, comprising 688,640 readers and 7,329,052 sensors worldwide, were analysed (including 17,691 readers and 147,166 sensors from Brazil). Scan rate per reader was determined and each reader was sorted into 20 equally-sized rank ordered groups, categorised by scan frequency. Glucose parameters were calculated for each group, including estimated A1c, time above, below and within range identified as 70-180 mg/dL. RESULTS: In Brazil, reader users performed an average of 14 scans per day, while around the world, reader users performed an average of 12 scans per day (p < 0.01). In Brazil dataset, those in the lowest and in the highest groups scanned on average 3.6 and 43.1 times per day had an estimated A1c of 7.56% (59 mmol/mol) and 6.71% (50 mmol/mol), respectively (p < 0.01). Worldwide, the lowest group and the highest groups scanned 3.4 times/day and 37.8 times/day and had an eA1c of 8.14% (65 mmol/mol) and 6.70% (50 mmol/mol), respectively (p < 0.01). For the scan groups in both populations, the time spent above 180 mg/dL decreased as the scan frequency increased. In both Brazil and around the world, as scan frequency increased, time in range (TIR) increased. In Brazil, TIR increased from 14.15 to 16.62 h/day (p < 0.01). Worldwide, TIR increased from 12.06 to 16.97 h/day (p < 0.01). CONCLUSIONS: We conclude that Brazilian users have a high frequency of scans, more frequent than global data. Similarly to the world findings, increased scan frequency is associated with better glycemic control.

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O trabalho visa avaliar eficácia e a preferência dos pacientes na monitorização da glicemia capilar em locais alternativos: lóbulo de orelha, antebraço e panturrilha em relação à ponta de dedo. Foram avaliados 89 pacientes (39 M/50 F) com diabetes melito tipo 2 (DM2). A monitorização foi feita com glicosímetro digital (ACCU - CHEK Performa, Roche), lancetador ACCU-CHEK Multiclix, em grau 5 na face palmar da falange distal do 3º dedo da mão direita, porção inferior do lóbulo da orelha direita, antebraço direito e região superior da panturrilha direita. Não houve diferença da glicemia capilar na ponta de dedo em relação aos locais alternativos. A ponta de dedo foi o local mais doloroso. Quanto ao local de preferência, a orelha e a ponta de dedo foram os preferidos. A monitorização glicêmica em locais alternativos é simples, segura e eficaz, como a glicemia de ponta de dedo.

This paper evaluate the efficacy and patients preferences of glucose monitoring in alternatives sites: ear lobe, forearm and calf against conventional fingerstick. We studied 89 patients (39 M/ 50 F) with type 2 diabetes mellitus (DM2). Glucose monitoring was measured using a digital glucosimeter (ACCU - CHEK Performa, Roche), and ACCU-CHEK Multiclix lancetador, with grade 5 on the distal phalange on the right hand's third finger, inferior part of right ear lobe, right forearm and right calf. There was not statistical significance on the comparative analyzes of fingerstick and alternatives sites. There was more pain in fingerstick. The patients preferred the fingerstick and the ear lobe. Glucose monitoring in alternative sites is as simple, safe and efficient as fingerstick.

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Introducción: El monitoreo de la glucosa se obtiene del cambio en la tinción de la zona de una tira reactiva. La educación en diabetes incluye el conocimiento de las mediciones en sangre capilar. Objetivo: Conocer si la capacitación a enfermeras influye en la precisión del monitoreo de glucemia en ayunas. Material y método: Estudio transversal, observacional, descriptivo, comparativo, de intervención educativa en 116 pacientes diabéticos hospitalizados. Las determinaciones se realizaron en forma ciega por enfermería, antes y después de la capacitación en días diferentes, y las muestras de sangre venosa por el personal del laboratorio. Resultados: Su distribución por sexo fue 22 mujeres y 25 hombres en el grupo pre-intervención y 30 mujeres y 39 hombres en el grupo post-intervención. El coeficiente de correlación fue de 0.45 entre las muestras de glucosa por tira reactiva y las de laboratorio antes de la intervención educativa y de 0.77 después de la intervención educativa. El 11% de los pacientes descontrolados metabólicamente quedaban sin diagnosticarse por imprecisión del método con tira visual; después de la intervención educativa disminuyó a 8%. La diferencia de los valores promedios obtenidos por laboratorio y por tira reactiva fue significativa (p<0.05) en los dos grupos. Conclusiones: Los resultados de la correlación que existe entre los resultados de glucemia por laboratorio y con tira reactiva visuales baja y coincide con lo reportado en la literatura, pero mejora con la intervención educativa hacia el personal involucrado en su determinación.

Introduction: The results of capillary glucose testing are obtained by especific zone strip tincture. The current use of accurate blood glucose monitor are even more used nowadays, so, health diabetes team education is a priority. Frequently on clinical practice there are not correlation between visual test strips and reference laboratory. Objective: To know the correlation between different glucose monitoring according hospital educational intervention program training. Methods: Transversal, comparative, intervention study Visual testing monitoring before and after educational intervention program were compared with central laboratory results. We use t-student and Parson's "r" correlation test. Results: 116 hospitalized subjects were studied. 52 women and 64 male correlation coefficient was 0.45 between visual strips and referral laboratory and 0.77 after education intervention. Difference in values obtained from reactive strip and laboratory tests was significative (<0.05) in both groups. Conclusions: This study shows that correlation between results of both tests is low and it is related to the existing evidence found in the literature review, and it is improved after the introduction of the education (training) program.

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