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Background:  The efficacy of injection therapy in diabetes depends on correct injection technique and, to provide patients with guidance in this area, we must understand how they currently inject. Methods:  From September 2008 to June 2009, 4352 insulin‐injecting Type 1 and Type 2 diabetic patients from 171 centers in 16 countries were surveyed regarding their injection practices. Results:  Overall, 3.6% of patients use the 12.7‐mm needle, 1.8% use the 12‐mm needle, 1.6% use the 10‐mm needle, 48.6% use the 8‐mm needle, 15.8% use the 6‐mm needle, and 21.6% use the 5‐mm needle; 7% of patients do not know what length of needle they use. Twenty‐one percent of patients admitted injecting into the same site for an entire day, or even a few days, a practice associated with lipohypertrophy. Approximately 50% of patients have or have had symptoms suggestive of lipohypertrophy. Abdominal lipohypertrophy seems to be more frequent in those using the two smaller injection size areas, and less frequent in those using larger areas. Nearly 3% of patients reported always injecting into lipohypertrophic lesions and 26% inject into them sometimes. Of the 65% of patients using cloudy insulins (e.g. NPH), 35% do not remix it before use. Conclusions:  It is clear from the latest survey that we have improved in certain areas, but that, in others, we have either not moved at all or our efforts have not yielded the results we expected. The results of the present survey are available online on a country‐by‐country and question‐by‐question basis at http://www.titan-workshop.org.

The emergence of the COVID-19 pandemic, which started in Wuhan in 2019 changed the world and created several challenges to healthcare services. In preparation for expected increased numbers of patients with severe respiratory failure, many hospitals across the globe have intentionally reduced non-emergent procedures and hospitalizations to assure that initially scarce personal protective equipment was available and to preserve the different levels of hospital capacity. During this period, some studies reported reduced numbers of hospital admissions across different areas -from cirrhosis to heart failure [1][2][3][4] . In Portugal, the first case and subsequent beginning of the pandemic were recorded with an average delay of one month compared to other neighboring western European countries, thus allowing health authorities and medical departments to delineate strategies to deal with both COVID-19 and non-COVID-19 patients. Whether these strategies have influenced admissions for patients with decompensation of cirrhosis is poorly documented.We report trends in hospitalizations in a tertiary, academic, high volume center by using the electronic health record system and hospital discharge database. We analysed the hospitalizations for decompensated cirrhosis from March 2, when the first patient with confirmed COVID-19 in Portugal was seen in our emergency department, to the end of the state of emergency, on May 2,2020. We compared the trends in decompensated cirrhosis hospitalizations with those observed in the same period in the years 2015-2019 to account for the potential for residual confounding based on seasonal trends in decompensated cirrhosis hospitalizations.Hospitalizations in adult patients with a principal diagnosis of cirrhosis based on ICD codes were included. Liver transplanted patients were excluded. Demographic, clinical and laboratory data pertaining to hospitalizations for decompensated cirrhosis were retrospectively analysed.During this period there were 40 admissions due to decompensated cirrhosis, a number that was not significantly different from that observed in the same time period in previous years (median 38 admissions, ranging from 34 in 2015 to 42 in 2019). There was no variability in week-to-week hospitalizations for decompensated cirrhosis. 27 patients (93%) were male, the median age was 61.5 years (range 41-75). Aetiology of cirrhosis was alcohol in 80%, viral hepatitis in 15% and autoimmune hepatitis in 2.5%. 17.5% had previously diagnosed hepatocellular carcinoma.Reason for admission was encephalopathy in 55% of patients, ascites in 12.5% and variceal bleeding in 10%. There were no significant differences in reason for admission compared to 2015-2019 (encephalopathy in 37.8% of patients, variceal bleeding in 12.8%

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The aim of the study was to examine the pattern of glycaemic behaviour and insulin requirements over two months postpartum in women with type 1 diabetes, to analyse differences between breastfeeding and non-breastfeeding mothers and to assess the relationship between hypoglycaemic episodes and nursing sessions.

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Background: Challenges of patient care in diabetes were exacerbated by COVID, undermining the ability of patients to engage in-person with health care professionals (HCPs). To combat this, there has been accelerated adoption of telemedicine to support patient and provider connectivity. Methods: We collated survey information regarding telemedicine from 21 European clinical institutions. Health care professionals joined virtual meetings focusing on the OneTouch Reveal (OTR) ecosystem and its utility for conducting telemedicine. Selected HCPs provided clinical case studies to explain how the OTR ecosystem supported patient care. Results: Remote consultations increased by nearly 50% in 21 European clinics during the pandemic (Belgium [24%], Iberia [65%], Germany [34%], Italy [54%]). In all, 52% of people with diabetes using OTR app to connect remotely with HCPs had type 1 diabetes and 48% had type 2 diabetes. Remote connection methods included telephone (60%), email (19%), video chat (10%), text only (3%), or a mix of these methods (8%). Health care professionals usually reviewed patient data during consultations (45%) rather than before consultations (25%). Fifty-five percent of HCPs indicated digital ecosystems like OTR ecosystem would become their standard of care for diabetes management. In-depth conversations with HCPs provided a deeper understanding of how a digital ecosystem integrated into clinical practice and population management. In addition, five patient case studies using OTR ecosystem were provided by a selection of our HCPs. Conclusion: Diabetes management solutions, such as OTR ecosystem, supported telemedicine during the pandemic and will continue to play a valuable role in patient care beyond the pandemic.

The study was designed to determine the usefulness of the CGMS (continuous glucose monitoring system) as a support tool in type 1 diabetes education. The CGMS is a sensor system that measures interstitial glucose levels every five minutes for three or more days, by means of a microelectrode inserted in the subcutaneous tissue.People with type 1 diabetes (n=52), who actively participated in diabetes selfmanagement programmes, were monitored with CGMS during three to five days. Patients were selected for CGMS when unsatisfied with the glycaemic results achieved, given the effort made. Ten patients used CSII, 14 used insulin glargine plus rapid acting insulin analogue and 28 used NPH insulin plus short acting insulin. All patients used blood glucose self-monitoring, with a mean of 6.5±1.4 glucose readings per day. The CGMS register was evaluated with the patient. Mean capillary glucose during the 15 days prior to CGMS, mean capillary glucose during CGMS and mean capillary glucose during the 15 days after CGMS are compared.Discussion of the record with the patient frequently allowed detection of inappropriate solving attitudes. Mean capillary glucose dropped from 155±20mg/dL (8.60±1.11mmol/L) prior to CGMS to 143±20mg/dL (7.94±1.11mmol/L) after CGMS (p=0.000). The effectiveness of CGMS (number of patients in whom mean glucose improved) rose from 66. 7% in 2001 to 70.6% in 2002, 78.9% in 2003 and 88.8% in 2004. When the patient is involved in the analysis of glucose fluctuations, CGMS is a useful tool in diabetes education that will help achieve attitude changes because of the evidence depicted by the continuous glucose record. Experience in the use of this tool by the professional will improve its effectiveness. Research design and methodology Original ArticleContinuous glucose monitoring system 20