ZHivkovikj, Marija
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ZHivkovikj, Marija
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ZHivkovikj, Marija
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13 results
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Item type:Publication, Type 1 Diabetes and Long-Term Continuous Subcutaneous Insulin Infusion Therapy: A 10-Year Experience from Macedonia(Mary Ann Liebert Inc, 2017-12); ; ; Todorova Jovanovska, BiljanaBackground: Subcutaneous insulin infusion (CSII) therapy is a challenge for both patients and healthcare providers. The long-term CSII use is scarce. The aim of this study is to describe the impact of CSII therapy for 10 years of use at our center. Methods: This single-center retrospective study includes 162 type 1 diabetes patients using CSII for >3 years during October 2004 until October 2014. Data were collected through the electronic medical record system, cross-sectional analysis (telephone, e-mail, or social media), and CSII reports generated by Carelink Therapy Management Software (Medtronic, Northridge, CA). Results: Patients were analyzed in three age groups: 12–18, 19–24, and >25 years. All patients were treated with CSII for >3 years. Total daily dose of insulin was >0.9 U/(kg$day) in age group 12–18 years old, which was significantly higher than other two age groups (P < 0.05). Basal ratio was lower in younger age (<40%) and showed trend of increasing with age and longer diabetes duration (up to 44%). Younger patients used bolus wizard on regular basis (>75%), which was significantly higher than other age groups (P < 0.05). More than 50% of patients achieved glycated hemoglobin (HbA1c) <7.0% and >70% of patients achieved HbA1c <7.5%. HbA1c level significantly changed from baseline in all groups (P < 0.05). Conclusion: Our study shows improved glucose control in long-term CSII users. A reduction of HbA1c levels by -1.1% was maintained during the study period. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Impact of Facebook on Glucose Control in Type 1 Diabetes: A Three-Year Cohort Study(JMIR Publications Inc., 2017-06-07); Background: As the world is changing, traditional health care services should be adapted for the new era of technology and the Internet. One of the possible ways for communication between health care providers and patients is social media. There are several benefits of social media in health: increased interactions with others; more available and shared information; increased accessibility; social or emotional support. Objective: The aim of this study was to evaluate the results of Facebook and CareLink software as a possible Internet tool to improve diabetes control in type 1 diabetes patients using a sensor augmented pump. Methods: A total of 67 adolescents with type 1 diabetes and in the age range of 14-23 years were randomized in 2 groups: (1) Traditional group and (2) Internet group. In the traditional group, 34 patients were treated using standard medical protocol with regular clinic visits, where data were uploaded at the clinic and interventions (pump settings-basal bolus insulin and education) were delivered to the patient. In the Internet group, 33 patients were treated using Facebook and CareLink software (Medtronic Diabetes) on a monthly basis, where the data were uploaded by the patient at home and interventions (same as traditional group) were delivered via Facebook (written reports and chats). Both the traditional and Internet group had regular visits every 3 months with standard medical protocol. Glycosylated hemoglobin (HbA1c) was obtained before and every 3 months during the study for a 3-year-period. Results: The improvement in glucose control was found in both groups: 7.9% (SD 1.4) [62.8 mmol/mol (SD 12.9)] to 6.9% (SD 1.2) [51.9 mmol/mol (SD 10.8)] in the traditional group, and 7.8% (SD 1.8) [61.7 mmol/mol (SD 17.2)] to 6.7% (SD 1.8) [49.7 mmol/mol (SD 17.3)] in the Internet group). Significant improvement of HbA1c (P<.05) was found in favor of the Internet group. Conclusions: Social media such as Facebook as a tool can assist in standard medical care to improve glucose control in a long term period in adolescents with type 1 diabetes using insulin pump therapy - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Successful desensitization in patient with type 2 diabetes with an insulin allergy using insulin pump and glargine(Springer, 2014-12); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Are We Ready to Treat Our Diabetes Patients Using Social Media? Yes, We Are(SAGE Publications, 2019-03); Aims: The aim of the study was to evaluate Facebook group as possible communication tool to improve glucose control in adolescents and young people with type 1 diabetes (T1D). Methods: This retrospective and cross-sectional study included 728 T1D patients (age 11-25) on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) treated at the center for insulin pump and glucose sensor in Skopje from January 2012 to December 2017. Data were collected through the electronic medical record system and crosssectional analysis (telephone, social media (Facebook and Viber) or email). Patients were analyzed in two groups: (a) nonInternet group, with 398 patients treated using standard medical protocol with regular clinic visits; (b) Internet group, with 330 patients who, besides standard medical protocol, were active members of a national closed Facebook group on diabetes. Both the non-Internet and Internet groups had regular visits every 2-3 months. Patients from the Internet group were members of the closed Facebook group “Diabetes Macedonia” and had an opportunity to interact with questions, answers, and comments on diabetes care. An additional analysis was performed of the Internet group on combined use of Facebook and Viber. Average HbA1c levels were compared in both groups. Results: Each patient from the Facebook group had 1.5 ± 3.5 posts per day. Hba1c was significantly lower in patients from the Internet group (7.1 ± 3.2%; 54 ± 35 mmol/mol) compared to patients from the non-Internet group (7.6 ± 2.8%; 60 ± 31 mmol/mol). Conclusions: Social media like Facebook and Viber can be additional communication tool in adolescents and young people with T1D and can significantly lower HbA1c compared to patients without social media use. CSII patients are more likely to use both social media (Facebook and Viber) compared with MDI patients (Facebook only). - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A 5-Step Approach Protocol Using CareLink Therapy Software in Type 1 Diabetes Patients(SAGE Publications, 2017-11); We have developed a 5-step approach protocol in interpreting SAP using CareLink. The main objective of this pilot study was to assess the usability of the protocol. The main analysis is based on the Therapy Management Dashboard, where five segments are allocated: (1) basic statistics; (2) glucose and insulin overlay; (3) postprandial period; (4) basal/bolus insulin; (5) suspends and sensor. Possible changes are noted on a printed insulin settings page with evaluation of rationale/physiological insulin. Every segment is analyzed with correlation through others with step by step confirmation of possible change. Thirty-four patients (F 18, M 16), age 15.3 ± 7.7 years with total of 128 CareLink downloads were analyzed on monthly basis in a period of 3 months. The patients profile matched our everyday clinical practice, similar to glucose control on patients using insulin pump reported in several studies.3,4 Our data showed increased insulin total daily dose (TDD), due to fine tuning with more bolus dose than the basal rates. The glucose control was improved (as seen in Table 1) with a decreased hyperglycemic and hypoglycemic patterns.A 5-step approach protocol in interpreting SAP using CareLink is simple, convenient, and efficient and should be assessed on the multicenter level and with a wider population. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Glucose control during kidney transplantation in type 1 diabetes patient on sensor augmented pump: a case report(Springer Science and Business Media LLC, 2018-09); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Social media and diabetes: can Facebook and Skype improve glucose control in patients with type 1 diabetes on pump therapy? One-year experience(American Diabetes Association, 2015-04); ; The aims of the study were to evaluate results from social media (Skype and Facebook) and CareLink software as tools to improve diabetes control in patients with type 1 diabetes using insulin pumps with glucose sensors. To our knowledge, this is the first study where Facebook is used as treatment alternative to regular clinic visits. A total of 56 children and adolescents with type 1 diabetes, ages 14–23, were randomized in two groups: Regular group and Internet group. The Regular group is composed of 29 patients who were treated using standard medical protocol with regular visits at clinic. Data were uploaded at the clinic and interventions (pump settings, basal bolus insulin, and education) were given to the patient by health care professionals. The Internet group was composed of 27 patients who were treated using CareLink software (Medtronic Diabetes). Data were uploaded by the patient at home and interventions (same as Regular group) were given via Facebook (chats) and Skype (sound and video). Both groups had improved A1C at 12 months (Regular group: 7.7 6 1.6% [61 6 17.5 mmol/mol] at baseline vs. 6.6 6 1.5% [49 6 16.4 mmol/mol] at 12 months; Internet group: 7.8 6 1.9% [62 6 20.8 mmol/mol] at baseline vs. 6.4 6 1.6% [46 6 17.5 mmol/mol] at 12 months, P , 0.05 at 12 months) (Table 1). Internet visits were performed with Facebook (54%), Skype (12%), and both Facebook and Skype (34%). Improvement occurred in the first 6 months and was maintained for 6 additional months. There were no differences in acute complications (diabetic ketoacidosis and severe hypoglycemia events), total daily dose of insulin, and weight change in both groups at 12 months. Personalization, presentation, and participation in social media and health care (5) can be tailored to the priorities of the patient Every Internet visit was personalized with patient needs (appointment date and time) and used active patient participation in the decision-making process of diabetes management. We found that social media use allows patients to gain diabetes knowledge and information and interact in their daily insulin adjustments. Moreover, it could help patients cope better with their daily life. This brief trial suggests that patients prefer to communicate with their health care providers using social media. Facebook and Skype can improve diabetes control similar to regular clinic visits. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ЛATЕНТЕН АВТОИМУН ДИЈАБЕТЕС НА ВОЗРАСНИ: ПРИКАЗ НА СЛУЧАЈ(2020); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PОSTSURGICAL HUNGRY BONE SYNDROME IN UNRECOGNIZED SEVERE PRIMARY HYPERPARATHYROIDISM: A CASE REPORT(Endocrine Abstracts (2021), 2021-05); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, GLUCOSE CONTROL DURING CORONAVIRUS DISEASE IN TYPE 1 DIABETES PATIENT ON SENSOR AUGMENTED PUMP(Mary Ann Liebert Inc, 2021-06); ; ; Introduction:Since the outbreak of novel coronavirus Sars-CoV-2 pandemic, much attention has focused on patients with diabetes due to increased risk of infection. This increased risk of infection is due to hyperglycemia induced immune dysfunction (damage to the neutrophil function, depression of the antioxidant system, and humoral immunity), micro- and macro-angiopathies, and greater requirement of medical interventions in these patients. Since it is well established that uncontrolled hyperglycemia impairs immune function in all forms of diabetes, it would be logical to presume that T1D, particularly if not well controlled, could have an increased risk of infection and intensifying glycemic control could serve as a means of primary prevention. We present the case of a patient with type 1 diabetes and mild clinical presentation of Sars-CoV-2 infection during June 2020, successfully managed with SAP (Sensor Augmented Pump Therapy, Medtronic Minimed Veo Enlite sensor). Case report: A 33 year old patient with history of type 1 diabetes for the last 14 years and primary hypothyroidism for 8 years, presented with fever, cough, muscle aches, headache and new loss of smell. RT-PCR smear confirmed the presence of a SARS-CoV-2. The last 8 years patient was on insulin pump therapy with intermittent use of glucose sensor. Her last A1c was 7.7% and she doesn’t have any diabetes complications. As it was a mild clinical presentation of COVID-19 (with absence of viral pneumonia and hypoxia) she did not require hospitalization and was able to manage her illness at home. Patient contacted our clinic and underwent online reeducation about “sick day rules”, upload of insulin pump data using CareLink Therapy Management Personal Software (Medtronic, Northridge, CA) and was advised to insert glucose sensor. We made daily online follow up of glucose profile and adjustments in insulin requirements. Basal dose of insulin was adjusted using temporary basal rate (70-80% of basal rate) which allowed stable glycemic control with Avg BG 8.9 ± 3.4mmol/L, GMI-6,2% (43,9 mmol/mol) during 14 days following confirmation of SarsCoV-2 infection. Conclusion: SAP is helpful in monitoring glucose during viral infections allowing prompt action and prevention of further complications like DKA. In settings of COVID-19 pandemic, remote monitoring enables physicians and other health-care professionals to intervene timely in patients and improve clinical outcomes.