Abnormal Glucose Metabolism: Diagnosis and Management in the Ambulatory Setting

A predictive model incorporating the change detection and Winsorization methods for alerting hypoglycemia and hyperglycemia

This paper focuses on establishing an effective predictive model to quickly and accurately alert hypoglycemia and hyperglycemia for helping control blood glucose levels of people with diabetes. In general, a good predictive model is established on the features of data. Inspired by this, we first analyze the characteristics of continuous glucose monitoring (CGM) data by the equality of variances test and outlier detection, which show time-varying fluctuations and jump points in CGM data. Therefore, we incorporate the change detection method and the Winsorization method into the predictive model based on the autoregressive moving average (ARMA) model and the recursive least squares (RLS) method to fit the above characteristics. To the best of our knowledge, the proposed method is the first attempt to give a solution for matching the time-varying fluctuations and jump points of CGM data simultaneously. A case study using CGM data is given to validate the effectiveness of the proposed method under 30-min-ahead prediction. The results show that the proposed method can improve the true alarm ratio of hypoglycemia and hyperglycemia from 0.7983 to 0.8783, and lengthen the average advance detection time of hypoglycemia and hyperglycemia from 19.77 to 22.64 min.

Pregnant women exercise at a higher intensity during 30 min of self-paced cycling compared with walking during late gestation: implications for 2 h postprandial glucose levels

OBJECTIVE

To compare the effect of an acute 30-min bout of self-paced stationary cycling (SC) with treadmill walking (TW) or a resting control (CON) on maternal blood glucose, insulin and metabolic responses during pregnancy.

METHODS

Twelve healthy women at 29.9±2.4 (mean±SD) weeks gestation consumed a 75 g carbohydrate drink as part of an oral glucose tolerance test (OGTT) following 30 min of SC, TW or CON. Blood was sampled before and after exercise, and for 2 h in response to the OGTT for the determination of glucose and insulin. Exercise intensity was monitored and enjoyment of TW and SC was assessed post-exercise.

RESULTS

Women selectively worked harder in SC compared with TW, with a higher maternal heart rate, rating of perceived exertion, mean oxygen consumption, respiratory exchange ratio, and total energy expenditure during exercise (p<0.05). SC was also associated with significantly lower postprandial blood glucose levels at 120 min following the OGTT (6.9±0.9 mmol∙l(-1)) compared with both CON (8.1±0.7 mmol∙l(-1), p=0.001) and TW (7.8±0.9 mmol∙l(-1), p=0.004) and lower insulin at 120 min post-glucose ingestion compared with TW (p=0.021). Enjoyment was similar between exercise protocols (p=0.437).

CONCLUSIONS

In late pregnancy, an acute 30 min bout of self-paced SC may be preferable to a matched duration of TW given the additional energy expenditure that can be achieved, which in turn appears beneficial for blunting the glycemic response to glucose ingestion.