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Huang L, Zhang M, Han S, He L, Li B. Co-word analysis of dynamic blood glucose monitoring in neonatal blood glucose management: A review of published literature. Diabetes Metab Syndr 2023; 17:102851. [PMID: 37716238 DOI: 10.1016/j.dsx.2023.102851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Lizhu Huang
- The School of Nursing of Jinan University, Guangzhou, Guangdong, 510630, China.
| | - Meng Zhang
- The School of Nursing of Jinan University, Guangzhou, Guangdong, 510630, China.
| | - Shasha Han
- Department of Neonatology and Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, China.
| | - Lilan He
- Department of Neonatology and Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, China.
| | - Bingxiao Li
- Department of Neonatology and Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, China.
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Mozzillo E, Franceschi R, Di Candia F, Ricci A, Leonardi L, Girardi M, Rosanio FM, Marcovecchio ML. Optimal Prandial Timing of Insulin Bolus in Youths with Type 1 Diabetes: A Systematic Review. J Pers Med 2022; 12:jpm12122058. [PMID: 36556278 PMCID: PMC9781659 DOI: 10.3390/jpm12122058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
The aim of this systematic review was to report the evidence on optimal prandial timing of insulin bolus in youths with type 1 diabetes. A systematic search was performed including studies published in the last 20 years (2002-2022). A PICOS framework was used in the selection process and evidence was assessed using the GRADE system. Up to one third of children and adolescents with type 1 diabetes injected rapid-acting insulin analogues after a meal. Moderate-high level quality studies showed that a pre-meal bolus compared with a bolus given at the start or after the meal was associated with a lower peak blood glucose after one to two hours, particularly after breakfast, as well as with reduced HbA1c, without any difference in the frequency of hypoglycemia. There were no differences related to the timing of bolus in total daily insulin and BMI, although these results were based on a single study. Data on individuals' treatment satisfaction were limited but did not show any effect of timing of bolus on quality of life. In addition, post-prandial administration of fast-acting analogues was superior to rapid-acting analogues on post-prandial glycemia. There was no evidence for any difference in outcomes related to the timing of insulin bolus across age groups in the two studies. In conclusion, prandial insulin injected before a meal, particularly at breakfast, provides better post-prandial glycemia and HbA1c without increasing the risk of hypoglycemia, and without affecting total daily insulin dose and BMI. For young children who often have variable eating behaviors, fast-acting analogues administered at mealtime or post-meal could provide an additional advantage.
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Affiliation(s)
- Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara General Hospital of Trento, 38122 Trento, Italy
- Correspondence: ; Tel.: +39-0461-903542
| | - Francesca Di Candia
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Alessia Ricci
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara General Hospital of Trento, 38122 Trento, Italy
| | - Letizia Leonardi
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara General Hospital of Trento, 38122 Trento, Italy
| | - Martina Girardi
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara General Hospital of Trento, 38122 Trento, Italy
| | - Francesco Maria Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Maria Loredana Marcovecchio
- Department of Pediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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Substantial Intra-Individual Variability in Post-Prandial Time to Peak in Controlled and Free-Living Conditions in Children with Type 1 Diabetes. Nutrients 2021; 13:nu13114154. [PMID: 34836409 PMCID: PMC8620341 DOI: 10.3390/nu13114154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022] Open
Abstract
The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- and between-person variability in time to peak (TTP) glycaemic responses after consuming meals under controlled and free-living conditions. Participants aged 8–15 years with T1D ≥ 1 year and using a continuous glucose monitor (CGM) were recruited. Participants consumed a standardised breakfast for six controlled days and maintained their usual daily routine for 14 free-living days. CGM traces were collected after eating. Linear mixed models were used to identify within- and between-person variability in the TTP after each of the controlled breakfasts, free-living breakfasts (FLB), and free-living dinners (FLD) conditions. Thirty participants completed the study (16 females; mean age and standard deviation (SD) 10.5 (1.9)). The TTP variability was greater within a person than the variability between people for all three meal types (between-person vs. within-person SD; controlled breakfast 18.5 vs. 38.9 min; FLB 14.1 vs. 49.6 min; FLD 5.7 vs. 64.5 min). For the first time, the study showed that within-person variability in TTP glycaemic responses is even greater than between-person variability.
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Tyler NS, Jacobs PG. Artificial Intelligence in Decision Support Systems for Type 1 Diabetes. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3214. [PMID: 32517068 PMCID: PMC7308977 DOI: 10.3390/s20113214] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
Abstract
Type 1 diabetes (T1D) is a chronic health condition resulting from pancreatic beta cell dysfunction and insulin depletion. While automated insulin delivery systems are now available, many people choose to manage insulin delivery manually through insulin pumps or through multiple daily injections. Frequent insulin titrations are needed to adequately manage glucose, however, provider adjustments are typically made every several months. Recent automated decision support systems incorporate artificial intelligence algorithms to deliver personalized recommendations regarding insulin doses and daily behaviors. This paper presents a comprehensive review of computational and artificial intelligence-based decision support systems to manage T1D. Articles were obtained from PubMed, IEEE Xplore, and ScienceDirect databases. No time period restrictions were imposed on the search. After removing off-topic articles and duplicates, 562 articles were left to review. Of those articles, we identified 61 articles for comprehensive review based on algorithm evaluation using real-world human data, in silico trials, or clinical studies. We grouped decision support systems into general categories of (1) those which recommend adjustments to insulin and (2) those which predict and help avoid hypoglycemia. We review the artificial intelligence methods used for each type of decision support system, and discuss the performance and potential applications of these systems.
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Affiliation(s)
| | - Peter G. Jacobs
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA;
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Real-time Monitoring of Biomarkers in Serum for Early Diagnosis of Target Disease. BIOCHIP JOURNAL 2020. [DOI: 10.1007/s13206-020-4102-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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