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Resmini E, Zarra E, Dotti S, Rotondi G, Cornaghi AV, Madaschi S, Cimino E, Massari G, Pezzaioli LC, Buoso C, Sandri M, Girelli A. Impact on Glycemia Risk Index and other metrics in type 1 adult patients switching to Advanced Hybrid Closed-Loop systems: a one-year real-life experience. Eur J Med Res 2024; 29:365. [PMID: 39004734 PMCID: PMC11247841 DOI: 10.1186/s40001-024-01946-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/23/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Advanced Hybrid Closed-Loop system (AHCL) has profoundly changed type 1 diabetes therapy. This study primarily aimed to assess the impact on Glycemia Risk Index (GRI) and other continuous glucose monitoring (CGM) metrics when switching from one of four insulin strategies to AHCL in type 1 adult patients. METHODS A single-center, retrospective pre/post observational study; 198 patients (age 44.4 ± 12.7 years, 115 females/83 males, diabetes duration 24.7 ± 11.6 years, HbA1c 7.4 ± 1%), treated with different insulin therapies (MDI, CSII, SAP with PLGS, HCL) were assessed before and after switching to an AHCL (MiniMed 780G, Diabeloop Roche, Tandem Control-IQ) at 1, 3, 6, and 12 months. Mixed-effects multivariable regression models were used to estimate the mean pre/post variations at different time points, adjusted for potential confounders. RESULTS A month after the switch, there was an improvement in CGM metrics and HbA1c for all patients: GRI -10.7, GMI -0.27%, CV -2.1%, TAR>250 -3.7%, TAR180-250 -5.6%, TIR + 9.7%, HbA1c -0.54% (all p < 0.001). This improvement was maintained throughout the observational period (at 3, 6, and 12 months, with all p-values < 0.001). When improvements across the 780, Diabeloop, and Tandem CIQ devices were compared: Diabeloop demonstrated significantly better performance in terms of GRI, GMI, CV, TAR>250 at T1 (for all p < 0.01); 780 recorded highest average decrease in TAR180-250 (p = 0.020), while Tandem achieved the most significant reduction in TBR54-69 (p = 0.004). CONCLUSIONS Adopting an AHCL leads to a rapid and sustained improvement in GRI and other parameters of metabolic control for up to a year, regardless of prior insulin therapies, baseline conditions or brands.
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Affiliation(s)
- Eugenia Resmini
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy.
| | - Emanuela Zarra
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Silvia Dotti
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Giulia Rotondi
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Angelo Vincenzo Cornaghi
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Sara Madaschi
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Elena Cimino
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Giulia Massari
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Letizia Chiara Pezzaioli
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Caterina Buoso
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Marco Sandri
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Angela Girelli
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
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Almurashi AM, Rodriguez E, Garg SK. Emerging Diabetes Technologies: Continuous Glucose Monitors/Artificial Pancreases. J Indian Inst Sci 2023; 103:1-26. [PMID: 37362851 PMCID: PMC10043869 DOI: 10.1007/s41745-022-00348-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 03/30/2023]
Abstract
Over the past decade there have been many advances in diabetes technologies, such as continuous glucose monitors (CGM s), insulin-delivery devices, and hybrid closed loop systems . Now most CGMs (Medtronic-Guardian, Dexcom-G6, and Abbott-Libre-2) have MARD values of < 10%, in contrast to two decades ago when the MARD used to be > 20%. In addition, the majority of the new CGMs do not require calibrations, and the latest CGMs last for 10-14 days. An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. Recently, the FDA approved Libre 3 which provides real-time glucose values every minute. Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. The newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. Most of the newer CGM have several features like automatic initialization, easy insertion, predictive alarms, and alerts. It has also been noticed that an arm insertion site might have better accuracy than abdomen or other sites, like the buttock for kids. Lag time between YSI and different sensors have been reported differently, sometimes it is down to 2-3 min; however, in many instances, it is still 15-20 min, especially when the rate of change of glucose is > 2 mg/min. We believe that in the next decade there will be a significant increase in the number of people who use CGM for their day-to-day diabetes care.
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Affiliation(s)
- Abdulhalim M. Almurashi
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
- Madinah Health Cluster, Madinah, Saudi Arabia
| | - Erika Rodriguez
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
| | - Satish K. Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
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3
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Improved HbA1c and reduced glycaemic variability after 1-year intermittent use of flash glucose monitoring. Sci Rep 2021; 11:23950. [PMID: 34907285 PMCID: PMC8671539 DOI: 10.1038/s41598-021-03480-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Flash glucose monitoring (FGM) was introduced in China in 2016, and it might improve HbA1c measurements and reduce glycaemic variability during T1DM therapy. A total of 146 patients were recruited from October 2018 to September 2019 in Liaocheng. The patients were randomly divided into the FGM group or self-monitoring blood glucose (SMBG) group. Both groups wore the FGM device for multiple 2-week periods, beginning with the 1st, 24th, and 48th weeks for gathering data, while blood samples were also collected for HbA1c measurement. Dietary guidance and insulin dose adjustments were provided to the FGM group patients according to their Ambulatory Glucose Profile (AGP) and to the SMBG group patients according to their SMBG measurements taken 3–4 times daily. All of the participants underwent SMBG measurements on the days when not wearing the FGM device. At the final visit, HbA1c, time in range (TIR), duration of hypoglycaemia and the number of diabetic ketoacidosis (DKA) events were taken as the main endpoints. There were no significant difference in the baseline characteristics of the two groups. At 24 weeks, the HbA1c level of the FGM group was 8.16 ± 1.03%, which was much lower than that of the SMBG group (8.68 ± 1.01%) (p = 0.003). The interquartile range (IQR), mean blood glucose (MBG), and the duration of hypoglycaemia in the FGM group also showed significant declines, compared with the SMBG group (p < 0.05), while the TIR increased in the FGM group [(49.39 ± 17.54)% vs (42.44 ± 15.49)%] (p = 0.012). At 48 weeks, the differences were more pronounced (p < 0.01). There were no observed changes in the number of episodes of DKA by the end of the study [(0.25 ± 0.50) vs (0.28 ± 0.51), p = 0.75]. Intermittent use of FGM by T1DM patients can improve their HbA1c and glycaemic control without increasing the hypoglycaemic exposure in insulin-treated individuals with type 1 diabetes in an developing country.
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Zhang J, Xu J, Lim J, Nolan JK, Lee H, Lee CH. Wearable Glucose Monitoring and Implantable Drug Delivery Systems for Diabetes Management. Adv Healthc Mater 2021; 10:e2100194. [PMID: 33930258 DOI: 10.1002/adhm.202100194] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/12/2021] [Indexed: 12/11/2022]
Abstract
The global cost of diabetes care exceeds $1 trillion each year with more than $327 billion being spent in the United States alone. Despite some of the advances in diabetes care including continuous glucose monitoring systems and insulin pumps, the technology associated with managing diabetes has largely remained unchanged over the past several decades. With the rise of wearable electronics and novel functional materials, the field is well-poised for the next generation of closed-loop diabetes care. Wearable glucose sensors implanted within diverse platforms including skin or on-tooth tattoos, skin-mounted patches, eyeglasses, contact lenses, fabrics, mouthguards, and pacifiers have enabled noninvasive, unobtrusive, and real-time analysis of glucose excursions in ambulatory care settings. These wearable glucose sensors can be integrated with implantable drug delivery systems, including an insulin pump, glucose responsive insulin release implant, and islets transplantation, to form self-regulating closed-loop systems. This review article encompasses the emerging trends and latest innovations of wearable glucose monitoring and implantable insulin delivery technologies for diabetes management with a focus on their advanced materials and construction. Perspectives on the current unmet challenges of these strategies are also discussed to motivate future technological development toward improved patient care in diabetes management.
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Affiliation(s)
- Jinyuan Zhang
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN 47907 USA
| | - Jian Xu
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN 47907 USA
| | - Jongcheon Lim
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN 47907 USA
| | - James K. Nolan
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN 47907 USA
| | - Hyowon Lee
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN 47907 USA
| | - Chi Hwan Lee
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN 47907 USA
- School of Mechanical Engineering School of Materials Engineering Purdue University West Lafayette IN 47907 USA
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Hirsch IB, Nardacci E, Verderese CA. Flash Continuous Glucose Monitoring: Implications for Use of Continuous Data in Daily Diabetes Management. Diabetes Spectr 2019; 32:355-367. [PMID: 31798294 PMCID: PMC6858083 DOI: 10.2337/ds18-0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Full realization of the benefits of continuous glucose monitoring (CGM) depends on addressing barriers such as cost, accuracy, burdens of daily use, and uncertainty about applying the data. Lack of systematic education has also hampered widespread adoption among patients and health care professionals. This article describes the practical application of an affordable and intuitive category of CGM called "flash" that requires users to scan the sensor with a handheld reader for on-demand access to continuous data. The data may be used for in-the-moment therapy adjustment, retrospective review of glucose patterns, and observation of glucose trending in response to behavior. Higher rates of flash CGM scanning have been associated with increased time in the glycemic target range and reduced time in hyper- and hypoglycemia. Growing interest in this technology suggests new opportunities for helping more patients incorporate CGM into their daily self-care.
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Bao Y, Chen L, Chen L, Dou J, Gao Z, Gao L, Guo L, Guo X, Ji L, Ji Q, Jia W, Kuang H, Li Q, Li Q, Li X, Li Y, Li L, Liu J, Ma J, Ran X, Shi L, Song G, Wang Y, Weng J, Xiao X, Xie Y, Xi G, Yang L, Zhao Z, Zhou J, Zhou Z, Zhu D, Zou D. Chinese clinical guidelines for continuous glucose monitoring (2018 edition). Diabetes Metab Res Rev 2019; 35:e3152. [PMID: 30884108 DOI: 10.1002/dmrr.3152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/22/2019] [Accepted: 02/19/2019] [Indexed: 02/05/2023]
Abstract
Blood glucose monitoring is an important part of diabetes management. Continuous glucose monitoring (CGM) technology has become an effective complement to conventional blood glucose monitoring methods and has been widely applied in clinical practice. The indications for its use, the accuracy of the generated data, the interpretation of the CGM results, and the application of the results must be standardized. In December 2009, the Chinese Diabetes Society (CDS) drafted and published the first Chinese Clinical Guideline for Continuous Glucose Monitoring (2009 edition), providing a basis for the standardization of CGM in clinical application. Based on the updates of international guidelines and the increasing evidence of domestic studies, it is necessary to revise the latest CGM guidelines in China so that the recent clinical evidence can be effectively translated into clinical benefit for diabetic patients. To this end, the CDS revised the Chinese Clinical Guideline for Continuous Glucose Monitoring (2012 Edition) based on the most recent evidence from international and domestic studies.
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Affiliation(s)
- Yuqian Bao
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan City, Shandong Province, China
| | - Liming Chen
- Tianjin Medical University Metabolic Disease Hospital, Tianjin, China
| | - Jingtao Dou
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Leili Gao
- Peking University People's Hospital, Beijing, China
| | - Lixin Guo
- Beijing Hospital of the Ministry of Health, Beijing, China
| | - Xiaohui Guo
- Peking University First Hospital, Beijing, China
| | - Linong Ji
- Peking University People's Hospital, Beijing, China
| | - Qiuhe Ji
- Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shanxi Province, China
| | - Weiping Jia
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongyu Kuang
- The First Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Qifu Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Xiaoying Li
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yanbing Li
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Ling Li
- Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Jianhua Ma
- Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing City, Jiangsu Province, China
| | - Xingwu Ran
- West China Hospital of Sichuan University, Chengdu City, Sichuan Province, China
| | - Lixin Shi
- The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, China
| | - Guangyao Song
- Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Yufei Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianping Weng
- The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, Anhui Province, China
| | - Xinhua Xiao
- Peking Union Medical College Hospital, Beijing, China
| | - Yun Xie
- Tianjin Medical University Metabolic Disease Hospital, Tianjin, China
| | - Guangxia Xi
- Shanxi Dayi Hospital, Taiyuan City, Shanxi Province, China
| | - Liyong Yang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Zhigang Zhao
- Zhengzhou Yihe Hospital Affiliated to Henan University, Zhengzhou City, Henan Province, China
| | - Jian Zhou
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhiguang Zhou
- The Second Xiangya Hospital of Central South University, Changsha City, Hunan Province, China
| | - Dalong Zhu
- Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing City, Jiangsu Province, China
| | - Dajin Zou
- Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
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7
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Abstract
IN BRIEF Obstacles to realizing the clinical benefits of continuous glucose monitoring (CGM) for daily diabetes management are being overcome with more affordable, user-friendly technologies. This article describes a novel category of CGM known as "flash" that may allow more routine use of continuous data for greater numbers of patients treated in primary care.
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Affiliation(s)
- Irl B. Hirsch
- University of Washington School of Medicine, Seattle, WA
| | - Eugene E. Wright
- Department of Medicine and Community and Family Medicine, Duke Southern Regional Area Health Education Center, Fayetteville, NC
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Prevalence of Hypoglycaemia among Insulin-Treated Pregnant Women with Diabetes Who Achieved Tight Glycaemic Control. J ASEAN Fed Endocr Soc 2019; 34:29-35. [PMID: 33442134 PMCID: PMC7784197 DOI: 10.15605/jafes.034.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives To determine the prevalence of hypoglycaemia using continuous glucose monitoring system (CGMS) among insulin-treated pregnant women with diabetes whose glycosylated haemoglobin (HbA1c) were <6.0% and identify the risk factors associated with hypoglycaemia occurrence. Methodology We conducted a cross-sectional study using 6-days CGMS to detect the prevalence of hypoglycaemia in 31 insulin-treated pregnant women with diabetes who achieved HbA1c <6.0%. Patients were required to log-keep their self-monitoring blood glucose (SMBG) readings and hypoglycaemia events. Results Eight women experienced confirmed hypoglycaemia with additional seven experienced relative hypoglycaemia, giving rise to prevalence rate of 45.2% (one had both confirmed and relative hypoglycaemia). Nine relative hypoglycaemia and 17 confirmed hypoglycaemic events were recorded. Sixteen (94%) out of 17 confirmed hypoglycaemia events recorded by CGMS were asymptomatic and were missed despite performing regular SMBG. Nocturnal hypoglycaemia events were recorded in seven women. Univariable analysis did not identify any association between conventional risk factors and hypoglycaemia events in our cohort. Conclusion Insulin-treated pregnant women with diabetes who achieved HbA1c <6.0% were associated with high prevalence of hypoglycaemia. Asymptomatic hypoglycaemia is common in our cohort and frequently missed despite regular SMBG. Present study did not identify any association between conventional risk factors and hypoglycaemia events in our cohort.
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Yetisen AK, Martinez‐Hurtado JL, Ünal B, Khademhosseini A, Butt H. Wearables in Medicine. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:e1706910. [PMID: 29893068 PMCID: PMC6541866 DOI: 10.1002/adma.201706910] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/14/2018] [Indexed: 05/21/2023]
Abstract
Wearables as medical technologies are becoming an integral part of personal analytics, measuring physical status, recording physiological parameters, or informing schedule for medication. These continuously evolving technology platforms do not only promise to help people pursue a healthier life style, but also provide continuous medical data for actively tracking metabolic status, diagnosis, and treatment. Advances in the miniaturization of flexible electronics, electrochemical biosensors, microfluidics, and artificial intelligence algorithms have led to wearable devices that can generate real-time medical data within the Internet of things. These flexible devices can be configured to make conformal contact with epidermal, ocular, intracochlear, and dental interfaces to collect biochemical or electrophysiological signals. This article discusses consumer trends in wearable electronics, commercial and emerging devices, and fabrication methods. It also reviews real-time monitoring of vital signs using biosensors, stimuli-responsive materials for drug delivery, and closed-loop theranostic systems. It covers future challenges in augmented, virtual, and mixed reality, communication modes, energy management, displays, conformity, and data safety. The development of patient-oriented wearable technologies and their incorporation in randomized clinical trials will facilitate the design of safe and effective approaches.
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Affiliation(s)
- Ali K. Yetisen
- Institute for Measurement Systems and Sensor TechnologyTechnische Universität MünchenTheresienstrasse 90Munich80333Germany
- School of Chemical EngineeringThe University of BirminghamEdgbastonBirminghamB15 2TTUK
- Institute of Translational MedicineMindelsohn Way, EdgbastonBirminghamB15 2THUK
| | | | - Barış Ünal
- Triton Systems Inc.200 Turnpike Rd.ChelmsfordMA01824USA
| | - Ali Khademhosseini
- Department of BioengineeringDepartment of RadiologyDepartment of Chemical and Biomolecular EngineeringUniversity of CaliforniaLos AngelesCA90095USA
| | - Haider Butt
- Nanotechnology LaboratorySchool of EngineeringUniversity of BirminghamBirminghamB15 2TTUK
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Garg SK, Akturk HK. A New Era in Continuous Glucose Monitoring: Food and Drug Administration Creates a New Category of Factory-Calibrated Nonadjunctive, Interoperable Class II Medical Devices. Diabetes Technol Ther 2018; 20:391-394. [PMID: 29901411 DOI: 10.1089/dia.2018.0142] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver , Aurora, Colorado
| | - H Kaan Akturk
- Barbara Davis Center for Diabetes, University of Colorado Denver , Aurora, Colorado
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Charleer S, Mathieu C, Nobels F, De Block C, Radermecker RP, Hermans MP, Taes Y, Vercammen C, T'Sjoen G, Crenier L, Fieuws S, Keymeulen B, Gillard P. Effect of Continuous Glucose Monitoring on Glycemic Control, Acute Admissions, and Quality of Life: A Real-World Study. J Clin Endocrinol Metab 2018; 103:1224-1232. [PMID: 29342264 DOI: 10.1210/jc.2017-02498] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 01/09/2018] [Indexed: 02/04/2023]
Abstract
CONTEXT Randomized controlled trials evaluating real-time continuous glucose monitoring (RT-CGM) patients with type 1 diabetes (T1D) show improved glycemic control, but limited data are available on real-world use. OBJECTIVE To assess impact of RT-CGM in real-world settings on glycemic control, hospital admissions, work absenteeism, and quality of life (QOL). DESIGN Prospective, observational, multicenter, cohort study. PARTICIPANTS A total of 515 adults with T1D on continuous subcutaneous insulin infusion (CSII) therapy starting in the Belgian RT-CGM reimbursement program. INTERVENTION Initiation of RT-CGM reimbursement. MAIN OUTCOME MEASURE Hemoglobin A1c (HbA1c) evolution from baseline to 12 months. RESULTS Between September 1, 2014, and December 31, 2016, 515 adults entered the reimbursement system. Over this period, 417 (81%) patients used RT-CGM for at least 12 months. Baseline HbA1c was 7.7 ± 0.9% (61 ± 9.8 mmol/mol) and decreased to 7.4 ± 0.8% (57 ± 8.7 mmol/mol) at 12 months (P < 0.0001). Subjects who started RT-CGM because of insufficient glycemic control showed stronger decrease in HbA1c at 4, 8, and 12 months compared with patients who started because of hypoglycemia or pregnancy. In the year preceding reimbursement, 16% of patients were hospitalized for severe hypoglycemia or ketoacidosis in contrast to 4% (P < 0.0005) the following year, with decrease in admission days from 54 to 18 per 100 patient years (P < 0.0005). In the same period, work absenteeism decreased and QOL improved significantly, with strong decline in fear of hypoglycemia. CONCLUSION Sensor-augmented pump therapy in patients with T1D followed in specialized centers improves HbA1c, fear of hypoglycemia, and QOL, whereas work absenteeism and admissions for acute diabetes complications decreased.
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Affiliation(s)
- Sara Charleer
- Department of Endocrinology, University Hospitals Leuven-Katholieke Universiteit Leuven, Leuven, Belgium
- PhD Fellowship Strategic Basic Research of the Research Foundation-Flanders (Fonds Wetenschappelijk Onderzoek), Brussels, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven-Katholieke Universiteit Leuven, Leuven, Belgium
| | - Frank Nobels
- Department of Endocrinology, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, University of Antwerp-Antwerp University Hospital, Antwerp, Belgium
| | - Regis P Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Centre Hospitalier Universitaire Liege-Liege University, Liege, Belgium
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc-Université Catholique de Louvain, Brussels, Belgium
| | - Youri Taes
- Department of Endocrinology, Algemeen Ziekenhuis Sint-Jan Brugge AV, Bruges, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Laurent Crenier
- Department of Endocrinology, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Steffen Fieuws
- Department of Public Health and Primary Care, I-BioStat, KU Leuven-University of Leuven and Universiteit Hasselt, Leuven, Belgium
| | - Bart Keymeulen
- Diabeteskliniek, University Hospital Brussels-Vrije Universiteit Brussel, Brussels, Belgium
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven-Katholieke Universiteit Leuven, Leuven, Belgium
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Christiansen SC, Fougner AL, Stavdahl Ø, Kölle K, Ellingsen R, Carlsen SM. A Review of the Current Challenges Associated with the Development of an Artificial Pancreas by a Double Subcutaneous Approach. Diabetes Ther 2017; 8:489-506. [PMID: 28503717 PMCID: PMC5446388 DOI: 10.1007/s13300-017-0263-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patients with diabetes type 1 (DM1) struggle daily to achieve good glucose control. The last decade has seen a rush of research groups working towards an artificial pancreas (AP) through the application of a double subcutaneous approach, i.e., subcutaneous (SC) continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion. Few have focused on the fundamental limitations of this approach, especially regarding outcome measures beyond time in range. METHODS Based on insulin physiology, the limitations of CGM, SC insulin absorption, meal challenge, and physical activity in DM1 patients, we discuss the limitations of the double SC approach. Finally, we discuss safety measures and the achievements reported in some recent AP studies that have utilized the double SC approach. RESULTS Most studies show that a double SC AP increases the time in range compared to a sensor-augmented insulin pump and shortens the time in hypoglycemia. Despite these achievements, the proportion of time spent in hyperglycemia is still roughly 20-40%, and hypoglycemia is still present 1-4% of the time. The main factors limiting further progress are the latency of SC CGM (at least 5-10 min) and the slow pharmacokinetics of SC-delivered fast-acting insulin. The maximum blood insulin level is reached after 45 min and the maximum glucose-lowering effect is observed after 1.5-2 h, while the glucose-lowering effect lasts for at least 5 h. CONCLUSIONS Although using a double SC AP leads to significant improvements in glucose control, the SC approach has severe limitations that hamper further progress towards a robust AP.
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Affiliation(s)
- Sverre Christian Christiansen
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anders Lyngvi Fougner
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Norway Regional Health Authority, Stjørdal, Norway
| | - Øyvind Stavdahl
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Konstanze Kölle
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Norway Regional Health Authority, Stjørdal, Norway
| | - Reinold Ellingsen
- Department of Electronic Systems, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sven Magnus Carlsen
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Lewis KR, McCrone S, Deiriggi P, Bendre S. Effectiveness of continuous glucose monitoring in children, adolescents, and young adults with poorly controlled type 1 diabetes. J SPEC PEDIATR NURS 2017; 22:10.1111/jspn.12162. [PMID: 27739620 PMCID: PMC5482228 DOI: 10.1111/jspn.12162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/30/2016] [Accepted: 09/02/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of continuous glucose monitoring (CGM) on glycemic control in children, adolescents, and young adults ages 7-21 years with poorly controlled diabetes HbA1c 9.0% or more (74 mmol/mol IFCC). MATERIALS AND METHODS The primary outcome was improvement in HbA1c. The secondary outcome included self-reported hypoglycemia. This 12-week study used a prospective, one-group, pre- and posttest pre-experimental design with a convenience sample. The study used the Medtronic Guardian CGM with Enlite Sensor. RESULTS AND CONCLUSIONS Thirty-three subjects enrolled in the study. The mean age of the participants was 15.57 years, range was 11-20 years, 47.6% were male, and 52.4% were female. Twenty-one (63.6%) completed the final study visit. There was a clinically and statistically significant reduction of 1.46 (SD = 1.6711) (p = .001) in HbA1c at 12 weeks. Fifteen of the 21 participants (71.4%) had an HbA1c reduction of greater than 0.5%. The CGM monitor was worn a mean of 4.262 days a week. None of the subjects reported significant hypoglycemia while wearing the monitor. CGM was effective in improving glycemic control in this population with poorly controlled diabetes.
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Affiliation(s)
- Kevin R Lewis
- Clinical Associate Professor, West Virginia University, School of Medicine, Charleston, West Virginia
| | - Susan McCrone
- Professor, West Virginia University, School of Nursing, Morgantown, West Virginia
| | - Pamela Deiriggi
- Associate Professor, West Virginia University, School of Nursing, Morgantown, West Virginia
| | - Sachin Bendre
- Assistant Professor, West Virginia University, School of Medicine, Charleston, West Virginia
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Mariani HS, Layden BT, Aleppo G. Continuous Glucose Monitoring: A Perspective on Its Past, Present, and Future Applications for Diabetes Management. Clin Diabetes 2017; 35:60-65. [PMID: 28144048 PMCID: PMC5241770 DOI: 10.2337/cd16-0008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Hanna S. Mariani
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian T. Layden
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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CRESPO NOEC, MULLANE SARAHL, ZEIGLER ZACHARYS, BUMAN MATTHEWP, GAESSER GLENNA. Effects of Standing and Light-Intensity Walking and Cycling on 24-h Glucose. Med Sci Sports Exerc 2016; 48:2503-2511. [DOI: 10.1249/mss.0000000000001062] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Pettus J, Edelman SV. Differences in Use of Glucose Rate of Change (ROC) Arrows to Adjust Insulin Therapy Among Individuals With Type 1 and Type 2 Diabetes Who Use Continuous Glucose Monitoring (CGM). J Diabetes Sci Technol 2016; 10:1087-93. [PMID: 27044518 PMCID: PMC5032948 DOI: 10.1177/1932296816639069] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand differences between individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D) in utilization of continuous glucose monitoring (CGM) data to adjust insulin therapy, either continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI). METHODS We surveyed 300 individuals who regularly used real-time CGM, using 70 questions to obtain information about general CGM use and response to glucose rate of change (ROC) arrows. RESULTS The survey was completed by 222 T1D and 78 T2D respondents treated with intensive insulin therapy. T1D respondents included CSII (n = 166) and MDI (n = 56) users. T2D respondents were more balanced: 34 (44%) versus 44 (56%), respectively. A larger percentage of T1D then T2D respondents reported a constant use of CGM (85% vs 61%, P < .001). T1D and T2D respondents reported similar substantial increases in correction dosages in response to rapidly increasing glucose (>3 mg/dL/min; 2 arrows up): +140% versus +136%, P = .4534. However, T1D respondents reported making smaller correction dosage reductions than T2D respondents in response to rapidly decreasing glucose (-42% vs -80%, P < .001). Differences between T1D and T2D respondents were also observed in mealtime dosage adjustments in response to rapidly increasing glucose compared to when glucose is stable (flat arrow) at 110 mg/dl: +81% versus +108%, respectively (P = .003). Although these adjustments are statistically different, both are large. CONCLUSIONS CGM users often rely on ROC information when determining insulin doses and tend to be more aggressive in their insulin adjustments despite differences in type of diabetes.
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Affiliation(s)
- Jeremy Pettus
- University of California, San Diego, San Diego, CA, USA
| | - Steven V Edelman
- University of California, San Diego, San Diego, CA, USA Veterans Affairs Medical Center, San Diego, CA, USA
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17
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Abstract
The original continuous glucose monitors (CGMs) were limited to 3-day, blinded observation periods where glucose data was hidden from patients and later retrospectively analyzed by a provider to help guide the management of diabetes. Unblinded CGM, released several years later, allows patients to view their glucose data in real-time amidst their daily routines, enabling them to better understand how variables such as activity, nutrition, and medications affect glucose levels. Research studies consistently demonstrate improved glycemic control and reduced hypoglycemia in children and adults with type 1 and type 2 diabetes while using unblinded CGM.(1-4) As such, we believe that all CGM usage in clinical practice should be in real-time, unblinded mode for short-term and long-term wear periods.
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Affiliation(s)
- David Ahn
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeremy Pettus
- University of California, San Diego, San Diego, CA, USA
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Abstract
Real-time continuous glucose monitoring (RT-CGM) has, in the span of just a few years, established an essential role in the contemporary management of type 1 diabetes. Nonetheless, masked CGM retains an important place in the management of diabetes including assisting with hypoglycemia detection and avoidance, optimizing glycemic control, and acting as a teaching tool for people living with diabetes.
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Affiliation(s)
- Ian Blumer
- Charles H. Best Diabetes Centre, Ajax, ON, Canada University of Toronto, 27 King's College Cir, Toronto, ON, Canada
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19
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Abstract
Continuous glucose monitoring (CGM) provides information unattainable by intermittent capillary blood glucose, including instantaneous real-time display of glucose level and rate of change of glucose, alerts and alarms for actual or impending hypo- and hyperglycemia, "24/7" coverage, and the ability to characterize glycemic variability. Progressively more accurate and precise, reasonably unobtrusive, small, comfortable, user-friendly devices connect to the Internet to share information and are sine qua non for a closed-loop artificial pancreas. CGM can inform, educate, motivate, and alert people with diabetes. CGM is medically indicated for patients with frequent, severe, or nocturnal hypoglycemia, especially in the presence of hypoglycemia unawareness. Surprisingly, despite tremendous advances, utilization of CGM has remained fairly limited to date. Barriers to use have included the following: (1) lack of Food and Drug Administration approval, to date, for insulin dosing ("nonadjuvant use") in the United States and for use in hospital and intensive care unit settings; (2) cost and variable reimbursement; (3) need for recalibrations; (4) periodic replacement of sensors; (5) day-to-day variability in glycemic patterns, which can limit the predictability of findings based on retrospective, masked "professional" use; (6) time, implicit costs, and inconvenience for uploading of data for retrospective analysis; (7) lack of fair and reasonable reimbursement for physician time; (8) inexperience and lack of training of physicians and other healthcare professionals regarding interpretation of CGM results; (9) lack of standardization of software methods for analysis of CGM data; and (10) need for professional medical organizations to develop and disseminate additional clinical practice guidelines regarding the role of CGM. Ongoing advances in technology and clinical research have addressed several of these barriers. Use of CGM in conjunction with an insulin pump with automated suspension of insulin infusion in response to actual observed or predicted hypoglycemia, as well as progressive refinement of closed-loop systems, is expected to dramatically enhance the clinical utility and utilization of CGM.
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Affiliation(s)
- David Rodbard
- Biomedical Informatics Consultants LLC , Potomac, Maryland
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20
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Pettus J, Edelman SV. Use of Glucose Rate of Change Arrows to Adjust Insulin Therapy Among Individuals with Type 1 Diabetes Who Use Continuous Glucose Monitoring. Diabetes Technol Ther 2016; 18 Suppl 2:S234-42. [PMID: 26784128 PMCID: PMC4717500 DOI: 10.1089/dia.2015.0369] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study was performed to understand and to compare differences in utilization of continuous glucose monitoring (CGM) and the rate of change (ROC) arrow to adjust insulin therapy among individuals with type 1 diabetes (T1D), comparing those treated with multiple daily insulin injections (MDI) with those treated with continuous subcutaneous insulin infusion (CSII). RESEARCH DESIGN AND METHODS We surveyed 222 T1D individuals who regularly used real-time CGM to obtain information about general CGM use and response to glucose ROC arrows in managing their diabetes. RESULTS The survey was completed by 222 T1D individuals. Respondents included CSII (n = 166) and MDI (n = 56) users. MDI and CSII respondents reported similar substantial increases in correction dosages (from 220 mg/dL to 120 mg/dL) in response to increasing glucose (one ROC arrow up: rising 2-3 mg/dL/min): +120% and +108%, respectively (P = 0.13). MDI and CSII respondents reported similar substantial increases in correction dosages in response to rapidly increasing glucose (two arrows up: rising >3 mg/dL/min): +146% and +138%, respectively (P = 0.72). When correcting from 220 mg/dL to 120 mg/dL, MDI respondents reported larger correction dosage reductions than CSII respondents in response to decreasing glucose (one ROC down arrow: decreasing 2-3 mg/dL/min) and rapidly decreasing glucose (two ROC down arrows: decreasing >3 mg/dL/min): -50% versus -37%, respectively (P = .024) and -52% versus 38%, respectively (P = 0.034). Similar between-group differences were observed in mealtime dosage adjustments. CONCLUSIONS CGM users often rely on ROC information when determining insulin doses and tend to make larger changes than current recommendations suggest regardless of insulin delivery method.
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Affiliation(s)
- Jeremy Pettus
- University of California San Diego, San Diego, California
| | - Steven V. Edelman
- University of California San Diego, San Diego, California
- Veterans Affairs Medical Center, San Diego, California
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Bailey TS, Grunberger G, Bode BW, Handelsman Y, Hirsch IB, Jovanovič L, Roberts VL, Rodbard D, Tamborlane WV, Walsh J. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY 2016 OUTPATIENT GLUCOSE MONITORING CONSENSUS STATEMENT. Endocr Pract 2016; 22:231-61. [PMID: 26848630 DOI: 10.4158/ep151124.cs] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.
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Desouza CV, Rosenstock J, Zhou R, Holcomb RG, Fonseca VA. GLYCATED ALBUMIN AT 4 WEEKS CORRELATES WITH A1C LEVELS AT 12 WEEKS AND REFLECTS SHORT-TERM GLUCOSE FLUCTUATIONS. Endocr Pract 2015; 21:1195-203. [PMID: 26214108 PMCID: PMC5010365 DOI: 10.4158/ep14570.or] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Evaluate the performance of glycated albumin (GA) monitoring by comparing it to other measures of glycemic control during intensification of antidiabetic therapy. METHODS This 12-week, prospective, multicenter study compared the diagnostic clinical performance of GA to glycated hemoglobin A1C (A1C), fructosamine corrected for albumin (FRA), fasting plasma glucose (FPG), and mean blood glucose (MBG) estimated from self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) in 30 patients with suboptimally controlled type 1 or 2 diabetes. RESULTS Mean A1C decreased from 9.5% to 8.1%. Mean SMBG correlated closely with CGM (Pearson r = 0.783 for daily estimates and r = 0.746 for weekly estimates, P<.0001). Both GA and FRA levels significantly correlated with changes from baseline in A1C and mean weekly SMBG (P<.001). The lowest observed median GA occurred at 4 weeks, followed by a small increase and then a slight reduction, mirroring changes in overall mean SMBG values. The median A1C fell throughout the treatment period, failing to reflect short-term changes in SMBG. A ≥1% reduction in GA at 4 weeks was significantly associated with a ≥0.5% change in A1C at 12 weeks (odds ratio [OR] = 19.0, 95% confidence interval [CI]: 1.4, 944, P = .018). CONCLUSION In patients receiving glucose-lowering therapy, changes in GA at 4 weeks were concordant with changes in A1C at 12 weeks, and both GA and FRA more accurately reflected short-term blood glucose fluctuations than A1C.
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Lavernia F, Kushner P, Trence D, Rice D, Dailey G, Kuritzky L. Recognizing and minimizing hypoglycemia: The need for individualized care. Postgrad Med 2015; 127:801-7. [PMID: 26359949 DOI: 10.1080/00325481.2015.1086628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hypoglycemia is a condition known to disrupt many everyday activities and is associated with increased risks of hospitalization, falls, motor vehicle accidents and mortality. Many patients with diabetes have an increased risk of hypoglycemia due to interventions targeting glycemic control. In these patients, hypoglycemia and fear of hypoglycemia may further reduce adherence to glucose-lowering regimens, contributing to the further aggravation of diabetes-related complications. Avoiding hypoglycemia should be one of the principal goals of any treatment strategies employing agents that can induce hypoglycemia in order to prevent the occurrence of associated symptoms and consequences. The education of patients and their families is an important feature of individualized management strategies in order to prevent, mitigate and treat hypoglycemic episodes. Patients with diabetes need to be made aware of how to recognize the signs of hypoglycemia and of the simple, highly effective steps that they can take to self-manage hypoglycemic episodes. Clinicians should be familiar with the risk factors for hypoglycemia, especially the profiles of the different classes of glucose-lowering medications such as the sulfonylureas and insulin. This article aims to review the risk factors for hypoglycemia and its implications for patients and healthcare systems, and provide practical advice for minimizing the risk of hypoglycemia and its consequences.
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Affiliation(s)
- Frank Lavernia
- a 1 North Broward Diabetes Center , Coconut Creek, FL, USA
| | | | - Dace Trence
- c 3 University of Washington , Seattle, WA, USA
| | - Donna Rice
- d 4 Sanofi U.S., Inc. , Bridgewater, NJ, USA
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Al Hayek AA, Robert AA, Al Dawish M, Ahmed RA, Al Sabaan FS. The Evolving Role of Short-Term Professional Continuous Glucose Monitoring on Glycemic Control and Hypoglycemia Among Saudi Patients with Type 1 Diabetes: A Prospective Study. Diabetes Ther 2015; 6:329-37. [PMID: 26142891 PMCID: PMC4575306 DOI: 10.1007/s13300-015-0120-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The aim of this study was to find out the evolving role of professional continuous glucose monitoring (PCGM) on hemoglobin A1c (HbA1c) and the frequency of hypoglycemia. METHODS This was a 3-month, prospective study conducted among patients (aged 15-24 years) with type 1 diabetes mellitus who attended a diabetes clinic [Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia] due to recurrent unexplained hypoglycemia unawareness episodes between July 2014 and December 2014. The respondents were purposively and conveniently selected and they were asked to wear the PCGM device (iPro(®)2; Medtronic MiniMed, Inc., Northridge, CA, USA) for 5 days. The PCGM results were collected by the diabetic educator and reviewed by the treating physician on the same day as removal of the device. Clinical and demographic data were also collected. RESULTS Overall, 56 patients were included in the study. The mean (±SD) age of the study cohort was 18.1 ± 1.82 years and 27 (48.2%) patients were male. Compared with baseline, non-significant but positive differences were observed in HbA1c levels in both male and female patients and in those who were older (aged 20-24 years). Similar results were observed in the frequency of hypoglycemia and a significant change was observed for female patients (P < 0.05). Compared with baseline, a significant positive difference was observed in patients' overall frequency of hypoglycemia by the end of the study (P < 0.001). CONCLUSIONS Professional continuous glucose monitoring is a valuable tool for detecting episodes of hypoglycemia and may help to decrease HbA1c levels and reduce the frequency of hypoglycemia.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Asirvatham A Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rania A Ahmed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fahad S Al Sabaan
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Abstract
Technological innovations have revolutionized the treatment of type 1 diabetes. Although technological advances can potentially improve diabetes outcomes, maintenance of target glycemic control, at the present time, remains largely dependent on patient and family motivation, competence, and adherence to daily diabetes care requirements. Trials of closed loop or "artificial pancreas" technology show great promise to automate insulin delivery and achieve near normal glucose control and reduced hypoglycemia with minimal patient intervention.
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Affiliation(s)
- Katharine Garvey
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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26
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Affiliation(s)
- Tadej Battelino
- University Medical Centre University Children's Hospital, Medical Faculty, University of Ljubljana, Slovenia Atlanta Diabetes Associates, Atlanta, GA, USA
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Pettus J, Price DA, Edelman SV. HOW PATIENTS WITH TYPE 1 DIABETES TRANSLATE CONTINUOUS GLUCOSE MONITORING DATA INTO DIABETES MANAGEMENT DECISIONS. Endocr Pract 2015; 21:613-20. [PMID: 25716635 DOI: 10.4158/ep14520.or] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To understand how patients use continuous glucose monitoring (CGM) data in their diabetes management. METHODS We surveyed patients who regularly used CGM (>6 days per week), using 70 questions, many scenario-based. The survey had 6 sections: patient characteristics, general CGM use, hypoglycemia prevention and management, hyperglycemia prevention and management, insulin dosing adjustments (both for incidental hyperglycemia not at meals and at mealtimes), and real-time use versus retrospective analysis. RESULTS The survey was completed by 222 patients with type 1 diabetes. In response to a glucose of 220 mg/dL, the average correction dose adjustment based on rate of change arrows varied dramatically. Specifically, when the CGM device showed 2 arrows up (glucose increasing >3 mg/dL/minute), respondents stated they would increase their correction bolus, on average, by 140% (range, 0 to 600%). Conversely, 2 arrows down (glucose decreasing >3 mg/dL/minute) caused respondents to reduce their dose by 42%, with 24% omitting their dose entirely. Furthermore, 59% of respondents stated they would delay a meal in response to rapidly rising glucose, whereas 60% would wait until after a meal to bolus in response to falling glucose levels. With a glucose value of 120 mg/dL and a falling glucose trend, 70% of respondents would prophylactically consume carbohydrates to avoid hypoglycemia. CONCLUSION CGM users utilize CGM data to alter multiple aspects of their diabetes care, including insulin dose timing, dose adjustments, and in hypoglycemia prevention. The insulin adjustments are much larger than common recommendations. Additional studies are needed to determine appropriate insulin adjustments based on glucose trend data.
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Bruttomesso D, Laviola L, Lepore G, Bonfanti R, Bozzetto L, Corsi A, Di Blasi V, Girelli A, Grassi G, Iafusco D, Rabbone I, Schiaffini R. Continuous subcutaneous insulin infusion in Italy: third national survey. Diabetes Technol Ther 2015; 17:96-104. [PMID: 25479035 DOI: 10.1089/dia.2014.0242] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) is increasing worldwide, mostly because of improved technology. The aim of this study was to evaluate the current status of CSII in Italy. MATERIALS AND METHODS Physicians from 272 diabetes centers received a questionnaire investigating clinical features, pump technology, and management of patients on CSII. RESULTS Two hundred seventeen centers (79.8%) joined the study and, by the end of April 2013, gave information about 10,152 patients treated with CSII: 98.2% with type 1 diabetes mellitus, 81.4% adults, 57% female, and 61% with a conventional pump versus 39% with a sensor-augmented pump. CSII advanced functions were used by 68% of patients, and glucose sensors were used 12 days per month on average. Fifty-eight percent of diabetes centers had more than 20 patients on CSII, but there were differences among centers and among regions. The main indication for CSII was poor glucose control. Dropout was mainly due to pump wearability or nonoptimal glycemic control. Twenty-four hour assistance was guaranteed in 81% of centers. A full diabetes team (physician+nurse+dietician+psychologist) was available in 23% of adult-care diabetes centers and in 53% of pediatric diabetes units. CONCLUSIONS CSII keeps increasing in Italy. More work is needed to ensure uniform treatment strategies throughout the country and to improve pump use.
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Affiliation(s)
- Daniela Bruttomesso
- 1 Metabolic Diseases, Department of Medicine-DIMED, University of Padua , Padua, Italy
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Tumminia A, Sciacca L, Frittitta L, Squatrito S, Vigneri R, Le Moli R, Tomaselli L. Integrated insulin pump therapy with continuous glucose monitoring for improved adherence: technology update. Patient Prefer Adherence 2015; 9:1263-70. [PMID: 26379428 PMCID: PMC4567238 DOI: 10.2147/ppa.s69482] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Insulin pump therapy combined with real-time continuous glucose monitoring, known as sensor-augmented pump (SAP) therapy, has been shown to improve metabolic control and to reduce the rate of hypoglycemia in adults with type 1 diabetes compared to multiple daily injections or standard continuous subcutaneous insulin infusion. Glycemic variability is also reduced in patients on SAP therapy. This approach allows patients to monitor their glucose levels being informed of glycemic concentration and trend. Trained diabetic patients, therefore, can appropriately modify insulin infusion and/or carbohydrate intake in order to prevent hypo- or hyperglycemia. For these reasons, SAP therapy is now considered the gold standard for type 1 diabetes treatment. To be clinically effective, however, devices and techniques using advanced technology should not only have the potential to theoretically ameliorate metabolic control, but also be well accepted by patients in terms of satisfaction and health-related quality of life, because these factors will improve treatment adherence and consequently overall outcome. SAP therapy is generally well tolerated by patients; however, many clinical trials have identified significant noncompliance in the use of this device, most notably in the pediatric and adolescent populations. In this review we aim to analyze the main reasons for good or poor adherence to SAP therapy and to provide useful tips in order to fully benefit from this kind of novel therapeutic approach.
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Affiliation(s)
- Andrea Tumminia
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Laura Sciacca
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Lucia Frittitta
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Sebastiano Squatrito
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | | | - Rosario Le Moli
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
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Abstract
Monitoring of glycemic control is a key component of the diabetes treatment plan. Patients who are not meeting targets often require more intensive monitoring, ranging from frequent self-monitored glucose to continuous glucose monitoring in order to facilitate medication and lifestyle changes. However, more intensive monitoring demands more training and a structured plan for interpretation and use of the data. Better patient and provider tools to support decision-making and progress toward an artificial pancreas may help to alleviate this burden.
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Affiliation(s)
- Sara J Healy
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 5th Floor McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA
| | - Kathleen M Dungan
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 5th Floor McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA.
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Matuleviciene V, Joseph JI, Andelin M, Hirsch IB, Attvall S, Pivodic A, Dahlqvist S, Klonoff D, Haraldsson B, Lind M. A clinical trial of the accuracy and treatment experience of the Dexcom G4 sensor (Dexcom G4 system) and Enlite sensor (guardian REAL-time system) tested simultaneously in ambulatory patients with type 1 diabetes. Diabetes Technol Ther 2014; 16:759-67. [PMID: 25233297 PMCID: PMC4201312 DOI: 10.1089/dia.2014.0238] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) is a tool widely used in the treatment of patients with type 1 diabetes. The purpose of the current study was to evaluate whether accuracy and patient treatment satisfaction differ between the Enlite™ (Medtronic MiniMed, Inc., Northridge, CA) and Dexcom(®) (San Diego, CA) G4 PLATINUM CGM sensors. SUBJECTS AND METHODS Thirty-eight ambulatory patients with type 1 diabetes used the Dexcom G4 and Enlite sensors simultaneously for a minimum of 4 and maximum of 6 days. Patients measured capillary glucose levels with a HemoCue(®) (Ängelholm, Sweden) system six to 10 times a day. In addition, two inpatient studies were performed between Days 1-3 and 4-6. RESULTS The mean absolute relative difference (MARD) in blood glucose for the Dexcom G4 was significantly lower (13.9%) than for the Enlite sensor (17.8%) (P<0.0001). The corresponding MARDs for Days 1-3 were 15.0% versus 19.4% (P=0.0027) and 13.6% versus 15.9% (P=0.026) for Days 4-6. For glucose levels in the hypoglycemic range (<4.0 mmol/L), the MARD for the Dexcom G4 was 20.0% compared with 34.7% for the Enlite (P=0.0041). On a visual analog scale (VAS) (0-100), patients rated the Dexcom G4 more favorably than the Enlite in 12 out of the 13 user experience questions. For example, more patients rated their experience with the Dexcom G4 as positive (VAS, 79.7 vs. 46.6; P<0.0001) and preferred to use it in their daily lives (VAS, 79.1 vs. 42.1; P<0.0001). CONCLUSIONS The Dexcom G4 sensor was associated with greater overall accuracy than the Enlite sensor during initial (Days 1-3) and later (Days 4-6) use and for glucose levels in the hypoglycemic range. Patients reported a significantly more positive experience using the Dexcom G4 than the Enlite.
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Affiliation(s)
| | - Jeffrey I. Joseph
- Department of Anesthesiology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mervi Andelin
- Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden
| | | | - Stig Attvall
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Sofia Dahlqvist
- Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden
| | - David Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, California
| | - Börje Haraldsson
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Lind
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden
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Rajendran R, Rayman G. Point-of-care blood glucose testing for diabetes care in hospitalized patients: an evidence-based review. J Diabetes Sci Technol 2014; 8:1081-90. [PMID: 25355711 PMCID: PMC4455482 DOI: 10.1177/1932296814538940] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Glycemic control in hospitalized patients with diabetes requires accurate near-patient glucose monitoring systems. In the past decade, point-of-care blood glucose monitoring devices have become the mainstay of near-patient glucose monitoring in hospitals across the world. In this article, we focus on its history, accuracy, clinical use, and cost-effectiveness. Point-of-care devices have evolved from 1.2 kg instruments with no informatics to handheld lightweight portable devices with advanced connectivity features. Their accuracy however remains a subject of debate, and new standards for their approval have now been issued by both the International Organization for Standardization and the Clinical and Laboratory Standards Institute. While their cost-effectiveness remains to be proved, their clinical value for managing inpatients with diabetes remains unchallenged. This evidence-based review provides an overall view of its use in the hospital setting.
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Kesavadev J, Sadikot S, Wangnoo S, Kannampilly J, Saboo B, Aravind SR, Kalra S, Makkar BM, Maji D, Saikia M, Anjana RM, Rajput R, Singh SK, Shah S, Dhruv U, Vishwanathan V. Consensus guidelines for glycemic monitoring in type 1/type 2 & GDM. Diabetes Metab Syndr 2014; 8:187-195. [PMID: 25200925 DOI: 10.1016/j.dsx.2014.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Stringent monitoring of blood glucose in diabetes plays an important role as the treatment of the disease itself. Blood glucose monitoring (BGM) strategies such as measurement of Hb1Ac, Self-Monitoring of Blood Glucose (SMBG) and Continuous Glucose Monitoring (CGM) plays a vital role in achieving the important goal of preventing long term complications of diabetes. Although the use of BGM is recommended by various international guidelines in T1DM and T2DM, there is no consensus on the utility of BGM in India. So, there is a need to develop a guidance for uniform monitoring mechanism among the care givers taking into account the variations and challenges that are unique to Indian population. A committee was established that comprised of physicians, researchers and other healthcare professionals having expertise in diabetes treatment to oversee the formulation of guidelines on different monitoring and treatment aspects of diabetes. Extensive literature searches were conducted to identify and analyze the evidence available on BGM. An initial draft of BGM guidelines was presented to core members who discussed the subject matter and presented their opinion. This was then taken to wider expert audience to invite their comments that were incorporated in the initial draft. The first compilation was presented at a conference attended by nearly 200 experts. Again, their opinion was sought and the next version was prepared which was sent to core committee members for the final inputs. The Indian consensus guideline on BGM using Hb1Ac, SMBG and CGM as the primary tools was then finalized.
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Skae M, Avatapalle HB, Banerjee I, Rigby L, Vail A, Foster P, Charalambous C, Bowden L, Padidela R, Patel L, Ehtisham S, Cosgrove KE, Dunne MJ, Clayton PE. Reduced Glycemic Variability in Diazoxide-Responsive Children with Congenital Hyperinsulinism Using Supplemental Omega-3-Polyunsaturated Fatty Acids; A Pilot Trial with MaxEPA(R.). Front Endocrinol (Lausanne) 2014; 5:31. [PMID: 24659984 PMCID: PMC3952031 DOI: 10.3389/fendo.2014.00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/21/2014] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Congenital hyperinsulinism (CHI) is a rare condition of hypoglycemia where therapeutic options are limited and often complicated by side-effects. Omega-3-polyunsaturated fatty acids (PUFA), which can suppress cardiac myocyte electrical activity, may also reduce ion channel activity in insulin-secreting cells. PUFA supplements in combination with standard medical treatment may improve glucose profile and may reduce glycemic variability in diazoxide-responsive CHI. DESIGN Open label pilot trial with MaxEPA(R) liquid (eicosapentaenoic and docosahexaenoic acid) PUFA (3 ml/day for 21 days) in diazoxide-responsive CHI patients (https://eudract.ema.europa.eu/, EudraCT number 201100363333). METHODS Glucose levels were monitored pre-treatment, end of treatment, and at follow-up by subcutaneous continuous glucose monitoring systems (CGMS) in 13 patients (7 girls) who received PUFA. Outcome measures were an improved glucose profile, reduced glycemic variability quantified by a reduction in the frequency of glucose levels <4 and >10 mmol/l, and safety of PUFA. All children were analyzed either as intention to treat (n = 13) or as per protocol (n = 7). RESULTS Mean (%) CGMS glucose levels increased by 0.1 mmol/l (2%) in intention to treat and by 0.4 mmol/l (8%) in per protocol analysis (n = 7). The frequency of CGMS <4 mmol/l was significantly less at the end of treatment than in the pre-treatment period [556 (7%) vs. 749 (10%)]. Similarly, the frequency of CGMS >10 mmol/l, was also less at the end of treatment [27 (0.3%) vs. 49 (0.7%)]. Except for one child with increased LDL cholesterol, all safety parameters were normal. CONCLUSION MaxEPA(R) was safe and reduced glycemic variability, but did not increase glucose profiles significantly in diazoxide-responsive CHI. The supplemental value of PUFA should be evaluated in a comprehensive clinical trial.
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Affiliation(s)
- Mars Skae
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Hima Bindu Avatapalle
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- *Correspondence: Indraneel Banerjee, Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Oxford Road, Manchester M13 9WL, UK e-mail: ;
| | - Lindsey Rigby
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Andy Vail
- Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Peter Foster
- School of Mathematics, University of Manchester, Manchester, UK
| | | | - Louise Bowden
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Raja Padidela
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Leena Patel
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Sarah Ehtisham
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | | | - Mark J. Dunne
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Peter E. Clayton
- Department of Paediatric Endocrinology, Manchester Academic Health Science Centre, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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Bergenstal RM, Rosenstock J, Bastyr EJ, Prince MJ, Qu Y, Jacober SJ. Lower glucose variability and hypoglycemia measured by continuous glucose monitoring with novel long-acting insulin LY2605541 versus insulin glargine. Diabetes Care 2014; 37:659-65. [PMID: 24198302 DOI: 10.2337/dc12-2621] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To use continuous glucose monitoring (CGM) to evaluate the impact of the novel, long-acting basal insulin analog LY2605541 on hypoglycemia and glycemic variability in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Hypoglycemia and glucose variability were assessed with CGM of interstitial glucose (IG) in a subset of patients with type 2 diabetes from a phase II, randomized, open-label, parallel study of LY2605541 (n = 51) or insulin glargine (GL) (n = 25). CGM was conducted on 3 consecutive days (72-84 h) during the week before week 0, 6, and 12 study visits. RESULTS Measured by CGM for 3 days prior to the 12-week visit, fewer LY2605541-treated patients experienced hypoglycemic events overall (50.0 vs. 78.3%, P = 0.036) and nocturnally (20.5 vs. 47.8%, P = 0.027) and spent less time with IG ≤70 mg/dL than GL-treated patients during the 24-h (25 ± 6 vs. 83 ± 16 min, P = 0.012) and nocturnal periods (11 ± 5 vs. 38 ± 13 min, P = 0.024). These observations were detected without associated differences in the average duration of individual hypoglycemic episodes (LY2605541 compared with GL 57.2 ± 5.4 vs. 69.9 ± 10.2 min per episode, P = NS). Additionally, LY2605541-treated patients had lower within-day glucose SD for both 24-h and nocturnal periods. CONCLUSIONS By CGM, LY2605541 treatment compared with GL resulted in fewer patients with hypoglycemic events and less time in the hypoglycemic range and was not associated with protracted hypoglycemia.
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Lenhard MJ, Kinsley BT. Insulin therapy for the treatment of type 1 diabetes during pregnancy. J Matern Fetal Neonatal Med 2013; 27:1270-5. [PMID: 24224883 PMCID: PMC4133963 DOI: 10.3109/14767058.2013.864631] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pregnancies affected by type 1 diabetes (T1D) carry a major risk for poor fetal, neonatal and maternal outcomes. Achieving normoglycemia while minimizing the risk of hypoglycemia is a major goal in the management of T1D as this can greatly reduce the risk of complications. However, maintaining optimal glucose levels is challenging because insulin requirements are not uniform throughout the course of the pregnancy. Over the past decade, there has been significant improvement in the methods for glucose monitoring and insulin administration, accompanied by an increase in the number of treatment options available to pregnant patients with T1D. Through study of the scientific literature and accumulated evidence, we review advances in the management of T1D in pregnancy and offer advice on how to achieve optimal care for the patient.
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Affiliation(s)
- M James Lenhard
- Department of Endocrinology and Metabolism, Diabetes and Metabolic Diseases Center, Christiana Care Health System , Wilmington, DE , USA
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37
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Affiliation(s)
- Satish K Garg
- 1 Barbara Davis Center for Diabetes, University of Colorado Denver , Aurora, Colorado
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38
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Vashist SK. Continuous Glucose Monitoring Systems: A Review. Diagnostics (Basel) 2013; 3:385-412. [PMID: 26824930 PMCID: PMC4665529 DOI: 10.3390/diagnostics3040385] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/10/2013] [Accepted: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
There have been continuous advances in the field of glucose monitoring during the last four decades, which have led to the development of highly evolved blood glucose meters, non-invasive glucose monitoring (NGM) devices and continuous glucose monitoring systems (CGMS). Glucose monitoring is an integral part of diabetes management, and the maintenance of physiological blood glucose concentration is the only way for a diabetic to avoid life-threatening diabetic complications. CGMS have led to tremendous improvements in diabetic management, as shown by the significant lowering of glycated hemoglobin (HbA1c) in adults with type I diabetes. Most of the CGMS have been minimally-invasive, although the more recent ones are based on NGM techniques. This manuscript reviews the advances in CGMS for diabetes management along with the future prospects and the challenges involved.
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Affiliation(s)
- Sandeep Kumar Vashist
- HSG-IMIT-Institut für Mikro-und Informationstechnik, Georges-Koehler-Allee 103, 79100, Freiburg, Germany.
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Christiansen M, Bailey T, Watkins E, Liljenquist D, Price D, Nakamura K, Boock R, Peyser T. A new-generation continuous glucose monitoring system: improved accuracy and reliability compared with a previous-generation system. Diabetes Technol Ther 2013; 15:881-8. [PMID: 23777402 PMCID: PMC3781114 DOI: 10.1089/dia.2013.0077] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Use of continuous glucose monitoring (CGM) systems can improve glycemic control, but widespread adoption of CGM utilization has been limited, in part because of real and perceived problems with accuracy and reliability. This study compared accuracy and performance metrics for a new-generation CGM system with those of a previous-generation device. SUBJECTS AND METHODS Subjects were enrolled in a 7-day, open-label, multicenter pivotal study. Sensor readings were compared with venous YSI measurements (blood glucose analyzer from YSI Inc., Yellow Springs, OH) every 15 min (±5 min) during in-clinic visits. The aggregate and individual sensor accuracy and reliability of a new CGM system, the Dexcom(®) (San Diego, CA) G4™ PLATINUM (DG4P), were compared with those of the previous CGM system, the Dexcom SEVEN(®) PLUS (DSP). RESULTS Both study design and subject characteristics were similar. The aggregate mean absolute relative difference (MARD) for DG4P was 13% compared with 16% for DSP (P<0.0001), and 82% of DG4P readings were within ± 20 mg/dL (for YSI ≤ 80 mg/dL) or 20% of YSI values (for YSI >80 mg/dL) compared with 76% for DSP (P<0.001). Ninety percent of the DG4P sensors had an individual MARD ≤ 20% compared with only 76% of DSP sensors (P=0.015). Half of DG4P sensors had a MARD less than 12.5% compared with 14% for the DSP sensors (P=0.028). The mean absolute difference for biochemical hypoglycemia (YSI <70 mg/dL) for DG4P was 11 mg/dL compared with 16 mg/dL for DSP (P<0.001). CONCLUSIONS The performance of DG4P was significantly improved compared with that of DSP, which may increase routine clinical use of CGM and improve patient outcomes.
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Dungan K, Graessle K, Sagrilla C. The effect of congestive heart failure on sensor accuracy among hospitalized patients with type 2 diabetes. Diabetes Technol Ther 2013; 15:817-24. [PMID: 24050738 PMCID: PMC3781123 DOI: 10.1089/dia.2013.0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Congestive heart failure (CHF) features disturbances in the interstitial environment that may affect the accuracy of subcutaneous continuous glucose monitoring (CGM). SUBJECTS AND METHODS A pooled analysis of two studies of hospitalized patients with type 2 diabetes randomized to intravenous or subcutaneous insulin was conducted. One study enrolled patients with CHF exacerbation, whereas history of CHF was an exclusion criterion in the other. All patients wore a professional CGM device for at least 24 h. Intravenous insulin was administered according to the institution's nursing-run protocol (duration of 12 and 48 h in non-CHF and CHF protocols, respectively). Subcutaneous insulin was delivered similarly in both groups. RESULTS Subjects with CHF (n=43) had higher admission glucose and hemoglobin A1c compared with non-CHF subjects (n=32), but the sensor glucose values were similar. Overall mean absolute relative difference (MARD) was similar between CHF and non-CHF subjects (0.11 vs. 0.08, respectively; P=0.12). MARD was higher in the 100-149 mg/dL (P=0.003) and >199 mg/dL (P = 0.02) strata among CHF subjects. Static glucose and continuous glucose error grid analyses favored the non-CHF group. In multivariable analyses, only glucose coefficient of variation and log sensor time were independent predictors of elevated overall MARD >0.10. After adjustment for other factors, only increasing log sensor time was a significant predictor of elevated MARD in the 100-149 mg/dL strata. CONCLUSIONS Among hospitalized subjects with type 2 diabetes, CHF exacerbation is not associated with lower sensor accuracy after adjustment for other factors, but this requires confirmation over a wider glucose range.
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Affiliation(s)
- Kathleen Dungan
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University , Columbus, Ohio
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Hug SA, Riond B, Schwarzwald CC. Evaluation of a continuous glucose monitoring system compared with an in-house standard laboratory assay and a handheld point-of-care glucometer in critically ill neonatal foals. J Vet Emerg Crit Care (San Antonio) 2013; 23:408-15. [PMID: 23859299 DOI: 10.1111/vec.12072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/29/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the applicability and accuracy of a continuous glucose monitoring system (CGMS) in critically ill foals by comparing the performance of the CGMS, a point-of-care (POC) glucometer, and an in-house standard laboratory assay (SLA). DESIGN Prospective study. SETTING University teaching hospital. ANIMALS Seven critically ill neonatal foals requiring intensive care. INTERVENTIONS Foals were instrumented with a CGMS that measured interstitial glucose concentration every 5 minutes for the duration of 15-79 hours. Capillary and venous blood samples were taken every 4-6 hours for POC and SLA measurements, respectively. MEASUREMENTS AND MAIN RESULTS Bland-Altman analysis showed a mean bias (95% limits of agreement) of -0.1 (-3.9 to 3.5) mmol/L for comparison of CGMS versus SLA, 0.06 (-3.9 to 4.0) mmol/L for comparison of CGMS versus POC glucometer, and -0.16 (-1.8 to 1.5) mmol/L for comparison of POC glucometer versus SLA. Percent agreement and weighted kappa for classification in hypoglycemia, normoglycemia, and hyperglycemia were 68.4% and 0.296 for CGMS versus SLA, 72.4% and 0.442 for CGMS versus POC glucometer, and 80.7% and 0.568 for POC glucometer versus SLA. CONCLUSIONS The CGMS may be helpful for monitoring a trend in interstitial glucose concentration in critically ill neonatal foals. However, considering the wide limits of agreement between methods, the CGMS should only be used as an adjunctive device to other, more accurate and readily available methods that are able to detect acute changes in glucose concentration. Its use is further limited by the relatively high costs of the sensors, the mandatory 2-hour initialization period, and the difficulties of keeping the transducer in place in an active foal. The POC glucometer used in this study is easy to use and proved to be sufficiently accurate for repeated, stall-sided glucose monitoring in neonatal foals.
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Affiliation(s)
- Sophie A Hug
- Equine Department, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
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Jensen MH, Christensen TF, Tarnow L, Seto E, Dencker Johansen M, Hejlesen OK. Real-time hypoglycemia detection from continuous glucose monitoring data of subjects with type 1 diabetes. Diabetes Technol Ther 2013; 15:538-43. [PMID: 23631608 DOI: 10.1089/dia.2013.0069] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Hypoglycemia is a potentially fatal condition. Continuous glucose monitoring (CGM) has the potential to detect hypoglycemia in real time and thereby reduce time in hypoglycemia and avoid any further decline in blood glucose level. However, CGM is inaccurate and shows a substantial number of cases in which the hypoglycemic event is not detected by the CGM. The aim of this study was to develop a pattern classification model to optimize real-time hypoglycemia detection. MATERIALS AND METHODS Features such as time since last insulin injection and linear regression, kurtosis, and skewness of the CGM signal in different time intervals were extracted from data of 10 male subjects experiencing 17 insulin-induced hypoglycemic events in an experimental setting. Nondiscriminative features were eliminated with SEPCOR and forward selection. The feature combinations were used in a Support Vector Machine model and the performance assessed by sample-based sensitivity and specificity and event-based sensitivity and number of false-positives. RESULTS The best model was composed by using seven features and was able to detect 17 of 17 hypoglycemic events with one false-positive compared with 12 of 17 hypoglycemic events with zero false-positives for the CGM alone. Lead-time was 14 min and 0 min for the model and the CGM alone, respectively. CONCLUSIONS This optimized real-time hypoglycemia detection provides a unique approach for the diabetes patient to reduce time in hypoglycemia and learn about patterns in glucose excursions. Although these results are promising, the model needs to be validated on CGM data from patients with spontaneous hypoglycemic events.
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Affiliation(s)
- Morten Hasselstrøm Jensen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, Aalborg, Denmark.
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Bhide M, Grey JMS, Moser EG, Garg SK. A primary care perspective on the use of continuous glucose monitoring in clinical practice. Diabetes Technol Ther 2013; 15:533-7. [PMID: 23786230 DOI: 10.1089/dia.2013.0169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Nørgaard K, Scaramuzza A, Bratina N, Lalić NM, Jarosz-Chobot P, Kocsis G, Jasinskiene E, De Block C, Carrette O, Castañeda J, Cohen O. Routine sensor-augmented pump therapy in type 1 diabetes: the INTERPRET study. Diabetes Technol Ther 2013; 15:273-80. [PMID: 23438304 PMCID: PMC3696941 DOI: 10.1089/dia.2012.0288] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sensor-augmented pump (SAP) therapy can improve glycemic control, compared with multiple daily insulin injections or with insulin pump therapy alone, without increasing the risk of hypoglycemia. SUBJECTS AND METHODS A 12-month observational study in patients with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII), upon the introduction of continuous glucose monitoring (CGM), was conducted in 15 countries (in Europe and in Israel) to document the real-life use of SAP and assess which variables are associated with improvement in type 1 diabetes management. RESULTS Data from 263 patients (38% male; mean age, 28.0 ± 15.7 years [range, 1-69 years]; body mass index, 23.3 ± 4.9 kg/m(2); diabetes duration, 13.9 ± 10.7 years; CSII duration, 2.6 ± 3 years) were collected. Baseline mean glycated hemoglobin A1c (HbA1c) was 8.1 ± 1.4%; 82% had suboptimal HbA1c (≥ 7%). The average sensor use for 12 months was 30% (range, 0-94%), and sensor use decreased with time (first 3 months, 37%; last 3 months, 27%). Factors associated with improvement in HbA1c after 12 months in patients with baseline HbA1c ≥ 7% were high baseline HbA1c (P<0.001), older age group (P<0.001), and more frequent sensor use (P = 0.047). Significantly less hospitalization, increased treatment satisfaction, and reduced fear of hypoglycemia were reported after 12 months of SAP. CONCLUSIONS This is the largest and longest multicenter prospective observational study providing real-life data on SAP. These results are consistent with those of controlled trials showing the effectiveness of CGM in pump users.
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Jensen MH, Christensen TF, Tarnow L, Mahmoudi Z, Johansen MD, Hejlesen OK. Professional continuous glucose monitoring in subjects with type 1 diabetes: retrospective hypoglycemia detection. J Diabetes Sci Technol 2013; 7:135-43. [PMID: 23439169 PMCID: PMC3692225 DOI: 10.1177/193229681300700116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An important task in diabetes management is detection of hypoglycemia. Professional continuous glucose monitoring (CGM), which produces a glucose reading every 5 min, is a powerful tool for retrospective identification of unrecognized hypoglycemia. Unfortunately, CGM devices tend to be inaccurate, especially in the hypoglycemic range, which limits their applicability for hypoglycemia detection. The objective of this study was to develop an automated pattern recognition algorithm to detect hypoglycemic events in retrospective, professional CGM. METHOD Continuous glucose monitoring and plasma glucose (PG) readings were obtained from 17 data sets of 10 type 1 diabetes patients undergoing insulin-induced hypoglycemia. The CGM readings were automatically classified into a hypoglycemic group and a nonhypoglycemic group on the basis of different features from CGM readings and insulin injection. The classification was evaluated by comparing the automated classification with PG using sample-based and event-based sensitivity and specificity measures. RESULTS With an event-based sensitivity of 100%, the algorithm produced only one false hypoglycemia detection. The sample-based sensitivity and specificity levels were 78% and 96%, respectively. CONCLUSIONS The automated pattern recognition algorithm provides a new approach for detecting unrecognized hypoglycemic events in professional CGM data. The tool may assist physicians and diabetologists in conducting a more thorough evaluation of the diabetes patient's glycemic control and in initiating necessary measures for improving glycemic control.
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Benhamou PY, Catargi B, Delenne B, Guerci B, Hanaire H, Jeandidier N, Leroy R, Meyer L, Penfornis A, Radermecker RP, Renard E, Baillot-Rudoni S, Riveline JP, Schaepelynck P, Sola-Gazagnes A, Sulmont V, Tubiana-Rufi N, Durain D, Mantovani I, Sola-Gazagnes A, Riveline JP. Real-time continuous glucose monitoring (CGM) integrated into the treatment of type 1 diabetes: consensus of experts from SFD, EVADIAC and SFE. DIABETES & METABOLISM 2012; 38 Suppl 4:S67-83. [PMID: 22980520 DOI: 10.1016/s1262-3636(12)71538-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P-Y Benhamou
- Service Endocrinologie-Diabétologie-Nutrition, CHU Grenoble, et Université Grenoble-1, France
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Abstract
Continuing glucose monitoring (CGM) is a relatively new and rapidly developing technology that shows promise for the future management of type 1 diabetes. When used with near-daily frequency, it has a significant effect on improvement of glucose metabolism as measured by HbA1C and reduction of hypoglycemia. It appears to be safe and actually reduces both DKA and severe hypoglycemia. Early studies indicate that it should be cost effective.
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Affiliation(s)
- Robert Henry Slover
- Barbara Davis Center and The Children's Hospital Colorado, University of Colorado, Aurora, CO 80045, USA.
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Pepper GM, Steinsapir J, Reynolds K. Effect of short-term iPRO continuous glucose monitoring on hemoglobin A1c levels in clinical practice. Diabetes Technol Ther 2012; 14:654-7. [PMID: 22690923 DOI: 10.1089/dia.2012.0030] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study determined if short-term (professional) blinded continuous glucose monitoring (CGM) improves hemoglobin A1c levels in a mixed group of patients with type 1 and type 2 diabetes in the clinical setting of an office practice. RESEARCH DESIGN AND METHODS This was a retrospective analysis of 102 consecutive patients with diabetes over the course of 10 months in a subspecialty practice undergoing 3-day blinded CGM using the iPRO(™) device (Medtronic, Northridge, CA). Hemoglobin A1c levels were measured prior to and up to 7 months after the CGM procedure. RESULTS Before blinded CGM the average hemoglobin A1c level was 7.7±1.0%, and after it was 7.8±1.1%. These values are not statistically different. A subgroup analysis of subjects using continuous subcutaneous insulin infusion treatment also failed to show a significant hemoglobin A1c difference pre- and post-CGM. CONCLUSIONS Using the iPro device for short-term (professional) blinded CGM in an office setting to improve hemoglobin A1c levels may not be a feasible goal for patients with type 1 and type 2 diabetes. The expectations of benefit, choice of patient, and choice of technology for short-term CGM are factors requiring careful consideration before testing takes place.
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Affiliation(s)
- Gary M Pepper
- Palm Beach Diabetes and Endocrine Specialists, P.A. 550 Heritage Drive, Jupiter, FL 33458, USA.
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Dungan KM, Han W, Miele A, Zeidan T, Weiland K. Determinants of the accuracy of continuous glucose monitoring in non-critically ill patients with heart failure or severe hyperglycemia. J Diabetes Sci Technol 2012; 6:884-91. [PMID: 22920815 PMCID: PMC3440160 DOI: 10.1177/193229681200600420] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The accuracy of continuous glucose monitoring (CGM) in non-critically ill hospitalized patients with heart failure or severe hyperglycemia (SH) is unknown. METHODS Hospitalized patients with congestive heart failure (CHF) exacerbation (receiving IV or subcutaneous insulin) or SH requiring insulin infusion were compared to outpatients referred for retrospective CGM. RESULTS Forty-three patients with CHF, 15 patients with SH, and 88 outpatients yielded 470, 164, and 2150 meter-sensor pairs, respectively. Admission glucose differed (188 versus 509 mg/dl in CHF and SH, p < .001) but not the first sensor glucose (p = .35). In continuous glucose error grid analysis, 67-78% of pairs during hypoglycemia were in zones A+B (p = .63), compared with 98-100% in euglycemia (p < .001) and 98%, 92%, and 99% (p = .001) during hyperglycemia for the CHF, SH, and outpatient groups, respectively. Mean absolute relative difference (MARD) was lower in the CHF versus the SH group in glucose strata above 100 mg/dl, but there was no difference between the CHF and outpatient groups. Linear regression models showed that CHF versus outpatient, SH versus CHF, and coefficient of variation were significant predictors of higher MARD. Among subjects with CHF, MARD was not associated with brain natriuretic peptide or change in plasma volume, but it was significantly higher in subjects randomized to IV insulin (p = .04). CONCLUSIONS The results suggest that SH and glycemic variability are more important determinants of CGM accuracy than known CHF status alone in hospitalized patients.
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Affiliation(s)
- Kathleen M Dungan
- Division of Endocrinology, Diabetes, and Metabolism, Ohio State University, Columbus, Ohio, USA.
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Sola-Gazagnes A, Vigeral C. Emergent technologies applied to diabetes: what do we need to integrate continuous glucose monitoring into daily practice? Where the long-term use of continuous glucose monitoring stands in 2011. DIABETES & METABOLISM 2012; 37 Suppl 4:S65-70. [PMID: 22208713 DOI: 10.1016/s1262-3636(11)70968-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The earliest continuous glucose monitoring (CGM) devices did not permit real-time readouts of glucose measurements. Instead, they were used to determine the glucose profile of patients in "real life" and as educational tools. In contrast, the latest real-time devices, whether linked or not to an insulin pump, give the patient access to glucose measurements and incorporate alarms that can be set. Thus, they are the newest self-management tools for patients with type 1 diabetes requiring an intensive insulin regimen. Some long-term studies in a selected population of patients with type 1 diabetes have shown improvement of glycaemic control as measured by HbA(1c). Although the characteristics of "responsive" patients have yet to be identified, the ability of the patient to use the system on a near-daily basis (about 80% of the time) is a key point. Initial training of the patient by a professional team with expertise in CGM is also of the utmost importance. To date, CGM is not reimbursed by Social Security in France.
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Affiliation(s)
- A Sola-Gazagnes
- Service de diabétologie, hôpital Hôtel-Dieu, APHP, 1, place du Parvis Notre Dame, 75004 Paris, France.
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