Continuous Glucose Monitoring

Background: Preliminary studies have demonstrated improvement in metabolic control of patients (PTs) using subcutaneous Continuous Glucose Monitoring systems (CGMs). In this study, we investigated the effect of CGMs on PTs’ glycemic control and compared the change in patient HbA1c levels between sensors. Objective: To determine how CGMs affect metabolic control in PTs and the effect of different sensors on glycemic control. Patients and Methods: 33 PTs with Type 1 diabetes mellitus (DM) who began using a CGM between 2017 and 2019 were selected for inclusion. CGM systems used included DexcomG6™, DexcomG5™, DexcomG4™, Enlite™, Guardian 3™, or Medtronic Sure-T™ sensors. Results: The mean (MN) age of PTs at initial visit was 15.3 ± 5.1 yrs and the MN age at second visit was 15.8 ± 5.1 yrs. The MN time between visits was 5.0 ± 2.4 months (mos). 6 PTs had follow up (F/U) times less than 3 mos, 18 PTs had F/U times between 3 and 6 mos, 6 PTs had F/U times between 6 and 9 mos, and 3 PTs had...

The presented case is a 68-year-old female with Type 1 diabetes (T1D). She was admitted for an emergency case with acute distress in January 2018 and was diagnosed with T1D with a blood glucose (BG) level of 459 mg/dL, HbA1c of 13.7%, glutamic acid decarboxylase autoantibody (GADA) level >2000 U/mL (<5 U/mL), and C-reactive protein (CRP) level of 1.10 ng/mL. She received Multiple Daily Injections (MDI) of insulin for 3 months, and then her HbA1c decreased to 7.3%. After that, she has been on a super-low carbohydrate diet (LCD) and received only Lantus XR and ipragliflozin. Serum CRP showed 0.2 ng/mL, suggesting a prolonged honeymoon period for years through continuous LCD.

For type 2 diabetes (T2D), the recommended meal has shifted from calorie restriction (CR) to a low carbohydrate diet (LCD). LCD gained worldwide prevalence through the efforts of Atkins and Bernstein, and we further developed LCD both medically and socially through the Japan LCD Promotion Association (JLCDPA). The beneficial and convenient methods of LCD include petite, standard, and super LCD, which have carbohydrate ratios of 40%, 26%, and 12%, respectively. For these three types, the approximate permitted carbohydrate amounts in each meal appear to be 20g, 30g, and 40g. Some foods with lower carbohydrate content include eggs (0.1g), a piece of cheese (0.2g), chicken meat (180g) (0.4g), and Japanese tofu (300g) (4g).

Type 1 diabetes mellitus is a disease in which the highest rates of premature mortality and early disability of patients are observed, which is caused by the onset of the disease at an early age, the instability of the course of type 1 diabetes and the threat of acute and chronic complications. The goals of type 1 diabetes mellitus treatment are its compensation, prevention of the risk of complications when normoglycemia is reached and stabilized.

Type 1 diabetes mellitus is a disease in which the highest rates of premature mortality and early disability of patients are observed, which is caused by the onset of the disease at an early age, the instability of the course of type 1 diabetes and the threat of acute and chronic complications. The goals of type 1 diabetes mellitus treatment are its compensation, prevention of the risk of complications when normoglycemia is reached and stabilized.

Various discussions have continued concerning low carbohydrate diet (LCD) and calorie restriction (CR). The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have gradually recognized LCD as the recommendation for nutritional treatment. Recent reports have shown the predominance of LCD with clinical evidence from the accumulated data of the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS), with analyses of total LCD scores (TLCDS). Using TLCDS to analyze 139 thousand person-years, the hazard ratio (HR) of total mortality was 0.87 for TLCDS and 0.76 for vegetable (VLCDS). Authors continue developing LCD activities through the Japan LCD Promotion Association (JLCDPA).

Recently, actual changes in blood glucose can be measured by continuous glucose monitoring (CGM) using FreeStyle Libre. The case involves a 67-year-old male patient with type 2 diabetes (T2D) treated with Multiple Daily Insulin (MDI) therapy, who underwent CGM. Analysis of the CGM data revealed that hyperglycemia resulted from increased carbohydrate intake and irregular meal timings and quantities. The estimated HbA1c from CGM was 6.6%, whereas the HbA1c value recorded at the outpatient clinic during the same period was 7.3%. The use of CGM applications encourages diabetic patients to be mindful of their carbohydrate intake in daily life, leading to an increased ratio of time spent in the target range (TIR).

Aims The effects of continuous subcutaneous insulin infusion (CSII) therapy with or without continuous glucose monitoring (CGM) on neonatal outcomes and glycemic outcomes of pregnant women with type 1 diabetes (T1D), living in Poland, were assessed. Methods This prospective observational study enrolled women with T1D (N = 481, aged 18–45 years) who were pregnant or planned pregnancy. All used CSII therapy and a subset used CGM with CSII (CSII + CGM). Neonatal outcomes (e.g., rate of large for gestational age [LGA] delivery [birth weight &gt; 90th percentile]) and maternal glycemia (e.g., HbA1c and percentage of time at sensor glucose ranges) were evaluated. Results Overall HbA1c at trimesters 1, 2, and 3 was 6.8 ± 1.1% (50.9 ± 12.3 mmol/mol, N = 354), 5.8 ± 0.7% (40.1 ± 8.0 mmol/mol, N = 318), and 5.9 ± 0.7% (41.4 ± 8.0 mmol/mol, N = 255), respectively. A HbA1c target of &lt; 6.0% (42 mmol/mol) at each trimester was achieved by 20.9% (74/354), 65.1% (207/318), and 58.0% (148/255), r...

The mechanisms behind the cardiovascular benefits of Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors have not been fully clarified. We aimed to identify potential mechanisms underlying the favorable effects of SGLT2 inhibitors on cardiovascular events. The 50 diabetic patients with established Coronary Artery Disease (CAD) included in this study analysis were administered 10 mg/day of empagliflozin. Cookie meal testing (carbohydrates: 75 g, fat: 28.5 g), endothelial function testing using Flow-Mediated Dilatation (FMD), and body composition evaluation were performed before and after 6 months treatments. Evaluation of changes in % FMD between treatment periods, and its association with metabolic biomarkers were evaluated. Results: After the 6 month treatment, body weight and body fat percentage decreased significantly, while body muscle percentage increased significantly. HbA1C level and fasting and postprandial plasma glucose levels were significantly decreased by treatment. Postprandial insulin secretion was also significantly suppressed and insulin resistance index was significantly decreased. Furthermore, fasting and postprandial triglyceride levels decreased significantly while total ketone body increased significantly after the 6 months treatment. While plasma brain natriuretic peptide level was not changed, C-reactive protein was decreased, and FMD was significantly improved after the 6 months treatment. Multiple regression analysis showed the strongest predictive factor of FMD improvement to be change in fasting and postprandial plasma triglyceride levels. SGLT2 inhibitors improved multiple metabolic parameters. Of these, reduction in plasma triglyceride was strongly associated with endothelial function recovery in diabetic patients with CAD, and this reduction may be related to the cardiovascular benefit of SGLT2 inhibitors.

Cardiovasculary diseases are affecting a constantly growing number of people. Due to this reason we are continously looking for new ways of investigations. The processing of the heart's audio signals also belong to this category. Heart sound is an acoustic wave generated by the mechanical movement of the heart and blood. The sounds can be divided into normal heart sounds and heart murmurs. Murmurs are abnormal signals that appear over wider ranges of frequency than normal heart sounds. The auscultation is a very effective method in detecting heart diseases. Along this paper the authors present the results of the combined time-frequency analysis for short-time periods applied to cardiac signals useful for diagnosis in medical practice.

OBJECTIVE: To determine which of two simplified blood glucose monitoring schemes promotes better metabolic control in type1 diabetic patients during 12 months of participation in educational groups. METHODS: A crossover clinical trial involving 21 patients divided into two groups was conducted. They were submitted to a two monitoring schemes:2 alternate daily preprandial measurements and 2 alternate daily pre-and postprandial measurements. The effectiveness of the schemes was evaluated based on HbA1c. Variations in mean HbA1c were analyzed by Friedman test. RESULTS: The groups were homogenous in terms of sociodemographic and clinical variables…

Background A scoping review from 2021 identified a lack of studies on the incidence, prevention and management of hypoglycaemia in home-dwelling older people with diabetes. The aim of this study was to investigate the frequency and duration of hypoglycaemic episodes measured by continuous glucose monitoring (CGM) in older people with diabetes who received home care and who were treated with glucose-lowering medications, and to compare the frequency and duration of hypoglycaemic episodes between subgroups of the study population according to demographic and clinical variables. Methods This was an observational study investigating the occurrence of hypoglycaemia in people with diabetes aged ≥ 65 years. Data were collected using blinded continuous glucose monitoring (CGM, iPro2) for 5 consecutive days. Frequency and duration of hypoglycaemic episodes were assessed using a sensor glucose cut-off value of 3.9 mmol/L. A blood sample for measurement of HbA1c and creatinine-based eGFR (CKD-...

Use of continuous glucose monitoring (CGM) is recognized as a valuable component of diabetes selfmanagement and is increasingly considered a standard of care for individuals with diabetes who are treated with intensive insulin therapy. As the clinical use of CGM technology expands, consistent and standardized glycemic metrics and glucose profile visualization have become increasingly important. A common set of CGM metrics has been proposed by an international expert panel in 2017, including standard definitions of time in ranges, glucose variability, and adequacy of data collection. We describe the core CGM metrics, as well as the standardized glucose profile format consolidating 2 weeks of CGM measurements, referred to as the ambulatory glucose profile (AGP), which was also recommended by the CGM expert panel. We present an updated AGP report featuring the core CGM metrics and a visualization of glucose patterns that need clinical attention. New tools for use by clinicians and patients to interpret AGP data are reviewed. Strategies based on the authors' experience in implementing CGM technology across the clinical care spectrum are highlighted.

Predicting blood glucose trends and implementing suitable interventions are crucial for managing diabetes. Modern sensor technologies enable the collection of continuous glucose monitoring (CGM) data along with diet and activity records. However, machine learning (ML) techniques are often used for glucose level predictions without explicit physiological interpretation. This study introduces a method to extract physiological insights from MLbased glucose forecasts using constrained programming. A feed-forward neural network (FFNN) is trained for glucose prediction using CGM data, diet, and activity logs. Additionally, a physiological model of glucose dynamics is optimized in tandem with FFNN forecasts using sequential quadratic programming and individualized constraints. Comparisons between the constrained response and ML predictions show higher root mean square error (RMSE) in certain intervals for the constrained approach. Nevertheless, Clarke error grid (CEG) analysis indicates acceptable accuracy for the constrained method. This combined approach merges the generalization capabilities of ML with physiological insights through constrained optimization.

lycosylated haemoglobin is the substance formed when glucose chemically combine with haemoglobin molecule. This study examined glycosylated haemoglobin as a possible surrogate marker for dyslipidemia and glycemic index in type 2 diabetes mellitus subjects. A cross-sectional study was carried out in Warri, Delta State with a total of four hundred (400) volunteers recruited comprising of three hundred and twenty (320) diabetes mellitus subjects and eighty (80) apparently healthy subjects. Standard methods were used for anthropometric measurement and biochemical assays. Data were analyzed using statistical package for social sciences (SPSS). Parameters including Blood pressure, body mass index, fasting blood glucose, glycosylated haemoglobin, total cholesterol, triglycerides, LDL-C were significantly higher in diabetic subjects than non-diabetics while HDL-C was significantly lower in diabetics. Glycosylated haemoglobin is positively correlated with blood glucose, cholesterol, triglycerides, and LDL-C but inversely associated with HDL-C. Based on this study, glycosylated haemoglobin has the potential to serve as surrogate marker of dyslipidemia.

A continuous glucose monitoring (CGM) system was applied using FreeStyle Libre 3 to evaluate glucose variability in response to various food intakes and exercise. The subject was a 45-year-old registered nurse with a BMI of 17.9. When she drank 500 cc of a carbonated beverage containing 23.5 g of sugar, her blood glucose increased acutely. She then exercised by jumping for 3 minutes, after which her glucose levels decreased shortly thereafter. Consumption of pound cake, pork bowl, and corn soup caused a rapid rise in blood glucose. She consistently follows a standard low-carbohydrate diet (LCD) and consumes only 15 g of nuts and soybeans for lunch, during which her blood glucose does not increase. Appropriate CGM application significantly contributes to overall well-being.

This study aimed to develop a paper-based glucose sensor using artificial sweat and saliva samples, a non-invasive, practical, and affordable concept for measuring glucose levels. The chosen method was the colorimetric method using the Glucose Oxidase (GOx) enzyme, Horseradish Peroxidase (HRP) enzyme, and 3,3′-diaminobenzidine (DAB) chromogen. The wax stamping method was utilized on a piece of filter paper to test the glucose sensor. The test was carried out in several stages, including testing various concentrations of reagents and wax stamping sizes, fabricating the glucose sensors, and testing multiple concentrations of glucose, artificial sweat, and artificial saliva. The RGB method was used to test the resulting color. The data obtained were then validated using UV-Vis Spectrophotometry. The GOx concentration on the glucose sensor affected the color change velocity. The HRP, DAB, and wax stamping size concentration simultaneously indicated a strong correlation with changes in the color intensity that appeared on the glucose sensor. The glucose sensor in this study could measure the glucose concentration of the artificial sweat and saliva samples, respectively, from 0-3000 μM with R 2 = 0.9862 and 0.9987. This study proved a strong correlation between the reagents' concentration and the color intensity on the developed glucose sensor.

Objetivo: Verificar se leituras de continuous glucose monitoring (CGM, monitoramento contínuo da glicose) anormais (hipoglicemia/hiperglicemia) podem prever o aparecimento de diabetes relacionado à fibrose cística (DRFC) e/ou comprometimento clínico (declínio do IMC e/ou do VEF 1 ) em pacientes pediátricos com fibrose cística (FC). Métodos: Estudo de coorte longitudinal prospectivo envolvendo pacientes com FC sem diabetes no início do estudo. O tempo médio de acompanhamento foi de 3,1 anos. Os pacientes foram submetidos a CGM de três dias, teste oral de tolerância à glicose (TOTG) e medida de VEF 1 e IMC no início do estudo. TOTG, VEF 1 e IMC foram reavaliados ao final do acompanhamento. Resultados: Trinta e nove pacientes com FC (10-19 anos de idade) apresentaram leituras de CGM válidas no início do estudo, e 34 completaram o acompanhamento (média = 3,1 ± 0,5 anos). Nenhuma das variáveis estudadas previu evolução para DRFC ou apresentou associação com eventos hipoglicêmicos. O CGM conseguiu detectar anormalidades glicêmicas não reveladas pelo TOTG. Pacientes com níveis de glicose ≥ 140 mg/dL no CGM, comparados àqueles com níveis menores, apresentaram valores de IMC e escores z de IMC menores no início do estudo -17,30

Background: Use of telemedicine for children and adolescents with type 1 diabetes at the beginning of the COVID-19 pandemic was investigated. Method: 68 Italian pediatric diabetes centers were invited to complete a survey about telemedicine usage in their pediatric patients, allocated to the no-tech group (multiple daily injections and self-monitoring blood glucose) and the tech group (insulin pump and/or flash- or continuous-glucose monitoring). Results: 60.3% of the centers completed the survey. In both the no-tech and tech groups, the most used ways of communication were generic download portals, instant messaging with personal physicians’ mobiles, working emails, and phone calls to physicians’ mobiles, with no difference, except for the use of email being higher in the no-tech group (p = 0.03). Seventy-four percent of the centers did not have any systematization and/or reimbursement, with significant differences among regions (p = 0.03). Conclusions: Almost all Italian pediatric...

Cystic fibrosis related diabetes (CFRD) is a comorbidity of cystic fibrosis (CF) that negatively impacts on its clinical course. Prediabetes is an important predictor of either CFRD development and unfavorable prognosis of CF in both pediatric and adult patients. International guidelines recommend insulin only in case of CFRD diagnosis. Whether early detection and treatment of prediabetes may contribute to improve the clinical course of CF is still debated. A subgroup of pediatric diabetologists of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) performed a systematic review of the literature based on predefined outcomes: impact of pre-diabetes on clinical outcomes and on the risk of developing CFRD; diagnosis of diabetes and pre-diabetes under 10 years of age; effectiveness of therapy on glycemic control, impact of therapy on pulmonary function and nutritional status. Thirty-one papers were selected for the analysis data presented in these papers were report...

Background: Diabetes mellitus, particularly type 2 diabetes (T2DM), is a chronic disease associated with serious complications, such as heart disease, kidney failure, and blindness. Continuous glucose monitoring (CGM) systems have emerged as a more effective alternative to traditional fingerstick testing, offering patients greater control over their condition. Despite their potential benefits, several barriers to CGM sensor use persist, limiting their widespread adoption among patients with T2DM. This review explores the barriers to CGM sensor use, particularly from the patient's perspective. Methods: A systematic literature review is conducted following PRISMA guidelines. The search focuses on studies published between January 2018 and June 2024 and is performed in two primary databases, PubMed and Scopus, selected for their relevance to T2DM research. Studies are included if they explore challenges and barriers to CGM adoption, report patient perspectives, or provide insights into the usability and accessibility of technology. The data are analyzed using deductive content analysis, applying Wilson et al. 's thematic categories as a predefined framework to systematically classify and interpret barriers to CGM adoption. This approach ensures methodological consistency and alignment with existing research on eHealth adoption challenges. Results: The review identifies several key barriers to CGM sensor use despite the benefits, such as improved glucose control and reduced hypoglycemic events. Major challenges include the high cost of sensors, wearability issues, discomfort from adhesive materials, and concerns about the visibility of the sensors. Additionally, patients report difficulties in interpreting the large volumes of data generated by CGM systems, as well as discomfort or fear related to sensor insertion. Lack of technological support, low health literacy, and insufficient social support are also identified as factors contributing to non-adoption. Conclusions: Policymakers and healthcare providers are encouraged to address these barriers by developing patient-centered strategies that support the adoption of CGM sensors. Successfully overcoming these challenges can further support integrating CGM sensors with the Chronic Care Model and Automated Insulin Delivery systems. As an implication, this integration has the potential to enhance glycemic control and improve patient quality of life in the management of T2DM. Furthermore, addressing these barriers may drive advancements in sensor design, improve accessibility, and minimize the environmental impact of CGM sensor use.

The high need for optimal diabetes management among an ever-increasing number of patients dictates the development and implementation of new digital sensors for continuous glucose monitoring. The purpose of this work is to systematize the global patenting trends of digital sensors for continuous glucose monitoring and analyze their effectiveness in controlling the treatment of diabetes patients of different ages and risk groups. The Lens database was used to build the patent landscape of sensors for continuous glucose monitoring. Retrospective analysis showed that the patenting of sensors for continuous glucose monitoring had positive trend over the analyzed period (2000–2022). Leading development companies are Dexcom Inc., Abbott Diabetes Care Inc., Medtronic Minimed Inc., Roche Diabetes Care Inc., Roche Diagnostics Operations Inc., Roche Diabetes Care Gmbh, and Ascensia Diabetes Care Holdings Ag, among others. Since 2006, a new approach has emerged where digital sensors are used f...

A hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA). First, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory facto...

The benefits of continuous glucose monitoring (CGM) in diabetes management are extensively documented. Yet, the broader adoption of CGM systems is limited by their cost and invasiveness. Current CGM devices, requiring implantation or the use of hypodermic needles, fail to offer a convenient solution. We have demonstrated that magnetohydrodynamics (MHD) is effective at extracting dermal interstitial fluid (ISF) containing glucose, without the use of needles. Here we present the first study of ISF sampling with MHD for glucose monitoring in humans. We conducted 10 glucose tolerance tests on 5 healthy volunteers and obtained a significant correlation between the concentration of glucose in ISF samples extracted with MHD and capillary blood glucose samples. Upon calibration and time lag removal, the data indicate a Mean Absolute Relative Difference (MARD) of 12.9% and Precision Absolute Relative Difference of 13.1%. In view of these results, we discuss the potential value and limitation...

Laser-induced graphene (LIG) has emerged as a versatile platform for fabricating graphene-based sensors, offering efficient production and precise control over structural properties. While most LIG-based sensors have been developed on polyimide substrates, their performance on textile platforms remains underexplored. This study investigates the material properties and performance of a flexible electrochemical biosensor fabricated on a Kevlar textile for non-invasive glucose detection. The biosensor incorporates LIG electrodes functionalized with glucose oxidase (GOx) immobilized in a polyvinyl alcohol (PVA) matrix, along with Prussian Blue (PB) as an electron mediator to enhance electron transfer efficiency. A Silver/Silver Chloride (Ag/AgCl) reference electrode was integrated to ensure stable potential measurements. The electrochemical performance was evaluated using cyclic voltammetry (CV) and chronoamperometry (CA), confirming the sensor's sensitivity and stability across physiological glucose concentrations. The biosensor demonstrated a linear glucose detection range from 0.01 to 2 mM, a sensitivity of 1.85 μA·mM⁻¹, and a calculated limit of detection of 0.0573 mM. This work highlights the feasibility of textile-based laser-induced graphene sensors as a non-invasive glucose monitoring solution for diabetic care.

Hypoglycemia can lead to seizures, unconsciousness, or death. Insulin pump treatment reduces the frequency of severe hypoglycemia compared with multiple daily injections treatment. The addition of a continuous glucose monitor, so-called sensor-augmented pump (SAP) treatment, has the potential to further limit the duration and severity of hypoglycemia as the system can detect and in some systems act on impending and prevailing low blood glucose levels. In this narrative review we summarize the available knowledge on SAPs with and without automated insulin suspension, in relation to hypoglycemia prevention. We present evidence from randomized trials, observational studies, and meta-analyses including nonpregnant individuals with type 1 diabetes mellitus. We also outline concerns regarding SAPs with and without automated insulin suspension. There is evidence that SAP treatment reduces episodes of moderate and severe hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that SAPs both with and without automated suspension reduces the frequency of severe hypoglycemic events compared with insulin pumps without continuous glucose monitoring.

Background: The aim was to compare the accuracy of the Dexcom Ò G4 Platinum continuous glucose monitor (CGM) sensor inserted on the upper arm and the abdomen in adults. Methods: Fourteen adults with type 1 diabetes wore two CGMs, one placed on the upper arm and one placed on the abdomen. Three in-clinic visits of 5 h with YSI (2300 STAT, Yellow Springs Instrument) measurements as comparator were performed. Each visit was followed by 4 days with seven-point self-monitoring of blood glucose (SMBG) in free-living conditions. Accuracy analyses on the paired CGM-YSI and CGM-SMBG measurements of the two CGM sensors were performed. Results: Using YSI as comparator, the overall Mean Absolute Relative Difference (MARD) for the CGM abd was 12.3% and CGM arm was 12.0%. The percentage of the CGM measurements in zone A of Clarke error grid analysis for the CGM abd was 85.6% and CGM arm was 86.0%. The hypoglycemia sensitivity for the CGM abd and CGM arm was 69.3%. Using SMBG as comparator, the overall MARD for the CGM abd was 12.5% and CGM arm was 12.0%. The percentage of the CGM measurements in zone A for the CGM abd was 84.1% and the CGM arm was 85.0%. The hypoglycemia sensitivity for the CGM abd was 60.0% and the CGM arm was 71.1%. All the Pvalues from the comparisons between the accuracy of CGM abd and CGM arm were >0.05. The accuracy of a Dexcom G4 Platinum CGM sensor placed on the upper arm was not different from the accuracy of the sensor placed on the abdomen in adults with type 1 diabetes.

The management of diabetes has been revolutionized by the introduction of novel technological treatments and modalities of care, such as continuous glucose monitoring, insulin pump therapy, and telehealth. While these technologies have demonstrated improvement in health outcomes, it remains unclear whether they have reduced inequities from racial/ethnic minority or socioeconomic status. We review the current literature to discuss evidence of benefit, current limitations, and future opportunities of diabetes technologies. Findings While there is ample evidence of the health and psychological benefit of diabetes technologies in large populations of people with type 1 and type 2 diabetes, there remain wide disparities in the use of diabetes technologies, which may be perpetuating or widening inequities. Multilevel barriers include inequitable prescribing practices, lack of support for social determinants of health, mismatch of patient preferences and care models, and cost. Summary We provide a review of disparities in diabetes technology use, possible root causes of continued inequity in outcomes, and insight into ways to overcome remaining gaps. This article is part of the Topical collection on Psychosocial Aspects

Background: General Practice Optimising Structured Monitoring to Improve Clinical Outcomes in Type 2 Diabetes (GP-OSMOTIC) is a multicentre, individually randomised controlled trial aiming to compare the use of intermittent retrospective continuous glucose monitoring (r-CGM) to usual care in patients with type 2 diabetes attending general practice. The study protocol was published in the British Medical Journal Open and described the principal features of the statistical methods that will be used to analyse the trial data. This paper provides greater detail on the statistical analysis plan, including background and justification for the statistical methods chosen, in accordance with SPIRIT guidelines. Objective: To describe in detail the data management process and statistical methods that will be used to analyse the trial data. Methods: An overview of the trial design and primary and secondary research questions are provided. Sample size assumptions and calculations are explained, and randomisation and data management processes are described in detail. The planned statistical analyses for primary and secondary outcomes and sub-group analyses are specified along with the intended table layouts for presentation of the results. In accordance with best practice, all analyses outlined in the document are based on the aims of the study and have been pre-specified prior to the completion of data collection and outcome analyses.

Optimal glycaemia can reduce type 2 diabetes (T2D) complications. Observing retrospective continuous glucose monitoring (r-CGM) patterns may prompt therapeutic changes but evidence for r-CGM use in T2D is limited. We describe the protocol for a randomised controlled trial (RCT) examining intermittent r-CGM use (up to 14 days every three months) in T2D in general practice (GP). General Practice Optimising Structured MOnitoring To achieve Improved Clinical Outcomes is a two-arm RCT asking &#39;does intermittent r-CGM in adults with T2D in primary care improve HbA1c?&#39; Absolute difference in mean HbA1c at 12 months follow-up between intervention and control arms. (a) r-CGM per cent time in target (4-10 mmol/L) range, at baseline and 12 months; (b) diabetes-specific distress (Problem Areas in Diabetes). Aged 18-80 years, T2D for ≥1 year, a (past month) HbA1c&gt;5.5 mmol/mol (0.5%) above their individualised target while prescribed at least two non-insulin hypoglycaemic therapies and/...

Estimation of future glucose concentration is important for diabetes management. To develop a model predictive control (MPC) system that measures the glucose concentration and automatically inject the amount of insulin needed to keep the glucose level within its normal range, the accuracy of the predicted glucose level and the longer prediction time are major factors affecting the performance of the control system. The predicted glucose values can be used for early hypoglycemic/hyperglycemic alarms for adjustment of insulin injections or insulin infusion rates of manual or automated pumps. Recent developments in continuous glucose monitoring (CGM) devices open new opportunities for glycemia management of diabetic patients. In this article a new technique, which uses a recurrent neural network (RNN) and data obtained from CGM device, is proposed to predict the future values of the glucose concentration for prediction horizons (PH) of 15, 30, 45, 60 minutes. The results of the proposed technique is evaluated and compared relative to that obtained from a feed forward neural network prediction model (NNM). Our results indicate that, the RNN is better in prediction than the NNM for the relatively long prediction horizons.

  Modern glycemic monitoring systems make it easier for doctors and nurses to manage diabetic patients on intravenous insulin therapy in hospital wards and intensive care units (ICU). But one of the most important questions - is it safe for inpatients and usable and cost-effective for hospitals?In our study, we included 1,684 glucometer measurements and 72 cycles (1 cycle = 6 days) of the glycemic monitoring system (Guardian Connect Enlite, Medtronic) in patients on intravenous insulin therapy. Most of them were after pancreatectomy. The mean discrepancy between CGM and glucometer values was -4.1%. According to our study, 77.48% of patients were within the target glycemic range (77.4 mg/dL to 189 mg/dL / 4.3 mmol/L to 10.5 mmol/L), hypoglycemia below 50.4 mg/dL / 2.3 mmol/L was recorded in only 2 cases out of 1648. Results confirm safety and usefulness of glucose monitoring systems in-hospital even in the most severe patients, such as those who were in several days after total pancr...

Background: Sensors detect the rate and direction of glucose trend. They need to be accurate and reproducible as could be evidenced by strong agreement between multiple sensors. We evaluated this relationship through simultaneously worn glucose sensors using several methods of slope analysis. Methods: Ten type 1 diabetic, insulin pump-treated subjects were studied while simultaneously wearing three CGMS® Gold sensors each. Sensors were placed in the right abdomen (reference), left abdomen, and left upper arm. Sensors were calibrated and chronologically aligned. Data were only interpreted and included if there were 24 hours of data simultaneously obtained from all three sensors. Results: Using a two-point derived slope, increasing the duration of the trend from 5 to 60 minutes improved agreement between sensors. Using a 20-minute rolling average trend (using every 5-minute glucose value during the 20 minutes) improved the agreement to 94.3%. Finally, using whichever of the two compar...

Inzucchi received research funding from Eli Lilly Co. and honoraria for speaking engagements from Novo Nordisk, manufacturers of insulin products, including those used in the hospital setting. He has also served as a consultant to Medtronic, a manufacturer of glucose sensors with potential use in the hospital setting.

Background: The safety and effectiveness of the in-home use of a hybrid closed-loop (HCL) system that automatically increases, decreases, and suspends insulin delivery in response to continuous glucose monitoring were investigated. Methods: Adolescents (n = 30, ages 14-21 years) and adults (n = 94, ages 22-75 years) with type 1 diabetes participated in a multicenter (nine sites in the United States, one site in Israel) pivotal trial. The Medtronic MiniMed Ò 670G system was used during a 2-week run-in phase without HCL control, or Auto Mode, enabled (Manual Mode) and, thereafter, with Auto Mode enabled during a 3-month study phase. A supervised hotel stay (6 days/5 nights) that included a 24-h frequent blood sample testing with a reference measurement (i-STAT) occurred during the study phase. Results: Adolescents (meanstandard deviation [SD] 16.5 -2.29 years of age and 7.7 -4.15 years of diabetes) used the system for a median 75.8% (interquartile range [IQR] 68.0%-88.4%) of the time (2977 patient-days). Adults (mean -SD 44.6 -12.79 years of age and 26.4 -12.43 years of diabetes) used the system for a median 88.0% (IQR 77.6%-92.7%) of the time (9412 patient-days). From baseline run-in to the end of study phase, adolescent and adult HbA 1c levels decreased from 7.7% -0.8% to 7.1% -0.6% (P < 0.001) and from 7.3% -0.9% to 6.8% -0.6% (P < 0.001, Wilcoxon signed-rank test), respectively. The proportion of overall in-target (71-180 mg/dL) sensor glucose (SG) values increased from 60.4% -10.9% to 67.2% -8.2% (P < 0.001) in adolescents and from 68.8% -11.9% to 73.8% -8.4% (P < 0.001) in adults. During the hotel stay, the proportion of in-target i-STAT Ò blood glucose values was 67.4% -27.7% compared to SG values of 72.0% -11.6% for adolescents and 74.2% -17.5% compared to 76.9% -8.3% for adults. There were no severe hypoglycemic or diabetic ketoacidosis events in either cohort.

From early May 2009, the novel influenza A (H1N1) pandemic affected mainland China. Of those infected, a small proportion of patients developed acute respiratory distress syndrome (ARDS) so rapidly and severely that conventional ventilation treatment was ineffective. As an alternative treatment, the effect of extracorporeal membrane oxygenation (ECMO) was evaluated. From November 2009 to January 2010, all patients suffering from influenza A (H1N1)‐associated ARDS referred to Beijing Anzhen Hospital for treatment with ECMO were enrolled. We describe the characteristics, treatment, and outcomes of these patients at 1‐ and 3‐month follow‐up. Nine patients (four females; mean age, 31.2 [21–59] years) from four centers were enrolled. All females had a history of recent pregnancy or had recently given birth. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a mean partial pressure of arterial oxygen/fraction of inspired oxygen of 52....

It is estimated that in the UK alone there are 2.6 million people diagnosed with diabetes and a further half a million unknown people with diabetes. Although diabetes is seen across all ethnic groups it is more common in those of Afro-Caribbean populations living in the UK. One of the most common complications of diabetes is diabetic retinopathy, which features in a third of the population of those affected by the condition. This article will give a brief overview of diabetes and then it will focus on diabetic retinopathy, and will conclude with a case study.

7 ES P E Poster presented at: INTRODUCTİON ➢ The most common type of diabetes in childhood is type 1 diabetes. The group of diabetes called MODY (maturity onset diabetes of the young) is much more rare. ➢ Mutations that occur in the MODY 2 glucokinase gene cause disruption in the perception of the resultant glucose level and, consequently, impaired insulin release, leading to the development of diabetes. ➢ Because of mild, non-progressive hyperglycemia, medical treatment is rarely recommended to the patients. ➢ In our clinic, we performed continuous glucose monitoring (CGM) in 8 patients who were diagnosed with MODY 2 by genetic analysis. With this study we aim to reveal the presence of hyperglycaemic periods in a day. Continuous Glucose Monitoring Results of Our Cases With MODY Type 2 Diabetes

This longitudinal cohort study examines the effects of combined lifestyle modifications (LM) and pharmacotherapy on glycemic variability (GV) in adults recently diagnosed with type 2 diabetes mellitus (T2DM). A 12-month follow-up of 150 participants (aged 30–60) stratified into three intervention groups—LM only, pharmacotherapy only, and combined therapy—revealed that the combined approach yielded the most significant reductions in GV metrics, including mean amplitude of glycemic excursions (MAGE: -34%) and coefficient of variation (CV: -18%), compared to either intervention alone. Superior outcomes were linked to strict adherence to dietary and physical activity recommendations. The findings underscore the importance of integrated therapeutic strategies in early T2DM management to mitigate glucose fluctuations and potentially reduce complication risks

Hyperglycemia is very common in critically ill patients and interventional studies of intensive insulin therapy with the goal of returning ICU glycemia to normal levels have demonstrated mixed results. A large body of literature has demonstrated that diabetes, per se, is not independently associated with increased risk of mortality in this population and that the relationship of glucose metrics to mortality is different for patients with and without diabetes. Moreover, these relationships are confounded by preadmission glycemia; in this regard, patients with diabetes and good preadmission glucose control, as reflected by HbA1c levels obtained at the time of ICU admission, are similar to patients without diabetes. These data point the way toward an era when blood glucose targets in the ICU will be "personalized," based on assessment of preadmission glycemia.