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Chimatapu SN, Mittelman SD, Habib M, Osuna-Garcia A, Vidmar AP. Wearable Devices Beyond Activity Trackers in Youth With Obesity: Summary of Options. Child Obes 2024; 20:208-218. [PMID: 37023409 PMCID: PMC10979694 DOI: 10.1089/chi.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Background: Current treatment protocols to prevent and treat pediatric obesity focus on prescriptive lifestyle interventions. However, treatment outcomes are modest due to poor adherence and heterogeneity in responses. Wearable technologies offer a unique solution as they provide real-time biofeedback that could improve adherence to and sustainability of lifestyle interventions. To date, all reviews on wearable devices in pediatric obesity cohorts have only explored biofeedback from physical activity trackers. Hence, we conducted a scoping review to (1) catalog other biofeedback wearable devices available in this cohort, (2) document various metrics collected from these devices, and (3) assess safety and adherence to these devices. Methods: This scoping review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Fifteen eligible studies examined the use of biofeedback wearable devices beyond activity trackers in pediatric cohorts, with an emphasis on feasibility of these devices. Results: Included studies varied in sample sizes (15-203) and in ages 6-21 years. Wearable devices are being used to capture various metrics of multicomponent weight loss interventions to provide more insights about glycemic variability, cardiometabolic function, sleep, nutrition, and body fat percentage. High safety and adherence rates were reported among these devices. Conclusions: Available evidence suggests that wearable devices have several applications aside from activity tracking, which could modify health behaviors through real-time biofeedback. Overall, these devices appear to be safe and feasible so as to be employed in various settings in the pediatric age group to prevent and treat obesity.
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Affiliation(s)
- Sri Nikhita Chimatapu
- Division of Endocrinology, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Steven D. Mittelman
- Division of Endocrinology, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Manal Habib
- Division of Endocrinology, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Antonia Osuna-Garcia
- Department of Health and Life Sciences Librarian, Nursing, Biomedical Library, University of California Los Angeles, Los Angeles, CA, USA
| | - Alaina P. Vidmar
- Center for Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Jeeyavudeen MS, Crosby M, Pappachan JM. Continuous glucose monitoring metrics in pregnancy with type 1 diabetes mellitus. World J Methodol 2024; 14:90316. [PMID: 38577196 PMCID: PMC10989406 DOI: 10.5662/wjm.v14.i1.90316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
Managing diabetes during pregnancy is challenging, given the significant risk it poses for both maternal and foetal health outcomes. While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests, the advent of continuous glucose monitoring (CGM) systems has revolutionized the approach. These devices offer a safe and reliable means of tracking glucose levels in real-time, benefiting both women with diabetes during pregnancy and the healthcare providers. Moreover, CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes, especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device. Such a combined approach has been demonstrated to improve overall blood sugar control, lessen the occurrence of preeclampsia and neonatal hypoglycaemia, and minimize the duration of neonatal intensive care unit stays. This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.
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Affiliation(s)
| | - Mairi Crosby
- Department of Endocrinology and Metabolism, University Hospitals of Edinburgh, Edinburgh EH16 4SA, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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3
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Antonova IV, Ivanov AI, Shavelkina MB, Poteryayev DA, Buzmakova AA, Soots RA. Engineering of graphene-based composites with hexagonal boron nitride and PEDOT:PSS for sensing applications. Phys Chem Chem Phys 2024; 26:7844-7854. [PMID: 38376373 DOI: 10.1039/d3cp05953g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
A unique nanomaterial has been developed for sweat analysis, including glucose level monitoring. Simple resusable low-cost sensors from composite materials based on graphene, hexagonal boron nitride, and conductive PEDOT:PSS (poly(3,4-ethylenedioxythiophene)polystyrene sulfonate) polymer have been developed and fabricated via 2D printing on flexible substrates. The sensors were tested as biosensors using different water-based solutions. A strong increase in the current response (several orders of magnitude) was observed for aqua vapors or glucose solution vapors. This property is associated with the sorption capacity of graphene synthesized in a volume of plasma jets and thus having many active centers on the surface. The structure and properties of graphene synthesized in a plasma are different from those of graphene created by other methods. As a result, the current response for a wearable sensor is 3-5 orders of magnitude higher for the reference blood glucose concentration range of 4-14 mM. It has been found that the most promising sensor with the highest response was fabricated based on the graphene:PEDOT:PSS composite. The graphene:h-BN:PEDOT:PSS (h-BN is hexagonal boron nitride) sensors demonstrated a longer response and the highest response after the functionalization of the sensors with a glucose oxidase enzyme. The reusable wearable graphene:PEDOT:PSS glucose sensors on a paper substrate demonstrated a current response of 10-10 to 10-5 A for an operating voltage of 0.5 V and glucose range of 4-10 mM.
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Affiliation(s)
- Irina V Antonova
- Rzhanov Institute of Semiconductor Physics SB RAS, 13 Lavrentiev Av., Novosibirsk 630090, Russia.
- Department of Semiconductor Devices and Microelectronics, Novosibirsk State Technical University, 20 K. Marx Str., Novosibirsk 630073, Russia
| | - Artem I Ivanov
- Rzhanov Institute of Semiconductor Physics SB RAS, 13 Lavrentiev Av., Novosibirsk 630090, Russia.
| | - Marina B Shavelkina
- Joint Institute for High Temperatures RAS, Izhorskaya Str. 13 Bd.2, Moscow 125412, Russia
| | - Dmitriy A Poteryayev
- Rzhanov Institute of Semiconductor Physics SB RAS, 13 Lavrentiev Av., Novosibirsk 630090, Russia.
- Department of Semiconductor Devices and Microelectronics, Novosibirsk State Technical University, 20 K. Marx Str., Novosibirsk 630073, Russia
| | - Anna A Buzmakova
- Department of Semiconductor Devices and Microelectronics, Novosibirsk State Technical University, 20 K. Marx Str., Novosibirsk 630073, Russia
| | - Regina A Soots
- Rzhanov Institute of Semiconductor Physics SB RAS, 13 Lavrentiev Av., Novosibirsk 630090, Russia.
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4
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Obeagu EI. Red blood cells as biomarkers and mediators in complications of diabetes mellitus: A review. Medicine (Baltimore) 2024; 103:e37265. [PMID: 38394525 DOI: 10.1097/md.0000000000037265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Red blood cells (RBCs), traditionally recognized for their oxygen transport role, have garnered increasing attention for their significance as crucial contributors to the pathophysiology of diabetes mellitus. In this comprehensive review, we elucidate the multifaceted roles of RBCs as both biomarkers and mediators in diabetes mellitus. Amidst the intricate interplay of altered metabolic pathways and the diabetic milieu, RBCs manifest distinct alterations in their structure, function, and lifespan. The chronic exposure to hyperglycemia induces oxidative stress, leading to modifications in RBC physiology and membrane integrity. These modifications, including glycation of hemoglobin (HbA1c), establish RBCs as invaluable biomarkers for assessing glycemic control over extended periods. Moreover, RBCs serve as mediators in the progression of diabetic complications. Their involvement in vascular dysfunction, hemorheological changes, and inflammatory pathways contributes significantly to diabetic microangiopathy and associated complications. Exploring the therapeutic implications, this review addresses potential interventions targeting RBC abnormalities to ameliorate diabetic complications. In conclusion, comprehending the nuanced roles of RBCs as biomarkers and mediators in diabetes mellitus offers promising avenues for enhanced diagnostic precision, therapeutic interventions, and improved patient outcomes. This review consolidates the current understanding and emphasizes the imperative need for further research to harness the full potential of RBC-related insights in the realm of diabetes mellitus.
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5
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Lamberti V, Dolci M, Zijlstra P. Continuous Monitoring Biosensing Mediated by Single-Molecule Plasmon-Enhanced Fluorescence in Complex Matrices. ACS NANO 2024. [PMID: 38334312 PMCID: PMC10883122 DOI: 10.1021/acsnano.3c12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Continuous detection of critical markers directly at the point of interest and in undiluted biological fluids represents the next fundamental step in biosensing. The goal of realizing such a platform is utterly challenging because it requires a reversible biosensor that enables the tracking of pico- to nanomolar molecular concentrations over long time spans in a compact device. Here we describe a sensing method based on plasmon-enhanced fluorescence capable of single-molecule detection of unlabeled analyte by employing biofunctionalized gold nanoparticles. The very strong plasmon-enhanced fluorescence signals allow for single-molecule sensing in unaltered biological media, while the use of low-affinity interactions ensures the continuous tracking of increasing and decreasing analyte concentrations with picomolar sensitivity. We demonstrate the use of a sandwich assay for a DNA cancer marker with a limit of detection of picomolar and a time response of 10 min. The enhanced single-molecule signals will allow for miniaturization into a small and cheap platform with multiplexing capability for application in point-of-care diagnostics, monitoring of industrial processes, and safe keeping of the environment.
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Affiliation(s)
- Vincenzo Lamberti
- Eindhoven University of Technology, Department of Applied Physics and Science Education and Institute for Complex Molecular Systems, 5600 MB Eindhoven, The Netherlands
| | - Mathias Dolci
- Eindhoven University of Technology, Department of Applied Physics and Science Education and Institute for Complex Molecular Systems, 5600 MB Eindhoven, The Netherlands
| | - Peter Zijlstra
- Eindhoven University of Technology, Department of Applied Physics and Science Education and Institute for Complex Molecular Systems, 5600 MB Eindhoven, The Netherlands
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Skroce K, Zignoli A, Fontana FY, Maturana FM, Lipman D, Tryfonos A, Riddell MC, Zisser HC. Real World Interstitial Glucose Profiles of a Large Cohort of Physically Active Men and Women. SENSORS (BASEL, SWITZERLAND) 2024; 24:744. [PMID: 38339464 PMCID: PMC10857405 DOI: 10.3390/s24030744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
The use of continuous glucose monitors (CGMs) in individuals living without diabetes is increasing. The purpose of this study was to profile various CGM metrics around nutritional intake, sleep and exercise in a large cohort of physically active men and women living without any known metabolic disease diagnosis to better understand the normative glycemic response to these common stimuli. A total of 12,504 physically active adults (age 40 ± 11 years, BMI 23.8 ± 3.6 kg/m2; 23% self-identified as women) wore a real-time CGM (Abbott Libre Sense Sport Glucose Biosensor, Abbott, USA) and used a smartphone application (Supersapiens Inc., Atlanta, GA, USA) to log meals, sleep and exercise activities. A total of >1 M exercise events and 274,344 meal events were analyzed. A majority of participants (85%) presented an overall (24 h) average glucose profile between 90 and 110 mg/dL, with the highest glucose levels associated with meals and exercise and the lowest glucose levels associated with sleep. Men had higher mean 24 h glucose levels than women (24 h-men: 100 ± 11 mg/dL, women: 96 ± 10 mg/dL). During exercise, the % time above >140 mg/dL was 10.3 ± 16.7%, while the % time <70 mg/dL was 11.9 ± 11.6%, with the remaining % within the so-called glycemic tight target range (70-140 mg/dL). Average glycemia was also lower for females during exercise and sleep events (p < 0.001). Overall, we see small differences in glucose trends during activity and sleep in females as compared to males and higher levels of both TAR and TBR when these active individuals are undertaking or competing in endurance exercise training and/or competitive events.
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Affiliation(s)
- Kristina Skroce
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Supersapiens Inc., Atlanta, GA 30318, USA; (A.Z.); (H.C.Z.)
| | - Andrea Zignoli
- Supersapiens Inc., Atlanta, GA 30318, USA; (A.Z.); (H.C.Z.)
- Department of Industrial Engineering, University of Trento, 38123 Trento, Italy
| | - Federico Y. Fontana
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Felipe M. Maturana
- Sports Medicine Department, University Hospital of Tübingen, 72076 Tübingen, Germany
| | - David Lipman
- Supersapiens Inc., Atlanta, GA 30318, USA; (A.Z.); (H.C.Z.)
| | - Andrea Tryfonos
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institute, 171 77 Stockholm, Sweden;
- School of Science, Department of Life Science, European University Cyprus, Nicosia 1516, Cyprus
| | - Michael C. Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada;
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Nilsen I, Sundbom M, Osterberg J, Laurenius A, Andersson A, Haenni A. Glycemic variability and hypoglycemia before and after Roux-en-Y Gastric Bypass and Sleeve Gastrectomy - A cohort study of females without diabetes. Surg Obes Relat Dis 2024; 20:10-16. [PMID: 37652806 DOI: 10.1016/j.soard.2023.07.008] [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: 02/24/2023] [Revised: 06/05/2023] [Accepted: 07/15/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) lead to lower fasting glucose concentrations, but might cause higher glycemic variability (GV) and increased risk of hypoglycemia. However, it has been sparsely studied in patients without preoperative diabetes under normal living conditions. OBJECTIVES To study 24-hour interstitial glucose (IG) concentrations, GV, the occurrence of hypoglycemia and dietary intake before and after laparoscopic RYGB and SG in females without diabetes. SETTING Outpatient bariatric units at a community and a university hospital. METHODS Continuous glucose monitoring and open-ended food recording over 4 days in 4 study periods: at baseline, during the preoperative low-energy diet (LED) regimen, and at 6 and 12 months postoperatively. RESULTS Of 47 patients included at baseline, 83%, 81%, and 79% completed the remaining 3 study periods. The mean 24-hour IG concentration was similar during the preoperative LED regimen and after surgery and significantly lower compared to baseline in both surgical groups. GV was significantly increased 6 and 12 months after surgery compared to baseline. The self-reported carbohydrate intake was positively associated with GV after surgery. IG concentrations below 3.9 mmol/L were observed in 14/25 (56%) of RYGB- and 9/12 (75%) of SG-treated patients 12 months after surgery. About 70% of patients with low IG concentrations also reported hypoglycemic symptoms. CONCLUSIONS The lower IG concentration in combination with the higher GV after surgery, might create a lower margin to hypoglycemia. This could help explain the increased occurrence of hypoglycemic episodes after RYGB and SG.
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Affiliation(s)
- Inger Nilsen
- Department of Dietetics and Speech Therapy, Mora Hospital, Mora, Sweden; Center for Clinical Research Dalarna, Falun, Sweden; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Johanna Osterberg
- Department of Surgery, Mora Hospital, Mora, Sweden; Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Sweden
| | - Anna Laurenius
- Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Andersson
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Arvo Haenni
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Department of Surgery, Bariatric Unit, Falun Hospital, Falun, Sweden; Department of Diabetes/Endocrinology, University Hospital, Uppsala, Sweden
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8
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Daniali M, Nikfar S, Abdollahi M. Advancements in pharmacotherapy options for treating diabetes in children and adolescents. Expert Rev Endocrinol Metab 2024; 19:37-47. [PMID: 38078451 DOI: 10.1080/17446651.2023.2290491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION This study compares diabetes management between pediatric and adult patients and identifies treatment challenges and gaps. AREAS COVERED We searched PubMed and Clinicaltrails.gov databases for studies published from 2001 to 2023 on diabetes management in different age groups. EXPERT OPINION Research shows children have lower insulin sensitivity, clearance, and β cell function than adults. The US FDA only allows insulin, metformin, and liraglutide as antidiabetic medication options for children. However, some off-label drugs, like meglitinides, sulfonylureas, and alogliptin, have demonstrated positive results in treating certain types of diabetes caused by gene mutations. It's crucial to adopt personalized and precise approaches to managing diabetes in pediatrics, which vary from those used for adult patients. New studies support the classification of type 2 diabetes into several subtypes based on age, BMI, glycemia, homeostasis model estimates, varying insulin resistance, different rates of complications, and islet autoantibodies. With this insight, prevention, treatment, and precision medicine of diabetes might be changed. More research is necessary to assess the safety and efficacy of different antidiabetic drugs and improve diabetes treatment for children and adolescents.
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Affiliation(s)
- Marzieh Daniali
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Personalized Medicine Research Center (PMRC), the Endocrinology and Metabolism Research Institute (EMRI), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, Iran
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Tucker AP, Erdman AG, Schreiner PJ, Ma S, Chow LS. Neural Networks With Gated Recurrent Units Reduce Glucose Forecasting Error Due to Changes in Sensor Location. J Diabetes Sci Technol 2024; 18:124-134. [PMID: 35658633 PMCID: PMC10899835 DOI: 10.1177/19322968221100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 Continuous glucose monitors (CGMs) have become important tools for providing estimates of glucose to patients with diabetes. Recently, neural networks (NNs) have become a common method for forecasting glucose values using data from CGMs. One method of forecasting glucose values is a time-delay feedforward (FF) NN, but a change in the CGM location on a participant can increase forecast error in a FF NN. METHODS In response, we examined a NN with gated recurrent units (GRUs) as a method of reducing forecast error due to changes in sensor location. RESULTS We observed that for 13 participants with type 2 diabetes wearing blinded CGMs on both arms for 12 weeks (FreeStyle Libre Pro-Abbott), GRU NNs did not produce significantly different errors in glucose prediction due to sensor location changes (P < .05). CONCLUSION We observe that GRU NNs can mitigate error in glucose prediction due to differences in CGM location.
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Affiliation(s)
- Aaron P. Tucker
- Earl E. Bakken Medical Devices Center, University of Minnesota, Minneapolis, MN, USA
| | - Arthur G. Erdman
- Earl E. Bakken Medical Devices Center, University of Minnesota, Minneapolis, MN, USA
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Sisi Ma
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lisa S. Chow
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN, USA
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Watkins Z, McHenry A, Heikenfeld J. Wearing the Lab: Advances and Challenges in Skin-Interfaced Systems for Continuous Biochemical Sensing. ADVANCES IN BIOCHEMICAL ENGINEERING/BIOTECHNOLOGY 2024; 187:223-282. [PMID: 38273210 DOI: 10.1007/10_2023_238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Continuous, on-demand, and, most importantly, contextual data regarding individual biomarker concentrations exemplify the holy grail for personalized health and performance monitoring. This is well-illustrated for continuous glucose monitoring, which has drastically improved outcomes and quality of life for diabetic patients over the past 2 decades. Recent advances in wearable biosensing technologies (biorecognition elements, transduction mechanisms, materials, and integration schemes) have begun to make monitoring of other clinically relevant analytes a reality via minimally invasive skin-interfaced devices. However, several challenges concerning sensitivity, specificity, calibration, sensor longevity, and overall device lifetime must be addressed before these systems can be made commercially viable. In this chapter, a logical framework for developing a wearable skin-interfaced device for a desired application is proposed with careful consideration of the feasibility of monitoring certain analytes in sweat and interstitial fluid and the current development of the tools available to do so. Specifically, we focus on recent advancements in the engineering of biorecognition elements, the development of more robust signal transduction mechanisms, and novel integration schemes that allow for continuous quantitative analysis. Furthermore, we highlight the most compelling and promising prospects in the field of wearable biosensing and the challenges that remain in translating these technologies into useful products for disease management and for optimizing human performance.
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Affiliation(s)
- Zach Watkins
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA.
| | - Adam McHenry
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Jason Heikenfeld
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
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González-Pacheco H, Rivero-Santana A, Ramallo-Fariña Y, Valcárcel-Nazco C, Álvarez-Pérez Y, García-Pérez L, García-Bello MA, Perestelo-Pérez L, Serrano-Aguilar P. Effectiveness, safety and costs of the FreeStyle Libre glucose monitoring system for children and adolescents with type 1 diabetes in Spain: a prospective, uncontrolled, pre-post study. BMJ Open 2023; 13:e071334. [PMID: 38097245 PMCID: PMC10729222 DOI: 10.1136/bmjopen-2022-071334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness, safety and costs of FreeStyle Libre (FSL) glucose monitoring system for children and adolescents with type 1 diabetes mellitus (T1DM) in Spain. DESIGN Prospective, multicentre pre-post study. SETTING Thirteen Spanish public hospitals recruited patients from January 2019 to March 2020, with a 12-month follow-up. PARTICIPANTS 156 patients were included. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: glycated haemoglobin (HbA1c) change. Secondary: severe hypoglycaemic events (self-reported and clinical records), quality of life, diabetes treatment knowledge, treatment satisfaction, adverse events, adherence, sensor usage time and scans. Healthcare resource utilisation was assessed for cost analysis from the National Health System perspective, incorporating direct healthcare costs. Data analysis used mixed regression models with repeated measures. The intervention's total cost was estimated by multiplying health resource usage with unit costs. RESULTS In the whole sample, HbA1c increased significantly (0.32%; 95% CI 0.10% to 0.55%). In the subgroup with baseline HbA1c≥7.5% (n=88), there was a significant reduction at 3 months (-0.46%; 95% CI -0.69% to -0.23%), 6 months (-0.49%; 95% CI -0.73% to -0.25%) and 12 months (-0.43%; 95% CI -0.68% to -0.19%). Well-controlled patients had a significant 12-month worsening (0.32%; 95% CI 0.18% to 0.47%). Self-reported severe hypoglycaemia significantly decreased compared with the previous year for the whole sample (-0.37; 95% CI -0.62 to -0.11). Quality of life and diabetes treatment knowledge showed no significant differences, but satisfaction increased. Adolescents had lower sensor usage time and scans than children. Reduction in HbA1c was significantly associated with device adherence. No serious adverse effects were observed. Data suggest that use of FSL could reduce healthcare resource use (strips and lancets) and costs related to productivity loss. CONCLUSIONS The use of FSL in young patients with T1DM was associated with a significant reduction in severe hypoglycaemia, and improved HbA1c levels were seen in patients with poor baseline control. Findings suggest cost savings and productivity gains for caregivers. Causal evidence is limited due to the study design. Further research is needed to confirm results and assess risks, especially for patients with lower baseline HbA1c.
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Affiliation(s)
- Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Cristina Valcárcel-Nazco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Miguel Angel García-Bello
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Lilisbeth Perestelo-Pérez
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
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12
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D’Souza NC, Kesibi D, Yeung C, Shakeri D, D’Souza AI, Macpherson AK, Riddell MC. The Impact of Sex, Body Mass Index, Age, Exercise Type and Exercise Duration on Interstitial Glucose Levels during Exercise. SENSORS (BASEL, SWITZERLAND) 2023; 23:9059. [PMID: 38005447 PMCID: PMC10674905 DOI: 10.3390/s23229059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
The impact of age, sex and body mass index on interstitial glucose levels as measured via continuous glucose monitoring (CGM) during exercise in the healthy population is largely unexplored. We conducted a multivariable generalized estimating equation (GEE) analysis on CGM data (Dexcom G6, 10 days) collected from 119 healthy exercising individuals using CGM with the following specified covariates: age; sex; BMI; exercise type and duration. Females had lower postexercise glycemia as compared with males (92 ± 18 vs. 100 ± 20 mg/dL, p = 0.04) and a greater change in glycemia during exercise from pre- to postexercise (p = 0.001) or from pre-exercise to glucose nadir during exercise (p = 0.009). Younger individuals (i.e., <20 yrs) had higher glucose during exercise as compared with all other age groups (all p < 0.05) and less CGM data in the hypoglycemic range (<70 mg/dL) as compared with those aged 20-39 yrs (p < 0.05). Those who were underweight, based on body mass index (BMI: <18.5 kg/m2), had higher pre-exercise glycemia than the healthy BMI group (104 ± 20 vs. 97 ± 17 mg/dL, p = 0.02) but similar glucose levels after exercise. Resistance exercise was associated with less of a drop in glycemia as compared with aerobic or mixed forms of exercise (p = 0.008) and resulted in a lower percent of time in the hypoglycemic (p = 0.04) or hyperglycemic (glucose > 140 mg/dL) (p = 0.03) ranges. In summary, various factors such as age, sex and exercise type appear to have subtle but potentially important influence on CGM measurements during exercise in healthy individuals.
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Affiliation(s)
- Ninoschka C. D’Souza
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | - Durmalouk Kesibi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | - Christopher Yeung
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | - Dorsa Shakeri
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | | | - Alison K. Macpherson
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | - Michael C. Riddell
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
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13
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Jayakumar A, Gillett ES, Wee CP, Kim A, Vidmar AP. Impact of 8-hour time-limited eating on sleep in adolescents with obesity. J Clin Sleep Med 2023; 19:1941-1949. [PMID: 37477160 PMCID: PMC10620649 DOI: 10.5664/jcsm.10734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
STUDY OBJECTIVES The relationship between time-limited eating (TLE) and sleep quality is a topic of growing interest in the field of chronobiology. Data in adult cohorts shows that TLE may improve sleep quality, but this has not been evaluated in adolescents. The aim of this secondary analysis was to (1) examine the impact of 8-hour TLE on sleep parameters in youth with obesity and (2) explore if there was any association between sleep patterns and glycemic profiles. METHODS Adolescents with obesity were randomized into one of three groups: 8-hour TLE (participants self-selected their eating window) + real-time continuous glucose monitor, 8-hour TLE + blinded continuous glucose monitor, or a prolonged eating window. In the primary analysis, it was found that participants in the real-time continuous glucose monitor group + 8-hour TLE group did not access their continuous glucose monitor data and thus for this analysis the two TLE groups were combined and only completers who had available Pittsburgh Sleep Quality Index (PSQI) data at all three time points were included. Participants completed the PSQI at baseline, week 4, and week 12. Mixed-effects generalized linear regression models were utilized to examine the change in PSQI score and assess association between glycemic variability and PSQI total score overtime by intervention arm. RESULTS The median PSQI total score for the TLE groups (n = 27) was 6 at week 0 (interquartile range = 5 to 10) and 5 at week 12 (interquartile range = 2 to 7). There was no significant difference in the change in total PSQI score or sleep latency between TLE and control over the study period (P > .05). There was no association between PSQI score and change in weight or glycemic profile between groups (all P values > 0.05). CONCLUSIONS These results suggest that in adolescents with obesity, an 8-hour TLE approach did not negatively impact sleep quality or efficiency when compared to a prolonged eating window. The potential effects of TLE on sleep should be further investigated in larger randomized trials. CITATION Jayakumr A, Gillett ES, Wee CP, Kim A, Vidmar AP. Impact of 8-hour time-limited eating on sleep in adolescents with obesity. J Clin Sleep Med. 2023;19(11):1941-1949.
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Affiliation(s)
- Archana Jayakumar
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Emily S. Gillett
- Division of Pediatric Pulmonology and Sleep Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Choo Phei Wee
- Southern California Clinical and Translational Science Institute, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ahlee Kim
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- Center for Endocrinology, Diabetes and Metabolism, Diabetes & Obesity Program, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Alaina P. Vidmar
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- Center for Endocrinology, Diabetes and Metabolism, Diabetes & Obesity Program, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
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14
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Doucet J, Gourdy P, Meyer L, Benabdelmoumene N, Bourdel-Marchasson I. Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities. Clin Interv Aging 2023; 18:1687-1703. [PMID: 37841649 PMCID: PMC10573466 DOI: 10.2147/cia.s423122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
The population of older adults (≥65 years) with type 2 diabetes mellitus (T2DM) is diverse, encompassing individuals with varying functional capabilities, living arrangements, concomitant medical conditions, and life expectancies. Hence, their categorization into different patient profiles (ie, good health, intermediate health, poor health) may aid in clinical decision-making when establishing glycemic goals and pharmacological treatment strategies. Further granularity in assessing each patient profile through interdisciplinary collaboration may also add precision to therapeutic and monitoring decisions. In this review, we discuss with a multidisciplinary approach how to deliver the best benefit from advanced diabetes therapies and technologies to older adults with T2DM according to each patient profile. There remain however several areas that deserve further research in older adults with T2DM, including the efficacy and safety of continuous glucose monitoring and automated insulin delivery systems, the switch to once-weekly insulin, the effectiveness of multidisciplinary care models, and the use of supported telemedicine and remote blood glucose monitoring in the oldest-old (≥85 years) who particularly require the assistance of others.
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Affiliation(s)
- Jean Doucet
- Department of Polyvalent Internal Medicine, Saint Julien Hospital, Rouen University Hospital, Rouen, France
| | - Pierre Gourdy
- Department of Diabetology, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UT3, Toulouse University, Toulouse, France
| | - Laurent Meyer
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Benabdelmoumene
- Department of Internal Medicine and Geriatrics, University Hospital of Marseille, Marseille, France
| | - Isabelle Bourdel-Marchasson
- CNRS, CRMSB, UMR 5536, University of Bordeaux, Bordeaux, France
- University Hospital of Bordeaux, Bordeaux, France
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15
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Vettoretti M, Drecogna M, Del Favero S, Facchinetti A, Sparacino G. A Markov Model of Gap Occurrence in Continuous Glucose Monitoring Data for Realistic in Silico Clinical Trials. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107700. [PMID: 37437469 DOI: 10.1016/j.cmpb.2023.107700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/31/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Continuous glucose monitoring (CGM) sensors measure interstitial glucose concentration every 1-5 min for days or weeks. New CGM-based diabetes therapies are often tested in in silico clinical trials (ISCTs) using diabetes simulators. Accurate models of CGM sensor inaccuracies and failures could help improve the realism of ISCTs. However, the modeling of CGM failures has not yet been fully addressed in the literature. This work aims to develop a mathematical model of CGM gaps, i.e., occasional portions of missing data generated by temporary sensor errors (e.g., excessive noise or artifacts). METHODS Two datasets containing CGM traces collected in 167 adults and 205 children, respectively, using the Dexcom G6 sensor (Dexcom Inc., San Diego, CA) were used. Four Markov models, of increasing complexity, were designed to describe three main characteristics: number of gaps for each sensor, gap distribution in the monitoring days, and gap duration. Each model was identified on a portion of each dataset (training set). The remaining portion of each dataset (real test set) was used to evaluate model performance through a Monte Carlo simulation approach. Each model was used to generate 100 simulated test sets with the same size as the real test set. The distributions of gap characteristics on the simulated test sets were compared with those observed on the real test set, using the two-sample Kolmogorov-Smirnov test and the Jensen-Shannon divergence. RESULTS A six-state Markov model, having two states to describe normal sensor operation and four states to describe gap occurrence, achieved the best results. For this model, the Kolmogorov-Smirnov test found no significant differences between the distribution of simulated and real gap characteristics. Moreover, this model obtained significantly lower Jensen-Shannon divergence values than the other models. CONCLUSIONS A Markov model describing CGM gaps was developed and validated on two real datasets. The model describes well the number of gaps for each sensor, the gap distribution over monitoring days, and the gap durations. Such a model can be integrated into existing diabetes simulators to realistically simulate CGM gaps in ISCTs and thus enable the development of more effective and robust diabetes management strategies.
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Affiliation(s)
- Martina Vettoretti
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy.
| | - Martina Drecogna
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy
| | - Simone Del Favero
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy
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16
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Javanbakht S, Darvishi S, Dorchei F, Hosseini-Ghalehno M, Dehghani M, Pooresmaeil M, Suzuki Y, Ul Ain Q, Ruiz Rubio L, Shaabani A, Hayashita T, Namazi H, Heydari A. Cyclodextrin Host-Guest Recognition in Glucose-Monitoring Sensors. ACS OMEGA 2023; 8:33202-33228. [PMID: 37744789 PMCID: PMC10515351 DOI: 10.1021/acsomega.3c03746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023]
Abstract
Diabetes mellitus is a prevalent chronic health condition that has caused millions of deaths worldwide. Monitoring blood glucose levels is crucial in diabetes management, aiding in clinical decision making and reducing the incidence of hypoglycemic episodes, thereby decreasing morbidity and mortality rates. Despite advancements in glucose monitoring (GM), the development of noninvasive, rapid, accurate, sensitive, selective, and stable systems for continuous monitoring remains a challenge. Addressing these challenges is critical to improving the clinical utility of GM technologies in diabetes management. In this concept, cyclodextrins (CDs) can be instrumental in the development of GM systems due to their high supramolecular recognition capabilities based on the host-guest interaction. The introduction of CDs into GM systems not only impacts the sensitivity, selectivity, and detection limit of the monitoring process but also improves biocompatibility and stability. These findings motivated the current review to provide a comprehensive summary of CD-based blood glucose sensors and their chemistry of glucose detection, efficiency, and accuracy. We categorize CD-based sensors into four groups based on their modification strategies, including CD-modified boronic acid, CD-modified mediators, CD-modified nanoparticles, and CD-modified functionalized polymers. These findings shed light on the potential of CD-based sensors as a promising tool for continuous GM in diabetes mellitus management.
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Affiliation(s)
- Siamak Javanbakht
- Research
Laboratory of Dendrimers and Natural Polymers, Faculty of Chemistry, University of Tabriz, P.O. Box 51666, Tabriz, Iran
| | - Sima Darvishi
- Faculty
of Chemistry, Khajeh Nasir Toosi University, Tehran, Iran
| | - Faeze Dorchei
- Polymer
Institute of the Slovak Academy of Sciences, Dúbravská cesta 9, 845 41 Bratislava, Slovakia
| | | | - Marjan Dehghani
- Department
of Chemistry, Shahid Bahonar University
of Kerman, Kerman 76169, Iran
| | - Malihe Pooresmaeil
- Research
Laboratory of Dendrimers and Natural Polymers, Faculty of Chemistry, University of Tabriz, P.O. Box 51666, Tabriz, Iran
| | - Yota Suzuki
- Department
of Materials and Life Sciences, Faculty of Science and Technology, Sophia University, 7-1, Kioi-cho, Chiyoda-ku, Tokyo 102-8554, Japan
- Graduate
School of Science and Engineering, Saitama
University, Saitama 338-8570, Japan
| | - Qurat Ul Ain
- Department
of Materials Engineering, School of Chemical and Materials Engineering, National University of Sciences and Technology, Islamabad H-12, Pakistan
| | - Leire Ruiz Rubio
- Macromolecular
Chemistry Group (LQM), Department of Physical Chemistry, Faculty of
Science and Technology, University of Basque
Country (UPV/EHU), Leioa 48940, Spain
- Basque
Centre for Materials, Applications and Nanostructures
(BCMaterials), UPV/EHU
Science Park, Leioa 48940, Spain
| | - Ahmad Shaabani
- Faculty
of Chemistry, Shahid Beheshti University, Tehran, Iran
| | - Takashi Hayashita
- Department
of Materials and Life Sciences, Faculty of Science and Technology, Sophia University, 7-1, Kioi-cho, Chiyoda-ku, Tokyo 102-8554, Japan
| | - Hassan Namazi
- Research
Laboratory of Dendrimers and Natural Polymers, Faculty of Chemistry, University of Tabriz, P.O. Box 51666, Tabriz, Iran
- Research
Center for Pharmaceutical Nanotechnology (RCPN), Tabriz University of Medical Science, Tabriz, Iran
| | - Abolfazl Heydari
- Polymer
Institute of the Slovak Academy of Sciences, Dúbravská cesta 9, 845 41 Bratislava, Slovakia
- National
Institute of Rheumatic Diseases, Nábrežie I. Krasku 4782/4, 921 12 Piešt’any, Slovakia
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17
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Lin YK, Agni A, Chuisano S, Fetters MD, Funnell M, Pop-Busui R, DeJonckheere MJ. Patient-Reported Usefulness and Challenges in Using Hypoglycemia-Informing Features of Continuous Glucose Monitors to Manage Hypoglycemia. Sci Diabetes Self Manag Care 2023; 49:229-238. [PMID: 37086168 PMCID: PMC10960636 DOI: 10.1177/26350106231168859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
PURPOSE The purpose of this study series, which involves a questionnaire survey and qualitative interviews, was to (a) evaluate patient-reported usefulness of continuous glucose monitor (CGM) hypoglycemia-informing features and (b) identify challenges in using these features (ie, CGM glucose numbers, trend arrows, trend graphs, and hypoglycemia alarms) during hypoglycemia in adults with type 1 diabetes (T1DM). METHODS A cross-sectional questionnaire survey study was conducted with adults who have T1DM and were using CGMs to assess the perceived usefulness of hypoglycemia-informing features. A semistructured interview study with T1DM CGM-using adults and inductive thematic analysis were subsequently performed to identify challenges in using CGM hypoglycemia-informing features to manage hypoglycemia. RESULTS In the survey study (N = 252), the CGM glucose numbers, trend arrows, trend graphs, and hypoglycemia alarms were found to be very useful by 79%, 70%, 43%, and 64% of participants, respectively. Several challenges in using these features to manage hypoglycemia were identified in the qualitative study (N = 23): (1) hypoglycemia information not fully reliable,; (2) unpredictability of future blood glucose levels, (3) lack of awareness about how information can be used, and (4) disruptions associated with information. CONCLUSIONS Although the majority of T1DM adults found their CGMs' hypoglycemia-informing features helpful, challenges in optimally using these features persisted. Targeted knowledge and behavioral interventions could improve CGM use to reduce hypoglycemia.
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Affiliation(s)
- Yu Kuei Lin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Annika Agni
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Samantha Chuisano
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Mixed Methods Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - Martha Funnell
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Melissa J DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Mixed Methods Program, University of Michigan Medical School, Ann Arbor, Michigan
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18
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Vargas E, Nandhakumar P, Ding S, Saha T, Wang J. Insulin detection in diabetes mellitus: challenges and new prospects. Nat Rev Endocrinol 2023:10.1038/s41574-023-00842-3. [PMID: 37217746 DOI: 10.1038/s41574-023-00842-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Tremendous progress has been made towards achieving tight glycaemic control in individuals with diabetes mellitus through the use of frequent or continuous glucose measurements. However, in patients who require insulin, accurate dosing must consider multiple factors that affect insulin sensitivity and modulate insulin bolus needs. Accordingly, an urgent need exists for frequent and real-time insulin measurements to closely track the dynamic blood concentration of insulin during insulin therapy and guide optimal insulin dosing. Nevertheless, traditional centralized insulin testing cannot offer timely measurements, which are essential to achieving this goal. This Perspective discusses the advances and challenges in moving insulin assays from traditional laboratory-based assays to frequent and continuous measurements in decentralized (point-of-care and home) settings. Technologies that hold promise for insulin testing using disposable test strips, mobile systems and wearable real-time insulin-sensing devices are discussed. We also consider future prospects for continuous insulin monitoring and for fully integrated multisensor-guided closed-loop artificial pancreas systems.
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Affiliation(s)
- Eva Vargas
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ponnusamy Nandhakumar
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Shichao Ding
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Tamoghna Saha
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
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19
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Brinkmann C, Bloch W, Mutinati GC. ELSAH (electronic smart patch system for wireless monitoring of molecular biomarkers for healthcare and wellbeing): definition of possible use cases. Front Bioeng Biotechnol 2023; 11:1166857. [PMID: 37251564 PMCID: PMC10211345 DOI: 10.3389/fbioe.2023.1166857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
The ELSAH (electronic smart patch system for wireless monitoring of molecular biomarkers for healthcare and wellbeing) project has received funding from EU's Horizon 2020 research and innovation program (grant agreement no. 825549). Its aim is to develop a wearable smart patch-based microneedle sensor system that can simultaneously measure several biomarkers in users' dermal interstitial fluid. This system could have several use cases based on continuous glucose and lactate monitoring: early detection of (pre-) diabetes mellitus, increasing physical performance through optimal carbohydrate intake, achieving a healthier lifestyle through behavioral changes based on the interpretation of glucose data, performance diagnostics (lactate threshold test), control of optimal training intensities corresponding with certain lactate levels, or warning of diseases/health threats, such as the metabolic syndrome or sepsis associated with increased lactate levels. The ELSAH patch system has a high potential of increasing health and wellbeing in users.
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Affiliation(s)
- Christian Brinkmann
- Department of Preventive and Rehabilitative Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
- Department of Fitness and Health, IST University of Applied Sciences, Düsseldorf, Germany
| | - Wilhelm Bloch
- Department of Preventive and Rehabilitative Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Giorgio C. Mutinati
- AIT Austrian Institute of Technology GmbH, Center for Health and Bioresources, Molecular Diagnostics, Vienna, Austria
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20
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Chmayssem A, Nadolska M, Tubbs E, Sadowska K, Vadgma P, Shitanda I, Tsujimura S, Lattach Y, Peacock M, Tingry S, Marinesco S, Mailley P, Lablanche S, Benhamou PY, Zebda A. Insight into continuous glucose monitoring: from medical basics to commercialized devices. Mikrochim Acta 2023; 190:177. [PMID: 37022500 DOI: 10.1007/s00604-023-05743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
According to the latest statistics, more than 537 million people around the world struggle with diabetes and its adverse consequences. As well as acute risks of hypo- or hyper- glycemia, long-term vascular complications may occur, including coronary heart disease or stroke, as well as diabetic nephropathy leading to end-stage disease, neuropathy or retinopathy. Therefore, there is an urgent need to improve diabetes management to reduce the risk of complications but also to improve patient's quality life. The impact of continuous glucose monitoring (CGM) is well recognized, in this regard. The current review aims at introducing the basic principles of glucose sensing, including electrochemical and optical detection, summarizing CGM technology, its requirements, advantages, and disadvantages. The role of CGM systems in the clinical diagnostics/personal testing, difficulties in their utilization, and recommendations are also discussed. In the end, challenges and prospects in future CGM systems are discussed and non-invasive, wearable glucose biosensors are introduced. Though the scope of this review is CGMs and provides information about medical issues and analytical principles, consideration of broader use will be critical in future if the right systems are to be selected for effective diabetes management.
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Affiliation(s)
- Ayman Chmayssem
- UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, INSERM, TIMC, VetAgro Sup, 38000, Grenoble, France
| | - Małgorzata Nadolska
- Institute of Nanotechnology and Materials Engineering, Faculty of Applied Physics and Mathematics, Gdansk University of Technology, 80-233, Gdansk, Poland
| | - Emily Tubbs
- Univ. Grenoble Alpes, CEA, INSERM, IRIG, 38000, Grenoble, Biomics, France
- Univ. Grenoble Alpes, LBFA and BEeSy, INSERM, U1055, F-38000, Grenoble, France
| | - Kamila Sadowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4, 02-109, Warsaw, Poland
| | - Pankaj Vadgma
- School of Engineering and Materials Science, Queen Mary University of London, Mile End, London, E1 4NS, UK
| | - Isao Shitanda
- Department of Pure and Applied Chemistry, Faculty of Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
- Research Institute for Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
| | - Seiya Tsujimura
- Japanese-French lAaboratory for Semiconductor physics and Technology (J-F AST)-CNRS-Université Grenoble Alpes-Grenoble, INP-University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8573, Japan
- Division of Material Science, Faculty of Pure and Applied Science, University of Tsukuba, 1-1-1, Tennodai, Ibaraki, Tsukuba, 305-5358, Japan
| | | | - Martin Peacock
- Zimmer and Peacock, Nedre Vei 8, Bldg 24, 3187, Horten, Norway
| | - Sophie Tingry
- Institut Européen Des Membranes, UMR 5635, IEM, Université Montpellier, ENSCM, CNRS, Montpellier, France
| | - Stéphane Marinesco
- Plate-Forme Technologique BELIV, Lyon Neuroscience Research Center, UMR5292, Inserm U1028, CNRS, Univ. Claude-Bernard-Lyon I, 69675, Lyon 08, France
| | - Pascal Mailley
- Univ. Grenoble Alpes, CEA, LETI, 38000, Grenoble, DTBS, France
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, LBFA and BEeSy, INSERM, U1055, F-38000, Grenoble, France
- Department of Endocrinology, Grenoble University Hospital, Univ. Grenoble Alpes, Pôle DigiDune, Grenoble, France
| | - Pierre Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Univ. Grenoble Alpes, Pôle DigiDune, Grenoble, France
| | - Abdelkader Zebda
- UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, INSERM, TIMC, VetAgro Sup, 38000, Grenoble, France.
- Japanese-French lAaboratory for Semiconductor physics and Technology (J-F AST)-CNRS-Université Grenoble Alpes-Grenoble, INP-University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8573, Japan.
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Diez Alvarez S, Fellas A, Santos D, Sculley D, Wynne K, Acharya S, Navathe P, Girones X, Coda A. The Clinical Impact of Flash Glucose Monitoring-a Digital Health App and Smartwatch Technology in Patients With Type 2 Diabetes: Scoping Review. JMIR Diabetes 2023; 8:e42389. [PMID: 36920464 PMCID: PMC10131890 DOI: 10.2196/42389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes has a growing prevalence and confers significant cost burden to the health care system, raising the urgent need for cost-effective and easily accessible solutions. The management of type 2 diabetes requires significant commitment from the patient, caregivers, and the treating team to optimize clinical outcomes and prevent complications. Technology and its implications for the management of type 2 diabetes is a nascent area of research. The impact of some of the more recent technological innovations in this space, such as continuous glucose monitoring, flash glucose monitoring, web-based applications, as well as smartphone- and smart watch-based interactive apps has received limited attention in the research literature. OBJECTIVE This scoping review aims to explore the literature available on type 2 diabetes, flash glucose monitoring, and digital health technology to improve diabetic clinical outcomes and inform future research in this area. METHODS A scoping review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to July 2021), EMBASE (January 1980 to July 2021), Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases. RESULTS There were very few studies that have explored the use of mobile health and flash glucose monitoring in type 2 diabetes. These studies have explored somewhat disparate and limited areas of research, and there is a distinct lack of methodological rigor in this area of research. The 3 studies that met the inclusion criteria have addressed aspects of the proposed research question. CONCLUSIONS This scoping review has highlighted the lack of research in this area, raising the opportunity for further research in this area, focusing on the clinical impact and feasibility of the use of multiple technologies, including flash glucose monitoring in the management of patients with type 2 diabetes.
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Affiliation(s)
- Sergio Diez Alvarez
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Antoni Fellas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Dean Sculley
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Katie Wynne
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
- Department of Diabetes and Endocrinology, Hunter New England Health, John Hunter Hospital, Newcastle, Australia
| | - Shamasunder Acharya
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Department of Diabetes and Endocrinology, Hunter New England Health, John Hunter Hospital, Newcastle, Australia
| | - Pooshan Navathe
- Central Queensland Hospital and Health Service, Brisbane, Australia
| | - Xavier Girones
- Department of Research, Universities de Catalunya, Generalitat de Catalunya, Barcelona, Cataluna, Spain
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
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Abstract
BACKGROUND Optimal inpatient glycemic management targets a blood glucose (BG) of 140-180 mg/dL and is an important safety measure for hospitalized patients with hyperglycemia. Traditional barriers to appropriate insulin administration include incorrect timing of prandial insulin administration, failure to administer basal insulin to persons with insulin deficiency/type 1 diabetes mellitus (DM), and inaccurate insulin dosing or timing resulting in hypoglycemia. Given the ongoing rapid assimilation of technology to manage our patients with DM, we investigated the use of continuous glucose monitoring (CGM) in the inpatient setting as a potential solution to traditional barriers to optimal hyperglycemia management for inpatient care. In this study, we evaluated the efficacy of use of inpatient CGM for insulin dosing in comparison with current standard of care and whether CGM could aid in minimizing hypoglycemic events. METHODS This study evaluated the use of Abbott professional (blinded) Freestyle Libre CGMs in participants treated with basal bolus insulin administered with subcutaneous insulin (basal bolus therapy [BBT]: n = 20) or on intravenous insulin (IVI) infusions (n =16) compared with standard point of care (POC) BG measurements. All participants on IVI were admitted with a diagnosis of diabetic ketoacidosis (DKA). The CGM data was not available in real time. Sensors were removed at the time of discharge and data uploaded to Libre View. Continuous BG data were aggregated for each subject and matched to POC BG or lab chemistry values within five minutes. The POC BG results were assessed for comparability (CGM vs standard BG testing). Data were further analyzed for clinical decision-making for correction insulin. RESULTS The overall mean absolute relative difference including both IVI and BBT groups was 22.3% (SD, 9.0), with a median of 20.0%. By group, the IVI arm mean was 19.6% (SD, 9.4), with a median of 16.0%; for BBT, the arm mean was 24.6% (SD, 8.1), with a median 23.4%. Using the Wilcoxon two-sample test, the means were not different (P = .10), whereas the medians were (P = .015). The CGM consistently reported lower glucose values than POC BG in the majority of paired values (BBT arm mean difference = 44.8 mg/dL, IVI mean difference = 19.7 mg/dL). Glucose results were in agreement for the group 83% of the time with Bland-Altman Plot of Difference versus the mean of all glucometric data. Analysis of correction dose insulin using either CGM or POC BG values resulted in a negligible difference in calculated insulin dose recommended in those receiving subcutaneous insulin. Corrective doses were based on weight and insulin sensitivity (type 1 vs type 2 DM). Participants initially on IVI were included in a data set of BBT once IVI therapy ceased and basal bolus insulin regimen was started. The data of all basal bolus therapy participants with 1142 paired values of CGM versus POC glucose were used. The dosing difference was less for CGM than POC BG in the majority of paired values, and there was an absolute difference in dose of insulin of only 1.34 units. In the IVI group with 300 paired values of CGM versus POC glucose, there was an absolute difference in dose of insulin of only 0.74 units. About a third of the patients studied in the BBT arm experienced a hypoglycemic event with POC BG <70 mg/dL. If used in real time, CGM would have identified a hypoglycemic event for our patients on average 3 hours and 34 minutes before it was detected by standard POC BG. Two participants incurred severe nocturnal hypoglycemia during the study with POC BG <54 mg/dL with hypoglycemia detected on CGM up to 3 hours and 42 minutes before POC testing. CONCLUSIONS These results suggest that the use of inpatient CGM arrives at similar correction insulin dosing. The routine use of CGM for inpatients would consistently underestimate the BG compared with POC BG and could aid in minimizing and predicting hypoglycemia in the hospital setting. Our data support that the model of adoption of real-time inpatient CGM technology is anticipated to have significant impact in the clinical setting in efforts to maintain adequate glycemic control targeting BG 140-180 mg/dL while minimizing the frequency of hypoglycemic events.
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Affiliation(s)
- Catherine Price
- Department of Internal Medicine,
Section on Endocrinology, Wake Forest School of Medicine, Winston-Salem, NC,
USA
- Catherine Price, MD, Department of Internal
Medicine, Section on Endocrinology, Wake Forest School of Medicine, Medical
Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Gillian Ditton
- Department of Endocrinology &
Diabetes, Boulder Medical Center, Boulder, CO, USA
| | - Gregory B. Russell
- Department of Biostatistics and Data
Science, Division of Public Health Sciences, Wake Forest School of Medicine,
Winston-Salem, NC, USA
| | - Joseph Aloi
- Department of Internal Medicine,
Section on Endocrinology, Wake Forest School of Medicine, Winston-Salem, NC,
USA
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23
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Weber MR, Diebold M, Wiesli P, Kistler AD. Accuracy of Flash Glucose Monitoring in Hemodialysis Patients With and Without Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2023; 131:132-141. [PMID: 36377191 PMCID: PMC9998185 DOI: 10.1055/a-1978-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Glucose and insulin metabolism are altered in hemodialysis patients, and diabetes management is difficult in these patients. We aimed to validate flash glucose monitoring (FGM) in hemodialysis patients with and without diabetes mellitus as an attractive option for glucose monitoring not requiring regular self-punctures. METHODS We measured interstitial glucose using a FreeStyle Libre device in eight hemodialysis patients with and seven without diabetes mellitus over 14 days and compared the results to simultaneously performed self-monitoring of capillary blood glucose (SMBG). RESULTS In 720 paired measurements, mean flash glucose values were significantly lower than self-measured capillary values (6.17±2.52 vs. 7.15±2.41 mmol/L, p=1.3 E-86). Overall, the mean absolute relative difference was 17.4%, and the mean absolute difference was 1.20 mmol/L. The systematic error was significantly larger in patients without vs. with diabetes (- 1.17 vs. - 0.82 mmol/L) and on dialysis vs. interdialytic days (-1.09 vs. -0.90 mmol/L). Compared to venous blood glucose (72 paired measurements), the systematic error of FGM was even larger (5.89±2.44 mmol/L vs. 7.78±7.25 mmol/L, p=3.74E-22). Several strategies to reduce the systematic error were evaluated, including the addition of +1.0 mmol/L as a correction term to all FGM values, which significantly improved accuracy. CONCLUSIONS FGM systematically underestimates blood glucose in hemodialysis patients but, taking this systematic error into account, the system may be useful for glucose monitoring in hemodialysis patients with or without diabetes.
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Affiliation(s)
- Michèle R Weber
- Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Matthias Diebold
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter Wiesli
- Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Andreas D Kistler
- Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
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24
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Ibarra-Salce R, Pozos-Varela FJ, Martinez-Zavala N, Lam-Chung CE, Mena-Ureta TS, Janka-Zires M, Faradji RN, Madrigal-Sanroman JR, de la Garza-Hernandez NE, Almeda-Valdes P. Correlation Between Hemoglobin Glycation Index Measured by Continuous Glucose Monitoring With Complications in Type 1 Diabetes. Endocr Pract 2023; 29:162-167. [PMID: 36627022 DOI: 10.1016/j.eprac.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE HbA1C is the "gold standard" parameter to evaluate glycemic control in diabetes; however, its correlation with mean glucose is not always perfect. The objective of this study was to correlate continuous glucose monitoring (CGM)-derived hemoglobin glycation index (HGI) with microvascular complications. METHODS We conducted a cross-sectional study including permanent users of CGM with type 1 diabetes mellitus or latent autoimmune diabetes of the adult. HGI was estimated, and presence of microvascular complications was compared in subgroups with high or low HGI. A logistic regression analysis to assess the contribution of high HGI to chronic kidney disease (CKD) was performed. RESULTS In total, 52 participants who were aged 39.7 ± 14.7 years, with 73.1% women and 15.5 years (IQR, 7.5-29 years) since diagnosis, were included; 32.7% recorded diabetic retinopathy, 25% CKD, and 19.2% neuropathy. The median HbA1C was 7.6% (60 mmol/mol) and glucose management indicator (GMI) 7.0% (53 mmol/mol). The average HGI was 0.55% ± 0.66%. The measured HbA1C was higher in the group with high HGI (8.1% [65 mmol/mol] vs 6.9% [52 mmol/mol]; P < .001), whereas GMI (7.0% [53 mmol/mol] vs 7.0% [53 mmol/mol]; P = .495) and mean glucose were similar in both groups (153 mg/dL vs 153 mg/dL; P = .564). In the high HGI group, higher occurrence of CKD (P = .016) and neuropathy were observed (P = .025). High HGI was associated with increased risk of CKD (odds ratio [OR]: 5.05; 95% CI: 1.02-24.8; P = .04) after adjusting for time since diagnosis (OR: 1.09; 95% CI: 1.02-1.16; P = .008). CONCLUSION High HGI measured by CGM may be a useful marker for increased risk of microvascular diabetic complications.
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Affiliation(s)
- Raul Ibarra-Salce
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Francisco Javier Pozos-Varela
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Nestor Martinez-Zavala
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Cesar Ernesto Lam-Chung
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Tania Sofia Mena-Ureta
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Marcela Janka-Zires
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | | | | | | | - Paloma Almeda-Valdes
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico; Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico.
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25
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Machine-Learning-Based Detection of Pressure-Induced Faults in Continuous Glucose Monitors. Ind Eng Chem Res 2023. [DOI: 10.1021/acs.iecr.2c03259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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26
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Bosnic-Anticevich S, Bakerly ND, Chrystyn H, Hew M, van der Palen J. Advancing Digital Solutions to Overcome Longstanding Barriers in Asthma and COPD Management. Patient Prefer Adherence 2023; 17:259-272. [PMID: 36741814 PMCID: PMC9891071 DOI: 10.2147/ppa.s385857] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/09/2022] [Indexed: 01/30/2023] Open
Abstract
Maintenance therapy delivered via inhaler is central to asthma and chronic obstructive pulmonary disease (COPD) management. Poor adherence to inhaled medication and errors in inhalation technique have long represented major barriers to the optimal management of these chronic conditions. Technological innovations may provide a means of overcoming these barriers. This narrative review examines ongoing advances in digital technologies relevant to asthma and COPD with the potential to inform clinical decision-making and improve patient care. Digital inhaler devices linked to mobile apps can help bring about changes in patients' behaviors and attitudes towards disease management, particularly when they build in elements of interactivity and gamification. They can also support ongoing technique education, empowering patients and helping providers maximize the value of consultations and develop effective action plans informed by insights into the patient's inhaler use patterns and their respiratory health. When combined with innovative techniques such as machine learning, digital devices have the potential to predict exacerbations and prompt pre-emptive intervention. Finally, digital devices may support an advanced precision medicine approach to respiratory disease management and help support shared decision-making. Further work is needed to increase uptake of digital devices and integrate their use into care pathways before their full potential in personalized asthma and COPD management can be realized.
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Affiliation(s)
- Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Correspondence: Sinthia Bosnic-Anticevich, Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, 2037, NSW, Australia, Tel +61 414 015 614, Email
| | - Nawar Diar Bakerly
- Manchester Metropolitan University, Manchester, United Kingdom, Salford Royal NHS Foundation Trust, Manchester, UK
| | | | - Mark Hew
- Allergy, Asthma, and Clinical Immunology, Alfred Health, Melbourne, VIC, Australia
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands, and Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands
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27
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Germain N, Genteuil CD, Belleton G, Da Silva TL, Exbrayat C, Degas F, Hammour A, Gay A, Ravey B, Massoubre C, Galusca B. Continuous glucose monitoring assessment in patients suffering from anorexia nervosa reveals chronic prolonged mild hypoglycemia all over the nycthemeron. EUROPEAN EATING DISORDERS REVIEW 2022; 31:402-412. [PMID: 36541517 DOI: 10.1002/erv.2963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/04/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is an eating disorder characterised by voluntary dietary restriction leading to severe undernutrition. Hypoglycaemia is mostly described through severe case reports and is always evaluated by fasting or post-meal blood glucose, showing nothing about hypoglycaemia's length or duration. The interest of continuous interstitial glucose monitoring (CGM), largely used in diabetes mellitus, has never been evaluated in AN patients. METHOD Glycaemia cycles in AN patients were assessed using CGM over 5 days and then analysed according to food intake. RESULTS Mean glycaemia was within normal range. 91% of the patients presented with at least one episode with glycaemia under 70 mg/dl. Within the 24 h, the percentage of time spent with a glycaemia under 70 mg/dl was of 20.82 ± 3.90% with a maximum of 52%. We found 2.52 ± 0.33 hypoglycaemia events per 24 h, including 21.11 ± 3.76% at night. CGM parameters correlated with cortisol and IGF1 plasma levels. Comparison with estimated carbohydrate intakes discriminated concordant and non-concordant estimations depending on patient. CONCLUSIONS AN patients display chronic prolonged mild hypoglycaemia all over the nycthemeron despite normal fasting glycaemia. Associated adaptive increased counter-regulatory hormones might protect AN patients from deeper hypoglycaemia. CGM allowed testing food intake self-estimation reliability of AN patients and could be a very useful biofeedback tool.
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Affiliation(s)
- Natacha Germain
- Department of Endocrinology Diabetes, Metabolism and Eating Disorders University Hospital of Saint‐Etienne Saint‐Etienne France
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Clara Devin Genteuil
- Department of Endocrinology Diabetes, Metabolism and Eating Disorders University Hospital of Saint‐Etienne Saint‐Etienne France
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Gwenaëlle Belleton
- Department of Endocrinology Diabetes, Metabolism and Eating Disorders University Hospital of Saint‐Etienne Saint‐Etienne France
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Trecy Lopes Da Silva
- Department of Endocrinology Diabetes, Metabolism and Eating Disorders University Hospital of Saint‐Etienne Saint‐Etienne France
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Chloé Exbrayat
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
| | - Fabien Degas
- Department of Endocrinology Diabetes, Metabolism and Eating Disorders University Hospital of Saint‐Etienne Saint‐Etienne France
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Amira Hammour
- Department of Endocrinology Diabetes, Metabolism and Eating Disorders University Hospital of Saint‐Etienne Saint‐Etienne France
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Aurélia Gay
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
- Department of Psychiatry University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Baptiste Ravey
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
- Department of Psychiatry University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Catherine Massoubre
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
- Department of Psychiatry University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Bogdan Galusca
- Department of Endocrinology Diabetes, Metabolism and Eating Disorders University Hospital of Saint‐Etienne Saint‐Etienne France
- TAPE Research Group Jean Monnet University of Saint‐Etienne Saint‐Etienne France
- Eating Disorder Reference Center University Hospital of Saint‐Etienne Saint‐Etienne France
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Kumar S, Pallin M, Soldatos G, Teede H. Comparison of continuous glucose monitoring to reference standard oral glucose tolerance test for the detection of dysglycemia in cystic Fibrosis: A systematic review. J Clin Transl Endocrinol 2022; 30:100305. [PMID: 36200022 PMCID: PMC9529501 DOI: 10.1016/j.jcte.2022.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/30/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022] Open
Abstract
Aims Increasing evidence for benefit of early detection of cystic fibrosis related diabetes (CFRD) coupled with limitations of current diagnostic investigations has led to interest and utilisation of continuous glucose monitoring (CGM). We conducted a systematic review to assess current evidence on CGM compared to reference standard oral glucose tolerance test for the detection of dysglycemia in people with cystic fibrosis without confirmed diabetes. Methods MEDLINE, Embase, CENTRAL, Evidence-Based Medicine Reviews, grey literature and six relevant journals were searched for studies published after year 2000. Studies reporting contemporaneous CGM metrics and oral glucose tolerance test results were included. Outcomes on oral glucose tolerance tests were categorised into a) normal, b) abnormal (indeterminate and impaired) or c) diabetic as defined by American Diabetes Association criteria. CGM outcomes were defined as hyperglycemia (≥1 peak sensor glucose ≥ 200 mg/dL), dysglycemia (≥1 peak sensor glucose ≥ 140–199 mg/dL) or normoglycemia (all sensor glucose peaks < 140 mg/dL). CGM hyperglycemia in people with normal or abnormal glucose tolerances was used to define an arbitrary CGM-diagnosis of diabetes. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess risk of bias. Primary outcome was relative risk of an arbitrary CGM-diagnosis of diabetes compared to the oral glucose tolerance test. Results We identified 1277 publications, of which 19 studies were eligible comprising total of 416 individuals with contemporaneous CGM and oral glucose tolerance test results. Relative risk of an arbitrary CGM-diagnosis of diabetes compared to oral glucose tolerance test was 2.92. Studies analysed were highly heterogenous, prone to bias and inadequately assessed longitudinal associations between CGM and relevant disease-specific sequela. Conclusions A single reading > 200 mg/dL on CGM is not appropriate for the diagnosis of CFRD. Prospective studies correlating CGM metrics to disease-specific outcomes are needed to determine appropriate cut-points.
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Affiliation(s)
- Shanal Kumar
- Monash Centre for Health Research and Implementation, Monash University
- Diabetes and Vascular Medicine Unit, Monash Health
| | | | - Georgia Soldatos
- Monash Centre for Health Research and Implementation, Monash University
- Diabetes and Vascular Medicine Unit, Monash Health
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University
- Diabetes and Vascular Medicine Unit, Monash Health
- Corresponding author at: Monash Centre for Health Research and Implementation, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia.
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Prendin F, Díez JL, Del Favero S, Sparacino G, Facchinetti A, Bondia J. Assessment of Seasonal Stochastic Local Models for Glucose Prediction without Meal Size Information under Free-Living Conditions. SENSORS (BASEL, SWITZERLAND) 2022; 22:8682. [PMID: 36433278 PMCID: PMC9694694 DOI: 10.3390/s22228682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Accurate blood glucose (BG) forecasting is key in diabetes management, as it allows preventive actions to mitigate harmful hypoglycemic/hyperglycemic episodes. Considering the encouraging results obtained by seasonal stochastic models in proof-of-concept studies, this work assesses the methodology in two datasets (open-loop and closed-loop) recorded in free-living conditions. First, similar postprandial glycemic profiles are grouped together with fuzzy C-means clustering. Then, a seasonal stochastic model is identified for each cluster. Finally, real-time BG forecasting is performed by weighting each model’s prediction. The proposed methodology (named C-SARIMA) is compared to other linear and nonlinear black-box methods: autoregressive integrated moving average (ARIMA), its variant with input (ARIMAX), a feed-forward neural network (NN), and its modified version (NN-X) fed by BG, insulin, and carbohydrates (timing and dosing) information for several prediction horizons (PHs). In the open-loop dataset, C-SARIMA grants a median root-mean-squared error (RMSE) of 20.13 mg/dL (PH = 30) and 27.23 mg/dL (PH = 45), not significantly different from ARIMA and NN. Over a longer PH, C-SARIMA achieves an RMSE = 31.96 mg/dL (PH = 60) and RMSE = 33.91 mg/dL (PH = 75), significantly outperforming the ARIMA and NN, without significant differences from the ARIMAX for PH ≥ 45 and the NN-X for PH ≥ 60. Similar results hold on the closed-loop dataset: for PH = 30 and 45 min, the C-SARIMA achieves an RMSE = 21.63 mg/dL and RMSE = 29.67 mg/dL, not significantly different from the ARIMA and NN. On longer PH, the C-SARIMA outperforms the ARIMA for PH > 45 and the NN for PH > 60 without significant differences from the ARIMAX for PH ≥ 45. Although using less input information, the C-SARIMA achieves similar performance to other prediction methods such as the ARIMAX and NN-X and outperforming the CGM-only approaches on PH > 45min.
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Affiliation(s)
- Francesco Prendin
- Department of Information Engineering (DEI), University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy
| | - José-Luis Díez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera, s/n, 46022 València, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Simone Del Favero
- Department of Information Engineering (DEI), University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering (DEI), University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering (DEI), University of Padova, Via G. Gradenigo 6/B, 35131 Padova, Italy
| | - Jorge Bondia
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera, s/n, 46022 València, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Tucker AP, Erdman AG, Schreiner PJ, Ma S, Chow LS. Examining Sensor Agreement in Neural Network Blood Glucose Prediction. J Diabetes Sci Technol 2022; 16:1473-1482. [PMID: 34109837 PMCID: PMC9631521 DOI: 10.1177/19322968211018246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Successful measurements of interstitial glucose are a key component in providing effective care for patients with diabetes. Recently, there has been significant interest in using neural networks to forecast future glucose values from interstitial measurements collected by continuous glucose monitors (CGMs). While prediction accuracy continues to improve, in this work we investigated the effect of physiological sensor location on neural network blood glucose forecasting. We used clinical data from patients with Type 2 Diabetes who wore blinded FreeStyle Libre Pro CGMs (Abbott) on both their right and left arms continuously for 12 weeks. We trained patient-specific prediction algorithms to test the effect of sensor location on neural network forecasting (N = 13, Female = 6, Male = 7). In 10 of our 13 patients, we found at least one significant (P < .05) increase in forecasting error in algorithms which were tested with data taken from a different location than data which was used for training. These reported results were independent from other noticeable physiological differences between subjects (eg, height, age, weight, blood pressure) and independent from overall variance in the data. From these results we observe that CGM location can play a consequential role in neural network glucose prediction.
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Affiliation(s)
- Aaron P. Tucker
- Earl E. Bakken Medical Devices Center,
University of Minnesota, Minneapolis, MN, USA
- Aaron P. Tucker, Earl E. Bakken Medical
Devices Center, University of Minnesota, G217 Mayo Memorial Building MMC 95, 420
Delaware St., Minneapolis, MN 55455, USA.
| | - Arthur G. Erdman
- Earl E. Bakken Medical Devices Center,
University of Minnesota, Minneapolis, MN, USA
| | - Pamela J. Schreiner
- Division of Epidemiology and Community
Health, University of Minnesota, Minneapolis, MN, USA
| | - Sisi Ma
- Division of General Internal Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Lisa S. Chow
- Division of Diabetes, Endocrinology and
Metabolism, University of Minnesota, Minneapolis, MN, USA
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31
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Tackling the challenges of developing microneedle-based electrochemical sensors. Mikrochim Acta 2022; 189:440. [DOI: 10.1007/s00604-022-05510-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
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32
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Tekale S, Varma A, Tekale S, Kumbhare U. A Review on Newer Interventions for the Prevention of Diabetic Foot Disease. Cureus 2022; 14:e30591. [DOI: 10.7759/cureus.30591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
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Buskermolen AD, Lin YT, van Smeden L, van Haaften RB, Yan J, Sergelen K, de Jong AM, Prins MWJ. Continuous biomarker monitoring with single molecule resolution by measuring free particle motion. Nat Commun 2022; 13:6052. [PMID: 36229441 PMCID: PMC9561105 DOI: 10.1038/s41467-022-33487-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
There is a need for sensing technologies that can continuously monitor concentration levels of critical biomolecules in applications such as patient care, fundamental biological research, biotechnology and food industry, as well as the environment. However, it is fundamentally difficult to develop measurement technologies that are not only sensitive and specific, but also allow monitoring over a broad concentration range and over long timespans. Here we describe a continuous biomolecular sensing methodology based on the free diffusion of biofunctionalized particles hovering over a sensor surface. The method records digital events due to single-molecule interactions and enables biomarker monitoring at picomolar to micromolar concentrations without consuming any reagents. We demonstrate the affinity-based sensing methodology for DNA-based sandwich and competition assays, and for an antibody-based cortisol assay. Additionally, the sensor can be dried, facilitating storage over weeks while maintaining its sensitivity. We foresee that this will enable the development of continuous monitoring sensors for applications in fundamental research, for studies on organs on a chip, for the monitoring of patients in critical care, and for the monitoring of industrial processes and bioreactors as well as ecological systems.
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Affiliation(s)
- Alissa D. Buskermolen
- grid.6852.90000 0004 0398 8763Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Yu-Ting Lin
- grid.6852.90000 0004 0398 8763Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Laura van Smeden
- grid.6852.90000 0004 0398 8763Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Rik B. van Haaften
- grid.6852.90000 0004 0398 8763Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Junhong Yan
- Helia Biomonitoring, Eindhoven, the Netherlands
| | - Khulan Sergelen
- grid.6852.90000 0004 0398 8763Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Arthur M. de Jong
- grid.6852.90000 0004 0398 8763Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Menno W. J. Prins
- grid.6852.90000 0004 0398 8763Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands ,Helia Biomonitoring, Eindhoven, the Netherlands
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Inoue Y, Kusaka Y, Shinozaki K, Lee I, Sode K. In Vitro Evaluation of Miniaturized Amperometric Enzyme Sensor Based on the Direct Electron Transfer Principle for Continuous Glucose Monitoring. J Diabetes Sci Technol 2022; 16:1101-1106. [PMID: 34986665 PMCID: PMC9445329 DOI: 10.1177/19322968211070614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The bacterial derived flavin adenine dinucleotide (FAD)-dependent glucose dehydrogenase (FADGDH) is the most promising enzyme for the third-generation principle-based enzyme sensor for continuous glucose monitoring (CGM). Due to the ability of the enzyme to transfer electrons directly to the electrode, recognized as direct electron transfer (DET)-type FADGDH, although no investigation has been reported about DET-type FADGDH employed on a miniaturized integrated electrode. METHODS The miniaturized integrated electrode was formed by sputtering gold (Au) onto a flexible film with 0.1 mm in thickness and divided into 3 parts. After an insulation layer was laminated, 3 openings for a working electrode, a counter electrode and a reference electrode were formed by dry etching. A reagent mix containing 1.2 × 10-4 Unit of DET-type FADGDH and carbon particles was deposited. The long-term stability of sensor was evaluated by continuous operation, and its performance was also evaluated in the presence of acetaminophen and the change in oxygen partial pressure (pO2) level. RESULTS The amperometric response of the sensor showed a linear response to glucose concentration up to 500 mg/dL without significant change of the response over an 11-day continuous measurement. Moreover, the effect of acetaminophen and pO2 on the response were negligible. CONCLUSIONS These results indicate the superb potential of the DET-type FADGDH-based sensor with the combination of a miniaturized integrated electrode. Thus, the described miniaturized DET-type glucose sensor for CGM will be a promising tool for effective glycemic control. This will be further investigated using an in vivo study.
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Affiliation(s)
| | | | | | - Inyoung Lee
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Koji Sode
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
- Koji Sode, PhD, Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA.
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Augstein P, Heinke P, Vogt L, Kohnert KD, Salzsieder E. Patient-Tailored Decision Support System Improves Short- and Long-Term Glycemic Control in Type 2 Diabetes. J Diabetes Sci Technol 2022; 16:1159-1166. [PMID: 34000840 PMCID: PMC9445344 DOI: 10.1177/19322968211008871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The increasing prevalence of type 2 diabetes mellitus (T2D) and specialist shortage has caused a healthcare gap that can be bridged by a decision support system (DSS). We investigated whether a diabetes DSS can improve long- and/or short-term glycemic control. METHODS This is a retrospective observational cohort study of the Diabetiva program, which offered a patient-tailored DSS using Karlsburger Diabetes-Management System (KADIS) once a year. Glycemic control was analyzed at baseline and after 12 months in 452 individuals with T2D. Time in range (TIR; glucose 3.9-10 mmol/L) and Q-Score, a composite metric developed for analysis of continuous glucose profiles, were short-term and HbA1c long-term measures of glycemic control. Glucose variability (GV) was also measured. RESULTS At baseline, one-third of patients had good short- and long-term glycemic control. Q-Score identified insufficient short-term glycemic control in 17.9% of patients with HbA1c <6.5%, mainly due to hypoglycemia. GV and hyperglycemia were responsible in patients with HbA1c >7.5% and >8%, respectively. Application of DSS at baseline improved short- and long-term glycemic control, as shown by the reduced Q-Score, GV, and HbA1c after 12 months. Multiple regression demonstrated that the total effect on GV resulted from the single effects of all influential parameters. CONCLUSIONS DSS can improve short- and long-term glycemic control in individuals with T2D without increasing hypoglycemia. The Q-Score allows identification of individuals with insufficient glycemic control. An effective strategy for therapy optimization could be the selection of individuals with T2D most at need using the Q-Score, followed by offering patient-tailored DSS.
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Affiliation(s)
- Petra Augstein
- Institute of Diabetes “Gerhardt Katsch”, Karlsburg, Germany
- Department for Diabetology, Klinikum Karlsburg, Heart and Diabetes Center Karlsburg, Germany
- Petra Augstein, MD & Dsc, Department for Diabetology, Klinikum Karlsburg, Heart and Diabetes Center Karlsburg, Greifswalder Str. 11, Germany.
| | - Peter Heinke
- Institute of Diabetes “Gerhardt Katsch”, Karlsburg, Germany
| | - Lutz Vogt
- Diabetes Service Centre DCC, Karlsburg, Germany
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36
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Fiedorova K, Augustynek M, Kubicek J, Kudrna P, Bibbo D. Review of present method of glucose from human blood and body fluids assessment. Biosens Bioelectron 2022; 211:114348. [DOI: 10.1016/j.bios.2022.114348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 12/15/2022]
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Abstract
PURPOSE OF REVIEW Glucose management in the hospital is difficult due to non-static factors such as antihyperglycemic and steroid doses, renal function, infection, surgical status, and diet. Given these complex and dynamic factors, machine learning approaches can be leveraged for prediction of glucose trends in the hospital to mitigate and prevent suboptimal hypoglycemic and hyperglycemic outcomes. Our aim was to review the clinical evidence for the role of machine learning-based models in predicting hospitalized patients' glucose trajectory. RECENT FINDINGS The published literature on machine learning algorithms has varied in terms of population studied, outcomes of interest, and validation methods. There have been tools developed that utilize data from both continuous glucose monitors and large electronic health records (EHRs). With increasing sample sizes, inclusion of a greater number of predictor variables, and use of more advanced machine learning algorithms, there has been a trend in recent years towards increasing predictive accuracy for glycemic outcomes in the hospital setting. While current models predicting glucose trajectory offer promising results, they have not been tested prospectively in the clinical setting. Accurate machine learning algorithms have been developed and validated for prediction of hypoglycemia and hyperglycemia in the hospital. Further work is needed in implementation/integration of machine learning models into EHR systems, with prospective studies to evaluate effectiveness and safety of such clinical decision support on glycemic and other clinical outcomes.
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Affiliation(s)
- Andrew Zale
- Division of Endocrinology, Diabetes & Metabolism, Division of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes & Metabolism, Division of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
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38
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Evin F, Ata A, Er E, Demir G, Çetin H, Altınok YA, Özen S, Darcan Ş, Gökşen D. Predictive low-glucose suspend system and glycemic variability. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-021-00957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Continuous Glucose Monitoring System Based on Percutaneous Microneedle Array. MICROMACHINES 2022; 13:mi13030478. [PMID: 35334773 PMCID: PMC8949222 DOI: 10.3390/mi13030478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022]
Abstract
A continuous blood glucose monitoring system (CGMS) which include a microneedle-array blood glucose sensor, a circuit module, and a transmission module placed in a wearable device is developed in this research. When in use, the wearable device is attached to the human body with the microneedle array inserted under the skin for continuous blood glucose sensing, and the measured signals are transmitted wirelessly to a mobile phone or computer for analysis. The purpose of this study is to replace the conventionally used method of puncture for blood collection and test strips are used to measure the blood glucose signals. The microneedle sensor of this CGMS uses a 1 mm length needle in a 3 mm × 3 mm microneedle array for percutaneous minimally invasive blood glucose measurement. This size of microneedle does not cause bleeding damage to the body when used. The microneedle sensor is placed under the skin and their solutions are discussed. The blood glucose sensor measured the in vitro simulant fluid with a glucose concentration range of 50~400 mg/dL. In addition, a micro-transfer method is developed to accurately deposit the enzyme onto the tip of the microneedle, after which cyclic voltammetry (CV) is used to measure the glucose simulation solution to verify whether the difference in the amount of enzyme on each microneedle is less than 10%. Finally, various experiments and analyses are carried out to reduce the size of the device, test effective durability (approximately 7 days), and the feasibility of minimally invasive CGMS is evaluated by tests on two persons.
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40
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Glucose Oxidase, an Enzyme “Ferrari”: Its Structure, Function, Production and Properties in the Light of Various Industrial and Biotechnological Applications. Biomolecules 2022; 12:biom12030472. [PMID: 35327664 PMCID: PMC8946809 DOI: 10.3390/biom12030472] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 01/25/2023] Open
Abstract
Glucose oxidase (GOx) is an important oxidoreductase enzyme with many important roles in biological processes. It is considered an “ideal enzyme” and is often called an oxidase “Ferrari” because of its fast mechanism of action, high stability and specificity. Glucose oxidase catalyzes the oxidation of β-d-glucose to d-glucono-δ-lactone and hydrogen peroxide in the presence of molecular oxygen. d-glucono-δ-lactone is sequentially hydrolyzed by lactonase to d-gluconic acid, and the resulting hydrogen peroxide is hydrolyzed by catalase to oxygen and water. GOx is presently known to be produced only by fungi and insects. The current main industrial producers of glucose oxidase are Aspergillus and Penicillium. An important property of GOx is its antimicrobial effect against various pathogens and its use in many industrial and medical areas. The aim of this review is to summarize the structure, function, production strains and biophysical and biochemical properties of GOx in light of its various industrial, biotechnological and medical applications.
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41
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Huhn F, Lange K, Jördening M, Ernst G. Real-World Use of Continuous Glucose Monitoring (CGM) Systems Among Adolescents and Young Adults With Type 1 Diabetes: Reduced Burden, but Little Interest in Data Analysis. J Diabetes Sci Technol 2022:19322968221081216. [PMID: 35255729 DOI: 10.1177/19322968221081216] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since 2016, German health insurance companies reimburse continuous glucose monitoring (CGM) systems for persons with insulin-dependent diabetes, leading to a tremendous increase of CGM use. This study assessed the use of CGM, the satisfaction with, and the data analysis behavior among young people. METHODS During a diabetes camp for young people from all over Germany, participants anonymously answered a questionnaire on their method of glucose monitoring, satisfaction and quality of CGM use, HbA1c, and diabetes distress (Problem Areas in Diabetes Scale [PAID]-5). RESULTS A total of 308 participants (age 21.4 ± 3.5 years; 73% female; diabetes duration 10.1 ± 5.9 years) completed the questionnaire. Approximately, 25% used self-monitoring of blood glucose (SMBG), 46% intermittent-scanning continuous glucose monitoring (iscCGM), and 30% real-time continuous glucose monitoring (rtCGM). Mean HbA1c was slightly, but not significantly, higher among SMBG users compared with CGM users (8.0% ± 1.9% vs. 7.7% ± 1.4%; P = .791). Diabetes distress was not associated with the method of glucose monitoring (SMBG 5.6 vs. iscCGM 6.2 vs. rtCGM 6.5; P = .386). Overall, satisfaction with CGM use was very high; 98% of the CGM users reported better well-being with CGM compared with previous SMBG use. Only 19% of CGM users reported regular data analyses; their HbA1c was lower compared with other CGM users (7.2% ± 1.2% vs. 7.7% ± 1.4%; P = .039). CONCLUSIONS In this large sample of young people, 75% were using a CGM system. Treatment satisfaction was very high, but CGM use was not associated with reduced diabetes distress or better glycemic control. However, young people who regularly analyzed their CGM data reported lower HbA1c levels.
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Affiliation(s)
- Friederike Huhn
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Mia Jördening
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Gundula Ernst
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
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Holzer R, Bloch W, Brinkmann C. Continuous Glucose Monitoring in Healthy Adults—Possible Applications in Health Care, Wellness, and Sports. SENSORS 2022; 22:s22052030. [PMID: 35271177 PMCID: PMC8915088 DOI: 10.3390/s22052030] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/11/2022]
Abstract
Introduction: Continuous glucose monitoring (CGM) systems were primarily developed for patients with diabetes mellitus. However, these systems are increasingly being used by individuals who do not have diabetes mellitus. This mini review describes possible applications of CGM systems in healthy adults in health care, wellness, and sports. Results: CGM systems can be used for early detection of abnormal glucose regulation. Learning from CGM data how the intake of foods with different glycemic loads and physical activity affect glucose responses can be helpful in improving nutritional and/or physical activity behavior. Furthermore, states of stress that affect glucose dynamics could be made visible. Physical performance and/or regeneration can be improved as CGM systems can provide information on glucose values and dynamics that may help optimize nutritional strategies pre-, during, and post-exercise. Conclusions: CGM has a high potential for health benefits and self-optimization. More scientific studies are needed to improve the interpretation of CGM data. The interaction with other wearables and combined data collection and analysis in one single device would contribute to developing more precise recommendations for users.
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Affiliation(s)
- Roman Holzer
- Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, 50933 Cologne, Germany; (R.H.); (W.B.)
| | - Wilhelm Bloch
- Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, 50933 Cologne, Germany; (R.H.); (W.B.)
| | - Christian Brinkmann
- Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, 50933 Cologne, Germany; (R.H.); (W.B.)
- Department of Fitness & Health, IST University of Applied Sciences, 40223 Düsseldorf, Germany
- Correspondence:
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Stahl JE, Ammana HR, Kwak L, Comi RJ. SMART-ly Managing Type 1 Diabetes - Modifying Glucose Metabolism With an Online Mind-Body Intervention: A Feasibility and Pilot Study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:802461. [PMID: 36992749 PMCID: PMC10012099 DOI: 10.3389/fcdhc.2022.802461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveManaging type 1 diabetes is stressful. Stress physiology influences glucose metabolism. Continuous glucose monitors allow us to track glucose variability in the real-world environment. Managing stress and cultivating resiliency should improve diabetes management and reduce glucose variability.Research Design and MethodsThe study was designed as a randomized prospective cohort pre-post study with wait time control. Participants were adult type 1 diabetes patients who used a continuous glucose monitor and recruited from an academic endocrinology practice. The intervention was the Stress Management and Resiliency Training (SMART) program conducted over 8 sessions over web-based video conference software. The main outcome measures were Glucose variability, the Diabetes Self-Management questionnaire (DSMQ),Short-Form Six-Dimension (SF-6D), and the Connor-Davidson Resiliency (CD-RSIC) instrument.ResultsThere was statistically significant improvement in participants DSMQ and CD RISC scores though the SF-6D did not change. Participants under age 50 years-old showed a statistically significant reduction in average glucose (p = .03) and Glucose Management Index (GMI) (p = .02). Participants also had reduced percentage of time high and increased time in range though this did not reach statistical significance. The participants found doing the intervention online acceptable if not always ideal.ConclusionsAn 8-session stress management and resiliency training program reduced diabetes related stress and improved resiliency and reduced average blood glucose and GMI in those under 50 years-old.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT04944264.
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Affiliation(s)
- James E. Stahl
- Section General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, United States
- *Correspondence: James E. Stahl, ;
| | - Hima R. Ammana
- Section Endocrinology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Leigh Kwak
- Section Endocrinology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Richard J. Comi
- Section Endocrinology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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Abstract
Type 1 diabetes mellitus (T1DM) is an endocrine disorder in which pancreatic β cells stop producing insulin, typically due to autoimmune destruction. This results in hyperglycemia and ketosis; thus, insulin replacement is vital to management. Incidence peaks in puberty and early adulthood, but onset can occur at any age. However, prevalence is highest among adults because persons with T1DM live for many years. Symptoms include polyuria, polydipsia, and weight loss. Acute complications include diabetic ketoacidosis, which requires urgent management. Long-term complications include microvascular and macrovascular disease. Patients with T1DM are at higher risk for other autoimmune diseases and psychosocial issues. Management should focus on optimizing glucose control to reduce acute and long-term complications.
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Affiliation(s)
- Fatima Z Syed
- Duke University Division of General Internal Medicine, Durham, North Carolina
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45
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Isaacson B, Kaufusi S, Sorensen J, Joy E, Jones C, Ingram V, Mark N, Phillips M, Briesacher M. Demonstrating the Clinical Impact of Continuous Glucose Monitoring Within an Integrated Healthcare Delivery System. J Diabetes Sci Technol 2022; 16:383-389. [PMID: 32935561 PMCID: PMC8861781 DOI: 10.1177/1932296820955228] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Approximately 30 million Americans currently suffer from diabetes, and nearly 55 million people will be impacted by 2030. Continuous glucose monitoring (CGM) systems help patients manage their care with real-time data. Although approximately 95% of those with diabetes suffer from type 2, few studies have measured CGM's clinical impact for this segment within an integrated healthcare system. METHODS A parallel randomized, multisite prospective trial was conducted using a new CGM device (Dexcom G6) compared to a standard of care finger stick glucometer (FSG) (Contour Next One). All participants received usual care in primary care clinics for six consecutive months while using these devices. Data were collected via electronic medical records, device outputs, exit surveys, and insurance company (SelectHealth) claims in accordance with institutional review board approval. RESULTS Ninety-nine patients were randomized for analysis (n = 50 CGM and n = 49 FSG). CGM patients significantly decreased hemoglobin A1c (p = .001), total visits (p = .009), emergency department encounters (p = .018), and labs ordered (p = .001). Among SelectHealth non-Medicare Advantage patients, per member per month savings were $417 for CGM compared to FSG, but $9 more for Medicare Advantage. Seventy percent of CGM users reported that the technology helped them better understand daily activity and diet compared to only 16% for FSG. DISCUSSION Participants using CGM devices had meaningful improvements in clinical outcomes, costs, and self-reported measures compared to the FSG group. Although a larger study is necessary to confirm these results, CGM devices appear to improve patient outcomes while making treatment more affordable.
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Affiliation(s)
- Brad Isaacson
- Intermountain Healthcare, Salt Lake
City, UT, USA
- Brad Isaacson, Intermountain Healthcare, 36
S. State Street, Salt Lake City, UT 84111, USA.
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Gothong C, Singh LG, Satyarengga M, Spanakis EK. Continuous glucose monitoring in the hospital: an update in the era of COVID-19. Curr Opin Endocrinol Diabetes Obes 2022; 29:1-9. [PMID: 34845159 PMCID: PMC8711300 DOI: 10.1097/med.0000000000000693] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Continuous glucose monitoring (CGM) systems are Food and Drug Administration approved devices for the ambulatory setting; however, they remain investigational systems for inpatient use. This review summarizes the most recent and relevant literature on the use of continuous glucose monitoring in the hospital setting. RECENT FINDINGS CGM provides real-time glucose data that enable healthcare professionals to make proactive and timelier clinical decisions with regards to diabetes management. CGM devices appear to be safe and accurate systems for glucose monitoring in the hospital setting. Real-time CGM systems and glucose telemetry can decrease hypoglycemia and reduce hyperglycemia in hospitalized patients with diabetes. Remote glucose monitoring decreases the need of frequent Point-of-care checks and personal protective equipment use while also mitigating staff exposure risk which is timely in the advent of the COVID-19 pandemic. Although most nursing staff have limited exposure and training on CGM technology, early studies show that CGM use in the hospital is well received by nurses. SUMMARY Given the evidence in the current literature regarding CGM use in the hospital, CGM devices may be incorporated in the inpatient setting.
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Affiliation(s)
- Chikara Gothong
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine
| | - Lakshmi G. Singh
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore
| | - Medha Satyarengga
- Center for Diabetes and Endocrinology, University of Maryland Shore Regional Health, Easton, Maryland, USA
| | - Elias K. Spanakis
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore
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Lubken RM, de Jong AM, Prins MWJ. Real-Time Monitoring of Biomolecules: Dynamic Response Limits of Affinity-Based Sensors. ACS Sens 2022; 7:286-295. [PMID: 34978190 PMCID: PMC8805115 DOI: 10.1021/acssensors.1c02307] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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Sensors for monitoring
biomolecular dynamics in biological systems
and biotechnological processes in real time, need to accurately and
precisely reconstruct concentration–time profiles. This requirement
becomes challenging when transport processes and biochemical kinetics
are important, as is typically the case for biomarkers at low concentrations.
Here, we present a comprehensive methodology to study the concentration–time
profiles generated by affinity-based sensors that continuously interact
with a biological system of interest. Simulations are performed for
sensors with diffusion-based sampling (e.g., a sensor
patch on the skin) and advection-based sampling (e.g., a sensor connected to a catheter). The simulations clarify how
transport processes and molecular binding kinetics result in concentration
gradients and time delays in the sensor system. Using these simulations,
measured and true concentration–time profiles of insulin were
compared as a function of sensor design parameters. The results lead
to guidelines on how biomolecular monitoring sensors can be designed
for optimal bioanalytical performance in terms of concentration and
time properties.
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Affiliation(s)
- Rafiq M. Lubken
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5612 AZ, the Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven 5612 AZ, the Netherlands
| | - Arthur M. de Jong
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven 5612 AZ, the Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven 5612 AZ, the Netherlands
| | - Menno W. J. Prins
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5612 AZ, the Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven 5612 AZ, the Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven 5612 AZ, the Netherlands
- Helia Biomonitoring, Eindhoven 5612 AZ, the Netherlands
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Olmedo-Aguirre JO, Reyes-Campos J, Alor-Hernández G, Machorro-Cano I, Rodríguez-Mazahua L, Sánchez-Cervantes JL. Remote Healthcare for Elderly People Using Wearables: A Review. BIOSENSORS 2022; 12:bios12020073. [PMID: 35200334 PMCID: PMC8869443 DOI: 10.3390/bios12020073] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 05/21/2023]
Abstract
The growth of health care spending on older adults with chronic diseases faces major concerns that require effective measures to be adopted worldwide. Among the main concerns is whether recent technological advances now offer the possibility of providing remote health care for the aging population. The benefits of suitable prevention and adequate monitoring of chronic diseases by using emerging technological paradigms such as wearable devices and the Internet of Things (IoT) can increase the detection rates of health risks to raise the quality of life for the elderly. Specifically, on the subject of remote health monitoring in older adults, a first approach is required to review devices, sensors, and wearables that serve as tools for obtaining and measuring physiological parameters in order to identify progress, limitations, and areas of opportunity in the development of health monitoring schemes. For these reasons, a review of articles on wearable devices was presented in the first instance to identify whether the selected articles addressed the needs of aged adults. Subsequently, the direct review of commercial and prototype wearable devices with the capability to read physiological parameters was presented to identify whether they are optimal or usable for health monitoring in older adults.
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Affiliation(s)
- José Oscar Olmedo-Aguirre
- Department of Electrical Engineering, CINVESTAV-IPN, Av. Instituto Politécnico Nacional 2 508, Col. San Pedro Zacatenco, Delegación Gustavo A. Madero, Mexico City C.P. 07360, Mexico;
| | - Josimar Reyes-Campos
- Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9 852, Col. Emiliano Zapata, Orizaba C.P. 94320, Veracruz, Mexico; (J.R.-C.); (L.R.-M.)
| | - Giner Alor-Hernández
- Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9 852, Col. Emiliano Zapata, Orizaba C.P. 94320, Veracruz, Mexico; (J.R.-C.); (L.R.-M.)
- Correspondence: ; Tel./Fax: +52-272-725-7056
| | - Isaac Machorro-Cano
- Universidad del Papaloapan, Circuito Central #200, Col. Parque Industrial, Tuxtepec C.P. 68301, Oaxaca, Mexico;
| | - Lisbeth Rodríguez-Mazahua
- Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9 852, Col. Emiliano Zapata, Orizaba C.P. 94320, Veracruz, Mexico; (J.R.-C.); (L.R.-M.)
| | - José Luis Sánchez-Cervantes
- CONACYT-Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9 852, Col. Emiliano Zapata, Orizaba C.P. 94320, Veracruz, Mexico;
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Diet and Physical Activity as Determinants of Continuously Measured Glucose Levels in Persons at High Risk of Type 2 Diabetes. Nutrients 2022; 14:nu14020366. [PMID: 35057547 PMCID: PMC8781180 DOI: 10.3390/nu14020366] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 01/21/2023] Open
Abstract
We examined how dietary and physical activity behaviors influence fluctuations in blood glucose levels over a seven-day period in people at high risk for diabetes. Twenty-eight participants underwent a mixed meal tolerance test to assess glucose homeostasis at baseline. Subsequently, they wore an accelerometer to assess movement behaviors, recorded their dietary intakes through a mobile phone application, and wore a flash glucose monitoring device that measured glucose levels every 15 min for seven days. Generalized estimating equation models were used to assess the associations of metabolic and lifestyle risk factors with glycemic variability. Higher BMI, amount of body fat, and selected markers of hyperglycemia and insulin resistance from the meal tolerance test were associated with higher mean glucose levels during the seven days. Moderate- to vigorous-intensity physical activity and polyunsaturated fat intake were independently associated with less variation in glucose levels (CV%). Higher protein and polyunsaturated fatty acid intakes were associated with more time-in-range. In contrast, higher carbohydrate intake was associated with less time-in-range. Our findings suggest that dietary composition (a higher intake of polyunsaturated fat and protein and lower intake of carbohydrates) and moderate-to-vigorous physical activity may reduce fluctuations in glucose levels in persons at high risk of diabetes.
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Pullano SA, Greco M, Bianco MG, Foti D, Brunetti A, Fiorillo AS. Glucose biosensors in clinical practice: principles, limits and perspectives of currently used devices. Am J Cancer Res 2022; 12:493-511. [PMID: 34976197 PMCID: PMC8692922 DOI: 10.7150/thno.64035] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022] Open
Abstract
The demand of glucose monitoring devices and even of updated guidelines for the management of diabetic patients is dramatically increasing due to the progressive rise in the prevalence of diabetes mellitus and the need to prevent its complications. Even though the introduction of the first glucose sensor occurred decades ago, important advances both from the technological and clinical point of view have contributed to a substantial improvement in quality healthcare. This review aims to bring together purely technological and clinical aspects of interest in the field of glucose devices by proposing a roadmap in glucose monitoring and management of patients with diabetes. Also, it prospects other biological fluids to be examined as further options in diabetes care, and suggests, throughout the technology innovation process, future directions to improve the follow-up, treatment, and clinical outcomes of patients.
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