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Munshi M, Slyne C, Davis D, Michals A, Sifre K, Dewar R, Atakov-Castillo A, Toschi E. Use of Technology in Older Adults with Type 1 Diabetes: Clinical Characteristics and Glycemic Metrics. Diabetes Technol Ther 2022; 24:1-9. [PMID: 34524033 PMCID: PMC8783629 DOI: 10.1089/dia.2021.0246] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: The use of diabetes-related technology, both for insulin administration and glucose monitoring, has shown benefits in older adults with type 1 diabetes (T1D). However, the characteristics of older adults with T1D and their use of technology in real-world situations are not well documented. Methods: Older adults (age ≥65 years) with T1D, using insulin pump or multiple daily injections (MDI) for insulin administration, and continuous glucose monitoring (CGM) or glucometer (blood glucose monitoring [BGM]) for glucose monitoring were evaluated. Participants wore CGM for 2 weeks, completed surveys, and underwent laboratory evaluation. Results: We evaluated 165 older adults with T1D; mean age 70 ± 10 years, diabetes duration 40 ± 17 years, and A1C 7.4% ± 0.9% (57 ± 10 mmol/mol). For insulin administration, 63 (38%) were using MDI, while 102 (62%) were using pump. Compared to MDI, pump users were less likely to have cognitive dysfunction (49% vs. 65%, P = 0.04) and had lower scores on the hypoglycemia fear survey (P = 0.03). For glucose monitoring, 95 (58%) used CGM, while 70 (42%) used BGM. Compared to BGM, CGM users were more likely to report impaired awareness of hypoglycemia (IAH) (P = 0.01), and had lower A1C (P = 0.02). Participants who used any technology (pump or CGM) had lower A1C (P = 0.04, 0.006), less hypoglycemia ≤54 mg/dL (P = 0.0006, <0.0001) and <70 mg/dL (P = 0.0002, 0.0001), and fewer glycemic excursions (coefficient of variation %) (P = 0.0001, <0.0001), while reporting more IAH (P = 0.04, P = 0.006) and diabetes distress (P = 0.02, 0.004). Conclusion: Older adults with T1D who use newer diabetes-related technology had better glycemic control, lower hypoglycemia risk, and fewer glycemic excursions. However, they were more likely to report IAH and diabetes-related distress. Clinical trials.gov NCT03078491.
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Affiliation(s)
- Medha Munshi
- Joslin Diabetes Center, Clinical Research, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Address correspondence to: Medha Munshi, MD, Joslin Diabetes Center, Clinical Research, 1 Joslin Place Suite 350, Boston, MA 02215, USA
| | - Christine Slyne
- Joslin Diabetes Center, Clinical Research, Boston, Massachusetts, USA
| | - Dai'Quann Davis
- Joslin Diabetes Center, Clinical Research, Boston, Massachusetts, USA
| | - Amy Michals
- Joslin Diabetes Center, Clinical Research, Boston, Massachusetts, USA
| | - Kayla Sifre
- Joslin Diabetes Center, Clinical Research, Boston, Massachusetts, USA
| | - Rachel Dewar
- Joslin Diabetes Center, Clinical Research, Boston, Massachusetts, USA
| | | | - Elena Toschi
- Joslin Diabetes Center, Clinical Research, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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2
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Sun K, Ding Z, Zhang J, Chen H, Qin Y, Xu S, Wu C, Yu J, Chiu DT. Enhancing the Long-Term Stability of a Polymer Dot Glucose Transducer by Using an Enzymatic Cascade Reaction System. Adv Healthc Mater 2021; 10:e2001019. [PMID: 33094566 PMCID: PMC8168372 DOI: 10.1002/adhm.202001019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/15/2020] [Indexed: 12/22/2022]
Abstract
Impaired glucose metabolism in diabetes causes severe acute and long-term complications, making real-time detection of blood glucose indispensable for diabetic patients. Existing continuous glucose monitoring systems are unsuitable for long-term clinical glycemic management due to poor long-term stability. Polymer dot (Pdot) glucose transducers are implantable optical nanosensors that exhibit excellent brightness, sensitivity, selectivity, and biocompatibility. Here, it is shown that hydrogen peroxide-a product of glucose oxidation in Pdot glucose sensors-degrades sensor performance via photobleaching, reduces glucose oxidase activity, and generates cytotoxicity. By adding catalase to a glucose oxidase-based Pdot sensor to create an enzymatic cascade, the hydrogen peroxide product of glucose oxidation is rapidly decomposed by catalase, preventing its accumulation and improving the sensor's photostability, enzymatic activity, and biocompatibility. Thus, a next-generation Pdot glucose transducer with a multienzyme reaction system (Pdot-GOx/CAT) that provides excellent sensing characteristics as well as greater detection system stability is presented. Pdot glucose transducers that incorporate this enzymatic cascade to eliminate hydrogen peroxide will possess greater long-term stability for improved continuous glucose monitoring in diabetic patients.
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Affiliation(s)
- Kai Sun
- Department of Chemistry, University of Washington, Seattle, WA, 98195, USA
| | - Zhaoyang Ding
- Department of Chemistry, University of Washington, Seattle, WA, 98195, USA
| | - Jicheng Zhang
- Department of Chemistry, University of Washington, Seattle, WA, 98195, USA
| | - Haobin Chen
- Department of Chemistry, University of Washington, Seattle, WA, 98195, USA
| | - Yuling Qin
- Department of Chemistry, University of Washington, Seattle, WA, 98195, USA
| | - Shihan Xu
- Department of Chemistry, University of Washington, Seattle, WA, 98195, USA
| | - Changfeng Wu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, 518055, China
| | - Jiangbo Yu
- Department of Chemistry, University of Washington, Seattle, WA, 98195, USA
| | - Daniel T Chiu
- Department of Chemistry, University of Washington, Seattle, WA, 98195, USA
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Sun K, Liu S, Liu J, Ding Z, Jiang Y, Zhang J, Chen H, Yu J, Wu C, Chiu DT. Improving the Accuracy of Pdot-Based Continuous Glucose Monitoring by Using External Ratiometric Calibration. Anal Chem 2021; 93:2359-2366. [DOI: 10.1021/acs.analchem.0c04223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kai Sun
- Department of Chemistry and Bioengineering, University of Washington, Seattle, Washington 98195, United States
| | - Siyang Liu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China
| | - Jing Liu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China
| | - Zhaoyang Ding
- Department of Chemistry and Bioengineering, University of Washington, Seattle, Washington 98195, United States
| | - Yifei Jiang
- Department of Chemistry and Bioengineering, University of Washington, Seattle, Washington 98195, United States
| | - Jicheng Zhang
- Department of Chemistry and Bioengineering, University of Washington, Seattle, Washington 98195, United States
| | - Haobin Chen
- Department of Chemistry and Bioengineering, University of Washington, Seattle, Washington 98195, United States
| | - Jiangbo Yu
- Department of Chemistry and Bioengineering, University of Washington, Seattle, Washington 98195, United States
| | - Changfeng Wu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China
| | - Daniel T. Chiu
- Department of Chemistry and Bioengineering, University of Washington, Seattle, Washington 98195, United States
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4
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Dadlani V, Kaur RJ, Stegall M, Xyda SE, Kumari K, Bonner K, Smith B, Thapa P, Dean PG, Kudva YC. Continuous glucose monitoring to assess glycemic control in the first 6 weeks after pancreas transplantation. Clin Transplant 2019; 33:e13719. [PMID: 31545535 DOI: 10.1111/ctr.13719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/31/2019] [Accepted: 09/12/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Current therapy for Type 1 diabetes (T1D) is characterized by significant glucose variability (GV). Pancreas transplantation (PT) is performed in certain T1D patients with and without end-stage renal disease. To date, GV has been examined to a limited extent after PT. METHODS We investigated GV using continuous glucose monitoring (CGM) 3-6 weeks after PT. RESULTS Eleven patients had simultaneous kidney pancreas transplantation (SPK), nine pancreas after kidney (PAK), and six pancreas transplantation alone (PTA). Mean CGM showed no difference between SPK, 126.5 ± 13.9, PAK 119.9 ± 12.8, and PTA 131.1 ± 29 mg/dL (P value .6). Percentage of time in range (TIR, 70-180 mg/dL) was 92% for SPK, 93.4% in PAK, and 88.5% in PTA with only 0.3%, 1.5%, and 0.3% of time <70 mg/dL. Percentage >180 mg/dL was 7.9% for SPK, 4.9% PAK, and 11% in PTA. Other measures of GV were similar in the three cohorts. In six patients, CGM was performed before and after PT and improved significantly. GV was also better compared with a matched cohort of T1D patients. CONCLUSIONS All 3 types of PT resulted in excellent glucose control 3-6 weeks post-procedure. CGM outcomes represent an important objective outcome after PT.
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Affiliation(s)
- Vikash Dadlani
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | - Mark Stegall
- Department of Transplant Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | | | - Kanchan Kumari
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Keisha Bonner
- Department of Transplant Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Byron Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Patrick G Dean
- Department of Transplant Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Yogish C Kudva
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Klaprat N, MacIntosh A, McGavock JM. Gaps in Knowledge and the Need for Patient-Partners in Research Related to Physical Activity and Type 1 Diabetes: A Narrative Review. Front Endocrinol (Lausanne) 2019; 10:42. [PMID: 30787908 PMCID: PMC6372552 DOI: 10.3389/fendo.2019.00042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022] Open
Abstract
Regular physical activity (PA) is a cornerstone in the management of complications associated with type 1 diabetes (T1D). Most national guidelines advocate for regular PA for persons living with T1D, however the evidence to support these recommendations has not be reviewed recently. Additionally, in an era of patient-centered care and patient oriented research, the role of patient partners in the area of PA and T1D interventions has never been explored. The purpose of this narrative review is to overcome these two gaps in the literature. Here we review selected epidemiological evidence and identify gaps in research that would add important information to guide practitioners and future guidelines. We also provide an overview of patient-oriented research projects co-developed with persons living with T1D. Significant gaps in the field include: (1) a lack of adequately powered prospective cohort studies using serial measures of PA and hard chronic disease end-points; (2) no multi-centered, highly powered, randomized controlled trials of PA, and long-term health outcomes; (3) little data on the role of new technologies to support PA-related behavior change, and (4) no trials that involved patients in the design and execution of PA-based clinical trials. This review provides a template for scientists and patient partners to develop future research priorities and agendas in the field.
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Affiliation(s)
- Nika Klaprat
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Andrea MacIntosh
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan M. McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Action Canada SPOR Network, Toronto, ON, Canada
- *Correspondence: Jonathan M. McGavock
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Sun K, Yang Y, Zhou H, Yin S, Qin W, Yu J, Chiu DT, Yuan Z, Zhang X, Wu C. Ultrabright Polymer-Dot Transducer Enabled Wireless Glucose Monitoring via a Smartphone. ACS NANO 2018; 12:5176-5184. [PMID: 29694016 DOI: 10.1021/acsnano.8b02188] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Optical methods such as absorptiometry, fluorescence, and surface plasmon resonance have long been explored for sensing glucose. However, these schemes have not had the clinical success of electrochemical methods for point-of-care testing because of the limited performance of optical sensors and the bulky instruments they require. Here, we show that an ultrasensitive optical transducer can be used for wireless glucose monitoring via a smartphone. The optical transducer combines oxygen-sensitive polymer dots (Pdots) with glucose oxidase that sensitively detect glucose when oxygen is consumed in the glucose oxidation reaction. By judicious design of the Pdots with ultralong phosphorescence lifetime, the transducer exhibited a significantly enhanced sensitivity by 1 order of magnitude as compared to the one in a previous study. As a result, the optical images of subcutaneous glucose level obtained with the smartphone camera could be utilized to clearly distinguish between euglycemia and hyperglycemia. We further developed an image processing algorithm and a software application that was installed on a smartphone. Real-time dynamic glucose monitoring in live mice was demonstrated with the smartphone and the implanted Pdot transducer.
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Affiliation(s)
- Kai Sun
- State Key Laboratory of Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun , Jilin 130012 , China
| | - Yingkun Yang
- State Key Laboratory of Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun , Jilin 130012 , China
| | - Hua Zhou
- State Key Laboratory of Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun , Jilin 130012 , China
| | - Shengyan Yin
- State Key Laboratory of Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun , Jilin 130012 , China
| | - Weiping Qin
- State Key Laboratory of Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun , Jilin 130012 , China
| | - Jiangbo Yu
- Department of Chemistry and Bioengineering , University of Washington , Seattle , Washington 98195 , United States
| | - Daniel T Chiu
- Department of Chemistry and Bioengineering , University of Washington , Seattle , Washington 98195 , United States
| | - Zhen Yuan
- Faculty of Health Science , University of Macau , Taipa , Macau SAR 999078 , China
| | - Xuanjun Zhang
- Faculty of Health Science , University of Macau , Taipa , Macau SAR 999078 , China
| | - Changfeng Wu
- Department of Biomedical Engineering , Southern University of Science and Technology , Shenzhen 518055 , China
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7
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Impact of Geriatric Syndromes on Diabetes Management. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Cao C, Zhang Y, Jiang C, Qi M, Liu G. Advances on Aryldiazonium Salt Chemistry Based Interfacial Fabrication for Sensing Applications. ACS APPLIED MATERIALS & INTERFACES 2017; 9:5031-5049. [PMID: 28124552 DOI: 10.1021/acsami.6b16108] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Aryldiazonium salts as coupling agents for surface chemistry have evidenced their wide applications for the development of sensors. Combined with advances in nanomaterials, current trends in sensor science and a variety of particular advantages of aryldiazonium salt chemistry in sensing have driven the aryldiazonium salt-based sensing strategies to grow at an astonishing pace. This review focuses on the advances in the use of aryldiazonium salts for modifying interfaces in sensors and biosensors during the past decade. It will first summarize the current methods for modification of interfaces with aryldiazonium salts, and then discuss the sensing applications of aryldiazonium salts modified on different transducers (bulky solid electrodes, nanomaterials modified bulky solid electrodes, and nanoparticles). Finally, the challenges and perspectives that aryldiazonium salt chemistry is facing in sensing applications are critically discussed.
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Affiliation(s)
- Chaomin Cao
- Key Laboratory of Pesticide and Chemical Biology of Ministry of Education, College of Chemistry, Central China Normal University , Wuhan 430079, P. R. China
| | - Yin Zhang
- Key Laboratory of Pesticide and Chemical Biology of Ministry of Education, College of Chemistry, Central China Normal University , Wuhan 430079, P. R. China
| | - Cheng Jiang
- Nuffield Department of Clinical Neurosciences, Department of Chemistry, University of Oxford , Oxford OX1 2JD, United Kingdom
| | - Meng Qi
- Key Laboratory of Pesticide and Chemical Biology of Ministry of Education, College of Chemistry, Central China Normal University , Wuhan 430079, P. R. China
| | - Guozhen Liu
- Key Laboratory of Pesticide and Chemical Biology of Ministry of Education, College of Chemistry, Central China Normal University , Wuhan 430079, P. R. China
- ARC Centre of Excellence in Nanoscale BioPhotonics (CNBP), Department of Physics and Astronomy, Macquarie University , North Ryde 2109, Australia
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9
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Ferenci T, Körner A, Kovács L. The interrelationship of HbA1c and real-time continuous glucose monitoring in children with type 1 diabetes. Diabetes Res Clin Pract 2015; 108:38-44. [PMID: 25666106 DOI: 10.1016/j.diabres.2015.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/03/2014] [Accepted: 01/15/2015] [Indexed: 01/18/2023]
Abstract
AIMS The aim of this observational study is to investigate the relationship between age, duration of diabetes, HbA1c and the parameters of glucose levels measured with real-time CGM in children with type 1 diabetes. METHODS Glucose level was characterized with the relative time spent in hyper- and hypoglycemia, central tendency, variability and MAGE during (real-time) CGM. These parameters were measured in 57 children with type 1 diabetes mellitus. The univariate association of the measured parameters was investigated with scatterplots as well as with linear and distance correlation coefficients. RESULTS Age and duration of diabetes were not clinically relevantly associated with any descriptor of glucose level. HbA1c had an overall positive association with variability and MAGE observed during CGM. Slight, but non-significant, positive association of HbA1c was observed with the time spent in hyperglycemia and the central tendency of glucose level. With the exception of MAGE, the associations of the descriptors with HbA1c are non-monotonic, with a temporary break in the positive correlation at 10%. CONCLUSIONS The results confirmed the well-known positive association of HbA1c with the central tendency of glucose level. The non-monotonic relationship between HbA1c and the indicators of the central tendency of glucose level might be caused by the changed adherence of the patients during the period of CGM. HbA1c's positive association with MAGE without non-monotonicity underlines MAGE's usefulness in the reliable assessment of the patients' glycemic state.
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Affiliation(s)
- Tamás Ferenci
- Óbuda University, John von Neumann Faculty of Informatics, Physiological Controls Group, Bécsi út 96/b, H-1034 Budapest, Hungary.
| | - Anna Körner
- Semmelweis University, 1st Department of Paediatrics, Bókay János u. 53-54, H-1083 Budapest, Hungary.
| | - Levente Kovács
- Óbuda University, John von Neumann Faculty of Informatics, Physiological Controls Group, Bécsi út 96/b, H-1034 Budapest, Hungary.
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10
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Kotanen CN, Guiseppi-Elie A. Monitoring systems and quantitative measurement of biomolecules for the management of trauma. Biomed Microdevices 2014; 15:561-77. [PMID: 23494594 DOI: 10.1007/s10544-013-9756-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Continued high morbidity and complications due to trauma related hemorrhage underscores the fact that our understanding of the detailed molecular events of trauma are inadequate to bring life-saving changes to practice. The current state of efficacy and advances in biomedical microdevice technology for trauma diagnostics concerning hemorrhage and hemorrhagic shock was considered with respect to vital signs and metabolic biomarkers. Tachycardia and hypotension are markers of hemorrhagic shock in decompensated trauma patients. Base deficit has been predicative of injury severity at hospital admission. Tissue oxygen saturation has been predicative of onset of multiple organ dysfunction syndrome. Blood potassium levels increase with onset of hemorrhagic shock. Lactate is a surrogate for tissue hypoxia and its clearance predicts mortality. Triage glucose measurements have been shown to be specific in predicting major injuries. No vital sign has yet to be proven effective as an independent predictor of trauma severity. Point of care (POC) devices allow for rapid results, easy sample preparation and processing, small sample volumes, small footprint, multifunctional analysis, and low cost. Advances in the field of in-vivo biosensors has provided a much needed platform by which trauma related metabolites can be monitored easily, rapidly and continuously. Multi-analyte monitoring biosensors have the potential to explore areas still undiscovered in the realm of trauma physiology.
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Affiliation(s)
- Christian N Kotanen
- Center for Bioelectronics, Biosensors and Biochips, Clemson University Advanced Materials Center, 100 Technology Drive, Anderson, SC 29625, USA.
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11
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Minder AE, Albrecht D, Schäfer J, Zulewski H. Frequency of blood glucose testing in well educated patients with diabetes mellitus type 1: how often is enough? Diabetes Res Clin Pract 2013; 101:57-61. [PMID: 23726303 DOI: 10.1016/j.diabres.2012.12.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 11/01/2012] [Accepted: 12/17/2012] [Indexed: 11/16/2022]
Abstract
AIMS Self-monitored blood glucose (SMBG) and knowledge of insulin requirements are pivotal for good metabolic control in patients with diabetes mellitus type 1. However, the SMBG-frequency needed for optimal glycaemic control especially in well educated patients is unclear. METHODS In patients with type 1 diabetes treated with flexible intensified insulin therapy, we evaluated HbA1c values and the directly preceding computerised SMBG-frequencies over a 12 months period. To estimate the association between HbA1c and SMBG-frequency, we fitted a piecewise linear spline model with a change in slope at 4 SMBGs per day which is the recommended minimal SMBG-frequency at our institution. RESULTS A total of 150 patients were available for analysis, with a median baseline HbA1c of 7.1% (interquartile range 6.6, 7.8). In the multivariable analysis (adjusted for gender and psychological problems), each additional SMBG measurement was associated with an estimated difference in HbA1c of -0.19% (95% confidence interval (CI) -0.42, 0.05) for ≤4 SMBGs per day and of -0.02% (95% CI -0.10, 0.06) for >4 SMBGs per day. CONCLUSIONS Good diabetes control can be achieved in routine diabetes care with flexible intensified insulin therapy based on continuing patients' education and with a minimum of 4 SMBGs per day.
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Affiliation(s)
- Anna Elisabeth Minder
- Division of Endocrinology Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Dominique Albrecht
- Division of Endocrinology Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Juliane Schäfer
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031 Basel, Switzerland; Clinical Trial Unit, University Hospital Basel, Schanzenstrasse 55, 4031 Basel, Switzerland
| | - Henryk Zulewski
- Division of Endocrinology Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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12
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Pepper GM, Steinsapir J, Reynolds K. Effect of short-term iPRO continuous glucose monitoring on hemoglobin A1c levels in clinical practice. Diabetes Technol Ther 2012; 14:654-7. [PMID: 22690923 DOI: 10.1089/dia.2012.0030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study determined if short-term (professional) blinded continuous glucose monitoring (CGM) improves hemoglobin A1c levels in a mixed group of patients with type 1 and type 2 diabetes in the clinical setting of an office practice. RESEARCH DESIGN AND METHODS This was a retrospective analysis of 102 consecutive patients with diabetes over the course of 10 months in a subspecialty practice undergoing 3-day blinded CGM using the iPRO(™) device (Medtronic, Northridge, CA). Hemoglobin A1c levels were measured prior to and up to 7 months after the CGM procedure. RESULTS Before blinded CGM the average hemoglobin A1c level was 7.7±1.0%, and after it was 7.8±1.1%. These values are not statistically different. A subgroup analysis of subjects using continuous subcutaneous insulin infusion treatment also failed to show a significant hemoglobin A1c difference pre- and post-CGM. CONCLUSIONS Using the iPro device for short-term (professional) blinded CGM in an office setting to improve hemoglobin A1c levels may not be a feasible goal for patients with type 1 and type 2 diabetes. The expectations of benefit, choice of patient, and choice of technology for short-term CGM are factors requiring careful consideration before testing takes place.
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Affiliation(s)
- Gary M Pepper
- Palm Beach Diabetes and Endocrine Specialists, P.A. 550 Heritage Drive, Jupiter, FL 33458, USA.
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13
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Abstract
Recent technological advancements in insulin administration and glucose monitoring have allowed patients with diabetes to become increasingly involved in their own care. Devices replacing the traditional vial and syringe, such as insulin pens, are gaining popularity and offer simple and convenient insulin administration. Pen devices are associated with improved dose accuracy, reducing the risk of hypo- or hyperglycemia, and are continually being updated with new safety features in order to optimize their performance. In patients for whom glucose variability remains a problem, continuous subcutaneous insulin infusion via an implanted canula or continuous intraperitoneal insulin infusion via an implanted pump is safe and effective when used correctly, although cost can be a limitation. More accurate retrospective and real-time continuous monitoring devices, which can better detect blood glucose excursions, have become standard components of modern-day diabetes management. The most recent devices have sensor-signaling capabilities with wireless data transmission, leading to reduced time delay and more accurate alerts. Ultimately, though, while self-management remains a critical factor in improving glycemic control at present, human error may undermine even the most accurate treatment interventions. A key long-term goal in diabetes management is, therefore, to develop an automated and accurate closed-loop system for blood glucose monitoring and insulin delivery to better reflect the physiological mechanisms of glucose homeostasis and remove the "human" element. This "artificial pancreas" would offer the most innovative intervention for diabetes management and has the potential to considerably reduce the patient's burden of self-care.
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Affiliation(s)
- Alfred Penfornis
- University Hospital of Besançon, and EA 3920, University of Franche-Comté, Besançon, France.
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14
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Rubin RR, Borgman SK, Sulik BT. Crossing the technology divide: practical strategies for transitioning patients from multiple daily insulin injections to sensor-augmented pump therapy. DIABETES EDUCATOR 2011; 37 Suppl 1:5S-18S; quiz 19S-20S. [PMID: 21217102 DOI: 10.1177/0145721710391107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the benefits of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) systems compared with self-monitoring of blood glucose (SMBG) and multiple daily injection (MDI) therapy; to assess the benefits of sensor-augmented pump therapy (SAPT) in patients with type 1 diabetes; and to present an evidence-based practical protocol for introducing SAPT in patients with no prior pump or CGM experience. CONCLUSION Continuous glucose monitoring and CSII have advantages over SMBG and MDI, respectively, in terms of A1C and hypoglycemia reduction. The Sensor-Augmented Pump Therapy for A1C Reduction (STAR) 3 trial demonstrated that initiating both CGM and CSII in selected adult and pediatric patients with type 1 diabetes unable to meet glycemic goals with intensive insulin injection therapy significantly improved glucose control. In all subjects using SAPT, A1C levels fell rapidly from baseline to 3 months and remained significantly lower than among subjects in the SMBG+MDI group for 1 year. A distinguishing feature of the STAR 3 study was its stepwise protocol for systematizing education and self-management support using Web-based training modules and therapy management software. The demonstrated strengths of this education protocol recommend it as a model for implementing SAPT in the broader population of patients with type 1 diabetes who have not achieved their glycemic goals with optimized MDI therapy.
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Affiliation(s)
- Richard R Rubin
- The Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Rubin)
| | - Sarah K Borgman
- The International Diabetes Center at Nicollet, Minneapolis, MN (Ms. Borgman)
| | - Becky T Sulik
- The Rocky Mountain Diabetes and Osteoporosis Center (Ms. Sulik)
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Plaxco KW, Soh HT. Switch-based biosensors: a new approach towards real-time, in vivo molecular detection. Trends Biotechnol 2011; 29:1-5. [PMID: 21106266 PMCID: PMC3010506 DOI: 10.1016/j.tibtech.2010.10.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/18/2010] [Accepted: 10/25/2010] [Indexed: 01/21/2023]
Abstract
Although the ability to monitor specific molecules in vivo in real-time could revolutionize many aspects of healthcare, the technological challenges that stand in the way of reaching this goal are considerable and are poorly met by most existing analytical approaches. Nature, however, has already solved the problem of real-time molecular detection in complex media by employing biomolecular "switches". That is, protein and nucleic acids that sense chemical cues and, by undergoing specific, binding-induced conformational changes, transduce this recognition into high-gain signal outputs. Here, we argue that devices that employ such switches represent a promising route towards versatile, real-time molecular monitoring in vivo.
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Affiliation(s)
- Kevin W Plaxco
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, CA 93106, USA
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