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Villa-Tamayo MF, Builes-Montaño CE, Ramirez-Rincón A, Carvajal J, Rivadeneira PS. Accuracy of an Off-Label Transmitter and Data Manager Paired With an Intermittent Scanned Continuous Glucose Monitor in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024; 18:701-708. [PMID: 36281579 PMCID: PMC11089852 DOI: 10.1177/19322968221133405] [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: 11/15/2022]
Abstract
BACKGROUND This work evaluates the accuracy and agreement between the FreeStyle Libre sensor (FSL) and an off-label converted real-time continuous glucose monitor (c-rtCGM) device consisting of the MiaoMiao transmitter and the xDrip+ application which can be coupled to the FSL. METHODS Four weeks of glucose data were collected from 21 participants with type 1 diabetes using the c-rtCGM and FSL: two weeks with a single initial calibration (uncalibrated) and two weeks with a daily calibration (calibrated). Accuracy and agreement evaluation included mean absolute relative difference (MARD), the %20/20 rule, Bland-Altman plots, and the Consensus Error Grid analysis. RESULTS Values reported by the c-rtCGM system compared with the FSL resulted in an overall MARD of 12.06% and 84.71% of the results falling within Consensus Error Grid Zone A when the device is calibrated. For uncalibrated devices, an overall MARD of 17.49% was obtained. Decreased accuracy was shown in the hypoglycemic range and for rates of change greater than 2 mg/dL/min. The between-device bias also incremented with increasing glucose values. CONCLUSION Measurements recorded by the c-rtCGM were found to be accurate when compared with FSL data only when performing daily c-rtCGM device calibrations. High drops in accuracy and agreement between devices occurred when the c-rtCGM was not calibrated.
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Affiliation(s)
- María F. Villa-Tamayo
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, USA
| | | | - Alex Ramirez-Rincón
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
- Clínica Integral de Diabetes, Medellín, Colombia
| | | | - Pablo S. Rivadeneira
- Grupo GITA, Facultad de Minas, Universidad Nacional de Colombia, Medellín, Colombia
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2
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Freckmann G, Eichenlaub M, Waldenmaier D, Pleus S, Wehrstedt S, Haug C, Witthauer L, Jendle J, Hinzmann R, Thomas A, Eriksson Boija E, Makris K, Diem P, Tran N, Klonoff DC, Nichols JH, Slingerland RJ. Clinical Performance Evaluation of Continuous Glucose Monitoring Systems: A Scoping Review and Recommendations for Reporting. J Diabetes Sci Technol 2023; 17:1506-1526. [PMID: 37599389 PMCID: PMC10658695 DOI: 10.1177/19322968231190941] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
The use of different approaches for design and results presentation of studies for the clinical performance evaluation of continuous glucose monitoring (CGM) systems has long been recognized as a major challenge in comparing their results. However, a comprehensive characterization of the variability in study designs is currently unavailable. This article presents a scoping review of clinical CGM performance evaluations published between 2002 and 2022. Specifically, this review quantifies the prevalence of numerous options associated with various aspects of study design, including subject population, comparator (reference) method selection, testing procedures, and statistical accuracy evaluation. We found that there is a large variability in nearly all of those aspects and, in particular, in the characteristics of the comparator measurements. Furthermore, these characteristics as well as other crucial aspects of study design are often not reported in sufficient detail to allow an informed interpretation of study results. We therefore provide recommendations for reporting the general study design, CGM system use, comparator measurement approach, testing procedures, and data analysis/statistical performance evaluation. Additionally, this review aims to serve as a foundation for the development of a standardized CGM performance evaluation procedure, thereby supporting the goals and objectives of the Working Group on CGM established by the Scientific Division of the International Federation of Clinical Chemistry and Laboratory Medicine.
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Affiliation(s)
- Guido Freckmann
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Manuel Eichenlaub
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stephanie Wehrstedt
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Lilian Witthauer
- Diabetes Center Berne, Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital Bern, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Johan Jendle
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Rolf Hinzmann
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Roche Diabetes Care GmbH, Mannheim, Germany
| | - Andreas Thomas
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Pirna, Germany
| | - Elisabet Eriksson Boija
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Equalis AB, Uppsala, Sweden
| | - Konstantinos Makris
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Clinical Biochemistry Department, KAT General Hospital, Athens, Greece
| | - Peter Diem
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Endokrinologie Diabetologie Bern, Bern, Switzerland
| | - Nam Tran
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA, USA
| | - David C. Klonoff
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - James H. Nichols
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robbert J. Slingerland
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Department of Clinical Chemistry, Isala Clinics, Zwolle, the Netherlands
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3
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Ng SM, Dearman S, Fisher M, Mushtaq T, Randell T. Case for funding of continuous glucose monitoring systems for patients with recurrent hypoglycaemia. Arch Dis Child 2023; 108:816-817. [PMID: 36202595 DOI: 10.1136/archdischild-2022-323872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/24/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Sze May Ng
- Paediatric Department, Southport and Ormskirk Hospital NHS Trust, Southport, Sefton, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Edge Hill University, Ormskirk, UK
| | | | - Mark Fisher
- UK Children's Hyperinsulinism Charity, London, UK
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Li A, Li X, Xu Y, Wu C, Geng Z, Zhang J, Wang X, Li Y, Li H, Guo X, Tang F. Evaluating the Clinical Accuracy of a Non-invasive Single-Fasting-Calibration Glucometer in Patients with Diabetes: A Multicentre Study. Diabetes Ther 2023; 14:989-1004. [PMID: 37103775 DOI: 10.1007/s13300-023-01402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/23/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the stability and accuracy of glucose measurements determined using the metabolic heat conformation (MHC)-based non-invasive glucometer in a multicentre, self-controlled clinical trial. This device is the first to obtain a medical device registration certificate awarded by the National Medical Products Administration of China (NMPA). METHODS The multicentre clinical study was conducted at three sites and enrolled 200 subjects whose glucose was measured with a non-invasive glucometer (the Contour Plus blood glucose monitoring system) and by venous plasma glucose (VPG) measurements, in a fasted state and at 2 and 4 h after meals. RESULTS Based on both the non-invasive and VPG measurements, 93.9% (95% confidence interval 91.7-95.6%) of the blood glucose (BG) values fell within consensus error grid (CEG) zones A + B. The measurements obtained in a fasted state and at 2 h after meals were more accurate, with 99.0% and 97.0% of the BG values, respectively, falling within zones A + B. Compared to those subjects who received insulin, the proportion of values in zones A + B and the correlation coefficients were 3.1% and 0.0596 higher, respectively. The accuracy of the non-invasive glucometer was influenced by the level of insulin resistance calculated by the homeostatic model assessment method, which had a correlation coefficient with the mean absolute relative difference of - 0.1588 (P = 0.0001). CONCLUSION The MHC-based non-invasive glucometer assessed in the present study demonstrates generally high stability and accuracy in the glucose monitoring of people with diabetes. The calculation model needs to be further explored and optimised for patients with different diabetes subtypes, levels of insulin resistance and insulin secretion capacity. CLINICAL TRIAL REGISTRY NUMBER ChiCTR1900020523.
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Affiliation(s)
- Ang Li
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, China
| | - Xiang Li
- Department of Precision Instrument, State Key Laboratory of Precision Measurement Technology and Instruments, Tsinghua University, Beijing, 100084, China
| | - Yuanmeng Xu
- Department of Precision Instrument, State Key Laboratory of Precision Measurement Technology and Instruments, Tsinghua University, Beijing, 100084, China
| | - Chenyang Wu
- Department of Precision Instrument, State Key Laboratory of Precision Measurement Technology and Instruments, Tsinghua University, Beijing, 100084, China
| | - Zhanxiao Geng
- Department of Precision Instrument, State Key Laboratory of Precision Measurement Technology and Instruments, Tsinghua University, Beijing, 100084, China
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, China
| | - Xiaohao Wang
- Department of Precision Instrument, State Key Laboratory of Precision Measurement Technology and Instruments, Tsinghua University, Beijing, 100084, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College and the Chinese Academy of Medical Sciences, Beijing, China
| | - Hongmei Li
- Department of Endocrinology, China Emergency General Hospital, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, China.
| | - Fei Tang
- Department of Precision Instrument, State Key Laboratory of Precision Measurement Technology and Instruments, Tsinghua University, Beijing, 100084, China.
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5
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Muhs A, Bobrowski T, Lielpētere A, Schuhmann W. Catalytic Biosensors Operating under Quasi-Equilibrium Conditions for Mitigating the Changes in Substrate Diffusion. Angew Chem Int Ed Engl 2022; 61:e202211559. [PMID: 36253337 PMCID: PMC10099152 DOI: 10.1002/anie.202211559] [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: 08/05/2022] [Indexed: 11/07/2022]
Abstract
Despite the success of continuous glucose measuring systems operating through the skin for about 14 days, long-term implantable biosensors are facing challenges caused by the foreign-body reaction. We present a conceptually new strategy using catalytic enzyme-based biosensors based on a measuring sequence leading to minimum disturbance of the substrate equilibrium concentration by controlling the sensor between "on" and "off" state combined with short potentiometric data acquisition. It is required that the enzyme activity can be completely switched off and no parasitic side reactions allow substrate turnover. This is achieved by using an O2 -independent FAD-dependent glucose dehydrogenase embedded within a crosslinked redox polymer. A short measuring interval allows the glucose concentration equilibrium to be restored quickly which enables the biosensor to operate under quasi-equilibrium conditions.
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Affiliation(s)
- Anna Muhs
- Analytical Chemistry-Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Universitätsstrasse 150, 44780, Bochum, Germany
| | - Tim Bobrowski
- Analytical Chemistry-Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Universitätsstrasse 150, 44780, Bochum, Germany
| | - Anna Lielpētere
- Analytical Chemistry-Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Universitätsstrasse 150, 44780, Bochum, Germany
| | - Wolfgang Schuhmann
- Analytical Chemistry-Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Universitätsstrasse 150, 44780, Bochum, Germany
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6
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Eichenlaub M, Stephan P, Waldenmaier D, Pleus S, Rothenbühler M, Haug C, Hinzmann R, Thomas A, Jendle J, Diem P, Freckmann G. Continuous Glucose Deviation Interval and Variability Analysis (CG-DIVA): A Novel Approach for the Statistical Accuracy Assessment of Continuous Glucose Monitoring Systems. J Diabetes Sci Technol 2022:19322968221134639. [PMID: 36329636 DOI: 10.1177/19322968221134639] [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: 11/06/2022]
Abstract
BACKGROUND The accuracy of continuous glucose monitoring (CGM) systems is crucial for the management of glucose levels in individuals with diabetes mellitus. However, the discussion of CGM accuracy is challenged by an abundance of parameters and assessment methods. The aim of this article is to introduce the Continuous Glucose Deviation Interval and Variability Analysis (CG-DIVA), a new approach for a comprehensive characterization of CGM point accuracy which is based on the U.S. Food and Drug Administration requirements for "integrated" CGM systems. METHODS The statistical concept of tolerance intervals and data from two approved CGM systems was used to illustrate the CG-DIVA. RESULTS The CG-DIVA characterizes the expected range of deviations of the CGM system from a comparison method in different glucose concentration ranges and the variability of accuracy within and between sensors. The results of the CG-DIVA are visualized in an intuitive and straightforward graphical presentation. Compared with conventional accuracy characterizations, the CG-DIVA infers the expected accuracy of a CGM system and highlights important differences between CGM systems. Furthermore, it provides information on the incidence of large errors which are of particular clinical relevance. A software implementation of the CG-DIVA is freely available (https://github.com/IfDTUlm/CGM_Performance_Assessment). CONCLUSIONS We argue that the CG-DIVA can simplify the discussion and comparison of CGM accuracy and could replace the high number of conventional approaches. Future adaptations of the approach could thus become a putative standard for the accuracy characterization of CGM systems and serve as the basis for the definition of future CGM performance requirements.
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Affiliation(s)
- Manuel Eichenlaub
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Rolf Hinzmann
- Roche Diabetes Care GmbH, Mannheim, Germany
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring (WG-CGM)
| | - Andreas Thomas
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring (WG-CGM)
- Pirna, Germany
| | - Johan Jendle
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring (WG-CGM)
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Peter Diem
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring (WG-CGM)
- Endokrinologie Diabetologie Bern, Bern, Switzerland
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring (WG-CGM)
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7
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Subcutaneous amperometric biosensors for continuous glucose monitoring in diabetes. Talanta 2022. [DOI: 10.1016/j.talanta.2022.124033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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8
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Soni A, Wright N, Agwu JC, Drew J, Kershaw M, Moudiotis C, Regan F, Williams E, Timmis A, Ng SM. Fifteen-minute consultation: Practical use of continuous glucose monitoring. Arch Dis Child Educ Pract Ed 2022; 107:188-193. [PMID: 33963071 PMCID: PMC9125373 DOI: 10.1136/archdischild-2020-321190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022]
Abstract
Type 1 diabetes is a self-managed condition. Regular monitoring of blood glucose (BG) levels has been the cornerstone of diabetes management. Finger prick BG testing traditionally has been the standard method employed. More recently, rapid advancements in the development of continuous glucose monitoring devices have led to increased use of technology to help children and young people with diabetes manage their condition. These devices have the potential to improve diabetes control and reduce hypoglycaemia especially if used in conjunction with a pump to automate insulin delivery. This paper aims to provide an update on main CGM devices available and practical considerations for doctors if they come across a child with diabetes who is using one of these devices.
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Affiliation(s)
- Astha Soni
- Paediatrics, Sheffield Children's Hospital, Sheffield, UK
| | - Neil Wright
- Paediatric Endocrinology & Diabetes, Sheffield Children's Hospital, Sheffield, UK
| | - Juliana Chizo Agwu
- Paediatrics, Sandwell and West Birmingham NHS Trust, West Bromwich, UK.,Institute of Clinical Sciences, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Josephine Drew
- Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Melanie Kershaw
- Endocrinology and diabetes, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | | | - Fiona Regan
- Paediatrics, Wexham Park Hospital, Slough, UK
| | - Eleri Williams
- Paediatrics, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK
| | - Alison Timmis
- Paediatrics, Countess of Chester Hospital, NHS Foundation Trust, Chester, Cheshire West and Chester, UK
| | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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9
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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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Bayoumy K, Gaber M, Elshafeey A, Mhaimeed O, Dineen EH, Marvel FA, Martin SS, Muse ED, Turakhia MP, Tarakji KG, Elshazly MB. Smart wearable devices in cardiovascular care: where we are and how to move forward. Nat Rev Cardiol 2021; 18:581-599. [PMID: 33664502 PMCID: PMC7931503 DOI: 10.1038/s41569-021-00522-7] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
Technological innovations reach deeply into our daily lives and an emerging trend supports the use of commercial smart wearable devices to manage health. In the era of remote, decentralized and increasingly personalized patient care, catalysed by the COVID-19 pandemic, the cardiovascular community must familiarize itself with the wearable technologies on the market and their wide range of clinical applications. In this Review, we highlight the basic engineering principles of common wearable sensors and where they can be error-prone. We also examine the role of these devices in the remote screening and diagnosis of common cardiovascular diseases, such as arrhythmias, and in the management of patients with established cardiovascular conditions, for example, heart failure. To date, challenges such as device accuracy, clinical validity, a lack of standardized regulatory policies and concerns for patient privacy are still hindering the widespread adoption of smart wearable technologies in clinical practice. We present several recommendations to navigate these challenges and propose a simple and practical 'ABCD' guide for clinicians, personalized to their specific practice needs, to accelerate the integration of these devices into the clinical workflow for optimal patient care.
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Affiliation(s)
- Karim Bayoumy
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Mohammed Gaber
- Department of Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | | | - Omar Mhaimeed
- Department of Medical Education, Weill Cornell Medicine, Doha, Qatar
| | - Elizabeth H Dineen
- Department of Cardiovascular Medicine, University of California Irvine, Irvine, CA, USA
| | - Francoise A Marvel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Evan D Muse
- Scripps Research Translational Institute and Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA
| | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed B Elshazly
- Department of Medical Education, Weill Cornell Medicine, Doha, Qatar.
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
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11
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Nadia Ahmad NF, Nik Ghazali NN, Wong YH. Wearable patch delivery system for artificial pancreas health diagnostic-therapeutic application: A review. Biosens Bioelectron 2021; 189:113384. [PMID: 34090154 DOI: 10.1016/j.bios.2021.113384] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022]
Abstract
The advanced stimuli-responsive approaches for on-demand drug delivery systems have received tremendous attention as they have great potential to be integrated with sensing and multi-functional electronics on a flexible and stretchable single platform (all-in-one concept) in order to develop skin-integration with close-loop sensation for personalized diagnostic and therapeutic application. The wearable patch pumps have evolved from reservoir-based to matrix patch and drug-in-adhesive (single-layer or multi-layer) type. In this review, we presented the basic requirements of an artificial pancreas, surveyed the design and technologies used in commercial patch pumps available on the market and provided general information about the latest wearable patch pump. We summarized the various advanced delivery strategies with their mechanisms that have been developed to date and representative examples. Mechanical, electrical, light, thermal, acoustic and glucose-responsive approaches on patch form have been successfully utilized in the controllable transdermal drug delivery manner. We highlighted key challenges associated with wearable transdermal delivery systems, their research direction and future development trends.
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Affiliation(s)
- Nur Farrahain Nadia Ahmad
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia; School of Mechanical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
| | - Nik Nazri Nik Ghazali
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yew Hoong Wong
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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12
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Lindner N, Kuwabara A, Holt T. Non-invasive and minimally invasive glucose monitoring devices: a systematic review and meta-analysis on diagnostic accuracy of hypoglycaemia detection. Syst Rev 2021; 10:145. [PMID: 33971958 PMCID: PMC8111899 DOI: 10.1186/s13643-021-01644-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of minimally and non-invasive monitoring systems (including continuous glucose monitoring) has increased rapidly over recent years. Up to now, it remains unclear how accurate devices can detect hypoglycaemic episodes. In this systematic review and meta-analysis, we assessed the diagnostic accuracy of minimally and non-invasive hypoglycaemia detection in comparison to capillary or venous blood glucose in patients with type 1 or type 2 diabetes. METHODS Clinical Trials.gov, Cochrane Library, Embase, PubMed, ProQuest, Scopus and Web of Science were systematically searched. Two authors independently screened the articles, extracted data using a standardised extraction form and assessed methodological quality using a review-tailored quality assessment tool for diagnostic accuracy studies (QUADAS-2). The diagnostic accuracy of hypoglycaemia detection was analysed via meta-analysis using a bivariate random effects model and meta-regression with regard to pre-specified covariates. RESULTS We identified 3416 nonduplicate articles. Finally, 15 studies with a total of 733 patients were included. Different thresholds for hypoglycaemia detection ranging from 40 to 100 mg/dl were used. Pooled analysis revealed a mean sensitivity of 69.3% [95% CI: 56.8 to 79.4] and a mean specificity of 93.3% [95% CI: 88.2 to 96.3]. Meta-regression analyses showed a better hypoglycaemia detection in studies indicating a higher overall accuracy, whereas year of publication did not significantly influence diagnostic accuracy. An additional analysis shows the absence of evidence for a better performance of the most recent generation of devices. CONCLUSION Overall, the present data suggest that minimally and non-invasive monitoring systems are not sufficiently accurate for detecting hypoglycaemia in routine use. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2018 CRD42018104812.
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Affiliation(s)
- Nicole Lindner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK. .,Department of Family Medicine, University of Marburg, Karl-von Frisch-Straße 4, 35043, Marburg, Germany.
| | - Aya Kuwabara
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Tim Holt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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Heile M, Hollstegge B, Broxterman L, Cai A, Close K. Automated Insulin Delivery: Easy Enough to Use in Primary Care? Clin Diabetes 2020; 38:474-485. [PMID: 33384472 PMCID: PMC7755048 DOI: 10.2337/cd20-0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There are three automated insulin delivery devices on the U.S. market, two of which are currently approved by the U.S. Food and Drug Administration. These systems have already made a significant impact for the people who use them in improving diabetes outcomes, including glycemic control and hypoglycemia prevention. This article aims to help primary care and endocrinology providers better understand the components, differences, limitations, and potential fit of these systems into clinical practice.
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Affiliation(s)
- Michael Heile
- TriHealth Physician Partners–Family Medicine and Diabetology, Cincinnati, OH
| | - Betty Hollstegge
- TriHealth Physician Partners–Family Medicine and Diabetology, Cincinnati, OH
| | - Laura Broxterman
- TriHealth Physician Partners–Family Medicine and Diabetology, Cincinnati, OH
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Ibrahim M, Baker J, Cahn A, Eckel RH, El Sayed NA, Fischl AH, Gaede P, Leslie RD, Pieralice S, Tuccinardi D, Pozzilli P, Richelsen B, Roitman E, Standl E, Toledano Y, Tuomilehto J, Weber SL, Umpierrez GE. Hypoglycaemia and its management in primary care setting. Diabetes Metab Res Rev 2020; 36:e3332. [PMID: 32343474 DOI: 10.1002/dmrr.3332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
Hypoglycaemia is common in patients with type 1 diabetes and type 2 diabetes and constitutes a major limiting factor in achieving glycaemic control among people with diabetes. While hypoglycaemia is defined as a blood glucose level under 70 mg/dL (3.9 mmol/L), symptoms may occur at higher blood glucose levels in individuals with poor glycaemic control. Severe hypoglycaemia is defined as an episode requiring the assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions to assure neurologic recovery. Hypoglycaemia is the most important safety outcome in clinical studies of glucose lowering agents. The American Diabetes Association Standards of Medical Care recommends that a management protocol for hypoglycaemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan. A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycaemic goals and promote new therapies to improve quality of life of patients. Data from recent large clinical trials reported low risk of hypoglycaemic events with the use of newer anti-diabetic drugs. Increased hypoglycaemia risk is observed with the use of insulin and/or sulphonylureas. Vulnerable patients with T2D at dual risk of severe hypoglycaemia and cardiovascular outcomes show features of "frailty." Many of such patients may be better treated by the use of GLP-1 receptor agonists or SGLT2 inhibitors rather than insulin. Continuous glucose monitoring (CGM) should be considered for all individuals with increased risk for hypoglycaemia, impaired hypoglycaemia awareness, frequent nocturnal hypoglycaemia and with history of severe hypoglycaemia. Patients with impaired awareness of hypoglycaemia benefit from real-time CGM. The diabetes educator is an invaluable resource and can devote the time needed to thoroughly educate the individual to reduce the risk of hypoglycaemia and integrate the information within the entire construct of diabetes self-management. Conversations about hypoglycaemia facilitated by a healthcare professional may reduce the burden and fear of hypoglycaemia among patients with diabetes and their family members. Optimizing insulin doses and carbohydrate intake, in addition to a short warm up before or after the physical activity sessions may help avoiding hypoglycaemia. Several therapeutic considerations are important to reduce hypoglycaemia risk during pregnancy including administration of rapid-acting insulin analogues rather than human insulin, pre-conception initiation of insulin analogues, and immediate postpartum insulin dose reduction.
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Affiliation(s)
| | - Jason Baker
- Weill Cornell Medicine, New York, New York, USA
| | - Avivit Cahn
- The Diabetes Unit & Endocrinology and Metabolism Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Robert H Eckel
- University of Colorado Denver Anschutz Medical Campus and University of Colorado Hospital, Denver, Colorado, USA
| | - Nuha Ali El Sayed
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Hess Fischl
- University of Chicago Kovler Diabetes Center, Chicago, Illinois, USA
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - R David Leslie
- Blizard Institute, Queen Mary, University of London, London, UK
- Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
| | - Silvia Pieralice
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Dario Tuccinardi
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Paolo Pozzilli
- Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Bjørn Richelsen
- Steno Diabetes Center Aarhus and Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Eytan Roitman
- Institute of Diabetes, Technology and Research, Clalit Health Services, Herzelia, Israel
| | - Eberhard Standl
- Forschergruppe Diabetes eV at Munich Helmholtz Centre, Munich, Germany
| | - Yoel Toledano
- Division of Maternal Fetal Medicine, Helen Schneider Women's Hospital, Rabin Medical Center, Petah Tikva, Israel
| | | | - Sandra L Weber
- Greenville Health System, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, USA
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Ferber C, Mao CS, Yee JK. Type 1 Diabetes in Youth and Technology-Based Advances in Management. Adv Pediatr 2020; 67:73-91. [PMID: 32591065 DOI: 10.1016/j.yapd.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Christopher Ferber
- Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Harbor Box 446, Torrance, CA 90509, USA
| | - Catherine S Mao
- Division of Endocrinology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, 1000 West Carson Street, Harbor Box 446, Torrance, CA 90509, USA; The Lundquist Institute of Biomedical Innvoation at Harbor-UCLA, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Jennifer K Yee
- Division of Endocrinology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, 1000 West Carson Street, Harbor Box 446, Torrance, CA 90509, USA; The Lundquist Institute of Biomedical Innvoation at Harbor-UCLA, 1124 West Carson Street, Torrance, CA 90502, USA.
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Avari P, Reddy M, Oliver N. Is it possible to constantly and accurately monitor blood sugar levels, in people with Type 1 diabetes, with a discrete device (non-invasive or invasive)? Diabet Med 2020; 37:532-544. [PMID: 30803028 DOI: 10.1111/dme.13942] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 12/15/2022]
Abstract
Real-time continuous glucose monitors using subcutaneous needle-type sensors continue to develop. The limitations of currently available systems, however, include time lag behind changes in blood glucose, the invasive nature of such systems, and in some cases, their accuracy. Non-invasive techniques have been developed, but, to date, no commercial device has been successful. A key research priority for people with Type 1 diabetes identified by the James Lind Alliance was to identify ways of monitoring blood glucose constantly and accurately using a discrete device, invasive or non-invasive. Integration of such a sensor is important in the development of a closed-loop system and the technology must be rapid, selective and acceptable for continuous use by individuals. The present review provides an update on existing continuous glucose-sensing technologies, and an overview of emergent techniques, including their accuracy and limitations.
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Affiliation(s)
- P Avari
- Division of Diabetes, Endocrinology and Metabolism, Faculty of Medicine, Imperial College, London, UK
| | - M Reddy
- Division of Diabetes, Endocrinology and Metabolism, Faculty of Medicine, Imperial College, London, UK
| | - N Oliver
- Division of Diabetes, Endocrinology and Metabolism, Faculty of Medicine, Imperial College, London, UK
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Abstract
Regular self-monitoring of blood glucose levels, and ketones when indicated, is an essential component of type 1 diabetes (T1D) management. Although fingerstick blood glucose monitoring has been the standard of care for decades, ongoing rapid technological developments have resulted in increasingly widespread use of continuous glucose monitoring (CGM). This article reviews recommendations for self-monitoring of glucose and ketones in pediatric T1D with particular emphasis on CGM and factors that impact the accuracy and real-world use of this technology.
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Affiliation(s)
- Brynn E. Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, United States
- *Correspondence: Brynn E. Marks
| | - Joseph I. Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
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Abstract
BACKGROUND A good metabolic control before conception and throughout pregnancy with diabetes decreases the risk of short- and long-term adverse outcomes of the mothers and their offsprings. Insulin treatment remains the gold standard treatment recommended for any type of diabetes. New technologies including new insulins and insulin analogues, continuous subcutaneous insulin infusion without and with sensors, the low-glucose predictive suspension function, and closed-loop systems that persistently and automatically self-adjust according to patients' continuous glucose monitoring readings have expanded the offer to clinicians for achieving tight glucose control. AREAS OF UNCERTAINTY Unsafe effects of insulin and insulin analogues in pregnancy with diabetes could be linked with changes in insulin immunogenicity, teratogenicity, and mitogenicity. Second-generation insulin analogues need to be tested and proven. Effectiveness and safety of new insulin delivery systems in real life of diabetic women in pregnancy need further confirmations. SOURCES MEDLINE, EMBASE, Web of Science, Cochrane Library, randomized controlled trials, systematic review and meta-analysis, observational prospective and retrospective studies, case series reports for the most recent insulin analogues, published in English impacted journals, and consensus statements from scientific societies I excluded 60 from 221 papers as not suitable for the purpose of the subject. RESULTS Subcutaneous insulin infusion can be safely used during pregnancy and delivery of well-trained women. Sensors are increasingly accurate tools that improve the efficacy and safety of integrated systems' functioning. Continuous glucose monitoring provides metrics ("time in range" time in "hypoglycemia" and in "hyperglycemia," glucose variability, average glucose levels in different time intervals) used as a guide to diabetes management; these new metrics are object of discussion in special populations. Randomized controlled trials have shown that sensor-augmented pump therapy improves pregnancy outcomes in women with type 1 diabetes. Closed-loop insulin delivery provides better glycemic control than sensor-augmented pump therapy during pregnancy, before, and after delivery. CONCLUSION Second-generation insulin analogues and newer insulin infusion systems that automatically self-adjust according to patients continuous glucose monitor readings are important tools improving the treatment and quality of life of these women. Multi-institutional and disciplinary teams are working to develop and evaluate a pregnancy-specific artificial pancreas.
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Cappon G, Vettoretti M, Sparacino G, Facchinetti A. Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications. Diabetes Metab J 2019; 43:383-397. [PMID: 31441246 PMCID: PMC6712232 DOI: 10.4093/dmj.2019.0121] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/10/2019] [Indexed: 01/21/2023] Open
Abstract
By providing blood glucose (BG) concentration measurements in an almost continuous-time fashion for several consecutive days, wearable minimally-invasive continuous glucose monitoring (CGM) sensors are revolutionizing diabetes management, and are becoming an increasingly adopted technology especially for diabetic individuals requiring insulin administrations. Indeed, by providing glucose real-time insights of BG dynamics and trend, and being equipped with visual and acoustic alarms for hypo- and hyperglycemia, CGM devices have been proved to improve safety and effectiveness of diabetes therapy, reduce hypoglycemia incidence and duration, and decrease glycemic variability. Furthermore, the real-time availability of BG values has been stimulating the realization of new tools to provide patients with decision support to improve insulin dosage tuning and infusion. The aim of this paper is to offer an overview of current literature and future possible developments regarding CGM technologies and applications. In particular, first, we outline the technological evolution of CGM devices through the last 20 years. Then, we discuss about the current use of CGM sensors from patients affected by diabetes, and, we report some works proving the beneficial impact provided by the adoption of CGM. Finally, we review some recent advanced applications for diabetes treatment based on CGM sensors.
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Affiliation(s)
- Giacomo Cappon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Martina Vettoretti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Padova, Italy.
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20
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Artificial Pancreas: Current Progress and Future Outlook in the Treatment of Type 1 Diabetes. Drugs 2019; 79:1089-1101. [DOI: 10.1007/s40265-019-01149-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Zaharieva DP, Turksoy K, McGaugh SM, Pooni R, Vienneau T, Ly T, Riddell MC. Lag Time Remains with Newer Real-Time Continuous Glucose Monitoring Technology During Aerobic Exercise in Adults Living with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:313-321. [PMID: 31059282 PMCID: PMC6551983 DOI: 10.1089/dia.2018.0364] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Real-time continuous glucose monitoring (CGM) devices help detect glycemic excursions associated with exercise, meals, and insulin dosing in patients with type 1 diabetes (T1D). However, the delay between interstitial and blood glucose may result in CGM underestimating the true change in glycemia during activity. The purpose of this study was to examine CGM discrepancies during exercise and the meal postexercise versus self-monitoring of blood glucose (SMBG). Methods: Seventeen adults with T1D using insulin pump therapy and CGM completed 60 min of aerobic exercise on three occasions. A standardized meal was given 30 min postexercise. SMBG was measured during exercise and in recovery using OmniPod® Personal Diabetes Manager (PDM; Insulet, Billerica, MA) with built-in glucose meter (FreeStyle; Abbott Laboratories, Abbott Park, IL), while CGM was measured with Dexcom G4® with 505 algorithm (n = 4) or G5® (n = 13), which were calibrated with subjects' own PDM. Results: SMBG showed a large drop in glycemia during exercise, while CGM showed a lag of 12 ± 11 (mean ± standard deviation) minutes and bias of -7 ± 19 mg/dL/min during activity. Mean absolute relative difference (MARD) for CGM versus SMBG was 13 (6-22)% [median (interquartile range)] during exercise and 8 (5-14)% during mealtime. Clarke error grids showed CGM values were in zones A and B 94%-99% of the time for SMBG. Conclusion: In summary, the drop in CGM lags behind the drop in blood glucose during prolonged aerobic exercise by 12 ± 11 min, and MARD increases to 13 (6-22)% during exercise as well. Therefore, if hypoglycemia is suspected during exercise, individuals should confirm glucose levels with a capillary glucose measurement.
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Affiliation(s)
- Dessi P. Zaharieva
- Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada
| | - Kamuran Turksoy
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Sarah M. McGaugh
- Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada
| | - Rubin Pooni
- Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada
| | | | - Trang Ly
- Insulet Corporation, Billerica, Massachusetts
| | - Michael C. Riddell
- Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada
- LMC Diabetes and Endocrinology, Toronto, Canada
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Freckmann G, Pleus S, Grady M, Setford S, Levy B. Measures of Accuracy for Continuous Glucose Monitoring and Blood Glucose Monitoring Devices. J Diabetes Sci Technol 2019; 13:575-583. [PMID: 30453761 PMCID: PMC6501529 DOI: 10.1177/1932296818812062] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Currently, patients with diabetes may choose between two major types of system for glucose measurement: blood glucose monitoring (BGM) systems measuring glucose within capillary blood and continuous glucose monitoring (CGM) systems measuring glucose within interstitial fluid. Although BGM and CGM systems offer different functionality, both types of system are intended to help users achieve improved glucose control. Another area in which BGM and CGM systems differ is measurement accuracy. In the literature, BGM system accuracy is assessed mainly according to ISO 15197:2013 accuracy requirements, whereas CGM accuracy has hitherto mainly been assessed by MARD, although often results from additional analyses such as bias analysis or error grid analysis are provided. The intention of this review is to provide a comparison of different approaches used to determine the accuracy of BGM and CGM systems and factors that should be considered when using these different measures of accuracy to make comparisons between the analytical performance (ie, accuracy) of BGM and CGM systems. In addition, real-world implications of accuracy and its relevance are discussed.
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Affiliation(s)
- Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
- Stefan Pleus, MSc, Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Lise-Meitner-Straße 8/2, D-89081 Ulm, Germany.
| | - Mike Grady
- LifeScan Scotland Ltd, Inverness, Scotland, UK
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Ajjan R, Slattery D, Wright E. Continuous Glucose Monitoring: A Brief Review for Primary Care Practitioners. Adv Ther 2019; 36:579-596. [PMID: 30659511 PMCID: PMC6824352 DOI: 10.1007/s12325-019-0870-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Indexed: 12/17/2022]
Abstract
Glycated hemoglobin A1c (HbA1c) is routinely used as a marker of average glycemic control, but it fails to provide data on hypoglycemia and glycemic variability, both of which are associated with adverse clinical outcomes. Self-monitoring of blood glucose (SMBG), particularly in insulin-treated patients, is a cornerstone in the management of patients with diabetes. SMBG helps with treatment decisions that aim to reduce high glucose levels while avoiding hypoglycemia and limiting glucose variability. However, repeated SMBG can be inconvenient to patients and difficult to maintain in the long term. By contrast, continuous glucose monitoring (CGM) provides a convenient, comprehensive assessment of blood glucose levels, allowing the identification of high and low glucose levels, in addition to evaluating glycemic variability. CGM using newer detection and visualization systems can overcome many of the limitations of an HbA1c-based approach while addressing the inconvenience and fragmented glucose data associated with SMBG. When used together with HbA1c monitoring, CGM provides complementary information on glucose levels, thus facilitating the optimization of diabetes therapy while reducing the fear and risk of hypoglycemia. Here we review the capabilities and benefits of CGM, including cost-effectiveness data, and discuss the potential limitations of this glucose-monitoring strategy for the management of patients with diabetes. FUNDING: Sanofi US, Inc.
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Affiliation(s)
- Ramzi Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, The LIGHT Laboratories, University of Leeds, Leeds, UK.
| | - David Slattery
- Endocrinology and Metabolic Medicine, York Teaching Hospital, NHS Foundation Trust, York, UK
| | - Eugene Wright
- Department of Medicine and Community and Family Medicine, Duke Southern Regional AHEC, Fayetteville, NC, USA
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Villena Gonzales W, Mobashsher AT, Abbosh A. The Progress of Glucose Monitoring-A Review of Invasive to Minimally and Non-Invasive Techniques, Devices and Sensors. SENSORS (BASEL, SWITZERLAND) 2019; 19:E800. [PMID: 30781431 PMCID: PMC6412701 DOI: 10.3390/s19040800] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
Abstract
Current glucose monitoring methods for the ever-increasing number of diabetic people around the world are invasive, painful, time-consuming, and a constant burden for the household budget. The non-invasive glucose monitoring technology overcomes these limitations, for which this topic is significantly being researched and represents an exciting and highly sought after market for many companies. This review aims to offer an up-to-date report on the leading technologies for non-invasive (NI) and minimally-invasive (MI) glucose monitoring sensors, devices currently available in the market, regulatory framework for accuracy assessment, new approaches currently under study by representative groups and developers, and algorithm types for signal enhancement and value prediction. The review also discusses the future trend of glucose detection by analyzing the usage of the different bands in the electromagnetic spectrum. The review concludes that the adoption and use of new technologies for glucose detection is unavoidable and closer to become a reality.
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Affiliation(s)
- Wilbert Villena Gonzales
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Brisbane 4072, Australia.
| | - Ahmed Toaha Mobashsher
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Brisbane 4072, Australia.
| | - Amin Abbosh
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Brisbane 4072, Australia.
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Picard S, Bonnemaison-Gilbert E, Leutenegger E, Barat P. Optimization of insulin regimen and glucose outcomes with short-term real-time continuous glucose monitoring (RT-CGM) in type 1 diabetic children with sub-optimal glucose control on multiple daily injections: The pediatric DIACCOR study. Arch Pediatr 2019; 26:95-101. [PMID: 30642746 DOI: 10.1016/j.arcped.2018.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/27/2018] [Accepted: 11/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The impact of 7-day real-time continuous glucose monitoring (RT-CGM) on type 1 diabetes (T1D) management remains unknown in youths with suboptimal control by multiple daily injections (MDI). The DIACCOR Study aimed to describe treatment decisions and glucose outcomes after a short-term RT-CGM sequence in real-life conditions. METHODS This French multicenter longitudinal observational study included T1D youths with HbA1c>7.5% or a history of severe hypoglycemia (SH) or recurrent documented hypoglycemia. A sensor was inserted at the study-inclusion visit, and one of three predefined treatment changes was proposed by the investigator within 7-15 days: INT=MDI intensification, CSII=switch to continuous insulin infusion, or ER=educational reinforcement with no change in insulin regimen and a 4-month follow-up visit (M4) was scheduled. RESULTS A total of 229 children (12.2±3.5 years old) were recruited by 74 pediatricians; 12.8% had a history of SH, 22.2% had recurrent hypoglycemia. Baseline HbA1c was 8.7±1.5% (>7.5% in 82.8%). Overall, 139 (79.4%), 19 (10.9%), and 17 patients (9.7%) were, respectively, included in the INT, CSII, and ER subgroups. At M4, the global incidence of SH and recurrent hypoglycemia dropped (3.4% vs. 12.8% and 6.0% vs. 22.2%, respectively) as well as the incidence of ketoacidosis (2.1% vs. 8.1%) or ketosis (6.9% vs. 11.4%). The HbA1c decrease was significant overall and in the INT subgroup (adjusted difference -0.29%, P=0.009). The satisfaction rate was≥93.0% among children. CONCLUSION In a real-life setting, a 1-week RT-CGM can promote treatment optimization in youths with uncontrolled T1D resulting mostly in less acute events. CGM acceptance may improve with new-generation sensors.
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Affiliation(s)
- S Picard
- Point Médical, Rond-Point de la Nation, 21000 Dijon, France
| | - E Bonnemaison-Gilbert
- Tours University Hospital, Clocheville Hospital (USP), 49, boulevard Béranger, 37000 Tours, France
| | | | - P Barat
- Unité endocrinologie et diabétologie pédiatrique, université Bordeaux, CHU Bordeaux, 33000 Bordeaux, France.
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Massa GG, Gys I, Op 't Eyndt A, Bevilacqua E, Wijnands A, Declercq P, Zeevaert R. Evaluation of the FreeStyle® Libre Flash Glucose Monitoring System in Children and Adolescents with Type 1 Diabetes. Horm Res Paediatr 2018; 89:189-199. [PMID: 29587254 DOI: 10.1159/000487361] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/31/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/AIMS The FreeStyle® Libre Flash Glucose Monitoring System (FGM, Abbott) measures glucose concentrations in the interstitial fluid for up to 14 days. It has been approved for use in children aged > 4 years in January 2016. Experience in children is still limited. We evaluated the accuracy and usability of the FGM in children with type 1 diabetes mellitus (DM). METHODS 67 children with type 1 DM (35 girls), aged 4-18 years, were included. Subjects wore a sensor on the back of their upper arm. For the first 14 days, they regularly measured capillary blood glucose (BG) with their usual BG meter (Accu-Chek® Mobile [ACM], Roche [n = 24]; Contour® Next Link [CNL], Bayer [n = 26]; OneTouch® Verio® IQ [OTV], LifeScan [n = 17]) followed by a sensor glucose (SG) scanning. SG readings were compared to BG measurements by consensus error grid (CEG) analysis; the mean difference (MD), the mean relative difference (MRD), the mean absolute difference (MAD), and the mean absolute relative difference (MARD) were calculated. After 14 days, subjects were asked to fill in a questionnaire on the usability of the FGM. RESULTS 2,626 SG readings were paired with BG results. FGM readings were highly correlated with BG (r = 0.926, p < 0.001). 80.3% of the data pairs were in zone A (= no effect on clinical action) and 18.4% were in zone B (= altered clinical action with little or no effect on the clinical outcome) of the CEG. Overall MD was +7.5 mg/dL; MD varied with the BG meter: ACM +10.4 mg/dL, CNL +14.2 mg/dL, OTV -3.6 mg/dL (p < 0.001). Overall, MARD was 16.7%. We observed a large interindividual variability in the accuracy parameters. MD and MRD were inversely related to BMI (r = -0.261 [p < 0.05]; r = -0.266 [p < 0.05], respectively). MARD was inversely related to age (r = -0.266 [p < 0.05]). Twenty-nine patients (43.3%) reported sensor problems, mainly early detachment of the sensor. Nonetheless, the usability questionnaire indicated high levels of satisfaction. CONCLUSIONS Our results showed a reasonable agreement between the FGM SG readings and capillary BG measurements in children. There was, however, a large interindividual variability. The wearing of the sensor requires special attention. Further studies in children are imperative in order to document the accuracy and safety of the FGM in the paediatric population.
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Affiliation(s)
- Guy G Massa
- Department of Paediatric Endocrinology and Diabetology, Jessa Hospital, Hasselt, Belgium
| | - Inge Gys
- Department of Paediatric Endocrinology and Diabetology, Jessa Hospital, Hasselt, Belgium
| | - Anniek Op 't Eyndt
- Department of Paediatric Endocrinology and Diabetology, Jessa Hospital, Hasselt, Belgium
| | - Esmiralda Bevilacqua
- Department of Paediatric Endocrinology and Diabetology, Jessa Hospital, Hasselt, Belgium
| | - Anne Wijnands
- Department of Paediatric Endocrinology and Diabetology, Jessa Hospital, Hasselt, Belgium
| | | | - Renate Zeevaert
- Department of Paediatric Endocrinology and Diabetology, Jessa Hospital, Hasselt, Belgium
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Heinemann L, Stuhr A, Brown A, Freckmann G, Breton MD, Russell S, Heinemann L. Self-measurement of Blood Glucose and Continuous Glucose Monitoring - Is There Only One Future? EUROPEAN ENDOCRINOLOGY 2018; 14:24-29. [PMID: 30349591 PMCID: PMC6182926 DOI: 10.17925/ee.2018.14.2.24] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 06/29/2018] [Indexed: 01/13/2023]
Abstract
Monitoring glycaemic control in patients with diabetes has evolved dramatically over the past decades. The introduction of easy-to-use systems for self-monitoring of blood glucose (SMBG) utilising capillary blood samples has resulted in the availability of a wide range of systems, providing different measurement quality. Systems for continuous glucose monitoring (CGM) – used mainly in patients with type 1 diabetes (T1D) – were made possible by the development of glucose sensors that measure glucose levels in the interstitial fluid (ISF) in the subcutaneous tissue of the skin. CGM readings might not correspond exactly to SMBG measurement results taken at the same time, especially during rapid changes in either blood glucose or ISF glucose levels. The mean absolute relative difference is the most popular method used for characterising the measurement performance of CGM systems. Unlike the International Organization for Standardization 15197:2013 criteria for SMBG systems, no accuracy standards for CGM systems exist. Measurement quality of CGM systems can vary based on several factors, limiting their safety and effective use in managing diabetes. Patients have to be trained adequately to make safe and efficient use of CGM systems (like with SMBG systems). Also, systems for CGM must be evaluated in terms of patient safety and the ability to provide accurate measurements regardless of the fluctuation of glucose levels. As new technological advancements in glucose monitoring are essential for improved management options of diabetes, such as automated insulin dosing systems, there is a need for a critical view of all such developments. It is likely that both, SMBG and CGM systems, will play important future roles in the treatment of diabetes.
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Affiliation(s)
| | | | - Adam Brown
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
| | - Guido Freckmann
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
| | - Marc D Breton
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
| | - Steven Russell
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
| | - Lutz Heinemann
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
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Vettoretti M, Cappon G, Acciaroli G, Facchinetti A, Sparacino G. Continuous Glucose Monitoring: Current Use in Diabetes Management and Possible Future Applications. J Diabetes Sci Technol 2018; 12:1064-1071. [PMID: 29783897 PMCID: PMC6134613 DOI: 10.1177/1932296818774078] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The recent announcement of the production of new low-cost continuous glucose monitoring (CGM) sensors, the approval of marketed CGM sensors for making treatment decisions, and new reimbursement criteria have the potential to revolutionize CGM use. After briefly summarizing current CGM applications, we discuss how, in our opinion, these changes are expected to extend CGM utilization beyond diabetes patients, for example, to subjects with prediabetes or even healthy individuals. We also elaborate on how the integration of CGM data with other relevant information, for example, health records and other medical device/wearable sensor data, will contribute to creating a digital data ecosystem that will improve our understanding of the etiology and complications of diabetes and will facilitate the development of data analytics for personalized diabetes management and prevention.
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Affiliation(s)
- Martina Vettoretti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giacomo Cappon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giada Acciaroli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Padova, Italy
- Giovanni Sparacino, PhD, Department of Information Engineering University of Padova, Via G. Gradenigo 6B, Padova, 35131, Italy.
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Blum JR, Rayfield EJ. AN ENDOCRINE CLINIC'S PERSPECTIVE AND EXPERIENCE WITH THE ABBOTT FREESTYLE LIBRE CGM. Endocr Pract 2018; 24:309-311. [PMID: 29547048 DOI: 10.4158/ep-2017-0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
The FreeStyle Libre flash glucose monitor became available on prescription (subject to local health authority approval) in all four nations of the UK from November 2017, a watershed moment in the history of diabetes care. Calibration free, the FreeStyle Libre is a disc worn on the arm for 14 days which is designed largely to replace the recommended 4-10 painful finger-stick blood glucose tests required each day for the self-management of diabetes. This review discusses clinical data from randomized and observational studies, considers device accuracy metrics and deliberates its popularity and the potential challenges that this new device brings to diabetes care in the UK. In randomized trials, FreeStyle Libre use is associated with a reduction in hypoglycaemia and, in observational studies, improvements in HbA1c levels. User satisfaction is high and adverse events are low. Accuracy of the FreeStyle Libre is comparable to currently available real-time continuous glucose monitors in adults, children and during pregnancy; the cost of the FreeStyle Libre is lower. Glucose data can be visualized in multiple devices and platforms, and summarized in an ambulatory glucose profile to aid pattern recognition and insulin dose adjustment. There is a need for appropriate education, of both users and healthcare professionals, to harness the full benefits. Further randomized studies to assess the long-term impact on HbA1c , particularly in those with high baseline HbA1c and in specific age groups, such as adolescents and young adults, are warranted. The potential impact on complications, is yet to be realized.
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Affiliation(s)
- L Leelarathna
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - E G Wilmot
- Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK
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Abstract
PURPOSE OF REVIEW The purpose of the study is to discuss emerging technologies available in the management of type 1 diabetes in pregnancy. RECENT FINDINGS The latest evidence suggests that continuous glucose monitoring (CGM) should be offered to all women on intensive insulin therapy in early pregnancy. Studies have additionally demonstrated the ability of CGM to help gain insight into specific glucose profiles as they relate to glycaemic targets and pregnancy outcomes. Despite new studies comparing insulin pump therapy to multiple daily injections, its effectiveness in improving glucose and pregnancy outcomes remains unclear. Sensor-integrated insulin delivery (also called artificial pancreas or closed-loop insulin delivery) in pregnancy has been demonstrated to improve time in target and performs well despite the changing insulin demands of pregnancy. Emerging technologies show promise in the management of type 1 diabetes in pregnancy; however, research must continue to keep up as technology advances. Further research is needed to clarify the role technology can play in optimising glucose control before and during pregnancy as well as to understand which women are candidates for sensor-integrated insulin delivery.
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Affiliation(s)
- Jennifer M Yamamoto
- Department of Medicine, Division of Endocrinology and Metabolism, University of Calgary, Calgary, AB, Canada
| | - Helen R Murphy
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- Women's Health Academic Centre, Division of Women's and Children's Health, King's College London, London, UK.
- Norwich Medical School, University of East Anglia, Floor 2, Bob Champion Research and Education Building, James Watson Road, Norwich Research Park, Norwich, NR4 7UQ, UK.
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A prolonged run-in period of standard subcutaneous microdialysis ameliorates quality of interstitial glucose signal in patients after major cardiac surgery. Sci Rep 2018; 8:1262. [PMID: 29352162 PMCID: PMC5775252 DOI: 10.1038/s41598-018-19768-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/08/2018] [Indexed: 12/21/2022] Open
Abstract
We evaluated a standard subcutaneous microdialysis technique for glucose monitoring in two critically ill patient populations and tested whether a prolonged run-in period improves the quality of the interstitial glucose signal. 20 surgical patients after major cardiac surgery (APACHE II score: 10.1 ± 3.2) and 10 medical patients with severe sepsis (APACHE II score: 31.1 ± 4.3) were included in this investigation. A microdialysis catheter was inserted in the subcutaneous adipose tissue of the abdominal region. Interstitial fluid and arterial blood were sampled in hourly intervals to analyse glucose concentrations. Subcutaneous adipose tissue glucose was prospectively calibrated to reference arterial blood either at hour 1 or at hour 6. Median absolute relative difference of glucose (MARD), calibrated at hour 6 (6.2 (2.6; 12.4) %) versus hour 1 (9.9 (4.2; 17.9) %) after catheter insertion indicated a significant improvement in signal quality in patients after major cardiac surgery (p < 0.001). Prolonged run-in period revealed no significant improvement in patients with severe sepsis, but the number of extreme deviations from the blood plasma values could be reduced. Improved concurrence of glucose readings via a 6-hour run-in period could only be achieved in patients after major cardiac surgery.
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Yardley JE, Brockman NK, Bracken RM. Could Age, Sex and Physical Fitness Affect Blood Glucose Responses to Exercise in Type 1 Diabetes? Front Endocrinol (Lausanne) 2018; 9:674. [PMID: 30524371 PMCID: PMC6262398 DOI: 10.3389/fendo.2018.00674] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022] Open
Abstract
Closed-loop systems for patients with type 1 diabetes are progressing rapidly. Despite these advances, current systems may struggle in dealing with the acute stress of exercise. Algorithms to predict exercise-induced blood glucose changes in current systems are mostly derived from data involving relatively young, fit males. Little is known about the magnitude of confounding variables such as sex, age, and fitness level-underlying, uncontrollable factors that might influence blood glucose control during exercise. Sex-related differences in hormonal responses to physical exercise exist in studies involving individuals without diabetes, and result in altered fuel metabolism during exercise. Increasing age is associated with attenuated catecholamine responses and lower carbohydrate oxidation during activity. Furthermore, higher fitness levels can alter hormonal and fuel selection responses to exercise. Compounding the limited research on these factors in the metabolic response to exercise in type 1 diabetes is a limited understanding of how these variables affect blood glucose levels during different types, timing and intensities of activity in individuals with type 1 diabetes (T1D). Thus, there is currently insufficient information to model a closed-loop system that can predict them accurately and consistently prevent hypoglycemia. Further, studies involving both sexes, along with a range of ages and fitness levels, are needed to create a closed-loop system that will be more precise in regulating blood glucose during exercise in a wide variety of individuals with T1D.
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Affiliation(s)
- Jane E. Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Jane E. Yardley
| | | | - Richard M. Bracken
- Diabetes Research Unit and School of Sport and Exercise Science, Swansea University, Swansea, United Kingdom
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Review of a commercially available hybrid closed-loop insulin-delivery system in the treatment of Type 1 diabetes. Ther Deliv 2017; 9:77-87. [PMID: 29235423 DOI: 10.4155/tde-2017-0099] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Type 1 diabetes is an important medical condition causing significant burden and morbidity to those persons affected by it. Improvements in insulin products, insulin delivery and glucose monitoring technology have all contributed to reductions in long-term complications and hypoglycemia. This article reviews the Medtronic 670G device and summarizes the data supporting how this product reduces the burden and increases the safety of insulin dosing in Type 1 diabetes.
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Affiliation(s)
- Satish K. Garg
- University of Colorado, Denver School of Medicine, Aurora, Colorado
- Barbara Davis Center for Diabetes - Adult Clinic, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Halis Kaan Akturk
- University of Colorado, Denver School of Medicine, Aurora, Colorado
- Barbara Davis Center for Diabetes - Adult Clinic, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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