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Fakheran O, Bencze B, Mischak I, Vegh D, Payer M. The reliability of using gingival crevicular blood to measure blood glucose and hba1c levels in the dental setting: a systematic review and meta-analysis. Clin Oral Investig 2024; 28:299. [PMID: 38702475 PMCID: PMC11068679 DOI: 10.1007/s00784-024-05685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE There are 500 million patients living with diabetes mellitus worldwide and 50% of them remain undiagnosed. Routine periodontal probing provides gingival crevicular blood in patients with gingivitis. Gingival blood may be useful for diabetes screening without the need for any expensive, painful or time-consuming method by using convenient glucometers. Therefore, the objective of this systematic review and meta-analysis is to answer the question to "is there a difference in glucose or HbA1c levels (O) in patients with positive gingival bleeding (P) measured on gingival crevicular blood (GCB) (I) compared to finger prick capillary blood (CB) (C). MATERIALS AND METHODS The authors performed an electronic search of six databases using identical MeSH phrases. Only human clinical studies without limitations on the year of publication were considered. Data extraction was done by using standardized data collection sheets. Risk of bias assessment were conducted using QUADAS-2 and QUADAS-C. Meta-analyses were carried out with the random effects model to aggregate the correlation coefficients and the difference between the means between gingival and capillary blood reading, using 95% confidence intervals. RESULTS The database and manual search yielded 268 articles, from which the selection procedure provided 36 articles for full-text screening, and the final pool of eligible articles composed of 23 studies with 1680 patients. Meta-analysis results on glycemic levels showed differences between the GCB and CB procedures in patients with and without diabetes with values of -6.80 [-17.35; 3.76] and - 4.36 [-9.89; 1.18], respectively. Statistically significant correlations were found (p = 0.001) between GCB and CB measurements in patients with (0.97 [0.927; 0.987]) and without diabetes (0.927 [0.873; 0.958]). CONCLUSION Gingival blood could prove to be useful to identify patients with undiagnosed diabetes when the necessary amount of uncontaminated blood is present. However, this technique is limited by the possibility of contamination, prandial status and inaccuracies, so it is unsuited to address the patient's glycemic control accurately.
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Affiliation(s)
- Omid Fakheran
- Division of Oral Surgery and Orthodontics, Department of Dentistry and Oral Health, Medical University of Graz, Billrothgasse 4, Graz, 8010, Austria
| | - Bulcsu Bencze
- Department of Prosthodontics, Semmelweis University, Szentkiralyi utca 47, Budapest, 1088, Hungary
| | - Irene Mischak
- Department of Prosthodontics, Semmelweis University, Szentkiralyi utca 47, Budapest, 1088, Hungary
| | - Daniel Vegh
- Department of Prosthodontics, Semmelweis University, Szentkiralyi utca 47, Budapest, 1088, Hungary.
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, Department of Dentistry and Oral Health, Medical University of Graz, Billrothgasse 4, Graz, 8010, Austria
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2
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Waterman LA, Pyle L, Forlenza GP, Towers L, Karami AJ, Jost E, Berget C, Wadwa RP, Cobry EC. Accuracy of a Real-Time Continuous Glucose Monitor in Pediatric Diabetic Ketoacidosis Admissions. Diabetes Technol Ther 2024. [PMID: 38441904 DOI: 10.1089/dia.2023.0542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Objective: Continuous glucose monitoring (CGM) devices are integral in the outpatient care of people with type 1 diabetes, although they lack inpatient labeling. Food and Drug Administration began allowing inpatient use during the coronavirus disease 2019 (COVID-19) pandemic, with some accuracy data now available, primarily from adult hospitals. Pediatric inpatient data remain limited, particularly during diabetic ketoacidosis (DKA) admissions and for patients receiving intravenous (IV) insulin. Design and Methods: This retrospective chart review compared point-of-care glucose values to personal Dexcom G6 sensor data during pediatric hospitalizations. Accuracy was assessed using mean absolute relative difference (MARD), Clarke Error Grids, and the percentage of values within 15/20/30% if glucose value >100 mg/dL and 15/20/30 mg/dL if glucose value ≤100 mg/dL. Results: Matched paired glucose values (N = 612) from 36 patients (median age 14 years, 58.3% non-Hispanic White, 47.2% male) and 42 inpatient encounters were included in this subanalysis of DKA admissions. The MARDs for DKA and non-DKA admissions (N = 503) were 11.8% and 11.7%, with 97.6% and 98.6% of pairs falling within A and B zones of the Clarke Error Grid, respectively. Severe DKA admissions (pH <7.15 and/or bicarbonate <5 mmol/L) had a MARD of 8.9% compared to 14.3% for nonsevere DKA admissions. The MARD during administration of IV insulin (N = 266) was 13.4%. Conclusions: CGM accuracy is similar between DKA and non-DKA admissions and is maintained in severe DKA and during IV insulin administration, suggesting potential usability in pediatric hospitalizations. Further study on the feasibility of implementation of CGM in the hospital is needed.
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Affiliation(s)
- Lauren A Waterman
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Gregory P Forlenza
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Lindsey Towers
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Angela J Karami
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Emily Jost
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Cari Berget
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - R Paul Wadwa
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Erin C Cobry
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
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3
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Lundemose SB, Laugesen C, Ranjan AG, Nørgaard K. Factory-Calibrated Continuous Glucose Monitoring Systems in Type 1 Diabetes: Accuracy during In-Clinic Exercise and Home Use. SENSORS (BASEL, SWITZERLAND) 2023; 23:9256. [PMID: 38005642 PMCID: PMC10675113 DOI: 10.3390/s23229256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
Continuous glucose monitors (CGMs) are valuable tools for improving glycemic control, yet their accuracy might be influenced by physical activity. This study sought to assess the accuracy of the three latest factory-calibrated CGM systems available in Europe at the time the study was conducted, both during aerobic exercise and in typical daily scenarios. The accuracy evaluation, based on metrics such as the median absolute relative difference (MARD) and point and rate error-grid analyses (PEGA and REGA), involved 13 adults with type 1 diabetes. Participants wore all sensors during a 1 h in-clinic exercise session followed by a subsequent 3-day home period, with blood glucose measurements serving as reference values in both contexts. During exercise, no statistically significant differences in MARD were observed (Dexcom G6: 12.6%, Guardian 4: 10.7%, and Freestyle Libre 2: 17.2%; p = 0.31), and similarly, no significant differences emerged in PEGA-zone-AB (100%, 100%, 96.8%; p = 0.37). Nevertheless, Freestyle Libre 2 showed comparatively diminished accuracy in estimating glucose trends during exercise (REGA-zone-AB: 100%, 93.0%, 73.3%; p = 0.0003). In the home environment, Freestyle Libre 2 exhibited a significantly higher MARD when compared to the other systems (10.2%, 11.9%, 16.7%, p = 0.02). Overall, Dexcom G6 and Guardian 4 demonstrated superior accuracy in both exercise and daily life scenarios compared to Freestyle Libre 2.
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Affiliation(s)
- Sissel Banner Lundemose
- Steno Diabetes Center Copenhagen, Clinical Research, Diabetes Technology Research, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (C.L.); (A.G.R.); (K.N.)
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4
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Spanakis EK, Cook CB, Kulasa K, Aloi JA, Bally L, Davis G, Dungan KM, Galindo RJ, Mendez CE, Pasquel FJ, Shah VN, Umpierrez GE, Aaron RE, Tian T, Yeung AM, Huang J, Klonoff DC. A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials. J Diabetes Sci Technol 2023; 17:1527-1552. [PMID: 37592726 PMCID: PMC10658683 DOI: 10.1177/19322968231191104] [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: 08/19/2023]
Abstract
Diabetes Technology Society organized an expert consensus panel to develop metrics for research in the use of continuous glucose monitors (CGMs) in a hospital setting. The experts met virtually in small groups both before and after an April 13, 2023 virtual meeting of the entire panel. The goal of the panel was to develop consensus definitions in anticipation of greater use of CGMs in hospital settings in the future. Establishment of consensus definitions of inpatient analytical metrics will be easier to compare outcomes between studies. Panelists defined terms related to 10 dimensions of measurements related to the use of CGMs including (1) hospital hypoglycemia, (2) hospital hyperglycemia, (3) hospital time in range, (4) hospital glycemic variability, (5) hospital glycemia risk index, (6) accuracy of CGM devices and reference methods for CGMs in the hospital, (7) meaningful time blocks for hospital glycemic goals, (8) hospital CGM data sufficiency, (9) using CGM data for insulin dosing, and (10) miscellaneous factors. The panelists voted on 51 proposed recommendations. Based on the panel vote, 51 recommendations were classified as either strong (43) or mild (8). Additional research is needed on CGM performance in the hospital. This consensus report is intended to support that type of research intended to improve outcomes for hospitalized people with diabetes.
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Affiliation(s)
- Elias K. Spanakis
- Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Curtiss B. Cook
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Kristen Kulasa
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Joseph A. Aloi
- Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Georgia Davis
- Emory University School of Medicine, Atlanta, GA, USA
| | - Kathleen M. Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, USA
| | | | | | | | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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5
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 2023; 46:e151-e199. [PMID: 37471273 PMCID: PMC10516260 DOI: 10.2337/dci23-0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association for Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (HbA1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA
| | - George L. Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IL
| | - David E. Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA
| | - Andrea R. Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E. Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL
| | - David M. Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA
| | - M. Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC
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6
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem 2023:hvad080. [PMID: 37473453 DOI: 10.1093/clinchem/hvad080] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association of Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (Hb A1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA, United States
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, ILUnited States
| | - David E Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA, United States
| | - Andrea R Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL, United States
| | - David M Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA, United States
| | - M Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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7
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Gomez LA, Toye AA, Hum RS, Kleinberg S. Simulating Realistic Continuous Glucose Monitor Time Series By Data Augmentation. J Diabetes Sci Technol 2023:19322968231181138. [PMID: 37350111 DOI: 10.1177/19322968231181138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Simulated data are a powerful tool for research, enabling benchmarking of blood glucose (BG) forecasting and control algorithms. However, expert created models provide an unrealistic view of real-world performance, as they lack the features that make real data challenging, while black-box approaches such as generative adversarial networks do not enable systematic tests to diagnose model performance. METHODS To address this, we propose a method that learns missingness and error properties of continuous glucose monitor (CGM) data collected from people with type 1 diabetes (OpenAPS, OhioT1DM, RCT, and Racial-Disparity), and then augments simulated BG data with these properties. On the task of BG forecasting, we test how well our method brings performance closer to that of real CGM data compared with current simulation practices for missing data (random dropout) and error (Gaussian noise, CGM error model). RESULTS Our methods had the smallest performance difference versus real data compared with random dropout and Gaussian noise when individually testing the effects of missing data and error on simulated BG in most cases. When combined, our approach was significantly better than Gaussian noise and random dropout for all data sets except OhioT1DM. Our error model significantly improved results on diverse data sets. CONCLUSIONS We find a significant gap between BG forecasting performance on simulated and real data, and our method can be used to close this gap. This will enable researchers to rigorously test algorithms and provide realistic estimates of real-world performance without overfitting to real data or at the expense of data collection.
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Affiliation(s)
| | | | - R Stanley Hum
- The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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8
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Lin YK, Agni A, Chuisano S, Fetters MD, Funnell M, Pop-Busui R, DeJonckheere MJ. Patient-Reported Usefulness and Challenges in Using Hypoglycemia-Informing Features of Continuous Glucose Monitors to Manage Hypoglycemia. Sci Diabetes Self Manag Care 2023; 49:229-238. [PMID: 37086168 PMCID: PMC10960636 DOI: 10.1177/26350106231168859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
PURPOSE The purpose of this study series, which involves a questionnaire survey and qualitative interviews, was to (a) evaluate patient-reported usefulness of continuous glucose monitor (CGM) hypoglycemia-informing features and (b) identify challenges in using these features (ie, CGM glucose numbers, trend arrows, trend graphs, and hypoglycemia alarms) during hypoglycemia in adults with type 1 diabetes (T1DM). METHODS A cross-sectional questionnaire survey study was conducted with adults who have T1DM and were using CGMs to assess the perceived usefulness of hypoglycemia-informing features. A semistructured interview study with T1DM CGM-using adults and inductive thematic analysis were subsequently performed to identify challenges in using CGM hypoglycemia-informing features to manage hypoglycemia. RESULTS In the survey study (N = 252), the CGM glucose numbers, trend arrows, trend graphs, and hypoglycemia alarms were found to be very useful by 79%, 70%, 43%, and 64% of participants, respectively. Several challenges in using these features to manage hypoglycemia were identified in the qualitative study (N = 23): (1) hypoglycemia information not fully reliable,; (2) unpredictability of future blood glucose levels, (3) lack of awareness about how information can be used, and (4) disruptions associated with information. CONCLUSIONS Although the majority of T1DM adults found their CGMs' hypoglycemia-informing features helpful, challenges in optimally using these features persisted. Targeted knowledge and behavioral interventions could improve CGM use to reduce hypoglycemia.
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Affiliation(s)
- Yu Kuei Lin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Annika Agni
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Samantha Chuisano
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Mixed Methods Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - Martha Funnell
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Melissa J DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Mixed Methods Program, University of Michigan Medical School, Ann Arbor, Michigan
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Twigg S, Lim S, Yoo SH, Chen L, Bao Y, Kong A, Yeoh E, Chan SP, Robles J, Mohan V, Cohen N, McGill M, Ji L. Asia-Pacific Perspectives on the Role of Continuous Glucose Monitoring in Optimizing Diabetes Management. J Diabetes Sci Technol 2023:19322968231176533. [PMID: 37232515 DOI: 10.1177/19322968231176533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Diabetes is prevalent, and it imposes a substantial public health burden globally and in the Asia-Pacific (APAC) region. The cornerstone for optimizing diabetes management and treatment outcomes is glucose monitoring, the techniques of which have evolved from self-monitoring of blood glucose (SMBG) to glycated hemoglobin (HbA1c), and to continuous glucose monitoring (CGM). Contextual differences with Western populations and limited regionally generated clinical evidence warrant regional standards of diabetes care, including glucose monitoring in APAC. Hence, the APAC Diabetes Care Advisory Board convened to gather insights into clinician-reported CGM utilization for optimized glucose monitoring and diabetes management in the region. We discuss the findings from a pre-meeting survey and an expert panel meeting regarding glucose monitoring patterns and influencing factors, patient profiles for CGM initiation and continuation, CGM benefits, and CGM optimization challenges and potential solutions in APAC. While CGM is becoming the new standard of care and a useful adjunct to HbA1c and SMBG globally, glucose monitoring type, timing, and frequency should be individualized according to local and patient-specific contexts. The results of this APAC survey guide methods for the formulation of future APAC-specific consensus guidelines for the application of CGM in people living with diabetes.
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Affiliation(s)
- Stephen Twigg
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, South Korea
| | - Seung-Hyun Yoo
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Liming Chen
- Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine, Affiliated Sixth People's Hospital, Shanghai, China
| | - Alice Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ester Yeoh
- Diabetes Centre, Admiralty Medical Centre and Division of Endocrinology, Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Siew Pheng Chan
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Jeremyjones Robles
- Section of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Chong Hua Hospital, Cebu, Philippines
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Neale Cohen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Margaret McGill
- Central Clinical School Faculty of Medicine and Health, Diabetes Centre, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Linong Ji
- Peking University Diabetes Center, Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
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10
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Henao-Pabon G, Gao N, Prasad KS, Li X. Direct Electron Transfer of Glucose Oxidase on Pre-Anodized Paper/Carbon Electrodes Modified through Zero-Length Cross-Linkers for Glucose Biosensors. BIOSENSORS 2023; 13:bios13050566. [PMID: 37232927 DOI: 10.3390/bios13050566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
A disposable paper-based glucose biosensor with direct electron transfer (DET) of glucose oxidase (GOX) was developed through simple covalent immobilization of GOX on a carbon electrode surface using zero-length cross-linkers. This glucose biosensor exhibited a high electron transfer rate (ks, 3.363 s-1) as well as good affinity (km, 0.03 mM) for GOX while keeping innate enzymatic activities. Furthermore, the DET-based glucose detection was accomplished by employing both square wave voltammetry and chronoamperometric techniques, and it achieved a glucose detection range from 5.4 mg/dL to 900 mg/dL, which is wider than most commercially available glucometers. This low-cost DET glucose biosensor showed remarkable selectivity, and the use of the negative operating potential avoided interference from other common electroactive compounds. It has great potential to monitor different stages of diabetes from hypoglycemic to hyperglycemic states, especially for self-monitoring of blood glucose.
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Affiliation(s)
- Gilberto Henao-Pabon
- Biomedical Engineering, University of Texas at El Paso, 500 W University Ave, El Paso, TX 79968, USA
| | - Ning Gao
- Independent Researcher, 206 Via Morella, Encinitas, CA 92024, USA
| | - K Sudhakara Prasad
- Department of Chemistry & Biochemistry, University of Texas at El Paso, 500 W University Ave, El Paso, TX 79968, USA
- Yenepoya Research Centre, Yenepoya University, Mangalore 575018, Karnataka, India
| | - XiuJun Li
- Biomedical Engineering, University of Texas at El Paso, 500 W University Ave, El Paso, TX 79968, USA
- Department of Chemistry & Biochemistry, University of Texas at El Paso, 500 W University Ave, El Paso, TX 79968, USA
- Forensic Science & Environmental Science and Engineering, 500 W University Ave, El Paso, TX 79968, USA
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11
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Pors A, Rasmussen KG, Inglev R, Jendrike N, Philipps A, Ranjan AG, Vestergaard V, Henriksen JE, Nørgaard K, Freckmann G, Hepp KD, Gerstenberg MC, Weber A. Accurate Post-Calibration Predictions for Noninvasive Glucose Measurements in People Using Confocal Raman Spectroscopy. ACS Sens 2023; 8:1272-1279. [PMID: 36877178 PMCID: PMC10043934 DOI: 10.1021/acssensors.2c02756] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
In diabetes prevention and care, invasiveness of glucose measurement impedes efficient therapy and hampers the identification of people at risk. Lack of calibration stability in non-invasive technology has confined the field to short-term proof of principle. Addressing this challenge, we demonstrate the first practical use of a Raman-based and portable non-invasive glucose monitoring device used for at least 15 days following calibration. In a home-based clinical study involving 160 subjects with diabetes, the largest of its kind to our knowledge, we find that the measurement accuracy is insensitive to age, sex, and skin color. A subset of subjects with type 2 diabetes highlights promising real-life results with 99.8% of measurements within A + B zones in the consensus error grid and a mean absolute relative difference of 14.3%. By overcoming the problem of calibration stability, we remove the lingering uncertainty about the practical use of non-invasive glucose monitoring, boding a new, non-invasive era in diabetes monitoring.
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Affiliation(s)
- Anders Pors
- RSP Systems, Sivlandvænget 27C, 5260 Odense, Denmark
| | | | - Rune Inglev
- RSP Systems, Sivlandvænget 27C, 5260 Odense, Denmark
| | - Nina Jendrike
- Institute for Diabetes Technology at University of Ulm, Lise-Meitner-Straße 8/2, 89081 Ulm, Germany
| | | | - Ajenthen G Ranjan
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Vibe Vestergaard
- Steno Diabetes Center Odense, Kløvervænget 10, 5000 Odense, Denmark
| | - Jan E Henriksen
- Steno Diabetes Center Odense, Kløvervænget 10, 5000 Odense, Denmark
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Guido Freckmann
- Institute for Diabetes Technology at University of Ulm, Lise-Meitner-Straße 8/2, 89081 Ulm, Germany
| | - Karl D Hepp
- University of Munich (emeritus), Geschwister-Scholl-Platz 1, 80539 Munich, Germany
| | | | - Anders Weber
- RSP Systems, Sivlandvænget 27C, 5260 Odense, Denmark
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12
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Chen L, Yang S, Dotzert M, Melling CWJ, Zhang J. Hybrid reduced graphene oxide nanosheets with negative magnetoresistance for the diagnosis of hypoglycemia. J Mater Chem B 2023; 11:998-1007. [PMID: 36621800 DOI: 10.1039/d2tb01927b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Few glucometers are available to easily and quickly measure low blood glucose levels (≤4 mmol L-1) from a small amount of blood samples. Here, a hybrid reduced graphene oxide (rGO)-based magnetoresistance (MR) sensor has been developed to monitor blood glucose levels to quickly detect hypoglycemia. Hybrid rGO nanosheets, incorporating Fe50Co50 nanoparticles onto rGO nanosheets, with an unusual large negative MR (-5.7%) at room temperature under a small magnetic field (9.5 kOe) have been successfully fabricated through a one-pot reaction. To quickly detect the low concentration of glucose in a small amount of blood (1 μL), a two-step process has been further developed by using the "sandwich" structural MR sensor. The results show that the higher the negative MR value of the sensor, the lower the concentration of glucose that can be detected. A linear relationship between the MR and the concentration of the spiked plasma glucose taken from streptozotocin-induced diabetic rats can be found when the concentration of glucose is in the range of 0-6 mmol L-1. The limit of detection (LOD) of this MR glucose sensor is 0.867 mmol L-1. The accuracy of the rGO-based MR sensor is improved in measuring low concentration of plasma glucose as compared to that of a commercialized glucometer. Furthermore, the selectivity of the rGO-based MR sensor has been studied. The results demonstrate that the rGO-based MR sensor is a flexible and sensitive detection platform and specifically suitable for monitoring low concentrations of plasma glucose to prevent from hypoglycemia.
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Affiliation(s)
- Longyi Chen
- Department of Chemical and Biochemical Engineering, University of Western Ontario, London, Ontario, N6A 5B9, Canada.
| | - Songlin Yang
- Department of Chemical and Biochemical Engineering, University of Western Ontario, London, Ontario, N6A 5B9, Canada.
| | - Michelle Dotzert
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, N6A 5B9, Canada
| | - C W James Melling
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, N6A 5B9, Canada
| | - Jin Zhang
- Department of Chemical and Biochemical Engineering, University of Western Ontario, London, Ontario, N6A 5B9, Canada. .,School of Biomedical Engineering, University of Western Ontario, London, Ontario, N6A 5B9, Canada
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13
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Ahmadian N, Manickavasagan A, Ali A. Comparative assessment of blood glucose monitoring techniques: a review. J Med Eng Technol 2023; 47:121-130. [PMID: 35895023 DOI: 10.1080/03091902.2022.2100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Monitoring blood glucose levels is a vital indicator of diabetes mellitus management. The mainstream techniques of glucometers are invasive, painful, expensive, intermittent, and time-consuming. The ever-increasing number of global diabetic patients urges the development of alternative non-invasive glucose monitoring techniques. Recent advances in electrochemical biosensors, biomaterials, wearable sensors, biomedical signal processing, and microfabrication technologies have led to significant research and ideas in elevating the patient's life quality. This review provides up-to-date information about the available technologies and compares the advantages and limitations of invasive and non-invasive monitoring techniques. The scope of measuring glucose concentration in other bio-fluids such as interstitial fluid (ISF), tears, saliva, and sweat are also discussed. The high accuracy level of invasive methods in measuring blood glucose concentrations gives them superiority over other methods due to lower average absolute error between the detected glucose concentration and reference values. Whereas minimally invasive, and non-invasive techniques have the advantages of continuous and pain-free monitoring. Various blood glucose monitoring techniques have been evaluated based on their correlation to blood, patient-friendly, time efficiency, cost efficiency, and accuracy. Finally, this review also compares the currently available glucose monitoring devices in the market.
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Affiliation(s)
- Nivad Ahmadian
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Annamalai Manickavasagan
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Amanat Ali
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
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14
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Setford S, Liu Z, McColl D, Phillips S, Cameron H, Grady M. Post-Market Surveillance Assessment of the Clinical Accuracy of a Blood Glucose Monitoring System with an Improved Algorithm for Enhanced Product Performance. J Diabetes Sci Technol 2023; 17:133-140. [PMID: 34463143 PMCID: PMC9846413 DOI: 10.1177/19322968211039465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND On-going manufacturer-led post-market surveillance (PMS), assessing the clinical accuracy of blood glucose monitoring (BGM) systems, is critical to substantiate the performance of such products for people with diabetes. MATERIALS AND METHODS Batches of Verio test-strip product were randomly and routinely selected over the period from launch of an improved-algorithm product to reporting date and sent to 3 clinic sites for clinician-led accuracy assessment. Accuracy is reported as per recently adopted FDA guidance for BGM systems, EN ISO 15197:2015 and MARD/MAD (Mean absolute relative difference/Mean absolute difference). RESULTS Thirty-three individual test-strip batches were evaluated corresponding to 506 unique donors. Accuracy performance - FDA: 98.9% of values within ±15% of comparator; ISO: 99.0% within ±15 mg/dL or ±15% at <100 mg/dL (<5.55 mmol/L) or ≥100 mg/dL (≥5.55 mmol/L) glucose, respectively. Overall MARD was 4.19% with a MARD range of 3.54%-5.73% across all test strip batches. CONCLUSIONS This post-market surveillance program demonstrates the new BGM system consistently meets measures of clinical accuracy specified by regulators. This program supports a growing demand by regulators for real-world evidence demonstrating consistent in-market product efficacy as opposed to the current largely passive approach that relies on assessment of reports filed by device users.
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Affiliation(s)
- Steven Setford
- LifeScan Scotland Ltd., Inverness,
UK
- Steven Setford, PhD, LifeScan Scotland Ltd,
Beechwood Park North, Inverness, Highland IV2 3ED, UK.
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15
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Moriuchi T, Otaki Y, Satou H, Chai F, Hayashida Y, Aikawa R, Sugiyama T, Sode K. Clinical Study of a High Accuracy Green Design Blood Glucose Monitor Using an Innovative Optical Transmission Absorbance System. J Diabetes Sci Technol 2022; 16:1069-1075. [PMID: 34889119 PMCID: PMC9445325 DOI: 10.1177/19322968211060865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Blood glucose monitoring (BGM) is essential for glycemic control in diabetic therapy. Followingly, accurate sensors are required for both daily personal and clinical use. The frequency of sensor use in patients with diabetes facilitates the use of disposable components. However, BGM systems are not exempt from green innovation sustainability initiatives. METHODS Clinical study of a high-accuracy green design blood glucose monitor using an innovative optical transmission absorbance system was carried out. Venous blood samples were collected from 104 patients with type II diabetes. The heat resistance of sensor strips was evaluated by storing sensor strips at 25℃ and 60℃ for approximately 3 months. Accuracy of the BGM system was evaluated via the ISO 15197:2013 protocol. RESULTS The BGM system achieved ±7.1% accuracy in glycemic level measurement, with 84% of all measurements within ±5% of the reference values. Furthermore, the sensor strip demonstrated heat resistance for more than 3 months when stored at 60℃. CONCLUSIONS A new, highly accurate BGM system was developed based on the latest optical measurement system, introducing a rare metal-free "green-strip." The developed BGM system achieved the highest reported accuracy in clinical research, using venous blood from patients with diabetes. The sensor strip also exhibited high heat resistance, reducing limitations on storage conditions.
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Affiliation(s)
| | | | | | | | | | | | | | - Koji Sode
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
- Koji Sode, PhD, Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA.
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16
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Freckmann G, Baumstark A, Jendrike N, Mende J, Schauer S, Link M, Pleus S, Haug C. Impact of Two Different Reference Measurement Procedures on Apparent System Accuracy of 18 CE-Marked Current-Generation Blood Glucose Monitoring Systems. J Diabetes Sci Technol 2022; 16:1076-1088. [PMID: 32814455 PMCID: PMC9445332 DOI: 10.1177/1932296820948873] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Measurement accuracy has been assessed for many different blood glucose monitoring systems (BGMS) over the years by different study groups. However, the choice of the comparison measurement procedure may impact the apparent level of accuracy found in such studies. MATERIALS AND METHODS Measurement accuracy of 18 different BGMS was assessed in a setting based on ISO 15197 using two different comparison methods in parallel: a glucose oxidase (GOD)-based and a hexokinase (HK)-based method. Accuracy limits of ISO 15197 were applied, and additional analyses were performed, including bias, linear regression, and mean absolute relative difference (MARD) to assess the impact of possible differences between comparison methods on the apparent level of accuracy. RESULTS While ≈80% of BGMS met the accuracy criteria of ISO 15197 when compared with the respective manufacturers' reference measurement procedure, only two-thirds did so against both comparison methods. The mean relative bias ranged from -6.6% to +5.7% for the analysis against the GOD-based method and from -11.1% to +1.3% for the analysis against the HK-based method, whereas MARD results ranged from 3.7% to 9.8% and from 2.3% to 10.5%, respectively. Results of regression analysis showed slopes between 0.85 and 1.08 (GOD-based method) and between 0.81 and 1.01 (HK-based method). CONCLUSIONS The results of this study indicate that there are systematic differences between the reference measurement procedures used for BGMS calibration as well as for system accuracy assessment. Because of the potential impact on therapy of patients with diabetes resulting from these differences, further steps toward harmonization of the measurement procedures' results are important.
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Affiliation(s)
- Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Annette Baumstark
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Nina Jendrike
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Jochen Mende
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sebastian Schauer
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Manuela Link
- 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, Ulm, D-89081, Germany.
| | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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17
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Huang J, Yeung AM, Nguyen KT, Xu NY, Preiser JC, Rushakoff RJ, Seley JJ, Umpierrez GE, Wallia A, Drincic AT, Gianchandani R, Lansang MC, Masharani U, Mathioudakis N, Pasquel FJ, Schmidt S, Shah VN, Spanakis EK, Stuhr A, Treiber GM, Klonoff DC. Hospital Diabetes Meeting 2022. J Diabetes Sci Technol 2022; 16:1309-1337. [PMID: 35904143 PMCID: PMC9445340 DOI: 10.1177/19322968221110878] [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: 11/17/2022]
Abstract
The annual Virtual Hospital Diabetes Meeting was hosted by Diabetes Technology Society on April 1 and April 2, 2022. This meeting brought together experts in diabetes technology to discuss various new developments in the field of managing diabetes in hospitalized patients. Meeting topics included (1) digital health and the hospital, (2) blood glucose targets, (3) software for inpatient diabetes, (4) surgery, (5) transitions, (6) coronavirus disease and diabetes in the hospital, (7) drugs for diabetes, (8) continuous glucose monitoring, (9) quality improvement, (10) diabetes care and educatinon, and (11) uniting people, process, and technology to achieve optimal glycemic management. This meeting covered new technology that will enable better care of people with diabetes if they are hospitalized.
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Affiliation(s)
| | | | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | | | | | - Amisha Wallia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Umesh Masharani
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | | | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Diabetes Research Institute, Mills-Peninsula Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo, CA 94401, USA.
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18
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Glycemic Targets and Glucose Monitoring. Prim Care 2022; 49:213-223. [DOI: 10.1016/j.pop.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Marks BE, Williams KM, Sherwood JS, Putman MS. Practical aspects of diabetes technology use: Continuous glucose monitors, insulin pumps, and automated insulin delivery systems. J Clin Transl Endocrinol 2022; 27:100282. [PMID: 34917483 PMCID: PMC8666668 DOI: 10.1016/j.jcte.2021.100282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/01/2021] [Accepted: 11/27/2021] [Indexed: 02/06/2023] Open
Abstract
There have been tremendous advances in diabetes technology in the last decade. Continuous glucose monitors (CGM), insulin pumps, and automated insulin delivery (AID) systems aim to improve glycemic control while simultaneously decreasing the burden of diabetes management. Although diabetes technologies have been shown to decrease both hypoglycemia and hyperglycemia and to improve health-related quality of life in individuals with type 1 diabetes, the impact of these devices in individuals with cystic fibrosis-related diabetes (CFRD) is less clear. There are unique aspects of CFRD, including the different underlying pathophysiology and unique lived health care experience and comorbidities, that likely affect the use, efficacy, and uptake of diabetes technology in this population. Small studies suggest that CGM is accurate and may be helpful in guiding insulin therapy for individuals with CFRD. Insulin pump use has been linked to improvements in lean body mass and hemoglobin A1c among adults with CFRD. A recent pilot study highlighted the promise of AID systems in this population. This article provides an overview of practical aspects of diabetes technology use and device limitations that clinicians must be aware of in caring for individuals with CF and CFRD. Cost and limited insurance coverage remain significant barriers to wider implementation of diabetes technology use among patients with CFRD. Future studies exploring strategies to improve patient and CF provider education about these devices and studies showing the effectiveness of these technologies on health and patient-reported outcomes may lead to improved insurance coverage and increased rates of uptake and sustained use of these technologies in the CFRD community.
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Affiliation(s)
- Brynn E. Marks
- Division of Endocrinology and Diabetes, Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC 20010, USA
| | - Kristen M. Williams
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Columbia University Irving Medical Center, 1150 St Nicholas Avenue, New York, NY 10032, United States
| | - Jordan S. Sherwood
- Diabetes Research Center, Division of Pediatric Endocrinology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Melissa S. Putman
- Division of Endocrinology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Diabetes Research Center, Division of Endocrinology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
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20
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Kennard MR, Daniels Gatward LF, Roberts AG, White ERP, Nandi M, King AJF. The use of mice in diabetes research: The impact of experimental protocols. Diabet Med 2021; 38:e14705. [PMID: 34596274 DOI: 10.1111/dme.14705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 12/17/2022]
Abstract
Mice are used extensively in preclinical diabetes research to model various aspects of blood glucose homeostasis. Careful experimental design is vital for maximising welfare and improving reproducibility of data. Alongside decisions regarding physiological characteristics of the animal cohort (e.g., sex, strain and age), experimental protocols must also be carefully considered. This includes choosing relevant end points of interest and understanding what information they can provide and what their limitations are. Details of experimental protocols must, therefore, be carefully planned during the experimental design stage, especially considering the impact of researcher interventions on preclinical end points. Indeed, in line with the 3Rs of animal research, experiments should be refined where possible to maximise welfare. The role of welfare may be particularly pertinent in preclinical diabetes research as blood glucose concentrations are directly altered by physiological stress responses. Despite the potential impact of variations in experimental protocols, there is distinct lack of standardisation and consistency throughout the literature with regards to several experimental procedures including fasting, cage changing and glucose tolerance test protocol. This review firstly highlights practical considerations with regard to the choice of end points in preclinical diabetes research and the potential for novel technologies such as continuous glucose monitoring and glucose clamping techniques to improve data resolution. The potential influence of differing experimental protocols and in vivo procedures on both welfare and experimental outcomes is then discussed with focus on standardisation, consistency and full disclosure of methods.
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Affiliation(s)
| | | | - Anna G Roberts
- Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ella R P White
- Department of Diabetes, King's College London, London, UK
| | - Manasi Nandi
- Institute of Pharmaceutical Science, King's College London, London, UK
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21
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Farhoudi N, Laurentius LB, Magda JJ, Reiche CF, Solzbacher F. In Vivo Monitoring of Glucose Using Ultrasound-Induced Resonance in Implantable Smart Hydrogel Microstructures. ACS Sens 2021; 6:3587-3595. [PMID: 34543020 DOI: 10.1021/acssensors.1c00844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A novel glucose sensor is presented using smart hydrogels as biocompatible implantable sensing elements, which eliminates the need for implanted electronics and uses an external medical-grade ultrasound transducer for readout. The readout mechanism uses resonance absorption of ultrasound waves in glucose-sensitive hydrogels. In vivo glucose concentration changes in the interstitial fluid lead to swelling or deswelling of the gels, which changes the resonance behavior. The hydrogels are designed and shaped such as to exhibit specific mechanical resonance frequencies while remaining sonolucent to other frequencies. Thus, they allow conventional and continued ultrasound imaging, while yielding a sensing signal at specific frequencies that correlate with glucose concentration. The resonance frequencies can be tuned by changing the shape and mechanical properties of the gel structures, such as to allow for multiple, colocated implanted hydrogels with different sensing characteristics or targets to be employed and read out, without interference using the same ultrasound transducer, by simply toggling frequencies. The fact that there is no need for any implantable electronics, also opens up the path toward future use of biodegradable hydrogels, thus creating a platform that allows injection of sensors that do not need to be retrieved when they reach the end of their useful lifespan.
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Affiliation(s)
- Navid Farhoudi
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah 84112, United States
| | - Lars B. Laurentius
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah 84112, United States
| | - Jules J. Magda
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah 84112, United States
| | - Christopher F. Reiche
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah 84112, United States
| | - Florian Solzbacher
- Departments of Electrical and Computer Engineering, Materials Science & Engineering, and Biomedical Engineering, University of Utah, Salt Lake City, Utah 84112, United States
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22
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Kemas AM, Youhanna S, Zandi Shafagh R, Lauschke VM. Insulin-dependent glucose consumption dynamics in 3D primary human liver cultures measured by a sensitive and specific glucose sensor with nanoliter input volume. FASEB J 2021; 35:e21305. [PMID: 33566368 DOI: 10.1096/fj.202001989rr] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 12/27/2022]
Abstract
The liver plays a central role in glucose homeostasis and hepatic insulin resistance constitutes a key feature of type 2 diabetes. However, platforms that accurately mimic human hepatic glucose disposition and allow for rapid and scalable quantification of glucose consumption dynamics are lacking. Here, we developed and optimized a colorimetric glucose assay based on the glucose oxidase-peroxidase system and demonstrate that the system can monitor glucose consumption in 3D primary human liver cell cultures over multiple days. The system was highly sensitive (limit of detection of 3.5 µM) and exceptionally accurate (R2 = 0.999) while requiring only nanoliter input volumes (250 nL), enabling longitudinal profiling of individual liver microtissues. By utilizing a novel polymer, off-stoichiometric thiol-ene (OSTE), and click-chemistry based on thiol-Michael additions, we furthermore show that the assay can be covalently bound to custom-build chips, facilitating the integration of the sensor into microfluidic devices. Using this system, we find that glucose uptake of our 3D human liver cultures closely resembles human hepatic glucose uptake in vivo as measured by euglycemic-hyperinsulinemic clamp. By comparing isogenic insulin-resistant and insulin-sensitive liver cultures we furthermore show that insulin and extracellular glucose levels account for 55% and 45% of hepatic glucose consumption, respectively. In conclusion, the presented data show that the integration of accurate and scalable nanoliter glucose sensors with physiologically relevant organotypic human liver models enables longitudinal profiling of hepatic glucose consumption dynamics that will facilitate studies into the biology and pathobiology of glycemic control, as well as antidiabetic drug screening.
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Affiliation(s)
- Aurino M Kemas
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Sonia Youhanna
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Reza Zandi Shafagh
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Micro and Nanosystem, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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23
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Abstract
Continuous glucose monitoring (CGM) is being used with increasing frequency as an adjunct to self-monitoring of blood glucose in pregnancy, and novel targets based on CGM data are becoming standardized. This adoption of CGM is the result of its improving accuracy, patient preference, and evolving data demonstrating associations of novel targets such as time in range (TIR) with pregnancy and neonatal outcomes. A greater understanding of the relationship of various CGM metrics to outcomes in pregnancy complicated by diabetes is needed. It is clear that TIR parameters need to be uniquely lower for pregnant women than for nonpregnant individuals. CGM technology is also an integral part of hybrid closed-loop insulin delivery systems. These insulin delivery systems will be a significant advance in the management of diabetes during pregnancy if they can achieve the pre- and postprandial targets required for pregnancy and optimize TIR.
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24
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Nagl K, Berger G, Aberer F, Ziko H, Weimann K, Bozic I, Rami‐Merhar B, Mader JK. Performance of three different continuous glucose monitoring systems in children with type 1 diabetes during a diabetes summer camp. Pediatr Diabetes 2021; 22:271-278. [PMID: 33219728 PMCID: PMC7984061 DOI: 10.1111/pedi.13160] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to assess accuracy of the three most commonly used continuous glucose monitoring (CGM) systems in almost real-life situation during a diabetes camp in children with type 1 diabetes (T1D) aged 9-14 years. Data was gathered during a 2-week summer camp under physicians' supervision. Out of 38 participating children with T1D (aged: 11.0 [9.9; 12.1] years; 57% girls, mean HbA1c 7.2 [6.9; 7.7] %,) 37 wore a CGM system (either Abbott FreeStyle Libre (FSL), Dexcom G6 (DEX) or Medtronic Enlite (ENL)) throughout the camp. All concomitantly available data pairs of capillary glucose measurements and sensor values were used for the analysis. Mean absolute relative difference (MARD) was calculated and Parkes Error Grid analyses were done for all three systems used. In total 2079 data pairs were available for analysis. The overall MARDs of CGM systems used at the camp was FSL: 13.3% (6.7;21.6). DEX: 10.3% (5.8; 16.7) and ENL 8.5% (3.6; 15.6). During eu-, hypo- and hyperglycemia MARDs were lowest in ENL. Highest MARDs were seen in hypoglycemia, where all three systems exhibited MARDs above 15%. Overnight MARDs of all systems was higher than during daytime. All sensors performed worst in hypoglycemia. Performance of the adequately calibrated Medtronic system outperformed the factory-calibrated sensors. For clinical practice, it is important to adequately train children with T1D and families in the correct procedures for sensors that require calibrations.
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Affiliation(s)
- Katrin Nagl
- Department of Pediatrics and Adolescent MedicineMedical University ViennaAustria
| | - Gabriele Berger
- Department of Pediatrics and Adolescent MedicineMedical University ViennaAustria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Haris Ziko
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Katharina Weimann
- Department of Pediatrics and Adolescent MedicineMedical University ViennaAustria
| | - Ina Bozic
- Department of Pediatrics and Adolescent MedicineMedical University ViennaAustria
| | - Birgit Rami‐Merhar
- Department of Pediatrics and Adolescent MedicineMedical University ViennaAustria
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
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Kurstjens S, Gemen E, Walk S, Njo T, Krabbe J, Gijzen K, Elisen MG, Kusters R. Performance of commercially-available cholesterol self-tests. Ann Clin Biochem 2021; 58:289-296. [PMID: 33478240 DOI: 10.1177/0004563221992393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypercholesterolemia (plasma cholesterol concentration ≥5.2 mmol/L) is a risk factor for cardiovascular disease and stroke. Many different cholesterol self-tests are readily available at general stores, pharmacies and web shops. However, there is limited information on their analytical and diagnostic performance. METHODS We included 62 adult patients who required a lipid panel measurement (cholesterol, high-density lipoprotein (HDL), triglycerides and LDLcalc) for routine care. The performance of five different cholesterol self-tests, three quantitative meters (Roche Accutrend Plus, Mission 3-in-1 and Qucare) and two semi-quantitative strip tests (Veroval and Mylan MyTest), was assessed according to the manufacturers' protocol. RESULTS The average plasma cholesterol concentration was 5.2 ± 1.2 mmol/L. The mean absolute relative difference (MARD) of the five cholesterol self-tests ranged from 6 ± 5% (Accutrend Plus) to 20 ± 12% (Mylan Mytest). The Accutrend Plus cholesterol meter showed the best diagnostic performance with a 92% sensitivity and 89% specificity. The Qucare and Mission 3-in-1 are able to measure HDL concentrations and can thus provide a cholesterol:HDL ratio. The Passing-Bablok regression analyses for the ratio showed poor performance in both self-tests (Mission 3-in-1: y = 1.62x-1.20; Qucare: y = 0.61x + 1.75). The Accutrend Plus is unable to measure the plasma high-density lipoprotein concentration.Conclusions/interpretation: The Accutrend Plus cholesterol meter (Roche) had excellent diagnostic and analytic performance. However, several of the commercially-available self-tests had considerably poor accuracy and diagnostic performance and therefore do not meet the required qualifications, potentially leading to erroneous results. Better regulation, standardization and harmonization of cholesterol self-tests is warranted.
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Affiliation(s)
- Steef Kurstjens
- Laboratory of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Eugenie Gemen
- Laboratory of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Selina Walk
- Laboratory of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Tjin Njo
- Laboratory of Clinical Chemistry, Saltro, Utrecht, the Netherlands
| | - Johannes Krabbe
- Laboratory of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.,Laboratory of Clinical Chemistry, Medlon BV, Enschede, the Netherlands
| | - Karlijn Gijzen
- Laboratory of Clinical Chemistry and Hematology, Meander Medical Center, Amersfoort, the Netherlands
| | - Marc Glm Elisen
- Laboratory of Clinical Chemistry & Hematology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands.,Netherlands Society of Clinical Chemistry & Laboratory Medicine (NVKC), Utrecht, the Netherlands
| | - Ron Kusters
- Laboratory of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, Den Bosch, the Netherlands.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, the Netherlands
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26
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Kim HN, Yoon SY. Comparative study of i-SENS glucometers in neonates using capillary blood samples. Clin Chem Lab Med 2021; 59:1133-1141. [PMID: 33915605 DOI: 10.1515/cclm-2020-1367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The accuracy of point-of-care blood glucometers in the detection and evaluation of neonatal hypoglycemia is a concern. This study compared the performance of three i-SENS glucometers with that of the YSI 2300 STAT Plus Analyzer, which was used as a reference. METHODS The leftover neonatal capillary blood samples of 319 patients were used in this study. The evaluation process and accuracy performance criteria were based on the International Organization for Standardization 15197:2013 guidelines. The evaluation involved three i-SENS glucometers (BAROzen H Expert plus, CareSens PRO, and CareSens H Beat) and the ACCU-CHEK® Inform II glucometer. RESULTS The accuracy evaluation yielded acceptable results as follows: a) 100 and 100% for BAROzen H Expert plus; 99.8 and 100% for CareSens PRO; 98.7%, and 97.2% for CareSens H Beat glucometers were within the range of ±0.8 mmol/L (15 mg/dL) and ±15% of the average reference values at glucose concentrations <5.55 mmol/L (100 mg/dL) and ≥5.55 mmol/L (100 mg/dL), respectively, and b) all estimated glucose values (100%) were within the zones A and B of Consensus Error Grid for all three i-SENS glucometers. There was good correlation between the glucose values estimated by the glucometers and the reference values (R>0.990). CONCLUSIONS This study demonstrated that i-SENS glucometers exhibit acceptable performance and can be used as effective point-of-care devices in neonates.
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Affiliation(s)
- Ha Nui Kim
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Soo-Young Yoon
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
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27
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A Comprehensive Review of Continuous Glucose Monitoring Accuracy during Exercise Periods. SENSORS 2021; 21:s21020479. [PMID: 33445438 PMCID: PMC7828017 DOI: 10.3390/s21020479] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
Continuous Glucose Monitoring (CGM) has been a springboard of new diabetes management technologies such as integrated sensor-pump systems, the artificial pancreas, and more recently, smart pens. It also allows patients to make better informed decisions compared to a few measurements per day from a glucometer. However, CGM accuracy is reportedly affected during exercise periods, which can impact the effectiveness of CGM-based treatments. In this review, several studies that used CGM during exercise periods are scrutinized. An extensive literature review of clinical trials including exercise and CGM in type 1 diabetes was conducted. The gathered data were critically analysed, especially the Mean Absolute Relative Difference (MARD), as the main metric of glucose accuracy. Most papers did not provide accuracy metrics that differentiated between exercise and rest (non-exercise) periods, which hindered comparative data analysis. Nevertheless, the statistic results confirmed that CGM during exercise periods is less accurate.
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28
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Jafri RZ, Balliro CA, El-Khatib F, Maheno MM, Hillard MA, O'Donovan A, Selagamsetty R, Zheng H, Damiano ER, Russell SJ. A Three-Way Accuracy Comparison of the Dexcom G5, Abbott Freestyle Libre Pro, and Senseonics Eversense Continuous Glucose Monitoring Devices in a Home-Use Study of Subjects with Type 1 Diabetes. Diabetes Technol Ther 2020; 22:846-852. [PMID: 32453604 DOI: 10.1089/dia.2019.0449] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: There is a dearth of comparative accuracy studies of continuous glucose monitoring (CGM) devices in the home-use setting, and none with the Eversense implantable CGM. Methods: We evaluated the accuracy of the Dexcom G5, Abbott Freestyle Libre Pro, and Senseonics Eversense during a 6-week free-living home-use bionic pancreas study involving 23 subjects with type 1 diabetes who wore all three devices concurrently. The primary outcome was the mean absolute relative difference (MARD) between CGM readings and point-of-care (POC) plasma-glucose (PG) values obtained approximately twice daily by the subjects. We compared PG values with CGM readings when available from all three CGMs in the 5 min preceding the PG values (n = 829 sets). Since the Libre Pro records readings every 15 min, we also did a two-way comparison between the G5 and the Eversense with a higher number of comparisons (n = 2277 sets). Results: All three CGM systems produced higher average MARDs than during in-clinic studies. However, since all three CGM systems were worn by the same individuals and used the same meter for comparator PG measurements, we could directly compare their performances. In the three-way comparison, Eversense achieved the lowest nominal MARD (14.8%) followed by Dexcom G5 (16.3%) and Libre Pro (18.0%) (Eversense vs. Libre Pro P = 0.004, other comparisons P = NS). There was a statistically significant difference (P = 0.008) in the two-way comparison of the MARDs for Eversense (15.1%) and G5 (16.9%). Conclusions: The point accuracy of the Eversense was better than two other CGMs when compared with POC PG values.
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Affiliation(s)
- Rabab Z Jafri
- Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
- Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Courtney A Balliro
- Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Firas El-Khatib
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Michele M Maheno
- Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mallory A Hillard
- Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexander O'Donovan
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | | | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Edward R Damiano
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Steven J Russell
- Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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29
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Teymourian H, Barfidokht A, Wang J. Electrochemical glucose sensors in diabetes management: an updated review (2010-2020). Chem Soc Rev 2020; 49:7671-7709. [PMID: 33020790 DOI: 10.1039/d0cs00304b] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While over half a century has passed since the introduction of enzyme glucose biosensors by Clark and Lyons, this important field has continued to be the focus of immense research activity. Extensive efforts during the past decade have led to major scientific and technological innovations towards tight monitoring of diabetes. Such continued progress toward advanced continuous glucose monitoring platforms, either minimal- or non-invasive, holds considerable promise for addressing the limitations of finger-prick blood testing toward tracking glucose trends over time, optimal therapeutic interventions, and improving the life of diabetes patients. However, despite these major developments, the field of glucose biosensors is still facing major challenges. The scope of this review is to present the key scientific and technological advances in electrochemical glucose biosensing over the past decade (2010-present), along with current obstacles and prospects towards the ultimate goal of highly stable and reliable real-time minimally-invasive or non-invasive glucose monitoring. After an introduction to electrochemical glucose biosensors, we highlight recent progress based on using advanced nanomaterials at the electrode-enzyme interface of three generations of glucose sensors. Subsequently, we cover recent activity and challenges towards next-generation wearable non-invasive glucose monitoring devices based on innovative sensing principles, alternative body fluids, advanced flexible materials, and novel platforms. This is followed by highlighting the latest progress in the field of minimally-invasive continuous glucose monitoring (CGM) which offers real-time information about interstitial glucose levels, by focusing on the challenges toward developing biocompatible membrane coatings to protect electrochemical glucose sensors against surface biofouling. Subsequent sections cover new analytical concepts of self-powered glucose sensors, paper-based glucose sensing and multiplexed detection of diabetes-related biomarkers. Finally, we will cover the latest advances in commercially available devices along with the upcoming future technologies.
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Affiliation(s)
- Hazhir Teymourian
- Department of NanoEngineering, University of California San Diego, La Jolla, CA 92093, USA.
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30
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Guillot FH, Jacobs PG, Wilson LM, Youssef JE, Gabo VB, Branigan DL, Tyler NS, Ramsey K, Riddell MC, Castle JR. Accuracy of the Dexcom G6 Glucose Sensor during Aerobic, Resistance, and Interval Exercise in Adults with Type 1 Diabetes. BIOSENSORS-BASEL 2020; 10:bios10100138. [PMID: 33003524 PMCID: PMC7600074 DOI: 10.3390/bios10100138] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022]
Abstract
The accuracy of continuous glucose monitoring (CGM) sensors may be significantly impacted by exercise. We evaluated the impact of three different types of exercise on the accuracy of the Dexcom G6 sensor. Twenty-four adults with type 1 diabetes on multiple daily injections wore a G6 sensor. Participants were randomized to aerobic, resistance, or high intensity interval training (HIIT) exercise. Each participant completed two in-clinic 30-min exercise sessions. The sensors were applied on average 5.3 days prior to the in-clinic visits (range 0.6–9.9). Capillary blood glucose (CBG) measurements with a Contour Next meter were performed before and after exercise as well as every 10 min during exercise. No CGM calibrations were performed. The median absolute relative difference (MARD) and median relative difference (MRD) of the CGM as compared with the reference CBG did not differ significantly from the start of exercise to the end exercise across all exercise types (ranges for aerobic MARD: 8.9 to 13.9% and MRD: −6.4 to 0.5%, resistance MARD: 7.7 to 14.5% and MRD: −8.3 to −2.9%, HIIT MARD: 12.1 to 16.8% and MRD: −14.3 to −9.1%). The accuracy of the no-calibration Dexcom G6 CGM was not significantly impacted by aerobic, resistance, or HIIT exercise.
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Affiliation(s)
- Florian H. Guillot
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA; (F.H.G.); (L.M.W.); (J.E.Y.); (V.B.G.); (D.L.B.); (J.R.C.)
| | - Peter G. Jacobs
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA;
- Correspondence:
| | - Leah M. Wilson
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA; (F.H.G.); (L.M.W.); (J.E.Y.); (V.B.G.); (D.L.B.); (J.R.C.)
| | - Joseph El Youssef
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA; (F.H.G.); (L.M.W.); (J.E.Y.); (V.B.G.); (D.L.B.); (J.R.C.)
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Virginia B. Gabo
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA; (F.H.G.); (L.M.W.); (J.E.Y.); (V.B.G.); (D.L.B.); (J.R.C.)
| | - Deborah L. Branigan
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA; (F.H.G.); (L.M.W.); (J.E.Y.); (V.B.G.); (D.L.B.); (J.R.C.)
| | - Nichole S. Tyler
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Katrina Ramsey
- Oregon Clinical and Translational Research Institute Biostatistics & Design Program, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Michael C. Riddell
- Muscle Health Research Centre, School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada;
| | - Jessica R. Castle
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA; (F.H.G.); (L.M.W.); (J.E.Y.); (V.B.G.); (D.L.B.); (J.R.C.)
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31
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Mondal H, Mondal S. Usefulness of YouTube™ videos in training patients for blood glucose self-monitoring in current coronavirus disease-19 pandemic. INDIAN JOURNAL OF MEDICAL SCIENCES 2020. [PMCID: PMC7485635 DOI: 10.25259/ijms_150_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: During the coronavirus disease-19 pandemic, due to restricted health-care access, patients may not get hands-on training for self-monitoring of blood glucose (SMBG) from physicians. YouTube™ is a popular video-sharing web platform that can be used as a source of information for SMBG. This study aimed to assess the usefulness of YouTube™ videos on SMBG. Material and Methods: We searched the keywords “blood glucose self-monitoring,” “home blood glucose monitoring,” “blood glucose test,” and “blood sugar test” on YouTube™. The first 40 videos of each search were listed. After the two-stage screening, 49 videos were included for final data analysis. General characteristics and SMBG-specific characteristics (namely, strip handling, lancing device handling, measurement, and post- measurement action) were observed with pre-defined criteria having “yes” and “no” closed option. Data were tested statistically by the binomial test. Results: Average duration of 49 videos was 244.20 ± 72.61 s and those were online since 35.14 ± 20.52 months on YouTube™. Information about strip handling was mostly deficient, major being checking the expiry date (16.33% videos had the information). The handling of the lancing device was correct in the majority of the videos except for the disinfection of the tip of the lancing device (6.12% videos had the information). The measurement procedure was also correct in the majority of the videos except for the instruction to dry the hands (38.78% videos had the information) after washing. The post-measurement logbook entry was found in 48.98% videos. Conclusion: YouTube™ videos can be used as a potential source of information for patients’ education for SMBG. However, there are various levels of the incompleteness of the tutorials. Primary care physicians may suggest YouTube™ videos after exploring the videos and selecting the most appropriate one for their patients.
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Affiliation(s)
- Himel Mondal
- Department of Physiology, Bhima Bhoi Medical College and Hospital, Balangir, Odisha, India,
| | - Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India,
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32
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O'Malley EG, Reynolds CME, O'Kelly R, Killalea A, Sheehan SR, Turner MJ. A Prospective Evaluation of Point-of-Care Measurements of Maternal Glucose for the Diagnosis of Gestational Diabetes Mellitus. Clin Chem 2020; 66:316-323. [PMID: 32040574 DOI: 10.1093/clinchem/hvz005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/27/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Point-of-care (POC) measurement of glucose is currently recommended only for the monitoring of gestational diabetes mellitus (GDM). This prospective observational study evaluated the use of POC measurements of maternal glucose to diagnose GDM in women being screened selectively with a 1-step 75 g oral glucose tolerance test (OGTT). METHODS The strictest preanalytic and analytic international laboratory standards were applied to measure maternal plasma glucose at fasting and at 1 and 2 h post glucose load. The recent International Association of Diabetes and Pregnancy Study Groups diagnostic criteria were used. At the same time, maternal capillary glucose was measured. Because of differences in plasma and capillary glucose measurements, regression analysis of POC capillary glucose results vs laboratory plasma glucose results was conducted. The regression equations for plasma glucose were derived in a derivation cohort (n = 102). These equations were applied in the validation cohort (n = 100). Predicted and actual plasma glucose values were compared. RESULTS Of the 202 women screened, 36.6% were nulliparous, 56.4% were obese, and 81.2% were Irish-born. Two thirds had a single risk factor for GDM, and a third had multiple risk factors. Based on the plasma measurements, 53.5% had GDM. As a predictor of GDM, the diagnostic accuracy of POC measurement was 83.0% (95% confidence interval, 74.2-89.8). CONCLUSIONS In high-resource settings where measures to inhibit glycolysis are implemented, the use of POC measurements for the diagnosis of GDM is not justified based on this study. In low- and medium-resource settings, where measures to inhibit glycolysis are not achievable, regression analysis using POC measurements may be acceptable compared with plasma samples subject to glycolysis.
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Affiliation(s)
- Eimer G O'Malley
- UCD Centre for Human Reproduction, Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ciara M E Reynolds
- UCD Centre for Human Reproduction, Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ruth O'Kelly
- Department of Biochemistry, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Anne Killalea
- Department of Biochemistry, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Sharon R Sheehan
- UCD Centre for Human Reproduction, Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
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Bruns DE, Metzger BE, Sacks DB. Diagnosis of Gestational Diabetes Mellitus Will Be Flawed until We Can Measure Glucose. Clin Chem 2020; 66:265-267. [PMID: 32040567 DOI: 10.1093/clinchem/hvz027] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 01/21/2023]
Affiliation(s)
- David E Bruns
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
| | - Boyd E Metzger
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David B Sacks
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, MD
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Foreman YD, Brouwers MCGJ, van der Kallen CJH, Pagen DME, van Greevenbroek MMJ, Henry RMA, Koster A, Wesselius A, Schaper NC, Stehouwer CDA. Glucose Variability Assessed with Continuous Glucose Monitoring: Reliability, Reference Values, and Correlations with Established Glycemic Indices-The Maastricht Study. Diabetes Technol Ther 2020; 22:395-403. [PMID: 31886732 DOI: 10.1089/dia.2019.0385] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Glucose variability (GV) measured by continuous glucose monitoring (CGM) has become an accepted marker of glycemic control. Nevertheless, several methodological aspects of GV assessment require further study. We, therefore, investigated the minimum number of days needed to reliably measure GV, assessed GV reference values, and studied the correlation of GV with established glycemic indices (i.e., HbA1c, seven-point oral glucose tolerance test [OGTT]-derived indices). Methods: We used cross-sectional data from The Maastricht Study, an observational population-based cohort enriched with type 2 diabetes. Participants with more than 48 h of CGM (iPro2; Medtronic) were included for analysis (n = 851; age: 60 ± 9years; 49% women; 23% type 2 diabetes). We used mean sensor glucose (MSG), standard deviation (SD), and coefficient of variation (CV) as CGM-derived indices (the latter two for GV quantification). We calculated reliability using the Spearman-Brown prophecy formula, established reference values by calculating 2.5th-97.5th percentiles, and studied correlations using Spearman's rho. Results: Sufficient reliability (R > 0.80) was achieved with two (MSG and SD), or three monitoring days (CV). The reference ranges, assessed in individuals with normal glucose metabolism (n = 470), were 90.5-120.6 mg/dL (MSG), 7.9-24.8 mg/dL (SD), and 7.74%-22.45% (CV). For MSG, the strongest correlation was found with fasting plasma glucose (rho = 0.65 [0.61; 0.69]); for SD, with the 1-h OGTT value (rho = 0.61 [0.56; 0.65]); and for CV, with both the incremental glucose peak (IGP) during the OGTT (rho = 0.50 [0.45; 0.55]) and the 1-h OGTT value (rho = 0.50 [0.45; 0.55]). Conclusions: The reliability findings and reference values are relevant for studies that aim to investigate CGM-measured GV. One-hour OGTT and IGP values can be used as GV indices when CGM is unavailable.
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Affiliation(s)
- Yuri D Foreman
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Martijn C G J Brouwers
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Demi M E Pagen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Marleen M J van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Anke Wesselius
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Complex Genetics and Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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Inman M, Parker K, Strueby L, Lyon AW, Lyon ME. A Simulation Study to Assess the Effect of Analytic Error on Neonatal Glucose Measurements Using the Canadian Pediatric Society Position Statement Action Thresholds. J Diabetes Sci Technol 2020; 14:519-525. [PMID: 31694397 PMCID: PMC7576938 DOI: 10.1177/1932296819884923] [Citation(s) in RCA: 4] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Canadian Pediatric Society (CPS) has endorsed an algorithm for the screening and immediate management of babies at risk of neonatal hypoglycemia that provides time-dependent glucose concentration action thresholds. The objective of this study was to evaluate the impact of glucose analytic error (bias and imprecision) on the misclassification of glucose meter results from a neonatal intensive care unit (NICU) using the CPS guidelines. METHODS A simulation dataset of true glucose values (N = 100 000) was derived by finite mixture model analysis of NICU glucose data (N = 23 749). Bias and imprecision were added to create measured glucose values. The percentages of measured glucose values that were misclassified at CPS action thresholds were determined by Monte Carlo simulation. RESULTS Measurement biases ranging from -20 to +20 mg/dL combined with coefficients of variation 0% to 20% were evaluated to predict misclassification rates at 32, 36, and 47 mg/dL. The models demonstrated low risk of false normoglycemia-at 5% CV and +10 mg/dL bias: 0.8% to 5% misclassification at the 32 and 47 mg/dL thresholds due to bias. The models demonstrated risk of false hypoglycemia-at 5% CV and -10 mg/dL bias: 3% to 12.5% misclassification at 32 and 47 mg/dL thresholds due to both bias and imprecision. CONCLUSION Using CPS action thresholds, the simulation model predicted the proportion of neonates at risk of inappropriate clinical action-both of omission or "failure to treat" and commission or "overtreatment" in response to NICU glucose meter results at specific bias and imprecision values.
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Affiliation(s)
- Mark Inman
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kayla Parker
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lannae Strueby
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrew W. Lyon
- Division of Clinical Biochemistry, Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Royal University Hospital, Saskatoon, SK, Canada
| | - Martha E. Lyon
- Division of Clinical Biochemistry, Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Royal University Hospital, Saskatoon, SK, Canada
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Wang Y, Plebani M, Sciacovelli L, Zhang S, Wang Q, Zhou R. Commutability of external quality assessment materials for point-of-care glucose testing using the Clinical and Laboratory Standards Institute and International Federation of Clinical Chemistry approaches. J Clin Lab Anal 2020; 34:e23327. [PMID: 32342567 PMCID: PMC7439342 DOI: 10.1002/jcla.23327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/21/2020] [Accepted: 03/17/2020] [Indexed: 01/17/2023] Open
Abstract
Objectives The aim of this study was to assess the commutability of three external quality assessment (EQA) materials for point‐of‐care (POC) glucose testing using two approaches, to identify suitable EQA materials to evaluate and monitor the quality of POC testing. Methods Commercial control materials (CCMs), pooled human serum samples (PHSs), and homemade human whole‐blood samples (HWBs) were measured along with 33 individual clinical samples using five POC instruments and a Hitachi 7600 analyzer. Data were analyzed by Deming regression analysis with a 95% prediction interval as described in Clinical and Laboratory Standards Institute (CLSI) EP30‐A, and by difference in bias analysis as described by the International Federation of Clinical Chemistry (IFCC) Working Group on Commutability. Results Using the CLSI approach, HWBs, CCMs, and PHSs were commutable with five, one, and two instruments, respectively. With the IFCC approach, HWBs were commutable with two instruments, while CCMs and PHSs were largely inconclusive or non‐commutable on five instruments. Conclusions HWBs were commutable on all instruments by the CLSI approach and may be a suitable EQA material for POC testing. Although some results differed between the IFCC and CLSI approaches, both indicated that HWBs were far superior to CCMs and PHSs in commutability.
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Affiliation(s)
- Yan Wang
- Department of Laboratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mario Plebani
- Department of Laboratory Medicine, Padova University Hospital, Padova, Italy
| | - Laura Sciacovelli
- Department of Laboratory Medicine, Padova University Hospital, Padova, Italy
| | - Shunli Zhang
- Department of Laboratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qingtao Wang
- Department of Laboratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Center for Clinical Laboratories, Beijing, China
| | - Rui Zhou
- Department of Laboratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Abstract
The development of basal insulin analogues has reduced the risk of hypoglycaemia in insulin-treated individuals with type 2 diabetes. Insulin degludec and insulin glargine 300 U/ml (glargine U300) represent an evolution of basal insulin analogues, both of them reducing the risk of hypoglycaemia as compared with that associated with glargine U100. However, whether degludec and glargine U300 are equivalent with respect to glycaemic control and risk of hypoglycaemia remains to be fully ascertained. In the CONCLUDE trial, 1609 individuals with type 2 diabetes were randomised to either degludec 200 U/ml (degludec U200) or glargine U300. In this issue of Diabetologia (https://doi.org/10.1007/s00125-019-05080-9) the investigators report that during the maintenance period, HbA1c improved to a similar extent in the two groups with no significant difference in the rate of overall hypoglycaemia (the primary endpoint of the study), while rates of nocturnal symptomatic and severe hypoglycaemia (secondary endpoints) were lower with degludec U200 than with glargine U300. These results, although of great interest to the clinician, need to be carefully interpreted as they cannot be considered as conclusive. First, the primary endpoint was not met and, therefore, analyses of secondary endpoints remain exploratory. Even assuming that degludec is superior to glargine in reducing the risk of hypoglycaemia, the mechanism(s) accounting for such an advantage remain elusive and potential differences in pharmacokinetics and pharmacodynamics difficult to appreciate because of methodological issues. The study design had to be amended because of lack of reliability of the glucometers initially used in the trial, particularly in the low blood glucose ranges, so the potential implications of these changes in the subsequent conduct of the trial cannot be excluded. Finally, comparison with the BRIGHT trial, the only other available head-to-head study, is complicated by differences between the two studies in the primary endpoint (HbA1c reduction vs reduction of the risk of hypoglycaemia), study population (insulin-experienced vs insulin-naive) and concomitant glucose-lowering medications. In spite of all this, CONCLUDE teaches us an important lesson regarding the need, particularly in the clinical setting, to monitor the reliability of the glucometers the diabetic individual uses to adjust his/her insulin dose. Insufficient precision or inappropriate use of the glucometer can easily offset any minute advantage a new insulin can offer with respect to glycaemic control and risk of hypoglycaemia.
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Affiliation(s)
- Stefano Del Prato
- Department of Clinical & Experimental Medicine, Section of Diabetes, University of Pisa, Nuovo Ospedale Santa Chiara, Via Paradisa, 2, 56124, Pisa, Italy.
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Xie L, Zeng H, Sun J, Qian W. Engineering Microneedles for Therapy and Diagnosis: A Survey. MICROMACHINES 2020; 11:E271. [PMID: 32150866 PMCID: PMC7143426 DOI: 10.3390/mi11030271] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023]
Abstract
Microneedle (MN) technology is a rising star in the point-of-care (POC) field, which has gained increasing attention from scientists and clinics. MN-based POC devices show great potential for detecting various analytes of clinical interests and transdermal drug delivery in a minimally invasive manner owing to MNs' micro-size sharp tips and ease of use. This review aims to go through the recent achievements in MN-based devices by investigating the selection of materials, fabrication techniques, classification, and application, respectively. We further highlight critical aspects of MN platforms for transdermal biofluids extraction, diagnosis, and drug delivery assisted disease therapy. Moreover, multifunctional MNs for stimulus-responsive drug delivery systems were discussed, which show incredible potential for accurate and efficient disease treatment in dynamic environments for a long period of time. In addition, we also discuss the remaining challenges and emerging trend of MN-based POC devices from the bench to the bedside.
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Affiliation(s)
- Liping Xie
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China;
| | - Hedele Zeng
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China;
| | - Jianjun Sun
- Border Biomedical Research Center, University of Texas at El Paso, El Paso, TX 79968, USA
| | - Wei Qian
- Department of Electrical and Computer Engineering, University of Texas, EI Paso, TX 79968, USA;
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Mondal S, Mondal H, Biri SK. Surveillance Accuracy of Smartphone-Dependent Glucose Meters in the Measurement of Plasma Glucose. Indian J Endocrinol Metab 2020; 24:181-186. [PMID: 32699787 PMCID: PMC7333746 DOI: 10.4103/ijem.ijem_580_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/02/2019] [Accepted: 12/20/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Along with stand-alone glucose monitors, smartphone-dependent glucose meters (SDGM) are available for self-monitoring of blood glucose (SMBG). These display-less devices, connected to a smartphone, measure glucose and display report on a smartphone screen, which can be easily shared with doctors. AIM The aim of this study was to check the accuracy of the available SDGMs in relation to the laboratory reference method. MATERIALS AND METHODS Two available SDGMs: BeatO™ and GlucoMe™ were tested. A total of 104 venous blood samples were tested for glucose in SDGMs and by the reference method. The accuracy of the report was checked by the International Standards Organization (ISO), American Diabetes Association (ADA), and Clinical Laboratory Improvement Amendments (CLIA) criteria. Clarke error grid analysis (CEGA) was carried out to find the suitability of SDGM in clinical usage. RESULTS Mean plasma glucose (n = 104) level from laboratory report was 106.48 ± 44.58 mg/dL, that from BeatO™ was 105.78 ± 52.6, and GlucoMe™ was 99.72 ± 51.22. The accuracy was lower than that recommended by ISO 2013 (29.8% and 30.77% error in BeatO™ and GlucoMe™, respectively), ADA (63.46% and 74% error in BeatO™ and GlucoMe™, respectively), and CLIA (42.31% and 46.15% error in BeatO™ and GlucoMe™, respectively) criteria. According to CEGA, BeatO™ and GlucoMe™ can guide correct treatment in diabetes mellitus patients for 74% and 71% of measurement, respectively. CONCLUSION The accuracy of both the SDGMs was lower than that suggested by ISO, ADA, and CLIA criteria. The result of this study would help patients and doctors in informed choice for the procurement of glucose monitors.
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Affiliation(s)
- Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India
| | - Himel Mondal
- Department of Physiology, Bhima Bhoi Medical College and Hospital, Balangir, Odisha, India
| | - Sairavi Kiran Biri
- Department of Biochemsitry, Fakir Mohan Medical College and Hospital, Balasore, Odisha, India
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Beck RW, Brown SA, Lum JW, Kovatchev BP. Nonadjunctive Use of Continuous Glucose Monitoring: The End of Fingersticks? Diabetes Technol Ther 2020; 22:67-68. [PMID: 31657622 DOI: 10.1089/dia.2019.0387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
| | - Sue A Brown
- University of Virginia Center for Diabetes Technology, Charlottesville, Virginia
| | - John W Lum
- Jaeb Center for Health Research, Tampa, Florida
| | - Boris P Kovatchev
- University of Virginia Center for Diabetes Technology, Charlottesville, Virginia
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Porumb M, Stranges S, Pescapè A, Pecchia L. Precision Medicine and Artificial Intelligence: A Pilot Study on Deep Learning for Hypoglycemic Events Detection based on ECG. Sci Rep 2020; 10:170. [PMID: 31932608 PMCID: PMC6957484 DOI: 10.1038/s41598-019-56927-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/18/2019] [Indexed: 01/21/2023] Open
Abstract
Tracking the fluctuations in blood glucose levels is important for healthy subjects and crucial diabetic patients. Tight glucose monitoring reduces the risk of hypoglycemia, which can result in a series of complications, especially in diabetic patients, such as confusion, irritability, seizure and can even be fatal in specific conditions. Hypoglycemia affects the electrophysiology of the heart. However, due to strong inter-subject heterogeneity, previous studies based on a cohort of subjects failed to deploy electrocardiogram (ECG)-based hypoglycemic detection systems reliably. The current study used personalised medicine approach and Artificial Intelligence (AI) to automatically detect nocturnal hypoglycemia using a few heartbeats of raw ECG signal recorded with non-invasive, wearable devices, in healthy individuals, monitored 24 hours for 14 consecutive days. Additionally, we present a visualisation method enabling clinicians to visualise which part of the ECG signal (e.g., T-wave, ST-interval) is significantly associated with the hypoglycemic event in each subject, overcoming the intelligibility problem of deep-learning methods. These results advance the feasibility of a real-time, non-invasive hypoglycemia alarming system using short excerpts of ECG signal.
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Affiliation(s)
- Mihaela Porumb
- School of Engineering, University of Warwick, Coventry, CV4 7AL, UK
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
- Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Antonio Pescapè
- Department of Electrical Engineering, University of Napoli "Federico II", Naples, Italy
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, CV4 7AL, UK.
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Lisi F, Peterson JR, Gooding JJ. The application of personal glucose meters as universal point-of-care diagnostic tools. Biosens Bioelectron 2020; 148:111835. [DOI: 10.1016/j.bios.2019.111835] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
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Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose. Paediatr Child Health 2019; 24:536-554. [PMID: 31844395 DOI: 10.1093/pch/pxz134] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/21/2019] [Indexed: 11/12/2022] Open
Abstract
Hypoglycemia in the first hours to days after birth remains one of the most common conditions facing practitioners across Canada who care for newborns. Many cases represent normal physiologic transition to extrauterine life, but another group experiences hypoglycemia of longer duration. This statement addresses key issues for providers of neonatal care, including the definition of hypoglycemia, risk factors, screening protocols, blood glucose levels requiring intervention, and managing care for this condition. Screening, monitoring, and intervention protocols have been revised to better identify, manage, and treat infants who are at risk for persistent, recurrent, or severe hypoglycemia. The role of dextrose gels in raising glucose levels or preventing more persistent hypoglycemia, and precautions to reduce risk for recurrence after leaving hospital, are also addressed. This statement differentiates between approaches to care for hypoglycemia during the 'transitional' phase-the first 72 hours post-birth-and persistent hypoglycemia, which occurs or presents for the first time past that point.
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Affiliation(s)
- Michael R Narvey
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Seth D Marks
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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Narvey MR, Marks SD. Le dépistage et la prise en charge des nouveau-nés à risque d’hypoglycémie. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Résumé
L’hypoglycémie entre les premières heures et les premiers jours suivant la naissance demeure l’une des principales affections qu’observent les praticiens du Canada qui s’occupent de nouveau-nés. Bien des cas vivent une transition physiologique normale à la vie extra-utérine, mais un groupe présente une hypoglycémie pendant une plus longue période. Le présent document de principes expose les principaux enjeux auxquels sont exposés les dispensateurs de soins néonatals, y compris la définition d’hypoglycémie, les facteurs de risque, les protocoles de dépistage, les valeurs de glycémie nécessitant une intervention et la gestion des soins pour cette affection. Les auteurs passent en revue le dépistage, la surveillance et les protocoles d’intervention pour mieux distinguer, prendre en charge et traiter les nouveau-nés à risque d’hypoglycémie persistante, récurrente ou marquée. Ils abordent également le rôle des gels de dextrose pour accroître la glycémie ou prévenir une hypoglycémie plus persistante, de même que les précautions à prendre pour réduire les risques de récurrence après le congé de l’hôpital. Le présent document de principes distingue les approches des soins de l’hypoglycémie pendant la « phase de transition » (les 72 premières heures de vie) de celles de l’hypoglycémie persistante, qui se manifeste ou est constatée pour la première fois après cette période.
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Affiliation(s)
- Michael R Narvey
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Seth D Marks
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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Beck RW, Bergenstal RM, Laffel LM, Pickup JC. Advances in technology for management of type 1 diabetes. Lancet 2019; 394:1265-1273. [PMID: 31533908 DOI: 10.1016/s0140-6736(19)31142-0] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/26/2019] [Accepted: 05/01/2019] [Indexed: 01/07/2023]
Abstract
Technological advances have had a major effect on the management of type 1 diabetes. In addition to blood glucose meters, devices used by people with type 1 diabetes include insulin pumps, continuous glucose monitors, and, most recently, systems that combine both a pump and a monitor for algorithm-driven automation of insulin delivery. In the next 5 years, as many advances are expected in technology for the management of diabetes as there have been in the past 5 years, with improvements in continuous glucose monitoring and more available choices of systems that automate insulin delivery. Expansion of the use of technology will be needed beyond endocrinology practices to primary-care settings and broader populations of patients. Tools to support decision making will also need to be developed to help patients and health-care providers to use the output of these devices to optimise diabetes management.
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Affiliation(s)
- Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA.
| | - Richard M Bergenstal
- International Diabetes Center, Park Nicollet and Health Partners, Minneapolis, MN, USA
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - John C Pickup
- King's College London, Faculty of Life Sciences and Medicine, Guy's Hospital, London, UK
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Russell SJ, Sala R, Conaghan PG, Habib G, Vo Q, Manning R, Kivitz A, Davis Y, Lufkin J, Johnson JR, Kelley S, Bodick N. Triamcinolone acetonide extended-release in patients with osteoarthritis and type 2 diabetes: a randomized, phase 2 study. Rheumatology (Oxford) 2019; 57:2235-2241. [PMID: 30203101 PMCID: PMC6256333 DOI: 10.1093/rheumatology/key265] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Indexed: 01/08/2023] Open
Abstract
Objective Approximately 30% of patients with type 2 diabetes mellitus have knee osteoarthritis. IA corticosteroids used to manage osteoarthritis pain can elevate blood glucose in these patients. We compared blood glucose levels following intra-articular injection of triamcinolone acetonide extended-release (TA-ER), an extended-release, microsphere-based triamcinolone acetonide formulation, vs standard triamcinolone acetonide crystalline suspension (TAcs) in patients with knee osteoarthritis and comorbid type 2 diabetes. Methods In this double-blind, randomized, parallel-group, phase 2 study (NCT02762370), 33 patients with knee osteoarthritis (American College of Rheumatology criteria) and type 2 diabetes mellitus (HbA1c 6.5-9.0% [48-75 mmol/mol]; 1-2 oral hypoglycaemic agents) were treated with intra-articular TA-ER (32 mg n = 18) or TAcs 40 mg (n = 15). Continuous glucose monitoring-measured glucose (CGMG) was assessed from 1 week pre-injection through 2 weeks postinjection. Endpoints included change in average daily CGMG from baseline (days -3 to -1) to days 1-3 postinjection (CGMGdays1-3) (primary) and percent time average hourly CGMG levels remained in prespecified glycaemic ranges. Results The change CGMGdays1-3 was significantly lower following TA-ER vs TAcs (14.7 vs 33.9 mg/dl, least-squares-mean-difference [95% CI]: -19.2 [-38.0, -0.4]; P = 0.0452). The percentage of time over days 1-3 that CGMG was in the target glycaemic range (70-180 mg/dl) was numerically greater for TA-ER (63.3%) vs TAcs (49.7%), and that CGMG was >180 mg/dl was lower for TA-ER (34.5%) vs TAcs (49.9%). Non-glycaemic adverse events were mild and comparable between groups. Conclusion TA-ER may enable intra-articular corticosteroid treatment with minimal blood glucose disruption in patients with knee osteoarthritis and type 2 diabetes mellitus. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT02762370.
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Affiliation(s)
- Steven J Russell
- Department of Medicine, Massachusetts General Hospital Diabetes Research Center, Boston, MA, USA
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - George Habib
- Rheumatology Unit, Laniado Hospital, Kiryat Sanz, Netanya, Israel
| | - Quang Vo
- Dream Team Clinical Research, Anaheim, CA
| | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, PA
| | - Yvonne Davis
- Coastal Carolina Research Center, Mt. Pleasant, SC
| | | | | | | | - Neil Bodick
- Flexion Therapeutics, Inc. Burlington, MA, USA
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Longo R, Sperling S. Personal Versus Professional Continuous Glucose Monitoring: When to Use Which on Whom. Diabetes Spectr 2019; 32:183-193. [PMID: 31462872 PMCID: PMC6695260 DOI: 10.2337/ds18-0093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IN BRIEF With the introduction of intermittently scanned continuous glucose monitoring (CGM) systems to the marketplace, providers and patients now have several options to continuously monitor glucose levels. This article addresses appropriate patient selection criteria for using patient- or practice-based CGM systems and the barriers to achieving optimal benefits from this technology. The authors have developed a flowchart to guide clinicians and patients in decision-making regarding the most appropriate type of CGM to use in various circumstances.
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Tschaikner M, Powell K, Jungklaus M, Fritz M, Ellmerer M, Hovorka R, Lane S, Pieber TR, Regittnig W. Novel Single-Site Device for Conjoined Glucose Sensing and Insulin Infusion: Performance Evaluation in Diabetes Patients During Home-Use. IEEE Trans Biomed Eng 2019; 67:323-332. [PMID: 31251175 DOI: 10.1109/tbme.2019.2925434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study evaluated a novel diabetes treatment device that combines commercially available continuous glucose monitoring and insulin infusion technology in such a way as to perform insulin delivery and glucose sensing through a single skin insertion site (single-port device). METHODS Ten type 1 diabetes patients used the device for up to six days in their home/work environment for open-loop insulin delivery and glucose sensing. On an additional day, the device was used in combination with an algorithm to perform automated closed-loop glucose control under hospital settings. To assess the performance of the device, capillary blood glucose concentrations were frequently determined and a continuous glucose sensor was additionally worn by the patients. RESULTS The average mean absolute relative deviation from blood glucose concentrations obtained for the sensor of the device was low (median, 13.0%; interquartile range, 10.5-16.7%; n = 10) and did not differ from that of the additionally worn glucose sensor (versus 13.9%; 11.9-15.3%; P = 0.922). Furthermore, insulin delivery with the single-port device was reliable and safe during home use and, when performed in combination with the control algorithm, was adequate to achieve and maintain near normoglycemia. CONCLUSION Our data show the feasibility of open- and closed-loop glucose control in diabetes patients using a device that combines insulin delivery and glucose sensing at a single tissue site. SIGNIFICANCE The reduction in device size and invasiveness achieved by this design may largely increase patient convenience and enhance acceptance of diabetes treatment with continuous glucose monitoring and insulin delivery technology.
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Kuzulugil D, Papeix G, Luu J, Kerridge RK. Recent advances in diabetes treatments and their perioperative implications. Curr Opin Anaesthesiol 2019; 32:398-404. [PMID: 30958402 PMCID: PMC6522201 DOI: 10.1097/aco.0000000000000735] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The implications for perioperative management of new oral antihyperglycemic medications and new insulin treatment technologies are reviewed. RECENT FINDINGS The preoperative period represents an opportunity to optimize glycemic control and potentially to reduce adverse outcomes. There is now general consensus that the optimal blood glucose target for hospitalized patients is approximately 106-180 mg/dl (6-10 mmol/l). Recommendations for the management of antihyperglycemic medications vary among national guidelines. It may not be necessary to cease all antihyperglycemic agents prior to surgery. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are associated with higher rates of ketoacidosis especially in acutely unwell and postsurgical patients. The clinical practice implications of new insulin formulations, and new systems for insulin delivery, are not clear. The optimal perioperative management of these will vary depending on local institutional factors such as staff skills and existing clinical practices. Improved hospital care delivery standards, quality assurance, process improvements, consistency in clinical practice, and coordinated multidisciplinary teamwork should be a major focus for improving outcomes of perioperative patients with diabetes. SUMMARY Sulfonylureas and SGLT2i should be ceased before moderate or major surgery. Other oral antihyperglycemic therapies may be continued or ceased. Complex patients and/or new therapies require specialized multidisciplinary management.
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Affiliation(s)
| | - Gabrielle Papeix
- Department of Anaesthesia & Perioperative Medicine, John Hunter Hospital
| | - Judy Luu
- Department of Endocrinology, John Hunter Hospital
- Department of General Medicine, John Hunter Hospital
- Diabetes Stream, Hunter New England Local Health District
- School of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ross K. Kerridge
- Department of Anaesthesia & Perioperative Medicine, John Hunter Hospital
- School of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Larose S, Rabasa-Lhoret R, Roy-Fleming A, Suppère C, Tagougui S, Messier V, Taleb N. Changes in Accuracy of Continuous Glucose Monitoring Using Dexcom G4 Platinum Over the Course of Moderate Intensity Aerobic Exercise in Type 1 Diabetes. Diabetes Technol Ther 2019; 21:364-369. [PMID: 31045433 DOI: 10.1089/dia.2018.0400] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Continuous glucose monitoring (CGM) systems help diabetes management in patients with type 1 diabetes (T1D) but could have lower accuracy during exercise. We aim to evaluate the dynamics of CGM accuracy during exercise in patients with T1D. Secondary analysis of data was carried out on 22 patients with T1D (glycated hemoglobin [HbA1c]: 7.3% ± 1.0%, diabetes duration: 23 ± 13 years), who did three exercise sessions (45 min at 60% VO2max on an ergocycle, 3 h postmeal) with paired Dexcom G4 Platinum, and capillary glucose values that were collected every 5 min. Dexcom accuracy was evaluated using sensor bias (SB) and absolute relative difference (ARD). For dynamics of SB analysis, data pairs following hypoglycemia correction were excluded. The analyzed data included 792 pairs (594 during 66 exercise sessions, 198 at rest before exercise). Median ARD was 8.44 (5.35-12.13)% at rest and increased to 16.77 (10.75-26.72)% during exercise (P < 0.001). During exercise, mean SB values evolved from T0 minutes = 5.95 ± 16.04 mg/dL (exercise start); T5 = 9.55 ± 16.40; T10 = 13.51 ± 18.02; T15 = 15.32 ± 20.36; T20 = 17.30 ± 18.92; T25 = 19.46 ± 17.48; T30 = 21.08 ± 19.64; T35 = 19.10 ± 20.36; T40 = 19.82 ± 20.18; and T45 = 18.02 ± 20.90 (exercise end). CGM overestimated capillary at a mean SB of 14.23 ± 16.76 mg/dL over the whole exercise session. CGM accuracy decreased during moderate aerobic exercise as previously described. However, the trend to overestimate capillary glucose was maintained at relatively stable values within 15 min of exercise initiation, which could help patients in their clinical decisions. Similar analyses would be needed for other types of exercise.
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Affiliation(s)
- Stéphanie Larose
- 1 Metabolic Diseases, Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- 1 Metabolic Diseases, Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
- 2 Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- 3 Montreal Diabetes Research Center and Endocrinology Division, Montréal, Québec, Canada
| | - Amélie Roy-Fleming
- 1 Metabolic Diseases, Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - Corinne Suppère
- 1 Metabolic Diseases, Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - Sémah Tagougui
- 1 Metabolic Diseases, Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - Virginie Messier
- 1 Metabolic Diseases, Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - Nadine Taleb
- 1 Metabolic Diseases, Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
- 4 Division of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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