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Wrench E, Subar DA, Bampouras TM, Lauder RM, Gaffney CJ. Myths and methodologies: Assessing glycaemic control and associated regulatory mechanisms in human physiology research. Exp Physiol 2024; 109:1461-1477. [PMID: 39014995 PMCID: PMC11363129 DOI: 10.1113/ep091433] [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: 12/15/2023] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
Accurate measurements of glycaemic control and the underpinning regulatory mechanisms are vital in human physiology research. Glycaemic control is the maintenance of blood glucose concentrations within optimal levels and is governed by physiological variables including insulin sensitivity, glucose tolerance and β-cell function. These can be measured with a plethora of methods, all with their own benefits and limitations. Deciding on the best method to use is challenging and depends on the specific research question(s). This review therefore discusses the theory and procedure, validity and reliability and any special considerations of a range common methods used to measure glycaemic control, insulin sensitivity, glucose tolerance and β-cell function. Methods reviewed include glycosylated haemoglobin, continuous glucose monitors, the oral glucose tolerance test, mixed meal tolerance test, hyperinsulinaemic euglycaemic clamp, hyperglycaemic clamp, intravenous glucose tolerance test and indices derived from both fasting concentrations and the oral glucose tolerance test. This review aims to help direct understanding, assessment and decisions regarding which method to use based on specific physiology-related research questions.
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Affiliation(s)
- Elizabeth Wrench
- Lancaster Medical School, Health Innovation One, Sir John Fisher DriveLancaster UniversityLancasterUK
| | - Daren A. Subar
- Royal Blackburn HospitalEast Lancashire Hospitals NHS TrustBlackburnUK
| | | | - Robert M. Lauder
- Lancaster Medical School, Health Innovation One, Sir John Fisher DriveLancaster UniversityLancasterUK
| | - Christopher J. Gaffney
- Lancaster Medical School, Health Innovation One, Sir John Fisher DriveLancaster UniversityLancasterUK
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2
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Hazlehurst J, Khoo B, Lobato CB, Ilesanmi I, Abbott S, Chan T, Pillai S, Maslin K, Purkayastha S, McGowan B, Andrews R, Nicholson E, McCullough K, Albon L, Batterham R, Dimitriadis GK, Forbes S, Bewick G, Tan TMM. Society for Endocrinology guidelines for the diagnosis and management of post-bariatric hypoglycaemia. Endocr Connect 2024; 13:EC-23-0285. [PMID: 38451861 PMCID: PMC11046333 DOI: 10.1530/ec-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/07/2024] [Indexed: 03/09/2024]
Abstract
Post bariatric hypoglycaemia (PBH) is typically a post-prandial hypoglycaemia occurring about 2-4 hours after eating in people who have undergone bariatric surgery. PBH develops relatively late after surgery and often after discharge from post-surgical follow-up by bariatric teams, leading to variability in diagnosis and management in non-specialist centres. AIM to improve and standardise clinical practice in the diagnosis and management of PBH. OBJECTIVES (1) to undertake an up-to-date review of the current literature; (2) to formulate practical and evidence-based guidance with regards on the diagnosis and treatment of PBH; (3) to recommend future avenues for research in this condition. METHOD A scoping review was undertaken after an extensive literature search. A consensus on the guidance and confidence in the recommendations was reached by the steering group authors prior to review by key stakeholders. OUTCOME We make pragmatic recommendations for the practical diagnosis and management of PBH including criteria for diagnosis and recognition, as well as recommendations for research areas that should be explored.
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Affiliation(s)
- Jonathan Hazlehurst
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bernard Khoo
- Endocrinology, Division of Medicine, University College London, London, UK
| | - Carolina Brito Lobato
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark
| | - Ibiyemi Ilesanmi
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Sally Abbott
- Department of Dietetics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Tin Chan
- Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Sanesh Pillai
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Kate Maslin
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Sanjay Purkayastha
- Brunel University, London, UK
- Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
| | - Barbara McGowan
- Endocrinology, Guys’ and St Thomas’s NHS Foundation Trust, London, UK
| | - Rob Andrews
- University of Exeter Medical School, Exeter, UK
| | | | | | - Lorraine Albon
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Rachel Batterham
- Endocrinology, Division of Medicine, University College London, London, UK
| | | | - Shareen Forbes
- BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Gavin Bewick
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Tricia M-M Tan
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
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Yurkovich JT, Evans SJ, Rappaport N, Boore JL, Lovejoy JC, Price ND, Hood LE. The transition from genomics to phenomics in personalized population health. Nat Rev Genet 2024; 25:286-302. [PMID: 38093095 DOI: 10.1038/s41576-023-00674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 03/21/2024]
Abstract
Modern health care faces several serious challenges, including an ageing population and its inherent burden of chronic diseases, rising costs and marginal quality metrics. By assessing and optimizing the health trajectory of each individual using a data-driven personalized approach that reflects their genetics, behaviour and environment, we can start to address these challenges. This assessment includes longitudinal phenome measures, such as the blood proteome and metabolome, gut microbiome composition and function, and lifestyle and behaviour through wearables and questionnaires. Here, we review ongoing large-scale genomics and longitudinal phenomics efforts and the powerful insights they provide into wellness. We describe our vision for the transformation of the current health care from disease-oriented to data-driven, wellness-oriented and personalized population health.
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Affiliation(s)
- James T Yurkovich
- Phenome Health, Seattle, WA, USA
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, USA
| | - Simon J Evans
- Phenome Health, Seattle, WA, USA
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
| | - Noa Rappaport
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
- Institute for Systems Biology, Seattle, WA, USA
| | - Jeffrey L Boore
- Phenome Health, Seattle, WA, USA
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
| | - Jennifer C Lovejoy
- Phenome Health, Seattle, WA, USA
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
- Institute for Systems Biology, Seattle, WA, USA
| | - Nathan D Price
- Institute for Systems Biology, Seattle, WA, USA
- Thorne HealthTech, New York, NY, USA
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Leroy E Hood
- Phenome Health, Seattle, WA, USA.
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA.
- Institute for Systems Biology, Seattle, WA, USA.
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA.
- Department of Immunology, University of Washington, Seattle, WA, USA.
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Huang X, Yao C, Huang S, Zheng S, Liu Z, Liu J, Wang J, Chen HJ, Xie X. Technological Advances of Wearable Device for Continuous Monitoring of In Vivo Glucose. ACS Sens 2024; 9:1065-1088. [PMID: 38427378 DOI: 10.1021/acssensors.3c01947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Managing diabetes is a chronic challenge today, requiring monitoring and timely insulin injections to maintain stable blood glucose levels. Traditional clinical testing relies on fingertip or venous blood collection, which has facilitated the emergence of continuous glucose monitoring (CGM) technology to address data limitations. Continuous glucose monitoring technology is recognized for tracking long-term blood glucose fluctuations, and its development, particularly in wearable devices, has given rise to compact and portable continuous glucose monitoring devices, which facilitates the measurement of blood glucose and adjustment of medication. This review introduces the development of wearable CGM-based technologies, including noninvasive methods using body fluids and invasive methods using implantable electrodes. The advantages and disadvantages of these approaches are discussed as well as the use of microneedle arrays in minimally invasive CGM. Microneedle arrays allow for painless transdermal puncture and are expected to facilitate the development of wearable CGM devices. Finally, we discuss the challenges and opportunities and look forward to the biomedical applications and future directions of wearable CGM-based technologies in biological research.
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Affiliation(s)
- Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Chuanjie Yao
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Shuang Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Shantao Zheng
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Zhengjie Liu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Jing Liu
- The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Ji Wang
- The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
- The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510006, China
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Mondal H, Biri SK, Pipil N, Mondal S. Accuracy of a Non-Invasive Home Glucose Monitor for Measurement of Blood Glucose. Indian J Endocrinol Metab 2024; 28:60-64. [PMID: 38533291 PMCID: PMC10962770 DOI: 10.4103/ijem.ijem_36_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 03/28/2024] Open
Abstract
Introduction Patients with diabetes mellitus monitor their blood glucose at home with monitors that require a drop of blood or use a continuous glucose monitoring device that implants a small needle in the body. However, both cause discomfort to the patients which may inhibit them for regular blood glucose checks. Photoplethysmogram (PPG) sensing technology is an approach for non-invasive blood glucose measurement and PPG sensors can be used to predict hypoglycaemic episodes. InChcek is a PPG-based non-invasive glucose monitor. However, its accuracy has not been checked yet. Hence, this study aimed to evaluate the accuracy of InCheck, a non-invasive glucose monitor for the estimation of blood glucose. Methods In a tertiary care hospital, patients who came for blood glucose estimation were tested for blood glucose non-invasively on the InCheck device and then by the laboratory method (glucose oxidase-peroxidase). These two readings were compared. We used International Organization for Standardization (ISO) 15197:2013 (95% of values should be within ± 15 mg/dL of reference reading if reference glucose <100 mg/dL or within ± 15% of reference reading if reference glucose ≥100 mg/dL and 99% of the values should be within zones A and B in consensus error grid), and Surveillance Error Grid for analyzing the accuracy. Results A total of 1223 samples were analyzed. There was a significant difference between the reference method glucose level (135 [Q1-Q3: 97 - 179] mg/dL) and monitor-measured glucose level (188.33 [Q1-Q3: 167.33-209.33] mg/dL) (P < 0.0001). A total of 18.5% of readings were following ISO 15197:2013 criteria and 67.25% of coordinates were within zone A and zone B of the consensus error grid. In the surveillance error grid analysis, about 29.4% of values were in the no-risk zone, 51.8% in slight risk, 18.6% in moderate risk, and 0.2% were in the severe risk zone. Conclusion The accuracy of the InCheck device for the estimation of blood glucose by PPG signal is not following the recommended guidelines. Hence, further research is necessary for programming or redesigning the hardware and software for a better result from this optical sensor-based non-invasive home glucose monitor.
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Affiliation(s)
- Himel Mondal
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Sairavi Kiran Biri
- Department of Biochemistry, Phulo Jhano Medical College, Dumka, Jharkhand, India
| | - Neha Pipil
- Department of Pharmacology, Rajshree Medical Research Institute, Bareilly, Uttar Pradesh, India
| | - Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India
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Lin CW, Tsai YH, Peng YS, Yang JT, Lu YP, Chen MY, Tung CW. A Novel Salivary Sensor with Integrated Au Electrodes and Conductivity Meters for Screening of Diabetes. BIOSENSORS 2023; 13:702. [PMID: 37504101 PMCID: PMC10377178 DOI: 10.3390/bios13070702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
The rise in diabetes cases is a growing concern due to the aging of populations. This not only places a strain on healthcare systems but also creates serious public health problems. Traditional blood tests are currently used to check blood sugar levels, but they are invasive and can discourage patients from regularly monitoring their levels. We recently developed nano-sensing probes that integrate Au microelectrodes and conductivity meters, requiring only 50 μL of saliva for measurement. The usage of the co-planar design of coating-free Au electrodes makes the measurement more stable, precise, and easier. This study found a positive correlation between the participant's fasting blood sugar levels and salivary conductivity. We observed a diabetes prevalence of 11.6% among 395 adults under 65 years in this study, using the glycated hemoglobin > 6.5% definition. This study found significantly higher salivary conductivity in the diabetes group, and also a clear trend of increasing diabetes as conductivity levels rose. The prediction model, using salivary conductivity, age, and body mass index, performed well in diagnosing diabetes, with a ROC curve area of 0.75. The study participants were further divided into low and high groups based on salivary conductivity using the Youden index with a cutoff value of 5.987 ms/cm. Individuals with higher salivary conductivity had a 3.82 times greater risk of diabetes than those with lower levels, as determined by the odds ratio calculation. In conclusion, this portable sensing device for salivary conductivity has the potential to be a screening tool for detecting diabetes.
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Affiliation(s)
- Chen-Wei Lin
- Department of Medical Education, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yun-Shing Peng
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Jen-Tsung Yang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yen-Pei Lu
- National Applied Research Laboratories, Taiwan Instrument Research Institute, Hsinchu 30261, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Chun-Wu Tung
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Chang Gung Medical Education Research Centre, Taoyuan 33302, Taiwan
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi 61363, Taiwan
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Gómez Medina AM, Henao Carrillo DC, León Vargas FM, Jojoa Jojoa RI, Quijano Naranjo JE, Rondón-Sepulveda MA, García Jaramillo MA, Muñoz Velandia OM. Numerical and clinical precision in hypoglycemia of the intermittent FreeStyle Libre glucose monitoring through an NFC-Bluetooth transmitter associated with the xDrip+ algorithm in diabetic patients under insulin therapy. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2023; 70:212-219. [PMID: 36967328 DOI: 10.1016/j.endien.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/11/2022] [Indexed: 04/08/2023]
Abstract
INTRODUCTION There are data capture devices that attach to the FreeStyle Libre sensor and convert its communication from NFC (Near-field communication) to Bluetooth technology, generating real-time continuous glucose monitoring. The accuracy of hypoglycemia measurements displayed by smartphone apps using this device has not been established. METHODS Study of diagnostic tests. Numerical accuracy was evaluated, utilizing the absolute difference with respect to capillary glucometry (ISO 15197:2015 standard) and clinical accuracy, using the Clarke and Parkes (Consensus) error grids, for glucose measurements less than 70mg/dL performed with the FreeStyle Libre system and with the digital estimation xDrip+ app, in diabetic patients managed with insulin therapy. RESULTS Twenty-seven patients were included (TIR 73.4%, TBR70 5.6%), who contributed 83 hypoglycemic events. Numerical accuracy was adequate in similar proportions with the FreeStyle Libre system compared to the xDrip+ app (81.92% vs. 68.67%, p=0.0630). The clinical accuracy evaluation showed that 92.8% of the measurements for xDrip+ and 98.8% for FreeStyle libre met the criteria according to the Parkes (Consensus) grid (p=0.0535); and 79.5% and 91.6% of the measurements met the criteria according to the Clarke grid (p=0.0273), being higher with FreeStyle libre. CONCLUSIONS The use of the NFC-Bluetooth transmitter (Miao-Miao) associated with the xDrip+ app does not improve numerical or clinical accuracy for detecting hypoglycemic events in diabetic patients managed with insulin therapy, compared to the FreeStyle Libre device.
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Affiliation(s)
- Ana María Gómez Medina
- Unidad de endocrinología, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | | | | | | | | | - Oscar Mauricio Muñoz Velandia
- Departamento de Medicina Interna, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
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Gómez Medina AM, Henao Carrillo DC, León Vargas FM, Jojoa Jojoa RI, Quijano Naranjo JE, Rondón-Sepulveda MA, García Jaramillo MA, Muñoz Velandia OM. Precisión numérica y clínica en hipoglucemia de la monitorización intermitente de glucosa FreeStyle Libre a través de un transmisor NFC-Bluetooth asociado al algoritmo xDrip+ en pacientes diabéticos en insulinoterapia. ENDOCRINOL DIAB NUTR 2023. [DOI: 10.1016/j.endinu.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Papaioannou TG, Sanoudou D, Tsioufis C. Continuous glucose monitoring and hypoglycaemia events: unmet needs. Diabetologia 2022; 65:1569-1570. [PMID: 35736992 DOI: 10.1007/s00125-022-05739-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Theodore G Papaioannou
- First Department of Cardiology, 'Hippokration' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Despina Sanoudou
- Clinical Genomics and Pharmacogenomics Unit, 4th Department of Internal Medicine, 'Attikon' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Center for New Biotechnologies and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Molecular Biology Division, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Nowak C, Lind M, Sumnik Z, Pelikanova T, Nattero-Chavez L, Lundberg E, Rica I, Martínez-Brocca MA, Ruiz de Adana M, Wahlberg J, Hanas R, Hernandez C, Clemente-León M, Gómez-Gila A, Ferrer Lozano M, Sas T, Pruhova S, Dietrich F, Puente-Marin S, Hannelius U, Casas R, Ludvigsson J. Intralymphatic GAD-Alum (Diamyd®) Improves Glycemic Control in Type 1 Diabetes With HLA DR3-DQ2. J Clin Endocrinol Metab 2022; 107:2644-2651. [PMID: 35665810 PMCID: PMC9721339 DOI: 10.1210/clinem/dgac343] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Indexed: 01/07/2023]
Abstract
AIMS Residual beta cell function in type 1 diabetes (T1D) is associated with lower risk of complications. Autoantigen therapy with GAD-alum (Diamyd) given in 3 intralymphatic injections with oral vitamin D has shown promising results in persons with T1D carrying the human leukocyte antigen (HLA) DR3-DQ2 haplotype in the phase 2b trial DIAGNODE-2. We aimed to explore the efficacy of intralymphatic GAD-alum on blood glucose recorded by continuous glucose monitoring (CGM). METHODS DIAGNODE-2 (NCT03345004) was a multicenter, randomized, placebo-controlled, double-blind trial of 109 recent-onset T1D patients aged 12 to 24 years with GAD65 antibodies and fasting C-peptide > 0.12 nmol/L, which randomized patients to 3 intralymphatic injections of 4 μg GAD-alum and oral vitamin D, or placebo. We report results for exploratory endpoints assessed by 14-day CGM at months 0, 6, and 15. Treatment arms were compared by mixed-effects models for repeated measures adjusting for baseline values. RESULTS We included 98 patients with CGM recordings of sufficient quality (DR3-DQ2-positive patients: 27 GAD-alum-treated and 15 placebo-treated). In DR3-DQ2-positive patients, percent of time in range (TIR, 3.9-10 mmol/L) declined less between baseline and month 15 in GAD-alum-treated compared with placebo-treated patients (-5.1% and -16.7%, respectively; P = 0.0075), with reduced time > 13.9 mmol/L (P = 0.0036), and significant benefits on the glucose management indicator (P = 0.0025). No differences were detected for hypoglycemia. GAD-alum compared to placebo lowered the increase in glycemic variability (standard deviation) observed in both groups (P = 0.0219). Change in C-peptide was correlated with the change in TIR. CONCLUSIONS Intralymphatic GAD-alum improves glycemic control in recently diagnosed T1D patients carrying HLA DR3-DQ2.
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Affiliation(s)
- Christoph Nowak
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden
- Diamyd Medical AB, 11135 Stockholm, Sweden
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, University of Gothenburg, 41345 Gothenburg, Sweden, Sahlgrenska University Hospital, Gothenburg and NU-Hospital Group, S41553, Uddevalla, Sweden
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15000 Prague, Czech Republic
| | - Terezie Pelikanova
- Diabetes Centre of the Institute of Clinical and Experimental Medicine, 14000 Prague, Czech Republic
| | - Lía Nattero-Chavez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Elena Lundberg
- Institution of Clinical Science, Department of Pediatrics, Umeå University, Norrland University Hospital, 93451 Umeå, Sweden
| | - Itxaso Rica
- Department of Pediatric Endocrinology, Cruces University Hospital, 48902 Bilbao, Ciberdem, Spain
| | - Maria A Martínez-Brocca
- Department of Endocrinology, Virgen Macarena Hospital, Department of Endocrinology and Nutrition, Virgen Macarena University Hospital, 41009 Sevilla, Spain
| | - MariSol Ruiz de Adana
- Diabetes Unit, Department of Endocrinology and Nutrition, Ibima, Ciberdem, General University Hospital, 29010 Malaga, Spain
| | - Jeanette Wahlberg
- Department of Endocrinology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
- Department of Internal Medicine, School of Health and Medical Sciences, Örebro University, 70281 Örebro, Sweden
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, 45153 Uddevalla, Sweden
| | - Cristina Hernandez
- Department of Endocrinology and Nutrition, Vall d’Hebron Hospital, 08035 Barcelona, Ciberdem, Spain
| | - Maria Clemente-León
- Department of Endocrinology, Pediatric Service, Vall d’Hebron Hospital, 08035 Barcelona, CibererSpain
| | - Ana Gómez-Gila
- Pediatric Endocrinology Service, Virgen del Rocío University Hospital, 41013 Sevilla, Spain
| | - Marta Ferrer Lozano
- Department of Pediatric Endocrinology, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Theo Sas
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, and Department of Pediatric Endocrinology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Stepanka Pruhova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15000 Prague, Czech Republic
| | - Fabricia Dietrich
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, 58183 Linköping, Sweden
| | - Sara Puente-Marin
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, 58183 Linköping, Sweden
| | | | - Rosaura Casas
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences and Crown Princess Victoria Children´s Hospital, Linköping University, 58183 Linköping, Sweden
| | - Johnny Ludvigsson
- Correspondence: Johnny Ludvigsson, MD, PhD, Professor of Pediatrics, Division of Pediatrics, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, and Crown Princess Victoria Children’s Hospital, Linköping University, SE-58185 Linköping, Sweden.
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Zhao J, Lu S, Bastos-Arrieta J, Palet C, Sun Y, Wang R, Qian Z, Fan S. Enhanced terahertz sensitivity for glucose detection with a hydrogel platform embedded with Au nanoparticles. BIOMEDICAL OPTICS EXPRESS 2022; 13:4021-4031. [PMID: 35991910 PMCID: PMC9352292 DOI: 10.1364/boe.461414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
We presented a strategy for enhancing the sensitivity of terahertz glucose sensing with a hydrogel platform pre-embedded with Au nanoparticles. Physiological-level glucose solutions ranging from 0 to 0.8 mg/mL were measured and the extracted absorption coefficients can be clearly distinguished compared to traditional terahertz time domain spectroscopy performed directly on aqueous solutions. Further, Isotherm models were applied to successfully describe the relationship between the absorption coefficient and the glucose concentration (R2 = 0.9977). Finally, the origin of the sensitivity enhancement was investigated and verified to be the pH change induced by the catalysis of Au nanoparticles to glucose oxidation.
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Affiliation(s)
- Jingjing Zhao
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Physics and Optoelectronic Engineering, Shenzhen University, 518060, China
- Contributed equally to this work
| | - Shaohua Lu
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Physics and Optoelectronic Engineering, Shenzhen University, 518060, China
- Contributed equally to this work
| | - Julio Bastos-Arrieta
- Department of Chemical Engineering and Analytical Chemistry, University of Barcelona, Martí i Franquès 1-11, 08028 Barcelona, Spain
- Institut de Recerca de l’Aigua (IdRA), University of Barcelona, 08028 Barcelona, Spain
| | - Cristina Palet
- Group of Separation Techniques in Chemistry, Department of Chemistry, Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalunya, Spain
| | - Yiling Sun
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Physics and Optoelectronic Engineering, Shenzhen University, 518060, China
| | - Renheng Wang
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Physics and Optoelectronic Engineering, Shenzhen University, 518060, China
| | - Zhengfang Qian
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Physics and Optoelectronic Engineering, Shenzhen University, 518060, China
| | - Shuting Fan
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Physics and Optoelectronic Engineering, Shenzhen University, 518060, China
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Corcione E, Pfezer D, Hentschel M, Giessen H, Tarín C. Machine Learning Methods of Regression for Plasmonic Nanoantenna Glucose Sensing. SENSORS (BASEL, SWITZERLAND) 2021; 22:s22010007. [PMID: 35009555 PMCID: PMC8747440 DOI: 10.3390/s22010007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 05/11/2023]
Abstract
The measurement and quantification of glucose concentrations is a field of major interest, whether motivated by potential clinical applications or as a prime example of biosensing in basic research. In recent years, optical sensing methods have emerged as promising glucose measurement techniques in the literature, with surface-enhanced infrared absorption (SEIRA) spectroscopy combining the sensitivity of plasmonic systems and the specificity of standard infrared spectroscopy. The challenge addressed in this paper is to determine the best method to estimate the glucose concentration in aqueous solutions in the presence of fructose from the measured reflectance spectra. This is referred to as the inverse problem of sensing and usually solved via linear regression. Here, instead, several advanced machine learning regression algorithms are proposed and compared, while the sensor data are subject to a pre-processing routine aiming to isolate key patterns from which to extract the relevant information. The most accurate and reliable predictions were finally made by a Gaussian process regression model which improves by more than 60% on previous approaches. Our findings give insight into the applicability of machine learning methods of regression for sensor calibration and explore the limitations of SEIRA glucose sensing.
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Affiliation(s)
- Emilio Corcione
- Research Center SCoPE, Institute for System Dynamics, University of Stuttgart, 70563 Stuttgart, Germany;
- Correspondence:
| | - Diana Pfezer
- Research Center SCoPE, 4th Physics Institute, University of Stuttgart, 70569 Stuttgart, Germany; (D.P.); (M.H.); (H.G.)
| | - Mario Hentschel
- Research Center SCoPE, 4th Physics Institute, University of Stuttgart, 70569 Stuttgart, Germany; (D.P.); (M.H.); (H.G.)
| | - Harald Giessen
- Research Center SCoPE, 4th Physics Institute, University of Stuttgart, 70569 Stuttgart, Germany; (D.P.); (M.H.); (H.G.)
| | - Cristina Tarín
- Research Center SCoPE, Institute for System Dynamics, University of Stuttgart, 70563 Stuttgart, Germany;
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Selvin E. Hemoglobin A 1c-Using Epidemiology to Guide Medical Practice: Kelly West Award Lecture 2020. Diabetes Care 2021; 44:dci210035. [PMID: 34548283 PMCID: PMC8929182 DOI: 10.2337/dci21-0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 02/03/2023]
Abstract
The discovery that HbA1c was a valid and reliable measure of average glucose exposure was one of the most important advances in diabetes care. HbA1c was rapidly adopted for monitoring glucose control and is now recommended for the diagnosis of diabetes. HbA1c has several advantages over glucose. Glucose assessment requires fasting, has poor preanalytic stability, and is not standardized; concentrations are acutely altered by a number of factors; and measurement can vary depending on sample type (e.g., plasma or whole blood) and source (e.g., capillary, venous, interstitial). HbA1c does not require fasting, reflects chronic exposure to glucose over the past 2-3 months, and has low within-person variability, and assays are well standardized. One reason HbA1c is widely accepted as a prognostic and diagnostic biomarker is that epidemiologic studies have demonstrated robust links between HbA1c and complications, with stronger associations than those observed for usual measures of glucose. Clinical trials have also demonstrated that lowering HbA1c slows or prevents the development of microvascular disease. As with all laboratory tests, there are some clinical situations in which HbA1c is unreliable (e.g., certain hemoglobin variants, alterations in red blood cell turnover). Recent studies demonstrate that fructosamine and glycated albumin may be substituted as measures of hyperglycemia in these settings. Other approaches to monitoring glucose have recently been introduced, including continuous glucose monitoring, although this technology relies on interstitial glucose and epidemiologic evidence supporting its routine use has not yet been established for most clinical settings. In summary, a large body of epidemiologic evidence has convincingly established HbA1c as a cornerstone of modern diabetes care.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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