Treatment of Mild Hypoglycemia

Enhancing the Capabilities of Continuous Glucose Monitoring With a Predictive App

BACKGROUND

Despite abundant evidence demonstrating the benefits of continuous glucose monitoring (CGM) in diabetes management, a significant proportion of people using this technology still struggle to achieve glycemic targets. To address this challenge, we propose the Accu-Chek® SmartGuide Predict app, an innovative CGM digital companion that incorporates a suite of advanced glucose predictive functionalities aiming to inform users earlier about acute glycemic situations.

METHODS

The app's functionalities, powered by three machine learning models, include a two-hour glucose forecast, a 30-minute low glucose detection, and a nighttime low glucose prediction for bedtime interventions. Evaluation of the models' performance included three data sets, comprising subjects with T1D on MDI (n = 21), subjects with type 2 diabetes (T2D) on MDI (n = 59), and subjects with T1D on insulin pump therapy (n = 226).

RESULTS

On an aggregated data set, the two-hour glucose prediction model, at a forecasting horizon of 30, 45, 60, and 120 minutes, achieved a percentage of data points in zones A and B of Consensus Error Grid of: 99.8%, 99.3%, 98.7%, and 96.3%, respectively. The 30-minute low glucose prediction model achieved an accuracy, sensitivity, specificity, mean lead time, and area under the receiver operating characteristic curve (ROC AUC) of: 98.9%, 95.2%, 98.9%, 16.2 minutes, and 0.958, respectively. The nighttime low glucose prediction model achieved an accuracy, sensitivity, specificity, and ROC AUC of: 86.5%, 55.3%, 91.6%, and 0.859, respectively.

CONCLUSIONS

The consistency of the performance of the three predictive models when evaluated on different cohorts of subjects with T1D and T2D on different insulin therapies, including real-world data, offers reassurance for real-world efficacy.

American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes

ABSTRACT

The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.

Nutritional management of type 2 diabetes in subjects with obesity: an international guideline for clinical practice

Type 2 diabetes mellitus (T2DM) and obesity represent a global public health problem. Current nutritional recommendations focused on weight loss and overall dietary quality. However, there is no consensus on the optimal macronutrient composition of the diet, particularly for the long-term management of T2DM in subjects with obesity. An international panel of experts reviewed and critically appraised the updated literature published on the topic. This review primarily examines the evidence for areas of consensus and uncertainty about nutritional therapy in patients with T2DM and obesity. The aim of this article is to provide nutritional advice to manage these patients in clinical practice.

Developing the hypoglycemia-nursing early warning score system (Hy-NEWSS): A pilot study

Background: Severe hypoglycemia occurs in 6% of type 2 DM patients with a 6 to 7% mortality rate. Amidst the COVID-19 pandemic, there has been a higher rate of fatality among diabetes patients, at least 22% of COVID-19 deaths in Wuhan, China. Furthermore, the condition impairs physiological defense against recurrent hypoglycemia in the future. Accordingly, the innovation in this study aims to prevent severe hypoglycemia among type 2 patients through early risk screening, the use of preventative protocols, and patient and family empowerment. This intervention bundle is called Hypoglycemia-Nursing Early Warning Score System (Hy-NEWSS).

Design and Methods: The innovation was implemented in inpatient and outpatient settings, within two weeks with the following sequence: i) internal training, ii) Hy-NEWSS implementation, iii) outcomes evaluation.

Results: Of the twenty-eight patients involved in the study, 3 patients (19%) had a high risk of hypoglycemia, while the remaining had a low risk for the condition. However, at the end of the study there was no event of severe hypoglycemia (0%), and only 1 event (6.33%) of mild hypoglycemia. The results also showed that the accuracy of nurses in implementing the protocols was 93% and that during the evaluation, 95.62% of the responses of the nurses from the inpatient and outpatient settings were positive. Finally, the scores of the sensitivity and specificity evaluation were 99% and 88%, respectively.

Conclusion: It may be concluded from this initial study that Hy-NEWSS is effective in preventing severe hypoglycemia, accurate in identifying patient risk level for the condition, and has high applicability to be implemented in hospital settings.

Hypoglycemia in Diabetes Mellitus

Hypoglycemia is a serious acute complication of diabetes treatment. Recognizing the risk factors and taking steps to prevent low blood glucose should be a part of self-management education for all people taking glucose-lowering medications. It is important for home care clinicians to evaluate their patient's understanding of hypoglycemia and the appropriate treatment options.

Use of an Integrated Tool for Interpretation of Blood Glucose Data Improves Correctness of Glycemic Risk Assessment in Individuals With Type 1 and Type 2 Diabetes

BACKGROUND

Manufacturers now incorporate blood glucose (bG) value interpretation tools into their monitoring systems; however, usability of these support tools has not been well studied. We evaluated the utility and perceived benefits of support tool use by individuals with type 1 (T1D) and type 2 diabetes (T2D).

METHODS

This 3-arm, randomized, simulation study assessed the impact of use of bG value interpretation support tools on participants' ability to correctly interpret bG values, using 1 of 3 tools: a new tool that uses colored scales with target range indicator (TRI), Colors and Smiley icons (already available). Participants assessed 50 bG values without use of any tool and repeated the assessment using 1 of the 3 tool configurations. Changes in percentage of correct responses when using a support tool and user perceptions were assessed.

RESULTS

Data sets from 140 participants were analyzed. Increases in correct responses were seen in all study groups but most notably in the TRI group (26%, P < .001) versus the Colors (3%, P = .018) and Smiley icons (6%, P < .001) groups. Significant improvements in confidence were seen among TRI users ( P = .023) but not among other tool users ( P > .627). Most TRI users felt confident (94%), agreed the tool will help them identify high and low values (96%) and will help them to make correct insulin dosage decisions (80%).

CONCLUSIONS

Use of the TRI significantly increases users' ability to correctly and confidently determine their glycemic risk when self-monitoring bG levels. This suggests the tool may offer clinical value to individuals with T1D and T2D.

Brugia malayi soluble and excretory-secretory proteins attenuate development of streptozotocin-induced type 1 diabetes in mice

Understanding the modulation of the host-immune system by pathogens-like filarial parasites offers an alternate approach to prevent autoimmune diseases. In this study, we have shown that treatment with filarial proteins prior to or after the clinical onset of streptozotocin-induced type-1 diabetes (T1D) can ameliorate the severity of disease in BALB/c mice. Pre-treatment with Brugia malayi adult soluble (Bm A S) or microfilarial excretory-secretory (Bm mf ES) or microfilarial soluble (Bm mf S) antigens followed by induction of diabetes led to lowering of fasting blood glucose levels with as many as 57.5-62.5% of mice remaining nondiabetic. These proteins were more effective when they were used to treat the mice with established T1D as 62.5-71.5% of the mice turned to be nondiabetic. Histopathological examination of pancreas of treated mice showed minor inflammatory changes in pancreatic islet cell architecture. The therapeutic effect was found to be associated with the decreased production of cytokines TNF-α & IFN-γ and increased production of IL-10 in the culture supernatants of splenocytes of treated mice. A switch in the production of anti-insulin antibodies from IgG2a to IgG1 isotype was also seen. Together these results provide a proof towards utilizing the filarial derived proteins as novel anti-diabetic therapeutics.

A Review of Insulin for the Treatment of Diabetes Mellitus

Insulin is commonly used in the treatment of diabetes in the home care setting. Understanding the wide variety of insulin preparations available will assist the clinician in guiding people with diabetes and their caregivers through the complexities of self-care and promote safe and optimal glucose control. The purpose of this article is to review the various available insulin preparations and discuss their use in the treatment of diabetes mellitus.

Filarial Abundant Larval Transcript Protein ALT-2: An Immunomodulatory Therapeutic Agent for Type 1 Diabetes

Type 1 diabetes (T1D) that accounts for about 5-10 % of all diabetes cases results from the autoimmune destruction of the insulin-producing beta cells in the pancreas. It is characterized by severe inflammatory reaction mediated by pronounced T helper type-1 response. Parasitic infections having the ability to skew the host immune responses towards type-2 type as a part of their defense mechanism are able to induce protection against autoimmune diseases like T1D. Hence, the present study is undertaken to explore a recombinant abundant larval transcript protein of the human lymphatic filarial parasite Brugia malayi (rBmALT-2), a known anti-inflammatory molecule for its therapeutic effect on streptozotocin (STZ)-induced T1D in mice. The diabetic mice on treatment with rBmALT-2 showed a significant (p < 0.0005) decrease in their fasting blood glucose levels. By the end of the second week after the initiation of treatment with the rBmALT-2, 28 % of the diabetic mice became normal and none of them were diabetic by the end of 5th week. The anti-diabetic effect of rBmALT-2 significantly correlated with the concomitant redressal of the pancreatic histopathological damage caused by STZ assault (rho = 0.87; p < 0.0005). The sera of rBmALT-2 treated diabetic mice had increased levels of IgG1 antibodies associated with decreased IgG2a antibodies against the principal autoantigen insulin. The splenocyte proliferative response and the cytokine release in the treated mice showed marked bias against inflammation skewing the immune response to Th-2 type. From this study, it can be envisaged that that filarial proteins like rBmALT-2 with effective immunomodulatory activity and anti-diabetic effect are promising alternative therapeutic agents for T1D.