scholarly journals Impact of free-living pattern of sedentary behaviour on intra-day glucose regulation in type 2 diabetes

2019 ◽  
Vol 120 (1) ◽  
pp. 171-179 ◽  
Author(s):  
Aye C. Paing ◽  
Kathryn A. McMillan ◽  
Alison F. Kirk ◽  
Andrew Collier ◽  
Allan Hewitt ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Sedentary Behaviour ◽  
Sedentary Time ◽  
Glucose Monitoring ◽  
Glucose Regulation ◽  
Dawn Phenomenon ◽  
Freestyle Libre ◽  
Breaks In Sedentary Time ◽  
Target Glucose

Abstract Purpose To investigate how the pattern of sedentary behaviour affects intra-day glucose regulation in type 2 diabetes. Methods This intensive longitudinal study was conducted in 37 participants with type 2 diabetes (age, 62.8 ± 10.5 years). Glucose and sedentary behaviour/physical activity were assessed with a continuous glucose monitoring (Abbott FreeStyle Libre) and an activity monitor (activPAL3) for 14 days. Multiple regression models with generalised estimating equations (GEEs) approach were used to assess the associations of sedentary time and breaks in sedentary time with pre-breakfast glucose, pre-lunch glucose, pre-dinner glucose, post-breakfast glucose, post-lunch glucose, post-dinner glucose, bedtime glucose, the dawn phenomenon, time in target glucose range (TIR, glucose 3.9–10 mmol/L) and time above target glucose range (TAR, glucose > 10 mmol/L). Results Sedentary time was associated with higher pre-breakfast glucose (p = 0.001), pre-dinner glucose (p < 0.001), post-lunch glucose (p = 0.005), post-dinner glucose (p = 0.013) and the dawn phenomenon (p < 0.001). Breaks in sedentary time were associated with lower pre-breakfast glucose (p = 0.023), pre-dinner glucose (p = 0.023), post-breakfast glucose (p < 0.001) and the dawn phenomenon (p = 0.004). The association between sedentary time and less TIR (p = 0.022) and the association between breaks in sedentary time and more TIR (p = 0.001) were also observed. Conclusions Reducing sedentary time and promoting breaks in sedentary time could be clinically relevant to improve intra-day glucose regulation in type 2 diabetes.

scholarly journals Glucose Regulation Beyond HbA1c in Type 2 Diabetes Treated With Insulin: Real-World Evidence From the DIALECT-2 Cohort

2021 ◽  
Author(s):  
Niala den Braber ◽  
Miriam M.R. Vollenbroek-Hutten ◽  
Kathryn M. Westerik ◽  
Stephan J.L. Bakker ◽  
Gerjan Navis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Glucose Regulation ◽  
Nocturnal Hypoglycemia ◽  
Real World Evidence ◽  
Freestyle Libre ◽  
Time In Range ◽  
Design And Methods

OBJECTIVE To investigate glucose variations associated with HbA<sub>1c</sub> in insulin treated patients with type 2 diabetes. <p>RESEARCH DESIGN AND METHODS Patients included in the Diabetes and Lifestyle Cohort Twente (DIALECT)-2 (n=79) were categorized in three HbA<sub>1c</sub> categories: low, intermediate and high (≤ 53; 54–62 and ≥ 63 mmol/mol or ≤ 7, 7.1–7.8, ≥ 7.9%). Blood glucose time in range (TIR), time below range (TBR), time above range (TAR), glucose variability parameters, day and night duration and frequency of TBR and TAR episodes were determined by continuous glucose monitoring (CGM), using the FreeStyle Libre sensor and compared between HbA<sub>1c</sub> categories.</p> <p>RESULTS <a>CGM was performed for a median [interquartile range] of 10 [7-12] days/ patient. </a>TIR was not different for low and intermediate HbA<sub>1c</sub> categories:<sub> </sub>(76.8% [68.3–88.2] vs 76.0% [72.5.0–80.1]), whereas in the low category<sub> </sub>TBR was higher and TAR lower (7.7% [2.4–19.1] vs 0.7% [0.3–6.1], and 8.2% [5.7–17.6] vs 20.4% [11.6–27.0], respectively, <i>p </i>< 0.05). Patients in the highest HbA<sub>1c </sub>category had lower TIR (52.7% [40.9–67.3]) and higher TAR (44.1% [27.8–57.0]) than the other HbA<sub>1c </sub>categories (<i>p</i> < 0.05), but did not have less TBR during the night. All patients had more (0.06 ± 0.06/h vs 0.03 ± 0.03/h, <i>p </i>= 0.002) and longer (88.0 [45.0–195.5] vs 53.4 [34.4–82.8] minutes, <i>p </i>< 0.001) TBR episodes during the night than during the day. </p> <p>CONCLUSIONS In this study, a high HbA<sub>1c</sub> did not reduce the occurrence of nocturnal hypoglycemia and low HbA<sub>1c</sub> was not associated with the highest TIR. Optimal personalization of glycemic control requires the use of newer tools, including CGM-derived parameters. <br> </p>

scholarly journals Glucose Regulation Beyond HbA1c in Type 2 Diabetes Treated With Insulin: Real-World Evidence From the DIALECT-2 Cohort

2021 ◽  
Author(s):  
Niala den Braber ◽  
Miriam M.R. Vollenbroek-Hutten ◽  
Kathryn M. Westerik ◽  
Stephan J.L. Bakker ◽  
Gerjan Navis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Glucose Regulation ◽  
Nocturnal Hypoglycemia ◽  
Real World Evidence ◽  
Freestyle Libre ◽  
Time In Range ◽  
Design And Methods

OBJECTIVE To investigate glucose variations associated with HbA<sub>1c</sub> in insulin treated patients with type 2 diabetes. <p>RESEARCH DESIGN AND METHODS Patients included in the Diabetes and Lifestyle Cohort Twente (DIALECT)-2 (n=79) were categorized in three HbA<sub>1c</sub> categories: low, intermediate and high (≤ 53; 54–62 and ≥ 63 mmol/mol or ≤ 7, 7.1–7.8, ≥ 7.9%). Blood glucose time in range (TIR), time below range (TBR), time above range (TAR), glucose variability parameters, day and night duration and frequency of TBR and TAR episodes were determined by continuous glucose monitoring (CGM), using the FreeStyle Libre sensor and compared between HbA<sub>1c</sub> categories.</p> <p>RESULTS <a>CGM was performed for a median [interquartile range] of 10 [7-12] days/ patient. </a>TIR was not different for low and intermediate HbA<sub>1c</sub> categories:<sub> </sub>(76.8% [68.3–88.2] vs 76.0% [72.5.0–80.1]), whereas in the low category<sub> </sub>TBR was higher and TAR lower (7.7% [2.4–19.1] vs 0.7% [0.3–6.1], and 8.2% [5.7–17.6] vs 20.4% [11.6–27.0], respectively, <i>p </i>< 0.05). Patients in the highest HbA<sub>1c </sub>category had lower TIR (52.7% [40.9–67.3]) and higher TAR (44.1% [27.8–57.0]) than the other HbA<sub>1c </sub>categories (<i>p</i> < 0.05), but did not have less TBR during the night. All patients had more (0.06 ± 0.06/h vs 0.03 ± 0.03/h, <i>p </i>= 0.002) and longer (88.0 [45.0–195.5] vs 53.4 [34.4–82.8] minutes, <i>p </i>< 0.001) TBR episodes during the night than during the day. </p> <p>CONCLUSIONS In this study, a high HbA<sub>1c</sub> did not reduce the occurrence of nocturnal hypoglycemia and low HbA<sub>1c</sub> was not associated with the highest TIR. Optimal personalization of glycemic control requires the use of newer tools, including CGM-derived parameters. <br> </p>

scholarly journals A review of flash glucose monitoring in type 2 diabetes

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Marcio Krakauer ◽  
Jose Fernando Botero ◽  
Fernando J. Lavalle-González ◽  
Adrian Proietti ◽  
Douglas Eugenio Barbieri
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Real World ◽  
Glucose Monitoring ◽  
Well Being ◽  
Main Body ◽  
Flash Glucose Monitoring ◽  
Glucose Levels ◽  
Freestyle Libre

Abstract Background Continuous glucose monitoring systems are increasingly being adopted as an alternative to self-monitoring of blood glucose (SMBG) by persons with diabetes mellitus receiving insulin therapy. Main body The FreeStyle Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, United Kingdom) consists of a factory-calibrated sensor worn on the back of the arm which measures glucose levels in the interstitial fluid every minute and stores the reading automatically every 15 min. Swiping the reader device over the sensor retrieves stored data and displays current interstitial glucose levels, a glucose trend arrow, and a graph of glucose readings over the preceding 8 h. In patients with type 2 diabetes (T2D) receiving insulin therapy, pivotal efficacy data were provided by the 6-month REPLACE randomized controlled trial (RCT) and 6-month extension study. Compared to SMBG, the flash system significantly reduced the time spent in hypoglycemia and frequency of hypoglycemic events, although no significant change was observed in glycosylated hemoglobin (HbA1c) levels. Subsequent RCTs and real-world chart review studies have since shown that flash glucose monitoring significantly reduces HbA1c from baseline. Real-world studies in both type 1 diabetes or T2D populations also showed that flash glucose monitoring improved glycemic control. Higher (versus lower) scanning frequency was associated with significantly greater reductions in HbA1c and significant improvements in other measures such as time spent in hypoglycemia, time spent in hyperglycemia, and time in range. Additional benefits associated with flash glucose monitoring versus SMBG include reductions in acute diabetes events, all-cause hospitalizations and hospitalized ketoacidosis episodes; improved well-being and decreased disease burden; and greater treatment satisfaction. Conclusion T2D patients who use flash glucose monitoring might expect to achieve significant improvement in HbA1c and glycemic parameters and several associated benefits.

68-LB: Acute Diabetes Events and All-Cause Hospitalizations among Continuous Glucose Monitoring Device Recipients with Type 1 and Type 2 Diabetes: A Comparison of FreeStyle Libre and Dexcom

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 68-LB
Author(s):  
IRL B. HIRSCH ◽  
GREGORY J. ROBERTS ◽  
JENNIFER JOSEPH ◽  
YELENA NABUTOVSKY ◽  
NAUNIHAL VIRDI ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Monitoring Device ◽  
Freestyle Libre ◽  
Acute Diabetes

scholarly journals Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes

Diabetologia ◽  
2011 ◽  
Vol 55 (3) ◽  
pp. 589-599 ◽  
Author(s):  
A. R. Cooper ◽  
S. Sebire ◽  
A. A. Montgomery ◽  
T. J. Peters ◽  
D. J. Sharp ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Sedentary Time ◽  
Newly Diagnosed ◽  
Metabolic Variables ◽  
Breaks In Sedentary Time

scholarly journals Integration of Flash Glucose Monitoring During the Transition of Care From Inpatient to Outpatient Settings in Patients With Type 2 Diabetes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A427-A428
Author(s):  
Radhika Jaiswal ◽  
Meng Zhang ◽  
Sharon Zuniga ◽  
Alyson K Myers
Keyword(s):  
Type 2 Diabetes ◽  
Hospital Discharge ◽  
Mobile Application ◽  
Glucose Monitoring ◽  
Outpatient Setting ◽  
Transition Of Care ◽  
Freestyle Libre ◽  
The Mean ◽  
Outpatient Settings

Abstract Background: The use of continuous glucose monitoring (CGM) technology in the outpatient setting has been associated with both improved patient satisfaction1 and increased glucose monitoring2. It remains to be seen, how well this technology can be integrated during the transition from hospital discharge to outpatient settings. Here, we aim to assess the feasibility of introducing the FreeStyle Libre during the transition of care from inpatient to the outpatient environment in patients with Type 2 diabetes (T2D). We will assess CGM use as measured by the numbers of days used and frequency of daily scans. Methods: During the time period April and September 2020, 20 patients with T2D being discharged on multiple daily injections admitted to North Shore University Hospital were enrolled in this study. Exclusion criteria were those with adhesive allergy, CKD 4/5 or on dialysis and pregnant women. Participants were trained on how to use the FreeStyle Libre with the LibreLink mobile application. All patients received 2 Libre sensors at the time of discharge, one that was placed in the hospital and the other to be placed after 14 days. 1 participant died prior to discharge. Analyses included descriptive statistics, specifically categorical variables using frequencies and percentages while continuous variables using mean and standard deviation. Results: Among who used the mobile application, 10 were men and 9 were women. Majority of patients were Black (n=11, 57.9%) with a mean age of 52 years (range 31–76). The mean duration of diabetes was 9.7 years (range: 0 to 22) and mean Hemoglobin A1c of 11.2% (range: 5.5–15.5). 10 out of 19 persons used CGM for more than 2 weeks, while the remaining 9 utilized the CGM for less than 2 weeks. Mean average daily scans were 5 times per day (range: 1–12) with majority of the persons (n=15, 78.9%) scanning more frequently (3 or more times per day). The average glucose ranged from 62 to 268 mg/dl and the mean active CGM time was 52.05% (range 0–98). Mean glycemic variability was 29.17% (range: 14.5–56.7). Technical issues with the CGM included poor adhesion or issues connecting to the mobile application. Conclusion: Our study found that the initiation of CGM during the transition from hospital discharge to the outpatient setting is feasible and a useful tool. A limitation of this study was the inability for all people to use the mobile application due to incompatible phones or operating systems. References: 1. Beck RW, Riddlesworth TD, Ruedy K, et al. Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections. Ann Intern Med. 2017;167(6):365–374. doi:10.7326/M16-2855. 2. Shehav-Zaltzman G, Segal G, Konvalina N, Tirosh A. Remote Glucose Monitoring of Hospitalized, Quarantined Patients With Diabetes and COVID-19. Diabetes Care. 2020;43(7):e75-e76. doi:10.2337/dc20-0696.

scholarly journals Dose-response between frequency of interruption of sedentary time and fasting glucose, the dawn phenomenon and night-time glucose in Type 2 diabetes

2018 ◽  
Vol 36 (3) ◽  
pp. 376-382 ◽  
Author(s):  
A. C. Paing ◽  
K. A. McMillan ◽  
A. F. Kirk ◽  
A. Collier ◽  
A. Hewitt ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Dose Response ◽  
Sedentary Time ◽  
Fasting Glucose ◽  
Night Time ◽  
Dawn Phenomenon

scholarly journals The associations of sedentary time and breaks in sedentary time with 24-hour glycaemic control in type 2 diabetes

2018 ◽  
Vol 12 ◽  
pp. 94-100 ◽  
Author(s):  
Aye C. Paing ◽  
Kathryn A. McMillan ◽  
Alison F. Kirk ◽  
Andrew Collier ◽  
Allan Hewitt ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Sedentary Time ◽  
Breaks In Sedentary Time
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