A Flexible Microfluidic Chip-Based Universal Fully Integrated Nanoelectronic System with Point-of-Care Raw Sweat, Tears, or Saliva Glucose Monitoring for Potential Noninvasive Glucose Management

Hyperglycemia is common in the intensive care unit (ICU) both in patients with and without a previous diagnosis of diabetes. The optimal glucose range in the ICU population is still a matter of debate. Given the risk of hypoglycemia associated with intensive insulin therapy, current recommendations include treating hyperglycemia after two consecutive glucose >180 mg/dL with target levels of 140-180 mg/dL for most patients. The optimal method of sampling glucose and delivery of insulin in critically ill patients remains elusive. While point of care glucose meters are not consistently accurate and have to be used with caution, continuous glucose monitoring (CGM) is not standard of care, nor is it generally recommended for inpatient use. Intravenous insulin therapy using paper or electronic protocols remains the preferred approach for critically ill patients. The advent of new technologies, such as electronic glucose management, CGM, and closed-loop systems, promises to improve inpatient glycemic control in the critically ill with lower rates of hypoglycemia.

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Glucose as the 5th Vital Sign: A Randomized Controlled Trial of Continuous Glucose Monitoring in a non-ICU Hospital Setting

10.2337/figshare.12691793.v1 ◽

2020 ◽

Author(s):

Addie L. Fortmann ◽

Samantha R Spierling Bagsic ◽

Laura Talavera ◽

Isabel Maria Garcia ◽

Haley Sandoval ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Vital Sign ◽

Point Of Care ◽

Controlled Trial ◽

Glucose Monitoring ◽

Hospital Setting ◽

Current Standard ◽

Randomized Controlled ◽

Glucose Management ◽

Design And Methods

OBJECTIVE: The current standard for hospital glucose management is point-of-care (POC) testing. We conducted a randomized controlled trial comparing real-time CGM (RT-CGM) to POC in a non-ICU hospital setting. RESEARCH DESIGN AND METHODS: N=110 adults with type 2 diabetes (T2D) on a non-ICU floor received RT-CGM with Dexcom G6 vs usual care (UC). RT-CGM data were wirelessly transmitted from the bedside. Hospital telemetry monitored RT-CGM data and notified bedside nursing of glucose alerts and trends. Standardized protocols were used for interventions. RESULTS: The RT-CGM group demonstrated significantly lower mean glucose (M∆= -18.5 mg/dL) and percentage of time in hyperglycemia >250 mg/dL (-11.41%), and higher median TIR 70-250 mg/dL (+11.26%) compared with UC (ps<0.05). Percentage of time in hypoglycemia was very low. CONCLUSION: RT-CGM can be used successfully in community-based hospital non-ICU settings to improve glucose management; continuously streaming glucose readings may truly be the 5th vital sign.

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Nanoplasmonic Strip Test for Salivary Glucose Monitoring

Nanomaterials ◽

10.3390/nano12010105 ◽

2021 ◽

Vol 12 (1) ◽

pp. 105

Author(s):

Helena Torné-Morató ◽

Paolo Donati ◽

Pier Paolo Pompa

Keyword(s):

Recent Progress ◽

Color Change ◽

Point Of Care ◽

Glucose Monitoring ◽

Quantitative Detection ◽

Self Monitoring ◽

Fully Integrated ◽

Red Color ◽

Whole Saliva ◽

Strip Test

Nowadays, there is an increasing interest in Point-of-care (POC) devices for the noninvasive glucose assessment. Despite the recent progress in glucose self-monitoring, commercially available devices still use invasive samples such as blood or interstitial fluids, and they are not equipment-free and affordable for the whole population. Here, we report a fully integrated strip test for the semi-quantitative detection of glucose in whole saliva. The colorimetric mechanism consists of an enzyme-mediated reshaping of multibranched gold nanoparticles (MGNPs) into nanospheres with an associated plasmonic shift and consequent blue-to-red color change, clearly detectable in less than 10 min.

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Glucose as the 5th Vital Sign: A Randomized Controlled Trial of Continuous Glucose Monitoring in a non-ICU Hospital Setting

10.2337/figshare.12691793 ◽

2020 ◽

Author(s):

Addie L. Fortmann ◽

Samantha R Spierling Bagsic ◽

Laura Talavera ◽

Isabel Maria Garcia ◽

Haley Sandoval ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Vital Sign ◽

Point Of Care ◽

Controlled Trial ◽

Glucose Monitoring ◽

Hospital Setting ◽

Current Standard ◽

Randomized Controlled ◽

Glucose Management ◽

Design And Methods

OBJECTIVE: The current standard for hospital glucose management is point-of-care (POC) testing. We conducted a randomized controlled trial comparing real-time CGM (RT-CGM) to POC in a non-ICU hospital setting. RESEARCH DESIGN AND METHODS: N=110 adults with type 2 diabetes (T2D) on a non-ICU floor received RT-CGM with Dexcom G6 vs usual care (UC). RT-CGM data were wirelessly transmitted from the bedside. Hospital telemetry monitored RT-CGM data and notified bedside nursing of glucose alerts and trends. Standardized protocols were used for interventions. RESULTS: The RT-CGM group demonstrated significantly lower mean glucose (M∆= -18.5 mg/dL) and percentage of time in hyperglycemia >250 mg/dL (-11.41%), and higher median TIR 70-250 mg/dL (+11.26%) compared with UC (ps<0.05). Percentage of time in hypoglycemia was very low. CONCLUSION: RT-CGM can be used successfully in community-based hospital non-ICU settings to improve glucose management; continuously streaming glucose readings may truly be the 5th vital sign.

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Hand-Held Zoom Micro-Imaging System Based on Microfluidic Chip for Point-of-Care Testing (POCT) of Vaginal Inflammation

IEEE Journal of Translational Engineering in Health and Medicine ◽

10.1109/jtehm.2021.3054556 ◽

2021 ◽

Vol 9 ◽

pp. 1-9

Author(s):

Ning Yang ◽

Jingxin Peng ◽

Liang Wu ◽

Xue Han ◽

Naila Shaheen ◽

...

Keyword(s):

Microfluidic Chip ◽

Imaging System ◽

Point Of Care ◽

Point Of Care Testing

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Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

Journal of Diabetes Science and Technology ◽

10.1177/1932296821998724 ◽

2021 ◽

pp. 193229682199872

Author(s):

Gregg D. Simonson ◽

Richard M. Bergenstal ◽

Mary L. Johnson ◽

Janet L. Davidson ◽

Thomas W. Martens

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Glucose Monitoring ◽

Care Model ◽

Time In Range ◽

Glucose Management ◽

The Impact ◽

Primary Care Management

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

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