Examining the Relationship Between Pre- and Postprandial Glucose Levels and Insulin Bolus Timing Using Bluetooth-Enabled Insulin Pen Cap Technology and Continuous Glucose Monitoring

2020 ◽  
Vol 22 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Elena Toschi ◽  
Christine Slyne ◽  
Jordan M. Greenberg ◽  
Tori Greaves ◽  
Astrid Atakov-Castillo ◽  
...  
2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Rengna Yan ◽  
Yun Hu ◽  
Fengfei Li ◽  
Lanlan Jiang ◽  
Xiaohua Xu ◽  
...  

Aim. To clarify the contributions of fasting glucose (FG) and postprandial glucose (PG) to HbA1c in drug-naïve patients with type 2 diabetes (T2D) and impaired glucose tolerate (IGT)/impaired fasting glucose (IFG). Methods. Continuous glucose monitoring (CGM) was performed in 305 drug-naïve Chinese patients with T2D or IGT/IFG. The incremental area under the curve (AUC) above a glucose value of 6.1 mmol/L or FG glucose levels were calculated to evaluate the contributions of PG or FG to HbA1c values. Results. According to quintiles of HbA1c, T2D patients were divided into five groups (group 1 to 5), and patients with IGT/IFG were assigned into group 0. PG was the predominant contributor in the lower groups with HbA1c 4.9∼6.0% and 6.1∼7.8%. The relative contributions of FG and PG to HbA1c had no significance in the middle groups of HbA1c (7.9∼8.7% and 8.8∼9.5%). FG contributed significantly more than PG in the higher groups of HbA1c (9.6∼10.9% and 11.0∼14.6%). Regression analyses indicate that the contributions of FG and PG were equal (both 50%) when the level of HbA1c was 8.5%. Conclusions. In drug-naïve patients with T2D or IGT/IFG, PG contributed more in patients with HbA1c < 8.5%, whereas FG became the predominant contributor in the poorly controlled patients with HbA1c ≥ 8.5%. These results may help the health-care provider set appropriate plasma glucose testing goals with the expectation of achieving specific HbA1c values.


2021 ◽  
Vol 24 (3) ◽  
pp. 334-347
Author(s):  
Fateme Dehghani Yunarti1 ◽  
◽  
Vazgen Minasian ◽  

Background and Aim: This study aimed to investigate the effect of exercise timing on elevated postprandial glucose and after brief interval exercises in women with obesity. Methods & Materials: Ten women with obesity (Mean±SD age = 40.41±3.97 years; weight = 86.66±7.26 kg; and BMI = 33.22±2.20 kg/m2) participated in a crossover design exercise intervention: 1) postprandial aerobic exercise, 2) pre-prandial aerobic exercise, 3) brief periodic exercise, and 4) control. Pre- and postprandial exercise included 30 min of moderate-intensity walking on the treadmill before and after each main meal (1 minute of exercise -30 seconds rest). The brief periodic exercise had three one-minute reps of activity every 30 min for 20 times during the day. Twelve-hour continuous glucose monitoring and two-hour postprandial glucose levels were calculated to examine changes in blood glucose levels. Ethical Considerations: This study was approved by the institutional review board of the University of Isfahan (Ethics Code: IR.UI.REC.1397.119) and conducted in agreement with the ethical principles for biomedical research involving human subjects outlined in the declaration of Helsinki. Results: The findings of this study suggested that brief periodic exercise resulted in a significant decrease in continuous glucose monitoring levels and postprandial glucose compared to the control group as well as pre-prandial exercise (P˂0.05). However, pre- and postprandial exercise did not result in significant changes in continuous glucose monitoring (P˃0.05). In addition, postprandial exercise led to a significant decrease in postprandial glucose compared to the control group (P˂0.05). Conclusion: It seems that brief periodic exercise can have more beneficial effects on postprandial glucose levels, probably due to improved glucose metabolism in skeletal muscle.


Author(s):  
Christine L Chan ◽  
Laura Pyle ◽  
Tim Vigers ◽  
Philip S Zeitler ◽  
Kristen J Nadeau

Abstract Context Early glucose abnormalities in people with CF (PwCF) are commonly detected by continuous glucose monitoring (CGM). Relationships between these CGM abnormalities and oral glucose tolerance testing (OGTT) in PwCF have not been fully characterized. Objective(s) 1) To determine the relationship between CGM and common OGTT-derived estimates of β-cell function, including C-peptide index and oral disposition index (oDI) and 2) to explore whether CGM can be used to screen for OGTT-defined prediabetes and cystic fibrosis related diabetes (CFRD). Study Design/Methods PwCF not on insulin and healthy controls ages 6-25 yrs were enrolled in a prospective study collecting OGTT and CGM. A subset underwent frequently-sampled OGTTs (fsOGTT) with 7-point glucose, insulin, and C-peptide measurements. Pearson’s correlation coefficient was used to test the association between select CGM and fsOGTT measures. ROC analysis was applied to CGM variables to determine the cutoff optimizing sensitivity and specificity for detecting prediabetes and CFRD. Results A total of 120 participants (controls=35, CF=85), including 69 with fsOGTTs, were included. CGM coefficient of variation correlated inversely with C-peptide index (Cpeptide30-Cpeptide0/Glucose30-Glucose0) (r=-0.45, p&lt;0.001) and oDIcpeptide (C-peptide index)(1/cpep0) (r=-0.48, p&lt;0.0001). In PwCF, CGM variables had ROC-AUCs ranging from 0.43-0.57 for prediabetes and 0.47-0.6 for CFRD. Conclusions Greater glycemic variability on CGM correlated with reduced β-cell function. However, CGM performed poorly at discriminating individuals with and without OGTT-defined CFRD and prediabetes. Prospective studies are now needed to determine how well the different tests predict clinically-relevant non-glycemic outcomes in PwCF.


Author(s):  
Henri Honka ◽  
Janet Chuang ◽  
David D’Alessio ◽  
Marzieh Salehi

Abstract Context Gastric bypass (GB) increases postprandial glucose excursion, which in turn can predispose to the late complication of hypoglycemia. Diagnosis remains challenging and requires documentation of symptoms associated with low glucose, and relief of symptom when glucose is normalized (Whipple’s triad). Objective To compare the yield of mixed meal test (MMT) and continuous glucose monitoring system (CGMS) in detecting hypoglycemia after gastric bypass surgery (GB). Setting The study was conducted at General Clinical Research Unit, Cincinnati Children’s Hospital (Cincinnati, OH, United States). Methods Glucose profiles were evaluated in 15 patients with documented recurrent clinical hypoglycemia after GB, 8 matched asymptomatic GB subjects, and 9 healthy weight-matched non-operated controls using MMT in a control setting and CGMS under free-living conditions. Results Patients with prior GB had larger glucose variability during both MMT and CGMS when compared to non-surgical controls regardless of their hypoglycemic status. Sensitivity (71 vs. 47 %) and specificity (100 vs. 88 %) of MMT in detecting hypoglycemia was superior to CGMS. Conclusions Our findings indicate that a fixed carbohydrate ingestion during MMT is a more reliable test to diagnose GB-related hypoglycemia compared to CGMS during free-living state.


2019 ◽  
Vol 104 (10) ◽  
pp. 4356-4364 ◽  
Author(s):  
Viral N Shah ◽  
Stephanie N DuBose ◽  
Zoey Li ◽  
Roy W Beck ◽  
Anne L Peters ◽  
...  

Abstract Context Use of continuous glucose monitoring (CGM) is increasing for insulin-requiring patients with diabetes. Although data on glycemic profiles of healthy, nondiabetic individuals exist for older sensors, assessment of glycemic metrics with new-generation CGM devices is lacking. Objective To establish reference sensor glucose ranges in healthy, nondiabetic individuals across different age groups using a current generation CGM sensor. Design Multicenter, prospective study. Setting Twelve centers within the T1D Exchange Clinic Network. Patients or Participants Nonpregnant, healthy, nondiabetic children and adults (age ≥6 years) with nonobese body mass index. Intervention Each participant wore a blinded Dexcom G6 CGM, with once-daily calibration, for up to 10 days. Main Outcome Measures CGM metrics of mean glucose, hyperglycemia, hypoglycemia, and glycemic variability. Results A total of 153 participants (age 7 to 80 years) were included in the analyses. Mean average glucose was 98 to 99 mg/dL (5.4 to 5.5 mmol/L) for all age groups except those over 60 years, in whom mean average glucose was 104 mg/dL (5.8 mmol/L). The median time between 70 to 140 mg/dL (3.9 to 7.8 mmol/L) was 96% (interquartile range, 93 to 98). Mean within-individual coefficient of variation was 17 ± 3%. Median time spent with glucose levels &gt;140 mg/dL was 2.1% (30 min/d), and median time spent with glucose levels &lt;70 mg/dL (3.9 mmol/L) was 1.1% (15 min/d). Conclusion By assessing across age groups in a healthy, nondiabetic population, normative sensor glucose data have been derived and will be useful as a benchmark for future research studies.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kuroda ◽  
M Kawata ◽  
A Matsuura ◽  
K Adachi ◽  
Y Hirayama ◽  
...  

Abstract Background There has been growing evidence that the glucose fluctuation is an important contributing factor to the development of coronary artery disease. However, whether large glucose fluctuation, especially hypoglycemia, may be associated with acute myocardial infarction (AMI) remains largely unknown. Aim As new continuous glucose monitoring (CGM) has recently become available to evaluate glucose fluctuation from immediately after an emergency visit, this study sought to investigate glucose fluctuation and the occurrence of hypoglycemia in patients with AMI. Methods In this prospective study, 93 consecutive patients with AMI from April 2017 to November 2018 were enrolled. Subcutaneous interstitial glucose levels were monitored from emergency room to discharge using the CGM System. Based on the CGM data, 24-h mean glucose levels, the time in hyperglycemia and hypoglycemia and the occurrence of hypoglycemia, defined as less than 70 mg/dL, were measured, and the mean amplitude of glycemic excursions (MAGE) were calculated. Results The majority of patients [n=57, 61% (non-DM)] did not have diabetes and 36 patients had diabetes (DM). The occurrence of hypoglycemia within 24 hours after admission was observed in 49 patients [DM: n=11 (30.6%), non-DM: n=38 (66.7%)]. MAGE within 24 hours after admission were 100±47 in DM patients and 67±20 in non-DM patients. The mean time in hypoglycemia within 24 hours after admission was 148 minutes [DM: 100±260 minutes, non-DM: 178±287 minutes]. The occurrence of hypoglycemia during a hospital stay (mean 11.5 days) was detected in 76 patients [DM: n=28 (77.8%), non-DM: n=48 (84.2%)]. Representative case of hypoglycemia Conclusion Not only in DM patients but also in non-DM patients with AMI, large glucose fluctuation and high incidence of hypoglycemia were observed using new CGM system. Further investigations should address the rationale for the early detection and control of glucose fluctuation for AMI patients.


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