scholarly journals Discrepancies Between Blood Glucose and Interstitial Glucose—Technological Artifacts or Physiology: Implications for Selection of the Appropriate Therapeutic Target

2017 ◽  
Vol 11 (4) ◽  
pp. 766-772 ◽  
Author(s):  
Thorsten Siegmund ◽  
Lutz Heinemann ◽  
Ralf Kolassa ◽  
Andreas Thomas
Keyword(s):  
Blood Glucose ◽  
Therapeutic Target ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Blood Glucose Measurement ◽  
Glucose Measurement ◽  
Glucose Levels ◽  
Therapeutic Decisions ◽  
The Impact ◽  
Selection Of

Background: For decades, the major source of information used to make therapeutic decisions by patients with diabetes has been glucose measurements using capillary blood samples. Knowledge gained from clinical studies, for example, on the impact of metabolic control on diabetes-related complications, is based on such measurements. Different to traditional blood glucose measurement systems, systems for continuous glucose monitoring (CGM) measure glucose in interstitial fluid (ISF). The assumption is that glucose levels in blood and ISF are practically the same and that the information provided can be used interchangeably. Thus, therapeutic decisions, that is, the selection of insulin doses, are based on CGM system results interpreted as though they were blood glucose values. Methods: We performed a more detailed analysis and interpretation of glucose profiles obtained with CGM in situations with high glucose dynamics to evaluate this potentially misleading assumption. Results: Considering physical activity, hypoglycemic episodes, and meal-related differences between glucose levels in blood and ISF uncover clinically relevant differences that can make it risky from a therapeutic point of view to use blood glucose for therapeutic decisions. Conclusions: Further systematic and structured evaluation as to whether the use of ISF glucose is more safe and efficient when it comes to acute therapeutic decisions is necessary. These data might also have a higher prognostic relevance when it comes to long-term metabolic consequences of diabetes. In the long run, it may be reasonable to abandon blood glucose measurements as the basis for diabetes management and switch to using ISF glucose as the appropriate therapeutic target.

scholarly journals The Correlation of Hemoglobin A1c to Blood Glucose

2009 ◽  
Vol 3 (3) ◽  
pp. 429-438 ◽  
Author(s):  
Ken Sikaris
Keyword(s):  
Blood Glucose ◽  
Hemoglobin A1c ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Glucose Measurement ◽  
Glucose Levels ◽  
Average Blood Glucose ◽  
Current Concerns ◽  
Average Glucose ◽  
Hba1c Levels

The understanding that hemoglobin A1c (HbA1c) represents the average blood glucose level of patients over the previous 120 days underlies the current management of diabetes. Even in making such a statement, we speak of “average blood glucose” as though “blood glucose” were itself a simple idea. When we consider all the blood glucose forms—arterial versus venous versus capillary, whole blood versus serum versus fluoride-preserved plasma, fasting versus nonfasting—we can start to see that this is not a simple issue. Nevertheless, it seems as though HbA1c correlates to any single glucose measurement. Having more than one measurement and taking those measurements in the preceding month improves the correlation further. In particular, by having glucose measurements that reflect both the relatively lower overnight glucose levels and measurements that reflect the postprandial peaks improves not only our ability to manage diabetes patients, but also our understanding of how HbA1c levels are determined. Modern continuous glucose monitoring (CGM) devices may take thousands of glucose results over a week. Several studies have shown that CGM glucose averages account for the vast proportion of the variation of HbA1c. The ability to relate HbA1c to average glucose may become a popular method for reporting HbA1c, eliminating current concerns regarding differences in HbA1c standardization. Hemoglobin A1c expressed as an average glucose may be more understandable to patients and improve not only their understanding, but also their ability to improve their diabetes management.

Indole as a new tentative marker in exhaled breath for non-invasive blood glucose monitoring of diabetic subjects

2021 ◽  
Author(s):  
Herbert Fink ◽  
Tim Maihöfer ◽  
Jeffrey Bender ◽  
Jochen Schulat
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Glucose Measurement ◽  
Diabetic Patients ◽  
Exhaled Breath ◽  
Invasive Approach ◽  
Test Strips ◽  
Non Invasive

Abstract Blood glucose monitoring (BGM) is the most important part of diabetes management. In classical BGM, glucose measurement by test strips involves invasive finger pricking. We present results of a clinical study that focused on a non-invasive approach based on volatile organic compounds (VOCs) in exhaled breath. Main objective was the discovery of markers for prediction of blood glucose levels (BGL) in diabetic patients. Exhaled breath was measured repeatedly in 60 diabetic patients (30 type 1, 30 type 2) in fasting state and after a standardized meal. Proton Transfer Reaction Time of Flight Mass Spectrometry (PTR-ToF-MS) was used to sample breath every 15 minutes for a total of six hours. BGLs were tested in parallel via BGM test strips. VOC signals were plotted against glucose trends for each subject to identify correlations. Exhaled indole (a bacterial metabolite of tryptophan) showed significant mean correlation to BGL (with negative trend) and significant individual correlation in 36 patients. The type of diabetes did not affect this result. Additional experiments of one healthy male subject by ingestion of lactulose and 13C-labeled glucose (n=3) revealed that exhaled indole does not directly originate from food digestion by intestinal microbiota. As indole has been linked to human glucose metabolism, it might be a tentative marker in breath for non-invasive BGM. Clinical studies with greater diversity are required for confirmation of such results and further investigation of metabolic pathways.

Modern technologies in diabetes management - continuous glucose monitoring and insulin pump therapy

2021 ◽  
Vol 87 (1) ◽  
pp. 50-55
Author(s):  
E.Yu. Pyankova ◽  
◽  
L.A. Anshakova ◽  
I.A. Pyankov ◽  
S.V. Yegorova ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Individual ◽  
Glucose Lowering Therapy

The problems of complications of diabetes mellitus cannot be solved without constant monitoring of blood glucose levels. The evolution of additional technologies for the determination of glucose in the blood of the last decades makes it possible to more accurately predict the risks of complications, both in the individual and in the patient population as a whole. The article provides an overview of the methods used in modern diabetology, facilitating control over the variability of blood glucose levels and helping in a more accurate selection of glucose-lowering therapy. All presented methods are currently working in real clinical practice in the Khabarovsk Krai

scholarly journals VP184 A Cost Analysis Of Flash Glucose Monitoring Systems In Veneto Region

2017 ◽  
Vol 33 (S1) ◽  
pp. 235-236
Author(s):  
Alessandro Curto ◽  
Marika Torbol ◽  
Anna Cavazzana ◽  
Margherita Andretta ◽  
Giovanna Scroccaro
Keyword(s):  
Blood Glucose ◽  
Cost Analysis ◽  
New Technology ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Diabetic Patients ◽  
Veneto Region ◽  
Glucose Levels ◽  
Medical App ◽  
The Impact

INTRODUCTION:A novel, sensor-based, factory-calibrated Flash Monitoring System (FMS) has recently proved to be an effective alternative to conventional self-monitoring of blood glucose (SMBG) in patients affected by type 1 and type 2 diabetes. The 14-days adhesive sensor, that continuously measures glucose levels in the interstitial fluid, can transfer glucose levels data to a handheld reader or a smartphone equipped with a specific medical app. The uptake of the new technology has been limited so far, because of its high costs. A cost analysis has been conducted to identify the optimal target population of introducing FSM in Veneto.METHODS:The model was designed with a 1-year time horizon for patients with diabetes using intensive insulin in Veneto region. The costs of the new technology was estimated using inputs from the two main randomized controlled trials (the IMPACT study and the REPLACE study) published in the international literature, Regional evidence-based guidelines and administrative database. Resource utilization included strips, lancets, needles, sensors, distribution and patients training. Regional unit costs were adopted.RESULTS:FSM has not shown so far relevant and statically significant benefits in terms of severe adverse events’ reduction. Estimated yearly costs for a FSM user included glucose monitoring, technology training and distribution costs, for a total of EUR1277 per patient. The new technology has been shown to be affordable in diabetic patients with i) 4years<age<18years, ii) continuous subcutaneous insulin infusion and iii) ≥5 blood glucose monitoring per day.CONCLUSIONS:The Veneto Region should carefully consider prescribing extension to other diabetic patients categories, since the high cost of the new technology. A strict prescribing monitoring is strongly recommended with the aim of ensuring appropriateness and avoiding overspending.

scholarly journals The Promise and Perils of Wearable Physiological Sensors for Diabetes Management

2018 ◽  
Vol 12 (3) ◽  
pp. 587-591 ◽  
Author(s):  
Frank L. Schwartz ◽  
Cynthia R. Marling ◽  
Razvan C. Bunescu
Keyword(s):  
Diabetes Management ◽  
Contact Lenses ◽  
Insulin Pump ◽  
Improve Patient Safety ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Current Status ◽  
Pump Therapy ◽  
Glucose Levels ◽  
The Impact

Development of truly useful wearable physiologic monitoring devices for use in diabetes management is still in its infancy. From wearable activity monitors such as fitness trackers and smart watches to contact lenses measuring glucose levels in tears, we are just at the threshold of their coming use in medicine. Ultimately, such devices could help to improve the performance of sense-and-respond insulin pumps, illuminate the impact of physical activity on blood glucose levels, and improve patient safety. This is a summary of our experience attempting to use such devices to enhance continuous glucose monitoring–augmented insulin pump therapy. We discuss the current status and present difficulties with available devices, and review the potential for future use.

scholarly journals Design and Dimensional Measurement of Interdigital Sensor for Blood Glucose Measurement through Non-Invasive Method

2019 ◽  
Vol 8 (4) ◽  
pp. 6437-6441
Keyword(s):  
Glucose Monitoring ◽  
Blood Glucose Measurement ◽  
World Health ◽  
Glucose Measurement ◽  
Noninvasive Technique ◽  
Glucose Levels ◽  
Non Invasive ◽  
Reduced Physical Activity ◽  
Invasive Method ◽  
Health Organization

Diabetes has shown to be a chronic disease world over, mainly caused due to reduced physical activity and increased obesity. World health organization statistics show diabetes as a leading cause of disability universally. To avoid extreme medical conditions of subjects, regular monitoring of their glucose levels has been suggested. The most common method that has been in use is the pinprick method for glucose monitoring which carries the risk of contamination as well as irritation. One possible approach called noninvasive technique can be adopted to avoid this major concern. This paper presents designing Inter-Digital-Sensor (IDS) for non-invasive sensing of the glucose level. The sensor-based chip once mounted onto the upper arm or pinkie finger of diabetes subject, is able to sense different glucose levels concentration as impedance plots. A set of several simulation results has been obtained using COMSOL for getting optimized dimensions of the sensor digits. This research has presented the generation of an electric field and intensity by using electrode of known length with element spacing varying from 250µm to 600µm developed over 15mm x 20mm sensor area. An ID of 475µm width spacing with ten (10) digits producing 2.33 pF of capacitance value with impedance resonating at 13 GHz of frequency is reported in this paper

Blood Glucose Monitoring In Pediatric Patients—Looking Toward Better Diabetes Management and Perspectives for the Future

2010 ◽  
Vol 06 (01) ◽  
pp. 54
Author(s):  
William L Clarke ◽  
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Artificial Pancreas ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Blood Glucose Monitoring ◽  
Intensive Glucose Control ◽  
Nocturnal Hypoglycemia ◽  
Glucose Levels ◽  
Analytical Accuracy

Self-blood glucose monitoring (SBGM) is an important component of day-to-day diabetes management for children and their families. Despite some recent concerns in terms of its analytical accuracy, it has been used successfully to implement intensive glucose control in the Diabetes Control and Complications Trial, reduce glycated hemoglobin (HbA1c) levels, prevent acute complications, and make it possible for children to attend school and participate in sports activities safely. While still in its infancy, continuous glucose monitoring (CGM) has been shown to be useful in reducing the occurrence of nocturnal hypoglycemia, lowering HbA1clevels, and reducing glycemic variability. Its analytical accuracy has prevented its approval as an alternative to SBGM for insulin decision-making. However, it has made possible the development and testing of closed-loop ‘artificial pancreas’ systems for controlling glucose levels in adults and adolescents.

scholarly journals Antidiabetic Activity of Sungkai (Peronema canescens Jack) Leaves Ethanol Extract on the Male Mice Induced Alloxan Monohydrate

2021 ◽  
Vol 6 (2) ◽  
pp. 64
Author(s):  
Madyawati Latief ◽  
Putri M. Sari ◽  
Liddini T. Fatwa ◽  
Indra L. Tarigan ◽  
H. P. Vasantha Rupasinghe
Keyword(s):  
Body Weight ◽  
Blood Glucose ◽  
Urine Volume ◽  
Ethanol Extract ◽  
Blood Glucose Measurement ◽  
Antidiabetic Activity ◽  
Glucose Measurement ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Reduce Blood Glucose

  Sungkai (Peronema canescens Jack) is an alternative natural ingredient that can be used as an antidiabetic containing several secondary metabolites which are thought to reduce blood glucose levels by inhibiting the action of the α-glucokinase enzyme and increasing the activity of antioxidant enzymes and being able to regenerate β-cells, damaged pancreas so that insulin deficiency can be overcome. The aim of this study was to determine the effect of P. canescens leaves ethanol extract on antidiabetic activity and to determine the effect of various doses of sungkai leaf ethanol extract as antidiabetic. The scientific research method used in this study was a completely randomized design (CRD) and data analysis used in this study is the one way ANOVA, following by the Duncan test. Blood glucose measurement in treated mice was carried out 3 times. Mice were devided into five groups, three mice in each group, and each group was administered different dosages of sungkai extract (T1 = extract 175 mg/kg body weight; T2 = extract 350 mg/kg body weight; T3 = extract 700 mg/ kg body weight). First, the mice were acclimatized for six days and the injection of treatment was started at day 7. Blood glucose levels, urine volume, body weight and daily drinking of mice was carried out before induction (day 0), after induction (day 8) and after the end of treatment for 10 days (day 18), was carried out using the Point of Care Test (POCT) method using the Easy Touch GCU. The results showed that the ethanol extract of sungkai leaves had the potential to reduce blood glucose levels in mice. The ethanol extract of sungkai leaves at a dose of 350 mg/kg body weight has the most optimal potential to reduce blood glucose levels, urine volume, daily drinking, and body weight. 

scholarly journals Glucose Management during Insulinoma Resection Using Real-Time Subcutaneous Continuous Glucose Monitoring

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yuki Sugiyama ◽  
Chiaki Kiuchi ◽  
Maiko Suzuki ◽  
Yuki Maruyama ◽  
Ryo Wakabayashi ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Blood Glucose Measurement ◽  
Glucose Measurement ◽  
Glucose Loading ◽  
Before And After ◽  
Interstitial Glucose ◽  
Glucose Management

Insulinoma is a rare neuroendocrine tumor that causes hypoglycemia due to unregulated insulin secretion. Blood glucose management during insulinoma resection is therefore challenging. We present a case in which real-time subcutaneous continuous glucose monitoring (SCGM) in combination with intermittent blood glucose measurement was used for glycemic control during surgery for insulinoma resection. The SCGM system showed the trends and peak of interstitial glucose in response to glucose loading and the change of interstitial glucose before and after insulinoma resection. These data were helpful for adjusting the glucose infusion; therefore, we think that an SCGM system as a supportive device for glucose monitoring may be useful for glucose management during surgery.

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