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.

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 A Novel Adaptive Basal Therapy Based on the Value and Rate of Change of Blood Glucose

2009 ◽  
Vol 3 (5) ◽  
pp. 1099-1108 ◽  
Author(s):  
Youqing Wang ◽  
Matthew W. Percival ◽  
Eyal Dassau ◽  
Howard C. Zisser ◽  
Lois Jovanovič ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Insulin Sensitivity ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Rate Of Change ◽  
Activity Level ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Diurnal Variability ◽  
Glucose Levels

Background: Modern insulin pump therapy for type 1 diabetes mellitus offers the freedom to program several basal profiles that may accommodate diurnal variability in insulin sensitivity and activity level. However, these basal profiles do not change even if a pending hypoglycemic or hyperglycemic event is foreseen. New insulin pumps could receive a direct feed of glucose values from a continuous glucose monitoring (CGM) system and could enable dynamic basal adaptation to improve glycemic control. Method: The proposed method is a two-step procedure. After the design of an initial basal profile, an adaptation of the basal rate is suggested as a gain multiplier based on the current CGM glucose value and its rate of change (ROC). Taking the glucose value and its ROC as axes, a two-dimensional plane is divided into a nine-zone mosaic, where each zone is given a predefined basal multiplier; for example, a basal multiplier of zero indicates a recommendation to shut off the pump. Results: The proposed therapy was evaluated on 20 in silico subjects (ten adults and ten adolescents) in the Food and Drug Administration-approved UVa/Padova simulator. Compared with conventional basal therapy, the proposed basal adjustment improved the percentage of glucose levels that stayed in the range of 60–180 mg/dl for all 20 subjects. In addition, the adaptive basal therapy reduced the average blood glucose index values. Conclusions: The proposed therapy provides the flexibility to account for insulin sensitivity variations that may result from stress and/or physical activities. Because of its simplicity, the proposed method could be embedded in a chip in a future artificial pancreatic β cell or used in a “smart” insulin pump.

Fasting during the holy month of Ramadan among older children and adolescents with type 1 diabetes in Kuwait

2019 ◽  
Vol 32 (8) ◽  
pp. 843-849 ◽  
Author(s):  
Kholoud Mohamed ◽  
Dalia Al-Abdulrazzaq ◽  
Amel Fayed ◽  
Eman El Busairi ◽  
Faisal Al Shawaf ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Control Level ◽  
Insulin Pump Therapy ◽  
Insulin Regimen ◽  
Pump Therapy ◽  
Significant Difference

Abstract Background To evaluate the safety of fasting during the holy month of Ramadan among children and adolescent with type 1 diabetes (T1D). Methods A retrospective cohort study of 50 children and adolescents with T1D whose mean age was 12.7 ± 2.1 years was conducted. Twenty-seven patients (54%) were on multiple daily injections (MDI) insulin regimen and 23 (46%) were on insulin pump therapy. Before fasting for Ramadan, children and their families were evaluated and educated about diabetes management during Ramadan. Hemoglobin A1c (HbA1c), weight, number of days fasted, hypoglycemia and hyperglycemia episodes, and emergency hospital visits were collected and analyzed after completing the month. Participants were compared according to the insulin treatment regimen and their glycemic control level before Ramadan. Results The children were able to fast 20 ± 9.9 days of Ramadan, and the most common cause for breaking the fast was mild hypoglycemia (7.8% among all cases). There was no significant difference between the two insulin regimen groups in breaking fast days, frequency of hypo- or hyperglycemia, weight and HbA1c changes post Ramadan. Patients with HbA1c ≤ 8.5% were able to fast more days during Ramadan with significantly less-frequent hypoglycemic attacks as compared to patients with HbA1c > 8.5 (1.2 ± 1.5 vs. 3.3 ± 2.9 days of hypoglycemia, p = 0.01, respectively). Conclusions Fasting for children with T1D above the age of 10 years is feasible and safe in both pump and non-pump users, and well-controlled patients are less likely to develop complications. Education of the families and their children before Ramadan, along with intensive monitoring of fasting children during the month are crucial.

scholarly journals Glycemic Control and Hypoglycemia in Patients Treated with Insulin Pump Therapy: An Observational Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Guillermo Guzmán ◽  
Veline Martínez ◽  
Julián David Yara ◽  
Miguel Angel Mina ◽  
Juan Sebastian Solarte ◽  
...  
Keyword(s):  
Insulin Pump ◽  
Glycosylated Hemoglobin ◽  
Clinical Status ◽  
Life Quality ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
University Hospital ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Clinically Significant

Introduction. Diabetes mellitus (DM) is a highly prevalent disease worldwide. It has been associated with an important morbimortality due to its complications and sometimes as a result of adverse events related to treatment. Insulin pump therapy (IPT) is one of the options used to control this disease and reduces one of the most frequent complication associated with treatment: hypoglycemia, which has also a great impact on life quality and clinical status of patients. Materials and Methods. A descriptive and retrospective study was performed including patients treated and followed by the department of endocrinology from a high-complexity university hospital in Cali, Colombia, between 2012 and 2017. Patients were on IPT and continuous glucose monitoring (CGM): MiniMed Paradigm® Veo™ Insulin Pump (Medtronic®) and MiniMed 640G Insulin Pump-Enlite™ Sensor (Medtronic®). Presentation of hypoglycemia and variables associated with its development were evaluated. Results. 51 patients were included. The main indication for IPT initiation was the report of hypoglycemic episodes and inappropriate metabolic control. Initiation of IPT was related with a decrease in glycosylated hemoglobin (HbA1c) and also a decrease in severe hypoglycemic events and hospitalization due to hypoglycemia. The risk factors linked with clinically significant hypoglycemia were male gender, and standard deviation of glucose measures calculated by CGM. A diminished glomerular filtration rate (GFR) (<60 mL/min/1.73 m2) was correlated with higher risk of severe hypoglycemia. Conclusion. IPT with CGM is a useful strategy in the management of patients with DM; it is associated with a reduction of adverse hypoglycemic events and hospitalizations due to hypoglycemia.

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 Integrated insulin pump therapy with continuous glucose monitoring for improved adherence: technology update

2015 ◽  
pp. 1263 ◽  
Author(s):  
Andrea Tumminia ◽  
Laura Sciacca ◽  
Lucia Frittitta ◽  
Sebastiano Squatrito ◽  
Riccardo Vigneri ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Pump Therapy

scholarly journals Accurate Carbohydrate Counting Is an Important Determinant of Postprandial Glycemia in Children and Adolescents With Type 1 Diabetes on Insulin Pump Therapy

2016 ◽  
Vol 11 (4) ◽  
pp. 753-758 ◽  
Author(s):  
Asma Deeb ◽  
Ahlam Al Hajeri ◽  
Iman Alhmoudi ◽  
Nico Nagelkerke
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Insulin Pump ◽  
Postprandial Glucose ◽  
Meal Size ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Postprandial Glycemia ◽  
The Impact

Background: Carbohydrate (CHO) counting is a key nutritional intervention utilized in the management of diabetes to optimize postprandial glycemia. The aim of the study was to examine the impact of accuracy of CHO counting on the postprandial glucose in children and adolescents with type 1 diabetes on insulin pump therapy. Methods: Children/adolescents with type 1 diabetes who were on insulin pump therapy for a minimum of 6 months are enrolled in the study. Patients were instructed to record details of meals consumed, estimated CHO count per meal, and 2-hour postprandial glucose readings over 3-5 days. Meals’ CHO contents were recounted by an experienced clinical dietician, and those within 20% of the dietician’s counting were considered accurate. Results: A total of 30 patients (21 females) were enrolled. Age range (median) was 8-18 (SD 13) years. Data of 247 meals were analyzed. A total of 165 (67%) meals’ CHO contents were accurately counted. Of those, 90 meals (55%) had in-target postprandial glucose ( P < .000). There was an inverse relationship between inaccurate CHO estimates and postprandial glucose. Of the 63 underestimated meals, 55 had above-target glucose, while 12 of the 19 overestimated meals were followed by low glucose. There was no association between accuracy and meal size (Spearman’s rho = .019). Conclusion: Accuracy of CHO counting is an important determining factor of postprandial glycemia. However, other factors should be considered when advising on prandial insulin calculation. Underestimation and overestimation of CHO result in postprandial hyperglycemia and hypoglycemia, respectively. Accuracy does not correlate with meal size.

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