scholarly journals Advancing the Use of CGM Devices in a Non-ICU Setting

2019 ◽  
Vol 13 (4) ◽  
pp. 674-681 ◽  
Author(s):  
Meng Wang ◽  
Lakshmi G. Singh ◽  
Elias K. Spanakis

Improvements in glycemic control using continuous glucose monitoring (CGM) systems have been demonstrated in the outpatient setting. Among hospitalized patients the use of CGM is largely investigational, particularly in the non-ICU setting. Although there is no commercially available closed-loop system, it has recently been evaluated in the non–critical care setting. Both CGMs and closed-loop systems may lead to improved glycemic control, decreased length of stay, reduced risk of adverse events related to severe hypoglycemia or hyperglycemia. Limitations of inpatient use of CGM and closed-loop systems include lack of FDA approvals, inexperience with this technology, and costs related to supplies. Significant investment may be necessary for hospital staff training and for development of infrastructure to support inpatient use. Additional limitations for CGM systems includes potential inaccuracy of interstitial glucose measurements due to medication interferences, sensor lag, or sensor drift. Limitations for closed-loop systems also includes need for routine monitoring to detect infusion site issues as well as monitoring to ensure adequate insulin supply in reservoir to avoid abrupt cessation of insulin infusion leading to severe hyperglycemia. Hospital staff must be familiar with trouble-shooting and conversion to alternative mode of insulin delivery in the event of insulin pump malfunction. Given these complexities, implementation of closed-loop systems may require involvement of an endocrinology team, limiting widespread adoption. This article reviews current state of CGM and closed-loop system use in the non-ICU setting, available literature, advantages and limitations, as well as suggestions for future CGM design, specifically for the inpatient setting.

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 102-LB
Author(s):  
ADRIAN E. PROIETTI ◽  
MARCIAL A. ANGÓS ◽  
ALEJANDRO DAIN ◽  
MARIELA I. ECHENIQUE ◽  
MARÍA L. KABAKIAN ◽  
...  

Diabetes Care ◽  
2020 ◽  
Vol 43 (12) ◽  
pp. 3102-3105
Author(s):  
Vera Lehmann ◽  
Thomas Zueger ◽  
Anna Zeder ◽  
Sam Scott ◽  
Lia Bally ◽  
...  

2017 ◽  
Vol 55 (3) ◽  
pp. 357
Author(s):  
Nguyen Doan Phuoc ◽  
Nguyen Hoai Nam

In this paper, the settling time of closed loop systems controlled with PID, which is established by using magnitude and symmetric optimum methods, are analyzed. These methods have some limitations such as limited frequency bands, existence of overshoot and larger settling time. Thus, our aim is to improve these performances of the closed loop system for a certain class of transfer functions. The proposed method will be tested on a DC motor by simulation. It can be concluded that the method provides a larger range of frequency, smaller settling time and no overshoot.


Author(s):  
С.Л. Подвальный ◽  
Д.В. Логунов ◽  
Е.М. Васильев

Рассматривается задача воспроизведения в искусственных объектах способности естественных систем к самовосстановлению вследствие существования в них замкнутого круговорота вещества и энергии. Показано, что создание замкнутого жизненного цикла в системе предполагает реализацию в ней процессов восстановления ресурсов и их накопления в виде внутренних резервов, расходуемых системой в неблагоприятных условиях существования. Получена функциональная схема системы с замкнутым циклом и предложена математическая модель её функционирования в виде дискретного однородного марковского процесса без последействия. Обнаружено, что введение в систему внутреннего резервирования требует рассмотрения двух альтернативных вариантов модели системы: варианта для случая, в котором объём резервов ограничен возможностями каналов восстановления в системе, и варианта, в котором указанное ограничение отсутствует. Составлены графы состояний системы для указанных режимов функционирования и получены выражения для финальных вероятностей этих состояний. На основе полученных финальных вероятностей составлены аналитические расчётные соотношения для характеристик эффективности системы с замкнутым циклом. В качестве основной характеристики эффективности такого рода систем предлагается использовать вероятность полного функционирования системы, т.е. вероятность её работы с использованием всего объёма активных ресурсов. Представлен числовой пример, подтверждающий работоспособность предложенной модели, и проведён сопоставительный анализ вариантов управления эффективностью замкнутой системы путём изменения объёма резервов, количества процессов восстановления и интенсивности этих процессов. Выявлено доминирующее значение внутренних резервов при обеспечении заданных показателей эффективности системы с замкнутым циклом Here we consider the problem of reproduction of the ability of natural systems to self-repair in artificial objects due to the existence of a closed loop of matter and energy in them. We show that the creation of a closed life cycle in the system presupposes the implementation of the process of restoring resources and their accumulation in the form of internal reserves consumed by the system in unfavorable conditions of existence. We obtained a functional diagram of a closed-loop system and proposed a mathematical model of its functioning in the form of a discrete homogeneous Markov process without aftereffect. We found that the introduction of internal redundancy into the system requires consideration of two alternative options for the system model: the option for the case in which the volume of reserves is limited by the capabilities of the recovery channels in the system, and the option in which the specified limitation is absent. We compiled the graphs of the states of the system for the specified modes of operation and obtained expressions for the final probabilities of these states. On the basis of the obtained final probabilities, we got analytical design ratios for the characteristics of the efficiency of a system with a closed loop. As the main characteristic of the efficiency of such systems, we propose to use the probability of the complete functioning of the system, i.e. the probability of its work using the entire volume of active resources. We present a numerical example that confirms the performance of the proposed model, and carried out a comparative analysis of options for managing the efficiency of a closed-loop system by changing the volume of reserves, the number of recovery processes and the intensity of these processes. We revealed the dominant value of internal reserves while ensuring the specified performance indicators of a closed-loop system


Volume 3 ◽  
2004 ◽  
Author(s):  
Robert A. Leishear ◽  
Jeffrey H. Morehouse

The effects of fluid transients, or water hammer, in closed loop systems are somewhat different than those observed in open ended systems. The open loop system has received much attention in the literature, not so for the closed system. The generally accepted method of characteristics (MOC) technique was applied herein to investigate closed loop systems. The magnitudes of the pressures during fluid transients were investigated for examples of rapid valve closures, and the operations of parallel pumps. The effects of trapped air in the system were also considered for these examples. To reduce the pressures caused by the transients, the installation of slow closing valves were evaluated for different conditions.


2016 ◽  
Vol 19 (3) ◽  
pp. 209-218 ◽  
Author(s):  
Kazuhiro Hanazaki ◽  
Masaya Munekage ◽  
Hiroyuki Kitagawa ◽  
Tomoaki Yatabe ◽  
Eri Munekage ◽  
...  

2020 ◽  
Vol 169 ◽  
pp. 108440 ◽  
Author(s):  
Miriam Longo ◽  
Paola Caruso ◽  
Michela Petrizzo ◽  
Filomena Castaldo ◽  
Annalisa Sarnataro ◽  
...  

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