scholarly journals Mitigation of Rebound Hyperglycemia With Real-Time Continuous Glucose Monitoring Data and Predictive Alerts

2021 ◽  
pp. 193229682098258
Author(s):  
Giada Acciaroli ◽  
John B. Welsh ◽  
Halis Kaan Akturk
Keyword(s):  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Time Curve ◽  
Convenience Sample ◽  
Baseline Phase ◽  
Mean Frequency ◽  
The Mean ◽  
The Impact

Background: Excess carbohydrate intake during hypoglycemia can lead to rebound hyperglycemia (RH). We investigated associations between RH and use of real-time continuous glucose monitoring (rtCGM) and an rtCGM system’s predictive alert. Methods: RH events were series of sensor glucose values (SGVs) >180 mg/dL starting within two hours of an antecedent SGV <70 mg/dL. Events were characterized by their frequency, duration (consecutive SGVs >180 mg/dL × five minutes), and severity (area under the glucose concentration-time curve). To assess the impact of rtCGM, data gathered during the four-week baseline phase (without rtCGM) and four-week follow-up phase (with rtCGM) from 75 participants in the HypoDE clinical trial (NCT02671968) of hypoglycemia-unaware individuals were compared. To assess the impact of predictive alerts, we identified a convenience sample of 24 518 users of an rtCGM system without predictive alerts who transitioned to a system whose predictive alert signals an SGV ≤55 mg/dL within 20 minutes (Dexcom G5 and G6, respectively). RH events from periods of blinded versus unblinded rtCGM wear and from periods of G5 and G6 wear were compared with paired t tests. Results: Compared to RH events in the HypoDE baseline phase, the mean frequency, duration, and severity of events fell by 14%, 12%, and 23%, respectively, in the follow-up phase (all P < .05). Compared to RH events during G5 use, the mean frequency, duration, and severity of events fell by 7%, 8%, and 13%, respectively, during G6 use (all P < .001). Conclusions: Rebound hypreglycemia can be objectively quantified and mitigated with rtCGM and rtCGM-based predictive alerts.

The impact of real-time continuous glucose monitoring on metabolic control in children with type 1 diabetes

2020 ◽  
Author(s):  
Ruxandra Calapod Ioana ◽  
Irina Bojoga ◽  
Duta Simona Gabriela ◽  
Ana-Maria Stancu ◽  
Amalia Arhire ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Metabolic Control ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
The Impact

Significance of “Time below Range” as a Glycemic Marker Derived from Continuous Glucose Monitoring in Japanese Children and Adolescents with Type 1 Diabetes

2020 ◽  
Vol 93 (4) ◽  
pp. 251-257
Author(s):  
Tatsuhiko Urakami ◽  
Kei Yoshida ◽  
Remi Kuwabara ◽  
Yusuke Mine ◽  
Masako Aoki ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Target Range ◽  
Japanese Children ◽  
Mean Frequency ◽  
The Mean

<b><i>Introduction:</i></b> We evaluated the frequencies of various glycemic markers derived from continuous glucose monitoring in Japanese children and adolescents with type 1 diabetes and assessed the significance of hypoglycemia duration. <b><i>Methods:</i></b> We enrolled 85 children and adolescents (36 boys and 49 girls) with type 1 diabetes who used FreeStyle<sup>®</sup> Libre in the present study. Frequencies of blood glucose levels as time within target range (TIR; 70–180 mg/dL), time below target range (TBR; &#x3c;70 mg/dL), time below extreme hypoglycemia range (TBER; &#x3c;54 mg/dL), and time above range (TAR; &#x3e;180 mg/dL) were assessed during a 3-month study period. Furthermore, we evaluated the intraday frequencies of TBR and TBER. <b><i>Results:</i></b> The mean frequencies of TIR, TBR, and TAR were 52.7 ± 11.3%, 10.8 ± 5.4%, and 36.5 ± 10.8%, respectively, whereas the mean frequency of TBER was 1.1 ± 0.9% (0–3.0%); there was no clinical episode of severe hypoglycemia. The mean frequency of TBR was significantly greater in 0–6 h (16.9 ± 5.2%) than in 6–12 h (7.8 ± 2.9%) and 18–24 h (6.8 ± 4.8%; <i>p</i> &#x3c; 0.01) time zones, respectively. <b><i>Discussion/Conclusion:</i></b> We found similar TIR and comparatively higher TBR frequencies, particularly during sleep, than those that were previously reported. Possible reasons for the higher frequency of TBR include differences in the quality of insulin treatment and diabetes care between the present study and the European studies. The utilization of advanced technologies, such as a predictive low-glucose suspend-function pump or closed-loop therapy, can reduce the frequency of TBR, with a consequent increase in TIR frequency and comprehensive improvement in glycemic control.

Evaluating the impact of an international short-term medical mission through diabetic glycemic control

2018 ◽  
Vol 41 (4) ◽  
pp. 815-820
Author(s):  
John C Mach ◽  
Hope Barone ◽  
Christopher Boni ◽  
Humberto Jimenez ◽  
Michael Tinglin
Keyword(s):  
Disease Burden ◽  
Prospective Observational Study ◽  
Glucose Monitoring ◽  
Phone Call ◽  
Short Term ◽  
Education Medical ◽  
The Mean ◽  
The Impact ◽  
Diabetic Care

AbstractBackgroundThis prospective observational study evaluated the impact of a primary care-based, international, short-term medical mission’s (STMM) impact on diabetes disease burden as represented through reductions in hemoglobin A1C (HbA1c).MethodsFrom November 2016 to May 2017, we tracked the HbA1c’s of diabetic individuals in Dajabon, Dominican Republic through care provided by Waves of Health (WOH). Participants were provided counseling, glucose monitoring equipment, a 6-month supply of anti-diabetic medications, and received a ‘check-in’ phone call at 3 months. HbA1c’s were re-measured at 6-month follow up. We hypothesized WOH diabetic care would have a modest impact of reducing mean HbA1c by 0.5%.ResultsIn total, 75% (n = 76) of 101 participants presented for follow-up care. Mean and median HbA1c decreased from 8.71 (SD 2.0) and 8.5% to 8.36 (SD 2.1) and 7.7%, respectively (P = 0.07). The percentage of individuals with HbA1c ≤7.5 increased by 10.4% at follow-up. The mean HbA1c decrease was 1.1%.ConclusionsThough limited by sample size, our results suggest that medical STMM’s may have a clinically meaningful impact in chronic disease management when utilizing a systematic combination of education, medical therapy, clearly documented medication instructions and regular trip intervals.

scholarly journals Rationale and protocol for the Assessment of Impact of Real-time Continuous Glucose Monitoring on people presenting with severe Hypoglycaemia (AIR-CGM) study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Parizad Avari ◽  
Rozana Ramli ◽  
Monika Reddy ◽  
Nick Oliver ◽  
Rachael Fothergill
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Standard Care ◽  
Severe Hypoglycaemia ◽  
Glucose Monitoring ◽  
Significant Risk ◽  
Patient Reported ◽  
The Impact

Abstract Background Severe hypoglycaemia carries a significant risk of morbidity and mortality for people with type 1 diabetes. Economic costs are also high, estimated at approximately £13 million annually in England, UK. Continuous glucose monitoring (CGM) has been shown to reduce hypoglycaemia and associated fear, improve overall glycaemia and quality of life, and is cost-effective. Despite effective pathways in place with high levels of resource utilization, it has been reported there are low levels of follow-up, therapy change and specialist intervention after severe hypoglycaemia. This study is designed to assess the impact of providing real-time CGM to people with type 1 diabetes, who have had a recent episode of severe hypoglycaemia (within 72 h), compared to standard care. Methods/design Fifty-five participants with type 1 diabetes and a recent episode of severe hypoglycaemia, who are CGM naïve, will be recruited to the study. Participants will be randomised to CGM or standard care. The primary outcome is percentage time spent in hypoglycaemia (< 3.0 mmol/L, 55 mg/dL). Secondary outcomes include other measures of hypoglycaemia, time in euglycaemia, overall glucose status and patient reported qualitative measures. Discussion This study assesses the impact of providing continuous glucose monitoring at the outset in individuals at highest risk of hypoglycaemia. Changing demand means that novel approaches need to be taken to healthcare provision. This study has the potential to shape future national standards. Trial registration NCT03748433, November 2018 (UK).

scholarly journals Continuous Glucose Monitoring as a Valuable Tool in the Early Detection of Diabetes Related to Cystic Fibrosis

2021 ◽  
Vol 9 ◽  
Author(s):  
Bojana Gojsina ◽  
Predrag Minic ◽  
Sladjana Todorovic ◽  
Ivan Soldatovic ◽  
Aleksandar Sovtic
Keyword(s):  
Cystic Fibrosis ◽  
Continuous Glucose Monitoring ◽  
Medical Records ◽  
Early Recognition ◽  
Glucose Monitoring ◽  
Therapy Initiation ◽  
Second Year ◽  
Two Peaks ◽  
The Impact

Aims: We evaluated the impact of cystic fibrosis-related diabetes (CFRD) on lung disease and nutritional status.Study Design: The retrospective cohort study evaluated the subjects' medical records from 2004 to 2019. All participants older than 10 years diagnosed by a 30-minutely sampled OGTT formed OGTT-CFRD subgroup. The participants diagnosed with continuous glucose monitoring (CGM) (at least two peaks above 11.1 mmol/l and more than 10% of recorded time above 7.8 mmol/l) formed a CFRD-CGM subgroup. The participants without CFRD formed a non-CFRD group. The longitudinal follow-up was made 2 years before and 3 years after insulin therapy initiation.Results: Of 144 participants included, aged 10–55 years (44% males), 28 (19.4%) had CFRD. The HbA1c was significantly lower in the CGM-CFRD in comparison to the OGTT-CFRD subgroup (5.9 ± 0.62 and 7.3 ± 1.7% respectfully; p = 0.04). Subjects with CFRD were malnourished in comparison to non-CFRD, with significant improvements with insulin replacement therapy in regard to BMI Z-score (−1.4 ± 1.3 vs. −0.5 ± 1.2%, p = 0.04) and pulmonary exacerbation score (p = 0.02). In OGTT-CFRD subgroup there is an increase in FEV1 (62.7 ± 26.3 to 65.1 ± 21.7%, p = 0.7) and decrease in FVC (from 76.4 ± 24.2 to 71.2 ± 20%, p = 0.003) from diagnosis to second year of follow-up. In CGM-CFRD subgroup there was a decrease in FEV1 (from 58.2 ± 28.2 to 52.8 ± 25.9%, p = 0.2) and FVC-values (from 72.4 ± 26.5 to 67.4 ± 29.1%, p = 0.08).Chronic Pseudomonas aeruginosa infection was more prevalent in the CFRD group (p = 0.003).Conclusion: Continuous glucose monitoring is a useful tool for insight of glucose impairment and diagnosis of CFRD. Early recognition of CFRD and therapeutic intervention has favorable effects on clinical course of the disease.

scholarly journals The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older

2016 ◽  
Vol 10 (4) ◽  
pp. 892-897 ◽  
Author(s):  
William H. Polonsky ◽  
Anne L. Peters ◽  
Danielle Hessler
Keyword(s):  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
The Impact

scholarly journals Therapy adjustments in people with type 1 diabetes with impaired hypoglycemia awareness on multiple daily injections using real-time continuous glucose monitoring: a mechanistic analysis of the HypoDE study

2021 ◽  
Vol 9 (1) ◽  
pp. e001848
Author(s):  
Delia Waldenmaier ◽  
Guido Freckmann ◽  
Stefan Pleus ◽  
Norbert Hermanns ◽  
Dominic Ehrmann ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Multiple Daily Injections ◽  
Mechanistic Analysis ◽  
Multicenter Randomized Controlled Trial ◽  
Low Glucose

IntroductionStudies have shown beneficial effects of real-time continuous glucose monitoring (rtCGM) usage on clinical outcomes. The objective of this analysis was to identify which therapy adjustments were made by people with type 1 diabetes with impaired hypoglycemia awareness during rtCGM usage enabling reductions in the number of low glucose events observed in the HypoDE (Hypoglycemia in Deutschland) study.Research design and methodsIn the multicenter randomized controlled trial in people with type 1 diabetes on multiple daily injections with impaired hypoglycemia awareness, participants recorded their diabetes therapy in 7-day logbooks at baseline and at 6-month follow-up. They used rtCGM or self-monitoring of blood glucose for therapy adjustments. This mechanistic analysis looked at changes in various aspects of therapy.ResultsLogbooks were completed by 70 participants in the rtCGM group and 65 participants in the control group. Participants in the rtCGM group kept their total carbohydrate consumption, daily insulin doses and distribution constant during the study. However, they reported an increased intake of rescue carbohydrates (0.8±0.6 (mean±SD) vs 1.0±0.8 intake/day; baseline-adjusted between-group difference 0.3 intake (0.1–0.5), p=0.031). The glucose threshold at which rescue carbohydrate intake was initiated was elevated from 71±13 mg/dL (3.9±0.7 mmol/L) to 79±14 mg/dL (4.4±0.8 mmol/L) (adjusted between-group difference +7.6 mg/dL (2.4–12.8) (+0.4 mmol/L (0.1–0.7)); p=0.005) in the rtCGM group. Regression analysis showed that follow-up low glucose events were associated with group allocation (p<0.001), low glucose events at baseline (p=0.016) and rescue threshold (p=0.001).ConclusionsNo major adjustments in insulin therapy were made by study participants with impaired hypoglycemia awareness; however, they were more active in preventing hypoglycemia by taking rescue carbohydrates earlier and more often.Trial registration numberNCT02671968.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

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