scholarly journals Blood glucose and subcutaneous continuous glucose monitoring in critically ill horses: A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247561
Author(s):  
Valentina Vitale ◽  
Lise C. Berg ◽  
Bettina Birch Larsen ◽  
Andrea Hannesdottir ◽  
Preben Dybdahl Thomsen ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Interstitial Fluid ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Relevant Information ◽  
Glucose Levels ◽  
Interstitial Glucose ◽  
Blood Gas Analyzer

This pilot prospective study reports the feasibility, management and cost of the use of a continuous glucose monitoring (CGM) system in critically ill adult horses and foals. We compared the glucose measurements obtained by the CGM device with blood glucose (BG) concentrations. Neonatal foals (0–2 weeks of age) and adult horses (> 1 year old) admitted in the period of March-May 2016 with clinical and laboratory parameters compatible with systemic inflammatory response syndrome (SIRS) were included. Glucose concentration was monitored every 4 hours on blood samples with a point-of-care (POC) glucometer and with a blood gas analyzer. A CGM system was also placed on six adults and four foals but recordings were successfully obtained only in four adults and one foal. Glucose concentrations corresponded fairly well between BG and CGM, however, there appeared to be a lag time for interstitial glucose levels. Fluctuations of glucose in the interstitial fluid did not always follow the same trend as BG. CGM identified peaks and drops that would have been missed with conventional glucose monitoring. The use of CGM system is feasible in ill horses and may provide clinically relevant information on glucose levels, but there are several challenges that need to be resolved for the system to gain more widespread usability.

scholarly journals Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study

2020 ◽  
Vol 14 (6) ◽  
pp. 1065-1073
Author(s):  
Archana R. Sadhu ◽  
Ivan Alexander Serrano ◽  
Jiaqiong Xu ◽  
Tariq Nisar ◽  
Jessica Lucier ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Pilot Study ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Target Range

Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). Methods: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. Results: CGM devices were placed on 11 patients: Medtronic ( n = 6) and Dexcom G6 ( n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of −17.76 mg/dL (Medtronic) and −1.94 mg/dL (Dexcom), with wide 95% limits of agreement. Conclusions: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.

scholarly journals Interstitium versus Blood Equilibrium in Glucose Concentration and its Impact on Subcutaneous Continuous Glucose Monitoring Systems

2010 ◽  
Vol 10 (1) ◽  
pp. 36 ◽  
Author(s):  
Cosimo Scuffi ◽  
Keyword(s):  
Blood Glucose ◽  
Continuous Glucose Monitoring ◽  
Glucose Concentration ◽  
Interstitial Fluid ◽  
Glucose Monitoring ◽  
Foreign Body Response ◽  
Monitoring Systems ◽  
Glucose Levels ◽  
Consequent Reduction ◽  
The Impact

The relationship between both interstitial and blood glucose remains a debated topic, on which there is still no consensus. The experimental evidence suggests that blood and interstitial fluid glucose levels are correlated by a kinetic equilibrium, which as a consequence has a time and magnitude gradient in glucose concentration between blood and interstitium. Furthermore, this equilibrium can be perturbed by several physiological effects (such as foreign body response, wound-healing effect, etc.), with a consequent reduction of interstitial fluid glucose versus blood glucose correlation. In the present study, the impact of operating in the interstitium on continuous glucose monitoring systems (CGMs) will be discussed in depth, both for the application of CGMs in the management of diabetes and in other critical areas, such as tight glycaemic control in critically ill patients.

scholarly journals Assessment of a Noninvasive Chronic Glucose Monitoring System in Euglycemic and Diabetic Swine (Sus scrofa)

2020 ◽  
Author(s):  
Rebecca A Ober ◽  
Gail E Geist
Keyword(s):  
Blood Glucose ◽  
Monitoring System ◽  
Continuous Glucose Monitoring ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Continuous Glucose Monitoring System ◽  
Serum Chemistry ◽  
Continuous Glucose Monitor ◽  
Glucose Levels ◽  
Skin Patch

Models of type-I diabetes are well-characterized and commonly used in the preclinical evaluation of drugs and medical devices. The diabetic minipig is an excellent example of a translational model. However, chronic glucose monitoring in this species can be challenging; frequent blood sampling can be technically difficult and poorly tolerated in conscious swine. Skin-patch continuous blood glucose monitors are FDA-approved for human use and offer a potential refinement to cageside blood collection. However, this modality has not been evaluated in pigs. In this study, young adult male STZ-induced diabetic Yucatan minipigs (n = 4) and healthy York pigs (n = 4) were implanted with a 14-d skin-patch continuous glucose monitor. Readings from continuous glucose monitors were time-matched to whole blood samples, with glucose measurements performed using point-of-care blood glucose monitors, serum chemistry or both. The aims of the study were to assess if a continuous glucose monitoring system could accurately detect glucose levels in swine, and to compare the readings toboth point-of-care glucometers and serum chemistry results. We hypothesized that a continuous glucose monitoring system would accurately detect glucose levels in swine in comparison with a validated analyzer and could serve as an animal welfarerefinement for studies of diabetes. We found that the continuous glucose monitor used in this study provided an adequateadjunct for clinical management in the stable diabetic pig and a minimally invasive and inexpensive option for colony maintenanceof chronically diabetic swine.

Comparison of two glucose-monitoring systems for use in horses

2022 ◽  
pp. 1-7
Author(s):  
Caitlin E. Malik ◽  
David M. Wong ◽  
Katarzyna A. Dembek ◽  
Katherine E. Wilson
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Concentration ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Glucose Absorption ◽  
Monitoring Systems ◽  
Oral Glucose ◽  
Clinically Normal ◽  
Freestyle Libre ◽  
Interstitial Glucose

Abstract OBJECTIVE To determine the accuracy of 2 interstitial glucose-monitoring systems (GMSs) for use in horses compared with a point-of-care (POC) glucometer and standard laboratory enzymatic chemistry method (CHEM). ANIMALS 8 clinically normal adult horses. PROCEDURES One of each GMS device (Dexcom G6 and Freestyle Libre 14-day) was placed on each horse, and blood glucose concentration was measured via POC and CHEM at 33 time points and compared with simultaneous GMS readings. An oral glucose absorption test (OGAT) was performed on day 2, and glucose concentrations were measured and compared. RESULTS Glucose concentrations were significantly correlated with one another between all devices on days 1 to 5. Acceptable agreement was observed between Dexcom G6 and Freestyle Libre 14-day when compared with CHEM on days 1, 3, 4, and 5 with a combined mean bias of 10.45 mg/dL and 1.53 mg/dL, respectively. During dextrose-induced hyperglycemia on day 2, mean bias values for Dexcom G6 (10.49 mg/dL) and FreeStyle Libre 14-day (0.34 mg/dL) showed good agreement with CHEM. CLINICAL RELEVANCE Serial blood glucose measurements are used to diagnose or monitor a variety of conditions in equine medicine; advances in near-continuous interstitial glucose monitoring allow for minimally invasive glucose assessment, thereby reducing stress and discomfort to patients. Data from this study support the use of the Dexcom G6 and Freestyle Libre 14-day interstitial glucose-monitoring systems to estimate blood glucose concentrations in horses.

P6441New continuous glucose monitoring reveals hypoglycemia risk in both diabetic and nondiabetic patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kuroda ◽  
M Kawata ◽  
A Matsuura ◽  
K Adachi ◽  
Y Hirayama ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Mean Amplitude ◽  
Glucose Fluctuation ◽  
Glucose Levels ◽  
Interstitial Glucose ◽  
The Mean ◽  
Artery Disease

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.

Use of Continuous Glucose Monitoring in Patients with Diabetes Mellitus on Peritoneal Dialysis: Correlation with Glycated Hemoglobin and Detection of High Incidence of Unaware Hypoglycemia

2015 ◽  
Vol 41 (1-3) ◽  
pp. 18-24 ◽  
Author(s):  
Ahad Qayyum ◽  
Tahseen A. Chowdhury ◽  
Elizabeth Ley Oei ◽  
Stanley L. Fan
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Glucose Monitoring ◽  
Glycated Hemoglobin ◽  
Glucose Monitoring ◽  
Diabetic Control ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
High Incidence ◽  
Patients With Diabetes ◽  
Interstitial Glucose

Introduction: Glycated hemoglobin is used to assess diabetic control although its accuracy in dialysis has been questioned. How does it compare to the Continuous Glucose Monitoring System (CGMS) in peritoneal dialysis (PD) patients? Methods: We conducted a retrospective analysis of 60 insulin-treated diabetic patients on PD. We determined the mean interstitial glucose concentration and the proportion of patients with hypoglycemia (<4 mmol/l) or hyperglycemia (>11 mmol/l). Results: The correlation between HbA1c and glucose was 0.48, p < 0.0001. Three of 15 patients with HbA1c >75 mmol/mol experienced significant hypoglycemia (14-144 min per day). The patients with frequent episodes of hypoglycemia could not be differentiated from those with frequent hyperglycemia by demographics or PD prescription. Conclusion: HbA1c and average glucose levels measured by the CGMS are only weakly correlated. On its own, HbA1c as an indicator of glycemic control in patients with diabetes on PD appears inadequate. We suggest that the CGMS technology should be more widely adopted.

scholarly journals Correlation between short- and mid-term hemoglobin A1c and glycemic control determined by continuous glucose monitoring

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Jen-Hung Huang ◽  
Yung-Kuo Lin ◽  
Ting-Wei Lee ◽  
Han-Wen Liu ◽  
Yu-Mei Chien ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Hemoglobin A1c ◽  
Glucose Monitoring ◽  
Mean Amplitude ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Before And After ◽  
Patients With Diabetes

Abstract Background Glucose monitoring is vital for glycemic control in patients with diabetes mellitus (DM). Continuous glucose monitoring (CGM) measures whole-day glucose levels. Hemoglobin A1c (HbA1c) is a vital outcome predictor in patients with DM. Methods This study investigated the relationship between HbA1c and CGM, which remained unclear hitherto. Data of patients with DM (n = 91) who received CGM and HbA1c testing (1–3 months before and after CGM) were retrospectively analyzed. Diurnal and nocturnal glucose, highest CGM data (10%, 25%, and 50%), mean amplitude of glycemic excursions (MAGE), percent coefficient of variation (%CV), and continuous overlapping net glycemic action were compared with HbA1c values before and after CGM. Results The CGM results were significantly correlated with HbA1c values measured 1 (r = 0.69) and 2 (r = 0.39) months after CGM and 1 month (r = 0.35) before CGM. However, glucose levels recorded in CGM did not correlate with the HbA1c values 3 months after and 2–3 months before CGM. MAGE and %CV were strongly correlated with HbA1c values 1 and 2 months after CGM, respectively. Diurnal blood glucose levels were significantly correlated with HbA1c values 1–2 months before and 1 month after CGM. The nocturnal blood glucose levels were significantly correlated with HbA1c values 1–3 months before and 1–2 months after CGM. Conclusions CGM can predict HbA1c values within 1 month after CGM in patients with DM.

Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

2021 ◽  
Author(s):  
Georgia M. Davis ◽  
Eileen Faulds ◽  
Tara Walker ◽  
Debbie Vigliotti ◽  
Marina Rabinovich ◽  
...  
Keyword(s):  
Real Time ◽  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Critically Ill Patients ◽  
Insulin Infusion ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Proof Of Concept ◽  
Computerized Decision Support ◽  
Glucose Testing

<b>Objective: </b>The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment (PPE) and reduce potential exposures during COVID-19. <p><b>Design and Methods:</b> We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII) and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 ICU.<b></b></p> <p><b>Results: </b>All nine patients required mechanical ventilation and corticosteroids. Seventy six percent of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients.</p> <p><b>Conclusions: </b>A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion. </p>

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