Future Perspectives in Glucose Monitoring Sensors

The prevalence of diabetes is increasing. Improved glucose control is fundamental to reduce both long-term micro- and macrovascular complications and short-term complications, such as diabetic ketoacidosis and severe hypoglycemia. Frequent blood glucose monitoring is an essential part of diabetes management. However, almost all available blood glucose monitoring devices are invasive. This determines a reduced patient compliance, which in turn reflects negatively on glucose control. Therefore, there is a need to develop noninvasive glucose monitoring devices that will reduce the need of invasive procedures, thus increasing patient compliance and consequently improving quality of life and health of patients with diabetes.

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Self-monitoring Blood Glucose (SMBG): Now and the Future

Journal of Pharmacy Practice ◽

10.1177/0897190003261306 ◽

2004 ◽

Vol 17 (1) ◽

pp. 29-38 ◽

Cited By ~ 13

Author(s):

Amber L. Briggs ◽

Susan Cornell

Keyword(s):

Blood Glucose ◽

Glucose Control ◽

Microvascular Complications ◽

Blood Glucose Control ◽

Glucose Monitoring ◽

The United States ◽

Blood Glucose Monitoring ◽

Self Monitoring ◽

State Management ◽

Monitoring Devices

In 2002, the cost of diabetes in the United States reached $132 billion. There is a well-established relationship between blood glucose control and the risk of diabetes-related complications. Tight blood glucose control, through intensive diabetes therapy, reduces the risk and delays the onset of diabetesrelated microvascular complications. Regular and consistent self-monitoring of blood glucose (SMBG) is and should be a part of all diabetes disease state management programs. Pharmacists can truly increase the numbers of patients who use SMBG by being aware and familiar with the monitoring devices available to patients and identifying the physical and psychological issues surrounding SMBG. Results from SMBG and hemoglobin A1C are the basis formost of the medical decisions made for patients with diabetes. This review discusses the best time for patients to test their blood glucose, information regarding blood glucose monitoring devices, alternative site testing, and the newest technology available in glucose monitoring.

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Measures of Accuracy for Continuous Glucose Monitoring and Blood Glucose Monitoring Devices

Journal of Diabetes Science and Technology ◽

10.1177/1932296818812062 ◽

2018 ◽

Vol 13 (3) ◽

pp. 575-583 ◽

Cited By ~ 6

Author(s):

Guido Freckmann ◽

Stefan Pleus ◽

Mike Grady ◽

Steven Setford ◽

Brian Levy

Keyword(s):

Blood Glucose ◽

Continuous Glucose Monitoring ◽

Measurement Accuracy ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Glucose Measurement ◽

Bias Analysis ◽

Patients With Diabetes ◽

Monitoring Devices ◽

Error Grid

Currently, patients with diabetes may choose between two major types of system for glucose measurement: blood glucose monitoring (BGM) systems measuring glucose within capillary blood and continuous glucose monitoring (CGM) systems measuring glucose within interstitial fluid. Although BGM and CGM systems offer different functionality, both types of system are intended to help users achieve improved glucose control. Another area in which BGM and CGM systems differ is measurement accuracy. In the literature, BGM system accuracy is assessed mainly according to ISO 15197:2013 accuracy requirements, whereas CGM accuracy has hitherto mainly been assessed by MARD, although often results from additional analyses such as bias analysis or error grid analysis are provided. The intention of this review is to provide a comparison of different approaches used to determine the accuracy of BGM and CGM systems and factors that should be considered when using these different measures of accuracy to make comparisons between the analytical performance (ie, accuracy) of BGM and CGM systems. In addition, real-world implications of accuracy and its relevance are discussed.

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Diabetes and COVID-19 Vaccination

Journal of Korean Diabetes ◽

10.4093/jkd.2021.22.4.221 ◽

2021 ◽

Vol 22 (4) ◽

pp. 221-224

Author(s):

Hae Dong Choi ◽

Jun Sung Moon

Keyword(s):

Immune Response ◽

Blood Glucose ◽

Clinical Outcomes ◽

Glucose Control ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Effective Strategy ◽

Risk Of Mortality ◽

Increased Risk ◽

Patients With Diabetes

Diabetes is one of the major comorbidities associated with increased risk of mortality and severe clinical outcomes in coronavirus disease 19 (COVID-19) patients. Thus, timely and appropriate vaccination is the most effective strategy for mitigating the risk of COVID-19 infection in people with diabetes. Recent studies have shown that immune response after vaccination is significant in both diabetes and non-diabetes groups, but slightly lower in patients with diabetes. Inadequate glucose control might impair the immune response. Blood glucose monitoring is required more often than usual for several days after vaccination. If a patient’s blood glucose is not controlled adequately, appropriate management should be provided.

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

Journal of Breath Research ◽

10.1088/1752-7163/ac4610 ◽

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.

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Applying Parkes Grid Method to Evaluate Impact of Variation in Blood Glucose Monitoring (BGM) Strip Accuracy Performance in Type 1 Diabetes Highlights the Potential for Amplification of Imprecision With Less Accurate BGM Strips

Journal of Diabetes Science and Technology ◽

10.1177/1932296820905880 ◽

2020 ◽

Vol 15 (1) ◽

pp. 76-81 ◽

Cited By ~ 2

Author(s):

Michael Stedman ◽

Rustam Rea ◽

Christopher J. Duff ◽

Mark Livingston ◽

Gabriela Moreno ◽

...

Keyword(s):

Blood Glucose ◽

Clinical Outcomes ◽

Glucose Monitoring ◽

Grid Method ◽

Clinical Decision ◽

Glucose Variability ◽

Blood Glucose Monitoring ◽

Real World Data ◽

Almost All ◽

Error Grid

Background: The National Health Service spends £170 million on blood glucose monitoring (BGM) strips each year and there are pressures to use cheaper less accurate strips. Technology is also being used to increase test frequency with less focus on accuracy. Previous modeling/real-world data analysis highlighted that actual blood glucose variability can be more than twice blood glucose meter reported variability (BGMV). We applied those results to the Parkes error grid to highlight potential clinical impact. Method: BGMV is defined as the percent of deviation from reference that contains 95% of results. Four categories were modeled: laboratory (<5%), high accuracy strips (<10%), ISO 2013 (<15%), and ISO 2003 (<20%) (includes some strips still used). The Parkes error grid model with its associated category of risk including “alter clinical decision” and “affect clinical outcomes” was used, with the profile of frequency of expected results fitted into each BGM accuracy category. Results: Applying to single readings, almost all strip accuracy ranges derived in a controlled setting fell within the category: clinically accurate/no effect on outcomes areas. However modeling the possible blood glucose distribution in more detail, 30.6% of longer term results of the strips with current ISO accuracy would fall into the “alter clinical action” category. For previous ISO strips, this rose to 44.1%, and for the latest higher accuracy strips, this fell to 12.8%. Conclusion: There is a minimum standard of accuracy needed to ensure that clinical outcomes are not put at risk. This study highlights the potential for amplification of imprecision with less accurate BGM strips.

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

European Endocrinology ◽

10.17925/ee.2012.08.01.22 ◽

2010 ◽

Vol 8 (1) ◽

pp. 22

Author(s):

William L Clarke ◽

Keyword(s):

Blood Glucose ◽

Diabetes Management ◽

Artificial Pancreas ◽

Glucose Monitoring ◽

Glycated Haemoglobin ◽

Blood Glucose Monitoring ◽

Nocturnal Hypoglycaemia ◽

Intensive Glucose Control ◽

Glycaemic Variability ◽

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 (DCCT), reduce glycated haemoglobin (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 hypoglycaemia, lowering HbA1c levels and reducing glycaemic 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.

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Can Blood Glucose Monitoring be Simplified/Modified in Order to Achieve Better Diabetes Management—Perspectives for the Future

US Endocrinology ◽

10.17925/use.2010.06.1.48 ◽

2010 ◽

Vol 06 (01) ◽

pp. 48

Author(s):

Robert M Cuddihy ◽

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Diabetes Management ◽

Healthcare Providers ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Clear Understanding ◽

Major Advance ◽

Oral Agents

Self-monitoring of blood glucose (SMBG) with reflectance meters was heralded as a major advance in the management of diabetes and has been available to individuals with diabetes for home use since the late 1970s. This tool was put to use in the landmark Diabetes Control and Complications Trial (DCCT), which revolutionized care for individuals with type 1 diabetes, enabling these individuals to intensify their glucose control. SMBG has similar benefit in individuals with type 2 diabetes requiring insulin therapy. Its use in other individuals with type 2 diabetes treated with oral agents or non-insulin therapies is less clear. While SMBG is a potentially powerful tool to aid in the daily management of diabetes, to be used effectively, SMBG must be optimized to ensure the information derived from it can be acted on to modify physical activity, dietary intake, or medications to improve glycemic control. Recently, studies looking at this population have called into question the utility of SMBG in the management of individuals with type 2 diabetes treated with non-insulin therapies. However, these studies are lacking in the specifics of how such information was used to modify therapies. In addition to this, the lack of a universally accepted output for SMBG data significantly impedes its uptake and appropriate use by healthcare providers and patients. To maximize the effectiveness of SMBG, both patients and providers need to have a clear understanding of when and how to use SMBG data and, most importantly, act upon the data to effect a change in their diabetes management.

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Evaluation of information retention and adherence to treatment in patients with gestational diabetes mellitus after multidisciplinary group

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.03.212 ◽

2016 ◽

Vol 62 (3) ◽

pp. 212-217 ◽

Cited By ~ 4

Author(s):

Ana Maria da Silva Sousa ◽

Daine Fiuza ◽

Fernanda Cristina Ferreira Mikami ◽

Karen Cristine Abrão ◽

Rossana Pulcineli Vieira Francisco ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Diabetes Management ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Contact Method ◽

Information Retention ◽

Multidisciplinary Group

SUMMARY Objective: To evaluate the retention of information after participation in multidisciplinary group in patients with gestational diabetes mellitus (GDM) through a phone contact. Method: 122 pregnant women diagnosed with gestational diabetes were included. After diagnosis of gestational diabetes, the patients were referred to the multidisciplinary group where they received medical, nutrition and nursing guidelines related to the disease. After three days these patients received one telephone call from a nurse, who made the same questions regarding the information received. In the statistical analysis, results were presented as absolute and relative frequencies. Results: Most patients 119/122 patients (97.5%) were managing to do self glucose monitoring. Twenty-one patients (17.2%) reported having difficulty performing the blood glucose, especially finger pricking. When questioning whether the woman was following the proposed diet, 24/122 (19.7%) patients said they did not; the meal frequency was not reached by 23/122 (18.9%) of the women, and forty-seven (38.5%) of the women reported having ingested sugar in the days following the guidance in multidisciplinary group. Conclusion: Regarding the proposed treatment, there was good adherence of patients, especially in relation to blood glucose monitoring. As for nutritional control, we observed greater difficulty in following the guidelines demonstrating the need for long-term monitoring, as well as further clarification to the patients about the importance of nutrition in diabetes management.

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