154-OR: People Who Get More Hours of Sleep Have Lower Mean Glucose: Analysis of Continuous Glucose Monitoring and Fitbit Data in a Free-Living Population without Diabetes

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 154-OR
Author(s):  
MARGARET A. CRAWFORD ◽  
SARAH K. PICKUS ◽  
KAZANNA C. HAMES ◽  
MATTHEW JOHNSON ◽  
ILENE J. KLEIN ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Free Living ◽  
Mean Glucose ◽  
Glucose Analysis

Utility of Continuous Glucose Monitoring vs. Meal Study in Detecting Hypoglycemia After Gastric Bypass

2021 ◽  
Author(s):  
Henri Honka ◽  
Janet Chuang ◽  
David D’Alessio ◽  
Marzieh Salehi
Keyword(s):  
Gastric Bypass ◽  
Continuous Glucose Monitoring ◽  
Gastric Bypass Surgery ◽  
Late Complication ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Postprandial Glucose ◽  
Healthy Weight ◽  
Free Living ◽  
Carbohydrate Ingestion

Abstract Context Gastric bypass (GB) increases postprandial glucose excursion, which in turn can predispose to the late complication of hypoglycemia. Diagnosis remains challenging and requires documentation of symptoms associated with low glucose, and relief of symptom when glucose is normalized (Whipple’s triad). Objective To compare the yield of mixed meal test (MMT) and continuous glucose monitoring system (CGMS) in detecting hypoglycemia after gastric bypass surgery (GB). Setting The study was conducted at General Clinical Research Unit, Cincinnati Children’s Hospital (Cincinnati, OH, United States). Methods Glucose profiles were evaluated in 15 patients with documented recurrent clinical hypoglycemia after GB, 8 matched asymptomatic GB subjects, and 9 healthy weight-matched non-operated controls using MMT in a control setting and CGMS under free-living conditions. Results Patients with prior GB had larger glucose variability during both MMT and CGMS when compared to non-surgical controls regardless of their hypoglycemic status. Sensitivity (71 vs. 47 %) and specificity (100 vs. 88 %) of MMT in detecting hypoglycemia was superior to CGMS. Conclusions Our findings indicate that a fixed carbohydrate ingestion during MMT is a more reliable test to diagnose GB-related hypoglycemia compared to CGMS during free-living state.

scholarly journals Glucose Control in the Intensive Care Unit by Use of Continuous Glucose Monitoring: What Level of Measurement Error Is Acceptable?

2014 ◽  
Vol 60 (12) ◽  
pp. 1500-1509 ◽  
Author(s):  
Malgorzata E Wilinska ◽  
Roman Hovorka
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Measurement Error ◽  
Continuous Glucose Monitoring ◽  
Glucose Control ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Glucose Measurement ◽  
Target Range ◽  
Mean Glucose

Abstract BACKGROUND Accuracy and frequency of glucose measurement is essential to achieve safe and efficacious glucose control in the intensive care unit. Emerging continuous glucose monitors provide frequent measurements, trending information, and alarms. The objective of this study was to establish the level of accuracy of continuous glucose monitoring (CGM) associated with safe and efficacious glucose control in the intensive care unit. METHODS We evaluated 3 established glucose control protocols [Yale, University of Washington, and Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR)] by use of computer simulations. Insulin delivery was informed by intermittent blood glucose (BG) measurements or CGM levels with an increasing level of measurement error. Measures of glucose control included mean glucose, glucose variability, proportion of time glucose was in target range, and hypoglycemia episodes. RESULTS Apart from the Washington protocol, CGM with mean absolute relative deviation (MARD) ≤15% resulted in similar mean glucose as with the use of intermittent BG measurements. Glucose variability was also similar between CGM and BG-informed protocols. Frequency and duration of hypoglycemia were not worse by use of CGM with MARD ≤10%. Measures of glucose control varied more between protocols than at different levels of the CGM error. CONCLUSIONS The efficacy of CGM-informed and BG-informed commonly used glucose protocols is similar, but the risk of hypoglycemia may be reduced by use of CGM with MARD ≤10%. Protocol choice has greater influence on glucose control measures than the glucose measurement method.

scholarly journals Eight-Point Glucose Testing Versus the Continuous Glucose Monitoring System in Evaluation of Glycemic Control in Type 1 Diabetes

2005 ◽  
Vol 90 (6) ◽  
pp. 3387-3391 ◽  
Keyword(s):  
Type 1 Diabetes ◽  
Monitoring System ◽  
Continuous Glucose Monitoring ◽  
Hemoglobin A1c ◽  
Glucose Monitoring ◽  
Continuous Glucose Monitoring System ◽  
Diabetes Research ◽  
Glucose Profiles ◽  
Mean Glucose

Context: Advantages/disadvantages of continuous vs. discrete glucose monitoring are not well documented. Objective: Compare glucose profiles from home meters vs. continuous sensors. Design: Randomized clinical trial conducted by the Diabetes Research in Children Network (DirecNet) to assess the utility of the GlucoWatch G2 Biographer. Setting: Home glucose measurements. Patients: Two hundred children (age, 7 to < 18 yr) with type 1 diabetes. Intervention: At baseline, subjects were asked to wear the continuous glucose monitoring system (CGMS) sensor and perform meter tests at eight prespecified times of the day (eight-point testing) each for 3 d (2 d using both, 1 d eight-point testing only, 1 d CGMS only). Hemoglobin A1c was measured in a central laboratory. Main Outcome Measure: Six-month hemoglobin A1c. This analysis looked at baseline glucose profiles/hemoglobin A1c. Results: Only 10% of subjects completed full eight-point testing for 3 d, but median CGMS use was 70 h. Mean glucose was lower when measured by the CGMS compared with eight-point testing (183 ± 37 vs. 188 ± 41 mg/dl; 10.2 ± 2.1 vs.10.4 ± 2.3 mmol/liter; P = 0.009), especially overnight (2400–0400 h; 174 vs. 199 mg/dl; 9.7 vs. 11.1 mmol/liter; P < 0.001). Associations of hemoglobin A1c with mean glucose were similar for eight-point testing [slope 23 mg/dl per 1% (1.3 mmol/liter); correlation 0.40; P < 0.001] and CGMS [slope 19 mg/dl per 1% (1.1 mmol/liter); correlation 0.39; P < 0.001]. Postprandial excursions were lower for eight-point testing vs. CGMS, especially after dinner (mean excursion −17 vs. 63 mg/dl; −1.0 vs. 3.5 mmol/liter; P < 0.001). Conclusions: Both methods gave similar mean glucose profiles and associations with hemoglobin A1c. Advantages of the CGMS were higher density of data and better detection of postprandial peaks. However, the CGMS may overestimate the frequency of low glucose levels, especially overnight.

scholarly journals The Use of HbA1c, Glycated Albumin and Continuous Glucose Monitoring to Assess Glucose Control in the Chronic Kidney Disease Population Including Dialysis

Nephron ◽  
2020 ◽  
Vol 145 (1) ◽  
pp. 14-19
Author(s):  
Tobias Bomholt ◽  
Therese Adrian ◽  
Kirsten Nørgaard ◽  
Ajenthen G. Ranjan ◽  
Thomas Almdal ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Glycated Albumin ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Glycated Haemoglobin ◽  
Time Data ◽  
Precise Estimation ◽  
Patients With Diabetes ◽  
Mean Glucose

<b><i>Background:</i></b> Glycated haemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) has limitations as a glycemic marker for patients with diabetes and CKD and for those receiving dialysis. Glycated albumin is an alternative glycemic marker, and some studies have found that glycated albumin more accurately reflects glycemic control than HbA<sub>1c</sub> in these groups. However, several factors are known to influence the value of glycated albumin including proteinuria. Continuous glucose monitoring (CGM) is another alternative to HbA<sub>1c</sub>. CGM allows one to assess mean glucose, glucose variability, and the time spent in hypo-, normo-, and hyperglycemia. Currently, several different CGM models are approved for use in patients receiving dialysis; CKD (not on dialysis) is not a contraindication in any of these models. Some devices are for blind recording, while others provide real-time data to patients. Small studies suggest that CGM could improve glycemic control in hemodialysis patients, but this has not been studied for individual CKD stages. <b><i>Summary:</i></b> Glycated albumin and CGM avoid the pitfalls of HbA<sub>1c</sub> in CKD and dialysis populations. However, the value of glycated albumin may be affected by several factors. CGM provides a precise estimation of the mean glucose. Here, we discuss the strengths and limitations for using HbA1c, glycated albumin, or CGM in CKD and dialysis population. <b><i>Key Messages:</i></b> Glycated albumin is an alternative glycemic marker but is affected by proteinuria. CGM provides a precise estimation of mean glucose and glucose variability. It remains unclear if CGM improves glycemic control in the CKD and dialysis populations.

scholarly journals Real-World Hypoglycemia Avoidance With a Predictive Low Glucose Alert Does Not Depend on Frequent Screen Views

2019 ◽  
Vol 14 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Sarah Puhr ◽  
Mark Derdzinski ◽  
Andrew Scott Parker ◽  
John B. Welsh ◽  
David A. Price
Keyword(s):  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Mobile App ◽  
Convenience Sample ◽  
Minute Interval ◽  
Patients With Diabetes ◽  
Low Glucose ◽  
Device Interaction ◽  
Mean Glucose ◽  
Monitoring Devices

Background: Frequent real-time continuous glucose monitoring (rtCGM) data viewing has been associated with reduced mean glucose and frequent scanning of an intermittently scanned continuous glucose monitoring (isCGM) system has been associated with reduced hypoglycemia for patients with diabetes. However, requiring patients to frequently interact with their glucose monitoring devices to detect actual or impending hypoglycemia is burdensome. We hypothesized that a predictive low glucose alert, which forecasts glucose ≤55 mg/dL within 20 minutes and is included in a new rtCGM system, could mitigate hypoglycemia without requiring frequent device interaction. Methods: We analyzed estimated glucose values (EGVs) from an anonymized convenience sample of 15,000 patients who used Dexcom G6 (Dexcom, Inc, San Diego, CA, USA) and its mobile app for at least 30 days with or without the “Urgent Low Soon” alert (ULS) enabled. Screen view frequency was determined as the frequency with which the trend screen was accessed on the app. Multiple screen views within any 5-minute interval were counted as one. Hypoglycemia exposure for patients in the top and bottom quartiles of screen view frequency (>8.25 and <3.30 per day, respectively) was calculated as the percentage of EGVs below various thresholds. Results: Over 93% of users enabled the ULS alert; its use was associated with significantly reduced hypoglycemia <55 and <70 mg/dL, independent of screen view frequency. Conclusion: Use of the G6 ULS alert may disencumber rtCGM users by promoting significant reductions in hypoglycemia without requiring frequent device interactions.

scholarly journals Accuracy of Continuous Glucose Monitoring During Three Closed-Loop Home Studies Under Free-Living Conditions

2015 ◽  
Vol 17 (11) ◽  
pp. 801-807 ◽  
Author(s):  
Hood Thabit ◽  
Lalantha Leelarathna ◽  
Malgorzata E. Wilinska ◽  
Daniella Elleri ◽  
Janet M. Allen ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Closed Loop ◽  
Glucose Monitoring ◽  
Living Conditions ◽  
Free Living ◽  
Free Living Conditions

scholarly journals The Bihormonal Bionic Pancreas Improves Glycemic Control in Individuals With Hyperinsulinism and Postpancreatectomy Diabetes— A Pilot Study

2021 ◽  
Author(s):  
Arpana Rayannavar ◽  
Lauren M. Mitteer ◽  
Courtney A. Balliro ◽  
Firas H. El-Khatib ◽  
Katherine L. Lord ◽  
...  
Keyword(s):  
Pilot Study ◽  
Glycemic Control ◽  
Usual Care ◽  
Continuous Glucose Monitoring ◽  
Glucose Concentration ◽  
Glucose Monitoring ◽  
Congenital Hyperinsulinism ◽  
Open Label ◽  
Mean Glucose

<i>Objective:</i> To determine if the bihormonal bionic pancreas (BHBP) improves glycemic control and reduces hypoglycemia in individuals with congenital hyperinsulinism (HI) and post-pancreatectomy diabetes (PPD) compared with usual care (UC). <p><i>Methods</i>: Ten subjects with HI and PPD completed this open-label, crossover pilot study. Co-primary outcomes were mean glucose concentration and time with continuous glucose monitoring (CGM) glucose concentration <3.3 mmol/L.</p> <p><i>Results</i>: Mean (SD) CGM glucose concentration was 8.3 mmol/L (0.7) in the BHBP period vs. 9 mmol/L (1.8) in the UC period (p=0.13). Mean (SD) time with CGM glucose concentration <3.3 mmol/L was 0% (0.002) in the BHBP period vs. 1.3% (0.018) in the UC period (p=0.11). </p> <p><i>Conclusion</i>: Relative to UC, the BHBP resulted in comparable glycemic control in our population. </p>

Continuous Glucose Monitoring System in Free-Living Healthy Subjects: Results from a Pilot Study

2009 ◽  
Vol 11 (3) ◽  
pp. 159-169 ◽  
Author(s):  
Giuseppe Derosa ◽  
Sibilla A.T. Salvadeo ◽  
Roberto Mereu ◽  
Angela D'Angelo ◽  
Leonardina Ciccarelli ◽  
...  
Keyword(s):  
Pilot Study ◽  
Monitoring System ◽  
Continuous Glucose Monitoring ◽  
Healthy Subjects ◽  
Glucose Monitoring ◽  
Continuous Glucose Monitoring System ◽  
Free Living

scholarly journals The Bihormonal Bionic Pancreas Improves Glycemic Control in Individuals With Hyperinsulinism and Postpancreatectomy Diabetes— A Pilot Study

2021 ◽  
Author(s):  
Arpana Rayannavar ◽  
Lauren M. Mitteer ◽  
Courtney A. Balliro ◽  
Firas H. El-Khatib ◽  
Katherine L. Lord ◽  
...  
Keyword(s):  
Pilot Study ◽  
Glycemic Control ◽  
Usual Care ◽  
Continuous Glucose Monitoring ◽  
Glucose Concentration ◽  
Glucose Monitoring ◽  
Congenital Hyperinsulinism ◽  
Open Label ◽  
Mean Glucose

<i>Objective:</i> To determine if the bihormonal bionic pancreas (BHBP) improves glycemic control and reduces hypoglycemia in individuals with congenital hyperinsulinism (HI) and post-pancreatectomy diabetes (PPD) compared with usual care (UC). <p><i>Methods</i>: Ten subjects with HI and PPD completed this open-label, crossover pilot study. Co-primary outcomes were mean glucose concentration and time with continuous glucose monitoring (CGM) glucose concentration <3.3 mmol/L.</p> <p><i>Results</i>: Mean (SD) CGM glucose concentration was 8.3 mmol/L (0.7) in the BHBP period vs. 9 mmol/L (1.8) in the UC period (p=0.13). Mean (SD) time with CGM glucose concentration <3.3 mmol/L was 0% (0.002) in the BHBP period vs. 1.3% (0.018) in the UC period (p=0.11). </p> <p><i>Conclusion</i>: Relative to UC, the BHBP resulted in comparable glycemic control in our population. </p>

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