Ramadan Fasting: A Study of Changes in Glucose Profiles Among Patients With Diabetes Using Continuous Glucose Monitoring

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.

Download Full-text

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

Blood Purification ◽

10.1159/000439242 ◽

2015 ◽

Vol 41 (1-3) ◽

pp. 18-24 ◽

Cited By ~ 7

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.

Download Full-text

Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Diabetes

10.2337/figshare.14454357.v1 ◽

2021 ◽

Author(s):

Georgia M. Davis ◽

Elias K. Spanakis ◽

Alexandra L. Migdal ◽

Lakshmi G. Singh ◽

Bonnie Albury ◽

...

Keyword(s):

Critically Ill ◽

Continuous Glucose Monitoring ◽

Diabetes Management ◽

Glucose Monitoring ◽

Relative Difference ◽

Hospitalized Patients ◽

Matched Pair ◽

Patients With Diabetes ◽

Clarke Error Grid ◽

Error Grid

Background: Advances in continuous glucose monitoring (CGM) have transformed ambulatory diabetes management. Until recently, inpatient use of CGM has remained investigational with limited data on its accuracy in the hospital setting. Methods: To analyze the accuracy of Dexcom G6 CGM, we compared retrospective matched-pair CGM and capillary point-of-care (POC) glucose data from three inpatient CGM studies (two interventional and one observational) in general medicine and surgery patients with diabetes treated with insulin. Analysis of accuracy metrics included mean absolute relative difference (MARD), median absolute relative difference (ARD), and proportion of CGM values within ±15, 20 and 30% or ±15, 20 and 30 mg/dL of POC reference values for blood glucose >100 mg/dL or ≤100 mg/dL, respectively (?/15, /20, 0/30). Clinical reliability was assessed using Clarke error grid analyses. Results: A total of 218 patients were included (96% with type 2 diabetes) with a mean age of 60.6 ± 12 years. The overall MARD (n=4,067 matched glucose pairs) was 12.8% and median ARD was 10.1% [IQR 4.6, 17.6]. The proportion of readings meeting ?/15, /20 and 0/30 criteria were 68.7, 81.7, and 93.8%. Clarke error grid analysis showed 98.7% of all values in zones A+B. MARD and median ARD were higher in hypoglycemia (<70mg/dL) and severe anemia (hemoglobin <7g/dL). Conclusion: Our results indicate that CGM technology is a reliable tool for hospital use and may help improve glucose monitoring in non-critically ill hospitalized patients with diabetes.

Download Full-text