scholarly journals A Comprehensive Review of Continuous Glucose Monitoring Accuracy during Exercise Periods

Sensors ◽  
2021 ◽  
Vol 21 (2) ◽  
pp. 479
Author(s):  
Elena Muñoz Fabra ◽  
José-Luis Díez ◽  
Jorge Bondia ◽  
Alejandro José Laguna Sanz
Keyword(s):  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Artificial Pancreas ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Extensive Literature ◽  
Integrated Sensor ◽  
Monitoring Accuracy ◽  
The Mean

Continuous Glucose Monitoring (CGM) has been a springboard of new diabetes management technologies such as integrated sensor-pump systems, the artificial pancreas, and more recently, smart pens. It also allows patients to make better informed decisions compared to a few measurements per day from a glucometer. However, CGM accuracy is reportedly affected during exercise periods, which can impact the effectiveness of CGM-based treatments. In this review, several studies that used CGM during exercise periods are scrutinized. An extensive literature review of clinical trials including exercise and CGM in type 1 diabetes was conducted. The gathered data were critically analysed, especially the Mean Absolute Relative Difference (MARD), as the main metric of glucose accuracy. Most papers did not provide accuracy metrics that differentiated between exercise and rest (non-exercise) periods, which hindered comparative data analysis. Nevertheless, the statistic results confirmed that CGM during exercise periods is less accurate.

scholarly journals Variation of Mean Absolute Relative Differences of Continuous Glucose Monitoring Systems Throughout the Day

2021 ◽  
pp. 193229682199237
Author(s):  
Stefan Pleus ◽  
Andreas Stuhr ◽  
Manuela Link ◽  
Cornelia Haug ◽  
Guido Freckmann
Keyword(s):  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Number Of Factors ◽  
Marked Variability ◽  
Therapeutic Decisions ◽  
Complete Study ◽  
The Mean ◽  
Relative Differences

Background: There is an increasing use of continuous glucose monitoring (CGM) by people with diabetes. Measurement performance is often characterized by the mean absolute relative difference (MARD). However, MARD is influenced by a number of factors and little is known about whether MARD is stable throughout the day. Material and Methods: A total of 24 participants with type 1 diabetes were enrolled in the study. The study was performed for seven in-patient days. Participants wore two CGM systems in parallel and performed additional frequent blood glucose (BG) measurements. On two days, glucose excursions were induced. MARD was calculated between pairs of CGM and BG values, with BG values serving as reference values. ARD values calculated from CGM-BG pairs were grouped by hour of the day. Results were analyzed separately for glucose excursion days and for regular days. Results: Total MARDs for the complete study duration were 12.5% ± 3.6% and 13.2% ± 2.4% ( n = 24). Throughout the day marked variability of MARD was observed (8.0% ± 1.3%-16.3% ± 2.9% (G5); 9.1% ± 1.4%-16.3% ± 5.3% (FL), up to n = 157 each). Low(est) MARD values were observed before breakfast and dinner, when subjects were in or near a fasting state. Especially after breakfast and lunch, MARD values were higher than average. Conclusions: Analytical performance of the two CGM systems, assessed by MARD, was found to vary markedly throughout the day. Activities of daily life likely triggered these variations. An increasing number of CGM users base therapeutic decisions on CGM values, and they should be aware of these variations of performance throughout the day.

scholarly journals Functional data analysis and prediction tools for continuous glucose-monitoring studies

2020 ◽  
pp. 1-10
Author(s):  
Emrah Gecili ◽  
Rui Huang ◽  
Jane C. Khoury ◽  
Eileen King ◽  
Mekibib Altaye ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Functional Data ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Patient Specific ◽  
Prediction Errors ◽  
Medical Monitoring

Abstract Introduction: To identify phenotypes of type 1 diabetes based on glucose curves from continuous glucose-monitoring (CGM) using functional data (FD) analysis to account for longitudinal glucose patterns. We present a reliable prediction model that can accurately predict glycemic levels based on past data collected from the CGM sensor and real-time risk of hypo-/hyperglycemic for individuals with type 1 diabetes. Methods: A longitudinal cohort study of 443 type 1 diabetes patients with CGM data from a completed trial. The FD analysis approach, sparse functional principal components (FPCs) analysis was used to identify phenotypes of type 1 diabetes glycemic variation. We employed a nonstationary stochastic linear mixed-effects model (LME) that accommodates between-patient and within-patient heterogeneity to predict glycemic levels and real-time risk of hypo-/hyperglycemic by creating specific target functions for these excursions. Results: The majority of the variation (73%) in glucose trajectories was explained by the first two FPCs. Higher order variation in the CGM profiles occurred during weeknights, although variation was higher on weekends. The model has low prediction errors and yields accurate predictions for both glucose levels and real-time risk of glycemic excursions. Conclusions: By identifying these distinct longitudinal patterns as phenotypes, interventions can be targeted to optimize type 1 diabetes management for subgroups at the highest risk for compromised long-term outcomes such as cardiac disease or stroke. Further, the estimated change/variability in an individual’s glucose trajectory can be used to establish clinically meaningful and patient-specific thresholds that, when coupled with probabilistic predictive inference, provide a useful medical-monitoring tool.

scholarly journals A Review of the First Long-term Implantable Continuous Glucose Monitoring System Available in the United States

2019 ◽  
Vol 15 (1) ◽  
pp. 160-166 ◽  
Author(s):  
Kevin Cowart
Keyword(s):  
Diabetes Mellitus ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
The United States ◽  
Relative Difference ◽  
Cochrane Library ◽  
Additional Clinical Trial ◽  
Novel Approach

Background: Although real-time continuous glucose monitoring (rtCGM) has been shown to improve glycemic control in patients with type 1 diabetes mellitus and type 2 diabetes mellitus treated with insulin, rates of adoption have been low. A novel approach, with the use of a long-term implantable continuous glucose monitoring (LTI CGM) has the potential to overcome barriers to rtCGM. The purpose of this review is to provide a background on the first LTI CGM technology to be approved, along with a review of contraindications, interference, safety, accuracy, and efficacy. Considerations for patient selection are discussed based on the available evidence. Methods: PubMed, EMBASE, and Cochrane Library were searched for keywords and subject headings to identify studies assessing LTI CGM. Results: Seven studies were identified which assessed LTI CGM. Mean absolute relative difference is similar to available CGM devices. Rates of adverse events were low. Change in hemoglobin A1c with LTI CGM may be comparable to rtCGM. Conclusions: Based on the available evidence, LTI CGM appears to be safe and accurate. Additional clinical trial investigation is warranted to evaluate the glycemic efficacy of LTI CGM.

scholarly journals Predictive Factors of the Adherence to Real-Time Continuous Glucose Monitoring Sensors: A Prospective Observational Study (PARCS STUDY)

2020 ◽  
pp. 193229682093920
Author(s):  
Takashi Murata ◽  
Akio Kuroda ◽  
Munehide Matsuhisa ◽  
Masao Toyoda ◽  
Moritsugu Kimura ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Prospective Observational Study ◽  
Insulin Infusion ◽  
Glucose Monitoring ◽  
Self Monitoring ◽  
Related Quality ◽  
The Mean ◽  
One Year

Background: Information about factors related to better adherence to continuous glucose monitoring (CGM) sensor adherence is quite limited. Materials and Methods: Forty-six participants with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) without CGM were recruited. The participants’ characteristics and diabetes-related quality of life (QOL) were evaluated at baseline and one year after starting to use CGM. Participants wearing the sensor for ≥60% of the time were considered as adherent. Results: The mean age of the 46 participants was 44.1 ± 15.0 years old and the mean glycohemoglobin (HbA1c) was 7.7 ± 1.0%; 60.9% of the participants were classified as adherent. The duration of using CSII was longer in the adherent group, and the degree of diabetic retinopathy was significantly different. There were no significant differences in age, frequency of self-monitoring of blood glucose, or Hypoglycemia Fear Survey (HFS-B for behavior, HFS-W for worry) score at baseline between the adherent and nonadherent groups. The Problem Areas in Diabetes (PAID) score at baseline was significantly higher and the total CSII-QOL score at baseline was significantly lower in the adherent group. The usage of dual-wave bolus was significantly increased in the adherent group (34.6%-61.5%, P = .016), but not in the nonadherent group (33.3%-33.3%, P > .999). The HbA1c level showed a significant improvement in the adherent group (7.8%-7.3%, P < .001), but not in the nonadherent group (7.5%-7.2%, P = .102). Conclusions: Higher adherence to CGM sensors may be associated with a heavier emotional burden of diabetes and a worse QOL in relation to CSII at baseline.

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

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

<b>Background: </b>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. <p><b>Methods: </b>To analyze the accuracy of Dexcom G6 CGM,<b> </b>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.</p> <p><b>Results: </b>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).</p> <p><b>Conclusion: </b>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. </p>

scholarly journals Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes Mellitus

2020 ◽  
pp. 193229682091889 ◽  
Author(s):  
Rachel S. Rigo ◽  
Laura E. Levin ◽  
Donald V. Belsito ◽  
Maria C. Garzon ◽  
Rachelle Gandica ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Diabetes Management ◽  
Demographic Data ◽  
Glucose Monitoring ◽  
Subcutaneous Insulin ◽  
Cutaneous Reactions

Background: Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are the standard of care for type 1 diabetes in children. There is little reported on device-related skin complications and treatment options. This study documents cutaneous reactions to CGM and CSII devices in children and young adults with type 1 diabetes. Methods: One hundred and twenty-one subjects (3-25 years) with type 1 diabetes and CGM and/or CSII use were recruited over a three-month period from the Naomi Berrie Diabetes Center at Columbia University Irving Medical Center. A five-question survey was completed for each subject detailing demographic data, diabetes management, and device-related skin complications. Results: Sixty percent of subjects reported skin complications related to CGM and/or CSII use. Terms most frequently used to describe cutaneous reactions were “red,” “itchy,” “painful,” and “rash.” Subjects who used both CGM and CSII were more likely to report skin problems than those who used only CSII (odds ratio 2.9, [95% confidence interval: 1.2-6.7]; P = .015). There were no associations between skin complications and sex or race/ethnicity. Twenty-two percent of subjects with adverse skin event(s) discontinued use of a device due to their skin problem. Seven percent were evaluated by a dermatologist. Eighty-one percent used a range of products to treat their symptoms, with variable perceived clinical outcomes. Conclusions: Skin complications related to CSII or CGM devices are commonly reported in pediatric patients with type 1 diabetes and may lead to interruption or discontinuation of device use. Future studies are needed to elucidate the causes of these reactions and determine the best methods for prevention.

scholarly journals Technology for Augmenting Type 1 Diabetes Mellitus Management

2019 ◽  
Vol 24 (2) ◽  
pp. 99-106
Author(s):  
Michelle Condren ◽  
Samie Sabet ◽  
Laura J. Chalmers ◽  
Taylor Saley ◽  
Jenna Hopwood
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Delivery ◽  
Diabetes Mellitus Management

Type 1 diabetes mellitus has witnessed significant progress in its management over the past several decades. This review highlights technologic advancements in type 1 diabetes management. Continuous glucose monitoring systems are now available at various functionality and cost levels, addressing diverse patient needs, including a recently US Food and Drug Administration (FDA)–approved implantable continuous glucose monitoring system (CGMS). Another dimension to these state-of-the-art technologies is CGMS and insulin pump integration. These integrations have allowed for CGMS-based adjustments to basal insulin delivery rates and suspension of insulin delivery when a low blood glucose event is predicted. This review also includes a brief discussion of upcoming technologies such as patch-based CGMS and insulin-glucagon dual-hormonal delivery.

Realtime Continuous Glucose Monitoring in Children and Adolescents— An Overview of the Current Technology and its Impact on Patient Outcomes

2012 ◽  
Vol 08 (01) ◽  
pp. 30
Author(s):  
Jeniece Trast ◽  
Neesha Ramchandani ◽  
◽  
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Patient Outcomes ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Age Groups ◽  
Glucose Monitoring ◽  
Parental Satisfaction ◽  
Patient Use

Continuous glucose monitoring (CGM) systems, available for patient use since 1999, and realtime continuous glucose monitoring (RT-CGM) systems, available since 2006, have helped optimize diabetes management. Previously, RT-CGM studies found benefits mainly in patients with type 1 diabetes over the age of 25. Children and adolescents often present a challenge when managing type 1 diabetes. However, it is now apparent that RT-CGM has clear benefits in these age groups as well as in adults. Not only have studies shown improvements in glycemic control in this population, they have also demonstrated parental satisfaction with the technology. Challenges with RT-CGM use still exist and must be addressed. Nevertheless, RT-CGM is a beneficial tool to assist in diabetes management, and its use should be encouraged in the majority of pediatric patients with type 1 diabetes.

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