Flash glucose monitoring in gestational diabetes mellitus: possibilities for assessing glycemic variability

Introduction. Blood glucose monitoring is critical in maintaining glycemic control in women with GDM and in reducing adverse maternal and fetal outcomes. One of the tools that can help achieve optimal glycemic control during pregnancy is continuous glucose monitoring, which empowers clinicians to assess the characteristics of daily glycemic variability.The aim. Compare biweekly glycemic profiles and glycemic variability in pregnant women with GDM and in healthy pregnant women using the FreeStyle Libre flash glycemic monitoring system.Materials and methods. Analysis of the glycemic profile of 49 pregnant women aged 33.2 ± 6.1 years. The average gestational age of the women included in the study was 12.6 ± 6.4 weeks. Pregnant women were divided into 2 groups: 37 pregnant women with GDM and 12 healthy pregnant women. Each group underwent two-week glucose profile monitoring using the FreeStyle Libre continuous monitoring system. Statistical analysis was carried out using Microsoft Office Excel 2016, STATISTICA 10 programs (developed by StatSoft.Inc), EasyGV, version 9.Results. The average glycemic level in the groups was 4.724 ± 0.37 mmol/L vs 4.24 ± 0.34 mmol/L, respectively (p˂0.001). Comparative analysis of GV parameters in groups of pregnant women with and without GDM: SD – 0.908 vs 0.7213 (p˂0.05); LI – 1.5 vs 0.8 (p˂0.05); HBGI – 0.503 vs 0.42 (p˂0.05); J-index – 10.343 vs 7.9870 (p˂0.001); MOOD – 0.956 vs 0.7992 (p˂0.05); MAGE – 2.326 vs 1.8042 (p˂0.05); ADDR – 2.216 vs 0.4210 (p˂0.05); MAG – 4.612 vs 2.6163 (p˂0.001), respectively. The CONGA index did not show a statistically significant difference in both groups: 3.95 vs 3.7 (p = 0.5).Conclusions. Flash-glycemic monitoring can be used to obtain more detailed information about the glycemic profile, especially when it is difficult to assess the degree of GDM compensation. Continuous glucose monitoring can facilitate the optimization of glycemic control and provide a basis for treatment decisions.

Responses to Low- and High-Intensity Exercise in Adolescents with Type 1 Diabetes in Relation to Their Level of VO2 Max

The purpose of this study was to investigate the influence of maximal oxygen uptake (VO2 max) on the glycemic changes during low and high intensity exercises in young type 1 diabetic patients. Twenty boys (age: 14.3 ± 1.6 years; height: 171.0 ± 11.3 cm; weight; 59.5 ± 12.8 kg) were divided into low-fit group (LFG, n = 10) and high-fit group (HFG, n = 10). According to the experimental design, participants performed three physical efforts (VO2 max test, mixed aerobic–anaerobic effort and aerobic effort) on the cycloergometer, during which real-time glycemia was measured. Mixed aerobic–anaerobic exercise demanded significantly smaller carbohydrate supplementation (0.2 ± 0.2 g/kg during exercise) than the aerobic test session (0.4 ± 0.3 g/kg during exercise). Moreover, patients with higher VO2 max had lower tendency for glycemic changes during the aerobic effort. The results of the current study suggest that young type 1 diabetic patients should perform different intensity activities using continuous glycemic monitoring system to avoid acute and chronic complications of the disease.

Effectiveness of a simulation activity on knowledge about glucose monitoring and hypoglycemia management: a pre-post intervention study

Adequate management of diabetes requires professional improvement programs. This study aimed to analyze the effect of a simulation activity on the acquisition of knowledge about blood glucose monitoring and hypoglycemia management. The study employed a pre-post intervention approach and was carried out in a university hospital located in Brazil. The participants were 82 graduating nursing students and nursing professionals studying/working at the university hospital. The intervention consisted of theoretical sessions, a practical simulation about glycemic monitoring and hypoglycemia management, and the pre- and post-tests. The simulation consisted of a rubber hand mannequin that allows simulating the glucose testing. There was a significant increase in knowledge after intervention with the total number of correct answers increasing from 186 in the pre-test to 326 in the post-test (+140, p < .001). The intervention was effective in increasing the participants' knowledge about glycemic monitoring and hypoglycemia management, favoring a better nursing care for people with diabetes.

Placement of insulin pump by telemedicine

In the lockdown period, during the recent pandemic from COVID-19, the use of telemedicine for all categories of chronic patients has been encouraged by all scientific societies and governing bodies. In type 1 diabetic patients, telemedicine has been used for some time to control and verify the state of metabolic balance, through specific platforms for data download. There are numerous evidences that support the positive effect of insulin therapy by insulin pump (CSII) compared to multinjective insulin therapy and the use of continuous blood glucose monitoring systems (CGM) and integrated insulin pump systems and glycemic monitoring (SAP). The purpose of our study is to describe the results of our first experience of remote implants through the use of telemedicine of insulin pumps and continuous glycemic monitoring in four patients with type 1 diabetes in low metabolic compensation complicated by hypoglycemias. Two weeks after the insulin pump has been implanted, a hypoglycemic episode reset was recorded in all patients and the ‘time in range’ was greater than 90% in three of the four patients. Furthermore, the implanted patients were given a survey to evaluate their experience and everyone declared that they were satisfied overall. Our first and small experience of pump system through the use of remote technologies has obtained encouraging results and could be taken into consideration for the therapeutic management of selected patients, trained in the use of technologies and followed over time. KEY WORDS diabetes mellitus; insulin pumps; telemedicine system.

Glycemic Status Assessment by the Latest Glucose Monitoring Technologies

The advanced and performing technologies of glucose monitoring systems provide a large amount of glucose data that needs to be properly read and interpreted by the diabetology team in order to make therapeutic decisions as close as possible to the patient’s metabolic needs. For this purpose, new parameters have been developed, to allow a more integrated reading and interpretation of data by clinical professionals. The new challenge for the diabetes community consists of promoting an integrated and homogeneous reading, as well as interpretation of glucose monitoring data also by the patient himself. The purpose of this review is to offer an overview of the glycemic status assessment, opened by the current data management provided by latest glucose monitoring technologies. Furthermore, the applicability and personalization of the different glycemic monitoring devices used in specific insulin-treated diabetes mellitus patient populations will be evaluated.

Noninvasive, wearable, and tunable electromagnetic multisensing system for continuous glucose monitoring, mimicking vasculature anatomy

Painless, needle-free, and continuous glucose monitoring sensors are needed to enhance the life quality of diabetic patients. To that extent, we propose a first-of-its-kind, highly sensitive, noninvasive continuous glycemic monitoring wearable multisensor system. The proposed sensors are validated on serum, animal tissues, and animal models of diabetes and in a clinical setting. The noninvasive measurement results during human trials reported high correlation (>0.9) between the system’s physical parameters and blood glucose levels, without any time lag. The accurate real-time responses of the sensors are attributed to their unique vasculature anatomy–inspired tunable electromagnetic topologies. These wearable apparels wirelessly sense hypo- to hyperglycemic variations with high fidelity. These components are designed to simultaneously target multiple body locations, which opens the door for the development of a closed-loop artificial pancreas.

Possibilities of using continuous glycemic monitoring to assess the effectiveness of therapy in patients with MODY-diabetes

Verification of the type of diabetes mellitus in young people is of high clinical significance in the clinical practice since the purpose of treatment depends on this: from the correction of carbohydrate metabolism by a rational diet to the administration of oral hypoglycemic drugs and insulin therapy. The chosen therapy has a significant impact on the quality of life of the patient. With the most common types of diabetes in young people the appointment of therapy is not in doubt, since with type 1 diabetes mellitus there is an absolute need for the maintenance of exogenous insulin, and with type 2 the administration of metformin is pathogenetically substantiated. In more rare forms of diabetes which MODY belongs to sulfonylurea preparations are recommended in most cases and there are few conflicting data on the effects of newer classes (DPP4, SGLT2 inhibitors, GLP1 agonists) with monogenic forms. Using the method of continuous monitoring of glucose (CGMS) and glycemic variability indicators it is possible to determine the effectiveness of various classes of sugar-lowering drugs for rare types of diabetes mellitus which will help practitioners in choosing therapy. In the literature single studies using CGMS have been described in this group of patients. In Turkey CGMS was performed for 8 patients with GCK-MODY; it was shown that in 50% of patients the glucose values during the day exceeded the normal ranges. Italian scientists conducted a study in which they diagnosed glycemic variability, in particular episodes of hypoglycemia, in patients with HNF4AMODY diabetes (MODY1) using CGMS. The clinical consequence of episodes of asymptomatic hypoglycemia in the MODY cohort remains unknown. Diagnosing the predominance of fasting or postprandial hyperglycemia, the determination of hypoglycemia can help in the appointment of pathogenetic therapy and improve the quality of life of people diagnosed with MODY-diabetes.