Comparison of two glucose-monitoring systems for use in horses

OBJECTIVE To determine the accuracy of 2 interstitial glucose-monitoring systems (GMSs) for use in horses compared with a point-of-care (POC) glucometer and standard laboratory enzymatic chemistry method (CHEM). ANIMALS 8 clinically normal adult horses. PROCEDURES One of each GMS device (Dexcom G6 and Freestyle Libre 14-day) was placed on each horse, and blood glucose concentration was measured via POC and CHEM at 33 time points and compared with simultaneous GMS readings. An oral glucose absorption test (OGAT) was performed on day 2, and glucose concentrations were measured and compared. RESULTS Glucose concentrations were significantly correlated with one another between all devices on days 1 to 5. Acceptable agreement was observed between Dexcom G6 and Freestyle Libre 14-day when compared with CHEM on days 1, 3, 4, and 5 with a combined mean bias of 10.45 mg/dL and 1.53 mg/dL, respectively. During dextrose-induced hyperglycemia on day 2, mean bias values for Dexcom G6 (10.49 mg/dL) and FreeStyle Libre 14-day (0.34 mg/dL) showed good agreement with CHEM. CLINICAL RELEVANCE Serial blood glucose measurements are used to diagnose or monitor a variety of conditions in equine medicine; advances in near-continuous interstitial glucose monitoring allow for minimally invasive glucose assessment, thereby reducing stress and discomfort to patients. Data from this study support the use of the Dexcom G6 and Freestyle Libre 14-day interstitial glucose-monitoring systems to estimate blood glucose concentrations in horses.

Metabolic Control of the FreeStyle Libre System in the Pediatric Population with Type 1 Diabetes Dependent on Sensor Adherence

Aims: To evaluate the relationship between daily sensor scan rates and changes in HbA1c and hypoglycemia in children. Methods: We enrolled 145 paediatric T1D patients into a prospective, interventional study of the impact of the FreeStyle Libre 1 system on measures of glycemic control. Results: HbA1c was higher at lower scan rates, and decreased as the scan rate increased to 15–20 scans, after which it rose at higher scan rates. An analysis of the change in hypoglycemia, based on the number of daily sensor scans, showed there was a significant correlation between daily scan rates and hypoglycemia. Subjects with higher daily scan rates reduced all levels of hypoglycaemia. Conclusions: HbA1c is higher at lower scan rates, and decreases as scan rate increases. Reductions in hypoglycemia were evident in subjects with higher daily scan rates.

Allergic Reaction Following Implantation of a Blood Glucose Sensor.

Increasing incidence and onset at a younger age has changed the treatment strategy of diabetes mellitus (DM) towards prevention, delaying the onset, and minimizing disease complications. Self-monitoring blood glucose systems and continuous glucose monitoring systems are routinely preferred in diabetic children.Flash glucose monitoring system has come as an entirely new concept in glucose monitoring by providing much greater data than blood glucose testing while being more affordable than the continuous glucose monitors. The FreeStyle Libre provides ‘flash glucose monitoring’ with glucose readings by scanning a sensor rather than pricking the patient’s finger. The sensor measures interstitial tissue glucose levels every minute via a disposable round sensor with a small catheter inserted under the skin that can be worn for up to 14 days. The entire system’s on-body sensor patch worn on the back of the upper arm is disposable. However, the mild erythema may occur on the skin and disappear spontaneously after 24 hours from the detachment of the sensor. Similar skin lesions were observed in diabetic patients, and there was moderate to severe itching in 0.5% of the cases and moderate erythema in 4% of cases

Simposio: Nuevos horizontes en la terapéutica de la diabetes mellitus tipo 1. Monitoreo glucémico continuo y control glucémico on line

Las herramientas para evaluar el grado de control glucémico se modificaron últimamente. La hemoglobina glicosilada (HbA1c), parámetro considerado como gold standard, solo refleja el control glucémico de los últimos tres meses de manera retrospectiva, sin expresar la variabilidad glucémica (VG), lo que limita tomar decisiones terapéuticas adecuadas y en tiempo.El automonitoreo glucémico capilar (AGC) solo brinda información inmediata sin detectar tendencias ni datos de VG. Además, es un método invasivo. La incorporación del monitoreo continuo de glucosa (MCG) no solamente permite medir la glucosa instantáneamente, sino que además muestra sus tendencias y su variabilidad en forma continua incorporando nuevas métricas. Esto constituye una nueva forma de evaluar el control glucémico mediante el perfil ambulatorio de glucosa (PAG).Gracias al PAG pueden analizarse los patrones del control glucémico durante el sueño, los ayunos prolongados, la actividad física y las intercurrencias, expresándolos durante períodos de horas (8 a 24 horas) o días (7, 14, 30 y 90 días). El PAG contiene las siguientes métricas: porcentaje de tiempo en rango (70-180 mg/dl=TIR), porcentaje de tiempo por encima del rango (>180 mg/dl=TAR), porcentaje de tiempo por debajo del rango o hipoglucemia (<70 mg/dl=TBR) y coeficiente de variabilidad (%CV). Se sugiere alcanzar un TIR durante >70% del día, un TAR >180 mg/dl durante <25% del día y un TBR <70 mg/dl durante <5% del día, y en pacientes lábiles, un TIR de solo el 50% del día; en la diabetes mellitus tipo 1 (DM1) con embarazo, un TIR de 63-140 mg/dl durante >70% del día.El MCG estaría indicado en adultos, adolescentes y niños (a partir de 4 años para FreeStyle Libre y 2 años para Dexcom), con diabetes mellitus tipo 1 (DM1) sin adecuado control glucémico o con adecuado control que presentan hipoglucemias leves/moderadas. También en pacientes embarazadas con DM1 o con DM2 bajo terapéuticas insulínicas intensificadas (TII).La información continua permite tomar decisiones inmediatas, ya sea con la ingesta de carbohidratos o con la aplicación de insulina. El MCG con TII o bomba portable de insulina (BPI) es una herramienta muy útil y complementaria para el tratamiento de la DM1 y DM2 en la insulinoterapia. Su utilización se asoció con descensos significativos en la HbA1c, disminución de la variabilidad glucémica, reducción de las hipoglucemias totales y nocturnas, y mejoría de la calidad de vida en estos pacientes. Finalmente, la otra ventaja de esta metodología es la posibilidad de compartir los datos telemétricamente, ya sea entre el paciente y sus familiares o responsables, y entre el paciente y su centro médico permitiendo tomar decisiones terapéuticas online.

Accuracy of Flash Glucose Monitoring During Postprandial Rest and Different Walking Conditions in Overweight or Obese Young Adults

Aims: To investigate the accuracy of FreeStyle LibreTM flash glucose monitoring (FGM) relevant to plasma glucose (PG) measurements during postprandial rest and different walking conditions in overweight/obese young adults.Methods: Data of 40 overweight/obese participants from two randomized crossover studies were pooled into four trials: (1) sitting (SIT, n = 40); (2) walking continuously for 30 min initiated 20 min before individual postprandial glucose peak (PPGP) (20iP + CONT, n = 40); (3) walking continuously for 30 min initiated at PPGP (iP + CONT, n = 20); and (4) accumulated walking for 30 min initiated 20 min before PPGP (20iP + ACCU, n = 20). Paired FGM and PG were measured 4 h following breakfast.Results: The overall mean absolute relative difference (MARD) between PG and FGM readings was 16.4 ± 8.6% for SIT, 16.2 ± 4.7% for 20iP + CONT, 16.7 ± 12.2% for iP + CONT, and 19.1 ± 6.8% for 20iP + ACCU. The Bland–Altman analysis showed a bias of −1.03 mmol⋅L–1 in SIT, −0.89 mmol⋅L–1 in 20iP + CONT, −0.82 mmol⋅L–1 in iP + CONT, and −1.23 mmol⋅L–1 in 20iP + ACCU. The Clarke error grid analysis showed that 99.6–100% of the values in all trials fell within zones A and B.Conclusion: Although FGM readings underestimated PG, the FGM accuracy was overall clinically acceptable during postprandial rest and walking in overweight/obese young adults.