Retrospective, observational study to see the effect of evogliptin on continuous glucose monitoring (CGM) in T2DM Indian patients: A real-world experience

This study aimed to assess effectiveness of Evogliptin 5 mg through continues glucose monitoring (CGM) in patients with T2DM in retrospective observational real world settings. Overall 6 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. FreeStyle Librepro 1.0.6 was used for CGM. CGM was done 15 days prior to adding Evogliptin and repeated immediately after that for next 15 days. Mean BG level, Percentage time in target range (80-140mg/dl), Percentage time above target and Percentage time below target were assessed prior and after adding Evogliptin in existing treatment regimen. Significant reduction in Mean blood glucose level seen after adding Evogliptin in existing treatment regimen from 215 mg/dl to 138 mg/dl (-77 mg/dl P=0.006). Significant improvement seen in Percentage time in target range (80-140mg/dl) from 17% to 44% (27% P value 0.007) and in Percentage time above target from 81% to 43% (- 38%, P valve 0.003). 13.5 % of the patients seen below target. Evogliptin was found to be effective when added to the patients who were uncontrolled on other oral anti-diabetic medications. It effectively showed improvement in continues glucose monitoring (CGM) parameters like Mean blood glucose, more number of patients were in Time in Target range i.e (80-140mg/dl) after adding Evogliptin to existing anti-diabetic medications & well tolerated. Small sample size and retrospective study

Comprehensive Review on Wearable Sweat-Glucose Sensors for Continuous Glucose Monitoring

The incidence of diabetes is increasing at an alarming rate, and regular glucose monitoring is critical in order to manage diabetes. Currently, glucose in the body is measured by an invasive method of blood sugar testing. Blood glucose (BG) monitoring devices measure the amount of sugar in a small sample of blood, usually drawn from pricking the fingertip, and placed on a disposable test strip. Therefore, there is a need for non-invasive continuous glucose monitoring, which is possible using a sweat sensor-based approach. As sweat sensors have garnered much interest in recent years, this study attempts to summarize recent developments in non-invasive continuous glucose monitoring using sweat sensors based on different approaches with an emphasis on the devices that can potentially be integrated into a wearable platform. Numerous research entities have been developing wearable sensors for continuous blood glucose monitoring, however, there are no commercially viable, non-invasive glucose monitors on the market at the moment. This review article provides the state-of-the-art in sweat glucose monitoring, particularly keeping in sight the prospect of its commercialization. The challenges relating to sweat collection, sweat sample degradation, person to person sweat amount variation, various detection methods, and their glucose detection sensitivity, and also the commercial viability are thoroughly covered.

Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future.

Clinical and economic benefits of continuous blood glucose monitoring devices

The main intervention to reduce the macro-and microvascular complications of diabetes mellitus (DM) remains to achieve better long-term glycemic control. We have discussed the clinical and economic advantages of using continuous glucose monitoring (CGM) devices for type 1 DM and type 2 DM (T1DM and T2DM) based on data from relevant studies in the literature. Our findings show that using these modalities is associated with remarkable outcomes, including reduced HbA1c levels and enhanced glycemic control among patients with T1DM and T2DM. This can enhance the quality of care and life for diabetic patients and intervene against the development of serious complications and hypoglycemia-related adverse events. The cost of routinely using these devices might seem relatively high. However, the estimated cost benefits are usually higher as they can significantly reduce hospitalization rates due to hypoglycemia and the frequency of diabetic therapy malpractices, which are frequently encountered. However, not many studies have reported these outcomes, indicating the need to conduct future relevant studies.

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.

Recent Progress and Perspectives on Non-Invasive Glucose Sensors

Self-monitoring of blood glucose forms an important part of the management of diabetes and the prevention of hyperglycaemia and hypoglycaemia. Current glucose monitoring methods either use needle-prick enzymatic glucose-meters or subcutaneous continuous glucose sensors (CGM) and thus, non-invasive glucose measurements could greatly improve the self-management of diabetes. A wide range of non-invasive sensing techniques have been reported, though achieving a level of precision comparable to invasive meters remains a challenge. Optical sensors, which utilise the interactions between glucose and light, offer the potential for non-invasive continuous sensing, allowing real-time monitoring of glucose levels, and a range of different optical sensing technologies have been proposed. These are primarily based upon optical absorption and scattering effects and include infrared spectroscopy, Raman spectroscopy and optical coherence tomography (OCT), with other optical techniques such as photoacoustic spectroscopy (PAS) and polarimetry also reported. This review aims to discuss the current progress behind the most reported optical glucose sensing methods, theory and current limitations of optical sensing methods and the future technology development required to achieve an accurate optical-based glucose monitoring device.

Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

<i>Objective:</i> This study aims to: (1) identify the frequency of severe and level 2 hypoglycemia presenting in people with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting; (2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. <p><i>Research Design and Methods:</i> A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demographics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire) and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. </p> <p><i>Results: </i>A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ≥1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyperglycemia avoidance was associated with severe hypoglycemia development (<i>P</i><0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ≥1% of time in level 2 hypoglycemia (<i>P</i>=0.038).</p> <p><i>Conclusions:</i> Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in people with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may remain to impact the effectiveness of glucose self-management.</p>

Continuous Glucose Monitoring Initiation Within First Year of Type 1 Diabetes Diagnosis Is Associated With Improved Glycemic Outcomes: 7-Year Follow-Up Study

Objective: To evaluate long-term glycemic outcomes of CGM initiation within the first year of type 1 diabetes. <p>Research Design and Methods: 396 patients with type 1 diabetes were divided into three groups; 1) CGM [CGM use within one year of diabetes and continued through the study], 2) no-CGM [no CGM use throughout the study], 3) new-CGM [CGM use after 3 years of diabetes] and were followed up to 7-years. </p> <p>Results: A1c was significantly lower in CGM compared to no-CGM group throughout 7 years of follow-up [LS mean A1cs (%): 6-month 7.3 vs 8.1, 1-year 7.4 vs 8.6, 2-year 7.7 vs 9.1, 3-year 7.6 vs 9.3, 4-year 7.4 vs 9.6, 5-year 7.6 vs 9.7, 6-year 7.5 vs 10.0 and 7-year 7.6 vs 9.8, all p<0.001] adjusting for age at diagnosis, sex, and insulin delivery method. </p> <p>Conclusion: CGM initiation within first year of type 1 diabetes results in long-term improvement in A1c. </p>