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https://www.readbyqxmd.com/read/28533136/effect-of-artificial-pancreas-systems-on-glycaemic-control-in-patients-with-type-1-diabetes-a-systematic-review-and-meta-analysis-of-outpatient-randomised-controlled-trials
#1
Alanna Weisman, Johnny-Wei Bai, Marina Cardinez, Caroline K Kramer, Bruce A Perkins
BACKGROUND: Closed-loop artificial pancreas systems have been in development for several years, including assessment in numerous varied outpatient clinical trials. We aimed to summarise the efficacy and safety of artificial pancreas systems in outpatient settings and explore the clinical and technical factors that can affect their performance. METHODS: We did a systematic review and meta-analysis of randomised controlled trials comparing artificial pancreas systems (insulin only or insulin plus glucagon) with conventional pump therapy (continuous subcutaneous insulin infusion [CSII] with blinded continuous glucose monitoring [CGM] or unblinded sensor-augmented pump [SAP] therapy) in adults and children with type 1 diabetes...
May 19, 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/28530490/role-of-continuous-glucose-monitoring-in-clinical-trials-recommendations-on-reporting
#2
Oliver Schnell, Katharine Barnard, Richard Bergenstal, Emanuele Bosi, Satish Garg, Bruno Guerci, Thomas Haak, Irl B Hirsch, Linong Ji, Shashank R Joshi, Maarten Kamp, Lori Laffel, Mathieu Chantal, William H Polonsky, Frank Snoek, Philip Home
Thanks to significant improvements in the precision, accuracy, and usability of continuous glucose monitoring (CGM), its relevance in both ambulatory diabetes care and clinical research is increasing. In this study, we address the latter perspective and derive provisional reporting recommendations. CGM systems have been available since around the year 2000 and used primarily in people with type 1 diabetes. In contrast to self-measured glucose, CGM can provide continuous real-time measurement of glucose levels, alerts for hypoglycemia and hyperglycemia, and a detailed assessment of glycemic variability...
May 22, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28520532/effectiveness-of-smartguard-technology-in-the-prevention-of-nocturnal-hypoglycemia-after-prolonged-physical-activity
#3
Lenka Petruzelkova, Klara Pickova, Zdenek Sumnik, Jan Soupal, Barbora Obermannova
BACKGROUND: The prevention of postexercise nocturnal hypoglycemia after prolonged physical activity using sensor-augmented pump (SAP) therapy with predictive low-glucose management (PLGM) has not been well studied. We conducted a study at a pediatric diabetes camp to determine whether a SAP with PLGM reduces the frequency of nocturnal hypoglycemia after prolonged physical activity more effectively than a SAP with a carbohydrate intake algorithm. METHODS: During a 1-week sport camp, 20 children (aged 10-13 years) with type 1 diabetes (T1D) managed by SAP therapy either with (n = 7) or without PLGM (n = 13) were studied...
May 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28513255/successful-mechanical-thrombectomy-in-a-comatose-patient-with-cerebral-venous-sinus-thrombosis-a-case-report
#4
Merel Jj Verhagen, Adriaan Cgm van Es, Geert J Lycklama À Nijeholt, Korné Jellema, Jonathan Coutinho, Ido R van den Wijngaard
Cerebral venous sinus thrombosis is a rare cause of stroke, which is routinely treated with systemic heparin. Unfavourable outcome is often seen in severe cases. Therefore alternative treatment methods should be explored in these patients. Due to the risk of haemorrhagic complications, treatment without administration of thrombolytics is of particular interest. This report presents a case of successful mechanical thrombectomy, without the use of thrombolytics, in a comatose patient with cerebral venous sinus thrombosis...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28509691/development-of-glucose-responsive-smart-insulin-systems
#5
Nischay K Rege, Nelson F B Phillips, Michael A Weiss
PURPOSE OF REVIEW: The complexity of modern insulin-based therapy for type I and type II diabetes mellitus and the risks associated with excursions in blood-glucose concentration (hyperglycemia and hypoglycemia) have motivated the development of 'smart insulin' technologies (glucose-responsive insulin, GRI). Such analogs or delivery systems are entities that provide insulin activity proportional to the glycemic state of the patient without external monitoring by the patient or healthcare provider...
May 15, 2017: Current Opinion in Endocrinology, Diabetes, and Obesity
https://www.readbyqxmd.com/read/28503717/a-review-of-the-current-challenges-associated-with-the-development-of-an-artificial-pancreas-by-a-double-subcutaneous-approach
#6
REVIEW
Sverre Christian Christiansen, Anders Lyngvi Fougner, Øyvind Stavdahl, Konstanze Kölle, Reinold Ellingsen, Sven Magnus Carlsen
INTRODUCTION: Patients with diabetes type 1 (DM1) struggle daily to achieve good glucose control. The last decade has seen a rush of research groups working towards an artificial pancreas (AP) through the application of a double subcutaneous approach, i.e., subcutaneous (SC) continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion. Few have focused on the fundamental limitations of this approach, especially regarding outcome measures beyond time in range. METHODS: Based on insulin physiology, the limitations of CGM, SC insulin absorption, meal challenge, and physical activity in DM1 patients, we discuss the limitations of the double SC approach...
May 13, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28486841/accuracy-of-a-cgm-sensor-in-pediatric-subjects-with-type-1-diabetes-comparison-of-three-insertion-sites-arm-abdomen-and-gluteus
#7
Simone Faccioli, Simone Del Favero, Roberto Visentin, Riccardo Bonfanti, Dario Iafusco, Ivana Rabbone, Marco Marigliano, Riccardo Schiaffini, Daniela Bruttomesso, Claudio Cobelli
BACKGROUND: Patients with diabetes, especially pediatric ones, sometimes use continuous glucose monitoring (CGM) sensor in different positions from the approved ones. Here we compare the accuracy of Dexcom® G5 CGM sensor in three different sites: abdomen, gluteus (both approved) and arm (off-label). METHOD: Thirty youths, 5-9 years old, with type 1 diabetes (T1D) wore the sensor during a clinical trial where frequent self-monitoring of blood glucose (SMBG) measurements were obtained...
May 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28484424/continuous-subcutaneous-insulin-infusion-in-children-a-pilot-study-validating-a-protocol-to-avoid-hypoglycemia-at-initiation
#8
Despoina Manousaki, Johnny Deladoëy, Louis Geoffroy, Patricia Olivier
BACKGROUND: The occurrence of hypoglycemia and hyperglycemia during the first days after transition to continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes has not been systematically studied in children. The aim of this prospective study was to demonstrate that the protocol applied in our diabetes clinic is safe at CSII initiation in children. METHODS: We assessed 22 pediatric patients with type 1 diabetes, using continuous glucose monitoring (CGM) before and after CSII initiation (±3 days)...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28484269/features-of-glycemic-variations-in-drug-na%C3%A3-ve-type-2-diabetic-patients-with-different-hba1c-values
#9
Feng-Fei Li, Bing-Li Liu, Reng-Na Yan, Hong-Hong Zhu, Pei-Hua Zhou, Hui-Qin Li, Xiao-Fei Su, Jin-Dan Wu, Dan-Feng Zhang, Lei Ye, Jian-Hua Ma
To define the features of glycemic variations in drug naïve type 2 diabetic (T2D) patients with different HbA1c values using continuous glucose monitoring (CGM), a total of 195 drug naïve T2D patients were admitted. The subjects were divided into the following groups: lower HbA1c values (≤8%), moderate HbA1c values (>8% and ≤10%), and higher HbA1c values (>10%). The patients underwent oral glucose tolerance tests and were then subjected to 3-day CGM. The primary endpoint was the differences in the 24-hr mean amplitude of glycemic excursions (MAGE) in patients with different HbA1c values...
May 8, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28476567/dietary-intake-and-risk-of-non-severe-hypoglycemia-in-adolescents-with-type-1-diabetes
#10
Victor W Zhong, Jamie L Crandell, Christina M Shay, Penny Gordon-Larsen, Stephen R Cole, Juhaeri Juhaeri, Anna R Kahkoska, David M Maahs, Michael Seid, Gregory P Forlenza, Elizabeth J Mayer-Davis
AIMS: To determine the association between dietary intake and risk of non-severe hypoglycemia in adolescents with type 1 diabetes. METHODS: Type 1 adolescents from a randomized trial wore a blinded continuous glucose monitoring (CGM) system at baseline for one week in free-living conditions. Dietary intake was calculated as the average from two 24-h dietary recalls. Non-severe hypoglycemia was defined as having blood glucose <70mg/dL for ≥10min but not requiring external assistance, categorized as daytime and nocturnal (11PM-7AM)...
April 20, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28459617/outpatient-closed-loop-control-with-unannounced-moderate-exercise-in-adolescents-using-zone-model-predictive-control
#11
Lauren M Huyett, Trang T Ly, Gregory P Forlenza, Suzette Reuschel-DiVirgilio, Laurel H Messer, R Paul Wadwa, Ravi Gondhalekar, Francis J Doyle, Jordan E Pinsker, David M Maahs, Bruce A Buckingham, Eyal Dassau
BACKGROUND: The artificial pancreas (AP) has the potential to improve glycemic control in adolescents. This article presents the first evaluation in adolescents of the Zone Model Predictive Control and Health Monitoring System (ZMPC+HMS) AP algorithms, and their first evaluation in a supervised outpatient setting with frequent exercise. MATERIALS AND METHODS: Adolescents with type 1 diabetes underwent 3 days of closed-loop control (CLC) in a hotel setting with the ZMPC+HMS algorithms on the Diabetes Assistant platform...
May 1, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28459603/closed-loop-control-of-postprandial-glycemia-using-an-insulin-on-board-limitation-through-continuous-action-on-glucose-target
#12
Paolo Rossetti, Carmen Quirós, Vanessa Moscardó, Anna Comas, Marga Giménez, F Javier Ampudia-Blasco, Fabián León, Eslam Montaser, Ignacio Conget, Jorge Bondia, Josep Vehí
BACKGROUND: Postprandial (PP) control remains a challenge for closed-loop (CL) systems. Few studies with inconsistent results have systematically investigated the PP period. OBJECTIVE: To compare a new CL algorithm with current pump therapy (open loop [OL]) in the PP glucose control in type 1 diabetes (T1D) subjects. METHODS: A crossover randomized study was performed in two centers. Twenty T1D subjects (F/M 13/7, age 40.7 ± 10.4 years, disease duration 22...
May 1, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28459159/a-comparison-of-time-delay-in-three-continuous-glucose-monitors-for-adolescents-and-adults
#13
Manasi Sinha, Katherine M McKeon, Savan Parker, Laura G Goergen, Hui Zheng, Firas H El-Khatib, Steven J Russell
BACKGROUND: The physiologic delay in glucose diffusion from the blood to the interstitial fluid and instrumental factors contribute to the delay between changes in plasma glucose (PG) and measurements made by continuous glucose monitors (CGMs). This study compared the duration of this delay for three CGMs. METHODS: A total of 24 healthy adolescent and adult subjects with type 1 diabetes wore three CGM devices simultaneously for 48 hours: Dexcom G4 Platinum, Abbott Navigator, and Medtronic Enlite...
April 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28449590/continuous-glucose-monitoring-in-older-adults-with-type-1-and-type-2-diabetes-using-multiple-daily-injections-of-insulin-results-from-the-diamond-trial
#14
Katrina J Ruedy, Christopher G Parkin, Tonya D Riddlesworth, Claudia Graham
OBJECTIVE: The objective was to determine the effectiveness of real-time continuous glucose monitoring (CGM) in adults ≥ 60 years of age with type 1 (T1D) or type 2 (T2D) diabetes using multiple daily insulin injections (MDI). METHODS: A multicenter, randomized trial was conducted in the United States and Canada in which 116 individuals ≥60 years (mean 67 ± 5 years) with T1D (n = 34) or T2D (n = 82) using MDI therapy were randomly assigned to either CGM (Dexcom™ G4 Platinum CGM System® with software 505; n = 63) or continued management with self-monitoring blood glucose (SMBG; n = 53)...
April 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28429906/eating-glutinous-brown-rice-for-one-day-improves-glycemic-control-in-japanese-patients-with-type-2-diabetes-assessed-by-continuous-glucose-monitoring
#15
Yuko Terashima, Yoshio Nagai, Hiroyuki Kato, Akio Ohta, Yasushi Tanaka
BACKGROUND AND OBJECTIVES: We investigated whether intake of non-glutinous brown rice (BR) or glutinous brown rice (GBR) for 1 day had an influence on the daily glucose profile measured by continuous glucose monitoring (CGM) when compared with intake of non-glutinous white rice (WR). METHODS AND STUDY DESIGN: A total of 37 inpatients with type 2 diabetes mellitus (T2DM) were recruited for a 3-day randomized triple cross-over trial in which they ate WR, BR, or GBR for 1 day each...
May 2017: Asia Pacific Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28429611/consensus-statement-on-inpatient-use-of-continuous-glucose-monitoring
#16
Amisha Wallia, Guillermo E Umpierrez, Robert J Rushakoff, David C Klonoff, Daniel J Rubin, Sherita Hill Golden, Curtiss B Cook, Bithika Thompson
In June 2016, Diabetes Technology Society convened a panel of US experts in inpatient diabetes management to discuss the current and potential role of continuous glucose monitoring (CGM) in the hospital. This discussion combined with a literature review was a follow-up to a meeting, which took place in May 2015. The panel reviewed evidence on use of CGM in 3 potential inpatient scenarios: (1) the intensive care unit (ICU), (2) non-ICU, and (3) transitioning outpatient CGM use into the hospital setting. Panel members agreed that data from limited studies and theoretical considerations suggested that use of CGM in the hospital had the potential to improve patient clinical outcomes, and in particular reduction of hypoglycemia...
April 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28429581/nighttime-is-the-worst-time-parental-fear-of-hypoglycemia-in-young-children-with-type-1-diabetes
#17
Michelle A Van Name, Marisa E Hilliard, Claire T Boyle, Kellee M Miller, Daniel J DeSalvo, Barbara J Anderson, Lori M Laffel, Stephanie E Woerner, Linda A DiMeglio, William V Tamborlane
BACKGROUND: Fear of hypoglycemia is common in parents of young children with type 1 diabetes (T1D), but little is known about the specific fears that parents most often experience. Hypoglycemia fear has been associated with poorer glycemic control in older children, though not yet studied in a large cohort of very young children. MATERIALS AND METHODS: Parents of 549 children <7 years (mean 5.2 ± 1.2 years [19% <3 years]) with a mean diabetes duration of 2...
April 21, 2017: Pediatric Diabetes
https://www.readbyqxmd.com/read/28426239/performance-of-an-artificial-pancreas-system-for-young-children-with-type-1-diabetes
#18
Mark D DeBoer, Marc D Breton, Christian Wakeman, Elaine M Schertz, Emma G Emory, Jessica L Robic, Laura L Kollar, Boris P Kovatchev, Daniel R Cherñavvsky
BACKGROUND: Young children 5-8 years old with type 1 diabetes (T1D) exhibit clear needs for improved glycemic control but may be limited in their ability to safely interact with an artificial pancreas system. Our goal was to evaluate the safety and performance of an artificial pancreas (AP) system among young children with T1D. RESEARCH DESIGN AND METHODS: In a randomized, crossover trial, children with T1D age 5-8 years were enrolled to receive on separate study periods (in random order) either the UVa AP using the DiAs Control Platform software with child-resistant lock-out screens (followed as an out-patient admission) or their usual insulin pump+continuous glucose monitor (CGM) care at home...
May 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28418217/24-hour-variations-in-blood-glucose-level-in-type-2-diabetic-japanese-based-on-continuous-glucose-monitoring
#19
Maiko Hajime, Yosuke Okada, Hiroko Mori, Takashi Otsuka, Mayuko Kawaguchi, Megumi Miyazaki, Fumi Kuno, Kei Sugai, Satomi Sonoda, Kenichi Tanaka, Akira Kurozumi, Manabu Narisawa, Keiichi Torimoto, Tadashi Arao, Yoshiya Tanaka
AIMS/INTRODUCTION: High fluctuations in blood glucose are associated with various complications. The correlation between glycated hemoglobin (HbA1c) level and fluctuations in blood glucose level has not been studied in Japanese patients with type 2 diabetes (T2DM). In this study, blood glucose profile stratified by HbA1c level was evaluated by continuous glucose monitoring (CGM) in Japanese T2DM patients. MATERIALS AND METHODS: Our retrospective study included 294 patients with T2DM, who were divided by HbA1c level into five groups (≥6...
April 18, 2017: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/28397367/continuous-glucose-monitoring-reveals-hypoglycemia-risk-in-elderly-patients-with-type-2-diabetes-mellitus
#20
Takahiro Ishikawa, Masaya Koshizaka, Yoshiro Maezawa, Minoru Takemoto, Yoshiharu Tokuyama, Toshihiro Saito, Koutaro Yokote
INTRODUCTION: The incidence of type 2 diabetes is higher in elderly patients, in whom this disease is associated with dementia, falling, stroke, and death. We utilized a continuous glucose monitoring (CGM) device to analyze the relationship between hypoglycemia and diabetes treatments to identify risk factors for hypoglycemia (defined as a blood glucose level <70 mg/dL). MATERIALS AND METHODS: We classified 170 patients aged ≥65 years with type 2 diabetes who were receiving steady-state medication (29 of whom were inpatients) into hypoglycemic and non-hypoglycemic groups, and compared their HbA1c levels, treatment types, continuous glucose monitoring data, and other parameters...
April 11, 2017: Journal of Diabetes Investigation
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