Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level mon...Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests,the advent of continuous glucose monitoring(CGM)systems has revolutionized the approach.These devices offer a safe and reliable means of tracking glucose levels in real-time,benefiting both women with diabetes during pregnancy and the healthcare providers.Moreover,CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes,especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device.Such a combined approach has been demonstrated to improve overall blood sugar control,lessen the occurrence of preeclampsia and neonatal hypoglycaemia,and minimize the duration of neonatal intensive care unit stays.This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.展开更多
Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly fou...Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly found in diabetic patients with DKD and especially ESKD,as a result of impaired renal metabolism.It is essential to monitor glycemia for effective management of DKD.Hemoglobin A1c(HbA1c)has long been considered as the gold standard for monitoring glycemia for>3 months.However,assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction.Continuous glucose monitoring(CGM)has provided new insights on glycemic assessment and management.CGM directly measures glucose level in interstitial fluid,reports real-time or retrospective glucose concentration,and provides multiple glycemic metrics.It avoids the pitfalls of HbA1c in some contexts,and may serve as a precise alternative to estimation of mean glucose and glycemic variability.Emerging studies have demonstrated the merits of CGM for precise monitoring,which allows fine-tuning of glycemic management in diabetic patients.Therefore,CGM technology has the potential for better glycemic monitoring in DKD patients.More research is needed to explore its application and management in different stages of DKD,including hemodialysis,peritoneal dialysis and kidney transplantation.展开更多
In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoi...In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.展开更多
BACKGROUND Time in range(TIR),as a novel metric for glycemic control,has robust relevance with diabetic complications.Diabetic peripheral neuropathy(DPN)is characterized by sudomotor dysfunction.AIM To explore the rel...BACKGROUND Time in range(TIR),as a novel metric for glycemic control,has robust relevance with diabetic complications.Diabetic peripheral neuropathy(DPN)is characterized by sudomotor dysfunction.AIM To explore the relationship between TIR obtained from continuous glucose monitoring(CGM)and sudomotor function detected by SUDOSCAN in subjects with type 2 diabetes.METHODS The research enrolled 466 inpatients with type 2 diabetes.All subjects underwent 3-d CGM and SUDOSCAN.SUDOSCAN was assessed with electrochemical skin conductance in hands(HESC)and feet(FESC).Average feet ESC<60μS was defined as sudomotor dysfunction(+),otherwise it was sudomotor dysfunction(-).TIR refers to the percentage of time when blood glucose is between 3.9-10 mmol/L during 1 d period.RESULTS Among the enrolled subjects,135(28.97%)presented with sudomotor dysfunction.Patients with sudomotor dysfunction(+)showed a decreased level of TIR(P<0.001).Compared to the lowest tertile of TIR,the middle and the highest tertiles of TIR was associated with an obviously lower prevalence of sudomotor dysfunction(20.51%and 21.94%vs 44.52%)(P<0.001).In addition,with the increase of TIR,HESC and FESC increased(P<0.001).Regression analysis demonstrated that TIR was inversely and independently linked with the prevalence of sudomotor dysfunction after adjusting for confounding values(odds ratio=0.979,95%CI:0.971-0.987,P<0.001).CONCLUSION The tight glycemic control assessed by TIR is of vitally protective value for sudomotor dysfunction in type 2 diabetes mellitus.展开更多
BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations ...BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIM To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODS Patients receiving distal gastrectomy with Billroth-I(DG-BI)or Roux-en-Y reconstruction(DG-RY)and total gastrectomy with RY(TG-RY)for gastric cancer(March 2018-January 2020)were prospectively enrolled.Interstitial tissue glycemic profiles were measured every 15 min,up to 14 d,by continuous glucose monitoring.Dumping episodes were recorded on 5 patient-selected days by diary.Within 3 h postprandially,dumping-associated glycemic changes were defined as a dumping profile,those without symptoms as a control profile.These profiles were compared.RESULTS Thirty patients were enrolled(10 DG-BI,10 DG-RY,10 TG-RY).The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal,which 47 control profiles did not(P<0.05).Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles,with lower glycemic levels.DGRY and TG-RY late dumping profiles(7 and 13,respectively)showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia,with a steeper drop in TG-RY than in DG-RY.CONCLUSION Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer.Furthermore,glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.展开更多
Diabetes mellitus affects people worldwide,and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients.Previous reports have confirmed that hyperg...Diabetes mellitus affects people worldwide,and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients.Previous reports have confirmed that hyperglycemia can increase the risk of mortality in patients cared in the intensive care unit(ICU).In addition,severe and multiple hypoglycemia increases the risk of mortality when using insulin or intensive antidiabetic therapy.The innovation of continuous glucose monitoring(CGM)may help to alert medical caregivers with regard to the development of hyperglycemia and hypoglycemia,which may decrease the potential complications in patients in the ICU.The major limitation of CGM is the measurement of interstitial glucose levels rather than real-time blood glucose levels;thus,there will be a delay in the treatment of hyperglycemia and hypoglycemia in patients.Recently,the European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control,which may provide a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients.In this mini-review paper,we describe the application of CGM to patients in the ICU and summarize the pros and cons of CGM.展开更多
Continuous blood glucose monitoring is important for the diagnosis,treatment,and study of diabetes. many organizations have been working on this subject in recent two decades. Glucose concentration in interstitial flu...Continuous blood glucose monitoring is important for the diagnosis,treatment,and study of diabetes. many organizations have been working on this subject in recent two decades. Glucose concentration in interstitial fluid is closely related to the blood glucose levels. Minimally invasive continuous blood glucose monitoring technology based on the glucose detection in interstitial fluid develops rapidly and gets more and more attentions from the patients and the doctors,due to its instantaneous real-time display of glucose level,"24/7"coverage,and the ability to characterize glycemic variability. According to the different detection methods,most of the continuous glucose monitoring technology could be divided into two kinds: subcutaneous implantation method and transdermal extraction method. This paper review s the recent development of minimally invasive blood glucose monitoring technology and instruments. The mainly remained challenges and related research directions are presented as well.展开更多
Most information used to evaluate diabetic statuses is collected at a special time-point,such as taking fasting plasma glucose test and providing a limited view of individual’s health and disease risk.As a new parame...Most information used to evaluate diabetic statuses is collected at a special time-point,such as taking fasting plasma glucose test and providing a limited view of individual’s health and disease risk.As a new parameter for continuously evaluating personal clinical statuses,the newly developed technique“continuous glucose monitoring”(CGM)can characterize glucose dynamics.By calculating the complexity of glucose time series index(CGI)with refined composite multi-scale entropy analysis of the CGM data,the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes(P for trend<0.01).Furthermore,CGI was significantly associated with various parameters such as insulin sensitivity/secretion(all P<0.01),and multiple linear stepwise regression showed that the disposition index,which reflectsβ-cell function after adjusting for insulin sensitivity,was the only independent factor correlated with CGI(P<0.01).Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.展开更多
Artificial intelligence(AI)algorithms in combination with continuous monitoring technologies have the potential to revolutionize chronic disease management.The recent innovations in both continuous glucose monitoring(...Artificial intelligence(AI)algorithms in combination with continuous monitoring technologies have the potential to revolutionize chronic disease management.The recent innovations in both continuous glucose monitoring(CGM)and the closed-loop highlight the far-reaching potential of AI biosensors for individual healthcare.This review summarizes some of the most advanced progress made in CGM biosensing.We will focus on three main applications of AI algorithms in diabetes management:closed-loop control algorithms,glucose predictions,and calibrations.The challenges and opportunities of AI technologies for CGM in individualized and proactive medicine will also be discussed.展开更多
Continuous glucose monitoring(CGM)systems play an increasingly vital role in the glycemic control of patients with diabetes mellitus.However,the immune responses triggered by the implantation of poorly biocompatible s...Continuous glucose monitoring(CGM)systems play an increasingly vital role in the glycemic control of patients with diabetes mellitus.However,the immune responses triggered by the implantation of poorly biocompatible sensors have a significant impact on the accuracy and lifetime of CGM systems.In this review,research efforts over the past few years to mitigate the immune responses by enhancing the anti-biofouling ability of sensors are summarized.This review divided these works into active immune engaging strategy and passive immune escape strategy based on their respective mechanisms.In each strategy,the various biocompatible layers on the biosensor surface,such as drug-releasing membranes,hydrogels,hydrophilic membranes,anti-biofouling membranes based on zwitterionic polymers,and bio-mimicking membranes,are described in detail.This review,therefore,provides researchers working on implantable biosensors for CGM systems with vital information,which is likely to aid in the research and development of novel CGM systems with profound anti-biofouling properties.展开更多
BACKGROUND The FreeStyle Libre flash glucose monitoring(FGM)system entered the Chinese market in 2017 to complement the self-monitoring of blood glucose.Due to its increased usage in clinics,the number of studies inve...BACKGROUND The FreeStyle Libre flash glucose monitoring(FGM)system entered the Chinese market in 2017 to complement the self-monitoring of blood glucose.Due to its increased usage in clinics,the number of studies investigating its accuracy has increased.However,its accuracy has not been investigated in highland populations in China.AIM To evaluate measurements recorded using the FreeStyle Libre FGM system compared with capillary blood glucose measured using the enzyme electrode method in patients with type 2 diabetes(T2D)who had migrated within 3 mo from highlands to plains.METHODS Overall,68 patients with T2D,selected from those who had recently migrated from highlands to plains(within 3 mo),were hospitalized at the Department of Endocrinology from August to October 2017 and underwent continuous glucose monitoring(CGM)with the FreeStyle Libre FGM system for 14 d.Throughout the study period,fingertip capillary blood glucose was measured daily using the enzyme electrode method(Super GL,China),and blood glucose levels were read from the scanning probe during fasting and 2 h after all three meals.Moreover,the time interval between reading the data from the scanning probe and collecting fingertip capillary blood was controlled to<5 min.The accuracy of the FGM system was evaluated according to the CGM guidelines.Subsequently,the factors influencing the mean absolute relative difference(MARD)of this system were analyzed by a multiple linear regression method.RESULTS Pearson’s correlation analysis showed that the fingertip and scanned glucose levels were positively correlated(R=0.86,P=0.00).The aggregated MARD of scanned glucose was 14.28±13.40%.Parker's error analysis showed that 99.30%of the data pairs were located in areas A and B.According to the probe wear time of the FreeStyle Libre FGM system,MARD_(1 d) and MARD_(2-14 d) were 16.55%and 14.35%,respectively(t=1.23,P=0.22).Multiple stepwise regression analysis showed that MARD did not correlate with blood glucose when the largest amplitude of glycemic excursion(LAGE)was<5.80 mmol/L but negatively correlated with blood glucose when the LAGE was≥5.80 mmol/L.CONCLUSION The FreeStyle Libre FGM system has good accuracy in patients with T2D who had recently migrated from highlands to plains.This system might be ideal for avoiding the effects of high hematocrit on blood glucose monitoring in populations that recently migrated to plains.MARD is mainly influenced by glucose levels and fluctuations,and the accuracy of the system is higher when the blood glucose fluctuation is small.In case of higher blood glucose level fluctuations,deviation in the scanned glucose levels is the highest at extremely low blood glucose levels.展开更多
Diabetes is a condition that can come to the surface at any point throughout a person’s life. Although Type 1 and Type 2 Diabetes have different triggers that cause them to arise, a person can experience similar comp...Diabetes is a condition that can come to the surface at any point throughout a person’s life. Although Type 1 and Type 2 Diabetes have different triggers that cause them to arise, a person can experience similar complications from either if not monitored and treated accordingly. Through the Diabetes Control and Complications Trial, it was found that a significant way to monitor diabetes is through glucose levels in a person’s body. The research surrounding glucose monitoring dates to the mid-1800s, with the first successful reagent for glucose testing being developed in 1908. Since then, glucose sensing has become one of the most rapidly growing areas of research and development in biosensor technology, creating a competitive market for more advanced, accurate, and convenient glucose monitoring. This article reviews the history of biosensors used for glucose monitoring, and major advancements in biosensor technology to enhance performance and improve quality of life for patients with diabetes.展开更多
Glucose monitoring is an important component in diabetes treatment and management. The results of blood glucose monitoring are useful for determining the degree of glucose metabolic disturbance, evaluating therapeuti...Glucose monitoring is an important component in diabetes treatment and management. The results of blood glucose monitoring are useful for determining the degree of glucose metabolic disturbance, evaluating therapeutic outcomes, and guiding adjustments of treatment regimens.1 Self-monitoring of blood glucose （SMBG） still remains the most common form of in-home blood glucose monitoring with the glycosylated hemoglobin （HbAlc） as the ＂gold standard＂ for understanding the patients＇ average glucose over the last 3 months. However, both HbA1 c and SMBG have certain limitations： HbAlc represents the average blood glucose level over the previous 2-3 months;展开更多
BACKGROUND The continuous glucose monitoring(CGM)system has become a popular evaluation tool for glucose fluctuation,providing a detailed description of glucose change patterns.We hypothesized that glucose fluctuation...BACKGROUND The continuous glucose monitoring(CGM)system has become a popular evaluation tool for glucose fluctuation,providing a detailed description of glucose change patterns.We hypothesized that glucose fluctuations may contain specific information on differences in glucose change between type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM),despite similarities in change patterns,because of different etiologies.Unlike Fourier transform,continuous wavelet transform(CWT)is able to simultaneously analyze the time and frequency domains of oscillating data.AIM To investigate whether CWT can detect glucose fluctuations in T1DM.METHODS The 60-d and 296-d glucose fluctuation data of patients with T1DM(n=5)and T2DM(n=25)were evaluated respectively.Glucose data obtained every 15 min for 356 d were analyzed.Data were assessed by CWT with Morlet form(n=7)as the mother wavelet.This methodology was employed to search for limited frequency glucose fluctuation in the daily glucose change.The frequency and enclosed area(0.02625 scalogram value)of 18 emerged signals were compared.The specificity for T1DM was evaluated through multiple regression analysis using items that demonstrated significant differences between them as explanatory variables.RESULTS The high frequency at midnight(median:75 Hz,cycle time:19 min)and middle frequency at noon(median:45.5 Hz,cycle time:32 min)were higher in T1DM vs T2DM(median:73 and 44 Hz;P=0.006 and 0.005,respectively).The area of the>100 Hz zone at midnight to forenoon was more frequent and larger in T1DM vs T2DM.In a day,the lower frequency zone(15-35 Hz)was more frequent and the area was larger in T2DM than in T1DM.The threedimensional scatter diagrams,which consist of the time of day,frequency,and area of each signal after CWT,revealed that high frequency signals belonging to T1DM at midnight had a loose distribution of wave cycles that were 17-24 min.Multivariate analysis revealed that the high frequency signal at midnight could characterize T1DM(odds ratio:1.33,95%confidence interval:1.08-1.62;P=0.006).CONCLUSION CWT might be a novel tool for differentiate glucose fluctuation of each type of diabetes mellitus using CGM data.展开更多
The aim of this study was to compare the difference of blood glucose(BG) fluctuation in the patients of type-2 diabetes mellitus(DM-2) with and without clinical diagnosed diabetic nephropathy(DN) by the continuous glu...The aim of this study was to compare the difference of blood glucose(BG) fluctuation in the patients of type-2 diabetes mellitus(DM-2) with and without clinical diagnosed diabetic nephropathy(DN) by the continuous glucose monitoring system(CGMS).Thirty DM-2 patients with clinical diagnosed DN and fifteen DM-2 patients without complication underwent continuous glucose monitoring for 3 days(72 h) by CGMS.The difference of daily glucose fluctuation in both groups was compared by the parameter of CGMS.The 24-h mean blood glucose (MBG),minimal BG(MIN-BG),area under curve of BG over 7.8(AUC7.8),percentage of time of BG over 7.8 (PT7.8),area under curve of BG over 11.1(AUC11.1),percentage of time of BG over 11.1(PT11.1),as well as mean of daily difference(MODD) were significantly increased in the group of DN,compared with those in the group of DM-2 without complication(all statistic probability P<0.05).No statistical significance of mean amplitude of glycaemic excursion(MAGE) was found.In the group of DN,MBG,standard deviation of blood glucose(SDBG),large amplitude of glycaemic excursion(LAGE),AUC7.8,PT7.8,AUC11.1,PT11.1,MAGE and MODD were(10.7±1.9) mmol/L,(2.5±1.3) mmol/L,(9.2±3.9) mmol/L,3.2±1.7,(81±18)%,1.2±1.0,(42±24)%, (5.8±2.5) mmol/L and(2.6±1.5) mmol/L,respectively.The study showed that the BG level of the patients with DN fluctuated throughout the day.MBG of the patients with DN was higher than that of the patients of DM-2 without complications,with the characteristics of long-lasting high BG period,dramatic instability during the day and especially high postprandial blood glucose.CGMS is a useful tool for physicians to know the details of the change of BG in the patients with DN.展开更多
BACKGROUND In 2017,35000 Saudi children and adolescents were living with a type 1 diabetes(T1D)diagnosis.Diabetic complications are minimized upon strengthened glycemic regulation.The annual cost of treating diabetic ...BACKGROUND In 2017,35000 Saudi children and adolescents were living with a type 1 diabetes(T1D)diagnosis.Diabetic complications are minimized upon strengthened glycemic regulation.The annual cost of treating diabetic patients with complications was four-fold higher than for patients without complications.The use of flash glucose monitoring(FGM)enables better diabetes treatment and thereby improves glycemic control.Understanding the factors that affect effectiveness of FGM will help enhance the device’s use and management of hospital resources,resulting in improved outcomes.AIM To investigate factors that affect effectiveness of the FGM system for glycated hemoglobin(HbA1c)levels/glycemic control among T1D patients.METHODS A retrospective empirical analysis of T1D patient records from King Abdul-Aziz University Hospital and Prince Sultan Military Medical City was performed.T1D patients who began FGM between 2017 and 2019 were included.RESULTS The data included 195 T1D patients(70 males and 125 females)with a mean age of 23.6±8.1 years.Among them,152 patients used multiple daily injection and 43 used an insulin pump.The difference in HbA1c level from baseline and after using FGM was-0.60±2.10,with a maximum of 4.70 and a minimum of-6.30.There was a statistically significant negative correlation between the independent variables(age,duration of diabetes,level of engagement)and HbA1c.The group with the highest HbA1c mean(9.85)was 18-years-old,while the group with the lowest HbA1c mean(7.87)was 45-years-old.Patients with a low level of engagement(less than six scans per day)had the highest HbA1c mean(9.84),whereas those with a high level of engagement(more than eight scans per day)had the lowest HbA1c mean(8.33).CONCLUSION With proper education,FGM can help people with uncontrolled T1D over the age of 18 years to control their glucose level.展开更多
Critically ill patients are prone to high glycemic variations irrespective of their diabetes status.This mandates frequent blood glucose(BG)monitoring and regulation of insulin therapy.Even though the most commonly em...Critically ill patients are prone to high glycemic variations irrespective of their diabetes status.This mandates frequent blood glucose(BG)monitoring and regulation of insulin therapy.Even though the most commonly employed capillary BG monitoring is convenient and rapid,it is inaccurate and prone to high bias,overestimating BG levels in critically ill patients.The targets for BG levels have also varied in the past few years ranging from tight glucose control to a more liberal approach.Each of these has its own fallacies,while tight control increases risk of hypoglycemia,liberal BG targets make the patients prone to hyperglycemia.Moreover,the recent evidence suggests that BG indices,such as glycemic variability and time in target range,may also affect patient outcomes.In this review,we highlight the nuances associated with BG monitoring,including the various indices required to be monitored,BG targets and recent advances in BG monitoring in critically ill patients.展开更多
BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predictin...BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predicting hypoglycemia,and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings.All participants underwent a 7-days continuous glucose monitoring(CGM)using a retrospective CGM system.We obtained glycemic variability indices using the CGM system.We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator.Patients were categorized into low HGI(HGI<0.5)and high HGI groups(HGI≥0.5)according to HGI median(0.5).Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia.RESULTS We included 129 subjects with T2DM(54.84±12.56 years,46%male)in the study.Median TIR score was 90%.The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group;this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group.Multivariate analyses revealed that mean blood glucose,standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia.Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia.In addition,the optimal cut-off points for HGI,mean blood glucose,and standard deviation of blood glucose in predicting hypoglycemia were 0.5%,7.2 mmol/L and 1.4 mmol/L respectively.CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR>70%.Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.展开更多
Continuous glucose monitoring(CGM)is a popular technology among the diabetic population,especially in patients with type 1 diabetes and those with type 2 diabetes treated with insulin.The American Diabetes Association...Continuous glucose monitoring(CGM)is a popular technology among the diabetic population,especially in patients with type 1 diabetes and those with type 2 diabetes treated with insulin.The American Diabetes Association recommends standardization of CGM reports with visual cues,such as the ambulatory glucose profile.Nevertheless,interpreting this report requires training and time for CGM to be cost-efficient.In this work it has been proposed to incorporate Japanese candlestick charts in glucose monitoring.These graphs are used in price analysis in financial markets and are easier to view.Each candle provides extra information to make prudent decisions since it reports the opening,maximum,minimum and closing glucose levels of the chosen time frame,usually the daily one.The Japanese candlestick chart is an interesting tool to be considered in glucose control.This graphic representation allows identification of glucose trends easily through the colors of the candles and maximum and minimum glucose values.展开更多
Objective Evidence suggests that type 2 diabetes （T2DM） is associated with an increased risk of dementia and that glucose variability is an independent risk factor for diabetic complications. This study investigated...Objective Evidence suggests that type 2 diabetes （T2DM） is associated with an increased risk of dementia and that glucose variability is an independent risk factor for diabetic complications. This study investigated the relationship between glucose excursion and cognitive function in aged T2DM patients. Methods A total of 248 aged T2DM patients wore a continuous glucose monitoring system （CGMS） for 3 days in order to evaluate glucose excursion, including mean amplitude of glycemic excursions （MAGE） and mean of daily difference （MODD）. All subjects were evaluated with a number of accepted cognitive function tests, including the mini-mental status examination （MMSE）. The relationship between MAGE and MODD and performance on these cognitive tests was assessed. Results The MAGE and MMSE score were negatively correlated, likewise with the correlation between MODD and MMSE. Liner multivariate regression analysis showed that MAGE and MODD were also negatively related to MMSE independent of age, sex, glycemic control, hypertension, smoking, or coronary heart disease history. Conclusion Glucose excursion is related to cognitive function in aged T2DM patients. Elevated glucose excursion decreased the MMSE score, which reflects general cognitive function. Thus, therapy aimed at controlling glucose excursion may be beneficial for maintaining cognitive function in aged T2DM patients.展开更多
文摘Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests,the advent of continuous glucose monitoring(CGM)systems has revolutionized the approach.These devices offer a safe and reliable means of tracking glucose levels in real-time,benefiting both women with diabetes during pregnancy and the healthcare providers.Moreover,CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes,especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device.Such a combined approach has been demonstrated to improve overall blood sugar control,lessen the occurrence of preeclampsia and neonatal hypoglycaemia,and minimize the duration of neonatal intensive care unit stays.This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY23H050005and Zhejiang Medical Technology Project,No.2022RC009.
文摘Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly found in diabetic patients with DKD and especially ESKD,as a result of impaired renal metabolism.It is essential to monitor glycemia for effective management of DKD.Hemoglobin A1c(HbA1c)has long been considered as the gold standard for monitoring glycemia for>3 months.However,assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction.Continuous glucose monitoring(CGM)has provided new insights on glycemic assessment and management.CGM directly measures glucose level in interstitial fluid,reports real-time or retrospective glucose concentration,and provides multiple glycemic metrics.It avoids the pitfalls of HbA1c in some contexts,and may serve as a precise alternative to estimation of mean glucose and glycemic variability.Emerging studies have demonstrated the merits of CGM for precise monitoring,which allows fine-tuning of glycemic management in diabetic patients.Therefore,CGM technology has the potential for better glycemic monitoring in DKD patients.More research is needed to explore its application and management in different stages of DKD,including hemodialysis,peritoneal dialysis and kidney transplantation.
文摘In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.
基金National Natural Science Foundation of China,No.81774134 and No.81873174Natural Science Foundation of Jiangsu Province of China,No.BK20150558 and No.BK20171331+2 种基金Postdoctoral Foundation of Jiangsu Province of China,No.1501120CJiangsu Province 333 Talent Funding Project,No.BRA2017595Young Medical Key Talents Project of Jiangsu Province,No.QNRC2016902.
文摘BACKGROUND Time in range(TIR),as a novel metric for glycemic control,has robust relevance with diabetic complications.Diabetic peripheral neuropathy(DPN)is characterized by sudomotor dysfunction.AIM To explore the relationship between TIR obtained from continuous glucose monitoring(CGM)and sudomotor function detected by SUDOSCAN in subjects with type 2 diabetes.METHODS The research enrolled 466 inpatients with type 2 diabetes.All subjects underwent 3-d CGM and SUDOSCAN.SUDOSCAN was assessed with electrochemical skin conductance in hands(HESC)and feet(FESC).Average feet ESC<60μS was defined as sudomotor dysfunction(+),otherwise it was sudomotor dysfunction(-).TIR refers to the percentage of time when blood glucose is between 3.9-10 mmol/L during 1 d period.RESULTS Among the enrolled subjects,135(28.97%)presented with sudomotor dysfunction.Patients with sudomotor dysfunction(+)showed a decreased level of TIR(P<0.001).Compared to the lowest tertile of TIR,the middle and the highest tertiles of TIR was associated with an obviously lower prevalence of sudomotor dysfunction(20.51%and 21.94%vs 44.52%)(P<0.001).In addition,with the increase of TIR,HESC and FESC increased(P<0.001).Regression analysis demonstrated that TIR was inversely and independently linked with the prevalence of sudomotor dysfunction after adjusting for confounding values(odds ratio=0.979,95%CI:0.971-0.987,P<0.001).CONCLUSION The tight glycemic control assessed by TIR is of vitally protective value for sudomotor dysfunction in type 2 diabetes mellitus.
文摘BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIM To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODS Patients receiving distal gastrectomy with Billroth-I(DG-BI)or Roux-en-Y reconstruction(DG-RY)and total gastrectomy with RY(TG-RY)for gastric cancer(March 2018-January 2020)were prospectively enrolled.Interstitial tissue glycemic profiles were measured every 15 min,up to 14 d,by continuous glucose monitoring.Dumping episodes were recorded on 5 patient-selected days by diary.Within 3 h postprandially,dumping-associated glycemic changes were defined as a dumping profile,those without symptoms as a control profile.These profiles were compared.RESULTS Thirty patients were enrolled(10 DG-BI,10 DG-RY,10 TG-RY).The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal,which 47 control profiles did not(P<0.05).Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles,with lower glycemic levels.DGRY and TG-RY late dumping profiles(7 and 13,respectively)showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia,with a steeper drop in TG-RY than in DG-RY.CONCLUSION Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer.Furthermore,glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.
文摘Diabetes mellitus affects people worldwide,and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients.Previous reports have confirmed that hyperglycemia can increase the risk of mortality in patients cared in the intensive care unit(ICU).In addition,severe and multiple hypoglycemia increases the risk of mortality when using insulin or intensive antidiabetic therapy.The innovation of continuous glucose monitoring(CGM)may help to alert medical caregivers with regard to the development of hyperglycemia and hypoglycemia,which may decrease the potential complications in patients in the ICU.The major limitation of CGM is the measurement of interstitial glucose levels rather than real-time blood glucose levels;thus,there will be a delay in the treatment of hyperglycemia and hypoglycemia in patients.Recently,the European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control,which may provide a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients.In this mini-review paper,we describe the application of CGM to patients in the ICU and summarize the pros and cons of CGM.
基金supported by the National Natural Science Foundation of China (No.61176107,No.11204210,No.61428402,and No.61201039)the Key Program of Tianjin Natural Science Foundation (No.15JCZDJC36100)+1 种基金the National High Technology Research and Development Program of China (No.2012AA022602)the 111 Project of China (No.B07014)
文摘Continuous blood glucose monitoring is important for the diagnosis,treatment,and study of diabetes. many organizations have been working on this subject in recent two decades. Glucose concentration in interstitial fluid is closely related to the blood glucose levels. Minimally invasive continuous blood glucose monitoring technology based on the glucose detection in interstitial fluid develops rapidly and gets more and more attentions from the patients and the doctors,due to its instantaneous real-time display of glucose level,"24/7"coverage,and the ability to characterize glycemic variability. According to the different detection methods,most of the continuous glucose monitoring technology could be divided into two kinds: subcutaneous implantation method and transdermal extraction method. This paper review s the recent development of minimally invasive blood glucose monitoring technology and instruments. The mainly remained challenges and related research directions are presented as well.
基金the National Natural Science Foundation of China(Nos.81873646 and 61903071)the Shanghai United Developing Technology Project of Municipal Hospitals(Nos.SHDC12006101 and SHDC12010115)the Shanghai Municipal Education Commission Gaofeng Clinical Medicine grant support(Nos.20161430).
文摘Most information used to evaluate diabetic statuses is collected at a special time-point,such as taking fasting plasma glucose test and providing a limited view of individual’s health and disease risk.As a new parameter for continuously evaluating personal clinical statuses,the newly developed technique“continuous glucose monitoring”(CGM)can characterize glucose dynamics.By calculating the complexity of glucose time series index(CGI)with refined composite multi-scale entropy analysis of the CGM data,the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes(P for trend<0.01).Furthermore,CGI was significantly associated with various parameters such as insulin sensitivity/secretion(all P<0.01),and multiple linear stepwise regression showed that the disposition index,which reflectsβ-cell function after adjusting for insulin sensitivity,was the only independent factor correlated with CGI(P<0.01).Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.
基金Shenzhen Stability Support Plan,Grant/Award Number:20200806163622001National Natural Science Foundation of China,Grant/Award Numbers:21804007,21890742SZU Top Ranking Project,Grant/Award Number:86000000210。
文摘Artificial intelligence(AI)algorithms in combination with continuous monitoring technologies have the potential to revolutionize chronic disease management.The recent innovations in both continuous glucose monitoring(CGM)and the closed-loop highlight the far-reaching potential of AI biosensors for individual healthcare.This review summarizes some of the most advanced progress made in CGM biosensing.We will focus on three main applications of AI algorithms in diabetes management:closed-loop control algorithms,glucose predictions,and calibrations.The challenges and opportunities of AI technologies for CGM in individualized and proactive medicine will also be discussed.
基金the financial support from the National Natural Science Foundation of China(Grant No.22175130)the Basic Research General Program of Shenzhen Science and Technology Innovation Commission in 2020(Grant No.JCYJ20190806162412752)。
文摘Continuous glucose monitoring(CGM)systems play an increasingly vital role in the glycemic control of patients with diabetes mellitus.However,the immune responses triggered by the implantation of poorly biocompatible sensors have a significant impact on the accuracy and lifetime of CGM systems.In this review,research efforts over the past few years to mitigate the immune responses by enhancing the anti-biofouling ability of sensors are summarized.This review divided these works into active immune engaging strategy and passive immune escape strategy based on their respective mechanisms.In each strategy,the various biocompatible layers on the biosensor surface,such as drug-releasing membranes,hydrogels,hydrophilic membranes,anti-biofouling membranes based on zwitterionic polymers,and bio-mimicking membranes,are described in detail.This review,therefore,provides researchers working on implantable biosensors for CGM systems with vital information,which is likely to aid in the research and development of novel CGM systems with profound anti-biofouling properties.
基金Supported by Health and Family Planning Project of Sichuan Province,No.17PJ069Tibet Autonomous Region Science and Technology Program,No.XZ202303ZY0011G.
文摘BACKGROUND The FreeStyle Libre flash glucose monitoring(FGM)system entered the Chinese market in 2017 to complement the self-monitoring of blood glucose.Due to its increased usage in clinics,the number of studies investigating its accuracy has increased.However,its accuracy has not been investigated in highland populations in China.AIM To evaluate measurements recorded using the FreeStyle Libre FGM system compared with capillary blood glucose measured using the enzyme electrode method in patients with type 2 diabetes(T2D)who had migrated within 3 mo from highlands to plains.METHODS Overall,68 patients with T2D,selected from those who had recently migrated from highlands to plains(within 3 mo),were hospitalized at the Department of Endocrinology from August to October 2017 and underwent continuous glucose monitoring(CGM)with the FreeStyle Libre FGM system for 14 d.Throughout the study period,fingertip capillary blood glucose was measured daily using the enzyme electrode method(Super GL,China),and blood glucose levels were read from the scanning probe during fasting and 2 h after all three meals.Moreover,the time interval between reading the data from the scanning probe and collecting fingertip capillary blood was controlled to<5 min.The accuracy of the FGM system was evaluated according to the CGM guidelines.Subsequently,the factors influencing the mean absolute relative difference(MARD)of this system were analyzed by a multiple linear regression method.RESULTS Pearson’s correlation analysis showed that the fingertip and scanned glucose levels were positively correlated(R=0.86,P=0.00).The aggregated MARD of scanned glucose was 14.28±13.40%.Parker's error analysis showed that 99.30%of the data pairs were located in areas A and B.According to the probe wear time of the FreeStyle Libre FGM system,MARD_(1 d) and MARD_(2-14 d) were 16.55%and 14.35%,respectively(t=1.23,P=0.22).Multiple stepwise regression analysis showed that MARD did not correlate with blood glucose when the largest amplitude of glycemic excursion(LAGE)was<5.80 mmol/L but negatively correlated with blood glucose when the LAGE was≥5.80 mmol/L.CONCLUSION The FreeStyle Libre FGM system has good accuracy in patients with T2D who had recently migrated from highlands to plains.This system might be ideal for avoiding the effects of high hematocrit on blood glucose monitoring in populations that recently migrated to plains.MARD is mainly influenced by glucose levels and fluctuations,and the accuracy of the system is higher when the blood glucose fluctuation is small.In case of higher blood glucose level fluctuations,deviation in the scanned glucose levels is the highest at extremely low blood glucose levels.
文摘Diabetes is a condition that can come to the surface at any point throughout a person’s life. Although Type 1 and Type 2 Diabetes have different triggers that cause them to arise, a person can experience similar complications from either if not monitored and treated accordingly. Through the Diabetes Control and Complications Trial, it was found that a significant way to monitor diabetes is through glucose levels in a person’s body. The research surrounding glucose monitoring dates to the mid-1800s, with the first successful reagent for glucose testing being developed in 1908. Since then, glucose sensing has become one of the most rapidly growing areas of research and development in biosensor technology, creating a competitive market for more advanced, accurate, and convenient glucose monitoring. This article reviews the history of biosensors used for glucose monitoring, and major advancements in biosensor technology to enhance performance and improve quality of life for patients with diabetes.
文摘Glucose monitoring is an important component in diabetes treatment and management. The results of blood glucose monitoring are useful for determining the degree of glucose metabolic disturbance, evaluating therapeutic outcomes, and guiding adjustments of treatment regimens.1 Self-monitoring of blood glucose （SMBG） still remains the most common form of in-home blood glucose monitoring with the glycosylated hemoglobin （HbAlc） as the ＂gold standard＂ for understanding the patients＇ average glucose over the last 3 months. However, both HbA1 c and SMBG have certain limitations： HbAlc represents the average blood glucose level over the previous 2-3 months;
文摘BACKGROUND The continuous glucose monitoring(CGM)system has become a popular evaluation tool for glucose fluctuation,providing a detailed description of glucose change patterns.We hypothesized that glucose fluctuations may contain specific information on differences in glucose change between type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM),despite similarities in change patterns,because of different etiologies.Unlike Fourier transform,continuous wavelet transform(CWT)is able to simultaneously analyze the time and frequency domains of oscillating data.AIM To investigate whether CWT can detect glucose fluctuations in T1DM.METHODS The 60-d and 296-d glucose fluctuation data of patients with T1DM(n=5)and T2DM(n=25)were evaluated respectively.Glucose data obtained every 15 min for 356 d were analyzed.Data were assessed by CWT with Morlet form(n=7)as the mother wavelet.This methodology was employed to search for limited frequency glucose fluctuation in the daily glucose change.The frequency and enclosed area(0.02625 scalogram value)of 18 emerged signals were compared.The specificity for T1DM was evaluated through multiple regression analysis using items that demonstrated significant differences between them as explanatory variables.RESULTS The high frequency at midnight(median:75 Hz,cycle time:19 min)and middle frequency at noon(median:45.5 Hz,cycle time:32 min)were higher in T1DM vs T2DM(median:73 and 44 Hz;P=0.006 and 0.005,respectively).The area of the>100 Hz zone at midnight to forenoon was more frequent and larger in T1DM vs T2DM.In a day,the lower frequency zone(15-35 Hz)was more frequent and the area was larger in T2DM than in T1DM.The threedimensional scatter diagrams,which consist of the time of day,frequency,and area of each signal after CWT,revealed that high frequency signals belonging to T1DM at midnight had a loose distribution of wave cycles that were 17-24 min.Multivariate analysis revealed that the high frequency signal at midnight could characterize T1DM(odds ratio:1.33,95%confidence interval:1.08-1.62;P=0.006).CONCLUSION CWT might be a novel tool for differentiate glucose fluctuation of each type of diabetes mellitus using CGM data.
基金the Shanghai United Developing Technology Project of Municipal Hospitals (No.SHDC12006101)
文摘The aim of this study was to compare the difference of blood glucose(BG) fluctuation in the patients of type-2 diabetes mellitus(DM-2) with and without clinical diagnosed diabetic nephropathy(DN) by the continuous glucose monitoring system(CGMS).Thirty DM-2 patients with clinical diagnosed DN and fifteen DM-2 patients without complication underwent continuous glucose monitoring for 3 days(72 h) by CGMS.The difference of daily glucose fluctuation in both groups was compared by the parameter of CGMS.The 24-h mean blood glucose (MBG),minimal BG(MIN-BG),area under curve of BG over 7.8(AUC7.8),percentage of time of BG over 7.8 (PT7.8),area under curve of BG over 11.1(AUC11.1),percentage of time of BG over 11.1(PT11.1),as well as mean of daily difference(MODD) were significantly increased in the group of DN,compared with those in the group of DM-2 without complication(all statistic probability P<0.05).No statistical significance of mean amplitude of glycaemic excursion(MAGE) was found.In the group of DN,MBG,standard deviation of blood glucose(SDBG),large amplitude of glycaemic excursion(LAGE),AUC7.8,PT7.8,AUC11.1,PT11.1,MAGE and MODD were(10.7±1.9) mmol/L,(2.5±1.3) mmol/L,(9.2±3.9) mmol/L,3.2±1.7,(81±18)%,1.2±1.0,(42±24)%, (5.8±2.5) mmol/L and(2.6±1.5) mmol/L,respectively.The study showed that the BG level of the patients with DN fluctuated throughout the day.MBG of the patients with DN was higher than that of the patients of DM-2 without complications,with the characteristics of long-lasting high BG period,dramatic instability during the day and especially high postprandial blood glucose.CGMS is a useful tool for physicians to know the details of the change of BG in the patients with DN.
文摘BACKGROUND In 2017,35000 Saudi children and adolescents were living with a type 1 diabetes(T1D)diagnosis.Diabetic complications are minimized upon strengthened glycemic regulation.The annual cost of treating diabetic patients with complications was four-fold higher than for patients without complications.The use of flash glucose monitoring(FGM)enables better diabetes treatment and thereby improves glycemic control.Understanding the factors that affect effectiveness of FGM will help enhance the device’s use and management of hospital resources,resulting in improved outcomes.AIM To investigate factors that affect effectiveness of the FGM system for glycated hemoglobin(HbA1c)levels/glycemic control among T1D patients.METHODS A retrospective empirical analysis of T1D patient records from King Abdul-Aziz University Hospital and Prince Sultan Military Medical City was performed.T1D patients who began FGM between 2017 and 2019 were included.RESULTS The data included 195 T1D patients(70 males and 125 females)with a mean age of 23.6±8.1 years.Among them,152 patients used multiple daily injection and 43 used an insulin pump.The difference in HbA1c level from baseline and after using FGM was-0.60±2.10,with a maximum of 4.70 and a minimum of-6.30.There was a statistically significant negative correlation between the independent variables(age,duration of diabetes,level of engagement)and HbA1c.The group with the highest HbA1c mean(9.85)was 18-years-old,while the group with the lowest HbA1c mean(7.87)was 45-years-old.Patients with a low level of engagement(less than six scans per day)had the highest HbA1c mean(9.84),whereas those with a high level of engagement(more than eight scans per day)had the lowest HbA1c mean(8.33).CONCLUSION With proper education,FGM can help people with uncontrolled T1D over the age of 18 years to control their glucose level.
文摘Critically ill patients are prone to high glycemic variations irrespective of their diabetes status.This mandates frequent blood glucose(BG)monitoring and regulation of insulin therapy.Even though the most commonly employed capillary BG monitoring is convenient and rapid,it is inaccurate and prone to high bias,overestimating BG levels in critically ill patients.The targets for BG levels have also varied in the past few years ranging from tight glucose control to a more liberal approach.Each of these has its own fallacies,while tight control increases risk of hypoglycemia,liberal BG targets make the patients prone to hyperglycemia.Moreover,the recent evidence suggests that BG indices,such as glycemic variability and time in target range,may also affect patient outcomes.In this review,we highlight the nuances associated with BG monitoring,including the various indices required to be monitored,BG targets and recent advances in BG monitoring in critically ill patients.
基金Supported by Investigator-initiated Trial Research Funds from Eli Lilly and Co.and Amylin Pharmaceuticals,Inc.,No.A1570Natural Science Foundation of Guangdong Province,No.2018A030313915。
文摘BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predicting hypoglycemia,and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings.All participants underwent a 7-days continuous glucose monitoring(CGM)using a retrospective CGM system.We obtained glycemic variability indices using the CGM system.We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator.Patients were categorized into low HGI(HGI<0.5)and high HGI groups(HGI≥0.5)according to HGI median(0.5).Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia.RESULTS We included 129 subjects with T2DM(54.84±12.56 years,46%male)in the study.Median TIR score was 90%.The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group;this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group.Multivariate analyses revealed that mean blood glucose,standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia.Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia.In addition,the optimal cut-off points for HGI,mean blood glucose,and standard deviation of blood glucose in predicting hypoglycemia were 0.5%,7.2 mmol/L and 1.4 mmol/L respectively.CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR>70%.Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.
文摘Continuous glucose monitoring(CGM)is a popular technology among the diabetic population,especially in patients with type 1 diabetes and those with type 2 diabetes treated with insulin.The American Diabetes Association recommends standardization of CGM reports with visual cues,such as the ambulatory glucose profile.Nevertheless,interpreting this report requires training and time for CGM to be cost-efficient.In this work it has been proposed to incorporate Japanese candlestick charts in glucose monitoring.These graphs are used in price analysis in financial markets and are easier to view.Each candle provides extra information to make prudent decisions since it reports the opening,maximum,minimum and closing glucose levels of the chosen time frame,usually the daily one.The Japanese candlestick chart is an interesting tool to be considered in glucose control.This graphic representation allows identification of glucose trends easily through the colors of the candles and maximum and minimum glucose values.
基金funded by the Medical College Natural Science Foundation of Shanghai Jiaotong University (09XJ21028)
文摘Objective Evidence suggests that type 2 diabetes （T2DM） is associated with an increased risk of dementia and that glucose variability is an independent risk factor for diabetic complications. This study investigated the relationship between glucose excursion and cognitive function in aged T2DM patients. Methods A total of 248 aged T2DM patients wore a continuous glucose monitoring system （CGMS） for 3 days in order to evaluate glucose excursion, including mean amplitude of glycemic excursions （MAGE） and mean of daily difference （MODD）. All subjects were evaluated with a number of accepted cognitive function tests, including the mini-mental status examination （MMSE）. The relationship between MAGE and MODD and performance on these cognitive tests was assessed. Results The MAGE and MMSE score were negatively correlated, likewise with the correlation between MODD and MMSE. Liner multivariate regression analysis showed that MAGE and MODD were also negatively related to MMSE independent of age, sex, glycemic control, hypertension, smoking, or coronary heart disease history. Conclusion Glucose excursion is related to cognitive function in aged T2DM patients. Elevated glucose excursion decreased the MMSE score, which reflects general cognitive function. Thus, therapy aimed at controlling glucose excursion may be beneficial for maintaining cognitive function in aged T2DM patients.
