Advanced Fabrication Techniques and Case Studies in Biosensor Technology: A Review

Diabetes technology and devices transform the lives of people with diabetes.

Abstracts from ATTD 20158th International Conference on Advanced Technologies & Treatments for DiabetesParis, France—February 18–21, 2015

Abstracts from ATTD 2016 9th International Conference on Advanced Technologies & Treatments for Diabetes Milan, Italy-February 3-6, 2016.

Searching for glycemic control in pediatric type 1 diabetes: A long way to go

The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference 22‐25 February 2023 I Berlin & Online

Continuous Glucose Monitoring for Diagnosis and Treatment of Neonatal Hypoglycemia

Closed-loop therapy in older adults with type 1 diabetes: hypoglycaemia benefits and risk stratification

The accuracy of the GlucoWatch G2 Biographer (GW2B; Cygnus, Inc., Redwood City, CA) was assessed in children and adolescents with type 1 diabetes mellitus (T1DM). During a 24-h clinical research center stay, 89 children and adolescents with T1DM (3.5-17.7 years old) wore 174 GW2Bs and had frequent serum glucose determinations during the day and night and during insulin-induced hypoglycemia and meal-induced hyperglycemia, resulting in 3672 GW2B-reference glucose pairs. The median relative absolute difference between the GW2B and reference glucose values was 16% (25th, 75th percentiles = 7%, 29%). The proposed International Organisation for Standardisation criteria were met for 60% of sensor values. Accuracy was better at higher serum glucose levels than low glucose levels. Accuracy degraded slightly as the sensor aged. Time of day, subject age, gender, or body mass index did not impact GW2B accuracy. There were no cases of serious skin reactions. Although the accuracy of this generation of sensor does not approach that of current home glucose meters, the majority of sensor glucose values are within 20% of the serum glucose. This level of accuracy may be sufficient for detecting trends and modifying diabetes management. Further longitudinal outpatient studies are needed to assess the utility of the GW2B as a management tool to improve glycemic control and decrease the incidence of severe hypoglycemia in children with diabetes.

T he past year saw marked advances in research in pediatric diabetes with numerous studies investigating the use of closed-loop systems in the pediatric population. While such technologies are on the horizon for clinical use in pediatrics, other studies in the past year have highlighted the challenges with clinical implementation of insulin pump therapy, a technology that has been available for decades. The hope for an automatedor initially a semiautomated or hybrid closed-loop system requiring the user to give premeal boluses of insulinis well deserved. These systems aim to improve glucose control and lower the burden of care for children with type 1 diabetes (T1D) and their families. However, initial systems will continue to require significant user involvement as well as experienced and informed pediatric diabetes teams for successful adoption of these diabetes technologies. In addition, advances were seen in the use of a novel intranasal formulation of glucagon to treat hypoglycemia that simplifies the current injectable version of this potentially lifesaving medication. A randomized trial on the benefits of metformin in overweight adolescents with T1D found no benefit on HbA1c, but other potential metabolic improvements. Technology was also studied using telehealth to improve diabetes outcomes by delivering care to rural populations and in pediatric patients struggling to achieve treatment goals. Research in diabetes technology in pediatrics has accelerated in the past few years and with the advent of clinical availability of closed-loop technology promises to remain a rich field of investigation for years to come. Pediatric patients and their families should begin to reap the benefits of decades of work on these diabetes technologies to improve glucose control and lower the burden of care for diabetes. We conducted a Medline search for articles on the following topics: diabetes technology, insulin pump therapy (continuous subcutaneous insulin infusion [CSII]), continuous glucose monitoring (CGM), closed-loop systems, and new therapies in T1D relating to the pediatric age group (0-18 years). This article focuses on key articles that were published between July 1, 2015 and June 30, 2016. Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries

Type 1 Diabetes in Children and Adolescents.

Reducing the rates of diabetes across the United States

In Brief OBJECTIVE To compare the daily glycemic profile reflected by continuous and intermittent blood glucose monitoring in pregnant women with type 1 diabetes and to compare the treatment protocols based on the two monitoring methods. METHODS The study sample consisted of 34 gravid patients at gestational weeks 16–32, with type 1 diabetes being treated by multiple insulin injections. Data derived from the continuous glucose monitoring system for 72 hours were compared with fingerstick glucose measurements performed 6–8 times per day. During the study period, patients documented the time of food intake, insulin injections, and hypoglycemic events. Data on demographics, gravidity, parity, body mass index, hemoglobin A1c, and fructosamine levels were collected for each patient. RESULTS An average (± standard deviation) of 780 ± 54 glucose measurements was recorded for each patient with continuous glucose monitoring. The mean total time of hyperglycemia (glucose level greater than 140 mg/dL) undetected by the fingerstick method was 192 ± 28 minutes per day. Nocturnal hypoglycemic events (glucose level less than 50 mg/dL) were recorded in 26 patients; in all cases, there was an interval of 1–4 hours before clinical manifestations appeared or the event was revealed by random blood glucose examination. Based on the additional information obtained by continuous monitoring, the insulin therapeutic regimen was adjusted in 24 patients (70%). CONCLUSION Continuous glucose monitoring can diagnose high postprandial blood glucose levels and nocturnal hypoglycemic events that are unrecognized by intermittent blood glucose monitoring and may serve as a basis for determining treatment regimens. A large, prospective study on maternal and neonatal outcome is needed to evaluate the clinical implications of this new monitoring technique. Continuous glucose monitoring may be a method for adjusting treatment in gravid women with type 1 diabetes mellitus.

<i>Journal of Diabetes</i> News

Diabetes Technology and the Human Factor.

Traditional diabetes self-monitoring of blood glucose (SMBG) involves inconvenient finger pricks. Continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems offer CGM, enhancing type 2 diabetes (T2D) management with convenient, comprehensive data. To assess the benefits and potential harms of CGM and isCGM compared with usual care or SMBG in individuals with T2D. We conducted a comprehensive search of MEDLINE, Embase, the Cochrane Library, Web of Science, and bibliographies up to August 2023. We analyzed studies meeting these criteria: randomized controlled trials (RCT) with comparison of at least two interventions for ≥8 weeks in T2D patients, including CGM in real-time/retrospective mode, short-/long-term CGM, isCGM, and SMBG, reporting glycemic and relevant data. We used a standardized data collection form, extracting details including author, year, study design, baseline characteristics, intervention, and outcomes. We included 26 RCTs (17 CGM and 9 isCGM) involving 2,783 patients with T2D (CGM 632 vs. usual care/SMBG 514 and isCGM 871 vs. usual care/SMBG 766). CGM reduced HbA1c (mean difference -0.19% [95% CI -0.34, -0.04]) and glycemic medication effect score (-0.67 [-1.20 to -0.13]), reduced user satisfaction (-0.54 [-0.98, -0.11]), and increased the risk of adverse events (relative risk [RR] 1.22 [95% CI 1.01, 1.47]). isCGM reduced HbA1c by -0.31% (-0.46, -0.17), increased user satisfaction (0.44 [0.29, 0.59]), improved CGM metrics, and increased the risk of adverse events (RR 1.30 [0.05, 1.62]). Neither CGM nor isCGM had a significant impact on body composition, blood pressure, or lipid levels. Limitations include small samples, single-study outcomes, population variations, and uncertainty for younger adults. Additionally, inclusion of <10 studies for most end points restricted comprehensive analysis, and technological advancements over time need to be considered. Both CGM and isCGM demonstrated a reduction in HbA1c levels in individuals with T2D, and unlike CGM, isCGM use was associated with improved user satisfaction. The impact of these devices on body composition, blood pressure, and lipid levels remains unclear, while both CGM and isCGM use were associated with increased risk of adverse events.