Daily Blood Glucose Research Articles

The relationship between daily blood glucose fluctuation and readmission in patients with acute coronary syndrome

Abstract Background Although the comprehensive diagnos and treatment of patients with acute coronary syndrome(ACS) has been greatly improved,the morbidity and mortality are still high. Previous literature has reported that about 70-75% of patients diagnosed with acute coronary syndrome have abnormal blood glucose metabolism1,and there existed gender differences. At present, most research results showed that elevated blood glucose is related to the prognosis of ACS. However, further intervention studies indicated that simply strengthen the reducement of blood glucose did not improve prognosis of these patients2. Glucose fluctuations, another dimension of blood glucose, reflect acute changes in blood glucose. However, there are few studies on the effect of blood glucose fluctuation on the prognosis of patients with ACS. Purpose This study aimed to explore the relationship between seven daily fluctuations of blood glucose and readmission in ACS patients. Methods In this study, a total of 664 patients admitted to our University from January 1, 2019 to December 31, 2019 were included and their blood glucose was monitored seven times a day during their hospitalization. The coefficient of variation of blood glucose (CV) was calculated from the results of seven daily blood glucose monitoring to represent the daily fluctuation of blood glucose. Univariate and multivariate regression analyses were performed to determine whether CV was an independent risk factor for re-hospitalization. In addition, the area under the curve (AUC) was used to evaluate the predictive efficacy of CV for outcome events. Finally, we performed a subgroup analysis based on gender and diabetes status to assess the association between CV and readmission in each subgroup. Results After a median follow-up of 21 months, the rate of readmission was 38.4%. Unstable angina pectoris (71.4%) and heart failure (16.4%) were the most common reasons for readmission. Patients with greater CV levels typically exhibited lower fasting blood glucose, higher post breakfast blood glucose, and higher admission blood glucose.The readmission rate increased with the increasing blood glucose variability after the cox regression analysis. Moreover, independent of glycated hemoglobin,CV could predict the risk of readmission in patients with ACS.When using 26.66% as the cutoff point of CV, the study population was divided into two groups and showed a significant differentiation for rehospitalization.In subgroup analysis, there was no significant association between seven daily blood glucose fluctuations and readmission in female and non-diabetes mellitus patients with acute coronary syndrome. Conclusions Besides some normal blood glucose index,seven daily fluctuations of blood glucose was associated with readmission in ACS patients. ACS patients who were male and combined with diabetes were more likely to be readmitted if their CV levels were greater.

Effects of postprandial exercise timing on blood glucose and fluctuations in patients with type 2 diabetes mellitus.

The aim of this study was to assess how moderate-intensity aerobic exercise performed 45 minutes and 90 minutes after a meal affects blood glucose levels and fluctuations in individuals diagnosed with type 2 diabetes mellitus (T2DM). Twenty-two patients with T2DM, who were solely receiving oral hypoglycemic medication, were enrolled and divided randomly into two categories: those exercising 45 minutes after a meal (45-minute postprandial exercise group) and those exercising 90 minutes post-meal (90-minute postprandial exercise group). Both groups engaged in a 30-minute session of moderate-intensity aerobic stationary bike exercise following breakfast. This aerobic exercise regimen consisted of two stages, with the groups switching exercise timings after the initial phase. Continuous glucose monitoring (CGM) was utilized to evaluate the blood glucose levels and fluctuations in the participants. After breakfast, both overall daily blood glucose levels and the area under the curve for blood glucose following breakfast were reduced in the 45-minute postprandial exercise group compared to the 90-minute postprandial exercise group. The 45-minute postprandial exercise group demonstrated greater time spent within the target glucose range and less time above the target range than the 90-minute postprandial exercise group. Additionally, measures such as standard deviation, mean amplitude of glycemic excursions, largest amplitude of glycemic excursions, and postprandial glucose excursion for breakfast, peak postprandial glucose levels, and duration of elevated glucose levels were all lower in the 45-minute postprandial exercise group compared to the 90-minute postprandial exercise group. Moderate-intensity aerobic exercise lasting 45 minutes after meals was found to be more efficient in decreasing blood glucose levels and minimizing fluctuations compared to exercising 90 minutes after meals in patients with T2DM. Additionally, it notably reduced the peak in blood glucose levels after meals.

Health beyond biology: the extended health hypothesis and technology.

There are ethical dilemmas faced by clinicians when responding to using unregistered medical devices, such as innovative internet technologies for managing type 1 diabetes mellitus. This chronic disease significantly impacts patients' health, requiring intensive daily activities like blood glucose monitoring, insulin injections, and specific dietary recommendations. Recent technological advances, including continuous glucose monitors and insulin pumps, have been shown to improve glycemic control. Di-it Yourself Artificial Pancreas Systems are emerging open-source automated delivery methods initiated by the diabetes community, although they are not clinically evaluated and present a liability challenge for healthcare providers. To use them or not? Should parents and healthcare providers use such technology that helps, but is not proven?Having all of that in mind, we argue that the World Health Organization's (WHO) definition of health is outdated, advocating for the "Extended Health Hypothesis". This hypothesis claims that health extends beyond traditional biological boundaries to include essential functional structures like diabetes-related technology, making technology a part of a patient's health. This view aligns with the "Extended Mind Hypothesis," suggesting that health should include elements beyond organic material if they are vital to a patient's functions.In the commentary, we highlight that both naturalist and normative conceptions of health support the extended health hypothesis, emphasizing that human health is not confined to organic material. This perspective raises critical questions about whether devices like insulin pumps and continuous glucose monitors are integral to a patient's health and whether their malfunction constitutes a form of disease. Devices are considered integral to health, there is no ethical dilemma in using unregistered medical devices for managing type 1 diabetes. Finally, we call for reevaluating the definitions of health and patients, particularly for children with type 1 diabetes using advanced technologies. It asserts that the optimal use of such devices represents a new form of health, creating a health-device symbiosis that should be evaluated with the child's best interests in mind.

Evaluation of High-dose versus Standard-dose of Dexamethasone on Mortality among the Mechanically Ventilated COVID-19 Patients.

Anti-inflammatory agents like dexamethasone (DEX) are a mainstay of treatment for COVID-19. Despite randomized trials demonstrating that a 6 mg daily dose of DEX improved patient outcomes in hospitalized COVID-19 patients receiving oxygen, clinicians often prescribe higher doses of corticosteroids without evidence to support this practice. The purpose of this study was to compare outcomes of ventilated COVID-19 patients who received standard dose (SD) versus high dose (HD) DEX. This was a multi-site, retrospective, observational study on ventilated COVID-19- positive patients who received DEX for at least three days between June 1, 2020, and January 31, 2022. The primary outcome of this study was the association between mortality and SD (<6 mg daily) versus HD (>10 mg daily) DEX in ventilated COVID-19 patients. Secondary outcomes included average blood glucose (BG), number of BG readings above 200, incidence of bacterial nosocomial infection, ventilator-free days, length of stay (LOS), and ICU LOS. Of the 212 included patients, 53 (25%) received SD DEX, and 159 (75%) received HD DEX. There was no significant effect of DEX dose on mortality, number of BG readings >200, incidence of nosocomial infections, LOS, or ventilator-free days (p >0.05). After controlling for confounding factors, no difference in mortality persisted (OR 1.34 95% CI 0.62- 2.90). Average daily BG and ICU LOS were significantly greater in the HD group compared to the SD group (p = 0.003, p = 0.019, respectively). There was no association between HD DEX and mortality among ventilated COVID- 19 patients compared to SD DEX. Moreover, HD DEX is associated with detrimental effects such as prolonged ICU LOS and higher average daily BG. This study supports the use of SD DEX in ventilated COVID-19 patients.

Low preoperative hemoglobin A1c level is a predictor of perioperative infectious complications after esophagectomy: A retrospective, single-center study.

This retrospective, single-center study aimed to evaluate the impact of blood glucose (BG) markers on perioperative complications after esophagectomy in a cohort of 176 patients. Study analyses included the correlation of daily maximum BG level and hemoglobin A1c (HbA1c) with clinicopathological factors. Maximum BG levels were significantly higher on postoperative day (POD) 0 than on PODs 2, 3, 5, and 7 (p < 0.05). Additionally, maximum BG levels on PODs 1, 2, and 7 were significantly higher in patients with preoperative HbA1c levels of ≥ 5.6% than in those with preoperative HbA1c levels of < 5.6% (p < 0.05 for all). The rates of any complications and infectious complications were higher in patients with preoperative HbA1c levels of < 5.6% than in those with preoperative HbA1c levels of ≥ 5.6% (p < 0.05 for both). A preoperative HbA1c level of < 5.6% was a significant predictor of infectious complications after esophagectomy by logistic regression analysis (p < 0.05). Maximum BG level after esophagectomy remained high in patients with high preoperative HbA1c levels, whereas a normal HbA1c level was an independent risk factor for infectious complications.

Clinical and functional characterization of a novel KCNJ11 (c.101G > A, p.R34H) mutation associated with maturity-onset diabetes mellitus of the young type 13.

This study aimed to describe the clinical features, diagnostic and therapeutic course of a patient with MODY13 caused by KCNJ11 (c.101G > A, p.R34H) and how it contributes to the pathogenesis of MODY13, and to explore new therapeutic targets. Whole-exome sequencing was used to screen prediagnosed individuals and family members with clinically suspected KCNJ11 mutations. Real-time fluorescence quantitative PCR, western blotting, thallium flux of potassium channels, glucose-stimulated insulin secretion (GSIS), and immunofluorescence assays were used to analyze the regulation of insulin secretion by the KCNJ11 mutant in MIN6 cells. Daily blood glucose levels were continuously monitored for 14 days in the proband using the ambulatory blood glucose meter (SIBIONICS). Mutation screening of the entire exon of the gene identified a heterozygous KCNJ11 (c.101G > A, p.R34H) mutation in the proband and his mother. Cell-based GSIS assays after transfection of MIN6 using wild-type and mutant plasmids revealed that this mutation impaired insulin secretory function. Furthermore, we found that this impaired secretory function is associated with reduced functional activity of the mutant KCNJ11 protein and reduced expression of the insulin secretion-associated exocytosis proteins STXBP1 and SNAP25. For the first time, we revealed the pathogenic mechanism of KCNJ11 (c.101G > A, p.R34H) associated with MODY13. This mutant can cause alterations in KATP channel activity, reduce sensitivity to glucose stimulation, and impair pancreatic β-cell secretory function by downregulating insulin secretion-associated exocytosis proteins. Therefore, oral sulfonylurea drugs can lower blood glucose levels through pro-insulinotropic effects and are more favorable for patients with this mutation.

Effectiveness of Smartphone Application “Gororokapp” for Type 2 Diabetes Patients’ Self-Management in Rwanda: A Randomized Controlled Trial

BackgroundType 2 diabetes has become a public health concern, representing more than 90%of all types of diabetes and affecting 536.6 million people worldwide in 2021. It isa disabling condition and is considered a major risk factor for developing chroniccomplication such as cardiovascular diseases if not well controlled. Studies haveshown that individuals with diabetes can make a positive impact on the outcomesof their disease by participating to their healthcare. Contextualized innovative andeffective applications are needed to facilitate individuals with diabetes to participateto their care.AimTo assess the effectiveness of Smartphone Application “GororokApp” in monitoringof glucose control among type 2 diabetes individuals.Materials &amp; MethodsA Randomized Controlled Trial (RCT) was used to assess the effectiveness of smartphoneapplication (GororokApp) in monitoring of glucose control for self-management bythe patients with type 2 diabetes in Rwanda. Participants in intervention group usedthe GororokApp and recorded their blood glucose measurements and received healthcare advice remotely while the control group continued routine care. The participantswere followed up over a period of 12 weeks. The primary outcomes were glycatedhaemoglobin, and daily blood glucose measurements.ResultsAfter 12 weeks of follow up, the intervention and control, groups demonstrateddifference of changes in glycated haemoglobin; whereby in the intervention groupthe glycated haemoglobin reduced from 8.45±2.93 to 6.89±1.86 (p ≤ 0.001),whereas in the control group the glycated haemoglobin increased from 7.12±2.52 to 8.14±2.17 (p ≤0.001).ConclusionThe smartphone application “GororokApp” is effective in self-monitoring andmanagement of the daily blood glucose levels in intervention group to achievetreatment targets of blood glucose and glycated haemoglobin among individualswith type 2 diabetes.Rwanda J Med Health Sci. 2024;7(1):79-88

Association of persistent postoperative hyperglycemia with mortality after elective craniotomy.

The influence of persistent postoperative hyperglycemia after craniotomy has not yet been explored. This study aimed to investigate the hypothesis that persistent postoperative hyperglycemia is associated with mortality in patients undergoing an elective craniotomy. This study included adult patients (age ≥ 18 years) undergoing an elective craniotomy between January 2011 and March 2021 at the West China Hospital, Sichuan University. Peak daily blood glucose values measured within the first 7 days after craniotomy were collected. Persistent hyperglycemia was defined by two or more consecutive serum glucose levels of mild, moderate, or severe hyperglycemia. Normoglycemia, mild hyperglycemia, moderate hyperglycemia, and severe hyperglycemia were defined as glucose values of ≤ 6.1 mmol/L, > 6.1 and ≤ 7.8 mmol/L, > 7.8 and ≤ 10.0 mmol/L, and > 10.0 mmol/L, respectively. This study included 14,907 patients undergoing an elective craniotomy. In the multivariable analysis, both moderate (adjusted OR 3.76, 95% CI 2.68-5.27) and severe (adjusted OR 3.82, 95% CI 2.54-5.76) persistent hyperglycemia in patients were associated with higher 30-day mortality compared with normoglycemia. However, this association was not observed in patients with mild hyperglycemia (adjusted OR 1.32, 95% CI 0.93-1.88). Interestingly, this association was observed regardless of whether patients had preoperative hyperglycemia. There was no interaction between moderate or severe hyperglycemia and preexisting diabetes (p for interaction = 0.65). When postoperative peak blood glucose values within the first 7 days after craniotomy were evaluated as a continuous variable, for each 1-mmol/L increase in blood glucose, the adjusted OR of 30-day mortality was 1.17 (95% CI 1.14-1.21). Postoperative blood glucose (area under the curve [AUC] = 0.78) was superior to preoperative blood glucose (AUC = 0.65; p < 0.001) for predicting mortality. Moderate and severe persistent hyperglycemia in patients were associated with an increased risk of deep venous thrombosis (adjusted OR 3.20, 95% CI 2.31-4.42), pneumonia (adjusted OR 2.77, 95% CI 2.40-3.21), myocardial infarction (adjusted OR 4.38, 95% CI 3.41-5.61), and prolonged hospital stays (adjusted OR 1.43, 95% CI 1.29-1.59). In patients undergoing an elective craniotomy, moderate and severe persistent postoperative hyperglycemia were associated with an increased risk of mortality compared with normoglycemia, regardless of preoperative hyperglycemia.

Body mass index moderates the association between diabetes distress and objective self-management behaviours in adolescents with type 1 diabetes and elevated A1Cs.

To examine the cross-sectional associations between diabetes distress, BMI (zBMI; BMI z-score), objectively measured mean daily blood glucose readings and insulin boluses administered, and A1C in adolescents with type 1 diabetes (T1D) using insulin pumps. T1D self-management behaviour data were downloaded from adolescents' (N = 79) devices and mean daily frequency of blood glucose readings and insulin boluses were calculated. Diabetes distress was measured (Problem Areas in Diabetes-Teen questionnaire [PAID-T]), A1C collected, and zBMI calculated from height and weight. Three multiple linear regressions were performed with blood glucose readings, insulin boluses, and A1C as the three dependent variables and covariates (age, T1D duration), zBMI, diabetes distress, and the diabetes distress x zBMI interaction as independent variables. Participants (55.7% female) were 14.9 ± 1.9 years old with T1D for 6.6 ± 3.4 years. zBMI moderated the relationship between diabetes distress and mean daily insulin boluses administered (b = -0.02, p = 0.02); those with higher zBMI and higher diabetes distress administered fewer daily insulin boluses. zBMI was not a moderator of the association between diabetes distress and blood glucose readings (b = -0.01, p = 0.29) or A1C (b = 0.002, p = 0.81). Using objective behavioural data is useful for identifying how adolescent diabetes distress and zBMI affect daily bolusing behaviour amongst adolescent insulin pump users. Although distinct interventions exist to improve T1D self-management or diabetes distress, none addresses them together while considering zBMI. Decreasing diabetes distress could be especially important for youth with high zBMI.

Quantifying the effect of glucose 6-phosphate dehydrogenase deficiency on glycated hemoglobin values in children and adolescents with type 1 diabetes

The primary objectives of the study were (a) to confirm that glucose 6-phosphate dehydrogenase (G6PD) deficiency affects HbA1c values in a sample of children and adolescents with type 1 diabetes (T1D) and (b) to quantify this effect so that a correction can be applied to the HbA1c values found in current clinical practice. The following data were collected: age, sex, G6PD, number of daily capillary blood glucose measurements, 90-day average blood glucose levels prior to the study, HbA1c, and glycated hemoglobin estimated (eA1c) obtained from blood glucose levels. Patients were divided into three groups based on G6PD values: deficient, intermediate, and nondeficient. In each group, a comparison between the average eA1C and HbA1c values was performed. Then, the difference between the eA1c and HbA1c values of each patient and the mean of the differences (MD) of all patients was calculated within the three groups. Finally, a comparison of the MD values between groups was performed. Seventy-four subjects with T1D were studied. Based on the G6PD value, 33 subjects were deficient, 8 were intermediate, and 33 subjects were nondeficient. In deficient patients, the eA1c values were significantly higher than the HbA1c values. In the other two groups, however, there were no differences. The MD values between the three groups were significantly different. In deficient patients, MD values were higher than those in intermediate and in nondeficient patients. No difference was found between intermediate and nondeficient subjects. Our study confirms that G6PD deficiency affects HbA1c values in children and adolescents with T1D, both in deficient subjects and, to a much lesser extent, in intermediate subjects. In deficient subjects, there is an average reduction in HbA1c attributable to enzyme deficiency of 1.3% (14 mmol/mol) and in intermediate subjects of 0.3% (3 mmol/mol).

Predicting health outcomes with intensive longitudinal data collected by mobile health devices: a functional principal component regression approach

BackgroundIntensive longitudinal data (ILD) collected in near real time by mobile health devices provide a new opportunity for monitoring chronic diseases, early disease risk prediction, and disease prevention in health research. Functional data analysis, specifically functional principal component analysis, has great potential to abstract trends in ILD but has not been used extensively in mobile health research.ObjectiveTo introduce functional principal component analysis (fPCA) and demonstrate its potential applicability in estimating trends in ILD collected by mobile heath devices, assessing longitudinal association between ILD and health outcomes, and predicting health outcomes.MethodsfPCA and scalar-to-function regression models were reviewed. A case study was used to illustrate the process of abstracting trends in intensively self-measured blood glucose using functional principal component analysis and then predicting future HbA1c values in patients with type 2 diabetes using a scalar-to-function regression model.ResultsBased on the scalar-to-function regression model results, there was a slightly increasing trend between daily blood glucose measures and HbA1c. 61% of variation in HbA1c could be predicted by the three preceding months’ blood glucose values measured before breakfast (P < 0.0001, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${R}_{adjusted}^{2}=0.61$$\\end{document}).ConclusionsFunctional data analysis, specifically fPCA, offers a unique tool to capture patterns in ILD collected by mobile health devices. It is particularly useful in assessing longitudinal dynamic association between repeated measures and outcomes, and can be easily integrated in prediction models to improve prediction precision.

Tailored diffusion limiting membrane for microneedle glucose sensors with wide linear range

Continuous glucose monitoring is very important to daily blood glucose control in diabetic patients, but its accuracy is limited by the narrow linear range of the response of biosensor to the glucose concentration because of the oxygen starvation in tissue and the limited maximum conversion rate of glucose oxidase. In this work, a biocompatible diffusion limiting membrane based on two medical-grade polyurethanes is developed via blending modification to restrict the diffusion flux of glucose to match the oxygen concentration and the maximum conversion rate. The expansiveness of the linear range for the nanomaterials-modified electrode in the glucose biosensor can be achieved through the regulation of two polyurethanes, the solvent, and the thickness of the membrane. In addition, the mass transport of hydrogen peroxide and interfering substances is also limited of the membrane. The in vitro experiments demonstrated that the membrane-modified microneedle biosensor exhibited a rapid response to the concentration variation of glucose, a wide linear range that is sufficient to cover the blood concentration of healthy and diabetic people, the ability to resist the oxygen concentration fluctuation and interfering substances, good reproducibility and long-term stability. The custom wearable electrochemical system, possessing these characteristics, has been proven to accurately monitor the blood concentration in a living rat in real time. This demonstrates a significant potential for application in both daily and clinical blood glucose monitoring.

Neonatal Birth Weight With Daily Compared With Every-Other-Day Glucose Monitoring in Gestational Diabetes Mellitus: A Randomized Controlled Trial.

To assess whether universal use of every-other-day glucose monitoring in patients with gestational diabetes mellitus (GDM) resulted in similar birth weights and medication use and was preferred by the patient compared with traditional daily glucose monitoring. This was a noninferiority randomized controlled trial conducted at a single New York City hospital between April 2021 and May 2022. Patients with singleton pregnancies who were diagnosed with GDM after 20 weeks of gestation and had a minimum of 7 days of previous daily blood glucose testing were randomly assigned to test blood glucose values daily or every other day. The primary outcome was neonatal birth weight. We calculated a total sample size of 196 participants needed for noninferiority to be tested, assuming the mean birth weight in the every-other-day group, compared with the daily group, was no higher than the predefined noninferiority margin of 200 g (80% power and one-sided alpha of 0.05). Postrandomization characteristics, including blood glucose values and medication initiation and timing, were recorded. Satisfaction with treatment group was assessed using the validated Oxford Maternity Diabetes Treatment Satisfaction Questionnaire. A total of 197 patients were randomized: 98 in the daily group and 99 in the every-other-day group. Baseline characteristics were similar between groups. The mean neonatal birth weight was similar between groups (mean±SD 3,090±418 g among newborns in the daily group compared with 3,181±482 g among newborns in the every-other-day group). For the primary outcome, the every-other-day group was found to be noninferior to the daily group with an upper confidence limit for the mean difference in mean birth weight of 197 g, which was below the noninferiority margin of 200 g ( P =.046). Postrandomization, there were no significant differences in the number of patients who required medication, the gestational age at which medication was started, or the type of medication used. Average fasting and postprandial glucose values were similar between groups. There was an increase in adherence to treatment group in those randomized to every-other-day blood sugars, but no difference in patient satisfaction. In patients with GDM, testing blood glucose values every other day was as effective as testing daily, without apparent effects on birth weight, medication initiation, or glucose control. Reduced frequency of blood glucose monitoring might help decrease the emotional, physical, and financial burden experienced by patients with GDM. ClinicalTrials.gov , NCT04857073.

Sliding Scale Insulin Use in Nursing Homes Before and After Onset of the COVID-19 Pandemic

ObjectiveTo characterize sliding-scale insulin (SSI) use in US nursing homes (NHs) before and after the COVID-19 pandemic. DesignCross-sectional study. Setting and ParticipantsA total of 129,829 US NH residents on SSI (01/2018-06/2022) across 12 NH chains with a common electronic health record system. MethodsAmong all residents with at least 1 administration of SSI documented in the electronic medication administration record, we described resident demographics, frequency of SSI monotherapy vs combination therapy with another diabetes medication, number of daily capillary blood glucose readings (“fingersticks”), and hypoglycemia (capillary blood glucose <70 mg/dL) and hyperglycemia after first SSI use. We used interrupted time series analysis (ITS) with segmented linear regression models to examine whether the monthly prevalence of SSI use changed at and after the onset of the COVID-19 pandemic (March 2020). ResultsThere were 129,829 unique NH residents with SSI use [51% women, average age 71.3 (SD 11.7) years]. Of these, 36% of residents received SSI monotherapy and 64% received SSI combination therapy. Residents on SSI received an average of 3.96 (SD 1.41) fingersticks per day. Overall, 26% of SSI users experienced a hypoglycemic event within 30 days of the first SSI dose. The ITS analysis identified a step decrease in the rate of SSI use following the onset of the COVID-19 pandemic (43 fewer SSI users per 1000 insulin users) but no change in overall trend over time from before the onset of the pandemic. Conclusions and ImplicationsSSI use and fingerstick burden are high in NH residents. Hypoglycemia occurred commonly among residents on SSI. Future research should compare the safety and effectiveness of SSI monotherapy vs other diabetes medication regimens to guide person-centered prescribing decisions in NHs.

Nonlinear MPC for Insulin Titratio2shn of Type 2 Diabetes

This paper explores the development and application of both linear and nonlinear model predictive control (MPC) strategies for insulin titration in type 2 diabetes (T2D) subjects. By utilizing daily blood glucose measurements, alongside information on insulin injections and meal intake from the previous day, we adjust the insulin sensitivity parameter of the internal model of the controller. This adjustment is based on the steady-state glucose error between the internal model and the plant model. The performance of these strategies was assessed using a high-fidelity T2D model, demonstrating their potential in enhancing the management of T2D.

Improvement of blood glucose control and reduction of hypoglycemia, body weight, and C-reactive protein in type 1 diabetic patients treated with intensive insulin therapy with insulin analogs

Background/Aim. Good metabolic control can delay the onset and progression of chronic complications of diabetes mellitus (DM). Intensified insulin therapy (IIT) is the cornerstone of good metabolic control in the treatment of type 1 DM (T1DM) while avoiding hypoglycemia and body weight (BW) gain in those patients. The aim of the study was to assess the effects of IIT with insulin analogs (aspart and glargine) in T1DM patients. Methods. This prospective clinical study included 49 patients with at least one year of T1DM duration, who were on IIT with human insulin at that moment. They commenced therapy with insulin aspart for three months, followed by insulin glargine for another three months. An analysis of blood glucose (BG) control (glycated hemoglobin ? HbA1c, mean BG, fasting BG, postprandial BG, and glycemic variability) and analysis of BW, hypoglycemia, and C-reactive protein (CRP) levels were performed. Results. The HbA1c level decreased slightly (non-significantly) after three months of insulin aspart therapy (from 9.28% to 8.83%) and decreased significantly after the aspart/glargine combination (to 8.08%; p &lt; 0.001). After the first three months with aspart therapy, a significant reduction in postprandial BG was noted after all three main meals. The mean postprandial rise of BG was significantly reduced. The variability of daily BG was significantly reduced (standard deviation of BG fell from 2.28 mmol/L to 1.90 mmol/L; p &lt; 0.05). The mean BG value in the profiles decreased (from 9.11 mmol/L to 8.31 mmol/L; p &lt; 0.05). All BG values in the profiles after six months were statistically significantly lower compared to the initial values, as well as the mean BG (6.88 mmol/L; p &lt; 0.001) and the variability of daily BG (1.49 mmol/L; p &lt; 0.01). Our results showed a significant reduction in the number of hypoglycemias after three months, especially after the introduction of insulin glargine therapy (significant reduction in the number of symptomatic, asymptomatic, and nocturnal hypoglycemias). The results showed a discrete but significant reduction in BW and a significant reduction in CRP levels (from 3.43 mg/L to 2.25 mg/L; p &lt; 0.001). Conclusion. Treatment of patients with T1DM with insulin analogs (insulin aspart and insulin glargine) in IIT leads to improved BG control with a reduction in the number of hypoglycemia, BW, and CRP levels.

Light-responsive microneedle array with tunable insulin release function for painless and on-demand anti-diabetic therapy

Diabetes is a chronic disease with a high incidence that requires persistent therapy with accurate drug administration. We report a near-infrared light-responsive microneedle with tunable insulin supply for painless and on-demand anti-diabetes therapy. It comprises of a calcium alginate frame having near-infrared radiation-responsive polydopamine-coated poly-lactic-co-glycolic acid microspheres serving as a capsule for insulin on the frame. The microneedle initiated and stopped insulin release via a light triggered on–off mechanism. In vivo experiments revealed that our microneedle provided an appropriate dose of insulin in conformity with the daily blood glucose fluctuations to precisely maintain the blood glucose levels for a long period. These findings suggest the efficacy and safety of the developed microneedle for anti-diabetic therapy.

Family conflict: Risk factor for low adherence in adolescents with type 1 diabetes in Greek families

Introduction: Type 1 Diabetes Melitus (T1DM) treatment is demanding, due to daily blood glucose monitoring, certain diet plan, specific exercise program, multiple daily insulin injections, and management of episodes of hypo- or hyperglycemia. Family conflict may play a significant role in the adherence of adolescents with type 1 diabetes. Purpose: To evaluate Greek families’ conflicts and determine their relationship with T1DM adolescents’ adherence. Methods: A cross-sectional study was conducted from October 2021 to June 2022. Due to COVID-19 restriction, all the interviews were conducted through online survey. Three questionnaires were distributed to the adolescents. Pediatric Quality of Life Inventory tool, Diabetes Self-Management Profile and Collaborative Parent Involvement Scale for Youths Questionnaire. PeDsQL was distributed to their parents as well. Results: 59 adolescents (N=21) aged 10-19 years and their parents (N=38) participated. The mean values of PedsQL for all five factors ranged from 55.7 (Worry subcategory) to 77.8 (Treatment adherence), showing an overall moderate QoL. According to the mean values, parents’ perspectives PedsQL for all five factors ranged from 38.6 (Worry subcategory) to 77 (Treatment adherence), showing an overall moderate QoL. Mean DSMP score indicated a high level of adherence of children with diabetes mellitus to their treatment, whilst mean cooperation score indicated a high level of cooperation between parents and adolescents with T1DM and low level of FC. Bivariate analysis revealed that less FC was related to better treatment adherence in adolescents. Conclusions: T1DM management remains challenging, particularly as children grow older and move into adolescence. The family can play a significant role in T1DM management. Diabetes multidisciplinary teams should evaluate and understand family members' interactions detecting inter-family problems such as high frequency of FC. Provision of family support can improve communication between adolescents and parents and may reduce FC resulting in better T1DM treatment adherence and outcomes.

Recovery Phase Nutrition and Insulin Strategies for a Collegiate Distance Runner with Type 1 Diabetes Mellitus: A Case Study.

There is scant published research regarding nutrition and insulin strategies for athletic performance in collegiate distance runners with type 1 diabetes mellitus (CDRT1). Acute carbohydrate supplementation (CHOsup) and insulin reduction used to minimize hypoglycemia during exercise may result in deteriorated glycemic control post exercise in CDRT1. The present case study of a CDRT1 investigated outcomes associated with a moderate-carbohydrate (ModCHO) diet and 24 h insulin adjustment during recovery phases for improved glycemic control and reduced use of acute strategies. During an 8-day period, a female CDRT1 followed a ModCHO (~4 g/kg/day) nutrition program. Recovery phase adjustments to insulin doses were made using an equation developed to estimate reduced insulin needs post exercise, as a function of exercise intensity and duration. Daily training was performed in the fasted state at 6:00 a.m. and included additional exercise strategies to reduce glycemic variability when needed. Daily blood glucose time-in-range (TIR) and use of CHOsup were assessed. Athlete well-being was determined using the Student-Athlete Well-Being Scale (SAWS)TM at baseline, and days 1, 3, and 7. Throughout the 8-day period, mean TIR increased (77% versus < 50%) and the magnitude of glycemic excursions decreased (~3.8-15 versus ~3.0-26 mmol/L) relative to a prior comparison period. Minimal pre-exercise CHOsup was employed and CHOsup during exercise was not required. Additionally, the athlete achieved a new lifetime best in the 5000 m run and maintained positive well-being. The present case study provides examples of recovery phase strategies (i.e., ModCHO diet and 24 h insulin adjustments) that may support glycemic control and athletic performance in CDRT1 and provides potential considerations for nutrition and insulin strategies for use by athletes and coaches.

Predictive Value of Glycemic Variability and HDL-C for Secondary Persistent Inflammatory Immunosuppressed Catabolic Syndrome in Patients with Sepsis.

Sepsis patients with persistent inflammation, immunosuppression, and catabolism syndrome (PICS) have a poor prognosis, and early detection of biomarkers to predict its prognosis is particularly important. The purpose of this study is to investigate the predictive value of glycemic variability (GV) and high density lipid-cholesterol (HDL-C) for secondary PICS in patients with sepsis. One hundred and sixty-five patients with sepsis were enrolled in the retrospective study and divided into sepsis secondary PICS and non-PICS group. The daily blood glucose levels from 1 to 7 days after the diagnosis of sepsis were recorded, and GV was calculated. Logistic regression was used to analyze the risk factors of sepsis with PICS, receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of GV, and HDL-C for the prognosis of sepsis with PICS. In a study of 165 patients, PICS group tended to have higher GV and lower HDL-C levels than those in the non-PICS group. Logistic regression analysis identified GV and HDL-C as independent risk factors for the secondary PICS of sepsis. The results of ROC curve showed that GV and HDL-C had a certain predictive value for the secondary PICS of sepsis, the sensitivity of GV was 77.5%, specificity of 81.8%, the sensitivity of HDL-C was 76.6%, and specificity of 74.8%. GV and HDL are risk factors for PICS secondary to sepsis and have predictive value for patients' prognosis.