Daily Glucose Research Articles

A smartphone-assisted “all-in-one” paper chip for one-pot noninvasive detection of salivary glucose level

Noninvasive glucose detection for diabetes monitoring, in comparison with the conventional finger-prick test that causes inevitable pain, is on demand. Salivary glucose level that possesses a well-established correlation with blood glucose level can be a promising alternative for noninvasive detection, however, the sensitivity and user-friendliness remained to be improved. Herein, an “all-in-one” paper chip was fabricated by one-pot method for sensitive and user-friendly detection of salivary glucose level. Glucose oxidase (GOx) and the chromogenic reagent, luminol, were both in situ encapsulated in a metal–organic framework, ZIF-67, to form the GOx&luminol@ZIF-67@Paper (G&L@ZIF@Paper). Owing to the specificity of GOx and the peroxidase activity of ZIF-67, the paper chips are highly sensitive and specific for glucose with a linear range from 0.2 to 2 mM, and a limit of detection of 0.12 mM (S/N = 3). Moreover, ascribing to the protection and “all-in-one” structure by ZIF-67, the chip is highly stable that maintains the detection performance after storage at room temperature in air for 4 weeks, and this strategy also facilitates the one-pot detection without multiple steps of sampling and incubation. With the assistance of a smartphone application, the glucose level in saliva can be accurately detected with “sample-in-result-out” manner, and the results were highly consistent with those measured by commercial kit. This paper chip is a promising device for daily glucose monitoring, and the highly-integrated strategy provides an innovative resolution for the construction of colorimetric paper chips.

Dysglycemias in patients admitted to ICUs with severe acute respiratory syndrome due to COVID-19 versus other causes - a cohort study

BackgroundDysglycemias have been associated with worse prognosis in critically ill patients with COVID-19, but data on the association of dysglycemia with COVID-19 in comparison with other forms of severe acute respiratory syndrome are lacking. This study aimed to compare the occurrence of different glycemic abnormalities in patients with severe acute respiratory syndrome and COVID-19 admitted to intensive care units versus glycemic abnormalities in patients with severe acute respiratory syndrome from other causes, to evaluate the adjusted attributable risk associated with COVID-19 and dysglycemia and to assess the influence of these dysglycemias on mortality.MethodsWe conducted a retrospective cohort of consecutive patients with severe acute respiratory syndrome and suspected COVID-19 hospitalized in intensive care units between March 11 and September 13, 2020, across eight hospitals in Curitiba-Brazil. The primary outcome was the influence of COVID-19 on the variation of the following parameters of dysglycemia: highest glucose level at admission, mean and highest glucose levels during ICU stay, mean glucose variability, percentage of days with hyperglycemia, and hypoglycemia during ICU stay. The secondary outcome was the influence of COVID-19 and each of the six parameters of dysglycemia on hospital mortality within 30 days from ICU admission.ResultsThe sample consisted of 841 patients, of whom 703 with and 138 without COVID-19. Comparing patients with and without COVID-19, those with COVID-19 had significantly higher glucose peaks at admission (165 mg/dL vs. 146 mg/dL; p = 0.002) and during ICU stay (242 mg/dL vs. 187md/dL; p < 0.001); higher mean daily glucose (149.7 mg/dL vs. 132.6 mg/dL; p < 0.001); higher percentage of days with hyperglycemia during ICU stay (42.9% vs. 11.1%; p < 0.001); and greater mean glucose variability (28.1 mg/dL vs. 25.0 mg/dL; p = 0.013). However, these associations were no longer statistically significant after adjustment for Acute Physiology and Chronic Health Evaluation II scores, Sequential Organ Failure Assessment scores, and C-reactive protein level, corticosteroid use and nosocomial infection. Dysglycemia and COVID-19 were each independent risk factors for mortality. The occurrence of hypoglycemia (< 70 mg/dL) during ICU stay was not associated with COVID-19.ConclusionPatients with severe acute respiratory syndrome due to COVID-19 had higher mortality and more frequent dysglycemia than patients with severe acute respiratory syndrome due to other causes. However, this association did not seem to be directly related to the SARS-CoV-2 infection.

Clinical Experience of Using Telemedicine for the Management of Patients Using Continuous Subcutaneous Insulin Infusion in a Highly Complex Latin American Hospital

Continuous subcutaneous insulin infusion (CSII) has emerged as a potential solution for diabetes management during the pandemic, as it reduces the need for in-person visits and allows for remote monitoring of patients. Telemedicine has also become increasingly important in the management of diabetes during the pandemic, as it allows healthcare providers to provide remote consultations and support. Here, we discuss the implications of this approach for diabetes management beyond the pandemic, including the potential for increased access to care and improved patient outcomes. We performed a longitudinal observational study between 1 March 2020 and 31 December 2020 to evaluate glycemic parameters in diabetic patients with CSII in a telehealth service. Glycemic parameters were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability control. A total of 36 patients were included in the study, with 29 having type 1 diabetes and 6 having type 2 diabetes. The study found that the proportion of patients achieving target glucose variability and GMI remained unchanged during follow-up. However, in patients with type 2 diabetes, the time in target range increased from 70% to 80%, and the time in hyperglycemia decreased from 2% to 0%. The results of this study suggest that telemedicine is a strategy for maintaining glycemic control in patients using CSII. However, the lack of access to the internet and adequate telemonitoring devices make it difficult to use on a large scale in emerging countries like ours.

Clinically-Similar Clusters of Daily CGM Profiles: Tracking the Progression of Glycemic Control Over Time.

The adoption of CGM results in vast amounts of data, but their interpretation is still more art than exact science. The International Consensus on Time in Range (TIR) proposed the widely accepted TIR system of metrics, which we now take forward by introducing a finite and fixed set of clinically-similar clusters (CSCs), such that the TIR metrics of the daily CGM profiles within a cluster are homogeneous. CSC definition and validation used 204,710 daily CGM profiles in health, type 1 and type 2 diabetes (T1D, T2D), on different treatments. The CSCs were defined using 23,916 daily CGM profiles (Training set), and the final fixed set of CSCs was obtained using another 37,758 profiles (Validation set). The Testing set (143,036 profiles) was used to establish the robustness and generalizability of the CSCs. The final set of CSCs contains 32 clusters. Any daily CGM profile was classifiable to a single CSC which approximated common glycemic metrics of the daily CGM profile, as evidenced by regression analyses with 0 intercept (R-squares≥0.83, e.g., correlation≥0.91), for all TIR and several other metrics. The CSCs distinguished CGM profiles in health, T2D, and T1D on different treatments, and allowed tracking of the daily changes in a person's glycemic control over time. Daily CGM profiles can be classified into one of 32 prefixed CSCs, which enables a host of applications, e.g. tabulated data interpretation and algorithmic approaches to treatment, database indexing, pattern recognition, and tracking disease progression.

The effect of traditional diet on glucose homoeostasis in carriers and non-carriers of a common TBC1D4 variant in Greenlandic Inuit: a randomised crossover study.

Consumption of traditional foods is decreasing amid a lifestyle transition in Greenland as incidence of type 2 diabetes (T2D) increases. In homozygous carriers of a TBC1D4 variant, conferring postprandial insulin resistance, the risk of T2D is markedly higher. We investigated the effects of traditional marine diets on glucose homoeostasis and cardio-metabolic health in Greenlandic Inuit carriers and non-carriers of the variant ina randomised crossover study consisting of two 4-week dietary interventions: Traditional (marine-based, low-carbohydrate) and Western (high in imported meats and carbohydrates). Oral glucose tolerance test (OGTT, 2-h), 14-d continuous glucose and cardio-metabolic markers were assessed to investigate the effect of diet and genotype. Compared with the Western diet, the Traditional diet reduced mean and maximum daily blood glucose by 0·17 mmol/l (95 % CI 0·05, 0·29; P = 0·006) and 0·26 mmol/l (95 % CI 0·06, 0·46; P = 0·010), respectively, with dose-dependency. Furthermore, it gave rise to a weight loss of 0·5 kg (95 % CI; 0·09, 0·90; P = 0·016) relative to the Western diet and 4 % (95 % CI 1, 9; P = 0·018) lower LDL:HDL-cholesterol, which after adjustment for weight loss appeared to be driven by HDL elevation (0·09 mmol/l (0·03, 0·15), P = 0·006). A diet-gene interaction was indicated on insulin sensitivity in the OGTT (p = 0·093), which reflected a non-significant increase of 1·4 (-0·6, 3·5) mmol/l in carrier 2-h glucose. A Traditional diet marginally improved daily glycaemic control and plasma lipid profile compared with a Westernised diet in Greenlandic Inuit. Possible adverse effects on glucose tolerance in carriers of the TBC1D4 variant warrant further studies.

HbA1c, And Blood Glucose, Changes When Treating Periodontal Disease with the Perio Protect Method™

Periodontal disease is a chronic wound resulting in host elevated local and systemic inflammatory markers in response to the microorganisms of the periodontal biofilm. Separately from its importance as an oral ailment, chronic periodontitis has gained relevance since it can develop into a systemic condition characterized by hyper-inflammation, disruption of the innate and adaptive immune system, and other system-wide alterations. There is compelling evidence that inflammation and chronic infection play an essential role in the development of inflammatory markers and of type 2 diabetes. Studies in humans suggest that circulating inflammatory marker levels may predict type 2 diabetes years in advance of the onset of the disease. Local and systemic expression of inflammatory cytokines, such as TNF-alpha and IL-6, increase in individuals with periodontitis. TNF-alpha and IL-6 impair intracellular insulin signaling, which may lead to insulin resistance and are significantly associated with cardiovascular events and stroke. This case study demonstrates treating periodontal disease with a direct medication delivery method (Perio Protect Method™) manages the patient’s periodontal disease and lowers daily blood glucose and HbA1c levels.

Continuous Glucose Monitoring-Derived Metrics and Capillary Vessel Density in Subjects with Type 1 Diabetes without Diabetic Retinopathy.

Optical coherence tomography angiography (OCTA) is an innovative and reliable technique detecting the early preclinical retinal vascular change in patients with diabetes. We have designed our study to evaluate whether an independent relationship exists between continuous glucose monitoring (CGM)-derived glucose metrics and OCTA parameters in young adult patients with type 1 diabetes without diabetic retinopathy (DR). Inclusion criteria were age ≥ 18 years, diagnosis of type 1 diabetes from ≥ 1 year, stable insulin treatment in the last three months, use of real-time CGM, and CGM wear time ≥ 70%. Each patient underwent dilated slit lamp fundus biomicroscopy to exclude the presence of DR. A skilled operator performed OCTA scans in the morning to avoid possible diurnal variation. CGM-derived glucose metrics from the last 2 weeks were collected through the dedicated software during OCTA. Forty-nine patients with type 1 diabetes (age 29 [18; 39] years, HbA1c 7.7 ± 1.0%) and 34 control subjects participated in the study. Vessel density (VD) of the whole image and parafoveal retina in the superficial (SCP) and deep capillary plexus (DCP) was significantly lower in patients with type 1 diabetes compared to controls. The coefficient of variation of average daily glucose, evaluated by CGM, significantly correlated with foveal and parafoveal VD in SCP and with foveal VD in DCP. High glucose variability might be responsible for the early increase of VD in these areas. Prospective studies may help understand if this pattern precedes DR. The difference we detected between patients with and without diabetes confirms that OCTA is a reliable tool for detecting early retinal abnormalities.

Effect of dapagliflozin on 24-hour glycemic variables in Japanese patients with type 2 diabetes mellitus receiving basal insulin supported oral therapy (DBOT): a multicenter, randomized, open-label, parallel-group study

IntroductionThis study aimed to evaluate the impacts of dapagliflozin on 24-hour glucose variability and diabetes-related biochemical variables in Japanese patients with type 2 diabetes who had received basal insulin supported...

A comparison of daily glucose fluctuation among GCK-MODY and type 2 diabetes using continuous glucose monitoring technology.

Glucokinase variant-induced maturity-onset diabetes of the young (GCK-MODY) exhibits the unique clinical features of mild fasting hyperglycaemia. However, formal studies of its glucose excursion pattern in daily life in comparison with those with or without other types of diabetes are lacking. We conducted a case-control study including 25 patients with GCK-MODY, 25 A1c-matched, drug naive patients with type 2 diabetes (T2DM) and 25 age-, BMI- and sex-matched subjects with normal glucose tolerance (NGT). All the subjects wore flash glucose monitoring (FGM) sensors for 2 weeks, and glucose readings were masked. Glucose excursion was significantly lower in the GCK-MODY than that in A1c-matched T2DM during the daytime, but was similar during the nighttime. The daytime coefficient of variation [CV] driven by postprandial glucose could separate GCK-MODY from well-controlled T2DM, but the nighttime CV could not. In discriminating between GCK-MODY and T2DM, the area under the curve (AUC) of the CV was 0.875. However, in GCK-MODY and NGT subjects, the CVs were similar at 24h, whereas the other four excursion parameters were significantly higher in GCK-MODY than those in NGT subjects. FGM confirmed the stability and mildness of hyperglycemia in GCK-MODY patients. Postprandial regulation is a key driver of the difference in excursion between GCK-MODY and T2DM.

Daily diabetes-specific family conflict, problems, and blood glucose during adolescence.

Diabetes-related family conflict is widely regarded as a risk factor for diabetes outcomes, yet it has not been examined on a daily basis. Parental acceptance may attenuate the degree to which family conflict is associated with diabetes outcomes. The present study examined (a) within- and between-person fluctuations in diabetes problems and family conflict, (b) within- and between-person links between conflict and blood glucose (BG) mean, and (c) whether parental acceptance moderated these associations. One hundred eighty adolescents (Mage = 12.92 years) with T1D completed a 14-day diary measuring diabetes problems, conflict with mother, conflict with father, and parental acceptance at the end of each day. Daily average BG values were calculated from glucometer readings. Higher diabetes problems on average across the 14-day diary were associated with more average conflict with mothers (between-person), but daily fluctuations in the number of diabetes problems were not related to daily conflict (within-person). Adolescents with higher conflict with mothers and fathers on average across the 14 days had higher BG means (between-person); however, on days when adolescents reported higher conflict, they had greater risk for low BG (within-person). Daily parental acceptance did not moderate associations between problems and conflict nor conflict and BG mean. This study was the first to examine daily diabetes-specific conflict with mothers and fathers during adolescence. The number of diabetes problems did not predict daily conflict. Fluctuations in daily conflict were associated with greater risk for low BG, underscoring the need for future research examining in-the-moment relations among conflict and BG extremes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Detemir improves diabetic regulation in poorly controlled diabetic dogs with concurrent diseases.

This study evaluated the use of detemir for treating diabetic dogs with comorbidities that were poorly controlled with intermediate-acting insulins. 7 insulin-treated diabetic dogs. Retrospective pilot study. Dogs were treated with detemir for at least 3 months, and glycemia was assessed by the owners at home initially 2 to 4 times daily for 6 to 8 weeks and twice daily thereafter. Clinical evaluations occurred on days 7 to 14, day 30, and then every 60 to 90 days, and dosage adjustments of detemir occurred as needed to control glycemia. The mean, peak, nadir, morning, and evening preinsulin daily blood glucose concentrations were significantly lower after dosing with detemir for 1, 3, or 6 months and during the last month of treatment compared to the final month of treatment with intermediate-acting insulin. Intermediate-acting insulins resulted in significantly worse glycemic control than detemir in all 3 categories of control. The odds of a biochemical hypoglycemic measurement with detemir were not significantly different compared to intermediate-acting insulins. Clinical hypoglycemia did not occur following detemir treatment. When insulin was withheld because of low morning preinsulin blood glucose concentration < 6.7 mmol/L (≤ 120 mg/dL) and dogs were fed, mean blood glucose concentration was significantly higher 1 hour later. Glucose concentrations were also significantly higher 12 hours later on days when insulin was withheld in the morning or evening for either 1 or 12 hours. Detemir is useful in diabetic dogs with other comorbidities and can be considered an alternative treatment in poorly controlled diabetic dogs.

The impact of physical inactivity on glucose homeostasis when diet is adjusted to maintain energy balance in healthy, young males

It is unclear if dietary adjustments to maintain energy balance during reduced physical activity can offset inactivity-induced reductions in insulin sensitivity and glucose disposal to produce normal daily glucose concentrations and meal responses. Therefore, the aim of the present study was to examine the impact of long-term physical inactivity (60 days of bed rest) on daily glycemia when in energy balance. Interstitial glucose concentrations were measured using Continuous Glucose Monitoring Systems (CGMS) for 5 days before and towards the end of bed rest in 20 healthy, young males (Age: 34±8 years; BMI: 23.5±1.8kg/m2). Energy intake was reduced during bed rest to match energy expenditure, but the types of foods and timing of meals was maintained. Fasting venous glucose and insulin concentrations were determined, as well as the change in whole-body glucose disposal using a hyperinsulinemic-euglycemic clamp (HIEC). Following long-term bed rest, fasting plasma insulin concentration increased 40% (p=0.004) and glucose disposal during the HIEC decreased 24% (p<0.001). Interstitial daily glucose total area under the curve (tAUC) from pre-to post-bed rest increased on average by 6% (p=0.041), despite a 20 and 25% reduction in total caloric and carbohydrate intake, respectively. The nocturnal period (00:00-06:00) showed the greatest change to glycemia with glucose tAUC for this period increasing by 9% (p=0.005). CGMS measures of daily glycemic variability (SD, J-Index, M-value and MAG) were not changed during bed rest. Reduced physical activity (bed rest) increases glycemia even when daily energy intake is reduced to maintain energy balance. However, the disturbance to daily glucose homeostasis was much more modest than the reduced capacity to dispose of glucose, and glycemic variability was not negatively affected by bed rest, likely due to positive mitigating effects from the contemporaneous reduction in dietary energy and carbohydrate intake. NCT03594799 (registered July 20, 2018) (https://clinicaltrials.gov/ct2/show/NCT03594799).

Fasting and diurnal blood ketonemia and glycemia responses to a six-week, energy-controlled ketogenic diet, supplemented with racemic R/S-BHB salts

Single doses of exogenous ketone salts (KS) transiently increase circulating beta-hydroxybutyrate (BHB) (∼1mM; 1-2h) regardless of starting levels of ketosis; however, no studies have explored how sustained use of KS influences measures of ketonemia and glycemia. To determine the response to a hypocaloric, well-formulated ketogenic diet (KD), with and without the inclusion of two daily racemic KS doses (6g R-BHB+6g S-BHB per serving) on 1) daily fasting capillary R-BHB and glucose (R-BHB/GLUfast), 2) bi-weekly 13h diurnal BHB and glucose (R-BHB/GLUdiur), 3) three-hours post-KS ingestion kinetics (R-BHBKS), and 4) bi-weekly fasting plasma enantiomer-specific BHB (R/S-BHBplasma). Non-diabetic adults with overweight and obesity were randomized to receive a precisely measured hypocaloric KD (∼75 %en of maintenance) for six weeks, supplemented twice-daily with KS or placebo (PL). A non-randomized comparison group was provided an isonitrogenous/isoenergetic low-fat diet (LFD). All meals were provided to subjects. Capillary blood was collected daily to measure R-BHB/GLUfast and hourly for R-BHB/GLUdiur. Plasma was collected to measure R/S-BHBplasma, insulin, fasting glucose, and insulin resistance (HOMA-IR). Total AUC was calculated using the trapezoidal method. Mean R-BHBfast increased significantly during KD+PL (1.0mM BHB), an effect enhanced 26% during KD+KS. GLUfast AUC was-6% lower during KD+KS versus LFD. Mean R-BHBdiur increased 40% in KD+KS versus KD+PL, whereas GLUdiur decreased 13% during both KDs versus LFD. R-BHBKS peaked (Δ: ∼1mM) 1h after the morning KS dose, but not following the afternoon dose. Both R/S-BHBplasma increased during KD independent of KS inclusion. R-BHBplasma was 50-times greater compared to S-BHBplasma, and the KS augmented S-BHBplasma 50% more than PL. Fasting insulin and HOMA-IR decreased after 14 days independent of diet. A hypocaloric KD was effective at reducing diurnal glucose compared to a LFD independent of weight loss, but twice-daily racemic KS ingestion during KD augmented ketonemia, both as R- and S-BHB, and decreased mean fasting glucose beyond a KD alone. The hypoglycemic effects of KD in combination with exogenous ketones merit further investigation.

Real-time artificial intelligence assisted insulin dosage titration system for glucose control in type 2 diabetic patients: a proof of concept study

ObjectiveThis study aims to develop an insulin dosage adjustment model using machine learning of high quality electronic health records (EHRs) notes and then to form an artificial intelligence-based insulin clinical decision support workflow (iNCDSS) implemented in the HIS system to give a real-time recommendation of insulin dosage titration. The efficacy and safety in clinical practice is evaluated in this proof-of-concept study.Research design and methodsWe extracted patient-specific and time-varying features from the original EHRs data and performed machine learning analysis through 5-fold cross validation. In the patient-blind, single-arm interventional study, insulin dosage was titrated according to iNCDSS in type 2 diabetic inpatients for up to 7 d or until hospital discharge. The primary end point of the trial was the difference in glycemic control as measured by mean daily blood glucose concentration during the intervention period.ResultsA total of 3275 type 2 diabetic patients with 38,406 insulin counts were included for the model analysis. The XGBoost model presented the best performance with root mean square error (RMSE) of 1.06 unit and mean absolute relative difference (MARD) of 6.0% in the training dataset, and RMSE of 1.30 unit and MARD of 6.9% in the testing dataset. Twenty-three patients with T2DM (male 14, 60.9%; age 58.8 ± 10.7 years; duration of diabetes 11.8 ± 8.8 years, HbA1c 9.1 ± 1.1%) were enrolled in the proof of concept trial. The duration of iNCDSS intervention was 7.0 ± 0.1 d. The insulin dose recommended by iNCDSS was accepted by physicians in 97.8%. The mean daily capillary blood glucose was markedly improved during the intervention period, with a reduction of mean daily capillary BG from 11.3(8.0, 13.9) mmol/L in the first 24 h to 7.9(6.5,8.9) mmol/L in the last 24 h of the trial (P < 0.001). In addition, the time range below 3.9 mmol/L was decreased from 1.1% to 0.5%.ConclusionsThe clinical decision support system of insulin dosage titration developed using a machine learning algorithm based on the EHRs data was effective and safe in glycemic control in in type 2 diabetic inpatients.Trial registrationsClinicalTrials.gov Identifier: NCT04053959.

Estimated average blood glucose level based on fructosamine level.

To define the mathematical relationship between fructosamine levels and average glucose values. The study comprised laboratory data of 1,227 patients with type 1 or 2 diabetes mellitus. Fructosamine levels measured at the end of a 3-week period were compared against the average blood glucose levels of the previous 3 weeks. Average glucose levels were determined by the weighted average of the daily fasting capillary glucose results performed during the study period, and the plasma glucose measured in the same sample collected for fructosamine measurement. In total, 9,450 glucose measurements were performed. Linear regression analysis between fructosamine levels and average glucose levels showed that for each 1.0 μmol/L increase in fructosamine level there was a 0.5 mg/dL increase in average glucose level, as estimated by the equation Mean glucose level = (0.5157 × Fructosamine) - 20. The coefficient of determination (r2 = 0.353492, p < 0.006881) allowed the calculation of the estimated average glucose based on fructosamine level. Our study demonstrated a linear correlation between fructosamine level and mean blood glucose level, suggesting that fructosamine levels can be a proxy for the average glucose level in assessing the metabolic control of patients with diabetes.

EFFECT ON GLYCEMIC INDEX POST SELECTIVE NERVE ROOT BLOCK IN NEURAL FORAMINAL STENOSIS PATIENTS- PROSPECTIVE STUDY

Purpose: To study the effect on glycemic index post selective nerve root block in neural foraminal stenosis patients. The study involved Methods: 30 patients in total from September 2021 to August 2022, we prospectively enrolled patients who matched our inclusion criteria with IVDP, patients having symptoms of radicular pain for at least 3 months, patients with a known history of type I or type II diabetes mellitus. Patients were made to maintain a diary of their daily fasting blood glucose levels one week before after the SNRB. At the end of the last follow-up at 3 months, HbA1c were repeated along with capillary blood glucose. A mean of 135.77 mg/dL and S Results: D of 22.60 mg/dL were blood sugar levels which varies from 78- 204 mg/dl before SNRB. The immediate post-injection glucose levels varied from 78 to 399, with a mean of 216.13 and a SD of 44.19. The average glucose level change was 135.77 ± 80.37, and the range of this change was from 135.77 to 216.13. The estimated duration of the glucose level increase was 3.7 days with a 95% CI. For the rst 2-4 days following injection, there is a noticeable brief spike in blood glucose levels. There was no association between observed glucose level change pre-injection HBA1c levels and 3 months post HBA1c levels after the procedure. Conclusion: Administering steroids in selective nerve root blocks for patients with diabetes mellitus is associated with a transient hyperglycaemic state, which will return to baseline level within 4 days of SNRB injection.

Virtual Clinics for Diabetes Care.

Virtual Clinics for Diabetes Care.

Diabetes Technology and Therapy in the Pediatric Age Group.

Diabetes Technology and Therapy in the Pediatric Age Group.

Fasting plasma glucose level-based formula for estimating starting daily dose in basal-bolus insulin therapy

There is no standard formula for estimating the starting daily dose (SDD) of basal-bolus insulin therapy (BBT). We aimed to develop a formula for estimating SDD and evaluate its efficacy and safety in patients with type 2 diabetes hospitalized for BBT. In the first study (n = 104), we retrospectively analyzed the relationship between peak daily dose (PDD) during hospitalization and clinical parameters. The PDD was significantly associated with fasting plasma glucose (FPG) (R = 0.449, P < 0.0001) and HbA1c levels (R = 0.384, P < 0.0001) but not body weight, body mass index, body surface area, or serum C-peptide levels. Based on the results, we developed a formula for estimating SDD using FPG levels: SDD (U/day) = 0.08 × FPG (mg/dL). In the second study (n = 405), we assessed efficacy and safety of the formula by evaluating the M-value from the daily glucose profile and assessing the frequency of hypoglycemia (blood glucose level < 70 mg/dL). When BBT was initiated using the FPG level-based formula, the M-values decreased from 61.0 ± 52.8 to 12.8 ± 10.8 (P < 0.0001), and hypoglycemia was observed in only 3/405 cases (0.74%) under the SDD. The FPG level-based formula is useful for estimating SDD in BBT and is safe for clinical use.

Continuous Glucose Monitoring in Enterally Fed Children with Severe Central Nervous System Impairment.

This prospective, observational study included nineteen patients (median (25-75 pc) age: 12.75 (6.17-15.55) years) with permanent CNS damage (Gross Motor Function Classification System V) receiving long-term tube enteral feeding, recruited from two paediatric university nutritional treatment centres. Patients with acute conditions and diagnosed diabetes were excluded. The nutritional status and nutritional support were analysed in all the inpatients in accordance with a uniform protocol. Using the CGM system (Medtronic iPro2), glycaemic curves were analysed, and in addition, HbA1C levels were determined in fourteen patients. CGM results were analysed using GlyCulator2.0. Statistical analysis was performed using the Statistica version 11 software (StatSoft Inc. Tulsa, OK, USA). More than half (11/19; 58%) of the patients were undernourished (BMI < 3 pc for age and gender), with the stature age being significantly lower than calendar age (5 (4.5-9) vs. 12.75 (6.17-15.55) years; p = 0.0010). The actual caloric intake was 50 (37.7-68.8) kcal/kg (median; 25-75 pc). In patients fed using the bolus method, the number of calories consumed per day was statistically significantly higher than in children subjected to a continuous feeding supply (56.00 (41.00-75.00) vs. 33.40 (26.70-50.00) kcal/kg BW (body weight; p = 0.0159). Decreases in blood glucose levels below the alarm level (<70 mg/dL) were recorded in fifteen patients (78.9%), including two patients with episodes of clinically significant hypoglycaemia (<54 mg/dL). The minimum and maximum glycaemic values recorded in any individual CGM records were 67 mg/dL (median) (minimum: 41 mg/dL; maximum: 77 mg/dL) and 146 (minimum: 114 mg/dL; maximum: 180 g/dL), respectively, for the entire recording. The maximum percentage of glycaemic concentrations > 140 mg/dL (TAR 140) recorded overnight in children with BMI ≥ 3 amounted to 1.6% vs. 0% in undernourished patients (TAR 140: 0.0 (0.00-1.6%) vs. 0% (0.00-0.0%; p = 0.0375); the percentage of glycaemic concentrations <70 mg/dL in the entire recording was comparable (0.77% (0.13-2.2%) vs. 1.8% (0.5-14.4%) vs. p = 0.2629). There was a positive correlation between the mean daily glucose recorded using the CGM method and patients' BMI z-scores (R = 0.48, p = 0.0397). No statistically significant relationship was demonstrated between the occurrence of alarm hypoglycaemia events in the CGM records and undernutrition expressed by BMI z-scores (OR = 1.50 (95%CI: 0.16-13.75), the type of diet (for commercially manufactured OR = 0.36 (95%CI: 0.04-3.52), and the modality of diet delivery (for bolus feeding OR = 2.75 (95%CI: 0.28-26.61). In children with chronic OU damage, enteral feeding is associated with a risk of hypoglycaemia, but further studies involving a larger number of patients are needed, and CGM might be a useful tool to estimate the metabolic adequacy of enteral nutritional support in terms of glucose control.