Glucose Monitoring Devices Research Articles

A Concise and Systematic Review on Non-Invasive Glucose Monitoring for Potential Diabetes Management.

The current standard of diabetes management depends upon the invasive blood pricking techniques. In recent times, the availability of minimally invasive continuous glucose monitoring devices have made some improvements in the life of diabetic patients however it has its own limitations which include painful insertion, excessive cost, discomfort and an active risk due to the presence of a foreign body under the skin. Due to all these factors, the non-invasive glucose monitoring has remain a subject of research for the last two decades and multiple techniques of non-invasive glucose monitoring have been proposed. These proposed techniques have the potential to be evolved into a wearable device for non-invasive diabetes management. This paper reviews research advances and major challenges of such techniques or methods in recent years and broadly classifies them into four types based on their detection principles. These four methods are: optical spectroscopy, photoacoustic spectroscopy, electromagnetic sensing and nanomaterial based sensing. The paper primarily focuses on the evolution of non-invasive technology from bench-top equipment to smart wearable devices for personalized non-invasive continuous glucose monitoring in these four methods. With the rapid evolve of wearable technology, all these four methods of non-invasive blood glucose monitoring independently or in combination of two or more have the potential to become a reality in the near future for efficient, affordable, accurate and pain-free diabetes management.

PSUN325 Provider Time Required for Effective Remote Glucose Monitoring Among Patients with Type 1 Diabetes

Abstract Background Recent advances in digital health technology have accelerated interest in remote patient monitoring (RPM) for chronic disease management. Diabetes management – which has a long history of utilizing patient-generated health data (PGHD) – is well-suited to RPM innovation. However, building RPM programs requires designing new workflows for providers, who are accustomed to accessing PGHD only at scheduled visits. We conducted a pilot study of RPM in a pediatric population with type 1 diabetes (T1D) to estimate the frequency and duration of contact between patients and providers that would be needed in such a program. Methods Patients who met these criteria were approached for participation: 1) age 1-20 years, 2) diagnosis of T1D with a duration of ≥12 months, 3) use of a glooko-compatible continuous glucose monitoring (CGM) device for ≥3 months. After providing informed consent, participants’ CGM data were linked to a research team account on the glooko platform and followed for a one-month baseline period to ensure the data relay was consistently functioning, with technical assistance provided by research staff as needed. CGM data were then analyzed using the glooko population analytics platform once per month during a six-month intervention period. Participants meeting high-risk criteria, defined as >15% of glucose values >250 mg/dl or >5% of glucose values <70 mg/dl, in the prior 30 days were contacted by a pediatric endocrinologist with individualized recommendations for diabetes management. Time spent communicating recommendations to the participant by phone or electronic messaging was recorded by the provider on each date of contact. Results Of 39 participants who were enrolled and linked to the research team via glooko, 35 (90%) were successful in establishing consistent data-sharing during the baseline period and moved on to the intervention period. To date, 20 participants have completed at least 3 months of the intervention. In preliminary analyses, an average of 47% have met high-risk criteria monthly (range 40 to 55%). Contact from the pediatric endocrinologist has required a median of 10 minutes (range 5 to 25 minutes) per participant contacted each month. Of the 20 participants who have completed 3 months of intervention, 14 have repeat hemoglobin A1c (HbA1c) data available thus far, which demonstrate a median HbA1c change of -0.55% from baseline (range -1.5 to +0.5%). Complete data analysis will be available in April 2022. Discussion This pilot study indicates that RPM is feasible and potentially beneficial in a population of pediatric patients with T1D. Our data also provide preliminary estimates for provider time required to deliver effective remote assistance to patients with concerning glycemic profiles. This study and others of its type are essential so that endocrinologists can design RPM programs which efficiently provide individualized care to high-risk patients without over-burdening a limited supply of providers. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Supporting the Use of a Person's Own Diabetes Technology in the Inpatient Setting.

The use of diabetes technology, including insulin pumps, continuous glucose monitoring devices, and automated insulin delivery systems, has increased significantly in recent years. As more people with diabetes adopt technology in the outpatient setting, we are seeing these devices more frequently in the inpatient setting. This review offers best-practice guidelines for the continuation of personal diabetes technology use in the inpatient setting. It describes policy and guideline stipulations, roles and responsibilities, and device- and brand-specific considerations. Although these devices are not approved for inpatient use by the U.S. Food and Drug Administration, there is general expert consensus that the continuation of personal diabetes devices during hospitalization is appropriate for patients who have sufficient knowledge, are not critically ill, and retain sufficient mental capacity during an acute illness. Health care systems and inpatient providers need to understand the benefits and limitations of personal diabetes technology use during hospitalization.

Placement Optimization of Infrared Sensors as Non-Invasive Blood Sugar Measurements

In the light of the increasing prevalence of diabetes, research on non-invasive blood sugar measuring devices have begun to be developed, one of which utilizes infrared spectroscopy methods. This method uses a pair of IR LED and photodiode placed in line. In doing so, the location of its placement in the human body has to be considered, thereby enabling the photodiode to capture the light emitted by the IR LED. Therefore, the voltage data generated by the photodiode circuit in several parts of the body is taken as the representation of the ability of the photodiode to absorb infrared light. A higher voltage value is captured in the range of 1 Volt when the sensor is on the finger. Meanwhile, there is no voltage read on the wrist. The results of this study will be used as a reference to determine the location of the sensor placement in the designed blood glucose monitoring device.

OR28-1 Racial and Ethnic Disparities in Diabetes Technology Use amongst Persons with Type 1 Diabetes

Abstract Objective Despite recent advances in diabetes technology, the distribution of healthcare resources is often unequal among racial and socio-economic groups. A recent multicenter study looking at technology use amongst young adults with T1D demonstrated that socioeconomic status (SES) was not the sole driver of racial/ethnic disparities and that adjustment for income, insurance level, and health literacy did not significantly attenuate disparities. Here we present a retrospective cohort study looking at racial/ethnic disparities in insulin pump and CGM use in adults with T1D at an urban university hospital system. Methods We reviewed the charts of all adults aged 18 to 89 with T1D who attended the University of Maryland Center for Diabetes and Endocrinology (UMCDE) between 1/2019 and 12/2019. Age, gender, race/ethnicity, type of insurance, ZIP code, BMI, A1c, method of insulin delivery, and type of glucose monitoring device were obtained from each chart. We utilized the 2019 US Census data to determine the median income for each ZIP code. Patient charts were re-accessed in 2021 to check for changes in diabetes technology use from 1/2020 until 12/2021. Logistic regression modeling was done in PRISM to control for age, gender, race, insurance type, ZIP code, last known provider, BMI, and A1c. Hosmer-Lemeshow test was done to evaluate goodness of fit. Stratified analysis was done for potential confounders such as insurance type and income. The Breslow-Day test and Likelihood Ratio test for nested models were used to evaluate their degree and significance. Result A total of 532 adults were included in the study; 277 identified as non-Hispanic (NH) White, 204 identified as NH Black, 7 identified as Hispanic, and 44 identified as other racial/ethnic groups. NH White adults had a significantly higher insulin pump use when compared to NH Black (adjusted ratio 54.0% vs. 18.4%, OR 2.43 after regression, 95%CI [1.41-4.22]). Similarly, NH White adults had significantly higher CGM use when compared to NH Black (66.5% vs. 35.2%, OR 2.00 after regression, 95%CI [1.24-3.22]). Disparities between NH White and NH Black patients did not resolve throughout 2020-2021. Insurance type was a potential effect modifier for CGM prescriptions between NH White and NH Blacks (Crude OR 4.04, Commercial Strata OR 2.68, Medicaid 1.79, Medicare 2.79, Other/Self-pay 25.7, p=0.039 on Breslow-Day test). There was large heterogeneity in the rate of Pump or CGM prescriptions between providers. Conclusion NH White adults with T1D were significantly more likely to have been prescribed diabetes-related technologies when compared to other racial/ethnic groups, and this difference did not resolve over 2 years of follow-up. Future directions include a comprehensive survey of our population regarding patient-derived and patient-perceived factors driving disparities beyond socioeconomic status. Presentation: Tuesday, June 14, 2022 9:45 a.m. - 10:00 a.m.

The socio-economic burden of expenditure for diabetes mellitus treatment: A cross sectional study

Background: Diabetes mellitus is a chronic disorder, non-curable, only controlled by medicines and /or insulin therapy. The aim of this study was to evaluate the expenditure on diagnoses and treatment of diabetes mellitus patients with economic burden to households. Methodology: We collected data by directly interacting with the pre-informed diabatic patients regarding the duration of diabetes, types of insulin therapy and oral hypoglycemic agent, cost of medicine/month and cost of blood sugar test by glucometer/month. Results: A total of 254 patients were enrolled in the study of which 30.71% (n=78) belongs to upper cost family (UCF), 44.88% (n=114) belongs to middle cost family (MCF), and 24.41% (n=62) belongs to lower cost family (LCF), categorized according to their total score. While studying, it was found that the mean family income (rupees)/month of UCF, MCF and LCF are Rs. 33860.26, Rs. 9326.75 and Rs. 7551.79 respectively. The mean blood sugar test cost (rupees)/month for UCF, MCF and LCF are Rs. 377.44, Rs. 382.89 and Rs. 360.00 respectively. Whereas the mean medicine purchase cost (rupees)/month for UCF, MCF and LCF are Rs. 1004.81, Rs. 784.40 and Rs. 721.79 Respectively. The total cost (rupees)/month for sugar test and purchasing medicine that is taken from their family income are Rs. 1382.24, Rs. 1167.30 and Rs. 1081.79 for UCF, MCF and LCF respectively. We also derived that, the UCF, MCF, LCF spent 1.19%, 2.28%, 4.84% of their monthly income on blood sugar test respectively and spent 3.20%, 4.76%, 9.95% of their monthly income on medicine purchase respectively. The percentage of cost, the UCF, MCF, and LCF has spent on both the blood sugar test and medicine purchase is 4.39%, 7.04%, 14.80% respectively. Conclusion: The urgent need should be arisen for better health care policies for making low or no cost blood glucose monitoring device (alternative to glucometer) with low-cost anti-diabetic medicines by Government, for diabetes management.

Remote consultations for diabetes care in a post COVID-19 world.

Remote consultations for diabetes care in a post COVID-19 world.

Do the UK's commercially available real-time continuous glucose monitoring devices have robust accuracy data for paediatrics?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Diabete hi-tech

Recently, technological innovations have radically changed diabetes care. Insulin pumps and continuous glucose monitoring systems have significantly improved diabetes outcomes in both children and adults with Type 1 diabetes. For this reason, the major international associations recommend the use of technology in the management of Type 1 diabetes. The limitations of glycemic self-monitoring have prompted research to develop alternative techniques, favouring the expansion of continuous blood glucose monitoring systems (CGMs). CGM measures interstitial glucose through tiny sensors inserted in the subcutaneous tissue. Sensors can provide information in real time on the current glucose level and its trend. These data can be uploaded to the cloud and checked any time by doctors, patients and their caregivers. CGM can be combined with multiple daily injections (MDI) therapy or continuous subcutaneous insulin infusion (CSII). With CSII, basal insulin is supplied in the form of a continuous infusion and pre-meal bolus doses are calculated based on the meals’ carbohydrate content. A variety of insulin pumps is available, some of which can communicate with specific CGM devices, helping the patient to make better decisions about insulin dosing. This approach is known as sensor-augmented insulin pump therapy and it is the gold standard for the treatment of Type 1 diabetes in children and young adults, as recommended by the Italian Association of Paediatric Endocrinology and Diabetology. In the most recent systems, basal insulin delivery can be automatically modified through algorithms, based on CGM results, target glucose and the amount of active insulin, even though the patients still have to set the pre-meal insulin bolus manually. This system is defined as a partially hybrid closed-loop system, also known as artificial pancreas. Compared to MDI, CSII is associated with better control of blood glucose - measured by haemoglobin A1c and glycemic variability -, reduction of daily insulin requirement and an improvement of the quality of life. Psychophysical disabilities, language barriers or socio-economic disadvantage should not be considered limitations of CSII treatment as long as the caregiver is able to manage the therapy. Nowadays, MDI is recommended as first line therapy exclusively for those patients who do not want to use insulin pumps due to physical discomfort. The aim of this article is to provide updated information on the management of paediatric diabetes with modern technological devices for glucose monitoring and insulin delivery.

Higher scanning frequency is correlated with less fear of hypoglycemia in type 1 diabetes patients using isCGM.

BackgroundFrequent scanning of intermittently scanned continuous glucose monitoring (isCGM) devices is associated with improvements in glycemic indices. Limited data is available for its correlation with fear of hypoglycemia (FOH), an established factor affecting quality of life and glycemic control in type 1 diabetes (T1DM).AimThe aim of the study was to analyze the association of sensor scanning frequency with FOH and glycemic indices in T1DM patients using isCGM.Subjects and methodsT1DM patients using isCGM were eligible. Clinical data and Ambulatory Glucose Profile (AGP) reports were obtained from medical records. At outpatient visits, AGP of last 14 days prior to visit were analyzed and FOH was assessed using Hypoglycemia Fear Survey II (HFS II).ResultsWe included 77 consecutive T1DM patients (58 females, 19 males). Mean age was 34.1 ± 10.2 years and mean T1DM duration was 14.7 ± 12.0 years. Baseline mean glycemic indices were as follows: mean glucose - 155.8 ± 29.8 mg/dL; GMI - 53.3 ± 7.5 mmol/mol; TIR - 66.4 ± 17.8%; TBR70 - 4.5 ± 4.1%; TBR54 - 0.6 ± 1.2%; TAR180 - 29.2 ± 17.9%; TAR250 - 9.6 ± 10.4%; %CV - 36.7 ± 8.3. Average scanning frequency was 13.8 ± 7.8 scans/day. Mean HFS II scores were 16.1 ± 7.2 and 18.7 ± 12.2 in behavior and worry subscale, respectively. Correlation was confirmed between scanning frequency and mean glucose, GMI, TIR, TBR70, TAR180, TAR250, %CV and HFS II total, and HFS II - B (p<0.05 for all statistics).ConclusionsFor the first time, we report that higher scanning frequency is associated not only with better glycemic indices but also with less FOH in T1DM adult patients using isCGM.

Is Raman the best strategy towards the development of non-invasive continuous glucose monitoring devices for diabetes management?

Diabetes has no well-established cure; thus, its management is critical for avoiding severe health complications involving multiple organs. This requires frequent glycaemia monitoring, and the gold standards for this are fingerstick tests. During the last decades, several blood-withdrawal-free platforms have been being studied to replace this test and to improve significantly the quality of life of people with diabetes (PWD). Devices estimating glycaemia level targeting blood or biofluids such as tears, saliva, breath and sweat, are gaining attention; however, most are not reliable, user-friendly and/or cheap. Given the complexity of the topic and the rise of diabetes, a careful analysis is essential to track scientific and industrial progresses in developing diabetes management systems. Here, we summarize the emerging blood glucose level (BGL) measurement methods and report some examples of devices which have been under development in the last decades, discussing the reasons for them not reaching the market or not being really non-invasive and continuous. After discussing more in depth the history of Raman spectroscopy-based researches and devices for BGL measurements, we will examine if this technique could have the potential for the development of a user-friendly, miniaturized, non-invasive and continuous blood glucose-monitoring device, which can operate reliably, without inter-patient variability, over sustained periods.

Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring.

Hyperglycaemia, hypoglycaemia and higher glucose variability during the Early Brain Injury (EBI) period of aneurysmal subarachnoid hemorrhage (aSAH) have been associated with poor clinical outcome. However, it is unclear whether these associations are due to direct glucose-driven injury or if hyperglycaemia simply acts as a marker of initial severity. Actually, strict glucose control with intensive insulin therapy has not been demonstrated as an effective strategy for improving clinical outcomes after aSAH. Currently published studies describing an association between hyperglycaemia and prognosis in aSAH patients have been based on isolated glucose measurements and did not incorporate comprehensive dynamic evaluations, such as those derived from subcutaneous continuous glucose monitoring devices (CMG). Arguably, a more accurate knowledge on glycaemic patterns during the acute phase of aSAH could increase our understanding of the relevance of glycaemia as a prognostic factor in this disease as well as to underpin its contribution to secondary focal and diffuse brain injury. Herein, we have summarized the available evidence on the diagnostic and prognostic relevance of glucose metrics during the acute phase of cerebrovascular diseases, focusing in the EBI period after aSAH. Overall, obtaining a more precise scope of acute longitudinal glucose profiles could eventually be useful for improving glucose management protocols in the setting of acute aSAH and to advance toward a more personalized management of aSAH patients during the EBI phase.

Automated insulin delivery systems: from early research to routine care of type 1 diabetes.

Automated insulin delivery (AID) systems, so-called closed-loop systems or artificial pancreas, are based upon the concept of insulin supply driven by blood glucose levels and their variations according to body glucose needs, glucose intakes and insulin action. They include a continuous glucose monitoring device which provides a signal to a control algorithm tuning insulin delivery from an infusion pump. The control algorithm is the key of the system since it commands insulin administration in order to maintain blood glucose in a predefined target range and close to a near-normal glucose level. The last two decades have shown dramatic advances toward the use in free life of AID systems for routine care of type 1 diabetes through step-by-step demonstrations of feasibility, safety and efficacy in successive hospital, transitional and outpatient trials. Because of the constraints of pharmacokinetics and dynamics of subcutaneous insulin delivery, the currently available AID systems are all 'hybrid' or 'semi-automated' insulin delivery systems with a need of meal and exercise announcements in order to anticipate rapid glucose variations through pre-meal bolus or pre-exercise reduction of infusion rate. Nevertheless, these AID systems significantly improve time spent in a near-normal range with a reduction of the risk of hypoglycemia and the mental load of managing diabetes in everyday life, representing a milestone in insulin therapy. Expected progression toward fully automated, further miniaturized and integrated, possibly implantable on long-term and more physiological closed-loop systems paves the way for a functional cure of type 1 diabetes.

Stencil printing of a highly conductive graphene ink toward flexible electrochemical biosensors for glucose monitoring

Disposable, flexible and low-cost coated biosensor electrode obtained by printing conductive inks presents a great potential as health monitoring devices. A novel and highly conductive coating of graphene ink was printed on a flexible substrate using the stencil method to prepare a sensitive biosensor for enzymatic electrochemical detection of glucose. A novel water-based graphene ink including an acrylic copolymer was formulated in this work. The Sheet resistance was obtained in the range of 42.14 Ω/sq in new formulation of the newly proposed graphene ink to make it a proper candidate for flexible biosensor manufacturing. The sensitivity and limit of detection of 16.42 μA·mM−1·cm−2 and 1.34 mM were respectively achieved for the biosensor in the linear range of <2 mM to >28 mM. The results signified high selectivity against interfering species such as ascorbic acid and lactose, and high repeatability and reproducibility with low relative standard deviation values of 1.04 % and 1.5 %, respectively, for the device. No considerable reduction in the printed electrochemical biosensor (PEB) performance was observed after bending cycles of up to 100, indicating the high flexibility of the biosensor. The PEB presented a great potential to be used as a personalized glucose monitoring device in complex biological fluids.

Monitoring Devices for glucose in critical patients during the COVID-19 pandemic

Background: Hyperglycemia is common in Intensive Care Unit (ICU) and was reported with high mortality and adverse patients’ outcomes. The infection of COVID-19 is identified as a main source of increase in the incidence of hyperglycemia and associated elevated mortality. In order to reduce the healthcare providers exposure and the personal protective equipment use during the pandemic, the US Food and Drug Administration (FDA) regulated the usage of continuous glucose monitoring (CGM) devices to address these concerns as well as control the glucose level at a desired range. What are the benefits of using CGM applications? The article updates knowledge on this topic. Methods：We did our search on the following databases: MEDLINE, EMBASE and Cochrane database, articles included were all recent and between January 2020 to July 2022. Our main focus was on articles with evidence concerning the effectiveness and the accuracy of continuous blood glucose monitoring methods in ICU during the COVID-19 pandemic. Results: A few recent articles were identified and scrutinized. These allow the article to present an overview of the most recent international evidence on the topic, ts benefits and a comparison between methods and devices. Main Contribution to Evidence-Based Practice: The article puts together the most recent evidence on the demonstrated benefits of continuous glucose monitoring and identifies the few glucose Monitoring Devices about which there is recent published scientific evidence on its application to critical care.

Fear of hypoglycemia and quality of life in young people with type 1 diabetes and their parents in the era of sensor glucose monitoring.

IntroductionIt is crucial to understand psychosocial outcomes in children and adolescents with type 1 diabetes (T1D) and their families to provide optimal family-centered care. Hence, the aim of this study was to explore psychosocial outcomes in young people with T1D and their parents using currently available glucose monitoring devices in a real-life clinic setting.MethodsChildren and adolescents aged 2-18 years with T1D for more than 6 months and their parents were recruited into a cross-sectional study to complete the Hypoglycemia Fear Survey (HFS) and the Pediatric Quality of Life Inventory (PedsQL) Generic Score Scales, Diabetes Module and Family Impact Module. Demographics and diabetes-specific parameters were obtained from medicals records.ResultsFifty-nine children and adolescents (mean age 15.1 ± 3.0 years) and 49 parents of children (mean age of children 12.5± 3.3 years) of which 44 were child-parent dyads completed the questionnaires. Parents had a higher mean (SD) FOH total and worry subscore than children, total score was 37.9 (14.6) vs. 32.2 (11.9), p = 0.047 and worry subscore was 17.8 (10.4) vs. 12.8 (9.0), p = 0.01. Furthermore, lower parental diabetes-specific QoL score was observed in parents, 78.8 (12.2) vs. 82.7 (10.3), p=0.02. No difference in FOH and QoL between real-time continuous glucose monitoring (rtCGM) and intermittently scanned glucose monitoring (isCGM) users and users of devices with and without alerts was observed. In isCGM users (n=36 completing the child questionnaires, n=33 completing parent questionnaires), higher parental FOH and lower parental diabetes-specific QoL correlated with higher scanning frequency, r = 0.399, p = 0.021, and r = -0.464, p = 0.007 respectively. No significant correlation was documented between scanning frequency and child questionnaire scores.ConclusionsParents are more likely to perceive higher levels of psychosocial burden related to their child’s diabetes than children and adolescents with T1D, especially parents of younger children. This highlights the need for family-based education and treatment resources to support parents in diabetes management in addition to rapidly advancing diabetes technology. In isCGM users, higher parental FOH and lower parent-perceived QoL correlated with a higher scanning frequency, indicating the potential impact of glucose monitoring modality on psychosocial outcomes or vice versa.

Three weeks of time-restricted eating improves glucose homeostasis in adults with type 2 diabetes but does not improve insulin sensitivity: a randomised crossover trial

Aims/hypothesisTime-restricted eating (TRE) is suggested to improve metabolic health by limiting food intake to a defined time window, thereby prolonging the overnight fast. This prolonged fast is expected to lead to a more pronounced depletion of hepatic glycogen stores overnight and might improve insulin sensitivity due to an increased need to replenish nutrient storage. Previous studies showed beneficial metabolic effects of 6–8 h TRE regimens in healthy, overweight adults under controlled conditions. However, the effects of TRE on glucose homeostasis in individuals with type 2 diabetes are unclear. Here, we extensively investigated the effects of TRE on hepatic glycogen levels and insulin sensitivity in individuals with type 2 diabetes.MethodsFourteen adults with type 2 diabetes (BMI 30.5±4.2 kg/m2, HbA1c 46.1±7.2 mmol/mol [6.4±0.7%]) participated in a 3 week TRE (daily food intake within 10 h) vs control (spreading food intake over ≥14 h) regimen in a randomised, crossover trial design. The study was performed at Maastricht University, the Netherlands. Eligibility criteria included diagnosis of type 2 diabetes, intermediate chronotype and absence of medical conditions that could interfere with the study execution and/or outcome. Randomisation was performed by a study-independent investigator, ensuring that an equal amount of participants started with TRE and CON. Due to the nature of the study, neither volunteers nor investigators were blinded to the study interventions. The quality of the data was checked without knowledge on intervention allocation. Hepatic glycogen levels were assessed with 13C-MRS and insulin sensitivity was assessed using a hyperinsulinaemic–euglycaemic two-step clamp. Furthermore, glucose homeostasis was assessed with 24 h continuous glucose monitoring devices. Secondary outcomes included 24 h energy expenditure and substrate oxidation, hepatic lipid content and skeletal muscle mitochondrial capacity.ResultsResults are depicted as mean ± SEM. Hepatic glycogen content was similar between TRE and control condition (0.15±0.01 vs 0.15±0.01 AU, p=0.88). M value was not significantly affected by TRE (19.6±1.8 vs 17.7±1.8 μmol kg−1 min−1 in TRE vs control, respectively, p=0.10). Hepatic and peripheral insulin sensitivity also remained unaffected by TRE (p=0.67 and p=0.25, respectively). Yet, insulin-induced non-oxidative glucose disposal was increased with TRE (non-oxidative glucose disposal 4.3±1.1 vs 1.5±1.7 μmol kg−1 min−1, p=0.04). TRE increased the time spent in the normoglycaemic range (15.1±0.8 vs 12.2±1.1 h per day, p=0.01), and decreased fasting glucose (7.6±0.4 vs 8.6±0.4 mmol/l, p=0.03) and 24 h glucose levels (6.8±0.2 vs 7.6±0.3 mmol/l, p<0.01). Energy expenditure over 24 h was unaffected; nevertheless, TRE decreased 24 h glucose oxidation (260.2±7.6 vs 277.8±10.7 g/day, p=0.04). No adverse events were reported that were related to the interventions.Conclusions/interpretationWe show that a 10 h TRE regimen is a feasible, safe and effective means to improve 24 h glucose homeostasis in free-living adults with type 2 diabetes. However, these changes were not accompanied by changes in insulin sensitivity or hepatic glycogen.Trial registrationClinicalTrials.gov NCT03992248FundingZonMW, 459001013Graphical abstract

Effect of short‐term acute moderate‐intensity resistance exercise on blood glucose in older patients with type 2 diabetes mellitus and sarcopenia

To investigate the effects of short-term acute moderate-intensity resistance exercise on blood glucose in older patients with type2 diabetes mellitus and sarcopenia using ambulatory glucose monitoring technology. This is a prospective intervention of an own-controlled before-and-after cohort study. A total of 24 older type2 diabetes mellitus patients who met the enrollment criteria were selected, including 12 cases in the sarcopenia and 12 in the non-sarcopenia groups. First, they wore ambulatory glucose monitoring devices (Medtronic, Ipro2) and retained baseline data. Then they wore Ipro2 again and carried out two sessions of resistance exercise on alternate days. Blood glucose level, blood glucose fluctuation, and time in target range on the contrast and exercise days were compared and analyzed in both groups. The area under the curve of glucose level across 24 h and the mean blood glucose post exercise decreased (P <0.05) in the sarcopenia group. On the exercise day, the coefficient of variation of glucose, the largest amplitude of glycemic excursions, amplitude of postprandial glucose excursions and low blood glucose index decreased, whereas the time in target range increased (P < 0.05). Short-term acute moderate-intensity resistance exercise is an effective and safe exercise modality, which can reduce blood glucose levels, blood glucose fluctuations and the risk of hypoglycemia, as well as improve the time in target range for older patients with type2 diabetes mellitus and sarcopenia. Geriatr Gerontol Int 2022; 22: 653-659.

Noninvasive Glucose Measurements Through Transcutaneous Raman Spectroscopy: A Review.

People living with diabetes need constant glucose monitoring to avoid health complications. However, they do not monitor their glucose levels as often as recommended, probably because glucose measurement devices can be painful, costly, need testing strips or sensors, require lancing the finger or inserting a sensor with risk of infection, and can be inaccurate or have failures. Therefore, developing new alternatives for noninvasive glucose measurements that overcome these disadvantages is necessary, being Raman spectroscopy (RS) a solution. This review aims to provide an overview of the current glucose-monitoring technologies and the uses and advantages of RS to improve noninvasive transcutaneously glucose-monitoring devices. The skin has been used to assess glucose levels noninvasively because it is an accessible tissue where glucose can be measured in the interstitial fluid (ISF) in the epidermis (especially in the stratum corneum). The most selected skin sites to apply RS for noninvasive glucose measurements were the nailfold, finger, and forearm because, in these sites, the penetration depth of the excitation light can reach the stratum corneum (10-20 µm) and the ISF. Studies found that RS is a good optical technique to measure glucose noninvasively by comparing glucose levels obtained by RS with those from invasive methods such as glucose meters with testing strips during an oral glucose tolerance test (OGTT). New alternatives for noninvasive glucose measurements that overcome the disadvantages of current devices is necessary, and RS is a possible solution. However, more research is needed to evaluate the stability, accuracy, costs, and acceptance.

Effects of Variability in Glycemic Indices on Longevity in Chinese Centenarians.

BackgroundLarge fluctuations in blood glucose levels greatly impact the health and life span of elderly individuals. This study describes the characteristics of variability in glycemic indices in centenarians with the aim of emphasizing the importance of glycemic variability in elderly people.MethodsWe recruited individuals from Rugao City, Jiangsu Province, China from April 2020 to May 2021. The study cohort included 60 centenarians and 60 first-generation offspring, as well as 20 randomly selected non-cohabitant control individuals aged 60–80 years. A FreeStyle Libre H (hospital version) continuous glucose monitoring (CGM) device (Abbott Ireland UK) was used to measure glycemic variability. The indices measured included the time in target glucose range (TIR), time below target glucose range (TBR), time above target glucose range (TAR), mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), coefficient of variation (CV), standard deviation of blood glucose (SDBG), continuous overlapping net glycemic action (CONGA), glucose management indicator (GMI) and estimated glycated hemoglobin (eHbA1c). Logistic regression was used to analyze the association between glycemic variability and longevity.ResultsMean blood glucose (MBG), eHbA1c, GMI, mean fasting plasma glucose (M-FPG) and CONGA were lower in the centenarian group (p all < 0.05). PPGE-2 was higher in the control group than that measured in the centenarian and first-generation offspring groups (p < 0.05). There were no differences between the groups in MAGE, MODD, MAG, or TIR (p > 0.05). The risk of not achieving longevity increased with each one unit increase in MBG by 126% [2.26 (1.05–4.91)], eHbA1c by 67% [1.67 (1.03–2.72)], GMI by 568% [6.68 (1.11–40.30)], M-FPG by 365% [4.65 (1.57–13.75)], M-PPG1h by 98% [1.98 (1.18–3.31)], CONGA1 by 102% [2.02 (1.01–4.06)], Li by 200% [3.00 (1.04–8.61)], and PPGE-2 by 150% [2.50 (1.39–4.50)]. However, the risk of achieving longevity decreased with each unit increase of LBGI by 53% [0.47 (0.28–0.80)], ADRR by 60% [0.40 (0.18–0.86)], and TBR by 11% [0.89 (0.80–0.98)].ConclusionFluctuation in blood glucose levels in centenarians is relatively small. Maintaining an average blood glucose level and keeping blood glucose fluctuations in the normal range is conducive to longevity.