Glucose Monitoring Research Articles

Impact of glycemic treatment and blood glucose monitoring on outcomes in patients with acute ischemic stroke without prior diabetes: a longitudinal cohort study

ObjectivesTo explore the short- and long-term effects of glycemic management—through glycemic treatment and blood glucose monitoring (BGM)—on stroke recurrence and mortality specifically in patients experiencing a first-ever ischemic stroke (FIS) with hyperglycemia (FISHG) who have not previously been diagnosed with diabetes mellitus (DM).MethodsWe gathered data on patients who were registered on Taiwan’s National Health Insurance Research Database from 2000 to 2015. We one-fold propensity-score-matched (by sex, age, and index date) 207,054 patients into 3 cohorts: those with FIS (1) without hyperglycemia, (2) hyperglycemia without glycemic treatment, and (3) hyperglycemia with glycemic treatment. We used Cox proportional hazard regression to evaluate the short- (within 1 year after FIS) and long-term (9.3 ± 8.6 years after FIS) prognostic effects of glycemic management on stroke recurrence and mortality of FISHG.ResultsStroke recurrence and mortality were significantly more likely in the patients with FISHG than their counterparts without hyperglycemia (p < 0.05). Under glycemic treatment, patients with FISHG demonstrated lower risk of mortality at every follow-up than those without (p < 0.001) but were not less likely to have stroke recurrence (p > 0.05). Integrating BGM with glycemic treatment in the FISHG cohort significantly reduced the risk of stroke recurrence compared to patients receiving only glycemic treatment at 1-month, 3-month, 6-month, and 1-year post-stroke follow-ups (adjusted hazard ratios = 0.84, 0.90, 0.88, and 0.92, respectively); additionally, this approach significantly decreased mortality risk at each post-stroke follow-up period (p < 0.05).ConclusionsBGM combined with glycemic treatment significantly improves prognosis in patients with FISHG who have not been previously diagnosed with DM, reducing the risks of stroke recurrence and mortality.

Association between time in tight range and incident diabetic retinopathy in adults with type 2 diabetes.

Time spent in the glucose range of 70-180 mg/dL (TIR) has become entrenched as a key measure of glycaemic control, which was linked to diabetes-related outcomes in previous studies. However, there has been a recent debate about whether to instead emphasize time in the target range of 70-140 mg/dL (time in tight range, TITR). We aimed to assess the association between TITR and incident diabetic retinopathy in adults with type 2 diabetes. This is a dynamic cohort study conducted at a tertiary hospital. 2518 adults with type 2 diabetes and without diabetic retinopathy at baseline were finally included. TITR was obtained from continuous glucose monitoring data at baseline. Cox proportional hazard regression analysis was performed to assess the relationships of TITR with the risk of incident diabetic retinopathy. During a mean follow-up period of 5.43 years, 646 patients developed retinopathy. The multivariable-adjusted hazard ratios (HRs) for incident retinopathy across descending TITR quartiles (Q4: >58% [reference], Q3: 38% ~ 57%, Q2: 19% ~ 37%, and Q1: <19%) were 1.00, 1.47 (95%CI 1.16, 1.87), 1.52 (95%CI 1.20, 1.93) and 1.93 (95%CI 1.53, 2.43), respectively. For per 10% decrease in TITR, the risk of diabetic retinopathy was increased by 9% (HR = 1.09, 95%CI 1.06, 1.13) after full adjustment for covariates. In the TIR >70% subgroup, the significant association between TIR, as a continuous variable and the risk of incident retinopathy disappeared, whereas TITR remained significantly associated with the outcome. Similar results were observed in the TIR >80% and TIR >90% subgroups. TITR is inversely associated with the incidence of diabetic retinopathy in adults with type 2 diabetes. Among adults with well-controlled TIR (70% or higher), TITR may provide added value regarding glucose control.

Continuous Glucose Monitoring in Comorbid Dementia and Diabetes: The Evidence So Far.

Type 2 diabetes mellitus (T2DM) and dementia are two of the leading chronic diseases in aging and are known to influence each other's disease progression. There is well-established evidence that T2DM increases the risk for cognitive decline and dementia. At the same time, people with cognitive changes or dementia can find it difficult to manage their diabetes, resulting in hyper- or hypoglycemic events which can exacerbate the dementia disease progression further. Monitoring of glucose variability is, therefore, of critical importance during aging and when people with T2DM develop dementia. The advent of continuous glucose monitoring (CGM) has allowed the monitoring of glucose variability in T2DM more closely. The CGM seems to be highly feasible and acceptable to use in older people with T2DM and has been shown to significantly reduce their hypoglycemic events, often resulting in falls. Less is known as to whether CGM can have a similar beneficial effect on people with T2DM who have cognitive impairment or dementia in community or hospital settings. The current perspective will explore how CGM has made an impact on T2DM management in older people and those with comorbid cognitive impairment or dementia. We will further explore opportunities and challenges of using CGM in comorbid T2DM and dementia in community and hospital settings.

Precision medicine in type 1 diabetes: comparing metabolic outcomes of Control-IQ and MiniMed 780G according to patient characteristics.

This study aimed to compare 12-month metabolic outcomes in patients with type 1 diabetes (T1D) treated with either MiniMed 780G (Guardian 4) or Control-IQ (Dexcom G6) automated insulin delivery (AID) systems and identify interaction with patient characteristics. We conducted a single-centre, retrospective study including all patients (aged ≥16) with T1D who were started on either MiniMed 780G or Control-IQ between January 2021 and October 2022 and continued for ≥12 months. We used propensity score matching to compare the average marginal effects between MiniMed 780G and Control-IQ regarding the primary outcome (time in range [TIR]) and secondary outcomes (time below range [TBR], glucose monitoring indicator [GMI] and coefficient of variation [CV]) after 12 months. We tested for interaction effects between baseline characteristics (age, sex, socio-professional background, body mass index, insulin daily dose, carbohydrate counting practice) and treatment effect. We included 245 patients (58% women): 178 treated with Control-IQ and 67 with MiniMed 780G. The mean ± SD age and haemoglobin A1c were 39 ± 15 years and 8.7 ± 1.8% (72 ± 20 mmol/mol) respectively. In the propensity score-matched sample (n = 221), we observed significant differences in 12-month TIR (MiniMed 780G minus Control-IQ [95% CI]: 6.4 [3.4;9.5]), GMI (-0.42 [-0.59; -0.25]) and CV (-2.12 [-3.68; -0.55]), while TBR showed no significant difference (-0.04 [-0.47; +0.40]). The 12-month TIR difference was consistent across subgroups, including baseline carbohydrate counting characteristics. MiniMed 780G is associated with moderate metabolic superiority compared to Control-IQ, without interaction with patient characteristics. These results suggest that neither model is more appropriate for certain populations, particularly patients without carbohydrate counting practice.

Ramadan diurnal intermittent fasting in patients with diabetes: assessment of knowledge, practices, risk of complications, and impact of pre-ramadan education.

Evaluate diabetic patients' knowledge, practices, and the prevalence of complications during Ramadan fasting (RF) before and after an education program. We conducted a prospective study including 140 consecutive diabetic patients (DP) who intended to observe RF in 2023. Patients underwent a questionnaire and received pre-Ramadan education (PRE) according to the IDF-DAR 2021 recommendations. Practices and outcomes (hypoglycemia, hyperglycemia, and cardiovascular events) of RF patients were determined during Ramadan 2022 and 2023 using a questionnaire. Participants mean age was 56.0 ± 9.3 years. Their knowledge level was good, average, and poor in 37.1%, 35%, and 27.9% of cases, respectively. Before RF 2022, 40.9% of patients reported consulting their physicians about diabetes management during fasting and 12.1% received education. The risk stratification showed that 45.7% of patients were at low risk, 32.9% at moderate risk, and 21.4% at high risk. Compared to 2022 RF, significant changes in eating patterns and physical activity practice were observed in 2023. Self-monitoring blood glucose (SMBG) was practiced by 35.6% of patients in 2022 and 75% in 2023 (p < 0.001). The number of patients who fasted the whole month of Ramadan and hypoglycemia prevalence were comparable between 2022 and 2023. Hyperglycemia prevalence was higher in 2023 (14.9%) than in 2022 (3%) (p < 0.001). No severe hypoglycemia, cardiovascular events, or hospital admissions were observed during RF 2022 and 2023. The majority of diabetic patients had poor to average knowledge about diabetes and fasting. They were categorized as moderate- to high-risk of complications during RF. PRE had a positive impact on lifestyle, dietary patterns, and SMBG practice. Although this education did not lead to a decrease in hypoglycemia or hyperglycemia events, no severe metabolic or cardiovascular complications were reported.

PROFOUND HYPOGLYCEMIA AND BLOOD GLUCOSE TESTING METHODOLOGIES IN FLORIDA MANATEES (TRICHECHUS MANATUS LATIROSTRIS) PRESENTED TO A CRITICAL CARE CENTER.

Florida manatees (Trichechus manatus latirostris) continue to experience pressure from various stressors that frequently result in the need for rescue and veterinary assistance. Interestingly, a subset of rescued manatees in critical condition exhibits profound hypoglycemia. The goals of this study were to enhance our understanding of this important aspect of manatee care by 1) characterizing the clinical presentation and factors associated with manatees that present with profound hypoglycemia, and 2) assessing agreement across blood glucose testing modalities [glucometer (whole blood), in-house bench-top analyzer (whole blood), a point of care analyzer (whole blood), and a local human hospital laboratory analyzer (serum)]. Twenty-five manatees were admitted to the Jacksonville Zoo and Gardens from 2017 to 2021. Seven manatees were profoundly hypoglycemic on presentation with blood glucose concentrations of < 30 mg/dL. Hypoglycemic manatees were admitted due to cold stress syndrome (n = 3; 1 calf, 2 adults) or emaciation consistent with an unusual mortality event (n = 4; 2 calves, 2 adults). Physical examination findings in hypoglycemic animals included emaciation (n = 7, 100%), lethargy (n = 7, 100%), and intermittent mild muscle fasciculations of the muzzle (n = 3, 42.8%). Hypoglycemia resolved with intense supportive care and monitoring in all affected animals within 32 h of admission. No associations were identified between hypoglycemia on presentation and life-stage, sex, transport distance to JZG's critical care facility, or rehabilitation outcome (death/euthanasia vs. release). Statistical agreement was observed between all blood glucose testing modalities except for the glucometer vs. the human hospital analyzer. Despite the limited sample size, these findings inform on the clinical presentation of severe hypoglycemia, the importance of close blood glucose monitoring after admission, blood glucose testing modalities, and clinical decision-making in Florida manatees admitted to critical care centers.

Enhanced Metabolic Control in a Pediatric Population with Type 1 Diabetes Mellitus Using Hybrid Closed-Loop and Predictive Low-Glucose Suspend Insulin Pump Treatments

Background: Insulin pumps coupled with continuous glucose monitoring sensors use algorithms to analyze real-time blood glucose levels. This allows for the suspension of insulin administration before hypoglycemic thresholds are reached or for adaptive tuning in hybrid closed-loop systems. This longitudinal retrospective study aims to analyze real-world glycemic outcomes in a pediatric population transitioning to such devices. Methods: We evaluated children with type 1 diabetes mellitus (T1D) admitted to the Pediatric Diabetes Department from a major University Hospital in Bucharest, Romania, who transitioned to hybrid closed-loop or predictive low-glucose suspend system from either non-automated insulin pumps or multiple daily injections. The primary outcome was assessing the change in glycated hemoglobin (HbA1c) after initiating these devices. Secondary outcomes analyzed changes in glucose metrics from the 90 days prior to the baseline and follow-up visit. Results: 51 children were included (58.8% girls), the mean age was 10.3 ± 3.7 years, and the mean follow-up duration was 13.2 ± 4.5 months. The analyzed parameters, such as HbA1c (6.9 ± 0.7% vs. 6.7 ± 0.6%, p = 0.023), time in range (69.3 ± 11.2% vs. 76 ± 9.9%, p &lt; 0.001), time in tight range (47.4 ± 10.9% vs. 53.7 ± 10.7%, p &lt; 0.001), time below range (5.6 ± 2.9% vs. 3.5 ± 1.9%, p &lt; 0.001), time above range (25 ± 11.2% vs. 20.4 ± 9.4%, p = 0.001), and coefficient of variation (37.9 ± 4.8% vs. 35.6 ± 4.6%, p = 0.001), showed significant improvements. Conclusions: The application of these sensor-integrated insulin pumps can significantly enhance metabolic control in pediatric populations, minimizing glycemic variations to mitigate complications and enrich the quality of life.

Association Between Glycemia, Glycemic Variability, and Pregnancy Complications in Early GDM.

To investigate the association of timing of commencing glucose management with glycemia, glycemic variability, and pregnancy outcomes among women with early gestational diabetes mellitus (GDM). In this substudy among participants of a trial of immediate vs delayed treatment of early GDM diagnosed by 2013 World Health Organization criteria, all women treated immediately and those with delayed diagnosis at 24-28 weeks' gestation (treated as if late GDM) were instructed to monitor capillary blood glucose (BG) four times a day (fasting and 2-h postprandial) until delivery. Optimal glycemia was defined as ≥95% of BG measurements between 70 and 140 mg/dL (3.9-7.8 mmol/L). Overall, 107,716 BG values were obtained from 329 of 549 (59.9%) women (mean age 32.3 ± 4.9 years, BMI 32.0 ± 8.0 kg/m2, 35% European, gestation at GDM diagnosis 15.2 ± 2.4 weeks). Women treated early (n = 213) showed lower mean glucose (MG) and mean fasting glucose (MFG) compared with those treated late (n = 116) (MG: 5.7 ± 0.4 vs. 5.9 ± 0.5, P < 0.001; MFG: 5.2 ± 0.3 vs. 5.3 ± 0.4, P = 0.004), with greater optimal glycemia (74.6% vs. 59.5%, P = 0.006) and similar glycemic variability. MG was similar from 30 weeks' gestation. Overall, optimal glycemia was achieved in 69% of women and associated with lower birth weight, fewer large-for-gestational-age infants (14.4% vs. 26.7%, P = 0.01), more small-for-gestational-age infants (15.3% vs. 5.9%, P = 0.02), and lower gestational weight gain (4.9 ± 6.4 vs. 7.6 ± 6.2 kg, P = 0.001). Suboptimal glycemia was associated with non-European ethnicity, prior GDM, 1-h glucose at booking oral glucose tolerance test, and insulin use. Both early and delayed treatment of early GDM resulted in similar glycemia toward the end of pregnancy. Early treatment was associated with improved glycemia overall.

Screening fasting glucose before the OGTT: near-patient glucometer- or laboratory-based measurement?

The measurement of fasting glucose is a common practice for lowering the risk of hyperglycemia before an oral glucose tolerance test (OGTT). In this study we analyze advantages and limitations of near-patient measurement of capillary fasting glucose with a portable glucometer or blood sampling and measurement of plasma glucose with laboratory instrumentation. The final study population consisted of 241 subjects (mean age: 36±8 years; 97.9 % pregnant women) referred to our local phlebotomy center for an OGTT. Fasting glucose was measured in capillary blood using a near-patient glucometer (glucometer-based strategy) and in plasma with laboratory instrumentation using the hexokinase reference assay (laboratory-based strategy). The mean turnaround time from sample collection to obtaining the glucose value was longer with the laboratory-based strategy (32 min 8 vs. 8 s). The imprecision of the glucometer was higher than that of the laboratory assay (3.4 vs. 0.8 %). A negative bias of-3.3 % in fasting glucose was found with the glucometer compared to the laboratory measurement. The diagnostic accuracy, sensitivity and specificity of the glucometer for detecting fasting glucose values≥7.0 mmol/L were 99.2 , 50.0 and 100.0 % compared to the laboratory assay. The glucometer-based strategy had an incremental cost of 0.17€ per patient compared to the laboratory-based strategy. Screening fasting glucose in capillary blood with a near-patient glucometer instead of measuring fasting plasma glucose with laboratory instrumentation allows faster patient management in the phlebotomy center but is associated with higher imprecision, inaccuracy, costs and avoidable finger pricks.

Daily glucose variability is associated with intrahepatic fat content, β cell sensitivity, and biomarkers of glycolysis in youth with obesity.

Pediatric obesity is associated with insulin resistance, which, in turn, impacts glucose and lipid metabolism. This study sought to assess how glucose variability relates to intrahepatic fat content, β cell insulin sensitivity, and glycolysis in youth with obesity. A total of 27 youth with obesity (11 girls, BMI percentile, median [25th-75th percentiles]: 99.0 [97.9-99.0]) wore a continuous glucose monitoring device for 10 days and underwent a 3-h oral glucose tolerance test. β cell function was assessed using the oral minimal model, and liver proton density fat fraction was measured by magnetic resonance imaging. Average sensor-derived glucose and glucose standard deviation (STDEV) and coefficient of variation (CV) were associated with liver proton density fat fraction(p = 0.0130, p = 0.0005, and p = 0.0028, respectively). First-phase insulin secretion, basal insulin secretion, and insulin sensitivity were associated with STDEV (p = 0.0344, p = 0.0091, and p = 0.0031, respectively) and CV (p = 0.0128, p = 0.0012, and p = 0.0022, respectively). STDEV and CV were also associated with 2-h glucose (p = 0.0067 and p = 0.0324, respectively) and plasma lactate (p = 0.0030 and p = 0.0123, respectively). Daily glucose variability is associated with the degree of intrahepatic fat content, postprandial glucose, and plasma lactate concentrations.

OptimAAPP, a smartphone insulin dose calculator for carbohydrate, fat, and protein: A cross-over, randomised controlled trial in adolescents and adults with type 1 diabetes using multiple daily injection therapy.

To (1) evaluate the efficacy of OptimAAPP, a smartphone insulin dose calculator for carbohydrate, fat, and protein in managing glycaemia compared with carbohydrate counting in adolescents and adults with type 1 diabetes using flexible multiple daily injection therapy (MDI, ≥4 injections/day) and (2) assess user acceptability of OptimAAPP. In this free-living trial, participants aged 12-50 years were randomised to use carbohydrate counting or OptimAAPP for meal insulin dose calculation for 3 months, then use the alternate method for 3 months. The primary outcome, time-in-range (3.9-10.0 mmol/L) was measured in weeks 3-4 of each arm using continuous glucose monitoring. The acceptability of OptimAAPP was assessed at end intervention using a purpose-designed questionnaire. An intention-to-treat analysis of 41 participants, mean age 28 ± 12 years and HbA1c 56 ± 10 mmol/mol (7.3 ± 0.9%) found no significant difference in glycaemic outcomes when using OptimAAPP compared with carbohydrate counting including time-in-range (70.5 vs. 67.6%, p = 0.102), above range (24.5% vs. 28.0%, p = 0.068), below range (4.9% vs. 4.4%, p = 0.318), and coefficient of variation (32.2% vs. 33.3%, p = 0.136). There was no severe hypoglycaemia. Participants reported that OptimAAPP was easy to use (79%), and they were confident in giving the recommended doses (82%). Barriers to use were the small food database and the time associated with food entry. In adolescents and adults using flexible MDI therapy, OptimAAPP use did not produce glycaemic outcomes that were significantly different from carbohydrate counting. Participant views of OptimAAPP indicate a high level of acceptability. Increasing the size of the food database will likely enhance the user experience.

Scp776, A Novel IGF-1 Fusion Protein for Acute Therapy to Promote Escape From Apoptosis in Tissues Affected by Ischemic Injury: 2 Randomized Placebo-Controlled Phase 1 Studies in Healthy Adults.

Apoptosis is a major driver of cell loss and infarct expansion in ischemic injuries such as acute ischemic stroke (AIS) and acute myocardial infarction (AMI). Insulin-like growth factor-1 (IGF-1) can mitigate cell death and potentiate recovery following acute ischemic injury, but short half-life and nonspecificity limit its therapeutic potential. Scp776 is an IGF-1 fusion protein designed to target damaged tissue and promote apoptosis escape and is in clinical development as an acute therapy for AIS and AMI. Two phase 1 placebo-controlled studies in healthy volunteers evaluated safety, tolerability, pharmacokinetic profile, and pharmacodynamics under single (1, 2, or 4mg/kg) or multiple (6, 6.2, or 7.25mg/kg total doses) dosing regimens. In addition, a blood glucose management plan was developed and implemented to mitigate hypoglycemia that may develop following scp776 injection. Scp776 was well tolerated in healthy volunteers (n=51) without serious adverse events. Exposure increased in a near dose-proportional manner with a mean half-life across all doses of 8hours. Adaptive dextrose infusions maintained normal blood glucose levels with occasional mild hypoglycemic events. These results informed scp776 dose selection and the design of blood glucose monitoring protocols for phase 2 studies.

Fear of hypoglycemia relates to glycemic levels during and after real-world physical activity in adolescents with type 1 diabetes.

We explore the association between hypoglycaemia fear (FH) and glycaemia during and after exercise sessions in a large sample of physically active youth with type 1 diabetes (T1D). We used data from the Type 1 Diabetes Exercise Initiative Paediatric (T1DEXIP) Study. Youth self-reported on FH using the Hypoglycaemia Fear Survey-Child (HFS-C). They used a smart phone application to self-report food intake and insulin dosing (multiple daily injection only). We collected pump and continuous glucose monitoring data directly from the device. Our sample included n = 251 youth (mean age: 14 ± 2 years, 55% closed loop pump; 42% women). Youth reporting higher HFS-C Total and Helplessness/Worry scores (HFS-C subscale) had slightly fewer competitive and fewer high intensity exercise events compared to youth with lower HFS-C Total and Helplessness/Worry scores. Youth reporting the highest Maintain High Blood Glucose scores (HFS-C subscale) had the lowest percent glucose time in range, higher mean glucose levels, and higher percent time above range during exercise. Youth reporting the highest Maintain High Blood Glucose scores also tended to have higher mean glucose levels post-exercise and a smaller drop in glucose during exercise. FH relates to glycaemia during and after exercise in adolescents with T1D and may signal an inclination for some youth to engage in avoidance behaviours to reduce their vulnerability to exercise-induced hypoglycaemia.

Biotechnology Revolution Shaping the Future of Diabetes Management

Introduction: Diabetes mellitus (DM) has a millennia-long history, with early references dating back to ancient Egypt and India. However, it was not until the 20th century that the connection between diabetes and insulin was fully understood. The sequencing of insulin in the 1950s initiated the convergence of biotechnology and diabetes management, leading to the development of recombinant human insulin in 1982. This marked the start of peptide-based therapies in DM. Recombinant peptides for DM treatment: Numerous recombinant peptides have been developed since, starting with modified insulin molecules, with the aim of bettering DM management through fine-tuning the glycemic response to insulin. Peptide-based therapies in DM have expanded substantially beyond insulin to include agonists of Glucagon-like peptide-1 receptor and Glucose-dependent insulinotropic polypeptide receptor, glucagon receptor antagonists, and even peptides exerting multiple receptor agonist effects, for better metabolic control. Insulin pumps, continuous glucose monitoring, and automated insulin delivery systems: The development of modern delivery systems combined with real-time glucose monitoring has significantly advanced diabetes care. Insulin pumps evolved from early large devices to modern sensor-augmented pumps with automated shutoff features and hybrid closed-loop systems, requiring minimal user input. The second-generation systems have demonstrated superior outcomes, proving highly effective in diabetes management. Islet cell transplantation, organoids, and biological pancreas augmentation represent innovative approaches to diabetes management. Islet cell transplantation aims to restore insulin production by transplanting donor beta cells, though challenges persist regarding graft survival and the need for immunosuppression. Organoids are a promising platform for generating insulin-producing cells, although far from clinical use. Biological pancreas augmentation relies on therapies that promote beta-cell (re)generation, reduce stress, and induce immune tolerance. Further biotechnology-driven perspectives in DM will include metabolic control via biotechnology-enabled tools such as custom-designed insulin hybrid molecules, machine-learning algorithms to control peptide release, and engineering cells for optimal peptide production and secretion.

Frequency of Insulin Omission and It’s Associated Factors in Patients with Type 2 Diabetes Mellitus on Insulin Therapy

ABSTRACT Background: Poor adherence to prescribed insulin regimen leads to poor glycemic control. This study was intended to see the frequency of insulin omission and it's associated factors among patients with inadequate glycemic control on insulin therapy. Methods: This cross-sectional observational study enrolled 384 patients with type 2 diabetes on insulin therapy recruited by convenient sampling from the Department of Endocrinology of BIRDEM General Hospital. As per study protocol, investigation reports were collected from patient records. Data were analyzed by SPSS version 25. Results: Forty-six percent of patients had some form of insulin omission. A documented event of one or more episodes of hypoglycemia (70.7%) was found to be the prime reason behind the omission of insulin. Worsened glycemic control (fasting plasma glucose, 2-h postprandial glucose, and glycated hemoglobin) and health hazard (obesity) were statistically significantly higher among the subjects who omitted their insulin. Only a few people in the insulin omission group were compliant with diet (2.8%), exercise (5.1%), and weekly self-monitoring of blood glucose (2.8%). Only 22.5% and 21.3% knew about target blood glucose and the insulin dose adjustment, respectively, in the omission group. Conclusions: High frequency of insulin omission due to several lifestyle-related factors and lack of structured diabetic education predisposed the patients to poor glycemic control.

Evidence-Based Perioperative Care of Patients with Continuous Glucose Monitoring Devices

Introduction Diabetes : Hyperglycemia Diabetes Management: CGM Devices Perioperative Nursing Education Patient Outcomes Background Adults with DM are rising in epidemic proportions worldwide. Metabolic disorder characterized by persistent changes in blood glucose levels. Hyperglycemia is a serum glucose level higher than 140mg/dl Postoperative variability in blood glucose levels = relative immunodeficiency. DM complicates the patient’s disease status. Detection of perioperative hyperglycemia is essential. CGMs provide real-time glucose monitoring. CGMs accuracy can be affected during surgery. Awareness of this inaccuracy is essential for making clinical decision.

Association between consumption of ultra-processed foods and glycemic self-monitoring in women with gestational diabetes mellitus and their newborns: A cohort study.

To evaluate the association between the consumption of ultra-processed foods (UPFs) and outcomes of self-monitoring of blood glucose in pregnant woman with gestational diabetes mellitus (GDM) and the occurrence of hypoglycemia in their newborns. Prospective cohort study of pregnant woman with GDM who were followed up from the second trimester of pregnancy in high-risk prenatal care until the immediate postpartum period. Dietary intake was assessed using 24-h recalls and analyzed according to the Nova Classification. The glycemic profile was assessed by self-monitoring of fasting and postprandial capillary glycemia (pregnant) and by capillary glycemia in the first 48 h of life (neonate). Multilevel binary logistic regression models were used to assess the relationship between increasing UPF intake, considering the highest tertile of UPF consumption, and women's glycemic control and the occurrence of neonatal hypoglycemia. UPFs provided 15% of calories consumed; 33.3% (n = 30) and 52.3% (n = 45) of the women had hyperglycemia in the second and third trimesters of pregnancy, respectively. After adjustment it was observed that UPF consumption had no significant association with maternal glycemic control but it showed a positive association with the occurrence of neonatal hypoglycemia (odds ratio [OR] 1.144, 95% confidence interval [CI] 1.037-1.262, p = 0.007). These data reinforce the need to address food processing during high-risk prenatal care in order to help reduce the negative impacts of UPF consumption on the mother-infant dyad.

A Randomized Trial Comparing Inhaled Insulin Plus Basal Insulin Versus Usual Care in Adults With Type 1 Diabetes.

To evaluate a regimen of inhaled Technosphere insulin (TI) plus insulin degludec in adults with type 1 diabetes, who prestudy were predominately using either an automated insulin delivery (AID) system or multiple daily insulin injections (MDI) with continuous glucose monitoring. At 19 sites, adults with type 1 diabetes were randomly assigned to TI plus insulin degludec (N = 62) or usual care (UC) with continuation of prestudy insulin delivery method (N = 61) for 17 weeks. Prestudy, AID was used by 48% and MDI by 45%. Mean ± SD HbA1c was 7.57% ± 0.97% at baseline and 7.62% ± 1.06% at 17 weeks in the TI group and 7.59% ± 0.80% and 7.54% ± 0.77%, respectively, in the UC group (adjusted difference 0.11%, 95% CI -0.10 to 0.33, P value for noninferiority = 0.01). HbA1c improved from baseline to 17 weeks by >0.5% (5.5 mmol/mol) in 12 (21%) in the TI group and in 3 (5%) in the UC group and worsened by >0.5% (5.5 mmol/mol) in 15 (26%) in the TI group and in 2 (3%) in the UC group. The most common TI side effect was a brief cough; eight participants discontinued TI due to side effects. In adults with type 1 diabetes, HbA1c after 17 weeks with a regimen of TI and degludec was noninferior to UC, which consisted predominately of either AID or MDI. TI should be considered an option for people with type 1 diabetes, particularly those who are motivated to further reduce postprandial hyperglycemia.

Implementation of Diabetic Remote Patient Monitor for Underserved Population.

A nurse-led interprofessional clinic adopted the use of remote patient monitoring (RPM) for glucose monitoring to better serve their patient population of uninsured patients with uncontrolled diabetes. The adoption of the RPM system required an infrastructure design to connect multiple data points and adapt to the needs of the clinic's unique patient population for a seamless provider and patient experience. Implementation requirements were addressed in three phases: protocol adaptation, enrollment workflow, and clinic management of RPM patients.

Tuning the Localized Microenvironment near a Continuous Glucose Meter to Ensure Monitoring Accuracy and Longevity by Plasma-Induced Grafting Zwitterionic Brushes.

Diabetes mellitus is a metabolic disorder that affects millions of individuals worldwide. Continuous glucose monitoring (CGM) offers a prevalent method for continuously monitoring interstitial glucose levels instead of traditional self-monitoring of blood glucose (BG), eliminating the need for finger pricking and providing only discrete data. However, challenges in accuracy persist in CGM, including substantial noise interference and tissue fluid erosion, as well as the pH fluctuations in the localized ISF microenvironment during acute inflammation periods. Herein, we reported a facile atmospheric plasma-induced grafting technique to surface functionalize a zwitterionic brush coating on the sensor, with the aim to adjust the sensor's microenvironmental chemistry. The zwitterionic brush-coated CGM (Z-coated CGM) could regulate pH values with a good glucose response in the pH range from 6.2 to 7.6 and a prolonged sensor life over the uncoated sensor. We evaluated the rat practice that the Z-coated CGM consistently outperformed the uncoated in tracking BG fluctuations, with higher correlation coefficients and significant noise reduction for both non-recalibration and recalibration. This technology holds substantial implications for subcutaneous embedded glucose monitors and facilitates CGMs in achieving independence from routine BG fingerstick calibrations.