Glucose Monitoring Methods Research Articles

Фотометричний метод і прилад для моніторингу рівня глюкози хворих на цукровий діабет

Фотометричний метод і прилад для моніторингу рівня глюкози хворих на цукровий діабет

Qualitative research on compliance of blood glucose monitoring in elderly patients with type 2 diabetes in rural areas

Objective To understand the factors affecting the compliance of blood glucose monitoring in patients with type 2 diabetes in rural areas, and to provide evidence for improving the compliance of patients with blood glucose monitoring. Methods A method of phenomenological study in qualitative research was conducted to conduct deep semi-structured interviews on 43 patients with poor blood glucose compliance in type 2 diabetes in rural areas, and to analyze the collected data. Results Extracted five themes: bad experience affected compliance; lack of knowledge about blood glucose monitoring; economic and time was not sufficient; long-term illness into a good doctor overconfidence; social support uncertainty. Conclusions The status of blood glucose monitoring in rural type 2 diabetes patients is not optimistic. In order to improve the compliance of patients with blood glucose monitoring, nursing workers should pay attention to the mastery of blood glucose monitoring knowledge in rural type 2 diabetes patients, improve blood glucose monitoring methods and techniques, and give full play to the role of family doctors. Efforts to improve patient blood glucose monitoring compliance. Key words: Diabetes, type 2; Blood glucose monitoring; Compliance; Qualitative research

Chinese clinical guidelines for continuous glucose monitoring (2018 edition).

Blood glucose monitoring is an important part of diabetes management. Continuous glucose monitoring (CGM) technology has become an effective complement to conventional blood glucose monitoring methods and has been widely applied in clinical practice. The indications for its use, the accuracy of the generated data, the interpretation of the CGM results, and the application of the results must be standardized. In December 2009, the Chinese Diabetes Society (CDS) drafted and published the first Chinese Clinical Guideline for Continuous Glucose Monitoring (2009 edition), providing a basis for the standardization of CGM in clinical application. Based on the updates of international guidelines and the increasing evidence of domestic studies, it is necessary to revise the latest CGM guidelines in China so that the recent clinical evidence can be effectively translated into clinical benefit for diabetic patients. To this end, the CDS revised the Chinese Clinical Guideline for Continuous Glucose Monitoring (2012 Edition) based on the most recent evidence from international and domestic studies.

The impact of a structured education and treatment programme (FLASH) for people with diabetes using a flash sensor-based glucose monitoring system: Results of a randomized controlled trial

AimsFlash sensor-based glucose monitoring (FSGM) provides people with diabetes considerably more information on their glycaemic control. We have developed and evaluated a structured education and treatment programme, termed FLASH, to assist FSGM users to understand and use the available glycaemic information for optimization of their diabetes treatment. MethodsWe report on a multi-centre, randomized, parallel trial with a six-month follow-up involving 216 eligible participants (16–75 years old) on intensive insulin therapy. The primary outcome was HbA1c change from baseline to six months. Secondary outcomes were measures of glucose control as assessed by FSGM, as well as changes in behavioural and psychosocial measures. ResultsAt six months, the between-group difference in HbA1c reduction was significant, favouring FLASH education compared to the control group receiving no FLASH education (−0.28%, 95% CI −0.16% to −0.40% vs.−0.11%, 95% CI 0.00% to −0.22%; with a between-group difference of −0.17%, 95% CI −0.01% to −0.33%; p = 0.033). Participation in FLASH education also resulted in significant improvements in time spent in the target glucose range, in diabetes-related distress scores and in satisfaction with the glucose monitoring method. FLASH education also resulted in significant improvements in the use of glycaemic information provided by FSGM and in reduced self-monitoring of blood glucose (SMBG) fingerstick testing. ConclusionFLASH is an effective programme to improve glycaemic control and lower diabetes-related distress in users of FSGM.The study was registered in ClinicalTrials: NCT03175315.

The Progress of Glucose Monitoring-A Review of Invasive to Minimally and Non-Invasive Techniques, Devices and Sensors.

Current glucose monitoring methods for the ever-increasing number of diabetic people around the world are invasive, painful, time-consuming, and a constant burden for the household budget. The non-invasive glucose monitoring technology overcomes these limitations, for which this topic is significantly being researched and represents an exciting and highly sought after market for many companies. This review aims to offer an up-to-date report on the leading technologies for non-invasive (NI) and minimally-invasive (MI) glucose monitoring sensors, devices currently available in the market, regulatory framework for accuracy assessment, new approaches currently under study by representative groups and developers, and algorithm types for signal enhancement and value prediction. The review also discusses the future trend of glucose detection by analyzing the usage of the different bands in the electromagnetic spectrum. The review concludes that the adoption and use of new technologies for glucose detection is unavoidable and closer to become a reality.

A wireless-electrodeless quartz crystal microbalance method for non-enzymatic glucose monitoring

Continuous glucose monitoring (CGM) in vivo is required for tight glycaemic control. Enzyme-free glucose sensors were proposed to solve the problems of daily invasive calibration and short lifespan of the current enzyme based continuous glucose monitors. In this report, a wireless-electrodeless quartz crystal microbalance method that tracks film dissipation was developed and proposed as a basis for a miniaturized implantable glucose monitor. An AT-cut blank quartz disc (14 mm in diameter) was stimulated wirelessly by a planar copper coil and working in the ring-down mode at a fixed frequency point (˜6 MHz). A 600–800 nm (3-acrylamidopropyl) tri-methylammonium chloride modified poly(acrylamide-co-3-acrylamideophenylboronic acid) hydrogel film was coated on the quartz disc for glucose sensing. The viscosity variations of the polymer film induced by the glucose binding were observed by measuring the dissipation change of the sensor. The linear relationship between the dissipation response and the glucose concentration was achieved in the range of ˜0 to 10 mM, with a sensitivity of 2 × 10−5 mM−1 and a response time of around 5 min at 37 °C. Furthermore, the response of the modified film to other interferences including the fructose, galactose, mannose, uric acid was dramatically reduced. The results suggest the wireless-electrodeless quartz crystal microbalance with dissipation system has the potential to be used as a subcutaneously implanted real-time glucose monitor.

Effects of flash glucose-sensing technology-based continuous glucose monitoring on compliance of patients with type 2 diabetes mellitus: study protocol for a randomized controlled trial

Background and objectives: Multiple insulin injection therapy has been widely used in the intensive treatment of diabetes mellitus and enabled more patients to obtain good glycemic control. Intensive insulin treatment such as multiple insulin injection every day had been proven to have effects on the protection of islet and delay the onset of diabetic complications. However, during the insulin intensive therapy, severe hypoglycemia must be avoided by intensive glucose monitoring because it can increase the risks of stroke and cardiovascular disease. Conventional invasive intensive blood glucose monitoring is limited in clinical practice because it can cause patient pain and inconveniences. Patient's poor compliance in blood glucose monitoring would restrict the application of insulin intensive therapy in patients outside the hospital. The latest method of flash glucose-sensing technology-based continuous glucose monitoring (CGM) made insulin intensive therapy safer and less painful for a patient with diabetes mellitus. However, little is reported on the effects of flash glucose-sensing technology based CGM in patients receiving multiple daily injections of insulin. This study will provide evidence to validate whether flash glucose-sensing technology-based CGM can increase the behavioral self-monitoring and compliance with self-management of a Chinese patient with diabetes mellitus receiving multiple daily injections of insulin compared with conventional invasive blood glucose monitoring. Subjects and methods: This is a prospective, single-center, open-label, randomized controlled trial. Forty patients with type 2 diabetes mellitus who receive multiple daily injections of insulin at the Department of Endocrinology, Northern Jiangsu People's Hospital, Yangzhou University, China between August 2018 and December 2019 are included in this study. These patients are randomly divided to undergo conventional blood glucose monitoring (n = 20) or a flash glucose-sensing technology-based CGM group (n = 20). Patient recruitment began in August 2018 and will end in June 2019. Analysis of primary outcome measure will be completed in June 2019. The study will end in December 2019. Study protocol: 1.0. The protocol was approved by the Medical Ethics Committee of Northern Jiangsu People's Hospital (approval No. 2018045) and is performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. All participants provide written informed consent. Outcome measures: The primary outcome measure is the compliance of glycemic monitoring. The secondary outcome measures include the time taken for reaching the goal of glycemic control, HbA1c, self-management scores, the number of hypoglycemia attacks, and Hamilton Anxiety Scale score. Discussion: This study will provide evidence to validate whether flash glucose-sensing technology can increase patient's compliance of intensive insulin treatments, control blood glucose, and improve quality of life. Trial registration: This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017456) on July 31, 2018.

Non-Invasive Blood Glucose Monitoring using Visible Laser Light

Diabetes Mellitus is a widely spreading disease worldwide which claims millions of lives every year. Blood glucose monitor is vital for keeping daily track of blood glucose levels and helps in the routine management of diabetes. Current blood glucose monitoring methods mainly involve finger pricks which leads to pain, puncture of skin, inconvenience and causes prone to infections. The costs of disposable test strips and the unavailability of reliable non-invasive glucose monitors are also the challenges in blood glucose monitoring regimen. Recently introduced minimally invasive blood glucose monitors have limited lifespan, unstable accuracy and require invasive methods for regular calibration. Therefore, there is a need to develop a reliable non-invasive blood glucose monitor that addresses the existing challenges. In this project work, we focused on the development of non-invasive blood glucose monitor using visible laser light of 650nm wavelength. In the initial stage, in vitro, experimental measurements were performed using laser based non-invasive blood glucose monitor module to ensure the sensitivity of the system to glucose concentrations. Then, fasting and postprandial in vivo measurements were conducted using the laser based non-invasive blood glucose monitor module integrated with Lab VIEW data acquisition system in the form of voltage output. The in vivo voltage output results were compared with Accu-check glucose monitor measurements which have shown good linearity. Finally, laser based non-invasive blood glucose monitor prototype was developed. This work involved 11 volunteer subjects and 18 different measurements for in vivo blood glucose measurement. The in vitro measurement results have shown an overall linearity of 96% while in vivo results had an overall linearity of 94.1% compared with Accu-check active blood glucose monitor measurements. The results are promising and show the potential use of 650nm visible laser light for blood glucose monitoring.

Taking the Pain Out of Glucose Monitoring

A painless method for glucose monitoring has been miniaturised and it is now ready for obtaining medical certifications.

Non‐enzymatic continuous glucose monitoring system

A prominent field of study in biosensor development is the study of electric properties which provide valuable insight into the fluids contents. In this research, a non-enzymatic glucose sensor is fabricated, characterised, and employed. The developed device determines the effects of electrode surface area on sensing efficacy, the effects of glucose concentration on impedimetric response, and a real-time measurement of glucose concentration. Deviations throughout the entire glucose range are detected as an inverse of the impedance in the cell due to the inverse relationship of glucose concentration and charge transfer resistance. The continuous monitoring of glucose is demonstrated by a rapid device response over two iterations of glucose concentration in ascending order: 50 μM, 400 μM, and 3.2 mM. At a sustained frequency of 10 kHz, the result shows a stable impedimetric response of 1038, 752, and 688 kΩ, respectively. The validity of the device as a continuous glucose monitoring method is carried out by repeating the cycle and observing the response.

Study of the Correlation between Tear Glucose Concentrations and Blood Glucose Concentrations

To achieve intensive glucose control for avoiding diabetic complications, it is necessary for diabetic patients to measure their blood glucose levels frequently. However, all currently available methods for blood glucose monitoring, including the finger prick method, are invasive. One of the possible noninvasive glucose monitoring approaches is tear glucose monitoring. Previous studies have showed the correlations between blood and tear glucose concentrations. But these correlations were not accurate sufficiently because the methods for tear sample collection were not standardized. For clinical development of tear glucose monitoring as a tool for predicting the blood glucose concentrations, we recruited 10 nondiabetic subjects and 20 diabetic subjects, observed the daily blood and tear glucose dynamics using samples collected under the standardized method, and determined the correlation between the blood and tear glucose concentrations. Preprandial blood glucose levels of diabetic subjects were significantly higher than those of nondiabetic subjects (p < 0.001), and preprandial tear glucose levels of diabetic subjects had a higher tendency than those of nondiabetic subjects (p = 0.051). Two hours postprandial blood and tear glucose levels of diabetic subjects were significantly higher than those of nondiabetic subjects (p < 0.001, p < 0.05, respectively). The blood and tear glucose dynamics showed that the behavior of the tear glucose concentrations paralleled that of the blood glucose concentrations. A linear mixed model for diabetic subjects revealed the existence of a significant association between the blood glucose concentrations and tear glucose concentrations (p < 0.001), and the association consisted even after adjusting for HbA1c levels and conditions of meals. In conclusion, tear glucose monitoring would be a tool for predicting the blood glucose levels noninvasively for various diabetic patients. Disclosure M. Aihara: None. N. Kubota: None. T. Kadowaki: Consultant; Self; Novo Nordisk A/S, AstraZeneca, Merck Sharp & Dohme Corp.. Research Support; Self; Kissei Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Sanofi, Kyowa Hakko Kirin Co., Ltd., Novo Nordisk A/S, Astellas Pharma, Daiichi Sankyo Company, Limited, Takeda, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd.. Speaker's Bureau; Self; Astellas Pharma, AstraZeneca, Merck Sharp & Dohme Corp., Ono Pharmaceutical Co., Ltd., Takeda, Eli Lilly and Company, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk A/S.

Cardiovascular Autonomic Neuropathy and Glucose Variability in Patients With Type 1 Diabetes: Is There an Association?

The oxidative stress associated with glucose variability might be responsible for neuronal damage while autonomic neuropathy (AN) has a detrimental effect on metabolism. The aim of the study was to find relationship between AN and GV in type 1 diabetic patients and to identify further factors that affect GV. Twenty type 1 diabetic patients were involved (age: 39.5 ± 3.4 years, duration of diabetes: 17.5 ± 2.5 years; HbA1c: 8.1 ± 0.2%, mean ± SE). AN was assessed by the cardiovascular reflex tests. The interstitial glucose levels were determined following insertion of a subcutaneous electrode during the continuous glucose monitoring (CGM) method on six consecutive days. GV was characterized by calculation of four parameters. SD of interstitial glucose values correlated positively with the overall AN score and the degree of the orthostatic reduction of systolic blood pressure (AN-score-SD ρ = 0.47, p < 0.05; orthostasis-SD: ρ = 0.51, p < 0.05). Mean absolute glucose (MAG) correlated with three parameters of AN (AN-score-MAG: ρ = 0.62, p < 0.01; 30/15 ratio-MAG: ρ = -0.50, p < 0.05; orthostasis-MAG: ρ = 0.59, p < 0.01). The HbA1c also correlated with two parameters of GV (HbA1c-continuous overlapping net glycemic action: ρ = 0.56, p < 0.05; HbA1c-MAG: ρ = 0.45, p < 0.05). The frequency of hypoglycemia did not exhibit any correlation with measures of GV. Severity of glucose variability but not overall glucose load correlates with both parasympathetic and sympathetic dysfunctions in type 1 diabetes. Higher HbA1c is associated with more severe glucose variability. The observed correlation between increased glucose variability and the severity of AN necessitates the further exploration of this relationship.

Enzyme-Based Glucose Sensor: From Invasive to Wearable Device.

Blood glucose concentration is a key indicator of patients' health, particularly for symptoms associated with diabetes mellitus. Because of the large number of diabetic patients, many approaches for glucose measurement have been studied to enable continuous and accurate glucose level monitoring. Among them, electrochemical analysis is prominent because it is simple and quantitative. This technology has been incorporated into commercialized and research-level devices from simple test strips to wearable devices and implantable systems. Although directly monitoring blood glucose assures accurate information, the invasive needle-pinching step to collect blood often results in patients (particularly young patients) being reluctant to adopt the process. An implantable glucose sensor may avoid the burden of repeated blood collections, but it is quite invasive and requires periodic replacement of the sensor owing to biofouling and its short lifetime. Therefore, noninvasive methods to estimate blood glucose levels from tears, saliva, interstitial fluid (ISF), and sweat are currently being studied. This review discusses the evolution of enzyme-based electrochemical glucose sensors, including materials, device structures, fabrication processes, and system engineering. Furthermore, invasive and noninvasive blood glucose monitoring methods using various biofluids or blood are described, highlighting the recent progress in the development of enzyme-based glucose sensors and their integrated systems.

Pain-Free Blood Glucose Monitoring Using Wearable Sensors: Recent Advancements and Future Prospects.

Keeping track of blood glucose levels non-invasively is now possible due to diverse breakthroughs in wearable sensors technology coupled with advanced biomedical signal processing. However, each user might have different requirements and priorities when it comes to selecting a self-monitoring solution. After extensive research and careful selection, we have presented a comprehensive survey on noninvasive/pain-free blood glucose monitoring methods from the recent five years (2012-2016). Several techniques, from bioinformatics, computer science, chemical engineering, microwave technology, etc., are discussed in order to cover a wide variety of solutions available for different scales and preferences. We categorize the noninvasive techniques into nonsample- and sample-based techniques, which we further grouped into optical, nonoptical, intermittent, and continuous. The devices manufactured or being manufactured for noninvasive monitoring are also compared in this paper. These techniques are then analyzed based on certain constraints, which include time efficiency, comfort, cost, portability, power consumption, etc., a user might experience. Recalibration, time, and power efficiency are the biggest challenges that require further research in order to satisfy a large number of users. In order to solve these challenges, artificial intelligence (AI) has been employed by many researchers. AI-based estimation and decision models hold the future of noninvasive glucose monitoring in terms of accuracy, cost effectiveness, portability, efficiency, etc. The significance of this paper is twofold: first, to bridge the gap between IT and medical field; and second, to bridge the gap between end users and the solutions (hardware and software).

Recent advances in perioperative glucose monitoring.

There is ongoing controversy surrounding the use of glucose monitoring in the perioperative setting. It is an important aspect of patient care, but the best way to go about monitoring this parameter is still up for debate. This article will review previously established data and new developments in this field. Several different methods exist to measure blood glucose levels in the perioperative setting, including central laboratory devices, blood gas analyzers, and point-of-care devices. However, it has been recommended that point-of-care devices not be used on 'critically ill' patients, which throws into question the common use of these devices perioperatively. Recently, the Centers for Medicare and Medicaid placed a moratorium on this recommendation, and these devices continue to be a staple in the perioperative setting, but there are other methods of glucose monitoring that can be employed. The monitoring of blood glucose levels in the perioperative patient remains an important part of patient care; however, debate still exist on how best to reliably measure blood glucose levels in the most effective manner.

Mauriac syndrome — is already a history?

In 1930 Mauriac described a syndrome characterized by the presence of growth impairment, hepatomegaly, delayed puberty and cushingoid features in patients with poorly controlled type 1 diabetes mellitus (T1DM). At that time, Mauriac syndrome was a common occur­rence. This state was maintained even in the fifties and sixties of the last century. The introduction of modern methods of insulin and glucose monitoring decisively reduced the frequency of occurrence of this syndrome. The incidence of Mauriac syndrome decreased dramati­cally, although it is still being reported. Often in these cases the patients present only some symptoms of this syndrome. The introduction of diagnostic tests allowed to find the genetic basis of these disorders in some of the cases. (Clin Diabetol 2017; 6, 3: 101–104)

Carbon-Based Nanobiohybrid Thin Film for Amperometric Glucose Sensing.

This pioneering study involved the fabrication of a new class of nanohybrid-based electrochemical glucose biosensor. First, three-dimensional (3D) graphene was fabricated as a platform of multiwalled carbon nanotube (MWCNT). Then, it was used to immobilize glucose oxidase (GOD) on nanohybrid thin film via the entrapment technique. The modified glucose biosensor indicated excellent biocatalytic activity toward the glucose measurment with a sensitivity of up to 49.58 μA mM-1 cm-2 and a wide linear dynamic range up to 16 mM. The fabricated biosensor shows an excellent stability of 87.8%, with its current diminishing after 3 months. This facile and simple electrochemical method for glucose monitoring using a modified glassy carbon electrode (GCE) by 3DG-MWCNT-GOD could open new avenues in producing of a inexpensive and sensitive glucose nanobiosensors.

Dysglycemia in Critically Ill Patients: Common Problems and Future Direction

The management of blood glucose (BG) in the critically ill became a topic of great interest following the publication of the landmark single-center surgical ICU study targeting euglycemia (80 to 110 mg/dL) in Leuven, Belgium, in 2001 (1). This study resulted in thousands of protocols and guidelines promoting 'tight' BG control . The failure to show the same results and high incidence of hypoglycemia in following trials have resulted in controversy in blood glucose management in critically ill patients. Analysis of dysglycemia in critically ill patients should include markers of three domains: hyperglycemia, hypoglycemia, and glycemic variability (2,3). Thus, hyperglycemia, hypoglycemia, and blood glucose variability should all be regarded as independent predictors of adverse outcomes in critically ill patients. Agus et al., in their multicenter study (4), showed that critically ill children with hyperglycemia did not benefit from strict glycemic control to a target glucose of 80-110 mg/dL compared to 150-180 mg/dL and patients in lower treatment target showed an insignificant 90-day mortally rate compared to other group. There are so many reasons to describe these controversies: In LEUVEN III study (5), despite a 25% hypoglycemia incidence, tight glycemic control had a significant treatment effect; nevertheless, in Agus et al. study, despite a lower incidence of hypoglycemia, treatment effect was not significant. The reasons can be explained with the fact that first trials were single centered open label studies which were terminated at early stages of the study because of observed benefits which may have exaggerated the treatment effect. Also, the observed difference was found in subgroup analysis which could have been due to chance factor. Findings from RCTs conducted on critically ill adults and children strongly suggest that the largest benefit for blood glucose control can be expected if the difference in blood glucose concentrations between the study groups is large and if the study is done in a single-centre setting where the blood glucose management is tailored to the local treatment habits. Consequently, we could not compare those single centered trials which are not externally validated with high level of adherence to protocols, lower time to target range, higher time in target range with multi centered trials with a low level of adherence to protocol higher time to target range, lower time in target range and a totally different method of energy supplementation. Finally, the era of 'one size fits all' in regard to glycemic targets in the critically ill seems to be over. We should also consider the correct and earlier diagnosis of patients, their glycemic status and preadmission glycemic control individually (6). Future trials should consider the discrepancies accounting for controversial points like nutritional status of patients, glucose monitoring methods (7) and insulin titration method.

Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes.

Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes.

Highlights from the Diabetes UK Professional Conference 2017

Highlights from the Diabetes UK Professional Conference 2017