Real-time Glucose Monitoring System Research Articles

Photonic hydrogel for continuous glucose monitoring using smartphone readout

Diabetes has become one of the leading deaths causes worldwide. Developing low-cost, rapid, and reusable sensors can provide a solution for continuous glucose monitoring to reduce the diabetic complications that could be fatal. Here, Phenylboronic acid (PBA)-based hydrogel sensors with embedded photonic nanostructures were developed for rapid and continuous glucose quantification within the physiological range. The photonic nanostructures were imprinted on the PBA-based hydrogel using simple and rapid process. Three different sensors: free-standing (FS), stand-alone (SA), and optical fiber (OF) were fabricated and tested in the glucose concentration range of 0–50 mM. A sensitivity of 6, 3, and 1.2 µW/mM was documented for FS, SA, and OF sensors, respectively. A rapid response time of 20 s and saturation time of 3 min were recorded along with a limit of detection of 1 mM. The sensing capabilities of these sensors were examined in both transmission and reflection configurations. Practicality of the sensors was tested using smartphone readout. The optical power was measured using a smartphone exploiting its photodiode and the power changes were correlated with glucose concentrations. These developed sensors may have applications in remote, continuous, and real-time glucose monitoring systems.

Efficacy and safety of simulated artificial pancreas in modulating stress hyperglycemia in critically ill patients: a prospective randomized controlled study

To explore efficacy and safety of simulated artificial pancreas in modulating stress hyperglycemia in critically ill patients. A prospective randomized controlled study was performed. Seventy-two critically ill patients with stress hyperglycemia, aged 18-85 years, acute physiology and chronic health evaluation II (APACHE II) score over 15, two consecutive random blood glucose 11.1 mmol/L or higher, glycated hemoglobin (HbA1C) below 0.065, unable to eat food for 3 days after inclusion, or only accepting parenteral nutrition, admitted to intensive care unit (ICU) in Shanghai Punan Hospital of Pudong New District from January 1st, 2015 to June 30th, 2017 were enrolled. The patients were divided into three groups according to the random number table method, high-intensity group and low-intensity group were injected Novolin R (high-intensity group 2/3 dosage, low-intensity group 1/3 dosage) to modulate stress hyperglycemia by simulated artificial pancreas. Simulated artificial pancreas consisted of Guardian real time glucose monitoring system (GRT system), close-circle control algorithm and micro-pump; subcutaneous injection of Humulin 70/30 was applied to modulate stress hyperglycemia in humulin group. Real-time glucose levels of interstitial fluid in abdominal wall, equivalent to blood glucose levels, 10 minutes each time, were monitored by using of GRT system for all patients in three groups. Fasting serum levels of stress hormones including epinephrine and cortisol and insulin resistance index (IRI) were recorded within 24 hours after inclusion. Mean blood glucose, blood glucose variation coefficient, blood glucose target-reaching rate, blood glucose target-reaching time, hypoglycemia rate and 6-month mortality were measured. Twenty healthy adults from health administration department of the hospital were recruited as healthy control group. A total of 60 eligible critically ill patients were included in this study, each group with 20 patients. There was no significant difference in gender, age, APACHE II scores among three groups. The levels of serum epinephrine, cortisol and IRI within 24 hours after inclusion in the three groups were significantly higher than those in healthy control group. The mean blood glucose levels of humulin group, low-intensity group, high-intensity group were decreased (mmol/L: 10.2±3.2, 8.4±2.6, 8.1±2.2), the blood glucose target-reaching rate were increased [40.2% (3 295/8 196), 71.1% (5 393/7 585), 80.4% (6 286/7 818)], the blood glucose target-reaching time were shortened (hours: 49.1±5.8, 24.6±4.6, 17.5±4.2), the hypoglycemia rates were increased respectively [1.3% (108/8 196), 2.8% (211/7 585), 4.0% (313/7 818)], with statistically significant differences (all P = 0.000). There was no significant difference in blood glucose variation coefficient and 6-month mortality among three groups [blood glucose variation coefficient: (29.4±3.7)%, (28.5±5.3)%, (26.1±4.6)%, 6-month mortality: 55.0%, 45.0%, 40.0%, all P > 0.05]. Simulated artificial pancreas could effectively and safely modulate stress hyperglycemia in critically ill patients, high-intensity modulation could bring about better efficacy in the regulation of hyperglycemia. High-frequency blood glucose monitoring by using GRT system could promptly identify hypoglycemia and help it to be corrected.

Application of real-time continuous glucose monitoring in outpatient management system for type 1 diabetes mellitus

Objective To evaluate the effect of continuous glucose monitoring system(CGMS) in improving the current status of type 1 diabetes mellitus(T1DM) control and reducing the economic burden of the patients. Methods One hundred and fifteen patients with T1DM were randomly assigned to the CGMS group and the self-monitoring of blood glucose(SMBG) group respectively. The patients in CGMS group were on 72 h CGMS every 6 months, while SMBG group only with SMBG to guide the insulin dose adjustment. The levels of blood glucose and the statistics of the number of hypoglycemia and diabetic ketoacidosis were taken as the main observational indexes every 6 months. The chronic complication and the statistics of the number of hospitalizations and the total cost of treatment were made as the secondary observational index every 12 months. Results 2 h postprandial plasma glucose(2hPG) and mean blood glucose(MBG) in the CGMS group were lower than those in the SMBG group [(10.7±1.9 vs 11.5±2.7) mmol/L, (9.7±0.5 vs 10.6±0.7) mmol/L, P<0.05] in the clinical follow-up visit after 6 months. The per capita number of hypoglycaemia in the CGMS group was lower than that in the SMBG group[(7.9±2.6 vs 9.2±3.4) times, P<0.05]. In the outpatient follow-up re-visit to the patients after 6 months, fasting plasma glucose(FPG), 2hPG, MBG, and HbA1C of the patients in the CGMS group were lower than those in the SMBG group(t=4.71~9.75, P<0.05), the per capita numbers of hypoglycemia and DKA in the CGMS group were lower than those in the SMBG group(t=3.61~4.37, P<0.05). Conclusion The application of real-time continuous glucose monitoring in T1DM outpatient management may reduce the whole-day blood glucose of the patients, decrease the incidence risk of hypoglycemia, and improve the compliance of the treatment while without increasing the economic burden of the disease. (Chin J Endocrinol Metab, 2017, 33: 367-371) Key words: Real-time continuous glucose monitoring system; Diabetes mellitus, type 1; Outpatient management system; Control status; Economic burden of disease

The advantages of insulin pump therapy and real time glucose monitoring systems as the tools for reducing the frequency of hypoglycemic episodes in the children and adolescents with type 1 diabetes mellitus

The primary objective of the present study was to analyse the advantages of insulin pump therapy and real time glucose monitoring systems as the tools for reducing the frequency of hypoglycemic episodes. The study included 190 children and adolescents at the age varying from 1 to 18 years suffering from type 1 diabetes mellitus. All the patients were hospitalized at the Endocrinological Research Centre for the treatment the disease using different modalities of insulin therapy, such as multiple injections of insulin (MII) and its continuous subcutaneous infusion (CSII). The blood glucose level was monitored during 72 hours making use of the continuous blind and real time monitoring protocols (blind-CGM and RT-CGM respectively). All the patients were divided into 4 groups depending on the therapeutic modality and the mode of blood glucose monitoring. Group 1 was comprised of the patients given multiple insulin injections in combination with blind glucose monitoring ("blind-CGM + MII"), group 2 included the patients undergoing blind glucose monitoring in conjunction with continuous insulin infusion ("blind-CGM + CSII"), group 3 contained the patients treated by multiple insulin injections followed by real-time blood glucose monitoring ("RT-CGM + MII"), and group 4 was composed of the patients undergoing continuous subcutaneous infusion of insulin combined with real-time blood glucose monitoring ("RT-CGM + CSII"). In all the cases, the blood glucose levels were measured and the occurrence of hypoglycemia during the period of monitoring time was evaluated. It was shown that the highest frequency of hypoglycemia during 72 hours was recorded in the "blind-CGM" group and the lowest one in the RT-CGM groups. Despite adequate self-control, almost half of the patients in the "blind-CGM + MII" group reported at least one hypoglycemic episode either at the daytime or at night ; the duration of such episode was more than 1 hour on the average. In the "blind-CGM" group, CSII resulted in the decrease of the number of hypoglycemic episodes both at night and daytime (p&lt;0.05). In the "RT-CGM + CSII" group, continuous insulin infusion reduced the mean duration of nocturnal hypoglycemic episodes (p&lt;0.05) whereas this parameter was not significantly different between the other groups. It is concluded that hypoglycemia especially nocturnal one is rather a common problem facing children and adolescents suffering from type 1 diabetes mellitus. The use of insulin pump therapy and real time glucose monitoring systems (RT-CGM) makes it possible to substantially decrease the frequency and duration of hypoglycemic episodes in this population group.

Technological solutions in chronic disease management for monitoring diabetes

In a challenging environment of demographic transition and tightening budget policy regimes, technological innovation and subsequent solutions come into the focus of healthcare decision-makers to improve the management of chronic diseases like diabetes against the backdrop of their rising prevalence. Within this context, the paper on hand presents ten effectiveness studies on diabetes monitoring systems currently on the market as well as innovational concepts that are being discussed. Aiming to shed light on the present outcome of such solutions in daily routine, three of the mentioned studies were selected for a more thorough review by applying a sound evaluation framework. Hereby, the considered real-time glucose monitoring systems, wireless and smartphone technologies illustrate improvement of diabetes monitoring and management within the studies’ premises. This paper’s review, however, cautions that in the light of methodological shortcomings in respect to generalisation and aspects of usability, the presented evidence should be considered limited meriting further research with a broader focus

Assessment of the accuracy of real-time continuous glucose monitoring system and its correlated factors

Objective To assess the factors that influence the accuracy of real-time continuous glucose monitoring system (RT-CGM).Methods A total of 79 diabetic patients wore RT-CGM for three days continuously while calibrating by interphalangeal glucose values 4-8 times a day.We counted matching rate of interphalangeal glucose values and RT-CGM probe value,and analyzed correlation of the matching rate with MAGE,SDBG,MBG,AUC10,AUC3.9,and NGE by Pearson correlation analysis and multiple linear regression analysis.Then we grouped corresponding match rate by MAGE and MBG,compared the difference among groups.Furthermore,we analyzed correlation of RT-CGM probe values of all-day,fasting-postprandial,and nighttime and the corresponding interphalangeal glucose values by Pearson correlation analysis.Results Pearson correlation analysis showed that the matching rate was negatively correlated with the MAGE,SDBG,MBG,and AUC10.MAGE,MBG,and NGE were in the regression equation.MAGE ＜3.9 mmol/L,matching rate was 81％,3.9 ≤ MAGE＜7 mmol/L,matching rate was 67％,MAGE≥7 mmol/L,the matching rate was 52％,the difference among 3 groups was statistically significant (P＜0.01).MBG＜7.8 mmol/L,matching rate was 78％,7.8 ≤ MBG＜ 10 mmol/L,matching rate was 68％,MBG ≥10 mmol/L,the matching rate was 57％,the difference among 3 groups was statistically significant (P ＜ 0.01).When Youden index was 0.409 and MAGE was less than 3.745 mmol/L,the match rate was more than 75％.When Youden index was 0.369 and MBG was less than 8.38 mmol/L,the matching rate was more than 75％.The correlation coefficients of all day,fasting,postprandial and nighttime probe values and the corresponding interphalangeal glucose values were 0.958,0.963,0.944,and 0.965 (all P＜0.01).Conclusions The probe values show good consistency with the interphalangeal glucose values,are able to be used for blood glucose assessment.Blood glucose fluctuations influences accuracy of RT-CGM,the smaller the blood glucose fluctuations,the smaller the mean glucose concentration,the smaller the effective blood glucose fluctuations in frequency,the higher would be the accuracy.It seems to be more effective to do calibration during fasting and nighttime. Key words: Real-time continuous glucose monitoring; Accuracy; Blood glucose fluctuations; Matching rate

Research progress of dead-in-bed syndrome in type 1 diabetes

Dead-in-bed syndrome (DBS) is a rare but devastating sudden death condition that mainly affects young patients with type 1 diabetes.Its mechanism is quite complicated and may involve multiple factors.Acute onset of recurrent and severe nocturnal hypoglycemia,abnormal cardiac repolarization,genetic factors,and obstructive sleep apnea may all contribute to ventricular arrhythmias and even sudden death.The future research plans include elucidating and understanding the underlying mechanisms and triggers for DBS,developing a risk stratification system,using real-time continuous glucose monitoring system to detect severe nocturnal hypoglycemia,and initiating appropriate therapeutic interventions to uhimately prevent the tragedy. Key words: Dead-in bed syndrome; Diabetes mellitus, type 1 ; Sudden death; Mechanism