Continuous Glucose Monitoring System Research Articles

THE PROPER USE OF HYPOGLYCEMIC AGENTS, TYPES OF INSULIN AND TECHNOLOGICAL ADVANCES IN THE TREATMENT OF DIABETES. CASE REPORT OF A PATIENT WITH TYPE 1 DIABETES

The article entitled The Appropriate Use of Hypoglycemic Drugs, Types of Insulin and Technological Advances in the Treatment of Diabetes addresses the importance of correct management in the use of drugs and technologies to improve the treatment of diabetes. Focusing on hypoglycemic drugs and the different types of insulin, the text explores how the personalized and appropriate use of these substances helps to maintain patients' glycemic control and reduce associated complications. In addition, the article analyzes recent technological advances, such as insulin pumps and continuous glucose monitoring systems, which have made it possible to monitor glycemic rates more precisely and in real time, increasing patients' quality of life and autonomy. Together, these tools and innovations promote more effective treatment tailored to individual needs, allowing for greater safety and efficacy in diabetes management.

Digital continuous glucose monitoring systems for patients with HIV-diabetes comorbidity in Ethiopia: a situational analysis

In patients with HIV-diabetes mellitus (DM) comorbidity, invasive blood glucose testing can increase the risk of HIV-related blood contamination and discourage regular glucose monitoring. Digital continuous glucose monitoring (CGM) systems may allow real-time glucose monitoring without the need for blood specimens. However, in high-burden HIV-DM countries, current glucose monitoring practices and their challenges are insufficiently explored to guide digital CGM research and developments. This study sought to explore the lived experiences of patients with HIV-DM comorbidity and their healthcare providers regarding glucose monitoring practices, and their openness to CGM and other digital technologies, to provide formative insights for a planned implementation trial of digital CGM in Ethiopia. A phenomenological qualitative study was conducted among patients with HIV-DM and their providers at the two largest public hospitals in Ethiopia. Both groups were interviewed face-to-face about DM clinic workflows, blood glucose monitoring and self-testing practices, and potential benefits and limitations of digital CGM systems. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. A total of 37 participants were interviewed, consisting of 18 patients with HIV-DM comorbidity and 19 healthcare providers. Patients had an average (min-max) duration of living with HIV and DM of 14 (8–31) and 6.6 (1–16) years, respectively, with 61% taking insulin—33% alone and 28% alongside oral hypoglycemic agents—and 79% having comorbid hypertension. The thematic analysis identified five main themes: “Diabetes routine clinical care and follow-up”, “Blood glucose monitoring practices”, “Perceptions about digital CGMs”, “Technology adoption”, and “Financial coverage”. Home self-testing was deemed beneficial, but the need for regular follow-ups, result cross-referencing, and glucometer reliability were emphasized. Patients performed fingerstick themselves or with family members, expressing concerns about waste disposal and the risk of HIV transmission. They rely mainly on health insurance for DM care. Patients and providers are happy with the quality of DM services but note a lack of integrated HIV-DM care. Very few providers and patients possessed background information about digital CGMs, and all have not yet utilized them in practice, but expressed keen interest in trying them, representing an important step for upcoming CGM clinical trials in these settings. Given the crucial role of regular glucose testing in managing HIV-DM comorbidity, it is essential to explore testing options that align with patient preferences and minimize the risk of HIV transmission.

Is Automated Insulin Delivery System Therapy Safe and Effectıve in Children Under 7 Years Old?

This study aims to evaluate the off-label use of the MiniMed™ 780G system in children under seven years old, as clinical outcomes in this age group are less established despite the improvements in glycemic control seen with MiniMed™ 780G therapy. Children under seven years old with type 1 diabetes (T1D) using MiniMed™ 780G pump therapy were retrospectively compared with children of similar age and gender using MiniMed™ 640G insulin pump therapy and multiple-dose insulin (MDI) therapy with continuous glucose monitoring systems (CGMs). CGM metrics, total daily insulin dose (TDI), and HbA1c levels were evaluated retrospectively at baseline and at the 3rd, 6th, and 12th months. At the initiation of MiniMed™ 780G therapy, the mean age was 5,25±1,22 years (range: 2,8-6,8 years), and the mean TDI was 10,12±4,34 U/day (range: 4,5-17 U/day). The glucose management indicator (GMI) and HbA1c remained lower in the MiniMed™ 780G group at the 3rd, 6th, and 12th months compared to baseline (p=0,009 and p<0,001, respectively). In the MiniMed™ 780G group, Time Above Range (TAR) was significantly lower at the 3rd, 6th, and 12th months (p=0,018, 0,017, and 0,04, respectively), and Time in Range (TIR) was higher at the 3rd and 12th months (p=0,026 and 0,019, respectively). The coefficient of variation (CV) and HbA1c were lower at the 12th month (p=0,008 and 0,015, respectively) compared to the other groups. No instances of ketoacidosis or severe hypoglycemic events were observed in any of the children during the follow-up period. The absence of significantly higher levels of hypoglycemia compared to other groups at any time point, along with a significant decrease in TAR across all time points, a significant increase in TIR at the 3rd and 12th months, and a significant decrease in HbA1c and CV, indicates that the MiniMed™ 780G system is both safe and effective for children under seven years old.

The Need for Standardization of Continuous Glucose Monitoring Performance Evaluation: An Opinion by the International Federation of Clinical Chemistry and Laboratory Medicine Working Group on Continuous Glucose Monitoring.

Metrics derived from continuous glucose monitoring (CGM) systems are often discordant between systems. A major cause is that CGM systems are not standardized; they use various algorithms and calibration methods, leading to discordant CGM readings across systems. This discordance can be addressed by standardizing CGM performance assessments: If manufacturers aim their CGM systems at the same target, then CGM readings will align across systems. This standardization should include the comparator device, sample origin, and study procedures. With better aligned CGM readings, CGM-derived metrics will subsequently also align better between systems.

Abstract 4138815: Prognostic Implications of Glycemic Variability Assessed by Continuous Glucose Monitoring-derived Coefficient of Variation among Patients Hospitalized for Acute Heart Failure

Background: Recent findings indicate that high glycemic variability (GV) could increase the risk of adverse outcomes in patients with cardiovascular disease. With the advances in technology, the utility of continuous glucose monitoring (CGM) has grown during recent years, which can provide valuable information that is not captured by HbA1c. We used the glucose coefficient of variation (CV, calculated as the ratio of standard deviation divided by the mean glucose level) of the obtained CGM data to analyze GV. Aims: We aimed to analyze CGM-derived CV as an indicator of GV and to evaluate prognostic implications of CGM-derived CV in patients hospitalized for acute heart failure (HF). Methods: Patients hospitalized for HF who had not been diagnosed diabetes were performed 75g-oral glucose tolerance test (OGTT). CV was evaluated using CGM system for at least 72 consecutive hours after being able to have meals stably during hospitalization. The primary outcome was a composite of cardiovascular death or re-hospitalization for HF. Patients were divided into two groups based on the median value of CV. Results: We prospectively analyzed 130 patients (mean age: 76±10 years, male 56%) admitted for acute HF. Following the 75g-OGTT, only 21% of the entire cohort exhibited normal glucose tolerance. During the median follow up period of 905 days, Kaplan–Meier curve analysis revealed that the cumulative incidence of the primary outcome event was significantly higher in patients with CV above median than in those with CV less than median (51.7% versus 24.4%, Log-rank P=0.01)(Figure). Multivariate Cox proportional analysis demonstrated that the risk of CV per 1% increment for the primary outcome was significant adjusted for history of diabetes, CGM-derived mean glucose level, and HbA1c level (hazard ratio: 1.06, 95% confidence interval 1.03–1.09). Conclusions: CGM-derived CV was associated with long term prognosis of patients hospitalized for HF with or without diabetes.

Research Progress on the Application of CGM in Patients with Diabetes and Hemodialysis.

Diabetes mellitus is the main cause of end-stage renal disease (ESKD), and most patients need hemodialysis (HD) treatment after they progress to uremia. Patients with diabetes and HD have obvious blood glucose fluctuation, hyperglycemia and hypoglycemia may both related to the higher mortality. Therefore, maintaining blood glucose stability is the main treatment strategy to improve the prognosis of patients. It is challenging to evaluate the blood glucose control of patients with diabetes and HD. The traditional blood glucose detection methods have certain limitations, they may be affected by many factors in HD patients. The application of continuous glucose monitoring (CGM) system is gradually recognized, CGM can monitor blood glucose real-time, timely, and predictive capabilities, there are fewer factors that are affected blood glucose in HD patients.

Increased FT3/FT4 ratio in a certain range is associated with decreased glycemic variability in patients with type 2 diabetes

Thyroid hormone (TH) plays a crucial role in regulating glucose metabolism. However, the potential impact of the FT3/FT4 ratio, which reflects peripheral sensitivity to thyroid hormones, on glycemic variability in patients with type 2 diabetes (T2DM), has not been previously reported. To investigate the correlation between the FT3/FT4 ratio and glycemic variability in individuals with T2DM. In this retrospective analysis, a total of 468 inpatients with T2DM underwent continuous glucose monitoring (CGM) systems for a period of 6–14 days. Baseline clinical characteristics, laboratory tests, and CGM parameters were documented to investigate the correlation between FT3/FT4 ratio and CGM parameters. The levels of HBA, MG, SD, CV, LAGE, MODD and TAR2Scale were all higher in FT3/FT4Q1 compared with FT3/FT4Q2, FT3/FT4Q3 and FT3/FT4Q4 (all P < 0.01). Additionally, TIR was lower in FT3/FT4Q1 compared with the other quartiles (P < 0.01). Smooth curve fitting and saturation effect analysis revealed that there are curve-like relationships between the FT3/FT4 ratio and SD, MAGE, MODD and TAR2Scale. The inflection points of the fitted curves were found to be at FT3/FT4 = 0.279, 0.237, 0.253 and 0.282 respectively (all P < 0.05). Prior to the inflection point, the FT3/FT4 ratio was negatively related to SD, MAGE, MODD and TAR2Scale (all P < 0.05). Furthermore, The FT3/FT4 ratio exhibits a negative linear correlation with HBA and MG, while demonstrating a positive linear relationship with TIR (all P < 0.05). Binary logistic regression demonstrated that the FT3/FT4 ratio was independently related to HBA (P = 0.001), MG (P = 0.01), TAR2Scale (P = 0.003), LAGE (P = 0.014) and MAGE (P < 0.001). The increased FT3/FT4 ratio within a certain range (FT3/FT4 ≤ 0.282) is associated with decreased blood glucose variability and increased TIR. The FT3/FT4 ratio may act as a potential independent protective factor for glycemic fluctuation and glycemic control in patients with T2DM when it increases within a specific range.

Call for Fair Access to Continuous Glucose Monitoring Systems in Türkiye.

Call for Fair Access to Continuous Glucose Monitoring Systems in Türkiye.

Performance of Continuous Glucose Monitoring System Among Patients With Acute Ischaemic Stroke Treated With Mechanical Thrombectomy.

Glucose metabolism abnormalities are prevalent in acute ischaemic stroke (AIS) patients and are associated with poor prognosis. The continuous glucose monitoring (CGM) system can provide detailed information on glucose levels and glycaemic excursions. This study aimed to evaluate the feasibility and accuracy of CGM application in the acute phase of AIS patients. This single-centre, prospective, and observational study consecutively enrolled patients with AIS with anterior circulation large vessel occlusion (AC-LVO) and received mechanical thrombectomy (MT) within 24h of symptom onset. A user-retrospectively calibrated iPro2 CGM system was implanted right before the MT procedure started and removed on the fifth day after MT or at discharge. Fingertip glucose was measured as a reference. Accuracy evaluation included the Bland-Altman plot (with a proportion of CGM values within 15/15, 20/20 and 30/30), the absolute relative difference (ARD) and error grid analysis (EGA). The safety and glucose profiles were also evaluated. Of the 183 patients screened, 141 were included, with a median monitoring duration of 4.49days. Compared to reference measurements, 3097 CGM readings were matched with a mean bias of -4.16mg/dL. The proportions of sensor readings meeting the 15/15, 20/20 and 30/30 criteria were 64.55%, 76.07% and 87.21%, respectively. The overall mean and median ARD were 14.60%±14.62% and 9.77% (4.15, 20.00). EGA showed that 98.97%, 99.42% and 99.06% values fall within clinically accurate zones in Clarke, Parkes and continuous glucose EGA, respectively. The CGM system was feasible, safe and accurate for in-hospital use among AIS patients who received MT.

Digital Medicine Tools and the Work of Being a Patient: A Qualitative Investigation of Digital Treatment Burden in Patients With Diabetes

ObjectiveTo understand the contribution of digital medicine tools (eg, continuous glucose monitoring systems, scheduling, and messaging applications) to treatment burden in patients with diabetes. Patients and MethodsBetween October and November 2023, we invited patients with type 1 or type 2 diabetes to participate in semistructured interviews. The interviewees completed the Treatment Burden Questionnaire as they reflected on how digital medicine tools affect their daily routines. A published taxonomy of treatment burden guided the qualitative content analysis of interview transcripts. ResultsIn total, 20 patients agreed to participate and completed interviews (aged 21-77 years, 55% female, 60% living with type 2 diabetes). We found 5 categories of tasks related to the use of digital medicine tools that patients had to complete (eg, calibrating continuous glucose monitors), 3 factors that made these tasks burdensome (eg, cost of device replacements), and 2 categories of consequences of burdensome tasks on patient wellbeing (eg, fatigue from device alarms). ConclusionPatients identified how digital medicine tools contribute to their treatment burden. The resulting digital burden taxonomy can be used to inform the design, implementation, and prescription of digital medicine tools including support for patients as they normalize them in their lives.

Evaluation of Glycemic Control in Patients With Diabetes by a Continuous Glucose Monitoring System During the Month of Ramadan.

Ramadan presents challenges for patients with type 2 diabetes mellitus (T2DM) who choose to fast. Maintaining good glycemic control through regular monitoring during fasting is crucial. This study aims to evaluate and compare glycemic fluctuations in fasting and non-fasting T2DM patients during Ramadan. We conducted a prospective comparative study on 39 T2DM patients, divided into fasting and non-fasting groups based on the International Diabetes Federation - Diabetes and Ramadan Alliance (IDF-DAR) Practical Guidelines 2021. Each patient wore an iPro®2 Continuous Glucose Monitoring System (CGMS) device (Medtronic plc, Dublin, Ireland),for five to seven days, with consultations scheduled before, during, and after Ramadan. Glycated hemoglobin (HbA1c) levels were measured before and after Ramadan. The fasting risk score was calculated using the DAR guidelines. The fasting group included 29 fasting patients with an average fasting risk score of 2.7 according to the DAR guidelines, while the non-fasting group had 10 non-fasting patients with an average score of 6.55. The average HbA1c was estimated by the CGMS at 7.36% for fasting patients and 7.1% for non-fasting patients. In the fasting group, 80% of patients experienced at least one episode of hyperglycemia, averaging 4.03 episodes per day, predominantly occurring during pre-dawn (suhoor) and post-sunset (iftar) periods. Hypoglycemia occurred in 24% of fasting patients, mainly before iftar. In contrast, the non-fasting group had a higher average of 6.8 hyperglycemic episodes per day, with 50% of the group also experiencing hypoglycemia. Notably, a significant improvement in HbA1c was observed in the non-fasting group after Ramadan (7.77 ± 0.89 vs. 9.13 ± 1.99, p=0.037). No significant changes in HbA1c, weight, or body mass index were found in the fasting group. Pre-Ramadan education, risk stratification, and continuous monitoring during Ramadan are essential to prevent metabolic complications in T2DM patients, whether fasting or non-fasting. CGMSs reveal a high prevalence of hyperglycemia, especially in non-fasting patients, underscoring the need for tailored treatment adjustments to achieve optimal glycemic control.

Consensus Considerations and Good Practice Points for Use of Continuous Glucose Monitoring Systems in Hospital Settings.

Continuous glucose monitoring (CGM) systems provide frequent glucose measurements in interstitial fluid and have been used widely in ambulatory settings for diabetes management. During the coronavirus disease 2019 (COVID-19) pandemic, regulators in the U.S. and Canada temporarily allowed for CGM systems to be used in hospitals with the aim of reducing health care professional COVID-19 exposure and limiting use of personal protective equipment. As such, studies on hospital CGM system use have been possible. With improved sensor accuracy, there is increased interest in CGM usage for diabetes management in hospitals. Laboratorians and health care professionals must determine how to integrate CGM usage into practice. The aim of this consensus guidance document is to provide an update on the application of CGM systems in hospital, with insights and opinions from laboratory medicine, endocrinology, and nursing.

The Relation of Diabetes Complications to a New Interpretation of Glycaemic Variability from Continuous Glucose Monitoring in People with Type 1 Diabetes.

Microvascular and macrovascular complications in type 1 diabetes (T1D) may be linked to endothelial stress due to glycaemic variability. Continuous glucose monitoring systems (CGMs) provide new opportunities to quantify this variability, utilising the amplitude of glucose change summated over time. The aim of this study was to examine whether this determination of glucose variability (GV) is associated with microvascular clinical sequelae. Continuous glucose monitoring values were downloaded for 89 type 1 diabetes mellitus (T1D) individuals for up to 18 months from 2021 to 2023. Data for patient demographics was also taken from the patient record which included Sex, Date of Birth, and Date of Diagnosis. The recorded laboratory glycated haemoglobin (HbA1c) test results were also recorded. The glucose management index (GMI) was calculated from average glucose readings for 18 months using the formula GMI (%) = (0.82-(Average glucose/100)). This was then adjusted to give GMI (mmol/mol) = 10.929 * (GMI (%) - 2.15). Average Glucose Fluctuation (AGF) was calculated by adding up the total absolute change value between all recorded results over 18 months and dividing by the number of results minus one. The % Above Critical Threshold (ACT) was calculated by summing the total number of occurrences for each result value. A cumulative 95% limit was then applied to identify the glucose value that only 5% of results exceeded in the overall population. Using this value, we estimated the percentage of total tests that were above the Critical Threshold (ACT). Results for the 89 individuals (44 men and 45 women) were analysed over 18months. The mean age of participants was 43 years and the mean duration of diabetes was 18years. A total of 3.22 million readings were analysed, giving an average of 10.3mmol/L blood glucose. Those with the largest change in glucose from reading to reading, summated over time, showed the greatest change in eGFR of 3.12ml/min/1.73 m2 (p = 0.007). People with a higher proportion of glucose readings > 18mmol/L showed a fall in eGFR of 2.8ml/min/1.73 m2 (p = 0.009) and experienced higher rates of sight-threatening retinopathy (44% of these individuals) (p = 0.01) as did 39% of individuals in the highest tertile of glucose levels (p = 0.008). Those individuals with T1D in the highest tertile of reading-to-reading glucose change showed the greatest change in eGFR. Those with a higher proportion of glucose readings > 18mmol/L also showed a fall in eGFR and experienced higher rates of sight-threatening retinopathy, as did people with higher mean glucose. Discussions with T1D individuals could reflect on how the percentage recorded glucose above a critical level and degree of change in glucose are important in avoiding future tissue complications.

α-MnO2 with a cryptomelane structure for the non-enzymatic glucose electrooxidation in a neutral medium

A high demand for non-enzymatic glucose sensors and continuous glucose monitoring systems encourages the development of stable and active catalysts for the enzymeless anodic oxidation of glucose in the neutral medium. In regard to this reaction, we analyze the prospects of alpha manganese dioxide with a cryptomelane structure synthesized via an aqueous chemical route. To provide various specific surface area, the hydrated α-MnO2 oxide is annealed in a wide temperature range from 60 to 700 °C. Furthermore, we investigate the influence of the oxide annealing temperature on the amount of crystal water, chemical composition, morphology, electrochemical recharging behavior, electrocatalytic activity and stability in the glucose oxidation carried out in an isotonic NaCl-based phosphate-buffered saline (pH 7.40). To solidly determine potentials of the irreversible cathodic dissolution of α-MnO2 as well as O2/Cl2 evolution on α-MnO2, a rotating ring-disk electrode is applied. For the most active α-MnO2 sample with the 100 μg cm−2geo loading the glucose oxidation current of ca. 40 μA cm−2geo after 1 h at +0.8 V (SCE) for 7 mM of glucose is achieved. The linear concentration dependence in a physiological glucose range (1–30 mM) with the sensitivity of ca. 17.8 μA mM−0.5 cm−2geo at 25 °C is observed. Finally, glucose selectivity of α-MnO2 in relation to fructose, galactose, xylose, ribose, urea, lactic acid, acetone, ascorbic acid and paracetamol is revealed.

Accuracy of continuous glucose monitoring systems in intensive care unit patients: a scoping review.

Glycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation. We systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes. We identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5-14.2% and 6.4-13% for intraarterial CGM. In this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia.

Icodec ONWARDS: A review of the first once-weekly diabetes treatment for nurse practitioners and physician assistants.

Diabetes management is challenged by the complexity of treatment regimens and the need for frequent injections, affecting patient adherence and quality of life. Insulin icodec, a once-weekly basal insulin analog, represents a significant innovation, potentially simplifying diabetes care and improving outcomes. This review aims to evaluate the safety, efficacy, and clinical implications of insulin icodec for individuals with type 1 and type 2 diabetes, highlighting its potential to affect current treatment paradigms. A review was conducted comparing once-weekly insulin icodec with daily basal insulin analogs using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to ensure transparent reporting of systematic reviews. A search was performed in the following databases: PubMed, Google Scholar, Embase, and ClinicalTrials.gov, focusing on efficacy and safety outcomes. Insulin icodec has demonstrated effective glycemic management and a safety profile comparable to daily basal insulins. Its extended half-life and steady-state glucose-lowering effect have the potential to reduce the burden of daily injections and improve patient adherence. The introduction of once-weekly insulin icodec represents an advancement in diabetes care. For front-line clinicians, this innovation aligns with the need for more straightforward medication regimens. Coupled with continuous glucose monitoring systems, it enables a more personalized and efficient approach to diabetes management, with the potential to improve patient satisfaction and clinical outcomes. This underscores the impact of integrating such advancements into practice, highlighting the role of nurse practitioners and physician assistants in adopting these innovations to optimize patient care.

The Performance of Continuous Glucose Monitoring During the Intraoperative Period: A Scoping Review.

Introduction: Perioperative dysglycemia is associated with negative surgical outcomes, including increased risk of infections and longer hospital stays. Continuous glucose monitoring (CGM) provides real-time glucose data, potentially improving glycemic control during surgery. However, the performance of CGM in the intraoperative environment has not been well established. This scoping review aimed to evaluate the performance of CGM systems during the intraoperative period, focusing on their technical reliability, accuracy, adverse device effects, and efficacy. Inclusion criteria: Studies that assessed intraoperative CGM performance, focusing on technical reliability, accuracy, adverse effects, or efficacy, were included. No restrictions were placed on the study design, surgical type, participant demographics, or publication date. Methods: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, covering publications up to 12 June 2024. Two independent reviewers screened and selected the studies for inclusion based on predefined eligibility criteria. Data extraction focused on the study characteristics, CGM performance, and outcomes. Results: Twenty-two studies were included, the majority of which were prospective cohort studies. CGM systems demonstrated a high technical reliability, with sensor survival rates above 80%. However, the accuracy varied, with some studies reporting mean or median absolute relative differences of over 15%. The adverse effects were minimal and mainly involved minor skin irritation. One randomized trial found no significant difference between CGM and point-of-care glucose monitoring for glycemic control. Conclusions: Although CGM has the potential to improve intraoperative glycemic management, its accuracy remains inconsistent. Future research should explore newer CGM technologies and assess their impact on surgical outcomes.

Relationship between hemoglobin glycation index and risk of hypoglycemia in type 2 diabetes with time-in-range in target

BACKGROUND In patients with type 2 diabetes mellitus (T2DM), the risk of hypoglycemia also occurs in at a time-in-range (TIR) of &gt; 70%. The hemoglobin glycation index (HGI) is considered the best single factor for predicting hypoglycemia, and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings. AIM To investigate the relationship between HGI and hypoglycemia and the implications of HGI on hypoglycemia in T2DM with TIR &gt; 70%. METHODS All participants underwent a 7-days continuous glucose monitoring (CGM) using a retrospective CGM system. We obtained glycemic variability indices using the CGM system. We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator. Patients were categorized into low HGI (HGI &lt; 0.5) and high HGI groups (HGI ≥ 0.5) according to HGI median (0.5). Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia. RESULTS We included 129 subjects with T2DM (54.84 ± 12.56 years, 46% male) in the study. Median TIR score was 90%. The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group; this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group. Multivariate analyses revealed that mean blood glucose, standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia. Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia. In addition, the optimal cut-off points for HGI, mean blood glucose, and standard deviation of blood glucose in predicting hypoglycemia were 0.5%, 7.2 mmol/L and 1.4 mmol/L respectively. CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR &gt; 70%. Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.

Development of a Theoretical Continuous Glucose Monitoring Module for Pharmacy Students: Preparing Pharmacists for the Future.

To enhance the digital competencies of pharmacy students, the Institute of Clinical Pharmacy and Pharmacotherapy at Heinrich-Heine University Duesseldorf developed and evaluated a theoretical module on digital health and data analysis. This innovative module integrated a continuous glucose-monitoring (CGM) wearable device into teaching, providing students with in-depth practical experience and a 2.5 h seminar on digital health and CGM systems. Students' knowledge of CGM and self-assessment of their CGM competencies were assessed in a pre-post manner. Additionally, students' satisfaction with the module and their perceptions of the future integration of digital health training and the role of wearables in pharmacy practice were also assessed after the module. A total of 39 final-year pharmacy students completed the module conducted in June 2024 as part of the clinical pharmacy seminar. In total, 32 students completed the pre- and post-knowledge tests and self-assessment questionnaires. Both the knowledge and the students' self-assessment of CGM-related skills after the module increased significantly (p < 0.05). Students expanded their knowledge regarding digital health solutions, in particular the CGM systems, and increased their self-reported competence in CGM-related skills. With this module, an important foundation was laid, as this is the first theoretical module including the essentials of CGM digital health tools for pharmacy students in Germany.

7252 Difference between interstitial and blood glucose during glucose loading is associated with the degree of insulin resistance in subjects with prediabetes and type 2 diabetes

Abstract Disclosure: D. Kim: None. S. Ryang: None. M. Im: None. J. Kim: None. Y. Kim: None. Y. kim: None. J. ha: None. J. Kim: None. S. Kim: None. Background and Aims: This study investigated the main factors responsible for the differences between blood glucose (BG) and interstitial fluid glucose (ISF) during glucose loading. Methods: A total of 204 Korean subjects without history of type 2 diabetes were enrolled. The subjects were categorized into three groups according to diabetes criteria by American Diabetes Association; NGT (normal glucose tolerance, n=36), PreDM (prediabetes, n=130) and T2D (undiagnosed type 2 diabetes, n=38). For glucose monitoring, a CGM (continuous glucose monitoring) system (Dexcom G6, Dexcom, San Diego, USA) was attached for 10 days. 75g oral glucose tolerance test (OGTT) was performed during applying CGM with stabilization (after wear of 3 days). Blood sample collected at t=0, 30, 60, 90 and 120 min for glucose and insulin concentration. Two parameters [insulin sensitivity (mIS) and beta-cell function (mBCF)] were derived novel mathematical model. Results: Among NGT, PreDM and T2D, there are heterogeneity in the difference and pattern between BG and ISF in this study. We identified the probability density function of BG - ISF across glucose tolerance, there is a trend that the means of BG - ISF with G60, 90, and 120 move to the right, as glucose tolerance status changes NGT to PreDM and DM. BG - ISF is significantly associated with insulin resistance (R=0.32, p&amp;lt;0.001), not diminished beta cell function. Conclusions: Because individuals vary in their degree of insulin resistance as a primary pathophysiology of type 2 diabetes, the caution should be needed in interpreting the glycemic response of CGM after a glucose load. Presentation: 6/3/2024