Variations In Glucose Levels Research Articles

High β-Glucan Barley Improves Postprandial Hyperglycemia after Meal Loading in Patients with Type 2 Diabetes

Objective: We investigated whether barley with a high β-glucan content (7.2 g per 100 g) improves postprandial plasma glucose levels and fluctuations using a meal tolerance test and Continuous Glucose Monitoring (CGM) in patients with type 2 diabetes. Methods: A meal tolerance test (500 kcal) was conducted using two types of test meals: one with white rice (WR diet) and one with white rice mixed 1:1 with high β-glucan-containing barley (BR diet). Both meals included the same side dish. Plasma glucose changes over 180 minutes were compared after ingestion of the test meals. In addition, participants wore a CGM device for the 2 study days, to measure the daily variations in glucose levels when the WR or BR diet as staple food was provided 3 times a day with the same side dish in both meals. Results: Twenty-nine patients with type 2 diabetes (age 52.5 ± 15.1 years, BMI 27.5 ± 4.7 kg/m2, HbA1c 8.1 ±1.8 %) were included in this study. The incremental area under the curve of plasma glucose levels after BR diet ingestion was significantly lower than that after WR diet ingestion (7934.0 ± 4151.2 vs 9434.0 ± 4701.2 mg·min/dL). CGM showed a 24-hour standard deviation of blood glucose after the BR diet was significantly lower than that after the WR diet. Conclusion: These results suggest that postprandial plasma glucose elevation and fluctuation in patients with type 2 diabetes are suppressed by adding high-β-glucan barley to white rice in meals.

Multiple-Cell Microfluidic Dielectric Resonator for Liquid Sensing Applications

This paper presents a high-sensitive planar microwave sensor based on the metamaterial technology, integrated with a microfluidic channel to be used for liquid sensing in a variety of biomedical applications. The sensor design comprises three cells of circular complementary split ring resonators (CSRRs) engraved on the ground plane of a dielectric substrate in a cascaded configuration. The sensing cells are excited with a time-varying electric field coupled from a planar microstrip-line (MTL) etched on the bottom side of the substrate. The proposed design of multiple coupled resonators would enhance the electric field intensity over a larger sensing region through the inter-resonator coupling, thus improving the overall sensitivity for detecting liquid samples of high permittivity and dielectric losses. The sensor exhibits a reject (band stop) filter behaviour with multiple resonances in the centimeter-wave band 1 – 6 GHz when loaded symmetrically with liquid samples. The sensor is fabricated on an FR4 dielectric substrate with a biocompatible microfluidic channel aligned appropriately over the sensing area to enable consistent and intact sensing of the liquid samples. The CSSR-sensor is numerically modeled and compared in performance to the single-cell CSRR for detecting small variations in the dielectric properties. The sensitivity, reliability, and repeatability of the proposed sensor are practically demonstrated by the in-lab measurements for different liquid samples using a Vector Network Analyzer (VNA) setup where distinctive resonant features (amplitude and frequency) are extracted from multiple resonance modes in the reflection and transmission responses. A high sensitivity is also demonstrated for monitoring glucose level variations in synthetic blood samples of concentrations (70 – 150 mg/dL) which are clinically-relevant to diabetes conditions. Beside its impressive capability in detecting small dielectric variations, the developed sensor features other favorable attributes including compact size, simple fabrication, affordable cost, non-ionizing nature, and minimal health risk or impact. Such key advantages could potentially promote the proposed sensor for integration with other microwave components in an embedded device for non-invasive monitoring of blood glucose for diabetes.

Effect of CGM in the HbA1c and Coefficient of Variation of glucose in a pediatric sample

Aim of the studyPrevious studies have found no significant improvements in glycated hemoglobin (HbA1c), while using Continuous Glucose Monitoring (CGM), with children and adolescents. The aim of this paper is to measure the change in HbA1c, and the Coefficient of Variation in glucose levels, when using CGM, once the effect of other relevant variables, such as gender, actual age, the years the patient has had diabetes, use of an insulin pump, the presence of autoimmune disease, other associated pathologies, and weekly hours of exercise, are controlled for. MethodsThis is a retrospective study that uses a linear regression model. Data was collected from Type 1 Diabetes Mellitus (T1DM), children diagnosed between 2003 and 2017 in the Pediatric Unit for Diabetes in Zaragoza, Spain. We used a linear regression and the method of estimation is Ordinary Least Squares. ResultsResults show that the use of CGM decreased the HbA1c value by 3.5% and the Coefficient of Variation by 14%. ConclusionsThe implication of these results is that this device helped in the management of diabetes, although more research is needed to distinguish between different devices in terms of their efficacy.

Combination of Catechin, Epicatechin, and Rutin: Optimization of a novel complete antidiabetic formulation using a mixture design approach

Nowadays, synthetic chemical antidiabetic drugs, besides their therapeutic effects, present adverse effects that could be hard to handle over time. In the last decade, studies reported new alternative molecules with more health benefits and less adverse effects. The goal of this study is to optimize a new antidiabetic formulation using plant flavonoids: Catechin, Epicatechin, and Rutin. They are also a powerful antioxidant and anti-inflammatory molecules. A mixture design experiment will optimize their combination to obtain a new, safe multi-targets antidiabetic formulation making it a powerful combination for the management of diabetes and its complications. To study the variation of blood glucose level in response to the treatment over the time we performed an Oral Glucose Tolerance Test. The blood glucose level variations recorded as responses for the mixture design experiment. We used the molecules at a dose of 10 mg/kg. According to the software analysis, the prediction profiler showed us the optimum combination, and the result was a binary combination between Rutin and Epicatechin (25% and 75%, respectively). This combination prevented hyperglycemia and hypoglycemia, along with the best area under the curve, and after that, we validated it through a repeated oral administration on alloxan-induced diabetic mice for 28 d. Rutin, Catechin, and Epicatechin exhibit a potent antihyperglycemic activity, their synergistic combination validates a new formulation that could be a real candidate to conventional drugs.

A Non-Invasive Flexible Glucose Monitoring Sensor Using a Broadband Reject Filter

In this paper, a novel, highly accurate, non-invasive glucose-monitoring sensor that is based on a flexible broadband reject filter is presented. The filter topology comprises a tapered feed line at a top layer that excites four open loop resonators on the bottom layer. The broadband reject response is achieved by relying on a modified log-periodic distribution of the open loop resonators. The embedded resonators are reduced in size and are designed to exhibit an enhanced sensitivity to track the variations of the glucose level across the 1.25-2.65 GHz frequency span. The proposed flexible filter is tested within in-vitro, ex-vivo and in-vivo setups. A high correlation between the scattering parameters of the proposed sensor and the variations in glucose levels is attained. Regression models are developed using experimental data obtained from healthy patients that are subjected to glucose tolerance tests. Results demonstrate less than 4% mean absolute relative difference between the reference and estimated glucose levels, and the predicted glucose levels lie 100% within the clinically acceptable zones as shown by the Clarke Error Grid analysis.

Body condition and poxvirus infection predict circulating glucose levels in a colorful songbird that inhabits urban and rural environments.

There is widespread contemporary interest in causes and consequences of blood glucose status in humans (e.g., links to diabetes and cardiovascular disease), but we know comparatively less about what underlies variation in glucose levels of wild animals. Several environmental factors, including diet, disease status, and habitat quality, may regulate glucose circulation, and we are in need of work that assesses many organismal traits simultaneously to understand the plasticity and predictability of glucose levels in ecological and evolutionary contexts. Here, we measured circulating glucose levels in a species of passerine bird (the house finch, Haemorhous mexicanus) that has served as a valuable model for research on sexual selection, disease, and urban behavioral ecology, as these animals display sexually dichromatic ornamental coloration, harbor many infectious diseases (e.g., poxvirus, coccidiosis, mycoplasmal conjunctivitis), and reside in both natural habitats and cities. We tested the effects of sex, habitat type, body condition, coccidiosis and poxvirus infections, and expression of carotenoid plumage coloration on blood glucose concentrations and found that the body condition and poxvirus infection significantly predicted circulating glucose levels. Specifically, birds with higher blood glucose levels had higher body condition scores and were infected with poxvirus. This result is consistent with biomedical, domesticated-animal, and wildlife-rehabilitation findings, and the premise that glucose elevation is a physiological response to or indicator of infection and relative body weight. The fact that we failed to find links between glucose and our other measurements suggests that blood glucose levels can reveal some but not all aspects of organismal or environmental quality.

Effects of glucose variability on hematopoietic stem/progenitor cells in patients with type 1 diabetes.

Diabetes reduces the levels of hematopoietic stem/progenitor cells (HSPCs), which can contribute to organ and tissue homeostasis. Among patients with diabetes, lower HSPC levels predict the development or worsening of micro- and macro-angiopathy. High glucose variability is also associated with diabetic complications and we have previously shown that acute hypoglycaemia can stimulate stem/progenitor cells. Thus, we evaluated the relationship between glucose variability or time in hypoglycaemia and HSPCs in patients with type 1 diabetes (T1D). Patients with T1D were compared to healthy subjects. HSPCs (CD34+, CD133+, CD34+CD133+, CD34 + CD45dim) were quantified by flow cytometry. Using flash glucose monitoring system for 90days, we calculated several measures of glucose variability and time in hypoglycaemia. Forty-four patients with T1D and 44 healthy subjects were enrolled. Compared to healthy controls, T1D patients had significantly lower levels of HSPCs and duration of diabetes was inversely correlated with HSPC levels. Significant direct correlations were found between HSPC levels and the coefficient of variation of glucose levels or time in hypoglycaemia, which were stronger in patients with short-term than in those with long-standing diabetes. This study confirms the pauperization of HSPCs in T1D patients and demonstrates a potential HSPC-stimulatory effect of hypoglycaemia, which mitigates with long-lasting diabetes. These data are consistent with a model whereby disease chronicity progressively blunts the release of HSPCs in response to adrenergic triggers, like hypoglycaemic events.

Portable Radar-Driven Microwave Sensor for Intermittent Glucose Levels Monitoring

In this study, a portable prototype of a planar microwave sensor is proposed for intermittent glucose level monitoring. The sensor element basically consists of four distinct hexagonal-shaped complementary split ring resonators (CSRRs) configured in the honey-cell pattern and fabricated on an FR4 dielectric substrate. The CSRRs are coupled via microstrip transmission line to a radar system operating in the ISM band 2.4–2.5 GHz. The integrated sensor shows a remarkable detection sensitivity for the diabetes-spectrum glucose levels dissolved in the blood mimicking aqueous solutions. This is demonstrated by the raw data collected by the radar receiving channel, which shows a clear trend following the variations in glucose levels.

Glucose Variations in the First Day of Life of Newborns under Observational Surveillance

Nursing protocols for glucose management are well known for both healthy term newborns and high-risk newborns. However, for less risky newborns who are under only observation surveillance, hypoglycemia could be overlooked unless clinical symptoms develop. A retrospective study was performed to explore factors influencing variations in glucose levels in 91 newborns who did not require any interventions, but were under nursing surveillance, at a level II neonatal intensive care unit. Data were retrieved from electrical medical records on glucose levels, demographic characteristics, and other clinical characteristics of newborns in their first day of life from January 2016 to May 2019. Glucose levels tended to stabilize within the normal range (60~80 mg/dL) as time passed during the first day of life. Cesarean section, multiple gestation, abnormal growth, and later preterm birth were associated with low glucose levels in the first 2 hours of life. Thirty-one newborns experienced a hypoglycemic episode (< 45 mg/dL) during the first 24 hours of life. The findings of this study support the active encouragement of early feeding within 2 hours of birth and urgent adoption of a structural protocol for glucose surveillance in newborns with potential health problems immediately after birth.

The HbA1c, coefficient of variation of glucose levels and hypoglycaemia in a pediatric sample when using continuous glucose monitoring

The HbA1c, coefficient of variation of glucose levels and hypoglycaemia in a pediatric sample when using continuous glucose monitoring

Experts opinion: implantable continuous glucose monitoring system — innovation in the management of diabetes

Continuous glucose monitoring (CGM) systems have revolutionized the treatment and monitoring of diabetes. These devices are recommended for diabetic patients treated with insulin, especially with recurring episodes of hypoglycemia or large circadian variation of glucose levels. CGM allows more effective adjustment of insulin doses to blood glucose trends, resulting in better metabolic control: more time spend in glucose target range, lower time spend in hypoglycemic range, lower glucose variability and improved quality of life of patients and their family members. Real time CGM provides patients not only with continuous information on glucose levels but also alerts for hypo- or hyperglycemic events. Traditional transcutaneous CGM have some limitations, which can be resolved by the system with an implantable sensor. The Eversense CGM is the only long-term implantable rtCGM. The subcutaneous implantation procedure has proved to be simple and uncomplicated. This CGM system can be recommended in particular for patients who, due to their profession and sports discipline, cannot or do not want to use traditional transcutaneous sensors. Further groups are patients with skin complications associated with the use of traditional sensors, people who perceive frequent sensor replacement as a burden or would benefit from on-body vibration alerts. The studies showed that the patients were satisfied with Eversense, and the majority used it several times after the study ended. The main reason for resigning from the next implantation was cost of the device.

One-pot HTST synthesis of responsive fluorescent ZnO@apo-enzyme composite microgels for intracellular glucometry.

Responsive fluorescent microgels, that can selectively, reversibly, and rapidly convert the fluctuation in intracellular glucose level into fluorescence signal, have the potential use for intracellular glucometry to promote the understanding of physiology. Herein, we report one-pot synthesis of such a responsive fluorescent composite microgels, which is made of a representative apo-enzyme, apo-glucose oxidase (apo-GOx), interpenetrated in a composite gel network that is comprised of ZnO quantum dots covalently bonded onto crosslinked poly(ethylene glycol) dimethacrylate. The key of this one-pot synthesis is applying a high-temperature short-time heating (HTST) method, so that the naturally dynamic profile of apo-GOx can be maintained and harnessed on the composite microgels to allow the highly selective response to glucose over a glucose concentration range of 0–20 mM. While the composite microgels can undergo volume phase transitions and convert both an increase and a decrease in glucose concentration into fluorescence signal shortly (<1 s), the changes in average hydrodynamic diameter and fluorescence of the composite microgels can be fully reversible even after twenty cycles of adding/removing glucose, indicating a reversible and rapid time response to the glucose concentration variations. With the composite microgels as biosensors, the fluorescence of the composite microgels embedded in the model cancer cells B16F10 can be modulated in response to intracellular glucose level variations, which are derived from a change in glucose concentration in the culture medium by an external supply, or that can be triggered by biochemical reactions (with the β-galactosidase catalysed hydrolysis of lactose as a model reaction for achieving increased glucose levels, and the GOx catalysed oxidation of glucose for achieving decreased glucose levels).

Effects of Malaria Infection on some Haematological and Biochemical Parameters in the General Population and Pregnant Malaria Patients Attending Two District Hospitals in Niger State, Nigeria

The effects of malaria on some haematological and biochemical parameters among males, pregnant and non-pregnant female patients attending district hospitals in Bida and Kagara areas of Niger State, Nigeria was investigated. The subjects were volunteers confirmed to be positive for malaria and without other clinical symptoms. A total of 231 patients (103 males and 128 females) within the age range of 1-50 years were studied. Fifty (20 males and 30 females) apparently healthy individuals in the similar age bracket were used as controls. Haematological and biochemical parameters were analyzed using standard methods. Overall, the reduction in haemoglobin concentration and packed cell volume (PCV) in patients were significantly higher/lower from non-infected patients (p&gt;0.05), while there was no significant differences observed in the male patients. The mean cell haemoglobin concentration (MCHC) (36.03 ± 1.29g/dl) in pregnant subjects was significantly higher (p&lt;0.05) compared to the non-infected pregnant control group (32.65 ± 0.46g/dl). There was a significant reduction in neutrophils but increase in lymphocytes in all subjects irrespective of sex. Non-significant (p&gt;0.05) increase existed in serum lipid levels among pregnant and non-pregnant women. When males and females were compared, serum lipids except triglycerides varied significantly. There were apparently no variations in glucose levels between pregnant and non-pregnant subjects, whereas males had significantly higher values. Some of these parameters can thus be useful tools in the monitoring and management of malaria.

Effect of glucose on the expression of CD24 marker in Umbilical-cord derived Mesenchymal Stem Cells

Diabetes Mellitus (DM) is a chronic metabolic disease with high morbidity and significant mortality. The prevalence of DM is quite alarming with around 347 million people affected worldwide, the largest contributors to the disease load being India (65.1 million people affected in 2013) and China. Though the prevalence in India of 9.1% is only marginally higher than the worldwide prevalence of 8.3% the massive population contributes to the disease load. Though many drugs are available, insulin is the better choice to reduce blood sugar levels. Insulin administered through syringes and pumps is discharged at doses adjusted according to blood sugar levels estimated either once daily or once in two weeks. However, there occur periods of variation in glucose level at the cellular level which is responsible for long term complications. The only definitive treatment option is a source of islet cells that discharges human insulin according to the changing milieu in the body to maintain sugar levels. The difficulties encountered with islet allograft transplants are the availability of cadaver donor, need for immune suppressants, graft cell loss, and autoimmunity. Hence it is the need of the hour to manufacture islet cells in vitro to have a constant source of supply replacing the currently available therapeutic measures. The development of in vitro islets requires a viable source of stem cells. The perinatal tissues which include umbilical cord and placenta are wasted every day in tons. They are rich sources of MSCs which are immunologically naive and obtaining consent is relatively easy, as these tissues are only discarded otherwise. At the initial stage of the process, the MSCs have to be isolated. Though there are different protocols defined by researchers to isolate MSCs from the umbilical cord, no standardized protocol is available yet. Currently, islets cultured from human stem cells are quite fragile and have a limited shelf life of only 72 hours. Also, the characterization, culture, and storage protocols have to be standardized. By studying pancreatic progenitor cells and development pathways we may find methods to improve our culture and storage techniques. Novel markers identify pancreatic precursor cells. Based on the observations made in the present study and review of literature about other studies done so far, it seems that MSCs express CD24. These cells may develop into a clone of pancreatic progenitors, neural stem cells, or cancer stem cells. This development depends on the environmental conditions and differentiating factors available. It is known that elevated glucose concentrations impair cellular functions and induce apoptosis and is supposed to be the cause of further degeneration of pancreatic beta cells and all the long term complications in DM. It is hypothesized that high blood glucose levels also affect the body’s native stem cells through mechanisms still under study. Controversial reports on the toxic effects of glucose on MSCs both in vivo and in vitro are available. It had been reported by Stolzing, et al. that high glucose is toxic to MSCs derived from rats while cell proliferation increased and the rate of apoptosis decreased when glucose concentration was reduced. Li, et al. cultured bone marrow-derived human MSCs in media containing 5, 6, 11, 25, and 40 mmol concentration of glucose and measured the rate of proliferation and apoptosis. The inhibitory effect on cell apoptosis was noticed on short term exposure to high glucose medium but there was no effect on cell proliferation and apoptosis in long term cultures. Also Dhanasekaran, et al. reported retention of MSC surface marker characteristics, proliferation, and differentiation potential in bone marrow and adipose-derived MSCs cultured at 25 mmol glucose concentration.

Baseline glucose level is an individual trait that is negatively associated with lifespan and increases due to adverse environmental conditions during development and adulthood.

High baseline glucose levels are associated with pathologies and shorter lifespan in humans, but little is known about causes and consequences of individual variation in glucose levels in other species. We tested to what extent baseline blood glucose level is a repeatable trait in adult zebra finches, and whether glucose levels were associated with age, manipulated environmental conditions during development (rearing brood size) and adulthood (foraging cost), and lifespan. We found that: (1) repeatability of glucose levels was 30%, both within and between years. (2) Having been reared in a large brood and living with higher foraging costs as adult were independently associated with higher glucose levels. Furthermore, the finding that baseline glucose was low when ambient temperature was high, and foraging costs were low, indicates that glucose is regulated at a lower level when energy turnover is low. (3) Survival probability decreased with increasing baseline glucose. We conclude that baseline glucose is an individual trait negatively associated with survival, and increases due to adverse environmental conditions during development (rearing brood size) and adulthood (foraging cost). Blood glucose may be, therefore, part of the physiological processes linking environmental conditions to lifespan.

Uncoupling Protein 2 Inhibition Exacerbates Glucose Fluctuation-Mediated Neuronal Effects.

Though glucose fluctuations have been considered as an adverse factor for the development of several diabetes-related complications, their impact in the central nervous system is still not fully elucidated. This study was conducted to evaluate the responses of neuronal cells to different glycemic exposures alongside to elucidate the role of uncoupling protein 2 (UCP2) in regulating such responses. To achieve our goals, primary cortical neurons were submitted to constant high (HG)/low (LG) or glucose level variations (GVs), and the pharmacological inhibition of UCP2 activity was performed using genipin. Results obtained show that GV decreased neuronal cells' viability, mitochondrial membrane potential, and manganese superoxide dismutase activity and increased reactive oxygen species (ROS) production. GV also caused an increase in the glutathione/glutathione disulfide ratio and in the protein expression levels of nuclear factor E2-related factor 2 (NRF2), UCP2, NADH-ubiquinone oxidoreductase chain 1 (ND1), and mitochondrially encoded cytochrome c oxidase I (MTCO1), both mitochondrial DNA encoded subunits of the electron transport chain. Contrariwise, genipin abrogated all those compensations and increased the levels of caspase 3-like activity, potentiated mitochondrial ROS levels, and the loss of neuronal synaptic integrity, decreased the protein expression levels of NRF1, and increased the protein expression levels of UCP5. Further, in the control and LG conditions, genipin increased mitochondrial ROS and the protein expression levels of UCP4, postsynaptic density protein 95 (PSD95), ND1, and MTCO1. Overall, these observations suggest that UCP2 is in the core of neuronal cell protection and/or adaptation against GV-mediated effects and that other isoforms of neuronal UCPs can be upregulated to compensate the inhibition of UCP2 activity.

Lixisenatide, a Once-Daily Prandial Glucagon-Like Peptide-1 Receptor Agonist for the Treatment of Adults with Type 2 Diabetes.

Lixisenatide, a short-acting glucagon-like peptide-1 receptor agonist (GLP-1 RA), has been available in Europe since 2013 and was recently approved in the United States for the treatment of type 2 diabetes (T2D) as an adjunct to diet and exercise. The objective of this systematic review is to describe the pharmacology, pharmacokinetics, safety, and efficacy of lixisenatide in patients with T2D. We conducted a search of the EMBASE database, limited to human studies with abstracts available in English. Published conference abstracts, limited to the American Diabetes Association (ADA) and the European Association for the Study of Diabetes meetings in 2015, as well as abstracts presented at the ADA meeting in 2016, were also screened. The abstracts retrieved were assessed for relevance; review articles and meta-analyses focusing on GLP-1 RAs as a class were excluded. Lixisenatide induced mean reductions of 0.46-0.99% in glycated hemoglobin A1c (HbA1c ), 55.86-143.43mg/dl in 2-hour postprandial glucose (PPG) levels, and 56.58-127.75mg/dl in mealtime glucose level variations. Changes in fasting plasma glucose (FPG) levels and weight ranged from -21.98 to +5.41mg/dl and from -2.96 to +0.3kg, respectively, in patients with T2D enrolled in the GetGoal clinical program (a program of clinical trials that established the efficacy and safety profile of lixisenatide 20μg once/day across patients with T2D with differing background therapies). Lixisenatide was well tolerated, demonstrating rates of symptomatic hypoglycemia of 0.8-42.9% and a very low rate of severe hypoglycemia (<1.5%) as well as no increased risk of cardiovascular events. The most common adverse events were gastrointestinal in nature, mainly transient nausea and vomiting of mild-to-moderate severity. Lixisenatide effectively lowers HbA1c levels in patients with T2D through a mechanism of action complementary to that of agents that mainly target FPG, with the additional benefit of weight loss. Its once-daily administration schedule and effect on PPG levels make it an attractive option as add-on treatment to basal insulin therapy or oral antidiabetic agents.

Glycemic Variability in Type 1 Diabetes Compared with Degludec and Glargine on the Morning Injection: An Open-label Randomized Controlled Trial.

IntroductionOptimal adjustment of basal insulin to overcome hypoglycemia and glycemic variability (GV) depends on its duration of action and peak-less profile. Owing to the ability of long-acting basal insulin to avoid hypoglycemia, we titrated pre-meal glucose to normal fasting blood glucose, 80–110 mg/dL (4.5–6.1 mmol/L), and post-meal glucose to 80–140 mg/dL (4.5–7.8 mmol/L). The purpose of this study was to evaluate two basal insulin analogues degludec (IDeg) and glargine (IGlar), injected in the morning, for GV using continuous glucose monitoring (CGM) in type 1 diabetes (T1DM).MethodsIn this crossover study, 20 Japanese patients with T1DM (age 54 ± 16 years, disease duration 16 ± 8 years, BMI 24 ± 4 kg/m2, HbA1c 7.4 ± 0.8%) were randomized into one of two different starting regimens, and CGM was conducted on three consecutive days during the last week of each 12-week titration period. Treatment satisfaction was assessed at the end of each treatment period using the Diabetes Therapy-Related Quality of Life Questionnaire (DTR-QOL).ResultsThere were no differences in HbA1c, total insulin dosage, body weight changes, and basal to bolus ratio between the IDeg and IGlar arms. The day-to-day variability in fasting interstitial GV on the CGM curves was significantly less in the IDeg than IGlar treatment period (25.9 ± 22.0 vs. 43.8 ± 30.1 mg/dl, p = 0.04). Other markers of GV, calculated by the EasyGV software, including mean amplitude of glycemic excursions (MAGE), J-index, total and nocturnal hypoglycemia were not different between the two treatment periods. The score of “satisfaction with treatment”, a subdomain of the DTR-QOL system, was higher in the IDeg period.ConclusionThus, the morning injection of the two long-acting insulin analogues seemed similar with regard to the magnitude of hypoglycemia in T1DM, but treatment with IDeg was associated with lower day-to-day variation in glucose level. These results suggest that IDeg is safe with minimal morning GV in patients with T1DM.Clinical trial registrationJapanese Clinical Trials Registry, UMIN000012358.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0269-0) contains supplementary material, which is available to authorized users.

Glycemic Excursions in Type 1 Diabetes in Pregnancy: A Semiparametric Statistical Approach to Identify Sensitive Time Points during Gestation.

Aim. To examine the gestational glycemic profile and identify specific times during pregnancy that variability in glucose levels, measured by change in velocity and acceleration/deceleration of blood glucose fluctuations, is associated with delivery of a large-for-gestational-age (LGA) baby, in women with type 1 diabetes. Methods. Retrospective analysis of capillary blood glucose levels measured multiple times daily throughout gestation in women with type 1 diabetes was performed using semiparametric mixed models. Results. Velocity and acceleration/deceleration in glucose levels varied across gestation regardless of delivery outcome. Compared to women delivering LGA babies, those delivering babies appropriate for gestational age exhibited significantly smaller rates of change and less variation in glucose levels between 180 days of gestation and birth. Conclusions. Use of innovative statistical methods enabled detection of gestational intervals in which blood glucose fluctuation parameters might influence the likelihood of delivering LGA baby in mothers with type 1 diabetes. Understanding dynamics and being able to visualize gestational changes in blood glucose are a potentially useful tool to assist care providers in determining the optimal timing to initiate continuous glucose monitoring.

Continuous glucose monitoring and HbA1c in the evaluation of glucose metabolism in children at high risk for type 1 diabetes mellitus

AimsContinuous glucose monitoring (CGM) parameters, self-monitored blood glucose (SMBG), HbA1c and oral glucose tolerance test (OGTT) were studied during preclinical type 1 diabetes mellitus. MethodsTen asymptomatic children with multiple (⩾2) islet autoantibodies (cases) and 10 age and sex-matched autoantibody-negative controls from the Type 1 Diabetes Prediction and Prevention (DIPP) Study were invited to 7-day CGM with Dexcom G4 Platinum Sensor. HbA1c and two daily SMBG values (morning and evening) were analyzed. Five-point OGTTs were performed and carbohydrate intake was assessed by food records. The matched pairs were compared with the paired sample t-test. ResultsThe cases showed higher mean values and higher variation in glucose levels during CGM compared to the controls. The time spent ⩾7.8mmol/l was 5.8% in the cases compared to 0.4% in the controls (p=0.040). Postprandial CGM values were similar except after the dinner (6.6mmol/l in cases vs. 6.1mmol/l in controls; p=0.023). When analyzing the SMBG values higher mean level, higher evening levels, as well as higher variation were observed in the cases when compared to the controls. HbA1c was significantly higher in the cases [5.7% (39mmol/mol) vs. 5.3% (34mmol/mol); p=0.045]. No differences were observed in glucose or C-peptide levels during OGTT. Daily carbohydrate intake was slightly higher in the cases (254.2g vs. 217.7g; p=0.034). ConclusionsGlucose levels measured by CGM and SMBG are useful indicators of dysglycemia during preclinical type 1 diabetes mellitus. Increased evening glucose values seem to be common in children with preclinical type 1 diabetes mellitus.