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PubMed1996

An intravascular microdialysis sampling system suitable for application in continuous biochemical monitoring of glucose and lactate.

Direct sensor implantation for continuous biochemical monitoring has proved disappointing, but microdialysis sampling devices can serve as a biocompatible patient-sensor interface. We propose a novel "MiniShunt" extracorporeal microdialysis sampling circuit designed to sample core blood, and report the performance of different microdialysis probe membrane types and sizes with pumped and non-pumped blood flow in anaesthetised dogs. Discrete microdialysate and plasma samples collected during glucose and lactate monitoring were analysed with a YSI analyzer and showed microdialysis efficiency (% relative recovery) in excess of 95% for both analytes using fibres of greater than 70 mm2 internal surface area. Pumped veno-venous extracorporeal blood microdialysis sampling of this type could provide a suitable interface for future multi-analyte on-line biosensor applications in critically ill patients.

Animals↗

PubMedDate not supplied

Telemetry glucose monitoring device with needle-type glucose sensor: a useful tool for blood glucose monitoring in diabetic individuals.

For continuous monitoring of glucose concentration in ambulant diabetic patients, a telemetry glucose monitoring system with a needle-type glucose sensor has been developed. The system consists of a sensor transmitter (4 X 6 X 2 cm, 50 g) that converts current signals generated in a needle-type glucose sensor to high-frequency audio signals and a receiver that continuously calculates glucose concentrations from the received audio signals. The noise range of a monitoring record with the telemetry system (0.3 +/- 0.04%, mean +/- SEM) was significantly smaller than that with a wire-connected system, the wearable artificial endocrine pancreas (2.5 +/- 0.3%). Postprandial tissue glucose concentration responded well to the plasma glucose concentration, with a time lag of 5 min. Continuous glucose monitoring of five diabetic subjects for 77 +/- 22 h revealed that a significant correlation existed between the subcutaneous tissue glucose concentration and the plasma glucose concentration measured simultaneously in each patient. These data indicate the usefulness of the telemetry glucose monitoring system in strict glycemic control of diabetic individuals.

Autoanalysis↗

PubMed2026

Continuous Intraperitoneal Insulin Infusion for People With Type 1 Diabetes: A Literature Review and International Position Statement.

Achieving glucose targets without hypoglycaemia is the treatment goal in type 1 diabetes. Structured education, intensified insulin injection regimens, continuous glucose monitoring, automated insulin delivery, and ongoing support from a multidisciplinary team all support people with type 1 diabetes to achieve this goal. Despite these advances, significant barriers to achieving optimal management remain. Continuous intraperitoneal insulin infusion has comparable or better glucose outcomes to continuous subcutaneous insulin infusion and may reduce the frequency of hypoglycaemia, including severe episodes. Intraperitoneal insulin may be considered as a treatment modality for children and adults with type 1 diabetes using optimised intensive insulin therapy for whom subcutaneous insulin has failed due to lipoatrophy, -dystrophy or -hypertrophy, local allergy, subcutaneous insulin resistance or co-existing skin conditions. Failure of subcutaneous insulin may result in recurrent or unexplained severe hypoglycaemia or hyperglycaemia. Intraperitoneal insulin may also be considered as a treatment modality for people with type 1 diabetes with severe needle-phobia, and for those being considered for islet cell or pancreatic transplantation, or where transplantation is not available. This paper summarises current intraperitoneal insulin delivery technology, its potential risks and benefits, and an expert position statement. It is intended for use by diabetes specialist healthcare professionals, and as a reference for other healthcare professionals, commissioners, payors, people with diabetes, their carers, and advocates.

Humans↗

PubMed2005

Real-time glucose sensing using transdermal fluid under continuous vacuum pressure in children with type 1 diabetes.

BACKGROUND: This study was designed to evaluate the accuracy and tolerance in children of an experimental device for continuous glucose monitoring. This real-time glucose sensing (RTGS) system measures transdermal fluid glucose through micropores in the stratum corneum that are kept open by continuous vacuum pressure. DESIGN AND METHODS: A comparison of self-monitored blood glucose values and RTGS values was obtained in 110 children with type 1 diabetes ranging in age from 2 to 18 years. The RTGS system was worn for two periods of 48-56 h each. Children went home and had no restrictions in diet during the data collection period. Physical activity also was not restricted, with the exception of swimming or other water immersion that would interfere with or damage the RTGS. RESULTS: The procedure for obtaining transdermal fluid was well tolerated, and adequate flow was maintained out to 48 h or more in most study participants. Comparison of RTGS glucose and self-measured glucose paired values (3,064 values) indicated 69% within Clarke Error Grid Zone A and 21% within Grid Zone B when device tracking was maintained. Errors in tracking occurred with displacement of the vacuum device, or damage to the glucose sensor. CONCLUSIONS: Transdermal fluid glucose measurements using a prototype device system were well tolerated by children with type 1 diabetes and showed good correlation with concomitant capillary glucose blood measurements. Changes in glucose as tracked by the RTGS system appeared accurate. The durability of the prototype system will need improvement.

Adolescent↗

PubMed2026

Effects of continuous isomaltulose-containing gummy intake on interstitial glucose and salivary hormones during an 18-hole golf round: a randomized, double-blind controlled pilot study.

BACKGROUND: Golf is a prolonged, moderate-intensity sport requiring sustained physiological stability to manage cumulative stress and maintain performance. Although carbohydrate intake is commonly used to reduce fatigue, rapidly absorbed sugar-induced rapid blood glucose fluctuations may induce volatile arousal and latent metabolic stress. Isomaltulose, a slow-digesting disaccharide, provides a steadier glucose supply compared with sucrose. This exploratory pilot study examined the effects of isomaltulose intake on physiological stress markers, glycemic dynamics, and subjective responses during a competitive 18-hole golf round. METHODS: Twenty-three male collegiate golfers were randomized to either the isomaltulose group (ISO; n = 12) or the sucrose group (CON; n = 11) in a double-blind controlled trial. Participants consumed gummies containing isomaltulose or sucrose immediately after each hole (12.1 g carbohydrate per hole; total carbohydrate intake: 217.5 g). Primary outcomes were salivary stress markers [cortisol, testosterone, and dehydroepiandrosterone sulfate (DHEAS)] levels. Secondary outcomes included interstitial glucose concentration measured via continuous glucose monitoring, subjective assessments (i.e. sleepiness, relaxation, and concentration), and golf performance (18-hole score). Between-group comparisons at each time point were conducted using planned Welch's t-tests. RESULTS: No significant between-group differences were observed for 18-hole score (p = 0.38) or mean interstitial glucose concentration (p = 0.20). However, exploratory analyses revealed distinct hormonal variations; salivary DHEAS and testosterone levels were higher in the ISO group during the latter half of the round (p < 0.05), whereas both declined in the CON group. Regarding glycemic variability, the ISO group demonstrated a more stable glucose profile with a medium effect size for lower standard deviation (ISO: 14.7 ± 1.9 vs. CON: 16.7 ± 4.6 mg/dL; d = 0.58), although this difference was not significant. Conversely, subjective outcomes diverged; the CON group reported significantly greater subjective arousal (wakefulness and relaxation) (p < 0.01) relative to the ISO group. CONCLUSIONS: In conclusion, continuous intake of isomaltulose-containing gummies during an 18-hole golf round was associated with differences in selected physiological markers, including DHEAS and testosterone concentrations. However, these findings were not accompanied by improvements in objective golf performance outcomes compared with sucrose-containing gummies. Isomaltulose may influence glycemic dynamics and hormonal responses during prolonged golf play; however, the practical significance of these effects remains exploratory. Further studies with larger sample sizes and appropriate repeated-measures frameworks are needed to determine whether such physiological changes translate into meaningful performance or recovery benefits.

Humans↗

PubMed2026

Interaction of melatonin receptor 1B (MTNR1B) genotype and type of breakfast (protein-enriched v carbohydrate-rich) on postprandial glucose response: a randomised crossover trial.

BACKGROUND: The risk allele (G) of MTNR1B rs10830963 has been associated with impaired glucose tolerance, increased fasting glucose and type 2 diabetes (T2D). Late evening eating, when endogenous melatonin levels are elevated, is associated with impaired glucose control in MTNR1B risk carriers. Endogenous melatonin levels remain elevated into the morning so may influence glucose response to breakfast. OBJECTIVE: To investigate the interaction of MTNR1B genotype and type of breakfast on postprandial glucose response in a real-world setting. METHODS: Following an overnight fast, participants consumed either a standard carbohydrate-rich or protein-enriched porridge breakfast. Post-prandial glucose levels were recorded for two hours using a continuous glucose monitor (CGM). One week later, participants repeated the protocol consuming the alternate breakfast. A two-way mixed ANOVA determined the effect of breakfast and genotype on post-prandial glucose levels. RESULTS: Fifty-four adults completed the study. Fasting glucose was significantly higher (p = 0.008) in GG (5.53 ± 0.43 mmol/L) compared to CC or CG participants (5.02 ± 0.42 and 5.19 ± 0.52 mmol/L). Post-prandial iAUC was significantly greater following the carbohydrate-rich breakfast compared to the protein-enriched breakfast (p < 0.001). Following the carbohydrate-rich breakfast iAUC was significantly greater in GG participants compared to CC (p = 0.026) and CG participants (p = 0.029). There was no significant difference between genotype groups following the protein-enriched breakfast (p > 0.05). CONCLUSION: The study findings demonstrate, in a relatively young and healthy population, MTNR1B genotype significantly affects markers associated with T2D risk. Personalised genotype-based advice to adjust timing and composition of meals consumed when endogenous melatonin levels are increased may reduce subsequent T2D risk.

Humans↗

PubMed2026

Duration and characteristics of hypoglycemia with once-weekly insulin efsitora alfa versus once-daily basal insulins in adults with type 2 diabetes: Exploratory safety analysis of QWINT 2-4.

AIMS: Efsitora is a novel once-weekly basal insulin. Efsitora demonstrated similar efficacy and safety compared with once-daily basal insulin comparators across four phase 3 clinical trials for type 2 diabetes. This exploratory safety analysis further characterizes hypoglycemia events in the efsitora and once-daily treatment groups in three of these trials (QWINT-2, -3, and -4). METHODS: Median duration of hypoglycemia events was assessed with masked continuous glucose monitoring. Incidence of persistent-recurrent (PR) hypoglycemia was assessed by investigators and by a pre-specified algorithm using SMBG e-diary data. Factors contributing to hypoglycemia, characteristics of hypoglycemia, and treatment methods were reported by participants and assessed across groups. RESULTS: Across the three trials, durations of hypoglycemic events for efsitora vs once-daily basal insulin comparators were: Level 1 and 2 [<70 mg/dL]: 40-42.5 vs 40 min; Level 2 [<54 mg/dL]: 35-39.9 vs 35 min. Few incidences of PR hypoglycemia were reported for efsitora or once-daily comparators. No major descriptive differences were observed between hypoglycemia contributing factors, characteristics, or treatment methods in efsitora and once-daily treatment groups. CONCLUSIONS: No clinically relevant differences were observed between the duration or characteristics of hypoglycemic events in efsitora and once-daily treatment groups in the QWINT-2, -3, and -4 trials.

Adult↗

PubMed2026

Relationship between participant-reported outcomes, residual beta cell function and metabolic parameters in youth with newly diagnosed type 1 diabetes.

AIMS/HYPOTHESIS: Clinical trials of interventions to preserve beta cell function in new-onset type 1 diabetes frequently employ participant-reported outcome measures (PROMs). However, the expected changes in PROMs scores immediately following diagnosis and their association with residual beta cell function, metabolic markers and continuous glucose monitoring (CGM) are unclear. METHODS: Repeated PROMs including Paediatric Quality of Life Inventory diabetes module (PedsQL) and hypoglycaemia fear survey (HFS) were recorded from participants aged 10-18 years with newly diagnosed type 1 diabetes and their parents in two clinical trials: CLOuD (N=97, hybrid closed loop [HCL] vs multiple daily injections [MDI]) and USTEKID (N=72, ustekinumab immunotherapy vs placebo). Scores were compared with serial mixed meal-stimulated C-peptide levels (AUC C-peptide), HbA1c and CGM data. RESULTS: PedsQL and HFS scores for children/adolescents and their parents showed wide variation between individuals but did not change substantially within individuals over the first 48 months from diagnosis. Baseline scores were highly predictive of scores at 12-48 months (p<0.001). PedsQL scores were higher (better) in those reported by children/adolescents than by their parents (p<0.01). In contrast, HFS scores were higher in parents than children (p<0.001), indicating more fear. Strong correlations were observed between child and parent scores (p<0.001). No significant improvement in these scores was detected following intervention (ustekinumab or HCL). Meta-analysis revealed modest but statistically significant associations between HbA1c and PedsQL (β(std)=-0.11; 95% CI -0.20, -0.03) and HFS (β(std)=0.11; 95% CI 0.00, 0.21), and between CGM time in range and PedsQL (β(std)=0.14; 95% CI 0.03, 0.26) but not HFS (β(std)=-0.05; 95% CI -0.16, 0.06). Beta cell function (AUC C-peptide) was strongly associated with HbA1c (β(std)=-0.29; 95% CI -0.39, -0.20) and CGM time in range (β(std)=0.41; 95% CI 0.30, 0.52). Higher beta cell function showed a trend towards better PedsQL (β(std)=0.11; 95% CI -0.03, 0.25) and lower HFS (β(std)=-0.05; 95% CI -0.17, 0.07) but this did not reach statistical significance. CONCLUSIONS/INTERPRETATION: PedsQL and HFS scores changed little during the first 48 months after diagnosis of type 1 diabetes. These scores showed modest but statistically significant associations with measures of glucose management (HbA1c and CGM time in range), whereas the relationships with residual beta cell function (C-peptide) were weaker and did not reach significance. The modest size of these effects suggests current PROMs capture only limited aspects of the clinical benefit associated with beta cell preservation. Future research should incorporate psychometric instruments that are specifically adapted for young people using modern diabetes technologies and undergoing disease-modifying therapy, to ensure outcomes are meaningfully represented in early-stage type 1 diabetes trials.

Adolescent↗

PubMed2005

Self-monitoring of blood glucose in children and teens with diabetes.

Improved metabolic control has unequivocally been demonstrated to delay the onset and slow the progression of microvascular complications in adolescents and adults with diabetes mellitus. Growing evidence also supports the association of tighter glucose control and more frequent blood glucose monitoring. Therefore, self-monitoring of blood glucose (SMBG) has become a fundamental part of diabetes care in children. Here, we review recent advances and ongoing trends in glucose monitoring in children with diabetes. Technologies have been developed to improve patient compliance with recommended monitoring, requiring less blood, involving less pain, and providing results more quickly. Alternate-site testing (AST) is also a potential means of improving patient compliance with SMBG by avoiding the sensitive fingertip area. The Continuous Glucose Monitoring System (CGMS) and the GlucoWatch Biographer are two recent tools that can track glucose levels continuously. However, inconsistency in their accuracy and precision remain challenges when using these technologies to guide management.

Adolescent↗

PubMed2000

Noninvasive glucose measurement by monitoring of scattering coefficient during oral glucose tolerance tests. Non-Invasive Task Force.

BACKGROUND: Continuous glucose monitoring by means of optical glucose sensors would allow patients with diabetes to check their metabolic control to their convenience. In an earlier study, we showed that noninvasive glucose monitoring is feasible for rapid changes in blood glucose by means of measuring the scattering coefficient of human skin. In this study, we investigated whether also slower changes in blood glucose, this time induced by an oral glucose load, can also be monitored by this approach. METHODS: Five healthy subjects and 13 patients with type 2 diabetes have been given a 75-g oral glucose load. Portable noninvasive systems were used to measure the skin tissue scattering coefficient. For this purpose, two optical sensor heads were attached directly to the skin of each volunteer. Light was applied to the skin and the reflected light intensity was registered. RESULTS: In 8 of 10 measurements, correlation of changes in scattering coefficient with changes in glycemia was acceptable. In 19 of 26 measurements (73%) of patients with type 2 diabetes the observed changes in the scattering coefficient also correlated in acceptable manner. The accordance between the simultaneous measurements of the two sensor heads was acceptable in 13 of 18 volunteers and patients studied. There were virtually no differences in the quality of the measurements between healthy volunteers and patients with diabetes. CONCLUSIONS: This study shows that also slow changes in blood glucose induced by an oral glucose load can be monitored by registration of scattering coefficient changes. It remains to be elucidated why this has not been possible in all experiments.

Adult↗

PubMed2004

Assessment of glycemia in diabetes mellitus--self-monitoring of blood glucose.

Self-monitoring of blood glucose (SMBG) is an integral component of diabetes self-care and, if use optimally, essential to obtaining glycemic control. There are many methods currently available and the use of glucometers can provide readily available information on blood glucose patterns over time. However, some barriers to the use of SMBG, such as its cost, are significant. Other barriers, such as pain, patient denial or insufficient encouragement from the health care professional, should be overcome. While we find pre-prandial testing to be more informative, there are instances where post-prandial testing may be useful such as in pregnancy or in patients with early stages of glucose intolerance. In the future, continuous glucose monitoring will become available, and ultimately an insulin delivery device will be linked to continuous monitoring making the "closed loop" artificial pancreas a reality. At present, SMBG is an under-utilized but important part of modern diabetes care and should be recommended for all people with diabetes.

Blood Glucose Self-Monitoring↗

PubMed1991

Combination of microdialysis and Glucosensor permits continuous (on line) s.c. glucose monitoring in a patient operated device: I. In vitro evaluation.

A device for continuous glucose monitoring in fluids was obtained by combining the microdialysis technique with a measuring flow chamber of the "Glucosensor Unitec Ulm" using the GOD method for determining amperometrically blood glucose profiles. The in vitro experiments demonstrate that the relative recovery of glucose by this device is inversely related to the flow rate of the microdialysis perfusion fluid, which, in turn, is inversely related to the response time of the device. The glucose signal increases linearly with the area of the microdialysis working membrane (r = 0.98), and with the glucose concentrations of the standard solutions (r greater than 0.95). The variation coefficient for repeated measurements is below 8%. The accuracy of the device as demonstrated by mean measuring deviation ranges between 1 and 3.8%.

Biosensing Techniques↗

PubMed2004

Impact of posture and fixation technique on impedance spectroscopy used for continuous and noninvasive glucose monitoring.

Impedance spectroscopy allows for the assessment of changes in the permittivity and conductivity of erythrocyte cell membranes, induced by blood glucose variations. This study was performed to evaluate the potential influence of motion-induced microvascular blood flow variations from different forearm postures on the PENDRA (Pendragon Medical AG, Zürich, Switzerland) signal. Fifteen volunteers without diabetes were included (seven female, eight male, mean +/- SD age 33.3 +/- 9.9 years, body mass index 24.8 +/- 3.0 kg/m(2)). PENDRA devices were fixed at both upper extremities with different fixation techniques (bracelet and adhesive tape). Standardized position changes of the upper extremities were performed to induce variations in cutaneous microcirculation, which were assessed by laser-Doppler-fluxmetry with different probe temperatures on the forearm. Changes in microcirculation were seen in some of the different motion procedures: supine to hanging, 61.1 +/- 29.9 arbitrary units (AU) to 46.2 +/- 24.8 AU at 37 degrees C and 15.9 +/- 13.0 AU to 13.4 +/- 10.1 at skin temperature (P < 0.01 for both probes); supine to upright, 80.5 +/- 55.4 AU to 74.9 +/- 43.8 AU (not significant) at 37 degrees C and 18.7 +/- 16.8 AU to 20.9 +/- 16.1 AU at skin temperature (P < 0.01). An initially observed subtle influence of microcirculation variations on the impedance signal was minimized when the device was fixed by both bracelet and tape. Other influencing factors (such as temperature, local anatomy, etc.) are addressed in the complex calibration procedure. Well-educated patients might be the best candidates for first using the device for continuous glucose monitoring. They may especially benefit from the trend indication and the hypoglycemia/hyperglycemia threshold and alarm functions.

Adult↗

PubMed2004

Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion.

OBJECTIVE: To compare glycemic patterns by mode of therapy in children with type 1 diabetes mellitus using the Continuous Glucose Monitoring System (CGMS). DESIGN: Open randomized crossover comparing 3(1/2) months of multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII). SETTING: Tertiary care, university-affiliated medical center. Patients Twenty-three children and adolescents with type 1 diabetes mellitus. INTERVENTIONS: The CGMS was applied for 72 hours after 1 month and at the end of each study arm. MAIN OUTCOME MEASURES: Hemoglobin A(1c) levels and glucose level profiles were compared between the 2 study arms and the 2 sensor applications for each arm. RESULTS: The arms were similar for mean (SD) hemoglobin A(1c) levels (CSII, 8.0% [0.8%]; and MDI, 8.2% [0.8%]) and glucose levels. Areas under the curve were significantly larger during MDI for nocturnal and 24-hour hypoglycemia (P =.01 and.04, respectively) and for postprandial hypoglycemia and hyperglycemia (P =.03 and.05, respectively). The rate of hyperglycemia increased during CSII (P =.03), but 24-hour duration and area under the curve for hyperglycemia were similar. Compared with the first CGMS reading in each arm, the second had a longer mean duration of postprandial within-target glucose levels (P =.04), tendency for lower rate of diurnal hypoglycemic events (P =.1), shorter duration of nocturnal hypoglycemia (P =.05), and smaller 24-hour area under the curve for hypoglycemia (P =.04). CONCLUSIONS: Intensive treatment with CSII seemed to be associated with slightly better prebreakfast, postprandial, and within-target glucose profiles than MDI, as well as a smaller area under the curve for hypoglycemia. Lower hypoglycemia-related variables in the second sensor reading in each arm indicate that the CGMS may serve as an educational tool to decrease the rate and magnitude of hypoglycemia.

Adolescent↗

PubMed2006

Influence of acute exercise on hyperglycemia in insulin-treated type 2 diabetes.

INTRODUCTION: The impact of exercise on blood glucose homeostasis has not been assessed in long-standing type 2 diabetes patients receiving exogenous insulin treatment. PURPOSE: To study the effects of an acute bout of exercise on the subsequent 24-h blood glucose excursions under free-living conditions in insulin-treated type 2 diabetes patients. METHODS: Eleven male type 2 diabetes patients (59 +/- 2 yr) performed an acute bout of exercise. One day before the exercise bout, a continuous glucose monitoring system (GlucoDay, A. Menarini Diagnostics) was inserted subcutaneously in the periumbilical region. The glucose sensor continuously measured glucose concentrations in the dialysate during a 48-h period. RESULTS: The prevalence of hyperglycemic glucose excursions was reduced by 39% during a 24-h period (equivalent to 3 h) after an acute bout of exercise (P < 0.05). Average glucose concentrations 24 h before and after the exercise bout did not differ (NS). Mean dialysate glucose concentrations and the prevalence of hyperglycemic periods correlated strongly with baseline blood HbA1c concentrations (Pearson's R = 0.69, P < 0.05). CONCLUSION: An acute bout of exercise effectively reduces the prevalence of hyperglycemia during a 24-h period under free-living conditions in long-standing type 2 diabetes patients on exogenous insulin therapy.

Aged↗

PubMedDate not supplied

Evaluation of subcutaneously-implanted glucose sensors for continuous glucose measurements in hyperglycemic pigs.

BACKGROUND: Subcutaneously-implanted glucose sensors for continuous glucose monitoring have the potential to replace serial blood glucose measurements. The objective of the present study was to test whether continuous glucose measurements could be obtained with glucose sensors implanted in the subcutis of pigs. Moreover, the in vivo biocompatibility of the sensors was evaluated since an inflammatory reaction may lead to drift in sensor-signaling. MATERIALS AND METHODS: Two types of glucose sensor were implanted for 3 days in the subcutis of hyperglycemic pigs. The plasma glucose concentration was correlated to the sensor outputs, and tissue was sampled for histological evaluation. RESULTS: There was a good correlation between the interstitial fluid and blood glucose levels. However, there was a statistical significantly difference in linearity from days 0 and 1 to day 2 (p<0.001) and variations in the sensitivity and background current of individual sensors were observed over time. The tissue reaction caused by the sensors was a mild focal subacute fibrinous dermatitis. CONCLUSION: Continuous glucose measurement can be achieved by glucose sensors implanted in the subcutis of pigs. The observed drift in sensor signals over time may have been caused by heterophils, macrophages and/or fibrinogen at the tissue-sensor interface.

Animals↗

PubMed2001

[Progress in the field of medical devices for diabetes].

In the eighties major improvements were made in insulin injection and home blood glucose monitoring. However, in the nineties further improvements were rather disappointing. Despite considerable effort, non-invasive, continuous monitoring glucose sensors are still not ready for marketing. It will take 10-20 years before 'closed-loop systems' will appear, with the amount of insulin released by the pump adjusted automatically on the basis of the measuring results of a permanently implanted blood glucose sensor. Islet cell transplantation, if possible in a way that abolishes the need to take immunosuppressive medicines, is still under development. The number of people suffering from diabetes in the Netherlands is estimated to increase from about 285,400 in 1999 to about 400,000 in 2020. The costs of medical devices for diabetes will probably double in 2020. However, increased costs for devices may improve the quality of life and may result in decreased expenditure in other parts of health care by reducing the long-term complications.

Blood Glucose Self-Monitoring↗

PubMed2006

Assessing glycemia in diabetes using self-monitoring blood glucose and hemoglobin A1c.

CONTEXT: With the increasing prevalence of diabetes, successful management of blood glucose control is increasingly important. Current approaches to assessing glycemia include the use of self-monitoring of blood glucose (SMBG) and hemoglobin A1c (HbA1c). OBJECTIVES: To assess the evidence underlying the use of these 2 modalities, to evaluate confounders and sources of error in each test, to describe upcoming developments, and to reach evidence-based conclusions on their optimal use. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Reports identified from MEDLINE searches (1976-2005) using relevant terms were selected for quality and relevance to the stated questions. Particular attention was paid to larger cohort studies, clinical trials, meta-analyses, and established recommendations. DATA SYNTHESIS: If used properly SMBG gives an acceptably accurate reflection of immediate plasma glucose levels. Study results vary, but in general, the evidence supports a positive effect of regular SMBG for improving glycemia, particularly in individuals treated with insulin. The best timing of SMBG and its frequency are controversial issues, but the clinical recommendation is for regular monitoring with frequency depending on the treatment and the instability of glycemia. In the relatively near term, SMBG could gradually be replaced by continuous glucose monitoring. HbA1c measures long-term glycemic control, reflecting a time-weighted mean over the previous 3 to 4 months. There are a number of physiologic and methodologic confounders that can affect HbA1c, but standardization of assays has been well established. The main value of HbA1c is its use as a predictor of diabetic complications and the proven effect of improved control of HbA1c on complication risk. A reasonable target value for HbA1c is less than 7%. A new method for measuring HbA1c may cause significant changes in the recommended levels, the numbers reported, and even the name of the test. CONCLUSION: Assessing glycemia in diabetes can be a challenge, but approaches are available that promote successful management of blood glucose and may thereby lead to a significant reduction in morbidity and mortality related to diabetes.

Blood Glucose Self-Monitoring↗