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PubMedDate not supplied

Use of low-glycaemic index bread to reduce 24-h blood glucose: implications for dietary advice to non-diabetic and diabetic subjects.

The present study investigated the effect of a simple dietary change on 24-h blood glucose. In a randomized cross-over design, 10 healthy subjects were prescribed a low-glycaemic-index (LGI) diet and a high-glycaemic-index (HGI) diet. The diets were identical with the exception of the type of bread consumed (LGI or HGI). Glucose concentrations over 24 h were measured using a continuous glucose monitoring system. The LGI diet resulted in a lower mean glucose response compared with the HGI diet over 24 h (P=0.135), during the day (P=0.171) and at night (P=0.100). Similarly, the 24-h, daytime and overnight incremental area under the curve for glucose following the LGI diet was consistently lower than following the HGI diet (P=0.093, P=0.132 and P=0.061, respectively). The results demonstrate how a very simple dietary change can favourably alter overall blood glucose concentrations. Such small modifications to the diet, if adopted in the long term, could improve glucose control and consequently reduce the risk of chronic disease in both diabetic and non-diabetic individuals.

Adolescent↗

PubMed2003

Glucose sensor evaluation of glycemic instability in pediatric type 1 diabetes mellitus.

Maintaining blood glucose (BG) levels within the target range can be an elusive goal in children with type 1 diabetes mellitus (DM). To identify factor(s) that may contribute to glycemic instability, we analyzed the Continuous Glucose Monitoring System (CGMS) (Medtronic MiniMed, Northridge, CA) profiles of a group of children with type 1 DM and a history of frequent BG fluctuations and hypoglycemia. A total of 30 (17 girls, 13 boys) pediatric patients with a history of frequent BG fluctuations and hypoglycemia (mean age, 10.5 +/- 0.7 years; duration, 5.0 +/- 0.6 years), on three to four injections of insulin daily or insulin pump therapy, were evaluated by the CGMS. The mean BG (MBG), absolute means of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and number of hypoglycemic events (BG <60 mg/dL) for 48 h were calculated in each patient. There was a significant correlation between MBG and glycosylated hemoglobin (HbA1c) (r(2) = 0.22, p < 0.009). There was also a significant correlation between severity of lipohypertrophy and glycemic control (HbA1c) (r(2) = 0.20, p < 0.01). The MODD values had a positive correlation with the severity of injection site lipohypertrophy (r(2) = 0.37, p < 0.0003). The MAGE values had a positive correlation with bolus:basal insulin ratio (r(2) = 0.22, p < 0.009) and number of hypoglycemic events (r(2) = 0.21, p < 0.008), independent of age, MBG, and glycemic control. The 48-h CGMS profile can help characterize day-to-day and within-day BG variability and identify factors influencing glycemic instability in pediatric type 1 DM.

Adolescent↗

PubMed2003

The accuracy of the CGMS in children with type 1 diabetes: results of the diabetes research in children network (DirecNet) accuracy study.

The accuracy of the Continuous Glucose Monitoring System, CGMS (Medtronic MiniMed, Northridge, CA) was assessed in children and adolescents with type 1 diabetes mellitus (T1DM) when compared with reference serum glucose levels during spontaneous fluctuations in glucose levels over 24 h and during acute hyper- and hypoglycemia. Ninety-one subjects with type 1 diabetes (3.5-17.7 years old) wore one or two CGMSs while blood samples were obtained for serum glucose determinations (made at a central laboratory) hourly during the day, every 30 min overnight, and every 5 min during meal-induced hyperglycemia and insulin-induced hypoglycemia tests, resulting in 6778 CGMS-reference glucose pairs. CGMS function was assessed on each of the 3 days of sensor life. The median relative absolute difference (RAD) between the CGMS and reference values was 18% (25th, 75th percentiles = 8%, 34%). Similar results were obtained on each of the 3 days of sensor life. Accuracy was worse during hypoglycemia than during hyperglycemia. Modified sensors that first became available in November 2002 were more accurate than were the original sensors (median RAD = 11% vs. 19%) and had better precision (r = 0.92 vs. r = 0.77) during time periods in which two CGMSs were simultaneously used. The CGMS sensors that have been in clinical use until recently are often inaccurate in quantifying glucose values in children with T1DM. However, recent modifications to the sensor have resulted in substantially better accuracy and reliability. This improved function, if confirmed by additional data, may enhance the clinical utility of the CGMS.

Adolescent↗

PubMed2003

Determination of plasma glucose during rapid glucose excursions with a subcutaneous glucose sensor.

Continuous glucose monitoring has the potential to improve glucose management and reduce the risk of hypoglycemia in individuals with diabetes. Accurate sensors may also allow the development of a closed-loop insulin delivery system. The purpose of this work was to determine the delay time associated with a subcutaneous glucose sensor during rapidly changing glucose excursions. Subcutaneous glucose sensors (Medtronic MiniMed, Inc., Northridge, CA) were inserted in five healthy men. After a 2-h stabilization period, a 3-h hyperglycemic (approximately 11 mM) clamp was performed followed by a 90-min period in which plasma glucose was allowed to decline to as low as 2.8 mM. Sensors were calibrated using two points (basal and hyperglycemia), and the calibrated sensor glucose measurements were compared with those from a reference analyzer (Beckman Instruments, Fullerton, CA). Response time was estimated from a first-order kinetic model. Plasma glucose levels, determined with the subcutaneous sensor, were highly correlated with those obtained with the reference glucose analyzer (r(2) = 0.91, p < 0.001; mean absolute difference of approximately 8%). The half-time for the sensor response was estimated to be 4.0 +/- 1.0 min. The subcutaneous glucose sensor has the potential to facilitate the detection of hypoglycemia and improve overall glycemic control when used in a real-time monitor. The rapid response should be sufficient to allow a fully automated closed-loop insulin delivery system to be developed based on the subcutaneous sensing site.

Biosensing Techniques↗

PubMed2005

Hypoglycemia prediction and detection using optimal estimation.

Patients with diabetes play with a double-edged sword when it comes to deciding glucose and A1c target levels. On the one side, tight control has been shown to be crucial in avoiding long-term complications; on the other, tighter control leads to an increased risk of iatrogenic hypoglycemia, which is compounded when hypoglycemia unawareness sets in. Development of continuous glucose monitoring systems has led to the possibility of being able not only to detect hypoglycemic episodes, but to make predictions based on trends that would allow the patient to take preemptive action to entirely avoid the condition. Using an optimal estimation theory approach to hypoglycemia prediction, we demonstrate the effect of measurement sampling frequency, threshold level, and prediction horizon on the sensitivity and specificity of the predictions. We discuss how optimal estimators can be tuned to trade-off the false alarm rate with the rate of missed predicted hypoglycemic episodes. We also suggest the use of different alarm levels as a function of current and future estimates of glucose and the hypoglycemic threshold and prediction horizon.

Algorithms↗

PubMed2005

Continuous subcutaneous insulin infusion and multiple dose of insulin regimen display similar patterns of blood glucose excursions in pediatric type 1 diabetes.

BACKGROUND: Continuous subcutaneous insulin infusion (CSII) is believed to decrease glycemic variability and clinical hypoglycemia compared with the multiple daily insulin (MDI) regimen. To compare the indices of glycemic instability between CSII and MDI, we analyzed the continuous glucose monitoring system (CGMS) (Medtronic MiniMed, Northridge, CA) profiles of a group of children with type 1 diabetes mellitus with history of frequent blood glucose (BG) fluctuations and hypoglycemia. PATIENTS AND METHODS: Data from 14 (nine girls, five boys) patients (3.9-16.8 years old) on CSII and 14 age- and sex-matched (nine girls, five boys) patients (3.9-16.0 years old) on MDI with similar glycemic control (hemoglobin A1c: 7.9 +/- 1.0% vs. 7.9 +/- 1.5%) and body mass index (BMI) (20.1 +/- 4.3 vs. 19.9 +/- 4.1 kg/m(2)) were evaluated by the CGMS. Mean BG (MBG), absolute means of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and number of hypoglycemic events (BG <60 mg/dL) for 48 h were calculated. RESULTS: The MBG, MODD, MAGE, and number and mean duration of hypoglycemia events in the CSII group were similar to those in the MDI group. The MAGE had an inverse correlation with age (CSII: r (2) = 0.52, P = 0.003; MDI: r (2) = 0.29, P < 0.04) and BMI (CSII: r (2) = 0.38, P < 0.02; MDI: r (2) = 0.71, P < 0.0002). However, there was a positive relationship between MAGE and bolus:basal insulin ratio in the CSII (r (2) = 0.28, P < 0.05) and MDI (r (2) = 0.33, P < 0.03) groups. Also, the MAGE had a positive correlation with frequency of hypoglycemic events in the CSII (r (2) = 0.44, P < 0.01) and MDI (r (2) = 0.35, P < 0.03) groups. CONCLUSIONS: The CSII and MDI regimens in children and adolescents with comparable glycemic control displayed similar patterns of glycemic excursions, implying that factors influencing glycemic instability in pediatric type 1 diabetes mellitus appear to be independent of treatment modality.

Adolescent↗

PubMed2006

A long-wavelength fluorescent glucose biosensor based on bioconjugates of galactose/glucose binding protein and Nile Red derivatives.

BACKGROUND: Fluorescent biosensors based on galactose/glucose binding protein (GGBP) and environmentally sensitive derivatives of the phenoxazine dye Nile Red are described. These biosensors are proposed as the sensing platform for a minimally invasive, continuous glucose monitoring system that can be implanted under the skin and read transdermally using an external fluorometer. METHODS: To construct the biosensors, the thiol-reactive Nile Red derivatives INR and IANR were prepared and conjugated to GGBP proteins possessing cysteine mutations that were designed for optimal site-specific fluorophore attachment. The attachment sites were selected to maximize the local environment change for attached dyes between the bound and unbound conformations of GGBP. RESULTS: Fluorescence responses at the selected cysteine sites of GGBP upon binding to glucose showed that the conjugates typically yielded fluorescence emission around 640-650 nm with up to 50% changes in fluorescence intensity. Conjugate E149C/A213C/L238S INR GGBP also displayed glucose binding in the human physiological range (K (D) = 7.4 mM). CONCLUSIONS: The phenoxazine derivatives fluoresced at longer wavelengths (>600 nm) approaching the near-infrared spectral window, where interference from scattering and tissue absorbance are minimal. Ultimately, we expect that monitoring systems based on GGBP and longwavelength dyes will be implanted for up to 6 months and can be used to transmit information through the skin to an external monitor.

Biosensing Techniques↗

PubMed2006

Continuous glucose sensing with fluorescent thin-film hydrogels. 2. Fiber optic sensor fabrication and in vitro testing.

BACKGROUND: There continues to be a need for better sensors for continuous glucose monitoring. We are working on a two-component sensing system based on a viologen boronic acid and a fluorescent dye, which are immobilized in a hydrogel. This system has the potential for further development into a real-time glucose-monitoring device. The current study reports the fabrication of sensors using preformed hydrogels and the first in vitro monitoring of glucose concentrations in a prototype sensor configuration. METHODS: Glucose sensing hydrogels containing a fluorescent dye and viologen boronic acid quencher were preformed in a mold. These preformed hydrogels were then attached to the distal end of a plastic fiber optic cable using different adhesives to prepare the in vitro sensors. These sensors were connected to a flow cell and monitored using a fluorescence spectrometer. The fluorescence emitted by the hydrogel changes depending on the glucose concentration. Hydrogel components were modified in order to optimize the performance of the sensors. RESULTS: A soft tissue adhesive used by veterinarians was found to be an effective adhesive for bonding the hydrogel to the fiber tip. This adhesive did not affect the glucose sensing ability of the hydrogels after fabrication. Several sensors were fabricated with varying composition of sensing elements, and all of them showed stable and reversible glucose response. The glucose signal was found to be stable over months on repeated testing. Glucose sensing studies using the sensors with hydrogels containing different compositions of sensing elements showed that the ratio of dye to quencher is an important parameter in determining the magnitude and linearity of glucose response in the biological range. The response time of the sensor was shown to be dependent on the hydrophilicity of the hydrogels. Modifying the hydrogels with ionic comonomers shortened the response time. CONCLUSIONS: The combination of the anionic dye 2 and viologen-based boronic acid 1 immobilized in a 2-hydroxyethyl methacrylate hydrogel functions well in a fiber optic configuration. This preliminary study suggests that the two-component sensing system has several advantages in terms of stability and ease of fabrication. Improvement of the configuration of the sensor and further development of the sensor towards application for in vitro study are underway.

Drug Monitoring↗

PubMed2006

Evaluation of factors affecting CGMS calibration.

BACKGROUND: The optimal number/timing of calibrations entered into the CGMS (Medtronic MiniMed, Northridge, CA) continuous glucose monitoring system have not been previously described. METHODS: Fifty subjects with Type 1 diabetes mellitus (10-18 years old) were hospitalized in a clinical research center for approximately 24 h on two separate days. CGMS and OneTouch Ultra meter (LifeScan, Milpitas, CA) data were obtained. The CGMS was retrospectively recalibrated using the Ultra data varying the number and timing of calibrations. Resulting CGMS values were compared against laboratory reference values. RESULTS: There was a modest improvement in accuracy with increasing number of calibrations. The median relative absolute deviation (RAD) was 14%, 15%, 13%, and 13% when using three, four, five, and seven calibration values, respectively (P < 0.001). Corresponding percentages of CGMS-reference pairs meeting the International Organisation for Standardisation criteria were 66%, 67%, 71%, and 72% (P < 0.001). Nighttime accuracy improved when daytime calibrations (pre-lunch and pre-dinner) were removed leaving only two calibrations at 9 p.m. and 6 a.m. (median difference, -2 vs. -9 mg/dL, P < 0.001; median RAD, 12% vs. 15%, P = 0.001). Accuracy was better on visits where the average absolute rate of glucose change at the times of calibration was lower. On visits with average absolute rates <0.5, 0.5 to <1.0, 1.0 to <1.5, and >or=1.5 mg/dL/min, median RAD values were 13% versus 14% versus 17% versus 19%, respectively (P = 0.05). CONCLUSIONS: Although accuracy is slightly improved with more calibrations, the timing of the calibrations appears more important. Modifying the algorithm to put less weight on daytime calibrations for nighttime values and calibrating during times of relative glucose stability may have greater impact on accuracy.

Adolescent↗

PubMed2006

Biocompatibility of electrochemical glucose sensors implanted in the subcutis of pigs.

BACKGROUND: Lowering blood glucose concentration slows or prevents the development of complications in diabetes. One of the tools to control glucose levels is continuous glucose measurements. A promising technique involves measurements from glucose sensors implanted directly in skin/subcutis. However, in vivo bioinstability and drift in sensor signals have been reported after implantation, suggestively caused by the infiltration of inflammatory cells and adhesion of proteins to sensor membranes. The aim of this study was to evaluate the in vivo biocompatibility of two electrochemical glucose sensors after implantation in the skin of pigs. METHODS: In vivo biocompatibility of in-house fabricated electrochemical glucose sensors and a commercially available continuous glucose monitoring system (CGMS, Medtronic MiniMed, Northridge, CA) implanted 1 h, 2 h, 24 h, 3 days, or 7 days was examined by histological and immunohistochemical techniques. RESULTS: The extent of inflammation increased significantly as a function of time. The inflammation ranged from an acute focal fibrinous/suppurative dermatitis to a chronic fibrinous and granulating foreign body dermatitis 7 days after implantation. Immunohistochemical stainings showed that heterophilic granulocytes, macrophages, and fibrinogen/fibrinogen fragments D and E were consistent findings. Infiltration of CD3epsilon-positive T-cells was primarily confined to day 7 of implantation. In addition, the pro-inflammatory cytokines interleukin-1 and tumor necrosis factor-alpha played a role in the reaction to sensors. CONCLUSION: The reported in vivo bioinstability of sensors is likely to be caused by protein and cellular biofouling on the sensor membrane. Furthermore, the consistent finding of fibrinogen and fibrinogen fragments D and E at the sensor-tissue interface seems to play an important role in the pathogenesis as it possibly maintains the inflammation by promoting the recruitment of inflammatory cells to the implantation site.

Animals↗

PubMed2006

Function and accuracy of glucose sensors beyond their stated expiry date.

BACKGROUND: The sensor of the Continuous Glucose Monitoring System (CGMS, Medtronic Minimed, Northridge, CA) is labeled to expire 6 months following its production and to measure the glucose concentration in interstitial fluid up to 3 days after insertion. The purpose of this study was to demonstrate potential possibilities of sensors when used beyond their expiry date. METHODS: Twenty sensors, each between 3 to 18 months after the expiry date, were assessed in a 7-day period after insertion. Twenty healthy volunteers 23.4 +/- 2.92 (mean +/- SD) years old were trained in handling the CGMS and the Hypoguard (Woodbridge, UK) Advance glucometer system to measure their capillary plasma glucose concentration 18 times a day. Sensor function was estimated according to the number of readings per day, the accuracy according to the mean absolute difference (MAD), and correlation coefficient (r) between glucometer and sensor resulting from paired values. RESULTS: Uninterrupted sensor function was found in 117 of 140 sensor-days (83.6%). A reduction of readings in 23 sensor-days (16.4%) was caused by user error (5 sensor-days, 3.6%), connecting cable (7 sensor-days, 5%), sensor failure (8 sensor-days, 5.7%), or uncertain factors (3 sensor-days, 2.1%). MAD was always < 28%, and r = 0.79. CONCLUSIONS: Neither the expiry date nor the 3-day period of use limits the reliable function of a CGMS sensor. Sensors were found to function as long as 18 months after the expiry date, mostly for at least 7 days. There were no serious local adverse reactions. Prolongation of shelflife label and insertion time appears to be reasonable. Further studies are in progress.

Adult↗

PubMed1988

Dietary fiber decreases fasting blood glucose levels and plasma LDL concentration in noninsulin-dependent diabetes mellitus patients.

Realistic high-fiber and regular low-fiber diets were given for 8 wk each to noninsulin-dependent diabetes mellitus (NIDDM) patients whose diabetes was being controlled satisfactorily by diet alone. The purpose of the study was to evaluate the metabolic effects of dietary fiber without changing energy intake or proportions of protein, fat, and carbohydrates. The high-fiber diet induced lower fasting blood glucose levels (p less than 0.01) and decreased the ratio of low-density lipoproteins to high-density lipoproteins (p less than 0.025); no difference was found in HbA1c between the two diet periods. Continuous glucose monitoring also showed a difference in fasting glucose levels that remained after identical low-fiber test meals. The incremental glucose responses did not differ. The fasting and incremental postprandial levels of insulin, C-peptide, glucagon, and somatostatin did not change, whereas the mean triglyceride concentrations were lower after the high-fiber diet. The results suggest a beneficial effect of dietary fiber in the metabolic control of NIDDM.

Aged↗

PubMed2006

Computer-aided continuous drug infusion: setup and test of a mobile closed-loop system for the continuous automated infusion of insulin.

For a diabetes mellitus patient, tight control of glucose level is essential. Results are reported of an investigation of the suitability of existing wearable continuous insulin infusors controlled and adjusted by a control algorithm using continuous glucose measurements as input to perform the functionality of an artificial pancreas. Special attention was given to the development of a continuous glucose monitor and to evaluate which quality of input data is necessary for the control algorithm. In clinical trials, it was found that for patients in a controlled environment an autonomously regulating control algorithm leads to an improved adjustment of patient glucose values and less overall insulin infusion as compared with the best fixed preprogrammed insulin infusion profiles of standard pump therapy. For the limited number of cases studied here, functionality of the control algorithm could tolerate some delay between the actual glucose values in the patient interstitial fluid and the algorithm input of up to 30 min. A quasicontinuous glucose measurement delivering actual glucose values every 5-10 min seems to be suited to control an artificial pancreas.

Algorithms↗

PubMed1984

Studies on the mechanisms of somatostatin release after insulin induced hypoglycaemia in man.

Insulin-induced hypoglycaemia, which stimulates gastric acid secretion, is associated with an increase in circulating somatostatin levels in man. In order to assess the mechanisms involved in this rise, six normal volunteers connected to a Biostator for continuous glucose monitoring were studied, on three separate occasions. On each occasion after basal blood sampling, 0.15 i.u./kg body weight of insulin was administered i.v. and further samples were obtained intermittently over 150 min. On one occasion, dextrose was infused by the Biostator to prevent hypoglycaemia, while on the other two, a constant infusion of either normal saline or the specific H2 antagonist cimetidine was administered. Insulin plus dextrose caused no significant changes in circulating somatostatin levels, whereas insulin plus saline was associated with a marked, sustained and significant rise in all subjects; insulin plus cimetidine also produced a rise but it was delayed; the area under the curve was significantly (P less than 0.05) greater with insulin plus saline than with insulin plus cimetidine. These results show that in man insulin itself does not stimulate somatostatin secretion directly, but indirectly via hypoglycaemia. Further, the inhibition of gastric acid secretion with cimetidine reduces somatostatin release during insulin-induced hypoglycaemia. This suggests that gastric acid may mediate somatostatin secretion associated with insulin-induced hypoglycaemia.

Adult↗

PubMed2005

Dichotomous responses of inter and postprandial hyperglycaemia to short-term calorie restriction in patients with type 2 diabetes.

BACKGROUND: In type 2 diabetes the effects of short-term calorie restrictions on glycaemia are usually judged on fasting plasma glucose. As fasting duration rarely exceeds 2-3 h, we determined the effects of calorie restriction over different daytime periods using a continuous glucose monitoring system (CGMS) in noninsulin-using patients with type 2 diabetes. DESIGN: Fourteen poorly controlled (mean HbA1c = 9.3%) overweight or obese patients (mean body mass index = 30.1 +/- 0.7 kg m(-2)) with type 2 diabetes were investigated twice with a CGMS, at baseline and at the end of a 18-day calorie-restricted diet (1490 kcal day(-1)). Areas under curves (AUCs) of 24-h glucose monitoring were measured and divided into postprandial and interprandial AUCs according to meal times. RESULTS: Areas under curves of 24-h glucose monitoring were significantly decreased after dieting: -37%, P = 0.0047. Both post and interprandial AUCs were significantly diminished (-26%, P = 0.0186 and -48%, P = 0.0037, respectively), but changes in interprandial AUCs were more marked than changes in postprandial AUCs (P = 0.0060). Nycthemeral peaks of glucose were observed at mid-morning times and were not significantly different before (242 +/- 15 mg dL(-1)) and after dieting (227 +/- 16 mg dL(-1)). CONCLUSIONS: Short-term calorie restriction in overweight or obese patients with type 2 diabetes resulted in dichotomous responses between interprandial and postprandial glycaemic excursions. The resistance of mid-morning glucose peaking to calorie restriction should result in additional dietary or pharmacological measures at breakfast.

Area Under Curve↗

PubMed2006

Fulfilling the promise of insulin pump therapy in childhood diabetes.

Although insulin pump or continuous subcutaneous insulin infusion (CSII) treatment was first introduced more than 25 yr ago, very few children and adolescents with type 1 diabetes mellitus (T1DM) utilized this therapy until recently. In this paper, we review many of the early triumphs, as well as a number of unexpected obstacles that were encountered in applying CSII in the treatment of T1DM. Nevertheless, the greater urgency to obtain optimal control of diabetes following the Diabetes Control and Complications Trial (DCCT), the introduction of rapid-acting insulin analogs and improvements in pump technology have led to a sharp increase in the use of this therapy in youth with T1DM and, generally, favorable outcomes. Moreover, the recent introduction of continuous glucose monitoring systems (CGMSs) offers the prospect of finally realizing the full potential of insulin pump therapy to normalize hemoglobin A1c (HbAlc) levels with minimal risk of hypoglycemia.

Adolescent↗

PubMed2005

Subcutaneous microdialysis before and after an oral glucose tolerance test: a method to determine insulin resistance in the subcutaneous adipose tissue in diabetes mellitus.

AIMS: Subcutaneous microdialysis has been used for continuous glucose monitoring in patients with diabetes mellitus (DM) to facilitate tight regulation of blood glucose levels. The aims of this study were therefore to investigate (i) the relationship between capillary and interstitial glucose in patients with type 1 or 2 DM and healthy subjects and (ii) the feasibility of using microdialysis to assess local insulin sensitivity in adipose tissue. METHODS: Using subcutaneous microdialysis, interstitial glucose, lactate, pyruvate and glycerol were determined as measures of glucose and lipid metabolism in adipose tissue, before and after an oral glucose tolerance test (OGTT) in 14 patients and seven controls. The results were correlated to whole-body insulin sensitivity and insulin sensitivity in liver estimated from the levels of insulin-like growth factor-binding protein 1 (IGFBP-1). RESULTS: Capillary and interstitial glucose correlated before and after OGTT in healthy subjects and in type 1 DM but not in type 2 DM. In fasting state, the glycerol levels were higher in both type 1 and type 2 DM compared with controls. After the OGTT, the insulin levels were sufficient to suppress lipolysis in type 1 but not in type 2 DM. The glucose/lactate ratio was higher at fasting in type 1 DM and after OGTT in type 1 and 2 DM. In type 1 DM, basal interstitial glycerol levels correlated to whole-body glucose utilization. In type 2 DM, correlations were found between the basal glycerol levels and whole-body insulin sensitivity and between glucose/lactate and per cent decrease in IGFBP-1 levels 120 min after OGTT. CONCLUSION: Capillary and interstitial glucose correlated before and after OGTT in healthy subjects and patients with type 1 DM. Correlations were also found between insulin sensitivity in whole body and in adipose tissue in both type 1 and type 2 DM and between insulin sensitivity in subcutaneous adipose tissue and liver in type 2 DM. This study shows that microdialysis technique can be used to study in vivo insulin sensitivity in adipose tissue over time and may be useful in the evaluation of, for example, the effects of new drugs on insulin sensitivity.

Adult↗

PubMed2002

Experience with insulin analogues in children.

Current data on rapid and long-acting insulin analogues in the paediatric age group is limited. While several studies indicate a benefit in reducing hypoglycaemia, particularly at night, with rapid or long-acting insulin analogue treatment, the effect on long-term glycaemic control remains controversial. The continuous glucose monitoring system offers a new option for tailoring treatment with insulin analogues to achieve optimal glycaemia. In 29 adolescents with diabetes this approach confirmed the non-inferiority of postprandial rapid-acting analogue administration compared to preprandial regular insulin, but revealed significant mealtime differences, with increased analogue requirement at breakfast and dinner. Although rapid- and long-acting insulin analogues may offer potential benefits for problems frequently encountered in paediatric diabetology, their value for the individual child still has to be tested in long-term observations in daily clinical practice.

Blood Glucose↗