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At least 397 records · Page 22Linked to original sources
PubMed2004

The dual-wave bolus feature in continuous subcutaneous insulin infusion pumps controls prolonged post-prandial hyperglycaemia better than standard bolus in Type 1 diabetes.

The dual-wave bolus delivers a combination of an immediate normal pre-meal insulin bolus (approximately 3 min) followed by an extended (or square-wave) bolus that is evenly delivered over several hr as programmed by the patient. The purpose of this study was to compare post-prandial glycaemic excursions following a high-fat meal after administration of insulin by normal vs dual-wave bolus. During this prospective, cross-over, repeated measures study, subjects with diabetes and treated with insulin pump therapy were evaluated using the continuous glucose monitoring system (CGMS) following three combinations of meal and bolus type. A control meal or a high-fat meal was given in place of the evening meal on three separate occasions and comparisons were made between: a) the control meal with normal insulin bolus delivery, b) the high-fat meal with normal insulin bolus delivery, and c) the high-fat meal with dual-wave insulin bolus delivery. Although mean baseline CGMS values were similar in each of the three combinations of meal and bolus type (p=0.54) and in the three hr immediately following the meal (p=0.64, p=0.83, p=1.0), when compared to the control meal/normal bolus and high-fat meal/dual-wave bolus combinations, CGMS profiles disclosed significantly elevated post-prandial glucose in hr 5 through 14 (p<0.05) following the high-fat/normal bolus combination. Prolonged post-prandial glycaemic excursions are identified using the CGMS. Treating post-prandial hyperglycaemia with dual-wave insulin delivery may help manage chronic hyperglycaemia in patients with diabetes.

Area Under Curve↗
PubMed2004

New trends in diabetes management: mobile telemedicine closed-loop system.

The rapid growth and development of information technologies over recent years, in the areas of mobile and wireless technologies is shaping a new technological scenario of telemedicine in diabetes. This telemedicine scenario can play an important role for further acceptance by diabetic patients of the existing continuous glucose monitoring systems and insulin pumps with the final goal of improving current therapeutic procedures. This paper describes a Personal Smart Assistant integrated in a multi-access telemedicine architecture for the implementation of a mobile telemedicine closed-loop system for diabetes management. The system is being evaluated within the European Union project named INCA ("Intelligent Control Assistant for Diabetes").

Blood Glucose Self-Monitoring↗
PubMed2006

[The features of postprandial glucose state in type 2 diabetes mellitus].

OBJECTIVE: To study the features of postprandial glucose state in individuals with normal glucose regulation (NGR) and type 2 diabetes (T2DM) and the relations between hemoglobin A1c (HbA1c) and postprandial glucose in T2DM. METHODS: 41 NGR individuals and 60 newly diagnosed T2DM patients without previous management in Shanghai were measured by continuous glucose monitoring system for 3 days. The postprandial glucose spike (PGS), time to PGS (Deltat), postprandial glucose excursion (PPGE), duration of postprandial glucose (DUR) and incremental area under the curve of postprandial glucose (IAUC) were calculated in each individual. RESULTS: (1) The levels of PGS and Deltat in the T2DM group were significantly higher than those of the NGR group (all P < 0.01). The levels of PPGE, DUR and IAUC of the T2DM group were 5.87 mmol/L +/- 0.19 mmol/L, 14.1 h +/- 0.3 h and 2.04 mmol.L(-1).d +/- 0.09 mmol.L(-1).d respectively, all significantly higher than those of the NGR group (2.10 mmol/L +/- 0.12 mmol/L, 8.3 h +/- 0.4 h and 0.43 mmol.L(-1).d +/- 0.03 mmol.L(-1).d respectively, all P < 0.01). The breakfast had higher PGS and lower Deltat than those of lunch and dinner in the T2DM group (both P < 0.01). The PPGE was arranged from high to low in the order of breakfast, dinner and lunch. The highest IAUC appeared during dinner. (2) There was a significantly correlation between PPGE and IAUC (r = 0.93, P < 0.01) in the T2DM group. After being adjusted by preprandial glucose, the partial correlation of HbA1c and IAUC disappeared (before r = 0.29, P = 0.03, after P = 0.05). (3) The relative contribution of postprandial glucose to overall glucose levels in the T2DM group was significantly higher than that of the NGR group (18.1% +/- 0.8% vs 8.0% +/- 0.7%, P < 0.01), but both were significantly lower than those of preprandial glucose. (4) Relative contribution of postprandial hyperglycemia to overall diurnal hyperglycemia decreased progressively from the lowest to the highest quarter of HbA1c. By contrast, the relative contribution of preprandial hyperglycemia showed a significant increase with increasing levels of HbA1c. Postprandial hyperglycemia played a major role when the HbA1c level below 7.5% (P < 0.05). CONCLUSION: (1) The features of postprandial glucose state in T2DM is representative in the delay of PGS and excessive glucose excursion for a long time after the ingestion of a meal. (2) HbA1c can't reflect postprandial glucose excursions. PPGE can be used as a simple clinic index to evaluate the amplitude of postprandial glucose excursions. (3) Postprandial glucose excursions play a major role in T2DM suffering from mild or moderate hyperglycemia. The present results suggest that postprandial hyperglycemia is an important target for intervention when T2DM patients are approaching the ideal glycemic control.

Adult↗
PubMed2006

[Effect of recombinant human growth hormone on glucose metabolism in children with growth hormone deficiency].

OBJECTIVE: Numerous studies in children with growth hormone deficiency (GHD) show that recombinant human growth hormone (rhGH) treatment results in significant catch-up growth, but some papers reported that the children who underwent rhGH therapy might be at increased risk of diabetes. The aim of this study was to investigate the effects of rhGH treatment on blood glucose and insulin metabolism in children with GHD and the relationship between growth hormone (GH) and glucose homeostasis. METHODS: In this study, 44 children with GHD treated with rhGH [0.1 U/(kgxd)] and age- and sex-matched 20 healthy children were enrolled. The GHD group included 28 males and 16 females aged from 4.5 to 16.5 years (mean 10.4 +/- 2.6 years), including 18 cases of complete GHD and 26 cases of partial GHD. The sexual development stage of all subjects was in Tanner I. Oral glucose tolerance tests (OGTT) were done, and body mass index (BMI), serum insulin-like growth factor-1 (IGF-1) level and insulin resistance by homeostasis model (HOMA-IR) were measured at the time of diagnosis and every 3 months after rhGH therapy. Continuous glucose monitoring system (CGMS) was applied for two cases with hyperglycemia. RESULTS: (1) Fasting glucose and IGF-1 levels increased since 3 months of treatment and did not decrease since then. The levels of fasting glucose and IGF-1 at every time points of rhGH therapy were higher than the levels at the time of diagnosis (F = 6.81, P < 0.01; F = 7.31, P < 0.01, respectively). HOMA-IR and fasting insulin levels were increased since 3 and 9 months of treatment (P = 0.001 and P = 0.021, respectively). They decreased after 12 months of therapy and the levels at 18 months of therapy were similar to that at diagnosis. (2) Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI, IGF-1 and the duration of treatment (r = 0.251, 0.437, 0.281, P < 0.01, respectively). The curve between HOMA-IR and duration of therapy was similar with parabola and the quadratic equation obtained was as follows: HOMA-IR = 1.5048 + 0.2177 x duration of therapy (months)-0.0103 x duration of therapy (months)(2) (r(2) = 0.147, F = 14.16, P < 0.01). (3) Two cases had transitory hyperglycemia. Their fasting glucose levels were all higher than 7.1 mmol/L. The glucose levels returned to normal after 1 month and 5 days respectively. OGTT and CGMS showed that their plasma glucose levels were normal after rhGH therapy was applied again. CONCLUSION: The children who underwent rhGH therapy may be at increased risk of insulin resistance (especially during the first year) and the therapy may even induce transitory glucose metabolic disorder in a very small proportion of patients. Circulating IGF-1 may participate in the control of insulin sensitivity and play an important role in the hormonal balance between GH and insulin. It may be necessary to monitor glucose metabolism and IGF-1 for all children who are treated with rhGH therapy.

Adolescent↗
PubMed1987

Fibre and the diabetic diet. An evaluation of the metabolic response to standardized meals.

Dietary fibre has a beneficial influence on glucose homeostasis, varying for different fibre sources. Fruit, wheat, rye and beet fibre were studied in isoenergetic meals for NIDD patients and healthy volunteers. The effects of extrusion cooking and flaking were also evaluated. The metabolic response was followed by continuous glucose monitoring and by analyses of pancreatic and gastrointestinal hormones as well as plasma lipid concentrations, For NIDD patients the effects, reflected in the area and the shape of the glucose curve, were greater for the more soluble fibre types, but the insulin and C-peptide responses were largely unaffected by dietary fibre. Beet fibre gave increased somatostatin concentrations also in age-matched healthy controls. They showed, however, unchanged plasma glucose responses and markedly decreased insulin and C-peptide levels. These changes were associated with less pronounced postprandial glycerol reduction, but otherwise none of the fibre preparations affected the postprandial lipemia. Extruded bread, based on wholegrain wheat flour, with high availability of in vitro starch, elicited a greater glucose response than wholegrain wheat bread, associated with a modest increase of GIP and insulin and with a stimulated early glucagon secretion. Flaked rye seemed to contain both faster and slower carbohydrates than the corresponding rye bread of similar fibre content. Analyses of the glucose curves suggested that the effect of fibre might be mediated by an effect on glucose absorption and parallel experiments in rat indicated that a delayed rate of gastric emptying might contribute. Further, the liver glycogen content was higher in rats given a slowly absorbed gastric load. A realistic increase in fibre content, given in long-term treatment, improved the metabolic control in NIDD patients, by decreasing the fasting blood glucose and LDL-cholesterol levels, as well as the LDL/HDL ratio. Hypothetically, slower absorption achieved with dietary fibre increases the proportion of glycogen in the liver. This postprandial improvement may cause the long-term trend to normalization of the fasting blood glucose level.

Aged↗
PubMedDate not supplied

Evaluation of a miniature blood glucose sensor.

A miniature version of the electrocatalytic glucose sensor has been designed and fabricated with thick-film metalization technology. The in vitro stability tests of the sensor were performed in buffered saline, human plasma ultrafiltrate, and bovine plasma. For bovine plasma studies the sensor was directly coated with a semipermeable ethylene vinyl alcohol (EVAL) membrane. To stabilize the activity of the sensing platinum electrode, a fast-pulsing reactivation method was applied. Good performance of the continuously operating sensor was achieved in buffer (10% stability of the baseline current within 12 days) and human ultrafiltrate (10% stability of the baseline current and 5% stability of the sensitivity within 7 days). However, for measurements in plasma a slow degradation of the sensor's sensitivity (approximately 10% per day) was observed. These results indicate that when a proper screening membrane is provided the continuous glucose monitoring of body fluids with the miniature sensor is possible for at least 7 days.

Animals↗
PubMed1995

[Self-regulated closed-loop therapy of diabetes].

The development of an artificial pancreas, a system in which insulin delivery would be regulated continuously by concomitant glucose levels, has been for a long time considered as a dream by diabetologists and diabetic patients. Two approaches are possible. The first one, electromechanical, consists of a glucose sensor, a computer and an insulin pump. Its development may be hindered by the inadequate biocompatibility of the glucose sensor. This led to consider at first the use of a disposable glucose sensor as part of a continuous glucose monitoring system. The second approach aims at developing a bioartificial pancreas, in which isolated islets of Langerhans would be protected against immune rejection by an artificial membrane permeable to glucose and insulin but not so to factors responsible for immune rejection. Thus, it may become possible to transplant a large number of patients before the onset of diabetic complications with xenogeneic islets, without need for any immunosuppression. Promises and obstacles of these two approaches are described herein.

Artificial Organs↗
PubMed1994

[Artificial and bioartificial pancreas for the treatment of diabetes mellitus].

The development of an artificial pancreas, a system in which insulin delivery would be regulated continuously by concomitant glucose levels, has been for a long time considered as a dream by diabetologists and diabetic patients. Two approaches are possible. The first one, electromechanical, consists of a glucose sensor, a computer and an insulin pump. Its development may be hindered by the inadequate biocompatibility of the glucose sensor. This led to consider at first the use of a disposable glucose sensor as part of a continuous glucose monitoring system. The second approach aims at developing a bioartificial pancreas, in which isolated islets of Langerhans would be protected against immune rejection by an artificial membrane permeable to glucose and insulin but not so to factors responsible for immune rejection. Thus, it may become possible to transplant a large number of patients before the onset of diabetic complications with xenogeneic islets, without need for any immunosuppression. Promises and obstacles of these two approaches are described herein.

Animals↗
PubMed2004

Noninvasive continuous monitoring of physiological glucose using a monosaccharide-sensing contact lens.

We have tested the feasibility of tear glucose sensing using a daily, disposable contact lens embedded with boronic acid-containing fluorophores as a potential alternative to current invasive glucose-monitoring techniques. Our findings show that our approach may, indeed, be suitable for the continuous monitoring of tear glucose levels in the range 50-500 microM, which track blood glucose levels that are approximately 5-10-fold higher. We compare the response of the boronic acid probes in the contact lens to solution-based measurements and can conclude that both the pH and polarity within the contact lens need to be considered with respect to choosing/designing and optimizing glucose-sensing probes for contact lenses.

Biosensing Techniques↗
PubMedDate not supplied

["Glucosensor Unitec Ulm". A portable, continuously measuring glucose sensor and monitor].

The "Glucosensor Unitec Ulm" is the first commercially available, portable glucose monitor that permits continuous measurement in venous blood under ambulatory conditions for up to 256 hours. The device weights 850 g, and measures 15 x 19 x 7 cm. Depending on the flow rate of the pump, the blood requirement is 15-25 ml/24 h. The size of the built-in-memory is 32 kByte, enough to store 3180-15,900 glucose values. The "24 hour glucogram" obtained under day to day living conditions permits the detection of disturbances of carbohydrate metabolism. Thus, early abnormalities of type II diabetes can be detected as well the degree of blood glucose normalization in patients suffering from severe insulin-dependent diabetes. Moreover, the effects of glucose-lowering drugs can be analyzed objectively. Finally, this portable glucose monitor permits the recognition of hypoglycemia induced by insulin administration or endogenous insulin overproduction due to tumors.

Blood Glucose↗
PubMedDate not supplied

Postprandial glucose monitoring in type 1 diabetes mellitus: use of a continuous subcutaneous monitoring device.

BACKGROUND: Pre-prandial glucose gives insufficient information on glycemic excursions throughout the day. We aimed to test a continuous subcutaneous glucose-monitoring device (GlucoDay) to describe postprandial glucose changes. METHODS: In 23 T1DM patients, 24-h GlucoDay registrations were started about 14 h before receiving a standard breakfast B and 3 h later lunch L. RESULTS: The 3-min glucose values were computed into parameters describing the postprandial changes after B and L. Two-hour glucose was higher after B (243 +/- 69 vs 180 +/- 79 mg/dL after L, p < 0.0001). Maximum glycemia (313 +/- 105 mg/dL after B and 304 +/- 119 after L, p < 0.0001) was higher and was reached after 78 and 57 min respectively. Three-hour AUC was higher but 30-min AUC was lower after B (5725 +/- 2414 vs 7488 +/- 2208 min mg/dL after L, p = 0.004). Glucose spikes (maximum peak minus fasting plasma glucose) were similar after B and L but the difference between maximum and minimum values was smaller after B (165 +/- 110 vs 219 +/- 115 mg/dL after L, p = 0.020). Duration of hyperglycemic periods >200, 140 or 126 mg/dL were not different after B or L, but time spent at glucose <100 mg/dL was longer after L (p < 0.0001). CONCLUSIONS: These results illustrate the use of subcutaneous glucose registration to characterize postprandial glycemia patterns in T1DM. Application of such methods to evaluate this and other clinical situations in DM can lead to therapeutic and dietary adjustments and ultimately improve glycemic control.

Adult↗
PubMed2003

[Biosensors for continuous glucose and lactate monitoring].

Biosensors, and in particular glucose and lactate sensors, are being widely developed and a few have been registered for continuous and semi-continuous use. Three glucose sensors, a transcutaneous sensor (GlucoWatch), a needle sensor (MiniMed) and microdialysis sensor (GlucoDay) have recently been evaluated among diabetes patients. The precise relationship between the biosensor signal and blood glucose is still a problem. For example, the utility of the subcutaneously placed needle sensor to detect nocturnal hypoglycaemia has been shown to be limited. The best subcutaneous site for placing the sensor needs to be systematically investigated. The three types of sensors have only been tested for a 3-5 day period. The utility of the microdialysis (separate from a direct link to biosensors) sensors among diabetes patients was established over a 3-week period following subcutaneous implantation. Furthermore, biosensors are being developed to monitor lactate in preterm babies, and patients with ischaemia, sepsis, or threatened organ damage (e.g. heart and brain infarction). In view of the current progress it is expected that within 5 years biosensor technology will have developed far enough to be used in the management of diabetes and in intensive care units.

Adult↗
PubMed2004

Feasibility of continuous long-term glucose monitoring from a subcutaneous glucose sensor in humans.

The feasibility of continuous long-term glucose monitoring in humans has not yet been demonstrated. Enzyme-based electrochemical glucose sensors with telemetric output were subcutaneously implanted and evaluated in five human subjects with type I diabetes. Subject-worn radio-receiver data-loggers stored sensor outputs. Every 1-4 weeks the subject's glucose levels were manipulated through the full clinical range of interest using standard protocols. Reference blood glucose samples were obtained every 5-10 min and analyzed in our hospital clinical laboratory and/or on glucose meters. The sensor data were evaluated versus the reference data by linear least squares regression and by the Clarke Error Grid method. After surgical explantation and device inspection, the tissue-sensor interface was evaluated histologically. The remaining sensor-membranes were also recalibrated for comparison with preimplant performance. Four of the five glucose sensors tracked glucose in vivo. One sensor responded to manipulated glucose changes for 6.2 months with clinically useful performance (>/=90% of sensor glucose values within the A and B regions of the Clarke Error Grid). For this sensor, recalibration was required every 1-4 weeks. The other three transiently responding sensors had electronic problems associated with packaging failure. The remaining sensor never tracked glucose because of failure to form any sustained connection to adjacent subcutaneous tissue. Thus, stable, clinically useful sensor performance was demonstrated in one of five subjects with diabetes for a sustained interval of greater than 6 months. While this glucose sensor implant technology shows promise in humans, it needs to be made more reliable and robust with respect to device packaging and sensor-tissue connection.

Adolescent↗
PubMed2002

Reliable glucose monitoring through the use of microsystem technology.

A continuous amperometric glucose monitoring system is presented. All analytically relevant units are integrated on a microchip (microreactor, control electrode, glucose oxidase based sensor electrode, reference electrode, counter electrode). The scavenging electrochemical microreactor pre-oxidises all interfering compounds enabling a reliable glucose determination. The reliability of the microreactor is demonstrated with the most important antioxidants, ascorbic and uric acids. The glucose sensor system operates at volumetric flow rates of common body interfaces (e.g. microdialysis, microperfusion).

Electrochemistry↗
PubMed1983

Comparative study of immunoactivity and bioactivity of sodium insulin.

The bioactivity of equal doses (by radioimmunoassay) of regular insulin and sodium insulin were measured in six preconditioned female mongrel hound dogs by a previously described bioassay. The hypoglycemic nadir of blood glucose induced by intravenous injection of the drugs was compared with the nadirs induced by a known amount of the international standard insulin. The level of blood glucose was monitored-instantaneously and continuously using a nonthrombogenic continuous glucose-monitoring system. The hypoglycemic effect of subcutaneously injected sodium insulin was compared with the effect of subcutaneously injected regular insulin. The two drugs were injected at 1-2-week intervals to seven dogs. While the bioactivity of intravenously administered sodium insulin was equal to the bioactivity of intravenously administered regular insulin, the hypoglycemic effect of subcutaneously injected sodium insulin differed from the effect of subcutaneously injected regular insulin. The blood glucose nadir after subcutaneous injection of regular insulin occurred 101 +/- 21 min after the injection. The nadir after subcutaneous injection of sodium insulin occurred 163 +/- 33 min after the injection.

Animals↗
PubMed2001

Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes.

OBJECTIVE: Children with type 1 diabetes are usually asked to perform self-monitoring of blood glucose (SMBG) before meals and at bedtime, and it is assumed that if results are in target range, along with HbA(1c) measurements, then overall glycemic control is adequate. However, the brief glimpses in the 24-h glucose profile provided by SMBG may miss marked glycemic excursions. The MiniMed Continuous Glucose Monitoring System (CGMS) has provided a new method to obtain continuous glucose profiles and opportunities to examine limitations of conventional monitoring. RESEARCH DESIGN AND METHODS: A total of 56 children with type 1 diabetes (age 2-18 years) wore the CGMS for 3 days. Patients entered four fingerstick blood samples into the monitor for calibration and kept records of food intake, exercise, and hypoglycemic symptoms. Data were downloaded, and glycemic patterns were identified. RESULTS: Despite satisfactory HbA(1c) levels (7.7 +/- 1.4%) and premeal glucose levels near the target range, the CGMS revealed profound postprandial hyperglycemia. Almost 90% of the peak postprandial glucose levels after every meal were >180 mg/dl (above target), and almost 50% were >300 mg/dl. Additionally, the CGMS revealed frequent and prolonged asymptomatic hypoglycemia (glucose <60 mg/dl) in almost 70% of the children. CONCLUSIONS: Despite excellent HbA(1c) levels and target preprandial glucose levels, children often experience nocturnal hypoglycemia and postprandial hyperglycemia that are not evident with routine monitoring. Repeated use of the CGMS may provide a means to optimize basal and bolus insulin replacement in patients with type 1 diabetes.

Adolescent↗