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PubMed2004

A Continuous Glucose Monitoring System (CGMS) - a promising approach for improving metabolic control in persons with type 1 Diabetes mellitus treated by insulin pumps.

This pilot study deals with the possibilities of a Continuous Glucose Monitoring System (CGMS, Minimed- Medtronic) to optimize insulin substitution. Ten persons with type 1 diabetes mellitus treated by means of an insulin pump entered the study and eight of them completed the protocol. CGMS was introduced for a period of 5 days. The standard dinner (60 g of carbohydrates) and overnight fasting were designed to ensure standard night conditions in all persons in the study while maintaining their usual daily eating routine, physical exercise and assessment of prandial insulin boluses. The only adaptation of basal rates of insulin pump was performed on day 3. Comparison of the mean plasma glucose concentration (0:00-24:00 hrs) between day 2 (before adaptation) and day 4 (following adaptation) was made. An independent comparison of the mean plasma glucose concentration between the night from day 2 till day 3 (22:00-6:00 hrs) and the night from day 4 till day 5 (22:00-6:00 hrs) was performed. The mean plasma glucose investigated by means of CGMS improved in the 24-hour period in 5 out of 8 persons and in the night fasting period (22:00 to 6 hrs) in 6 out of 8 persons. The CGMS is a useful means for assessment of the effectiveness of basal rate and prandial insulin doses in persons with type 1 diabetes treated by means of an insulin pump. However, further studies are necessary to improve the algorithm for insulin substitution.

Adult↗

PubMed2003

Glycemic control in diabetic CAPD patients assessed by continuous glucose monitoring system (CGMS).

INTRODUCTION: From 20% to 40% of all patients commencing dialysis are diabetic. The quality of glycemic control is an important determinant of outcome. The aims of this study were to investigate the use of the continuous glucose monitoring system (CGMS) to assess overall 24-hour glycemic control and the effects of both nonglucose containing and more biocompatible alternative peritoneal dialysis solutions in insulin-treated continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: We studied 8 insulin treated diabetic CAPD patients. A CGMS probe was inserted [allowing automatic measurement of interstitial fluid (ISF) glucose every 5 minutes, for a 72-hour period]. The patients were then allowed home with CGMS monitoring to assess the effect on glycemic control of three differing peritoneal dialysis regimes. Phase 1 consisted of three exchanges of 1.36% glucose and one of 3.86% glucose, utilizing a lactate/bicarbonate buffer. Phase 2 was identical but used lactate-buffered fluid alone. Phase 3 utilized a minimally glycemic combination of one amino acid, one icodextrin, and two 1.36% glucose lactate/bicarbonate-containing exchanges. RESULTS: ISF glucose measured by CGMS correlated well with venous glucose measurements (r2 = 0.82, P < 0.0001). There was a statistically significant difference in the mean ISF glucose between all three phases (P < 0.0001). The variation in glycemic control was tighter during phase 3 [mean coefficient of variation (CV) 0.21 +/- 0.03]. CONCLUSION: CGMS appears to be a clinically useful tool to gain additional insights into the glycemic control of diabetic CAPD patients. More biocompatible and nonglucose-containing dialysis fluids seem to be associated with improvements in glycemic control in this group of patients.

Adult↗

PubMed2003

Computerized generation of circadian sensor modal days with continuous glucose monitoring for comparison of various insulin regimens based on insulin glargine in type 1 diabetes.

AIM: Our aims were (1) to design and standardize a statistical approach for data reduction in continuous glucose monitoring, allowing comparison of circadian glycemic patterns in therapeutic subcohorts of patients with type 1 diabetes, and (2) to investigate the applicability of this approach for CGMS assessment in clinical study of basal insulin replacement quality with various timings of basal injections (pre-breakfast, dinner, bedtime) of a new insulin analog. METHODS: Prospective randomized three-arm parallel study with switch over after 6 months for another 3 months of free choice injection time point (options pre-breakfast, pre-dinner and bedtime) of the new insulin analog in 16 type 1 diabetic subjects on functional insulin treatment (FIT: basal, prandial and correctional dosages). CGMS was used at the end of each follow up period of a clinical study. Representative daily profiles were off-line computed as "circadian sensor modal days" for each insulin regimen consisting of consecutive means of hourly glucose values. RESULTS: Although the overall quality of glycemic control (HbAIC) for different regimens did not reach statistical differences, CGMS displayed slightly divergent maximal swings in the course of glycemia (p=0.04-0.08) and allowed--with delineated data reduction procedure--a reliable between treatment comparison. CONCLUSION: Off-line computation of "hourly circadian sensor modal days" for data reduction can be effectively used with CGMS for description of circadian glycemic patterns in type 1 diabetes.

Adult↗

PubMed2004

Accuracy of the GlucoWatch G2 Biographer and the continuous glucose monitoring system during hypoglycemia: experience of the Diabetes Research in Children Network.

OBJECTIVE: The goal of this study was to assess the accuracy of the GlucoWatch G2 Biographer (GW2B) and the continuous glucose monitoring system (CGMS) during hypoglycemia in children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: During a 24-h clinical research center stay, 91 children and adolescents with type 1 diabetes (aged 3.5-17.7 years) wore one or two CGMSs, and 89 of these subjects wore one or two GW2Bs. Frequent serum glucose determinations were made during the day, overnight, and during insulin-induced hypoglycemia resulting in 192 GW2B reference pairs and 401 CGMS reference pairs during hypoglycemia (reference glucose < or =60 mg/dl). RESULTS: During hypoglycemia, the median absolute difference between the 192 GW2B reference glucose pairs was 26 mg/dl and between the 401 CGMS reference glucose pairs was 19 mg/dl with 31 and 42%, respectively, of the sensor values within 15 mg/dl of the reference glucose. Sensitivity to detect hypoglycemia when the GW2B alarm level was set to 60 mg/dl was 23% with a false-alarm rate of 51%. Analyses suggested that modified CGMS sensors that became available in November 2002 might be more accurate than the original CGMS sensors (median absolute difference 15 vs. 20 mg/dl). CONCLUSIONS: These data show that the GW2B and the CGMS do not reliably detect hypoglycemia. Both of these devices perform better at higher glucose levels, suggesting they may be more useful in reducing HbA1c levels than in detecting hypoglycemia.

Adolescent↗

PubMed2005

The extended Kalman filter for continuous glucose monitoring.

Glucose monitoring is a problem with evolving solutions using sensors and data processing techniques that are continually improving. This paper presents the development and application of the extended Kalman filter to the problem of real-time estimation of blood glucose levels and is consistent with sensors based on optical, electrical, or chemical processes. The structure of the extended Kalman filter provides the capability to systematically accommodate new information as it develops. This flexibility and the potential for performance improvement are demonstrated by processing patient data files generated using the Medtronic (Northridge, CA) MiniMed continuous glucose monitoring system (CGMS).

Algorithms↗

PubMed2003

Closed-loop glucose control in critically ill patients using continuous glucose monitoring system (CGMS) in real time.

A study was conducted to determine if continuous subcutaneous glucose monitoring (from MiniMed CGMS) could be used in real-time to control blood sugar level (BSL) in patients with critical illness. A closed-loop control system was constructed to use CGMS in a real-time manner, coupled with a proportional integral (PI) control algorithm based on a sliding scale approach, for automatic intravenous infusion of insulin to patients. A total of five subjects with high BSL (> 10 mmol/L) participated in formal studies of the closed-loop control system. Subjects were recruited from critically ill patients in the intensive care unit (ICU) after informed consent was obtained. Error grid analysis showed that 64.6% of the BSL readings as determined in real time using CGMS sensor, when compared to conventional BSL measurements on blood drawn from an arterial line, was clinically accurate (i.e., < 20% deviation from glucometer value). In the five patients who underwent closed-loop control, the controller managed to control only one patient's glycaemia without any manual intervention. Manual intervention was required due to the real-time sensor reading deviating more than 20% from the glucometer value, and also as a safety mechanism. Test on equality of mean and variance for BSL attained prior to, during, and post trial showed that the controller's performance was comparable to manual control. We conclude that the automatic sliding scale approach of closed-loop BSL control is feasible in patients in intensive care. More work is needed in the refinement of the algorithm and the improvement of real-time sensor accuracy.

Algorithms↗

PubMed2006

Continuous glucose monitoring system for early detection of graft dysfunction in allogenic islet transplant recipients.

BACKGROUND: There are no effective indicators of graft dysfunction in islet transplantation. This study evaluated the role of the Continuous Glucose Monitoring System (CGMS) as an early indicator of graft dysfunction in islet transplant recipients. METHODS: In 5 islet allograft recipients, we retrospectively determined the date of graft dysfunction: 3 fasting blood glucose levels >7.8 mmol/L (140 mg/dL) and/or 3 postprandial blood glucose levels >10 mmol/L (180 mg/dL) in 1 week. We then determined 2 time points in respect to graft dysfunction, 5 to 9 months before (time point A) and 2 to 3 months before (time point B). For these 2 time points, we assessed the following: HbA1c, C-peptide (CP), C-peptide glucose ratio (CPGR), 90-minute glucose from mixed meal tolerance test, and percentage of capillary blood glucose levels >7.8 mmol/L (%CBG >7.8) in a 15-day interval (1 week before and after CGMS placement). From the CGMS recordings, we calculated the glucose variability and the percentage of time spent in hyperglycemia >7.8 mmol/L (%HGT >7.8) and >10 mmol/L (%HGT >10). RESULTS: No difference was found between time points A and B for the following parameters: HbA1c, CP, CPGR, 90-minute glucose, %CBG >7.8, and %HGT >10. We observed a statistically significant increase from time point A to time point B in glucose variability (1.1 +/- 0.5 mmol/L to 1.6 +/- 0.6 mmol/L; P = .004), and in the %HGT >7.8 (11 +/- 12% to 22 +/- 18%; P = .036). CONCLUSION: Glucose variability and %HGT >7.8 determined using CGMS are useful as early indicators of graft dysfunction in islet transplant recipients. Further studies with larger sample sizes will help validate these observations.

Adult↗

PubMed2003

Performance assessment of the Medtronic-MiniMed Continuous Glucose Monitoring System and its use for measurement of glycaemic control in Type 1 diabetic subjects.

AIMS: To assess the accuracy, reliability and measurement of glycaemic control associated with the Medtronic-MiniMed Continuous Glucose Monitoring System (CGMS) in comparison with blood glucose self-monitoring (BGSM) in Type 1 diabetic patients. METHODS: Type 1 diabetic patients (n = 18) underwent glucose monitoring by the CGMS for up to 3 days, when control was also assessed by BGSM performed eight times daily. RESULTS: Ninety-five per cent of paired non calibration samples were in the clinically acceptable zones of the Clarke error grid, and 97% in a consensus grid. The median bias was 0.1 mmol/l and relative bias 15%. The failure rate of sensors was 28% of those initially inserted. The CGMS detected significantly more hypoglycaemia and post-prandial hyperglycaemia, but total duration of hyperglycaemia, blood glucose oscillations and day-to-day variability were similarly assessed by CGMS and BGSM. CONCLUSIONS: The CGMS has acceptable clinical accuracy. Detection by the CGMS of more hypoglycaemia and post-prandial hyperglycaemia than BGSM promises a valuable tool for control assessment and optimization of treatment.

Adult↗

PubMed2005

Accuracy of the modified Continuous Glucose Monitoring System (CGMS) sensor in an outpatient setting: results from a diabetes research in children network (DirecNet) study.

OBJECTIVE: We previously reported the results of an inpatient accuracy study in children with type 1 diabetes using the Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed, Northridge, CA). During the course of that study, a new process was implemented for manufacturing the CGMS sensor. Accuracy from the resulting modified sensor used by only 14 children was significantly better than the original version [median relative absolute difference (RAD), 11% vs. 19%; P < 0.001]. Baseline data from a subsequent outpatient study provide an opportunity to further assess the accuracy of the modified sensor in a much larger sample of children with type 1 diabetes. RESEARCH DESIGN AND METHODS: As part of a randomized trial to assess the utility of the GlucoWatch G2 Biographer (Cygnus, Inc., Redwood City, CA), 200 children with type 1 diabetes were instructed to wear a CGMS for 48-72 h in an outpatient setting at baseline. Glucose measurements from a OneTouch UltraSmart (Lifescan, Inc., Milpitas, CA) home glucose meter were downloaded and used as reference values to calculate accuracy measures. RESULTS: The overall median RAD was 12%. Accuracy was better during hyperglycemia than during hypoglycemia (median RAD, 10% vs. 20%; P < 0.001) and on optimal versus non-optimal days but did not vary significantly by the number of calibrations entered. CONCLUSIONS: These data confirm the improved accuracy previously reported for the modified version of the CGMS sensor.

Blood Glucose↗

PubMed2003

The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control.

OBJECTIVE: To evaluate whether the continuous glucose monitoring system (CGMS; MiniMed, Sylmar, CA) is useful for investigating the incidence of unrecognized hypoglycemias in type 1 and type 2 diabetic patients and for improving metabolic control in type 1 diabetic patients. RESEARCH DESIGN AND METHODS: A total of 70 diabetic subjects (40 type 1 and 30 type 2 subjects) were monitored using the CGMS. The number of unrecognized hypoglycemias was registered. Furthermore, the 40 type 1 diabetic patients whose treatment was modified in accordance with the information obtained from the CGMS were compared with a control group of 35 different type 1 diabetic patients using intensive capillary glucose measurements. HbA(1c) levels were measured before the monitoring period and 3 months later. RESULTS: The CGMS detected unrecognized hypoglycemias in 62.5% of the type 1 diabetic patients and in 46.6% of the type 2 diabetic patients. We found that 73.7% of all events occurred at night. HbA(1c) concentrations decreased significantly in both the group of type 1 diabetic subjects monitored with the CGMS (from 8.3 +/- 1.6 to 7.5 +/- 1.2%, P < 0.01) and the control group (from 8.0 +/- 1.4 to 7.5 +/- 0.8%, P < 0.01). The greatest reduction was observed in the subgroup of patients who started continuous subcutaneous insulin infusion therapy, both in the CGMS-monitored and control groups (from 9.4 +/- 2 to 7.2 +/- 1.4% and from 8.1 +/- 1.8 to 7.1 +/- 0.6%, respectively). CONCLUSIONS: The CGMS is useful for detecting unrecognized hypoglycemias in type 1 and type 2 diabetic subjects; however, it is not better than standard capillary glucose measurements for improving metabolic control of type 1 diabetic subjects, regardless of the therapeutic regimen.

Adult↗

PubMed2004

Application of the Continuous Glucose Monitoring System (CGMS) in the 72-hour fast test in two patients with hypoglycemia.

OBJECTIVE: Hypoglycemia occurs in several pathologic states, and the supervised 72-h fast is the classic diagnostic test for hypoglycemia caused by insulinoma. The Continuous Glucose Monitoring System (CGMS), Medtronic MiniMed, Northridge, CA) is an appropriate method to detect asymptomatic hypoglycemia episodes in diabetes mellitus patients. In the present study, we use the CGMS to monitor glucose dynamics during a 72-h fast. METHODS: Two patients with hypoglycemia disorders were admitted to the hospital for testing. The CGMS sensors were inserted into the subcutaneous tissue prior to starting a 72-h fast test. Finger stick glucose levels were taken every 3-4 h, and the data were entered into the monitor for calibration. RESULTS: Paired glucose readings from CGMS and conventional meters were correlated significantly (P < 0.001, r2 = 0.79). There was no significant difference between the CGMS glucose levels and conventional meter glucose levels (P > 0.05). Use of CGMS detected a high prevalence of asymptomatic hypoglycemia and two types of hypoglycemia dynamics during a 72-h fast test. CONCLUSIONS: This initial report using CGMS detected two types of hypoglycemia dynamics during 72-h fasting, which may provide clues to better understand the pathophysiology of hypoglycemia.

Adult↗

PubMed2006

Performance of the continuous glucose monitoring system (CGMS) during development of ketosis in patients on insulin pump therapy.

AIMS: Ketoacidosis is one of the most severe complications of Type 1 diabetes. Development of ketosis leads to substantial shifts in electrolyte and ion concentrations in the different fluid compartments of the body. This study was performed to investigate the performance of the continuous glucose monitoring device (CGMS) during ketoacidosis. METHODS: Twelve patients with Type 1 diabetes using continuous subcutaneous insulin infusion (CSII) participated in this trial [10 women, two men; age (mean +/- sd) 34 +/- 9 years; disease duration 17 +/- 10 years; HbA(1c) 7.1 +/- 1.0%]. In the morning, patients ate breakfast and the insulin pump was stopped at 11.00 h and restarted after 8 h. Observation parameters during this experiment were: blood glucose (laboratory reference and CGMS), 3-hydroxy-butyrate (3-OHB), pH, Na, pCO(2), pO(2), free fatty acids, osmolarity, standard bicarbonate, and lactate. RESULTS: Blood glucose increased and reached a plateau within 2 h after pump stop (from 6.2 +/- 2.56 to 16.7 +/- 4.44 mmol/l, P < 0.001). A constant increase in 3-OHB (from 0.0 to 0.8 +/- 0.5 mmol/l, P < 0.001) and decrease in pH (from 7.43 +/- 0.02 to 7.40 +/- 0.03, P < 0.05) indicated ketosis development. Na decreased from 141 +/- 1.4 to 138 +/- 2.8 mmol/l, P < 0.001). Free fatty acids increased from 0.577 +/- 0.330 to 1.330 +/- 0.462 mmol/l (P < 0.001). The CGMS values showed excellent agreement with the capillary blood laboratory method during the entire experiment, and a modified error grid analysis revealed that 99.5% of the values were in the clinically acceptable zones A and B. CONCLUSION: The CGMS device was confirmed to be reliable and accurate during the development of hyperglycaemia and ketotic conditions.

Adult↗

PubMed2004

Experience with the continuous glucose monitoring system in a medical intensive care unit.

Strict glycemic control improves clinical outcomes in critically ill patients. However, practical tools for frequent monitoring of blood glucose (BG) levels in the intensive care unit (ICU) are limited. The Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed, Northridge, CA) is currently approved for detecting glycemic excursions in outpatients with diabetes mellitus. The use of this device has never been carefully examined in the inpatient setting. This preliminary study was designed to investigate the accuracy of the CGMS in critically ill patients admitted to a medical ICU (MICU). Subjects at risk for hyperglycemia were recruited from among all patients admitted to our MICU. CGMS sensors were implanted for up to 72 h. Study subjects wore between one and five consecutive sensors. Four or more standard capillary BG readings were recorded per 24 h. All paired meter-sensor (M-S) readings were used both for CGMS calibration and for data analysis. Twenty-two MICU patients wore 41 CGMS sensors, yielding 546 M-S BG pairs. Overall, the Pearson correlation coefficient ( r ) was 0.88, with a mean M-S difference of 3.3 +/- 26.7 mg/dL (0.6 +/- 17.4%) and a mean absolute M-S difference of 19.7 +/- 18.3 mg/dL (12.8 +/- 11.9%). Clarke Error Grid analysis categorized 98.7% of the M-S pairs within "clinically acceptable" zones A and B. The CGMS is promising for potential use in critically ill patients. If validated in larger studies, the device could serve as a useful research tool for investigating the role of hyperglycemia (and strict glycemic control) in ICU patients. If further developed as a "real-time" glucose sensor, CGMS technology could ultimately prove clinically useful in the ICU, by decreasing nursing workload and/or by providing alarm signals for impending glycemic excursions.

APACHE↗

PubMed2004

Continuous glucose monitoring: a stepping stone in the journey towards a cure for diabetes.

Probably the most important advance in the field of diabetes and pregnancy since the discovery of insulin in 1921 is self-monitoring of blood glucose. Within the past 30 years, home monitoring of blood glucose has introduced a more efficient means of tracking patient progress. The advent of continuous glucose monitoring has broadened the horizons for improving patient care. Barriers to intensive therapy such as standard methods of monitoring blood glucose, the risk of hypoglycemia, the limitations of present therapy and inadequate patient education must be overcome in order to improve diabetes management. This paper discusses methods of blood glucose monitoring and its aims at bringing the above mentioned barriers to a minimum in order to maintain normoglycemia, to reduce risks of diabetes-related complications and to optimize the possibility for pregnant women with diabetes of delivering healthy babies.

Blood Glucose↗

PubMed2006

[Characteristics of the daily blood glucose profiles of impaired glucose tolerance and type 2 diabetes mellitus subjects by continuous glucose monitoring system].

OBJECTIVE: To investigate the characteristics of daily glucose profiles of the impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) subjects by continuous glucose monitoring system (CGMS) so as to instruct the development of rational programs of treatment. METHODS: The CGMS data of 6 normal glucose tolerance (NGT), 10 IGT, and 20 newly diagnosed T2DM subjects were analyzed. RESULTS: (1) The values of average blood glucose, standard deviation of blood glucose, total time of plasma glucose > or = 7.8 mmol/L (T(PG) > or = 7.8 mmol/L) of the T2DM subjects were all significantly higher than those of IGT subjects (all P < 0.05), and these values of the IGI subjects were all significantly higher than those of the NGT subjects (all P < 0.05). The CGMS blood glucose profile excursion were also more and more fluctuant with the deterioration of glucose tolerance. (2) In the IGT group, the time of PG reaching peak was 109 minutes +/- 32 minutes and the daily time of PG > or = 7.8 mmol/L was 3.0 hours +/- 0.8 hours. In the newly diagnosed T2DM group, the time of PG reaching peak was 92 minutes +/- 22 minutes, and the daily time of PG > or = 11.1 mmol/L was 12.6 hours +/- 1.3 hours. The blood glucose increased more quickly and more sharply, and continued for more time after breakfast. CONCLUSIONS: (1) CGMS data accurately display the characteristics of daily 24 h blood glucose profiles of the IGT and newly diagnosed T2DM subjects, and CGMS examination helps instruct the development of rational treatment program. (2) In daily life, the time of PG > or = 7.8 mmol/L in IGT subjects was nearly 3 hours. (3) With the deterioration of glucose tolerance, the postprandial glucose peak is elevated higher and more rapidly, and the daily blood glucose profile excursion becomes more and more fluctuant.

Blood Glucose↗

PubMed2006

Continuous glucose monitoring and closed-loop systems.

BACKGROUND: The last two decades have witnessed unprecedented technological progress in the development of continuous glucose sensors, resulting in the first generation of commercial glucose monitors. This has fuelled the development of prototypes of a closed-loop system based on the combination of a continuous monitor, a control algorithm, and an insulin pump. METHOD: A review of electromechanical closed-loop approaches is presented. This is followed by a review of existing prototypes and associated glucose sensors. A literature review was undertaken from 1960 to 2004. RESULTS: Two main approaches exist. The extracorporeal s.c.-s.c. approach employs subcutaneous glucose monitoring and subcutaneous insulin delivery. The implantable i.v.-i.p. approach adopts intravenous sampling and intraperitoneal insulin delivery. Feasibility of both solutions has been demonstrated in small-scale laboratory studies using either the classical proportional-integral-derivative controller or a model predictive controller. Performance in the home setting has yet to be demonstrated. CONCLUSIONS: The glucose monitor remains the main limiting factor in the development of a commercially viable closed-loop system, as presently available monitors fail to demonstrate satisfactory characteristics in terms of reliability and/or accuracy. Regulatory issues are the second limiting factor. Closed-loop systems are likely to be used first by health-care professionals in controlled environments such as intensive care units.

Administration, Cutaneous↗

PubMed2005

Continuous glucose monitoring in diabetic long distance runners.

Marathon running is growing in popularity, and many diabetic patients are participating in various marathon races all over the world each year. This study aimed to investigate the prevalence and extent of glycemic excursions (hypo- and hyperglycemic) during a marathon run in patients with well-controlled diabetes mellitus using a continuous glucose monitoring system (CGMS). Five subjects with type 1 and one patient with type 2 diabetes mellitus were monitored with the Medtronic MiniMed CGMS during the 2002 Vienna City Marathon (n = 3) or the "Fernwärme run" (n = 3) long distance runs of 42.19/15.8 km. All six patients finished their course. The CGSM system was well tolerated in all patients over an average duration of 34 +/- 4.0 hours and it did not limit the patients' activities. The mean running time for the Vienna city marathon was 257 +/- 8 min (247 to 274 min) and for the Fernwärme run 134 +/- 118 min (113 to 150 min). A total of 1470 blood glucose measurements (mean 245 readings per subject) were performed. During and after the marathons frequent hypo- and hyperglycemic episodes with and without clinical symptoms were measured. Our data confirm that the CGMS may help to identify asymptomatic hypoglycemia or hyperglycemia during and after a long distance run. The system may also be helpful to improve our understanding about the individual changes of glucose during and after a marathon and may protect hypoglycemic or hyperglycemic periods in future races.

Adult↗

PubMedDate not supplied

Evaluation of metabolic control in women with gestational diabetes mellitus by the continuous glucose monitoring system: a pilot study.

OBJECTIVE: To evaluate the blood glucose concentrations in a group of women with gestational diabetes mellitus (GDM), by the use of a continuous glucose monitoring system (CGMS). METHODS: Seven women with diet-controlled GDM (group G1), 5 with diet- and insulin-controlled GDM (group G2), and 7 healthy, pregnant women (group N) were included in the study. The treatment was adjusted on the basis of self-monitoring of blood glucose (SMBG). The self-monitoring was performed 4 times a day, with the goals of fasting blood glucose values of <90 mg/dL and postprandial (2 hours after each meal) values of <120 mg/dL. Then patients were submitted to a 72-hour period of use of the CGMS. RESULTS: In the 3 study groups--N, G1, and G2, respectively--no significant differences were noted in individual study parameters, measured with the CGMS in regard to the following: mean 24-hour glycemia (85, 87, and 91 mg/dL), fasting blood glucose (79, 88, and 82 mg/dL), postprandial glucose (96, 97, and 105 mg/dL), mean glucose level during the night (77, 71, and 75 mg/dL), and area under the glycemia curve (281, 315, and 310). Moreover, no significant difference was found in the total duration of glycemia below 60 mg/dL (317, 300, and 370 minutes) or the duration of glycemia of more than 120 mg/dL (259, 225, and 394 minutes) in group N, G1, and G2, respectively. With use of the CGMS, however, in comparison with SMBG, a wider range of glycemic levels was observed in all 3 study groups: for the healthy, pregnant women, 41 to 194 mg/dL versus 61 to 151 mg/dL; for G1, 40 to 244 mg/dL versus 40 to 180 mg/dL; and for G2, 40 to 173 mg/dL versus 50 to 157 mg/dL. CONCLUSION: The therapy, based on SMBG levels, when applied to the group of women with GDM, brought the glucose levels under effective control, with mean outcome values similar to those observed in the group of normal pregnant women. Nevertheless, using the CGMS, we detected long, asymptomatic periods of high and low blood glucose levels, both in the patients with GDM and in the unaffected pregnant women. The use of the CGMS for monitoring blood glucose profiles might be beneficial in this group of pregnant women.

Adult↗