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At least 127 records · Page 7Linked to original sources

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↗

PubMed2001

Continuous glucose monitoring in children with glycogen storage disease type I.

Glycogen storage disease type I (GSD I) is characterized by impaired production of glucose from glycogenolysis and gluconeogenesis resulting in severe fasting hypoglycaemia. The aim of the present study was to examine the efficacy of a continuous subcutaneous glucose monitoring system (CGMS MiniMed), to determine the magnitude and significance of hypoglycaemia in GSD I and to evaluate the efficacy of its dietary treatment. Four children with GSD I were studied over a 72-h period. Results indicated that the values recorded with continuous subcutaneous glucose monitoring were highly correlated with paired blood glucose values measured by glucometer. Significant periods of asymptomatic hypoglycaemia were noted, especially during night-time. The study suggests that repeated continuous subcutaneous glucose monitoring may serve as a useful tool for the assessment of the long-term management of GSD I patients.

Adolescent↗

PubMedDate not supplied

A continuous glucose monitoring system based on microdialysis.

The development of a system for continuous glucose measurement is described. A microdialysis fibre is used to continuously withdraw the glucose sample. After passing through the microdialysis fibre the perfusion liquid enters a micro-enzyme reactor which is filled with immobilized glucose oxidase. The enzyme activity, which varies with the glucose concentration, is monitored by an oxygen electrode. The measuring system can be adapted to a desired dynamic range by varying the perfusion rate. The measurement system has been calibrated for two different perfusion rates and shows a linear response to glucose concentrations between 0-3.5 mmol at 12 microliters/min and 0-8 mmol at 25 microliters/min. A probe, which can be configured with different lengths of the dialysing fibre, has also been designed to enable subcutaneous insertion of the microdialysis fibre in clinical studies. Subcutaneous glucose sampling by means of microdialysis is suggested to be used in the design of a glucose monitoring device for clinical use.

Blood Glucose↗

PubMed2004

[The glycemic excursions in normal glucose tolerance individuals revealed by continuous glucose monitoring system].

OBJECTIVE: To probe more details about the daily glycemic excursions in normal glucose tolerance (NGT) individuals. METHODS: The fluctuations of glucose levels in 43 NGT individuals were measured by continuous glucose monitoring system (CGMS) for (72 +/- 7) hours. RESULTS: The number of glucose values detected by CGMS amounted to 858 +/- 77 with a mean absolute difference (MAD) of 8.9% +/- 3.0%. The CGMS values in this study were significantly correlated with the plasma glucose and capillary glucose measurements (n = 204, r = 0.93; n = 804, r = 0.95; both P < 0.001). The glycemic excursions revealed that the daily glycemic levels were lower at night and before meals, the climax of daily glycemic level tended to appear 1- 2 hours after meals, particularly after dinner. The average glycemic value was 5.3 mmol/L. The daily glycemic peak and nadir levels were (7.8 +/- 1.4) mmol/L and (3.9 +/- 0.7) mmol/L respectively; the difference between maximal and minimal glucose levels was (3.9 +/- 1.6) mmol/L. Twenty-seven of the 43 individuals (63%) showed glycemic excursion above 7.8 mmol/L, and 9 individuals (21%) showed brief glycemic excursion below 2.8 mmol/L. During 95% (74% - 100%) of the daytime the glycemic level drifted to and fro between 3.3 mmol/L and 7.0 mmol/L; and during 99% (87% - 100%) of the daytime the glycemic level drifted to and fro between 2.8 mmol/L and 7.8 mmol/L. CONCLUSION: The profile of glycemic excursion in NGT individuals may have an important significance in defining the diagnostic cut-points and targets for glycemic control on diabetes mellitus.

Adult↗

PubMed2006

[Continuous glucose monitoring in high-risk subjects for developing type 2 diabetes].

BACKGROUND AND OBJECTIVE: To assess the relevance of unrecognised hyperglycaemia among high-risk subjects for developing type 2 diabetes. SUBJECTS AND METHOD: Cross-sectional multicentre study in primary care. Subjects aged 40 to 75 years with previous evidence of impaired glucose metabolism were screened according to the World Health Organization rules by means of an oral glucose tolerance test (OGTT). Those with diabetes diagnostic criteria were excluded. An individualized 48-h ambulatory continuous glucose monitoring (CGM) calibrated by plasma values (Glucoday) was performed. Data from biosensor activity were computerized in order to identify hyperglycaemic records. RESULTS: 50 out of 64 screened subjects were included and evaluated; there were 30 female (60%). Mean age was 59 years; body mass index, 30.9; HbA1c, 5.3%, and HOMA, 2.8. Regarding the CGM results, 9 whole registers (18%) were rejected because of technical problems and 41 continuous profiles (72%) were analysed, corresponding to 17 (41.5%) subjects with normal OGTT and 24 (58.5%) with non-diabetic hyperglycaemia on OGTT. Mean CGM time with hyperglycaemia (fasting > or = 6.1 mmol/l or non-fasting > or = 7.8 mmol/l) accounted for 5.8 h, a 17.2% of the effective register per subject (33.8 h). Both groups matched the World Health Organization diabetes diagnostic interval (fasting > or = 7 mmol/l or non-fasting > or = 11.1 mmol/l): 1.1 h of effective register (3.6%) and 1.2 h (3.3%), respectively. CONCLUSIONS: The CGM evidenced a high degree of unrecognised hyperglycaemia among high-risk individuals. Therefore, casual plasma glucose measurements should be recommended to achieve early screening.

Adult↗

PubMed2001

Continuous glucose monitoring during pregnancy complicated by gestational diabetes mellitus.

Postprandial glucose has been reported to be the best predictor of neonatal macrosomia. Therefore, self-blood glucose monitoring (SBGM) protocols for diabetic pregnant women stress the importance of measuring blood glucose after meals. However, there is controversy in the literature. Traditionally, glucose monitoring has been prescribed at 2 hours after eating to coincide with the times a patient is at increased risk of hypoglycemia. Human regular insulin peaks at 2 to 3 hours after injection; thus, checking blood glucose at the 2-hour point is a relic of strategies to prevent hypoglycemia. In pregnancy, the emphasis has been on measuring during times when blood glucose levels are highest. One hour after the start of the meal has been shown to be the time of peak postprandial response in 90% of pregnant woman. Because glucose excursions may reach their maximum at varying times, based on the size and number of meals ingested, SBGM alone may not capture the full extent of total daily postprandial hyperglycemia. Because intermittent blood glucose monitoring underestimates the number of hyperglycemic events, a more accurate determination of postprandial glucose levels is necessary to decrease the risk of macrosomia in gestational diabetes mellitus. Continuous glucose monitoring may facilitate the detection of all postprandial peaks, including those due to unscheduled meals, and may provide an opportunity for better intervention by providing the complete glucose profile.

Blood Glucose Self-Monitoring↗

PubMedDate not supplied

What is hypoglycemia in patients with well-controlled type 1 diabetes treated by subcutaneous insulin pump with use of the continuous glucose monitoring system?

OBJECTIVE: To analyze 72-hour interstitial glucose concentrations measured by a glucose sensor in adult subjects. METHODS: We compared glucose levels in 10 patients with type 1 diabetes mellitus (DM-1) and 10 normal control subjects with use of the Medtronic Continuous Glucose Monitoring System (CGMS). Hypoglycemic events identified by the CGMS, the patients, or both were compared in the patients with DM-1. In addition, the results between two glucose sensors placed at similar sites in the same subject were evaluated. RESULTS: Hemoglobin A1c and mean glucose values were higher in the DM-1 group than in the control group (P<0.01), whereas time spent at glucose levels of less than 60, 60 to 79, and 121 to 150 mg/dL were similar between the two study groups. Time spent at glucose levels above 150 mg/dL was greater in the DM-1 group than in the control group (P<0.05). Of the 74 total hypoglycemic events in the patients with DM-1, the sensor and the patient recognized 14%, only the patient recognized 9% (confirmed by readings of <55 mg/dL on a glucose meter), and only the sensor detected 77%. Of note, 41% of the patient-identified symptomatic hypoglycemic events were missed by the CGMS. When one patient with DM-1 and one control subject wore two glucose sensors simultaneously, one and not the other sensor often identified "hypoglycemia," and the correlation was only fair to good by intraclass correlation analysis. CONCLUSION: Many asymptomatic "hypoglycemic events" identified by the CGMS may not be actual hypoglycemia. Hypoglycemia is both overreported and underreported with use of the CGMS. Thus, adjustment of insulin doses to reduce asymptomatic hypoglycemia identified by the CGMS alone may not be warranted.

Adult↗

PubMed2003

Hypoglycaemia after pancreas transplantation: usefulness of a continuous glucose monitoring system.

BACKGROUND: After pancreas transplantation (PTx) some patients report occasional symptoms of hypoglycaemia and at times, serious hypoglycaemia. Continuous blood glucose monitoring (CBGM) allows determination of the daily glucose profile and detection of unrecognized hypoglycaemia. The aims of our study were to determine the incidence of hypoglycaemia in PTx and evaluate whether the use of CBGM helps to detect unrecognized nocturnal hypoglycaemia. PATIENTS AND METHODS: We studied 12 patients (six males) with normal functioning PTx and kidney transplantation for more than 3 yr, with systemic drainage of endocrine secretion and stable immunosuppression. A 24-h CBGM using a microdialysis technique (GlucoDay, A. Menarini Diagnostics, Florence, Italy) was performed in all the patients. RESULTS: Three patients had asymptomatic recorded glucose levels below 3.3 nmol/L during the nocturnal period (01:00-07:00 hours) with the glucose levels during these episodes being 2.6, 2.5 and 2.5 nmol/L, and the duration of nocturnal hypoglycaemia being 27, 62 and 93 min, respectively, rising spontaneously without intervention. Patients with hypoglycaemia presented lower glycosylated haemoglobin levels when compared with those not presenting hypoglycaemic episodes, although basal glucose and insulin levels and insulin antibody titres were similar. In one of the three patients presenting hypoglycaemia CBGM was re-evaluated after including an extra snack at bedtime, with subsequent normalization of the blood glucose profile being observed. CONCLUSION: Unrecognized nocturnal hypoglycaemia is relatively frequent in patients with PTx and 24-h CBMG may be useful to detect these episodes.

Adult↗

PubMed2005

Validation of the Continuous Glucose Monitoring System (CGMS) by the use of two CGMS simultaneously in pregnant women with type 1 diabetes mellitus.

BACKGROUND: In pregnant women with type 1 diabetes tight glycemic control reduces perinatal complications. Intensive observation of glucose profiles is essential in the achievement of tight glycemic control. The recent availability of the Continuous Glucose Monitoring System (CGMS, Minimed, Sylmar, CA) creates the opportunity to obtain more complete glucose profiles. This study was aimed at evaluating the accuracy of the CGMS in pregnant women with type 1 diabetes. METHODS: Five pregnant women with type 1 diabetes were asked to use two CGMS devices simultaneously. The simultaneously measured glucose levels were analyzed using the Pearson correlation, the mean absolute difference, and Bland-Altman analysis. Second, the percentage of concordance of paired data in the hypoglycemic, normoglycemic, or hyperglycemic range was calculated. RESULTS: The correlation coefficient between simultaneously measured data was 0.94 (P < 0.001). The mean absolute difference was 1.1 +/- 0.8 mmol/L. Bland-Altman analysis shows that 95% of the data pairs have a difference < or = 1.74 mmol/L. Almost 80% of the data pairs could be classified in the same glucose range. In 81% of the non-concordant pairs, one glucose value was classified in the hypoglycemic range and one in the normoglycemic range. CONCLUSIONS: This study shows that the reproducibility of the CGMS in pregnant women with type 1 diabetes is adequate. This indicates that the CGMS is a useful tool in the management of type 1 diabetes in pregnant women. However, the CGMS should only be used as a supplementary method of daily glucose level measurement as a small degree of error, mainly in the hypoglycemic range, is present.

Blood Glucose↗

PubMed2003

Evaluation of a continuous glucose monitoring system in diabetic dogs.

The generation of a blood glucose curve is important for assessing the response to insulin therapy in diabetic dogs. Disadvantages of this technique include patient discomfort and the potential for missing transient hypo- or hyperglycaemic episodes. The aim of the current study was to evaluate a continuous glucose monitoring system (CGMS) for use in diabetic dogs. Interstitial fluid glucose concentrations were recorded in 10 diabetic dogs, every five minutes for up to 48 hours, using a subcutaneous sensor attached to the CGMS device. Blood glucose concentrations were measured simultaneously using a glucometer. The correlation between interstitial fluid and blood glucose values was 0.81 (P < 0.01). The largest discrepancies between the two sets of data were seen during the one- to three-hour period following feeding, suggesting that postprandial hyperglycaemia might not be reflected in the interstitial fluid. The authors conclude that the CGMS is a potentially valuable tool in the management of canine diabetic patients.

Animals↗

PubMed1998

Continuous glucose monitoring in the free-moving rat.

The aim of this work was to set up an experimental model of glycemic fluctuations for assessing in the conscious freely moving rat, the performance of a continuous glucose-monitoring system, using a pocket-calculator-size electronic control unit and a miniaturized subcutaneous glucose sensor. The well-known triphasic glycemic pattern following streptozotocin injection (initial peak and secondary hypoglycemia preceding the establishment of permanent hyperglycemia) was used as a way to obtain spontaneous changes in blood glucose level over a wide concentration range. This report demonstrates that streptozotocin injection produced highly reproducible changes in the current generated by the sensor: an initial peak and a secondary nadir, during which blood sampling provided the evidence of hyperglycemia associated with immunoreactive hypoinsulinemia, and of hypoglycemia associated with hyperinsulinemia, respectively. This reproducible experimental model should be valuable for the assessment of a continuous glucose-monitoring system.

Animals↗

PubMed2005

Continuous glucose monitoring system signals the occurrence of marked postprandial hyperglycemia in the elderly.

BACKGROUND: The aim of this study was to ascertain whether dysglycemic episodes occur in institutionalized elderly persons and, if that is the case, to determine whether such episodes are related to meal patterns. Another objective was to investigate the feasibility of subcutaneous (s.c.) glucose measurements in the elderly using a Medtronic MiniMed (Sylmar, CA) continuous glucose monitoring system (CGMS). METHODS: Nine nursing home residents (74-95 years old) without known diabetes or other metabolic disorders were included. The s.c. glucose level was measured for 3 days with the Medtronic MiniMed CGMS. Capillary blood glucose was measured four times daily with a Glucometer Elite device (Bayer, Leverkusen, Germany). Body mass index and basal metabolic rate were calculated, and food intake was recorded. RESULTS: The s.c. glucose level fluctuated noticeably over time; 22.5% of the values recorded during the 3-day period were > or = 8 mmol/L, and values < 3.5 mmol/L were rarely seen. A marked (> 5 mmol/L) and short-term (2-4 h) increase in s.c. glucose was seen after a meal. The mean capillary blood glucose concentration was 7.5 +/- 1.8 mmol/L. Capillary blood glucose > or = 8 mmol/L was recorded on 32.5% of the measurement occasions, and no values were < 3.5 mmol/L. The s.c. glucose values agreed with corresponding capillary blood glucose levels (mean r = 0.75; range 0.43-0.86). Five participants consumed less energy than recommended according to their age, weight, and physical activity level. CONCLUSIONS: Postprandial hyperglycemia frequently occurs in elderly people living in nursing homes. The CGMS is convenient to use to detect hyperglycemia in this age group.

Aged↗

PubMed2006

1,5-anhydroglucitol and postprandial hyperglycemia as measured by continuous glucose monitoring system in moderately controlled patients with diabetes.

OBJECTIVE: Postprandial hyperglycemia is often inadequately assessed in diabetes management. Serum 1,5-anhydroglucitol (1,5-AG) drops as serum glucose rises above the renal threshold for glucose and has been proposed as a marker for postprandial hyperglycemia. The objective of this study is to demonstrate the relationship between 1,5-AG and postprandial hyperglycemia, as assessed by the continuous glucose monitoring system (CGMS) in suboptimally controlled patients with diabetes. RESEARCH DESIGN AND METHODS: Patients with type 1 or type 2 diabetes and an HbA(1c) (A1C) between 6.5 and 8% with stable glycemic control were recruited from two sites. A CGMS monitor was worn for two consecutive 72-h periods. Mean glucose, mean postmeal maximum glucose (MPMG), and area under the curve for glucose above 180 mg/dl (AUC-180), were compared with 1,5-AG, fructosamine (FA), and A1C at baseline, day 4, and day 7. RESULTS: 1,5-AG varied considerably between patients (6.5 +/- 3.2 mug/ml [means +/- SD]) despite similar A1C (7.3 +/- 0.5%). Mean 1,5-AG (r = -0.45, P = 0.006) correlated with AUC-180 more robustly than A1C (r = 0.33, P = 0.057) or FA (r = 0.38, P = 0.88). MPMG correlated more strongly with 1,5-AG (r = -0.54, P = 0.004) than with A1C (r = 0.40, P = 0.03) or FA (r = 0.32, P = 0.07). CONCLUSIONS: 1,5-AG reflects glycemic excursions, often in the postprandial state, more robustly than A1C or FA. 1,5-AG may be useful as a complementary marker to A1C to assess glycemic control in moderately controlled patients with diabetes.

Deoxyglucose↗

PubMed2005

Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system.

BACKGROUND: We attempted to identify an optimal insulin pump meal bolus by comparing postprandial sensor glucose values following three methods of insulin pump meal bolusing for a consistent pizza meal. RESEARCH DESIGN AND METHODS: Twenty-four patients with type 1 diabetes participated in a study to compare postprandial glucose values following three meal bolus regimens for a consistent evening pizza meal. Each participant utilized the following insulin lispro regimens on consecutive evenings, and glucose values were tracked by the Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed, Northridge, CA): (a) single-wave bolus (100% of insulin given immediately); (b) 4-h dual-wave bolus (50% of insulin given immediately and 50% given over a 4-h period); and (c) 8-h dual-wave bolus (50% of insulin given immediately and 50% given over a 8-h period). Total insulin bolus amount was kept constant for each pizza meal. RESULTS: Divergence in blood glucose among the regimens was greatest at 8-12 h. The 8-h dual-wave bolus provided the best glycemic control and lowest mean glucose values (singlewave bolus, 133 mg/dL; 4-h dual-wave bolus, 145 mg/dL; 8-h dual-wave bolus, 104 mg/dL), leading to a difference in mean glucose of 29 mg/dL for the single-wave bolus versus the 8-h dual-wave bolus and 42 mg/dL for the 4-h dual-wave bolus versus the 8-h dual-wave bolus. The lower mean glucose in the 8-h dual-wave bolus was not associated with any increased incidence of hypoglycemia. CONCLUSIONS: Use of a dual-wave bolus extended over an 8-h period following a pizza meal provided significantly less postprandial hyperglycemia in the late postprandial period (8-12 h) with no increased risk of hypoglycemia.

Adult↗

PubMed2006

Continuous glucose monitoring -- a novel approach to the determination of the glycaemic index of foods (DEGIF 1) -- determination of the glycaemic index of foods by means of the CGMS.

UNLABELLED: The glycaemic index (GI) is a measure of the food power to raise plasma glucose (PG) concentration after a meal. For its determination, classical methods register the development of glucose concentration in capillary plasma or whole blood. The aim of this prospective open-label trial was to compare the GI of selected foods obtained by means of the Continuous Glucose Monitoring System (CGMS) (Minimed Medtronic, Northridge, USA) which has not been applied for this purpose until now, with the respective GI determined by a conventional method using the Glucometer Advance System (GAS) (Hypoguard, Woodbridge, United Kingdom), and to assess the advantages of each approach. METHODS: Portions of tested foods containing 50 g of carbohydrates were eaten for breakfast and for dinner after 10 and 4 h fast, respectively, by 20 healthy volunteers. Using GAS, PG-curves were constructed from 9 PG values at time 0, 15, 30, 45, 60, 75, 90, 105 and 120 min after the meal, and, using CGMS, from 25 values of interstitial fluid glucose concentration (ISFG) stored within 120 min in 5-minute intervals in CGMS memory. The GI was calculated (for GAS and CGMS separately) by dividing the incremental area under the curve for the tested food by the average area of 3 tests performed with the standard. Having excluded tests with missing glucose values, there remained 285 GAS- and 290 CGMS tests for further analysis. In each volunteer, each food was tested 3 times within one week so that 1 to 3 GI's were obtained and averaged. The GI for each tested food was calculated as the mean from the respective average GI's of 20 volunteers. The GI-variability was assessed according to the respective SD. The preference of GAS vs. CGMS in the persons tested was explored by means of a questionnaire. MS Excel and the statistical program SPSS v. 10.1 were used to analyze the data. RESULTS: The GI values (mean +/- SD) measured by GAS/CGMS were for dark chocolate 43.6 +/- 22.13 %/44.0 +/- 21.71 % (p > 0.01); for apple baby food 46.1 +/- 21.38 %/53.8 +/- 37.69 % (p > 0.01); for puffed rice squares 76.5 +/- 20.24 %/76.9 +/- 27.62 % (p > 0.01); for yogurt 43.2 +/- 20.17 %/37.7 +/- 21.55 % (p > 0.01). The GI's of dark chocolate, apple baby food and yogurt, determined by either method, were significantly lower than the GI of puffed rice squares (p < 0.01). CGMS was preferred by 12 of 20 volunteers (60 %). CONCLUSIONS: No significant difference could be seen between the GI's determined by conventional method (GAS) and by CGMS (p > 0.01). The method with CGMS is reliable and comfortable for both tested persons and investigators. Hence, it appears to become a sophisticated approach to determine the GI.

Adult↗

PubMed2005

[Usefulness of continuous glucose monitoring system (CGMS) in monitoring glycaemic profile in small children with diabetes type 1].

BACKGROUND: Improved methods of diabetes therapy result in a near normoglycaemic state in many patients. This leads however unfortunately to more frequent hypoglycaemic incidents. Particularly small children, whose nervous system is not fully mature, are at high risk of central nervous system damage in case of hypoglycaemia. A new method of detail monitoring of glycaemia provides CGMS system. OBJECTIVES: The aim of the study was to compare the glycaemic profile, with high attention to hypoglycaemia in groups of young and older children with diabetes type 1, using CGMS and routine glucose meter. MATERIAL AND METHODS: We studied 32 children with diabetes type 1. Children were divided into groups: group I--small children, n=17 (<7 yrs of age), mean age 5,8 years, with disease duration--2,46 years, with mean HbA1c level--7,22%, and group II--older children, n=15 (>10 years of age), mean age--12 years, with disease duration--3 years, with HbA1c level--7,21%. Continuous glucose monitoring system (CGMS), by MiniMed, was applied in outpatient or hospital conditions, after short training of patient and parents; together with routine glucose meter measurements, 4-8 times/24 hours. In 9 patients from small children group CGMS was repeated after 2 months. RESULTS: Hypoglycaemic incidents detected with CGMS were similar in both groups: 4,6 in I group vs. 4,2 in II group (ns). Hypoglycaemic incidents found with meter were lower in I group--1,6 vs. 2,3 in II group (ns). Mean hypoglycaemic time/24 hour was longer in small children group: 101 min vs. 74 min in group II (p<00,05). In I group we found higher number of hypoglycaemic incidents during the night compared to group II--1,7 vs. 0,8 (p<00,05) and longer duration of night hypoglycaemia: in I group--56 min vs. 32 min in group II (p<00,05). Repeated CGMS study in 9 children from I group revealed decreased mean time of hypoglycaemia/24 hours from 134 min/24 h to 90 min/24 h (p<00,05) and decreased time of night hypoglycaemia from 65 min to 40 min (p<00,05), with a comparable number of hypoglycaemic incidents. Hypoglycaemic incidents found with routine meter measurements in small children were 1,6 vs. 4,6 hypoglycaemia found with CGMS (p<00,05), in the older children group routine measurement found 2,3 hypoglycaemia vs. 4,2 detected with CGMS (ns). CONCLUSIONS: 1. CGMS can be particularly usefull in monitoring glucose profile and detecting hypoglycaemia incidents, mainly nocturnal in small children. 2. CGMS allows to verify meal dose of insulin and to decrease postprandial hyperglycaemia. 3. Modification of insulin therapy on the base of CGMS helps to decrease the time of hypoglycaemia and hyperglycemia, particularly during the night.

Age Factors↗

PubMedDate not supplied

Evaluation of a new real-time blood continuous glucose monitoring system in pregnant women without gestational diabetes. A pilot study.

The incidence of gestational diabetes mellitus (GDM) has reached epidemic proportions in the United States, affecting 200,000 pregnant women annually. Controversies exist regarding whether the glucose levels used to diagnose GDM in pregnancy should be lowered since similar fetal complications are seen in women with GDM as well as in nondiabetic women. Although GDM has been extensively studied, the effects of the earlier stage of glucose intolerance are not well understood. The objectives of this descriptive, comparative, correlational pilot study include assessment of real-time blood glucose concentrations in women (20) with idiopathic macrosomia and/or polyhydramnios but with a normal baseline glucose screening test. This group was compared to pregnant women (20) without idiopathic macrosomia and/or polyhydromnios as confirmed by normal ultrasounds (controls). All subjects had a normal screeing test and/or a 3-hour Glucose Tolerance Test earlier in the pregnancy and wore a continuous glucose monitoring system for 72 hours. No adverse maternal complications were seen. Neonatal complications included macrosomia, shoulder dystocia, and hyperbilirubinemia. There was no significant association between real-time blood glucose levels and adverse maternal or fetal/neonatal complications. There is little evidence available regarding real-time physiologic glycemic levels in pregnant women. The findings of our pilot study provide baseline data for the design of a larger study to compare blood glucose levels and complications in euglycemic women and compare to women with those impaired glucose tolerance.

Adult↗

PubMed1999

Continuous glucose monitoring: long-term implantable sensor approach.

Problems with existing glucose monitoring technology have resulted in poor compliance with recommended monitoring guidelines by patients with diabetes. To achieve the goal of tight glucose control by patients with diabetes, a long-term implantable glucose sensor should meet the following functional requirements: it should be a one-time minimally invasive implantable with a wireless external unit; provide on-demand real-time glucose levels and trends; operate for up to 12 months after implantation with infrequent recalibration; contain built-in hypoglycemic and hyperglycemic alarms; and have an ergonomically designed, external, wearable user interface. Measurements of glucose in interstitial fluid (ISF) can be used for long-term monitoring. A novel approach to continuous and long-term glucose sensing could be based on measuring the changes in fluorescence of glucose-sensitive indicator molecules. To measure these changes in fluorescence a miniature optoelectronic device with a glucose sensitive indicator could be implanted subcutaneously for long-term remote operation. The fluorescence-based glucose sensing process is reversible and does not consume glucose. The combination of fluorescence-based glucose detection, sensor miniaturization and the use of biomaterials, inducing neovascularization at the implant site, opens the opportunity for achieving the requirements for long-term, continuous and convenient glucose monitoring.

Blood Glucose↗