Remote Blood Glucose Monitoring in mHealth Scenarios: A Review

Directory of Open Access Journals (Sweden)

Giordano Lanzola

2016-11-01

Full Text Available Glucose concentration in the blood stream is a critical vital parameter and an effective monitoring of this quantity is crucial for diabetes treatment and intensive care management. Effective bio-sensing technology and advanced signal processing are therefore of unquestioned importance for blood glucose monitoring. Nevertheless, collecting measurements only represents part of the process as another critical task involves delivering the collected measures to the treating specialists and caregivers. These include the clinical staff, the patient’s significant other, his/her family members, and many other actors helping with the patient treatment that may be located far away from him/her. In all of these cases, a remote monitoring system, in charge of delivering the relevant information to the right player, becomes an important part of the sensing architecture. In this paper, we review how the remote monitoring architectures have evolved over time, paralleling the progress in the Information and Communication Technologies, and describe our experiences with the design of telemedicine systems for blood glucose monitoring in three medical applications. The paper ends summarizing the lessons learned through the experiences of the authors and discussing the challenges arising from a large-scale integration of sensors and actuators.

Optical coherence tomography for blood glucose monitoring in vitro through spatial and temporal approaches

Science.gov (United States)

De Pretto, Lucas Ramos; Yoshimura, Tania Mateus; Ribeiro, Martha Simões; Zanardi de Freitas, Anderson

2016-08-01

As diabetes causes millions of deaths worldwide every year, new methods for blood glucose monitoring are in demand. Noninvasive approaches may increase patient adherence to treatment while reducing costs, and optical coherence tomography (OCT) may be a feasible alternative to current invasive diagnostics. This study presents two methods for blood sugar monitoring with OCT in vitro. The first, based on spatial statistics, exploits changes in the light total attenuation coefficient caused by different concentrations of glucose in the sample using a 930-nm commercial OCT system. The second, based on temporal analysis, calculates differences in the decorrelation time of the speckle pattern in the OCT signal due to blood viscosity variations with the addition of glucose with data acquired by a custom built Swept Source 1325-nm OCT system. Samples consisted of heparinized mouse blood, phosphate buffer saline, and glucose. Additionally, further samples were prepared by diluting mouse blood with isotonic saline solution to verify the effect of higher multiple scattering components on the ability of the methods to differentiate glucose levels. Our results suggest a direct relationship between glucose concentration and both decorrelation rate and attenuation coefficient, with our systems being able to detect changes of 65 mg/dL in glucose concentration.

Non-invasive blood glucose monitor based on spectroscopy using a smartphone.

Science.gov (United States)

Dantu, Vishnu; Vempati, Jagannadh; Srivilliputhur, Srinivasan

2014-01-01

Development of a novel method for non-invasive measurement of blood glucose concentration using smartphone is discussed. Our research work has three major contributions to society and science. First, we modified and extended the Beer-Lambert's law in physics to accommodate for multiple wavelengths. This extension can aid researchers who wish to perform optical spectroscopy. Second, we successfully developed a creative and non-invasive way for diabetic patients to measure glucose levels via a smartphone. Researchers and chemists can now use their smartphones to determine the absorbance and, therefore, concentration of a chemical. Third, we created an inexpensive way to perform optical spectroscopy by using a smartphone. Monitoring blood glucose using a smartphone application that simply uses equipment already available on smartphones will improve the lives of diabetic patients who can continuously check their blood glucose levels while avoiding the current inconvenient, unhygienic, and costly invasive glucose meters.

Application of optical coherence tomography for noninvasive blood glucose monitoring during hyperglycemia

Science.gov (United States)

Larin, Kirill V.; Ashitkov, Taras V.; Motamedi, Massoud; Esenaliev, Rinat O.

2003-10-01

Approximately 14 million people in the USA and more than 140 million people worldwide suffer from Diabetes Mellitus. The current glucose sensing technique involves a finger puncture several times a day to obtain a droplet of blood for chemical analysis. Recently we proposed to use optical coherence tomography (OCT) for continuous noninvasive blood glucose sensing through skin. In this paper we tested the OCT technique for noninvasive monitoring of blood glucose concentration in lip tissue of New Zealand rabbits and Yucatan micropigs during glucose clamping experiments. Obtained results show good agreement with results obtained in skin studies, good correlation of changes in the OCT signal slope measured at the depth of 250 to 500 μm with changes in blood glucose concentration, and higher stability of the OCT data points than that obtained from skin.

Non Invasive Glucose Monitoring System Using Nanosensors

Directory of Open Access Journals (Sweden)

Rajasekaran C.

2016-03-01

Full Text Available The most existing future technology is an outcome of the fields of computer science, electronics and Biology. Health inequalities have become the focus of a number of descriptive and analytical studies. One of the health related problem is diabetes. Diabetes at its serious stage leads to blindness. Monitoring glucose level in blood is one preventive measure to check diabetes. Increase in Glucose is a common risk factor which leads to hyperglycemia, Hypoglycemia, heart attack, stokes and aneurysms. A glucose monitoring system continuously measures and monitors the glucose level in a patient’s blood. Normal blood glucose level of human is 70-110 milligram/deciliter. The level is maintained by using the secretion of insulin inside the body. When the insulin level gets increased it leads to hyperglycemia, and hypoglycemia when the level gets decreased. Hyperglycemia disease includes cataract,edema, hypertension, polyuria and polydipsia. Hypoglycemaia disease includes confusion, giddiness, unconsciousness, coma and death. The proposed system finds a new way for measuring the glucose level. The work uses Nanopellets which measure’s the glucose level, when the glucose level gets increased or decreased, it will be automatically get monitored and processed using microcontroller (MSP430G2553. The information is then send to the doctor through GSM.

Determination of Blood Glucose Concentration by Using Wavelet Transform and Neural Networks

Directory of Open Access Journals (Sweden)

Vajravelu Ashok

2013-03-01

Full Text Available Background: Early and non-invasive determination of blood glucose level is of great importance. We aimed to present a new technique to accurately infer the blood glucose concentration in peripheral blood flow using non-invasive optical monitoring system.Methods: The data for the research were obtained from 900 individuals. Of them, 750 people had diabetes mellitus (DM. The system was designed using a helium neon laser source of 632.8 nm wavelength with 5mW power, photo detectors and digital storage oscilloscope. The laser beam was directed through a single optical fiber to the index finger and the scattered beams were collected by the photo detectors placed circumferentially to the transmitting fiber. The received signals were filtered using band pass filter and finally sent to a digital storage oscilloscope. These signals were then decomposed into approximation and detail coefficients using modified Haar Wavelet Transform. Back propagation neural and radial basis functions were employed for the prediction of blood glucose concentration.Results: The data of 450 patients were randomly used for training, 225 for testing and the rest for validation. The data showed that outputs from radial basis function were nearer to the clinical value. Significant variations could be seen from signals obtained from patients with DM and those without DM.Conclusion: The proposed non-invasive optical glucose monitoring system is able to predict the glucose concentration by proving that there is a definite variation in hematological distribution between patients with DM and those without DM.

Continuous glucose monitoring in subcutaneous tissue using factory-calibrated sensors: a pilot study.

Science.gov (United States)

Hoss, Udo; Jeddi, Iman; Schulz, Mark; Budiman, Erwin; Bhogal, Claire; McGarraugh, Geoffrey

2010-08-01

Commercial continuous subcutaneous glucose monitors require in vivo calibration using capillary blood glucose tests. Feasibility of factory calibration, i.e., sensor batch characterization in vitro with no further need for in vivo calibration, requires a predictable and stable in vivo sensor sensitivity and limited inter- and intra-subject variation of the ratio of interstitial to blood glucose concentration. Twelve volunteers wore two FreeStyle Navigator (Abbott Diabetes Care, Alameda, CA) continuous glucose monitoring systems for 5 days in parallel for two consecutive sensor wears (four sensors per subject, 48 sensors total). Sensors from a prototype sensor lot with a low variability in glucose sensitivity were used for the study. Median sensor sensitivity values based on capillary blood glucose were calculated per sensor and compared for inter- and intra-subject variation. Mean absolute relative difference (MARD) calculation and error grid analysis were performed using a single calibration factor for all sensors to simulate factory calibration and compared to standard fingerstick calibration. Sensor sensitivity variation in vitro was 4.6%, which increased to 8.3% in vivo (P glucose monitoring is feasible with similar accuracy to standard fingerstick calibration. Additional data are required to confirm this result in subjects with diabetes.

Noninvasive glucose monitoring using saliva nano-biosensor

Directory of Open Access Journals (Sweden)

Wenjun Zhang

2015-06-01

Full Text Available Millions of people worldwide live with diabetes and several millions die from it each year. A noninvasive, painless method of glucose testing would highly improve compliance and glucose control while reducing complications and overall disease management costs. To provide accurate, low cost, and continuous glucose monitoring, we have developed a unique, disposable saliva nano-biosensor. More than eight clinical trials on real-time noninvasive salivary glucose monitoring were carried out on two healthy individuals (a 2–3 h-period for each trial, including both regular food and standard glucose beverage intake with more than 35 saliva samples obtained. Excellent clinical accuracy was revealed as compared to the UV Spectrophotometer. By measuring subjects’ salivary glucose and blood glucose in parallel, we found the two generated profiles share the same fluctuation trend but the correlation between them is individual dependent. There is a time lag between the peak glucose values from blood and from saliva. However, the correlation between the two glucose values at fasting is constant for each person enabling noninvasive diagnosis of diabetes through saliva instead of blood. Furthermore, a good correlation of glucose levels in saliva and in blood before and 2 h after glucose intake was observed. Glucose monitoring before and 2 h after meals is usually prescribed by doctors for diabetic patients. Thus, this disposable biosensor will be an alternative for real-time salivary glucose tracking at any time.

Micro-Electromechanical Affinity Sensor for the Monitoring of Glucose in Bioprocess Media

Directory of Open Access Journals (Sweden)

Lorenz Theuer

2017-06-01

Full Text Available An affinity-viscometry-based micro-sensor probe for continuous glucose monitoring was investigated with respect to its suitability for bioprocesses. The sensor operates with glucose and dextran competing as binding partner for concanavalin A, while the viscosity of the assay scales with glucose concentration. Changes in viscosity are determined with a micro-electromechanical system (MEMS in the measurement cavity of the sensor probe. The study aimed to elucidate the interactions between the assay and a typical phosphate buffered bacterial cultivation medium. It turned out that contact with the medium resulted in a significant long-lasting drift of the assay’s viscosity at zero glucose concentration. Adding glucose to the medium lowers the drift by a factor of eight. The cglc values measured off-line with the glucose sensor for monitoring of a bacterial cultivation were similar to the measurements with an enzymatic assay with a difference of less than ±0.15 g·L−1. We propose that lectin agglomeration, the electro-viscous effect, and constitutional changes of concanavalin A due to exchanges of the incorporated metal ions may account for the observed viscosity increase. The study has demonstrated the potential of the MEMS sensor to determine sensitive viscosity changes within very small sample volumes, which could be of interest for various biotechnological applications.

Continuous glucose monitoring systems for type 1 diabetes mellitus

NARCIS (Netherlands)

Langendam, Miranda; Luijf, Yoeri M.; Hooft, Lotty; DeVries, J. Hans; Mudde, Aart H.; Scholten, Rob J. P. M.

2012-01-01

Background Self-monitoring of blood glucose is essential to optimise glycaemic control in type 1 diabetes mellitus. Continuous glucose monitoring (CGM) systems measure interstitial fluid glucose levels to provide semi-continuous information about glucose levels, which identifies fluctuations that

Accuracy of a Flash Glucose Monitoring System in Diabetic Dogs

OpenAIRE

Corradini, S.; Pilosio, B.; Dondi, F.; Linari, G.; Testa, S.; Brugnoli, F.; Gianella, P.; Pietra, M.; Fracassi, F.

2016-01-01

Background A novel flash glucose monitoring system (FGMS) (FreeStyle Libre, Abbott, UK) was recently developed for humans. It continuously measures the interstitial glucose (IG) concentrations for 14 days. Objectives To assess the clinical and analytical accuracy of the FGMS in diabetic dogs. Animals Ten client?owned diabetic dogs on insulin treatment. Methods Prospective and observational study. The FGMS was placed on the neck for up to 14 days. During the 1st?2nd, 6?7th, and 13?14th days fr...

Continuous Glucose Monitoring (CGM) or Blood Glucose Monitoring (BGM): Interactions and Implications.

Science.gov (United States)

Heinemann, Lutz

2018-04-01

At the 2017 10th annual International Conference on Advanced Technologies and Treatments for Diabetes (ATTD) in Paris, France, four speakers presented their perspectives on the roles of continuous glucose monitoring (CGM) and of blood glucose monitoring (BGM) in patient management within one symposium. These presentations included discussions of the differences in the accuracy of CGM and BGM, a clinical perspective on the physiological reasons behind differences in CGM and BGM values, and an overview of the impact of variations in device accuracy on patients with diabetes. Subsequently a short summary of these presentations is given, highlighting the value of good accuracy of BGM or CGM systems and the ongoing need for standardization. The important role of both BGM and CGM in patient management was a theme across all presentations.

Recent advances in noninvasive glucose monitoring

Directory of Open Access Journals (Sweden)

So CF

2012-06-01

Full Text Available Chi-Fuk So,1 Kup-Sze Choi,1 Thomas KS Wong,2 Joanne WY Chung2,31Centre for Integrative Digital Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, 2Department of Nursing and Health Sciences, Tung Wah College, Hong Kong, 3Department of Health and Physical Education, The Hong Kong Institute of Education, Hong KongAbstract: The race for the next generation of painless and reliable glucose monitoring for diabetes mellitus is on. As technology advances, both diagnostic techniques and equipment improve. This review describes the main technologies currently being explored for noninvasive glucose monitoring. The principle of each technology is mentioned; its advantages and limitations are then discussed. The general description and the corresponding results for each device are illustrated, as well as the current status of the device and the manufacturer; internet references for the devices are listed where appropriate. Ten technologies and eleven potential devices are included in this review. Near infrared spectroscopy has become a promising technology, among others, for blood glucose monitoring. Although some reviews have been published already, the rapid development of technologies and information makes constant updating mandatory. While advances have been made, the reliability and the calibration of noninvasive instruments could still be improved, and more studies carried out under different physiological conditions of metabolism, bodily fluid circulation, and blood components are needed.Keywords: noninvasive, glucose monitoring, diabetes mellitus, blood glucose measurement

Toward CMOS image sensor based glucose monitoring.

Science.gov (United States)

Devadhasan, Jasmine Pramila; Kim, Sanghyo

2012-09-07

Complementary metal oxide semiconductor (CMOS) image sensor is a powerful tool for biosensing applications. In this present study, CMOS image sensor has been exploited for detecting glucose levels by simple photon count variation with high sensitivity. Various concentrations of glucose (100 mg dL(-1) to 1000 mg dL(-1)) were added onto a simple poly-dimethylsiloxane (PDMS) chip and the oxidation of glucose was catalyzed with the aid of an enzymatic reaction. Oxidized glucose produces a brown color with the help of chromogen during enzymatic reaction and the color density varies with the glucose concentration. Photons pass through the PDMS chip with varying color density and hit the sensor surface. Photon count was recognized by CMOS image sensor depending on the color density with respect to the glucose concentration and it was converted into digital form. By correlating the obtained digital results with glucose concentration it is possible to measure a wide range of blood glucose levels with great linearity based on CMOS image sensor and therefore this technique will promote a convenient point-of-care diagnosis.

Salivary glucose concentration and excretion in normal and diabetic subjects.

Science.gov (United States)

Jurysta, Cedric; Bulur, Nurdan; Oguzhan, Berrin; Satman, Ilhan; Yilmaz, Temel M; Malaisse, Willy J; Sener, Abdullah

2009-01-01

The present report aims mainly at a reevaluation of salivary glucose concentration and excretion in unstimulated and mechanically stimulated saliva in both normal and diabetic subjects. In normal subjects, a decrease in saliva glucose concentration, an increase in salivary flow, but an unchanged glucose excretion rate were recorded when comparing stimulated saliva to unstimulated saliva. In diabetic patients, an increase in salivary flow with unchanged salivary glucose concentration and glucose excretion rate were observed under the same experimental conditions. Salivary glucose concentration and excretion were much higher in diabetic patients than in control subjects, whether in unstimulated or stimulated saliva. No significant correlation between glycemia and either glucose concentration or glucose excretion rate was found in the diabetic patients, whether in unstimulated or stimulated saliva. In the latter patients, as compared to control subjects, the relative magnitude of the increase in saliva glucose concentration was comparable, however, to that of blood glucose concentration. The relationship between these two variables was also documented in normal subjects and diabetic patients undergoing an oral glucose tolerance test.

Non-invasive blood glucose monitoring with Raman spectroscopy: prospects for device miniaturization

International Nuclear Information System (INIS)

Wróbel, M.S.

2016-01-01

The number of patients with diabetes has reached over 350 million, and still continues to increase. The need for regular blood glucose monitoring sparks the interest in the development of modern detection technologies. One of those methods, which allows for noninvasive measurements, is Raman spectroscopy. The ability of infrared light to penetrate deep into tissues allows for obtaining measurements through the skin without its perforation. This paper presents the limitations and possibilities of non-invasive blood glucose monitoring with Raman spectroscopy. Especially focusing on the possibilities for device miniaturization. Such device incorporates a Raman spectrometer, a fiber-optical probe, and a computing device (microcontroller, smartphone, etc.) which calculates the glucose concentration using specialized algorithms. Simplification of device design, as well as turbidity correction technique and a new proposed method of synchronized detection are described

Challenges and perspectives in continuous glucose monitoring.

Science.gov (United States)

van Enter, Benjamin Jasha; von Hauff, Elizabeth

2018-04-24

Diabetes is a global epidemic that threatens the health and well-being of hundreds of millions of people. The first step in patient treatment is to monitor glucose levels. Currently this is most commonly done using enzymatic strips. This approach suffers from several limitations, namely it requires a blood sample and is therefore invasive, the quality and the stability of the enzymatic strips vary widely, and the patient is burdened by performing the measurement themselves. This results in dangerous fluctuations in glucose levels often going undetected. There is currently intense research towards new approaches in glucose detection that would enable non-invasive continuous glucose monitoring (CGM). In this review, we explore the state-of-the-art in glucose detection technologies. In particular, we focus on the physical mechanisms behind different approaches, and how these influence and determine the accuracy and reliability of glucose detection. We begin by reviewing the basic physical and chemical properties of the glucose molecule. Although these play a central role in detection, especially the anomeric ratio, they are surprisingly often overlooked in the literature. We then review state-of-the art and emerging detection methods. Finally, we survey the current market for glucometers. Recent results show that past challenges in glucose detection are now being overcome, thereby enabling the development of smart wearable devices for non-invasive continuous glucose monitoring. These new directions in glucose detection have enormous potential to improve the quality of life of millions of diabetics, as well as offer insight into the development, treatment and even prevention of the disease.

A label-free fiber-optic Turbidity Affinity Sensor (TAS) for continuous glucose monitoring.

Science.gov (United States)

Dutt-Ballerstadt, Ralph; Evans, Colton; Pillai, Arun P; Gowda, Ashok

2014-11-15

In this paper, we describe the concept of a novel implantable fiber-optic Turbidity Affinity Sensor (TAS) and report on the findings of its in-vitro performance for continuous glucose monitoring. The sensing mechanism of the TAS is based on glucose-specific changes in light scattering (turbidity) of a hydrogel suspension consisting of small particles made of crosslinked dextran (Sephadex G100), and a glucose- and mannose-specific binding protein - Concanavalin A (ConA). The binding of ConA to Sephadex particles results in a significant turbidity increase that is much greater than the turbidity contribution by the individual components. The turbidity of the TAS was measured by determining the intensity of light passing through the suspension enclosed within a small semi-permeable hollow fiber (OD: 220 μm, membrane thickness: 20 μm, molecular weight cut-off: 10 kDa) using fiber optics. The intensity of measured light of the TAS was proportional to the glucose concentration over the concentration range from 50mg/dL to 400mg/dL in PBS and whole blood at 37°C (R>0.96). The response time was approximately 4 min. The stability of the glucose response of the TAS decreased only slightly (by 20%) over an 8-day study period at 37°C. In conclusion, this study demonstrated proof-of-concept of the TAS for interstitial glucose monitoring. Due to the large signal amplitude of the turbidity change, and the lack of need for wavelength-specific emission and excitation filters, a very small, robust and compact TAS device with an extremely short optical pathlength could be feasibly designed and implemented for in-vivo glucose monitoring in people with diabetes. Copyright © 2014 Elsevier B.V. All rights reserved.

Continuous Monitoring of Glucose for Type 1 Diabetes: A Health Technology Assessment.

Science.gov (United States)

2018-01-01

Type 1 diabetes is a condition in which the pancreas produces little or no insulin. People with type 1 diabetes must manage their blood glucose levels by monitoring the amount of glucose in their blood and administering appropriate amounts of insulin via injection or an insulin pump. Continuous glucose monitoring may be beneficial compared to self-monitoring of blood glucose using a blood glucose meter. It provides insight into a person's blood glucose levels on a continuous basis, and can identify whether blood glucose levels are trending up or down. We conducted a health technology assessment, which included an evaluation of clinical benefit, value for money, and patient preferences related to continuous glucose monitoring. We compared continuous glucose monitoring with self-monitoring of blood glucose using a finger-prick and a blood glucose meter. We performed a systematic literature search for studies published since January 1, 2010. We created a Markov model projecting the lifetime horizon of adults with type 1 diabetes, and performed a budget impact analysis from the perspective of the health care payer. We also conducted interviews and focus group discussions with people who self-manage their type 1 diabetes or support the management of a child with type 1 diabetes. Twenty studies were included in the clinical evidence review. Compared with self-monitoring of blood glucose, continuous glucose monitoring improved the percentage of time patients spent in the target glycemic range by 9.6% (95% confidence interval 8.0-11.2) to 10.0% (95% confidence interval 6.75-13.25) and decreased the number of severe hypoglycemic events.Continuous glucose monitoring was associated with higher costs and small increases in health benefits (quality-adjusted life-years). Incremental cost-effectiveness ratios (ICERs) ranged from $592,206 to $1,108,812 per quality-adjusted life-year gained in analyses comparing four continuous glucose monitoring interventions to usual care

Blood glucose control and monitoring in the critically ill

NARCIS (Netherlands)

van Hooijdonk, R.T.M.

2015-01-01

This thesis deals with blood glucose control and blood glucose monitoring in intensive care unit (ICU) patients: two important aspects of care for and monitoring of critically ill patients. While the precise targets of blood glucose control in ICU patients remain a matter of debate, currently many,

PROFESSIONAL FLASH CONTINUOUS GLUCOSE MONITORING WITH AMBULATORY GLUCOSE PROFILE REPORTING TO SUPPLEMENT A1C: RATIONALE AND PRACTICAL IMPLEMENTATION.

Science.gov (United States)

Hirsch, Irl B; Verderese, Carol A

2017-11-01

Recent consensus statements strongly advocate downloading and interpreting continuous glucose data for diabetes management in patients with type 1 or 2 diabetes. Supplementing periodic glycated hemoglobin (A1C) testing with intermittent continuous glucose monitoring (CGM) using a standardized report form known as the ambulatory glucose profile (AGP) is an evolving standard of care. The rationale for this approach and its implementation with a recently approved novel monitoring technology are explored. Search of the medical literature, professional guidelines, and real-world evidence guided this introduction of an integrative practice framework that uses AGP in conjunction with intermittent flash continuous glucose monitoring (FCGM) as a supplement to A1C testing. The combination of intermittent continuous glucose pattern analysis, standardized glucose metrics, and a readily interpretable data report has the potential to practically extend the recognized benefits of CGM to more patients and clarify the relationship between A1C and average glucose levels in individual cases. Novel FCGM technologies portend greater use of continuous forms of glucose monitoring and wider adoption of AGP report analysis. Additional formal and empirical evidence is needed to more fully characterize best practice. A1C = glycated hemoglobin; AGP = ambulatory glucose profile; CGM = continuous glucose monitoring; FCGM = flash continuous glucose monitoring; IQR = interquartile range; SMBG = self-monitoring of blood glucose.

Continuous Monitoring of Glucose for Type 1 Diabetes: A Health Technology Assessment

Science.gov (United States)

Vandersluis, Stacey; Kabali, Conrad; Djalalov, Sandjar; Gajic-Veljanoski, Olga; Wells, David; Holubowich, Corinne

2018-01-01

Background Type 1 diabetes is a condition in which the pancreas produces little or no insulin. People with type 1 diabetes must manage their blood glucose levels by monitoring the amount of glucose in their blood and administering appropriate amounts of insulin via injection or an insulin pump. Continuous glucose monitoring may be beneficial compared to self-monitoring of blood glucose using a blood glucose meter. It provides insight into a person's blood glucose levels on a continuous basis, and can identify whether blood glucose levels are trending up or down. Methods We conducted a health technology assessment, which included an evaluation of clinical benefit, value for money, and patient preferences related to continuous glucose monitoring. We compared continuous glucose monitoring with self-monitoring of blood glucose using a finger-prick and a blood glucose meter. We performed a systematic literature search for studies published since January 1, 2010. We created a Markov model projecting the lifetime horizon of adults with type 1 diabetes, and performed a budget impact analysis from the perspective of the health care payer. We also conducted interviews and focus group discussions with people who self-manage their type 1 diabetes or support the management of a child with type 1 diabetes. Results Twenty studies were included in the clinical evidence review. Compared with self-monitoring of blood glucose, continuous glucose monitoring improved the percentage of time patients spent in the target glycemic range by 9.6% (95% confidence interval 8.0–11.2) to 10.0% (95% confidence interval 6.75–13.25) and decreased the number of severe hypoglycemic events. Continuous glucose monitoring was associated with higher costs and small increases in health benefits (quality-adjusted life-years). Incremental cost-effectiveness ratios (ICERs) ranged from $592,206 to $1,108,812 per quality-adjusted life-year gained in analyses comparing four continuous glucose monitoring

Monitoring of glucose levels in mouse blood with noninvasive optical methods

International Nuclear Information System (INIS)

Ullah, H; Ikram, M; Ahmed, E

2014-01-01

We report the quantification/monitoring of glucose levels in a blood sample using optical diffuse reflectance (ODR) underlying variations in optical parameters with a white light source (at peak wavelength ∼600 nm and range 450–850 nm) and in blood in vivo using M-mode optical coherence tomography (OCT) in terms of the translational diffusion coefficient (D T ). In the ODR experiments, we have investigated two types of mono-dispersive particles, i.e. polystyrene microspheres (PMSs) with diameters of 1.4 μm (variable concentrations) and 2.6 μm (fixed concentration) in a water phantom by observing changes in the reduced scattering coefficient. We believe that these differences in optical properties will be helpful for the understanding and optimal use of laser applications in blood glucometry without piercing the skin. In the OCT experiments, this idea of glucose monitoring was applied on an in vivo normal mouse without injection of glucose intravenously to provide the threshold levels by envisioning/identifying a blood vessel by speckle variance (SV-OCT) using a dorsal skinfold mouse windows chamber model. We report an average value of translation decorrelation time τ T = 41.18 ± 1.92 ms and D T = 8.90 × 10 −14  m 2  s −1 underlying the dynamic light scattering (DLS). Our results have a potential application in the quantification of higher glucose levels in vivo administrated intravenously. (paper)

Blood Glucose Monitoring Before and After Type 1 Diabetes Clinic Visits.

Science.gov (United States)

Driscoll, Kimberly A; Johnson, Suzanne Bennett; Wang, Yuxia; Wright, Nancy; Deeb, Larry C

2017-12-23

To determine patterns of blood glucose monitoring in children and adolescents with type 1 diabetes (T1D) before and after routine T1D clinic visits. Blood glucose monitoring data were downloaded at four consecutive routine clinic visits from children and adolescents aged 5-18 years. Linear mixed models were used to analyze patterns of blood glucose monitoring in patients who had at least 28 days of data stored in their blood glucose monitors. In general, the frequency of blood glucose monitoring decreased across visits, and younger children engaged in more frequent blood glucose monitoring. Blood glucose monitoring increased before the T1D clinic visits in younger children, but not in adolescents. It declined after the visit regardless of age. Members of the T1D care team need to consider that a T1D clinic visit may prompt an increase in blood glucose monitoring when making treatment changes and recommendations. Tailored interventions are needed to maintain that higher level of adherence across time. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

A technology roadmap of smart biosensors from conventional glucose monitoring systems.

Science.gov (United States)

Shende, Pravin; Sahu, Pratiksha; Gaud, Ram

2017-06-01

The objective of this review article is to focus on technology roadmap of smart biosensors from a conventional glucose monitoring system. The estimation of glucose with commercially available devices involves analysis of blood samples that are obtained by pricking finger or extracting blood from the forearm. Since pain and discomfort are associated with invasive methods, the non-invasive measurement techniques have been investigated. The non-invasive methods show advantages like non-exposure to sharp objects such as needles and syringes, due to which there is an increase in testing frequency, improved control of glucose concentration and absence of pain and biohazard materials. This review study is aimed to describe recent invasive techniques and major noninvasive techniques, viz. biosensors, optical techniques and sensor-embedded contact lenses for glucose estimation.

Nocturnal continuous glucose monitoring

DEFF Research Database (Denmark)

Bay, Christiane; Kristensen, Peter Lommer; Pedersen-Bjergaard, Ulrik

2013-01-01

Abstract Background: A reliable method to detect biochemical nocturnal hypoglycemia is highly needed, especially in patients with recurrent severe hypoglycemia. We evaluated reliability of nocturnal continuous glucose monitoring (CGM) in patients with type 1 diabetes at high risk of severe...

Data Based Prediction of Blood Glucose Concentrations Using Evolutionary Methods.

Science.gov (United States)

Hidalgo, J Ignacio; Colmenar, J Manuel; Kronberger, Gabriel; Winkler, Stephan M; Garnica, Oscar; Lanchares, Juan

2017-08-08

Predicting glucose values on the basis of insulin and food intakes is a difficult task that people with diabetes need to do daily. This is necessary as it is important to maintain glucose levels at appropriate values to avoid not only short-term, but also long-term complications of the illness. Artificial intelligence in general and machine learning techniques in particular have already lead to promising results in modeling and predicting glucose concentrations. In this work, several machine learning techniques are used for the modeling and prediction of glucose concentrations using as inputs the values measured by a continuous monitoring glucose system as well as also previous and estimated future carbohydrate intakes and insulin injections. In particular, we use the following four techniques: genetic programming, random forests, k-nearest neighbors, and grammatical evolution. We propose two new enhanced modeling algorithms for glucose prediction, namely (i) a variant of grammatical evolution which uses an optimized grammar, and (ii) a variant of tree-based genetic programming which uses a three-compartment model for carbohydrate and insulin dynamics. The predictors were trained and tested using data of ten patients from a public hospital in Spain. We analyze our experimental results using the Clarke error grid metric and see that 90% of the forecasts are correct (i.e., Clarke error categories A and B), but still even the best methods produce 5 to 10% of serious errors (category D) and approximately 0.5% of very serious errors (category E). We also propose an enhanced genetic programming algorithm that incorporates a three-compartment model into symbolic regression models to create smoothed time series of the original carbohydrate and insulin time series.

Optimization of a Liquid Crystal-based Sensory Platform for Monitoring Enzymatic Glucose Oxidation

Energy Technology Data Exchange (ETDEWEB)

Wei, Yibin; Jang, Chang-Hyun [Gachon University, Seongnam (Korea, Republic of)

2016-05-15

Managing glucose levels in human blood is extremely important for the treatment of diabetes. Here, an innovative sensory strategy has been developed to monitor the enzymatic activities of glucose and glucose oxidase by using confined liquid crystal (LC) birefringent droplet patterns. Acidic products released during the glucose oxidation process lead to a slight decrease in the pH of aqueous systems that can be monitored by pH-sensitive LC materials. Of the existing pH-sensitive LC materials, dodecanoic acid-doped 4-cyano-4'-pentylbiphenyl is inexpensive and easily adjusted to satisfy the 7.4 ± 0.05 pH requirement of human blood. Moreover, the orientational alignment of capillary-confined pH-responsive LCs can be disrupted at the aqueous/LC interface following a slight decrease in the critical pH of aqueous reaction systems, which results in an optical signal that can be observed with the naked eye by using polarizing optical microscopy. Based on the stable LC droplet patterns generated by the cylindrical confinement system, the functionalized LCs can selectively detect glucose at concentrations as low as 0.1 pM. This study further advances the previously reported LC-based glucose monitoring systems by reducing production costs and instituting a smarter LC sensory design. This improved system shows potential for the use in clinical bioassay applications.

Sleep/wake dependent changes in cortical glucose concentrations.

Science.gov (United States)

Dash, Michael B; Bellesi, Michele; Tononi, Giulio; Cirelli, Chiara

2013-01-01

Most of the energy in the brain comes from glucose and supports glutamatergic activity. The firing rate of cortical glutamatergic neurons, as well as cortical extracellular glutamate levels, increase with time spent awake and decline throughout non rapid eye movement sleep, raising the question whether glucose levels reflect behavioral state and sleep/wake history. Here chronic (2-3 days) electroencephalographic recordings in the rat cerebral cortex were coupled with fixed-potential amperometry to monitor the extracellular concentration of glucose ([gluc]) on a second-by-second basis across the spontaneous sleep-wake cycle and in response to 3 h of sleep deprivation. [Gluc] progressively increased during non rapid eye movement sleep and declined during rapid eye movement sleep, while during wake an early decline in [gluc] was followed by an increase 8-15 min after awakening. There was a significant time of day effect during the dark phase, when rats are mostly awake, with [gluc] being significantly lower during the last 3-4 h of the night relative to the first 3-4 h. Moreover, the duration of the early phase of [gluc] decline during wake was longer after prolonged wake than after consolidated sleep. Thus, the sleep/wake history may affect the levels of glucose available to the brain upon awakening. © 2012 The Authors Journal of Neurochemistry © 2012 International Society for Neurochemistry.

Twenty-four-hour variations in blood glucose level in Japanese type 2 diabetes patients based on continuous glucose monitoring.

Science.gov (United States)

Hajime, Maiko; Okada, Yosuke; Mori, Hiroko; Otsuka, Takashi; Kawaguchi, Mayuko; Miyazaki, Megumi; Kuno, Fumi; Sugai, Kei; Sonoda, Satomi; Tanaka, Kenichi; Kurozumi, Akira; Narisawa, Manabu; Torimoto, Keiichi; Arao, Tadashi; Tanaka, Yoshiya

2018-01-01

High fluctuations in blood glucose are associated with various complications. The correlation between glycated hemoglobin (HbA1c) level and fluctuations in blood glucose level has not been studied in Japanese patients with type 2 diabetes. In the present study, blood glucose profile stratified by HbA1c level was evaluated by continuous glucose monitoring (CGM) in Japanese type 2 diabetes patients. Our retrospective study included 294 patients with type 2 diabetes who were divided by HbA1c level into five groups (≥6.0 to level and CGM data was analyzed. The primary end-point was the difference in blood glucose fluctuations among the HbA1c groups. The mean blood glucose level increased significantly with increasing HbA1c (P trend  levels of maximum blood glucose, minimum blood glucose, each preprandial blood glucose, each postprandial maximum blood glucose, range of increase in postprandial glucose from pre-meal to after breakfast, the area under the blood concentration-time curve >180 mg/dL and percentage of the area under the blood concentration-time curve >180 mg/dL were higher with higher HbA1c. Mean glucose level and pre-breakfast blood glucose level were significant and independent determinants of HbA1c. In Japanese patients treated for type 2 diabetes, the mean amplitude of glycemic excursions did not correlate with HbA1c, making it difficult to assess blood glucose fluctuations using HbA1c. Parameters other than HbA1c are required to evaluate fluctuations in blood glucose level in patients receiving treatment for type 2 diabetes. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Evaluation of a Novel Glucose Area Under the Curve (AUC Monitoring System: Comparison with the AUC by Continuous Glucose Monitoring

Directory of Open Access Journals (Sweden)

Satoshi Ugi

2016-07-01

Full Text Available BackgroundManagement of postprandial hyperglycemia is a key aspect in diabetes treatment. We developed a novel system to measure glucose area under the curve (AUC using minimally invasive interstitial fluid extraction technology (MIET for simple monitoring of postprandial glucose excursions. In this study, we evaluated the relationship between our system and continuous glucose monitoring (CGM by comparing glucose AUC obtained using MIET with that obtained using CGM for a long duration.MethodsTwenty diabetic inpatients wearing a CGM system were enrolled. For MIET measurement, a plastic microneedle array was applied to the skin as pretreatment, and hydrogels were placed on the pretreated area to collect interstitial fluid. Hydrogels were replaced every 2 or 4 hours and AUC was predicted on the basis of glucose and sodium ion levels.ResultsAUC predicted by MIET correlated well with that measured by CGM (r=0.93. Good performances of both consecutive 2- and 4-hour measurements were observed (measurement error: 11.7%±10.2% for 2 hours and 11.1%±7.9% for 4 hours, indicating the possibility of repetitive measurements up to 8 hours. The influence of neither glucose fluctuation nor average glucose level over the measurement accuracy was observed through 8 hours.ConclusionOur system showed good relationship with AUC values from CGM up to 8 hours, indicating that single pretreatment can cover a large portion of glucose excursion in a day. These results indicated possibility of our system to contribute to convenient monitoring of glucose excursions for a long duration.

Evaluation of a Novel Glucose Area Under the Curve (AUC) Monitoring System: Comparison with the AUC by Continuous Glucose Monitoring.

Science.gov (United States)

Ugi, Satoshi; Maegawa, Hiroshi; Morino, Katsutaro; Nishio, Yoshihiko; Sato, Toshiyuki; Okada, Seiki; Kikkawa, Yasuo; Watanabe, Toshihiro; Nakajima, Hiromu; Kashiwagi, Atsunori

2016-08-01

Management of postprandial hyperglycemia is a key aspect in diabetes treatment. We developed a novel system to measure glucose area under the curve (AUC) using minimally invasive interstitial fluid extraction technology (MIET) for simple monitoring of postprandial glucose excursions. In this study, we evaluated the relationship between our system and continuous glucose monitoring (CGM) by comparing glucose AUC obtained using MIET with that obtained using CGM for a long duration. Twenty diabetic inpatients wearing a CGM system were enrolled. For MIET measurement, a plastic microneedle array was applied to the skin as pretreatment, and hydrogels were placed on the pretreated area to collect interstitial fluid. Hydrogels were replaced every 2 or 4 hours and AUC was predicted on the basis of glucose and sodium ion levels. AUC predicted by MIET correlated well with that measured by CGM (r=0.93). Good performances of both consecutive 2- and 4-hour measurements were observed (measurement error: 11.7%±10.2% for 2 hours and 11.1%±7.9% for 4 hours), indicating the possibility of repetitive measurements up to 8 hours. The influence of neither glucose fluctuation nor average glucose level over the measurement accuracy was observed through 8 hours. Our system showed good relationship with AUC values from CGM up to 8 hours, indicating that single pretreatment can cover a large portion of glucose excursion in a day. These results indicated possibility of our system to contribute to convenient monitoring of glucose excursions for a long duration.

[Design and implementation of real-time continuous glucose monitoring instrument].

Science.gov (United States)

Huang, Yonghong; Liu, Hongying; Tian, Senfu; Jia, Ziru; Wang, Zi; Pi, Xitian

2017-12-01

Real-time continuous glucose monitoring can help diabetics to control blood sugar levels within the normal range. However, in the process of practical monitoring, the output of real-time continuous glucose monitoring system is susceptible to glucose sensor and environment noise, which will influence the measurement accuracy of the system. Aiming at this problem, a dual-calibration algorithm for the moving-window double-layer filtering algorithm combined with real-time self-compensation calibration algorithm is proposed in this paper, which can realize the signal drift compensation for current data. And a real-time continuous glucose monitoring instrument based on this study was designed. This real-time continuous glucose monitoring instrument consisted of an adjustable excitation voltage module, a current-voltage converter module, a microprocessor and a wireless transceiver module. For portability, the size of the device was only 40 mm × 30 mm × 5 mm and its weight was only 30 g. In addition, a communication command code algorithm was designed to ensure the security and integrity of data transmission in this study. Results of experiments in vitro showed that current detection of the device worked effectively. A 5-hour monitoring of blood glucose level in vivo showed that the device could continuously monitor blood glucose in real time. The relative error of monitoring results of the designed device ranged from 2.22% to 7.17% when comparing to a portable blood meter.

Development of a nanowire based titanium needle probe sensor for glucose monitoring

Science.gov (United States)

Deshpande, Devesh C.

glucose monitoring. The working electrode of the sensor comprised of vertically aligned, free standing Au nanowires to utilize the advantages of nanostructures. The sensor was fabricated on biocompatible titanium substrate using Micro/Nano fabrication processes such as Plasma Enhanced Chemical Vapor Deposition (PECVD), Electron Beam Evaporation, Lithography, aligned nanowire growth and wet and plasma etching. Arrays of free-standing nanowires were grown at room temperature and pressure using a novel template based growth process. After fabrication of the sensor, immobilization of an enzyme was carried out on the sensing electrode to ensure selectivity of the sensor to glucose. This was achieved by using self-assembled thiol monolayers and entrapment in a conducting polymer matrix. Glucose oxidase was used for this purpose, which catalyzed the conversion of glucose to gluconic acid, producing hydrogen peroxide in the process. Amperometry was used for glucose detection, in which a constant voltage was applied to the sensor. This potential oxidized the hydrogen peroxide and produced changes in the current which were correlated to the glucose concentration. This dissertation will address the importance of continuous glucose monitoring, current technology and problems faced, the design and fabrication of the sensor and electrochemical sensing to detect glucose levels in solution. Finally, the problems encountered during the process will be discussed and the future work will be detailed.

Systematic review and meta-analysis of the effectiveness of continuous glucose monitoring (CGM) on glucose control in diabetes

OpenAIRE

Poolsup, Nalinee; Suksomboon, Naeti; Kyaw, Aye Mon

2013-01-01

Diabetes mellitus is a chronic disease that necessitates continuing treatment and patient self-care education. Monitoring of blood glucose to near normal level without hypoglycemia becomes a challenge in the management of diabetes. Although self monitoring of blood glucose (SMBG) can provide daily monitoring of blood glucose level and help to adjust therapy, it cannot detect hypoglycemic unawareness and nocturnal hypoglycemia which occurred mostly in T1DM pediatrics. Continuous glucose monito...

Continuous glucose monitoring for patients with diabetes: an evidence-based analysis.

Science.gov (United States)

2011-01-01

sensor is required. The device is equipped with alarms which warn the patient of impending hypo-or hyperglycemia. Two types of CGM are available: Systems that is stored in a monitor and can be downloaded later.Real time systems that continuously provide the actual glucose concentration on a display. What is the effectiveness and cost-effectiveness of CGM combined with SMBG compared with SMBG alone in the management of diabetes? A literature search was performed on September 15, 2010 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1, 2002 until September 15, 2010. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist, then a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low or very low according to GRADE methodology. English languageRandomized controlled trials (N>30 patients)Adults or pediatric patients with insulin dependent diabetes (type 1 or 2 or gestational)Studies comparing CGM plus SMBG versus SMBG alone Case studiesStudies that did not compare CGM plus SMBG versus SMBG aloneStudies that did not report statistical analysis of outcomes or data was unextractable Change in glycosylated hemoglobin (HbA1c)Frequency or duration of hypo-or hyperglycemic episodes or euglycemiaAdverse effects Moderate quality evidence that CGM + SMBG: is not more effective than self monitoring of blood glucose (SMBG) alone in the reduction of HbA1c using insulin infusion pumps for Type 1 diabetes.is not more effective than SMBG

Oral glucose tolerance test and continuous glucose monitoring to assess diabetes development in cystic fibrosis patients.

Science.gov (United States)

Clemente León, María; Bilbao Gassó, Laura; Moreno-Galdó, Antonio; Campos Martorrell, Ariadna; Gartner Tizzano, Silvia; Yeste Fernández, Diego; Carrascosa Lezcano, Antonio

2018-01-01

Patients with cystic fibrosis (CF) undergo a slow and progressive process toward diabetes. Oral glucose tolerance test (OGTT) is recommended to diagnose impaired glucose levels in these patients. Continuous glucose monitoring (CGM) measures glucose profiles under real-life conditions. To compare OGTT and CGM results in CF patients. Paired OGTT and 6-day CGM profiles (146.2±9.1h/patient) were performed in 30 CF patients aged 10-18 years. According to OGTT, 14 patients had normal glucose tolerance (NGT), 14 abnormal glucose tolerance (AGT), and two cystic fibrosis-related diabetes (CFRD). In 27 patients (13 NGT, 13 AGT, 1 CFRD), CGM showed glucose values ranging from 140 to 200mg/dL during similar monitoring times (2%-14% with NGT, 1%-16.9% with AGT, and 3% with CFRD). Glucose peak levels ≥200mg/dL were seen in seven patients (3 NGT, 3 AGT, 1 CFRD). According to CGM, two patients had all glucose values under 140mg/dL (1 NGT, 1 AGT). Seventeen patients had glucose levels ranging from 140 to 200mg/dL (10 NGT, 6 AGT, 1 CFRD). Ten patients (3 NGT, 7 AGT) had glucose values ≥200mg/dL for ≤1% of the monitoring time and one (CFRD) for >1% of the monitoring time. OGTT results did not agree with those of the CGM. CGM allows for diagnosis of glucose changes not detected by OGTT. Such changes may contribute to optimize pre-diabetes management in CF patients. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Electromagnetic Radiofrequency Radiation Emitted from GSM Mobile Phones Decreases the Accuracy of Home Blood Glucose Monitors

Science.gov (United States)

Mortazavi, SMJ; Gholampour, M; Haghani, M; Mortazavi, G; Mortazavi, AR

2014-01-01

Mobile phones are two-way radios that emit electromagnetic radiation in microwave range. As the number of mobile phone users has reached 6 billion, the bioeffects of exposure to mobile phone radiation and mobile phone electromagnetic interference with electronic equipment have received more attention, globally. As self-monitoring of blood glucose can be a beneficial part of diabetes control, home blood glucose testing kits are very popular. The main goal of this study was to investigate if radiofrequency radiation emitted from a common GSM mobile phone can alter the accuracy of home blood glucose monitors. Forty five female nondiabetic students aged 17-20 years old participated in this study. For Control-EMF group (30 students), blood glucose concentration for each individual was measured in presence and absence of radiofrequency radiation emitted by a common GSM mobile phone (HTC touch, Diamond 2) while the phone was ringing. For Control- Repeat group (15 students), two repeated measurements were performed for each participant in the absence of electromagnetic fields. The magnitude of the changes between glucose levels in two repeated measurements (|ΔC|) in Control-Repeat group was 1.07 ± 0.88 mg/dl while this magnitude for Control-EMF group was 7.53 ± 4.76 mg/dl (P electromagnetic interference in home blood glucose monitors. It can be concluded that electromagnetic interference from mobile phones has an adverse effect on the accuracy of home blood glucose monitors. We suggest that mobile phones should be used at least 50 cm away from home blood glucose monitors. PMID:25505778

Optical coherence tomography for glucose monitoring in blood

Science.gov (United States)

Ullah, Hafeez; Hussain, Fayyaz; Ikram, Masroor

2015-08-01

In this review, we have discussed the potential application of the emerging imaging modality, i.e., optical coherence tomography (OCT) for glucose monitoring in biological tissues. OCT provides monitoring of glucose diffusion in different fibrous tissues like in sclera by determining the permeability rate with acceptable accuracy both in type 1 and in type 2 diabetes. The maximum precision of glucose measurement in Intralipid suspensions, for example, with the OCT technique yields the accuracy up to 4.4 mM for 10 % Intralipid and 2.2 mM for 3 % Intralipid.

[Glucose-monitoring neurons of the medial ventrolateral prefrontal (orbitofrontal) cortex are involved in the maintenance of homeostasis].

Science.gov (United States)

Szabó, István; Hormay, Edina; Csetényi, Bettina; Nagy, Bernadett; Karádi, Zoltán

2017-05-01

The medial orbitofrontal cortex is involved in the regulation of feeding and metabolism. Little is known, however, about the role of local glucose-monitoring neurons in these processes, and our knowledge is also poor about characteristics of these cells. The functional significance of these chemosensory neurons was to be elucidated. Electrophysiology, by the multibarreled microelectrophoretic technique, and metabolic investigations, after streptozotocin induced selective destruction of the chemosensory neurons, were employed. Fifteen percent of the neurons responded to glucose, and these chemosensory cells displayed differential neurotransmitter and taste sensitivities. In acute glucose tolerance test, at the 30th and 60th minutes, blood glucose level in the streptozotocin-treated rats was significantly higher than that in the controls. The plasma triglyceride concentrations were also higher in the streptozotocin-treated group. Glucose-monitoring neurons of the medial orbitofrontal cortex integrate internal and external environmental signals, and monitor metabolic processes, thus, are indispensable to maintain the healthy homeostasis. Orv Hetil. 2017; 158(18): 692-700.

Salivary glucose in monitoring glycaemia in patients with type 1 diabetes mellitus: a systematic review.

Science.gov (United States)

Naing, Cho; Mak, Joon Wah

2017-01-01

Incidence of type 1 diabetes mellitus is increasing worldwide. Monitoring glycaemia is essential for control of diabetes mellitus. Conventional blood-based measurement of glucose requires venepuncture or needle prick, which is not free from pain and risk of infection. The non-invasiveness, ease and low-cost in collection made saliva an attractive alternative sample. The objective of this review was to systematically review the evidence on the relationship between salivary glucose level and blood glucose level in monitoring glycaemia in patients with type 1 diabetes mellitus. We searched studies which evaluate salivary glucose levels and serum glycaemia in type 1 diabetes mellitus in electronic databases of MEDLINE, EMBASE, Ovid and Google Scholar. We selected the eligible studies, following the inclusion criteria set for this review. Due to heterogeneity of studies, we conducted qualitative synthesis of studies. Ten observational studies were included in this review, including a total of 321 cases and 323 controls with ages between 3 and 61 years and the majority were males (62%). Two studies were done exclusively on children below 17 years old. The significant difference between salivary glucose levels in type 1 diabetes mellitus and controls were reported in 6 studies with 8 data sets. Five studies with 7 datasets reported the correlation coefficient between salivary glucose and blood glucose in patients with diabetes. Findings suggest that salivary glucose concentrations may be helpful in monitoring glycaemia in type 1 diabetes mellitus. However, the utility of using salivary glucose level to monitor glycaemia should be evaluated in future well designed, prospective studies with adequate number of participants with type 1 diabetes mellitus.

Effects of taurine on plasma glucose concentration and active glucose transport in the small intestine.

Science.gov (United States)

Tsuchiya, Yo; Kawamata, Koichi

2017-11-01

Taurine lowers blood glucose levels and improves hyperglycemia. However, its effects on glucose transport in the small intestine have not been investigated. Here, we elucidated the effect of taurine on glucose absorption in the small intestine. In the oral glucose tolerance test, addition of 10 mmol/L taurine suppressed the increase in hepatic portal glucose concentrations. To investigate whether the suppressive effect of taurine occurs via down-regulation of active glucose transport in the small intestine, we performed an assay using the everted sac of the rat jejunum. Addition of taurine to the mucosal side of the jejunum suppressed active glucose transport via sodium-glucose cotransporter 1 (SGLT1). After elimination of chloride ions from the mucosal solution, taurine did not show suppressive effects on active glucose transport. These results suggest that taurine suppressed the increase in hepatic portal glucose concentrations via suppression of SGLT1 activity in the rat jejunum, depending on chloride ions. © 2017 Japanese Society of Animal Science.

Continuous tissue glucose monitoring correlates with measurement of intermittent capillary glucose in patients with distributive shock.

Science.gov (United States)

Ballesteros, D; Martínez, Ó; Blancas Gómez-Casero, R; Martín Parra, C; López Matamala, B; Estébanez, B; Chana, M

2015-10-01

Intermittent glycemic measurements in patients admitted to the intensive care unit (ICU) can result in episodes of severe hypoglycemia or in a poor control of glycemia range. We designed a study to assess accuracy and reliability of continuous monitoring of tissue glucose for patients with distributive shock. Consecutive patients admitted to the ICU with a diagnosis of distributive shock and the need of insulin infusion for glycemic control were included in the study. These patients were implanted a Continuous Glucose Control Monitoring System (CGMS) with the sensor inserted subcutaneously into the abdominal wall. CGMS values were recorded every 5min. Capillary glucose (CG) was monitored for adjusting insulin perfusion according to the ICU protocol. Correlation between both methods was assessed. A total of 11,673 CGMS and 348 CG values were recorded. In five patients, CGMS failed to detect tissue glucose. A glucose value <3.33mmol/l (<60mg/dl) was observed in 3.6% of CGMS and in 0.29% CG values. 295 pairs of measurements were included in the statistical analysis for correlation assessment. The intraclass correlation coefficient was 0.706. The Pearson correlation coefficient was 0.71 (p<0.0001, 95% CI 0.65-0.76). The mean of differences between both measurement methods was 0.22mmol/l (3.98mg/dl) (95% CI 0.66-7.31). When the Continuous Glucose Control Monitoring System (CGMS) is able to obtain data (75% of the patients), there is correlation between the values obtained by this method and capillary blood glucose in patients with distributive shock. CGMS can detect more episodes of glycemic excursions outside the normal range than intermittent capillary glucose monitoring. Variables that may impair glucose metabolism and peripheral soft tissues perfusion could impair CGMS measurements. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Lowering Plasma Glucose Concentration by Inhibiting Renal Sodium-Glucose Co-Transport

Science.gov (United States)

Abdul-Ghani, Muhammad A; DeFronzo, Ralph A

2017-01-01

Maintaining normoglycaemia not only reduces the risk of diabetic microvascular complications but also corrects the metabolic abnormalities that contribute to the development and progression of hyperglycaemia (i.e. insulin resistance and beta-cell dysfunction). Progressive beta-cell failure, in addition to the multiple side effects associated with many current antihyperglycaemic agents (e.g., hypoglycaemia and weight gain) presents major obstacle to the achievement of the recommended goal of glycaemic control in patients with diabetes mellitus (DM). Thus, novel effective therapies are needed for optimal glucose control in subjects with DM. Recently, specific inhibitors of renal sodium glucose cotransporter 2 (SGLT2) have been developed to produce glucosuria and lower the plasma glucose concentration. Because of their unique mechanism of action (which is independent of the secretion and action of insulin), these agents are effective in lowering the plasma glucose concentration in all stages of DM and can be combined with all other antidiabetic agents. In this review, we summarize the available data concerning the mechanism of action, efficacy and safety of this novel class of antidiabetic agent. PMID:24690096

Clinical use of continuous glucose monitoring in adults with type 1 diabetes

OpenAIRE

Slattery, David; Choudhary, Pratik

2017-01-01

With the emphasis on intensive management of type 1 diabetes, data from studies support frequent monitoring of glucose levels to improve glycemic control and reduce glucose variability, which can be related to an increase in macro and microvascular complications. However, few perform capillary blood glucose that frequently. There are currently two available alternatives that this review will discuss, continuous glucose monitoring (CGM) and flash glucose monitoring. CGM has become an important...

Flash Glucose Monitoring: Differences Between Intermittently Scanned and Continuously Stored Data.

Science.gov (United States)

Pleus, Stefan; Kamecke, Ulrike; Link, Manuela; Haug, Cornelia; Freckmann, Guido

2018-03-01

The flash glucose monitoring system FreeStyle Libre (Abbott Diabetes Care Ltd., Witney, UK) measures interstitial glucose concentrations and continuously stores measurement values every 15 minutes. To obtain a current glucose reading, users have to scan the sensor with the reader. In a clinical trial, 5% of the scanned data showed relative differences of more than ±10% compared with continuously stored data points (median -0.5%). Such differences might impact results of studies using this system. It should be indicated whether scanned or continuously stored data were used for analyses. Health care professionals might have to differentiate between data reports from clinical software and the scanned data their patients are provided with. Additional information on these differences and their potential impact on therapeutic decisions would be helpful.

Continuous glucose monitoring in acute coronary syndrome.

Science.gov (United States)

Rodríguez-Quintanilla, Karina Alejandra; Lavalle-González, Fernando Javier; Mancillas-Adame, Leonardo Guadalupe; Zapata-Garrido, Alfonso Javier; Villarreal-Pérez, Jesús Zacarías; Tamez-Pérez, Héctor Eloy

2013-01-01

Diabetes mellitus is an independent risk factor for cardiovascular disease. To compare the efficacy of devices for continuous glucose monitoring and capillary glucose monitoring in hospitalized patients with acute coronary syndrome using the following parameters: time to achieve normoglycemia, period of time in normoglycemia, and episodes of hypoglycemia. We performed a pilot, non-randomized, unblinded clinical trial that included 16 patients with acute coronary artery syndrome, a capillary or venous blood glucose ≥ 140 mg/dl, and treatment with a continuous infusion of fast acting human insulin. These patients were randomized into 2 groups: a conventional group, in which capillary measurement and recording as well as insulin adjustment were made every 4h, and an intervention group, in which measurement and recording as well as insulin adjustment were made every hour with a subcutaneous continuous monitoring system. Student's t-test was applied for mean differences and the X(2) test for qualitative variables. We observed a statistically significant difference in the mean time for achieving normoglycemia, favoring the conventional group with a P = 0.02. Continuous monitoring systems are as useful as capillary monitoring for achieving normoglycemia. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Non-invasive method to detect the changes of glucose concentration in whole blood using photometric technique.

Science.gov (United States)

Rajan, Shiny Amala Priya; Towe, Bruce C

2014-01-01

A non-invasive method is developed to monitor rapid changes in blood glucose levels in diabetic patients. The system depends on an optical cell built with a LED that emits light of wavelength 535nm, which is a peak absorbance of hemoglobin. As the glucose concentration in blood decreases, its osmolarity also decreases and the Red Blood Cells (RBCs) swell and decrease the path length absorption coefficient. Decreasing absorption coefficient increases the transmission of light through the whole blood. The system was tested with a constructed optical cell that held whole blood in a capillary tube. As expected the light transmitted to the photodiode increases with decreasing glucose concentration. The average response time of the system was between 30-40 seconds.

Extended Near-Infrared Optoacoustic Spectrometry for Sensing Physiological Concentrations of Glucose

Directory of Open Access Journals (Sweden)

Ara Ghazaryan

2018-03-01

Full Text Available Glucose sensing is pursued extensively in biomedical research and clinical practice for assessment of the carbohydrate and fat metabolism as well as in the context of an array of disorders, including diabetes, morbid obesity, and cancer. Currently used methods for real-time glucose measurements are invasive and require access to body fluids, with novel tools and methods for non-invasive sensing of the glucose levels highly desired. In this study, we introduce a near-infrared (NIR optoacoustic spectrometer for sensing physiological concentrations of glucose within aqueous media and describe the glucose spectra within 850–1,900 nm and various concentration ranges. We apply the ratiometric and dictionary learning methods with a training set of data and validate their utility for glucose concentration measurements with optoacoustics in the probe dataset. We demonstrate the superior signal-to-noise ratio (factor of ~3.9 achieved with dictionary learning over the ratiometric approach across the wide glucose concentration range. Our data show a linear relationship between the optoacoustic signal intensity and physiological glucose concentration, in line with the results of optical spectroscopy. Thus, the feasibility of detecting physiological glucose concentrations using NIR optoacoustic spectroscopy is demonstrated, enabling the sensing glucose with ±10 mg/dl precision.

Electromagnetic Radiofrequency Radiation Emitted from GSM Mobile Phones Decreases the Accuracy of Home Blood Glucose Monitors

Directory of Open Access Journals (Sweden)

SMJ Mortazavi

2014-09-01

Full Text Available Mobile phones are two-way radios that emit electromagnetic radiation in microwave range. As the number of mobile phone users has reached 6 billion, the bioeffects of exposure to mobile phone radiation and mobile phone electromagnetic interference with electronic equipment have received more attention, globally. As self-monitoring of blood glucose can be a beneficial part of diabetes control, home blood glucose testing kits are very popular. The main goal of this study was to investigate if radiofrequency radiation emitted from a common GSM mobile phone can alter the accuracy of home blood glucose monitors. Forty five female nondiabetic students aged 17-20 years old participated in this study. For Control-EMF group (30 students, blood glucose concentration for each individual was measured in presence and absence of radiofrequency radiation emitted by a common GSM mobile phone (HTC touch, Diamond 2 while the phone was ringing. For Control- Repeat group (15 students, two repeated measurements were performed for each participant in the absence of electromagnetic fields. The magnitude of the changes between glucose levels in two repeated measurements (ΔC in Control-Repeat group was 1.07 ± 0.88 mg/dl while this magnitude for Control-EMF group was 7.53 ± 4.76 mg/dl (P < 0.001, two-tailed test. To the best of our knowledge, this is the first study to assess the electromagnetic interference in home blood glucose monitors. It can be concluded that electromagnetic interference from mobile phones has an adverse effect on the accuracy of home blood glucose monitors. We suggest that mobile phones should be used at least 50 cm away from home blood glucose monitors.

Continuous Glucose Monitoring in the Cardiac ICU: Current Use and Future Directions.

Science.gov (United States)

Scrimgeour, Laura A; Potz, Brittany A; Sellke, Frank W; Abid, M Ruhul

2017-11-01

Perioperative glucose control is highly important, particularly for patients undergoing cardiac surgery. Variable glucose levels before, during and after cardiac surgery lead to increased post-operative complications and patient mortality. [1] Current methods for intensive monitoring and treating hyperglycemia in the Intensive Care Unit (ICU) usually involve hourly glucose monitoring and continuous intravenous insulin infusions. With the advent of more accurate subcutaneous glucose monitoring systems, the role of improved glucose control with newer systems deserves consideration for widespread adoption.

Noninvasive Monitoring of Blood Glucose with Raman Spectroscopy.

Science.gov (United States)

Pandey, Rishikesh; Paidi, Santosh Kumar; Valdez, Tulio A; Zhang, Chi; Spegazzini, Nicolas; Dasari, Ramachandra Rao; Barman, Ishan

2017-02-21

not only addressed the physiological lag between the actual blood glucose and the measured interstitial fluid glucose values but also offered a powerful tool for predictive measurements of hypoglycemia. This framework has recently been extended to provide longitudinal tracking of glucose concentration without necessitating extensive a priori concentration information. These findings are advanced by the results of recent glucose tolerance studies in human subjects, which also hint at the need for designing nonlinear calibration models that can account for subject-to-subject variations in skin heterogeneity and hematocrit levels. Together, the emerging evidence underscores the promise of a blood withdrawal-free optical platform-featuring a combination of high-throughput Raman spectroscopic instrumentation and data analysis of subtle variations in spectral expression-for diabetes screening in the clinic and, ultimately, for personalized monitoring.

Evanescent Wave Absorption Based Fiber Sensor for Measuring Glucose Solution Concentration

Science.gov (United States)

Marzuki, Ahmad; Candra Pratiwi, Arni; Suryanti, Venty

2018-03-01

An optical fiber sensor based on evanescent wave absorption designed for measuring glucose solution consentration was proposed. The sensor was made to detect absorbance of various wavelength in the glucose solution. The sensing element was fabricated by side polishing of multimode polymer optical fiber to form a D-shape. The sensing element was immersed in different concentration of glucoce solution. As light propagated through the optical fiber, the evanescent wave interacted with the glucose solution. Light was absorbed by the glucose solution. The larger concentration the glucose solution has, the more the evanescent wave was absorbed in particular wavelenght. Here in this paper, light absorbtion as function of glucose concentration was measured as function of wavelength (the color of LED). We have shown that the proposed sensor can demonstrated an increase of light absorption as function of glucose concentration.

Continuous glucose monitoring microsensor with a nanoscale conducting matrix and redox mediator

Science.gov (United States)

Pesantez, Daniel

The major limiting factor in kidney clinical transplantation is the shortage of transplantable organs. The current inability to distinguish viability from non-viability on a prospective basis represents a major obstacle in any attempt to expand organ donor criteria. Consequently, a way to measure and monitor a relevant analyte to assess kidney viability is needed. For the first time, the initial development and characterization of a metabolic microsensor to assess kidney viability is presented. The rate of glucose consumption appears to serve as an indicator of kidney metabolism that may distinguish reversible from irreversible kidney damage. The proposed MetaSense (Metabolic Sensor) microdevice would replace periodic laboratory diagnosis tests with a continuous monitor that provides real-time data on organ viability. Amperometry, a technique that correlates an electrical signal with analyte concentration, is used as a method to detect glucose concentrations. A novel two-electrode electrochemical sensing cell design is presented. It uses a modified metallic working electrode (WE) and a bare metallic reference electrode (RE) that acts as a pseudo-reference/counter electrode as well. The proposed microsensor has the potential to be used as a minimally invasive sensor for its reduced number of probes and very small dimensions achieved by micromachining and lithography. In order to improve selectivity of the microdevice, two electron transfer mechanisms or generations were explored. A first generation microsensor uses molecular oxygen as the electron acceptor in the enzymatic reaction and oxidizes hydrogen peroxide (H2O2) to get the electrical signal. The microsensor's modified WE with conductive polymer polypyrrole (PPy) and corresponding enzyme glucose oxidase (GOx) immobilized into its matrix, constitutes the electrochemical detection mechanism. Photoluminescence spectroscopic analysis confirmed and quantified enzyme immobilized concentrations within the matrix. In

A history of continuous glucose monitors (CGMs) in self-monitoring of diabetes mellitus.

Science.gov (United States)

Olczuk, David; Priefer, Ronny

Self-monitoring of glucose for individuals afflicted with diabetes mellitus has allowed patients to take control of their disease and thus directly affect the outcomes related to it. It has been almost a century since the first test to monitor one's sugar was developed; that being a urine test. The most well-known and prominent medical device for monitor blood glucose for individuals with diabetes are the finger-prick devices. This itself is an approximately 50year old technology. More recently has been the introduction of continuous glucose monitors (CGMs) which entered the market place in the last year of the 20th century. As this technology has been further refined and improved, limitations associated with it have decreased. The scope of this review is to present a brief history of CGMs, both with the development of these medical devices and the challenges/limitations that they have shown. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Perspectives of patients with type 1 or insulintreated type 2 diabetes on self-monitoring of blood glucose : a qualitative study

NARCIS (Netherlands)

Hortensius, Johanna; Kars, Marijke C.; Wierenga, Willem S.; Kleefstra, Nanne; Bilo, Henk J. G.; van der Bijl, Jaap J.

2012-01-01

Background: Self-monitoring of blood glucose (SMBG), including self-regulation, is an important tool to achieve good glycemic control. However, many patients measure their glucose concentrations less often than is recommended. This study investigates patients' perspectives of SMBG and all relevant

Glucose metabolism disorder in obese children assessed by continuous glucose monitoring system.

Science.gov (United States)

Zou, Chao-Chun; Liang, Li; Hong, Fang; Zhao, Zheng-Yan

2008-02-01

Continuous glucose monitoring system (CGMS) can measure glucose levels at 5-minute intervals over a few days, and may be used to detect hypoglycemia, guide insulin therapy, and control glucose levels. This study was undertaken to assess the glucose metabolism disorder by CGMS in obese children. Eighty-four obese children were studied. Interstitial fluid (ISF) glucose levels were measured by CGMS for 24 hours covering the time for oral glucose tolerance test (OGTT). Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), type 2 diabetic mellitus (T2DM) and hypoglycemia were assessed by CGMS. Five children failed to complete CGMS test. The glucose levels in ISF measured by CGMS were highly correlated with those in capillary samples (r=0.775, Pobese children who finished the CGMS, 2 children had IFG, 2 had IGT, 3 had IFG + IGT, and 2 had T2DM. Nocturnal hypoglycemia was noted during the overnight fasting in 11 children (13.92%). Our data suggest that glucose metabolism disorder including hyperglycemia and hypoglycemia is very common in obese children. Further studies are required to improve the precision of the CGMS in children.

Differential photoacoustic spectroscopy with continuous wave lasers for non-invasive blood glucose monitoring

Science.gov (United States)

Tanaka, Y.; Tajima, T.; Seyama, M.

2018-02-01

We propose a differential photoacoustic spectroscopy (PAS), wherein two wavelengths of light with the same absorbance are selected, and differential signal is linearized by one of the two signals for a non-invasive blood glucose monitoring. PAS has the possibility to overcome the strong optical scattering in tissue, but there are still remaining issues: the water background and instability due to the variation in acoustic resonance conditions. A change in sample solution temperature is one of the causes of the variation in acoustic resonance conditions. Therefore, in this study, we investigated the sensitivity against glucose concentration under the condition where the temperature of the sample water solution ranges 30 to 40 °C. The glucose concentration change is simulated by shifting the wavelength of irradiated laser light, which can effectively change optical absorption. The temperature also affects optical absorption and the acoustic resonance condition (acoustic velocity). A distributed-feedback (DFB) laser, tunable wavelength laser (TWL) and an acoustic sensor were used to obtain the differential PAS signal. The wavelength of the DFB laser was 1.382 μm, and that of TWL was switched from 1.600 to 1.610 μm to simulate the glucose concentration change. Optical absorption by glucose occurs at around 1.600 μm. The sensitivities against temperature are almost the same: 1.9 and 1.8 %/°C for 1.600 and 1.610 μm. That is, the glucose dependence across the whole temperature range remains constant. This implies that temperature correction is available.

Accuracy evaluation of contour next compared with five blood glucose monitoring systems across a wide range of blood glucose concentrations occurring in a clinical research setting.

Science.gov (United States)

Klaff, Leslie J; Brazg, Ronald; Hughes, Kristen; Tideman, Ann M; Schachner, Holly C; Stenger, Patricia; Pardo, Scott; Dunne, Nancy; Parkes, Joan Lee

2015-01-01

This study evaluated the accuracy of Contour(®) Next (CN; Bayer HealthCare LLC, Diabetes Care, Whippany, NJ) compared with five blood glucose monitoring systems (BGMSs) across a wide range of clinically occurring blood glucose levels. Subjects (n=146) were ≥ 18 years and had type 1 or type 2 diabetes. Subjects' glucose levels were safely lowered or raised to provide a wide range of glucose values. Capillary blood samples were tested on six BGMSs and a YSI glucose analyzer (YSI Life Sciences, Inc., Yellow Springs, OH) as the reference. Extreme glucose values were achieved by glucose modification of the blood sample. System accuracy was assessed by mean absolute difference (MAD) and mean absolute relative difference (MARD) across several glucose ranges, with glucose range (Abbott Diabetes Care, Inc., Alameda, CA), 2.77 mg/dL; OneTouch(®) Ultra(®) 2 (LifeScan, Inc., Milpitas, CA), 10.20 mg/dL; OneTouch(®) Verio(®) Pro (LifeScan, Inc.), 4.53 mg/dL; and Truetrack(®) (Nipro Diagnostics, Inc., Fort Lauderdale, FL), 11.08 mg/dL. The lowest MAD in the low glucose range, from CN, was statistically significantly lower than those of the other BGMSs with the exception of the FSL. CN also had a statistically significantly lower MARD than all other BGMSs in the low glucose range. In the overall glucose range (21-496 mg/dL), CN yielded the lowest MAD and MARD values, which were statistically significantly lower in comparison with the other BGMSs. When compared with other BGMSs, CN demonstrated the lowest mean deviation from the reference value (by MAD and MARD) across multiple glucose ranges.

Detection of saliva-range glucose concentrations using organic thin-film transistors

International Nuclear Information System (INIS)

Elkington, D.; Belcher, W. J.; Dastoor, P. C.; Zhou, X. J.

2014-01-01

We describe the development of a glucose sensor through direct incorporation of an enzyme (glucose oxidase) into the gate of an organic thin film transistor (OTFT). We show that glucose diffusion is the key determinant of the device response time and present a mechanism of glucose sensing in these devices that involves protonic doping of the transistor channel via enzymatic oxidation of glucose. The integrated OTFT sensor is sensitive across 4 decades of glucose concentration; a range that encompasses both the blood and salivary glucose concentration levels. As such, this work acts as a proof-of-concept for low-cost printed biosensors for salivary glucose.

Detection of saliva-range glucose concentrations using organic thin-film transistors

Energy Technology Data Exchange (ETDEWEB)

Elkington, D.; Belcher, W. J.; Dastoor, P. C.; Zhou, X. J. [Centre for Organic Electronics, University of Newcastle, Callaghan, New South Wales 2308 (Australia)

2014-07-28

We describe the development of a glucose sensor through direct incorporation of an enzyme (glucose oxidase) into the gate of an organic thin film transistor (OTFT). We show that glucose diffusion is the key determinant of the device response time and present a mechanism of glucose sensing in these devices that involves protonic doping of the transistor channel via enzymatic oxidation of glucose. The integrated OTFT sensor is sensitive across 4 decades of glucose concentration; a range that encompasses both the blood and salivary glucose concentration levels. As such, this work acts as a proof-of-concept for low-cost printed biosensors for salivary glucose.

Self-monitoring of blood glucose measurements and glycaemic ...

African Journals Online (AJOL)

Background. Intensive diabetes management requires intensive insulin treatment and self-monitoring of blood glucose (SMBG) measurements to obtain immediate information on the status of the blood glucose level and to obtain data for pattern analysis on which meal planning, insulin and lifestyle adjustments can be ...

Conjoint regulation of glucagon concentrations via plasma insulin and glucose in dairy cows.

Science.gov (United States)

Zarrin, M; Wellnitz, O; Bruckmaier, R M

2015-04-01

Insulin and glucagon are glucoregulatory hormones that contribute to glucose homeostasis. Plasma insulin is elevated during normoglycemia or hyperglycemia and acts as a suppressor of glucagon secretion. We have investigated if and how insulin and glucose contribute to the regulation of glucagon secretion through long term (48 h) elevated insulin concentrations during simultaneous hypoglycemia or euglycemia in mid-lactating dairy cows. Nineteen Holstein dairy cows were randomly assigned to 3 treatment groups: an intravenous insulin infusion (HypoG, n = 5) to decrease plasma glucose concentrations (2.5 mmol/L), a hyperinsulinemic-euglycemic clamp to study effects of insulin at simultaneously normal glucose concentrations (EuG, n = 6) and a 0.9% saline infusion (NaCl, n = 8). Plasma glucose was measured at 5-min intervals, and insulin and glucose infusion rates were adjusted accordingly. Area under the curve of hourly glucose, insulin, and glucagon concentrations on day 2 of infusion was evaluated by analysis of variance with treatments as fixed effect. Insulin infusion caused an increase of plasma insulin area under the curve (AUC)/h in HypoG (41.9 ± 8.1 mU/L) and EuG (57.8 ± 7.8 mU/L) compared with NaCl (13.9 ± 1.1 mU/L; P insulin infusion induces elevated glucagon concentrations during hypoglycemia, although the same insulin infusion reduces glucagon concentrations at simultaneously normal glucose concentrations. Thus, insulin does not generally have an inhibitory effect on glucagon concentrations. If simultaneously glucose is low and insulin is high, glucagon is upregulated to increase glucose availability. Therefore, insulin and glucose are conjoint regulatory factors of glucagon concentrations in dairy cows, and the plasma glucose status is the key factor to decide if its concentrations are increased or decreased. This regulatory effect can be important for the maintenance of glucose homeostasis if insulin secretion is upregulated by other factors than high

Hematocrit correction does not improve glucose monitor accuracy in the assessment of neonatal hypoglycemia.

Science.gov (United States)

Wang, Li; Sievenpiper, John L; de Souza, Russell J; Thomaz, Michele; Blatz, Susan; Grey, Vijaylaxmi; Fusch, Christoph; Balion, Cynthia

2013-08-01

The lack of accuracy of point of care (POC) glucose monitors has limited their use in the diagnosis of neonatal hypoglycemia. Hematocrit plays an important role in explaining discordant results. The objective of this study was to to assess the effect of hematocrit on the diagnostic performance of Abbott Precision Xceed Pro (PXP) and Nova StatStrip (StatStrip) monitors in neonates. All blood samples ordered for laboratory glucose measurement were analyzed using the PXP and StatStrip and compared with the laboratory analyzer (ABL 800 Blood Gas analyzer [ABL]). Acceptable error targets were ±15% for glucose monitoring and ±5% for diagnosis. A total of 307 samples from 176 neonates were analyzed. Overall, 90% of StatStrip and 75% of PXP values met the 15% error limit and 45% of StatStrip and 32% of PXP values met the 5% error limit. At glucose concentrations ≤4 mmol/L, 83% of StatStrip and 79% of PXP values met the 15% error limit, while 37% of StatStrip and 38% of PXP values met the 5% error limit. Hematocrit explained 7.4% of the difference between the PXP and ABL whereas it accounted for only 0.09% of the difference between the StatStrip and ABL. The ROC analysis showed the screening cut point with the best performance for identifying neonatal hypoglycemia was 3.2 mmol/L for StatStrip and 3.3 mmol/L for PXP. Despite a negligible hematocrit effect for the StatStrip, it did not achieve recommended error limits. The StatStrip and PXP glucose monitors remain suitable only for neonatal hypoglycemia screening with confirmation required from a laboratory analyzer.

Glucose Monitoring System Based on Osmotic Pressure Measurements

Directory of Open Access Journals (Sweden)

Alexandra LEAL

2011-02-01

Full Text Available This paper presents the design and development of a prototype sensor unit for implementation in a long-term glucose monitoring system suitable for estimating glucose levels in people suffering from diabetes mellitus. The system utilizes osmotic pressure as the sensing mechanism and consists of a sensor prototype that is integrated together with a pre-amplifier and data acquisition unit for both data recording and processing. The sensor prototype is based on an embedded silicon absolute pressure transducer and a semipermeable nanoporous membrane that is enclosed in the sensor housing. The glucose monitoring system facilitates the integration of a low power microcontroller that is combined with a wireless inductive powered communication link. Experimental verification have proven that the system is capable of tracking osmotic pressure changes using albumin as a model compound, and thereby show a proof of concept for novel long term tracking of blood glucose from remote sensor nodes.

A glucose concentration and temperature sensor based on long period fiber gratings induced by electric-arc discharge

Science.gov (United States)

Du, Chao; Wang, Qi

2017-10-01

As one of the key parameters in biological and chemical reactions, glucose concentration objectively reflects the characteristics of reactions, so the real-time monitoring of glucose concentration is important in the field of biochemical. Meanwhile, the influence from temperature should be considered. The fiber sensors have been studied extensively for decades due to the advantages of small size, immunity to electromagnetic interference and high sensitivity, which are suitable for the application of biochemical sensing. A long period fiber grating (LPFG) sensor induced by electric-arc discharge has been fabricated and demonstrated for simultaneous measurement of glucose concentration and temperature. The proposed sensor was fabricated by inscribing a sing mode fiber (SMF) with periodic electric-arc discharge technology. During the fabrication process, the electric-arc discharge technology was produced by a commercial fusion splicer, and the period of inscribed LPFG was determined by the movement of translation stages. A serials of periodic geometrical deformations would be formed in SMF after the fabrication, and the discharge intensity and discharge time can be adjusted though the fusion splicer settings screen. The core mode can be coupled into the cladding modes at certain wavelength when they satisfy the phase-matching conditions, and there will be several resonance dips in the transmission spectrum in LPFG. The resonance dips formed by the coupling between cladding modes and core mode have different sensitivity responses, so the simultaneous measurement for multi-parameter can be realized by monitoring the wavelength shifts of the resonance dips. Compared with the LPFG based on conventional SMF, the glucose concentration sensitivity has been obviously enhanced by etching the cladding with hydrofluoric acid solution. Based on the independent measured results, a dual-parameter measurement matrix has been built for signal demodulation. Because of the easy

The continuous glucose monitoring sensor in neonatal intensive care

OpenAIRE

Beardsall, K; Ogilvy-Stuart, A; Ahluwalia, J; Thompson, M; Dunger, D

2005-01-01

Objective: To determine the feasibility of continuous glucose monitoring in the very low birthweight baby requiring intensive care, as these infants are known to be at high risk of abnormalities of glucose control.

Effects of elevated glucose concentration on cultured bovine retinal endothelial (BRE) cells

International Nuclear Information System (INIS)

Capetandes, A.; Gerritsen, M.E.

1986-01-01

Salient clinical features of diabetic retinopathy include capillary microaneurysm and neovascularization, which progress with the severity of the disease. It has been suggested that exposure of the retinal vascular cells to high glucose concentrations may play a causative role in the retinopathy. In the present study, the effects of variant media glucose concentrations on BRE cell growth were determined. Normal growth curves were obtained with glucose concentrations of 100, 450 and 600 mg%, but the replication rate was decreased with 600 mg%. To determine if elevated glucose concentrations also altered DNA synthesis, BRE cells cultivated with 100 and 600 mg% glucose demonstrated increased thymidine uptake and total DNA content compared to the 100 mg% group. Furthermore, vacuolation and increased cell diameter occurred in BRE cells cultivated 600 mg% compared to 100 mg% glucose. In conclusion, increases in media glucose concentrations result in a decreased cellular replication rate, increased DNA synthesis and increased cell diameter during the log phase of growth

Multiple functional attributes of glucose-monitoring neurons in the medial orbitofrontal (ventrolateral prefrontal) cortex.

Science.gov (United States)

Szabó, István; Hormay, Edina; Csetényi, Bettina; Nagy, Bernadett; Lénárd, László; Karádi, Zoltán

2018-02-01

Multiple functional attributes of glucose-monitoring neurons in the medial orbitofrontal (ventrolateral prefrontal) cortex. NEUROSCI BIOBEHAV REV 73(1) XXX-XXX, 2017.- Special chemosensory cells, the glucose-monitoring (GM) neurons, reportedly involved in the central feeding control, exist in the medial orbitofrontal (ventrolateral prefrontal) cortex (mVLPFC). Electrophysiological, metabolic and behavioral studies reveal complex functional attributes of these cells and raise their homeostatic significance. Single neuron recordings, by means of the multibarreled microelectrophoretic technique, elucidate differential sensitivities of limbic forebrain neurons in the rat and the rhesus monkey to glucose and other chemicals, whereas gustatory stimulations demonstrate their distinct taste responsiveness. Metabolic examinations provide evidence for alteration of blood glucose level in glucose tolerance test and elevation of plasma triglyceride concentration after destruction of the local GM cells by streptozotocin (STZ). In behavioral studies, STZ microinjection into the mVLPFC fails to interfere with the acquisition of saccharin conditioned taste avoidance, does cause, however, taste perception deficit in taste reactivity tests. Multiple functional attributes of GM neurons in the mVLPFC, within the frame of the hierarchically organized central GM neuronal network, appear to play important role in the maintenance of the homeostatic balance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Continuous Glucose Monitoring in Patients with Abnormal Glucose Tolerance during Pregnancy: A Case Series

Directory of Open Access Journals (Sweden)

Mie Tonoike

2016-01-01

Full Text Available Abnormal glucose tolerance during pregnancy is associated with perinatal complications. We used continuous glucose monitoring (CGM in pregnant women with glucose intolerance to achieve better glycemic control and to evaluate the maternal glucose fluctuations. We also used CGM in women without glucose intolerance (the control cases. Furthermore, the standard deviation (SD and mean amplitude of glycemic excursions (MAGE were calculated for each case. For the control cases, the glucose levels were tightly controlled within a very narrow range; however, the SD and MAGE values in pregnant women with glucose intolerance were relativity high, suggesting postprandial hyperglycemia. Our results demonstrate that pregnant women with glucose intolerance exhibited greater glucose fluctuations compared with the control cases. The use of CGM may help to improve our understanding of glycemic patterns and may have beneficial effects on perinatal glycemic control, such as the detection of postprandial hyperglycemia in pregnant women.

The experiences of diabetics on self-monitoring of blood glucose: a qualitative metasynthesis.

Science.gov (United States)

Chen, Chen-Mei; Chang Yeh, Mei

2015-03-01

To interpret, describe and analyse the results of various qualitative studies and comprehensively elucidate the self-monitoring of blood glucose experiences of diabetic patients, and to make recommendations based on these findings for clinical practices. Patients exhibited both positive and negative perceptions towards the self-monitoring of blood glucose. Numerous recent qualitative studies have explored the self-monitoring of blood glucose experiences of diabetic patients; however, no integrated results have been provided. Qualitative metasynthesis. A systematic literature search of English and Chinese databases was undertaken, covering the period between January 2004 and April 2014. The following databases were searched: CINAHL, PubMed, MEDLINE, Cochrane Library, Airiti library and PsycInfo. Seven studies were assessed in the final analysis; the Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to evaluate these studies. The self-monitoring experiences of patients with diabetes were divided into five themes: perceived disease severity, effects on daily life, lifestyle adjustments after becoming aware of blood glucose levels, determining the meaning of self-monitoring, and the differences between diabetic patients who use and do not use insulin. Individual differences in blood glucose self-monitoring vary widely among diabetic patients. These differences result from personal cognition and feelings concerning blood glucose monitoring. Insights into and discussions regarding the self-monitoring of blood glucose experiences of diabetic patients enable health care professionals to understand the factors that influence the intentions of patients to perform self-monitoring of blood glucose and facilitate establishing customised self-monitoring of blood glucose treatment plans. Health care professionals must adopt flexible and individualised criteria to determine patient cognitive misconceptions, understand negative emotional reactions and

In-vitro performance of the Enlite Sensor in various glucose concentrations during hypobaric and hyperbaric conditions.

Science.gov (United States)

Adolfsson, Peter; Ornhagen, Hans; Eriksson, Bengt M; Gautham, Raghavendhar; Jendle, Johan

2012-11-01

There is a need for reliable methods of glucose measurement in different environmental conditions. The objective of this in vitro study was to evaluate the performance of the Enlite® Sensor when connected to either the iPro™ Continuous Glucose Monitor recording device or the Guardian® REAL-Time transmitting device, in hypobaric and hyperbaric conditions. Sixteen sensors connected to eight iPro devices and eight Guardian REAL-Time devices were immersed in three beakers containing separate glucose concentrations: 52, 88, and 207 mg/dl (2.9, 4.9, and 11.3 mmol/liter). Two different pressure tests were conducted: a hypobaric test, corresponding to maximum 18000 ft/5500 m height, and a hyperbaric test, corresponding to maximum 100 ft/30 m depth. The linearity of the sensor signals in the different conditions was evaluated. The sensors worked continuously, and the sensor signals were collected without interruption at all pressures tested. When comparing the input signals for glucose (ISIGs) and the different glucose concentrations during altered pressure, linearity (R(2)) of 0.98 was found. During the hypobaric test, significant differences (p hyperbaric test, no differences were found. The Enlite Sensors connected to either the iPro or the Guardian REAL-Time device provided values continuously. In hyperbaric conditions, no significant differences were seen during changes in ambient pressure; however, during hypobaric conditions, the ISIG was significantly different in the low and high glucose concentrations. © 2012 Diabetes Technology Society.

Clinical Use of Continuous Glucose Monitoring in Adults with Type 1 Diabetes.

Science.gov (United States)

Slattery, David; Choudhary, Pratik

2017-05-01

With the emphasis on intensive management of type 1 diabetes, data from studies support frequent monitoring of glucose levels to improve glycemic control and reduce glucose variability, which can be related to an increase in macro and microvascular complications. However, few perform capillary blood glucose that frequently. There are currently two available alternatives that this review will discuss, continuous glucose monitoring (CGM) and flash glucose monitoring. CGM has become an important diagnostic and therapeutic option in optimizing diabetes management. CGM systems are now more accurate, smaller, and easier to use compared to original models. Randomized controlled trials (RCTs) have demonstrated that CGM can improve Hemoglobin A1c (HbA1C) and reduce glucose variability in both continuous subcutaneous insulin infusion and multiple daily injection users. When used in an automated "insulin-suspend" system, reduced frequency of hypoglycemia and shorter time spent in hypoglycemic range have been demonstrated. Despite the potential benefits CGM has to offer in clinical practice, concerns exist on the accuracy of these devices and patient compliance with therapy, which may prevent the true clinical benefit of CGM being achieved, as observed in RCTs. Flash glucose monitoring systems FreeStyle ® Libre™ (Abbott Diabetes Care, Alameda, CA) are as accurate as many CGM systems available and have the added benefit of being factory calibrated. Studies have shown that flash glucose monitoring systems are very well tolerated by patients and effectively reduce glucose variability, increasing time in range.

Skin-like biosensor system via electrochemical channels for noninvasive blood glucose monitoring.

Science.gov (United States)

Chen, Yihao; Lu, Siyuan; Zhang, Shasha; Li, Yan; Qu, Zhe; Chen, Ying; Lu, Bingwei; Wang, Xinyan; Feng, Xue

2017-12-01

Currently, noninvasive glucose monitoring is not widely appreciated because of its uncertain measurement accuracy, weak blood glucose correlation, and inability to detect hyperglycemia/hypoglycemia during sleep. We present a strategy to design and fabricate a skin-like biosensor system for noninvasive, in situ, and highly accurate intravascular blood glucose monitoring. The system integrates an ultrathin skin-like biosensor with paper battery-powered electrochemical twin channels (ETCs). The designed subcutaneous ETCs drive intravascular blood glucose out of the vessel and transport it to the skin surface. The ultrathin (~3 μm) nanostructured biosensor, with high sensitivity (130.4 μA/mM), fully absorbs and measures the glucose, owing to its extreme conformability. We conducted in vivo human clinical trials. The noninvasive measurement results for intravascular blood glucose showed a high correlation (>0.9) with clinically measured blood glucose levels. The system opens up new prospects for clinical-grade noninvasive continuous glucose monitoring.

The importance of different frequency bands in predicting subcutaneous glucose concentration in type 1 diabetic patients.

Science.gov (United States)

Lu, Yinghui; Gribok, Andrei V; Ward, W Kenneth; Reifman, Jaques

2010-08-01

We investigated the relative importance and predictive power of different frequency bands of subcutaneous glucose signals for the short-term (0-50 min) forecasting of glucose concentrations in type 1 diabetic patients with data-driven autoregressive (AR) models. The study data consisted of minute-by-minute glucose signals collected from nine deidentified patients over a five-day period using continuous glucose monitoring devices. AR models were developed using single and pairwise combinations of frequency bands of the glucose signal and compared with a reference model including all bands. The results suggest that: for open-loop applications, there is no need to explicitly represent exogenous inputs, such as meals and insulin intake, in AR models; models based on a single-frequency band, with periods between 60-120 min and 150-500 min, yield good predictive power (error bands produce predictions that are indistinguishable from those of the reference model as long as the 60-120 min period band is included; and AR models can be developed on signals of short length (approximately 300 min), i.e., ignoring long circadian rhythms, without any detriment in prediction accuracy. Together, these findings provide insights into efficient development of more effective and parsimonious data-driven models for short-term prediction of glucose concentrations in diabetic patients.

Continuous Glucose Monitoring in Newborn Infants

Science.gov (United States)

Thomas, Felicity; Signal, Mathew; Harris, Deborah L.; Weston, Philip J.; Harding, Jane E.; Shaw, Geoffrey M.

2014-01-01

Neonatal hypoglycemia is common and can cause serious brain injury. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing blood glucose (BG) measurements. Calibration algorithms use BG measurements to convert sensor signals into CGM data. Thus, inaccuracies in calibration BG measurements directly affect CGM values and any metrics calculated from them. The aim was to quantify the effect of timing delays and calibration BG measurement errors on hypoglycemia metrics in newborn infants. Data from 155 babies were used. Two timing and 3 BG meter error models (Abbott Optium Xceed, Roche Accu-Chek Inform II, Nova Statstrip) were created using empirical data. Monte-Carlo methods were employed, and each simulation was run 1000 times. Each set of patient data in each simulation had randomly selected timing and/or measurement error added to BG measurements before CGM data were calibrated. The number of hypoglycemic events, duration of hypoglycemia, and hypoglycemic index were then calculated using the CGM data and compared to baseline values. Timing error alone had little effect on hypoglycemia metrics, but measurement error caused substantial variation. Abbott results underreported the number of hypoglycemic events by up to 8 and Roche overreported by up to 4 where the original number reported was 2. Nova results were closest to baseline. Similar trends were observed in the other hypoglycemia metrics. Errors in blood glucose concentration measurements used for calibration of CGM devices can have a clinically important impact on detection of hypoglycemia. If CGM devices are going to be used for assessing hypoglycemia it is important to understand of the impact of these errors on CGM data. PMID:24876618

Tattoo-based noninvasive glucose monitoring: a proof-of-concept study.

Science.gov (United States)

Bandodkar, Amay J; Jia, Wenzhao; Yardımcı, Ceren; Wang, Xuan; Ramirez, Julian; Wang, Joseph

2015-01-06

We present a proof-of-concept demonstration of an all-printed temporary tattoo-based glucose sensor for noninvasive glycemic monitoring. The sensor represents the first example of an easy-to-wear flexible tattoo-based epidermal diagnostic device combining reverse iontophoretic extraction of interstitial glucose and an enzyme-based amperometric biosensor. In-vitro studies reveal the tattoo sensor's linear response toward physiologically relevant glucose levels with negligible interferences from common coexisting electroactive species. The iontophoretic-biosensing tattoo platform is reduced to practice by applying the device on human subjects and monitoring variations in glycemic levels due to food consumption. Correlation of the sensor response with that of a commercial glucose meter underscores the promise of the tattoo sensor to detect glucose levels in a noninvasive fashion. Control on-body experiments demonstrate the importance of the reverse iontophoresis operation and validate the sensor specificity. This preliminary investigation indicates that the tattoo-based iontophoresis-sensor platform holds considerable promise for efficient diabetes management and can be extended toward noninvasive monitoring of other physiologically relevant analytes present in the interstitial fluid.

Detection of glycemic abnormalities in adolescents with beta thalassemia using continuous glucose monitoring and oral glucose tolerance in adolescents and young adults with β-thalassemia major: Pilot study

Directory of Open Access Journals (Sweden)

Ashraf T Soliman

2013-01-01

Full Text Available Background: Both insulin deficiency and resistance are reported in patients with β-thalassemia major (BTM. The use of continuous blood glucose monitoring (CGM, among the different methods for early detection of glycemic abnormalities, has not been studied thoroughly in these adolescents. Materials and Methods: To assess the oralglucose tolerance (OGT and 72-h continuous glucose concentration by the continuous glucose monitoring system (CGMS and calculate homeostatic model assessment (HOMA, and the quantitative insulin sensitivity check index (QUICKI was conducted in 16 adolescents with BTM who were receiving regular blood transfusions every 2-4 weeks and iron-chelation therapy since early childhood. Results: Sixteen adolescents with BTM (age: 19.75 ± 3 years were investigated. Using OGTT, (25% had impaired fasting blood (plasma glucose concentration (BG (>5.6 mmol/L. 2-h after the glucose load, one of them had BG = 16.2 mmol/L (diabetic and two had impaired glucose tolerance (IGT (BG > 7.8 and 11.1 mmol/L and 9 with IGT (56%. HOMA and QUICKI revealed levels 0.33 (0.36 ± 0.03, respectively, ruling out significant insulin resistance in these adolescents. There was a significant negative correlation between the β-cell function (B% on one hand and the fasting and the 2-h BG (r=−0.6, and − 0.48, P < 0.01, respectively on the other hand. Neither fasting serum insulin nor c-peptide concentrations were correlated with fasting BG or ferritin levels. The average and maximum blood glucose levels during CGM were significantly correlated with the fasting BG (r = 0.68 and 0.39, respectively, with P < 0.01 and with the BG at 2-hour after oral glucose intake (r = 0.87 and 0.86 respectively, with P < 0.001. Ferritin concentrations were correlated with the fasting BG and the 2-h blood glucose levels in the OGTT (r = 0.52, and r = 0.43, respectively, P < 0.01 as well as with the average BG recorded by CGM (r = 0.75, P < 0.01. Conclusion: CGM has proven to

Real-time continuous glucose monitoring shows high accuracy within 6 hours after sensor calibration: a prospective study.

Directory of Open Access Journals (Sweden)

Xiao-Yan Yue

Full Text Available Accurate and timely glucose monitoring is essential in intensive care units. Real-time continuous glucose monitoring system (CGMS has been advocated for many years to improve glycemic management in critically ill patients. In order to determine the effect of calibration time on the accuracy of CGMS, real-time subcutaneous CGMS was used in 18 critically ill patients. CGMS sensor was calibrated with blood glucose measurements by blood gas/glucose analyzer every 12 hours. Venous blood was sampled every 2 to 4 hours, and glucose concentration was measured by standard central laboratory device (CLD and by blood gas/glucose analyzer. With CLD measurement as reference, relative absolute difference (mean±SD in CGMS and blood gas/glucose analyzer were 14.4%±12.2% and 6.5%±6.2%, respectively. The percentage of matched points in Clarke error grid zone A was 74.8% in CGMS, and 98.4% in blood gas/glucose analyzer. The relative absolute difference of CGMS obtained within 6 hours after sensor calibration (8.8%±7.2% was significantly less than that between 6 to 12 hours after calibration (20.1%±13.5%, p<0.0001. The percentage of matched points in Clarke error grid zone A was also significantly higher in data sets within 6 hours after calibration (92.4% versus 57.1%, p<0.0001. In conclusion, real-time subcutaneous CGMS is accurate in glucose monitoring in critically ill patients. CGMS sensor should be calibrated less than 6 hours, no matter what time interval recommended by manufacturer.

Glucose monitoring as a guide to diabetes management. Critical subject review.

OpenAIRE

Koch, B.

1996-01-01

PURPOSE: To encourage a balanced approach to blood glucose monitoring in diabetes by a critical review of the history, power and cost of glucose testing. DATA SOURCES: The Cambridge Data Base was searched and was supplemented by a random review of other relevant sources, including textbooks, company pamphlets, and laboratory manuals. STUDY SELECTION: Keywords used were "glucosuria diagnosis," "blood glucose self-monitoring," "glycosylated hemoglobin," and "fructosamine" for the 10-year period...

Glucose-monitoring neurons in the mediodorsal prefrontal cortex.

Science.gov (United States)

Nagy, Bernadett; Szabó, István; Papp, Szilárd; Takács, Gábor; Szalay, Csaba; Karádi, Zoltán

2012-03-20

The mediodorsal prefrontal cortex (mdPFC), a key structure of the limbic neural circuitry, plays important roles in the central regulation of feeding. As an integrant part of the forebrain dopamine (DA) system, it performs complex roles via interconnections with various brain areas where glucose-monitoring (GM) neurons have been identified. The main goal of the present experiments was to examine whether similar GM neurons exist in the mediodorsal prefrontal cortex. To search for such chemosensory cells here, and to estimate their involvement in the DA circuitry, extracellular single neuron activity of the mediodorsal prefrontal cortex of anesthetized Wistar and Sprague-Dawley rats was recorded by means of tungsten wire multibarreled glass microelectrodes during microelectrophoretic administration of d-glucose and DA. One fourth of the neurons tested changed in firing rate in response to glucose, thus, proved to be elements of the forebrain GM neural network. DA responsive neurons in the mdPFC were found to represent similar proportion of all cells; the glucose-excited units were shown to display excitatory whereas the glucose-inhibited neurons were demonstrated to exert mainly inhibitory responses to dopamine. The glucose-monitoring neurons of the mdPFC and their distinct DA sensitivity are suggested to be of particular significance in adaptive processes of the central feeding control. Copyright © 2012 Elsevier B.V. All rights reserved.

In vivo glucose monitoring using dual-wavelength polarimetry to overcome corneal birefringence in the presence of motion.

Science.gov (United States)

Pirnstill, Casey W; Malik, Bilal H; Gresham, Vincent C; Coté, Gerard L

2012-09-01

Over the past 35 years considerable research has been performed toward the investigation of noninvasive and minimally invasive glucose monitoring techniques. Optical polarimetry is one noninvasive technique that has shown promise as a means to ascertain blood glucose levels through measuring the glucose concentrations in the anterior chamber of the eye. However, one of the key limitations to the use of optical polarimetry as a means to noninvasively measure glucose levels is the presence of sample noise caused by motion-induced time-varying corneal birefringence. In this article our group presents, for the first time, results that show dual-wavelength polarimetry can be used to accurately detect glucose concentrations in the presence of motion-induced birefringence in vivo using New Zealand White rabbits. In total, nine animal studies (three New Zealand White rabbits across three separate days) were conducted. Using the dual-wavelength optical polarimetric approach, in vivo, an overall mean average relative difference of 4.49% (11.66 mg/dL) was achieved with 100% Zone A+B hits on a Clarke error grid, including 100% falling in Zone A. The results indicate that dual-wavelength polarimetry can effectively be used to significantly reduce the noise due to time-varying corneal birefringence in vivo, allowing the accurate measurement of glucose concentration in the aqueous humor of the eye and correlating that with blood glucose.

Continuous non-invasive blood glucose monitoring by spectral image differencing method

Science.gov (United States)

Huang, Hao; Liao, Ningfang; Cheng, Haobo; Liang, Jing

2018-01-01

Currently, the use of implantable enzyme electrode sensor is the main method for continuous blood glucose monitoring. But the effect of electrochemical reactions and the significant drift caused by bioelectricity in body will reduce the accuracy of the glucose measurements. So the enzyme-based glucose sensors need to be calibrated several times each day by the finger-prick blood corrections. This increases the patient's pain. In this paper, we proposed a method for continuous Non-invasive blood glucose monitoring by spectral image differencing method in the near infrared band. The method uses a high-precision CCD detector to switch the filter in a very short period of time, obtains the spectral images. And then by using the morphological method to obtain the spectral image differences, the dynamic change of blood sugar is reflected in the image difference data. Through the experiment proved that this method can be used to monitor blood glucose dynamically to a certain extent.

Fault and meal detection by redundant continuous glucose monitors and the unscented Kalman filter

DEFF Research Database (Denmark)

Mahmoudi, Zeinab; Nørgaard, Kirsten; Poulsen, Niels Kjølstad

2017-01-01

The purpose of this study is to develop a method for detecting and compensating the anomalies of continuous glucose monitoring (CGM) sensors as well as detecting unannounced meals. Both features, sensor fault detection/correction and meal detection, are necessary to have a reliable artificial pan...... is corrupted by PISA. The fault isolator can detect 199 out of 200 unannounced meals. The average change in the glucose concentrations between the meals and the detection time points is 46.3 mg/dL.......The purpose of this study is to develop a method for detecting and compensating the anomalies of continuous glucose monitoring (CGM) sensors as well as detecting unannounced meals. Both features, sensor fault detection/correction and meal detection, are necessary to have a reliable artificial...... from the two fault detectors differentiates between a sensor fault and an unannounced meal appearing as an anomaly in the CGM data. If the fault isolator indicates a sensor fault, a method based on the covariance matching technique tunes the covariance of the measurement noise associated...

Recommending blood glucose monitors, a pharmacy perspective.

Science.gov (United States)

Carter, Alan

2007-03-01

Selection of what blood glucose monitoring system to utilize has become an issue for physicians, diabetes educators, pharmacists, and patients. The field of competing makes and models of blood glucose monitoring systems has become crowded, with manufacturers touting improvements in accuracy, ease of use/alternate site options, stored results capacity, software evaluation tools, and/or price point. Personal interviews of 12 pharmacists from community and academic practice settings about monitor preference, as well as results from a national survey of pharmacist recommendations, were compared to actual wholesale sales data to estimate the impact of such recommendations on final monitor selection by the patient. Accu-Chek monitors were recommended 34.65% of the time and represented 28.58% of sales, with a success rate of 82.48% of being the monitor selected. OneTouch monitors had 27.72% of recommendations but represented 31.43% of sales, indicating possible patient brand loyalty or formulary preference for that product. FreeStyle(R) monitors came in third for pharmacist recommendations and were selected by the patient 61.68% of the time when recommended. The category of "other monitor" choices was selected 60.89% of the time by patients given those suggestions. Included in the "other monitor" category was the new disposable monitor marketed as the Sidekick. Based on sales data provided, the Sidekick made up 2.87% of "other monitor" category sales, representing 68% of the "other monitor" segment. While patients frequently follow pharmacist monitoring system suggestions, the ultimate deciding factor is most often the final out-of-pocket cost to the patient. As a result, cost of supplies often becomes the most important determining factor in final monitor selection at the patient level. If the patient cannot afford to perform the recommended daily testing intervals, all other determining factors and suggestions become moot.

Continuous glucose monitoring systems for type 1 diabetes mellitus.

Science.gov (United States)

Langendam, Miranda; Luijf, Yoeri M; Hooft, Lotty; Devries, J Hans; Mudde, Aart H; Scholten, Rob J P M

2012-01-18

Self-monitoring of blood glucose is essential to optimise glycaemic control in type 1 diabetes mellitus. Continuous glucose monitoring (CGM) systems measure interstitial fluid glucose levels to provide semi-continuous information about glucose levels, which identifies fluctuations that would not have been identified with conventional self-monitoring. Two types of CGM systems can be defined: retrospective systems and real-time systems. Real-time systems continuously provide the actual glucose concentration on a display. Currently, the use of CGM is not common practice and its reimbursement status is a point of debate in many countries. To assess the effects of CGM systems compared to conventional self-monitoring of blood glucose (SMBG) in patients with diabetes mellitus type 1. We searched The Cochrane Library, MEDLINE, EMBASE and CINAHL for the identification of studies. Last search date was June 8, 2011. Randomised controlled trials (RCTs) comparing retrospective or real-time CGM with conventional self-monitoring of blood glucose levels or with another type of CGM system in patients with type 1 diabetes mellitus. Primary outcomes were glycaemic control, e.g. level of glycosylated haemoglobin A1c (HbA1c) and health-related quality of life. Secondary outcomes were adverse events and complications, CGM derived glycaemic control, death and costs. Two authors independently selected the studies, assessed the risk of bias and performed data-extraction. Although there was clinical and methodological heterogeneity between studies an exploratory meta-analysis was performed on those outcomes the authors felt could be pooled without losing clinical merit. The search identified 1366 references. Twenty-two RCTs meeting the inclusion criteria of this review were identified. The results of the meta-analyses (across all age groups) indicate benefit of CGM for patients starting on CGM sensor augmented insulin pump therapy compared to patients using multiple daily injections of

[Influence of an infusion of 5- or 20% glucose solution on blood glucose and inorganic phosphate concentrations in dairy cows].

Science.gov (United States)

Aldaek, T A A; Failing, K; Wehrend, A; Klymiuk, M C

2011-01-01

The study was performed to evaluate the influence of an intravenous infusion of 5% and 20% dextrose solution on the plasma concentration of glucose and inorganic phosphate in healthy, dairy cows. Ten healthy, lactating, nonpregnant 3 to 6 year-old Holstein-Friesian cows were included in this investigation. The daily milk yield was 20.3±2.7 liters. Blood plasma concentrations of inorganic phosphate and glucose were determined before, during, immediately and 60 minutes after infusion of 0.9% physiological saline, 5% or 20% dextrose solution. A statistically significant influence of dextrose infusion on blood glucose concentration was observed. After 20% dextrose infusion (200 g dextrose) the blood glucose concentration increased by approximately 13.26 mmol/l. The administration of 5% dextrose solution (50 g dextrose) yielded an increase of blood glucose concentration by 3.31 mmol/l. There was no significant correlation between plasma inorganic phosphate concentrations and infusion of 0.9% saline, 5% or 20% dextrose solution. Intravenous administration of 1000 ml of 5% or 20% dextrose solution does not induce a lasting plasma phosphate reduction and is suitable for elevating the blood glucose concentration.

Genetic Algorithm Tuning of PID Controller in Smith Predictor for Glucose Concentration Control

OpenAIRE

Tsonyo Slavov; Olympia Roeva

2011-01-01

This paper focuses on design of a glucose concentration control system based on nonlinear model plant of E. coli MC4110 fed-batch cultivation process. Due to significant time delay in real time glucose concentration measurement, a correction is proposed in glucose concentration measurement and a Smith predictor (SP) control structure based on universal PID controller is designed. To reduce the influence of model error in SP structure the estimate of measured glucose concentration is used. For...

Correlation between the Plasma Insulin and Glucose Concentration in Normal Korean Adults

Energy Technology Data Exchange (ETDEWEB)

Lee, Jang Kyu; Sung, Ho Kyung; Kim, Jin Eui [Radiological Research Institute, Seoul (Korea, Republic of)

1971-09-15

The correlation between the plasma insulin, and glucose concentration was studied in healthy Korean adults consisting of 20 males and 22 females of 16 to 38 years of age. The blood samples of above subjects were obtained through cubital vein at arbitrary times during their usual working hours. Plasma insulin was assayed by means of double antibody system of radioimmunoassay technics, and blood glucose was determined by means of Van Slyke-Folch method. Results were as follows : 1. There were no differences in the blood sugar levels in relation to the plasma insulin concentration either by sex or age. 2. In the case, when the plasma insulin concentration was within 50 mmuU/ml, the correlation between the insulin, and glucose concentration existed, the ratio of which was expressed as; Plasma glucose concentration (mg/dl)=91.9 + 0.08 X Insulin concentration r=0.62. 3. Insulinogenic index was 12.4%, which was somewhat higher than other reports. 4. It is suggested that the correlation between plasma insulin and glucose concentration could be determined at arbitrary times instead of fasting times.

Raman Spectroscopy as a Promising Tool for Noninvasive Point-of-Care Glucose Monitoring

NARCIS (Netherlands)

Scholtes-Timmerman, M.J.; Bijlsma, S.; Fokkert, M.J.; Slingerland, R.; Veen, S.J.F. van

2014-01-01

Self-monitoring of glucose is important for managing diabetes. Noninvasive glucose monitors are not yet available, but patients would benefit highly from such a device. We present results that may lead to a novel, point-of-care noninvasive system to measure blood glucose based on Raman spectroscopy.

Skin-like biosensor system via electrochemical channels for noninvasive blood glucose monitoring

OpenAIRE

Chen, Yihao; Lu, Siyuan; Zhang, Shasha; Li, Yan; Qu, Zhe; Chen, Ying; Lu, Bingwei; Wang, Xinyan; Feng, Xue

2017-01-01

Currently, noninvasive glucose monitoring is not widely appreciated because of its uncertain measurement accuracy, weak blood glucose correlation, and inability to detect hyperglycemia/hypoglycemia during sleep. We present a strategy to design and fabricate a skin-like biosensor system for noninvasive, in situ, and highly accurate intravascular blood glucose monitoring. The system integrates an ultrathin skin-like biosensor with paper battery–powered electrochemical twin channels (ETCs). The ...

Nanosensors and nanomaterials for monitoring glucose in diabetes.

Science.gov (United States)

Cash, Kevin J; Clark, Heather A

2010-12-01

Worldwide, diabetes is a rapidly growing problem that is managed at the individual level by monitoring and controlling blood glucose levels to minimize the negative effects of the disease. Because of limitations in diagnostic methods, significant research efforts are focused on developing improved methods to measure glucose. Nanotechnology has impacted these efforts by increasing the surface area of sensors, improving the catalytic properties of electrodes and providing nanoscale sensors. Here, we discuss developments in the past several years on both nanosensors that directly measure glucose and nanomaterials that improve glucose sensor function. Finally, we discuss challenges that must be overcome to apply these developments in the clinic. Copyright © 2010 Elsevier Ltd. All rights reserved.

Effects of simulated altitude on blood glucose meter performance: implications for in-flight blood glucose monitoring.

Science.gov (United States)

Olateju, Tolu; Begley, Joseph; Flanagan, Daniel; Kerr, David

2012-07-01

Most manufacturers of blood glucose monitoring equipment do not give advice regarding the use of their meters and strips onboard aircraft, and some airlines have blood glucose testing equipment in the aircraft cabin medical bag. Previous studies using older blood glucose meters (BGMs) have shown conflicting results on the performance of both glucose oxidase (GOX)- and glucose dehydrogenase (GDH)-based meters at high altitude. The aim of our study was to evaluate the performance of four new-generation BGMs at sea level and at a simulated altitude equivalent to that used in the cabin of commercial aircrafts. Blood glucose measurements obtained by two GDH and two GOX BGMs at sea level and simulated altitude of 8000 feet in a hypobaric chamber were compared with measurements obtained using a YSI 2300 blood glucose analyzer as a reference method. Spiked venous blood samples of three different glucose levels were used. The accuracy of each meter was determined by calculating percentage error of each meter compared with the YSI reference and was also assessed against standard International Organization for Standardization (ISO) criteria. Clinical accuracy was evaluated using the consensus error grid method. The percentage (standard deviation) error for GDH meters at sea level and altitude was 13.36% (8.83%; for meter 1) and 12.97% (8.03%; for meter 2) with p = .784, and for GOX meters was 5.88% (7.35%; for meter 3) and 7.38% (6.20%; for meter 4) with p = .187. There was variation in the number of time individual meters met the standard ISO criteria ranging from 72-100%. Results from all four meters at both sea level and simulated altitude fell within zones A and B of the consensus error grid, using YSI as the reference. Overall, at simulated altitude, no differences were observed between the performance of GDH and GOX meters. Overestimation of blood glucose concentration was seen among individual meters evaluated, but none of the results obtained would have resulted in

Self-monitoring of blood glucose versus self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes receiving structured education: a cluster randomized controlled trial.

Science.gov (United States)

Dallosso, H M; Bodicoat, D H; Campbell, M; Carey, M E; Davies, M J; Eborall, H C; Hadjiconstantinou, M; Khunti, K; Speight, J; Heller, S

2015-03-01

To compare the effectiveness and acceptability of self-monitoring of blood glucose with self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes. We conducted a multi-site cluster randomized controlled trial with practice-level randomization. Participants attended a structured group education programme, which included a module on self-monitoring using blood glucose or urine glucose monitoring. HbA1c and other biomedical measures as well as psychosocial data were collected at 6, 12 and 18 months. A total of 292 participants with Type 2 diabetes were recruited from 75 practices. HbA1c levels were significantly lower at 18 months than at baseline in both the blood monitoring group [mean (se) -12 (2) mmol/mol; -1.1 (0.2) %] and the urine monitoring group [mean (se) -13 (2) mmol/mol; -1.2 (0.2)%], with no difference between groups [mean difference adjusted for cluster effect and baseline value = -1 mmol/mol (95% CI -3, 2); -0.1% (95% CI -0.3, 0.2)]. Similar improvements were observed for the other biomedical outcomes, with no differences between groups. Both groups showed improvements in total treatment satisfaction, generic well-being, and diabetes-specific well-being, and had a less threatening view of diabetes, with no differences between groups at 18 months. Approximately one in five participants in the urine monitoring arm switched to blood monitoring, while those in the blood monitoring arm rarely switched (18 vs 1% at 18 months; P self-monitoring. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

Construction of near-infrared photonic crystal glucose-sensing materials for ratiometric sensing of glucose in tears.

Science.gov (United States)

Hu, Yumei; Jiang, Xiaomei; Zhang, Laiying; Fan, Jiao; Wu, Weitai

2013-10-15

Noninvasive monitoring of glucose in tears is highly desirable in tight glucose control. The polymerized crystalline colloidal array (PCCA) that can be incorporated into contact lens represents one of the most promising materials for noninvasive monitoring of glucose in tears. However, low sensitivity and slow time response of the PCCA reported in previous arts has limited its clinical utility. This paper presents a new PCCA, denoted as NIR-PCCA, comprising a CCA of glucose-responsive sub-micrometered poly(styrene-co-acrylamide-co-3-acrylamidophenylboronic acid) microgels embedded within a slightly positive charged hydrogel matrix of poly(acrylamide-co-2-(dimethylamino)ethyl acrylate). This newly designed NIR-PCCA can reflect near-infrared (NIR) light, whose intensity (at 1722 nm) would decrease evidently with increasing glucose concentration over the physiologically relevant range in tears. The lowest glucose concentration reliably detectable was as low as ca. 6.1 μg/dL. The characteristic response time τ(sensing) was 22.1±0.2s when adding glucose to 7.5 mg/dL, and the higher the glucose concentration is, the faster the time response. Such a rationally designed NIR-PCCA is well suited for ratiometric NIR sensing of tear glucose under physiological conditions, thereby likely to bring this promising glucose-sensing material to the forefront of analytical devices for diabetes. Copyright © 2013 Elsevier B.V. All rights reserved.

Fasting blood glucose and haemoglobin concentrations of healthy ...

African Journals Online (AJOL)

Menstruation is associated with loss of blood monthly in women of reproductive age. In some women this physiological phenomenon is also associated with some complaints such as menstrual pain, vomiting, and tiredness. We investigated the fasting blood glucose concentration and hemoglobin concentration before and ...

Exogenous glucagon-like peptide-1 attenuates glucose absorption and reduces blood glucose concentration after small intestinal glucose delivery in critical illness.

Science.gov (United States)

Miller, Asaf; Deane, Adam M; Plummer, Mark P; Cousins, Caroline E; Chapple, Lee-Anne S; Horowitz, Michael; Chapman, Marianne J

2017-03-01

To evaluate the effect of exogenous glucagonlike peptide-1 (GLP-1) on small intestinal glucose absorption and blood glucose concentrations during critical illness. A prospective, blinded, placebo-controlled, cross-over, randomised trial in a mixed medical-surgical adult intensive care unit, with 12 mechanically ventilated critically ill patients, who were suitable for receiving small intestinal nutrient. On consecutive days, in a randomised order, participants received intravenous GLP-1 (1.2 pmol/ kg/min) or placebo (0.9% saline) as a continuous infusion over 270 minutes. After 6 hours of fasting, intravenous infusions of GLP-1 or placebo began at T = -30 min (in which T = time), with the infusion maintained at a constant rate until study completion at T = 240 min. At T = 0 min, a 100 mL bolus of mixed liquid nutrient meal (1 kcal/mL) containing 3 g of 3-O-methyl-D-gluco-pyranose (3-OMG), a marker of glucose absorption, was administered directly into the small intestine, via a post-pyloric catheter, over 6 minutes. Blood samples were taken at regular intervals for the measurement of plasma glucose and 3-OMG concentrations. Intravenous GLP-1 attenuated initial small intestinal glucose absorption (mean area under the curve [AUC] 0-30 for 3-OMG: GLP-1 group, 4.4 mmol/L/min [SEM, 0.9 mmol/L/min] v placebo group, 6.5 mmol/L/min [SEM, 1.0 mmol/L/min]; P = 0.01), overall small intestinal glucose absorption (mean AUC 0-240 for 3-OMG: GLP-1, 68.2 mmol/L/ min [SEM, 4.7 mmol/L/min] v placebo, 77.7 mmol/L/min [SEM, 4.4 mmol/lLmin]; P = 0.02), small intestinal glucose absorption and overall blood glucose concentration (mean AUC 0-240 for blood glucose: GLP-1, 2062 mmol/L/min [SEM, 111 mmol/L/min] v placebo 2328 mmol/L/min [SEM, 145 mmol/L/min]; P = 0.005). Short-term administration of exogenous GLP-1 reduces small intestinal glucose absorption for up to 4 hours during critical illness. This is likely to be an additional mechanism for the glucose-lowering effect of this agent.

Noninvasive measurement of glucose concentration on human fingertip by optical coherence tomography

Science.gov (United States)

Chen, Tseng-Lin; Lo, Yu-Lung; Liao, Chia-Chi; Phan, Quoc-Hung

2018-04-01

A method is proposed for determining the glucose concentration on the human fingertip by extracting two optical parameters, namely the optical rotation angle and the depolarization index, using a Mueller optical coherence tomography technique and a genetic algorithm. The feasibility of the proposed method is demonstrated by measuring the optical rotation angle and depolarization index of aqueous glucose solutions with low and high scattering, respectively. It is shown that for both solutions, the optical rotation angle and depolarization index vary approximately linearly with the glucose concentration. As a result, the ability of the proposed method to obtain the glucose concentration by means of just two optical parameters is confirmed. The practical applicability of the proposed technique is demonstrated by measuring the optical rotation angle and depolarization index on the human fingertip of healthy volunteers under various glucose conditions.

Effect of feeding glucose, fructose, and inulin on blood glucose and insulin concentrations in normal ponies and those predisposed to laminitis.

Science.gov (United States)

Borer, K E; Bailey, S R; Menzies-Gow, N J; Harris, P A; Elliott, J

2012-09-01

Identification of ponies (Equus caballus) at increased risk of pasture-associated laminitis would aid in the prevention of the disease. Insulin resistance has been associated with laminitis and could be used to identify susceptible individuals. Insulin resistance may be diagnosed by feeding supplementary water-soluble carbohydrate (WSC) and measuring blood glucose and insulin concentrations. The aim of this study was to assess the glycemic and insulinemic responses of 7 normal (NP) and 5 previously laminitic (PLP), mixed breed, native UK ponies fed glucose, fructose, and inulin [1 g/(kg·d) for 3 d] or no supplementary WSC (control) in spring and fall after a 7-d adaptation to a pasture or hay diet. Blood samples were taken for 12 h after feeding on each day, and baseline and peak concentrations and area under the curve (AUC) for glucose and insulin were recorded. Linear mixed models were used for statistical analysis. Differences between PLP and NP groups were most marked after glucose feeding with differences in peak glucose (P = 0.02) and peak insulin (P = 0.016) concentrations. Season and diet adaptation also affected results. Peak concentrations of glucose and insulin occurred 2 to 4 h after WSC feeding. Peak insulin concentration was greater and more variable in fall, particularly in PLP adapted to fall pasture. Baseline glucose and insulin concentrations varied between individuals and with season and diet adaptation but were not greater in PLP than NP. Insulin AUC was greater in PLP than NP after feeding both glucose and fructose (P = 0.017), but there were no differences between PLP and NP in glucose AUC. Glycemic and insulinemic changes were less (P ≤ 0.05) after feeding fructose than glucose, although differences between PLP and NP were still evident. Minimal changes in glucose and insulin concentrations occurred after inulin feeding. Measurement of peak insulin 2 h after feeding of a single dose of glucose (1 g/kg) may be a simple and practical way to

Salivary glucose concentration exhibits threshold kinetics in normal-weight, overweight, and obese children

Directory of Open Access Journals (Sweden)

Hartman ML

2014-12-01

Full Text Available Mor-Li Hartman,1 J Max Goodson,1 Roula Barake,2 Osama Alsmadi,3 Sabiha Al-Mutawa,4 Jitendra Ariga,4 Pramod Soparkar,1 Jawad Behbehani,5 Kazem Behbehani,6 Francine Welty7 1Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA; 2Department of Nutrition, The Dasman Diabetes Institute, Dasman, Kuwait; 3Genome Center, The Dasman Diabetes Institute, Dasman, Kuwait; 4Ministry of Health, Kuwait City, Kuwait; 5Faculty of Dentistry, Kuwait University, Kuwait City, Kuwait; 6The Dasman Diabetes Institute, Dasman, Kuwait; 7Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA Background: Metabolic syndrome in childhood predicts the development of cardiovascular disease and type 2 diabetes (T2D in adulthood. Testing for features of metabolic syndrome, such as fasting plasma glucose concentration, requires blood sampling which can be difficult in children. Here we evaluated salivary glucose concentration as a surrogate measurement for plasma glucose concentration in 11-year-old US children. Methods: Children from Portland, Maine, and Cambridge, Massachusetts, with a mean age of 10.6±0.2 years provided 6-hour fasting samples of both blood and whole saliva. Salivary glucose levels were measured with a high-sensitivity assay (sensitivity =0.002 mg/dL. Plasma glucose levels were determined by a commercial clinical laboratory. Blood pressure, salivary flow rate, height, and weight were also measured. Results: Of the 65 children enrolled, there were two underweight children (3.1%, 30 normal-weight children (46.2%, 12 overweight children (18.4%, and 21 obese children (32.3%. The mean overall glucose concentrations were 0.11±0.02 mg/dL in saliva and 86.3±0.8 mg/dL in plasma, and these did not differ significantly by body–weight groups. By regression analysis, the plasma concentration equaled 13.5 times the saliva concentration, with a threshold level of 84.8 mg/dL. Salivary glucose values less than threshold plasma

Hydrogen peroxide and glucose concentration measurement using optical fiber grating sensors with corrodible plasmonic nanocoatings.

Science.gov (United States)

Zhang, Xuejun; Wu, Ze; Liu, Fu; Fu, Qiangqiang; Chen, Xiaoyong; Xu, Jian; Zhang, Zhaochuan; Huang, Yunyun; Tang, Yong; Guo, Tuan; Albert, Jacques

2018-04-01

We propose and demonstrate hydrogen peroxide (H 2 O 2 ) and glucose concentration measurements using a plasmonic optical fiber sensor. The sensor utilizes a tilted fiber Bragg grating (TFBG) written in standard single mode communication fiber. The fiber is over coated with an nm-scale film of silver that supports surface plasmon resonances (SPRs). Such a tilted grating SPR structure provides a high density of narrow spectral resonances (Q-factor about 10 5 ) that overlap with the broader absorption band of the surface plasmon waves in the silver film, thereby providing an accurate tool to measure small shifts of the plasmon resonance frequencies. The H 2 O 2 to be detected acts as an oxidant to etch the silver film, which has the effect of gradually decreasing the SPR attenuation. The etching rate of the silver film shows a clear relationship with the H 2 O 2 concentration so that monitoring the progressively increasing attenuation of a selected surface plasmon resonance over a few minutes enables us to measure the H 2 O 2 concentration with a limit of detection of 0.2 μM. Furthermore, the proposed method can be applied to the determination of glucose in human serum for a concentration range from 0 to 12 mM (within the physiological range of 3-8 mM) by monitoring the H 2 O 2 produced by an enzymatic oxidation process. The sensor does not require accurate temperature control because of the inherent temperature insensitivity of TFBG devices referenced to the core mode resonance. A gold mirror coated on the fiber allows the sensor to work in reflection, which will facilitate the integration of the sensor with a hypodermic needle for in vitro measurements. The present study shows that Ag-coated TFBG-SPR can be applied as a promising type of sensing probe for optical detection of H 2 O 2 and glucose detection in human serum.

Hydrogen peroxide and glucose concentration measurement using optical fiber grating sensors with corrodible plasmonic nanocoatings

Science.gov (United States)

Zhang, Xuejun; Wu, Ze; Liu, Fu; Fu, Qiangqiang; Chen, Xiaoyong; Xu, Jian; Zhang, Zhaochuan; Huang, Yunyun; Tang, Yong; Guo, Tuan; Albert, Jacques

2018-01-01

We propose and demonstrate hydrogen peroxide (H2O2) and glucose concentration measurements using a plasmonic optical fiber sensor. The sensor utilizes a tilted fiber Bragg grating (TFBG) written in standard single mode communication fiber. The fiber is over coated with an nm-scale film of silver that supports surface plasmon resonances (SPRs). Such a tilted grating SPR structure provides a high density of narrow spectral resonances (Q-factor about 105) that overlap with the broader absorption band of the surface plasmon waves in the silver film, thereby providing an accurate tool to measure small shifts of the plasmon resonance frequencies. The H2O2 to be detected acts as an oxidant to etch the silver film, which has the effect of gradually decreasing the SPR attenuation. The etching rate of the silver film shows a clear relationship with the H2O2 concentration so that monitoring the progressively increasing attenuation of a selected surface plasmon resonance over a few minutes enables us to measure the H2O2 concentration with a limit of detection of 0.2 μM. Furthermore, the proposed method can be applied to the determination of glucose in human serum for a concentration range from 0 to 12 mM (within the physiological range of 3-8 mM) by monitoring the H2O2 produced by an enzymatic oxidation process. The sensor does not require accurate temperature control because of the inherent temperature insensitivity of TFBG devices referenced to the core mode resonance. A gold mirror coated on the fiber allows the sensor to work in reflection, which will facilitate the integration of the sensor with a hypodermic needle for in vitro measurements. The present study shows that Ag-coated TFBG-SPR can be applied as a promising type of sensing probe for optical detection of H2O2 and glucose detection in human serum. PMID:29675315

Correlation between glucose concentrations in serum, plasma, and whole blood measured by a point-of-care glucometer and serum glucose concentration measured by an automated biochemical analyzer for canine and feline blood samples.

Science.gov (United States)

Tauk, Barbara S; Drobatz, Kenneth J; Wallace, Koranda A; Hess, Rebecka S

2015-06-15

To investigate the correlation between glucose concentrations in serum, plasma, and whole blood measured by a point-of-care glucometer (POCG) and serum glucose concentration measured by a biochemical analyzer. Prospective clinical study. 96 blood samples from 80 dogs and 90 blood samples from 65 cats. Serum, plasma, and whole blood were obtained from each blood sample. The glucose concentrations in serum, plasma, and whole blood measured by a POCG were compared with the serum glucose concentration measured by a biochemical analyzer by use of the Lin concordance correlation coefficient (ρc) and Bland-Altman plots. For both canine and feline samples, glucose concentrations in serum and plasma measured by the POCG were more strongly correlated with the serum glucose concentration measured by the biochemical analyzer (ρc, 0.98 for both canine serum and plasma; ρc, 0.99 for both feline serum and plasma) than was that in whole blood (ρc, 0.62 for canine samples; ρc, 0.90 for feline samples). The mean difference between the glucose concentrations determined by the biochemical analyzer and the POCG in serum, plasma, and whole blood was 0.4, 0.3, and 31 mg/dL, respectively, for canine samples and 7, 6, and 32 mg/dL, respectively, for feline samples. Results indicated that use of a POCG to measure glucose concentrations in serum or plasma may increase the accuracy and reliability of diagnostic and treatment decisions associated with glucose homeostasis disorders in dogs and cats.

Noradrenaline and acetylcholine responsiveness of glucose-monitoring and glucose-insensitive neurons in the mediodorsal prefrontal cortex.

Science.gov (United States)

Nagy, Bernadett; Szabó, István; Csetényi, Bettina; Hormay, Edina; Papp, Szilárd; Keresztes, Dóra; Karádi, Zoltán

2014-01-16

The mediodorsal prefrontal cortex (mdPFC), as part of the forebrain glucose-monitoring (GM) system, plays important role in several regulatory processes to control the internal state of the organism and to initiate behavioral outputs accordingly. Little is known, however, about the neurochemical sensitivity of neurons located in this area. Substantial evidence indicates that the locus ceruleus - noradrenaline (NA) projection system and the nucleus basalis magnocellularis - cholinergic projection system regulate behavioral state and state dependent processing of sensory information, various cognitive functions already associated with the mdPFC. The main goal of the present study was to examine noradrenergic and cholinergic responsiveness of glucose-monitoring and glucose-insensitive (GIS) neurons in the mediodorsal prefrontal cortex. One fifth of the neurons tested changed in firing rate to microelectrophoretically applied NA. Responsiveness of the GM cells to this catecholamine proved to be significantly higher than that of the GIS units. Microiontophoretic application of acetylcholine (Ach) resulted in activity changes (predominantly facilitation) of more than 40% of the mdPFC neurons. Proportion of Ach sensitive units among the GM and the GIS neurons was found to be similar. The glucose-monitoring neurons of the mdPFC and their distinct NA and remarkable Ach sensitivity are suggested to be of particular significance in prefrontal control of adaptive behaviors. © 2013 Published by Elsevier B.V.

Patient satisfaction and barriers to initiating real-time continuous glucose monitoring in early pregnancy in women with diabetes

DEFF Research Database (Denmark)

Secher, A L; Madsen, A B; Nielsen, Lene Ringholm

2012-01-01

of initial monitoring). Ten women (15%) did not wish to use continuous glucose monitoring again in pregnancy. Main causes behind early removal of continuous glucose monitoring were self-reported skin irritation, technical problems and continuous glucose monitoring inaccuracy. No differences were found......Aim: To evaluate self-reported satisfaction and barriers to initiating real-time continuous glucose monitoring in early pregnancy among women with pregestational diabetes. Methods: Fifty-four women with Type 1 diabetes and 14 women with Type 2 diabetes were offered continuous glucose monitoring...

Evaluation of Postprandial Glucose Excursion Using a Novel Minimally Invasive Glucose Area-Under-the-Curve Monitoring System

OpenAIRE

Kuranuki, Sachi; Sato, Toshiyuki; Okada, Seiki; Hosoya, Samiko; Seko, Akinobu; Sugihara, Kaya; Nakamura, Teiji

2013-01-01

Objective: To develop a minimally invasive interstitial fluid extraction technology (MIET) to monitor postprandial glucose area under the curve (AUC) without blood sampling, we evaluated the accuracy of glucose AUC measured by MIET and compared with that by blood sampling after food intake. Methods: Interstitial fluid glucose AUC (IG-AUC) following consumption of 6 different types of foods was measured by MIET. MIET consisted of stamping microneedle arrays, placing hydrogel patches on the are...

A contact lens with integrated telecommunication circuit and sensors for wireless and continuous tear glucose monitoring

International Nuclear Information System (INIS)

Yao, H; Liao, Y; Lingley, A R; Afanasiev, A; Lähdesmäki, I; Otis, B P; Parviz, B A

2012-01-01

We present an integrated functional contact lens, composed of a differential glucose sensor module, metal interconnects, sensor read-out circuit, antenna and telecommunication circuit, to monitor tear glucose levels wirelessly, continuously and non-invasively. The electrochemical differential sensor module is based on immobilization of activated and de-activated glucose oxidase. We characterized the sensor on a model polymer eye and determined that it showed good repeatability, molecular interference rejection and linearity in the range of 0–2 mM glucose, covering normal tear glucose concentrations (0.1–0.6 mM). We also report the temperature, ageing and protein-fouling sensitivity of the sensor. We report the design and implementation of a low-power (3 µW) sensor read-out and telecommunication circuit to deliver wireless power and transmit data for the sensor module. Using this small chip (0.36 mm 2 ), we produced an integrated contact lens with sensors and demonstrated wireless operation of the system and glucose read-out over the distance of several centimeters. (paper)

Measurement of glucose area under the curve using minimally invasive interstitial fluid extraction technology: evaluation of glucose monitoring concepts without blood sampling.

Science.gov (United States)

Sato, Toshiyuki; Okada, Seiki; Hagino, Kei; Asakura, Yoshihiro; Kikkawa, Yasuo; Kojima, Junko; Watanabe, Toshihiro; Maekawa, Yasunori; Isobe, Kazuki; Koike, Reona; Nakajima, Hiromu; Asano, Kaoru

2011-12-01

Monitoring postprandial hyperglycemia is crucial in treating diabetes, although its dynamics make accurate monitoring difficult. We developed a new technology for monitoring postprandial hyperglycemia using interstitial fluid (ISF) extraction technology without blood sampling. The glucose area under the curve (AUC) using this system was measured as accumulated ISF glucose (IG) with simultaneous calibration with sodium ions. The objective of this study was to evaluate this technological concept in healthy individuals. Minimally invasive ISF extraction technology (MIET) comprises two steps: pretreatment with microneedles and ISF accumulation over a specific time by contact with a solvent. The correlation between glucose and sodium ion levels using MIET was evaluated in 12 subjects with stable blood glucose (BG) levels during fasting. BG and IG time courses were evaluated in three subjects to confirm their relationship while BG was fluctuating. Furthermore, the accuracy of glucose AUC measurements by MIET was evaluated several hours after a meal in 30 subjects. A high correlation was observed between glucose and sodium ion levels when BG levels were stable (R=0.87), indicating that sodium ion is a good internal standard for calibration. The variation in IG and BG with MIET was similar, indicating that IG is an adequate substitute for BG. Finally, we showed a strong correlation (R=0.92) between IG-AUC and BG-AUC after a meal. These findings validate the adequacy of glucose AUC measurements using MIET. Monitoring glucose using MIET without blood sampling may be beneficial to patients with diabetes.

A signal processing application for evaluating self-monitoring blood glucose strategies in a software agent model.

Science.gov (United States)

Wang, Zhanle; Paranjape, Raman

2015-07-01

We propose the signal processing technique of calculating a cross-correlation function and an average deviation between the continuous blood glucose and the interpolation of limited blood glucose samples to evaluate blood glucose monitoring frequency in a self-aware patient software agent model. The diabetic patient software agent model [1] is a 24-h circadian, self-aware, stochastic model of a diabetic patient's blood glucose levels in a software agent environment. The purpose of this work is to apply a signal processing technique to assist patients and physicians in understanding the extent of a patient's illness using a limited number of blood glucose samples. A second purpose of this work is to determine an appropriate blood glucose monitoring frequency in order to have a minimum number of samples taken that still provide a good understanding of the patient's blood glucose levels. For society in general, the monitoring cost of diabetes is an extremely important issue, and these costs can vary tremendously depending on monitoring approaches and monitoring frequencies. Due to the cost and discomfort associated with blood glucose monitoring, today, patients expect monitoring frequencies specific to their health profile. The proposed method quantitatively assesses various monitoring protocols (from 6 times per day to 1 time per week) in nine predefined categories of patient agents in terms of risk factors of health status and age. Simulation results show that sampling 6 times per day is excessive, and not necessary for understanding the dynamics of the continuous signal in the experiments. In addition, patient agents in certain conditions only need to sample their blood glucose 1 time per week to have a good understanding of the characteristics of their blood glucose. Finally, an evaluation scenario is developed to visualize this concept, in which appropriate monitoring frequencies are shown based on the particular conditions of patient agents. This base line can

An Integrated Glucose Sensor with an All-Solid-State Sodium Ion-Selective Electrode for a Minimally Invasive Glucose Monitoring System

Directory of Open Access Journals (Sweden)

Junko Kojima

2015-06-01

Full Text Available We developed a minimally invasive glucose monitoring system that uses a microneedle to permeate the skin surface and a small hydrogel to accumulate interstitial fluid glucose. The measurement of glucose and sodium ion levels in the hydrogel is required for estimating glucose levels in blood; therefore, we developed a small, enzyme-fixed glucose sensor with a high-selectivity, all-solid-state, sodium ion-selective electrode (ISE integrated into its design. The glucose sensor immobilized glucose oxidase showed a good correlation between the glucose levels in the hydrogels and the reference glucose levels (r > 0.99, and exhibited a good precision (coefficient of variation = 2.9%, 0.6 mg/dL. In the design of the sodium ISEs, we used the insertion material Na0.33MnO2 as the inner contact layer and DD16C5 exhibiting high Na+/K+ selectivity as the ionophore. The developed sodium ISE exhibited high selectivity (\\( \\log \\,k^{pot}_{Na,K} = -2.8\\ and good potential stability. The sodium ISE could measure 0.4 mM (10−3.4 M sodium ion levels in the hydrogels containing 268 mM (10−0.57 M KCl. The small integrated sensor (ϕ < 10 mm detected glucose and sodium ions in hydrogels simultaneously within 1 min, and it exhibited sufficient performance for use as a minimally invasive glucose monitoring system.

Glucose monitoring as a guide to diabetes management. Critical subject review.

Science.gov (United States)

Koch, B

1996-06-01

To encourage a balanced approach to blood glucose monitoring in diabetes by a critical review of the history, power and cost of glucose testing. The Cambridge Data Base was searched and was supplemented by a random review of other relevant sources, including textbooks, company pamphlets, and laboratory manuals. Keywords used were "glucosuria diagnosis," "blood glucose self-monitoring," "glycosylated hemoglobin," and "fructosamine" for the 10-year period ending 1992, restricted to English language and human. About 200 titles were retrieved and reviewed according to the author's judgment of relevance. "Snapshot tests" (venous and capillary blood glucose) and "memory tests" (urine glucose, glycated hemoglobin fractions and fructosamine) must be employed according to individual patients treatment goals. Day-to-day metabolic guidance is facilitated by capillary blood glucose testing for patients receiving insulin and by urine glucose testing for others. Capillary blood glucose testing is mandatory in cases of hypoglycemia unawareness (inability to sense hypoglycemia because of neuropathy) but is not a substitute for a knowledge of clinical hypoglycemia self-care. Criteria by reason (clinical judgement and cost effectiveness) must be separated from criteria by emotion (preoccupation with technology and marketing). No randomized studies show that any of these tests consistently improve clinical outcome. Optimal metabolic control and cost savings can be expected from a rational selection of tests.

Steady-state cerebral glucose concentrations and transport in the human brain

OpenAIRE

Gruetter, R.; Ugurbil, K.; Seaquist, E. R.

1998-01-01

Understanding the mechanism of brain glucose transport across the blood- brain barrier is of importance to understanding brain energy metabolism. The specific kinetics of glucose transport nave been generally described using standard Michaelis-Menten kinetics. These models predict that the steady- state glucose concentration approaches an upper limit in the human brain when the plasma glucose level is well above the Michaelis-Menten constant for half-maximal transport, K(t). In experiments wh...

Quality assessment of patients’ self-monitoring of blood glucose in community pharmacies

Directory of Open Access Journals (Sweden)

Kjome RL

2010-03-01

Full Text Available Objective: To evaluate diabetes patients’ self-monitoring of blood glucose using a community pharmacy-based quality assurance procedure, to investigate whether the procedure improved the quality of the patient performance of self monitoring of blood glucose, and to examine the opinions of the patients taking part in the study. Methods: The results of patient blood glucose measurements were compared to the results obtained with HemoCue Glucose 201+ by pharmacy employees in 16 Norwegian community pharmacies. Patient performance was monitored using an eight item checklist. Patients whose blood glucose measurements differed from pharmacy measurements by more than 20% were instructed in the correct use of their glucometer. The patients then re-measured their blood glucose. If the results were still outside the set limits, the control procedure was repeated with a new lot of glucometer strips, and then with a new glucometer. The patients returned for a follow-up visit after three months. Results: During the first visit, 5% of the 338 patients had measurements that deviated from pharmacy blood glucose values by more than 20% and user errors were observed for 50% of the patients. At the second visit, there was no significant change in the analytical quality of patient measurements, but the percentage of patients who made user errors had decreased to 29% (p < 0.001. Eighty-five percent of the patients reported that they used their blood glucose results to adjust medication, exercise or meals. Fifty-one percent of the patients reported a greater trust in their measurements after the second visit. Eighty percent of patients wished to have their measurements assessed yearly. Of these patients, 83% preferred to have the assessment done at the community pharmacy. Conclusion: A community pharmacy-based quality assessment procedure of patients’ self monitoring of blood glucose significantly reduced the number of user errors. The analytical quality of the

A glucose oxidase-coupled DNAzyme sensor for glucose detection in tears and saliva.

Science.gov (United States)

Liu, Chengcheng; Sheng, Yongjie; Sun, Yanhong; Feng, Junkui; Wang, Shijin; Zhang, Jin; Xu, Jiacui; Jiang, Dazhi

2015-08-15

Biosensors have been widely investigated and utilized in a variety of fields ranging from environmental monitoring to clinical diagnostics. Glucose biosensors have triggered great interest and have been widely exploited since glucose determination is essential for diabetes diagnosis. In here, we designed a novel dual-enzyme biosensor composed of glucose oxidase (GOx) and pistol-like DNAzyme (PLDz) to detect glucose levels in tears and saliva. First, GOx, as a molecular recognition element, catalyzes the oxidation of glucose forming H2O2; then PLDz recognizes the produced H2O2 as a secondary signal and performs a self-cleavage reaction promoted by Mn(2+), Co(2+) and Cu(2+). Thus, detection of glucose could be realized by monitoring the cleavage rate of PLDz. The slope of the cleavage rate of PLDz versus glucose concentration curve was fitted with a Double Boltzmann equation, with a range of glucose from 100 nM to 10mM and a detection limit of 5 μM. We further applied the GOx-PLDz 1.0 biosensor for glucose detection in tears and saliva, glucose levels in which are 720±81 μM and 405±56 μM respectively. Therefore, the GOx-PLDz 1.0 biosensor is able to determine glucose levels in tears and saliva as a noninvasive glucose biosensor, which is important for diabetic patients with frequent/continuous glucose monitoring requirements. In addition, induction of DNAzyme provides a new approach in the development of glucose biosensors. Copyright © 2015 Elsevier B.V. All rights reserved.

Different methods and settings for glucose monitoring for gestational diabetes during pregnancy.

Science.gov (United States)

Raman, Puvaneswary; Shepherd, Emily; Dowswell, Therese; Middleton, Philippa; Crowther, Caroline A

2017-10-29

Incidence of gestational diabetes mellitus (GDM) is increasing worldwide. Blood glucose monitoring plays a crucial part in maintaining glycaemic control in women with GDM and is generally recommended by healthcare professionals. There are several different methods for monitoring blood glucose which can be carried out in different settings (e.g. at home versus in hospital). The objective of this review is to compare the effects of different methods and settings for glucose monitoring for women with GDM on maternal and fetal, neonatal, child and adult outcomes, and use and costs of health care. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 September 2016) and reference lists of retrieved studies. Randomised controlled trials (RCTs) or quasi-randomised controlled trials (qRCTs) comparing different methods (such as timings and frequencies) or settings, or both, for blood glucose monitoring for women with GDM. Two authors independently assessed study eligibility, risk of bias, and extracted data. Data were checked for accuracy.We assessed the quality of the evidence for the main comparisons using GRADE, for:- primary outcomes for mothers: that is, hypertensive disorders of pregnancy; caesarean section; type 2 diabetes; and- primary outcomes for children: that is, large-for-gestational age; perinatal mortality; death or serious morbidity composite; childhood/adulthood neurosensory disability;- secondary outcomes for mothers: that is, induction of labour; perineal trauma; postnatal depression; postnatal weight retention or return to pre-pregnancy weight; and- secondary outcomes for children: that is, neonatal hypoglycaemia; childhood/adulthood adiposity; childhood/adulthood type 2 diabetes. We included 11 RCTs (10 RCTs; one qRCT) that randomised 1272 women with GDM in upper-middle or high-income countries; we considered these to be at a moderate to high risk of bias. We assessed the RCTs under five comparisons. For outcomes assessed using

Perspectives of patients with non-insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study.

Science.gov (United States)

Chen, Chen-Mei; Hung, Li-Chen; Chen, Yang-Lin; Yeh, Mei Chang

2018-04-01

To explore experiences of self-monitoring of blood glucose among patients with non-insulin-treated type 2 diabetes. Self-monitoring of blood glucose is essential to diabetes care and facilitates glycaemic control. Patients' perspectives of self-monitoring of blood glucose have seldom been discussed in the literature, and engagement in self-monitoring of blood glucose is consistently low. The descriptive phenomenological method was used. Purposive sampling was conducted to recruit participants from the endocrinology departments of medical institutions in Taiwan based on the following criteria: (i) having a medical diagnosis of type 2 diabetes, (ii) not being treated with insulin, (iii) having engaged in self-monitoring of blood glucose at least once within the preceding 6 months, (iv) being at least 20 years old and (v) not having any major mental or cognitive disorders. Data were collected in outpatient consultation rooms, the participants' homes and other settings where the participants felt secure and comfortable. In-depth interviews were conducted to collect data from 16 patients with diabetes. The participants perceived that lifestyle affected blood glucose levels and did not know how to handle high or low blood glucose levels. Their willingness to continue self-monitoring of blood glucose depended on whether healthcare professionals checked or discussed their blood glucose levels with them. The patients' knowledge regarding blood glucose variation and healthcare professionals' attitudes affected the patients' self-monitoring of blood glucose behaviours. The empirical findings illustrated self-monitoring of blood glucose experiences and recommended that healthcare professionals' closely attend to patients' requirements and responses to diabetes and incorporate the self-monitoring of blood glucose into therapy plans. Healthcare professionals should reinforce patients' knowledge on appropriate responses to high and low blood glucose levels, intervene

Modelling the growth and ethanol production of Brettanomyces bruxellensis at different glucose concentrations.

Science.gov (United States)

Aguilar-Uscanga, M G; Garcia-Alvarado, Y; Gomez-Rodriguez, J; Phister, T; Delia, M L; Strehaiano, P

2011-08-01

To study the effect of glucose concentrations on the growth by Brettanomyces bruxellensis yeast strain in batch experiments and develop a mathematical model for kinetic behaviour analysis of yeast growing in batch culture. A Matlab algorithm was developed for the estimation of model parameters. Glucose fermentation by B. bruxellensis was studied by varying its concentration (5, 9.3, 13.8, 16.5, 17.6 and 21.4%). The increase in substrate concentration up to a certain limit was accompanied by an increase in ethanol and biomass production; at a substrate concentration of 50-138 g l(-1), the ethanol and biomass production were 24, 59 and 6.3, 11.4 g l(-1), respectively. However, an increase in glucose concentration to 165 g l(-1) led to a drastic decrease in product formation and substrate utilization. The model successfully simulated the batch kinetic observed in all cases. The confidence intervals were also estimated at each phase at a 0.95 probability level in a t-Student distribution for f degrees of freedom. The maximum ethanol and biomass yields were obtained with an initial glucose concentration of 138 g l(-1). These experiments illustrate the importance of using a mathematical model applied to kinetic behaviour on glucose concentration by B. bruxellensis. © 2011 The Authors. Letters in Applied Microbiology © 2011 The Society for Applied Microbiology.

On-line determination of glucose and lactate concentrations in animal cell culture based on fibre optic detection of oxygen in flow-injection analysis.

Science.gov (United States)

Dremel, B A; Li, S Y; Schmid, R D

1992-01-01

A flow-injection analysis (FIA) system based on fibre optic detection of oxygen consumption using immobilized glucose oxidase (GOD) and lactate oxidase (LOD) is described for the on-line monitoring of glucose and lactate concentrations in animal cell cultures. The consumption of oxygen was determined via dynamic quenching by molecular oxygen of the fluorescence of an indicator. GOD and LOD were immobilized on controlled pore glass (CPG) in enzyme reactors which were directly linked to a specially designed fibre optic flow-through cell covering the oxygen optrode. The system is linear for 0-30 mM glucose, with an r.s.d. of 5% at 30 mM (five measurements) and for 0-30 mM lactate, with an r.s.d. of 5% at 30 mM (five measurements). The enzyme reactors used were stable for more than 4 weeks in continuous operation, and it was possible to analyse up to 20 samples per hour. The system has been successfully applied to the on-line monitoring of glucose and lactate concentrations of an animal cell culture designed for the production of recombinant human antithrombine III (AT-III). Results of the on-line measurement obtained by the FIA system were compared with the off-line results obtained by a glucose and lactate analyser from Yellow Springs Instrument Company (YSI).

Prediction Methods for Blood Glucose Concentration

DEFF Research Database (Denmark)

“Recent Results on Glucose–Insulin Predictions by Means of a State Observer for Time-Delay Systems” by Pasquale Palumbo et al. introduces a prediction model which in real time predicts the insulin concentration in blood which in turn is used in a control system. The method is tested in simulation...... EEG signals to predict upcoming hypoglycemic situations in real-time by employing artificial neural networks. The results of a 30-day long clinical study with the implanted device and the developed algorithm are presented. The chapter “Meta-Learning Based Blood Glucose Predictor for Diabetic......, but the insulin amount is chosen using factors that account for this expectation. The increasing availability of more accurate continuous blood glucose measurement (CGM) systems is attracting much interest to the possibilities of explicit prediction of future BG values. Against this background, in 2014 a two...

Comparison of a Point-of-Care Glucometer and a Laboratory Autoanalyzer for Measurement of Blood Glucose Concentrations in Domestic Pigeons ( Columba livia domestica).

Science.gov (United States)

Mohsenzadeh, Mahdieh Sadat; Zaeemi, Mahdieh; Razmyar, Jamshid; Azizzadeh, Mohammad

2015-09-01

Biochemical analysis is necessary for diagnosis and monitoring of diseases in birds; however, the small volume of blood that can be safely obtained from small avian species often limits laboratory diagnostic testing. Consequently, a suitable methodology requiring only a small volume of blood must be used. This study was designed to compare blood glucose concentrations in domestic pigeons ( Columba livia domestica) as measured by a commercial, handheld, human glucometer and a standard autoanalyzer. During the first phase of the study, whole blood samples obtained from 30 domestic pigeons were used to measure the blood glucose concentration with a glucometer, the packed cell volume (PCV), and the total erythrocyte count (nRBC). Plasma separated from the each sample was then used to obtain the plasma glucose concentration with the autoanalyzer. During the second phase of the study, 30 pigeons were assigned to 2 equal groups (n = 15). Hypoglycemia or hyperglycemia was induced in each group by intravenous injection of insulin or glucose, respectively. Blood was collected and processed, and glucose concentrations, PCV, and nRBC were measured as previously described. Linear-regression models demonstrated a significant relationship between results measured by the glucometer and autoanalyzer results from normoglycemic (correlation coefficient [R] = 0.43, P = .02), hypoglycemic (R = 0.95; P < .001), and hyperglycemic (R = 0.81; P < .001) birds. The results of this study suggest that we can predict the real blood-glucose concentration of pigeons by using results obtained by a glucometer.

Polymer Optical Fiber Compound Parabolic Concentrator fiber tip based glucose sensor: In-Vitro Testing

DEFF Research Database (Denmark)

Hassan, Hafeez Ul; Janting, Jakob; Aasmul, Soren

2016-01-01

We present in-vitro sensing of glucose using a newly developed efficient optical fiber glucose sensor based on a Compound Parabolic Concentrator (CPC) tipped polymer optical fiber (POF). A batch of 9 CPC tipped POF sensors with a 35 mm fiber length is shown to have an enhanced fluorescence pickup...... efficiency with an average increment factor of 1.7 as compared to standard POF sensors with a plane cut fiber tip. Invitro measurements for two glucose concentrations (40 and 400 mg/dL) confirm that the CPC tipped sensors efficiently can detect both glucose concentrations. it sets the footnote at the bottom...

On-line monitoring of Glucose and penicillin by sequential injection analysis

DEFF Research Database (Denmark)

Min, R.W.; Nielsen, Jens Bredal; Villadsen, John

1996-01-01

and a detector. The glucose analyzer is based on an enzymatic reaction using glucose oxidase, which converts glucose to glucono-lactone with formation of hydrogen peroxide and subsequent detection of H2O2 by a chemiluminescence reaction involving luminol. The penicillin analysis is based on formation......A sequential injection analysis (SIA) system has been developed for on-line monitoring of glucose and penicillin during cultivations of the filamentous fungus Penicillium chrysogenum. The SIA system consists of a peristaltic pump, an injection valve, two piston pumps, two multi-position valves...

Comparison of the clinical information provided by the FreeStyle Navigator continuous interstitial glucose monitor versus traditional blood glucose readings.

Science.gov (United States)

McGarraugh, Geoffrey V; Clarke, William L; Kovatchev, Boris P

2010-05-01

The purpose of the analysis was to compare the clinical utility of data from traditional self-monitoring of blood glucose (SMBG) to that of continuous glucose monitoring (CGM). A clinical study of the clinical accuracy of the FreeStyle Navigator CGM System (Abbott Diabetes Care, Alameda, CA), which includes SMBG capabilities, was conducted by comparison to the YSI blood glucose analyzer (YSI Inc., Yellow Springs, OH) using 58 subjects with type 1 diabetes. The Continuous Glucose-Error Grid Analysis (CG-EGA) was used as the analytical tool. Using CG-EGA, the "clinically accurate," "benign errors," and "clinical errors" were 86.8%, 8.7%, and 4.5% for SMBG and 92.7%, 3.7%, and 3.6% for CGM, respectively. If blood glucose is viewed as a process in time, SMBG would provide accurate information about this process 86.8% of the time, whereas CGM would provide accurate information about this process 92.7% of the time (P glucose values than CGM, control of blood glucose involves a system in flux, and CGM provides more detailed insight into the dynamics of that system. In the normal and elevated glucose ranges, the additional information about the direction and rate of glucose change provided by the FreeStyle Navigator CGM System increases the ability to make correct clinical decisions when compared to episodic SMBG tests.

Comparison of Glucose Area Under the Curve Measured Using Minimally Invasive Interstitial Fluid Extraction Technology with Continuous Glucose Monitoring System in Diabetic Patients

OpenAIRE

Uemura, Mei

2017-01-01

Background: Continuous glucose monitoring (CGM) is reported to be a useful technique, but difficult or inconvenient for some patients and institutions. We are developing a glucose area under the curve (AUC) monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET). Here we evaluated the accuracy of interstitial fluid glucose (IG) AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting h...

Comparison of Glucose Area Under the Curve Measured Using Minimally Invasive Interstitial Fluid Extraction Technology with Continuous Glucose Monitoring System in Diabetic Patients

OpenAIRE

Mei Uemura; Yutaka Yano; Toshinari Suzuki; Taro Yasuma; Toshiyuki Sato; Aya Morimoto; Samiko Hosoya; Chihiro Suminaka; Hiromu Nakajima; Esteban C. Gabazza; Yoshiyuki Takei

2017-01-01

Background Continuous glucose monitoring (CGM) is reported to be a useful technique, but difficult or inconvenient for some patients and institutions. We are developing a glucose area under the curve (AUC) monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET). Here we evaluated the accuracy of interstitial fluid glucose (IG) AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting hy...

Glucose concentration in capillary blood of dairy cows obtained by a minimally invasive lancet technique and determined with three different hand-held devices

OpenAIRE

Mair, B.; Drillich, M.; Klein-J?bstl, D.; Kanz, P.; Borchardt, S.; Meyer, L.; Schwendenwein, I.; Iwersen, M.

2016-01-01

Background Dairy cows have a massive demand for glucose at the onset of lactation. A poor adaption to this period leads to an excessive negative energy balance with an increased risk for ketosis and impaired animal health and production. Besides the measurement of ketones, analysing the glucose concentration in blood is reported as helpful instrument for diagnosis and differentiation of ketosis. Monitoring metabolic parameters requires multiple blood sampling. In other species, new blood samp...

Precision and costs of techniques for self-monitoring of serum glucose levels.

OpenAIRE

Chiasson, J. L.; Morrisset, R.; Hamet, P.

1984-01-01

The poor correlation between serum and urine glucose measurements has led to the development of new techniques for monitoring the blood glucose level in diabetic patients. Either a nurse or the patient can perform these tests, which involve spreading a single drop of blood onto a reagent strip. A colour change that is proportional to the serum glucose level can be read visually or with a reflectance meter. Evaluated against simultaneous serum glucose levels determined by the hospital biochemi...

Self-Monitoring Using Continuous Glucose Monitors with Real-Time Feedback Improves Exercise Adherence in Individuals with Impaired Blood Glucose: A Pilot Study.

Science.gov (United States)

Bailey, Kaitlyn J; Little, Jonathan P; Jung, Mary E

2016-03-01

Exercise helps individuals with prediabetes or type 2 diabetes (T2D) manage their blood glucose (BG); however, exercise adherence in this population is dismal. In this pilot study we tested the efficacy of a self-monitoring group-based intervention using continuous glucose monitors (CGMs) at increasing exercise adherence in individuals with impaired BG. Thirteen participants with prediabetes or T2D were randomized to an 8-week standard care exercise program (CON condition) (n = 7) or self-monitoring exercise intervention (SM condition) (n = 6). Participants in the SM condition were taught how to self-monitor their exercise and BG, to goal set, and to use CGM to observe how exercise influences BG. We hypothesized that compared with the CON condition, using a real-time CGM would facilitate self-monitoring behavior, resulting in increased exercise adherence. Repeated-measures analysis of variance revealed significant Condition × Time interactions for self-monitoring (P goal setting (P = 0.01), and self-efficacy to self-monitor (P = 0.01), such that the SM condition showed greater increases in these outcomes immediately after the program and at the 1-month follow-up compared with the CON condition. The SM condition had higher program attendance rates (P = 0.03), and a greater proportion of participants reregistered for additional exercise programs (P = 0.048) compared with the CON condition. Participants in both conditions experienced improvements in health-related quality of life, waist circumference, and fitness (P values exercise behavior in individuals living with prediabetes or T2D.

A 3D paper-based enzymatic fuel cell for self-powered, low-cost glucose monitoring.

Science.gov (United States)

Fischer, Christopher; Fraiwan, Arwa; Choi, Seokheun

2016-05-15

In this work, we demonstrate a novel low-cost, self-powered paper-based biosensor for glucose monitoring. The device operating mechanism is based on a glucose/oxygen enzymatic fuel cell using an electrochemical energy conversion as a transducing element for glucose monitoring. The self-powered glucose biosensor features (i) a 3D origami paper-based structure for easy system integration onto paper, (ii) an air-cathode on paper for low-cost production and easy operation, and (iii) a screen printed chitosan/glucose oxidase anode for stable current generation as an analytical signal for glucose monitoring. The sensor showed a linear range of output current at 1-5mM glucose (R(2)=0.996) with a sensitivity of 0.02 µA mM(-1). The advantages offered by such a device, including a low cost, lack of external power sources/sophisticated external transducers, and the capacity to rapidly generate reliable results, are well suited for the clinical and social settings of the developing world. Copyright © 2015 Elsevier B.V. All rights reserved.

A Fully Implantable, NFC Enabled, Continuous Interstitial Glucose Monitor

OpenAIRE

Anabtawi, Nijad; Freeman, Sabrina; Ferzli, Rony

2016-01-01

This work presents an integrated system-on-chip (SoC) that forms the core of a long-term, fully implantable, battery assisted, passive continuous glucose monitor. It integrates an amperometric glucose sensor interface, a near field communication (NFC) wireless front-end and a fully digital switched mode power management unit for supply regulation and on board battery charging. It uses 13.56 MHz (ISM) band to harvest energy and backscatter data to an NFC reader. System was implemented in 14nm ...

Nanotechnology in glucose monitoring: advances and challenges in the last 10 years.

Science.gov (United States)

Scognamiglio, Viviana

2013-09-15

In the last decades, a wide multitude of research activity has been focused on the development of biosensors for glucose monitoring, devoted to overcome the challenges associated with smart analytical performances with commercial implications. Crucial issues still nowadays elude biosensors to enter the market, such as sensitivity, stability, miniaturisation, continuous and in situ monitoring in a complex matrix. A noteworthy tendency of biosensor technology is likely to push towards nanotechnology, which allows to reduce dimensions at the nanoscale, consenting the construction of arrays for high throughput analysis with the integration of microfluidics, and enhancing the performance of the biological components by using new nanomaterials. This review aims to highlight current trends in biosensors for glucose monitoring based on nanotechnology, reporting widespread representative examples of the recent approaches for nanobiosensors over the past 10 years. Progress in nanotechnology for the development of biosensing systems for blood glucose level monitoring will be discussed, in view of their design and construction on the bases of the new materials offered by nanotechnology. Copyright © 2013 Elsevier B.V. All rights reserved.

Cutpoints for screening blood glucose concentrations in healthy senior cats.

Science.gov (United States)

Reeve-Johnson, Mia K; Rand, Jacquie S; Vankan, Dianne; Anderson, Stephen T; Marshall, Rhett; Morton, John M

2017-12-01

Objectives The objectives of this study were to determine the reference interval for screening blood glucose in senior cats, to apply this to a population of obese senior cats, to compare screening and fasting blood glucose, to assess whether screening blood glucose is predicted by breed, body weight, body condition score (BCS), behaviour score, fasting blood glucose and/or recent carbohydrate intake and to assess its robustness to changes in methodology. Methods The study included a total of 120 clinically healthy client-owned cats aged 8 years and older of varying breeds and BCSs. Blood glucose was measured at the beginning of the consultation from an ear/paw sample using a portable glucose meter calibrated for cats, and again after physical examination from a jugular sample. Fasting blood glucose was measured after overnight hospitalisation and fasting for 18-24 h. Results The reference interval upper limit for screening blood glucose was 189 mg/dl (10.5 mmol/l). Mean screening blood glucose was greater than mean fasting glucose. Breed, body weight, BCS, behaviour score, fasting blood glucose concentration and amount of carbohydrate consumed 2-24 h before sampling collectively explained only a small proportion of the variability in screening blood glucose. Conclusions and relevance Screening blood glucose measurement represents a simple test, and cats with values from 117-189 mg/dl (6.5-10.5 mmol/l) should be retested several hours later. Cats with initial screening blood glucose >189 mg/dl (10.5 mmol/l), or a second screening blood glucose >116 mg/dl (6.4 mmol/l) several hours after the first, should have fasting glucose and glucose tolerance measured after overnight hospitalisation.

The Relationship Between a Balanced Time Perspective and Self-monitoring of Blood Glucose Among People With Type 1 Diabetes.

Science.gov (United States)

Baird, Harriet M; Webb, Thomas L; Martin, Jilly; Sirois, Fuschia M

2018-05-10

Self-monitoring of blood glucose helps people with type 1 diabetes to maintain glycemic control and reduce the risk of complications. However, adherence to blood glucose monitoring is often suboptimal. Like many health behaviors, self-monitoring of blood glucose involves exerting effort in the present to achieve future benefits. As such, the present research explored whether individual differences in time perspective-specifically, the extent to which people have a balanced time perspective-are associated with the frequency with which people with type 1 diabetes monitor their blood glucose and, thus, maintain glycemic control. Adults with type 1 diabetes completed measures of time perspective, feelings associated with monitoring, attitudes toward monitoring, and trait self-control. Objective data regarding the frequency with which participants monitored their blood glucose levels and their long-term glycemic control were extracted from their medical records. Hierarchical regression analyses and tests of indirect effects (N = 129) indicated that having a more balanced time perspective was associated with more frequent monitoring of blood glucose and, as a result, better glycemic control. Further analyses (N = 158) also indicated that there was an indirect relationship between balanced time perspective and monitoring of blood glucose via the feelings that participants associated with monitoring and their subsequent attitudes toward monitoring. These findings point to the importance and relevance of time perspective for understanding health-related behavior and may help to inform interventions designed to promote self-monitoring of blood glucose in people with type 1 diabetes.

New Criteria for Assessing the Accuracy of Blood Glucose Monitors meeting, October 28, 2011.

Science.gov (United States)

Walsh, John; Roberts, Ruth; Vigersky, Robert A; Schwartz, Frank

2012-03-01

Glucose meters (GMs) are routinely used for self-monitoring of blood glucose by patients and for point-of-care glucose monitoring by health care providers in outpatient and inpatient settings. Although widely assumed to be accurate, numerous reports of inaccuracies with resulting morbidity and mortality have been noted. Insulin dosing errors based on inaccurate GMs are most critical. On October 28, 2011, the Diabetes Technology Society invited 45 diabetes technology clinicians who were attending the 2011 Diabetes Technology Meeting to participate in a closed-door meeting entitled New Criteria for Assessing the Accuracy of Blood Glucose Monitors. This report reflects the opinions of most of the attendees of that meeting. The Food and Drug Administration (FDA), the public, and several medical societies are currently in dialogue to establish a new standard for GM accuracy. This update to the FDA standard is driven by improved meter accuracy, technological advances (pumps, bolus calculators, continuous glucose monitors, and insulin pens), reports of hospital and outpatient deaths, consumer complaints about inaccuracy, and research studies showing that several approved GMs failed to meet FDA or International Organization for Standardization standards in postapproval testing. These circumstances mandate a set of new GM standards that appropriately match the GMs' analytical accuracy to the clinical accuracy required for their intended use, as well as ensuring their ongoing accuracy following approval. The attendees of the New Criteria for Assessing the Accuracy of Blood Glucose Monitors meeting proposed a graduated standard and other methods to improve GM performance, which are discussed in this meeting report. © 2012 Diabetes Technology Society.

What Happens to Blood Glucose Concentrations After Oral Treatment for Neonatal Hypoglycemia?

Science.gov (United States)

Harris, Deborah L; Gamble, Greg D; Weston, Philip J; Harding, Jane E

2017-11-01

To determine the change in blood glucose concentration after oral treatment of infants with hypoglycemia in the first 48 hours after birth. We analyzed data from 227 infants with hypoglycemia (blood glucose dextrose or placebo gel plus feeding with formula, expressed breast milk, or breast feeding. The overall mean increase in blood glucose concentration was 11.7 mg/dL (95% CI 10.4-12.8). The increase was greater after buccal dextrose gel than after placebo gel (+3.0 mg/dL; 95% CI 0.7-5.3; P = .01) and greater after infant formula than after other feedings (+3.8 mg/dL; 95% CI 0.8-6.7; P = .01). The increase in blood glucose concentration was not affected by breast feeding (+2.0 mg/dL; 95% CI -0.3 to 44.2; P = .09) or expressed breast milk (-1.4 mg/dL; 95% CI -3.7 to 0.9; P = .25). However, breast feeding was associated with reduced requirement for repeat gel treatment (OR = 0.52; 95% CI 0.28-0.94; P = .03). Treatment of infants with hypoglycemia with dextrose gel or formula is associated with increased blood glucose concentration and breast feeding with reduced need for further treatment. Dextrose gel and breast feeding should be considered for first-line oral treatment of infants with hypoglycemia. Copyright © 2017 Elsevier Inc. All rights reserved.

Glucose uptake and transport in contracting, perfused rat muscle with different pre-contraction glycogen concentrations

DEFF Research Database (Denmark)

Hespel, P; Richter, Erik

1990-01-01

1. Glucose uptake and transport, muscle glycogen, free glucose and glucose-6-phosphate concentrations were studied in perfused resting and contracting rat skeletal muscle with different pre-contraction glycogen concentrations. Rats were pre-conditioned by a combination of swimming exercise and diet......, resulting in either low (glycogen-depleted rats), normal (control rats) or high (supercompensated rats) muscle glycogen concentrations at the time their hindlimbs were perfused. 2. Compared with control rats, pre-contraction muscle glycogen concentration was approximately 40% lower in glycogen-depleted rats......, whereas it was 40% higher in supercompensated rats. Muscle glycogen break-down correlated positively (r = 0.76; P less than 0.001) with pre-contraction muscle glycogen concentration. 3. Glucose uptake during contractions was approximately 50% higher in glycogen-depleted hindquarters than in control...

Evaluation of postprandial glucose excursion using a novel minimally invasive glucose area-under-the-curve monitoring system.

Science.gov (United States)

Kuranuki, Sachi; Sato, Toshiyuki; Okada, Seiki; Hosoya, Samiko; Seko, Akinobu; Sugihara, Kaya; Nakamura, Teiji

2013-01-01

To develop a minimally invasive interstitial fluid extraction technology (MIET) to monitor postprandial glucose area under the curve (AUC) without blood sampling, we evaluated the accuracy of glucose AUC measured by MIET and compared with that by blood sampling after food intake. Interstitial fluid glucose AUC (IG-AUC) following consumption of 6 different types of foods was measured by MIET. MIET consisted of stamping microneedle arrays, placing hydrogel patches on the areas, and calculating IG-AUC based on glucose levels in the hydrogels. Glycemic index (GI) was determined using IG-AUC and reference AUC measured by blood sampling. IG-AUC strongly correlated with reference AUC (R = 0.91), and GI determined using IG-AUC showed good correlation with that determined by reference AUC (R = 0.88). IG-AUC obtained by MIET can accurately predict the postprandial glucose excursion without blood sampling. In addition, feasibility of GI measurement by MIET was confirmed.

The effect of extremely high glucose concentrations on 21 routine chemistry and thyroid Abbott assays: interference study.

Science.gov (United States)

Çuhadar, Serap; Köseoğlu, Mehmet; Çinpolat, Yasemin; Buğdaycı, Güler; Usta, Murat; Semerci, Tuna

2016-01-01

Extremely high glucose concentrations have been shown to interfere with creatinine assays especially with Jaffe method in peritoneal dialysate. Because diabetes is the fastest growing chronic disease in the world, laboratories study with varying glucose concentrations. We investigated whether different levels of glucose spiked in serum interfere with 21 routine chemistry and thyroid assays at glucose concentrations between 17-51 mmol/L. Baseline (group I) serum pool with glucose concentration of 5.55 (5.44-5.61) mmol/L was prepared from patient sera. Spiking with 20% dextrose solution, sample groups were obtained with glucose concentrations: 17.09, 34.52, and 50.95 mmol/L (group II, III, IV, respectively). Total of 21 biochemistry analytes and thyroid tests were studied on Abbott c8000 and i2000sr with commercial reagents. Bias from baseline value was checked statistically and clinically. Creatinine increased significantly by 8.74%, 31.66%, 55.31% at groups II, III, IV, respectively with P values of < 0.001. At the median glucose concentration of 50.95 mmol/L, calcium, albumin, chloride and FT4 biased significantly clinically (-0.85%, 1.63%, 0.65%, 7.4% with P values 0.138, 0.214, 0.004, < 0.001, respectively). Remaining assays were free of interference. Among the numerous biochemical parameters studied, only a few parameters are affected by dramatically increased glucose concentration. The creatinine measurements obtained in human sera with the Jaffe alkaline method at high glucose concentrations should be interpreted with caution. Other tests that were affected with extremely high glucose concentrations were calcium, albumin, chloride and FT4, hence results should be taken into consideration in patients with poor diabetic control.

A Fully Implantable, NFC Enabled, Continuous Interstitial Glucose Monitor.

Science.gov (United States)

Anabtawi, Nijad; Freeman, Sabrina; Ferzli, Rony

2016-02-01

This work presents an integrated system-on-chip (SoC) that forms the core of a long-term, fully implantable, battery assisted, passive continuous glucose monitor. It integrates an amperometric glucose sensor interface, a near field communication (NFC) wireless front-end and a fully digital switched mode power management unit for supply regulation and on board battery charging. It uses 13.56 MHz (ISM) band to harvest energy and backscatter data to an NFC reader. System was implemented in 14nm CMOS technology and validated with post layout simulations.

Blood Glucose and Insulin Concentrations after Octreotide Administration in Horses With Insulin Dysregulation.

Science.gov (United States)

Frank, N; Hermida, P; Sanchez-Londoño, A; Singh, R; Gradil, C M; Uricchio, C K

2017-07-01

Octreotide is a somatostatin analog that suppresses insulin secretion. We hypothesized that octreotide would suppress insulin concentrations in horses and that normal (N) horses and those with insulin dysregulation (ID) would differ significantly in their plasma glucose and insulin responses to administration of octreotide. Twelve horses, N = 5, ID = 7. Prospective study. An oral sugar test was performed to assign horses to N and ID groups. Octreotide (1.0 μg/kg IV) was then administered, and blood was collected at 0, 5, 10, 15, 20, 25, 30, 45, 60, 75, and 90 minute, and 2, 3, 4, 6, 8, 12, and 24 hour for measurement of glucose and insulin concentrations. Area under the curve (AUC) values were calculated. Mean AUC values for glucose and insulin did not differ between normal (n = 5) and ID (n = 7) groups after octreotide injection. Significant time (P glucose and insulin concentrations. A group × time interaction (P = .091) was detected for insulin concentrations after administration of octreotide, but the group (P = .33) effect was not significant. Octreotide suppresses insulin secretion, resulting in hyperglycemia, and then concentrations increase above baseline as glycemic control is restored. Our hypothesis that octreotide causes insulin concentrations to decrease in horses was supported, but differences between N and ID groups did not reach statistical significance when blood glucose and insulin responses were compared. The utility of an octreotide response test remains to be determined. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Simultaneous Monitoring of Glucose and Lactate by Self-powered Biosensor

Directory of Open Access Journals (Sweden)

Ankit Baingane

2017-07-01

Full Text Available A dual self-powered biosensing system integrated with energy amplification circuit is described, for simultaneously monitoring glucose and lactate. The self-powered biosensing system is based on the conventional enzymatic biofuel cell equipped with three 4 mm x 4 mm massively dense mesh network of multi-walled carbon nanotubes (MWCNTs bioelectrodes in parallel configuration. The bioelectrodes employed pyroquinoline quinone glucose dehydrogenase (PQQ-GDH as the biocatalyst for the glucose oxidation and D-Lactate dehydrogenase (D-LDH as the biocatalyst for lactate oxidation. A common laccase modified-MWCNTs bioelectrode served as the cathode for the reduction of molecular oxygen. Two charge pump circuits were coupled with 0.1 mF capacitors functioning as transducers. The advantages of employing capacitors were coupled with the efficient energy amplification of the charge pump circuit to amplify the power output from each of the biofuel and charge/discharge the corresponding capacitor. Under operating conditions, the open circuit voltages and short circuit current densities for 180 mg/dL glucose and 25 mM lactate were 339.2 mV and 228.75 µA/cm2 and 370 mV and 66.17 µA/cm2, respectively. The responses for glucose and lactate were linear up to 630 mg/dL and 30 mM with sensitivities of 20.11 Hz/ mM cm-2 and 9.869 Hz/ mM cm-2, respectively. The potential of the described system was demonstrated to provide stable voltage and current output that was capable of driving the charge pump circuit integrated with the capacitor for simultaneously monitoring glucose and lactate. These results were in good agreement with those previously reported.

Differential effects of vildagliptin and glimepiride on glucose fluctuations in patients with type 2 diabetes mellitus assessed using continuous glucose monitoring.

Science.gov (United States)

He, Y L; Foteinos, G; Neelakantham, S; Mattapalli, D; Kulmatycki, K; Forst, T; Taylor, A

2013-12-01

To assess whether there is a difference in the effects of vildagliptin and glimepiride on glucose fluctuation in patients with type 2 diabetes mellitus (T2DM) using continuous glucose monitoring (CGM). This was an open-label, randomized cross-over study conducted in T2DM patients. A total of 24 patients (age: 58.3 ± 5.56 years, baseline HbA1c: 7.6 ± 0.50%) who were on stable metformin monotherapy (500-3000 mg) were enrolled, and all completed the study. Each patient received two 5-day treatments (vildagliptin 50 mg b.i.d. or glimepiride 2 mg q.d.) in a cross-over manner. Various biomarkers and blood glucose concentrations were measured following breakfast. The 24-h glucose profiles were also measured using the CGM device at baseline and after 5 days of treatment, and fluctuations in glucose levels were estimated from CGM data. Both vildagliptin and glimepiride reduced postprandial glucose levels, based on both CGM data (15% vs. 16%) and measured plasma glucose (13% vs.17%). Vildagliptin showed lower glucose fluctuations than glimepiride as measured by mean amplitude of glycaemic excursions (MAGE, p = 0.1076), standard deviation (s.d., p = 0.1346) of blood glucose rate of change, but did not reach statistical significance attributed to the small sample size. MAGE was reduced by ∼20% with vildagliptin versus glimepiride. Vildagliptin led to statistically significant lowering of the rate of change in the median curve (RCMC) and interquartile range (IQR) of glucose. Treatment with vildagliptin significantly increased the levels of active glucagon-like peptide-1 by 2.36-fold (p ≤ 0.0001) and suppressed glucagon by 8% (p = 0.01), whereas glimepiride significantly increased the levels of insulin and C-peptide by 21% (p = 0.012) and 12% (p = 0.003), respectively. Vildagliptin treatment was associated with less fluctuation of glucose levels than glimepiride treatment as assessed by 24-h CGM device, suggesting vildagliptin may

Effect of varying concentrations of orally ingested glucose on platelet ...

African Journals Online (AJOL)

The physiologic basis of bleeding is a function of normal platelets and coagulation factors. This study is aimed at ascertaining the effect of varying concentrations of orally ingested glucose on platelet count and hemoglobin concentration during menstruation. Forty menstruating students between the ages of 18 and 25 from ...

The performance of flash glucose monitoring in critically ill patients with diabetes.

Science.gov (United States)

Ancona, Paolo; Eastwood, Glenn M; Lucchetta, Luca; Ekinci, Elif I; Bellomo, Rinaldo; Mårtensson, Johan

2017-06-01

Frequent glucose monitoring may improve glycaemic control in critically ill patients with diabetes. We aimed to assess the accuracy of a novel subcutaneous flash glucose monitor (FreeStyle Libre [Abbott Diabetes Care]) in these patients. We applied the FreeStyle Libre sensor to the upper arm of eight patients with diabetes in the intensive care unit and obtained hourly flash glucose measurements. Duplicate recordings were obtained to assess test-retest reliability. The reference glucose level was measured in arterial or capillary blood. We determined numerical accuracy using Bland- Altman methods, the mean absolute relative difference (MARD) and whether the International Organization for Standardization (ISO) and Clinical and Laboratory Standards Institute Point of Care Testing (CLSI POCT) criteria were met. Clarke error grid (CEG) and surveillance error grid (SEG) analyses were used to determine clinical accuracy. We compared 484 duplicate flash glucose measurements and observed a Pearson correlation coefficient of 0.97 and a coefficient of repeatability of 1.6 mmol/L. We studied 185 flash readings paired with arterial glucose levels, and 89 paired with capillary glucose levels. Using the arterial glucose level as the reference, we found a mean bias of 1.4 mmol/L (limits of agreement, -1.7 to 4.5 mmol/L). The MARD was 14% (95% CI, 12%-16%) and the proportion of measurements meeting ISO and CLSI POCT criteria was 64.3% and 56.8%, respectively. The proportions of values within a low-risk zone on CEG and SEG analyses were 97.8% and 99.5%, respectively. Using capillary glucose levels as the reference, we found that numerical and clinical accuracy were lower. The subcutaneous FreeStyle Libre blood glucose measurement system showed high test-retest reliability and acceptable accuracy when compared with arterial blood glucose measurement in critically ill patients with diabetes.

Parsimonious model for blood glucose level monitoring in type 2 diabetes patients.

Science.gov (United States)

Zhao, Fang; Ma, Yan Fen; Wen, Jing Xiao; DU, Yan Fang; Li, Chun Lin; Li, Guang Wei

2014-07-01

To establish the parsimonious model for blood glucose monitoring in patients with type 2 diabetes receiving oral hypoglycemic agent treatment. One hundred and fifty-nine adult Chinese type 2 diabetes patients were randomized to receive rapid-acting or sustained-release gliclazide therapy for 12 weeks. Their blood glucose levels were measured at 10 time points in a 24 h period before and after treatment, and the 24 h mean blood glucose levels were measured. Contribution of blood glucose levels to the mean blood glucose level and HbA1c was assessed by multiple regression analysis. The correlation coefficients of blood glucose level measured at 10 time points to the daily MBG were 0.58-0.74 and 0.59-0.79, respectively, before and after treatment (Pblood glucose levels measured at 6 of the 10 time points could explain 95% and 97% of the changes in MBG before and after treatment. The three blood glucose levels, which were measured at fasting, 2 h after breakfast and before dinner, of the 10 time points could explain 84% and 86% of the changes in MBG before and after treatment, but could only explain 36% and 26% of the changes in HbA1c before and after treatment, and they had a poorer correlation with the HbA1c than with the 24 h MBG. The blood glucose levels measured at fasting, 2 h after breakfast and before dinner truly reflected the change 24 h blood glucose level, suggesting that they are appropriate for the self-monitoring of blood glucose levels in diabetes patients receiving oral anti-diabetes therapy. Copyright © 2014 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

[Designing and implementation of a web-based quality monitoring system for plasma glucose measurement in multicenter population study].

Science.gov (United States)

Liu, Yong; Wang, Limin; Pang, Richard; Mo, Nanxun; Hu, Yan; Deng, Qian; Hu, Zhaohui

2015-05-01

The aim of this paper is to describe the designing and implementation of a web-based plasma glucose measurement quality monitoring system to assess the analytical quality of plasma glucose measurements in multicenter population study and provide evidence for the future studies. In the chronic non-communicable disease and related factor surveillance in China, a web based quality monitoring system for plasma glucose measurement was established to conduct evaluation on plasma glucose monitoring quality and effectiveness in 302 surveillance centers, including quality control data entry, transmission and feedback. The majority of the surveillance centers met the quality requirements and passed the evaluation of reproducibility and precision of plasma glucose measurement, only a few centers required intensive training and re-assessment. In order to ensure the completeness and reliability of plasma glucose measurement in the surveillance centers, the establishment of web-based plasma glucose measurement quality control system can facilitate the identification of the qualified surveillance centers and evaluation of plasma glucose measurement quality in different regions. Communication and training are important in ensuring plasma glucose measurement quality. It is necessary to further improve this web-based plasma glucose measurement quality monitoring system in the future to reduce the method specific plasma glucose measurement bias.

The effect of extremely high glucose concentrations on 21 routine chemistry and thyroid Abbott assays: interference study

OpenAIRE

?uhadar, Serap; K?seo?lu, Mehmet; ?inpolat, Yasemin; Bu?dayc?, G?ler; Usta, Murat; Semerci, Tuna

2016-01-01

Abstract Introduction: Extremely high glucose concentrations have been shown to interfere with creatinine assays especially with Jaffe method in peritoneal dialysate. Because diabetes is the fastest growing chronic disease in the world, laboratories study with varying glucose concentrations. We investigated whether different levels of glucose spiked in serum interfere with 21 routine chemistry and thyroid assays at glucose concentrations between 17-51 mmol/L. Materials and methods: Base...

Evaluation of Postprandial Glucose Excursion Using a Novel Minimally Invasive Glucose Area-Under-the-Curve Monitoring System

Directory of Open Access Journals (Sweden)

Sachi Kuranuki

2013-01-01

Full Text Available Objective: To develop a minimally invasive interstitial fluid extraction technology (MIET to monitor postprandial glucose area under the curve (AUC without blood sampling, we evaluated the accuracy of glucose AUC measured by MIET and compared with that by blood sampling after food intake. Methods: Interstitial fluid glucose AUC (IG-AUC following consumption of 6 different types of foods was measured by MIET. MIET consisted of stamping microneedle arrays, placing hydrogel patches on the areas, and calculating IG-AUC based on glucose levels in the hydrogels. Glycemic index (GI was determined using IG-AUC and reference AUC measured by blood sampling. Results: IG-AUC strongly correlated with reference AUC (R = 0.91, and GI determined using IG-AUC showed good correlation with that determined by reference AUC (R = 0.88. Conclusions: IG-AUC obtained by MIET can accurately predict the postprandial glucose excursion without blood sampling. In addition, feasibility of GI measurement by MIET was confirmed.

Monitoring of radon concentration in dwellings

International Nuclear Information System (INIS)

Kurosawa, Ryuhei

1991-01-01

Radon problems in dwellings have recently received much attention. Radon concentration in dwellings, as well as in the general environment, varies with various factors such as meteorological conditions and soil components. Therefore, a long term monitoring of radon concentration is required to obtain an average concentration. This paper reviews a passive type radon monitor that is handy and allows a long term radon monitoring. It provides the structure and principle of the radon monitor, covering the type, filter function, sensitivity of diffusion collecting type (cup type), electrostatic collecting type, adsorption collecting type, and detector of radon monitor. Actual examples of the radon monitor are also given. Radon daughter nuclides will have become major foci of exposure countermeasures. In the future, the development of a passive type monitor for determining potential alpha energy concentration is required. (N.K.)

Low Red Blood Cell Vitamin C Concentrations Induce Red Blood Cell Fragility: A Link to Diabetes Via Glucose, Glucose Transporters, and Dehydroascorbic Acid

Directory of Open Access Journals (Sweden)

Hongbin Tu

2015-11-01

Full Text Available Strategies to prevent diabetic microvascular angiopathy focus on the vascular endothelium. Because red blood cells (RBCs are less deformable in diabetes, we explored an original concept linking decreased RBC deformability to RBC ascorbate and hyperglycemia. We characterized ascorbate concentrations from human and mouse RBCs and plasma, and showed an inverse relationship between RBC ascorbate concentrations and deformability, measured by osmotic fragility. RBCs from ascorbate deficient mice were osmotically sensitive, appeared as spherocytes, and had decreased β-spectrin. These aberrancies reversed with ascorbate repletion in vivo. Under physiologic conditions, only ascorbate's oxidation product dehydroascorbic acid (DHA, a substrate for facilitated glucose transporters, was transported into mouse and human RBCs, with immediate intracellular reduction to ascorbate. In vitro, glucose inhibited entry of physiologic concentrations of dehydroascorbic acid into mouse and human RBCs. In vivo, plasma glucose concentrations in normal and diabetic mice and humans were inversely related to respective RBC ascorbate concentrations, as was osmotic fragility. Human RBC β-spectrin declined as diabetes worsened. Taken together, hyperglycemia in diabetes produced lower RBC ascorbate with increased RBC rigidity, a candidate to drive microvascular angiopathy. Because glucose transporter expression, DHA transport, and its inhibition by glucose differed for mouse versus human RBCs, human experimentation is indicated.

The fluctuation of blood glucose, insulin and glucagon concentrations before and after insulin therapy in type 1 diabetes

Science.gov (United States)

Arif, Idam; Nasir, Zulfa

2015-09-01

A dynamical-systems model of plasma glucose, insulin and glucagon concentrations has been developed to investigate the effects of insulin therapy on blood glucose, insulin and glucagon regulations in type 1 diabetic patients. Simulation results show that the normal regulation of blood glucose concentration depends on insulin and glucagon concentrations. On type 1 diabetic case, the role of insulin on regulating blood glucose is not optimal because of the destruction of β cells in pancreas. These β cells destructions cause hyperglycemic episode affecting the whole body metabolism. To get over this, type 1 diabetic patients need insulin therapy to control the blood glucose level. This research has been done by using rapid acting insulin (lispro), long-acting insulin (glargine) and the combination between them to know the effects of insulin therapy on blood glucose, insulin and glucagon concentrations. Simulation results show that these different types of insulin have different effects on blood glucose concentration. Insulin therapy using lispro shows better blood glucose control after consumption of meals. Glargin gives better blood glucose control between meals and during sleep. Combination between lispro and glargine shows better glycemic control for whole day blood glucose level.

Glucose-stimulated insulin response in pregnant sheep following acute suppression of plasma non-esterified fatty acid concentrations

Directory of Open Access Journals (Sweden)

Sriskandarajah Nadarajah

2004-09-01

Full Text Available Abstract Background Elevated non-esterified fatty acids (NEFA concentrations in non-pregnant animals have been reported to decrease pancreatic responsiveness. As ovine gestation advances, maternal insulin concentrations fall and NEFA concentrations increase. Experiments were designed to examine if the pregnancy-associated rise in NEFA concentration is associated with a reduced pancreatic sensitivity to glucose in vivo. We investigated the possible relationship of NEFA concentrations in regulating maternal insulin concentrations during ovine pregnancy at three physiological states, non-pregnant, non-lactating (NPNL, 105 and 135 days gestational age (dGA, term 147+/- 3 days. Methods The plasma concentrations of insulin, growth hormone (GH and ovine placental lactogen (oPL were determined by double antibody radioimmunoassay. Insulin responsiveness to glucose was measured using bolus injection and hyperglycaemic clamp techniques in 15 non-pregnant, non-lactating ewes and in nine pregnant ewes at 105 dGA and near term at 135 dGA. Plasma samples were also collected for hormone determination. In addition to bolus injection glucose and insulin Area Under Curve calculations, the Mean Plasma Glucose Increment, Glucose Infusion Rate and Mean Plasma Insulin Increment and Area Under Curve were determined for the hyperglycaemic clamp procedures. Statistical analysis of data was conducted with Students t-tests, repeated measures ANOVA and 2-way ANOVA. Results Maternal growth hormone, placental lactogen and NEFA concentrations increased, while basal glucose and insulin concentrations declined with advancing gestation. At 135 dGA following bolus glucose injections, peak insulin concentrations and insulin area under curve (AUC profiles were significantly reduced in pregnant ewes compared with NPNL control ewes (p Conclusions Results suggest that despite an acute suppression of circulating NEFA concentrations during pregnancy, the associated steroids and hormones

[CGM-Continuous Glucose Monitoring--Statement of the Austrian Diabetes Association].

Science.gov (United States)

Schütz-Fuhrmann, Ingrid; Rami-Merhar, Birgit; Hofer, Sabine; Stadler, Marietta; Bischof, Martin; Zlamal-Fortunat, Sandra; Laimer, Markus; Weitgasser, Raimund; Prager, Rudolf

2016-04-01

This position statement represents the recommendations of the Austrian Diabetes Association regarding the clinical diagnostic and therapeutic application, safety and benefits of continuous subcutaneous glucose monitoring systems in patients with diabetes mellitus, based on current evidence.

[CGM-continuous glucose monitoring - statement of the Austrian Diabetes Association].

Science.gov (United States)

Schütz-Fuhrmann, Ingrid; Schober, Edith; Rami, Birgit; Stadler, Marietta; Bischof, Martin; Fortunat, Sandra; Laimer, Markus; Weitgasser, Raimund; Prager, Rudolf

2012-12-01

This position statement represents the recommendations of the Austrian Diabetes Association regarding the clinical diagnostic and therapeutic application, safety and benefits of continuous subcutaneous glucose monitoring systems in patients with diabetes mellitus, based on current evidence.

In vivo Microscopic Photoacoustic Spectroscopy for Non-Invasive Glucose Monitoring Invulnerable to Skin Secretion Products.

Science.gov (United States)

Sim, Joo Yong; Ahn, Chang-Geun; Jeong, Eun-Ju; Kim, Bong Kyu

2018-01-18

Photoacoustic spectroscopy has been shown to be a promising tool for non-invasive blood glucose monitoring. However, the repeatability of such a method is susceptible to changes in skin condition, which is dependent on hand washing and drying due to the high absorption of infrared excitation light to the skin secretion products or water. In this paper, we present a method to meet the challenges of mid-infrared photoacoustic spectroscopy for non-invasive glucose monitoring. By obtaining the microscopic spatial information of skin during the spectroscopy measurement, the skin region where the infrared spectra is insensitive to skin condition can be locally selected, which enables reliable prediction of the blood glucose level from the photoacoustic spectroscopy signals. Our raster-scan imaging showed that the skin condition for in vivo spectroscopic glucose monitoring had significant inhomogeneities and large variability in the probing area where the signal was acquired. However, the selective localization of the probing led to a reduction in the effects of variability due to the skin secretion product. Looking forward, this technology has broader applications not only in continuous glucose monitoring for diabetic patient care, but in forensic science, the diagnosis of malfunctioning sweat pores, and the discrimination of tumors extracted via biopsy.

Towards a continuous glucose monitoring system using tunable quantum cascade lasers

Science.gov (United States)

Haase, Katharina; Müller, Niklas; Petrich, Wolfgang

2018-02-01

We present a reagent-free approach for long-term continuous glucose monitoring (cgm) of liquid samples using midinfrared absorption spectroscopy. This method could constitute an alternative to enzymatic glucose sensors in order to manage the widespread disease of Diabetes. In order to acquire spectra of the liquid specimen, we use a spectrally tunable external-cavity (EC-) quantum cascade laser (QCL) as radiation source in combination with a fiber-based in vitro sensor setup. Hereby we achieve a glucose sensitivity in pure glucose solutions of 3 mg/dL (RMSEP). Furthermore, the spectral tunability of the EC-QCL enables us to discriminate glucose from other molecules. We exemplify this by detecting glucose among other saccharides with an accuracy of 8 mg/dL (within other monosaccharides, RMSEVC) and 14 mg/dL (within other mono- and disaccharides, RMSECV). Moreover, we demonstrate a characterization of the significance of each wavenumber for an accurate prediction of glucose among other saccharides using an evolutionary algorithm. We show, that by picking 10 distinct wavenumbers we can achieve comparable accuracies to the use of a complete spectrum.

The Performance and Usability of a Factory-Calibrated Flash Glucose Monitoring System

OpenAIRE

Bailey, Timothy; Bode, Bruce W.; Christiansen, Mark P.; Klaff, Leslie J.; Alva, Shridhara

2015-01-01

Abstract Introduction: The purpose of the study was to evaluate the performance and usability of the FreeStyle? Libre? Flash glucose monitoring system (Abbott Diabetes Care, Alameda, CA) for interstitial glucose results compared with capillary blood glucose results. Materials and Methods: Seventy-two study participants with type 1 or type 2 diabetes were enrolled by four U.S. clinical sites. A sensor was inserted on the back of each upper arm for up to 14 days. Three factory-only calibrated s...

AMPK is involved in the regulation of incretin receptors expression in pancreatic islets under a low glucose concentration.

Directory of Open Access Journals (Sweden)

Kazuki Tajima

Full Text Available The precise role of AMP-activated protein kinase (AMPK, a target of metformin, in pancreatic β cells remains controversial, even though metformin was recently shown to enhance the expression of incretin receptors (GLP-1 and GIP receptors in pancreatic β cells. In this study, we investigated the effect of AMPK in the regulation of incretin receptors expression in pancreatic islets. The phosphorylation of AMPK in the mouse islets was decreased by increasing glucose concentrations. We showed the expression of incretin receptors in bell-shaped response to glucose. Expression of the incretin receptors in the isolated islets showed higher levels under a medium glucose concentration (11.1 mM than that under a low glucose concentration (2.8 mM, but was suppressed under a high glucose concentration (22.2 mM. Both treatment with an AMPK inhibitor and DN-AMPK expression produced a significant increase of the incretin receptors expression under a low glucose concentration. By contrast, in hyperglycemic db/db islets, the enhancing effect of the AMPK inhibitor on the expression of incretin receptors was diminished under a low glucose concentration. Taken together, AMPK is involved in the regulation of incretin receptors expression in pancreatic islets under a low glucose concentration.

The effect of an instant hand sanitizer on blood glucose monitoring results.

Science.gov (United States)

Mahoney, John J; Ellison, John M; Glaeser, Danielle; Price, David

2011-11-01

People with diabetes mellitus are instructed to clean their skin prior to self-monitoring of blood glucose to remove any dirt or food residue that might affect the reading. Alcohol-based hand sanitizers have become popular when soap and water are not available. The aim of this study was to determine whether a hand sanitizer is compatible with glucose meter testing and effective for the removal of exogenous glucose. We enrolled 34 nonfasting subjects [14 male/20 female, mean ages 45 (standard deviation, 9.4)] years, 2 with diagnosed diabetes/32 without known diabetes]. Laboratory personnel prepared four separate fingers on one hand of each subject by (1) cleaning the second finger with soap and water and towel drying (i.e., control finger), (2) cleaning the third finger with an alcohol-based hand sanitizer, (3) coating the fourth finger with cola and allowing it to air dry, and (4) coating the fifth finger with cola and then cleaning it with the instant hand sanitizer after the cola had dried. Finger sticks were performed on each prepared finger and blood glucose was measured. Several in vitro studies were also performed to investigate the effectiveness of the hand sanitizer for removal of exogenous glucose.z Mean blood glucose values from fingers cleaned with instant hand sanitizer did not differ significantly from the control finger (p = .07 and .08, respectively) and resulted in 100% accurate results. Blood glucose data from the fourth (cola-coated) finger were substantially higher on average compared with the other finger conditions, but glucose data from the fifth finger (cola-coated then cleaned with hand sanitizer) was similar to the control finger. The data from in vitro experiments showed that the hand sanitizer did not adversely affect glucose meter results, but when an exogenous glucose interference was present, the effectiveness of the hand sanitizer on glucose bias (range: 6% to 212%) depended on the surface area and degree of dilution. In our study

Carbohydrate ingestion before and during soccer match play and blood glucose and lactate concentrations.

Science.gov (United States)

Russell, Mark; Benton, David; Kingsley, Michael

2014-01-01

The ingestion of carbohydrate (CHO) before and during exercise and at halftime is commonly recommended to soccer players for maintaining blood glucose concentrations throughout match play. However, an exercise-induced rebound glycemic response has been observed in the early stages of the second half of simulated soccer-specific exercise when CHO-electrolyte beverages were consumed regularly. Therefore, the metabolic effects of CHO beverage consumption throughout soccer match play remain unclear. To investigate the blood glucose and blood lactate responses to CHOs ingested before and during soccer match play. Crossover study. Applied research study. Ten male outfield academy soccer players (age = 15.6 ± 0.2 years, height = 1.74 ± 0.02 m, mass = 65.3 ± 1.9 kg, estimated maximal oxygen consumption = 58.4 ± 0.8 mL·kg(-1)·min(-1)). Players received a 6% CHO-electrolyte solution or an electrolyte (placebo) solution 2 hours before kickoff, before each half (within 10 minutes), and every 15 minutes throughout exercise. Blood samples were obtained at rest, every 15 minutes during the match (first half: 0-15, 15-30, and 30-45 minutes; second half: 45-60, 60-75, and 75-90 minutes) and 10 minutes into the halftime break. Metabolic responses (blood glucose and blood lactate concentrations) and markers of exercise intensity (heart rate) were recorded. Supplementation influenced the blood glucose response to exercise (time × treatment interaction effect: P ≤ .05), such that glucose concentrations were higher at 30 to 45 minutes in the CHO than in the placebo condition. However, in the second half, blood glucose concentrations were similar between conditions because of transient reductions from peak values occurring in both trials at halftime. Blood lactate concentrations were elevated above those at rest in the first 15 minutes of exercise (time-of-sample effect: P interaction effect: P = .49). Ingestion of a 6% CHO-electrolyte beverage before and during soccer match

Genetic Algorithm Tuning of PID Controller in Smith Predictor for Glucose Concentration Control

Directory of Open Access Journals (Sweden)

Tsonyo Slavov

2011-07-01

Full Text Available This paper focuses on design of a glucose concentration control system based on nonlinear model plant of E. coli MC4110 fed-batch cultivation process. Due to significant time delay in real time glucose concentration measurement, a correction is proposed in glucose concentration measurement and a Smith predictor (SP control structure based on universal PID controller is designed. To reduce the influence of model error in SP structure the estimate of measured glucose concentration is used. For the aim an extended Kalman filter (EKF is designed. To achieve good closed-loop system performance genetic algorithm (GA based optimal controller tuning procedure is applied. A standard binary encoding GA is applied. The GA parameters and operators are specified for the considered here problem. As a result the optimal PID controller settings are obtained. The simulation experiments of the control systems based on SP with EKF and without EKF are performed. The results show that the control system based on SP with EKF has a better performance than the one without EKF. For a short time the controller sets the control variable and maintains it at the desired set point during the cultivation process. As a result, a high biomass concentration of 48.3 g·l-1 is obtained at the end of the process.

Noninvasive biosensor and wireless interrogating system for glucose in blood

Science.gov (United States)

Varadan, Vijay K.; Whitchurch, Ashwin K.; Sarukesi, K.

2003-07-01

Hypoglycemia-abnormal decrease in blood sugar-is a major obstacle in the management of diabetes and prevention of long-term complications, and it may impose serious effects on the brain, including impairment of memory and other cognitive functions. This paper presents the development of a non-invasive sensor with miniaturized telemetry device in a wrist-watch for monitoring glucose concentration in blood. The sensor concept is based on optical chirality of glucose level in the interstitial fluid. The wrist watch consists of a laser power source of the wavelength compatible with the glucose. A nanofilm with specific chirality is placed at the bottom of the watch. The light then passes through the film and illuminates a small area on the skin. It has been documented that there is certain concentration of sugar level is taken by the intertitial fluid from the blood stream and deposit a portion of it at the dead skin. The wrist-watch when in contact with the outer skin of the human will thus monitor the glucose concentration. A wireless monitoring system in the watch then downloads the data from the watch to a Palm or a laptop computer.

Evaluating clinical accuracy of continuous glucose monitoring devices: other methods

NARCIS (Netherlands)

Wentholt, Iris M. E.; Hart, August A.; Hoekstra, Joost B. L.; DeVries, J. Hans

2008-01-01

With more and more continuous glucose monitoring devices entering the market, the importance of adequate accuracy assessment grows. This review discusses pros and cons of Regression Analysis and Correlation Coefficient, Relative Difference measures, Bland Altman plot, ISO criteria, combined curve

Enhanced self-monitoring blood glucose in non-insulin requiring Type 2 diabetes: A qualitative study in primary care.

Science.gov (United States)

Brackney, Dana Elisabeth

2018-03-31

To contribute to both theoretical and practical understanding of the role of self-monitoring blood glucose for self-management by describing the experience of people with non-insulin requiring Type 2 diabetes in an enhanced structured self-monitoring blood glucose intervention. The complex context of self-monitoring blood glucose in Type 2 diabetes requires a deeper understanding of the clients' illness experience with structured self-monitoring of blood glucose. Clients' numeracy skills contribute to their response to blood glucose readings. Nurses' use of motivational interviewing to increase clients' regulatory self-efficacy is important to the theoretical perspective of the study. A qualitative descriptive study. A purposive sample of eleven adults recently (diabetes who had experienced a structured self-monitoring blood glucose intervention participated in this study. Audio recordings of semi-structured interviews and photos of logbooks were analyzed for themes using constant comparison and member checking. The illness experience states of Type 2 diabetes include 'Diagnosis', 'Behavior change', and 'Routine checking'. People check blood glucose to confirm their Type 2 diabetes diagnosis, to console their diabetes related fears, to create personal explanations of health behavior's impact on blood glucose, to activate behavior change and to congratulate their diabetes self-management efforts. These findings support the Transtheoretical model's stages of change and change processes. Blood glucose checking strengthens the relationships between theoretical concepts found in Diabetes Self-management Education-Support including: engagement, information sharing, and behavioral support. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Self-care among patients enrolled in a self-monitoring blood glucose program

Directory of Open Access Journals (Sweden)

Vivian Saraiva Veras

Full Text Available This cross-sectional study checks specific self-care activities of patients with diabetes mellitus enrolled in a self-monitoring blood glucose program from August to December 2012 in two Primary Health Care units in the interior of São Paulo, Brazil. The sample was composed of 74 female and male individuals, aged 18 years old or older. The Summary of Diabetes Self-Care Activities Questionnaire was used. It contains six dimensions: general diet, specific diet, physical activity, blood glucose monitoring, foot care, medication usage, plus three items about smoking. Eight out of the 15 self-care activities were within desirable levels, namely: healthy diet, not eating sweets, blood glucose testing and as frequently as recommended, drying between toes after washing feet, and taking medications (three items. The results enabled the identification of gaps in specific self-care activities among patients with diabetes mellitus.

Predictors of Daily Blood Glucose Monitoring in Appalachian Ohio

Science.gov (United States)

Raffle, Holly; Ware, Lezlee J.; Ruhil, Anirudh V. S.; Hamel-Lambert, Jane; Denham, Sharon A.

2012-01-01

Objective: To determine factors contributing to successful diabetes self-management in Appalachia, as evidenced by daily blood glucose monitoring. Methods: A telephone survey (N = 3841) was conducted to assess health status and health care access. The current investigation is limited to the subset of this sample who report having diabetes (N =…

Continuous glucose monitoring system and new era of early diagnosis of diabetes in high risk groups

Directory of Open Access Journals (Sweden)

Ashraf Soliman

2014-01-01

Full Text Available Continuous glucose monitoring (CGM systems are an emerging technology that allows frequent glucose measurements to monitor glucose trends in real time. Their use as a diagnostic tool is still developing and appears to be promising. Combining intermittent glucose self-monitoring (SGM and CGM combines the benefits of both. Significant improvement in the treatment modalities that may prevent the progress of prediabetes to diabetes have been achieved recently and dictates screening of high risk patients for early diagnosis and management of glycemic abnormalities. The use of CGMS in the diagnosis of early dysglycemia (prediabetes especially in high risk patients appears to be an attractive approach. In this review we searched the literature to investigate the value of using CGMS as a diagnostic tool compared to other known tools, namely oral glucose tolerance test (OGTT and measurement of glycated hemoglobin (HbA1C in high risk groups. Those categories of patients include adolescents and adults with obesity especially those with family history of type 2 diabetes mellitus, polycystic ovary syndrome (PCO, gestational diabetes, cystic fibrosis, thalassemia major, acute coronary syndrome (ACS, and after renal transplantation. It appears that the ability of the CGMS for frequently monitoring (every 5 min glucose changes during real-life settings for 3 to 5 days stretches the chance to detect more glycemic abnormalities during basal and postprandial conditions compared to other short-timed methods.

Differential Responses of Plasma Adropin Concentrations To Dietary Glucose or Fructose Consumption In Humans.

Science.gov (United States)

Butler, Andrew A; St-Onge, Marie-Pierre; Siebert, Emily A; Medici, Valentina; Stanhope, Kimber L; Havel, Peter J

2015-10-05

Adropin is a peptide hormone encoded by the Energy Homeostasis Associated (ENHO) gene whose physiological role in humans remains incompletely defined. Here we investigated the impact of dietary interventions that affect systemic glucose and lipid metabolism on plasma adropin concentrations in humans. Consumption of glucose or fructose as 25% of daily energy requirements (E) differentially affected plasma adropin concentrations (P Glucose consumption reduced plasma adropin from 3.55 ± 0.26 to 3.28 ± 0.23 ng/ml (N = 42). Fructose consumption increased plasma adropin from 3.63 ± 0.29 to 3.93 ± 0.34 ng/ml (N = 45). Consumption of high fructose corn syrup (HFCS) as 25% E had no effect (3.43 ± 0.32 versus 3.39 ± 0.24 ng/ml, N = 26). Overall, the effect of glucose, HFCS and fructose on circulating adropin concentrations were similar to those observed on postprandial plasma triglyceride concentrations. Furthermore, increases in plasma adropin levels with fructose intake were most robust in individuals exhibiting hypertriglyceridemia. Individuals with low plasma adropin concentrations also exhibited rapid increases in plasma levels following consumption of breakfasts supplemented with lipids. These are the first results linking plasma adropin levels with dietary sugar intake in humans, with the impact of fructose consumption linked to systemic triglyceride metabolism. In addition, dietary fat intake may also increase circulating adropin concentrations.

Glucose-responsive neurons in the subfornical organ of the rat--a novel site for direct CNS monitoring of circulating glucose.

Science.gov (United States)

Medeiros, N; Dai, L; Ferguson, A V

2012-01-10

Glucose-sensitive neurons have been identified in a number of CNS regions including metabolic control centers of the hypothalamus. The location of these regions behind the blood-brain barrier restricts them to sensing central, but not circulating glucose concentrations. In this study, we have used patch-clamp electrophysiology to examine whether neurons in a specialized region lacking the blood-brain barrier, the subfornical organ (SFO), are also glucose sensitive. In dissociated SFO neurons, altering the bath concentration of glucose (1 mM, 5 mM, 10 mM) influenced the excitability of 49% of neurons tested (n=67). Glucose-inhibited (GI) neurons depolarized in response to decreased glucose (n=10; mean, 4.6±1.0 mV) or hyperpolarized in response to increased glucose (n=8; mean,-4.4±0.8 mV). In contrast, glucose-excited (GE) neurons depolarized in response to increased glucose (n=9; mean, 6.4±0.4 mV) or hyperpolarized in response to decreased glucose (n=6; mean,-4.8±0.6 mV). Using voltage-clamp recordings, we also identified GI (outward current to increased glucose) and GE (inward current to increased glucose) SFO neurons. The mean glucose-induced inward current had a reversal potential of -24±12 mV (n=5), while GE responses were maintained during sodium-dependent glucose transporter inhibition, supporting the conclusion that GE properties result from the activation of a nonselective cation conductance (NSCC). The glucose-induced outward current had a mean reversal potential of -78±1.2 mV (n=5), while GI responses were not observed in the presence of glibenclamide, suggesting that these properties result from the modulation of K(ATP) channels. These data demonstrate that SFO neurons are glucose responsive, further emphasizing the potential roles of this circumventricular organ as an important sensor and integrator of circulating signals of energy status. Copyright © 2011 IBRO. Published by Elsevier Ltd. All rights reserved.

First Clinical Experience with Retrospective Flash Glucose Monitoring (FGM) Analysis in South Africa: Characterizing Glycemic Control with Ambulatory Glucose Profile.

Science.gov (United States)

Distiller, Larry A; Cranston, Iain; Mazze, Roger

2016-11-01

In 2014, an innovative blinded continuous glucose monitoring system was introduced with automated ambulatory glucose profile (AGP) reporting. The clinical use and interpretation of this new technology has not previously been described. Therefore we wanted to understand its use in characterizing key factors related to glycemic control: glucose exposure, variability, and stability, and risk of hypoglycemia in clinical practice. Clinicians representing affiliated diabetes centers throughout South Africa were trained and subsequently were given flash glucose monitoring readers and 2-week glucose sensors to use at their discretion. After patient use, sensor data were collected and uploaded for AGP reporting. Complete data (sensor AGP with corresponding clinical information) were obtained for 50 patients with type 1 (70%) and type 2 diabetes (30%), irrespective of therapy. Aggregated analysis of AGP data comparing patients with type 1 versus type 2 diabetes, revealed that despite similar HbA1c values between both groups (8.4 ± 2 vs 8.6 ± 1.7%, respectively), those with type 2 diabetes had lower mean glucose levels (9.2 ± 3 vs 10.3 mmol/l [166 ± 54 vs 185 mg/dl]) and lower indices of glucose variability (3.0 ± 1.5 vs 5.0 ± 1.9 mmol/l [54 ± 27 vs 90 ± 34.2 mg/dl]). This highlights key areas for future focus. Using AGP, the characteristics of glucose exposure, variability, stability, and hypoglycemia risk and occurrence were obtained within a short time and with minimal provider and patient input. In a survey at the time of the follow-up visit, clinicians indicated that aggregated AGP data analysis provided important new clinical information and insights. © 2016 Diabetes Technology Society.

Fermentation of solutions of glucose-protein concentrate in a cascade-multi-ray unit

Energy Technology Data Exchange (ETDEWEB)

Denshchikov, M T; Shashilova, V P

1964-01-01

Glucose-protein concentrate is a material obtained by the hydrolysis of corn, containing glucose 75 to 80, maltose, isomaltose, and other non-fermentable sugars 1.5 to 2, H/sub 2/O 15 to 17, mineral matter 1.9 to 1%, and N-containing materials 3.2 to 3.4 g/kg. In earlier fermentation trails with this material, after addition of H/sub 2/O, only 10 to 12% ethanol concentrations were obtained. With period addition of citric acid and replacement of the yeast at regular intervals, using a cascade-multitray unit, 12 to 13% concentrations of ethanol were obtained.

Associations of fatty acids in cerebrospinal fluid with peripheral glucose concentrations and energy metabolism.

Directory of Open Access Journals (Sweden)

Reiner Jumpertz

Full Text Available Rodent experiments have emphasized a role of central fatty acid (FA species, such as oleic acid, in regulating peripheral glucose and energy metabolism. Thus, we hypothesized that central FAs are related to peripheral glucose regulation and energy expenditure in humans. To test this we measured FA species profiles in cerebrospinal fluid (CSF and plasma of 32 individuals who stayed in our clinical inpatient unit for 6 days. Body composition was measured by dual energy X-ray absorptiometry and glucose regulation by an oral glucose test (OGTT followed by measurements of 24 hour (24EE and sleep energy expenditure (SLEEP as well as respiratory quotient (RQ in a respiratory chamber. CSF was obtained via lumbar punctures; FA concentrations were measured by liquid chromatography/mass spectrometry. As expected, FA concentrations were higher in plasma compared to CSF. Individuals with high concentrations of CSF very-long-chain saturated FAs had lower rates of SLEEP. In the plasma moderate associations of these FAs with higher 24EE were observed. Moreover, CSF monounsaturated long-chain FA (palmitoleic and oleic acid concentrations were associated with lower RQs and lower glucose area under the curve during the OGTT. Thus, FAs in the CSF strongly correlated with peripheral metabolic traits. These physiological parameters were most specific to long-chain monounsaturated (C16:1, C18:1 and very-long-chain saturated (C24:0, C26:0 FAs.Together with previous animal experiments these initial cross-sectional human data indicate that central FA species are linked to peripheral glucose and energy homeostasis.

Real-time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

DEFF Research Database (Denmark)

Cordua, S; Secher, A L; Ringholm, L

2013-01-01

To explore whether real-time continuous glucose monitoring during labour and delivery supplementary to hourly self-monitored plasma glucose in women with Type 1 diabetes reduces the prevalence of neonatal hypoglycaemia.......To explore whether real-time continuous glucose monitoring during labour and delivery supplementary to hourly self-monitored plasma glucose in women with Type 1 diabetes reduces the prevalence of neonatal hypoglycaemia....

Investigation of the Influence of the As-Grown ZnO Nanorods and Applied Potentials on an Electrochemical Sensor for In-Vitro Glucose Monitoring

Directory of Open Access Journals (Sweden)

Mohammed Marie

2017-01-01

Full Text Available The influence of the as-grown zinc oxide nanorods (ZnO NRs on the fabricated electrochemical sensor for in vitro glucose monitoring were investigated. A direct growth of ZnO NRs was performed on the Si/SiO2/Au electrode, using hydrothermal and sol-gel techniques at low temperatures. The structure, consisting of a Si/SiO2/Au/GOx/Nafion membrane, was considered as a baseline, and it was tested under several applied potential 0.1–0.8 V. The immobilized working electrode, with GOx and a nafion membrane, was characterized amperometrically using a source meter Keithely 2410, and an electrochemical impedance Gamry potentiostat. The sensor exhibited the following: a high sensitivity of ~0.468 mA/cm2 mM, a low detection limit in the order of 166.6 µM, and a fast and sharp response time of around 2 s. The highest sensitivity and the lowest limit of detection were obtained at 0.4 volt, after the growth of ZnO NRs. The highest net sensitivity was obtained after subtracting the sensitivity of the baseline, and it was in the order of 0.315 mA/cm2·mM. The device was tested with a range of glucose concentrations from 1–10 mM, showing a linear line from 3–8 mM, and the device was saturated after exceeding high concentrations of glucose. Such devices can be used for in vitro glucose monitoring, since glucose changes can be accurately detected.

Vasopressin activates Akt/mTOR pathway in smooth muscle cells cultured in high glucose concentration

Energy Technology Data Exchange (ETDEWEB)

Montes, Daniela K.; Brenet, Marianne; Muñoz, Vanessa C.; Burgos, Patricia V.; Villanueva, Carolina I. [Department of Physiology, Universidad Austral de Chile, Valdivia 509-9200 (Chile); Figueroa, Carlos D. [Department of Anatomy, Histology and Pathology, Universidad Austral de Chile, Valdivia 509-9200 (Chile); González, Carlos B., E-mail: cbgonzal@uach.cl [Department of Physiology, Universidad Austral de Chile, Valdivia 509-9200 (Chile); Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555 (United States)

2013-11-29

Highlights: •AVP induces mTOR phosphorylation in A-10 cells cultured in high glucose concentration. •The mTOR phosphorylation is mediated by the PI3K/Akt pathway activation. •The AVP-induced mTOR phosphorylation inhibited autophagy and stimulated cell proliferation. -- Abstract: Mammalian target of rapamycin (mTOR) complex is a key regulator of autophagy, cell growth and proliferation. Here, we studied the effects of arginine vasopressin (AVP) on mTOR activation in vascular smooth muscle cells cultured in high glucose concentration. AVP induced the mTOR phosphorylation in A-10 cells grown in high glucose, in contrast to cells cultured in normal glucose; wherein, only basal phosphorylation was observed. The AVP-induced mTOR phosphorylation was inhibited by a PI3K inhibitor. Moreover, the AVP-induced mTOR activation inhibited autophagy and increased thymidine incorporation in cells grown in high glucose. This increase was abolished by rapamycin which inhibits the mTORC1 complex formation. Our results suggest that AVP stimulates mTOR phosphorylation by activating the PI3K/Akt signaling pathway and, subsequently, inhibits autophagy and raises cell proliferation in A-10 cells maintained in high glucose concentration.

Differential Mueller matrix polarimetry technique for non-invasive measurement of glucose concentration on human fingertip.

Science.gov (United States)

Phan, Quoc-Hung; Lo, Yu-Lung

2017-06-26

A differential Mueller matrix polarimetry technique is proposed for obtaining non-invasive (NI) measurements of the glucose concentration on the human fingertip. The feasibility of the proposed method is demonstrated by detecting the optical rotation angle and depolarization index of tissue phantom samples containing de-ionized water (DI), glucose solutions with concentrations ranging from 0~500 mg/dL and 2% lipofundin. The results show that the extracted optical rotation angle increases linearly with an increasing glucose concentration, while the depolarization index decreases. The practical applicability of the proposed method is demonstrated by measuring the optical rotation angle and depolarization index properties of the human fingertips of healthy volunteers.

Self-monitoring of blood glucose in diabetes mellitus: arguments for an individualized approach.

Science.gov (United States)

Nauck, Michael A; El-Ouaghlidi, Andrea; Vardarli, Irfan

2009-09-01

The utility of glucose self-monitoring in different types and stages of diabetes is controversial, as there is only sparse relevant evidence from randomized controlled clinical trials. In this analysis, the authors aim to develop individualized recommendations based on clinical needs and the available literature. The PubMed database was searched for articles that appeared up to 30 September 2008 containing the terms "measurement," "control","monitoring," and "hypoglycemia"; the retrieved articles were supplemented by other articles that were cited in them. A directed search was also made for the recommendations of the German, European, American, and international diabetological societies. Conclusions were then drawn about the useful modalities and extent of glucose self-monitoring on the basis of the clinical features of the major types of diabetes and the main treatment strategies for them. With the exception of intensified treatment strategies (which rely on blood-sugar regulation with insulin), only a few evidence-based recommendations can be derived from randomized clinical trials and meta-analyses. Nonetheless, a strategy for self-monitoring according to the patient's individual needs can be derived from the characteristics of therapeutic regimens: depending on the type of diabetes from which the patient suffers, the predicted number of glucometer strips required for self-monitoring will vary from almost none to roughly 400 per month. The decision to use glucose self-monitoring, as well as the type and extent of self-monitoring that will be used, should be based on the individual patient's type of diabetes, treatment regimen, and clinical characteristics. Like any other type of therapeutic intervention, self-monitoring should have a well-documented, rational justification.

Reliable glucose monitoring by ex-vivo blood microdialysis and infrared spectrometry for patients in critical care

Science.gov (United States)

Vahlsing, Thorsten; Delbeck, Sven; Budde, Janpeter; Ihrig, Dieter; Leonhardt, Steffen; Heise, H. Michael

2017-02-01

Blood glucose monitoring has been realised by biosensors in combination with micro-dialysis, using either subcutaneously or intravascularly implanted catheters. Another alternative is ex-vivo micro-dialysis of continuously sampled heparinized whole blood available from the patient even under critical care conditions. However, most devices suffer from inaccuracies due to variable recovery rates. Infrared spectrometry has been suggested for analyte quantification, since besides glucose other clinically relevant analytes can be simultaneously determined that are, e.g., important for intensive care patients. Perfusates with acetate and mannitol have been investigated as recovery markers (internal standards). In contrast to the previously used acetate, an almost linear dependency between mannitol loss and glucose recovery was observed for micro-dialysis of glucose spiked aqueous albumin solutions or porcine heparinized whole blood when testing flat membranes within a custom-made micro-dialysator. By this, a straightforward compensation of any dialysis recovery rate variation during patient monitoring is possible. The combination of microdialysis with infrared spectrometry provides a calibration-free assay for accurate continuous glucose monitoring, as reference spectra of dialysate components can be a-priori allocated.

ONLINE MONITORING OF EXTRACELLULAR BRAIN GLUCOSE USING MICRODIALYSIS AND A NADPH-LINKED ENZYMATIC ASSAY

NARCIS (Netherlands)

VANDERKUIL, JHF; KORF, J

A method to monitor extracellular glucose in freely moving rats, based on intracerebral microdialysis coupled to an enzyme reactor is described. The dialysate is continuously mixed with a solution containing the enzymes hexokinase and glucose-6-phosphate dehydrogenase, and the fluorescence of NADPH

The biphasic effect of extracellular glucose concentration on carbachol-induced fluid secretion from mouse submandibular glands.

Science.gov (United States)

Terachi, Momomi; Hirono, Chikara; Kitagawa, Michinori; Sugita, Makoto

2018-06-01

Cholinergic agonists evoke elevations of the cytoplasmic free-calcium concentration ([Ca 2+ ] i ) to stimulate fluid secretion in salivary glands. Salivary flow rates are significantly reduced in diabetic patients. However, it remains elusive how salivary secretion is impaired in diabetes. Here, we used an ex vivo submandibular gland perfusion technique to characterize the dependency of salivary flow rates on extracellular glucose concentration and activities of glucose transporters expressed in the glands. The cholinergic agonist carbachol (CCh) induced sustained fluid secretion, the rates of which were modulated by the extracellular glucose concentration in a biphasic manner. Both lowering the extracellular glucose concentration to less than 2.5 mM and elevating it to higher than 5 mM resulted in decreased CCh-induced fluid secretion. The CCh-induced salivary flow was suppressed by phlorizin, an inhibitor of the sodium-glucose cotransporter 1 (SGLT1) located basolaterally in submandibular acinar cells, which is altered at the protein expression level in diabetic animal models. Our data suggest that SGLT1-mediated glucose uptake in acinar cells is required to maintain the fluid secretion by sustaining Cl - secretion in real-time. High extracellular glucose levels may suppress the CCh-induced secretion of salivary fluid by altering the activities of ion channels and transporters downstream of [Ca 2+ ] i signals. © 2018 Eur J Oral Sci.

HBA1C AND MEAN GLUCOSE DERIVED FROM SHORT-TERM CONTINUOUS GLUCOSE MONITORING ASSESSMENT DO NOT CORRELATE IN PATIENTS WITH HBA1C >8.

Science.gov (United States)

Yamada, Eijiro; Okada, Shuichi; Nakajima, Yasuyo; Bastie, Claire C; Vatish, Manu; Tagaya, Yuko; Osaki, Aya; Shimoda, Yoko; Shibusawa, Ryo; Saito, Tsugumichi; Okamura, Takashi; Ozawa, Atsushi; Yamada, Masanobu

2017-01-01

Optimum therapy for patients with diabetes depends on both acute and long-term changes in plasma glucose, generally assessed by glycated hemoglobin (HbA1c) levels. However, the correlation between HbA1c and circulating glucose has not been fully determined. Therefore, we carefully examined this correlation when glucose levels were assessed by continuous glucose monitoring (CGM). Fifty-one patients (70% female, 30% male) were examined; among them were 28 with type 1 diabetes and 23 with type 2 diabetes. Clinically determined HbA1c levels were compared with blood glucose determined by CGM during a short time period. Changes in HbA1c levels up to 8.0% showed a clear and statistically strong correlation (R = 0.6713; PHbA1c and CGM-assessed glucose levels in our patient population when HbA1c was >8.0%. Short-term CGM appears to be a good clinical indicator of long-term glucose control (HbA1c levels); however, cautions should be taken while interpreting CGM data from patients with HbA1c levels >8.0%. Over- or underestimation of the actual mean glucose from CGM data could potentially increase the risks of inappropriate treatment. As such, our results indicate that a more accurate analysis of CGM data might be useful to adequately tailor clinical treatments. ADAG = A1c-Derived Average Glucose CGM = continuous glucose monitoring %CV = percent coefficient of variation HbA1c = glycated hemoglobin.

Crosslinked basement membrane-based coatings enhance glucose sensor function and continuous glucose monitoring in vivo.

Science.gov (United States)

Klueh, Ulrike; Ludzinska, Izabela; Czajkowski, Caroline; Qiao, Yi; Kreutzer, Donald L

2018-01-01

Overcoming sensor-induced tissue reactions is an essential element of achieving successful continuous glucose monitoring (CGM) in the management of diabetes, particularly when used in closed loop technology. Recently, we demonstrated that basement membrane (BM)-based glucose sensor coatings significantly reduced tissue reactions at sites of device implantation. However, the biocompatible BM-based biohydrogel sensor coating rapidly degraded over a less than a 3-week period, which effectively eliminated the protective sensor coating. In an effort to increase the stability and effectiveness of the BM coating, we evaluated the impact of crosslinking BM utilizing glutaraldehyde as a crosslinking agent, designated as X-Cultrex. Sensor performance (nonrecalibrated) was evaluated for the impact of these X-Cultrex coatings in vitro and in vivo. Sensor performance was assessed over a 28-day time period in a murine CGM model and expressed as mean absolute relative difference (MARD) values. Tissue reactivity of Cultrex-coated, X-Cultrex-coated, and uncoated glucose sensors was evaluated over a 28-day time period in vivo using standard histological techniques. These studies demonstrated that X-Cultrex-based sensor coatings had no effect on glucose sensor function in vitro. In vivo, glucose sensor performance was significantly enhanced following X-Cultrex coating throughout the 28-day study. Histological evaluations of X-Cultrex-treated sensors demonstrated significantly less tissue reactivity when compared to uncoated sensors. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 7-16, 2018. © 2017 Wiley Periodicals, Inc.

Continuous glucose monitoring-enabled insulin-pump therapy in diabetic pregnancy

DEFF Research Database (Denmark)

Secher, Anna L; Schmidt, Signe; Nørgaard, Kirsten

2010-01-01

We describe the feasibility of continuous glucose monitoring (CGM)-enabled insulin-pump therapy during pregnancy in a woman with type 1 diabetes, who was treated with CGM-enabled insulin-pump therapy in her third pregnancy. During her first pregnancy, the woman was treated with multiple daily inj...

Glucose control in pregnant women with type 1 diabetes mellitus: Studies using a continuous glucose monitoring system

NARCIS (Netherlands)

Kerssen, Anneloes

2005-01-01

Pregnancy in women with type 1 diabetes mellitus is associated with neonatal morbidity. It is commonly agreed that the morbidity decreases when diabetic control is tightened. The most common methods for the determination of diabetic control are the self-monitoring of blood glucose levels (SMBG) and

Venous, Arterialized-Venous, or Capillary Glucose Reference Measurements for the Accuracy Assessment of a Continuous Glucose Monitoring System

NARCIS (Netherlands)

Kropff, Jort; van Steen, Sigrid C.; deGraaff, Peter; Chan, Man W.; van Amstel, Rombout B. E.; DeVries, J. Hans

2017-01-01

Background: Different reference methods are used for the accuracy assessment of continuous glucose monitoring (CGM) systems. The effect of using venous, arterialized-venous, or capillary reference measurements on CGM accuracy is unclear. Methods: We evaluated 21 individuals with type 1 diabetes

Efficacy of Additional Canagliflozin Administration to Type 2 Diabetes Patients Receiving Insulin Therapy: Examination of Diurnal Glycemic Patterns Using Continuous Glucose Monitoring (CGM).

Science.gov (United States)

Matsumura, Mihoko; Nakatani, Yuki; Tanka, Seiichi; Aoki, Chie; Sagara, Masaaki; Yanagi, Kazunori; Suzuki, Kunihiro; Aso, Yoshimasa

2017-08-01

The efficacy of administering a sodium-glucose cotransporter 2 inhibitor during insulin therapy has not been established. In this study, we examined its effects based on diurnal glycemic patterns using continuous glucose monitoring (CGM). The subjects were 15 patients who had received insulin therapy for 1 year or more. A CGM device was attached to all subjects for 1 week. The administration of canagliflozin at 100 mg was started 4 days after attachment. The mean glucose concentrations, standard deviation (SD), mean amplitude of glycemic excursions (MAGE), mean of daily difference of blood glucose (MODD), and area under the curve (AUC) (≥180, glucose concentrations decreased from 161.1 to 139.1 mg/dL (P AUC of ≥180, i.e., the total area of blood glucose levels at or above 180 on the blood glucose curve of CGM, decreased from 339.1 to 113.6 mg/dL (P AUC of blood glucose levels below 70 on the blood glucose curve of CGM, slightly decreased from 1.6 to 0.3 mg/dL (P = 0.08). The total number of basal insulin units decreased from 128 to 76, and that of bolus insulin decreased from 266 to 154; the dose of insulin could be markedly decreased. In addition, the mean 8-OHdG level decreased from 11.4 to 10.8 ng/mg Cre (P blood glucose changes in type 2 diabetes using insulin. In addition, the results suggest its antioxidant actions. University Hospital Medical Information Network (UMIN no. 000019429).

Consumption of meat is associated with higher fasting glucose and insulin concentrations regardless of glucose and insulin genetic risk scores: a meta-analysis of 50,345 Caucasians12

Science.gov (United States)

Fretts, Amanda M; Follis, Jack L; Nettleton, Jennifer A; Lemaitre, Rozenn N; Ngwa, Julius S; Wojczynski, Mary K; Kalafati, Ioanna Panagiota; Varga, Tibor V; Frazier-Wood, Alexis C; Houston, Denise K; Lahti, Jari; Ericson, Ulrika; van den Hooven, Edith H; Mikkilä, Vera; Kiefte-de Jong, Jessica C; Mozaffarian, Dariush; Rice, Kenneth; Renström, Frida; North, Kari E; McKeown, Nicola M; Feitosa, Mary F; Kanoni, Stavroula; Smith, Caren E; Garcia, Melissa E; Tiainen, Anna-Maija; Sonestedt, Emily; Manichaikul, Ani; van Rooij, Frank JA; Dimitriou, Maria; Raitakari, Olli; Pankow, James S; Djoussé, Luc; Province, Michael A; Hu, Frank B; Lai, Chao-Qiang; Keller, Margaux F; Perälä, Mia-Maria; Rotter, Jerome I; Hofman, Albert; Graff, Misa; Kähönen, Mika; Mukamal, Kenneth; Johansson, Ingegerd; Ordovas, Jose M; Liu, Yongmei; Männistö, Satu; Uitterlinden, André G; Deloukas, Panos; Seppälä, Ilkka; Psaty, Bruce M; Cupples, L Adrienne; Borecki, Ingrid B; Franks, Paul W; Arnett, Donna K; Nalls, Mike A; Eriksson, Johan G; Orho-Melander, Marju; Franco, Oscar H; Lehtimäki, Terho; Dedoussis, George V; Meigs, James B; Siscovick, David S

2015-01-01

Background: Recent studies suggest that meat intake is associated with diabetes-related phenotypes. However, whether the associations of meat intake and glucose and insulin homeostasis are modified by genes related to glucose and insulin is unknown. Objective: We investigated the associations of meat intake and the interaction of meat with genotype on fasting glucose and insulin concentrations in Caucasians free of diabetes mellitus. Design: Fourteen studies that are part of the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium participated in the analysis. Data were provided for up to 50,345 participants. Using linear regression within studies and a fixed-effects meta-analysis across studies, we examined 1) the associations of processed meat and unprocessed red meat intake with fasting glucose and insulin concentrations; and 2) the interactions of processed meat and unprocessed red meat with genetic risk score related to fasting glucose or insulin resistance on fasting glucose and insulin concentrations. Results: Processed meat was associated with higher fasting glucose, and unprocessed red meat was associated with both higher fasting glucose and fasting insulin concentrations after adjustment for potential confounders [not including body mass index (BMI)]. For every additional 50-g serving of processed meat per day, fasting glucose was 0.021 mmol/L (95% CI: 0.011, 0.030 mmol/L) higher. Every additional 100-g serving of unprocessed red meat per day was associated with a 0.037-mmol/L (95% CI: 0.023, 0.051-mmol/L) higher fasting glucose concentration and a 0.049–ln-pmol/L (95% CI: 0.035, 0.063–ln-pmol/L) higher fasting insulin concentration. After additional adjustment for BMI, observed associations were attenuated and no longer statistically significant. The association of processed meat and fasting insulin did not reach statistical significance after correction for multiple comparisons. Observed associations were not modified by genetic

Novel fungal FAD glucose dehydrogenase derived from Aspergillus niger for glucose enzyme sensor strips.

Science.gov (United States)

Sode, Koji; Loew, Noya; Ohnishi, Yosuke; Tsuruta, Hayato; Mori, Kazushige; Kojima, Katsuhiro; Tsugawa, Wakako; LaBelle, Jeffrey T; Klonoff, David C

2017-01-15

In this study, a novel fungus FAD dependent glucose dehydrogenase, derived from Aspergillus niger (AnGDH), was characterized. This enzyme's potential for the use as the enzyme for blood glucose monitor enzyme sensor strips was evaluated, especially by investigating the effect of the presence of xylose during glucose measurements. The substrate specificity of AnGDH towards glucose was investigated, and only xylose was found as a competing substrate. The specific catalytic efficiency for xylose compared to glucose was 1.8%. The specific activity of AnGDH for xylose at 5mM concentration compared to glucose was 3.5%. No other sugars were used as substrate by this enzyme. The superior substrate specificity of AnGDH was also demonstrated in the performance of enzyme sensor strips. The impact of spiking xylose in a sample with physiological glucose concentrations on the sensor signals was investigated, and it was found that enzyme sensor strips using AnGDH were not affected at all by 5mM (75mg/dL) xylose. This is the first report of an enzyme sensor strip using a fungus derived FADGDH, which did not show any positive bias at a therapeutic level xylose concentration on the signal for a glucose sample. This clearly indicates the superiority of AnGDH over other conventionally used fungi derived FADGDHs in the application for SMBG sensor strips. The negligible activity of AnGDH towards xylose was also explained on the basis of a 3D structural model, which was compared to the 3D structures of A. flavus derived FADGDH and of two glucose oxidases. Copyright © 2016 Elsevier B.V. All rights reserved.

Effect of self-monitoring of blood glucose on glycaemic outcome ...

African Journals Online (AJOL)

Background: Diabetes mellitus is a chronic metabolic disorder which leads to complications especially when not properly managed. The role of self-monitoring of blood glucose (SMBG) in type 2 diabetic patients using oral hypoglycaemic agents has been a source of controversy. Objective: The objective was to study the ...

Uranium concentration monitor manual: 2300 system

International Nuclear Information System (INIS)

Russo, P.A.; Sprinkle, J.K. Jr.; Stephens, M.M.

1985-04-01

This manual describes the design, operation, and procedures for measurement control for the automated uranium concentration monitor on the 2300 solvent extraction system at the Oak Ridge Y-12 Plant. The nonintrusive monitor provides a near-real time readout of uranium concentration at two locations simultaneously in the solvent extraction system for process monitoring and control. Detectors installed at the top of the extraction column and at the bottom of the backwash column acquire spectra of gamma rays from the solvent extraction solutions in the columns. Pulse-height analysis of these spectra gives the concentration of uranium in the organic product of the extraction column and in the aqueous product of the solvent extraction system. The visual readouts of concentrations for process monitoring are updated every 2 min for both detection systems. Simultaneously, the concentration results are shipped to a remote computer that has been installed by Y-12 to demonstrate automatic control of the solvent extraction system based on input of near-real time process operation information. 8 refs., 13 figs., 4 tabs

The salivary microbiome is altered in the presence of a high salivary glucose concentration.

Directory of Open Access Journals (Sweden)

J Max Goodson

Full Text Available Type II diabetes (T2D has been associated with changes in oral bacterial diversity and frequency. It is not known whether these changes are part of the etiology of T2D, or one of its effects.We measured the glucose concentration, bacterial counts, and relative frequencies of 42 bacterial species in whole saliva samples from 8,173 Kuwaiti adolescents (mean age 10.00 ± 0.67 years using DNA probe analysis. In addition, clinical data related to obesity, dental caries, and gingivitis were collected. Data were compared between adolescents with high salivary glucose (HSG; glucose concentration ≥ 1.0 mg/d, n = 175 and those with low salivary glucose (LSG, glucose concentration < 0.1 mg/dL n = 2,537.HSG was associated with dental caries and gingivitis in the study population. The overall salivary bacterial load in saliva decreased with increasing salivary glucose concentration. Under HSG conditions, the bacterial count for 35 (83% of 42 species was significantly reduced, and relative bacterial frequencies in 27 species (64% were altered, as compared with LSG conditions. These alterations were stronger predictors of high salivary glucose than measures of oral disease, obesity, sleep or fitness.HSG was associated with a reduction in overall bacterial load and alterations to many relative bacterial frequencies in saliva when compared with LSG in samples from adolescents. We propose that hyperglycemia due to obesity and/or T2D results in HSG and subsequent acidification of the oral environment, leading to a generalized perturbation in the oral microbiome. This suggests a basis for the observation that hyperglycemia is associated with an increased risk of dental erosion, dental caries, and gingivitis. We conclude that HSG in adolescents may be predicted from salivary microbial diversity or frequency, and that the changes in the oral microbial composition seen in adolescents with developing metabolic disease may the consequence of hyperglycemia.

Recent Advances in Fluorescent Arylboronic Acids for Glucose Sensing

Directory of Open Access Journals (Sweden)

Jon Stefan Hansen

2013-12-01

Full Text Available Continuous glucose monitoring (CGM is crucial in order to avoid complications caused by change in blood glucose for patients suffering from diabetes mellitus. The long-term consequences of high blood glucose levels include damage to the heart, eyes, kidneys, nerves and other organs, among others, caused by malign glycation of vital protein structures. Fluorescent monitors based on arylboronic acids are promising candidates for optical CGM, since arylboronic acids are capable of forming arylboronate esters with 1,2-cis-diols or 1,3-diols fast and reversibly, even in aqueous solution. These properties enable arylboronic acid dyes to provide immediate information of glucose concentrations. Thus, the replacement of the commonly applied semi-invasive and non-invasive techniques relying on glucose binding proteins, such as concanavalin A, or enzymes, such as glucose oxidase, glucose dehydrogenase and hexokinases/glucokinases, might be possible. The recent progress in the development of fluorescent arylboronic acid dyes will be emphasized in this review.

Perceptions of Caribbean type 2 diabetes patients on self-monitoring of blood glucose

DEFF Research Database (Denmark)

Ezenwaka, C. E.; Olukoga, A.; Onuoha, P.

2012-01-01

Context: The views of type 2 diabetes (T2DM) patients have not been considered in the debate on the role of self-monitoring of blood glucose (SMBG) in the management of T2DM. Objective: To assess the views of T2DM patients on SMBG. Methods: Two previously trained research assistants used a struct......Context: The views of type 2 diabetes (T2DM) patients have not been considered in the debate on the role of self-monitoring of blood glucose (SMBG) in the management of T2DM. Objective: To assess the views of T2DM patients on SMBG. Methods: Two previously trained research assistants used...

Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes.

Science.gov (United States)

Moy, Foong Ming; Ray, Amita; Buckley, Brian S; West, Helen M

2017-06-11

Self-monitoring of blood glucose (SMBG) is recommended as a key component of the management plan for diabetes therapy during pregnancy. No existing systematic reviews consider the benefits/effectiveness of various techniques of blood glucose monitoring on maternal and infant outcomes among pregnant women with pre-existing diabetes. The effectiveness of the various monitoring techniques is unclear. To compare techniques of blood glucose monitoring and their impact on maternal and infant outcomes among pregnant women with pre-existing diabetes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2016), searched reference lists of retrieved studies and contacted trial authors. Randomised controlled trials (RCTs) and quasi-RCTs comparing techniques of blood glucose monitoring including SMBG, continuous glucose monitoring (CGM) or clinic monitoring among pregnant women with pre-existing diabetes mellitus (type 1 or type 2). Trials investigating timing and frequency of monitoring were also included. RCTs using a cluster-randomised design were eligible for inclusion but none were identified. Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. This review update includes at total of 10 trials (538) women (468 women with type 1 diabetes and 70 women with type 2 diabetes). The trials took place in Europe and the USA. Five of the 10 included studies were at moderate risk of bias, four studies were at low to moderate risk of bias, and one study was at high risk of bias. The trials are too small to show differences in important outcomes such as macrosomia, preterm birth, miscarriage or death of baby. Almost all the reported GRADE outcomes were assessed as being very low-quality evidence. This was due to design limitations in the studies, wide confidence intervals, small

Alterations in blood glucose and plasma glucagon concentrations during deep brain stimulation in the shell region of the nucleus accumbens in rats

Directory of Open Access Journals (Sweden)

Charlene eDiepenbroek

2013-12-01

Full Text Available Deep brain stimulation (DBS of the nucleus accumbens (NAc is an effective therapy for obsessive compulsive disorder (OCD and is currently under investigation as a treatment for eating disorders. DBS of this area is associated with altered food intake and pharmacological treatment of OCD is associated with the risk of developing type 2 diabetes. Therefore we examined if DBS of the NAc-shell (sNAc influences glucose metabolism. Male Wistar rats were subjected to DBS, or sham stimulation, for a period of one hour. To assess the effects of stimulation on blood glucose and glucoregulatory hormones, blood samples were drawn before, during and after stimulation. Subsequently, all animals were used for quantitative assessment of Fos immunoreactivity in the lateral hypothalamic area (LHA using computerized image analysis. DBS of the sNAc rapidly increased plasma concentrations of glucagon and glucose while sham stimulation and DBS outside the sNAc were ineffective. In addition, the increase in glucose was dependent on DBS intensity. In contrast, the DBS-induced increase in plasma corticosterone concentrations was independent of intensity and region, indicating that the observed DBS-induced metabolic changes were not due to corticosterone release. Stimulation of the sNAc with 200 μA increased Fos immunoreactivity in the LHA compared to sham or 100 μA stimulated animals. These data show that DBS of the sNAc alters glucose metabolism in a region- and intensity dependent manner in association with neuronal activation in the LHA. Moreover, these data illustrate the need to monitor changes in glucose metabolism during DBS-treatment of OCD patients.

Blood glucose self-monitoring patterns in Mexican Americans: further lessons from the Starr County Border Health Initiative.

Science.gov (United States)

Cuevas, Heather E; Brown, Sharon A; García, Alexandra A; Winter, Mary; Brown, Adama; Hanis, Craig L

2015-02-01

The purpose was to describe patterns of home self-monitoring of blood glucose (SMBG) in Mexican Americans with type 2 diabetes mellitus enrolled in a diabetes self-management education protocol. Research questions were as follows: (1) What were the patterns and rates of home glucose self-monitoring over the 6-month course of the study? (2) What were the differences in monitoring rates between experimental and control groups? (3) What were the relationships between rates of monitoring and glycosylated hemoglobin (A1C), gender, and years with diabetes? We used a randomized (by group) repeated-measures pretest/posttest control group design. Glucometer data from an experimental group (diabetes self-management education plus nurse case management) and a comparison group (diabetes self-management education only) were analyzed. Data were collected at baseline and at 3 and 6 months. Overall average SMBG rates were low. Experimental and control group monitoring levels were not significantly different. More females than males never monitored glucose values, but more females than males checked at least one time per week. Those participants who checked their glucose levels more than once per week had diabetes for a longer period of time. Rates of monitoring were not strongly associated with A1C levels at 3 and 6 months, but at 6 months A1C levels were statistically significantly different based on whether or not individuals monitored their glucose levels (P=0.03, n=71). SMBG rates were low in this study despite SMBG education and access to free glucometers and test strips. The lower rates of SMBG may reflect the effects of unexpected environmental challenges, but exact causes remain unclear. Reasons for low rates of SMBG need to be explored further, especially in underserved communities.

Self-monitoring of blood glucose is associated with problem-solving skills in hyperglycemia and hypoglycemia.

Science.gov (United States)

Wang, Jing; Zgibor, Janice; Matthews, Judith T; Charron-Prochownik, Denise; Sereika, Susan M; Siminerio, Linda

2012-01-01

The purpose of this study was to examine the association between self-monitoring of blood glucose (SMBG) and problem-solving skills in response to detected hyperglycemia and hypoglycemia among patients with type 2 diabetes. Data were obtained from the American Association of Diabetes Educators Outcome System, implemented in 8 diabetes self-management education programs in western Pennsylvania. SMBG was measured by asking patients how often they checked, missed checking, or checked blood glucose later than planned. Problem-solving skill was measured by asking how often they modified their behaviors after detecting high or low blood glucose. Most patients checked their blood glucose at least once per day. However, when blood glucose was high or low, many of them reported doing nothing, and only some of them resolved the problem. There were significant associations between self-monitoring of blood glucose and problem-solving skills for hyperglycemia and hypoglycemia, after controlling for age, gender, ethnicity, education, and time since diagnosis. Patients reported poor problem-solving skills when detecting hyperglycemia and hypoglycemia via SMBG. Patients need to learn problem-solving skills along with SMBG training to achieve glycemic control.

First Clinical Experience with Retrospective Flash Glucose Monitoring (FGM) Analysis in South Africa

Science.gov (United States)

Distiller, Larry A.; Cranston, Iain; Mazze, Roger

2016-01-01

Background: In 2014, an innovative blinded continuous glucose monitoring system was introduced with automated ambulatory glucose profile (AGP) reporting. The clinical use and interpretation of this new technology has not previously been described. Therefore we wanted to understand its use in characterizing key factors related to glycemic control: glucose exposure, variability, and stability, and risk of hypoglycemia in clinical practice. Methods: Clinicians representing affiliated diabetes centers throughout South Africa were trained and subsequently were given flash glucose monitoring readers and 2-week glucose sensors to use at their discretion. After patient use, sensor data were collected and uploaded for AGP reporting. Results: Complete data (sensor AGP with corresponding clinical information) were obtained for 50 patients with type 1 (70%) and type 2 diabetes (30%), irrespective of therapy. Aggregated analysis of AGP data comparing patients with type 1 versus type 2 diabetes, revealed that despite similar HbA1c values between both groups (8.4 ± 2 vs 8.6 ± 1.7%, respectively), those with type 2 diabetes had lower mean glucose levels (9.2 ± 3 vs 10.3 mmol/l [166 ± 54 vs 185 mg/dl]) and lower indices of glucose variability (3.0 ± 1.5 vs 5.0 ± 1.9 mmol/l [54 ± 27 vs 90 ± 34.2 mg/dl]). This highlights key areas for future focus. Conclusions: Using AGP, the characteristics of glucose exposure, variability, stability, and hypoglycemia risk and occurrence were obtained within a short time and with minimal provider and patient input. In a survey at the time of the follow-up visit, clinicians indicated that aggregated AGP data analysis provided important new clinical information and insights. PMID:27154973

The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy

DEFF Research Database (Denmark)

Battelino, T; Conget, I; Olsen, B

2012-01-01

The aim of this multicentre, randomised, controlled crossover study was to determine the efficacy of adding continuous glucose monitoring (CGM) to insulin pump therapy (CSII) in type 1 diabetes.......The aim of this multicentre, randomised, controlled crossover study was to determine the efficacy of adding continuous glucose monitoring (CGM) to insulin pump therapy (CSII) in type 1 diabetes....

Effects of intravenous glucose infusion and nutritional balance on serum concentrations of nonesterified fatty acids, glucose, insulin, and progesterone in nonlactating dairy cows.

Science.gov (United States)

Vieira, F V R; Lopes, C N; Cappellozza, B I; Scarpa, A B; Cooke, R F; Vasconcelos, J L M

2010-07-01

The objective of this study was to evaluate serum concentrations of nonesterified fatty acids, glucose, insulin, and progesterone in nonlactating dairy cows according to nutritional balance and glucose infusion. Ten nonlactating, ovariectomized Gir x Holstein cows were stratified by body weight (BW) and body condition score (BCS) on d -28 of the study, and randomly assigned to 1) negative nutrient balance (NB) or 2) positive nutrient balance (PB). From d -28 to d 0, cows were allocated according to nutritional treatment (5 cows/treatment) into 2 low-quality pastures with reduced forage availability. However, PB cows individually received, on average, 3 kg/cow per day (as-fed) of a concentrate during the study. All cows had an intravaginal progesterone releasing device inserted on d -14, which remained in cows until the end of the study. Cow BW and BCS were assessed again on d 0. On d 0, cows within nutritional treatment were randomly assigned to receive, in a crossover design containing 2 periods of 24h each, 1) intravenous glucose infusion (GLU; 0.5 g of glucose/kg of BW, as a 5% glucose solution administered, on average, at 32 mL/min over a 3-h period), or 2) intravenous saline infusion (SAL; 0.9% solution infused on average at 32 mL/min over a 3-h period). Prior to the beginning of each period, all cows were fasted for 12h. Blood samples were collected, relative to the beginning of the infusion, at -12 and -11.5h (beginning of fasting), and at -0.5, 0, 0.5, 1, 2, 3, 4, 5, and 6h. Following the last blood collection of period 1, cows received (PB) or not (NB) concentrate and were returned to their respective pastures. Changes in BCS and BW were greater in NB cows compared with PB cows (-0.60 and -0.25+/-0.090 for BCS, respectively; -22.4 and 1.2+/-6.58 kg for BW, respectively). Cows receiving GLUC had greater glucose concentrations from 0.5 to 3h relative to infusion compared with SAL cows. Insulin concentrations were greater in PB cows assigned to GLUC compared

Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease

DEFF Research Database (Denmark)

Sarwar, N; Gao, P; Seshasai, S R Kondapally

2010-01-01

BACKGROUND: Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances. METHODS: We undertook a meta-analysis...... of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and body......-mass index to calculate hazard ratios (HRs) for vascular disease. FINDINGS: Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million person-years at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart...

Performance of a new test strip for freestyle blood glucose monitoring systems.

Science.gov (United States)

Lock, John Paul; Brazg, Ronald; Bernstein, Robert M; Taylor, Elizabeth; Patel, Mona; Ward, Jeanne; Alva, Shridhara; Chen, Ting; Welsh, Zoë; Amor, Walter; Bhogal, Claire; Ng, Ronald

2011-01-01

a new strip, designed to enhance the ease of use and minimize interference of non-glucose sugars, has been developed to replace the current FreeStyle (Abbott Diabetes Care, Alameda, CA) blood glucose test strip. We evaluated the performance of this new strip. laboratory evaluation included precision, linearity, dynamic range, effects of operating temperature, humidity, altitude, hematocrit, interferents, and blood reapplication. System accuracy, lay user performance, and ease of use for finger capillary blood testing and accuracy for venous blood testing were evaluated at clinics. Lay users also compared the speed and ease of use between the new strip and the current FreeStyle strip. for glucose concentrations blood glucose results obtained by lay users fell within ± 5, 10, and 15 mg/dL, respectively, of the reference. For glucose concentrations ≥75 mg/dL, 68%, 95%, 99%, and 99% of the lay user results fell within  ±  5%, 10%, 15%, and 20%, respectively, of the reference. Comparable accuracy was obtained in the venous blood study. Lay users found the new test strip easy to use and faster and easier to use than the current FreeStyle strip. The new strip maintained accuracy under various challenging conditions, including high concentrations of various interferents, sample reapplication up to 60 s, and extremes in hematocrit, altitude, and operating temperature and humidity. our results demonstrated excellent accuracy of the new FreeStyle test strip and validated the improvements in minimizing interference and enhancing ease of use.

Reproducibility and reliability of hypoglycaemic episodes recorded with Continuous Glucose Monitoring System (CGMS) in daily life

DEFF Research Database (Denmark)

Høi-Hansen, T; Pedersen-Bjergaard, U; Thorsteinsson, B

2005-01-01

AIM: Continuous glucose monitoring may reveal episodes of unrecognized hypoglycaemia. We evaluated reproducibility and reliability of hypoglycaemic episodes recorded in daily life by the Medtronic MiniMed Continuous Glucose Monitoring System (CGMS). METHODS: Twenty-nine adult patients with Type 1...... data were recalibrated generating four different CGMS data sets [left-A (left side of abdomen, calibration set A), left-B, right-A and right-B]. Agreement between CGMS data sets was evaluated during hypoglycaemic events, comparing CGMS readings = 2.2 mmol/l with nadir values from corresponding CGMS...... data sets. CGMS readings were also compared with independent self-monitored blood glucose (SMBG) values. RESULTS: With hypoglycaemia (CGMS readings = 2.2 mmol/l) in calibration set left-A, values below 3.5 mmol/l were present in 99% (95% CI: 95-100%) of samples in left-B, 91% (95% CI: 84...

In vitro evidence of glucose-induced toxicity in GnRH secreting neurons: high glucose concentrations influence GnRH secretion, impair cell viability, and induce apoptosis in the GT1-1 neuronal cell line.

Science.gov (United States)

Pal, Lubna; Chu, Hsiao-Pai; Shu, Jun; Topalli, Ilir; Santoro, Nanette; Karkanias, George

2007-10-01

To evaluate for direct toxic effects of high glucose concentrations on cellular physiology in GnRH secreting immortalized GT1-1 neurons. Prospective experimental design. In vitro experimental model using a cell culture system. GT1-1 cells were cultured in replicates in media with two different glucose concentrations (450 mg/dL and 100 mg/dL, respectively) for varying time intervals (24, 48, and 72 hours). Effects of glucose concentrations on GnRH secretion by the GT1-1 neurons were evaluated using a static culture model. Cell viability, cellular apoptosis, and cell cycle events in GT1-1 neurons maintained in two different glucose concentrations were assessed by flow cytometry (fluorescence-activated cell sorter) using Annexin V-PI staining. Adverse influences of high glucose concentrations on GnRH secretion and cell viability were noted in cultures maintained in high glucose concentration (450 mg/dL) culture medium for varying time intervals. A significantly higher percentage of cells maintained in high glucose concentration medium demonstrated evidence of apoptosis by a fluorescence-activated cell sorter. We provide in vitro evidence of glucose-induced cellular toxicity in GnRH secreting GT1-1 neurons. Significant alterations in GnRH secretion, reduced cell viability, and a higher percentage of apoptotic cells were observed in GT1-1 cells maintained in high (450 mg/dL) compared with low (100 mg/dL) glucose concentration culture medium.

Effects of self-monitoring of blood glucose on diabetes control in a ...

African Journals Online (AJOL)

Methods:This study assessed the effect on diabetes control in patients who received glucometers and education ... Self-monitoring of blood glucose (SMBG) helps patients make ..... unhealthy eating habits could possibly be related to the low.

Wearable physiological systems and technologies for metabolic monitoring.

Science.gov (United States)

Gao, Wei; Brooks, George A; Klonoff, David C

2018-03-01

Wearable sensors allow continuous monitoring of metabolites for diabetes, sports medicine, exercise science, and physiology research. These sensors can continuously detect target analytes in skin interstitial fluid (ISF), tears, saliva, and sweat. In this review, we will summarize developments on wearable devices and their potential applications in research, clinical practice, and recreational and sporting activities. Sampling skin ISF can require insertion of a needle into the skin, whereas sweat, tears, and saliva can be sampled by devices worn outside the body. The most widely sampled metabolite from a wearable device is glucose in skin ISF for monitoring diabetes patients. Continuous ISF glucose monitoring allows estimation of the glucose concentration in blood without the pain, inconvenience, and blood waste of fingerstick capillary blood glucose testing. This tool is currently used by diabetes patients to provide information for dosing insulin and determining a diet and exercise plan. Similar technologies for measuring concentrations of other analytes in skin ISF could be used to monitor athletes, emergency responders, warfighters, and others in states of extreme physiological stress. Sweat is a potentially useful substrate for sampling analytes for metabolic monitoring during exercise. Lactate, sodium, potassium, and hydrogen ions can be measured in sweat. Tools for converting the concentrations of these analytes sampled from sweat, tears, and saliva into blood concentrations are being developed. As an understanding of the relationships between the concentrations of analytes in blood and easily sampled body fluid increases, then the benefits of new wearable devices for metabolic monitoring will also increase.

Photoacoustic determination of glucose concentration in whole blood by a near-infrared laser diode

Science.gov (United States)

Zhao, Zuomin; Myllylae, Risto A.

2001-06-01

The near-infrared photoacoustic technique is recognized as a potential method for the non-invasive determination of human glucose, because near-infrared light can incident a few millimeters into human tissue, where it produces an acoustic wave capable of carrying information about the composition of the tissue. This paper demonstrates a photoacoustic glucose measurement in a blood sample as a step toward a non-invasive measurement. The experimental apparatus consists of a near-infrared laser diode operating with 4 micro joules pulse energy at 905 nm, a roller pump connected to a silicon plastic tube and a cuvette for circulating the blood sample. In addition, the apparatus comprises a PZT piezoelectric transducer integrated with a battery-powered preamplifier to receive the photoacoustic signal. During the experiment, a glucose solution is mixed into a human blood sample to change its concentration. Although the absorption coefficient of glucose is much smaller than that of blood in the near-infrared region, the osmotic and hydrophilic properties of glucose decrease the reduced scattering coefficient of blood caused by the dissolved glucose surrounding the blood cells. This changes the distribution of the absorbed optical energy in blood, which, in turn, produces a change in the photoacoustic signal. Our experiment demonstrates that signal amplitudes in fresh and stored blood samples in crease about 7% and 10%, respectively, when the glucose concentration reaches the upper limit of the physiological region (500 mg/dl).

Effect of ground cinnamon on postprandial blood glucose concentration in normal-weight and obese adults.

Science.gov (United States)

Magistrelli, Ashley; Chezem, Jo Carol

2012-11-01

In healthy normal-weight adults, cinnamon reduces blood glucose concentration and enhances insulin sensitivity. Insulin resistance, resulting in increased fasting and postprandial blood glucose and insulin levels, is commonly observed in obese individuals. The objective of the study was to compare declines in postprandial glycemic response in normal-weight and obese subjects with ingestion of 6 g ground cinnamon. In a crossover study, subjects consumed 50 g available carbohydrate in instant farina cereal, served plain or with 6 g ground cinnamon. Blood glucose concentration, the main outcome measure, was assessed at minutes 0, 15, 30, 45, 60, 90, and 120. Repeated-measures analysis of variance evaluated the effects of body mass index (BMI) group, dietary condition, and time on blood glucose. Paired t-test assessed blood glucose at individual time points and glucose area under the curve (AUC) between dietary conditions. Thirty subjects between the ages of 18 and 30 years, 15 with BMIs between 18.5 and 24.9 and 15 with BMIs of 30.0 or more, completed the study. There was no significant difference in blood glucose between the two BMI groups at any time point. However, in a combined analysis of all subjects, the addition of cinnamon to the cereal significantly reduced 120-minute glucose AUC (P=0.008) and blood glucose at 15 (P=0.001), 30 (Pblood glucose was significantly higher with cinnamon consumption (Pglucose response in normal weight and obese adults. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Evaluation of OneTouch Verio, a new blood glucose self-monitoring system for patients with diabetes

DEFF Research Database (Denmark)

Littman, Karin; Petersen, Eva R.B.; Pussinen, Christel

2013-01-01

(ADA) quality goals. Blood samples were collected and measured on the OneTouch Verio® by laboratory personnel and patients with diabetes (n = 91, randomized into groups receiving personal training or mail instructions for the OneTouch Verio® system). Results were compared to a validated routine method......, imprecision and bias were calculated. User-friendliness was evaluated with a questionnaire. Results. Quality specifications for blood glucose concentration monitoring systems according to ISO 15197 were fulfilled. The mean coefficients of variation (CV%) of repeatability was 3.4% when tested by laboratory...... personnel and within the goal of imprecision suggested by ADA. Mean CV% of repeatability for patient self-monitoring was 5.0% and 5.1% in the training- and the mail group, respectively. Total error was 6.4-10.0%. The OneTouch Verio® showed no hematocrit interference or variation between strip lots...

Alteration of postprandial glucose and insulin concentrations with meal frequency and composition.

Science.gov (United States)

Kanaley, Jill A; Heden, Timothy D; Liu, Ying; Fairchild, Timothy J

2014-11-14

A frequent eating pattern may alter glycaemic control and augment postprandial insulin concentrations in some individuals due to the truncation of the previous postprandial period by a subsequent meal. The present study examined glucose, insulin, C-peptide and glucose-dependent insulinotropic peptide (GIP) responses in obese individuals when meals were ingested in a high-frequency pattern (every 2 h, 6M) or in a low-frequency pattern (every 4 h, 3M) over 12 h. It also examined these postprandial responses to high-frequency, high-protein meals (6MHP). In total, thirteen obese subjects completed three 12 h study days during which they consumed 6276 kJ (1500 kcal): (1) 3M - 15 % protein and 65 % carbohydrate; (2) 6M - 15 % protein and 65 % carbohydrate; (3) 6MHP - 45 % protein and 35 % carbohydrate. Blood samples were collected every 10 min and analysed for glucose, insulin, C-peptide and GIP. Insulin total AUC (tAUC) and peak insulin concentrations (Pmeal frequency or composition. In obese subjects, ingestion of meals in a low-frequency pattern does not alter glucose tAUC, but increases postprandial insulin responses. The substitution of carbohydrates with protein in a frequent meal pattern results in tighter glycaemic control and reduced postprandial insulin responses.

Continuous glucose monitoring and its relationship to hemoglobin A1c and oral glucose tolerance testing in obese and prediabetic youth.

Science.gov (United States)

Chan, Christine L; Pyle, Laura; Newnes, Lindsey; Nadeau, Kristen J; Zeitler, Philip S; Kelsey, Megan M

2015-03-01

The optimal screening test for diabetes and prediabetes in obese youth is controversial. We examined whether glycosylated hemoglobin (HbA1c) or the oral glucose tolerance test (OGTT) is a better predictor of free-living glycemia as measured by continuous glucose monitoring (CGM). This was a cross-sectional study of youth 10-18 years old, body mass index (BMI) 85th percentile or greater, with diabetes risk factors. Participants (n = 118) with BMI 85th percentile or greater, not on medications for glucose management, were recruited from primary care and pediatric endocrinology clinics around Denver, Colorado. HbA1c, fasting plasma glucose, and 2-hour glucose were collected and all participants wore a blinded CGM for 72 hours. CGM outcomes were determined and descriptive statistics calculated. Performance characteristics at current American Diabetes Association cutpoints were compared with CGM outcomes. CGM data were successfully collected on 98 obese youth. Those with prediabetes had significantly higher average glucose, area under the curve (AUC), peak glucose, and time greater than 120 and greater than 140 mg/dL (P obese youth, HbA1c and 2-hour glucose performed equally well at predicting free-living glycemia on CGM, suggesting that both are valid tests for dysglycemia screening.

Long-term blood glucose monitoring with implanted telemetry device in conscious and stress-free cynomolgus monkeys.

Science.gov (United States)

Wang, B; Sun, G; Qiao, W; Liu, Y; Qiao, J; Ye, W; Wang, H; Wang, X; Lindquist, R; Wang, Y; Xiao, Y-F

2017-09-01

Continuous blood glucose monitoring, especially long-term and remote, in diabetic patients or research is very challenging. Nonhuman primate (NHP) is an excellent model for metabolic research, because NHPs can naturally develop Type 2 diabetes mellitus (T2DM) similarly to humans. This study was to investigate blood glucose changes in conscious, moving-free cynomolgus monkeys (Macaca fascicularis) during circadian, meal, stress and drug exposure. Blood glucose, body temperature and physical activities were continuously and simultaneously recorded by implanted HD-XG telemetry device for up to 10 weeks. Blood glucose circadian changes in normoglycemic monkeys significantly differed from that in diabetic animals. Postprandial glucose increase was more obvious after afternoon feeding. Moving a monkey from its housing cage to monkey chair increased blood glucose by 30% in both normoglycemic and diabetic monkeys. Such increase in blood glucose declined to the pre-procedure level in 30 min in normoglycemic animals and >2 h in diabetic monkeys. Oral gavage procedure alone caused hyperglycemia in both normoglycemic and diabetic monkeys. Intravenous injection with the stress hormones, angiotensin II (2 μg/kg) or norepinephrine (0.4 μg/kg), also increased blood glucose level by 30%. The glucose levels measured by the telemetry system correlated significantly well with glucometer readings during glucose tolerance tests (ivGTT or oGTT), insulin tolerance test (ITT), graded glucose infusion (GGI) and clamp. Our data demonstrate that the real-time telemetry method is reliable for monitoring blood glucose remotely and continuously in conscious, stress-free, and moving-free NHPs with the advantages highly valuable to diabetes research and drug discovery.

Glucose Sensing Using Functionalized Amorphous In-Ga-Zn-O Field-Effect Transistors.

Science.gov (United States)

Du, Xiaosong; Li, Yajuan; Motley, Joshua R; Stickle, William F; Herman, Gregory S

2016-03-01

Recent advances in glucose sensing have focused on the integration of sensors into contact lenses to allow noninvasive continuous glucose monitoring. Current technologies focus primarily on enzyme-based electrochemical sensing which requires multiple nontransparent electrodes to be integrated. Herein, we leverage amorphous indium gallium zinc oxide (IGZO) field-effect transistors (FETs), which have found use in a wide range of display applications and can be made fully transparent. Bottom-gated IGZO-FETs can have significant changes in electrical characteristics when the back-channel is exposed to different environments. We have functionalized the back-channel of IGZO-FETs with aminosilane groups that are cross-linked to glucose oxidase and have demonstrated that these devices have high sensitivity to changes in glucose concentrations. Glucose sensing occurs through the decrease in pH during glucose oxidation, which modulates the positive charge of the aminosilane groups attached to the IGZO surface. The change in charge affects the number of acceptor-like surface states which can deplete electron density in the n-type IGZO semiconductor. Increasing glucose concentrations leads to an increase in acceptor states and a decrease in drain-source conductance due to a positive shift in the turn-on voltage. The functionalized IGZO-FET devices are effective in minimizing detection of interfering compounds including acetaminophen and ascorbic acid. These studies suggest that IGZO FETs can be effective for monitoring glucose concentrations in a variety of environments, including those where fully transparent sensing elements may be of interest.

Practical approaches for self-monitoring of blood glucose: an Asia-Pacific perspective.

Science.gov (United States)

Chowdhury, Subhankar; Ji, Linong; Suwanwalaikorn, Sompongse; Yu, Neng-Chun; Tan, Eng Kiat

2015-03-01

Comprehensive glycemic control is necessary to improve outcomes and avoid complications in individuals with diabetes. Self-monitoring of blood glucose (SMBG) is a key enabler of glycemic assessment, providing real-time information that complements HbA1c monitoring and supports treatment optimization. However, SMBG is under-utilized by patients and physicians within the Asia-Pacific region, because of barriers such as the cost of monitoring supplies, lack of diabetes self-management skills, or concerns about the reliability of blood glucose readings. Practice recommendations in international and regional guidelines vary widely, and may not be detailed or specific enough to guide SMBG use effectively. This contributes to uncertainty among patients and physicians about how best to utilize this tool: when and how often to test, and what action(s) to take in response to high or low readings. In developing a practical SMBG regimen, the first step is to determine the recommended SMBG frequency and intensity needed to support the chosen treatment regimen. If there are practical obstacles to monitoring, such as affordability or access, physicians should identify the most important aspects of glycemic control to target for individual patients, and modify monitoring patterns accordingly. This consensus paper proposes a selection of structured, flexible SMBG patterns that can be tailored to the clinical, educational, behavioral, and financial requirements of individuals with diabetes.

Evaluation of the agreement among three handheld blood glucose meters and a laboratory blood analyzer for measurement of blood glucose concentration in Hispaniolan Amazon parrots (Amazona ventralis).

Science.gov (United States)

Acierno, Mark J; Mitchell, Mark A; Schuster, Patricia J; Freeman, Diana; Sanchez-Migallon Guzman, David; Tully, Thomas N

2009-02-01

To determine the degree of agreement between 3 commercially available point-of-care blood glucose meters and a laboratory analyzer for measurement of blood glucose concentrations in Hispaniolan Amazon parrots (Amazona ventralis). 20 healthy adult Hispaniolan Amazon parrots. A 26-gauge needle and 3-mL syringe were used to obtain a blood sample (approx 0.5 mL) from a jugular vein of each parrot. Small volumes of blood (0.6 to 1.5 microL) were used to operate each of the blood glucose meters, and the remainder was placed into lithium heparin microtubes and centrifuged. Plasma was harvested and frozen at -30 degrees C. Within 5 days after collection, plasma samples were thawed and plasma glucose concentrations were measured by means of the laboratory analyzer. Agreement between pairs of blood glucose meters and between each blood glucose meter and the laboratory analyzer was evaluated by means of the Bland-Altman method, and limits of agreement (LOA) were calculated. None of the results of the 3 blood glucose meters agreed with results of the laboratory analyzer. Each point-of-care blood glucose meter underestimated the blood glucose concentration, and the degree of negative bias was not consistent (meter A bias, -94.9 mg/dL [LOA, -148.0 to -41.7 mg/dL]; meter B bias, -52 mg/dL [LOA, -107.5 to 3.5 mg/dL]; and meter C bias, -78.9 mg/dL [LOA, -137.2 to -20.6 mg/dL]). On the basis of these results, use of handheld blood glucose meters in the diagnosis or treatment of Hispaniolan Amazon parrots and other psittacines cannot be recommended.

Effects of pH value and substrate concentration on hydrogen production from the anaerobic fermentation of glucose

Energy Technology Data Exchange (ETDEWEB)

Li, Zhi; Wang, Hui; Tang, Zongxun; Wang, Xiaofang [Key Laboratory of Synthetic and Natural Functional Molecule Chemistry (Ministry of Education), Department of Chemisty, Northwest University, Xi' an 710069 (China); Bai, Jinbo [Lab. MSS/MAT, CNRS UMR 8579, Ecole Centrale Paris, 92295 Chatenay Malabry (France)

2008-12-15

A series of batch experiments were conducted to investigate the effects of pH and glucose concentrations on biological hydrogen production by using the natural sludge obtained from the bed of a local river as inoculant. Batch experiments numbered series I and II were designed at an initial and constant pH of 5.0-7.0 with 1.0 increment and four different glucose concentrations (5.0, 7.5, 10 and 20 g glucose/L). The results showed that the optimal condition for anaerobic fermentative hydrogen production is 7.5 g glucose/L and constant pH 6.0 with a maximum H{sub 2} production rate of 0.22 mol H{sub 2} mol{sup -1} glucose h{sup -1}, a cumulative H{sub 2} yield of 1.83 mol H{sub 2} mol{sup -1} glucose and a H{sub 2} percentage of 63 in biogas. (author)

Hydrogel-Forming Microneedle Arrays Allow Detection of Drugs and Glucose In Vivo: Potential for Use in Diagnosis and Therapeutic Drug Monitoring.

Directory of Open Access Journals (Sweden)

Ester Caffarel-Salvador

Full Text Available We describe, for the first time the use of hydrogel-forming microneedle (MN arrays for minimally-invasive extraction and quantification of drug substances and glucose from skin in vitro and in vivo. MN prepared from aqueous blends of hydrolysed poly(methyl-vinylether-co-maleic anhydride (11.1% w/w and poly(ethyleneglycol 10,000 daltons (5.6% w/w and crosslinked by esterification swelled upon skin insertion by uptake of fluid. Post-removal, theophylline and caffeine were extracted from MN and determined using HPLC, with glucose quantified using a proprietary kit. In vitro studies using excised neonatal porcine skin bathed on the underside by physiologically-relevant analyte concentrations showed rapid (5 min analyte uptake. For example, mean concentrations of 0.16 μg/mL and 0.85 μg/mL, respectively, were detected for the lowest (5 μg/mL and highest (35 μg/mL Franz cell concentrations of theophylline after 5 min insertion. A mean concentration of 0.10 μg/mL was obtained by extraction of MN inserted for 5 min into skin bathed with 5 μg/mL caffeine, while the mean concentration obtained by extraction of MN inserted into skin bathed with 15 μg/mL caffeine was 0.33 μg/mL. The mean detected glucose concentration after 5 min insertion into skin bathed with 4 mmol/L was 19.46 nmol/L. The highest theophylline concentration detected following extraction from a hydrogel-forming MN inserted for 1 h into the skin of a rat dosed orally with 10 mg/kg was of 0.363 μg/mL, whilst a maximum concentration of 0.063 μg/mL was detected following extraction from a MN inserted for 1 h into the skin of a rat dosed with 5 mg/kg theophylline. In human volunteers, the highest mean concentration of caffeine detected using MN was 91.31 μg/mL over the period from 1 to 2 h post-consumption of 100 mg Proplus® tablets. The highest mean blood glucose level was 7.89 nmol/L detected 1 h following ingestion of 75 g of glucose, while the highest mean glucose concentration

Effect of radioactive isotope 32P upon alpha amylase activity and glucose concentration in chickens

International Nuclear Information System (INIS)

Kraljevic, P.; Emanovic, D.; Simpraga, M.; Nejedli, S.; Stojevic, Z.

1996-01-01

An attempt has been made to investigate whether alpha amylase activity and glucose concentration in blood plasma can serve as the help in establishing on early diagnosis of organic or functional damage caused by ionizing radiation in chickens. Fifty day old hybrid chickens of heavy 'Jata' breeds of both sexes, were treated by 32 P administered intramusculary as sodium orthophosphate in a single dose of 333 MBq per kilogram of body weight. Blood samples was taken from the wing vein on day 1, 3, 5, 7 and 10 after administration of 32 P. Alpha amylase activity and glucose concentration were determined spectrophotometrically using kits produced by 'Radonja', Sisak. Alpha amylase activity was decreased and glucose concentration was increased during investigated period. Yet, the further investigations are needed to find out whether these two parameters can be used for early diagnosis of injury in chicken organism by ionizing radiation. (author)

Concentration of Rutin Model Solutions from Their Mixtures with Glucose Using Ultrafiltration

Directory of Open Access Journals (Sweden)

Zaid S. Saleh

2010-02-01

Full Text Available Separation of polyphenolic phytochemical compounds from their mixtures with sugars is necessary to produce an added-value sugar-reduced extract with high biological activity from fruit juice processing industry waste streams. The separation characteristics of a binary mixture of rutin and glucose using a Pellicon-2 regenerated cellulose ultrafiltration membrane with an area of 0.1 m2 having nominal MWCO of 1,000 Da were investigated, to demonstrate the separation of phenolic compounds from sugars. The effects of the operating variables–transmembrane pressure, feed solution temperature and pH, initial feed concentration and feed flow rate–on the permeate flux and enrichment of rutin, were determined. The permeate flux increased with the increase in transmembrane pressure up to a certain limit and after that the flux remained more or less constant. The optimum transmembrane pressure was within 4–5 bar. The flux increased with the increase in feed solution temperature because of reduced feed viscosity, and better solubility. The concentration of rutin was optimum at lower temperature (30ºC, with an enrichment factor of 1.3. The effect of pH on permeate flux was less obvious. Lowering the feed solution pH increased the retention of rutin and the optimum separation was obtained within pH 3–4. The permeate flux decreased with the increase in feed concentration of rutin (concentration range 0.1–0.5 g/L. The enrichment of rutin was significant in the glucose concentration range 0.35–0.5 g/L. The feed flow rate had a significant effect on the flux and separation characteristics. Higher cross-flow through the membrane reduced the fouling by providing a shear force to sweep away deposited materials from the membrane surface. At high feed flow rate, more rutin was retained by the membrane with less sugar permeating through. The optimum feed flow rate was 1.5 L/min. For the separation of rutin (in the retentate and glucose (in the permeate, the

Is type 2 diabetes really resolved after laparoscopic sleeve gastrectomy? Glucose variability studied by continuous glucose monitoring.

Science.gov (United States)

Capoccia, D; Coccia, F; Guida, A; Rizzello, M; De Angelis, F; Silecchia, G; Leonetti, F

2015-01-01

The study was carried out on type 2 diabetic obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Patients underwent regular glycemic controls throughout 3 years and all patients were defined cured from diabetes according to conventional criteria defined as normalization of fasting glucose levels and glycated hemoglobin in absence of antidiabetic therapy. After 3 years of follow-up, Continuous Glucose Monitoring (CGM) was performed in each patient to better clarify the remission of diabetes. In this study, we found that the diabetes resolution after LSG occurred in 40% of patients; in the other 60%, even if they showed a normal fasting glycemia and A1c, patients spent a lot of time in hyperglycemia. During the oral glucose tolerance test (OGTT), we found that 2 h postload glucose determinations revealed overt diabetes only in a small group of patients and might be insufficient to exclude the diagnosis of diabetes in the other patients who spent a lot of time in hyperglycemia, even if they showed a normal glycemia (<140 mg/dL) at 120 minutes OGTT. These interesting data could help clinicians to better individualize patients in which diabetes is not resolved and who could need more attention in order to prevent chronic complications of diabetes.

Comparison of Glucose Area Under the Curve Measured Using Minimally Invasive Interstitial Fluid Extraction Technology with Continuous Glucose Monitoring System in Diabetic Patients.

Science.gov (United States)

Uemura, Mei; Yano, Yutaka; Suzuki, Toshinari; Yasuma, Taro; Sato, Toshiyuki; Morimoto, Aya; Hosoya, Samiko; Suminaka, Chihiro; Nakajima, Hiromu; Gabazza, Esteban C; Takei, Yoshiyuki

2017-08-01

Continuous glucose monitoring (CGM) is reported to be a useful technique, but difficult or inconvenient for some patients and institutions. We are developing a glucose area under the curve (AUC) monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET). Here we evaluated the accuracy of interstitial fluid glucose (IG) AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting hyperglycemia using CGM data as a reference. Thirty-eight inpatients with diabetes undergoing CGM were enrolled. MIET comprised a pretreatment step using a plastic microneedle array and glucose accumulation step with a hydrogel patch, which was placed on two sites from 9:00 AM to 5:00 PM or from 10:00 PM to 6:00 AM. IG AUC was calculated by accumulated glucose extracted by hydrogel patches using sodium ion as standard. A significant correlation was observed between the predicted AUC by MIET and CGM in daytime (r=0.76) and nighttime (r=0.82). The optimal cutoff for the IG AUC value of MIET to predict hyperglycemia over 200 mg/dL measured by CGM for 8 hours was 1,067.3 mg·hr/dL with 88.2% sensitivity and 81.5% specificity. We showed that 8-hour IG AUC levels using MIET were valuable in estimating the blood glucose AUC without blood sampling. The results also supported the concept of using this technique for evaluating glucose excursion and for screening hyperglycemia during 8 hours in patients with diabetes at any time of day. Copyright © 2017 Korean Diabetes Association

Comparison of Glucose Area Under the Curve Measured Using Minimally Invasive Interstitial Fluid Extraction Technology with Continuous Glucose Monitoring System in Diabetic Patients

Directory of Open Access Journals (Sweden)

Mei Uemura

2017-07-01

Full Text Available BackgroundContinuous glucose monitoring (CGM is reported to be a useful technique, but difficult or inconvenient for some patients and institutions. We are developing a glucose area under the curve (AUC monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET. Here we evaluated the accuracy of interstitial fluid glucose (IG AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting hyperglycemia using CGM data as a reference.MethodsThirty-eight inpatients with diabetes undergoing CGM were enrolled. MIET comprised a pretreatment step using a plastic microneedle array and glucose accumulation step with a hydrogel patch, which was placed on two sites from 9:00 AM to 5:00 PM or from 10:00 PM to 6:00 AM. IG AUC was calculated by accumulated glucose extracted by hydrogel patches using sodium ion as standard. ResultsA significant correlation was observed between the predicted AUC by MIET and CGM in daytime (r=0.76 and nighttime (r=0.82. The optimal cutoff for the IG AUC value of MIET to predict hyperglycemia over 200 mg/dL measured by CGM for 8 hours was 1,067.3 mg·hr/dL with 88.2% sensitivity and 81.5% specificity.ConclusionWe showed that 8-hour IG AUC levels using MIET were valuable in estimating the blood glucose AUC without blood sampling. The results also supported the concept of using this technique for evaluating glucose excursion and for screening hyperglycemia during 8 hours in patients with diabetes at any time of day.

Visfatin and retinol-binding protein 4 concentrations in lean, glucose-tolerant women with PCOS.

Science.gov (United States)

Yildiz, Bulent O; Bozdag, Gurkan; Otegen, Umit; Harmanci, Ayla; Boynukalin, Kubra; Vural, Zehra; Kirazli, Serafettin; Yarali, Hakan

2010-01-01

Since insulin resistance is accepted to be a common feature of polycystic ovary syndrome (PCOS), the exact molecular mechanism(s) involved in glucose and lipid metabolism have been under investigation in the syndrome. Recently, two novel adipokines, namely visfatin and retinol-binding protein 4 (RBP4), have been suggested to play a role in insulin resistance and diabetes. This study sought to determine whether plasma concentrations of visfatin and RBP4 are altered in PCOS by comparing a total of 27 lean, normal glucose-tolerant PCOS patients with 19 age- and body mass index-matched healthy controls. The mean plasma visfatin concentrations were higher in PCOS patients than those in healthy subjects (37.9+/-18.2 versus 19.8+/-17.5, PPCOS (r=0.52, Plean, glucose-tolerant women with PCOS have increased circulating visfatin and unaltered RBP4 concentrations compared with healthy lean women. In order to clarify overlapping effects and their potential contribution to the pathophysiology of PCOS, further studies are needed. Copyright (c) 2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Lived experience of blood glucose self-monitoring among pregnant women with gestational diabetes mellitus: a phenomenological research.

Science.gov (United States)

Youngwanichsetha, Sununta; Phumdoung, Sasitorn

2017-10-01

To explore and describe lived experience of blood glucose self-monitoring among pregnant Thai women with gestational diabetes mellitus. Self-monitoring of blood glucose is an essential practice among pregnant women with diabetes to prevent complications in pregnancy and the newborn infant. Phenomenological research was employed to understand lived experiences in glycemic control. Thirty participants were approached and interviewed using a semistructured interview guides. Qualitative data were analysed following Colaizzi's method. The findings revealed three themes: being worried about diabetes and blood testing, trying to control it and being patient for the child. Their worry comprised three dimensions: (1) wondering about the impacts of diabetes on the child, (2) concern about maternal health and (3) being worried about doing blood test. Trying to control diabetes was composed of three dimensions: (1) learning to test blood glucose, (2) being afraid of elevated blood sugar and (3) being aware of what to eat. Being patient for the child was composed of three dimensions: (1) overcoming food desires, (2) tolerating the fingerprick pain and (3) satisfaction with the outcomes. Women with gestational diabetes experienced being worried and afraid regarding blood glucose self-monitoring; however, they could overcome and tolerate this with some difficulties. These findings can be used to guide nursing practice in assessment of perception and response towards blood glucose self-monitoring in order to improve achievement of a good glycaemic control among pregnant women with gestational diabetes mellitus. © 2016 John Wiley & Sons Ltd.

Translating glucose variability metrics into the clinic via Continuous Glucose Monitoring: a Graphical User Interface for Diabetes Evaluation (CGM-GUIDE©).

Science.gov (United States)

Rawlings, Renata A; Shi, Hang; Yuan, Lo-Hua; Brehm, William; Pop-Busui, Rodica; Nelson, Patrick W

2011-12-01

Several metrics of glucose variability have been proposed to date, but an integrated approach that provides a complete and consistent assessment of glycemic variation is missing. As a consequence, and because of the tedious coding necessary during quantification, most investigators and clinicians have not yet adopted the use of multiple glucose variability metrics to evaluate glycemic variation. We compiled the most extensively used statistical techniques and glucose variability metrics, with adjustable hyper- and hypoglycemic limits and metric parameters, to create a user-friendly Continuous Glucose Monitoring Graphical User Interface for Diabetes Evaluation (CGM-GUIDE©). In addition, we introduce and demonstrate a novel transition density profile that emphasizes the dynamics of transitions between defined glucose states. Our combined dashboard of numerical statistics and graphical plots support the task of providing an integrated approach to describing glycemic variability. We integrated existing metrics, such as SD, area under the curve, and mean amplitude of glycemic excursion, with novel metrics such as the slopes across critical transitions and the transition density profile to assess the severity and frequency of glucose transitions per day as they move between critical glycemic zones. By presenting the above-mentioned metrics and graphics in a concise aggregate format, CGM-GUIDE provides an easy to use tool to compare quantitative measures of glucose variability. This tool can be used by researchers and clinicians to develop new algorithms of insulin delivery for patients with diabetes and to better explore the link between glucose variability and chronic diabetes complications.

The business of self-monitoring of blood glucose: a market profile.

Science.gov (United States)

Hughes, Mark D

2009-09-01

The market for self-monitoring of blood glucose (SMBG) approached $8.8 billion worldwide in 2008. Yet despite dramatic double-digit growth in sales of SMBG products since 1980, the business is now facing declining prices and slower dollar growth. Given that SMBG meters and test strips are viewed by consumers and insurers as essentially generic products, it will be extremely challenging for new market entrants to displace well-entrenched existing competitors without a truly innovative technology. Also, in the face of declining glucose test strip prices, market expansion can only occur through identification of more of the undiagnosed diabetes population and convincing existing diabetes patients to adopt glucose testing or to test more frequently. Ultimately, a combination of technology innovations, patient education, and economic incentives may be needed to significantly expand the SMBG market and build sustainable long-term dollar growth for SMBG vendors. 2009 Diabetes Technology Society.

Plasma glucose, cholesterol, triglyceride, and glycerol concentrations in the postmature rabbit.

Science.gov (United States)

Harlow, A C; Roux, J F; Shapiro, M I

1980-02-15

Plasma cholesterol, triglycerides, glycerol, and glucose concentrations were measured in term and postmature rabbits. The data show that the term and postmature mothers have significantly higher glycemia than their fetuses. However, triglyceride and cholesterol concentrations are lower in the postmature mother than in her fetus. Postmature fetuses are characterized by very high plasma triglyceride and cholesterol concentrations. The results demonstrate that postmaturity is accompanied by maternal and fetal lipid metabolic changes related to a decrease in the transfer of maternal fatty acids through the placenta and to a diminution in fetal liver glucose utilization. The postmature fetus is then in a relative state of fasting and must rely on its own supply of fuel (glycogen and lipids) to provide cells for growth and survival. The maternal metabolic changes can possibly be explained by a decreased utilization of maternal substrates by the fetus, the placenta becoming insufficient. The close interrelationship of fetal and maternal lipid metabolism with the activity of the placenta suggests that an accurate knowledge of the metabolic changes taking place in the fetus during alteration of the maternal environment is indispensable to the understanding of the short- and long-term effects of maternal disease on the fetus.

Preliminary evaluation of optical glucose sensing in red cell concentrations using near-infrared diffuse-reflectance spectroscopy

Science.gov (United States)

Suzuki, Yusuke; Maruo, Katsuhiko; Zhang, Alice W.; Shimogaki, Kazushige; Ogawa, Hideto; Hirayama, Fumiya

2012-01-01

Bacterial contamination of blood products is one of the most frequent infectious complications of transfusion. Since glucose levels in blood supplies decrease as bacteria proliferate, it should be possible to detect the presence of bacterial contamination by measuring the glucose concentrations in the blood components. Hence this study is aimed to serve as a preliminary study for the nondestructive measurement of glucose level in transfusion blood. The glucose concentrations in red blood cell (RBC) samples were predicted using near-infrared diffuse-reflectance spectroscopy in the 1350 to 1850 nm wavelength region. Furthermore, the effects of donor, hematocrit level, and temperature variations among the RBC samples were observed. Results showed that the prediction performance of a dataset which contained samples that differed in all three parameters had a standard error of 29.3 mg/dL. Multiplicative scatter correction (MSC) preprocessing method was also found to be effective in minimizing the variations in scattering patterns created by various sample properties. The results suggest that the diffuse-reflectance spectroscopy may provide another avenue for the detection of bacterial contamination in red cell concentrations (RCC) products.

Capacitive Sensing of Glucose in Electrolytes Using Graphene Quantum Capacitance Varactors.

Science.gov (United States)

Zhang, Yao; Ma, Rui; Zhen, Xue V; Kudva, Yogish C; Bühlmann, Philippe; Koester, Steven J

2017-11-08

A novel graphene-based variable capacitor (varactor) that senses glucose based on the quantum capacitance effect was successfully developed. The sensor utilizes a metal-oxide-graphene varactor device structure that is inherently compatible with passive wireless sensing, a key advantage for in vivo glucose sensing. The graphene varactors were functionalized with pyrene-1-boronic acid (PBA) by self-assembly driven by π-π interactions. Successful surface functionalization was confirmed by both Raman spectroscopy and capacitance-voltage characterization of the devices. Through glucose binding to the PBA, the glucose concentration in the buffer solutions modulates the level of electrostatic doping of the graphene surface to different degrees, which leads to capacitance changes and Dirac voltage shifts. These responses to the glucose concentration were shown to be reproducible and reversible over multiple measurement cycles, suggesting promise for eventual use in wireless glucose monitoring.

Raised concentrations of lipid peroxidation products (LPO in pregnant women with impaired glucose tolerance

Directory of Open Access Journals (Sweden)

Krzysztof C. Lewandowski

2014-06-01

Full Text Available introduction. Lipid peroxidation (LPO results from oxidative damage to membrane lipids. Whereas LPO rises in normal pregnancy, the effect of gestational diabetes mellitus (GDM on this process has not been clearly defined. materials and method. Fasting blood concentrations of malondialdehyde+4-hydroxyalkenals (MDA+4-HDA, as LPO index, TNFa soluble receptors (sTNF-R1 and sTNF-R2, and soluble adhesion molecules (sICAM-1, sVCAM-1, were measured in 51 women at 28 weeks of gestation. The women were divided according to the results of 50.0 g glucose challenge test (GCT and 75.0 g oral glucose tolerance test (OGTT: Controls (n=20, normal responses to both GCT and OGTT; Intermediate Group (IG (n=15, abnormal GCT but normal OGTT; GDM group (n=16, abnormal both GCT and OGTT. results. Glucose concentrations in women diagnosed with GDM were within the range of impaired glucose tolerance. There were no significant differences in concentrations of either TNF a soluble receptors R1 and R2, or sICAM-1 or sVCAM-1. LPO concentrations [MDA+4-HDA (nmol/mg protein] were significantly higher in women with GDM than in the other two groups [64.1±24.3 (mean±SD, 39.3±23.1, 47.0±18.1, for GDM, IG and Controls, respectively; p<0.05]. In multivariate analysis, the only significant independent correlation was between LPO level and glucose at 120 minutes of OGTT (rs=0.42; p=0.009. conclusions. Oxidative damage to membrane lipids is increased in GDM and might result directly from hyperglycaemia. Physiological significance of this phenomenon remains to be elucidated.

Application of optical lens of a CD writer for detecting the blood glucose semi-invasively

Science.gov (United States)

Meshram, N. D.; Dahikar, P. B.

2014-10-01

Recent technological advancements in the photonics industry have led to a resurgence of interest in optical glucose sensing and to realistic progress toward the development of an optical glucose sensor. Such a sensor has the potential to significantly improve the quality of life for the estimated 16 million diabetics in this country by making routine glucose measurements more convenient. Currently over 100 small companies and universities are working to develop noninvasive or minimally invasive glucose sensing technologies, and optical methods play a large role in these efforts. It has become overwhelmingly clear that frequent monitoring and tight control of blood sugar levels are requisite for effective management of Diabetes mellitus and reduction of the complications associated with this disease. The pain and trouble associated with current "finger-stick" methods for blood glucose monitoring result in decreased patient compliance and a failure to control blood sugar levels. Thus, the development of a convenient noninvasive blood glucose monitor holds the potential to significantly reduce the morbidity and mortality associated with Diabetes. A method and apparatus for noninvasive measurement of blood glucose concentration based on transilluminated laser beam via the Index Finger has been reported in this paper. This method depends on photodiode based laser operating at 632.8 nm wavelength. During measurement, the index finger is inserted into the glucose sensing unit, the transilluminated optical signal is converted into an electrical signal, compared with the reference electrical signal, and the obtained difference signal is processed by signal processing unit which presents the results in the form of blood glucose concentration. This method would enable the monitoring blood glucose level of the diabetic patient continuously, safely and noninvasively..

Application of optical lens of a CD writer for detecting the blood glucose semi-invasively

International Nuclear Information System (INIS)

Meshram, N. D.; Dahikar, P. B.

2014-01-01

Recent technological advancements in the photonics industry have led to a resurgence of interest in optical glucose sensing and to realistic progress toward the development of an optical glucose sensor. Such a sensor has the potential to significantly improve the quality of life for the estimated 16 million diabetics in this country by making routine glucose measurements more convenient. Currently over 100 small companies and universities are working to develop noninvasive or minimally invasive glucose sensing technologies, and optical methods play a large role in these efforts. It has become overwhelmingly clear that frequent monitoring and tight control of blood sugar levels are requisite for effective management of Diabetes mellitus and reduction of the complications associated with this disease. The pain and trouble associated with current “finger-stick” methods for blood glucose monitoring result in decreased patient compliance and a failure to control blood sugar levels. Thus, the development of a convenient noninvasive blood glucose monitor holds the potential to significantly reduce the morbidity and mortality associated with Diabetes. A method and apparatus for noninvasive measurement of blood glucose concentration based on transilluminated laser beam via the Index Finger has been reported in this paper. This method depends on photodiode based laser operating at 632.8 nm wavelength. During measurement, the index finger is inserted into the glucose sensing unit, the transilluminated optical signal is converted into an electrical signal, compared with the reference electrical signal, and the obtained difference signal is processed by signal processing unit which presents the results in the form of blood glucose concentration. This method would enable the monitoring blood glucose level of the diabetic patient continuously, safely and noninvasively.

Application of optical lens of a CD writer for detecting the blood glucose semi-invasively

Energy Technology Data Exchange (ETDEWEB)

Meshram, N. D., E-mail: meshramnileshsd@gmail.com [Mathuradas Mohota College of Sciences, Nagpur-440009 (India); Dahikar, P. B., E-mail: pbdahikar@rediffmail.com [Kamla Nehru Mahavidyalaya, Sakkardara Square, Nagpur-440009 (India)

2014-10-15

Recent technological advancements in the photonics industry have led to a resurgence of interest in optical glucose sensing and to realistic progress toward the development of an optical glucose sensor. Such a sensor has the potential to significantly improve the quality of life for the estimated 16 million diabetics in this country by making routine glucose measurements more convenient. Currently over 100 small companies and universities are working to develop noninvasive or minimally invasive glucose sensing technologies, and optical methods play a large role in these efforts. It has become overwhelmingly clear that frequent monitoring and tight control of blood sugar levels are requisite for effective management of Diabetes mellitus and reduction of the complications associated with this disease. The pain and trouble associated with current “finger-stick” methods for blood glucose monitoring result in decreased patient compliance and a failure to control blood sugar levels. Thus, the development of a convenient noninvasive blood glucose monitor holds the potential to significantly reduce the morbidity and mortality associated with Diabetes. A method and apparatus for noninvasive measurement of blood glucose concentration based on transilluminated laser beam via the Index Finger has been reported in this paper. This method depends on photodiode based laser operating at 632.8 nm wavelength. During measurement, the index finger is inserted into the glucose sensing unit, the transilluminated optical signal is converted into an electrical signal, compared with the reference electrical signal, and the obtained difference signal is processed by signal processing unit which presents the results in the form of blood glucose concentration. This method would enable the monitoring blood glucose level of the diabetic patient continuously, safely and noninvasively.

Educational intervention together with an on-line quality control program achieve recommended analytical goals for bedside blood glucose monitoring in a 1200-bed university hospital.

Science.gov (United States)

Sánchez-Margalet, Víctor; Rodriguez-Oliva, Manuel; Sánchez-Pozo, Cristina; Fernández-Gallardo, María Francisca; Goberna, Raimundo

2005-01-01

Portable meters for blood glucose concentrations are used at the patients bedside, as well as by patients for self-monitoring of blood glucose. Even though most devices have important technological advances that decrease operator error, the analytical goals proposed for the performance of glucose meters have been recently changed by the American Diabetes Association (ADA) to reach nurses in a 1200-bed University Hospital to achieve recommended analytical goals, so that we could improve the quality of diabetes care. We used portable glucose meters connected on-line to the laboratory after an educational program for nurses with responsibilities in point-of-care testing. We evaluated the system by assessing total error of the glucometers using high- and low-level glucose control solutions. In a period of 6 months, we collected data from 5642 control samples obtained by 14 devices (Precision PCx) directly from the control program (QC manager). The average total error for the low-level glucose control (2.77 mmol/l) was 6.3% (range 5.5-7.6%), and even lower for the high-level glucose control (16.66 mmol/l), at 4.8% (range 4.1-6.5%). In conclusion, the performance of glucose meters used in our University Hospital with more than 1000 beds not only improved after the intervention, but the meters achieved the analytical goals of the suggested ADA/National Academy of Clinical Biochemistry criteria for total error (<7.9% in the range 2.77-16.66 mmol/l glucose) and optimal total error for high glucose concentrations of <5%, which will improve the quality of care of our patients.

Clinical value of Flash glucose monitoring in patients with type 1 diabetes treated with continuous subcutaneous insulin infusion.

Science.gov (United States)

Moreno-Fernandez, Jesus; Pazos-Couselo, Marcos; González-Rodriguez, Maria; Rozas, Pedro; Delgado, Manuel; Aguirre, Miguel; Garcia-Lopez, Jose Manuel

2018-06-12

To analyze the clinical impact of the Flash glucose monitoring system in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). A 24-week retrospective cohort study in CSII-treated T1DM patients exposed (1:1) to the Flash glucose monitoring system vs. self-monitoring of capillary blood glucose (SMBG). The primary outcome was the difference in hemoglobin A1c (HbA1c) levels between both groups at the end of the study. Thirty-six patients with a mean age of 38.2 years (range 22-55) and a mean T1DM duration of 20.9±7.8 years, treated with CSII for 7.1±5.4 years, were enrolled into the study. At the end of the study, mean HbA1c levels improved in patients in the Flash group (7.1±0.7 vs. 7.8±1.0, p=0.04). Only the Flash group showed a significant decrease in HbA1c levels of -0.4% (95% CI, -0.6, -0.2; p=0.004) during follow-up. Flash patients captured 93.9% of data through 17.8±9.9 scans daily. In fact, the Flash cohort showed a three-fold increase in daily self-monitoring of glucose, while daily frequency of SMBG decreased during the study (-1.8 tests/24h (95% CI -3, -0.7; p=0.01). No safety issues related to Flash use were recorded. The Flash glucose monitoring system is a novel approach to improve blood glucose control in CSII-treated T1DM patients. Randomized controlled trials are needed to assess the effectiveness of this system in CSII-treated T1DM patients. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Value of self-monitoring blood glucose pattern analysis in improving diabetes outcomes.

Science.gov (United States)

Parkin, Christopher G; Davidson, Jaime A

2009-05-01

Self-monitoring of blood glucose (SMBG) is an important adjunct to hemoglobin A1c (HbA1c) testing. This action can distinguish between fasting, preprandial, and postprandial hyperglycemia; detect glycemic excursions; identify and monitor resolution of hypoglycemia; and provide immediate feedback to patients about the effect of food choices, activity, and medication on glycemic control. Pattern analysis is a systematic approach to identifying glycemic patterns within SMBG data and then taking appropriate action based upon those results. The use of pattern analysis involves: (1) establishing pre- and postprandial glucose targets; (2) obtaining data on glucose levels, carbohydrate intake, medication administration (type, dosages, timing), activity levels and physical/emotional stress; (3) analyzing data to identify patterns of glycemic excursions, assessing any influential factors, and implementing appropriate action(s); and (4) performing ongoing SMBG to assess the impact of any therapeutic changes made. Computer-based and paper-based data collection and management tools can be developed to perform pattern analysis for identifying patterns in SMBG data. This approach to interpreting SMBG data facilitates rational therapeutic adjustments in response to this information. Pattern analysis of SMBG data can be of equal or greater value than measurement of HbA1c levels. 2009 Diabetes Technology Society.

Pseudohyperglycemia: Effects of Unwashed Hand after Fruit Peeling or Handling on Fingertips Blood Glucose Monitoring Results.

Science.gov (United States)

Olamoyegun, M A; Oloyede, T; Adewoye, O G; Abdulkarim, S O; Adeleke, A A

2016-01-01

Self-monitoring of blood glucose (SMBG) is an important component of management for diabetes mellitus (DM), especially in T1DM and T2DM patients who are on insulin therapy. Adequate blood glucose monitoring and prompt intervention are necessary to prevent blood glucose (BG) fluctuation and delay long-term diabetes complications. People with DM are advised to clean their hands before SMBG to remove any dirt or food residue that might affect the reading. The study tested the hypothesis that falsely elevated BG levels from fingertip occur after peeling or handling fruits in an unwashed hand. Fifty apparently healthy nondiabetes volunteers were enrolled. Capillary BG samples were collected from the fingertips after peeling or handling apple, orange, banana, watermelon, and pawpaw, followed by no hand washing for 1 h, cleaning the fingertip with alcohol swab once, five times, and washing hand thoroughly with tap water and drying. These samples were then analyzed with two different glucose meters. The mean BG values, measured from fingertip blood samples after peeling, and handling any of the fruits followed by no hand washing were significantly high, even after cleaning fingertip with a swab of alcohol once. However, there were no significant difference in BG levels measured after peeling and handling fruits followed by hand washing and the level of BG before peeling and handling fruits. Handling of peeled fruits with no hand washing with tap water is associated with overestimation of capillary BG (Pseudohyperglycemia) monitored with glucose meters.

Glucose concentration in capillary blood of dairy cows obtained by a minimally invasive lancet technique and determined with three different hand-held devices.

Science.gov (United States)

Mair, B; Drillich, M; Klein-Jöbstl, D; Kanz, P; Borchardt, S; Meyer, L; Schwendenwein, I; Iwersen, M

2016-02-24

Dairy cows have a massive demand for glucose at the onset of lactation. A poor adaption to this period leads to an excessive negative energy balance with an increased risk for ketosis and impaired animal health and production. Besides the measurement of ketones, analysing the glucose concentration in blood is reported as helpful instrument for diagnosis and differentiation of ketosis. Monitoring metabolic parameters requires multiple blood sampling. In other species, new blood sampling techniques have been introduced in which small amounts of blood are rapidly analysed using electronic hand-held devices. The objective of this study was to evaluate the suitability of capillary blood for blood glucose measurement in dairy cows using the hand-held devices FreeStyle Precision (FSP, Abbott), GlucoMen LX Plus (GLX, A. Menarini) and the WellionVet GLUCO CALEA, (WGC, MED TRUST). In total, 240 capillary blood samples were obtained from dry and fresh lactating Holstein-Friesian cows. Blood was collected from the skin of the exterior vulva by using a lancet. For method comparison, additional blood samples were taken from a coccygeal vessel and analyzed in a laboratory. Glucose concentrations measured by a standard laboratory method were defined as the criterion standard. The Pearson correlation coefficients between the glucose concentrations analyzed in capillary blood with the devices and the reference were 73% for the FSP, 81% for the GLX and 41% for the WGC. Bland-Altman plots showed biases of -18.8 mg/dL for the FSP, -11.2 mg/dL for the GLX and +20.82 mg/dL for the WGC. The optimized threshold determined by a Receiver Operating Characteristics analysis to detect hyperglycemia using the FSP was 43 mg/dL with a sensitivity (Se) and specificity (Sp) of 76 and 80%. Using the GLX and WGC optimized thresholds were 49 mg/dL (Se = 92%, Sp = 85%) and 95 mg/dL (Se = 39%, Sp = 92%). The results of this study demonstrate good performance characteristics for the GLX

Glucose intolerance and the amount of visceral adipose tissue contribute to an increase in circulating triglyceride concentrations in Caucasian obese females.

Science.gov (United States)

Berings, Margot; Wehlou, Charline; Verrijken, An; Deschepper, Ellen; Mertens, Ilse; Kaufman, Jean-Marc; Van Gaal, Luc F; Ouwens, D Margriet; Ruige, Johannes B

2012-01-01

Lipotoxicity is a risk factor for developing obesity-related metabolic complications, including non-alcoholic fatty liver disease, type 2 diabetes (DM2), cardiovascular disease and stroke. Yet, the mechanisms underlying the development of lipotoxicity itself remain poorly understood. Here, we investigated whether glucose intolerance aggravates lipotoxicity by evaluating the association between triglyceride (TG) concentrations and glucose tolerance status in a cross-sectional study on obese Caucasian women at risk for DM2. 913 obese females unknown to have diabetes were recruited (mean age: 41.2 ± SD 12.3; median BMI: 36.2, IQR 32.9-40.2). Visceral (VAT) and subcutaneous abdominal adipose tissue volumes were quantified with computed tomography. Glucose, insulin, and triglyceride concentrations were determined in fasting state and following a 75 gram oral glucose tolerance test. Based on fasting and 2 h post-load glucose levels, 27% of the women had impaired glucose tolerance (IGT), and 8% had newly diagnosed DM2. Fasting TG concentrations were similar between the IGT- and DM2-groups, and increased as compared to women with normal glucose tolerance (NGT). Even when adjusting for age, hip circumference and VAT, fasting TG concentrations remained elevated as compared to NGT. Mixed modelling analysis of post-load responses showed that TG concentrations declined more slowly in the DM2-group as compared to IGT and NGT. However, when adjusting for VAT the difference in decline between the glucose tolerance groups disappeared. Glucose intolerance associates with elevated fasting TG concentrations in obese Caucasian women. We propose that glucose intolerance and increased VAT reduce lipid disposal mechanisms and may accelerate lipotoxicity.

Glucose intolerance and the amount of visceral adipose tissue contribute to an increase in circulating triglyceride concentrations in Caucasian obese females.

Directory of Open Access Journals (Sweden)

Margot Berings

Full Text Available CONTEXT: Lipotoxicity is a risk factor for developing obesity-related metabolic complications, including non-alcoholic fatty liver disease, type 2 diabetes (DM2, cardiovascular disease and stroke. Yet, the mechanisms underlying the development of lipotoxicity itself remain poorly understood. Here, we investigated whether glucose intolerance aggravates lipotoxicity by evaluating the association between triglyceride (TG concentrations and glucose tolerance status in a cross-sectional study on obese Caucasian women at risk for DM2. METHODS: 913 obese females unknown to have diabetes were recruited (mean age: 41.2 ± SD 12.3; median BMI: 36.2, IQR 32.9-40.2. Visceral (VAT and subcutaneous abdominal adipose tissue volumes were quantified with computed tomography. Glucose, insulin, and triglyceride concentrations were determined in fasting state and following a 75 gram oral glucose tolerance test. RESULTS: Based on fasting and 2 h post-load glucose levels, 27% of the women had impaired glucose tolerance (IGT, and 8% had newly diagnosed DM2. Fasting TG concentrations were similar between the IGT- and DM2-groups, and increased as compared to women with normal glucose tolerance (NGT. Even when adjusting for age, hip circumference and VAT, fasting TG concentrations remained elevated as compared to NGT. Mixed modelling analysis of post-load responses showed that TG concentrations declined more slowly in the DM2-group as compared to IGT and NGT. However, when adjusting for VAT the difference in decline between the glucose tolerance groups disappeared. CONCLUSIONS: Glucose intolerance associates with elevated fasting TG concentrations in obese Caucasian women. We propose that glucose intolerance and increased VAT reduce lipid disposal mechanisms and may accelerate lipotoxicity.

Development of glucose-responsive 'smart' insulin systems.

Science.gov (United States)

Rege, Nischay K; Phillips, Nelson F B; Weiss, Michael A

2017-08-01

The complexity of modern insulin-based therapy for type I and type II diabetes mellitus and the risks associated with excursions in blood-glucose concentration (hyperglycemia and hypoglycemia) have motivated the development of 'smart insulin' technologies (glucose-responsive insulin, GRI). Such analogs or delivery systems are entities that provide insulin activity proportional to the glycemic state of the patient without external monitoring by the patient or healthcare provider. The present review describes the relevant historical background to modern GRI technologies and highlights three distinct approaches: coupling of continuous glucose monitoring (CGM) to deliver devices (algorithm-based 'closed-loop' systems), glucose-responsive polymer encapsulation of insulin, and molecular modification of insulin itself. Recent advances in GRI research utilizing each of the three approaches are illustrated; these include newly developed algorithms for CGM-based insulin delivery systems, glucose-sensitive modifications of existing clinical analogs, newly developed hypoxia-sensitive polymer matrices, and polymer-encapsulated, stem-cell-derived pancreatic β cells. Although GRI technologies have yet to be perfected, the recent advances across several scientific disciplines that are described in this review have provided a path towards their clinical implementation.

Glucose oxidase probe as a surface-enhanced Raman scattering sensor for glucose.

Science.gov (United States)

Qi, Guohua; Wang, Yi; Zhang, Biying; Sun, Dan; Fu, Cuicui; Xu, Weiqing; Xu, Shuping

2016-10-01

Glucose oxidase (GOx) possessing a Raman-active chromophore (flavin adenine dinucleotide) is used as a signal reporter for constructing a highly specific "turn off" surface-enhanced Raman scattering (SERS) sensor for glucose. This sensing chip is made by the electrostatic assembly of GOx over silver nanoparticle (Ag NP)-functionalized SERS substrate through a positively charged polyelectrolyte linker under the pH of 6.86. To trace glucose in blood serum, owing to the reduced pH value caused by the production of gluconic acid in the GOx-catalyzed oxidation reaction, the bonding force between GOx and polyelectrolyte weakens, making GOx drop off from the sensing chip. As a result, the SERS intensity of GOx on the chip decreases along with the concentration of glucose. This glucose SERS sensor exhibits excellent selectivity based on the specific GOx/glucose catalysis reaction and high sensitivity to 1.0 μM. The linear sensing range is 2.0-14.0 mM, which also meets the requirement on the working range of the human blood glucose detection. Using GOx as a probe shows superiority over other organic probes because GOx almost has no toxicity to the biological system. This sensing mechanism can be applied for intracellular in vivo SERS monitoring of glucose in the future. Graphical abstract Glucose oxidase is used as a Raman signal reporter for constructing a highly specific glucose surface-enhanced Raman scattering (SERS) sensor.

Translating Glucose Variability Metrics into the Clinic via Continuous Glucose Monitoring: A Graphical User Interface for Diabetes Evaluation (CGM-GUIDE©)

Science.gov (United States)

Rawlings, Renata A.; Shi, Hang; Yuan, Lo-Hua; Brehm, William; Pop-Busui, Rodica

2011-01-01

Abstract Background Several metrics of glucose variability have been proposed to date, but an integrated approach that provides a complete and consistent assessment of glycemic variation is missing. As a consequence, and because of the tedious coding necessary during quantification, most investigators and clinicians have not yet adopted the use of multiple glucose variability metrics to evaluate glycemic variation. Methods We compiled the most extensively used statistical techniques and glucose variability metrics, with adjustable hyper- and hypoglycemic limits and metric parameters, to create a user-friendly Continuous Glucose Monitoring Graphical User Interface for Diabetes Evaluation (CGM-GUIDE©). In addition, we introduce and demonstrate a novel transition density profile that emphasizes the dynamics of transitions between defined glucose states. Results Our combined dashboard of numerical statistics and graphical plots support the task of providing an integrated approach to describing glycemic variability. We integrated existing metrics, such as SD, area under the curve, and mean amplitude of glycemic excursion, with novel metrics such as the slopes across critical transitions and the transition density profile to assess the severity and frequency of glucose transitions per day as they move between critical glycemic zones. Conclusions By presenting the above-mentioned metrics and graphics in a concise aggregate format, CGM-GUIDE provides an easy to use tool to compare quantitative measures of glucose variability. This tool can be used by researchers and clinicians to develop new algorithms of insulin delivery for patients with diabetes and to better explore the link between glucose variability and chronic diabetes complications. PMID:21932986

The use of Fourier-transform infrared spectroscopy for the quantitative determination of glucose concentration in whole blood

International Nuclear Information System (INIS)

Shen, Y C; Davies, A G; Linfield, E H; Elsey, T S; Taday, P F; Arnone, D D

2003-01-01

Fourier-transform infrared transmission spectroscopy has been used for the determination of glucose concentration in whole blood samples from 28 patients. A 4-vector partial least-squares calibration model, using the spectral range 950-1200 cm -1 , yielded a standard-error-of-prediction of 0.59 mM for an independent test set. For blood samples from a single patient, we found that the glucose concentration was proportional to the difference between the values of the second derivative spectrum at 1082 cm -1 and 1093 cm -1 . This indicates that spectroscopy at these two specific wavenumbers alone could be used to determine the glucose concentration in blood plasma samples from a single patient, with a prediction error of 0.95 mM

Assessment of Knowledge of Self Blood Glucose Monitoring and Extent of Self Titration of Anti-Diabetic Drugs among Diabetes Mellitus Patients - A Cross Sectional, Community Based Study.

Science.gov (United States)

Krishnan, V; Thirunavukkarasu, J

2016-03-01

Self blood glucose monitoring is an important context of self care in the management of diabetes mellitus. All the guidelines must be followed while performing self blood glucose monitoring and tracking of values is essential to facilitate the physician while titrating the drugs and /or doses of anti diabetes medication. Self titration by patients following self monitoring must be discouraged. To assess the knowledge and practice of self blood glucose monitoring among diabetes patients and extent of self titration of anti diabetes medicines among diabetes patients based on self blood glucose monitoring. This pilot, cross-sectional, observational study was conducted using a validated questionnaire among adult male and female diabetes patients performing self blood glucose monitoring at home. Diabetes patients with complications and juvenile diabetes patients were excluded. Out of 153 patients surveyed, only 37 (24.1%) (20 males, 17 females) patients were aware and have been following self blood glucose monitoring appropriately. About 116 (75.8%) (64 males, 52 females) of patients were devoid of adequate knowledge and did not practice self blood glucose monitoring in a proper way. Ninety eight (64.05%) accepted that they self titrate their anti diabetic medicines based on self monitoring. Self monitoring of blood glucose should be encouraged and patients should be taught importance of following correct steps and tracking of self monitoring by physician or diabetes educator.

Practical implementation, education and interpretation guidelines for continuous glucose monitoring: A French position statement.

Science.gov (United States)

Borot, S; Benhamou, P Y; Atlan, C; Bismuth, E; Bonnemaison, E; Catargi, B; Charpentier, G; Farret, A; Filhol, N; Franc, S; Gouet, D; Guerci, B; Guilhem, I; Guillot, C; Jeandidier, N; Joubert, M; Melki, V; Merlen, E; Penfornis, A; Picard, S; Renard, E; Reznik, Y; Riveline, J P; Rudoni, S; Schaepelynck, P; Sola-Gazagnes, A; Tubiana-Rufi, N; Verier-Mine, O; Hanaire, H

2018-02-01

The use by diabetes patients of real-time continuous interstitial glucose monitoring (CGM) or the FreeStyle Libre ® (FSL) flash glucose monitoring (FGM) system is becoming widespread and has changed diabetic practice. The working group bringing together a number of French experts has proposed the present practical consensus. Training of professionals and patient education are crucial for the success of CGM. Also, institutional recommendations must pay particular attention to the indications for and reimbursement of CGM devices in populations at risk of hypoglycaemia. The rules of good practice for CGM are the precursors of those that need to be enacted, given the oncoming emergence of artificial pancreas devices. It is necessary to have software combining user-friendliness, multiplatform usage and average glucose profile (AGP) presentation, while integrating glucose and insulin data as well as events. Expression of CGM data must strive for standardization that facilitates patient phenotyping and their follow-up, while integrating indicators of variability. The introduction of CGM involves a transformation of treatment support, rendering it longer and more complex as it also includes specific educational and technical dimensions. This complexity must be taken into account in discussions of organization of diabetes care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Quantifying temporal glucose variability in diabetes via continuous glucose monitoring: mathematical methods and clinical application.

Science.gov (United States)

Kovatchev, Boris P; Clarke, William L; Breton, Marc; Brayman, Kenneth; McCall, Anthony

2005-12-01

Continuous glucose monitors (CGMs) collect detailed blood glucose (BG) time series, which carry significant information about the dynamics of BG fluctuations. In contrast, the methods for analysis of CGM data remain those developed for infrequent BG self-monitoring. As a result, important information about the temporal structure of the data is lost during the translation of raw sensor readings into clinically interpretable statistics and images. The following mathematical methods are introduced into the field of CGM data interpretation: (1) analysis of BG rate of change; (2) risk analysis using previously reported Low/High BG Indices and Poincare (lag) plot of risk associated with temporal BG variability; and (3) spatial aggregation of the process of BG fluctuations and its Markov chain visualization. The clinical application of these methods is illustrated by analysis of data of a patient with Type 1 diabetes mellitus who underwent islet transplantation and with data from clinical trials. Normative data [12,025 reference (YSI device, Yellow Springs Instruments, Yellow Springs, OH) BG determinations] in patients with Type 1 diabetes mellitus who underwent insulin and glucose challenges suggest that the 90%, 95%, and 99% confidence intervals of BG rate of change that could be maximally sustained over 15-30 min are [-2,2], [-3,3], and [-4,4] mg/dL/min, respectively. BG dynamics and risk parameters clearly differentiated the stages of transplantation and the effects of medication. Aspects of treatment were clearly visualized by graphs of BG rate of change and Low/High BG Indices, by a Poincare plot of risk for rapid BG fluctuations, and by a plot of the aggregated Markov process. Advanced analysis and visualization of CGM data allow for evaluation of dynamical characteristics of diabetes and reveal clinical information that is inaccessible via standard statistics, which do not take into account the temporal structure of the data. The use of such methods improves the

Prediction Methods for Blood Glucose Concentration

DEFF Research Database (Denmark)

-day workshop on the design, use and evaluation of prediction methods for blood glucose concentration was held at the Johannes Kepler University Linz, Austria. One intention of the workshop was to bring together experts working in various fields on the same topic, in order to shed light from different angles...... discussions which allowed to receive direct feedback from the point of view of different disciplines. This book is based on the contributions of that workshop and is intended to convey an overview of the different aspects involved in the prediction. The individual chapters are based on the presentations given...... in the process of writing this book: All authors for their individual contributions, all reviewers of the book chapters, Daniela Hummer for the entire organization of the workshop, Boris Tasevski for helping with the typesetting, Florian Reiterer for his help editing the book, as well as Oliver Jackson and Karin...

Near-Infrared Resonance Energy Transfer Glucose Biosensors in Hybrid Microcapsule Carriers

Directory of Open Access Journals (Sweden)

Mike McShane

2008-09-01

Full Text Available Fluorescence-based sensing systems offer potential for noninvasive monitoring with implantable devices, but require carrier technologies that provide suitable immobilization, accessibility, and biocompatibility. Recent developments towards this goal include a competitive binding assay for glucose that has been encapsulated in semipermeable microcapsule carriers. This paper describes an extension of this work to increase the applicability to in vivo monitoring, wherein two significant developments are described: (1 a near-infrared resonance energy transfer system for transducing glucose concentration, and (2 novel hybrid organic-inorganic crosslinked microcapsules as carriers. The quenching-based assay is a competitive binding (CB system based on apo-glucose oxidase (AG as the receptor and dextran as the competitive ligand. The encapsulated quencher-labeled dextran and near infrared donor-labeled glucose receptor showed a stable and reversible response with tunable sensitivity of 1–5%/mM over the physiological range, making these transducers attractive for continuous monitoring for biomedical applications.

A minimally invasive system for glucose area under the curve measurement using interstitial fluid extraction technology: evaluation of the accuracy and usefulness with oral glucose tolerance tests in subjects with and without diabetes.

Science.gov (United States)

Sakaguchi, Kazuhiko; Hirota, Yushi; Hashimoto, Naoko; Ogawa, Wataru; Sato, Toshiyuki; Okada, Seiki; Hagino, Kei; Asakura, Yoshihiro; Kikkawa, Yasuo; Kojima, Junko; Maekawa, Yasunori; Nakajima, Hiromu

2012-06-01

Recent studies have highlighted the importance of managing postprandial hyperglycemia, but adequate monitoring of postprandial glucose remains difficult because of wide variations in levels. We have therefore developed a minimally invasive system to monitor postprandial glucose area under the curve (AUC). This system involves no blood sampling and uses interstitial fluid glucose (IG) AUC (IG-AUC) as a surrogate marker of postprandial glucose. This study aimed to evaluate the usefulness of this system by comparing data with the findings of oral glucose tolerance tests (OGTTs) in subjects with and without diabetes. The glucose AUC monitoring system was validated by OGTTs in 37 subjects with and 10 subjects without diabetes. A plastic microneedle array was stamped on the forearm to extract IG. A hydrogel patch was then placed on the pretreated area to accumulate IG. Glucose and sodium ion concentrations in the hydrogel were measured to calculate IG-AUC at 2-h postload glucose. Plasma glucose (PG) levels were measured every 30 min to calculate reference PG-AUC. IG-AUC correlated strongly with reference PG-AUC (r=0.93) over a wide range. The level of correlation between IG-AUC and maximum PG level was also high (r=0.86). The painless nature of the technique was confirmed by the response of patients to questionnaires. The glucose AUC monitoring system using IG provided good estimates of reference PG-AUC and maximum PG level during OGTTs in subjects with and without diabetes. This system provides easy-to-use monitoring of glucose AUC, which is a good indicator of postprandial glucose.

Relationship between fluctuations in glucose levels measured by continuous glucose monitoring and vascular endothelial dysfunction in type 2 diabetes mellitus

Directory of Open Access Journals (Sweden)

Torimoto Keiichi

2013-01-01

Full Text Available Abstract Background Fluctuations in blood glucose level cause endothelial dysfunction and play a critical role in onset and/or progression of atherosclerosis. We hypothesized that fluctuation in blood glucose levels correlate with vascular endothelial dysfunction and that this relationship can be assessed using common bedside medical devices. Methods Fluctuations in blood glucose levels were measured over 24 hours by continuous glucose monitoring (CGM on admission day 2 in 57 patients with type 2 diabetes mellitus. The reactive hyperemia index (RHI, an index of vascular endothelial function, was measured using peripheral arterial tonometry (EndoPAT on admission day 3. Results The natural logarithmic-scaled RHI (L_RHI correlated with SD (r=−0.504; PPP=0.001 and percentage of time ≥200 mg/dl (r=−0.292; P=0.028. In 12 patients with hypoglycemia, L_RHI also correlated with the percentage of time at hypoglycemia (r=−0.589; P=0.044. L_RHI did not correlate with HbA1c or fasting plasma glucose levels. Furthermore, L_RHI did not correlate with LDL cholesterol, HDL cholesterol, and triglyceride levels or with systolic and diastolic blood pressures. Finally, multivariate analysis identified MAGE as the only significant determinant of L_RHI. Conclusions Fluctuations in blood glucose levels play a significant role in vascular endothelial dysfunction in type 2 diabetes. Trial registration UMIN000007581

Uranium concentration monitor manual, secondary intermediate evaporator

International Nuclear Information System (INIS)

Russo, P.A.; Sprinkle, J.K. Jr.; Slice, R.W.; Strittmatter, R.B.

1985-08-01

This manual describes the design, operation, and measurement control procedures for the automated uranium concentration monitor on the secondary intermediate evaporator at the Oak Ridge Y-12 Plant. The nonintrusive monitor provides a near-real time readout of uranium concentration in the return loop of time recirculating evaporator for purposes of process monitoring and control. A detector installed near the bottom of the return loop is used to acquire spectra of gamma rays from the evaporator solutions during operation. Pulse height analysis of each spectrum gives the information required to deduce the concentration of uranium in the evaporator solution in near-real time. The visual readout of concentration is updated at the end of every assay cycle. The readout includes an alphanumeric display of uranium concentration and an illuminated, colored LED (in an array of colored LEDs) indicating whether the measured concentration is within (or above or below) the desired range. An alphanumeric display of evaporator solution acid molarity is also available to the operator. 9 refs., 16 figs., 4 tabs

Professional flash continuous glucose monitoring as a supplement to A1C in primary care.

Science.gov (United States)

Hirsch, Irl B

2017-11-01

Decreasing glycated hemoglobin (A1C) is the primary goal of current diabetes management due to intervention studies in type 1 and type 2 diabetes associating levels <7.0% (53 mmol/mol) with lower complication risk. Strategic self-monitoring of blood glucose (SMBG) is also recommended to achieve greater time in range, with fewer extremes of hypo- or hyperglycemia. Unlike A1C, SMBG can distinguish among fasting, prandial, and postprandial hyperglycemia; uncover glycemic variability, including potentially dangerous hypoglycemia; and provide feedback to patients about the effects of behavior and medication on glycemic control. However, it has the drawback of capturing only static glucose readings and users are often dependent on time-pressed clinicians to interpret numerous data points. A novel flash continuous glucose monitoring (FCGM) device used for a single 2-week period with a readily interpretable data report know as the ambulatory glucose profile (AGP) has the potential to overcome limitations of conventional technologies, with less cost and greater convenience. This review summarizes the rationale for using intermittent FCGM as a supplement to A1C in primary care, and provides a stepwise approach to interpreting the AGP visual display for efficient individualized therapy.

Comparative study of the concentration of salivary and blood glucose in type 2 diabetic patients.

Science.gov (United States)

Vasconcelos, Ana Carolina U; Soares, Maria Sueli M; Almeida, Paulo C; Soares, Teresa C

2010-06-01

The objective of the present study was to comparatively evaluate the concentrations of blood and salivary glucose as well as salivary flow and xerostomia in type 2 diabetic and non-diabetic patients. The mean salivary glucose level in diabetic patients was 14.03 +/-16.76 mg/dl and 6.35 +/- 6.02 mg/dl (P = 0.036) in the control group. The mean capillary blood glucose level in diabetic patients was 213 +/- 88 mg/dl, while that in non-diabetic patients was 99 +/- 14 mg/dl (P = 0.000). The mean value for resting salivary flow was 0.21 +/- 0.16 ml/min in diabetic patients and 0.33 +/- 0.20 ml/min in the control group (P = 0.002). The stimulated salivary flow was lower in the group of diabetic patients, with a mean of 0.63 +/- 0.43 ml/min, whereas the control group showed a mean of 1.20 +/- 0.70 ml/min (P = 0.000). Of the diabetic patients, 45% exhibited hyposalivation, in contrast to 2.5% of the non-diabetic patients (P = 0.000). Xerostomia was reported in 12.5% of diabetic patients and 5% of non-diabetic patients (P = 0.23). We can conclude that salivary glucose concentration was significantly higher in the experimental group and that there was no correlation between salivary and blood glucose concentrations in diabetic patients. The total salivary flow was significantly reduced in diabetic patients and there was no significant difference as to the presence of xerostomia in both groups.

Professional continuous glucose monitoring for the identification of type 1 diabetes mellitus among subjects with insulin therapy.

Science.gov (United States)

Chen, Yin-Chun; Huang, Yu-Yao; Li, Hung-Yuan; Liu, Shih-Wei; Hsieh, Sheng-Hwu; Lin, Chia-Hung

2015-01-01

The identification of type 1 diabetes in diabetic subjects receiving insulin therapy is sometimes difficult. The purpose of this study is to evaluate whether results of professional continuous glucose monitoring can improve the identification of type 1 diabetes.From 2007 to 2012, 119 adults receiving at least twice-daily insulin therapy and professional continuous glucose monitoring were recruited. Type 1 diabetes was diagnosed by endocrinologists according to American Diabetes Association standards, including a very low C-peptide level (diabetic ketoacidosis. Continuous glucose monitoring was applied for 3 days.Among 119 subjects, 86 were diagnosed with type 1 diabetes. Subjects with type 1 diabetes were younger (33.8 vs 52.3 years old, P 1), had lower body mass index (BMI, 21.95 vs 24.42, P = 0.003), lower serum creatinine (61.77  vs 84.65 μmol/L, P = 0.001), and higher estimated glomerular filtration rate (108.71 vs 76.48 mg/mL/min/1.73m2, P 1) than subjects with type 2 diabetes. Predictive scores for identification of type 1 diabetes were constructed, including age, BMI, average mean amplitude of glucose excursion in days 2 and 3, and the area under the curve of nocturnal hyperglycemic and hypoglycemic states. The area under the receiver operating characteristic curve was 0.90. With the cutoff of 0.58, the sensitivity was 86.7% and the specificity was 80.8%. The good performance was validated by the leave-one-out method (sensitivity 83.3%, specificity 73.1%).Professional continuous glucose monitoring is a useful tool that improves identification of type 1 diabetes among diabetic patients receiving insulin therapy.

Impaired brain energy gain upon a glucose load in obesity.

Science.gov (United States)

Wardzinski, Ewelina K; Kistenmacher, Alina; Melchert, Uwe H; Jauch-Chara, Kamila; Oltmanns, Kerstin M

2018-03-06

There is evidence that the brain's energy status is lowered in obesity despite of chronic hypercaloric nutrition. The underlying mechanisms are unknown. We hypothesized that the brain of obese people does not appropriately generate energy in response to a hypercaloric supply. Glucose was intravenously infused in 17 normal weights and 13 obese participants until blood glucose concentrations reached the postprandial levels of 7 mmol/L and 10 mmol/L. Changes in cerebral adenosine triphosphate (ATP) and phosphocreatine (PCr) content were measured by 31 phosphorus magnetic resonance spectroscopy and stress hormonal measures regulating glucose homeostasis were monitored. Because vitamin C is crucial for a proper neuronal energy synthesis we determined circulating concentrations during the experimental testing. Cerebral high-energy phosphates were increased at blood glucose levels of 7 mmol/L in normal weights, which was completely missing in the obese. Brain energy content moderately raised only at blood glucose levels of 10 mmol/L in obese participants. Vitamin C concentrations generally correlated with the brain energy content at blood glucose concentrations of 7 mmol/L. Our data demonstrate an inefficient cerebral energy gain upon a glucose load in obese men, which may result from a dysfunctional glucose transport across the blood-brain barrier or a downregulated energy synthesis in mitochondrial oxidation processes. Our finding offers an explanation for the chronic neuroenergetic deficiency and respectively missing satiety perception in obesity. Copyright © 2018. Published by Elsevier Inc.

Impact of buccal glucose spray, liquid sugars and dextrose tablets on the evolution of plasma glucose concentration in healthy persons.

Science.gov (United States)

Chlup, Rudolf; Zapletalova, Jana; Peterson, Karolina; Poljakova, Iveta; Lenhartova, Eva; Tancred, Adam; Perera, Russel; Smital, Jan

2009-09-01

The purpose of this prospective controlled trial was to assess the efficacy of three commercially available glucose products, (1) buccal glucose spray, (2) liquid sugars, and (3) dextrose tablet, on the evolution of plasma glucose concentration (PG). Sixteen healthy volunteers aged 21.8 +/- 0.78 y (mean +/- SE), BMI 23.5 +/- 0.84 kg/m(2), tested their PG over the course of 3 sets of 4 sessions (S) each: S(0)-control fasting, S(1)-buccal administration of 10 glucose spray-doses (0.84 g of glucose) without swallowing; S(2-) consumption of 1 sachet (13 ml) of liquid sugar (ca. 5.2 g glucose, 5.2 g fructose, 5.2 g sucrose); S(3-) consumption of one dextrose tablet (6 g). PG was tested in finger-prick capillary blood using a personal glucometer Linus at the start, and at 5, 10, 15, 20 and 30 min. The means of 3 respective sessions for each of the 16 subjects were analyzed. The Wilcoxon signed rank test revealed no significant differences between changes in the mean PG at the start vs. 5-minute interval either in control, or any intervention sessions. Analysis of regression coefficients after 30 min compared to the control session, demonstrated an increase in PG with the sachet of liquid sugars (0.068 mmol/l/min, p = 0.001) which was greater than a single dextrose tablet (0.052 mmol/l/min, p = 0.002), but no significant PG increase was found after buccal glucose spray. Liquid sugars or dextrose tablets, but not the buccal glucose spray, are effective means to increase PG within 10 minutes after ingestion.

Usefulness of continuous glucose monitoring for the diagnosis of hypoglycemia after a gastric bypass in a patient previously treated for type 2 diabetes.

Science.gov (United States)

Hanaire, Hélène; Dubet, Audrey; Chauveau, Marie-Emilie; Anduze, Yves; Fernandes, Martine; Melki, Vincent; Ritz, Patrick

2010-01-01

Hypoglycemia is rare after a gastric bypass and can be taken for a dumping syndrome. There is no report in the literature of the contribution of continuous glucose monitoring to the diagnosis of hypoglycemia in these circumstances. The present case report shows that continuous glucose monitoring can be a useful tool for the diagnosis and the management of such episodes. Continuous glucose monitoring revealed hypoglycemic episodes in free living circumstances that were not present during 72-h fasting. These episodes followed wide hyperglycemic swings. No such episode resumed over 8 months after specific dietary advices and treatment by 50 mg TID of acarbose. Because hypoglycemia can be difficult to diagnose from dumping syndrome, continuous glucose monitoring is a very useful tool revealing the episodes in free living circumstances and can be used to monitor the treatment success.

Continuous glucose monitoring and HbA1c in the evaluation of glucose metabolism in children at high risk for type 1 diabetes mellitus.

Science.gov (United States)

Helminen, Olli; Pokka, Tytti; Tossavainen, Päivi; Ilonen, Jorma; Knip, Mikael; Veijola, Riitta

2016-10-01

Continuous glucose monitoring (CGM) parameters, self-monitored blood glucose (SMBG), HbA1c and oral glucose tolerance test (OGTT) were studied during preclinical type 1 diabetes mellitus. Ten asymptomatic children with multiple (⩾2) islet autoantibodies (cases) and 10 age and sex-matched autoantibody-negative controls from the Type 1 Diabetes Prediction and Prevention (DIPP) Study were invited to 7-day CGM with Dexcom G4 Platinum Sensor. HbA1c and two daily SMBG values (morning and evening) were analyzed. Five-point OGTTs were performed and carbohydrate intake was assessed by food records. The matched pairs were compared with the paired sample t-test. The cases showed higher mean values and higher variation in glucose levels during CGM compared to the controls. The time spent ⩾7.8mmol/l was 5.8% in the cases compared to 0.4% in the controls (p=0.040). Postprandial CGM values were similar except after the dinner (6.6mmol/l in cases vs. 6.1mmol/l in controls; p=0.023). When analyzing the SMBG values higher mean level, higher evening levels, as well as higher variation were observed in the cases when compared to the controls. HbA1c was significantly higher in the cases [5.7% (39mmol/mol) vs. 5.3% (34mmol/mol); p=0.045]. No differences were observed in glucose or C-peptide levels during OGTT. Daily carbohydrate intake was slightly higher in the cases (254.2g vs. 217.7g; p=0.034). Glucose levels measured by CGM and SMBG are useful indicators of dysglycemia during preclinical type 1 diabetes mellitus. Increased evening glucose values seem to be common in children with preclinical type 1 diabetes mellitus. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Short communication: Associations between blood glucose concentration, onset of hyperketonemia, and milk production in early lactation dairy cows.

Science.gov (United States)

Ruoff, J; Borchardt, S; Heuwieser, W

2017-07-01

The objectives of this study were to describe the associations between hypoglycemia and the onset of hyperketonemia (HYK) within the first 6 wk of lactation, to evaluate the effects of body condition score at calving on glucose concentration, and to study the effects of hypoglycemia on milk production. A total of 621 dairy cows from 6 commercial dairy farms in Germany were enrolled between 1 and 4 d in milk (DIM). Cows were tested twice weekly using an electronic handheld meter for glucose and β-hydroxybutyrate (BHB), respectively, for a period of 42 d. Hypoglycemia was defined as glucose concentration ≤2.2 mmol/L. Hyperketonemia was defined as a BHB concentration ≥1.2 mmol/L. The onset of HYK was described as early onset (first HYK event within the first 2 wk postpartum) and late onset (first HYK event in wk 3 to 6 postpartum). The effect of ketosis status on blood glucose within 42 DIM was evaluated using a generalized linear mixed model. No effect was observed of HYK on glucose concentration in primiparous cows. Multiparous cows with early-onset HYK had a lower glucose concentration (-0.21 mmol/L) compared with nonketotic cows. Overall, primiparous cows had a lower prevalence and incidence of hypoglycemia than multiparous cows. Hypoglycemia in multiparous cows was associated with higher first test-day milk production and 100 DIM milk production. In conclusion, hypoglycemia mainly occurred in multiparous cows with early-onset HYK, whereas primiparous cows were at a lower risk for hypoglycemia. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

First step toward near-infrared continuous glucose monitoring: in vivo evaluation of antibody coupled biomaterials

Science.gov (United States)

Gellynck, Karolien; Kodeck, Valérie; Van De Walle, Elke; Kersemans, Ken; De Vos, Filip; Declercq, Heidi; Dubruel, Peter; Vlaminck, Lieven

2015-01-01

Continuous glucose monitoring (CGM) is crucial in diabetic care. Long-term CGM systems however require an accurate sensor as well as a suitable measuring environment. Since large intravenous sensors are not feasible, measuring inside the interstitial fluid is considered the best alternative. This option, unfortunately, has the drawback of a lag time with blood glucose values. A good strategy to circumvent this is to enhance tissue integration and enrich the peri-implant vasculature. Implants of different optically transparent biomaterials (poly(methyl-methacrylate) [PMMA] and poly(dimethylsiloxane) [PDMS]) – enabling glucose monitoring in the near-infrared (NIR) spectrum – were surface-treated and subsequently implanted in goats at various implantation sites for up to 3 months. The overall in vivo biocompatibility, tissue integration, and vascularization at close proximity of the surfaces of these materials were assessed. Histological screening showed similar tissue reactions independent of the implantation site. No significant inflammation reaction was observed. Tissue integration and vascularization correlated, to some extent, with the biomaterial composition. A modification strategy, in which a vascular endothelial-cadherin antibody was coupled to the biomaterials surface through a dopamine layer, showed significantly enhanced vascularization 3 months after subcutaneous implantation. Our results suggest that the developed strategy enables the creation of tissue interactive NIR transparent packaging materials, opening the possibility of continuous glucose monitoring. PMID:25304314

Use of a real time continuous glucose monitoring system as an educational tool for patients with gestational diabetes.

Science.gov (United States)

Alfadhli, Eman; Osman, Eman; Basri, Taghreed

2016-01-01

Women with gestational diabetes mellitus (GDM) are required to control their blood glucose shortly after GDM diagnosis to minimize adverse pregnancy outcomes. A real time-continuous glucose monitoring system (RT-CGMS) provides the patient with continuous information about the alterations in levels of the blood glucose. This visibility may empower the patient to modify her lifestyle and engage in therapeutic management. The aim of this study was to determine whether a single application of RT-CGMS to pregnant women shortly after GDM diagnosis is useful as an educational and motivational tool. This study was a prospective open label randomized controlled study conducted at Maternity and Children Hospital, Medina, Saudi Arabia. A total of 130 pregnant women with GDM were randomised to either blood glucose self-monitor alone (SMBG group) (n = 62) or in addition to SMBG, patients wore a Guardian(®) REAL-Time Continuous Glucose Monitoring System (Medtronic MiniMed) once for 3-7 days, within 2 weeks of GDM diagnosis (RT-CGMS group) (n = 68). The primary outcomes were maternal glycemic control and pregnancy outcomes. Secondary outcomes were the changes in parameters of glucose variability, which includes mean sensor readings, standard deviation (SD) of blood glucose, and area under the curve for hyper and hypoglycaemia at the end of the RT-CGMS application. HbA1c, mean fasting and postprandial glucose levels were similar in both groups at the end of the pregnancy. Pregnancy outcomes were comparable. However, there was significant improvement in the parameters of glucose variability on the last day of sensor application; both mean glucose and the SD of mean glycaemia were reduced significantly; P = 0.016 and P = 0.034, respectively. The area under the curve for hyper and hypoglycaemia were improved, however, the results were not statistically significant. Although a single application of RT-CGMS shortly after GDM diagnosis is helpful as an educational tool, it

A comparative effectiveness analysis of three continuous glucose monitors.

Science.gov (United States)

Damiano, Edward R; El-Khatib, Firas H; Zheng, Hui; Nathan, David M; Russell, Steven J

2013-02-01

To compare three continuous glucose monitoring (CGM) devices in subjects with type 1 diabetes under closed-loop blood glucose (BG) control. Six subjects with type 1 diabetes (age 52 ± 14 years, diabetes duration 32 ± 14 years) each participated in two 51-h closed-loop BG control experiments in the hospital. Venous plasma glucose (PG) measurements (GlucoScout, International Biomedical) obtained every 15 min (2,360 values) were paired in time with corresponding CGM glucose (CGMG) measurements obtained from three CGM devices, the Navigator (Abbott Diabetes Care), the Seven Plus (DexCom), and the Guardian (Medtronic), worn simultaneously by each subject. Errors in paired PG-CGMG measurements and data reporting percentages were obtained for each CGM device. The Navigator had the best overall accuracy, with an aggregate mean absolute relative difference (MARD) of all paired points of 11.8 ± 11.1% and an average MARD across all 12 experiments of 11.8 ± 3.8%. The Seven Plus and Guardian produced aggregate MARDs of all paired points of 16.5 ± 17.8% and 20.3 ± 18.0%, respectively, and average MARDs across all 12 experiments of 16.5 ± 6.7% and 20.2 ± 6.8%, respectively. Data reporting percentages, a measure of reliability, were 76% for the Seven Plus and nearly 100% for the Navigator and Guardian. A comprehensive head-to-head-to-head comparison of three CGM devices for BG values from 36 to 563 mg/dL revealed marked differences in performance characteristics that include accuracy, precision, and reliability. The Navigator outperformed the other two in these areas.

Use of continuous glucose monitoring as an outcome measure in clinical trials.

Science.gov (United States)

Beck, Roy W; Calhoun, Peter; Kollman, Craig

2012-10-01

Although developed to be a management tool for individuals with diabetes, continuous glucose monitoring (CGM) also has potential value for the assessment of outcomes in clinical studies. We evaluated using CGM as such an outcome measure. Data were analyzed from six previously completed inpatient studies in which both CGM (Freestyle Navigator™ [Abbott Diabetes Care, Alameda, CA] or Guardian(®) [Medtronic, Northridge, CA]) and reference glucose measurements were available. The analyses included 97 days of data from 93 participants with type 1 diabetes (age range, 5-57 years; mean, 18 ± 12 years). Mean glucose levels per day were similar for the CGM and reference measurements (median, 148 mg/dL vs. 143 mg/dL, respectively; P = 0.92), and the correlation of the two was high (r = 0.89). Similarly, most glycemia metrics showed no significant differences comparing CGM and reference values, except that the nadir glucose tended to be slightly lower and peak glucose slightly higher with reference measurements than CGM measurements (respective median, 59 mg/dL vs. 66 mg/dL [P = 0.05] and 262 mg/dL vs. 257 mg/dL [P = 0.003]) and glucose variability as measured with the coefficient of variation was slightly lower with CGM than reference measurements (respective median, 31% vs. 35%; Pblood glucose measurements. CGM inaccuracy and underestimation of the extremes of hyperglycemia and hypoglycemia can be accounted for in a clinical trial's study design. Thus, in appropriate settings, CGM can be a very meaningful and feasible outcome measure for clinical trials.

Self-monitoring of blood glucose experiences of adults with type 2 diabetes.

Science.gov (United States)

Dlugasch, Lucie B; Ugarriza, Doris N

2014-06-01

The purpose of this study was to analyze the experiences of self-monitoring of blood glucose (SMBG) usage of adults with type 2 diabetes mellitus (T2DM) who are not using insulin. Nineteen adults were asked to describe their experiences with self-monitoring. Data were analyzed using the grounded theory method. The theory of "SMBG as a Cue in T2DM Self-Care" emerged from the data and is composed of four categories: (a) Engaging, (b) Checking, (c) Responding, and (d) Establishing a Pattern. Engaging marks the beginning. Frequent monitoring characterizes this stage. Checking involves evaluating and validating the blood glucose level. The most common item evaluated or validated was the effect of foods. Responding involves taking action or experiencing emotion. Actions taken centered on dietary changes. Emotions felt were dependent on the level and ranged from blame to happiness. Participants established a pattern and used SMBG regularly or sporadically. Frequency was based on obtaining "normal" patterns, the absence of symptoms, provider disinterest, and fingertip pain. Participants described many benefits and struggles when incorporating SMBG into their self-care. Information from this study could be used to develop effective guidelines for the use of SMBG in T2DM. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Promoting health and reducing costs: a role for reform of self-monitoring of blood glucose provision within the National Health Service.

Science.gov (United States)

Leigh, S; Idris, I; Collins, B; Granby, P; Noble, M; Parker, M

2016-05-01

To determine the cost-effectiveness of all options for the self-monitoring of blood glucose funded by the National Health Service, providing guidance for disinvestment and testing the hypothesis that advanced meter features may justify higher prices. Using data from the Health and Social Care Information Centre concerning all 8 340 700 self-monitoring of blood glucose-related prescriptions during 2013/2014, we conducted a cost-minimization analysis, considering both strip and lancet costs, including all clinically equivalent technologies for self-monitoring of blood glucose, as determined by the ability to meet ISO-15197:2013 guidelines for meter accuracy. A total of 56 glucose monitor, test strip and lancet combinations were identified, of which 38 met the required accuracy standards. Of these, the mean (range) net ingredient costs for test strips and lancets were £0.27 (£0.14-£0.32) and £0.04 (£0.02-£0.05), respectively, resulting in a weighted average of £0.28 (£0.18-£0.37) per test. Systems providing four or more advanced features were priced equal to those providing just one feature. A total of £12 m was invested in providing 42 million self-monitoring of blood glucose tests with systems that fail to meet acceptable accuracy standards, and efficiency savings of £23.2 m per annum are achievable if the National Health Service were to disinvest from technologies providing lesser functionality than available alternatives, but at a much higher price. The study uncovered considerable variation in the price paid by the National Health Service for self-monitoring of blood glucose, which could not be explained by the availability of advanced meter features. A standardized approach to self-monitoring of blood glucose prescribing could achieve significant efficiency savings for the National Health Service, whilst increasing overall utilisation and improving safety for those currently using systems that fail to meet acceptable standards for measurement accuracy

What do professionals recommend regarding the frequency of self-monitoring of blood glucose?

NARCIS (Netherlands)

Hortensius, J.; Kleefstra, N.; Houweling, S. T.; van der Bijl, J. J.; Gans, R. O. B.; Bilo, H. J. G.

Background: Patients' adherence to guidelines regarding self-monitoring of blood glucose (SMBG) is limited. However, there are no previous reports about the recommendations that are given in clinical practice concerning SMBG. The aim of this study was to investigate what healthcare providers

Coexistence of insulin resistance and increased glucose tolerance in pregnant rats: a physiological mechanism for glucose maintenance.

Science.gov (United States)

Carrara, Marcia Aparecida; Batista, Márcia Regina; Saruhashi, Tiago Ribeiro; Felisberto, Antonio Machado; Guilhermetti, Marcio; Bazotte, Roberto Barbosa

2012-06-06

The contribution of insulin resistance (IR) and glucose tolerance to the maintenance of blood glucose levels in non diabetic pregnant Wistar rats (PWR) was investigated. PWR were submitted to conventional insulin tolerance test (ITT) and glucose tolerance test (GTT) using blood sample collected 0, 10 and 60 min after intraperitoneal insulin (1 U/kg) or oral (gavage) glucose (1g/kg) administration. Moreover, ITT, GTT and the kinetics of glucose concentration changes in the fed and fasted states were evaluated with a real-time continuous glucose monitoring system (RT-CGMS) technique. Furthermore, the contribution of the liver glucose production was investigated. Conventional ITT and GTT at 0, 7, 14 and 20 days of pregnancy revealed increased IR and glucose tolerance after 20 days of pregnancy. Thus, this period of pregnancy was used to investigate the kinetics of glucose changes with the RT-CGMS technique. PWR (day 20) exhibited a lower (pinsulin sensitivity and/or glucose tolerance during late pregnancy. In contrast to the general view that IR is a pathological process associated with gestational diabetes, a certain degree of IR may represent an important physiological mechanism for blood glucose maintenance during fasting. Copyright © 2012 Elsevier Inc. All rights reserved.

Mobile communication using a mobile phone with a glucometer for glucose control in Type 2 patients with diabetes: as effective as an Internet-based glucose monitoring system.

Science.gov (United States)

Cho, Jae-Hyoung; Lee, Hye-Chung; Lim, Dong-Jun; Kwon, Hyuk-Sang; Yoon, Kun-Ho

2009-01-01

A mobile phone with a glucometer integrated into the battery pack (the 'Diabetes Phone') was launched in Korea in 2003. We compared its effect on management of type 2 diabetes to the Internet-based glucose monitoring system (IBGMS), which had been studied previously. We conducted a randomized trial involving 69 patients for three months. Participants were assigned to an Internet group or a phone group. The phone group communicated with medical staff through the mobile phone only. Their glucose-monitoring data were automatically transferred to individual, web-based charts and they received medical recommendations by short message service. The Internet group used the IBGMS. There were no significant differences between the groups at baseline. After three months' intervention, HbA(1c) levels of both groups had decreased significantly, from 7.6% to 6.9% for the Internet group and from 8.3% to 7.1% for the phone group (P glucose control as the previously-studied Internet-based monitoring system and it was good for patient satisfaction and adherence.

Effects of 1 and 3 g cinnamon on gastric emptying, satiety, and postprandial blood glucose, insulin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and ghrelin concentrations in healthy subjects

DEFF Research Database (Denmark)

Hlebowicz, Joanna; Hlebowicz, Anna; Lindstedt, Sandra

2009-01-01

glucose, plasma concentrations of insulin and incretin hormones [glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1)], the ghrelin response, and satiety in healthy subjects. DESIGN: GER was measured by using real-time ultrasonography after ingestion of rice pudding...... with and without 1 or 3 g cinnamon. Fifteen healthy subjects were assessed in a crossover trial. RESULTS: The addition of 1 or 3 g cinnamon had no significant effect on GER, satiety, glucose, GIP, or the ghrelin response. The insulin response at 60 min and the area under the curve (AUC) at 120 min were...... cinnamon (P = 0.0082 and P = 0.0138, respectively, after Bonferroni correction). CONCLUSIONS: Ingestion of 3 g cinnamon reduced postprandial serum insulin and increased GLP-1 concentrations without significantly affecting blood glucose, GIP, the ghrelin concentration, satiety, or GER in healthy subjects...

Accuracy of a real-time continuous glucose monitoring system in children with septic shock: A pilot study

OpenAIRE

Prabhudesai, Sumant; Kanjani, Amruta; Bhagat, Isha; Ravikumar, Karnam G.; Ramachandran, Bala

2015-01-01

Aims: The aim of this prospective, observational study was to determine the accuracy of a real-time continuous glucose monitoring system (CGMS) in children with septic shock. Subjects and Methods: Children aged 30 days to 18 years admitted to the Pediatric Intensive Care Unit with septic shock were included. A real-time CGMS sensor was used to obtain interstitial glucose readings. CGMS readings were compared statistically with simultaneous laboratory blood glucose (BG). Results: Nineteen chil...

Continuous glucose monitoring in newborn infants: how do errors in calibration measurements affect detected hypoglycemia?

OpenAIRE

Thomas, Felicity Louise; Signal, Mathew; Harris, Deborah L.; Weston, Philip J.; Harding, Jane E.; Shaw, Geoffrey M.; Chase, J. Geoffrey

2014-01-01

Neonatal hypoglycemia is common and can cause serious brain injury. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing blood glucose (BG) measurements. Calibration algorithms use BG measurements to convert sensor signals into CGM data. Thus, inaccuracies in calibration BG measurements directly affect CGM values and any metrics calculated from them. The aim was to quantify the effect of timing delays and calibration BG measurement errors on hypoglycemia me...

Hypoglycemia in type 2 diabetes patients treated with insulin: the advantages of continuous glucose monitoring

Directory of Open Access Journals (Sweden)

Vadim Valer'evich Klimontov

2014-03-01

Full Text Available Aims.  To determine the incidence and risk factors for hypoglycemia in elderly insulin-treated type 2 diabetes mellitus (T2DM patients by means of continuous glucose monitoring (CGM. Materials and Methods.  We observed seventy-six hospitalized patients with T2DM, aged 65 to 79 years. Treatment with basal insulin (n=36, premixed insulin (n=12 or basal-bolus insulin regimen (n=28 was followed by metformin (n=44, glimepiride (n=14 and dipeptidyl peptidase-4 inhibitors (n=14. 2-days CGM with retrospective data analysis was performed in all patients. During CGM, three fasting and three 2-h postprandial finger-prick glucose values were obtained daily with portable glucose meter. Results.  Hypoglycemia (identified as blood glucose

Spatial relationship between tumor perfusion and endogeneous glucose distribution

International Nuclear Information System (INIS)

Schroeder, T.; Larrier, N.; Viglianti, B.; Rabbani, Z.N.; Peltz, C.; Vujascovic, Z.; Dewhirst, M.W.

2003-01-01

Earlier studies detecting glucose in tissue and solid tumors by bioluminescence imaging suggested, that glucose distribution patterns may be spatially related to functional vascularity. The purpose of this study was to evaluate this relationship by comparing glucose distribution patterns as determined by bioluminescence imaging to perfusion patterns of endogeneous Hoechst 33342 in rats bearing mammary carcinomas. R 3230 mammary carcinoma cells have been implanted subcutaneously into 7 female Fischer 344 rats. Two months post implantation, after injection of Hoechst 33342 the tumors were removed and snap frozen to conserve metabolite levels. Concomitantly, blood was sampled from the animals for analysis of glucose concentrations using a micodialysis analyzer. Cryosections of the tumors have been prepared, and every slice has been analyzed for both, Hoechst binding by fluorescence microscopy, and for glucose distribution patterns using bioluminescence imaging. In many cases vascular structures could be retrieved by the spatial pattern of glucose distribution. In some cases however, higher glucose concentrations could be found independent from Hoechst signal. On the other hand, regions of high Hoechst signal are not necessarily correlated with high glucose concentrations. When comparing blood and tissue glucose levels, tissue glucose content as measured with bioluminescence imaging (1.9-3.5 mM) is considerably lower than blood glucose (5.6-8.0 mM), demonstrating the expected gradient from blood to tissue. This study demonstrates the feasibility of monitoring glucose gradients in relation to functional vasculature throughout the body, from blood down to tissue or tumor and further, throughout the microenvironment of the solid tumor. Glucose distribution patterns may be an important tool in perfusion studies, e. g. in detecting the direction of blood flow in ex-vivo samples or in estimating glucose consumption rates of tumor cells adjacent to or in between perfused

Cost calculation for a flash glucose monitoring system for UK adults with type 1 diabetes mellitus receiving intensive insulin treatment.

Science.gov (United States)

Hellmund, Richard; Weitgasser, Raimund; Blissett, Deirdre

2018-04-01

To estimate the costs associated with a flash glucose monitoring system as a replacement for routine self-monitoring of blood glucose (SMBG) in patients with type 1 diabetes mellitus (T1DM) using intensive insulin, from a UK National Health Service (NHS) perspective. The base-case cost calculation was created using the maximum frequency of glucose monitoring recommended by the 2015 National Institute for Health and Care Excellence guidelines (4-10 tests per day). Scenario analyses considered SMBG at the frequency observed in the IMPACT clinical trial (5.6 tests per day) and at the frequency of flash monitoring observed in a real-world analysis (16 tests per day). A further scenario included potential costs associated with severe hypoglycaemia. In the base case, the annual cost per patient using flash monitoring was £234 (19%) lower compared with routine SMBG (10 tests per day). In scenario analyses, the annual cost per patient of flash monitoring compared with 5.6 and 16 SMBG tests per day was £296 higher and £957 lower, respectively. The annual cost of severe hypoglycaemia for flash monitoring users was estimated to be £221 per patient, compared with £428 for routine SMBG users (based on 5.6 tests/day), corresponding to a reduction in costs of £207. The flash monitoring system has a modest impact on glucose monitoring costs for the UK NHS for patients with T1DM using intensive insulin. For people requiring frequent tests, flash monitoring may be cost saving, especially when taking into account potential reductions in the rate of severe hypoglycaemia. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Nocturnal hypoglycemia identified by a continuous glucose monitoring system in patients with primary adrenal insufficiency (Addison's Disease).

Science.gov (United States)

Meyer, Gesine; Hackemann, Annika; Reusch, Juergen; Badenhoop, Klaus

2012-05-01

Hypoglycemia can be a symptom in patients with Addison's disease. The common regimen of replacement therapy with oral glucocorticoids results in unphysiological low cortisol levels in the early morning, the time of highest insulin sensitivity. Therefore patients with Addison's disease are at risk for unrecognized and potentially severe nocturnal hypoglycemia also because of a disturbed counterregulatory function. Use of a continuous glucose monitoring system (CGMS) could help to adjust hydrocortisone treatment and to avoid nocturnal hypoglycemia in these patients. Thirteen patients with Addison's disease were screened for hypoglycemia wearing a CGMS for 3-5 days. In one patient we identified a hypoglycemic episode at 3:45 a.m. with a blood glucose level of 46 mg/dL, clearly beneath the 95% tolerance interval of minimal glucose levels between 2 and 4 a.m. (53.84 mg/dL). After the hydrocortisone replacement scheme was changed, the minimum blood glucose level between 2 and 4 a.m. normalized to 87 mg/dL. Continuous glucose monitoring can detect nocturnal hypoglycemia in patients with primary adrenal insufficiency and hence prevent in these patients an impaired quality of life and even serious adverse effects.

Comparison of lancing devices for self-monitoring of blood glucose regarding lancing pain.

Science.gov (United States)

Kocher, Serge; Tshiananga, J K Tshiang; Koubek, Richard

2009-09-01

Self-monitoring of blood glucose empowers diabetes patients to effectively control their blood glucose (BG) levels. A potential barrier to frequent BG controls is lancing pain, intrinsically linked to pricking the finger several times a day. In this study, we compared different state-of-the-art lancing devices from leading manufacturers regarding lancing pain, and we intended to identify lancing devices that are less painful. First, 165 subjects compared 6 different BG monitoring systems-consisting of a lancing device and a BG meter-at home for 36 days and at least 3 BG tests per day. Second, the subjects directly compared 6 different lancing devices-independent from a BG meter-in a laboratory setting. The test results were collected in questionnaires, and lancing pain was rated on a numerical rating scale. One hundred fifty-seven subjects were included in the analysis. Accu-Chek BG monitoring systems were significantly (p competitor BG monitoring systems and were rated by >50% of the subjects as "less painful" than competitor BG monitoring systems. Accu-Chek lancing devices were significantly (p competitor lancing devices and were rated by >60% of the subjects as "less painful" than competitor lancing devices. We found significant differences in lancing pain between lancing devices. Diabetes patients clearly preferred lancing devices that cause less lancing pain. In order to improve patient compliance with respect to an adequate glycemic control, the medical staff should preferentially prescribe lancing devices that cause less lancing pain. 2009 Diabetes Technology Society.

Assessment of three frequently used blood glucose monitoring devices in clinical routine.

Science.gov (United States)

Zueger, Thomas; Schuler, Vanessa; Stettler, Christoph; Diem, Peter; Christ, Emanuel R

2012-07-12

Self-monitoring of blood glucose plays an important role in the management of diabetes and has been shown to improve metabolic control. The use of blood glucose meters in clinical practice requires sufficient reliability to allow adequate treatment. Direct comparison of different blood glucose meters in clinical practice, independent of the manufactures is scarce. We, therefore, aimed to evaluate three frequently used blood glucose meters in daily clinical practice. Capillary blood glucose was measured simultaneous using the following glucose meters: Contour® (Bayer Diabetes Care, Zürich, Switzerland), Accu-Chek® aviva (Roche Diagnostics, Rotkreuz, Switzerland), Free-Style® lite (Abbott Diabetes Care, Baar, Switzerland). The reference method consisted of the HemoCue® Glucose 201+ System (HemoCue® AB, Ängelholm, Sweden) with plasma conversion. The devices were assessed by comparison of the Mean Absolute Relative Differences (MARD), the Clarke Error Grid Analysis (EGA) and the compliance with the International Organization of Standardization criteria (ISO 15197:2003). Capillary blood samples were obtained from 150 patients. MARD was 10.1 ± 0.65%, 7.0 ± 0.62% and 7.8 ± 0.48% for Contour®, Accu-Chek® and Free-Style®, respectively. EGA showed 99.3% (Contour®), 98.7% (Accu-Chek®) and 100% (Free-Style®) of all measurements in zone A and B (clinically acceptable). The ISO criteria were fulfilled by Accu-Chek® (95.3%) and Free-Style® (96%), but not by Contour® (92%). In the present study the three glucose meters provided good agreement with the reference and reliable results in daily clinical routine. Overall, the Free-Style® and Accu-Chek® device slightly outperformed the Contour® device.

Glucose concentrations modulate brain-derived neurotrophic factor responsiveness of neurones in the paraventricular nucleus of the hypothalamus.

Science.gov (United States)

McIsaac, W; Ferguson, A V

2017-04-01

The hypothalamic paraventricular nucleus (PVN) is critical for normal energy balance and has been shown to contain high levels of both brain-derived neurotrophic factor (BDNF) and tropomyosin-receptor kinase B mRNA. Microinjections of BDNF into the PVN increase energy expenditure, suggesting that BDNF plays an important role in energy homeostasis through direct actions in this nucleus. The present study aimed to examine the postsynaptic effects of BDNF on the membrane potential of PVN neurones, and also to determine whether extracellular glucose concentrations modulated these effects. We used hypothalamic PVN slices from male Sprague-Dawley rats to perform whole cell current-clamp recordings from PVN neurones. BDNF was bath applied at a concentration of 2 nmol L -1 and the effects on membrane potential determined. BDNF caused depolarisations in 54% of neurones (n=25; mean±SEM, 8.9±1.2 mV) and hyperpolarisations in 23% (n=11; -6.7±1.4 mV), whereas the remaining cells were unaffected. These effects were maintained in the presence of tetrodotoxin (n=9; 56% depolarised, 22% hyperpolarised, 22% nonresponders), or the GABA a antagonist bicuculline (n=12; 42% depolarised, 17% hyperpolarised, 41% nonresponders), supporting the conclusion that these effects on membrane potential were postsynaptic. Current-clamp recordings from PVN neurones next examined the effects of BDNF on these neurones at varying extracellular glucose concentrations. Larger proportions of PVN neurones hyperpolarised in response to BDNF as the glucose concentrations decreased [10 mmol L -1 glucose 23% (n=11) of neurones hyperpolarised, whereas, at 0.2 mmol L -1 glucose, 71% showed hyperpolarising effects (n=12)]. Our findings reveal that BDNF has direct GABA A independent effects on PVN neurones, which are modulated by local glucose concentrations. The latter observation further emphasises the critical importance of using physiologically relevant conditions in an investigation of the central

Invasiveness as a barrier to self-monitoring of blood glucose in diabetes.

Science.gov (United States)

Wagner, Julie; Malchoff, Carl; Abbott, Gina

2005-08-01

This study investigated the degree to which the invasive characteristic of glucose monitoring is a barrier to self-monitoring of blood glucose (SMBG). A paper-and-pencil Measure of Invasiveness as a reason for Skipping SMBG (MISS) was created and administered to 339 people with diabetes. The correlations between MISS scores and actual SMBG frequency, percent adherence to SMBG recommendations, SMBG anxiety, SMBG burden, and knowledge of the importance of glycemic control for avoiding diabetes complications were each explored. On a scale of 0-28, the average MISS score was M = 4.3 (SD = 5.4, range 0-28). Fully 63% (nearly two-thirds) of respondents reported skipping SMBG because of the invasiveness of the procedure. MISS scores were negatively related to percent adherence to healthcare provider SMBG recommendations as measured by memory function of automated meters (Spearman's r= -0.47, P diabetes vascular complications. Invasiveness is a common and serious barrier to SMBG. These findings suggest that people with diabetes would perform SMBG more frequently and have improved quality of life with non-invasive SMBG.

Glucose transport and milk secretion during manipulated plasma insulin and glucose concentrations and during LPS-induced mastitis in dairy cows.

Science.gov (United States)

Gross, J J; van Dorland, H A; Wellnitz, O; Bruckmaier, R M

2015-08-01

In dairy cows, glucose is essential as energy source and substrate for milk constituents. The objective of this study was to investigate effects of long-term manipulated glucose and insulin concentrations in combination with a LPS-induced mastitis on mRNA abundance of glucose transporters and factors involved in milk composition. Focusing on direct effects of insulin and glucose without influence of periparturient endocrine adaptations, 18 dairy cows (28 ± 6 weeks of lactation) were randomly assigned to one of three infusion treatments for 56 h (six animals each). Treatments included a hyperinsulinemic hypoglycaemic clamp (HypoG), a hyperinsulinemic euglycaemic clamp (EuG) and a control group (NaCl). After 48 h of infusions, an intramammary challenge with LPS from E. coli was performed and infusions continued for additional 8 h. Mammary gland biopsies were taken before, at 48 (before LPS challenge) and at 56 h (after LPS challenge) of infusion, and mRNA abundance of genes involved in mammary gland metabolism was measured by RT-qPCR. During the 48 h of infusions, mRNA abundance of glucose transporters GLUT1, 3, 4, 8, 12, SGLT1, 2) was not affected in HypoG, while they were downregulated in EuG. The mRNA abundance of alpha-lactalbumin, insulin-induced gene 1, κ-casein and acetyl-CoA carboxylase was downregulated in HypoG, but not affected in EuG. Contrary during the intramammary LPS challenge, most of the glucose transporters were downregulated in NaCl and HypoG, but not in EuG. The mRNA abundance of glucose transporters in the mammary gland seems not to be affected by a shortage of glucose, while enzymes and milk constituents directly depending on glucose as a substrate are immediately downregulated. During LPS-induced mastitis in combination with hypoglycaemia, mammary gland metabolism was more aligned to save glucose for the immune system compared to a situation without limited glucose availability during EuG. Journal of Animal Physiology and Animal

Effects of self-monitoring of glucose in non-insulin treated patients with type 2 diabetes: design of the IN CONTROL-trial

NARCIS (Netherlands)

Malanda, U.L.; Bot, S.D.M.; Kostense, P.J.; Snoek, F.J.; Dekker, J.M.; Nijpels, M.G.A.A.M.

2009-01-01

or = 7.0%, and not using insulin will be recruited and randomized into 3 groups; Self-monitoring of Blood Glucose (SMBG), Self-monitoring of Urine Glucose (SMUG) and usual care (n = 200 per group). Participants are eligible if they have a known disease duration of over 1 year and have used SMBG or

High glucose concentration induces endothelial cell proliferation by regulating cyclin-D2-related miR-98.

Science.gov (United States)

Li, Xin-Xin; Liu, Yue-Mei; Li, You-Jie; Xie, Ning; Yan, Yun-Fei; Chi, Yong-Liang; Zhou, Ling; Xie, Shu-Yang; Wang, Ping-Yu

2016-06-01

Cyclin D2 is involved in the pathology of vascular complications of type 2 diabetes mellitus (T2DM). This study investigated the role of cyclin-D2-regulated miRNAs in endothelial cell proliferation of T2DM. Results showed that higher glucose concentration (4.5 g/l) significantly promoted the proliferation of rat aortic endothelial cells (RAOECs), and significantly increased the expression of cyclin D2 and phosphorylation of retinoblastoma 1 (p-RB1) in RAOECs compared with those under low glucose concentration. The cyclin D2-3' untranslated region is targeted by miR-98, as demonstrated by miRNA analysis software. Western blot also confirmed that cyclin D2 and p-RB1 expression was regulated by miR-98. The results indicated that miR-98 treatment can induce RAOEC apoptosis. The suppression of RAOEC growth by miR-98 might be related to regulation of Bcl-2, Bax and Caspase 9 expression. Furthermore, the expression levels of miR-98 decreased in 4.5 g/l glucose-treated cells compared with those treated by low glucose concentration. Similarly, the expression of miR-98 significantly decreased in aortas of established streptozotocin (STZ)-induced diabetic rat model compared with that in control rats; but cyclin D2 and p-RB1 levels remarkably increased in aortas of STZ-induced diabetic rats compared with those in healthy control rats. In conclusion, this study demonstrated that high glucose concentration induces cyclin D2 up-regulation and miR-98 down-regulation in the RAOECs. By regulating cyclin D2, miR-98 can inhibit human endothelial cell growth, thereby providing novel therapeutic targets for vascular complication of T2DM. © 2016 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

Clinical implication of blood glucose monitoring in general dental offices: the Ehime Dental Diabetes Study

OpenAIRE

Harase, Tadahiro; Nishida, Wataru; Hamakawa, Tomohiro; Hino, Satoshi; Shigematsu, Kenji; Kobayashi, Satoru; Sako, Hirofumi; Ito, Shirou; Murakami, Hajime; Nishida, Kei; Inoue, Hiroshi; Fujisawa, Masahito; Yoshizu, Hiroshi; Kawamura, Ryoichi; Takata, Yasunori

2015-01-01

Objective We examined whether general dentists can contribute to the detection of patients with undiagnosed diabetes and prediabetes by monitoring blood glucose in dental clinics. Research design and methods A total of 716 patients who visited clinics for dental treatment were enrolled and classified into 3 groups (mild, moderate, and severe) according to Kornman's criteria for periodontitis. The correlations between the casual blood glucose level, presence or absence of the history of diabet...

High Glucose Concentration Promotes Vancomycin-Enhanced Biofilm Formation of Vancomycin-Non-Susceptible Staphylococcus aureus in Diabetic Mice.

Directory of Open Access Journals (Sweden)

Chi-Yu Hsu

Full Text Available We previously demonstrated that vancomycin treatment increased acquisition of eDNA and enhanced biofilm formation of drug-resistant Staphylococcus aureus through a cidA-mediated autolysis mechanism. Recently we found that such enhancement became more significant under a higher glucose concentration in vitro. We propose that besides improper antibiotic treatment, increased glucose concentration environment in diabetic animals may further enhance biofilm formation of drug-resistant S. aureus. To address this question, the diabetic mouse model infected by vancomycin-resistant S. aureus (VRSA was used under vancomycin treatment. The capacity to form biofilms was evaluated through a catheter-associated biofilm assay. A 10- and 1000-fold increase in biofilm-bound bacterial colony forming units was observed in samples from diabetic mice without and with vancomycin treatment, respectively, compared to healthy mice. By contrast, in the absence of glucose vancomycin reduced propensity to form biofilms in vitro through the increased production of proteases and DNases from VRSA. Our study highlights the potentially important role of increased glucose concentration in enhancing biofilm formation in vancomycin-treated diabetic mice infected by drug-resistant S. aureus.

User Performance Evaluation of Four Blood Glucose Monitoring Systems Applying ISO 15197:2013 Accuracy Criteria and Calculation of Insulin Dosing Errors.

Science.gov (United States)

Freckmann, Guido; Jendrike, Nina; Baumstark, Annette; Pleus, Stefan; Liebing, Christina; Haug, Cornelia

2018-04-01

The international standard ISO 15197:2013 requires a user performance evaluation to assess if intended users are able to obtain accurate blood glucose measurement results with a self-monitoring of blood glucose (SMBG) system. In this study, user performance was evaluated for four SMBG systems on the basis of ISO 15197:2013, and possibly related insulin dosing errors were calculated. Additionally, accuracy was assessed in the hands of study personnel. Accu-Chek ® Performa Connect (A), Contour ® plus ONE (B), FreeStyle Optium Neo (C), and OneTouch Select ® Plus (D) were evaluated with one test strip lot. After familiarization with the systems, subjects collected a capillary blood sample and performed an SMBG measurement. Study personnel observed the subjects' measurement technique. Then, study personnel performed SMBG measurements and comparison measurements. Number and percentage of SMBG measurements within ± 15 mg/dl and ± 15% of the comparison measurements at glucose concentrations performed by lay-users. The study was registered at ClinicalTrials.gov (NCT02916576). Ascensia Diabetes Care Deutschland GmbH.

Unannounced Meals in the Artificial Pancreas: Detection Using Continuous Glucose Monitoring

Directory of Open Access Journals (Sweden)

Charrise M. Ramkissoon

2018-03-01

Full Text Available The artificial pancreas (AP system is designed to regulate blood glucose in subjects with type 1 diabetes using a continuous glucose monitor informed controller that adjusts insulin infusion via an insulin pump. However, current AP developments are mainly hybrid closed-loop systems that include feed-forward actions triggered by the announcement of meals or exercise. The first step to fully closing the loop in the AP requires removing meal announcement, which is currently the most effective way to alleviate postprandial hyperglycemia due to the delay in insulin action. Here, a novel approach to meal detection in the AP is presented using a sliding window and computing the normalized cross-covariance between measured glucose and the forward difference of a disturbance term, estimated from an augmented minimal model using an Unscented Kalman Filter. Three different tunings were applied to the same meal detection algorithm: (1 a high sensitivity tuning, (2 a trade-off tuning that has a high amount of meals detected and a low amount of false positives (FP, and (3 a low FP tuning. For the three tunings sensitivities 99 ± 2%, 93 ± 5%, and 47 ± 12% were achieved, respectively. A sensitivity analysis was also performed and found that higher carbohydrate quantities and faster rates of glucose appearance result in favorable meal detection outcomes.

Polymer optical fiber compound parabolic concentrator tip for enhanced coupling efficiency for fluorescence based glucose sensors

DEFF Research Database (Denmark)

Hassan, Hafeez Ul; Nielsen, Kristian; Aasmul, Søren

2015-01-01

We demonstrate that the light excitation and capturing efficiency of fluorescence based fiber-optical sensors can be significantly increased by using a CPC (Compound Parabolic Concentrator) tip instead of the standard plane-cut tip. We use Zemax modelling to find the optimum CPC tip profile...... and fiber length of a polymer optical fiber diabetes sensor for continuous monitoring of glucose levels. We experimentally verify the improved performance of the CPC tipped sensor and the predicted production tolerances. Due to physical size requirements when the sensor has to be inserted into the body...... a non-optimal fiber length of 35 mm is chosen. For this length an average improvement in efficiency of a factor of 1.7 is experimentally demonstrated and critically compared to the predicted ideal factor of 3 in terms of parameters that should be improved through production optimization....

Polymer optical fiber compound parabolic concentrator tip for enhanced coupling efficiency for fluorescence based glucose sensors.

Science.gov (United States)

Hassan, Hafeez Ul; Nielsen, Kristian; Aasmul, Soren; Bang, Ole

2015-12-01

We demonstrate that the light excitation and capturing efficiency of fluorescence based fiber-optical sensors can be significantly increased by using a CPC (Compound Parabolic Concentrator) tip instead of the standard plane-cut tip. We use Zemax modelling to find the optimum CPC tip profile and fiber length of a polymer optical fiber diabetes sensor for continuous monitoring of glucose levels. We experimentally verify the improved performance of the CPC tipped sensor and the predicted production tolerances. Due to physical size requirements when the sensor has to be inserted into the body a non-optimal fiber length of 35 mm is chosen. For this length an average improvement in efficiency of a factor of 1.7 is experimentally demonstrated and critically compared to the predicted ideal factor of 3 in terms of parameters that should be improved through production optimization.

Novel glucose fiber sensor combining ThFBG with GOD

Science.gov (United States)

Li, Mengmeng; Zhou, Ciming; Fan, Dian; Ou, Yiwen

2016-10-01

We propose a novel glucose fiber optic sensor combining a thinned cladding fiber Bragg grating (ThFBG) with glucose oxidase (GOD). By immobilizing GOD on the surface of a ThFBG, the fabricated sensor can obtain a high specificity to glucose. Because of the evanescent field, the sensor is very sensitive to the ambient refractive index change arising from the catalytic reaction between glucose and GOD. A four-level fiber model was simulated and verified the precision of the sensing principle. Two methods, glutaraldehyde crosslinking method (GCM) and 3-aminopropyl triethoxysilane covalent coupling method (ATCCM), were experimentally utilized to immobilize GOD. And sensor fabricated with the method ATCCM shows a measurement range of 0-0.82 mg/mL which is better than the sensor fabricated with the method GCM with measurement range of 0-0.67 mg/mL under the same condition. By using ATCCM to immobilize GOD with different concentrations, three sensors were fabricated and used for glucose measurement by monitoring the Bragg wavelength (λb) shifts, the results indicate a good linear relationship between wavelength shift and glucose concentration within a specific range, and the measurement range increases as GOD concentration increases. The highest sensitivity of sensor reaches up to 0.0549 nm/(mg.mL-1). The proposed sensor has distinct advantages in sensing structure, cost and specificity.

Glucose concentration and blood acid-basis status in high-yielding dairy cows during heat stress

Directory of Open Access Journals (Sweden)

Vujanac Ivan

2011-01-01

Full Text Available The objective of this work was to examine the effect of heat stress on glucose and pH values in blood of high-yielding dairy cows in the early stage of lactation, as well as to determine whether the changes in these parameters are interdependent under such conditions. An experiment was performed on high-yielding dairy cows during the summer and the spring periods. Forty cows were selected, twenty each for the two periods under investigation. In the course of the experiment, the temperature humidity index (THI was determined for the entire period of investigations, and then also the average daily THI, nightmorning THI (average value of hourly THI measured from 22h on the previous day until 10h of the current day, as well as the day-night THI (average value of hourly THI measured during the period from 10h to 22h of the current day. The pH and glucose concentration were determined in blood samples taken in the morning and afternoon of days 30, 60, and 90 of lactation during the spring and summer periods of the investigations. Based on the results for the THI, it was established that the animals were not exposed to the effect of extreme heat stress during the spring period of investigations, while they were periodically exposed to moderate but also extreme heat stress during the summer, in particular in the afternoon hours. It can be concluded from the results obtained for the blood pH that the cows were in respiratory alkalosis during the summer in the morning and afternoon hours on day 30, in the afternoon hours of days 60 and 90 of lactation, as well as in the afternoon on day 90 of lactation during the spring period of investigations. During the summer period, there were no statistically significant differences between the pH value determined in the morning and afternoon hours on day 30 of lactation, while the pH value was significantly higher in the afternoon hours than in the morning hours on days 60 and 90 of lactation. There were no

Alizarin Complexone Functionalized Mesoporous Silica Nanoparticles: A Smart System Integrating Glucose-Responsive Double-Drugs Release and Real-Time Monitoring Capabilities.

Science.gov (United States)

Zou, Zhen; He, Dinggeng; Cai, Linli; He, Xiaoxiao; Wang, Kemin; Yang, Xue; Li, Liling; Li, Siqi; Su, Xiaoya

2016-04-06

The outstanding progress of nanoparticles-based delivery systems capable of releasing hypoglycemic drugs in response to glucose has dramatically changed the outlook of diabetes management. However, the developed glucose-responsive systems have not offered real-time monitoring capabilities for accurate quantifying hypoglycemic drugs released. In this study, we present a multifunctional delivery system that integrates both delivery and monitoring issues using glucose-triggered competitive binding scheme on alizarin complexone (ALC) functionalized mesoporous silica nanoparticles (MSN). In this system, ALC is modified on the surface of MSN as the signal reporter. Gluconated insulin (G-Ins) is then introduced onto MSN-ALC via benzene-1,4-diboronic acid (BA) mediated esterification reaction, where G-Ins not only blocks drugs inside the mesopores but also works as a hypoglycemic drug. In the absence of glucose, the sandwich-type boronate ester structure formed by BA binding to the diols of ALC and G-Ins remains intact, resulting in an fluorescence emission peak at 570 nm and blockage of pores. Following a competitive binding, the presence of glucose cause the dissociation of boronate ester between ALC and BA, which lead to the pores opening and disappearance of fluorescence. As proof of concept, rosiglitazone maleate (RSM), an insulin-sensitizing agent, was doped into the MSN to form a multifunctional MSN (RSM@MSN-ALC-BA-Ins), integrating with double-drugs loading, glucose-responsive performance, and real-time monitoring capability. It has been demonstrated that the glucose-responsive release behaviors of insulin and RSM in buffer or in human serum can be quantified in real-time through evaluating the changes of fluorescence signal. We believe that this developed multifunctional system can shed light on the invention of a new generation of smart nanoformulations for optical diagnosis, individualized treatment, and noninvasive monitoring of diabetes management.

No relationship between cerebral blood flow velocity and cerebrovascular reserve capacity and contemporaneously measured glucose and insulin concentrations in diabetes mellitus

NARCIS (Netherlands)

Fülesdi, B.; Limburg, M.; Bereczki, D.; Molnár, C.; Michels, R. P.; Leányvári, Z.; Csiba, L.

1999-01-01

Blood glucose and insulin concentrations have been reported to influence cerebral hemodynamics. We studied the relationship between actual blood glucose and insulin concentrations and resting cerebral blood flow velocity in the middle cerebral artery and cerebrovascular reserve capacity after

Dietary patterns predict changes in two-hour post-oral glucose tolerance test plasma glucose concentrations in middle-aged adults.

Science.gov (United States)

Lau, Cathrine; Toft, Ulla; Tetens, Inge; Carstensen, Bendix; Jørgensen, Torben; Pedersen, Oluf; Borch-Johnsen, Knut

2009-03-01

We examined whether the adherence to major dietary patterns at baseline of 5824 nondiabetic Danes (30-60 y) enrolled in the nonpharmacological Inter99 intervention predicted changes in fasting plasma glucose (FPG) and postchallenge 2-h plasma glucose (2h-PG) concentrations during a 5 y period and whether a potential association was dependent on baseline glucose tolerance status. Through principal component analysis, a score for a traditional dietary pattern (characterized by higher intakes of high-fat sandwich spreads, red meat, potatoes, butter and lard, low-fat fish, sandwich meat, and sauces) and a score for a modern dietary pattern (characterized by higher intakes of vegetables, fruit, vegetable oil/vinegar dressing, poultry, pasta, rice, and cereals) were estimated for each person at baseline. Random effect models adjusting for relevant confounders were used to estimate changes in repetitive measures of FPG and 2h-PG. A higher modern score (of 1 SD) predicted an annual decrease in 2h-PG of 0.015 mmol/L (P dressing, poultry, pasta, rice, and cereals.

Slow ultrafiltration for continuous in vivo sampling : application for glucose and lactate in man

NARCIS (Netherlands)

Tiessen, RG; Kaptein, WA; Venema, K; Korf, J

1999-01-01

Background: An ultrafiltration (UF) technique was developed for continuous subcutaneous (s.c.) sampling and on-line analysis of absolute glucose and lactate concentrations in tissue. The relation between subcutaneous and blood concentrations was studied in men, because a subcutaneous monitoring

Evaluation of two methods of rapid blood-glucose monitoring by unskilled personnel during surgery

DEFF Research Database (Denmark)

Madsbad, S; Adelhøj, B; Bigler, Dennis Richard

1984-01-01

The accuracy of two rapid methods of blood-glucose monitoring without (Haemo-glucotest 1-44) and with a reflectance meter (Hypocount B) was compared using a laboratory method. The assessment was carried out by personnel with no previous experience in measuring blood glucose. Eighty-five percent...... of the 92 measurements obtained with the hypocount B were within +/- 20% of the laboratory glucose values. Using haemo-glucotest 1-44 strips, 74% of the readings were within +/- 20% of the reference laboratory values. For values below 5.5 mmol/l, there was a tendency for results to be too low, with 77......% of the readings below laboratory values -20%. All situations with severe hypoglycaemia were detected with both strips. The study also demonstrates the ineffectiveness of s.c. insulin regimens during surgery. Only 47% of the measured blood glucose values were within the range of 5.5-10 mmol/l and two of ten...

Synergistic binding of glucose and aluminium ATP to hexokinase from Saccharomyces cerevisiae.

Science.gov (United States)

Woolfitt, A R; Kellett, G L; Hoggett, J G

1988-08-10

The binding of glucose, AlATP and AlADP to the monomeric and dimeric forms of the native yeast hexokinase PII isoenzyme and to the proteolytically modified SII monomeric form was monitored at pH 6.7 by the concomitant quenching of intrinsic protein fluorescence. No fluorescence changes were observed when free enzyme was mixed with AlATP at concentrations up to 7500 microM. In the presence of saturating concentrations of glucose, the maximal quenching of fluorescence induced by AlATP was between 1.5 and 3.5% depending on species, and the average value of [L]0.5, the concentration of ligand at half-saturation, over all monomeric species was 0.9 +/- 0.4 microM. The presence of saturating concentrations of AlATP diminished [L]0.5 for glucose binding by between 260- and 670-fold for hexokinase PII and SII monomers, respectively (dependent on the ionic strength), and by almost 4000-fold for PII dimer. The data demonstrate extremely strong synergistic interactions in the binding of glucose and AlATP to yeast hexokinase, arising as a consequence of conformational changes in the free enzyme induced by glucose and in enzyme-glucose complex induced by AlATP. The synergistic interactions of glucose and AlATP are related to their kinetic synergism and to the ability of AlATP to act as a powerful inhibitor of the hexokinase reaction.

Carbon Nanotube Yarn-Based Glucose Sensing Artificial Muscle.

Science.gov (United States)

Lee, Junghan; Ko, Sachan; Kwon, Cheong Hoon; Lima, Márcio D; Baughman, Ray H; Kim, Seon Jeong

2016-04-01

Boronic acid (BA), known to be a reversible glucose-sensing material, is conjugated to a nanogel (NG) derived from hyaluronic acid biopolymer and used as a guest material for a carbon multiwalled nanotube (MWNT) yarn. By exploiting the swelling/deswelling of the NG that originates from the internal anionic charge changes resulting from BA binding to glucose, a NG MWNT yarn artificial muscle is obtained that provides reversible torsional actuation that can be used for glucose sensing. This actuator shows a short response time and high sensitivity (in the 5-100 × 10(-3) m range) for monitoring changes in glucose concentration in physiological buffer, without using any additional auxiliary substances or an electrical power source. It may be possible to apply the glucose-sensing MWNT yarn muscles as implantable glucose sensors that automatically release drugs when needed or as an artificial pancreas. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Numerical and clinical precision of continuous glucose monitoring in Colombian patients treated with insulin infusion pump with automated suspension in hypoglycemia.

Science.gov (United States)

Gómez, Ana M; Marín Sánchez, Alejandro; Muñoz, Oscar M; Colón Peña, Christian Alejandro

2015-12-01

Insulin pump therapy associated with continuous glucose monitoring has shown a positive clinical impact on diabetes control and reduction of hypoglycemia episodes. There are descriptions of the performance of this device in other populations, but its precision and accuracy in Colombia and Latin America are unknown, especially in the routine outpatient setting. Data from 33 type 1 and type 2 diabetes patients with sensor-augmented pump therapy with threshold suspend automation, MiniMed Paradigm® Veo™ (Medtronic, Northridge, California), managed at Hospital Universitario San Ignacio (Bogotá, Colombia) and receiving outpatient treatment, were analyzed. Simultaneous data from continuous glucose monitoring and capillary blood glucose were compared, and their precision and accuracy were calculating with different methods, including Clarke error grid. Analyses included 2,262 continuous glucose monitoring -reference paired glucose values. A mean absolute relative difference of 20.1% was found for all measurements, with a value higher than 23% for glucose levels ≤75mg/dL. Global compliance with the ISO criteria was 64.9%. It was higher for values >75mg/dl (68.3%, 1,308 of 1,916 readings), than for those ≤ 75mg/dl (49.4%, 171 of 346 readings). Clinical accuracy, as assessed by the Clarke error grid, showed that 91.77% of data were within the A and B zones (75.6% in hypoglycemia). A good numerical accuracy was found for continuous glucose monitoring in normo and hyperglycemia situations, with low precision in hypoglycemia. The clinical accuracy of the device was adequate, with no significant safety concerns for patients. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Nanomaterials in glucose sensing

CERN Document Server

Burugapalli, Krishna

2013-01-01

The smartness of nano-materials is attributed to their nanoscale and subsequently unique physicochemical properties and their use in glucose sensing has been aimed at improving performance, reducing cost and miniaturizing the sensor and its associated instrumentation. So far, portable (handheld) glucose analysers were introduced for hospital wards, emergency rooms and physicians' offices; single-use strip systems achieved nanolitre sampling for painless and accurate home glucose monitoring; advanced continuous monitoring devices having 2 to 7 days operating life are in clinical and home use; and continued research efforts are being made to develop and introduce increasingly advanced glucose monitoring systems for health as well as food, biotechnology, cell and tissue culture industries. Nanomaterials have touched every aspect of biosensor design and this chapter reviews their role in the development of advanced technologies for glucose sensing, and especially for diabetes. Research shows that overall, nanomat...

Evaluation of Hematocrit Influence on Self-Monitoring of Blood Glucose Based on ISO 15197:2013: Comparison of a Novel System With Five Systems With Different Hematocrit Ranges.

Science.gov (United States)

Hattemer, Andrew; Wardat, Sami

2018-03-01

ISO 15197:2013 recommends testing procedures and acceptance criteria for the evaluation of influence quantities such as hematocrit on measurement results with systems for self-monitoring of blood glucose (SMBG). In this study, hematocrit influence was evaluated for a novel SMBG system (system A) and five other systems with different hematocrit ranges based on ISO 15197:2013. Test procedures were performed with one test strip lot for each system. Each system was tested within the hematocrit range indicated in the manufacturer's labeling (system A: 10-65%, B: 15-65%, C: 20-60%, D: 35-60%, E: 30-60%, F: 30-55%). According to ISO 15197:2013, clause 6.4.2, venous blood samples were used for the evaluation of hematocrit influence. The evaluation was performed for three glucose concentration categories (30-50 mg/dL, 96-144 mg/dL, and 280-420 mg/dL). For each glucose concentration category, at least five different hematocrit levels were investigated. The novel system A and systems B, E, and F complied with the tested lot with the defined criteria and showed ≤10 mg/dL and ≤10% difference between the test sample and the respective control sample with a hematocrit value of 42% ± 2% for BG concentrations 10% difference at glucose concentrations ≥100 mg/dL. Remarkable hematocrit influence within the labeled hematocrit range was obtained in two systems with the tested reagent system lot. Adequate SMBG systems should be carefully chosen by patients and their health care professionals, particularly for patients with increased and decreased hematocrit values.

Comparison of three nonlinear filters for fault detection in continuous glucose monitors.

Science.gov (United States)

Mahmoudi, Zeinab; Wendt, Sabrina Lyngbye; Boiroux, Dimitri; Hagdrup, Morten; Norgaard, Kirsten; Poulsen, Niels Kjolstad; Madsen, Henrik; Jorgensen, John Bagterp

2016-08-01

The purpose of this study is to compare the performance of three nonlinear filters in online drift detection of continuous glucose monitors. The nonlinear filters are the extended Kalman filter (EKF), the unscented Kalman filter (UKF), and the particle filter (PF). They are all based on a nonlinear model of the glucose-insulin dynamics in people with type 1 diabetes. Drift is modelled by a Gaussian random walk and is detected based on the statistical tests of the 90-min prediction residuals of the filters. The unscented Kalman filter had the highest average F score of 85.9%, and the smallest average detection delay of 84.1%, with the average detection sensitivity of 82.6%, and average specificity of 91.0%.

Accuracy evaluation of five blood glucose monitoring systems obtained from the pharmacy: a European multicenter study with 453 subjects

NARCIS (Netherlands)

Tack, C.J.; Pohlmeier, H.; Behnke, T.; Schmid, V.; Grenningloh, M.; Forst, T.; Pfutzner, A.

2012-01-01

BACKGROUND: This multicenter study was conducted to evaluate the performance of five recently introduced blood glucose (BG) monitoring (BGM) devices under daily routine conditions in comparison with the YSI (Yellow Springs, OH) 2300 Stat Plus glucose analyzer. METHODS: Five hundred one diabetes

[A comparison of post-surgical plasma glucose levels in patients on fluids with different glucose concentrations].

Science.gov (United States)

Martínez Carapeto, Isabel; López Castilla, José Domingo; Fresneda Gutiérrez, Reyes

2017-11-11

To compare plasma glucose levels and incidence of hyperglycaemia in the post-operative period after general surgery using fluids with different glucose. A randomised, open-label, non-blind, clinical trial was conducted on patients admitted to Paediatric Intensive Care Unit after elective surgery. The inclusion criteria were from 6 months to 14 years of age, with a weight greater than 6kg, onset glucose level >60mg/dL, and a signed informed consent, with no oral intake and maintenance intravenous fluid therapy using fluids with 3.3% or 5% glucose. Plasma glucose levels were measured before surgery, on admission, and 8, 24, and 48h, with the mean glucose levels and incidence of hyperglycaemia (glucose level >150mg/dL) in both groups being compared. A total of 60 patients received glucose/saline 1/3 (51mEq/L sodium and 33g/L glucose), and 70 glucose/saline 5/0.9% (154mEq/L sodium and 50g/L glucose). Mean glucose levels were higher in the group receiving glucose 5%, with no statistical difference. There was no significant difference in the incidence of hyperglycaemia; 8h: 26% in the 3.3% group vs. 21.3% in the 5% group (P=.63); 24h: 20% vs. 22.7% (P=.8); and 48h: 19% vs. 23.1% (P=.78). The use of fluids with 3.3% glucose in the post-operative period of general surgery maintains mean glucose levels in a similar range to that of patients receiving fluids with 5% glucose, with no difference in the incidence of hyperglycaemia. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Early Glucose Derangement Detected by Continuous Glucose Monitoring and Progression of Liver Fibrosis in Nonalcoholic Fatty Liver Disease: An Independent Predictive Factor?

Science.gov (United States)

Schiaffini, Riccardo; Liccardo, Daniela; Alisi, Anna; Benevento, Danila; Cappa, Marco; Cianfarani, Stefano; Nobili, Valerio

2016-01-01

Glucose derangement has been reported to increase oxidative stress, one of the most important factors underlying the progression of hepatic fibrosis in adults with nonalcoholic fatty liver disease (NAFLD). To date, careful evaluation of the glucose profile in pediatric NAFLD has not been performed. A total of 30 severely obese children (15 males; mean age 12.87 ± 2.19 years) with biopsy-proven NAFLD were enrolled in this study from September to December 2013. All patients underwent anthropometric and laboratory evaluation, including the oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM). Our study reveals some differences between OGTT and CGM in detecting NAFLD children with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). OGTT showed 2 (6.67%) patients with IFG and 1 (3.34%) with IGT, while CGM showed 5 (16.67%) patients with IFG and 6 (20%) with IGT. The daily blood glucose profile positively correlated with the baseline blood glucose (r = 0.39, p = 0.04) and the homeostatic model assessment (r = 0.56, p = 0.05). A positive correlation between hyperglycemia and liver fibrosis was found (r = 0.65, p < 0.05). Mean glucose values (F3-F4 group: 163.2 ± 35.92 mg/dl vs. F1 group: 136.58 ± 46.83 mg/dl and F2 group: 154.12 ± 22.51 mg/dl) and the difference between the minimum and maximum blood glucose levels (F3-F4 group: 110.21 ± 25.26 mg/dl vs. F1 group: 91.67 ± 15.97 mg/dl and F2 group: 92 ± 15.48 mg/dl) were significantly (p < 0.05) higher in the F3-F4 group compared to the F1 and F2 groups. Glucose profile derangement as detected by CGM is associated with the severity of hepatic fibrosis in children with NAFLD. © 2015 S. Karger AG, Basel.

Accuracy and reliability of continuous glucose monitoring systems: a head-to-head comparison

NARCIS (Netherlands)

Luijf, Yoeri M.; Mader, Julia K.; Doll, Werner; Pieber, Thomas; Farret, Anne; Place, Jerome; Renard, Eric; Bruttomesso, Daniela; Filippi, Alessio; Avogaro, Angelo; Arnolds, Sabine; Benesch, Carsten; Heinemann, Lutz; DeVries, J. Hans

2013-01-01

This study assessed the accuracy and reliability of three continuous glucose monitoring (CGM) systems. We studied the Animas® (West Chester, PA) Vibe™ with Dexcom® (San Diego, CA) G4™ version A sensor (G4A), the Abbott Diabetes Care (Alameda, CA) Freestyle® Navigator I (NAV), and the Medtronic

Smart point-of-care systems for molecular diagnostics based on nanotechnology: whole blood glucose analysis

Science.gov (United States)

Devadhasan, Jasmine P.; Kim, Sanghyo

2015-07-01

Complementary metal oxide semiconductor (CMOS) image sensors are received great attention for their high efficiency in biological applications. The present work describes a CMOS image sensor-based whole blood glucose monitoring system through a point-of-care (POC) approach. A simple poly-ethylene terephthalate (PET) film chip was developed to carry out the enzyme kinetic reaction at various concentrations of blood glucose. In this technique, assay reagent was adsorbed onto amine functionalized silica (AFSiO2) nanoparticles in order to achieve glucose oxidation on the PET film chip. The AFSiO2 nanoparticles can immobilize the assay reagent with an electrostatic attraction and eased to develop the opaque platform which was technically suitable chip to analyze by the camera module. The oxidized glucose then produces a green color according to the glucose concentration and is analyzed by the camera module as a photon detection technique. The photon number decreases with increasing glucose concentration. The simple sensing approach, utilizing enzyme immobilized AFSiO2 nanoparticle chip and assay detection method was developed for quantitative glucose measurement.

Fluorescent blood glucose monitor by hemin-functionalized graphene quantum dots based sensing system

Energy Technology Data Exchange (ETDEWEB)

He, Yuezhen; Wang, Xiaoxun; Sun, Jian; Jiao, Shoufeng; Chen, Hongqi; Gao, Feng; Wang, Lun, E-mail: wanglun@mail.ahnu.edu.cn

2014-01-31

Graphical abstract: -- Highlights: •Hemin is assembled onto the surfaces of graphene quantum dots (GQDs). •With the aid of hemin, H{sub 2}O{sub 2} could quench the FL signal of GQDs obviously. •Based on this effect, a fluorescent platform is proposed for the sensing of glucose. •The proposed method provides a new pathway to explore practical application of GQDs. -- Abstract: In the present work, a highly sensitive and specific fluorescent biosensor for blood glucose monitoring is developed based on hemin-functionalized graphene quantum dots (GQDs) and glucose oxidase (GOx) system. The GQDs which are simply prepared by pyrolyzing citric acid exhibit strong fluorescence and good water-solubility. Due to the noncovalent assembly between hemin and GQDs, the addition of hemin can make hydrogen peroxide (H{sub 2}O{sub 2}) to destroy the passivated surface of GQDs, leading to significant fluorescence quenching of GQDs. Based on this effect, a novel fluorescent platform is proposed for the sensing of glucose. Under the optimized conditions, the linear range of glucose is from 9 to 300 μM, and the limit of detection is 0.1 μM. As unique properties of GQDs, the proposed biosensor is green, simple, cost-efficient, and it is successfully applied to the determination of glucose in human serum. In addition, the proposed method provides a new pathway to further design the biosensors based on the assembly of GQDs with hemin for detection of biomolecules.

The Performance and Usability of a Factory-Calibrated Flash Glucose Monitoring System.

Science.gov (United States)

Bailey, Timothy; Bode, Bruce W; Christiansen, Mark P; Klaff, Leslie J; Alva, Shridhara

2015-11-01

The purpose of the study was to evaluate the performance and usability of the FreeStyle(®) Libre™ Flash glucose monitoring system (Abbott Diabetes Care, Alameda, CA) for interstitial glucose results compared with capillary blood glucose results. Seventy-two study participants with type 1 or type 2 diabetes were enrolled by four U.S. clinical sites. A sensor was inserted on the back of each upper arm for up to 14 days. Three factory-only calibrated sensor lots were used in the study. Sensor glucose measurements were compared with capillary blood glucose (BG) results (approximately eight per day) obtained using the BG meter built into the reader (BG reference) and with the YSI analyzer (Yellow Springs Instrument, Yellow Springs, OH) reference tests at three clinic visits (32 samples per visit). Sensor readings were masked to the participants. The accuracy of the results was demonstrated against capillary BG reference values, with 86.7% of sensor results within Consensus Error Grid Zone A. The percentage of readings within Consensus Error Grid Zone A on Days 2, 7, and 14 was 88.4%, 89.2%, and 85.2%, respectively. The overall mean absolute relative difference was 11.4%. The mean lag time between sensor and YSI reference values was 4.5±4.8 min. Sensor accuracy was not affected by factors such as body mass index, age, type of diabetes, clinical site, insulin administration, or hemoglobin A1c. Interstitial glucose measurements with the FreeStyle Libre system were found to be accurate compared with capillary BG reference values, with accuracy remaining stable over 14 days of wear and unaffected by patient characteristics.

Real-time continuous glucose monitoring as a tool to prevent severe hypoglycaemia in selected pregnant women with Type 1 diabetes

DEFF Research Database (Denmark)

Secher, A L; Stage, E; Ringholm, Lene

2014-01-01

AIMS: Among women with Type 1 diabetes who have had severe hypoglycaemia the year before pregnancy, 70% also experience this complication in pregnancy, and particularly in the first half of pregnancy. We evaluated whether routine use of real-time continuous glucose monitoring from early pregnancy...... onwards could prevent severe hypoglycaemia in these women. METHODS: All 136 consecutive pregnant women with Type 1 diabetes referred to our centre were asked about severe hypoglycaemic events in the year before pregnancy and early in pregnancy at their first antenatal visit. Women with a relevant recent...... history were informed about their additional high risk of severe hypoglycaemia, their treatment was focused on restricted insulin doses during the first 16 gestational weeks, and they were offered real-time continuous glucose monitoring on top of self-monitored plasma glucose measurements. RESULTS: Among...

Effect of chronic hypoglycaemia on glucose concentration and glycogen content in rat brain: a localized 13C NMR study

OpenAIRE

Lei, Hongxia; Gruetter, Rolf

2006-01-01

While chronic hypoglycaemia has been reported to increase unidirectional glucose transport across the blood-brain barrier (BBB) and to increase GLUT1 expression at the endothelium, the effect on steady-state brain d-glucose and brain glycogen content is currently unknown. Brain glucose and glycogen concentrations were directly measured in vivo using localized 13C magnetic resonance spectroscopy (MRS) following 12-14 days of hypoglycaemia. Brain glucose content was significantly increased by 4...

Assessing sensor accuracy for non-adjunct use of continuous glucose monitoring.

Science.gov (United States)

Kovatchev, Boris P; Patek, Stephen D; Ortiz, Edward Andrew; Breton, Marc D

2015-03-01

The level of continuous glucose monitoring (CGM) accuracy needed for insulin dosing using sensor values (i.e., the level of accuracy permitting non-adjunct CGM use) is a topic of ongoing debate. Assessment of this level in clinical experiments is virtually impossible because the magnitude of CGM errors cannot be manipulated and related prospectively to clinical outcomes. A combination of archival data (parallel CGM, insulin pump, self-monitoring of blood glucose [SMBG] records, and meals for 56 pump users with type 1 diabetes) and in silico experiments was used to "replay" real-life treatment scenarios and relate sensor error to glycemic outcomes. Nominal blood glucose (BG) traces were extracted using a mathematical model, yielding 2,082 BG segments each initiated by insulin bolus and confirmed by SMBG. These segments were replayed at seven sensor accuracy levels (mean absolute relative differences [MARDs] of 3-22%) testing six scenarios: insulin dosing using sensor values, threshold, and predictive alarms, each without or with considering CGM trend arrows. In all six scenarios, the occurrence of hypoglycemia (frequency of BG levels ≤50 mg/dL and BG levels ≤39 mg/dL) increased with sensor error, displaying an abrupt slope change at MARD =10%. Similarly, hyperglycemia (frequency of BG levels ≥250 mg/dL and BG levels ≥400 mg/dL) increased and displayed an abrupt slope change at MARD=10%. When added to insulin dosing decisions, information from CGM trend arrows, threshold, and predictive alarms resulted in improvement in average glycemia by 1.86, 8.17, and 8.88 mg/dL, respectively. Using CGM for insulin dosing decisions is feasible below a certain level of sensor error, estimated in silico at MARD=10%. In our experiments, further accuracy improvement did not contribute substantively to better glycemic outcomes.

Evaluation of an open access software for calculating glucose variability parameters of a continuous glucose monitoring system applied at pediatric intensive care unit.

Science.gov (United States)

Marics, Gábor; Lendvai, Zsófia; Lódi, Csaba; Koncz, Levente; Zakariás, Dávid; Schuster, György; Mikos, Borbála; Hermann, Csaba; Szabó, Attila J; Tóth-Heyn, Péter

2015-04-24

Continuous Glucose Monitoring (CGM) has become an increasingly investigated tool, especially with regards to monitoring of diabetic and critical care patients. The continuous glucose data allows the calculation of several glucose variability parameters, however, without specific application the interpretation of the results is time-consuming, utilizing extreme efforts. Our aim was to create an open access software [Glycemic Variability Analyzer Program (GVAP)], readily available to calculate the most common parameters of the glucose variability and to test its usability. The GVAP was developed in MATLAB® 2010b environment. The calculated parameters were the following: average area above/below the target range (Avg. AUC-H/L); Percentage Spent Above/Below the Target Range (PATR/PBTR); Continuous Overall Net Glycemic Action (CONGA); Mean of Daily Differences (MODD); Mean Amplitude of Glycemic Excursions (MAGE). For verification purposes we selected 14 CGM curves of pediatric critical care patients. Medtronic® Guardian® Real-Time with Enlite® sensor was used. The reference values were obtained from Medtronic®(')s own software for Avg. AUC-H/L and PATR/PBTR, from GlyCulator for MODD and CONGA, and using manual calculation for MAGE. The Pearson and Spearman correlation coefficients were above 0.99 for all parameters. The initial execution took 30 minutes, for further analysis with the Windows® Standalone Application approximately 1 minute was needed. The GVAP is a reliable open access program for analyzing different glycemic variability parameters, hence it could be a useful tool for the study of glycemic control among critically ill patients.

Can the Accuracy of Home Blood Glucose Monitors be affected by the Received Signal Strength of 900 MHz GSM Mobile Phones?

Science.gov (United States)

Eslami, J; Ghafaripour, F; Mortazavi, S A R; Mortazavi, S M J; Shojaei-Fard, M B

2015-12-01

People who use home blood glucose monitors may use their mobile phones in the close vicinity of medical devices. This study is aimed at investigating the effect of the signal strength of 900 MHz GSM mobile phones on the accuracy of home blood glucose monitors. Sixty non-diabetic volunteer individuals aged 21 - 28 years participated in this study. Blood samples were analyzed for glucose level by using a common blood glucose monitoring system. Each blood sample was analyzed twice, within ten minutes in presence and absence of electromagnetic fields generated by a common GSM mobile phone during ringing. Blood samples were divided into 3 groups of 20 samples each. Group 1: exposure to mobile phone radiation with weak signal strength. Group2: exposure to mobile phone radiation with strong signal strength. Group3: exposure to a switched-on mobile phone with no signal strength. The magnitude of the changes in the first, second and third group between glucose levels of two measurements (׀ΔC׀) were 7.4±3.9 mg/dl, 10.2±4.5 mg/dl, 8.7±8.4 mg/dl respectively. The difference in the magnitude of the changes between the 1st and the 3rd groups was not statistically significant. Furthermore, the difference in the magnitude of the changes between the 2nd and the 3rd groups was not statistically significant. Findings of this study showed that the signal strength of 900 MHz GSM mobile phones cannot play a significant role in changing the accuracy of home blood glucose monitors.

[Current status and recommendations on the use of continuous blood glucose monitoring systems in children and adolescents with type 1 diabetes mellitus].

Science.gov (United States)

Torres Lacruz, M; Barrio Castellanos, R; García Cuartero, B; Gómez Gila, A; González Casado, I; Hermoso López, F; Luzuriaga Tomás, C; Oyarzabal Irigoyen, M; Rica Etxebarria, I; Rodríguez Rigual, M

2011-08-01

Glucose monitoring methods have made great advances in the last decade with the appearance of the continuous glucose monitoring systems (CGMS) that measure the glucose levels in the interstitial liquid, providing information about glucose patterns and trends, but do not replace the self-monitoring of capillary glucose. Improvement in diabetes control using the CGMS depends on the motivation and training received by the patient and family and on the continuity in its use. Due to the development and widespread use of these systems in clinical practice, the diabetes group of the Sociedad Española de Endocrinología Pediátrica has drafted a document of consensus for their indication and use in children and adolescents. Only a limited number of trials have been performed in children and adolescent populations. More data are needed on the use of this technology in order to define the impact on metabolic control. Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Development of the Diabetes Technology Society Blood Glucose Monitor System Surveillance Protocol.

Science.gov (United States)

Klonoff, David C; Lias, Courtney; Beck, Stayce; Parkes, Joan Lee; Kovatchev, Boris; Vigersky, Robert A; Arreaza-Rubin, Guillermo; Burk, Robert D; Kowalski, Aaron; Little, Randie; Nichols, James; Petersen, Matt; Rawlings, Kelly; Sacks, David B; Sampson, Eric; Scott, Steve; Seley, Jane Jeffrie; Slingerland, Robbert; Vesper, Hubert W

2016-05-01

Inaccurate blood glucsoe monitoring systems (BGMSs) can lead to adverse health effects. The Diabetes Technology Society (DTS) Surveillance Program for cleared BGMSs is intended to protect people with diabetes from inaccurate, unreliable BGMS products that are currently on the market in the United States. The Surveillance Program will provide an independent assessment of the analytical performance of cleared BGMSs. The DTS BGMS Surveillance Program Steering Committee included experts in glucose monitoring, surveillance testing, and regulatory science. Over one year, the committee engaged in meetings and teleconferences aiming to describe how to conduct BGMS surveillance studies in a scientifically sound manner that is in compliance with good clinical practice and all relevant regulations. A clinical surveillance protocol was created that contains performance targets and analytical accuracy-testing studies with marketed BGMS products conducted by qualified clinical and laboratory sites. This protocol entitled "Protocol for the Diabetes Technology Society Blood Glucose Monitor System Surveillance Program" is attached as supplementary material. This program is needed because currently once a BGMS product has been cleared for use by the FDA, no systematic postmarket Surveillance Program exists that can monitor analytical performance and detect potential problems. This protocol will allow identification of inaccurate and unreliable BGMSs currently available on the US market. The DTS Surveillance Program will provide BGMS manufacturers a benchmark to understand the postmarket analytical performance of their products. Furthermore, patients, health care professionals, payers, and regulatory agencies will be able to use the results of the study to make informed decisions to, respectively, select, prescribe, finance, and regulate BGMSs on the market. © 2015 Diabetes Technology Society.

Development of the Diabetes Technology Society Blood Glucose Monitor System Surveillance Protocol

Science.gov (United States)

Klonoff, David C.; Lias, Courtney; Beck, Stayce; Parkes, Joan Lee; Kovatchev, Boris; Vigersky, Robert A.; Arreaza-Rubin, Guillermo; Burk, Robert D.; Kowalski, Aaron; Little, Randie; Nichols, James; Petersen, Matt; Rawlings, Kelly; Sacks, David B.; Sampson, Eric; Scott, Steve; Seley, Jane Jeffrie; Slingerland, Robbert; Vesper, Hubert W.

2015-01-01

Background: Inaccurate blood glucsoe monitoring systems (BGMSs) can lead to adverse health effects. The Diabetes Technology Society (DTS) Surveillance Program for cleared BGMSs is intended to protect people with diabetes from inaccurate, unreliable BGMS products that are currently on the market in the United States. The Surveillance Program will provide an independent assessment of the analytical performance of cleared BGMSs. Methods: The DTS BGMS Surveillance Program Steering Committee included experts in glucose monitoring, surveillance testing, and regulatory science. Over one year, the committee engaged in meetings and teleconferences aiming to describe how to conduct BGMS surveillance studies in a scientifically sound manner that is in compliance with good clinical practice and all relevant regulations. Results: A clinical surveillance protocol was created that contains performance targets and analytical accuracy-testing studies with marketed BGMS products conducted by qualified clinical and laboratory sites. This protocol entitled “Protocol for the Diabetes Technology Society Blood Glucose Monitor System Surveillance Program” is attached as supplementary material. Conclusion: This program is needed because currently once a BGMS product has been cleared for use by the FDA, no systematic postmarket Surveillance Program exists that can monitor analytical performance and detect potential problems. This protocol will allow identification of inaccurate and unreliable BGMSs currently available on the US market. The DTS Surveillance Program will provide BGMS manufacturers a benchmark to understand the postmarket analytical performance of their products. Furthermore, patients, health care professionals, payers, and regulatory agencies will be able to use the results of the study to make informed decisions to, respectively, select, prescribe, finance, and regulate BGMSs on the market. PMID:26481642

Effects of self-monitoring of glucose in non-insulin treated patients with type 2 diabetes: design of the IN CONTROL-trial

Directory of Open Access Journals (Sweden)

Kostense Piet J

2009-04-01

Full Text Available Abstract Background Diabetes specific emotional problems interfere with the demanding daily management of living with type 2 diabetes mellitus (T2DM. Possibly, offering direct feedback on diabetes management may diminish the presence of diabetes specific emotional problems and might enhance the patients' belief they are able to manage their illness. It is hypothesized that self-monitoring of glucose in combination with an algorithm how and when to act will motivate T2DM patients to become more active participants in their own care leading to a decrease in diabetes related distress and an increased self-efficacy. Methods and design Six hundred patients with T2DM (45 ≤ 75 years who receive care in a structured diabetes care system, HbA1c ≥ 7.0%, and not using insulin will be recruited and randomized into 3 groups; Self-monitoring of Blood Glucose (SMBG, Self-monitoring of Urine Glucose (SMUG and usual care (n = 200 per group. Participants are eligible if they have a known disease duration of over 1 year and have used SMBG or SMUG less than 3 times in the previous year. All 3 groups will receive standardized diabetes care. The intervention groups will receive additional instructions on how to perform self-monitoring of glucose and how to interpret the results. Main outcome measures are changes in diabetes specific emotional distress and self-efficacy. Secondary outcome measures include difference in HbA1c, patient satisfaction, occurrence of hypoglycaemia, physical activity, costs of direct and indirect healthcare and changes in illness beliefs. Discussion The IN CONTROL-trial is designed to explore whether feedback from self-monitoring of glucose in T2DM patients who do not require insulin can affect diabetes specific emotional distress and increase self-efficacy. Based on the self-regulation model it is hypothesized that glucose self-monitoring feedback changes illness perceptions, guiding the patient to reduce emotional responses to

Blood Glucose Monitoring Devices

Science.gov (United States)

... are below 100 mg/dL before meals and fasting and are less than 140 mg/dL two hours after meals. People with diabetes should consult their doctor or health care provider to set appropriate blood glucose goals. ...

Clinical results from a noninvasive blood glucose monitor

Science.gov (United States)

Blank, Thomas B.; Ruchti, Timothy L.; Lorenz, Alex D.; Monfre, Stephen L.; Makarewicz, M. R.; Mattu, Mutua; Hazen, Kevin

2002-05-01

Non-invasive blood glucose monitoring has long been proposed as a means for advancing the management of diabetes through increased measurement and control. The use of a near-infrared, NIR, spectroscopy based methodology for noninvasive monitoring has been pursued by a number of groups. The accuracy of the NIR measurement technology is limited by challenges related to the instrumentation, the heterogeneity and time-variant nature of skin tissue, and the complexity of the calibration methodology. In this work, we discuss results from a clinical study that targeted the evaluation of individual calibrations for each subject based on a series of controlled calibration visits. While the customization of the calibrations to individuals was intended to reduce model complexity, the extensive requirements for each individual set of calibration data were difficult to achieve and required several days of measurement. Through the careful selection of a small subset of data from all samples collected on the 138 study participants in a previous study, we have developed a methodology for applying a single standard calibration to multiple persons. The standard calibrations have been applied to a plurality of individuals and shown to be persistent over periods greater than 24 weeks.

Continuous glucose monitoring in newborn infants: how do errors in calibration measurements affect detected hypoglycemia?

Science.gov (United States)

Thomas, Felicity; Signal, Mathew; Harris, Deborah L; Weston, Philip J; Harding, Jane E; Shaw, Geoffrey M; Chase, J Geoffrey

2014-05-01

Neonatal hypoglycemia is common and can cause serious brain injury. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing blood glucose (BG) measurements. Calibration algorithms use BG measurements to convert sensor signals into CGM data. Thus, inaccuracies in calibration BG measurements directly affect CGM values and any metrics calculated from them. The aim was to quantify the effect of timing delays and calibration BG measurement errors on hypoglycemia metrics in newborn infants. Data from 155 babies were used. Two timing and 3 BG meter error models (Abbott Optium Xceed, Roche Accu-Chek Inform II, Nova Statstrip) were created using empirical data. Monte-Carlo methods were employed, and each simulation was run 1000 times. Each set of patient data in each simulation had randomly selected timing and/or measurement error added to BG measurements before CGM data were calibrated. The number of hypoglycemic events, duration of hypoglycemia, and hypoglycemic index were then calculated using the CGM data and compared to baseline values. Timing error alone had little effect on hypoglycemia metrics, but measurement error caused substantial variation. Abbott results underreported the number of hypoglycemic events by up to 8 and Roche overreported by up to 4 where the original number reported was 2. Nova results were closest to baseline. Similar trends were observed in the other hypoglycemia metrics. Errors in blood glucose concentration measurements used for calibration of CGM devices can have a clinically important impact on detection of hypoglycemia. If CGM devices are going to be used for assessing hypoglycemia it is important to understand of the impact of these errors on CGM data. © 2014 Diabetes Technology Society.

Accuracy and precision evaluation of seven self-monitoring blood glucose systems.

Science.gov (United States)

Kuo, Chih-Yi; Hsu, Cheng-Teng; Ho, Cheng-Shiao; Su, Ting-En; Wu, Ming-Hsun; Wang, Chau-Jong

2011-05-01

Self-monitoring blood glucose (SMBG) systems play a critical role in management of diabetes. SMBG systems should at least meet the minimal requirement of the World Health Organization's ISO 15197:2003. For tight glycemic control, a tighter accuracy requirement is needed. Seven SMBG systems were evaluated for accuracy and precision: Bionime Rightest(™) GM550 (Bionime Corp., Dali City, Taiwan), Accu-Chek(®) Performa (Roche Diagnostics, Indianapolis, IN), OneTouch(®) Ultra(®)2 (LifeScan Inc., Milpitas, CA), MediSense(®) Optium(™) Xceed (Abbott Diabetes Care Inc., Alameda, CA), Medisafe (TERUMO Corp., Tokyo, Japan), Fora(®) TD4227 (Taidac Technology Corp., Wugu Township, Taiwan), and Ascensia Contour(®) (Bayer HealthCare LLC, Mishawaka, IN). The 107 participants (44 men and 63 women) were between 23 and 91 years old. The analytical results of seven SMBG systems were compared with those of plasma analyzed with the hexokinase method (Olympus AU640, Olympus America Inc., Center Valley, PA). The imprecision of the seven blood glucose meters ranged from 1.1% to 4.7%. Three of the seven blood glucose meters (42.9%) fulfilled the minimum accuracy criteria of ISO 15197:2003. The mean absolute relative error value for each blood glucose meter was calculated and ranged from 6.5% to 12.0%. More than 40% of evaluated SMBG systems meet the minimal accuracy criteria requirement of ISO 15197:2003. However, considering tighter criteria for accuracy of ±15%, only the Bionime Rightest GM550 meets this requirement. Because SMBG systems play a critical role in management of diabetes, manufacturers have to strive to improve accuracy and precision and to ensure the good quality of blood glucose meters and test strips.

Monitoring of Glucose in Beer Brewing by a Carbon Nanotubes Based Nylon Nanofibrous Biosensor

Directory of Open Access Journals (Sweden)

Marco Mason

2016-01-01

Full Text Available This work presents the design, preparation, and characterization of a novel glucose electrochemical biosensor based on the immobilization of glucose oxidase (GOX into a nylon nanofibrous membrane (NFM prepared by electrospinning and functionalized with multiwalled carbon nanotubes (CNT. A disc of such GOX/CNT/NFM membrane (40 μm in thickness was used for coating the surface of a glassy carbon electrode. The resulting biosensor was characterized by cyclic voltammetry and chronoamperometry, with ferrocene methanol as mediator. The binding of GOX around the CNT/NFM greatly enhances the electron transfer, which results in a biosensor with a current five times higher than without CNT. The potential usefulness of the proposed biosensor was demonstrated with the analysis of glucose in commercial beverages and along the monitoring of the brewing process for making beer, from the mashing to the fermentation steps.

Effects of Insulin on Brain Glucose Metabolism in Impaired Glucose Tolerance

Science.gov (United States)

Hirvonen, Jussi; Virtanen, Kirsi A.; Nummenmaa, Lauri; Hannukainen, Jarna C.; Honka, Miikka-Juhani; Bucci, Marco; Nesterov, Sergey V.; Parkkola, Riitta; Rinne, Juha; Iozzo, Patricia; Nuutila, Pirjo

2011-01-01

OBJECTIVE Insulin stimulates brain glucose metabolism, but this effect of insulin is already maximal at fasting concentrations in healthy subjects. It is not known whether insulin is able to stimulate glucose metabolism above fasting concentrations in patients with impaired glucose tolerance. RESEARCH DESIGN AND METHODS We studied the effects of insulin on brain glucose metabolism and cerebral blood flow in 13 patients with impaired glucose tolerance and nine healthy subjects using positron emission tomography (PET). All subjects underwent PET with both [18F]fluorodeoxyglucose (for brain glucose metabolism) and [15O]H2O (for cerebral blood flow) in two separate conditions (in the fasting state and during a euglycemic-hyperinsulinemic clamp). Arterial blood samples were acquired during the PET scans to allow fully quantitative modeling. RESULTS The hyperinsulinemic clamp increased brain glucose metabolism only in patients with impaired glucose tolerance (whole brain: +18%, P = 0.001) but not in healthy subjects (whole brain: +3.9%, P = 0.373). The hyperinsulinemic clamp did not alter cerebral blood flow in either group. CONCLUSIONS We found that insulin stimulates brain glucose metabolism at physiological postprandial levels in patients with impaired glucose tolerance but not in healthy subjects. These results suggest that insulin stimulation of brain glucose metabolism is maximal at fasting concentrations in healthy subjects but not in patients with impaired glucose tolerance. PMID:21270256

Serum proatrial natriuretic peptide concentrations during oral glucose-induced acute hyperinsulinemia in lean and obese men

DEFF Research Database (Denmark)

Asferg, Camilla L; Nielsen, Søren J; Andersen, Ulrik B

2018-01-01

Atrial natriuretic peptide (ANP) is primarily seen as a hormone involved in salt and water homeostasis and blood pressure regulation. Evidence supports a link between metabolism and ANP. Circulating ANP concentrations are low in obese individuals with insulin resistance and hyperinsulinemia....... The dynamic relationship between insulin and ANP has been sparsely studied. We therefore measured circulating concentrations of midregional proatrial natriuretic peptide (MR-proANP), a stable marker of ANP secretion, and insulin in lean and obese men during an oral glucose challenge. One hundred and three...... obese men (body mass index (BMI) ≥30.0 kg/m2) were compared with 27 lean men (BMI = 20.0-24.9 kg/m2). During a 75 g oral glucose challenge, circulating concentrations of MR-proANP and insulin were measured at baseline and every half hour for 2 h. Fasting MR-proANP concentrations were lower in the obese...

On-line monitoring of glucose and/or lactate in a fermentation process using an expanded micro-bed flow injection analyser.

Science.gov (United States)

Nandakumar, M P; Lali, A M; Mattiasson, B

1999-01-01

A novel flow injection biosensor system for monitoring fermentation processes has been developed using an expanded micro bed as the enzyme reactor. An expanded bed reactor is capable of handling a mobile phase containing suspended matter like cells and cell debris. Thus, while the analyte is free to interact with the adsorbent, the suspended particulate matter passes through unhindered. With the use of a scaled down expanded bed in the flow injection analysis (FIA) system, it was possible to analyse samples directly from a fermentor without the pretreatment otherwise required to extract the analyte or remove the suspended cells. This technique, therefore, provides a means to determine the true concentrations of the metabolites in a fermentor, with more ease than possible with other techniques. Glucose oxidase immobilised on STREAMLINE was used to measure glucose concentration in a suspension of dead yeast cells. There was no interference from the cell particles even at high cell densities such as 15 gm dry weight per litre. The assay time was about 6 min. Accuracy and reproducibility of the system was found to be good. In another scheme, lactate oxidase was covalently coupled to STREAMLINE for expanded bed operation. With the on-line expanded micro bed FIA it was possible to follow the fermentation with Lactobacillus casei.

Dietary fructose and glucose differentially affect lipid and glucose homeostasis.

Science.gov (United States)

Schaefer, Ernst J; Gleason, Joi A; Dansinger, Michael L

2009-06-01

Absorbed glucose and fructose differ in that glucose largely escapes first-pass removal by the liver, whereas fructose does not, resulting in different metabolic effects of these 2 monosaccharides. In short-term controlled feeding studies, dietary fructose significantly increases postprandial triglyceride (TG) levels and has little effect on serum glucose concentrations, whereas dietary glucose has the opposite effects. When dietary glucose and fructose have been directly compared at approximately 20-25% of energy over a 4- to 6-wk period, dietary fructose caused significant increases in fasting TG and LDL cholesterol concentrations, whereas dietary glucose did not, but dietary glucose did increase serum glucose and insulin concentrations in the postprandial state whereas dietary fructose did not. When fructose at 30-60 g ( approximately 4-12% of energy) was added to the diet in the free-living state, there were no significant effects on lipid or glucose biomarkers. Sucrose and high-fructose corn syrup (HFCS) contain approximately equal amounts of fructose and glucose and no metabolic differences between them have been noted. Controlled feeding studies at more physiologic dietary intakes of fructose and glucose need to be conducted. In our view, to decrease the current high prevalence of obesity, dyslipidemia, insulin resistance, and diabetes, the focus should be on restricting the intake of excess energy, sucrose, HFCS, and animal and trans fats and increasing exercise and the intake of vegetables, vegetable oils, fish, fruit, whole grains, and fiber.

BioRadioTransmitter: a self-powered wireless glucose-sensing system.

Science.gov (United States)

Hanashi, Takuya; Yamazaki, Tomohiko; Tsugawa, Wakako; Ikebukuro, Kazunori; Sode, Koji

2011-09-01

Although an enzyme fuel cell can be utilized as a glucose sensor, the output power generated is too low to power a device such as a currently available transmitter and operating system, and an external power source is required for operating an enzyme-fuel-cell-based biosensing system. We proposed a novel biosensor that we named BioCapacitor, in which a capacitor serves as a transducer. In this study, we constructed a new BioCapacitor-based system with an added radio-transmitter circuit and a miniaturized enzyme fuel cell. A miniaturized direct-electron-transfer-type compartmentless enzyme fuel cell was constructed with flavin adenine dinucleotide-dependent glucose dehydrogenase complex-based anode and a bilirubin-oxidase-based cathode. For construction of a BioRadioTransmitter wireless sensing system, a capacitor, an ultra-low-voltage charge-pump-integrated circuit, and Hartley oscillator circuit were connected to the miniaturized enzyme fuel cell. A radio-receiver circuit, comprising two field-effect transistors and a coil as an antenna, was used to amplify the signal generated from the biofuel cells. Radio wave signals generated by the BioRadioTransmitter were received, amplified, and converted from alternate to direct current by the radio receiver. When the capacitor discharges in the presence of glucose, the BioRadioTransmitter generates a radio wave, which is monitored by a radio receiver connected wirelessly to the sensing device. Magnitude of the radio wave transmission frequency change observed at the radio receiver was correlated to glucose concentration in the fuel cells. We constructed a stand-alone, self-powered, wireless glucose-sensing system called a BioRadioTransmitter by using a radio transmitter in which the radio wave transmission frequency changes with the glucose concentration in the fuel cell. The BioRadioTransmitter is a significant advance toward construction of an implantable continuous glucose monitor. © 2011 Diabetes Technology Society.

Correlation of continuous glucose monitoring profiles with pregnancy outcomes in nondiabetic women.

Science.gov (United States)

Sung, Joyce F; Kogut, Elizabeth A; Lee, Henry C; Mannan, Jana L; Navabi, Kasra; Taslimi, M Mark; El-Sayed, Yasser Y

2015-04-01

To determine whether hyperglycemic excursions detected by continuous glucose monitoring (CGM) correlate with birth weight percentile and other pregnancy outcomes, and whether CGM correlates better with these outcomes than a single glucose value from a 1-hour glucose challenge test (GCT). This was a prospective observational study of 55 pregnant patients without preexisting diabetes, who wore a CGM device for up to 7 days, between 24 and 28 weeks' gestation. The area under the curve (AUC) of hyperglycemic excursions above various thresholds (110, 120, 130, 140, and 180 mg/dL) was calculated. These AUC values, and results from a standard 50-g GCT, were correlated with our primary outcome of birth weight percentile, and secondary outcomes of unplanned operative delivery, pregnancy complications, delivery complications, fetal complications, and neonatal complications. A consistent correlation was seen between all AUC thresholds and birth weight percentile (r = 0.29, p AUC-110, -120, -130, and -140; r = 0.25, p = 0.07 for AUC-180). This correlation was stronger than that of 1-hour oral GCT (r = -0.02, p = 0.88). There was no association between AUC values and other outcomes. Among nondiabetic pregnant patients, hyperglycemic excursions detected by CGM show a stronger correlation to birth weight percentile than blood glucose values obtained 1-hour after a 50-g oral GCT. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Can the Accuracy of Home Blood Glucose Monitors be affected by the Received Signal Strength of 900 MHz GSM Mobile Phones?

Directory of Open Access Journals (Sweden)

Eslami J.

2015-12-01

Full Text Available Background: People who use home blood glucose monitors may use their mobile phones in the close vicinity of medical devices. This study is aimed at investigating the effect of the signal strength of 900 MHz GSM mobile phones on the accuracy of home blood glucose monitors. Methods: Sixty non-diabetic volunteer individuals aged 21 - 28 years participated in this study. Blood samples were analyzed for glucose level by using a common blood glucose monitoring system. Each blood sample was analyzed twice, within ten minutes in presence and absence of electromagnetic fields generated by a common GSM mobile phone during ringing. Blood samples were divided into 3 groups of 20 samples each. Group 1: exposure to mobile phone radiation with weak signal strength. Group2: exposure to mobile phone radiation with strong signal strength. Group3: exposure to a switched–on mobile phone with no signal strength. Results: The magnitude of the changes in the first, second and third group between glucose levels of two measurements (׀ΔC׀ (were 7.4±3.9 mg/dl, 10.2±4.5 mg/ dl, 8.7±8.4 mg/dl respectively. The difference in the magnitude of the changes between the 1st and the 3rd groups was not statistically significant. Furthermore, the difference in the magnitude of the changes between the 2nd and the 3rd groups was not statistically significant. Conclusion: Findings of this study showed that the signal strength of 900 MHz GSM mobile phones cannot play a significant role in changing the accuracy of home blood glucose monitors.

Can the Accuracy of Home Blood Glucose Monitors be affected by the Received Signal Strength of 900 MHz GSM Mobile Phones?

Science.gov (United States)

Eslami, J.; Ghafaripour, F.; Mortazavi, S.A.R.; Mortazavi, S.M.J.; Shojaei-fard, M.B.

2015-01-01

Background People who use home blood glucose monitors may use their mobile phones in the close vicinity of medical devices. This study is aimed at investigating the effect of the signal strength of 900 MHz GSM mobile phones on the accuracy of home blood glucose monitors. Methods Sixty non-diabetic volunteer individuals aged 21 - 28 years participated in this study. Blood samples were analyzed for glucose level by using a common blood glucose monitoring system. Each blood sample was analyzed twice, within ten minutes in presence and absence of electromagnetic fields generated by a common GSM mobile phone during ringing. Blood samples were divided into 3 groups of 20 samples each. Group 1: exposure to mobile phone radiation with weak signal strength. Group2: exposure to mobile phone radiation with strong signal strength. Group3: exposure to a switched–on mobile phone with no signal strength. Results The magnitude of the changes in the first, second and third group between glucose levels of two measurements (׀ΔC׀) were 7.4±3.9 mg/dl, 10.2±4.5 mg/dl, 8.7±8.4 mg/dl respectively. The difference in the magnitude of the changes between the 1st and the 3rd groups was not statistically significant. Furthermore, the difference in the magnitude of the changes between the 2nd and the 3rd groups was not statistically significant. Conclusion Findings of this study showed that the signal strength of 900 MHz GSM mobile phones cannot play a significant role in changing the accuracy of home blood glucose monitors. PMID:26688798

A systematic approach for the accurate non-invasive estimation of blood glucose utilizing a novel light-tissue interaction adaptive modelling scheme

Science.gov (United States)

Rybynok, V. O.; Kyriacou, P. A.

2007-10-01

Diabetes is one of the biggest health challenges of the 21st century. The obesity epidemic, sedentary lifestyles and an ageing population mean prevalence of the condition is currently doubling every generation. Diabetes is associated with serious chronic ill health, disability and premature mortality. Long-term complications including heart disease, stroke, blindness, kidney disease and amputations, make the greatest contribution to the costs of diabetes care. Many of these long-term effects could be avoided with earlier, more effective monitoring and treatment. Currently, blood glucose can only be monitored through the use of invasive techniques. To date there is no widely accepted and readily available non-invasive monitoring technique to measure blood glucose despite the many attempts. This paper challenges one of the most difficult non-invasive monitoring techniques, that of blood glucose, and proposes a new novel approach that will enable the accurate, and calibration free estimation of glucose concentration in blood. This approach is based on spectroscopic techniques and a new adaptive modelling scheme. The theoretical implementation and the effectiveness of the adaptive modelling scheme for this application has been described and a detailed mathematical evaluation has been employed to prove that such a scheme has the capability of extracting accurately the concentration of glucose from a complex biological media.

A systematic approach for the accurate non-invasive estimation of blood glucose utilizing a novel light-tissue interaction adaptive modelling scheme

Energy Technology Data Exchange (ETDEWEB)

Rybynok, V O; Kyriacou, P A [City University, London (United Kingdom)

2007-10-15

Diabetes is one of the biggest health challenges of the 21st century. The obesity epidemic, sedentary lifestyles and an ageing population mean prevalence of the condition is currently doubling every generation. Diabetes is associated with serious chronic ill health, disability and premature mortality. Long-term complications including heart disease, stroke, blindness, kidney disease and amputations, make the greatest contribution to the costs of diabetes care. Many of these long-term effects could be avoided with earlier, more effective monitoring and treatment. Currently, blood glucose can only be monitored through the use of invasive techniques. To date there is no widely accepted and readily available non-invasive monitoring technique to measure blood glucose despite the many attempts. This paper challenges one of the most difficult non-invasive monitoring techniques, that of blood glucose, and proposes a new novel approach that will enable the accurate, and calibration free estimation of glucose concentration in blood. This approach is based on spectroscopic techniques and a new adaptive modelling scheme. The theoretical implementation and the effectiveness of the adaptive modelling scheme for this application has been described and a detailed mathematical evaluation has been employed to prove that such a scheme has the capability of extracting accurately the concentration of glucose from a complex biological media.

A systematic approach for the accurate non-invasive estimation of blood glucose utilizing a novel light-tissue interaction adaptive modelling scheme

International Nuclear Information System (INIS)

Rybynok, V O; Kyriacou, P A

2007-01-01

Diabetes is one of the biggest health challenges of the 21st century. The obesity epidemic, sedentary lifestyles and an ageing population mean prevalence of the condition is currently doubling every generation. Diabetes is associated with serious chronic ill health, disability and premature mortality. Long-term complications including heart disease, stroke, blindness, kidney disease and amputations, make the greatest contribution to the costs of diabetes care. Many of these long-term effects could be avoided with earlier, more effective monitoring and treatment. Currently, blood glucose can only be monitored through the use of invasive techniques. To date there is no widely accepted and readily available non-invasive monitoring technique to measure blood glucose despite the many attempts. This paper challenges one of the most difficult non-invasive monitoring techniques, that of blood glucose, and proposes a new novel approach that will enable the accurate, and calibration free estimation of glucose concentration in blood. This approach is based on spectroscopic techniques and a new adaptive modelling scheme. The theoretical implementation and the effectiveness of the adaptive modelling scheme for this application has been described and a detailed mathematical evaluation has been employed to prove that such a scheme has the capability of extracting accurately the concentration of glucose from a complex biological media

High glycemic variability assessed by continuous glucose monitoring after surgical treatment of obesity by gastric bypass.

Science.gov (United States)

Hanaire, Helene; Bertrand, Monelle; Guerci, Bruno; Anduze, Yves; Guillaume, Eric; Ritz, Patrick

2011-06-01

Obesity surgery elicits complex changes in glucose metabolism that are difficult to observe with discontinuous glucose measurements. We aimed to evaluate glucose variability after gastric bypass by continuous glucose monitoring (CGM) in a real-life setting. CGM was performed for 4.2 ± 1.3 days in three groups of 10 subjects each: patients who had undergone gastric bypass and who were referred for postprandial symptoms compatible with mild hypoglycemia, nonoperated diabetes controls, and healthy controls. The maximum interstitial glucose (IG), SD of IG values, and mean amplitude of glucose excursions (MAGE) were significantly higher in operated patients and in diabetes controls than in healthy controls. The time to the postprandial peak IG was significantly shorter in operated patients (42.8 ± 6.0 min) than in diabetes controls (82.2 ± 11.1 min, P = 0.0002), as were the rates of glucose increase to the peak (2.4 ± 1.6 vs. 1.2 ± 0.3 mg/mL/min; P = 0.041). True hypoglycemia (glucose fasting state and 2 h postmeal. Glucose variability is exaggerated after gastric bypass, combining unusually high and early hyperglycemic peaks and rapid IG decreases. This might account for postprandial symptoms mimicking hypoglycemia but often seen without true hypoglycemia. Early postprandial hyperglycemia might be underestimated if glucose measurements are done 2 h postmeal.

Glycated haemoglobin may in future be reported as estimated mean blood glucose concentration--secondary publication

DEFF Research Database (Denmark)

Borg, R.; Nerup, J.; Nathan, D.M.

2009-01-01

Glycated haemoglobin (HbA 1c ) is widely used to determine levels of chronic glycaemia, to judge the adequacy of diabetes treatment and to adjust therapy. HbA 1c results are expressed as the percentage of HbA that is glycated. Day-to-day management is guided by self-monitoring of capillary glucose...

Blood glucose level reconstruction as a function of transcapillary glucose transport.

Science.gov (United States)