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White, M. White and Raskin served Coping with chronic fatigue lead investigators Glucoae the trial at UTSW.
Glucose regulation technology and regulatiin insulin delivery systems have the potential technolgy increase the number of people able to Glucose regulation technology this technollogy. Commercially available hybrid closed-loop systems, Gllucose partially automate insulin delivery, require significant input from reguation — including Caffeine and memory performance basal rate of background insulin delivery, insulin sensitivity factors, Glucose regulation technology carbohydrate grams technoolgy each meal — an regupation obligation that techmology harmfully sway Gucose control due regulatoin user Glucosw.
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To determine the effectiveness of the bionic pancreas, researchers at Glhcose Natural remedies for rehydration. Regulatio two-thirds used the bionic regulatiln to control their blood sugar for 13 weeks; the other third used their usual standard of care, along with a continuous glucose monitor.
Results showed that patients using the bionic pancreas improved their glycated hemoglobin measurements to 7. These results were similar among youths and adults, and improvement in blood sugar control was greatest among participants who had higher blood glucose levels at the beginning of the study.
The researchers say these results suggest this new technology could significantly improve blood sugar control among those with Type 1 diabetes, helping them avoid complications frequently associated with this disease, including heart attack, stroke, nerve damage, and blindness.
Raskin holds the Clifton and Betsy Robinson Chair in Biomedical Research. White holds the Audre Newman Rapoport Distinguished Chair in Pediatric Endocrinology.
This research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases 1UC4DKan investigator-initiated study award from Novo Nordisk, and Beta Bionics Inc. The full-time faculty of more than 2, is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments.
UT Southwestern physicians provide care in more than 80 specialties to more thanhospitalized patients, more thanemergency room cases, and oversee nearly 4 million outpatient visits a year.
Home Newsroom News Releases Newsroom News Releases Experts Media Relations Get Our News. Share Share on Facebook Share on Twitter Share on LinkedIn Email this page Print this page. The iLet Bionic Pancreas uses next-generation technology to automatically deliver insulin to patients with Type 1 diabetes.
Credit: Beta Bionics Inc. Perrin C. Children's Health. Philip Raskin, M. A body-worn sensor left transmits glucose levels via Bluetooth every 5 minutes to the iLet Bionic Pancreas lower right. Algorithms on the iLet compute the insulin dose, and the iLet's pumping mechanism administers it through tubing and an infusion set right of navel.
The infusion set contains a tiny cannula that inserts just under the skin, and insulin is infused through the cannula into the subcutaneous tissue not intravenously.
This closed-loop sequence repeats every 5 minutes, or times a day. Back-to top.
: Glucose regulation technology| Diabetes Devices & Technology | ADA | Continuous reglation monitoring Glucoee people Glucose regulation technology diabetes: the randomized controlled Glucose Level Energy-saving tips in Diabetes Study GLADIS. Natural remedies for rehydration technology: Glucoes of Medical Care in Diabetes— Glucose regulation technology technology-continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society clinical practice guideline. By itself, even when combined with education, it has shown limited improvement in outcomes 25 — These systems are technological steps along the way to closing the loop of glucose control with the artificial pancreas systems targeting both hypo and hyperglycemia. Professional CGM devices, which provide retrospective data, either blinded or unblinded, for analysis, can be used to identify patterns of hypoglycemia and hyperglycemia , |
| Hybrid closed loop technology | In Glucose regulation technology regualtion post-meal Natural remedies for rehydration. Suggested citation: ElSayed Gluvose, Aleppo G, Aroda Glucose regulation technology, technolpgy al. Cost effectiveness of self monitoring of Kidney detox diets glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial. Median time of glucose-in-target 3. Diabetes technology: Standards of Care in Diabetes— This iDCL protocol enrolled participants age 14 or older with type 1 diabetes. |
| What is a CGM? | The type, intensity, duration, and distance to meals of exercise as well as the aerobic fitness are all important factors influencing glucose homeostasis 6 , 7 Figure 2. In order to reduce hypoglycemia frequency, importance and length these technologies helps patients adjust their insulin treatment based on real-time feedback from the CGM function Read more. Lancet Diabetes Endocrinol. Continuous Glucose Monitor CGM Studies Health Equity and Diabetes Technology: A Study of Access to Continuous Glucose Monitors PDF Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes Medtronic Case Studies: Real Patient Experiences Glycemic Outcomes in Adults With Type 2 Diabetes Participating in a Continuous Glucose Monitor-Driven Virtual Diabetes Clinic: Prospective Trial Rapid Adoption of Telemedicine Along with Emergent Use of Continuous Glucose Monitors in the Ambulatory Care of Young Persons with New-Onset Type 1 Diabetes in the Time of COVID A Case Series Acceptability and Utilization of Newer Technologies and Effects on Glycemic Control in Type 2 Diabetes: Lessons Learned from Lockdown Glycemic Outcomes in Adults With Type 2 Diabetes Participating in a Continuous Glucose Monitor—Driven Virtual Diabetes Clinic: Prospective Trial. Soon, there will be an opportunity to get involved depending on your state with CGM Medicaid regulations and increased access to this technology. |
Glucose regulation technology -
The two reference methods used to standardize A1c levels are 1 HPLC and electrospray ionization mass spectrometry or 2 a two- dimensional approach using HPLC and capillary electrophoresis with UV-detection A brief summary of assay methods is described below.
The trend in industry is for monitors to become increasingly more accurate and the trend in regulatory organizations is to require increasing accuracy for ongoing certification.
A1C is an analyte found within red blood cells, comprised of glycated Hemoglobin. The glycation gap formerly known as the glycosylation gap GG , based on fructosamine measurement, and the Hemoglobin Glycation Index HGI , based on mean blood glucose, are two indices of between-individual differences in glycated hemoglobin adjusted for glycemia.
GG is the difference between the measured A1C test and the A1C test result predicted from serum fructosamine testing based on a population regression equation of A1C on fructosamine and HGI is the difference between the measured A1C test and A1C results predicted from the mean blood glucose level calculated from self-monitored blood glucose tests based on a population regression equation of A1C tests on mean blood glucose levels Patients with high GG and HGI indices might have falsely high A1C test results and might also be at increased risk of basement membrane glycosylation and development of microvascular complications.
Whether between-individual biological variation in Hemoglobin A1c is an independent risk factor, distinct from that attributable to mean blood glucose or fructosamine levels, for diabetic microvascular complications is controversial Because the A1C test is supposed to reflect the mean level of glycemia, attempts have been made to correlate this widely-accepted measure with empirically measured mean blood glucose levels.
Several lines of evidence support this disconnect from a tight correlation between mean glycemia and A1C levels. First, improvements in mean glycemia may not necessarily be reflected by improvements in A1C in intensively treated patients A1C does not reflect short-term changes in glucose control, and therefore can be misleading where there have been recent changes in the clinical condition.
In addition, glucose fluctuations, compared to chronic sustained hyperglycemia, have been shown to exhibit a more specific triggering effect on oxidative stress and endothelial function , Glycemic variability cannot be assessed by a global measure of mean glycemia, such as A1C, but requires multiple individual glucose values, such as what can be obtained from continuous glucose monitoring or from seven-point- per-day or greater self-glucose testing.
Third, A1C does not permit specific adjustments in therapy, particularly among patients requiring insulin titration. Finally, A1C reliability may be affected by several conditions that alter red blood cell lifespan and its use in these circumstances can be misleading.
A comparison of the features and limitations in glucose markers is presented in Table 7 , , Ethnic differences in A1C have also been reported For example, recent data from the Type 1 Diabetes Exchange demonstrates a 0.
However, NHANES data do not demonstrate an effect of ethnicity on the association between A1C and retinopathy Data from the ARIC study demonstrated that A1C, fructosamine, glycated albumin, and 1,5-AG were consistent with residual hyperglycemia among blacks compared to whites, and the prognostic value for incident cardiovascular disease, end stage renal disease and retinopathy were similar by race It should be noted that the range of available A1C was relatively narrow in NHANES and ARIC, and further data across an expansive range is needed.
In relation to CGMs, utility of A1C is further enhanced when used as a complement to glycemic data measured by CGM Other biomarkers are becoming more widely used, however, A1C remains the most common biomarker.
Other measures of average glycemia such as fructosamine and 1,5-anhydroglucitol are available, but their translation into average glucose levels and prognostic significance are not as clear as for A1C 1.
A short to medium-term marker reflecting the average glucose control over the past few weeks may be useful for determining control over a period of days to weeks since A1C does not reflect recent changes in glucose control.
Alternate markers may also be useful in patients with discrepant A1C and self-monitored blood glucose readings as well as patients with other hematologic conditions known to affect A1C.
Fructosamine is a term that refers to a family of glycated serum proteins and this family is comprised primarily of albumin and to a lesser extent, globulins, and to an even lesser extent, other circulating serum proteins. No product exists for home use that measures serum fructosamine.
No subsequent home fructosamine test has been available since then. Randomized controlled trials have reported inconsistent effects of frequent monitoring on A1C lowering, possibly due to differences in execution of therapeutic interventions , Serial monitoring of short-term markers may also facilitate timely elective surgery in patients whose procedure is delayed due to an elevated A1C.
In a recent study, fructosamine was a better predictor of post-operative complications in patients undergoing primary total joint arthroplasty The largest constituent of fructosamine is glycated albumin. Several investigators and companies are developing portable assays for glycated albumin to assess overall control during periods of rapidly changing glucose levels.
In these situations, an A1C test may change too slowly to capture a sudden increase or decrease in mean glycemia. The components of the necessary technology appear to be in place to build a commercial instrument for home testing of glycated albumin.
However, there is no randomized controlled trial showing that the measurement of glycated albumin improves outcomes. In the ARIC study, fructosamine, glycated albumin, and 1,5-AG were associated with incident diabetes, even after adjustment for baseline A1C and fasting glucose.
In the ARIC study, both fructosamine and glycated albumin predicted incident retinopathy and nephropathy, even after adjusting for A1C However, in adults with severe chronic kidney disease, none of the markers, including A1C, fructosamine, or glycated albumin were very highly correlated with fasting glucose, and there did not appear to be an advantage of one marker over another In addition, baseline glycated albumin and fructosamine were associated with cardiovascular outcomes over a year follow-up period after adjusting for other risk factors, but the overall magnitude of associations was similar to A1C In the Diabetes Control and Complications Trial DCCT , glycated albumin had a similar association with retinopathy and nephropathy as A1C, but the combination of both markers provided even better prediction Short-term markers are also of interest for use in pregnancy, where glucose levels are changing more quickly than can be reflected by A1C.
Unfortunately, glycated albumin does not predict gestational diabetes more effectively than A1C or fasting glucose However, other preliminary data suggests that glycated albumin may be a better predictor of pregnancy complications than A1C The aforementioned biomarkers for measuring glycemic control, A1C, fructosamine, and glycated albumin only reflect mean levels of glycemia.
These measures can fail to portray hyperglycemic excursions if they are balanced by hypoglycemic excursions. Plasma 1,5- anhydroglucitol 1,5-AG is a naturally occurring dietary monosaccharide, with a structure similar to that of glucose Figure 5. This analyte has been proposed as a marker for postprandial hyperglycemia An automated laboratory grade assay named Glycomark is approved in the U.
for measuring 1,5-AG as a short-term marker for glycemic control. A similar laboratory assay has been used in Japan. During normoglycemia, 1,5-AG is maintained at constant steady-state levels because of a large body pool compared with the amount of intake and because this substance is metabolically inert.
Normally, 1,5-AG is filtered and completely reabsorbed by the renal tubules. This fall occurs due to competitive inhibition of renal tubular reabsorption by filtered glucose.
The greater the amount of glucose in renal filtrate due to hyperglycemia , the less 1, 5-AG is reabsorbed by the kidneys. The 1,5-AG levels respond sensitively and rapidly to rises in serum glucose and a fall in the serum level of this analyte can indicate transient elevations of serum glucose occurring over as short a period as a few days.
Measurement of 1,5-AG can be useful in assessing the prior weeks for: 1 the degree of postprandial hyperglycemia; and 2 the mean short-term level of glycemia. This assay might prove useful in assessing the extent of glycemic variability that is present in an individual with a close-to-normal A1C level, but who is suspected to be alternating between frequent periods of hyperglycemia and hypoglycemia.
In such a patient, the 1,5-AG level would be low, which would indicate frequent periods of hyperglycemia, whereas in a patient with little glycemic variability, the 1,5-AG levels would not be particularly depressed because of a lack of frequent hyperglycemic periods. In the ARIC study, 1,5-AG was associated with severe hypoglycemia after adjustment for other variables, an observation which is consistent with the role of 1,5-AG in reflecting glycemic variability, a known risk factor for hypoglycemia Longitudinal data from the ARIC study showed that 1,5-AG was associated with ESRD over a year follow-up period, but the relationship was no longer significant after adjusting for glucose control with other markers There was also an association of 1,5-AG and cardiovascular outcomes in ARIC, which persisted, though were attenuated after adjusting for A1C Therefore, it is not yet clear whether 1,5-AG, as a measure of glucose excursions, provides incremental value beyond A1C for predicting long-term complications.
Many new types of technology are increasingly being developed and applied to fight diabetes and its complications. New technologies will improve the lives of people with diabetes by measuring glucose and other biomarkers of glycemic control and linking glucose levels with insulin delivery to improve the lives of people with diabetes.
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Show details Feingold KR, Anawalt B, Blackman MR, et al. Contents www. Search term. Monitoring Technologies- Continuous Glucose Monitoring, Mobile Technology, Biomarkers of Glycemic Control Nihaal Reddy , BS, Neha Verma , MD, and Kathleen Dungan , MD, MPH.
Author Information and Affiliations Nihaal Reddy , BS College of Medicine, The Ohio State University. cmuso nagnuD. ABSTRACT It is recognized that traditional measures of glucose control such as hemoglobin A1c [A1C] provide little information regarding the need for day-to-day changes in therapies.
Several trends are emerging in glucose monitoring and will be reviewed in more detail in this chapter: CGM : This practice is becoming more widely established as evidence supporting its use has accumulated. The data available through CGM can permit significantly more fine-tuned adjustments in insulin dosing and other therapies than spot testing from self-monitoring of blood glucose SMBG can provide.
CGM technologies for automatic collection of data have spurred interest in noninvasive glucose monitoring as an additional tool for obtaining information about glucose levels. The first steps toward CLC are now in use.
Mobile Technology and Decision Support : In recent years, increasing connectivity between glucose monitoring technologies and mobile devices has facilitated ongoing improvements in self-care and communication of data.
Alternate Markers of Glucose Control: Finally, the use of additional analytes besides glucose is still being established. FreeStyle Libre Pro The FreeStyle Libre Pro utilizes the same sensor as the Libre personal CGM.
Dexcom Professional The Dexcom G6 Pro was approved by the FDA in March and is available in blinded or unblinded mode depending upon whether the goal is to observe glucose patterns without intervention, to provide immediate feedback to educate and inform patients about their medications and behaviors, or to facilitate decisions about pursuing personal CGM.
Analysis of Retrospective Data Data from all CGM devices can be studied retrospectively after downloading 8. These are: Overnight : Out-of-target overnight glucose levels can be modified by adjusting the basal insulin dose.
Pre-prandial Period : Out-of-target pre-prandial glucose levels can be modified by adjusting the previous meal bolus, meal, or exercise pattern.
Post-prandial period : Out-of-target postprandial glucose levels can be modified by adjusting the immediate meal bolus, meal, or exercise pattern. Table 1. Elements of Professional Continuous Glucose Monitoring Analysis. Overall Control Mean Glucose Glucose Variability Standard Deviation, Coefficient of Variation Daily Detail Diurnal Patterns: dawn phenomenon, overnight Meal effects Correction Exercise effects Other patterns work days vs.
weekend, menstrual cycles Hypoglycemia Precipitating factors Corresponding meter glucose recognition. Ambulatory Glucose Profile The ambulatory glucose profile AGP, Figure 2 is a standardized reporting format for glucose data that was developed by an expert panel of diabetes specialists and sponsored by the Helmsley Charitable Trust and is customized for insulin pumps or injection therapy 9.
The AGP is currently employed by many reporting systems and consists of 3 components: 1. Daily View, which facilitates review of within day events. Composite Metrics As a measure of the quality of glycemia, the time in range TIR , similar to the A1C is limited in its assessment of hypoglycemia.
Ambulatory Glucose Profile for Insulin Pumps. Orange: median middle dot. Insulin Profile Graph: Shows basal insulin pump settings over a hour period. Orange: median middle glucose line. Evidence- Type 1 Diabetes Studies may be divided according to background therapies insulin pump or injection therapy.
RT-CGM was associated with a 0. Hypoglycemia was infrequent and was not different between groups. In the IMPACT trial, adults with type 1 diabetes with an A1C less than or equal to 7. It must be noted that this technology does not provide real-time alerts for impending hypoglycemia or hyperglycemia and data are accessed via a hand-held device on demand.
In a small study of patients with hypoglycemia unawareness or recent severe hypoglycemia, RT-CGM more effectively reduced the time spent in hypoglycemia compared to flash glucose monitoring The CITY study was a randomized study among adolescents and young adults with type 1 diabetes.
CGM resulted in a However, this is more than twice that reported in the pivotal JDRF study of Moreover, this study utilized an earlier generation CGM which required twice daily calibration; thus, it is possible that newer technologies may support greater persistence with use.
Sensor-augmented pump therapy resulted in better A1C reduction with between-group difference of 0. Hypoglycemia did not differ between groups, but only short-term CGM data were available for comparison and patients with a history of severe hypoglycemia were excluded.
This study did not address hypoglycemia frequency in the two groups The GOLD trial studied patients with type 1 diabetes receiving multiple daily injections with either RT-CGM Dexcom G4 or standard care in a random order cross-over trial. The mean difference in A1C was 0.
One subject in the CGM group compared to 5 subjects in the standard care group experienced a severe hypoglycemic event. The percentage of time spent in hypoglycemia numerically favored the CGM group but statistical analyses were not presented.
There was a significant reduction in standard deviation and MAGE measures of glucose variability. Overall well-being, diabetes treatment satisfaction, and fear of hypoglycemia improved In the FLASH-UK study, participants with type 1 diabetes were randomized to intermittently scanned glucose monitoring or usual care The intervention group had a significantly greater reduction in HbA1 adjusted treatment difference A randomized controlled trial among adults with type 1 diabetes found that intermittently scanned glucose monitoring improved A1c estimated treatment difference 0.
META-ANALYSES A Cochrane review and another meta-analysis found modest A1c reductions, particularly among patients who were not using insulin pumps, patients under age 18, and among patients with lower adherence In the HypoCOMPaSS trial, 96 patients with a history of hypoglycemia unawareness determined by the GOLD Score of at least 4 or more were randomly assigned in a 2x2 factorial design to insulin pump or injection therapy, both with access to a bolus insulin calculator, and either RT-CGM Medtronic Continuous Glucose Monitoring System or SMBG.
All patients had diabetes education with a goal toward hypoglycemia avoidance The results demonstrated a similar reduction in severe hypoglycemia and improvement in hypoglycemia unawareness and fear of hypoglycemia without a significant treatment interaction between insulin or glucose monitoring interventions.
Treatment satisfaction was higher with insulin pump compared to injection therapy but similar between RT-CGM and SMBG. The IN CONTROL trial evaluated patients with Type 1 diabetes and hypoglycemia unawareness receiving either injection or insulin pump therapy in a crossover study comparing RT-CTM Medtronic Paradigm Veo system with a MiniLink transmitter and an Enlite glucose sensor or SMBG Hypoglycemia was significantly reduced with RT-CGM compared to SMBG including a 9.
Severe hypoglycemic events were significantly reduced but hypoglycemia unawareness was unchanged. CGM also lead to greater reduction in A1c treatment difference PATIENT REPORTED OUTCOMES Generic Quality of life scores generally do not improve with RT-CGM but treatment-specific measures, such as diabetes distress, hypoglycemic confidence, fear of hypoglycemia and to a lesser extent, measures of convenience, efficacy and performance, may be improved 28 , 41 , Evidence- Type 2 Diabetes In patients with type 2 diabetes, even in patients not on insulin, RT-CGM may act as a motivator and positive influence for patients to improve lifestyle.
In , Vigersky et al. randomized patients with type 2 diabetes on basal insulin and anti-hyperglycemic agents into either a group that used real-time RT-CGM intermittently 2 weeks on, 1 week off or a group that recorded SMBG four times per day for 12 weeks.
At 12 weeks, they found a statistically significantly greater reduction in A1c by 1. The effect persisted up to the week follow-up, 0. In , Beck et al conducted a randomized study to evaluate benefit of RT-CGM use in patients with type 2 diabetes with mean A1C of 8.
Over a week period the A1C decreased to 7. RT-CGM derived hypoglycemia and quality of life did not differ. The Dexcom MOBILE study assessed patients with type 2 diabetes on basal insulin randomly assigned to the Dexcom G6 or usual care for 8 months and reported a significant reduction in A1C, improved TIR and hypoglycemia This was accomplished without an appreciable change in insulin or other medication use, indicating that CGM improves glucose levels by facilitating behavioral changes.
Moreover, subsequent discontinuation of CGM for 6 months resulted in loss of about half of the improvement in TIR younger adults In a week study of patients with type 2 diabetes on multiple daily injections of insulin, patients randomized flash glucose monitoring Freestyle Libre had greater A1C reduction In a randomized trial of adults with type 2 diabetes using non-insulin therapies, intermittently scanned glucose monitoring in combination with diabetes self-management education demonstrated superior A1c reduction at 16 weeks treatment difference 0.
In a study of UK hospitals incorporating 16, participants, with repeated TIR data, improvements in TIR were associated with improvement in hypoglycemia unawareness and diabetes related distress. In the Swedish National Diabetes Registry that included 14, adults with type 1 diabetes, intermittently scanned glucose monitoring was associated with a small 0.
Moreover, the reduction in hospitalizations persisted after 2 years In Belgium, a study of adults with type 1 diabetes were studied before and after nationwide reimbursement of intermittently scanned continuous glucose monitoring Following the policy change, treatment satisfaction improved, there was a significant reduction in admissions for acute complications severe hypoglycemia or ketoacidosis , and there were fewer absences from work.
Among 41, patients with insulin requiring diabetes in an integrated health care delivery system, patients initiated CGM, which was associated with a greater reduction in A1C adjusted treatment difference 0.
However, there was no difference in hospitalizations for hyperglycemia or ketoacidosis. Recommendations Patients should be adequately informed of the benefits and limitations of this technology, particularly with respect to the role for SMBG. In , the Endocrine Society, co-sponsored by The American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology, published guidelines for use of insulin pumps and CGM.
The guidelines recommended RT-CGM in adults with type 1 diabetes and any A1C who are willing and able to use the devices nearly daily. The American Diabetes Association ADA Standards of Care recommend CGM in adults with type 1 diabetes and those with hypoglycemia unawareness or frequent hypoglycemia Table 2a.
Among pediatric patients, the ADA notes that CGM may reduce missed school days with regular usage 1. Table 2 a. ADA Recommendations for CGM. Group Recommendation Level of Evidence Real-time CGM Intermittently Scanned CGM Adults Youth Adults Youth MDI or CSII insulin use Should be offered A Should be offered B-T1D, E-T2D Should be offered B Should be offered E- T1D Should be used as close to daily as possible A Should be scanned frequently, at least every 8 hours A Basal insulin use A NA C NA All Devices are recommended for individuals or caregivers who can use the devices safely The choice of device should be individualized based on patient centered factors.
People should have uninterrupted access to supplies to minimize gaps in monitoring A Periodic RT-CGM, intermittently scanned CGM, or professional CGM can be helpful where continuous use is not possible C Diabetes and pregnancy CGM can help to achieve A1C targets in pregnancy when used as an adjunct to pre- and postprandial SMBG B.
Table 2b. AACE Recommendations for CGM by Methodology. Intermediate 1 C. Table 2c. AACE Recommendations for CGM—Patient Characteristics. Table 3. CGM-Based Targets for Different Diabetes Populations.
Table 4. Summary of ATTD Recommendations for CGM. Limitations of A1C CGM should be utilized when there is a discrepancy in A1C and other measures of glucose control.
CGM should be utilized to assess hypoglycemia and glucose variability. Guiding management and assessing outcomes CGM should be considered for patients with type 1 diabetes and insulin treated type 2 diabetes who are not achieving targets or those with hypoglycemia. All patients should receive training education regarding how to interpret and respond to their data, utilizing standardized programs with follow-up.
Performance No accepted standard exists for CGM system performance. with recovery defined as persistent readings over the threshold for at least 15 min.
CGM Metrics Standardized reporting using the AGP and integration into electronic health records is recommended. Hospital Use CGM is not currently approved for use in the hospital setting.
The panel made the specific recommendations for clinical care including: Consider use of CGM to reduce exposures such as for point of care glucose and need for personal protective equipment in persons with highly contagious diseases. Barring use in the setting of highly contagious disease, CGM values should be confirmed with point of care POC glucose prior to making treatment decisions.
Providers should recognize CGM pattern caused by compression of the device, which can cause a falsely low value. Providers should ensure patients are not taking medications or supplements that can interfere with CGM.
Nurses should be adequately trained on use of CGM, inspect the insertion site every shift, and set expectations that POC values are still necessary to support ongoing use of CGM typically every 6 hours.
Hospitals need to develop security protocols, data storage, visualization tools, and integration within the electronic medical record to support the use of CGM. Hospitals need to identify CGM values in the electronic medical record to distinguish values from blood glucose values.
Hospitals need to adopt the Unique Device Identifier UDI to track devices in the electronic medical record. Limitations of Use It should be emphasized that most prospective randomized controlled trials enroll highly motivated patients.
Daily Use Patients must be aware that sensor readings can deviate from actual blood glucose measurements, particularly during rapid glucose changes such as that which occurs post-meal or during exercise.
The algorithm by Jenkins et al. provides tiered recommendations that are based upon the meter glucose and sensor trend arrows In addition, the algorithm advises patients how to review downloads of the data periodically weekly and make adjustments.
Patients who were randomly assigned to sensor augmented pump with the algorithm had lower A1C and reported better quality of life at 16 weeks compared to patients who did not get the algorithm.
The effect on quality of life persisted at the week follow-up, and was associated with A1C reduction. Importantly, patients who received the algorithm at 16 weeks after initiating sensor augmented pump did not benefit.
Algorithm use was high in the first 3 weeks but dropped off by week 13, despite increasing insulin self- adjustments, possibly as patients became more independent over time. Subsequent methods recommended adjustment of only the correction insulin dose by the amount needed to cover a glucose level that is incrementally higher or lower than the current glucose, based upon the trend arrow 83 , Klonoff and Kerr proposed a more straightforward correction dose in 0.
A consensus statement facilitated by the Endocrine Society provides expert guidance on the use of trend arrows for making treatment decisions The guidance recommends adjustment of boluses pre-meal and no sooner than 4 hours post-meal in 0.
The statement recommends no additional treatment within 2 hours of a previous meal bolus, and correction bolus using the bolus calculator or usual correction dose only in the 4 hours after a meal.
Similar expert guidance has been developed for the Freestyle Libre system A more recent adaptation of the Endocrine Society guidance incorporated pre-meal glucose levels in addition to the insulin sensitivity 88 and a small randomized study demonstrated it was more effective than the incorporation of insulin sensitivity alone, particularly among insulin pump patients Overview of Stand-alone Personal RT-CGM and IS-CGM Systems The first RT-CGM Guardian, Medtronic R was approved in Table 5.
Comparison of Subcutaneous Continuous Glucose Monitoring Devices. Calibration required Confirmatory Fingersticks required prior to treatment Real-time alerts Sensor Life days Warm-up hrs Remove for MRI, CT diathermy Acetaminophen interference Dexcom G5 Y N Y 7 2 Y Y Dexcom G6 N N Y 10 2 Y N Dexcom G7 N N Y 10 0.
DEXCOM G6 The Dexcom CGM utilizes a glucose oxidase sensor at the tip of a wire that is implanted in the subcutaneous space. FREESTYLE LIBRE 2 The FreeStyle Libre 2 system offers real-time alerts for high or low glucose values and improved accuracy, approved for ages 4 years and older FREESTYLE LIBRE 3 The FreeStyle Libre 3 is even smaller than other devices the size of 2 stacked pennies , does not require scanning unlike older models, but does require the use of a compatible smartphone.
EVERSENSE The Eversense system Senseonics is a day implantable sensor that uses fluorescent technology to send measures via a rechargeable transmitter which rests just above the skin to a smartphone app titled Eversense NOW Sensor Augmented Pumps To date the largest A1C reductions have been observed when sensors are initiated with insulin pump technology.
These include: Low glucose threshold suspend: the insulin pump suspends when the glucose decreases below a pre-set value. Hybrid closed loop: insulin delivery increases or decreases based upon the sensor glucose value but meal boluses are still required. Dual hormone systems: these are hybrid closed loop or closed loop control systems that utilize glucagon or other peptides such as amylin in an effort to more closely mimic the physiology of the endocrine pancreas.
Threshold Suspend Progress is expected toward a fully functional closed loop system in incremental steps. Suspend Before Low The next incremental step in closed loop systems is the suspend before low feature, currently available in the Medtronic G approved only in Europe and the G systems.
Hybrid Closed Loop HCL This step refers to sensor glucose driven automatic adjustment of basal insulin with or without additional auto boluses, and still requires the patient to bolus for meals. In a recent consensus statement, an ideal candidate for automated insulin delivery systems : Is technically capable of managing a pump, has basic carbohydrate counting skills, and is able to implement a back-up plan including the use of manual injections.
Has realistic expectations of system capabilities. In particular, several situations that are unique to HCL are worth emphasizing:. Bolusing: pre-blousing approximately 15 minutes prior to meals is critical to maintain TIR. In many systems, delayed boluses not only cause early postmeal hyperglycemia but also precipitate delayed hypoglycemia as the system has already begun to augment insulin delivery in response to hyperglycemia.
Exercise management: Similarly, carbohydrate loading prior to exercise while using HCL systems will only stimulate insulin delivery and thus is recommended that users implement other means for management such as setting a higher target, typically with a designated exercise mode, or exiting to manual mode with temporary basal insulin reduction or temporary suspension of the pump.
Hypoglycemia management: HCL users typically need fewer carbohydrates about half to manage hypoglycemia since the pump has generally already suspended insulin delivery based upon glucose trends.
Has adequate support, including diabetes education, insurance coverage, and caregiver or other social support where relevant. MEDTRONIC G The first system to gain FDA approval is the Medtronic G, which adjusts basal insulin delivery every 5 minutes when in auto mode. TANDOM CONTROL-IQ This system utilizes a t:slim X2 insulin pump with a calibration-free Dexcom G6 sensor OMNIPOD 5 The Omnipod 5 is a HCL system that uses the Omnipod DASH platform Table 6.
Comparison of Hybrid Closed Loop Systems. Closed Loop Systems CLC Additional steps toward closed loop control CLC insulin delivery require algorithmic insulin adjustments, which arguably present additional safety concerns.
ILET BIONIC PANCREAS The iLet Bionic pancreas was approved by the FDA in OTHER SYSTEMS Systems have utilized single hormone rapid acting insulin only or dual hormone both fast- acting insulin analog and glucagon to imitate normal physiology as directed by a computer algorithm Figure 4 The three most common algorithms are: Model Predictive Control MPC : predicts future glucose levels and adjusts insulin delivery in response.
Proportional Integral Derivative PID : calculates the deviation of glucose from target to determine insulin delivery. MINIMALLY INVASIVE AND NON-INVASIVE GLUCOSE MONITORS Continuous hypoglycemia detection systems using current sensing technology must be either implanted fully or partially, either subcutaneously or into a blood vessel.
Optical approaches utilize reflective, absorptive, or refractive properties of infrared and optical bands of the light spectrum to detect glucose. Pure optical methods under development utilize Raman and Near infra-red spectroscopy. Thermal methods detect glucose via the far-infrared band of the spectrum and provide noninvasive approaches for glucose monitoring.
Electric methods use electromagnetic radiation, currents, or ultrasound approaches to detect dielectric properties of glucose. Reverse iontophoresis has been employed with early minimally invasive approaches while bioimpedance spectroscopy has been used in recent noninvasive approaches.
Nanotechnologies aim to miniaturize existing technologies, including fluorescence and surface plasmon resonance SPR approaches Device Downloading, Connectivity, and Interoperability Manual recording of glucose data is fraught with inaccuracies Diabetes Apps A variety of stand-alone smart phone applications that support glucose monitoring are also available.
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News Releases. News Release Wednesday, September 28, Bionic pancreas improves type 1 diabetes management compared to standard insulin delivery methods Next-generation technology maintains blood glucose levels by automatically delivering insulin. iLet bionic pancreas device Beta Bionics.
Connect with Us Contact Us X Facebook Instagram YouTube Flickr More Social Media from NIH. Back to Top. What is hybrid closed loop technology? How does hybrid closed loop technology work?
The pros and cons of hybrid closed loop technology The pros Reducing the burden of type 1 diabetes decisions By automating the treatment loop, hybrid closed loop systems can dramatically reduce the number of decisions you have to make every day.
What hybrid closed loop systems are available? Hybrid closed loop or artificial pancreas? Automated insulin delivery is another term for HCL which is being used more often.
Shared stories. Embracing hybrid closed loop. Sharing the load through tech. Tara and Thalia Humphrey Daughter Thalia, was diagnosed with type 1 aged five. Read Tara and Thalia story Read Tara and Thalia story. James Harris Living with type 1 diabetes.
Sara and Tim Giles Parents of Leon who uses hybrid closed loop. Read more Read more. Les Watson Living with type 1 for 40 years. More helpful information. Read more. Can I get hybrid closed loop technology on the NHS? Information about NHS access for this latest type 1 tech across the four nations of the UK Can I get hybrid closed loop technology on the NHS?
Insulin pumps Learn more about how insulin pumps work and how they can help you manage your type 1 Insulin pumps. What is continuous glucose monitoring?
Find out about how continuous glucose monitoring can help you manage your glucose levels in real-time Continuous glucose monitoring.
Our research into hybrid closed loop technology Nearly 20 years of JDRF research has pushed forward the development of hybrid closed loop technology, changing the lives of people living with type 1.
Learn more. More stories. Pregnancy and hybrid closed loop. Nina Willer Living with type 1. Yasmin Hopkins Diagnosed with type 1 aged Explore other type 1 tech. Read more Smart insulin pens A smart insulin pen is a reusable self-injection pen, which records information about how much insulin you inject and the timing of it.
Smart insulin pens. Read more Blood glucose meters Blood glucose meters measure the amount of glucose in the blood. Blood glucose meters. Read more Continuous glucose monitoring Continuous glucose monitoring can help you manage your glucose levels in real-time and relieve the burden of having to do multiple finger prick tests throughout the day.
Continuous glucose monitoring. Read more Flash glucose monitoring A flash glucose monitor is a small wearable device that you scan with a reader or mobile phone to check your glucose levels.
Flash glucose monitoring. Read more Hybrid closed loop artificial pancreas Hybrid closed loop technology — also known as the artificial pancreas — automates many of the decisions that you have to make on a daily basis when you have type 1 diabetes. Hybrid closed loop research.
Read more Open source and DIY systems Open source and DIY systems are sometimes used by people with type 1 diabetes or people caring for someone with type 1 to help manage the condition. Open source and DIY systems.
The Control-IQ artificial pancreas Glucose regulation technology was derived from research done at teechnology Center for Diabetes Technology regularion the University of Virginia. Image credit: Tandem Diabetes Care. Treat muscle soreness naturally multicenter randomized clinical trial reegulation Natural remedies for rehydration new artificial pancreas system — which Natural remedies for rehydration monitors and reggulation blood glucose levels Glucose regulation technology has found that the new system was more effective than existing treatments at controlling blood glucose levels in people with type 1 diabetes. The trial, based partly at the University of Virginia Center for Diabetes Technology, was primarily funded by the National Institute of Diabetes and Digestive and Kidney Diseases NIDDKpart of the National Institutes of Health. The latter is a common but serious challenge for children and adults with type 1 diabetes, since blood glucose can drop to dangerously low levels when a person is asleep. The research is published in the New England Journal of Medicine. From blood glucose meters Glucpse Glucose regulation technology rechnology monitoring CGM to cutting-edge insulin pumps and Natural remedies for rehydration, devices are easier to use and less invasive. There are lots of options so that you can find what works best for you. Many people hide their diabetes from others instead of reaching out for support. Read about one man's personal journey. A smart insulin pen is a reusable injector pen with an intuitive smartphone app that can help people with diabetes better manage insulin delivery.
Mir gefällt diese Phrase:)
Ich denke, dass gibt es.
die Klugen Sachen, sagt)
Wunderbar!