An estimate of the need for continuous glucose monitoring in type 2 diabetes with intensive insulin treatment in secondary healthcare.

AIM: To estimate the proportion of persons with type 2 diabetes (T2DM) receiving intensive insulin treatment in the secondary healthcare who could be candidates for continuous glucose monitoring (CGM), based on different HbA1c criteria. For comparison, the results are also presented as proportion of persons with type 1 diabetes (T1DM) in the same region. PATIENTS AND METHODS: In the Central Denmark Region, we identified all persons with T1DM (n = 6179) and T2DM (n = 4315) who had a minimum of one contact to a diabetes outpatient clinic from September 2021 to September 2022. Insulin regimen and HbA1c measured after a minimum of 2 months with a stable insulin regimen were retrieved from the healthcare administrative electronic platform used in the region. RESULTS: The numbers of persons with T1DM and T2DM with HbA1c meeting the criteria were 5145 and 3090, respectively. The fraction of T2DM with basal-bolus insulin was 35.3%, and the fraction with basal-bolus insulin and HbA1c >53 (7%) mmol/mol or >58 (7.5%) mmol/mol was 20.5% and 16.6%, respectively. These proportions correspond to 19.4%, 14.4% and 11.7% of the persons with T1DM in the same geographical area. CONCLUSION: The proportion of persons with T2DM in secondary healthcare undergoing intensive insulin treatment who could be candidates for CGM corresponded to only a minor fraction of persons with T1DM in the same region, irrespective of any HbA1c criteria applied.

Time With Rapid Change of Glucose.

BACKGROUND: A variety of metrics are used to describe glycemic variation, some of which may be difficult to comprehend or require complex strategies for smoothing of the glucose curve. We aimed to describe a new metric named time with rapid change of glucose (TRC), which is presented as percentage of time, similar to time above range (TAR), time in range (TIR), and time below range (TBR). METHOD: We downloaded glucose data for 90 days from 159 persons with type 1 diabetes using the Abbott Freestyle Libre version 1. We defined TRC as the proportion of time (%) with an absolute rate of change of glucose > 1.5 mmol/L/15 minutes (1.8mg/dL/min) corresponding to a minimum rate of change for glucose in the 3.9-10.0 mmol/L (70-180 mg/dL) range within 1 hour. TRC is related to the other glucose variability metrics: CV within day (CVw) and mean amplitude of glycemic excursion (MAGE). RESULTS: The more than 1.27 million glucose rates were t-location scale distributed with SD 0.91 mmol/L/15 min (1.1 mg/dL/15 min). The median TRC was 6.9% (IQR 4.5%-9.5%). The proportion of TRC with positive slope was 3.9% (2.6%-5.3%) and significantly higher than the proportion with negative slope 2.8% (1.5%-4.4%) P < .001. TRC correlated with CVw and MAGE (Spearman's correlation coefficient .56 and .65, respectively, P < .001). CONCLUSION: TRC is proposed as an easily perceived metric to compare the performance of hybrid or fully automated closed-loop insulin delivery systems to obtain glucose homeostasis.

Unravelling the occurrence of trace contaminants in surface waters using semi-quantitative suspected non-target screening analyses.

Several classes of anthropogenic chemicals such as pesticides and pharmaceuticals are frequently used in human-related life activities and are discharged into the aquatic environment. These compounds can exert an unknown effect on aquatic life and humans if the water is used for human consumption. Thus, unravelling their occurrence in the aquatic system is crucial for the well-being of life and monitoring purposes. To this end, we used nanoflow-liquid and ion-exchange chromatography hyphenated with orbitrap high-resolution tandem mass spectrometry to detect several thousands of features (chemical entities) in surface water. Later, the features were narrowed down to a few focused lists using a stepwise filtering strategy, for which the structural elucidation was made. Accordingly, the chemical structure was confirmed for 83 compounds from different application areas, mainly being pharmaceuticals, pesticides, and other multiple application industrial compounds and xenobiotic degradation products. The compounds with the highest concentration were lamotrigine (27.6 µg/L), valsartan (14.4 µg/L), and ibuprofen (12.7 µg/L). Some compounds such as prosulfocarb, fluopyram, and tris(3-chloropropyl) phosphate were found to be the most abundant and widespread contaminants. Of the 32 sampling sites, nearly half of the sites (47%) contained more than 30 different compounds. Two sampling sites were far more contaminated than other sites based on the estimated concentration and the number of identified contaminants they contained. Our triplicate analysis revealed a low relative standard deviation between replicates, advocating for the added value in analysing more sampling sites instead of sample repetition. Overall, our study elucidated the occurrence of organic contaminants from a variety of sources in the aquatic environment. Furthermore, our findings highlighted the role of suspected non-target screening in exposing a snapshot of the chemical composition of surface water and the localized possible contamination sources.