ABSTRACT
BACKGROUND: Advanced chronic kidney disease (CKD) is a common complication for people with type 1 and 2 diabetes and can often lead to glucose instability. Continuous glucose monitoring (CGM) helps users monitor and stabilize their glucose levels. To date, CGM and intermittent scanning CGM are only approved for people with diabetes but not for those with advanced CKD. AIM: To compare the performance of Dexcom G5 and FreeStyle Libre sensors in adults with type 1 or 2 diabetes and advanced CKD. METHODS: This was a non-randomized clinical trial that took place in two outpatient clinics in western Sweden. All patients with type 1 or 2 diabetes and an estimated glomerular filtration rate (eGFR) of < 30 mL/min per 1.73 m2 were invited to participate. Forty patients (full analysis set = 33) carried the Dexcom G5 sensor for 7 d and FreeStyle Libre sensor for 14 d simultaneously. For referencing capillary blood glucose (SMBG) was measured with a high accuracy glucose meter (HemoCue®) during the study period. At the end of the study, all patients were asked to answer a questionnaire on their experience using the sensors. RESULTS: The mean age was 64.1 (range 41-77) years, hemoglobin A1c was 7.0% [standard deviation (SD) 3.2], and diabetes duration was 28.5 (SD 14.7) years. A total of 27.5% of the study population was on hemodialysis and 22.5% on peritoneal dialysis. The mean absolute relative difference for Dexcom G5 vs SMBG was significantly lower than that for FreeStyle Libre vs SMBG [15.2% (SD 12.2) vs 20.9% (SD 8.6)], with a mean difference of 5.72 [95% confidence interval (CI): 2.11-9.32; P = 0.0036]. The mean absolute difference was also significantly lower for Dexcom G5 than for FreeStyle Libre, 1.21 mmol/L (SD 0.78) and 1.76 mmol/L (SD 0.78), with a mean diffrenec of 0.55 (95%CI: 0.27-0.83; P = 0.0004).The mean difference (MD) was -0.107 mmol/L and -1.10 mmol/L (P = 0.0002), respectively. In all, 66% of FreeStyle Libre values were in the no risk zone on the surveillance error grid compared to 82% of Dexcom G5 values. CONCLUSION: Dexcom G5 produces more accurate sensor values than FreeStyle Libre in people with diabetes and advanced CKD and is likely safe to be used by those with advanced CKD.
ABSTRACT
Due to the increased resistance to antibiotics and chemical biocides, the use of bacterial exopolysaccharides has been considered. The objective of the current study was to investigate the strength of the antibacterial and antibiofilm activity of EPS extracted from Lactobacillus reuteri and Streptococcus mitis because previous studies showed there were structural differences between EPS, during this study, EPS extracted from Lactobacillus reuteri and Streptococcus miti by ethanol precipitation method and estimated antibacterial and antibiofilm activity against several Oral Bacteria (Staphylococcus aureus, Staphylococcus hominis, Acinetobacter baumannii, Raoultella ornithinolytica, Streptococcus thoraltensis in different concentration as (100,150,200,250,300 mg/ml ), the results showed carbohydrates rate in extracted EPS from L. reuteri and S. mitis were recorded was 85, 80 % respectively.The concentration 100 and 150 mg/ml for EPS from L. reuteri and S. mitis, there was no inhibitory effect, except in S. aureus (1.1±0.10) and S. hominis (1.0±0.10) at 100 mg/ml, 3.1±2.01, 2.1±0.54 mg/ml respectively at 150 mg/ml concentration but no significant differences (P≤0.05). However, the antibacterial effect of that EPSs started at the concentration of 200 and upwards, where different results were recorded between the concentrations of both EPSs against all bacteria isolated (P≤0.05), On the other hand, the effect of EPS from L. reuteri and S. mitis was clear against the formation of biofilm compared with the control, worth mentioning that EPS from L. reuteri was more effective compared with EPS from S. mitis in all isolates (P≤0.05) except for S. thoraltensis where it was noted that the EPS from S. mitis is more effective than EPS from L. reuteri. Through the results obtained in this study, it was noted that the difference in the structural nature of EPS has an important role in its effectiveness as an antibacterial and anti-biofilm formation and, as it was found that the EPS from L. reuteri showed more effectiveness than EPS from S. mitis and thus the mechanism of preventing and inhibiting bacteria depending of the structural nature of EPS.
