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1.
Ther Umsch ; 77(7): 289-296, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32996428

RESUMO

The Discovery of Insulin Abstract. The initiative for the work that led to the discovery of insulin in Toronto in 1921 came from Frederik G. Banting. He worked under the direction of John J. R. Macleod in the Institute of Physiology at the University of Toronto. In his experimental program he was assisted by the student Charles H. Best. On dogs with experimental diabetes they demonstrated the blood sugar-lowering effect of pancreatic extracts. Thanks to collaboration with Macleod and James B. Collip, a biochemist from the University of Alberta who was on sabbatical in Toronto, the work was quickly crowned with success and the first clinical applications of the extracts became possible in early 1922. As early as 1923, Banting and Macleod were awarded the Nobel Prize for Physiology or Medicine. Banting shared his half of the prize with Best, while Macleod shared his half with Collip. That their research was crowned with success is probably due in large part to Banting's abilities as a surgeon, Best's enthusiasm as a student, Collip's abilities as a biochemist and Macleod's prudence in bringing the group together and providing it with the necessary resources. In the 1950s, important advances were made in insulin research that were to spur further research in diabetology. These included the clarification of insulin structure and the possibility of measuring insulin in the blood. These two discoveries were awarded the Nobel Prize for Chemistry (see Kasten 1). In the 1960s-70s, insulin manufacturers developed ever better purification methods, which eventually led to preparations with very good tolerability and only very rare allergies. Later, in the 1980s, the possibility of biotechnological production of insulin led to an ever-increasing spread of human insulin. Based on the same technology, insulin analogues were produced in the 1990s and then in the new millennium, which, as "designer insulins" so to speak, enabled new clinically interesting active profiles. Today's variety of available insulins, modern forms of insulin application (insulin pens, insulin pumps) and blood glucose self-monitoring or continuous glucose monitoring form the basis of modern intensive insulin therapy.


Assuntos
Automonitorização da Glicemia , Insulina , Animais , Glicemia , Cães , Emoções , Humanos , Prêmio Nobel
2.
Ther Umsch ; 77(7): 312-318, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32996429

RESUMO

Closed-loop systems - Update 2020 Abstract. The artificial pancreas (also referred to as a Closed-loop system) represents the latest development in diabetes therapy. Closed-loop systems autonomously direct subcutaneous insulin infusion via a control algorithm based on real-time continuous glucose monitoring. Closed-loop systems have been tested in clinical studies since 2011, and were shown to improve glucose control by reducing hyper- and hypoglycaemia as well as glucose variability when compared with conventional insulin pump therapy. In 2016, the US regulatory authority approved the first hybrid-closed-loop system for the treatment of type 1 diabetes. Hybrid-closed loop systems are not yet fully automated and still require the user to be actively involved for insulin dosing at mealtimes. In spite of the remarkable progress, the delayed action profile of subcutaneously administered insulin and the need to wear multiple devices on the body remain challenging. The present review article summarizes the current state of the art of closed-loop systems in diabetes care and will address technical aspects, evidence from clinical studies as well as future developments in the field.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Pâncreas Artificial , Glicemia , Automonitorização da Glicemia , Humanos , Sistemas de Infusão de Insulina
3.
Vnitr Lek ; 66(3): 107-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972177

RESUMO

Due to the spread of new coronavirus disease, COVID-19, social interactions between people have been significantly reduced. In healthcare, outpatient care is a high-risk frontline of infection transmission in both patients and healthcare professionals. The presence of routine digital communication, remote data management and the availability of glucose monitoring and insulin delivery devices have given diabetology a certain advantage in this situation. However, the potential of these modalities has not been fully utilized so far. We provide an overview of practical methods of distance patient management, which can be used in most diabetes outpatient clinics without any difficult adjustments or additional investments. This approach can be used in different patients according to their treatment strategies and individual abilities.


Assuntos
Automonitorização da Glicemia , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/diagnóstico , Pneumonia Viral/epidemiologia , Telemedicina , Betacoronavirus , Glicemia , Humanos , Pandemias
4.
Wiad Lek ; 73(7): 1427-1433, 2020.
Artigo em Polonês | MEDLINE | ID: mdl-32759432

RESUMO

OBJECTIVE: Introduction: The Nightscout system is a free Do It Yourself solution. This system appeared in Poland in 2016. The concept of the project is to provide insight into measurements from the system of continuous glucose monitoring in interstitial fluid by authorized persons. The aim: The study was carried out to assess the functionality of the Nightscout system and its effect onmetabolic control, safety and the incidence of complications in patients with type 1 diabetes mellitus. PATIENTS AND METHODS: Material and methods:The study comprised 98 patients with type 1 diabetes. The study was conducted online using an anonymous questionnaire targeted at members of the "Nightscout Polska (Poland)" group on the Facebook. RESULTS: Results: Severe hypoglycaemic episodes with loss of consciousness were more frequent before using the Nightscout system and were reported by 3 adults (1-2 episodes). No severe hypoglycaemic episodes were reported when using the Nightscout system. The number of ketoacidosis episodes was reduced from 5 before using the Nightscout system to 2 episodes during the use of the system in children, and from 3 to 0 episodes in adults. Levels of glycated haemoglobin were lower in patients using the Nightscout system, both compared to control groups and values before the use it. In people using the Nightscout system glycated hemoglobin values were lower than their values before using this system. It was also shown that people using the Nightscout system had lower glycated hemoglobin than people from the control group. CONCLUSION: Conclusions: Using the Nightscout system can positively affect the safety of insulin therapy and the treatment process of type 1 diabetes. The Nightscout system can be an improvement of the system of continuous glucose monitoring in interstitial fluid.


Assuntos
Diabetes Mellitus Tipo 1 , Sistemas de Infusão de Insulina , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/complicações , Hemoglobina A Glicada , Humanos , Hipoglicemiantes , Incidência , Polônia
5.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(4): 338-342, 2020 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-32762210

RESUMO

According to users and places, blood glucose monitoring systems(BGMSs) can be divided into self-monitoring blood glucose test systems(SMBGs) and Point-of-Care Blood Glucose monitoring systems(POC-BGMSs). The Food and Drug Administration(FDA) believes that standards for SMBGs and POC-BGMSs should be different because of different operators, different use environments, different intendance uses and different applicable populations. Now the international standards for evaluating BGMSs include ISO 15197:2013 issued by International Organization for Standardization(ISO), two guidelines on blood glucose monitoring systems issued by FDA, and POCT12-A3 guidelines issued by the American Association for Clinical and Laboratory Standardization(CLSI), ISO standard and FDA guideline-OTC are applicable in SMBGs, CLSI guideline and FDA guideline-POCTI2-A3 are suitable for POC-BGMSs. By analyzing the accuracy evaluation processes of BGMSs based on four standard documents, it is found that the accuracy evaluation of medical BGMSs is more stringent. It is proposed that SMBGs and POC-BGMSs should be supervised separately.


Assuntos
Automonitorização da Glicemia , Glicemia , Sistemas Automatizados de Assistência Junto ao Leito , Padrões de Referência , Reprodutibilidade dos Testes , Estados Unidos , United States Food and Drug Administration
6.
Rev Med Suisse ; 16(703): 1494-1497, 2020 Aug 26.
Artigo em Francês | MEDLINE | ID: mdl-32852170

RESUMO

The artificial pancreas is a system coupling an automatic insulin infusion according to a continuous glucose monitoring. It is mainly intended for type 1 diabetic patients. Many advances in this area have led to the commercialization of so-called hybrid artificial pancreas devices. These devices always require human intervention to announce the amount of carbohydrates ingested at each meal. The complete fully automated system, called closed loop, is being evaluated thanks to the improvement of prediction algorithms. This paper aims to describe the progress of the artificial pancreas in 2020.


Assuntos
Diabetes Mellitus Tipo 1 , Pâncreas Artificial , Algoritmos , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/terapia , Humanos , Hipoglicemiantes , Insulina , Sistemas de Infusão de Insulina , Pâncreas Artificial/tendências
7.
Diabetes Res Clin Pract ; 167: 108354, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32739380

RESUMO

AIMS: Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with T1D prone to hypoglycemia using standalone continuous glucose monitoring. METHODS: Patients with T1D prone to hypoglycemia using multiple daily injections and either a Dexcom G5® or a Free Style Libre® CGM systems for at least 6 months under the funding of National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st-14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data were also analysed. RESULTS: 92 patients were included: 40 women, age 42.8 ± 3.9 years, disease duration of 23.1 ± 12.6 years. Seventeen patients used Dexcom G5® and 75 Free Style Libre®. TIR 70-180 mg/dL (59.3 ± 16.2 vs 62.6 ± 15.2%), time > 180 (34.4 ± 18.0 vs 30.7 ± 16.9%), >250 (11.1 ± 10.6 vs 9.2 ± 9.7%) and Glucose Management Indicator (7.2 ± 0.8 vs 7.0 ± 0.8%) significantly improved (PL vs WL, respectively, p < 0.05). Time in hypoglycemia remained unchanged. CONCLUSIONS: Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycemic control by population with T1D prone to hypoglycemia using CGM. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time in hypoglycemia.


Assuntos
Automonitorização da Glicemia , Controle de Doenças Transmissíveis , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Monitorização Ambulatorial , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Glicemia , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Humanos , Injeções , Insulina de Ação Prolongada/uso terapêutico , Insulina de Ação Curta/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Espanha/epidemiologia , Medicina Estatal
8.
S Afr Med J ; 110(5): 416-421, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657728

RESUMO

BACKGROUND: Glycated haemoglobin (HbA1c) has been used for decades as a measure of chronic glycaemia. A simple linear relationship between HbA1c values and mean blood glucose (MBG) has been identified and led to conversion of HbA1c values into estimated average glucose (eAG) levels, following the findings of the A1c-Derived Average Glucose (ADAG) Study Group. The intention was to help patients with diabetes mellitus (DM) understand their glycaemic control better, as eAG is reported in the same units as self-monitored glucose levels. However, factors other than glycaemia have been found to affect the relationship between HbA1c and MBG. OBJECTIVES: To: (i) determine the relationship between self-monitored MBG levels and HbA1c values; and (ii) evaluate the correlation between MBG levels and eAG levels calculated from HbA1c values using the regression equation derived from the ADAG Study Group in black South African patients with DM. METHODS: This was a prospective observational study of 96 diabetic patients. MBG levels were calculated using glucose measurements downloaded from the glucose meters for the previous 90 days (3 months). High-performance liquid chromatography was used for measurement of HbA1c values, collected at the end of 3 months. eAG was calculated using the regression equation from the ADAG Study Group, as follows: eAG (mmol/L) = 1.5944 × HbA1c (NGSP, %) - 2.594. RESULTS: A positive correlation was found between MBG and HbA1c in all participants (R2=0.69, p<0.0001). There was a wide range of MBG levels for any given HbA1c value. Clinically significant differences between MBG and eAG were found, with a ≥10% difference in 65.6% of the participants. eAG overestimated MBG in ~71.8% of the study population, with an overestimation of ≥1.6 mmol/L (28.7 mg/dL, equivalent to a 1% change in HbA1c value) in ~50% of the total study population. CONCLUSIONS: Our findings showed an imperfect relationship between MBG levels and HbA1c values. eAG significantly overestimated MBG, and this disagreement may cause confusion among both patients and clinicians. The risk of hypoglycaemic episodes may also increase if HbA1c and eAG alone are used to intensify therapy. We recommend that the use of eAG should be validated prior to implementation in clinical practice. It would be ideal to evaluate the relationship between average glucose and HbA1c in each individual patient in order to provide more personalised diabetes care.


Assuntos
Automonitorização da Glicemia , Glicemia/análise , Hemoglobina A Glicada/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Estudos Prospectivos , África do Sul/epidemiologia , Adulto Jovem
12.
Am J Vet Res ; 81(8): 642-650, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32700996

RESUMO

OBJECTIVE: To determine effects of PCV on blood glucose (BG) concentration measurements obtained with a human portable blood glucometer (HPBG) and a veterinary portable blood glucometer (VPBG) on canine (cVPBG) and feline (fVPBG) settings (test methods) when used in rabbits and to develop correction formulas to mitigate effects of PCV on such measurements. SAMPLE: 48 resuspended blood samples with known PVCs (range, 0% [plasma] to 92% [plasma and packed RBCs]) from 6 healthy research rabbits (experimental sample set) and 252 historic measurements of BG concentration and PCV in 84 client-owned rabbits evaluated at a veterinary hospital (validation data set). PROCEDURES: Duplicate measurements of BG concentration with each test method and of PCV were obtained for each sample in the experimental sample set, and the mean results for each variable for each test method and sample were compared with results from a clinical laboratory analyzer (reference method) used to determine the true BG concentration for each sample. Mean ± SD differences in measurements between the reference and test methods were calculated. Linear regression and modified Clarke error grid analysis were used to develop correction formulas for the test methods given known PCVs, and these formulas were evaluated on the validation data set with linear regression and a modified Clarke error grid. RESULTS: Blood glucose concentrations were falsely low for cVPBG and fVPBG used on samples with PCV < 31% and were falsely high for all test methods used on samples with PCV > 43%. Compared with original measurements, formula-corrected measurements overall had better agreement with reference method measurements for the experimental sample set; however, only the formula-corrected HPBG measurements had improved agreement for the validation data set. CONCLUSIONS AND CLINICAL RELEVANCE: Findings indicated that, in rabbits, HPBG measurements had improved accuracy with the use of the correction formula HPBG measurement of BG concentration + ([0.75 × PCV] - 15); however, the correction formulas did not improve the accuracy of VPBG measurements, and we believe that neither the cVPBG nor fVPBG should be used in rabbits.


Assuntos
Glicemia , Sistemas Automatizados de Assistência Junto ao Leito , Animais , Automonitorização da Glicemia/veterinária , Gatos , Tamanho Celular , Cães , Modelos Lineares , Coelhos
13.
Diabetes Res Clin Pract ; 166: 108307, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32650036

RESUMO

AIMS: On the 10th of March, Greece imposed the closure of schools and universities and a full lockdown a few days later in order to counter the spread of the coronavirus outbreak. Our aim was to monitor the effect of the coronavirus lockdown in diabetes management in children with Type 1 Diabetes Mellitus (T1DM) wearing insulin pump equipped with continuous glucose monitoring system. METHODS: In 34 children with T1DM on Medtronic 640G insulin pump equipped with the Enlite Sensor uploaded CareLink data were categorized in 2 three-week periods before and after the 10th of March. RESULTS: Mean time in range (TIR) did not significantly differ between the two periods. However, a significantly higher Coefficient of Variation (CV) indicating an increased glucose variability in the pre-lockdown period was observed (39.52% versus 37.40%, p = 0.011). Blood glucose readings were significantly fewer during the lockdown period (7.91 versus 7.41, p = 0.001). No significant difference was recorded regarding the total daily dose of insulin and the reported carbohydrates consumed. However, the meal schedule has changed dramatically as the percentage of breakfast consumed before 10.00 a.m. has fallen from 80.67% to 41.46% (p < 0.001) during the lockdown. Correspondingly, the percentage of dinner consumption before 10.00 p.m. significantly fell during the lockdown period (60.22% versus 53.78%, p = 0.019). CONCLUSIONS: Glycemic control during the coronavirus lockdown can be adequately achieved and be comparable to the pre-lockdown period in children with type 1 diabetes mellitus wearing insulin pump equipped with sensor.


Assuntos
Betacoronavirus/isolamento & purificação , Automonitorização da Glicemia/métodos , Glicemia/análise , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Sistemas de Infusão de Insulina/estatística & dados numéricos , Insulina/uso terapêutico , Pneumonia Viral/complicações , Adolescente , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/virologia , Feminino , Grécia/epidemiologia , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico
14.
Diabetes Res Clin Pract ; 166: 108344, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32710997

RESUMO

AIMS: To assess knowledge, attitude, and practices (KAP) of young adults with type 1 diabetes mellitus (T1DM) towards COVID-19 amid nationwide lockdown in India. METHODS: We conducted a cross-sectional web-based survey among young adults with T1DM (aged 18-30 years) in the North, Central, South, and West zones of India. It consisted of fifteen, five and eight questions pertaining to knowledge, attitude, and practices towards COVID-19, respectively. Certain questions relevant to T1DM were also incorporated. RESULTS: After exclusion, 212 participants were included (mean age = 25.1 ± 4.3 years; M:F = 10:11). The overall correct rate of the knowledge questionnaire was 83% (mean total knowledge score = 12.4 ± 1.9). Most (74%) had an average knowledge score (mean ± 1SD). Higher educational status, urban residence, and being married were associated with better knowledge scores; however, only urban residence was found to be statistically significant on multinomial logistic regression. Most (88%) felt that being a patient of T1DM, they were at higher risk of getting infected with COVID-19. At the same time, 98% were confident about self-protection. Fifty-one percent of respondents had left home amid lockdown mostly to procure insulin/injection needles/syringes/glucometer strips from the pharmacy. However, all were maintaining proper hand hygiene and majority were following routine dietary advice (95%) and administering prescribed insulin doses (99%). Seventy-two participants (34%) had experienced one or more episodes of hypoglycemia since the commencement of lockdown. CONCLUSIONS: Young adults with T1DM have average knowledge, positive attitude, and healthy preventive practices towards COVID-19. Awareness campaigns targeted towards rural communities and providing doorstep delivery of insulin/needles/syringes may be more rewarding.


Assuntos
Betacoronavirus/isolamento & purificação , Automonitorização da Glicemia/métodos , Infecções por Coronavirus/prevenção & controle , Diabetes Mellitus Tipo 1/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Insulina/uso terapêutico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Adolescente , Adulto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/virologia , Feminino , Educação em Saúde , Humanos , Hipoglicemiantes/uso terapêutico , Índia/epidemiologia , Masculino , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Inquéritos e Questionários , Adulto Jovem
15.
Diabetes Res Clin Pract ; 166: 108348, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32711000

RESUMO

INTRODUCTION: The COVID-19 pandemic has forced governments to take exceptional measures to minimize its spread, imposing lockdown policies. The aim of this study was to evaluate the impact of lockdown on type 1 diabetes (T1D) glycemic control. MATERIAL AND METHODS: People with T1D using flash glucose monitoring were included. Data from the 14 days before lockdown were compared with data from the last 14 days after 8 weeks of lockdown. RESULTS: A total of 307 patients were included (age 45.8 ± 12.6 years, 50.2% male, diabetes duration 21.1 ± 12.3 years). Only one patient had COVID-19 infection. Mean glucose decreased from 166.89 ± 29.4 to 158.0 ± 29.0 mg/dL and estimated HbA1c declined from 7.4 ± 1.0 to 7.1 ± 1.0% (54 ± 10.9 vs 57 ± 10.9 mmol/mol; p < 0.001). Time in range increased from 57.8 ± 15.8 to 62.46 ± 16.1%. Time in hyperglycemia > 180 mg/dL and >250 mg/dL decreased from 37.3 ± 1.9% to 32.0 ± 17.1% and from 13.0 ± 11.3 to 10.3 ± 10.6%, respectively; (p < 0.001). Time in hypoglycaemia <70 mg/dL increased from 4.9 ± 4.0% to 5.5 ± 4.4% (p < 0.001). No differences in time <54 mg/dl, coefficient of variation (CV%) or number of scans per day were found. CONCLUSION: Despite the limitations of lockdown, glycemic control improved in patients with T1D. These results suggest that having more time for self-management may help improve glycemic control in the short term.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Insulina/uso terapêutico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Automonitorização da Glicemia/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/virologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Espanha/epidemiologia
16.
Diabetes Res Clin Pract ; 166: 108308, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32650035

RESUMO

AIMS: To investigate the frequency of dawn phenomenon (DP) and its relationship with time in range (TIR) and glycemic variability (GV) using continuous glucose monitoring (CGM). METHODS: 781 subjects of a multicenter CGM study in China were included: those with normal glucose tolerance (NGT n = 360); impaired glucose regulation (IGR n = 173); newly diagnosed type 2 diabetes mellitus (T2D n = 248). Analysis of the magnitude of DP (ΔG) was conducted with the primary definition of 1.11 mmol/L and a secondary definition of 0.56 mmol/L. RESULTS: The frequency of DP was 8.9%, 30.1% and 52.4% in NGT, IGR and T2D group, respectively, using the primary definition. In all three groups, TIR was lower (all P < 0.05), coefficient of variation (CV) was higher in DP subgroup (all P < 0.05). In DP subgroup of T2D, TIR was 7.0% (1.68 h) lower and CV was 3.0% higher, and HbA1c was 0.6% (7 mmol/mol) higher using the primary definition (all P < 0.05). CONCLUSIONS: DP was present in a high percent of subjects with NGT and IGR. In newly diagnosed T2D group, the presence of DP was associated with poorer overall glycemic control.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Hiperglicemia/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Stud Health Technol Inform ; 270: 1413-1414, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570685

RESUMO

In this study, we investigated which predictors from people with type 1 diabetes at initiation of intensive treatment that increase the risk of not achieving glycemic target. Data from a clinical trial with type 1 diabetes people (n=460) were used in a logistic regression model to analyze the effect of the predictors on achievement of glycemic target. Results indicate that age, smoking, glycated hemoglobin, 1,5-anhydroglucitol and fluctuation from continuous glucose monitoring are predictors of achievement of glycemic target, which can be used in an algorithm to predict people who fail to achieve glycemic target.


Assuntos
Glicemia , Diabetes Mellitus Tipo 1 , Automonitorização da Glicemia , Hemoglobina A Glicada , Humanos , Hipoglicemiantes , Estudos Longitudinais
18.
Diabetes Res Clin Pract ; 165: 108233, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32497744

RESUMO

Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity.


Assuntos
Glicemia/análise , Transtornos do Metabolismo de Glucose/diagnóstico , Hemoglobina A Glicada/análise , Estado Pré-Diabético/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Automonitorização da Glicemia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Criança , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Frutosamina/sangue , Intolerância à Glucose/sangue , Transtornos do Metabolismo de Glucose/sangue , Teste de Tolerância a Glucose , Humanos , Hiperglicemia/diagnóstico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Albumina Sérica/análise , Adulto Jovem
19.
Stud Health Technol Inform ; 270: 693-697, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570472

RESUMO

Patients with diabetes are often worried about having low blood glucose because of the unpleasant feeling and possible dangerous situations this can lead to. This can make patients consume more carbohydrates than necessary. Ad-hoc carbohydrate estimation and dosing by the patients can be unreliable and may produce unwanted periods of high blood glucose. In this paper we present a system that automatically estimates and dispenses the amount of juice (or similar) according to the current patients' blood glucose values. The system is remotely accessible and customizable from a chatbot, exploits sensors and actuators to dispense the necessary amount of liquid carbohydrates. It relies on a cloud solution (Nightscout) to acquire the patient's blood glucose values, which are constantly updated thanks to a commercial wearable continuous glucose monitor (CGM).


Assuntos
Diabetes Mellitus , Hipoglicemia , Glicemia , Automonitorização da Glicemia , Carboidratos , Humanos , Hipoglicemiantes , Sistemas de Infusão de Insulina
20.
Expert Opin Pharmacother ; 21(13): 1565-1578, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32521177

RESUMO

INTRODUCTION: Recent advances in anti-diabetic medications and glucose monitoring have led to a paradigm shift in diabetes care. Newer anti-diabetic medications such as DPP-4 inhibitors, GLP-1 receptor agonists (GLP-1RAs), and SGLT2 inhibitors have enabled optimal glycemic control to be achieved without increasing the risk of hypoglycemia and weight gain. Treatment with GLP-1RAs and SGLT2 inhibitors has been demonstrated to improve cardiorenal outcomes, positioning these agents as the mainstay of treatment for patients with type 2 diabetes (T2DM). The development of these newer agents has also prompted a paradigm shift in the concept of T2DM, highlighting the importance of beta cell dysfunction in the pathophysiology of T2DM. AREAS COVERED: Recent advances in pharmacotherapy for diabetes are summarized with a focus on the role of incretin-based drugs and SGLT2 inhibitors. The importance of a paradigm shift from a glucose-centric to a beta cell-centric concept of T2DM is also discussed, given from an Asian perspective. EXPERT OPINION: Management of T2DM including lifestyle modification as well as pharmacotherapy should be focused on reducing beta cell workload, to preserve functional beta cell mass. A paradigm shift from a glucose-centric to a beta cell-centric concept of T2DM enhances the implementation of person-centered diabetes care.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Células Secretoras de Insulina/efeitos dos fármacos , Glicemia/análise , Automonitorização da Glicemia , Diabetes Mellitus Tipo 2/metabolismo , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Glucose/metabolismo , Humanos , Hipoglicemia/induzido quimicamente , Incretinas/metabolismo , Insulina/uso terapêutico , Células Secretoras de Insulina/metabolismo , Medicina de Precisão , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico
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