This study aimed to evaluate the relationship between time in targeted blood glucose range (TIR) and 28-day mortality in critically ill patients.

A retrospective cohort analysis was conducted using data from the MIMIC-IV database. Patients (n = 18,905) were stratified into four quartiles based on TIR values. The association between TIR and mortality was assessed using multivariable logistic regression models with adjustments for potential confounders.

In the fully adjusted model, each percentage point increase in TIR was associated with a 1 % reduction in 28-day mortality risk (OR = 0.99, 95 % CI: 0.98-0.99, P < 0.001). Patients in the highest TIR quartile showed a 60 % lower mortality risk compared to those in the lowest quartile (OR = 0.40, 95 % CI: 0.22-0.74, P = 0.003). The predictive model demonstrated good discriminative ability (AUC = 0.7543).

Time in targeted blood glucose range is independently associated with 28-day mortality in ICU patients, suggesting its potential value as a metric for risk stratification and glycemic management optimization.

Abdominal normothermic regional perfusion (aNRP) is an in situ normothermic oxygenated donor perfusion technique before procurement during controlled donation after circulatory death (cDCD) procedures and allows for organ quality evaluation. There are few data on the effect of aNRP on pancreatic islet isolation and subsequent transplantation outcomes. We aim to evaluate the impact of aNRP on cDCD pancreatic islet isolation and transplantation. A retrospective analysis was performed on pancreatic islet isolation outcomes from aNRP, cDCD, and donation after brain death pancreases. Isolations were compared to previous donor age (60-75 years) matched isolations. Islet function was assessed by a dynamic glucose-stimulated insulin secretion. Donor baseline characteristics did not differ among groups. Isolations from aNRP pancreases (471 739 islet equivalents [IEQ] [655 435-244 851]) yielded more islets compared to cDCD (218 750 IEQ [375 951-112 364], P < .01) and to donation after brain death (206 522 IEQ [385 544-142 446], P = .03) pancreases. Dynamic glucose-stimulated insulin secretion tests in 7 aNRP islet preparations showed a mean stimulation index of 4.91, indicating good functionality. Bilirubin and alanine aminotransferase during aNRP correlated with islet yield (r2 = 0.685, P = .002; r2 = 0.491, P = .016, respectively). Islet isolation after aNRP in cDCD donors results in a high islet yield with viable functional islets. aNRP could increase the utilization of the pancreases for islet transplantation.

This study aimed to explore the relationship between time below range (TBR), impaired awareness of hypoglycemia (IAH), and severe hypoglycemia (SH).

This cross-sectional study analyzed data from individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetologists audit. Hypoglycemia awareness was assessed via the Gold score (≥4 denoting IAH), and SH was defined as hypoglycemia requiring third-party assistance. Logistic regression was used to determine the association between TBR percentage (<70 mg/dL; 3.9 mmol/L) at first follow-up and follow-up Gold score and SH incidence. The Youden J index identified optimal TBR percentage cutoffs for detecting IAH and SH.

The study included 15,777 participants, with follow-up TBR and SH data available for 5,029. The median TBR percentage was 4% (interquartile range 2-6.6%), with 42% meeting the recommended TBR of ≤4%. Adjusted for age, sex, and BMI, TBR was significantly associated with SH (P < 0.001) and IAH (P = 0.005). Optimal TBR cutoffs for identifying IAH and SH were 3.35% and 3.95%, yielding negative predictive value (NPV) values of 85% and 97%, respectively.

Our findings support the international consensus recommending a TBR of <4% in type 1 diabetes, with high NPV values suggesting the utility of TBR in screening for SH.

Diabetes is a chronic disease that results in elevated blood glucose levels due to insufficient insulin production by the pancreas or impaired insulin utilization by the body. The development of effective tools for the in vitro detection of blood glucose is of paramount importance. Flexible electrodes serve as indispensable components in point-of-care systems, thus increasing accessibility and personalization in health monitoring. We present the preparation of handmade screen-printed electrode with water-based conductive ink for in vitro nonenzymatic glucose (Glu) determination at physiological pH values. The investigation aimed to identify the optimal conditions for formulating and composing the conductive ink used to create a copper ferrite/sulfur-doped graphene oxide/graphite/screen-printed electrode (CuFe2O4/S-GO/G/SPE). The resulting CuFe2O4/S-GO/G/SPE shows excellent glucose sensing ability with a limit of detection (LOD) of 2.93 μM. The superior determination at physiological pH is attributed to the complex structure formed by CuFe2O4 nanoparticles with glucose molecules in the basic pH conductive ink structure. Additionally, the excellent delocalization and conductivity of the S-GO particles in this complex structure contribute to improved performance. The study on artificial sweat samples resulted in achieving recovery values of 96.60% to 104.97%. In conclusion, the nonenzymatic and noninvasive Glu sensor printed with conductive ink containing CuFe2O4/S-GO/G on a flexible paper substrate surface demonstrated remarkable capabilities for determining Glu levels in artificial sweat samples. SPEs prepared with conductive ink produced by using these materials are promising candidates for use as electrodes in flexible and wearable sensor technology.

Transformation of epithelial to mesenchymal (EMT) is an important event in the process of tumor initiation, invasion and metastasis. Circulating tumor cells (CTCs) are one kind of important markers in the field of liquid tumor biopsy, whose number and phenotype represent the occurrence and progression of tumors. Therefore, it is our interest to investigate the epithelial mesenchymal transition process occurring on the surface of CTCs. Herein in this work, two proteins of E-cadherin (E-cad) and N-cadherin (N-cad) were selected as representative proteins of EMT process. To achieve simultaneous analysis of E-cad and N-cad on the surface of rare CTCs, we designed a duplex and portable immunosensor using AuNPs and AgNPs as nanolabels to amplify the immunoreaction signals. The dual channel immunosensor not only exhibited good electrochemical responses for recombinant E-cad and N-cad as low as 0.1 ng/mL and 0.05 ng/mL, respectively, but also showed good linear correlations with different numbers of phenotypic CTCs (10-500 cells/10 μL). The above strategy was further employed to inspect the occurrence of EMT on CTCs surface, which displayed a high consistence with other molecular biological characterizations. Finally, this immunoassay was successfully applied to inspect the correlations of numbers, phenotype of CTCs, as well as E-cad and N-cad expressions on these CTCs in bloods of NSCLC patients with disease stage.

To examine the association between tear glucose (TG) and the presence and severity of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

A cross-sectional study. TG was examined by rapid qualitative test strip in 160 patients. The severity of DR was graded as mild DR and severe DR. The presence and severity of DR were compared between patients with positive and negative TG. The association of TG with the presence and the severity of DR was estimated by multivariable regression analysis and spearman's rank correlation test, respectively. The performance of TG to detect DR was evaluated by the receiver operating characteristic (ROC) curve.

In this study, 160 patients were included, with a median age of 64.0 years, and 88 (55.0%) patients were males. A total of 91 (56.9%) patients had positive TG, and 69 (43.1%) patients had negative TG. In TG-positive group, 41 (45.1%) patients were diagnosed with DR, among them, 8 (19.5%) patients had mild DR, and 33 (80.5%) patients were afflicted with severe DR. Multivariable logistic regression indicated that the presence of DR positively correlated with the presence of positive TG (odds ratio [OR], 3.62; 95% confidence interval [CI], 1.56-8.40; p < 0.01), longer duration of diabetes (OR, 1.11; 95% CI 1.06-1.17; p < 0.01) and higher HbA1c (OR, 1.25; 95% CI 1.01-1.54; p = 0.03). Moreover, Spearman's correlation analysis suggested that the grading of TG increased with the severity of DR (rs = 0.28, p < 0.01). The area under the curve (AUC) of the model integrating TG, the duration of diabetes and HbA1c was 0.76 (95% CI 0.69-0.84), indicating a fair discriminative ability of DR.

TG level was associated with the presence and the severity of DR. TG might be an easy-to-use, non-invasive parameter to the screening and monitoring of DR among patients with diabetes.

Diabetes mellitus is a metabolic disorder that affects millions of individuals worldwide. Continuous glucose monitoring (CGM) offers a prevalent method for continuously monitoring interstitial glucose levels instead of traditional self-monitoring of blood glucose (BG), eliminating the need for finger pricking and providing only discrete data. However, challenges in accuracy persist in CGM, including substantial noise interference and tissue fluid erosion, as well as the pH fluctuations in the localized ISF microenvironment during acute inflammation periods. Herein, we reported a facile atmospheric plasma-induced grafting technique to surface functionalize a zwitterionic brush coating on the sensor, with the aim to adjust the sensor's microenvironmental chemistry. The zwitterionic brush-coated CGM (Z-coated CGM) could regulate pH values with a good glucose response in the pH range from 6.2 to 7.6 and a prolonged sensor life over the uncoated sensor. We evaluated the rat practice that the Z-coated CGM consistently outperformed the uncoated in tracking BG fluctuations, with higher correlation coefficients and significant noise reduction for both non-recalibration and recalibration. This technology holds substantial implications for subcutaneous embedded glucose monitors and facilitates CGMs in achieving independence from routine BG fingerstick calibrations.

Diabetes is prevalent, and it imposes a substantial public health burden globally and in the Asia-Pacific (APAC) region. The cornerstone for optimizing diabetes management and treatment outcomes is glucose monitoring, the techniques of which have evolved from self-monitoring of blood glucose (SMBG) to glycated hemoglobin (HbA1c), and to continuous glucose monitoring (CGM). Contextual differences with Western populations and limited regionally generated clinical evidence warrant regional standards of diabetes care, including glucose monitoring in APAC. Hence, the APAC Diabetes Care Advisory Board convened to gather insights into clinician-reported CGM utilization for optimized glucose monitoring and diabetes management in the region. We discuss the findings from a pre-meeting survey and an expert panel meeting regarding glucose monitoring patterns and influencing factors, patient profiles for CGM initiation and continuation, CGM benefits, and CGM optimization challenges and potential solutions in APAC. While CGM is becoming the new standard of care and a useful adjunct to HbA1c and SMBG globally, glucose monitoring type, timing, and frequency should be individualized according to local and patient-specific contexts. The results of this APAC survey guide methods for the formulation of future APAC-specific consensus guidelines for the application of CGM in people living with diabetes.

Diabetes currently affects approximately 500 million people worldwide and is one of the most common causes of mortality in the United States. To diagnose and monitor diabetes, finger-prick blood glucose testing has long been used as the clinical gold standard. For diabetes treatment, insulin is typically delivered subcutaneously through cannula-based syringes, pens, or pumps in almost all type 1 diabetic (T1D) patients and some type 2 diabetic (T2D) patients. These painful, invasive approaches can cause non-adherence to glucose testing and insulin therapy. To address these problems, researchers have developed miniaturized blood glucose testing devices as well as microfluidic platforms for non-invasive glucose testing through other body fluids. In addition, glycated hemoglobin (HbA1c), insulin levels, and cellular biomechanics-related metrics have also been considered for microfluidic-based diabetes diagnosis. For the treatment of diabetes, insulin has been delivered transdermally through microdevices, mostly through microneedle array-based, minimally invasive injections. Researchers have also developed microfluidic platforms for oral, intraperitoneal, and inhalation-based delivery of insulin. For T2D patients, metformin, glucagon-like peptide 1 (GLP-1), and GLP-1 receptor agonists have also been delivered using microfluidic technologies. Thus far, clinical studies have been widely performed on microfluidic-based diabetes monitoring, especially glucose sensing, yet technologies for the delivery of insulin and other drugs to diabetic patients with microfluidics are still mostly in the preclinical stage. This article provides a concise review of the role of microfluidic devices in the diagnosis and monitoring of diabetes, as well as the delivery of pharmaceuticals to treat diabetes using microfluidic technologies in the recent literature.

Type 1 diabetes (T1D) severely impairs metabolic control and can lead to erectile dysfunction (ED) through hyperglycemia-induced vascular damage, autonomic neuropathy, and psychological distress. This review examines the role of continuous glucose monitoring (CGM) in ameliorating ED by addressing glucose variability and inflammation. A comprehensive analysis of studies and clinical trials was conducted to evaluate the impact of CGM on metabolic control, inflammatory responses, and vascular health in patients with T1D. Evidence suggests that CGM systems significantly stabilize blood glucose levels and reduce hyper- and hypoglycemic episodes that contribute to endothelial dysfunction and ED. CGM's real-time feedback helps patients optimize metabolic control, improve vascular health, and reduce inflammation. CGM has the potential to redefine ED management in patients with T1D by improving glycemic control and reducing the physiological stressors that cause ED, potentially improving quality of life and sexual health. Further research is warranted to explore the specific benefits of CGM for ED management.

Continuous Glucose Monitoring (CGM) not only can be used for glycemic control in chronic diseases (e.g., diabetes), but is increasingly being utilized by individuals and athletes to monitor fluctuations in training and everyday life. However, it is not clear how accurately CGM reflects plasma glucose concentration in a healthy population in the absence of chronic diseases. In an oral glucose tolerance test (OGTT) with forty-four healthy male subjects (25.5 ± 4.5 years), the interstitial fluid glucose (ISFG) concentration obtained by a CGM sensor was compared against finger-prick capillary plasma glucose (CPG) concentration at fasting baseline (T0) and 30 (T30), 60 (T60), 90 (T90), and 120 (T120) min post OGTT to investigate differences in measurement accuracy. The overall mean absolute relative difference (MARD) was 12.9% (95%-CI: 11.8-14.0%). Approximately 100% of the ISFG values were within zones A and B in the Consensus Error Grid, indicating clinical accuracy. A paired t-test revealed statistically significant differences between CPG and ISFG at all time points (T0: 97.3 mg/dL vs. 89.7 mg/dL, T30: 159.9 mg/dL vs. 144.3 mg/dL, T60: 134.8 mg/dL vs. 126.2 mg/dL, T90: 113.7 mg/dL vs. 99.3 mg/dL, and T120: 91.8 mg/dL vs. 82.6 mg/dL; p < 0.001) with medium to large effect sizes (d = 0.57-1.02) and with ISFG systematically under-reporting the reference system CPG. CGM sensors provide a convenient and reliable method for monitoring blood glucose in the everyday lives of healthy adults. Nonetheless, their use in clinical settings wherein implications are drawn from CGM readings should be handled carefully.

To conduct a discursive review on continuous glucose monitoring use among Black older adults and to address the issue of racial disparities in diabetes management and outcomes. Type 2 diabetes mellitus is a global health concern with significant complications and mortality rates. Black older adults are disproportionately affected. Initially designed for type 1 diabetes, continuous glucose monitoring has emerged as an innovative tool for type 2 diabetes mellitus management. Despite its potential, there are challenges related to adherence and digital literacy among Black older adults for managing Diabetes.

A discursive review.

Searching literature in PubMed, Scopus, and Google Scholar for papers published from 2017 to 2023, we explored the use of continuous glucose monitoring in Black older adults with type 2 diabetes mellitus, examining barriers, facilitators and challenges.

We highlight recommendations from the literature which included barriers, facilitators, and cultural factors associated with continuous glucose monitoring use. Findings underscore the importance of addressing these challenges to reduce racial-ethnic disparities in type 2 diabetes mellitus management among Black older adults. Nurses and advanced practice registered nurses are at the forefront and can play a pivotal role in exploring and implementing interventions to promote access and proper use of continuous glucose monitoring among Black older adult patients with type 2 diabetes mellitus.

We aimed to investigate the neuromuscular contributions to enhanced fatigue resistance with carbohydrate (CHO) ingestion and to identify whether fatigue is associated with changes in interstitial glucose levels assessed using a continuous glucose monitor (CGM).

Twelve healthy participants (six males, six females) performed isokinetic single-leg knee extensions (90°·s -1 ) at 20% of the maximal voluntary contraction (MVC) torque until MVC torque reached 60% of its initial value (i.e., task failure). Central and peripheral fatigue were evaluated every 15 min during the fatigue task using the interpolated twitch technique and electrically evoked torque. Using a single-blinded crossover design, participants ingested CHO (85 g sucrose per hour), or a placebo (PLA), at regular intervals during the fatigue task. Minute-by-minute interstitial glucose levels measured via CGM and whole blood glucose readings were obtained intermittently during the fatiguing task.

CHO ingestion increased time to task failure over PLA (113 ± 69 vs 81 ± 49 min, mean ± SD; P < 0.001) and was associated with higher glycemia as measured by CGM (106 ± 18 vs 88 ± 10 mg·dL -1 , P < 0.001) and whole blood glucose sampling (104 ± 17 vs 89 ± 10 mg·dL -1 , P < 0.001). When assessing the values in the CHO condition at a similar time point to those at task failure in the PLA condition (i.e., ~81 min), MVC torque, percentage voluntary activation, and 10 Hz torque were all better preserved in the CHO versus PLA condition ( P < 0.05).

Exogenous CHO intake mitigates neuromuscular fatigue at both the central and peripheral levels by raising glucose concentrations rather than by preventing hypoglycemia.

Despite remarkable progress in diabetes technology, most systems still require estimating meal carbohydrate (CHO) content for meal-time insulin delivery. Emerging smartphone applications may obviate this need, but performance data in relation to patient estimates remain scarce.

The objective is to assess the accuracy of two commercial CHO estimation applications, SNAQ and Calorie Mama, and compare their performance with the estimation accuracy of people with type 1 diabetes (T1D).

Carbohydrate estimates of 53 individuals with T1D (aged ≥16 years) were compared with those of SNAQ (food recognition + quantification) and Calorie Mama (food recognition + adjustable standard portion size). Twenty-six cooked meals were prepared at the hospital kitchen. Each participant estimated the CHO content of two meals in three different sizes without assistance. Participants then used SNAQ for CHO quantification in one meal and Calorie Mama for the other (all three sizes). Accuracy was the estimate's deviation from ground-truth CHO content (weight multiplied by nutritional facts from recipe database). Furthermore, the applications were rated using the Mars-G questionnaire.

Participants' mean ± standard deviation (SD) absolute error was 21 ± 21.5 g (71 ± 72.7%). Calorie Mama had a mean absolute error of 24 ± 36.5 g (81.2 ± 123.4%). With a mean absolute error of 13.1 ± 11.3 g (44.3 ± 38.2%), SNAQ outperformed the estimation accuracy of patients and Calorie Mama (both P > .05). Error consistency (quantified by the within-participant SD) did not significantly differ between the methods.

SNAQ may provide effective CHO estimation support for people with T1D, particularly those with large or inconsistent CHO estimation errors. Its impact on glucose control remains to be evaluated.

The use of continuous glucose monitoring (CGM) in elderly patients with diabetes is not well documented. The present study search to know the current status of use of CGM devices in patients with diabetes over 65 years of age.

A systematic literature search was performed in PubMed and Scopus databases in November 2023. The following descriptors were used, linked using the Boolean operators AND and OR: Diabetes, Continuous glucose monitoring, Flash glucose monitoring, Glycemia, Glycemic control, Controlled diabetes, Diabetes care, Metrics, Older and Elder. The CASPe critical reading system and the PRISMA methodology were applied to document the review.

Fourteen selected studies published between 2019 and 2023 were reviewed. Publications from European countries used small sample sizes and were intervention studies. The duration of the interventions was generally short: 7 were ≤14 days in duration and only 3 were 6-12 months in duration. Overall, the selected articles found that CGM improved glycemic outcomes due to a decrease in glycosylated hemoglobin value and an improvement in CGM metrics, and diabetes-associated complications in elderly patients with diabetes.

CGM seems to be a useful and effective tool to improving glycemic outcomes of people with diabetes over age 65. Further studies under real-world conditions and of longer duration are needed to expand and improve the evidence.

Amidst the escalating prevalence of glucose-related chronic diseases, the advancements, potential uses, and growing accessibility of continuous glucose monitors (CGM) have piqued the interest of healthcare providers, consumers, and health behaviour researchers. Yet, there is a paucity of literature characterising the use of CGM in behavioural intervention research. This scoping review aims to describe targeted populations, health behaviours, health-related outcomes, and CGM protocols in randomised controlled trials (RCTs) that employed CGM to support health behaviour change.

We searched Ovid MEDLINE, Elsevier Embase, Cochrane Central Register of Controlled Trials, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global from inception to January 2024 for RCTs of behavioural interventions conducted in adults that incorporated CGM-based biological feedback. Citation searching was also performed. The review protocol was registered ( https://doi.org/10.17605/OSF.IO/SJREA ).

Collectively, 5389 citations were obtained from databases and citation searching, 3995 articles were screened, and 31 were deemed eligible and included in the review. Most studies (n = 20/31, 65%) included adults with type 2 diabetes and reported HbA1c as an outcome (n = 29/31, 94%). CGM was most commonly used in interventions to target changes in diet (n = 27/31, 87%) and/or physical activity (n = 16/31, 52%). 42% (n = 13/31) of studies provided prospective CGM-based guidance on diet or activity, while 61% (n = 19/31) included retrospective CGM-based guidance. CGM data was typically unblinded (n = 24/31, 77%) and CGM-based biological feedback was most often provided through the CGM and two-way communication (n = 12/31, 39%). Communication typically occurred in-person (n = 13/31, 42%) once per CGM wear (n = 13/31; 42%).

This scoping review reveals a predominant focus on diabetes in CGM-based interventions, pointing out a research gap in its wider application for behaviour change. Future research should expand the evidence base to support the use of CGM as a behaviour change tool and establish best practices for its implementation.

doi.org/10.17605/OSF.IO/SJREA.

Insertable biosensor systems are medical diagnostic devices with two primary components: an implantable biosensor within the body and a wearable monitor that can remotely interrogate the biosensor from outside the body. Because the biosensor does not require a physical connection to the electronic monitor, insertable biosensor systems promise improved patient comfort, reduced inflammation and infection risk, and extended operational lifetimes relative to established percutaneous biosensor systems. However, the lack of physical connection also presents technical challenges that have necessitated new innovations in developing sensing chemistries, transduction methods, and communication modalities. In this review, we discuss the key developments that have made insertables a promising option for longitudinal biometric monitoring and highlight the essential needs and existing development challenges to realizing the next generation of insertables for extended-use diagnostic and prognostic devices.

In this three-year retrospective study, data from 51 patients with type 1 or type 2 diabetes mellitus (DM), receiving a minimum of 3-4 insulin injections per day and self-monitoring their blood glucose (SMBG) four times a day, were derived from our internal medicine residency primary care clinic. The patients were equipped with a continuous glucose monitoring (CGM) device that shared 24-hour glucose data with the clinic. They were assigned to members of our CGM team, which included internal medicine or transitional year medical residents who functioned under the supervision of a board-certified endocrinologist. The residents, in consultation with our endocrinologist, assessed the patients' glucose management data and adjusted their treatment regimens biweekly by calling the patients, and monthly by seeing the patients in the clinic. Significant results from the study include a reduction in HbA1c from 9.9% to 7.6%, an average blood glucose decrement from 242 mg/dL to 169 mg/dL, a reduction in the incidence of mild hypoglycemia from below 70 mg/dL to 54 mg/dL, from 4.68% to 0.76% per day, and a more pronounced hypoglycemia with glucose less than 54 mg/dL from 3.1% per day to 0.2% per day. We observed a significant increase in the time in the range of the blood glucose from 33% to 67% per day. Furthermore, 9.5% of the patients in this study eventually discontinued their daily insulin injections and continued treatment with oral diabetic medications with or without the use of injectable GLP-1 receptors once a week. Our study affirms that CGM devices significantly improve glycemic control compared to SMBG, supporting its efficacy in optimizing glycemic control in real-world clinical practice. The results imply that this can be accomplished in internal medicine residency clinics and not exclusively in specialized endocrine clinics. As far as we know, this is the first study of its kind in a residency clinic in the USA. This study confirms the benefits of widening the application of CGM in DM, along with the challenges that must be overcome to realize the evidence-based benefits of this technology. CGM needs to become a part of routine monitoring for type 1 and type 2 DM.

Christmas holidays can impact weight and glycemic control in type 2 diabetes, but their effect on type 1 diabetes (T1D) remains understudied. This study assessed how Christmas holidays affect individuals with T1D who use flash continuous glucose monitoring systems.

This retrospective study involved 812 adults diagnosed with T1D recruited from 3 hospitals. Clinical, anthropometric, and socioeconomic data were collected. Glucose metrics from 14 days before January 1st, and before December 1st and February 1st as control periods, were recorded. Analyses adjusted for multiple variables were conducted to assess the holiday season's impact on glycemic control.

The average time in range during the holidays (60.0 ± 17.2%) was lower compared to December (61.9 ± 17.2%, P < .001) and February (61.7 ± 17.7%, P < .001). Time above range (TAR > 180 mg/dL) was higher during Christmas (35.8 ± 18.2%) compared to December (34.1 ± 18.3%, P < .001) and February (34.2 ± 18.4%, P < .001). Differences were also observed in TAR >250 mg/dL, coefficient of variation, and average glucose (P < .05). No differences were found in time below range or other metrics. Linear regression models showed that the holidays reduced time in range by 1.9% (β = -1.92, P = .005) and increased TAR >180 mg/dL by 1.8% (β = 1.75, P = .016).

Christmas holidays are associated with a mild and reversible deterioration in glucose metrics among individuals with T1D using flash continuous glucose monitoring, irrespective of additional influencing factors. These discoveries can be useful to advise individuals with diabetes during the festive season and to recognize potential biases within studies conducted during this timeframe.

Introduction: Continuous glucose monitoring (CGM) has shown favorable outcomes in patients with type 2 diabetes (T2D) who are on insulin therapy. However, the efficacy of CGM in managing glucose levels in noninsulin-treated people with T2D remains controversial. Methods: PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing CGM to self-monitoring of blood glucose (SMBG) in people with T2D not using insulin. We computed weighted mean differences (WMDs) and standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Statistical analyses were performed using R version 4.2.3. Results: We included six RCTs comprising 407 noninsulin-treated people with T2D of whom 228 were randomized to CGM. Diabetes duration ranged from 5.4 to 13.9 years. The mean age was 57.9 years and the mean body mass index was 30.8 kg/m2. Four trials used real-time CGM (rt-CGM) and two intermittent scanning CGM (is-CGM). Compared with SMBG, CGM significantly reduced the glycated hemoglobin level (WMD -0.31%; 95% CI -0.42 to -0.21; I2 = 0%), glucose level (WMD -11.16 mg/dL; 95% CI -19.94 to -2.39; I2 = 0%), time in hypoglycemia level 2 (WMD -0.28%; 95% CI -0.52 to -0.03; I2 = 91%), glucose time >180 mg/dL (WMD -7.75%; 95% CI -12.04 to -3.45; I2 = 0%), and the standard deviation of glucose variation (WMD -4.00 mg/dL; 95% CI -6.86 to -1.14; I2 = 0%). CGM also increased time in range (WMD 8.63%; 95% CI 4.54-12.71; I2 = 0%) and treatment satisfaction (SMD 0.79; 95% CI 0.54-1.05; I2 = 0%). Conclusion: In this meta-analysis, rt-CGM and is-CGM were associated with improvement in glycemic control in people with T2D not using insulin when compared to SMBG.

At present, traditional analytical methods suffer from issues such as complex operation, expensive equipment, and a lengthy testing time. Electrochemical sensors have shown great advantages and application potential as an alternative solution. In this study, we proposed a novel semiautomated electrochemical sensor array (SAESA) platform. The sensor array was fabricated using screen-printed technology with a tubular design where all electrodes were printed on the inner wall. The integration of the tubular sensor array with a pipet allows for a semiautomated process including sampling and rinsing, which simplifies operation and reduces overall time. Each working electrode in the tubular sensor array underwent distinct decoration to get specific sensing responses toward the target analytes in a mixture environment (e.g., blood samples). To demonstrate the applicability of the developed sensing platform for simultaneous multianalyte detection, we chose antibiotic treatment for inflammatory infection as a model scenario and continuously measured three biomarkers, namely, tigecycline (TGC), procalcitonin (PCT), and alanine aminotransferase (ALT). The detection limits were 0.3 μM, 0.3 ng/L, and 2.76 U/L, respectively. The developed semiautomated electrochemical sensor array exhibits characteristics such as rapid and simple operation, portability, good selectivity, and excellent stability.

Managing diabetes during pregnancy is challenging, given the significant risk it poses for both maternal and foetal health outcomes. While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests, the advent of continuous glucose monitoring (CGM) systems has revolutionized the approach. These devices offer a safe and reliable means of tracking glucose levels in real-time, benefiting both women with diabetes during pregnancy and the healthcare providers. Moreover, CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes, especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device. Such a combined approach has been demonstrated to improve overall blood sugar control, lessen the occurrence of preeclampsia and neonatal hypoglycaemia, and minimize the duration of neonatal intensive care unit stays. This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.

This study aimed to determine the minimum frequency of flash glucose monitoring (FGM) scans necessary for optimal glycemic control in patients with type 1 diabetes (T1D).

Data were collected from 692 patients (47.5% female, with a median age of 47.4 years) who used FGM systems daily and recorded their clinical variables and device data.

Logistic regression models showed that performing more than 12 scans per day was associated with improved T1D control (OR = 4.22, p < 0.001) and a reduction in HbA1c (7.6 vs 7.0%, 60-53 mmol/mol p < 0.001). However, those performing less than 6 scans showed no improvement in HbA1c (7.9 vs 7.8%, 63-61 mmol/mol p = 0.514). Thirteen daily scans were determined as the optimal cutoff point for predicting optimal glycemic control using a maximally selected rank algorithm. Significant reductions were observed in mean glucose (< 0.001), coefficient of variation (< 0.001), HbA1c (< 0.001), and an increase in TIR (< 0.001) in patients who performed more than 12 daily scans.

The results suggest that a higher frequency of daily scans by T1D patients using FGM systems leads to improved chronic glycemic control. The minimum recommended frequency for optimal control is 13 scans per day, and more than 6 daily scans are needed to improve HbA1c.

COVID-19 vaccination is recommended in diabetic patients since diabetes is associated with worse clinical outcomes in COVID-19 infection. The safety profile of different types of COVID-19 vaccines, especially on glycemic control, can be explored due to availability of data from continuous glucose monitoring (CGM) devices. This meta-analysis aimed to quantify the impact of COVID-19 vaccination on glycemic control in patients with type 1 diabetes mellitus (T1DM).

A systematic search of PubMed, Embase, and Google Scholar was conducted using a search strategy for studies published till January 2023 in English language. Comparative observational studies reporting glycemic control obtained from CGM before and after COVID-19 vaccination in T1DM patients were included. The primary outcome was time in range (TIR) metric of proportion of glucose results falling within the range: 3.9-10 mmol/l. Other outcomes were time above range (TAR) (>10 mmol/l), time below range (TBR) (<3.9 mmol/l), coefficient of variation (CV), and mean blood glucose levels. The pooled outcomes were compared pre-vaccination and post-vaccination using Hedges' g (HG) with 95% CI.

A total of seven studies (632 participants) were included in the meta-analysis. COVID-19 vaccination caused small and statistically insignificant decrease in TIR after both the first (HG = 0.21, 95% CI: -0.02 to 0.44, P=0.07) and second dose (HG = 0.09, 95% CI: -0.04 to 0.21, P = 0.19). Likewise, TAR was not affected after neither first (HG = -0.09, 95% CI: -0.22 to 0.03, P = 0.12) nor second vaccine dose (HG = -0.07, 95% CI: -0.21 to 0.06, P = 0.30). Likewise, TBR, mean blood glucose levels, and CV were not significantly altered following uptake of either of the doses.

COVID-19 vaccination has an excellent safety profile in T1DM patients owing to its minimal impacts on immediate glycemic control.

This study examined the use of a self-monitoring/self-management smartphone application (app) for patients with bipolar disorder. The app was specifically designed with patient-centered computational software system based on concepts from nonlinear systems (chaos) theory.

This was a randomized, active comparator study of use of the KIOS app compared to an existing free app that has high utilization rates known as eMoods, over 52 weeks, and performed in three academic centers. Patients were evaluated monthly utilizing the Bipolar Inventory of Symptoms Schedule (BISS). The primary outcome measure was the persistence of using the app over the year of the study.

Patients assigned to KIOS persisted in the study longer than those assigned to eMoods; 57 patients (87.70%) in the KIOS group versus 42 (73.69%) in the eMoods group completed the study (p = 0.03). By 52 weeks, significantly more of KIOS group (84.4%) versus eMoods group (54%) entered data into their programs (χ2  = 14.2, df = 1, p = 0.0002). Patient satisfaction for KIOS was greater (F = 5.21, df = 1, 108, p = 0.025) with a standardized effect size (Cohen's d) of 0.41. There was no difference in clinical outcome at the end of the study between the two groups.

This is the first randomized comparison study comparing two apps for the self-monitoring/self-management of bipolar disorder. The study revealed greater patient satisfaction and greater adherence to a patient-centered software program (KIOS) than a monitoring program that does not provide feedback (eMoods).

This study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines.

A follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications.

The average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use.

Socioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.

The American Diabetes Association/European Association for the Study of Diabetes recently recommend the preferential use of continuous glucose monitoring(CGM) over self-monitoring of blood glucose for the management of type 1 diabetes (T1DM). For most adults with T1DM, the recommended target time in range is > 70% with < 4% time below range. In Ireland, CGM use has become increasingly popular since 2021. We aimed to audit adult CGM use and analyse CGM metrics in our cohort of adults with diabetes attending a tertiary diabetes centre.

People with diabetes who were using DEXCOM G6 CGM devices, and sharing their data with the healthcare team on the DEXCOM CLARITY for healthcare professionals platform were included in the audit. Clinical information, glycated haemoglobin (HbA1c) and CGM metrics were gathered retrospectively from medical records and the DEXCOM CLARITY platform.

Data were available for 119 CGM users, 96.9% with T1DM, median age 36 years (IQR = 20) and median diabetes duration 17 years (IQR = 20). Fifty-three per cent of the cohort was male. Mean time in range was 56.2% (SD = 19.2) and mean time below range was 2.3% (SD = 2.6). Mean HbA1c in CGM users was 56.7 mmol/mol (SD = 13.1). This represented a decrease of 6.7 mmol/mol compared to the last HbA1c measurements available pre-commencement of CGM (p ≤ 0.0001, CI 4.4-8.9). The percentage of people in this cohort with a HbA1c < 53 mmol/mol was 40.6% (n = 39/96), compared to 17.5% (n = 18/103) pre-commencement of CGM.

Our study highlights the challenges in optimising the use of CGM. Our team aims to focus on providing additional education to CGM users, more frequent touch-base virtual reviews and increasing access to hybrid closed-loop insulin pump therapy.

Health literacy is a multidimensional set of skills (e.g., narrative, numeracy, digital, medication) that patients need to access and understand health information timely and accurately to make evidence-based informed decisions.

Multiple barriers prevent patients from effectively interacting with health information. The most salient barriers are poor overall health literacy skills and linguistic proficiency in English. As patients prefer direct access to laboratory test results, especially those of routine tests, contextualization and provider-directed interpretation of results are required to foster shared decision-making to address their healthcare issues and improve health outcomes.

The use of systematic approaches that account for poor health literacy skills and include culturally and linguistically appropriate planning and availability of resources is warranted at individual and population health levels (e.g., human-centered design of patient portals).

As diabetes prevalence has continued to increase in the United States, as well as globally, utilization of disease management techniques has also improved. The evolution in disease management for diabetes has adapted greatly from the initial dipstix method. Continuous glucose monitors have grown in popularity with its introduction to the market. After introduction of CGMs as part of DM management, various advancements have been made to the current models to promote the usage CGMs to promote glycemic control. The main competitors in the CGM market is Medtronic, Dexcom, Freestyle, and Eversense.

Information was primarily gathered by employing various PubMed scholarly articles for real-world examples in addition to data extraction from supplementary manuscripts. Articles were evaluated from over the past 20 years.

Clinically improvement of disease management of blood glucose levels, specifically with regards to mean absolute relative difference (MARD) was utilized to highlight effectiveness of continuous glucose monitors.

Of the four key continuous glucose monitors device on the market in the US, all have demonstrated to have similar beneficial qualities which can be utilized in both T1DM and T2DM patients. The best device for an individual would be based on their specific diabetes management goal (maintain TIR, decreasing TBR/TAR, decrease A1c).

We report the case of a 50-year old woman with a known history of lipodystrophy. A pelvic radiograph was taken for the investigation of right hip pain. The image shown demonstrates an indeterminate artefact projected over the right iliac fossa. A previous CT renal study was reviewed, demonstrating the same device in the subcutaneous tissues of the contralateral left lower quadrant which on close inspection was consistent with a continuous glucose monitoring device. Features of lipodystrophy were also noted on review of the CT imaging. Although many devices such as vagal stimulators and prosthetic valves are easily recognized by radiologists on radiographic images, they may be less familiar with devices such as continuous glucose monitors. The aim of this case report is to familiarize radiologists with the appearances of continuous glucose monitors to allow for effective reporting.

Continuous glucose monitoring systems (CGM) are a very useful tool to understand the behaviour of glucose in different situations and populations. Despite the widespread use of CGM systems in both clinical practice and research, our understanding of the reproducibility of CGM data remains limited. The present work examines the reproducibility of the results provided by a CGM system in a random sample of a free-living adult population, from a functional data analysis approach. Functional intraclass correlation coefficients (ICCs) and their 95% confidence intervals (CI) were calculated to assess the reproducibility of CGM results in 581 individuals. 62% were females 581 participants (62% women) mean age 48 years (range 18-87) were included, 12% had previously been diagnosed with diabetes. The inter-day reproducibility of the CGM results was greater for subjects with diabetes (ICC 0.46 [CI 0.39-0.55]) than for normoglycaemic subjects (ICC 0.30 [CI 0.27-0.33]); the value for prediabetic subjects was intermediate (ICC 0.37 [CI 0.31-0.42]). For normoglycaemic subjects, inter-day reproducibility was poorer among the younger (ICC 0.26 [CI 0.21-0.30]) than the older subjects (ICC 0.39 [CI 0.32-0.45]). Inter-day reproducibility was poorest among normoglycaemic subjects, especially younger normoglycaemic subjects, suggesting the need to monitor some patient groups more often than others.

Type 1 diabetes mellitus is a chronic autoimmune disease that affects millions of people and generates high healthcare costs due to frequent complications when inappropriately managed. Our paper aimed to review the latest technologies used in T1DM management for better glycemic control and their impact on daily life for people with diabetes. Continuous glucose monitoring systems provide a better understanding of daily glycemic variations for children and adults and can be easily used. These systems diminish diabetes distress and improve diabetes control by decreasing hypoglycemia. Continuous subcutaneous insulin infusions have proven their benefits in selected patients. There is a tendency to use more complex systems, such as hybrid closed-loop systems that can modulate insulin infusion based on glycemic readings and artificial intelligence-based algorithms. It can help people manage the burdens associated with T1DM management, such as fear of hypoglycemia, exercising, and long-term complications. The future is promising and aims to develop more complex ways of automated control of glycemic levels to diminish the distress of individuals living with diabetes.

We present a critical review of the current progress in wearable insulin biosensors. For over 40 years, glucose biosensors have been used for diabetes management. Measurement of blood glucose is an indirect method for calculating the insulin administration dosage, which is critical for insulin-dependent diabetic patients. Research and development efforts aiming towards continuous-insulin-monitoring biosensors in combination with existing glucose biosensors are expected to offer a more accurate estimation of insulin sensitivity, regulate insulin dosage and facilitate progress towards development of a reliable artificial pancreas, as an ultimate goal in diabetes management and personalised medicine. Conventional laboratory analytical techniques for insulin detection are expensive and time-consuming and lack a real-time monitoring capability. On the other hand, biosensors offer point-of-care testing, continuous monitoring, miniaturisation, high specificity and sensitivity, rapid response time, ease of use and low costs. Current research, future developments and challenges in insulin biosensor technology are reviewed and assessed. Different insulin biosensor categories such as aptamer-based, molecularly imprinted polymer (MIP)-based, label-free and other types are presented among the latest developments in the field. This multidisciplinary field requires engagement between scientists, engineers, clinicians and industry for addressing the challenges for a commercial, reliable, real-time-monitoring wearable insulin biosensor.

This retrospective study aimed to assess the effectiveness of continuous glucose monitoring (CGM) devices in managing uncontrolled diabetes mellitus (DM). The study cohort comprised 25 patients with uncontrolled diabetes who received treatment at an internal medicine resident clinic. The objective was to evaluate the impact of transitioning from self-monitoring of blood glucose (SMBG) to CGM devices on glycemic control, as measured by changes in hemoglobin A1c (HbA1c) levels, average blood glucose levels, hypoglycemic events, time spent within the target blood sugar range, and glucose variability. The findings indicated significant improvements in glycemic control with the adoption of CGM devices, highlighting their potential benefits for optimizing diabetes management. The study is particularly interesting because it was done in an internal medicine continuity clinic with the main participation of the internal medicine residents under the supervision of an endocrinologist. It was not done as the majority of the other studies used CGM in specialized endocrinology clinics.

Patients with suspected COVID-19 remain at risk for clinical deterioration after discharge and may benefit from home oxygen saturation (SpO2) monitoring using portable pulse oximeter devices. Our study aims to evaluate patient engagement and compliance with a home SpO2 monitoring program.

This is a single center, prospective pilot study of patients being discharged from the ED or urgent care after evaluation of symptoms consistent with COVID-19. Subjects were given a portable pulse oximeter and instructed to obtain measurements at rest and with exertion twice daily for 14 days. Patients were contacted daily to collect recorded data. If attempts to contact the patient were unsuccessful for 3 consecutive days, patients were considered lost to follow up. The primary outcome of interest was patient engagement in the program which was defined as the percentage of patients that completed the 14-day study period, meaning they were not lost to follow up. Secondary outcomes included compliance with performing the SpO2 readings. Patient compliance was calculated as a percentage of completed readings out of the total expected readings.

Fifty patients were enrolled - 2 withdrew and 1 was a screen failure. Overall, engagement in the program was 46.8% with no significant difference between those who tested positive for SARS-CoV-2 versus those who tested negative (48.2% vs 45%, p = 0.831). Median compliance overall was 42.9% (IQR 22.22-78.57). Median compliance for the positive group was 50.0% (IQR 20-85.71) and 42.86% (IQR 22.92-76.44) for the negative group (p= 0.838).

Our study demonstrated that there was acceptable engagement and compliance in a 14-day home SpO2 monitoring program. These results support the use of home pulse oximetry monitoring in a select group of mildly ill patients with suspected COVID-19.

Continuous glucose monitoring (CGM) is approved for insulin dosing decisions in the ambulatory setting, but not currently for inpatients. CGM has the capacity to reduce patient-provider contact in inpatients with coronavirus disease 2019 (COVID-19), thus potentially reducing in hospital virus transmission. However, there are sparse data on the accuracy and efficacy of CGM to titrate insulin doses in inpatients.

Under an emergency use protocol, CGM (Dexcom G6) was used alongside standard point-of-care (POC) glucose measurements in patients critically ill from complications of COVID-19 requiring intravenous (IV) insulin. Glycemic control during IV insulin therapy was retrospectively assessed comparing periods with and without adjunctive CGM use. Accuracy metrics were computed and Clarke Error Grid analysis performed comparing CGM glucose values with POC measurements.

Twenty-four critically ill patients who met criteria for emergency use of CGM resulted in 47 333 CGM and 5677 POC glucose values. During IV insulin therapy, individuals' glycemic control improved when CGM was used (mean difference -30.7 mg/dL). Among 2194 matched CGM: POC glucose pairs, a high degree of concordance was observed with a mean absolute relative difference of 14.8% and 99.5% of CGM: POC pairs falling in Zones A and B of the Clarke Error Grid.

Continuous glucose monitoring use in critically ill COVID-19 patients improved glycemic control during IV insulin therapy. Continuous glucose monitoring glucose data were highly concordant with POC glucose during IV insulin therapy in critically ill patients suggesting that CGM could substitute for POC measurements in inpatients thus reducing patient-provider contact and mitigating infection transmission.

Type 2 diabetes has a growing prevalence and confers significant cost burden to the health care system, raising the urgent need for cost-effective and easily accessible solutions. The management of type 2 diabetes requires significant commitment from the patient, caregivers, and the treating team to optimize clinical outcomes and prevent complications. Technology and its implications for the management of type 2 diabetes is a nascent area of research. The impact of some of the more recent technological innovations in this space, such as continuous glucose monitoring, flash glucose monitoring, web-based applications, as well as smartphone- and smart watch-based interactive apps has received limited attention in the research literature.

This scoping review aims to explore the literature available on type 2 diabetes, flash glucose monitoring, and digital health technology to improve diabetic clinical outcomes and inform future research in this area.

A scoping review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to July 2021), EMBASE (January 1980 to July 2021), Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases.

There were very few studies that have explored the use of mobile health and flash glucose monitoring in type 2 diabetes. These studies have explored somewhat disparate and limited areas of research, and there is a distinct lack of methodological rigor in this area of research. The 3 studies that met the inclusion criteria have addressed aspects of the proposed research question.

This scoping review has highlighted the lack of research in this area, raising the opportunity for further research in this area, focusing on the clinical impact and feasibility of the use of multiple technologies, including flash glucose monitoring in the management of patients with type 2 diabetes.

Continuous glucose monitoring (CGM) devices have the potential to lead to better disease management and improved outcomes in patients with diabetes. Chemo-optical glucose sensors offer a promising, accurate, long-term alternative to the current CGMs that require frequent calibration and replacement. Recently, we have proposed glucose sensor designs using phosphorescence lifetime-based measurement of chemo-optical glucose sensing microdomains embedded within alginate hydrogels. Due to the poor long-term stability of calcium-crosslinked alginate, we propose poly(ethylene glycol) (PEG) hydrogels synthesized via thiol-Michael addition chemistry as an alternative hydrogel carrier. The objective of this study was to evaluate the suitability of Michael addition crosslinked PEG hydrogels compared to calcium crosslinked alginate hydrogels for encapsulating glucose-sensing microdomains. PEG hydrogels crosslinked via thiol-vinyl sulfone addition achieved gelation in under 5 minutes, resulting in an even distribution of sensing microdomains. The shear storage modulus of the PEG hydrogels was tunable from 2.2 ± 0.1 kPa to 9.5 ± 1.8 kPa, which was comparable to the alginate hydrogels (10.5 ± 0.8 kPa), and the inclusion of microdomains did not significantly impact stiffness. The high water content of PEG hydrogels resulted in high glucose permeability that closely corresponded to the glucose permeability of alginate (D = 0.09 and 0.12 cm² s^-1, respectively; p = 0.47), but the PEG hydrogels exhibited superior stability. Both PEG and alginate-embedded sensors exhibited a sensing range up to ∼200 mg dL^-1 glucose. The lower limits of detection (LOD) for PEG and alginate-based glucose sensors were 19.8 and 20.6 mg dL^-1 with a difference of just 4.2% variation. The small difference between PEG and alginate embedded sensors indicates that their sensing properties are primarily determined by the glucose sensing microdomains rather than the hydrogel matrix. Overall, the results of this study indicate that Michael addition-crosslinked PEG hydrogels are a promising platform for encapsulation of chemo-optical glucose sensing microdomains.

Pregestational diabetes (PGDM) is an increasingly common and complex condition that infers risk to both mother and infant. To prevent serious morbidity, strict glycaemic control is essential. The aim of this review is to review the glucose sensing and insulin delivering technologies currently available for women with PGDM.

We reviewed online databases for articles relating to technology use in pregnancy using a combination of keywords and MeSH headings. Relevant articles are included below.

A number of technological advancements have improved care and outcomes for women with PGDM. Real time continuous glucose monitoring (rtCGM) offers clear advantages in terms of infants size and neonatal intensive care unit admissions; and further benefits are seen when combined with continuous subcutaneous insulin delivery (insulin pump) and algorithms which continuously adjust insulin levels to glucose targets (hybrid closed loop). Other advancements including flash or intermittent scanning CGM (isCGM) and stand-alone insulin pumps do not confer as many advantages for women and their infants, however they are increasingly used outside of pregnancy and many women enter pregnancy already using these devices.

This article offers a discussion of the most commonly used technologies in pregnancy and evaluates their current and future roles.

Diabetes seriously affects the health of middle-aged and elderly. What we can do is to suppress the progression and avoid complications of diabetes. The aim of this study was to evaluate the prevalence, management and influencing factors in middle-aged and elderly diabetics. The data used in our study came from the follow-up survey (2015) of China Health and Retirement Longitudinal Study. After all the questionnaire data of participants was acquired, the first screening step was conducted and the participants without blood glucose or glycosylated hemoglobin test results were excluded. In the second screening step, participants without self-reported diabetes, age <45 were excluded. After data screening, STATA 16.0 software (StataCorp, USA) was used to conduct statistical analysis. Multiple logistics regression was used to analyze the influencing factors of diabetes in middle-aged and elderly. After data screening, A total of 9738 participants were enrolled in the survey of the China Health and Retirement Longitudinal Study in 2015, including diabetes 1965 and control 7773. The prevalence of diabetes in age >60 (22.20%) was significantly higher than that in age 45 to 60 (16.60%). Age, residence, physical activity, drinking, smoking and body mass index were key influencing factors according to the results of logistics regression. 46.92% diabetics were diagnosed in hospital, 22.14% were diagnosed by community medical care. 1298 among 1965 diabetes patients had standardized medication to control blood glucose, the rate was only 66.01%. The awareness rate of diabetes was only 28.75%, and the monitoring, treatment and accepting medical advice rates were 68.32%, 66.01% and 56.99% separately. The follow-up rate of diabetes was only 14.16%. Diabetes is widely prevalent in the middle-aged and elderly with the prevalence of 16.60% in the participants with age 45 to 60. The rate of self-rated diabetics underestimated the true prevalence of diabetes. Age, residence, physical activity, drinking, smoking and body mass index are key influencing factors to diabetes. Although a national diabetes health management model has been established, the awareness of diabetes was only 28.75%. Standardized diabetes registration and regular follow up should also be strictly implemented.

Increasing evidence suggests that glucagon-like peptide 1 (GLP-1) receptor agonists (RA) can stabilize glycemic variability (GV) and interfere with eating behavior. This study compared the impact of insulin, GLP-1 RA, and dietary components on GV using professional continuous glucose monitoring (CGM).

Patients with type 2 diabetes underwent CGM before and after switching from a twice-daily pre-mixed insulin treatment regimen to a GLP-1 RA (liraglutide) plus basal insulin regimen. The dietary components were recorded and analyzed by a certified dietitian. The interactions between the medical regimen, GV indices, and nutrient components were analyzed.

Sixteen patients with type 2 diabetes were enrolled in this study. No significant differences in the diet components and total calorie intake between the two regimens were found. Under the pre-mixed insulin regimen, for increase in carbohydrate intake ratio, mean amplitude of glucose excursion (MAGE) and standard deviation (SD) increased; in contrast, under the new regimen, for increase in fat intake ratio, MAGE and SD decreased, while when the protein intake ratio increased, the coefficient of variation (CV) decreased. The impact of the food intake ratio on GV indices disappeared under the GLP-1 RA regimen. After switching to the GLP-1 RA regimen, the median MAGE, SD, and CV values decreased significantly. However, the significant difference in GV between the two regimens decreased during the daytime.

A GLP-1 RA plus basal insulin regimen can stabilize GV better than a regimen of twice-daily pre-mixed insulin, especially in the daytime, and can diminish the effect of food components on GV.