Journal of diabetes science and technology
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J Diabetes Sci Technol · Jul 2009
Analysis: Continuous glucose monitoring during intensive insulin therapy.
Results of the Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial, intensive insulin therapy (IIT), and use of a continuous glucose sensor in intensive care units (ICU) were analyzed. The NICE-SUGAR trial was unable to determine if optimal intensive insulin therapy decreases mortality. ⋯ Studies evaluating the accuracy and reliability of CGM devices, based on a whole blood sample in perioperative and ICU settings, are needed. Once a reliable CGM sensor for ICU use is identified, a large, prospective, controlled, multicenter study could determine if optimal IIT with a low or zero incidence of hypoglycemic events improves mortality.
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J Diabetes Sci Technol · Jul 2009
ReviewExercise and glucose metabolism in persons with diabetes mellitus: perspectives on the role for continuous glucose monitoring.
Exercise causes profound changes in glucose homeostasis. For people with type 1 diabetes, aerobic exercise usually causes blood glucose concentration to drop rapidly, while anaerobic exercise may cause it to rise, thereby making glycemic control challenging. ⋯ Continuous glucose monitoring is a potentially useful adjunct to diabetes management for the active person with either forms of diabetes. This review aims to guide the reader to use this technology to its maximum advantage by providing an overview of technical features, performance characteristics, and clinical utility, all balanced against the limitations that may be more prominent during physical activity.
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J Diabetes Sci Technol · Jul 2009
A feasibility study of bihormonal closed-loop blood glucose control using dual subcutaneous infusion of insulin and glucagon in ambulatory diabetic swine.
We sought to test the feasibility and efficacy of bihormonal closed-loop blood glucose (BG) control that utilizes subcutaneous (SC) infusion of insulin and glucagon, a model-predictive control algorithm for determining insulin dosing, and a proportional-derivative control algorithm for determining glucagon dosing. ⋯ We demonstrate the feasibility of bihormonal closed-loop BG regulation using a control system that employs SC infusion of insulin and glucagon as governed by an algorithm that reacts only to BG without any feed-forward information regarding carbohydrate consumption or physical activity. As such, this study can reasonably be regarded as the first practical implementation of an artificial endocrine pancreas that has a hormonally derived counterregulatory capability.
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J Diabetes Sci Technol · Mar 2009
Temporal and geographic patterns of hypoglycemia among hospitalized patients with diabetes mellitus.
Hypoglycemia is often cited as a barrier to achieving inpatient glycemic targets. We sought to characterize hypoglycemic events in our institution by work-shift cycle and by specific treatment area. ⋯ There are temporal and geographic patterns in the occurrence of hypoglycemia among patients with diabetes or hyperglycemia in our hospital. Further study should focus on the reasons underlying these variations so that specific interventions can address the risk of hypoglycemia during peak times and places.