Benefits of Three-Month Continuous Glucose Monitoring for Persons With Diabetes Using Insulin Pumps and Sensors

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Aims.To explore the feasibility of subcutaneous continuous glucose monitoring (CGM) in perioperative settings and to evaluate the perioperative development of glycaemia in persons with diabetes mellitus or impaired glucose tolerance by means of CGM. Methods. Monitoring by means of Guardian® REAL-Time CGMS (Medtronic, Nortridge, USA) in 20 perioperative periods. Sensor was inserted on the day before surgery and continued for 3 days with some exceptions. Results. Full implementation of the method was successful in the intensive care unit setting only. No electromagnetic interference and no side effects were found. The Wilcoxon signed-rank test revealed no significant difference between sensor and laboratory analyser values. Pearson´s correlation coefficients of the values obtained by sensor and the Wellion Linus glucometer were 0.875 for the whole perioperative period, 0.866 for the intraoperative period and 0.903 for the first perioperative day. A decline in sensor accuracy on the 6 th day was registered in one case. 16 monitored cases (80%) did not meet the criteria for safe plasma glucose range. Hypoglycaemia was found in 4 (20%) cases. There was an association between grade of the perioperative dysglycaemia and need for reoperation within the next 3 months. The most frequent perioperative glycaemic patterns are demonstrated. Conclusion. Subcutaneous CGM is safe offering detailed insight into glucose homeostasis in the dynamic perioperative period. Laboratory confirmation of sensor plasma glucose concentration by approved laboratory analyser is still necessary. The potentional benefits of maintaining patients within a safe glucose range should be comfirmed by future studies.

Section: Hunger After the Surgerymentioning

confidence: 99%

Glucose sensing module - is it time to integrate it into real-time perioperative monitoring? An observational pilot study with subcutaneous sensors

Poljakova¹,

Elsikova²,

Chlup³

et al. 2013

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“…The frequency of SMPG -as an indicator of patient's of adherence to treatment recommendations and as a prerequisite for an adequate adaptation of insulin dosage proved to be a strong predictor of glycaemic control 16 . PWD with Type 1 as well as PWD with Type 2 diabetes who follow a MDI regime should consider monitoring their blood glucose levels between 2-4 times daily depending on their treat- 20 . Only 17% of respondents in our study reported that they perform daily SMPG but 52% respondents reported adaptation of insulin dosage in relation to factors, such as carbohydrate intake, glycaemia values or degree of physical activity.…”

Section: Frequency Of Smpg and Quality Of Life And Treatment Satisfacmentioning

confidence: 99%

Self-care behaviour, treatment satisfaction and quality of life in people on intensive insulin treatment

Gurková¹,

Žiaková²

2014

Aim. The aim of this cross-sectional study was to identify self-care behaviours and their relationships with treatment satisfaction and quality of life in people attending a structured educational programme for patients on intensive insulin therapy. Methods. A sample of 104 people with diabetes (62 with type-1; 42 with type 2) was recruited from the National Institute of Endocrinology and Diabetology in Ľubochňa over six months. The majority of respondents were women (62.5%); had multiple daily injections of insulin (73%); diabetic late complications (68%) and had not previously participated in the structured educational programmes in the specialized diabetes centre (64.4%). Self-management behaviour data were collected by means of structured interviews with patients as well as during clinic visits. For measuring quality of life, the Audit Diabetes Dependent Quality of Life questionnaire and for measuring satisfaction with their treatment regimen, the Diabetes Treatment Satisfaction Questionnaire status version was used. Results. General satisfaction with the treatment was significantly higher in people with diabetes, who implemented regular self-monitoring of the concentration of glucose in plasma (SMPG). We also demonstrated low adherence in the frequency of SMPG. 17% of respondents in our study performed daily SMPG. However, 52% respondents reported adaptation of insulin dosage in relation to factors such as carbohydrate intake, glycaemia values or degree of physical activity. Differences in quality of life due to performing the regular self-monitoring of glycaemia, adjustments of insulin doses in specific situations as well as carbohydrate counting were not significant. Conclusion. Performing the regular self-monitoring of glycaemia was associated only with higher treatment satisfaction. No significant improvement in quality of life was seen in people performing the regular self-monitoring of glycaemia, adjustments of insulin doses in specific situations or carbohydrate counting.

“…This overcomes the limitations of traditional monitoring by producing glucose profiles instead of distinct measurements, real-time glucose values, glucose trends and warnings when glucose values approach dangerously low or high concentrations. In this way, frequent use of CGM systems and careful pattern analysis can improve glycaemic control [7][8][9][10] . On the other hand, evaluation of the prolific data provided by CGMS often makes the implementation of CGMS in practice, difficult.…”

Section: Introductionmentioning

confidence: 99%

“…From1974, following the introduction of glucometers into daily routine, self-monitoring of plasma/ blood glucose (SMPG/SMBG) became the predominant mode of glucose monitoring 6 . From the year 2000, the use of continuous glucose monitoring systems (CGMS) has shown remarkable benefits for both people with type 1 and type 2 diabetes [7][8][9][10][11][12] . The development of CGMS technology is a great step toward modern diabetes management 13 .…”

Section: Introductionmentioning

confidence: 99%

Glucose concentrations in blood and tissue - a pilot study on variable time lag

Chlup¹,

Krejčí²,

O’Connell³

et al. 2015

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Aim. The aim of this pilot study was to acquire insight into the parameters of glycaemic control, especially, (1) the time delay (lag phase) between plasma and tissue glucose concentrations in relation to rise and fall in glucose levels and (2) the rate of glucose increase and decrease. Methods. Four healthy people (HP), 4 people with type 1diabetes (DM1) and 4 with type 2 diabetes (DM2) underwent concurrent glucose measurements by means of (1) the continuous glucose monitoring system (CGMS-Medtronic), Medtronic-Minimed, CA, USA, calibrated by the glucometer Calla, Wellion, Austria, and, (2) the Beckman II analyser to measure glucose concentrations in venous plasma. Samples were taken on 4 consecutive days in the fasting state and 4 times after consumption of 50 g glucose. Carelink Personal, MS Excel, Maple and Mat lab were applied to plot the evolution of glucose concentration and analyse the results. The time difference between increase and decrease was calculated for HP, DM 1 and DM 2. Results. In DM1and DM2, glucose tolerance testing (GTT) resulted in slower transport of glucose into subcutaneous tissue than in HP where the lag phase lasted up to 12 min. The maximum increase/decrease rates in DM1 and DM2 vs HP were 0.25 vs < 0.1 mmol/L/min. Conclusion. CGMS is shown to provide reliable plasma glucose concentrations provided the system is calibrated during a steady state. The analysis of glucose change rates improves understanding of metabolic processes better than standard GTT.