Journal of diabetes science and technology
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J Diabetes Sci Technol · Jul 2009
ReviewGlucose meters: a review of technical challenges to obtaining accurate results.
Glucose meters are universally utilized in the management of hypoglycemic and hyperglycemic disorders in a variety of healthcare settings. Establishing the accuracy of glucose meters, however, is challenging. Glucose meters can only analyze whole blood, and glucose is unstable in whole blood. ⋯ Acceptance criteria for clinical agreement vary across the range of glucose concentrations and depend on how the result will be used in screening or management of the patient. A variety of factors can affect glucose meter results, including operator technique, environmental exposure, and patient factors, such as medication, oxygen therapy, anemia, hypotension, and other disease states. This article reviews the challenges involved in obtaining accurate glucose meter results.
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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
Intermediary variables and algorithm parameters for an electronic algorithm for intravenous insulin infusion.
Algorithms for intravenous insulin infusion may assign the infusion rate (IR) by a two-step process. First, the previous insulin infusion rate (IR(previous)) and the rate of change of blood glucose (BG) from the previous iteration of the algorithm are used to estimate the maintenance rate (MR) of insulin infusion. Second, the insulin IR for the next iteration (IR(next)) is assigned to be commensurate with the MR and the distance of the current blood glucose (BG(current)) from target. With use of a specific set of algorithm parameter values, a family of iso-MR curves is created, each giving IR as a function of MR and BG. ⋯ An algorithm is described that estimates MR prior to the attainment of euglycemia and computes MR-dependent values for IR(next). Design features address glycemic variability, promote safety with respect to hypoglycemia, and define a method for specifying glycemic targets that are allowed to differ according to patient condition.
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J Diabetes Sci Technol · Jul 2009
Numerical and clinical accuracy of a continuous glucose monitoring system during intravenous insulin therapy in the surgical and burn intensive care units.
Intensive insulin therapy (IIT) for glycemic control in critically ill patients has been shown to be beneficial. Continuous glucose monitoring systems (CGMSs) have been approved as an adjunct to complement standard glucose monitoring in type 2 diabetes mellitus. This study was designed to evaluate the accuracy of a real-time CGMS (DexCom STS) in the intensive care unit (ICU). We also evaluated its reliability and accuracy using a hyperinsulinemic-euglycemic and a hyperglycemic clamp study. ⋯ Despite the high percentage of measurements in zones A and B, underestimation of hypoglycemia by DexCom measurements makes it an unreliable device in the ICU setting.
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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.