Journal of diabetes science and technology
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J Diabetes Sci Technol · May 2010
ReviewAsynchronous and synchronous teleconsultation for diabetes care: a systematic literature review.
A systematic literature review, covering publications from 1994 to 2009, was carried out to determine the effects of teleconsultation regarding clinical, behavioral, and care coordination outcomes of diabetes care compared to usual care. Two types of teleconsultation were distinguished: (1) asynchronous teleconsultation for monitoring and delivering feedback via email and cell phone, automated messaging systems, or other equipment without face-to-face contact; and (2) synchronous teleconsultation that involves real-time, face-to-face contact (image and voice) via videoconferencing equipment (television, digital camera, webcam, videophone, etc.) to connect caregivers and one or more patients simultaneously, e.g., for the purpose of education. ⋯ The included studies suggest that both synchronous and asynchronous teleconsultations for diabetes care are feasible, cost-effective, and reliable. However, it should be noted that many of the included studies showed no significant differences between control (usual care) and intervention groups. This might be due to the diversity and lack of quality in study designs (e.g., inaccurate or incompletely reported sample size calculations). Future research needs quasi-experimental study designs and a holistic approach that focuses on multilevel determinants (clinical, behavioral, and care coordination) to promote self-care and proactive collaborations between health care professionals and patients to manage diabetes care. Also, a participatory design approach is needed in which target users are involved in the development of cost-effective and personalized interventions. Currently, too often technology is developed within the scope of the existing structures of the health care system. Including patients as part of the design team stimulates and enables designers to think differently, unconventionally, or from a new perspective, leading to applications that are better tailored to patients' needs.
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J Diabetes Sci Technol · May 2010
ReviewPractical considerations in the use of real-time continuous glucose monitoring alerts.
The safety and efficacy of real-time (RT) continuous glucose monitoring (CGM) systems in the management of type 1 diabetes are increasingly apparent. Clinical trials have demonstrated the utility of these systems in lowering hemoglobin A1c, minimizing hypoglycemia, and reducing glycemic variability. These RT systems allow patients to conveniently monitor their glucose levels by displaying concentration and trending information. Several of these RT systems provide preset alerts that sound when absolute glucose thresholds are reached. Additionally, some systems allow for predictive algorithm-based alerts that incorporate rates of change. However, clinical trials have identified significant noncompliance in the use of these devices, most notably in the pediatric and adolescent populations. A retrospective review of CGM reports shows that many patients set high and low alert thresholds at levels that result in frequent alerts, potentially resulting in patient nuisance, dismissal of consequential alerts, and eventual product abandonment. Therefore, setting the alert thresholds at appropriate high and low settings can determine the balance between either a perceived benefit by the patient and their long-term use of CGM systems or annoyance to the patient and discontinuation. ⋯ Care should be taken to set CGM alerts at levels that result in a manageable number of notifications per day. In some cases, providers should consider not using alerts at all or consider using broad targets when initiating CGM to maximize alert specificity. Real-time CGM is safe and generally well tolerated; however, individualization of alert settings is necessary maximize the system's benefits and patient adherence.
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J Diabetes Sci Technol · May 2010
Clinical TrialContinuous glucose monitoring system in a rural intensive care unit: a pilot study evaluating accuracy and acceptance.
Glucose management in an intensive care unit (ICU) is labor-intensive. A continuous glucose monitoring system (CGMS) has the potential to improve efficiency and safety in this setting. The goal of this study was to determine if the Medtronic Guardian REAL-Time CGMS was accurate and tolerated by patients in a rural hospital ICU unit. ⋯ The CGMS is well tolerated by ICU patients but, at present, is not sufficiently accurate to be used for therapeutic decisions in the acute setting, particularly in patients with diabetic ketoacidosis. There is a need to find resolution to the technical issues regarding electrode "wetting" and calibration if CGMS use in the ICU setting is to provide an effective means of diabetes care and management.
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J Diabetes Sci Technol · Mar 2010
Real-time glucose estimation algorithm for continuous glucose monitoring using autoregressive models.
Continuous glucose monitors (CGMs) present a problem of lack of accuracy, especially in the lower range, sometimes leading to missed or false hypoglycemia. A new algorithm is presented here aimed at improving the measurement accuracy and hypoglycemia detection. Its core is the estimation of blood glucose (BG) in real time (RT) from CGM intensity readings using autoregressive (AR) models. ⋯ The performance measured with both clinical and numerical accuracy metrics illustrates the improved accuracy of the proposed algorithm compared with values presented in the literature. A significant improvement in hypoglycemia detection was also observed.
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J Diabetes Sci Technol · Jan 2010
Aluminum gallium nitride (GaN)/GaN high electron mobility transistor-based sensors for glucose detection in exhaled breath condensate.
Immobilized aluminum gallium nitride (AlGaN)/GaN high electron mobility transistors (HEMTs) have shown great potential in the areas of pH, chloride ion, and glucose detection in exhaled breath condensate (EBC). HEMT sensors can be integrated into a wireless data transmission system that allows for remote monitoring. This technology offers the possibility of using AlGaN/GaN HEMTs for extended investigations of airway pathology of detecting glucose in EBC without the need for clinical visits. ⋯ There is great promise for using HEMT-based sensors to enhance the detection sensitivity for glucose detection in EBC. Depending on the immobilized material, HEMT-based sensors can be used for sensing different materials. These electronic detection approaches with rapid response and good repeatability show potential for the investigation of airway pathology. The devices can also be integrated into a wireless data transmission system for remote monitoring applications. This sensor technology could use the exhaled breath condensate to measure the glucose concentration for diabetic applications.