Diabetes technology & therapeutics
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Diabetes Technol. Ther. · Jul 2013
Randomized Controlled Trial Comparative Study Clinical TrialComparison between shorter straight and thinner microtapered insulin injection needles.
Many diabetes patients who require insulin perform multiple subcutaneous injections every day that often cause pain, discomfort, and anxiety. We compared efficacy (glycemic control) and patient preference for two types of needle: a shorter straight needle (32 gauge×4 mm, straight wall; Nippon Becton Dickinson Co., Ltd., Tokyo, Japan; hereafter referred to as BD32S4) and a thinner microtapered needle (33-gauge tip and 28-gauge base×5 mm, double-tapered wall; Terumo Corp., Tokyo, Japan; hereafter referred to as TR33T5) in a single-center study. ⋯ The BD32S4 needle was more highly evaluated and was preferred by the patients with respect to pain during injection, usability, and visual impression, without having a negative impact on glycemic control. The overall preference of patients for the shorter needle in this study suggests that needle length may be one of the major contributing factors for patients' comfort in insulin injection, although the other relevant factors of needles still need to be considered.
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Diabetes Technol. Ther. · Jul 2013
Real-time hypoglycemia detection from continuous glucose monitoring data of subjects with type 1 diabetes.
Hypoglycemia is a potentially fatal condition. Continuous glucose monitoring (CGM) has the potential to detect hypoglycemia in real time and thereby reduce time in hypoglycemia and avoid any further decline in blood glucose level. However, CGM is inaccurate and shows a substantial number of cases in which the hypoglycemic event is not detected by the CGM. The aim of this study was to develop a pattern classification model to optimize real-time hypoglycemia detection. ⋯ This optimized real-time hypoglycemia detection provides a unique approach for the diabetes patient to reduce time in hypoglycemia and learn about patterns in glucose excursions. Although these results are promising, the model needs to be validated on CGM data from patients with spontaneous hypoglycemic events.
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Diabetes Technol. Ther. · Jun 2013
Evaluation of glycemic variability in well-controlled type 2 diabetes mellitus.
It is necessary to evaluate glucose variability and postprandial hyperglycemia in patients with well-controlled type 2 diabetes mellitus because of the limitations associated with hemoglobin A1c (HbA1c) measurements. We evaluated parameters reflecting postprandial hyperglycemia and glycemic variability in patients with optimal HbA1c. ⋯ This study demonstrated postprandial hyperglycemia and glycemic variability in subjects with well-controlled diabetes. FA may reflect postprandial hyperglycemia and glycemic variability, but 1,5-AG may be of limited value for assessing glucose variability in patients with well-controlled type 2 diabetes mellitus.
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Diabetes Technol. Ther. · Apr 2013
Randomized Controlled Trial Comparative StudyEffect of infusion rate and indwelling time on tissue resistance pressure in small-volume subcutaneous infusion like in continuous subcutaneous insulin infusion.
To deliver exact volumes of liquid subcutaneously (e.g., during continuous subcutaneous insulin infusion [CSII]), the insulin pump has to overcome not only frictional losses of the mechanical drive and pressure losses in the tubing and infusion set, but also the tissue resistance pressure (TRP). Up to now, detailed information about the dependence of TRP on volumes and delivery rates common for CSII is missing. However, knowledge of the typical range of TRP during CSII is important to optimize occlusion detection and the design of insulin pumps. ⋯ Median TRP increased significantly with higher infusion rates. Catheter indwelling time had no significant effect on the TRP. Occlusion detection may be improved by using rate-dependent detection thresholds.
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Diabetes Technol. Ther. · Mar 2013
Computerization of the Yale insulin infusion protocol and potential insights into causes of hypoglycemia with intravenous insulin.
The management of critically ill hyperglycemic patients in the intensive care unit (ICU) has been fraught with recent controversy. Only one randomized trial has demonstrated a mortality benefit to intensive glycemic control, with all subsequent studies failing to confirm this benefit and revealing a markedly increased risk of severe hypoglycemia (SH) in intensively treated patients. In most of these trials, adherence to the protocols were neither tracked nor reported. ⋯ The results of the GlucoCare-directed Yale 100-140 mg/dL protocol experience revealed an extremely low incidence of SH and an incidence of MH of 1.1%. The incidence of SH in this study was lower than the control group of the NICE-SUGAR study and are supportive of the new Society of Critical Care guidelines to target BG levels of 100-150 mg/dL in critically ill patients. Further refinements to the original protocol and emphasis on staff adherence to protocol directives could potentially further reduce these very low hypoglycemia rates.