Utilising continuous glucose monitoring for glycemic control in diabetic kidney disease

In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.

Effect of a 26-month floorball training on male elderly's cardiovascular fitness, glucose control, body composition, and functional capacity

Background: Floorball training offers a motivating and socially stimulating team activity for older adults, and 12 weeks of floorball training twice a week among men aged 65—76 years have been shown to have positive effects on a number of physiological parameters important for health. However, the effect of long-term participation in floorball training among male elderly has not been investigated. The aim of the present study was to examine the effect of 26-month self-organized regular participation in floorball training on cardiovascular fitness, body composition, blood lipids, glucose control, and physical function among recreationally active men aged 66—78 years.Methods: After completing a 12-week randomized and controlled intervention with floorball and petanque training in the autumn 2014 or spring2015, 15 subjects chose to participate in floorball training(floorball group, FG), whereas 16 subjects resumed their usual lifestyle(control group,CG). FG took part in self-organized floorball training 1.7 sessions of 40 min/week, and CG continued their normal recreationally active lifestyle during a 26-month follow-up period. At baseline and after the follow-up period subjects were tested for cardiovascular fitness, glucose control(resting blood samples), body composition dual-energy X-ray absorptiometry(DXA-scanning), and functional capacity.Results: In FG, the decline in maximal oxygen uptake(VO_(2max)) during the follow-up period was lower(242 ± 379 mL/min, p = 0.01), blood glycosylated hemoglobin(HbA1c) increased less(—1.6 ± 2.9 mmol/L, p = 0.02), and leg bone mineral density increased more(0.03 ± 0.05 g/cm^2,p = 0.02) than those in CG. The effects on body mass, total lean body mass, fat mass, blood lipids, and physical function were similar in FG and CG.Conclusion: Approximately twice weekly floorball sessions with 40 min/session over 26-month appear to reduce age-related decline in cardiovascular fitness and glucose control and improve leg bone mineral density, suggesting that long-term participation in floorball training can be considered as a health-enhancing activity in recreationally active male elderly.

Effect of hospital discharge plan for children with type 1 diabetes on discharge readiness,discharge education quality,and blood glucose control

BACKGROUND Type 1 diabetes is one of the most common chronic diseases in childhood.The number of type 1 diabetes patients in China still ranks fourth in the world.Therefore,children with type 1 diabetes in China are a group that needs attention.The management of type 1 diabetes mellitus(T1DM)involves many aspects of daily life.It is extremely challenging for children and their families.T1DM children have complex medical care needs.Despite the continuous development of therapeutic medicine and treatment technologies,blood glucose control in children with T1DM is still not ideal.They and their parents need to acquire more knowledge and skills before being discharged.AIM To explore the influence of hospital discharge plan based on parental care needs of children with T1DM on discharge readiness,quality of discharge education and blood glucose control level.METHODS In total,102 parents of children with type 1 diabetes were divided into control group and intervention group according to admission time.Fifty cases from February to June 2019 were selected as the control group,and 52 cases from July to October 2019 were selected as the intervention group to implement the discharge plan.The Readiness for Hospital Discharge Scale,Hospital Discharged Education Quality Scale and children's blood glucose metabolism indicators were used to compare the differences in discharge preparation,discharge education quality and blood glucose control between the two groups of children and their parents.RESULTS On the day of discharge,the two groups of children had the following scores of readiness for discharge:The intervention group score was 225.34±32.47,and the control group score was 208.68±29.31.The P value was 0.007,and the difference was statistically significant.The discharge education quality scores were as follows:The intervention group score was 135.11±19.86,the control group score was 124.13±15.56,the P value was 0.002 and the difference was statistically significant.Three months after discharge,the blood glucose metabolism indicator showed that the glycosylated hemoglobin value of the two groups was(7.45%±1.04%),and that of the control group was(8.04%±1.27%),P=0.012.Therefore,the improvement of parents'readiness for discharge,quality of discharge education and blood glucose metabolism indicators(glycosylated hemoglobin,fasting blood glucose and postprandial blood glucose)in the intervention group were better than those in the control group(P<0.05),and the difference was statistically significant.CONCLUSION The discharge plan for children with T1DM can help the children and their families realize the transition from hospital care to home self-management and improve the parents'readiness for discharge,thereby improving children’s blood glucose control levels.

Continuous glucose monitoring metrics in pregnancy with type 1 diabetes mellitus

Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests,the advent of continuous glucose monitoring(CGM)systems has revolutionized the approach.These devices offer a safe and reliable means of tracking glucose levels in real-time,benefiting both women with diabetes during pregnancy and the healthcare providers.Moreover,CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes,especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device.Such a combined approach has been demonstrated to improve overall blood sugar control,lessen the occurrence of preeclampsia and neonatal hypoglycaemia,and minimize the duration of neonatal intensive care unit stays.This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.

Effects of DPP-4 inhibitor combined with metformin on blood glucose control, oxidative stress and inflammatory response in patients with type 2 diabetes mellitus

Objective: To investigate the effects of DPP-4 inhibitor combined with metformin on blood glucose control, oxidative stress and inflammatory response in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 138 patients with newly diagnosed T2DM who were treated in the hospital between March 2016 and April 2017 were divided into routine group (n=69) and combined treatment group (n=69) by random number table method. Routine group were treated with metformin alone and combined treatment group received DPP-4 inhibitor combined with metformin therapy. The differences in blood glucose control as well as oxidative stress-related indicator and inflammatory factor contents were compared between the two groups before and after treatment. Results: Before treatment, the differences in blood glucose index levels in peripheral blood as well as the oxidative stress index and inflammatory mediator contents in serum were not statistically significant between the two groups. After 4 weeks of treatment, blood glucose indexes FBG and HOMA-IR levels in peripheral blood of combined treatment group were lower than those of routine group;oxidative stress indexes MDA and LHP contents in serum were lower than those of routine group whereas GSH-Px and T-AOC contents were higher than those of routine group;inflammatory mediators hs-CRP, IL-1 and IL-6 contents in serum were lower than those of routine group. Conclusion: DPP-4 inhibitor combined with metformin therapy can effectively control the blood glucose and suppress the systemic oxidative stress and inflammatory response in T2DM paients.

Perception of difficulty and glucose control:Effects on academic performance in youth with type Ⅰ diabetes

AIM:To investigate whether perceptions of task difficulty on neuropsychological tests predicted academic achievement after controlling for glucose levels and depression.METHODS :Participants were type 1 diabetic adolescents,with a mean age = 12.5 years(23 females and 16 males),seen at a northwest suburban Chicago hospital.The sample population was free of comorbid clinical health conditions.Subjects completed a three-part neuropsychological battery including the Digit Symbol Task,Trail Making Test,and Controlled Oral Word Association test.Following each task,individuals rated task difficulty and then completed a depression inventory.Performance on these three tests is reflective of neuropsychological status in relation to glucose control.Blood glucose levels were measured immediately prior to and after completing the neuropsychological battery using a glucose meter.Hb A1 c levels were obtained from medical records.Academic performance was based on self-reported grades in Math,Science,and English.Data was analyzed using multiple regression models to evaluate the associations between academic performance,perception of task difficulty,and glucose control.RESULTS:Perceptions of difficulty on a neuropsychological battery significantly predicted academic performance after accounting for glucose control and depression.Perceptions of difficulty on the neuropsychological tests were inversely correlated with academic performance(r =-0.48),while acute(blood glucose) and long-term glucose levels increased along with perceptions of task difficulty(r = 0.47).Additionally,higher depression scores were associatedwith poorer academic performance(r =-0.43).With the first regression analysis,perception of difficulty on the neuropsychological tasks contributed to 8% of the variance in academic performance after controlling for peripheral blood glucose and depression.In the second regression analysis,perception of difficulty accounted for 11% of the variance after accounting for academic performance and depression.The final regression analysis indicated that perception of difficulty increased with peripheral blood glucose,contributing to 22% of the variance.Most importantly,after controlling for perceptions of task difficulty,academic performance no longer predicted glucose levels.Finally,subjects who found the cognitive battery difficult were likely to have poor academic grades.CONCLUSION:Perceptions of difficulty on neurological tests exhibited a significant association with academic achievement,indicating that deficits in this skill may lead to academic disadvantage in diabetic patients.

CONTROLLED SYNTHESIS OF AMPHIPHILIC BLOCK POLYMERS HAVING GLUCOSE RESIDUES AND THEIR STRUCTURE FORMATION

Vinyl ether (VE)-based amphiphilic block copolymers with D-glucose residues as hydrophilicpendants were synthesized by CH_3 CH(OiBu)Cl/ZnI_2-initiated sequential living cationic copolymerization of3-O-(vinyloxy)ethyl-1, 2:5, 6-di-O-isopropylidene-D-glucofuranose (IGVE) and isobutyl VE (IBVE ) andsubsequent deprotection. The precursor block copolymers had a narrow molecular weight distribution(M_w/M_n～1.1) and a controlled segmental composition. The solubility characteristics of the amphiphiliccopolymer depended strongly on composition. Their solvent-cast thin films were examined, under atransmission electron microscope, and could be seen to exhibit various microphase-separated surfacemorphologies such as spheres, cylinders, and lamellae, depending on composition. The amphiphiliccopolymers with the appropriate segmental composition were found to form a stable monolayer at the air-water interface, which was successfully transferred onto a substrate by the Langmuir-Blodgett (LB)technique. The layered strucfure of the built-up LB films was controlled by blending the homopolymer.

Blood glucose control in the intensive care unit: Where is the data?

Blood glucose control, including hyperglycemia correction, maintaining glucose at optimal level and avoiding hypoglycemia, is a challenge clinicians face every day in intensive care units (ICUs). If managed inadequately, its related mortality can increase. Prior to 2001, no relevant data from randomized, controlled studies assessing glucose control in the ICU were available. In the past 18 years, however, many clinical trials have defined criteria for managing abnormal blood glucose levels, as well as provided suggestions for glycemic monitoring. Point-ofcare blood glucose monitors have become the preferred bedside technology to aid in glycemic management. In addition, in some institutions, continuous glucose monitoring is now available. Cost-effectiveness of adequate glycemic control in the ICU must be taken into consideration when addressing this complex issue. Newer types of glycemic monitoring may reduce nursing staff fatigue and shorten times for the treatment of hyperglycemia or hypoglycemia. There are a variety of glycemic care protocols available. However, not all ICU clinicians are aware of them. The following minireview describes some of these concepts.

Is nonlinear model predictive control with fuzzy predictive model proper for managing the blood glucose level in typeI diabetes?

In recent decades, due to the increasing risk of diabetes, the measurement and control of the blood sugar is of great importance. In typeI diabetes, because of the lack of insulin secretion, the cells cannot absorb glucose, and thus have a low level of glucose. To control blood glucose, the insulin must be injected to the body. In fact, the injection must be in a completely controlled environment. If the level of the insulin exceeds the physiological limits, it may cause death. This paper presents an online approach to control the blood glucose level using a nonlinear model predictive control. This method, maintains the level of blood glucose concentration within a normal range. Thus, the blood glucose level is measured in each minute and predicted for the next time interval. If that is not in the normal range, amount of the insulin which must be injected will be determined. The proposed control approach includes important features such as model uncertainties and prevents acute decrease in the blood glucose level, and instability. In order to assess performance of the proposed controller, computer simulations have been carried out in Matlab/Simulink. Simulation results will reveal the effectiveness of the proposed nonlinear model predictive controller in adjusting the blood glucose level by injecting required insulin. So if the nutrition of the person decreases instantly, the hypoglycemia does not happen.

Self monitoring of blood glucose and its association with glycaemic control and lipid levels in type 2 diabetic patients aged 40 - 75 in Trinidad and Tobago

This study was done to assess whether self monitoring of blood glucose is associated with better glycaemic control in type 2 diabetic Trinidadians. Data was collected from 146 type 2 diabetics via interviews and medical files. Variables extracted included fasting blood glucose, HbA1c and lipid profile. Recent users of the glucometer had better glycemic control compared with longstanding users (HbA1c: 8.4% ± 0.28% vs 9.4% ± 0.62%). Diabetics using a glucometer for >11 years had the highest cholesterol (234 ± 27mg/dL) while those using it 6 months to 5 yrs had the lowest values (206 ± 8 mg/dL). Using the glucometer occasionally or once a week had little impact on these indices. Usage of insulin preparation was positively correlated with HbA1c (r = 0.295;p = 0.001) while those relying on oral hypoglycaemic agents showed a negative correlation (r = -0.265). Further, those who took their medication as prescribed had a lower HbA1c than those who took their medication occasionally. Ironically, HbA1c fell with increasing duration between clinic visits with those visiting annually having the lowest HbA1c (9.0% ± 0.2% vs 7.1% ± 0.7%). Compliance with lifestyle and exercise resulted in lower HbA1c and blood lipids. Poor client education on glucometer usage, administration of insulin and non-compliance with diet and exercise were associated with higher HbA1c.

Factors influencing the effectiveness of using flash glucose monitoring on glycemic control for type 1 diabetes in Saudi Arabia

BACKGROUND In 2017,35000 Saudi children and adolescents were living with a type 1 diabetes(T1D)diagnosis.Diabetic complications are minimized upon strengthened glycemic regulation.The annual cost of treating diabetic patients with complications was four-fold higher than for patients without complications.The use of flash glucose monitoring(FGM)enables better diabetes treatment and thereby improves glycemic control.Understanding the factors that affect effectiveness of FGM will help enhance the device’s use and management of hospital resources,resulting in improved outcomes.AIM To investigate factors that affect effectiveness of the FGM system for glycated hemoglobin(HbA1c)levels/glycemic control among T1D patients.METHODS A retrospective empirical analysis of T1D patient records from King Abdul-Aziz University Hospital and Prince Sultan Military Medical City was performed.T1D patients who began FGM between 2017 and 2019 were included.RESULTS The data included 195 T1D patients(70 males and 125 females)with a mean age of 23.6±8.1 years.Among them,152 patients used multiple daily injection and 43 used an insulin pump.The difference in HbA1c level from baseline and after using FGM was-0.60±2.10,with a maximum of 4.70 and a minimum of-6.30.There was a statistically significant negative correlation between the independent variables(age,duration of diabetes,level of engagement)and HbA1c.The group with the highest HbA1c mean(9.85)was 18-years-old,while the group with the lowest HbA1c mean(7.87)was 45-years-old.Patients with a low level of engagement(less than six scans per day)had the highest HbA1c mean(9.84),whereas those with a high level of engagement(more than eight scans per day)had the lowest HbA1c mean(8.33).CONCLUSION With proper education,FGM can help people with uncontrolled T1D over the age of 18 years to control their glucose level.

Establishment of blood glucose control model in diabetic mice

AIM:To explore the established method of the diabetic mouse blood glucose control model and preliminar y observation of its influence on the retinas of diabetic mice.METHODS:The db/db BKS-DB(Lepr^(ko/ko))mice were randomly divided into two groups:the poor blood glucose control group(PG group,n=18)and the stable blood glucose control group(SG group,n=12),with BKS-DB(Lepr^(wt/wt))as the normal blood glucose control group(NG group,n=18).According to the blood glucose values for 5 intervals which were monitored during the period of adaption,the PG group was injected with insulin aspart twice daily,fasted for 2h and then returned to normal.The SG group was injected with insulin aspart twice and insulin glargine once daily and fed with a quantitative ration.Fundus images were collected after eight weeks.The glycosylated hemoglobin(Hb A1c),mean blood glucose level(MBG),standard deviation of blood glucose(SDBG),coefficient of variation of blood glucose(CVBG),and mean amplitude of glycemic excursion(MAGE)in each group were examined and calculated.RESULTS:The Hb A1c,MBG,SDBG,CVBG,and MAGE levels in the PG group were significantly higher than those in the NG and SG groups(all P<0.05).MBG,SDBG,CVBG,and MAGE levels in the SG group were higher than those in the NG group(all P<0.05).There was no significant difference in Hb A1c levels between the NG and SG groups(P>0.05).Preliminary observation of fundus images in the PG group and SG groups showed scattered retinal bleeding spots,while bleeding was more obvious in the PG group.CONCLUSION:The blood glucose control model of type 2 diabetes mellitus mice can be successfully established by subcutaneous injection of insulin aspart insulin glargine and rationed food,which is valuable for studying the mechanism of blood glucose fluctuations in diabetic complications in vivo.

A Fuzzy Controller for Blood Glucose-Insulin System

Diabetes therapy is normally based on discrete insulin infusion that uses long-time interval measurements. Nevertheless, in this paper, a continuous drug infusion closed-loop control system was proposed to avoid the traditional discrete approaches by automating diabetes therapy. Based on a continuous insulin injection model, two controllers were designed to deal with this plant. The controllers designed in this paper are: proportional integral derivative (PID), and fuzzy logic controllers (FLC). Simulation results have illustrated that the fuzzy logic controller outperformed the PID controller. These results were based on serious disturbances to glucose, such as exercise, delay or noise in glucose sensor and nutrition mixed meal absorption at meal time.

Fuzzy Logic Strategy for Solving an Optimal Control Problem of Glucose and Insulin in Diabetic Human

This paper aims at the development of an approach integrating the fuzzy logic strategy for a glucose and insulin in diabetic human optimal control problem. To test the efficiency of this strategy, the author proposes a numerical comparison with the indirect method. The results are in good agreement with experimental data.

Can the Glucose Central Control System Dysfunctions Induce Diabetes Mellitus?

We study afresh how the glucose control system anomalies impact the organicity of the glucose homeostasis and build up events of persistent hyperglycemia and diabetes mellitus. We have used critically the state of art literature related to the subject, in order to cross, to compare, and to organize the relevant contents to create a logical and consistent support to the finds. We show that it is consistent to assume that persistent hyperglycemia and diabetes mellitus can have precursors not only in pancreas, but also in brain, mainly induced by noxious dysfunctions of hypothalamus sensor neurons circuits and external noxious elements, causing pancreas overload, and the consequent exhaustion—overburden.

Investigation on Blood Glucose Control Nursing of ICU Severe Patients

Objective:To analyze the effect of blood glucose control mursing in intensive care umit (ICU)patients.Methods:The clinical data of 70 severe patients in ICU of ou hospital fom January 2019 to May 2020 were retrospectively analyzed.The climical data of 34 patients with routine intervention were divided into the control group,and the clinical data of 36 patients with routine intervention and blood glucose control mursing were divided into the observation group,all were intervened for 14 days.The blood glucose levels and prognosis of the two groups were compared before intervention and at the end of 14 days of intervention,the time required o achieve the standard blood glucose level of the two groups was recorded Results:After 14 days of intervention,the fasting blood glucose level of the observation group was lower than the control group,the difference was satisically significant(P<0.05);the time of blood glucose reaching the standard in the observation group was shorter than that in the control group,the difference was statistically significant(P<0.05);on the 14th day of intervention,the sequential organ failure asessment score(SOFA)score of the two groups was lower than before intervention,the SOFA score of the observation group was lower than control group,the difference was statistically significant(P<0.05).Conclusion:The effect of blood glucose control mursing in ICU is better,which effectively controlled the blood glucose level of patients and improved the prognosis of patients.

Correlation of anxiety state with blood glucose control, microinflammation and oxidative stress in patients with type 2 diabetes mellitus

Objective:To study the correlation of anxiety state with blood glucose control, microinflammation and oxidative stress in patients with type 2 diabetes mellitus.Methods:A total of 138 patients with type 2 diabetes mellitus were divided into the non-anxiety group (n=43) (SAS score < 50 points), mild-to-moderate anxiety group (n=71) (SAS score 50-69 points) and severe anxiety group (n=24) (SAS score 70 points) according to the self-rating anxiety scale (SAS) score. The differences in levels of glucose metabolism indexes, microinflammation indexes and oxidative stress indexes were compared among the three groups.Results: Peripheral blood FPG, P2hPG, HOMA-IR, CRP, ASAA, IL-6, MDA and ROS levels of mild-to-moderate anxiety group and severe anxiety group were higher than those of non-anxiety group while CAT and GSH-Px contents were lower than those of non-anxiety group;peripheral blood FPG, P2hPG, HOMA-IR, CRP, ASAA, IL-6, MDA and ROS levels of severe anxiety group were higher than those of mid-to-moderate anxiety group while CAT and GSH-Px contents were lower than those of mid-to-moderate anxiety group.Conclusion:The increase of anxiety in patients with type 2 diabetes mellitus is a direct factor leading to the abnormal glucose metabolism as well as the aggravation of microinflammatory state and oxidative stress state.

Effects of a New Long-term Controlled-release Fertilizer on Growth and Development and Yield of Summer Maize

[Objective] The aim was to select the optimal amount of controlled-release fertilizer and provide theoretical references for controlled-release fertilizers use in summer maize. [Method] Long-term controlled-release fertilizers were applied once at sowing summer maize to explore effects on maize growth, yield, economic profits and environment. [Result] Maize yield reduced a little in the treatment group with 60% CRF, and increased in varying degrees in the rest groups in the range of 1.1%-7.4%, and some showed significant differences. [Conclusion] Controlled-release fertilizers can be applied once at the amount of 80% common fertilizer＇s, with con- sideration of maize yield, nitrogen use rate and economic profits, which is beneficial for summer maize application and promotion in North China.

Survey of <i>C. difficile</i>-Specific Infection Control Policies in Local Long-Term Care Facilities

Introduction: The incidence and severity of Clostridium difficile infection (CDI) has been increasing and long-term care facility (LTCF) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. Infection control policies are crucial for controlling CDI, but there are currently no regulatory guidelines in the United States. Therefore, we evaluated infection control policies in local LTCFs to define the CDI-specific policies and the administrative and staff understanding of CDI, so as to identify perceived barriers for compliance. Methods: IRB approval was sought and exemption granted, all 8 local LTCFs were asked to participate. Each facility was visited by study personnel who interviewed the administrative Infection Control Practitioner (ICP) and 3-4 Licensed Practical Nurses (LPNs) with distinct survey format. Infection control policies were then compared to the SHEA recommendations for CDI in LTCFs. Results: Of the eligible facilities, 75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All facilities accept residents with active CDI and 2 had written CDI-specific infection control policies. All facilities had hand hygiene or glove use policies and 2 had policies for the use of sporicidal environmental cleaning. No facility restricted antibiotic use. Each facility has a policy to instruct their staff through in-services, either annually or upon new hire, but 33% (n = 7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs felt comfortable with the facility CDI policies, only 11 accurately restated it. ICPs felt the most relevant barrier to staff compliance was time constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10, 48%) and poor communication (n = 2, 10%). Discussion and Conclusions: With the increasing incidence and severity of CDI in LCTF, few of the facilities surveyed had CDI-specific policies. Despite CDI-specific training, there is a perceived knowledge and communication gap for staff caring for residents with CDI.