Accuracy of pipeline blood glucose monitoring in patients with severe liver injury undergoing artificial liver support system treatment

Severe deterioration of liver function in patients can be characterized by coagulation disorders, jaundice, hepatic encephalopathy, ascites, and other symptoms. Severe liver injury can develop as acute liver failure, subacute liver failure, acute-on-chronic liver failure, or further worsening of end-stage liver disease [1].

Evaluation of hybrid closed-loop insulin delivery system in type 1 diabetes in real-world clinical practice:One-year observational study

BACKGROUND In 2016,the Food and Drug Administration approved the first hybrid closed-loop(HCL)insulin delivery system for adults with type 1 diabetes(T1D).There is limited information on the impact of using HCL systems on patient-reported outcomes(PROs)in patients with T1D in real-world clinical practice.In this independent study,we evaluated glycemic parameters and PROs over one year of continuous use of Medtronic’s 670G HCL in real-world clinical practice.AIM To assess the effects of hybrid closed loop system on glycemic control and quality of life in adults with T1D.METHODS We evaluated 71 patients with T1D(mean age:45.5±12.1 years;59%females;body weight:83.8±18.7 kg,body mass index:28.7±5.6 kg/m2,A1C:7.6%±0.8%)who were treated with HCL at Joslin Clinic from 2017 to 2019.We measured A1C and percent of glucose time-in-range(%TIR)at baseline and 12 months.We measured percent time in auto mode(%TiAM)for the last two weeks preceding the final visit and assessed PROs through several validated quality-of-life surveys related to general health and diabetes management.RESULTS At 12 mo,A1C decreased by 0.3%±0.1%(P=0.001)and%TIR increased by 8.1%±2.5%(P=0.002).The average%TiAM was only 64.3%±32.8%and was not associated with A1C,%TIR or PROs.PROs,provided at baseline and at the end of the study,showed that the physical functioning submodule of 36Item Short-Form Health Survey increased significantly by 22.9%(P<0.001).Hypoglycemia fear survey/worry scale decreased significantly by 24.9%(P<0.000);Problem Areas In Diabetes reduced significantly by-17.2%(P=0.002).The emotional burden submodules of dietary diversity score reduced significantly by-44.7%(P=0.001).Furthermore,analysis of Clarke questionnaire showed no increase in awareness of hypoglycemic episodes.WHO-5 showed no improvements in subject’s wellbeing among participants after starting the 670G HCL system.Finally,analysis of Pittsburgh Sleep Quality Index showed no difference in sleep quality,sleep latency,or duration of sleep from baseline to 12 mo.CONCLUSION The use of HCL in real-world clinical practice for one year was associated with significant improvements in A1C,%TIR,physical functioning,hypoglycemia fear,emotional distress,and emotional burden related to diabetes management.However,these changes were not associated with time in auto mode.

Practice of Glycemic Self-Monitoring in Diabetic Patients Followed at the Endocrinology Department of Donka University Hospital in Guinea

Diabetes is a chronic pathology whose evolution is marked by micro and macroangiopathic complications. Optimal management can prevent the onset of complications and improve patients’ quality of life. Objectives: To determine the frequency of self-monitoring of blood glucose and to describe the errors found during self-monitoring in diabetic patients followed at the Endocrinology Department of Donka University Hospital in Guinea. Materials and methods: Descriptive cross-sectional study carried out between August and September 2020 involving diabetic patients followed up at the Endocrinology and Diabetology Department of the Donka National Hospital, CHU Conakry. Results: A total of 301 patients were enrolled, with an average age of 44.24 ± 21.01 years. 64.12% were female. Type 2 diabetes predominated in 64% of cases. The mean duration of diabetes was 6.14 ± 4.67 years, and 75.08% of patients lived in urban areas. Patients were on insulin in 36.21% of cases, insulin and biguanides (26.25%), hypoglycemic sulfonamide and biguanides (19.27%) and biguanides in 18.27% of cases. The frequency of self-monitoring of blood glucose was 43%, and 38% of patients made errors, notably reusing lancets (60%), not checking the expiration date (55.65%) and not washing their hands (48%). Conclusion: This study shows that self-monitoring of blood glucose is not performed by the majority of patients. Numerous errors were identified during blood glucose testing. Continued therapeutic education on the use of blood glucose meters will help empower patients and improve their quality of life.

Detection and management of perioperative blood glucose abnormalities

Diabetes mellitus is a common chronic disease.With the improvement of living standards,the prevalence of diabetes mellitus in China is increasing.There are now more people with diabetes in China(>100 million)than in any other country.About half of these people with diabetes need to undergo at least one procedure in their lifetime.Diabetic patients have a much higher probability of perioperative dysglycemia than the normal population,which has a great impact on their prognosis.In addition,non-diabetic patients may also have abnormal blood glucose levels due to various reasons during the perioperative period,which will also lead to a series of adverse consequences.This ar ticle reviews the perioperative blood glucose management of patients to provide a reference for improving their health status.

Investigation and Analysis on the Management Standard of Blood Glucose Monitoring for Clinical Nurses in Nyingchi Region of Tibet

Background: In participating in the medical support work in the Nyingchi area of Tibet, the author found that the medical education resources in this area are scarce, and the clinical nurses in this area have relatively insufficient knowledge about blood glucose monitoring and management. Accurately understanding the knowledge-attitude/belief-practice (KAP) level of nurses in Nyingchi area on blood glucose management is of great significance to the development of blood glucose monitoring management guidance for nurses in this area. Therefore, this study investigated the current status of the management of blood glucose monitoring management standards for clinical nurses in Nyingchi, Tibet. Objective: To investigate and analyze the current situation of clinical nurses in Nyingchi region of Tibet to grasp the regulation of blood glucose monitoring and guide the implementation of the norm of blood glucose monitoring for clinical nurses. Methods: The research survey was carried out from March to April 2020. Random sampling method was used to select 134 clinical in-service nurses in Nyingchii, Tibet. The self-designed knowledge-attitude/belief-practice survey questionnaire for clinical nurses’ blood glucose monitoring and management in Tibet was used. Nurses’ blood glucose monitoring management “KAP” scores and related influencing factors are analyzed. Results: Blood sugar monitoring and management knowledge score is (36.78 ± 6.80), attitude dimension is (42.48 ± 6.42), practice dimension is (61.87 ± 10.24) and total score is (304.73 ± 36.24). The nurse’s department and whether to participate in diabetes training are the main influencing factors of the blood glucose monitoring management norms, knowledge and behavior (both P < 0.05). Conclusion: The standard knowledge of blood glucose monitoring and management of clinical nurses in Nyingchi region of Tibet is at the middle level, positive attitude and unsatisfactory behavior. Nursing managers should conduct standardized training for clinical nurses in blood glucose monitoring, develop the training mode of diabetes specialty nursing talents in Nyingchi area, and construct a complete management system of diabetes specialty nursing.

Development of Wearable Semi-invasive Blood Sampling Devices for Continuous Glucose Monitoring: A Survey

Semi-invasive blood sampling devices mimic the way female mosquitoes extract blood from a host. They generally consist of a microneedle, a microactuator for needle insertion, a blood extraction mechanism and a blood glucose sensor. These devices have great potential to overcome the major disadvantages of several current blood glucose monitoring methods. Over last two decades, extensive research has been made in all of these related fields. More recently, several wearable devices for semi-invasive blood sampling have been developed. This review aims at summarizing the current state-of-the-art development and utilization of such wearable devices for continuous monitoring of blood glucose levels, with a special attention on design considerations, fabrication technologies and testing methods.

Self-monitoring of blood glucose in gestational diabetes mellitus patients during the COVID-19 pandemic in low- and middle-income countries

Self-monitoring of blood glucose(SMBG)is critical for gestational diabetes mellitus(GDM)care.However,there are several hurdles to its practice during the coronavirus disease 2019(COVID-19)pandemic in GDM patients in low-and middle-income countries when GDM care recommendations emphasize telemedicine-based care.Based on available knowledge,this letter proposes the following barriers to SMBG in these GDM patients during the ongoing COVID-19 pandemic:Poor internet connectivity,affordability of SMBG and digital applications to connect with healthcare providers,government-imposed social mobility restriction,psychological stress,and mental health conditions.Nevertheless,definitive evidence will only be acquired from rigorous research.

What,why and how to monitor blood glucose in critically ill patients

Critically ill patients are prone to high glycemic variations irrespective of their diabetes status.This mandates frequent blood glucose(BG)monitoring and regulation of insulin therapy.Even though the most commonly employed capillary BG monitoring is convenient and rapid,it is inaccurate and prone to high bias,overestimating BG levels in critically ill patients.The targets for BG levels have also varied in the past few years ranging from tight glucose control to a more liberal approach.Each of these has its own fallacies,while tight control increases risk of hypoglycemia,liberal BG targets make the patients prone to hyperglycemia.Moreover,the recent evidence suggests that BG indices,such as glycemic variability and time in target range,may also affect patient outcomes.In this review,we highlight the nuances associated with BG monitoring,including the various indices required to be monitored,BG targets and recent advances in BG monitoring in critically ill patients.

Parsimonious Model for Blood Glucose Level Monitoring in Type 2 Diabetes patients

To establish the parsimonious model for blood glucose monitoring in patients with type 2 diabetes receiving oral hypoglycemic agent treatment. One hundred and fifty-nine adult Chinese type 2 diabetes patients were randomized to receive rapid-acting or sustained-release gliclazide therapy for 12 weeks.

Review of minimally invasive continuous glucose monitoring technology & instruments

Continuous blood glucose monitoring is important for the diagnosis,treatment,and study of diabetes. many organizations have been working on this subject in recent two decades. Glucose concentration in interstitial fluid is closely related to the blood glucose levels. Minimally invasive continuous blood glucose monitoring technology based on the glucose detection in interstitial fluid develops rapidly and gets more and more attentions from the patients and the doctors,due to its instantaneous real-time display of glucose level,"24/7"coverage,and the ability to characterize glycemic variability. According to the different detection methods,most of the continuous glucose monitoring technology could be divided into two kinds: subcutaneous implantation method and transdermal extraction method. This paper review s the recent development of minimally invasive blood glucose monitoring technology and instruments. The mainly remained challenges and related research directions are presented as well.

Glucagon-like peptide-1 receptor agonists as a possible intervention to delay the onset of type 1 diabetes:A new horizon

Type 1 diabetes(T1D)is a chronic autoimmune condition that destroys insulinproducing beta cells in the pancreas,leading to insulin deficiency and hyperglycemia.The management of T1D primarily focuses on exogenous insulin replacement to control blood glucose levels.However,this approach does not address the underlying autoimmune process or prevent the progressive loss of beta cells.Recent research has explored the potential of glucagon-like peptide-1 receptor agonists(GLP-1RAs)as a novel intervention to modify the disease course and delay the onset of T1D.GLP-1RAs are medications initially developed for treating type 2 diabetes.They exert their effects by enhancing glucose-dependent insulin secretion,suppressing glucagon secretion,and slowing gastric emptying.Emerging evidence suggests that GLP-1RAs may also benefit the treatment of newly diagnosed patients with T1D.This article aims to highlight the potential of GLP-1RAs as an intervention to delay the onset of T1D,possibly through their potential immunomodulatory and anti-inflammatory effects and preservation of beta-cells.This article aims to explore the potential of shifting the paradigm of T1D management from reactive insulin replacement to proactive disease modification,which should open new avenues for preventing and treating T1D,improving the quality of life and long-term outcomes for individuals at risk of T1D.

Recent developments in non-invasive blood glucose monitoring technology

Diabetes mellitus is a huge and significantly grow ing problem. Continuous and real-time monitoring of blood glucose plays a key role for the people with diabetes,which can help them to control glucose concentration more effectively. However,current blood glucose monitoring methods require blood by needle-pricking,which limit the detection frequency. It is necessary to develop non-invasive blood glucose monitoring methods to achieve the ideal therapeutic and management of diabetes. In this paper,the developments and challenges of non-invasive blood glucose monitoring technologies in recent years are reviewed. And the bottleneck and the developing trends are also analyzed.

Dextrose in the banked blood products does not seem to affect the blood glucose levels in patients undergoing liver transplantation

AIM: Hyperglycemia commonly seen in liver transplantation (LT) has often been attributed to the dextrose in the storage solution of blood transfusion products. The purpose of the study is to compare the changes of the blood glucose levels in transfused and non-transfused patients during LT. METHODS: A retrospective study on 60 biliary pediatric patients and 16 adult patients undergoing LT was carried out. Transfused pediatric patients were included in Group Ⅰ (GI), those not transfused in Group Ⅱ (GⅡ). Twelve adult patients were not given transfusion and assigned to Group Ⅲ (GⅢ); whereas, four adult patients who received massive transfusion were assigned to Group Ⅳ (GⅣ). The blood glucose levels, volume of blood transfused, and the volume of crystalloid infused were recorded, compared and analyzed. RESULTS: Results showed that the changes in bloodglucose levels during LT for both non-transfused and minimally transfused pediatric groups and non-transfused and massively-transfused adult groups were almost the same. CONCLUSION: We conclude that blood transfusion does not cause significant changes in the blood glucose levels inthis study.

肝癌切除手术患者目标导向性血糖监测的证据总结

目的检索并总结肝癌切除手术患者目标导向性血糖监测相关证据,为临床提供指导依据。方法应用PICO程式结构化临床问题,检索中国指南网,美国指南网,英国国家临床医学研究所指南库,国际指南图书馆,英格兰学院间指南网,UpToDate,BMJ,Cochrane Library,PubMed,Web of Science,EMbase,CINAHL,中国生物医学数据库,中国知网,万方医学数据库。采用相关评价工具对纳入的文献进行质量评价。结果共纳入文献15篇,包括指南6篇,专家共识3篇,原始研究6篇,总结出18条审查指标,包括多学科团队构建、术前评估及健康教育、监测方法、术前/术中/术后目标导向性血糖监测措施、异常血糖处理、术后交接及管理等内容。结论本研究总结了肝癌切除手术患者目标导向性血糖监测的最佳证据,为规范临床血糖监测及控制,降低血糖异常事件及并发症发生率,加速术后康复提供循证依据。

基于动态血糖监测结果评价门诊教育对2型糖尿病患者血糖谱的影响研究

背景 动态血糖监测(CGM)在门诊患者治疗中应用较少,基于CGM进行糖尿病教育,改变不良的生活、饮食习惯对血糖谱的影响尚不清楚。目的 基于回顾性CGM结果,对使用口服降糖药的门诊2型糖尿病(T2DM)患者进行饮食、运动等门诊教育,评价其对患者血糖谱的影响。方法 选取2021于南京市第一医院内分泌科门诊就诊使用口服降糖药的T2DM患者88例,其中男60例、女28例,给予CGM。入组患者给予门诊教育,即第1~3天维持原降糖治疗方案及生活习惯;第4天下载并分析CGM数据,结合患者饮食、运动等门诊教育,第6天取下CGM传感器和记录器,下载数据。比较第2天和第5天动态血糖数据[24 h平均血糖(MBG),平均血糖波动幅度(MAGE),葡萄糖目标范围内时间(TIR)]。结果 基于CGM结果,给予门诊教育后(第5天)T2DM患者的MBG由(8.34±1.97)mmol/L下降到(7.85±1.65)mmol/L,TIR由(78.21±24.64)%上升到(84.28±21.87)%,MAGE由(4.53±2.25)mmol/L下降到(3.80±1.80)mmol/L(P<0.05)。按糖尿病病程、年龄进行分层分析:病程<10年组(62例)和病程≥10年组(26例)干预后MBG均较干预前降低,干预后病程<10年组标准差(SD)、MAGE、TAR较干预前降低,TIR较干预前升高(P<0.05);按年龄分为<65岁组(55例)和≥65岁组(33例),两组干预后MBG、TAR较干预前降低,TIR较干预前升高,干预后<65岁组SD、MAGE较干预前降低(P<0.05)。结论 基于CGM结果,对使用口服降糖药物的门诊T2DM患者进行饮食、运动等门诊教育,可以有效改善患者MBG、提高TIR水平,改善血糖变异度;<65岁、糖尿病病程<10年的患者获益更大。

医院血糖管理平台建设及相关问题探讨

糖尿病是作为一种常见病,治疗难度较大,需要对患者频繁进行血糖监测,以及内分泌科医生协助治疗。传统的手动记录血糖数据的方式效率低下,容易出错且耗时。其次,不同科室之间缺乏有效的数据共享和交流机制,导致病情管理的不连贯性。另外,不同品牌和型号的血糖监测设备之间缺乏兼容性,给医生和护士的工作带来了不便。我院建立的全院血糖管理平台通过数据联通、统一展示诊疗数据和设备兼容性强等特点,让医务人员可以随时查看患者的血糖数据,了解病情的变化趋势,及时进行干预和调整治疗方案,提高了血糖管理的效率和质量。

术后早期连续血糖监测与取栓后急性缺血性卒中患者预后评估的相关性研究

目的 探讨急性缺血性卒中患者机械取栓术后1~7 d连续血糖水平与预后的相关性。方法 回顾性选取首都医科大学附属北京朝阳医院2021年1月1日至2023年8月31日期间接受机械取栓手术的151例急性缺血性卒中患者为研究对象,收集术后1~7 d空腹及早、午、晚餐后2 h的指尖血糖数据。出院后随访患者术后90 d改良Rankin评分(mRS),采用双变量相关性分析法研究术后1~7 d血糖水平与患者预后的相关性。结果 患者术后第1天(空腹,P=0.028)、第2天(午餐后,P=0.027)、第4天(早餐后,P=0.014)、第5天(午餐后,P=0.006)及第6天(早餐后,P=0.043)血糖水平与术后90 d mRS评分存在显著相关性。结论 术后1~7 d血糖控制对患者预后恢复有显著影响,高血糖状态与术后90 d较差的神经功能障碍显著相关。有效的血糖管理策略可以为患者提供更有利的康复条件和改善预后的可能性。

健康信念模式对动态血糖监测糖尿病患者的应用效果研究

目的探讨健康信念模式对血糖监测的糖尿病患者的应用效果。方法动态血糖监测的糖尿病患者70例,随机分为试验组与对照组,各35例。对照组实施糖尿病常规健康指导,试验组实施基于健康信念模式的健康教育。比较两组患者干预后糖化血红蛋白、空腹血糖、餐后2 h血糖水平及常见并发症发生情况、健康促进生活方式量表(HPLP-Ⅱ)评分。结果干预后,试验组患者糖化血红蛋白(6.15±0.85)%、空腹血糖(6.51±1.11)mmol/L、餐后2 h血糖(7.62±1.15)mmol/L均低于对照组的(7.28±1.04)%、(7.45±1.15)mmol/L、(8.54±1.09)mmol/L,差异具有统计学意义(P<0.05)。试验组常见并发症发生率14.3%低于对照组的45.7%,差异具有统计学意义(P<0.05)。干预后,试验组患者体育运动评分(24.17±4.13)分、健康责任评分(31.11±3.82)分、压力管理评分(31.05±2.26)分、营养评分(25.65±4.50)分、人际关系评分(24.78±1.83)分、精神成长评分(25.16±3.39)分、总分(161.92±9.30)分均高于对照组的(22.04±3.91)、(28.28±3.86)、(29.51±2.52)、(21.43±4.11)、(23.42±1.60)、(22.95±3.67)、(147.63±11.43)分,差异具有统计学意义(P<0.05)。结论基于健康信念模式的健康指导可改善动态血糖监测糖尿病患者健康行为、生化指标及并发症发生情况,一定程度上为改善动态血糖监测糖尿病患者的并发症相关治疗护理提供了借鉴内容。

甘油三酯-葡萄糖乘积指数与女性非糖尿病高血压左心室肥厚的相关性探讨

目的:探讨女性非糖尿病高血压患者甘油三酯-葡萄糖乘积(TyG)指数与左心室肥厚(LVH)的相关性。方法:回顾分析133名女性非糖尿病高血压患者,采用Pearson相关性分析与左室质量指数(LVMI)相关的因素,通过二元logistic回归分析获得LVH的影响因素,并通过ROC曲线分析TyG指数预测LVH的最佳截断值以及灵敏度和特异度。结果:在女性非糖尿病高血压患者中,与TyG指数低值组比较,TyG指数高值组其LVMI也较高。Pearson相关性分析发现LVMI与TyG指数、收缩压及夜间舒张压呈正相关(P<0.05)。二元Logistic回归分析显示,TyG指数和夜间收缩压是LVH的预测因素(OR=3.486,95%CI:1.417~8.577;OR=1.048,95%CI:1.019~1.077)。TyG指数与夜间收缩压联合预测LVH的AUC为0.75(95%CI:0.659~0.847),灵敏度为64.7%,特异度为76.8%。结论:在女性非糖尿病高血压患者中,TyG指数和夜间收缩压与左室质量指数呈正相关,可以作为左心室肥厚的预测因子。

基于扫描式葡萄糖监测系统分析肝移植受者术后血糖变化情况

目的基于扫描式葡萄糖监测系统(FGM)分析肝移植受者术后血糖变化情况。方法选择2022年1月—2023年1月在本院行同种异体肝移植术的30例受者作为研究对象,应用FGM连续监测组织间液葡萄糖浓度,回顾性收集术后首日佩戴且满13 d非糖尿病受者的动态血糖监测数据图谱,包含空腹血糖、12个时间段血糖、预估糖化血红蛋白及每日葡萄糖平均值、目标范围内的时间、低于及高于目标范围内的时间,同时采集受者清晨空腹静脉血糖值。使用R语言软件进行Clarke误差分析及SPSS软件进行Pearson相关分析评价FGM的临床应用准确性。采用非参数秩和检验对比术后1~13 d的动态血糖变化情况。结果30例受者佩戴期间均未出现传感器脱离,平均佩戴时间(14.47±0.86)d,FGM血糖值(7.04±2.43)mmol/L,预估糖化血红蛋白(5.98±1.35)%,目标范围内时间(62.86±28.96)%,低于和高于目标范围内的时间分别为(9.87±16.05)%和(27.13±31.57)%。FGM佩戴期间共采集360对空腹FGM血糖值与静脉血糖值,Pearson相关分析结果示二者呈高度正相关(r=0.95,P<0.05)。Clarke误差分析结果示82%的血糖值落在A区,18%落在B区。不同术后天数在葡萄糖平均值及低于目标范围内的时间方面有差异(P<0.05),术后1~2 d血糖平均值最高,且低于目标范围内的时间均较其余术后时间短(P<0.05)。术后13 d内血糖呈下降趋势,不同时间段的血糖值有差异(P<0.05),每日0︰00~6︰00点血糖值为当日最低值(P<0.05)。服用免疫抑制剂后10︰00~12︰00点及22︰00~0︰00点血糖值均较服药前降低(P<0.05)。结论FGM应用于肝移植受者术后血糖监测准确性较高,术后早期易发生应激性高血糖,应注意及时调控血糖,避免发展成移植后糖尿病,增加并发症的发生。术后每日0︰00~8︰00点血糖值呈下降趋势,服用免疫抑制剂后10︰00~12︰00点及22︰00~0︰00点血糖值均较服药前降低。因此护理人员应密切监测夜间血糖的变化,并加强夜间血糖的管理,同时还应关注服用免疫抑制剂前后空腹期间的血糖变化,避免出现低血糖。