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Ramadan fasting (RF) can represent various challenges to glycaemic control especially in insulin-treated patients with diabetes. We aimed to assess the effect of RF on several glucose metrics using flash glucose monitoring (FGM).Complete FGM data for 29-30 days before, during and after Ramadan were available for 40 patients with type 1 (n = 13) and type 2 diabetes (n = 27) on insulin (with or without oral hypoglycaemic) treatment. Indicators of mean glucose, glucose variability (GV) and time in different glycaemic ranges were analysed.RF was associated with increase in time in hyperglycaemia (38.5 ± 18.2 vs 48.7 ± 20.7%; P 0.001) and decrease in time in hypoglycaemia (3.2 ± 2.8 vs 2.1 ± 2.1%; P = 0.003), and time in target range (56.3 ± 17.2 vs 47.9 ± 19.7%, P 0.001). There were no significant differences in markers of GV with RF; however, RF was associated with a significant reduction in GV during the day but not night time with an increase in the ensuing non-fasting period.In insulin-treated patients, RF is associated with an increase in time in hyperglycaemia, a reduced time in target range and nocturnal increase in GV, indicating a need for more refined management algorithms.

Although subcutaneously implanted continuous glucose monitoring (CGM) devices have been shown to support diabetes self-management, their uptake remains low due to a combination of high manufacturing cost and limited accuracy and precision arising from their invasiveness. To address these points, minimally invasive, a solid microneedle array-based sensor for continuous glucose monitoring is reported here. These intradermal solid microneedle CGM sensors are designed for low cost manufacturing. The tolerability and performance of these devices is demonstrated through clinical studies, both in healthy volunteers and participants with type 1 diabetes (T1D). The geometry of these solid microneedles allows them to penetrate dermal tissue without the need for an applicator. The outer surface of these solid microneedles are modified as glucose biosensors. The microneedles sit in the interstitial fluid of the skin compartment and monitor real-time changes in glucose concentration. Optical coherence tomography measurements revealed no major axial movement of the microneedles in the tissue. No significant adverse events were observed and low pain scores were reported when compared to catheter insertion, deeming it safe for clinical studies in T1D. These amperometric sensors also yielded currents that tracked venous blood glucose concentrations, showing a clinically acceptable correlation. Studies in people with T1D gave a mean absolute relative difference (MARD) of 9% (with respect to venous blood glucose) with over 94% of the data points in the A and B zones of the Clarke error grid. These findings provide baseline data for further device development and a larger clinical efficacy and acceptability study of this microneedle intradermal glucose sensor in T1D.

Aim Hypoglycaemia in Type 1 diabetes is associated with mortality and morbidity, especially where awareness of hypoglycaemia is impaired. Clinical pathways for access to continuous glucose monitoring (CGM) and flash glucose monitoring technologies are unclear. We assessed the impact of CGM and flash glucose monitoring in a high‐risk group of people with Type 1 diabetes. Methods A randomized, non‐masked parallel group study was undertaken. Adults with Type 1 diabetes using a multiple‐dose insulin‐injection regimen with a Gold score of ≥ 4 or recent severe hypoglycaemia were recruited. Following 2 weeks of blinded CGM, they were randomly assigned to CGM (Dexcom G5) or flash glucose monitoring (Abbott Freestyle Libre) for 8 weeks. The primary outcome was the difference in time spent in hypoglycaemia (below 3.3 mmol/l) from baseline to endpoint with CGM versus flash glucose monitoring. Results Some 40 participants were randomized to CGM (n = 20) or flash glucose monitoring (n = 20). The participants (24 men, 16 women) had a median (IQR) age of 49.6 (37.5–63.5) years, duration of diabetes of 30.0 (21.0–36.5) years and HbA1c of 56 (48–63) mmol/mol [7.3 (6.5–7.8)%]. The baseline median percentage time < 3.3 mmol/l was 4.5% in the CGM group and 6.7% in the flash glucose monitoring. At the end‐point the percentage time < 3.3 mmol/l was 2.4%, and 6.8% respectively (median between group difference −4.3%, P = 0.006). Time spent in hypoglycaemia at all thresholds, and hypoglycaemia fear, were different between groups, favouring CGM. Conclusion CGM more effectively reduces time spent in hypoglycaemia in people with Type 1 diabetes and impaired awareness of hypoglycaemia compared with flash glucose monitoring. (Clinical Trial Registry No: NCT03028220), What's new? This is the first head‐to‐head glucose monitoring study comparing continuous glucose monitoring (CGM) and flash glucose monitoring. This study addresses the highest risk group with problematic and severe hypoglycaemia.CGM has a greater beneficial impact on hypoglycaemia outcomes than flash glucose monitoring for people at high risk of hypoglycaemia.The data contribute to the existing CGM literature and are the first for flash glucose monitoring in a high‐risk group, expanding the evidence base.The results are clinically relevant and support a role for CGM in the clinical pathway in people with severe hypoglycaemia or impaired awareness of hypoglycaemia.

The need to develop an insulin delivery system that can closely mimic physiologically induced changes in prandial insulin release has been a major research target since the discovery of insulin. The challenges facing existing insulin delivery systems, related to relatively slow pharmacokinetics and pharmacodynamics, have been further highlighted by rapid advances in diabetes technology and progress in artificial pancreas research. Despite the growing interest in alternative routes of insulin administration, the subcutaneous route remains-at least for now-the preferred route for insulin administration. In this article, we review efforts aimed at developing subcutaneously injected ultrafast-acting insulin and measures aimed at enhancing insulin absorption, focusing on local warming devices.

Objective: To report the impact of continuous glucose monitoring (CGM) on glycemic variability (GV) indices, factors predictive of change and to correlate variability with conventional markers of glycaemia. Methods: Data from the JDRF study of CGM in participants with type 1 diabetes were used. Participants were randomised to CGM or self-monitored blood glucose (SMBG). GV indices at baseline, at 26 weeks in both groups, and at 52 weeks in the control group were analysed. The associations of demographic and clinical factors with change in GV indices from baseline to 26 weeks were evaluated. Results: Baseline data were available for 448 subjects. GV indices were all outside normative ranges (P

Continuous glucose monitoring (CGM) technology has emerged as an important diabetes management tool. Use of CGM with real-time glucose data can improve glycemic control with reduction in HbA1c and reduced time spent in hypoglycemia in both children and adults with type 1 diabetes. The magnitude of clinical benefit is related to duration of use.1 Despite the advantages of CGM, it has not been widely integrated into routine management of type 1 diabetes. T1D exchange data demonstrates that CGM technology is being used by only 6.5% of people with type 1 diabetes in United States and that among individuals who have used CGM, two-thirds stopped using it.2 One of the major challenges facing widespread adoption of CGM technology is reduced accuracy and reliability of CGM systems, with a subsequent negative impact on adherence and effectiveness.3 We present a case of deliberate insulin overdose in a person with type 1 diabetes wearing blinded CGM, highlighting the issue of accuracy of existing CGM systems in the hypoglycemic range.