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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.

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.

Microneedle array devices provide the opportunity to overcome the barrier characteristics of the outermost skin layer, the stratum corneum. This novel technology can be used as a therapeutic tool for transdermal drug delivery, including insulin, or as a diagnostic tool providing access to dermal biofluids, with subsequent analysis of its contents. Over the last decade, the use of microneedle array technology has been the focus of extensive research in the field of transdermal drug delivery. More recently, the diagnostic applications of microneedle technology have been developed. This review summarizes the existing evidence for the use of microneedle array technology as biosensors for continuous monitoring of the glucose content of interstitial fluid, focusing also on mechanics of insertion, microchannel characteristics, and safety profile.

Introduction Extra-pulmonary complications of Burkholderia cepacia complex (Bcc) infection in patients with cystic fibrosis are unusual. To the best of the authors' knowledge no case of pyomyositis secondary to Bcc infection has been reported previously. Case presentation We report a case of pyomyositis of the forearm caused by Bcc infection in a patient with CF. We also briefly discuss the management of pyomyositis. Conclusion Pyomyositis is a potential extra-pulmonary complication of Bcc infection in patients with CF. A high index of clinical suspicion is required to make a prompt diagnosis. Final diagnosis may need MRI. An early diagnosis, aggressive medical therapy, multidisciplinary care and timely surgical intervention are all essential for proper management of this condition.

Patients starting palliative systemic therapy for incurable cancer will often be taking medications on repeat prescription for pre-existing medical disorders. Common examples include antihypertensives, statins, and anticoagulants for the primary or secondary prevention of cardiovascular disorders. Such drugs have uncertain benefits in patients whose life-expectancy is now dominated by advanced cancer, rather than future non-cancer risks. Most landmark studies establishing common preventative medications did not include significant numbers of cancer patients, or excluded them altogether. There is also uncertainty around the risks and side effects of non-cancer medications in patients with cancer. Indeed it appears that, at least within the medical literature, this issue has been almost entirely overlooked by the oncology and wider healthcare communities. Attention is needed as practitioners remain uncertain about how to manage their patient's comorbidities alongside a new diagnosis of cancer. The important role of the GP as an expert in primary and secondary prevention may not be appreciated by patients, oncologists, and the GPs themselves, where the assumption exists that an oncologist will manage, with competence, all aspects of a cancer patient's care. We shall consider some examples. In the case of statins for the primary prevention of coronary heart disease, the WOSCOPS study was a pivotal randomised controlled trial that justified the use of pravastatin in this setting. With an average follow-up of 5 years, the …