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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 glycemia.Methods: Data from the JDRF study of CGM in participants with type 1 diabetes were used. Participants were randomized 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 analyzed. 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 < 0.001). Intercorrelation between GV indices was common and, apart from coefficient of variation (CV), low blood glucose index (LBGI), and percentage of glycemic risk assessment diabetes equation score attributable to hypoglycemia (%GRADEhypoglycemia), all indices correlate positively with HbA1c. There was strong correlation between time spent in hypoglycemia, and CV, LBGI, and %GRADEhypoglycemia, but not with HbA1c. A significant reduction in all GV indices, except lability index and mean absolute glucose change per unit time (MAG), was demonstrated in the intervention group at 26 weeks compared with the control group. Baseline factors predicting a change in GV with CGM include baseline HbA1c, baseline GV, frequency of daily SMBG, and insulin pump use.Conclusions: CGM reduces most GV indices compared with SMBG in people with type 1 diabetes. The strong correlation between time spent in hypoglycemia and CV, LBGI, and %GRADEhypoglycemia highlights the value of these metrics in assessing hypoglycemia as an adjunct to HbA1c in the overall assessment of glycemia. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Abstract: 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) [ABSTRACT FROM AUTHOR]

Aim(s): 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).Methods: 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.Results: 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.Conclusions: 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. [ABSTRACT FROM AUTHOR]