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Purpose: Glycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation. Methods: We systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes. Results: We identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5–14.2% and 6.4–13% for intraarterial CGM. Conclusions: In this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia. [ABSTRACT FROM AUTHOR]

Background/Objectives: Traditional glycemic monitoring in type 2 diabetes is limited, whereas continuous glucose monitoring (CGM) offers better insights into glucose fluctuations. This study aimed to determine the correlations and relative contributions of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels to hyperglycemia. Methods: We utilized CGM and recorded carbohydrate intake data from lifestyle diaries of 59 patients enrolled in the Diabetes and Lifestyle Cohort Twente (DIALECT-2). Correlations between FPG and the glucose management indicator (GMI), FPG and Time Above Range (TAR), PPG and GMI, and PPG and TAR were conducted. Daily and mealtime relative contributions of PPG and FPG to glycated hemoglobin (HbA1c) and GMI were determined, considering two ranges: on target (<7.0%, 53 mmol/mol) and not on target (≥7.0%, 53 mmol/mol). Correlations between mealtime PPG and carbohydrate consumption were examined. Results: FPG and PPG correlated with GMI (r = 0.82 and 0.41, respectively, p < 0.05). The relative contribution of PPG in patients with HbA1c, GMI, and TAR values not on target was lower than in patients with HbA1c, GMI, and TAR values on target. When analyzing different mealtimes, patients with target GMI values had a higher PPG (73 ± 21%) than FPG after breakfast (27 ± 21%, p < 0.001). Individuals with elevated GMI levels had lower PPG after lunch (30 ± 20%), dinner (36 ± 23%), and snacks (34 ± 23%) than FPG. PPG after breakfast positively correlated (r = 0.41, p < 0.01) with breakfast carbohydrate intake. Conclusions: Both PPG and FPG contribute to hyperglycemia, with PPG playing a larger role in patients with better glycemic control, especially after breakfast. Targeting PPG may be crucial for optimizing glucose management. [ABSTRACT FROM AUTHOR]

Introduction: Hyperglycaemia is common in intensive care unit (ICU) patients. Glycaemic monitoring and effective glycaemic control with insulin are crucial in the ICU to improve patient outcomes. However, glycaemic control and insulin use vary between ICU patients and hypo‐ and hyperglycaemia occurs. Therefore, we aim to provide contemporary data on glycaemic control and management, and associated outcomes, in adult ICU patients. We hypothesise that the occurrence of hypoglycaemia in acutely admitted ICU patients is lower than that of hyperglycaemia. Methods: We will conduct a bi‐centre cohort study of 300 acutely admitted adult ICU patients. Routine data will be collected retrospectively at baseline (ICU admission) and daily during ICU stay up to a maximum of 30 days. The primary outcome will be the number of patients with hypoglycaemia during their ICU stay. Secondary outcomes will be occurrence of severe hypoglycaemia, occurrence of hyperglycaemia, time below blood glucose target range, time above target range, all‐cause mortality at Day 30, number of days alive without life support at Day 30 and number of days alive and out of hospital at Day 30. Process outcomes include the number of in‐ICU days, glucose measurements (number of measurements and method) and use of insulin (including route of administration and dosage). All statistical analyses will be descriptive. Conclusions: This cohort study will provide a contemporary overview of glucose evaluation and management practices in adult ICU patients and, thus, highlight potential areas for improvement through future clinical trials in this area. [ABSTRACT FROM AUTHOR]

As total ankle arthroplasty (TAA) increases in popularity nationwide for the management of end-stage arthritis, it is essential to understand ways to mitigate the risk of infection. Diabetes increases the risk of infection due to compromised immunity and impaired wound-healing mechanisms. However, there is limited research on how diabetic management, inclusive of medications and glucose control, may impact infection risks post-TAA. This study aims to demonstrate the impact of diabetic management on the occurrence of periprosthetic joint infection (PJI) following TAA. This was a retrospective study of patients who underwent a TAA at a single academic institution from March 2002 to May 2022. Patients with diabetes who developed an intraarticular infection following TAA were propensity score matched (1:3) to diabetic patients who did not. Data collection included demographics, implant types, diabetic medications, and preoperative hemoglobin A1c. PJI was diagnosed based on Musculoskeletal Infection Society (MSIS) criteria. Statistical analyses assessed differences in medication use, glucose control, and infection rates between groups. Of the 1863 patients who underwent TAA, 177 patients had a diagnosis of diabetes. The infection rate in patients with diabetes (2.8%) was higher than the total cohort rate (0.8%). Five patients with diabetes developed a PJI at an average of 2.2 months postoperatively. This cohort (n = 5) was compared to propensity score-matched controls (n = 15). There was no significant difference in diabetic medication use. Patients who developed PJI had higher rates of uncontrolled diabetes (60.0% vs. 6.7%) and average A1c levels (7.02% vs. 6.29%) compared to controls. Our findings suggest that the elevated risk of PJI observed in individuals with diabetes subsequent to TAA may be attributed not solely to the presence of diabetes, but to inadequate glycemic control. Effectively managing blood glucose levels is imperative for achieving favorable outcomes following TAA. III [ABSTRACT FROM AUTHOR]

Min He, Huinan Wu, Guanrong Lin, Yongqin Wang, Longling Shi, Chaoling Huang, Qingyun Xu, Zhenxing Li, Shanbo Huang, Yanni Chen, Na Li Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People’s Republic of ChinaCorrespondence: Min He, Department of Endocrinology, Shishi General Hospital, No. 2156 Shijin Road, Shishi, Fujian, 362700, People’s Republic of China, Tel +8613506048712, Email heminhem463@163.comObjective: This study proposes a region-wide blood glucose management system to solve the problem of blood glucose management in patients with diabetes.Methods: A professional team of doctors, nurses and dietitians jointly developed a region-wide blood glucose management system. The system operates through a collaborative approach where each team member utilises their specialised role, such as data monitoring, algorithm development or patient support, to contribute to a comprehensive blood glucose management network. This integration ensures accurate glucose tracking, personalised feedback and timely adjustments to treatment plans. The system allows the patient to have a good treatment plan, giving comprehensive medical guidance, and the physician team is responsible for the patient’s health status.Results: The region-wide blood glucose management system increased the overall blood glucose monitoring rate of patients and reduced the hospitalisation time (from 11.27 days to 9.52 days) and hospitalisation costs (from 12,173.8 yuan to 9502.4 yuan). At the same time, the system effectively counted the incidence and occurrence time of hyperglycaemia and hypoglycaemia adverse events, which can provide a reference for clinical prevention of adverse events.Conclusion: A region-wide blood glucose management system can improve medical efficiency, save medical resources and provide a strong guarantee for the health of patients with diabetes. Compared with the traditional diabetes management mode, the region-wide blood glucose management system is more systematic and standardised, meaning it can better meet the needs of patients with diabetes.Keywords: diabetic, glucose management, professional team, guarantee for the health, improve medical efficiency

Abstract Background With the advent of the smart phone era, managing blood glucose at home through apps will become more common for older individuals with diabetes. Adult children play important roles in glucose management of older parents. Few studies have explored how adult children really feel about engaging in the glucose management of their older parents with type 2 diabetes mellitus (T2DM) through mobile apps. This study provides insights into the role perceptions and experiences of adult children of older parents with T2DM participating in glucose management through mobile apps. Methods In this qualitative study, 16 adult children of older parents with T2DM, who had used mobile apps to manage blood glucose for 6 months, were recruited through purposive sampling. Semi-structured, in-depth, face-to-face interviews to explore their role perceptions and experiences in remotely managing their older parents’ blood glucose were conducted. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were followed to ensure rigor in the study. The data collected were analyzed by applying Colaizzi’s seven-step qualitative analysis method. Results Six themes and eight sub-themes were identified in this study. Adult children’s perceived roles in glucose management of older parents with T2DM through mobile apps could be categorized into four themes: health decision-maker, remote supervisor, health educator and emotional supporter. The experiences of participation could be categorized into two themes: facilitators to participation and barriers to participation. Conclusion Some barriers existed for adult children of older parents with T2DM participating in glucose management through mobile apps; however, the findings of this study were generally positive. It was beneficial and feasible for adult children to co-manage the blood glucose of older parents. Co-managing blood glucose levels in older parents with T2DM can enhance both adherence rates and confidence in managing blood glucose effectively.

For early hominids, frequent encounters with plant foods necessitated the ability to discern bitter poisons and adjust the activity of the gastrointestinal system in anticipation of carbohydrate-rich meals. Plants bitters were also used historically to manage a variety of metabolic and digestive disorders despite an immense structural diversity of bitter phytochemicals without a common molecular target. Our study confirms these observations in a standardized C57BL/6J prediabetic mouse model using 24 model compounds by demonstrating acute lower peak blood glucose values and improved glucose tolerance following intragastric, but not intraperitoneal, treatment. The administration of the synthetic bitter compound denatonium benzoate yielded similar results that were attenuated by co-application of the allosteric inhibitor of the bitter TAS2R receptors. We also show that these effects occur dose-dependently; associate with reduced glucose uptake, increased intracellular [Ca2+] fluxes, and enhanced GLP-1 expression; and are attenuated by the TAS2R inhibitor in the neuroendocrine STC-1 intestinal cells. These findings support the view that inhibition of glucose transport from the intestinal lumen to the blood by TAS2R bitter receptor signaling in the gut may represent a common mechanism in the acute response to oral ingestion of bitter phytochemicals.

For early hominids, frequent encounters with plant foods necessitated the ability to discern bitter poisons and adjust the activity of the gastrointestinal system in anticipation of carbohydrate-rich meals. Plants bitters were also used historically to manage a variety of metabolic and digestive disorders despite an immense structural diversity of bitter phytochemicals without a common molecular target. Our study confirms these observations in a standardized C57BL/6J prediabetic mouse model using 24 model compounds by demonstrating acute lower peak blood glucose values and improved glucose tolerance following intragastric, but not intraperitoneal, treatment. The administration of the synthetic bitter compound denatonium benzoate yielded similar results that were attenuated by co-application of the allosteric inhibitor of the bitter TAS2R receptors. We also show that these effects occur dose-dependently; associate with reduced glucose uptake, increased intracellular [Ca2+] fluxes, and enhanced GLP-1 expression; and are attenuated by the TAS2R inhibitor in the neuroendocrine STC-1 intestinal cells. These findings support the view that inhibition of glucose transport from the intestinal lumen to the blood by TAS2R bitter receptor signaling in the gut may represent a common mechanism in the acute response to oral ingestion of bitter phytochemicals. [ABSTRACT FROM AUTHOR]

Inadequate management of blood glucose levels in gestational diabetes mellitus (GDM) poses risks for both pregnant women and the developing fetus. Attaining appropriate blood glucose control is crucial to mitigate potential adverse outcomes. This study aimed to consolidate the latest guidelines from representative professional societies, providing insights into exercise therapy for GDM patients and suggesting potential avenues for future research. The review was conducted with up-to-date exercise guidelines from prominent societies, such as the American College of Obstetricians and Gynecologists (ACOG), the Society of Obstetricians and Gynecologists of Canada (SOGC), the Canadian Society for Exercise Physiology (CSEP), the American College of Sports Medicine, the American Diabetes Association (ADA), and the Korean Diabetes Association. The ACOG and SOGC/CSEP recommend 150 min of low to moderate intensity exercise, 3–4 times a week, combining aerobic and resistance exercises. All guidelines advise against activities involving sudden directional changes, physical contact, a risk of falling, and exercises performed lying down. Despite cautions from the ADA and ACOG on blood glucose fluctuations during physical activity, the lack of specific methods and recommendations from other societies reveals a notable gap in evidence-based guidelines for GDM. For effective and safe blood glucose management in GDM patients, further research should be conducted on the exercise-related precautions outlined for GDM patients. Establishing ample evidence would facilitate the development of customized exercise guidelines for GDM patients. [ABSTRACT FROM AUTHOR]

Background: With the advent of the smart phone era, managing blood glucose at home through apps will become more common for older individuals with diabetes. Adult children play important roles in glucose management of older parents. Few studies have explored how adult children really feel about engaging in the glucose management of their older parents with type 2 diabetes mellitus (T2DM) through mobile apps. This study provides insights into the role perceptions and experiences of adult children of older parents with T2DM participating in glucose management through mobile apps. Methods: In this qualitative study, 16 adult children of older parents with T2DM, who had used mobile apps to manage blood glucose for 6 months, were recruited through purposive sampling. Semi-structured, in-depth, face-to-face interviews to explore their role perceptions and experiences in remotely managing their older parents' blood glucose were conducted. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were followed to ensure rigor in the study. The data collected were analyzed by applying Colaizzi's seven-step qualitative analysis method. Results: Six themes and eight sub-themes were identified in this study. Adult children's perceived roles in glucose management of older parents with T2DM through mobile apps could be categorized into four themes: health decision-maker, remote supervisor, health educator and emotional supporter. The experiences of participation could be categorized into two themes: facilitators to participation and barriers to participation. Conclusion: Some barriers existed for adult children of older parents with T2DM participating in glucose management through mobile apps; however, the findings of this study were generally positive. It was beneficial and feasible for adult children to co-manage the blood glucose of older parents. Co-managing blood glucose levels in older parents with T2DM can enhance both adherence rates and confidence in managing blood glucose effectively. [ABSTRACT FROM AUTHOR]

Neonatal hypoglycemia presents significant challenges in the management of small for gestational age (SGA) infants with early onset sepsis. This literature review and case report examine the clinical implications and therapeutic strategies in such cases. The study underscores the importance of timely recognition and intervention to mitigate the risks associated with hypoglycemia and sepsis in term newborns, emphasizing early glucose management and appropriate antibiotic therapy for optimal outcomes [ABSTRACT FROM AUTHOR]

By reducing carbohydrate intake, people with type 1 diabetes may reduce fluctuations in blood glucose, but the evidence in this area is sparse. The aim of this study was to investigate glucose metrics during a one-week low-carbohydrate-high-fat (HF) and a low-carbohydrate-high-protein (HP) diet compared with an isocaloric high-carbohydrate (HC) diet. In a randomized, three-period cross-over study, twelve adults with insulin-pump-treated type 1 diabetes followed an HC (energy provided by carbohydrate: 48%, fat: 33%, protein: 19%), HF (19%, 62%, 19%), and an HP (19%, 57%, 24%) diet for one week. Glucose values were obtained during intervention periods using a Dexcom G6 continuous glucose monitoring system. Participant characteristics were: 33% females, median (range) age 50 (22–70) years, diabetes duration 25 (11–52) years, HbA1c 7.3 (5.5–8.3)% (57 (37–67) mmol/mol), and BMI 27.3 (21.3–35.9) kg/m2. Glycemic variability was lower with HF (30.5 ± 6.2%) and HP (30.0 ± 5.5%) compared with HC (34.5 ± 4.1%) (PHF-HC = 0.009, PHP-HC = 0.003). There was no difference between groups in mean glucose (HF: 8.7 ± 1.1, HP: 8.2 ± 1.0, HC: 8.7 ± 1.0 mmol/L, POverall = 0.08). Time > 10.0 mmol/L was lower with HP (22.3 ± 11.8%) compared with HF (29.4 ± 12.1%) and HC (29.5 ± 13.4%) (PHF-HP = 0.037, PHC-HP = 0.037). In conclusion, a one-week HF and, specifically, an HP diet improved glucose metrics compared with an isocaloric HC diet. [ABSTRACT FROM AUTHOR]

Context Current guidelines for exercise-related glucose management focus on reducing bolus and/or basal insulin doses and considering carbohydrate intake. Yet far less attention has been paid to the potential role of other macronutrients alongside carbohydrates on glucose dynamics around exercise. Objective To investigate the effects of a low-carbohydrate-high-protein (LCHP) compared with a high-carbohydrate-low-protein (HCLP) pre-exercise meal on the metabolic, hormonal, and physiological responses to exercise in adults with insulin pump–treated type 1 diabetes. Methods Fourteen adults (11 women, 3 men) with insulin pump–treated type 1 diabetes (median [range] HbA1c of 50 [43-59] mmol/mol (6.7% [6.1%-7.5%]), age of 49 [25-65] years, and body mass index of 24.0 [19.3-27.1] kg/m2) completed an unblinded, 2-arm, randomized, crossover study. Participants ingested isocaloric meals that were either LCHP (carbohydrate 21%, protein 52%, fat 27%) or HCLP (carbohydrate 52%, protein 21%, fat 27%) 90 minutes prior to undertaking 45 minutes of cycling at moderate intensity. Meal insulin bolus was dosed according to meal carbohydrate content but reduced by 25%. Basal insulin rates were reduced by 35% from meal ingestion to end of exercise. Results Around exercise the coefficient of variability was lower during LCHP (LCHP: 14.5 ± 5.3 vs HCLP: 24.9 ± 7.7%, P =.001). Over exercise, LCHP was associated with a lesser drop (LCHP: Δ−1.49 ± 1.89 vs HCLP: Δ−3.78 ± 1.95 mmol/L, P =.001). Mean insulin concentration was 30% lower during exercise for LCHP compared with HCLP (LCHP: 25.5 ± 11.0 vs HCLP: 36.5 ± 15.9 mU/L, P <.001). Conclusion Ingesting a LCHP pre-exercise meal lowered plasma glucose variability around exercise and diminished the drop in plasma glucose over exercise. [ABSTRACT FROM AUTHOR]

› Regular physical activity optimizes cardiometabolic as well as musculoskeletal health and improves cognitive and psychosocial functioning in people with type 1 diabetes mellitus (T1DM). Physical activity and exercise should therefore be promoted for all people with T1DM. Unfortunately, people with T1DM often avoid engaging in sports activities because of concerns of hypoglycemia and metabolic fluctuations. They must consider a variety of factors when planning to exercise (insulin therapy, food intake, stress, time of day, etc.). › Pharmacological and technological innovations in recent years have made exercise easier for people with T1DM. For example, continuous glucose monitoring allows for better treatment decisions, taking current sensor glucose levels and trend arrows into account. Support from qualified and motivated diabetes teams and sports therapists/ trainers is needed to ensure that as many people with T1DM as possible benefit from the positive effects of sport and exercise. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Diabetes Mellitus (DM) is a main public health issue worldwide, with Egypt among the world’s top countries with diabetic patients. Data on the degree of selfcare behaviors of Egyptian diabetic patients is not fully reported. Therefore, the study aimed to assess the adequacy of diabetes self-management (DSM) habits among diabetic patients in Egypt and to identify associated socio-demographic factors that could negatively impact the patients’ glycemic state, using a structured questionnaire. SUBJECTS AND METHODS: This study was a cross-sectional observational study. The diabetes self-management questionnaire (DSMQ) was used to assess diabetes self-care activities, which is a 16-item questionnaire. The statistical analysis was conducted on SPSS software, and the data were significant with a p-value <0.05. RESULTS: A total of 2,164 participants were included. The majority of the patients (83.8%) had type 2 DM. The mean glycated hemoglobin (HbA1c) of the study group was 8.44±1.99. Significant differences were found between different glycemic control groups both in terms of the DSMQ sum scores and the subscale scores, with the exception of physical activity. Moreover, there was a significant weak inverse correlation between the total DSMQ sum score and HbA1c ≥9.0% (ρ=-0.116, p<0.01). The overall internal consistency (Cronbach’s alpha) was acceptable (0.756). CONCLUSIONS: The study indicated that patients with controlled blood glucose had significantly higher ‘glucose management’, and ‘total DSMQ sum’ scores compared to uncontrolled diabetic patients. All significant correlations between assessed parameters and DSMQ were weak. [ABSTRACT FROM AUTHOR]

Continuous glucose monitoring (CGM) systems are valuable for managing glucose levels. They provide insight into how glucose is affected by factors such as physical activity, drugs, and food intake. However, the lifetime of commercially implanted CGM sensors has been limited to around 15 days due to tissue rejection. As an important part of sensors, the outer membrane selection deters sensors' lifetime and in vivo stability. In this study, a biocompatible outer membrane based on the blending of Chronosil and HydroMed is developed and investigated on the glucose sensors. Results show that the sensors on non-diabetic beagles can work for at least 21 days with accurate results. This new material could extend the lifetime of implanted CGM sensors and improve in vivo stability, making them more useful for managing diabetes. [Display omitted] • The CGM sensors modified with HMD/CS blending outer membrane extend their lifetime to 21 days with acceptable in vivo stability. Their lifetime exceeds that of the commercial CGM electrochemical sensors, which only have a lifetime of 15 days. • The outer membrane is cheap and easy-accessible. • The outer membrane modification method is reproducible, cost-effective, and rapid for large-scale production. [ABSTRACT FROM AUTHOR]

Chronic pancreatitis results in permanent parenchymal destruction of the pancreas gland leading to anatomical and physiological consequences for patients. Surgical management varies, and some patients require total pancreatectomy with autologous islet cell transplantation (TPIAT). Patients undergoing TPIAT require complex and diligent management after surgery. This encompasses the management of glucose control (endocrine function of the pancreas) and supplementing loss of exocrine function of the pancreas with digestive enzymes. Other areas of management include optimizing pain relief while reducing narcotic usage, providing antimicrobial prophylaxis, and reducing loss of islet cells by improving its integrity through anticoagulation and use of anti-inflammatory agents. Each aspect of care is unique to this population. However, comprehensive reviews on its pharmacological management are scarce. This review will discuss the available literature to date surrounding all aspects of pharmacological management of patients undergoing TPIAT. [ABSTRACT FROM AUTHOR]

Copyright of Wiener Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to. Aim: To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values. Methods: We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS‐team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10 mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3 months. Results: None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1 group, 50% and in the AGS2 group, 53% were appropriately managed (p <.001). The events of hyperglycaemia (CPG >7.8 mmol/L at least twice) and of severe hyperglycaemia (CPG >10 mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications. Conclusions: AGS intervention significantly improves adherence to guidelines and glucose values. [ABSTRACT FROM AUTHOR]

Copyright of Nosileftiki is the property of Hellenic Nurses' Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetes is a chronic metabolic disorder that affects an estimated 463 million people worldwide. Aiming to improve the treatment of people with diabetes, digital health has been widely adopted in recent years and generated a huge amount of data that could be used for further management of this chronic disease. Taking advantage of this, approaches that use artificial intelligence and specifically deep learning, an emerging type of machine learning, have been widely adopted with promising results. In this paper, we present a comprehensive review of the applications of deep learning within the field of diabetes. We conducted a systematic literature search and identified three main areas that use this approach: diagnosis of diabetes, glucose management, and diagnosis of diabetes-related complications. The search resulted in the selection of 40 original research articles, of which we have summarized the key information about the employed learning models, development process, main outcomes, and baseline methods for performance evaluation. Among the analyzed literature, it is to be noted that various deep learning techniques and frameworks have achieved state-of-the-art performance in many diabetes-related tasks by outperforming conventional machine learning approaches. Meanwhile, we identify some limitations in the current literature, such as a lack of data availability and model interpretability. The rapid developments in deep learning and the increase in available data offer the possibility to meet these challenges in the near future and allow the widespread deployment of this technology in clinical settings. [ABSTRACT FROM AUTHOR]

Background and objective Hyperglycemia following a stroke can independently aggravate the ischemic area. Ensuring adequate glucose management can help avoid complications and minimize mortality and disability in these patients. This study aimed to investigate hyperglycemic patterns in acute stroke patients. Materials and methods We conducted a non-interventional prospective observational study involving acute stroke patients by employing continuous glucose monitoring (CGM) for 72 hours after the onset of stroke symptoms. Admission glucose, patients' total mean glucose (TMG), and time in range (TIR) (70-140 mg/dl) were correlated with the hyperglycemic patterns elicited by the CGM system software. Data were analyzed using SPSS Statistics 26.0 (IBM Corp., Armonk, NY) with descriptive statistics, the Kruskal-Wallis test, and χ2 test. Results Our cohort comprised 105 diabetic and non-diabetic stroke patients. The hyperglycaemic patterns that we observed were as follows: (i) hyperglycemia from 23:00 to 10:00, (ii) 06.00 to 10.00, (iii) at night and after meals, iv) no pattern, v) unspecified patterns. Patients with nocturnal and morning hyperglycemia had admission glucose of 183 mg/dl, mean 72-hour glucose of 156 mg/dl, and TIR of 37%. Patients who did not develop a hyperglycemic pattern either had admission glucose of 131 mg/dl and TIR of 89% or had high admission glucose (197 mg/dl) and a short TIR (14%). Conventional pre-meal capillary glucose tests do not appear to detect these patients' hyperglycemic tendencies. Conclusions These results may indicate the necessity for more intensive measurements during the night or dawn in this patient population. Admission glucose could be considered a predictor of hyperglycemic patterns and contribute to the patient's care plan., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Aristotle University Medical Ethics Committee issued approval 29/7/2020/6.261. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fountouki et al.)

Objective : To investigate the status of perioperative blood glucose management in patients with diabetes under - going elective surgery in the Shanghai Ninth Peoples Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, and establish a hierarchical pharmaceutical care system for perioperative blood glucose management. Methods: The clinical data of patients with diabetes who underwent elective surgery from June 2018 to December 2018 in this hospital were retrospectively investigated, and then the classification criteria and main items of hierarchical pharmaceutical care system were deter - mined. Results: Of the 150 patients included in the study, 92 .7% of them were checked on fasting blood glucose at admission, and 32 A% of them were checked on HbAlc. The rates of preoperative and postoperative regular blood glucose monitoring accounted for 74 .7% and 74 .0%, respectively, and the rates of blood glucose-reaching the set standards 3 days before operation, during operation and 3 days after operation were 68 .8%, 86 .2% and 56 ，respectively • The main problems occurred during perioperative blood glucose management included : failure to adjust dosage of insulin promptly, persistent use of oral hypoglycemic drugs during perioperative period，and lack of regular hypoglycemic treatment for perioperative hyperglycemia. The pharmaceutical care of diabetic patients during perioperative period was divided into three levels，and the main items of pharmaceutical care were determined according to the defects of clinical blood glucose management and the needs of patients. Conclusion: In perioperative management of diabetic patients，perioperative blood glucose monitoring, rational use of insulin, medication education of patients should be further strengthened • Based on the current status of blood glucose management，the establishment of a hierarchical pharmaceutical care system applied during perioperative period could help to improve the work efficiency of clinical pharmacists, and at the same time would offer better pharmaceutical care for patients. [ABSTRACT FROM AUTHOR]

Introduction: Type 1 diabetes (T1D) is a chronic condition characterized by a complete deficiency in insulin production. Optimal management requires constant knowledge of glucose levels for safe and effective insulin administration. Self-monitoring of blood glucose (SMBG) using capillary blood glucose meters is cumbersome and provides limited information to guide management. Continuous glucose monitoring (CGM) technology addresses many of these gaps, but itself has limitations which have prevented people with diabetes and their clinicians from fully embracing this technology. This review covers the benefits and limitations of CGM use, and looks toward future application of this technology in the management of T1D. Areas covered: Impact of CGM on physical and psychosocial outcomes in people with T1D. Barriers to CGM uptake. Integration with insulin pumps and other technologies. Opportunities for future application. Expert opinion: CGM technology will be utilized by the majority of people with T1D and increasing numbers of people with type 2 diabetes due to improved insurance coverage and easier-to-use systems. Its use as part of artificial pancreas systems will add further utility, as it will help to protect from both hypoglycemia and hyperglycemia. People with diabetes will spend more time in range and experience fewer acute and chronic complications. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus prevalence is increasing among adults and children around the world. Diabetes care is complex; examining the diet, type of medication, diabetes recognition, and willingness to use self-management tools are just a few of the challenges faced by diabetes clinicians who should make decisions about them. Making the appropriate decisions will reduce the cost of treatment, decrease the mortality rate of diabetes, and improve the life quality of patients with diabetes. Effective decision-making is within the realm of multicriteria decision-making (MCDM) techniques., Objective: The central objective of this study is to evaluate the effectiveness and applicability of MCDM methods and then introduce a novel categorization framework for their use in this field., Methods: The literature search was focused on publications from 2003 to 2023. Finally, by applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method, 63 articles were selected and examined., Results: The findings reveal that the use of MCDM methods in diabetes research can be categorized into 6 distinct groups: the selection of diabetes medications (19 publications), diabetes diagnosis (12 publications), meal recommendations (8 publications), diabetes management (14 publications), diabetes complication (7 publications), and estimation of diabetes prevalence (3 publications)., Conclusions: Our review showed a significant portion of the MCDM literature on diabetes. The research highlights the benefits of using MCDM techniques, which are practical and effective for a variety of diabetes challenges., (©Tahmineh Aldaghi, Jan Muzik. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 01.02.2024.)

Background The complications of type 2 diabetes mellitus (T2DM) continue to cause significant morbidity and mortality, resulting in a substantial economic burden on both individual patients and society. The adoption of self-care practices leads to enhanced glycemic control, decreased complications, and an elevated quality of life. This study aimed to examine self-care activities and their association with glycemic control among individuals with diabetes. Materials and methods A cross-sectional study was conducted, involving 150 previously diagnosed T2DM patients who visited the tertiary care hospital in Perambalur, Tamilnadu, India, from March 2023 to May 2023. The collection of data involved conducting a semi-structured interview using the diabetes self-management questionnaire (DSMQ) over an eight-week period. Following the input of the data into MS Excel (Microsoft® Corp., Redmond, WA), SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp) was used for data analysis. Results The mean age of the patients was 58.35±11.97 years, and 54.7% (n=82) of them were male. Nearly 65% of diabetic patients (n=98) were on orally administered antihyperglycemic agents. Fifty-nine percent (n=89) of the patients were observed to possess self-care behaviors that met the criteria for adequacy, as the DSMQ scores were dichotomized into "adequate" (≥6) and "inadequate" (<6) categories. We observed that 65% (n=98) of the patients had uncontrolled T2DM, characterized by an HbA1C level above 7.5%. Out of the four subscales of self-care behaviors assessed in this study, "glucose management" scored the highest (5.27±1.30), followed by "dietary control" (5.09±1.53), "healthcare use" (4.86±1.50), and "physical activity" (3.27±1.42). The proportion of diabetic patients who had adequate self-management (55%, n=49) had better glycemic control compared to diabetic patients who had inadequate self-management (4.91%, n=3), and this difference in proportion was statistically significant by the chi-square test (p-value 0.001). Similarly, a statistically significant association was noted between glycemic control and the subscales of DSMQ, namely glucose management, dietary control, physical activity, and healthcare utilization. Conclusion The findings in this study indicate that a noticeable proportion of T2DM patients practice inadequate self-care behaviors. According to the DSMQ, diabetic patients with adequate self-management had better glycemic control than diabetic patients with inadequate self-management. According to this research, patients with good glycemic control also tend to exercise better self-care management and show a greater concern for their illness., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Muniyapillai et al.)

Purpose Of Review: The protection against CVD observed in women compared to men in the general population is essentially erased in type 1 diabetes. This review will discuss evidence regarding the role of glucose management on CVD risk by sex, with a particular focus on studies of long-duration type 1 diabetes of > 20 years.Recent Findings: Across studies, women with type 1 diabetes have similar or worse glycemic control compared to men, despite higher rates of intensive insulin therapy. The association between HbA1c and CVD risk does not seem to differ by sex, but few studies have reported on sex-specific analyses. Beyond HbA1c, there is a lack of published data regarding the relationship between other aspects of glucose management and CVD risk by sex in type 1 diabetes. Glucose management factors do not seem to directly account for the increased CVD risk in women with type 1 diabetes, but may influence other risk factors that play a more direct role. [ABSTRACT FROM AUTHOR]

Context: Current guidelines for exercise-related glucose management focus on reducing bolus and/or basal insulin doses and considering carbohydrate intake. Yet far less attention has been paid to the potential role of other macronutrients alongside carbohydrates on glucose dynamics around exercise., Objective: To investigate the effects of a low-carbohydrate-high-protein (LCHP) compared with a high-carbohydrate-low-protein (HCLP) pre-exercise meal on the metabolic, hormonal, and physiological responses to exercise in adults with insulin pump-treated type 1 diabetes., Methods: Fourteen adults (11 women, 3 men) with insulin pump-treated type 1 diabetes (median [range] HbA1c of 50 [43-59] mmol/mol (6.7% [6.1%-7.5%]), age of 49 [25-65] years, and body mass index of 24.0 [19.3-27.1] kg/m2) completed an unblinded, 2-arm, randomized, crossover study. Participants ingested isocaloric meals that were either LCHP (carbohydrate 21%, protein 52%, fat 27%) or HCLP (carbohydrate 52%, protein 21%, fat 27%) 90 minutes prior to undertaking 45 minutes of cycling at moderate intensity. Meal insulin bolus was dosed according to meal carbohydrate content but reduced by 25%. Basal insulin rates were reduced by 35% from meal ingestion to end of exercise., Results: Around exercise the coefficient of variability was lower during LCHP (LCHP: 14.5 ± 5.3 vs HCLP: 24.9 ± 7.7%, P = .001). Over exercise, LCHP was associated with a lesser drop (LCHP: Δ-1.49 ± 1.89 vs HCLP: Δ-3.78 ± 1.95 mmol/L, P = .001). Mean insulin concentration was 30% lower during exercise for LCHP compared with HCLP (LCHP: 25.5 ± 11.0 vs HCLP: 36.5 ± 15.9 mU/L, P < .001)., Conclusion: Ingesting a LCHP pre-exercise meal lowered plasma glucose variability around exercise and diminished the drop in plasma glucose over exercise., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Lipohypertrophy is a common skin complication associated with insulin-treated diabetes. The impact of lipohypertrophy as a contributing factor to suboptimal glycemic control, glucose variability, and hypoglycemia is often under-recognized by health care professionals. In a recent Webinar on April 26, 2023, Diabetes Technology Society asked international experts to provide updates on the latest knowledge related to lipohypertrophy for practicing clinicians and educators, researchers, and industries involved in insulin delivery. A recording of the Webinar is freely available on the Diabetes Technology Society Web site (https://www.diabetestechnology.org/)., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: L.H. is a consultant for a number of companies that are developing novel diagnostic and therapeutic options for diabetes treatment. He is a shareholder of the Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany. D.K. has received remuneration for participation in Advisory Boards from Sanofi, Novo Nordisk, and Abbott Diabetes Care. He also has received research support from Novo Nordisk and Abbott Diabetes Care and has financial interests in Glooko, Proteomics, Better Therapeutics, Hi.Health, and SNAQ. D.C.K. is a consultant to Better, Eoflow, Integrity, Lifecare, Nevro, Novo, Sanofi, and Thirdwayv.T.T., R.E.A., J.H., A.M.Y., J.S., S.G., A.F., and J.J.S. have no relevant discloses.

Background: Model predictive control (MPC) has become one of the most popular control strategies for automated insulin delivery (AID) in type 1 diabetes (T1D). These algorithms rely on a prediction model to determine the best insulin dosing every sampling time. Although these algorithms have been shown to be safe and effective for glucose management through clinical trials, managing the ever-fluctuating relationship between insulin delivery and resulting glucose uptake (aka insulin sensitivity, IS) remains a challenge. We aim to evaluate the effect of informing an AID system with IS on the performance of the system., Method: The University of Virginia (UVA) MPC control-based hybrid closed-loop (HCL) and fully closed-loop (FCL) system was used. One-day simulations at varying levels of IS were run with the UVA/Padova T1D Simulator. The AID system was informed with an estimated value of IS obtained through a mixed meal glucose tolerance test. Relevant controller parameters are updated to inform insulin dosing of IS. Performance of the HCL/FCL system with and without information of the changing IS was assessed using a novel performance metric penalizing the time outside the target glucose range., Results: Feedback in AID systems provides a certain degree tolerance to changes in IS. However, IS-informed bolus and basal dosing improve glycemic outcomes, providing increased protection against hyperglycemia and hypoglycemia according to the individual's physiological state., Conclusions: The proof-of-concept analysis presented here shows the potentially beneficial effects on system performance of informing the AID system with accurate estimates of IS. In particular, when considering reduced IS, the informed controller provides increased protection against hyperglycemia compared with the naïve controller. Similarly, reduced hypoglycemia is obtained for situations with increased IS. Further tailoring of the adaptation schemes proposed in this work is needed to overcome the increased hypoglycemia observed in the more resistant cases and to optimize the performance of the adaptation method., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.M-.V. receives research support and royalties through her institution from Dexcom. C.F. receives royalties from Dexcom and Novo Nordisk managed through her institution. M.D.B. receives research support through his institution from Tandem, Dexcom, and Novo Nordisk; M.D.B. received honorarium and travel compensation from Sanofi and Tandem; M.D.B. consults for Dexcom and Sanofi.

Background: Practice guidelines recommend against intensive insulin therapy in patients who are critically ill based on trials that had high rates of severe hypoglycemia. Intermountain Healthcare uses a computerized IV insulin protocol that allows choice of blood glucose (BG) targets (80-110 vs 90-140 mg/dL) and has low rates of severe hypoglycemia. We sought to study the effects of BG target on mortality in adult patients in cardiac ICUs that have very low rates of severe hypoglycemia.Methods: Critically ill patients receiving IV insulin were treated with either of two BG targets (80-110 vs 90-140 mg/dL). We created a propensity score for BG target using factors thought to have influenced clinicians' choice, and then we performed a propensity score-adjusted regression analysis for 30-day mortality.Results: There were 1,809 patients who met inclusion criteria. Baseline patient characteristics were similar. Median glucose was lower in the 80-110 mg/dL group (104 vs 122 mg/dL, P < .001). Severe hypoglycemia occurred at very low rates in both groups (1.16% vs 0.35%, P = .051). Unadjusted 30-day mortality was lower in the 80-110 mg/dL group (4.3% vs 9.2%, P < .001). This remained after propensity score-adjusted regression (OR, 0.65; 95% CI, 0.43-0.98; P = .04).Conclusions: Tight glucose control can be achieved with low rates of severe hypoglycemia and is associated with decreased 30-day mortality in a cohort of largely patients in cardiac ICUs. Although such findings should not be used to guide clinical practice at present, the use of tight glucose control should be reexamined using a protocol that has low rates of severe hypoglycemia. [ABSTRACT FROM AUTHOR]

The article presents the European Association for Cardio-Thoracic Surgery (EACTS) guidelines on perioperative medication in adult cardiac surgery. Information is provided about antithrombotic treatment with anticoagulants and platelet inhibitors for prevention of thromboembolic complications, atrial fibrillation, drugs that inhibit the renin-angiotensin-aldosterone system, beta-blockers, dyslipidemia, ulcer prevention and use of steroids in patients undergoing coronary artery bypass grafting.