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The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the technology behind glucose monitoring, and its role in glucose-responsive integrated technology that is feasible with the use of automated insulin delivery (AID) systems in children and adolescents. [ABSTRACT FROM AUTHOR]

Purpose: Pancreatectomy patients often experience challenging fluctuations in blood glucose levels; therefore, they require a reliable monitoring system. This study aimed to determine the accuracy and acceptability of a continuous glucose monitoring (CGM) system compared with the intermittent capillary glucose test in patients who have undergone pancreatectomy. Methods: Thirty non-diabetic pancreatectomy patients participated. We used the FreeStyle Libre Flash Glucose Monitoring System (Abbott Diabetes Care) for continuous interstitial glucose monitoring. Capillary reference glucose levels were checked four times daily. Accuracy was checked using the Clarke Error Grid. Results: The mean age of the participants was 56.8 ± 12.0 years, of whom 61.3% underwent pancreaticoduodenectomy and 38.7% underwent distal pancreatectomy. Three patients developed pancreatogenic diabetes after pancreatectomy. The clinical accuracy of continuous glucose monitoring compared with capillary glucose was 43.9% in Zone A (clinically accurate zone) and 99.8% in Zone A + B (low risk of error) of the Clarke Error Grid. No device-related adverse events were reported. Patients rated favorable user acceptability on the questionnaire. Conclusion: This pilot study demonstrated that the CGM device is accurate and safe for patients who underwent pancreatectomy, with favorable user acceptability. Despite these challenges, the study proposes that the CGM device is beneficial for monitoring glucose levels after discharge in patients with impaired glucose levels following pancreatectomy. [ABSTRACT FROM AUTHOR]

Purpose: We report important steps on the way to non-invasive glucose measuring. Methods: We developed a measurement system composed of a light source, three wavelength specific detectors, and a motor that allows the thickness of the irradiated tissue to be changed in a targeted manner. Results: We achieved very good correlation of glucose concentration in water and transmission ratios; in addition, we could monitor blood flow dependent transmission curves. Conclusions: By "marrying" the two measurements (glucose in water; blood flow dependent transmission curves) as a next and final step we hope to clear the way to non-invasive glucose measuring. [ABSTRACT FROM AUTHOR]

The Diabetes and Ramadan Risk Calculator, developed in 2021, is a pivotal tool for assessing fasting-related risks among patients with diabetes. This ground-breaking innovation offers a quantitative assessment of risk scores during fasting, revolutionizing the landscape of diabetes management during Ramadan. Many components assessed by the calculator are amenable to modification, presenting an opportunity for year-round intervention to mitigate risk scores and subsequent fasting risks. By targeting modifiable risk factors and adapting strategies over time, individuals with diabetes can proactively diminish their fasting-related risks, safeguarding their physical well-being and spiritual engagement and potentially improving their overall diabetes control. This review aims to elucidate the evolution of the strategies for addressing modifiable risk factors, reducing risk scores and levels, and ensuring safe fasting practices. [ABSTRACT FROM AUTHOR]

Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) exhibit an elevated risk for cardiac arrhythmias, such as bradycardia, which may potentially lead to sudden cardiac death (SCD). While hypoglycemia, defined as a critical drop in glucose levels below the normal range, has long been associated with adverse cardiovascular events, recent studies have highlighted the need for a comprehensive reevaluation of its direct impact on cardiovascular outcomes, particularly in high-risk populations such as those with DM and CKD. In this study, we investigated the association between glucose levels and bradycardia by simultaneously monitoring interstitial glucose (IG) and ECG for 7 days in insulin-treated patients with DM and CKD. We identified bradycardia episodes in 19 of 85 patients (22%) and associated these episodes with personalized low, medium, and high relative glucose levels. Our analysis revealed a significant increase in bradycardia frequency during periods of lowest relative glucose, particularly between 06:00-09:00 and 12:00-15:00. Furthermore, leveraging a Random Forests classifier, we achieved a promising area under the curve (AUC) of 0.94 for predicting bradyarrhythmias using glucose levels and heart rate variability features. Contrary to previous findings, only 4% of bradycardia episodes in our study population occurred at glucose levels of 70 mg/dL or lower, with 28% observed at levels exceeding 180 mg/dL. Our findings not only highlight the strong correlation between relative glucose levels, heart rate parameters, and bradycardia onset but also emphasize the need for a more personalized definition of hypoglycemia to understand its relationship with bradyarrhythmias in high-risk DM and CKD patient populations. [ABSTRACT FROM AUTHOR]

A highly sensitive non-enzymatic absorption-based glucose sensor is introduced that combines ZnO nanorods with the ferrous oxidation-xylenol orange (FOX) assay. ZnO nanorods were successfully synthesized on the surface of a copper wire mesh, exhibiting high crystallinity, purity, and a large surface area. The glucose sensor displays a high sensitivity of 0.394 mM−1 in a wide linear detection range (0 − 6 mM), along with a low limit of detection of 0.25 mM. The proposed assay has an excellent selectivity towards glucose compared with other sugars such as sucrose, maltose, and fructose. The potential use of the non-enzymatic absorbance sensor for diabetes monitoring is demonstrated by measuring the glucose concentration in human blood serum, obtaining values that are consistent with clinical analysis. [ABSTRACT FROM AUTHOR]

Background and Aims: There has been an evolving trend in the use of intermittently scanned continuous glucose monitoring (isCGM) among individuals with type 1 diabetes. Although isCGM is proven to be beneficial in the treatment of individuals with type 1 diabetes, its use leads to increasing device costs. This study aimed to investigate the long-term cost-effectiveness of isCGM. Methods: Long-term clinical outcomes and costs were projected using the IQVIA Core Diabetes Model (v10.0) based on the observed real-world outcomes of isCGM. The clinical input data for the analysis were sourced from a real-world patient cohort from Eastern Finland, including 877 adult individuals with type 1 diabetes with isCGM (i.e., Freestyle Libre 1 and 2). At the baseline, the patients' mean age was 48 years, and the mean duration of diabetes was 25.8 years. The mean baseline HbA1c was 8.6%, and the mean 12-month change from baseline in HbA1c was −0.37% after the initiation of isCGM. The cost-effectiveness analysis was performed over a lifetime time horizon. A discount rate of 3% was used for the future costs and health outcomes. Results: The projected use of isCGM was associated with improved quality-adjusted life year (QALY) expectancy of 0.84 QALYs after the start of isCGM. The direct lifetime costs were 7861 EUR higher with the use of isCGM, which resulted in an incremental cost-effectiveness ratio of 9396 EUR per QALY gained. Conclusions: According to the present analysis, the use of isCGM is considered cost-effective in adult individuals with type 1 diabetes in a real-world setting in Finland. [ABSTRACT FROM AUTHOR]

The management of diabetes mellitus has undergone remarkable progress with the introduction of cutting-edge technologies in glucose monitoring and artificial pancreas systems. These innovations have revolutionized diabetes care, offering patients more precise, convenient, and personalized management solutions that significantly improve their quality of life. This review aims to provide a comprehensive overview of recent technological advancements in glucose monitoring devices and artificial pancreas systems, focusing on their transformative impact on diabetes care. A detailed review of the literature was conducted to examine the evolution of glucose monitoring technologies, from traditional invasive methods to more advanced systems. The review explores minimally invasive techniques such as continuous glucose monitoring (CGM) systems and flash glucose monitoring (FGM) systems, which have already been proven to enhance glycemic control and reduce the risk of hypoglycemia. In addition, emerging non-invasive glucose monitoring technologies, including optical, electrochemical, and electro-mechanical methods, were evaluated. These techniques are paving the way for more patient-friendly options that eliminate the need for frequent finger-prick tests, thereby improving adherence and ease of use. Advancements in closed-loop artificial pancreas systems, which integrate CGM with automated insulin delivery, were also examined. These systems, often referred to as "hybrid closed-loop" or "automated insulin delivery" systems, represent a significant leap forward in diabetes care by automating the process of insulin dosing. Such advancements aim to mimic the natural function of the pancreas, allowing for better glucose regulation without the constant need for manual interventions by the patient. Technological breakthroughs in glucose monitoring and artificial pancreas systems have had a profound impact on diabetes management, providing patients with more accurate, reliable, and individualized treatment options. These innovations hold the potential to significantly improve glycemic control, reduce the incidence of diabetes-related complications, and ultimately enhance the quality of life for individuals living with diabetes. Researchers are continually exploring novel methods to measure glucose more effectively and with greater convenience, further refining the future of diabetes care. Researchers are also investigating the integration of artificial intelligence and machine learning algorithms to further enhance the precision and predictive capabilities of glucose monitoring and insulin delivery systems. With ongoing advancements in sensor technology, connectivity, and data analytics, the future of diabetes care promises to deliver even more seamless, real-time management, empowering patients with greater autonomy and improved health outcomes. [ABSTRACT FROM AUTHOR]

Diabetes management is critical for a vast population worldwide, and traditional blood glucose monitoring methods typically require invasive blood sampling, leading to patient discomfort and poor adherence. This study proposes the development of a non-invasive breath-based glucose monitoring system that leverages gas sensors to detect specific volatile organic compounds (VOCs) in exhaled breath, particularly acetone, which correlates with blood glucose levels. The system will utilize metal oxide semiconductor (MOS) sensors and machine learning algorithms to provide accurate real-time glucose readings. By eliminating the need for finger pricks, this innovative device aims to enhance the convenience and compliance of glucose monitoring for diabetic patients, ultimately contributing to better disease management and quality of life. The feasibility, accuracy, and usability of the system will be validated through clinical trials, paving the way for future advancements in diabetes care technologies. [ABSTRACT FROM AUTHOR]

Ruoxuan Zheng,1,2 Xiangman Zeng,1 Ruiting Shen,1 Yueqiu Wang,1 Jing Liu,1,3 Mingchen Zhang1 1Department of Endocrinology and Metabolism, Ningbo No.2 hospital, Ningbo, Zhejiang Province, People’s Republic of China; 2School of Medicine, Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China; 3Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang Province, People’s Republic of ChinaCorrespondence: Mingchen Zhang, Department of Endocrinology and Metabolism, Ningbo No.2 hospital, Ningbo, Zhejiang Province, People’s Republic of China, Email zhangmc1015@163.comPurpose: To identify the key populations for Hospital Hyperglycemia (HH) management and to assess recent trends in the management of HH.Patients and Methods: This retrospective study analyzed 1,136,092 point-of-care blood glucose (POC-BG) measurements from 40,758 patients with HH in non-intensive care unit (non-ICU) wards at Ningbo No.2 hospital from January 2020 to December 2022. We compared glucose monitoring and management across varying years, age groups, and hospital departments.Results: The overall incidence of HH was 16.87%. From 2020 to 2022, the number of patients with HH increased from 9,893 to 15,639, accompanied by a marginal improvement in average BG levels (slope difference, − 8.137E-09 [CI, − 8.742E-09 to − 7.531E-09]; p < 0.001). In the ≥ 80 years group, the median BG was 9.4 mmol/L, significantly higher than in other age groups (p< 0.001). Hypoglycemia in this group was most frequently detected during nighttime and bedtime, with an incidence of 2.67%, significantly higher than at other times of the day (p< 0.001). The daily POC-BG testing rate was significantly higher in the medical ward group than it in the surgical ward group (57.9% vs 51.7%, p< 0.05). Proportions of glycemic targets days were 35.66% and 39.90% in the medical wards on day 1 and day 7, respectively (Day 7 39.90% vs Day 1 35.66%, p> 0.05), and 46.16% and 45.07% in the surgical wards (Day 7 45.07% vs Day 1 46.16%, p> 0.05), showing no significant improvements in glycemic control. Endocrinology consultations occurred at rates of 14.2% in the medical wards and 14.9% in the surgical wards (p> 0.05).Conclusion: Although the prevalence of HH is consistently high and the number of affected patients continues to rise, modest improvements in glycemic management have been observed. However, control among the elderly remains poor, with a notably high risk of hypoglycemia during nighttime and bedtime periods.Keywords: hyperglycemia, glycemic management, glucose monitoring, hospitalization, diabetes mellitus

Mauriac syndrome (MS) is an exceptionally rare disorder occurring in poorly controlled Type-1 diabetic patients. The consequences include dwarfism, obesity, hepatomegaly, delayed puberty, growth failure and higher levels of transaminase enzyme. We report a case of an adolescent female with classical features of Mauriac syndrome.

During the past 8 years, a large number of reports have appeared on allergic contact dermatitis to glucose sensors and insulin pumps in paediatric and adult patients with type 1 diabetes mellitus. Isobornyl acrylate in one particular sensor sensitised many hundreds of (published) individuals, and many other allergens were discovered in a large number of sensors and pumps. Diagnostic procedures with patch tests proved very complicated, as manufacturers showed a serious lack of cooperation with dermatologists in providing information on the ingredients of their products and samples for patch testing. This two‐part article provides a full and detailed review of all aspects of the subject of allergic contact dermatitis to glucose sensors and insulin pumps. Part 1 begins with a general introduction to sensors and pumps, followed by the cutaneous adverse reactions that they have caused and a full account of the allergens in the diabetes devices. In addition, an overview of the glucose sensors and insulin pumps that have caused allergic contact dermatitis is presented. Part 2 presents all published case reports and case series, clinical features of allergic contact dermatitis to sensors and pumps, patch test procedures, differentiation from irritant dermatitis, management of allergic patients and (proposed) legislation. [ABSTRACT FROM AUTHOR]

Background: The risk of developing a state of low energy availability (LEA) (<30 kcals/kg free-fat mass) in endurance athletes is known and recommendations for nutrition are available. However, information on male adolescent cyclists and the influence of hot temperatures is limited. Objectives: The aim of this study was to investigate the impact on energy availability of two 4-day nutritional intervention strategies: (1) supplementary carbohydrate (CHO) intake during exercise and (2) designing and implementing individual nutritional interventions. Methods: Each intervention was preceded by a 4-day basal assessment. Eight competitive male junior road cyclists (aged 16–17 years) were investigated using a 4-day diet and activity records, alongside bioelectric impedance analysis. Their real-time power output, interstitial glucose, and temperature were recorded via sensors and a bike computer. Their energy intake (EI) was estimated from daily, self-reported food diaries. Results: Overall, 100% and 71% of the cyclists were in a state of LEA during the baseline assessment of the supplementary CHO and nutritional interventions, respectively. LEA prevalence, not modified by supplementary CHO intake alone (from 100% to 87%, ns), was markedly reduced by the individual nutritional intervention (from 71% to 14%, p < 0.05). When considering all the data as a whole, LEA was positively influenced by the training load (OR 1.06; 95% Cl 1.03 to 1.09) and free-fat mass (OR 1.46; 1.04 to 2.04) and was negatively affected by EI (OR 0.994; 0.991 to 0.997). A hot environment (air temperature) failed to influence the LEA or glucose dynamics. Conclusions: the nutritional intervention, but not the supplementary CHO intake, markedly reduced the prevalence of LEA in adolescents, who often fail to match their energy expenditure with their energy intake during the competitive season. Nutritional education is essential for adolescent endurance cycling teams. [ABSTRACT FROM AUTHOR]

This review provides a comprehensive overview of point-of-care (PoC) devices across several key diagnostic applications, including blood analysis, infectious disease detection, neural interfaces, and commercialized integrated circuits (ICs). In the blood analysis section, the focus is on biomarkers such as glucose, dopamine, and aptamers, and their respective detection techniques. The infectious disease section explores PoC technologies for detecting pathogens, RNA, and DNA, highlighting innovations in molecular diagnostics. The neural interface section reviews advancements in neural recording and stimulation for therapeutic applications. Finally, a survey of commercialized ICs from companies such as Abbott and Medtronic is presented, showcasing existing PoC devices already in widespread clinical use. This review emphasizes the role of complementary metal-oxide-semiconductor (CMOS) technology in enabling compact, efficient diagnostic systems and offers insights into the current and future landscape of PoC devices. [ABSTRACT FROM AUTHOR]

Diabetes currently affects approximately 500 million people worldwide and is one of the most common causes of mortality in the United States. To diagnose and monitor diabetes, finger-prick blood glucose testing has long been used as the clinical gold standard. For diabetes treatment, insulin is typically delivered subcutaneously through cannula-based syringes, pens, or pumps in almost all type 1 diabetic (T1D) patients and some type 2 diabetic (T2D) patients. These painful, invasive approaches can cause non-adherence to glucose testing and insulin therapy. To address these problems, researchers have developed miniaturized blood glucose testing devices as well as microfluidic platforms for non-invasive glucose testing through other body fluids. In addition, glycated hemoglobin (HbA1c), insulin levels, and cellular biomechanics-related metrics have also been considered for microfluidic-based diabetes diagnosis. For the treatment of diabetes, insulin has been delivered transdermally through microdevices, mostly through microneedle array-based, minimally invasive injections. Researchers have also developed microfluidic platforms for oral, intraperitoneal, and inhalation-based delivery of insulin. For T2D patients, metformin, glucagon-like peptide 1 (GLP-1), and GLP-1 receptor agonists have also been delivered using microfluidic technologies. Thus far, clinical studies have been widely performed on microfluidic-based diabetes monitoring, especially glucose sensing, yet technologies for the delivery of insulin and other drugs to diabetic patients with microfluidics are still mostly in the preclinical stage. This article provides a concise review of the role of microfluidic devices in the diagnosis and monitoring of diabetes, as well as the delivery of pharmaceuticals to treat diabetes using microfluidic technologies in the recent literature. [ABSTRACT FROM AUTHOR]

This work is devoted to studying and manufacturing a highly sensitive nonenzymatic glucose biosensing system of metal oxides via the sol–gel technique. The X‐ray diffraction patterns of all the prepared samples confirm that the samples present hexagonal crystal lattice structures of ZnO and Ag–ZnO nanoparticles. Ultraviolet (UV) analysis of all the samples is carried out to evaluate the absorption of silver in the UV region for electrical and chronoamperometric analysis. The transmittance of all the samples is observed, and the maximum transmittance is 11% for 4% AgZnO. Fourier transform infrared spectroscopy reveal the functional group stretching and vibration of the particles at different wavelength ranges. Scanning electron microsocpy analysis reveals the grain size and morphology of the samples, which decrease with increasing doping agent. Chronoamperometric analysis of all the samples reveals that the value increases with time for the 4% doped sample. The sensing response is also observed and is enhanced with increasing temperature for the 4% doped sample. The sensing response of the samples coated with carbon fiber electrodes is assessed from −0.2 to +0.5 V at a scan rate of 50 mV s−1. [ABSTRACT FROM AUTHOR]

Nile tilapia Oreochromis niloticus is an important aquaculture species worldwide, and understanding its behavior and growth performance under variable culture conditions is essential for optimizing culture. Light as an environmental factor profoundly affects fish development, growth, food consumption, hormone secretion, and other life processes. This study investigated the effects of different light colors (blue, green, and red) on the stress response of individually reared Nile tilapia using a wireless biosensor system for real-time glucose monitoring. The biosensor system effectively measured glucose concentration (stress indicator) by enzymatic oxidation, allowing continuous monitoring of fish eyeball interstitial sclera fluid (EISF), providing longer and more accurate data. Air exposure and ammonia exposure were used as stressors, and stress responses were monitored under different light colors. Nile tilapia exhibited lower quiescent blood glucose levels, lower blood glucose elevations, and faster stress recovery under blue light. Green light induced more significant glucose elevations during acute physical stress, but showed similar fluctuations to blue light during chronic chemical stress, indicating potential benefits for fish welfare. In contrast, whether exposed to air or ammonia, red light induced large fluctuations in blood glucose levels, which may be detrimental to the fish. The study highlights the importance of light color in influencing stress responses and recovery in Nile tilapia, providing valuable insights for improving aquaculture practices and promoting fish welfare. [ABSTRACT FROM AUTHOR]

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programmes are being increasingly emphasised. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody-positive (IAb+) children and adults who are at risk of (confirmed single IAb+) or living with (multiple IAb+) early-stage (stage 1 and stage 2) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in non-specialised settings. To inform this monitoring, JDRF in conjunction with international experts and societies developed consensus guidance. Broad advice from this guidance includes the following: (1) partnerships should be fostered between endocrinologists and primary-care providers to care for people who are IAb+; (2) when people who are IAb+ are initially identified there is a need for confirmation using a second sample; (3) single IAb+ individuals are at lower risk of progression than multiple IAb+ individuals; (4) individuals with early-stage type 1 diabetes should have periodic medical monitoring, including regular assessments of glucose levels, regular education about symptoms of diabetes and DKA, and psychosocial support; (5) interested people with stage 2 type 1 diabetes should be offered trial participation or approved therapies; and (6) all health professionals involved in monitoring and care of individuals with type 1 diabetes have a responsibility to provide education. The guidance also emphasises significant unmet needs for further research on early-stage type 1 diabetes to increase the rigour of future recommendations and inform clinical care. [ABSTRACT FROM AUTHOR]

Abstract Non‐invasive biosensors have attracted attention for their potential to obtain continuous, real‐time physiological information through measurements of biochemical markers, such as one of the most important—glucose, in biological fluids. Although some optical sensing materials are used in non‐invasive devices for continuous glucose monitoring (CGM), surface or localized plasmon sensing material are seldom applied in CGM owing to modest sensitivity and bulk sensing apparatus. Herein, a metasurface (MGMSPR) biosensor based on the metasurface plasmon resonance chip modified with heterostructured Ti3C2 MXene−Graphene oxide (MG) is reported, which potentially enables ultra‐sensitive glucose detection. The sensor consists of a dual‐channel microfluidic device integrated with silver mirror enhanced MGMSPR chips. Not only does it promote the entry of glucose oxidase (GOD) into the internal pores and enhance the stable fixation of GOD in the membrane, but also the integration of MG material provides a high specific surface area and unique electronic properties, thereby significantly enhancing the sensitivity of the MGMSPR sensor. The detection limit of MGMSPR biosensor is 106.8 µM. This pioneering approach opens new avenues for monitoring physiological parameters and process analytical technology on an optical platform, providing continuous health monitoring and production process control through optical sensors.

BackgroundDisparities in Insulin Pump Use Among Spanish-Speaking Children With Type 1 Diabetes Compared to Their Non-Hispanic White Peers: Mixed Methods Study.ObjectiveWe aimed to investigate the use of insulin pumps and continuous glucose monitoring (CGM) devices among Spanish-language-preferring children in our clinic population and to identify specific barriers to technology use.MethodsFirst, we assessed rates and patterns of diabetes technology use (eg, insulin pumps and CGM devices) in a sample of 76 children (38 Spanish-language preferring and 38 non-Hispanic White). We compared rates of technology use, average length of time between diabetes diagnosis and initiation of insulin pump or CGM device, and rates of discontinuation of these devices between the Spanish-language-preferring and non-Hispanic White children. Second, to understand specific barriers to technology use, we compared responses to a questionnaire assessing decision-making about insulin pumps.ResultsSpanish-language-preferring patients had lower rates of insulin pump use, even after controlling for age, gender, age at diagnosis, and type of health insurance. Spanish-language-preferring participants were more likely to report concerns over learning to use an insulin pump and were more likely to discontinue using an insulin pump after starting one.ConclusionsThese data confirm demographic disparities in insulin pump use among children with T1D and provide new insights about insulin pump discontinuation among Spanish-language-preferring children. Our findings suggest a need for improved patient education about insulin pump technology in general and improved support for Spanish-language-preferring families with T1D after initiation of pump therapy.

Abstract Background Continuous glucose monitoring can improve glycemic control for hospitalized patients with diabetes, according to current evidence. However, there is a lack of consensus-established recommendations for the management of hospitalized patients with diabetes using flash continuous glucose monitoring system (fCGM) in Latin America. Therefore, this expert consensus exercise aimed to establish guidelines on the implementation of fCGM in the management of hospitalized patients with diabetes in Latin America. Methods The modified Delphi method was applied on a panel of nine specialists, establishing consensus at 80%. A twenty-two-question instrument was developed to establish recommendations on the use of fCGM in hospitalized patients living with diabetes. Results Based on consensus, experts recommend the use of fCGM in hospitalized patients with diabetes starting at admission or whenever hyperglycemia (> 180 mg/dl) is confirmed and continue monitoring throughout the entire hospital stay. The recommended frequency of fCGM scans varies depending on the patient's age and diabetes type: ten scans per day for pediatric patients with type 1 and 2 diabetes, adult patients with type 1 diabetes and pregnant patients, and seven scans for adult patients with type 2 diabetes. Different hospital services can benefit from fCGM, including the emergency room, internal medicine departments, intensive care units, surgery rooms, and surgery wards. Conclusions The use of fCGM is recommended for patients with diabetes starting at the time of admission in hospitals in Latin America, whenever the necessary resources (devices, education, personnel) are available.

Introduction: Type 1 diabetes mellitus (T1DM) is a chronic auto-immune disease in which loss of pancreatic islet β-cells leads to the deficiency of insulin in the body thus resulting in enhanced blood sugar levels. Effective blood glucose monitoring is crucial in T1DM management to prevent complications, particularly hypoglycemia. Method: The study adopted a cross-sectional survey to assess satisfaction and quality of life among T1DM patients using the freestyle libre continuous glucose monitoring (FSL-CGM), and a retrospective cohort study design to evaluate changes in HbA1c over a year. Result: The study involved 98 Saudi subjects, with 46.9% (n = 46) being male. The results indicated a high level of user satisfaction, with more than 85% of the participants responding positively, yielding a total satisfaction score of 30.86. User satisfaction with FSL-CGM was found to be significantly associated with the level of education. The use of FSL-CGM was also found to significantly improve the patients’ quality of life. However, the levels of HbA1c had an impact on both satisfaction and quality of life. Before using the FSL-CGM system, the mean HbA1c was 9.83%, which significantly decreased to 8.63% after using the system (P-value

Introduction: This study assessed experiences, attitudes, and behaviors of people with diabetes (PwD) regarding diabetes self-management and glucose control, and their level of awareness, knowledge, and attitudes toward time in range (TIR). Methods: This quantitative survey was conducted using an online questionnaire across seven countries. Respondents were PwD classified into three subgroups: type 1 (T1), type 2 insulin (T2 insulin), and type 2 not on insulin (T2 N/insulin). Results: Respondents included 621 people in the T1, 780 people in the T2 insulin, and 735 people in the T2 N/insulin subgroups. Awareness of TIR was low, particularly in the T2 N/insulin subgroup (T1 53%, T2 insulin 29%, T2 N/insulin 9%). Despite a lower current use of continuous glucose monitoring (CGM) among the T2 insulin and T2 N/insulin participants (38% and 9%, respectively), versus T1 participants (64%), most (> 70%) were positive toward utilizing new tools and measures to self-manage blood glucose. Recommendations from their healthcare professionals (HCPs) were cited as a strong motivator to try new measures for analyzing glucose levels. The main barriers cited were limited access to CGM and lack of understanding of TIR benefits. Cost was the main reason given by ≥ 40% of respondents for stopping CGM use. Conclusions: There is an unmet need in diabetes management, and TIR and CGM offer a potential solution. PwD are motivated to manage their blood glucose levels and are positive toward utilizing new tools and measures to achieve this goal. HCPs play a pivotal role in informing and guiding PwD on new measures for analyzing glucose. [ABSTRACT FROM AUTHOR]

Diabetes has emerged as a worldwide health crisis, affecting approximately 537 million adults. Maintaining blood glucose requires careful observation of diet, physical activity, and adherence to medications if necessary. Diet monitoring historically involves keeping food diaries; however, this process can be labor-intensive, and recollection of food items may introduce errors. Automated technologies such as food image recognition systems (FIRS) can make use of computer vision and mobile cameras to reduce the burden of keeping diaries and improve diet tracking. These tools provide various levels of diet analysis, and some offer further suggestions for improving the nutritional quality of meals. The current study is a systematic review of mobile computer vision-based approaches for food classification, volume estimation, and nutrient estimation. Relevant articles published over the last two decades are evaluated, and both future directions and issues related to FIRS are explored. [ABSTRACT FROM AUTHOR]

This study endeavored to design and develop an innovative closed-loop diagnostic and therapeutic system with the following objectives: (a) the noninvasive detection of glucose concentration in sweat utilizing nanonengineered screen-printed biosensors; (b) the management of measured data through a specialized computer system comprising both hardware and software components, thereby enabling the precise control of therapeutic responses via a patch-based nanomedicine delivery system. This initiative addresses the significant challenges inherent in the management of diabetes mellitus, including the imperative need for glucose-level monitoring to optimize glycemic control. Leveraging chronoamperometric results as a foundational dataset and the in vivo hypoglycemic activity of nanoemulsion formulations, this research underscores the efficacy and accuracy of glucose concentration estimation, decision-making mechanism responses, and transdermal hypoglycemic treatment effects, within the proposed system. [ABSTRACT FROM AUTHOR]

Hydrogel-based technologies have emerged as transformative tools in the management of diabetes, offering novel solutions in both drug delivery and diagnostic techniques. Diabetes, a chronic metabolic disorder characterized by elevated blood glucose levels, necessitates precise and consistent therapeutic interventions to mitigate its complications and improve patient outcomes. This abstract explores recent innovations in hydrogel applications tailored for diabetes care, focusing on advanced drug delivery systems and flexible diagnostic techniques. Hydrogels, three-dimensional networks of hydrophilic polymers capable of absorbing and retaining large amounts of water, exhibit properties that make them ideal candidates for biomedical applications. In drug delivery, hydrogels offer controlled release mechanisms that can mimic physiological conditions, enhancing the efficacy of therapeutics such as insulin and GLP-1 receptor agonists. Innovations in this area include stimuliresponsive hydrogels that release drugs in response to changes in glucose levels or other physiological cues, thereby improving glycemic control and patient compliance. Additionally, the development of injectable hydrogel formulations allows for sustained drug release, reducing the frequency of administrations and providing long-term therapeutic benefits. Furthermore, hydrogelbased diagnostic techniques have revolutionized diabetes management by enabling non-invasive and continuous monitoring of glucose levels. Hydrogel-based biosensors offer real-time monitoring capabilities, detecting glucose and other biomarkers through wearable devices or integrated patches. These sensors leverage the biocompatibility and flexibility of hydrogels to adhere comfortably to the skin, ensuring prolonged and accurate monitoring without the discomfort associated with traditional methods. Moreover, advancements in microneedle technology have facilitated minimally invasive glucose monitoring, with hydrogel-based microneedle patches capable of sampling interstitial fluid for glucose analysis. [ABSTRACT FROM AUTHOR]

Background: Continuous glucose monitoring can improve glycemic control for hospitalized patients with diabetes, according to current evidence. However, there is a lack of consensus-established recommendations for the management of hospitalized patients with diabetes using flash continuous glucose monitoring system (fCGM) in Latin America. Therefore, this expert consensus exercise aimed to establish guidelines on the implementation of fCGM in the management of hospitalized patients with diabetes in Latin America. Methods: The modified Delphi method was applied on a panel of nine specialists, establishing consensus at 80%. A twenty-two-question instrument was developed to establish recommendations on the use of fCGM in hospitalized patients living with diabetes. Results: Based on consensus, experts recommend the use of fCGM in hospitalized patients with diabetes starting at admission or whenever hyperglycemia (> 180 mg/dl) is confirmed and continue monitoring throughout the entire hospital stay. The recommended frequency of fCGM scans varies depending on the patient's age and diabetes type: ten scans per day for pediatric patients with type 1 and 2 diabetes, adult patients with type 1 diabetes and pregnant patients, and seven scans for adult patients with type 2 diabetes. Different hospital services can benefit from fCGM, including the emergency room, internal medicine departments, intensive care units, surgery rooms, and surgery wards. Conclusions: The use of fCGM is recommended for patients with diabetes starting at the time of admission in hospitals in Latin America, whenever the necessary resources (devices, education, personnel) are available. [ABSTRACT FROM AUTHOR]

Introduction: Type 1 diabetes mellitus (T1DM) is a chronic auto‑immune disease in which loss of pancreatic islet β‑cells leads to the deficiency of insulin in the body thus resulting in enhanced blood sugar levels. Effective blood glucose monitoring is crucial in T1DM management to prevent complications, particularly hypoglycemia. Method: The study adopted a cross‑sectional survey to assess satisfaction and quality of life among T1DM patients using the freestyle libre continuous glucose monitoring (FSL‑CGM), and a retrospective cohort study design to evaluate changes in HbA1c over a year. Result: The study involved 98 Saudi subjects, with 46.9% (n = 46) being male. The results indicated a high level of user satisfaction, with more than 85% of the participants responding positively, yielding a total satisfaction score of 30.86. User satisfaction with FSL‑CGM was found to be significantly associated with the level of education. The use of FSL‑CGM was also found to significantly improve the patients’ quality of life. However, the levels of HbA1c had an impact on both satisfaction and quality of life. Before using the FSL‑CGM system, the mean HbA1c was 9.83%, which significantly decreased to 8.63% after using the system (P-value <0.001). Conclusion: The study’s findings align with previous literature on satisfaction and quality of life, but there are conflicting results regarding the reduction of HbA1c levels using FSL‑CGM. Given the limited sample size, future research could explore the topic more comprehensively, potentially utilizing a longitudinal study design to better measure changes in HbA1c level. [ABSTRACT FROM AUTHOR]

Background: This study assessed glucometric changes in Type 2 diabetes mellitus (T2DM) patients before, during, and after Ramadan fasting using an intermittently scanned continuous glucose monitoring system (isCGMS). Methods: This prospective comparative study included T2DM patients aged 30–70 years who were receiving nonintensive insulin in Riyadh, Saudi Arabia. In addition to the baseline characteristics, glycated hemoglobin (HbA1c) and ambulatory glucose profile (AGP)-derived metric data were collected at three specific points: pre-, during-, and post-Ramadan. Self-care activities during Ramadan were evaluated using the Diabetes Self-Management Questionnaire (DSMQ). Results: Overall, a total of 93 T2DM patients were enrolled in the study. Their mean age ±SD age was 47.9 ± 7.5 years, and 51.6 % of them were males. Compared with pre- and post-Ramadan, there was a significant decrease in HbA1c (p

The study aims to address the need for accurate and real-time monitoring of glucose levels in college athletes during physical activities. This work reports on the development of an electrochemical sensor that uses glucose oxidase (GOx) immobilized on PdO nanoparticles to reduce graphene oxide (rGO) nanocomposite printed on a cellulose substrate (GOx/PdO-rGO/C-PE). The successful reduction of GO to rGO, the production of the PdO-rGO nanocomposite, and the electropolymerization of GOx on the PdO-rGO nanocomposite were all validated by the material characterization. The biosensor's electrochemical response investigation showed that its detection limit was 0.046 μM and its sensitivity was 0.03239 μA/μM. Excellent stability, reproducibility, and glucose selectivity were shown by the GOx/PdO-rGO/C-PE, which makes it a viable option for consistent and dependable glucose sensing in real-world applications. The real sample analysis assessed how well the combination of GOx/PdO-rGO/C-PE could identify glucose in human serum. Furthermore, under a variety of real-world conditions, such as during various physical activities and at different times of the day, the sensor demonstrated outstanding performance in real-time glucose monitoring. These findings imply that the GOx/PdO-rGO/C-PE offers accurate and dependable readings in the field of non-invasive glucose monitoring, which will be especially helpful for college and professional athletes.

The study aims to address the need for accurate and real-time monitoring of glucose levels in college athletes during physical activities. This work reports on the development of an electrochemical sensor that uses glucose oxidase (GOx) immobilized on PdO nanoparticles to reduce graphene oxide (rGO) nanocomposite printed on a cellulose substrate (GO x /PdO-rGO/C-PE). The successful reduction of GO to rGO, the production of the PdO-rGO nanocomposite, and the electropolymerization of GOx on the PdO-rGO nanocomposite were all validated by the material characterization. The biosensor's electrochemical response investigation showed that its detection limit was 0.046 μM and its sensitivity was 0.03239 μA/μM. Excellent stability, reproducibility, and glucose selectivity were shown by the GOx/PdO-rGO/C-PE, which makes it a viable option for consistent and dependable glucose sensing in real-world applications. The real sample analysis assessed how well the combination of GOx/PdO-rGO/C-PE could identify glucose in human serum. Furthermore, under a variety of real-world conditions, such as during various physical activities and at different times of the day, the sensor demonstrated outstanding performance in real-time glucose monitoring. These findings imply that the GOx/PdO-rGO/C-PE offers accurate and dependable readings in the field of non-invasive glucose monitoring, which will be especially helpful for college and professional athletes. [ABSTRACT FROM AUTHOR]

Aims: To explore the lived experiences of initiating real-time continuous glucose monitoring (rt-CGM) use in individuals with type 2 diabetes using insulin. Methods: Twelve semi-structured interviews were conducted amongst individuals with type 2 diabetes taking insulin who were enrolled in the 2GO-CGM randomised controlled trial and had completed 3 months of rtCGM. Interviews were transcribed verbatim and analysed to identify common themes regarding their experiences. Results: The interviews revealed three key themes: i) rtCGM as a facilitator of improved health behaviours; ii) the acceptability of rtCGM systems compared to capillary blood glucose testing; and iii) barriers to the continual usage of rtCGM technology – including: connection difficulties, longevity of the sensors, and local cutaneous reactions to the sensor adhesive. Conclusion: Adults on insulin with type 2 diabetes find rtCGM systems widely acceptable, and easier to engage with than traditional self-monitoring of capillary blood glucose. [ABSTRACT FROM AUTHOR]

Objective Glucose self-monitoring is critical for the management of diabetes in pregnancy, and increased adherence to testing is associated with improved obstetrical outcomes. Incentives have been shown to improve adherence to diabetes self-management. We hypothesized that use of financial incentives in pregnancies complicated by diabetes would improve adherence to glucose self-monitoring. Study Design We conducted a single center, randomized clinical trial from May 2016 to July 2019. In total, 130 pregnant patients, <29 weeks with insulin requiring diabetes, were recruited. Participants were randomized in a 1:1:1 ratio to one of three payment groups: control, positive incentive, and loss aversion. The control group received $25 upon enrollment. The positive incentive group received 10 cents/test, and the loss aversion group received $100 for >95% adherence and "lost" payment for decreasing adherence. The primary outcome was percent adherence to recommended glucose self-monitoring where adherence was reliably quantified using a cellular-enabled glucometer. Adherence, calculated as the number of tests per day divided by the number of recommended tests per day×100%, was averaged from time of enrollment until admission for delivery. Results We enrolled 130 participants and the 117 participants included in the final analysis had similar baseline characteristics across the three groups. Average adherence rates in the loss aversion, control and positive incentive groups were 69% (SE=5.12), 57% (SE = 4.60), and 58% (SE=3.75), respectively (p =0.099). The loss aversion group received an average of $50 compared with $38 (positive incentive) and $25 (control). Conclusion In this randomized clinical trial, loss aversion incentives tended toward higher adherence to glucose self-monitoring among patients whose pregnancies were complicated by diabetes, though did not reach statistical significance. Further studies are needed to determine whether use of incentives improve maternal and neonatal outcomes. Key Points Self-glucose monitoring is a critical part of diabetes management in pregnancy. Loss aversion financial incentives may increase adherence to glucose self-monitoring in pregnancy. The impact of testing incentives on maternal and neonatal outcomes requires further investigation. [ABSTRACT FROM AUTHOR]

Internal organ failure, retinopathy, and neuropathy are a few of the complications of diabetes, a medical condition characterized by persistently high blood sugar levels. By 2040, the WHO predicts that this number will have increased to 642 million, with one in ten individuals suffering from diabetes due to poor diet and inactivity. Using machine learning algorithms to predict diabetes has been the focus of extensive research by a few writers. Most medical data are nonlinear, nonnormal, correlationbased, and complex, making the analysis of diabetic data disease more challenging. In healthcare and medical imaging, machine learning-based algorithms have been prohibited. Prediction of diabetes mellitus at an early stage requires a departure from current practices. Patients can be diagnosed as diabetic or non-diabetic utilising risk stratification algorithms based on machine learning. Utilizing AI and cognitive computing to treat diabetes offers great promise. The objective of this paper is to provide PWDs, clinicians, family members, and carers with a better understanding of the possible uses of current AI advancements in the treatment of PWDs. Automated retinal screening, and patient selfmanagement systems are all paper themes that have the potential to revolutionize diabetes care. There are a variety of innovative AI-powered decision-support technologies available currently, including retinal imaging systems, Modelling software for predictions, insulin pumps, apps for smartphones, and more. Millions of PWD could benefit from the enhanced blood glucose management, lower frequency of hypoglycemic episodes, and decreased risk of diabetes-related comorbidities that could be facilitated by AI applications. AI applications enhance the lives of people with disabilities (PWDs), their clinicians, and their family members and carers by enhancing accuracy, efficiency, usability, and satisfaction. In this study, the performance metrics of the top three machine learning models currently available are compared. Four out of the five parameters analyzed, the KNN model fared the best. KNN is superior in terms of accuracy, area under the curve (AUC), precision, and fl score. Logistic Regression achieves the optimal Recall/Sensitivity of 93%. Our study is highly recommended because it gathers research papers from a range of sources that will be useful to other academics working on various Novel diabetic prediction models. [ABSTRACT FROM AUTHOR]

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Objective: We previously showed that intermittently scanned continuous glucose monitoring (isCGM) reduces HbA1c at 24 weeks compared with self‐monitoring of blood glucose with finger pricking (SMBG) in adults with type 1 diabetes and high HbA1c levels (58–97 mmol/mol [7.5%–11%]). We aim to assess the economic impact of isCGM compared with SMBG. Methods: Participant‐level baseline and follow‐up health status (EQ‐5D‐5L) and within‐trial healthcare resource‐use data were collected. Quality‐adjusted life‐years (QALYs) were derived at 24 weeks, adjusting for baseline EQ‐5D‐5L. Participant‐level costs were generated. Using the IQVIA CORE Diabetes Model, economic analysis was performed from the National Health Service perspective over a lifetime horizon, discounted at 3.5%. Results: Within‐trial EQ‐5D‐5L showed non‐significant adjusted incremental QALY gain of 0.006 (95% CI: −0.007 to 0.019) for isCGM compared with SMBG and an adjusted cost increase of £548 (95% CI: 381–714) per participant. The lifetime projected incremental cost (95% CI) of isCGM was £1954 (−5108 to 8904) with an incremental QALY (95% CI) gain of 0.436 (0.195–0.652) resulting in an incremental cost‐per‐QALY of £4477. In all subgroups, isCGM had an incremental cost‐per‐QALY better than £20,000 compared with SMBG; for people with baseline HbA1c >75 mmol/mol (9.0%), it was cost‐saving. Sensitivity analysis suggested that isCGM remains cost‐effective if its effectiveness lasts for at least 7 years. Conclusion: While isCGM is associated with increased short‐term costs, compared with SMBG, its benefits in lowering HbA1c will lead to sufficient long‐term health‐gains and cost‐savings to justify costs, so long as the effect lasts into the medium term. [ABSTRACT FROM AUTHOR]

Introduction: In 2020, teprotumumab became the first FDA-approved treatment for thyroid eye disease (TED). In clinical trials, hyperglycemia had been described as mild and controlled with medication. We present a case that occurred in 2020 of a 67-year-old male with TED and pre-existing glucose intolerance, who was hospitalized with severe hyperglycemia (1,059 mg/dL) after three doses of teprotumumab. Case Presentation: This patient’s HbA1c was in the pre-diabetic range (6.3%) 6 months prior to initiating teprotumumab. After three doses, the patient was hospitalized with hyperosmolar hyperglycemic nonketotic syndrome and an HbA1c of 11.7%. He was diagnosed with type 2 diabetes mellitus and treated with insulin aspart mixed 70/30. He remained on this regimen for 14 months with an A1c of 6.0%. He then self-discontinued the insulin, with an A1c 4 months later measuring 5.5%. The patient’s latest HbA1c approximately two and a half years after hospitalization was 6.1% on no medications. Conclusion: It appears that teprotumumab was a trigger for this transient case of diabetes, and detecting those that have underlying glucose intolerance ahead of time is important. We recommend blood glucose levels for patients with pre-diabetes prior to and ideally in the first few days after each infusion, to help determine patients at a greater risk for adverse hyperglycemic outcomes. A glucometer may be valuable for patients to self-monitor while on teprotumumab. If fasting blood glucose is ≥126 mg/dL or non-fasting glucose is >200 mg/dL, patients should be referred for further diabetes assessment and possible treatment initiation.