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ObjectiveHypoglycemia represents a serious acute complication in individuals with type 1 diabetes mellitus (T1DM). In order to more effectively identify and discriminate the occurrence of hypoglycemic events in patients with T1DM, this study aims to evaluate the impact of two distinct glucose monitoring systems—Flash Glucose Monitoring (FGM) and Continuous Glucose Monitoring (CGM)—on the management of blood glucose levels and the emotional responses associated with hypoglycemic episodes in individuals with T1DM.MethodIn this study, a total of 113 patients with type 1 diabetes mellitus were enrolled and allocated to two groups for the implementation of Glucose Monitoring Systems (GMS). The groups consisted of the FreeStyle Libre group (FGM, n=56) and the ipro2 group (CGM, n=57). Participants in both groups utilized GMS at least biannually and completed a set of three questionnaires: the Diabetes Monitoring and Treatment Satisfaction Questionnaire (DMTSQ), the Diabetes Specific Quality of Life (DQOL), and the Chinese Version of the Hypoglycemia Fear Survey II (CFHSII). Clinical data, CGM metrics, and questionnaire scores were collected at the initial visit and after a one-year follow-up period.ResultsThe glucose coefficient of variation (GCV) and the standard deviation of blood glucose (SDBG) were independently associated with Time Below Range (TBR). Specifically, GCV could predict TBR ≥12%, with a cut-off point of 40.55. This yielded a specificity of 88.10% and a sensitivity of 68.18% in the overall patient population. For the FreeStyle Libre group and the iPro2 group, the cut-off points were 38.69 and 40.55, respectively, with specificities of 0.74 and 0.92, and sensitivities of 0.73 and 0.86, respectively. In the FreeStyle Libre group, where the frequency of use was greater than or equal to five times per year, the hypoglycemic episodes (time/month) and CHFSII-B scores were significantly reduced at follow-up compared to baseline (7.80 ± 10.25 vs 13.95 ± 14.87; 27.37 ± 11.05 vs 38.90 ± 21.61, respectively, all P 12%). The optimal cut-off point for GCV was determined to be 40.55.

Copyright of Revista Mexicana de Endocrinología, Metabolismo y Nutrición is the property of Publicidad Permanyer SLU 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.)

Abstract Background Flash glucose monitoring systems like the FreeStyle Libre (FSL) sensor have gained popularity for monitoring glucose levels in people with diabetes mellitus. This sensor can be paired with an off-label converted real-time continuous glucose monitor (c-rtCGM) plus an ad hoc computer/smartphone interface for remote real-time monitoring of diabetic subjects, allowing for trend analysis and alarm generation. Objectives This work evaluates the accuracy and agreement between the FSL sensor and the developed c-rtCGM system. As real-time monitoring is the main feature, the system's connectivity was assessed at 5-min intervals during the trials. Methods One week of glucose data were collected from 16 type 1 diabetic rats using the FSL sensor and the c-rtCGM. Baseline blood samples were taken the first day before inducing type 1 diabetes with streptozotocin. Once confirmed diabetic rats, FSL and c-rtCGM, were implanted, and to improve data matching between the two monitoring devices, the c-rtCGM was calibrated to the FSL glucometer readings. A factorial design 2 × 3^3 and a second-order regression was used to find the base values of the linear model transformation of the raw data obtained from the sensor. Accuracy, agreement, and connectivity were assessed by median absolute relative difference (Median ARD), range averaging times, Parkes consensus error grid analysis (EGA), and Bland–Altman analysis with a non-parametric approach. Results Compared to the FSL sensor, the c-rtCGM had an overall Median ARD of 6.58%, with 93.06% of results in zone A when calibration was not carried out. When calibration frequency changed from every 50 h to 1 h, the overall Median ARD improved from 6.68% to 2.41%, respectively. The connectivity evaluation showed that 95% of data was successfully received every 5 min by the computer interface. Conclusions and clinical importance The results demonstrate the feasibility and reliability of real-time and remote subjects with diabetes monitoring using the developed c-rtCGM system. Performing calibrations relative to the FSL readings increases the accuracy of the data displayed at the interface.

Background The clinical application of flash glucose monitoring system (FGM) is becoming increasingly widespread, which can be continuously monitored for 14 days and does not require fingertip blood correction during wearing, providing a basis for clinical treatment. Therefore, the accuracy of FGM is particularly important. Objective To investigate the effect of human body composition and serum biochemical indicators on the accuracy of FGM sensor. Methods Patients with type 2 diabetes mellitus (T2DM) hospitalized in the Department of Endocrinology of the Second Affiliated Hospital of Zhengzhou University in 2022 were selected as the study objects, and their general data was collected through the electronic medical record system. The blood glucose was detected by FGM and compared with intravenous blood glucose, the physical analysis data of patients was collected. Fasting venous blood was collected to analyze hematological parameters. The clinical accuracy of FGM was evaluated by Clarke error grid analysis. The included patients were divided into the accurate group (MARD20%, n=34) according to the matched mean absolute relative difference of blood glucose (MARD). Binary Logistic regression analysis was used to analyze the influencing factors of FGM accuracy. Results A total of 694 pairs of blood glucose data were collected. Clarke error grid analysis was performed on the blood glucose values of FGM scans using venous blood glucose as the reference value. The results showed that 82.9% fell in zone A, 16.9% fell in zone B, 99.8% fell in zone A+B, and 0.2% fell in zone D, with an average MARD of 12.7%. MARD and muscle mass in the inaccurate group were higher than those in the accurate group (P

Background: Flash glucose monitoring systems like the FreeStyle Libre (FSL) sensor have gained popularity for monitoring glucose levels in people with diabetes mellitus. This sensor can be paired with an off-label converted real-time continuous glucose monitor (c-rtCGM) plus an ad hoc computer/smartphone interface for remote real-time monitoring of diabetic subjects, allowing for trend analysis and alarm generation. Objectives: This work evaluates the accuracy and agreement between the FSL sensor and the developed c-rtCGM system. As real-time monitoring is the main feature, the system's connectivity was assessed at 5-min intervals during the trials. Methods: One week of glucose data were collected from 16 type 1 diabetic rats using the FSL sensor and the c-rtCGM. Baseline blood samples were taken the first day before inducing type 1 diabetes with streptozotocin. Once confirmed diabetic rats, FSL and c-rtCGM, were implanted, and to improve data matching between the two monitoring devices, the c-rtCGM was calibrated to the FSL glucometer readings. A factorial design 2 × 3^3 and a second-order regression was used to find the base values of the linear model transformation of the raw data obtained from the sensor. Accuracy, agreement, and connectivity were assessed by median absolute relative difference (Median ARD), range averaging times, Parkes consensus error grid analysis (EGA), and Bland–Altman analysis with a non-parametric approach. Results: Compared to the FSL sensor, the c-rtCGM had an overall Median ARD of 6.58%, with 93.06% of results in zone A when calibration was not carried out. When calibration frequency changed from every 50 h to 1 h, the overall Median ARD improved from 6.68% to 2.41%, respectively. The connectivity evaluation showed that 95% of data was successfully received every 5 min by the computer interface. Conclusions and clinical importance: The results demonstrate the feasibility and reliability of real-time and remote subjects with diabetes monitoring using the developed c-rtCGM system. Performing calibrations relative to the FSL readings increases the accuracy of the data displayed at the interface. [ABSTRACT FROM AUTHOR]

Xia Sheng, Ting Li, Yi Hu, Cheng-Shun Xiong, Ling Hu Department of Endocrine, The First Hospital of NanChang City, Nanchang, Jiangxi, 330008, People’s Republic of ChinaCorrespondence: Ling Hu, Email drhu_hl1172@163.comObjective: To discuss the relationship between time in range (TIR) which is deprived of the FGMS and the risk of diabetic vascular complications and to provide a theoretical foundation for the clinical application of TIR and other FGMS-deprived indexes.Methods: Patients with T2DM who wore the FGMS sensor continuously were enrolled. Relevant indexes such as TIR, time below range (TBR), time above range (TAR), a standard deviation of blood glucose (SDBG), coefficient of variation of blood glucose (CV), and mean amplitude of glycemic excursion (MAGE) generated by the FGMS were recorded, and the risk of diabetic vascular complications were followed up for one year. The TIR was measured by continuous glucose monitoring at baseline, and patients were grouped according to TIR every 20%. Finally, the Cox proportional hazards regression model was used to estimate the association of different levels of TIR with different rates of diabetic vascular complications.Results: TIR was negatively correlated with HbA1C, CV, SDBG, and amplitude of glycemic excursion (MV), wherein, the lower the TIR, the higher the HbA1C, CV, SDBG, and MV. TIR in the diabetic microvascular complication was significantly lower than that in the non-microvascular complication group, and the difference was statistically significant. TIR < 40% was identified as a risk factor for DN, DPN, and DR according to the risk assessment. The mean TAR in the DN group was significantly higher than that in the non-DN group. TAR, CV, SD, MAGE, and HbA1C in the DR group were significantly higher than those in the non-DR group. TAR, ABG, CV, SD, MAGE, and HbA1C in the DPN group were significantly higher than those in the non-DPN group.Conclusion: The relationships between the TIR and the prevalence and risk of diabetic vascular complications and the HbA1C may be negative. Other CGM-deprived indexes such as CV and MV should be integrated into glycemic control and diabetes complication prediction.Keywords: flash glucose monitoring system, diabetes, diabetic vascular complications, time in range, HbA1C

ABSTRACT This report described temporary hyperpigmentation occurring in a cat after use of the FreeStyle® Libre sensor by applying three different adhesive glues. The device was continuously used as an aid for the treatment of diabetes mellitus. Histopathological examination revealed mild focal chronic active dermatitis. While the coat color change occurred due to inflammation and did not affect the device functioning, owners should be alerted to the possibility of this complication.

ABSTRACT Objectives: To evaluate the alternate use of flash glucose monitoring (FGM) with self-monitoring blood glucose (SMBG), in patients with type 1 diabetes (T1D). Materials and methods: Two weeks of open FGM (P2), both preceded (P1) and followed by 2 weeks (P3) of SMBG with a blinded FGM system. Mean absolute relative difference (MARD) was calculated by (|FGMi − SMBGi|) / SMBGi, where it was a paired data sample. Results: In total, 34 patients were evaluated. Time in range (TIR) did not change between P1 and P2. In 12 patients (35.3%), TIR increased from 40% at P1 to 52% at P2 (p = 0.002) and in 22 (64.7%), TIR decreased or did not change. FGM use resulted in decreased % time spent in hypoglycemia (180 mg/dL) (44.5% to 51%; p = 0.046) with no significant change in % TIR. The proportion of patients who reached sensor-estimated glycated hemoglobin (eA1c) < 7% decreased from 23.5% at P1 to 12.9% at P2, p = 0.028. For the whole sample, the MARD between the two methods was 15.5% (95% CI 14.5-16.6%). For normal glucose range, hyperglycemic levels and hypoglycemic levels MARD were 16.0% (95% CI 15.0-17.0%), 13.3% (95% CI 11.5-15.2%) and 23.4% [95% CI 20.5-26.3%)], respectively. Conclusion: FGM after usual SMBG decreased the % time spent in hypoglycemia concomitant with an undesired increase in % time spent in hyperglycemia. Lower accuracy of FGM regarding hypoglycemia levels could result in overcorrection of hypoglycemia.

Background With the advances in blood glucose monitoring technologies, a flash glucose monitoring system (FGMS) has recently been used to panoramically observe the blood glucose level in patients with type 2 diabetes mellitus (T2DM). Evaluating the relationship of blood glucose metrics monitored by the FGMS with T2DM complications will facilitate the clinical application of FGMS but relevant studies are rare. Objective To assess the correlation of time in range (TIR) and other markers with urine albumin-to-creatinine ratio (UACR) in patients with T2DM using a FGMS. Methods T2DM patients (n=79) using a FGMS were selected from Department of Geriatrics, Peking University People's Hospital from January 2019 to October 2021, including 29 with UACR greater than 30 mg/g (albuminuria group) and 50 with UACR less than 30 mg/g (non-albuminuria group). The clinical characteristics, laboratory test markers, and blood glucose metrics monitored by the FGMS of the two groups were compared. Pearson correlation and Spearman correlation analyses were used to explore the correlation of TIR and time above range (TAR) with glycated hemoglobin (HbA1c). Pearson correlation, Spearman correlation and partial correlation analyses were used to explore the correlations of FGMS markers with natural logarithm-transformed UACR, respectively. Multivariate Logistic regression analysis was used to explore the factors influencing the development of albuminuria in T2DM. The predictive value of TIR for albuminuria was assessed using the receiver operating characteristic (ROC) curve. Results Compared with the non-albuminuria group, albuminuria group had longer duration of T2DM (P70%〔OR=0.038, 95%CI (0.003, 0.467) 〕 was associated with decreased risk of albuminuria in T2DM (P70% but increased with elevated TAR in T2DM. UACR was closely related with SDBG, LAGE, MAGE, CONGA2 and other markers reflecting blood glucose fluctuations. Early screening and identifying T2DM patients with a low TIR level, and a high TAR, SDBG, LAGE, MAGE, and CONGA2 will help to prevent the development of albuminuria.

BackgroundThe prevalence of T1DM (type 1 diabetes) is increasing year by year, and its autoimmunity can easily lead to the destruction of pancreaticβcells and insulin deficiency, making blood glucose difficult to reach the target.ObjectiveTo investigate the influencing factors of glucose variability in patients with T1DM by using flash glucose monitoring system (FGMS) , and to provide basis for future clinical use of targeted hypoglycemic treatment.MethodsUsing convenience sampling method, 85 patients with T1DM admitted to the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from May 2019 to April 2020 were selected as the research objects. The gender, age, diabetesduration, marital status, education level, smoking history, drinking history and other general data to determine body mass index (BMI) , waist hip ratio (WHR) , blood pressure (BP) , glycosylated hemoglobin (HbA1c) , total cholesterol (TC) , total triglycerides (TG) , high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (HDL-C) , estimated glomerular filtration rate (eGFR) , and urinary albumin creatinine ratio (UACR) of patients were collected. According to whether the mean amplitude of glycemic excursions (MAGE) of patient is higher than the overall average value of 0.82 mmol/L, patients were divided into high blood glucose fluctuation group and low blood glucose fluctuation group. The scores of the Summary of Diabetes Self Care Activities (SDSCA) and the Diabetes Empowerment Scale-Short Form (DES-SF) were calculated. Multiple linear regression was used to analyze the influencing factors of blood glucose fluctuation.ResultsThere were statistically significant difference between two groups in age, diabetes duration, HbA1c, TG, UACR, MEAN, SD, TIR, DES-SF scores and SDSCA scores (P

Compliance with self-monitoring of blood glucose is highly related to the efficacy of Blood-glucose control in patients with type 1 diabetes mellitus (T1DM). This paper summarized the studies about T1DM and related standardized insulin treatment, compliance with self-monitoring of blood glucose and related influencing factors, clinical applications of Flash glucose monitoring system, in order to provide reference for intervention on compliance with Flash glucose monitoring system usage in patients with type 1 diabetes mellitus (自我血糖监测依从性直接关系到1型糖尿病(T1DM)患者的血糖控制效果。本文从T1DM及胰岛素规范治疗、自我血糖监测依从性及影响因素、扫描式葡萄糖监测系统在T1DM患者中的应用等方面做一综述, 旨在为增强T1DM患者使用扫描式葡萄糖监测系统的依从行为提供参考意见。)

Aim:Glycemic variability can be affected in diabetes camps as a result of sports, social activities and nutrition. Close glucose monitoring is necessary to reduce glycemic variability, especially hypoglycemia. The aim assessment of glycemic variability and time in range by use of the flash glucose monitoring system (FGMS) in children and adolescents with type 1 diabetes.Materials and Methods:Thirty-three children and adolescents between 10-18 years of age who participated in the 2018 diabetes camp of Ege University were included. Their glycemic variability indexes were recorded.Results:The mean age and duration of diabetes mellitus in the study group was 13.3±0.5 and 4.9±0.7 years respectively. Twelve (43%) of the participants were boys and 16 (57%) were girls. Ten (35.7%) of the participants used continuous subcutaneous insulin infusion (CSII) pump therapy while 18 (64.3%) used multiple dose insulin therapy. When the participants were evaluated according to time in range (TIR), the duration of TIR increased, and level 1 and level 2 hyperglycemia decreased during the camp. Participants using CSII had spent more time in level 2 hypoglycemia before camp, but during and after the camp, similar values were reached for both groups. Before the camp, participants with good metabolic control had a longer duration of hypoglycemia than those participants with poor metabolic control. During and after the camp, level 1 and level 2 hypoglycemia periods were similar between the two groups.Conclusion:In diabetes camp, healthy diet, regular exercise, and close glycemic control improve glycemic variability. By using FGMS, normoglycemia periods can be increased without increasing hypoglycemic attacks. As a result, using FGMS had a positive effect on diabetes management and the control of hypoglycemia periods during the diabetes camp.

Objective To assess differences in the reduction of blood glucose fluctuations (GV), glucose target time (TIR) and oxidative stress levels in liraglutide plus insulin degludec and multiple daily insulin injections (MDI) using scanning glucose monitoring (FGM) system. Methods In this randomized parallel-design study, subjects who were treated with MDI for at least one month were randomly assigned (through a computer-generated, random order) 1∶1 to either MDI treatment (control group, n=26) or liraglutide combined with insulin degludec treatment (experimental group, n=26). The primary endpoint of this study was the change in GV and TIR (3.9-10 mmol/L) from baseline to 14 days. Secondary endpoints included hypoglycemia, oxidative stress levels and body weight. Results The serum 1,5-anhydroglucitol (1,5- AG) was significantly increased in both groups (P＜0.05). After treatment, the MAGE and eHbA1c were significantly lower in the experimental group than those of the control group (P＜0.05), and 1,5-AG was significantly higher in the experimental group than that of the control group (P＜0.05). The TIR was significantly prolonged after treatment in both groups, and the time above range (TAR) (＞10 mmol/L) was significantly shortened. The time below range (TBR) (＜3.9 mmol/L) was significantly lower in the experimental group than that in the control group (P＜0.05). After treatment, 8-iso-PGF2α and 8- OHdG were significantly decreases in the experimental group than those of the control group (P＜0.05). After treatment, the body weights decreased significantly in the experimental group, while no significant changes in the control group (P＜0.05). Conclusion Liraglutide combined with insulin degludec treatment can achieve good glycemic control in patients with type 2 diabetes and which is superior to MDI in improving GV, reducing hypoglycemia risk, oxidative stress levels and body weight. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption is a prevalent behavior that is bi-directionally related to the risk of type 2 diabetes. However, the effect of daily alcohol consumption on glucose levels in real-world situations in the general population has not been well elucidated. This study aimed to clarify the relationship between alcohol consumption and all-day and time-specific glucose levels among non-diabetic individuals. Methods: We investigated 913 non-diabetic males and females, aged 40–69 years, during 2018–2020 from four communities across Japan. The daily alcohol consumption was assessed using a self-report questionnaire. All-day and time-specific average glucose levels were estimated from the interstitial glucose concentrations measured using the Flash glucose monitoring system for a median duration of 13 days. Furthermore, we investigated the association between all-day and time-specific average glucose levels and habitual daily alcohol consumption levels, using never drinkers as the reference, and performed multiple linear regression analyses after adjusting for age, community, and other diabetes risk factors for males and females separately. Results: All-day average glucose levels did not vary according to alcohol consumption categories in both males and females. However, for males, the average glucose levels between 5:00 and 11:00 h and between 11:00 and 17:00 h were higher in moderate and heavy drinkers than in never drinkers, with the difference values of 4.6 and 4.7 mg/dL for moderate drinkers, and 5.7 and 6.8 mg/dL for heavy drinkers. Conversely, the average glucose levels between 17:00 and 24:00 h were lower in male moderate and heavy drinkers and female current drinkers than in never drinkers; the difference values of mean glucose levels were −5.8 for moderate drinkers, and −6.1 mg/dL for heavy drinkers in males and −2.7 mg/dL for female current drinkers. Conclusions: Alcohol consumption was associated with glucose levels in a time-dependent biphasic pattern.

Aim: Glycemic variability can be affected in diabetes camps as a result of sports, social activities and nutrition. Close glucose monitoring is necessary to reduce glycemic variability, especially hypoglycemia. The aim assessment of glycemic variability and time in range by use of the flash glucose monitoring system (FGMS) in children and adolescents with type 1 diabetes. Materials and Methods: Thirty-three children and adolescents between 10-18 years of age who participated in the 2018 diabetes camp of Ege University were included. Their glycemic variability indexes were recorded. Results: The mean age and duration of diabetes mellitus in the study group was 13.3±0.5 and 4.9±0.7 years respectively. Twelve (43%) of the participants were boys and 16 (57%) were girls. Ten (35.7%) of the participants used continuous subcutaneous insulin infusion (CSII) pump therapy while 18 (64.3%) used multiple dose insulin therapy. When the participants were evaluated according to time in range (TIR), the duration of TIR increased, and level 1 and level 2 hyperglycemia decreased during the camp. Participants using CSII had spent more time in level 2 hypoglycemia before camp, but during and after the camp, similar values were reached for both groups. Before the camp, participants with good metabolic control had a longer duration of hypoglycemia than those participants with poor metabolic control. During and after the camp, level 1 and level 2 hypoglycemia periods were similar between the two groups. Conclusion: In diabetes camp, healthy diet, regular exercise, and close glycemic control improve glycemic variability. By using FGMS, normoglycemia periods can be increased without increasing hypoglycemic attacks. As a result, using FGMS had a positive effect on diabetes management and the control of hypoglycemia periods during the diabetes camp. [ABSTRACT FROM AUTHOR]

The novel Eversense XL continuous glucose monitoring system (Senseonics, Inc., Germantown, Maryland) has recently been developed for monitoring diabetes in humans. The sensor is fully implanted and has a functional life of up to 180 days. The present study describes the use of Eversense XL in three diabetic dogs (DD) with good glycemic control managed by motivated owners. The insertion and use of the device were straightforward and well tolerated by the dogs. During the wearing period, some device-related drawbacks, such as sensor dislocation and daily calibrations, were reported. A good correlation between the glucose values measured by the Eversense XL and those obtained with two commercially available devices, previously validated for use in DD, was found (rs = 0.85 and rs = 0.81, respectively). The life of the sensor was 180 days in two of the DD and provided high satisfaction. This innovative device might be considered a future alternative for home glucose monitoring in DD.

This study investigated the accuracy of a flash glucose monitoring system (FGMS) in a postprandial setting. Ten fasted adults without diabetes wore the FGMS sensors then consumed a standard breakfast. Their glucose levels were subsequently recorded for 2 hours, both by the FGMS and by measuring capillary glucose levels using the glucose oxidase method. The accuracy of the FGMS data was assessed using the accuracy limits stated in ISO 15197:2013. FGMS measurements were mostly lower than glucose oxidase measurements (mean absolute relative difference ± SD: 25.4 ± 17.0%, p < 0.001). However, the maximum difference from baseline captured by the two methods was not significantly different (mean ± SD, glucose oxidase: 58.5 ± 18.9 mg/dl; FGMS, 54.4 ± 28.9 mg/dl, p = 0.366). FGMS could track the incremental glycaemic excursions after meals in adults without diabetes, yet further studies with greater sample sizes are needed to confirm this finding. [ABSTRACT FROM AUTHOR]

Glycemic variability (GV) refers to swings in blood glucose levels and is an emerging measure of glycemic control in clinical practice. It is associated with micro- and macrovascular complications and poor clinical outcomes in diabetic humans. Although an integral part of patient assessment in human patients, it is to a large extent neglected in insulin-treated diabetic dogs. This prospective pilot study was performed to describe canine within-day GV in non-diabetic dogs with the aim to provide a basis for the interpretation of daily glucose profiles, and to promote GV as an accessible tool for future studies in veterinary medicine. Interstitial glucose concentrations of ten non-diabetic, non-obese beagles were continuously measured over a 48-h period using a flash glucose monitoring system. GV was assessed using the common indices MAGE (mean amplitude of glycemic excursion), GVP (Glycemic variability percentage) and CV (coefficient of variation). A total of 2260 sensor measurements were obtained, ranging from 3.7 mmol/L (67 mg/dL) to 8.5 mmol/L (153 mg/dL). Glucose profiles suggested a meal-dependent circadian rhythmicity with small but significant surges during the feeding periods. No differences in GV indices were observed between day and night periods (p > 0.05). The MAGE (mmol/L), GVP (%) and CV (%) were 0.86 (± 0.19), 7.37 (± 1.65), 6.72 (± 0.89) on day one, and 0.83 (± 0.18), 6.95 (± 1.52), 6.72 (± 1.53) on day two, respectively. The results of this study suggest that GV is low in non-diabetic dogs and that glucose concentrations are kept within narrow ranges., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

BackgroundThis study aimed to investigate the characteristics and extent of glycometabolism impairment in patients with adrenal diseases, including Cushing syndrome, primary aldosteronism, pheochromocytoma, and nonfunctional adrenal incidentaloma.MethodsThis study enrolled thirty-two patients with adrenal diseases as adrenal disease groups and eight healthy individuals as healthy controls. Blood glucose levels were indicated by glucose concentration in interstitial fluid, which was documented using flash glucose monitoring system. According to flash glucose monitoring system data, parameters representing general blood glucose alterations, within-day and day-to-day glucose variability, and glucose-target-rate were calculated. Furthermore, blood glucose levels at nocturnal, fasting, and postprandial periods were analyzed. Besides, islet β-cell function and insulin resistance were assessed.ResultsAnalysis of flash glucose monitoring system-related parameters indicated impaired glycometabolism in patients with adrenal diseases compared with that of healthy controls at general blood glucose, within-day and day-to-day glucose variability, and glucose-target-rate levels. Furthermore, the dynamic glucose monitoring data revealed that significantly affected blood glucose levels compared with that of healthy controls were observed at postprandial periods in the Cushing syndrome and primary aldosteronism groups; at nocturnal, fasting and postprandial periods in the pheochromocytoma group. Significant insulin resistance and abnormal β-cell function were observed in the Cushing syndrome group compared with that in healthy controls.ConclusionAdrenal diseases can negatively affect glucose metabolism. Patients diagnosed with adrenal diseases should receive timely and appropriate treatment to avoid adverse cardiovascular events linked to hyperglycemia and insulin resistance.

Background: This study aimed to investigate the characteristics and extent of glycometabolism impairment in patients with adrenal diseases, including Cushing syndrome, primary aldosteronism, pheochromocytoma, and nonfunctional adrenal incidentaloma. Methods: This study enrolled thirty-two patients with adrenal diseases as adrenal disease groups and eight healthy individuals as healthy controls. Blood glucose levels were indicated by glucose concentration in interstitial fluid, which was documented using flash glucose monitoring system. According to flash glucose monitoring system data, parameters representing general blood glucose alterations, within-day and day-to-day glucose variability, and glucose-target-rate were calculated. Furthermore, blood glucose levels at nocturnal, fasting, and postprandial periods were analyzed. Besides, islet β-cell function and insulin resistance were assessed. Results: Analysis of flash glucose monitoring system-related parameters indicated impaired glycometabolism in patients with adrenal diseases compared with that of healthy controls at general blood glucose, within-day and day-to-day glucose variability, and glucose-target-rate levels. Furthermore, the dynamic glucose monitoring data revealed that significantly affected blood glucose levels compared with that of healthy controls were observed at postprandial periods in the Cushing syndrome and primary aldosteronism groups; at nocturnal, fasting and postprandial periods in the pheochromocytoma group. Significant insulin resistance and abnormal β-cell function were observed in the Cushing syndrome group compared with that in healthy controls. Conclusion: Adrenal diseases can negatively affect glucose metabolism. Patients diagnosed with adrenal diseases should receive timely and appropriate treatment to avoid adverse cardiovascular events linked to hyperglycemia and insulin resistance. [ABSTRACT FROM AUTHOR]

Aim: It is important to consider hypoglycemia for glycemic control in elderly patients with type 2 diabetes. Continuous blood glucose monitoring system is an effective method to investigate blood glucose fluctuation. This study examined hypoglycemia frequency using continuous blood glucose monitoring system in older patients with type 2 diabetes. Methods: A total of 70 patients with type 2 diabetes aged >65 years, receiving oral treatment only and having a glycated hemoglobin (HbA1c) level of <8% were enrolled. Flash glucose monitoring system was used for the device. Patients were classified into three groups according to the type of medicine administered, in addition to other oral hypoglycemics, and were compared: (i) those taking sulfonylureas (SU); (ii) those taking glinides; and (iii) those who did not take either SU or glinides. Results: There was a significant positive correlation between the coefficient of variation and hypoglycemic frequency in all the patients, and a significant negative correlation between HbA1c and hypoglycemia in those receiving SU. When hypoglycemia was defined as glucose levels <54 mg/dL and <70 mg/dL, the cut‐off HbA1c values for developing hypoglycemia were 6.3% and 6.7%, sensitivity was 75.0% and 76.2%, and specificity was 90.9% and 77.6%, respectively. Conclusions: In older patients with type 2 diabetes receiving SU, hypoglycemic frequency increases with decreases in HbA1c level. In particular, in patients with HbA1c levels of <6.3% receiving SU, it is necessary to consider medication modification. Geriatr Gerontol Int 2019; 19: 1030–1035. [ABSTRACT FROM AUTHOR]

Copyright of Revista Mexicana de Endocrinología, Metabolismo y Nutrición is the property of Publicidad Permanyer SLU 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: Glucose monitoring systems, for example, Freestyle Libre (Abott) and Dexcom (Nintamed), are increasingly being used instead of conventional blood sugar measurement. However, many patients have experienced adverse skin reactions such as severe allergic contact dermatitis (ACD). Finally, in August 2017, the culprit allergen in Freestyle Libre, isobornyl acrylate (IBOA), was identified. Objectives: After patients have developed ACD, it is recommended that they no longer use their glucose monitoring systems. Thus, it is important to find an alternative IBOA‐free device. Patients and Methods: Five patients presented with ACD caused by Freestyle Libre. Each was patch tested with allergens from the baseline series and from a plastics and glues series, and additionally with IBOA 0.1% pet. Gas chromatography‐mass spectrometry (GC/MS) of the Freestyle Libre sensor and the Dexcom sensor was performed. The Dexcom sensor remained on the skin of all patients for at least 2 days. Results: All patients were sensitized to IBOA. GC/MS showed the presence of IBOA in the Freestyle Libre sensor, whereas the Dexcom sensor was IBOA‐free. None of the patients had skin reactions to the Dexcom sensor. Conclusions: Patients with Freestyle Libre and IBOA allergy may use the Dexcom sensor as an alternative for glucose monitoring. [ABSTRACT FROM AUTHOR]

Aims: Frequent glucose testing is required for optimal management of type 1 diabetes (T1D). Limited data are available regarding real-world experience of the novel technology for monitoring by continuous interstitial fluid glucose (IFG), using flash glucose-sensing technology (FSL-CGM). We aimed to assess the effect of FSL-CGM in a real-life clinical setting on glycemic control parameters, compliance, and adverse events among pediatric and young adult T1D patients.Methods: This observational multi-center study assessed FSL-CGM use (6-12 months) in T1D patients (mean ± SD age 13.4 ± 4.9 years) who purchased the device out-of-pocket. Outcome measures included HbA1c, mean IFG levels, CGM metrics [time in hypoglycemia (< 54 mg/dL; < 3 mmol/L), in target range (70-180 mg/dL; 3.9-10 mmol/L), and in hyperglycemia > 240 mg/dL; > 13.3 mmol/L)], frequency of self-monitoring of blood glucose, acute complications, skin reactions, and reasons for initiation/discontinuation.Results: Among patients with regular use of the FSL-CGM (n = 59), mean HbA1c decreased from 8.86 ± 0.23 to 8.05 ± 0.2% (73.3-64.5 mmol/mol) in 3 months (p = 0.0001) and plateaued thereafter. A clinically significant reduction in HbA1c (defined as a decrease of ≥ 0.5%) was associated with shorter diabetes duration. Of 71 patients who initiated use of the FSL-CGM, 12 (16.9%) discontinued during the study period. No statistically significant changes were found after FSL-CGM use, in mean and standard deviation IFG levels, and in time of glucose levels in target, hypoglycemia, and hyperglycemia ranges. One patient with hypoglycemia unawareness was found dead-in-bed while using FSL-CGM.Conclusions: Real-life observational data in a self-selected young T1D population demonstrated a significant and sustained reduction in HbA1c with FSL-CGM in one-third of the participants. Surveillance of glucose monitoring should be individualized, especially for patients with hypoglycemia unawareness. [ABSTRACT FROM AUTHOR]

A flash glucose monitoring system (FGMS) has been validated for use in diabetic dogs. However, it is unknown whether skin thickness affects FGMS measurements. The aim of this study was to evaluate whether FGMS accuracy is affected by skin thickness. Fourteen client-owned diabetic dogs on insulin treatment were prospectively enrolled in the study. The dogs were divided into two groups according to their ultrasound-measured skin thickness: dogs with skin thickness < 5 mm (Group 1) and dogs with skin thickness > 5 mm (Group 2). On days 1, 7 and 14, glucose curves were obtained simultaneously using the FGMS and a validated portable blood glucose meter. Paired measurements were used to calculate the mean bias and to determine accuracy according to ISO 15197:2013 criteria. The mean bias was significantly inversely correlated (p = 0.02; r = −0.6) with the mean skin thickness. Clinical accuracy was observed only in Group 2, with 99% of the results in zone A + B of the Parkes consensus error grid analysis. In conclusion, skin thickness seems to affect FGMS measurements, and the device is accurate in dogs with thicker skin (>5 mm); in dogs with thin skin (

Background: Glucose control for pregnant women with glucose intolerance is important, as hyperglycemia may adversely affect the mother and the fetus. Case presentation: We report the case of a pregnant Japanese woman who experienced gestational diabetes mellitus during her first pregnancy and developed impaired glucose tolerance after the delivery. During her second pregnancy with twins, she required up to 75 units of injected insulin to control her postprandial hyperglycemia and occasionally experienced hypoglycemia. We used a newly developed flash glucose monitoring system, which allowed her to successfully achieve ideal glycemic control and experience an uncomplicated delivery. Conclusion: We suggest that this flash glucose monitoring system may be clinically effective for similar cases that involve pregnant women with abnormal glucose tolerance. [ABSTRACT FROM AUTHOR]

Background: Commonly used glucocorticoids replacement regimens in patients with hypopituitarism have difficulty mimicking physiological cortisol rhythms and are usually accompanied by risks of over-treatment, with adverse effects on glucose metabolism. Disorders associated with glucose metabolism are established risk factors of cardiovascular events, one of the life-threatening ramifications., Aim: To investigate the glycometabolism profile in patients with hypopituitarism receiving prednisone (Pred) replacement, and to clarify the impacts of different Pred doses on glycometabolism and consequent adverse cardiovascular outcomes., Methods: Twenty patients with hypopituitarism receiving Pred replacement [patient group (PG)] and 20 normal controls (NCs) were recruited. A flash glucose monitoring system was used to record continuous glucose levels during the day, which provided information on glucose-target-rate, glucose variability (GV), period glucose level, and hypoglycemia occurrence at certain periods. Islet β-cell function was also assessed. Based on the administered Pred dose per day, the PG was then regrouped into Pred > 5 mg/d and Pred ≤ 5 mg/d subgroups. Comparative analysis was carried out between the PG and NCs., Results: Significantly altered glucose metabolism profiles were identified in the PG. This includes significant reductions in glucose-target-rate and nocturnal glucose level, along with elevations in GV, hypoglycemia occurrence and postprandial glucose level, when compared with those in NCs. Subgroup analysis indicated more significant glucose metabolism impairment in the Pred > 5 mg/d group, including significantly decreased glucose-target-rate and nocturnal glucose level, along with increased GV, hypoglycemia occurrence, and postprandial glucose level. With regard to islet β-cell function, PG showed significant difference in homeostasis model assessment (HOMA)-β compared with that of NCs; a notable difference in HOMA-β was identified in Pred > 5 mg/d group when compared with those of NCs; as for Pred ≤ 5 mg/d group, significant differences were found in HOMA-β, and fasting glucose/insulin ratio when compared with NCs., Conclusion: Our results demonstrated that Pred replacement disrupted glycometabolic homeostasis in patients with hypopituitarism. A Pred dose of > 5 mg/d seemed to cause more adverse effects on glycometabolism than a dose of ≤ 5 mg/d. Comprehensive and accurate evaluation is necessary to consider a suitable Pred replacement regimen, wherein, flash glucose monitoring system is a kind of promising and reliable assessment device. The present data allows us to thoroughly examine our modern treatment standards, especially in difficult cases such as hormonal replacement mimicking delicate natural cycles, in conditions such as diabetes mellitus that are rapidly growing in worldwide prevalence., Competing Interests: Conflict-of-interest statement: There are no conflicts of interest to report., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To evaluate the alternate use of flash glucose monitoring (FGM) with self-monitoring blood glucose (SMBG), in patients with type 1 diabetes (T1D)., Materials and Methods: Two weeks of open FGM (P2), both preceded (P1) and followed by 2 weeks (P3) of SMBG with a blinded FGM system. Mean absolute relative difference (MARD) was calculated by (|FGMi - SMBGi|) / SMBGi, where it was a paired data sample., Results: In total, 34 patients were evaluated. Time in range (TIR) did not change between P1 and P2. In 12 patients (35.3%), TIR increased from 40% at P1 to 52% at P2 ( p = 0.002) and in 22 (64.7%), TIR decreased or did not change. FGM use resulted in decreased % time spent in hypoglycemia (<70 mg/dL) (6.5% vs. 5.0%; p = 0.005), increased % time spent in hyperglycemia (>180 mg/dL) (44.5% to 51%; p = 0.046) with no significant change in % TIR. The proportion of patients who reached sensor-estimated glycated hemoglobin (eA1c) < 7% decreased from 23.5% at P1 to 12.9% at P2, p = 0.028. For the whole sample, the MARD between the two methods was 15.5% (95% CI 14.5-16.6%). For normal glucose range, hyperglycemic levels and hypoglycemic levels MARD were 16.0% (95% CI 15.0-17.0%), 13.3% (95% CI 11.5-15.2%) and 23.4% [95% CI 20.5-26.3%)], respectively., Conclusion: FGM after usual SMBG decreased the % time spent in hypoglycemia concomitant with an undesired increase in % time spent in hyperglycemia. Lower accuracy of FGM regarding hypoglycemia levels could result in overcorrection of hypoglycemia.

Background: Alcohol consumption is a prevalent behavior that is bi-directionally related to the risk of type 2 diabetes. However, the effect of daily alcohol consumption on glucose levels in real-world situations in the general population has not been well elucidated. This study aimed to clarify the relationship between alcohol consumption and all-day and time-specific glucose levels among non-diabetic individuals., Methods: We investigated 913 non-diabetic males and females, aged 40-69 years, during 2018-2020 from four communities across Japan. The daily alcohol consumption was assessed using a self-report questionnaire. All-day and time-specific average glucose levels were estimated from the interstitial glucose concentrations measured using the Flash glucose monitoring system for a median duration of 13 days. Furthermore, we investigated the association between all-day and time-specific average glucose levels and habitual daily alcohol consumption levels, using never drinkers as the reference, and performed multiple linear regression analyses after adjusting for age, community, and other diabetes risk factors for males and females separately., Results: All-day average glucose levels did not vary according to alcohol consumption categories in both males and females. However, for males, the average glucose levels between 5:00 and 11:00 h and between 11:00 and 17:00 h were higher in moderate and heavy drinkers than in never drinkers, with the difference values of 4.6 and 4.7 mg/dL for moderate drinkers, and 5.7 and 6.8 mg/dL for heavy drinkers. Conversely, the average glucose levels between 17:00 and 24:00 h were lower in male moderate and heavy drinkers and female current drinkers than in never drinkers; the difference values of mean glucose levels were -5.8 for moderate drinkers, and -6.1 mg/dL for heavy drinkers in males and -2.7 mg/dL for female current drinkers., Conclusions: Alcohol consumption was associated with glucose levels in a time-dependent biphasic pattern.

Objectives: Patients with classical type 1 diabetes mellitus (T1DM) require lifelong dependence on exogenous insulin therapy due to pancreatic beta-cell destruction and absolute insulin deficiency. T1DM accounts for about 90% of children with diabetes in China, with a rapid increase in incidence and a younger-age trend. Epidemiological studies have shown that the overall glycated haemoglobin (HbA1c) and compliance rate are low in Chinese children with T1DM. Optimal glucose control is the key for diabetes treatment, and maintaining blood glucose within the target range can prevent or delay chronic vascular complications in patients with T1DM. Therefore, this study aims to investigate the glycemic control of children with T1DM from Hunan and Henan Province with flash glucose monitoring system (FGMS), and to explore factors associated with glycemic variability., Methods: A total of 215 children with T1DM under 14 years old were enrolled continuously in 16 hospitals from August 2017 to August 2020. All subjects wore a FGMS device to collect glucose data. Correlation of HbA1c, duration of diabetes, or glucose scan rates with glycemic variability was analyzed. Glucose variability was compared according to the duration of diabetes, HbA1c, glucose scan rates and insulin schema., Results: HbA1c and duration of diabetes were positively correlated with mean blood glucose, standard deviation of glucose, mean amplitude of glucose excursions (MAGE), and coefficient of variation (CV) of glucose (all P <0.01). The glucose scan rates during FGMS wearing was significantly positively correlated with time in range (TIR) ( P =0.001) and negatively correlated with MAGE and mean duration of hypoglycemia (all P <0.01). Children with duration ≤1 year had lower time below range (TBR) and MAGE when compared with those with duration >1 year (all P <0.05). TIR and TBR in patients with HbA1c ≤7.5% were higher (TIR: 65% vs 45%, TBR: 5% vs 4%, P <0.05), MAGE was lower (7.0 mmol/L vs 9.4 mmol/L, P <0.001) than those in HbA1c >7.5% group. Compared to the multiple daily insulin injections group, TIR was higher (60% vs 52%, P =0.006), MAGE was lower ( P =0.006) in the continuous subcutaneous insulin infusion group. HbA1c was lower in the high scan rates (≥14 times/d) group (7.4% vs 8.0%, P =0.046), TIR was significantly higher (58% vs 47%, P <0.001), and MAGE was lower ( P <0.001) than those in the low scan rate (<14 times/d) group., Conclusions: The overall glycemic control of T1DM patients under 14 years old in Hunan and Henan Province is under a high risk of hypoglycemia and great glycemic variability. Shorter duration of diabetes, targeted HbA1c, higher glucose scan rates, and CSII are associated with less glycemic variability.

Simple Summary: A flash glucose monitoring system (FGMS) has been validated for use in dogs with diabetes mellitus and diabetic ketoacidosis. It continuously measures the glucose in the interstitial fluid through a small filament (5 mm long) inserted under the skin. Interstitial glucose concentrations are reportedly comparable to whole blood glucose concentrations. However, several factors can influence the performance of interstitial sensors, including the proportion of interstitial fluid in a tissue. The influence of skin thickness on flash glucose monitoring system accuracy has not been investigated in previous studies; therefore, the aim of this study was to evaluate whether FGMS accuracy is affected by skin thickness. On the basis of our results, skin thickness seems to affect FGMS measurements; the mean bias was significantly inversely correlated (p = 0.02; r = −0.6) with the mean skin thickness, and clinical accuracy according to ISO 15197:2013 criteria was observed only in dogs with skin thickness > 5 mm, with 99% of the results falling in zone A + B of the Parkes consensus error grid analysis. In dogs with thin skin (<5 mm), the clinical accuracy was low, and the results should be interpreted with caution. A flash glucose monitoring system (FGMS) has been validated for use in diabetic dogs. However, it is unknown whether skin thickness affects FGMS measurements. The aim of this study was to evaluate whether FGMS accuracy is affected by skin thickness. Fourteen client-owned diabetic dogs on insulin treatment were prospectively enrolled in the study. The dogs were divided into two groups according to their ultrasound-measured skin thickness: dogs with skin thickness < 5 mm (Group 1) and dogs with skin thickness > 5 mm (Group 2). On days 1, 7 and 14, glucose curves were obtained simultaneously using the FGMS and a validated portable blood glucose meter. Paired measurements were used to calculate the mean bias and to determine accuracy according to ISO 15197:2013 criteria. The mean bias was significantly inversely correlated (p = 0.02; r = −0.6) with the mean skin thickness. Clinical accuracy was observed only in Group 2, with 99% of the results in zone A + B of the Parkes consensus error grid analysis. In conclusion, skin thickness seems to affect FGMS measurements, and the device is accurate in dogs with thicker skin (>5 mm); in dogs with thin skin (<5 mm), the clinical accuracy is low, and the results should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Background and Hypothesis: Patients with type-2 diabetes mellitus (T2DM) on multiple glucose-lowering therapies who fast during Ramadan are at increased risk of hypoglycemia. We have assessed the utility of the flash glucose monitoring system after adjusting the dose of insulin and sulphonylureas to mitigate the risk of hypoglycemia in patients with T2DM who fast during Ramadan.Patients and Methods: Patients with T2DM on either basal insulin or a sulphonylurea and at least 2 other glucose-lowering agents received structured education and adjustment of insulin or sulphonylurea dose according to the PROFAST Ramadan protocol. Glucose variability and episodes of hypoglycemia were assessed using the flash glucose monitoring system (Free Style Libre) before and during Ramadan.Results: A total of 33 patients with T2DM (on sulphonylurea (SU+) (n = 21), on basal insulin (BI+) (n = 12) aged 50.8 ± 1.6 years with a diabetes duration of 13.1 ± 6.5 years were studied. The average sensor glucose was 154 ± 34 mg/dl (8.5 ± 1.88 mmol/l) with 65.2% in the target range before Ramadan and the average sensor glucose was 156 ± 36 mg/dl (8.6 ± 2.0 mmol/l) with 67.1% in the target range during Ramadan. The incidence of hypoglycemia in the whole group (2.9 v 2.9) and in the SU+ (3.7 vs 3.0) and BI+ (1.7 vs 2.9) groups and eHbA1c (P = 0.56, P = 0.93), average glucose (P = 0.56, P = 0.92) and time within range (P = 0.63, P = 0.73) did not change in the SU+ and BI+ groups, respectively, before and during Ramadan.Conclusion: Structured education with adjustment of the dose of glucose lowering medication alongside use of the FGMS can effectively mitigate the increased risk of hypoglycemia in patients with T2DM on multiple glucose-lowering therapies who fast during Ramadan. [ABSTRACT FROM AUTHOR]

Objective: To develop a machine-based algorithm from clinical and demographic data, physical activity and glucose variability to predict hyperglycaemic and hypoglycaemic excursions in patients with type 2 diabetes on multiple glucose lowering therapies who fast during Ramadan.Patients and Methods: Thirteen patients (10 males and three females) with type 2 diabetes on 3 or more anti-diabetic medications were studied with a Fitbit-2 pedometer device and Freestyle Libre (Abbott Diagnostics) 2 weeks before and 2 weeks during Ramadan. Several machine learning techniques were trained to predict blood glucose levels in a regression framework utilising physical activity and contemporaneous blood glucose levels, comparing Ramadan to non-Ramadan days.Results: The median age of participants was 51 years (IQR 49-52); median BMI was 33.2 kg/m2 (IQR 33.0-35.9) and median HbA1c was 7.3% (IQR 6.7-7.8). The optimal model using physical activity achieved an R2 of 0.548 and a mean absolute error (MAE) of 30.30. The addition of electronic health record (ehr) information increased R2 to 0.636 and reduced MAE to 26.89 and the time of the day feature further increased R2 to 0.768 and reduced MAE to 20.55. Combining all the features together resulted in an optimal XGBoost model with an R2 of 0.836 and MAE of 17.47. This model accurately estimated normal glucose levels in 2584/2715 (95.2%) readings and hyperglycaemic events in 852/1031 (82.6%) readings, but fewer hypoglycaemic events (48/172 (27.9%)). The optimal XGBoost model prioritized age, gender, BMI and HbA1c followed by glucose levels and physical activity. Interestingly, the blood glucose level prediction by our model was influenced by use of SGLT2i.Conclusion: XGBoost, a machine learning AI algorithm achieves high predictive performance for normal and hyperglycaemic excursions, but has limited predictive value for hypoglycaemia in patients on multiple therapies who fast during Ramadan. [ABSTRACT FROM AUTHOR]

Background : To investigate the effects of insulin glargine injection given with a QS-P jet injector on the glucose profile using a professional mode flash glucose monitoring (FGM) system in patients with type 2 diabetes mellitus (T2DM). Research design and methods : In this randomized, controlled, cross-sectional study, 66 patients with T2DM who received insulin glargine (12-18 IU/day) injection were enrolled. The patients were randomly divided into group A (jet injector before insulin pen) and group B (insulin pen before jet injector). Each subject injected insulin daily before breakfast. We analyzed the changes in the glucose profile using a professional mode FGM system. Results : Treatment with a jet injector led to significantly lower 24-h mean glucose, maximum blood glucose, area under the curve (AUC) > 10.0 mmol/L, time above range and increased AUC < 3.9 mmol/L and time below range than those when using an insulin pen. There was no difference in glycemic variability between the two groups. We observed that patients using a jet injector had significantly lower mean glucose between 12:00 to 22:00. Conclusions : Needle-free jet injection of insulin glargine was more effective than use of an insulin pen for good glycemic control in patients with T2DM. Clinical trial registration : www.clinicaltrials.gov identifier is NCT04093284.

The aim of this study was to assess the "FreeStyle Libre" flash glucose monitoring system regarding its measurement accuracy and tolerability in cats. Results from 66 sensors applied to 34 predominantly diabetic cats are included. The behaviour during the attachment, wearing, and removal of the sensor and the skin site of attachment were assessed. Blood samples were regularly collected for comparative measurements (hexokinase method). Minimal signs of discomfort were noted, although the sensor was additionally fixed using individual skin stitches. Sensors, which stopped working in situ (70% [46/66]), had a median functional life of 8.3 (1.6-14) days. Skin reactions on the adhesive surface occurred after removal of 39% (23) of 59 sensors with assessable skin reaction (mild erythema: n = 21; superficial dermatitis: n = 2). Due to the upper limit of the measurement range of 27.8 mmol/l (500 mg/dl), the reading device displayed "Hi" in 62% (17/34) of cats repeatedly and/or for periods >1 h. Results were highly correlated with those of the reference method (r S  = 0.90, n = 359). 67.7% (243/359) of the "FreeStyle Libre" measurement values had a maximum deviation of 15% from reference measurements and 99.4% (357/359) were within the zones A and B of Parkes Consensus error grid analysis. In conclusion, the device proved to be practicable, less stressful for the animals and generated in general acceptable results. Although the upper limit of the measurement range is a limiting factor, the device promises to significantly facilitate the management of diabetic cats., (Copyright © 2020. Published by Elsevier Ltd.)

We aimed to explore the use of the flash glucose monitoring (FGM) system in hospitalized newly diagnosed type 2 diabetes mellitus (T2DM) patients and to evaluate a new combination therapy of continuous subcutaneous insulin infusion (CSII) with or without liraglutide. This was an open-label, randomized study that was conducted in 60 newly diagnosed T2DM patients. The patients were randomized to receive either CSII (n = 30) or CSII + liraglutide (n = 30). The FGM system was used to assess the glycemic control and glycemic variability (GV) indices for 2 weeks. Mean blood glucose concentration (MBG), estimated hemoglobin A1c (HbA1c), and measures of GV, including the standard deviation of the mean glucose (SD), coefficient of variation (CV), interquartile range (IQR), mean amplitude of glycemic excursions (MAGE), largest amplitude of glycemic excursions (LAGE), and mean of daily difference (MODD) were compared between the two groups. Two oxidative stress biomarkers, 4-hydroxynonenal (4-HNE) and 8-hydroxydeoxyguanosine (8-OHdG), were measured before and after treatment. The estimated HbA1c and MBG decreased in both groups, especially the CSII + liraglutide group. SD, IQR, LAGE, and MODD were significantly lower in the CSII + liraglutide group than in the CSII group (all p < 0.05); there was no difference in CV or MAGE (p > 0.05). Similarly, the 4-HNE and 8-OHdG levels were significantly lower in the CSII + liraglutide group (p < 0.05). Our findings suggest that CSII with liraglutide was superior to CSII monotherapy in improving glycemic control and glycemic variability and in decreasing oxidative stress markers. Flash glucose monitoring can successfully provide ambulatory glucose profile data in the real world.