Diabetes Technology &amp Therapeutics (DIABETES TECHNOL THE )

Publisher: Mary Ann Liebert

Description

This new peer-reviewed quarterly journal covers new technology and new products for the treatment, monitoring, diagnosis, and prevention of diabetes and its complications. Technologies include noninvasive glucose monitoring, implantable continuous glucose sensors, novel routes of insulin administration, genetic engineering, the artificial pancreas, measures of longterm control, computer applications for case management, telemedicine, the internet, and new medications.

  • Impact factor
    2.21
  • 5-year impact
    2.25
  • Cited half-life
    3.80
  • Immediacy index
    0.82
  • Eigenfactor
    0.01
  • Article influence
    0.60
  • Website
    Diabetes Technology & Therapeutics website
  • Other titles
    Diabetes technology & therapeutics (Online), Diabetes technology & therapeutics, Diabetes technology and therapeutics
  • ISSN
    1557-8593
  • OCLC
    43498340
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Mary Ann Liebert

  • Pre-print
    • Author cannot archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's final version or publisher's version/PDF
    • Publisher's version/PDF may be used
    • On author's personal website, institution's intranet, or institutional repository
    • Authors may deposit in funder's designated repository after 12 months
    • Set statement to accompany deposit (see policy)
    • Publisher copyright and source must be acknowledged
    • NIH authors will have their final paper, (post peer review, copy-editing and proof-reading) deposited in PubMed Central on their behalf
  • Classification
    ​ blue

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Aim: This study assessed whether Helicobacter pylori infection could influence metformin tolerance in patients with type 2 diabetes mellitus. Subjects and Methods: Demographic, anthropometric, ultrasound, and laboratory data were obtained from 415 metformin-naive patients with diabetes. H. pylori infection was assessed based on the (13)C-labeled urea breath test ((13)C-UBT). The study duration was 4 weeks, and all subjects started metformin from 500 mg/day to 1,500 mg/day progressively. Gastrointestinal side effects were assessed each week, and the metformin doses were adjusted by the compliance. Gastrointestinal side effects were compared between H. pylori-positive and -negative groups. Results: According to the (13)C-UBT results, 220 patients were categorized as H. pylori negative versus 195 as H. pylori positive. At baseline, the scoring of gastrointestinal symptoms showed no statistical difference between the two groups. After 4 weeks, for gastrointestinal symptoms such as abdominal pain, nausea, bloating, and anorexia, the respective percentages in H. pylori-positive and -negative subjects were 44.6% versus 21.8% (P<0.01), 20.0% versus 9.6% (P<0.01), 47.7% versus 23.2% (P<0.01), and 32.8% versus 12.3% (P<0.01). The final metformin dose was 951.28±661.1 mg in H. pylori-positive subjects, significantly less than that in H. pylori-negative subjects (1,209.09±522.91 mg) (P<0.01). On multivariate analysis, female gender, H. pylori infection, body mass index, triglycerides, age, and low-density lipoprotein-cholesterol were the independent parameters associated with any gastrointestinal symptoms. Conclusions: Patients with diabetes having H. pylori infection demonstrated more gastrointestinal side effects than those without H. pylori infection after taking metformin. Furthermore, female gender, H. pylori infection, body mass index, triglycerides, age, and low-density lipoprotein-cholesterol are independent determinants of metformin's side effects.
    Diabetes Technology &amp Therapeutics 11/2014;
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    ABSTRACT: Abstract Objectives: This study assessed the relationship between diabetic retinopathy (DR) and coronary artery diseases (CAD) in Asian Indians, who are known to be at high risk of CAD and diabetes but have lower prevalence of DR. Subjects and Methods: Type 2 diabetes subjects (n=1,736) were selected from the urban component of the population-based Chennai Urban Rural Epidemiology Study Eye Study. Four-field stereo retinal color photography was done, and DR when present was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Among the 1,723 subjects with gradable fundus photographs, 12-lead electrocardiogram (ECG) was performed in 1,602 individuals, and analysis was restricted to this group. CAD was diagnosed based on documented medical history of CAD or Minnesota coding of ECGs. Results: The prevalence of CAD was significantly higher among subjects with DR compared with those without (11.3% vs. 6.7%; P=0.007). A significant association was observed between DR and CAD in subjects with glycated hemoglobin (HbA1c) levels >7% (P=0.002). After controlling for age and gender, only hard exudates were associated with CAD (P=0.032). Logistic regression analysis revealed that even after adjusting for age, gender, HbA1c, mean arterial blood pressure, smoking, serum cholesterol, triglyceride, and low-density lipoprotein cholesterol levels, DR was significantly associated with CAD among the study subjects (odds ratio [OR]=1.58; 95% confidence interval [CI], 1.00-2.49; P=0.049) and those subjects with duration of diabetes >10 years (OR=4.06; 95% CI, 1.55-10.60; P=0.004). Conclusions: This cross-sectional study shows a significant association between DR and CAD in South Indian subjects with type 2 diabetes.
    Diabetes Technology &amp Therapeutics 11/2014;
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    ABSTRACT: Abstract Background: Insulin is an essential therapy for patients with type 1 diabetes mellitus (T1DM). With the progression of the disease, many patients with T1DM may have an increased prevalence of insulin resistance; thus the common standard insulin therapy requires a high insulin dosage (>1 unit/kg/day) and is usually associated with many side effects. Studies have shown that metformin may benefit those insulin-resistant individuals with T1DM. This meta-analysis was performed to provide the evidence of clinical efficacy and safety of metformin in T1DM. Materials and Methods: We conducted a search on Medline, EMBASE, and the Cochrane Library for relevant studies published before May 2014 based on "metformin" and "diabetes mellitus, type 1." The following outcomes were evaluated: hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), lipid metabolism, weight, insulin dosage, hypoglycemia, diabetic ketoacidosis, or gastrointestinal adverse events (AEs). The meta-analysis was performed using Review Manager version 5.2 software (The Nordic Cochrane Centre, Copenhagen, Denmark). Results: In total, eight randomized controlled trials were included. Metformin was associated with a reduction in daily insulin dosage, body weight, total cholesterol level, low-density lipoprotein level, and high-density lipoprotein level but an increase in risk of gastrointestinal AEs compared with placebo treatment in T1DM patients. No significant difference was found between the metformin group and the placebo group in HbA1c level, FPG level, or triglycerides level. No significant difference was found between the metformin group and the placebo group in the risk of severe hypoglycemia or diabetic ketoacidosis. Conclusions: Metformin may decrease the daily insulin dosage, body weight, and lipid levels in T1DM. However, metformin does not increase the incidence of hypoglycemia and ketoacidosis. High-quality, large-sample, and long-term follow-up clinical trials are needed to confirm these conclusions.
    Diabetes Technology &amp Therapeutics 11/2014;
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    ABSTRACT: Abstract Background: The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control. Subjects and Methods: Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control. Results: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [χ(2)(275)=450.07, P<0.001, R(2)=99, root mean square error of approximation=0.03, comparative fit index=0.98] showed lower psychological distress (r=-0.13, P=0.012), higher social support (r=0.14, P=0.01), and higher self-efficacy (r=0.47, P<0.001) were significantly related to diabetes self-care. Lower psychological distress (r=0.10, P=0.03), lower social support (r=0.10, P=0.02), and higher self-efficacy (r=-0.37, P<0.001) were significantly related to lower glycemic control. When social determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r=0.01, P=0.83). Conclusions: This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Background: The Impact of Weight on Self-Perceptions Questionnaire (IW-SP) assesses an individual's self-perception related to his or her weight. The primary objective of this study was to provide evidence of the reliability, validity, and responsiveness of the IW-SP. Materials and Methods: Study participants were individuals with type 2 diabetes mellitus (T2DM) and obesity enrolled in clinical weight-loss programs in the United States. Data were obtained for clinical measures, IW-SP, and other patient-reported outcome measures. An intraclass correlation coefficient (ICC) and Cronbach's α were calculated for test-retest reliability and internal consistency, respectively. For validity, correlations and t tests were performed. For responsiveness, baseline and 6-month data for a subgroup of patients were analyzed using the paired t test and calculation of effect size (ES). Results: Reliability data for 106 study participants (mean age, 52 years; 69% female; 31% white; mean body mass index, 38 kg/m(2)) yielded an ICC of 0.85 and Cronbach's α values of >0.89. IW-SP scores were associated with obesity-related quality of life, mental health, and vitality (r>0.50, P<0.001). In the subgroup (n=40) used to estimate responsiveness, weight was significantly less at end point than at baseline (mean, baseline=231.9 vs. end point=222.0 pounds; P<0.001; ES=0.23), and IW-SP scores were significantly better than at baseline (mean, baseline=61.0 vs. end point=72.1 [on a scale of 0-100]; P=0.01; ES=0.34). Mean IW-SP change scores significantly discriminated between those achieving >5% body weight loss and those who achieved <5% (mean change, 23.6 vs. 5.7; P=0.03). Conclusions: The IW-SP has demonstrated reliability, validity, and responsiveness in individuals with T2DM and obesity, thereby making it a potentially valuable tool in the evaluation of weight-loss interventions targeted toward patients with T2DM.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). Conclusions: A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Background: Intramuscular (IM) injection can increase insulin absorption, causing hypoglycemia. Available needle lengths today are 4-12.7 mm for pens and 6-12.7 mm for syringes. We describe the distance (D) from skin surface to muscle fascia at injection sites for subcutaneous (SC) insulin therapy and recommend needle lengths to reduce IM injection risk. Materials and Methods: At two locations in the United States, skin and SC fat thicknesses were measured by ultrasound at the abdomen, arm, thigh, and buttock in diverse adults (body mass index [BMI] range, approximately 19-65 kg/m(2)) with diabetes (n=341 with one or more paired skin and SC measurement, permitting calculation of D). The natural log of D by body site, BMI, and gender were analyzed using a mixed model to estimate IM risk. Results: D varied significantly by body site, BMI, and gender (each P<0.001), increasing with higher BMI and in women. Median D ranged from 10.9 mm (95% confidence interval, 10.3, 11.6) at the thigh to 16.9 mm (15.9, 18.1) at the buttock. Minimum D was <3 mm at the thigh and <5 mm elsewhere. When inserted 90° without pinch-up, the most commonly used needle worldwide (8 mm) has estimated IM risks of 25% and 9.7%, respectively, in the thigh and abdomen, versus 1.6% and 0.1%, respectively, with a 4 mm needle. A 45° insertion reduces, but does not eliminate, IM risk with longer needles. Conclusions: Gender, BMI, and body site affect D; when combined with needle length and insertion angle, these factors permit detailed estimates of IM insulin injection risk. Such risk varies across sites, appears greatest at the thigh, is unnecessarily increased with 8 mm and 12.7 mm needles, and is greatly reduced with shorter-length needles and good injection technique.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Background: Hyperglycemia occurs in cancer patients receiving high-dose steroids with cyclophosphamide, doxorubicin, vincristine, and dexamethasone (hyper-CVAD) protocol. The purpose of our study was to determine insulin requirements in patients with hyperglycemia on hyper-CVAD therapy using a systematic algorithm. Subjects and Methods: We did a retrospective chart review of 23 leukemia inpatients with hyperglycemia (two glucose values >250 mg/dL) on hyper-CVAD chemotherapy managed by the Endocrine Diabetes Inpatient Team algorithm. We reviewed demographic and glycemic data, insulin dosages, and use of oral hypoglycemic agents. Using our algorithm, the dose of insulin for each patient was titrated daily and with each subsequent cycle of hyper-CVAD. Results: Ninety-one percent of patients had known diabetes. The median body mass index was 32.5 (range, 21.6-40.9) kg/m(2), and median age was 61 (range, 40-80) years. The overall trend in glucose values across cycles showed a statistically significant decrease with each subsequent cycle of hyper-CVAD. Hyperglycemia accounted for 81% of glucose measurements in the first cycle and 60% of glucose values in the last cycle. Patients received 1-1.3 units/kg of insulin per cycle, and insulin requirements were similar across cycles. The distribution of basal versus bolus insulin for each cycle was 63-77% prandial and 23-37% basal. Nine of the 23 patients had at least one glucose value <70 mg/dL, which accounted for 1.3% of all recorded glucose values. None of the patients had severe hypoglycemia. Conclusions: Multiple-dose insulin therapy initiated at 1-1.2 units/kg/day, distributed as 25% basal and 75% prandial, reduced hyperglycemia in patients who were receiving high-dose dexamethasone as part of hyper-CVAD.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Objective: Continuous subcutaneous insulin infusion (CSII) is an effective method of intensive therapy for patients with type 1 diabetes; however, most studies have not examined long-term glycemic control. We evaluated the long-term efficacy of CSII in a cohort of adult patients with type 1 diabetes. Subjects and Methods: This was a retrospective observational study of 200 patients with type 1 diabetes who initiated CSII at a single outpatient clinic in Kingston, ON, Canada between January 1998 and December 2012. Data were collected from 3 months prior to and up to 15 years after initiation of CSII and included glycated hemoglobin (HbA1c) level and demographic factors potentially associated with glycemic control. Results: Mean age and duration of diabetes at CSII initiation were 35.4 years and 22.4 years, respectively. Mean duration of CSII at the time of analysis was 6 years. Mean HbA1c at initiation of CSII was 8.7% and decreased to a nadir of 7.5% 6 months post-initiation (SD=1.0) (P<0.001). This increased over time (range, 7.8-8.2%) but remained lower than the pre-CSII HbA1c (P<0.001). Shorter duration of diabetes prior to CSII initiation, history of missed appointments, mental illness, and active smoking were predictors of higher HbA1c on CSII. Pre-CSII HbA1c predicted long-term HbA1c on CSII. Conclusions: The data demonstrate that in a clinic setting, patients on CSII maintain lower HbA1c values over a 1-10-year period compared with pre-CSII values. Poor pre-CSII HbA1c, history of missed appointments, mental illness, and active smoking are predictors of those less likely to achieve an HbA1c target of ≤7.0%.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Background: Diabetes is a systemic disease affecting many organs, including skin. Skin may reflect the condition of internal organs. The aim of our study was to measure skin pH in type 1 diabetes mellitus (T1DM) patients and in healthy controls and to evaluate the association between metabolic control of diabetes and skin acidity in T1DM patients. Materials and Methods: The study was conducted on 105 patients with T1DM and 53 age- and sex-matched healthy people. Skin surface pH was measured in three different areas of the body (cheek, forearm, and foot) in diabetes patients and healthy controls. The results were compared for patients' and controls' clinical characteristics and for patients' metabolic control and also evaluated according to the presence of complications of diabetes. Results: Patients with T1DM had lower skin pH compared with the control group in three measured areas: within the cheek (5.49±0.42 vs. 5.69±0.31; P=0.001), forearm (5.41±0.46 vs. 5.73±0.69; P=0.004), and foot (5.20±0.53 vs. 5.41±0.41; P=0.008). In the multiple linear regression skin pH was negatively correlated with fasting plasma glucose on the cheek (β=-0.34, P=0.0004), forearm (β=-0.30, P=0.0009), and foot (β=-0.18, P=0.04). Diabetes patients with glycated hemoglobin (HbA1c)≥8% had significantly lower skin pH than patients with better glycemic control (HbA1c<8%). However, we observed a statistically significant difference only on the foot (5.09±0.50 vs. 5.34±0.55; P=0.019). Conclusions: Skin surface pH is lower in individuals with diabetes, and it is negatively related to actual and chronic hyperglycemia.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Background: Body sway increases in the elderly because of normal aging and high incidence of disease such as diabetes. Prevalence of sway is greater in the elderly with diabetes because of damage to the central and peripheral nervous systems. Increase in body sway is associated with an elevated risk of falling. Falling is one of the major causes of morbidity and mortality in the elderly. The purpose of this study was to develop a new technique to improve body stability and decrease body sway in the elderly people with or without diabetes. Subjects and Methods: Twenty-two subjects-12 elderly (mean age, 75.5±7.3 years) and 10 age-matched elderly with diabetes (mean age, 72.5±5.3 years)-were recruited for this study. Subjects received tactile feedback as a tingling sensation resulting from electrical stimulation triggered by body sway. Results: The results showed a significant reduction in body sway in the elderly while standing on foam with eyes open (1.0±0.31 vs. 1.9±0.8; P=0.006) and eyes closed (1.8±0.7 vs. 3.3±1.5; P=0.001). In the group with diabetes, there was a significant reduction in body sway while standing on foam with eyes closed (1.4±0.5 vs. 2.3±0.8; P=0.045) but not with eyes open. Conclusions: In this small study, this technique offers a new tool for training people with diabetes and elderly people to improve body stability and balance.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Objective: This study assessed the level of patient satisfaction with diabetes remote consultations via videoconferencing in a virtual outreach clinic. Materials and Methods: A cross-sectional observational survey was conducted of people with diabetes who were living in regional cities of Queensland, Australia, and remotely consulted by endocrinologists at the Princess Alexandra Hospital tele-endocrinology clinic in Brisbane during autumn 2013. A questionnaire with 15 multiple-choice questions and one open-ended question was developed for assessing patient satisfaction with videoconferencing for specialty consultation. The questionnaire items showed strong internal consistency (Cronbach's α=0.90). Patient satisfaction was assessed by this 16-item questionnaire exploring four dimensions: equipment/technical issues; communication and rapport; clinical assessment; and program evaluation. Results: In total, 62 questionnaires were mailed to the patients, with 24 (39%) surveys completed and returned. The quality of video had the highest satisfaction rate (100%). The lowest satisfaction scores were reported in the "Clinical Assessment" dimension, in which 21% of respondents (five of 24) were concerned that the lack of physical contact could be a problem for managing their diabetes. The patients did not report any problem with building rapport with their consultant over the videoconference. Conclusions: The patients with diabetes who were seen remotely by endocrinologists via videoconferencing were generally satisfied with remote consultation. The questionnaire developed specifically for diabetes video teleconsultation in this study is useful for the measurement of patient satisfaction, and a modified version may be used in other clinical specialties.
    Diabetes Technology &amp Therapeutics 10/2014;
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    ABSTRACT: Abstract Background: The purpose was to describe patterns of home self-monitoring of blood glucose (SMBG) in Mexican Americans with type 2 diabetes mellitus enrolled in a diabetes self-management education protocol. Research questions were as follows: (1) What were the patterns and rates of home glucose self-monitoring over the 6-month course of the study? (2) What were the differences in monitoring rates between experimental and control groups? (3) What were the relationships between rates of monitoring and glycosylated hemoglobin (A1C), gender, and years with diabetes? Subjects and Methods: We used a randomized (by group) repeated-measures pretest/posttest control group design. Glucometer data from an experimental group (diabetes self-management education plus nurse case management) and a comparison group (diabetes self-management education only) were analyzed. Data were collected at baseline and at 3 and 6 months. Results: Overall average SMBG rates were low. Experimental and control group monitoring levels were not significantly different. More females than males never monitored glucose values, but more females than males checked at least one time per week. Those participants who checked their glucose levels more than once per week had diabetes for a longer period of time. Rates of monitoring were not strongly associated with A1C levels at 3 and 6 months, but at 6 months A1C levels were statistically significantly different based on whether or not individuals monitored their glucose levels (P=0.03, n=71). Conclusions: SMBG rates were low in this study despite SMBG education and access to free glucometers and test strips. The lower rates of SMBG may reflect the effects of unexpected environmental challenges, but exact causes remain unclear. Reasons for low rates of SMBG need to be explored further, especially in underserved communities.
    Diabetes Technology &amp Therapeutics 10/2014;
  • Diabetes Technology &amp Therapeutics 10/2014; 16(10):611-612.
  • Diabetes Technology &amp Therapeutics 09/2014;
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    ABSTRACT: Abstract Background: This study evaluated the accuracy of Contour(®) Next (CN; Bayer HealthCare LLC, Diabetes Care, Whippany, NJ) compared with five blood glucose monitoring systems (BGMSs) across a wide range of clinically occurring blood glucose levels. Subjects and Methods: Subjects (n=146) were ≥18 years and had type 1 or type 2 diabetes. Subjects' glucose levels were safely lowered or raised to provide a wide range of glucose values. Capillary blood samples were tested on six BGMSs and a YSI glucose analyzer (YSI Life Sciences, Inc., Yellow Springs, OH) as the reference. Extreme glucose values were achieved by glucose modification of the blood sample. System accuracy was assessed by mean absolute difference (MAD) and mean absolute relative difference (MARD) across several glucose ranges, with <70 mg/dL evaluated by MAD as the primary end point. Results: In the low glucose range (<70 mg/dL), MAD values were as follows: Accu-Chek(®) Aviva Nano (Roche Diagnostics, Indianapolis, IN), 3.34 mg/dL; CN, 2.03 mg/dL; FreeStyle Lite(®) (FSL; Abbott Diabetes Care, Inc., Alameda, CA), 2.77 mg/dL; OneTouch(®) Ultra(®) 2 (LifeScan, Inc., Milpitas, CA), 10.20 mg/dL; OneTouch(®) Verio(®) Pro (LifeScan, Inc.), 4.53 mg/dL; and Truetrack(®) (Nipro Diagnostics, Inc., Fort Lauderdale, FL), 11.08 mg/dL. The lowest MAD in the low glucose range, from CN, was statistically significantly lower than those of the other BGMSs with the exception of the FSL. CN also had a statistically significantly lower MARD than all other BGMSs in the low glucose range. In the overall glucose range (21-496 mg/dL), CN yielded the lowest MAD and MARD values, which were statistically significantly lower in comparison with the other BGMSs. Conclusions: When compared with other BGMSs, CN demonstrated the lowest mean deviation from the reference value (by MAD and MARD) across multiple glucose ranges.
    Diabetes Technology &amp Therapeutics 09/2014;
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    ABSTRACT: Abstract Background: Closed-loop control of blood glucose levels in people with type 1 diabetes offers the potential to reduce the incidence of diabetes complications and reduce the patients' burden, particularly if meals do not need to be announced. We therefore tested a closed-loop algorithm that does not require meal announcement. Materials and Methods: A multiple model probabilistic predictive controller (MMPPC) was assessed on four patients, revised to improve performance, and then assessed on six additional patients. Each inpatient admission lasted for 32 h with five unannounced meals containing approximately 1 g/kg of carbohydrate per admission. The system used an Abbott Diabetes Care (Alameda, CA) Navigator(®) continuous glucose monitor (CGM) and Insulet (Bedford, MA) Omnipod(®) insulin pump, with the MMPPC implemented through the artificial pancreas system platform. The controller was initialized only with the patient's total daily dose and daily basal pattern. Results: On a 24-h basis, the first cohort had mean reference and CGM readings of 179 and 167 mg/dL, respectively, with 53% and 62%, respectively, of readings between 70 and 180 mg/dL and four treatments for glucose values <70 mg/dL. The second cohort had mean reference and CGM readings of 161 and 142 mg/dL, respectively, with 63% and 78%, respectively, of the time spent euglycemic. There was one controller-induced hypoglycemic episode. For the 30 unannounced meals in the second cohort, the mean reference and CGM premeal, postmeal maximum, and 3-h postmeal values were 139 and 132, 223 and 208, and 168 and 156 mg/dL, respectively. Conclusions: The MMPPC, tested in-clinic against repeated, large, unannounced meals, maintained reasonable glycemic control with a mean blood glucose level that would equate to a mean glycated hemoglobin value of 7.2%, with only one controller-induced hypoglycemic event occurring in the second cohort.
    Diabetes Technology &amp Therapeutics 09/2014;