Glucose sensor excludes hypoglycaemia as cause of death
Department of Endocrinology, Hvidovre University Hospital, Hvidovre, Denmark.Diabetes research and clinical practice (Impact Factor: 2.54). 02/2012; 96(2):e30-2. DOI: 10.1016/j.diabres.2012.01.019
The cause of death can be difficult to verify post-mortem in unexpected deaths in patients with Type 1 diabetes. This report describes an unexpected death in a 44-year-old man with Type 1 diabetes treated with sensor-augmented pump therapy. Continuous glucose monitoring data proved useful in determining the cause of death.
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ABSTRACT: Background: This follow-up study investigates the metabolic and psychosocial effects of sensor-augmented pump (SAP) therapy in adults with type 1 diabetes 36 months after therapy start. Subjects and methods: We invited all 24 Danish adults with type 1 diabetes who had previously participated in the European multicenter randomized controlled Eurythmics Trial. Thirteen of the 24 patients started SAP therapy during the Eurythmics Trial; 11 patients were controls but started using SAP immediately after completion of the trial. In the current study, we estimated the effects of SAP 36 months after therapy start by change in glycated hemoglobin (HbA1c) and diabetes questionnaire scores (Diabetes Treatment Satisfactions Questionnaire [DTSQs], Problem Areas in Diabetes [PAID] questionnaire, and Hypoglycemia Fear Survey [HFS]). Results: At 36 months, 16 of the 24 patients were still using SAP, 14 of them > 70% of time. The HbA1c level decreased from 8.7% at therapy start to 7.3% at 36 months (P < 0.0001). Similar reductions in HbA1c were obtained regardless of whether SAP therapy was initiated during or after the Eurythmics Trial. DTSQs, PAID questionnaire, and HFS scores improved by 9.0 (P < 0.0001), -10.8 (P = 0.013), and -5.5 (P = 0.152), respectively, in the 16 SAP users. Conclusions: This study documents persisting beneficial effects of SAP on HbA1c, treatment satisfaction, magnitude of diabetes-related problems, and fear of hypoglycemia 36 months after therapy start. The follow-up is considerably longer than in other published studies; still, the results are in line with the positive short-term outcomes of larger studies of SAP use.
Article: Continuous glucose monitors[Show abstract] [Hide abstract]
ABSTRACT: Advances in diabetes technologies allow patients to manage their diabetes with greater precision and flexibility. Many recent studies show that continuous glucose monitors (CGMs) can be used to tighten glycemic control safely and to ease certain burdens of diabetes self-management. The following summary reflects the most recent findings in CGM and provides an overall review of who would most benefit from CGM use. Benefits of CGM may vary based on age, type of diabetes, pregnancy, health, sleep, or heart rate. Accuracy and reliability are critical in current uses of CGM and especially for new and future systems that automate insulin partially (e.g., low glucose suspend) or entirely (e.g., 'fully closed-loop' artificial pancreas). Clinicians are simultaneously testing available products in new patient groups such as the critically ill and type 2 diabetes patients not using mealtime insulin. In a widening set of circumstances, use of CGM has been shown to promote safer and more effective glycemic control than self-monitoring of blood glucose. Imperfections remain in certain scenarios such as hypoglycemia and in certain populations such as young children. Ongoing research on sensors and calibration software should translate to better systems.
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ABSTRACT: Type 1 diabetes is a chronic condition characterized by insufficient production of insulin, a hormone needed for proper control of blood glucose levels. People with type 1 diabetes must monitor their blood glucose throughout the day using a glucose meter or a continuous glucose monitor, calculate how much insulin is needed to maintain normal blood glucose levels, and administer the insulin dose by pen injection or insulin pump infusion into the subcutaneous tissue. In recent years, several new technologies for the treatment of type 1 diabetes have been developed. This PhD thesis covers two studies of the effects of commercially available technologies - sensor-augmented pump therapy and automated insulin bolus calculators - when used in clinical practice. Both studies demonstrated that these technologies have the potential to improve diabetes care. In addition, two in-clinic studies related to emerging technologies - closed-loop glucose control and virtual simulation environments - are included in the thesis. The results of these experiments provided proof of concept and will serve as a basis for further research in these fields.
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