The recent announcement of the production of new low-cost continuous glucose monitoring (CGM) sensors, the approval of marketed CGM sensors for making treatment decisions, and new reimbursement criteria have the potential to revolutionize CGM use. After briefly summarizing current CGM applications, we discuss how, in our opinion, these changes are expected to extend CGM utilization beyond diabetes patients, for example, to subjects with prediabetes or even healthy individuals. We also elaborate on how the integration of CGM data with other relevant information, for example, health records and other medical device/wearable sensor data, will contribute to creating a digital data ecosystem that will improve our understanding of the etiology and complications of diabetes and will facilitate the development of data analytics for personalized diabetes management and prevention.

https://journals.sagepub.com/doi/pdf/10.1177/1932296818774078

Continuous Glucose Monitoring: Current Use in Diabetes Management and Possible Future Applications:

One year after its initial meeting, the Glycemia Modeling Working Group reconvened during the 2009 Diabetes Technology Meeting in San Francisco, CA. The discussion, involving 39 scientists, again focused on the need for individual investigators to have access to the clinical data required to develop and refine models of glucose metabolism, the need to understand the differences among the distinct models and control algorithms, and the significance of day-to-day subject variability. The key conclusion was that model-based comparisons of different control algorithms, or the models themselves, are limited by the inability to access individual model-patient parameters. It was widely agreed that these parameters, as opposed to the average parameters that are typically reported, are necessary to perform such comparisons. However, the prevailing view was that, if investigators were to make the parameters available, it would limit their ability (and that of their institution) to benefit from the invested work in developing their models. A general agreement was reached regarding the importance of each model having an insulin pharmacokinetic/pharmacodynamic profile that is not different from profiles reported in the literature (88% of the respondents agreed that the model should have similar curves or be analyzed separately) and the importance of capturing intraday variance in insulin sensitivity (91% of the respondents indicated that this could result in changes in fasting glucose of ≥15%, with 52% of the respondents believing that the variability could effect changes of ≥30%). Seventy-six percent of the participants indicated that high-fat meals were thought to effect changes in other model parameters in addition to gastric emptying. There was also widespread consensus as to how a closed-loop controller should respond to day-to-day changes in model parameters (with 76% of the participants indicating that fasting glucose should be within 15% of target, with 30% of the participants believing that it should be at target). The group was evenly divided as to whether the glucose sensor per se continues to be the major obstacle in achieving closed-loop control. Finally, virtually all participants agreed that a future two-day workshop should be organized to compare, contrast, and understand the differences among the different models and control algorithms.

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Update on Mathematical Modeling Research to Support the Development of Automated Insulin Delivery Systems

Current endeavors in diabetes care focus on helping patients and providers deal successfully with the complexities of the disease by improving the system of care, expanding the reach of interventions, and empowering patients to engage in self-care behaviors. Internet technologies that combine the broad reach of mass media with the interactive capabilities of interpersonal media provide a wide range of advantages over standard modes of delivery. The technical affordances of Web delivery enable individualization or tailoring, appropriately timed reinforcement of educational messages, social support, improved feedback, and increased engagement. In turn, these have been significantly correlated with improved health outcomes.This article is a narrative review of Web-based interventions for managing type 2 diabetes published from 2000 to 2007 that utilize Web sites, Web portals, electronic medical records, videoconference, interactive voice response, and short messaging systems. The most effective systems link medical management and self-management. Patient satisfaction is highest when the Web-based system gives them the ability to track blood glucose, receive electronic reminders, schedule physician visits, email their health care team, and interact with other diabetic patients. However, comprehensive medical and self-management programs have not been implemented widely outside of systems funded by government agencies. The cost of developing and maintaining comprehensive systems continues to be a challenge and is seldom measured in efficacy studies. Lack of reimbursement for Web-based treatments is also a major barrier to implementation. These barriers must be overcome for widespread adoption and realization of subsequent cost savings.

https://journals.sagepub.com/doi/pdf/10.1177/193229680700100615

A review of web-assisted interventions for diabetes management: maximizing the potential for improving health outcomes.

The role of telenursing in the management of Diabetes Type 1: A randomized controlled trial.

Continuous glucose monitoring (CGM) has revolutionised diabetes management. CGM enables complete visualisation of the glucose profile, and the uncovering of metabolic ‘weak points’. A standardised procedure to evaluate the complex data acquired by CGM, and to create patient-tailored recommendations has not yet been developed. We aimed to develop a new patient-tailored approach for the routine clinical evaluation of CGM profiles. We developed a metric allowing screening for profiles that require therapeutic action and a method to identify the individual CGM parameters with improvement potential. Fifteen parameters frequently used to assess CGM profiles were calculated for 1,562 historic CGM profiles from subjects with type 1 or type 2 diabetes. Factor analysis and varimax rotation was performed to identify factors that accounted for the quality of the profiles. We identified five primary factors that determined CGM profiles (central tendency, hyperglycaemia, hypoglycaemia, intra- and inter-daily variations). One parameter from each factor was selected for constructing the formula for the screening metric, (the ‘Q-Score’). To derive Q-Score classifications, three diabetes specialists independently categorised 766 CGM profiles into groups of ‘very good’, ‘good’, ‘satisfactory’, ‘fair’, and ‘poor’ metabolic control. The Q-Score was then calculated for all profiles, and limits were defined based on the categorised groups (<4.0, very good; 4.0–5.9, good; 6.0–8.4, satisfactory; 8.5–11.9, fair; and ≥12.0, poor). Q-Scores increased significantly (P <0.01) with increasing antihyperglycaemic therapy complexity. Accordingly, the percentage of fair and poor profiles was higher in insulin-treated compared with diet-treated subjects (58.4% vs. 9.3%). In total, 90% of profiles categorised as fair or poor had at least three parameters that could potentially be optimised. The improvement potential of those parameters can be categorised as ‘low’, ‘moderate’ and ‘high’. The Q-Score is a new metric suitable to screen for CGM profiles that require therapeutic action. Moreover, because single components of the Q-Score formula respond to individual weak points in glycaemic control, parameters with improvement potential can be identified and used as targets for optimising patient-tailored therapies.

/pdf/q-score-development-of-a-new-metric-for-continuous-glucose-41e2pm384j.pdf

Q-Score: development of a new metric for continuous glucose monitoring that enables stratification of antihyperglycaemic therapies

Background:The Karlsburg Diabetes Management System (KADIS®) was developed over almost two decades by modeling physiological glucose-insulin interactions. When combined with the telemedicine-based communication system TeleDIAB® and a continuous glucose monitoring system (CGMS™), KADIS has the potential to provide effective, evidence-based support to doctors in their daily efforts to optimize glycemic control.Methods:To demonstrate the feasibility of improving diabetes control with the KADIS system, an experimental version of a telemedicine-based diabetes care network was established, and an international, multicenter, pilot study of 44 insulin-treated patients with type 1 and 2 diabetes was performed. Patients were recruited from five outpatient settings where they were treated by general practitioners or diabetologists. Each patient underwent CGMS monitoring under daily life conditions by a mobile monitoring team of the Karlsburg diabetes center at baseline and 3 months following participation in the KAD...

https://dst.sagepub.com/content/1/4/511.full.pdf

Telemedicine-Based KADIS® Combined with CGMS™ Has High Potential for Improving Outpatient Diabetes Care

Objectives: To Evaluate the relationship between Knowledge and Drug adherence in hypertensive patients in UAE. Methodology: A questionnaire was delivered to random sample of 385 hypertensive patients in Abu Dhabi, Sharjah and Ajman. SPSS version 20 was used for data entry and analysis. Results: Out of the 385 patients, 353 (91.7%) had high knowledge value and scored within the high knowledge category while 32 (8.3%) was considered as having poor knowledge and scored within the poor knowledge category.  On the other hand, 325 (84.4%) of the study participants showed good adherence to medication and scored within the positive attitude category while only 60 (15.6%) showed poor adherence to medication and scored within the negative attitude category.  Spearman rank order correlation coefficient (rho) between total knowledge score and total adherence score was used to indicate the association between knowledge and adherence among the study participants.  Conclusion: The result of the study clearly showed that there was positive correlation between knowledge and drug adherence among hypertensive patients in UAE.  Despite this finding, it is believed that medication adherence is a multi-factorial phenomenon and knowledge is only one key of these factors.

/pdf/the-relationship-between-knowledge-and-drug-adherence-in-53521dv4c2.pdf

The Relationship Between Knowledge and Drug Adherence in Hypertensive Patients: A Cross Sectional Study in UAE

Natural sources of treatment have long been sought by humans as a safe alternative to conventional, synthetic medications and antibiotics in order to avoid their complications. The repeated use of antibiotics, especially in minor illnesses results among other side effects and complications, in weakened immunity, antimicrobial resistance, and susceptibility to fungal infections as that caused by Candida albicans. The prolonged use of antibiotics also may lead to gastrointestinal tract disturbances, which usually results in discontinuation of the treatment. We have studied a natural therapy consisting of Allium sativum, Zingiber officinale and Apis mellifera for their potential use in infections. Each component was extracted and prepared according to standard methods and in-vitro tested as a single component and in combination on Staph. aureus, Strep. pyogenes, E. coli and Candida albicans and compared with the standard amoxicillin disk. The combination proved effective in-vitro and hence in-vivo testing was carried out on albino mice to test for antibacterial and analgesic activities as well as prophylactic potential. From both the in-vitro and in-vivo testing, it is concluded that these herbs are effective as antibacterial agents.

Zakia Metwali

Papers

Telemedicine-Based KADIS® Combined with CGMS™ Has High Potential for Improving Outpatient Diabetes Care

The Relationship Between Knowledge and Drug Adherence in Hypertensive Patients: A Cross Sectional Study in UAE

A Natural Alternative to Conventional Antibiotics.