| 1. |
- Adolfsson, Peter, 1963, et al.
(författare)
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Accuracy and reliability of continuous glucose monitoring in individuals with type 1 diabetes during recreational diving
- 2009
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert. - 1557-8593 .- 1520-9156. ; 11:8, s. 493-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study evaluated the accuracy and function of the Continuous Glucose Monitoring System (CGMS, Minneapolis, MN) during recreational scuba diving in individuals with type 1 diabetes. METHODS: Twenty-four adults, 12 with type 1 diabetes and 12 healthy controls, were studied during five recreational scuba dives performed on three consecutive days. All the participants used the CGMS on all the days and during all the dives. Comparisons were made between plasma glucose at specific time intervals and the CGMS. RESULTS: The recording by the CGMS was robust, with few sensor problems. The mean sensor survival time was >48 h. Eighty-five percent of the individuals used one sensor during the entire length of the trial. The overall mean absolute difference (MAD) within the group with diabetes was 14.4 +/- 6%, and the corresponding daily figures were 23.2 +/- 19.3% on day 1, 11.6 +/- 4.5% on day 2, and 11.2 +/- 5.7% on day 3. A significant improvement regarding MAD when day 1 was compared with day 2 and 3 (P < 0.05). With a limit set at 70 mg/dL, hypoglycemia pre- and post-dive was detected with a positive predictive value of 0.39, negative predictive value of 0.98, sensitivity of 0.64, and specificity of 0.94. CONCLUSIONS: We demonstrate that the CGMS was used with accuracy in such difficult conditions as scuba diving and provided robust information on glucose variations.
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| 2. |
- Bohman, Sara, et al.
(författare)
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No differences in efficacy between noncultured and cultured islets in reducing hyperglycemia in a nonvascularized islet graft model
- 2006
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 8:5, s. 536-545
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although islet transplantation is a promising method to restore normoglycemia in recipients with diabetes, large numbers of pancreatic islets are still needed. It has been suggested that the use of freshly isolated islets could improve transplantation outcome through better vascular engraftment. Using a technique of microencapsulation, a model where revascularization is not possible, we investigated the importance of revascularization for transplantation outcome. Methods: Either 700 or 350 3-day-cultured or noncultured encapsulated islets were transplanted intraperitoneally into syngeneic mice with alloxan-induced diabetes. In addition, 700 nonencapsulated islets were transplanted to mice with diabetes. Blood glucose concentrations were monitored, and glucose tolerance tests were carried out. After 42 days, the encapsulated islets were retrieved and assayed for glucose oxidation and insulin release rates. Results: There were no differences between capsules containing fresh or cultured islets in their capacity to lower the blood glucose concentration of the recipients or in the in vitro function after capsule retrieval. Interestingly, mice that were intraperitoneally transplanted with 700 encapsulated islets had average blood glucose levels well below 11 mM for most of the study, whereas the same number of nonencapsulated islets had no beneficial effects on the blood glucose homeostasis. Conclusions: Encapsulated islets can reverse hyperglycemia after transplantation to the intraperitoneal site. This effect was not seen when nonencapsulated islets were grafted. Since a 3-day culture period did not influence the outcome of transplantation of encapsulated islets there is evidence to suggest that a more appropriate revascularization may explain why freshly isolated islets are more efficient than cultured islets.
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| 3. |
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| 4. |
- Jamali, Reza, 1967-, et al.
(författare)
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Continuous glucose monitoring system signals the occurrence of marked postprandial hyperglycemia in the elderly
- 2005
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 7:3, s. 509-515
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to ascertain whether dysglycemic episodes occur in institutionalized elderly persons and, if that is the case, to determine whether such episodes are related to meal patterns. Another objective was to investigate the feasibility of subcutaneous (s.c.) glucose measurements in the elderly using a Medtronic MiniMed (Sylmar, CA) continuous glucose monitoring system (CGMS®). Methods: Nine nursing home residents (74-95 years old) without known diabetes or other metabolic disorders were included. The s.c. glucose level was measured for 3 days with the Medtronic MiniMed CGMS. Capillary blood glucose was measured four times daily with a Glucometer Elite® device (Bayer, Leverkusen, Germany). Body mass index and basal metabolic rate were calculated, and food intake was recorded. Results: The s.c. glucose level fluctuated noticeably over time, 22.5% of the values recorded during the 3-day period were ≥8 mmol/L, and values <3.5 mmol/L were rarely seen. A marked (>5 mmol/L) and short-term (2-4 h) increase in s.c. glucose was seen after a meal. The mean capillary blood glucose concentration was 7.5 ± 1.8 mmol/L. Capillary blood glucose ≥8 mmol/L was recorded on 32.5% of the measurement occasions, and no values were <3.5 mmol/L. The s.c. glucose values agreed with corresponding capillary blood glucose levels (mean r = 0.75, range 0.43-0.86). Five participants consumed less energy than recommended according to their age, weight, and physical activity level. Conclusions: Postprandial hyperglycemia frequently occurs in elderly people living in nursing homes. The CGMS is convenient to use to detect hyperglycemia in this age group.
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| 5. |
- Lind, Marcus, 1976, et al.
(författare)
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The effect of insulin lispro on glycemic control in a large patient cohort.
- 2009
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Ingår i: Diabetes technology & therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 11:1, s. 51-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The use of rapid-acting insulin analogs and regular insulin differs considerably in countries throughout the world. We therefore studied how glycemic control has been affected by using insulin lispro in clinical practice over 5 years in 14 hospitals in Sweden. METHODS: We used a time period when most patients had not changed the basal insulin, but only the mealtime insulin. Accordingly the most recent years were not suitable since many patients had changed basal insulin from NPH to glargine or determir. We therefore analyzed the metabolic consequences on glycosylated hemoglobin (HbA1c) when changing from regular insulin to insulin lispro from 1997 and during the following 5 years. We studied 1,069 patients with diabetes taking NPH insulin as basal insulin and at least three daily injections of regular insulin, of whom 423 changed their mealtime insulin to insulin lispro and 646 controls who continued with regular insulin. RESULTS: Patients changing to insulin lispro on average decreased by 0.19% units more in HbA1c than those remaining on regular insulin. The effect was most pronounced in patients with high HbA1c even after controlling for regression to the mean. A beneficial effect of insulin lispro was also indicated since patients had the same level of HbA1c during a long period of time with regular insulin but then dropped when changing to insulin lispro. CONCLUSIONS: This study indicates that insulin lispro has had a beneficial and persisting effect on glycemic control when used in patients with diabetes on multiple daily injections of insulin in clinical practice.
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| 6. |
- Nordfeldt, Sam, 1957-, et al.
(författare)
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Development of a PC-based diabetes simulator in collaboration with teenagers with Type 1 diabetes
- 2007
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 9:1, s. 17-25
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Tidskriftsartikel (refereegranskat)abstract
- Background: The main aim of this study was to develop and test in a pilot study a PC-based interactive diabetes simulator prototype as a part of future Internet-based support systems for young teenagers and their families. A second aim was to gain experience in user-centered design (UCD) methods applied to such subjects. Methods: Using UCD methods, a computer scientist participated in iterative user group sessions involving teenagers with Type 1 diabetes 13-17 years old and parents. Input was transformed into a requirements specification by the computer scientist and advisors. This was followed by gradual prototype development based on a previously developed mathematical core. Individual test sessions were followed by a pilot study with five subjects testing a prototype. The process was evaluated by registration of flow and content of input and opinions from expert advisors. Results: It was initially difficult to motivate teenagers to participate. User group discussion topics ranged from concrete to more academic matters. The issue of a simulator created active discussions among parents and teenagers. A large amount of input was generated from discussions among the teenagers. Individual test runs generated useful input. A pilot study suggested that the gradually elaborated software was functional. Conclusions: A PC-based diabetes simulator may create substantial interest among teenagers and parents, and the prototype seems worthy of further development and studies. UCD methods may generate significant input for computer support system design work and contribute to a functional design. Teenager involvement in design work may require time, patience, and flexibility. © Mary Ann Liebert, Inc.
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| 7. |
- Roback, Kerstin, et al.
(författare)
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Feasibility of a Thermographic Method for Early Detection of Foot Disorders in Diabetes
- 2009
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Ingår i: DIABETES TECHNOLOGY and THERAPEUTICS. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 11:10, s. 663-667
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Tidskriftsartikel (refereegranskat)abstract
- Background: Foot complications due to diabetes impose a major economic burden to society and loss of health-related quality of life for the patients. Early diagnosis and intensified preventive measures have proved useful to limit the incidence of foot ulcers and lower limb amputations in diabetes, and the development of new tools for early diagnosis has therefore become an attractive option. This article covers a feasibility study of the SpectraSole (Linkoping, Sweden) Pro 1000 foot indicator, an innovation based on liquid crystal thermography. The technology identifies increases in temperature, a known indicator of inflammation. Methods: Sixty-five patients with diagnosed diabetes were examined with the foot indicator immediately after their ordinary foot examinations according to current practice, and findings from the two investigations were compared. Results: Sixty-nine examinations were performed. The foot indicator identified increased temperature in 31 cases, of which six had not been detected in the preceding ordinary examinations. The instrument was perceived as easy to use, and the thermographs could be used to visualize problem areas of the foot, which might contribute to better compliance with therapeutic advice. Conclusions: The foot indicator detected a relatively high share of the different types of complications but not all. It can be used as a complement to current practices for foot examination. The instrument provides rapid imaging of the foot temperature, and the study indicates that it yields valuable diagnostic information in early stages of foot disease.
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| 8. |
- Wollmer, Per, et al.
(författare)
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Delivering needle-free insulin using AERx (R) iDMS (Insulin Diabetes Management System) technology
- 2007
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 9, s. 57-64
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Tidskriftsartikel (refereegranskat)abstract
- Background and Methods: Inhaled insulin has recently emerged as an alternative to subcutaneous insulin administration. One inhaled insulin device, AERx (R) (a registered trademark of Aradigm Corp., Hayward, CA, or its affiliates in the United States and other countries) insulin diabetes management system (iDMS) (Novo Nordisk A/S, Bagsvoerd, Denmark), uses a unique liquid human insulin strip to deliver an aerosol of insulin to the lungs. AERx iDMS enables 1-unit increment dosing, and the device ensures that the insulin dose is released at the optimal point of inhalation for delivery to the lungs. Results: Compared with subcutaneous human insulin, the pharmacokinetic and pharmacodynamic profile of inhaled insulin with AERx iDMS is similar, but with a more rapid onset of action. Data from these pharmacokinetic studies have also demonstrated that inhaled insulin dosing with AERx iDMS is as consistent and reproducible as subcutaneous human insulin. Conclusions: In individuals with diabetes prandial inhaled insulin with AERx iDMS is as effective and well tolerated as subcutaneous prandial human insulin or insulin aspart in terms of glycemic control and overall hypoglycemia. No major safety concerns have been raised with respect to pulmonary function tests. Other clinical studies using AERx iDMS in special populations, such as smokers, people with asthma, or people suffering from upper respiratory tract infections, have provided important information regarding the use of inhaled insulin in these circumstances. Overall, pulmonary insulin delivery with the AERx iDMS device appears to be a promising safe and efficacious alternative to subcutaneous insulin injections.
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| 9. |
- Åkesson, Lina, et al.
(författare)
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Decreased core temperature and Increased beta(3)-Adrenergic sensitivity in diabetes-prone BB rats
- 2007
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 9:4, s. 354-362
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Tidskriftsartikel (refereegranskat)abstract
- Background: Diabetes-prone (DP) congenic DR.lypllyp BioBreeding (BB) rats all develop Type I diabetes between 50 and 81 days of age, while DR. lyp/+ or DR.+/+ BB rats are diabetes resistant (DR). The DP rats display reduced weight gain prior to developing hyperglycemia, implying that metabolic events may precede diabetes onset. We tested the hypothesis that temperature measurements could serve as a physiological marker for the impending onset of hyperglycemia. Methods: Prior to the onset of hyperglycemia, brain, lower back, and intrascapular brown adipose tissue temperatures were analyzed by thermal signature analysis, , which measures infrared emission from tissues. A thermocoupled rectal probe measured core temperature. In addition we performed a beta 3-adrenergic receptor challenge test with the beta 3-adrenergic receptor agonist BRL37344. Results: DP rats displayed lower core temperature than DR rats prior to the onset of hyperglycemia. No temperature difference was detected in brain, lower back, or intrascapular brown adipose tissue between DP and DR rats. The beta 3-adrenergic challenge showed that the rate of temperature increase after administration of BRL37344 was significantly higher (0.005 +/- 0.002 degrees C/min) in DP than in DR rats (P = 0.044). Conclusions: These studies reveal that the prediabetic DP rats fail to maintain core temperature and that they display increased sensitivity to heat production induced by a beta 3-adrenergic receptor agonist. These studies suggest that body temperature as a measure of metabolic dysregulation is altered in the prediabetic DP rat prior to the onset of hyperglycemia.
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