Search Results (19)

An overview of seasonal variations in glycaemic patterns in children and young adults with type 1 diabetes has been addressed in a previous work, which paved the way for an in-depth study involving not only traditional Multiple Dose Injection (MDI) therapy, but also a comparative analysis with the use of Advanced Hybrid Closed-Loop (AHCL) insulin pumps. The widespread use of Flash Glucose Monitoring (FGM) and Continuous Glucose Monitoring (CGM) systems, as well as dedicated platforms for synchronizing and storing CGM reports, has facilitated an efficient approach to analyzing glycaemic patterns. The effect of environmental parameters on glycemic trends undoubtedly has a clinical relevance, which however can be appropriately managed by knowing the responses in patients treated with different therapeutic approaches. In this sense, it is possible to evaluate how the glycemic trend in diabetic patients, in relation to external temperatures, responds differently to therapies. In this work, the response, in terms of glucose level, in diabetic patients was analyzed, according to the different therapeutic approaches and in relation to variations in external temperature. For the same period of the previous work (one year: Autumn 2022–Summer 2023), seasonal variations in CGM metrics (i.e., Time In Range—TIR, Time Above Range—TAR, Time Below Range—TBR and Coefficient of Variation—CV) were analyzed. The results show a better metabolic control, linked to the effect of the algorithm on the trend of glycaemia. However, the analysis focused on the heatwave of July 2023 highlights the role of extreme temperatures as a stress factor in the insulin pumps performance. A further focus was carried out on the comparison of glycaemic patterns during the school and non-school period for all patients until 21 years old. Results suggest that during the school period, glycaemic patterns, in patients treated with MDI, show a greater onset of hyperglycaemia. From all that has emerged, it appears clear that structured education on diabetes self-management for patients and their families is fundamental and must take into account multiple factors (type of therapy, daily activities, atmospheric temperature) in order to keep their effects under control. Full article

Background/Objectives: Continuous and flash glucose monitoring (CGM and FGM) may enhance glucose management by providing real-time glucose data. Furthermore, growing evidence is linking altered blood glucose concentrations and worse short-term outcomes in critically ill patients. While hyperglycemia is more common in these patients and is associated with an increased risk of adverse events, hypoglycemia is particularly concerning and significantly raises the risk of fatal outcomes. This exploratory study investigated the link between FGM variables and cardiogenic shock in critically ill Coronary Care Unit (CCU) patients. Methods: Twenty-eight CCU patients (1 May 2021–31 January 2022) were monitored using a Libre FreeStyle system. Analyzed data included patient demographic and laboratory data, left ventricular ejection fraction, standard glucose monitoring, APACHE IV scores, and cardiogenic shock occurrence. Analysis was performed using the χ² test, Mann–Whitney U test, and logistic regression. Results: Among the patients, 13 (46.43%) developed cardiogenic shock. FGM detected hypoglycemia in 18 (64.29%) patients, while standard methods in 6 (21.43%) patients. FGM-detected hypoglycemia was more frequent in patients who developed cardiogenic shock (p = 0.0129, χ² test) with a significantly higher time below range reading (p = 0.0093, Mann Withney U test), despite no differences in mean glucose values. In addition, hypoglycemia detected by FGM was an independent predictor of shock (p = 0.0390, logistic regression). Conclusions: FGM identified more hypoglycemic events compared to standard glucose monitoring in the CCU. Frequent FGM-detected hypoglycemic events were associated with cardiogenic shock, regardless of a history of diabetes. Due to a limited sample size, these results should be interpreted cautiously and further research in this area is justified. Full article

Continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) systems have revolutionized diabetes management by delivering real-time, dynamic insights into blood glucose levels. This article provides a concise overview of the evolution of CGM technology, highlights emerging innovations in the field and explores current and potential future applications (including insulin management, early diagnostics, predictive modeling, diabetes education and integration into automated insulin delivery (AID) systems) of CGM in healthcare. Full article

Background: Gestational diabetes mellitus (GDM) occurs in approximately 9% of pregnancies, and proper glycemic control is of utmost importance in the prevention of GDM-associated obstetric complications. Flash glucose monitoring (FGM), a subtype of continuous glucose monitoring (CGM), offers intermittent blood glucose scanning and is considered a propitious alternative to the standard method of self-monitoring of blood glucose (SMBG). Aim: The aim of this review was to systematically assess the efficacy and acceptability of FGM in in pregnancies complicated by GDM. Methods: A systematic literature search was performed in the PubMed, MEDLINE, Scopus, and Cochrane databases. The review was conducted following the PRISMA guidelines, and the study protocol has been registered in the PROSPERO database with the registration number CRD42024545874. Results: A total of 872 articles were initially identified, 141 publications underwent an in-depth full-text analysis, resulting in 133 studies being excluded from further assessment. Eventually, eight studies were included in the analysis. Conclusions: The analysis revealed that FGM is a safe and efficient method of glycemic control in GDM. The majority of the studies consider its accuracy comparable to SMBG. Furthermore, FGM is well accepted by patients with numerous advantages in user-friendliness over SMBG. Full article

Cats with diabetic ketosis or ketoacidosis DK(A) require intensive glucose monitoring. The aim of this study was to assess the agreement between a portable blood glucose meter (PBGM) and a flash glucose monitoring system (FGMS; FreeStyle Libre 2.0 Abbott^®) measuring interstitial glucose in cats with DK(A). Ten client-owned cats with naturally occurring DK(A) were prospectively enrolled. Glucose concentrations were assessed with both methods every 1–3 h until resolution of DK(A), and every 4–8 h thereafter. While the median FGMS measured glucose concentration (14.3 mmol/L) was significantly lower than the median PBGM measured glucose concentration (19 mmol/L) (p < 0.001), the overall correlation between the FGMS and PBGM was high (r = 0.88; p < 0.001). In the Parkes error grid analysis, 98.3% of measurements fell in zones A and B. Bland–Altman plot analysis demonstrated that in the low glycaemic range (BG < 5.5 mmol/L), 50% of FGMS measurements deviated more than ±0.83 mmol/L, and in the high glycaemic range (BG > 5.5 mmol/L), 81% of results deviated >15% from the PBGM measurements. There was significant inter-individual variation in the difference between glucose concentrations measured by the FGMS and PBGM (p < 0.001). In spite of being more easily tolerated and easier to use, currently this method cannot be recommended for routine monitoring of cats with DK(A). Full article

Type 1 diabetes has become prevalent among the adult population, who have increasingly gained access to sensing technology. This study delved into the impact of diet, nutritional status, and the use of a continuous glucose monitoring system (CGM) on glycemic regulation among adults diagnosed with T1D. Employing a prospective design, data were gathered from 151 participants aged 18–60 across multiple cycles. Participants utilized the FreeStyle Libre (FSL) Flash Glucose Monitoring (FGM) System and provided dietary details via questionnaires and diaries. The findings unveiled correlations between dietary patterns and glycemic control, with higher protein intake associated with improved glycated hemoglobin A1C values (p = 0.019), yet elevated fat and protein consumption was linked to heightened rates of hyperglycemia. Conversely, no significant relationship was observed between dietary variables and hypoglycemia occurrence. Interestingly, subjects with more readings of glucose levels consumed fewer carbohydrates (p = 0.004) and more proteins (p = 0.000). Furthermore, physical activity and marital status correlated with glycemic stability, while higher education was associated with enhanced glycemic control (p = 0.021). This study confirmed the importance of structured education on glycemic regulation and the importance of dietary patterns in glucose management. Also, the educational role of the FGM system in changing dietary habits was confirmed, which is one of the key factors for improving glycemic regulation in continuous glucose monitoring system users. Full article

We aimed to evaluate glycaemic control in patients with type 1 diabetes during the first three months of use of the flash glucose monitoring (FGM) system. Methods: We conducted a study of a cohort of 81 people with type 1 diabetes mellitus who used the FreeStyle Libre 2 (FSL2) sensor continuously for 3 months. Patients had not used a CGM before. The effectiveness of using the FSL2 system was assessed using AGP reports at two time points (3–4 weeks and 11–12 weeks of system use). Results: Eight weeks after using FSL2, compared with results from 3–4 weeks of use, there were no differences in the glucose management indicator, time spent in range, above range and below range, or glucose variability. In the first month of FGM use, patients scanned the sensor significantly more often than in the following two months (p = 0.021). No significant differences were found in the change of the evaluated parameters when comparing patients by duration of diabetes and treatment method. Conclusions: Short-term use of FSL2 promotes a significant reduction in GMI in patients with more time spent in hyperglycaemia (especially > 250 mg/dL). In this short period of use, no other changes in glycaemic control parameters are observed. Full article

Seasonal variations in glycaemic patterns in children and young adults affected by type 1 diabetes are currently poorly studied. However, the spread of Flash Glucose Monitoring (FGM) and continuous glucose monitoring (CGM) systems and of dedicated platforms for the synchronization and conservation of CGM reports allows an efficient approach to the comprehension of these phenomena. Moreover, the impact that environmental parameters may have on glycaemic control takes on clinical relevance, implying a need to properly educate patients and their families. In this context, it can be investigated how blood glucose patterns in diabetic patients may have a link to outdoor temperatures. Therefore, in this study, the relationship between outdoor temperatures and glucose levels in diabetic patients, aged between 4 and 21 years old, has been analysed. For a one-year period (Autumn 2022–Summer 2023), seasonal variations in their CGM metrics (i.e., time in range (TIR), Time Above Range (TAR), Time Below Range (TBR), and coefficient of variation (CV)) were analysed with respect to atmospheric temperature. The results highlight a negative correlation between glucose in diabetic patients and temperature patterns (R value computed considering data for the entire year; Ry = −0.49), behaviour which is strongly confirmed by the analysis focused on the July 2023 heatwave (R = −0.67), which shows that during heatwave events, the anticorrelation is accentuated. The diurnal analysis shows how glucose levels fluctuate throughout the day, potentially correlating with atmospheric diurnal temperature changes in addition to the standard trend. Data captured during the July 2023 heatwave (17–21 July 2023) highlight pronounced deviations from the long-term average, signalling the rapid effects of extreme temperatures on glucose regulation. Our findings underscore the need to integrate meteorological parameters into diabetes management and clinical trial designs. These results suggest that structured diabetes self-management education of patients and their families should include adequate warnings about the effects of atmospheric temperature variations on the risk of hypoglycaemia and about the negative effects of excessive therapeutic inertia in the adjustment of insulin doses. Full article

(1) Background: It has been previously shown that sourdough bread, compared to commercial yeast bread, elicits a lower postprandial glycemic and insulinemic response in patients with impaired glucose tolerance (IGT). Aims: Our aim was to evaluate the following aspects in persons with type 2 diabetes (T2DM): (1) glucose variations induced by three different doughs: X = bread prepared with functional alkaline biocrystal water, Y = sourdough-leavened bread, and W = bakery yeast bread; (2) the utility of flash glucose monitoring (FGM) to measure GL. (2) Methods: Twelve T2DM following diets (six males, diabetes duration 10.9 ± 1.3 years with no complications, Hba1c < 7.0%), after 12 h of fasting, consumed 180 g of the study breads leavened/matured for 48 (X), 8 (Y), and 4 h (W) at room temperature with 200 mL of water, in a random order, in single-blind conditions, on three different days. All patients had FGM running for the entire period of the experiments. Insulin was determined by capillary blood obtained for the basal and peak glucose concentrations. (3) Results: The peak glucose and peak insulin concentrations were significantly (p < 0.05) higher for W versus both X and Y, without significant differences between X and Y. The area under the curve of glucose variations for over 240 min was significantly higher in W than X (p < 0.01) and Y (p < 0.05), without significant differences between X and Y. (4) Conclusions: (1) Bread prepared with biocrystal water has the same lower GL of sourdough bread compared to bakery yeast bread, and it is easier to manage its leavening/maturation period; (2) FGM is a reliable method for determining rapid glucose changes in response to a carbohydrate meal in persons with type 2 diabetes. Full article

This study’s aim was to assess FreeStyle Libre Flash glucose monitoring (FGM) performance during an oral glucose tolerance test (OGTT) and treadmill exercise in healthy adolescents. This should advance the feasibility and utility of user-friendly technologies for metabolic assessments in adolescents. Seventeen healthy adolescents (nine girls aged 12.8 ± 0.9 years) performed an OGTT and submaximal and maximal treadmill exercise tests in a laboratory setting. The scanned interstitial fluid glucose concentration ([ISFG]) obtained by FGM was compared against finger-prick capillary plasma glucose concentration ([CPG]) at 0 (pre-OGTT), −15, −30, −60, −120 min post-OGTT, pre-, mid-, post- submaximal exercise, and pre- and post- maximal exercise. Overall mean absolute relative difference (MARD) was 13.1 ± 8.5%, and 68% (n = 113) of the paired glucose data met the ISO 15197:2013 criteria. For clinical accuracy, 84% and 16% of FGM readings were within zones A and B in the Consensus Error Grid (CEG), respectively, which met the ISO 15197:2013 criteria of having at least 99% of results within these zones. Scanned [ISFG] were statistically lower than [CPG] at 15 (−1.16 mmol∙L⁻¹, p < 0.001) and 30 min (−0.74 mmol∙L⁻¹, p = 0.041) post-OGTT. Yet, post-OGTT glycaemic responses assessed by total and incremental areas under the curve (AUCs) were not significantly different, with trivial to small effect sizes (p ≥ 0.084, d = 0.14–0.45). Further, [ISFGs] were not different from [CPGs] during submaximal and maximal exercise tests (interaction p ≥ 0.614). FGM can be a feasible alternative to reflect postprandial glycaemia (AUCs) in healthy adolescents who may not endure repeated finger pricks. Full article

The flash glucose monitoring system (FGMS) has recently become one of the most common monitoring methods in dogs and cats with diabetes mellitus. The aim of this study was to evaluate the impact of FGMS on the quality of life of diabetic pet owners (DPOs). Fifty DPOs were asked to answer a 30-question survey. More than 80% of DPOs considered FGMS easier to use and less stressful and painful for the animal compared to blood glucose curves (BGCs). Overall, 92% of DPOs reported that their pet had better diabetes control since using FGMS. The most challenging aspects of using the FGMS were ensuring proper sensor fixation during the wearing period (47%), preventing premature detachment (40%), and purchasing the sensor (34%). Moreover, 36% of DPOs reported that the device cost was difficult to afford in the long term. Comparing dogs and cats, a significantly higher number of dogs’ owners found the FGMS to be well-tolerated (79% vs. 40%), less invasive than BGCs (79% vs. 43%), and easier to maintain in situ (76% vs. 43%). In conclusion, FGMS is considered by DPOs to be easy to use and less stressful compared to BGCs, while enabling better glycemic control. Nevertheless, the costs related to its long-term use might be difficult to sustain. Full article

Ketogenic diet (KD) and pulsatile dexamethasone therapy (PDT) are commonly used in the treatment of children with drug resistant epilepsy. Potential side effects of the KD are hypoglycemia, whereas PDT might lead to hyperglycemia. One practical option to measure glucose concentrations regularly is the flash glucose monitoring system (FGM). In this single-center study in Germany, two pediatric patients with epilepsy (age: 6.0 and 6.8 years) received FGM from the beginning of the KD over six months, in the year 2020, and one patient (9.8 years) was observed for one month on PDT and switched to the KD thereafter. Glucose concentrations were measured by using an FGM system and capillary blood measurement. Seizure frequency, changes in cognition, motor performance, social behavior, and sleep quality were evaluated. The mean hypoglycemia rate per day (65 mg/dL and lower) declined significantly in patient 1 and 2 after three months. Patient 3 showed in total seven hyperglycemic events during PDT. Patient 1 became seizure free. Improvement of attention and memory performance were reported. FGM during the KD as a treatment for drug resistant epilepsies in childhood is a practical option to explore and to avoid hypoglycemia during the KD and hyperglycemia during PDT. Full article

The benefits of medical devices are often multifaceted and may have an important impact on patients’ and relatives’ physical, mental and/or social well-being. Diabetes is a metabolic disorder and a continuous subcutaneous glucose monitoring sensor can suggest increasing treatment satisfaction. The purpose of this study was to describe parents’ experiences during their daily lives and support needs when a child uses a Flash Glucose Monitoring system (FGM). Twenty parents (n = 3 men vs. n = 17 women) to children (age ranged between 22 months and 16 years) with diabetes disease type 1, treated with an FGM unit (used for an average of 7 months (range 1–72)) at home, participated in this study. A qualitative questionnaire survey with open questions including follow-up dialogues was distributed to the parents, and collected data were analysed using qualitative content analysis. Overall satisfaction with the Libre device was Md 10 (IQR 9.25–10). One main theme “Advances in technology significantly improved everyday life” emerged from 2 categories: Improvements in quality of life and Elements of challenges. In conclusion, this qualitative study determined that parents of children with DMT1 experience a great improvement in daily life when given the opportunity to use the Libre device. Full article

Flash glucose monitoring (FGM) and real-time continuous glucose monitoring (RT-CGM) are increasingly used in clinical practice, with improvements in HbA1c and time in range (TIR) reported in clinical studies. We aimed to evaluate the impact of FGM and RT-CGM use on glycaemic outcomes in adults with type 1 diabetes (T1DM) under routine clinical care. We performed a retrospective data analysis from electronic outpatient records and proprietary web-based glucose monitoring platforms. We measured HbA1c (pre-sensor vs. on-sensor data) and sensor-based outcomes from the previous three months as per the international consensus on RT-CGM reporting guidelines. Amongst the 789 adults with T1DM, HbA1c level decreased from 61.0 (54.0, 71.0) mmol/mol to 57 (49, 65.8) mmol/mol in 561 people using FGM, and from 60.0 (50.0, 70.0) mmol/mol to 58.8 (50.3, 66.8) mmol/mol in 198 using RT-CGM (p < 0.001 for both). We found that 23% of FGM users and 32% of RT-CGM users achieved a time-in-range (TIR) (3.9 to 10 mmol/L) of >70%. For time-below-range (TBR) < 4 mmol/L, 70% of RT-CGM users and 58% of FGM users met international recommendations of <4%. Our data add to the growing body of evidence supporting the use of FGM and RT-CGM in T1DM. Full article

Flash glucose monitoring (FGM) systems have been suggested to have clinical beneficial effects in patients with diabetes mellitus, although their improvements in terms of quality of life (QoL) and patients’ satisfaction are not always addressed or are considered a secondary outcome. Thus, the aim of this meta-review is to establish the benefits of FGM in terms of patients’ satisfaction and QoL in both type 1 and type 2 diabetes patients using evidence from past systematic reviews and meta-analyses. Major databases were searched for systematic reviews (with or without meta-analyses) that assessed the satisfaction or QoL of type 1 or 2 diabetes patients using FGM compared with other glucose monitoring systems. The quality of the included systematic reviews was addressed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Six systematic reviews (including two meta-analyses) were included in the meta-review. Evidence suggests that FGM systems seem to improve patients’ satisfaction and QoL compared with self-monitoring of blood glucose, although the high variability in the measurement tools, the clinical significance and the quality of the systematic reviews included do not allow us to state FGM benefits with any certainty. Further research, including high-quality randomised clinical trials, differentiating the needs of both type 1 and type 2 diabetes patients and focusing on psychosocial benefits for these patients is needed to optimise clinical decisions between patients and professionals by developing the right health technology assessment for FGM systems. Full article