ABSTRACT
This communication conceptualizes, defines and describes glucometric guardianship, as a means of ensuring optimal glycemic management. We define glucometric guardianship as the process of ensuring appropriate measurement, monitoring and analysis of glucose levels, so as to ensure alertness in glycemic management, and agility in anticipating and detecting suboptimal glycemic parameters, and responding to them. This paper hopes to draw attention to the need for glucometric science, encourage debate and discussion and facilitate research on the topic.
ABSTRACT
Un adecuado control glucémico evita o retarda la aparición y/o evolución de las complicaciones crónicas en pacientes con diabetes mellitus (DM). Para lograrlo es necesario adecuar las dosis de insulina en personas con DM tipo 1 o tipo 2 en insulinoterapia, por el tradicional automonitoreo de glucosa capilar (AGC) que presenta aún limitaciones para generar un registro adecuado de datos, es invasivo y tiene baja adherencia. En contraposición, los nuevos sistemas de monitoreo continuo de glucosa (MCG) brindan una información más completa, más dinámica y con mejor tolerancia. Están constituidos por un sensor subcutáneo que informa ininterrumpidamente los niveles de glucosa del tejido celular subcutáneo y un módulo receptor que permite su lectura y almacenamiento. Los modelos de tiempo real (MCG-RT) permiten observar continuamente los datos, mientras que los sistemas intermitentes (MCG-Flash/EI) los muestran siempre y cuando se acerque el receptor al módulo sensor, generando una lectura voluntaria e intermitente, aunque almacenan todo en la memoria. El MCG informa además las tendencias glucémicas, indicando si están en ascenso o descenso y a qué velocidad cambian. El uso del MCG vs. AGC reduce la hemoglobina glicosilada (A1c) entre 0.53 y 1.0% con disminución significativa (38%) del tiempo de exposición a hipoglucemias. Presenta además, mayor adherencia. Los objetivos de esta revisión son: describir la homeostasis glucémica, evaluar la precisión del MCG, interpretar los datos adecuadamente y finalmente, sugerir en forma práctica los cambios para incorporar a la insulinoterapia tradicional, basados en la información que aportan estos novedosos sistemas de monitoreo.
An adequate glycemic control prevents and/or delays the development and/or progression of chronic complications in patients with diabetes mellitus (DM). To achieve this control, it is necessary to adjust insulin doses, in type 1 or insulinized type 2 DM persons, based on traditional capillary glucose self-monitoring, which has limitations to generate an adequate data record, is invasive and has low adherence. In contrast, new continuous glucose monitoring (CGM) systems provide more complete and dynamic information, and better compliance. In these systems, a subcutaneous sensor continuously sends glucose values which are captured and stocked by a receptor module. Real-time models (CGM-RT) allow continuous and real-time readings of interstitial glucose, whereas CGM-Flash/EI systems require lector approach to sensor module performing intermittent scanning. CGM shows if glycemic levels are increasing or decreasing and how fast it is happening (tendency). CGM decreases glycosylated hemoglobin between 0.53% and 1.0%, as well as time in hypoglycemia by 38%, increasing the time in range of glucose levels, in patients with high adherence. The objectives of this review are to describe the glycemic homeostasis, to evaluate the accuracy of the CGM to interpret the data adequately and finally, based on the information provided by these novel monitoring systems, to suggest a practical way to be added to the traditional intensive insulin therapy.
Subject(s)
Humans , Blood Glucose/analysis , Blood Glucose Self-Monitoring/methods , Time Factors , Computer Systems , Blood Glucose Self-Monitoring/instrumentation , Diabetes Mellitus/prevention & controlABSTRACT
Objective:To compare the results of three kinds of glucometers and automatic biochemistry analyzer for the detection of blood glucose level of finger capillary and vein blood, and adopt linear regression to analyze their relationship.Methods: 204 patients with or without diabetes were enrolled in this study. Their finger capillary and vein blood were detected by three kinds of glucose meters and automatic biochemistry analyzer, respectively. And these data were analyzed by using linear regression and pair-t-test.Results: The comparative results revealed that the order of correlation between every glucose meters with automatic biochemistry analyzer was Accuchek higher than GT-1920 and GT-1920 higher than One Touch when the range of hematocrit (Hct) value was in 35.1%-51.6%. The correlation of Hct between every glucose meter and automatic biochemistry analyzer when the range of Hct was 25.0%-35.0% was significant higher than that when the range was 35.1%-51.6% (t=2.19,P<0.05). For finger capillary blood, the bias of One Touch was largest, while for vein blood, the bias of GT-1920 and One Touch were better. Besides, the detected results of blood glucose both of GT-1920 and One Touch were significantly higher than automatic biochemistry analyzer(t=2.34,P<0.05).Conclusion: There were better correlation between every glucose meter and automatic biochemistry analyzer, respectively, and the correlations between them can be effected by Hct. While there were still certainly difference between them.
ABSTRACT
Background: Diabetes mellitus is an independent risk factor for cardiovascular disease. Objective: To compare the efficacy of devices for continuous glucose monitoring and capillary glucose monitoring in hospitalized patients with acute coronary syndrome using the following parameters: time to achieve normoglycemia, period of time in normoglycemia, and episodes of hypoglycemia. Methods: We performed a pilot, non-randomized, unblinded clinical trial that included 16 patients with acute coronary artery syndrome, a capillary or venous blood glucose ≥ 140 mg/dl, and treatment with a continuous infusion of fast acting human insulin. These patients were randomized into 2 groups: a conventional group, in which capillary measurement and recording as well as insulin adjustment were made every 4h, and an intervention group, in which measurement and recording as well as insulin adjustment were made every hour with a subcutaneous continuous monitoring system. Student's t-test was applied for mean differences and the X² test for qualitative variables. Results: We observed a statistically significant difference in the mean time for achieving normoglycemia, favoring the conventional group with a P = 0.02. Conclusion: Continuous monitoring systems are as useful as capillary monitoring for achieving normoglycemia.
Antecedentes: La diabetes mellitus es un factor de riesgo independiente de enfermedad cardiovascular. Objetivo: Comparar la eficacia de los dispositivos de monitorización continua de glucosa y monitorización de glucosa capilar en pacientes hospitalizados con síndrome coronario agudo, mediante los siguientes parámetros: tiempo en lograr normoglucemia, periodo en normoglucemia y número de hipoglucemias. Métodos: Ensayo clínico no aleatorizado, no ciego, que incluyó a 16 pacientes con síndrome coronario agudo, glucosa capilar o venosa ≥ 140mg/dl, en tratamiento con infusión de insulina humana de acción rápida durante 48 h. Se distribuyeron en 2 grupos: convencional, con medición y registro de glucosa capilar, y ajuste de insulina cada 4h, y de intervención, con medición y registro de glucosa intersticial y ajuste de insulina cada hora a través de un dispositivo de monitorización continua colocado vía subcutánea. Se aplicaron pruebas t para diferencia de medias y prueba de X² para las variables cualitativas. Resultados: Se observó diferencia significativa en la media del tiempo para lograr normoglucemia a favor del grupo convencional, con un valor de p = 0.02. Conclusión: Los dispositivos de monitorización continua de glucosa son tan útiles como la monitorización de glucosa capilar para lograr normoglucemia.
Subject(s)
Female , Humans , Male , Middle Aged , Acute Coronary Syndrome/blood , Blood Glucose Self-Monitoring/instrumentation , Equipment Design , Hospitalization , Pilot ProjectsABSTRACT
O envelhecimento é um processo pelo qual todos os indivíduos e organismos são acometidos e é caracterizado pela diminuição gradativa dos vários sistemas orgânicos em realizar suas funções de maneira eficaz. Nesse sentido, o objetivo deste estudo foi analisar a glicemia capilar de mulheres de meia idade e idosas após 12 semanas de treinamento de força. Participaram do estudo 22 mulheres fisicamente ativas (41 a 71 anos de idade), separadas em dois grupos: mulheres de meia idade (n = 14) e mulheres idosas (n = 8). Foram determinadas massa corporal (MC), IMC e glicemia capilar pós-prandial (GPP) (duas horas após o almoço) em dois momentos: no início do estudo (M0) e após 12 semanas de acompanhamento (M1). O treinamento de força teve duração total de 12 semanas. Os dados foram analisados mediante o pacote estatístico BioEstat® 5.0 (Brasil) e expressos em média ± erro padrão. Foi utilizado Mann-Whitney para comparação entre os grupos e Wilcoxon para comparar os momentos M0 e M1 intragrupos. Para as mulheres de meia idade a MC (M0 = 67,8±8,3; M1 = 67,4±8,8), IMC (M0 = 27,4±4,4; M1 = 27,2±4,5) e GPP (M0 = 109,6±5,2; M1 = 113,6±5,3) não apresentaram diferença estatisticamente significativa (p = 0,55; 0,62; 0,73 respectivamente). Em relação às mulheres idosas, MC (M0 = 74,3±8,0; M1 = 73,8±7,7), IMC (M0 = 29,8±2,1; M1 = 29,6±1,9) e GPP (M0 = 158,2±41,0; M1 = 121,6±20,6) o mesmo foi observado (p = 0,12; 0,13; 0,07). Concluímos que o treinamento de força em 12 semanas foi insuficiente para promover a redução da glicemia pós-prandial em mulheres de meia-idade, possivelmente em decorrência da alteração hormonal própria do climatério.
The aging is characterized by gradual reduction in the function of hysiological systems. In this sense, the aim of the present study was to evaluate the capillary glucose of middle-age and elderly women subjected to 12-week strength-training. Twenty-two non sedentary women (41-71 years old) were separated into 2 groups: middle-age (n=14), and elderly (n=8). It were determined body mass (BM) and postprandial capillary glucose (PCG) (two hours after launch) in two different moments: baseline (B) and after 12 weeks (12w). The strength training lasted 12 weeks. The data were analyzed by BioEstat® 5.0 (Brazil) statistical package and expressed as mean ± standard error. Mann-Whitney test was used for comparison between groups plus Wilcoxon to compare the B and 12w moments within groups. The BM (B = 67.8±8.3; 12w = 67.4±8.8; p=0.55), BMI (B = 27.4±4.4; 12w = 27.2±4.5; p=0.62), and PCG (B = 109.6±5.2; 12w = 113.6±5.3; p=0.73) were not changed after training period. Concern for elderly woman, the same was observed in relation to BM (B = 74.3±8.0; 12w = 73.8±7.7; 0.12), BMI (B = 29.8±2.1; 12w = 29.6±1.9; 0.13), and PCG (B = 158.2±41.0; 12w = 121.6±20.6; 0.07). We concluded that 12-week strength-training was not able to promote postprandial capillary glucose reduction in middle-aged and elderly women, possibly due to the hormonal changes inherent to menopause condition.