Development and validation of an instrument (CSII - Brazil) to assess users' conceptual and procedural knowledge of continuous subcutaneous infusion systems

ABSTRACT Objective: To develop, adapt and validate an instrument named "CSII - Brazil" to assess users' conceptual and procedural knowledge of continuous subcutaneous insulin infusion systems. Materials and methods: Methodological and exploratory study developed in three stages: a) instrument development; b) content validation and cultural adaptation (evaluation by a committee of experts and pre-test with CSII users); c) psychometric validation through instrument application in a sample of 60 patients by means of the web tool e-Surv. Internal consistency and reproducibility analyses were performed within IBM SPSS Statistics 20 programming environment. Results: The 16 multiple-choice question instrument successfully attained a content validity index of 0.97, showing satisfactory internal consistency, with 0.61 Cronbach's alpha [95% CI 0.462-0.746] and an intraclass correlation coefficient of 0.869 [95% CI: 0.789-0.919] between the test and retest scores. Conclusion: The CSII - Brazil instrument is considered adequate and validated to assess continuous subcutaneous infusion system users' conceptual and procedural knowledge.

Desarrollo y Simulación de un Algoritmo de Control Automatizado para Insulinoterapia de Urgencias Hiperglucémicas en Diabetes / Development and Simulation of an Automated Control Algorithm for Insulin Therapy of Hyperglycemic Emergencies in Diabetes

Resumen El presente trabajo describe el desarrollo y simulación de un algoritmo para el control automático de la infusión de insulina en el manejo glucémico de pacientes con cetoacidosis diabética (CAD) y estado hiperosmolar hiperglucémico (EHH). Se programó un algoritmo que calcula la insulina necesaria para lograr un descenso glucémico de 50 mg/dL/h hasta llegar a glucemias de 250 mg/dL, para posteriormente mantenerlas en 220 mg/dL hasta la remisión de la patología. La simulación del software se realizó haciendo uso de registros glucémicos de 10 pacientes con CAD manejados en el Hospital Juárez de México. Los resultados de la simulación mostraron una incidencia 6 veces menor de hipoglucemias, así como un 33.7% menos de insulina necesaria dentro del tratamiento, sin diferencias entre los descensos medios de glucosa por hora de las mediciones reales y simuladas. Este software propone un uso innovador de los llamados páncreas artificiales al aplicarlos en urgencias hiperglucémicas, implementando además el uso de la sensibilidad a la insulina como variable para el funcionamiento de los mismos. Los resultados demuestran que el algoritmo podría ser capaz de lograr un manejo glucémico apegado a las guías de tratamiento, generando un menor gasto de insulina y evitando hipoglucemias durante la terapéutica, con una posible aplicación en dispositivos biomédicos autónomos.

Abstract This paper describes the development and simulation of an algorithm for the automatic control of insulin infusion, in the glycemic management of patients with diabetic ketoacidosis (CAD) and hyperglycemic hyperosmolar state (EHH). An algorithm was programmed to calculate the requirement insulin for a glycemic decrease of 50 mg/dL/h until reach 250 mg/dL in blood glucose levels, and thus maintaining it at 220 mg/dL until the pathology remission. The software simulation was performed using glycemic records of 10 patients with CAD managed in the Hospital Juárez de México. The results of the simulation showed a lower incidence of hypoglycemia, as well as a lower insulin requirement within the treatment, without differences in the average glucose decreases per hour between real and simulated measurements. This software proposes an innovative use of the artificial pancreas in hyperglycemic emergencies, and also implementing the use of insulin sensitivity as a variable for their function. The results show that the algorithm could be able to achieve glycemic management attached to the treatment guidelines, generating lower insulin expenditure and avoiding hypoglycemia during therapy, with a possible application in autonomous biomedical devices.

Update in artificial pancreas clinical studies / 中华内分泌代谢杂志

[Summary] Good glycemic control can delay the occurrence and development of diabetic complications. Artificial pancreas, which autonomously mimics the physiologic glucose control of pancreas islet, regulates the blood glucose subtly. Artificial pancreas seems to be one of the promising glucose control approaches.

Efficacy of continuous glucose monitoring system combined with insulin pump in diabetic pafients aged 60 years and over / 中华全科医师杂志

Objective To observe hypoglycemic efficacy of continuous glucose monitoring system (CGMS)combined with continuous insulin infusion(CSII)in the elderly diabetic patients aged 60 years and over.Methods A total 0f 100 elderly diabetic patients were randomly divided into two groups.50 were treated with CGMS or self-monitoring blood glucose(SMBG)and CSII.and whose insulin dose was adjusted based on results of monitoring,and the other 50 with SMBG and insulin pump as controls.whose insulin dose was adiusted based on the results of SMBG for three days.After two weeks.all the patients were monitored by CGMS for blood glucose.Results Mean blood level of glucose and mean amplitude of glycemic excursions(MAGE)were significantly lower in CGMS+CSII group than those in controls[(6.6±2.3)mmol/L vs.(7.5±2.1)mmol/L,and(3.9±0.9)mmol/L vs.(5.1±0.6)mmol/L,respectively,P＜0.05 1.Average insulin dose used was significantly lower in CGMS+CSII group than that in controls [(0.64±0.21)U/kg vs.(0.82±0.41)U/kg,P＜0.05],and duration of hypoglycemia was less in the former than that in the latter[(20±3)min vs.(40± 9)min,P＜0.05 ].Conclnsions CGMS combined with CSII can decrease blood glucose.glucose excursions.average dose of insulin and duration of hypoglycemia in the elderly diabetic patients,as well as prevent occurrence of hypoglycemia.

The effect of insulin aspart on postprandial glucose and the excursion of serum glucose level in type 2 diabetic patients managed with delivered in insulin pump therapy / 中国医师进修杂志

Objective To compare the efficacy of insulin aspart and human soluble insulin on postprandial glucose control and blood glucose excursion in type 2 diabetic patients managed with insulin pump therapy. Methods All of 345 hospitalized type 2 diabetic patients were randomized divided into two groups. One group underwent insulin pump therapy with insulin aspart (aspart group, 173 cases),another group with human soluble insulin (humulin R group, 172 cases). Capillary glucose concentrations were measured at 9 time points,including preprandial,2 hours postprandial,bedtime (22:00),midnight(0:00) and 3:00 every day during the treatment. The change of blood glucose at each time point and the variation of postprandial blood glucose excursion was compared between the two groups. The frequency of hypoglycemia was also evaluated. Results After treatment, fasting blood glucose and post breakfast and post dinner blood glucose levels were decreased more significantly in the aspart group than those in the humulin R group. And a significantly smaller postprandial blood glucose excursion was shown in the aspart group compared with that in the humulin R group (P< 0.05). The time to achieve good glycemic control in the aspart group was (4.40 ± 2.16) d, significantly shorter than that in the humulin R group[(5.68 ± 2.29) d](P< 0.05). The incidence of hypoglycemia was significantly lower in the aspart group (P <0.05). Conclusion Insulin aspart results in better control of blood glucose and less glycemic variability compare with human soluble insulin in type 2 diabetic patients during delivery by continuous subcutaneous insulin infusion.