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Original Articles
Type 1 Diabetes
Optimal Coefficient of Variance Threshold to Minimize Hypoglycemia Risk in Individuals with Well-Controlled Type 1 Diabetes Mellitus
Jee Hee Yoo, Seung Hee Yang, Sang-Man Jin, Jae Hyeon Kim
Received March 14, 2023  Accepted August 12, 2023  Published online March 4, 2024  
DOI: https://doi.org/10.4093/dmj.2023.0083    [Epub ahead of print]
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  • 19 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study investigated the optimal coefficient of variance (%CV) for preventing hypoglycemia based on real-time continuous glucose monitoring (rt-CGM) data in people with type 1 diabetes mellitus (T1DM) already achieving their mean glucose (MG) target.
Methods
Data from 172 subjects who underwent rt-CGM for at least 90 days and for whom 439 90-day glycemic profiles were available were analyzed. Receiver operator characteristic analysis was conducted to determine the cut-off value of %CV to achieve time below range (%TBR)<54 mg/dL <1 and =0.
Results
Overall mean glycosylated hemoglobin was 6.8% and median %TBR<54 mg/dL was 0.2%. MG was significantly higher and %CV significantly lower in profiles achieving %TBR<54 mg/dL <1 compared to %TBR<54 mg/dL ≥1 (all P<0.001). The cut-off value of %CV for achieving %TBR<54 mg/dL <1 was 37.5%, 37.3%, and 31.0%, in the whole population, MG >135 mg/dL, and ≤135 mg/dL, respectively. The cut-off value for %TBR<54 mg/dL=0% was 29.2% in MG ≤135 mg/dL. In profiles with MG ≤135 mg/dL, 94.2% of profiles with a %CV <31 achieved the target of %TBR<54 mg/dL <1, and 97.3% with a %CV <29.2 achieved the target of %TBR<54 mg/ dL=0%. When MG was >135 mg/dL, 99.4% of profiles with a %CV <37.3 achieved %TBR<54 mg/dL <1.
Conclusion
In well-controlled T1DM with MG ≤135 mg/dL, we suggest a %CV <31% to achieve the %TBR<54 mg/dL <1 target. Furthermore, we suggest a %CV <29.2% to achieve the target of %TBR<54 mg/dL =0 for people at high risk of hypoglycemia.
Technology/Device
Clinical and Lifestyle Determinants of Continuous Glucose Monitoring Metrics in Insulin-Treated Patients with Type 2 Diabetes Mellitus
Da Young Lee, Namho Kim, Inha Jung, So Young Park, Ji Hee Yu, Ji A Seo, Jihee Kim, Kyeong Jin Kim, Nam Hoon Kim, Hye Jin Yoo, Sin Gon Kim, Kyung Mook Choi, Sei Hyun Baik, Sung-Min Park, Nan Hee Kim
Diabetes Metab J. 2023;47(6):826-836.   Published online August 24, 2023
DOI: https://doi.org/10.4093/dmj.2022.0273
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  • 190 Download
  • 1 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
There was limited evidence to evaluate the association between lifestyle habits and continuous glucose monitoring (CGM) metrics. Thus, we aimed to depict the behavioral and metabolic determinants of CGM metrics in insulin-treated patients with type 2 diabetes mellitus (T2DM).
Methods
This is a prospective observational study. We analyzed data from 122 insulin-treated patients with T2DM. Participants wore Dexcom G6 and Fitbit, and diet information was identified for 10 days. Multivariate-adjusted logistic regression analysis was performed for the simultaneous achievement of CGM-based targets, defined by the percentage of time in terms of hyper, hypoglycemia and glycemic variability (GV). Intake of macronutrients and fiber, step counts, sleep, postprandial C-peptide-to-glucose ratio (PCGR), information about glucose lowering medications and metabolic factors were added to the analyses. Additionally, we evaluated the impact of the distribution of energy and macronutrient during a day, and snack consumption on CGM metrics.
Results
Logistic regression analysis revealed that female, participants with high PCGR, low glycosylated hemoglobin (HbA1c) and daytime step count had a higher probability of achieving all targets based on CGM (odds ratios [95% confidence intervals] which were 0.24 [0.09 to 0.65], 1.34 [1.03 to 1.25], 0.95 [0.9 to 0.99], and 1.15 [1.03 to 1.29], respectively). And participants who ate snacks showed a shorter period of hyperglycemia and less GV compared to those without.
Conclusion
We confirmed that residual insulin secretion, daytime step count, HbA1c, and women were the most relevant determinants of adequate glycemic control in insulin-treated patients with T2DM. In addition, individuals with snack consumption were exposed to lower times of hyperglycemia and GV.

Citations

Citations to this article as recorded by  
  • Explanatory variables of objectively measured 24-h movement behaviors in people with prediabetes and type 2 diabetes: A systematic review
    Lotte Bogaert, Iris Willems, Patrick Calders, Eveline Dirinck, Manon Kinaupenne, Marga Decraene, Bruno Lapauw, Boyd Strumane, Margot Van Daele, Vera Verbestel, Marieke De Craemer
    Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2024; 18(4): 102995.     CrossRef
Technology/Device
Glycemia according to the Use of Continuous Glucose Monitoring among Adults with Type 1 Diabetes Mellitus in Korea: A Real-World Study
You-Bin Lee, Minjee Kim, Jae Hyeon Kim
Diabetes Metab J. 2023;47(3):405-414.   Published online March 6, 2023
DOI: https://doi.org/10.4093/dmj.2022.0032
  • 3,210 View
  • 121 Download
  • 2 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
We explored the association between continuous glucose monitoring (CGM) use and glycemia among adults with type 1 diabetes mellitus (T1DM) and determined the status of CGM metrics among adults with T1DM using CGM in the real-world.
Methods
For this propensity-matched cross-sectional study, individuals with T1DM who visited the outpatient clinic of the Endocrinology Department of Samsung Medical Center between March 2018 and February 2020 were screened. Among them, 111 CGM users (for ≥9 months) were matched based on propensity score considering age, sex, and diabetes duration in a 1:2 ratio with 203 CGM never-users. The association between CGM use and glycemic measures was explored. In a subpopulation of CGM users who had been using official applications (not “do-it-yourself” software) such that Ambulatory Glucose Profile data for ≥1 month were available (n=87), standardized CGM metrics were summarized.
Results
Linear regression analyses identified CGM use as a determining factor for log-transformed glycosylated hemoglobin. The fully-adjusted odds ratio (OR) and 95% confidence interval (CI) for uncontrolled glycosylated hemoglobin (>8%) were 0.365 (95% CI, 0.190 to 0.703) in CGM users compared to never-users. The fully-adjusted OR for controlled glycosylated hemoglobin (<7%) was 1.861 (95% CI, 1.119 to 3.096) in CGM users compared to never-users. Among individuals who had been using official applications for CGM, time in range (TIR) values within recent 30- and 90-day periods were 62.45%±16.63% and 63.08%±15.32%, respectively.
Conclusion
CGM use was associated with glycemic control status among Korean adults with T1DM in the real-world, although CGM metrics including TIR might require further improvement among CGM users.

Citations

Citations to this article as recorded by  
  • Real-World Continuous Glucose Monitoring Data from a Population with Type 1 Diabetes in South Korea: Nationwide Single-System Analysis
    Ji Yoon Kim, Sang-Man Jin, Sarah Andrade, Boyang Chen, Jae Hyeon Kim
    Diabetes Technology & Therapeutics.2024;[Epub]     CrossRef
  • Accuracy and Safety of the 15-Day CareSens Air Continuous Glucose Monitoring System
    Kyung-Soo Kim, Seung-Hwan Lee, Won Sang Yoo, Cheol-Young Park
    Diabetes Technology & Therapeutics.2024; 26(4): 222.     CrossRef
  • Navigating the Seas of Glycemic Control: The Role of Continuous Glucose Monitoring in Type 1 Diabetes Mellitus
    Jun Sung Moon
    Diabetes & Metabolism Journal.2023; 47(3): 345.     CrossRef
  • Smart Insulin Pen: Managing Insulin Therapy for People with Diabetes in the Digital Era
    Jee Hee Yoo, Jae Hyeon Kim
    The Journal of Korean Diabetes.2023; 24(4): 190.     CrossRef
Reviews
Technology/Device
Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control
Jee Hee Yoo, Jae Hyeon Kim
Diabetes Metab J. 2023;47(1):27-41.   Published online January 12, 2023
DOI: https://doi.org/10.4093/dmj.2022.0271
  • 6,118 View
  • 380 Download
  • 10 Web of Science
  • 15 Crossref
AbstractAbstract PDFPubReader   ePub   
Continuous glucose monitoring (CGM) technology has evolved over the past decade with the integration of various devices including insulin pumps, connected insulin pens (CIPs), automated insulin delivery (AID) systems, and virtual platforms. CGM has shown consistent benefits in glycemic outcomes in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) treated with insulin. Moreover, the combined effect of CGM and education have been shown to improve glycemic outcomes more than CGM alone. Now a CIP is the expected future technology that does not need to be worn all day like insulin pumps and helps to calculate insulin doses with a built-in bolus calculator. Although only a few clinical trials have assessed the effectiveness of CIPs, they consistently show benefits in glycemic outcomes by reducing missed doses of insulin and improving problematic adherence. AID systems and virtual platforms made it possible to achieve target glycosylated hemoglobin in diabetes while minimizing hypoglycemia, which has always been challenging in T1DM. Now fully automatic AID systems and tools for diabetes decisions based on artificial intelligence are in development. These advances in technology could reduce the burden associated with insulin treatment for diabetes.

Citations

Citations to this article as recorded by  
  • Accuracy and Safety of the 15-Day CareSens Air Continuous Glucose Monitoring System
    Kyung-Soo Kim, Seung-Hwan Lee, Won Sang Yoo, Cheol-Young Park
    Diabetes Technology & Therapeutics.2024; 26(4): 222.     CrossRef
  • Real-World Continuous Glucose Monitoring Data from a Population with Type 1 Diabetes in South Korea: Nationwide Single-System Analysis
    Ji Yoon Kim, Sang-Man Jin, Sarah Andrade, Boyang Chen, Jae Hyeon Kim
    Diabetes Technology & Therapeutics.2024;[Epub]     CrossRef
  • Recent advances in the precision control strategy of artificial pancreas
    Wuyi Ming, Xudong Guo, Guojun Zhang, Yinxia Liu, Yongxin Wang, Hongmei Zhang, Haofang Liang, Yuan Yang
    Medical & Biological Engineering & Computing.2024;[Epub]     CrossRef
  • Digital Health in Diabetes and Cardiovascular Disease
    Dorothy Avoke, Abdallah Elshafeey, Robert Weinstein, Chang H. Kim, Seth S. Martin
    Endocrine Research.2024; : 1.     CrossRef
  • Glycemic Outcomes During Early Use of the MiniMed™ 780G Advanced Hybrid Closed-Loop System with Guardian™ 4 Sensor
    Toni L. Cordero, Zheng Dai, Arcelia Arrieta, Fang Niu, Melissa Vella, John Shin, Andrew S. Rhinehart, Jennifer McVean, Scott W. Lee, Robert H. Slover, Gregory P. Forlenza, Dorothy I. Shulman, Rodica Pop-Busui, James R. Thrasher, Mark S. Kipnes, Mark P. Ch
    Diabetes Technology & Therapeutics.2023; 25(9): 652.     CrossRef
  • Navigating the Seas of Glycemic Control: The Role of Continuous Glucose Monitoring in Type 1 Diabetes Mellitus
    Jun Sung Moon
    Diabetes & Metabolism Journal.2023; 47(3): 345.     CrossRef
  • APSec1.0: Innovative Security Protocol Design with Formal Security Analysis for the Artificial Pancreas System
    Jiyoon Kim, Jongmin Oh, Daehyeon Son, Hoseok Kwon, Philip Virgil Astillo, Ilsun You
    Sensors.2023; 23(12): 5501.     CrossRef
  • Advances and Development of Electronic Neural Interfaces
    Xue Jiaxiang, Liu Zhixin
    Journal of Computing and Natural Science.2023; : 147.     CrossRef
  • Continuous Glucose Monitoring (CGM) and Metabolic Control in a Cohort of Patients with Type 1 Diabetes and Coeliac Disease
    Flavia Amaro, Maria Alessandra Saltarelli, Marina Primavera, Marina Cerruto, Stefano Tumini
    Endocrines.2023; 4(3): 595.     CrossRef
  • Comparison of Glycemia Risk Index with Time in Range for Assessing Glycemic Quality
    Ji Yoon Kim, Jee Hee Yoo, Jae Hyeon Kim
    Diabetes Technology & Therapeutics.2023; 25(12): 883.     CrossRef
  • The Benefits Of Continuous Glucose Monitoring In Pregnancy
    Jee Hee Yoo, Jae Hyeon Kim
    Endocrinology and Metabolism.2023; 38(5): 472.     CrossRef
  • The Growing Challenge of Diabetes Management in an Aging Society
    Seung-Hwan Lee
    Diabetes & Metabolism Journal.2023; 47(5): 630.     CrossRef
  • Recent advances in artificial intelligence-assisted endocrinology and diabetes
    Ioannis T. Oikonomakos, Ranjit M. Anjana, Viswanathan Mohan, Charlotte Steenblock, Stefan R. Bornstein
    Exploration of Endocrine and Metabolic Disease.2023; 1(1): 16.     CrossRef
  • An Observational Pilot Study of a Tailored Environmental Monitoring and Alert System for Improved Management of Chronic Respiratory Diseases
    Mohammed Alotaibi, Fady Alnajjar, Badr A Alsayed, Tareq Alhmiedat, Ashraf M Marei, Anas Bushnag, Luqman Ali
    Journal of Multidisciplinary Healthcare.2023; Volume 16: 3799.     CrossRef
  • Smart Insulin Pen: Managing Insulin Therapy for People with Diabetes in the Digital Era
    Jee Hee Yoo, Jae Hyeon Kim
    The Journal of Korean Diabetes.2023; 24(4): 190.     CrossRef
Guideline/Fact Sheet
Comprehensive Understanding for Application in Korean Patients with Type 2 Diabetes Mellitus of the Consensus Statement on Carbohydrate-Restricted Diets by Korean Diabetes Association, Korean Society for the Study of Obesity, and Korean Society of Hypertension
Jong Han Choi, Jee-Hyun Kang, Suk Chon
Diabetes Metab J. 2022;46(3):377-390.   Published online May 25, 2022
DOI: https://doi.org/10.4093/dmj.2022.0051
  • 4,888 View
  • 247 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFPubReader   ePub   
The Joint Committee of the Korean Diabetes Association, the Korean Society for the Study of Obesity, and the Korean Society of Hypertension announced a consensus statement on carbohydrate-restricted diets and intermittent fasting, representing an emerging and popular dietary pattern. In this statement, we recommend moderately-low-carbohydrate or low-carbohydrate diets, not a very-low-carbohydrate diet, for patients with type 2 diabetes mellitus. These diets can be considered a dietary regimen to improve glycemic control and reduce body weight in adults with type 2 diabetes mellitus. This review provides the detailed results of a meta-analysis and systematic literature review on the potential harms and benefits of carbohydrate-restricted diets in patients with diabetes. We expect that this review will help experts and patients by fostering an in-depth understanding and appropriate application of carbohydrate-restricted diets in the comprehensive management of diabetes.

Citations

Citations to this article as recorded by  
  • Efficacy of convenience meal-type foods designed for diabetes in the management of metabolic syndrome based on a 3-week trial
    Do Gyeong Lee, In Gyeong Kang, Tae Seok Kim, Yun Ahn, Sang Yun Lee, Hye Jin Ahn, Yoo Kyoung Park
    Nutrition.2024; 118: 112287.     CrossRef
  • Long-Term Results of a Digital Diabetes Self-Management and Education Support Program Among Adults With Type 2 Diabetes: A Retrospective Cohort Study
    Ashley Berthoumieux, Sarah Linke, Melinda Merry, Alison Megliola, Jessie Juusola, Jenna Napoleone
    The Science of Diabetes Self-Management and Care.2024; 50(1): 19.     CrossRef
  • Medical nutrition therapy for diabetes mellitus
    Suk Chon
    Journal of the Korean Medical Association.2023; 66(7): 421.     CrossRef
Short Communication
Technology/Device
Comparison of Laser and Conventional Lancing Devices for Blood Glucose Measurement Conformance and Patient Satisfaction in Diabetes Mellitus
Jung A Kim, Min Jeong Park, Eyun Song, Eun Roh, So Young Park, Da Young Lee, Jaeyoung Kim, Ji Hee Yu, Ji A Seo, Kyung Mook Choi, Sei Hyun Baik, Hye Jin Yoo, Nan Hee Kim
Diabetes Metab J. 2022;46(6):936-940.   Published online March 30, 2022
DOI: https://doi.org/10.4093/dmj.2021.0293
  • 5,218 View
  • 255 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFPubReader   ePub   
Self-monitoring of capillary blood glucose is important for controlling diabetes. Recently, a laser lancing device (LMT-1000) that can collect capillary blood without skin puncture was developed. We enrolled 150 patients with type 1 or 2 diabetes mellitus. Blood sampling was performed on the same finger on each hand using the LMT-1000 or a conventional lancet. The primary outcome was correlation between glucose values using the LMT-1000 and that using a lancet. And we compared the pain and satisfaction of the procedures. The capillary blood sampling success rates with the LMT-1000 and lancet were 99.3% and 100%, respectively. There was a positive correlation (r=0.974, P<0.001) between mean blood glucose levels in the LMT-1000 (175.8±63.0 mg/dL) and conventional lancet samples (172.5±63.6 mg/dL). LMT-1000 reduced puncture pain by 75.0% and increased satisfaction by 80.0% compared to a lancet. We demonstrated considerable consistency in blood glucose measurements between samples from the LMT-1000 and a lancet, but improved satisfaction and clinically significant pain reduction were observed with the LMT-1000 compared to those with a lancet.

Citations

Citations to this article as recorded by  
  • Comparison between a laser-lancing device and automatic incision lancet for capillary blood sampling from the heel of newborn infants: a randomized feasibility trial
    Chul Kyu Yun, Eui Kyung Choi, Hyung Jin Kim, Jaeyoung Kim, Byung Cheol Park, Kyuhee Park, Byung Min Choi
    Journal of Perinatology.2024;[Epub]     CrossRef
Original Article
Technology/Device
Glucose Profiles Assessed by Intermittently Scanned Continuous Glucose Monitoring System during the Perioperative Period of Metabolic Surgery
Kyuho Kim, Sung Hee Choi, Hak Chul Jang, Young Suk Park, Tae Jung Oh
Diabetes Metab J. 2022;46(5):713-721.   Published online January 24, 2022
DOI: https://doi.org/10.4093/dmj.2021.0164
  • 4,742 View
  • 316 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Continuous glucose monitoring (CGM) has been widely used in the management of diabetes. However, the usefulness and detailed data during perioperative status were not well studied. In this study, we described the immediate changes of glucose profiles after metabolic surgery using intermittently scanned CGM (isCGM) in individuals with type 2 diabetes mellitus (T2DM).
Methods
This was a prospective, single-center, single-arm study including 20 participants with T2DM. The isCGM (FreeStyle Libre CGM) implantation was performed within 2 weeks before surgery. We compared CGM metrics of 3 days before surgery and 3 days after surgery, and performed the correlation analyses with clinical variables.
Results
The mean glucose significantly decreased after surgery (147.0±40.4 to 95.5±17.1 mg/dL, P<0.001). Time in range (TIR; 70 to 180 mg/dL) did not significantly change after surgery in total. However, it was significantly increased in a subgroup of individuals with glycosylated hemoglobin (HbA1c) ≥8.0%. Time above range (>250 or 180 mg/dL) was significantly decreased in total. In contrast, time below range (<70 or 54 mg/dL) was significantly increased in total and especially in a subgroup of individuals with HbA1c <8.0% after surgery. The coefficient of variation significantly decreased after surgery. Higher baseline HbA1c was correlated with greater improvement in TIR (rho=0.607, P=0.005).
Conclusion
The isCGM identified improvement of mean glucose and glycemic variability, and increase of hypoglycemia after metabolic surgery, but TIR was not significantly changed after surgery. We detected an increase of TIR only in individuals with HbA1c ≥8.0%.

Citations

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  • Comparative Effect of Glucose-Lowering Drugs for Type 2 Diabetes Mellitus on Stroke Prevention: A Systematic Review and Network Meta-Analysis
    Ji Soo Kim, Gyeongsil Lee, Kyung-Il Park, Seung-Won Oh
    Diabetes & Metabolism Journal.2024; 48(2): 312.     CrossRef
  • Use of Continuous Glucose Monitoring in Patients Following Bariatric Surgery: A Scoping Review
    Yang Yu, Susan W. Groth
    Obesity Surgery.2023; 33(8): 2573.     CrossRef
  • Asymptomatic Hypoglycemia after Metabolic Surgery: New Insights from Perioperative Continuous Glucose Monitoring
    Sang-Man Jin
    Diabetes & Metabolism Journal.2022; 46(5): 675.     CrossRef
Review
Technology/Device
Current Advances of Artificial Pancreas Systems: A Comprehensive Review of the Clinical Evidence
Sun Joon Moon, Inha Jung, Cheol-Young Park
Diabetes Metab J. 2021;45(6):813-839.   Published online November 22, 2021
DOI: https://doi.org/10.4093/dmj.2021.0177
  • 14,311 View
  • 794 Download
  • 27 Web of Science
  • 28 Crossref
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Since Banting and Best isolated insulin in the 1920s, dramatic progress has been made in the treatment of type 1 diabetes mellitus (T1DM). However, dose titration and timely injection to maintain optimal glycemic control are often challenging for T1DM patients and their families because they require frequent blood glucose checks. In recent years, technological advances in insulin pumps and continuous glucose monitoring systems have created paradigm shifts in T1DM care that are being extended to develop artificial pancreas systems (APSs). Numerous studies that demonstrate the superiority of glycemic control offered by APSs over those offered by conventional treatment are still being published, and rapid commercialization and use in actual practice have already begun. Given this rapid development, keeping up with the latest knowledge in an organized way is confusing for both patients and medical staff. Herein, we explore the history, clinical evidence, and current state of APSs, focusing on various development groups and the commercialization status. We also discuss APS development in groups outside the usual T1DM patients and the administration of adjunct agents, such as amylin analogues, in APSs.

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    María F. Villa-Tamayo, Patricio Colmegna, Marc D. Breton
    Journal of Diabetes Science and Technology.2024; 18(2): 318.     CrossRef
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    S. Syafiie, Fahd Alharbi, Abdullah Ali Alshehri, Bassam Hasanain
    Journal of the Franklin Institute.2024; 361(1): 543.     CrossRef
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    Ingrid Anna Teigen, Marte Kierulf Åm, Misbah Riaz, Sverre Christian Christiansen, Sven Magnus Carlsen
    Current Therapeutic Research.2024; 100: 100736.     CrossRef
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    Martin Dodek, Eva Miklovičová
    IEEE Access.2024; 12: 35899.     CrossRef
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    B. Wayne Bequette
    Korean Journal of Chemical Engineering.2023; 40(1): 1.     CrossRef
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    Sun Joon Moon, Kyung‐Soo Kim, Woo Je Lee, Mi Yeon Lee, Robert Vigersky, Cheol‐Young Park
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    Karim Davari Benam, Hasti Khoshamadi, Marte Kierulf Åm, Øyvind Stavdahl, Sebastien Gros, Anders Lyngvi Fougner
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    Jee Hee Yoo, Jae Hyeon Kim
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    John S Pemberton, Emma G Wilmot, Katharine Barnard‐Kelly, Lalantha Leelarathna, Nick Oliver, Tabitha Randell, Craig E Taplin, Pratik Choudhary, Peter Adolfsson
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    Howaida Moawad Ahmed Ali
    Kontakt.2023; 25(2): 100.     CrossRef
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    Martin Dodek, Eva Miklovičová
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  • A Markov Model of Gap Occurrence in Continuous Glucose Monitoring Data for Realistic in Silico Clinical Trials
    Martina Vettoretti, Martina Drecogna, Simone Del Favero, Andrea Facchinetti, Giovanni Sparacino
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    Beate Bittner, Manuel Sánchez-Félix, Dennis Lee, Athanas Koynov, Joshua Horvath, Felix Schumacher, Simon Matoori
    Journal of Controlled Release.2023; 360: 335.     CrossRef
  • Importance of continuous glucose monitoring in the treatment of diabetes mellitus
    Sun Joon Moon, Won-Young Lee
    Journal of the Korean Medical Association.2023; 66(7): 432.     CrossRef
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    Chiara Toffanin, Lalo Magni
    IEEE Transactions on Control Systems Technology.2023; 31(5): 2288.     CrossRef
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    Valentina Maria Cambuli, Marco Giorgio Baroni
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    Gopal Bhagwan Khodve, Sugato Banerjee
    Current Diabetes Reviews.2023;[Epub]     CrossRef
  • The artificial pancreas: two alternative approaches to achieve a fully closed-loop system with optimal glucose control
    M. K. Åm, I. A. Teigen, M. Riaz, A. L. Fougner, S. C. Christiansen, S. M. Carlsen
    Journal of Endocrinological Investigation.2023; 47(3): 513.     CrossRef
  • Multivariable Automated Insulin Delivery System for Handling Planned and Spontaneous Physical Activities
    Mohammad Reza Askari, Mohammad Ahmadasas, Andrew Shahidehpour, Mudassir Rashid, Laurie Quinn, Minsun Park, Ali Cinar
    Journal of Diabetes Science and Technology.2023; 17(6): 1456.     CrossRef
  • Advanced Technology (Continuous Glucose Monitoring and Advanced Hybrid Closed-Loop Systems) in Diabetes from the Perspective of Gender Differences
    Maria Grazia Nuzzo, Marciano Schettino
    Diabetology.2023; 4(4): 519.     CrossRef
  • Artificial Pancreas under a Zone Model Predictive Control based on Gaussian Process models: toward the personalization of the closed loop
    Marco Polver, Beatrice Sonzogni, Mirko Mazzoleni, Fabio Previdi, Antonio Ferramosca
    IFAC-PapersOnLine.2023; 56(2): 9642.     CrossRef
  • Personalized Constrained MPC for glucose regulation
    Chiara Toffanin, Lalo Magni
    IFAC-PapersOnLine.2023; 56(2): 9648.     CrossRef
  • Automated Insulin Delivery Systems in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-analysis of Outpatient Randomized Controlled Trials
    Baoqi Zeng, Le Gao, Qingqing Yang, Hao Jia, Feng Sun
    Diabetes Care.2023; 46(12): 2300.     CrossRef
  • Novel Glycemic Index Based on Continuous Glucose Monitoring to Predict Poor Clinical Outcomes in Critically Ill Patients: A Pilot Study
    Eun Yeong Ha, Seung Min Chung, Il Rae Park, Yin Young Lee, Eun Young Choi, Jun Sung Moon
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Dual‐hormone artificial pancreas for glucose control in type 1 diabetes: A meta‐analysis
    Baoqi Zeng, Hao Jia, Le Gao, Qingqing Yang, Kai Yu, Feng Sun
    Diabetes, Obesity and Metabolism.2022; 24(10): 1967.     CrossRef
  • Dual-Hormone Insulin-and-Pramlintide Artificial Pancreas for Type 1 Diabetes: A Systematic Review
    Alezandra Torres-Castaño, Amado Rivero-Santana, Lilisbeth Perestelo-Pérez, Andrea Duarte-Díaz, Analia Abt-Sacks, Vanesa Ramos-García, Yolanda Álvarez-Pérez, Ana M. Wäagner, Mercedes Rigla, Pedro Serrano-Aguilar
    Applied Sciences.2022; 12(20): 10262.     CrossRef
  • History of insulin treatment of pediatric patients with diabetes in Korea
    Jae Hyun Kim, Choong Ho Shin, Sei Won Yang
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Short Communication
Type 1 Diabetes
Real-World Analysis of Therapeutic Outcome in Type 1 Diabetes Mellitus at a Tertiary Care Center
Antonia Kietaibl, Michaela Riedl, Latife Bozkurt
Diabetes Metab J. 2022;46(1):149-153.   Published online July 6, 2021
DOI: https://doi.org/10.4093/dmj.2020.0267
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AbstractAbstract PDFPubReader   ePub   
Insulin replacement in type 1 diabetes mellitus (T1DM) needs intensified treatment, which can either be performed by multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). This retrospective analysis of a real-world scenario aimed to evaluate whether glycaemic and cardiovascular risk factors could be controlled with CSII outclass MDI as suggested by recent evidence. Data from patients with either insulin pump (n=68) or injection (n=224) therapy at an Austrian tertiary care centre were analysed between January 2016 and December 2017. There were no significant differences with regard to the latest glycosylated hemoglobin, cardiovascular risk factor control or diabetes-associated late complications. Hypoglycaemia was less frequent (P<0.001), sensor-augmented therapy was more common (P=0.003) and mean body mass index (BMI) was higher (P=0.002) with CSII treatment. This retrospective analysis of real-world data in T1DM did not demonstrate the superiority of insulin pump treatment with regard to glycaemic control or cardiovascular risk factor control.
Original Articles
Drug/Regimen
Effects of Teneligliptin on HbA1c levels, Continuous Glucose Monitoring-Derived Time in Range and Glycemic Variability in Elderly Patients with T2DM (TEDDY Study)
Ji Cheol Bae, Soo Heon Kwak, Hyun Jin Kim, Sang-Yong Kim, You-Cheol Hwang, Sunghwan Suh, Bok Jin Hyun, Ji Eun Cha, Jong Chul Won, Jae Hyeon Kim
Diabetes Metab J. 2022;46(1):81-92.   Published online June 16, 2021
DOI: https://doi.org/10.4093/dmj.2021.0016
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Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
To evaluate the effects of teneligliptin on glycosylated hemoglobin (HbA1c) levels, continuous glucose monitoring (CGM)-derived time in range, and glycemic variability in elderly type 2 diabetes mellitus patients.
Methods
This randomized, double-blinded, placebo-controlled study was conducted in eight centers in Korea (clinical trial registration number: NCT03508323). Sixty-five participants aged ≥65 years, who were treatment-naïve or had been treated with stable doses of metformin, were randomized at a 1:1 ratio to receive 20 mg of teneligliptin (n=35) or placebo (n=30) for 12 weeks. The main endpoints were the changes in HbA1c levels from baseline to week 12, CGM metrics-derived time in range, and glycemic variability.
Results
After 12 weeks, a significant reduction (by 0.84%) in HbA1c levels was observed in the teneligliptin group compared to that in the placebo group (by 0.08%), with a between-group least squares mean difference of –0.76% (95% confidence interval [CI], –1.08 to –0.44). The coefficient of variation, standard deviation, and mean amplitude of glycemic excursion significantly decreased in participants treated with teneligliptin as compared to those in the placebo group. Teneligliptin treatment significantly decreased the time spent above 180 or 250 mg/dL, respectively, without increasing the time spent below 70 mg/dL. The mean percentage of time for which glucose levels remained in the 70 to 180 mg/dL time in range (TIR70–180) at week 12 was 82.0%±16.0% in the teneligliptin group, and placebo-adjusted change in TIR70–180 from baseline was 13.3% (95% CI, 6.0 to 20.6).
Conclusion
Teneligliptin effectively reduced HbA1c levels, time spent above the target range, and glycemic variability, without increasing hypoglycemia in our study population.

Citations

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  • Comparison of teneligliptin and other gliptin-based regimens in addressing insulin resistance and glycemic control in type 2 diabetic patients: a cross-sectional study
    Harmanjit Singh, Ravi Rohilla, Shivani Jaswal, Mandeep Singla
    Expert Review of Endocrinology & Metabolism.2024; 19(1): 81.     CrossRef
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    Expert Review of Clinical Pharmacology.2023; 16(1): 49.     CrossRef
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    Michelangelo Bauwelz Gonzatti, José Edvar Monteiro Júnior, Antônio José Rocha, Jonathas Sales de Oliveira, Antônio José de Jesus Evangelista, Fátima Morgana Pio Fonseca, Vânia Marilande Ceccatto, Ariclécio Cunha de Oliveira, José Ednésio da Cruz Freire
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    Banshi Saboo, Suhas Erande, A.G. Unnikrishnan
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Drug/Regimen
Efficacy and Safety of Self-Titration Algorithms of Insulin Glargine 300 units/mL in Individuals with Uncontrolled Type 2 Diabetes Mellitus (The Korean TITRATION Study): A Randomized Controlled Trial
Jae Hyun Bae, Chang Ho Ahn, Ye Seul Yang, Sun Joon Moon, Soo Heon Kwak, Hye Seung Jung, Kyong Soo Park, Young Min Cho
Diabetes Metab J. 2022;46(1):71-80.   Published online June 16, 2021
DOI: https://doi.org/10.4093/dmj.2020.0274
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Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
To compare the efficacy and safety of two insulin self-titration algorithms, Implementing New Strategies with Insulin Glargine for Hyperglycemia Treatment (INSIGHT) and EDITION, for insulin glargine 300 units/mL (Gla-300) in Korean individuals with uncontrolled type 2 diabetes mellitus (T2DM).
Methods
In a 12-week, randomized, open-label trial, individuals with uncontrolled T2DM requiring basal insulin were randomized to either the INSIGHT (adjusted by 1 unit/day) or EDITION (adjusted by 3 units/week) algorithm to achieve a fasting self-monitoring of blood glucose (SMBG) in the range of 4.4 to 5.6 mmol/L. The primary outcome was the proportion of individuals achieving a fasting SMBG ≤5.6 mmol/L without noct urnal hypoglycemia at week 12.
Results
Of 129 individuals (age, 64.1±9.5 years; 66 [51.2%] women), 65 and 64 were randomized to the INSIGHT and EDITION algorithms, respectively. The primary outcome of achievement was comparable between the two groups (24.6% vs. 23.4%, P=0.876). Compared with the EDITION group, the INSIGHT group had a greater reduction in 7-point SMBG but a similar decrease in fasting plasma glucose and glycosylated hemoglobin. The increment of total daily insulin dose was significantly higher in the INSIGHT group than in the EDITION group (between-group difference: 5.8±2.7 units/day, P=0.033). However, body weight was significantly increased only in the EDITION group (0.6±2.4 kg, P=0.038). There was no difference in the occurrence of hypoglycemia between the two groups. Patient satisfaction was significantly increased in the INSIGHT group (P=0.014).
Conclusion
The self-titration of Gla-300 using the INSIGHT algorithm was effective and safe compared with that using the EDITION algorithm in Korean individuals with uncontrolled T2DM (ClinicalTrials.gov number: NCT03406663).

Citations

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  • Basal insulin titration algorithms in patients with type 2 diabetes: the simplest is the best (?)
    V.I. Katerenchuk
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    V.I. Katerenchuk, A.V. Katerenchuk
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    Camilla Heisel Nyholm Thomsen, Stine Hangaard, Thomas Kronborg, Peter Vestergaard, Ole Hejlesen, Morten Hasselstrøm Jensen
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Review
Type 1 Diabetes
Time in Range from Continuous Glucose Monitoring: A Novel Metric for Glycemic Control
Jee Hee Yoo, Jae Hyeon Kim
Diabetes Metab J. 2020;44(6):828-839.   Published online December 23, 2020
DOI: https://doi.org/10.4093/dmj.2020.0257
Correction in: Diabetes Metab J 2021;45(5):795
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AbstractAbstract PDFPubReader   ePub   
Glycosylated hemoglobin (HbA1c) has been the sole surrogate marker for assessing diabetic complications. However, consistently reported limitations of HbA1c are that it lacks detailed information on short-term glycemic control and can be easily interfered with by various clinical conditions such as anemia, pregnancy, or liver disease. Thus, HbA1c alone may not represent the real glycemic status of a patient. The advancement of continuous glucose monitoring (CGM) has enabled both patients and healthcare providers to monitor glucose trends for a whole single day, which is not possible with HbA1c. This has allowed for the development of core metrics such as time spent in time in range (TIR), hyperglycemia, or hypoglycemia, and glycemic variability. Among the 10 core metrics, TIR is reported to represent overall glycemic control better than HbA1c alone. Moreover, various evidence supports TIR as a predictive marker of diabetes complications as well as HbA1c, as the inverse relationship between HbA1c and TIR reveals. However, there are more complex relationships between HbA1c, TIR, and other CGM metrics. This article provides information about 10 core metrics with particular focus on TIR and the relationships between the CGM metrics for comprehensive understanding of glycemic status using CGM.

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Original Article
Basic Research
Role of Intestinal Microbiota in Metabolism of Voglibose In Vitro and In Vivo
Mahesh Raj Nepal, Mi Jeong Kang, Geon Ho Kim, Dong Ho Cha, Ju-Hyun Kim, Tae Cheon Jeong
Diabetes Metab J. 2020;44(6):908-918.   Published online April 6, 2020
DOI: https://doi.org/10.4093/dmj.2019.0147
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

Voglibose, an α-glucosidase inhibitor, inhibits breakdown of complex carbohydrates into simple sugar units in intestine. Studies showed that voglibose metabolism in the liver might be negligible due to its poor intestinal absorption. Numerous microorganisms live in intestine and have several roles in metabolism and detoxification of various xenobiotics. Due to the limited information, the possible metabolism of voglibose by intestinal microbiota was investigated in vitro and in vivo.

Methods

For the in vitro study, different concentrations of voglibose were incubated with intestinal contents, prepared from both vehicle- and antibiotics-treated mice, to determine the decreased amount of voglibose over time by using liquid chromatography-mass spectrometry. Similarly, in vivo pharmacodynamic effect of voglibose was determined following the administration of voglibose and starch in vehicle- and antibiotic-pretreated non-diabetic and diabetic mice, by measuring the modulatory effects of voglibose on blood glucose levels.

Results

The in vitro results indicated that the remaining voglibose could be significantly decreased when incubated with the intestinal contents from normal mice compared to those from antibiotic-treated mice, which had less enzyme activities. The in vivo results showed that the antibiotic pretreatment resulted in reduced metabolism of voglibose. This significantly lowered blood glucose levels in antibiotic-pretreated mice compared to the control animals.

Conclusion

The present results indicate that voglibose would be metabolized by the intestinal microbiota, and that this metabolism might be pharmacodynamically critical in lowering blood glucose levels in mice.

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Review
Others
Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications
Giacomo Cappon, Martina Vettoretti, Giovanni Sparacino, Andrea Facchinetti
Diabetes Metab J. 2019;43(4):383-397.   Published online July 25, 2019
DOI: https://doi.org/10.4093/dmj.2019.0121
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AbstractAbstract PDFPubReader   

By providing blood glucose (BG) concentration measurements in an almost continuous-time fashion for several consecutive days, wearable minimally-invasive continuous glucose monitoring (CGM) sensors are revolutionizing diabetes management, and are becoming an increasingly adopted technology especially for diabetic individuals requiring insulin administrations. Indeed, by providing glucose real-time insights of BG dynamics and trend, and being equipped with visual and acoustic alarms for hypo- and hyperglycemia, CGM devices have been proved to improve safety and effectiveness of diabetes therapy, reduce hypoglycemia incidence and duration, and decrease glycemic variability. Furthermore, the real-time availability of BG values has been stimulating the realization of new tools to provide patients with decision support to improve insulin dosage tuning and infusion. The aim of this paper is to offer an overview of current literature and future possible developments regarding CGM technologies and applications. In particular, first, we outline the technological evolution of CGM devices through the last 20 years. Then, we discuss about the current use of CGM sensors from patients affected by diabetes, and, we report some works proving the beneficial impact provided by the adoption of CGM. Finally, we review some recent advanced applications for diabetes treatment based on CGM sensors.

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Short Communication
Epidemiology
Low-Normal Free Thyroxine Levels in Euthyroid Male Are Associated with Prediabetes
Sung Woo Kim, Jae-Han Jeon, Jun Sung Moon, Eon Ju Jeon, Mi-Kyung Kim, In-Kyu Lee, Jung Beom Seo, Keun-Gyu Park
Diabetes Metab J. 2019;43(5):718-726.   Published online March 19, 2019
DOI: https://doi.org/10.4093/dmj.2018.0222
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AbstractAbstract PDFSupplementary MaterialPubReader   

Abnormal thyroid function is associated with impaired glucose homeostasis. This study aimed to determine whether free thyroxine (FT4) influences the prevalence of prediabetes in euthyroid subjects using a cross-sectional survey derived from the Korea National Health and Nutrition Examination Survey, conducted between 2013 and 2015. We studied 2,399 male participants of >20 years of age who were euthyroid and non-diabetic. Prediabetic participants had lower FT4 concentrations than those without prediabetes, but their thyrotropin concentrations were similar. We stratified the population into tertiles according to FT4 concentration. After adjusting for multiple confounding factors, glycosylated hemoglobin (HbA1c) levels significantly decreased with increasing FT4 tertile, whereas fasting plasma glucose (FPG) levels were not associated with FT4 tertiles (HbA1c, P<0.01 in T3 vs. T1; FPG, P=0.489 in T3 vs. T1). The prevalence of prediabetes was significantly higher in T1 (odds ratio, 1.426; 95% confidence interval, 1.126 to 1.806; P<0.01) than in T3. In conclusion, subjects with low-normal serum FT4 had high HbA1c and were more likely to have prediabetes. These results suggest that low FT4 concentration is a risk factor for prediabetes in male, even when thyroid function is within the normal range.


Diabetes Metab J : Diabetes & Metabolism Journal