Journal of Diabetes Science and Technology最新文献

{"title":"Finding Optimal Alphabet for Encoding Daily Continuous Glucose Monitoring Time Series Into Compressed Text.","authors":"Tobore Igbe, Boris Kovatchev","doi":"10.1177/19322968251323913","DOIUrl":"10.1177/19322968251323913","url":null,"abstract":"<p><strong>Background: </strong>The emergence of continuous glucose monitoring (CGM) devices has not only revolutionized diabetes management but has also opened new avenues for research. This article presents a novel approach to encoding a CGM daily profile into a CGM string and CGM text that preserves clinical metrics information but compresses the data.</p><p><strong>Methods: </strong>Eight alphabets were defined to represent glucose ranges. The Akaike information criterion (AIC) was derived from error, and the compression ratio was estimated for each alphabet to determine the optimal alphabet for encoding the CGM daily profile. The analysis was done with data from six distinct studies, with different treatment modalities, applied to individuals with type 1 diabetes (T1D) or type 2 diabetes (T2D), and without diabetes. The data set was divided into 70% for training and 30% for validation.</p><p><strong>Result: </strong>The result from the training data reveals that a 9-letter alphabet was optimal for encoding daily CGM profiles for T1D or T2D, yielding the lowest AIC score that minimizes information loss. However, in health, fewer letters were needed, and this is to be expected, given the lower variation of the data. Further testing with the Pearson correlation showed that the 9-letter alphabet approximated the coefficient of variation, with correlations between 0.945 and 0.965.</p><p><strong>Conclusion: </strong>Encoding CGM data into text could enhance the classification of CGM profiles and enable the use of well-established search engines with CGM data. Other potential applications include predictive modeling, anomaly detection, indexing, trend analysis, or future generative artificial intelligence applications for diabetes research and clinical practice.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251323913"},"PeriodicalIF":4.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for Lipohypertrophy in People With Insulin-Treated Diabetes: A Systematic Meta-Analysis.","authors":"Julia K Mader, Riccardo Fornengo, Ahmed Hassoun, Lutz Heinemann, Bernhard Kulzer, Magdalena Monica, Trung Nguyen, Jochen Sieber, Eric Renard, Yves Reznik, Przemysław Ryś, Anita Stożek-Tutro, Emma G Wilmot","doi":"10.1177/19322968251325569","DOIUrl":"10.1177/19322968251325569","url":null,"abstract":"<p><strong>Background: </strong>Lipohypertrophy is a common skin complication in people with insulin-treated diabetes. Despite its high prevalence and potential impact on diabetes management and outcomes, published data regarding the risk factors for the development of this complication are contradictory. The study aimed to determine risk factors for lipohypertrophy related to patient characteristics and insulin therapy.</p><p><strong>Method: </strong>Medical databases (MEDLINE/PubMed, Embase, CENTRAL) were searched from 1990 to August 21, 2023. All relevant studies describing potential risk factors for lipohypertrophy in people with insulin-treated diabetes (eg, sex, age, body mass index [BMI], type of diabetes, and injection technique) were included. Data enabling calculations of prevalence odds ratios (pOR) and mean differences (MD) with 95% confidence intervals [95% CI] were extracted and pooled in meta-analyses.</p><p><strong>Results: </strong>Fifty-one studies of risk factors for lipohypertrophy were identified. Performed meta-analyses indicate that the strongest contributor to lipohypertrophy was incorrect injection site rotation (pOR = 8.85 [95% CI: 5.10-15.33]), followed by needle reuse (3.20 [1.99-5.13]), duration of insulin therapy >5 years (2.62 [1.70-4.04]) and >2 daily injections per day (2.27 [1.58-3.25]). Those with type 1 diabetes and obese/overweight individuals also had significantly higher odds of developing lipohypertrophy. Sex, age, and insulin device (pen, syringes) were not significant risk factors for lipohypertrophy.</p><p><strong>Conclusions: </strong>This systematic review with meta-analysis revealed that incorrect injection site rotation and needle reuse are the most substantial factors in developing lipohypertrophy. Notably, both factors are modifiable through patient education, emphasizing the importance of teaching proper injection techniques for better diabetes management.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251325569"},"PeriodicalIF":4.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Safely Use Diluted Insulin in an Automated Insulin Delivery System in Very Young Children: An Educator Perspective.","authors":"Eilidh Nicol, Jennifer Ashford, Beatrice Prampolini, M Loredana Marcovecchio","doi":"10.1177/19322968251322183","DOIUrl":"10.1177/19322968251322183","url":null,"abstract":"<p><p>Managing type 1 diabetes in infants and very young children poses unique challenges due to their low insulin requirements, high insulin sensitivity, and rapidly changing metabolic needs. Standard insulin formulations (U100) may prove inadequate for this age group, especially when utilizing continuous subcutaneous insulin infusion or automated insulin delivery (AID) systems.This article presents our clinical experience with diluted insulin (U10) in very young children using the AID system CamAPS FX, along with a literature review, highlighting its potential benefits, such as reduced incidence of hypoglycemia and rates of technical malfunctions. We also discuss key practical considerations for implementing insulin dilution in clinical practice, including the establishment of safety protocols, caregivers and healthcare professionals training, and the importance of accurate preparation and labeling of diluted formulations to mitigate potential serious dosing errors.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251322183"},"PeriodicalIF":4.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repair, Regeneration, and Replacement, Revisited (Redux).","authors":"David G Armstrong, Bijan Najafi, Wei Gao, David C Klonoff, Charles Liu","doi":"10.1177/19322968251326906","DOIUrl":"10.1177/19322968251326906","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251326906"},"PeriodicalIF":4.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Time to Moderate and Severe Hyperglycemia and Ketonemia Following an Insulin Pump Occlusion\".","authors":"","doi":"10.1177/19322968251325907","DOIUrl":"10.1177/19322968251325907","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251325907"},"PeriodicalIF":4.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Insulin Delivery in Pregnancies Complicated by Type 1 Diabetes.","authors":"Katrien Benhalima, Sarit Polsky","doi":"10.1177/19322968251323614","DOIUrl":"10.1177/19322968251323614","url":null,"abstract":"<p><p>Automated insulin delivery (AID) systems adapt insulin delivery via a predictive algorithm integrated with continuous glucose monitoring and an insulin pump. Automated insulin delivery has become standard of care for glycemic management of people with type 1 diabetes (T1D) outside pregnancy, leading to improvements in time in range, with lower risk for hypoglycemia and improved treatment satisfaction. The use of AID facilitates optimal preconception care, thus more women of reproductive age are becoming pregnant while using AID. The effectiveness and safety in pregnant populations of using AID systems with algorithms for non-pregnant populations may be impacted by requirements for lower glucose targets and existence of increased insulin resistance during gestation. The CamAPS FX is the only AID system approved for use in pregnancy. A large randomized controlled trial (RCT) with this AID system demonstrated a 10.5% increase in time in pregnancy range (an additional 2.5 hours/day) compared with standard insulin therapy in pregnant women with T1D with a baseline glycated hemoglobin A1c (HbA_1c) ≥48 mmol/mol (6.5%). A RCT of AID not approved for use in pregnancy (MiniMed 780G) has also demonstrated some benefits of AID compared with standard insulin therapy with improved time in pregnancy range overnight (24 minutes), less hypoglycemia, and improved treatment satisfaction. There is also increasing evidence that AID can be safely continued during delivery and postpartum, while maintaining glycemic goals with lower risk for hypoglycemia. More AID systems are needed with flexible glucose targets in the pregnancy range and possibly with algorithms that better adapt to changing insulin requirements. More evidence is needed on the impact of AID on maternal and neonatal outcomes. We review the current evidence on the use of AID in pregnancy and postpartum.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251323614"},"PeriodicalIF":4.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classifying Continuous Glucose Monitoring Documents From Electronic Health Records.","authors":"Yaguang Zheng, Eduardo Iturrate, Lehan Li, Bei Wu, William R Small, Susan Zweig, Jason Fletcher, Zhihao Chen, Stephen B Johnson","doi":"10.1177/19322968251324535","DOIUrl":"10.1177/19322968251324535","url":null,"abstract":"<p><strong>Background: </strong>Clinical use of continuous glucose monitoring (CGM) is increasing storage of CGM-related documents in electronic health records (EHR); however, the standardization of CGM storage is lacking. We aimed to evaluate the sensitivity and specificity of CGM Ambulatory Glucose Profile (AGP) classification criteria.</p><p><strong>Methods: </strong>We randomly chose 2244 (18.1%) documents from NYU Langone Health. Our document classification algorithm: (1) separated multiple-page documents into a single-page image; (2) rotated all pages into an upright orientation; (3) determined types of devices using optical character recognition; and (4) tested for the presence of particular keywords in the text. Two experts in using CGM for research and clinical practice conducted an independent manual review of 62 (2.8%) reports. We calculated sensitivity (correct classification of CGM AGP report) and specificity (correct classification of non-CGM report) by comparing the classification algorithm against manual review.</p><p><strong>Results: </strong>Among 2244 documents, 1040 (46.5%) were classified as CGM AGP reports (43.3% FreeStyle Libre and 56.7% Dexcom), 1170 (52.1%) non-CGM reports (eg, progress notes, CGM request forms, or physician letters), and 34 (1.5%) uncertain documents. The agreement for the evaluation of the documents between the two experts was 100% for sensitivity and 98.4% for specificity. When comparing the classification result between the algorithm and manual review, the sensitivity and specificity were 95.0% and 91.7%.</p><p><strong>Conclusion: </strong>Nearly half of CGM-related documents were AGP reports, which are useful for clinical practice and diabetes research; however, the remaining half are other clinical documents. Future work needs to standardize the storage of CGM-related documents in the EHR.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251324535"},"PeriodicalIF":4.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of an Automated Insulin Delivery System in People Living With Type 2 Diabetes and Insulin Resistance: First Real-World Evidence in 26 427 Users.","authors":"Isabeau Thijs, Arcelia Arrieta, Javier Castañeda, Michael Joubert, Francesco Giorgino, Benedikt Voelker, Tim Van den Heuvel, Jeremy Basset-Sagarminaga, Goran Petrovski, John Shin, Robert Vigersky, Ohad Cohen","doi":"10.1177/19322968251318373","DOIUrl":"10.1177/19322968251318373","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes (T2D) is a phenotypically heterogeneous disease. The use of insulin is required in a significant portion of people with T2D, despite recent developments in antidiabetic medications. This study analyzes glycemic outcomes in automated insulin delivery (AID) users with T2D with different insulin requirements.</p><p><strong>Methods: </strong>This is a retrospective, real-world analysis including MiniMed 780G (MM780G) data uploaded to CareLink Personal (January 2020 to April 2024). Four cohorts were identified based on phenotypes of T2D: (A) users with total daily dose of insulin (TDD) ≥ 100 IU, (B) users with self-reported T2D, (C) users with self-reported T2D and TDD ≥ 100 IU, and (D) users with self-reported T2D and TDD <100 IU. Glycemic outcomes and insulin use were assessed post-AID, pre-AID versus post-AID, and six-month longitudinal post-AID.</p><p><strong>Results: </strong>A total of 26 427 users were included in this study, of which 18 466 in cohort A, 10 795 in cohort B, 2 834 in cohort C, and 7 961 in cohort D. Mean time in range (TIR) was 71.1% ± 12.2 for cohort A, 75.1% ±14.1 for cohort B, 72.2% ± 15.0 for cohort C, and 76.1% ± 13.6 for cohort D. Mean time below range (TBR) <70 mg/dL was ≤1% in all cohorts. The users in cohort C using the recommended optimal settings (glucose target [GT] of 100 mg/dL and active insulin time [AIT] of two hours) had a greater TIR with 78.7% ± 10.8. All cohorts increased ≥10% post-AID compared with pre-AID.</p><p><strong>Conclusions: </strong>The use of this AID is associated with effective therapy outcomes, as indicated by over 70% TIR, and appears to be safe, as demonstrated by a low TBR in a large cohort of real-life users with self-reported T2D and high or low TDD.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251318373"},"PeriodicalIF":4.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Postprandial Glycemic Responses With Limited Data in Type 1 and Type 2 Diabetes.","authors":"Yiheng Shen, Euiji Choi, Samantha Kleinberg","doi":"10.1177/19322968251321508","DOIUrl":"10.1177/19322968251321508","url":null,"abstract":"<p><strong>Background: </strong>A core challenge in managing diabetes is predicting glycemic responses to meals. Prior work identified significant interindividual variation in responses and developed personalized forecasts. However, intraindividual variation is still not well understood, and the most accurate approaches require invasive microbiome data. We aimed to investigate (1) whether postprandial glycemic responses (PPGRs) can be predicted with limited data and (2) sources of intraindividual variation.</p><p><strong>Methods: </strong>We used data collected from 397 people with Type 1 Diabetes (T1DEXI) and 100 people with Type 2 Diabetes (ShanghaiT2DM) who wore continuous glucose monitors (CGMs) and logged meals. Using dietary, demographic, and temporal features, we predicted 2 hours PPGR, and peak 2 hours postprandial glucose rise (Glu_max). We evaluated the contribution of food features (eg, macronutrients, food category) and use of personal training data and investigated intraindividual variability in responses.</p><p><strong>Results: </strong>We achieved comparable accuracy to prior work for PPGR (T1DEXI R = 0.61, ShanghaiT2DM R = 0.72) and Glu_max (T1DEXI R = 0.64, ShanghaiT2DM R = 0.73), without using invasive data like microbiome. Including food category features led to higher accuracy than macronutrients alone. Analysis of glycemic responses to duplicate meals identified time of day (PPGR: T1DEXI <i>P</i> < .05 for lunch, ShanghaiT2DM <i>P</i> < .001 for lunch and dinner) and menstrual cycle (Glu_max: <i>P</i> < .05 for perimenstrual) as sources of variability.</p><p><strong>Conclusions: </strong>We demonstrate that in individuals with T1D and T2D, glycemic responses to meals can be predicted without personalized training data or invasive physiological data.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251321508"},"PeriodicalIF":4.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Robust Needle Tip Design Enables Needle Reuse and Reduced Skin Trauma in Combination With Autoinjector Needle Shields.","authors":"Anne-Sofie Madsen Staples, Julie Schwartz, Kezia Ann Friis Præstmark, Marie Sand Traberg","doi":"10.1177/19322968231190408","DOIUrl":"10.1177/19322968231190408","url":null,"abstract":"<p><strong>Background: </strong>Pen needles and autoinjectors are necessary for millions of patients needing injectable drug treatment but pose economic and environmental burdens. A durable device with a multiuse needle could reduce cost and improve user experience. This study explores a novel robust needle tip (EXP) designed for multiple uses and durability against hooking.</p><p><strong>Method: </strong>Needle robustness was investigated through a structural analysis. Furthermore, EXP and control needles (NF30, NF28) were evaluated in an in-vivo porcine model as pen needles or embedded in autoinjectors to study the resulting increase in skin blood perfusion (SBP). The SBP was assessed by laser speckle contrast analysis (LASCA) of 192 randomized and blinded needle insertions.</p><p><strong>Results: </strong>Forming a 33 µm hook against a hard surface requires 0.92 N for the NF30 control needle and 5.38 N for EXP. The EXP did not induce more tissue trauma than the NF30. There was a positive relation between needle diameter and SBP (<i>P</i> < .05). Furthermore, the presence of an autoinjector shield and applied force of 10 N was found to significantly reduce SBP for worn EXP needles (<i>P</i> < .05) compared to insertions without autoinjector shield.</p><p><strong>Conclusions: </strong>The investigated robust needle EXP is on par with the single-use needle NF30 in terms of tissue trauma, which is further reduced by combining the needle with a needle shield. These results should encourage the innovation and development of durable, reusable injection systems with pharmacoeconomic and environmental value and a simplified and enhanced user experience for patients.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"352-360"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9957884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}