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Table of contents

Presenting kernel regression smooths of periodicities over day or week gives insight into pattern of blood glucose variation over various periods. A trend detection algorithm gives feedback on significant trends, increasing or decreasing, in self-measured blood glucose on any scale.

Significant trends emerge in all patients' data at some time. Similarity matching of events gives a list of comparable situations in the past given a suitable metric. The list can be used as a decision support tool for the users, e. Discussion: Giving patients data-driven feedback directly on their mobile phones can give better insight into their own data and disease, and improve disease management.

We will present these three methods in detail, and discuss the strength and weaknesses in practical situations.

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Introduction : Hypoglycemia and hyperglycemia both have been implicated in adverse effects on brain development and function in children with T1DM. Most attention has focused on hypoglycemia because of its dramatic symptoms that act as a barrier in achieving metabolic control. Results : Neuropsychological profiles in children 12 years after the onset of T1DM demonstrate impaired verbal ability, working memory and non-verbal processing speed related to hypoglycemia.

Using magnetic resonance spectroscopy MRS , N-acetylaspartate NAA was reduced in the basal ganglia of adolescents; studies in younger children have not been performed due to technical limitations and ethical considerations. Hyperglycemia also contributes to functional abnormalities as well as in neurocognitive abilities of children with T1DM. Using diffusion tensor imaging to quantify white matter in relation to chronic hyperglycemia, severe hyperglycemic episodes and severe hypoglycemia, it has been reported that white matter changes occur in distinct brain areas including the superior parietal lobule, hippocampus and thalamus.

Similar studies are now being performed in young children focusing on hypoglycemia as the determining factor for structural brain abnormalities. Conclusions : Newer technologies in CGM coupled to functional and structural imaging will enable new insights into the neurodevelopmental abnormalities seen in children with T1DM.

Introduction: We developed a transdermal continuous glucose monitoring system comprised of a long-lasting up to days , fully-implantable fluorescent-hydrogel sensor and a wearable detector. This system has the great potential to realize the long-term continuous glucose monitoring system. Materials and methods: We fabricated glucose-sensitive fluorescent-hydrogel fibers and implanted them under the skin of ears of rats. The fluorescence intensity was transdermally detected through skin layers by the wearable detector. The obtained signals were transmitted to the personal computer PC through a wireless device.

Result: The measured signals successfully tracked the fluctuation of blood glucose concentration. We calculated the blood glucose concentration from the sensor signals according to the calibration algorithm. The calculated glucose concentration values showed a good correlation with reference blood glucose concentrations.


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Conclusion: We demonstrated the feasible application of our system for continuous glucose monitoring. We envision that this method can accelerate a paradigm shift from intermittent, test-strip based self-monitoring blood glucose to continuous, implanted monitors, thereby helping people with diabetes to live a high-quality life like healthy people. Implanted fluorescent hydrogel microfibers. Bradley: www. Thirty patients used CGM iPro2 for six days and completed the HypoSRQ hour version daily for seven days, at the end of each week 7-day version , and at the end of four weeks recent-weeks version.

Four patients used CGM for 28 days for within-person analyses. These relationships remained significant after adjustments for age, sex, treatment duration and type of diabetes. Conclusions: The HypoSRQ has moderate to high sensitivity in detecting CGM-measured hypoglycaemia and its psychometric properties provide an attractive instrument for use in people with type 1 and insulin-treated type 2 diabetes. Further cross-validation and use of the HypoSRQ in different centres and in non-insulin-treated patients is recommended. Introduction: We have developed an implantable peritoneal artificial pancreas.

A glucose-sensitive gel controlled an insulin supply held in a reservoir. The gel was the glucose sensor in the device but also formed the insulin delivery port to the peritoneal cavity. Filling with insulin was via a circuit linked to subcutaneous ports. Objective and aim: To assess its ability to control basal and boost requirements automatically in the streptozotocin diabetic pig model.

Method: Surgery was developed to insert the system for testing, diabetes was induced and then the device was filled in situ. The animal was monitored over a period of weeks with ad lib food and several large oral glucose challenges. The insulin was removed from the device after about 10 days of good glycemic control and the return to diabetic levels was established after a further 24 days implying residual insulin retained in the gel.

Conclusion: A non-electronic, non-biological closed-loop system has been developed and trialled in the diabetic pig. It controlled the basal and bolus needs for diabetes for more than four weeks without any manual insulin adjustment, relying for three of those weeks on deposited insulin from the reservoir that acted as a depot in the gel. Methods: 16 pump-treated patients with type 1 diabetes received 60 hours of closed-loop therapy with a telemonitored insulin and glucagon delivering closed-loop system and 60 hours of patient-managed open-loop therapy.

The system used the Medtronic SofSensor or Enlite sensor.

The control algorithm was tuned in the first 12 hours of closed loop. The remaining 48 hours were compared to open loop per hour period. Results: Due to technical problems, 11 patients could be analyzed. However, median glucose was significantly lower during day 2 of closed loop CL2 vs open loop OL2 7.

Time spent in euglycemia 3. Conclusion: Bihormonal closed-loop control is feasible at home, with comparable time in euglycemia to open loop and significantly lower median glucose levels on day 2 of control at the expense of more time in hypoglycemia, albeit still at a very low percentage of time. Objective: Tight blood glucose control TGC in critically ill patients is difficult, labour intensive and associated with increased hypoglycaemia rate. GPI decreased from While the proportion of patients with severe hypoglycaemia was not decreased Nurse-C 3. We previously demonstrated that pramlintide injections in T1D subjects mitigated glycemic excursions during CLC; possible mechanisms include delaying carbohydrate absorption and suppressing endogenous glucagon.

Aims: To characterize the effect of pramlintide on meal-related glucagon responses and correlate glucagon responses with glycemic responses during CLC. During CLC, identical meals were provided for both study days without manual pre-meal boluses. Glucose and glucagon excursions were compared between conditions. Conclusion: Reduction of prandial glycemic excursions during CLC with pramlinitide was due at least in part to suppression of endogenous glucagon.

Additional strategies to suppress inappropriate meal-related glucagon responses should improve performance of closed-loop systems.

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Research design and methods: Enrollment began in July with longitudinal data collected from the time of diagnosis. Analyses included participants with T1D duration of at least 1 year. Logistic regression was used to determine factors associated with transition from injection to pump therapy. When adjusting for the factors listed above, HbA1c level prior to pump initiation was similar to that of a comparison group that did not use a pump. Conclusions: Pump therapy is commonly initiated in youth during the first year of T1D.

Patients of African-American race and lower socioeconomic status are less likely to be placed on pumps during the first year. Further investigations are needed to gain a better understanding of barriers to use of pumps in youth with T1D, especially in disadvantaged and minority families. Background: Continuous subcutaneous insulin infusion CSII patients experience switches of pump systems on a regular basis. Glycemic control, safety and diabetes management parameters were measured at baseline, after 3 and 6 months.

Changes from baseline were analyzed.

Carl Czerny, Schule der Geläufigkeit, Op. 299, Nrn. 21-30

Hypoglycemic episodes decreased during the study. Number of glucose measurements increased, whereas number of boluses decreased. HbA1c and Diabetes Management Values. Increased SMBG frequency and decrease of bolus frequency showed a more confident diabetes management and a reduced need for correction boluses. Compared to insulin as it is secreted in people without diabetes, today's subcutaneous rapid-acting insulin analogs have a slow onset, a slow offset, a nonphysiological distribution in the body, and a variable pattern of uptake.

These factors pose challenges in diabetes management, especially closed-loop glycemic control. Therefore, a myriad of methods to improve insulin's action profile are being investigated. Meanwhile, exploration continues on alternative routes of insulin delivery, such as intradermal e. The benefits of these many promising approaches will depend on their safety, efficacy, tolerability, and ease of use.

Regulatory and commercial issues also deserve consideration, as these affect whether and how new insulin delivery products will ultimately be used by patients and healthcare providers. Objective: The aim of this study was to evaluate periodontal health in children diagnosed with type 1 diabetes mellitus. Subjects and methods: Periodontal health was clinically examined and compared in 95 children diagnosed with type 1 diabetes and 61 healthy control subjects. Plaque index, gingival index, clinical attachment loss and bleeding on probing were assessed on the 6 Ramfjord index teeth.

Diabetes history was recorded based on information provided by the physician from the medical record of each diabetic child. Diabetes history included: date of diagnosis, diabetes duration, age at diagnosis, latest reading for the glycosylated hemoglobin HbA1c, and any existing diabetes complications. Part of the diabetic group have received scaling therapy. Results: Children with type 1 diabetes mellitus had significantly higher plaque index, and gingival index than control subjects. For patients who received periodontal treatment; supportive periodontal treatment helped in improving HbA1c level.

Conclusions: Compared to children without diabetes, periodontal diseases in young patients with type 1 diabetes is more evident.

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Diabetes duration may play a significant role on the progression of periodontal disease in diabetic children. Periodontal destruction can start very early in life and periodontal treatment is very essential to prevent future bone destruction. Acknowledgment: This study was supported by Kuwait University research grant No.

Background: Regular physical activity RPA is of great importance for maintaining a healthy lifestyle in diabetic children. Methods: Thirty three children with type 1 diabetes mellitus T1DM , were equally divided in three groups: a control group GC who receive no training; the second G1 and the third group G2 completed a week aerobic training programmes.

G1 participated in 1 hour of aerobic exercise twice weekly, while G2 had 4 single hour sessions weekly. HbA1c and lipid profile were measured before, after 12 and 24 weeks.