Glycemic Monitoring

As the number of patients with diabetes increases annually, it is not surprising that the number of patients with diabetes who are admitted to the hospital also increases. Once in the hospital, patients with diabetes or hyperglycemia may be admitted to the Intensive Care Unit, require urgent or elective surgery, enteral or parenteral nutrition, intravenous insulin infusion, or therapies that significantly impact glycemic control (e.g., steroids). Because many clinical outcomes are influenced by the degree of glycemic control, knowledge of the best practices in inpatient diabetes management is extremely important. The field of inpatient management of diabetes and hyperglycemia has grown substantially in the last several years. This body of knowledge is summarized in this book, so it can reach the audience of hospitalists, endocrinologists, nurses and other team members who take care of hospitalized patients with diabetes and hyperglycemia.

Use of real-time continuous glucose monitors among people with type 1 and type 2 diabetes is growing rapidly and should continue to grow until an artificial pancreas is brought to market. Likewise, use of professional systems in healthcare practices is expanding. But, other than manufacturer instructional manuals and some book chapters on CGMs, there are no standalone publications available with concise, non-commercial instructions on CGM prescription and use. Additionally, continuous glucose monitors are too often not used to their full and proper potential. This leaves users with suboptimal glucose control and can result in system abandonment. To address this, diabetes educator and author Gary Scheiner has created Practical CGM: Improving Patient Outcomes through Continuous Glucose Monitoring to give healthcare providers the skill to make more effective use of the data generated by continuous glucose monitors, in both real-time and on a retrospective analytic basis. Using a plain-language approach and distilling content to concise, practical tips and techniques, Scheiner has created a guide that will help practitioners optimize patient use of CGM systems and, ultimately, improve glucose control and patient health outcomes.

Intended for diabetes researchers and medical professionals who work closely with patients with diabetes, this newly updated and expanded edition provides new perspectives and direct insight into the causes and consequences of this serious medical condition from one of the foremost experts in the field. Using the latest scientific and medical developments and trends, readers will learn how to identify, prevent, and treat this challenging phenomenon within the parameters of the diabetes care regimen.

Glucose Monitoring Devices: Measuring Blood Glucose to Manage and Control Diabetes presents the state-of-the-art regarding glucose monitoring devices and the clinical use of monitoring data for the improvement of diabetes management and control. Chapters cover the two most common approaches to glucose monitoring–self-monitoring blood glucose and continuous glucose monitoring–discussing their components, accuracy, the impact of use on quality of glycemic control as documented by landmark clinical trials, and mathematical approaches. Other sections cover how data obtained from these monitoring devices is deployed within diabetes management systems and new approaches to glucose monitoring. This book provides a comprehensive treatment on glucose monitoring devices not otherwise found in a single manuscript. Its comprehensive variety of topics makes it an excellent reference book for doctoral and postdoctoral students working in the field of diabetes technology, both in academia and industry. Presents a comprehensive approach that spans self-monitoring blood glucose devices, the use of continuous monitoring in the artificial pancreas, and intraperitoneal glucose sensing Provides a high-level descriptions of devices, as well as detailed mathematical descriptions of methods and techniques Written by experts in the field with vast experience in the field of diabetes and diabetes technology

This book provides comprehensive information on continuous glucose monitoring (CGM). The first section focuses on the fundamentals of CGM technology, including the principles of CGM, accuracy assessment, operation procedure, management processes, the picture-interpretation methodology, the clinical value of CGM parameters, reference values, clinical applications of CGM report and management systems, and clinical indications. In turn, the second section describes the clinical application of CGM, including assessing blood glucose fluctuation and hypoglycemic effects, detecting hypoglycemia and identifying fasting hyperglycemia. It also describes the role of CGM in connection with specific diseases, such as fulminant type 1 diabetes, gestational diabetes mellitus, steroid diabetes, and insulinoma. The closing chapter outlines the future of CGM. In addition, the book presents typical cases and analyses of nearly a hundred typical monitoring maps. As such, it offers diabetic health care doctors a valuable reference guide to the clinical application of and scientific research on CGM.

Glycemic Control in the Hospitalized Patient: A Comprehensive Clinical Guide is a unique, practical resource for health care providers dealing with hyperglycemia in the inpatient setting. Outlining a hands-on approach used by the Duke University Inpatient Diabetes Management team, the book discusses a wide range of scenarios that occur while treating patients with hyperglycemia, including challenging circumstances such as steroids and tube feeding regimens. Special emphasis is given to insulin therapy. The chapters are written by a group of health care providers with extensive, pioneering experience in hyperglycemia control in the inpatient setting at the Duke University Medical Center. The book includes the most up-to-date scientific evidence and information and is addressed to not only hospitalists and general internists but also endocrinology fellows, residents, nurse practitioners, nurses, and other primary care practitioners who treat patients in the inpatient setting. The focus is clearly on practical, patient-care topics. Glycemic Control in the Hospitalized Patient: A Comprehensive Clinical Guide is a first-of-its kind, comprehensive guide to state-of-the-art inpatient glycemic management.

Intensive diabetes management is the process by which blood glucose levels are closely controlled using multiple daily insulin injections or an insulin pump. People who use this method of diabetes management must be closely aligned with their health care team and highly motivated because it not only requires close scrutiny of blood glucose levels, but also constant monitoring of food intake and medication dosage, among other things. Although difficult to maintain, intensive diabetes management has proven very effective and is now the rule, rather than the exception, in diabetes care. Virtually all patients with diabetes—type 1 or type 2—can improve their glycemic control and overall health through intensive diabetes management. Intensive Diabetes Management is geared toward the health care practitioner who wants to implement this method in his or her patients. It emphasizes a team approach to patient care and offers guidance in helping patients move toward treatment goals appropriate for their individual skills and medical condition. Individual sections address all of the key topics in intensive diabetes management, including rationale/physiological Basis, team approach, education, pyschosocial issues patient selection/goals of therapy, insulin regimens, insulin pump therapy, monitoring, and nutrition management. This new edition is updated to cover the latest advances in medical research. New insights into diabetes and how they impact this particular treatment are covered. In addition, the data, guidelines, and procedures have been revised to reflect that newest positions of the American Diabetes Association's standards of care.

Recent use of continuous glucose monitoring (CGM) has increased and initiates closer to diagnosis of type 1 diabetes (T1D) among pediatric patients in the United States. However, little is known about benefits of starting CGM soon after diagnosis. We assessed glycemic control in youth initiating Dexcom G5 CGM within 40 days of diagnosis compared to no CGM use within 180 days of onset of T1D.Methods: Data from 55 study participants (mean age 11.1 u00b1 3.6 years, range 2-17 years, 50% female, 69% non-Hispanic white) were obtained for 6 months. 42 participants randomized to initiate CGM within 40 days of diagnosis (CGM group) and 13 randomized to use blinded CGM one week per month for 6 months (control group). HbA1c was measured at baseline, 13, and 26 weeks. CGM data from the groups were compared using t-tests.Results: Data in table show HbA1c decreased in both groups over 6 months with no significant difference. Time in range (70-180 mg/dl) was not significantly different at 3 and 6 months; however, time

Being diagnosed with diabetes, no longer means giving up an active life. New technology, such as insulin pumps and continuous glucose monitors, can help people with both type 1 and type 2 diabetes stay active and flexible and maintain healthy attitudes and lifestyles. Designed to mimic the action of the pancreas, insulin pumps are small, pager-sized devices that infuse insulin under the skin based on programmed rates. Not only does this eliminate the need for injections, it also allows for small amounts of insulin to to be released throughout the day, and large amounts to be administered at meals based on what's being eaten. When paired with a continuous glucose monitor, which provides a continuous readout of glucose levels, users can enjoy accurate, tight glucose control that provides much greater flexibility and freedom than the old check-and-inject method. Dr. Francine Kaufman's Insulin Pumps and Continuous Glucose Monitoring explains the advances in glucose management, and thoroughly discusses the technology, as well as the physical and psychological aspects of diabetes care. It provides a comprehensive medical approach toward diabetes management and pump therapy with an appreciation of the real-life challenges and frustrations faced every day by people with diabetes.