DexCom - Continuous Glucose Monitoring
Filed under: Type 1, Childhood, Lifestyle, Products, Support
DexCom has developed a continuous glucose monitoring ("CGM") system that could be the next generation of aggressive control. The DexCom GCM is a device that measures glucose trends throughout the day, providing up to 288 glucose measurements every 24 hours.
A traditional glucose monitoring test -like finger sticks - leave gaps in time where you are uncertain as to your blood sugar reading. Continuous monitoring is different from traditional blood glucose monitoring because it affords a comprehensive picture of where your blood sugars are throughout the day and night. The trend reveals times throughout the day where your sugar may increase or decrease, as well as how fast it is happening. This trend information together with the glucose value shows you patterns and problems that traditional finger sticks cannot cover as thoroughly. CGM allows you to set a target range for your desired glucose. When your glucose goes above or below this range, an alert automatically lets you know.
A 2006 study showed that people who used this device were able to achieve a 23% decrease in time spent high and a 21% decrease in time spent low. After speaking with Dianne on the DexCom customer support line - she advised me that they are offering a $375 startup kit that has everything you need to get going. The Rechargeable STS Receiver has a sleek rounded design that can easily be carried with the carry case on both your belt or in a handbag. The STS Transmitter is lightweight and fits comfortably underneath clothing. The STS Sensor & Applicator is easy to insert and safe to use with no visible needles or exposed sharps. With this wireless system, no cables or wires will get in your way allowing you to Take Control and Live Uninterrupted.. Each sensor lasts for 3 days. A set of 5 sensors costs $175 and will last you approximately 15 days.
The annual cost of continuous glucose monitoring averages a ballpark figure of $4,258. Okay, sounds a little steep - but lean on Uncle Sam to offset the cost of the best control. Sounds like it might be time to open up a Flexible Spending Account and write-off the yearning for glucose precision.
No Benefit Found for Post-Stroke Tight Glucose Control
Filed under: Type 1, Type 2, Childhood, Adult Onset, Research
British researchers have found that tight glucose control during hospitalization for a stroke may not improve survivalThe study involved 933 patients enrolled within 24 hours of a stroke who had glucose in the range of 6.0 to 17 mmol/l. Participants received saline solution or continuous glucose, potassium, insulin infusions to reduce their blood glucose. Patients were monitored every two hours with glucose adjusted if needed every eight hours. The researchers found that both treatment and placebo groups had improvement in glucose levels. The treatment group had an overall mean 0.57 mmol/l reduction in glucose over 24 hours while glucose levels also fell spontaneously with simple saline hydration. There was also no difference in the secondary outcome of disability. There was a significant reduction in systolic blood pressure in the treatment group. A researcher noted, "In the majority of patients, treatment with a simple saline infusion will correct mild to moderate hyperglycemia."
The saline and glucose relationship is similar to the way the noninvasive glucose monitors measure blood sugar (aka Glucowatch)., This relationship between sodium and glucose in the blood moves inverse. When your sugar levels are elevated, your sodium is down. When you force sodium into your blood, your sugar is suppressed. Doctors must proceed with caution in light of this study. When it comes to aggressively lowering glucose, especially after a trauma, it could be more harmful than helpful.
The Glycemic Index
The GI is a scale that measures how quickly carbohydrate foods are broken down into glucose. Find out how it relates to the bodybuilding, fitness and weight loss world.
[RESEARCH] Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial
Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus.
Design Prospective randomised controlled trial of self monitoring versus no monitoring (control).
Setting Hospital diabetes clinics.
Participants 184 (111 men) people aged <70 with newly diagnosed type 2 diabetes referred to the participating diabetes clinics. Major exclusion criteria were secondary diabetes, insulin treatment, previous self monitoring of blood glucose.
Interventions Participants were randomised to self monitoring or no monitoring (control) groups for one year with follow-up at three monthly intervals. Both groups underwent an identical structured core education programme. The self monitoring group received additional education on monitoring.
Main outcome measures Between group differences in HbA1c, psychological indices, use of oral hypoglycaemic drugs, body mass index (BMI), and reported hypoglycaemia rates.
Results 96 patients (55 men) were randomised to monitoring and 88 (56 men) to control. There were no baseline differences in mean (SD) age (57.7 (11.0) in monitoring group v 60.9 (11.5) in control group) or HbA1c (8.8 (2.1)% v 8.6 (2.3)%, respectively). Those in the monitoring group had a higher baseline BMI (34 (7) v 32 (6.2)). There were no significant differences between groups at any time point (12 months values given) in HbA1c (6.9 (0.8)% v 6.9 (1.2)%, P=0.69; 95% confidence interval for difference –0.25% to 0.38%), BMI (33.1 (6.4) v 31.8 (6.0); adjusted for baseline BMI, P=0.32), use of oral hypoglycaemic drugs, or reported incidence of hypoglycaemia. Monitoring was associated with a 6% higher score on the depression subscale of the well-being questionnaire (P=0.01).
Conclusions In patients with newly diagnosed type 2 diabetes self monitoring of blood glucose concentration has no effect on glycaemic control but is associated with higher scores on a depression subscale.
Trial registration ISRCTN 49814766.
[RESEARCH] Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial
Objective To assess the cost effectiveness of self monitoring of blood glucose alone or with additional training in incorporating the results into self care, in addition to standardised usual care for patients with non-insulin treated type 2 diabetes.
Design Incremental cost utility analysis from a healthcare perspective. Data on resource use from the randomised controlled diabetes glycaemic education and monitoring (DiGEM) trial covered 12 months before baseline and 12 months of trial follow-up. Quality of life was measured at baseline and 12 months using the EuroQol EQ-5D questionnaire.
Setting Primary care in the United Kingdom.
Participants 453 patients with non-insulin treated type 2 diabetes.
Interventions Standardised usual care (control) compared with additional self monitoring of blood glucose alone (less intensive self monitoring) or with training in self interpretation of the results (more intensive self monitoring).
Main outcome measures Quality adjusted life years and healthcare costs (sterling in 2005-6 prices).
Results The average costs of intervention were £89 (113; $179) for standardised usual care, £181 for less intensive self monitoring, and £173 for more intensive self monitoring, showing an additional cost per patient of £92 (95% confidence interval £80 to £103) in the less intensive group and £84 (£73 to £96) in the more intensive group. No other significant cost difference was detected between the groups. An initial negative impact of self monitoring on quality of life occurred, averaging –0.027 (95% confidence interval–0.069 to 0.015) for the less intensive self monitoring group and –0.075 (–0.119 to –0.031) for the more intensive group.
Conclusions Self monitoring of blood glucose with or without additional training in incorporating the results into self care was associated with higher costs and lower quality of life in patients with non-insulin treated type 2 diabetes. In light of this, and no clinically significant differences in other outcomes, self monitoring of blood glucose is unlikely to be cost effective in addition to standardised usual care.
Trial registration Current Controlled Trials ISRCTN47464659.
New findings on continuous blood glucose monitoring
Filed under: Type 1, Childhood, Adult Onset, Research
The results of this study on continuous blood glucose monitoring (CBGM) were surprising to researchers, and I can see why. In this study, CBGM's effect on long-term blood glucose control was insignificant.
Researchers evaluated the benefits of two different CBGM devices in a study of over 400 insulin-taking type 1 or type 2 diabetics. 102 were randomly assigned to MiniMed's Continuous Glucose Monitoring System (R) (CGMS) and 100 patients were hooked up to Animas' Biographer. Approximately 200 remaining patients comprised a standard control group or an "attention" control group. The "attention" group was devised to compare against the increased contact with healthcare officials realized by patients on CBGM devices. Makes sense.
A little info for you, MiniMed's CGMS is connected via a wire under the skin, takes blood sugar recordings every 5 minutes and can be worn up to 72 hours. The Biographer works differently, extracting fluid electro-osmotically from the skin for 12 to 15 hours, offering blood sugar readings every 10 minutes. The only 'Biographer' product I could find was Animas' GlucoWatch (R) Biographer, which is literally worn on the wrist.
Patients entering the study had mean A1C levels from 7.0% to 15.5%. All four groups declined in mean A1C, especially during the study's first few months. But 18 months later, the differences in A1Cs were not significantly different from the mean baseline A1Cs nor from other groups.
By no means should anyone write off CBGM from this study. Simon Heller, professor of clinical diabetes and director of research and development with the Sheffield Teaching Hospitals Foundation (England) stated clinicians are still working out how to use the information offered by CBGM, so the lack of significant CBGM benefit in this study is to be expected. Dr. Heller stated CBGM devices should primarily be used as research tools and not marketed to patients. Future research needs to examine how patients and doctors can best use data generated by CBGM to positively impact treatment.
An aside, some experts are saying the average blood glucose level per individual is a better insight into diabetes control than A1C levels. The sharp fluctuations in blood sugars cause many diabetes complications. Don't miss this post by Allie Beatty.
[RESEARCH] Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis
Objective To quantify the effectiveness of pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance.
Data sources Medline, Embase, and the Cochrane library searched up to July 2006. Expert opinions sought and reference lists of identified studies and any relevant published reviews checked.
Study selection Randomised controlled trials that evaluated interventions to delay or prevent type 2 diabetes in individuals with impaired glucose tolerance.
Results 21 trials met the inclusion criteria, of which 17, with 8084 participants with impaired glucose tolerance, reported results in enough detail for inclusion in the meta-analyses. From the meta-analyses the pooled hazard ratios were 0.51 (95% confidence interval 0.44 to 0.60) for lifestyle interventions v standard advice, 0.70 (0.62 to 0.79) for oral diabetes drugs v control, 0.44 (0.28 to 0.69) for orlistat v control, and 0.32 (0.03 to 3.07) for the herbal remedy jiangtang bushen recipe v standard diabetes advice. These correspond to numbers needed to treat for benefit (NNTB) and harm (NNTH) of 6.4 for lifestyle (95% credible interval, NNTB 5.0 to NNTB 8.4), 10.8 for oral diabetes drugs (NNTB 8.1 to NNTB 15.0), 5.4 for orlistat (NNTB 4.1 to NNTB 7.6), and 4.0 for jiangtang bushen (NNTH 16.9 to NNTB 24.8).
Conclusions Lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance. Lifestyle interventions seem to be at least as effective as drug treatment.
Pine Tree Extract Delays Glucose Absorption
Filed under: Type 2, Adult Onset, Drugs, Research, Products
A new study reveals that French maritime pine tree extract (known as Pycnogenol) delays the uptake of glucose from a meal 190 times more than prescription medications, preventing the typical high-glucose peak in the blood stream after a meal.
The study revealed the pine bark is more potent for suppressing carbohydrate absorption in diabetes than synthetic prescription alpha-glucosidase inhibitors such as Precose. Researchers reviewed the interaction of Pycnogenol with alpha-glucosidase, an enzyme responsible for the breaks down of carbohydrates in a meal. Results revealed Pycnogenol is 190 times more potent for inhibition of alpha-glucosidase than the synthetic inhibitor acarbose, a common prescription medication for treatment of type 2 diabetes. These drugs are sold in Europe under the name Glucobay and the United States under the name Precose. The bark contains a unique combination of procyanidins, bioflavonoids and organic acids. The alpha-glucosidase breaks down carbohydrates into glucose molecules which are then absorbed into the blood stream.
In two separate studies Pycnogenol was found to significantly lower blood sugar in type 2 diabetes patients. One study showed that patients who supplemented with Pycnogenol experienced lower blood sugar after meals and lower fasting blood sugar. Another study revealed a significantly lowered blood glucose level in patients who supplemented with Pycnogenol while continuing their anti-diabetic medication with acarbose and metformin. This study opens new avenues for product development of Pycnogenol in the field of diabetes, metabolic syndrome and obesity.
Diabetes research innovator Landau dies
Filed under: Type 2, Adult Onset, Research, Daily News, Support
The world famous biochemist, Bernard R. Landau, whose medical research proved invaluable to understanding diabetes, has died in Cleveland at the age of 80.
Dr. Landau focused his research on how the human body processes glucose. By focusing his research on how the liver stores glucose as glycogen, he proved vital in later research of some types of diabetes. In certain diabetes types, complications arise after the body ceases processing glycogen. The former Nobel fellow at Sweden's Karolinska Institute also worked with other scientists in finding out exactly how glucose is broken down inside the body. In the late '50s, Dr. Landau and others investigated how tissues process glucose, especially in the liver, where it is stored as glycogen. He developed methods to follow and measure this metabolism by using radioactive tracers that were infused into bodily tissue. In some types of diabetes, the processing of glycogen is disrupted, leading to further complications.
Bernard Robert Landau was born in Newark. He graduated from the Massachusetts Institute of Technology before receiving his doctorate in organic chemistry from Harvard in 1950. He later received a medical degree, also from Harvard. He is survived by his two sons, Steven and Rodger, and five grandchildren. Thank you for all you have contributed to the scientific community, Dr. Landau.
High Blood Sugar Increases Cancer Risk
Filed under: Type 2, Adult Onset, Lifestyle, Research
A Swedish study has found that elevated blood sugar in women is linked with increased risk of developing cancer.Researchers identified 2,478 incident cases of cancer from records of 33,293 women and 31,304 men who participated in the study. Participants were recruited in the mid-1980s at age 40, 50 and 60 and the study covered a 13-year period. The records included levels of glucose in the blood when fasting and after receiving an infusion of glucose. Researchers calculated the cancer risk relative to blood glucose while adjusting for: age, year of enrollment, fasting time and smoking status. Women with blood sugar levels higher than normal have a total higher risk for cancer while for men the risk was unchanged at higher blood sugar levels. The overall risk of developing cancer for women in the top 25% of fasting blood glucose levels was 26% higher than those in the bottom 25%. Women with high fasting glucose levels had a higher risk of pancreatic, breast and endometrial cancers, while the increase in risk for malignant melanoma was two times higher.
While previous studies have shown that cancer risk for some cancers is higher for people with type 2 diabetes, this study suggests that something could be happening to trigger cancer much earlier, as glucose levels begin to rise. The scientists also found that the blood sugar levels gradually rose over the period of the study, which they suggest means that cancer risks would also continue to rise unless glucose levels were brought down by some means. The results were no different when they took Body Mass Index (BMI) into account.
The study provides further evidence for an association between abnormal glucose metabolism and cancer. If you ask me - I think this has to do with the pH levels of the blood. It is well known that cancer manifests in blood levels of higher acidity. Poor diabetic control can result in higher acid levels in the blood. The catch 22 is poor diabetic control leaves your entire blood chemistry off kilter and it cannot defend any rogue cells - especially those associated with malignant growth (i.e. cancer!)