bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Tissue Heterogeneity on Noninvasive Near-Infrared Glucose Measurements in Interstitial Fluid of Rat Skin
Authors: Alexeeva Natalia V. , Arnold Mark A.
Published: January 2014

Background:

Movement of the optical interface used to collect noninvasive near-infrared spectra is known to dramatically increase prediction errors for glucose concentration measurements within the interstitial fluid of living rat skin. Prediction errors increase by more than 2.5-fold when the interface is moved before each noninvasive measurement compared to measurements where the interface position is constant throughout. Chemical heterogeneity of the skin matrix is examined as a possible mechanism for the strong sensitivity to the interface placement during noninvasive measurements conducted from transmission near-infrared absorption spectroscopy.

Method:

Microspectroscopy was performed over a region of the near-infrared spectrum (4000–5000 cm1) to map the concentrations of water, collagen protein, fat, and keratin protein within the skin tissue matrix through which noninvasive spectra are collected. Maps were created for multiple samples of skin excised from male and female animals. Sets of near-infrared spectra were constructed to simulate noninvasive spectra in accord with the basic tissue composition found from the microspectroscopic maps with added information corresponding to a span of glucose concentrations ranging from 5 to 35 mM and Gaussian-distributed noise.

Results:

Microspectroscopic maps of rat skin reveal similar patterns of heterogeneity for major chemical components of skin samples excised from both male and female animals. These maps demonstrate concentration domains with dimensions similar to the size of the fiber interface used to collect noninvasive spectra. Partial least squares calibration models generated from sets of simulated spectra demonstrate increases in prediction errors for glucose when the spectral matrix is changed in accord with the degree of chemical heterogeneity displayed in the skin maps. Prediction errors typically increase between 100 and 1000% when comparing errors generated from spectra that represent a single tissue composition versus spectra that represent a varied skin composition in accord with the distribution displayed in the skin maps.

Conclusions:

The distribution of the major components of skin is not uniform, but establishes domains within the skin matrix that strongly impact prediction errors for the noninvasive spectroscopic measurement of glucose within the interstitial fluid of rat dermis tissue. The observed increase in prediction error (>2.5-fold) determined from actual noninvasive measurements is within the lower range of prediction error increases demonstrated by this simulation study. These findings implicate that chemical heterogeneity within the tissue matrix is a major factor in the sensitivity of the location of the fiber interface used to collect noninvasive spectral data.
Use of Subcutaneous Interstitial Fluid Glucose to Estimate Blood Glucose: Revisiting Delay and Sensor Offset
Authors: Rebrin Kerstin , Sheppard Norman F. , Steil Garry M.
Published: January 2014

Background:

Estimates for delays in the interstitial fluid (ISF) glucose response to changes in blood glucose (BG) differ substantially among research groups. We review these findings along with arguments that continuous glucose monitoring (CGM) devices used to measure ISF delay contribute to the variability. We consider the impact of the ISF delay and review approaches to correct for it, including strategies pursued by the manufacturers of these devices. The focus on how the manufacturers have approached the problem is motivated by the observation that clinicians and researchers are often unaware of how the existing CGM devices process the ISF glucose signal.

Methods:

Numerous models and simulations were used to illustrate problems related to measurement and correction of ISF glucose delay.

Results:

We find that (1) there is no evidence that the true physiologic ISF glucose delay is longer than 5–10 min and that the values longer than this can be explained by delays in CGM filtering routines; (2) the primary impact of the true ISF delay is on sensor calibration algorithms, making it difficult to estimate calibration factors and offset (OS) currents; (3) inaccurate estimates of the sensor OS current result in overestimation of sensor glucose at low values, making it difficult to detect hypoglycemia; (4) many device companies introduce nonlinear components into their filters, which can be expected to confound attempts by investigators to reconstruct BG using linear deconvolution; and (5) algorithms advocated by academic groups are seldom compared to algorithms pursued by industry, making it difficult to ascertain their value.

Conclusions:

The absence of any direct comparisons between existing and new algorithms for correcting ISF delay and sensor OS current is, in part, due to the difficulty in extracting relevant details from industry patents and/or extracting unfiltered sensor signals from industry products. The model simulation environment, where all aspects of the signal can be derived, may be more appropriate for developing new filtering and calibration strategies. Nevertheless, clinicians, academic researchers, and the industry would benefit from collaborating when evaluating those strategies.
Novel Use of Platelet-Rich Plasma to Augment Curative Diabetic Foot Surgery
Authors: Scimeca Christy L. , Bharara Manish , Fisher Timothy K. , Kimbriel Heather , Armstrong David G.
Published: January 2014

Autologous platelet-rich plasma (PRP) may enhance wound healing through the formation of a platelet plug that provides both hemostasis and the secretion of biologically active proteins, including growth factors such as platelet-derived growth factor, transforming growth factor (TGF)-β, TGF-β2, and epidermal growth factor. The release of these growth factors into the wound may create an environment more conducive to tissue repair and could accelerate postoperative wound healing. To our knowledge, there are no reports of combining the use of PRP with curative diabetic foot surgery. This article provides a summary of the literature regarding PRP and wound healing and presents a case of a 49-year-old man with diabetes and a three-month history of a deep, nonhealing plantar hallux wound in which PRP was combined with a first metatarsophalangeal joint arthroplasty. Through the use of the PRP and bioengineered tissue to supplement curative diabetic foot surgery, the patient healed uneventfully at seven weeks.
Diabetes in the Desert: What Do Patients Know about the Heat?
Authors: Nassar Adrienne A. , Childs Raymond D. , Boyle Mary E. , Jameson Kimberly A. , Fowke Margaret , Waters Ken R. , Hovan Michael J. , Cook Curtiss B.
Published: January 2014

Background:

This study aims to identify self-management strategies used by patients with diabetes in hot weather, examine knowledge of safe temperatures and exposure times, and evaluate comprehension of weather data.

Methods:

Patients attending an endocrinology clinic in southwestern United States were surveyed.

Results:

One hundred fifty-two surveys completed from November 30 to December 31, 2009 were analyzed. Mean patient age was 64 years; diabetes duration, 15 years; 51% were women, 83% had type 2 diabetes, 58% were non Hispanic white, and 77% were on insulin injections. Mean hemoglobin A1c was 7.9%; 38% had hemoglobin A1c values of 8.0% or higher. Patients used an array of personal protective measures during hot weather, and 71% limited heat exposure to less than one hour. Respondents typically took steps to protect their diabetes medication and supplies, but 37% chose to leave medications and supplies at home. Although 73% of respondents had received information regarding the effect of heat on insulin, only 39% had received information about the effect of heat on oral medications, 41% on glucose meters, and 38% on glucose test strips. The temperature at which patients took protective measures varied. Only 55% knew the definition of the heat index.

Conclusion:

Most survey participants took measures to protect themselves from the heat, although gaps in knowledge were evident. Many patients had suboptimal glycemic control, placing them potentially at risk for dehydration during the hottest months. Increased public awareness of this topic is needed, and diabetes education programs should include information about the heat where appropriate.
Evaluating the Clinical Accuracy of GlucoMen®Day: A Novel Microdialysis-Based Continuous Glucose Monitor
Authors: Valgimigli Francesco , Lucarelli Fausto , Scuffi Cosimo , Morandi Sara , Sposato Iolanda
Published: January 2014

Background:

The objective of this work was to determine the clinical accuracy of GlucoMen®Day, a new microdialysis-based continuous glucose monitoring system (CGMS) from A. Menarini Diagnostics (Florence, Italy). Accuracy evaluation was performed using continuous glucose-error grid analysis (CG-EGA), as recommended by the Performance Metrics for Continuous Interstitial Glucose Monitoring; Approved Guideline (POCT05-A).

Methods:

Two independent clinical trials were carried out on patients with types 1 and 2 diabetes mellitus, the glycemic levels of whom were monitored in an in-home setting for 100-hour periods. A new multiparametric algorithm was developed and used to compensate in real-time the GlucoMen®Day signal. The time lag between continuous glucose monitoring (CGM) and reference data was first estimated using the Poincaré plot method. The entire set of CGM/reference data pairs was then evaluated following the CG-EGA criteria, which allowed an estimation of the combined point and rate accuracy stratified by glycemic ranges.

Results:

With an estimated time lag of 11 minutes, the linear regression analysis of the CGM/reference glucose values yielded r = 0.92. The mean absolute error (MAE) was 11.4 mg/dl. The calculated mean absolute rate deviation (MARD) was 0.63 mg/dl/min. The data points falling within the A+B zones of CG-EGA were 100% in hypoglycemia, 95.7% in euglycemia, and 95.2% in hyperglycemia.

Conclusions:

The GlucoMen®Day system provided reliable, real-time measurement of subcutaneous glucose levels in patients with diabetes for up to 100 hours. The device showed the ability to follow rapid glycemic excursions and detect severe hypoglycemic events accurately. Its accuracy parameters fitted the criteria of the state-of-the-art consensus guideline for CGMS, with highly consistent results from two independent studies.
Validation of a Deconvolution Procedure (AutoDecon) for Identification and Characterization of Fasting Insulin Secretory Bursts
Authors: Johnson Michael L. , Veldhuis Paula P. , Grimmichova Tereza , Farhy Leon S. , Evans William S.
Published: January 2014

Background:

Insulin secretion is pulsatile, and has been shown to be altered in both physiologic and pathophysiologic conditions. The identification and characterization of such pulses have been challenging, partially because of the low concentrations of insulin during fasting and its short half-life. Existing pulse detection algorithms used to identify insulin pulses either cannot separate hormone pulses into their secretory burst and clearance components, or have been limited by both the subjective nature of initial peak selection and a lack of statistical verification of bursts.

Methods:

To address these concerns, we have developed AutoDecon, a novel deconvolution computer program.

Results:

AutoDecon was applied to synthetic insulin concentration-time series modeled on data derived from normal fasting subjects and simulated to reflect several sampling frequencies, sampling durations, and assay replicates. The operating characteristics of AutoDecon were compared to those obtained with Cluster, a standard pulse detection algorithm. AutoDecon performed considerably better than Cluster with regard to sensitivity and secretory burst detection rates for true positives, false positives, and false negatives. As expected, given the short half-life of insulin, sampling at 30-second intervals is required for optimal analytical results. The choice of sampling duration is more flexible and relates to the number of replicates assayed.

Conclusion:

AutoDecon represents a viable alternative to standard pulse detection algorithms for the appraisal of fasting insulin pulsatility.
Obesity Reduction and Awareness and Screening of Noncommunicable Diseases through Group Education in Children and Adolescents (ORANGE): Methodology Paper (ORANGE-1)
Authors: Sonya Jagadesan , Ranjani Harish , Pradeepa Rajendra , Mohan Viswanathan
Published: January 2014

Aim:

Our goal is to estimate the prevalence of obesity, glucose intolerance, hypertension, dyslipidemia, and metabolic syndrome among urban children and adolescents aged 6–19 years and to raise awareness about noncommunicable diseases (NCDs) among school children in Chennai, South India.

Methods:

The Obesity Reduction and Awareness and Screening of Noncommunicable Diseases through Group Education project plans to reach out to children and adolescents using two approaches: The school and the community approach. The school approach aims to reach out to a representative sample of approximately 20,000 urban school children and adolescents, aged 6–19 years, covering 50 schools from all parts of Chennai. Anthropometric measures will include height, weight, waist, body fat, and blood pressure. Data on demographics, family Profile, behavioral aspects, physical activity, and food pattern will be obtained by using a validated questionnaire. Awareness about metabolic NCDs like obesity and diabetes will be increased by educating the children and adolescents about healthy lifestyles. Through the community approach, 2000 children and adolescents from randomly selected residential colonies in Chennai will be screened for obesity, glucose intolerance, hypertension, dyslipidemia, and metabolic syndrome.

Expected Outcomes:

Awareness about NCDs will be increased among children and their parents in Chennai. This study will also provide valuable epidemiological data on obesity, glucose intolerance, dyslipidemia, hypertension and metabolic syndrome in children and adolescents in urban India.
The Nature of Amyloid-like Glucagon Fibrils
Authors: Pedersen Jesper Søndergaard
Published: January 2014

Protein aggregation and formation of amyloid fibrils is a phenomenon usually associated with proteotoxicity and degenerative diseases, such as type 2 diabetes, Alzheimer's disease, and prion diseases. However, several protein and peptide hormones are known to have a high propensity to form amyloid-like fibrils in vitro raising concerns about safety and stability of pharmaceutical protein solutions. Comprehensive understanding of the aggregation mechanisms is an important prerequisite to the design of strategies to prevent fibril formation. Detailed kinetic, spectroscopic, and morphological studies have revealed that glucagon can form several types of fibrils that differ at the level of molecular packing of the peptide. Each type forms through distinct nucleation-dependent aggregation pathways Influenced by solution conditions and can be self-propagated by seeding. An increasing number of functional amyloid-like structures have been discovered in nature, and it has recently been proposed that an amyloid-like state of glucagon may be utilized by the pancreatic α-cells as in vivo storage form. This article reviews the current state of our knowledge about the nature of the different types of amyloid-like glucagon fibrils, the mechanisms by which they form, and discusses implications for formulation strategies and the safety of glucagon pharmaceuticals.
Fetal Risk Assessment in Pregnancies Complicated by Diabetes Mellitus
Authors: Zisser Howard C. , Biersmith Michael A. , Jovanovič Lois B. , Yogev Yariv , Hod Moshe , Kovatchev Boris P.
Published: January 2014

Background:

Hypoglycemia and hyperglycemia can pose a number of serious risks to pregnant mothers with diabetes, but these risks are not always related to glucose concentrations directly. Previous studies have shown the utility of using mathematical transformation functions to create patient risk profiles that can then be used to analyze and predict adverse outcomes in individuals with diabetes. We propose a novel use of these functions to analyze the risks posed to the fetus in pregnancies complicated by diabetes.

Methods:

We retrospectively analyzed 71 h continuous glucose monitoring system (CGMS Gold, Medtronic Northridge, CA) third trimester tracings obtained during a normal pregnancy and in those complicated by gestational diabetes mellitus (GDM), type 2 diabetes mellitus (T2DM), and type 1 diabetes mellitus (T1DM). We then used a transformation function to calculate fetal and maternal risk in each case.

Results:

In the normal pregnancy (0.93), the risk was at a minimum. Along with mean glucose values, the risk increased in those cases where gestation was complicated by GDM (3.12), T2DM (7.85), and T1DM (16.94). In contrast, the original patient risk profile yielded a minimal value for the GDM tracings.

Conclusions:

Total fetal risk increases from normal to GDM to T2DM to T1DM pregnancies. This new risk assignment better distinguishes the stages of fetal risk than the original method and therefore may be useful in future clinical trials and applications to predict risk for adverse outcomes in pregnancies complicated by diabetes.
Multinational Study of Subcutaneous Model-Predictive Closed-Loop Control in Type 1 Diabetes Mellitus: Summary of the Results
Authors: Kovatchev Boris , Cobelli Claudio , Renard Eric , Anderson Stacey , Breton Marc , Patek Stephen , Clarke William , Bruttomesso Daniela , Maran Alberto , Costa Silvana , Avogaro Angelo , Man Chiara Dalla , Facchinetti Andrea , Magni Lalo , De Nicolao Giuseppe , Place Jerome , Farret Anne
Published: January 2014

Background:

In 2008–2009, the first multinational study was completed comparing closed-loop control (artificial pancreas) to state-of-the-art open-loop therapy in adults with type 1 diabetes mellitus (T1DM).

Methods:

The design of the control algorithm was done entirely in silico, i.e., using computer simulation experiments with N = 300 synthetic “subjects” with T1DM instead of traditional animal trials. The clinical experiments recruited 20 adults with T1DM at the Universities of Virginia (11); Padova, Italy (6); and Montpellier, France (3). Open-loop and closed-loop admission was scheduled 3–4 weeks apart, continued for 22 h (14.5 h of which were in closed loop), and used a continuous glucose monitor and an insulin pump. The only difference between the two sessions was that insulin dosing was performed by the patient under a physician's supervision during open loop, whereas insulin dosing was performed by a control algorithm during closed loop.

Results:

In silico design resulted in rapid (less than 6 months compared to years of animal trials) and cost-effective system development, testing, and regulatory approvals in the United States, Italy, and France. In the clinic, compared to open-loop, closed-loop control reduced nocturnal hypoglycemia (blood glucose below 3.9 mmol/liter) from 23 to 5 episodes (p < .01) and increased the amount of time spent overnight within the target range (3.9 to 7.8 mmol/liter) from 64% to 78% (p = .03).

Conclusions:

In silico experiments can be used as viable alternatives to animal trials for the preclinical testing of insulin treatment strategies. Compared to open-loop treatment under identical conditions, closed-loop control improves the overnight regulation of diabetes.
Design and Clinical Pilot Testing of the Model-Based Dynamic Insulin Sensitivity and Secretion Test (DISST)
Authors: Lotz Thomas F. , Chase J. Geoffrey , McAuley Kirsten A. , Shaw Geoffrey M. , Docherty Paul D. , Berkeley Juliet E. , Williams Sheila M. , Hann Christopher E. , Mann Jim I.
Published: January 2014

Background:

Insulin resistance is a significant risk factor in the pathogenesis of type 2 diabetes. This article presents pilot study results of the dynamic insulin sensitivity and secretion test (DISST), a high-resolution, low-intensity test to diagnose insulin sensitivity (IS) and characterize pancreatic insulin secretion in response to a (small) glucose challenge. This pilot study examines the effect of glucose and insulin dose on the DISST, and tests its repeatability.

Methods:

DISST tests were performed on 16 subjects randomly allocated to low (5 g glucose, 0.5 U insulin), medium (10 g glucose, 1 U insulin) and high dose (20 g glucose, 2 U insulin) protocols. Two or three tests were performed on each subject a few days apart.

Results:

Average variability in IS between low and medium dose was 10.3% ( p = .50) and between medium and high dose 6.0% ( p = .87). Geometric mean variability between tests was 6.0% (multiplicative standard deviation (MSD) 4.9%). Geometric mean variability in first phase endogenous insulin response was 6.8% (MSD 2.2%). Results were most consistent in subjects with low IS.

Conclusions:

These findings suggest that DISST may be an easily performed dynamic test to quantify IS with high resolution, especially among those with reduced IS.
β-Cell Dysfunction under Hyperglycemic Stress: A Molecular Model
Authors: Despa Florin , Berry R. Stephen
Published: January 2014

Background:

Pancreatic β cells respond to chronic hyperglycemia by increasing the synthesis of proinsulin (the precursor molecule of insulin). Prolonged stimulations lead to accumulation of misfolded proinsulin in the secretory track, delayed insulin secretion, and release of unprocessed proinsulin in the blood. The molecular mechanisms connecting the state of endoplasmic reticulum overloading with the efficiency of proinsulin to insulin conversion remain largely unknown.

Method:

Computer simulations can help us to understand mechanistic features of the β-cell secretory defect and to design experiments that may reveal the molecular basis of this dysfunction. We used molecular crowding concepts and statistical thermodynamics to dissect possible biophysical mechanisms underlying the alteration of the secretory track of β cells and to elucidate the chemistry aspects of the secretory dysfunction. We then used numerical algorithms to relate the degree of biophysical alteration of these secretory compartments with the change of proinsulin to insulin conversion rate.

Results:

Our computer simulations suggest that overloading the endoplasmic reticulum initiates downstream molecular crowding effects that affect protein translational mechanisms, including proinsulin misfolding, delayed packing of proinsulin in secretory vesicles, and low kinetic coefficient of proinsulin to insulin conversion.

Conclusions:

Together with previous experimental data, the present study can help us to better understand chemistry aspects related to the secondary translational mechanisms in β cells and how hyperglycemic stress can alter secretory function. This can give a further impetus to the development of novel software to be used in a clinical setup for prediction and assessment of diabetic states in susceptible patients.
Evaluation of an Over-the-Counter Glycated Hemoglobin (A1C) Test Kit
Authors: Chang Anna , Frank Joy , Knaebel Jennifer , Fullam Jeanellen , Pardo Scott , Simmons David A.
Published: January 2014

Background:

Glycated hemoglobin (A1C) monitoring is an integral component of diabetes management. This study was conducted to evaluate the performance of the A1CNow® SELFCHECK device when used by lay users and health care professionals (HCPs) to measure A1C.

Methods:

Subjects performed two A1CNow SELFCHECK finger-stick self-tests followed by a finger-stick test of the subject's blood by a HCP. The primary endpoint assessed accuracy of the subject and HCP A1CNow SELFCHECK readings. Secondary endpoints included precision, comprehension of instructional material (written material ± DVD), and product satisfaction. For accuracy comparison, a venous blood sample was drawn from each subject and tested by laboratory (TOSOH) analysis. Subject comprehension of product instructional material was evaluated via first-time failure (FTF) rate as recorded by the HCP, and subject satisfaction was assessed through written survey.

Results:

A total of 110 subjects with ( n = 93) and without ( n = 17) diabetes participated. Of 177 subject A1C values, 165 (93.2%) were within the acceptable range of ±13.5% of the laboratory reference value and considered accurate. Regression analysis showed good correlation of subject values to laboratory and HCP results ( R2 = 0.93 for both). The average within-subject coefficient of variation was 4.57% ( n = 74). The FTF rates with and without instructional DVD were 11.3% ( n = 56) and 39.6% ( n = 54), respectively. Subjects with diabetes/prediabetes overwhelmingly indicated that they were “very” to “extremely” likely (93.5%) to discuss their home A1C results with their HCP.

Conclusions:

Lay users found the A1CNow SELFCHECK easy to use, and both lay users and HCPs were able to measure A1C accurately.
Why Patients Should Be More Empowered: A European Perspective on Lessons Learned in the Management of Diabetes
Authors: Chatzimarkakis Jorgo
Published: January 2014

Patient empowerment has emerged as a new paradigm that can help improve medical outcomes while lowering costs of treatment. The concept seems particularly promising in the management of chronic diseases. Diabetes may provide a blueprint for implementing patient empowerment because empowering patients has been instrumental in achieving the successes we have witnessed in the management of diabetes in recent decades. Looking at the example of diabetes, this article investigates the role and contribution of patient empowerment to therapy success and derives actions that need to be taken in order to fully leverage the potential of this concept for patients, health care professionals, and health systems.
How Continuous Monitoring Changes the Interaction of Patients with a Mobile Telemedicine System
Authors: Martínez-Sarriegui Iñaki , García-Sáez Gema , Rigla Mercedes , Brugués Eulalia , de Leiva Alberto , Gómez Enrique J. , Hernando M. Elena
Published: January 2014

Background:

The combination of telemedicine systems integrating mobile technologies with the use of continuous glucose monitors improves patients' glycemic control but demands a higher interaction with information technology tools that must be assessed. In this article, we analyze patients' behavior from the use-of-the-system point of view, identifying how continuous monitoring may change the interaction of patients with the mobile telemedicine system.

Methods:

Patients' behavior were evaluated in a clinical experiment consisting of a 2-month crossover randomized study with 10 type 1 diabetes patients. During the entire experiment, patients used the DIABTel telemedicine system, and during the intervention phase, they wore a continuous glucose monitor. Throughout the experiment, all user actions were automatically registered. This article analyzes the occurrence of events and the behavior patterns in blood glucose (BG) self-monitoring and insulin adjustments. A subjective evaluation was also performed based on the answers of the patients to a questionnaire delivered at the end of the study.

Results:

The number of sessions established with the mobile Smart Assistant was considerably higher during the intervention period than in the control period (29.0 versus 18.8, p < .05), and it was also higher than the number of Web sessions (29.0 versus 22.2, p < .01). The number of daily boluses was higher during the intervention period than in the control period (5.27 versus 4.40, p < .01). The number of daily BG measurements was also higher during the intervention period (4.68 versus 4.05, p < .05) and, in percentage, patients increased the BG measurements not associated to meals while decreasing the percentage of preprandial measurements. The subjective evaluation shows that patients would recommend the use of DIABTel in routine care.

Conclusions:

The use of a continuous glucose monitor changes the way patients manage their diabetes, as observed in the increased number of daily insulin bolus, the increased number of daily BG measurements, and the differences in the distribution of BG measurements throughout the day. Continuous monitoring also increases the interaction of patients with the information system and modifies their patterns of use. We can conclude that mobile technologies are especially useful in scenarios of tight monitoring in diabetes, and they are well accepted by patients.
DrishtiCare: A Telescreening Platform for Diabetic Retinopathy Powered with Fundus Image Analysis
Authors: Joshi Gopal Datt , Sivaswamy Jayanthi
Published: January 2014

Objective:

Diabetic retinopathy is the leading cause of blindness in urban populations. Early diagnosis through regular screening and timely treatment has been shown to prevent visual loss and blindness. It is very difficult to cater to this vast set of diabetes patients, primarily because of high costs in reaching out to patients and a scarcity of skilled personnel. Telescreening offers a cost-effective solution to reach out to patients but is still inadequate due to an insufficient number of experts who serve the diabetes population. Developments toward fundus image analysis have shown promise in addressing the scarcity of skilled personnel for large-scale screening. This article aims at addressing the underlying issues in traditional telescreening to develop a solution that leverages the developments carried out in fundus image analysis.

Method:

We propose a novel Web-based telescreening solution (called DrishtiCare) integrating various value-added fundus image analysis components. A Web-based platform on the software as a service (SaaS) delivery model is chosen to make the service cost-effective, easy to use, and scalable. A server-based prescreening system is employed to scrutinize the fundus images of patients and to refer them to the experts. An automatic quality assessment module ensures transfer of fundus images that meet grading standards. An easy-to-use interface, enabled with new visualization features, is designed for case examination by experts.

Results:

Three local primary eye hospitals have participated and used DrishtiCare's telescreening service. A preliminary evaluation of the proposed platform is performed on a set of 119 patients, of which 23% are identified with the sight-threatening retinopathy. Currently, evaluation at a larger scale is under process, and a total of 450 patients have been enrolled.

Conclusion:

The proposed approach provides an innovative way of integrating automated fundus image analysis in the telescreening framework to address well-known challenges in large-scale disease screening. It offers a low-cost, effective, and easily adoptable screening solution to primary care providers.
Utilizing Information Technologies for Lifelong Monitoring in Diabetes Patients
Authors: Capozzi Davide , Lanzola Giordano
Published: January 2014

Background:

Information and communication technologies have long been acknowledged to support information sharing along the whole chain of care, from the clinic to the homes of patients and their relatives. Thus they are increasingly being considered for improving the delivery of health care services also in light of clinical and technological achievements that propose new treatments requiring a tighter interaction among patients and physicians.

Methods:

The multiagent paradigm has been utilized within an architecture for delivering telemedicine services to chronic outpatients at their domiciles and enforcing cooperation among patients, caregivers, and different members of the health care staff. The architecture sees each communication device such as a palmtop, smart phone, or personal digital assistant as a separate agent upon which different services are deployed, including telemetry, reminders, notifications, and alarms. Decoupling services from agents account for a highly configurable environment applicable to almost any context that can be customized as needed.

Results:

The architecture has been used for designing and implementing a prototypical software infrastructure, called LifePhone, that runs on several communication devices. A basic set of services has been devised with which we were able to configure two different applications that address long-term and short-term monitoring scenarios for diabetes patients. The long-term scenario encompasses telemetry and reminder services for patients undergoing peritoneal dialysis, which is a treatment for chronic renal failure, a diabetes complication. The short-term scenario incorporates telemetry and remote alarms and is applicable for training patients to use an artificial pancreas.

Conclusions:

Our experiments proved that an infrastructure such as LifePhone can be used successfully for bridging the interaction gap that exists among all the components of a health care delivery process, improving the quality of service and possibly reducing the overall costs of health care. Furthermore, the modularity of services allows for more complex scenarios encompassing data analysis or even involving actors at multiple institutions in order to better support the overall health care organization.
Self-Monitoring of Cardiac Autonomic Function at Home is Feasible
Authors: Fleischer Jesper , Nielsen Roni , Laugesen Esben , Nygaard Hans , Poulsen Per Logstrup , Ejskjaer Niels
Published: January 2014

Background:

Cardiovascular autonomic neuropathy (CAN) is associated with diabetes and may be related to the development of hypertension, ischemic stroke, and a number of other late complications. The earliest sign of CAN is a reduction of heart rate variability (HRV). Standard HRV tests for CAN include expiration-to-inspiration ratio, response to active standing (30:15), and the Valsalva maneuver. Because of the technical requirements for these tests, they are limited to the point-of-care Office or a clinical laboratory setting. It is unknown if a “white-coat” phenomenon exists in autonomic neuropathy testing and if home testing is feasible. The aims of this study were (1) to evaluate the reproducibility of CAN testing in a clinical setting, (2) to evaluate the feasibility of self-monitoring of cardiovascular autonomic function at home, and (3) report possible differences in measurements taken at the hospital versus those taken at home.

Method:

Ten healthy subjects were included. Participants underwent in-hospital testing for CAN before and after home monitoring. For 6 consecutive days, participants measured autonomic function once a day at home. The intra- and interindividual reproducibility was determined by coefficient of variation (CV) and the reproducibility coefficient (RC). Agreement between hospital and home testing was analyzed using Pearson r, mean difference, and Bland-Altman analysis with Pitman's test of difference in variance.

Results:

Pitman's test showed no Significant difference in variance between hospital and home measurements, indicating suitable agreement between the two measurements. Reproducibility was moderate to high in all measures, with RC ranging from 66–94% and CV ranging from 5–10%.

Conclusions:

Home testing of CAN is feasible. The evaluations showed no Significant systematic error of in-hospital testing compared with self-monitoring at home. In this study, we were not able to demonstrate the presses of “white coat” effect in standard cardiovascular reflex tests.
Guidelines for Optimal Bolus Calculator Settings in Adults
Authors: Walsh John , Roberts Ruth , Bailey Timothy
Published: January 2014

Bolus insulin calculators (BCs) became available in insulin pumps in 2002 and are being integrated into glucose meters and portable device applets for use with multiple daily injections. A retrospective analysis of continuous subcutaneous insulin infusion data from the Actual Pump Practices (APP) study is used in this article to generate formulas for more precise BC settings.

A well-designed BC determines accurate bolus doses for carbohydrate intake and for correcting elevated glucose levels. It should also provide the logic necessary to track residual bolus insulin and reduce bolus recommendations to minimize insulin stacking. To provide appropriate bolus doses, a BC requires accurate settings for the carbohydrate factor or insulin:carbohydrate ratio, glucose correction factor, duration of insulin action, and correction target. We provide guidelines to select BC settings from the user's current total daily dose (TDD) of insulin and to determine more appropriate BC settings from an improved TDD based on the mean glucose level.
Performance of the CONTOUR® TS Blood Glucose Monitoring System
Authors: Frank Joy , Wallace Jane F. , Pardo Scott , Parkes Joan Lee
Published: January 2014

Background:

Self-monitoring of blood glucose (SMBG) remains an important component of diabetes management, engendering a need for affordable blood glucose (BG) meters that are accurate, precise, and convenient. The CONTOUR® TS is a BG meter that endeavors to meet this need. It uses glucose dehydrogenase/flavin dinucleotide chemistry, automatic test strip calibration, and autocompensation for hematocrit along with the ease of use that has come to be expected of a modern meter. The objective of this clinical trial was to determine whether the CONTOUR TS system met these criteria.

Methods:

The system was evaluated at a single clinical site with 106 subjects with type 1 or type 2 diabetes. Blood glucose values ranged from 60 to 333 mg/dl over all subjects. Both lay users and health care professionals (HCPs) tested the meters, with test strips from three different lots. Results were compared to a reference analyzer of verified precision and accuracy. Forty-nine of the subjects also participated in a home study of the meter. Lay users learned to use the system without assistance and were surveyed on its use at the end of the study.

Results:

When used with capillary blood, both subjects and HCPs obtained results that exceeded the International Organization for Standardization 15197:2003 criteria, (i.e., ≥95% of values fell within 20% or 15 mg/dl of the laboratory value for BG levels greater than or less than 75 mg/dl, respectively). Specifically, lay users achieved 97.9% and HCPs 98.6%. When used with venous blood, 99.8% of measurements were within the criteria. All measurements for both capillary and venous blood fell into zones A or B of the Parkes error grid, deemed clinically accurate. Hematocrit was found to have no influence on BG measurements. A large majority of the subjects found the system easy to learn and to use.

Conclusions:

The CONTOUR TS BG meter system gave accurate and reproducible results with both capillary and venous blood; subjects learned to use the meter system by following the user guide and quick reference guide.
Analysis of the Performance of the CONTOUR® TS Blood Glucose Monitoring System: When Regulatory Performance Criteria are Met, Should We Have Confidence to Use a Medical Device with All Patients?
Authors: Lyon Martha E. , Lyon Andrew W.
Published: January 2014

The article entitled, Performance of the CONTOUR® TS Blood Glucose Monitoring System, by Frank and colleagues in this issue of Journal of Diabetes Science and Technology, demonstrates that the CONTOUR® TS glucose meter exceeds current regulatory expectations for glucose meter performance. However, the appropriateness of current regulatory expectations, such as International Organization for Standardization (ISO) 15197:2003, is being reevaluated because of increasing concern regarding the reliability of glucose meters in ambulatory and hospitalized environments. Between 2004 and 2008, 12,673 serious adverse events with glucose meters that met the ISO 15197 expectations were reported in the Food and Drug Administration-Manufacturer and User Facility Device Experience surveillance database. Should different glucose meter performance criteria be applied to ambulatory versus critical care patients?
Virtual Reality Technologies for Research and Education in Obesity and Diabetes: Research Needs and Opportunities
Authors: Ershow Abby G. , Peterson Charles M. , Riley William T. , Rizzo Albert Skip , Wansink Brian
Published: January 2014

The rising rates, high prevalence, and adverse consequences of obesity and diabetes call for new approaches to the complex behaviors needed to prevent and manage these conditions. Virtual reality (VR) technologies, which provide controllable, multisensory, interactive three-dimensional (3D) stimulus environments, are a potentially valuable means of engaging patients in interventions that foster more healthful eating and physical activity patterns. Furthermore, the capacity of VR technologies to motivate, record, and measure human performance represents a novel and useful modality for conducting research. This article summarizes background information and discussions for a joint July 2010 National Institutes of Health — Department of Defense workshop entitled Virtual Reality Technologies for Research and Education in Obesity and Diabetes. The workshop explored the research potential of VR technologies as tools for behavioral and neuroscience studies in diabetes and obesity, and the practical potential of VR in fostering more effective utilization of diabetes- and obesity-related nutrition and lifestyle information.

Virtual reality technologies were considered especially relevant for fostering desirable health-related behaviors through motivational reinforcement, personalized teaching approaches, and social networking. Virtual reality might also be a means of extending the availability and capacity of health care providers. Progress in the field will be enhanced by further developing available platforms and taking advantage of VR's capabilities as a research tool for well-designed hypothesis-testing behavioral science. Multidisciplinary collaborations are needed between the technology industry and academia, and among researchers in biomedical, behavioral, pedagogical, and computer science disciplines. Research priorities and funding opportunities for use of VR to improve prevention and management of obesity and diabetes can be found at agency websites (National Institutes of Health: http://grants.nih.gov/grants/guide/index.html ; Department of Defense: www.tatrc.org ).
Virtual Reality and Interactive Gaming Technology for Obese and Diabetic Children: Is Military Medical Technology Applicable?
Authors: Talbot Thomas Brett
Published: January 2014

The Telemedicine and Advanced Technology Research Center has pursued a number of technologies that may have application to the problems of obesity and diabetes management in children. Children are getting fatter because of increased caloric intake and less physical activity. Furthermore, technology advances have failed to significantly improve metabolic control of type 1 diabetes. Behavioral strategies should target video games, mobile phones, and other popular items used by children and seen by them as necessities. Exergaming is considerably more active than traditional video gaming and can be equivalent to moderate-intensity exercise. Diabetes equipment such as continuous glucose monitors and insulin pumps lack integration and live connectivity and suffer from a poor user interface. In contrast, mobile phones offer wireless connectivity, an excellent voice-enabled interface, and cloud connectivity that could possibly serve as a motivational and compliance tool for diabetes patients through text messaging to the patient, parents, and physician. Mobile phones have the potential to motivate and educate obese children as well. Exergaming for obese children could also be integrated into award systems of game consoles and game play time. The key to successful implementation of these strategies depends on the ability to integrate and connect the various technologies.
Turning Virtual Reality into Reality: A Checklist to Ensure Virtual Reality Studies of Eating Behavior and Physical Activity Parallel the Real World
Authors: Tal Aner , Wansink Brian
Published: January 2014

Virtual reality (VR) provides a potentially powerful tool for researchers seeking to investigate eating and physical activity. Some unique conditions are necessary to ensure that the psychological processes that influence real eating behavior also influence behavior in VR environments. Accounting for these conditions is critical if VR-assisted research is to accurately reflect real-world situations. The current work discusses key considerations VR researchers must take into account to ensure similar psychological functioning in virtual and actual reality and does so by focusing on the process of spontaneous mental simulation. Spontaneous mental simulation is prevalent under real-world conditions but may be absent under VR conditions, potentially leading to differences in judgment and behavior between virtual and actual reality. For simulation to occur, the virtual environment must be perceived as being available for action. A useful chart is supplied as a reference to help researchers to investigate eating and physical activity more effectively.
The Science of Learning: Breaking News
Authors: Straumanis Joan
Published: January 2014

We begin with a paradox. On one hand, not nearly enough is known about exactly how learning takes place in the brain, although exciting new results are emerging thanks to improved brain imaging and a greater focus on neuroscience by government and universities. But this research is just beginning, and a much larger effort and investment are needed to answer even the most basic questions. On the other hand, more than enough is already known about what best promotes learning to motivate and drive educational reform for years to come. This is a report from the front lines of both research and educational implementation. This information should prove of use to anyone—teachers, students, parents, patients, and health practitioners—who is concerned about how best to improve formal or informal teaching and learning, to help people remember complex instructions, or to change unhealthy habits and practices.
Virtual Reality and Interactive Digital Game Technology: New Tools to Address Obesity and Diabetes
Authors: Rizzo Albert Skip , Lange Belinda , Suma Evan A. , Bolas Mark
Published: January 2014

The convergence of the exponential advances in virtual reality (VR)-enabling technologies with a growing body of clinical research and experience has fueled the evolution of the discipline of clinical VR. This article begins with a brief overview of methods for producing and delivering VR environments that can be accessed by users for a range of clinical health conditions. Interactive digital games and new forms of natural movement-based interface devices are also discussed in the context of the emerging area of exergaming, along with some of the early results from studies of energy expenditure during the use of these systems. While these results suggest that playing currently available active exergames uses significantly more energy than sedentary activities and is equivalent to a brisk walk, these activities do not reach the level of intensity that would match playing the actual sport, nor do they deliver the recommended daily amount of exercise for children. However, these results provide some support for the use of digital exergames using the current state of technology as a complement to, rather than a replacement, for regular exercise. This may change in the future as new advances in novel full-body interaction systems for providing vigorous interaction with digital games are expected to drive the creation of engaging, low-cost interactive game-based applications designed to increase exercise participation in persons at risk for obesity.