bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between Plantar Foot Temperature and Diabetic Neuropathy: A Case Study by Using an Infrared Thermal Imaging Technique
Authors: Bagavathiappan Subramnaiam , Philip John , Jayakumar Tammana , Raj Baldev , Rao Pallela Narayana Someshwar , Varalakshmi Muthukrishnan , Mohan Viswanathan 
Published: January 2014

Background: Diabetic neuropathy consists of multiple clinical manifestations of which loss of sensation is most prominent. High temperatures under the foot coupled with reduced or complete loss of sensation can predispose the patient to foot ulceration. The aim of this study was to look at the correlation between plantar foot temperature and diabetic neuropathy using a noninvasive infrared thermal imaging technique. Methods: Infrared thermal imaging, a remote and noncontact experimental tool, was used to study the plantar foot temperatures of 112 subjects with type 2 diabetes selected from a tertiary diabetes centre in South India. Results: Patients with diabetic neuropathy (defined as vibration perception threshold (VPT) values on biothesiometry greater than 20 V) had a higher foot temperature (32–35 °C) compared to patients without neuropathy (27–30 °C). Diabetic subjects with neuropathy also had higher mean foot temperature (MFT) ( p = .001) compared to non-neuropathic subjects. MFT also showed a positive correlation with right great toe ( r = 0.301, p = .001) and left great toe VPT values ( r = 0.292, p = .002). However, there was no correlation between glycated hemoglobin and MFT. Conclusion: Infrared thermal imaging may be used as an additional tool for evaluation of high risk diabetic feet.
Combining Basal-Bolus Insulin Infusion for Tight Postprandial Glucose Control: An in Silico Evaluation in Adults, Children, and Adolescents
Authors: Revert Ana , Rossetti Paolo , Calm Remei , Vehí Josep , Bondia Jorge 
Published: January 2014

Background: Achieving good postprandial glycemic control, without triggering hypoglycemia events, is a challenge of treatment strategies for type 1 diabetes subjects. Continuous subcutaneous insulin infusion, the gold standard of therapy, is based on heuristic adjustments of both basal and prandial insulin. Some tools, such as bolus calculators, are available to aid patients in selecting a meal-related insulin dose. However, they are still based on empiric parameters such as the insulin-to-carbohydrate ratio and on the physicians' and patients' ability to fit bolus mode to meal composition. Method: In this article, a nonheuristic method for assessment of prandial insulin administration is presented and evaluated. An algorithm based on set inversion via interval analysis is used to coordinate basal and bolus insulin infusions to deal with postprandial glucose excursions. The evaluation is carried out through an in silico study using the 30 virtual patients available in the educational version of the Food and Drug Administration-accepted University of Virginia simulator. Results obtained using the standard bolus strategy and different coordinated basal-bolus solutions provided by the algorithm are compared. Results: Coordinated basal-bolus solutions improve postprandial glucose performance in most cases, mainly in terms of reducing hypoglycemia risk, but also increasing the percentage of time in normoglycemia. Moreover, glycemic variability is reduced considerably by using these innovative solutions. Conclusions: The algorithm presented here is a robust nonheuristic alternative to deal with postprandial glycemic control. It is shown as a powerful tool that could be integrated in future smart insulin pumps.
Dose Accuracy and Injection Force of Disposable Pens Delivering Pramlintide for the Treatment of Diabetes
Authors: Merritt Douglas , Schreiner Barb , Harris Scott , DeYoung Mary Beth , Strobel Susan , Lauinger Joseph 
Published: January 2014

Background: The pen injection format, typically used for insulin administration, has been adapted for the injectable, noninsulin diabetes therapy pramlintide. Administered before major meals, pramlintide therapy requires two to four injections/day in addition to the patients' usual insulin injections. The dose accuracy and injection force was determined for the 60 and 120 μg pramlintide pens. Methods: Dose accuracy testing was conducted at two sites on multiple 60 μg (15, 30, and 60 μg doses) and 120 μg pens (60 and 120 μg doses) at prespecified temperatures (5–40 °C) and humidities (0–75%) using 29 G half-inch needles. All pens were stabilized under testing conditions for 4 h prior to testing. One site used a compression load cell (Zwick device) to test pens; one site performed tests manually. Injection-force testing was conducted at one site on multiple 60 and 120 μg pens at multiple temperatures (18–28 °C) and humidities (25–75%) using 29 and 31 G half-inch needles and an injection speed of 150 m/min. Injection-force testing was performed using a Zwick device. Results: Dose accuracy for all pens tested, regardless of location, reproducibly met/exceeded acceptance criteria. Mean percentage of dose accuracy was 96.04 to 102.45% [standard deviations (SDs) 0.3 to 1.4 μg] for the 60 μg pen and 98.16 to 101.83% (SDs 0.4 to 2.5 μg) for the 120 μg pen. The average injection force across both pens did not exceed 7 N regardless of needle size. Conclusions: High dose accuracy and low injection force were observed for the 60 and 120 μg pens under a variety of conditions.
Helping High-Risk Youth Move through High-Risk Periods: Personally Controlled Health Records for Improving Social and Health Care Transitions
Authors: Weitzman Elissa R. , Kaci Liljana , Quinn Maryanne , Mandl Kenneth D. 
Published: January 2014

Background: New patient-centered information technologies are needed to address risks associated with health care transitions for adolescents and young adults with diabetes, including systems that support individual and structural impediments to self- and clinical-care. Methods: We describe the personally controlled health record (PCHR) system platform and its key structural capabilities and assess its alignment with tenets of the chronic care model (CCM) and the social-behavioral and health care ecologies within which adolescents and young adults with diabetes mature. Results: Confgured as Web-based platforms, PCHRs can support a new class of patient-facing applications that serve as monitoring and support systems for adolescents navigating complex social, developmental, and health care transitions. The approach can enable supportive interventions tailored to individual patient needs to boost adherence, self-management, and monitoring. Conclusions: The PCHR platform is a paradigm shift for the organization of health information systems and is consistent with the CCM and conceptualizations of patient- and family-centered care for diabetes. Advancing the approach augers well for improvement around health care transitions for youth and also requires that we address (i) structural barriers impacting diabetes care for maturing youth; (ii) challenges around health and technology literacy; (iii) privacy and confidentiality issues, including sharing of health information within family and institutional systems; and (iv) needs for evaluation around uptake, impacts, and outcomes.
The Design and Development of Fluorescent Nano-Optodes for in Vivo Glucose Monitoring
Authors: Balaconis Mary K. , Billingsley Kelvin , Dubach J. Matthew , Cash Kevin J. , Clark Heather A. 
Published: January 2014

Background: The advent of fluorescent nanosensors has enabled intracellular monitoring of several physiological analytes, which was previously not possible with molecular dyes or other invasive techniques. We have extended the capability of these sensors to include the detection of small molecules with the development of glucose-sensitive nano-optodes. Herein, we discuss the design and development of glucose-sensitive nano-optodes, which have been proven functional both in vitro and in vivo. Methods: Throughout the design process, each of the sensor formulations was evaluated based on their response to changes in glucose levels. The percent change in signal, sensor reversibility, and the overall fluorescence intensity were the specific parameters used to assess each formulation. Results: A hydrophobic boronic acid was selected that yielded a fully reversible fluorescence response to glucose in accordance with the sensor mechanism. The change in fluorescence signal in response to glucose was approximately 11%. The use of different additives or chromophores did not improve the response; however, modifications to the plasticized polymeric membrane extended sensor lifetime. Conclusions: Sensors were developed that yielded a dynamic response to glucose and through further modification of the components, sensor lifetime was improved. By following specific design criteria for the macrosensors, the sensors were miniaturized into nano-optodes that track changes in glucose levels in vivo.
Use of a Continuous Glucose Sensor in an Extracorporeal Life Support Circuit
Authors: Steil Garry M. , Alexander Jamin , Papas Alexandra , Langer Monica , Modi Biren P. , Piper Hannah , Jaksic Tom , Gottlieb Rebecca , Agus Michael S. D. 
Published: January 2014

Background: Standard care for infants on extracorporeal life support (ECLS) relies on intermittent measurement of blood glucose (BG); however, this can lead to significant changes in BG that go unrecognized for several hours. The present study was designed to assess performance and clinical applicability of a subcutaneous glucose sensor technology modified for use as a blood-contacting sensor within the ECLS circuit. Methods: Twelve children, aged 3 years or less, requiring ECLS support were studied. Three continuous glucose sensors (Medtronic MiniMed) were inserted into hubs placed in line with the ECLS circuit. Blood glucose was assessed with a laboratory analyzer ( BGLAB; Bayer Rapidlab 860) approximately every 5 h (mean 4.9 ± 3.3 h) with more frequent samples obtained with a bedside monitor (HemoCue) as needed. Sensor current ( ISIG) was transmitted to a laptop computer and retrospectively calibrated using BGLAB. Sensor performance was assessed by mean absolute relative difference (MARD), linear regression slope and intercept, and correlation, all with BGLAB as reference. Results: The BGLAB averaged 107.6 ± 36.4 mg/dl (mean ± standard deviation) ranging from 58 to 366 mg/dl. The MARD was 11.4%, with linear regression slope (0.86 ± 0.030) and intercept (9.0 ± 3.2 mg/dl) different from 1 and 0, respectively ( p < .05), and correlation ( r2 = 0.76; p < .001). The system was not associated with any adverse events, and placement and removal into the hubs was easily accomplished. Instances in which more frequent BG values were obtained using a bedside HemoCue ( BGHEMO) monitor showed the sensor to respond rapidly to changes. Conclusions: We conclude that continuous sensors can be adapted for use in an ECLS circuit with accuracy similar to or better than that achieved with the subcutaneous site. Continuous glucose monitoring in this population can rapidly detect changes in BG that would not otherwise be observed. Further studies will be needed to assess the benefit of continuous glucose monitoring in this population.
Explorative Study of Pharmacokinetics and Pharmacodynamics after Change in Basal Insulin Infusion Rate
Authors: Ihlo Charlotte A. , Lauritzen Torsten , Sturis Jeppe , Skyggebjerg Ole , Christiansen Jens S. , Laursen Torben 
Published: January 2014

Background: The use of insulin pumps is rapidly increasing and new, technologically more advanced pumps are continuously being developed. It is of interest to assess the clinical relevance of the many technical features of these pumps, e.g., the effect on pharmacokinetics and pharmacodynamics with change in infusion rate. Method: The aim of this study was to explore the sequence of pharmacokinetic and pharmacodynamic changes after dose doubling of the basal insulin infusion rate with subcutaneous bolus insulin injections once an hour, continuous subcutaneous insulin infusion, and continuous intravenous insulin infusion. Ten type 1 diabetes mellitus patients were included. The insulin doses were calculated based on the habitual insulin doses. The study was designed as an open-labeled, single-center, randomized, crossover exploratory trial. Results: Dose doubling of the basal insulin infusion rate with the three different administration protocols did not result in any clinically relevant differences in the time courses of the pharmacokinetic and pharmacodynamic parameters. With all three administration protocols, we observed a time interval of more than 6 hours before a new steady state of insulin was achieved. Conclusions: Our results indicate that frequent changes in basal subcutaneous insulin infusion rates are not of significant clinical relevance on a 24-hour basis. Regarding technological features of subcutaneous insulin pumps, no discernable advantages of increasing pump stroke frequency were found. This indicates that pump stroke frequency sophistication might not be of clinical relevance in pumps used for basal subcutaneous insulin infusion.
Do Different Body Colors and Labels of Insulin Pens Enhance a Patient's Ability to Correctly Identify Pens for Injecting Long-Acting versus Short-Acting Insulins?
Authors: Lefkowitz Mark 
Published: January 2014

Background: The objective of this study was to characterize how successfully patients with diabetes are able to distinguish between pens of the same pen type containing long- and short-acting insulins. Methods: Structured one-on-one interviews were conducted with 400 patients with diabetes in the United States, using either a differentiated ( n = 100) or undifferentiated ( n = 100) SoloSTAR® (insulin glargine vs insulin glulisine) or ( n = 200) FlexPen® (insulin detemir vs insulin aspart). A pair of each pen type was presented simultaneously, and participants were asked to identify the pen that they would use to (1) inject at lunch, (2) inject once daily, and (3) inject at breakfast and how they differentiated between pens. The short-acting insulin pen was then presented, and the interviewer asked whether this was the correct pen to administer insulin once or thrice daily. Results: More patients successfully identified the correct SoloSTAR pen across the tests vs FlexPen, and the error rate (incorrect selection/inability to select) was Significantly lower, respectively [2.7% ( n = 8) vs 16.3% ( n = 98)]. The most common reason cited for correct responses among all patients was color (of the label/pen, according to pen type). Conclusions: This study suggests that the full pen body color used on SoloSTAR pens enhances the patient's ability to differentiate between the pens for long- and short-acting insulin and is a notable improvement compared with the standard approach of differing label color.
Pilot Study of Aurora, a Social, Mobile-Phone-Based Emotion Sharing and Recording System
Authors: Gay Geri , Pollak J. P. , Adams Phil , Leonard John P. 
Published: January 2014

Background: Emotion is a ubiquitous aspect of humanity that governs behavior in a number of ways and is linked inextricably with health. Pausing to evaluate one's emotional state in the face of decisions and reflecting on past patterns of emotion have been shown to improve behaviors. Further, social expression of emotion has been shown to directly improve health outcomes. While the virtual reality research community does not ignore emotion on the whole, there does exist a need to explore what roles emotional awareness and emotion sharing can play in this domain. Methods: A mobile-phone-based social emotion recording and sharing system, Aurora, was developed to provide individuals with a means to pause and evaluate their emotional state, reflect on past emotions, share emotions with others, and participate in socially supportive activities with peers. A study was conducted with 65 subjects to evaluate Aurora as a tool to encourage emotional reflection and awareness as well as social sharing of emotion. Results: Users of Aurora reported an increased comfort in socially expressing emotion and were encouraged to share emotions, even with strangers. Subjects also reported liking reflecting on their emotional state and found it valuable. Subjects' behavior also suggested that the system encouraged individuals to reach out to one another in acts of social support. Conclusions: The Aurora system offers a tool for encouraging emotional awareness, emotion sharing, and socially supportive behavior. Such a tool could be impactful in numerous health settings where emotion is considered to be an important indicator of or influence on outcome, such as for weight loss, alcohol cessation, or cancer sufferers.
Assessment of Blood Glucose Control in the Pediatric Intensive Care Unit: Extension of the Glycemic Penalty Index toward Children and Infants
Authors: Van Herpe Tom , Gielen Marijke , Vanhonsebrouck Koen , Wouters Pieter J. , Van den Berghe Greet , De Moor Bart , Mesotten Dieter 
Published: January 2014

Background: The glycemic penalty index (GPI) is a measure to assess blood glucose (BG) control in critically ill adult patients but needs to be adapted for children and infants. Method: The squared differences between a clinical expertise penalty function and the corresponding polynomial function are minimized for optimization purposes. The average of all penalties (individually assigned to all BG readings) represents the patient-specific GPI. Results: Penalization in the hypoglycemic range is more severe than in the hyperglycemic range as the developing brains of infants and children may be more vulnerable to hypoglycemia. Similarly, hypoglycemia is also more heavily penalized in infants than in children. Conclusions: Extending the adult GPI toward the age-specific GPI is an important methodological step. Long-term clinical studies are needed to determine the clinically acceptable GPI cut-off level.
A Closed-Loop Artificial Pancreas Based on Risk Management
Authors: Cameron Fraser , Bequette B. Wayne , Wilson Darrell M. , Buckingham Bruce A. , Lee Hyunjin , Niemeyer Günter 
Published: January 2014

Background: Control algorithms that regulate blood glucose (BG) levels in individuals with type 1 diabetes mellitus face several fundamental challenges. Two of these are the asymmetric risk of clinical complications associated with low and high glucose levels and the irreversibility of insulin action when using only insulin. Both of these nonlinearities force a controller to be more conservative when uncertainties are high. We developed a novel extended model predictive controller (EMPC) that explicitly addresses these two challenges. Method: Our extensions to model predictive control (MPC) operate in three ways. First, they explicitly minimize the combined risk of hypoglycemia and hyperglycemia. Second, they integrate the effect of prediction uncertainties into the risk. Third, they understand that future control actions will vary if measurements fall above or below predictions. Using the University of Virginia/Padova Simulator, we compared our novel controller (EMPC) against optimized versions of a proportional-integral-derivative (PID) controller, a traditional MPC, and a basal/bolus (BB) controller, as well as against published results of an independent MPC (IMPC). The BB controller was optimized retrospectively to serve as a bound on the possible performance. Results: We tuned each controller, where possible, to minimize a published blood glucose risk index (BGRI). The simulated controllers (PID/MPC/EMPC/BB) provided BGRI values of 2.99/3.05/2.51/1.27 as compared to the published IMPC BGRI value of 4.10. These correspond to 73/79/84/92% of BG values lying in the euglycemic range (70–180 mg/dl), respectively, with mean BG levels of 151/156/147/140 mg/dl. Conclusion: The EMPC strategy extends MPC to explicitly address the issues of asymmetric glycemic risk and irreversible insulin action using estimated prediction uncertainties and an explicit risk function. This controller reduces the avoidable BGRI by 56% ( p < .05) relative to a published MPC algorithm studied on a similar population.
Noninvasive Polarimetric-Based Glucose Monitoring: An in Vivo Study
Authors: Purvinis Georgeanne , Cameron Brent D. , Altrogge Douglas M. 
Published: January 2014

Background: Since 1990, there has been significant research devoted toward development of a noninvasive physiological glucose sensor. In this article, we report on the use of optical polarimetry for the noninvasive measurement of physiological glucose concentration in the anterior chamber of the eye of New Zealand white (NZW) rabbits. Method: Measurements were acquired using a custom-designed laser-based optical polarimetry system in a total of seven NZW rabbits anesthetized using an isoflurane-only anesthesia protocol. Aqueous humor-based polarimetric measurements were obtained by coupling light through the anterior chamber of the eye. Blood glucose levels were first stabilized and then altered with intravenous dextrose and insulin administration and measured every 3–5 min with a standard glucometer and intermittently with a YSI 2300 glucose analyzer. Acquired polarimetric glucose signals are calibrated to measured blood glucose concentration. Results: Based on a total of 41 data points, Clarke error grid analysis indicated 93% in zone A, 7% in zone B, and 0% in zones C and D, with reference concentrations between 93 and 521 mg/dl. Errors in prediction are shown to be related to gross movement of the rabbit during the procedures, incurring time-varying corneal birefringence effects that directly affect the measured polarimetric signal. These effects can be compensated for with appropriate design modifications. Conclusions: An optical polarimetry technique was used for in vivo physiological glucose monitoring. The technique demonstrated provides a basis for the development of a noninvasive polarimetric glucose monitor for home, personal, or hospital use.
Effects of a Structured Self-Monitoring of Blood Glucose Method on Patient Self-Management Behavior and Metabolic Outcomes in Type 2 Diabetes Mellitus
Authors: Khamseh Mohammad E. , Ansari Majid , Malek Mojtaba , Shafiee Gita , Baradaran Hamid 
Published: January 2014

Background: The purpose of this study was to evaluate the effect of structured self-monitoring of blood glucose (SMBG) on patient self-management behavior and metabolic outcomes in patients with type 2 diabetes mellitus (T2DM). Methods: From January to June 2009, 30 patients with basic diabetes education were followed for a period of 90 days. To provide assessment of glycemic control and frequency of dysglycemia, patients, underwent 3 consecutive days of seven-point SMBG during each month for 3 consecutive months, using the ACCU-CHEK 360° View tool. Glucose profiles of the first and third month were used for comparison. Results: Hemoglobin A1c (HbA1c) improved significantly during the 90-day period in all patients [confidence interval (CI) 95%, 0.32–1.64%, p < .05] and those with poor metabolic control (group B; CI 95%, 0.86–2.64%, p < .05). Mean blood glucose (MBG) values decreased significantly in group B (CI 95%, 0.56–24.78 mg/dl, p < .05) and all cases (CI 95%, 1.61–19.73 mg/dl, p < .05). Meanwhile, there was an average decrease of 15.7 mg/dl in fasting blood sugar (FBS) levels in the whole subjects. Mean postprandial blood glucose levels (MPP) decreased by 19.3 and 11.3 mg/dl in group B and in all cases, respectively. However, there were no significant changes in HbA1c, MBG, FBS, and MPP in people with good metabolic control. Conclusion: A structured SMBG program improves HbA1c, FBS, MPP, and MBG in people with poorly controlled diabetes. This improvement shows the importance of patient self-management behavior on metabolic outcomes in T2DM.