bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computerized Prompting and Feedback of Diabetes Care: A Review of the Literature
Authors: Boren Suzanne Austin , Puchbauer Aaron M. , Williams Faustine 
Published: January 2014

Background: The objective of this study was to assess published literature on computerized prompting and feedback of diabetes care as well as to identify opportunities to strengthen diabetes care processes. Methods: Medline (1970–2008), Cumulative Index to Nursing and Allied Health Literature (1982–2008), and Cochrane Central Register of Controlled Trials (4th quarter 2008) were searched, and reference lists from included articles were reviewed to identify additional studies. Patient sample, clinician sample, setting, duration of the trial, intervention description, control description, and results were abstracted from each study. Results: Fifteen trials were included in this review. The following elements were observed in the interventions: general prompt for a particular patient to be seen for diabetes-related follow-up (5 studies), specific prompt reminding clinicians of particular tests or procedures related to diabetes (13 studies), feedback to clinicians in addition to prompting (5 studies), and patient reminders in addition to clinician prompts (5 studies). Twelve of the 15 studies (80%) measured a significant process or outcome from the intervention. Conclusions: The majority of trials identified at least one process or outcome that was significantly better in the intervention group than in the control group; however, the success of the information interventions varied greatly. Providing and receiving appropriate care is the first step toward better outcomes in chronic disease management.
Identification of Intraday Metabolic Profiles during Closed-Loop Glucose Control in Individuals with Type 1 Diabetes
Authors: Kanderian Sami S. , Weinzimer Stu , Voskanyan Gayane , Steil Garry M. 
Published: January 2014

Background: Algorithms for closed-loop insulin delivery can be designed and tuned empirically; however, a metabolic model that is predictive of clinical study results can potentially accelerate the process. Methods: Using data from a previously conducted closed-loop insulin delivery study, existing models of meal carbohydrate appearance, insulin pharmacokinetics, and the effect on glucose metabolism were identified for each of the 10 subjects studied. Insulin's effects to increase glucose uptake and decrease endogenous glucose production were described by the Bergman minimal model, and compartmental models were used to describe the pharmacokinetics of subcutaneous insulin absorption and glucose appearance following meals. The composite model, comprised of only five equations and eight parameters, was identified with and without intraday variance in insulin sensitivity ( SI), glucose effectiveness at zero insulin ( GEZI), and endogenous glucose production ( EGP) at zero insulin. Results: Substantial intraday variation in SI, GEZI and EGP was observed in 7 of 10 subjects (root mean square error in model fit greater than 25 mg/dl with fixed parameters and nadir and/or peak glucose levels differing more than 25 mg/dl from model predictions). With intraday variation in these three parameters, plasma glucose and insulin were well fit by the model ( R2 = 0.933 ± 0.00971 [mean ± standard error of the mean] ranging from 0.879–0.974 for glucose; R2 = 0.879 ± 0.0151, range 0.819–0.972 for insulin). Once subject parameters were identified, the original study could be reconstructed using only the initial glucose value and basal insulin rate at the time closed loop was initiated together with meal carbohydrate information (glucose, R2 = 0.900 ± 0.015; insulin delivery, R2 = 0.640 ± 0.034; and insulin concentration, R2 = 0.717 ± 0.041). Conclusion: Metabolic models used in developing and comparing closed-loop insulin delivery algorithms will need to explicitly describe intraday variation in metabolic parameters, but the model itself need not be comprised by a large number of compartments or differential equations.
Performance Analysis of the OneTouch® UltraVue™ Blood Glucose Monitoring System
Authors: Chang Anna , Orth Alice , Le Bryan , Menchavez Perla , Miller Lupe 
Published: January 2014

Background: OneTouch® UltraVue™ is a new meter for self-monitoring of blood glucose that includes a color display, used-strip ejector, and no-button interface. The system uses an electrochemical biosensor technology based on glucose oxidase chemistry to detect glucose concentrations from 20 to 600 mg/dl (1.1 to 33.3 mmol/liter). Methods: Accuracy and reproducibility were evaluated over a wide range of glucose concentrations according to standard criteria. Clinical accuracy was assessed by health care providers (HCPs) in two studies and by diabetes patients in the second study. Reference glucose levels were determined by a YSI 2300 analyzer. Same-day reproducibility and day-to-day reproducibility were also evaluated. Results: In the accuracy studies, 99.7% and 98.7% of tests by HCPs and 97.0% of tests by patients were within ±15 mg/dl (±0.8 mmol/liter) of the YSI reference for blood glucose <75 mg/dl (<4.2 mmol/liter), and within ±20% for blood glucose ≥75 mg/dl (≥4.2 mmol/liter), respectively. Consensus error grid analysis showed that 99.7% and 95.3% of tests by HCPs and 97.0% of tests by patients fell within zone A (i.e., has no effect on clinical action); all other results were in zone B (i.e., altered clinical action, little or no effect on clinical outcome). In the reproducibility studies, the standard deviation was <1.5 mg/dl (<0.1 mmol/liter) for glucose concentrations <100 mg/dl (<5.6 mmol/liter), and the coefficient of variation was <2% for concentrations ≥100 mg/dl (≥5.6 mmol/liter). Conclusions: OneTouch UltraVue meets standard acceptability criteria for accuracy and reproducibility across a wide range of glucose concentrations. Its simple interface and lack of contact with used strips make it a viable option for older patients and their caregivers.
Modeling the Error of Continuous Glucose Monitoring Sensor Data: Critical Aspects Discussed through Simulation Studies
Authors: Facchinetti Andrea , Sparacino Giovanni , Cobelli Claudio 
Published: January 2014

Background: Knowing the statistical properties of continuous glucose monitoring (CGM) sensor errors can be important in several practical applications, e.g., in both open- and closed-loop control algorithms. Unfortunately, modeling the accuracy of CGM sensors is very difficult for both experimental and methodological reasons. It has been suggested that the time series of CGM sensor errors can be described as realization of the output of an autoregressive (AR) model of first order driven by a white noise process. The AR model was identified exploiting several reference blood glucose (BG) samples (collected frequently in parallel to the CGM signal), a procedure to recalibrate CGM data, and a linear time-invariant model of blood-to-interstitium glucose (BG-to-IG) kinetics. By resorting to simulation, this work shows that some assumptions made in the Breton and Kovatchev modeling approach may significantly affect the estimated sensor error and its statistical properties. Method: Three simulation studies were performed. The first simulation was devoted to assessing the influence of CGM data recalibration, whereas the second and third simulations examined the role of the BG-to-IG kinetic model. Analysis was performed by comparing the “original” (synthetically generated) time series of sensor errors vs its “reconstructed” version in both time and frequency domains. Results: Even small errors either in CGM data recalibration or in the description of BG-to-IG dynamics can severely affect the possibility of correctly reconstructing the statistical properties of sensor error. In particular, even if CGM sensor error is a white noise process, a spurious correlation among its samples originates from suboptimal recalibration or from imperfect knowledge of the BG-to-IG kinetics. Conclusions: Modeling the statistical properties of CGM sensor errors from data collected in vivo is difficult because it requires perfect calibration and perfect knowledge of BG-to-IG dynamics. Results suggest that correct characterization of CGM sensor error is still an open issue and requires further development upon the pioneering contribution of Breton and Kovatchev.
Accuracy of a New Real-Time Continuous Glucose Monitoring Algorithm
Authors: Keenan D. Barry , Cartaya Raymond , Mastrototaro John J. 
Published: January 2014

Background: Through minimally invasive sensor-based continuous glucose monitoring (CGM), individuals can manage their blood glucose (BG) levels more aggressively, thereby improving their hemoglobin A1c level, while reducing the risk of hypoglycemia. Tighter glycemic control through CGM, however, requires an accurate glucose sensor and calibration algorithm with increased performance at lower BG levels. Methods: Sensor and BG measurements for 72 adult and adolescent subjects were obtained during the course of a 26-week multicenter study evaluating the efficacy of the Paradigm® REAL-Time (PRT) sensor-augmented pump system (Medtronic Diabetes, Northridge, CA) in an outpatient setting. Subjects in the study arm performed at least four daily finger stick measurements. A retrospective analysis of the data set was performed to evaluate a new calibration algorithm utilized in the Paradigm® Veo™ insulin pump (Medtronic Diabetes) and to compare these results to performance metrics calculated for the PRT. Results: A total of N = 7193 PRT sensor downloads for 3 days of use, as well as 90,472 temporally and nonuniformly paired data points (sensor and meter values), were evaluated, with 5841 hypoglycemic and 15,851 hyperglycemic events detected through finger stick measurements. The Veo calibration algorithm decreased the overall mean absolute relative difference by greater than 0.25 to 15.89%, with hypoglycemia sensitivity increased from 54.9% in the PRT to 82.3% in the Veo (90.5% with predictive alerts); however, hyperglycemia sensitivity was decreased only marginally from 86% in the PRT to 81.7% in the Veo. Conclusions: The Veo calibration algorithm, with sensor error reduced significantly in the 40- to 120-mg/dl range, improves hypoglycemia detection, while retaining accuracy at high glucose levels.
Telehealth Behavior Therapy for the Management of Type 1 Diabetes in Adolescents
Authors: Lehmkuhl Heather D. , Storch Eric A. , Cammarata Christina , Meyer Kara , Rahman Omar , Silverstein Janet , Malasanos Toree , Geffken Gary 
Published: January 2014

Background: Poor management of type 1 diabetes mellitus (T1DM) may result in serious medical complications. Psychological intervention may improve adherence to medical regimens; however, access to trained professionals is limited, particularly in rural communities. Telehealth interventions may address this by allowing families to access services at home; however, little is known about the efficacy of such services. Method: This study presents results from a pilot trial of a randomized waitlist controlled trial of Telehealth Behavioral Therapy (TBT) for youths with T1DM. Primary outcome measures were adherence to the diabetes regimen, glycemic control, and level of family discord. Thirty-two youths (23 female) with T1DM (aged 9 to 17 years) and one parent or caregiver participated. Telehealth Behavioral Therapy sessions were conducted thrice weekly for 12 weeks by phone and lasted an average of 15 min each. Results: Results indicated that youths in treatment decreased their hemoglobin A1c by 0.74 compared to 0.09 in the waitlist, though this was not statistically significant. Youths in treatment reported increased unsupportive and decreased caring parental behaviors. Conclusion: Telehealth Behavioral Therapy improves access to knowledgeable providers and results in a clinically significant improvement in glycemic control. Despite some youths experiencing an increase in unsupportive parental behaviors, TBT is a promising method of service delivery that warrants further investigation.
A Comparison of Dosing Accuracy: Visually Impaired and Sighted People Using Insulin Pens
Authors: Williams Ann S. , Schnarrenberger Patrick A. 
Published: January 2014

Background: In the United States, 18% of people with diagnosed diabetes have visual impairment. Insulin pens are widely used by both blind and sighted people. However, major manufacturers include a disclaimer in the instructions warning against use by visually impaired people, without giving a rationale. Published studies neither support nor refute the disclaimer. Method: The purpose of this study was to compare accuracy of dosing with insulin pens between visually impaired and sighted people. Inclusion criteria were self-reported diabetes and inability (visually impaired group) or ability (sighted group) to read regular print. The sole exclusion criterion was inability to pass a brief test of decisional capacity. Each participant received standardized instructions for insulin pen use, either in recorded (visually impaired group) or in printed (sighted group) format, and delivered 10 systematically varied doses into an injection ball, which was weighed on a precision laboratory balance. Results: No significant correlation with accuracy of insulin dosing was found for any of the analyzed variables: Visual status, age, gender, years of having diabetes mellitus (DM), or treatment of DM with or without insulin. Conclusions: This study provided preliminary evidence of the safety of use of insulin pens by visually impaired people and raised questions about the validity of the disclaimer. Further study of the safety of use of insulin pens by blind people is needed. Inclusion of people with disabilities in research on technology intended for patient use would ensure that people with disabilities can benefit from new technology.
Patients' Perception and Future Acceptance of an Artificial Pancreas
Authors: van Bon Arianne C. , Kohinor Miriam J. E. , Hoekstra Joost B. L. , von Basum Golo , DeVries J. Hans 
Published: January 2014

Background: Little is known of patient acceptance of an artificial pancreas (AP). The purpose of this study was to investigate future acceptance of an AP and its determinants. Methods: Patients with type 1 diabetes treated with insulin pump therapy were interviewed using questions based on the technology acceptance model and completed the diabetes treatment and satisfaction questionnaire (DTSQ). Results: Twenty-two adults with type 1 diabetes participated. Half of the patients were followed in a university hospital, and the others were under treatment in an affiliated teaching hospital. Half of the patients were male. The mean DTSQ score was 29 (range 23–33). The AP was perceived as likely to be useful. Perceived advantages were a stable glucose regulation, less need for self-monitoring of blood glucose, relief of daily concerns, and time saving. Participants were confident in their capability to use the system. Although many participants (58%) had been reluctant to start continuous subcutaneous insulin infusion, the majority (79%) felt they would have no barriers to start using the AP. Trust in the AP was related to the quality of glucose control it would provide. Almost everyone expressed the intention to use the new system when available, even if it would initially not cover 24/24 hours. Conclusion: The overall attitude on the AP was positive. Intention to use was dependent on trust in the AP, which was related to the quality of glucose control provided by the AP.
Development of an Internet-Based Obesity Prevention Program for Children
Authors: Gabriele Jeanne M. , Stewart Tiffany M. , Sample Alicia , Davis Allison B. , Allen Ray , Martin Corby K. , Newton Robert L. , Williamson Donald A. 
Published: January 2014

Background: Childhood obesity is a growing problem, particularly in rural, Louisiana school children. Traditionally, school-based obesity prevention programs have used a primary prevention approach. Finding methods to deliver secondary prevention programs to large numbers of students without singling out overweight students has been a challenge. An innovative approach to achieving this goal is through use of an Internet intervention targeted toward a student's weight status. This article describes the Louisiana (LA) Health Internet intervention, including the student Web site, the Internet counselor Web site, and the Internet counseling process. Method: The LA Health Internet intervention had separate interfaces for students and Internet counselors. The main features of the student site were behavioral weight loss lessons, lesson activities, chat with an Internet counselor, and email. The Internet counselor site contained these same features, plus a student directory and various means of obtaining student information to guide counseling. Based on their baseline weight status, students received lessons and counseling that promoted either weight loss or weight maintenance. Intervention was delivered during class time, and teachers scheduled Internet counseling sessions with intervention personnel. Results: The LA Health Internet intervention was initially implemented within 14 schools; 773 students were granted access to the site. From Fall 2007 to Spring 2009, 1174 hours of Internet counselor coverage was needed to implement the Internet counseling component of this intervention Conclusion: The LA Health Internet intervention is an innovative and feasible method of delivering a secondary prevention program within a school setting to large numbers of students.
An Analysis of Alternate Site Tests to Improve Patient Compliance with Self-Monitoring of Blood Glucose
Authors: Jacoby Jeanne M. 
Published: January 2014

Background: Multiple barriers stand in the way of patients performing self-monitoring of blood glucose (SMBG). Alternate-site testing (AST) has been introduced as one solution to reduce pain and improve compliance. In a study published in this issue of Journal of Diabetes Science and Technology, Ito and colleagues studied patients who exclusively used the traditional fingertip blood glucose testing (FBGT) and introduced these patients to the palm blood glucose testing (PBGT). These patients did not see much benefit in using PBGT over FBGT but did plan to use PBGT in the future (likely allowing for increased testing frequency). Future studies should consider populations of patients who may find more benefit to AST—minimizing barriers and improving compliance in diabetes self-management. Additionally, other barriers to SMBG should be explored and solutions studied to improve compliance in diabetes care.
Quantifying the Composition of Human Skin for Glucose Sensor Development
Authors: Groenendaal Willemijn , von Basum Golo , Schmidt Kristiane A. , Hilbers Peter A. J. , van Riel Natal A. W. 
Published: January 2014

Background: Glucose is heterogeneously distributed within human skin. In order to develop a glucose measurement method for human skin, both a good quantification of the different compartments of human skin and an understanding of glucose transport processes are essential. This study focused on the composition of human skin. In addition, the extent to which intersubject variability in skin composition alters glucose dynamics in human skin was investigated. Methods: To quantify the composition of the three layers of human skin—epidermis, dermis, and adipose tissue—cell and blood vessel volumes were calculated from skin biopsies. These results were combined with data from the literature. The composition was applied as input for a previously developed computational model that calculates spatiotemporal glucose dynamics in human skin. The model was used to predict the physiological effects of intersubject variability in skin composition on glucose profiles in human skin. Results: According to the model, the lag time of glucose dynamics in the epidermis was sensitive to variation in the volumes of interstitial fluid, cells, and blood of all layers. Data showed most variation/uncertainty in the volume composition of the adipose tissue. This variability mainly influences the dynamics in the adipose tissue. Conclusions: This study identified the intersubject variability in human skin composition. The study shows that this variability has significant influence on the glucose dynamics in human skin. In addition, it was determined which volumes are most critical for the quantification and interpretation of measurements in the different layers.
Bioluminescence Imaging of Glucose in Tissue Surrounding Polyurethane and Glucose Sensor Implants
Authors: Prichard Heather L. , Schroeder Thies , Reichert William M. , Klitzman Bruce 
Published: January 2014

Background: The bioluminescence technique was used to quantify the local glucose concentration in the tissue surrounding subcutaneously implanted polyurethane material and surrounding glucose sensors. In addition, some implants were coated with a single layer of adipose-derived stromal cells (ASCs) because these cells improve the wound-healing response around biomaterials. Methods: Control and ASC-coated implants were implanted subcutaneously in rats for 1 or 8 weeks (polyurethane) or for 1 week only (glucose sensors). Tissue biopsies adjacent to the implant were immediately frozen at the time of explant. Cryosections were assayed for glucose concentration profile using the bioluminescence technique. Results: For the polyurethane samples, no significant differences in glucose concentration within 100 μm of the implant surface were found between bare and ASC-coated implants at 1 or 8 weeks. A glucose concentration gradient was demonstrated around the glucose sensors. For all sensors, the minimum glucose concentration of approximately 4 mM was found at the implant surface and increased with distance from the sensor surface until the glucose concentration peaked at approximately 7 mM at 100 μm. Then the glucose concentration decreased to 5.5–6.5 mM more than 100 μm from the surface. Conclusions: The ASC attachment to polyurethane and to glucose sensors did not change the glucose profiles in the tissue surrounding the implants. Although most glucose sensors incorporate a diffusion barrier to reduce the gradient of glucose and oxygen in the tissue, it is typically assumed that there is no steep glucose gradient around the sensors. However, a glucose gradient was observed around the sensors. A more complete understanding of glucose transport and concentration gradients around sensors is critical.
Importance of Interleukin-1 and Interleukin-1 Receptor Antagonist in Short-Term Glucose Sensor Function in Vivo
Authors: Klueh Ulrike , Liu Zenghe , Feldman Ben , Kreutzer Don 
Published: January 2014

Background: The importance of the interleukin (IL)-1 cytokine family in inflammation and immunity is well established as a result of extensive in vitro and in vivo studies. In fact, much of our understanding of the in vivo importance of interleukin-1beta (IL-1B) is the result of research utilizing transgenic mice, such as overexpression or deficiencies of the naturally occurring inhibitor of IL-1 known as interleukin-1 receptor antagonist (IL-1RA). For the present studies, we utilized these transgenic mice to determine the role of IL-1B in glucose sensor function in vivo. Methods: To investigate the role of IL-1B in glucose sensor function in vivo, we compared glucose sensor function in transgenic mice that (1) overexpressed IL-1RA [B6.Cg-Tg(II1rn)1Dih/J] and (2) are deficient in IL-1RA (B6.129S- Il1rntm1Dih/J), with mice that have normal levels of IL-1RA (C57BL/6). Results: Our studies demonstrated that, during the first 7 days post-sensor implantation (PSI), mice deficient in IL-1RA had extensive inflammation and decreased sensor function when compared to normal or IL-1RA-overexpressing mice. Conclusion: These data directly support our hypothesis that the IL-1 family of cytokines and antagonists play a critical role in controlling tissue reactions and thereby sensor function in vivo during the first 7 days PSI.