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Frontiers of Medicine 2023年第1期17卷 68-74页

作者： Cheng Li Xiaojing Ma Jingyi Lu Rui Tao Xia Yu Yifei Mo Wei Lu Yuqian Bao Jian Zhou Weiping Jia Department of Endocrinology and Metabolism Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s HospitalShanghai Clinical Center for DiabetesShanghai Diabetes InstituteShanghai Key Laboratory of Diabetes MellitusShanghai 200233China College of Information Science and Engineering Northeastern UniversityShenyang 110819China

Most information used to evaluate diabetic statuses is collected at a special time-point,such as taking fasting plasma glucose test and providing a limited view of individual’s health and disease risk.As a new parameter for continuously evaluating personal clinical statuses,the newly developed technique“continuous glucose monitoring”(CGM)can characterize glucose dynamics.By calculating the complexity of glucose time series index(CGI)with refined composite multi-scale entropy analysis of the CGM data,the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes(P for trendglucose homeostasis.

关键词： complexity of glucose time series continuous glucose monitoring impaired glucose regulation insulin secretion and sensitivity refined composite multi-scale entropy

Application and management of continuous glucose monitoring in diabetic kidney disease

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World Journal of Diabetes 2024年第4期15卷 591-597页

作者： Xin-Miao Zhang Quan-Quan Shen Geriatric Medicine Center Department of EndocrinologyZhejiang Provincial People's Hospital(Affiliated People's HospitalHangzhou Medical College)Hangzhou 310014Zhejiang ProvinceChina Urology and Nephrology Center Department of NephrologyZhejiang Provincial People’s Hospital(Affiliated People’s HospitalHangzhou Medical College)Hangzhou 310014Zhejiang ProvinceChina

Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly found in diabetic patients with DKD and especially ESKD,as a result of impaired renal metabolism.It is essential to monitor glycemia for effective management of DKD.Hemoglobin A1c(HbA1c)has long been considered as the gold standard for monitoring glycemia for>3 months.However,assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction.continuous glucose monitoring(CGM)has provided new insights on glycemic assessment and management.CGM directly measures glucose level in interstitial fluid,reports real-time or retrospective glucose concentration,and provides multiple glycemic metrics.It avoids the pitfalls of HbA1c in some contexts,and may serve as a precise alternative to estimation of mean glucose and glycemic variability.Emerging studies have demonstrated the merits of CGM for precise monitoring,which allows fine-tuning of glycemic management in diabetic patients.Therefore,CGM technology has the potential for better glycemic monitoring in DKD patients.More research is needed to explore its application and management in different stages of DKD,including hemodialysis,peritoneal dialysis and kidney transplantation.

关键词： Diabetic kidney disease continuous glucose monitoring Glycemic monitoring Hemodialysis Peritoneal dialysis Kidney transplantation

continuous glucose monitoring defined time-in-range is associated with sudomotor dysfunction in type 2 diabetes

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World Journal of Diabetes 2020年第11期11卷 489-500页

作者： Qing-Yu Guo Bin Lu Zhan-Hong Guo Zhou-Qin Feng Yan-Yu Yuan Xu-Guang Jin Pu Zang Ping Gu Jia-Qing Shao Department of Endocrinology Jinling HospitalSchool of MedicineNanjing UniversityNanjing 210002Jiangsu ProvinceChina Department of Endocrinology Jinling HospitalNanjing Medical UniversityNanjing 210002Jiangsu ProvinceChina Department of Endocrinology Jinling HospitalSouthern Medical UniversityNanjing 210002Jiangsu ProvinceChina

BACKGROUND Time in range(TIR),as a novel metric for glycemic control,has robust relevance with diabetic complications.Diabetic peripheral neuropathy(DPN)is characterized by sudomotor dysfunction.AIM To explore the relationship between TIR obtained from continuous glucose monitoring(CGM)and sudomotor function detected by SUDOSCAN in subjects with type 2 diabetes.METHODS The research enrolled 466 inpatients with type 2 diabetes.All subjects underwent 3-d CGM and SUDOSCAN.SUDOSCAN was assessed with electrochemical skin conductance in hands(HESC)and feet(FESC).Average feet ESCglucose is between 3.9-10 mmol/L during 1 d period.RESULTS Among the enrolled subjects,135(28.97%)presented with sudomotor dysfunction.Patients with sudomotor dysfunction(+)showed a decreased level of TIR(P<0.001).Compared to the lowest tertile of TIR,the middle and the highest tertiles of TIR was associated with an obviously lower prevalence of sudomotor dysfunction(20.51%and 21.94%vs 44.52%)(P<0.001).In addition,with the increase of TIR,HESC and FESC increased(P<0.001).Regression analysis demonstrated that TIR was inversely and independently linked with the prevalence of sudomotor dysfunction after adjusting for confounding values(odds ratio=0.979,95%CI:0.971-0.987,P<0.001).CONCLUSION The tight glycemic control assessed by TIR is of vitally protective value for sudomotor dysfunction in type 2 diabetes mellitus.

关键词： Time in range Sudomotor dysfunction SUDOSCAN Diabetic peripheral neuropathy continuous glucose monitoring Diabetes mellitus Type 2

Anti-biofouling strategies for implantable biosensors of continuous glucose monitoring systems

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Frontiers of Chemical Science and Engineering 2023年第12期17卷 1866-1878页

作者： Yan Zheng Dunyun Shi Zheng Wang School of Pharmaceutical Science&Technology Tianjin UniversityTianjin 300072China Institute of Hematology Shenzhen Second People’s Hospital/the First Affiliated Hospital of Shenzhen UniversityShenzhen 518035China

continuous glucose monitoring(CGM)systems play an increasingly vital role in the glycemic control of patients with diabetes mellitus.However,the immune responses triggered by the implantation of poorly biocompatible sensors have a significant impact on the accuracy and lifetime of CGM systems.In this review,research efforts over the past few years to mitigate the immune responses by enhancing the anti-biofouling ability of sensors are summarized.This review divided these works into active immune engaging strategy and passive immune escape strategy based on their respective mechanisms.In each strategy,the various biocompatible layers on the biosensor surface,such as drug-releasing membranes,hydrogels,hydrophilic membranes,anti-biofouling membranes based on zwitterionic polymers,and bio-mimicking membranes,are described in detail.This review,therefore,provides researchers working on implantable biosensors for CGM systems with vital information,which is likely to aid in the research and development of novel CGM systems with profound anti-biofouling properties.

关键词： implantable glucose biosensor anti-biofouling continuous glucose monitoring immune responses

continuous glucose monitoring metrics in pregnancy with type 1 diabetes mellitus

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World Journal of Methodology 2024年第1期14卷 6-17页

作者： Mohammad Sadiq Jeeyavudeen Mairi Crosby Joseph M Pappachan Metabolic Unit Western General HospitalEdinburgh EH42XUUnited Kingdom Department of Endocrinology and Metabolism University Hospitals of EdinburghEdinburgh EH164SAUnited Kingdom Department of Endocrinology and Metabolism Lancashire Teaching Hospitals NHS TrustPreston PR29HTUnited Kingdom Faculty of Science Manchester Metropolitan UniversityManchester M156BHUnited Kingdom Faculty of Biology Medicine and HealthThe University of ManchesterManchester M139PLUnited Kingdom

Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests,the advent of continuous glucose monitoring(CGM)systems has revolutionized the approach.These devices offer a safe and reliable means of tracking glucose levels in real-time,benefiting both women with diabetes during pregnancy and the healthcare providers.Moreover,CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes,especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device.Such a combined approach has been demonstrated to improve overall blood sugar control,lessen the occurrence of preeclampsia and neonatal hypoglycaemia,and minimize the duration of neonatal intensive care unit stays.This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.

关键词： Type 1 diabetes mellitus continuous glucose monitoring Pregnancy Glycaemic control continuous glucose monitoring system

Artificial intelligence biosensors for continuous glucose monitoring

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Interdisciplinary Materials 2023年第2期2卷 290-307页

作者： Xiaofeng Jin Andrew Cai Tailin Xu Xueji Zhang School of Life Sciences Anhui UniversityHefeiChina McKelvey School of Engineering Washington University in St.LouisSt.LouisMissouriUSA School of Biomedical Engineering Shenzhen UniversityShenzhenChina

Artificial intelligence(AI)algorithms in combination with continuous monitoring technologies have the potential to revolutionize chronic disease management.The recent innovations in both continuous glucose monitoring(CGM)and the closed-loop highlight the far-reaching potential of AI biosensors for individual healthcare.This review summarizes some of the most advanced progress made in CGM biosensing.We will focus on three main applications of AI algorithms in diabetes management:closed-loop control algorithms,glucose predictions,and calibrations.The challenges and opportunities of AI technologies for CGM in individualized and proactive medicine will also be discussed.

关键词： artificial intelligence closed-loop continuous glucose monitoring machine learning

Preliminary prospective study of real-time post-gastrectomy glycemic fluctuations during dumping symptoms using continuous glucose monitoring

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World Journal of Gastroenterology 2021年第23期27卷 3386-3395页

作者： Motonari Ri Souya Nunobe Satoshi Ida Naoki Ishizuka Shinichiro Atsumi Rie Makuuchi Koshi Kumagai Manabu Ohashi Takeshi Sano Department of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyo 135-8550Japan Clinical Trial Planning and Management Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyo 135-8550Japan

BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIM To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODS Patients receiving distal gastrectomy with Billroth-I(DG-BI)or Roux-en-Y reconstruction(DG-RY)and total gastrectomy with RY(TG-RY)for gastric cancer(March 2018-January 2020)were prospectively enrolled.Interstitial tissue glycemic profiles were measured every 15 min,up to 14 d,by continuous glucose monitoring.Dumping episodes were recorded on 5 patient-selected days by diary.Within 3 h postprandially,dumping-associated glycemic changes were defined as a dumping profile,those without symptoms as a control profile.These profiles were compared.RESULTS Thirty patients were enrolled(10 DG-BI,10 DG-RY,10 TG-RY).The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal,which 47 control profiles did not(P<0.05).Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles,with lower glycemic levels.DGRY and TG-RY late dumping profiles(7 and 13,respectively)showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia,with a steeper drop in TG-RY than in DG-RY.CONCLUSION Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer.Furthermore,glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.

关键词： Gastric cancer Gastrectomy Billroth-I reconstruction Roux-en-Y reconstruction Dumping syndrome continuous glucose monitoring

Chinese clinical guideline for continuous glucose monitoring （2012）

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Chinese Medical Journal 2012年第23期 4167-4174页

作者：无 JIA Wei-ping Chinese Diabetes Society Department of Endocrinology and Metabolism Shanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai 200233China

glucose monitoring is an important component in diabetes treatment and management. The results of blood glucose monitoring are useful for determining the degree of glucose metabolic disturbance, evaluating therapeutic outcomes, and guiding adjustments of treatment regimens.1 Self-monitoring of blood glucose （SMBG） still remains the most common form of in-home blood glucose monitoring with the glycosylated hemoglobin （HbAlc） as the ＂gold standard＂ for understanding the patients＇ average glucose over the last 3 months. However, both HbA1 c and SMBG have certain limitations： HbAlc represents the average blood glucose level over the previous 2-3 months;

关键词： guideline continuous glucose monitoring clinical application

Relationship between time in range and corneal nerve fiber loss in asymptomatic patients with type 2 diabetes

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Chinese Medical Journal 2022年第16期135卷 1978-1985页

作者： Wejing Zhao Jingyi Lu Lei Zhang Wei Lu Wei Zhu Yuqian Bao Jjian Zhou 'Department of Endocrinology and Metabolism Shanghai Jiao Tong Universty Ailatede Sith People's HospitalShanghai Cinical Center for DiabetesShanghai Key Clinical Center for Metabolic DiseaseShanghai Diabetes IstuteShanghai Key Laboratory of Diabetes MellitusShanghai 200233China Shanghai Clinical Center for Metabolic Diseases Shanghai Key Laboratory of Diabetes MeliusShanghai Diabetes IstituteShanghai Jiao Tong University Alilatedae Sith People's HospitalShanghai 200233China Department of Endocrinology and Metabolism Jinshan Branch of Shanghai Jiao Tong University Aflatedae Sixth People's HospitalShanghai 201500China

Background: Corneal confocal microscopy (CCM) is a noninvasive technique to detect early nerve damage of diabetic sensorimotor polyneuropathy (DSPN). Time in range (TIR) is an emerging metric of glycemic control which was reported to be associated with diabetic complications. We sought to explore the relationship between TIR and corneal nerve parameters in asymptomatic patients with type 2 diabetes (T2DM).Methods: In this cross-sectional study, 206 asymptomatic inpatients with T2DM were recruited. After 7 days of continuous glucose monitoring, the TIR was calculated as the percentage of time in the glucose range of 3.9 to 10.0 mmol/L. CCM was performed to determine corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length (CNFL). Abnormal CNFL was defined as ≤15.30 mm/mm2.Results: Abnormal CNFL was found in 30.6% (63/206) of asymptomatic subjects. Linear regression analyses revealed that TIR was positively correlated with CCM parameters both in the crude and adjusted models (all P< 0.05). Each 10% increase in TIR was associated with a 28.2% (95% CI: 0.595–0.866,P = 0.001) decreased risk of abnormal CNFL after adjusting for covariates. With the increase of TIR quartiles, corneal nerve fiber parameters increased significantly (allP for trend <0.01). The receiver operating characteristic curve indicated that the optimal cutoff point of TIR was 77.5% for predicting abnormal CNFL in asymptomatic patients.Conclusions: There is a significant independent correlation between TIR and corneal nerve fiber loss in asymptomatic T2DM patients. TIR may be a useful surrogate marker for early diagnosis of DSPN.

关键词： continuous glucose monitoring Corneal confocal microscopy Time in range Type 2 diabetes

Research progress in the application of time in range: more than a percentage

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Chinese Medical Journal 2023年第5期136卷 522-527页

作者： Jintao Wan Jingyi Lu Cheng Li Xiaojing Ma Jian Zhou Department of Endocrinology and Metabolism Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai Clinical Center for DiabetesShanghai Key Clinical Center for Metabolic DiseaseShanghai Diabetes InstituteShanghai Key Laboratory of Diabetes MellitusShanghai 200233China.

glucose monitoring is an important part of medical care in diabetes mellitus,which not only helps assess glycemic control and treatment safety,but also assists with treatment adjustment.With the development of continuous glucose monitoring(CGM),the use of CGM has increased rapidly.With the wealth of glucose data produced by CGM,new metrics are greatly needed to optimally evaluate glucose status and guide the treatment.One of the parameters that CGM provides,time in range(TIR),has been recognized as a key metric by the international consensus.Before the adoption of TIR in clinical practice,several issues including the minimum length of CGM use,the setting of the target range,and individualized TIR goals are summarized.Additionally,we discussed the mounting evidence supporting the association between TIR and diabetes-related outcomes.As a novel glucose metric,it is of interest to compare TIR with other conventional glucose markers such as glycated hemoglobin A1c.It is anticipated that the use of TIR may provide further information on the quality of glucose control and lead to improved diabetes management.

关键词： Diabetes mellitus Time in range continuous glucose monitoring