BACKGROUND: Today's diabetes-oriented telemedicine systems can gather and analyze many parameters like blood glucose levels, carbohydrate intake, insulin doses, and physical activity levels (steps). Information collected can be presented to patients in a variety of graphical outputs. Despite the availability of several technical means, a large percentage of patients do not reach the goals established in their diabetes treatment. OBJECTIVE: The objective of the study was to evaluate the benefits of the Diani telemedicine system for the treatment of patients with type 1 diabetes mellitus. METHODS: Data were collected during a 24-week feasibility study. Patients responded to the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire and a system evaluation questionnaire. The level of glycated hemoglobin (HbA1c) and the patient's body weight were measured, and the patient's use of the telemedicine system and their daily physical activity level were monitored. All data were sent from the patient's device to the Diani server using a real-time diabetes diary app. Wilcoxon and Friedman tests and the linear mixed effects method were used for data analysis. RESULTS: This study involved 10 patients (men: n=5; women: n=5), with a mean age of 47.7 (SD 19.3) years, a mean duration of diabetes of 10.5 (SD 8.6) years, and a mean HbA1c value of 59.5 (SD 6.7) mmol/mol. The median number of days the patients used the system was 84. After the intervention, the mean HbA1c decreased by 4.35 mmol/mol (P=.01). The patients spent 18.6 (SD 6.8) minutes on average using the app daily. After the intervention, the number of patients who measured their blood glucose level at least 3 times a day increased by 30%. The graphical visualization of the monitored parameters, automatic transmission of measured data from the glucometer, compatibility, and interconnection of individual devices when entering data were positively evaluated by patients. CONCLUSIONS: The Diani system was found to be beneficial for patients with type 1 diabetes mellitus in terms of managing their disease. Patients perceived it positively; it strengthened their knowledge of diabetes and their understanding of the influences of the measured values on the management of their disease. Its use had a positive effect on the HbA1c level.
- Publikační typ
- časopisecké články MeSH
Kontinuální monitorace glykemie (CGM) poskytuje podrobné informace o průběhu glykemických změn během dne, což umožňuje mnohem přesnější nastavení inzulinoterapie. Nabízí také nové parametry, které je pak možné v klinické praxi využít k hodnocení míry kompenzace diabetu. Jako nejsilnější indikátor glykemické kompenzace se ukazuje procento času stráveného v cílovém glykemickém rozmezí, tzv. čas v cílovém rozmezí, neboli time-in-range (TIR). Za to je považováno pásmo glykemie od 3,9 do 10 mmol/l. Od roku 2019 existují konkrétní doporučení vymezující čas v rozmezí u různých skupin pacientů s diabetem (diabetiků 1. a 2. typu, těhotných diabetiček a rizikových/křehkých pacientů), jež umožňují interpretovat výsledky z CGM na více individuální bázi.
Continuous glucose monitoring (CGM) provides detailed information about the course of glycaemic changes during the day, which allows for a much more accurate setting of insulin therapy. Also, it offers new parameters, which can then be used in clinical practice to assess the degree of compensation for diabetes. The strongest indicator of glycaemic compensation is the percentage of time spent in the target glycaemic range, the so-called time-in-range (TIR). It is considered to range from 3.9 to 10 mmol/L. Since 2019, there have been specific TIR recommendations for different groups of diabetic patients (type 1 and type 2 diabetics, pregnant diabetics, and at-risk/fragile patients) that allow CGM results to be interpreted on a more individual basis.
- Klíčová slova
- kontinuální monitor glykemie,
- MeSH
- časové faktory MeSH
- diabetes mellitus * krev prevence a kontrola MeSH
- lidé MeSH
- selfmonitoring glykemie * MeSH
- Check Tag
- lidé MeSH
Mobilní a nositelná elektronika nabízí pacientům s diabetes mellitus nové možnosti sběru dat a jejich efektivnější analýzu. Aplikace pro chytré telefony Diabetesdagboka a webový portál Diani umožňují shromažďování a analýzu hodnot glykemie, dávek sacharidů a inzulinu a míry pohybové aktivity. Hodnoty jsou dostupné v příslušném mobilním telefonu, ale jsou též automatizovaně přenášeny do internetového portálu, kde mohou být doplněny o záznam z elektronického krokoměru a kontinuálního monitoru glykemie. Lze je též zobrazit v různých typech grafických výstupů a jsou dostupné nejenom pacientovi, ale i jeho lékaři. Kazuistika pacienta, který systém téměř 2 roky využíval, prokazuje významné zlepšení metabolické kompenzace (pokles průměrné hodnoty HbA1c o 18,6 mmol/mol v porovnání s předchozím obdobím).
Mobile and wearable technologies offer patients with diabetes mellitus new possibilities for data collection and their more effective analysis. The Diabesdagboga smartphone application and the Diani web portal enable to collect and analyze glycaemia values, carbohydrates intake, insulin doses and the level of physical activity. The data are not only accessible in the corresponding smartphone but also automatically transferred to an Internet portal, where they may be completed by the records from an electronic pedometer and continuous glucose monitor. All these data may then be displayed in various types of graphical outputs and are available to both the patient and the physician. The case report of a patient who has used the system for almost two years shows a significant improvement in metabolic compensation (a decrease in the mean HbA1c value by 18.6 mmol/mol as compared with the previous period).
- Klíčová slova
- diabetický deník, telemonitoring, webová aplikace, webový portál,
- MeSH
- deníky jako téma MeSH
- diabetes mellitus 1. typu * diagnóza terapie MeSH
- diabetes mellitus diagnóza terapie MeSH
- dospělí MeSH
- glykovaný hemoglobin analýza MeSH
- hypoglykemie prevence a kontrola MeSH
- lidé MeSH
- mobilní aplikace MeSH
- selfmonitoring glykemie metody MeSH
- telemedicína metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
BACKGROUND: Type 1 diabetes is a chronic condition of blood glucose metabolic disorder caused by a lack of insulin secretion from pancreas cells. In people with type 1 diabetes, hyperglycemia often occurs upon infection incidences. Despite the fact that patients increasingly gather data about themselves, there are no solid findings that uncover the effect of infection incidences on key parameters of blood glucose dynamics to support the effort toward developing a digital infectious disease detection system. OBJECTIVE: The study aims to retrospectively analyze the effect of infection incidence and pinpoint optimal parameters that can effectively be used as input variables for developing an infection detection algorithm and to provide a general framework regarding how a digital infectious disease detection system can be designed and developed using self-recorded data from people with type 1 diabetes as a secondary source of information. METHODS: We retrospectively analyzed high precision self-recorded data of 10 patient-years captured within the longitudinal records of three people with type 1 diabetes. Obtaining such a rich and large data set from a large number of participants is extremely expensive and difficult to acquire, if not impossible. The data set incorporates blood glucose, insulin, carbohydrate, and self-reported events of infections. We investigated the temporal evolution and probability distribution of the key blood glucose parameters within a specified timeframe (weekly, daily, and hourly). RESULTS: Our analysis demonstrated that upon infection incidence, there is a dramatic shift in the operating point of the individual blood glucose dynamics in all the timeframes (weekly, daily, and hourly), which clearly violates the usual norm of blood glucose dynamics. During regular or normal situations, higher insulin and reduced carbohydrate intake usually results in lower blood glucose levels. However, in all infection cases as opposed to the regular or normal days, blood glucose levels were elevated for a prolonged period despite higher insulin and reduced carbohydrates intake. For instance, compared with the preinfection and postinfection weeks, on average, blood glucose levels were elevated by 6.1% and 16%, insulin (bolus) was increased by 42% and 39.3%, and carbohydrate consumption was reduced by 19% and 28.1%, respectively. CONCLUSIONS: We presented the effect of infection incidence on key parameters of blood glucose dynamics along with the necessary framework to exploit the information for realizing a digital infectious disease detection system. The results demonstrated that compared with regular or normal days, infection incidence substantially alters the norm of blood glucose dynamics, which are quite significant changes that could possibly be detected through personalized modeling, for example, prediction models and anomaly detection algorithms. Generally, we foresee that these findings can benefit the efforts toward building next generation digital infectious disease detection systems and provoke further thoughts in this challenging field.
- MeSH
- diabetes mellitus 1. typu komplikace MeSH
- dospělí MeSH
- incidence MeSH
- individualizovaná medicína metody MeSH
- infekční nemoci etiologie patologie MeSH
- komplikace diabetu diagnóza MeSH
- lidé MeSH
- retrospektivní studie MeSH
- telemedicína metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Klíčová slova
- systém DIANI,
- MeSH
- diabetes mellitus prevence a kontrola MeSH
- lidé MeSH
- telemedicína * metody MeSH
- Check Tag
- lidé MeSH
Methamphetamine (MA) is an addictive psychostimulant, often abused by drug-addicted women during pregnancy. The offspring of drug-addicted mothers are often exposed to perinatal stressors. The present study examines the effect of perinatal stressors and drug exposure on plasma oxytocin (OXY) levels in female progeny. Rat mothers were divided into three groups according to drug treatment during pregnancy: intact controls (C); saline (SA, s.c., 1 ml/kg); and MA (s.c., 5 mg/kg). Litters were divided into four groups according to postnatal stressors lasting from PD1 to 21: non-stressed controls (N); maternal separation (S); maternal cold-water stress (W); and maternal separation plus cold-water stress (SW). On postnatal day 30, acute MA or SA was administrated 1 h before the rats were sacrificed. Trunk blood was collected and plasma OXY was measured by specific ELISA after extraction. Our results showed that acute MA administration significantly increases plasma OXY levels in juvenile female rats; this effect was observed in prenatally intact rats only. Prenatal exposure of rats to mild stressor of daily SA injection prevented both acute MA-induced OXY stimulation and also stress-induced OXY inhibition. Although postnatal MA and stress exposure exert opposite effects on OXY release in juvenile rats, our data point out the modulatory role of prenatal mild stress in OXY response to postnatal stressors or MA treatment.
- Publikační typ
- časopisecké články MeSH
