Michèle Weber, Matthias Hannes Diebold, Peter Wiesli, Andreas David Kistler
Aims: Glucose and insulin metabolism are altered in hemodialysis patients, and diabetes management is difficult in these patients. We aimed to validate flash glucose monitoring (FGM) in hemodialysis patients with and without diabetes mellitus as an attractive option for glucose monitoring not requiring regular self-punctures.
Methods: We measured interstitial glucose using a FreeStyle Libre device in eight hemodialysis patients with and seven without diabetes mellitus over 14 days and compared the results to simultaneously performed self-monitoring of capillary blood glucose (SMBG).
Results: In 720 paired measurements, mean flash glucose values were significantly lower than self-measured capillary values (6.17±2.52 vs. 7.15±2.41 mmol/L, p=1.3 E-86). Overall, the mean absolute relative difference was 17.4%, and the mean absolute difference was 1.20 mmol/L. The systematic error was significantly larger in patients without vs. with diabetes (- 1.17 vs. - 0.82 mmol/L) and on dialysis vs. interdialytic days (-1.09 vs. -0.90 mmol/L). Compared to venous blood glucose (72 paired measurements), the systematic error of FGM was even larger (5.89±2.44 mmol/L vs. 7.78±7.25 mmol/L, p=3.74E-22). Several strategies to reduce the systematic error were evaluated, including the addition of +1.0 mmol/L as a correction term to all FGM values, which significantly improved accuracy.
Conclusions: FGM systematically underestimates blood glucose in hemodialysis patients but, taking this systematic error into account, the system may be useful for glucose monitoring in hemodialysis patients with or without diabetes.
目的:血液透析患者的葡萄糖和胰岛素代谢发生改变，这些患者的糖尿病管理困难。我们的目的是验证在有或没有糖尿病的血液透析患者中，快速血糖监测(FGM)是一种有吸引力的血糖监测选择，不需要定期自我穿刺。方法:我们使用FreeStyle Libre装置测量了8例合并糖尿病和7例非糖尿病血液透析患者14天间质血糖，并将结果与同时进行的毛细血管血糖(SMBG)自我监测进行比较。结果:在720组配对测量中，平均瞬时血糖值显著低于自测毛细血管值(6.17±2.52 vs. 7.15±2.41 mmol/L, p=1.3 E-86)。总体而言，平均绝对相对差为17.4%，平均绝对差为1.20 mmol/L。无糖尿病患者的系统误差明显大于糖尿病患者(- 1.17 vs - 0.82 mmol/L)，透析患者的系统误差明显大于透析期间的系统误差(-1.09 vs -0.90 mmol/L)。与静脉血血糖(72对测量)相比，FGM的系统误差更大(5.89±2.44 mmol/L vs. 7.78±7.25 mmol/L, p=3.74E-22)。评估了几种减少系统误差的策略，包括在所有女性生殖器切割值中添加+1.0 mmol/L作为校正项，这显着提高了准确性。结论:女性生殖器切割系统地低估了血液透析患者的血糖，但考虑到这一系统误差，该系统可能对伴有或不伴有糖尿病的血液透析患者的血糖监测有用。
{"title":"Accuracy of Flash Glucose Monitoring in Hemodialysis Patients With and Without Diabetes Mellitus.","authors":"Michèle Weber, Matthias Hannes Diebold, Peter Wiesli, Andreas David Kistler","doi":"10.1055/a-1978-0226","DOIUrl":"https://doi.org/10.1055/a-1978-0226","url":null,"abstract":"<p><strong>Aims: </strong>Glucose and insulin metabolism are altered in hemodialysis patients, and diabetes management is difficult in these patients. We aimed to validate flash glucose monitoring (FGM) in hemodialysis patients with and without diabetes mellitus as an attractive option for glucose monitoring not requiring regular self-punctures.</p><p><strong>Methods: </strong>We measured interstitial glucose using a FreeStyle Libre device in eight hemodialysis patients with and seven without diabetes mellitus over 14 days and compared the results to simultaneously performed self-monitoring of capillary blood glucose (SMBG).</p><p><strong>Results: </strong>In 720 paired measurements, mean flash glucose values were significantly lower than self-measured capillary values (6.17±2.52 vs. 7.15±2.41 mmol/L, p=1.3 E-86). Overall, the mean absolute relative difference was 17.4%, and the mean absolute difference was 1.20 mmol/L. The systematic error was significantly larger in patients without vs. with diabetes (- 1.17 vs. - 0.82 mmol/L) and on dialysis vs. interdialytic days (-1.09 vs. -0.90 mmol/L). Compared to venous blood glucose (72 paired measurements), the systematic error of FGM was even larger (5.89±2.44 mmol/L vs. 7.78±7.25 mmol/L, p=3.74E-22). Several strategies to reduce the systematic error were evaluated, including the addition of +1.0 mmol/L as a correction term to all FGM values, which significantly improved accuracy.</p><p><strong>Conclusions: </strong>FGM systematically underestimates blood glucose in hemodialysis patients but, taking this systematic error into account, the system may be useful for glucose monitoring in hemodialysis patients with or without diabetes.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/d2/10-1055-a-1978-0226.PMC9998185.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9088415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Hummel, Martin Füchtenbusch, Wilgard Battefeld, Christoph Bührer, Tanja Groten, Thomas Haak, Franz Kainer, Alexandra Kautzky-Willer, Andreas Lechner, Thomas Meissner, Christine Nagel-Reuper, Ute Schäfer-Graf, Thorsten Siegmund
Bernhard Kulzer, Christian Albus, Stephan Herpertz, Johannes Kruse, Karin Lange, Florian Lederbogen, Frank Petrak
Affiliations 1 Diabetes Center Bad Mergentheim, Research Institute of the Diabetes Academy (Forschungsinstitut der Diabetes Akademie – FIDAM), Mergentheim, Germany 2 Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Cologne, Germany 3 Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr-University Bochum, Bochum, Germany 4 Department of Psychosomatics and Psychotherapy of the Justus-Liebig-University Giessen and Philipps University Marburg, Marburg, Germany 5 Research and Teaching Unit of Medical Psychology, Medical School, Hannover, Germany 6 Joint practice Weimer/Tabakhtory-Fard; Marburg, Heidelberg, Germany
{"title":"Psychosocial Factors and Diabetes.","authors":"Bernhard Kulzer, Christian Albus, Stephan Herpertz, Johannes Kruse, Karin Lange, Florian Lederbogen, Frank Petrak","doi":"10.1055/a-1946-3863","DOIUrl":"https://doi.org/10.1055/a-1946-3863","url":null,"abstract":"Affiliations 1 Diabetes Center Bad Mergentheim, Research Institute of the Diabetes Academy (Forschungsinstitut der Diabetes Akademie – FIDAM), Mergentheim, Germany 2 Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Cologne, Germany 3 Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr-University Bochum, Bochum, Germany 4 Department of Psychosomatics and Psychotherapy of the Justus-Liebig-University Giessen and Philipps University Marburg, Marburg, Germany 5 Research and Teaching Unit of Medical Psychology, Medical School, Hannover, Germany 6 Joint practice Weimer/Tabakhtory-Fard; Marburg, Heidelberg, Germany","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9427151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ludwig Merker, Thomas Ebert, Martina Guthoff, Berend Isermann
recommendation 1: Additional information added to the general measures reason: Important measures for the self-management of CKD supporting reference: [11] recommendation 2: Blood pressure target value lowered reason: Current guideline recommendation supporting reference: [12] recommendation 3: Use of non-steroidal mineralocorticoid receptor antagonists in future reason: New data from endpoint studies supporting reference: [13–14] recommendation 4: Use of some SGLT-2 inhibitors also in stage G4 reason: Newer data supporting reference: [11] Preliminary note
{"title":"Nephropathy in Diabetes.","authors":"Ludwig Merker, Thomas Ebert, Martina Guthoff, Berend Isermann","doi":"10.1055/a-1946-3783","DOIUrl":"https://doi.org/10.1055/a-1946-3783","url":null,"abstract":"recommendation 1: Additional information added to the general measures reason: Important measures for the self-management of CKD supporting reference: [11] recommendation 2: Blood pressure target value lowered reason: Current guideline recommendation supporting reference: [12] recommendation 3: Use of non-steroidal mineralocorticoid receptor antagonists in future reason: New data from endpoint studies supporting reference: [13–14] recommendation 4: Use of some SGLT-2 inhibitors also in stage G4 reason: Newer data supporting reference: [11] Preliminary note","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9428371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephan Morbach, Michael Eckhard, Ralf Lobmann, Eckhard Müller, Heinrich Reike, Alexander Risse, Gerhard Rümenapf, Maximilian Spraul
Affiliations 1 Department of Diabetology and Angiology, Marienkrankenhaus gGmbH, Soest, Germany 2 University Diabetes Center and Interdisciplinary Diabetic Foot Center of Central Hessen, University Hospital Giessen and Marburg GmbH, Location: Giessen and GZW Diabetes Clinic Bad Nauheim, Germany 3 Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Location: Bad Cannstatt, Germany 4 Practice for Diabetology and Nephrology, KfH Kidney Center, Bernkastel-Kues, Germany 5 Dortmund, Germany 6 Diabetes Center at Sophie-Charlotte-Platz, Berlin, Germany 7 Upper Rhine Vascular Center, Department of Vascular Surgery, Diakonissen-Stiftungs-Hospital, Speyer, Germany 8 Diabetes Practice, Rheine, Germany
{"title":"Diabetic Foot Syndrome.","authors":"Stephan Morbach, Michael Eckhard, Ralf Lobmann, Eckhard Müller, Heinrich Reike, Alexander Risse, Gerhard Rümenapf, Maximilian Spraul","doi":"10.1055/a-1946-3838","DOIUrl":"https://doi.org/10.1055/a-1946-3838","url":null,"abstract":"Affiliations 1 Department of Diabetology and Angiology, Marienkrankenhaus gGmbH, Soest, Germany 2 University Diabetes Center and Interdisciplinary Diabetic Foot Center of Central Hessen, University Hospital Giessen and Marburg GmbH, Location: Giessen and GZW Diabetes Clinic Bad Nauheim, Germany 3 Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Location: Bad Cannstatt, Germany 4 Practice for Diabetology and Nephrology, KfH Kidney Center, Bernkastel-Kues, Germany 5 Dortmund, Germany 6 Diabetes Center at Sophie-Charlotte-Platz, Berlin, Germany 7 Upper Rhine Vascular Center, Department of Vascular Surgery, Diakonissen-Stiftungs-Hospital, Speyer, Germany 8 Diabetes Practice, Rheine, Germany","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9779755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diana Rubin, Anja Bosy-Westphal, Stefan Kabisch, Peter Kronsbein, Marie-Christine Simon, Astrid Tombek, Katharina S Weber, Thomas Skurk
Affiliations 1 Vivantes Hospital Spandau, Berlin, Germany 2 Vivantes Humboldt Hospital, Berlin, Germany 3 Institute of Human Nutrition, Faculty of Agriculture and Nutritional Sciences, Christian-Albrechts University of Kiel, Kiel, Germany 4 Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany 5 German Center for Diabetes Research (DZD), Munich, Germany 6 Faculty of Nutrition and Food Sciences, Niederrhein University of Applied Sciences, Mönchengladbach, Germany 7 Institute of Nutrition and Food Sciences, Rhenish Friedrich Wilhelm University of Bonn, Bonn, Germany 8 Diabetes Center Bad Mergentheim, Bad Mergentheim, Germany 9 Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany 10 ZIEL – Institute for Food & Health, Technical University Munich, Freising, Germany published online 13.01.2023
{"title":"Nutritional Recommendations for People with Type 1 Diabetes Mellitus.","authors":"Diana Rubin, Anja Bosy-Westphal, Stefan Kabisch, Peter Kronsbein, Marie-Christine Simon, Astrid Tombek, Katharina S Weber, Thomas Skurk","doi":"10.1055/a-1946-3753","DOIUrl":"https://doi.org/10.1055/a-1946-3753","url":null,"abstract":"Affiliations 1 Vivantes Hospital Spandau, Berlin, Germany 2 Vivantes Humboldt Hospital, Berlin, Germany 3 Institute of Human Nutrition, Faculty of Agriculture and Nutritional Sciences, Christian-Albrechts University of Kiel, Kiel, Germany 4 Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany 5 German Center for Diabetes Research (DZD), Munich, Germany 6 Faculty of Nutrition and Food Sciences, Niederrhein University of Applied Sciences, Mönchengladbach, Germany 7 Institute of Nutrition and Food Sciences, Rhenish Friedrich Wilhelm University of Bonn, Bonn, Germany 8 Diabetes Center Bad Mergentheim, Bad Mergentheim, Germany 9 Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany 10 ZIEL – Institute for Food & Health, Technical University Munich, Freising, Germany published online 13.01.2023","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9482047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
recommendation 1: Modification of the use of GLP-1 agonists and SGLT-2 inhibitors in the elderly reason: NVL Type 2 DM supporting reference: REWIND, LEADER, SUSTAIN-6, EXSCEL, ELIXA, EMPE-REG, DAPA-HF recommendation 2: Participatory decision-making, individualized therapy reason: NVL Type 2 DM supporting reference: [5] recommendation 3: HbA1c target corridor reason: NVL Type 2 DM supporting reference: [5] recommendation 4: References Due to the good medical care in Germany, many people with diabetes mellitus now reach old age: Of the 340,000 adults with type 1 diabetes, more than 100,000 are over 70 years of age. Approximately 8 million people have type 2 diabetes and one-fourth of this group is over 75 years of age, and approximately 1 million over the age of 80 [1]. Nationwide, there are a total of about 630,000 people with diabetes mellitus in need of care. The statements in the practice recommendations are mainly directed at the majority of elderly people with type 2 diabetes and can only reflect some of the special characteristics of elderly people with diabetes. Topics such as type 1 diabetes at an elderly age, end of life, interface management or ethics are covered in the complete S2k guideline. The geriatric patient is defined by multimorbidity and a higher age. Age-typical functional limitations and high vulnerability create a special need for action that goes beyond blood glucose control and the management of cardiovascular risk factors or diabetes-typical complications. For differentiated therapy planning, elderly patients should be divided into functional groups (▶tab. 1). A geriatric assessment should be conducted to determine resources and deficits (division into functional groups) (Practice Tool 1, see Appendix).
{"title":"Diabetes Mellitus at an Elderly Age.","authors":"Andrej Zeyfang, Jürgen Wernecke, Anke Bahrmann","doi":"10.1055/a-1946-3728","DOIUrl":"https://doi.org/10.1055/a-1946-3728","url":null,"abstract":"recommendation 1: Modification of the use of GLP-1 agonists and SGLT-2 inhibitors in the elderly reason: NVL Type 2 DM supporting reference: REWIND, LEADER, SUSTAIN-6, EXSCEL, ELIXA, EMPE-REG, DAPA-HF recommendation 2: Participatory decision-making, individualized therapy reason: NVL Type 2 DM supporting reference: [5] recommendation 3: HbA1c target corridor reason: NVL Type 2 DM supporting reference: [5] recommendation 4: References Due to the good medical care in Germany, many people with diabetes mellitus now reach old age: Of the 340,000 adults with type 1 diabetes, more than 100,000 are over 70 years of age. Approximately 8 million people have type 2 diabetes and one-fourth of this group is over 75 years of age, and approximately 1 million over the age of 80 [1]. Nationwide, there are a total of about 630,000 people with diabetes mellitus in need of care. The statements in the practice recommendations are mainly directed at the majority of elderly people with type 2 diabetes and can only reflect some of the special characteristics of elderly people with diabetes. Topics such as type 1 diabetes at an elderly age, end of life, interface management or ethics are covered in the complete S2k guideline. The geriatric patient is defined by multimorbidity and a higher age. Age-typical functional limitations and high vulnerability create a special need for action that goes beyond blood glucose control and the management of cardiovascular risk factors or diabetes-typical complications. For differentiated therapy planning, elderly patients should be divided into functional groups (▶tab. 1). A geriatric assessment should be conducted to determine resources and deficits (division into functional groups) (Practice Tool 1, see Appendix).","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9482045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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