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Li, Guang M. Eng Massachusetts Institute of Technology. "Evaluation of continuous glucose monitoring systems." Thesis, Massachusetts Institute of Technology, 2008. http://hdl.handle.net/1721.1/45357.
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Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Materials Science and Engineering, 2008.Includes bibliographical references (p. 45-48).
There has been much hype in the research and development of continuous glucose monitoring technologies, driven by the enormous and rapidly expanding glucose monitoring market and the large and growing base of diabetes patients. Continuous glucose monitoring has shown significant benefits over traditional intermittent blood glucose testing in reducing the risks of developing long-term complications associated with diabetes, by maintaining blood glucose concentrations to near-normoglycemic levels and reducing glycemic variability. In this thesis, commercially available continuous glucose monitoring systems as well as those still in development are evaluated. SWOT analysis shows that continuous glucose monitoring has a promising future, but there remain a number of challenges to be overcome, such as accuracy, sensor span, data handling, cost and reimbursement issues. It is concluded that continuous glucose monitoring will be the roadmap for future diabetes management. Ongoing technological advances in continuous glucose monitoring systems will hopefully close the loop for a fully automated artificial pancreas and develop a cure for Type I diabetes.
by Guang Li.
M.Eng.
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Sharma, Shweta Humad. "Continuous glucose monitoring and U.S. market strategy." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/90224.
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Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references.
There are about 25M (million) diabetics in the US alone, of which only 5-10% of the type 1 diabetics (1M) market has been penetrated with continuous glucose monitoring (CGM) devices. This thesis will provide an overview of the glucose monitoring, then focus on who the key market players for CGM are. Ensuing sections will explore product offerings, understanding what features patients care for and what critical limitations exist in design. It will also tackle why there hasn't been a more widespread adoption of CGM systems considering the technology has been on the market for a decade now. It will dive into a variety of potential market drivers, such as, first mover's advantage, pricing, product attributes and reimbursement coverage. It will emphasize the two US leaders, Medtronic and Dexcom and analyze the companies by comparing their revenue and underlying strategies. Finally the thesis will cover emerging technologies that could pose a market threat to incumbents.
by Shweta Humad Sharma.
M.B.A.
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Chen, Xuesong. "Impact of Continuous Glucose Monitoring System on Model Based Glucose Control." Thesis, University of Canterbury. Electrical and Computer Engineering, 2007. http://hdl.handle.net/10092/1228.
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Critically ill patients are known to experience stress-induced hyperglycemia. Inhibiting the physiological response to increased glycaemic levels in these patients are factors such as increased insulin resistance, increased dextrose input, absolute or relative insulin deficiency, and drug therapy. Although hyperglycemia can be a marker for severity of illness, it can also worsen outcomes, leading to an increased risk of further complications. Recent studies have shown that tight control can reduce mortality up to 43%. Metabolic modelling has been used to study physiological behaviour and/or to control glycaemia for a long time and many successful approximate system models have been developed. Due to the malfunction of medical equipments, clinical measurements obtained usually come with noise. In addition, the few such systems currently available can have errors in excess of 20-30%. Therefore, to fully simulate the clinical data, the system model also needs to couple with a successful noise model. This research has developed a new noise model that better fits the current available statistical description of the noise profile and therefore can be applied to achieve better simulation results. The research also designed a filter algorithm that is capable of reducing the sensor measurement error down to an acceptable value. Achieving such a goal is a significant step towards fully automated adaptive control of hyperglycaemia in critically ill patients and would therefore reduce mortality.
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Laurell, Thomas. "Microdialysis and continuous glucose monitoring towards wafer integration /." Lund : Lund Institute of Technology, Dept. of Electrical Measurements, 1995. http://catalog.hathitrust.org/api/volumes/oclc/37932770.html.
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Araujo, Cespedes Fabiola. "RF Sensing System for Continuous Blood Glucose Monitoring." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6998.
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The purpose of this research was to design a blood glucose sensing system based on the induced shift in the resonant frequency of an antenna patch operating in the ISM band (5.725 – 5.875 GHz). The underlying concept is the fact that when a person has variations in their blood glucose levels, the permittivity of their blood varies accordingly. This research analyzed the feasibility of using an antenna patch as a blood glucose sensing device in three configurations: 1) as an implantable active sensor, 2) as an implantable passive antenna sensor, and 3) as a non-invasive sensor. In the first arrangement, the antenna is to be implanted inside the body as an active antenna, requiring that its power supply and internal circuitry to be implanted. In the second arrangement, the antenna is also implanted, but would not require a power supply or internal circuity since it would be passive. For the third arrangement, the non-invasive sensing approach, the antenna is placed facing the upper arm while mounted outside the body. In order to evaluate the best approach all the three approaches were simulated using the electromagnetic field tool simulator ANSYS EM15.0 HFSSTM, along with a human tissue model. The tissue model included physiological and electrical characteristics of the human abdomen for simulating the active and passive approaches, and the upper arm for the non-invasive approach. The electromagnetic boundaries were set with perfectly matched layers to eliminate any reflections which would cause a non-physical resonance in the results. Simulation of the active sensing configuration resulted in a resonant frequency shift from 5.76 to 5.78GHz (i.e., a 20 MHz shift) for a simulated blood permittivity variation of 62.0 to 63.6. This corresponds, theoretically, to an approximate glucose shift of 500 mg/dL. The passive configuration simulations did not yield conclusive variations in resonant frequency and this approach was abandoned early on in this research. Thirdly, the non-invasive approach resulted in a simulated shift of resonant frequency from 5.797 to 5.807 (i.e., a 10MHz shift) for simulated blood permittivity variation of 51.397 to 52.642 (an approximate variation of 2000 mg/dL in glucose). In the literature planar, continuous blood-rich layers are used to simulate RF sensing of glucose, which is not applicable when measuring glucose in actual human veins, which are tubular in geometry and of finite extent. Therefore the model employed assumed a 1.8 mm diameter blood vessel, buried under a fatty layer that was capped with skin. The above results, both simulated and verified experimentally, used this more realistic model which is further proof that a practical non-invasive blood glucose measurement system should be possible.
The non-invasive approach was tested experimentally by using oil in gel phantoms to mimic the electrical properties of skin, fat, blood and muscle. A fat phantom was placed over a muscle phantom, with a strip of blood phantom within and a skin phantom was placed on top. The blood phantom had a 2000mg/dL variation of D-glucose in the phantom mixture which decreased the relative permittivity from 52.635 to 51.482 and resulted in a shift of resonant frequency from 5.855 to 5.842 (i.e., a 13MHz shift). This is consistent with the non-invasive simulated results thus validating our model of the non-invasive sensing approach. While this variation in blood glucose is non-physical (typical human glucose range can range in the extremes from 30 to 400 mg/dL, where healthy glucose levels vary from 70mg/dL to 180mg/dL) it was necessary to provide a high confidence fit between the simulated and experimental data. This is because the level of precision with which the physical phantoms could be fabricated with was insufficient to match the highly precise simulated data.
Analysis on the effect of lateral displacement of the antenna from the blood vessel, its elevation above the skin and variations caused by different skin thickness, and blood vessel depth were evaluated. A calibration technique to correct physical misalignment by the user is proposed in which two additional antennas, located diagonally with respect to the sensing antenna, serve as reference point for placement over the upper arm in line of sight with the blood vessel.
Once the non-invasive sensor approach was shown to be viable for continuous glucose monitoring, a sensor platform was designed whereby an RF generator was used to drive the antenna with a frequency sweep between 5.725 to 5.875GHz. A fraction of its output power was coupled to both the antenna and the system analysis circuitry through a directional coupler. The transmitted and received power were then processed with demodulating logarithmic amplifiers which convert the RF signal to a corresponding voltage for downstream processing. Both inputs were then fed into a microcontroller and the measured shift in resonant frequency, fO, converted to glucose concentration which was displayed on glucose meter display.
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Cooley, Daniel Warren. "Data acquisition unit for low-noise, continuous glucose monitoring." Diss., University of Iowa, 2012. https://ir.uiowa.edu/etd/2844.
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As the number of people with diabetes continues to increase, research efforts improving glucose testing methods and devices are under way to improve outcomes and quality of life for diabetic patients. This dissertation describes the design and testing of a Data Acquisition Unit (DAU) providing low noise photocurrent spectra for use in a continuous glucose monitoring system. The goal of this research is to improve the signal to noise ratio (SNR) of photocurrent measurements to increase glucose concentration measurement accuracy. The glucose monitoring system consists of a portable monitoring device and base station. The monitoring device measures near infrared (IR) absorption spectra from interstitial fluid obtained by microdialysis or ultrafiltration probe and transmits the spectra to a base station via USB or a ZigBee radio link. The base station utilizes chemometric calibration methods to calculate glucose concentration from the photocurrent spectra. Future efforts envisage credit card-sized monitoring devices. The glucose monitor system measures the optical absorbance spectrum of an interstitial fluid (ISF) sample pumped through a fluid chamber inside a glucose sensor. Infrared LEDs in the glucose sensor illuminate the ISF sample with IR light covering the 2.2 to 2.4 micron wavelength region where glucose has unique features in its absorption spectrum. Light that passes through the sample propagates through a linearly variable bandpass filter and impinges on a photodiode array. The center frequency of the variable filter is graded along its length such that the filter and photodiode array form a spectrometer. The data acquisition unit (DAU) conditions and samples photocurrent from each photodiode channel and sends the resulting photocurrent spectra to the Main Controller Unit (MCU). The MCU filters photocurrent samples providing low noise photocurrent spectra to a base station via USB or Zigbee radio link. The glucose monitoring system limit of detection (LOD) from a single glucose sensor wavelength is 5.8 mM with a system bandwidth of 0.00108 Hz. Further analysis utilizing multivariate calibration methods such as the net analyte signal method promise to reduce the glucose monitoring system LOD approaching a clinically useful level of approximately 2 mM.
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Olsson, Sara, and Sabina Forsberg. "Exploring the User Experience in Continuous Glucose Monitoring Systems." Thesis, Malmö universitet, Fakulteten för teknik och samhälle (TS), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20575.
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Typ 1-diabetes kräver ordentlig uppsyn dag och natt för att upprätthålla ett fungerandeliv. Idag använder människor allt oftare kontinuerlig glukosövervakning (CGM) för atthantera sin diabetessjukdom. Detta system mäter blodsockernivån genom en sensor somplaceras på användarens hud. Användaren skannar sedan sensorn med en handenhet ellermobilapplikation för att läsa av den nuvarande blodsockernivån och i vilken riktningblodsockret är på väg. Forskare föreslår att för att kunna skapa den bästaanvändarupplevelsen för diabetespatienter måste designers verkligen förstå användarna ochhur de interagerar med sina CGM-system, vilket är målet med denna studie.Problemen med nuvarande CGM-system är att i många fall upplevs navigeringsstrukturensom otydlig och att det finns brister i användarupplevelsen. På grund av sjukdomenskomplexitet är kategorisering i navigeringen avgörande för att användarna ska kunna förstågränssnittet. Det här är ett område som de flesta studier tar upp, men en väl utformadlösning har ännu inte presenterats. Den centrala delen för att användarna ska kunna förståinformationen är genom att involvera slutanvändare i designprocessen. Medicinskinformation kan vara svår att förstå och när denna information presenteras kan användarenfå en känsla av ”information overload”. Patienterna vill ha ett väl utformat verktyg för atthantera sin sjukdom. Tidigare studier visar även att patienter vill ha ett system för allasina behov, ett så kallat ”system of systems”, snarare än flera separata system.Denna studie syftar till att undersöka tre av de tillgängliga produkterna på den svenskamarknaden för att förstå användarens behov och användarupplevelsen av dessa produkter.Genom en intervju och enkätundersökning med slutanvändare samlas data in för attutvärdera de produkter som används idag. Resultatet från den första fasen analyseras ochfynden lägger sedan grund för nästa fas, där en prototyp utvecklas. Prototypen ärutformad för att validera resultatet av den nya navigeringsstrukturen ochanvändarupplevelsen utifrån de problemområden som uppgetts i första fasen av studien.Valideringen görs genom ytterligare en enkätundersökning där deltagarna får jämföra sinnuvarande produkt med den utvecklade prototypen, i samband med de förutbestämdafrågorna i System Usability Scale (SUS).Denna studie visar på att det är möjligt att skapa en bättre navigationsstruktur ochinformationspresentation med gestaltlagarna i åtanke. Dock påpekas även behovet av attutföra ytterligare forskning av den tekniska lösning som krävs för att möjliggöra ett“system of system” för CGM-systemen.Sökord: Användarbehov, Användarupplevelse, Design, Diabetes, Kontinuerlig GlukosövervakningType 1 diabetes requires proper supervision day and night to maintain a healthy living. Tomanage diabetes research shows that people today more often use Continuous GlucoseMonitoring (CGM). This system measures the blood glucose levels through a sensorplaced on the users' skin. The user then scans the sensor with a hand device or mobileapplication to get a reading of current blood glucose level and in which direction the levelsare heading. Researchers suggest that to be able to create the best user experiencesolution for diabetes patients, the designers truly need to understand the users and theway that they interact with their monitoring systems, which is the goal of this study.The problems with current diabetes monitoring systems are, in most cases, the unclearstructure of the navigation and lack of thoughtful and meaningful user experience. Due tothe complexity of the disease, labeling is vital to make users understand the interface.This is an area that most studies acknowledge, but a well thought out solution has not yetbeen presented. The central part of making users understand the information is to involveend users in the design process. Medical information can be hard to grasp and when a lotof information is presented it can lead to information overload. Patients want a well-designed tool to help manage their disease. Previous studies show that patients want tohave one system for all their functions, a so-called system of systems, rather than havingmultiple ones.This study aims to examine three of the available products on the Swedish market tounderstand the user needs and the user experience of these products. Throughinterviews and surveys with end users, data is collected to evaluate currently used products.The data from the first phase is analyzed and findings then lay the foundation for the nextphase, where a prototype is made. The prototype is designed to validate the findings ofuser-needs in terms of navigation structure and user experience from the first phase. Thevalidation is conducted through a second survey where the end users are asked to comparecurrently used product versus the prototype, alongside with the predetermined questions inSystem Usability Scale (SUS).The results show that user experience in CGM systems needs further development tomake the patients satisfied with the way that they can manage their disease. This studysuggests that by designing with the gestalt laws in mind, a better navigation structure andinformation presentation is possible. But also suggests that future research within thetechnical solution of making the CGM systems to a system of system, is required.Keywords: Continuous Glucose Monitoring, Design, Diabetes, User Experience, User-Needs
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Allen, Nancy A. "Changing Physical Activity Behavior with Continuous Glucose Monitoring: A Dissertation." eScholarship@UMMS, 2006. https://escholarship.umassmed.edu/gsn_diss/2.
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Up to 60% of individuals with type 2 diabetes (T2DM) do not participate in regular physical activity (PA) despite the known benefits. To encourage these individuals to increase PA behavior, this study tested the feasibility and implementation of a nurse-directed counseling intervention using continuous glucose monitoring system (CGMS). The study used a framework derived from self-efficacy theory to 1) compare changes in self-efficacy, BP and activity counts between participants receiving CGMS counseling and standard T2DM counseling, 2) examine relationships between PA self-efficacy and BP and activity counts, 3) evaluate recruitment, retention, and screening strategies, and 4) assess instrument reliability and utility.
Adults (N=52) with T2DM (non-insulin requiring, inactive) were randomized to intervention (n=27) or control groups (n=25). Both groups received 90 minutes of diabetes education with a follow-up phone call at 4 weeks. The intervention group also received feedback on their own CGMS graphs and a role model's graph depicting PA related reductions in glucose levels. PA benefits/barriers were discussed and goals were set. Outcomes were recorded at 1 and 8 weeks.
Participants were older (57±14 years), predominantly (90%) white, about half (52%) female, and had diabetes for 8±7 years. Relative to the control group, participants receiving the intervention had higher self-efficacy scores at 8 weeks, indicating more confidence in sticking to a PA program. Their light/sedentary activity minutes decreased significantly and moderate activity minutes increased significantly; systolic BP, A1c and BMI decreased significantly. Only self-efficacy for "Sticking to it" was positively associated with moderate activity. The most successful recruitment media was multiple newspaper press releases. Most referrals came from endocrinology physicians. Of 231 study volunteers, 106 did not meet the criterion of A1c≥7.5%.
These data suggest that CGMS feedback is feasible for counseling individuals with T2DM to improve PA and may improve risk factors for diabetes-related complications. Newspaper press releases are effective for recruiting participants with T2DM. Less restrictive inclusion criteria in a larger study may allow more participation by sedentary individuals with T2DM but may reduce effect size. CGMS was well tolerated and its data aided diabetes-related teaching.
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Barceló, Rico Fátima. "Multimodel Approaches for Plasma Glucose Estimation in Continuous Glucose Monitoring. Development of New Calibration Algorithms." Doctoral thesis, Universitat Politècnica de València, 2012. http://hdl.handle.net/10251/17173.
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ABSTRACT
Diabetes Mellitus (DM) embraces a group of metabolic diseases which main characteristic is the presence of high glucose levels in blood. It is one of the diseases with major social and health impact, both for its prevalence and also the consequences of the chronic complications that it implies.
One of the research lines to improve the quality of life of people with diabetes is of technical focus. It involves several lines of research, including the development and improvement of devices to estimate "online" plasma glucose: continuous glucose monitoring systems (CGMS), both invasive and non-invasive. These devices estimate plasma glucose from sensor measurements from compartments alternative to blood. Current commercially available CGMS are minimally invasive and offer an estimation of plasma glucose from measurements in the interstitial fluid
CGMS is a key component of the technical approach to build the artificial pancreas, aiming at closing the loop in combination with an insulin pump. Yet, the accuracy of current CGMS is still poor and it may partly depend on low performance of the implemented Calibration Algorithm (CA). In addition, the sensor-to-patient sensitivity is different between patients and also for the same patient in time.
It is clear, then, that the development of new efficient calibration algorithms for CGMS is an interesting and challenging problem.
The indirect measurement of plasma glucose through interstitial glucose is a main confounder of CGMS accuracy. Many components take part in the glucose transport dynamics. Indeed, physiology might suggest the existence of different local behaviors in the glucose transport process.
For this reason, local modeling techniques may be the best option for the structure of the desired CA. Thus, similar input samples are represented by the same local model. The integration of all of them considering the input regions where they are valid is the final model of the whole data set.
Clustering is tBarceló Rico, F. (2012). Multimodel Approaches for Plasma Glucose Estimation in Continuous Glucose Monitoring. Development of New Calibration Algorithms [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/17173
Palancia
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Signal, Matthew Kent. "Continuous Glucose Monitoring and Tight Glycaemic Control in Critically Ill Patients." Thesis, University of Canterbury. Department of Mechanical Engineering, 2013. http://hdl.handle.net/10092/8458.
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Critically ill patients often exhibit abnormal glycaemia that can lead to severe complications and potentially death. In critically ill adults, hyperglycaemia is a common problem that has been associated with increased morbidity and mortality. In contrast, critically ill infants often suffer from hypoglycaemia, which may cause seizures and permanent brain injury. Further complicating the matter, both of these conditions are diagnosed by blood glucose (BG) measurements, often taken several hours apart, and, as a result, these conditions can remain poorly managed or go completely undetected. Emerging ‘continuous’ glucose monitoring (CGM) devices with 1-5 minute measurement intervals have the potential to resolve many issues associated with conventional intermittent BG monitoring. The objective of this research was to investigate and develop methods and models to optimise the clinical use of CGM devices in critically ill patients.
For critically ill adults, an in-silico study was conducted to quantify the potential benefits of introducing CGM devices into the intensive care unit (ICU). Mathematical models of CGM error characteristics were implemented with existing, clinically validated, models of the insulin-glucose regulatory system, to simulate the behaviour of CGM devices in critically ill patients. An alarm algorithm was also incorporated to provide a warning at the onset of predicted hypoglycaemia, allowing a virtual dextrose intervention to be administered as a preventative measure. The results of the in-silico study showed a potential reduction in nurse workload of approximately 75% and a significant reduction in hypoglycaemia, while also providing insight into the optimal rescue dose size and resulting dynamics of glucose recovery.
During 2012, ten patients were recruited into a pilot clinical trial of CGM devices in critical care with a primary goal of assessing the reliability of CGM devices in this environment, with a specific interest in the effects of CGM device type and sensor site on sensor glucose (SG) data. Results showed the mean absolute relative difference of SG data across the cohort was between 12-24% and CGM devices were capable of monitoring some patients with a high degree of accuracy. However, certain illnesses, drugs and therapies can potentially affect sensor performance, and one particular set of results suggested severe oedema may have affected sensor performance. A novel and first of its kind metric, the Trend Compass was developed and used to assesses trend accuracy of SG in a mathematically precise fashion without approximation, and, importantly, does so independent of glucose level or sensor bias, unlike any other such metrics. In this analysis, the trend accuracy between CGM devices was typically good.
A recent hypothesis suggesting that glucose complexity is associated with mortality was also investigated using the clinical CGM data. The results showed that complexity results from detrended fluctuation analysis (DFA) were influenced far more by CGM device type than patient outcome. In addition, the location of CGM sensors had no significant effect on complexity results in this data set. Thus, while this emerging analytical method has shown positive results in the literature, this analysis indicates that those results may be misleading given the impact of technology outweighing that of physiology. This particular result helps to further delineate the range of potential applications and insight that CGM devices might offer in this clinical scenario.
In critically ill infants, CGM devices were used to investigate hypoglycaemia during the first 48 hours after birth. More than 50 CGM data sets were obtained from several studies of CGM in infants at risk of hypoglycaemia at the Waikato hospital neonatal ICU (NICU). In light of concerns regarding CGM accuracy, particularly during the first few hours of monitoring and/or at low BG levels, an alternative, novel calibration scheme was developed to increase the reliability of SG data. The recalibration algorithm maximised the value of very accurate calibration BG measurements from a blood gas analyser (BGA), by forcing SG data to pass through these calibration BG measurements.
Recalibration increased all metrics of hypoglycaemia (number, duration, severity and hypoglycaemic index) as the factory CGM calibration was found to be reporting higher values at low BG levels due to its least squares calibration approach based on the assumption of a less accurate calibration glucose meter. Thus, this research defined new calibration methods to directly optimise the use of CGM devices in this clinical environment, where accurate reference BG measurements are available. Furthermore, this work showed that metrics such as duration or area under curve were far more robust to error than the typically used counted-incidence metrics, indicating how clinical assessment may have to change when using these devices.
The impact of errors in calibration measurements on metrics used to classify hypoglycaemia was also assessed. Across the cohort, measurement error, particularly measurement bias, had a larger effect on hypoglycaemia metrics than delays in entering calibration measurements. However, for patients with highly variable glycaemia, timing error can have a significantly larger impact on output SG data than measurement error. Unusual episodes of hypoglycaemia could be successfully identified using a stochastic model, based on kernel density estimation, providing another level of information to aid decision making when assessing hypoglycaemia.
Using the developed algorithms/tools, with CGM data from 161 infants, the incidence of hypoglycaemia was assessed and compared to results determined using BG measurements alone. Results from BG measurements showed that ~17% of BG measurements identified hypoglycaemia and over 80% of episodes occurred in the first day after birth. However, with concurrent BG and SG data available, the SG data consistently identified hypoglycaemia at a higher rate suggesting the BG measurements were not capturing some episodes. Duration of hypoglycaemia in SG data varied from 0-10+%, but was typically in the range 4-6%. Hypoglycaemia occurred most frequently on the first day after birth and an optimal measurement protocol for at risk infants would likely involve CGM for the first week after birth with frequent intermittent BG measurements for the first day.
Overall, CGM devices have the potential to increase the understanding of certain glycaemic abnormalities and aid in the diagnosis/treatment of other conditions in critically ill patients. This research has used a range of prospective and retrospective clinical studies to develop methods to further optimise the use of CGM devices within the critically ill clinical environment, as well as delineating where they are less useful or less robust. These latter results clearly define areas where clinical practice needs to adapt when using these devices, as well as areas where device makers could target technological improvements for best effect. Although further investigations are required before these devices are regularly implemented in day-to-day clinical practice, as an observational tool they are capable of providing useful information that is not currently available with conventional intermittent BG monitoring.
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Flou, Louise. "Exploring how users perceive and interact with continuous glucose monitoring software." Thesis, Malmö universitet, Fakulteten för teknik och samhälle (TS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20266.
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The present study is based on the hypotheses that a better user experience in mobile applications increases the frequency of use among users, and that a higher frequency of use of continuous glucose monitoring systems leads to better health status in patients with diabetes.The purpose of this study is to understand how users perceive and interact with CGM software.The result of this study shows that existing CGM applications and the functionalities they provide are very much appreciated by the participants. Many of the user needs may however not have been met in one application alone, since a large proportion of the participants use more than one CGM application.This study highlights importance of providing options for customization in every aspect offunctionality due to the individuality of each user’s condition, and that the settings of such should consider minimizing the cognitive load for the user.
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Olsson, Joanna. "Swedish Elite Swimmers Blood Glucose Levels During Recovery : A Descriptive Study Using Continuous Glucose Monitoring Systems." Thesis, Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:gih:diva-4770.
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Aim The aim of this study is to form a descriptive picture of Swedish national elite (SNLE) swimmers blood glucose (BG) levels in relation to their nutritional intake. - Do SNLE swimmers have BG level in a normal range of ≥3.9 mmol/L when measured during a six-day period? - Is there a relationship between the SNLE swimmers blood glucose levels and how often or when they eat, and how they perceive their workout effort? Method Four test subjects, three females and one male, were recruited based on their competitive level, National Championship qualifying cut, geographical location, in Stockholm, and amount of swimming workouts completed weekly, seven on average. The test subjects wore a Continuous Glucose Monitor for a week and in addition a brief meal journal and perceived effort (ranking) of each workout was recorded. The data gathered was analyzed based on three main variables; time spent LOW (blood glucose level below 3.9mmol/L), amount of meals, and ranking. Results This study found that three out of four test subjects had occurrences of a LOW during the week. The test subjects spent on average 1.75 ±1.26 days with a LOW, the average time spent with a LOW per day was 37.3 ±29.7 minutes, the average amount during the whole week was 224 ±177 minutes, and the percent of the whole week spent with a LOW was 2.59 ±0.02%. In addition to this a correlation was found between (total) time spent LOW and (total) amount of meals with an R-value of 0.99, an R2 of 0.979, and P-value of 0.044. Conclusions The results showed that three test subjects spent time with a LOW and indicates similar results should be found in the general population of SNLE swimmers, however, this is definitely in need of further research. The results also indicated that there is a relationship between the amount of meals ingested and the BG level over the full six-day period but not on a daily basis. A regression analysis between (total) time spent LOW and (total) number of meals showed correlations with statistical significance, however, there was too small of a data sample (N=4) to draw conclusions based from this. This study forms a descriptive picture of the situation, which could serve as a platform for further research in this field, and give a first glance at the possible potential use of CGM systems within the sports nutrition field.
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Serbiné, Anna-Katharina [Verfasser]. "Anwendung von Continuous Glucose Monitoring (CGM) und Flash Glucose Monitoring (FGM) bei Kindern und Jugendlichen mit Diabetes mellitus / Anna-Katharina Serbiné." Ulm : Universität Ulm, 2020. http://d-nb.info/1209199033/34.
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Udén, Andreas. "Continuous glucose monitoring in children with type 1 diabetes effects on glycaemic control." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-52647.
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Price, Sally Ann. "Continuous Subcutaneous Glucose Monitoring (CGM) to predict progression from abnormal glucose tolerance (Pre-diabetes) to Type 2 Diabetes Mellitus." Thesis, Cardiff University, 2016. http://orca.cf.ac.uk/95959/.
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The global incidence of Type 2 Diabetes Mellitus (T2DM) is increasing rapidly. Many people with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) will however not progress to T2DM but appear to spontaneous revert to normal glucose homeostasis, others however will progress slowly and in some cases rapidly progress towards diabetes. Therapeutic interventions will reduce the risk, or at least the pace, of deterioration from IFG and IGT to T2DM. However, in order to target interventions appropriately, to prevent progression in those at greatest risk further information as to which individuals are most likely to progress is needed. There is a variable rate of progression from either IFG, IGT or combined IFG and IGT to T2DM and in general, progression rates are lowest in the general population and highest in target “at-risk” group. Age, body mass index (BMI), fasting and 2 hour plasma glucose concentrations, elevated fasting pro-insulin, low 2-hour insulin and fasting triglyceride levels are known to be associated with a greater risk of progression and in order to maintain normoglycemia, adequate quantitative and qualitative moment-by-moment pancreatic beta-cell secretion and action is essential. A marker of deteriorating carbohydrate homeostasis would be increased fluctuations in blood glucose levels and continuous glucose monitoring (CGM) is an ideal method to look at just this. The use of CGM to quantify the fluctuations was proposed to assess whether CGM can help identify people with abnormal glucose tolerance that progress to T2DM. In this study, CGM profiles inspected by eye for variability appeared to correlate well with mathematically devised CGM parameters based on CGM data, both at baseline and at Year 1. However, neither the subject CGM profiles nor the CGM parameters at baseline were significant in predicting progression to diabetes (T2DM) at Year 1 or Year 3 from a pre diabetic state at baseline. However, when one looked at progression from pre diabetes to diabetes, with regard to CGM profiles and CGM parameters, the interval period between study baseline and Year 1 appeared to be when most variation in glucose levels occurred; this was especially the case for those subjects with IFG, compared to subjects with IGT or IFG+IGT mix, respectively. This effect was diluted at Year 3 and not observed. In conclusion, this study demonstrated that CGM did not predict progression from pre diabetes to diabetes (T2DM), but did however, correlate well by eye with mathematical assessments models of the same CGM data and identify an at risk IFG group that could be targeted at baseline with more intensive therapy.
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Cappuccio, Frank E. "Detection of glucose with arylboronic acid containing viologens and fluorescent dyes : progress toward a continuous glucose monitoring system for in vivo applications /." Diss., Digital Dissertations Database. Restricted to UC campuses, 2004. http://uclibs.org/PID/11984.
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Clarke, Brandon William. "Development and Optimization of an Integrated Faraday Modulator and Compensator Design for Continuous Polarimetric Glucose Monitoring." University of Toledo / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1364578141.
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Kingsnorth, Andrew P. "Measurement of physical activity, sedentary time and continuous glucose concentrations : novel techniques for behavioural profiling." Thesis, Loughborough University, 2017. https://dspace.lboro.ac.uk/2134/25492.
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STUDY 1. INTRODUCTION. Insufficient physical activity is a major risk factor for developing type 2 diabetes. Using isotemporal substitution models, the influence of replacing modest durations of sedentary time with physical activity on diabetes risk scores can be studied. The aims of this study were to examine the relationship between diabetes risk scores, sedentary time and physical activity measured using wrist worn accelerometry, and to model the changes in risk scores by reallocating movement behaviours from lower to a higher intensity. METHODS. Data from 251 (93 males; aged 56.7 ± 8.8) participants from a mixed ethnicity cohort from Leicestershire, UK were selected for analysis. The relationship between diabetes risk (using the Leicester Diabetes Risk Assessment Score), physical activity and sedentary time was identified using multiple linear regressions and isotemporal substitution analysis. Models were calculated for main effects and also adjusted for peak oxygen uptake (VO2) and accelerometer wear time. RESULTS. Both unadjusted and adjusted models revealed that diabetes risk was inversely related to sedentary time, and positively related to light and moderate to vigorous physical activity (MVPA) (p < 0.0005). Unadjusted, the replacement of sedentary time with 10 minutes of either light or MVPA resulted in a reduction in diabetes risk score of -0.22 and -0.54, respectively. There was an eight to nine times greater reduction in risk for the same MVPA replacement models when the least active participants were compared to the pooled analysis (3.601 unadjusted). CONCLUSION. Diabetes risk is associated with sedentary time and physical activity estimated from wrist worn accelerometry. The replacement of sedentary time with MVPA is most beneficial for the least active individuals. STUDY 2. INTRODUCTION. Most associations between physical behaviours and health are assessed using intensity and duration based estimations; however, individuals accrue physical activity in differing ways and behavioural profiles have been linked with varying cardiometabolic risk factors. The frequency or regularity of behaviour may hold additional relationships with health, but have not been extensively explored. Accelerometers provide researchers with a large stream of raw data to analyse. The aim of this paper was to calculate a novel method of behavioural regularity called sample entropy from wrist worn accelerometry and to ascertain whether there are associations with cardiometabolic risk factors in adults. METHODS. Data from 290 (107 males; aged 57.0 ± 8.8) participants from a mixed ethnicity cohort from Leicestershire, UK were selected for analysis. Entropy scores were calculated using 60-second count data within MATLAB. The relationship between entropy scores, physical activity, sedentary time and cardiometabolic risk factors was identified using multiple linear regressions. Models were calculated for main effects and also adjusted for age, sex, accelerometer wear time and body mass index (BMI). RESULTS. Sample entropy scores were significantly related to high-density lipoprotein (HDL) cholesterol (b = 0.148, p = 0.042), triglycerides (b = -0.293, p = 0.042) and glycated haemoglobin (HbA1c) (b = -0.225, p = 0.006), even after adjustment for confounding variables. Traditional intensity estimates of physical activity were not associated; however, the frequency of breaks in sedentary time were significantly related to entropy scores (b = 0.004, p = 0.002). CONCLUSION. Using a novel measure of signal complexity, associations have been revealed with cardiometabolic risk factors; however further analysis in a larger, more diverse dataset is required to ascertain the utility of this technique within behavioural research and if so, what constitutes typical/average levels of entropy within a population. STUDY 3. INTRODUCTION. Acute physiological changes such as reductions in postprandial glucose excursions have been demonstrated within experimental studies that have compared being physically active to sedentary conditions. However, for this information to be truly useful, the coupling of behaviour and glucose data in a free-living environment needs to be achieved. The aim of the study was to ascertain if there is a relationship between objectively measured physical activity, sedentary time and glucose variability using glucose monitoring in an adult population. METHODS. Data from 29 participants recruited from a mixed gender sample from Leicestershire, UK were selected for analysis. Physical activity, sedentary time and interstitial glucose was measured continuously over 14 days using an accelerometer and the Freestyle Libre flash glucose monitor. Daily time (minutes) spent sedentary, and in light activity and moderate to vigorous physical activity (MVPA) were regressed against glycaemic variability indices including daily mean (average) glucose, standard deviation and mean amplitude of glycaemic excursions (MAGE). Generalised Estimating Equations were calculated between behaviour and glycaemic variability variables. Models were calculated for main effects and also adjusted for age, gender and accelerometer wear time. RESULTS. Physical activity and sedentary time were associated with measures of glucose variability, however low fitness individuals showed a stronger relationship between MVPA and MAGE (MAGE: whole sample b = -0.002, low fitness b = -0.012. Additionally, after adjustment for covariates, sedentary time was positively associated with a higher daily mean glucose (b = 0.001, p = 0.001) and MAGE (b = 0.002, p < 0.0005) for the low fitness group. MVPA was negatively associated with mean glucose (b = -0.004, p < 0.0005) and MAGE (b = -0.012, p < 0.0005); however, standard deviation of glucose was not associated with behaviour of any intensity. The magnitudes of the relationships were small, although participants were non-diabetics and exhibited relatively good glucose control i.e. minimal fluctuations in daily glucose variability. CONCLUSION. This study shows that sedentary time, physical activity and glucose variability are related. Despite supporting the previous laboratory research, it is uncertain whether any changes in glucose will reliably occur in all individuals. MVPA confers the largest reductions in glucose variability indices, yet as one of the few studies to couple behaviour and glucose data, more research is needed on larger and more diverse samples.
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Isensee, Katharina [Verfasser], and Wolfgang [Akademischer Betreuer] Petrich. "Towards a quantum cascade laser-based implant for the continuous monitoring of glucose / Katharina Isensee ; Betreuer: Wolfgang Petrich." Heidelberg : Universitätsbibliothek Heidelberg, 2018. http://d-nb.info/1177045028/34.
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Isensee, Katharina Verfasser], and Wolfgang [Akademischer Betreuer] [Petrich. "Towards a quantum cascade laser-based implant for the continuous monitoring of glucose / Katharina Isensee ; Betreuer: Wolfgang Petrich." Heidelberg : Universitätsbibliothek Heidelberg, 2018. http://d-nb.info/1177045028/34.
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Yardley, Jane E. "The Acute Effects of Aerobic and Resistance Exercise on Blood Glucose Levels in Type 1 Diabetes." Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/20031.
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Aerobic exercise interventions involving individuals with type 1 diabetes have had little positive effect on blood glucose control as reflected by hemoglobin A1c. The few existing interventions involving resistance exercise, either alone or combined with aerobic exercise, while small in sample size, have had better outcomes. The purpose of this research program was to examine the changes in blood glucose levels during activity and for 24 hours post-exercise (as measured by continuous glucose monitoring) when resistance exercise is performed, either on its own or combined with aerobic exercise, as compared to aerobic exercise alone or no exercise. Twelve physically active individuals with type 1 diabetes performed 5 separate exercise sessions in random order separated by at least five days: 1) no exercise/control; 2) aerobic exercise (45 minutes of treadmill running at 60% VO2peak); 3) resistance exercise (45 minutes of weight lifting – 3 sets of 8 repetitions of 7 different exercises); 4) aerobic then resistance exercise (2 and 3 combined with the aerobic exercise first); 5) resistance then aerobic exercise (2 and 3 combined with the resistance exercise first). We found that resistance exercise was associated with a lower risk of hypoglycemia during exercise, less carbohydrate intake during exercise, less post-exercise hyperglycemia and more frequent (but less severe) nocturnal hypoglycemia than aerobic exercise. When aerobic and resistance exercise were combined, performing resistance exercise prior to aerobic exercise (rather than the reverse) resulted in attenuated declines in blood glucose during aerobic exercise, accompanied by a lower need for carbohydrate supplementation during exercise and a trend towards milder post-exercise nocturnal hypoglycemia.
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Tric, Mircea [Verfasser], and Stefan [Akademischer Betreuer] Wölfl. "Optical in-line biosensor for long-term continuous glucose monitoring and control in cell culture / Mircea Tric ; Betreuer: Stefan Wölfl." Heidelberg : Universitätsbibliothek Heidelberg, 2017. http://d-nb.info/1177689065/34.
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Kumareswaran, Kavita. "Closed-loop insulin delivery in adults with type 1 diabetes." Thesis, University of Cambridge, 2012. https://www.repository.cam.ac.uk/handle/1810/243942.
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Achieving tight glucose control safely in type 1 diabetes with currently available methods of insulin delivery is challenging. Aggressive regimens carry an increased risk of hypoglycaemia, particularly overnight. Both alcohol consumption and exercise predispose further to low glucose levels. The demands are even greater in pregnancy where, in addition to limiting hypoglycaemia, avoidance of postprandial hyperglycaemia is critical to minimising adverse obstetric outcomes. The aim of my studies was to evaluate feasibility and safety of a closed-loop or ’artificial pancreas’ system linking insulin delivery with continuous glucose monitoring (CGM), in adults with type 1 diabetes in a controlled setting. Three randomised crossover studies compared closed-loop insulin delivery with conventional insulin pump therapy on two separate occasions, matched in meals and activities. During closed-loop visits, CGM values were entered into a computer containing a model predictive control algorithm which advised on basal insulin infusion for subcutaneous delivery, every 15 minutes. During control visits, usual insulin pump regimen was continued. The feasibility study evaluated overnight closed-loop in 12 adults (seven females, mean age 37.7 years, HbA1c 7.8%) following 60g- carbohydrate evening meal. A follow-up study assessed overnight closed-loop in 12 further adults (seven females, mean age 37.2 years, HbA1c 7.8%) following 100g-carbohydrate meal and (mean 564 ml) white wine. The third study evaluated 24 hours of closed-loop in 12 pregnant women (mean age 32.9 years, 19 to 23 weeks gestation, HbA1c 6.4%) during normal daily activities, including low and moderate intensity exercise. Activity and glucose levels were also measured during free-living. CGM performance during exercise was evaluated. Overnight closed-loop insulin delivery in adults, compared with conventional pump therapy, increased time spent with plasma glucose in target range (3.9−8.0 mmol/l) following both standard meal (81% versus 57%; p = 0.012) and large meal accompanied by alcohol (70% versus 46%; p = 0.012). Glycaemic variability, and time spent in hypo- and hyper- glycaemia were lowered. In pregnant women, day and night closed-loop insulin delivery was as effective as usual pump regimen (81% versus 81% time spent with plasma glucose 3.5−7.8 mmol/l; p = 0.754). Hypoglycaemia occurred following exercise, although closed-loop prevented nocturnal episodes. Glycaemic control during free-living was suboptimal, compared with controlled diet and exercise conditions. Accuracy of CGM was lower during exercise. In conclusion, these studies confirm the feasibility and efficacy of overnight closed-loop insulin delivery in adults with type 1 diabetes. Closed-loop is safe during pregnancy and may be beneficial in women with suboptimal glycaemic control. Meals and physical activity currently limit optimal daytime use of closed-loop.
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Li, Yanhan. "Optimizing User Experience in Insulin Pump Therapy by Applying The Attributes of Fitness and Wellness Monitoring Systems." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1439310062.
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Helminen, O. (Olli). "Glucose metabolism in preclinical type 1 diabetes." Doctoral thesis, Oulun yliopisto, 2016. http://urn.fi/urn:isbn:9789526213255.
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Abstract Type 1 diabetes is considered to be a T cell-mediated autoimmune disease characterized by destruction of the pancreatic beta cells. Its prediction is currently based on diabetes-associated autoantibodies, giving a cumulative risk of 84% during 15 years of follow-up since seroconversion. Prediction of the timing of clinical onset has remained challenging, however. This thesis examines glucose metabolism in autoantibody-positive children with a high risk of developing type 1 diabetes. Out of a total of 14,876 children with an increased genetic risk followed up from birth in the Finnish DIPP study, 567 developed ≥2 autoantibodies during the follow-up and 255 of these (45%) were diagnosed with type 1 diabetes until the end of December 2011. The glucose parameters measured were HbA1c, OGTT and random plasma glucose with 3 to 12 months interval. Seven-day continuous glucose monitoring (CGM) was performed on an age and sex-matched cohort. We showed that rising HbA1c, impaired glucose tolerance in OGTT, random plasma glucose values of ≥7.8mmol/l and potentially CGM can predict type 1 diabetes with a median time to diagnosis of approximately one year. Our results suggest that especially HbA1c and random plasma glucose are cost-effective and improve the prediction of diabetes. These markers may be useful for monitoring the response to treatment in prevention studiesTiivistelmä Tyypin 1 diabetesta pidetään T-soluvälitteisenä autoimmuunitautina, joka johtaa haiman beetasolujen tuhoutumiseen. Tyypin 1 diabeteksen ennustaminen perustuu tällä hetkellä diabetekseen assosioituviin vasta-aineisiin, jotka antavat 84% kumulatiivisen riskin 15 vuoden seurannassa. Taudin puhkeamisen ajankohdan ennustaminen on kuitenkin edelleen vaikeaa. Tämä väitöskirja käsittelee glukoosiaineenvaihduntaa vasta-ainepositiivisilla lapsilla, joilla on suurentunut riski sairastua tyypin 1 diabetekseen. Suomalaisessa DIPP-tutkimuksessa vasta-aineiden kehittymistä on seurattu yhteensä 14876 lapselta. Seurannan aikana 567 lasta kehitti ≥2 autovasta-ainetta ja näistä 255 (45%) sairastui tyypin 1 diabetekseen joulukuun loppuun 2011 mennessä. Glukoosiaineenvaihduntaa seurattiin tutkimalla HbA1c, OGTT ja satunnaisia verensokeriarvoja 3-12 kuukauden välein. Ikä ja sukupuolivakioidussa kohortissa tehtiin jatkuvan sokeripitoisuuden seuranta (CGM). Tutkimuksessamme nouseva HbA1c, heikentynyt sokerin sieto OGTT-kokeessa, satunnainen verensokeri ≥7.8 mmol/l ja mahdollisesti CGM ennustavat tyypin 1 diabeteksen puhkeamista. Tulostemme perusteella erityisesti kustannustehokkaat HbA1c ja satunnainen verensokeri parantavat diabeteksen ennustamista. Nämä parametrit saattavat olla hyödyllisiä myös preventiotutkimuksissa hoitovasteen seurannassa
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Meisenhelder-Smith, Jodee. "The effects of American Diabetes Association (ADA) diabetes self-management education and continuous glucose monitoring on diabetes health beliefs, behaviors and metabolic control." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001837.
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Bilbao, Gassó Laura. "Evaluación de la utilidad de la monitorización contínua de glucosa para el estudio del metabolismo hidrocarbonado en pacientes afectos de fibrosis quística." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/458688.
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INTRODUCCIÓN. En pacientes con fibrosis quística (FQ) la instauración de la diabetes (DRFQ) es lenta y progresiva, con un amplio espectro de alteraciones del metabolismo hidrocarbonado. La aparición de la DRFQ se relaciona con un empeoramiento de la función pulmonar y del estado nutricional. Actualmente, el test de tolerancia oral a la glucosa (TTOG) es el método de cribado aceptado para el diagnóstico alteraciones del metabolismo hidrocarbonado (MHC) en pacientes con FQ, aunque varios estudios demuestran que no siempre es suficientemente sensible y específico. La monitorización continua de glucosa (MCG) permite valorar el perfil de glucosa continuo y de una manera "real" en las condiciones/situaciones cotidianas del paciente. Actualmente hay muchos estudios que demuestran que la MCG es un método válido en pacientes con FQ, y se encuentran alteraciones en la MCG previas al diagnóstico de diabetes por el valor de TTOG a los 120 minutos, que se relacionan con alteraciones clínicas.
OBJETIVOS. 1. Describir el perfil glucémico mediante MCG y compararlo con los resultados del TTOG. 2. Analizar posibles criterios de clasificación del MHC de los pacientes FQ según los resultados de MCG (mediante curva ROC) y evaluarlos según la evolución de la función pulmonar y estado nutricional durante el año previo.3. Estudiar la función de la célula beta pancreática en los pacientes FQ.
PACIENTES Y MÉTODOS. Estudio prospectivo de pacientes afectos de FQ >10 años, confirmados genéticamente y controlados en nuestro centro (Noviembre 2012-Mayo 2015), sometidos a MCG y TTOG. Excluidos los pacientes con exacerbaciones, tratados con esteroides, GH, inmunosupresores o insulinizados.
El TTOG clasifica a los pacientes en tolerancia normal (NGT), alterada (AGT) o diabetes (DRFQ).
Tras el TTOG se realiza la MCG (IproTM2) durante 6 días, con ejercicio y dieta habituales. Se analizan 1) Porcentaje del tiempo de monitorización >140mg/dl. 2) Porcentaje de determinaciones de glucosa en ayunas entre 100-126mg/dl. 3) Número de excursiones de glucosa >200mg/dl.
Se define como glucosa basal en MCG la media de las determinaciones de glucosa entre 6.30 a 7.00am. (previo interrogatorio de los horarios de comidas, siempre antes del desayuno), y como postprandial el resto de glucosa.
Se evalúan los cambios en IMC y VEF1 durante el año previo al estudio (DE IMC y ∆% VEF1, actual-1año previo).
Se elaboran diferentes criterios y se establecen los puntos de corte óptimos (curva ROC) para clasificar el MHC de los pacientes FQ en NGT, AGT o DFRQ mediante MCG. Análisis estadístico mediante programa STATA.
RESULTADOS Treinta pacientes. Edad media: 14,6 ± 2,6 años, 53,3% mujeres. Todos HbA1C<6,5%. Ninguno prepuberal. Genética: 36,7% homocigotos para F508Del, 40% heterocigotos para F508Del y 23,3% otras mutaciones. Resultados TTOG: 47%(n=14) NGT, 47% AGT y 6% DRFQ. Resultados MCG: Valores de hiperglucemia en prácticamente todos los pacientes con un inicio temprano. Comparación resultados TTOG con MCG : 21% pacientes con TTOG normal presentaban picos glucosa>200mg/dl en MCG (66% ≥2picos en días diferentes). 21% de pacientes AGT en TTOG presentaban glucemias>126mg/dl en ayunas en MCG. Evaluación de cambios en IMC y VEF1: Los pacientes con un perfil alterado en la MCG presentaban anormalidades clínicas durante el año previo: ROC AUC 0.75 en pacientes con pérdida de IMC vs 0.66 en pacientes con incremento IMC y ROC AUC 0.66 en pacientes con empeoramiento de la VEF1 vs 0.62 en pacientes con igual o mejor VEF1.
CONCLUSIONES La MCG es una herramienta útil para detectar las alteraciones del metabolismo hidrocarbonados en pacientes FQ permitiendo el diagnóstico de anormalidades sutiles y precoces, no detectadas con el TTOG, que se relacionan con alteraciones clínicas.INTRODUCTION. Cystic fibrosis (CF) patients undergo a slow and progressive process towards diabetes. Ranging from normal glucose tolerance to cystic fibrosis-related diabetes (CFRD), a broad spectrum exists in carbohydrate metabolism alterations. Decreased insulin secretion contributes to weight loss and lung function deterioration, even before CFRD is diagnosed. CFRD is usually diagnosed by the oral glucose tolerance test (OGTT), however several studies showed OGTT to have low sensitivity and specificity. Continuous glucose monitoring (CGM) provides glucose profiles under real-life conditions and has proved to be a useful clinical tool for evaluating changes in these profiles in CF patients even before CFRD is diagnosed by the OGTT, which are related to clinical alterations. We aimed to compare OGTT and GCM results, identify criteria for the classification of CF patients according to their glucose metabolism status by CGM and evaluate lung function and nutritional status changes during the year prior to evaluation. We also study the function of the pancreatic beta cell in CF patients. METHODS. A prospective study of genetically-confirmed CF age over 10 children, controlled at our Center was conducted between November 2012 and May 2015. Patients with respiratory exacerbations, those treated with steroids and/or growth hormone, and those receiving insulin therapy or who had a lung transplant were excluded. According to the OGTT results, patients were classified as having normal glucose tolerance (NGT), abnormal glucose tolerance (AGT) or CFRD. After the OGTT was completed, CGM was performed using the Medtronic-iProTM2 system and remained there for the six outpatient-real-life-day period. We recorded for each CGM profile: 1) Percentage of monitoring time over 140mg/dL, 2) Proportion of fasting glucose measurements (expressed as %) between 100 and 126 mg/dl over the 6 days 3) Number of glucose peaks over 200 mg/dL . Fasting glucose (FG) was evaluated after an 8-hour fast by calculating the mean of values obtained daily between 6.30 a.m. and 7.00 a.m. over the monitoring period. Evaluation of changes in BMI and FEV1 during the year prior to the study (DS BMI and Δ% FEV1, current-1 previous year). ROC curve comparing OGTT and CGM was used to seek for the optimal glycemic cut-offs to classify patients by CGM in three groups: NGT, AGT and CFRD. Statistical analysis was performed using Stata version13. RESULTS. Thirty CF children were included. Mean age: 14.6 ± 2.6 years, 53.3% female; Glycated haemoglobin values (HbA1C) were in normal range (<6,5%) in all patients. None prepuberal. Genotypes were: homozygous F508Del (36.7%), heterozygous F508Del (40%) and other mutations (23.3%). According to OGTT results: fourteen patients (47%) had normal glucose tolerance (NGT), fourteen (47%) abnormal glucose tolerance (AGT) and two (6%) CFRD. According to CGM results, values of hyperglycemia were detected in practically all patients with an early onset. CGM revealed high glucose peaks over 200mg/dl in 21% of CF patients with normal glucose tolerance by OGTT; of these, 66% had ≥ 2peaks on different days; 21% of AGT patients on OGTT presented FBG >126mg/dl during monitoring. CGM evaluation depending on variation in BMI and FEV1 show that early glucose abnormalities detected by CGM also appear to be associated with clinical abnormalities in the preceding year: ROC AUC 0.75 in patients with decreased BMI vs 0.64 in patients with increased BMI, ROC AUC 0.66 in patients with decreased FEV1 vs 0.62 in patients with increased FEV1. CONCLUSIONS. CGM may be a useful clinical tool for evaluating glucose profiles in CF patients, allowing the diagnosis of subtle and early glucose abnormalities not detected by the OGTT. The early detection of abnormal glucose values could help to optimise the management of these patients before over diabetes becomes established.
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Faulds, Eileen. "Self-Management Among Pre-teen and Adolescent Insulin Pump Users (SPIN)." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1587390858875183.
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Wohlfarth, Kathrin. "Einfluss der Ernährung auf das Blutzuckertagesprofil von gesunden Schwangeren, Schwangeren mit einer Impaired glucose tolerance und Gestationsdiabetikerinnen." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2005. http://dx.doi.org/10.18452/15179.
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Ziel: In der vorliegenden Studie wurden kontinuierliche Blutzuckertagesprofile über 48 h bei Schwangeren unterschiedlicher Glukosetoleranz erhoben und mit der Ernährung zu häuslichen Bedingungen verglichen. Ergebnisse: Bei den Gestationsdiabetikerinnen wurden statistisch signifikant länger Konzentrationen über 130 mg/dl gemessen als bei den gesunden Schwangeren. Keine Unterschiede ergaben sich in Bezug auf folgende Werte: Mittelwert, Zeitdauern mit Blutzuckerwerten < 50 mg/dl, >120 mg/dl, >140 mg/dl, >150 mg/dl. Periprandial wurden bei den Gestationsdiabetikerinnen und den Schwangeren mit IGT signifikant höhere Maximalwerte im Anschluss an die Mahlzeit gemessen, als bei gesunden Schwangeren. Keine Unterschiede ergaben sich hinsichtlich der Anfangswerte und der Area under the curve. In einigen Gruppen bestanden positive Korrelationen zwischen der Zufuhr von Disacchariden und Parametern der Glukosemessung, in der Gruppe der Gestationsdiabetikerinnen bestand eine signifikante negative Korrelation zwischen dem Stärkekonsum und dem Mittelwert der Glukosemessung. Nach Mahlzeiten, deren Hauptkohlenhydratquelle mit einem höheren glykämischen Index nach Jenkins attribuiert war, fiel die Glukosereaktion größer aus, als bei Mahlzeiten mit niedrigem glykämischem Index. Zusammenfassung: In dieser prospektiven Studie konnte mit Hilfe der Technik der kontinuierlichen Glukosemessung die Verbindung zwischen Blutzuckertagesprofil und Ernährungsgewohnheiten zu häuslichen- also nicht klinisch- artifiziellen- Bedingungen hergestellt werden.Objective: In the present study continuous glucose profiles in pregnant women with various levels of glucose tolerance were evaluated and compared with their diet in domestic conditions. Results: In women with GDM significantly longer periods with glucose levels above 130 mg/dl were measured than in healthy women. No differences were assessed as to average glucose levels and periods with glucose levels < 50 mg/dl, >120 mg/dl, >140 mg/dl, >150 mg/dl. In pregnant women with gestational diabetes or impaired glucose tolerance higher maximum glucose levels after a meal were found than in healthy women. No differences were found as to glucose levels at the beginning of the meal and area under the curve. In some groups positive correlations were calculated between intake of disaccharides and the glucose measurement, in gestational diabetic women a negative correlation between intake of starch and the average of the glucose level was found. After meals in which the main carbohydrate source was attributed with a high glycemic index change of the glucose level was higher than after meals with a low glycemic index. Conclusion: In the present prospective study we established the relation between glucose profiles measured by the method of continuous glucose monitoring and dietary habits in domestic conditions in pregnant women.
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Tauschmann, Martin. "The artificial pancreas in children and adolescents with type 1 diabetes : bringing closed-loop home." Thesis, University of Cambridge, 2019. https://www.repository.cam.ac.uk/handle/1810/288663.
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Type 1 diabetes is one of the most common chronic conditions in childhood and adolescence. Despite ongoing development of more physiological insulin preparations, recent advancements in insulin pump technology and more accurate blood glucose monitoring, in clinical practice it remains challenging to achieve normoglycaemia whilst reducing the risk of hypoglycaemia, particularly in young people with type 1 diabetes. Closed-loop insulin delivery (the artificial pancreas) is an emerging technology gradually progressing from bench to clinical practice. Closed-loop systems combine glucose sensing with computer-based algorithm informed insulin delivery to provide real-time glucose-responsive insulin administration. The key objective of my thesis is to evaluate the safety, efficacy and utility of closed-loop insulin delivery in children and adolescents with type 1 diabetes outside of the research facility setting. Results of five clinical trials are presented in the main chapters of this thesis. In a mechanistic study, the impact of glucose sensor operation duration on efficacy of overnight closed-loop was investigated comparing closed-loop performance on day 1 of sensor insertion to day 3 to 4 of sensor. Twelve adolescents with type 1 diabetes attended the research facility for two overnight visits. The sequence of the interventions was random. Despite differences in sensor accuracy, overnight CL glucose control informed by sensor glucose on day 1 or day 3-4 after sensor insertion was comparable. The model predictive controller appears to mitigate against sensor inaccuracies. In home settings, overnight closed-loop application was evaluated over three months in 25 children and adolescents with type 1 diabetes aged six to 18 years. The study was conducted at three centres in the UK and adopted a randomised cross-over design. Compared to sensor-augmented pump therapy, overnight home use of closed-loop increased the proportion of time sensor glucose was in target, and reduced mean glucose and hypoglycaemia. Two randomised crossover studies evaluated the safety and efficacy of day-and-night hybrid closed-loop insulin delivery in young people with type 1 diabetes aged 10 to 18 years over seven days, and 21 days, respectively. A total of 24 subjects were enrolled in this single centre trial. Free-living home use of day-and-night closed-loop in suboptimally controlled adolescents with type 1 diabetes was safe, and improved glucose control without increasing the risk of hypoglycaemia. Finally, closed-loop technology was assessed in five very young children (aged one to seven years) with type 1 diabetes in a two-period, crossover study. Closed-loop was used during both 3-week intervention periods, either with standard strength insulin (U100), or with diluted insulin (U20). The order of intervention was random. Free-living home use of day-and-night hybrid closed-loop in very young children with type 1 diabetes was feasible and safe. Glucose control was comparable during both intervention periods. Thus, use of diluted insulin during closed-loop insulin delivery might not be of additional benefit in this population. In conclusion, studies conducted as part of my thesis demonstrate that use of hybrid closed-loop insulin delivery systems in children and adolescents aged one to 18 years in free daily living without remote monitoring or supervision is feasible, safe and effective. My work supports the progression of this technology from research to mainstream clinical practice.
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Isberg, Anna. "Sensorstyrd pumpterapi : En studie om effekt på glykerat hemoglobin vid Diabetes Mellitus typ 1." Thesis, Umeå universitet, Farmakologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-119710.
Full textAbstract:
Introduktion Diabetes Mellitus typ 1 är en autoimmun sjukdom som så småningom leder till total insulinbrist vilket är livshotande. Insulinbristsjukdomen är kronisk och är i Sverige en av de vanligaste folksjukdomarna. I världen insjuknar i dagsläget flest antal i Sverige och Finland. Vad gäller behandling vid Diabetes Mellitus typ 1 får alla patienter i dagsläget insulininjektioner antingen via insulinpenna eller via insulinpump. Glukosnivån i blodet bör mätas kontinuerligt för att kunna optimera behandlingsterapin. En annan typ av behandlingsterapi vid Diabetes Mellitus typ 1 är SAP (Sensor- augmented pump). Denna metod innebär att insulinpumpsbehandling kombineras med kontinuerlig glukosmätning (continuous glucose monitoring, CGM).Att mäta glykerat hemoglobin (HbA1c) har blivit en viktig del för att följa samt utvärdera hur behandlingen av Diabetes Mellitus fungerar. Ett lågt HbA1c ger en minskad risk för komplikationer och är ett tydligt mål i behandlingen samtidigt som risken för hypoglykemi måste tas i anspråk. Syfte Syftet med denna litteraturstudie är att undersöka om HbA1c-värden kan förbättras hos patienter med Diabetes Mellitus typ 1 vid användning av SAP-behandlingsterapi jämfört med CSII-behandlingsterapi (continuous subcutaneous insulin infusion) kombinerat med SMBG (self monitoring of blood glucose) och MDI-behandlingsterapi (multiple daily injections) kombinerat med SMBG. Syftet är även att undersöka om det finns något samband mellan användningsfrekvens av CGM-sensorer och förbättrat HbA1c-värde. Metod Denna litteraturstudie baseras på åtta stycken artiklar som hittades via databasen PubMed. Resultat och diskussion Resultatet, av de utvalda originalstudierna, visar att SAP-behandlingsterapi har en bättre effekt på optimering av HbA1c-värden, hos patienter med Diabetes Mellitus typ 1, om det jämförs med MDI-behandlingsterapi kombinerat med SMBG. Om förbättringen beror på SAP-terapibehandlingen eller om CSII och CGM separat hade gett effekten är svårt att avgöra. Däremot ses ingen signifikant skillnad, i resultatet i de originalstudier som valts ut, av denna effekt vid jämförelse av SAP-behandlingsterapi mot CSII kombinerat med SMBG. Ytterligare studier med ett större antal deltagare behövs som underlag för att kunna avläsa detta. Vad gäller relationen mellan frekvens av CGM-sensoranvändning och förändring i HbA1c-värden finns både studier som stödjer och studier som förkastar. Vid ett eventuellt byte av behandlingsterapi bör hänsyn tas till andra aspekter än surrogatmåttet HbA1c. Slutsats Resultatet av denna litteraturstudie visar att SAP-behandlingsterapi i vissa fall kan reducera HbA1c-värden i jämförelse med andra metoder. En del resultat stödjer även sambandet mellan ökad användningsfrekvens av CGM-sensorer och reducering av HbA1c-värden. Det måste tas hänsyn till andra parametrar vid eventuellt byte av behandlingsterapi. Det är av stor vikt att patienterna känner sig tillfreds med sin behandlingsterapi då det kan bibehålla motivationen till att optimera sina HbA1c-värden.
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Engel, Barbara. "Einfluss der Kohlenhydratzufuhr auf den Kohlenhydratstoffwechsel Schwangerer mit und ohne Gestationsdiabetes, gemessen mit dem kontinuierlich messenden Glukosesensor (CGMS ®, Fa. MedtronicMinimed ®)." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2006. http://dx.doi.org/10.18452/15459.
Full textAbstract:
Der Gestationsdiabetes betrifft etwa 5 von 100 Schwangeren. In unserer prospektiven, randomisierten Studie mit Crossover-Design untersuchten wir den Einfluß der Kohlenhydrataufnahme auf den Glukosestoffwechsel Schwangerer. 18 Gestationsdiabetikerinnen, 9 Frauen mit eingeschränkter Glukosetoleranz und 25 Kontrollen haben jeweils eine Woche eine kohlenhydratarme (35 Energieprozent) und eine kohlenhydratreiche (55 Energieprozent) Diät durchgeführt. Auswirkungen wurden anhand des konventionellen BZTPs und des kontinuierlich messenden Glukosesensors CGMS® untersucht. Die KH-Aufnahme wurde mittels einer Ernährungsberatung deutlich beeinflußt, und lag bei 39 % in der KH-reduzierten, und bei 49 % in der KH-reichen Woche. Nach DDG-Kriterien hatte der KH-Anteil bei keiner Gruppe einen signifikanten Einfluß bezüglich der Insulinpflicht. Dagegen waren der BZTP-Mittelwert und die AUC (area under the curve des CGMS®) der GDMs und der Kontrollen signifikant niedriger in der KH-armen Woche. In dieser Woche nahmen die Probandinnen auch eine niedrigere Energiemenge zu sich. Bei einer selektierten Untergruppe konnten wir diesen Einfluß ausgrenzen, und für die Kontrollgruppe eine signifikante Erniedrigung bezüglich der BZTP-Mediane und der AUCs nachweisen. Diese Beobachtungen belegen, daß ein höherer Kohlenhydratanteil mit erhöhten Blutzuckerwerten assoziiert ist. Außerdem wurde ein größerer Einfluß einer kohlenhydratarmen Ernährung auf die postprandialen als auf die Nüchternwerte festgestellt. Wegen der Auswirkungen auf das fetale Wachstum soll man bei Gestationsdiabetikerinnen eine kohlenhydratarme Ernährung empfehlen.Gestational diabetes affects about 5 % of pregnancies. In our randomized prospective study with crossover design we examined the influence of carbohydrate intake on the glucose metabolism of pregnant women. 18 women with gestational diabetes, 9 with impaired glucose tolerance and 25 controls were put on a low (35 energy %) carbohydrate diet for one week and a high (55 energy %) carbohydrate diet for another. Blood glucose levels were recorded by self-monitoring and with a continuous glucose monitoring sensor (CGMS ®). Carbohydrate intake was strongly influenced by dietary advice, amounting to 39% into the low carbohydrate and 49% in the high carbohydrate week. According to DDG criteria, carbohydrate intake had no significant influence on insulin requirements. In contrast, mean blood glucose levels and the AUC (area under of the curve of the CGMS ®) were significantly lower for both gestational diabetics and controls in the low carbohydrate week. During this week, the average caloric intake was also reduced. We could exclude this influence for a selected subgroup, in which the controls displayed a significant reduction in median glucose levels and the AUCs. We could thus show that a higher carbohydrate content is associated with raised blood glucose levels. Furthermore, the influence of a low carbohydrate diet was greater on postprandial than on fasting levels. Because of the effects on fetal growth, one should recommend a low carbohydrate diet for gestational diabetics.
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Bühling, Kai Joachim. "Screening, Diagnostik und Therapie des Gestationsdiabetes." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2004. http://dx.doi.org/10.18452/13948.
Full textAbstract:
Der Gestationsdiabetes ist eine der häufigsten Erkrankungen in der Schwangerschaft. Obwohl der Zusammenhang zwischen den Blutzuckerwerten und der Morbidität der Schwangeren und des Kindes hinreichend belegt ist, gibt es bemerkenswert viele klinisch relevante Fragen, die bisher nur unzureichend untersucht wurden. Die vorliegende Arbeit beschäftigt sich mit einigen Fragestellungen aus diesem Themenbereich, unter Einbeziehung einer neuen Methode der Glukosemessung, der kontinuierlichen Glukosemessung. In Deutschland wird in der Schwangerschaft lediglich ein Urin-Stix als Screening-Methode auf Gestationsdiabetes durchgeführt. Die wenigen Publikationen, die sich mit der Sensitivität des Urin-Stix zur Detektion des Gestationsdiabetes beschäftigen, zeigen eine nur geringe Sensitivität. Die in unserem Hause durchgeführte Untersuchung an 1001 Schwangeren bestätigt die bisherigen Ergebnisse an einer großen Fallzahl und weist zudem noch eine deutliche Abhängigkeit der Glukosurie-Rate von den diastolischen Blutdruckwerten nach. Eine weitere Untersuchung wurde zu dem 50-g-Glukose-Screeningtests durchgeführt, den wir seit 1993 routinemäßig bei allen Schwangeren durchführen, die sich in unserer Klinik vorstellen. Mit einer Sensitivität und Spezifität von ca. 90% - bezogen auf den oralen Glukosetoleranztest - zeigte dieser Test ein gutes Ergebnis, allerdings fanden wir heraus, dass die Rate positiver Ergebnisse von dem Zeitpunkt der vorangegangenen Mahlzeit abhängig ist und zwischen 11%-40% liegt. Bisher konnte kein Nachweis erbracht werden, dass die einem oralen Glukosetoleranztest (oGTT) vorangehende Kohlenhydratzufuhr bei Schwangeren einen Einfluss auf die Ergebnisse hat, wie es die Empfehlungen der Fachgesellschaften vermuten. In der von uns durchgeführten Studie, bei der wir - im Gegensatz zu den anderen Studien - detallierte Ernährungsprotokolle verwendeten, konnte diese Vermutung bestätigt werden. Aufgrund erhöhter Konzentrationen an Gestagen, Östrogenen und dem humanen Plazentalaktogen wurde häufig vermutet, dass Schwangere mit Gemini eher einen Gestationsdiabetes haben müssten. Wir konnten dies in einer Matched-Pair-Studie widerlegen. Die kontinuierliche Glukosemessung erlaubte neue Einblicke in die Physiologie und Pathophysiologie der Schwangerschaft. Nachdem wir zunächst ein Auswertungsverfahren etabliert hatten, wurden Schwangere mit und ohne Glukosetoleranzstörung mit Hilfe des kontinuierlichen Glukosemonitors der Fa. MedtronicMinimed (CGMS) untersucht. Es zeigte sich, dass das CGMS eine deutlich bessere Differenzierung zwischen den Gesunden und den Schwangeren mit eingeschränkter Glukosetoleranz ermöglichte, dies im Gegensatz zum konventionellen Blutzuckertagesprofil. In einer weiteren Auswertung untersuchten wir den Zusammenhang zwischen der mütterlichen sowie der neonatalen Morbidität und den einzelnen postprandialen Messzeitpunkten. Es zeigten sich signifikante Unterschiede der Glukosewerte für die Schwangerschaftsausgangsparameter Entbindungsmodus, Makrosomie und fetale Verlegungsrate im postprandialen Zeitintervall von 45-105 Minuten. Erstmalig konnten wir so die Assoziation zwischen neonatalen Morbiditäten und den postprandialen Glukosekonzentrationen zu verschiedenen Messzeitpunkten nachweisen.Gestational diabetes is the most common complication during pregnancies. Although the correlation has been clearly established between blood glucose levels and morbidity rates for both mothers and babies, there are surprisingly many clinically relevant questions that still have not been adequately addressed. The study presented here investigates some aspects of this topic, using a new method for measuring blood sugar levels, continuous glucose measurement. In Germany, the only screening method normally used to test pregnant women for gestational diabetes is a urine test strip. The few publications that deal with the sensitivity of urine test strips for detecting gestational diabetes show only minimal sensitivity. The study carried out in our clinic with a large number of test cases (1001 pregnant women) confirmed previous findings and demonstrates that the glucosuria rate directly corresponds to diastolic blood pressure values. An additional appraisal was made of the 50-gram glucose screening tests which we have routinely carried out on all pregnant women visiting our clinic since 1993. With a sensitivity and specificity of approx. 90% - as compared to the oral glucose test – this screening method yielded good results; however, we did notice that the interval since the most recent meal influences the positive outcome rate, which ranges from 11 % - 40 %. Up to the present, no one has been able to prove that eating carbohydrates before an oral glucose tolerance test (oGTT) influences the results, a belief often found in experts’ recommendations for pregnant women. However, our study, in which the pregnant women – unlike other studies – kept detailed food journals, did indeed confirm this hypothesis. Based on the higher concentrations of gestagen, estrogen and the human placenta lactogen, researchers often presume that mothers carrying twins are more likely than other expectant mothers to have gestational diabetes. Using a matched-pair-study, we refuted this idea. Continuous glucose testing allows new insights into the physiology and pathophysiology of pregnancy. After establishing an analytical procedure, we examined pregnant women both with and without glucose tolerance dysfunction using the continuous glucose monitors (CGMS) made by MedtronicMinimed. We demonstrated that the CGMS - as opposed to a conventional daily log of blood glucose values - provided markedly better differentiation between healthy women and those with impaired glucose tolerance. In a further analytical step, we studied the correlation between postprandial testing intervals and maternal and infant morbidity rates. Corresponding to the pregnancy parameters birth method, macrosomia and fetal transferral rate, significant differences were seen when glucose levels monitored 45 - 105 minutes after a meal were compared. For the first time, it was possible to demonstrate a clear correlation between postprandial glucose concentrations checked at various intervals and neonatal morbidity.
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Pinheiro, Daniele Albano. "Estudo da monitorização contínua de glicose e das respostas de pressão arterial, frequência cardíaca e de outros parâmetros fisiológicos antes e após treinamento físico em diabéticos tipo II." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/82/82131/tde-05052014-103545/.
Full textAbstract:
Há muitas alterações nos sistemas fisiológicos de indivíduos com diabetes melittus em função dos constantes momentos de hiperglicemia, principalmente alterações relacionadas ao aumento dos riscos cardiovasculares. O objetivo desse estudo foi avaliar as respostas do controle glicêmico pelo monitor contínuo de glicose e da pressão arterial (PA), frequência cardíaca (FC) e sua variabilidade expressa pelos valores de RMSSD em diabéticos tipo II submetidos a testes de avaliação antes e após a realização de treinamento aeróbio e resistido. Participaram desse estudo 9 voluntários diabéticos tipo II do sexo masculino (45 a 65 anos) divididos em 3 grupos: DTA (n=7), diabéticos submetidos a seis semanas de treinamento aeróbio; DTR (n=5), diabéticos submetidos a treinamento resistido e GDC (n=5), diabéticos sem qualquer treinamento regular. Os voluntários realizaram testes laboratoriais, ergoespirometria e teste de fadiga em leg press antes e após o treinamento físico. Os resultados foram analisados estatisticamente pelo teste t de Student e pelo teste de Kruskal Wallis. Os voluntários tiveram a cinética da concentração de glicose mensurada pelo monitor contínuo e analisada qualitativamente antes, durante e após a realização da ergoespirometria e do teste de fadiga por 60 minutos. Como resultados o grupo DTA apresentou menores valores de concentração de glicose pela monitorização contínua e o grupo DTR a melhor resposta na cinética dessa curva, apresentando expressivo decaimento na mesma. Em relação à resposta pressórica, somente a PA diastólica (PAD) foi menor estatisticamente para o grupo DTA pós treinamento aeróbio no repouso. Não houve diferenças entre os valores pré e pós treinamentos em relação à FC e os voluntários do grupo DTA apresentaram maiores valores de RMSSD em repouso e o do grupo DTR incrementos desses valores na recuperação dos testes, mostrando maior ação parassimpática no controle autonômico cardíaco dos diabéticos submetidos a treinamentos. Os indivíduos do grupo GDC apresentaram decremento nesse valor, sugerindo piora no controle autonômico cardíaco. Como conclusão geral, este estudo sugere que indivíduos diabéticos tipo II que realizaram treinamento aeróbio e resistido apresentaram benefícios complementares no controle glicêmico registrado pelo monitor contínuo em repouso e no período de recuperação de exercício, respectivamente, adaptações que parecem estar associadas à melhora da ação parassimpática/vagal no controle autonômico cardíaco e, sugere, também, ser o treinamento físico aeróbio o que permite melhor organização hemodinâmica nas respostas de PAD.There are many changes in physiological systems of people with diabetes melittus due to the constant moments of hyperglycemia, mainly related to increasing of cardiovascular risk. The aim of this study was evaluate the responses of glycemic control by continuos glucose monitoring and blood pressure (BP), heart rate (HR) and its variability expressed by the values of RMSSD in type II diabetics undergoing evaluation tests before and after performing aerobic and resistance training. Participants were 9 volunteers type II diabetic male (45-64 years) divided in 3 groups: DTA (n=7), diabetics undergoing six weeks of aerobic training; DTR (n=5), diabetics undergoing resistance training and GDC (n=5), diabetics without any regular training. The volunteers underwent laboratory tests, spirometry and fatigue tests on leg press before and after physical training. The results were statistically analyzed by Students t and Kruskal Wallis tests. The volunteers had the kinetics of glucose concentration measured by the continuos monitor and qualitatively analyzed before, during and after the spirometry and the fatigue tests for 60 minutes. As a result the DTA group had lower glucose concentration by continuos monitoring and DTR the best response in the kinetic curve, showing important decrease in it. In relation to the BP response, only diastolic BP (DBP) was statistically lower for the DTA group after aerobic training. There were no differences between pre and post training in HR and the DTA group showed higher RMSSD at rest and the DTR group showed increments of these values in the tests recovery showing higher parasympathetic action on cardiac autonomic control in diabetics patients with training. Individuals in the GDC group showed decrement this value, suggesting deterioration in cardiac autonomic control. As a general conclusion, this study suggests that type II diabetic individuals who performed aerobic and resistance training showed additional benefits in glycemic control by continuos monitor recorded at rest and during exercise recovery, respectively, adaptations that seem to be associated with improvement in parasympathetic action in cardiac autonomic control, and also suggests that aerobic exercise training has better organization hemodynamic in responses of DBP.
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Biagi, Lyvia. "Condition assessment of patients with Type 1 diabetes using compositional data analysis." Doctoral thesis, Universitat de Girona, 2019. http://hdl.handle.net/10803/667966.
Full textAbstract:
Type 1 Diabetes Mellitus (T1DM) is a chronic disease that leads to absolute insulin deficiency. People with T1DM need exogenous insulin to maintain glucose at proper levels. Achieving optimal glycemic control is a major hurdle due to the large intra-patient variability, and continuous glucose monitoring (CGM) plays an essential role for individuals with T1DM. This thesis is devoted to describe the condition assessment of patients with T1DM through the analysis of glucose data obtained from CGM. This work focuses on understanding and dissecting the CGM measures. A model of the error of a CGM sensor has been obtained and the accuracy of the CGM has been assessed during challenging conditions. Additionally, a novel approach for the categorization of daily glucose profiles based on the analysis of compositional data (CoDa) is proposed. Finally, a probabilistic model of transition between different categories of periods of glucose data obtained with CoDa analysis is presented.La diabetes mellitus tipo 1 (T1DM) es una enfermedad crónica que conduce a una deficiencia absoluta de insulina. Las personas con T1DM requieren insulina exógena para mantener los niveles de glucosa apropiados. Alcanzar un control glicémico óptimo tiene una gran dificultad debido a la variabilidad intrapaciente, y el monitoreo continuo de glucosa (CGM) desempeña un papel esencial para los individuos con T1DM. Este trabajo se enfoca en entender y diseccionar las medidas obtenidas de CGM. Se ha obtenido un modelo de error de un sensor CGM y se ha evaluado la precisión del CGM en condiciones difíciles. Además, se presenta un nuevo enfoque para la caracterización de perfiles de glucosa diarios con base en el análisis de datos composicionales (CoDa). Finalmente, se presenta un modelo de transición probabilístico entre diferentes categorías de periodos de datos de glucosa que fue obtenido usando técnicas CoDa.
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Meredith, David James. "Continuous monitoring during haemodialysis." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:4623d45d-7bc5-469a-b126-dd0945fef6e8.
Full textAbstract:
Intradialytic Hypotension (IDH) is the commonest complication of maintenance haemodialysis and is associated with increased morbidity and mortality. However, there is no standardised definition of IDH, making comparisons between studies difficult. This observational study with a total of 80 patients and over 600 dialysis sessions showed a poor correlation between symptoms and hypotension. Importantly, patients experienced low blood pressure without symptoms, so continuous intradialytic blood pressure monitoring is required to identify this asymptomatic group. In light of these findings, a revised definition of IDH is suggested. This study also aimed to identify predictors of IDH that could be detected in sufficient time to allow a mitigating intervention. A novel non-invasive alternative for continuous blood pressure monitoring is introduced which uses intra-fistula pressure data from the sensors sited in the extracorporeal circuit of the dialysis machine. Results show that in the majority of patients, changes in intra-fistula pressure correlate with blood pressure measurements obtained by a standard oscillometric device. To investigate whether IDH can be predicted, a photoplethysmogram (PPG) waveform was obtained from a pulse oximeter attached to the finger or ear. Continuous PPG monitoring of patients with IDH during dialysis demonstrated that some IDH episodes were predictable using the variation in the PPG baseline with respiration as a surrogate for low blood volume. Additionally, the area under the curve of the PPG waveform can be used as a surrogate for cardiac output and peripheral vascular tone, resulting in a reasonable predictor for potentially critical changes in blood pressure during dialysis. Individually, the novel metrics described here are limited in their identification of IDH in all patients affected, but in combination they may be used to develop a multi-parameter predictive model. The relative merits of personalised versus population-based models are explored and a conclusion is drawn that personalised multi-parameter data fusion modelling for haemodialysis patients would be an important area for future work.
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Eagles, O. D. "Non-invasive blood glucose monitoring." Thesis, Swansea University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.636758.
Full textAbstract:
This Thesis covers the investigation into the feasibility of monitoring blood glucose non-invasively. The work carried out involved the development of an in-vitro instrument through a series of four stages, each stage of development being an improvement on the previous one. Using these instruments it was shown that by using an appropriate wavelength, glucose could be detected down to 156 mg/dL repeatedly in distilled water, saline and a non-opaque blood analogue. It was also demonstrated that this wavelength could be used to detect the difference between blood samples with different glucose levels. The instruments were also used to demonstrate that a appropriate wavelength could be used as a reference wavelength. In addition to the in-vitro instrument, a basic in-vivo instrument was developed so that physiological data could be taken from either a person's ear or little finger non-invasively. It was clearly demonstrated that the instrument could detect a physiological change in a person whilst the person carried out a 75 g oral glucose to tolerance test.
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Dahnoun, Naim. "Continuous monitoring of blood flow." Thesis, University of Leicester, 1990. http://hdl.handle.net/2381/34319.
Full textAbstract:
An extensive review of the literature revealed that there are still significant weakness in the available technology for blood flow measurement. This dissertation describes two techniques for blood velocity measurement. The first is an invasive method which uses multimodal optical fibres for light transmission to and from a sensing tip, which attenuates the light depending upon the blood velocity. The design and construction of this flowmeter is presented and bench results shown. The modulated light is transmitted to the detection and processing circuit and provision is made for the transducer to be insensitive to pressure fluctuations and ambient light. The second technique, which is noninvasive, uses a continuous wave Doppler ultrasonic technique; the instrument designed is a portable directional Doppler velocimeter with purpose-built probes intended for monitoring blood flow in femorodistal bypass grafts in ambulatory patients. This portable unit differs from conventional Doppler units in many respect which are described. This unit has been developed in order to understand the behaviour of blood flow in grafts while the patients are persuing everyday tasks. A postoperative study of successful in situ vein grafts from 8 patients has been undertaken to determine the feasibility of the technique. This pilot study shows that posture can have an effect on blood flow in grafts, and also shows that it is possible to monitor blood velocity with Doppler techniques for a long period of time, without intervention of an operator.
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Kerkelä, J. (Joni). "Continuous Integration server performance monitoring." Master's thesis, University of Oulu, 2018. http://urn.fi/URN:NBN:fi:oulu-201805091678.
Full textAbstract:
Continuous Integration (CI) is standard practice in Agile software development for source code management, including handling changes between development branches and master branch, and providing feedback for stakeholders. In the Continuous Integration the desirable practice is for development branches the be merged in to master branch daily. Before development branches is to be merged to master branch, the automated test tests builds are run on them and feedback of the tests is provided to developer and possible other stakeholders. If the tests are run without errors, the development branch is to be merged to master branch. The problems may arise, when the automated test build durations have variance. This leads developers to experience volatile service level causing irregularity to development process. The cause for the build duration variance can be the variance in the available system resources in the CI server. In some cases, the resource variation can cause false failures on the test build results as for example when there is defined maximum test build duration time limiter or when individual build step operation produces timeouts. To be able to resolve the resource starvation on the CI server, there needs to be means for identifying the resource starvation events in relation to test build statistics. By being able to identify relation between build statistics and resource starvation events, root cause, as starving resource, can be identified. By identifying the starving resource or resources, the system resources can be updated by adding more specific resource or handling the starvation through reserving the specific resource for key processes. The objective for this research is to implement monitoring tool for monitoring the Jenkins server’s builds and system resources during the builds. The thesis was conducted in the case company’s CI project including large-scale development project as customer project. The problem with case company was volatile test build durations and very insufficient data about system resources in the starvation events. The implemented monitoring tool achieved for providing extensive system resource data with combining it with the test build statistics to provide information about system resource availability in relation to test build statistics. The results indicate that the monitoring tool can be used for identifying resource starvation events and possible root causes for the events. The limitation of the implemented monitoring tool is the dependency for the database server as Elasticsearch. Elasticsearch was chosen to be used as database to establish adaptive monitoring data presenting functionality via Kibana server. This restricts portability of the monitoring tool to Jenkins instances as the monitoring tool needs mentioned instances for full functionality.
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Brooks, Steven. "A glucose sensor for fermentation monitoring." Thesis, Cranfield University, 1987. http://dspace.lib.cranfield.ac.uk/handle/1826/10284.
Full textAbstract:
The
evaluation, analysis and development of an
oxygen-insensitive amperometric glucose biosensor and its
application in microbial batch culture are described. The
biosensor consisted of a graphite foil electrode modified with
glucose oxidase and 1,1'-dimethylferrocene, and operated via
mediated electron transfer from the enzyme to the electrode.
Initial evaluations illustrated several
operating
characteristics which would be
expected to cause problems in
continuous
monitoring applications, most notably sensor
instability and a progressive increase in response time. The
main
underlying causes of these unfavorable characteristics were
identified as enzyme loss, mediator loss and substrate diffusion
limitation within the electrode. As a consequence of these
insights, further development of the sensor was undertaken. A
number of different electrode materials and enzyme immobilization
techniques were tested, resulting in the development of a novel
immobilization procedure using a hexadecylamine coating to bind
'the activated carbohydrate residues of periodate-oxidized glucose
oxidase.
This improved the sensor lifetime and response time
under continuous operation.
Strategies for the reliable application of the
biosensor in fermentation
monitoring were evaluated. In-line
flow cell and
in_§itu membrane probe approaches were considered,
and the latter
approach was
preferred: Considerable attention
was devoted to
optimising the design of such probes. The best
design accommodated a three electrode configuration with a
multiple biosensor array. It was found necessary to allow for
periodic on-line calibration within the aseptically operating
probe. This configuration was successfully applied on-line to
monitor glucose in batch cultures of Escherichia coli.
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Talebi, Fard Sahba. "Glucose monitoring measuring blood glucose using vertical cavity surface emitting lasers (VCSELs)." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/1509.
Full textAbstract:
Diabetes Mellitus is a common chronic disease that is an ever-increasing public health issue. Continuous glucose monitoring has been shown to help diabetes mellitus patients stabilize their glucose levels, leading to improved patient health. Hence, a glucose sensor, capable of continuous real-time monitoring, has been a topic of research for three decades. Current methods of glucose monitoring, however, require taking blood samples several times a day, hence patient compliance is an issue. Optical methods are one of the painless and promising methods that can be used for blood glucose predictions. However, having accuracies lower than what is acceptable clinically has been a major concern. To improve on the accuracy of the predictions, the signal-to-noise ratio in the spectrum can be increased, for which the use of thermally tunable vertical cavity surface emitting lasers (VCSELs) as the light source to obtain blood absorption spectra, along with a multivariate technique (Partial Least Square (PLS) techniques) for analysis, is proposed.
VCSELs are semiconductor lasers with small dimensions and low power consumption, which makes them suitable for implants. VCSELs provide higher signal-to-noise ratio as they have high power spectral density and operate within a small spectrum. In the current research, experiments were run for the preliminary investigations to demonstrate the feasibility of the proposed technique for glucose monitoring.
This research involves preliminary investigations for developing a novel optical system for accurate measurement of glucose concentration. Experiments in aqueous glucose solutions were designed to demonstrate the feasibility of the proposed technique for glucose monitoring. In addition, multivariate techniques, such as PLS, were customized for various specific purposes of this project and its preliminary investigation. This research will lead to the development of a small, low power, implantable optical sensor for diabetes patients, which will be a major breakthrough in the area of treating diabetes patients, upon successful completion of this research and development of the device.
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Mouratidis, Kyriakos. "Continuous monitoring of multi-dimensional queries /." View abstract or full-text, 2006. http://library.ust.hk/cgi/db/thesis.pl?COMP%202006%20MOURAT.
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Matuszewski, Damian Janusz. "Computer vision for continuous plankton monitoring." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/45/45134/tde-24042014-150825/.
Full textAbstract:
Plankton microorganisms constitute the base of the marine food web and play a great role in global atmospheric carbon dioxide drawdown. Moreover, being very sensitive to any environmental changes they allow noticing (and potentially counteracting) them faster than with any other means. As such they not only influence the fishery industry but are also frequently used to analyze changes in exploited coastal areas and the influence of these interferences on local environment and climate. As a consequence, there is a strong need for highly efficient systems allowing long time and large volume observation of plankton communities. This would provide us with better understanding of plankton role on global climate as well as help maintain the fragile environmental equilibrium. The adopted sensors typically provide huge amounts of data that must be processed efficiently without the need for intensive manual work of specialists. A new system for general purpose particle analysis in large volumes is presented. It has been designed and optimized for the continuous plankton monitoring problem; however, it can be easily applied as a versatile moving fluids analysis tool or in any other application in which targets to be detected and identified move in a unidirectional flux. The proposed system is composed of three stages: data acquisition, targets detection and their identification. Dedicated optical hardware is used to record images of small particles immersed in the water flux. Targets detection is performed using a Visual Rhythm-based method which greatly accelerates the processing time and allows higher volume throughput. The proposed method detects, counts and measures organisms present in water flux passing in front of the camera. Moreover, the developed software allows saving cropped plankton images which not only greatly reduces required storage space but also constitutes the input for their automatic identification. In order to assure maximal performance (up to 720 MB/s) the algorithm was implemented using CUDA for GPGPU. The method was tested on a large dataset and compared with alternative frame-by-frame approach. The obtained plankton images were used to build a classifier that is applied to automatically identify organisms in plankton analysis experiments. For this purpose a dedicated feature extracting software was developed. Various subsets of the 55 shape characteristics were tested with different off-the-shelf learning models. The best accuracy of approximately 92% was obtained with Support Vector Machines. This result is comparable to the average expert manual identification performance. This work was developed under joint supervision with Professor Rubens Lopes (IO-USP).Microorganismos planctônicos constituem a base da cadeia alimentar marinha e desempenham um grande papel na redução do dióxido de carbono na atmosfera. Além disso, são muito sensíveis a alterações ambientais e permitem perceber (e potencialmente neutralizar) as mesmas mais rapidamente do que em qualquer outro meio. Como tal, não só influenciam a indústria da pesca, mas também são frequentemente utilizados para analisar as mudanças nas zonas costeiras exploradas e a influência destas interferências no ambiente e clima locais. Como consequência, existe uma forte necessidade de desenvolver sistemas altamente eficientes, que permitam observar comunidades planctônicas em grandes escalas de tempo e volume. Isso nos fornece uma melhor compreensão do papel do plâncton no clima global, bem como ajuda a manter o equilíbrio do frágil meio ambiente. Os sensores utilizados normalmente fornecem grandes quantidades de dados que devem ser processados de forma eficiente sem a necessidade do trabalho manual intensivo de especialistas. Um novo sistema de monitoramento de plâncton em grandes volumes é apresentado. Foi desenvolvido e otimizado para o monitoramento contínuo de plâncton; no entanto, pode ser aplicado como uma ferramenta versátil para a análise de fluídos em movimento ou em qualquer aplicação que visa detectar e identificar movimento em fluxo unidirecional. O sistema proposto é composto de três estágios: aquisição de dados, detecção de alvos e suas identificações. O equipamento óptico é utilizado para gravar imagens de pequenas particulas imersas no fluxo de água. A detecção de alvos é realizada pelo método baseado no Ritmo Visual, que acelera significativamente o tempo de processamento e permite um maior fluxo de volume. O método proposto detecta, conta e mede organismos presentes na passagem do fluxo de água em frente ao sensor da câmera. Além disso, o software desenvolvido permite salvar imagens segmentadas de plâncton, que não só reduz consideravelmente o espaço de armazenamento necessário, mas também constitui a entrada para a sua identificação automática. Para garantir o desempenho máximo de até 720 MB/s, o algoritmo foi implementado utilizando CUDA para GPGPU. O método foi testado em um grande conjunto de dados e comparado com a abordagem alternativa de quadro-a-quadro. As imagens obtidas foram utilizadas para construir um classificador que é aplicado na identificação automática de organismos em experimentos de análise de plâncton. Por este motivo desenvolveu-se um software para extração de características. Diversos subconjuntos das 55 características foram testados através de modelos de aprendizagem disponíveis. A melhor exatidão de aproximadamente 92% foi obtida através da máquina de vetores de suporte. Este resultado é comparável à identificação manual média realizada por especialistas. Este trabalho foi desenvolvido sob a co-orientacao do Professor Rubens Lopes (IO-USP).
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Bradley, J. "Glucose biosensors for monitoring bakers yeast propagation." Thesis, Cranfield University, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.234492.
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Erturk, Volkan. "A Framework Based On Continuous Security Monitoring." Master's thesis, METU, 2008. http://etd.lib.metu.edu.tr/upload/12610139/index.pdf.
Full textAbstract:
Continuous security monitoring is the process of following up the IT systems by collecting measurements, reporting and analysis of the results for comparing the security level of the organization on continuous time axis to see how organizational security is progressing in the course of time. In the related literature there is very limited work done to continuously monitor the security of the organizations. In this thesis, a continuous security monitoring framework based on security metrics is proposed. Moreover, to decrease the burden of implementation a software tool called SecMon is introduced. The implementation of the framework in a public organization shows that the proposed system is successful for building an organizational memory and giving insight to the security stakeholders about the IT security level in the organization.
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Kayani, Badar Jahangir. "DEVELOPMENT OF CONTINUOUS MONITORING PULSE OXIMETER DEVICE." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1619622233546762.
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Aliakbar, Amir Mohsen. "Handheld impedance based biosensor system for glucose monitoring." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66772.
Full textAbstract:
ABSTRACT Biosensors play an important role in various applications including environmental monitoring, food and beverage industry, biomedical/clinical monitoring, and national security. Biosensors are devices or systems that monitor various physical, chemical or biological parameters in the surrounding environment and provide representative signals that can be measured or stored. The rapid developments in semiconductor technologies have sprouted newer integrated sensor technologies leading to the development of biosensor microsystems which offer the advantages of easy to use, point-of-care, low power and low cost. These microsystems allow highly sensitive and rapid detection with low sample volumes in cases of disease epidemics. This thesis focuses on the development of integrated, accurate, rapid and continuous monitoring glucose biosensors. With growing numbers of aging population and rising obesity rates, chronic diseases continue to be a major health problem in Canada and around the world. For instance, diabetes is a chronic disease which currently affects around 3 million Canadians. The cost of health care for diabetes and its complications amount to about $9 billion a year for Canada. In diabetes, the body either does not produce or ineffectively uses insulin, the hormone which regulates movement of glucose from the blood to the cells. It is generally agreed that the future of diabetes management depends on the success in the development of sensor-based continuous glucose monitoring systems. Although continuous glucose determination is presently available, it has evolved from single glucose determination methodology, which was not primary designed for continuous glucose sensing; hence several aspects of present day glucose sensors are not optimal. Notable shortcomings arethat they are not reagent-less or non-replenishable, and often are multiple enzyme-coupled, which can be complicated and prone toLes biodétecteurs jouent une rôle important dans diverses applications comprenant le contrôle de environnement, le contrôle alimentaire, surveillance biomédicale et clinique, et la sécurité nationale. Les biodétecteurs sont des dispositifs ou des systèmes qui surveillent de divers paramètres physique, chimiques ou biologiques dans l'environnement, et ils fournissent les signaux représentatifs qui peuvent être mesurés ou enregistrées. Les développements rapides en technologies de semi-conducteur ont poussé de plus nouvelles technologies de capteur intégré menant au développement de biodétecteur microsystèmes qui offrent les avantages de facile à employer, point-de-soin, de basse puissance et à prix réduit. Ces microsystèmes permettent la détection fortement sensible et rapide avec de bas volumes témoin dans les cas des épidémies de la maladie. Cette thèse se concentre sur le développement des biodétecteurs integreted qui sont rapide et précise, pour le contrôle continu du glucose.Avec un vieillissement de la population et le nombre croissant de cas d'obésité, les maladies chroniques continuent à être un problème de santé important au Canada et dans d'autres régions du monde. Par exemple, les diabetes est une maladie chronique qui affecte autour 3 millions de Canadiens. Le coût de santé pour le diabète et ses complications s'élèvent à environ $9 milliards par année pour le Canada. En diabète, le corps ne produit pas ou n'emploie pas inefficacement l'insuline, qui est l'hormone qui règle le mouvement du glucose du sang aux cellules. Il est généralement convenu que le futur de la gestion de diabète dépend du succès dans le développement des systèmes de surveillance continus à base de détecteur de glucose. Bien que la détermination de glucose continue soit actuellement disponible, il s'est développé de la méthodologie de détermination de gluco
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Choi, Kevin. "Glucose Kinetics of Hyperglycemic Rainbow Trout: Effects of Exogenous Glucose and Exercise." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32856.
Full textAbstract:
This thesis investigates the ability of rainbow trout to modulate hepatic glucose production (Ra) and disposal (Rd). My goals were to determine: (1) if resting trout can modulate fluxes to cope with exogenous glucose; (2) how fluxes change during graded swimming; (3) how exogenous glucose affects swimming kinetics; and (4) if exogenous glucose affects cost of transport or performance. Results show that resting trout suppress Ra completely and stimulate Rd from 10.6 to 27.6 μmol kg-1 min-1. During swimming, fluxes increase from 15.6 to 21.9 μmol kg-1 min-1, but only at speeds >2.4 BL s-1. When given glucose, trout suppress Ra from 16.4 to 4.1 μmol kg-1 min-1 and stimulate Rd from 16.4 to 40.1 μmol kg-1 min-1. Glucose lowers metabolic rate but does not affect critical swimming speed. Therefore, this research shows that rainbow trout have a much better capacity for glucoregulation than generally suggested by current literature.
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Pietras, Angela. "The Effects of Different Exercise Intensities on Glucoregulatory Response." University of Toledo / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1418222823.
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Dembowitz, Marti. "Improving Postpartum Glucose Monitoring in Women with Gestational Diabetes." Thesis, Icahn School of Medicine at Mount Sinai, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1595257.
Full textAbstract:
OBJECTIVE: To improve 6-week postpartum visit attendance, glucose test ordering, and test completion among postpartum GDM patients.
METHODS: Pre- and post-intervention GDM women at Mount Sinai were studied via chart review. Interventions included advanced order sets for glucose monitoring at the 35-week pregnancy visit, educational modules, and nutritionist phone calls reminding patients to attend postpartum visits fasting.
RESULTS: 107 pre-intervention and 42 post-intervention women were studied. Percentages of orders placed for postpartum testing was higher post-intervention vs. pre-intervention (57% vs. 42%, p=0.03). There were higher test completion rates post-intervention vs. pre-intervention (36% vs. 17%, p=0.01). Postpartum visit attendance rates didn’t vary between groups (73% vs. 69% p=0.60). 6% pre-intervention fasted for postpartum visits vs. 60% post-intervention.
CONCLUSION: There was no increase in women attending their 6-week postpartum visits, yet rates of completed orders for postpartum testing, women attending visits fasting, and postpartum test completions were higher post-intervention. More research may identify the barriers to attendance at 6-week post-partum visits.