Maternal diabetes significantly increases the risk of adverse maternal and neonatal outcomes.Traditional self-monitoring of blood glucose is often invasive and limited in its ability to capture glycemic variability.Fl...Maternal diabetes significantly increases the risk of adverse maternal and neonatal outcomes.Traditional self-monitoring of blood glucose is often invasive and limited in its ability to capture glycemic variability.Flash continuous glucose monitoring(FCGM)offers a promising alternative;however,its reliability and correlation with biochemical markers such as hemoglobin A1c(HbA1c)and glycated albumin(GA)in pregnant women with gestational diabetes mellitus(GDM)and type 2 diabetes mellitus(T2DM)remain underexplored.AIM To evaluate the performance of the FreeStyle Libre H FCGM against plasma glucose and its correlations with HbA1c and GA.METHODS This prospective observational study involved 152 pregnant women with GDM or T2DM,with intermittent collection of venous plasma glucose,HbA1c,GA,and concurrent FCGM data at regular intervals at a single center.Relationships were evaluated using restricted cubic spline and mixed-effects models.Receiver operating characteristic curve analysis was performed to compare the ability of HbA1c and GA to detect suboptimal glycemic control.RESULTS Analysis of 507 FCGM-plasma glucose pairs revealed an overall mean absolute relative difference of 7.96%.Mean absolute relative differences were 9.22%,7.75%,and 4.15%for low(3.5-4.4 mmol/L),medium(4.5-7.8 mmol/L),and high(7.9-13 mmol/L)glucose levels,respectively.Most values fell within zone A or zone B on the Clarke and Parkes Error Grids.Bland-Altman analysis indicated a slight underestimation by FCGM(-0.121 mmol/L).Restricted cubic spline analysis revealed significant linear or nonlinear associations between HbA1c/GA and mean glucose,time in range,time above range,and coefficient of variation,but not time below range.Both HbA1c and GA were influenced by gestational age and pregestational body mass index.Receiver operating characteristic analysis showed that HbA1c had comparable or superior performance to GA in detecting suboptimal glycemic control based on FCGM-derived thresholds.CONCLUSION The FCGM system served as a validated reference for evaluating glycemic markers in pregnant women with T2DM and GDM.HbA1c reliably assessed average glycemia,while GA provided complementary insight.展开更多
Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level mon...Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests,the advent of continuous glucose monitoring(CGM)systems has revolutionized the approach.These devices offer a safe and reliable means of tracking glucose levels in real-time,benefiting both women with diabetes during pregnancy and the healthcare providers.Moreover,CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes,especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device.Such a combined approach has been demonstrated to improve overall blood sugar control,lessen the occurrence of preeclampsia and neonatal hypoglycaemia,and minimize the duration of neonatal intensive care unit stays.This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.展开更多
目的研究旨在探讨连续血糖监测(CGM)与实时胰岛素调节(RTIA)联合应用对1型糖尿病(T1DM)患者低血糖事件的影响,并分析个体特征对该干预效果的影响。研究旨在为T1DM患者的个性化血糖管理提供科学依据,优化低血糖风险管理。方法采用回顾性...目的研究旨在探讨连续血糖监测(CGM)与实时胰岛素调节(RTIA)联合应用对1型糖尿病(T1DM)患者低血糖事件的影响,并分析个体特征对该干预效果的影响。研究旨在为T1DM患者的个性化血糖管理提供科学依据,优化低血糖风险管理。方法采用回顾性研究设计,纳入2023年8月至2024年6月符合标准的60例T1DM患者。所有患者佩戴CGM设备14天,同步接受RTIA干预。通过CareLinkTMPro软件分析血糖指标(包括低血糖事件次数、血糖波动参数等),采用HPLC法检测HbA1c,ELISA法测定C肽水平。统计方法包括t检验、ANOVA、ROC曲线及Logistic回归分析(显著性阈值P<0.05)。结果末期HbA1c显著低于基线(P=0.041);低血糖时间占比(TBR)从5.31%降至4.22%(P=0.022);血糖波动指标MAGE(3.18 vs 3.82 mmol/L)和CONGA(2.50 vs 2.82 mmol/L)均显著降低(P<0.05)。低血糖持续时间缩短(P=0.027),但事件总次数无显著变化(P>0.05)。CGM联合RTIA预测低血糖的AUC为0.81(95%CI:0.75~0.87),灵敏度85.23%,特异度70.35%,优于单一方法(P<0.05)。Logistic回归显示,联合干预显著降低低血糖风险(OR=0.45,P=0.027);年龄(OR=1.05)与高HbA1c(OR=1.35)为独立风险因素(P<0.05)。残余胰岛功能组(餐后C肽≥0.4 ng/mL)低血糖减少幅度达60%,显著高于衰竭组(30%,P<0.05)。结论连续血糖监测联合实时胰岛素调节技术能够有效减少1型糖尿病患者的低血糖事件,并改善血糖波动性,尤其在个体特征较为理想的患者中效果更加显著。展开更多
目的:分析“1+N”延续护理模式结合饮食干预在糖尿病患者中的护理效果及影响。方法:在东方社区中随机抽取120例糖尿病患者,就诊时间为2020年7月-2024年8月,采用数字表法,将其分为参照组、研究组,每组患者60例。参照组实施常规延续护理,...目的:分析“1+N”延续护理模式结合饮食干预在糖尿病患者中的护理效果及影响。方法:在东方社区中随机抽取120例糖尿病患者,就诊时间为2020年7月-2024年8月,采用数字表法,将其分为参照组、研究组,每组患者60例。参照组实施常规延续护理,研究组实施“1+N”延续护理及饮食干预,对比两组护理前后自我管理能力、血糖指标、生活质量。结果:护理后,研究组糖尿病自我管理能力评估量表(Summary of Diabetes Self-Care Activities,SDSCA)评分高于参照组(P<0.05);研究组空腹血糖、餐后2小时血糖、糖化血红蛋白水平均低于参照组(P<0.05);研究组糖尿病生存质量特异性评估工具(Diabetes-Specific Quality of Life,DSQL)评分低于参照组(P<0.05)。结论:“1+N”延续护理模式结合饮食干预可有效控制糖尿病患者血糖,提升自我管理能力,提高生活质量。展开更多
Pediatric type 1 diabetes(T1D)is a lifelong condition requiring meticulous glucose management to prevent acute and chronic complications.Conventional management of diabetic patients does not allow for continuous monit...Pediatric type 1 diabetes(T1D)is a lifelong condition requiring meticulous glucose management to prevent acute and chronic complications.Conventional management of diabetic patients does not allow for continuous monitoring of glucose trends,and can place patients at risk for hypo-and hyperglycemia.Continuous glucose monitors(CGMs)have emerged as a mainstay for pediatric diabetic care and are continuing to advance treatment by providing real-time blood glucose(BG)data,with trend analysis aided by machine learning(ML)algorithms.These predictive analytics serve to prevent against dangerous BG variations in the perioperative environment for fasted children undergoing surgical stress.Integration of CGM data into electronic health records(EHR)is essential,as it establishes a foundation for future technologic interfaces with artificial intelligence(AI).Challenges in perioperative CGM implementation include equitable device access,protection of patient privacy and data accuracy,ensuring institution of standardized protocols,and financing the cumbersome healthcare costs associated with staff training and technology platforms.This paper advocates for implementation of CGM data into the EHR utilizing multiple facets of AI/ML algorithms.展开更多
Branched continued fractions are one of the multidimensional generalization of the continued fractions. Branched continued fractions with not equivalent variables are an analog of the regular C-fractions for multiple ...Branched continued fractions are one of the multidimensional generalization of the continued fractions. Branched continued fractions with not equivalent variables are an analog of the regular C-fractions for multiple power series. We consider 1-periodic branched continued fraction of the special form which is an analog fraction with not equivalent variables if the values of that variables are fixed. We establish an analog of the parabola theorem for that fraction and estimate truncation error bounds for that fractions at some restrictions. We also propose to use weight coefficients for obtaining different parabolic regions for the same fraction without any additional restriction for first element.展开更多
BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients wi...BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients with type 1 diabetes(T1D).The glycemia risk index(GRI),a composite metric derived from continuous glucose monitoring(CGM),has emerged as a potential solution by systematically in-tegrating both hypoglycemia and hyperglycemia risks into a single interpretable score.The GRI exhibited linear correlations with HbA1c(r=0.53),time in range(r=-0.90),time above range(r=0.63),time below range(TBR)(r=0.37),and co-efficient of variation(CV)(r=0.71).It correlated strongly with TBR and CV than HbA1c.The association between HbA1c levels and GRI was influenced by TBR and CV.At a given HbA1c,each 1%increase in TBR or CV raised GRI by 1.87[95%confidence interval(CI):1.72-2.01]and 1.94(95%CI:1.80-2.10),respectively(P<0.001).Clustering of the CGM data identified four subgroups:Moderate-risk glycemic fluctuations,high-risk hypoglycemia,optimal glycemic control,and high-risk hyperglycemia.The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.CONCLUSION The GRI offers a comprehensive view of glycemic control in T1D.Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.展开更多
目的探讨连续血糖监测对血糖控制不佳的成人1型糖尿病(T1DM)患者的影响。方法选取郑州大学第一附属医院2021年6月至2023年8月收治的成人T1DM患者156例,按随机数表法分为对照组(常规干预,78例)和研究组(连续血糖监测干预,78例),比较两组...目的探讨连续血糖监测对血糖控制不佳的成人1型糖尿病(T1DM)患者的影响。方法选取郑州大学第一附属医院2021年6月至2023年8月收治的成人T1DM患者156例,按随机数表法分为对照组(常规干预,78例)和研究组(连续血糖监测干预,78例),比较两组血糖控制、血糖波动、生活质量。结果与干预前比较,两组干预后空腹血糖(FBG)、餐后2 h血糖(2 h BG)、糖化血红蛋白(HbA1c)降低(P<0.05),两组干预后空腹胰岛素(FINS)升高(P<0.05),且与对照组比较,研究组干预后FBG、2 h BG、HbA1c更低(P<0.05),研究组干预后FINS更高(P<0.05)。与干预前比较,两组干预后日内平均血糖波动幅度(MAGE)、血糖标准差(SDBG)、平均血糖(MBG)降低(P<0.05),且与对照组比较,研究组干预后MAGE、SDBG、MBG更低(P<0.05)。与干预前比较,两组干预后糖尿病特异性生活质量量表修订版(A-DQOL)各维度评分升高(P<0.05),且与对照组比较,研究组干预后A-DQOL各维度评分更高(P<0.05)。结论对血糖控制不佳的成人T1DM患者采用连续血糖监测,可控制血糖,减少高血糖程度,提高生活质量。展开更多
The Lt-norm method is one of the widely used matching filters for adaptive multiple subtraction. When the primaries and multiples are mixed together, the L1-norm method might damage the primaries, leading to poor late...The Lt-norm method is one of the widely used matching filters for adaptive multiple subtraction. When the primaries and multiples are mixed together, the L1-norm method might damage the primaries, leading to poor lateral continuity. In this paper, we propose a constrained L1-norm method for adaptive multiple subtraction by introducing the lateral continuity constraint for the estimated primaries. We measure the lateral continuity using prediction-error filters （PEF）. We illustrate our method with the synthetic Pluto dataset. The results show that the constrained L1-norm method can simultaneously attenuate the multiples and preserve the primaries.展开更多
基金Supported by the National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-015the Healthcare Quality and Safety Incubation Program of Peking Union Medical Foundation,No.XHFY2406.
文摘Maternal diabetes significantly increases the risk of adverse maternal and neonatal outcomes.Traditional self-monitoring of blood glucose is often invasive and limited in its ability to capture glycemic variability.Flash continuous glucose monitoring(FCGM)offers a promising alternative;however,its reliability and correlation with biochemical markers such as hemoglobin A1c(HbA1c)and glycated albumin(GA)in pregnant women with gestational diabetes mellitus(GDM)and type 2 diabetes mellitus(T2DM)remain underexplored.AIM To evaluate the performance of the FreeStyle Libre H FCGM against plasma glucose and its correlations with HbA1c and GA.METHODS This prospective observational study involved 152 pregnant women with GDM or T2DM,with intermittent collection of venous plasma glucose,HbA1c,GA,and concurrent FCGM data at regular intervals at a single center.Relationships were evaluated using restricted cubic spline and mixed-effects models.Receiver operating characteristic curve analysis was performed to compare the ability of HbA1c and GA to detect suboptimal glycemic control.RESULTS Analysis of 507 FCGM-plasma glucose pairs revealed an overall mean absolute relative difference of 7.96%.Mean absolute relative differences were 9.22%,7.75%,and 4.15%for low(3.5-4.4 mmol/L),medium(4.5-7.8 mmol/L),and high(7.9-13 mmol/L)glucose levels,respectively.Most values fell within zone A or zone B on the Clarke and Parkes Error Grids.Bland-Altman analysis indicated a slight underestimation by FCGM(-0.121 mmol/L).Restricted cubic spline analysis revealed significant linear or nonlinear associations between HbA1c/GA and mean glucose,time in range,time above range,and coefficient of variation,but not time below range.Both HbA1c and GA were influenced by gestational age and pregestational body mass index.Receiver operating characteristic analysis showed that HbA1c had comparable or superior performance to GA in detecting suboptimal glycemic control based on FCGM-derived thresholds.CONCLUSION The FCGM system served as a validated reference for evaluating glycemic markers in pregnant women with T2DM and GDM.HbA1c reliably assessed average glycemia,while GA provided complementary insight.
文摘Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests,the advent of continuous glucose monitoring(CGM)systems has revolutionized the approach.These devices offer a safe and reliable means of tracking glucose levels in real-time,benefiting both women with diabetes during pregnancy and the healthcare providers.Moreover,CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes,especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device.Such a combined approach has been demonstrated to improve overall blood sugar control,lessen the occurrence of preeclampsia and neonatal hypoglycaemia,and minimize the duration of neonatal intensive care unit stays.This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.
文摘目的研究旨在探讨连续血糖监测(CGM)与实时胰岛素调节(RTIA)联合应用对1型糖尿病(T1DM)患者低血糖事件的影响,并分析个体特征对该干预效果的影响。研究旨在为T1DM患者的个性化血糖管理提供科学依据,优化低血糖风险管理。方法采用回顾性研究设计,纳入2023年8月至2024年6月符合标准的60例T1DM患者。所有患者佩戴CGM设备14天,同步接受RTIA干预。通过CareLinkTMPro软件分析血糖指标(包括低血糖事件次数、血糖波动参数等),采用HPLC法检测HbA1c,ELISA法测定C肽水平。统计方法包括t检验、ANOVA、ROC曲线及Logistic回归分析(显著性阈值P<0.05)。结果末期HbA1c显著低于基线(P=0.041);低血糖时间占比(TBR)从5.31%降至4.22%(P=0.022);血糖波动指标MAGE(3.18 vs 3.82 mmol/L)和CONGA(2.50 vs 2.82 mmol/L)均显著降低(P<0.05)。低血糖持续时间缩短(P=0.027),但事件总次数无显著变化(P>0.05)。CGM联合RTIA预测低血糖的AUC为0.81(95%CI:0.75~0.87),灵敏度85.23%,特异度70.35%,优于单一方法(P<0.05)。Logistic回归显示,联合干预显著降低低血糖风险(OR=0.45,P=0.027);年龄(OR=1.05)与高HbA1c(OR=1.35)为独立风险因素(P<0.05)。残余胰岛功能组(餐后C肽≥0.4 ng/mL)低血糖减少幅度达60%,显著高于衰竭组(30%,P<0.05)。结论连续血糖监测联合实时胰岛素调节技术能够有效减少1型糖尿病患者的低血糖事件,并改善血糖波动性,尤其在个体特征较为理想的患者中效果更加显著。
文摘目的:分析“1+N”延续护理模式结合饮食干预在糖尿病患者中的护理效果及影响。方法:在东方社区中随机抽取120例糖尿病患者,就诊时间为2020年7月-2024年8月,采用数字表法,将其分为参照组、研究组,每组患者60例。参照组实施常规延续护理,研究组实施“1+N”延续护理及饮食干预,对比两组护理前后自我管理能力、血糖指标、生活质量。结果:护理后,研究组糖尿病自我管理能力评估量表(Summary of Diabetes Self-Care Activities,SDSCA)评分高于参照组(P<0.05);研究组空腹血糖、餐后2小时血糖、糖化血红蛋白水平均低于参照组(P<0.05);研究组糖尿病生存质量特异性评估工具(Diabetes-Specific Quality of Life,DSQL)评分低于参照组(P<0.05)。结论:“1+N”延续护理模式结合饮食干预可有效控制糖尿病患者血糖,提升自我管理能力,提高生活质量。
文摘Pediatric type 1 diabetes(T1D)is a lifelong condition requiring meticulous glucose management to prevent acute and chronic complications.Conventional management of diabetic patients does not allow for continuous monitoring of glucose trends,and can place patients at risk for hypo-and hyperglycemia.Continuous glucose monitors(CGMs)have emerged as a mainstay for pediatric diabetic care and are continuing to advance treatment by providing real-time blood glucose(BG)data,with trend analysis aided by machine learning(ML)algorithms.These predictive analytics serve to prevent against dangerous BG variations in the perioperative environment for fasted children undergoing surgical stress.Integration of CGM data into electronic health records(EHR)is essential,as it establishes a foundation for future technologic interfaces with artificial intelligence(AI).Challenges in perioperative CGM implementation include equitable device access,protection of patient privacy and data accuracy,ensuring institution of standardized protocols,and financing the cumbersome healthcare costs associated with staff training and technology platforms.This paper advocates for implementation of CGM data into the EHR utilizing multiple facets of AI/ML algorithms.
文摘Branched continued fractions are one of the multidimensional generalization of the continued fractions. Branched continued fractions with not equivalent variables are an analog of the regular C-fractions for multiple power series. We consider 1-periodic branched continued fraction of the special form which is an analog fraction with not equivalent variables if the values of that variables are fixed. We establish an analog of the parabola theorem for that fraction and estimate truncation error bounds for that fractions at some restrictions. We also propose to use weight coefficients for obtaining different parabolic regions for the same fraction without any additional restriction for first element.
基金Supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project,No.2023ZD0508201the National Key R and D Program of China,No.2022YFC2010100+3 种基金the National Natural Science Foundation of China,No.82070812the Natural Science Foundation of Hunan Province,No.2024JJ9049,No.2023JJ30762 and No.2021JC0003Sinocare Diabetes Foundation,No.2020SD08the National Clinical Research Center for Metabolic Diseases Clinical Diagnosis and Treatment Capacity Enhancement Program,No.2023ZLNL003.
文摘BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients with type 1 diabetes(T1D).The glycemia risk index(GRI),a composite metric derived from continuous glucose monitoring(CGM),has emerged as a potential solution by systematically in-tegrating both hypoglycemia and hyperglycemia risks into a single interpretable score.The GRI exhibited linear correlations with HbA1c(r=0.53),time in range(r=-0.90),time above range(r=0.63),time below range(TBR)(r=0.37),and co-efficient of variation(CV)(r=0.71).It correlated strongly with TBR and CV than HbA1c.The association between HbA1c levels and GRI was influenced by TBR and CV.At a given HbA1c,each 1%increase in TBR or CV raised GRI by 1.87[95%confidence interval(CI):1.72-2.01]and 1.94(95%CI:1.80-2.10),respectively(P<0.001).Clustering of the CGM data identified four subgroups:Moderate-risk glycemic fluctuations,high-risk hypoglycemia,optimal glycemic control,and high-risk hyperglycemia.The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.CONCLUSION The GRI offers a comprehensive view of glycemic control in T1D.Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.
文摘目的探讨连续血糖监测对血糖控制不佳的成人1型糖尿病(T1DM)患者的影响。方法选取郑州大学第一附属医院2021年6月至2023年8月收治的成人T1DM患者156例,按随机数表法分为对照组(常规干预,78例)和研究组(连续血糖监测干预,78例),比较两组血糖控制、血糖波动、生活质量。结果与干预前比较,两组干预后空腹血糖(FBG)、餐后2 h血糖(2 h BG)、糖化血红蛋白(HbA1c)降低(P<0.05),两组干预后空腹胰岛素(FINS)升高(P<0.05),且与对照组比较,研究组干预后FBG、2 h BG、HbA1c更低(P<0.05),研究组干预后FINS更高(P<0.05)。与干预前比较,两组干预后日内平均血糖波动幅度(MAGE)、血糖标准差(SDBG)、平均血糖(MBG)降低(P<0.05),且与对照组比较,研究组干预后MAGE、SDBG、MBG更低(P<0.05)。与干预前比较,两组干预后糖尿病特异性生活质量量表修订版(A-DQOL)各维度评分升高(P<0.05),且与对照组比较,研究组干预后A-DQOL各维度评分更高(P<0.05)。结论对血糖控制不佳的成人T1DM患者采用连续血糖监测,可控制血糖,减少高血糖程度,提高生活质量。
基金This work is sponsored by National Natural Science Foundation of China （No. 40874056）, Important National Science ＆ Technology Specific Projects 2008ZX05023-005-004, and the NCET Fund.Acknowledgements The authors are grateful to Liu Yang, and Zhu Sheng-wang for their constructive remarks on this manuscript.
文摘The Lt-norm method is one of the widely used matching filters for adaptive multiple subtraction. When the primaries and multiples are mixed together, the L1-norm method might damage the primaries, leading to poor lateral continuity. In this paper, we propose a constrained L1-norm method for adaptive multiple subtraction by introducing the lateral continuity constraint for the estimated primaries. We measure the lateral continuity using prediction-error filters （PEF）. We illustrate our method with the synthetic Pluto dataset. The results show that the constrained L1-norm method can simultaneously attenuate the multiples and preserve the primaries.
