Accuracy of Continuous Glucose Monitoring before, during, and after Aerobic and Anaerobic Exercise in Patients with Type 1 Diabetes Mellitus

[EN] Continuous glucose monitoring (CGM) plays an important role in treatment decisions for patients with type 1 diabetes under conventional or closed-loop therapy. Physical activity represents a great challenge for diabetes management as well as for CGM systems. In this work, the accuracy of CGM in the context of exercise is addressed. Six adults performed aerobic and anaerobic exercise sessions and used two Medtronic Paradigm Enlite-2 sensors under closed-loop therapy. CGM readings were compared with plasma glucose during different periods: one hour before exercise, during exercise, and four hours after the end of exercise. In aerobic sessions, the median absolute relative difference (MARD) increased from 9.5% before the beginning of exercise to 16.5% during exercise (p < 0.001), and then decreased to 9.3% in the first hour after the end of exercise (p < 0.001). For the anaerobic sessions, the MARD before exercise was 15.5% and increased without statistical significance to 16.8% during exercise realisation (p = 0.993), and then decreased to 12.7% in the first hour after the cessation of anaerobic activities (p = 0.095). Results indicate that CGM might present lower accuracy during aerobic exercise, but return to regular operation a few hours after exercise cessation. No significant impact for anaerobic exercise was found.This project was partially supported by the Spanish Government through grants DPI2013-46982-C2-1-R, DPI2013-46982-C2-2-R, DPI2016-78831-C2-1-R, and DPI2016-78831-C2-2-R, and by the National Council of Technological and Scientific Development, CNPq Brazil through grants 202050/2015-7 and 207688/2014-1.Biagi, L.; Bertachi, A.; Quirós, C.; Giménez, M.; Conget, I.; Bondía Company, J.; Vehí, J. (2018). Accuracy of Continuous Glucose Monitoring before, during, and after Aerobic and Anaerobic Exercise in Patients with Type 1 Diabetes Mellitus. Biosensors. 8(1):1-8. https://doi.org/10.3390/bios8010022S188

Extensive assessment of blood glucose monitoring during postprandial period and its impact on closed-loop performance

[EN] Background: Closed-loop (CL) systems aims to outperform usual treatments in blood glucose control and continuous glucose monitors (CGM) are a key component in such systems. Meals represents one of the main disturbances in blood glucose control, and postprandial period (PP) is a challenging situation for both CL system and CGM accuracy. Methods: We performed an extensive analysis of sensor¿s performance by numerical accuracy and precision during PP, as well as its influence in blood glucose control under CL therapy. Results: During PP the mean absolute relative difference (MARD) for both sensors presented lower accuracy in the hypoglycemic range (19.4 ± 12.8%) than in other ranges (12.2 ± 8.6% in euglycemic range and 9.3 ± 9.3% in hyperglycemic range). The overall MARD was 12.1 ± 8.2%. We have also observed lower MARD for rates of change between 0 and 2 mg/dl. In CL therapy, the 10 trials with the best sensor spent less time in hypoglycemia (PG < 70 mg/dl) than the 10 trials with the worst sensors (2 ± 7 minutes vs 32 ± 38 minutes, respectively). Conclusions: In terms of accuracy, our results resemble to previously reported. Furthermore, our results showed that sensors with the lowest MARD spent less time in hypoglycemic range, indicating that the performance of CL algorithm to control PP was related to sensor accuracy.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project has been partially supported by the Spanish Government through Grants DPI 2013-46982-C2-1-R, DPI 2016-78831-C2-1-R, DPI 2013-46982-C2-2-R, and DPI 2016-78831-C2-2-R, the National Council of Technological and Scientific Development, CNPq Brazil through Grants 202050/2015-7 and 207688/2014-1.Biagi, L.; Hirata-Bertachi, A.; Conget, I.; Quirós, C.; Giménez, M.; Ampudia-Blasco, F.; Rossetti, P.... (2017). Extensive assessment of blood glucose monitoring during postprandial period and its impact on closed-loop performance. Journal of Diabetes Science and Technology. 11(6):1089-1095. https://doi.org/10.1177/1932296817714272S10891095116Doyle, F. J., Huyett, L. M., Lee, J. B., Zisser, H. C., & Dassau, E. (2014). Closed-Loop Artificial Pancreas Systems: Engineering the Algorithms. Diabetes Care, 37(5), 1191-1197. doi:10.2337/dc13-2108Cengiz, E., & Tamborlane, W. V. (2009). A Tale of Two Compartments: Interstitial Versus Blood Glucose Monitoring. Diabetes Technology & Therapeutics, 11(S1), S-11-S-16. doi:10.1089/dia.2009.0002Cobelli, C., Schiavon, M., Dalla Man, C., Basu, A., & Basu, R. (2016). Interstitial Fluid Glucose Is Not Just a Shifted-in-Time but a Distorted Mirror of Blood Glucose: Insight from an In Silico Study. Diabetes Technology & Therapeutics, 18(8), 505-511. doi:10.1089/dia.2016.0112Castle, J. R., & Ward, W. K. (2010). Amperometric Glucose Sensors: Sources of Error and Potential Benefit of Redundancy. Journal of Diabetes Science and Technology, 4(1), 221-225. doi:10.1177/193229681000400127Basu, A., Dube, S., Veettil, S., Slama, M., Kudva, Y. C., Peyser, T., … Basu, R. (2014). Time Lag of Glucose From Intravascular to Interstitial Compartment in Type 1 Diabetes. Journal of Diabetes Science and Technology, 9(1), 63-68. doi:10.1177/1932296814554797Keenan, D. B., Grosman, B., Clark, H. W., Roy, A., Weinzimer, S. A., Shah, R. V., & Mastrototaro, J. J. (2011). Continuous Glucose Monitoring Considerations for the Development of a Closed-Loop Artificial Pancreas System. Journal of Diabetes Science and Technology, 5(6), 1327-1336. doi:10.1177/193229681100500603Van Bon, A. C., Jonker, L. D., Koebrugge, R., Koops, R., Hoekstra, J. B. L., & DeVries, J. H. (2012). Feasibility of a Bihormonal Closed-Loop System to Control Postexercise and Postprandial Glucose Excursions. Journal of Diabetes Science and Technology, 6(5), 1114-1122. doi:10.1177/193229681200600516Rossetti, P., Quirós, C., Moscardó, V., Comas, A., Giménez, M., Ampudia-Blasco, F. J., … Vehí, J. (2017). Closed-Loop Control of Postprandial Glycemia Using an Insulin-on-Board Limitation Through Continuous Action on Glucose Target. Diabetes Technology & Therapeutics, 19(6), 355-362. doi:10.1089/dia.2016.0443Bailey, T., Zisser, H., & Chang, A. (2009). New Features and Performance of a Next-Generation SEVEN-Day Continuous Glucose Monitoring System with Short Lag Time. Diabetes Technology & Therapeutics, 11(12), 749-755. doi:10.1089/dia.2009.0075Zschornack, E., Schmid, C., Pleus, S., Link, M., Klötzer, H.-M., Obermaier, K., … Freckmann, G. (2013). Evaluation of the Performance of a Novel System for Continuous Glucose Monitoring. Journal of Diabetes Science and Technology, 7(4), 815-823. doi:10.1177/193229681300700403Pleus, S., Schmid, C., Link, M., Zschornack, E., Klötzer, H.-M., Haug, C., & Freckmann, G. (2013). Performance Evaluation of a Continuous Glucose Monitoring System under Conditions Similar to Daily Life. Journal of Diabetes Science and Technology, 7(4), 833-841. doi:10.1177/193229681300700405Zisser, H. C., Bailey, T. S., Schwartz, S., Ratner, R. E., & Wise, J. (2009). Accuracy of the SEVEN® Continuous Glucose Monitoring System: Comparison with Frequently Sampled Venous Glucose Measurements. Journal of Diabetes Science and Technology, 3(5), 1146-1154. doi:10.1177/193229680900300519Obermaier, K., Schmelzeisen-Redeker, G., Schoemaker, M., Klötzer, H.-M., Kirchsteiger, H., Eikmeier, H., & del Re, L. (2013). Performance Evaluations of Continuous Glucose Monitoring Systems: Precision Absolute Relative Deviation is Part of the Assessment. Journal of Diabetes Science and Technology, 7(4), 824-832. doi:10.1177/193229681300700404Clarke, W. L., Cox, D., Gonder-Frederick, L. A., Carter, W., & Pohl, S. L. (1987). Evaluating Clinical Accuracy of Systems for Self-Monitoring of Blood Glucose. Diabetes Care, 10(5), 622-628. doi:10.2337/diacare.10.5.622Martin Bland, J., & Altman, D. (1986). STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT. The Lancet, 327(8476), 307-310. doi:10.1016/s0140-6736(86)90837-8Breton, M., & Kovatchev, B. (2008). Analysis, Modeling, and Simulation of the Accuracy of Continuous Glucose Sensors. Journal of Diabetes Science and Technology, 2(5), 853-862. doi:10.1177/193229680800200517Kropff, J., Bruttomesso, D., Doll, W., Farret, A., Galasso, S., Luijf, Y. M., … DeVries, J. H. (2014). Accuracy of two continuous glucose monitoring systems: a head‐to‐head comparison under clinical research centre and daily life conditions. Diabetes, Obesity and Metabolism, 17(4), 343-349. doi:10.1111/dom.12378Reddy, M., Herrero, P., Sharkawy, M. E., Pesl, P., Jugnee, N., Pavitt, D., … Oliver, N. S. (2015). Metabolic Control With the Bio-inspired Artificial Pancreas in Adults With Type 1 Diabetes. Journal of Diabetes Science and Technology, 10(2), 405-413. doi:10.1177/1932296815616134Pleus, S., Schoemaker, M., Morgenstern, K., Schmelzeisen-Redeker, G., Haug, C., Link, M., … Freckmann, G. (2015). Rate-of-Change Dependence of the Performance of Two CGM Systems During Induced Glucose Swings. Journal of Diabetes Science and Technology, 9(4), 801-807. doi:10.1177/193229681557871

Individual Categorisation of Glucose Profiles Using Compositional Data Analysis

[EN] The aim of this study was to apply a methodology based on compositional data analysis (CoDA) to categorise glucose profiles obtained from continuous glucose monitoring systems. The methodology proposed considers complete daily glucose profiles obtained from six patients with type 1 diabetes (T1D) who had their glucose monitored for eight weeks. The glucose profiles were distributed into the time spent in six different ranges. The time in one day is finite and limited to 24h, and the times spent in each of these different ranges are co-dependent and carry only relative information; therefore, CoDA is applied to these profiles. A K-means algorithm was applied to the coordinates obtained from the CoDA to obtain different patterns of days for each patient. Groups of days with relatively high time in the hypo and/or hyperglycaemic ranges and with different glucose variability were observed. Using CoDA of time in different ranges, individual glucose profiles were categorised into groups of days, which can be used by physicians to detect the different conditions of patients and personalise patient's insulin therapy according to each group. This approach can be useful to assist physicians and patients in managing the day-to-day variability that hinders glycaemic control.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project has been partially supported by the Spanish Government MINECO through Grants DPI-2016-78831-C2-1-R, DPI2016-78831-C2-2-R, the National Council of Technological and Scientific Development, CNPq Brazil through Grants 202050/2015-7, 207688/2014-1 and EU through FEDER funds.Biagi, L.; Bertachi, A.; Giménez, M.; Conget, I.; Bondía Company, J.; Martín-Fernández, JA.; Vehí, J. (2019). Individual Categorisation of Glucose Profiles Using Compositional Data Analysis. Statistical Methods in Medical Research. 28(12):3550-3567. https://doi.org/10.1177/0962280218808819S355035672812Cobelli, C., Dalla Man, C., Sparacino, G., Magni, L., De Nicolao, G., & Kovatchev, B. P. (2009). Diabetes: Models, Signals, and Control. IEEE Reviews in Biomedical Engineering, 2, 54-96. doi:10.1109/rbme.2009.2036073Kovatchev, B., & Cobelli, C. (2016). Glucose Variability: Timing, Risk Analysis, and Relationship to Hypoglycemia in Diabetes. Diabetes Care, 39(4), 502-510. doi:10.2337/dc15-2035Beck, R. W., Riddlesworth, T. D., Ruedy, K. J., Kollman, C., Ahmann, A. J., Bergenstal, R. M., … Kruger, D. F. (2017). Effect of initiating use of an insulin pump in adults with type 1 diabetes using multiple daily insulin injections and continuous glucose monitoring (DIAMOND): a multicentre, randomised controlled trial. The Lancet Diabetes & Endocrinology, 5(9), 700-708. doi:10.1016/s2213-8587(17)30217-6Contreras, I., Quirós, C., Giménez, M., Conget, I., & Vehi, J. (2016). Profiling intra-patient type I diabetes behaviors. Computer Methods and Programs in Biomedicine, 136, 131-141. doi:10.1016/j.cmpb.2016.08.022Chastin, S. F. M., Palarea-Albaladejo, J., Dontje, M. L., & Skelton, D. A. (2015). Combined Effects of Time Spent in Physical Activity, Sedentary Behaviors and Sleep on Obesity and Cardio-Metabolic Health Markers: A Novel Compositional Data Analysis Approach. PLOS ONE, 10(10), e0139984. doi:10.1371/journal.pone.0139984Pedišić, Ž., & Hardy, L. L. (2017). Physical activity prevalence in Australian children and adolescents: Kinesiology, 49(2), 135-145. doi:10.26582/k.49.2.14Mathematical contributions to the theory of evolution.—On a form of spurious correlation which may arise when indices are used in the measurement of organs. (1897). Proceedings of the Royal Society of London, 60(359-367), 489-498. doi:10.1098/rspl.1896.0076Egozcue, J. J. (2003). Mathematical Geology, 35(3), 279-300. doi:10.1023/a:1023818214614Egozcue, J. J., & Pawlowsky-Glahn, V. (2005). Groups of Parts and Their Balances in Compositional Data Analysis. Mathematical Geology, 37(7), 795-828. doi:10.1007/s11004-005-7381-9Martín-Fernández, J. A., Pawlowsky-Glahn, V., Egozcue, J. J., & Tolosona-Delgado, R. (2017). Advances in Principal Balances for Compositional Data. Mathematical Geosciences, 50(3), 273-298. doi:10.1007/s11004-017-9712-zEgozcue, J. J., & Pawlowsky-Glahn, V. (2006). Simplicial geometry for compositional data. Geological Society, London, Special Publications, 264(1), 145-159. doi:10.1144/gsl.sp.2006.264.01.11Palarea-Albaladejo, J., Martín-Fernández, J. A., & Soto, J. A. (2012). Dealing with Distances and Transformations for Fuzzy C-Means Clustering of Compositional Data. Journal of Classification, 29(2), 144-169. doi:10.1007/s00357-012-9105-4Palarea-Albaladejo, J., & Martín-Fernández, J. A. (2015). zCompositions — R package for multivariate imputation of left-censored data under a compositional approach. Chemometrics and Intelligent Laboratory Systems, 143, 85-96. doi:10.1016/j.chemolab.2015.02.019Bergenstal, R. M., Ahmann, A. J., Bailey, T., Beck, R. W., Bissen, J., Buckingham, B., … Wesley, D. M. (2013). Recommendations for Standardizing Glucose Reporting and Analysis to Optimize Clinical Decision Making in Diabetes: The Ambulatory Glucose Profile (AGP). Diabetes Technology & Therapeutics, 15(3), 198-211. doi:10.1089/dia.2013.0051Maahs, D. M., Buckingham, B. A., Castle, J. R., Cinar, A., Damiano, E. R., Dassau, E., … Lum, J. W. (2016). Outcome Measures for Artificial Pancreas Clinical Trials: A Consensus Report: Table 1. Diabetes Care, 39(7), 1175-1179. doi:10.2337/dc15-2716Schnell, O., Barnard, K., Bergenstal, R., Bosi, E., Garg, S., Guerci, B., … Home, P. (2017). Role of Continuous Glucose Monitoring in Clinical Trials: Recommendations on Reporting. Diabetes Technology & Therapeutics, 19(7), 391-399. doi:10.1089/dia.2017.0054Thió-Henestrosa, S., Egozcue, J. J., Pawlowsky-Glahn, V., Kovács, L. Ó., & Kovács, G. P. (2008). Balance-dendrogram. A new routine of CoDaPack. Computers & Geosciences, 34(12), 1682-1696. doi:10.1016/j.cageo.2007.06.011Hartigan, J. A., & Wong, M. A. (1979). Algorithm AS 136: A K-Means Clustering Algorithm. Applied Statistics, 28(1), 100. doi:10.2307/2346830Kovatchev, B. P., Straume, M., Cox, D. J., & Farhy, L. S. (2000). Risk Analysis of Blood Glucose Data: A Quantitative Approach to Optimizing the Control of Insulin Dependent Diabetes. Journal of Theoretical Medicine, 3(1), 1-10. doi:10.1080/10273660008833060Riddell, M. C., Gallen, I. W., Smart, C. E., Taplin, C. E., Adolfsson, P., Lumb, A. N., … Laffel, L. M. (2017). Exercise management in type 1 diabetes: a consensus statement. The Lancet Diabetes & Endocrinology, 5(5), 377-390. doi:10.1016/s2213-8587(17)30014-

Integración latinoamericana: hegemonía, Estado y populismo

Este libro es resultado de la compilación de las ponencias más destacadas del II Congreso de Pensamiento Político Latinoamericano, al cual se presentaron ciento veintidós trabajos. La publicación tiene como objetivo difundir el trabajo de investigadores comprometidos con la necesidad de afirmar un discurso propiamente latinoamericano, definiendo en ese mismo recorrido el concepto mismo de americanidad.-La comunicación popular para la batalla cultural por Josefina Adrover. -El cuento de la ley. Relaciones entre derecho y literatura por Arabia Federico & Boco Gastón. -O surgimento tardio da comissão da verdade no brasil e a predominância militar na política brasileira de direitos humanos por Msc. Camila Tribess & Msc. Sandra Avi Dos Santos. -La muerte y la mordaza. El doble silenciamiento de las Intelectuales desaparecidas: el caso de Alicia Eguren por Graciela Barbieri. -La influencia de la revolución bolivariana en América Latina y el Caribe por Alejando Beade. -Baldosas de la memoria como intervención político subjetiva por Diego Benegas Loyo, Ayelén Colosimo & Antonella Dalessio. -Ciudadanía del consumidor por Julián Bertachi. -Constitucionalismo latinoamericano y d.e.s.c. por Pablo Blanco. -Empresas estatales en el proceso de reforma neoliberal: los casos de YPF y Petrobrás por Cachés Javier & Garibaldi Pablo. -Tecnología y movimientos sociales: el caso del movimiento #yosoy132 en México por Juan José Carrillo Nieto. -Judicialização e questão social: as ações do estadona garantia de direitos por Hellen Soares Santana Carneiro. -Una lectura fanoniana de los conflictos de subjetividad en el siglo xxi por Juan Pablo Cedriani. -El pensamiento filosófico, político y pedagógico de Arturo Andrés Roig por Mónica Cerruti. -El discurso socio-político en torno a la construcción de memoria colectiva e identidad política de víctimas en el Cono Sur a partir del contexto de implementación de la doctrina de seguridad nacional por Marcos Cruz Ladino & Martha Isabel Gómez. -Claves de interpretación de la iglesia disidente frente a la dictadura en España (1970-1978). Las concomitancias con la teología de liberación y su proyección de los derechos humanos por Juan Antonio Delgado de la Rosa & Gredos San Diego. -As comunidades eclesiais de base e o movimento popular em volta redonda: o espaço urbano como lugar de luta por direitos sociais por Camila Faria. -Sindicalismo e força de trabalho no período desenvolvimentista em volta redonda (1940-1950)por Camila Faria. -Algunas consideraciones acerca de las brechas de género en la universidad: La UNRC. por Lilian Fernández del Moral, colaboradores: Diego Benegas Loyo & Nicolás Valverde. -Discursos y prácticas de resistencia del feminismo indígena: desafíos para el feminismo académico y aportes para un diálogo intercultural por Martín Forciniti & Mercedes Palumbo. -De los derechos humanos a los derechos posimperiales: La interpelacion de los pueblos originarios a la universalidad juridica por Martín Forciniti & Soledad Ramati. -La forja de un puente entre dos movimientos nacionales. La fuerza de orientación radical de la joven argentina (forja), eje entre el yrigoyenismo y peronismo por Juan Godoy. -Arte y política: semejanzas y diferencias por Elina Ibarra. -¿La investigación como práctica política? por Silvia María Kelly , Ruth Rajchenberg & Carolina Wajnerman. -¿Posneoliberalismo en América latina? transformaciones políticas y económicas en la última década por Agustín Lewit & Luis Wainer. -Descolonizando el desarrollo: aportes del MST y del MO.CA.SE.- VC.por Gabriel Rodrigues Lopes -El federalismo alternativo por Martín López & Pedro Ferré. -Ottobah Cugoano: pensar la libertad y la igualdad desde las víctimas por Juan Francisco Martinez Peria -Los poderes innominados del constitucionalismo latinoamericano. La necesidad de un nuevo marco de comprensión y comparación crítico situado por Alejandro Medici. -La falta de vocación exportadora en el productor PYME argentino y la colonización de actitudes empresariales por Ana María Mendoza. -El marxismo español contemporáneo: Francisco Fernández Buey in memoriam por Marta Nogueroles Jové -Del crisol de razas a la olla popular notas para este bicentenario de la patria por Juan José Olivera. -La conflictiva relación entre hambre y libertad por Rodolfo Enrique Peláez. -Deslocamento populacional brasileiro frente á hegemonia do capital, uma questão social por Vilma Pereira da Silva. -El rol de los sonidos en el funcionamiento de los centros clandestinos de detención por Facundo Petit de Murat. -¿Qué ignora el maestro ignorante de Ranciere? una lectura en clave descolonial por Ezequiel Pinacchio. -La construcción de identidades políticas durante el proceso de provincialización del territorio nacional de Chubut (1954-1955): reconfiguración de un discurso sobre el status político-institucional de los territorios nacionales por Anaclara Raffaele. -Arte terapia y decolonialización: una práctica para la liberación por Ruth Alejandra Rajchenberg -La política de los barrios ciudad en la provincia de Córdoba: territorio, política y poder por Saccucci, Erika Ave Oria. -Sexo, gênero e sexualidade: encontros e desencontros Benevento por Claudia Toffano. -Abrir la agenda e integrar otras voces: debates y compromisos del feminismo contemporáneo en América latina por Vanesa Vázquez Laba. -Polémicas culturales, política y poder en cuba: el caso de la creación y cierre de la revista Pensamiento Crítico por Vergara María Ximena. -¿Integración vs. crecimiento? algunas notas para la integración de Argentina en el MERCOSUR por MG. Juan Von Zeschau. -Aportes para (re) pensar el uso de la cuestión nacional en los discursos de la argentina kirchnerista por María Virginia Quiroga & Aarón Attias -Arte y participación: una relación estratégica y del buen vivir. Alcances y dimensiones del arte transformador por Carolina Wajnerman