Numerical and clinical precision in hypoglycemia of the intermittent FreeStyle Libre glucose monitoring through an NFC-Bluetooth transmitter associated with the xDrip+ algorithm in diabetic patients under insulin therapy

Métodos Estudio de pruebas diagnósticas. Se evaluó la exactitud numérica mediante la diferencia absoluta en los valores con respecto a la glucometría capilar (norma ISO 15197:2015) y la exactitud clínica, mediante las gradillas de error de Clarke y Parkes (Consensus), para mediciones de glucosa inferiores a 70 mg/dl realizadas con el sistema FreeStyle Libre y con la aplicación xDrip+ de estimación digital, en personas con diabetes con insulinoterapia. Resultados Se incluyó a 27 pacientes (TIR 73,4%, TBR70 5,6%), quienes aportaron 83 eventos de hipoglucemia. La exactitud numérica fue adecuada en proporciones similares con el sistema FreeStyle Libre en comparación con la aplicación xDrip+ (81,92% vs. 68,67%, p = 0,0630). La evaluación de la precisión clínica mostró que el 92,8% de las mediciones para xDrip+ y el 98,8% para FreeStyle libre cumplieron el criterio según la gradilla de Parkes (Consensus) (p = 0,0535), y el 79,5 y el 91,6% de las mediciones cumplieron el criterio según la gradilla de Clarke (p = 0,0273) siendo superior con Libre. Conclusiones El uso del transmisor NFC-Bluetooth (Miao-Miao) asociado a la aplicación xDrip+ no mejora la precisión numérica ni clínica para la detección de los eventos de hipoglucemia en los personas con diabetesQ3Q3Introduction There are data capture devices that attach to the FreeStyle Libre sensor and convert its communication from NFC (Near-field communication) to Bluetooth technology, generating real-time continuous glucose monitoring. The accuracy of hypoglycemia measurements displayed by smartphone apps using this device has not been established. Methods Study of diagnostic tests. Numerical accuracy was evaluated, utilizing the absolute difference with respect to capillary glucometry (ISO 15197:2015 standard) and clinical accuracy, using the Clarke and Parkes (Consensus) error grids, for glucose measurements less than 70 mg/dL performed with the FreeStyle Libre system and with the digital estimation xDrip+ app, in diabetic patients managed with insulin therapy. Results Twenty-seven patients were included (TIR 73.4%, TBR70 5.6%), who contributed 83 hypoglycemic events. Numerical accuracy was adequate in similar proportions with the FreeStyle Libre system compared to the xDrip+ app (81.92% vs. 68.67%, p = 0.0630). The clinical accuracy evaluation showed that 92.8% of the measurements for xDrip + and 98.8% for FreeStyle libre met the criteria according to the Parkes (Consensus) grid (p = 0.0535); and 79.5% and 91.6% of the measurements met the criteria according to the Clarke grid (p = 0.0273), being higher with FreeStyle libre. Conclusions The use of the NFC-Bluetooth transmitter (Miao-Miao) associated with the xDrip+ app does not improve numerical or clinical accuracy for detecting hypoglycemic events in diabetic patients managed with insulin therapy, compared to the FreeStyle Libre device.Revista Internacional - IndexadaS

Different indexes of glycemic variability as identifiers of patients with risk of hypoglycemia in type 2 diabetes mellitus

Q1Artículo original1007-1015Introduction: Recent publications frequently introduce new indexes to measure glycemic variability (GV), quality of glycemic control, or glycemic risk; however, there is a lack of evidence supporting the use of one particular parameter, especially in clinical practice. Methods: A cohort of type 2 diabetes mellitus (T2DM) patients in ambulatory care were followed using continuous glucose monitoring sensors (CGM). Mean glucose (MG), standard deviation, coefficient of variation (CV), interquartile range, CONGA1, 2, and 4, MAGE, M value, J index, high blood glucose index, and low blood glucose index (LBGI) were estimated. Hypoglycemia incidence (<54 mg/dl) was calculated. Area under the curve (AUC) was determined for different indexes as identifiers of patients with risk of hypoglycemia (IRH). Optimal cutoff thresholds were determined from analysis of the receiver operating characteristic curves. Results: CGM data for 657 days from 140 T2DM patients (4.69 average days per patient) were analyzed. Hypoglycemia was present in 50 patients with 144 hypoglycemic events in total (incidence rate of 0.22 events per patient/day). In the multivariate analysis, both CV (OR 1.20, 95% CI 1.12-1.28, P < .001) and LBGI (OR 4.83, 95% CI 2.41-9.71, P < .001) were shown to have a statistically significant association with hypoglycemia. The highest AUC were for CV (0.84; 95% CI 0.77-0.91) and LBGI (0.95; 95% CI 0.92-0.98). The optimal cutoff threshold for CV as IRH was 34%, and 3.4 for LBGI. Conclusion: This analysis shows that CV can be recommended as the preferred parameter of GV to be used in clinical practice for T2DM patients. LBGI is the preferred IRH between glycemic risk indexes

XVI International Congress of Control Electronics and Telecommunications: "Techno-scientific considerations for a post-pandemic world intensive in knowledge, innovation and sustainable local development"

Este título, sugestivo por los impactos durante la situación de la Covid 19 en el mundo, y que en Colombia lastimosamente han sido muy críticos, permiten asumir la obligada superación de tensiones sociales, políticas, y económicas; pero sobre todo científicas y tecnológicas. Inicialmente, esto supone la existencia de una capacidad de la sociedad colombiana por recuperar su estado inicial después de que haya cesado la perturbación a la que fue sometida por la catastrófica pandemia, y superar ese anterior estado de cosas ya que se encontraban -y aún se encuentran- muchos problemas locales mal resueltos, medianamente resueltos, y muchos sin resolver: es decir, habrá que rediseñar y fortalecer una probada resiliencia social existente - producto del prolongado conflicto social colombiano superado parcialmente por un proceso de paz exitoso - desde la tecnociencia local; como lo indicaba Markus Brunnermeier - economista alemán y catedrático de economía de la Universidad de Princeton- en su libro The Resilient Society…La cuestión no es preveerlo todo sino poder reaccionar…aprender a recuperarse rápido.This title, suggestive of the impacts during the Covid 19 situation in the world, and which have unfortunately been very critical in Colombia, allows us to assume the obligatory overcoming of social, political, and economic tensions; but above all scientific and technological. Initially, this supposes the existence of a capacity of Colombian society to recover its initial state after the disturbance to which it was subjected by the catastrophic pandemic has ceased, and to overcome that previous state of affairs since it was found -and still is find - many local problems poorly resolved, moderately resolved, and many unresolved: that is, an existing social resilience test will have to be redesigned and strengthened - product of the prolonged Colombian social conflict partially overcome by a successful peace process - from local technoscience; As Markus Brunnermeier - German economist and professor of economics at Princeton University - indicates in his book The Resilient Society...The question is not to foresee everything but to be able to react...learn to recover quickly.Bogot

Centrality evolution of the charged-particle pseudorapidity density over a broad pseudorapidity range in Pb-Pb collisions at root s(NN)=2.76TeV

Peer reviewe

Design and implementation of a closed-loop blood glucose control system in patients with type 1 diabetes

In the work presented in this dissertation, open-loop and closed-loop control strategies that were aimed at resolving major glucose control problems in the postprandial period were developed. A new model-based control algorithm for postprandial glucose regulation in open-loop, which is based on set-inversion technology, was developed. It automatically and efficiently coordinates the values of basal-bolus insulin to achieve certain predefined control objectives. The algorithm was designed to enable integration into existing smart insulin pumps. Closed-loop control strategies based on sliding mode techniques and insulin-on-board constraints were implemented to reduce the risk of late hypoglycaemic events and to obtain safer controller performance without increasing the period of hyperglycaemia. Extensive evaluation and validation of the control robustness was performed in a comprehensive virtual environment that was specifically designed and implemented to facilitate realistic simulations. A practical methodology to “virtualise” a cohort of real Type 1 diabetic patients was also developedEn aquesta investigació, es desenvolupen estratègies de control en llaç obert i llaç tancat encaminades a superar els principals problemes de control de glucosa al període postprandial. Es va desenvolupar un nou algoritme de control basat en models en llaç obert amb tecnologia d'inversió de conjunts. Aquest coordina automàticament els valors d'insulina basal-bol d'una manera eficient per tal d'aconseguir certs objectius de control predefinits. L'algoritme va ser dissenyat per permetre la seva integració en bombes d'insulina intel•ligents. També, es van implementar estratègies de regulació en llaç tancat basades en tècniques de control en mode lliscant i limitacions de la insulina a bord, per reduir el risc d'episodis d'hipoglucèmia tardana per tal d'aconseguir un acompliment més segur sense augmentar el temps a hiperglucèmia. La robustesa dels controladors va ser demostrada mitjançant una àmplia avaluació i validació en un entorn virtual integral específicament dissenyat i implementat en aquesta tesi per permetre simulacions realiste

Limiting vertical acceleration for ride comfort in active suspension systems

This article proposes a new adaptive control algorithm for active suspension systems of passenger cars. It combines a proportional–integral–derivative controller for suspension deflection together with a sliding mode reference conditioning outer loop that uses the vertical acceleration of the car body as a complementary source of control. The proposed approach is software-based and allows setting up limit values to critical variables, such as the vertical acceleration, which can be directly tuned by the system designer to range from the original proportional–integral–derivative response to other ones with tighter control on the constrained variable. A longitudinal half-car system subject to irregular excitation from a road surface is used for assessment. The proposed proportional–integral–derivative with sliding mode reference conditioning is compared to the same proportional–integral–derivative controller without the outer conditioning loop, as well as with a passive suspension system. International standards on overall vibration magnitudes are used to quantify the differences obtained in this assessment. Results obtained from the proposed control system show better performance and handle trade-offs, improving the ride comfort without adversely affecting the road holding of the car.Fil: León-Vargas, Fabian. Universidad Antonio Nariño; ColombiaFil: Garelli, Fabricio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Zapateiro, Mauricio. Edma Innova; Españ

Renewable energy use strategies focused on urban planning and environmental conditions of homes in Bogotá

This work establishes the methodological framework on which two scenarios of renewable energy use strategies (energy transition) focused on urban planning and environmental conditions of houses in Bogotá are evaluated, based on the technical, economic and environmental assessment. The results obtained in the predecessor research carried out at the Antonio Nariño University on the pre-feasibility of wind and solar systems for residential self-sufficiency are evaluated under the implication of the new incentives included in Law 1715 of 2014. The results of said study show that the wind system is unable to obtain a payback period for the investment, even considering the application of the new legal incentives, while the solar photovoltaic system can pay off within the established useful life horizon; when applying the incentives of Law 1715 (Value added tax and customs taxes excluded); The work concludes that it is possible to obtain a payback period of the system between 10.6 and 12.9 years, depending on the socioeconomic strata where it is implemented [1], however, according to the economic evaluation criteria and the variability of the Market conditions, this range of the payback period, as well as other profitability indicators can vary significantly. Additionally, the research methodology currently being carried out between the Universidad de La Salle and the Universidad Antonio Nariño entitled \u27Renewable energy use strategies focused on urban planning and environmental conditions of housing in Colombia\u27 is partially synthesized. In this investigative process and taking as reference the UPZ 36 (San José-Localidad Rafael Uribe) and 57 (Gran Yomasa-Localidad Usme) of the city of Bogotá, a pilot process is carried out to assess the possible change that may arise in the human and environmental health, with the potential replacement of the electrical energy source in homes

Hypoglycemia incidence and factors associated in a cohort of patients with type 2 diabetes hospitalized in general ward treated with basal bolus insulin regimen assessed by continuous glucose monitoring

Q1Artículo original233-239Introduction: Continuous glucose monitoring (CGM) is a better tool to detect hyper and hypoglycemia than capillary point of care in insulin-treated patients during hospitalization. We evaluated the incidence of hypoglycemia in patients with type 2 diabetes (T2D) treated with basal bolus insulin regimen using CGM and factors associated with hypoglycemia. Methods: Post hoc analysis of a prospective cohort study. Hypoglycemia was documented in terms of incidence rate and percentage of time <54 mg/dL (3.0 mmol/L) and <70 mg/dL (3.9 mmol/L). Factors evaluated included glycemic variability analyzed during the first 6 days of basal bolus therapy. Results: A total of 34 hospitalized patients with T2D in general ward were included, with admission A1c of 9.26 ± 2.62% (76.8 ± 13 mmol/mol) and mean blood glucose of 254 ± 153 mg/dL. There were two events of hypoglycemia below 54 mg/dL (3.0 mmol/L) and 11 events below 70 mg/dL (3.9 mmol/L) with an incidence of hypoglycemic events of 0.059 and 0.323 per patient, respectively. From second to fifth day of treatment the percentage of time in range (140-180 mg/dL, 7.8-10.0 mmol/L) increased from 72.1% to 89.4%. Factors related to hypoglycemic events <70 mg/dL (3.9 mmol/L) were admission mean glucose (IRR 0.86, 95% CI 0.79, 0.95, P < .01), glycemic variability measured as CV (IRR 3.12, 95% CI 1.33, 7.61, P < .01) and SD, and duration of stay. Conclusions: Basal bolus insulin regimen is effective and the overall incidence of hypoglycemia detected by CGM is low in hospitalized patients with T2D. Increased glycemic variability as well as the decrease in mean glucose were associated with events <70 mg/dL (3.9 mmol/L)

Active Surveillance of Antimicrobial Resistance and Carbapenemase-Encoding Genes According to Sites of Care and Age Groups in Mexico: Results from the INVIFAR Network

We analyzed the antimicrobial resistance (AMR) data of 6519 clinical isolates of Escherichia coli (n = 3985), Klebsiella pneumoniae (n = 775), Acinetobacter baumannii (n = 163), Pseudomonas aeruginosa (n = 781), Enterococcus faecium (n = 124), and Staphylococcus aureus (n = 691) from 43 centers in Mexico. AMR assays were performed using commercial microdilution systems (37/43) and the disk diffusion susceptibility method (6/43). The presence of carbapenemase-encoding genes was assessed using PCR. Data from centers regarding site of care, patient age, and clinical specimen were collected. According to the site of care, the highest AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from ICU patients. In contrast, in A. baumannii, higher AMR was observed in isolates from hospitalized non-ICU patients. According to age group, the highest AMR was observed in the ≥60 years age group for E. coli, E. faecium, and S. aureus, and in the 19–59 years age group for A. baumannii and P. aeruginosa. According to clinical specimen type, a higher AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from blood specimens. The most frequently detected carbapenemase-encoding gene in E. coli was blaNDM (84%)

Revista Temas Agrarios Volumen 26; Suplemento 1 de 2021

1st International and 2nd National Symposium of Agronomic Sciences: The rebirth of the scientific discussion space for the Colombian Agro.1 Simposio Intenacional y 2 Nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano