Continuous Ketone Monitoring – a world’s first from SiBio? by Tim Street for Diabettech.com, 17 July 2023.  

SiBio describes itself as “an innovative company with medical active implant and medical artificial intelligence research and development as its core technology. It is an innovator and leader in the field of biomonitoring, focusing on serving people in the consumer sector, dedicated to improving people’s lifestyles and understanding their physical state, and discovering more body secrets.”  They were founded in Shenzhen in 2015.

 

 

 

 

 

It appears very similar to the CGM sensors we know and love. The box everything comes in is similar sized to the Libre2, which contains a two-part applicator that’s very similar to the Libre system. Once applied, the sensor looks like any other sensor. It’s very flat but has a similar size to a Dexcom G6. It’s not got a large sticky patch, so it remains to be seen whether it lasts a full 14 days. The box also didn’t contain an additional overlay.  The app is fairly simple. It’s targeted at those who are following a ketogenic diet and is designed to tell you when you’re in ketosis. 

There doesn’t appear to be a way to extract data from the app, and frustratingly, it’s not a continuous monitor in the sense that it doesn’t appear to always receive data, although the ads suggest it is collected and transmitted every five minutes. The pseudo-continuous data and the setup of the app are clearly designed around nutrition rather than medical monitoring. There are, therefore, no alarms built into the system.

Is it accurate?  I don’t know yet. It will need some testing against ketone strips, and I need to acquire those. That and a couple of weeks of low carb should give some indication of how well it works and whether it’s accurate against the blood tests.

Another GREAT review … THANK YOU Tim Street of Diabettech.com!

Read more: 

• • • Continuous Ketone Monitoring – a world’s first from SiBio?
    • SiBio Website

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ATTD 2023: What Is The Right Time In Range? by  Leon Tribe for PracticalDiabetic.com, 12 March 2023.

The default standard is the range 70-180 mg/dL (3.9-10 mmol/L) and the traditional target was to reside within this range for more than 70% of the time, as measured by a Continuous Glucose Monitor (CGM).  Here is a link to Leon Tribe’s piece … What is Time in Range?  What is Time in Range?

This presentation at ATTD 2023 put the target under the microscope to see if it needed revising.  Professor Thomas Danne introduced a concept of a Time in Tight Range (TITR) which reduces the range to 70-140 mg/dL (3.9-7.8 mmol/L). Why a new range? Because Professor Danne literally said “I don’t want to lie any longer”.

The suggestion was, to live a normal, healthy life, 70% TIR was not enough but to give truth to what needs to be achieved would discourage when encouragement was needed so a “soft target” was given instead. An advantage of considering TITR is spikes, which may remain within TIR but not TITR, can be identified and worked on, assuming managing levels within TIR has been achieved.

Professor Danne stated he felt the latest ISPAD Time in Range guidelines do not go far enough, claiming the life expectancy of a child with type 1 diabetes will not be the same as a child without type 1 diabetes using these targets.  His preferred goal? An ambulatory glucose profile characterized as Flat, Narrow, and In Range (FNIR). Dr. Peter Adolfsson discussed what target we need to achieve, not to match people without diabetes, but to reduce the risk of complications to match the non-diabetic population, and suggested an HbA1c of 6.5% was sufficient for this which corresponded to a TITR of 50%.  Click here for more: HbA1c of 6.4% is BETTER.

His goal is to provide guidance to people with diabetes and their carers which is considered achievable and sustainable, even if this means historically softening the targets. Also, Professor Danne made it clear a qualitative daily target was insufficient but a SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal was also needed i.e. quantitative as well as qualitative. His solution? Automated Insulin Delivery i.e. Looping.  On top of using AID, he also mentioned the results being achieved with SGLT2i drugs (which basically redirect glucose in the blood to the bladder, keeping blood glucose levels low).

Rather than pursue the goal of “normal blood sugars”, the goal is to be “free of long-term complications”. TITR can be measured, at home, by anyone with a CGM (unlike HbA1c). Also, the individual can choose how strict they want to be in pursuing “normalcy” i.e. sit at 50% TITR and minimize the risk of complications or go harder to achieve the blood glucose levels of a person without diabetes. This latitude in the percentage allows flexibility in terms of the individual’s personal circumstances which, in turn, minimizes the risk of burnout.

Read more: 

• • • ATTD 2023: What Is The Right Time In Range?
    • Time in range becomes an increasingly important diabetes target

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A REVIEW:  Diabetes Chill Mode — the iLet by Marissa Town for ChildrenWithDiabetex.com, 25 July 2023.  Here’s one of the first reviews I’ve seen about the iLET.

When I started the training with Beta Bionics, they asked me to name the iLet, and this is something that I always feel like is a high-pressure thing. I immediately thought of “Chill Mode” which is something that Tesla has to describe a driving mode. My whole purpose of trying this device was hoping to put my diabetes in “Chill Mode” –meaning I wouldn’t be doing all kinds of things to try to stay in range. This is how the iLet was designed – not for a lot of micromanaging (more on this later).  Here are some of the bells and whistles:

• • • Induction charging with a battery that lasts about a week
    • The only setting you put into the pump is your body weight
    • The algorithm learns you as you wear it and adapts over time
    • The second cartridge slot is already in the device for when glucagon is an option

I knew I needed to wear it at home to see how it would really work for me. I also will share that I do not love the current cartridge system it uses. It honestly makes me a little nervous for people who are new to pumping to start on the system, but it’s a kink they have already planned on and started working out.

About three weeks into wearing the system I had this dream where I found out I was going to run out of supplies and have to go back to my Tandem Control IQ. Keep in mind, that I have LOVED my Control-IQ system for years at this point. I woke up thinking, “that was a weird dream” and moved on with being a normal human and going to work, etc.

The next day, I then reflected on the dream and realized how much I really am enjoying this system. I had not carefully counted my carbohydrates in three weeks, and I did not want to have to do it again if I could help it. I know it sounds like it’s not that big of a deal if you don’t do diabetes every day. But if you do – you get it. It’s been incredible not having this added task every day for almost 4 weeks now.

It’s not that my blood sugars are better or my time in range is increased, they are all about the same as Control-IQ. It’s that my diabetes is less work, less mental time, less frustration. It’s that when I’m high after a meal where I selected “usual” I think, welp, I guess I try “more than usual” next time. It’s that there is not as much effort going into a bolus that didn’t work out. I feel less defeated. I feel lighter. Diabetes sucks just a little bit less, and for me, this is a dream come true.

You have to do what works best for you and your diabetes, and that may change over time, and that’s okay, too! The beauty is that we have options and hopefully we continue to have options and access to using whatever diabetes tools we want. For now, I’m loving my “Chill Mode” iLet, and I hope you find something that helps diabetes feel a little lighter for you, too.

Read more: Diabetes Chill Mode — the iLet

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ANOTHER REVIEW: I’m sorry to say I’m not loving Dexcom’s G7 by Riva Greenberg for DiabetesStories.com, 21 July 2023.

Given the title here you know I’m not loving this new version (G7), but before I get to my negatives, I’ll tell you what I do like based on just a week of wear.

What I like about the G7:

• • • Half hour or less to warm up
    • Sensor and transmitter in one piece 
    • 12 hour grace period

What I don’t like about the G7:

• • • The signal gets dropped multiple times a day. 
    • No widget
    • First day numbers
    • The interface – Devoid of color I find it more clinical and less friendly
    • The inserter – I experience the insertion as a bullet’s impact but definitely too powerful
    • The overpatch – Why couldn’t they at least have made the overpatch clear?
    • The app – It’s spared downand not user friendly

In conclusion, the smaller size and rounder shape don’t mean enough to me to compensate for the things I don’t like. The MARD, which means how accurate it is, is slightly better than G6 but, for me, unnoticeable. There’s a feeling Dexcom rushed this one out of the gate and I wonder how many PWDs they consulted with. I can’t imagine a lot of these hiccups would exist if they’d listened to users.

Read more: I’m sorry to say I’m not loving Dexcom’s G7

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Aging and Type 1 Diabetes: ‘Complete Picture’ 40 Years On by Miriam Tucker for Medscape.com, 11 July 2023.

The landmark Diabetes Control and Complications Trial (DCCT) follow-up study has entered a new phase, focusing on a relatively recent phenomenon: aging in type 1 diabetes.  New funding for 2022-2027 for the DCCT long-term observational follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC) will go toward investigating aspects of type 1 diabetes that are associated with aging and are also common in type 2 diabetes, including cardiovascular disease, fatty liver disease, and sleep apnea.

The original randomized DCCT clinical trial results, published September 30, 1993, in the New England Journal of Medicine, proved that early intensive glycemic control was the key to preventing or slowing the progression of long-term eye, kidney, and nerve complications of type 1 diabetes. Subsequently, EDIC has yielded many more major findings including that early tight glycemic control also reduces cardiovascular risk and prolongs survival in type 1 diabetes.

And although the phenomenon of metabolic memory initially seen in EDIC means that early glycemic control is important, subsequent EDIC data also have suggested that it is never too late to initiate intensive glycemic control, speakers emphasized during a special symposium commemorating 40 years since the start of DCCT, held during the recent American Diabetes Association 83rd Scientific Sessions.

“DCCT/EDIC because of its longevity represents a unique opportunity to explore aging in long duration of type 1 diabetes, something that heretofore none of us could have imagined, especially for those of you in the audience who started your careers in the 70s and 80s,” commented study coordinator co-chair Gayle Lorenzi, RN, who is a Certified Diabetes Care and Education Specialist (CDCES) at the University of California, San Diego.

According to Barbara H. Braffett, PhD, co-principal investigator at the DCCT/EDIC data coordinating center, “The EDIC study is now shifting its focus during the next 5 years to understand the clinical course of type 1 diabetes in the setting of advancing duration and age, as well as increasing adiposity, which has progressively affected individuals with type 1 diabetes and has potential long-term adverse consequences.”

“All of the advances in the care of type 1 diabetes have developed because this study demonstrated that it was important — continuous glucose monitoring (CGM), new insulins, better [insulin] pumps … I think the most profound finding is that mortality in our intensively treated cohort is the same as in the general population. That says it all,” said DCCT/EDIC chair David M. Nathan, MD.

Read more: Aging and Type 1 Diabetes: ‘Complete Picture’ 40 Years On

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To Report adverse events for medical products to the FDA: MedWatch Online Voluntary Reporting Form

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The 9 Genes Identified that Cause Type 1 Diabetes by Tavia Vital, Director of Intensive Diabetes Management for Integrated Diabetes Sevices, 22 July 2023.

 

 

• • • This new discovery narrows down the target genes to a small number for potential immunotherapies, (treatments focused on reprogramming the immune system) to change the story of T1D.
    • With this new information, researchers can focus on developing genetic therapies that could potentially prevent, delay, or treat T1D.
      Think this is too far-fetched and way out in Science-Fiction Land?  Read about Teplizumab (Tzield), the first FDA-approved immunotherapy for delaying the onset of T1D.

Here are some definitions for you: 

• • • Single Nucleotide Polymorphism (SNPs): when 1 of the 4 parts that make up DNA in a gene has a change in it
    • Expression quantitative trait loci (eQTL):  a larger area in a genetic sequence that is different than the ‘norm’
    • Human Leukocyte Antigen (HLA):  a group of genes located in chromosome 6 that play a role in regulating the immune system
    • Core genes: genes found in nearly all people.  In this discussion, the core genes are the changed genes responsible for allowing T1D to occur
    • Trans-effects:  cause changes to the core genes, sometimes called “peripheral master regulators.”

There were several missing pieces to the genetic storyline for those of us with T1D.  The scientists from this study sorted and grouped 9 core genes that explain the different genetic makeups of T1D. These genetic variances help explain why some immunotherapy options work well in some people and not at all in other people with T1D.

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Could eating strawberries daily improve heart and brain health? by Corrie Pelc for MedicalNewsToday.com, 28 July 2023.

Generally speaking, berries are considered a superfood. That is because all berries — including acai berries, blueberries, blackberries, and raspberries — provide numerous health benefits.  Previous studies have found that consuming berries can help ease inflammation and oxidative stress, which can be triggers for many diseases.  Other studies have linked berry consumption to benefitting and protecting certain areas of the body, including the gut microbiota, nervous system, cardiovascular system, and immune system.

New research from San Diego State University says eating strawberries every day can help improve cognitive function, lower blood pressure, and increase a person’s antioxidant capacity.  The research was recently presented at NUTRITION 2023, the annual meeting of the American Society of Nutrition, and was funded by the California Strawberry Commission.  (IS THIS A RED FLAG FOR YOU???)

Strawberries (genus Fragaria) were first grown in gardens in France in the late 18th century. However, they could be found in the wild as far back as Roman times.  Today, strawberries are grown in many parts of the world, with most production occurring in the United States, Turkey, and Spain.  Interestingly, although strawberries are considered a “berry,” they are technically an accessory or aggregate fruit because of how they grow.

Strawberries contain many vitamins and minerals the body needs to stay healthy, including vitamin A, magnesium, potassium, and folate (vitamin B9).  Additionally, strawberries are very high in vitamin C — eating just eight strawberries provides the body with its daily vitamin C intake.  And strawberries are known to have a large amount of antioxidants, including polyphenols and phytosterols. Polyphenols have antioxidant and anti-inflammatory properties, and phytosterols aid in lowering cholesterol levels.

Read more: Could eating strawberries daily improve heart and brain health?

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Some more great videos from TCOYD with Drs. Steve Edelman Jeremy Pettus, both endos and T1Ds.

 

Learning about interpreting CGM download data, hybrid closed loop systems, cardiovascular health, and new approaches to managing T1D.

Learn more / Click the text: TCOYD Deep Dive Series