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Continuous glucose monitoring (CGM) is an essential tool for modern diabetes therapy. Randomized controlled studies have provided evidence that hemoglobin A1c (HbA1c) results can be improved in patients with type 1 diabetes with elevated baseline HbA1c when using CGM frequently enough and that the frequency and duration of hypoglycemic events can be reduced in patients with satisfactory baseline HbA1c. The CGM group within the Working Group Diabetes Technology (AGDT) of the German Diabetes Association (DDG) has defined evidence-based indications for the practical use of CGM in this consensus statement related to hypoglycemia (frequent, severe, or nocturnal) or hypoglycemia unawareness, insufficient metabolic control despite use of all possible therapeutic options and patient compliance, pregnancy associated with inadequate blood glucose results, and the need for more than 10 blood glucose measurements per day. Contraindications and defined preconditions for the successful use of CGM should be considered.

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BACKGROUND: The emergence of real-time glucose sensors for people with diabetes may replace discontinuous monitoring (self-monitored blood glucose [BG]) in the future. In this study, we use a computer-generated "virtual" patient to predict changes in behavior that may result from an increased awareness of BG levels. METHODS: The employed strategy required educated patients with type 1 diabetes to simulate a virtual patient using the DIABLOG Scientific simulator, interactive computer program. Thirty patients with a mean age of 34 years and duration of diabetes of 18 years (15 with continuous subcutaneous insulin infusion, 15 with intensive conventional therapy) simulated several daily glucose profiles with conventional self-monitoring of BG, using the time-lapse function of the program. Thereafter they had access to the actual glucose value either in a watch-type display or in a graphical display. Behavioral changes were monitored and stored. RESULTS: Mean BG value improved from 154 to 139 mg/dL (P < 0.05). The analysis of the process and behavioral changes revealed that patients recognized an impending hypoglycemia with the sensor in 94% of cases (59% without sensor) and reacted adequately in 98% of cases in order to avoid hypoglycemia. The frequency of hypoglycemia could be reduced from 1.7 per week to 0.5 per week. Unnecessary interventions (mostly by administration of carbohydrates) doubled to 3.2 per week using the continuous measurement system. Impending hyperglycemia could only be prevented in 25% of cases without a sensor, and with sensor this ratio could only be marginally improved to 29%. Supplementary insulin administration resulted in hypoglycemia only in a few cases. CONCLUSIONS: With the continuous measurement of their actual BG, subjects could reduce the frequency of hypoglycemia by 50% but increased the number of unnecessary interventions (excess carbohydrate intake or prematurely without a real hypoglycemia threat). Hyperglycemia prevention is a more difficult task. Simulation with an in silico disease model is a realistic alternative to studies in patients. A simulation program such as DIABLOG could be valuable for education in order to more rapidly and reliably recognize impending hypo- and hyperglycemia episodes.

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BACKGROUND: Patients with insulin dependent diabetes require frequent advice if their metabolic control is not optimal. This study focuses on the fiscal and administrative aspects of telemanagement, which was used to establish a supervised autonomy of patients on intensified insulin therapy. METHODS: A prospective, randomised trial with 43 patients on intensified insulin therapy was conducted. Travelling distance to the diabetes centre was 50 min one way; all patients had undergone a diabetes education course with lessons in dose adaptation. Patients were randomly assigned to telecare (n=27) or conventional care (n=16). They used BG-meters with a storage capacity of 120 values (Precision QID Abbott/Medisense) and transmitted their data over a combined modem/interface via telephone line to the diabetes centre. Data were displayed and stored by a customised software (Precision Link Plus, Abbott/Medisense). Advice for proper dose adjustment was given by telephone. RESULTS: Average time needed for instruction in the telemedical system was 15 min. Data were transmitted every 1-3 weeks and a teleconsultation was performed by phone every 2-4 weeks, depending on the extent of specific problems. On average, personal visits in the control group were performed once a month. Physician's time expenditure for telemanagement, compared to conventional advice was moderately higher (50 vs. 42 min per month). A substantial amount of time on the patients side could be saved through replacing personal communications by telephone contacts and data transmission reduction (96 vs. 163 min/month including data transmission time). Setting up an optimal telemanagement scenario, a cost analysis was carried out yielding savings of approximately 650 euro per year per patient. HbA(1c) dropped significantly from 8.2 to 7.0% after 8 months of observation, but there was no significant difference between the intervention and control groups. Major technical problems with the telematic system did not occur during the study. CONCLUSIONS: Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management.

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Durante los últimos años, el uso de la tecnología fotovoltaiza (FV) para el suministro mínimo de electricidad, para hogares rurales en áreas de población dispersa en el Tercer Mundo, se ha convertido en una alternativa real al suministro tradicional de electricidad.