Considering the local evolution, necrotizing soft tissue infection was suspected and a prompt surgical debridement was decided. Her symptoms extended within 12 h with increasing edema, blisters occurrence and necrosis ( Figure 1B). We started an empirical intravenous antibiotic therapy by amoxicillin–clavulanic acid and clindamycin. Laboratory findings showed a high white blood cell count of 28.4 × 10 9/l, predominantly neutrophils (26.1 × 10 9/l), a high level of C-reactive protein (2800 nmol/l) and negative blood cultures. Her physical examination was limited by pain but revealed an erythematous, swollen, warm, painful edema, with a purpuric plaque and no crepitus on the left upper arm, along with fever ( Figure 1A). She had been using a FreeStyle Libre™ FGM system (Abbott Diabetes Care, IL, USA) glucose monitoring system for 1 month and had changed the device 8 days earlier. She was using an insulin pump therapy to treat her diabetes diagnosed in 1988, offering a good control without diabetic complications. Many adults with T1D have suboptimal knowledge and behaviour regarding glucose self-management.A 35-year-old woman with Type 1 diabetes was admitted for an erysipelas of her left upper arm. Conclusions: A range of tools are available to test glucose and ketone levels at home. Further education was often desired, but difficult to predict based on demographics. Only 66% reported having in-date ketone test-strips at home. Only about one third reported treating nocturnal hypoglycaemia with the recommended refined then complex carbohydrate. Deficits in knowledge or practice related to the care of hypothetical pre-bed BG levels and of metabolic control around illness, exercise or alcohol were common. In surveys of adults with T1D in two tertiary referral diabetes clinics (n=205) and in general practice (GP, n=35) self-reported rates of blood glucose (BG) monitoring and glucose targets were similar, with a mean (SD) of 5.3 (2.5) tests/day. Blood and urine ketone test-strips are also available. More recently available are continuous glucose monitors (CGM) and flash glucose monitoring (FGM) which assess interstitial fluid glucose levels. Results: Blood glucose strips and meters and urine glucose strips have been available for decades. Additionally, findings from the authors' surveys of T1D adults regarding glucose self-care are discussed. Aims: This mini-review describes clinically available home glucose and ketone monitoring tools and discusses factors which impact glucose outcomes. Tools must be used appropriately, and the information gained utilised well to maximise clinical benefit. An increasing array of devices is available for at-home monitoring. The main objective of the review is to provide a thorough and critical analysis of recent advances and developments in microneedle research field and to bridge the gap between microneedles and biosensors.īackground: In Type 1 diabetes (T1D) glycaemic control is key to the prevention of acute and chronic complications. In this review, we provide a general overview of recent progress in microneedle-based sensing research, including: (a) in-vivo microneedle diagnostic systems for glucose monitoring with an emphasis on sensor construction and general health monitoring (b) in-vitro use of microneedle sensors. This would eliminate the need for blood extraction using hypodermic needles and in turn, reduce the related problems such as infections in the patients, sample contaminations, and analysis artifacts. Transdermal biosensing via microneedles offers remarkable opportunities for moving biosensing technologies from research laboratories to real-field applications and enables development of easy-to-use point-of-care microdevices, minimally invasive, and with minimal-training features that are very attractive for both developed and emerging countries. Microneedles have emerged for transdermal monitoring of biomarkers, which are a miniaturized replica of hypodermic needles with length-scales of hundreds of micrometers, with a goal to achieve time-sensitive clinical information for routine point-of-care health monitoring.
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