1
|
Secco K, Baumann PM, Pöttler T, Aberer F, Cigler M, Elsayed H, Harer CM, Weitgasser R, Schütz-Fuhrmann I, Mader JK. Glycemic Control Assessed by Intermittently Scanned Glucose Monitoring in Type 1 Diabetes during the COVID-19 Pandemic in Austria. SENSORS (BASEL, SWITZERLAND) 2024; 24:4514. [PMID: 39065912 PMCID: PMC11280813 DOI: 10.3390/s24144514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The aim of this analysis was to assess glycemic control before and during the coronavirus disease (COVID-19) pandemic. METHODS Data from 64 (main analysis) and 80 (sensitivity analysis) people with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM) were investigated retrospectively. The baseline characteristics were collected from electronic medical records. The data were examined over three periods of three months each: from 16th of March 2019 until 16th of June 2019 (pre-pandemic), from 1st of December 2019 until 29th of February 2020 (pre-lockdown) and from 16th of March 2020 until 16th of June 2020 (lockdown 2020), representing the very beginning of the COVID-19 pandemic and the first Austrian-wide lockdown. RESULTS For the main analysis, 64 individuals with T1D (22 female, 42 male), who had a mean glycated hemoglobin (HbA1c) of 58.5 mmol/mol (51.0 to 69.3 mmol/mol) and a mean diabetes duration 13.5 years (5.5 to 22.0 years) were included in the analysis. The time in range (TIR[70-180mg/dL]) was the highest percentage of measures within all three studied phases, but the lockdown 2020 phase delivered the best data in all these cases. Concerning the time below range (TBR[<70mg/dL]) and the time above range (TAR[>180mg/dL]), the lockdown 2020 phase also had the best values. Regarding the sensitivity analysis, 80 individuals with T1D (26 female, 54 male), who had a mean HbA1c of 57.5 mmol/mol (51.0 to 69.3 mmol/mol) and a mean diabetes duration of 12.5 years (5.5 to 20.7 years), were included. The TIR[70-180mg/dL] was also the highest percentage of measures within all three studied phases, with the lockdown 2020 phase also delivering the best data in all these cases. The TBR[<70mg/dL] and the TAR[>180mg/dL] underscored the data in the main analysis. CONCLUSION Superior glycemic control, based on all parameters analyzed, was achieved during the first Austrian-wide lockdown compared to prior periods, which might be a result of reduced daily exertion or more time spent focusing on glycemic management.
Collapse
Affiliation(s)
- Katharina Secco
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Petra Martina Baumann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Tina Pöttler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Monika Cigler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Hesham Elsayed
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Clemens Martin Harer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Raimund Weitgasser
- Department of Internal Medicine and Diabetology, Private Clinic Wehrle-Diakonissen, 5026 Salzburg, Austria;
| | - Ingrid Schütz-Fuhrmann
- 3rd Medical Division for Metabolic Diseases and Nephrology, Hospital Hietzing, 1130 Vienna, Austria;
- Institute for Metabolic Diseases and Nephrology, Karl-Landsteiner Institute, 1130 Vienna, Austria
| | - Julia Katharina Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| |
Collapse
|
2
|
Kim JY, Jin SM, Andrade SB, Chen B, Kim JH. Real-World Continuous Glucose Monitoring Data from a Population with Type 1 Diabetes in South Korea: Nationwide Single-System Analysis. Diabetes Technol Ther 2024; 26:394-402. [PMID: 38277166 DOI: 10.1089/dia.2023.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Background: We used continuous glucose monitoring (CGM) data to investigate glycemic outcomes in a real-world population with type 1 diabetes (T1D) from South Korea, where the widespread use of CGM and the nationwide education program began almost simultaneously. Methods: Data from Dexcom G6 users with T1D in South Korea were collected between January 2019 and January 2023. Users were included if they provided at least 90 days of glucose data and used CGM at least 70% of the days in the investigational period. The relationship between CGM utilization and glycemic metrics, including the percentage of time in range (TIR), time below range (TBR), and time above range (TAR), was assessed. The study was approved by the Institutional Review Board of Samsung Medical Center (SMC 2023-05-030). Results: A total of 2288 users were included. Mean age was 41.5 years (57% female), with average uploads of 428 days. Mean TIR was 62.4% ± 18.5%, mean TBR <70 mg/dL was 2.6% ± 2.8%, mean TAR >180 mg/dL was 35.0% ± 19.3%, mean glucose was 168.1 ± 35.8 mg/dL, mean glucose management indicator was 7.2% ± 0.9%, and mean coefficient of variation was 36.7% ± 6.0%. Users with higher CGM utilization had higher TIR (67.8% vs. 52.7%), and lower TBR <70 mg/dL (2.3% vs. 4.7%) and TAR >180 mg/dL (30.0% vs. 42.6%) than those with low CGM utilization (P < 0.001 for all). Users whose data were shared with others had higher TIR than those who did not (63.3% vs. 60.8%, P = 0.001). Conclusions: In this South Korean population, higher CGM utilization was associated with a favorably higher mean TIR, which was close to the internationally recommended target. Using its remote data-sharing feature showed beneficial impact on TIR.
Collapse
Affiliation(s)
- Ji Yoon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Affiliation(s)
- Satish Garg
- University of Colorado Denver, Barbara Davis Center for Childhood Diabetes, 1775 Aurora Court, A140, Aurora, Colorado, United States, 80045;
| | - Christopher G Parkin
- CGParkin Communications, Inc., 2352 Martinique Ave, Henderson, Nevada, United States, 89044
- United States;
| |
Collapse
|
4
|
Swaich H, Advani A. Sustained Improvement in Glycemic Control in Emerging Adults with Type 1 Diabetes 2 Years After the Start of the COVID-19 Pandemic. Diabetes Ther 2023; 14:153-165. [PMID: 36467396 PMCID: PMC9708124 DOI: 10.1007/s13300-022-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Although there were initial concerns that the public health response to the COVID-19 pandemic would adversely affect glycemic control in people with type 1 diabetes, several early continuous glucose monitor (CGM) studies reported an unexpected slight improvement in glucose metrics. Early emerging adulthood (roughly spanning the ages of 18-24 years) is often a vulnerable time in the life of a person with type 1 diabetes. Here, we set out to determine how the care and glucose management of emerging adults with type 1 diabetes changed over a period of approximately 2 years from the start of the COVID-19 pandemic. METHODS This was a retrospective study of a tertiary referral, multidisciplinary young adult diabetes clinic, spanning before and after the 777-day state of emergency in the City of Toronto. RESULTS Of 130 emerging adults with type 1 diabetes (80 male, 50 female; mean age 21.0 ± 2.1 years), baseline pre-pandemic HbA1c values were available for 120 individuals. During 24.9 ± 5.4 months of follow-up before and after the start of the COVID-19 pandemic, HbA1c fell from 8.5 ± 1.7% (69.3 ± 18.8 mmol/mol) to 8.1 ± 1.9% (65.2 ± 20.5 mmol/mol) (P < 0.05), with change in HbA1c from pre-lockdown levels being sustained throughout the second year of the pandemic. Over the same period, CGM use rose from 43% to 83%, primarily through increased uptake of intermittently scanned CGM, which is covered through the Ontario Drug Benefit program. Change in HbA1c was most evident in Dexcom G6 real-time CGM users - 0.7 ± 1.2% (- 9.8 ± 17.1 mmol/mol) (P < 0.01 vs. self-monitoring of blood glucose). CONCLUSION Among emerging adults with type 1 diabetes attending a multidisciplinary clinic in a high-income country, glycated hemoglobin levels are on average 0.4% (4.1 mmol/mol) lower than they were before the pandemic. This reduction in HbA1c is unlikely to be a consequence of early strict lockdowns given the length of time of follow-up. Rather, improved glycemic control coincided with increased utilization of wearable diabetes devices.
Collapse
Affiliation(s)
- Harshpreet Swaich
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 6-151 61 Queen Street East, Toronto, ON M5C 2T2 Canada
| | - Andrew Advani
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 6-151 61 Queen Street East, Toronto, ON M5C 2T2 Canada
| |
Collapse
|
5
|
Muacevic A, Adler JR, Klein S, Bassie M, Gu K, Hille C, Brown C, Daniel M, Drakeley C, Jahnke A, Karim A, Altabbakh O, Phillpotts L. The World-Wide Adaptations of Diabetic Management in the Face of COVID-19 and Socioeconomic Disparities: A Scoping Review. Cureus 2022; 14:e31911. [PMID: 36579222 PMCID: PMC9792358 DOI: 10.7759/cureus.31911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
Diabetes is an increasingly prevalent chronic disease throughout the world. It is imperative for patients to have access to reliable treatment and resources in order to avoid long-term complications. Economic and social factors contribute to the accessibility of these resources and have a direct impact on diabetes management. Socioeconomic status (SES) presents challenges to diabetic management due to financial and geographical access to care, medications, educational resources, healthy food options, and physical activity. The coronavirus (COVID-19) pandemic exacerbated these challenges, especially during the height of lockdowns. Therefore, it is important to gain insight into how the pandemic challenged diabetes management, taking into consideration socioeconomic disparities. The objective is to assess how the COVID-19 pandemic has impacted the care of chronic diabetic patients internationally and determine how these outcomes vary between patients of different socioeconomic classes. The following study was designed as a scoping review and utilized PubMed, EMBASE, CINAHL, and Web of Science. A Boolean search strategy combined search terms as follows: (((COVID-19) AND (diabetes)) AND ((socioeconomic factors) OR (social inequality OR standard of living))) AND (treatment OR management). Inclusion criteria included studies addressing diabetic patients, socioeconomic variables (income, occupation, level of education, and ethnicity), glycemic control, and degree of access to quality healthcare. Studies exploring the pathophysiology of COVID-19 or diabetes mellitus were excluded. In addition, studies were chosen between the years 2020 and 2022. The search resulted in 214 articles. The full-text assessment was then conducted on the remaining 67 articles. After screening for eligibility and relevance, 19 articles were retained for this review. The results of this study indicate that 8 out of the 18 studies revealed worse outcomes for those with diabetes mellitus and concomitant COVID-19 infection. Patients with diabetes were more likely to be hospitalized and represent a larger percentage of COVID-19 fatalities. In addition, patients with diabetes and co-morbid COVID-19 infection were more likely to have a higher hemoglobin A1c (HbA1c), belong to a lower SES, and have worse glycemic control due to pandemic-associated lockdown. In order to combat the effects of the pandemic, many countries created novel and innovative management strategies. Overall, there are positive and negative effects from the pandemic on diabetic management strategies. This scoping review identified successes in diabetic treatment under pandemic conditions and areas that need optimization. The successful adaptations of many nations convey the capacity for new policy implementation to care for diabetic patients regardless of SES.
Collapse
|
6
|
Jensen MH, Cichosz SL, Gustenhoff P, Nikontovic A, Hejlesen O, Vestergaard P. Long-term glucose-lowering effect of intermittently scanned continuous glucose monitoring for type 1 diabetes patients in poor glycaemic control from Region North Denmark: An observational real-world cohort study. PLoS One 2022; 17:e0274626. [PMID: 36240184 PMCID: PMC9565441 DOI: 10.1371/journal.pone.0274626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/31/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Lowering glucose levels is a complex task for patients with type 1 diabetes, and they often lack contact with health care professionals. Intermittently scanned continuous glucose monitoring (isCGM) has the potential to aid them with blood glucose management at home. The aim of this study was to investigate the long-term effect of isCGM on HbA1c in type 1 diabetes patients with poor glycaemic control in a region-wide real-world setting. METHODS All patients with type 1 diabetes receiving an isCGM due to poor glycaemic control (≥70 mmol/mol [≥8.6%]) in the period of 2020-21 in Region North Denmark ("T1D-CGM") were compared with all type 1 diabetes patients without isCGM ("T1D-NOCGM") in the same period. A multiple linear regression model adjusted for age, sex, diabetes duration and use of continuous subcutaneous insulin infusion was constructed to estimate the difference in change from baseline HbA1c between the two groups and within subgroups of T1D-CGM. RESULTS A total of 2,527 patients (T1D-CGM: 897; T1D-NOCGM: 1,630) were included in the study. The estimated adjusted difference in change from baseline HbA1c between T1D-CGM vs T1D-NOCGM was -5.68 mmol/mol (95% CI: (-6.69 to -4.67 mmol/mol; p<0.0001)). Older patients using isCGM dropped less in HbA1c. CONCLUSIONS Our results indicate that patients with type 1 diabetes in poor glycaemic control from Region North Denmark in general benefit from using isCGM with a sustained 24-month improvement in HbA1c, but the effect on HbA1c may be less pronounced for older patients.
Collapse
Affiliation(s)
- Morten Hasselstrøm Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- * E-mail:
| | - Simon Lebech Cichosz
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter Gustenhoff
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Amar Nikontovic
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
7
|
Skoufalos A, Thomas R, Patel R, Mei C, Clarke JL. Continuous Glucose Monitoring: An Opportunity for Population-Based Diabetes Management. Popul Health Manag 2022; 25:583-591. [PMID: 36154298 DOI: 10.1089/pop.2022.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The increasing prevalence of prediabetes and diabetes in the United States poses a serious threat to the health of the population. Closely associated with obesity, hypertension, dyslipidemia, and cardiovascular disease, a diagnosis of diabetes or prediabetes carries with it life-altering demands. Critically important among these is the requirement for frequent glucose level checks-typically performed with blood obtained from a fingerstick. Innovative real-time continuous glucose monitoring (rtCGM) technology makes it possible for patients and their clinicians to receive continuous glucose level measurements around the clock without finger sticks. Accruing evidence shows that rtCGM is an effective tool for patients and their clinicians in managing diabetes (ie, maintaining glucose levels within the recommended target range) and in understanding how lifestyle behaviors directly influence glucose levels. In recent years, a number of large payer organizations (eg, private health insurers, employers) have incorporated rtCGM in their diabetes management programs as a means of addressing the dual challenge of achieving/maintaining control of glucose levels and preventing or delaying the onset of complications. Programmatic integrated approaches have been used successfully and cost-effectively for managing other chronic conditions. Incorporating rtCGM in similar integrated approaches in diabetes management may be of value in improving quality outcomes and reducing costs on a population level. The evidence supports broader adoption and continued study to evaluate models that incorporate the use of rtCGM.
Collapse
Affiliation(s)
- Alexis Skoufalos
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Roy Thomas
- Medical Science and Communications, Managed Markets, Dexcom, San Diego, California, USA
| | - Ravi Patel
- Health Economics and Outcomes Research Fellowship, Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Chuchu Mei
- Health Economics and Outcomes Research Fellowship, Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Janice L Clarke
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| |
Collapse
|
8
|
de Kreutzenberg SV. Telemedicine for the Clinical Management of Diabetes; Implications and Considerations After COVID-19 Experience. High Blood Press Cardiovasc Prev 2022; 29:319-326. [PMID: 35579849 PMCID: PMC9111950 DOI: 10.1007/s40292-022-00524-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/07/2022] [Indexed: 12/15/2022] Open
Abstract
Telemedicine is a clinical approach that was seldom used in the day-to-day practice, if not only in certain settings, before the COVID-19 pandemic. As stated by the WHO, telemedicine is: the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies (ICT) for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, …. Telemedicine has actually represented the most useful and employed tool to maintain contacts between patients and physicians during the period of physical distance imposed by the pandemic, especially during the lockdown. Diabetes in particular, a chronic disease that often needs frequent confronting between patient and health professionals has taken advantage of the telehealth approach. Nowadays, technological tools are more and more widely used for the management of diabetes. In this review results obtained by telemendicine application in type 1 and type 2 diabetic individuals during COVID-19 are revised, and future perspectives for telemedicine use to manage diabetes are discussed.
Collapse
|
9
|
Wafa IA, Pratama NR, Sofia NF, Anastasia ES, Konstantin T, Wijaya MA, Wiyono MR, Djuari L, Novida H. Impact of COVID-19 Lockdown on the Metabolic Control Parameters in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Metab J 2022; 46:260-272. [PMID: 35255551 PMCID: PMC8987692 DOI: 10.4093/dmj.2021.0125] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/10/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Abrupt implementation of lockdowns during the coronavirus disease 2019 (COVID-19) pandemic affected the management of diabetes mellitus in patients worldwide. Limited access to health facilities and lifestyle changes potentially affected metabolic parameters in patients at risk. We conducted a meta-analysis to determine any differences in the control of metabolic parameters in patients with diabetes, before and during lockdown. METHODS We performed searches of five databases. Meta-analyses were carried out using random- or fixed-effect approaches to glycaemic control parameters as the primary outcome: glycosylated hemoglobin (HbA1c), random blood glucose (RBG), fasting blood glucose (FBG), time-in-range (TIR), time-above-range (TAR), time-below-range (TBR). Mean difference (MD), confidence interval (CI), and P value were calculated. Lipid profile was a secondary outcome and is presented as a descriptive analysis. RESULTS Twenty-one studies enrolling a total of 3,992 patients with type 1 or type 2 diabetes mellitus (T1DM or T2DM) were included in the study. Patients with T1DM showed a significant improvement of TIR and TAR (MD=3.52% [95% CI, 0.29 to 6.74], I2=76%, P=0.03; MD=-3.36% [95% CI, -6.48 to -0.25], I2=75%, P=0.03), while FBG among patients with T2DM significantly worsened (MD=3.47 mg/dL [95% CI, 1.22 to 5.73], I2=0%, P<0.01). No significant difference was found in HbA1c, RBG, and TBR. Use of continuous glucose monitoring in T1DM facilitated good glycaemic control. Significant deterioration of lipid parameters during lockdown, particularly triglyceride, was observed. CONCLUSION Implementation of lockdowns during the COVID-19 pandemic did not worsen glycaemic control in patients with diabetes. Other metabolic parameters improved during lockdown, though lipid parameters, particularly triglyceride, worsened.
Collapse
Affiliation(s)
- Ifan Ali Wafa
- Faculty of Medicine, Airlangga University, Surabaya,
Indonesia
| | | | | | | | | | | | - M. Rifqi Wiyono
- Faculty of Medicine, Airlangga University, Surabaya,
Indonesia
| | - Lilik Djuari
- Department of Public Health and Preventive Medicine, Airlangga University, Surabaya, Indonesia
| | - Hermina Novida
- Department of Internal Medicine, Airlangga University, Surabaya,
Indonesia
| |
Collapse
|
10
|
Abdulhussein FS, Chesser H, Boscardin WJ, Gitelman SE, Wong JC. Youth with Type 1 Diabetes Had Improvement in Continuous Glucose Monitoring Metrics During the COVID-19 Pandemic. Diabetes Technol Ther 2021; 23:684-691. [PMID: 34042523 PMCID: PMC8573792 DOI: 10.1089/dia.2021.0131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The impact of the coronavirus disease-2019 (COVID-19) pandemic on glycemic metrics in children is uncertain. This study evaluates the effect of the shelter-in-place (SIP) mandate on glycemic metrics in youth with type 1 diabetes (T1D) using continuous glucose monitoring (CGM) in Northern California, United States. Methods: CGM and insulin pump metrics in youth 3-21 years old with T1D at an academic pediatric diabetes center were analyzed retrospectively. Data 2-4 months before (distant pre-SIP), 1 month before (immediate pre-SIP), 1 month after (immediate post-SIP), and 2-4 months after (distant post-SIP) the SIP mandate were compared using paired t-tests, linear regression, and longitudinal analysis using a mixed effects model. Results: Participants (n = 85) had reduced mean glucose (-10.3 ± 4.4 mg/dL, P = 0.009), standard deviation (SD) (-5.0 ± 1.3 mg/dL, P = 0.003), glucose management indicator (-0.2% ± 0.03%, P = 0.004), time above range (TAR) >250 mg/dL (-3.5% ± 1.7%, P = 0.01), and increased time in range (TIR) (+4.7% ± 1.7%, P = 0.0025) between the distant pre-SIP and distant post-SIP periods. Relationships were maintained using a mixed effects model, when controlling for other demographic variables. There was improvement in SD, TAR 180-250 mg/dL, and TIR for participants with private insurance, but changes in the opposite direction for participants with public insurance. Conclusions: Improvement in CGM metrics in youth with T1D during the COVID-19 pandemic suggests that diabetes management can be maintained in the face of sudden changes to daily living. Youth with public insurance deserve more attention in research and clinical practice.
Collapse
Affiliation(s)
- Fatema S. Abdulhussein
- Division of Endocrinology, Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Hannah Chesser
- Division of Endocrinology, Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - W. John Boscardin
- Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Stephen E. Gitelman
- Division of Endocrinology, Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jenise C. Wong
- Division of Endocrinology, Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
11
|
Danne T, Limbert C, Puig Domingo M, Del Prato S, Renard E, Choudhary P, Seibold A. Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future. Diabetes Ther 2021; 12:2289-2310. [PMID: 34338994 PMCID: PMC8327601 DOI: 10.1007/s13300-021-01114-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/01/2021] [Indexed: 01/08/2023] Open
Abstract
People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70-180 mg/dL (3.9-10 mmol/L) increased across 19/27 cohorts with a median 3.3% (- 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.
Collapse
Affiliation(s)
- Thomas Danne
- Diabetes Center for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Germany.
| | - Catarina Limbert
- Unit for Paediatric Endocrinology and Diabetes, CHULC, Hospital Dona Estefania, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Manel Puig Domingo
- Endocrinology and Nutrition Service, Department of Medicine, Germans Trias i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Department of Physiology, Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Pratik Choudhary
- Department of Diabetes and Nutritional Sciences, King's College London, London, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | |
Collapse
|
12
|
Affiliation(s)
- Satish K Garg
- Department of Medicine and Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
13
|
Choudhary P, Bellido V, Graner M, Altpeter B, Cicchetti A, Durand-Zaleski I, Kristensen FB. The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond. Diabetes Ther 2021; 12:2311-2327. [PMID: 34390477 PMCID: PMC8363869 DOI: 10.1007/s13300-021-01132-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals in near-real time. Extreme social distancing and shielding in place for vulnerable patients during the COVID-19 pandemic has created both the challenge and the opportunity to provide care at a distance on a large scale. Available evidence suggests that glucose control has in fact improved during this period for people with diabetes who are able to use CGM devices for remote glucose monitoring. The development of telemedicine as part of the standard of care in diabetes faces significant challenges in the European context, particularly in terms of providing consistent and effective care at a distance to large populations of patients while using robust systems that can be supported by large regional and national healthcare services. These challenges include a fragmented approach to healthcare technology assessment and reimbursement, lack of eHealth education and literacy, particularly amongst healthcare professionals, lack of data integration, as well as concerns about electronic health records, patient consent and privacy. Here we review the benefits of and challenges to wider application of telemedicine and telemonitoring in the post-pandemic future, with the aim to ensure that the value of these eHealth services is provided to patients, healthcare providers and health systems.
Collapse
Affiliation(s)
- Pratik Choudhary
- Leicester Diabetes Centre (Bloom), Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Bernd Altpeter
- Digital Health Groupe and German Institute of Telemedicine, Frankfurt, Germany
| | - Americo Cicchetti
- School of Healthcare Systems, Economics and Management, Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | - Finn Børlum Kristensen
- Danish Centre for Health Economics (DaCHE), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
14
|
Thakur N, Mandal D, Nagaiah TC. Highly sensitive non-enzymatic electrochemical glucose sensor surpassing water oxidation interference. J Mater Chem B 2021; 9:8399-8405. [PMID: 34319345 DOI: 10.1039/d1tb01332g] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
An electrochemical non-enzymatic sensor based on a NiVP/Pi material was developed for the selective and sensitive determination of glucose. The novel sensor showed a high sensitivity of 6.04 mA μM-1 cm-2 with a lowest detection limit of 3.7 nM in a wide detection range of 100 nM-10 mM. The proposed sensor exhibited a superior selectivity without any interference from the oxygen evolution reaction during glucose sensing. We also found that this glucose sensor showed negligible interference from various interferents, such as ascorbic acid, uric acid, dopamine and sodium chloride. Additionally, a novel flexible sensor was developed by coating the NiVP/Pi over Whatman filter paper, which exhibited two linear ranges of 100 nM to 1 μM and 100 μM to 10 mM with an ultra-sensitivity of 1.130 mA μM-1 cm-2 and 0.746 mA μM-1 cm-2, respectively, in 0.1 M NaOH. The proposed sensor was tested with human blood serum samples demonstrating its practical application. Our findings provide a new route by fine tuning the composition of nickel and vanadium that sheds new light on better understanding the processes. This NiVP/Pi-based sensor offers a new approach towards the electrochemical detection of glucose, enabling glucose monitoring in a convenient way.
Collapse
Affiliation(s)
- Neha Thakur
- Department of Chemistry, Indian Institute of Technology Ropar, Rupnagar, Punjab 140001, India.
| | - Debaprasad Mandal
- Department of Chemistry, Indian Institute of Technology Ropar, Rupnagar, Punjab 140001, India.
| | - Tharamani C Nagaiah
- Department of Chemistry, Indian Institute of Technology Ropar, Rupnagar, Punjab 140001, India.
| |
Collapse
|
15
|
van der Linden J, Welsh JB, Walker TC. Sustainable Use of a Real-Time Continuous Glucose Monitoring System from 2018 to 2020. Diabetes Technol Ther 2021; 23:508-511. [PMID: 33567233 DOI: 10.1089/dia.2021.0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We aimed to describe patterns of continuous glucose monitoring (CGM) system use and glycemic outcomes from 2018 to 2020 in a large real-world cohort by analyzing anonymized data from US-based CGM users who transitioned from the G5 to the G6 System (Dexcom) in 2018. The main end points were persistent use, within-day and between-day utilization, hypoglycemia, time in range (TIR, 70-180 mg/dL [3.9-10 mmol/L]), and use of the optional calibration feature in 2019 and 2020. In a cohort of 31,034 individuals, rates of persistent use were high, with 27,932 (90.0%) and 26,861 (86.6%) continuing to upload data in 2019 and 2020, respectively. Compared with G5 use, G6 use was associated with higher device utilization, less hypoglycemia, higher TIR (in 2020), and >80% fewer calibrations in both 2019 and 2020 (P's < 0.001). High persistence and utilization of the G6 system may contribute to sustainable glycemic outcomes and decreased user burden.
Collapse
Affiliation(s)
| | - John B Welsh
- Dexcom, Inc., Global Clinical Initiatives, San Diego, California, USA
| | - Tomas C Walker
- Dexcom, Inc., Global Clinical Initiatives, San Diego, California, USA
| |
Collapse
|
16
|
Price DA, Deng Q, Kipnes M, Beck SE. Episodic Real-Time CGM Use in Adults with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial. Diabetes Ther 2021; 12:2089-2099. [PMID: 34089138 PMCID: PMC8177263 DOI: 10.1007/s13300-021-01086-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Resistance to initiating insulin therapy is common for people with type 2 diabetes (T2D) using multiple oral agents, resulting in sustained poor glycemic control. We explored a non-pharmacologic option and examined whether adults with T2D and elevated hemoglobin A1c (HbA1c) who were using multiple, non-insulin antihyperglycemics could obtain glycemic benefit from limited, episodic use of real-time continuous glucose monitoring (rtCGM). METHODS A randomized, pilot trial enrolled patients with T2D who were using two or more non-insulin therapies and had HbA1c values of 7.8-10.5%. Following a baseline, 10-day, blinded CGM session, participants were randomized 2:1, rtCGM or self-monitoring of blood glucose (SMBG). Medication changes were not made during the 12-week study unless required for safety; benefits would result from lifestyle changes. The rtCGM group used unblinded rtCGM for three sessions at weeks 0, 4, and 8, and the control group managed diabetes with SMBG and wore blinded rtCGM at week 8. Glycemic endpoints were assessed. RESULTS Seventy participants were enrolled from eight North American sites and data were available from 68 (n = 45 rtCGM; n = 23 SMBG). Median (IQR) baseline HbA1c was 8.4 (0.8)% and 8.3 (1.2)% and median (IQR) change in HbA1c at week 12 was - 0.5 (1.3)% and - 0.2 (1.1)% for the rtCGM and SMBG groups, respectively (between-group difference p = 0.74). More than one-third (34.1%) of the rtCGM group vs 17.4% of the SMBG group reached the HbA1c goal of less than 7.5% at week 12 (between-group difference p = 0.12). Compared to run-in, mean (SD) time in range (TIR 70-180 mg/dL) at week 8 increased for the rtCGM group (56.3 [24.5]% vs 63.1 [25.5]%) while it decreased for the SMBG group (68.4 [21.5]% vs 55.1 [30.3]%). HbA1c reductions were not sustained at month 9. CONCLUSION In this pilot study, limited episodic rtCGM use in people failing multiple non-insulin therapies resulted in modest, short-term glycemic benefits.
Collapse
Affiliation(s)
- David A Price
- Dexcom, Inc., 6340 Sequence Dr., San Diego, CA, 92121, USA.
| | - Qianqian Deng
- Dexcom, Inc., 6340 Sequence Dr., San Diego, CA, 92121, USA
| | - Mark Kipnes
- Diabetes & Glandular Disease Clinic, 5107 Medical Dr, San Antonio, TX, 78229, USA
| | - Stayce E Beck
- Dexcom, Inc., 6340 Sequence Dr., San Diego, CA, 92121, USA
| |
Collapse
|
17
|
Abramczyk U, Kuzan A. What Every Diabetologist Should Know about SARS-CoV-2: State of Knowledge at the Beginning of 2021. J Clin Med 2021; 10:1022. [PMID: 33801468 PMCID: PMC7958842 DOI: 10.3390/jcm10051022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
For almost a year, the major medical problem has been the pandemic caused by the SARS-CoV-2 virus. People with diabetes who contract COVID-19 are likely to experience more serious symptoms than patients without diabetes. This article presents new research about the epidemiology of COVID-19 in a group of patients with diabetes. It details the mortality and prognosis in such patients, as well as the relationship between COVID-19 and the diseases most often coexisting with diabetes: obesity, atherosclerosis, hypertension, and increased risk for infection. It also details how the virus infects and affects patients with hyperglycemia. The context of glycation and receptors for advanced glycation products (RAGE) seems to be of particular importance here. We also present a hypothesis related to the cause-and-effect axis-it turns out that diabetes can be both the cause of the more difficult course of COVID-19 and the result of SARS-CoV-2 infection. The last part of this article discusses the impact of antihyperglycemic drugs on the development of COVID-19 and other pharmacological implications, including which non-classical antihyperglycemic drugs seem to be effective in both the treatment of coronavirus infection and glucose homeostasis, and what strategies related to RAGE and glycation should be considered.
Collapse
Affiliation(s)
- Urszula Abramczyk
- A. Falkiewicz Specialist Hospital in Wroclaw, 52-114 Wroclaw, Poland;
| | - Aleksandra Kuzan
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland
| |
Collapse
|
18
|
Gilbert TR, Noar A, Blalock O, Polonsky WH. Change in Hemoglobin A1c and Quality of Life with Real-Time Continuous Glucose Monitoring Use by People with Insulin-Treated Diabetes in the Landmark Study. Diabetes Technol Ther 2021; 23:S35-S39. [PMID: 33470882 PMCID: PMC7957368 DOI: 10.1089/dia.2020.0666] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Initiating continuous glucose monitoring (CGM) can affect hemoglobin A1c (HbA1c) levels and patients' relationship with their diabetes. We used real-world HbA1c data to quantify short-term changes in glycemia and validated psychosocial questionnaires to assess changes in quality-of-life indicators in people during their first few months of CGM use. Methods: Eligibility was assessed during calls to Dexcom sales regarding its G6 CGM System. Eligibility criteria included ages 25-65 years, type 1 (T1D) or type 2 diabetes (T2D) on intensive insulin therapy (IIT), and no prior CGM use. Participants used a web-based portal to complete the 17-item Diabetes Distress Scale (DDS) and the 14-item Hypoglycemia Attitudes and Behavior Scale (HABS); provided validated HbA1c measurements; and shared their CGM data pre- and 3-5 months post-CGM initiation. Satisfaction and ease of use with the G6 System were also assessed. Results: Data were available from 248 patients (182 with T1D, 66 with T2D; 57% male, 88% non-Hispanic white). Mean (standard deviation) HbA1c fell significantly from 8.2% (1.9%) at baseline to 7.1% (1.1%) at the end of the study (P < 0.001); more than half (54.4%) of those with initial HbA1c values >7% experienced absolute HbA1c reductions of >1%. Significant reductions in diabetes distress (DDS) and hypoglycemic concerns (HABS) were observed (P < 0.001). Most (93%) participants were satisfied or very satisfied with the G6 System and 73% found it very easy to use. Conclusions: The first 3 months of CGM use was correlated with improvements in psychosocial outcomes and improved HbA1c levels for people with T1D or T2D who use IIT.
Collapse
Affiliation(s)
- Timothy R. Gilbert
- Endocrinology Center of Southwest Louisiana, Lake Charles, Louisiana, USA
| | - Adam Noar
- Dexcom, Inc., San Diego, California, USA
- Address correspondence to: Adam Noar, BA, Dexcom, Inc., 6340 Sequence Drive, San Diego, CA 92121, USA
| | - Olivia Blalock
- Endocrinology Center of Southwest Louisiana, Lake Charles, Louisiana, USA
| | - William H. Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- Department of Medicine, University of California, San Diego, California, USA
| |
Collapse
|
19
|
Garg S, Norman GJ. Impact of COVID-19 on Health Economics and Technology of Diabetes Care: Use Cases of Real-Time Continuous Glucose Monitoring to Transform Health Care During a Global Pandemic. Diabetes Technol Ther 2021; 23:S15-S20. [PMID: 33449822 PMCID: PMC7957369 DOI: 10.1089/dia.2020.0656] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has exposed vulnerabilities and placed tremendous financial pressure on nearly all aspects of the U.S. health care system. Diabetes care is an example of the confluence of the pandemic and heightened importance of technology in changing care delivery. It has been estimated the added total direct U.S. medical cost burden due to COVID-19 to range between $160B (20% of the population infected) and $650B (80% of the population infected) over the course of the pandemic. The corresponding range for the population with diabetes is between $16B and $65B, representing between 5% and 20% of overall diabetes expenditure in the United States. We examine the evidence to support allocating part of this added spend to infrastructure capabilities to accelerate remote monitoring and management of diabetes. Methods and Results: We reviewed recent topical literature and COVID-19-related analyses in the public health, health technology, and health economics fields in addition to databases and surveys from government sources and the private sector. We summarized findings on use cases for real-time continuous glucose monitoring in the community, for telehealth, and in the hospital setting to highlight the successes and challenges of accelerating the adoption of a digital technology out of necessity during the pandemic and beyond. Conclusions: One critical and lasting consequence of the pandemic will be the accelerated adoption of digital technology in health care delivery. We conclude by discussing ways in which the changes wrought by COVID-19 from a health care, policy, and economics perspective can add value and are likely to endure postpandemic.
Collapse
Affiliation(s)
- Sandip Garg
- Western Digital Corp., San Jose, California, USA
| | | |
Collapse
|