1
|
Penfornis A, Down S, Seignez A, Vives A, Bonnemaire M, Kulzer B. European Survey on Adult People With Type 1 Diabetes and Their Caregivers: Insights into Perceptions of Technology. J Diabetes Sci Technol 2025; 19:407-414. [PMID: 37937589 PMCID: PMC11874480 DOI: 10.1177/19322968231208690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Type 1 diabetes (T1D) is a complex condition requiring constant monitoring and self-management. The landscape of diabetes management is evolving with the development of new technologies. This survey aimed to gain insight into the perceptions and experiences of people with T1D (PWD) and their caregivers on the use of technology in diabetes care, and identify future needs for T1D management. METHODS PWD and caregivers (≥18 years) living in five European countries (France, Germany, Italy, Spain, and the United Kingdom) completed an online survey. Data were collected during July and August 2021. RESULTS Responders included 458 PWD and 54 caregivers. More than 60% of PWD perceived devices/digital tools for diabetes management as useful and 63% reported that access to monitoring device data made their life easier. Nearly half of participants hoped for new devices and/or digital tools. While approximately one-third of all PWD had used teleconsultation, perceptions and usage varied significantly between countries and by age (both P < .0001), with the lowest use in Germany (20%) and the highest in Spain (48%). The proportions of PWD contributing to diabetes care costs varied by device and were highest for smart insulin pen users at 83% compared with 44% for insulin pen users and 37% for insulin pump users. One-quarter (24%) of PWD and 15% of caregivers felt they lacked knowledge about devices/digital tools for T1D. CONCLUSIONS Most PWD and caregivers had positive perceptions and experiences of new technologies/digital solutions for diabetes management, although improved support and structured education for devices/digital tools are still required.
Collapse
Affiliation(s)
- Alfred Penfornis
- Diabetology Department, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France and Université Paris-Saclay, Saclay, France
| | - Su Down
- Somerset NHS Foundation Trust, Somerset, UK
| | | | | | | | - Bernhard Kulzer
- Diabetes Zentrum Mergentheim, Forschungsinstitut der Diabetes-Akademie Bad Mergentheim, Universität Bamberg, Bamberg, Germany
| |
Collapse
|
2
|
Bone J, Leach C, Addala A, Amed S. The Impact of Public Policy on Equitable Access to Technology for Children and Youth Living with Type 1 Diabetes in British Columbia, Canada. Diabetes Technol Ther 2025; 27:194-201. [PMID: 39588904 PMCID: PMC12056578 DOI: 10.1089/dia.2024.0366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
Objective: Structural inequities impede technology uptake in marginalized populations living with type 1 diabetes (T1D). Our objective was to describe hemoglobin A1c (HbA1c), time in range (TIR), and pump use to evaluate the impact of a universal funding policy for continuous glucose monitoring (CGM) across levels of deprivation in children with T1D in the Canadian province of British Columbia (BC). Methods: Patients with T1D and at least one outpatient visit after June 10, 2020 (1-year before universal CGM funding) who were enrolled in the BC Pediatric Diabetes Registry were included (n = 477). The Canadian Index of Multiple Deprivation (quintile 1 = least deprived; quintile 5 = most deprived) was determined using postal code. Mixed effects models were used to describe HbA1c, TIR, and pump use, and an interrupted time series generalized additive model estimated the change in CGM use pre- and postintroduction of universal coverage. Results: No differences were observed among the five levels of deprivation for HbA1c and TIR; however, for residential instability, those with the highest level of deprivation had a lower probability of pump use (-18.9%, 95% confidence interval [CI] = -26.1% to -11.7% for quintile 5 vs. 1). There was an increase in CGM uptake across all levels of deprivation 1-year after introduction of universal CGM funding. For example, the difference in sensor use from the most to least deprived situational group was -21.0% (-35.4%, -6.6%) at the time of universal coverage and shrank to -4.6% (-21.6%, 12.4%) after 12 months of coverage. However, an equity gap in CGM use persisted between the least and most deprived groups (-21.9, 95% CI = -34.5 to -9.4 for quintile 5 vs. 1 in economic dependency). Conclusions: Universal coverage of CGM improved uptake; however, equity gaps persisted. More research is needed to explore nonfinancial barriers to diabetes technology use in marginalized populations.
Collapse
Affiliation(s)
- Jeffrey Bone
- BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Courtney Leach
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ananta Addala
- Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
| | - Shazhan Amed
- BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| |
Collapse
|
3
|
O'Daffer A, Yi-Frazier JP, Roberts AJ, Lowry SJ, Pihoker C, Hirsch IB, Weaver KW, Zenno A, Malik FS. The association of resilience with HbA1c and key psychosocial factors in emerging adults with type 1 diabetes. J Pediatr Psychol 2024; 49:866-873. [PMID: 39394732 DOI: 10.1093/jpepsy/jsae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/14/2024] Open
Abstract
OBJECTIVE Emerging adults (EAs) with type 1 diabetes (T1D) have difficulty meeting glycemic targets and have a high prevalence of mental health comorbidities. Resilience, the ability to harness resources needed to sustain one's emotional and physical well-being, may be a key factor impacting poor mental health and glycemic outcomes. We aimed to (a) evaluate the association between resilience, HbA1c, and key psychosocial factors and (b) explore whether resilience moderates the relationship between psychosocial factors (depression, diabetes-related distress, anxiety) and HbA1c in EAs with T1D. METHOD EAs with T1D (N = 233) (mean age = 19.9 years (SD = 1.6), range 16.8-24.7) seen at an EA-specific diabetes clinic completed resilience, diabetes-related distress, depression, and anxiety measures and had their HbA1c level evaluated. We used linear regression models and conducted moderation analyses for the resilience factor. RESULTS Resilience was strongly associated with HbA1c, depression, diabetes-related distress, and anxiety in EAs with T1D. We did not find evidence that resilience moderates the relationship between depression, anxiety, or diabetes-related distress and HbA1c. CONCLUSIONS This study found that resilience is a highly relevant psychological factor associated with HbA1c and a key mental health factor for EAs with T1D. Novel interventions are needed to ameliorate high diabetes-related distress and HbA1c, and bolstering resilience may be one avenue to explore. Future research on resilience should longitudinally characterize and evaluate whether resilience may be a mechanism underlying the relationship between poor psychosocial outcomes and not meeting glycemic targets in EAs with T1D.
Collapse
Affiliation(s)
- Alison O'Daffer
- Joint Doctoral Program of Clinical Psychology, San Diego State University/University of California, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Joyce P Yi-Frazier
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Alissa J Roberts
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Sarah J Lowry
- Biostatistics Epidemiology and Analytics for Research Core, Seattle Children's Research Institute, Seattle, WA, United States
| | - Catherine Pihoker
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Irl B Hirsch
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Kathryn W Weaver
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Anna Zenno
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| |
Collapse
|
4
|
Conway RB, Snell-Bergeon J, Honda-Kohmo K, Peddi AK, Isa SB, Sulong S, Sibomana L, Gerard Gonzalez A, Song J, Lomax KE, Lo CN, Kim W, Haynes A, de Bock M, Burckhardt MA, Schwab S, Hong K. Disparities in Diabetes Technology Uptake in Youth and Young Adults With Type 1 Diabetes: A Global Perspective. J Endocr Soc 2024; 9:bvae210. [PMID: 39703363 PMCID: PMC11655873 DOI: 10.1210/jendso/bvae210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Indexed: 12/21/2024] Open
Abstract
Globally, nearly 9 million people are living with type 1 diabetes (T1D). Although the incidence of T1D is not affected by socioeconomic status, the development of complications and limited access to modern therapy is overrepresented in vulnerable populations. Diabetes technology, specifically continuous glucose monitoring and automated insulin delivery systems, are considered the gold standard for management of T1D, yet access to these technologies varies widely across countries and regions, and varies widely even within high-income countries. This review focuses on disparities in diabetes technology use among adolescents and young adults with T1D, barriers to access and use, and summarizes common themes emerging across countries and regions. We conducted a survey among medical technology manufacturers and physicians in various countries across diverse geographical regions and performed extensive literature searches. Across all countries and regions, economic barriers stand out as the largest and most common barriers, either preventing market penetrance of technology into a country or limiting its access to the individual with diabetes due to high out of pocket costs. Other common barriers include structural or accessibility barriers, such as stringent eligibility requirements by insurance providers, regardless of whether the insurance was private or government-based, and provider/individual level barriers. Based on the evidence presented, we suggest the need for a joint effort involving governments, private health insurers, technology manufacturers, and healthcare providers to address the global disparities of diabetic technology utilization and ensure equitable access for all individuals living with T1D worldwide.
Collapse
Affiliation(s)
- Rebecca Baqiyyah Conway
- Department of Epidemiology, University of Colorado, Aurora, CO 80045, USA
- American Academy of Epidemiology, Inc., Tyler, TX 75701, USA
| | - Janet Snell-Bergeon
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO 80045, USA
| | - Kyoko Honda-Kohmo
- Division of Preventative Healthcare, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan
| | | | - Salbiah Binti Isa
- Universiti Sains Malaysia, Advanced Medical and Dental Institute, 130200 Pulau, Pinang, Malaysia
| | - Shakira Sulong
- Division of Medical Operations, Metro Sihat Sdn Bhd, 60000 Kuala Lumpur, Malaysia
| | - Laurien Sibomana
- Department of the Director, Pillar of Health, Pittsburgh, PA 15237, USA
| | - Andrea Gerard Gonzalez
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO 80045, USA
| | - Jooyoun Song
- Department of Psychiatry, Jooyoun's Psychiatry, 07938 Seoul, Korea
| | - Kate Elizabeth Lomax
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA 6909, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6909, Australia
| | - Ching-Nien Lo
- GM Office, EPS BIO Technology Corp., Hsinchu 30076, Taiwan
| | - Wondong Kim
- Management (Including R&D Director), CareforU Co., Ltd., 14042 Anyang, Korea
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6909, Australia
| | - Martin de Bock
- Department of Pediatrics, University of Otago, Christchurch 8140, New Zealand
| | - Marie-Anne Burckhardt
- University Children's Hospital Basel UKBB, Pediatric Endocrinology and Diabetology, 4056 Basel, Switzerland
| | - Savannah Schwab
- Department of Epidemiology, University of Colorado, Aurora, CO 80045, USA
| | - Kwanho Hong
- Management (Marketing & Development), CareforU Co., Ltd., 14042 Anyang, Korea
| |
Collapse
|
5
|
Burckhardt MA, Auzanneau M, Rosenbauer J, Binder E, Weiskorn J, Hess M, Klinkert C, Mirza J, Zehnder LS, Wenzel S, Placzek K, Holl RW. What is the Relationship Between Time in Range, Time in Tight Range, and HbA1c in Youth and Young Adults With Type 1 Diabetes? Results From the German/Austrian/Luxembourgian/Swiss Diabetes Prospective Follow-Up Registry. J Diabetes Sci Technol 2024:19322968241288870. [PMID: 39548894 PMCID: PMC11571145 DOI: 10.1177/19322968241288870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2024]
Abstract
OBJECTIVES Time in range (TIR, 70-180 mg/dL) is an established marker of glycemic control. More recently, time in tight range (TTR, 70-140 mg/dL) has been proposed as well. The aim of this study was to examine the relationship between TIR, TTR, and HbA1c in youth and young adults with type 1 diabetes (T1D) in the German/Austrian/Luxembourgian/Swiss Diabetes Prospective Follow-up (DPV) registry. METHODS Data of youth and young adults aged ≤25 years with T1D for >3 months, documented in the DPV registry between 2019 and 2022 were analyzed. The most recent available HbA1c and corresponding continuous glucose monitoring (CGM) profiles in the 12 preceding weeks with at least 80% completeness were included. Associations were investigated using correlation and adjusted regression models. RESULTS 1901 individuals (median age 14.0 years [IQR 10.4-16.9]) were included in the analysis. TIR and TTR correlated strongly, r = 0.965 (95% CI [0.962, 0.968]), P < .001. TTR estimates predicted from TIR were significantly higher in the group with high coefficient of variation (CV group ≥ 36%), P < .001. Correlations between TIR or TTR and HbA1c were both strong, r = -0.764 (95% CI [-0.782, -0.745]) and r = -0.777 (95% CI [-0.795, -0.759]), both P < .001, with no significant difference (P = .312) However, adjusted regression models indicated a slightly better fit for the prediction of HbA1c from TIR compared with TTR. CONCLUSIONS Based on large, real-world data from a multinational registry, TIR and TTR correlated strongly, and both showed a good prediction of HbA1c. TTR estimates predicted from TIR were significantly higher in people with high glucose variability (CV).
Collapse
Affiliation(s)
- Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel UKBB, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research, Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Elisabeth Binder
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Jantje Weiskorn
- Diabetes Center for Children and Adolescents, Children’s Hospital Auf der Bult, Hanover, Germany
| | - Melanie Hess
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel UKBB, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Christof Klinkert
- Diabetes Specialized Practice for Children and Adolescents, Herford, Germany
| | - Joaquina Mirza
- Pediatric Diabetology, Children’s Hospital Amsterdamer Straße, Hospital for Child and Adolescent Medicine, Köln, Germany
| | | | - Sandra Wenzel
- Catholic Children’s Hospital Wilhelmstift, Hamburg, Germany
| | - Kerstin Placzek
- Department of Pediatrics, Faculty of Medicine, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| |
Collapse
|
6
|
Wright DR, Chen T, Chalmers KD, Shah SK, Yi-Frazier JP, LeBlanc JL, Garvey K, Senturia KD, Pihoker C, Malik FS. Adolescent-Preferred financial incentives to promote type 1 diabetes Self-Care: A discrete choice experiment. Diabetes Res Clin Pract 2024; 215:111798. [PMID: 39096938 DOI: 10.1016/j.diabres.2024.111798] [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] [Received: 06/03/2024] [Revised: 07/12/2024] [Accepted: 07/28/2024] [Indexed: 08/05/2024]
Abstract
AIMS This study aimed to quantify preferences for the characteristics of a financial incentives program that would motivate adolescent engagement in type 1 diabetes (T1D) self-care. METHOD We performed a discrete choice experiment with 12-18 year-olds with T1D from two pediatric hospital endocrinology clinics (n = 317). We identified key attributes of incentives: (1) monthly value of the reward, (2) payment structure, and (3) difficulty of incentivized behaviors. In twelve choice questions, adolescents chose the incentive option from a pair of profiles that was more likely to motivate them to increase adherence to recommended self-care. Options presented were tailored to adolescents' T1D technology use and perceived difficulty of completing each behavior. We analyzed data using a conditional logit model. RESULTS The value of the reward accounted for 60.8% of preferences. Adolescents were willing to accept lower value rewards when incentive payments used positive vs. negative reinforcement (-$10.88 (95% CI: -$12.60, -9.24)) and preferred higher incentives for performing hard vs. easier behaviors (+$14.92 (95% CI: +$12.66, +$17.28)). CONCLUSIONS Stated preferences can inform intervention design. Future research will evaluate the external validity of the discrete choice experiment-informed intervention design by assessing adolescent health and behavioral outcomes in a randomized controlled trial.
Collapse
Affiliation(s)
- Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Tom Chen
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Seema K Shah
- Department of Pediatrics, Northwestern University School of Medicine, Chicago, IL, USA; Smith Child Health Outreach, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Lurie Children's Hospital, Chicago, IL, USA
| | - Joyce P Yi-Frazier
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA USA
| | - Jessica L LeBlanc
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Kirsten D Senturia
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Catherine Pihoker
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Faisal S Malik
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| |
Collapse
|
7
|
Sandy JL, Tittel SR, Rompicherla S, Karges B, James S, Rioles N, Zimmerman AG, Fröhlich-Reiterer E, Maahs DM, Lanzinger S, Craig ME, Ebekozien O. Demographic, Clinical, Management, and Outcome Characteristics of 8,004 Young Children With Type 1 Diabetes. Diabetes Care 2024; 47:660-667. [PMID: 38305782 DOI: 10.2337/dc23-1317] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/08/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To compare demographic, clinical, and therapeutic characteristics of children with type 1 diabetes age <6 years across three international registries: Diabetes Prospective Follow-Up Registry (DPV; Europe), T1D Exchange Quality Improvement Network (T1DX-QI; U.S.), and Australasian Diabetes Data Network (ADDN; Australasia). RESEARCH DESIGN AND METHODS An analysis was conducted comparing 2019-2021 prospective registry data from 8,004 children. RESULTS Mean ± SD ages at diabetes diagnosis were 3.2 ± 1.4 (DPV and ADDN) and 3.7 ± 1.8 years (T1DX-QI). Mean ± SD diabetes durations were 1.4 ± 1.3 (DPV), 1.4 ± 1.6 (T1DX-QI), and 1.5 ± 1.3 years (ADDN). BMI z scores were in the overweight range in 36.2% (DPV), 41.8% (T1DX-QI), and 50.0% (ADDN) of participants. Mean ± SD HbA1c varied among registries: DPV 7.3 ± 0.9% (56 ± 10 mmol/mol), T1DX-QI 8.0 ± 1.4% (64 ± 16 mmol/mol), and ADDN 7.7 ± 1.2% (61 ± 13 mmol/mol). Overall, 37.5% of children achieved the target HbA1c of <7.0% (53 mmol/mol): 43.6% in DPV, 25.5% in T1DX-QI, and 27.5% in ADDN. Use of diabetes technologies such as insulin pump (DPV 86.6%, T1DX 46.6%, and ADDN 39.2%) and continuous glucose monitoring (CGM; DPV 85.1%, T1DX-QI 57.6%, and ADDN 70.5%) varied among registries. Use of hybrid closed-loop (HCL) systems was uncommon (from 0.5% [ADDN] to 6.9% [DPV]). CONCLUSIONS Across three major registries, more than half of children age <6 years did not achieve the target HbA1c of <7.0% (53 mmol/mol). CGM was used by most participants, whereas insulin pump use varied across registries, and HCL system use was rare. The differences seen in glycemia and use of diabetes technologies among registries require further investigation to determine potential contributing factors and areas to target to improve the care of this vulnerable group.
Collapse
Affiliation(s)
- Jessica L Sandy
- Sydney Children's Hospital Network, Westmead, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Sascha R Tittel
- Institute for Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm University, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | | | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, Rheinisch-Westfälische Technische Hochschule, Aachen University, Aachen, Germany
| | - Steven James
- University of the Sunshine Coast, Petrie, Queensland, Australia
| | | | | | - Elke Fröhlich-Reiterer
- Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA
| | - Stefanie Lanzinger
- Institute for Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm University, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - Maria E Craig
- Sydney Children's Hospital Network, Westmead, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales Medicine Sydney, Sydney, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Charles Perkins Centre, Westmead, New South Wales, Australia
| | | |
Collapse
|
8
|
Wu V, Choleva L, Wilkes M. Optimizing Glycemic Outcomes for Children with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:27-38. [PMID: 38272596 DOI: 10.1016/j.ecl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Changes in physical growth, neurocognitive development, and pubertal maturation are some of the challenges to achieving blood glucose targets in children with type 1 diabetes mellitus. To optimize glycemic outcomes, a comprehensive approach is crucial to address psychosocial needs, expand the use of diabetes technology, and diminish health inequities.
Collapse
Affiliation(s)
- Vickie Wu
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA
| | - Lauryn Choleva
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA
| | - Meredith Wilkes
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA.
| |
Collapse
|
9
|
Ebekozien O, Mungmode A, Hardison H, Rapaport R. Improving Outcomes for People with Type 1 Diabetes Through Collaboration: Summary of Type 1 Diabetes Exchange Quality Improvement Collaborative Studies. Endocrinol Metab Clin North Am 2024; 53:1-16. [PMID: 38272589 DOI: 10.1016/j.ecl.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes (T1D) management has evolved over the last decade. Innovations and groundbreaking research have paved the way for improved outcomes for people with T1D. One of the major T1D focused research network that has supported real-world research studies in the United States is the T1D Exchange Quality Improvement Collaborative (T1DX-QI) Network.T1DX-QI is a large multicenter network of 55 T1D clinics that uses quality improvement, health equity framework, and population health principles to improve outcomes for people with T1D. This article summarizes insights from T1DX-QI clinical and population health improvement studies.
Collapse
Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, USA; University of Mississippi School of Population Health, Jackson, MS, USA.
| | | | | | - Robert Rapaport
- Department of Pediatrics at Icahn School of Medicine; Mount Sinai Kravis Children's Hospital, New York, NY, USA
| |
Collapse
|
10
|
Ebekozien O, Fantasia K, Farrokhi F, Sabharwal A, Kerr D. Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all? Diabetes Obes Metab 2024; 26 Suppl 1:3-13. [PMID: 38291977 PMCID: PMC11040507 DOI: 10.1111/dom.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
Digital health technologies are being utilized increasingly in the modern management of diabetes. These include tools such as continuous glucose monitoring systems, connected blood glucose monitoring devices, hybrid closed-loop systems, smart insulin pens, telehealth, and smartphone applications (apps). Although many of these technologies have a solid evidence base, from the perspective of a person living with diabetes, there remain multiple barriers preventing their optimal use, creating a digital divide. In this article, we describe many of the origins of these barriers and offer recommendations on widening access to digital health technologies for underserved populations living with diabetes to improve their health outcomes.
Collapse
Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA
- Department of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Kathryn Fantasia
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Farnoosh Farrokhi
- Alta Bates Summit Medical Centre, Sutter East Bay Medical Foundation, Oakland, California, USA
| | - Ashutosh Sabharwal
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas, USA
| | - David Kerr
- Centre for Health System Research, Sutter Health, Santa Barbara, California, USA
| |
Collapse
|
11
|
Schütz A, Rami-Merhar B, Schütz-Fuhrmann I, Blauensteiner N, Baumann P, Pöttler T, Mader JK. Retrospective Comparison of Commercially Available Automated Insulin Delivery With Open-Source Automated Insulin Delivery Systems in Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241230106. [PMID: 38366626 PMCID: PMC11571566 DOI: 10.1177/19322968241230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Automated insulin delivery (AID) systems have shown to improve glycemic control in a range of populations and settings. At the start of this study, only one commercial AID system had entered the Austrian market (MiniMed 670G, Medtronic). However, there is an ever-growing community of people living with type 1 diabetes (PWT1D) using open-source (OS) AID systems. MATERIALS AND METHODS A total of 144 PWT1D who used either the MiniMed 670G (670G) or OS-AID systems routinely for a period of at least three to a maximum of six months, between February 18, 2020 and January 15, 2023, were retrospectively analyzed (116 670G aged from 2.6 to 71.8 years and 28 OS-AID aged from 3.4 to 53.5 years). The goal is to evaluate and compare the quality of glycemic control of commercially available AID and OS-AID systems and to present all data by an in-depth descriptive analysis of the population. No statistical tests were performed. RESULTS The PWT1D using OS-AID systems spent more time in range (TIR)70-180 mg/dL (81.7% vs 73.9%), less time above range (TAR)181-250 mg/dL (11.1% vs 19.6%), less TAR>250 mg/dL (2.5% vs 4.3%), and more time below range (TBR)54-69 mg/dL (2.2% vs 1.7%) than PWT1D using the 670G system. The TBR<54 mg/dL was comparable in both groups (0.3% vs 0.4%). In the OS-AID group, median glucose level and glycated hemoglobin (HbA1c) were lower than in the 670G system group (130 vs 150 mg/dL; 6.2% vs 7.0%). CONCLUSION In conclusion, both groups were able to achieve satisfactory glycemic outcomes independent of age, gender, and diabetes duration. However, the PWT1D using OS-AID systems attained an even better glycemic control with no clinical safety concerns.
Collapse
Affiliation(s)
- Anna Schütz
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Schütz-Fuhrmann
- Karl Landsteiner Institute, Endocrinology and Nephrology, Vienna, Austria
- Department of Endocrinology and Nephrology, Clinic Hietzing, Vienna Health Care Group, Vienna, Austria
| | - Nicole Blauensteiner
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Baumann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tina Pöttler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
12
|
Ebekozien O. Roadmap to Achieving Continuous Glucose Monitoring Equity: Insights From the T1D Exchange Quality Improvement Collaborative. Diabetes Spectr 2023; 36:320-326. [PMID: 37982057 PMCID: PMC10654123 DOI: 10.2337/dsi23-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This article describes successful interventions from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) to reduce inequities in access to and use of continuous glucose monitoring (CGM). The author proposes a roadmap with recommendations for different stakeholders to achieve CGM equity using insights from the T1DX-QI experience.
Collapse
Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, and the University of Mississippi School of Population Health, Jackson, MS
| |
Collapse
|
13
|
Ebekozien O, Mungmode A, Sanchez J, Rompicherla S, Demeterco-Berggren C, Weinstock RS, Jacobsen LM, Davis G, McKee A, Akturk HK, Maahs DM, Kamboj MK. Longitudinal Trends in Glycemic Outcomes and Technology Use for Over 48,000 People with Type 1 Diabetes (2016-2022) from the T1D Exchange Quality Improvement Collaborative. Diabetes Technol Ther 2023; 25:765-773. [PMID: 37768677 DOI: 10.1089/dia.2023.0320] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Objective: Previous studies revealed that hemoglobin A1c (HbA1c) increased overall in the United States in the past decade. In addition, health inequities in type 1 diabetes (T1D) outcomes by race/ethnicity and insurance type persist. This study examines the trends in HbA1c from 2016 to 2022 stratified by race/ethnicity and insurance in a large multicenter national database. Research Design and Methods: We analyzed glycemic outcomes and diabetes device use trends for >48,000 people living with type 1 diabetes (PwT1D) from 3 adult and 12 pediatric centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI), comparing data from 2016 to 2017 with data from 2021 to 2022. Results: The mean HbA1c in 2021-2022 was lower at 8.4% compared with the mean HbA1c in 2016-2017 of 8.7% (0.3% improvement; P < 0.01). Over the same period, the percentage of PwT1D using a continuous glucose monitor (CGM), insulin pump, or hybrid closed-loop system increased (45%, 12%, and 33%, respectively). However, these improvements were not equitably demonstrated across racial/ethnic groups or insurance types. Racial/ethnic and insurance-based inequities persisted over all 7 years across all outcomes; comparing non-Hispanic White and non-Hispanic Black PwT1D, disparate gaps in HbA1c (1.2%-1.6%), CGM (30%), pump (25%-35%), and hybrid-closed loop system (up to 20%) are illuminated. Conclusion: Population-level data on outcomes, including HbA1c, can provide trends and insights into strategies to improve health for PwT1D. The T1DX-QI cohort showed a significant improvement in HbA1c from 2016 to 2022. Improvements in diabetes device use are also demonstrated. However, these increases were inconsistent across all racial/ethnic groups or insurance types, an important focus for future T1D population health improvement work.
Collapse
Affiliation(s)
- Osagie Ebekozien
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
- School of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Ann Mungmode
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
| | - Janine Sanchez
- Department of Endocrinology, Miller School of Medicine, University of Miami, Maimi, Florida, USA
| | - Saketh Rompicherla
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
| | - Carla Demeterco-Berggren
- Department of Endocrinology, Rady Children's Hospital, San Diego, California, USA
- Department of Endocrinology, University of California, San Francisco, California, USA
| | - Ruth S Weinstock
- Department of Endocrinology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Laura M Jacobsen
- Department of Endocrinology, University of Florida, Gainsville, Florida, USA
| | | | - Alexis McKee
- Department of Endocrinology, Washington University at St Louis, St Louis, USA
| | - Halis K Akturk
- Department of Endocrinology, Barbara Davis Center, Aurora, Colorado, USA
| | - David M Maahs
- Department of Pediatric Endocrinology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, California, USA
| | - Manmohan K Kamboj
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
14
|
Nefs G, Feinn R, Chang AM, Wagner J. Longitudinal relations of sleep quality with depressive symptoms, diabetes distress and self-efficacy in young people with type 1 diabetes. J Psychosom Res 2023; 173:111457. [PMID: 37634323 PMCID: PMC10592068 DOI: 10.1016/j.jpsychores.2023.111457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To examine the longitudinal, bidirectional associations of sleep quality with depressive symptoms, diabetes-specific distress and diabetes management self-efficacy among adolescents and young adults with type 1 diabetes. METHODS Cross-lagged analyses used baseline, three-, six- and nine-month data from a randomized trial among 60 young people. Self-report measures included the Pittsburgh Sleep Quality Index, Center for Epidemiological Studies - Depressed Mood scale, Problem Areas in Diabetes Teen version, and Diabetes Management Self-efficacy Scale. RESULTS Lower sleep quality at baseline was associated with higher three-month depressive symptoms (b = 0.21, p = 0.005) and lower diabetes self-efficacy (b = -0.18, p = 0.014), but not diabetes distress (b = 0.06, p = 0.403). Similar patterns were found at six and nine months. Three-month psychological functioning was not associated with six-month sleep quality. CONCLUSIONS Among adolescents and young adults with type 1 diabetes, lower sleep quality predicted subsequent depressive symptoms and lower diabetes self-efficacy rather than vice versa. Sleep deserves a central place in diabetes care.
Collapse
Affiliation(s)
- Giesje Nefs
- Radboud University Medical Center, Department of Medical Psychology, Huispost 926, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, the Netherlands; Tilburg University, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, PO Box 90153, 5000 LE Tilburg, the Netherlands.
| | - Richard Feinn
- School of Medicine, Medical Sciences, Quinnipiac University, 275 Mount Carmel Avenue, Hamden, CT, USA.
| | - Anne-Marie Chang
- Pennsylvania State University, Biobehavioral Health Department, 219 Biobehavioral Health Building, University Park, PA, USA.
| | - Julie Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, Department of Behavioral Sciences and Community Health, UConn Health, 263 Farmington Ave., Farmington, CT, USA.
| |
Collapse
|
15
|
Alonso GT, Triolo TM, Akturk HK, Pauley ME, Sobczak M, Forlenza GP, Sakamoto C, Pyle L, Frohnert BI. Increased Technology Use Associated With Lower A1C in a Large Pediatric Clinical Population. Diabetes Care 2023; 46:1218-1222. [PMID: 37023293 PMCID: PMC10234743 DOI: 10.2337/dc22-2121] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/16/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE While continuous glucose monitors (CGMs), insulin pumps, and hybrid closed-loop (HCL) systems each improve glycemic control in type 1 diabetes, it is unclear how the use of these technologies impacts real-world pediatric care. RESEARCH DESIGN AND METHODS We found 1,455 patients aged <22 years, with type 1 diabetes duration >3 months, and who had data from a single center in between both 2016-2017 (n = 2,827) and 2020-2021 (n = 2,731). Patients were grouped by multiple daily injections or insulin pump, with or without an HCL system, and using a blood glucose monitor or CGM. Glycemic control was compared using linear mixed-effects models adjusting for age, diabetes duration, and race/ethnicity. RESULTS CGM use increased from 32.9 to 75.3%, and HCL use increased from 0.3 to 27.9%. Overall A1C decreased from 8.9 to 8.6% (P < 0.0001). CONCLUSIONS Adoption of CGM and HCL was associated with decreased A1C, suggesting promotion of these technologies may yield glycemic benefits.
Collapse
Affiliation(s)
- G. Todd Alonso
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Taylor M. Triolo
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Halis Kaan Akturk
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Meghan E. Pauley
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Marisa Sobczak
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Gregory P. Forlenza
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Casey Sakamoto
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Laura Pyle
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Brigitte I. Frohnert
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
16
|
Galderisi A, Sherr JL. Answering clinically pertinent questions with real-world data from paediatric type 1 diabetes registries. Lancet Diabetes Endocrinol 2023; 11:300-301. [PMID: 37004711 DOI: 10.1016/s2213-8587(23)00085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Alfonso Galderisi
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| |
Collapse
|
17
|
Scaramuzza AE, Rabbone I. Editorial: Conditions and results of effective glycemic control in children with type 1 diabetes. Front Endocrinol (Lausanne) 2022; 13:1034225. [PMID: 36213290 PMCID: PMC9540374 DOI: 10.3389/fendo.2022.1034225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Andrea Enzo Scaramuzza
- Division of Pediatrics, Pediatric Diabetes, Endocrinology and Nutrition, Azienda Socio Sanitaria Territoriale (ASST) Cremona, Cremona, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| |
Collapse
|