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Franceschi R, Pertile R, Marigliano M, Mozzillo E, Maffeis C, Morotti E, Di Candia F, Fedi L, Iafusco D, Zanfardino A, Cauvin V, Maltoni G, Zucchini S, Cherubini V, Tiberi V, Minuto N, Bassi M, Rabbone I, Savastio S, Tinti D, Tornese G, Schiaffini R, Passanisi S, Lombardo F, Bonfanti R, Scaramuzza A, Troncone A. Satisfaction with continuous glucose monitoring is associated with quality of life in young people with type 1 diabetes regardless of metabolic control and treatment type. Diabet Med 2024; 41:e15307. [PMID: 38383984 DOI: 10.1111/dme.15307] [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: 10/30/2023] [Revised: 01/15/2024] [Accepted: 02/03/2024] [Indexed: 02/23/2024]
Abstract
AIMS While continuous glucose monitoring (CGM) and associated technologies have positive effects on metabolic control in young people with type 1 diabetes (T1D), less is known about their impact on quality of life (QoL). Here, we quantified CGM satisfaction and QoL in young people with T1D and their parents/caregivers to establish (i) the relationship between QoL and CGM satisfaction and (ii) the impact of the treatment regimen on QoL. METHODS This was a cross-sectional study of children and adolescents with T1D on different treatment regimens (multiple daily injections, sensor-augmented pumps and automated insulin delivery). QoL was assessed with the KINDL instrument, and CGM satisfaction with the CGM-SAT questionnaire was evaluated in both youths with T1D and their parents. RESULTS Two hundred and ten consecutively enrolled youths with T1D completed the KINDL and CGM-SAT questionnaires. The mean total KINDL score was greater than neutral in both subjects with T1D (3.99 ± 0.47) and parents (4.06 ± 0.40), and lower overall CGM-SAT scores (i.e., higher satisfaction) were significantly associated with higher QoL in all six KINDL subscales (p < 0.05). There were no differences in KINDL scores according to delivery technology or when participants were grouped according to optimal and sub-optimal glucose control. CONCLUSIONS Higher satisfaction with recent CGMs was associated with better QoL in all dimensions. QoL was independent of both the insulin delivery technology and glycaemic control. CGM must be further disseminated. Attention on perceived satisfaction with CGM should be incorporated with the clinical practice to improve the well-being of children and adolescents with T1D and their families.
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Affiliation(s)
- Roberto Franceschi
- Department of Pediatrics, S. Chiara Hospital of Trento, APSS, Trent, Trentino-Alto Adige, Italy
| | - Riccardo Pertile
- Clinical and Evaluative Epidemiology Unit, Department of Governance, APSS, Trent, Italy
| | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Elisa Morotti
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Francesca Di Candia
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Ludovica Fedi
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania "L. Vanvitelli", Naples, Italy
| | - Angela Zanfardino
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vittoria Cauvin
- Department of Pediatrics, S. Chiara Hospital of Trento, APSS, Trent, Trentino-Alto Adige, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Zucchini
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, 'G. Salesi Hospital', Ancona, Italy
| | - Valentina Tiberi
- Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, 'G. Salesi Hospital', Ancona, Italy
| | - Nicola Minuto
- Pediatric Clinic, IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neuroscience Rehabilitation Ophthalmology Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marta Bassi
- Pediatric Clinic, IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neuroscience Rehabilitation Ophthalmology Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Silvia Savastio
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Davide Tinti
- Center of Pediatric Diabetology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Riccardo Schiaffini
- Pediatric Diabetology Department, Bambino Gesu Pediatric Hospital, Rome, Lazio, Italy
| | - Stefano Passanisi
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Diabetes Research Institute, IRCCS San Raffaele, Milan, Italy
| | - Andrea Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Pediatric Unit, ASST Cremona, Ospedale Maggiore, Cremona, Italy
| | - Alda Troncone
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
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Díaz-Soto G, Pérez-López P, Férnandez-Velasco P, Bahillo-Curieses P, de la O Nieto de la Marca M, Jimenez R, de Luis D. Quality of life, diabetes-related stress and treatment satisfaction are correlated with glycemia risk index (GRI), time in range and hypoglycemia/hyperglycemia components in type 1 diabetes. Endocrine 2024:10.1007/s12020-024-03846-9. [PMID: 38787511 DOI: 10.1007/s12020-024-03846-9] [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] [Received: 02/13/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION To evaluate the relationship between the GRI -component of hypoglycemia (CHypo) and hyperglycemia (CHyper)- with diabetes quality of life (DQoL), diabetes-related stress (DDS), perception of hypoglycemia (Clarke Test), visual analogic scale (VAS) and diabetes-knowledge (DKQ2) in T1D. METHODS Cross-sectional study in 92 patients with T1D under intensive insulin treatment (21.7% CSII) and flash glucose monitoring (isCGM). Clinical, metabolic and glycometric parameters and quality of life/satisfaction questionnaires were analyzed. RESULTS 92 patients (54.3% male, BMI 25.4 ± 4.5 kg/m2, HbA1c 7.5 ± 1.0%, TIR 53.9 ± 15.9%) with mean age 36.1 ± 12.6years and 17.8 ± 11.3 T1D duration. The mean GRI was 60.6 ± 22.2 with a CHypo and CHyper of 5.9 ± 4.8 and 27.3 ± 14.4, respectively. 19.1% presented a pathological Clarke's test. Patients with TIR > 70% and GRI < 40 showed better VAS (8.8 ± 1.3 vs 9.3 ± 0.9, p < 0.05) and DDS (46.4 ± 22.1 vs 36.7 ± 16.6, p < 0.05) scores, showing no differences between groups. CHyper > 15 and Chypo > 3.4 were related to worse levels of DQoL (91.1 ± 23.9 vs 76.6 ± 18.6 and 94.6 ± 24.8 vs 79.8 ± 20.1, p < 0.01), DDS(49.8 ± 22.4 vs 35.7 ± 16.5 and 49.8 ± 22.4 vs 35.7 ± 16.5, p < 0.01),and DKQ2 (24.4 ± 4.3 vs 26.8 ± 5.2 and 24.1 ± 4.8 vs 26.0 ± 4.6, p < 0.05), respectively. Worse metabolic control defined by GRI correlated with worse scores in VAS (r = -0.209, p < 0.05), DQoL (r = 0.205, p < 0.05), and DDS (r = 0.205, p < 0.05). No difference was observed in knowledge´s scale. CHyper correlated with worse scores in VAS (r = -0.231, p < 0.05), DQoL (r = 0.422, p < 0.01), and DDS (r = 0.341, p < 0.01) and lower degree of knowledge DKQ2 (r = -0.231, p < 0.05). When analyzing DQoL as a dependent variable in a multiple lineal regression, only age (β = 0.747; p < 0.001) and CHyper (β = 0.717; p < 0.001) maintained statistical significance. CONCLUSIONS Higher GRI was related to worse quality of life, diabetes-related stress and satisfaction with treatment, analogous to the TIR results.CHyper an Chypo were related to a greater decline in quality of life, diabetes-related stress, and lower satisfaction with treatment.However, in a multiple linear regression, only CHyper maintained statistical significance.
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Affiliation(s)
- Gonzalo Díaz-Soto
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain.
- Centro de Investigación en Endocrinología y Nutrición Clínica (CIENC), Universidad de Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain.
| | - Paloma Pérez-López
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
- Centro de Investigación en Endocrinología y Nutrición Clínica (CIENC), Universidad de Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
| | - Pablo Férnandez-Velasco
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
- Centro de Investigación en Endocrinología y Nutrición Clínica (CIENC), Universidad de Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
| | - Pilar Bahillo-Curieses
- Pediatrics Department, Hospital Clínico Universitario Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
| | - María de la O Nieto de la Marca
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
- Centro de Investigación en Endocrinología y Nutrición Clínica (CIENC), Universidad de Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
| | - Rebeca Jimenez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
- Centro de Investigación en Endocrinología y Nutrición Clínica (CIENC), Universidad de Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
| | - Daniel de Luis
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
- Centro de Investigación en Endocrinología y Nutrición Clínica (CIENC), Universidad de Valladolid, Avenida Ramón y Cajal 3, Valladolid, CP: 47005, Spain
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Boughton CK, Hovorka R. The role of automated insulin delivery technology in diabetes. Diabetologia 2024:10.1007/s00125-024-06165-w. [PMID: 38740602 DOI: 10.1007/s00125-024-06165-w] [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] [Received: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 05/16/2024]
Abstract
The role of automated insulin delivery systems in diabetes is expanding. Hybrid closed-loop systems are being used in routine clinical practice for treating people with type 1 diabetes. Encouragingly, real-world data reflects the performance and usability observed in clinical trials. We review the commercially available hybrid closed-loop systems, their distinctive features and the associated real-world data. We also consider emerging indications for closed-loop systems, including the treatment of type 2 diabetes where variability of day-to-day insulin requirements is high, and other challenging applications for this technology. We discuss issues around access and implementation of closed-loop technology, and consider the limitations of present closed-loop systems, as well as innovative approaches that are being evaluated to improve their performance.
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Affiliation(s)
- Charlotte K Boughton
- Wellcome-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
| | - Roman Hovorka
- Wellcome-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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Clark TL, Polonsky WH, Soriano EC. The Potential Impact of Continuous Glucose Monitoring Use on Diabetes-Related Attitudes and Behaviors in Adults with Type 2 Diabetes: A Qualitative Investigation of the Patient Experience. Diabetes Technol Ther 2024. [PMID: 38526557 DOI: 10.1089/dia.2023.0612] [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: 03/26/2024]
Abstract
Background: Despite the known glycemic benefits of continuous glucose monitoring (CGM) for adults with type 2 diabetes (T2D), the attitudinal and behavioral changes underlying these glycemic improvements remain understudied. This study aimed to qualitatively explore these changes among a sample of adults with T2D. Methods: In-depth, semistructured interviews were conducted with adults with T2D who had been using CGM for 3-6 months as part of a larger community project in Ohio. Thematic analysis was used to identify themes across participants' experiences. Results: A total of 34 participants provided insights into their experiences with CGM. Six primary themes emerged: (1) Making the Invisible Visible, highlighting the newfound awareness of T2D in daily life. (2) Effective Decision-Making, emphasizing the use of real-time glucose data for immediate and long-term choices. (3) Enhanced Self-Efficacy, describing a renewed sense of control and motivation. (4) Diabetes-Related Diet Modifications. (5) Changes in Physical Activity. (6) Changes in Medication Taking. Conclusions: Participants reported a far-reaching impact of CGM on their daily lives, with many stating that CGM fostered a greater understanding of diabetes and prompted positive behavior changes. The observed attitudinal and behavioral shifts likely contributed synergistically to the significant glycemic benefits observed over the study period. This study highlights the technology's potential to bring about meaningful attitudinal and behavioral changes.
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Affiliation(s)
- Taylor L Clark
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California, USA
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Hendrieckx C, Russell-Green S, Skinner T, Ng AH, Lee C, Barlow S, Davey A, Rogers C, Holmes-Truscott E, Speight J. Diabetes Research Matters: A Three-Round Priority-Setting Survey Consultation with Adults Living with Diabetes and Family Members in Australia. THE PATIENT 2024:10.1007/s40271-024-00688-5. [PMID: 38582797 DOI: 10.1007/s40271-024-00688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE We aimed to identify the health and quality-of-life research priorities of Australians with diabetes or family members. METHODS Through an iterative, three-step, online survey process we (1) qualitatively generated research topics (long list) in response to one question "What research is needed to support people with diabetes to live a better life?"; (2) determined the most important research questions (short list); and (3) ranked research questions in order of importance (priorities). We aimed to recruit N = 800 participants, with approximate equal representation of diabetes type and family members. RESULTS Participants (N = 661) were adults (aged 18+ years) in Australia with a self-reporting diagnosis of diabetes (type 1, n = 302; type 2, n = 204; prior/current gestational, n = 58; less common types, n = 22, or a family member, n = 75). Retention rates for Surveys 2 and 3 were 47% (n = 295) and 50% (n = 316), respectively. From 1549 open-text responses, 25 topics and 125 research questions were identified thematically. Research priorities differed by cohort, resulting in specific lists developed and ranked by each cohort. The top-ranked research question for the type 1 diabetes cohort was "How can diabetes technology be improved …?" and for the type 2 diabetes cohort: "How can insulin resistance be reversed …?". One question was common to the final lists of all cohorts: "What are the causes or triggers of diabetes?" Within cohorts, the top priorities were perceived as being of similar importance. CONCLUSIONS The research priorities differ substantially by diabetes type and for family members. These findings should inform funding bodies and researchers, to align future research and its communication with community needs.
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Affiliation(s)
- Christel Hendrieckx
- School of Psychology, Deakin University, 1-11 Gheringhap Street, Geelong, VIC, 3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Sienna Russell-Green
- School of Psychology, Deakin University, 1-11 Gheringhap Street, Geelong, VIC, 3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Timothy Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, VIC, Australia
| | - Ashley H Ng
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
| | - Chris Lee
- National Aboriginal Community Controlled Health Organisation, Canberra, ACT, Australia
| | - Siobhan Barlow
- Diabetes Research Matters Steering Group, Melbourne, Australia
| | - Alan Davey
- Diabetes Research Matters Steering Group, Melbourne, Australia
| | - Caitlin Rogers
- Diabetes Research Matters Steering Group, Melbourne, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, 1-11 Gheringhap Street, Geelong, VIC, 3220, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.
| | - Jane Speight
- School of Psychology, Deakin University, 1-11 Gheringhap Street, Geelong, VIC, 3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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Cherubini V, Fargalli A, Arnaldi C, Bassi M, Bonfanti R, Patrizia Bracciolini G, Cardella F, Dal Bo S, Delvecchio M, Di Candia F, Franceschi R, Maria Galassi S, Gallo F, Graziani V, Iannilli A, Mameli C, Marigliano M, Minuto N, Monti S, Mozzillo E, Pascarella F, Predieri B, Rabbone I, Roppolo R, Schiaffini R, Tiberi V, Tinti D, Toni S, Scaramuzza A, Vestrucci B, Gesuita R. Glucometrics and device satisfaction in children and adolescents with type 1 diabetes using different treatment modalities: A multicenter real-world observational study. Diabetes Res Clin Pract 2024; 210:111621. [PMID: 38499182 DOI: 10.1016/j.diabres.2024.111621] [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: 02/06/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024]
Abstract
AIMS To analyze metabolic outcomes, diabetes impact and device satisfaction in children and adolescents with type 1 diabetes in Italy who used different treatment modalities for diabetes care in a real-life context. METHODS In this multicenter, nationwide, cross-sectional study, 1464 participants were enrolled at a routine visit. The following treatment modalities were considered MDI + SMBG; MDI + CGM; Sensor Augmented Pump Therapy; predictive management of low glucose; Hybrid Closed Loop (HCL); Advanced Hybrid Closed Loop (AHCL). Health related quality of life was evaluated by the Italian version of the Diabetes Impact and Device Satisfaction Scale (DIDS) questionnaire. RESULTS Patients treated with AID systems were more likely to have HbA1c ≤ 6.5 %, higher percentage of time with glucose levels between 70 and 180 mg/dL, lower percentage of time with glucose levels above 180 mg/dL, higher device satisfaction, and reduced impact of diabetes. All the therapeutic modalities with respect to MDI + CGM, except for MDI + SMBG, contributed to increase the device satisfaction. HCL and AHCL respect to MDI + CGM were associated with lower diabetes impact. CONCLUSION Real-life use of automated insulin delivery systems is associated with reduced type 1 diabetes impact, increased device satisfaction, and achievement of glycemic goals.
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Affiliation(s)
- Valentino Cherubini
- Department of Women's and Children's Health, Salesi Hospital, 60123 Ancona, Italy
| | - Andrea Fargalli
- Center of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, 60020 Ancona, Italy.
| | - Claudia Arnaldi
- UOS Diabetologia Pediatrica ASL Viterbo, 01100 Viterbo, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, 20132 Milan, Italy
| | | | | | - Sara Dal Bo
- Department of Pediatrics, Santa Maria Delle Croci Hospital, 48121 Ravenna, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, L'Aquila, Italy
| | - Francesca Di Candia
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80138 Naples, Italy
| | | | | | | | - Vanna Graziani
- Department of Pediatrics, Santa Maria Delle Croci Hospital, 48121 Ravenna, Italy
| | - Antonio Iannilli
- Department of Women's and Children's Health, Salesi Hospital, 60123 Ancona, Italy
| | - Chiara Mameli
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Azienda Ospedaliera Universitaria Integrata Ospedale della Donna e del Bambino, 37126 Verona, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Sara Monti
- Department of Pediatrics, Bufalini Hospital, 47521 Cesena, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80138 Naples, Italy
| | - Filomena Pascarella
- Pediatric Endocrinology Unit, Sant'Anna e San Sebastiano Hospital, 81100 Caserta, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults - Pediatric Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Ivana Rabbone
- Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Rosalia Roppolo
- Department of Pediatrics, University of Palermo, 90133 Palermo, Italy
| | - Riccardo Schiaffini
- Diabetology and Growth Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Valentina Tiberi
- Department of Women's and Children's Health, Salesi Hospital, 60123 Ancona, Italy
| | - Davide Tinti
- Pediatric Diabetology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Sonia Toni
- Diabetology Unit, AOU Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Andrea Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Pediatric Unit, ASST Cremona, Ospedale Maggiore, 26100 Cremona, Italy
| | | | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, 60020 Ancona, Italy
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7
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Liarakos AL, Hasan N, Crabtree TSJ, Leelarathna L, Hammond P, Hussain S, Haq M, Aslam A, Gatdula E, Gibb FW, Lumb A, Bull K, Chinnasamy E, Carrieri G, Williams DM, Choudhary P, Ryder REJ, Wilmot EG. Real-world outcomes of Omnipod DASH system use in people with type 1 diabetes: Evidence from the Association of British Clinical Diabetologists (ABCD) study. Diabetes Res Clin Pract 2024; 209:111597. [PMID: 38417535 DOI: 10.1016/j.diabres.2024.111597] [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: 01/12/2024] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
AIMS To evaluate real-world outcomes in people with Type 1 Diabetes (PwT1D) initiated on Omnipod DASH® Insulin Management System. METHODS Anonymized clinical data were submitted to a secure web-based tool within the National Health Service network. Hemoglobin A1c (HbA1c), sensor-derived glucometrics, total daily dose of insulin (TDD), and patient-reported outcome changes between baseline and follow-up were assessed. Individuals were classified to "new-to-pump" (switched from multiple daily injections) and "established-on-pump" (switched from a tethered insulin pump) groups. RESULTS 276 individuals from 11 centers [66.7 % female; 92 % White British; median age 41 years (IQR 20-50); diabetes duration 20 years (IQR 11-31); 49.3 % within "new-to-pump" group] were included. Baseline HbA1c was 8.0 ± 1.3 % (64 ± 14 mmol/mol). At follow-up [3 years (IQR 1.5-3.2)], HbA1c reduced by 0.3 % [(3 mmol/mol); p = 0.002] across the total population, 0.4 % [(5 mmol/mol); p = 0.001] in those "new-to-pump" and remained unchanged in those "established-on-pump". TDD decreased in the "new-to-pump" cohort (baseline:44.9 ± 21.0units vs follow-up:38.1 ± 15.4units, p = 0.002). Of those asked, 141/143 (98.6 %) stated Omnipod DASH had a positive impact on quality of life. CONCLUSIONS Omnipod DASH was associated with improvements in HbA1c in PwT1D "new-to-pump" and maintained previous HbA1c levels in those "established-on-pump". User satisfaction in all groups and TDD reduction in those "new-to-pump" were reported.
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Affiliation(s)
- Alexandros L Liarakos
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Nebras Hasan
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Thomas S J Crabtree
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Lalantha Leelarathna
- Diabetes, Endocrinology and Metabolism Center, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Peter Hammond
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, UK
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK
| | - Masud Haq
- Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Royal Tunbridge Wells, UK
| | - Aisha Aslam
- Diabetes, Endocrinology and Metabolism Center, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Erneda Gatdula
- Cardiff and Vale University Health Board, University Hospital of Llandough, Llandough, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Kirsty Bull
- Stockport Foundation Trust, Stepping Hill Hospital, Stockport, UK
| | - Eswari Chinnasamy
- Kingston Hospital NHS Foundation Trust, Kingston Hospital, Surrey, UK
| | - Giorgio Carrieri
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, UK
| | - David M Williams
- Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
| | - Pratik Choudhary
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, UK; Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, UK
| | - Robert E J Ryder
- Department of Diabetes and Endocrinology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Emma G Wilmot
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
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8
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Hendrieckx C, Husin HM, Russell-Green S, Halliday JA, Lam B, Trawley S, McAuley SA, Bach LA, Burt MG, Cohen ND, Colman PG, Holmes-Walker DJ, Jenkins AJ, Lee MH, McCallum RW, Stranks SN, Sundararajan V, Jones TW, O'Neal DN, Speight J. The diabetes management experiences questionnaire: Psychometric validation among adults with type 1 diabetes. Diabet Med 2024; 41:e15195. [PMID: 37562414 DOI: 10.1111/dme.15195] [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: 04/20/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
AIMS To examine the psychometric properties of the Diabetes Management Experiences Questionnaire (DME-Q). Adapted from the validated Glucose Monitoring Experiences Questionnaire, the DME-Q captures satisfaction with diabetes management irrespective of treatment modalities. METHODS The DME-Q was completed by adults with type 1 diabetes as part of a randomized controlled trial comparing hybrid closed loop (HCL) to standard therapy. Most psychometric properties were examined with pre-randomization data (n = 149); responsiveness was examined using baseline and 26-week follow-up data (n = 120). RESULTS Pre-randomization, participants' mean age was 44 ± 12 years, 52% were women. HbA1c was 61 ± 11 mmol/mol (7.8 ± 1.0%), diabetes duration was 24 ± 12 years and 47% used an insulin pump prior to the trial. A forced three-factor analysis revealed three expected domains, that is, 'Convenience', 'Effectiveness' and 'Intrusiveness', and a forced one-factor solution was also satisfactory. Internal consistency reliability was strong for the three subscales (α range = 0.74-0.84) and 'Total satisfaction'( α = 0.85). Convergent validity was demonstrated with moderate correlations between DME-Q 'Total satisfaction' and diabetes distress (PAID: rs = -0.57) and treatment satisfaction (DTSQ; rs = 0.58). Divergent validity was demonstrated with a weak correlation with prospective/retrospective memory (PRMQ: rs = -0.16 and - 0.13 respectively). Responsiveness was demonstrated, as participants randomized to HCL had higher 'Effectiveness' and 'Total satisfaction' scores than those randomized to standard therapy. CONCLUSIONS The 22-item DME-Q is a brief, acceptable, reliable measure with satisfactory structural and construct validity, which is responsive to intervention. The DME-Q is likely to be useful for evaluation of new pharmaceutical agents and technologies in research and clinical settings.
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Affiliation(s)
- Christel Hendrieckx
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- Institute for Health Transformation, Deakin University, Victoria, Geelong, Australia
| | - Hanafi M Husin
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
| | - Sienna Russell-Green
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
| | - Jennifer A Halliday
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- Institute for Health Transformation, Deakin University, Victoria, Geelong, Australia
| | - Benjamin Lam
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- Education Futures, University of South Australia, Adelaide, Australia
| | - Steven Trawley
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Sybil A McAuley
- The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, The Alfred, Melbourne, Australia
- Department of Medicine (Alfred Medical Research and Education Precinct), Monash University, Melbourne, Australia
| | - Morton G Burt
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- School of Pharmacy, University of Queensland, Woolloongabba, Australia
| | - Peter G Colman
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
| | - D Jane Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Alicia J Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Melissa H Lee
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Roland W McCallum
- Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Australia
| | - Steve N Stranks
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Tim W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - David N O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- Institute for Health Transformation, Deakin University, Victoria, Geelong, Australia
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9
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Reddy M, Oliver N. The role of real-time continuous glucose monitoring in diabetes management and how it should link to integrated personalized diabetes management. Diabetes Obes Metab 2024; 26 Suppl 1:46-56. [PMID: 38441367 DOI: 10.1111/dom.15504] [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: 12/23/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 03/07/2024]
Abstract
Diabetes is a complex metabolic condition that demands tailored, individualized approaches for effective management. Real-time continuous glucose monitoring (rtCGM) systems have improved in terms of design, usability and accuracy over the years and play a pivotal role in the delivery of integrated personalized diabetes management (iPDM). iPDM is a comprehensive multidisciplinary approach that combines individualized care strategies utilizing technologies and interventions and encourages the active involvement of the person with diabetes in the care provided. The use of stand-alone rtCGM and its integration with other diabetes technologies, such as hybrid automated insulin delivery, have enabled improved glycaemic and quality of life outcomes for people with diabetes. As the uptake of rtCGM and associated technologies is increasing and becoming the standard of care for people with diabetes, it is important that efforts are focused on associated goals such as reducing health inequalities in terms of access, aligning structured education with rtCGM usage, choosing the right technology based on needs and preferences, and minimizing burden while aiming for optimal glucose outcomes. Utilizing rtCGM in other settings than outpatients and in diabetes cohorts beyond type 1 and type 2 diabetes needs further exploration. This review aims to provide an overview of the role of rtCGM and how best to link rtCGM to iPDM, highlighting its role in enhancing personalized treatment strategies.
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Affiliation(s)
- Monika Reddy
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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10
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Hermanns N, Kulzer B, Ehrmann D. Person-reported outcomes in diabetes care: What are they and why are they so important? Diabetes Obes Metab 2024; 26 Suppl 1:30-45. [PMID: 38311448 DOI: 10.1111/dom.15471] [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: 11/26/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/06/2024]
Abstract
In this review, we aim to show how person-reported outcomes (PROs) and person-reported experiences (PREs) can significantly contribute to the way diabetes care is delivered, the involvement of people with diabetes in diabetes care, and the collaboration between health care professionals and people with diabetes. This review focuses on the definition and measurement of PROs and PREs, the importance of PROs and PREs for person-centred diabetes care, and integrating the perspectives of people with diabetes in the evaluation of medical, psychological and technological interventions. PROs have been increasingly accepted by Health Technology Assessment bodies and are therefore valued in the context of reimbursement decisions and consequently by regulators and other health care stakeholders for the allocation of health care resources. Furthermore, the review identified current challenges to the assessment and use of PROs and PREs in clinical care and research. These challenges relate to the combination of questionnaires and ecological momentary assessment for measuring PROs and PREs, lack of consensus on a core outcome set, limited sensitivity to change within many measures and insufficient standardization of what can be considered a minimal clinically important difference. Another issue that has not been sufficiently addressed is the involvement of people with diabetes in the design and development of measures to assess PROs and PREs.
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
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11
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Gaglia JL, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S158-S178. [PMID: 38078590 PMCID: PMC10725810 DOI: 10.2337/dc24-s009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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12
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Hernar I, Cooper JG, Nilsen RM, Skinner TC, Strandberg RB, Iversen MM, Graue M, Ernes T, Løvaas KF, Madsen TV, Lie SS, Richards DA, Ueland GÅ, Haugstvedt A. Diabetes Distress and Associations With Demographic and Clinical Variables: A Nationwide Population-Based Registry Study of 10,186 Adults With Type 1 Diabetes in Norway. Diabetes Care 2024; 47:126-131. [PMID: 37922320 PMCID: PMC10733651 DOI: 10.2337/dc23-1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To estimate diabetes distress prevalence and associations with demographic and clinical variables among adults with type 1 diabetes in Norway. RESEARCH DESIGN AND METHODS In this nationwide population-based registry study, the 20-item Problem Areas in Diabetes (PAID-20) questionnaire was sent to 16,255 adults with type 1 diabetes. Linear regression models examined associations of demographic and clinical variables with distress. RESULTS In total, 10,186 individuals (62.7%) completed the PAID-20, with a mean score of 25.4 (SD 18.4) and 21.7% reporting high distress. Respondents endorsed worrying about the future and complications as the most problematic item (23.0%). Female sex, younger age, non-European origin, primary education only, unemployment, smoking, continuous glucose monitoring use, more symptomatic hypoglycemia, reduced foot sensitivity, treated retinopathy, and higher HbA1c were associated with higher distress. CONCLUSIONS Diabetes distress is common among adults with type 1 diabetes and associated with clinically relevant factors, underlining that regular care should include efforts to identify and address distress.
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Affiliation(s)
- Ingvild Hernar
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - John G. Cooper
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Roy M. Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Timothy C. Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Ragnhild B. Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marjolein M. Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Centre on Patient-Reported Outcomes Data, Haukeland University Hospital, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tony Ernes
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne F. Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone V. Madsen
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Silje S. Lie
- Department of Health, VID Specialized University, Stavanger, Norway
| | - David A. Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Grethe Å. Ueland
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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13
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Benioudakis ES, Karlafti E, Kalaitzaki A, Kalpou MA, Georgiou ED, Savopoulos C, Didangelos T. Comparison of the Sensor-Augmented Pump System with the Advanced Hybrid Closed-Loop Delivery System: Quality of Life, Diabetes Distress, and Glycaemic Outcomes in a Real-Life Context. Curr Diabetes Rev 2024; 20:e310523217505. [PMID: 37259938 DOI: 10.2174/1573399820666230531161858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1D) is a chronic disease that requires exogenous insulin administration and intensive management to prevent any complications. Recent innovations in T1D management technologies include the Advanced Hybrid Closed-Loop delivery system (AHCL). The pioneer AHCL system provides automated basal and automated bolus corrections when needed. OBJECTIVE This study aimed to compare the Advanced Hybrid Closed-Loop (AHCL) system and the Sensor-Augmented Pump (SAP) with Predictive Low Glucose Management (PLGM) system, in relation to glycaemic outcomes, general and diabetes-related Quality of Life (QoL), and diabetes distress. METHODS General and diabetes-related QoL were assessed with the Diabetes Quality of Life Brief Clinical Inventory (DQOL-BCI) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF), respectively. Diabetes distress was assessed with the Diabetes Distress Scale for Type 1 diabetes (T1-DDS). RESULTS Eighty-nine T1D adults participated in the study, mostly females (65.2%), with a mean age of 39.8 (± 11.5 years). They had on average 23 years of diabetes (± 10.7) and they were on continuous subcutaneous insulin infusion therapy. Significant differences favoring the AHCL over the SAP + PLGM system were demonstrated by lower mean glucose levels, less time above range, lower scores on DQOL-BCI, T1-DDS, and higher scores on WHOQOL-BREF. Finally, the linear regression models revealed the association of time in range in most of the above aspects. CONCLUSION This study highlighted the advantages of the AHCL system over the SAP + PLGM system in the real-world setting in relation to general and diabetes-related QoL, diabetes distress, and glycaemic outcomes.
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Affiliation(s)
- Emmanouil S Benioudakis
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karlafti
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyroula Kalaitzaki
- Department of Social Work, Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life, Health Sciences Faculty, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Maria-Alexandra Kalpou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos D Georgiou
- Department of Psychology, University of Cyprus Centre for Field Studies, University of Cyprus, Nicosia, Cyprus
| | - Christos Savopoulos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Triantafyllos Didangelos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Schipp J, Hendrieckx C, Braune K, Knoll C, O'Donnell S, Ballhausen H, Cleal B, Wäldchen M, Lewis DM, Gajewska KA, Skinner TC, Speight J. Psychosocial Outcomes Among Users and Nonusers of Open-Source Automated Insulin Delivery Systems: Multinational Survey of Adults With Type 1 Diabetes. J Med Internet Res 2023; 25:e44002. [PMID: 38096018 PMCID: PMC10755653 DOI: 10.2196/44002] [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: 11/02/2022] [Revised: 06/10/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Emerging research suggests that open-source automated insulin delivery (AID) may reduce diabetes burden and improve sleep quality and quality of life (QoL). However, the evidence is mostly qualitative or uses unvalidated, study-specific, single items. Validated person-reported outcome measures (PROMs) have demonstrated the benefits of other diabetes technologies. The relative lack of research investigating open-source AID using PROMs has been considered a missed opportunity. OBJECTIVE This study aimed to examine the psychosocial outcomes of adults with type 1 diabetes using and not using open-source AID systems using a comprehensive set of validated PROMs in a real-world, multinational, cross-sectional study. METHODS Adults with type 1 diabetes completed 8 validated measures of general emotional well-being (5-item World Health Organization Well-Being Index), sleep quality (Pittsburgh Sleep Quality Index), diabetes-specific QoL (modified DAWN Impact of Diabetes Profile), diabetes-specific positive well-being (4-item subscale of the 28-item Well-Being Questionnaire), diabetes treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire), diabetes distress (20-item Problem Areas in Diabetes scale), fear of hypoglycemia (short form of the Hypoglycemia Fear Survey II), and a measure of the impact of COVID-19 on QoL. Independent groups 2-tailed t tests and Mann-Whitney U tests compared PROM scores between adults with type 1 diabetes using and not using open-source AID. An analysis of covariance was used to adjust for potentially confounding variables, including all sociodemographic and clinical characteristics that differed by use of open-source AID. RESULTS In total, 592 participants were eligible (attempting at least 1 questionnaire), including 451 using open-source AID (mean age 43, SD 13 years; n=189, 41.9% women) and 141 nonusers (mean age 40, SD 13 years; n=90, 63.8% women). Adults using open-source AID reported significantly better general emotional well-being and subjective sleep quality, as well as better diabetes-specific QoL, positive well-being, and treatment satisfaction. They also reported significantly less diabetes distress, fear of hypoglycemia, and perceived less impact of the COVID-19 pandemic on their QoL. All were medium-to-large effects (Cohen d=0.5-1.5). The differences between groups remained significant after adjusting for sociodemographic and clinical characteristics. CONCLUSIONS Adults with type 1 diabetes using open-source AID report significantly better psychosocial outcomes than those not using these systems, after adjusting for sociodemographic and clinical characteristics. Using validated, quantitative measures, this real-world study corroborates the beneficial psychosocial outcomes described previously in qualitative studies or using unvalidated study-specific items.
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Affiliation(s)
- Jasmine Schipp
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- Section for Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- School of Psychology, Deakin University, Burwood, Australia
| | - Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Dedoc Labs GmbH, Berlin, Germany
| | - Christine Knoll
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Shane O'Donnell
- School of Sociology & School of Medicine, University College Dublin, Dublin, Ireland
| | - Hanne Ballhausen
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Dedoc Labs GmbH, Berlin, Germany
| | - Bryan Cleal
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Mandy Wäldchen
- School of Sociology & School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- School of Psychology, Deakin University, Burwood, Australia
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15
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Citro F, Bianchi C, Nicolì F, Aragona M, Marchetti P, Di Cianni G, Bertolotto A. Advances in diabetes management: have pregnancy outcomes in women with type 1 diabetes changed in the last decades? Diabetes Res Clin Pract 2023; 205:110979. [PMID: 37890701 DOI: 10.1016/j.diabres.2023.110979] [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: 08/10/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
AIMS Over the recent years multiple therapeutic and management opportunities have been made available to treat pregnant women with Type 1 diabetes (T1DM). However, analyses assessing whether these different approaches may have any specific advantage/disadvantage in metabolic control and neonatal outcomes is still limited. The aim of this study was to compare metabolic control and neonatal outcomes in pregnant women with T1DM among different basal insulins (NPH vs. analogue), insulin administration ways [Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusion (CSII)] and glucose monitoring systems [Self-Monitoring of Blood Glucose (SMBG) vs. real-time/intermittently scanned Continuous Glucose Monitoring (rtCGM/isCGM)]. METHODS A retrospective analysis on metabolic data and neonatal outcomes of 136 T1DM pregnant women (76% on MDI, based on NPH (51%) or analogue (49%); 24% on CSII; 24% using rtCGM/isCGM), managed between 2008 and 2020, was performed, comparing different therapeutic approaches. RESULTS Metabolic data and neonatal outcomes were comparable among women treated with different basal insulins. Women on CSII planned their pregnancy more frequently (82 vs. 60%; p = 0.043) and had better pregestational HbA1c (52 ± 5 vs. 60 ± 13 mmol/mol; p = 0.044) and first trimester HbA1c (48 ± 4 vs. 51 ± 8 mmol/mol; p = 0.047). Pregestational and first trimester HbA1c were also lower in women using rtCGM/isCGM (53 ± 8 vs. 58 ± 13 mmol/mol; p = 0.027 and 46 ± 5 vs. 51 ± 7 mmol/mol; p = 0.034, respectively). In the whole cohort, LGA risk was directly correlated to HbA1c at third trimester (correlation coefficient: 0.335, p = 0.001) and inversely correlated to the achievement of HbA1c target (≤6% [<42 mmol/mol]) at third trimester (correlation coefficient: - 0.367, p < 0.001). CONCLUSION Treatment with insulin analogs didn't significantly change metabolic control and neonatal outcomes in T1DM women, while CSII and rtCGM/isCGM can optimize preconception and first trimester pregnancy glycemic control. Irrespective of the therapeutic management, third trimester HbA1c remains the strongest risk factor for LGA.
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Affiliation(s)
- Fabrizia Citro
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | | | - Francesca Nicolì
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Sly B, Taylor J. Blood glucose monitoring devices: current considerations. Aust Prescr 2023; 46:54-59. [PMID: 38053807 PMCID: PMC10665089 DOI: 10.18773/austprescr.2023.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Measuring blood glucose concentrations via capillary (fingerprick) blood glucose monitoring or continuous (interstitial) glucose monitoring is an important aspect of management for many people with diabetes. Blood glucose monitoring informs patient self-management strategies, which can improve the patient's engagement in their own care and reduce barriers to achieving recommended blood glucose targets. Blood glucose monitoring also informs clinician-guided management plans. Compared to capillary blood glucose monitoring, continuous glucose monitoring in people using insulin significantly improves glycaemic metrics and is associated with improved patient-reported outcomes. Even with good glycaemic metrics, patients using continuous glucose monitoring should still have access to capillary blood glucose monitoring for correlation of hypoglycaemic readings when accuracy may be compromised or if there is a malfunction with the continuous blood glucose monitor.
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Skovlund SE, Renza S, Laurent J, Cerletti P. Identification of Core Outcome Domains and Design of a Survey Questionnaire to Evaluate Impacts of Digital Health Solutions That Matter to People With Diabetes. J Diabetes Sci Technol 2023:19322968231179740. [PMID: 37338104 DOI: 10.1177/19322968231179740] [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: 06/21/2023]
Abstract
BACKGROUND Digital health solutions (DHS) are increasingly used to support people with diabetes (PwD) to help manage their diabetes and to gather and manage health and treatment data. There is a need for scientifically reliable and valid methods to measure the value and impact of DHS on outcomes that matter to PwD. Here, we describe the development of a survey questionnaire designed to assess the perceptions of PwD toward DHS and their prioritized outcomes for DHS evaluation. METHOD We applied a structured process for engagement of a total of nine PwD and representatives of diabetes advocacy organizations. Questionnaire development consisted of a scoping literature review, individual interviews, workshops, asynchronous virtual collaboration, and cognitive debriefing interviews. RESULTS We identified three overarching categories of DHS, which were meaningful to PwD and crucial for the identification of relevant outcomes: (1) online/digital tools for information, education, support, motivation; (2) personal health monitoring to support self-management; (3) digital and telehealth solutions for engaging with health professionals. Overall outcome domains identified to be important were diabetes-related quality of life, distress, treatment burden, and confidence in self-management. Additional positive and negative outcomes specific to DHS were identified and corresponding questions were incorporated into the survey questionnaire. CONCLUSION We identified the need for self-reporting of quality of life, diabetes distress, treatment burden, and confidence in self-management, as well as specific positive and negative impacts of DHS. We designed a survey questionnaire to further assess the perceptions and perspectives of people with type 1 and 2 diabetes on outcomes relevant for DHS evaluations.
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Affiliation(s)
| | | | | | - Paco Cerletti
- Roche Diagnostics International AG, Basel Branch Diabetes Care, Basel, Switzerland
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Guo L, Li Y, Zhang M, Xiao X, Kuang H, Yang T, Jia X, Zhang X. Efficacy of unblinded and blinded intermittently scanned continuous glucose monitoring for glycemic control in adults with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1110845. [PMID: 36909344 PMCID: PMC9992877 DOI: 10.3389/fendo.2023.1110845] [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: 11/29/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Intermittently scanned continuous glucose monitoring (isCGM) is used for unblinded or blinded monitoring of interstitial glucose. We aimed to compare the efficacy of blinded and unblinded isCGM with the FreeStyle Libre system for glycemic control in adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS This randomized clinical trial conducted between October 2018 and September 2019 across four endocrinology practices in China included 273 adults aged ≥18 years with T1D, who were randomly divided in a 2:1 ratio into the unblinded (n = 199) or blinded isCGM group (n = 78). In the blinded group, the clinician used FreeStyle Libre Pro system for monitoring, but self-monitoring was also performed by the patients. RESULTS Two hundred sixteen (78%) participants completed the study (152 [75%] in the unblinded and 64 [82%] in the blinded group). At 12 weeks, a significant increase in TIR (3.9-10.0 mmol/L) was only observed in the unblinded group, along with a significant decrease in hyperglycemia (>13.9 mmol/L), hypoglycemia (<3.0 mmol/L), glycemic variability. Further, the mean HbA1c reduction from baseline to 12 weeks was 0.5% in the unblinded isCGM group and 0.4% in the blinded isCGM group respectively (P < 0.001), but the significance did not remain after adjustment for between-group differences. Finally, 99.5% of the blinded isCGM values and 93.8% the of unblinded isCGM values were obtained at the final visit. CONCLUSIONS The unblinded isCGM system was associated with benefits for glucose management, but nearly 100% of the attempted profiles were obtained successfully with the blinded isCGM system. Thus, combining real-time and retrospective data with isCGM might be the most impactful way to utilize flash glycemic monitoring devices.
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Affiliation(s)
- Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Sciences, Beijing, China
- *Correspondence: Lixin Guo,
| | - Yuxiu Li
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Zhang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinhua Xiao
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongyu Kuang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tao Yang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaofan Jia
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Sciences, Beijing, China
| | - Xianbo Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Sciences, Beijing, China
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Hügle T. Blood self-sampling: a missing link for remote patient care. RMD Open 2022; 8:rmdopen-2022-002728. [PMID: 36270745 PMCID: PMC9594585 DOI: 10.1136/rmdopen-2022-002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Thomas Hügle
- Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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