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Rossi MC, Bonfanti R, Graziano G, Larosa M, Lombardo F, Nicolucci A, Vespasiani G, Zucchini S, Rabbone I. Effectiveness of switching from first-generation basal insulin to Glargine 300 U/mL in children and adolescents with type 1 diabetes: results from the ISPED CARD database. Acta Diabetol 2024:10.1007/s00592-024-02304-2. [PMID: 38789610 DOI: 10.1007/s00592-024-02304-2] [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: 02/21/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
AIMS Glargine 300 U/mL (Gla-300) has been recently approved for use in children and adolescents with type 1 diabetes (T1D). However, real-world effectiveness data are scarce, and aim of this analysis was to assess clinical outcomes in young patients with T1D switching from 1st generation basal insulin (1BI) to Gla-300. METHODS ISPED CARD is a retrospective, multicenter study, based on data anonymously extracted from Electronic Medical Records. The study involved a network of 20 pediatric diabetes centers. Data on all patients aged < 18 years with T1D switching from 1BI to Gla-300 were analyzed to assess clinical characteristics at the switch and changes after 6 and 12 months in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and standardized body mass index (BMI/SDS). Titration of basal and short-acting insulin doses was also evaluated. RESULTS Overall, 200 patients were identified. The mean age at the switch to Gla-300 was 13 years, and mean duration of diabetes was 3.9 years. Average HbA1c levels at switch were 8.8%. After 6 months, HbA1c levels decreased by - 0.88% (95% CI - 1.28; - 0.48; p < 0.0001). The benefit was maintained after 12 months from the switch (mean reduction of HbA1c levels - 0.80%, 95% CI - 1.25; - 0.35, p = 0.0006). Trends of reduction in FBG levels were also evidenced both at 6 months and 12 months. No significant changes in short-acting and basal insulin doses were documented. CONCLUSIONS The study provides the first real-world evidence of the effectiveness of Gla-300 in children and adolescents with T1D previously treated with 1BI. The benefits in terms of HbA1c levels reduction were substantial, and sustained after 12 months. Additional benefits can be expected by improving the titration of insulin doses.
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Affiliation(s)
- Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | - Riccardo Bonfanti
- Pediatric Diabetology Unit, Department of Pediatrics, Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giusi Graziano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | | | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
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Mayberry LS, Wiebe DJ, Parks M, Campbell MS, Beam AB, Berg CA. Acceptability and feasibility of FAMS-T1D mHealth intervention to optimize self- and social regulation for emerging adults with type 1 diabetes. Pilot Feasibility Stud 2024; 10:68. [PMID: 38689356 PMCID: PMC11059732 DOI: 10.1186/s40814-024-01497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Among emerging adults with type 1 diabetes (T1D), self-regulation and social regulation skills can help avoid high A1c and diabetes distress. FAMS (Family/friend Activation to Motivate Self-care) is mobile phone-delivered intervention that supports development of these skills and is efficacious among adults with type 2 diabetes. However, the acceptability and feasibility of the FAMS intervention among emerging adults with T1D are unknown. METHODS Therefore, we adapted FAMS for in a new disease context and developmental stage and then conducted a 3-month mixed-methods pre-post pilot study. Participants were emerging adults with T1D and a friend/family member enrolled as a support person (optional). Feasibility/acceptability outcomes and associated progression thresholds were recruitment (≥ 70% eligible emerging adults), retention (≥ 85%), intervention engagement (≥ 70%), and satisfaction (≥ 70%). We also collected qualitative feedback to determine if the intervention addressed relevant needs and explored changes in outcomes of interest (family/friend involvement, self-efficacy, self-management, distress, A1c). RESULTS Recruitment rates indicate recruitment of emerging adults with T1D (n = 30) and their support persons (n = 20) is feasible - 79% of emerging adults who screened as eligible enrolled and 70% of enrolled emerging adults invited a support person. Emerging adults completed 98% of coaching sessions, and response rates to automated text messages were median 85% IQR [68%, 90%]. Changes in selected measures for outcomes of interest were in expected directions suggesting sensitivity to changes occasioned by the intervention in a future evaluative trial. Emerging adults said FAMS-T1D helped with setting realistic goals, motivated them to prioritize diabetes goals, and increased support, indicating acceptability of the intervention in this new disease and developmental context. CONCLUSIONS Findings suggest potential for FAMS-T1D to engage emerging adults and their support persons and feasibility for an evaluative trial examining effects on self-regulation (self-efficacy, self-management), social regulation (family/friend involvement), and outcomes (diabetes distress, A1c). TRIAL REGISTRATION We did not register this study on ClinicalTrials.gov because the purpose of the study was to assess the feasibility and acceptability of the intervention and study procedures and measures in preparation for a future trial. The purpose of that future trial will be to evaluate the effect of the intervention on health-related biomedical and behavioral outcomes, and that trial will be registered accordingly.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Deborah J Wiebe
- Department of Psychological Sciences and the Health Science Research Institute, University of California, Merced, CA, USA
| | - Makenzie Parks
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | | | - Aislinn B Beam
- Department of Psychological Sciences and the Health Science Research Institute, University of California, Merced, CA, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Kalyani RR, Allende-Vigo MZ, Antinori-Lent KJ, Close KL, Das SR, Deroze P, Edelman SV, El Sayed NA, Kerr D, Neumiller JJ, Norton A. Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement. J Clin Endocrinol Metab 2024; 109:1155-1178. [PMID: 38381587 DOI: 10.1210/clinem/dgad745] [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: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.
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Affiliation(s)
- Rita R Kalyani
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | | | | - Sandeep R Das
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Phyllisa Deroze
- dQ&A, The Diabetes Research Company, San Francisco, CA 94117, USA
| | - Steven V Edelman
- Division of Endocrinology, Diabetes & Metabolism at the University of California at San Diego, San Diego, CA 92103, USA
| | - Nuha A El Sayed
- American Diabetes Association, Harvard Medical School, Boston, MA 02215, USA
| | - David Kerr
- Director of Digital Health, Diabetes Technology Society, Santa Barbara, CA 94010, USA
| | - Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Anna Norton
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL 60440, USA
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Berg CA, Mansfield JH, Boggess SB, Martin JV, Creer B, Peck TK, Wiebe DJ, Butner JE, Mayberry LS. Goal change and goal achievement for emerging adults across the pilot FAMS-T1D intervention for type 1 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1297422. [PMID: 38685920 PMCID: PMC11056594 DOI: 10.3389/fcdhc.2024.1297422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/21/2024] [Indexed: 05/02/2024]
Abstract
Objective Interventions for emerging adults (EAs) with type 1 diabetes (T1D) focus on goal setting, but little is known about how goal achievement relates to intervention outcomes. We examined how goals change, how goal achievement relates to diabetes outcomes, and identified barriers and facilitators to goal achievement. Method EAs with T1D (N=29, M age=21.6 years, 57% female) were coached monthly to set a behavioral goal across a 3-month feasibility trial. Coaching notes were qualitatively coded regarding type, complexity, and changes in goals. Goal achievement was measured via daily responses to texts. HbA1c, self-efficacy, diabetes distress, and self-care were assessed pre- and post-intervention. Results EAs frequently set food goals (79%) in combination with other goals. EAs overwhelmingly changed their goals (90%), with most increasing goal complexity. Goal achievement was high (79% of days) and not affected by goal change or goal complexity. Goal achievement was associated with increases in self-efficacy and self-care across time. Qualitative themes revealed that aspects of self-regulation and social-regulation were important for goal achievement. Conclusion Meeting daily diabetes goals may enhance self-efficacy and self-care for diabetes. Practice Implications Assisting EAs to reduce self-regulation challenges and enhance social support for goals may lead to better diabetes outcomes.
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Affiliation(s)
- Cynthia A. Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | | | - Silas B. Boggess
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Julia V. Martin
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Benjamin Creer
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Torri K. Peck
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Deborah J. Wiebe
- Psychological Sciences, University of California, Merced, CA, United States
| | - Jonathan E. Butner
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Lindsay S. Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Grando Alves G, Cunha L, Henkes Machado R, Lins de Menezes V. Safety and efficacy of teplizumab in the treatment of type 1 diabetes mellitus: An updated systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2024. [PMID: 38602411 DOI: 10.1111/dom.15581] [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: 01/04/2024] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
AIM To provide updated efficacy and safety information for teplizumab in the treatment of Stage 3 type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS The PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) comparing teplizumab to placebo for T1DM that reported any of the following outcomes: (1) C-peptide area under the curve (AUC); (2) glycated haemoglobin (HbA1c) levels; (3) insulin requirements; and (4) adverse events. Heterogeneity was examined with I2 statistics. p values <0.05 were taken to indicate statistical significance. The continuous endpoints were compared through the pooled mean difference (MD) and binary endpoints were assessed using risk ratios, both with 95% confidence intervals (CIs). Statistical analyses were performed using Review Manager Web software. RESULTS Eight RCTs with 1052 patients (754 receiving teplizumab) were included. Teplizumab significantly increased the AUC of C-peptide levels at 6 (MD 0.10 nmol/L, 95% CI 0.05, 0.16), 12 (MD 0.13 nmol/L, 95% CI 0.06, 0.20), 18 (MD 0.18 nmol/L, 95% CI 0.09, 0.27) and 24 months (MD 0.16 nmol/L, 95% CI 0.02, 0.31), significantly reduced HbA1c levels at 6 (MD -0.57%, 95% CI -1.07, -0.08) and 12 months (MD -0.31%, 95% CI -0.59, -0.02), and significantly reduced insulin requirements at 6 (MD -0.12 U/kg, 95% CI -0.16, -0.08), 12 (MD -0.11 U/kg, 95% CI -0.15, -0.07), 18 (MD -0.17 U/kg, 95% CI -0.26, -0.09) and 24 months (MD -0.11 U/kg, 95% CI -0.22, -0.01). CONCLUSION Teplizumab increases AUC of C-peptide levels and decreases HbA1c levels and insulin use, without raising serious adverse event risk.
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Affiliation(s)
| | - Luisa Cunha
- Department of Medicine, Lusíada University Center, São Paulo, Brazil
| | | | - Vanessa Lins de Menezes
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Granados A, Carrillo Iregui A. Type 1 Diabetes Management in the Hospital Setting. Pediatr Rev 2024; 45:201-209. [PMID: 38556511 DOI: 10.1542/pir.2022-005645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The incidence of diabetes in children and adolescents has increased during the past decades, with a 1.9% increase per year in type 1 diabetes mellitus (T1DM). Patients with diabetes have a greater risk of hospitalizations compared with those without diabetes. Clear evidence has emerged in the past decade that supports appropriate glycemic control in the hospital setting to improve clinical outcomes and reduce the risk of hospital complications and mortality. Determining the appropriate insulin regimen in patients with T1DM in the hospital depends on the clinical status, type of outpatient insulin regimen (multiple daily injections versus pump therapy), glycemic control before admission, nutritional status, procedures, and enteral versus parenteral nutrition. Due to the complexity of the inpatient management of diabetes, institutions should have an inpatient diabetes management team that includes dietitians, diabetes educators, nurses, pharmacists, social workers, and endocrinologists. The use of inpatient diabetes teams has been demonstrated to be beneficial in the management of patients with T1DM.
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Affiliation(s)
- Andrea Granados
- Division of Pediatric Endocrinology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
| | - Adriana Carrillo Iregui
- Division of Pediatric Endocrinology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
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Deng C, Xie Y, Li J, Jiang H, Niu X, Yan D, Su H, Kuang H, Tian L, Liu J, Jiang S, Quan H, Xu J, Wu X, Tao N, Sun S, Tang X, Chen Y, Fan L, Li X, Zhou Z. Care, control and complications of hospitalised patients with type 1 diabetes in China: A nationwide-based registry study. Diabetes Metab Res Rev 2024; 40:e3796. [PMID: 38529788 DOI: 10.1002/dmrr.3796] [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: 12/15/2023] [Revised: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
AIMS To evaluate the status quo of type 1 diabetes (T1D) management and characteristics of hospitalised patients with T1D in China through a nationwide multicentre registry study, the China Diabetes Type 1 Study (CD1S). MATERIALS AND METHODS Clinical data from the electronic hospital records of all people with T1D were retrospectively collected in 13 tertiary hospitals across 7 regions of China from January 2016 to December 2021. Patients were defined as newly diagnosed who received a diagnosis of diabetes for less than 3 months. RESULTS Among the 4993 people with T1D, the median age (range) at diagnosis was 23.0 (1.0-87.0) years and the median disease duration was 2.0 years. The median haemoglobin A1c (HbA1c) level was 10.7%. The prevalence of obesity, overweight, dyslipidemia, and hypertension were 2.5%, 10.8%, 62.5% and 25.9%, respectively. The incidence rate of diabetic ketoacidosis at disease onset was 41.1%, with the highest in children <10 years of age (50.6%). In patients not newly diagnosed, 60.7% were diagnosed with at least one chronic diabetic complication, with the highest proportion (45.3%) of diabetic peripheral neuropathy. Chronic complications were detected in 79.2% of people with T1D duration ≥10 years. CONCLUSIONS In the most recent years, there were still unsatisfactory metabolic control and high incidence of diabetic ketoacidosis as well as chronic diabetic complications among inpatients with T1D in China. The ongoing CD1S prospective study aims to improve the quality of T1D management nationally.
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Affiliation(s)
- Chao Deng
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuting Xie
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Juan Li
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hongwei Jiang
- Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiaohong Niu
- Department of Endocrinology, Changzhi Medical College Affiliated Heji Hospital, Changzhi, China
| | - Dewen Yan
- Department of Endocrinology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Center for Diabetes Control and Prevention, Shenzhen, China
| | - Heng Su
- Department of Endocrinology and Metabolism, First People's Hospital of Yunnan Province (The Affiliated Hospital of Kunming University of Science and Technology), Kunming, China
| | - Hongyu Kuang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Liming Tian
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Jing Liu
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Sheng Jiang
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jixiong Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaohong Wu
- Department of Endocrinology, Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, China
| | - Na Tao
- Department of Endocrinology, The Kunming Children's Hospital, Kunming, China
| | - Shuguang Sun
- Department of Endocrinology, The First Affiliated Hospital of Dali University, Dali, China
| | - Xiaohan Tang
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yan Chen
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Fan
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, China
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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.
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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
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Bailey R, Calhoun P, Garg SK. Weight Gain and Glycemic Control in Adults with Type 1 Diabetes in the T1D Exchange Registry. Diabetes Technol Ther 2024; 26:156-160. [PMID: 38444314 DOI: 10.1089/dia.2023.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Aim: The impact of weight gain on insulin dosage and glycemic control in adults with type 1 diabetes (T1D) aged 25 years and older was investigated in the T1D Exchange Registry participants. Methods: Participants were categorized into four groups based on their change in weight from T1D Exchange registry enrollment to year 5: stable weight (-5 to <5 lb), gained 5 to <10 lb, gained 10 to <20 lb, or gained ≥20 lb. Those who lost >5 lb were excluded. The primary outcomes were glucose control, as measured by glycosylated hemoglobin (HbA1c), and total daily insulin dose (TDD) at year 5. Linear regression models were used to evaluate the association between weight gain, HbA1c, and TDD. Results: There were 1969 participants included in the analyses. The mean ± standard deviation age was 45 ± 13 years, 57% were female, and 92% were White non-Hispanic. For those with an enrollment HbA1c <8.0%, the mean HbA1c at year 5 was higher for those who gained ≥20 lb compared to those with a stable weight of -5 to <5 lb (7.4% ± 1.1% vs. 7.2% ± 0.8%, respectively; P = 0.005). For this cohort, the mean TDD at year 5 increased from 49 ± 25 to 61 ± 29 U for those who gained ≥20 lb, while decreased from 45 ± 27 to 44 ± 25 U for those with stable weight of -5 to <5 lb (P < 0.001). Among participants with an enrollment HbA1c ≥9.0%, the mean HbA1c at year 5 was statistically insignificant at 8.4% ± 1.3% for those who gained ≥20 lb compared to 9.2% ± 1.7% for those with a stable weight of -5 to <5 lb (P = 0.09). Conclusion: Significant weight gain in adults with T1D who had good to adequate glycemic control was associated with modest deterioration in glucose control despite an increase in TDD. Worsening glucose control may indicate insulin resistance related to weight gain despite significantly increased insulin dosage which was insufficient to maintain adequate glycemic control.
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Affiliation(s)
- Ryan Bailey
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
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10
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Freeman NLB, Muthukkumar R, Weinstock RS, Wickerhauser MV, Kahkoska AR. Use of machine learning to identify characteristics associated with severe hypoglycemia in older adults with type 1 diabetes: a post-hoc analysis of a case-control study. BMJ Open Diabetes Res Care 2024; 12:e003748. [PMID: 38413176 PMCID: PMC10900355 DOI: 10.1136/bmjdrc-2023-003748] [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: 09/04/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Severe hypoglycemia (SH) in older adults (OAs) with type 1 diabetes is associated with profound morbidity and mortality, yet its etiology can be complex and multifactorial. Enhanced tools to identify OAs who are at high risk for SH are needed. This study used machine learning to identify characteristics that distinguish those with and without recent SH, selecting from a range of demographic and clinical, behavioral and lifestyle, and neurocognitive characteristics, along with continuous glucose monitoring (CGM) measures. RESEARCH DESIGN AND METHODS Data from a case-control study involving OAs recruited from the T1D Exchange Clinical Network were analyzed. The random forest machine learning algorithm was used to elucidate the characteristics associated with case versus control status and their relative importance. Models with successively rich characteristic sets were examined to systematically incorporate each domain of possible risk characteristics. RESULTS Data from 191 OAs with type 1 diabetes (47.1% female, 92.1% non-Hispanic white) were analyzed. Across models, hypoglycemia unawareness was the top characteristic associated with SH history. For the model with the richest input data, the most important characteristics, in descending order, were hypoglycemia unawareness, hypoglycemia fear, coefficient of variation from CGM, % time blood glucose below 70 mg/dL, and trail making test B score. CONCLUSIONS Machine learning may augment risk stratification for OAs by identifying key characteristics associated with SH. Prospective studies are needed to identify the predictive performance of these risk characteristics.
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Affiliation(s)
- Nikki L B Freeman
- Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Rashmi Muthukkumar
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruth S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - M Victor Wickerhauser
- Department of Mathematics, Washington University in St Louis, St Louis, Missouri, USA
| | - Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Daniels AM, Law JK, Green Snyder L, Diehl K, Goin-Kochel RP, Feliciano P, Chung WK. Effectiveness of multimodal participant recruitment in SPARK, a large, online longitudinal research study of autism. J Clin Transl Sci 2023; 8:e64. [PMID: 38655455 PMCID: PMC11036434 DOI: 10.1017/cts.2023.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 04/26/2024] Open
Abstract
Background SPARK launched in 2016 to build a US cohort of autistic individuals and their family members. Enrollment includes online consent to share data and optional consent to provide saliva for genomic analysis. SPARK's recruitment strategies include social media and support of a nation-wide network of clinical sites. This study evaluates SPARK's recruitment strategies to enroll a core study population. Methods Individuals who joined between January 31, 2018, and May 29, 2019 were included in the analysis. Data include sociodemographic characteristics, clinical site referral, the website URL used to join, how the participant heard about SPARK, enrollment completion (online registration, study consents, and returning saliva sample), and completion of the baseline questionnaire. Logistic regressions were performed to evaluate the odds of core participant status (completing enrollment and baseline questionnaire) by recruitment strategy. Results In total, 31,715 individuals joined during the study period, including 40% through a clinical site. Overall, 88% completed online registration, 46% returned saliva, and 38% were core participants. Those referred by a clinical site were almost twice as likely to be core participants. Those who directly visited the SPARK website or performed a Google search were more likely to be core participants than those who joined through social media. Discussion Being a core participant may be associated with the "personal" connection and support provided by a clinical site and/or site staff, as well as greater motivation to seek research opportunities. Findings from this study underscore the value of adopting a multimodal recruitment approach that combines social media and a physical presence.
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Affiliation(s)
| | - J. Kiely Law
- Simons Foundation, New York, NY,
USA
- Kennedy Krieger Institute, Baltimore,
MD, USA
| | | | | | | | | | - Wendy K. Chung
- Department of Pediatrics, Boston Children’s Hospital, Harvard
Medical School, Boston, MA,
USA
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12
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Ratzki-Leewing A, Black JE, Kahkoska AR, Ryan BL, Zou G, Klar N, Timcevska K, Harris SB. Severe (level 3) hypoglycaemia occurrence in a real-world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States). Diabetes Obes Metab 2023; 25:3736-3747. [PMID: 37700692 PMCID: PMC10958739 DOI: 10.1111/dom.15268] [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: 02/28/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
AIMS Among adults with insulin- and/or secretagogue-treated diabetes in the United States, very little is known about the real-world descriptive epidemiology of iatrogenic severe (level 3) hypoglycaemia. Addressing this gap, we collected primary, longitudinal data to quantify the absolute frequency of events as well as incidence rates and proportions. MATERIALS AND METHODS iNPHORM is a US-wide, 12-month ambidirectional panel survey (2020-2021). Adults with type 1 diabetes mellitus (T1DM) or insulin- and/or secretagogue-treated type 2 diabetes mellitus (T2DM) were recruited from a probability-based internet panel. Participants completing ≥1 follow-up questionnaire(s) were analysed. RESULTS Among 978 respondents [T1DM 17%; mean age 51 (SD 14.3) years; male: 49.6%], 63% of level 3 events were treated outside the health care system (e.g. by family/friend/colleague), and <5% required hospitalization. Following the 12-month prospective period, one-third of individuals reported ≥1 event(s) [T1DM 44.2% (95% CI 36.8%-51.8%); T2DM 30.8% (95% CI 28.7%-35.1%), p = .0404, α = 0.0007]; and the incidence rate was 5.01 (95% CI 4.15-6.05) events per person-year (EPPY) [T1DM 3.57 (95% CI 2.49-5.11) EPPY; T2DM 5.29 (95% CI 4.26-6.57) EPPY, p = .1352, α = 0.0007]. Level 3 hypoglycaemia requiring non-transport emergency medical services was more common in T2DM than T1DM (p < .0001, α = 0.0016). In total, >90% of events were experienced by <15% of participants. CONCLUSIONS iNPHORM is one of the first long-term, prospective US-based investigations on level 3 hypoglycaemia epidemiology. Our results underscore the importance of participant-reported data to ascertain its burden. Events were alarmingly frequent, irrespective of diabetes type, and concentrated in a small subsample.
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Affiliation(s)
- Alexandria Ratzki-Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jason E. Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anna R. Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kristina Timcevska
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart B. Harris
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine/Division of Endocrinology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Mayberry LS, Wiebe D, Parks M, Campbell M, Beam A, Berg C. Acceptability and Feasibility of FAMS-T1D mHealth intervention to optimize self- & social regulation for emerging adults with type 1 diabetes. RESEARCH SQUARE 2023:rs.3.rs-2667134. [PMID: 38045417 PMCID: PMC10690330 DOI: 10.21203/rs.3.rs-2667134/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Among emerging adults with type 1 diabetes (T1D), self-regulation and social regulation skills can help avoid high A1c and diabetes distress. FAMS (Family/friend Activation to Motivate Self-care) is mobile phone-delivered intervention that supports development of these skills and is efficacious among adults with type 2 diabetes. However, the acceptability and feasibility of the FAMS intervention among emerging adults with T1D is unknown. Methods Therefore, we adapted FAMS for in a new disease context and developmental stage then conducted a 3-month mixed-methods pre-post pilot study. Participants were emerging adults with T1D and a friend/family member enrolled as a support person (optional). Feasibility/acceptability outcomes and associated progression thresholds were recruitment (≥ 70% eligible emerging adults), retention (≥ 85%), intervention engagement (≥ 70%) and satisfaction (≥ 70%). We also collected qualitative feedback to determine if the intervention addressed relevant needs and explored changes in outcomes of interest (family/friend involvement, self-efficacy, self-management, distress, A1c). Results Recruitment rates indicate recruitment of emerging adults with T1D and their support persons is feasible - 79% of emerging adults who screened as eligible enrolled and 70% of enrolled emerging adults invited a support person. Emerging adults completed 98% of coaching sessions, and response rates to automated text messages were median 85% IQR [68%, 90%]. Changes in selected measures for outcomes of interest were in expected directions suggesting sensitivity to changes occasioned by the intervention in a future evaluative trial. Emerging adults said FAMS-T1D helped with setting realistic goals, motivated them to prioritize diabetes goals, and increased support, indicating acceptability of the intervention in this new disease and developmental context. Conclusions Findings suggest potential for FAMS-T1D to engage emerging adults and their support persons and feasibility for evaluation of effects on hypothesized intervention targets and outcomes in a subsequent evaluative trial. Trial Registration We did not register this study on clinicaltrials.gov because the purpose of the study was to assess the feasibility and acceptability of the intervention and study procedures and measures in preparation for a future trial. The purpose of that future trial will be to evaluate the effect of the intervention on health-related biomedical and behavioral outcomes and that trial will be registered accordingly.
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14
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Bailey R, Donthi S, Markt S, Drummond C, Cullen J. Evaluating Factors Associated With Continuous Glucose Monitoring Utilization With the Type 1 Diabetes Exchange Registry. J Diabetes Sci Technol 2023; 17:1580-1589. [PMID: 35506181 PMCID: PMC10658673 DOI: 10.1177/19322968221091299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The 2022 American Diabetes Association (ADA) Standards of Care recommends considering use of continuous glucose monitoring (CGM) for insulin-managed diabetes mellitus (DM), but equitable access remains challenging. This study evaluates socioeconomic and demographic metrics associated with CGM use. METHODS RStudio 2021.09.1+372 was utilized to perform uni- and bivariable analysis, as well as binomial logistic regression modeling for categorical CGM use (yes/no) on the most recent cross-section from the Type 1 Diabetes Exchange (T1DX) Registry 2016-2018 cohort (n = 22 418). RESULTS Compared with White Non-Hispanic participants, Black Non-Hispanic (OR = 0.45, CI = 0.36-0.57, P < 0.001) and American Indian/Alaskan Native individuals (OR = 0.33, CI = 0.14-0.70, P = 0.008) had lower odds of CGM use. Compared with private insurance, government insurance had reduced odds of CGM use (OR = 0.59, CI = 0.52-0.66, P < 0.001). Individuals earning $100,000 or more were twice as likely to use CGMs (OR = 2.06, CI = 1.75-2.45, P < 0.001) compared with those earning <$25,000 annually. Subgroup analysis based on income bracket demonstrated that government insured individuals earning <$25,000 annually were the least likely to use CGMs (OR = 0.44, CI = 0.32-0.61, P < 0.001), as compared with private insurance. CONCLUSIONS T1DX Registry data demonstrate that CGM use follows the inverse care law, with health technology utilization inversely related to disease burden. Federal policies promoting CGM use in Medicare and Medicaid populations can facilitate the ADA's recommendation for patients with insulin-managed diabetes mellitus.
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Affiliation(s)
- Richard Bailey
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sriya Donthi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sarah Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Colin Drummond
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer Cullen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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15
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Ratzki-Leewing AA, Black JE, Ryan BL, Zou G, Klar N, Webster-Bogaert S, Timcevska K, Harris SB. Development and validation of a real-world model to predict 1-year Level 3 (severe) hypoglycaemia risk in adults with diabetes (the iNPHORM study, United States). Diabetes Obes Metab 2023; 25:2910-2927. [PMID: 37409569 DOI: 10.1111/dom.15186] [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: 01/24/2023] [Revised: 05/21/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
AIMS We aimed to develop and internally validate a real-world prognostic model for Level 3 hypoglycaemia risk compatible with outpatient care in the United States. MATERIALS AND METHODS iNPHORM is a 12-month, US-based panel survey. Adults (18-90 years old) with type 1 diabetes mellitus or insulin- and/or secretagogue-treated type 2 diabetes mellitus were recruited from a nationwide, probability-based internet panel. Among participants completing ≥ 1 follow-up questionnaire(s), we modelled 1-year Level 3 hypoglycaemia risk using Andersen and Gill's Cox survival and penalized regression with multiple imputation. Candidate variables were selected for their clinical relevance and ease of capture at point-of-care. RESULTS In total, 986 participants [type 1 diabetes mellitus: 17%; men: 49.6%; mean age: 51 (SD: 14.3) years] were analysed. Across follow-up, 035.1 (95% CI: 32.2-38.1)% reported ≥1 Level 3 event(s), and the rate was 5.0 (95% CI: 4.1-6.0) events per person-year. Our final model showed strong discriminative validity and parsimony (optimism corrected c-statistic: 0.77). Numerous variables were selected: age; sex; body mass index; marital status; level of education; insurance coverage; race; ethnicity; food insecurity; diabetes type; glycated haemoglobin value; glycated haemoglobin variability; number, type and dose of various medications; number of SH events requiring hospital care (past year and over follow-up); type and number of comorbidities and complications; number of diabetes-related health care visits (past year); use of continuous/flash glucose monitoring; and general health status. CONCLUSIONS iNPHORM is the first US-based primary prognostic study on Level 3 hypoglycaemia. Future model implementation could potentiate risk-tailored strategies that reduce real-world event occurrence and overall diabetes burden.
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Affiliation(s)
- Alexandria A Ratzki-Leewing
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jason E Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Robarts Research Institute, Western University, London, Canada
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Susan Webster-Bogaert
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Kristina Timcevska
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Stewart B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Sińska BI, Rzońca E, Kucharska A, Gałązkowski R, Traczyk I, Rzońca P. Factors Influencing the Control of Diabetes Measured via Glycated Hemoglobin Concentrations in Adults with Type 1 Diabetes. Eur J Investig Health Psychol Educ 2023; 13:2035-2045. [PMID: 37887145 PMCID: PMC10606861 DOI: 10.3390/ejihpe13100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/04/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Numerous complications of type 1 diabetes (T1D) may be prevented through suitable glycemic control. Glycated hemoglobin (HbA1c) may be one of the markers for the early detection of the metabolic imbalance characteristic of the disease. However, optimal control of diabetes is not achieved in a large group of patients. It was demonstrated that numerous factors (sociodemographic, psychological, and clinical) contributed to this condition. The aim of the study was to identify factors influencing the control of diabetes measured via glycated hemoglobin concentrations in people with T1D. Independent factors influencing better diabetes control measured via HbA1c in the study group included higher disease acceptance, higher nutritional adherence, lower BMI, and a lower risk of eating disorders. Describing the determinants will allow for the improvement of the system of care provided to people with T1D and for it to comprise important psychological variables related to self-care and acceptance of the disease.
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Affiliation(s)
- Beata I. Sińska
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (I.T.)
| | - Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland;
| | - Alicja Kucharska
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (I.T.)
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland;
| | - Iwona Traczyk
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (I.T.)
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland;
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Kong L, Deng B, Guo M, Chen M, Wang X, Zhang M, Tang H, Wang Q, Yang L, Xiong Z. A systematic bibliometric analysis on the clinical practice of CGM in diabetes mellitus from 2012 to 2022. Front Endocrinol (Lausanne) 2023; 14:1229494. [PMID: 37810892 PMCID: PMC10556737 DOI: 10.3389/fendo.2023.1229494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Background Continuous glucose monitoring (CGM) has revolutionized diabetes management, but a comprehensive analysis of its clinical implementation is lacking. This study aims to explore CGM in diabetes practice over the past decade using bibliometric analysis. It will identify trends, research focal points, and provide a framework for future investigations. Materials and methods The Web of Science Core Collection (WOSCC) was utilized to acquire literature pertaining to the employment of continuous glucose monitoring (CGM) in diabetes that was published between the years 2012 and 2022, and to conduct a comprehensive analysis of the associated citation data. To achieve bibliometric visualization and analysis of the collated data, the bibliography package in the Rstudio(v.4.2.2), Citespace 6.2.R4, and VOS viewer were employed. Results A total of 3024 eligible publications were extracted from 91 countries, with the United States being the leading country in terms of the number of issued articles. Furthermore, the annual publication rate has shown a gradual increase during the past decade. Among the various journals in this field, DIABETES TECHNOLOGY & THERAPEUTICS was identified as the most highly cited one. Keyword clustering analysis of the extracted publications indicates that the research hotspots in the past decade have primarily focused on "continuous glucose monitoring", "glycemic variability", "type 1 diabetes", "hypoglycemia", and "glycemic control". Moreover, the analysis of keyword emergence reveals that "Time In Range" and "Young Adult" represent the current research frontiers for the years 2012-2022. Conclusion The concept of Time in Range (TIR) has garnered considerable attention as a significant area of inquiry and an emerging research trend in the clinical practice of Continuous Glucose Monitoring (CGM) for Diabetes Mellitus. Moreover, recent investigations have demonstrated a growing focus on young adults with type 1 diabetes as the research population of interest. In the foreseeable future, research endeavors will persist in the pursuit of improving glycemic management among young adults through the utilization of continuous glucose monitoring (CGM) technology, while also delving into the examination of the Time in Range metric via supplementary clinical investigations.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Liwei Yang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
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18
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Choe J, Kudrna R, Fonseca LM, Chaytor NS. Usefulness of the Montreal Cognitive Assessment in Older Adults With Type 1 Diabetes. Diabetes Spectr 2023; 36:385-390. [PMID: 37982060 PMCID: PMC10654125 DOI: 10.2337/ds23-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Objective Older adults with type 1 diabetes are at high risk for cognitive impairment, yet the usefulness of common cognitive screening instruments has not been evaluated in this population. Methods A total of 201 adults ≥60 years of age with type 1 diabetes completed a battery of neuropsychological measures and the Montreal Cognitive Assessment (MoCA). Receiver operating characteristic (ROC) curves and Youden indices were used to evaluate overall screening test performance and to select an optimal MoCA cutoff score for detecting low cognitive performance, as defined as two or more neuropsychological test performances ≥1.5 SD below demographically corrected normative data. Results The ROC area under the curve (AUC) was 0.745 (P < 0.001). The publisher-recommended cutoff score of <26 resulted in sensitivity of 60.4% and specificity of 71.4%, whereas a cutoff score of <27 resulted in sensitivity of 75.0% and specificity of 61.0%. The Youden indices for these cutoff scores were 0.318 and 0.360, respectively. Minimally acceptable sensitivity (i.e., >0.80) was obtained when using a cutoff score of <28, whereas >0.80 specificity was obtained with a cutoff score of <25. Conclusions The MoCA has modest overall performance (AUC 0.745) as a cognitive screening instrument in older adults with type 1 diabetes. The standard cutoff score of <26/30 may not adequately detect individuals with neuropsychological testing-defined abnormal cognition. The optimal MoCA cutoff score (based on the Youden index) was <27/30. A score of <28 resulted in acceptable sensitivity but was accompanied by low specificity (42%). Future studies with a more diverse population are needed to confirm these findings.
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Affiliation(s)
- James Choe
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Rachel Kudrna
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | - Naomi S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
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Chen Y, Xie Y, Xia Y, Xie Z, Huang G, Fan L, Zhou Z, Li X. Prevalence, clinical characteristics and HLA genotypes of idiopathic type 1 diabetes: A cross-sectional study. Diabetes Metab Res Rev 2023; 39:e3676. [PMID: 37337767 DOI: 10.1002/dmrr.3676] [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: 02/06/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 06/21/2023]
Abstract
AIMS Idiopathic type 1 diabetes (T1D) is a neglected subtype of T1D. Our aim was to investigate the frequency, clinical characteristics, and human leucocyte antigen (HLA) genotypes of idiopathic T1D. METHODS We enrolled 1205 newly diagnosed T1D patients in our analysis. To exclude monogenic diabetes in autoantibody-negative patients, we utilised a custom monogenic diabetes gene panel. Individuals negative for autoantibodies and subsequently excluded for monogenic diabetes were diagnosed with idiopathic T1D. We collected clinical characteristics, measured islet autoantibodies by radioligand assay and obtained HLA data. RESULTS After excluding 11 patients with monogenic diabetes, 284 cases were diagnosed with idiopathic T1D, accounting for 23.8% (284/1194) of all newly diagnosed T1D cases. When compared with autoimmune T1D, idiopathic T1D patients showed an older onset age, higher body mass index among adults, lower haemoglobin A1c, higher levels of fasting C-peptide and 2-h postprandial C-peptide, and were likely to have type 2 diabetes (T2D) family history and carry 0 susceptible HLA haplotype (all p < 0.01). A lower proportion of individuals carrying 2 susceptible HLA haplotypes in idiopathic T1D was observed in the adult-onset subgroup (15.7% vs. 38.0% in child-onset subgroup, p < 0.001) and in subgroup with preserved beta-cell function (11.0% vs. 30.1% in subgroup with poor beta-cell function, p < 0.001). Multivariable correlation analyses indicated that being overweight, having T2D family history and lacking susceptible HLA haplotypes were associated with negative autoantibodies. CONCLUSIONS Idiopathic T1D represents about 1/4 of newly diagnosed T1D, with adult-onset and preserved beta-cell function patients showing lower HLA susceptibility and more insulin resistance.
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Affiliation(s)
- Yan Chen
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuting Xie
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Xia
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiguo Xie
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Gan Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li Fan
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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20
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Lin YK, Newman S, Piette J. Response Consistency of Crowdsourced Web-Based Surveys on Type 1 Diabetes. J Med Internet Res 2023; 25:e43593. [PMID: 37594797 PMCID: PMC10474500 DOI: 10.2196/43593] [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: 12/05/2022] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
Although Amazon Mechanical Turk facilitates the quick surveying of a large sample from various demographic and socioeconomic backgrounds, it may not be an optimal platform for obtaining reliable diabetes-related information from the online type 1 diabetes population.
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Affiliation(s)
- Yu Kuei Lin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Sean Newman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - John Piette
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
- VA Ann Arbor Healthcare System Center for Clinical Management Research, Ann Arbor, MI, United States
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21
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Williams DD, Ferro D, Mullaney C, Skrabonja L, Barnes MS, Patton SR, Lockee B, Tallon EM, Vandervelden CA, Schweisberger C, Mehta S, McDonough R, Lind M, D'Avolio L, Clements MA. Development of an "all-data-on-hand" deep learning model to predict hospitalization for diabetic ketoacidosis (DKA) in youth with type 1 diabetes (T1D). JMIR Diabetes 2023. [PMID: 37224506 PMCID: PMC10394604 DOI: 10.2196/47592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND While prior research has identified multiple risk factors for diabetic ketoacidosis (DKA), clinicians continue to lack clinic-ready models to predict dangerous and costly episodes of DKA. We asked whether we could apply deep learning, specifically use of a long short-term (LSTM) model, to accurately predict 180-day risk of DKA-related hospitalization for youth with type 1 diabetes (T1D). OBJECTIVE To describe the development of a LSTM model to predict 180-day risk of DKA-related hospitalization for youth with T1D. METHODS We used 17 consecutive calendar quarters of clinical data (01/10/2016-03/18/2020) for 1745 youth 8 to 18-years with T1D from a pediatric diabetes clinic network in the Midwestern US. Input data included demographics, discrete clinical observations (lab results, vital signs, anthropometric measures, diagnosis and procedure codes), medications, visit counts by type of encounter, number of historic DKA episodes, number of days since last DKA admission, patient-reported outcomes (answers to clinic intake questions), and data features derived from diabetes- and non-diabetes-related clinical notes via natural language processing (NLP). We trained the model using input data from quarters 1-7 (n=1377), validated using input from quarters 3-9 in a partial out-of-sample cohort (OOS-P; n=1505), and further validated in a full out-of-sample cohort (OOS-F; n=354) with input from quarters 10-15. RESULTS DKA admissions occurred at a rate of 5% per 180-days in both OOS cohorts. For the OOS-P and OOS-F cohorts, respectively: median age was 13.7 years (IQR=11.3,15.8) and 13.1 years (10.7,15.5); and HbA1c at enrollment was 8.6% (7.6,9.8) [70 (60,84) mmol/mol] and 8.1% (6.9,9.5) [65 (52,80) mmol/mol]; 14% and 13% had prior DKA admissions (post-T1D-diagnosis); and recall was 0.33 and 0.50 for the top-ranked 5% of youth with T1D. For lists rank-ordered by probability of hospitalization, precision increased from 0.33 to 0.56 to 1.0 for positions 1-80, 1-25, and 1-10 in the OOS-P cohort and from 0.50 to 0.60 to 0.80 for positions 1-18, 1-10, and 1-5 in the OOS-F cohort. CONCLUSIONS The proposed LSTM model for predicting 180-day DKA-related hospitalization is valid in the present sample. Future work should evaluate model validity in multiple populations and settings to account for health inequities that may be present in different segments of the population (e.g., racially and/or socioeconomically diverse cohorts). Rank-ordering youth by probability of DKA-related hospitalization will allow clinics to identify the most at-risk youth. The clinical implication of this is that clinics may then create and evaluate novel preventive interventions based on available resources.
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Affiliation(s)
- David D Williams
- Health Services and Outcomes Research, Children's Mercy - Kansas City, 2401 Gillham Road, Kansas City, US
| | - Diana Ferro
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children Hospital, Roma, IT
- Department of Endocrinology, Children's Mercy - Kansas City, Kansas City, US
| | | | | | - Mitchell S Barnes
- Department of Endocrinology, Children's Mercy - Kansas City, Kansas City, US
| | - Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health, Jacksonville, US
| | - Brent Lockee
- Department of Endocrinology, Children's Mercy - Kansas City, Kansas City, US
| | - Erin M Tallon
- Department of Endocrinology, Children's Mercy - Kansas City, Kansas City, US
| | | | | | | | - Ryan McDonough
- Department of Endocrinology, Children's Mercy - Kansas City, Kansas City, US
| | - Marcus Lind
- Department of Medicine, NU-Hospital Group, Uddevalla, SE
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, SE
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, SE
| | | | - Mark A Clements
- Department of Endocrinology, Children's Mercy - Kansas City, Kansas City, US
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22
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Mohan V, Uma Sankari G, Amutha A, Anjana RM, Jeba Rani S, Unnikrishnan R, Venkatesan U, Shanthi Rani CS. Clinical and biochemical profile of childhood-adolescent-onset type 1 diabetes and adult-onset type 1 diabetes among Asian Indians. Acta Diabetol 2023; 60:579-586. [PMID: 36700996 DOI: 10.1007/s00592-023-02034-x] [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: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
AIM To compare the clinical and biochemical profile and prevalence of complications among childhood/adolescent-onset (CAO; onset of diabetes< 20 years of age) and adult-onset (AO; onset of diabetes- ≥ 20 years of age) type 1 diabetes (T1D), seen at a tertiary care diabetes center in south India. METHOD Data of 5578 individuals with T1D, diagnosed based on a history of diabetic ketoacidosis or ketonuria, fasting C-peptide < 0.3 pmol/mL and stimulated C-peptide values < 0.6 pmol/mL, and requirement of insulin right from the time of diagnosis, presenting to our center between 1991 and 2021, were retrieved from our electronic medical records. Retinopathy was assessed by retinal photography, chronic kidney disease (CKD) by urinary albumin excretion ≥ 30 µg/mg of creatinine and/or eGFR < 60 mL/min, and neuropathy by vibration perception threshold >= 20v on biothesiometry. RESULTS Overall, 3559 (63.8%) of individuals with T1D, belonged to CAO group and 2019 (36.2%) to AO category. AO had higher prevalence of all microvascular complications compared to CAO at every diabetes duration interval, even after adjusting for A1c. Among the AO group, prevalence of retinopathy, CKD, and neuropathy was higher in the GAD negative group. Among CAO there were no differences between the GAD negative and GAD positive groups with respect to prevalence of complications of diabetes. CONCLUSION AO with T1D had higher prevalence of microvascular complications compared to CAO. Among AO, GAD negative individuals had higher percentage of retinopathy and CKD compared to GAD positive group.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
| | - Ganesan Uma Sankari
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Anandakumar Amutha
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Saravanan Jeba Rani
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Coimbatore Subramanian Shanthi Rani
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
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23
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Almurashi AM, Rodriguez E, Garg SK. Emerging Diabetes Technologies: Continuous Glucose Monitors/Artificial Pancreases. J Indian Inst Sci 2023; 103:1-26. [PMID: 37362851 PMCID: PMC10043869 DOI: 10.1007/s41745-022-00348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 03/30/2023]
Abstract
Over the past decade there have been many advances in diabetes technologies, such as continuous glucose monitors (CGM s), insulin-delivery devices, and hybrid closed loop systems . Now most CGMs (Medtronic-Guardian, Dexcom-G6, and Abbott-Libre-2) have MARD values of < 10%, in contrast to two decades ago when the MARD used to be > 20%. In addition, the majority of the new CGMs do not require calibrations, and the latest CGMs last for 10-14 days. An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. Recently, the FDA approved Libre 3 which provides real-time glucose values every minute. Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. The newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. Most of the newer CGM have several features like automatic initialization, easy insertion, predictive alarms, and alerts. It has also been noticed that an arm insertion site might have better accuracy than abdomen or other sites, like the buttock for kids. Lag time between YSI and different sensors have been reported differently, sometimes it is down to 2-3 min; however, in many instances, it is still 15-20 min, especially when the rate of change of glucose is > 2 mg/min. We believe that in the next decade there will be a significant increase in the number of people who use CGM for their day-to-day diabetes care.
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Affiliation(s)
- Abdulhalim M. Almurashi
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
- Madinah Health Cluster, Madinah, Saudi Arabia
| | - Erika Rodriguez
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
| | - Satish K. Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
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24
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Caccavale LJ, LaRose JG, Mazzeo SE, Bean MK. Development and Implementation of a Pilot Transition Preparation Intervention for Young Adults With Type 1 Diabetes in an Integrated Healthcare Setting. J Pediatr Psychol 2023; 48:228-240. [PMID: 36367835 PMCID: PMC10027053 DOI: 10.1093/jpepsy/jsac084] [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: 01/10/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of a multisystem transition preparation intervention, SHIFT, for young adults (YAs) with type 1 diabetes (T1D). METHODS A single-arm, clinic-based pilot was conducted with 25 YAs with T1D (M age = 18.9 ± 1.0 years; 80% female), their parents (n = 25), and their providers (n = 10). Young adults and parents participated in a 6-month intervention designed to enhance transition readiness and independent diabetes management. Providers viewed a video module highlighting their role preparing YAs for transition and received individualized reports of YA's goals and transition readiness. Intervention feasibility (i.e., recruitment, retention, and engagement) and acceptability (e.g., program satisfaction) were assessed. Assessments of transition readiness, diabetes engagement, hemoglobin A1c (HbA1c), and related psychosocial variables were conducted at baseline, post-intervention (6 m), and follow-up (9 m). Paired t-tests examined 0-6 m and 0-9 m changes in study constructs. RESULTS SHIFT was feasible, evidenced by recruitment (100% of sample recruited in 4 m), retention (100% at 6 m), and YA session attendance (100%). Program satisfaction was high for YAs, parents, and providers (9.12 ± 1.40, 8.79 ± 1.56, 8.20 ± 1.30, respectively, [out of 10]). Significant improvements (with effect sizes ranging from small to medium) were observed in parent and YA-reported transition readiness at 6 and 9 m (ps<.05) and diabetes engagement at 9 m (ps<.05). Although based on limited data due to COVID-19-related disruptions, a potential reduction in HbA1c was also observed. CONCLUSION Findings support the feasibility, acceptability, and preliminary efficacy of SHIFT (although limited by the single arm design and homogeneous sample), and suggest a larger randomized controlled trial is warranted.
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Affiliation(s)
- Laura Jean Caccavale
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Melanie K Bean
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
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25
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Venkatesh KK, Powe CE, Buschur E, Wu J, Landon MB, Gabbe S, Gandhi K, Grobman WA, Fareed N. Disparities in Continuous Glucose Monitoring Use Among Women of Reproductive Age with Type 1 Diabetes in the T1D Exchange. Diabetes Technol Ther 2023; 25:201-205. [PMID: 36753706 PMCID: PMC9983140 DOI: 10.1089/dia.2022.0412] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We identified characteristics associated with continuous glucose monitoring (CGM) use in women of reproductive age with type 1 diabetes (T1D) in the T1D Exchange clinic registry from 2015 to 2018. Among 6643 assessed women, the frequency of CGM increased from 2015 to 2018 (20.6% vs. 30.0%; adjusted odds ratios [aOR]: 1.72; confidence interval [95% CI]: 1.51-1.95) and was more likely with recent pregnancy (45.3% vs. 25.8%; aOR: 1.63; 95% CI: 1.23-2.16). Non-Hispanic Black and Hispanic race and ethnicity, younger age, lower educational attainment, lower income, and Medicaid insurance were associated with lower odds of CGM. The use of CGM was associated with lower odds of diabetic ketoacidosis and lower hemoglobin A1c without any difference in the odds of symptomatic severe hypoglycemia. In conclusion, although CGM use was associated with better glycemic control, the majority of reproductive-age women still did not use it. Those who did not use CGM were more likely to be those at greatest risk of adverse pregnancy outcomes.
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Affiliation(s)
- Kartik K. Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Camille E. Powe
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Buschur
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Mark B. Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Steven Gabbe
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Kajal Gandhi
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - William A. Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
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26
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Pauley ME, Vinovskis C, MacDonald A, Baca M, Pyle L, Wadwa RP, Fornoni A, Nadeau KJ, Pavkov M, Nelson RG, Gordin D, de Boer IH, Tommerdahl KL, Bjornstad P. Triglyceride content of lipoprotein subclasses and kidney hemodynamic function and injury in adolescents with type 1 diabetes. J Diabetes Complications 2023; 37:108384. [PMID: 36623423 PMCID: PMC10176326 DOI: 10.1016/j.jdiacomp.2022.108384] [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: 08/01/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
AIMS Elevated triglycerides (TG) are associated with development and progression of kidney disease, and TG distributions across lipoprotein subclasses predict kidney dysfunction in adults with type 1 diabetes (T1D). Little is known regarding these relationships in youth. METHODS In this single center study conducted from October 2018-2019, lipid constituents from lipoprotein subclasses were quantified by targeted nuclear magnetic resonance spectroscopy. Glomerular filtration rate (GFR), renal plasma flow (RPF), afferent arteriolar resistance (RA), efferent arteriolar resistance (RE), intraglomerular pressure (PGLO), urine albumin-to-creatinine ratio (UACR), and chitinase-3-like protein 1 (YKL-40), a marker of kidney tubule injury, were assessed. Cross-sectional relationships were assessed by correlation and multivariable linear regression (adjusted for age, sex, HbA1c) models. RESULTS Fifty youth with T1D (age 16 ± 3 years, 50 % female, HbA1c 8.7 ± 1.3 %, T1D duration 5.7 ± 2.6 years) were included. Very-low-density lipoprotein (VLDL)-TG concentrations correlated and associated with intraglomerular hemodynamic function markers including GFR, PGLO, UACR, as did small low-density lipoprotein (LDL)-TG and small high-density lipoprotein (HDL)-TG. YKL-40 correlated with all lipoprotein subclasses. CONCLUSION TG within lipoprotein subclasses, particularly VLDL, associated with PGLO, GFR, albuminuria, and YKL-40. Lipid perturbations may serve as novel targets to mitigate early kidney disease.
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Affiliation(s)
- Meghan E Pauley
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carissa Vinovskis
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexis MacDonald
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Madison Baca
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Pyle
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alessia Fornoni
- Peggy and Harold Katz Family Drug Discovery Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Ludeman Family Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meda Pavkov
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
| | - Robert G Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Daniel Gordin
- Minerva Foundation Institute for Medical Research, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Ian H de Boer
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Kalie L Tommerdahl
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Ludeman Family Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Petter Bjornstad
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Ludeman Family Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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27
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Klonoff AN, (Andy) Lee WA, Xu NY, Nguyen KT, DuBord A, Kerr D. Six Digital Health Technologies That Will Transform Diabetes. J Diabetes Sci Technol 2023; 17:239-249. [PMID: 34558330 PMCID: PMC9846384 DOI: 10.1177/19322968211043498] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The digital health revolution is transforming the landscape of medicine through innovations in sensor data, software, and wireless communication tools. As one of the most prevalent chronic diseases in the United States, diabetes is particularly impactful as a model disease for which to apply innovation. As with any other newly developed technologies, there are three key questions to consider: 1) How can the technology benefit people with diabetes?, 2) What barriers must be overcome to further advance the technology?, and 3) How will the technology be applied in the future?. In this article, we highlight six areas of innovation that have the potential to reduce the burden of diabetes for individuals living with the condition and their families as well as provide measurable benefits for all stakeholders involved in diabetes care. The six technologies which have the potential to transform diabetes care are (i) telehealth, (ii) incorporation of diabetes digital data into the electronic health record, (iii) qualitative hypoglycemia alarms, (iv) artificial intelligence, (v) cybersecurity of diabetes devices, and (vi) diabetes registries. To be successful, a new digital health technology must be accessible and affordable. Furthermore, the people and communities that would most likely benefit from the technology must be willing to use the innovation in their management of diabetes.
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Affiliation(s)
- Alexander N. Klonoff
- University of Southern California, Los
Angeles, CA, USA
- Alexander N. Klonoff, MD, MBA, LAC+USC
Medical Center, 2020 Zonal Avenue, IRD 620, Los Angeles, CA 90089, USA.
| | | | - Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | | | - David Kerr
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
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28
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Díaz-Balzac CA, Pillinger D, Wittlin SD. Continuous subcutaneous insulin infusions: Closing the loop. J Clin Endocrinol Metab 2022; 108:1019-1033. [PMID: 36573281 DOI: 10.1210/clinem/dgac746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Indexed: 12/29/2022]
Abstract
CONTEXT Continuous subcutaneous insulin infusions (CSIIs) and continuous glucose monitors (CGMs) have revolutionized the management of diabetes mellitus (DM). Over the last two decades the development of advanced, small, and user-friendly technology has progressed substantially, essentially closing the loop in the fasting and post-absorptive state, nearing the promise of an artificial pancreas. The momentum was mostly driven by the diabetes community itself, to improve its health and quality of life. EVIDENCE ACQUISITION Literature regarding CSII and CGM was reviewed. EVIDENCE SYNTHESIS Management of DM aims to regulate blood glucose to prevent long term micro and macrovascular complications. CSIIs combined with CGMs provide an integrated system to maintain tight glycemic control in a safe and uninterrupted fashion, while minimizing hypoglycemic events. Recent advances have allowed to 'close the loop' by better mimicking endogenous insulin secretion and glucose level regulation. Evidence supports sustained improvement in glycemic control with reduced episodes of hypoglycemia using these systems, while improving quality of life. Ongoing work in delivery algorithms with or without counterregulatory hormones will allow for further layers of regulation of the artificial pancreas. CONCLUSION Ongoing efforts to develop an artificial pancreas have created effective tools to improve the management of DM. CSIIs and CGMs are useful in diverse populations ranging from children to the elderly, as well as in various clinical contexts. Individually and more so together, these have had a tremendous impact in the management of DM, while avoiding treatment fatigue. However, cost and accessibility are still a hindrance to its wider application.
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Affiliation(s)
- Carlos A Díaz-Balzac
- Division of Endocrinology, Diabetes and Metabolism, University of Rochester Medical Center, 601 Elmwood Avenue, Box 693, Rochester, NY 14642, USA
| | - David Pillinger
- Division of Endocrinology, Diabetes and Metabolism, University of Rochester Medical Center, 601 Elmwood Avenue, Box 693, Rochester, NY 14642, USA
| | - Steven D Wittlin
- Division of Endocrinology, Diabetes and Metabolism, University of Rochester Medical Center, 601 Elmwood Avenue, Box 693, Rochester, NY 14642, USA
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29
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Brazeau AS, Messier V, Talbo MK, Gagnon C, Taleb N, Fortier I, Wu Z, Perkins BA, Carpentier AC, Bandini A, Rabasa-Lhoret R. Self-reported Severe and Nonsevere Hypoglycemia in Type 1 Diabetes: Population Surveillance Through the BETTER Patient Engagement Registry: Development and Baseline Characteristics. Can J Diabetes 2022; 46:813-821. [PMID: 35835670 DOI: 10.1016/j.jcjd.2022.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/05/2022] [Accepted: 05/23/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The BETTER (BEhaviors, Therapies, TEchnologies and hypoglycemic Risk in Type 1 diabetes) registry is a type 1 diabetes population surveillance system codeveloped with patient partners to address the burden of hypoglycemia and assess the impact of new therapies and technologies. The aim of this report was to describe the baseline characteristics of the BETTER registry cohort. METHODS A cross-sectional baseline evaluation was performed of a Canadian clinical cohort established after distribution of an online questionnaire. Participants were recruited through clinics, public foundations, advertising and social media. As of February 2021, 1,430 persons ≥14 years of age and living with type 1 diabetes or latent-autoimmune diabetes (LADA) were enrolled. The trial was registered on ClinicalTrials.gov (NCT03720197). RESULTS Participants were (mean ± standard deviation) 41.2±15.7 years old with a diabetes duration of 22.0±14.7 years, 62.0% female, 92.1% Caucasian and 7.8% self-reporting as LADA, with 40.9% using a continuous subcutaneous insulin infusion (CSII) system and 78.0% using a continuous glucose monitoring (CGM) system. The most recent glycated hemoglobin ≤7% was reported by 29.7% of participants. At least 1 episode of hypoglycemia <3.0 mmol/L (level 2-H) in the last month was reported by 78.4% of participants, with a median (interquartile range) of 5 (3, 10) episodes. The occurrence of severe hypoglycemia (level 3-H) in the last 12 months was reported by 13.3% of participants. Among these, the median number of episodes was 2 (1, 3). CONCLUSIONS We have established the first surveillance registry for people living with type 1 diabetes in Canada relying on patient-reported outcomes and experiences. Hypoglycemia is a highly prevalent burden despite a relatively wide adoption of CSII and CGM use.
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Affiliation(s)
- Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Québec, Canada; Montreal Clinical Research Institute, Montreal, Québec, Canada.
| | | | - Meryem K Talbo
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Claudia Gagnon
- Centre Hospitalier Universitaire de Québec-Université Laval Research Centre, Québec City, Québec, Canada; Department of Medicine, Université Laval, Québec City, Québec, Canada
| | - Nadine Taleb
- Montreal Clinical Research Institute, Montreal, Québec, Canada; Endocrinology Division, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Isabel Fortier
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Zekai Wu
- Montreal Clinical Research Institute, Montreal, Québec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Diabetes Clinical Research Unit, Leadership Sinai Centre for Diabetes, Sinai Health System, Toronto, Ontario, Canada
| | - André C Carpentier
- Division of Endocrinology, Department of Medicine, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Aude Bandini
- Department of Philosophy, Faculty of Arts and Sciences, Université de Montréal, Montreal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montreal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
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30
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Polsky S, Foster NC, DuBose SN, Agarwal S, Lyons S, Peters AL, Uwaifo GI, DiMeglio LA, Sherr JL, Levy CJ. Incident diabetes complications among women with type 1 diabetes based on parity. J Matern Fetal Neonatal Med 2022; 35:4629-4634. [PMID: 33280471 DOI: 10.1080/14767058.2020.1858278] [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: 01/29/2020] [Revised: 11/18/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess risk factors and incidence of diabetes complications in women with type 1 diabetes (T1D) based on parity. RESEARCH DESIGN/METHODS Data were collected from women (16-40 years old) in the T1D Exchange completing pregnancy/childbirth questionnaires during 2011-2013 and 2016-2018. Incidence of risk factors and diabetes complications were compared between women with a first pregnancy at/within 1-year of enrollment (n = 28) and never pregnant women by year 5 (n = 469). RESULTS There was a trend for lower HbA1c (adjusted p = .14) and higher rates of overweight/obesity, triglyceride/HDL > 2, log (triglyercide/HDL), and hypertension among parous women compared with nulliparous women. There were no significant differences in rates of advanced nephropathy, albuminuria or cardiovascular disease. CONCLUSIONS Four-5 years after delivery, parous women with T1D tended to have lower HbA1c levels despite higher body mass indices and more frequent adverse lipid profiles and hypertension compared with nulliparous women. Further studies based on these trends are warranted.
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO, USA
| | | | | | | | - Sarah Lyons
- Baylor College of Medicine, Houston, TX, USA
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Carol J Levy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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31
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Muntis FR, Igudesman D, Sarteau AC, Thomas J, Arrizon-Ruiz N, Hooper J, Addala A, Crandell JL, Riddell MC, Maahs DM, Pratley RE, Corbin K, Mayer-Davis EJ, Zaharieva DP. Relationship Between Moderate-to-Vigorous Physical Activity and Glycemia Among Young Adults with Type 1 Diabetes and Overweight or Obesity: Results from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON) Study. Diabetes Technol Ther 2022; 24:881-891. [PMID: 35984327 PMCID: PMC9805851 DOI: 10.1089/dia.2022.0253] [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: 01/13/2023]
Abstract
Aims: Using data from the ACT1ON study, we conducted secondary analyses to assess the relationship between minutes of moderate-to-vigorous physical activity (MVPA) and glycemia in adults with type 1 diabetes (T1D) and overweight or obesity. Materials and Methods: Participants (n = 66) with T1D provided measures of glycemia (hemoglobin A1c [HbA1c], percent of time below range <70 mg/dL, time-in-range [TIR 70-180 mg/dL], and time above range [TAR >180 mg/dL]) and self-reported physical activity (Global Physical Activity Questionnaire [GPAQ] and Previous Day Physical Activity Recalls [PDPAR]) at baseline, 3, 6, and 9 months postintervention. Wearable activity data were available for a subset of participants (n = 27). Associations were estimated using mixed effects regression models adjusted for design, demographic, clinical, and dietary covariates. Results: Among young adults 19-30 years of age with a baseline HbA1c of 7.9% ± 1.4% and body mass index of 30.3 (interquartile range 27.9, 33.8), greater habitual weekly MVPA minutes were associated with higher HbA1c through the GPAQ (P < 0.01) and wearable activity data (P = 0.01). We did not observe a significant association between habitual MVPA and any continuous glucose monitoring metrics. Using PDPAR data, however, we observed that greater daily MVPA minutes were associated with more TAR (P < 0.01) and reduced TIR (P < 0.01) on the day following reported physical activity. Conclusions: Among young adults with T1D and overweight or obesity, increased MVPA was associated with worsened glycemia. As physical activity is vital to cardiovascular health and weight management, additional research is needed to determine how to best support young adults with T1D and overweight or obesity in their efforts to increase physical activity. Clinical Trial Registration number: NCT03651622.
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Affiliation(s)
- Franklin R. Muntis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Advent Health Translational Research Institute, Orlando, Florida, USA
| | | | - Joan Thomas
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Arrizon-Ruiz
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - Julie Hooper
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - Jamie L. Crandell
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael C. Riddell
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - David M. Maahs
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | | | - Karen Corbin
- Advent Health Translational Research Institute, Orlando, Florida, USA
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dessi P. Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
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32
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Gu Hong WC, Ferri J, Ampudia-Blasco FJ, Martín-Brufau R, Peiró M, Benito E, Martinez-Hervas S, Sanz MJ, Real JT. Effect of personality on blood glucose control in patients with type 1 diabetes. ENDOCRINOL DIAB NUTR 2022; 69:677-685. [PMID: 36470643 DOI: 10.1016/j.endien.2021.11.034] [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: 07/08/2021] [Accepted: 11/04/2021] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The diagnosis of type 1 diabetes mellitus (DM1) has a major impact on young people and their families. Psychosocial factors, patient motivation, participation and acceptance of the disease are essential to achieve good blood glucose control. Our aims were to analyse personality traits and how they are related to blood glucose control in patients with DM1. METHODS Sixty-two patients with DM1 over 18 years of age, with at least one-year disease duration and absence of advanced chronic complications were studied. Clinical, biological and personality parameters were measured. The Millon Index of Personality Styles was administered for personality assessment. RESULTS Significant correlations between different personality variables and glycated haemoglobin (HbA1c) values were found. Individuals with poor blood glucose control had significantly higher scores on the Feeling-guided (53.6±25.7 vs 36.2±26.8, p=0.021), Innovation-seeking (36.7±24.1 vs 21.9±21.4, p=0.025), Dissenting (41.1±24.4 vs 15.6±16.6, p=0.001), Submissive (41.5±25.1 vs 28.3±14.7, p=0.038) and Dissatisfied (37.5±27.5 vs 19.5±20.2, p=0.015) scales. This psychological profile is characterised by greater focus on emotions and personal values (feeling-guided), the tendency to reject conventional ideas (innovation-seeking), an aversion to complying with norms and a preference for autonomy (unconventional/dissenting), labile self-confidence (submissive/yielding) and expressed disagreement with others (dissatisfied/complaining). Factor analysis based on the main components of the variance yielded four factors. Factor characterised as related to rebelliousness or independent judgement and action was correlated with poor blood glucose control (r=0.402, p<0.05). CONCLUSION The rebellious or non-conformist personality type is closely associated with poor blood glucose control in patients with DM1.
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Affiliation(s)
- Wan Chen Gu Hong
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jordi Ferri
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain; Institute of Health Research of Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Francisco Javier Ampudia-Blasco
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain; Institute of Health Research of Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | | | - Marta Peiró
- Institute of Health Research of Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) [Network Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases], Madrid, Spain
| | - Esther Benito
- Institute of Health Research of Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) [Network Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases], Madrid, Spain
| | - Sergio Martinez-Hervas
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain; Institute of Health Research of Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) [Network Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases], Madrid, Spain.
| | - María Jesús Sanz
- Institute of Health Research of Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) [Network Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases], Madrid, Spain; Department of Pharmacology, University of Valencia, Valencia, Spain
| | - José Tomás Real
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain; Institute of Health Research of Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) [Network Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases], Madrid, Spain
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Lal RA, Robinson H, Lanzinger S, Miller KM, Pons Perez S, Kovacic R, Calhoun P, Campbell F, Naeke A, Maahs DM, Holl RW, Warner J. Temporal Changes in Hemoglobin A1c and Diabetes Technology Use in DPV, NPDA, and T1DX Pediatric Cohorts from 2010 to 2018. Diabetes Technol Ther 2022; 24:628-634. [PMID: 35856740 PMCID: PMC9634993 DOI: 10.1089/dia.2022.0095] [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: 11/12/2022]
Abstract
Objective: The German/Austrian Diabetes Patient Follow-up Registry (Diabetes-Patienten-Verlaufsdokumentation or DPV), England/Wales National Pediatric Diabetes Audit (NPDA), and Type 1 Diabetes Exchange (T1DX) in the United States investigated changes in hemoglobin A1c (HbA1c) and diabetes technology use from 2010 to 2018. Methods: Registry/audit data from 2010 to 2018 were analyzed in annual cohorts using linear regression for those <18 years of age with type 1 diabetes diagnosed at age >6 months. Time trends in HbA1c, pump, and continuous glucose monitoring (CGM) use were studied using repeated measurements linear and logistic regression models with an autoregressive covariance structure and with year and data source as independent variables. Results: A total of 1,172,980 visits among 114,264 (54,119 DPV, 43,550 NPDA, 16,595 T1DX) patients were identified. HbA1c remained clinically stable in DPV (7.7% [61 mmol/mol] to 7.6% [60 mmol/mol]), decreased in the NPDA (8.7% [72 mmol/mol] to 7.9% [63 mmol/mol]), and increased in T1DX (8.0% [64 mmol/mol] to 8.5% [69 mmol/mol] from 2010 to 2018). In all registries/audits, insulin pump and CGM use increased over time with greatest pump use in T1DX and lowest uptake reported in NPDA. Conclusions: These data reveal three different longitudinal patterns of change in registry/audit HbA1c from 2010 to 2018. Diabetes technology use increased throughout, at different rates. Quality improvement (QI) programs in DPV have been ongoing for 25 years, began in NPDA in 2009 and T1DX in 2016. We speculate that in England/Wales, development of networks, peer review, and implementation of QI measures contributed to reductions in population HbA1c. Many of these interventions had been implemented in DPV before 2010. Further efforts to understand this improvement, including the role of QI, and continued success within standardized documentation and benchmarking could inform T1DX programs to reduce HbA1c.
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Affiliation(s)
- Rayhan A. Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Holly Robinson
- Royal College of Pediatrics and Child Health, London, United Kingdom
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | | | - Saira Pons Perez
- Royal College of Pediatrics and Child Health, London, United Kingdom
| | | | - Peter Calhoun
- JAEB Center for Health Research, Tampa, Florida, USA
| | | | | | - David M. Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Justin Warner
- Children's Hospital for Wales, Cardiff, United Kingdom
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34
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Everett EM, Wisk LE. Relationships Between Socioeconomic Status, Insurance Coverage for Diabetes Technology and Adverse Health in Patients With Type 1 Diabetes. J Diabetes Sci Technol 2022; 16:825-833. [PMID: 34632819 PMCID: PMC9264432 DOI: 10.1177/19322968211050649] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Insulin pumps and continuous glucose monitors (CGM) have many benefits in the management of type 1 diabetes. Unfortunately disparities in technology access occur in groups with increased risk for adverse effects (eg, low socioeconomic status [SES], public insurance). RESEARCH DESIGN & METHODS Using 2015 to 2016 data from 4,895 participants from the T1D Exchange Registry, a structural equation model (SEM) was fit to explore the hypothesized direct and indirect relationships between SES, insurance features, access to diabetes technology, and adverse clinical outcomes (diabetic ketoacidosis, hypoglycemia). SEM was estimated using the maximum likelihood method and standardized path coefficients are presented. RESULTS Higher SES and more generous insurance coverage were directly associated with CGM use (β = 1.52, SE = 0.12, P < .0001 and β = 1.21, SE = 0.14, P < .0001, respectively). Though SES displayed a small inverse association with pump use (β = -0.11, SE = 0.04, P = .0097), more generous insurance coverage displayed a stronger direct association with pump use (β = 0.88, SE = 0.10, P < .0001). CGM use and pump use were both directly associated with fewer adverse outcomes (β = -0.23, SE = 0.06, P = .0002 and β = -0.15, SE = 0.04, P = .0002, respectively). Both SES and insurance coverage demonstrated significant indirect effects on adverse outcomes that operated through access to diabetes technology (β = -0.33, SE = 0.09, P = .0002 and β = -0.40, SE = 0.09, P < .0001, respectively). CONCLUSIONS The association between SES and insurance coverage and adverse outcomes was primarily mediated through diabetes technology use, suggesting that disparities in diabetes outcomes have the potential to be mitigated by addressing the upstream disparities in technology use.
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Affiliation(s)
- Estelle M. Everett
- Department of Medicine, Division of
Endocrinology, Diabetes, & Metabolism, David Geffen School of Medicine,
University of California, Los Angeles, CA, USA
- Department of Medicine, Division of
General Internal Medicine & Health Services Research, David Geffen School of
Medicine, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare
System, Los Angeles, CA, USA
- Estelle M. Everett, MD, MHS, Department of
Medicine, Division of Endocrinology, Diabetes, & Metabolism, David Geffen
School of Medicine, University of California, Los Angeles, 1100 Glendon Ste 850,
Los Angeles, CA 90024, USA.
| | - Lauren E. Wisk
- Department of Medicine, Division of
General Internal Medicine & Health Services Research, David Geffen School of
Medicine, University of California, Los Angeles, CA, USA
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35
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Weinstein JM, Kahkoska AR. Association of Continuous Glucose Monitoring Use and Hemoglobin A1c Levels Across the Lifespan Among Individuals With Type 1 Diabetes in the US. JAMA Netw Open 2022; 5:e2223942. [PMID: 35895064 PMCID: PMC9331081 DOI: 10.1001/jamanetworkopen.2022.23942] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This cross-sectional study investigates age, probability of continuous glucose monitoring use, and their association with glycemic control across the lifespan among US individuals with type 1 diabetes.
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Affiliation(s)
- Joshua M. Weinstein
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina, Chapel Hill
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36
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Hu TY, Price J, Pierce JS, Gannon AW. The association between pediatric mental health disorders and type 1 diabetes-related outcomes. Pediatr Diabetes 2022; 23:507-515. [PMID: 35249249 DOI: 10.1111/pedi.13330] [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: 07/10/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Transition from pediatric to adult healthcare systems is a difficult process for young adults with Type 1 Diabetes (T1D) and most patients experience a deterioration in disease control. Mental health (MH) disorders are common in individuals with T1D and are believed to play a role in disease control and transition of care. We evaluated the association between the presence of pediatric MH disorder and measures of success in diabetes care in young adults who recently transitioned to adult care. RESEARCH DESIGN AND METHODS Retrospective cohort study of young adults in a large adult endocrinology system who transitioned from a pediatric hospital system after 2009. MH disorders were diagnosed by clinical pediatric psychologists during routine care at the pediatric hospital. Measurements of Hemoglobin A1c, diabetes-related emergencies, clinic attendance and intervals in transition were assessed and compared between the pediatric and adult hospital systems. RESULTS 237 young adults were identified and 100 (42%) of these were diagnosed with a MH disorder during pediatric care. Presence of a MH disorder was associated with higher Hemoglobin A1c levels prior to transition and increased rates of diabetes-related hospitalizations during the transition interval. Patients with a MH disorder were less likely to establish a pattern of consistent follow up after transition (p = 0.021). CONCLUSIONS MH disorders are common and predict greater challenges with diabetes management and less effective transition into the adult endocrinology system. Early recognition of MH disorders may allow for allocation of more proactive and intensive support for affected patients.
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Affiliation(s)
- Tina Y Hu
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.,Department of Internal Medicine, ChristianaCare Health System, Newark, Delaware, USA.,Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julia Price
- Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware, USA
| | - Jessica S Pierce
- Center for Healthcare Delivery Science, Nemours Children's Health System, Orlando, Florida, USA.,Department of Pediatrics, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Anthony W Gannon
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.,Department of Internal Medicine, ChristianaCare Health System, Newark, Delaware, USA.,Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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37
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Wolf RM, Noor N, Izquierdo R, Jett D, Rewers A, Majidi S, Sheanon N, Breidbart E, Demeterco‐Berggren C, Lee JM, Kamboj MK, Ebekozien O. Increase in newly diagnosed type 1 diabetes in youth during the COVID-19 pandemic in the United States: A multi-center analysis. Pediatr Diabetes 2022; 23:433-438. [PMID: 35218124 PMCID: PMC9115477 DOI: 10.1111/pedi.13328] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND An increase in newly diagnosed type 1 diabetes (T1D) has been posited during the COVID-19 pandemic, but data are conflicting. We aimed to determine trends in newly diagnosed T1D and severity of presentation at diagnosis for pediatric and adolescent patients during COVID-19 (2020) as compared to the previous year (2019) in a multi-center analysis across the United States. METHODS This retrospective study from seven centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) included data on new onset T1D diagnosis and proportion in DKA at diagnosis from January 1 to December 31, 2020, compared to the prior year. Chi-square tests were used to compare differences in patient characteristics during the pandemic period compared to the prior year. RESULTS Across seven sites, there were 1399 newly diagnosed T1D patients in 2020, compared to 1277 in 2019 (p = 0.007). A greater proportion of newly diagnosed patients presented in DKA in 2020 compared to 2019 (599/1399(42.8%) vs. 493/1277(38.6%), p = 0.02), with a higher proportion presenting with severe DKA (p = 0.01) as characterized by a pH <7.1 and/or bicarbonate of <5 mmol/L. Monthly data trends demonstrated a higher number of new T1D diagnoses over the spring and summer months (March to September) of 2020 compared to 2019 (p < 0.001). CONCLUSIONS We found an increase in newly diagnosed T1D and a greater proportion presenting in DKA at diagnosis during the COVID-19 pandemic compared to the prior year. Future longitudinal studies are needed to confirm these findings with population level data and determine the long-term impact of COVID-19 on diabetes trends.
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Affiliation(s)
- Risa M. Wolf
- Department of Pediatrics, Division of Pediatric EndocrinologyJohns Hopkins MedicineBaltimoreMarylandUSA
| | | | | | - Destiny Jett
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | | | | | - Nicole Sheanon
- Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | | | | | - Joyce M. Lee
- Mott Children's Hospital, Susan B. Meister Child Health Evaluation and Research CenterUniversity of MichiganAnn ArborMichiganUSA
| | | | - Osagie Ebekozien
- T1D ExchangeBostonMassachusettsUSA,University of Mississippi Medical CenterJacksonMississippiUSA
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38
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Mizokami-Stout K, Bailey R, Ang L, Aleppo G, Levy CJ, Rickels MR, Shah VN, Polsky S, Nelson B, Carlson AL, Vendrame F, Pop-Busui R. Symptomatic diabetic autonomic neuropathy in type 1 diabetes (T1D): Findings from the T1D exchange. J Diabetes Complications 2022; 36:108148. [PMID: 35279403 DOI: 10.1016/j.jdiacomp.2022.108148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
AIMS We aimed to evaluate the contemporary prevalence of and risk factors for symptomatic diabetic autonomic neuropathy (DAN) in participants with type 1 diabetes (T1D) enrolled in the T1D Exchange Clinic Registry. METHODS DAN symptoms and severity were assessed with the Survey of Autonomic Symptoms (SAS) in adults with ≥5 years of T1D participating in the T1D Exchange from years 2010-2017. Associations of demographic, clinical, and laboratory factors with symptomatic DAN were assessed. RESULTS Of the 4919 eligible T1D participants, 965 (20%) individuals completed the SAS questionnaire [mean age 40 ± 17 years, median diabetes duration 20 years (IQR: 13,34), 64% female, 90% non-Hispanic White, and 82% with private insurance]. DAN symptoms were present in 166 (17%) of responders with 72% experiencing moderate severity symptoms or worse. Symptomatic DAN participants had higher hemoglobin A1c (p = 0.03), longer duration (p = 0.004), were more likely to be female (p = 0.03), and more likely to have lower income (p = 0.03) versus no DAN symptoms. Symptomatic DAN was associated with diabetic peripheral neuropathy (p < 0.0001), smoking (p = 0.002), cardiovascular disease (p = 0.02), depression (p < 0.001), and opioid use (p = 0.004). CONCLUSIONS DAN symptoms are common in T1D. Socioeconomic factors and psychological comorbidities may contribute to DAN symptoms and should be explored further.
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Affiliation(s)
| | - Ryan Bailey
- Jaeb Center for Health Research, Tampa, FL, United States of America
| | - Lynn Ang
- University of Michigan, Ann Arbor, MI, United States of America
| | - Grazia Aleppo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Carol J Levy
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Michael R Rickels
- Rodebaugh Diabetes Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Bryce Nelson
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Anders L Carlson
- International Diabetes Center, Minneapolis, MN, United States of America
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39
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Tallon EM, Redondo MJ, Shyu CR, Liu D, Boles K, Clements MA. Contrast Pattern Mining With the T1D Exchange Clinic Registry Reveals Complex Phenotypic Factors and Comorbidity Patterns Associated With Familial Versus Sporadic Type 1 Diabetes. Diabetes Care 2022; 45:e56-e59. [PMID: 35045157 PMCID: PMC8918263 DOI: 10.2337/dc21-2239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/27/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Erin M Tallon
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO
| | - Maria J Redondo
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO.,Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO.,School of Medicine, University of Missouri, Columbia, MO
| | - Danlu Liu
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO
| | - Katrina Boles
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO
| | - Mark A Clements
- Division of Endocrinology and Diabetes, Children's Mercy Hospital, Kansas City, MO
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Lacy ME, Moran C, Gilsanz P, Beeri MS, Karter AJ, Whitmer RA. Comparison of cognitive function in older adults with type 1 diabetes, type 2 diabetes, and no diabetes: results from the Study of Longevity in Diabetes (SOLID). BMJ Open Diabetes Res Care 2022; 10:10/2/e002557. [PMID: 35346969 PMCID: PMC8961108 DOI: 10.1136/bmjdrc-2021-002557] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/06/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The incidence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing. Life expectancy is improving in T1D, resulting in a growing population of elderly adults with diabetes. While it is well established that older adults with T2D are at increased risk of cognitive impairment, little is known regarding cognitive aging in T1D and how their cognitive profiles may differ from T2D. RESEARCH DESIGN AND METHODS We compared baseline cognitive function and low cognitive function by diabetes status (n=734 T1D, n=232 T2D, n=247 without diabetes) among individuals from the Study of Longevity in Diabetes (mean age=68). We used factor analysis to group cognition into five domains and a composite measure of total cognition. Using linear and logistic regression models, we examined the associations between diabetes type and cognitive function, adjusting for demographics, comorbidities, depression, and sleep quality. RESULTS T1D was associated with lower scores on total cognition, language, executive function/psychomotor processing speed, and verbal episodic memory, and greater odds of low executive function/psychomotor processing speed (OR=2.99, 95% CI 1.66 to 5.37) and verbal episodic memory (OR=1.92, 95% CI 1.07 to 3.46), compared with those without diabetes. T2D was associated with lower scores on visual episodic memory. Compared with T2D, T1D was associated with lower scores on verbal episodic memory and executive function/psychomotor processing speed and greater odds of low executive function/psychomotor processing speed (OR=1.74, 95% CI 1.03 to 2.92). CONCLUSIONS Older adults with T1D had significantly poorer cognition compared with those with T2D and those without diabetes even after accounting for a range of comorbidities. Future studies should delineate how to reduce risk in this vulnerable population who are newly surviving to old age.
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Affiliation(s)
- Mary E Lacy
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Chris Moran
- Academic Unit, Peninsula Clinical School, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Michal S Beeri
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Joseph Sagol Neuroscience, Sheba Medical Center, Tel Hashomer, Israel
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Rachel A Whitmer
- Division of Research, Kaiser Permanente, Oakland, California, USA
- Department of Epidemiology, University of California Davis School of Medicine, Davis, California, USA
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McAuley SA, Trawley S, Vogrin S, Ward GM, Fourlanos S, Grills CA, Lee MH, Alipoor AM, O'Neal DN, O'Regan NA, Sundararajan V, Colman PG, MacIsaac RJ. Closed-Loop Insulin Delivery Versus Sensor-Augmented Pump Therapy in Older Adults With Type 1 Diabetes (ORACL): A Randomized, Crossover Trial. Diabetes Care 2022; 45:381-390. [PMID: 34844995 DOI: 10.2337/dc21-1667] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of closed-loop insulin delivery compared with sensor-augmented pump therapy among older adults with type 1 diabetes. RESEARCH DESIGN AND METHODS This open-label, randomized (1:1), crossover trial compared 4 months of closed-loop versus sensor-augmented pump therapy. Eligible adults were aged ≥60 years, with type 1 diabetes (duration ≥10 years), using an insulin pump. The primary outcome was continuous glucose monitoring (CGM) time in range (TIR; 3.9-10.0 mmol/L). RESULTS There were 30 participants (mean age 67 [SD 5] years), with median type 1 diabetes duration of 38 years (interquartile range [IQR] 20-47), randomized (n = 15 to each sequence); all completed the trial. The mean TIR was 75.2% (SD 6.3) during the closed-loop stage and 69.0% (9.1) during the sensor-augmented pump stage (difference of 6.2 percentage points [95% CI 4.4 to 8.0]; P < 0.0001). All prespecified CGM metrics favored closed loop over the sensor-augmented pump; benefits were greatest overnight. Closed loop reduced CGM time <3.9 mmol/L during 24 h/day by 0.5 percentage points (95% CI 0.3 to 1.1; P = 0.0005) and overnight by 0.8 percentage points (0.4 to 1.1; P < 0.0001) compared with sensor-augmented pump. There was no significant difference in HbA1c between closed-loop versus sensor-augmented pump stages (7.3% [IQR, 7.1-7.5] (56 mmol/mol [54-59]) vs. 7.5% [7.1-7.9] (59 mmol/mol [54-62]), respectively; P = 0.13). Three severe hypoglycemia events occurred during the closed-loop stage and two occurred during the sensor-augmented pump stage; no hypoglycemic events required hospitalization. One episode of diabetic ketoacidosis occurred during the sensor-augmented pump stage; no serious adverse events occurred during the closed-loop stage. CONCLUSIONS Closed-loop therapy is an effective treatment option for older adults with long-duration type 1 diabetes, and no safety issues were identified. These older adults had higher TIR accompanied by less time below range during closed loop than during sensor-augmented pump therapy. Of particular clinical importance, closed loop reduced the time spent in hypoglycemic range overnight.
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Affiliation(s)
- Sybil A McAuley
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Steven Trawley
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Psychology, Cairnmillar Institute, Melbourne, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Charlotte A Grills
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Andisheh Mohammad Alipoor
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Niamh A O'Regan
- Department of Geriatric Medicine, Waterford Integrated Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - Vijaya Sundararajan
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Public Health, La Trobe University, Melbourne, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Melbourne, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
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Marks BE, Mungmode A, Neyman A, Levin L, Rioles N, Eng D, Lee JM, Basina M, Hawah-Jones N, Mann E, O’Malley G, Wilkes M, Steenkamp D, Aleppo G, Accacha S, Ebekozien O. Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2022; 41:35-44. [PMID: 36714248 PMCID: PMC9845085 DOI: 10.2337/cd22-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes.
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Affiliation(s)
- Brynn E. Marks
- Children’s National Hospital, Washington, DC
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Corresponding author: Brynn E. Marks,
| | | | - Anna Neyman
- Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Laura Levin
- Ann and Robert H. Lurie Children Hospital, Chicago, IL
| | | | - Donna Eng
- Helen DeVos Children’s Hospital, Grand Rapids, MI
| | - Joyce M. Lee
- C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | | | | | - Elizabeth Mann
- UW Health Kids, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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The added value of transition programs in Dutch diabetes care: A controlled evaluation study. J Pediatr Nurs 2022; 62:155-163. [PMID: 34419327 DOI: 10.1016/j.pedn.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The desirability of evaluating transition programs is widely acknowledged. This study aimed to explore the added value of transitional care investments for young adults with type 1 diabetes mellitus. DESIGN AND METHODS Based on qualitative data, two groups of diabetes teams were created through cluster analysis: paying more (HI-ATT) versus less attention (LO-ATT) to transitional care. Retrospective controlled evaluation included chart reviews on healthcare use and clinical outcomes; and a survey on young adults' experiences, satisfaction with care, and self-management skills. RESULTS Data from 320 patients in fifteen diabetes teams were collected; 123 young adults (38.4%) completed a questionnaire. Self-reported outcomes showed that young adults treated by a HI-ATT team felt better prepared for transfer (p < .05). Self-management outcomes did not differ between groups. HI-ATT teams had more scheduled consultations in the year after transfer (p < .05); only 10.6% of all measurements had reached targeted HbA1c scores. CONCLUSIONS Current transitional care investments in Dutch diabetes care did not lead to notable improvements in experiences and outcomes, except for preparation for transfer. The period after transfer, however, is just as important. Attention is required for parent involvement. PRACTICE IMPLICATIONS Transitional care investments should extend beyond the transfer. By educating young adults about the importance of regular clinic attendance and introducing additional person-centered consultations in adult care, nurses may help ensure continuity of care. Nurses could also introduce support programs for parents to prepare for the transition and their change in role, taking into account their continuing partnership.
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Albanese-O'Neill A, Grimsmann JM, Svensson AM, Miller KM, Raile K, Akesson K, Calhoun P, Biesenbach B, Eeg-Olofsson K, Holl RW, Maahs DM, Hanas R. Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective. Diabetes Technol Ther 2022; 24:32-41. [PMID: 34524026 DOI: 10.1089/dia.2021.0225] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives.
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Affiliation(s)
| | - Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Ann-Marie Svensson
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetes, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Akesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Beate Biesenbach
- Department of Pediatrics, University Hospital Linz, Kepler University, Linz, Austria
| | - Katarina Eeg-Olofsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford Diabetes Research Center, Stanford, California, USA
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California, USA
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Gill A, Gothard MD, Briggs Early K. Glycemic outcomes among rural patients in the type 1 diabetes T1D Exchange registry, January 2016-March 2018: a cross-sectional cohort study. BMJ Open Diabetes Res Care 2022; 10:10/1/e002564. [PMID: 35042753 PMCID: PMC8768930 DOI: 10.1136/bmjdrc-2021-002564] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Does rural status influence glycemic outcomes among participants in the type 1 diabetes T1D Exchange clinic registry? RESEARCH DESIGN AND METHODS Data from the T1D Exchange clinic registry between January 2016 and March 2018 were identified by rural-urban status and stratified by age and hemoglobin A1c (HbA1c). Multivariable regression modeling was performed to isolate HbA1c differences. A full model including all significant (p<0.05 via two-sided testing) differential factors was determined with an additional indicator for rural status, and adjusted for duration of diabetes, use of continuous glucose monitoring device, age, race/ethnicity, and private insurance status. The model was reduced using backwards elimination stepwise procedures until only significant factors remained. RESULTS Mean HbA1c levels for all rural participants were significantly higher (8.71%; 72 mmol/mol) compared with the urban group (8.48%; 69 mmol/mol), p<0.001. For youth under 13 years of age, rural participants had a higher mean HbA1c (8.65%; 71 mmol/mol) compared with urban (8.45% 69 mmol/mol), p=0.022. Rural youth (13-<18 years) had a higher mean HbA1c (9.39%; 79 mmol/mol) than urban youth (9.14%; 76 mmol/mol), p<0.001. Rural young adults (18-<26 years) had a higher mean HbA1c (9.07%; 76 mmol/mol) than urban young adults (8.88%; 74 mmol/mol), p=0.042. Rural adults (≥26 years; n=589) were the only group that did not have a higher mean HbA1c (7.76%, 61.3 mmol) than urban adults (n=4770; 7.72%, 60.9 mmol/mol), p=0.503. Rural locale was highly significant (beta=0.175, p<0.001) despite controlling for potentially confounding differences between rural and urban groups. CONCLUSIONS Among this T1D Exchange cohort, there is a pattern of higher mean HbA1c being associated with rural status, even after adjustment for characteristic differences, most strikingly among those under 26 years of age. This disparity and contributing factors need to be more thoroughly studied to provide effective solutions.
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Affiliation(s)
- Arashpreet Gill
- College of Osteopathic Medicine, Pacific Northwest University, Yakima, Washington, USA
| | | | - Kathaleen Briggs Early
- College of Osteopathic Medicine, Department of Biomedical Sciences, Pacific Northwest University, Yakima, Washington, USA
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Bisio A, Anderson S, Norlander L, O'Malley G, Robic J, Ogyaadu S, Hsu L, Levister C, Ekhlaspour L, Lam DW, Levy C, Buckingham B, Breton MD. Impact of a Novel Diabetes Support System on a Cohort of Individuals With Type 1 Diabetes Treated With Multiple Daily Injections: A Multicenter Randomized Study. Diabetes Care 2022; 45:186-193. [PMID: 34794973 PMCID: PMC8753765 DOI: 10.2337/dc21-0838] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Achieving optimal glycemic control for many individuals with type 1 diabetes (T1D) remains challenging, even with the advent of newer management tools, including continuous glucose monitoring (CGM). Modern management of T1D generates a wealth of data; however, use of these data to optimize glycemic control remains limited. We evaluated the impact of a CGM-based decision support system (DSS) in patients with T1D using multiple daily injections (MDI). RESEARCH DESIGN AND METHODS The studied DSS included real-time dosing advice and retrospective therapy optimization. Adults and adolescents (age >15 years) with T1D using MDI were enrolled at three sites in a 14-week randomized controlled trial of MDI + CGM + DSS versus MDI + CGM. All participants (N = 80) used degludec basal insulin and Dexcom G5 CGM. CGM-based and patient-reported outcomes were analyzed. Within the DSS group, ad hoc analysis further contrasted active versus nonactive DSS users. RESULTS No significant differences were detected between experimental and control groups (e.g., time in range [TIR] +3.3% with CGM vs. +4.4% with DSS). Participants in both groups reported lower HbA1c (-0.3%; P = 0.001) with respect to baseline. While TIR may have improved in both groups, it was statistically significant only for DSS; the same was apparent for time spent <60 mg/dL. Active versus nonactive DSS users showed lower risk of and exposure to hypoglycemia with system use. CONCLUSIONS Our DSS seems to be a feasible option for individuals using MDI, although the glycemic benefits associated with use need to be further investigated. System design, therapy requirements, and target population should be further refined prior to use in clinical care.
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Affiliation(s)
- Alessandro Bisio
- 1Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA
| | - Stacey Anderson
- 1Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA
| | | | | | - Jessica Robic
- 1Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA
| | | | - Liana Hsu
- 2School of Medicine, Stanford University, Stanford, CA
| | | | | | - David W Lam
- 3Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carol Levy
- 3Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Marc D Breton
- 1Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA
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Gu Hong WC, Ferri J, Ampudia-Blasco FJ, Martín-Brufau R, Peiró M, Benito E, Martinez-Hervas S, Sanz MJ, Real JT. Effect of personality on blood glucose control in patients with type 1 diabetes. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dennig MJ, Sommer G, Zingg T, Flück CE, Boettcher C. Stable Metabolic Control but Increased Demand for Professional Support in Children with Type 1 Diabetes in the Past Ten Years in Bern/Switzerland: A Quality Control Study. J Diabetes Res 2022; 2022:3170558. [PMID: 36034586 PMCID: PMC9402297 DOI: 10.1155/2022/3170558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Lower HbA1c targets and increasingly complex diabetes management with substantially increasing costs dominate today's type 1 diabetes therapy in children and adolescents. OBJECTIVE To evaluate metabolic control in children and adolescents with type 1 diabetes and assess associated factors, evaluate determinants for frequency of healthcare contacts, and compare actual with historical data. METHOD This cross-sectional observational study collected data on 178 children and adolescents with type 1 diabetes treated at the University Children's Hospital in Bern. RESULTS Mean HbA1c was 7.9% (63 mmol/mol), 33.1% (59/178) of children reached the target of HbA1c < 7.5% (<59 mmol/mol), and 18.0% (32/178) had an HbA1c value < 7.0% (<53 mmol/mol). Compared to historical data, stable HbA1c levels appeared with a doubled proportion of individuals using insulin pumps. Metabolic control was worse with a longer duration of diabetes and younger age at diagnosis but better when parents came from a Western European country. Age at the consultation, use of diabetes technology and native language influenced the number of healthcare contacts. Younger patients, patients using CSII, and patients without an official Swiss language as mother tongue had more consultations with a healthcare professional than older and native language individuals. CONCLUSION The metabolic targets in childhood and adolescent type 1 diabetes are still unmet despite a shift towards more technology. Our study documents a higher demand for support and supervision in specific patient groups. An investment to increase healthcare contacts could help combat the increase in total diabetes cost and significantly improve metabolic control.
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Affiliation(s)
- Michelle J. Dennig
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Grit Sommer
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
- Department of BioMedical Research, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tanja Zingg
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Christa E. Flück
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
- Department of BioMedical Research, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudia Boettcher
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
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Dena M, Svensson AM, Olofsson KE, Young L, Carlson A, Miller K, Grimsmann J, Welp R, Mader JK, Maahs DM, Holl RW, Lind M. Renal Complications and Duration of Diabetes: An International Comparison in Persons with Type 1 Diabetes. Diabetes Ther 2021; 12:3093-3105. [PMID: 34697764 PMCID: PMC8586278 DOI: 10.1007/s13300-021-01169-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Renal complications are both a marker of previous suboptimal glycaemic control and a major risk factor for cardiovascular disease in persons with type 1 diabetes (T1D). The aim of the study was to evaluate the prevalence of renal complications in persons with T1D in four geographical regions. METHODS Nationwide registry data from Austria/Germany, Sweden and the US were used to estimate the prevalence of renal complications from January 2016 until September 2018. Chronic kidney disease (CKD) and albuminuria in the study population and each registry were analysed by diabetes duration. Risk factors for renal complications were described by registry. RESULTS In the total cohort of 78.926 adults with T1D, mean age was 44.4 ± 18.43 years and mean diabetes duration was 21.6 ± 22 years. Mean estimated glomerular filtration rate (eGFR) was 94.0 ± 31.45 ml/min, 13.0% had microalbuminuria and 3.9% had macroalbuminuria. Mean age, diabetes duration, use of insulin pumps and continuous glucose monitoring, as well as presence of albuminuria, varied between registries. Albuminuria was present in approximately 10% of persons with diabetes duration < 20 years and impaired renal function (eGFR < 60 ml/min) was present in 17%. In persons with diabetes duration > 40 years, approximately one-third had albuminuria and 25% had impaired renal function. CONCLUSIONS This analysis used three nationwide registries of persons with T1D. Despite recent use of more effective diabetes therapies, a substantial proportion of persons with T1D have renal complications at < 20 years after diagnosis. Efficient glucose-lowering and renal-protective strategies are needed in persons with T1D.
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Affiliation(s)
- Mary Dena
- Department of Medicine, NU Hospital Group, Uddevalla, Trollhättan, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Eeg Olofsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Laura Young
- Diabetes and Endocrinology Clinic at Meadowmont, UNC Hospitals, Chapel Hill, NC, USA
| | | | | | - Julia Grimsmann
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Munich, Germany
| | | | - Julia K Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - David M Maahs
- Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Munich, Germany
| | - Marcus Lind
- Department of Medicine, NU Hospital Group, Uddevalla, Trollhättan, Sweden.
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
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Riveline JP, Vergés B, Detournay B, Picard S, Benhamou PY, Bismuth E, Bordier L, Jeandidier N, Joubert M, Roussel R, Sola-Gazagnes A, Bonnefond A, Clavel S, Velayoudom FL, Beltrand J, Hanaire H, Fontaine P, Thivolet C, Servy H, Tubiana S, Lion S, Gautier JF, Larger E, Vicaut E, Sablone L, Fagherazzi G, Cosson E. Design of a prospective, longitudinal cohort of people living with type 1 diabetes exploring factors associated with the residual cardiovascular risk and other diabetes-related complications: The SFDT1 study. DIABETES & METABOLISM 2021; 48:101306. [PMID: 34813929 DOI: 10.1016/j.diabet.2021.101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is associated with a high risk of cardiovascular (CV) complications, even after controlling for traditional CV risk factors. Therefore, determinants of the residual increased CV morbidity and mortality remain to be discovered. This prospective cohort of people living with T1DM in France (SFDT1) will include adults and children aged over six years living with T1DM, recruited throughout metropolitan France and overseas French departments and territories. The primary objective is to better understand the parameters associated with CV complications in T1DM. Clinical data and biobank samples will be collected during routine visits every three years. Data from connected tools, including continuous glucose monitoring, will be available during the 10-year active follow-up. Patient-reported outcomes, psychological and socioeconomic information will also be collected either at visits or through web questionnaires accessible via the internet. Additionally, access to the national health data system (Health Data Hub) will provide information on healthcare and a passive 20-year medico-administrative follow-up. Using Health Data Hub, SFDT1 participants will be compared to non-diabetic individuals matched on age, gender, and residency area. The cohort is sponsored by the French-speaking Foundation for Diabetes Research (FFRD) and aims to include 15,000 participants.
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Affiliation(s)
- J P Riveline
- Department of Diabetology and Endocrinology, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, 2 rue Ambroise Paré, Paris 75010, France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France.
| | - B Vergés
- Department of Endocrinology-Diabetology, INSERM LNC UMR1231, University of Burgundy, Dijon, France
| | - B Detournay
- CEMKA, 43 boulevard du Maréchal Joffre, Bourg-la-Reine, France
| | - S Picard
- Endocrinology and Diabetes, Point Medical, Rond-Point de la Nation, Dijon 21000, France
| | - P Y Benhamou
- INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - E Bismuth
- Hôpital Universitaire Robert-Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Université de Paris, Paris F-75019, France
| | - L Bordier
- Department of Diabetology and Endocrinology, Begin Military Hospital, Saint Mandé, France
| | - N Jeandidier
- Department of Endocrinology, Diabetes, Nutrition, Hospices Civils Strasbourg, UdS, Strasbourg 67000, France
| | - M Joubert
- Diabetes Care Unit - Caen University Hospital - UNICAEN, Caen, France
| | - R Roussel
- Department of Diabetology, Endocrinology, and Nutrition, Bichat-Claude Bernard Hospital, Paris,France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France
| | - A Sola-Gazagnes
- Department of Diabetology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - A Bonnefond
- Université de Lille, Inserm UMR1283, CNRS UMR8199, Institut Pasteur de Lille, CHU de Lille, Lille, France
| | - S Clavel
- Department of Diabetology Endocrinology Hotel Dieu Le Creusot, France
| | - F L Velayoudom
- Department of Diabetology and Endocrinology, University Hospital of Guadeloupe, Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, Lille University Hospital, Lille 59000, France
| | - J Beltrand
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, APHP Centre, Hôpital Universitaire Necker Enfants Malades, Université de Paris - Inserm U1016, Institut Cochin, Paris, France
| | - H Hanaire
- Department of Diabetology, University Hospital of Toulouse, University of Toulouse, France
| | - P Fontaine
- Department of Endocrinology, Diabetology and Nutrition University Hospital of Lille, University of Lille, France
| | - C Thivolet
- Center for Diabetes DIAB-eCARE, Hospices Civils de Lyon and Lyon 1 University, Lyon France
| | - H Servy
- e-health Services Sanoïa, 188 av 2nd DB, Gémenos 13420, France
| | - S Tubiana
- AP-HP, Hôpital Bichat, Centre de Ressources Biologiques, Paris F-75018, France
| | - S Lion
- Société Francophone du Diabète, Paris, France
| | - Jean-François Gautier
- Department of Diabetology and Endocrinology, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, 2 rue Ambroise Paré, Paris 75010, France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France
| | - Etienne Larger
- AP-HP.Centre-Université de Paris, INSERM U1016, Institut Cochin Paris, France
| | - E Vicaut
- AP-HP, Hôpital F.Widal, Clinical Trial Unit, Paris 75010, France
| | - L Sablone
- Fondation Francophone Pour la Recherche sur le Diabète, 60 rue Saint Lazare, Paris 75009, France
| | - G Fagherazzi
- Department of Population Health, Deep Digital Phenotyping Research Unit, 1 AB rue Thomas Edison, Strassen, Luxembourg
| | - E Cosson
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Avicenne Hospital, Paris 13 University, Bobigny, France; UMR 557 INSERM/U11125 INRAE/CNAM / Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, Paris 13 University Sorbonne Paris Cité, Bobigny, France
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