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McFadden NT, Wilkerson AH, Jaiswal J, Chaney BH, Stellefson ML, Carmack HJ, Lovett K. Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study. Am J Health Promot 2024; 38:704-715. [PMID: 38342487 DOI: 10.1177/08901171241233407] [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: 02/13/2024]
Abstract
PURPOSE This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D). DESIGN A qualitative, phenomenological approach using semi-structured, one-on-one interviews. SETTING Interviews conducted on Zoom (n = 28) and in-person (n = 3). PARTICIPANTS Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States. METHOD This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis. RESULTS Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management. CONCLUSION Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.
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Affiliation(s)
- Ny'Nika T McFadden
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
| | - Amanda H Wilkerson
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Jessica Jaiswal
- Department of Family and Community Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Beth H Chaney
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Heather J Carmack
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kylie Lovett
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
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Parise M, Di Molfetta S, Graziano RT, Fiorentino R, Cutruzzolà A, Gnasso A, Irace C. A Head-to-Head Comparison of Two Algorithms for Adjusting Mealtime Insulin Doses Based on CGM Trend Arrows in Adult Patients with Type 1 Diabetes: Results from an Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3945. [PMID: 36900956 PMCID: PMC10002216 DOI: 10.3390/ijerph20053945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) users are encouraged to consider trend arrows before injecting a meal bolus. We evaluated the efficacy and safety of two different algorithms for trend-informed bolus adjustments, the Diabetes Research in Children Network/Juvenile Diabetes Research Foundation (DirectNet/JDRF) and the Ziegler algorithm, in type 1 diabetes. METHODS We conducted a cross-over study of type 1 diabetes patients using Dexcom G6. Participants were randomly assigned to either the DirectNet/JDRF or the Ziegler algorithm for two weeks. After a 7-day wash-out period with no trend-informed bolus adjustments, they crossed to the alternative algorithm. RESULTS Twenty patients, with an average age of 36 ± 10 years, completed this study. Compared to the baseline and the DirectNet/JDRF algorithm, the Ziegler algorithm was associated with a significantly higher time in range (TIR) and lower time above range and mean glucose. A separate analysis of patients on CSII and MDI revealed that the Ziegler algorithm provides better glucose control and variability than DirectNet/JDRF in CSII-treated patients. The two algorithms were equally effective in increasing TIR in MDI-treated patients. No severe hypoglycemic or hyperglycemic episode occurred during the study. CONCLUSIONS The Ziegler algorithm is safe and may provide better glucose control and variability than the DirectNet/JDRF over a two-week period, especially in patients treated with CSII.
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Affiliation(s)
- Martina Parise
- Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70121 Bari, Italy
| | | | | | - Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia, 88100 Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Graecia, 88100 Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
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McCall AL, Lieb DC, Gianchandani R, MacMaster H, Maynard GA, Murad MH, Seaquist E, Wolfsdorf JI, Wright RF, Wiercioch W. Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2023; 108:529-562. [PMID: 36477488 DOI: 10.1210/clinem/dgac596] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Hypoglycemia in people with diabetes is common, especially in those taking medications such as insulin and sulfonylureas (SU) that place them at higher risk. Hypoglycemia is associated with distress in those with diabetes and their families, medication nonadherence, and disruption of life and work, and it leads to costly emergency department visits and hospitalizations, morbidity, and mortality. OBJECTIVE To review and update the diabetes-specific parts of the 2009 Evaluation and Management of Adult Hypoglycemic Disorders: Endocrine Society Clinical Practice Guideline and to address developing issues surrounding hypoglycemia in both adults and children living with diabetes. The overriding objectives are to reduce and prevent hypoglycemia. METHODS A multidisciplinary panel of clinician experts, together with a patient representative, and methodologists with expertise in evidence synthesis and guideline development, identified and prioritized 10 clinical questions related to hypoglycemia in people living with diabetes. Systematic reviews were conducted to address all the questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. RESULTS The panel agreed on 10 questions specific to hypoglycemia risk and prevention in people with diabetes for which 10 recommendations were made. The guideline includes conditional recommendations for use of real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps in people with type 1 diabetes (T1D), use of CGM for outpatients with type 2 diabetes at high risk for hypoglycemia, use of long-acting and rapid-acting insulin analogs, and initiation of and continuation of CGM for select inpatient populations at high risk for hypoglycemia. Strong recommendations were made for structured diabetes education programs for those at high risk for hypoglycemia, use of glucagon preparations that do not require reconstitution vs those that do for managing severe outpatient hypoglycemia for adults and children, use of real-time CGM for individuals with T1D receiving multiple daily injections, and the use of inpatient glycemic management programs leveraging electronic health record data to reduce the risk of hypoglycemia. CONCLUSION The recommendations are based on the consideration of critical outcomes as well as implementation factors such as feasibility and values and preferences of people with diabetes. These recommendations can be used to inform clinical practice and health care system improvement for this important complication for people living with diabetes.
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Affiliation(s)
- Anthony L McCall
- University of Virginia Medical School, Department of Medicine, Division of Endocrinology and Metabolism, Charlottesville, VA 22901, USA
| | - David C Lieb
- Eastern Virginia Medical School, Division of Endocrine and Metabolic Disorders, Department of Medicine, Norfolk, VA 23510, USA
| | | | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55905, USA
| | - Elizabeth Seaquist
- Diabetes Center and the Division of Endocrinology & Metabolism, Minneapolis, MN 55455, USA
| | - Joseph I Wolfsdorf
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Wojtek Wiercioch
- McMaster University GRADE Centre and Michael G. DeGroote Cochrane Canada Centre Department of Health Research Methods, Evidence, and Impact, Hamilton, ON, L8S 4L8, Canada
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Mateu-Salat M, Moreno-Fernández J, Mangas N, Genua I, Martínez MJ, López A, González C, Chico A. Evaluation of the usefulness of and satisfaction with the flash glucose monitoring system (FreeStyle Libre®) guide for use in patients with type 1 diabetes⋆. ENDOCRINOL DIAB NUTR 2022; 69:316-321. [PMID: 35577748 DOI: 10.1016/j.endien.2022.03.007] [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: 02/08/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 06/15/2023]
Abstract
The Flash Guide (FG) for insulin dosing (A. Chico, C. González) was the first document intended for FreeStyle Libre® (FSL) user patients to help with decision-making depending on glucose level and trend. The objective of the study was to evaluate the usefulness of and the level of satisfaction with the recommendations given by the FG in a group of patients with type 1 diabetes (DM1) who were FSL users. It included 31 subjects (54% women; age 41 ± 15 years; DM duration 21 ± 14 years; 22 with FSL > 12 months) who were provided with the FG. They completed a questionnaire on decision-making depending on glucose trend in different situations (before and three months after using the FG), and a satisfaction questionnaire (ad hoc). Demographic, clinical and glycaemic control data were collected. The percentage of subjects who used glucose trend in decision-making after receiving the FG increased: for adjusting insulin (51 vs. 83; p = 0.016), action without insulin (51 vs. 90%; p = 0.001), and in special circumstances. The FG was evaluated as very useful (4.19/5). There were no significant changes in glycaemic control, although the percentage of data gathered increased significantly (89.07 vs. 94.46%; p = 0.042). In conclusion, the FG was evaluated well for managing glucose trends with FSL by the patients with DM1 analysed, increasing their use of trend in decision-making, with no changes in glycaemic control, but with more data gathered.
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Affiliation(s)
- Manuel Mateu-Salat
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jesús Moreno-Fernández
- Sección de Endocrinología y Nutrición, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - Natalia Mangas
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Idoia Genua
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María José Martínez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alicia López
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cintia González
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Ana Chico
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Marks BE, Williams KM, Sherwood JS, Putman MS. Practical aspects of diabetes technology use: Continuous glucose monitors, insulin pumps, and automated insulin delivery systems. J Clin Transl Endocrinol 2022; 27:100282. [PMID: 34917483 PMCID: PMC8666668 DOI: 10.1016/j.jcte.2021.100282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/01/2021] [Accepted: 11/27/2021] [Indexed: 02/06/2023] Open
Abstract
There have been tremendous advances in diabetes technology in the last decade. Continuous glucose monitors (CGM), insulin pumps, and automated insulin delivery (AID) systems aim to improve glycemic control while simultaneously decreasing the burden of diabetes management. Although diabetes technologies have been shown to decrease both hypoglycemia and hyperglycemia and to improve health-related quality of life in individuals with type 1 diabetes, the impact of these devices in individuals with cystic fibrosis-related diabetes (CFRD) is less clear. There are unique aspects of CFRD, including the different underlying pathophysiology and unique lived health care experience and comorbidities, that likely affect the use, efficacy, and uptake of diabetes technology in this population. Small studies suggest that CGM is accurate and may be helpful in guiding insulin therapy for individuals with CFRD. Insulin pump use has been linked to improvements in lean body mass and hemoglobin A1c among adults with CFRD. A recent pilot study highlighted the promise of AID systems in this population. This article provides an overview of practical aspects of diabetes technology use and device limitations that clinicians must be aware of in caring for individuals with CF and CFRD. Cost and limited insurance coverage remain significant barriers to wider implementation of diabetes technology use among patients with CFRD. Future studies exploring strategies to improve patient and CF provider education about these devices and studies showing the effectiveness of these technologies on health and patient-reported outcomes may lead to improved insurance coverage and increased rates of uptake and sustained use of these technologies in the CFRD community.
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Affiliation(s)
- Brynn E. Marks
- Division of Endocrinology and Diabetes, Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC 20010, USA
| | - Kristen M. Williams
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Columbia University Irving Medical Center, 1150 St Nicholas Avenue, New York, NY 10032, United States
| | - Jordan S. Sherwood
- Diabetes Research Center, Division of Pediatric Endocrinology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Melissa S. Putman
- Division of Endocrinology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Diabetes Research Center, Division of Endocrinology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
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Miller E, Gavin JR, Kruger DF, Brunton SA. Continuous Glucose Monitoring: Optimizing Diabetes Care: Executive Summary. Clin Diabetes 2022; 40:394-398. [PMID: 36385970 PMCID: PMC9622212 DOI: 10.2337/cd22-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Eden Miller
- Diabetes Nation and Diabetes and Obesity Care, Bend, OR
| | | | - Davida F. Kruger
- Division of Endocrinology, Diabetes, Bone and Mineral Disease, Henry Ford Health System, Detroit, MI
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Pinsker JE, Church MM, Brown SA, Voelmle MK, Bode BW, Narron B, Huyett LM, Lee JB, O'Connor J, Benjamin E, Dumais B, Ly TT. Clinical Evaluation of a Novel CGM-Informed Bolus Calculator with Automatic Glucose Trend Adjustment. Diabetes Technol Ther 2022; 24:18-25. [PMID: 34491825 PMCID: PMC8783627 DOI: 10.1089/dia.2021.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Expert opinion guidelines and limited data from clinical trials recommend adjustment to bolus insulin doses based on continuous glucose monitor (CGM) trend data, yet minimal evidence exists to support this approach. We performed a clinical evaluation of a novel CGM-informed bolus calculator (CIBC) with automatic insulin bolus dose adjustment based on CGM trend used with sensor-augmented pump therapy. Materials and Methods: In this multicenter, outpatient study, participants 6-70 years of age with type 1 diabetes (T1D) used the Omnipod® 5 System in Manual Mode, first for 7 days without a connected CGM (standard bolus calculator, SBC, phase 1) and then for 7 days with a connected CGM using the CIBC (CIBC phase 2). The integrated bolus calculator used stored pump settings plus user-estimated meal size and/or either a manually entered capillary glucose value (SBC phase) or an imported current CGM value and trend (CIBC phase) to recommend a bolus amount. The CIBC automatically increased or decreased the suggested bolus amount based on the CGM trend. Results: Twenty-five participants, (mean ± standard deviation) 27 ± 15 years of age, with T1D duration 12 ± 9 years and A1C 7.0% ± 0.9% completed the study. There were significantly fewer sensor readings <70 mg/dL 4 h postbolus with the CIBC compared to the SBC (2.1% ± 2.0% vs. 2.8 ± 2.7, P = 0.03), while percent of sensor readings >180 and 70-180 mg/dL remained the same. There was no difference in insulin use or number of boluses given between the two phases. Conclusion: The CIBC was safe when used with the Omnipod 5 System in Manual Mode, with fewer hypoglycemic readings in the postbolus period compared to the SBC. This trial was registered at ClinicalTrials.gov (NCT04320069).
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Affiliation(s)
- Jordan E. Pinsker
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Sue A. Brown
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Mary K. Voelmle
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Bruce W. Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Brooke Narron
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Lauren M. Huyett
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Joon Bok Lee
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Jason O'Connor
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Eric Benjamin
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Bonnie Dumais
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Trang T. Ly
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
- Address correspondence to: Trang T. Ly, MBBS, FRACP, PhD, Insulet Corporation, 100 Nagog Park, Acton, MA 01720, USA
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Elbarbary N, Moser O, Al yaarubi S, Alsaffar H, Al Shaikh A, Ajjan RA, Deeb A. Use of continuous glucose monitoring trend arrows in the younger population with type 1 diabetes. Diab Vasc Dis Res 2021; 18:14791641211062155. [PMID: 34898300 PMCID: PMC8671682 DOI: 10.1177/14791641211062155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Early control of glycaemia is key to reduce vascular complications in individuals with Type 1 diabetes. Therefore, encouraging children and adolescents with T1DM to take responsibility for controlling glucose levels is an important yet a challenging task. The rapid expansion of continuous glucose monitoring (CGM) systems has allowed for more comprehensive analysis of glycaemia in T1D. Moreover, CGM devices have the ability to calculate rate of change in glucose levels and display the information as trend arrows. In turn, this can help to take evasive actions to return glucose levels to near physiological glycaemia, which can be highly motivating for young people with T1DM. In the absence of standardised, evidence-based guidance, this consensus document, generated by experts from the Arab Society of Paediatric Endocrinology and Diabetes and international advisors, summarises recent literature on the use of trend arrows in young people with T1DM. The use of trend arrows in different CGM systems is reviewed and their clinical significance is highlighted. Adjusting insulin doses according to trend arrows is discussed while also addressing special situations, such as exercise, fasting, nocturnal hypoglycaemia and menstruation. Adequate understanding of trend arrows should facilitate optimisation of glycaemic control in the T1D population.
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Affiliation(s)
- Nancy Elbarbary
- Diabetes Unit, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Nancy Elbarbary, Professor of Pediatrics, Department of Pediatrics, Diabetes Unit, Faculty of Medicine, Ain Shams University, 25 Ahmed Fuad St. Saint Fatima, Heliopolis, Cairo 11361, Egypt.
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Saif Al yaarubi
- Pediatric Endocrine Department, Sultan Qaboos University Hospital, College of Medicine, Seeb, Oman
| | - Hussain Alsaffar
- Paediatric Endocrine and Diabetics Unit, Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adnan Al Shaikh
- Pediatric Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Asma Deeb
- Paediatric Endocrinology Department, Sheikh Shakhbout Medical City and Khalifa University Abu Dhabi, Abu Dhabi, UAE
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González de Buitrago Amigo J, González García A, Díaz Fernández P, Fernández Llamas M, Tejado Bravo ML, de Nicolás Jiménez JM, Ferrer Lozano M. The impact of "faster aspart" on blood glucose control in children and adolescents with type 1 diabetes treated using a sensor-augmented insulin pump. An Pediatr (Barc) 2021; 95:321-329. [PMID: 34645579 DOI: 10.1016/j.anpede.2020.11.006] [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: 06/09/2020] [Accepted: 11/03/2020] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND AIMS Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new "faster aspart" insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of "faster aspart" vs. "insulin aspart" in children and adolescents with DM1 on sensor-augmented pump treatment. PATIENTS AND METHODS Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) <70 and >180 mg/dL, mean sensor glucose pre- and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed. RESULTS The study included 32 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia >180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = .011) and >250 mg/dL (5.2±4.9 vs. 4.0 ± 3.6; p = .04), lower AUC >180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = .03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = .03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers. CONCLUSIONS Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps.
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Affiliation(s)
| | | | | | | | | | | | - Marta Ferrer Lozano
- Unidad de Endocrinología Pediátrica y del Adolescente, Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain
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Bassi M, Minuto N, Fichera G, Rebora C, Parodi A, Natoli V, Pontillo L, Buccianti M, d’Annunzio G, Maghnie M. Practical Approach to Using Trend Arrows on Real-Time Continuous Glucose Monitoring System in Type 1 Diabetes Adolescents Living Camp Setting Treated With Multiple Daily Injection or Continuous Subcutaneous Insulin Infusion Insulin Therapy. J Diabetes Sci Technol 2021; 15:1098-1103. [PMID: 32552001 PMCID: PMC8442179 DOI: 10.1177/1932296820934803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of the study was to determine the effect of an educational intervention on the use of trend arrows of a real-time continuous glucose monitoring (rt-CGM) to manage daily therapy decisions in a group of adolescents with type 1 diabetes attending a camp. The secondary aim was to evaluate the variations in total daily dose (TDD) of insulin requirement. METHODS Twenty patients (15-17 years) on multiple insulin injections (n = 8) or continuous subcutaneous insulin infusion (n = 12) attended a training session at the beginning of the camp to learn our algorithm for the management of therapy depending on trend arrows. TDD, time in range (TIR), time above range (TAR), and time below range (TBR) (in the 24 hours and in the three hours after breakfast) before the training session (run-in) and at the end of the camp (T1) were analyzed. RESULTS Data showed a reduction of TAR (run-in 42.6%, T1 32.05%, P = .036) and an increase in TIR (run-in 52.9%, T1 62.4%, P = .013). Reduction of TBR (run-in 42.5%, T1 37.5%, P = .05) and improvement in TIR (run-in 49.0%, T1 57.0%, P = .02) were also observed in the post-breakfast period. Data showed a significant reduction in the TDD (run-in 52.02 ± 17.44 U/die, T1 46.49 ± 12.39 U/die, P = .024). CONCLUSIONS Statistically significant improvement of glycemic control and reduction of TTD were observed in all patients regardless of therapy type. The improvement between run-in and T1 demonstrates the importance of patients' education on the correct use of rt-CGM with simple algorithms for the management of therapy.
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Affiliation(s)
- Marta Bassi
- Clinica pediatrica, IRCCS G.Gaslini,
Genova, Italy
| | - Nicola Minuto
- Clinica pediatrica, IRCCS G.Gaslini,
Genova, Italy
- Nicola Minuto, MD, Ospedale G.Gaslini -
Largo G.Gaslini 5, Padiglione 16 Piano Terra, 16147 Genova, Italy.
| | | | - Clara Rebora
- Clinica pediatrica, IRCCS G.Gaslini,
Genova, Italy
| | - Alice Parodi
- Clinica pediatrica, IRCCS G.Gaslini,
Genova, Italy
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Hirsch IB, Miller E. Integrating Continuous Glucose Monitoring Into Clinical Practices and Patients' Lives. Diabetes Technol Ther 2021; 23:S72-S80. [PMID: 34546085 DOI: 10.1089/dia.2021.0233] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Numerous studies have demonstrated the clinical benefits of continuous glucose monitoring (CGM) in individuals with diabetes. Within ongoing innovations in CGM technology, individuals now have an expanding array of options that allow them to select the device that meets their individual needs and preferences. Although demand for CGM in primary care continues to grow, many clinicians are reluctant to prescribe this technology due to their unfamiliarity with the various devices, uncertainty about which devices are best suited to each patient and the feasibility of using CGM. This article reviews the features and functionality of the most recent commercially available CGM devices and provides guidance for integrating CGM use into clinical practices.
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Affiliation(s)
- Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eden Miller
- Diabetes and Obesity Care, Bend, Oregon, USA
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12
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Mateu-Salat M, Moreno-Fernández J, Mangas N, Genua I, Martínez MJ, López A, González C, Chico A. Evaluation of the usefulness of and satisfaction with the flash glucose monitoring system (FreeStyle Libre®) guide for use in patients with type 1 diabetes. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00185-3. [PMID: 34452877 DOI: 10.1016/j.endinu.2021.04.008] [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: 02/08/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 10/20/2022]
Abstract
The Flash Guide (FG) for insulin dosing (A. Chico, C. González) was the first document intended for FreeStyle Libre® (FSL) user patients to help with decision-making depending on glucose level and trend. The objective of the study was to evaluate the usefulness of and the level of satisfaction with the recommendations given by the FG in a group of patients with type 1 diabetes (DM1) who were FSL users. It included 31 subjects (54% women; age 41±15 years; DM duration 21±14 years; 22 with FSL>12 months) who were provided with the FG. They completed a questionnaire on decision-making depending on glucose trend in different situations (before and three months after using the FG), and a satisfaction questionnaire (ad hoc). Demographic, clinical and glycaemic control data were collected. The percentage of subjects who used glucose trend in decision-making after receiving the FG increased: for adjusting insulin (51 vs. 83; P=.016), action without insulin (51 vs. 90%; P=.001), and in special circumstances. The FG was evaluated as very useful (4.19/5). There were no significant changes in glycaemic control, although the percentage of data gathered increased significantly (89.07 vs. 94.46%; P=.042). In conclusion, the FG was evaluated well for managing glucose trends with FSL by the patients with DM1 analysed, increasing their use of trend in decision-making, with no changes in glycaemic control, but with more data gathered.
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Affiliation(s)
- Manuel Mateu-Salat
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Jesús Moreno-Fernández
- Sección de Endocrinología y Nutrición, Hospital Universitario de Ciudad Real, Ciudad Real, España
| | - Natalia Mangas
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Idoia Genua
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - María José Martínez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Alicia López
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Cintia González
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
| | - Ana Chico
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España.
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13
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Forlenza GP, Buckingham BA, Brown SA, Bode BW, Levy CJ, Criego AB, Wadwa RP, Cobry EC, Slover RJ, Messer LH, Berget C, McCoy S, Ekhlaspour L, Kingman RS, Voelmle MK, Boyd J, O'Malley G, Grieme A, Kivilaid K, Kleve K, Dumais B, Vienneau T, Huyett LM, Lee JB, O'Connor J, Benjamin E, Ly TT. First Outpatient Evaluation of a Tubeless Automated Insulin Delivery System with Customizable Glucose Targets in Children and Adults with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:410-424. [PMID: 33325779 PMCID: PMC8215410 DOI: 10.1089/dia.2020.0546] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The objective of this study was to assess the safety and effectiveness of the first commercial configuration of a tubeless automated insulin delivery system, Omnipod® 5, in children (6-13.9 years) and adults (14-70 years) with type 1 diabetes (T1D) in an outpatient setting. Materials and Methods: This was a single-arm, multicenter, prospective clinical study. Data were collected over a 14-day standard therapy (ST) phase followed by a 14-day hybrid closed-loop (HCL) phase, where participants (n = 36) spent 72 h at each of three prespecified glucose targets (130, 140, and 150 mg/dL, 9 days total) then 5 days with free choice of glucose targets (110-150 mg/dL) using the Omnipod 5. Remote safety monitoring alerts were enabled during the HCL phase. Primary endpoints were difference in time in range (TIR) (70-180 mg/dL) between ST and HCL phases and proportion of participants reporting serious device-related adverse events. Results: Mean TIR was significantly higher among children in the free-choice period overall (64.9% ± 12.2%, P < 0.01) and when using a 110 mg/dL target (71.2% ± 10.2%, P < 0.01), a 130 mg/dL target (61.5% ± 7.7%, P < 0.01), and a 140 mg/dL target (64.8% ± 11.6%, P < 0.01), and among adults using a 130 mg/dL target (75.1% ± 11.6%, P < 0.05), compared to the ST phase (children: 51.0% ± 13.3% and adults: 65.6% ± 15.7%). There were no serious device-related adverse events reported during the HCL phase, nor were there episodes of severe hypoglycemia or diabetic ketoacidosis. Conclusion: The Omnipod 5 System was safe and effective when used at glucose targets from 110 to 150 mg/dL for 14 days at home in children and adults with T1D.
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Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bruce A. Buckingham
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
| | - Sue A. Brown
- Division of Endocrinology and Medicine, University of Virginia, Charlottesville, Virginia, USA
| | | | - Carol J. Levy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy B. Criego
- Department of Pediatric Endocrinology, Park Nicollet Clinic, International Diabetes Center at Park Nicollet, Minneapolis, Minnesota, USA
| | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erin C. Cobry
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert J. Slover
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Laurel H. Messer
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan McCoy
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Laya Ekhlaspour
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
| | - Ryan S. Kingman
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
| | - Mary K. Voelmle
- Division of Endocrinology and Medicine, University of Virginia, Charlottesville, Virginia, USA
| | | | - Grenye O'Malley
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aimee Grieme
- Department of Pediatric Endocrinology, Park Nicollet Clinic, International Diabetes Center at Park Nicollet, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | | | | | - Trang T. Ly
- Insulet Corporation, Acton, Massachusetts, USA
- Address correspondence to: Trang T. Ly, MBBS, FRACP, PhD, Insulet Corporation, 100 Nagog Park, Acton, MA 01720, USA
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14
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Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord 2021; 22:217-240. [PMID: 33755854 PMCID: PMC7985920 DOI: 10.1007/s11154-021-09635-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.
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Affiliation(s)
- Federico Boscari
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy.
| | - Angelo Avogaro
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy
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15
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Bruttomesso D, Boscari F, Lepore G, Noaro G, Cappon G, Girelli A, Bozzetto L, Tumminia A, Grassi G, Sparacino G, Laviola L, Facchinetti A. A "Slide Rule" to Adjust Insulin Dose Using Trend Arrows in Adults with Type 1 Diabetes: Test in Silico and in Real Life. Diabetes Ther 2021; 12:1313-1324. [PMID: 33725276 PMCID: PMC8099956 DOI: 10.1007/s13300-021-01020-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/30/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION In persons with type 1 diabetes (T1D) insulin dosing can be adjusted based on trend arrows derived from continuous glucose monitoring (CGM). We propose a slide rule with narrower blood glucose intervals and more classes of insulin sensitivity than are available in current models. METHODS The slide rule was tested in silico, in which a meal was simulated in 100 virtual subjects and the insulin bolus was calculated either in the standard way based on the insulin-to-carbohydrate ratio and the correction factor or according to the slide rule, following which the percentage time spent in range (70-180 mg/dl; %TIR), hypoglycemia (< 70 mg/dl; %THYPO), and hyperglycemia (> 180 mg/dl; %THYPER) was compared between the methods during the 4 h after the meal. Slide rule performance was also tested in real life by analyzing the same variables at during the 4 h postprandial period in 27 individuals with T1D. Only meals starting while the rate of change was at least 1 mg/dl per minute (increasing or decreasing) were considered for analysis. RESULTS In silico, when the preprandial trend arrow was increasing, our slide rule reduced %THYPER and increased %TIR (p < 0.05), whereas when the preprandial trend arrow was decreasing, it reduced %THYPO and slightly increased %THYPER (p < 0.05). In real life, our slide rule kept subjects on target for 70.8 and 91.6% of postprandial time when preprandial trend arrows were increasing or decreasing, respectively. CONCLUSION The proposed slide rule performed well both in silico and in real life, suggesting that it could be safely adopted by individuals with T1D to improve glucose control.
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Affiliation(s)
- Daniela Bruttomesso
- Unit of Metabolic Diseases, Department of Medicine, University of Padova, Padova, Italy.
| | - Federico Boscari
- Unit of Metabolic Diseases, Department of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Lepore
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Noaro
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giacomo Cappon
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Andrea Tumminia
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giorgio Grassi
- Department of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Luigi Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Padova, Italy
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16
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Al-Gadi I, Menon S, Lyons SK, DeSalvo DJ. Beyond A1C: A Practical Approach to Interpreting and Optimizing Continuous Glucose Data in Youth. Diabetes Spectr 2021; 34:139-148. [PMID: 34149254 PMCID: PMC8178721 DOI: 10.2337/ds20-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite significant pharmacological and technological advances in the treatment of type 1 diabetes, the majority of youth in the United States do not meet the American Diabetes Association's recommended A1C goal. Understanding and managing glycemic variability is important in children and adolescents. Because A1C provides an incomplete picture of day-to-day glycemic fluctuations, continuous glucose monitoring (CGM)-derived metrics are a promising addition to address glycemic management challenges in youth with diabetes. In this article, we discuss how to develop practical strategies to optimize the use of CGM in the pediatric population, interpret the valuable data it provides, and develop personalized and actionable treatment goals.
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Affiliation(s)
- Iman Al-Gadi
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sruthi Menon
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sarah K Lyons
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Daniel J DeSalvo
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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17
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Edelman SV, Cavaiola TS, Boeder S, Pettus J. Utilizing continuous glucose monitoring in primary care practice: What the numbers mean. Prim Care Diabetes 2021; 15:199-207. [PMID: 33257275 DOI: 10.1016/j.pcd.2020.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 12/17/2022]
Abstract
Use of continuous glucose monitoring (CGM) has been shown to improve glycemia control, reduce hypoglycemia, lower glycemic variability and enhance quality of life for individuals with type 1 diabetes and type 2 diabetes. However, many primary care physicians may be unfamiliar with the how CGM data can interpreted and acted upon. As adoption of this technology continues to grow, primary care physicians will be challenged to integrate CGM into their clinical practices. This article is intended to provide clinicians with practical guidance in interpreting and utilizing CGM data with their patients.
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Affiliation(s)
- Steven V Edelman
- University of California San Diego and Taking Control of Your Diabetes 501c3, San Diego, CA 92161, USA.
| | - Tricia Santos Cavaiola
- Department of Medicine, Clinical and Translational Research Institute (CTRI), San Diego, CA 92161, USA.
| | - Schafer Boeder
- Department of Medicine, Clinical and Translational Research Institute (CTRI), University of California SanDiego, San Diego, CA 92161, USA.
| | - Jeremy Pettus
- Department of Medicine, Clinical and Translational Research Institute (CTRI), University of California SanDiego, San Diego, CA 92161, USA.
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18
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Deeb A, Muammar T, Alsaffar H, Sedaghat S, Al Hassani N, Odeh R, Alkhayyat H, Al Sinani A, Attia N, Adhami S, Elbarbary N. Use of ambulatory glucose monitoring and analysis of ambulatory glucose profile in clinical practice for diabetes management; a position statement of the Arab Society of Paediatric Endocrinology and diabetes. Diabetes Res Clin Pract 2021; 173:108671. [PMID: 33493578 DOI: 10.1016/j.diabres.2021.108671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Diabetes mellitus imposes a significant burden around the world generally and in the Middle East and North Africa specifically. Glucose monitoring is a cornerstone of diabetes management. METHODS Glycated haemoglobin has always been the main metric for assessing glycaemic control, but its use is linked with multiple pitfalls. As an alternative, continuous glucose monitoring is becoming a standard of care in many countries. Intermittent scanning glucose monitoring (isCGM) has acquired a worldwide popularity and has been proven to improve glycaemic control, hypoglycaemia detection and prevention, and quality of life. RESULTS The most recent International Society of Paediatric and Adolescent Diabetes practice. guidelines recommended its use in young people with diabetes observing Ramadan to ensure safe fasting. At a meeting in Abu Dhabi in November 2019, the Arab Society for Paediatric. Endocrinology and Diabetes brought together a number of regional diabetes experts, patient. representatives and international expert advisors to review the evidence for isCGM and propose. guidelines for its use in the Middle East and North Africa region. CONCLUSION In this paper, the authors strongly recommend the use of isCGM for patients in MENA and present general recommendations and compressive specific guidance for physicians and patients, which they believe will also have wider resonance.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Tawfik Muammar
- Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Hussain Alsaffar
- Paediatric Endocrine and Diabetics Unit, Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Noura Al Hassani
- Department of Paediatrics, Tawam Hospital and UAE College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rasha Odeh
- Department of Paediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Haya Alkhayyat
- Bahrain Defence Force Royal Medical Services Military Hospital, West Riffa, Kingdom of Bahrain, Kingdom of Bahrain, Royal College of Surgeons in Ireland Medical University of Bahrain, Adliya, Bahrain
| | - Aisha Al Sinani
- National Diabetic and Endocrine Center, Royal Hospital, Muscat, Oman
| | - Najya Attia
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sarah Adhami
- Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Nancy Elbarbary
- Diabetes Unit, Department of Pediatrics, Faculty of medicine, Ain Shams University, Cairo, Egypt.
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Rodacki M, Calliari LE, Ramalho AC, Vianna AGD, Franco DR, Melo KFS, Araujo LR, Krakauer M, Scharf M, Minicucci W, Ziegler R, Gabbay M. Using trend arrows in continuous glucose monitoring systems for insulin adjustment in clinical practice: Brazilian Diabetes Society Position Statement. Diabetol Metab Syndr 2021; 13:2. [PMID: 33390180 PMCID: PMC7780381 DOI: 10.1186/s13098-020-00607-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/03/2020] [Indexed: 11/24/2022] Open
Abstract
This manuscript reports the Brazilian Diabetes Society Position Statement for insulin adjustments based on trend arrows observed in continuous glucose monitoring systems. The Brazilian Diabetes Society supports the utilization of trend arrows for insulin dose adjustments in patients with diabetes on basal-bolus insulin therapy, both with multiple daily insulin doses or insulin pumps without closed-loop features. For those on insulin pumps with predictive low-glucose suspend feature, we suggest that only upward trend arrows should be used for adjustments. In this paper, tables for insulin adjustment based on sensitivity factors are provided and strategies to optimize the use of trend arrows in clinical practice are discussed.
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Affiliation(s)
- M Rodacki
- Department of Internal Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
| | - L E Calliari
- Pediatric Endocrinology Unit, Pediatric Department, Santa Casa de São Paulo School of Mediccal Sciences, São Paulo, Brazil
| | - A C Ramalho
- Department of Endocrinology, Federal University of Bahia, Salvador, BA, Brazil
| | - A G D Vianna
- Curitiba Diabetes Center, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - D R Franco
- CPCLIN/DASA Clinical Research Center, São Paulo, Brazil
| | - K F S Melo
- Diabetes Secion, Hospital das Clinicas, University of São Paulo (USP), Quasar Telemedicine (Glic), São Paulo, Brazil
| | - L R Araujo
- Endocrinology Section, School of Medical Sciences, Belo Horizonte, MG, Brazil
| | - M Krakauer
- Diabetes and Endocrinology, Science Valley Research Institute, Santo André, SP, Brazil
| | - M Scharf
- Curitiba Diabetes Center, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - W Minicucci
- Endocrinology Section, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - R Ziegler
- Diabetes Clinic for Children and Adolescents, Munster, Germany
| | - M Gabbay
- Diabetes Centre-UNIFESP, Federal University of São Paulo, São Paulo, Brazil
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20
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González de Buitrago Amigo J, González García A, Díaz Fernández P, Fernández Llamas M, Tejado Bravo ML, de Nicolás Jiménez JM, Ferrer Lozano M. [The impact of «faster aspart» on blood glucose control in children and adolescents with type 1 diabetes treated using a sensor-augmented insulin pump]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30481-1. [PMID: 33384245 DOI: 10.1016/j.anpedi.2020.11.002] [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: 06/09/2020] [Revised: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND AIMS Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new «faster aspart» insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of «faster aspart» vs. «insulin aspart» in children and adolescents with DM1 on sensor-augmented pump treatment. PATIENTS AND METHODS Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) < 70 and > 180 mg/dL, mean sensor glucose pre and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed. RESULTS The study included 31 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia > 180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = 0.011) and > 250 mg/dL (5.2 ± 4.9 vs. 4.0 ± 3.6; p = 0.04), lower AUC > 180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = 0.03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = 0.03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers. CONCLUSIONS Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps.
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Affiliation(s)
| | | | | | | | | | | | - Marta Ferrer Lozano
- Unidad de Endocrinología Pediátrica y del Adolescente, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
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21
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Ibrahim M, Baker J, Cahn A, Eckel RH, El Sayed NA, Fischl AH, Gaede P, Leslie RD, Pieralice S, Tuccinardi D, Pozzilli P, Richelsen B, Roitman E, Standl E, Toledano Y, Tuomilehto J, Weber SL, Umpierrez GE. Hypoglycaemia and its management in primary care setting. Diabetes Metab Res Rev 2020; 36:e3332. [PMID: 32343474 DOI: 10.1002/dmrr.3332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
Hypoglycaemia is common in patients with type 1 diabetes and type 2 diabetes and constitutes a major limiting factor in achieving glycaemic control among people with diabetes. While hypoglycaemia is defined as a blood glucose level under 70 mg/dL (3.9 mmol/L), symptoms may occur at higher blood glucose levels in individuals with poor glycaemic control. Severe hypoglycaemia is defined as an episode requiring the assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions to assure neurologic recovery. Hypoglycaemia is the most important safety outcome in clinical studies of glucose lowering agents. The American Diabetes Association Standards of Medical Care recommends that a management protocol for hypoglycaemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan. A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycaemic goals and promote new therapies to improve quality of life of patients. Data from recent large clinical trials reported low risk of hypoglycaemic events with the use of newer anti-diabetic drugs. Increased hypoglycaemia risk is observed with the use of insulin and/or sulphonylureas. Vulnerable patients with T2D at dual risk of severe hypoglycaemia and cardiovascular outcomes show features of "frailty." Many of such patients may be better treated by the use of GLP-1 receptor agonists or SGLT2 inhibitors rather than insulin. Continuous glucose monitoring (CGM) should be considered for all individuals with increased risk for hypoglycaemia, impaired hypoglycaemia awareness, frequent nocturnal hypoglycaemia and with history of severe hypoglycaemia. Patients with impaired awareness of hypoglycaemia benefit from real-time CGM. The diabetes educator is an invaluable resource and can devote the time needed to thoroughly educate the individual to reduce the risk of hypoglycaemia and integrate the information within the entire construct of diabetes self-management. Conversations about hypoglycaemia facilitated by a healthcare professional may reduce the burden and fear of hypoglycaemia among patients with diabetes and their family members. Optimizing insulin doses and carbohydrate intake, in addition to a short warm up before or after the physical activity sessions may help avoiding hypoglycaemia. Several therapeutic considerations are important to reduce hypoglycaemia risk during pregnancy including administration of rapid-acting insulin analogues rather than human insulin, pre-conception initiation of insulin analogues, and immediate postpartum insulin dose reduction.
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Affiliation(s)
| | - Jason Baker
- Weill Cornell Medicine, New York, New York, USA
| | - Avivit Cahn
- The Diabetes Unit & Endocrinology and Metabolism Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Robert H Eckel
- University of Colorado Denver Anschutz Medical Campus and University of Colorado Hospital, Denver, Colorado, USA
| | - Nuha Ali El Sayed
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Hess Fischl
- University of Chicago Kovler Diabetes Center, Chicago, Illinois, USA
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - R David Leslie
- Blizard Institute, Queen Mary, University of London, London, UK
- Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
| | - Silvia Pieralice
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Dario Tuccinardi
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Paolo Pozzilli
- Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Bjørn Richelsen
- Steno Diabetes Center Aarhus and Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Eytan Roitman
- Institute of Diabetes, Technology and Research, Clalit Health Services, Herzelia, Israel
| | - Eberhard Standl
- Forschergruppe Diabetes eV at Munich Helmholtz Centre, Munich, Germany
| | - Yoel Toledano
- Division of Maternal Fetal Medicine, Helen Schneider Women's Hospital, Rabin Medical Center, Petah Tikva, Israel
| | | | - Sandra L Weber
- Greenville Health System, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, USA
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22
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Kim JH. Current status of continuous glucose monitoring among Korean children and adolescents with type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab 2020; 25:145-151. [PMID: 32871645 PMCID: PMC7538300 DOI: 10.6065/apem.2040038.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/16/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) requires life-long insulin therapy because of diminished insulin-secretion capability. Glycemic control and glucose monitoring are important to prevent T1DM complications. Continuous glucose monitoring (CGM) measures glucose level, every one to five minutes, in the interstitial fluid from a subcutaneous sensor and facilitates better glycemic control, reduces hypoglycemia, and is safely used in the pediatric population. CGM can be categorized as retrospective, real-time, or intermittently scanned CGM, and all forms are available in Korea. The CGM device has 3 components: sensor, transmitter, and monitor/receiver. Key metrics of CGM include days of CGM application, percentage of time with CGM, mean glucose, glucose management indicator, glycemic variability, and use of Ambulatory Glucose Profile for CGM reports. CGM sensors and transmitters have been partly reimbursed by the Korean National Health Insurance Service (NHIS) since 2019, and 1,434 T1DM patients (male, 40.8%; age <20 years, 52.4%) in Korea were prescribed CGM as of December 2019. In Korea, the number of CGM users will increase due to reimbursement for CGM sensors and transmitters by the NHIS. Successful CGM use requires long-term policies to establish diabetes education and financial assistance. Clinicians should become well-acquainted with interpretation of CGM data and information updates to facilitate integration of CGM data into clinical practice among pediatric T1DM patients.
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Affiliation(s)
- Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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23
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Unger J, Kushner P, Anderson JE. Practical guidance for using the FreeStyle Libre flash continuous glucose monitoring in primary care. Postgrad Med 2020; 132:305-313. [PMID: 32223687 DOI: 10.1080/00325481.2020.1744393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Use of continuous glucose monitoring (CGM) improves clinical outcomes in type 1 diabetes, and significant benefits been demonstrated in patients with type 2 diabetes, including improved glycemic control, better treatment adherence, and an increased understanding of their treatment regimens. Currently, there are two types of CGM systems: real-time CGM (rtCGM) and flash CGM (FCGM). Retrospective analysis of CGM data allows patients and their clinicians to identify glycemic patterns that support and facilitate informed therapy decisions. With the increasing prevalence of diabetes, primary care physicians will be compelled to take on more responsibility for managing patients with diabetes. This article focuses on practical approaches and decision-making strategies for utilizing FCGM in primary care settings.
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Affiliation(s)
- Jeff Unger
- Unger Primary Care , Rancho Cucamonga, CA, USA
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24
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Desrochers HR, Schultz AT, Laffel LM. Use of Diabetes Technology in Children: Role of Structured Education for Young People with Diabetes and Families. Endocrinol Metab Clin North Am 2020; 49:19-35. [PMID: 31980118 PMCID: PMC7140592 DOI: 10.1016/j.ecl.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The current era has witnessed an explosion of advanced diabetes technologies. Young people with diabetes and their families require detailed, structured diabetes education in order to optimize use of such devices. There is need for youth and their families to participate in the selection of particular devices for personal use and comprehensive education regarding the safe and effective use of such technologies. The education process should ensure that youth and their families receive realistic expectations of what the advanced technologies can and cannot do to avoid disappointment and the premature discontinuation of such systems.
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Affiliation(s)
- Hannah R Desrochers
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA
| | - Alan T Schultz
- Emergency Department, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY 10467, USA
| | - Lori M Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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25
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Corathers SD, DeSalvo DJ. Therapeutic Inertia in Pediatric Diabetes: Challenges to and Strategies for Overcoming Acceptance of the Status Quo. Diabetes Spectr 2020; 33:22-30. [PMID: 32116450 PMCID: PMC7026749 DOI: 10.2337/ds19-0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite significant advances in therapies for pediatric type 1 diabetes, achievement of glycemic targets remains elusive, and management remains burdensome for patients and their families. This article identifies common challenges in diabetes management at the patient-provider and health care system levels and proposes practical approaches to overcoming therapeutic inertia to enhance health outcomes for youth with type 1 diabetes.
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Affiliation(s)
- Sarah D. Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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26
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Chico A, Aguilera E, Ampudia-Blasco FJ, Bellido V, Cardona-Hernández R, Escalada FJ, Fernández D, Gómez-Peralta F, González Pérez de Villar N, Gorgojo JJ, Mezquita-Raya P, Morales C, de Pablos Velasco P, Palomares R, Parra J, Rivero MT, González-Blanco C. Clinical Approach to Flash Glucose Monitoring: An Expert Recommendation. J Diabetes Sci Technol 2020; 14:155-164. [PMID: 31081362 PMCID: PMC7189166 DOI: 10.1177/1932296819841911] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The flash glucose monitoring (FGM) system FreeStyle Libre® is a device that measures interstitial glucose in a very simple way and indicates direction and speed of glucose change. This allows persons with diabetes to prevent hypoglycemic and hyperglycemic events. Scientific evidence indicates that the system can improve glycemic control and quality of life. To obtain the maximum benefit, it is necessary to properly handle glucose values and trends. Due to the generalization of the system use, the purpose of the document is to provide recommendations for the optimal use of the device, not only in the management of glucose values and trends but also in the prevention of hypoglycemia, actuation in exercise, special situations, and retrospective analysis of the glucose data, among others.
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Affiliation(s)
- Ana Chico
- Endocrinology Department, Hospital Santa
Creu i Sant Pau, CIBER-BBN, Universitat Autònoma de Barcelona, Barcelona,
Spain
- Ana Isabel Chico, MD, PhD, Endocrinology
Department, Hospital Santa Creu i Sant Pau, Av Pare Claret 167, 08025
Barcelona,, Spain.
| | - Eva Aguilera
- Endocrinology Department, Hospital
Germans Trias i Pujol, Badalona, Spain
| | | | - Virgina Bellido
- Endocrinology Department, Hospital
Universitario Central de Asturias, Oviedo, Spain
| | - Roque Cardona-Hernández
- Division of Pediatric Endocrinology,
Diabetes Unit, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona,
Spain
| | | | - Diego Fernández
- Endocrinology Department, Hospital
Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | - Juan José Gorgojo
- Endocrinology Department, Hospital
Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Pedro Mezquita-Raya
- Endocrinology Department, Hospital
Universitario Torrecárdenas, Almería, Spain
| | - Cristóbal Morales
- Endocrinology Department, Hospital
Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Rafael Palomares
- Endocrinologist, Hospital
Universitario Reina Sofía, Córdoba, Spain
| | - Juan Parra
- Endocrinology Department, Hospital de
Mérida, Mérida, Badajoz, Spain
| | - María Teresa Rivero
- Endocrinology Department, Complexo
Hospitalario Universitario de Ourense, Orense, Spain
| | - Cintia González-Blanco
- Endocrinology Department, Hospital Santa
Creu i Sant Pau, CIBER-BBN, Universitat Autònoma de Barcelona, Barcelona,
Spain
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27
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Abstract
Regular self-monitoring of blood glucose levels, and ketones when indicated, is an essential component of type 1 diabetes (T1D) management. Although fingerstick blood glucose monitoring has been the standard of care for decades, ongoing rapid technological developments have resulted in increasingly widespread use of continuous glucose monitoring (CGM). This article reviews recommendations for self-monitoring of glucose and ketones in pediatric T1D with particular emphasis on CGM and factors that impact the accuracy and real-world use of this technology.
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Affiliation(s)
- Brynn E. Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, United States
- *Correspondence: Brynn E. Marks
| | - Joseph I. Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
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28
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Beck RW, Bergenstal RM, Laffel LM, Pickup JC. Advances in technology for management of type 1 diabetes. Lancet 2019; 394:1265-1273. [PMID: 31533908 DOI: 10.1016/s0140-6736(19)31142-0] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/26/2019] [Accepted: 05/01/2019] [Indexed: 01/07/2023]
Abstract
Technological advances have had a major effect on the management of type 1 diabetes. In addition to blood glucose meters, devices used by people with type 1 diabetes include insulin pumps, continuous glucose monitors, and, most recently, systems that combine both a pump and a monitor for algorithm-driven automation of insulin delivery. In the next 5 years, as many advances are expected in technology for the management of diabetes as there have been in the past 5 years, with improvements in continuous glucose monitoring and more available choices of systems that automate insulin delivery. Expansion of the use of technology will be needed beyond endocrinology practices to primary-care settings and broader populations of patients. Tools to support decision making will also need to be developed to help patients and health-care providers to use the output of these devices to optimise diabetes management.
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Affiliation(s)
- Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA.
| | - Richard M Bergenstal
- International Diabetes Center, Park Nicollet and Health Partners, Minneapolis, MN, USA
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - John C Pickup
- King's College London, Faculty of Life Sciences and Medicine, Guy's Hospital, London, UK
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29
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Fantasia K, Modzelewski K, Steenkamp D. Predictive Glucose Trends From Continuous Glucose Monitoring: Friend or Foe in Clinical Decision Making? J Diabetes Sci Technol 2019; 13:963-966. [PMID: 30636438 PMCID: PMC6955446 DOI: 10.1177/1932296818823538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this commentary, we briefly review the currently recommended approaches to interpretation and management of continuous glucose monitor (CGM) rate of change (ROC) trend arrows and discuss the inherent difficulty in incorporating practical recommendations for their application into routine clinical care. We have limited our review and discussion to the currently available Dexcom G5 and G6 CGM systems and Abbott's Freestyle Libre flash glucose monitor (FGM) system, as they are the most widely used and currently approved for nonadjunctive use in the United States.
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Affiliation(s)
- Kathryn Fantasia
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Kathryn Fantasia, MD, Boston Medical Center, 720 Harrison Ave, Ste 8100, Boston, MA 02118, USA.
| | - Katherine Modzelewski
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Devin Steenkamp
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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30
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Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, Bosi E, Buckingham BA, Cefalu WT, Close KL, Cobelli C, Dassau E, DeVries JH, Donaghue KC, Dovc K, Doyle FJ, Garg S, Grunberger G, Heller S, Heinemann L, Hirsch IB, Hovorka R, Jia W, Kordonouri O, Kovatchev B, Kowalski A, Laffel L, Levine B, Mayorov A, Mathieu C, Murphy HR, Nimri R, Nørgaard K, Parkin CG, Renard E, Rodbard D, Saboo B, Schatz D, Stoner K, Urakami T, Weinzimer SA, Phillip M. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care 2019. [PMID: 31177185 DOI: 10.2337/dci19‐0028] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations.
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Affiliation(s)
- Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | | | | | - Roy Beck
- Jaeb Center for Health Research, Tampa, FL
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruce A Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford Medical Center, Stanford, CA
| | | | - Kelly L Close
- Close Concerns and The diaTribe Foundation, San Francisco, CA
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padua, Italy
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - J Hans DeVries
- Profil, Neuss, Germany
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kim C Donaghue
- Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Satish Garg
- University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, CO
| | | | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, U.K
| | | | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, and Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | | | - Lori Laffel
- Pediatric, Adolescent and Young Adult Section and Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Brian Levine
- Close Concerns and The diaTribe Foundation, San Francisco, CA
| | | | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, U.K
| | - Revital Nimri
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | | | - Eric Renard
- Department of Endocrinology, Diabetes, and Nutrition, Montpellier University Hospital; Institute of Functional Genomics, University of Montpellier; and INSERM Clinical Investigation Centre, Montpellier, France
| | | | | | - Desmond Schatz
- Pediatric Endocrinology, University of Florida, Gainesville, FL
| | | | - Tatsuiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Moshe Phillip
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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31
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Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, Bosi E, Buckingham BA, Cefalu WT, Close KL, Cobelli C, Dassau E, DeVries JH, Donaghue KC, Dovc K, Doyle FJ, Garg S, Grunberger G, Heller S, Heinemann L, Hirsch IB, Hovorka R, Jia W, Kordonouri O, Kovatchev B, Kowalski A, Laffel L, Levine B, Mayorov A, Mathieu C, Murphy HR, Nimri R, Nørgaard K, Parkin CG, Renard E, Rodbard D, Saboo B, Schatz D, Stoner K, Urakami T, Weinzimer SA, Phillip M. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care 2019; 42:1593-1603. [PMID: 31177185 PMCID: PMC6973648 DOI: 10.2337/dci19-0028] [Citation(s) in RCA: 1954] [Impact Index Per Article: 390.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations.
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Affiliation(s)
- Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | | | | | - Roy Beck
- Jaeb Center for Health Research, Tampa, FL
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruce A Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford Medical Center, Stanford, CA
| | | | - Kelly L Close
- Close Concerns and The diaTribe Foundation, San Francisco, CA
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padua, Italy
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - J Hans DeVries
- Profil, Neuss, Germany.,Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kim C Donaghue
- Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Satish Garg
- University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, CO
| | | | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, U.K
| | | | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, and Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | | | - Lori Laffel
- Pediatric, Adolescent and Young Adult Section and Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Brian Levine
- Close Concerns and The diaTribe Foundation, San Francisco, CA
| | | | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, U.K
| | - Revital Nimri
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | | | - Eric Renard
- Department of Endocrinology, Diabetes, and Nutrition, Montpellier University Hospital; Institute of Functional Genomics, University of Montpellier; and INSERM Clinical Investigation Centre, Montpellier, France
| | | | | | - Desmond Schatz
- Pediatric Endocrinology, University of Florida, Gainesville, FL
| | | | - Tatsuiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Moshe Phillip
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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32
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Ziegler R, von Sengbusch S, Kröger J, Schubert O, Werkmeister P, Deiss D, Siegmund T. Therapy Adjustments Based on Trend Arrows Using Continuous Glucose Monitoring Systems. J Diabetes Sci Technol 2019; 13:763-773. [PMID: 30666883 PMCID: PMC6610609 DOI: 10.1177/1932296818822539] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Continuous glucose monitoring (CGM) systems use trend arrows to accurately display the anticipated glucose curve for the user. These are used for both "real-time" glucose monitoring and for intermittent scanning glucose monitoring. Trend arrow data are used by people with diabetes to make corrections to their glucose control. It is essential that they are correctly interpreted when adjusting insulin doses and to ensure that appropriate treatment decisions are made. The aim of this article is to provide general treatment guidance for diabetes teams and for people with diabetes using CGM in the context of trend arrows. This is based on previous recommendations for interpreting trend arrows without losing sight of the need for individual therapy adjustment.
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Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and
Adolescents, Münster, Germany
| | | | - Jens Kröger
- Centre for Diabetology, Hamburg
Bergedorf, Hamburg, Germany
| | | | | | | | - Thorsten Siegmund
- Department for Endocrinology, Diabetes
and Metabolism, ISAR Klinikum, Munich, Germany
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33
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Zaharieva DP, Turksoy K, McGaugh SM, Pooni R, Vienneau T, Ly T, Riddell MC. Lag Time Remains with Newer Real-Time Continuous Glucose Monitoring Technology During Aerobic Exercise in Adults Living with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:313-321. [PMID: 31059282 PMCID: PMC6551983 DOI: 10.1089/dia.2018.0364] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Real-time continuous glucose monitoring (CGM) devices help detect glycemic excursions associated with exercise, meals, and insulin dosing in patients with type 1 diabetes (T1D). However, the delay between interstitial and blood glucose may result in CGM underestimating the true change in glycemia during activity. The purpose of this study was to examine CGM discrepancies during exercise and the meal postexercise versus self-monitoring of blood glucose (SMBG). Methods: Seventeen adults with T1D using insulin pump therapy and CGM completed 60 min of aerobic exercise on three occasions. A standardized meal was given 30 min postexercise. SMBG was measured during exercise and in recovery using OmniPod® Personal Diabetes Manager (PDM; Insulet, Billerica, MA) with built-in glucose meter (FreeStyle; Abbott Laboratories, Abbott Park, IL), while CGM was measured with Dexcom G4® with 505 algorithm (n = 4) or G5® (n = 13), which were calibrated with subjects' own PDM. Results: SMBG showed a large drop in glycemia during exercise, while CGM showed a lag of 12 ± 11 (mean ± standard deviation) minutes and bias of -7 ± 19 mg/dL/min during activity. Mean absolute relative difference (MARD) for CGM versus SMBG was 13 (6-22)% [median (interquartile range)] during exercise and 8 (5-14)% during mealtime. Clarke error grids showed CGM values were in zones A and B 94%-99% of the time for SMBG. Conclusion: In summary, the drop in CGM lags behind the drop in blood glucose during prolonged aerobic exercise by 12 ± 11 min, and MARD increases to 13 (6-22)% during exercise as well. Therefore, if hypoglycemia is suspected during exercise, individuals should confirm glucose levels with a capillary glucose measurement.
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Affiliation(s)
- Dessi P. Zaharieva
- Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada
| | - Kamuran Turksoy
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Sarah M. McGaugh
- Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada
| | - Rubin Pooni
- Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada
| | | | - Trang Ly
- Insulet Corporation, Billerica, Massachusetts
| | - Michael C. Riddell
- Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada
- LMC Diabetes and Endocrinology, Toronto, Canada
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34
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Ziegler R. Analysis of "Performance of a Factory-Calibrated, Real-Time Continuous Glucose Monitoring System in Pediatric Participants With Type 1 Diabetes". J Diabetes Sci Technol 2019; 13:259-260. [PMID: 30453763 PMCID: PMC6399783 DOI: 10.1177/1932296818811672] [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: 11/15/2022]
Abstract
Accuracy of sensors play an important role in the acceptance and long-term use of CGM which is related to improved glycemic outcome. This has been lower in children and adolescents in the past for reasons such as size of the device, pain, and necessity to calibrate sensors but also inaccuracy and perceived nonreliability on alarms among others. In the study of Welsh et al, performance of a new, factory-calibrated sensor was assessed. The accuracy of the sensor, as measured in MARD, paired values within 20/20% or 15/15% and surveillance error grid analysis showed very good results, although less so in low value range <70 mg/dL, falling rate of change, and on first day of use. Accurate glucose measurements especially in these incidences are of utmost importance to people with diabetes as their treatment decisions are based on these, also in the beginning of sensor use.
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Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and
Adolescents, Muenster, Germany
- Ralph Ziegler, MD, Diabetes Clinic for
Children and Adolescents, Mondstr.148, 48155 Muenster, Germany.
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35
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Bianchi C, Aragona M, Rodia C, Baronti W, de Gennaro G, Bertolotto A, Del Prato S. Freestyle Libre trend arrows for the management of adults with insulin-treated diabetes: A practical approach. J Diabetes Complications 2019; 33:6-12. [PMID: 30446477 DOI: 10.1016/j.jdiacomp.2018.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/13/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
Freestyle Libre (FSL) system is a new method to detect glucose enabling a new paradigm in glucose monitoring and self-management. The sensor, reading the interstitial fluid glucose concentration, provides a numerical data of glucose level and a trend arrow that add context to static measurement of glucose level. Therefore, patients could easily follow the progression of their glucose levels over the time, allowing early detection and timely treatment of deviations from targeted glucose level range, thus preventing extreme fluctuations. In order to take full advantage of the system both the caregiver and the person with diabetes must appreciate the need of careful interpretation of the data generated by the FSL. To this purpose we have generated recommendations that are based on methods suggested for CGM, our clinical experience and discussion with experienced patients using FSL, to provide a pragmatic approach to use FSL trend arrow data for managing diabetes in adults.
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Affiliation(s)
- Cristina Bianchi
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Michele Aragona
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Cosimo Rodia
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giovanni de Gennaro
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alessandra Bertolotto
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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36
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Kruger DF, Edelman SV, Hinnen DA, Parkin CG. Reference Guide for Integrating Continuous Glucose Monitoring Into Clinical Practice. DIABETES EDUCATOR 2018; 45:3S-20S. [PMID: 30541402 DOI: 10.1177/0145721718818066] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Large randomized trials have demonstrated the efficacy of continuous glucose monitoring (CGM) in persons with type 1 diabetes and insulin-treated type 2 diabetes. The purpose of this article is to provide basic knowledge about CGM technology, discuss the use of CGM data in clinical practice, and direct clinicians to online resources that provide comprehensive information and tools relevant to patient selection, education/training, and reimbursement. CONCLUSIONS Effective use of CGM requires all members of the health care team to become knowledgeable and skilled in integrating CGM into their practices and in teaching their patients how to safely incorporate CGM use into their daily diabetes self-management.
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Affiliation(s)
- Davida F Kruger
- Henry Ford Health System, Division of Endocrinology, Diabetes and Bone & Mineral, Detroit, Michigan
| | - Steve V Edelman
- University of California San Diego and Taking Control of Your Diabetes 501c3, San Diego, California
| | - Deborah A Hinnen
- Memorial Hospital Diabetes Center, University of Colorado Health, Colorado Springs, Colorado
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37
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Peters AL, Ahmann AJ, Hirsch IB, Raymond JK. Advances in Glucose Monitoring and Automated Insulin Delivery: Supplement to Endocrine Society Clinical Practice Guidelines. J Endocr Soc 2018; 2:1214-1225. [PMID: 30324178 PMCID: PMC6179160 DOI: 10.1210/js.2018-00262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 12/22/2022] Open
Abstract
Endocrine Society guideline recommendations on diabetes technology in adults originate from the 2016 guideline titled “Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline.” Society recommendations on diabetes technology in children are contained in the 2011 guideline titled “Continuous Glucose Monitoring: An Endocrine Society Clinical Practice Guideline.” The field of diabetes technology is a rapidly advancing one, with new devices released annually and data from clinical trials published frequently. This report describes the most recent findings since the 2011 and 2016 guidelines were written, combining summaries of new literature with the authors’ clinical experience of new devices. Although we describe what we believe to be important scientific and technological updates since these guidelines were published, we are not advancing formal additions or amendments to previously offered recommendations.
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Affiliation(s)
- Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrew J Ahmann
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon
| | - Irl B Hirsch
- Endocrine and Diabetes Care Center, University of Washington Medical Center, Seattle, Washington
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
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38
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Laffel LM, Limbert C, Phelan H, Virmani A, Wood J, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Sick day management in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:193-204. [PMID: 30079506 DOI: 10.1111/pedi.12741] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/27/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Catarina Limbert
- NOVA Medical School, CHLC-Hospital Dona Estefania, Lisbon, Portugal
| | - Helen Phelan
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | | | - Jamie Wood
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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39
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Sherr JL, Tauschmann M, Battelino T, de Bock M, Forlenza G, Roman R, Hood KK, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies. Pediatr Diabetes 2018; 19 Suppl 27:302-325. [PMID: 30039513 DOI: 10.1111/pedi.12731] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Tadej Battelino
- UMC-University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Gregory Forlenza
- University of Colorado Denver, Barbara Davis Center, Aurora, Colorado
| | - Rossana Roman
- Medical Sciences Department, University of Antofagasta and Antofagasta Regional Hospital, Antofagasta, Chile
| | - Korey K Hood
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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40
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Adolfsson P, Riddell MC, Taplin CE, Davis EA, Fournier PA, Annan F, Scaramuzza AE, Hasnani D, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:205-226. [PMID: 30133095 DOI: 10.1111/pedi.12755] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Kungsbacka Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Craig E Taplin
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital; Telethon Kids Institute, University of Western Australia, Crawley, Australia
| | - Paul A Fournier
- School of Human Sciences, University of Western Australia, Perth, Australia
| | - Francesca Annan
- Children and Young People's Diabetes Service, University College London Hospitals NHS, Foundation Trust, London, UK
| | - Andrea E Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Dhruvi Hasnani
- Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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41
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Messer LH, Berget C, Beatson C, Polsky S, Forlenza GP. Preserving Skin Integrity with Chronic Device Use in Diabetes. Diabetes Technol Ther 2018; 20:S254-S264. [PMID: 29916740 PMCID: PMC6011799 DOI: 10.1089/dia.2018.0080] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Skin integrity and diabetes device placement are ongoing concerns for people with diabetes who utilize continuous glucose monitors (CGMs) and continuous subcutaneous insulin infusion pumps. This is especially significant for individuals with skin sensitivities, pediatric patients, and those who use devices chronically. Dermatological complications are often cited as a barrier to device use and a reason for device discontinuation. Furthermore, it is a frequent topic of discussion in diabetes follow-up visits, although little evidence-based literature exists to guide providers in managing skin integrity issues. The purpose of this article is to review current literature related to the prevalence of dermatological issues with insulin pumps and CGM, discuss published solutions to skin irritation, and to share the consolidated experience of our large academic diabetes clinic to address placement, prophylactic skin care, adhesives, removal, and skin healing with diabetes device use. Recommendations for targeted studies, increased surveillance, and development of new adhesive compounds are suggested to reduce the burden of device wear for management of diabetes.
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Affiliation(s)
- Laurel H Messer
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado
| | - Cari Berget
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado
| | - Christie Beatson
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado
| | - Sarit Polsky
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado
| | - Gregory P Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado
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42
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Welsh JB. Role of Continuous Glucose Monitoring in Insulin-Requiring Patients with Diabetes. Diabetes Technol Ther 2018; 20:S242-S249. [PMID: 29916736 DOI: 10.1089/dia.2018.0100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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43
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Abstract
New therapies, monitoring, and revolutionary enabling technologies applied to healthcare represent an historic opportunity to improve the lives of people with diabetes. These advances enable more meaningful monitoring of blood glucose values with the facilitation of more optimal insulin dosing and delivery. Newer insulins and delivery systems are in development that seek to mitigate both hyperglycemia and hypoglycemia and increase time in range. Information systems now exist that may be leveraged to merge data from previously discrete systems into new models of connected care. This review highlights important developments that serve to increase effectiveness while reducing the burden of diabetes care in the near future.
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Affiliation(s)
| | - John Walsh
- 2 Advanced Metabolic Care + Research , Escondido, California
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