Sensor-Based Technology: Bringing Value to People with Diabetes and the Healthcare System in an Evolving World

A Telehealth Program Using Continuous Glucose Monitoring and a Connected Insulin Pen Cap in Nursing Homes for Older Adults with Insulin-Treated Diabetes: The Trescasas Study

Objective: To assess the impact and feasibility of a telehealth program using continuous glucose monitoring (CGM) and a connected insulin pen cap (CIPC) in nursing homes for older adults with insulin-treated diabetes. Research Methods: This multicenter, prospective, sequential, single-arm study consisted of three phases: (1) baseline, blind CGM (Freestyle Libre Pro®); (2) intervention 1, CGM (Freestyle Libre2®) without alarms; and (3) intervention 2, CGM with alarms for hypo and hyperglycemia. Two telehealth visits from reference diabetes units were conducted to adjust antidiabetic treatments. Insulin treatment was tracked using the Insulclock® CIPC. The study's primary objective was to evaluate the reduction of hypoglycemia rate. Results: Of 82 eligible patients at seven nursing homes, 54 completed the study (age: 87.7 ± 7.1, 68-102 years, 56% women, duration of diabetes: 18.7 years, baseline glycated hemoglobin: 6.9% [52 mmol/mol]). The mean number of hypoglycemic events was significantly reduced from baseline (4.4) to intervention 1 (2.8; P = 0.060) and intervention 2 (2.1; P = 0.023). The time below range 70 mg/dL (3.9 mmol/L) significantly decreased from 3.7% at baseline to 1.4% at intervention 2 (P = 0.036). The number of insulin injections significantly decreased from baseline to intervention 1 (1.2 to 0.99; P = 0.027). Nursing home staff expressed a positive view of the program, greater convenience, and potential to reduce hypoglycemia with the Freestyle Libre2® CGM versus the glucometer. Conclusions: A telehealth program using CGM and a CIPC was associated with improved glycemic profiles among institutionalized older individuals with diabetes receiving insulin and was well perceived by professionals.

The World-Wide Adaptations of Diabetic Management in the Face of COVID-19 and Socioeconomic Disparities: A Scoping Review

Diabetes is an increasingly prevalent chronic disease throughout the world. It is imperative for patients to have access to reliable treatment and resources in order to avoid long-term complications. Economic and social factors contribute to the accessibility of these resources and have a direct impact on diabetes management. Socioeconomic status (SES) presents challenges to diabetic management due to financial and geographical access to care, medications, educational resources, healthy food options, and physical activity. The coronavirus (COVID-19) pandemic exacerbated these challenges, especially during the height of lockdowns. Therefore, it is important to gain insight into how the pandemic challenged diabetes management, taking into consideration socioeconomic disparities. The objective is to assess how the COVID-19 pandemic has impacted the care of chronic diabetic patients internationally and determine how these outcomes vary between patients of different socioeconomic classes. The following study was designed as a scoping review and utilized PubMed, EMBASE, CINAHL, and Web of Science. A Boolean search strategy combined search terms as follows: (((COVID-19) AND (diabetes)) AND ((socioeconomic factors) OR (social inequality OR standard of living))) AND (treatment OR management). Inclusion criteria included studies addressing diabetic patients, socioeconomic variables (income, occupation, level of education, and ethnicity), glycemic control, and degree of access to quality healthcare. Studies exploring the pathophysiology of COVID-19 or diabetes mellitus were excluded. In addition, studies were chosen between the years 2020 and 2022. The search resulted in 214 articles. The full-text assessment was then conducted on the remaining 67 articles. After screening for eligibility and relevance, 19 articles were retained for this review. The results of this study indicate that 8 out of the 18 studies revealed worse outcomes for those with diabetes mellitus and concomitant COVID-19 infection. Patients with diabetes were more likely to be hospitalized and represent a larger percentage of COVID-19 fatalities. In addition, patients with diabetes and co-morbid COVID-19 infection were more likely to have a higher hemoglobin A1c (HbA1c), belong to a lower SES, and have worse glycemic control due to pandemic-associated lockdown. In order to combat the effects of the pandemic, many countries created novel and innovative management strategies. Overall, there are positive and negative effects from the pandemic on diabetic management strategies. This scoping review identified successes in diabetic treatment under pandemic conditions and areas that need optimization. The successful adaptations of many nations convey the capacity for new policy implementation to care for diabetic patients regardless of SES.

Utilizing the New Glucometrics: A Practical Guide to Ambulatory Glucose Profile Interpretation

Traditional continuous glucose monitoring and flash glucose monitoring systems are proven to lower glycated haemoglobin levels, decrease the time and impact of hypoglycaemia or hyperglycaemia and, consequently, improve the quality of life for children and adults with type 1 diabetes mellitus (T1DM) and adults with type 2 diabetes mellitus (T2DM). These glucose-sensing devices can generate large amounts of glucose data that can be used to define a detailed glycaemic profile for each user, which can be compared with targets for glucose control set by an International Consensus Panel of diabetes experts. Targets have been agreed upon for adults, children and adolescents with T1DM and adults with T2DM; separate targets have been agreed upon for older adults with diabetes, who are at higher risk of hypoglycaemia, and women with pregestational T1DM during pregnancy. Along with the objective measures and targets identified by the International Consensus Panel, the dense glucose data delivered by traditional continuous glucose monitoring and flash glucose monitoring systems is used to generate an ambulatory glucose profile, which summarizes the data in a visually impactful format that can be used to identify patterns and trends in daily glucose control, including those that raise clinical concerns. In this article, we provide a practical guide on how to interpret these new glucometrics using a straightforward algorithm, and clear visual examples that demystify the process of reviewing the glycaemic health of people with T1DM or T2DM such that forward-looking goals for diabetes management can be agreed.