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Donat Ergin B, Gadsby-Davis K, Mattishent K, Dhatariya K, Garner N, Hornberger M. Continuous Glucose Monitoring in Comorbid Dementia and Diabetes: The Evidence So Far. J Diabetes Sci Technol 2024:19322968241301058. [PMID: 39691964 DOI: 10.1177/19322968241301058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and dementia are two of the leading chronic diseases in aging and are known to influence each other's disease progression. There is well-established evidence that T2DM increases the risk for cognitive decline and dementia. At the same time, people with cognitive changes or dementia can find it difficult to manage their diabetes, resulting in hyper- or hypoglycemic events which can exacerbate the dementia disease progression further. Monitoring of glucose variability is, therefore, of critical importance during aging and when people with T2DM develop dementia. The advent of continuous glucose monitoring (CGM) has allowed the monitoring of glucose variability in T2DM more closely. The CGM seems to be highly feasible and acceptable to use in older people with T2DM and has been shown to significantly reduce their hypoglycemic events, often resulting in falls. Less is known as to whether CGM can have a similar beneficial effect on people with T2DM who have cognitive impairment or dementia in community or hospital settings. AIMS The current perspective will explore how CGM has made an impact on T2DM management in older people and those with comorbid cognitive impairment or dementia. We will further explore opportunities and challenges of using CGM in comorbid T2DM and dementia in community and hospital settings.
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Affiliation(s)
| | | | - Katharina Mattishent
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk & Norwich University Hospital, Norwich, UK
| | - Ketan Dhatariya
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk & Norwich University Hospital, Norwich, UK
| | - Nikki Garner
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk & Norwich University Hospital, Norwich, UK
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2
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Biester T, Berget C, Boughton C, Cudizio L, Ekhlaspour L, Hilliard ME, Reddy L, Sap Ngo Um S, Schoelwer M, Sherr JL, Dovc K. International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Diabetes Technologies - Insulin Delivery. Horm Res Paediatr 2024; 97:636-662. [PMID: 39657603 PMCID: PMC11854989 DOI: 10.1159/000543034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 11/29/2024] [Indexed: 12/12/2024] Open
Abstract
The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the technology behind insulin administration, with special emphasis on insulin pump therapy, especially on glucose-responsive integrated technology that is feasible with the use of automated insulin delivery (AID) systems in children and adolescents. The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the technology behind insulin administration, with special emphasis on insulin pump therapy, especially on glucose-responsive integrated technology that is feasible with the use of automated insulin delivery (AID) systems in children and adolescents.
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Affiliation(s)
- Torben Biester
- AUF DER BULT, Hospital for Children and Adolescents, Hannover, Germany
| | - Cari Berget
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Charlotte Boughton
- Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Cambridge, UK
| | - Laura Cudizio
- Department of Pediatrics, Division of Pediatric Endocrinology, Santa Casa of São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Laya Ekhlaspour
- Division of Endocrinology, Department of Pediatric, University of California San Francisco, San Francisco, CA, USA
| | - Marisa E. Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Leenatha Reddy
- Department of Pediatrics Endocrinology, Rainbow Children’s Hospital, Hyderabad, India
| | - Suzanne Sap Ngo Um
- Department of Pediatrics, The University of Ebolowa, Mother and Child Center of the Chantal Biya Foundation, Yaounde, Cameroon
| | - Melissa Schoelwer
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Jennifer L. Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Klemen Dovc
- Department of Endocrinology, Diabetes and Metabolic Diseases and University of Ljubljana Faculty of Medicine, University Medical Centre Ljubljana, University Children’s Hospital, Ljubljana, Slovenia
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3
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Di Molfetta S, Rossi A, Boscari F, Irace C, Laviola L, Bruttomesso D. Criteria for Personalised Choice of a Continuous Glucose Monitoring System: An Expert Opinion. Diabetes Ther 2024; 15:2263-2278. [PMID: 39347900 PMCID: PMC11467157 DOI: 10.1007/s13300-024-01654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/09/2024] [Indexed: 10/01/2024] Open
Abstract
Despite the growing evidence supporting the outpatient use of continuous glucose monitoring (CGM) for improving glycaemic control and reducing hypoglycaemia, there is a need for a detailed understanding of the specific features of CGM devices that best meet individual patient needs. This expert opinion, based on a comprehensive literature review and the personal perspectives of clinicians, aims to provide the healthcare professionals (HCPs) with a comprehensive framework for selecting CGM devices. It evaluates the current state of CGM technology, categorizing features into essential features, major drivers of choice, and additional/useful features. Moreover, the practical model presented outlines a patient's journey with CGM, emphasising the importance of aligning device features with patient needs. This includes understanding the patient's lifestyle, clinical conditions, and personal preferences to optimize CGM use and improve diabetes management outcomes.
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Affiliation(s)
- Sergio Di Molfetta
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Antonio Rossi
- IRCCS Ospedale Galeazzi-Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
| | - Federico Boscari
- Unit of Metabolic Diseases, University Hospital of Padua, 35128, Padua, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Græcia Catanzaro, Viale Europa Località Germaneto, 88100, Catanzaro, Italy.
| | - Luigi Laviola
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Daniela Bruttomesso
- Unit of Metabolic Diseases, University Hospital of Padua, 35128, Padua, Italy
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4
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Adams BV, Heston AT, Davis D, Nelson GB. Partnering With Families Through Shared Decision-Making to Increase Connected Pen Use: A Quality Improvement Success Story. Clin Diabetes 2024; 42:484-487. [PMID: 39429448 PMCID: PMC11486890 DOI: 10.2337/cd24-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article is part of a special article collection from the T1D Exchange Quality Improvement Collaborative. It describes efforts at an academic pediatric diabetes clinic in Memphis, TN, to increase both the use of connected insulin pens (CIPs) and shared decision-making around diabetes technology aided by patient information and self-reflection handouts.
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Affiliation(s)
- Blake V. Adams
- Pediatric Endocrinology and Diabetes, Le Bonheur Children’s Hospital, Memphis, TN
| | - Anna T. Heston
- Pediatric Endocrinology and Diabetes, Le Bonheur Children’s Hospital, Memphis, TN
| | - Diveena Davis
- Department of Public Health, University of Tennessee Health Science Center, Memphis, TN
| | - Grace B. Nelson
- Pediatric Endocrinology and Diabetes, Le Bonheur Children’s Hospital, Memphis, TN
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN
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5
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Friedman JG, Silberman P, Herrmann S, Aleppo G. Strategies to Increase the Use of Connected Insulin Pens Through Shared Decision-Making: A Quality Improvement Success Story. Clin Diabetes 2024; 42:474-478. [PMID: 39429461 PMCID: PMC11486851 DOI: 10.2337/cd24-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article is part of a special article collection from the T1D Exchange Quality Improvement Collaborative. It describes an initiative to reduce inequities in diabetes technology access and use and increase the use of connected insulin pens at an academic endocrinology practice in Chicago, IL.
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Affiliation(s)
- Jared G. Friedman
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Endocrinology Practice, Northwestern Medical Group, Northwestern Medicine, Chicago, IL
| | - Philip Silberman
- Department of Information Technology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Stefanie Herrmann
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Endocrinology Practice, Northwestern Medical Group, Northwestern Medicine, Chicago, IL
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6
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Friedman JG, Odugbesan O, Ebekozien O, Aleppo G. Increasing Access to Connected Insulin Pens by Promoting Shared Decision-Making Through Collaborative Quality Improvement. Clin Diabetes 2024; 42:470-473. [PMID: 39429452 PMCID: PMC11486859 DOI: 10.2337/cd24-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Affiliation(s)
- Jared G. Friedman
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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7
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Wu V, Choleva L, Wilkes M. Optimizing Glycemic Outcomes for Children with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:27-38. [PMID: 38272596 DOI: 10.1016/j.ecl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Changes in physical growth, neurocognitive development, and pubertal maturation are some of the challenges to achieving blood glucose targets in children with type 1 diabetes mellitus. To optimize glycemic outcomes, a comprehensive approach is crucial to address psychosocial needs, expand the use of diabetes technology, and diminish health inequities.
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Affiliation(s)
- Vickie Wu
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA
| | - Lauryn Choleva
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA
| | - Meredith Wilkes
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA.
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8
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Ebekozien O, Mungmode A, Hardison H, Rapaport R. Improving Outcomes for People with Type 1 Diabetes Through Collaboration: Summary of Type 1 Diabetes Exchange Quality Improvement Collaborative Studies. Endocrinol Metab Clin North Am 2024; 53:1-16. [PMID: 38272589 DOI: 10.1016/j.ecl.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes (T1D) management has evolved over the last decade. Innovations and groundbreaking research have paved the way for improved outcomes for people with T1D. One of the major T1D focused research network that has supported real-world research studies in the United States is the T1D Exchange Quality Improvement Collaborative (T1DX-QI) Network.T1DX-QI is a large multicenter network of 55 T1D clinics that uses quality improvement, health equity framework, and population health principles to improve outcomes for people with T1D. This article summarizes insights from T1DX-QI clinical and population health improvement studies.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, USA; University of Mississippi School of Population Health, Jackson, MS, USA.
| | | | | | - Robert Rapaport
- Department of Pediatrics at Icahn School of Medicine; Mount Sinai Kravis Children's Hospital, New York, NY, USA
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9
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Ebekozien O, Fantasia K, Farrokhi F, Sabharwal A, Kerr D. Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all? Diabetes Obes Metab 2024; 26 Suppl 1:3-13. [PMID: 38291977 PMCID: PMC11040507 DOI: 10.1111/dom.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
Digital health technologies are being utilized increasingly in the modern management of diabetes. These include tools such as continuous glucose monitoring systems, connected blood glucose monitoring devices, hybrid closed-loop systems, smart insulin pens, telehealth, and smartphone applications (apps). Although many of these technologies have a solid evidence base, from the perspective of a person living with diabetes, there remain multiple barriers preventing their optimal use, creating a digital divide. In this article, we describe many of the origins of these barriers and offer recommendations on widening access to digital health technologies for underserved populations living with diabetes to improve their health outcomes.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA
- Department of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Kathryn Fantasia
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Farnoosh Farrokhi
- Alta Bates Summit Medical Centre, Sutter East Bay Medical Foundation, Oakland, California, USA
| | - Ashutosh Sabharwal
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas, USA
| | - David Kerr
- Centre for Health System Research, Sutter Health, Santa Barbara, California, USA
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10
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Zahid M, Dowlatshahi S, Kansara AH, Sadhu AR. The Evolution of Diabetes Technology - Options Towards Personalized Care. Endocr Pract 2023:S1530-891X(23)00387-7. [PMID: 37100350 DOI: 10.1016/j.eprac.2023.04.007] [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: 10/01/2022] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
Advances in diabetes technology, especially in the last few decades, have transformed our ability to deliver care to persons with diabetes (PWD). Developments in glucose monitoring, especially continuous glucose monitoring systems (CGM), have revolutionized diabetes care and empowered our patients to manage their disease. CGM has also played an integral role in advancing automated insulin delivery systems. Currently available and upcoming advanced hybrid-closed loop systems aim to decrease patient involvement and are approaching the functionality of a fully automated artificial pancreas. Other advances, such as smart insulin pens and daily patch pumps, offer more options for patients and require less complicated and costly technology. Evidence to support the role of diabetes technology is growing, and PWD and clinicians must choose the right type of technology with a personalized strategy to manage diabetes effectively. Here, we review currently available diabetes technologies, summarize their individual features and highlight key patient factors to consider when creating a personalized treatment plan. We also address current challenges and barriers to the adoption of diabetes technologies.
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Affiliation(s)
- Maleeha Zahid
- Fellow, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Samaneh Dowlatshahi
- Division of Endocrinology, Diabetes & Metabolism, Assistant Clinical Professor, Weill Cornell Medical College, Assistant Professor of Clinical Medicine, Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, Texas
| | - Abhishek H Kansara
- Division of Endocrinology, Diabetes & Metabolism, Assistant Professor of Clinical Medicine, Weill Cornell Medical College, Assistant Professor of Clinical Medicine, Houston Methodist Academic Institute, Adjunct Assistant Professor, Texas A&M University College of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Archana R Sadhu
- System Director, Diabetes Program at Houston Methodist, Medical Director, Pancreas Transplantation and Transplant Endocrinology, Houston Methodist J.C. Walter Jr. Transplant Center, Assistant Clinical Professor, Weill Cornell Medical College, Adjunct Assistant Professor, Texas A&M Health Sciences.
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11
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MacLeod J, Vigersky RA. A Review of Precision Insulin Management With Smart Insulin Pens: Opening Up the Digital Door to People on Insulin Injection Therapy. J Diabetes Sci Technol 2023; 17:283-289. [PMID: 36326233 PMCID: PMC10012386 DOI: 10.1177/19322968221134546] [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: 11/06/2022]
Abstract
Although advances in insulin therapy and delivery have been made, global evidence indicates sub-optimal glycemic management in people on insulin therapy with either type 1 diabetes (T1D) or type 2 diabetes (T2D). In this review, we discuss connected insulin pens that include tracking insulin pens (TIPs) and smart insulin pens (SIPs) and caps, as approaches to improving mean glucose or time in range while minimizing exposure to hypoglycemia or time below range (TBR) in people with diabetes (PwD) on multiple daily injection (MDI) therapy. We discuss various factors offered by SIPs that can facilitate precision insulin management, that is, delivering the right dose at the right time. These factors include the automatic recording of insulin dose size and delivery time; differentiating prime from therapy doses; active insulin tracking; dose calculators that provide individualized dosing recommendations; alerts for missed doses (ie, rapid-acting or long-acting insulin), insulin temperature, and insulin age monitoring; and integrated data reports for the clinical care team. A data-driven approach to care is critical to precision insulin management and includes helping PwD make informed choices regarding their preferred method of insulin delivery and ensuring insulin delivery technology tools are configured for their personal therapy plan. The data-driven approach involves developing a plan for ongoing collaborative use of the resulting data with their care team that may include adjusting insulin regimen and optimizing the care plan on a timely basis. We conclude with a list of practice protocols that are needed to support data-driven precision insulin management. This review includes a summary of research including various stages of connected insulin pens and caps.
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