Effects of Frequency of Sensor-Augmented Pump Use on HbA1c and C-Peptide Levels in the First Year of Type 1 Diabetes

Psychosocial Needs for Newly Diagnosed Youth with Type 1 Diabetes and Their Families

PURPOSE OF REVIEW

To synthesize findings from studies published within the last 5 to 10 years and recruiting families of children with new-onset type 1 diabetes (T1D).

RECENT FINDINGS

Children can establish glycated hemoglobin (HbA1c) trajectories in the new-onset period that may persist for up to a decade. Demographic factors, family conflict, and diabetic ketoacidosis at the time of diagnosis may be risk factors for sub-optimal child HbA1c, while new immune modulating therapies and a treatment approach that combines advanced technologies and remote patient monitoring may improve child HbA1c. Nonetheless, recent trials in the new-onset period have largely overlooked how treatments may impact families' psychosocial functioning and longitudinal observational studies have been limited. The new-onset period of T1D is an important time for research and clinical intervention, though gaps exist specific to families' psychosocial needs. Filling these gaps is essential to inform clinical management and standard of care guidelines and improve outcomes.

Is Continuous Glucose Monitoring Underappreciated in the UK?

Introduction: Information about continuous glucose monitoring (CGM) use in the UK is limited. We conducted an online survey of a representative sample of current CGM users in England, Scotland and Wales to address this deficit. Methods: The 29-item online survey was conducted between 29 December 2016 and 25 January 2017. Persons with type 1 diabetes (T1D) and caregivers of T1D children/adolescents were recruited from mailing lists, using Nielsen and Harris Polling databases. Results: 315 patients and caregivers responded to the survey — 170 adult patients and 145 caregivers. Among respondents, 144 received full funding for CGM use, 72 received partial funding and 83 received no funding. Most reported improvements in glycated haemoglobin (HbA1c) (67.0%), fewer hypoglycaemia episodes (70.2%), improved hypoglycaemia awareness (77.5%) and better diabetes management (92.4%). Self-funders reported significantly higher CGM use (76.1%) than those who were fully funded (58.9%) and/or partially funded (65.9%), p=0.0008. Fewer than 50% of all respondents reported receiving guidance in interpreting CGM data from their diabetes care team; 30.1% of self-funders reported receiving no CGM support from their diabetes team compared with fully funded (2.8%) and partially funded (1.4%) respondents, p<0.0001. Conclusions: Patients with T1D and their caregivers are realising benefits from CGM use but are largely unsupported by the UK healthcare system.

Recommendations for the use of sensor-augmented pumps with predictive low-glucose suspend features in children: The importance of education

Sensor-augmented pumps, which consist of a pump and a continuous glucose monitoring system, offer considerable therapeutic opportunities, despite requiring close attention in the early phase of their use. The aim of this paper is to provide recommendations on the use of a predictive low glucose management (PLGM) system (Minimed 640G™, Medtronic, Northridge, CA, USA) in adolescents with type 1 diabetes either at the start of therapy or during follow-up. Sound clinical recommendations on PLGM are of increasing importance since several recent papers have reported significant clinical improvements in patients with PLGM, especially in adults. These recommendations are based on the experience of a group of pediatric endocrinologists who collaborated to closely and intensively study the on-boarding of adolescent patients with type 1 diabetes on automated systems to gain first-hand experience and peer-to-peer insights in a unique free-living environment. The suggestions provided here are indicative, so can be adapted to the individual realities and experiences of different diabetes centers. However, we believe that close adherence to the proposed scheme is likely to increase the chances of improving the clinical and metabolic outcomes of patients treated with this therapy.

Continuous Glucose Monitoring (CGM) Adherence in Youth With Type 1 Diabetes: Associations With Biomedical and Psychosocial Variables

BACKGROUND

Continuous glucose monitoring (CGM) remains underutilized in youth with type 1 diabetes (T1D). There is a need to investigate factors associated with CGM use.

METHOD

In 61 T1D youth, CGM use was ascertained by downloads reflecting the 4-week periods preceding 3- and 6-month study visits. Demographic and clinical data were obtained from chart review and interview. Youth and parents completed validated psychosocial surveys at baseline and 6 months.

RESULTS

Youth (52% male, 93% Caucasian, 80% pump treated) were 12.7 ± 2.9 years old, with T1D for 6.3 ± 3.8 years; mean A1c was 7.9 ± 0.9%. Mean CGM use was 4.1 ± 2.1 days/week (median = 4.8) at 3 months and 3.4 ± 2.3 days/week (median = 3.9) at 6 months. At 3 and 6 months, 15% and 20% of youth, respectively, had stopped using CGM. At 6 months, youth using CGM 6-7 days/week had more frequent BG monitoring ( P = .05), less insulin omission ( P = .02), and greater probability of A1c < 7.5% ( P = .01) than youth using CGM less often. Youth using CGM 6-7 days/week consistently over the 6 months demonstrated lower A1c at 3 months compared to baseline ( P = .03) and the improvement was sustained at 6 months ( P = .5, 3 vs 6 months); youth using CGM less often had no significant A1c change. Baseline BG monitoring ≥8 times/day or A1c within target (<7.5%) predicted greater CGM use (6-7 days/week) at 6 months (OR = 4.6, P = .02). There was no deterioration of psychosocial functioning with CGM use.

CONCLUSIONS

Consistent and durable CGM use in youth with T1D is associated with treatment adherence and improved glycemic control without increasing psychosocial distress.

Continuous Glucose Monitoring Use in Type 1 Diabetes: Longitudinal Analysis Demonstrates Meaningful Improvements in HbA1c and Reductions in Health Care Utilization

BACKGROUND

Real-time continuous glucose monitoring (rtCGM) improves glycemic control in type 1 diabetes (T1D) patients treated with continuous subcutaneous insulin infusion (CSII). However, the benefits of rtCGM in T1D patients treated with multiple daily insulin injection (MDI) therapy has not been well studied. We explored the effects of rtCGM versus self-monitoring of blood glucose (SMBG) on clinical outcomes within a large T1D population treated with either CSII or MDI therapy.

METHODS

This retrospective, longitudinal analysis utilized datasets from T1D patients enrolled in a commercial health plan to assess changes in HbA1c in 187 naïve to rtCGM users and 6260 SMBG users. Propensity score modeling was used to assess inpatient admissions, emergency room (ER) visits in 1130 patients (565 rtCGM, 565 SMBG). Differences in HbA1c reduction (rtCGM+MDI vs rtCGM+CSII) were evaluated.

RESULTS

Larger, clinically meaningful HbA1c reductions were seen among rtCGM versus SMBG users: -0.5% ( P = .004) versus -0.2% ( P < .0001); 0.3% diff in diff, P = .03. All-cause inpatient admissions were lower for rtCGM users: -42%, P = .013. Emergency room visits coded for diabetic ketoacidosis (DKA) were four times higher for SMBG patients than rtCGM patients: 17 versus 4, P = .0318. HbA1c reductions were most notable with rtCGM+MDI versus rtCGM+CSII treatment: -0.6% ( P = .01) versus -0.3% ( P = .16).

CONCLUSIONS

Use of rtCGM in T1D patients facilitates greater HbA1c improvements and reduced health care system utilization compared with traditional SMBG use regardless of insulin administration method. Treatment with rtCGM in conjunction with MDI confers similar or greater glycemic benefits without the additional costs associated with CSII therapy.