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Trolle C, Christensen M, Hansen KW. An estimate of the need for continuous glucose monitoring in type 2 diabetes with intensive insulin treatment in secondary healthcare. Diabet Med 2024; 41:e15298. [PMID: 38308405 DOI: 10.1111/dme.15298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
AIM To estimate the proportion of persons with type 2 diabetes (T2DM) receiving intensive insulin treatment in the secondary healthcare who could be candidates for continuous glucose monitoring (CGM), based on different HbA1c criteria. For comparison, the results are also presented as proportion of persons with type 1 diabetes (T1DM) in the same region. PATIENTS AND METHODS In the Central Denmark Region, we identified all persons with T1DM (n = 6179) and T2DM (n = 4315) who had a minimum of one contact to a diabetes outpatient clinic from September 2021 to September 2022. Insulin regimen and HbA1c measured after a minimum of 2 months with a stable insulin regimen were retrieved from the healthcare administrative electronic platform used in the region. RESULTS The numbers of persons with T1DM and T2DM with HbA1c meeting the criteria were 5145 and 3090, respectively. The fraction of T2DM with basal-bolus insulin was 35.3%, and the fraction with basal-bolus insulin and HbA1c >53 (7%) mmol/mol or >58 (7.5%) mmol/mol was 20.5% and 16.6%, respectively. These proportions correspond to 19.4%, 14.4% and 11.7% of the persons with T1DM in the same geographical area. CONCLUSION The proportion of persons with T2DM in secondary healthcare undergoing intensive insulin treatment who could be candidates for CGM corresponded to only a minor fraction of persons with T1DM in the same region, irrespective of any HbA1c criteria applied.
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Affiliation(s)
- Christian Trolle
- Diagnostic Centre, University Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Mia Christensen
- Diagnostic Centre, University Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klavs Würgler Hansen
- Diagnostic Centre, University Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
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2
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Agarwal S, Galindo RJ, Shah AV, Abreu M. Diabetes Technology in People with Type 2 Diabetes: Novel Indications. Curr Diab Rep 2024; 24:85-95. [PMID: 38421505 DOI: 10.1007/s11892-024-01536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW Diabetes technology has been continuously evolving. Current versions of continuous glucose monitors (CGM) use minimally invasive designs, monitor glucose values with high accuracy, and can be used to guide insulin dosing. Extensive evidence supports the use of diabetes technology for monitoring and insulin administration in people with type 1 diabetes. However, there is emerging evidence for people with type 2 diabetes. In this review, we present the different technological devices used to monitor glucose and deliver insulin and the evidence supporting their use in people with type 2 diabetes. RECENT FINDINGS The use of CGMs in people with type 2 diabetes treated with insulin or non-insulin therapies has been associated with improvements in glycemic control and time spent in hypoglycemia. Smart insulin pens and smart connected devices are options to track compliance and guide insulin delivery in people who do not require insulin pump therapy. Mechanical patch pumps can be used to reduce the burden of multiple daily insulin injections. Automated insulin delivery algorithms improve glycemic control without an increase in hypoglycemia. The use of technology in the management of type 2 diabetes generates glycemic data previously inaccessible, reduces barriers for insulin initiation, improves glycemic control, tracks adherence to therapy, and improves user satisfaction.
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Affiliation(s)
- Shubham Agarwal
- The University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Rodolfo J Galindo
- University of Miami Miller School of Medicine, 1450 NW 10th Ave, Miami, FL, 33136, USA
| | - Amy V Shah
- The University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Marconi Abreu
- The University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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3
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Jancev M, Vissers TACM, Visseren FLJ, van Bon AC, Serné EH, DeVries JH, de Valk HW, van Sloten TT. Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis. Diabetologia 2024; 67:798-810. [PMID: 38363342 PMCID: PMC10954850 DOI: 10.1007/s00125-024-06107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
AIMS/HYPOTHESIS Continuous glucose monitoring (CGM) is increasingly used in the treatment of type 2 diabetes, but the effects on glycaemic control are unclear. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the effect of CGM on glycaemic control in adults with type 2 diabetes. METHODS We performed a systematic review using Embase, MEDLINE, Web of Science, Scopus and ClinicalTrials.gov from inception until 2 May 2023. We included RCTs investigating real-time CGM (rtCGM) or intermittently scanned CGM (isCGM) compared with self-monitoring of blood glucose (SMBG) in adults with type 2 diabetes. Studies with an intervention duration <6 weeks or investigating professional CGM, a combination of CGM and additional glucose-lowering treatment strategies or GlucoWatch were not eligible. Change in HbA1c and the CGM metrics time in range (TIR), time below range (TBR), time above range (TAR) and glycaemic variability were extracted. We evaluated the risk of bias using the Cochrane risk-of-bias tool version 2. Data were synthesised by performing a meta-analysis. We also explored the effects of CGM on severe hypoglycaemia and micro- and macrovascular complications. RESULTS We found 12 RCTs comprising 1248 participants, with eight investigating rtCGM and four isCGM. Compared with SMBG, CGM use (rtCGM or isCGM) led to a mean difference (MD) in HbA1c of -3.43 mmol/mol (-0.31%; 95% CI -4.75, -2.11, p<0.00001, I2=15%; moderate certainty). This effect was comparable in studies that included individuals using insulin with or without oral agents (MD -3.27 mmol/mol [-0.30%]; 95% CI -6.22, -0.31, p=0.03, I2=55%), and individuals using oral agents only (MD -3.22 mmol/mol [-0.29%]; 95% CI -5.39, -1.05, p=0.004, I2=0%). Use of rtCGM showed a trend towards a larger effect (MD -3.95 mmol/mol [-0.36%]; 95% CI -5.46 to -2.44, p<0.00001, I2=0%) than use of isCGM (MD -1.79 mmol/mol [-0.16%]; 95% CI -5.28, 1.69, p=0.31, I2=64%). CGM was also associated with an increase in TIR (+6.36%; 95% CI +2.48, +10.24, p=0.001, I2=9%) and a decrease in TBR (-0.66%; 95% CI -1.21, -0.12, p=0.02, I2=45%), TAR (-5.86%; 95% CI -10.88, -0.84, p=0.02, I2=37%) and glycaemic variability (-1.47%; 95% CI -2.94, -0.01, p=0.05, I2=0%). Three studies reported one or more events of severe hypoglycaemia and macrovascular complications. In comparison with SMBG, CGM use led to a non-statistically significant difference in the incidence of severe hypoglycaemia (RR 0.66, 95% CI 0.15, 3.00, p=0.57, I2=0%) and macrovascular complications (RR 1.54, 95% CI 0.42, 5.72, p=0.52, I2=29%). No trials reported data on microvascular complications. CONCLUSIONS/INTERPRETATION CGM use compared with SMBG is associated with improvements in glycaemic control in adults with type 2 diabetes. However, all studies were open label. In addition, outcome data on incident severe hypoglycaemia and incident microvascular and macrovascular complications were scarce. REGISTRATION This systematic review was registered on PROSPERO (ID CRD42023418005).
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Affiliation(s)
- Milena Jancev
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tessa A C M Vissers
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arianne C van Bon
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Erik H Serné
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - J Hans DeVries
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Harold W de Valk
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands.
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4
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Hirsch BR. Transforming diabetes care with continuous glucose monitoring: Rationale for expanded eligibility criteria. J Am Assoc Nurse Pract 2024:01741002-990000000-00217. [PMID: 38669198 DOI: 10.1097/jxx.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/13/2023] [Indexed: 04/28/2024]
Abstract
ABSTRACT Randomized trials and large retrospective database studies have shown that individuals treated with noninsulin therapies experience the same glycemic benefits from continuous glucose monitoring (CGM) use as those treated with more intensive treatment regimens. However, many policy makers and payers are reluctant to provide CGM coverage for these patients. Although the recent American Diabetes Association guidelines have taken an important first step in recommending that CGM should be offered to all adults treated with basal insulin who are capable of using it, clinicians should consider the acute and long-term consequences of persistent hyperglycemia in all of their patients with diabetes. This article describes how the use of the FreeStyle Libre 2 CGM System (Abbott Diabetes Care, Alameda, CA) improved glycemic outcomes and facilitates personalized diabetes care in two type 2 diabetes patients treated with noninsulin therapies.
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Affiliation(s)
- Barbara R Hirsch
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, New Hyde Park, New York
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Rama Chandran S, Rahman N, Gandhi M, Tan NC, Phoon IKY, Seah DEJ, Cheah MH, Sek K, Gardner DSL. Intermittently scanned continuous glucose monitoring provides no benefit over structured self-monitoring of blood glucose in type 2 diabetes not on prandial insulin, in the context of diabetes self-management education: GLucose monitoring programme SingaporE (GLiMPSE). Diabetes Res Clin Pract 2024; 211:111678. [PMID: 38642860 DOI: 10.1016/j.diabres.2024.111678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE We evaluated the impact of intermittently scanned continuous glucose monitoring(is-CGM)over self-monitoring of blood glucose(SMBG) in the context of diabetes self-management education (DSME) in sub-optimally controlled type 2 diabetes(T2D) in a multi-ethnicsetting. RESEARCH DESIGN AND METHOD Randomized-controlled, open-label trial (NCT04564911), of T2D with HbA1c ≥ 7.5-≤10 %, on oral agents with/without basal insulin was carried out. Intervention arm received 6 weeks(w) continuous is-CGM, followed by one is-CGM/month till 24w. Control arm was advised to perform 4 SMBG/day. Educationwas delivered at weeks 0, 2, 8, 16. PRIMARY OUTCOME Change in HbA1c from baseline at 24w. Modified intention-to-treat (mITT) analysis with linear mixed-effect model for repeated measurementswas performed. RESULTS 176 subjects, age 55 ± 10.7 years(y), DM duration 11 ± 7.3y, BMI 27.8 ± 5.9 kg/m2, 58 % Male, 29.5 % basal insulin users were analysed. Within each arm,from baseline to 24w, mean HbA1c decreasedby -0.6 % (-6.6.mmol/mol, p-value < 0.01)and weight decreased(isCGM: -1.44 kg; SMBG: -1.25 kg, both p < 0.01). These changes were sustained to one year. However, there wasno significant difference in these parameters between arms (p-value > 0.05). CONCLUSION In the context of DSME, use of either SMBG or is-CGM led to improved glycaemia and reduced weight over a period of 24 weeks, sustained to one year.
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Affiliation(s)
- Suresh Rama Chandran
- Department of Endocrinology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Nabilah Rahman
- Singapore Clinical Research Institute, Biostatistics, Singapore; National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
| | - Mihir Gandhi
- Duke-NUS Medical School, Singapore; Singapore Clinical Research Institute, Biostatistics, Singapore
| | | | | | | | | | - Kathleen Sek
- Department of Endocrinology, National University Health System, Singapore
| | - Daphne Su-Lyn Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
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6
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Ajjan RA, Battelino T, Cos X, Del Prato S, Philips JC, Meyer L, Seufert J, Seidu S. Continuous glucose monitoring for the routine care of type 2 diabetes mellitus. Nat Rev Endocrinol 2024:10.1038/s41574-024-00973-1. [PMID: 38589493 DOI: 10.1038/s41574-024-00973-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/10/2024]
Abstract
Although continuous glucose monitoring (CGM) devices are now considered the standard of care for people with type 1 diabetes mellitus, the uptake among people with type 2 diabetes mellitus (T2DM) has been slower and is focused on those receiving intensive insulin therapy. However, increasing evidence now supports the inclusion of CGM in the routine care of people with T2DM who are on basal insulin-only regimens or are managed with other medications. Expanding CGM to these groups could minimize hypoglycaemia while allowing efficient adaptation and escalation of therapies. Increasing evidence from randomized controlled trials and observational studies indicates that CGM is of clinical value in people with T2DM on non-intensive treatment regimens. If further studies confirm this finding, CGM could soon become a part of routine care for T2DM. In this Perspective we explore the potential benefits of widening the application of CGM in T2DM, along with the challenges that must be overcome for the evidence-based benefits of this technology to be delivered for all people with T2DM.
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Affiliation(s)
- Ramzi A Ajjan
- The LIGHT Laboratories, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana Medical Centre, Ljubljana, Slovenia
| | - Xavier Cos
- DAP Cat Research Group, Foundation University Institute for Primary Health Care Research Jordi Gol i Gorina, Barcelona, Spain
| | - Stefano Del Prato
- Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Laurent Meyer
- Department of Endocrinology, Diabetes and Nutrition, University Hospital, Strasbourg, France
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
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Ferreira ROM, Trevisan T, Pasqualotto E, Chavez MP, Marques BF, Lamounier RN, van de Sande-Lee S. Continuous Glucose Monitoring Systems in Noninsulin-Treated People with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Technol Ther 2024; 26:252-262. [PMID: 38090767 DOI: 10.1089/dia.2023.0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Introduction: Continuous glucose monitoring (CGM) has shown favorable outcomes in patients with type 2 diabetes (T2D) who are on insulin therapy. However, the efficacy of CGM in managing glucose levels in noninsulin-treated people with T2D remains controversial. Methods: PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing CGM to self-monitoring of blood glucose (SMBG) in people with T2D not using insulin. We computed weighted mean differences (WMDs) and standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Statistical analyses were performed using R version 4.2.3. Results: We included six RCTs comprising 407 noninsulin-treated people with T2D of whom 228 were randomized to CGM. Diabetes duration ranged from 5.4 to 13.9 years. The mean age was 57.9 years and the mean body mass index was 30.8 kg/m2. Four trials used real-time CGM (rt-CGM) and two intermittent scanning CGM (is-CGM). Compared with SMBG, CGM significantly reduced the glycated hemoglobin level (WMD -0.31%; 95% CI -0.42 to -0.21; I2 = 0%), glucose level (WMD -11.16 mg/dL; 95% CI -19.94 to -2.39; I2 = 0%), time in hypoglycemia level 2 (WMD -0.28%; 95% CI -0.52 to -0.03; I2 = 91%), glucose time >180 mg/dL (WMD -7.75%; 95% CI -12.04 to -3.45; I2 = 0%), and the standard deviation of glucose variation (WMD -4.00 mg/dL; 95% CI -6.86 to -1.14; I2 = 0%). CGM also increased time in range (WMD 8.63%; 95% CI 4.54-12.71; I2 = 0%) and treatment satisfaction (SMD 0.79; 95% CI 0.54-1.05; I2 = 0%). Conclusion: In this meta-analysis, rt-CGM and is-CGM were associated with improvement in glycemic control in people with T2D not using insulin when compared to SMBG.
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Affiliation(s)
| | - Talita Trevisan
- Private Practice, Talita Trevisan Endocrinologia, Itajaí, Brazil
| | - Eric Pasqualotto
- Federal University of Santa Catarina, Department of Internal Medicine, Florianopolis, Brazil
| | - Matheus Pedrotti Chavez
- Federal University of Santa Catarina, Department of Internal Medicine, Florianopolis, Brazil
| | | | | | - Simone van de Sande-Lee
- Federal University of Santa Catarina, Department of Internal Medicine, Florianopolis, Brazil
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8
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Uhl S, Choure A, Rouse B, Loblack A, Reaven P. Effectiveness of Continuous Glucose Monitoring on Metrics of Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Clin Endocrinol Metab 2024; 109:1119-1131. [PMID: 37987208 DOI: 10.1210/clinem/dgad652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE To provide a systematic review and meta-analysis synthesizing the findings of randomized controlled trials (RCTs) of continuous glucose monitors (CGMs) in the management of adults with type 2 diabetes mellitus (T2DM) on glucose control and clinical outcomes. METHODS MEDLINE, Embase, and Cochrane were searched for RCTs that assessed the effectiveness of real-time CGM (rt-CGM) or flash CGM (FGM) in adults (≥18 years) with T2DM that reported on at least 1 of the following outcomes: hemoglobin A1c (HbA1c), time in range, time in hyperglycemia, or time in hypoglycemia. The GRADE approach was used to assess certainty of evidence for primary outcomes. RESULTS Fourteen RCTs assessing CGM were included, with 825 patients in 9 RCTs using rt-CGM and 822 in 5 RCTs using FGM. Moderate certainty of evidence indicated that use of CGM had a modest but statistically significant reduction in HbA1c levels of about 0.32%. Our analyses of each device type separately showed similar reductions in HbA1c (0.34% and 0.33%, respectively, for rt-CGM and FGM), with trends for improvement in other glucose metrics favoring rt-CGM over self-monitored blood glucose. CONCLUSION Both rt-CGM and flash CGM led to modest but statistically significant declines in HbA1c among individuals with T2DM, with little heterogeneity in the results. However, the duration of the included RCTs was relatively short and few studies reported on important clinical outcomes, such as adverse events, emergency department use, or hospitalization. Longer term studies are needed to determine if the short-term improvements in glucose control leads to improvements in clinically important outcomes.
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Affiliation(s)
| | - Anuja Choure
- University of Arizona College of Medicine, Tucson, AZ 85724, USA
- Phoenix VA Healthcare System, Phoenix, AZ 85012, USA
| | | | | | - Peter Reaven
- Phoenix VA Healthcare System, Phoenix, AZ 85012, USA
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9
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Kong SY, Cho MK. Effects of Continuous Glucose Monitoring on Glycemic Control in Type 2 Diabetes: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:571. [PMID: 38470682 PMCID: PMC10931178 DOI: 10.3390/healthcare12050571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
As the prevalence of diabetes is rapidly increasing, the use of continuous glucose monitoring, which is effective in improving glycemic control in type 2 diabetes, is increasing. METHODS Systematic review was performed according to PRISMA criteria. The search was conducted for articles published until 31 May 2023 in PubMed, CINAHL, Cochrane Library, EMBASE, ClinicalKey, etc. The meta-analysis involved the synthesis of effect size; tests of homogeneity and heterogeneity; trim and fill plot; Egger's regression test; and Begg's test for assessing publication bias. RESULTS 491 studies were searched, of which 17 studies that met the selection criteria were analyzed. The overall effect on HbA1c was -0.37 (95% CI, -0.63~-0.11, p < 0.001), with HbA1c decreasing significantly after CGM interventions. Sub-analyses showed that the study was statistically significant in those aged 60 years or older, when rt-CGM was used and when the study was performed in multiple centers. CONCLUSION The results of this study showed that intervention using CGM was effective in reducing HbA1c in type 2 diabetes. The factors identified in this study can be used as guidelines for developing future CGM intervention programs.
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Affiliation(s)
- Seung-Yeon Kong
- Referral Center, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea;
| | - Mi-Kyoung Cho
- Department of Nursing Science, Chungbuk National University, Cheongju 28644, Republic of Korea
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Conti M, Massari G, Meneghini E, Pasquino B, Agosti B, Chinotti F, Pintaudi B, Girelli A, Bertuzzi F. Effectiveness and Safety of the Intermittently Scanned Continuous Glucose Monitoring System FreeStyle Libre 2 in Patients with Type 2 Diabetes Treated with Basal Insulin or Oral Antidiabetic Drugs: An Observational, Retrospective Real-World Study. J Clin Med 2024; 13:642. [PMID: 38337336 PMCID: PMC10856078 DOI: 10.3390/jcm13030642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Intermittently Scanned Continuous Glucose Monitoring (isCGM) devices are increasingly being used in patients with type 2 diabetes mellitus (T2DM) on insulin therapy for their benefits regarding disease management. Evidence of isCGM use in patients with T2DM on basal or non-insulin therapy is lacking. This study aimed at assessing the efficacy and safety of isCGM in this population. This was an observational, retrospective, real-world study enrolling patients with T2DM who were starting the use of isCGM. Data from medical records (i.e., demographics, clinical characteristics, laboratory assessments, and isCGM metrics) were collected over three time periods (baseline, 3 and 6 months). The endpoints were glycated haemoglobin (HbA1c) changes and changes in isCGM metrics as defined by the International Consensus from baseline to 3 months and 6 months. Overall, 132 patients were included (69.5% male; mean age 68.2 ± 11.0 years; mean disease duration 19.0 ± 9.4 years; 79.7% on basal insulin ±non-insulin therapy; mean baseline HbA1c 8.1% ± 1.3%). The estimated mean change in HbA1c was statistically significant at three (-0.4 ± 1.0%; p = 0.003) and six months (-0.6 ± 1.3%; p < 0.0001). In conclusion, isCGM proved to be effective and safe in improving glycaemic control in patients with T2DM on basal insulin or non-insulin therapy.
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Affiliation(s)
- Matteo Conti
- Diabetes Unit, Niguarda Cà Granda Hospital, 20162 Milan, Italy; (M.C.); (E.M.); (B.P.)
- Department of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy
| | - Giulia Massari
- Diabetes Unit, Spedali Civili di Brescia, 25123 Brescia, Italy; (G.M.); (B.P.); (B.A.); (A.G.)
| | - Elena Meneghini
- Diabetes Unit, Niguarda Cà Granda Hospital, 20162 Milan, Italy; (M.C.); (E.M.); (B.P.)
| | - Bernadetta Pasquino
- Diabetes Unit, Spedali Civili di Brescia, 25123 Brescia, Italy; (G.M.); (B.P.); (B.A.); (A.G.)
| | - Barbara Agosti
- Diabetes Unit, Spedali Civili di Brescia, 25123 Brescia, Italy; (G.M.); (B.P.); (B.A.); (A.G.)
| | | | - Basilio Pintaudi
- Diabetes Unit, Niguarda Cà Granda Hospital, 20162 Milan, Italy; (M.C.); (E.M.); (B.P.)
| | - Angela Girelli
- Diabetes Unit, Spedali Civili di Brescia, 25123 Brescia, Italy; (G.M.); (B.P.); (B.A.); (A.G.)
| | - Federico Bertuzzi
- Diabetes Unit, Niguarda Cà Granda Hospital, 20162 Milan, Italy; (M.C.); (E.M.); (B.P.)
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11
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Lu J, Ying Z, Wang P, Fu M, Han C, Zhang M. Effects of continuous glucose monitoring on glycaemic control in type 2 diabetes: A systematic review and network meta-analysis of randomized controlled trials. Diabetes Obes Metab 2024; 26:362-372. [PMID: 37828805 DOI: 10.1111/dom.15328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
AIMS The aim of this study was to assess the efficacy of continuous glucose monitoring (CGM) versus self-monitoring of blood glucose (SMBG) in maintaining glycaemic control among people with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS The protocol was registered in PROSPERO (CRD42023387583). PubMed, Web of Science, EMBASE and OVID databases were searched from 1 January 2000 until 31 December 2022 for randomized controlled trials comparing CGM with SMBG in glycaemic control among the outpatients with T2DM. The primary endpoint was glycated haemoglobin, while the secondary endpoints included time in range, time below range and time above range. Both traditional and network meta-analyses were conducted to explore the efficacy of CGM on glycaemic control in T2DM. RESULTS Eleven high-quality studies, involving 1425 individuals with T2DM, were identified. Traditional meta-analysis revealed that CGM exhibited a significantly decreased [mean difference (MD): -0.31, 95% confidence interval (CI) (-0.45, -0.18)], time above range [MD: -9.06%, 95% CI (-16.00, -2.11)], time below range [MD: -0.30%, 95% CI (-0.49, -0.12)] and a significantly increased time in range [MD: 8.49%, 95% CI (3.96, 13.02)] compared with SMBG. The network meta-analysis showed that real-time CGM can improve the glycaemic control of patients with T2DM to the most extent. CONCLUSIONS CGM could provide T2DM with greater benefits in glycaemic management compared with SMBG, particularly in patients using real-time CGM. These findings provide an updated perspective on previous research and offer guidance for CGM use in T2DM.
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Affiliation(s)
- Jiaping Lu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Zhen Ying
- Ministry of Education Key Laboratory of Metabolism and Molecular Medicine, Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Wang
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Minjie Fu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chenyu Han
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Min Zhang
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
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12
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S126-S144. [PMID: 38078575 PMCID: PMC10725813 DOI: 10.2337/dc24-s007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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13
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Ehrhardt N, Cedeno B, Montour L, Sinclair K, Ferguson G, Berberian P, Comstock B, Wright L. Effectiveness of a culturally tailored diabetes education curriculum with real-time continuous glucose monitoring in a Latinx population with type 2 diabetes: the CUT-DM with CGM for Latinx randomised controlled trial study protocol. BMJ Open 2023; 13:e082005. [PMID: 38154895 PMCID: PMC10759074 DOI: 10.1136/bmjopen-2023-082005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/29/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes (T2D) is increasing in the Latinx community. Despite telehealth and technology becoming more available, these resources are not reaching the Latinx population. Diabetes education is a cornerstone of treatment; however, access to culturally tailored content is a barrier to the Latinx population. Real-time continuous glucose monitoring (RT-CGM) is a patient-empowering tool that can improve glycaemic control, but it is not readily available for Latinx patients with T2D. We aim to evaluate a culturally tailored diabetes self-management education and support (DSMES) curriculum, using a team-based approach to improve glycaemic control, promote healthy behaviours and enhance patient access with the use of telehealth in Latinx individuals. The primary aim of the study is to evaluate the additive effectiveness of RT-CGM on glycaemia and behavioural changes among Latinx patients undergoing a culturally tailored DSMES. A sub aim of the study is to evaluate family members' change in behaviours. METHODS We propose a randomised controlled trial of blinded versus RT-CGM with 100 Latinx participants with T2D who will receive DSMES via telemedicine over 12 weeks (n=50 per group). The study will be conducted at a single large federally qualified health centre system. The control group will receive culturally tailored DSMES and blinded CGM. The intervention group will receive DSMES and RT-CGM. The DSMES is conducted by community health educators weekly over 12 weeks in Spanish or English, based on participant's language preference. Patients in the RT-CGM group will have cyclical use with a goal of 50 days wear time. The primary outcomes are changes in haemoglobin A1c and CGM-derived metrics at 3 and 6 months. The secondary outcomes include participants' self-management knowledge and behaviour and household members' change in lifestyle. ETHICS AND DISSEMINATION The study proposal was approved by the University of Washington ethics/institutional review board (IRB) Committee as minimal risk (IRB ID: STUDY00014396) and the Sea Mar IRB committee. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT05394844.
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Affiliation(s)
| | - Brian Cedeno
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Laura Montour
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Ka'imi Sinclair
- Washington State University - Spokane, Seattle, Washington, USA
| | - Gary Ferguson
- Washington State University, Pullman, Washington, USA
| | | | - Bryan Comstock
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Lorena Wright
- Medicine, University of Washington, Seattle, Washington, USA
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14
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Ruissen MM, Torres-Peña JD, Uitbeijerse BS, Arenas de Larriva AP, Huisman SD, Namli T, Salzsieder E, Vogt L, Ploessnig M, van der Putte B, Merle A, Serra G, Rodríguez G, de Graaf AA, de Koning EJP, Delgado-Lista J, Sont JK. Clinical impact of an integrated e-health system for diabetes self-management support and shared decision making (POWER2DM): a randomised controlled trial. Diabetologia 2023; 66:2213-2225. [PMID: 37775611 PMCID: PMC10627940 DOI: 10.1007/s00125-023-06006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/21/2023] [Indexed: 10/01/2023]
Abstract
AIMS/HYPOTHESIS There is a lack of e-health systems that integrate the complex variety of aspects relevant for diabetes self-management. We developed and field-tested an e-health system (POWER2DM) that integrates medical, psychological and behavioural aspects and connected wearables to support patients and healthcare professionals in shared decision making and diabetes self-management. METHODS Participants with type 1 or type 2 diabetes (aged >18 years) from hospital outpatient diabetes clinics in the Netherlands and Spain were randomised using randomisation software to POWER2DM or usual care for 37 weeks. This RCT assessed the change in HbA1c between the POWER2DM and usual care groups at the end of the study (37 weeks) as a primary outcome measure. Participants and clinicians were not blinded to the intervention. Changes in quality of life (QoL) (WHO-5 Well-Being Index [WHO-5]), diabetes self-management (Diabetes Self-Management Questionnaire - Revised [DSMQ-R]), glycaemic profiles from continuous glucose monitoring devices, awareness of hypoglycaemia (Clarke hypoglycaemia unawareness instrument), incidence of hypoglycaemic episodes and technology acceptance were secondary outcome measures. Additionally, sub-analyses were performed for participants with type 1 and type 2 diabetes separately. RESULTS A total of 226 participants participated in the trial (108 with type 1 diabetes; 118 with type 2 diabetes). In the POWER2DM group (n=111), HbA1c decreased from 60.6±14.7 mmol/mol (7.7±1.3%) to 56.7±12.1 mmol/mol (7.3±1.1%) (means ± SD, p<0.001), compared with no change in the usual care group (n=115) (baseline: 61.7±13.7 mmol/mol, 7.8±1.3%; end of study: 61.0±12.4 mmol/mol, 7.7±1.1%; p=0.19) (between-group difference 0.24%, p=0.008). In the sub-analyses in the POWER2DM group, HbA1c in participants with type 2 diabetes decreased from 62.3±17.3 mmol/mol (7.9±1.6%) to 54.3±11.1 mmol/mol (7.1±1.0%) (p<0.001) compared with no change in HbA1c in participants with type 1 diabetes (baseline: 58.8±11.2 mmol/mol [7.5±1.0%]; end of study: 59.2±12.7 mmol/mol [7.6±1.2%]; p=0.84). There was an increase in the time during which interstitial glucose levels were between 3.0 and 3.9 mmol/l in the POWER2DM group, but no increase in clinically relevant hypoglycaemia (interstitial glucose level below 3.0 mmol/l). QoL improved in participants with type 1 diabetes in the POWER2DM group compared with the usual care group (baseline: 15.7±3.8; end of study: 16.3±3.5; p=0.047 for between-group difference). Diabetes self-management improved in both participants with type 1 diabetes (from 7.3±1.2 to 7.7±1.2; p=0.002) and those with type 2 diabetes (from 6.5±1.3 to 6.7±1.3; p=0.003) within the POWER2DM group. The POWER2DM integrated e-health support was well accepted in daily life and no important adverse (or unexpected) effects or side effects were observed. CONCLUSIONS/INTERPRETATION POWER2DM improves HbA1c levels compared with usual care in those with type 2 diabetes, improves QoL in those with type 1 diabetes, improves diabetes self-management in those with type 1 and type 2 diabetes, and is well accepted in daily life. TRIAL REGISTRATION ClinicalTrials.gov NCT03588104. FUNDING This study was funded by the European Union's Horizon 2020 Research and Innovation Programme (grant agreement number 689444).
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Affiliation(s)
- Merel M Ruissen
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Medical Decision Making Section, Leiden University Medical Center, Leiden, the Netherlands
| | - José D Torres-Peña
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofía University Hospital, Córdoba, Spain
- Department of Medical and Surgical Sciences, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Bas S Uitbeijerse
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Antonio P Arenas de Larriva
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofía University Hospital, Córdoba, Spain
- Department of Medical and Surgical Sciences, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Sasja D Huisman
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Tuncay Namli
- SRDC Software Research & Development and Consultancy Corp., Ankara, Turkey
| | | | - Lutz Vogt
- Diabetes Service Center GmbH, Karlsburg, Germany
| | | | | | | | | | | | - Albert A de Graaf
- Netherlands Organization for Applied Scientific Research (TNO), Utrecht, the Netherlands
| | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands.
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofía University Hospital, Córdoba, Spain
- Department of Medical and Surgical Sciences, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Medical Decision Making Section, Leiden University Medical Center, Leiden, the Netherlands
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15
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Zahedani AD, McLaughlin T, Veluvali A, Aghaeepour N, Hosseinian A, Agarwal S, Ruan J, Tripathi S, Woodward M, Hashemi N, Snyder M. Digital health application integrating wearable data and behavioral patterns improves metabolic health. NPJ Digit Med 2023; 6:216. [PMID: 38001287 PMCID: PMC10673832 DOI: 10.1038/s41746-023-00956-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
The effectiveness of lifestyle interventions in reducing caloric intake and increasing physical activity for preventing Type 2 Diabetes (T2D) has been previously demonstrated. The use of modern technologies can potentially further improve the success of these interventions, promote metabolic health, and prevent T2D at scale. To test this concept, we built a remote program that uses continuous glucose monitoring (CGM) and wearables to make lifestyle recommendations that improve health. We enrolled 2,217 participants with varying degrees of glucose levels (normal range, and prediabetes and T2D ranges), using continuous glucose monitoring (CGM) over 28 days to capture glucose patterns. Participants logged food intake, physical activity, and body weight via a smartphone app that integrated wearables data and provided daily insights, including overlaying glucose patterns with activity and food intake, macronutrient breakdown, glycemic index (GI), glycemic load (GL), and activity measures. The app furthermore provided personalized recommendations based on users' preferences, goals, and observed glycemic patterns. Users could interact with the app for an additional 2 months without CGM. Here we report significant improvements in hyperglycemia, glucose variability, and hypoglycemia, particularly in those who were not diabetic at baseline. Body weight decreased in all groups, especially those who were overweight or obese. Healthy eating habits improved significantly, with reduced daily caloric intake and carbohydrate-to-calorie ratio and increased intake of protein, fiber, and healthy fats relative to calories. These findings suggest that lifestyle recommendations, in addition to behavior logging and CGM data integration within a mobile app, can enhance the metabolic health of both nondiabetic and T2D individuals, leading to healthier lifestyle choices. This technology can be a valuable tool for T2D prevention and treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Michael Snyder
- January AI, Menlo Park, CA, USA.
- Stanford University, Stanford, CA, USA.
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16
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Soriano EC, Polonsky WH. The Influence of Real-Time Continuous Glucose Monitoring on Psychosocial Outcomes in Insulin-Using Type 2 Diabetes. J Diabetes Sci Technol 2023; 17:1614-1622. [PMID: 35533137 PMCID: PMC10658676 DOI: 10.1177/19322968221094831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To examine the impact of real-time continuous glucose monitoring (rtCGM) on psychosocial outcomes in adults with insulin-using type 2 diabetes (T2D). METHODS A total of 174 insulin-using adults with T2D completed questionnaires assessing diabetes distress, hypoglycemic confidence, hypoglycemic fear, device-related emotional burden, and device-related trust before and after a six-month trial of rtCGM. Hemoglobin A1c (HbA1c) was assessed at the same time points; impaired hypoglycemic awareness (IAH) was assessed at baseline. Change in psychosocial outcomes was examined with t tests, then modeled as a function of baseline HbA1c and IAH and simultaneous change in HbA1c in multiple regression analyses. RESULTS Respondents were predominantly male (57.5%) and non-Hispanic white (67.8%). Significant improvement over the trial was observed in hypoglycemic fear (P = .031), hypoglycemic confidence (P < .001), diabetes distress (P < .001), and device-related emotional burden (P < .001). Impaired hypoglycemic awareness at baseline predicted greater improvement in hypoglycemic fear (P = .002), hypoglycemic confidence (P = .003), diabetes distress (P = .013), and device-related emotional burden (P < .001). Higher baseline HbA1c was linked with greater improvement in hypoglycemic fear (P = .030); HbA1c change over the trial was positively associated with change in diabetes distress (P = .010) and device-related emotional burden (P = .003). CONCLUSIONS Introduction of rtCGM in adults with insulin-using T2D was associated with significant improvements in diabetes-related psychosocial outcomes over six months. Gains were significantly greater among participants reporting IAH and those with higher HbA1c at baseline, thus providing the first evidence regarding which users might more likely benefit.
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Affiliation(s)
| | - William H. Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
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17
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Di Molfetta S, Laviola L, Natalicchio A, Leonardini A, Cignarelli A, Bonizzoni E, Acmet E, Giorgino F. Evaluation of a digital tool supporting therapeutic decision making for the personalized management of patients with type 2 diabetes not treated with insulin: A pilot study. Diabetes Res Clin Pract 2023; 203:110836. [PMID: 37478979 DOI: 10.1016/j.diabres.2023.110836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/25/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
AIMS To investigate the benefits of using the Personalized Treatment Tool (PTT), a web-based clinical decision support tool assisting the diabetologist in the evaluation of patient's clinical characteristics and SMBG data, in the management of patients with non-insulin treated type 2 diabetes and inadequate glucose control. METHODS We conducted a single-center, 16-week, cluster-randomized controlled trial. RESULTS Eighty-two patients with 64.3 ± 9.4 years of age, disease duration 13.2 ± 9.1 years and HbA1c 7.8 ± 0.6%, 41 in the PTT group and 41 in the control group, completed the study. At follow-up, changes in indicators of glucose control and variability were not statistically different between the two groups. However, when considering the subgroup of patients on a single anti-diabetes drug at baseline (9 in the PTT group, 14 in the control group), changes in HbA1c and CGM-derived TIR 70-140 mg/dl, 24-hour MSG, GRADE, and HBGI were significantly improved in the PTT group compared to the control group. CONCLUSION When performed in a structured manner and used to modify the diabetes therapy through an algorithm-driven digital tool, SMBG can lead to significant improvements of glycemic control and variability in patients with type 2 diabetes not treated with insulin.
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Affiliation(s)
- Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Luigi Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Annalisa Natalicchio
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Anna Leonardini
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Angelo Cignarelli
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Erminio Bonizzoni
- Section of Medical Statistics and Biometry "GA Maccacaro", Department of Clinical Science and Community, University of Milan, Milan, Italy
| | - Elena Acmet
- Medical Affair Director, Roche Diabetes Care Italy
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy.
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18
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Majewska A, Stanirowski PJ, Tatur J, Wojda B, Radosz I, Wielgos M, Bomba-Opon DA. Flash glucose monitoring in gestational diabetes mellitus (FLAMINGO): a randomised controlled trial. Acta Diabetol 2023; 60:1171-1177. [PMID: 37160787 PMCID: PMC10359198 DOI: 10.1007/s00592-023-02091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 05/11/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) is the most common type of hyperglycaemia in pregnancy. GDM is a risk factor of adverse perinatal outcomes, with the incidence rate increasing proportionally to the level of maternal dysglycaemia. Therefore, glycaemic control plays an important role in management of GDM. The aim of this study was to assess the efficacy of flash glucose monitoring (FGM) in GDM. MATERIALS AND METHODS This was a non-blinded, randomised controlled trial, that recruited 100 pregnant women diagnosed with GDM between 24 and 28 weeks of gestation at the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw. After meeting the inclusion criteria patients were randomly allocated to the study group (FGM, n = 50) or control group (self-monitoring of blood glucose-SMBG, n = 50). Clinical and laboratory results were assessed at four follow-up visits. The primary outcome was mean fasting and postprandial glycaemia. The secondary outcomes were perinatal outcomes. RESULTS There was no significant difference in mean glycaemia between the groups (p = 0.437) Compared to the control group, the study group significantly reduced their fasting (p = 0.027) and postprandial glycaemia (p = 0.034) during the first 4 weeks following GDM diagnosis, with no significant difference in progression to insulin therapy (OR 1.09, 95% CI 0.47-2.57). Incidence of fetal macrosomia was significantly higher in SMBG as compared to FGM group (OR 5.63, 95% CI 1.16-27.22). CONCLUSIONS Study results indicate that FGM has an impact on glycaemic control, dietary habits and incidence of fetal macrosomia in patients with GDM. Trial registration clinicaltrials.gov ID: NCT04422821.
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Affiliation(s)
- Agata Majewska
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015, Warsaw, Poland.
- Polish Society of Gynecologists and Obstetricians, Club 35, 02-677, Warsaw, Poland.
| | - Paweł Jan Stanirowski
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015, Warsaw, Poland
- Polish Society of Gynecologists and Obstetricians, Club 35, 02-677, Warsaw, Poland
| | - Jacek Tatur
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015, Warsaw, Poland
| | - Barbara Wojda
- Department of Nutrition and Nutritional Value of Food, National Institute of Public Health NIH-National Research Institute, Chocimska St. 24, 00-791, Warsaw, Poland
| | - Iwona Radosz
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015, Warsaw, Poland
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Klupa T, Czupryniak L, Dzida G, Fichna P, Jarosz-Chobot P, Gumprecht J, Mysliwiec M, Szadkowska A, Bomba-Opon D, Czajkowski K, Malecki MT, Zozulinska-Ziolkiewicz DA. Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease. Diabetes Ther 2023:10.1007/s13300-023-01431-3. [PMID: 37322319 PMCID: PMC10299981 DOI: 10.1007/s13300-023-01431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Application of continuous glucose monitoring (CGM) has moved diabetes care from a reactive to a proactive process, in which a person with diabetes can prevent episodes of hypoglycemia or hyperglycemia, rather than taking action only once low and high glucose are detected. Consequently, CGM devices are now seen as the standard of care for people with type 1 diabetes mellitus (T1DM). Evidence now supports the use of CGM in people with type 2 diabetes mellitus (T2DM) on any treatment regimen, not just for those on insulin therapy. Expanding the application of CGM to include all people with T1DM or T2DM can support effective intensification of therapies to reduce glucose exposure and lower the risk of complications and hospital admissions, which are associated with high healthcare costs. All of this can be achieved while minimizing the risk of hypoglycemia and improving quality of life for people with diabetes. Wider application of CGM can also bring considerable benefits for women with diabetes during pregnancy and their children, as well as providing support for acute care of hospital inpatients who experience the adverse effects of hyperglycemia following admission and surgical procedures, as a consequence of treatment-related insulin resistance or reduced insulin secretion. By tailoring the application of CGM for daily or intermittent use, depending on the patient profile and their needs, one can ensure the cost-effectiveness of CGM in each setting. In this article we discuss the evidence-based benefits of expanding the use of CGM technology to include all people with diabetes, along with a diverse population of people with non-diabetic glycemic dysregulation.
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Affiliation(s)
- Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Dzida
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Malgorzata Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Dorota Bomba-Opon
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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20
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Faber J, Ballegaard S, Ørsted N, Eldrup E, Karpatschof B, Gyntelberg F, Hecquet SK, Gjedde A. In Type 2 Diabetes Mellitus, normalization of hemoglobin A1c accompanies reduced sensitivity to pressure at the sternum. Front Neurosci 2023; 17:1067098. [PMID: 37389368 PMCID: PMC10303981 DOI: 10.3389/fnins.2023.1067098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/18/2023] [Indexed: 07/01/2023] Open
Abstract
Background The autonomic nervous system (ANS) maintains glucose homeostasis. While higher than normal glucose levels stimulate the ANS toward reduction, previous findings suggest an association between sensitivity to, or pain from, pressure at the chest bone (pressure or pain sensitivity, PPS) and activity of the ANS. A recent randomized controlled trial (RCT) of type 2 diabetes (T2DM) suggested that addition of an experimental, non-pharmacological intervention more effectively than conventional treatment lowered the levels of both PPS and HbA1c. Materials and analyses We tested the null hypothesis that conventional treatment (n = 60) would reveal no association between baseline HbA1c and normalization of HbA1c in 6 months, related to change of PPS. We compared the changes of HbA1c in PPS reverters who experienced a minimum reduction of 15 units of PPS and in PPS non-reverters who experienced no reduction. Depending on the result, we tested the association in a second group of participants with addition of the experimental program (n = 52). Results In the conventional group, PPS reverters experienced normalization of HbA1c that corrected the basal increase, thus disproving the null hypothesis. With the addition of the experimental program, PPS reverters experienced similar reduction. The reduction of HbA1c among reverters averaged 0.62 mmol/mol per mmol/mol increase of baseline HbA1c (P < 0.0001 compared to non-reverters). For baseline HbA1c ≥ 64 mmol/mol, reverters averaged 22% reduction of HbA1c (P < 0.01). Conclusion In consecutive analyses of two different populations of individuals with T2DM, we demonstrated that the higher the baseline HbA1c, the greater the reduction of HbA1c but only in individuals with a concomitant reduction of sensitivity to PPS, suggesting a homeostatic effect of the autonomic nervous system on glucose metabolism. As such, ANS function, measured as PPS, is an objective measure of HbA1c homeostasis. This observation may be of great clinical importance.
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Affiliation(s)
- Jens Faber
- Department of Endocrinology, Herlev-Gentofte University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Ballegaard
- Department of Endocrinology, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Nanna Ørsted
- Department of Endocrinology, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Ebbe Eldrup
- Department of Endocrinology, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Benny Karpatschof
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Center for the Working Environment, Copenhagen, Denmark
| | | | - Albert Gjedde
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Translational Neuropsychiatry Unit, Aarhus University, Aarhus, Denmark
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21
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Lameijer A, Bakker JJ, Kao K, Xu Y, Gans ROB, Bilo HJG, Dunn TC, van Dijk PR. Real-life 24-week changes in glycemic parameters among European users of flash glucose monitoring with type 1 and 2 diabetes and different levels of glycemic control. Diabetes Res Clin Pract 2023:110735. [PMID: 37276981 DOI: 10.1016/j.diabres.2023.110735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
AIM To evaluate real-life changes of glycemic parameters among flash glucose monitoring (FLASH) users who do not meet glycemic targets. METHODS De-identified data were obtained between 2014 and 2021 from patients using FLASH uninterrupted for a 24-week period. Glycemic parameters during first and last sensor use were examined in four identifiable groups: type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) on basal-bolus insulin, T2DM on basal insulin, and T2DM without insulin treatment. Within each group, subgroup analyses were performed in persons with initial suboptimal glycemic regulation (time in range (TIR; 3.9-10 mmol/L) <70%, time above range (TAR; >10 mmol/L) >25%, or time below range (TBR; <3.9 mmol/L) >4%). RESULTS Data were obtained from 1,909 persons with T1DM and 1,813 persons with T2DM (1,499 basal-bolus insulin, 189 basal insulin, and 125 non-insulin users). In most of the performed analyses, both overall and in the various subgroups, significant improvements were observed in virtually all predefined primary (TIR) and secondary endpoints (eHbA1c, TAR, TBR and glucose variability). CONCLUSIONS 24-weeks FLASH use in real life by persons with T1DM and T2DM with suboptimal glycemic regulation is associated with improvement of glycemic parameters, irrespective of pre-use regulation or treatment modality.
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Affiliation(s)
- Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Julia J Bakker
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | | | | | - Rijk O B Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Henk J G Bilo
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands; Isala, Diabetes Research Center, Zwolle, The Netherlands
| | | | - Peter R van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands; Isala, Diabetes Research Center, Zwolle, The Netherlands.
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22
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Srivastava SB. Empowering People with Diabetes: Role of Continuous Glucose Monitor Systems. Am J Lifestyle Med 2023; 17:359-364. [PMID: 37304746 PMCID: PMC10248365 DOI: 10.1177/15598276231158044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Continuous glucose monitoring in a person with diabetes who is embracing lifestyle changes can be greatly impactful in numerous ways. There are many factors that have been identified to affect blood glucose, and for someone who may be implementing the six pillars of lifestyle medicine, their blood sugar may require closer monitoring. Lifestyle medicine interventions may lead to improved glucose levels or even remission. The continuous glucose monitor allows people to see glucose levels, trends, and how rapidly their glucose levels are rising or dropping, empowering them to make connections with how they feel and how their actions are impacting their blood sugar, as well as giving information about how medications may need to be adjusted or deprescribed. CGM, when appropriately used, can help determine how to best manage diabetes, optimize outcomes, minimize risks, and empower the person and healthcare team.
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Affiliation(s)
- Sneha B Srivastava
- Associate Professor/Associate Director of Skills Education,
Clinical Pharmacist, Rosalind Franklin University of Medicine and
Science, North Chicago, IL, USA; Lake County Health Department, Highland Park, IL, USA
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23
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Legris P, Bouillet B, Pâris J, Pistre P, Devaux M, Bost S, Simoneau I, Manfredi S, Drouillard A, Bastie JN, Chaix M, Massoud P, Rouland A, Aho S, Boulin M, Petit JM. Glycemic control in people with diabetes treated with cancer chemotherapy: contribution of continuous glucose monitoring. Acta Diabetol 2023; 60:545-552. [PMID: 36637528 DOI: 10.1007/s00592-023-02032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
AIMS The aim of our study was to assess, with Continuous Glucose Monitoring (CGM), exhaustive information on the glucose profile in people with diabetes starting chemotherapy. We also evaluated the adaptation of glucose-lowering drugs following analysis of CGM recordings. METHODS Eighty-five people with diabetes starting chemotherapy were included in the ONCODIAB study. A CGM was worn for up to fourteen days in blinded mode before and after the diabetologist's intervention to evaluate the impact of modifying the glucose-lowering drugs. RESULTS Time spent in range was 67.2 ± 24.2%. Time below the target glucose range (TBR) (< 70 mg/dl) was 8.9% in all the study population. TBR was significantly higher in patients treated with at least one drug due to the risk of hypoglycemia compared to the others (11.5% vs. 4.4%, p = 0.009). Sixty-five patients had available sensor data for the two recordings. Forty-one patients (51.9%) saw a decrease in their antidiabetic treatment after the diabetologist's intervention guided by the first CGM recording. We observed a significant reduction in the time spent below the target glucose range (70-55 mg/dl) between the two CGM recordings (10.3 ± 14.6% vs. 6.3 ± 9.4%, p = 0.016 and 3.8 ± 8.4% vs. 1.2 ± 2.9%, p = 0.012, respectively). CONCLUSIONS CGM use in blinded mode could be an interesting tool to reduce the risk of hypoglycemia in people with diabetes starting chemotherapy. Our findings fully support the recommendation that assessing hypoglycemia risk should be mandatory in patients with diabetes before starting chemotherapy.
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Affiliation(s)
- Pauline Legris
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France
| | - Benjamin Bouillet
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Justine Pâris
- Department of Pharmacy, University Hospital, Dijon, France
| | - Pauline Pistre
- Department of Pharmacy, University Hospital, Dijon, France
| | | | - Stephanie Bost
- Department of Pharmacy, University Hospital, Dijon, France
| | - Isabelle Simoneau
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France
| | - Sylvain Manfredi
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital and EPICAD LNC UMR 1231, University of Burgundy & Franche-Comté, Dijon, France
| | - Antoine Drouillard
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital and EPICAD LNC UMR 1231, University of Burgundy & Franche-Comté, Dijon, France
| | - Jean-Noel Bastie
- Department of Clinical Hematology, University Hospital and SAPHIIT UMR 1231, University of Burgundy & Franche-Comté, Dijon, France
| | - Marie Chaix
- Department of Oncology, University Hospital Dijon, Dijon, France
| | - Pamela Massoud
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France
| | - Alexia Rouland
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Serge Aho
- Hospital Epidemiology and Infection Control Department, Dijon University Hospital, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, University Hospital, Dijon, France
- Department of Pharmacy, University Hospital and EPICAD LNC UMR 1231, University of Burgundy & Franche-Comté, Dijon, France
| | - Jean-Michel Petit
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France.
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France.
- Service de Diabétologie, Centre Hospitalier Universitaire François Mitterrand, BP 77908, 21079, Dijon, Cedex, France.
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24
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Aronson R, Brown RE, Chu L, Bajaj HS, Khandwala H, Abitbol A, Malakieh N, Goldenberg R. IMpact of flash glucose Monitoring in pEople with type 2 Diabetes Inadequately controlled with non-insulin Antihyperglycaemic ThErapy (IMMEDIATE): A randomized controlled trial. Diabetes Obes Metab 2023; 25:1024-1031. [PMID: 36546594 DOI: 10.1111/dom.14949] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
AIM To examine the efficacy and patient satisfaction of intermittently scanned continuous glucose monitoring (isCGM) in adults using non-insulin therapies for the management of type 2 diabetes. MATERIALS AND METHODS The IMMEDIATE study was a multisite, open label, randomized controlled trial with follow-up at 16 weeks. Adults with type 2 diabetes using at least one non-insulin therapy, with an HbA1c of 7.5% or higher (≥ 58 mmol/mol), were randomized 1:1 to receive an isCGM device plus diabetes self-management education (isCGM + DSME) or DSME alone. Enrolment occurred from 8 September 2020 to 24 December 2021. The primary outcome was percentage mean time in range (TIR), in the final 2-week period, measured via blinded CGM. RESULTS One hundred and sixteen participants were randomized (mean age, 58 years; diabetes duration, 10 years; mean HbA1c, 8.6% [70 mmol/mol]). At 16 weeks of follow-up, the isCGM and DSME arm had a significantly greater mean TIR by 9.9% (2.4 hours) (95% CI, -17.3% to -2.5%; P < .01), significantly less time above range by 8.1% (1.9 hours) (95% CI, 0.5% to 15.7%; P = .037), and a greater reduction in mean HbA1c by 0.3% (3 mmol/mol) (95% CI, 0% to 0.7%; P = .048) versus the DSME arm. Time below range was low and not significantly different between groups and hypoglycaemic events were few in both groups. Glucose monitoring satisfaction was higher among isCGM users (adjusted difference -0.5 [95% CI, -0.7 to -0.3], P < .01). CONCLUSIONS The IMMEDIATE study has shown that among non-insulin-treated individuals with type 2 diabetes, use of isCGM is associated with an improvement in glycaemic outcomes.
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Affiliation(s)
| | - Ruth E Brown
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - Lisa Chu
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
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Almurashi AM, Rodriguez E, Garg SK. Emerging Diabetes Technologies: Continuous Glucose Monitors/Artificial Pancreases. J Indian Inst Sci 2023; 103:1-26. [PMID: 37362851 PMCID: PMC10043869 DOI: 10.1007/s41745-022-00348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 03/30/2023]
Abstract
Over the past decade there have been many advances in diabetes technologies, such as continuous glucose monitors (CGM s), insulin-delivery devices, and hybrid closed loop systems . Now most CGMs (Medtronic-Guardian, Dexcom-G6, and Abbott-Libre-2) have MARD values of < 10%, in contrast to two decades ago when the MARD used to be > 20%. In addition, the majority of the new CGMs do not require calibrations, and the latest CGMs last for 10-14 days. An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. Recently, the FDA approved Libre 3 which provides real-time glucose values every minute. Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. The newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. Most of the newer CGM have several features like automatic initialization, easy insertion, predictive alarms, and alerts. It has also been noticed that an arm insertion site might have better accuracy than abdomen or other sites, like the buttock for kids. Lag time between YSI and different sensors have been reported differently, sometimes it is down to 2-3 min; however, in many instances, it is still 15-20 min, especially when the rate of change of glucose is > 2 mg/min. We believe that in the next decade there will be a significant increase in the number of people who use CGM for their day-to-day diabetes care.
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Affiliation(s)
- Abdulhalim M. Almurashi
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
- Madinah Health Cluster, Madinah, Saudi Arabia
| | - Erika Rodriguez
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
| | - Satish K. Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
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26
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Diez Alvarez S, Fellas A, Santos D, Sculley D, Wynne K, Acharya S, Navathe P, Girones X, Coda A. The Clinical Impact of Flash Glucose Monitoring-a Digital Health App and Smartwatch Technology in Patients With Type 2 Diabetes: Scoping Review. JMIR Diabetes 2023; 8:e42389. [PMID: 36920464 PMCID: PMC10131890 DOI: 10.2196/42389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes has a growing prevalence and confers significant cost burden to the health care system, raising the urgent need for cost-effective and easily accessible solutions. The management of type 2 diabetes requires significant commitment from the patient, caregivers, and the treating team to optimize clinical outcomes and prevent complications. Technology and its implications for the management of type 2 diabetes is a nascent area of research. The impact of some of the more recent technological innovations in this space, such as continuous glucose monitoring, flash glucose monitoring, web-based applications, as well as smartphone- and smart watch-based interactive apps has received limited attention in the research literature. OBJECTIVE This scoping review aims to explore the literature available on type 2 diabetes, flash glucose monitoring, and digital health technology to improve diabetic clinical outcomes and inform future research in this area. METHODS A scoping review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to July 2021), EMBASE (January 1980 to July 2021), Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases. RESULTS There were very few studies that have explored the use of mobile health and flash glucose monitoring in type 2 diabetes. These studies have explored somewhat disparate and limited areas of research, and there is a distinct lack of methodological rigor in this area of research. The 3 studies that met the inclusion criteria have addressed aspects of the proposed research question. CONCLUSIONS This scoping review has highlighted the lack of research in this area, raising the opportunity for further research in this area, focusing on the clinical impact and feasibility of the use of multiple technologies, including flash glucose monitoring in the management of patients with type 2 diabetes.
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Affiliation(s)
- Sergio Diez Alvarez
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Antoni Fellas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Dean Sculley
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Katie Wynne
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
- Department of Diabetes and Endocrinology, Hunter New England Health, John Hunter Hospital, Newcastle, Australia
| | - Shamasunder Acharya
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Department of Diabetes and Endocrinology, Hunter New England Health, John Hunter Hospital, Newcastle, Australia
| | - Pooshan Navathe
- Central Queensland Hospital and Health Service, Brisbane, Australia
| | - Xavier Girones
- Department of Research, Universities de Catalunya, Generalitat de Catalunya, Barcelona, Cataluna, Spain
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
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Ajjan RA, Heller SR, Everett CC, Vargas-Palacios A, Higham R, Sharples L, Gorog DA, Rogers A, Reynolds C, Fernandez C, Rodrigues P, Sathyapalan T, Storey RF, Stocken DD. Multicenter Randomized Trial of Intermittently Scanned Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Individuals With Type 2 Diabetes and Recent-Onset Acute Myocardial Infarction: Results of the LIBERATES Trial. Diabetes Care 2023; 46:441-449. [PMID: 36516054 PMCID: PMC9887626 DOI: 10.2337/dc22-1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To analyze the impact of modern glucose-monitoring strategies on glycemic and patient-related outcomes in individuals with type 2 diabetes (T2D) and recent myocardial infarction (MI) and assess cost effectiveness. RESEARCH DESIGN AND METHODS LIBERATES was a multicenter two-arm randomized trial comparing self-monitoring of blood glucose (SMBG) with intermittently scanned continuous glucose monitoring (isCGM), also known as flash CGM, in individuals with T2D and recent MI, treated with insulin and/or a sulphonylurea before hospital admission. The primary outcome measure was time in range (TIR) (glucose 3.9-10 mmol/L/day) on days 76-90 post-randomization. Secondary and exploratory outcomes included time in hypoglycemia, hemoglobin A1c (HbA1c), clinical outcome, quality of life (QOL), and cost effectiveness. RESULTS Of 141 participants randomly assigned (median age 63 years; interquartile range 53, 70), 73% of whom were men, isCGM was associated with increased TIR by 17 min/day (95% credible interval -105 to +153 min/day), with 59% probability of benefit. Users of isCGM showed lower hypoglycemic exposure (<3.9 mmol/L) at days 76-90 (-80 min/day; 95% CI -118, -43), also evident at days 16-30 (-28 min/day; 95% CI -92, 2). Compared with baseline, HbA1c showed similar reductions of 7 mmol/mol at 3 months in both study arms. Combined glycemic emergencies and mortality occurred in four isCGM and seven SMBG study participants. QOL measures marginally favored isCGM, and the intervention proved to be cost effective. CONCLUSIONS Compared with SMBG, isCGM in T2D individuals with MI marginally increases TIR and significantly reduces hypoglycemic exposure while equally improving HbA1c, explaining its cost effectiveness. Studies are required to understand whether these glycemic differences translate into longer-term clinical benefit.
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Affiliation(s)
- Ramzi A. Ajjan
- Clinical Population and Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
- Corresponding author: Ramzi A. Ajjan,
| | - Simon R. Heller
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, U.K
| | - Colin C. Everett
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, U.K
| | | | - Ruchi Higham
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, U.K
| | - Linda Sharples
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, U.K
| | - Diana A. Gorog
- School of Life and Medical Science, University of Hertfordshire, Hertfordshire, U.K
- National Heart and Lung Institute, Imperial College London, London, U.K
| | | | - Catherine Reynolds
- Clinical Population and Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Catherine Fernandez
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, U.K
| | - Pedro Rodrigues
- Academic Unit of Health Economics, University of Leeds, Leeds, U.K
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Allam Diabetes Centre, Hull York Medical School, University of Hull, Hull, U.K
| | - Robert F. Storey
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, U.K
| | - Deborah D. Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, U.K
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28
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S111-S127. [PMID: 36507635 PMCID: PMC9810474 DOI: 10.2337/dc23-s007] [Citation(s) in RCA: 106] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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29
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Guerci B, Roussel R, Levrat-Guillen F, Detournay B, Vicaut E, De Pouvourville G, Emery C, Riveline JP. Important Decrease in Hospitalizations for Acute Diabetes Events Following FreeStyle Libre System Initiation in People with Type 2 Diabetes on Basal Insulin Therapy in France. Diabetes Technol Ther 2023; 25:20-30. [PMID: 36094418 DOI: 10.1089/dia.2022.0271] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aims/Hypothesis: Initiation of insulin therapy in people with type 2 diabetes (T2DM) may be necessary to achieve glycemic targets but is associated with acute diabetes events (ADEs), including severe hypoglycemia (SH) or diabetic ketoacidosis (DKA). We assessed the impact of initiating FreeStyle Libre® system (FSL) on hospitalizations for ADEs in people with T2DM on basal insulin only regimen±noninsulin antidiabetic drugs. Materials and Methods: A retrospective study of the French national Système National des Données de Santé reimbursement claims database (≈66 million French people) identified people with T2DM on basal insulin therapy receiving a first reimbursement of FSL between August 1, 2017 and December 31, 2018. Claims data for the 12 months before, and up to 24 months after FSL initiation, were analyzed. Hospitalizations for ADEs were identified, using ICD-10 codes as main or related diagnosis, for: SH events; DKA events; comas; and hyperglycemia-related admissions. Results: A total of 5933 people with T2DM on basal insulin therapy initiated FSL during the selection period. Of the patients, 78.9% were on basal insulin and other hypoglycemic agents. Among the 5933 patients identified, 2.01% had at least one hospitalization for any ADE in the year before FSL initiation, compared to 0.75% (1 year) and 0.60% (2 years). Reductions in ADEs were driven by 75% fewer DKA admissions, with a 44% reduction in SH admissions. These patterns of reduced ADEs persisted after 2 years, with a further 43% reduction in DKA rates. Conclusions/Interpretation: This study emphasizes the value of the FSL system in reducing ADEs in people with T2DM in France not on intensive insulin therapy and initially treated with basal-only insulin therapy.
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Affiliation(s)
- Bruno Guerci
- Department of Endocrinology, Diabetology, and Nutrition, Brabois Adult Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Ronan Roussel
- Institut Necker Enfants Malades (INEM), Unité INSERM U1151 INEM, IMMEDIAB Laboratory, Paris, France
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Paris, France
| | | | | | - Eric Vicaut
- Clinical Research Unit, Fernand Vidal Hospital, Paris, France
| | | | | | - Jean-Pierre Riveline
- Department of Endocrinology and Diabetology, Lariboisière Hospital, Paris, France
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, IMMEDIAB Laboratory, Paris, France
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Moon SJ, Kim KS, Lee WJ, Lee MY, Vigersky R, Park CY. Efficacy of intermittent short-term use of a real-time continuous glucose monitoring system in non-insulin-treated patients with type 2 diabetes: A randomized controlled trial. Diabetes Obes Metab 2023; 25:110-120. [PMID: 36053813 DOI: 10.1111/dom.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the efficacy of intermittent short-term use of a real-time continuous glucose monitoring (RT-CGM) system in non-insulin-treated patients with type 2 diabetes (T2D) uncontrolled with oral antidiabetic drugs (OADs). MATERIALS AND METHODS In this multicentre, randomized prospective study, 61 participants were randomly assigned to treatment group 1 (one session of RT-CGM), treatment group 2 (two sessions of RT-CGM with a 3-month interval between sessions) and a control group. All participants used blinded continuous glucose monitoring for up to 6 days with education before randomization, and RT-CGM was additionally applied for 1 week in the intervention groups. The primary outcome was change in HbA1c at 6 months. RESULTS Among 61 participants, 48 subjects completed the study (baseline HbA1c 8.2% ± 0.5%). At 3 months, a significant HbA1c reduction was observed in treatment group 1 (adjusted difference = -0.60%, P = .044) and treatment group 2 (adjusted difference = -0.64%, P = .014) compared with the control group. However, at 6 months, only treatment group 2 achieved a significant HbA1c reduction (adjusted difference = -0.68%, P = .018). Especially in the treatment groups, patients performing self-monitoring of blood glucose (SMBG) at least 1.5 times/day showed a significant HbA1c improvement, at both 3 and 6 months, but those performing SMBG less than 1.5 times/day showed no significant improvement. CONCLUSIONS In non-insulin-treated patients with T2D uncontrolled with OADs, intermittent short-term use of RT-CGM was an effective method for glucose control, especially in those performing SMBG frequently.
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Affiliation(s)
- Sun Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Robert Vigersky
- Global Medical and Clinical Affairs, Medtronic Diabetes, Northridge, California, USA
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Eeg-Olofsson K, Svensson AM, Franzén S, Ahmed Ismail H, Törnblom M, Levrat-Guillen F. Real-world study of flash glucose monitoring among adults with type 2 diabetes within the Swedish National Diabetes Register. Diab Vasc Dis Res 2023; 20:14791641211067418. [PMID: 36715353 PMCID: PMC9903025 DOI: 10.1177/14791641211067418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The Swedish National Diabetes Register (NDR) initiated registration of the FreeStyle Libre® system and other continuous glucose monitoring (CGM) systems in June 2016. We investigated change in HbA1c for people with type 2 diabetes (T2DM) using FreeStyle Libre in Sweden. METHODS We included adults with T2DM, registered in the NDR after January 1, 2014, and an index date for first use of FreeStyle Libre of June 2016 or later. Methodology was a before/after comparison of HbA1c within 6 months before the index date versus HbA1c around 6 and 12 months after the index date. RESULTS 711 adults with T2DM using FreeStyle Libre had HbA1c measurements within the study period. Mean HbA1c was significantly reduced at 6 months (-0.50%-unit) and at 12 months (-0.52%-unit) in this group. Degree of change was negatively correlated to baseline HbA1c. Reductions in HbA1c were observed in incident users of FreeStyle Libre with T2DM who were truly naïve to CGM or had unknown prior experience of CGM, and aged 25-74 years. CONCLUSIONS This real-world study on the Swedish NDR shows that people with T2DM using FreeStyle Libre system for 6 and 12 months significantly reduced their HbA1c.
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Affiliation(s)
- Katarina Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- The Swedish National Diabetes Register, Center of Registries, Region of Västra Götaland, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Katarina Eeg-Olofsson, The National Diabetes Register and Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Ann-Marie Svensson
- The Swedish National Diabetes Register, Center of Registries, Region of Västra Götaland, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- Health Metrics, Department of Public Health and Community Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
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Battelino T, Alexander CM, Amiel SA, Arreaza-Rubin G, Beck RW, Bergenstal RM, Buckingham BA, Carroll J, Ceriello A, Chow E, Choudhary P, Close K, Danne T, Dutta S, Gabbay R, Garg S, Heverly J, Hirsch IB, Kader T, Kenney J, Kovatchev B, Laffel L, Maahs D, Mathieu C, Mauricio D, Nimri R, Nishimura R, Scharf M, Del Prato S, Renard E, Rosenstock J, Saboo B, Ueki K, Umpierrez GE, Weinzimer SA, Phillip M. Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol 2023; 11:42-57. [PMID: 36493795 DOI: 10.1016/s2213-8587(22)00319-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
Randomised controlled trials and other prospective clinical studies for novel medical interventions in people with diabetes have traditionally reported HbA1c as the measure of average blood glucose levels for the 3 months preceding the HbA1c test date. The use of this measure highlights the long-established correlation between HbA1c and relative risk of diabetes complications; the change in the measure, before and after the therapeutic intervention, is used by regulators for the approval of medications for diabetes. However, with the increasing use of continuous glucose monitoring (CGM) in clinical practice, prospective clinical studies are also increasingly using CGM devices to collect data and evaluate glucose profiles among study participants, complementing HbA1c findings, and further assess the effects of therapeutic interventions on HbA1c. Data is collected by CGM devices at 1-5 min intervals, which obtains data on glycaemic excursions and periods of asymptomatic hypoglycaemia or hyperglycaemia (ie, details of glycaemic control that are not provided by HbA1c concentrations alone that are measured continuously and can be analysed in daily, weekly, or monthly timeframes). These CGM-derived metrics are the subject of standardised, internationally agreed reporting formats and should, therefore, be considered for use in all clinical studies in diabetes. The purpose of this consensus statement is to recommend the ways CGM data might be used in prospective clinical studies, either as a specified study endpoint or as supportive complementary glucose metrics, to provide clinical information that can be considered by investigators, regulators, companies, clinicians, and individuals with diabetes who are stakeholders in trial outcomes. In this consensus statement, we provide recommendations on how to optimise CGM-derived glucose data collection in clinical studies, including the specific glucose metrics and specific glucose metrics that should be evaluated. These recommendations have been endorsed by the American Association of Clinical Endocrinologists, the American Diabetes Association, the Association of Diabetes Care and Education Specialists, DiabetesIndia, the European Association for the Study of Diabetes, the International Society for Pediatric and Adolescent Diabetes, the Japanese Diabetes Society, and the Juvenile Diabetes Research Foundation. A standardised approach to CGM data collection and reporting in clinical trials will encourage the use of these metrics and enhance the interpretability of CGM data, which could provide useful information other than HbA1c for informing therapeutic and treatment decisions, particularly related to hypoglycaemia, postprandial hyperglycaemia, and glucose variability.
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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, Ljubljana, Slovenia.
| | | | | | - Guillermo Arreaza-Rubin
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | - Bruce A Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford Medical Center, Stanford, CA, USA
| | | | | | - Elaine Chow
- Phase 1 Clinical Trial Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pratik Choudhary
- Leicester Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kelly Close
- diaTribe Foundation, San Francisco, CA, USA; Close Concerns, San Francisco, CA, USA
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Auf der Bult, Hanover, Germany
| | | | - Robert Gabbay
- American Diabetes Association, Arlington, VA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Satish Garg
- Barbara Davis Centre for Diabetes, University of Colorado Denver, Aurora, CO, USA
| | | | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, University of Washington, Seattle, WA, USA
| | - Tina Kader
- Jewish General Hospital, Montreal, QC, Canada
| | | | - Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Lori Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - David Maahs
- Department of Pediatrics, Stanford Diabetes Research Center, Stanford, CA, USA
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, CIBERDEM (Instituto de Salud Carlos III), Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Revital Nimri
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Rimei Nishimura
- The Jikei University School of Medicine, Jikei University, Tokyo, Japan
| | - Mauro Scharf
- Centro de Diabetes Curitiba and Division of Pediatric Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics, University of Montpellier, Montpellier, France; INSERM Clinical Investigation Centre, Montpellier, France
| | - Julio Rosenstock
- Velocity Clinical Research, Medical City, Dallas, TX; University of Texas Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Banshi Saboo
- Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Kohjiro Ueki
- Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, Yale University, New Haven, CT, USA
| | - Moshe Phillip
- 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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Oser TK, Hall TL, Dickinson LM, Callen E, Carroll JK, Nease DE, Michaels L, Oser SM. Continuous Glucose Monitoring in Primary Care: Understanding and Supporting Clinicians' Use to Enhance Diabetes Care. Ann Fam Med 2022; 20:541-547. [PMID: 36443083 PMCID: PMC9705045 DOI: 10.1370/afm.2876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/30/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Diabetes affects approximately 34 million Americans and many do not achieve glycemic targets. Continuous glucose monitoring (CGM) is associated with improved health outcomes for patients with diabetes. Most adults with diabetes receive care for their diabetes in primary care practices, where uptake of CGM is unclear. METHODS We used a cross-sectional web-based survey to assess CGM prescribing behaviors and resource needs among primary care clinicians across the United States. We used descriptive statistics and multivariable regression to identify characteristics associated with prescribing behaviors, openness to prescribing CGM, and to understand resources needed to support use of CGM in primary care. RESULTS Clinicians located more than 40 miles from the nearest endocrinologist's office were more likely to have prescribed CGM and reported greater likelihood to prescribe CGM in the future than those located within 10 miles of an endocrinologist. Clinicians who served more Medicare patients reported favorable attitudes toward future prescribing and higher confidence using CGM to manage diabetes than clinicians with lower Medicare patient volume. The most-needed resources to support CGM use in primary care were consultation on insurance issues and CGM training. CONCLUSIONS Primary care clinicians are interested in using CGM for patients with diabetes, but many lack the resources to implement use of this diabetes technology. Use of CGM can be supported with education in the form of workshops and consultation on insurance issues targeted toward residents, recent graduates, and practices without a nearby endocrinologist. Continued expansion of Medicare and Medicaid coverage for CGM can also support CGM use in primary care.
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Affiliation(s)
- Tamara K Oser
- University of Colorado Department of Family Medicine, Aurora, Colorado
| | - Tristen L Hall
- University of Colorado Department of Family Medicine, Aurora, Colorado
| | | | | | - Jennifer K Carroll
- University of Colorado Department of Family Medicine, Aurora, Colorado.,American Academy of Family Physicians, Leawood, Kansas
| | - Donald E Nease
- University of Colorado Department of Family Medicine, Aurora, Colorado
| | | | - Sean M Oser
- University of Colorado Department of Family Medicine, Aurora, Colorado
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Gao Y, Zhou M, Xu X, Chen WY. Effects of flash glucose monitoring on glycemic control in participants with diabetes mellitus: A meta-analysis of randomized controlled trials. J Diabetes Complications 2022; 36:108314. [PMID: 36208566 DOI: 10.1016/j.jdiacomp.2022.108314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND With the introduction of flash glucose monitoring (FGM) into the international market in 2014, academics worldwide are exploring whether this device improves glycemic control in participants with diabetes mellitus. OBJECTIVE A study was conducted in which participants were evaluated to determine the effect of FGM on glycemic control. METHODS From inception to April 9, 2022, we searched the Cochrane Library, PubMed, SinoMed, Embase, Web of Science, MEDLINE, CNKI, Wan Fang Data, and VIP databases to collect randomized controlled trials (RCTs) related to the effect of FGM on glycemic control in participants with diabetes mellitus. Outcomes included glycated hemoglobin, the occurrence of hypoglycemic events, fasting plasma glucose (FPG), and 2-h postprandial glucose (2hPG) levels. The statistical analysis was performed using R 4.1.3 software. RESULTS We included 19 studies involving 2013 participants, all of which were RCTs. Meta-analysis results revealed that compared to self-monitoring of blood glucose (SMBG), FGM significantly reduced glycated hemoglobin levels in participants with type 2 diabetes mellitus [mean difference = -0.74 [95 % CI-1.16, -0.32], P < 0.01] and type 1 diabetes mellitus combined with type 2 diabetes mellitus [mean difference = -1.14 [95 % CI-3.14, 0.87], P < 0.01], with a greater effect in participants aged ≤65 years with type 2 diabetes mellitus (mean difference = -1.38 [95 % CI-2.05, -0.72], P < 0.01). However, there was no effect of FGM on the improvement of glycated hemoglobin levels in patients with type 1 diabetes mellitus [P = 0.45]. Furthermore, fasting plasma glucose levels and 2-h postprandial glucose levels were significantly lower in FGM than SMBG, and the number of hypoglycemic events was also significantly lower. CONCLUSION Comparing SMBG with FGM indicated that FGM improves fasting plasma glucose levels, 2-h postprandial glucose levels, and glycated hemoglobin levels, and it reduces the number of hypoglycemic events.
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Affiliation(s)
- Yuan Gao
- The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, China; Nursing School of Nanchang University, Nanchang, China
| | - Min Zhou
- The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, China.
| | - Xuan Xu
- The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, China
| | - Wen Yu Chen
- The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, China
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Tang L, Xu Z, Yao P, Zhu H. Meta-Analysis of the Effect of Nursing Intervention on Children with Type 2 Diabetes. Comput Math Methods Med 2022; 2022:6185739. [PMID: 36060652 PMCID: PMC9436522 DOI: 10.1155/2022/6185739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Objective To systematically evaluate the effect of nursing intervention on children with type 2 diabetes. Methods The randomized controlled trials (RCTs) on nursing intervention in children with type 2 diabetes in CNKI, VIP, WanFang, Chinese Biomedical Database (CBM), PubMed, The Cochrane Library, Embase, and Science were searched by the computer until July 2022. Two evaluators reviewed the articles, selected the information, and assessed their quality according to the inclusion criteria and exclusion criteria and then carried out meta-analysis with RevMan 5.3. Results A total of 5 RCT studies were kept, including 319 patients with type 2 diabetes (≤21 years old), where 162 patients were in the nursing group and 157 patients were in the control group. Meta-analysis revealed that, compared with routine nursing, nursing intervention could effectively control children's fasting blood glucose (FBG) (MD = -1.68, 95% CI (-2.19, -1.17), P < 0.00001), 2 h postprandial blood glucose (2hPG) (MD = -4.01, 95% CI (-4.70, -3.33), P < 0.00001), fasting insulin (FINS) (MD = -7.42, 95% CI (-10.63, -4.20), P < 0.00001), 2 h postprandial insulin (2hINS) (MD = -58.18, 95% CI (-103.24, -13.11), P = 0.01), triglycerides (TG) (MD = -0.41, 95% CI (-0.56, -0.25), P < 0.00001), and systolic blood pressure (SBP) (MD = -8.85, 95% CI (-14.67, -3.03), P = 0.003) and effectively maintain patients' blood glucose at a normal level (MD = -8.85, 95% CI (-14.67, -3.03), P = 0.003), where all the differences were statistically significant. Conclusion The existing evidence showed that nursing intervention has a significant effect in controlling normal blood glucose and improving insulin utilization in children with type 2 diabetes, which can effectively improve the therapeutic effect on children.
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Affiliation(s)
- Liying Tang
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang 313000, China
| | - Zhen Xu
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang 313000, China
| | - Ping Yao
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang 313000, China
| | - Huiqin Zhu
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang 313000, China
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Chang YT, Tu YZ, Chiou HY, Lai K, Yu NC. Real-world Benefits of Diabetes Management App Use and Self-monitoring of Blood Glucose on Glycemic Control: Retrospective Analyses. JMIR Mhealth Uhealth 2022; 10:e31764. [PMID: 35704371 PMCID: PMC9244648 DOI: 10.2196/31764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 12/23/2021] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
Background Among self-care measures, the self-monitoring of blood glucose (SMBG) is a critical component for checking blood glucose levels. In addition, there is growing evidence suggesting that digital technologies are being adopted as an additional method for health care systems to increase patient contact. However, for patients with non–insulin-treated diabetes mellitus type 2 (DMT2), the value of SMBG was inconsistent among studies, and the evidence for digital technologies from real-world clinical practice is still limited. Objective Our study aimed to assess patients with non–insulin-treated DMT2 who were receiving care from a single clinic and analyze whether the use of a diabetes management app and SMBG behavior would affect glycemic control in a real-world clinical setting. Methods We collaborated with a large clinic focused on diabetes care in Taiwan that had been using the Health2Sync mobile app and web-based Patient Management Platform to collect the data. The patients were divided into 2 groups (app-engaged-user group and only-data-uploader group) according to different activities in the app, and blood glucose was recorded every month from 1 to 6 months after registration in the app. A sample of 420 patients was included in the analysis, and a linear mixed model was built to investigate which factors affected the patients’ blood glucose percentage change. Results Using the mixed model coefficient estimates, we found that the percentage change was significantly negative when the only-data-uploader group was set as the baseline (t=–3.873, df=1.81 × 104; P<.001 for the patients of the app-engaged-user group). We found that for patients with shorter diabetes duration, their blood glucose decreased more than patients with longer diabetes duration (t=2.823, df=1.71 × 104; P=.005 for the number of years of diabetes duration). In addition, we found that for younger patients, their blood glucose decreased more than older patients (t=2.652, df=1.71 × 104; P=.008 for the age of the patients). Furthermore, the patients with an education level of junior high school or lower saw a significantly greater decrease in blood glucose percentage change than the patients with an education level of senior high school or higher (t=4.996, df=1.72 × 104; P<.001 for the patients with an education level of senior high school or higher). We also found that the count of blood glucose measured enlarged the decrease along the interaction months (t=–8.266, df=1.97 × 104; P<.001 for the nth month × the count of blood glucose in the nth month). Lastly, the gender of the patients did not significantly affect the percentage change (t=0.534, df=1.74 × 104; P=.59 for female patients). Conclusions Our analysis showed the following: the blood glucose percentage change of the patients in the app-engaged-user group dropped more than that in the only-data-uploader group; shorter diabetes duration is associated with a steeper decrease in the patients’ blood glucose percentage change; the percentage decrease in blood glucose change in younger patients is greater than older patients; the blood glucose percentage change of the patients with an education level of junior high school or lower dropped more than those with an education level of senior high school or higher; and the more frequently the patients test SMBG each month, the greater the decrease in the patients’ blood glucose percentage. Further studies can be performed to consider the differences in daily behaviors such as exercise and diet across the patients and whether these factors could have vital effects on glycemic control.
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Affiliation(s)
| | | | | | | | - Neng Chun Yu
- Neng Chun Diabetes Clinic, Medical & Health in Lotung, Yilan, Taiwan
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Di Molfetta S, Rossi A, Assaloni R, Cherubini V, Consoli A, Di Bartolo P, Guardasole V, Laurenzi A, Lombardo F, Maffeis C, Scaramuzza A, Irace C. A guide for the use of LibreView digital diabetes platform in clinical practice: Expert paper of the Italian Working Group on Diabetes and Technology. Diabetes Res Clin Pract 2022; 187:109867. [PMID: 35405166 DOI: 10.1016/j.diabres.2022.109867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
Wider access to continuous glucose monitoring systems, including flash glucose monitoring, has enabled people with diabetes to achieve lower HbA1c levels and reduce the amount of time they spend in hypoglycaemia or hyperglycaemia, and has improved their quality of life. An International Consensus Panel proposed different target glucose ranges and recommendations according to different ages and situations (adults, young people and children with type 1 or type 2 diabetes, as well as elderly people who are at higher risk of hypoglycaemia, and women with diabetes during pregnancy). In this expert opinion, we interpret the international recommendations in the context of established clinical practice for diabetes care, and propose three different step-by-step algorithms to help the healthcare professionals use the most innovative glucose metrics, including time in glucose ranges, glucose management indicator, coefficient of variation, and ambulatory glucose profile. In detail, we focus on glucose metrics as measured by the FreeStyle Libre system and as visualized on the LibreView digital diabetes platform to support appropriate interpretation of flash glucose monitoring data. This is specifically structured for healthcare professionals and general practitioners who may have a low level of confidence with diabetes technology, with the aim of optimizing diabetes management, ensuring effective use of healthcare resources and to maximise outcomes for people with diabetes.
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Affiliation(s)
- Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone, GO, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
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Aggarwal A, Pathak S, Goyal R. Clinical and economic outcomes of continuous glucose monitoring system (CGMS) in patients with diabetes mellitus: A systematic literature review. Diabetes Res Clin Pract 2022; 186:109825. [PMID: 35278520 DOI: 10.1016/j.diabres.2022.109825] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Poor glycemic management increases the risk of cardiac, microvascular, and other complications. Therefore, timely assessment and control of glycemic levels is paramount in diabetes. Recent advancements in automated management methods is the use of a continuous glucose monitoring system (CGMS). The objective was to study its clinical and economic impact in the glucose level monitoring and how it can be effectively used or reimbursed for wider population. METHODS Comprehensive search was done using multiple databases to capture relevant and most recent evidence. All steps were conducted by two independent researchers and discrepancies resolved by a third reviewer. Quality appraisal was performed by relevant scale depending on study design. RESULTS Twenty-six and 12 studies were included for clinical and economic outcomes, respectively. Clinical outcomes like HbA1c and glucose variation, time in range, accuracy, etc. were captured. Comparison of different CGMS types was also reported. Major economic outcomes were direct cost, healthcare resource utilization, and work absenteeism. CONCLUSIONS CGMS in patients with diabetes is associated with a valuable clinical implications in reducing hypoglycemic events, glucose and HbA1c level. Additionally, it has an impact on direct and indirect costs of management. Further, quantitative analysis would be required to produce concrete evidence.
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Affiliation(s)
- Aditi Aggarwal
- Real-World Insights, Global Scientific Affairs, IQVIA, Novus Tower, Sec-18, Gurgaon, Haryana, India.
| | - Smit Pathak
- Real-World Insights, Global Scientific Affairs, IQVIA, Novus Tower, Sec-18, Gurgaon, Haryana, India
| | - Richa Goyal
- Real-World Insights, Global Scientific Affairs, IQVIA, Novus Tower, Sec-18, Gurgaon, Haryana, India
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39
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Affiliation(s)
- Roy W Beck
- JAEB Center for Health Research, Tampa, Florida, USA
| | - Richard M Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
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Liang B, Koye DN, Hachem M, Zafari N, Braat S, Ekinci EI. Efficacy of Flash Glucose Monitoring in Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Front Clin Diabetes Healthc 2022; 3:849725. [PMID: 36992733 PMCID: PMC10012125 DOI: 10.3389/fcdhc.2022.849725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveFlash glucose monitoring (FlashGM) is a sensor-based technology that displays glucose readings and trends to people with diabetes. In this meta-analysis, we assessed the effect of FlashGM on glycaemic outcomes including HbA1c, time in range, frequency of hypoglycaemic episodes and time in hypo/hyperglycaemia compared to self-monitoring of blood glucose, using data from randomised controlled trials.MethodsA systematic search was conducted on MEDLINE, EMBASE and CENTRAL for articles published between 2014 and 2021. We selected randomised controlled trials comparing flash glucose monitoring to self-monitoring of blood glucose that reported change in HbA1c and at least one other glycaemic outcome in adults with type 1 or type 2 diabetes. Two independent reviewers extracted data from each study using a piloted form. Meta-analyses using a random-effects model was conducted to obtain a pooled estimate of the treatment effect. Heterogeneity was assessed using forest plots and the I2 statistic.ResultsWe identified 5 randomised controlled trials lasting 10 – 24 weeks and involving 719 participants. Flash glucose monitoring did not lead to a significant reduction in HbA1c. However, it resulted in increased time in range (mean difference 1.16 hr, 95% CI 0.13 to 2.19, I2 = 71.7%) and decreased frequency of hypoglycaemic episodes (mean difference -0.28 episodes per 24 hours, 95% CI -0.53 to -0.04, I2 = 71.4%).ConclusionsFlash glucose monitoring did not lead to a significant reduction in HbA1c compared to self-monitoring of blood glucose, however, it improved glycaemic management through increased time in range and decreased frequency of hypoglycaemic episodes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42020165688).
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Affiliation(s)
- Bonnie Liang
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Digsu N. Koye
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mariam Hachem
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Neda Zafari
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Elif I. Ekinci
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
- *Correspondence: Elif I. Ekinci,
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Glennie JL, Berard L, Levrat-Guillen F. Sensor-Based Technology: Bringing Value to People with Diabetes and the Healthcare System in an Evolving World. Clinicoecon Outcomes Res 2022; 14:75-90. [PMID: 35177913 PMCID: PMC8843785 DOI: 10.2147/ceor.s346736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/15/2022] [Indexed: 02/06/2023]
Affiliation(s)
| | - Lori Berard
- Nurse Consultant, Pink Pearls Inc, Winnipeg, Manitoba, Canada
| | - Fleur Levrat-Guillen
- Abbott Diabetes Care, Maidenhead, UK
- Correspondence: Fleur Levrat-Guillen, Abbott Laboratories Ltd, Abbott House, Vanwall Business Park, Maidenhead, Berkshire, SL6 4XE, UK, Tel +44 7584108032, Email
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Oser TK, Litchman ML, Allen NA, Kwan BM, Fisher L, Jortberg BT, Polonsky WH, Oser SM. Personal Continuous Glucose Monitoring Use Among Adults with Type 2 Diabetes: Clinical Efficacy and Economic Impacts. Curr Diab Rep 2021; 21:49. [PMID: 34882273 PMCID: PMC8655087 DOI: 10.1007/s11892-021-01408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent clinical efficacy research and economic analysis of the use of personal continuous glucose monitoring (CGM) in type 2 diabetes (T2D). RECENT FINDINGS Studies from the past 5 years include a variety of randomized controlled trials, meta-analyses, and other studies which generally favor CGM over self-monitoring of blood glucose (SMBG) in T2D, especially among people with T2D treated with insulin. Concurrently, some studies show no significant difference, but there is no evidence of worse outcomes with CGM. CGM is frequently associated with greater reduction in HbA1c than is SMBG. HbA1c reductions tend to be greater when baseline HbA1c is higher. Reductions in hypoglycemia and hyperglycemia have also been demonstrated with CGM in people with T2D, as have comfort with, preference for, and psychosocial benefits of CGM compared to SMBG. There is a small but growing evidence base on the economics and cost-effectiveness of CGM in T2D. CGM has been clearly demonstrated to have clinical benefits in people with T2D, especially among those treated with insulin. Economic and cost-effectiveness data are more scant but are generally favorable. CGM should be an important consideration in the management of T2D, and its use is likely to increase as efficacy data accumulate further and as costs associated with CGM gradually decrease.
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Affiliation(s)
- Tamara K. Oser
- Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17thAvenue, Room 3513, Box F496, Aurora, CO 80045 USA
| | | | - Nancy A. Allen
- University of Utah College of Nursing, Salt Lake City, UT USA
| | - Bethany M. Kwan
- Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17thAvenue, Room 3513, Box F496, Aurora, CO 80045 USA
| | - Lawrence Fisher
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA USA
| | - Bonnie T. Jortberg
- Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17thAvenue, Room 3513, Box F496, Aurora, CO 80045 USA
| | | | - Sean M. Oser
- Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17thAvenue, Room 3513, Box F496, Aurora, CO 80045 USA
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Di Molfetta S, Bosi E, Ceriello A, Cucinotta D, Tiengo A, Scavini M, Piccolo C, Bonizzoni E, Acmet E, Giorgino F. Structured self-monitoring of blood glucose is associated with more appropriate therapeutic interventions than unstructured self-monitoring: A novel analysis of data from the PRISMA trial. Diabetes Res Clin Pract 2021; 181:109070. [PMID: 34592390 DOI: 10.1016/j.diabres.2021.109070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
AIMS To investigate the relationship between single therapeutic interventions and indicatorsofglycemic control in the PRISMA trial, a large study comparing the effects of intensive structured SMBG (ISM) vs. active control (AC) in non-insulin-treated type 2 diabetes (T2D). METHODS Information was collected at four time points, corresponding to months 3, 6, 9, and 12 and visits 2, 3, 4, and 5, respectively. Data on therapeutic interventions, HbA1c levels and the number of hypoglycemic episodes at each visit were analyzed. RESULTS Intensification of drug therapy occurred in 20.3% vs. 15.6%, and no change in 71.8% vs. 78.7% of visits for the ISM and AC groups, respectively. On the other hand, de-intensification and redistribution of drugs and/or drug dose occurred in a similar proportion of visits. Intensification of drug therapy in both groups was associated with significant reductions in HbA1c vs. the previous visit, while de-intensification of therapy led to a significant increase in HbA1c in the AC group only. CONCLUSIONS Our data strongly support that structured SMBG has clinical value in reducing HbA1c in non-insulin-treated T2D and suggest that this clinical benefit may be mediated by more appropriate and timely changes in drug therapy.
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Affiliation(s)
- Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari School of Medicine, Bari, Italy
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Domenico Cucinotta
- Department of Clinical and Experimental Medicine, Messina University, Messina, Italy
| | - Antonio Tiengo
- Emeritus Professor of Endocrinology, University of Padova, Padua, Italy
| | - Marina Scavini
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Carmine Piccolo
- Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari School of Medicine, Bari, Italy
| | - Erminio Bonizzoni
- Section of Medical Statistics and Biometry GA Maccacaro, Department of Clinical Science and Community, University of Milan, Milan, Italy
| | - Elena Acmet
- Medical Affair Director, Roche Diabetes Care Italy
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari School of Medicine, Bari, Italy.
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Abstract
INTRODUCTION CGM is an evidence-based intervention to improve glycemic control in persons with T1D and T2D using insulin. Use of CGM in persons with T2D not using insulin is not well studied. AREAS COVERED Existing clinical evidence for the use of CGM in persons with T2D is reviewed with a focus on persons with T2D not using insulin. Additional perspective and consideration are provided on the role and rationale for using CGM in persons with T2D not using insulin. EXPERT OPINION On the basis of available evidence, persons with T2D not using insulin benefit clinically through reduction in HbA1c, and improvement in time in range. Additional benefits include improvement in behavior modification, satisfaction, quality of life, empowerment, and diabetes distress. Drivers of these benefits are independent of insulin use in persons with T2D and may include an improved understanding of how diet, lifestyle, and exercise impact diabetes through CGM use. Clinical benefits from CGM independent of medication use include ability to modify health behavior and subsequently improve self-management.
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Affiliation(s)
- Kevin Cowart
- College of Public Health, University of South Florida, Tampa, Florida, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, Florida, USA
| | - Wendy H Updike
- Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, Florida, USA.,Department of Family Medicine, Morsani College of Medicine; University of South Florida, Tampa, Florida, USA
| | - Rachel Franks
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, Florida, USA
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Kitae A, Kimura T, Munekawa C, Hosomi Y, Osaka T, Kitagawa N, Ushigome E, Yamazaki M, Hamaguchi M, Fukui M. Development of application to automatically calculate mean amplitude of glycaemic excursions using intermittently scanned continuous glucose monitoring data. Diabetes Obes Metab 2021; 23:2155-2160. [PMID: 34085376 DOI: 10.1111/dom.14457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/19/2021] [Accepted: 05/30/2021] [Indexed: 11/27/2022]
Abstract
AIM We aimed to develop an application to calculate mean amplitude of glycaemic excursions (MAGE) automatically and to evaluate its accuracy. MATERIALS AND METHODS We named the application intermittently scanned continuous glucose monitoring (isCGM) calculator KAMOGAWA (Kyoto Auto MAGE Of Glucose cAlcutator With isCGM Application). The isCGM data from 20 patients, 10 with and 10 without diabetes, were used to compare manually calculated MAGE values with those calculated using KAMOGAWA. The rate of agreement for the MAGE values was calculated. RESULTS Comparing the MAGE values calculated manually with those calculated using KAMOGAWA, the total mean rate of agreement was 81.6%. Nonmatching values were checked and it was found that the inconsistencies were all attributable to errors in manual calculations. After correcting errors in the manual calculation, the MAGE values matched to one decimal place for all data in the manual and KAMOGAWA calculations. CONCLUSIONS KAMOGAWA can help diabetologists use MAGE in clinical practice, which could contribute to improving glycaemic control in patients who use isCGM.
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Affiliation(s)
- Aya Kitae
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Tetsuya Kimura
- Department of Medical Information, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chihiro Munekawa
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yukako Hosomi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takafumi Osaka
- Department of Endocrinology and Diabetology, Ayabe City Hospital, Ayabe, Japan
| | - Noriyuki Kitagawa
- Department of Diabetology, Kameoka Municipal Hospital, Kameoka, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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47
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Abstract
Numerous studies have demonstrated the clinical benefits of continuous glucose monitoring (CGM) use in individuals with type 1 diabetes and type 2 diabetes (T2D) who are treated with intensive insulin therapy. A growing body of evidence suggests that CGM use may also confer similar glycemic benefits in T2D individuals who are treated with less-intensive therapies. Investigators are also exploring the potential use of CGM as an aid in weight management. This article reviews the continuing evolution of CGM, focusing on how CGM may be used to improve glycemic control and promote adoption of desired health behaviors within broader T2D and prediabetes populations.
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48
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Dehghani Zahedani A, Shariat Torbaghan S, Rahili S, Karlin K, Scilley D, Thakkar R, Saberi M, Hashemi N, Perelman D, Aghaeepour N, McLaughlin T, Snyder MP. Improvement in Glucose Regulation Using a Digital Tracker and Continuous Glucose Monitoring in Healthy Adults and Those with Type 2 Diabetes. Diabetes Ther 2021; 12:1871-1886. [PMID: 34047962 PMCID: PMC8266934 DOI: 10.1007/s13300-021-01081-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION While continuous glucose monitoring (CGM) has been shown to decrease both hyper- and hypoglycemia in insulin-treated diabetes, its value in non-insulin-treated type 2 diabetes (T2D) and prediabetes is unclear. Studies examining the reduction in hyperglycemia with the use of CGM in non-insulin-treated T2D are limited. METHODS We investigated the potential benefit of CGM combined with a mobile app that links each individual's glucose tracing to meal composition, heart rate, and physical activity in a cohort of 1022 individuals, ranging from nondiabetic to non-insulin-treated T2D, spanning a wide range of demographic, geographic, and socioeconomic characteristics. The primary endpoint was the change in time in range (TIR), defined as 54-140 mg/dL for healthy and prediabetes, and 54-180 mg/dL for T2D, from the beginning to end of a 10-day period of use of the Freestyle Libre CGM. Logged food intake, physical activity, continuous glucose, and heart rate data were captured by a smartphone-based app that continuously provided feedback to participants, overlaying daily glucose patterns with activity and food intake, including macronutrient breakdown, glycemic load (GL), and glycemic index (GI). RESULTS A total of 665 participants meeting eligibility and data requirements were included in the final analysis. Among self-reported nondiabetic participants, CGM identified glucose excursions in the diabetic range among 15% of healthy and 36% of those with prediabetes. In the group as a whole, TIR improved significantly (p < 0.001). Among the 51.4% of participants who improved, TIR increased by an average of 6.4% (p < 0.001). Of those with poor baseline TIR, defined as TIR below comparable A1c thresholds for T2D and prediabetes, 58.3% of T2D and 91.7% of healthy/prediabetes participants improved their TIR by an average of 22.7% and 23.2%, respectively. Predictors of improved response included no prior diagnosis of T2D and lower BMI. CONCLUSIONS These results indicate that 10-day use of CGM as a part of multimodal data collection, with synthesis and feedback to participants provided by a mobile health app, can significantly reduce hyperglycemia in non-insulin-treated individuals, including those with early stages of glucose dysregulation.
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Affiliation(s)
| | | | - Salar Rahili
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA
| | - Kirill Karlin
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA
| | - Darrin Scilley
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA
| | - Riya Thakkar
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA
| | - Maziyar Saberi
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA
| | - Noosheen Hashemi
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA
| | - Dalia Perelman
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA
| | - Nima Aghaeepour
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA
| | | | - Michael P Snyder
- January AI, 1259 El Camino Real #231, Menlo Park, CA, 94025, USA.
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49
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Abstract
Background: Randomized controlled trials have investigated the effect of continuous glucose monitors on hemoglobin A1C; however, more evidence is needed to justify their use and expand insurance coverage. Additionally, there are few published studies investigating the A1C lowering effect of flash glucose monitors (FGMs) in broad diabetes populations with varying insulin requirements. This analysis aimed to help fill this gap in medical literature and help clinicians evaluate costs/benefits when considering FGMs for their patients with diabetes. Objectives: To determine the association between FGM use and A1C reduction in patients with type 1 or type 2 diabetes mellitus regardless of insulin dependence. Methods: Pharmacy dispensing records were used to identify patients for inclusion. Patients who received a FGM from a University of Utah pharmacy between July 7, 2018 and July 7, 2020 were included. Patients who did not receive at least an 84-day supply of FGM sensors or did not have a baseline or follow-up A1C were excluded. Baseline and follow-up A1Cs, defined as A1Cs that are within one year before and 3-12 months after the FGM dispense date, were collected for each patient. New diabetes medications within a six-month window of the initial FGM dispense date were also recorded. Outcome variables were collected before and after patients received their first FGM (pre-FGM vs. post-FGM, respectively). The primary outcome was the difference between baseline and follow-up A1C for each patient. Secondary outcomes were the difference in baseline and follow-up A1C for various clinical subgroups within the overall sample. Descriptive statistics were used to summarize baseline characteristics and outcome data. Paired Student's t-tests were used to evaluate outcome differences (α=0.05). Results: Fifty-seven patients (50.8% male; mean age: 49 years) were included. For the primary outcome, the average baseline and follow-up A1Cs were 9.33% and 8.32%, respectively for a difference of -1.01% ([95%CI -1.31:-0.72]; p<0.0001). Conclusions: The use of FGMs is associated with decreases in A1C within a cohort of patients at one health system. Further effort to determine impact of FGM on clinical and economic outcomes is warranted.
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Affiliation(s)
| | - Kyle Turner
- Department of Pharmacotherapy, University of Utah College of Pharmacy
| | - Daniel Witt
- Department of Pharmacotherapy, University of Utah College of Pharmacy
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50
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Al Hayek A, Al Dawish M, El Jammal M. The Impact of Flash Glucose Monitoring on Markers of Glycaemic Control and Patient Satisfaction in Type 2 Diabetes. Cureus 2021; 13:e16007. [PMID: 34354874 PMCID: PMC8328808 DOI: 10.7759/cureus.16007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The effect of flash glucose monitoring on glycaemic control and patient satisfaction in insulin-treated type 2 diabetes (T2D) from Saudi Arabia is uncertain. The aim of this prospective observational study was to evaluate the change in HbA1c (Hemoglobin A1c) and satisfaction with treatment following the initiation of flash glucose monitoring. METHODS This single-arm, single-centre prospective observational study included flash glucose monitoring-naive adult patients with T2D managed with multiple daily injections of insulin therapy (MDI) and HbA1c ≥7%. HbA1c was measured, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ, Arabic version) and Glucose Monitoring Satisfaction Survey (GMSS) were completed at baseline and 12 weeks. RESULTS For participants (n=54) from one diabetes centre, HbA1c significantly improved by 0.44% from 8.22%±0.69 (mean±SD) at baseline to 7.78%±0.71 at 12 weeks, p<0.001. Confirmed hypoglycaemic episodes reduced from 4.43±1.51 episodes/month to 1.24±1.15 (-3.19, p<0.001). Glucose monitoring frequency improved, indicated by the number of scans per day, with a mean increase of 5.13 (p <0.001) tests/day. GMSS scores improved across all four categories, as did overall treatment satisfaction (p<0.001 for all categories). Patients perceived clear improvements across all questions relating to satisfaction and frequency of hypo- or hyperglycaemic episodes. CONCLUSION Following initiation of flash glucose monitoring in patients with T2D and MDI insulin therapy, HbA1c improved with reduced hypoglycaemic events and increased patient-reported satisfaction. This study contributes valuable data on the use of flash glucose monitoring in this population, and a larger multicentre study is warranted to inform future health policy for T2D in Saudi Arabia.
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Affiliation(s)
- Ayman Al Hayek
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, SAU
| | - Mohamed Al Dawish
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, SAU
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