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Klonoff DC, Gabbay M, Moon SJ, Wilmot EG. Importance of FDA-Integrated Continuous Glucose Monitors to Ensure Accuracy of Continuous Glucose Monitoring. J Diabetes Sci Technol 2024:19322968241250357. [PMID: 38695387 DOI: 10.1177/19322968241250357] [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] [Indexed: 05/04/2024]
Abstract
Continuous glucose monitoring (CGM) has been shown to improve glycemic control and self-monitoring, as well as to reduce the risk of hypoglycemia. Integrated CGM (iCGM) FDA-cleared systems with published performance data are established nonadjunctive and accurate CGM tools that can directly inform decision-making in the treatment of diabetes (i.e., insulin dosing). Studies have assessed accuracy and safety data of CGMs that were eventually cleared for iCGM by the FDA and that informed the recommendation for their nonadjunctive use. Subsequent robust clinical trials and real-world studies demonstrated clinical effectiveness with improvements in a range of patient outcomes. In recent years, a number of non-iCGM-approved CGM devices have entered the market outside the United States worldwide. Some of these non-iCGM-approved CGM devices require additional user verification of blood glucose levels to be performed for making treatment decisions, termed adjunctive. Moreover, in many non-iCGM-approved CGM devices, accuracy studies published in peer-reviewed journals are scarce or have many limitations. Consequently, non-iCGM-approved CGM devices cannot be automatically perceived as having the same performance or quality standards than those approved for iCGM by the FDA. As a result, although these devices tend to cost less than iCGMs that carry FDA clearance and could therefore be attractive from the point of view of a health care payer, it must be emphasized that evaluation of costs should not be limited to the device (such as the usability preference that patients have for nonadjunctive sensors compared to adjunctive sensors) but to the wider value of the total benefit that the product provides to the patient.
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Affiliation(s)
- David C Klonoff
- Diabetes Research Institute, Mills-Península Medical Center, San Mateo, CA, USA
| | - Monica Gabbay
- UNIFESP-Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Sun Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Emma G Wilmot
- School of Medicine Academic Unit for Translational Medical Sciences, University of Notitngham, Derby, UK
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Mader JK, Fornengo R, Hassoun A, Heinemann L, Kulzer B, Monica M, Nguyen T, Sieber J, Renard E, Reznik Y, Ryś P, Stożek-Tutro A, Wilmot EG. Relationship Between Lipohypertrophy, Glycemic Control, and Insulin Dosing: A Systematic Meta-Analysis. Diabetes Technol Ther 2024; 26:351-362. [PMID: 38215209 PMCID: PMC11058417 DOI: 10.1089/dia.2023.0491] [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: 01/14/2024]
Abstract
Background: Lipohypertrophy is a common complication in patients with diabetes receiving insulin therapy. There is a lack of consensus regarding how much lipohypertrophy affects diabetes management. Our study aimed to assess the potential correlation between lipohypertrophy and glycemic control, as well as insulin dosing in patients with diabetes. Methods: We performed a systematic review followed by a meta-analysis to collect data about glycemic control and insulin dosing in diabetic patients with and without lipohypertrophy. To identify relevant studies published in English, we searched medical databases (MEDLINE/PubMed, Embase, and CENTRAL) from 1990 to January 20, 2023. An additional hand-search of references was performed to retrieve publications not indexed in medical databases. Results of meta-analyses were presented either as prevalence odds ratios (pORs) or mean differences (MDs) with 95% confidence intervals (95% CIs). This study was registered on PROSPERO (CRD42023393103). Results: Of the 5540 records and 240 full-text articles screened, 37 studies fulfilled the prespecified inclusion criteria. Performed meta-analyses showed that patients with lipohypertrophy compared with those without lipohypertrophy were more likely to experience unexplained hypoglycemia (pOR [95% CI] = 6.98 [3.30-14.77]), overall hypoglycemia (pOR [95% CI] = 6.65 [1.37-32.36]), and glycemic variability (pOR [95% CI] = 5.24 [2.68-10.23]). Patients with lipohypertrophy also had higher HbA1c (MD [95% CI] = 0.55 [0.23-0.87] %), and increased daily insulin consumption (MD [95% CI] = 7.68 IU [5.31-10.06]). Conclusions: These results suggest that overall glycemic control is worse in patients with lipohypertrophy than in those without this condition.
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Affiliation(s)
- Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ricardo Fornengo
- Dipartimento di Area Medica, ASL TO4 S.S.D. di Diabetologia, Chivasso, Italy
| | - Ahmed Hassoun
- Department of Medicine, Fakeeh University Hospital, Dubai, United Arab Emirates
| | | | - Bernhard Kulzer
- Research Institute Diabetes Academy Bad Mergentheim (FIDAM), Diabetes Center Bad Mergentheim, Bad Mergentheim, Germany
| | - Magdalena Monica
- HTA Consulting, Cracow, Poland
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | | | | | - Eric Renard
- Montpellier University Hospital and University of Montpellier, Montpellier, France
| | - Yves Reznik
- Endocrinology and Diabetes Department, CHU Côte de Nacre, Caen Cedex, France
| | | | - Anita Stożek-Tutro
- HTA Consulting, Cracow, Poland
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Emma G. Wilmot
- Department of Translational Medical Sciences, University of Nottingham, Nottingham, United Kingdom
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Ssemmondo E, Deshmukh H, Wilmot EG, Adeleke KA, Shah N, Walton C, Barnes D, Ryder REJ, Sathyapalan T. Effect of intermittently scanned continuous glucose monitoring in people with diabetes with a psychosocial indication for initiation. Diabetes Obes Metab 2024; 26:1340-1345. [PMID: 38228571 DOI: 10.1111/dom.15435] [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: 09/18/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
AIM To understand the effect of intermittently scanned continuous glucose monitoring (isCGM) in people with diabetes with a 'psychosocial' indication for access. METHODS The study utilized baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes in the UK. Diabetes-related distress (DRD) was assessed using the two-item diabetes-related distress scale (DDS). Participants were categorized into two groups: high DRD (DDS score ≥ 3) and lower DRD (DDS score < 3). The t-test was used to assess the difference in the pre- and post-isCGM continuous variables. RESULTS The study consisted of 17 036 people with diabetes, with 1314 (7%) using isCGM for 'psychosocial' reasons. Follow-up data were available for 327 participants, 322 (99%) of whom had type 1 diabetes with a median diabetes duration of 15 years; 75% (n = 241) had high levels of DRD. With the initiation of isCGM, after a mean follow-up period of 6.9 months, there was a significant reduction in DDS score; 4 at baseline versus 2.5 at follow-up (P < .001). The prevalence of high DRD reduced from 76% to 38% at follow-up (50% reduction in DRD, P < .001). There was also a significant reduction in HbA1c (78.5 mmol/mol [9.3%] at baseline vs. 66.5 mmol/mol [8.2%] at follow-up; P < .001). This group also experienced an 87% reduction in hospital admissions because of hyperglycaemia/diabetic ketoacidosis (P < .001). CONCLUSION People with diabetes who had isCGM initiated for a psychosocial indication had high levels of DRD and HbA1c, which improved with the use of isCGM.
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Affiliation(s)
- Emmanuel Ssemmondo
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Harshal Deshmukh
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby & Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Kazeem A Adeleke
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Najeeb Shah
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Thozhukat Sathyapalan
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
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Deshmukh H, Adeleke K, Wilmot EG, Folwell A, Barnes D, Walker N, Saunders S, Ssemmondo E, Walton C, Patmore J, Ryder REJ, Sathyapalan T. Clinical features of type 1 diabetes in older adults and the impact of intermittently scanned continuous glucose monitoring: An Association of British Clinical Diabetologists (ABCD) study. Diabetes Obes Metab 2024; 26:1333-1339. [PMID: 38164758 DOI: 10.1111/dom.15434] [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: 11/04/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
AIMS To evaluate the clinical features and impact of flash glucose monitoring in older adults with type 1 diabetes (T1D) across age groups defined as young-old, middle-old, and old-old. MATERIALS AND METHODS Clinicians were invited to submit anonymized intermittently scanned continuous glucose monitoring (isCGM) user data to a secure web-based tool within the National Health Service secure network. We collected baseline data before isCGM initiation, such as demographics, glycated haemoglobin (HbA1c) values from the previous 12 months, Gold scores and Diabetes Distress Scale (DDS2) scores. For analysis, people with diabetes were classified as young-old (65-75 years), middle-old (>75-85 years) and old-old (>85 years). We compared baseline clinical characteristics across the age categories using a t test. All the analyses were performed in R 4.1.2. RESULTS The study involved 1171 people with diabetes in the young-old group, 374 in the middle-old group, and 47 in the old-old group. There were no significant differences in baseline HbA1c and DDS2 scores among the young-old, middle-old, and old-old age groups. However, Gold score increased with age (3.20 [±1.91] in the young-old vs. 3.46 [±1.94] in the middle-old vs. 4.05 [±2.28] in the old-old group; p < 0.0001). This study showed reduced uptake of insulin pumps (p = 0.005) and structured education (Dose Adjustment For Normal Eating [DAFNE] course; p = 0.007) in the middle-old and old-old populations compared to the young-old population with T1D. With median isCGM use of 7 months, there was a significant improvement in HbA1c in the young-old (p < 0.001) and old-old groups, but not in the middle-old group. Diabetes-related distress score (measured by the DDS2) improved in all three age groups (p < 0.001) and Gold score improved (p < 0.001) in the young-old and old-old populations but not in the middle-old population. There was also a significant improvement in resource utilization across the three age categories following the use of is CGM. CONCLUSION This study demonstrated significant differences in hypoglycaemia awareness and insulin pump use across the older age groups of adults with T1D. The implementation of isCGM demonstrated significant improvements in HbA1c, diabetes-related distress, hypoglycaemia unawareness, and resource utilization in older adults with T1D.
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Affiliation(s)
- Harshal Deshmukh
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Kazeem Adeleke
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby & Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Anna Folwell
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - Neil Walker
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Simon Saunders
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Rainhill, UK
| | - Emmanuel Ssemmondo
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Jane Patmore
- Allam Diabetes Centre, University of Hull, Hull, UK
| | | | - Thozhukat Sathyapalan
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
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Elliott RA, Rogers G, Evans ML, Neupane S, Rayman G, Lumley S, Cranston I, Narendran P, Sutton CJ, Taxiarchi VP, Burns M, Thabit H, Wilmot EG, Leelarathna L. Estimating the cost-effectiveness of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in England. Diabet Med 2024; 41:e15232. [PMID: 37750427 DOI: 10.1111/dme.15232] [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: 07/23/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE We previously showed that intermittently scanned continuous glucose monitoring (isCGM) reduces HbA1c at 24 weeks compared with self-monitoring of blood glucose with finger pricking (SMBG) in adults with type 1 diabetes and high HbA1c levels (58-97 mmol/mol [7.5%-11%]). We aim to assess the economic impact of isCGM compared with SMBG. METHODS Participant-level baseline and follow-up health status (EQ-5D-5L) and within-trial healthcare resource-use data were collected. Quality-adjusted life-years (QALYs) were derived at 24 weeks, adjusting for baseline EQ-5D-5L. Participant-level costs were generated. Using the IQVIA CORE Diabetes Model, economic analysis was performed from the National Health Service perspective over a lifetime horizon, discounted at 3.5%. RESULTS Within-trial EQ-5D-5L showed non-significant adjusted incremental QALY gain of 0.006 (95% CI: -0.007 to 0.019) for isCGM compared with SMBG and an adjusted cost increase of £548 (95% CI: 381-714) per participant. The lifetime projected incremental cost (95% CI) of isCGM was £1954 (-5108 to 8904) with an incremental QALY (95% CI) gain of 0.436 (0.195-0.652) resulting in an incremental cost-per-QALY of £4477. In all subgroups, isCGM had an incremental cost-per-QALY better than £20,000 compared with SMBG; for people with baseline HbA1c >75 mmol/mol (9.0%), it was cost-saving. Sensitivity analysis suggested that isCGM remains cost-effective if its effectiveness lasts for at least 7 years. CONCLUSION While isCGM is associated with increased short-term costs, compared with SMBG, its benefits in lowering HbA1c will lead to sufficient long-term health-gains and cost-savings to justify costs, so long as the effect lasts into the medium term.
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Affiliation(s)
- Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Mark L Evans
- Wellcome-MRC Institute of Metabolic Science, NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge, UK
| | - Sankalpa Neupane
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Gerry Rayman
- The Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | | | - Iain Cranston
- Academic Department of Diabetes & Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher J Sutton
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew Burns
- Manchester Clinical Trials Unit, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester, Manchester, UK
| | - Hood Thabit
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma G Wilmot
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Lalantha Leelarathna
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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6
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Leelarathna L, Sutton CJ, Evans ML, Neupane S, Rayman G, Lumley S, Cranston I, Narendran P, Krishan A, Taxiarchi VP, Barnard-Kelly K, Elliott RA, Burns M, Camm M, Thabit H, Wilmot EG. Intermittently scanned continuous glucose monitoring in adults with type 1 diabetes: A subgroup analysis from the FLASH-UK study. Diabet Med 2024; 41:e15249. [PMID: 37897112 DOI: 10.1111/dme.15249] [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: 08/24/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
AIMS The FLASH-UK trial showed lower HbA1c with intermittently scanned continuous glucose monitoring (isCGM), as compared with self monitoring of blood glucose (SMBG), in adults with type 1 diabetes and HbA1c ≥58 mmol/mol (≥7.5%). Here, we present results from the pre-specified subgroup analysis for the 24-week HbA1c (primary outcome) and selected sensor-based secondary outcomes. METHODS This was a multi-centre, parallel-design, randomised controlled trial. The difference in treatment effect between subgroups (baseline HbA1c [≤75 vs. >75 mmol/mol] [≤9.0 vs >9.0%], treatment modality [pump vs injections], prior participation in structured education, age, educational level, impaired awareness of hypoglycaemia, deprivation index quintile sex, ethnic group and Patient Health Questionnaire-9 [PHQ-9] detected depression category) were evaluated. RESULTS One hundred fifty-six participants (females 44%, mean [SD] baseline HbA1c 71 [9] mmol/mol 8.6 [0.8%], age 44 [15]) were randomly assigned, in a 1:1 ratio to isCGM (n = 78) or SMBG (n = 78). The mean (SD) baseline HbA1c (%) was 8.7 (0.9) in the isCGM group and 8.5 (0.8) in the SMBG group, lowering to 7.9 (0.8) versus 8.3 (0.9), respectively, at 24 weeks (adjusted mean difference -0.5, 95% confidence interval [CI] -0.7 to -0.3; p < 0.001]. For HbA1c, there was no impact of treatment modality, prior participation in structured education, deprivation index quintile, sex or baseline depression category. The between-group difference in HbA1c was larger for younger people (a reduction of 2.7 [95% CI 0.3-5.0; p = 0.028] mmol/mol for every additional 15 years of age). Those with HbA1c 76-97 mmol/mol (>9.0%-11.0%) had a marginally non-significant higher reduction in HbA1c of 8.4 mmol/mol (3.3-13.5) compared to 3.1 (0.3-6.0) in those with HbA1c 58-75 mmol/mol (p = 0.08). For 'Time in range' (% 3.9-10 mmol/L), the difference was larger for those with at least a bachelor's degree. For 'Time below range' (% <3.9 mmol/L), the difference was larger for those using injections, older people and those with less than bachelor's degree. CONCLUSIONS Intermittently scanned continuous glucose monitoring is generally effective across a range of baseline characteristics.
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Affiliation(s)
- Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Christopher J Sutton
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Clinical Trials Unit, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Mark L Evans
- Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge, UK
| | - Sankalpa Neupane
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Gerry Rayman
- The Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | | | - Iain Cranston
- Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Ashma Krishan
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Matthew Burns
- Manchester Clinical Trials Unit, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Maisie Camm
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emma G Wilmot
- University of Nottingham, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
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7
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Liarakos AL, Hasan N, Crabtree TSJ, Leelarathna L, Hammond P, Hussain S, Haq M, Aslam A, Gatdula E, Gibb FW, Lumb A, Bull K, Chinnasamy E, Carrieri G, Williams DM, Choudhary P, Ryder REJ, Wilmot EG. Real-world outcomes of Omnipod DASH system use in people with type 1 diabetes: Evidence from the Association of British Clinical Diabetologists (ABCD) study. Diabetes Res Clin Pract 2024; 209:111597. [PMID: 38417535 DOI: 10.1016/j.diabres.2024.111597] [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: 01/12/2024] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
AIMS To evaluate real-world outcomes in people with Type 1 Diabetes (PwT1D) initiated on Omnipod DASH® Insulin Management System. METHODS Anonymized clinical data were submitted to a secure web-based tool within the National Health Service network. Hemoglobin A1c (HbA1c), sensor-derived glucometrics, total daily dose of insulin (TDD), and patient-reported outcome changes between baseline and follow-up were assessed. Individuals were classified to "new-to-pump" (switched from multiple daily injections) and "established-on-pump" (switched from a tethered insulin pump) groups. RESULTS 276 individuals from 11 centers [66.7 % female; 92 % White British; median age 41 years (IQR 20-50); diabetes duration 20 years (IQR 11-31); 49.3 % within "new-to-pump" group] were included. Baseline HbA1c was 8.0 ± 1.3 % (64 ± 14 mmol/mol). At follow-up [3 years (IQR 1.5-3.2)], HbA1c reduced by 0.3 % [(3 mmol/mol); p = 0.002] across the total population, 0.4 % [(5 mmol/mol); p = 0.001] in those "new-to-pump" and remained unchanged in those "established-on-pump". TDD decreased in the "new-to-pump" cohort (baseline:44.9 ± 21.0units vs follow-up:38.1 ± 15.4units, p = 0.002). Of those asked, 141/143 (98.6 %) stated Omnipod DASH had a positive impact on quality of life. CONCLUSIONS Omnipod DASH was associated with improvements in HbA1c in PwT1D "new-to-pump" and maintained previous HbA1c levels in those "established-on-pump". User satisfaction in all groups and TDD reduction in those "new-to-pump" were reported.
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Affiliation(s)
- Alexandros L Liarakos
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Nebras Hasan
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Thomas S J Crabtree
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Lalantha Leelarathna
- Diabetes, Endocrinology and Metabolism Center, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Peter Hammond
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, UK
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK
| | - Masud Haq
- Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Royal Tunbridge Wells, UK
| | - Aisha Aslam
- Diabetes, Endocrinology and Metabolism Center, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Erneda Gatdula
- Cardiff and Vale University Health Board, University Hospital of Llandough, Llandough, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Kirsty Bull
- Stockport Foundation Trust, Stepping Hill Hospital, Stockport, UK
| | - Eswari Chinnasamy
- Kingston Hospital NHS Foundation Trust, Kingston Hospital, Surrey, UK
| | - Giorgio Carrieri
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, UK
| | - David M Williams
- Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
| | - Pratik Choudhary
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, UK; Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, UK
| | - Robert E J Ryder
- Department of Diabetes and Endocrinology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Emma G Wilmot
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
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Forlenza GP, DeSalvo DJ, Aleppo G, Wilmot EG, Berget C, Huyett LM, Hadjiyianni I, Méndez JJ, Conroy LR, Ly TT, Sherr JL. Real-World Evidence of Omnipod ® 5 Automated Insulin Delivery System Use in 69,902 People with Type 1 Diabetes. Diabetes Technol Ther 2024. [PMID: 38375861 DOI: 10.1089/dia.2023.0578] [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] [Indexed: 02/21/2024]
Abstract
Background: The Omnipod® 5 Automated Insulin Delivery System was associated with favorable glycemic outcomes for people with type 1 diabetes (T1D) in two pivotal clinical trials. Real-world evidence is needed to explore effectiveness in nonstudy conditions. Methods: A retrospective analysis of the United States Omnipod 5 System users (aged ≥2 years) with T1D and sufficient data (≥90 days of data; ≥75% of days with ≥220 continuous glucose monitor readings/day) available in Insulet Corporation's device and person-reported datasets as of July 2023 was performed. Target glucose setting usage (i.e., 110-150 mg/dL in 10 mg/dL increments) was summarized and glycemic outcomes were examined. Subgroup analyses of those using the lowest average glucose target (110 mg/dL) and stratification by baseline characteristics (e.g., age, prior therapy, health insurance coverage) were conducted. Results: In total, 69,902 users were included. Multiple and higher glucose targets were more commonly used in younger age groups. Median percentage of time in range (TIR; 70-180 mg/dL) was 68.8%, 61.3%, and 53.6% for users with average glucose targets of 110, 120, and 130-150 mg/dL, respectively, with minimal time <70 mg/dL (all median <1.13%). Among those with an average glucose target of 110 mg/dL (n = 37,640), median TIR was 65.0% in children and adolescents (2-17 years) and 69.9% in adults (≥18 years). Subgroup analyses of users transitioning from Omnipod DASH or multiple daily injections and of Medicaid/Medicare users demonstrated favorable glycemic outcomes among these groups. Conclusion: These glycemic outcomes from a large and diverse sample of nearly 70,000 children and adults demonstrate effective use of the Omnipod 5 System under real-world conditions.
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Affiliation(s)
- Gregory P Forlenza
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel J DeSalvo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emma G Wilmot
- Translational Medical Sciences, University of Nottingham, School of Medicine, Royal Derby Hospital, Derby, United Kingdom
| | - Cari Berget
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | | | - Trang T Ly
- Insulet Corporation, Acton, Massachusetts, USA
| | - Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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9
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Mark-Wagstaff C, Deshmukh H, Wilmot EG, Walker N, Barnes D, Parfitt V, Saunders S, Gregory R, Choudhary P, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Intermittently scanned continuous glucose monitoring and hypoglycaemia awareness in drivers with diabetes: Insights from the Association of British Clinical Diabetologists Nationwide audit. Diabetes Obes Metab 2024; 26:46-53. [PMID: 37718554 DOI: 10.1111/dom.15283] [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: 07/24/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
AIM Frequent hypoglycaemia results in disruption to usual hypoglycaemic autonomic responses leading to impaired awareness of hypoglycaemia, which is associated with an increased risk of severe hypoglycaemia requiring third-party assistance (SH). The UK Driving and Vehicle Licensing Agency (DVLA) does not permit car driving if they have either a complete loss of hypoglycaemia awareness or more than one SH event a year. METHODS The FreeStyle Libre (FSL) Association of British Clinical Diabetologists (ABCD) Nationwide Audit consists of data collected by clinicians during routine clinical work, submitted into a secure web-based tool held within the National Health Service (NHS) N3 network. Analysis of paired baseline and follow-up data for people with type 1 diabetes who also held a driving licence was undertaken. RESULTS The study consisted of 6304 people who had data recorded about driving status from 102 UK specialist diabetes centres, of which 4218 held a driving licence: 4178 a group 1, standard licence, 33 a group 2, large lorries and buses, seven a taxi licence; 1819 did not drive. Paired baseline and follow-up data were available for a sub-cohort of 1606/4218. At a mean follow-up of 6.9 months [95% CI (6.8, 7.1)], the Gold score had improved (2.3 ± 1.5 vs. 2.0 ± 1.3 p < .001), and the number of people who experienced an SH episode was also significantly lower (12.1% vs. 2.7%, p < .001). CONCLUSION This study suggests that intermittently scanned continuous glucose monitoring may improve impaired awareness of hypoglycaemia and reduce the number of people with type 1 diabetes with a driving licence experiencing a severe hypoglycaemic episode.
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Affiliation(s)
| | - Harshal Deshmukh
- Hull University Teaching Hospitals NHS Trust, Hull, UK
- University of Hull, Hull, UK
| | - Emma G Wilmot
- University of Nottingham, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Neil Walker
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Dennis Barnes
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | | | | | - Rob Gregory
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Jane Patmore
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Robert E J Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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10
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Giorgino F, Battelino T, Bergenstal RM, Forst T, Green JB, Mathieu C, Rodbard HW, Schnell O, Wilmot EG. The Role of Ultra-Rapid-Acting Insulin Analogs in Diabetes: An Expert Consensus. J Diabetes Sci Technol 2023:19322968231204584. [PMID: 37937585 DOI: 10.1177/19322968231204584] [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] [Indexed: 11/09/2023]
Abstract
Ultra-rapid-acting insulin analogs (URAA) are a further development and refinement of rapid-acting insulin analogs. Because of their adapted formulation, URAA provide an even faster pharmacokinetics and thus an accelerated onset of insulin action than conventional rapid-acting insulin analogs, allowing for a more physiologic delivery of exogenously applied insulin. Clinical trials have confirmed the superiority of URAA in controlling postprandial glucose excursions, with a safety profile that is comparable to the rapid-acting insulins. Consequently, many individuals with diabetes mellitus may benefit from URAA in terms of prandial glycemic control. Unfortunately, there are only few available recommendations from authoritative sources for use of URAA in clinical practice. Therefore, this expert consensus report aims to define populations of people with diabetes mellitus for whom URAA may be beneficial and to provide health care professionals with concrete, practical recommendations on how best to use URAA in this context.
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Affiliation(s)
- 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
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolism, UCH-University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Thomas Forst
- Department of Endocrinology and Metabolic Diseases, Johannes Gutenberg University Medical Center, Mainz, Germany
- Clinical Research Services, Mannheim, Germany
| | - Jennifer B Green
- Division of Endocrinology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Oliver Schnell
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Academic Unit for Translational Medical Sciences, University of Nottingham, Nottingham, England, UK
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11
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Crabtree TS, Griffin TP, Yap YW, Narendran P, Gallen G, Furlong N, Cranston I, Chakera A, Philbey C, Karamat MA, Saraf S, Kamaruddin S, Gurnell E, Chapman A, Hussain S, Elliott J, Leelarathna L, Ryder RE, Hammond P, Lumb A, Choudhary P, Wilmot EG. Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study. Diabetes Care 2023; 46:1831-1838. [PMID: 37566697 PMCID: PMC10516256 DOI: 10.2337/dc23-0635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy. RESEARCH DESIGN AND METHODS We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed-loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.5% who were willing to commence HCL therapy were included. Outcomes included change in HbA1c, sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), acute event rates, and user opinion of HCL. RESULTS In total, 570 HCL users were included (median age 40 [IQR 29-50] years, 67% female, and 85% White). Mean baseline HbA1c was 9.4 ± 0.9% (78.9 ± 9.1 mmol/mol) with a median follow-up of 5.1 (IQR 3.9-6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8; P < 0.0001) (18.1 mmol/mol [95% CI 16.6, 19.6]; P < 0.0001). Time in range (70-180 mg/dL) increased from 34.2 to 61.9% (P < 0.001). Individuals with HbA1c of ≤58 mmol/mol rose from 0 to 39.4% (P < 0.0001), and those achieving ≥70% glucose time in range and <4% time below range increased from 0.8 to 28.2% (P < 0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7% [540 of 570]). CONCLUSIONS Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia, and diabetes-related distress and quality of life in people with type 1 diabetes in the real world.
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Affiliation(s)
- Thomas S.J. Crabtree
- Department of Diabetes and Endocrinology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Trusts, Derby, U.K
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, U.K
| | - Tomás P. Griffin
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, U.K
- Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, U.K
| | - Yew W. Yap
- Department of Diabetes and Endocrinology, Aintree University Hospital, Liverpool University Hospital NHS Foundation Trust, Liverpool, U.K
| | - Parth Narendran
- Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, Birmingham, U.K
- The Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, U.K
| | | | - Niall Furlong
- Diabetes Center, St. Helens Hospital, St. Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, U.K
| | - Iain Cranston
- Academic Department of Endocrinology and Diabetes Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Portsmouth, U.K
| | - Ali Chakera
- Department of Diabetes and Endocrinology, University Hospitals Sussex, Brighton, U.K
- Brighton and Sussex Medical School, Brighton, U.K
| | - Chris Philbey
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, U.K
| | - Muhammad Ali Karamat
- Department of Diabetes and Endocrinology, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Sanjay Saraf
- Department of Diabetes and Endocrinology, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, U.K
| | - Shafie Kamaruddin
- Department of Diabetes and Endocrinology, County Durham and Darlington Foundation Trust, Darlington, U.K
| | - Eleanor Gurnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Trust, Cambridge, U.K
| | - Alyson Chapman
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, U.K
| | - Sufyan Hussain
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King’s College London, London, U.K
- Department of Diabetes and Endocrinology, Guy’s and St. Thomas’ NHS Foundation Trust, London, U.K
| | - Jackie Elliott
- Diabetes and Endocrine Center, Sheffield Teaching Hospitals, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, U.K
| | - Lalantha Leelarathna
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, U.K
| | - Robert E.J. Ryder
- Department of Diabetes and Endocrinology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K
| | - Peter Hammond
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, U.K
| | - Alistair Lumb
- Oxford Center for Diabetes Endocrinology and Metabolism, Oxford University Hospitals NHS Trust, Oxford, U.K
- National Institute for Health and Care Research, Oxford Biomedical Research Center, Oxford, U.K
| | - Pratik Choudhary
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, U.K
- Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, U.K
| | - Emma G. Wilmot
- Department of Diabetes and Endocrinology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Trusts, Derby, U.K
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, U.K
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12
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Griffin TP, Gallen G, Hartnell S, Crabtree T, Holloway M, Gibb FW, Lumb A, Wilmot EG, Choudhary P, Hussain S. UK's Association of British Clinical Diabetologist's Diabetes Technology Network (ABCD-DTN): Best practice guide for hybrid closed-loop therapy. Diabet Med 2023; 40:e15078. [PMID: 36932929 DOI: 10.1111/dme.15078] [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: 01/18/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/19/2023]
Abstract
This best practice guide is written with the aim of providing an overview of current hybrid closed-loop (HCL) systems in use within the United Kingdom's (UK) National Health Service (NHS) and to provide education and advice for their management on both an individual and clinical service level. The environment of diabetes technology, and particularly HCL systems, is rapidly evolving. The past decade has seen unprecedented advances in the development of HCL systems. These systems improve glycaemic outcomes and reduce the burden of treatment for people with type 1 diabetes (pwT1D). It is anticipated that access to these systems will increase in England as a result of updates in National Institute of Health and Care Excellence (NICE) guidance providing broader support for the use of real-time continuous glucose monitoring (CGM) for pwT1D. NICE is currently undertaking multiple-technology appraisal into HCL systems. Based on experience from centres involved in supporting advanced technologies as well as from the recent NHS England HCL pilot, this guide is intended to provide healthcare professionals with UK expert consensus on the best practice for initiation, optimisation and ongoing management of HCL therapy.
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Affiliation(s)
- Tomás P Griffin
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
- Diabetes Research Centre, College of Health Sciences, University of Leicester, Leicester, UK
- School of Medicine, University of Limerick, Limerick, Ireland
- Centre for Diabetes and Endocrinology, University Hospital Limerick, Limerick, Ireland
| | - Geraldine Gallen
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK
| | - Sara Hartnell
- Department of Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Crabtree
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
| | | | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
| | - Pratik Choudhary
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
- Diabetes Research Centre, College of Health Sciences, University of Leicester, Leicester, UK
| | - Sufyan Hussain
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, London, UK
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13
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Field BCT, Ruan Y, Várnai KA, Davies J, Ryder REJ, Gandhi R, Harris S, Nagi D, Patel D, Kempegowda P, Wild SH, Wilmot EG, Khunti K, Rea R, Narendran P. A UK nationwide study of adults admitted to hospital with diabetic ketoacidosis or hyperosmolar hyperglycaemic state and COVID-19. Diabetes Obes Metab 2023. [PMID: 37016487 DOI: 10.1111/dom.15076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/06/2023]
Abstract
AIMS To investigate characteristics of people hospitalised with coronavirus-disease-2019 (COVID-19) and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS), and to identify risk factors for mortality and intensive care admission. MATERIALS AND METHODS Retrospective cohort study with anonymised data from the Association of British Clinical Diabetologists nationwide audit of hospital admissions with COVID-19 and diabetes, from start of pandemic to November 2021. Primary outcome was inpatient mortality. DKA and HHS were adjudicated against national criteria. Age-adjusted odds ratios (ORs) were calculated using logistic regression. RESULTS 85 confirmed DKA cases, and 20 HHS, occurred among 4073 people (211 type 1 diabetes, 3748 type 2 diabetes, 114 unknown type) hospitalised with COVID-19. Mean(SD) age was 60(18.2)y in DKA and 74(11.8)y in HHS (P < 0.001). A higher proportion of patients with HHS than with DKA were of non-White ethnicity (71.4% vs 39.0% P = 0.038). Mortality in DKA was 36.8% (n = 57) and 3.8% (n = 26) in type 2 and type 1 diabetes respectively. Among people with type 2 diabetes and DKA, mortality was lower in insulin users compared to non-users (21.4% vs. 52.2%; age-adjusted OR 0.13 [95%CI 0.03-0.60]). Crude mortality was lower in DKA than HHS (25.9% vs. 65.0%, P = 0.001) and in statin users vs non-users (36.4% vs. 100%; P = 0.035) but these were not statistically significant after age adjustment. CONCLUSIONS Hospitalisation with COVID-19 and adjudicated DKA is four times more common than HHS but both associate with substantial mortality. There is a strong association of prior insulin therapy with survival in type 2 diabetes-associated DKA. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Benjamin C T Field
- Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
- Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - Yue Ruan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Kinga A Várnai
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jim Davies
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Robert E J Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rajiv Gandhi
- Department of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sophie Harris
- Diabetes Department, King's College Hospital, London, UK
| | - Dinesh Nagi
- Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield, UK
| | | | - Punith Kempegowda
- Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Emma G Wilmot
- Diabetes Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Parth Narendran
- Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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14
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Pemberton JS, Wilmot EG, Barnard-Kelly K, Leelarathna L, Oliver N, Randell T, Taplin CE, Choudhary P, Adolfsson P. CGM accuracy: Contrasting CE marking with the governmental controls of the USA (FDA) and Australia (TGA): A narrative review. Diabetes Obes Metab 2023; 25:916-939. [PMID: 36585365 DOI: 10.1111/dom.14962] [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: 10/05/2022] [Revised: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
The National Institute for Clinical Excellence updated guidance for continuous glucose monitoring (CGM) in 2022, recommending that CGM be available to all people living with type 1 diabetes. Manufacturers can trade in the UK with Conformité Européenne (CE) marking without an initial national assessment. The regulatory process for CGM CE marking, in contrast to the Food and Drug Administration (FDA) and Australian Therapeutic Goods Administration (TGA) process, is described. Manufacturers operating in the UK provided clinical accuracy studies submitted for CE marking. Critical appraisal of the studies shows several CGM devices have CE marking for wide-ranging indications beyond available data, unlike FDA and TGA approval. The FDA and TGA use tighter controls, requiring comprehensive product-specific clinical data evaluation. In 2018, the FDA published the integrated CGM (iCGM) criteria permitting interoperability. Applying the iCGM criteria to clinical data provided by manufacturers trading in the UK identified several study protocols that minimized glucose variability, thereby improving CGM accuracy on all metrics. These results do not translate into real-life performance. Furthermore, for many CGM devices available in the UK, accuracy reported in the hypoglycaemic range is below iCGM standards, or measurement is absent. We offer a framework to evaluate CGM accuracy studies critically. The review concludes that FDA- and TGA-approved indications match the available clinical data, whereas CE marking indications can have discrepancies. The UK can bolster regulation with UK Conformity Assessed marking from January 2025. However, balanced regulation is needed to ensure innovation and timely technological access are not hindered.
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Affiliation(s)
- John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham, Nottingham, UK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | - Craig E Taplin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Pratik Choudhary
- Leicester Diabetes Center, University of Leicester, Leicester, UK
| | - Peter Adolfsson
- Department of Paediatrics, Kungsbacka Hospital; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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Deshmukh H, Adeleke KA, Ssemmondo E, Wilmot EG, Shah N, Pieri B, Gregory R, Kilvert A, Lumb A, Christian P, Barnes D, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Ethnic disparities in people accessing Free-Style Libre in the United Kingdom: Insights from the Association of British Clinical Diabetologists audit. Diabet Med 2023:e15095. [PMID: 36995354 DOI: 10.1111/dme.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/15/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Harshal Deshmukh
- Allam Diabetes Center, University of Hull UK
- Hull University teaching hospitals NHS trust, UK
| | - Kazeem A Adeleke
- Allam Diabetes Center, University of Hull UK
- Hull University teaching hospitals NHS trust, UK
| | - Emmanuel Ssemmondo
- Allam Diabetes Center, University of Hull UK
- Hull University teaching hospitals NHS trust, UK
| | - Emma G Wilmot
- University Hospitals of Derby & Burton
- University of Nottingham
| | - Najeeb Shah
- Allam Diabetes Center, University of Hull UK
- Hull University teaching hospitals NHS trust, UK
| | - Beatrice Pieri
- Allam Diabetes Center, University of Hull UK
- Hull University teaching hospitals NHS trust, UK
| | | | - Anne Kilvert
- Northampton General Hospital NHS Trust, Northampton, U.K
| | | | | | | | - Jane Patmore
- Hull University teaching hospitals NHS trust, UK
| | - Chris Walton
- Hull University teaching hospitals NHS trust, UK
| | | | - Thozhukat Sathyapalan
- Allam Diabetes Center, University of Hull UK
- Hull University teaching hospitals NHS trust, UK
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Phillip M, Nimri R, Bergenstal RM, Barnard-Kelly K, Danne T, Hovorka R, Kovatchev BP, Messer LH, Parkin CG, Ambler-Osborn L, Amiel SA, Bally L, Beck RW, Biester S, Biester T, Blanchette JE, Bosi E, Boughton CK, Breton MD, Brown SA, Buckingham BA, Cai A, Carlson AL, Castle JR, Choudhary P, Close KL, Cobelli C, Criego AB, Davis E, de Beaufort C, de Bock MI, DeSalvo DJ, DeVries JH, Dovc K, Doyle FJ, Ekhlaspour L, Shvalb NF, Forlenza GP, Gallen G, Garg SK, Gershenoff DC, Gonder-Frederick LA, Haidar A, Hartnell S, Heinemann L, Heller S, Hirsch IB, Hood KK, Isaacs D, Klonoff DC, Kordonouri O, Kowalski A, Laffel L, Lawton J, Lal RA, Leelarathna L, Maahs DM, Murphy HR, Nørgaard K, O’Neal D, Oser S, Oser T, Renard E, Riddell MC, Rodbard D, Russell SJ, Schatz DA, Shah VN, Sherr JL, Simonson GD, Wadwa RP, Ward C, Weinzimer SA, Wilmot EG, Battelino T. Consensus Recommendations for the Use of Automated Insulin Delivery Technologies in Clinical Practice. Endocr Rev 2023; 44:254-280. [PMID: 36066457 PMCID: PMC9985411 DOI: 10.1210/endrev/bnac022] [Citation(s) in RCA: 88] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/22/2022] [Indexed: 02/06/2023]
Abstract
The significant and growing global prevalence of diabetes continues to challenge people with diabetes (PwD), healthcare providers, and payers. While maintaining near-normal glucose levels has been shown to prevent or delay the progression of the long-term complications of diabetes, a significant proportion of PwD are not attaining their glycemic goals. During the past 6 years, we have seen tremendous advances in automated insulin delivery (AID) technologies. Numerous randomized controlled trials and real-world studies have shown that the use of AID systems is safe and effective in helping PwD achieve their long-term glycemic goals while reducing hypoglycemia risk. Thus, AID systems have recently become an integral part of diabetes management. However, recommendations for using AID systems in clinical settings have been lacking. Such guided recommendations are critical for AID success and acceptance. All clinicians working with PwD need to become familiar with the available systems in order to eliminate disparities in diabetes quality of care. This report provides much-needed guidance for clinicians who are interested in utilizing AIDs and presents a comprehensive listing of the evidence payers should consider when determining eligibility criteria for AID insurance coverage.
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Affiliation(s)
- Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
- Sacker Faculty of Medicine, Tel-Aviv University, 39040 Tel-Aviv, Israel
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
- Sacker Faculty of Medicine, Tel-Aviv University, 39040 Tel-Aviv, Israel
| | - Richard M Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | | | - Thomas Danne
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Boris P Kovatchev
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Laurel H Messer
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | | | | | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Roy W Beck
- Jaeb Center for Health Research Foundation, Inc., Tampa, FL 33647, USA
| | - Sarah Biester
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Torben Biester
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Julia E Blanchette
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA
- Center for Diabetes and Obesity, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Hospital and San Raffaele Vita Salute University, Milan, Italy
| | - Charlotte K Boughton
- Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, UK
| | - Marc D Breton
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Sue A Brown
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
- Division of Endocrinology, University of Virginia, Charlottesville, VA 22903, USA
| | - Bruce A Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94304, USA
| | - Albert Cai
- The diaTribe Foundation/Close Concerns, San Diego, CA 94117, USA
| | - Anders L Carlson
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kelly L Close
- The diaTribe Foundation/Close Concerns, San Diego, CA 94117, USA
| | - Claudio Cobelli
- Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Amy B Criego
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Elizabeth Davis
- Telethon Kids Institute, University of Western Australia, Perth Children’s Hospital, Perth, Australia
| | - Carine de Beaufort
- Diabetes & Endocrine Care Clinique Pédiatrique DECCP/Centre Hospitalier Luxembourg, and Faculty of Sciences, Technology and Medicine, University of Luxembourg, Esch sur Alzette, GD Luxembourg/Department of Paediatrics, UZ-VUB, Brussels, Belgium
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Daniel J DeSalvo
- Division of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77598, USA
| | - J Hans DeVries
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children’s Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Laya Ekhlaspour
- Lucile Packard Children’s Hospital—Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Naama Fisch Shvalb
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Dana C Gershenoff
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Linda A Gonder-Frederick
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Ahmad Haidar
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Sara Hartnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Irl B Hirsch
- Department of Medicine, University of Washington Diabetes Institute, University of Washington, Seattle, WA, USA
| | - Korey K Hood
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Diana Isaacs
- Cleveland Clinic, Endocrinology and Metabolism Institute, Cleveland, OH 44106, USA
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA 94010, USA
| | - Olga Kordonouri
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | | | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
| | - Julia Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rayhan A Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lalantha Leelarathna
- Manchester University Hospitals NHS Foundation Trust/University of Manchester, Manchester, UK
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94304, USA
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Gentofte, Denmark
| | - David O’Neal
- Department of Medicine and Department of Endocrinology, St Vincent’s Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Sean Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Tamara Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, and Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Michael C Riddell
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, Canada
| | - David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, MD, USA
| | - Steven J Russell
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Desmond A Schatz
- Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 02114, USA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jennifer L Sherr
- Department of Pediatrics, Yale University School of Medicine, Pediatric Endocrinology, New Haven, CT 06511, USA
| | - Gregg D Simonson
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Candice Ward
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, Pediatric Endocrinology, New Haven, CT 06511, USA
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Trust, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, England, UK
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children’s Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Shah N, Deshmukh H, Wilmot EG, Patmore J, Christian P, Barnes DJ, Walton C, Ryder REJ, Sathyapalan T. The long-term impact of glucose monitoring with the FreeStyle Libre on glycaemic control and hypoglycaemia awareness in people with type 1 diabetes: Insights from the Association of British Clinical Diabetologists national audit. Diabet Med 2023; 40:e15070. [PMID: 36797537 DOI: 10.1111/dme.15070] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
AIMS To investigate the change in glycated haemoglobin (HbA1c), hypoglycaemia awareness and diabetes-related distress in people with type 1 diabetes (T1D) using FreeStyle Libre (FSL) over a 2-year follow-up period. METHODS FSL user data from U.K wide hospitals collected during routine clinical care were analysed. People living with T1D were categorised into four groups based on the duration of follow-up. Group I (< 1 year, n = 6940), group II (1 to 1.5 years, n = 662), group III (1.5 to 2 years, n = 385), and group IV (> 2 years, n = 642). The t-test was used to compare the baseline and follow-up HbA1c, GOLD score (a measure of hypoglycaemia awareness) and diabetes-related distress scale (DDS score) (quality of life measure). RESULTS The study consisted of 16,834 people, with follow-up data available for 8,629 participants. The change in HbA1c, GOLD and DDS score from baseline within the follow-up sub-groups (group I vs group II vs group III vs group IV) was HbA1c (-6 vs -6 vs -4 vs -4 mmol/mol; p < 0.001) (-0.55 vs -0.55 vs -0.37 vs -0.37 %), GOLD score (-0.31 vs -0.45 vs -0.26 vs -0.42; p < 0.0001 group I, II, IV and p 0.07 group III), and DDS score(-0.59 vs -0.58 vs -0.63 vs -0.50; p < 0.001), respectively. CONCLUSIONS In people with T1D, FSL use resulted in a sustained improvement in HbA1c, hypoglycaemia awareness and diabetes-related distress for over two years.
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Affiliation(s)
- Najeeb Shah
- Hull University Teaching Hospitals, Allam Diabetes Centre, Hull, UK
- Department of Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK
| | - Harshal Deshmukh
- Hull University Teaching Hospitals, Allam Diabetes Centre, Hull, UK
- Department of Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Jane Patmore
- Hull University Teaching Hospitals, Allam Diabetes Centre, Hull, UK
| | - Peter Christian
- Department of Diabetic Medicine, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | | | - Chris Walton
- Hull University Teaching Hospitals, Allam Diabetes Centre, Hull, UK
| | - Robert E J Ryder
- Department of Diabetes, City Hospital, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Thozhukat Sathyapalan
- Hull University Teaching Hospitals, Allam Diabetes Centre, Hull, UK
- Department of Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK
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Pieri B, Deshmukh H, Wilmot EG, Choudhary P, Shah N, Gregory R, Barnes D, Saunders S, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Impaired awareness of hypoglycaemia: Prevalence and associated factors before and after FreeStyle Libre use in the Association of British Clinical Diabetologists audit. Diabetes Obes Metab 2023; 25:302-305. [PMID: 35979897 DOI: 10.1111/dom.14841] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Beatrice Pieri
- Academic Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- York Hospitals NHS Foundation Trust, York, UK
| | - Harshal Deshmukh
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Emma G Wilmot
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Najeeb Shah
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Dennis Barnes
- Department of Diabetes and Endocrinology, Tunbridge Wells Hospital, Royal Tunbridge Wells, UK
| | - Simon Saunders
- Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Jane Patmore
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Chris Walton
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Robert E J Ryder
- Department of Diabetes, Sandwell and West Birmingham Hospitals NHS Trust, West Midlands, UK
| | - Thozhukat Sathyapalan
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Speight J, Choudhary P, Wilmot EG, Hendrieckx C, Forde H, Cheung WY, Crabtree T, Millar B, Traviss-Turner G, Hill A, Ajjan RA. Impact of glycaemic technologies on quality of life and related outcomes in adults with type 1 diabetes: A narrative review. Diabet Med 2023; 40:e14944. [PMID: 36004676 DOI: 10.1111/dme.14944] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 02/07/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022]
Abstract
AIMS To explore the association between the use of glycaemic technologies and person-reported outcomes (PROs) in adults with type 1 diabetes (T1D). METHODS We included T1D and technology publications reporting on PROs since 2014. Only randomised controlled trials and cohort studies that used validated PRO measures (PROMs) were considered. RESULTS T1D studies reported on a broad range of validated PROMs, mainly as secondary outcome measures. Most studies examined continuous glucose monitoring (CGM), intermittently scanned CGM (isCGM), and the role of continuous subcutaneous insulin infusion (CSII), including sensor-augmented CSII and closed loop systems. Generally, studies demonstrated a positive impact of technology on hypoglycaemia-specific and diabetes-specific PROs, including reduced fear of hypoglycaemia and diabetes distress, and greater satisfaction with diabetes treatment. In contrast, generic PROMs (including measures of health/functional status, emotional well-being, depressive symptoms, and sleep quality) were less likely to demonstrate improvements associated with the use of glycaemic technologies. Several studies showed contradictory findings, which may relate to study design, population and length of follow-up. Differences in PRO findings were apparent between randomised controlled trials and cohort studies, which may be due to different populations studied and/or disparity between trial and real-world conditions. CONCLUSIONS PROs are usually assessed as secondary outcomes in glycaemic technology studies. Hypoglycaemia-specific and diabetes-specific, but not generic, PROs show the benefits of glycaemic technologies, and deserve a more central role in future studies as well as routine clinical care.
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Affiliation(s)
- Jane Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Emma G Wilmot
- Department of Diabetes, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Hannah Forde
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Wai Yee Cheung
- Diabetes Research Unit Cymru, Swansea University Medical School, Swansea, UK
| | - Thomas Crabtree
- Department of Diabetes, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Bekki Millar
- Diabetes Research Steering Group, Diabetes UK, London, UK
| | | | - Andrew Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, the LIGHT Laboratories, University of Leeds, Leeds, UK
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Leelarathna L, Evans ML, Neupane S, Rayman G, Lumley S, Cranston I, Narendran P, Barnard-Kelly K, Sutton CJ, Elliott RA, Taxiarchi VP, Gkountouras G, Burns M, Mubita W, Kanumilli N, Camm M, Thabit H, Wilmot EG. Intermittently Scanned Continuous Glucose Monitoring for Type 1 Diabetes. N Engl J Med 2022; 387:1477-1487. [PMID: 36198143 DOI: 10.1056/nejmoa2205650] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In persons with type 1 diabetes and high glycated hemoglobin levels, the benefits of intermittently scanned continuous glucose monitoring with optional alarms for high and low blood glucose levels are uncertain. METHODS In a parallel-group, multicenter, randomized, controlled trial involving participants with type 1 diabetes and glycated hemoglobin levels between 7.5% and 11.0%, we investigated the efficacy of intermittently scanned continuous glucose monitoring as compared with participant monitoring of blood glucose levels with fingerstick testing. The primary outcome was the glycated hemoglobin level at 24 weeks, analyzed according to the intention-to-treat principle. Key secondary outcomes included sensor data, participant-reported outcome measures, and safety. RESULTS A total of 156 participants were randomly assigned, in a 1:1 ratio, to undergo intermittently scanned continuous glucose monitoring (the intervention group, 78 participants) or to monitor their own blood glucose levels with fingerstick testing (the usual-care group, 78 participants). At baseline, the mean (±SD) age of the participants was 44±15 years, and the mean duration of diabetes was 21±13 years; 44% of the participants were women. The mean baseline glycated hemoglobin level was 8.7±0.9% in the intervention group and 8.5±0.8% in the usual-care group; these levels decreased to 7.9±0.8% and 8.3±0.9%, respectively, at 24 weeks (adjusted mean between-group difference, -0.5 percentage points; 95% confidence interval [CI], -0.7 to -0.3; P<0.001). The time per day that the glucose level was in the target range was 9.0 percentage points (95% CI, 4.7 to 13.3) higher or 130 minutes (95% CI, 68 to 192) longer in the intervention group than in the usual-care group, and the time spent in a hypoglycemic state (blood glucose level, <70 mg per deciliter [<3.9 mmol per liter]) was 3.0 percentage points (95% CI, 1.4 to 4.5) lower or 43 minutes (95% CI, 20 to 65) shorter in the intervention group. Two participants in the usual-care group had an episode of severe hypoglycemia, and 1 participant in the intervention group had a skin reaction to the sensor. CONCLUSIONS Among participants with type 1 diabetes and high glycated hemoglobin levels, the use of intermittently scanned continuous glucose monitoring with optional alarms for high and low blood glucose levels resulted in significantly lower glycated hemoglobin levels than levels monitored by fingerstick testing. (Funded by Diabetes UK and others; FLASH-UK ClinicalTrials.gov number, NCT03815006.).
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Affiliation(s)
- Lalantha Leelarathna
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Mark L Evans
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Sankalpa Neupane
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Gerry Rayman
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Sarah Lumley
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Iain Cranston
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Parth Narendran
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Katharine Barnard-Kelly
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Christopher J Sutton
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Rachel A Elliott
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Vicky P Taxiarchi
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Georgios Gkountouras
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Matthew Burns
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Womba Mubita
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Naresh Kanumilli
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Maisie Camm
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Hood Thabit
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
| | - Emma G Wilmot
- From the Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (L.L., W.M., N.K., M.C., H.T.), the Division of Diabetes, Endocrinology, and Gastroenterology, Faculty of Biology, Medicine, and Health (L.L., H.T.), and the Centre for Biostatistics (C.J.S., V.P.T.), the Manchester Centre for Health Economics (R.A.E., G.G.), and the Manchester Clinical Trials Unit (C.J.S., M.B.), Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, Wellcome Trust-Medical Research Council Institute of Metabolic Science, National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge (M.L.E.), Elsie Bertram Diabetes Centre, Norfolk (S.N.), Norwich University Hospitals NHS Foundation Trust, Norwich (S.N.), the Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich (G.R.), the Adam Practice, Upton and Poole, Dorset (S.L.), the Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth (I.C.), the Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham (P.N.), Barnard Health, Barnard Health Research Limited, Portsmouth (K.B.-K.), University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby (E.G.W.), and the University of Nottingham, Nottingham (E.G.W.) - all in the United Kingdom
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Choudhary P, Kao K, Dunn TC, Brandner L, Rayman G, Wilmot EG. Glycaemic measures for 8914 adult FreeStyle Libre users during routine care, segmented by age group and observed changes during the COVID-19 pandemic. Diabetes Obes Metab 2022; 24:1976-1982. [PMID: 35638378 PMCID: PMC9347804 DOI: 10.1111/dom.14782] [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] [Received: 02/01/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the impact of the stay-at-home policy on different glucose metrics for time in range (%TIR 3.9-10 mmol/L), time below range (%TBR < 3.9 mmol/L) and time above range (%TAR > 10 mmol/L) for UK adult FreeStyle Libre (FSL) users within four defined age groups and on observed changes during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Data were extracted from 8914 LibreView de-identified user accounts for adult users aged 18 years or older with 5 or more days of sensor readings in each month from January to June 2020. Age-group categories were based on self-reported age on LibreView accounts (18-25, 26-49, 50-64 and ≥65 years). RESULTS In January, prior to the COVID-19 pandemic, the 65 years or older age group had the highest %TIR (57.9%), while the 18-25 years age group had the lowest (51.2%) (P < .001). Within each age group, TIR increased during the analysed months, by 1.7% (26-49 years) to 3.1% (≥65 years) (P < .001 in all cases). %TBR was significantly reduced only in the 26-49 years age group, whereas %TAR was reduced by 1.5% (26-49 years) to 3.0% (≥65 years) (P < .001 in both cases). The proportion of adults achieving both of the more than 70% TIR and less than 4% TBR targets increased from 11.7% to 15.9% for those aged 65 years or older (P < .001) and from 6.0% to 9.1% for those aged 18-25 years (P < .05). Mean daily glucose-sensor scan rates were at least 12 per day and remained stable across the analysis period. CONCLUSIONS Our data show the baseline glucose metrics for FSL users in the UK across different age groups under usual care. During lockdown in the UK, the proportion of adults achieving TIR consensus targets increased among FSL users.
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Affiliation(s)
| | - Kalvin Kao
- Reseach and developmentAbbott LaboratoriesAlamedaCaliforniaUSA
| | - Timothy C. Dunn
- Reseach and developmentAbbott LaboratoriesAlamedaCaliforniaUSA
| | - Laura Brandner
- Reseach and developmentAbbott LaboratoriesAlamedaCaliforniaUSA
| | - Gerry Rayman
- Ipswich Diabetes CentreEast Suffolk and North East Essex Foundation TrustIpswichUK
| | - Emma G. Wilmot
- Diabetes Department, Royal Derby HospitalUniversity Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
- Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
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22
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Khunti K, Ruan Y, Davies J, Field BCT, Harris S, Kosiborod M, Nagi D, Narendran P, Patel D, Ryder REJ, Várnai KA, Wild SH, Wilmot EG, Rea R. Association Between SGLT2 Inhibitor Treatment and Diabetic Ketoacidosis and Mortality in People With Type 2 Diabetes Admitted to Hospital With COVID-19. Diabetes Care 2022; 45:dc220357. [PMID: 36074663 DOI: 10.2337/dc22-0357] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the association between prescription of SGLT2 inhibitors (SGLT2is) and diabetic ketoacidosis (DKA) incidence or mortality in people with type 2 diabetes (T2D) hospitalized with COVID-19. RESEARCH DESIGN AND METHODS This was a retrospective cohort study based on secondary analysis of data from a large nationwide audit from a network of 40 centers in the U.K. with data collection up to December 2020. The study was originally designed to describe risk factors associated with adverse outcomes among people with diabetes who were admitted to hospital with COVID-19. The primary outcome for this analysis was DKA on or during hospital admission. The secondary outcome was mortality. Crude, age-sex adjusted, and multivariable logistic regression models were used to generate odds ratios (ORs) and 95% CIs for people prescribed SGLT2i compared with those not prescribed SGLT2i. RESULTS The original national audit included 3,067 people with T2D who were admitted to hospital with COVID-19, of whom 230 (7.5%) were prescribed SGLT2is prior to hospital admission. The mean age of the overall cohort was 72 years, 62.3% were men, and 34.9% were prescribed insulin. Overall, 2.8% of the total population had DKA and 35.6% of people in the study died. The adjusted odds of DKA were not significantly different between those prescribed SGLT2is and those not (OR 0.56; 95% CI 0.16-1.97). The adjusted odds of mortality associated with SGLT2is were similar in the total study population (OR 1.13; 95% CI 0.78-1.63), in the subgroup prescribed insulin (OR 1.02; 95% CI 0.59-1.77), and in the subgroup that developed DKA (OR 0.21; 95% CI 0.01-8.76). CONCLUSIONS We demonstrate a low risk of DKA and high mortality rate in people with T2D admitted to hospital with COVID-19 and limited power, but no evidence, of increased risk of DKA or in-hospital mortality associated with prescription of SGLT2is.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Yue Ruan
- Oxford National Institute for Health Research Biomedical Research Centre, Oxford, U.K
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals National Health Service Foundation Trust, Oxford, U.K
| | - Jim Davies
- Oxford National Institute for Health Research Biomedical Research Centre, Oxford, U.K
- Department of Computer Science, University of Oxford, Oxford, U.K
| | - Benjamin C T Field
- Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, U.K
- Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, U.K
| | - Sophie Harris
- Department of Diabetes, King's College Hospital, London, U.K
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, MO
- University of Missouri, Kansas City, MO
| | - Dinesh Nagi
- Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield, U.K
| | - Parth Narendran
- Medical and Dental Sciences, University of Birmingham, Birmingham, U.K
- University Hospital Birmingham, NHS Foundation Trust, Birmingham, U.K
| | - Dipesh Patel
- Department of Diabetes, Division of Medicine, University College London, Royal Free Campus, London, U.K
| | - Robert E J Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K
| | - Kinga A Várnai
- Oxford National Institute for Health Research Biomedical Research Centre, Oxford, U.K
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, U.K
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, U.K
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby & Burton NHS Trust, Derby, U.K
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, U.K
| | - Rustam Rea
- Oxford National Institute for Health Research Biomedical Research Centre, Oxford, U.K
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals National Health Service Foundation Trust, Oxford, U.K
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23
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Patel R, Crabtree TSJ, Taylor N, Langeland L, Gazis AT, Mendis B, Wilmot EG, Idris I. Safety and effectiveness of do-it-yourself artificial pancreas system compared with continuous subcutaneous insulin infusions in combination with free style libre in people with type 1 diabetes. Diabet Med 2022; 39:e14793. [PMID: 35034388 DOI: 10.1111/dme.14793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/16/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
Abstract
AIMS The use of do-it-yourself artificial pancreas systems (DIYAPS) among people with type 1 diabetes is increasing. At present, it is unclear how DIYAPS compares with other technologies such as FreeStyle Libre (FSL) and continuous subcutaneous insulin infusion (CSII). The aim of this analysis is to compare safety, effectiveness and quality-of-life outcomes of DIYAPS use with the addition of FSL to CSII. METHOD Data from two large UK hospitals were extracted from the Association of British Clinical Diabetologists (ABCD) DIYAPS and FSL audits. Outcomes included HbA1c , glucose TBR (time-below-range), TIR (time-in-range), Diabetes Distress Score (DDS), and Gold hypoglycaemia score. Any adverse events were noted. Changes at follow-up were assessed using paired t-tests and ANOVA in Stata; TIR/TBR at follow-up assessed using unpaired t-tests; chi-square tests assessed the change in frequency of health utilisation (e.g. hospital admissions). RESULTS DIYAPS (n = 35) and FSL+CSII (n = 149) users, with median follow-up duration of 1.4 (IQR 0.8-2.1) and 1.3 (IQR 0.7-1.8) years, respectively, were included. HbA1c with DIYAPS use changed by -10 mmol/mol [0.9%] (p < 0.001, 95% CI 5, 14 [0.5, 1.3%]) significantly lower (p < 0.001) than in the FSL+CSII group -3 mmol/mol [0.25%] (p < 0.001, 95% CI 1, 4 [0.1, 0.4%]). TIR was higher and TBR was lower in the DIYAPS group. Adverse events were rare in both groups and no significant differences were observed in the frequency of healthcare utilisation. CONCLUSION DIYAPS use was associated with a lower HbA1c levels, higher TIR and lower TBR compared with FSL+CSII. There was no significant increase in adverse events, although this should be interpreted cautiously given the low numbers of users. Full results from the ABCD DIYAPS audit are awaited.
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Affiliation(s)
- Rachel Patel
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Thomas S J Crabtree
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Nicola Taylor
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
| | - Linn Langeland
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
| | - Anastasios Tasso Gazis
- Department of Diabetes and Endocrinology, Queens Medical Centre, Nottingham University Hospital, Nottingham, UK
| | - Buddhike Mendis
- Department of Diabetes and Endocrinology, Queens Medical Centre, Nottingham University Hospital, Nottingham, UK
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iskandar Idris
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham, UK
- NIHR, Nottingham BRC, University of Nottingham, Nottingham, UK
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24
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Harris S, Ruan Y, Wild SH, Wargny M, Hadjadj S, Delasalle B, Saignes M, Ryder RE, Field BCT, Narendran P, Zaccardi F, Wilmot EG, Vlacho B, Llauradó G, Mauricio D, Nagi D, Patel D, Várnai KA, Davies J, Gourdy P, Cariou B, Rea R, Khunti K. Association of statin and/or renin-angiotensin-aldosterone system modulating therapy with mortality in adults with diabetes admitted to hospital with COVID-19: A retrospective multicentre European study. Diabetes Metab Syndr 2022; 16:102484. [PMID: 35472685 PMCID: PMC8996468 DOI: 10.1016/j.dsx.2022.102484] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS To assess the impact of pre-admission renin-angiotensin-aldosterone system inhibitor (RAASi) and statin use on mortality following COVID-19 hospitalization in adults with pre-existing diabetes. METHODS Retrospective cohort study of adults with diabetes admitted to ninety-nine participating hospitals in the United Kingdom, France and Spain during the first wave of the COVID-19 pandemic. Logistic regression models adjusted for demographic factors and comorbidity were used to describe associations with mortality in hospital or within 28 days of admission and individual or combined RAASi and statin therapy prescription followed by a country level meta-analysis. RESULTS Complete data were available for 3474 (42.6%) individuals. Prescribing patterns varied by country: 25-50% neither RAASi nor statin therapy, 14-36% both RAASi and statin therapy, 9-24% RAASi therapy alone, 12-36% statin alone. Overall, 20-37% of patients died within 28 days. Meta-analysis found no evidence of an association between mortality and prescription of RAASi therapy (OR 1.09, CI 0.78-1.52 (I2 22.2%)), statin (OR 0.97, CI 0.59-1.61 (I2 72.9%)) or both (OR 1.14, CI 0.67-1.92 (I2 78.3%)) compared to those prescribed neither drug class. CONCLUSIONS This large multicentre, multinational study found no evidence of an association between mortality from COVID-19 infection in people with diabetes and use of either RAASi, statin or combination therapy. This provides reassurance that clinicians should not change their RAASi and statin therapy prescribing practice in people with diabetes during the COVID-19 pandemic.
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Affiliation(s)
| | - Yue Ruan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, UK; Oxford NIHR Biomedical Research Centre, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Matthieu Wargny
- L'institut du thorax, Université de Nantes, CHU Nantes, CNRS, Inserm, Nantes, France; CHU de Nantes, CIC Inserm 1413, Clinique des Données, Nantes, France
| | - Samy Hadjadj
- L'institut du thorax, Université de Nantes, CHU Nantes, CNRS, Inserm, Nantes, France
| | - Béatrice Delasalle
- CHU Nantes, Direction de la recherche clinique et de l'innovation, Nantes, France
| | - Maëva Saignes
- CHU Nantes, Direction de la recherche clinique et de l'innovation, Nantes, France
| | - Robert Ej Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Benjamin C T Field
- Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK; Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - Parth Narendran
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK; University Hospital Birmingham, NHS Foundation Trust, UK
| | - Francesco Zaccardi
- University Hospitals of Leicester NHS Trust, Diabetes Research Centre, Leicester General Hospital, UK
| | - Emma G Wilmot
- Diabetes Department, University Hospitals of Derby and Burton NHS FT, Derby, UK; University of Nottingham, Nottingham, UK
| | - Bogdan Vlacho
- DAP_CAT group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Gemma Llauradó
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Dept. of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Dinesh Nagi
- Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, UK
| | | | - Kinga A Várnai
- Oxford NIHR Biomedical Research Centre, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - Jim Davies
- Oxford NIHR Biomedical Research Centre, UK; Department of Computer Science, University of Oxford, Oxford, UK
| | - Pierre Gourdy
- CHU de Toulouse & UMR1048/I2MC, Université de Toulouse, Toulouse, France
| | - Bertrand Cariou
- L'institut du thorax, Université de Nantes, CHU Nantes, CNRS, Inserm, Nantes, France
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, UK; Oxford NIHR Biomedical Research Centre, UK
| | - Kamlesh Khunti
- University Hospitals of Leicester NHS Trust, Diabetes Research Centre, Leicester General Hospital, UK
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25
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Abstract
Diabetic retinopathy is a microangiopathy resulting from the chronic effects of diabetes mellitus. Healthcare professionals often work in isolation to deliver highly specialised care efficiently and effectively for people living with diabetes. It is not uncommon for people with diabetes to be making frequent visits to community and hospital clinics to see a variety of specialists and healthcare professionals, with seemingly little opportunity for coordination of this complex health management programme between the wider team. In a field that is so diverse and rapidly changing, healthcare professionals of all specialties need to be aware of developments across all aspects of diabetes management. In this article, we discuss the epidemiology and natural history of diabetic retinopathy and describe an approach to its assessment and diagnosis. We provide an overview of the principles of diabetic retinopathy management and outline possible future treatments for diabetic retinopathy.
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Affiliation(s)
| | - Bakula Patel
- University of Nottingham School of Medicine, Nottingham, UK
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Winfried Mk Amoaku
- reader of clinical ophthalmology and honorary consultant ophthalmologist, Nottingham University Hospitals NHS Trust, Nottingham, UK
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26
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Barker MM, Zaccardi F, Brady EM, Gulsin GS, Hall AP, Henson J, Htike ZZ, Khunti K, McCann GP, Redman EL, Webb DR, Wilmot EG, Yates T, Yeo J, Davies MJ, Sargeant JA. Age at diagnosis of type 2 diabetes and cardiovascular risk factor profile: A pooled analysis. World J Diabetes 2022; 13:260-271. [PMID: 35432761 PMCID: PMC8984563 DOI: 10.4239/wjd.v13.i3.260] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The diagnosis of type 2 diabetes (T2D) in younger adults, an increasingly common public health issue, is associated with a higher risk of cardiovascular complications and mortality, which may be due to a more adverse cardiovascular risk profile in individuals diagnosed at a younger age.
AIM To investigate the association between age at diagnosis and the cardiovascular risk profile in adults with T2D.
METHODS A pooled dataset was used, comprised of data from five previous studies of adults with T2D, including 1409 participants of whom 196 were diagnosed with T2D under the age of 40 years. Anthropometric and blood biomarker measurements included body weight, body mass index (BMI), waist circumference, body fat percentage, glycaemic control (HbA1c), lipid profile and blood pressure. Univariable and multivariable linear regression models, adjusted for diabetes duration, sex, ethnicity and smoking status, were used to investigate the association between age at diagnosis and each cardiovascular risk factor.
RESULTS A higher proportion of participants diagnosed with T2D under the age of 40 were female, current smokers and treated with glucose-lowering medications, compared to participants diagnosed later in life. Participants diagnosed with T2D under the age of 40 also had higher body weight, BMI, waist circumference and body fat percentage, in addition to a more adverse lipid profile, compared to participants diagnosed at an older age. Modelling results showed that each one year reduction in age at diagnosis was significantly associated with 0.67 kg higher body weight [95% confidence interval (CI): 0.52-0.82 kg], 0.18 kg/m2 higher BMI (95%CI: 0.10-0.25) and 0.32 cm higher waist circumference (95%CI: 0.14-0.49), after adjustment for duration of diabetes and other confounders. Younger age at diagnosis was also significantly associated with higher HbA1c, total cholesterol, low-density lipoprotein cholesterol and triglycerides.
CONCLUSION The diagnosis of T2D earlier in life is associated with a worse cardiovascular risk factor profile, compared to those diagnosed later in life.
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Affiliation(s)
- Mary M Barker
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Emer M Brady
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
| | - Andrew P Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester LE5 4PW, United Kingdom
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Zin Zin Htike
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Applied Research Collaboration East Midlands, Leicester LE5 4PW, United Kingdom
| | - Gerald P McCann
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Emma L Redman
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Emma G Wilmot
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- Department of Diabetes, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Jian Yeo
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
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27
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Sathyanarayanan A, Crabtree T, Choudhary P, Elliott J, Evans ML, Lumb A, Wilmot EG. Delivering evidence-based interventions for type 1 diabetes in the virtual world - A review of UK practice during the SARS-CoV-2 pandemic. Diabetes Res Clin Pract 2022; 185:109777. [PMID: 35157943 PMCID: PMC8831709 DOI: 10.1016/j.diabres.2022.109777] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 12/05/2022]
Abstract
AIMS This review considers the impact of the SARS-CoV-2 pandemic on access to interventions for those living with type 1 diabetes and discusses the solutions which have been considered and actioned to ensure ongoing access care. METHODS We performed a focussed review of the published literature, and the guidelines for changes that have been effected during the pandemic. We also drew from expert recommendations and information about local practice changes for areas where formal data have not been published. RESULTS Evidence based interventions which support the achievement of improved glucose levels and/or reduction in hypoglycaemia include group structured education to support self-management, insulin pump therapy and continuous glucose monitoring. The SARS-CoV-2 pandemic had impacted the ability of diabetes services to deliver these intervention. Multiple adaptations have been put in place - transition to online delivery of education and care, and usage of diabetes technology. CONCLUSIONS Although various adaptations have been made during the pandemic that have positively influenced uptake of services, there are many areas of delivery that need immediate improvement in the UK. We recommend a proactive approach in recognising the digital divide and inequity in distribution of these changes and we recommend introducing measures to reduce them.
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Affiliation(s)
| | - T Crabtree
- University Hospitals of Derby and Burton NHS FT, DE22 3NE, UK; Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, NG7 2RD, UK.
| | - P Choudhary
- Diabetes Research Centre, Leicester Diabetes Centre - Bloom, University of Leicester, LE1 7RH, UK.
| | - J Elliott
- Department of Oncology and Metabolism, University of Sheffield, S10 2TN, UK.
| | - M L Evans
- Wellcome Trust/ MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, CB2 1TN, UK.
| | - A Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LE, UK; NIHR Oxford Biomedical Research Centre, Oxford OX4 2PG, UK.
| | - E G Wilmot
- University Hospitals of Derby and Burton NHS FT, DE22 3NE, UK; Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, NG7 2RD, UK
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28
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Blissett R, Blissett D, Levrat-Guillen F, Deshmukh H, Wilmot EG, Ryder REJ, Walton C, Sathyapalan T. FreeStyle Libre Flash Glucose Monitoring system for people with type 1 diabetes in the UK: a budget impact analysis. BMJ Open Diabetes Res Care 2022; 10:10/2/e002580. [PMID: 35346970 PMCID: PMC8961112 DOI: 10.1136/bmjdrc-2021-002580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/05/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION This study aims to estimate the budget impact of increased uptake of the FreeStyle Libre Flash Glucose Monitoring system in people with type 1 diabetes mellitus (T1DM) in the UK. RESEARCH DESIGN AND METHODS A budget impact model was developed, applying real-world data collected in the Association of British Clinical Diabetologists (ABCD) FreeStyle Libre Nationwide Audit. Costs of diabetes glucose monitoring in a T1DM population (n=1790) using self-monitoring of blood glucose (SMBG) or the FreeStyle Libre system were compared with a scenario with increased use of the FreeStyle Libre system. RESULTS The ABCD audit demonstrates FreeStyle Libre system use reduces diabetes-related resource utilization. The cost analysis found that higher acquisition costs are offset by healthcare costs avoided (difference £168 per patient per year (PPPY)). Total costs were £1116 PPPY with FreeStyle Libre system compared with £948 PPPY with SMBG. In an average-sized UK local health economy, increasing FreeStyle Libre system uptake from 30% to 50% increased costs by 3.4% (£1 787 345-£1 847 618) and when increased to 70% increased by a further 3.3%. CONCLUSION Increased uptake of the FreeStyle Libre system in the T1DM population marginally increases the cost to UK health economies and offers many system benefits.
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Affiliation(s)
| | | | | | - Harshal Deshmukh
- University of Hull, Hull, UK
- Allam Diabetes Center, Hull University Teaching Hospital NHS trust, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham, Nottingham, UK
| | | | - Chris Walton
- Allam Diabetes Center, Hull University Teaching Hospital NHS trust, Hull, UK
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29
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Crabtree TSJ, Choudhary P, Lumb A, Hammond P, McLay A, Campbell F, Ng SM, Wilmot EG, Hussain S. Association of British Clinical Diabetologists, Diabetes Technology Network UK and Association of Children's Diabetes Clinicians Survey of UK Healthcare Professional Attitudes Towards Open-Source Automated Insulin Delivery Systems. Diabetes Ther 2022; 13:341-353. [PMID: 35099784 PMCID: PMC8873338 DOI: 10.1007/s13300-022-01203-5] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/12/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Automated insulin delivery (AID) systems can enable improved glycaemic outcomes with reduced mental burden. Open-source AID (OS-AID) systems overcome some of the developmental and access barriers enabling a wider use of these systems. Limited data are available on healthcare professional (HCP) opinions and current practice regarding these systems. The aim of this survey was to gain insight into HCP perceptions and practices around OS-AID. METHODS This survey was developed collaboratively with OS-AID users and distributed to adult and children's teams, using an online survey tool. Results were received between February and April 2019. Responses were assessed using simple descriptive statistics with analyses stratified by respondent characteristics. RESULTS 317 responses were obtained from a range of HCPs in both adult and paediatric services. Key results include: HCP perception of OS-AID as "risky in the wrong hands" (43%); 91% felt uncomfortable initiating discussions around OS-AID because of lack of regulation (67%) and/or their own lack of knowledge (63%). Half of HCPs (47%) reported that they would choose OS-AID if they themselves had type 1 diabetes. CONCLUSIONS HCPs are generally supportive of OS-AID users but many feel uncomfortable with the technicalities of the systems given the lack of approval. Knowledge around the use of these systems was limited. Re-assessment of HCP perceptions should be performed in the future given the evolving landscape of diabetes technology, recent consensus statements and emerging ethical and legal perspectives.
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Affiliation(s)
- Thomas S J Crabtree
- Division of Graduate Entry Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Peter Hammond
- Department of Diabetes, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - A McLay
- DIY APS Community, Derby, UK
| | - Fiona Campbell
- Paediatric Diabetes Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sze M Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby & Burton NHS Trust, Derby, UK.
- Division of Graduate Entry Medicine & Health Sciences, University of Nottingham, Nottingham, UK.
| | - Sufyan Hussain
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK.
- Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospital NHS Trust, London, UK.
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.
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Williams DM, Davies J, Field BCT, Gandhi R, Harris S, Khunti K, Nagi D, Narendran P, Rea R, Ruan Y, Ryder REJ, Várnai KA, Wild SH, Wilmot EG, Min T, Platts J, Chudleigh R, Stephens JW, Rice S. COVID-19 outcomes in people with diabetes in Wales: a secondary analysis of the ABCD audit. Br J Diabetes 2021. [DOI: 10.15277/bjd.2021.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: People with diabetes and coronavirus disease 2019 (COVID-19) have a significantly greater risk of death and/or intensive care unit (ICU) admission. The Association of British Clinical Diabetologists (ABCD) recently audited outcomes for people hospitalised in the UK with diabetes and COVID-19.
Methods: The ABCD COVID-19 and diabetes audit was a retrospective audit of patients admitted to UK hospitals with diabetes and COVID-19 between March and December 2020. Data related to patients admitted in Wales were compared with patients admitted in England and Scotland.
Results: In Wales, 40/82 (48.7%) patients with diabetes had COVID-19-related mortality compared with 1,149/2,916 (39.1%) in the UK group (p=0.08). The Welsh cohort were more likely to be Caucasian, have a higher body mass index and HbA1c, be diagnosed with diabetic retinopathy and prescribed a sodium-glucose co-transporter 2 inhibitor or insulin than those in England and Scotland. Patients admitted to the ICU in Wales were more likely to be male and have type 2 diabetes.
Conclusions: Patients admitted to hospital with diabetes and COVID-19 in Wales had a poorer outcome compared with England and Scotland. This disparity may reflect social inequality, differences in cardiovascular risk factors and/or differences in diabetes medications between hospitalised patients in Wales and the UK.
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Deshmukh H, Wilmot EG, Choudhary P, Narendran P, Shah N, Barnes D, Kamruddin S, Banatwalla R, Christian P, Saunders S, Lumb A, Herring R, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Impaired Awareness of Hypoglycemia and Severe Hypoglycemia in Drivers With Diabetes: Insights From the Association of British Clinical Diabetologists Nationwide Audit. Diabetes Care 2021; 44:e190-e191. [PMID: 34526308 PMCID: PMC8546285 DOI: 10.2337/dc21-1181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/31/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Harshal Deshmukh
- Hull University Teaching Hospitals NHS Trust and University of Hull, Hull, U.K
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K.,University of Nottingham, Nottingham, U.K
| | - Pratik Choudhary
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, U.K
| | - Parth Narendran
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, U.K
| | - Najeeb Shah
- Hull University Teaching Hospitals NHS Trust and University of Hull, Hull, U.K
| | | | | | | | - Peter Christian
- East Kent Hospitals University NHS Foundation Trust, Canterbury, U.K
| | - Simon Saunders
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, U.K
| | | | | | - Jane Patmore
- Hull University Teaching Hospitals NHS Trust and University of Hull, Hull, U.K
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust and University of Hull, Hull, U.K
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Renard E, Ikegami H, Daher Vianna AG, Pozzilli P, Brette S, Bosnyak Z, Lauand F, Peters A, Pilorget V, Jurišić‐Eržen D, Kesavadev J, Seufert J, Wilmot EG. The SAGE study: Global observational analysis of glycaemic control, hypoglycaemia and diabetes management in T1DM. Diabetes Metab Res Rev 2021; 37:e3430. [PMID: 33369842 PMCID: PMC8518876 DOI: 10.1002/dmrr.3430] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/20/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS To describe glycaemic control and diabetes management in adults with type 1 diabetes (T1DM), in a real-life global setting. MATERIALS AND METHODS Study of Adults' GlycEmia (SAGE) was a multinational, multicentre, single visit, noninterventional, cross-sectional study in adult patients with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26-44, 45-64 and ≥65 years) and reported across different regions. The primary endpoint was the proportion of participants achieving HbA1c less than 7.0 % in each age group. Secondary endpoints included incidence of hypoglycaemia, severe hypoglycaemia and severe hyperglycaemia leading to diabetic ketoacidosis (DKA) and therapeutic management of T1DM. RESULTS Of 3903 included participants, 3858 (98.8%) were eligible for the study. Overall, 24.3% (95% confidence interval [CI]: 22.9-25.6) of participants achieved the glycaemic target of HbA1c less than 7.0 %, with more participants achieving this target in the 26-44 years group (27.6% [95% CI: 25.5-29.8]). Target achievement was highest in Eastern and Western Europe, and lowest in the Middle East. The incidence of hypoglycaemia and of severe hyperglycaemia leading to DKA tended to decrease with age, and varied across regions. Age and regional differences were observed in therapeutic management, including types of device/insulin usage, frequency of insulin dose adjustment and technology usage. CONCLUSIONS Glycaemic control remains poor in adults with T1DM globally. Several areas of treatment may be optimised to improve outcomes, including supporting patient self-management of insulin therapy, increasing use of technologies such as CGM, and greater provision of healthcare support.
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Affiliation(s)
- Eric Renard
- Department of Endocrinology, Diabetes, NutritionMontpellier University HospitalINSERM Clinical Investigation Centre 1411Institute of Functional GenomicsCNRSINSERMUniversity of MontpellierMontpellierFrance
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and DiabetesKindai University Faculty of MedicineOsakaJapan
| | | | - Paolo Pozzilli
- Department of Diabetes and EndocrinologyUnit of Endocrinology and Diabetes, Campus Bio‐Medico University of RomeItaly
- Centre of Immunobiology, Barts and the London School of Medicine and Dentistry, Queen Mary University of LondonUK
| | | | | | | | - Anne Peters
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Dubravka Jurišić‐Eržen
- Department of Endocrinology and DiabetologyFaculty of MedicineUniversity Hospital CentreUniversity of RijekaRijekaCroatia
| | | | - Jochen Seufert
- Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Emma G. Wilmot
- Diabetes DepartmentUniversity Hospitals of Derby and BurtonDerbyUK
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Deshmukh H, Wilmot EG, Gregory R, Barnes D, Narendran P, Saunders S, Furlong N, Kamaruddin S, Banatwalla R, Herring R, Kilvert A, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Predictors of diabetes-related distress before and after FreeStyle Libre-1 use: Lessons from the Association of British Clinical Diabetologists nationwide study. Diabetes Obes Metab 2021; 23:2261-2268. [PMID: 34142425 DOI: 10.1111/dom.14467] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/28/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023]
Abstract
AIM To identify the baseline demographic and clinical characteristics associated with diabetes-related distress (DRD) and factors associated with improvement in DRD after initiating use of the FreeStyle Libre (FSL) in people living with type 1 diabetes (T1D). METHODS The study was performed using baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes who initiated use of the FSL in the United Kingdom. DRD was assessed using the two-item diabetes-related distress scale (DDS; defined as the average of the two-item score ≥3). People living with T1D were categorized into two groups: those with high DRD, defined as an average DDS score ≥3 and those with lower DRD, defined as a DDS score <3. We used a gradient-boosting machine-learning (GBM) model to identify the relative influence (RI) of baseline variables on average DDS score. RESULTS The study population consisted of 9159 patients, 96.6% of whom had T1D. The median (interquartile range [IQR]) age was 45.1 (32-56) years, 50.1% were women, the median (IQR) baseline body mass index was 26.1 (23.2-29.6) kg/m2 and the median (IQR) duration of diabetes was 20 (11-32) years. The two components of the DDS were significantly correlated (r2 = 0.73; P < 0.0001). Higher DRD was prevalent in 53% (4879/9159) of people living with T1D at baseline. In the GBM model, the top baseline variables associated with average DDS score were baseline glycated haemoglobin (HbA1c; RI = 51.1), baseline Gold score (RI = 23.3), gender (RI = 7.05) and fear of hypoglycaemia (RI = 4.96). Follow-up data were available for 3312 participants. The top factors associated with improvement in DDS score following use of the FSL were change in Gold score (RI = 28.2) and change in baseline HbA1c (RI = 19.3). CONCLUSIONS In this large UK cohort of people living with T1D, diabetes distress was prevalent and associated with higher HbA1c, impaired awareness of hypoglycaemia and female gender. Improvement in glycaemic control and hypoglycaemia unawareness with the use of the FSL was associated with improvement in DRD in people living with T1D.
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Affiliation(s)
- Harshal Deshmukh
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | | | - Parth Narendran
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Simon Saunders
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Niall Furlong
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | | | | | | | - Anne Kilvert
- Northampton General Hospital NHS Trust, Northampton, UK
| | - Jane Patmore
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
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Shah N, Deshmukh H, Wilmot EG, Patmore J, Choudhary P, Christian P, Herring R, Furlong N, Saunders S, Narendran P, Barnes DJ, Walton C, Ryder RE, Sathyapalan T. Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit. Br J Diabetes 2021. [DOI: 10.15277/bjd.2021.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness.
Aims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use.
Methods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identified predictors of change in HbA1c with FSL use.
Results: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a significant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identified higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model.
Conclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not influence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identified as a predictor of HbA1c reduction when combined with FSL use.
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Wilmot EG. Living with type 1 diabetes: what really matters? Pract Diab 2021. [DOI: 10.1002/pdi.2352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emma G Wilmot
- Diabetes Department, Royal Derby Hospital; Honorary (Clinical) Associate Professor University of Nottingham UK
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Ruan Y, Ryder REJ, De P, Field BCT, Narendran P, Iqbal A, Gandhi R, Harris S, Nagi D, Aziz U, Karra E, Ghosh S, Hanif W, Edwards AE, Zafar M, Dashora U, Várnai KA, Davies J, Wild SH, Wilmot EG, Webb D, Khunti K, Rea R. A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection. Diabetologia 2021; 64:1717-1724. [PMID: 33966090 PMCID: PMC8106514 DOI: 10.1007/s00125-021-05463-x] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/23/2021] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. METHODS A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. RESULTS Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55-74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. CONCLUSIONS/INTERPRETATION In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. IN PEOPLE WITH TYPE 1 DIABETES AND COVID-19 ADMITTED TO HOSPITAL IN THE UK, BMI AND ONE OR MORE MICROVASCULAR COMPLICATIONS HAD A POSITIVE ASSOCIATION AND LOW SERUM CREATINE LEVELS HAD A NEGATIVE ASSOCIATION WITH DEATH/ADMISSION TO INTENSIVE CARE UNIT AFTER ADJUSTING FOR AGE.
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Affiliation(s)
- Yue Ruan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Robert E J Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Parijat De
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Benjamin C T Field
- Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
- Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - Parth Narendran
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Iqbal
- Department of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rajiv Gandhi
- Department of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sophie Harris
- Diabetes and Endocrinology Department, King's College Hospital, London, UK
| | - Dinesh Nagi
- Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield, UK
| | | | | | - Sandip Ghosh
- Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wasim Hanif
- Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amy E Edwards
- Department of Diabetes and Endocrinology, Newham University Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Kinga A Várnai
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jim Davies
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Emma G Wilmot
- Diabetes Department, University Hospitals of Derby and Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - David Webb
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Oxford NIHR Biomedical Research Centre, Oxford, UK.
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Wilmot EG, Close KL, Jurišić-Eržen D, Bruttomesso D, Ampudia-Blasco FJ, Bosnyak Z, Roborel de Climens A, Bigot G, Peters AL, Renard E, Berard L, Calliari LE, Seufert J. Patient-reported outcomes in adults with type 1 diabetes in global real-world clinical practice: The SAGE study. Diabetes Obes Metab 2021; 23:1892-1901. [PMID: 33914401 DOI: 10.1111/dom.14416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/11/2020] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Abstract
AIMS To conduct a secondary analysis of the SAGE study to evaluate the association between glycaemic control and patient-reported outcomes (PROs), in adults with type 1 diabetes (T1DM) across different age groups and regions. MATERIALS AND METHODS SAGE was a multinational, cross-sectional, observational study in adults with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26-44, 45-64, and ≥65 years), and reported across different regions. PRO questionnaires were applied to assess hypoglycaemia fear (Hypoglycemia Fear Survey-II), diabetes-related distress (Problem Areas In Diabetes questionnaire), insulin treatment satisfaction (Insulin Treatment Satisfaction Questionnaire), and diabetes-specific quality of life (QoL; Audit of Diabetes-Dependent Quality of Life). Multivariable analysis was performed to evaluate the relationship between glycated haemoglobin (HbA1c) target achievement (<7% and individualised targets) with PRO scores. RESULTS The PRO scores showed relatively low levels of diabetes-related emotional distress and fear of hypoglycaemia, moderate to high treatment satisfaction, and low diabetes-related impact on QoL. Results were generally comparable across age groups with some regional variability. Achievement of the HbA1c <7% target was associated with less worry about hypoglycaemia, lower diabetes-related emotional distress, higher insulin treatment satisfaction, and higher QoL. Achievement of individualised HbA1c targets was associated with lower diabetes-related emotional distress and higher insulin treatment satisfaction. CONCLUSIONS Better glycaemic control was most closely associated with low emotional distress due to diabetes and high patient-reported insulin treatment satisfaction.
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Affiliation(s)
- Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Kelly L Close
- The diaTribe Foundation, San Francisco, California, USA
| | | | | | | | | | | | | | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital; INSERM Clinical Investigation Centre 1411; Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Lori Berard
- Nurse Consultant, Winnipeg, Manitoba, Canada
| | | | - Jochen Seufert
- Medical Faculty, University Hospital of Freiburg, Freiburg, Germany
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Wilmot EG, Evans M, Barnard-Kelly K, Burns M, Cranston I, Elliott RA, Gkountouras G, Kanumilli N, Krishan A, Kotonya C, Lumley S, Narendran P, Neupane S, Rayman G, Sutton C, Taxiarchi VP, Thabit H, Leelarathna L. Flash glucose monitoring with the FreeStyle Libre 2 compared with self-monitoring of blood glucose in suboptimally controlled type 1 diabetes: the FLASH-UK randomised controlled trial protocol. BMJ Open 2021; 11:e050713. [PMID: 34261691 PMCID: PMC8280849 DOI: 10.1136/bmjopen-2021-050713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/17/2022] Open
Abstract
INTRODUCTION Optimising glycaemic control in type 1 diabetes (T1D) remains challenging. Flash glucose monitoring with FreeStyle Libre 2 (FSL2) is a novel alternative to the current standard of care self-monitoring of blood glucose (SMBG). No randomised controlled trials to date have explored the potential benefits of FSL2 in T1D. We aim to assess the impact of FSL2 in people with suboptimal glycaemic control T1D in comparison with SMBG. METHODS This open-label, multicentre, randomised (via stochastic minimisation), parallel design study conducted at eight UK secondary and primary care centres will aim to recruit 180 people age ≥16 years with T1D for >1 year and glycated haemoglobin (HbA1c) 7.5%-11%. Eligible participants will be randomised to 24 weeks of FSL2 (intervention) or SMBG (control) periods, after 2-week of blinded sensor wear. Participants will be assessed virtually or in-person owing to the COVID-19 pandemic. HbA1c will be measured at baseline, 12 and 24 weeks (primary outcome). Participants will be contacted at 4 and 12 weeks for glucose optimisation. Control participants will wear a blinded sensor during the last 2 weeks. Psychosocial outcomes will be measured at baseline and 24 weeks. Secondary outcomes include sensor-based metrics, insulin doses, adverse events and self-report psychosocial measures. Utility, acceptability, expectations and experience of using FSL2 will be explored. Data on health service resource utilisation will be collected. ANALYSIS Efficacy analyses will follow intention-to-treat principle. Outcomes will be analysed using analysis of covariance, adjusted for the baseline value of the corresponding outcome, minimisation factors and other known prognostic factors. Both within-trial and life-time economic evaluations, informed by modelling from the perspective of the National Health Service setting, will be performed. ETHICS The study was approved by Greater Manchester West Research Ethics Committee (reference 19/NW/0081). Informed consent will be sought from all participants. TRIAL REGISTRATION NUMBER NCT03815006. PROTOCOL VERSION 4.0 dated 29 June 2020.
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Affiliation(s)
- Emma G Wilmot
- Diabetes Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Mark Evans
- Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Biomedicl Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - M Burns
- Manchester Clinical Trials Unit, University of Manchester, Manchester, UK
| | - Iain Cranston
- Academic Department of Diabetes and Endocrinology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel Ann Elliott
- Manchester Centre for Health Economics, Divison of Population Health, University of Manchester, Manchester, UK
| | - G Gkountouras
- Manchester Centre for Health Economics, Divison of Population Health, University of Manchester, Manchester, UK
| | | | - A Krishan
- Manchester Centre for Health Economics, Divison of Population Health, University of Manchester, Manchester, UK
| | - C Kotonya
- Diabetes Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - P Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sankalpa Neupane
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
| | - Gerry Rayman
- The Ipswich Diabetes Centre and Research Unit, Ipswich Hospital NHS Trust, Suffolk, Ipswich, UK
| | - Christopher Sutton
- Manchester Centre for Health Economics, Divison of Population Health, University of Manchester, Manchester, UK
| | - V P Taxiarchi
- Manchester Centre for Health Economics, Divison of Population Health, University of Manchester, Manchester, UK
| | - H Thabit
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - L Leelarathna
- Manchester Clinical Trials Unit, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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Forde H, Wilmot EG, Choudhary P. Letter to the editor. Diabet Med 2021; 38:e14546. [PMID: 33616262 DOI: 10.1111/dme.14546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hannah Forde
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Pratik Choudhary
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
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Nagi D, Ryder REJ, Ruan Y, Field BCT, Narendran P, Gandhi R, Harris S, Várnai KA, Davies J, Wild SH, Wilmot EG, Khunti K, Rea R. An audit of people admitted to hospital with diabetes and coronavirus (SARS-CoV-2): data collection methods. The Association of British Clinical Diabetologists (ABCD) Nationwide Audit. Br J Diabetes 2021. [DOI: 10.15277/bjd.2021.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We describe the rationale, aims and objectives and the methodology of data collection for the ABCD nationwide audit of individuals admitted to hospital with coronavirus (SARS-CoV-2; COVID-19) and diabetes. The audit was inspired and undertaken by the urgent need to understand the clinical course of COVID-19 in patients with diabetes admitted to hospital in the UK during the pandemic. We wished to understand the clinical behaviour of diabetes per se, post hospital admission and the factors with may be associated with admission to the Intensive Care Unit (ICU) and death due to COVID-19. This was a clinically-led audit. We used existing infrastructure and expertise to collect data using an electronic tool specifically designed and piloted by the steering group members. The clinical variables were chosen to fulfil the main aim of this audit as stated above, and factors influencing the clinical course of COVID-19 in individuals with both type 1 and type 2 diabetes at the time of admission to hospital and during the whole length of stay, until discharge or death from COVID-19. The data collected so far represent a large, multicentre audit with more than 3,500 admissions during the pandemic. We plan to continue collecting additional data and publish ongoing reports of interest to diabetes clinicians with the aim of enhancing knowledge and understanding and thereby improving clinical care of, and outcomes for, people with diabetes who are admitted to hospital with COVID-19 in the UK.
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41
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa-Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring: should sex and prandial state be additional considerations? Reply to Yardley JE and Sigal RJ [letter]. Diabetologia 2021; 64:935-938. [PMID: 33538843 PMCID: PMC7940283 DOI: 10.1007/s00125-020-05374-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Othmar Moser
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Max L Eckstein
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Sahlgrenska Academy at University of Gothenburg, Institution of Clinical Sciences, Gothenburg, Sweden
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, QC, Canada
- Endocrinology Division Centre Hospitalier Universitaire de Montréal, Montréal, QC, Canada
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Montreal Diabetes Research Centre, Montréal, QC, Canada
| | | | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Nick S Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, London, UK
| | - Dessi P Zaharieva
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
- Department of Pediatrics, Free University Brussels (VUB), Brussels, Belgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Bahçeşehir Üniversitesi, Istanbul, Turkey
| | - Asma Deeb
- Paediatric Endocrinology Division, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Department of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFT, Derby, UK
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Carmel E Smart
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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42
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Leelarathna L, Choudhary P, Wilmot EG, Lumb A, Street T, Kar P, Ng SM. Hybrid closed-loop therapy: Where are we in 2021? Diabetes Obes Metab 2021; 23:655-660. [PMID: 33269551 DOI: 10.1111/dom.14273] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [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: 10/26/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/23/2022]
Abstract
Hybrid closed-loop systems are characterized by the coexistence of algorithm-driven automated insulin delivery combined with manual mealtime boluses. Used correctly, these insulin delivery systems offer better glucose control and reduced risk of hypoglycaemia and represent the most advanced form of insulin delivery available for people with type 1 diabetes. The aim of this paper was to compare the currently available commercial hybrid closed-loop systems in the UK: the Medtronic 670G/780G, Tandem t:slim X2 Control IQ and CamAPS FX systems. The Medtronic 670G/780G systems use Guardian 3 sensor (7-day use, two to four calibrations per day), while Tandem and CamAPS systems use the calibration-free Dexcom G6 sensor (10 days). The CamAPS system is available as an android app, whereas the other two systems have the algorithm embedded in the insulin pump. During pivotal studies, depending on the study population and baseline glycated haemoglobin level, these systems achieve a time spent in the target range 3.9 to 10 mmol/L (70 to 180 mg/dL) of 65% to 76% with low burden of hypoglycaemia. All three systems allow a higher glucose target for announced exercise, while the Tandem system offers an additional night-time tighter target. The CamAPS system offers fully customizable glucose targets and is the only system licensed for use during pregnancy. Additional education is required for both users and healthcare professionals to harness the best performance from these systems as well as to troubleshoot when "automode exits" occur. We provide consensus recommendations to develop pragmatic pathways to guide patients, clinicians and commissioners in making informed decisions on the appropriate use of the diabetes technology.
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Affiliation(s)
- Lalantha Leelarathna
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Pratik Choudhary
- Leicester Diabetes Center, University of Leicester, Leicester, UK
| | - Emma G Wilmot
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Alistair Lumb
- OCDEM, Oxford University Hospitals NHS FT, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | | | - Partha Kar
- Portsmouth Hospital NHS Trust, NHS, Portsmouth, UK
| | - Sze M Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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43
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Choudhary P, Wilmot EG, Owen K, Patel DC, Mills L, Rayman G, Winocour P, Ayman G, Patel R, Hambling C, Nagi DK. A roadmap to recovery: ABCD recommendations on risk stratification of adult patients with diabetes in the post-COVID-19 era. Diabet Med 2021; 38:e14462. [PMID: 33230813 PMCID: PMC7744853 DOI: 10.1111/dme.14462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Pratik Choudhary
- Professor of DiabetesLeicester Diabetes Centre ‐ BloomUniversity of LeicesterLeicesterUK
| | - Emma G. Wilmot
- Consultant DiabetologistUniversity Hospitals of Derby and BurtonDerbyUK
- Associate ProfessorUniversity of NottinghamNottinghamUK
| | - Karissa Owen
- GP Clinical Lead for Diabetes, Derby and Derbyshire CCGPartnerLittlewick Medical CentreIlkestonUK
| | - Dipesh C. Patel
- Consultant PhysicianRoyal Free NHS FTHon Associate Professor University College LondonLondonUK
| | - Lesley Mills
- Consultant NurseWarrington and Halton Teaching Hospitals NHS FTCheshireUK
| | - Gerry Rayman
- Diabetes DepartmentThe Ipswich Hospital and Ipswich Diabetes Centre and Research UnitEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | | | | | | | - Clare Hambling
- GP Clinical Lead for DiabetesNorfolk and Waveney and LTC Lead West Norfolk CCGNorwichUK
- Chair, Primary Care Diabetes Society
| | - Dinesh K. Nagi
- ABCD ChairConsultant Diabetes and EndocrinologyPinderfields Hospital Mid Yorks NHS TrustWakefieldUK
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44
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Gulsin GS, Brady E, Marsh AM, Squire G, Htike ZZ, Wilmot EG, Biglands JD, Kellman P, Xue H, Webb DR, Khunti K, Yates T, Davies MJ, McCann GP. Clinical associations with stage B heart failure in adults with type 2 diabetes. Ther Adv Endocrinol Metab 2021; 12:20420188211030144. [PMID: 34349975 PMCID: PMC8287269 DOI: 10.1177/20420188211030144] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a high prevalence of asymptomatic (American Heart Association Stage B) heart failure (SBHF) in people with type 2 diabetes (T2D). We aimed to identify associations between clinical characteristics and markers of SBHF in adults with T2D, which may allow therapeutic interventions prior to symptom onset. METHODS Adults with T2D from a multi-ethnic population with no prevalent cardiovascular disease [n = 247, age 52 ± 12 years, glycated haemoglobin A1c (HbA1c) 7.4 ± 1.1% (57 ± 12 mmol/mol), duration of diabetes 61 (32, 120) months] underwent echocardiography and adenosine stress perfusion cardiovascular magnetic resonance imaging. Multivariable linear regression analyses were performed to identify independent associations between clinical characteristics and markers of SBHF. RESULTS In a series of multivariable linear regression models containing age, sex, ethnicity, smoking history, number of glucose-lowering agents, systolic blood pressure (BP) duration of diabetes, body mass index (BMI), HbA1c, serum creatinine, and low-density lipoprotein (LDL)-cholesterol, independent associations with: left ventricular mass:volume were age (β = 0.024), number of glucose-lowering agents (β = 0.022) and systolic BP (β = 0.027); global longitudinal strain were never smoking (β = -1.196), systolic BP (β = 0.328), and BMI (β = -0.348); myocardial perfusion reserve were age (β = -0.364) and male sex (β = 0.458); and aortic distensibility were age (β = -0.629) and systolic BP (β = -0.348). HbA1c was not independently associated with any marker of SBHF. CONCLUSIONS In asymptomatic adults with T2D, age, systolic BP, BMI, and smoking history, but not glycaemic control, are the major determinants of SBHF. Given BP and BMI are modifiable, these may be important targets to reduce the development of symptomatic heart failure.
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Affiliation(s)
| | - Emer Brady
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gareth Squire
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Zin Z. Htike
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Emma G. Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Peter Kellman
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Hui Xue
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - David R. Webb
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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45
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa-Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Diabetologia 2020; 63:2501-2520. [PMID: 33047169 DOI: 10.1007/s00125-020-05263-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [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: 12/20/2022]
Abstract
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (i.e. before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes. Graphical abstract.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria.
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Max L Eckstein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Sahlgrenska Academy at University of Gothenburg, Institution of Clinical Sciences, Gothenburg, Sweden
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, QC, Canada
- Endocrinology Division Centre Hospitalier Universitaire de Montréal, Montréal, QC, Canada
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Montreal Diabetes Research Centre, Montréal, QC, Canada
| | | | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Nick S Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, London, UK
| | - Dessi P Zaharieva
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
- Department of Pediatrics, Free University Brussels (VUB), Brussels, Belgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Bahçeşehir Üniversitesi, Istanbul, Turkey
| | - Asma Deeb
- Paediatric Endocrinology Division, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFT, Derby, UK
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Carmel E Smart
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
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46
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa‐Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Pediatr Diabetes 2020; 21:1375-1393. [PMID: 33047481 PMCID: PMC7702152 DOI: 10.1111/pedi.13105] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 02/07/2023] Open
Abstract
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of BayreuthBayreuthGermany
| | - Michael C. Riddell
- School of Kinesiology and Health ScienceYork UniversityTorontoOntarioCanada
| | - Max L. Eckstein
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Peter Adolfsson
- Department of PediatricsThe Hospital of HallandKungsbackaSweden
- Sahlgrenska Academy at University of GothenburgInstitution of Clinical SciencesGothenburgSweden
| | - Rémi Rabasa‐Lhoret
- Institut de recherches Cliniques de MontréalMontréalQCCanada
- Endocrinology division Centre Hospitalier Universitaire de MontréalMontréalQCCanada
- Nutrition Department, Faculty of MedicineUniversité de MontréalMontréalQCCanada
- Montreal Diabetes Research CentreMontréalQCCanada
| | | | - Pieter Gillard
- Department of EndocrinologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
| | - Kirsten Nørgaard
- Steno Diabetes Center CopenhagenUniversity of CopenhagenCopenhagenDenmark
| | - Nick S. Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial CollegeLondonLondonUK
| | - Dessi P. Zaharieva
- Department of Pediatric Endocrinology and DiabetesStanford University School of MedicineStanfordCaliforniaUSA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC ‐ University Children’s HospitalUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and EndocrinologyCentre Hospitalier LuxembourgLuxembourgLuxembourg
- Department of Pediatrics, Free University Brussels (VUB)BrusselsBelgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and DiabetesStanford University School of MedicineStanfordCaliforniaUSA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of MedicineNew HavenConnecticutUSA
- Bahçeşehir Üniversitesi, IstanbulTurkey
| | - Asma Deeb
- Paediatric Endocrinology DivisionShaikh Shakhbout Medical CityAbu DhabiUnited Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical SchoolUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation Trust, SheffieldUK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Chantal Mathieu
- Department of EndocrinologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, InselspitalBern University Hospital and University of BernBernSwitzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Emma G. Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFTDerbyUK
- Faculty of Medicine & Health SciencesUniversity of NottinghamNottinghamUK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Carmel E. Smart
- School of Health Sciences, University of NewcastleCallaghanNew South WalesAustralia
- Department of Paediatric Diabetes and EndocrinologyJohn Hunter Children’s HospitalNewcastleNew South WalesAustralia
| | - Peter G. Jacobs
- Department of Biomedical EngineeringOregon Health & Science UniversityPortlandOregonUSA
| | - Richard M. Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A‐STEM), College of EngineeringSwansea UniversitySwanseaUK
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
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Abstract
Growing numbers of people with type 1 diabetes are using do-it-yourself closed-loop systems. While these technologies are not approved by regulatory bodies and are not commercially available, users of the technology report improvements in HbA1c and time in range, and reduced burden of diabetes. Healthcare professionals have expressed their concern that legal or regulatory body actions could ensue if they support people who choose to use do-it-yourself closed-loop systems. Diabetes UK's position statements make recommendations that aim to provide guidance for both people with diabetes and healthcare professionals, based on the current professional and legal situation. They respect an individual's right to make their own informed decisions about their diabetes management, and recommend that they should have access to the technology they need for optimal diabetes management. People who wish to use do-it-yourself closed-loop systems should continue to receive support and care from their diabetes team. Healthcare professionals should engage in conversations around do-it-yourself closed-loop systems, if the issue is raised, to allow a balanced discussion of risks and benefits. However, healthcare professionals cannot recommend the use of do-it-yourself closed-loop systems because of a lack of regulatory body approval and robust, published research to support safety or effectiveness. People using this technology should be aware that they do so at their own risk. This position statement recognizes that the development of diabetes technology is a rapidly changing environment, and guidance around do-it-yourself systems is required from professional and regulatory bodies.
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Affiliation(s)
| | - E G Wilmot
- University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK
| | - P Choudhary
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
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48
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Affiliation(s)
- D Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - T S J Crabtree
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - P Hammond
- Harrogate and District Foundation Trust, Harrogate, UK
| | | | - E G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
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49
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Deshmukh H, Wilmot EG, Gregory R, Barnes D, Narendran P, Saunders S, Furlong N, Kamaruddin S, Banatwalla R, Herring R, Kilvert A, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Effect of Flash Glucose Monitoring on Glycemic Control, Hypoglycemia, Diabetes-Related Distress, and Resource Utilization in the Association of British Clinical Diabetologists (ABCD) Nationwide Audit. Diabetes Care 2020; 43:2153-2160. [PMID: 32669277 PMCID: PMC7440900 DOI: 10.2337/dc20-0738] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/03/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions. RESEARCH DESIGN AND METHODS Clinicians from 102 NHS hospitals in the U.K. submitted FSL user data, collected during routine clinical care, to a secure web-based tool held within the NHS N3 network. The t and Mann-Whitney U tests were used to compare the baseline and follow-up HbA1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA1c following the use of FSL. Within-person variations of HbA1c were calculated using [Formula: see text]. RESULTS Data were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (±18.8) years, 51% female, diabetes duration 16.0 (±49.9) years, and BMI of 25.2 (±16.5) kg/m2 (mean [±SD]). FSL users demonstrated a -5.2 mmol/mol change in HbA1c, reducing from 67.5 (±20.9) mmol/mol (8.3%) at baseline to 62.3 (±18.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4-7.8) months of follow-up (n = 3,182) (P < 0.0001). HbA1c reduction was greater in those with initial HbA1c ≥69.5 mmol/mol (>8.5%), reducing from 85.5 (±16.1) mmol/mol (10%) to 73.1 (±15.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (±1.8) and reduced to 2.4 (±1.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ≥4 at baseline had a score <4 at follow-up. FSL use was also associated with a reduction in diabetes distress (P < 0.0001). FSL use was associated with a significant reduction in paramedic callouts and hospital admissions due to hypoglycemia and hyperglycemia/diabetic ketoacidosis. CONCLUSIONS We show that the use of FSL was associated with significantly improved glycemic control and hypoglycemia awareness and a reduction in hospital admissions.
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Affiliation(s)
- Harshal Deshmukh
- Hull University Teaching Hospitals NHS Trust and University of Hull, Hull, U.K
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | | | | | - Parth Narendran
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, U.K
| | - Simon Saunders
- Warrington and Halton Teaching Hospitals NHS Foundation Trust Warrington, U.K
| | - Niall Furlong
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, U.K
| | | | | | | | - Anne Kilvert
- Northampton General Hospital NHS Trust, Northampton, U.K
| | - Jane Patmore
- Hull University Teaching Hospitals NHS Trust and University of Hull, Hull, U.K
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust and University of Hull, Hull, U.K
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50
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Gulsin GS, Henson J, Brady EM, Sargeant JA, Wilmot EG, Athithan L, Htike ZZ, Marsh AM, Biglands JD, Kellman P, Khunti K, Webb D, Davies MJ, Yates T, McCann GP. Cardiovascular Determinants of Aerobic Exercise Capacity in Adults With Type 2 Diabetes. Diabetes Care 2020; 43:2248-2256. [PMID: 32680830 PMCID: PMC7440912 DOI: 10.2337/dc20-0706] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the relationship between subclinical cardiac dysfunction and aerobic exercise capacity (peak VO2) in adults with type 2 diabetes (T2D), a group at high risk of developing heart failure. RESEARCH DESIGN AND METHODS Cross-sectional study. We prospectively enrolled a multiethnic cohort of asymptomatic adults with T2D and no history, signs, or symptoms of cardiovascular disease. Age-, sex-, and ethnicity-matched control subjects were recruited for comparison. Participants underwent bioanthropometric profiling, cardiopulmonary exercise testing, and cardiovascular magnetic resonance with adenosine stress perfusion imaging. Multivariable linear regression analysis was undertaken to identify independent associations between measures of cardiovascular structure and function and peak VO2. RESULTS A total of 247 adults with T2D (aged 51.8 ± 11.9 years, 55% males, 37% black or south Asian ethnicity, HbA1c 7.4 ± 1.1% [57 ± 12 mmol/mol], and duration of diabetes 61 [32-120] months) and 78 control subjects were included. Subjects with T2D had increased concentric left ventricular remodeling, reduced myocardial perfusion reserve (MPR), and markedly lower aerobic exercise capacity (peak VO2 18.0 ± 6.6 vs. 27.8 ± 9.0 mL/kg/min; P < 0.001) compared with control subjects. In a multivariable linear regression model containing age, sex, ethnicity, smoking status, and systolic blood pressure, only MPR (β = 0.822; P = 0.006) and left ventricular diastolic filling pressure (E/e') (β = -0.388; P = 0.001) were independently associated with peak VO2 in subjects with T2D. CONCLUSIONS In a multiethnic cohort of asymptomatic people with T2D, MPR and diastolic function are key determinants of aerobic exercise capacity, independent of age, sex, ethnicity, smoking status, or blood pressure.
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Affiliation(s)
- Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K.
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Zin Z Htike
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | | | - Peter Kellman
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - David Webb
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K.
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