1
|
Castorani V, Rigamonti A, Frontino G, Morotti E, Sandullo F, Scialabba F, Arrigoni F, Dionisi B, Foglino R, Morosini C, Olivieri G, Bonfanti R. Turning the tides: achieving rapid and safe glucose control in adolescents with suboptimally controlled type 1 diabetes using advanced hybrid closed loop systems. Front Endocrinol (Lausanne) 2024; 15:1243565. [PMID: 38628580 PMCID: PMC11019566 DOI: 10.3389/fendo.2024.1243565] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/04/2024] [Indexed: 04/19/2024] Open
Abstract
Aim Many adolescents with T1D experience a decline in metabolic control due to erratic eating habits and subpar adherence to treatment regimens. The objective of our retrospective observational study was to assess the effect of the Tandem Control IQ (CIQ) advanced hybrid closed-loop (AHCL) system on a cohort of adolescents with suboptimal glucose control. Methods We retrospectively evaluated 20 non-adherent patients with T1D, who were inconsistently using Multiple Daily Injections (MDIs) and flash glucose monitoring and were subsequently started and on CIQ. Glucometrics and the Glucose Risk Index were assessed at baseline and after 2 weeks, 1 month, and 6 months of CIQ use. Results The study included 20 adolescents with T1D (HbA1c: 10.0% ± 1.7). Time in range (TIR) increased from 27.1% ± 13.7 at baseline to 68.6% ± 14.2 at 2 weeks, 66.6% ± 10.7 at 1 month, and 60.4% ± 13.3 at 6 months of CIQ use. Time above range (TAR) >250 mg/dL decreased from 46.1% ± 23.8 to 9.9% ± 9.5 at 2 weeks, 10.8% ± 6.1 at 1 month, and 15.5% ± 10.5 at 6 months of AHCL use. Mean glucose levels improved from 251 mg/dL ± 68.9 to 175mg/dL ± 25.5 after 6 months of CIQ use. The Glucose Risk Index (GRI) also significantly reduced from 102 to 48 at 6 months of CIQ. HbA1c also improved from 10.0% ± 1.7 at baseline to 7.0% ± 0.7 after 6 months. Two patients experienced a single episode of mild diabetic ketoacidosis (DKA). Conclusions AHCL systems provide a significant, rapid, and safe improvement in glucose control. This marks a pivotal advancement in technology that primarily benefited those who were already compliant.
Collapse
Affiliation(s)
- Valeria Castorani
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrea Rigamonti
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Giulio Frontino
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Elisa Morotti
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Federica Sandullo
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Scialabba
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesca Arrigoni
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Benedetta Dionisi
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Foglino
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Camilla Morosini
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Gabriele Olivieri
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
2
|
Gómez AM, Henao C DC, Rebolledo M, Jaramillo P PE, Muñoz V OM, Niño G LM, Yepes C CA. Determination of Time in Range Associated With HbA1c ≤7% in a Prospective Cohort of Patients With Type 1 Diabetes Using Continuous Glucose Monitoring for Three Months. J Diabetes Sci Technol 2024; 18:345-350. [PMID: 35791440 PMCID: PMC10973842 DOI: 10.1177/19322968221108424] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Finding a goal of time in range (%TIR) that defines good glycemic control is necessary. Previous retrospective studies suggest good concordance between HbA1c ≤7% with a TIR >70%; however, the studies that included the largest number of patients used blood glucose measurement data with a follow-up time of less than 90 days. This study defined the TIR value that best discriminates HbA1c ≤7%. METHODS We performed a prospective study of diagnostic tests based on a cohort of patients with type 1 diabetes (T1D) treated with a hybrid closed loop (HCL) followed for three months. The ability of %TIR to distinguish patients with HbA1c ≤7% was evaluated through receiver operating characteristic curve analysis. We determined the %TIR cutoff point with the best operating characteristics. RESULTS A total of 118 patients were included (58.1% women, 47% overweight or obese, and 33% with high glycemic variability). A moderate negative correlation (R = -.54, P < .001) was found between %TIR and HbA1c. The discrimination ability was moderate, with an area under the curve of 0.7485 (95% confidence interval = 0.6608-0.8363). The cutoff point that best predicted HbA1c ≤7% was %TIR ≥75.5 (sensitivity 70%, specificity 67%). The findings were similar among those with a coefficient of variation (CV%) ≥36%. CONCLUSIONS Our data suggest that the %TIR adequately identifies patients with HbA1c ≤7%. A target of TIR ≥75%, rather than the currently recommended TIR ≥70%, may be a more suitable value for optimal glycemic control.
Collapse
Affiliation(s)
- Ana María Gómez
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diana Cristina Henao C
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Martín Rebolledo
- Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Esteban Jaramillo P
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Oscar Mauricio Muñoz V
- Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Carlos Augusto Yepes C
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
3
|
Stimson RH, Dover AR, Strachan MWJ, Wright RJ, Forbes S, Gibb FW. Changes in continuous glucose monitoring metrics and predictors of improvement 12 months after conversion from Freestyle Libre to Freestyle Libre 2. Diabet Med 2023; 40:e15130. [PMID: 37151106 DOI: 10.1111/dme.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/09/2023]
Abstract
AIMS We sought to assess whether conversion from Freestyle Libre to Freestyle Libre 2 (with low and high glucose alert functions) was associated with improved glucose metrics. RESEARCH DESIGN AND METHODS A prospective observational study to assess changes in CGM metrics in 672 adults with type 1 diabetes when converting to Freestyle Libre 2. Secondary outcomes included predictors of reduction in time below range (TBR) and increase in time in range (TIR). RESULTS TBR fell by a median of 1.0% (IQR -2.7 to 0.3, p < 0.001) after 12 months and TIR decreased by 1.0% (-8.7 to 6.0, p = 0.004). TIR did not fall in people using high glucose alerts (p = 0.353). Average duration of low glucose events (<3.9 mmoL/L) fell by 10 min (-46 to 18, p < 0.001). Significant improvements in TIR (p = 0.029) and time above 13.9 mM (p = 0.002) were observed in those using high glucose alerts. Alert threshold settings were not associated with glycaemic response; however, low alert use was independently associated with a fall in TBR of ≥0.5% (HR 1.9 [95% CI 1.2-3.1], p = 0.009) and high alert use was independently associated with a rise in TIR of ≥5% (HR 1.6 [95% CI 1.0-2.5], p = 0.043) at 12 months. CONCLUSIONS Conversion to Freestyle Libre 2 was associated with significant improvements in low glucose metrics. Alert function users were more likely to see improvements across all CGM metrics. Challenges remain in encouraging alert use, helping users set optimal alert thresholds and optimizing response to alerts.
Collapse
Affiliation(s)
- Roland H Stimson
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Anna R Dover
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark W J Strachan
- Edinburgh Centre for Endocrinology & Diabetes, Western General Hospital, Edinburgh, UK
| | - Rohana J Wright
- Edinburgh Centre for Endocrinology & Diabetes, St John's Hospital, Edinburgh, UK
| | - Shareen Forbes
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, 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
| |
Collapse
|
4
|
Al-Ozairi E, Irshad M, Taghadom E, Varghese A, Sojan L, Alkandari J. Effect of COVID-19 vaccine on blood glucose metrics in Arabic people with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1120384. [PMID: 37020598 PMCID: PMC10067894 DOI: 10.3389/fendo.2023.1120384] [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: 12/09/2022] [Accepted: 02/28/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION People with diabetes are at a higher risk for coronavirus disease-19 (COVID-19) and hence are prioritized for vaccination. The aim of the current study was to investigate the effects of COVID-19 vaccination on blood glucose control in Arabic people with type 1 diabetes (T1D). Secondary aim was to compare the responses between the two vaccines approved for use in Kuwait. METHOD This retrospective study compared ambulatory glucose metrics, using a continuous glucose monitoring device, measured for 14 days before, and 7 days and 14 days after, the first and second dose of the COVID-19 vaccine in Arabic people with Type 1 diabetes (T1D). We also explored possible links with vaccine type and other clinical characteristics. Glucose metrics calculated were time in range (TIR, 3.9-10 mmol/L), time above range (TAR, 10.1- 13.9 mmol/L or >13.9 mmol/L), time below range (TBR, 3- 3.9 mmol/L or <3 mmol/L) and glucose variability (CV). RESULTS We enrolled 223 participants in the study. Over the 7 days period after the first vaccination dose there was a decrease in TIR (mean difference (SD) -1.9% ± 14.8%; p = 0.05) and increase in TAR >10 mmol/L (2.2% ± 15.9%; p = 0.04), with no effects on TBR. These effects were not seen after the second dose or 14 days after either dose. There was a decrease in CV over the 7 days period after the first (-1.2% ± 7.4%; p = 0.02) and second vaccine doses (-1.1% ± 6.9%; p = 0.03), with no effects noted 14 days after either dose. In subgroup analysis similar effects on TIR and TAR were also seen in those who had received the viral vector-based vaccine, but not the mRNA-based vaccine, although the decrease in CV was seen in those who had received the mRNA based vaccine but not the viral vector-based vaccine. CONCLUSION We found a temporary impairment in glucose control in the first 7 days, particularly among individuals receiving viral vector vaccines. The group receiving mRNA vaccine was likely to experience an increase in glucose levels above the target range. However, the temporary change in metrics appears to return to pre-vaccination levels after one-week post-vaccination. The effects on glycemic parameters were more neutral after the second dose.
Collapse
Affiliation(s)
- Ebaa Al-Ozairi
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
- *Correspondence: Ebaa Al-Ozairi,
| | | | - Etab Taghadom
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | | | - Litty Sojan
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jumana Alkandari
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| |
Collapse
|