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Drydakis N. Mobile applications aiming to facilitate immigrants’ societal integration and overall level of integration, health and mental health. Does artificial intelligence enhance outcomes? COMPUTERS IN HUMAN BEHAVIOR 2021. [DOI: 10.1016/j.chb.2020.106661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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52
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Oscillatory pattern of glycemic control in patients with diabetes mellitus. Sci Rep 2021; 11:5789. [PMID: 33707491 PMCID: PMC7970978 DOI: 10.1038/s41598-021-84822-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/18/2021] [Indexed: 12/21/2022] Open
Abstract
Daily glucose variability is higher in diabetic mellitus (DM) patients which has been related to the severity of the disease. However, it is unclear whether glycemic variability displays a specific pattern oscillation or if it is completely random. Thus, to determine glycemic variability pattern, we measured and analyzed continuous glucose monitoring (CGM) data, in control subjects and patients with DM type-1 (T1D). CGM data was assessed for 6 days (day: 08:00-20:00-h; and night: 20:00-08:00-h). Participants (n = 172; age = 18-80 years) were assigned to T1D (n = 144, females = 65) and Control (i.e., healthy; n = 28, females = 22) groups. Anthropometry, pharmacologic treatments, glycosylated hemoglobin (HbA1c) and years of evolution were determined. T1D females displayed a higher glycemia at 10:00-14:00-h vs. T1D males and Control females. DM patients displays mainly stationary oscillations (deterministic), with circadian rhythm characteristics. The glycemia oscillated between 2 and 6 days. The predictive model of glycemia showed that it is possible to predict hyper and hypoglycemia (R2 = 0.94 and 0.98, respectively) in DM patients independent of their etiology. Our data showed that glycemic variability had a specific oscillation pattern with circadian characteristics, with episodes of hypoglycemia and hyperglycemia at day phases, which could help therapeutic action for this population.
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May SG, Huber C, Roach M, Shafrin J, Aubry W, Lakdawalla D, Kane JM, Forma F. Adoption of Digital Health Technologies in the Practice of Behavioral Health: Qualitative Case Study of Glucose Monitoring Technology. J Med Internet Res 2021; 23:e18119. [PMID: 33533725 PMCID: PMC7889421 DOI: 10.2196/18119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/05/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background Evaluation of patients with serious mental illness (SMI) relies largely on patient or caregiver self-reported symptoms. New digital technologies are being developed to better quantify the longitudinal symptomology of patients with SMI and facilitate disease management. However, as these new technologies become more widely available, psychiatrists may be uncertain about how to integrate them into daily practice. To better understand how digital tools might be integrated into the treatment of patients with SMI, this study examines a case study of a successful technology adoption by physicians: endocrinologists’ adoption of digital glucometers. Objective This study aims to understand the key facilitators of and barriers to clinician and patient adoption of digital glucose monitoring technologies to identify lessons that may be applicable across other chronic diseases, including SMIs. Methods We conducted focus groups with practicing endocrinologists from 2 large metropolitan areas using a semistructured discussion guide designed to elicit perspectives of and experiences with technology adoption. The thematic analysis identified barriers to and facilitators of integrating digital glucometers into clinical practice. Participants also provided recommendations for integrating digital health technologies into clinical practice more broadly. Results A total of 10 endocrinologists were enrolled: 60% (6/10) male; a mean of 18.4 years in practice (SD 5.6); and 80% (8/10) working in a group practice setting. Participants stated that digital glucometers represented a significant change in the treatment paradigm for diabetes care and facilitated more effective care delivery and patient engagement. Barriers to the adoption of digital glucometers included lack of coverage, provider reimbursement, and data management support, as well as patient heterogeneity. Participant recommendations to increase the use of digital health technologies included expanding reimbursement for clinician time, streamlining data management processes, and customizing the technologies to patient needs. Conclusions Digital glucose monitoring technologies have facilitated more effective, individualized care delivery and have improved patient engagement and health outcomes. However, key challenges faced by the endocrinologists included lack of reimbursement for clinician time and nonstandardized data management across devices. Key recommendations that may be relevant for other diseases include improved data analytics to quickly and accurately synthesize data for patient care management, streamlined software, and standardized metrics.
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Affiliation(s)
| | | | | | | | - Wade Aubry
- Philip R Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States
| | | | - John M Kane
- School of Medicine, Hofstra University, Hempstead, NY, United States.,Northwell Health, New York, NY, United States
| | - Felicia Forma
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, United States
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54
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Brew-Sam N, Chhabra M, Parkinson A, Hannan K, Brown E, Pedley L, Brown K, Wright K, Pedley E, Nolan CJ, Phillips C, Suominen H, Tricoli A, Desborough J. Experiences of Young People and Their Caregivers of Using Technology to Manage Type 1 Diabetes Mellitus: Systematic Literature Review and Narrative Synthesis. JMIR Diabetes 2021; 6:e20973. [PMID: 33528374 PMCID: PMC7886614 DOI: 10.2196/20973] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the last decade, diabetes management has begun to transition to technology-based care, with young people being the focus of many technological advances. Yet, detailed insights into the experiences of young people and their caregivers of using technology to manage type 1 diabetes mellitus are lacking. OBJECTIVE The objective of our study was to describe the breadth of experiences and perspectives on diabetes technology use among children and adolescents with type 1 diabetes mellitus and their caregivers. METHODS This systematic literature review used integrated thematic analysis to guide a narrative synthesis of the included studies. We analyzed the perspectives and experiences of young people with type 1 diabetes mellitus and their caregivers reported in qualitative studies, quantitative descriptive studies, and studies with a mixed methods design. RESULTS Seventeen articles met the inclusion criteria, and they included studies on insulin pump, glucose sensors, and remote monitoring systems. The following eight themes were derived from the analysis: (1) expectations of the technology prior to use, (2) perceived impact on sleep and overnight experiences, (3) experiences with alarms, (4) impact on independence and relationships, (5) perceived usage impact on blood glucose control, (6) device design and features, (7) financial cost, and (8) user satisfaction. While many advantages of using diabetes technology were reported, several challenges for its use were also reported, such as cost, the size and visibility of devices, and the intrusiveness of alarms, which drew attention to the fact that the user had type 1 diabetes mellitus. Continued use of diabetes technology was underpinned by its benefits outweighing its challenges, especially among younger people. CONCLUSIONS Diabetes technologies have improved the quality of life of many young people with type 1 diabetes mellitus and their caregivers. Future design needs to consider the impact of these technologies on relationships between young people and their caregivers, and the impact of device features and characteristics such as size, ease of use, and cost.
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Affiliation(s)
- Nicola Brew-Sam
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Madhur Chhabra
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kristal Hannan
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ellen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Lachlan Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Karen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Kristine Wright
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Elizabeth Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Christopher J Nolan
- Canberra Health Services, Canberra, Australia.,ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland.,Data61, Commonwealth Scientific and Industrial Research Organisation, Canberra, Australia
| | - Antonio Tricoli
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia.,Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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55
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Lai CW, Lipman TH, Willi SM, Hawkes CP. Racial and Ethnic Disparities in Rates of Continuous Glucose Monitor Initiation and Continued Use in Children With Type 1 Diabetes. Diabetes Care 2021; 44:255-257. [PMID: 33177169 DOI: 10.2337/dc20-1663] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Racial/ethnic disparities in continuous glucose monitor (CGM) use exist among children with type 1 diabetes. It is not known whether differential rates of device initiation or sustained use are the cause of this disparity. Our objective was to compare CGM initiation rates and continued use among non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic children. RESEARCH DESIGN AND METHODS We conducted a retrospective review including children with type 1 diabetes attending the Children's Hospital of Philadelphia between 1 January 2015 and 31 December 2018. RESULTS Of 1,509 eligible children, 726 (48%) started CGM during the study period. More NHW (54%) than NHB (31%) and Hispanic (33%) children started CGM (P < 0.001). One year after starting, fewer NHB (61%) than NHW (86%) and Hispanic (85%) children were using CGM (P < 0.001). CONCLUSIONS Lower CGM use in NHB children was due to lower rates of device initiation and higher rates of discontinuation. Interventions to address both of these barriers are needed to reduce disparities in CGM use.
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Affiliation(s)
- Charlene W Lai
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Terri H Lipman
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.,School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Steven M Willi
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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56
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Roze S, Isitt JJ, Smith-Palmer J, Lynch P, Klinkenbijl B, Zammit G, Benhamou PY. Long-Term Cost-Effectiveness the Dexcom G6 Real-Time Continuous Glucose Monitoring System Compared with Self-Monitoring of Blood Glucose in People with Type 1 Diabetes in France. Diabetes Ther 2021; 12:235-246. [PMID: 33165838 PMCID: PMC7651823 DOI: 10.1007/s13300-020-00959-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The aim was to determine the long-term cost-effectiveness of the Dexcom G6 real-time continuous glucose monitoring (RT-CGM) system versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes (T1D) in France. METHODS The analysis was performed using the IQVIA Core Diabetes Model and utilized clinical input data from the DIAMOND clinical trial in adults with T1D. Simulated patients were assumed to have a mean baseline HbA1c of 8.6%, and those in the RT-CGM arm were assumed to have a HbA1c reduction of 1.0% compared with 0.4% in the SMBG arm. A quality of life (QoL) benefit associated with a reduced fear of hypoglycemia (FoH) and elimination of the requirement for fingerstick testing in the RT-CGM arm was also applied. RESULTS The G6 RT-CGM system was associated with an incremental gain in quality-adjusted life expectancy of 1.38 quality-adjusted life years (QALYs) compared with SMBG (10.64 QALYs versus 9.23 QALYs). Total mean lifetime costs were 21,087 euros higher with RT-CGM (148,077 euros versus 126,990 euros), resulting in an incremental cost-effectiveness ratio of 15,285 euros per QALY gained. CONCLUSIONS In France, based on a willingness-to-pay threshold of 50,000 euros per QALY gained, the use of the G6 RT-CGM system is cost-effective relative to SMBG for adults with long-standing T1D, driven primarily by improved glycemic control and the QoL benefit associated with reduced FoH and elimination of the requirement for fingerstick testing.
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Affiliation(s)
| | | | | | | | | | | | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble Alpes University Hospital, Grenoble, France
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57
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Franceschi R, Micheli F, Mozzillo E, Cauvin V, Liguori A, Soffiati M, Giani E. Intermittently Scanned and Continuous Glucose Monitor Systems: A Systematic Review on Psychological Outcomes in Pediatric Patients. Front Pediatr 2021; 9:660173. [PMID: 34026692 PMCID: PMC8131655 DOI: 10.3389/fped.2021.660173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Aim: To explore the impact of real-time continuous glucose monitoring (rtCGMs) or intermittently scanned/viewed CGM (isCGM) on psychological outcomes in children and caregivers, and to grade the level of evidence. Method: Systematic review of the literature from PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Nursing reference center, Up to date, Google Scholar, and PsycINFO databases. The studies selected used validated questionnaires for investigating the psychological outcomes. We applied GRADE (Grading of Recommendations Assessment, Development and Evaluation) to rank the quality of a body of evidence. Results: A total of 192 studies were identified in the initial search and after the process of evaluation 25 studies were selected as appropriate to be included in this systematic review. We found in moderate quality studies that isCGM in adolescents can improve diabetes related distress, family conflicts, fear of hypoglycemia, and quality of life, while depression, anxiety, and quality of sleep have not yet been evaluated by validated questionnaires. In moderate-high quality studies, rtCGM technology does not impact on diabetes burden, diabetes specific family conflict, and depressive symptoms. The effect on fear of hypoglycemia, sleep quality, and anxiety is still debated and RCT studies powered to find significant results in psychological outcomes are lacking. RtCGM increases satisfaction and quality of life in parents and patients wearing rtCGM. Conclusion: these data present an interesting point to consider when families are deciding whether or not to start CGM use, choosing between rtCGM to reach a tighter metabolic control, or isCGM which allows greater benefits on psychological outcomes.
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Affiliation(s)
| | | | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | | | | | | | - Elisa Giani
- Humanitas Clinical and Research Center, Rozzano, Italy
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58
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Morales J, Kuritzky L, Lavernia F, Santiago M. Are residents receiving the training needed within their residency programs to optimally manage patients with diabetes? Postgrad Med 2020; 133:388-394. [PMID: 33327836 DOI: 10.1080/00325481.2020.1857603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Diabetes is a prevalent and growing problem in the United States (U.S.); primary care physicians need to be prepared to initiate and progressively advance treatment. The objective of this study was to understand how diabetes management is taught in U.S. Family Medicine (FM) and Internal Medicine (IM) residency programs.Methods: Invitations to complete an online survey were sent via postal mail to U.S. FM and IM residency programs in 2019.Results: Directors/associate directors from 68 FM residencies and 66 IM residencies completed the online survey out of 645 (10.5%) and 505 (13.1%) programs, respectively. Most respondents rated cardiovascular disease and risk management in diabetes as 'very important' (90%), but only about half (47%) did so for newer generation insulin analogs and 27% for digital health technologies. About two-thirds of programs cover non-insulin options for type 2 diabetes (66%) and types of insulin (63%) to a great extent, but only about one-third of programs cover social determinants of health (36%) and pre-diabetes (35%) to this degree. Many programs report plans to expand training on cardiovascular disease and diabetes (59%), but only 32% plan to expand training on digital technology for diabetes care. Lack of faculty time and competing priorities are cited as being the biggest barriers to expanding diabetes training.Conclusions: Our study found that the current U.S. FM and IM residency program diabetes curricula are dominantly oriented toward cardiovascular disease and 'traditional' insulins. A variety of training materials and resources could help overcome some of the current barriers to curriculum expansion of other important components of diabetes care that may help future physicians successfully manage diabetes with newer generation insulin and glucose monitoring technologies.Abbreviations: U.S: United States; PCP: Primary Care Physician; FM: Family Medicine; IM: Internal Medicine; CGM: Continuous Glucose Monitor; AAFP: American Academy of Family Physicians; ACGME: Accreditation Council for Graduate Medical Education; U/mL: units per milliliter; CME: Continuing Medical Education.
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Affiliation(s)
- Javier Morales
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA.,Advanced Internal Medicine Group, East Hills, NY, USA
| | - Louis Kuritzky
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.,NFRMC Family Medicine Residency Program at UCF COM/HCA GME, Gainesville, FL, USA
| | - Frank Lavernia
- Frank Lavernia MD, Internal Medicine & Diabetes, Delray Beach, FL, USA.,North Broward Diabetes Center, The Broward Health North Medical Center, Deerfield Beach, FL, USA
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Roze S, Isitt J, Smith-Palmer J, Javanbakht M, Lynch P. Long-term Cost-Effectiveness of Dexcom G6 Real-time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K. Diabetes Care 2020; 43:2411-2417. [PMID: 32647050 DOI: 10.2337/dc19-2213] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A long-term health economic analysis was performed to establish the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) (Dexcom G6) versus self-monitoring of blood glucose (SMBG) alone in U.K.-based patients with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS The analysis used the IQVIA CORE Diabetes Model. Clinical input data were sourced from the DIAMOND trial in adults with T1D. Simulations were performed separately in the overall population of patients with baseline HbA1c ≥7.5% (58 mmol/mol), and a secondary analysis was performed in patients with baseline HbA1c ≥8.5% (69 mmol/mol). The analysis was performed from the National Health Service health care payer perspective over a lifetime time horizon. RESULTS In the overall population, G6 RT-CGM was associated with a mean incremental gain in quality-adjusted life expectancy of 1.49 quality-adjusted life years (QALYs) versus SMBG (mean [SD] 11.47 [2.04] QALYs versus 9.99 [1.84] QALYs). Total mean (SD) lifetime costs were also pounds sterling (GBP) 14,234 higher with RT-CGM (GBP 102,468 [35,681] versus GBP 88,234 [39,027]) resulting in an incremental cost-effectiveness ratio of GBP 9,558 per QALY gained. Sensitivity analyses revealed that the findings were sensitive to changes in the quality-of-life benefit associated with reduced fear of hypoglycemia and avoidance of fingerstick testing as well as the HbA1c benefit associated with RT-CGM use. CONCLUSIONS For U.K.-based T1D patients, the G6 RT-CGM device is associated with significant improvements in clinical outcomes and, over patient lifetimes, is a cost-effective disease management option relative to SMBG on the basis of a willingness-to-pay threshold of GBP 20,000 per QALY gained.
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60
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Elbalshy M, Boucher S, Crocket H, Galland B, MacKenzie C, de Bock MI, Jefferies C, Wiltshire E, Wheeler BJ. Exploring Parental Experiences of Using a Do-It-Yourself Solution for Continuous Glucose Monitoring Among Children and Adolescents With Type 1 Diabetes: A Qualitative Study. J Diabetes Sci Technol 2020; 14:844-853. [PMID: 31875411 PMCID: PMC7753862 DOI: 10.1177/1932296819895290] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND MiaoMiao (MM) is a Bluetooth transmitter, which when paired with a smart phone/device, converts the Abbott FreeStyle Libre flash glucose monitoring system into a Do-It-Yourself (DIY) continuous glucose monitor (CGM). Families are increasingly adopting DIY CGM solutions, but little is known about parent and child experiences with these add-on technologies. We aimed to explore experiences of families using MM-CGM including challenges faced and their advice to others who may choose to use the technology. METHODS Between May and July 2019, we conducted 12 semistructured interviews (in person or via video conference) with parents of children (aged ≤16 years) with type 1 diabetes using MM-CGM. Interviews were audio recorded; professionally transcribed and key themes were identified through thematic analysis. RESULTS Overall, parents used MM-CGM to proactively manage their child's blood glucose. In all participants, this led to a perceived decrease in frequency of hypoglycemia. Participants reported that the visibility and easy access to blood glucose readings, glucose trends, and customized alarms on parent's phones decreased their disease burden and improved their sleep quality. Common barriers to using MM-CGM included difficulty of the setting up process, connectivity issues, and lack of support from medical teams. CONCLUSION This study highlights the potential feasibility of using a DIY CGM system like MM-CGM, which could be an empowering and cost-effective tool for enabling remote monitoring of blood glucose in real time.
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Affiliation(s)
- Mona Elbalshy
- Department of Women’s and Children’s
Health, Dunedin School of Medicine, University of Otago, New Zealand
| | - Sara Boucher
- Department of Women’s and Children’s
Health, Dunedin School of Medicine, University of Otago, New Zealand
| | - Hamish Crocket
- Te Huataki Waiora School of Health,
Sport & Human Performance, University of Waikato, Dunedin, New Zealand
| | - Barbara Galland
- Department of Women’s and Children’s
Health, Dunedin School of Medicine, University of Otago, New Zealand
| | - Craig MacKenzie
- Pharmacy Department, Southern District
Health Board, Dunedin, New Zealand
| | - Martin I. de Bock
- Department of Paediatrics, University of
Otago, Christchurch, New Zealand
- Department of Paediatrics, Canterbury
District Health Board, Christchurch, New Zealand
| | - Craig Jefferies
- Paediatric Endocrinology, Starship
Children’s Health, Auckland, New Zealand
- Liggins Institute, University of
Auckland, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child
Health, University of Otago, Wellington, New Zealand
- Paediatrics and Child Health, Capital
and Coast District Health Board, Wellington, New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s
Health, Dunedin School of Medicine, University of Otago, New Zealand
- Paediatric Endocrinology, Southern
District Health Board, Dunedin, New Zealand
- Benjamin J. Wheeler, MBChB, PhD, Department
of Women’s and Children’s Health, University of Otago, 201 Great King St,
Dunedin, Otago 9016, New Zealand.
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61
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Macaulay GC, Boucher SE, Yogarajah A, Galland BC, Wheeler BJ. Sleep and Night-time Caregiving in Parents of Children and Adolescents with Type 1 Diabetes Mellitus - A Qualitative Study. Behav Sleep Med 2020; 18:622-636. [PMID: 31370700 DOI: 10.1080/15402002.2019.1647207] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is a common chronic illness of childhood, with parents assuming considerable responsibility for night-time diabetes caregiving. This qualitative study explored diabetes-related factors affecting, and solutions proposed to improve, parental sleep. PARTICIPANTS 10 mothers and 10 fathers of children ≤18 years of age with T1DM in Otago, New Zealand. METHODS Semi-structured individual interviews were audio-recorded, transcribed, and systematically coded for themes. Parents completed the Pittsburgh Sleep Quality Index (PSQI) and habitual sleep of parents and children were assessed via 7-day actigraphy. RESULTS Parents (n = 20) and their children with T1DM (n = 16) were aged between 32 and 54 years, and 1 and 17 years, respectively. PSQI revealed poor quality sleep in 13/20 parents. A range of diabetes-related factors, including glucose monitoring and fear of hypoglycemia, contributed to parental sleep disturbance, including awakenings and the perception of "sleeping lightly". Two distinct time periods resulted in greater sleep disturbance, notably, following T1DM diagnosis and when transitioning to using a new diabetes technology. Factors influencing maternal and paternal sleep were similar, but, generally, mothers described greater night-time care burden and sleep disturbance. While the use of diabetes technologies was generally advocated to improve parental sleep and the provision of nocturnal T1DM care, they were also perceived to potentially contribute to parental sleep disturbance. CONCLUSIONS Pediatric diabetes care teams should be aware of diabetes-related factors potentially affecting parental sleep, the mixed impacts of diabetes technologies, and consider tailored parental support and education to reduce the burden of nocturnal care.
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Affiliation(s)
- Grace C Macaulay
- Department of Women's and Children's Health, University of Otago , Dunedin, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, University of Otago , Dunedin, New Zealand
| | - Ahrabie Yogarajah
- Department of Women's and Children's Health, University of Otago , Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago , Dunedin, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago , Dunedin, New Zealand.,Paediatric Endocrinology, Southern District Health Board , Dunedin, New Zealand
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Azhar A, Gillani SW, Mohiuddin G, Majeed RA. A systematic review on clinical implication of continuous glucose monitoring in diabetes management. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:102-111. [PMID: 32742108 PMCID: PMC7373113 DOI: 10.4103/jpbs.jpbs_7_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The aim of this systematic review was to evaluate the clinical implications of continuous glucose monitoring (CGM) among patients with diabetes mellitus using variables that include glycated hemoglobin (HbA1c), estimated A1c, glucose variability, and users' perspectives. Materials and Methods This study analyzed 17 articles that were identified and studied according to the research question criteria. PRISMA guidelines were used for identification and screening of the literature. The required data were searched using Medscape, PubMed, PROSPERO, Wiley Library, Scopus, Clinical Trial Registry, and Trip. Results The articles reviewed were on the use of CGM in type 1 and type 2 diabetes mellitus, which showed significant improvement in the levels of HbA1c as compared to non-CGM. The application of CGM on acute sudden onset type of adverse drug reactions (i.e., hypoglycemia) is better than fasting blood sugar or self-monitoring of blood glucose or capillary blood glucose (random blood glucose monitoring). CGM is beneficial for use in patients with type 2 diabetes mellitus including elderly patients as it gives information regarding glucose variability as well as HbA1c levels. The health-care providers require full spectrum of patients' CGM data to design a better therapeutic plan. However, the patients experienced inconvenience on wearing the device on the body for longer periods. The findings also stated the fact that more education and training is required for the patients to interpret their own glycemic data using CGM and modify their lifestyle accordingly. Use of CGM along with HbA1c has also been used to achieve better glycemic results and it allows the health care professional to guide patients in terms of their glucose level; whether they are hypoglycemic or hyperglycemic, however its use has some controversies that minimize its application. Conclusion The study concluded that CGM has significant potential in the management of not only patients with type 1 diabetes mellitus but also patients with type 2 diabetes mellitus in spite of the few limitations that are being improvised in the upcoming years. However, limited literature of CGM among patients with type 2 diabetes mellitus and pregnant women reduces the practice scope.
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Affiliation(s)
- Anam Azhar
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Syed W Gillani
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Ghasna Mohiuddin
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Rukhsar A Majeed
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
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March CA, Nanni M, Kazmerski TM, Siminerio LM, Miller E, Libman IM. Modern diabetes devices in the school setting: Perspectives from school nurses. Pediatr Diabetes 2020; 21:832-840. [PMID: 32249474 PMCID: PMC7682111 DOI: 10.1111/pedi.13015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To explore the experiences, practices, and attitudes of school nurses related to modern diabetes devices (insulin pumps, continuous glucose monitors, and hybrid-closed loop systems). RESEARCH DESIGN AND METHODS Semistructured interviews were conducted with 40 public school nurses caring for children in elementary and middle schools. Developed with stakeholder input, the interview questions explored experiences working with devices and communicating with the health care system. Deidentified transcripts were analyzed through an iterative process of coding to identify major themes. RESULTS School nurses reported a range of educational backgrounds (58% undergraduate, 42% graduate), geographic settings (20% urban, 55% suburban, 25% rural), and years of experience (20% <5 years, 38%, 5-15 years, 42% >15 years). Four major themes emerged: (a) As devices become more common, school nurses must quickly develop new knowledge and skills yet have inconsistent training opportunities; (b) Enthusiasm for devices is tempered by concerns about implementation due to poor planning prior to the school year and potential disruptions by remote monitors; (c) Barriers exist to integrating devices into schools, including school/classroom policies, liability/privacy concerns, and variable staff engagement; and (d) Collaboration between school nurses and providers is limited; better communication may benefit children with diabetes. CONCLUSIONS Devices are increasingly used by school-aged children. School nurses appreciate device potential but share structural and individual-level challenges. Guiding policy is needed as the technology progressively becomes standard of care. Enhanced training and collaboration with diabetes providers may help to optimize school-based management for children in the modern era.
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Affiliation(s)
- Christine A. March
- Division of Pediatric Endocrinology and Diabetes, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle Nanni
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Traci M. Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linda M. Siminerio
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ingrid M. Libman
- Division of Pediatric Endocrinology and Diabetes, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Haslund-Thomsen H, Hasselbalch LA, Laugesen B. Parental Experiences of Continuous Glucose Monitoring in Danish Children with Type 1 Diabetes Mellitus. J Pediatr Nurs 2020; 53:e149-e155. [PMID: 32245681 DOI: 10.1016/j.pedn.2020.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To explore parents 'experience of having a child aged 4-9 years with type 1 diabetes mellitus (T1DM) using continuous glucose monitor (CGM). DESIGN AND METHODS The study was a qualitative study. Twelve families were recruited for individual or dyadic interviews through purposeful and convenience sampling procedures. RESULTS Thematic analysis generated three main themes: 1) Living in the context of the unpredictability of diabetes 2) Establishing a sense of control and security with the CGM 3) Learning to use and trust the CGM and educating other caregivers. CONCLUSIONS Living in the context of the unpredictability of T1DM causes a loss of stability and control as T1DM pervades family life and transforms everyday routines. CGM use seems to increase opportunities for other family activities, as it provides parents with a sense of control and moderates the pervasiveness of T1DM. Yet the parents have to learn how to trust and use the CGM and take on the burdensome task of training and trusting other caregivers. PRACTICE IMPLICATIONS The CGM is used as an integral part of T1DM care in everyday life. Therefore, it should be accessible to families. Health-care professionals should be aware of how to assist parents with how to use and trust the CGM. Furthermore, parents may need help and support in educating other caregivers on how to use the CGM. This could be done through teaching sessions, written materials and recorded demonstrations of CGM use.
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Affiliation(s)
- Helle Haslund-Thomsen
- Clinical Nursing research Unit, Aalborg University Hospital, Aalborg, Denmark; Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark; Pediatric Department, Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark.
| | - Line Aagaard Hasselbalch
- Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark; Pediatric Department, Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Laugesen
- Clinical Nursing research Unit, Aalborg University Hospital, Aalborg, Denmark; Danish Centre of Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Denmark
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Castellana M, Parisi C, Di Molfetta S, Di Gioia L, Natalicchio A, Perrini S, Cignarelli A, Laviola L, Giorgino F. Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2020; 8:8/1/e001092. [PMID: 32487593 PMCID: PMC7265013 DOI: 10.1136/bmjdrc-2019-001092] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Flash glucose monitoring (FGM) is a factory-calibrated sensor-based technology for the measurement of interstitial glucose. We performed a systematic review and meta-analysis to assess its efficacy and safety in patients with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS PubMed, CENTRAL, Scopus and Web of Science were searched in July 2019. Twelve studies with a follow-up longer than 8 weeks, evaluating 2173 patients on prandial insulin, multiple daily insulin injections or continuous subcutaneous insulin infusion were included. The following data were extracted: HbA1c, time in range, time above 180 mg/dL, time below 70 mg/dL, frequency of hypoglycemic events, number of self-monitoring of blood glucose (SMBG) measurements, total daily insulin dose, patient-reported outcomes, adverse events, and discontinuation rate. A comparison with SMBG was conducted. RESULTS FGM use was associated with a reduction in HbA1c (-0.26% (-3 mmol/mol); p=0.002) from baseline to the last available follow-up, which correlated with HbA1c levels at baseline (-0.4% (-4 mmol/mol) for each 1.0% (11 mmol/mol) of HbA1c above 7.2% (55 mmol/mol)). Also, a decrease in time below 70 mg/dL was found (-0.60 hours/day; p=0.04). Favorable findings in patient-reported outcomes and no device-related serious adverse events were reported. When compared with SMBG, FGM was characterized by no statistically different change in HbA1c (p=0.09), with lower number of SMBG measurements per day (-3.76 n/day; p<0.001) and risk of discontinuation (relative risk=0.42; p=0.001). A limited number of studies, with a heterogeneous design and usually with a short-term follow-up and without specific training, were found. CONCLUSIONS The present review provides evidence for the use of FGM as an effective strategy for the management of diabetes.
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Affiliation(s)
- Marco Castellana
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Claudia Parisi
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Sergio Di Molfetta
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Ludovico Di Gioia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Annalisa Natalicchio
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Sebastio Perrini
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Angelo Cignarelli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Luigi Laviola
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
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Øversveen E. Stratified users and technologies of empowerment: theorising social inequalities in the use and perception of diabetes self-management technologies. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:862-876. [PMID: 32072666 DOI: 10.1111/1467-9566.13066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Medical technologies of various kinds play an increasingly important role in medical treatment, but may also increase health inequalities if they are primarily used by high-status patients. While many have problematised inequalities in the material access to medical technologies, differences in use and perception are also salient for explaining the relationship between medical technologies and health inequalities. This article attempts to theorise these inequalities by bringing health inequality research into dialogue with social constructivist perspectives on user-technology relations. Based on qualitative interview data from a case study of the technological self-management of type 1 diabetes, I construct three clusters of technological practices and perceptions corresponding to three broad user types. These user types are then discussed in the context of patient empowerment and the promotion of the active, autonomous and self-reflective 'expert' patient in European health care systems. To the extent that they materialise and enforce institutional expectations which only the most resourceful patients will be able to live up to, medical technologies may serve to entrench and legitimate social inequalities in health and medical care. Research therefore needs not only to consider how medical technologies are distributed, but also their design and appropriation by users.
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Affiliation(s)
- Emil Øversveen
- Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trodheim, Norway
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67
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Stoian AP, Banerjee Y, Rizvi AA, Rizzo M. Diabetes and the COVID-19 Pandemic: How Insights from Recent Experience Might Guide Future Management. Metab Syndr Relat Disord 2020; 18:173-175. [PMID: 32271125 DOI: 10.1089/met.2020.0037] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Anca Pantea Stoian
- Diabetes, Nutrition and Metabolic Diseases, University of Bucharest, Bucharest, Romania
| | - Yajnavalka Banerjee
- Department of Biochemistry, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ali A Rizvi
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Manfredi Rizzo
- Department of Medicine, University of South Carolina, Columbia, South Carolina, USA.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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Boucher SE, Aum SH, Crocket HR, Wiltshire EJ, Tomlinson PA, de Bock MI, Wheeler BJ. Exploring parental perspectives after commencement of flash glucose monitoring for type 1 diabetes in adolescents and young adults not meeting glycaemic targets: a qualitative study. Diabet Med 2020; 37:657-664. [PMID: 31769551 DOI: 10.1111/dme.14188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 12/11/2022]
Abstract
AIMS To explore parental perspectives after flash glucose monitoring commencement in adolescents and young adults with type 1 diabetes who were not meeting glycaemic targets. METHODS Twelve semi-structured interviews were conducted among parents of adolescents and young adults between the ages of 14 and 20 years (inclusive) with type 1 diabetes and not meeting glycaemic targets [HbA1c 81-130 mmol/mol (9.6-14.0%)] participating in a randomized controlled trial. Interviews were transcribed, then thematic analysis was performed to identify themes regarding parental experiences. RESULTS Four key themes were found: flash glucose monitoring improved parental emotional well-being; flash glucose monitoring reduced diabetes-specific conflict within families; flash glucose monitoring facilitated the parental role in diabetes management; and sensor-related challenges, particularly sensors falling off, interfered with using flash glucose monitoring for diabetes management. The cost of self-funded sensors was the only barrier to continuing flash glucose monitoring that parents reported. CONCLUSIONS This study provides new insights into the potential benefits and challenges of flash glucose monitoring use, drawn from the perspective of parents of adolescents and young adults not meeting glycaemic targets. As parents are often key partners in obtaining or purchasing this technology, these findings can be used to further inform parental expectations of this technology.
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Affiliation(s)
- S E Boucher
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - S Hye Aum
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - H R Crocket
- Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
| | - E J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
| | - P A Tomlinson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Southern District Health Board, Invercargill, New Zealand
| | - M I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
| | - B J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Southern District Health Board, Dunedin, New Zealand
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Barbed Ferrández SM, Montaner Gutiérrez T, Larramona Ballarín G, Ferrer Lozano M, Lou Francés GM. Impact on the well-being perceived by caregivers of children and adolescents with type 1 diabetes following the use of interstitial glucose measurement systems. ACTA ACUST UNITED AC 2020; 68:243-250. [PMID: 32113860 DOI: 10.1016/j.endinu.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus (DM-1) is one of the most common chronic childhood diseases, and it is essential to optimize glycemic control in order to avoid complications. For years, interstitial glucose measurement systems (MGI systems) have been among the new technologies at the forefront of self-care. OBJECTIVES To determine the impact on the well-being of the caregivers of patients with type 1 diabetes mellitus under 18 years of age, controlled at a Pediatric Diabetes Unit of a third level hospital, of the use of MGI systems. MATERIAL AND METHODS This was an observational, descriptive and analytical cohort study based on a questionnaire completed by the patients' caregivers, as well as from the patient's clinical history. RESULTS There were 120 participants (55.5% males), with a mean age 13.20+/-3.71 years and mean glycosylated haemoglobin (HbA1c) 7.36%+/-0.90. 52.5% of the sample used MGI systems. The caregivers of patients using MGI systems showed significantly higher scores (p<.05) regarding well-being, compared to the caregivers of patients not using this technology. In the former, a significant improvement (p<.05) in these variables with respect to the values prior to the beginning of their use was observed. CONCLUSIONS The use of MGI systems for diabetes self-management in our study led to a greater sense of well-being on the part of caregivers compared with before their introduction, as well as in comparison with those who continued to perform measurements using daily capillary glycemias.
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70
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Kubiak T, Priesterroth L, Barnard-Kelly KD. Psychosocial aspects of diabetes technology. Diabet Med 2020; 37:448-454. [PMID: 31943354 DOI: 10.1111/dme.14234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Abstract
AIM To identify key psychosocial research in the domain of diabetes technology. RESULTS Four trajectories of psychosocial diabetes technology research are identified that characterize research over the past 25 years. Key evidence is reviewed on psychosocial outcomes of technology use as well as psychosocial barriers and facilitating conditions of diabetes technology uptake. Psychosocial interventions that address modifiable barriers and psychosocial factors have proven to be effective in improving glycaemic and self-reported outcomes in diabetes technology users. CONCLUSIONS Psychosocial diabetes technology research is essential for designing interventions and education programmes targeting the person with diabetes to facilitate optimized outcomes associated with technology uptake. Psychosocial aspects of diabetes technology use and related research will be even more important in the future given the advent of systems for automated insulin delivery and the increasingly widespread digitalization of diabetes care.
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Affiliation(s)
- T Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - L Priesterroth
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - K D Barnard-Kelly
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
- BHR Limited, Fareham, UK
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Desrochers HR, Schultz AT, Laffel LM. Use of Diabetes Technology in Children: Role of Structured Education for Young People with Diabetes and Families. Endocrinol Metab Clin North Am 2020; 49:19-35. [PMID: 31980118 PMCID: PMC7140592 DOI: 10.1016/j.ecl.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The current era has witnessed an explosion of advanced diabetes technologies. Young people with diabetes and their families require detailed, structured diabetes education in order to optimize use of such devices. There is need for youth and their families to participate in the selection of particular devices for personal use and comprehensive education regarding the safe and effective use of such technologies. The education process should ensure that youth and their families receive realistic expectations of what the advanced technologies can and cannot do to avoid disappointment and the premature discontinuation of such systems.
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Affiliation(s)
- Hannah R Desrochers
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA
| | - Alan T Schultz
- Emergency Department, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY 10467, USA
| | - Lori M Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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Briganti G, Le Moine O. Artificial Intelligence in Medicine: Today and Tomorrow. Front Med (Lausanne) 2020; 7:27. [PMID: 32118012 PMCID: PMC7012990 DOI: 10.3389/fmed.2020.00027] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
Artificial intelligence-powered medical technologies are rapidly evolving into applicable solutions for clinical practice. Deep learning algorithms can deal with increasing amounts of data provided by wearables, smartphones, and other mobile monitoring sensors in different areas of medicine. Currently, only very specific settings in clinical practice benefit from the application of artificial intelligence, such as the detection of atrial fibrillation, epilepsy seizures, and hypoglycemia, or the diagnosis of disease based on histopathological examination or medical imaging. The implementation of augmented medicine is long-awaited by patients because it allows for a greater autonomy and a more personalized treatment, however, it is met with resistance from physicians which were not prepared for such an evolution of clinical practice. This phenomenon also creates the need to validate these modern tools with traditional clinical trials, debate the educational upgrade of the medical curriculum in light of digital medicine as well as ethical consideration of the ongoing connected monitoring. The aim of this paper is to discuss recent scientific literature and provide a perspective on the benefits, future opportunities and risks of established artificial intelligence applications in clinical practice on physicians, healthcare institutions, medical education, and bioethics.
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Affiliation(s)
- Giovanni Briganti
- Medical Informatics, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Unit of Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Le Moine
- Medical Informatics, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Hirsch IB, Welsh JB, Calhoun P, Puhr S, Walker TC, Price DA. Associations between HbA 1c and continuous glucose monitoring-derived glycaemic variables. Diabet Med 2019; 36:1637-1642. [PMID: 31267573 PMCID: PMC6899839 DOI: 10.1111/dme.14065] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 01/04/2023]
Abstract
AIMS To identify clinically useful associations between HbA1c levels and various continuous glucose monitoring-derived metrics. METHODS We retrospectively analysed end-of-study HbA1c levels and >2 weeks of continuous glucose monitoring data collected from 530 adults with Type 1 diabetes or insulin-requiring Type 2 diabetes during four randomized trials. Each trial lasted ≥24 weeks and provided central laboratory end-of-study HbA1c levels and continuous glucose monitoring data from the preceding 3 months. Participants were assigned to groups based on either HbA1c levels or continuous glucose monitoring-derived glucose values. RESULTS HbA1c was strongly correlated with mean glucose value (r=0.80), time spent with glucose values in the 3.9-10.0 mmol/l range (time in range; r=-0.75) and percentage of glucose values >13.9 mmol/l (r=0.72), but was weakly correlated with the percentage of glucose values <3.9 mmol/l (r=-0.39) or <3.0 mmol/l (r=-0.21). The median percentage of glucose values <3.0 mmol/l was <1.2% (<20 min/day) for all HbA1c -based groups, but the median percentage of values >13.9 mmol/l varied from 2.5% (0.6 h/day) to 27.8% (6.7 h/day) in the lowest and highest HbA1c groups, respectively. More than 90% of participants with either <2% of glucose values >13.9 mmol/l, mean glucose <7.8 mmol/l, or time in range >80% had HbA1c levels ≤53 mmol/mol (≤7.0%). For participants with HbA1c ≥64 mmol/mol (≥8.0%), the median time in range was 44%, with 90% of participants having a time in range of <59%. CONCLUSIONS The associations shown in the present study suggest that continuous glucose monitoring-derived metrics may help guide diabetes therapy intensification efforts in an HbA1c -independent manner.
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Affiliation(s)
- I. B. Hirsch
- University of Washington School of MedicineSeattleWAUSA
| | | | - P. Calhoun
- Dexcom, Inc.San DiegoCAUSA
- Present address:
Jaeb Center for Health ResearchTampaFLUSA
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Abdolkhani R, Gray K, Borda A, DeSouza R. Patient-generated health data management and quality challenges in remote patient monitoring. JAMIA Open 2019; 2:471-478. [PMID: 32025644 PMCID: PMC6993998 DOI: 10.1093/jamiaopen/ooz036] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/10/2019] [Accepted: 08/05/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patient-Generated Health Data (PGHD) in remote monitoring programs is a promising source of precise, personalized data, encouraged by expanding growth in the health technologies market. However, PGHD utilization in clinical settings is low. One of the critical challenges that impedes confident clinical use of PGHD is that these data are not managed according to any recognized approach for data quality assurance. OBJECTIVE This article aims to identify the PGHD management and quality challenges that such an approach must address, as these are expressed by key PGHD stakeholder groups. MATERIALS AND METHODS In-depth interviews were conducted with 20 experts who have experience in the use of PGHD in remote patient monitoring, including: healthcare providers, health information professionals within clinical settings, and commercial providers of remote monitoring solutions. Participants were asked to describe PGHD management processes in the remote monitoring programs in which they are involved, and to express their perspectives on PGHD quality challenges during the data management stages. RESULTS The remote monitoring programs in the study did not follow clear PGHD management or quality assurance approach. Participants were not fully aware of all the considerations of PGHD quality. Digital health literacy, wearable accuracy, difficulty in data interpretation, and lack of PGHD integration with electronic medical record systems were among the key challenges identified that impact PGHD quality. CONCLUSION Co-development of PGHD quality guidelines with relevant stakeholders, including patients, is needed to ensure that quality remote monitoring data from wearables is available for use in more precise and personalized patient care.
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Affiliation(s)
- Robab Abdolkhani
- Health and Biomedical Informatics Centre, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ann Borda
- Health and Biomedical Informatics Centre, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth DeSouza
- Health and Biomedical Informatics Centre, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Burckhardt MA, Fried L, Bebbington K, Hancock M, Nicholas JA, Roberts A, Abraham MB, Davis EA, Jones TW. Use of remote monitoring with continuous glucose monitoring in young children with Type 1 diabetes: the parents' perspective. Diabet Med 2019; 36:1453-1459. [PMID: 31257642 DOI: 10.1111/dme.14061] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 12/21/2022]
Abstract
AIM Remote monitoring with continuous glucose monitoring (CGM) in children with Type 1 diabetes mellitus has recently become available, but little is known about caregivers' experiences of its use, particularly in younger children. The aim of this study was to explore parents' everyday experiences of using this technology. METHODS The parents of children with Type 1 diabetes diagnosed for > 1 year, aged 2-12 years were invited to participate in a semi-structured interview. Interviews were the second phase of a randomized cross-over study using standard insulin therapy with or without CGM and remote monitoring for two 3-month periods. Open-ended questions were used to explore parents' real-life experiences of the remote monitoring and CGM system. Interviews were analysed using thematic analysis. RESULTS Five themes related to remote monitoring emerged: (i) impact on sleep quality for the parents, (ii) peace of mind, (iii) impact on anxiety, (iv) freedom and confidence for the parents and children, and (v) impact on relationships. Furthermore, parents reported on themes related to CGM in general, such as better understanding of how to manage and control their child's diabetes and experiences related to physical or technical aspects. CONCLUSION Overall, parents of primary school children reported that using remote monitoring and CGM was a mostly beneficial experience. However, negative aspects within the themes were also reported. These findings will help to provide a structure to discuss parent and child expectations and provide targeted education at the start of using remote monitoring and CGM.
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Affiliation(s)
- M-A Burckhardt
- Children's Diabetes Centre, Telethon Kids Institute, Perth, WA, Australia
- Division of Paediatrics, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
| | - L Fried
- Children's Diabetes Centre, Telethon Kids Institute, Perth, WA, Australia
| | - K Bebbington
- Children's Diabetes Centre, Telethon Kids Institute, Perth, WA, Australia
| | - M Hancock
- Division of Paediatrics, The University of Western Australia, Perth, WA, Australia
| | - J A Nicholas
- Children's Diabetes Centre, Telethon Kids Institute, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
| | - A Roberts
- Children's Diabetes Centre, Telethon Kids Institute, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
| | - M B Abraham
- Children's Diabetes Centre, Telethon Kids Institute, Perth, WA, Australia
- Division of Paediatrics, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
| | - E A Davis
- Children's Diabetes Centre, Telethon Kids Institute, Perth, WA, Australia
- Division of Paediatrics, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
| | - T W Jones
- Children's Diabetes Centre, Telethon Kids Institute, Perth, WA, Australia
- Division of Paediatrics, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
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76
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Leahy J(JL, Aleppo G, Fonseca VA, Garg SK, Hirsch IB, McCall AL, McGill JB, Polonsky WH. Optimizing Postprandial Glucose Management in Adults With Insulin-Requiring Diabetes: Report and Recommendations. J Endocr Soc 2019; 3:1942-1957. [PMID: 31608313 PMCID: PMC6781941 DOI: 10.1210/js.2019-00222] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Faster-acting insulins, new noninsulin drug classes, more flexible insulin-delivery systems, and improved continuous glucose monitoring devices offer unprecedented opportunities to improve postprandial glucose (PPG) management and overall care for adults with insulin-treated diabetes. These developments led the Endocrine Society to convene a working panel of diabetes experts in December 2018 to assess the current state of PPG management, identify innovative ways to improve self-management and quality of life, and align best practices to current and emerging treatment and monitoring options. Drawing on current research and collective clinical experience, we considered the following issues for the ∼200 million adults worldwide with type 1 and insulin-requiring type 2 diabetes: (i) the role of PPG management in reducing the risk of diabetes complications; (ii) barriers preventing effective PPG management; (iii) strategies to reduce PPG excursions and improve patient quality of life; and (iv) education and clinical tools to support endocrinologists in improving PPG management. We concluded that managing PPG to minimize or prevent diabetes-related complications will require elucidating fundamental questions about optimal ways to quantify and clinically assess the metabolic dysregulation and consequences of the abnormal postprandial state in diabetes and recommend research strategies to address these questions. We also identified practical strategies and tools that are already available to reduce barriers to effective PPG management, optimize use of new and emerging clinical tools, and improve patient self-management and quality of life.
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Affiliation(s)
| | - Grazia Aleppo
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vivian A Fonseca
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | - Irl B Hirsch
- Treatment and Teaching Chair, University of Washington School of Medicine, Seattle, Washington
| | - Anthony L McCall
- University of Virginia School of Medicine, Charlottesville, Virginia
- Cornell University, Ithaca, New York
| | - Janet B McGill
- Washington University School of Medicine, St. Louis, Missouri
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77
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Burckhardt MA, Abraham MB, Mountain J, Coenen D, Paniora J, Clapin H, Jones TW, Davis EA. Improvement in Psychosocial Outcomes in Children with Type 1 Diabetes and Their Parents Following Subsidy for Continuous Glucose Monitoring. Diabetes Technol Ther 2019; 21:575-580. [PMID: 31335192 DOI: 10.1089/dia.2019.0149] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: In April 2017, the Australian Government announced the full subsidy of continuous glucose monitors (CGM) to children and young people <21 years with type 1 diabetes (T1D). This study aimed to evaluate the effect of CGM on psychosocial outcomes in a T1D pediatric population-based sample. Methods: Children with T1D, commencing CGM between June 2017 and January 2018, and their parents were recruited in a prospective cohort study in a tertiary pediatric hospital in Western Australia. Parents and children older than 12 years self-completed questionnaires at onset of CGM and 2 months later, on fear of hypoglycemia (FOH) and diabetes treatment satisfaction (DTS). Parents provided measures of sleep quality. Children completed the Gold hypoglycemia awareness score. Hemoglobin A1c (HbA1c) values were compared at baseline (BL) and follow-up (FU). Results: Sixty parents and 38 children provided measures at BL and FU. Parental total FOH decreased (mean score BL vs. FU; 50.0 vs. 44.3, P = 0.004) with reduction in the Worry subscore (28.2 vs. 24.2, P = 0.004). Furthermore, parental and child DTS increased. Parental sleep quality improved (P < 0.001) and overnight finger prick testing decreased (P < 0.001). Impaired hypoglycemic awareness decreased in children (26.3% vs. 10.5%, P = 0.031). HbA1c reduced from 8.4% (68 mmol/mol) to 8.1% (65 mmol/mol) (P = 0.036). Conclusions: Introduction of subsidized CGM showed early improvement in psychosocial and glycemic outcomes in patients and their families in Western Australia. Ongoing evaluation is essential to assess whether equitable access to CGM will translate to sustained benefits for Australian T1D pediatric patients.
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Affiliation(s)
- Marie-Anne Burckhardt
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Division of Paediatrics, within the Medical School, The University of Western Australia, Perth, Australia
| | - Mary B Abraham
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Division of Paediatrics, within the Medical School, The University of Western Australia, Perth, Australia
| | - Jennifer Mountain
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Daina Coenen
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Jaimee Paniora
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Helen Clapin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Timothy W Jones
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Division of Paediatrics, within the Medical School, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Division of Paediatrics, within the Medical School, The University of Western Australia, Perth, Australia
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78
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Longo R, Sperling S. Personal Versus Professional Continuous Glucose Monitoring: When to Use Which on Whom. Diabetes Spectr 2019; 32:183-193. [PMID: 31462872 PMCID: PMC6695260 DOI: 10.2337/ds18-0093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IN BRIEF With the introduction of intermittently scanned continuous glucose monitoring (CGM) systems to the marketplace, providers and patients now have several options to continuously monitor glucose levels. This article addresses appropriate patient selection criteria for using patient- or practice-based CGM systems and the barriers to achieving optimal benefits from this technology. The authors have developed a flowchart to guide clinicians and patients in decision-making regarding the most appropriate type of CGM to use in various circumstances.
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79
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Trahtemberg U, Hallas T, Segman Y, Sheiman E, Shasha M, Nissim K, Segman Y(J. New Paradigm of Personalized Glycemic Control Using Glucose Temporal Density Histograms. J Diabetes Sci Technol 2019; 13:708-717. [PMID: 30616388 PMCID: PMC6610592 DOI: 10.1177/1932296818821423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current methods used to assess glycemic control use averaged measures and provide little information on the glycemic pathology of the patients. In this article we propose visual tools and their related mathematical formulas that allow for improved characterization of the glycemic behavior and achieve better glycemic control. METHODS We present a reanalysis of published data, based on SMBG measurements from clinical trials of both men and women older than 18 years who were either healthy volunteers, prediabetes, or type 1 or type 2 diabetes. New graphic visualizations of glycemia as well as mathematical formulas that describe the glycemic behavior are presented and described, as well as suggested methods for their use to improve glycemic control. RESULTS Patients with different problems in their glycemic control had different histogram shapes. In addition, patients who had the same HbA1c level at the time of the trial revealed significantly different glucose histograms with different shapes, variability and glycemic burden. The derived graphic visualizations provided information about the temporal evolution of the glycemic control. CONCLUSIONS A paradigm change of the existing model of diabetes control is proposed, shifting from standardized treatment algorithms based on HbA1c follow-up to a new controlling approach that is based on the personal glucose density histogram. The histogram is an informative, detailed tool for the current patient glycemic behavior, and a future histogram can be targeted for a successful treatment. In addition, the glucose burden and the glucose severity index are proposed as informative markers for successful treatment. This is applicable to any glycemic data, by means of invasive and noninvasive glucometers.
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Affiliation(s)
| | - Tova Hallas
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Yehonatan Segman
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Ella Sheiman
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Michal Shasha
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Kobi Nissim
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Yosef (Joseph) Segman
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
- Yosef (Joseph) Segman, PhD, Cnoga Medical
Ltd, Caesarea North Industrial Park, 5th Tarshish St, POB 3188, Caesarea,
3088900, Israel.
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80
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Ng SM, Moore HS, Clemente MF, Pintus D, Soni A. Continuous Glucose Monitoring in Children with Type 1 Diabetes Improves Well-Being, Alleviates Worry and Fear of Hypoglycemia. Diabetes Technol Ther 2019; 21:133-137. [PMID: 30785768 DOI: 10.1089/dia.2018.0347] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is limited published evidence regarding the psychological effect of use of continuous glucose monitoring (CGM) in the pediatric population with type 1 diabetes mellitus on metabolic control, fear of hypoglycemia, and patient or carer well-being. The aim of this study was to evaluate the effects of CGM on patient and carer well-being, worry, fear of hypoglycemia, and glycemic control. METHODS Children aged >12 years independently completed the hypoglycemia fear survey (HFS). Parents and carers of children using CGM for a minimum of 12 months were asked to complete a modified version of the hypoglycemia fear survey for parents of young children (HFS-P) before and after CGM usage. RESULTS Sixteen patients (8 boys) were included with median age of 13.5 years (2-17 years) and use of CGM for a minimum of 12 months. There was no significant improvement in the glycated hemoglobin after 12 months of CGM usage. Parents of all 16 patients completed the HFS-P survey. Of 12 young people eligible (age >12 years), 11 returned the HFS survey. Significant improvement was seen in both parental and patient fear of hypoglycemia after CGM (P < 0.001 and P = 0.003, respectively). CONCLUSION The use of CGM did not show any significant improvement in glycemic control after 12 months; however, parental and children's fear of hypoglycemia and worry were significantly reduced after the use of CGM. Larger studies on the psychological effects of CGM are warranted.
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Affiliation(s)
- Sze May Ng
- Paediatric Diabetes, Southport and Ormskirk Hospital NHS Trust, Ormskirk, United Kingdom
| | - Helen S Moore
- Paediatric Diabetes, Southport and Ormskirk Hospital NHS Trust, Ormskirk, United Kingdom
| | - Marisa F Clemente
- Paediatric Diabetes, Southport and Ormskirk Hospital NHS Trust, Ormskirk, United Kingdom
| | - Dona Pintus
- Paediatric Diabetes, Southport and Ormskirk Hospital NHS Trust, Ormskirk, United Kingdom
| | - Astha Soni
- Paediatric Diabetes, Southport and Ormskirk Hospital NHS Trust, Ormskirk, United Kingdom
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81
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Alcántara-Aragón V. Improving patient self-care using diabetes technologies. Ther Adv Endocrinol Metab 2019; 10:2042018818824215. [PMID: 30728941 PMCID: PMC6351708 DOI: 10.1177/2042018818824215] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022] Open
Abstract
Diabetes technologies are an unstoppable phenomenon. They offer opportunities to improve patient self-care through empowerment. However, they can be a challenge for both patients and clinicians. Thus, the use of technology may empower or burden. To understand and benefit from the use of diabetes technologies, one must understand the currently unmet needs in diabetes management. These unmet needs call for perspectives beyond glycated hemoglobin and an evaluation of technology solutions. Optimal use of these technologies is necessary to obtain benefits and achieve cost-effectiveness; this process depends on diabetes education and training. This review evaluates clinician and patient perspectives regarding diabetes technologies, followed by an evaluation of technology solutions. Diabetes technology solutions are evaluated according to available results about their effectiveness and their potential to empower people living with diabetes.
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Affiliation(s)
- Valeria Alcántara-Aragón
- Endocrinology and Nutrition Department, Hospital de la Santa Creu I Sant Pau, Sant Antoni Maria Claret 167, Barcelona, 08025, Spain
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82
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Leelarathna L, Wilmot EG. Reply to Argento. Flash forward, with caution. Diabet Med 2018; 35:1132-1134. [PMID: 29687494 DOI: 10.1111/dme.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Leelarathna
- Manchester Diabetes Centre, Central Manchester University Hospitals 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
| | - E G Wilmot
- Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK
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83
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Majeed W, Thabit H. Closed-loop insulin delivery: current status of diabetes technologies and future prospects. Expert Rev Med Devices 2018; 15:579-590. [PMID: 30027775 DOI: 10.1080/17434440.2018.1503530] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Type 1 diabetes is characterised by destruction of pancreatic beta cells, leading to insulin deficiency and hyperglycaemia. The mainstay of treatment remains lifelong insulin therapy as a sustainable cure has as yet proven elusive. The burden of daily management of type 1 diabetes has contributed to suboptimal outcomes for people living with the condition. Innovative technological approaches have been shown to improve glycaemic and patient-related outcomes. AREAS COVERED We discuss recent advances in technologies in type 1 diabetes including closed-loop systems, also known as the 'artificial pancreas. Its various components, technical aspects and limitations are reviewed. We also discuss its advent into clinical practice, and other systems in development. Evidence from clinical studies are summarised. EXPERT COMMENTARY The recent approval of a hybrid closed-loop system for clinical use highlights the significant progress made in this field. Results from clinical studies have shown safety and glycaemic benefit, however challenges remain around improving performance and acceptability. More data is required to establish long-term clinical efficacy and cost-effectiveness, to fulfil the expectations of people with type 1 diabetes.
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Affiliation(s)
- Waseem Majeed
- a Manchester Academic Health Science Centre , Manchester University Hospitals NHS Foundation Trust , Manchester , UK
| | - Hood Thabit
- a Manchester Academic Health Science Centre , Manchester University Hospitals NHS Foundation Trust , Manchester , UK.,b Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health , University of Manchester , Manchester , UK
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