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Kong YW, Yuan CY, Kiburg K, Brown K, Trawley S, Partovi A, Roem K, Pham C, Harrison N, Fourlanos S, Ekinci EI, O’Neal DN. Treatment Satisfaction With Omnipod DASH in Adults With Type 1 Diabetes: A Nonblinded 1:1 Randomized Controlled Trial. J Clin Endocrinol Metab 2024; 109:1984-1995. [PMID: 38373265 PMCID: PMC11244188 DOI: 10.1210/clinem/dgae088] [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] [Received: 11/04/2023] [Revised: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
CONTEXT Omnipod DASH Insulin Management System is a tubeless insulin pump that overcomes the physical inconveniences of conventional tubed insulin pump therapy (IPT). OBJECTIVE We compared treatment satisfaction with Omnipod DASH System to usual care (multiple daily injections [MDIs] or tubed IPT) in adults with type 1 diabetes using self-monitoring blood glucose (SMBG). METHODS Adults with type 1 diabetes on MDI (n = 40) or IPT (n = 25) from 4 diabetes centers in Australia were randomly assigned in a 1:1 nonblinded manner to Omnipod DASH System (Omnipod group) or continue usual care (Usual Care group) for 12 weeks, followed by a further 12-week extension during which all participants used the device. The primary outcome was treatment satisfaction assessed by change in Diabetes Technology Questionnaire "current" (ΔDTQ-current) score at 12 weeks (study end). Secondary outcomes included ΔDTQ-current following extension and other participant-reported outcomes (PROs) measuring quality of life, burden of disease treatment, and glycemic and device-related outcomes at 12 weeks (study end) and 24 weeks (end extension). RESULTS Treatment satisfaction improved more in the Omnipod group vs the Usual Care group (ΔDTQ-current score of 16.4 [21.2] vs 0.0 [12.8]; P < .001) at study end. Significantly greater improvements in other PROs and glycated hemoglobin A1c were also observed. Improvements in DTQ-current and other PROs comparing study end and end extension were similar. While percentage in time in range change from baseline did not differ at study end (-2.0 [12.7] %), it was significantly greater at end extension (5.6 [10.9] %; P = .016). CONCLUSION The Omnipod DASH System resulted in greater treatment satisfaction at 12 weeks in adults with type 1 diabetes using SMBG that was sustained after 24 weeks of device use without compromising sleep quality and fear of hypoglycemia. Improvements in glycemia were also observed.
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Affiliation(s)
- Yee Wen Kong
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria 3065, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Cheng Yi Yuan
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria 3065, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Katerina Kiburg
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria 3065, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Katrin Brown
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria 3065, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Steven Trawley
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria 3065, Australia
- Department of Psychology, Cairnmillar Institute, Camberwell, Victoria 3124, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria 3065, Australia
| | - Andi Partovi
- Keylead Health, Melbourne, Victoria 3065, Australia
| | - Kerryn Roem
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria 3065, Australia
| | - Cecilia Pham
- Department of Medicine, The University of Melbourne, Melbourne, Victoria 3065, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria 3084, Australia
- The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Natalie Harrison
- Geelong Endocrinology and Diabetes, Geelong, Victoria 3220, Australia
| | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, Melbourne, Victoria 3065, Australia
- The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria 3010, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria 3052, Australia
| | - Elif I Ekinci
- Department of Medicine, The University of Melbourne, Melbourne, Victoria 3065, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria 3084, Australia
- The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - David N O’Neal
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria 3065, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria 3065, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria 3065, Australia
- The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria 3010, Australia
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Wang Y, Gao W, Wang XJ. Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers. World J Clin Cases 2024; 12:3378-3384. [PMID: 38983416 PMCID: PMC11229934 DOI: 10.12998/wjcc.v12.i18.3378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/24/2024] [Accepted: 05/14/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients. AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion (CSII). METHODS Based on the treatment modality received, the patients were allocated into two cohorts: The CSII group and the multiple daily injections (MDI) group, with each cohort comprising 210 patients. Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5, homocysteine, and C1q/TNF-related protein 9. Furthermore, outcomes such as fasting plasma glucose, 2-hour postprandial glucose levels, pain assessment scores, and the incidence of complications were evaluated post-treatment. RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group (P < 0.05). Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group (60.00%) in contrast to the MDI group (36.19%) (P < 0.05). Additionally, the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group (P < 0.05). However, there were no significant variances observed in other pregnancy outcomes between the two groups (P > 0.05). A statistical analysis revealed a significant difference in the incidence of complications between the groups (χ 2 = 11.631, P = 0.001). CONCLUSION The utilization of CSII via an insulin pump, as opposed to MDI, can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery. This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar, reducing the likelihood of adverse pregnancy outcomes and complications. The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.
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Affiliation(s)
- Yan Wang
- Department of Obstetrics and Gynaecology, Xi'an Central Hospital, Xi'an 710003, Shaanxi Province, China
| | - Wan Gao
- Department of Obstetrics and Gynaecology, Xi'an Central Hospital, Xi'an 710003, Shaanxi Province, China
| | - Xiao-Juan Wang
- Department of Obstetrics and Gynaecology, Xi'an Central Hospital, Xi'an 710003, Shaanxi Province, China
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Yu J, Wang H, Zhu M, Xu J. MDI versus CSII in Chinese adults with type 1 diabetes in a real-world situation: based on propensity score matching method. Health Qual Life Outcomes 2024; 22:47. [PMID: 38872219 PMCID: PMC11170850 DOI: 10.1186/s12955-024-02263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Compared with multiple daily insulin injections (MDI), continuous subcutaneous insulin infusion (CSII) is significantly more expensive and has not been widely used in Chinese type 1 diabetes mellitus (T1DM) patients. So there are still significant knowledge gaps regarding clinical and patient-reported outcomes in China. AIMS This study aims to compare the glycated hemoglobin (HbA1C), insulin therapy related quality of life (ITR-QOL), fear of hypoglycemia (FOH) of adult T1DM patients treated with MDI and CSII based on propensity score matching in real-world conditions in China. METHODS Four hundred twenty adult T1DM patients who were treated with MDI or CSII continuously for more than 12 months in a national metabolic center from June 2021 to June 2023 were selected as the study subjects. Their QOL and FOH were evaluated with Insulin Therapy Related Quality of Life Measure Questionnaire-Chinese version (ITR-QOL-CV) and the Chinese Version Hypoglycemia Fear Survey-Worry Scale (CHFSII-WS), and their HbA1C were collected at the same time. Potential confounding variables between the two groups were matched using propensity score matching. RESULTS Of the 420 patients included in the study, 315 were in MDI group and 105 were in CSII group. 102 pairs were successfully matched. After matching, the total score of ITR-QOL-CV scale in CSII group was significantly higher than that in MDI group (87.08 ± 13.53 vs. 80.66 ± 19.25, P = 0.006). Among them, the dimensions of daily life, social life, and psychological state were all statistically different (P < 0.05). The scores of CHFSII-WS (8.33 ± 3.49 vs. 11.77 ± 5.27, P = 0.003) and HbA1C (7.19 ± 1.33% vs. 7.71 ± 1.93%, P = 0.045) in CSII group were lower than those in MDI group. CONCLUSIONS 25.0% of T1DM adults are treated with CSII. Compared with adult T1DM patients treated with MDI, those treated with CSII have higher ITR-QOL, less FoH, and better control of HbA1C in real-world conditions in China. Therefore, regardless of economic factors, CSII is recommended for adult T1DM patients to optimize the therapeutic effect and outcomes.
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Affiliation(s)
- Jian Yu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), 300 Guangzhou Road, Nanjing, LA, 210029, China
| | - Hong Wang
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), 300 Guangzhou Road, Nanjing, LA, 210029, China
| | - Min Zhu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), 300 Guangzhou Road, Nanjing, LA, 210029, China.
| | - Jingjing Xu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), 300 Guangzhou Road, Nanjing, LA, 210029, China
- Department of Nursing, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), Nanjing, China
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Ma Y, Xing Y, Han F, Xu J, Qian H, Chen W, Huang D. Dually crosslinked degradable polyionic micelles for sustained glucose-responsive insulin release. Biomater Sci 2024; 12:3202-3211. [PMID: 38747944 DOI: 10.1039/d4bm00314d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Glucose -sensitive delivery systems hold great promise as a therapeutic approach for high-incidence diabetes owing to their ability to release insulin whenever elevated glycemia is detected. However, they are unstable in a hyperglycemic environment, which leads to short-term sustained insulin release. Herein, we designed dually crosslinked insulin polyionic micelles (DCM@insulin) based on triblock polymers of o-glycol and phenylboronic acid-functionalized poly(ethylene glycol)-poly(dimethylamino carbonate)-poly(dimethylamino-trimethylene carbonate) (mPEG-P(AC-co-MPD)-PDMAC and mPEG-P(AC-co-MAPBA)-PDMATC, respectively) for sustained glucose-responsive insulin release. DCM@insulin with a phenylboronic acid ester structure (first crosslinking structure) enhanced glycemic responsiveness by regulating insulin release in a hyperglycemic environment. Additionally, the UV-crosslinking structure (second crosslinking structure) formed by the residual double bonds in AC units endowed DCM@insulin with the ability to effectively protect the loaded insulin against protease degradation and avoid burst release under multiple insulin release. The in vivo findings demonstrated that DCM@insulin effectively maintained glycemic levels (BGLs) within the normal range for 6 h in comparison to single-crosslinked micelles (SCM@insulin). Therefore, the glucose-responsive and dually crosslinked polyionic micelle system exhibits potential as a viable option for the treatment of diabetes.
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Affiliation(s)
- Yuhong Ma
- Department of Pharmaceutical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, P. R. China.
| | - Yu Xing
- Department of Pharmaceutical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, P. R. China.
| | - Fuwei Han
- Department of Pharmaceutical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, P. R. China.
| | - Jiahao Xu
- Department of Pharmaceutical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, P. R. China.
| | - Hongliang Qian
- Department of Pharmaceutical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, P. R. China.
| | - Wei Chen
- Department of Pharmaceutical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, P. R. China.
| | - Dechun Huang
- Department of Pharmaceutical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, P. R. China.
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Li Y, Shao Z, Zhu Y, Chen D, Zhu J. Comparing Equil patch versus traditional catheter insulin pump in type 2 diabetes using continuous glucose monitoring metrics and profiles. J Diabetes 2024; 16:e13536. [PMID: 38599884 PMCID: PMC11006617 DOI: 10.1111/1753-0407.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/02/2024] [Accepted: 01/13/2024] [Indexed: 04/12/2024] Open
Abstract
AIMS It is not clear whether there are differences in glycemic control between the Equil patch and the MMT-712 insulin pump. Our objective was to compare two types of insulin pumps in the treatment of type 2 diabetes mellitus (T2DM), using continuous glucose monitoring (CGM) metrics and profiles. METHODS This was a randomized case-crossover clinical trial. Participants were hospitalized and randomly allocated to two groups and underwent two types of insulin pump treatments (group A: Equil patch-Medtronic MMT-712 insulin pump; group B: Medtronic MMT-712-Equil patch insulin pump) separated by a 1-day washout period. Glycemic control was achieved after 7-8 days of insulin pump therapy. Each patient received CGM for 5 consecutive days (from day 1 to day 5). On day 3 of CGM performance, the Equil patch insulin pump treatment was switched to Medtronic MMT-712 insulin pump treatment at the same basal and bolus insulin doses or vice versa. CGM metrics and profiles including glycemic variability (GV), time in range (TIR, 3.9-10.0 mmol/L), time below range (TBR, <3.9 mmol/L), time above range (TAR, >10.0 mmol/L), and postprandial glucose excursions, as well as incidence of hypoglycemia. RESULTS Forty-six T2DM patients completed the study. There was no significant difference in parameters of daily GV and postprandial glucose excursions between the Equil patch insulin pump treatment and the Medtronic insulin pump treatment. Similarly, there was no between-treatment difference in TIR, TBR, and TAR, as well as the incidence of hypoglycemia. CONCLUSION The Equil patch insulin pump was similar to the traditional MMT-712 insulin pump in terms of glycemic control. Equil patch insulin pump is a reliable tool for glycemic management of diabetes mellitus.
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Affiliation(s)
- Yu‐Jiao Li
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Zi‐Yue Shao
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Yun‐Qing Zhu
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Da‐Shuang Chen
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Jian Zhu
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
- Department of EndocrinologyAffiliated Hospital of Jiangnan UniversityWuxiChina
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Barnard-Kelly K, Thienel F, Mader JK, Oliver N, Franek E, Vesper I, Dagenbach N, Vogt G, Etter T, Künsting T. A Three-Arm Randomized Controlled Study Comparing Patient-Reported Outcomes in People With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion or Multiple Daily Injections. J Diabetes Sci Technol 2024:19322968241234055. [PMID: 38456441 DOI: 10.1177/19322968241234055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND The aim of this study was to compare patient-reported outcomes (PROs) in people with type 1 diabetes using either continuous subcutaneous insulin infusion (CSII) with two different insulin patch pumps or multiple daily injections (MDIs). MATERIALS AND METHODS In this randomized three-arm study, people with type 1 diabetes on MDI therapy were included and used either MDI, the Accu-Chek Solo micropump system (Solo) or Omnipod for 26 weeks. From weeks 26 to 39, all participants used CSII with Solo. Patient-reported outcomes were assessed using the diabetes technology questionnaire (DTQ); in addition, HbA1c values were measured. RESULTS Overall, 181 participants were randomized (61 MDI arm, 62 Solo arm, 58 Omnipod arm) and 142 completed the study. After 26 weeks in the study, the DTQ "change" score in the Solo group (105.9 [100.6-111.2]; baseline-adjusted mean [95% confidence interval]) was significantly higher than in the MDI group (94.8 [89.6-100.0]) (P = .001). The comparison between the Solo group (105.1 [99.1-111.1]) and the Omnipod group (108.7 [103.1-114.4]) showed no significant differences (P = .382). HbA1c increased by 0.2% ± 0.7% in the MDI group and decreased in both pump groups (Solo group -0.2% ± 0.8% and Omnipod group -0.1% ± 0.8%). Differences in HbA1c between the Solo group and the MDI group were significant (P = .009), but not between the Solo group and the Omnipod group (P = .896). CONCLUSIONS This study showed that switching from MDI to CSII improves both psychosocial well-being and physiological outcomes. Furthermore, there were no substantial differences between the established and the recently released patch pump. Trial registration at www.clinicaltrials.gov is NCT03478969.
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Affiliation(s)
| | - Florian Thienel
- Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück, Germany
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Edward Franek
- Central Clinical Hospital of the MSWiA in Warsaw, Warsaw, Poland
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Alnaim N, Al Ghadeer HA, Al-Bunyan AA, Almulhem A, Alsaleh Y, AlHelal M, Almugaizel I, Alhashim Z, Alhamrani AM, Al Bosrour ZA. Effectiveness of Insulin Pump Therapy Versus Multiple Daily Injections for Glycemic Control and Rate of Diabetic Ketoacidosis Among Children With Type 1 Diabetes Mellitus. Cureus 2024; 16:e54123. [PMID: 38487160 PMCID: PMC10939104 DOI: 10.7759/cureus.54123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 03/17/2024] Open
Abstract
Background Advances in pump technology and the availability of insulin analogs, as well as the results of the Diabetes Control and Complications Trial (DCCT), which established the benefit of improved glycemic control, have all contributed to the increased use of insulin pump therapy in recent years, particularly in children. Purpose This research aims to compare the impact of insulin delivery method, i.e., continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) on glycemic control and the rate of diabetic ketoacidosis (DKA) among children with type 1 diabetes mellitus in Al Ahsa, Saudi Arabia. Methods A retrospective cohort study was carried out in a diabetic center in Al Ahsa, Saudi Arabia, over 24 months (2020-2022) among children with type I diabetes mellitus (age group 1-14 years). Results In total, 351 patients with diabetes were induced, with 316 (90%) on MDI and 35 (10%) on CSII. After six months of diagnosis, precisely 38 (12%) of patients with diabetes on the MDI regimen experienced DKA, compared to 4 (11.4%) of those on the CSII regimen, with no statistically significant difference (P=0.918). At six months and nine months of follow-up, the average hemoglobin A1c (HbA1c) was considerably higher in diabetic patients on MDI (8.9 ± 1.7% vs. 8.2 ± 1.5% and 9.1 ± 1.6% vs. 8.0 ± 1.3%, respectively, with a significant p-value ≤0.05). Conclusion In this study, we found that patients on the MDI regimen had considerably higher HbA1c levels than patients on the CSII regimen, but there was no statistically significant difference in DKA rates between them. This is a short-term follow-up study, and we recommend that patients be followed for a longer period of time for further accurate outcomes.
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Affiliation(s)
- Nusaybah Alnaim
- Endocrinology and Diabetes, Maternity and Children Hospital, Al Ahsa, SAU
| | | | | | | | - Yassin Alsaleh
- Endocrinology and Diabetes, Maternity and Children Hospital, Al Ahsa, SAU
| | - Manal AlHelal
- Endocrinology and Diabetes, Maternity and Children Hospital, Al Ahsa, SAU
| | - Ishaq Almugaizel
- Endocrinology and Diabetes, Maternity and Children Hospital, Al Ahsa, SAU
| | - Zahra Alhashim
- Endocrinology and Diabetes, King Faisal General Hospital, Al Ahsa, SAU
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Gitsi E, Livadas S, Angelopoulos N, Paparodis RD, Raftopoulou M, Argyrakopoulou G. A Nutritional Approach to Optimizing Pump Therapy in Type 1 Diabetes Mellitus. Nutrients 2023; 15:4897. [PMID: 38068755 PMCID: PMC10707799 DOI: 10.3390/nu15234897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Achieving optimal glucose control in individuals with type 1 diabetes (T1DM) continues to pose a significant challenge. While continuous insulin infusion systems have shown promise as an alternative to conventional insulin therapy, there remains a crucial need for greater awareness regarding the necessary adaptations for various special circumstances. Nutritional choices play an essential role in the efficacy of diabetes management and overall health status for patients with T1DM. Factors such as effective carbohydrate counting, assessment of the macronutrient composition of meals, and comprehending the concept of the glycemic index of foods are paramount in making informed pre-meal adjustments when utilizing insulin pumps. Furthermore, the ability to handle such situations as physical exercise, illness, pregnancy, and lactation by making appropriate adjustments in nutrition and pump settings should be cultivated within the patient-practitioner relationship. This review aims to provide healthcare practitioners with practical guidance on optimizing care for individuals living with T1DM. It includes recommendations on carbohydrate counting, managing mixed meals and the glycemic index, addressing exercise-related challenges, coping with illness, and managing nutritional needs during pregnancy and lactation. Additionally, considerations relating to closed-loop systems with regard to nutrition are addressed. By implementing these strategies, healthcare providers can better equip themselves to support individuals with T1DM in achieving improved diabetes management and enhanced quality of life.
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Affiliation(s)
- Evdoxia Gitsi
- Diabetes and Obesity Unit, Athens Medical Center, 15125 Athens, Greece; (E.G.); (M.R.)
| | | | | | - Rodis D. Paparodis
- Center for Diabetes and Endocrine Research, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA;
| | - Marina Raftopoulou
- Diabetes and Obesity Unit, Athens Medical Center, 15125 Athens, Greece; (E.G.); (M.R.)
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Stougaard EB, Amadid H, Søndergaard E, Carstensen B, Jørgensen ME, Nørgaard K, Rossing P, Persson F, Vistisen D. Time Trends in the Incidence of Diabetic Ketoacidosis Leading to Hospital Admission Among Adults With Type 1 Diabetes: A Nationwide Danish Register Study. Diabetes Care 2023; 46:1897-1902. [PMID: 37432944 DOI: 10.2337/dc23-0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) is a life-threatening but preventable complication in people with type 1 diabetes. We aimed to quantify the incidence of DKA according to age and describe the time trend of DKA among adults with type 1 diabetes in Denmark. RESEARCH DESIGN AND METHODS Individuals aged ≥18 years with type 1 diabetes were identified from a nationwide Danish diabetes register. Hospital admissions due to DKA were ascertained from the National Patient Register. The follow-up period was from 1996 to 2020. RESULTS The cohort consisted of 24,718 adults with type 1 diabetes. The incidence rate of DKA per 100 person-years (PY) decreased with increasing age for both men and women. From 20 to 80 years of age, the DKA incidence rate decreased from 3.27 to 0.38 per 100 PY. From 1996 to 2008, the incidence rate of DKA increased for all age-groups, with a subsequent minor decrease in incidence rate until 2020. From 1996 to 2008, the incidence rates increased from 1.91 to 3.77 per 100 PY for a 20-year-old individual and from 0.22 to 0.44 per 100 PY for an 80-year-old individual living with type 1 diabetes. From 2008 to 2020 the incidence rates decreased from 3.77 to 3.27 and from 0.44 to 0.38 per 100 PY, respectively. CONCLUSIONS The incidence rates of DKA are declining for all ages, with an overall decline from 2008 for both men and women. This likely reflects improved diabetes management for individuals with type 1 diabetes in Denmark.
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Affiliation(s)
| | - Hanan Amadid
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Capital Region, Denmark
| | | | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Capital Region, Denmark
| | - Marit E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Capital Region, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kirsten Nørgaard
- Diabetes Technology Research, Steno Diabetes Center Copenhagen, Capital Region, Denmark
- Department of Clinical Medicine, University of Copenhagen, Capital Region, Denmark
| | - Peter Rossing
- Complication Research, Steno Diabetes Center Copenhagen, Capital Region, Denmark
- Department of Clinical Medicine, University of Copenhagen, Capital Region, Denmark
| | - Frederik Persson
- Complication Research, Steno Diabetes Center Copenhagen, Capital Region, Denmark
| | - Dorte Vistisen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Capital Region, Denmark
- Department of Public Health, University of Copenhagen, Capital Region, Denmark
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Gandhi K, Ebekozien O, Noor N, McDonough RJ, Hsieh S, Miyazaki B, Dei-Tutu S, Golden L, Desimone M, Hardison H, Rompicherla S, Akturk HK, Kamboj MK. Insulin Pump Utilization in 2017-2021 for More Than 22,000 Children and Adults With Type 1 Diabetes: A Multicenter Observational Study. Clin Diabetes 2023; 42:56-64. [PMID: 38230341 PMCID: PMC10788665 DOI: 10.2337/cd23-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
This large type 1 diabetes cohort study showed that insulin pump utilization has increased over time and that use differs by sex, insurance type, and race/ethnicity. Insulin pump use was associated with more optimal A1C, increased use of continuous glucose monitoring (CGM), and lower rates of diabetic ketoacidosis and severe hypoglycemia. People who used an insulin pump with CGM had lower rates of acute events than their counterparts who used an insulin pump without CGM. These findings highlight the need to improve access of diabetes technology through provider engagement, multidisciplinary approaches, and efforts to address health inequities.
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Affiliation(s)
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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11
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Kong YW, Yuan CY, Kiburg K, Brown K, Trawley S, Partovi A, Roem K, Harrison N, Fourlanos S, Ekinci EI, O'Neal DN. A pilot randomised controlled parallel arm trial evaluating treatment satisfaction with the Omnipod DASH ® Insulin Management System compared with usual care in adults with type 1 diabetes in Australia: rationale, study design and methodologies. Pilot Feasibility Stud 2023; 9:171. [PMID: 37814352 PMCID: PMC10561483 DOI: 10.1186/s40814-023-01400-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/14/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Insulin pump therapy (IPT) improves glucose control in people with type 1 diabetes (T1D) compared with multiple daily injections (MDI). However, their size, the tethered insulin infusion set, intrusiveness when operating the device and the need to disconnect during showering limit their acceptance to many who may benefit. The Omnipod DASH® Insulin Management System is a small waterproof tubeless device which is wirelessly controlled by a handheld device which may be an acceptable alternative. However, there are no randomised controlled trials focusing on the impact on user perceptions of tubeless insulin pump therapy. This pilot study aims to assess study feasibility and acceptability of patch pump therapy compared with usual care in adults with T1D in Australia to inform power calculations and progression to a large-scale multi-site randomised controlled study. METHODS A pilot multi-site parallel randomised controlled study will be conducted in sixty-four adults with T1D who are managed on MDI or IPT and self-monitoring with finger-stick blood glucose from four specialist diabetes centres in Victoria, Australia. Following carbohydrate counting education, participants will be randomised to use Omnipod DASH® System (Omnipod group) or continue usual care (usual care group) for 12 weeks, followed by a 12-week extension phase where all participants will use Omnipod DASH® System. The primary outcome measure is feasibility determined by study completion rates with a threshold of 0.80. Acceptability of the intervention (Omnipod DASH® System) will be assessed by the difference in Diabetes Technology Questionnaire 'current' (DTQ-current) score at 12 weeks post-randomisation compared to baseline. Secondary outcomes will include other measures of user acceptance, process outcomes, resource outcomes, participant-centred outcomes, healthcare professional perceptions and glycaemic outcomes. DISCUSSION This pilot study will provide insights regarding the feasibility of the study design and the first data regarding user acceptance of insulin patch pump technology in Australian T1D adults. We anticipate that this study will provide information informing the design of a larger study evaluating the impact of patch pumps on subjective outcomes that are of significance to the person living with T1D. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( https://anzctr.org.au/ ) ACTRN12621001195842 (8th September 2021). Please refer to Additional file 1: Appendix 1 for full details.
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Affiliation(s)
- Yee Wen Kong
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, 4th Floor, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, Australia
| | - Cheng Yi Yuan
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, 4th Floor, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, Australia
| | - Katerina Kiburg
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Katrin Brown
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Steven Trawley
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, 4th Floor, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, Australia
- Cairnmillar Institute, Camberwell, VIC, Australia
| | | | - Kerryn Roem
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, 4th Floor, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Elif I Ekinci
- Department of Medicine, The University of Melbourne, 4th Floor, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
- The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC, Australia
| | - David N O'Neal
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, VIC, Australia.
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
- Department of Medicine, The University of Melbourne, 4th Floor, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, Australia.
- The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC, Australia.
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de Jongh D, Thom RL, Cronin AJ, Bunnik EM, Massey EK. Clinical Translation of Bio-Artificial Pancreas Therapies: Ethical, Legal and Psychosocial Interdisciplinary Considerations and Key Recommendations. Transpl Int 2023; 36:11705. [PMID: 37789914 PMCID: PMC10543913 DOI: 10.3389/ti.2023.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
The field of regenerative medicine offers potential therapies for Type 1 Diabetes, whereby metabolically active cellular components are combined with synthetic medical devices. These therapies are sometimes referred to as "bioartificial pancreases." For these emerging and rapidly developing therapies to be clinically translated to patients, researchers must overcome not just scientific hurdles, but also navigate complex legal, ethical and psychosocial issues. In this article, we first provide an introductory overview of the key legal, ethical and psychosocial considerations identified in the existing literature and identify areas where research is currently lacking. We then highlight two principal areas of concern in which these discrete disciplines significantly overlap: 1) individual autonomy and 2) access and equality. Using the example of beta-cell provenance, we demonstrate how, by harnessing an interdisciplinary approach we can address these key areas of concern. Moreover, we provide practical recommendations to researchers, clinicians, and policymakers which will help to facilitate the clinical translation of this cutting-edge technology for Type 1 Diabetes patients. Finally, we emphasize the importance of exploring patient perspectives to ensure their responsible and acceptable translation from bench to body.
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Affiliation(s)
- Dide de Jongh
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Rebecca L. Thom
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College, London, United Kingdom
| | - Antonia J. Cronin
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College, London, United Kingdom
| | - Eline M. Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Emma K. Massey
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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13
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Kostopoulou E, Sinopidis X, Fouzas S, Gkentzi D, Dassios T, Roupakias S, Dimitriou G. Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls. Diagnostics (Basel) 2023; 13:2602. [PMID: 37568965 PMCID: PMC10416834 DOI: 10.3390/diagnostics13152602] [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: 06/26/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Diabetic ketoacidosis (DKA) represents an acute, severe complication of relative insulin deficiency and a common presentation of Type 1 Diabetes Mellitus (T1DM) primarily and, occasionally, Type 2 Diabetes Mellitus (T2DM) in children and adolescents. It is characterized by the biochemical triad of hyperglycaemia, ketonaemia and/or ketonuria, and acidaemia. Clinical symptoms include dehydration, tachypnoea, gastrointestinal symptoms, and reduced level of consciousness, precipitated by a variably long period of polyuria, polydipsia, and weight loss. The present review aims to summarize potential pitfalls in the diagnosis and management of DKA. A literature review was conducted using the Pubmed/Medline and Scopus databases including articles published from 2000 onwards. Diagnostic challenges include differentiating between T1DM and T2DM, between DKA and hyperosmolar hyperglycaemic state (HHS), and between DKA and alternative diagnoses presenting with overlapping symptoms, such as pneumonia, asthma exacerbation, urinary tract infection, gastroenteritis, acute abdomen, and central nervous system infection. The mainstays of DKA management include careful fluid resuscitation, timely intravenous insulin administration, restoration of shifting electrolyte disorders and addressing underlying precipitating factors. However, evidence suggests that optimal treatment remains a therapeutic challenge. Accurate and rapid diagnosis, prompt intervention, and meticulous monitoring are of major importance to break the vicious cycle of life-threatening events and prevent severe complications during this potentially fatal medical emergency.
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Affiliation(s)
- Eirini Kostopoulou
- Department of Paediatrics, University of Patras, 26504 Patras, Greece; (X.S.); (S.F.); (D.G.); (T.D.); (S.R.); (G.D.)
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14
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Ren C, Zhong D, Qi Y, Liu C, Liu X, Chen S, Yan S, Zhou M. Bioinspired pH-Responsive Microalgal Hydrogels for Oral Insulin Delivery with Both Hypoglycemic and Insulin Sensitizing Effects. ACS NANO 2023; 17:14161-14175. [PMID: 37406357 DOI: 10.1021/acsnano.3c04897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The oral form of insulin is more convenient and has better patient compliance than subcutaneous or intravenous insulin. Current oral insulin preparations, however, cannot overcome the enzyme barrier, chemical barrier, and epithelial barrier of the gastrointestinal tract completely. In this study, a microalgae-based oral insulin delivery strategy (CV@INS@ALG) was developed using Chlorella vulgaris (CV)-based insulin delivery system cross-linking with sodium alginate (ALG). CV@INS@ALG could overcome the gastrointestinal barrier, protect insulin from harsh gastric conditions, and achieve a pH-responsive drug release in the intestine. CV@INS@ALG might contribute to two mechanisms of insulin absorption, including direct insulin release from the delivery system and endocytosis by M cells and macrophages. In the streptozotocin (STZ)-induced type 1 diabetic mouse model, CV@INS@ALG showed a more effective and long-lasting hypoglycemic effect than direct insulin injection and did not cause any damage to the intestinal tract. Additionally, the long-term oral administration of the carrier CV@ALG effectively ameliorated gut microbiota disorder, and significantly increased the abundance of probiotic Akkermansia in db/db type 2 diabetic mice, thereby enhancing the insulin sensitivity of mice. Microalgal insulin delivery systems could be degraded and metabolized in the intestinal tract after oral administration, showing good biodegradability and biosafety. This insulin delivery strategy based on microalgal biomaterials provides a natural, efficient, and multifunctional solution for oral insulin delivery.
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Affiliation(s)
- Chaojie Ren
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, Zhejiang University, Haining 314400, China
| | - Danni Zhong
- Institute of Translational Medicine, Zhejiang University, Hangzhou 310029, China
- Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, Zhejiang University, Haining 314400, China
| | - Yuchen Qi
- Institute of Translational Medicine, Zhejiang University, Hangzhou 310029, China
- Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, Zhejiang University, Haining 314400, China
| | - Chaoyi Liu
- Institute of Translational Medicine, Zhejiang University, Hangzhou 310029, China
- Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, Zhejiang University, Haining 314400, China
| | - Xingyu Liu
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | | | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Min Zhou
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Institute of Translational Medicine, Zhejiang University, Hangzhou 310029, China
- Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, Zhejiang University, Haining 314400, China
- Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou 310053, China
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Swaminathan K. One-Year follow-up of 50 Rural Underprivileged Type 1 Diabetes Children on Insulin Pump Therapy: Breaking Socio-Economic Barriers in Diabetes Technologies. Indian J Endocrinol Metab 2023; 27:213-215. [PMID: 37583411 PMCID: PMC10424104 DOI: 10.4103/ijem.ijem_324_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 04/29/2023] [Accepted: 05/13/2023] [Indexed: 08/17/2023] Open
Abstract
Aims To audit the feasibility and clinical outcomes of fifty rural underprivileged children with Type 1 diabetes on insulin pump therapy for a one-year duration. Material and Methods All patients were audited from the Type 1 database of Madhuram Diabetes and Thyroid Centre (Unit of Idhayangal Charitable Trust www.idhayangal.org, NGO focussed on Type 1 diabetes from poor socio-economic strata). Below Poverty Line (BPL) was defined as any family earning less than Rs 2 lacs per annum. All children acted as their own controls managed on MDI for at least six months before pump start. Data were tabulated in Microsoft Excel and analysed. Results There were significant reductions in glycosylated haemoglobin at 6 months and one-year of insulin pump therapy compared to baseline pre-pump MDI values. In addition, significant reductions in diabetic ketoacidosis and severe hypoglycaemia admissions were seen. Conclusion Insulin pump therapy without prejudice on indicated well-selected rural underprivileged children with Type 1 diabetes leads to clinically meaningful outcomes. NGO-Private-Industry partnership is vital to expand access of modern diabetes technologies to reach the most underprivileged.
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Affiliation(s)
- Krishnan Swaminathan
- Consultant Endocrinologist, Madhuram Diabetes and Thyroid Centre, Coimbatore, Tamil Nadu, India
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16
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García MI, Céspedes C, Durán P, Forero C, Coll M. Evaluation of the quality of life in children and adolescents with type 1 diabetes in two health institutions, Bogotá, D. C., Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:83-92. [PMID: 37167465 PMCID: PMC10533173 DOI: 10.7705/biomedica.6675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/17/2023] [Indexed: 05/13/2023]
Abstract
Introduction: Diabetes mellitus is one of the most prevalent chronic diseases in the pediatric and juvenile population that affects the quality of life of patients. Objective: To evaluate the quality of life of a pediatric population under 18 years of age diagnosed with type 1 diabetes from two pediatric institutions in the city of Bogotá. Material and methods: We collected of sociodemographic data and clinical variables and application of the PedsQL 4.0™ questionnaire, and the diabetes module 3.2 version validated in Spanish. The sociodemographic data, the clinical variables and the PedsQL™ were processed in the statistical software Stata 17™. Results: In the global score of the PedsQL™ 3.2, diabetes version, men presented better quality of life compared to women. The correlation between the hemoglobin A1c (HbA1c) values and the PedsQL scale in the global score was evaluated. Patients with HbA1c values below 9% presented a better health-related quality of life, while in the group with HbA1c greater than 9% a perception of low quality of life was observed (p=0.025). Regarding the type of therapy and the relationship with the domains of the PedsQL 3.2, diabetes version, patients who used insulin pumps had better scores in the domains barriers, adherence, concern, communication and in the global score compared to patients who used multiple daily injections of insulin as treatment (p=0.0363). Conclusions: In our patients, a better metabolic control (measured by the HbA1c value) and the use of an insulin pump contribute to a better perception of quality of life.
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Affiliation(s)
- María Isabel García
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, D. C., Colombia.
| | - Camila Céspedes
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, D. C., Colombia; Centro de Endocrinología Pediátrica y del Adolescente Endociencia, Bogotá, D. C., Colombia.
| | - Paola Durán
- Centro de Endocrinología Pediátrica y del Adolescente Endociencia, Bogotá, D. C., Colombia.
| | - Catalina Forero
- Centro de Endocrinología Pediátrica y del Adolescente Endociencia, Bogotá, D. C., Colombia.
| | - Mauricio Coll
- Centro de Endocrinología Pediátrica y del Adolescente Endociencia, Bogotá, D. C., Colombia.
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17
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Albaladejo L, Périnet-Marquet P, Buis C, Lablanche S, Iceta S, Arnol N, Logerot S, Borel JC, Bétry C. High prevalence with no gender difference of likely eating disorders in type 1 mellitus diabetes on insulin pump. Diabetes Res Clin Pract 2023; 199:110630. [PMID: 36934794 DOI: 10.1016/j.diabres.2023.110630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
AIM The aim of this study was to determine the prevalence of likely eating disorders and insulin misuse in a prospective cohort of adults with type 1 diabetes mellitus (T1DM) treated with insulin pump therapy. METHODS This prospective study was held at the participants' home. The participants completed the SCOFF questionnaire as well as a question related to insulin misuse. Information about lifestyle, medical history, insulin pump and Continuous Glucose Monitoring (CGM) data were collected. RESULTS The analysis covered 198 participants with a median age of 51 [95% CI 38; 62] years. The prevalence of likely eating disorders was 21.7% (95% CI 16.3; 28.2) in the study population and 20.6% (95% CI 14.3; 28.6) and 24.2% (95% CI 14.6; 37.0) in males and females respectively. The prevalence of insulin misuse was 39.0% (95% CI 30.8; 47.7). There was no significant difference in prevalence between males and females for likely eating disorders and insulin misuse. The analysis of CGM data revealed no factors related to glycaemic control associated with likely eating disorders. CONCLUSION The results of this study indicate that the prevalence of likely eating disorders is high even in a middle-aged population with a T1DM and satisfactory glucose control.
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Affiliation(s)
- Laura Albaladejo
- Remedee Labs, 99 chemin de l'étoile, 38330 Montbonnot St Martin, France; Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, MESP, 38000 Grenoble, France
| | | | - Claire Buis
- Adult Psychiatry Department, CHU de Grenoble, Grenoble, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble Alpes University Hospital, Grenoble, France
| | - Sylvain Iceta
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada; Department of Psychiatry and Neurosciences, Laval University, Québec, QC, Canada
| | - Nathalie Arnol
- AGIR à dom, 36 chemin du Vieux Chêne, 38240 Meylan, France
| | - Sophie Logerot
- AGIR à dom, 36 chemin du Vieux Chêne, 38240 Meylan, France
| | | | - Cécile Bétry
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France.
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Messer LH, Vigers T, Akturk HK, Forlenza GP, Huss KB, Karami AJ, Malecha E, Oser SM, Polsky S, Pyle L, Shah VN, Wadwa RP, Oser TK. Increasing Use of Diabetes Devices: What Do Health Care Professionals Need? Clin Diabetes 2023; 41:386-398. [PMID: 37456091 PMCID: PMC10338282 DOI: 10.2337/cd22-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Despite evidence of improved diabetes outcomes with diabetes technology such as continuous glucose monitoring (CGM) systems, insulin pumps, and hybrid closed-loop (HCL) insulin delivery systems, these devices are underutilized in clinical practice for the management of insulin-requiring diabetes. This low uptake may be the result of health care providers' (HCPs') lack of confidence or time to prescribe and manage devices for people with diabetes. We administered a survey to HCPs in primary care, pediatric endocrinology, and adult endocrinology practices in the United States. Responding HCPs expressed a need for device-related insurance coverage tools and online data platforms with integration to electronic health record systems to improve diabetes technology uptake in these practice settings across the United States.
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Affiliation(s)
- Laurel H. Messer
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Tim Vigers
- University of Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
| | - Halis K. Akturk
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Gregory P. Forlenza
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Kelsey B. Huss
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
| | - Angela J. Karami
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Emily Malecha
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Sean M. Oser
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
| | - Sarit Polsky
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Laura Pyle
- University of Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
| | - Viral N. Shah
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - R. Paul Wadwa
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Tamara K. Oser
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
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Estock JL, Codario RA, Keddem S, Zupa MF, Rodriguez KL, DiNardo MM. Insulin Pump-Associated Adverse Events: A Qualitative Descriptive Study of Clinical Consequences and Potential Root Causes. Diabetes Technol Ther 2023; 25:343-355. [PMID: 36724310 DOI: 10.1089/dia.2022.0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: To explore the clinical consequences and potential root causes of insulin pump-associated adverse events (AEs) reported in the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. Research Design and Methods: Qualitative template analysis of narrative data in a 20% stratified random sample (n = 2429) of reported AEs that occurred during the first 6 months of 2020 involving five insulin pump models marketed at that time: (1) MiniMed™ 670G, (2) MiniMed™ 630G, (3) Omnipod®, (4) Omnipod DASH®, and (5) t:slim X2™. Results: Of the 2429 AEs, 92% included a clinical consequence in the narrative description, with critical hyperglycemia (i.e., blood glucose [BG] >400 mg/dL; 47%) and critical hypoglycemia (i.e., BG <54 mg/dL; 24%) being the most common consequence cited. Only 50% of the AE narratives included information to support the identification of a root cause. The most cited root cause informing remarks were issues with the pump or pod reservoir/cartridge (9%), the occurrence of an obstruction of flow alarm (8%), and problems with the infusion set or site (8%). Some clinical consequences and root cause informing remarks were cited more frequently in AE narratives involving specific insulin pump models, but manufacturer variability in the amount and type of information reported may have affected these findings. Conclusions: Our findings show general themes found in insulin pump-associated AE that providers can use to raise patient awareness of potential risks associated with insulin pump use and develop strategies to prevent future AEs. Improvements in AE investigation and reporting processes are still necessary.
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Affiliation(s)
- Jamie L Estock
- Office of Research and Development; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Ronald A Codario
- Department of Endocrinology; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Endocrinology & Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Margaret F Zupa
- Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Endocrinology & Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Monica M DiNardo
- Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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van Wilpe R, Hulst AH, Siegelaar SE, DeVries JH, Preckel B, Hermanides J. Type 1 and other types of diabetes mellitus in the perioperative period. What the anaesthetist should know. J Clin Anesth 2023; 84:111012. [PMID: 36427486 DOI: 10.1016/j.jclinane.2022.111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Diabetes mellitus is often treated as a uniform disease in the perioperative period. Type 2 diabetes is most commonly encountered, and only a minority of surgical patients have been diagnosed with another type of diabetes. Patients with a specific type of diabetes can be particularly prone to perioperative glycaemic dysregulation. In addition, certain type-related features and pitfalls should be taken into account in the operating theatre. In this narrative review, we discuss characteristics of types of diabetes other than type 2 diabetes relevant to the anaesthetist, based on available literature and data from our clinic.
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Affiliation(s)
- Robert van Wilpe
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| | - Abraham H Hulst
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| | - Sarah E Siegelaar
- Department of Endocrinology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands.
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
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21
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Pauley ME, Tommerdahl KL, Snell-Bergeon JK, Forlenza GP. Continuous Glucose Monitor, Insulin Pump, and Automated Insulin Delivery Therapies for Type 1 Diabetes: An Update on Potential for Cardiovascular Benefits. Curr Cardiol Rep 2022; 24:2043-2056. [PMID: 36279036 PMCID: PMC9589770 DOI: 10.1007/s11886-022-01799-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The incidence of type 1 diabetes (T1D) is rising in all age groups. T1D is associated with chronic microvascular and macrovascular complications but improving glycemic trends can delay the onset and slow the progression of these complications. Utilization of technological devices for diabetes management, such as continuous glucose monitors (CGM) and insulin pumps, is increasing, and these devices are associated with improvements in glycemic trends. Thus, device use may be associated with long-term prevention of T1D complications, yet few studies have investigated the direct impacts of devices on chronic complications in T1D. This review will describe common diabetes devices and combination systems, as well as review relationships between device use and cardiovascular outcomes in T1D. RECENT FINDINGS Findings from existing cohort and national registry studies suggest that pump use may aid in improving cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, pump users have been shown to have lower arterial stiffness and better measures of myocardial function. In registry and case-control longitudinal data, pump use has been associated with fewer cardiovascular events and reduction of cardiovascular disease (CVD) and all-cause mortality. CVD is the leading cause of morbidity and mortality in T1D. Consistent use of diabetes devices may protect against the development and progression of macrovascular complications such as CVD through improvement in glycemic trends. Existing literature is limited, but findings suggest that pump use may reduce acute cardiovascular risk factors as well as chronic cardiovascular complications and overall mortality in T1D.
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Affiliation(s)
- Meghan E Pauley
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Kalie L Tommerdahl
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- Ludeman Family Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
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22
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Park J, Park N, Han S, Lee YB, Kim G, Jin SM, Lee WJ, Kim JH. A 4-Week, Two-Center, Open-Label, Single-Arm Study to Evaluate the Safety and Efficacy of EOPatch in Well-Controlled Type 1 Diabetes Mellitus. Diabetes Metab J 2022; 46:941-947. [PMID: 35255546 PMCID: PMC9723198 DOI: 10.4093/dmj.2021.0299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/05/2022] [Indexed: 12/29/2022] Open
Abstract
This study evaluated the safety and efficacy of tubeless patch pump called EOPatch in patients with well-controlled type 1 diabetes mellitus (T1DM). This 4-week, two-center, open-label, single-arm study enrolled 10 adult patients diagnosed with T1DM with glycosylated hemoglobin less than 7.5%. The co-primary end points were patch pump usage time for one attachment and number of serious adverse events related to the patch pump. The secondary end points were total amount of insulin injected per patch and changes in glycemic parameters including continuous glucose monitoring data compared to those at study entry. The median usage time per patch was 84.00 hours (interquartile range, 64.50 to 92.50). Serious adverse events did not occur during the trial. Four weeks later, time in range 70 to 180 mg/dL was significantly improved (70.71%±17.14 % vs. 82.96%±9.14%, P=0.01). The times spent below range (<54 mg/dL) and above range (>180 mg/dL) also improved (All P<0.05). Four-week treatment with a tubeless patch pump was safe and led to clinical improvement in glycemic control.
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Affiliation(s)
- Jiyun Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Nammi Park
- Divisions of Clinical Affairs, EOFLOW Co. Ltd., Seongnam,
Korea
| | - Sangjin Han
- Hardware Development, EOFLOW Co. Ltd., Seongnam,
Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul,
Korea
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23
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Stamati A, Karagiannis T, Tsapas A, Christoforidis A. Efficacy and safety of ultra-rapid insulin analogues in insulin pumps in patients with Type 1 Diabetes Mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract 2022; 193:110144. [PMID: 36351486 DOI: 10.1016/j.diabres.2022.110144] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022]
Abstract
AIMS To assess the efficacy and safety of ultra-rapid insulin analogues used with continuous subcutaneous insulin infusion systems (CSII) in adults with type 1 diabetes (T1DM). METHODS We searched MEDLINE and Cochrane Library up to May 2022 for randomized controlled trials comparing ultra-rapid with rapid-acting insulin analogues (RAIAs) used with CSII. We performed random effects meta-analyses for % of 24-h time in range of 70-180 mg/dl (TIR), time in hypoglycaemia (<70 mg/dl) and hyperglycaemia (>180 mg/dl), 1- and 2-hour post-prandial glucose [PPG] increment after a meal test, HbA1c and average insulin dose at endpoint, unplanned infusion set changes and severe hypoglycaemia. RESULTS Nine studies (1,156 participants) were included. Ultra-rapid insulins were superior to RAIAs on TIR (mean difference [MD] 1.1 %, 95 % CI 0.11-2.11), time spent in hypoglycaemia (MD -0.47 %, 95 % CI -0.63 to -30), and 1- and 2-hour PPG (MD -12.20 mg/dl, 95 % CI -19.85 to -4.54 and MD -17.61 mg/dl, 95 % CI -28.55 to -6.66, respectively). Ultra-rapid insulins increased odds of unplanned infusion set changes (odds ratio 1.60, 95 % CI 1.26-2.03). CONCLUSION Ultra-rapid acting insulins provided better PPG control compared to RAIAs but their use might result in more infusion set changes.
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Affiliation(s)
- Athina Stamati
- Postgraduate Program "Research Methodology in Medicine and in Health Sciences", Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Christoforidis
- 1(st) Paediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, Thessaloniki, Greece
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24
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An overview of advancements in closed-loop artificial pancreas system. Heliyon 2022; 8:e11648. [DOI: 10.1016/j.heliyon.2022.e11648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/15/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
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25
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Khaqan A, Nauman A, Shuja S, Khurshaid T, Kim KC. An Intelligent Model-Based Effective Approach for Glycemic Control in Type-1 Diabetes. SENSORS (BASEL, SWITZERLAND) 2022; 22:7773. [PMID: 36298123 PMCID: PMC9609843 DOI: 10.3390/s22207773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Type-1 diabetes mellitus (T1DM) is a challenging disorder which essentially involves regulation of the glucose levels to avoid hyperglycemia as well as hypoglycemia. For this purpose, this research paper proposes and develops control algorithms using an intelligent predictive control model, which is based on a UVA/Padova metabolic simulator. The primary objective of the designed control laws is to provide an automatic blood glucose control in insulin-dependent patients so as to improve their life quality and to reduce the need of an extremely demanding self-management plan. Various linear and nonlinear control algorithms have been explored and implemented on the estimated model. Linear techniques include the Proportional Integral Derivative (PID) and Linear Quadratic Regulator (LQR), and nonlinear control strategy includes the Sliding Mode Control (SMC), which are implemented in this research work for continuous monitoring of glucose levels. Performance comparison based on simulation results demonstrated that SMC proved to be most efficient in terms of regulating glucose profile to a reference level of 70 mg/dL compared to the classical linear techniques. A brief comparison is presented between the linear techniques (PID and LQR), and nonlinear technique (SMC) for analysis purposes proving the efficacy of the design.
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Affiliation(s)
- Ali Khaqan
- Department of Electrical Engineering, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Ali Nauman
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan 38541, Korea
| | - Sana Shuja
- Department of Electrical Engineering, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Tahir Khurshaid
- Department of Electrical Engineering, Yeungnam University, Gyeongsan 38541, Korea
| | - Ki-Chai Kim
- Department of Electrical Engineering, Yeungnam University, Gyeongsan 38541, Korea
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26
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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27
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Pitocco D, Laurenzi A, Tomaselli L, Assaloni R, Consoli A, Di Bartolo P, Guardasole V, Lombardo F, Maffeis C, Rossi A, Gesuita R, Di Molfetta S, Rigamonti A, Scaramuzza A, Irace C, Cherubini V. Health care organization and use of technological devices in people with diabetes in Italy: Results from a survey of the Working Group on Diabetes and Technology. Nutr Metab Cardiovasc Dis 2022; 32:2392-2398. [PMID: 35970683 DOI: 10.1016/j.numecd.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIM The use of technology offers recognized benefits to persons with diabetes. The aim of this study was to evaluate the organization of healthcare facilities, the composition of the diabetes team, and the use of Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in Italy. METHODS AND RESULTS Diabetes care centers were asked to complete a web survey based on information collected in 2018. Sixty-one pediatric and 243 adult centers participated in the survey, accounting for 507,386 patients, mostly with type 2 diabetes (86.4%). Fifty-three percent of pediatric centers and 11% of adult centers reported a team composed of diabetologists, nurses, and psychologists. Overall, 13,204 patients (2.6%) were using CSII (95% with type 1 diabetes), and 28,936 (5.7%), were using CGM (74% with type 1 diabetes). When stratifying for the type of diabetes, 24% and 40.8% of patients with type 1 were using CSII and CGM, respectively, whereas low use of technology was reported for patients with type 2 and women with gestational diabetes. The percentage of adult and pediatric patients with type 1 diabetes on CSII and CGM was respectively 21% and 32%, and 35% and 57%. CONCLUSIONS The spread of CGM and CSII increased in Italy between 2013 and 2018. However, the percentage of users is still lower than what is expected based on clinical indications for use of technology. The inadequate number of professionals in the diabetes care team and insufficient economic resources are relevant barriers to disseminating technology for diabetes management.
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Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, UOSD Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone [GO], Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Rigamonti
- Division of Pediatrics, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy.
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
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28
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Continuous subcutaneous insulin infusion is associated with a better glycemic control than multiple daily insulin injections without difference in diabetic ketoacidosis and hypoglycemia admissions among Emiratis with Type 1 diabetes. PLoS One 2022; 17:e0264545. [PMID: 36136973 PMCID: PMC9498969 DOI: 10.1371/journal.pone.0264545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/12/2022] [Indexed: 11/19/2022] Open
Abstract
Aims
To characterizes Emiratis patients with Type 1 diabetes (T1D) and compares outcomes between continuous subcutaneous insulin infusion (CSII) versus multiple daily insulin injections (MDI) users. The WHO-Five Well-Being Index (WHO-5) score was used to screen for depression.
Methods
In this cross-sectional study; sociodemographic, clinical characteristics and insulin replacement regimens were collected on patients with T1D between 2015–2018.
Results
134 patients with mean age of 20.9±7.5 years were included. Females constitute 56.7% and 50.7% had diabetes duration of >10 years. Diabetic ketoacidosis (DKA) at presentation was reported in 46.3%. Average glycemic control over preceding 12months was satisfactory (less than 7.5%), suboptimal (7.5–9%), and poor (more than 9%) in 26.6%, 42.7% & 30.6% of the patients, respectively. Higher proportion of patients using CSII achieved satisfactory or suboptimal glycemic control compared to patients with MDI (P = 0.003). The latest median /IQR HbA1c was significantly lower (P = 0.041) in patients using CSII (8.2 /1.93%) compared to MDI (8.5/2.45%). There was no significant difference between two groups in DKA, severe hypoglycemia or total WHO-5 score.
Conclusions
CSII usage was associated with better glycemic control than MDI, although no difference in DKA and severe hypoglycemia. The overall glycemic control among Emiratis subjects with T1D is unsatisfactory and needs more rigorous patient counseling and education.
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29
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Keyu G, Jiaqi L, Liyin Z, Jianan Y, Li F, Zhiyi D, Qin Z, Xia L, Lin Y, Zhiguang Z. Comparing the effectiveness of continuous subcutaneous insulin infusion with multiple daily insulin injection for patients with type 1 diabetes mellitus evaluated by retrospective continuous glucose monitoring: A real-world data analysis. Front Public Health 2022; 10:990281. [PMID: 36091534 PMCID: PMC9454013 DOI: 10.3389/fpubh.2022.990281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/11/2022] [Indexed: 01/26/2023] Open
Abstract
Objective Regarding the effects and practical application of insulin pumps on patients with type 1 diabetes mellitus (T1DM), the real-world evidence is limited especially concerning the incidence of hypoglycemia. This study aimed to compare the efficacy of continuous subcutaneous insulin infusion (CSII) therapy with multiple daily injection (MDI) therapy on glycemic metrics evaluated by retrospective continuous glucose monitoring (CGM) in Chinese patients with T1DM. Methods In total, 362 T1DM Chinese patients from the outpatient department of the Second Xiangya Hospital, Central South University, who underwent intensive insulin therapy and used a retrospective CGM system were included in this retrospective cross-sectional study. Comprehensive analysis of clinical and biological features and retrospective CGM derived-metrics was performed on the 362 enrolled T1DM patients who underwent CSII (n = 61) or MDI (n = 301) therapy (defined as 4 or more insulin injections per day). Results Our findings demonstrated that patients who underwent CSII therapy, compared with those who received MDI therapy, had lower levels of hemoglobin A1c (HbA1c) and fasting blood glucose; moreover, CSII therapy was associated with better glycemic outcomes in terms of increasing time in range (TIR), decreasing time above range (TAR), and achieving CGM-associated targets of TIR ≥70% and TAR <25%. However, patients who underwent CSII therapy did not experience decreasing time below range (TBR), achieving CGM-associated targets of TBR <4%, and reduction of the risk of hypoglycemia as evidenced by comparing TBR and low blood glucose index (LBGI) between the two treatment regimens. The parameters of glycemic variability, such as standard deviation of glucose (SD), mean amplitude glycemic excursion (MAGE), and large amplitude glycemic excursion (LAGE) in T1DM patients who underwent CSII therapy outperformed. Conclusion Our results provided further evidence that CSII therapy is safe and effective for management of Chinese T1DM patients, which was confirmed by a lower HbA1c level and better CGM-derived metrics but no demonstration of improvment in the risk of hypoglycemia. To achieve more satisfactory glycemic outcomes through the utilization of CSII therapy for Chinese T1DM patients, a strong physician-patient relationship is essential.
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Affiliation(s)
- Guo Keyu
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Jiaqi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhang Liyin
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ye Jianan
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fan Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ding Zhiyi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhou Qin
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Xia
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yang Lin
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhou Zhiguang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
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30
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Domingo-Lopez DA, Lattanzi G, H. J. Schreiber L, Wallace EJ, Wylie R, O'Sullivan J, Dolan EB, Duffy GP. Medical devices, smart drug delivery, wearables and technology for the treatment of Diabetes Mellitus. Adv Drug Deliv Rev 2022; 185:114280. [PMID: 35405298 DOI: 10.1016/j.addr.2022.114280] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/21/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus refers to a group of metabolic disorders which affect how the body uses glucose impacting approximately 9% of the population worldwide. This review covers the most recent technological advances envisioned to control and/or reverse Type 1 diabetes mellitus (T1DM), many of which will also prove effective in treating the other forms of diabetes mellitus. Current standard therapy for T1DM involves multiple daily glucose measurements and insulin injections. Advances in glucose monitors, hormone delivery systems, and control algorithms generate more autonomous and personalised treatments through hybrid and fully automated closed-loop systems, which significantly reduce hypo- and hyperglycaemic episodes and their subsequent complications. Bi-hormonal systems that co-deliver glucagon or amylin with insulin aim to reduce hypoglycaemic events or increase time spent in target glycaemic range, respectively. Stimuli responsive materials for the controlled delivery of insulin or glucagon are a promising alternative to glucose monitors and insulin pumps. By their self-regulated mechanism, these "smart" drugs modulate their potency, pharmacokinetics and dosing depending on patients' glucose levels. Islet transplantation is a potential cure for T1DM as it restores endogenous insulin and glucagon production, but its use is not yet widespread due to limited islet sources and risks of chronic immunosuppression. New encapsulation strategies that promote angiogenesis and oxygen delivery while protecting islets from recipients' immune response may overcome current limiting factors.
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31
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Everett EM, Copeland TP, Moin T, Wisk LE. Insulin Pump-related Inpatient Admissions in a National Sample of Youth With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e2381-e2387. [PMID: 35196382 PMCID: PMC9113825 DOI: 10.1210/clinem/dgac047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Insulin pump use in type 1 diabetes management has significantly increased in recent years, but we have few data on its impact on inpatient admissions for acute diabetes complications. METHODS We used the 2006, 2009, 2012, and 2019 Kids' Inpatient Database to identify all-cause type 1 diabetes hospital admissions in those with and without documented insulin pump use and insulin pump failure. We described differences in (1) prevalence of acute diabetes complications, (2) severity of illness during hospitalization and disposition after discharge, and (3) length of stay (LOS) and inpatient costs. RESULTS We identified 228 474 all-cause admissions. Insulin pump use was documented in 7% of admissions, of which 20% were due to pump failure. The prevalence of diabetic ketoacidosis (DKA) was 47% in pump nonusers, 39% in pump users, and 60% in those with pump failure. Admissions for hyperglycemia without DKA, hypoglycemia, sepsis, and soft tissue infections were rare and similar across all groups. Admissions with pump failure had a higher proportion of admissions classified as major severity of illness (14.7%) but had the lowest LOS (1.60 days, 95% CI 1.55-1.65) and healthcare costs ($13 078, 95% CI $12 549-$13 608). CONCLUSIONS Despite the increased prevalence of insulin pump in the United States, a minority of pediatric admissions documented insulin pump use, which may represent undercoding. DKA admission rates were lower among insulin pump users compared to pump nonusers. Improved accuracy in coding practices and other approaches to identify insulin pump users in administrative data are needed, as are interventions to mitigate risk for DKA.
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Affiliation(s)
- Estelle M Everett
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Timothy P Copeland
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Tannaz Moin
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lauren E Wisk
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Lah Tomulić K, Matko L, Verbić A, Milardović A, Severinski S, Kolić I, Baraba Dekanić K, Šerifi S, Butorac Ahel I. Epidemiologic Characteristics of Children with Diabetic Ketoacidosis Treated in a Pediatric Intensive Care Unit in a 10-Year-Period: Single Centre Experience in Croatia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:638. [PMID: 35630055 PMCID: PMC9143855 DOI: 10.3390/medicina58050638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. Materials and Methods: This retrospective study was performed in the PICU, Clinical Hospital Centre Rijeka, in Croatia. All children diagnosed with DKA from 2011-2020 were included in this study. Data were received from hospital medical documentation and patient paper history. The number of new cases and severity of DKA were identified and classified using recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: In this investigation period, 194 children with newly diagnosed T1D were admitted to our hospital: 58 of them were treated in the PICU due to DKA; 48 had newly diagnosed T1D (48/58); and ten previously diagnosed T1D (10/58). DKA as the initial presentation of T1D was diagnosed in 24.7% (48/194). Moderate or severe dehydration was present in 76% of the children at hospital admission. Polyuria, polydipsia, and Kussmaul breathing were the most common signs. Three patients (5.2%) developed cerebral edema, of whom one died. Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.
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Affiliation(s)
- Kristina Lah Tomulić
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Lucija Matko
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Arijan Verbić
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
| | - Ana Milardović
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Srećko Severinski
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Ivana Kolić
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Kristina Baraba Dekanić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Senada Šerifi
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Ivona Butorac Ahel
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
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Prigge R, McKnight JA, Wild SH, Haynes A, Jones TW, Davis EA, Rami-Merhar B, Fritsch M, Prchla C, Lavens A, Doggen K, Chao S, Aronson R, Brown R, Ibfelt EH, Svensson J, Young R, Warner JT, Robinson H, Laatikainen T, Rautiainen P, Delemer B, Souchon PF, Diallo AM, Holl RW, Schmid SM, Raile K, Tigas S, Bargiota A, Zografou I, Luk AOY, Chan JCN, Dinneen SF, Buckley CM, Kgosidialwa O, Cherubini V, Gesuita R, Strele I, Pildava S, Veeze H, Aanstoot HJ, Mul D, Jefferies C, Cooper JG, Løvaas KF, Battelino T, Dovc K, Bratina N, Eeg-Olofsson K, Svensson AM, Gudbjornsdottir S, Globa E, Zelinska N. International comparison of glycaemic control in people with type 1 diabetes: an update and extension. Diabet Med 2022; 39:e14766. [PMID: 34890078 DOI: 10.1111/dme.14766] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS To update and extend a previous cross-sectional international comparison of glycaemic control in people with type 1 diabetes. METHODS Data were obtained for 520,392 children and adults with type 1 diabetes from 17 population and five clinic-based data sources in countries or regions between 2016 and 2020. Median HbA1c (IQR) and proportions of individuals with HbA1c < 58 mmol/mol (<7.5%), 58-74 mmol/mol (7.5-8.9%) and ≥75 mmol/mol (≥9.0%) were compared between populations for individuals aged <15, 15-24 and ≥25 years. Logistic regression was used to estimate the odds ratio (OR) of HbA1c < 58 mmol/mol (<7.5%) relative to ≥58 mmol/mol (≥7.5%), stratified and adjusted for sex, age and data source. Where possible, changes in the proportion of individuals in each HbA1c category compared to previous estimates were calculated. RESULTS Median HbA1c varied from 55 to 79 mmol/mol (7.2 to 9.4%) across data sources and age groups so a pooled estimate was deemed inappropriate. OR (95% CI) for HbA1c < 58 mmol/mol (<7.5%) were 0.91 (0.90-0.92) for women compared to men, 1.68 (1.65-1.71) for people aged <15 years and 0.81 (0.79-0.82) aged15-24 years compared to those aged ≥25 years. Differences between populations persisted after adjusting for sex, age and data source. In general, compared to our previous analysis, the proportion of people with an HbA1c < 58 mmol/l (<7.5%) increased and proportions of people with HbA1c ≥ 75 mmol/mol (≥9.0%) decreased. CONCLUSIONS Glycaemic control of type 1 diabetes continues to vary substantially between age groups and data sources. While some improvement over time has been observed, glycaemic control remains sub-optimal for most people with Type 1 diabetes.
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Affiliation(s)
- Regina Prigge
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John A McKnight
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Metabolic Unit and Acute Receiving Unit, Western General Hospital, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aveni Haynes
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Birgit Rami-Merhar
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Fritsch
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Christine Prchla
- Klinik Donaustadt, Department of Paediatrics and Adolescent Medicine, Vienna, Austria
| | | | | | | | | | - Ruth Brown
- LMC Diabetes & Endocrinology, Toronto, Canada
| | | | - Jannet Svensson
- Department of Paediatrics, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | | | | | - Holy Robinson
- Royal College of Paediatrics and Child Health, London, UK
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Uusimaa, Finland
- Joint municipal authority for North Karelia social and health services (Siunsote), Joensuu, Finland
| | - Päivi Rautiainen
- Joint municipal authority for North Karelia social and health services (Siunsote), Joensuu, Finland
| | - Brigitte Delemer
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Pierre François Souchon
- Department of Paediatrics, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Alpha M Diallo
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Sebastian M Schmid
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetology, University Medicine Berlin, CharitéBerlin, Germany
| | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly, Volos, Greece
| | - Ioanna Zografou
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Andrea O Y Luk
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong Institute of Diabetes and Obesity, Hong Kong, China
| | - Juliana C N Chan
- The Chinese University of Hong Kong, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Sean F Dinneen
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
- NUI Galway, Galway, Ireland
| | | | - Oratile Kgosidialwa
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
| | | | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy, Italy
| | - Ieva Strele
- Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia
| | - Santa Pildava
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Henk Veeze
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Dick Mul
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Craig Jefferies
- Department of Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - John G Cooper
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne Fjeld Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Dovc
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Bratina
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Centre of Registers in Region VästraGötaland, Göteborg, Sweden
| | - Soffia Gudbjornsdottir
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Centre of Registers in Region VästraGötaland, Göteborg, Sweden
| | - Evgenia Globa
- Ukrainian Research Centre of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
| | - Nataliya Zelinska
- Ukrainian Research Centre of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
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Serné EH, Roze S, Buompensiere MI, Valentine WJ, De Portu S, de Valk HW. Cost-Effectiveness of Hybrid Closed Loop Insulin Pumps Versus Multiple Daily Injections Plus Intermittently Scanned Glucose Monitoring in People With Type 1 Diabetes in The Netherlands. Adv Ther 2022; 39:1844-1856. [PMID: 35226346 DOI: 10.1007/s12325-022-02058-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/24/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Hybrid closed loop (HCL) insulin pump systems and intermittently scanned continuous glucose monitoring (IS-CGM) are increasingly used by individuals with type 1 diabetes (T1D). The aim of the analysis was to compare the long-term cost-effectiveness of the MiniMed 670G HCL system versus IS-CGM plus multiple daily injections of insulin (MDI) or continuous subcutaneous insulin infusion (CSII) in adults with T1D in the Netherlands. METHODS The analysis was performed using the IQVIA CORE Diabetes Model with clinical input data sourced from observational studies. Simulated patients were assumed to have a baseline HbA1c of 7.8%. Use of the MiniMed 670G system was assumed to reduce HbA1c by 0.4% and confer a quality-of-life (QoL) benefit through reduced fear of hypoglycemia (FoH). The analysis was performed from a societal perspective over a lifetime time horizon; future costs and clinical outcomes pertaining to the Netherlands were used and discounted at 4% and 1.5% per annum, respectively. RESULTS Use of the MiniMed 670G HCL system was projected to improve mean quality-adjusted life expectancy by 2.231 quality-adjusted life years (QALYs) versus IS-CGM. Total mean lifetime costs were EUR 13,683 higher with the MiniMed 670G system resulting in an ICER of EUR 6133 per QALY gained. Sensitivity analyses revealed findings to be sensitive to changes in assumptions around severe hypoglycemic event rates and the (QoL) benefit associated with reduced FoH. CONCLUSIONS Over patient lifetimes, for adults with long-standing T1D in the Netherlands, use of the MiniMed 670G system is projected to be cost-effective versus IS-CGM plus MDI or CSII.
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Affiliation(s)
| | | | | | - William J Valentine
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland.
| | - Simona De Portu
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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35
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Affiliation(s)
- Mark A Sperling
- From the Department of Pediatrics, Division of Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York (M.A.S.); and the Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, and Harvard Medical School - both in Boston (L.M.L.)
| | - Lori M Laffel
- From the Department of Pediatrics, Division of Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York (M.A.S.); and the Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, and Harvard Medical School - both in Boston (L.M.L.)
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36
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Choe J, Won SH, Choe Y, Park SH, Lee YJ, Lee J, Lee YA, Lim HH, Yoo JH, Lee SY, Kim EY, Shin CH, Kim JH. Temporal Trends for Diabetes Management and Glycemic Control Between 2010 and 2019 in Korean Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:201-211. [PMID: 34704794 DOI: 10.1089/dia.2021.0274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: There is increasing use of modern devices in the management of patients with type 1 diabetes (T1D). We investigated temporal trends for diabetes management and outcomes in Korean pediatric T1D patients over 10 years. Methods: We retrospectively collected the data from 752 participants (boys: 311, 41.4%) diagnosed with T1D and aged ≤18 years, with ≥1 year of follow-up between 2010 and 2019 in any of the seven study hospitals in Korea. Results: Over the 10-year study period, use of continuous glucose monitoring (CGM) increased from 1.4% to 39.3%. From 2010 to 2019, there was an increased use of multiple daily insulin injections (MDI; 63.9%-77.0%, respectively) and continuous subcutaneous insulin infusion (CSII; 2.1%-14.0%, respectively), but decreased use of conventional insulin therapy (CIT, 33.9%-9.0%, respectively). Mean glycated hemoglobin (HbA1c) decreased from 8.56% to 8.01% (P < 0.001) and was lower in younger patients, boys, and CGM users (P < 0.001). MDI and CSII users had lower mean HbA1c levels than CIT users (P = 0.003). Regarding the acute complications of T1D, CGM use was associated with lower incidences of diabetic ketoacidosis (P = 0.015); CSII users were likely to experience less severe hypoglycemia (P = 0.008). Conclusions: The use of CSII and CGM increased ∼7- and 30-fold, respectively, over the 10-year study period. The glycemic control of pediatric T1D patients in Korea improved from 2010 to 2019, probably because of increased use of T1D technologies.
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Affiliation(s)
- Jaewon Choe
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Hyun Won
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yunsoo Choe
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Sang Hee Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Han Hyuk Lim
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, South Korea
| | - Jae-Ho Yoo
- Department of Pediatrics, Dong-A University Hospital, Busan, South Korea
| | - Seong Yong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Eun Young Kim
- Department of Pediatrics, Chosun University Hospital, Gwangju, South Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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Kietaibl A, Riedl M, Bozkurt L. Real-World Analysis of Therapeutic Outcome in Type 1 Diabetes Mellitus at a Tertiary Care Center. Diabetes Metab J 2022; 46:149-153. [PMID: 34228910 PMCID: PMC8831813 DOI: 10.4093/dmj.2020.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/10/2021] [Indexed: 11/08/2022] Open
Abstract
Insulin replacement in type 1 diabetes mellitus (T1DM) needs intensified treatment, which can either be performed by multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). This retrospective analysis of a real-world scenario aimed to evaluate whether glycaemic and cardiovascular risk factors could be controlled with CSII outclass MDI as suggested by recent evidence. Data from patients with either insulin pump (n=68) or injection (n=224) therapy at an Austrian tertiary care centre were analysed between January 2016 and December 2017. There were no significant differences with regard to the latest glycosylated hemoglobin, cardiovascular risk factor control or diabetes-associated late complications. Hypoglycaemia was less frequent (P<0.001), sensor-augmented therapy was more common (P=0.003) and mean body mass index (BMI) was higher (P=0.002) with CSII treatment. This retrospective analysis of real-world data in T1DM did not demonstrate the superiority of insulin pump treatment with regard to glycaemic control or cardiovascular risk factor control.
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Affiliation(s)
- Antonia Kietaibl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Department of 5th Internal Medicine with Endocrinology, Rheumatology and Gerontology with Outpatient Department, Clinic Ottakring, Vienna, Austria
| | - Michaela Riedl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Latife Bozkurt
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Department of 3rd Internal Medicine with Metabolic Disorders and Nephrology, Clinic Hietzing, Vienna, Austria
- Corresponding author: Latife Bozkurt https://orcid.org/0000-0002-3079-9226 Department of 3rd Internal Medicine with Metabolic Disorders and Nephrology, Clinic Hietzing, Wolkersbergenstraße 1, Vienna 1130, Austria E-mail:
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Fontecha J, González I, Barragán A, Lim T. Use and Trends of Diabetes Self-Management Technologies: A Correlation-Based Study. J Diabetes Res 2022; 2022:5962001. [PMID: 35712029 PMCID: PMC9197631 DOI: 10.1155/2022/5962001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/28/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022] Open
Abstract
Applications and systems for diabetes self-management are growing and involve a vast majority of factors to consider. This study was aimed at examining the integration of portable technologies for diabetes self-management, as well as benefits and issues arising of its use. From a web-based study on several groups of people with diabetes, most of them accustomed to the daily use of devices and applications for self-control, a deeper analysis based on correlations and inference was conducted considering information about the disease, technology knowledge and devices handling, use of technologies for diabetes control and management, and training with devices from a clinical and educational viewpoint. In this study, more than 70% of participants use Continuous Glucose Systems and additional devices (41.85% also use insulin pumps) which impacts positively on the knowledge of incoming technologies. The "easy to use" factor of current apps for diabetes self-management is the most valuable feature. Also, 88.98% of participants did not use gamification-based methods during the initial training sessions, although gamification is a useful technique in learning stages. An inference analysis shows how specific characteristics of diabetes devices and apps should improve. On the basis of the results, we discuss about benefits, shortcomings, and the state of these technologies and patient needs for the future.
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Affiliation(s)
- Jesús Fontecha
- MAmI Research Lab. University of Castilla-La Mancha, Ciudad Real, Spain
| | - Iván González
- MAmI Research Lab. University of Castilla-La Mancha, Ciudad Real, Spain
| | - Alfonso Barragán
- MAmI Research Lab. University of Castilla-La Mancha, Ciudad Real, Spain
| | - Theodore Lim
- School of Engineering & Physical Sciences, Heriot-Watt University, Edinburgh, UK
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De Block CEM, Van Cauwenberghe J, Bochanen N, Dirinck E. Rapid-acting insulin analogues: Theory and best clinical practice in type 1 and type 2 diabetes. Diabetes Obes Metab 2022; 24 Suppl 1:63-74. [PMID: 35403348 DOI: 10.1111/dom.14713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 12/01/2022]
Abstract
Since the discovery of insulin 100 years ago, insulin preparations have improved significantly. Starting from purified animal insulins, evolving to human insulins produced by genetically modified organisms, and ultimately to insulin analogues, all in an attempt to mimic physiological insulin action profiles seen in individuals without diabetes. Achieving strict glucose control without hypoglycaemia and preventing chronic complications of diabetes while preserving quality of life remains a challenging goal, but the advent of newer ultra-rapid-acting insulin analogues may enable intensive insulin therapy without being too disruptive to daily life. Ultra-rapid-acting insulin analogues can be administered shortly before meals and give better coverage of mealtime-induced glucose excursions than conventional insulin preparations. They also increase convenience with timing of bolus dosing. In this review, we focus on the progress that has been made in rapid-acting insulins. We summarize pharmacokinetic and pharmacodynamic data, clinical trial data supporting the use of these new formulations as part of a basal-bolus regimen and continuous subcutaneous insulin infusion, and provide a clinical perspective to help guide healthcare professionals when and for whom to use ultra-fast-acting insulins.
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Affiliation(s)
- Christophe E M De Block
- Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Paediatrics (LEMP), Wilrijk, Belgium
| | - Jolijn Van Cauwenberghe
- Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Paediatrics (LEMP), Wilrijk, Belgium
| | - Niels Bochanen
- Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Paediatrics (LEMP), Wilrijk, Belgium
| | - Eveline Dirinck
- Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Paediatrics (LEMP), Wilrijk, Belgium
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Thomas MG, Avari P, Godsland IF, Lett AM, Reddy M, Oliver N. Optimizing type 1 diabetes after multiple daily injections and capillary blood monitoring: Pump or sensor first? A meta-analysis using pooled differences in outcome measures. Diabetes Obes Metab 2021; 23:2521-2528. [PMID: 34286892 DOI: 10.1111/dom.14498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 12/25/2022]
Abstract
AIMS Most people living with type 1 diabetes self-manage using multiple daily injection (MDI) insulin regimens and self-monitoring of blood glucose (SMBG). Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) are adjuncts to education and support self-management optimization. The aim of this systematic review and meta-analysis was to assess which first-line technology is most effective. METHODS Electronic databases (MEDLINE, EMBASE and WEB OF SCIENCE) were systematically searched from 1999 to September 2020. Randomized controlled trials comparing either CSII with MDI or CGM with SMBG in adults with type 1 diabetes were included. Data were extracted in duplicate by two reviewers, and were analysed to assess individual and overall treatment effect measures (PROSPERO registration: CRD42020149915). RESULTS Glycated haemoglobin was significantly reduced for CGM when compared with SMBG [Cohen's d - 0.62 (95% CI -0.79 to -0.45)] and for CSII when compared with MDI [Cohen's d - 0.44 (95% CI -0.67 to -0.22)]. Rates of severe hypoglycaemia were significantly reduced with CGM compared with SMBG, but did not change for CSII when compared with MDI. Episodes of diabetic ketoacidosis were more likely to occur with CSII than MDI. Both CSII and CGM reduced glucose standard deviation, compared with MDI and SMBG respectively. CONCLUSIONS Both CGM and CSII remain impactful interventions compared with SMBG and MDI but in adults with type 1 diabetes and in the contexts in which they have been studied, CGM might have a greater positive impact on glycaemic variability and severe hypoglycaemia than CSII, when added to MDI and SMBG. A head-to-head study, including patient reported outcomes, is required to explore these findings further.
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Affiliation(s)
- Maria G Thomas
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Parizad Avari
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ian F Godsland
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Aaron M Lett
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Monika Reddy
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Szadkowska A, Baranowska-Jaźwiecka A, Michalak A, Jarosz-Chobot P, Myśliwiec M, Głowińska-Olszewska B, Szypowska A, Nazim J, Mazur A, Szalecki M, Skowrońska B, Kucharska-Zubkiewicz A, Beń-Skowronek I, Walczak M, Klupa T, Wolnik B, Zozulińska-Ziółkiewicz D, Młynarski W. Above 40% of Polish children and young adults with type 1 diabetes achieve international HbA1c target - results of a nationwide cross-sectional evaluation of glycemic control: The PolPeDiab HbA1c study. Pediatr Diabetes 2021; 22:1003-1013. [PMID: 34351670 DOI: 10.1111/pedi.13250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Youth with type 1 diabetes (T1D) (16-18 y.o.) present worst disease control of all age groups and need structured interventions. Those should be based on unbiased, national-scale outcomes, which have not yet been successfully assessed in Poland. OBJECTIVE To evaluate the glycemic control in young patients with T1D in Poland. METHOD All pediatric diabetes care centers and the nine largest centers for adults with T1D were invited to this cross-sectional study, conducted in March 2018. Eligibility was defined as age ≤ 30 years and diabetes duration ≥1 year. Blinded samples of capillary blood and clinical questionnaires were sent to coordinating center, where HbA1c was measured by high-pressure liquid chromatography. RESULTS Nine adult and 25/28 pediatric centers participated, providing data for 1255 patients (50.8% males), mean age 12.3 years (95%CI:12.1-12.6) for children and 23.2 years (22.9-23.6) for adults; mean diabetes duration 7.1 years (6.8-7.3). This covered ~8% of pediatric population and 2% of 18-30-years-olds with T1D. Mean HbA1c was comparable between children and adults (57 mmol/mol [7.4%], 95%CI:56-57 mmol/mol [7.3-7.4%] vs. 57 mmol/mol [7.4%], 95%CI:56-60 mmol/mol [7.3-7.6%], p = 0.1870). Overall, 45.2% of patients achieved ISPAD target (<53 mmol/mol [<7.0%]). During the month preceding the study, 0.9% of patients experienced severe hypoglycemia and 0.4% suffered ketoacidosis. HbA1c was related to the method of insulin therapy, continuous glucose monitoring use and body weight (p < 0.0001). CONCLUSIONS In Polish children and young adults with T1D glycemic control expressed as HbA1c is promising in the light of ISPAD guidelines. Our results confirm the known associations between better glycemic control and the use of new technologies and maintaining optimal body weight.
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Affiliation(s)
- Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Łódź, Poland
| | - Anna Baranowska-Jaźwiecka
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Łódź, Poland
| | - Arkadiusz Michalak
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Łódź, Poland.,Department of Biostatistics and Translational Medicine, Medical University of Lodz, Łódź, Poland
| | | | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | | | - Joanna Nazim
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Mazur
- Pediatric Department, University of Rzeszow, Rzeszów, Poland
| | - Mieczysław Szalecki
- Children's Memorial Health Institute, Department of Endocrinology and Diabetology, Warsaw, Poland and The Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Bogda Skowrońska
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Iwona Beń-Skowronek
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Mieczysław Walczak
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Bogumił Wolnik
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | | | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Łódź, Łódź, Poland
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Horii T, Oikawa Y, Atsuda K, Shimada A. On-label use of sodium-glucose cotransporter 2 inhibitors might increase the risk of diabetic ketoacidosis in patients with type 1 diabetes. J Diabetes Investig 2021; 12:1586-1593. [PMID: 33448127 PMCID: PMC8409873 DOI: 10.1111/jdi.13506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS/INTRODUCTION This study aimed to investigate the risk of diabetic ketoacidosis (DKA) in insulin-treated type 1 diabetes patients administered sodium-glucose cotransporter 2 (SGLT2) inhibitors in real-world clinical practice. MATERIALS AND METHODS We carried out a real-world, retrospective, observational cohort study using Japanese Medical Data Vision, a diagnosis procedure combination database. We identified insulin-treated adult type 1 diabetes patients enrolled from December 2018 to October 2019. We assessed the incidence and risk of DKA in type 1 diabetes patients using SGLT2 inhibitors in an 'on-label' manner. Cox multivariate regression analyses were carried out to determine clinical factors linked to SGLT2 inhibitor-associated DKA. RESULTS Of 11,475 type 1 diabetes patients, 1,898 (16.5%) were prescribed SGLT2 inhibitors. DKA occurred in 139 (7.3%) of these patients, with 20.2 incidences per 100 person-years. These patients also showed significantly higher DKA rates than did those not receiving SGLT2 inhibitors (hazard ratio 1.66, 95% confidence interval 1.33-2.06; P < 0.001). The mean time until DKA onset in SGLT2 inhibitor-treated type 1 diabetes patients was 30.6 ± 30.1 days. The risk of SGLT2 inhibitor-associated DKA increased in type 1 diabetes patients irrespective of sex, age or body mass index. However, the risk did not increase in type 1 diabetes patients receiving continuous subcutaneous insulin infusion, which warrants further investigation because of the small number of type 1 diabetes patients receiving continuous subcutaneous insulin infusion. CONCLUSIONS 'On-label' SGLT2 inhibitor use might increase DKA risk among insulin-treated type 1 diabetes patients irrespective of sex, age or body mass index. Both type 1 diabetes patients and healthcare providers should be wary of DKA, especially during the first month of initiating SGLT2 inhibitors.
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Affiliation(s)
- Takeshi Horii
- Laboratory of Pharmacy Practice and Science 1Division of Clinical Pharmacy, Research and Education Center for Clinical PharmacyKitasato University School of PharmacyKanagawaJapan
| | - Yoichi Oikawa
- Department of Endocrinology and DiabetesSchool of MedicineSaitama Medical UniversitySaitamaJapan
| | - Koichiro Atsuda
- Laboratory of Pharmacy Practice and Science 1Division of Clinical Pharmacy, Research and Education Center for Clinical PharmacyKitasato University School of PharmacyKanagawaJapan
| | - Akira Shimada
- Department of Endocrinology and DiabetesSchool of MedicineSaitama Medical UniversitySaitamaJapan
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Lu JC, Vogrin S, McAuley SA, Lee MH, Paldus B, Bach LA, Burt MG, Clarke PM, Cohen ND, Colman PG, de Bock MI, Jane Holmes-Walker D, Jenkins AJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Roem K, Sims C, Stranks SN, Trawley S, Ward GM, Sundararajan V, Jones TW, O'Neal DN. Meal-time glycaemia in adults with type 1 diabetes using multiple daily injections vs insulin pump therapy following carbohydrate-counting education and bolus calculator provision. Diabetes Res Clin Pract 2021; 179:109000. [PMID: 34455185 DOI: 10.1016/j.diabres.2021.109000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/14/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
AIMS To compare meal-time glycaemia in adults with type 1 diabetes mellitus (T1D) managed with multiple daily injections (MDI) vs. insulin pump therapy (IPT), using self-monitoring blood glucose (SMBG), following diabetes education. METHODS Adults with T1D received carbohydrate-counting education and a bolus calculator: MDI (Roche Aviva Expert) and IPT (pump bolus calculator). All then wore 3-weeks of masked-CGM (Enlite, Medtronic). Meal-times were assessed by two approaches: 1) Set time-blocks (breakfast 06:00-10:00hrs; lunch 11:00-15:00hrs; dinner 17:00-21:00hrs) and 2) Bolus-calculator carbohydrate entries signalling meal commencement. Post-meal masked-CGM time-in-range (TIR) 3.9-10.0 mmol/L was the primary outcome. RESULTS MDI(n = 61) and IPT (n = 59) participants were equivalent in age, sex, diabetes duration and HbA1c. Median (IQR) education time provided did not differ (MDI: 1.1 h (0.75, 1.5) vs. IPT: 1.1 h (1.0, 2.0); p = 0.86). Overall, daytime (06:00-24:00hrs), lunch and dinner TIR did not differ for MDI vs. IPT participants but was greater for breakfast with IPT in both analyses with a mean difference of 12.8%, (95 CI 4.8, 20.9); p = 0.002 (time-block analysis). CONCLUSION After diabetes education, MDI and IPT use were associated with similar day-time glycemia, though IPT users had significantly greater TIR during the breakfast period. With education, meal-time glucose levels are comparable with use of MDI vs. pumps.
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Affiliation(s)
- Jean C Lu
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Sybil A McAuley
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Melissa H Lee
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Barbora Paldus
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia
| | - Morton G Burt
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Philip M Clarke
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - D Jane Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Alicia J Jenkins
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Joey Kaye
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kavita Kumareswaran
- Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Roland W McCallum
- Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Kerryn Roem
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Catriona Sims
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Stephen N Stranks
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | | | - Glenn M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; Department of Pathology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Vijaya Sundararajan
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; Department of Public Health, La Trobe University, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - David N O'Neal
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
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Antich-Isern P, Caro-Barri J, Aparicio-Blanco J. The combination of medical devices and medicinal products revisited from the new European legal framework. Int J Pharm 2021; 607:120992. [PMID: 34390808 DOI: 10.1016/j.ijpharm.2021.120992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
Medical devices and medicinal products have many similarities in their nature, scope or specific medical purposes, and despite the differences in their principal means of action, they are often used in combination. Indeed, many medicinal products depend on medical devices for their administration, and it is increasingly common for medical devices to contain medicinal substances to support their action. Therefore, the combination of medicinal products and medical devices provides additional benefits for patients. However, their higher technical complexity requires a strengthening of their authorisation and certification requirements. In this regard, more comprehensive requirements and classification rules are introduced by a new European regulation on medical devices that fully applies from May 26th 2021. On account of their therapeutic significance, this review aims at gaining insight into the borderline between medical devices and medicinal products in this new 2021 regulatory framework. For the first time, any item containing a medical device and a medicinal product will have both parts evaluated. Through exemplification of both marketed and investigational devices incorporating medicinal substances and drug-device combinations, the new European requirements and their implications are thoroughly illustrated herein.
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Affiliation(s)
- Pau Antich-Isern
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Julia Caro-Barri
- Notified Body 0318, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Juan Aparicio-Blanco
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain; Institute of Industrial Pharmacy, Complutense University of Madrid, Madrid, Spain.
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Kramer G, Kloos C, Müller UA, Wolf G, Kuniss N. Metabolic control and hypoglycaemia in people with type 1 diabetes: insulin pump therapy vs. intensified insulin therapy in an unselected cohort in routine care. Diabetol Metab Syndr 2021; 13:80. [PMID: 34301317 PMCID: PMC8305953 DOI: 10.1186/s13098-021-00700-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS The aim of this study was to compare individuals with type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and intensified insulin therapy (ICT) in routine care regarding metabolic control and treatment satisfaction. METHODS Individuals with type 1 diabetes (CSII n = 74; ICT n = 163) were analysed regarding metabolic control, frequency of hypoglycaemia and treatment satisfaction (DTSQs range 0-36). RESULTS Individuals with CSII (duration of CSII: 14.1 ± 7.2 years) were younger (51.1 ± 15.8 vs. 56.2 ± 16.2 years, p = 0.023), had longer diabetes duration (28.7 ± 12.4 vs. 24.6 ± 14.3 years, p = 0.033), lower insulin dosage (0.6 ± 0.2 vs. 0.7 ± 0.4 IU/kg, p = 0.004), used more frequently short-acting analogue insulin (90.5% vs. 48.5%, p < 0.001) and flash/continuous glucose monitoring (50.0% vs. 31.9%, p = 0.009) than people with ICT. HbA1c was similar between CSII and ICT (7.1 ± 0.8%/54.4 ± 9.1 mmol/mol vs. 7.2 ± 1.0%/55.7 ± 10.9 mmol/mol, p = 0.353). Individuals with CSII had higher frequency of non-severe hypoglycaemia per week (in people with blood glucose monitoring: 1.9 ± 1.7 vs. 1.2 ± 1.6, p = 0.014; in people with flash/continuous glucose monitoring: 3.3 ± 2.2 vs. 2.1 ± 2.0, p = 0.006). Prevalence of polyneuropathy (18.9% vs. 38.0%, p = 0.004) and systolic blood pressure (138.0 ± 16.4 vs. 143.9 ± 17.1 mmHg, p = 0.014) was lower in CSII. Satisfaction with diabetes treatment (26.7 ± 7.3 vs. 26.0 ± 6.8, p = 0.600) did not differ between CSII and ICT. CONCLUSIONS CSII and ICT yielded comparable metabolic control and treatment satisfaction but CSII was associated with higher incidence of non-severe hypoglycaemia and lower insulin dosage.
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Affiliation(s)
- Guido Kramer
- Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Christof Kloos
- Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Ulrich A Müller
- Outpatient healthcare centre Dr. med. Kielstein, Erfurt, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Nadine Kuniss
- Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Outpatient healthcare centre Dr. med. Kielstein, Erfurt, Germany.
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Lyons SK, Ebekozien O, Garrity A, Buckingham D, Odugbesan O, Thomas S, Rioles N, Gallagher K, Sonabend RY, Lorincz I, Alonso GT, Kamboj MK, Lee JM. Increasing Insulin Pump Use Among 12- to 26-Year-Olds With Type 1 Diabetes: Results From the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2021; 39:272-277. [PMID: 34421202 PMCID: PMC8329008 DOI: 10.2337/cd21-0027] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Insulin pump therapy in pediatric type 1 diabetes has been associated with better glycemic control than multiple daily injections. However, insulin pump use remains limited. This article describes an initiative from the T1D Exchange Quality Improvement Collaborative aimed at increasing insulin pump use in patients aged 12-26 years with type 1 diabetes from a baseline of 45% in May 2018 to >50% by February 2020. Interventions developed by participating centers included increasing in-person and telehealth education about insulin pump technology, creating and distributing tools to assist in informed decision-making, facilitating insulin pump insurance approval and onboarding processes, and improving clinic staff knowledge about insulin pumps. These efforts yielded a 13% improvement in pump use among the five participating centers, from 45 to 58% over 22 months.
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Affiliation(s)
- Sarah K Lyons
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | | | - Ashley Garrity
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
| | - Don Buckingham
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | - Sarah Thomas
- Barbara Davis Center, University of Colorado, Aurora, CO
| | | | | | - Rona Y Sonabend
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Ilona Lorincz
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - G Todd Alonso
- Barbara Davis Center, University of Colorado, Aurora, CO
| | - Manmohan K Kamboj
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Joyce M Lee
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
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Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord 2021; 22:217-240. [PMID: 33755854 PMCID: PMC7985920 DOI: 10.1007/s11154-021-09635-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.
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Affiliation(s)
- Federico Boscari
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy.
| | - Angelo Avogaro
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy
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Vlahou CH, Petrovski G, Korayem M, Al Khalaf F, El Awwa A, Mahmood OM, Azeem MW. Outpatient clinic-wide psychological screening for children and adolescents with type 1 diabetes in Qatar: An initiative for integrative healthcare in the Gulf region. Pediatr Diabetes 2021; 22:667-674. [PMID: 33715298 DOI: 10.1111/pedi.13200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/12/2021] [Accepted: 03/05/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To identify culturally appropriate psychological screening measures for children and adolescents with type 1 diabetes in Qatar, determine rates of depressive and anxiety symptoms in a clinical sample, and examine associations between screening measures, demographic variables, medical characteristics, and diabetes treatment outcomes, specifically HbA1c. METHODS A total of 150 participants with type 1 diabetes aged 10-17 were recruited. Participants were Arabic or English speaking and of Qatari and non-Qatari nationality. Participants completed the Mood and Feelings Questionnaire (child and parent proxy form), the Spence Children's Anxiety Scale, and the Pediatric Quality of Life, Diabetes version (child and parent proxy form). Glycosylated hemoglobin (HbA1c) on the date of the testing was recorded. RESULTS Approximately ten percent (10.2%) of children and adolescents scored above the cutoff score of 27 indicating clinically significant depressive symptoms, and 12.8% of parents rated their child above the respective cutoff score of 21 for the parent proxy form. Further, 36% of the sample reported clinically significant anxiety symptoms, scoring above the cutoff score of 50. Parent report on their child's quality of life predicted HbA1c (F[6, 140] = 5.42, p = 0.000); B = -0.05, p = 0.002). CONCLUSIONS Rates of depressive and anxiety symptoms are comparable to those observed in western countries. Thus, systematic screening for depression and anxiety in children and adolescents with type 1 diabetes should be implemented in Qatar. This will help inform decisions to refer to mental health services and thus provide more integrated care, possibly improving treatment outcomes.
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Affiliation(s)
- Christina H Vlahou
- Department of Psychiatry, Sidra Medicine, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Goran Petrovski
- Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,Division of Pediatric Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Mona Korayem
- Department of Psychiatry, Sidra Medicine, Doha, Qatar
| | - Fawziya Al Khalaf
- Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,Division of Pediatric Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Ahmed El Awwa
- Division of Pediatric Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar.,Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omar M Mahmood
- Department of Psychiatry, Sidra Medicine, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Muhammed Waqar Azeem
- Department of Psychiatry, Sidra Medicine, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
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McKee AM, Albert SG, Al-Hammadi N, Hinyard LJ. Outcomes for continuous subcutaneous insulin infusion users in young adults from lower socioeconomic backgrounds. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00252. [PMID: 34277976 PMCID: PMC8279595 DOI: 10.1002/edm2.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/17/2021] [Indexed: 11/29/2022]
Abstract
Objective Diabetes technology is available and its efficacy and safety have been demonstrated; however, there is little evidence as to how this technology is being utilized and its effectiveness in vulnerable populations. This study evaluated differences in outcomes for young adults in the United States (U.S.) from lower socioeconomic (SES) backgrounds with type 1 diabetes (T1D) managed on continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) or fixed‐dose insulin (FDI). Research design, methods and participants Utilizing the Optum® de‐identified Electronic Health Record data set between 2008 and 2018 to perform a retrospective, cohort study, we identified 805 subjects with T1D aged 18–30 years with Medicaid. We evaluated median difference in HbA1c between CSII and MDI/FDI users for 24 months. Predictors of diabetic ketoacidosis (DKA)‐associated hospitalizations by CSII use were evaluated using logistic regression. Results CSII users showed statistically significant lower median HbA1c values at 24 months of follow‐up compared to individuals on MDI/FDI. Non‐white individuals were at lower odds of receiving treatment with CSII. Subjects on CSII were not more likely to be hospitalized for DKA compared to subjects treated with MDI/FDI. Older subjects were at lower odds of being hospitalized for DKA. Males and subjects followed by Endocrinologists were at higher odds of being hospitalized for DKA. Conclusions Young adults with T1D from lower SES backgrounds show improved glycaemic control when in CSII compared to MDI/FDI without increases in hospitalizations for DKA.
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Affiliation(s)
- Alexis M McKee
- Division of Endocrinology Metabolism & Lipid Research Washington University School of Medicine in St. Louis St. Louis MO USA
| | - Stewart G Albert
- Division of Endocrinology Diabetes & Metabolism Saint Louis University School of Medicine St. Louis MO USA
| | - Noor Al-Hammadi
- Department of Health & Clinical Outcomes Research Saint Louis University School of Medicine St. Louis MO USA.,Advanced HEAlth Data (AHEAD) Institute Saint Louis University St. Louis MO USA
| | - Leslie J Hinyard
- Department of Health & Clinical Outcomes Research Saint Louis University School of Medicine St. Louis MO USA.,Advanced HEAlth Data (AHEAD) Institute Saint Louis University St. Louis MO USA
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McKee AM, Al-Hammadi N, Hinyard LJ. Disparities in Utilization and Outcomes With Continuous Subcutaneous Insulin Infusion in Young Adults With Type 1 Diabetes. Endocr Pract 2021; 27:769-775. [PMID: 33991655 DOI: 10.1016/j.eprac.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate which factors determine utilization patterns and outcomes of continuous subcutaneous insulin infusion (CSII) in young adults with type 1 diabetes. METHODS Utilizing the Optum deidentified electronic health record data set between 2008 to 2018 to perform a retrospective cohort study, we identified 2104 subjects with type 1 diabetes aged 18 to 30 years. We evaluated the effect of race on determining CSII utilization, HbA1c (%), and hospital admission for diabetic ketoacidosis (DKA). Crude and adjusted estimates were computed using logistic regression and linear mixed models. RESULTS There was low CSII utilization among individuals who were Black, Hispanic, male, and those with governmental insurance. These groups also demonstrated higher HbA1c levels. Subjects who were Black, Hispanic, and those with governmental insurance had higher odds of DKA. Even when commercially insured, Black and Hispanic subjects demonstrated higher HbA1c levels, and Black individuals had higher odds of DKA. CONCLUSION In a large electronic health record database in the U.S., there was low CSII utilization overall, particularly in Black and Hispanic minorities, despite CSII showing superior HbA1c control without an increase in DKA events.
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Affiliation(s)
- Alexis M McKee
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
| | - Noor Al-Hammadi
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Institute, Saint Louis University, St. Louis, Missouri
| | - Leslie J Hinyard
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Institute, Saint Louis University, St. Louis, Missouri
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