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Amadou C, Melki V, Allain J, Clavel S, Gouet D, Chaillous L, Catargi B, Schaeplynck-Belicard P, Petit C, Thivolet C, Penfornis A. Performance and patients' satisfaction with the A7+TouchCare insulin patch pump system: A randomized controlled non-inferiority study. PLoS One 2023; 18:e0289684. [PMID: 37616289 PMCID: PMC10449223 DOI: 10.1371/journal.pone.0289684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/06/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND We assessed the performance and patient satisfaction of a new insulin patch pump, the A7+TouchCare (Medtrum), compared with the Omnipod system. METHODS This multicenter, randomized, open-label, controlled study enrolled 100 adult patients with type 1 or type 2 diabetes mellitus (A1C ≥ 6.5% and ≤ 9.5%, i.e., 48 to 80 mmol/mol) who were assigned with the Omnipod or with the A7+TouchCare pump for 3 months. The primary study outcome was the glucose management indicator (GMI) calculated with continuous glucose monitoring (CGM). RESULTS Premature withdrawals occurs respectively in 2 and 9 participants in the Omnipod and TouchCare groups. In the Per Protocol analysis, the difference in GMI between groups was 0.002% (95% confidence interval -0.251; 0.255). The non-inferiority was demonstrated since the difference between treatments did not overlap the pre-defined non-inferiority margin (0.4%). There was no significant difference in CGM parameters between groups. On average, patients in both groups were satisfied/very satisfied with the insulin pump system. Patients preferred Omnipod as an insulin management system and especially the patch delivery system but preferred the A7+TouchCare personal diabetes manager to control the system. CONCLUSIONS This study showed that the A7+TouchCare insulin pump was as efficient as the Omnipod pump in terms of performance and satisfaction. CLINICAL TRAIL REGISTRATION The study was registered in the ClinicalTrials.gov protocol register (NCT04223973).
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Affiliation(s)
- Coralie Amadou
- Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Centre Hospitalier Sud-Francilien de Corbeil-Essonnes, Corbeil-Essonnes, France
- Université Paris-Saclay, Gif-sur-Yvette, France
| | - Vincent Melki
- Service de Diabétologie–Maladies Métaboliques—Nutrition, CHU Hôpital Rangueil, Toulouse, France
| | - Jennifer Allain
- Service d’Endocrinologie-Diabétologie, Centre Hospitalier de Gonesse, Gonesse, France
| | | | - Didier Gouet
- Hôpitaux La Rochelle, Ré, Aunis, La Rochelle, France
| | - Lucy Chaillous
- Hôpital Nord Laennec, CHU Nantes, Saint-Herblain, France
| | | | | | - Catherine Petit
- Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Centre Hospitalier Sud-Francilien de Corbeil-Essonnes, Corbeil-Essonnes, France
- Université Paris-Saclay, Gif-sur-Yvette, France
| | - Charles Thivolet
- Centre du diabète Diab-e-Care—Hospices Civils de Lyon, Lyon, France
| | - Alfred Penfornis
- Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Centre Hospitalier Sud-Francilien de Corbeil-Essonnes, Corbeil-Essonnes, France
- Université Paris-Saclay, Gif-sur-Yvette, France
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2
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Wang L, Wang M, Du J, Gong ZC. Intensive insulin therapy in sepsis patients: Better data enables better intervention. Heliyon 2023; 9:e14063. [PMID: 36915524 PMCID: PMC10006498 DOI: 10.1016/j.heliyon.2023.e14063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
In clinics, sepsis is a critical disease that often develops into shock and multiple organ dysfunction, leading to a serious threat of death. Patients with sepsis are often accompanied by stress hyperglycemia which is an independent risk factor for poor prognosis in sepsis. Thus, the treatment for stress hyperglycemia has attracted more and more attention, among which intensive insulin therapy is widely concerned. However, the benefits and harms of intensive insulin therapy for sepsis patients remain controversial. What the existing literature discusses mostly are the clinical benefit and hypoglycemia risk of intensive insulin therapy, but there is no conclusion on the target range of blood glucose control, the applicable patients, the timing of treatment initiation, and how to avoid the risk. In this study, we have analyzed and summarized the existing literature, hoping to determine the adverse and clinical benefit of intensive insulin therapy in sepsis. And we attempt to assemble better evidence to propose a better recommendation on hyperglycemia intervention for sepsis patients.
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Affiliation(s)
- Ling Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Min Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Du
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Cheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Thivolet C, Gaudilliere M, Villar Fimbel S, Bendelac N, Mestre B, Protsenko N, Brunot S, Nicolino M. Hybrid closed Loop improved glucose control compared to sensor-augmented pumps in outpatients with type 1 diabetes in real-life conditions with telehealth monitoring. Acta Diabetol 2022; 59:395-401. [PMID: 34725723 PMCID: PMC8559915 DOI: 10.1007/s00592-021-01820-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The study aims at evaluating glucose metrics and HbA1C values after pump initiation in outpatient settings. RESEARCH DESIGN AND METHODS This single center observational study enrolled 121 subjects with type 1 diabetes between September 2020 and May 2021 initiating sensor-augmented pump therapy with stand-alone CGM (n = 26) or pump users who only changed their device (n = 51), with predictive low glucose management (n = 8) or with Hybrid Closed Loop using Medtronic 780G (n = 36) systems. Changes in HbA1C levels and glucose metrics were analyzed after 3 months. All subjects received diabetes and carbohydrate-counting education if needed at time of initiation and were proposed a telehealth monitoring by a diabetic nurse educator. RESULTS There was no episodes of severe hypoglycemia or diabetic ketoacidosis nor serious pump-related adverse events despite outpatient model of care. While only 18/121 (14.8%) participants reached initially the recommended HbA1C levels, 23/85 (27%) in the conventional group and 33/36 (91%) subjects in the Hybrid Closed Loop group reached target levels after 3 months of follow-up. Time in target range 3.9-10 mmol/L (70-180 mg/dl) also improved and was optimal with closed loop with 30/36 (83%) subjects with time in range above 70%. CONCLUSIONS Initiation of insulin pump therapy for outpatients is safe with a dedicated facility. Telehealth monitoring after outpatient initiation provides tools for improvement in glucose control with an insulin pump. Outpatient pump initiation is compatible with Hybrid Closed Loop systems which provide the largest improvements in glucose control.
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Affiliation(s)
- C Thivolet
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France.
| | - M Gaudilliere
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - S Villar Fimbel
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - N Bendelac
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - B Mestre
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - N Protsenko
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - S Brunot
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - M Nicolino
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
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4
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Meunier L, Aguadé AS, Videau Y, Verboux D, Fagot-Campagna A, Gastaldi-Menager C, Amadou C. Age, Male Gender, and Social Deprivation Are Associated with a Lower Rate of Insulin Pump Therapy Initiation in Adults with Type 1 Diabetes: A Population-Based Study. Diabetes Technol Ther 2021; 23:8-19. [PMID: 32522046 DOI: 10.1089/dia.2020.0112] [Citation(s) in RCA: 9] [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] [Indexed: 12/30/2022]
Abstract
Objectives: The objective of this population-based study was to identify factors associated with insulin pump therapy initiation in adults with insulin-requiring diabetes in France in 2015. Method: People with insulin-requiring diabetes and their characteristics were identified from the national health data system. Factors associated with insulin pump therapy initiation were identified by logistic regression analysis. Results: The study focused on 614,913 adults with diabetes treated by multiple daily injections before 2015: 4083 of them initiated insulin pump therapy during the year (71% of them had type 1 diabetes, T1D). Factors associated with insulin pump therapy initiation were the number of consultations with an endocrinologist within the past 2 years (2 vs. 0, odds ratio [OR] = 1.5, P < 0.01), the presence of a chronic cardiovascular or neurovascular disease (OR = 1.6 for T1D, OR = 1.3 for type 2 diabetes [T2D], P < 0.01) and treatment with antidepressants/anxiolytics (OR = 1.2 for T1D, OR = 1.4 for T2D, P < 0.01). The other determinants were female gender (OR = 1.5, P < 0.01) and history of hospitalization for acute metabolic complications (OR = 1.14, P < 0.01) in T1D. Factors associated with less insulin pump therapy initiation were age, duration of diabetes, end-stage renal disease, and social deprivation (OR = 0.662, P < 0.01, T1D only). Conclusion: Predictive factors of insulin pump therapy initiation in people with insulin-requiring diabetes in 2015 in France were globally consistent with clinical practice guidelines. Age, male gender, and social deprivation are still associated with a lower rate of insulin pump therapy initiation in adults with T1D.
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Affiliation(s)
- Lise Meunier
- CNAM (Caisse Nationale d'Assurance Maladie), French National Health Insurance, Paris, France
| | - Anne-Sophie Aguadé
- CNAM (Caisse Nationale d'Assurance Maladie), French National Health Insurance, Paris, France
| | - Yann Videau
- ERUDITE (Research Team on the Use of Individual Data related to Economic Theory). University of Paris-Est Créteil, Créteil, France
| | - Dorian Verboux
- CNAM (Caisse Nationale d'Assurance Maladie), French National Health Insurance, Paris, France
| | - Anne Fagot-Campagna
- CNAM (Caisse Nationale d'Assurance Maladie), French National Health Insurance, Paris, France
| | | | - Coralie Amadou
- Department of Diabetes and Endocrinology, University of Paris-Saclay and Sud-Francilien Hospital, Corbeil-Essonnes, France
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5
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Tubiana-Rufi N, Schaepelynck P, Franc S, Chaillous L, Joubert M, Renard E, Reznik Y, Abettan C, Bismuth E, Beltrand J, Bonnemaison E, Borot S, Charpentier G, Delemer B, Desserprix A, Durain D, Farret A, Filhol N, Guerci B, Guilhem I, Guillot C, Jeandidier N, Lablanche S, Leroy R, Melki V, Munch M, Penfornis A, Picard S, Place J, Riveline JP, Serusclat P, Sola-Gazagnes A, Thivolet C, Hanaire H, Benhamou PY. Practical implementation of automated closed-loop insulin delivery: A French position statement. DIABETES & METABOLISM 2020; 47:101206. [PMID: 33152550 DOI: 10.1016/j.diabet.2020.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 01/09/2023]
Abstract
Automated closed-loop (CL) insulin therapy has come of age. This major technological advance is expected to significantly improve the quality of care for adults, adolescents and children with type 1 diabetes. To improve access to this innovation for both patients and healthcare professionals (HCPs), and to promote adherence to its requirements in terms of safety, regulations, ethics and practice, the French Diabetes Society (SFD) brought together a French Working Group of experts to discuss the current practical consensus. The result is the present statement describing the indications for CL therapy with emphasis on the idea that treatment expectations must be clearly defined in advance. Specifications for expert care centres in charge of initiating the treatment were also proposed. Great importance was also attached to the crucial place of high-quality training for patients and healthcare professionals. Long-term follow-up should collect not only metabolic and clinical results, but also indicators related to psychosocial and human factors. Overall, this national consensus statement aims to promote the introduction of marketed CL devices into standard clinical practice.
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Affiliation(s)
- N Tubiana-Rufi
- Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert Debré, APHP Nord, Université de Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - P Schaepelynck
- Nutrition-Endocrinologie-Maladies Métaboliques, pôle ENDO, Hôpital de la Conception, APHM, Marseille, France
| | - S Franc
- Diabétologie, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, CERITD, Bioparc Genopole Evry-Corbeil, LBEPS, Université Evry, IRBA, Université Paris Saclay, Evry, France
| | - L Chaillous
- Endocrinologie Diabétologie Nutrition, Institut du Thorax, CHU, Nantes, France
| | - M Joubert
- Université de Caen et Endocrinologie Diabétologie, CHU Côte de Nacre, Caen, France
| | - E Renard
- Endocrinologie, Diabète, Nutrition et CIC INSERM 1411, CHU, Montpellier, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - Y Reznik
- Université de Caen et Endocrinologie Diabétologie, CHU Côte de Nacre, Caen, France
| | - C Abettan
- Endocrinologie Diabétologie Nutrition, Institut du Thorax, CHU, Nantes, France
| | - E Bismuth
- Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert Debré, APHP Nord, Université de Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - J Beltrand
- APHP Centre, Université de Paris, Hôpital Necker Enfants Malades, Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - E Bonnemaison
- Unité de Spécialités Pédiatriques, Hôpital Clocheville, CHRU de Tours, et SFEDP, France
| | - S Borot
- Université Franche-Comté et Endocrinologie, Nutrition et Diabétologie, CHU, Besançon, France
| | | | - B Delemer
- Endocrinologie Diabétologie, CHU, Reims, et Présidente du CNP d'Endocrinologie Diabétologie et Maladies Métaboliques, France
| | - A Desserprix
- IDE I-ETP, Hotel Dieu Le Creusot (71), Groupe SOS Santé et Vice-présidente de la SFD-Paramédical, France
| | - D Durain
- Cadre de Santé Endocrinologie et Diabétologie et ETP, CHRU, Nancy et SFD-Paramédical, France
| | - A Farret
- Endocrinologie, Diabète, Nutrition, CHU, Montpellier, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - N Filhol
- Endocrinologie et Diabétologie, Hôpital de la Conception, APHM, Marseille, France
| | - B Guerci
- Université de Lorraine et Endocrinologie Diabétologie Maladies Métaboliques et Nutrition, CHU, Nancy, France
| | - I Guilhem
- Endocrinologie-Diabétologie-Nutrition, CHU, Rennes, France
| | - C Guillot
- Sociologue responsable du Diabète LAB, FFD, Paris, France
| | - N Jeandidier
- Université de Strasbourg et Endocrinologie Diabétologie Nutrition, Hôpitaux Universitaires de Strasbourg, France
| | - S Lablanche
- Université Grenoble Alpes, INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, France
| | - R Leroy
- Cabinet libéral d'endocrinologie diabétologie, Lille, France
| | - V Melki
- Diabétologie, Maladies Métaboliques et Nutrition, CHU Rangueil, Toulouse, France
| | - M Munch
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU Strasbourg, France
| | - A Penfornis
- Université Paris-Saclay et Endocrinologie, Diabétologie et Maladies Métaboliques, CHSF Corbeil-Essonnes, France
| | - S Picard
- Cabinet d'Endocrino-Diabétologie, Point Médical, Dijon et FENAREDIAM, France
| | - J Place
- Ingénieur d'Études, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - J P Riveline
- Centre Universitaire du Diabète, Hôpital Lariboisière, APHP, Paris, France
| | - P Serusclat
- Groupe Hospitalier Mutualiste Les Portes du Sud, Vénissieux, France
| | - A Sola-Gazagnes
- Endocrinologie Diabétologie, Hôpital Cochin, APHP, Paris, France
| | - C Thivolet
- Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Président de la SFD, France
| | - H Hanaire
- Université de Toulouse et Diabétologie, Maladies Métaboliques et Nutrition, CHU Rangueil, Toulouse, France
| | - P Y Benhamou
- Université Grenoble Alpes, INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, Président du groupe de travail Télémédecine et Technologies Innovantes de la SFD, France.
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Renard E. Personal Experience With COVID-19 and Diabetes in the South of France: Technology Facilitates the Management of Diabetes in Disruptive Times. J Diabetes Sci Technol 2020; 14:772-773. [PMID: 32429701 PMCID: PMC7673169 DOI: 10.1177/1932296820929370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, France
- Institute of Functional Genomics, CNRS UMR 5203, INSERM U1191, University of Montpellier, France
- INSERM Clinical Investigation Centre 1411, Montpellier, France
- Eric Renard, MD, PhD, Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Lapeyronie Hospital, Avenue Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
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Schliess F, Heise T, Benesch C, Mianowska B, Stegbauer C, Broge B, Gillard P, Binkley G, Crône V, Carlier S, Delval C, Petkov A, Beck JP, Lodwig V, Gurdala M, Szecsenyi J, Rosenmöller M, Cypryk K, Mathieu C, Renard E, Heinemann L. Artificial Pancreas Systems for People With Type 2 Diabetes: Conception and Design of the European CLOSE Project. J Diabetes Sci Technol 2019; 13:261-267. [PMID: 30241444 PMCID: PMC6399797 DOI: 10.1177/1932296818803588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the last 10 years tremendous progress has been made in the development of artificial pancreas (AP) systems for people with type 1 diabetes (T1D). The pan-European consortium CLOSE (Automated Glu cose Contro l at H ome for People with Chronic Disea se) is aiming to develop integrated AP solutions (APplus) tailored to the needs of people with type 2 diabetes (T2D). APplus comprises a product and service package complementing the AP system by obligatory training as well as home visits and telemedical consultations on demand. Outcome predictors and performance indicators shall help to identify people who could benefit most from AP usage and facilitate the measurement of AP impact in diabetes care. In a first step CLOSE will establish a scalable APplus model case working at the interface between patients, homecare service providers, and payers in France. CLOSE will then scale up APplus by pursuing geographic distribution, targeting additional audiences, and enhancing AP functionalities and interconnectedness. By being part of the European Institute of Innovation and Technology (EIT) Health public-private partnership, CLOSE is committed to the EIT "knowledge triangle" pursuing the integrated advancement of technology, education, and business creation. Putting stakeholders, education, and impact into the center of APplus advancement is considered key for achieving wide AP use in T2D care.
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Affiliation(s)
| | | | | | - Beata Mianowska
- Department of Pediatrics, Oncology, Hematology and Diabetology Łódź, Medical University of Łódź, Poland
| | - Constance Stegbauer
- aQua-Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany
| | - Björn Broge
- aQua-Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany
| | - Pieter Gillard
- Clinical and Experimental Endocrinology, Catholic University of Leuven, Leuven, Belgium
| | - George Binkley
- IESE Business School, University of Navarra, Barcelona, Spain
| | | | | | | | | | | | | | | | - Joachim Szecsenyi
- aQua-Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany
| | | | - Katarzyna Cypryk
- Department of Internal Medicine and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, Catholic University of Leuven, Leuven, Belgium
| | - Eric Renard
- Montpellier University Hospital, Department of Endocrinology, Diabetes, Nutrition, and Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
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8
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Picard S, Hanaire H, Reznik Y, Benhamou PY, Fendri S, Dufaitre L, Leutenegger E, Guerci B. Optimization of Insulin Regimen and Glucose Outcomes with Short-Term Real-Time Continuous Glucose Monitoring in Adult Type 1 Diabetes Patients with Suboptimal Control on Multiple Daily Injections: The Adult DIACCOR Study. Diabetes Technol Ther 2018; 20:403-412. [PMID: 29847735 DOI: 10.1089/dia.2018.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The impact of a 7-day real-time continuous glucose monitoring (RT-CGM) on type 1 diabetes (T1D) management remains unclear in patients suboptimally controlled by multiple daily injections (MDI). The DIACCOR Study aimed to describe treatment decisions and glucose outcomes after a short-term RT-CGM sequence. PATIENTS AND METHODS This French multicenter longitudinal observational study included T1D patients with HbA1c >7.5% or history of severe hypoglycemia (SH) or recurrent documented hypoglycemia. A sensor was inserted at the inclusion visit, treatment changes were proposed by the investigator within 7-15 days ("INT" = MDI intensification, "CSII" = switch to continuous insulin infusion, or "ER" = educational reinforcement with no change in insulin regimen), and a 4-month follow-up visit (M4) was scheduled. RESULTS Four hundred fifty-nine patients were recruited by 155 diabetologists, 17.0% had SH history, and 24.2% had recurrent hypoglycemia. Baseline HbA1c was 8.34% ± 1.21% (>7.5% in 79.6%). Overall, 253 (64.4%), 64 (16.3%), and 76 patients (19.3%) were, respectively, included in the "INT," "CSII," and "ER" subgroups. The number of patients who experienced SH or recurrent hypoglycemia dropped dramatically (7.9% vs. 17.0% and 10.8% vs. 24.2%, respectively). The same trend was observed for ketoacidosis and ketosis (0.3% vs. 3.3% and 2.2% vs. 4.8%). At M4, HbA1c was significantly reduced in the whole cohort to 7.98% ± 1.01% (P < 0.0001). The adjusted differences in HbA1c level in the INT, CSII, and ER subgroups were, respectively, -0.32%, -0.69%, and -0.50% (P < 0.0001 for all). CONCLUSION In real-life setting, a 1-week diagnostic RT-CGM supports appropriate treatment changes in patients with uncontrolled T1D resulting in better glucose control and less hypoglycemia.
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Affiliation(s)
- Sylvie Picard
- 1 Point Médical, Rond-Point de la Nation , Dijon, France
| | - Hélène Hanaire
- 2 Endocrinology-Diabetes Care Unit, Toulouse University Hospital , Toulouse, France
| | - Yves Reznik
- 3 Endocrinology-Diabetes Care Unit, Caen University Hospital , Caen, France
| | - Pierre-Yves Benhamou
- 4 Endocrinology-Diabetes Care Unit, Grenoble University Hospital , Grenoble, France
| | - Salha Fendri
- 5 Endocrinology-Diabetes Care Unit, Amiens University Hospital , Amiens, France
| | - Lise Dufaitre
- 6 Endocrinology-Diabetes Care Unit, Marseille University Hospital , Marseille, France
| | | | - Bruno Guerci
- 8 Endocrinology, Diabetology and Nutrition, Brabois Adult Hospital CHRU of Nancy, University of Lorraine , Vandoeuvre Lès Nancy, France
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9
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Marchand L, Kawasaki-Ogita Y, Place J, Fayolle C, Lauton D, Boulet F, Farret A, Renard E. Long-Term Effects of Continuous Subcutaneous Insulin Infusion on Glucose Control and Microvascular Complications in Patients With Type 1 Diabetes. J Diabetes Sci Technol 2017; 11:924-929. [PMID: 28303725 PMCID: PMC5950989 DOI: 10.1177/1932296817700161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We investigated the long-term effects of continuous subcutaneous insulin infusion (CSII) on glucose control and microvascular complications in patients with type 1 diabetes (T1D). METHODS A total of 157 patients (59 M/98 W; age 39.1 ± 14.8 years) with T1D who switched from multiple daily injections to CSII and used CSII for at least one year were included. HbA1c levels and status of microvascular complications before and while under CSII were analyzed, retrospectively. RESULTS The follow-up period was 4.0 ± 1.5 years. HbA1c significantly decreased from 8.4 ± 1.3 to 7.7 ± 1.3% (68 ± 14 to 61 ± 14 mmol/mol) after 1-year CSII and remained lower than pre-CSII levels during four years. Patients with pre-CSII HbA1c >8.0% (64 mmol/mol) showed significant improvement of HbA1c for four years, while those with pre-CSII HbA1c <8.0% showed no significant change. The prevalence of retinopathy, albuminuria, and chronic kidney disease (CKD) were respectively 39%, 12%, and 9% at CSII initiation. During follow-up, the incidence of retinopathy, albuminuria, and CKD were 3.6, 2.5 and 1.4/100 patient-years. Onset or progression of retinopathy occurred in 16 (27.1%) patients with diabetes duration >15 years, and in three (4.3%) patients with diabetes duration <15 years ( P < .01). CONCLUSION CSII was effective in improving HbA1c for up to four years, specifically in patients with HbA1c >8% (64 mmol/mol) prior to CSII. Incidence and progression rates of retinopathy and albuminuria were low, particularly in patients with a diabetes duration <15 years at CSII initiation. These results argue for not delaying a proposal of CSII initiation in T1D with sustained HbA1c >8% (64 mmol/mol).
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Affiliation(s)
- Lucien Marchand
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Department of Endocrinology, Diabetes, Metabolic Diseases, Hospices Civils de Lyon, Lyon-South University Hospital, Lyon, France
| | - Yukiko Kawasaki-Ogita
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Jérome Place
- Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Corinne Fayolle
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Dominique Lauton
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Françoise Boulet
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Anne Farret
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Montpellier, France
- Eric Renard, MD, PhD, Department of Endocrinology, Diabetes, Nutrition, Lapeyronie Hospital, 371, avenue du Doyen Gaston Giraud, Cedex 5, Montpellier, 34295, France.
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Cohen O, Valentine W. Do We Need Updated Guidelines on the Use of Insulin Pump Therapy in Type 2 Diabetes? A Review of National and International Practice Guidelines. J Diabetes Sci Technol 2016; 10:1388-1398. [PMID: 27621141 PMCID: PMC5094344 DOI: 10.1177/1932296816667747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) is used less for type 2 than for type 1 diabetes because of inconsistencies in evidence of effectiveness. We reviewed published guidelines on intensive insulin therapy in type 2 diabetes to assess whether updating of guidance is needed with respect to evidence used and recommendations for CSII in diabetes management. METHODS A literature review was performed to identify published national and international guidelines on type 2 diabetes management. Searches were performed using PubMed, Cochrane Library, and Embase databases, and websites of national health care agencies, reimbursement agencies, and professional associations. Searches were limited to articles published in English between 2004 and 2014 and 1666 unique hits were identified, of which 22 were reviewed following screening. RESULTS Only 6 of the 22 guidelines identified from North and South America, Western Europe, Greece, and Israel provided specific recommendations on intensive insulin therapy and the role of CSII, and only 1 provided information on the grade of evidence supporting recommendations. Quality appraisal based on the AGREE II tool suggested that published guidelines may have limitations in terms of search methodology and evidence grading, and findings were of mixed rigor and clarity. Only 3 guidelines described the population for whom CSII may be appropriate. CONCLUSIONS Guidelines need to improve the evidence base, rigor, clarity, and grading of evidence associated with recommendations on intensive insulin therapy in type 2 diabetes. Future updates may benefit from considering recent evidence on the efficacy of CSII in poorly controlled patients on MDI.
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Affiliation(s)
- Ohad Cohen
- Sheba Medical Center, Tel Hashomer, Israel
- Medtronic, Tolochenaz, Switzerland
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11
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Roze S, Duteil E, Smith-Palmer J, de Portu S, Valentine W, de Brouwer BFE, Reznik Y, de Valk HW. Cost-effectiveness of continuous subcutaneous insulin infusion in people with type 2 diabetes in the Netherlands. J Med Econ 2016; 19:742-9. [PMID: 26985982 DOI: 10.3111/13696998.2016.1167695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS Up to 30% of insulin-treated type 2 diabetes patients are unable to achieve HbA1c targets despite optimization of insulin multiple daily injections (MDI). For these patients the use of continuous subcutaneous insulin infusion (CSII) represents a useful but under-utilized alternative. The aim of the present analysis was to examine the cost-effectiveness of initiating CSII in type 2 diabetes patients failing to achieve good glycemic control on MDI in the Netherlands. METHODS Long-term projections were made using the IMS CORE Diabetes Model. Clinical input data were sourced from the OpT2mise trial. The analysis was performed over a lifetime time horizon. The discount rates applied to future costs and clinical outcomes were 4% and 1.5% per annum, respectively. RESULTS CSII was associated with improved quality-adjusted life expectancy compared with MDI (9.38 quality-adjusted life years [QALYs] vs 8.95 QALYs, respectively). The breakdown of costs indicated that ∼50% of costs were attributable to diabetes-related complications. Higher acquisition costs of CSII vs MDI were partially offset by the reduction in complications. The ICER was estimated at EUR 62,895 per QALY gained and EUR 60,474 per QALY gained when indirect costs were included. CONCLUSIONS In the Netherlands, CSII represents a cost-effective option in patients with type 2 diabetes who continue to have poorly-controlled HbA1c despite optimization of MDI. Since the ICER falls below the willingness-to-pay threshold of EUR 80,000 per QALY gained, CSII is likely to represent good-value for money in the treatment of poorly-controlled T2D patients compared with MDI.
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Affiliation(s)
- S Roze
- a HEVA HEOR , Lyon , France
| | | | - J Smith-Palmer
- b Ossian Health Economics and Communications , Basel , Switzerland
| | - S de Portu
- c Medtronic International Sàrl , Tolochenaz , Switzerland
| | - W Valentine
- b Ossian Health Economics and Communications , Basel , Switzerland
| | | | - Y Reznik
- e University of Caen Côte de Nacre Regional Hospital Center , Caen , France
| | - H W de Valk
- f University Medical Centre Heidelberglaan , Utrecht , The Netherlands
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12
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Cohen O, Agabria Z, Lysyy L, Ianovitsky Y, Nguyen X, Fung M, Lee S, Wainstein J. Adaptability of structured forms for CSII initiation in patients with type 2 diabetes the Getting2Goal(SM) concept. J Endocrinol Invest 2016; 39:627-33. [PMID: 26746672 PMCID: PMC4869731 DOI: 10.1007/s40618-015-0407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/29/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND The goal is to assess the usability and satisfaction of implementing the Getting2Goal(SM) protocol by physicians transitioning patients with type 2 diabetes (T2DM) from multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII). METHODS T2DM patients from three diabetes clinics were switched from MDI to CSII. Physicians used the Getting2Goal type 2 pumping protocol to prescribe and manage insulin pump therapy for T2DM. Surveys were conducted in which the physicians rated their feedback related to acceptability of the Getting2Goal on a 5-point Likert scale. RESULTS 17 patients with T2DM were switched from MDI to CSII treatment. Mean (±standard deviation) age was 61.2 ± 7.7 (46-77) years, weight was 91.4 ± 21 (66-147) kg, BMI was 31.9 ± 7.6, A1C was 9.2 ± 1.4 % (7.2-12.3) and TDD on MDI was 109.1 ± 53.1 units. Surveys completed by physicians indicated Getting2Goal type 2 pumping protocol to be more efficient, time saving, and structured compared to their current processes. In addition, the primarily prescribed TDD on pump was 98.1 ± 50.0 units and the TDD at first download was 81.4 ± 36.4 units, representing a 25.4 % reduction in TDD At first download. The percentage of all blood glucose readings below 70 mg/dL was also very low. CONCLUSIONS The data indicate Getting2Goal materials as a standard approach that is simple and efficient to initiate pump therapy for T2DM. At the same time, it is safe and a useful tool for physicians that are starting to prescribe pump therapy for T2DM.
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Affiliation(s)
- O Cohen
- Sackler School of Medicine, Ch. Sheba Medical Center, Institute of Endocrinology, Tel Hashomer, Tel Aviv University, 52621, Tel Aviv, Israel.
| | - Z Agabria
- Cllalit Health Services, Tel Aviv, Israel
| | - L Lysyy
- Diabetes Clinic, Maccabi Health Service, Rehovot, Israel
- Endocrinology and Metabolism Clinic, Kaplan Medical Center, Rehovot, Israel
| | - Y Ianovitsky
- Diabetes Clinic, Maccabi Health Service, Ashkelon, Israel
| | - X Nguyen
- Medtronic, Inc., Northridge, CA, USA
| | - M Fung
- Medtronic, Inc., Northridge, CA, USA
| | - S Lee
- Medtronic, Inc., Northridge, CA, USA
| | - J Wainstein
- Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
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13
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Neylon OM, Skinner TC, O'Connell MA, Cameron FJ. A novel tool to predict youth who will show recommended usage of diabetes technologies. Pediatr Diabetes 2016; 17:174-83. [PMID: 25643603 DOI: 10.1111/pedi.12253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Controversy exists regarding which individuals will benefit most from commencement of diabetes technologies such as continuous subcutaneous insulin infusion (CSII) or continuous glucose monitoring systems (CGMS), such as 'real-time' sensor-augmented pumping (SAP). Because higher usage correlates with haemoglobin A1c (HbA1c) achieved, we aimed to predict future usage of technologies using a questionnaire-based tool. SUBJECTS The tool was distributed to two groups of youth with type 1 diabetes; group A (n = 50; mean age 12 ± 2.5 yr) which subsequently commenced 'real-time' CGMS and group B (n = 47; mean age 13 ± 3 yr) which commenced CSII utilisation. METHODS For the CGMS group, recommended usage was ≥5 days (70%) per week [≥70% = high usage (HU); <70% = low usage (LU)], assessed at 3 months. In the CSII group, HU was quantified as entering ≥5 blood sugars per day to the pump and LU as <5 blood sugars per day, at 6 months from initiation. Binary logistic regression with forward stepwise conditional was used to utilise tool scales and calculate an applied formula. RESULTS Of the CGMS group, using gender, baseline HbA1c, and two subscales of the tool generated a formula which predicted both high and low usage with 92% accuracy. Twelve (24%) showed HU vs. 38 who exhibited LU at 3 months. Of the CSII group, 32 (68%) exhibited HU vs. 15 who exhibited LU at 6 months. Four tool items plus gender predicted HU/LU with 95% accuracy. CONCLUSIONS This pilot study resulted in successful prediction of individuals who will and those who will not go on to show recommended usage of CSII and CGMS.
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Affiliation(s)
- Orla M Neylon
- Department of Endocrinology, Murdoch Childrens Research Institute and The Royal Children's Hospital, Parkville, Australia
| | - Timothy C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Australia
| | - Michele A O'Connell
- Department of Endocrinology, Murdoch Childrens Research Institute and The Royal Children's Hospital, Parkville, Australia
| | - Fergus J Cameron
- Department of Endocrinology, Murdoch Childrens Research Institute and The Royal Children's Hospital, Parkville, Australia
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14
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Picard S, Hanaire H, Baillot-Rudoni S, Gilbert-Bonnemaison E, Not D, Reznik Y, Guerci B. Evaluation of the Adherence to Continuous Glucose Monitoring in the Management of Type 1 Diabetes Patients on Sensor-Augmented Pump Therapy: The SENLOCOR Study. Diabetes Technol Ther 2016; 18:127-35. [PMID: 26950530 DOI: 10.1089/dia.2015.0240] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) and sensor-augmented pump (SAP) therapy improve glucose control provided good adherence. In France, not only diabetologists, nurses, and dieticians but also nurses employed by homecare providers (HCPNs) are together involved in the initiation and/or follow-up of continuous subcutaneous insulin injection (CSII) and SAP training. The SENLOCOR Study is an observational study designed to assess SAP adherence over 6 months (primary objective). Secondary objectives included the impact of SAP on metabolic control and patients' satisfaction. MATERIALS AND METHODS CGM initiation (M0) was performed within 3 months after CSII. CGM adherence, defined by sensor wear >70% of the time, glycated hemoglobin (HbA1c) levels, and satisfaction questionnaires were collected at inclusion and at 3 (M3) and 6 (M6) months. RESULTS The analysis population was 234 patients, including 27 children. Of the physicians, 88.0% were involved in SAP education for the whole cohort (median time, 45 min), whereas HCPNs were involved in CGM training for 190 patients (81.2%) (median time: at M0, 156 min; at M3, 20 min). Good adherence was obtained in 86.1% (M0-M3) and 68.9% (M3-M6) of the patients. The HbA1c level decreased from 8.16 ± 1.35% (M0) to 7.67 ± 1.01% (M6) in 189 patients (change, -0.48%; 95% confidence interval, -0.64, -0.33). The percentage of patients who experienced severe hypoglycemia decreased from 20.7% (M0) to 13.6% (M3) and 13.3% (M6). Satisfaction scores were high. CONCLUSIONS In patients with type 1 diabetes, a 6-month training on SAP involving a multidisciplinary team, and especially HCPNs, improved metabolic control with a high level of adherence and satisfaction.
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Affiliation(s)
- Sylvie Picard
- 1 Point Médical , Rond-Point de la Nation, Dijon, France
| | - Hélène Hanaire
- 2 Endocrinology-Diabetes Care Unit, Toulouse University Hospital , Toulouse, France
| | | | | | - Didier Not
- 5 Center of Clinical Research , Lyon, France
| | - Yves Reznik
- 6 Endocrinology-Diabetes Care Unit, Caen University Hospital , Caen, France
| | - Bruno Guerci
- 7 Endocrinology-Diabetes Care Unit, University of Lorraine , Vandoeuvre Lès Nancy, France
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15
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Roze S, Smith-Palmer J, Valentine W, Payet V, de Portu S, Papo N, Cucherat M, Hanaire H. Cost-Effectiveness of Sensor-Augmented Pump Therapy with Low Glucose Suspend Versus Standard Insulin Pump Therapy in Two Different Patient Populations with Type 1 Diabetes in France. Diabetes Technol Ther 2016; 18:75-84. [PMID: 26646072 DOI: 10.1089/dia.2015.0224] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sensor-augmented pump therapy (SAP) provides a useful adjunct relative to continuous subcutaneous insulin infusion (CSII) alone. It can provide early warning of the onset of hyperglycemia and hypoglycemia and has the functionality to suspend insulin delivery if sensor glucose levels fall below a predefined threshold. The aim was to assess the cost-effectiveness of SAP with low glucose suspend (LGS) versus CSII alone in type 1 diabetes. MATERIALS AND METHODS Cost-effectiveness analysis was performed using the CORE Diabetes Model, using published clinical input data. The analysis was performed in two cohorts: one with uncontrolled glycated hemoglobin at baseline and one at elevated risk for hypoglycemic events. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon; future costs and clinical outcomes were discounted at 4% per annum. RESULTS In patients with uncontrolled glycated hemoglobin at baseline, SAP + LGS resulted in improved discounted quality-adjusted life expectancy (QALE) versus CSII (10.55 quality-adjusted life-years [QALYs] vs. 9.36 QALYs) but higher mean lifetime direct costs (€84,972 vs. €49,171) resulting in an incremental cost-effectiveness ratio (ICER) of €30,163 per QALY gained. In patients at elevated risk for hypoglycemia, the ICER was €22,005 per QALY gained for SAP + LGS versus CSII as lifetime costs were higher (€88,680 vs. €57,097), but QALE was also higher (18.46 QALYs vs. 18.30 QALYs). CONCLUSIONS In France, projected improvements in outcomes with SAP + LGS versus CSII translated into an ICER generally considered as good value for money, particularly in patients who experience frequent and/or problematic hypoglycemic events.
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Affiliation(s)
| | | | | | - Vincent Payet
- 3 Department of Health Economics & Reimbursement, Medtronic France SAS , Boulogne Billancourt, France
| | - Simona de Portu
- 4 Medtronic International Trading Sàrl , Tolochenaz, Switzerland
| | - Natalie Papo
- 4 Medtronic International Trading Sàrl , Tolochenaz, Switzerland
| | | | - Helene Hanaire
- 6 Department of Cardiovascular & Metabolic, Toulouse University Hospital Center , Toulouse, France
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Pozzilli P, Battelino T, Danne T, Hovorka R, Jarosz‐Chobot P, Renard E. Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics. Diabetes Metab Res Rev 2016; 32:21-39. [PMID: 25865292 PMCID: PMC5033023 DOI: 10.1002/dmrr.2653] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/27/2015] [Indexed: 01/01/2023]
Abstract
The level of glycaemic control necessary to achieve optimal short-term and long-term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid-acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid-acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost-effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid-acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin infusion on patients' health-related quality of life; reviews relevant pharmacoeconomic data; and discusses recent advances in pump technology, including the development of closed-loop 'artificial pancreas' systems. © 2015 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Paolo Pozzilli
- Area of Endocrinology and DiabetesUniversity Campus Bio‐MedicoRomeItaly
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic DiseasesUniversity Children's Hospital LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Thomas Danne
- Diabetes Centre for Children and AdolescentsAUF DER BULT, Kinder‐ und JugendkrankenhausHannoverGermany
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
| | - Przemyslawa Jarosz‐Chobot
- Department of Pediatrics, Endocrinology and Diabetes School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition and CIC INSERM 1411Montpellier University HospitalMontpellierFrance
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17
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Crosnier H. [The social integration of children with diabetes]. SOINS. PEDIATRIE, PUERICULTURE 2016; 37:30-32. [PMID: 26776692 DOI: 10.1016/j.spp.2015.11.010] [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: 06/05/2023]
Abstract
Despite the regulatory programmes in place, the social integration of children with diabetes, in particular younger children, is still unsatisfactory. The lack of autonomy of the young child requires the active participation of adults in child care facilities and schools to administer and monitor their treatment. The training of all staff working with children is essential for their successful integration.
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Affiliation(s)
- Hélène Crosnier
- Hôpital Necker-Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France.
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18
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Ajzenman C, Nathanson S. Irruption de la pompe à insuline en pédiatrie générale: les problèmes posés. Arch Pediatr 2015; 22:159-60. [DOI: 10.1016/s0929-693x(15)30079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Rankin D, Harden J, Noyes K, Waugh N, Barnard K, Lawton J. Parents' experiences of managing their child's diabetes using an insulin pump: a qualitative study. Diabet Med 2015; 32:627-34. [PMID: 25581347 DOI: 10.1111/dme.12683] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
AIMS Continuous subcutaneous insulin infusion delivered via a pump is increasingly recommended for younger children with Type 1 diabetes. Our aims were: to understand the impact on parents who care for young children using insulin pumps; to help interpret psychological outcomes reported in quantitative research; and to inform provision of support to future parents. METHODS We conducted in-depth interviews with 19 parents of children (aged ≤ 12 years) with Type 1 diabetes who used an insulin pump. Data were analysed thematically. RESULTS Parents reported multiple benefits from using insulin pumps, including: no longer having to administer painful injections; fewer restrictions on the frequency, timing and carbohydrate contents of snacks and meals; and improvements in family life and their child's glycaemic control. Parents liked and felt less anxious about using bolus calculators to determine insulin doses; however, parents also described undertaking additional and unanticipated work to manage their child's diabetes using a pump. This included performing more blood glucose tests to calculate insulin doses for snacks and to address their concerns that the pump increased their child's risk of hypoglycaemia. Some parents reported doing additional blood glucose checks because they could adjust pump settings to better manage hypo- and hyperglycaemia. CONCLUSIONS Parents liked and perceived benefits for their child and themselves from using an insulin pump; however, parents would benefit from being made aware of the additional work involved in using a pump and also from education and support to address concerns about hypoglycaemia. Better measures to evaluate parents' experiences are also recommended.
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Affiliation(s)
- D Rankin
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh
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20
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Brancato D, Fleres M, Aiello V, Saura G, Scorsone A, Ferrara L, Provenzano F, Di Noto A, Spano L, Provenzano V. The effectiveness and durability of an early insulin pump therapy in children and adolescents with type 1 diabetes mellitus. Diabetes Technol Ther 2014; 16:735-41. [PMID: 25162664 PMCID: PMC4201306 DOI: 10.1089/dia.2014.0034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study evaluated the predictors of effectiveness and durability of insulin pump therapy in children and adolescents who have initiated continuous subcutaneous insulin infusion (CSII) within 2 years after the diagnosis of type 1 diabetes mellitus (T1DM). SUBJECTS AND METHODS The charts of individuals with T1DM using insulin pumps who were treated at our center were reviewed, including subjects with age at onset of <22 years, interval between onset and insulin pump commencement (interval onset-commencement) of <2 years, use of pumps of >1 year, and use of glucose sensors for <4 weeks/year. The primary end point was the mean glycosylated hemoglobin (HbA1c) value (MHbA1c) throughout the follow-up. RESULTS From 684 patients treated with insulin pumps, 119 met the inclusion criteria, and 113 were selected for statistical analysis (60 females; age at diabetes onset, 8.9±5.6 years [mean±SD]; follow-up, 4.0±1.8 years; range, 1-8 years; baseline HbA1c, 9.3±1.8%). Only the interval onset-commencement was a linear predictor of the MHbA1c (P=0.01; R(2)=0.089). A significant reduction of the mean yearly HbA1c from baseline throughout all the follow-up was observed (P<0.001). Categorizing the sample into four quartiles on the basis of an increasing interval onset-commencement resulted in levels of MHbA1c significantly lower in the first and second quartiles in comparison with the fourth quartile (7.6±0.8% and 7.8±1.0%, respectively, versus 8.5±0.8%; P<0.001 and P=0.004, respectively). CONCLUSIONS The present study suggests that early pump commencement in children and adolescents with T1DM provides lower and more durable HbA1c values than a late commencement. It is possible that an early pump commencement could prolong the honeymoon phase, but we cannot confirm or exclude this hypothesis because the lack of data about C-peptide levels during the follow-up.
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Affiliation(s)
- Davide Brancato
- Regional Reference Center for Diabetology and Insulin Pumps, Department of Internal Medicine and Diabetology, Hospital of Partinico , Partinico (PA), Italy
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Joubert M, Morera J, Vicente A, Rod A, Parienti JJ, Reznik Y. Cross-sectional survey and retrospective analysis of a large cohort of adults with type 1 diabetes with long-term continuous subcutaneous insulin infusion treatment. J Diabetes Sci Technol 2014; 8:1005-10. [PMID: 24876454 PMCID: PMC4455364 DOI: 10.1177/1932296814537040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Continuous subcutaneous insulin infusion (CSII) is an established modality for intensive insulin treatment of type 1 diabetes (T1D), but long-term data concerning satisfaction, CSII function use, safety, and efficacy in real-life conditions are scarce. Methods. We analyzed a cohort of adult patients with T1D treated with CSII for more than 1 year in a single diabetes center. We performed a cross-sectional survey in 2010 (tolerance/satisfaction and behavior forms) and a retrospective analysis of medical records (including HbA1c level, hospitalization, and catheter infections). The primary objective was to assess long-term tolerance/satisfaction, and secondary objectives were safety and efficacy. Results. There were 295 patients analyzed. After a median duration of CSII use of 5 years, overall satisfaction was high for about 90% of patients. Mean CSII-related discomfort scores were low for work, recreation, and sleep and moderate for sport and sexual activity (2.5 ± 1.9, 2.6 ± 1.8, 2.6 ± 2.1, 3.4 ± 2.3, and 4.0 ± 2.9 of 10, respectively). Despite a high level of diabetes education, only one third of patients were using advanced CSII functions. During long-term follow-up, the safety of CSII treatment was good; the hospitalization rate was 0.18 patients/year, and catheter infections were scarce. The HbA1c level dropped about -0.5% independently from CSII duration (P < .05). Conclusions. In this adult cohort, satisfaction and tolerance, together with safety, of CSII were maintained at long-term follow up. The sole basic functions of CSII were currently used by patients. A 0.5% decrease in the HbA1c level was maintained during the study period.
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Affiliation(s)
- Michael Joubert
- Endocrinology Department, Caen University Hospital, Caen, France
| | - Julia Morera
- Endocrinology Department, Caen University Hospital, Caen, France University of Caen (UNICAEN), Caen, France
| | - Angel Vicente
- Endocrinology Department, Caen University Hospital, Caen, France
| | - Anne Rod
- Endocrinology Department, Caen University Hospital, Caen, France
| | - Jean-Jacques Parienti
- University of Caen (UNICAEN), Caen, France Research and Biostatistic Department, Caen University Hospital, Caen, France
| | - Yves Reznik
- Endocrinology Department, Caen University Hospital, Caen, France University of Caen (UNICAEN), Caen, France
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Reznik Y, Morello R, Zenia A, Morera J, Rod A, Joubert M. Autonomy of patients with type 2 diabetes with an insulin pump device: is it predictable? J Diabetes Sci Technol 2014; 8:760-5. [PMID: 24876438 PMCID: PMC4764221 DOI: 10.1177/1932296814533171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Insulin pump therapy may be offered to patients with type 2 diabetes that is not controlled by multiple daily injections. Patients with type 2 diabetes may suffer from unrecognized cognitive disabilities, which may compromise the use of a pump device. METHODS To predict patient autonomy, we evaluated 39 patients with type 2 diabetes from our database (n = 143) after continuous subcutaneous insulin infusion (CSII) initiation using (1) an autonomy questionnaire evaluating the patient's cognitive and operative capacities for CSII utilization, (2) the Montreal Cognitive Assessment (MOCA) for the detection of mild cognitive disabilities, (3) the Hospital Anxiety and Depression Scale (HADS) for the detection of anxiety and depression, and (4) the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Patients were selected to constitute 3 groups matched for age, with different degrees of autonomy at discharge after the initial training program: complete (n = 13), partial (n = 13), or no autonomy (n = 13). RESULTS The satisfaction level with the pump device was high. At the last follow-up visit, only 23% of patients did not reach complete autonomy. The autonomy score correlated fairly with the MOCA score (R = 0.771, P < .001). A receiver operating characteristic (ROC) analysis showed that at a cut-off score of 24, the MOCA identified autonomous versus dependent patients at long-term follow-up (area under the ROC curve [AUC], 0.893; sensitivity, 81%; specificity, 81%). The HADS correlated negatively with the autonomy score, and the sociocultural level also influenced autonomy with pump utilization. CONCLUSION Patients with type 2 diabetes with partial autonomy at discharge may progress to complete autonomy. The MOCA and HADS may help predict a patient's ability to manage with a pump device.
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Affiliation(s)
- Yves Reznik
- Endocrinology and Diabetes Department, CHU Côte de Nacre, Caen Cedex, France
| | - Rémy Morello
- Biostatistic and Clinical Research Department, CHU Côte de Nacre, Caen Cedex, France
| | - Amel Zenia
- Endocrinology and Diabetes Department, CHU Côte de Nacre, Caen Cedex, France
| | - Julia Morera
- Endocrinology and Diabetes Department, CHU Côte de Nacre, Caen Cedex, France
| | - Anne Rod
- Endocrinology and Diabetes Department, CHU Côte de Nacre, Caen Cedex, France
| | - Michael Joubert
- Endocrinology and Diabetes Department, CHU Côte de Nacre, Caen Cedex, France
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Expérience des parents sur l’intégration des jeunes enfants diabétiques traités par pompe à insuline en crèche et à l’école : enquête en région Ile-de-France. Arch Pediatr 2013; 20 Suppl 4:S149-56. [DOI: 10.1016/s0929-693x(13)71430-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Tubiana-Rufi N. Les technologies au service de l’enfant atteint de diabète de type 1. Arch Pediatr 2013; 20 Suppl 4:S127-30. [DOI: 10.1016/s0929-693x(13)71426-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Reznik Y, Cohen O. Insulin pump for type 2 diabetes: use and misuse of continuous subcutaneous insulin infusion in type 2 diabetes. Diabetes Care 2013; 36 Suppl 2:S219-25. [PMID: 23882049 PMCID: PMC3920779 DOI: 10.2337/dcs13-2027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Yves Reznik
- Endocrinology and Diabetes Department, CHU Côte de Nacre, Caen Cedex, France.
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26
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Li W, Wang J, Chen QD, Qian X, Li Q, Yin Y, Shi ZM, Wang L, Lin J, Liu LZ, Jiang BH. Insulin promotes glucose consumption via regulation of miR-99a/mTOR/PKM2 pathway. PLoS One 2013; 8:e64924. [PMID: 23762265 PMCID: PMC3677911 DOI: 10.1371/journal.pone.0064924] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/20/2013] [Indexed: 01/17/2023] Open
Abstract
Insulin is known to regulate multiple cellular functions and is used for the treatment of diabetes. MicroRNAs have been demonstrated to be involved in many human diseases, including Type 2 diabetes. In this study, we showed that insulin decreased miR-99a expression levels, but induced glucose consumption and lactate production, and increased the expression of mTOR, HIF-1α and PKM2 in HepG2 and HL7702 cells. Forced expression of miR-99a or rapamycin treatment blocked insulin-induced PKM2 and HIF-1α expression, and glucose consumption and lactate production. Meanwhile, knockdown of HIF-1α inhibited PKM2 expression and insulin-induced glucose consumption. Taken together, these findings will reveal the role and mechanism of insulin in regulating glycolytic activities via miR-99a/mTOR.
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MESH Headings
- Antibiotics, Antineoplastic/pharmacology
- Blotting, Western
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/genetics
- Carcinoma, Hepatocellular/metabolism
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Cells, Cultured
- Gene Expression Regulation, Neoplastic/drug effects
- Glucose/metabolism
- Humans
- Hypoglycemic Agents/pharmacology
- Hypoxia-Inducible Factor 1, alpha Subunit/antagonists & inhibitors
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Hypoxia-Inducible Factor 1, alpha Subunit/metabolism
- Insulin/pharmacology
- Lactates/metabolism
- Liver/metabolism
- Liver/pathology
- Liver Neoplasms/drug therapy
- Liver Neoplasms/genetics
- Liver Neoplasms/metabolism
- Luciferases/metabolism
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- MicroRNAs/genetics
- Phosphorylation
- RNA, Messenger/genetics
- RNA, Small Interfering/genetics
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Signal Transduction/drug effects
- Sirolimus/pharmacology
- TOR Serine-Threonine Kinases/genetics
- TOR Serine-Threonine Kinases/metabolism
- Thyroid Hormones/genetics
- Thyroid Hormones/metabolism
- Thyroid Hormone-Binding Proteins
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Affiliation(s)
- Wei Li
- Department of Pathology, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Jing Wang
- Department of Pathology, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Qiu-Dan Chen
- Department of Pathology, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Xu Qian
- Department of Pathology, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Qi Li
- Department of Pathology, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Yu Yin
- Department of Pathology, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Zhu-Mei Shi
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Wang
- Department of Pathology, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Jie Lin
- Faculty of Software, Fujian Normal University, Fuzhou, China
| | - Ling-Zhi Liu
- Department of Pathology, Anatomy and Cell Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Bing-Hua Jiang
- Department of Pathology, Cancer Center, Nanjing Medical University, Nanjing, China
- Department of Pathology, Anatomy and Cell Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
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27
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Neylon OM, O'Connell MA, Skinner TC, Cameron FJ. Demographic and personal factors associated with metabolic control and self-care in youth with type 1 diabetes: a systematic review. Diabetes Metab Res Rev 2013; 29:257-72. [PMID: 23364787 DOI: 10.1002/dmrr.2392] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 12/02/2012] [Accepted: 01/02/2013] [Indexed: 11/11/2022]
Abstract
Optimal use of recent technological advances in insulin delivery and glucose monitoring remain limited by the impact of behaviour on self-care. In recent years, there has been a resurgence of interest in psychosocial methods of optimizing care in youth with type 1 diabetes. We therefore sought to examine the literature for demographic, interpersonal and intrapersonal correlates of self-care and/or metabolic control. Studies for this systematic review were obtained via an electronic search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and PsycINFO databases. Seventy studies fulfilled the inclusion criteria. These studies have indicated that identifiable individual characteristics in each domain are robustly associated with metabolic control and/or self-care in children and adolescents. We present these characteristics and propose a theoretical model of their interactions and effect on diabetes outcomes. There is currently no consensus regarding patient selection for insulin pump therapy. In this era of scarce healthcare resources, it may be prudent to identify youth requiring increased psychosocial support prior to regimen intensification. The importance of this review lies in its potential to create a framework for rationally utilizing resources by stratifying costly therapeutic options to those who, in the first instance, will be most likely to benefit from them.
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Affiliation(s)
- Orla M Neylon
- University of Tasmania, Burnie, Tasmania, Australia.
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28
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La pompe à insuline améliore-t-elle la qualité de vie et la satisfaction des enfants et adolescents diabétiques de type 1 ? Arch Pediatr 2013; 20:248-56. [DOI: 10.1016/j.arcped.2012.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 11/05/2012] [Accepted: 12/12/2012] [Indexed: 11/15/2022]
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29
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30
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Lv WS, Li L, Wen JP, Pan RF, Sun RX, Wang J, Xian YX, Cao CX, Gao YY. Comparison of a multiple daily insulin injection regimen (glargine or detemir once daily plus prandial insulin aspart) and continuous subcutaneous insulin infusion (aspart) in short-term intensive insulin therapy for poorly controlled type 2 diabetes patients. Int J Endocrinol 2013; 2013:614242. [PMID: 23737776 PMCID: PMC3662171 DOI: 10.1155/2013/614242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 03/27/2013] [Accepted: 04/13/2013] [Indexed: 11/18/2022] Open
Abstract
Aims. To examine the potential differences between multiple daily injection (MDI) regimens based on new long-acting insulin analogues (glargine or detemir) plus prandial insulin aspart and continuous subcutaneous insulin aspart infusion (CSII) in patients with poorly controlled type 2 diabetes. Methods. Patients (n = 119) with poorly controlled type 2 diabetes of a duration exceeding five years were randomly assigned into three groups: Group A treated with CSII using insulin aspart; Group B treated with glargine-based MDI and Group C treated with detemir-based MDI. Results. Good glycemic control was achieved by patients in Group A in a significantly shorter duration than patients in Groups B and C. Total daily insulin, basal insulin dose and dose per kg body weight in Group A were significantly less than those in Groups B and C. Daily blood glucose fluctuation in Group A was significantly less than that in Groups B and C. There were no differences between Groups B and C. Conclusions. Aspart-based CSII may achieve good blood glucose control with less insulin doses over a shorter period compared with glargine or detemir-based MDI. No differences between glargine- and detemir-based MDI were detected in poorly controlled subjects with type 2 diabetes.
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Affiliation(s)
- Wen-shan Lv
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Li Li
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Jun-ping Wen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, North Branch of Fujian Provincial Hospital, Fujian Provincial Geriatric Hospital, Fuzhou 350001, China
- *Jun-ping Wen: and
| | - Rong-fang Pan
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Rui-xia Sun
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Jing Wang
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Yu-xin Xian
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Cai-xia Cao
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Yan-yan Gao
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
- *Yan-yan Gao:
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31
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Affiliation(s)
- John C Pickup
- Diabetes Research Group, Division of Diabetes and Nutritional Sciences, King's College London School of Medicine and Guy's Hospital, London, United Kingdom.
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32
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Abstract
Continuous subcutaneous insulin infusion (CSII, or insulin pump therapy) reduces HbA1c levels and hypoglycaemia in patients with type 1 diabetes mellitus (T1DM) compared with multiple daily insulin injections (MDI). The greatest reduction in HbA(1c) levels with CSII occurs in patients with the worst glycaemic control; therefore, the most appropriate and cost-effective use of CSII in adults with T1DM is in those who have continued, elevated HbA(1c) levels or disabling hypoglycaemic episodes with MDI (including the use of long-acting insulin analogues and structured patient education). The disadvantages of CSII include higher costs than MDI and the risk of ketosis in the event of pump failure. In children with T1DM, CSII may be used when MDI is considered impractical or inappropriate. Pumps are not generally recommended for patients with type 2 diabetes mellitus but may improve control in some subgroups. A new generation of smaller insulin infusion pumps with an integrated cannula, called patch pumps, could improve uptake of CSII in general. The important clinical question is not whether CSII is more efficacious than MDI in general adult T1DM, but whether CSII further improves glycaemic control when this control continues to be poor with MDI, and evidence exists that in most cases it does.
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Affiliation(s)
- John C Pickup
- Diabetes Research Group, King's College London School of Medicine, Guy's Hospital, London SE1 1UL, UK.
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33
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Nixon R, Pickup JC. Fear of hypoglycemia in type 1 diabetes managed by continuous subcutaneous insulin infusion: is it associated with poor glycemic control? Diabetes Technol Ther 2011; 13:93-8. [PMID: 21284474 DOI: 10.1089/dia.2010.0192] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND We surveyed the extent of fear of hypoglycemia in people with type 1 diabetes treated by continuous subcutaneous insulin infusion (CSII) and tested the hypothesis that suboptimal glycemic control during CSII is related to fear of hypoglycemia. METHODS We audited nonpregnant type 1 diabetes patients attending an Insulin Pump Clinic with at least 6 months' duration of CSII. In 104 eligible subjects, fear of hypoglycemia was assessed by questionnaire; 75 responded. RESULTS The median duration of CSII was 5 years (range, 1-29 years). Poor glycemic control (hemoglobin A1c [HbA1c] ≥ 8.5%; mean ± SD, 9.1 ± 1.0%) was present in 27%, and this group had more men than a good-control group with HbA1c < 7.0% (43% vs. 11%). Substantial fear of hypoglycemia (score > 50%) occurred in 27% of subjects, but fear of hypoglycemia was not correlated with HbA1c. The only significant correlates of fear of hypoglycemia were accumulated episodes of severe hypoglycemia (r = 0.48, P < 0.001) and rate of hypoglycemia on CSII (r = 0.48, P < 0.001). The HbA1c on CSII was correlated with multiple daily injection (MDI) HbA1c (r = 0.66, P < 0.001) and the change in HbA1c (r = 0.63, P < 0.001). CONCLUSIONS Fear of hypoglycemia is not correlated with, and is unlikely to be a major determinant of, HbA1c on CSII. Other factors (such as HbA1c on MDI and adherence to insulin pump procedures) are likely to be more important. Nevertheless, substantial fear of hypoglycemia is present in many CSII-treated people and may adversely affect quality of life and psychological well-being.
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Affiliation(s)
- Rodanthe Nixon
- Diabetes Research Group, King's College London School of Medicine, Guy's Hospital, London, UK
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Sulmont V, Lassmann-Vague V, Guerci B, Hanaire H, Leblanc H, Leutenegger E, Mihaileanu M, Tubiana-Rufi N. Access of children and adolescents with type 1 diabetes to insulin pump therapy has greatly increased in France since 2001. DIABETES & METABOLISM 2010; 37:59-63. [PMID: 21147014 DOI: 10.1016/j.diabet.2010.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 07/11/2010] [Accepted: 07/19/2010] [Indexed: 11/30/2022]
Abstract
AIM Insulin pump therapy is an emerging option in the management of type 1 diabetes (T1D), but it often remains unused. For this reason, in 2007, a French national survey was carried out to update the frequency of insulin pump use in the paediatric population compared with a previous survey done in 2001. METHODS The present survey was performed in hospital departments involved in paediatric diabetes management (n = 67) and in adult departments involved in adolescent diabetes management (n = 113). The number of T1D children (age < 18 years) treated in each department, with or without the use of an insulin pump, and the number of insulin pump therapies initiated during the previous year were collected. RESULTS A total of 60 paediatric and 28 adult centres responded, involving 9073 T1D children and adolescents (93% in paediatric departments). Of these patients, 1461 (16%) were treated by insulin pump, 89% of which were managed in paediatric centres. However, pump use was more frequent in adult than in paediatric centres (32% versus 18%, respectively). Also, 38% of insulin pumps were initiated during the year prior to the survey. In addition, in 2001, 140 children were treated with insulin pump in 13 paediatric centres (versus 56 centres in 2007). CONCLUSION The number of centres using insulin pump therapy for diabetic children and the number of children treated by insulin pump were increased fourfold and 10-fold, respectively, from 2001 to 2007, indicating greater access to pump therapy in the French paediatric population. The present survey is still ongoing to evaluate the decision-making criteria that influence the initiation of insulin pump therapy in T1D paediatric patients.
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Affiliation(s)
- V Sulmont
- Service de pédiatrie A, American Memorial Hospital, CHU de Reims, France.
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35
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Reznik Y, Morera J, Rod A, Coffin C, Rousseau E, Lireux B, Joubert M. Efficacy of continuous subcutaneous insulin infusion in type 2 diabetes mellitus: a survey on a cohort of 102 patients with prolonged follow-up. Diabetes Technol Ther 2010; 12:931-6. [PMID: 21128839 DOI: 10.1089/dia.2010.0110] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We evaluated the long-term efficacy of continuous subcutaneous insulin infusion (CSII) for treating type 2 diabetes patients uncontrolled by multiple daily injections. RESEARCH DESIGN AND METHODS All 102 type 2 diabetes patients who began insulin pump therapy at Caen University Hospital (Caen, France) between January 1998 and August 2008 were included in a retrospective observational study. Ninety-three percent of the patients were previously treated by insulin with a mean duration of 5.6 years. RESULTS The median duration of follow-up with CSII was 24 months. A1c glycated hemoglobin (HbA1c) improved from baseline (9.3 ± 1.8%) to the 1-year evaluation (7.8 ± 1.4%) (P < 0.001). The magnitude of HbA1c improvement was highly dependent on (1) pretreatment HbA1c level, (2) degree of patient's autonomy, and (3) previous antidiabetes treatment. HbA1c decreased by 0.9 ± 1.6% (P = 0.002) in the group previously treated by a basal-bolus regimen. HbA1c decrease was maintained at follow-up until 6 years (P < 0.05). Mean body weight gain was 3.9 ± 8.6 kg at 1 year (P < 0.001) and remained stable at follow-up. No significant change in insulin requirement was observed. CONCLUSIONS The use of CSII in patients with type 2 diabetes is safe and effective for improving glycemic control, particularly in those patients with baseline HbA1c above 8%. Such beneficial effect of CSII may persist until 6-year follow-up, suggesting the durability of CSII efficacy in our study population.
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Affiliation(s)
- Yves Reznik
- Department of Medicine, Department of Endocrinology, Caen University Hospital, Caen, France
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36
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Reznik Y. Continuous subcutaneous insulin infusion (CSII) using an external insulin pump for the treatment of type 2 diabetes. DIABETES & METABOLISM 2010; 36:415-21. [DOI: 10.1016/j.diabet.2010.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 08/13/2010] [Accepted: 08/13/2010] [Indexed: 10/19/2022]
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Abstract
Although European groups have initiated innovative clinical research in the field of insulin pump therapy, insulin pump use remains currently limited in many European countries, and well behind that in the United States. The main reason is the late approval of cost coverage by most national healthcare insurance systems, which is still lacking in some countries. Partly in connection with this delay, the number of trained physicians to pump therapy is low in many countries, while diabetes educators do not exist as an acknowledged entity in many European countries, and pump manufacturers are excluded from the education process of patients in most of them. Pump use in pediatric-age populations has strongly increased during the last years, following the evidence-based demonstrations of the benefits of pump therapy in these patients leading to an international consensus on pump indications and practice. Failure to control type 1 diabetes to target and frequent hypoglycemia under multiple daily insulin injections are consensus-based but restrictive indications for pump therapy in adults in most countries. The economic burden on healthcare insurance systems does not facilitate wider use of insulin pumps, but a significant expansion of pump therapy according to consensus-based indications is still expected thanks to the growing knowledge of physicians in technologies and because of the increasing interest of patients to use technology to improve their control of diabetes and health-related quality of life. More sophisticated technologies connected to pump therapy, such as continuous glucose monitoring or telemedicine, will need specific cost coverage for a true implementation in diabetes care in Europe.
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Affiliation(s)
- Eric Renard
- Endocrinology Department, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
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