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Patel PM, Thomas D, Liu Z, Aldrich-Renner S, Clemons M, Patel BV. Systematic review of disparities in continuous glucose monitoring and insulin pump utilization in the United States: Key themes and evidentiary gaps. Diabetes Obes Metab 2024. [PMID: 39010293 DOI: 10.1111/dom.15774] [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: 05/13/2024] [Revised: 06/14/2024] [Accepted: 06/23/2024] [Indexed: 07/17/2024]
Abstract
AIM This study aims to provide a comprehensive overview of real-world evidence pertaining to disparities in the utilization of continuous glucose monitors (CGMs)/insulin pumps to highlight potential evidentiary gaps and discern emerging themes from the literature. MATERIALS AND METHODS A systematic review of published manuscripts and abstracts was conducted from: MEDLINE, EMBASE, Nursing and Allied Health, Web of Science and CINHAL. Attributes related to patients, outcomes, interventions (CGMs/pumps/both) and study type were captured. In addition, factors associated with disparities in device utilization were examined. RESULTS Thirty-six studies were included in the final analysis; the studies predominantly focused on people living with type 1 diabetes. Only two studies included individuals with type 2 diabetes. Almost two-thirds of the studies reported outcomes associated with disparities (e.g. glycated haemoglobin, diabetic ketoacidosis, resource utilization). Most studies highlighted disparities across race, ethnicity and insurance type. Evidentiary gaps were identified, particularly in the evidence for people with type 2 diabetes, the continuation of CGM/pump use and limited studies addressing disparities among Native Americans/American Indians. CONCLUSION This study reveals critical disparities in diabetes technology use across race, ethnicity and insurance type, particularly among people with type 1 diabetes. Evidentiary gaps assessing disparities in diabetes technology use persist, particularly concerning people with type 2 diabetes, Native American/American Indian and LGBTQ+ populations, and in outcomes related to continuation of use. Social and digital determinants of health, such as income, transportation, residential location and technological literacy, are crucial to achieving equitable access. Future research should focus on the patient journey to identify opportunities for equitable access to diabetes technology as its use grows.
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Affiliation(s)
- Pranav M Patel
- University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
| | - Divya Thomas
- University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
| | - Zhixi Liu
- University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
| | - Sarah Aldrich-Renner
- University of Toledo General Internal Medicine Clinic and College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
| | - Marilee Clemons
- University of Toledo General Internal Medicine Clinic and College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
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Zoccarato F, Manzoni M, Minotti D, Lettieri E, Boaretto A. Unveiling the interplay between rational, psychological and functional factors in continuous glucose monitoring early adoption: Novel evidence from the Dexcom ONE case in Italy. BMC Health Serv Res 2024; 24:747. [PMID: 38890619 PMCID: PMC11186290 DOI: 10.1186/s12913-024-11195-6] [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: 03/06/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The escalating prevalence of diabetes, with its multifaceted complications, poses a pressing challenge for healthcare systems globally. In response, the advent of continuous glucose monitoring (CGM) systems, offering technological solutions for daily diabetes management, presents significant opportunities. However, the widespread adoption faces several barriers, linked both to the technological configuration of the devices and to the psychological dimension of patients. Therefore, this study aims to apply and test a theoretical model that investigates the antecedents of the intention to use Continuous Glucose Monitoring systems. METHODS The research model was built to unveil the impacts of psychological factors, functional components and rational constructs derived from the Technology Acceptance Model (TAM) on CGM systems sustained adoption. To ensure the comparability of results, we have collected data from people who had used Dexcom ONE Dexcom (San Diego, CA) for the first time for at least one month. Employing Structural Equation Modelling (SEM) techniques, the hypothesized relationships among constructs were assessed. RESULTS The analyses confirmed the positive correlation of rational factors to the Intention to Use. Subjective Norm, intended as the physicians' influence, is positively correlated with the Perceived Usefulness. Trend Arrows, albeit being negatively correlated with Perceived Usefulness, have a positive correlation on Perceived Ease Of Use, reinforcing its mediating effect towards Perceived Usefulness. Among psychological factors, Trust in the CGM technology positively correlates with Intention to Use. Health Literacy is negatively correlated to the Intention to Use. CONCLUSIONS These findings contribute to theoretical and managerial understanding, providing recommendations to enhance the adoption of CGM systems like Dexcom ONE.
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Affiliation(s)
- Francesca Zoccarato
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milan, 20156, Italy.
| | - Martina Manzoni
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milan, 20156, Italy
| | - Davide Minotti
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milan, 20156, Italy
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milan, 20156, Italy
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Huang XS, Huang S, Zheng ST, Liang BM, Zhang T, Yue W, Liu FM, Shi P, Xie X, Chen HJ. Fabrication of Multiple-Channel Electrochemical Microneedle Electrode Array via Separated Functionalization and Assembly Method. BIOSENSORS 2024; 14:243. [PMID: 38785717 PMCID: PMC11118220 DOI: 10.3390/bios14050243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
Real-time monitoring of physiological indicators inside the body is pivotal for contemporary diagnostics and treatments. Implantable electrodes can not only track specific biomarkers but also facilitate therapeutic interventions. By modifying biometric components, implantable electrodes enable in situ metabolite detection in living tissues, notably beneficial in invasive glucose monitoring, which effectively alleviates the self-blood-glucose-managing burden for patients. However, the development of implantable electrochemical electrodes, especially multi-channel sensing devices, still faces challenges: (1) The complexity of direct preparation hinders functionalized or multi-parameter sensing on a small scale. (2) The fine structure of individual electrodes results in low spatial resolution for sensor functionalization. (3) There is limited conductivity due to simple device structures and weakly conductive electrode materials (such as silicon or polymers). To address these challenges, we developed multiple-channel electrochemical microneedle electrode arrays (MCEMEAs) via a separated functionalization and assembly process. Two-dimensional microneedle (2dMN)-based and one-dimensional microneedle (1dMN)-based electrodes were prepared by laser patterning, which were then modified as sensing electrodes by electrochemical deposition and glucose oxidase decoration to achieve separated functionalization and reduce mutual interference. The electrodes were then assembled into 2dMN- and 1dMN-based multi-channel electrochemical arrays (MCEAs), respectively, to avoid damaging functionalized coatings. In vitro and in vivo results demonstrated that the as-prepared MCEAs exhibit excellent transdermal capability, detection sensitivity, selectivity, and reproducibility, which was capable of real-time, in situ glucose concentration monitoring.
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Affiliation(s)
- Xin-Shuo Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China (S.H.); (S.-T.Z.); (B.-M.L.)
| | - Shuang Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China (S.H.); (S.-T.Z.); (B.-M.L.)
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China;
| | - Shan-Tao Zheng
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China (S.H.); (S.-T.Z.); (B.-M.L.)
| | - Bao-Ming Liang
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China (S.H.); (S.-T.Z.); (B.-M.L.)
| | - Tao Zhang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China;
| | - Wan Yue
- School of Materials Science and Engineering, Sun Yat-sen University, Guangzhou 510006, China;
| | - Fan-Mao Liu
- Division of Hypertension and Vascular Diseases, NHC Key Laboratory of Assisted Circulation and Vascular Diseases (Sun Yat-sen University), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China;
| | - Peng Shi
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, China;
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China (S.H.); (S.-T.Z.); (B.-M.L.)
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China (S.H.); (S.-T.Z.); (B.-M.L.)
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Huang X, Yao C, Huang S, Zheng S, Liu Z, Liu J, Wang J, Chen HJ, Xie X. Technological Advances of Wearable Device for Continuous Monitoring of In Vivo Glucose. ACS Sens 2024; 9:1065-1088. [PMID: 38427378 DOI: 10.1021/acssensors.3c01947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Managing diabetes is a chronic challenge today, requiring monitoring and timely insulin injections to maintain stable blood glucose levels. Traditional clinical testing relies on fingertip or venous blood collection, which has facilitated the emergence of continuous glucose monitoring (CGM) technology to address data limitations. Continuous glucose monitoring technology is recognized for tracking long-term blood glucose fluctuations, and its development, particularly in wearable devices, has given rise to compact and portable continuous glucose monitoring devices, which facilitates the measurement of blood glucose and adjustment of medication. This review introduces the development of wearable CGM-based technologies, including noninvasive methods using body fluids and invasive methods using implantable electrodes. The advantages and disadvantages of these approaches are discussed as well as the use of microneedle arrays in minimally invasive CGM. Microneedle arrays allow for painless transdermal puncture and are expected to facilitate the development of wearable CGM devices. Finally, we discuss the challenges and opportunities and look forward to the biomedical applications and future directions of wearable CGM-based technologies in biological research.
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Affiliation(s)
- Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Chuanjie Yao
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Shuang Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Shantao Zheng
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Zhengjie Liu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Jing Liu
- The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Ji Wang
- The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China
- The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510006, China
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Holt E, Nguyen H, Bispham J, Liu J, Chapman K, Grady M. Perceptions of Continuous Glucose Monitoring Systems in the T1D Exchange Diabetes Registry: Satisfaction, Concerns, and Areas for Future Improvement. Clin Diabetes 2023; 42:104-115. [PMID: 38230340 PMCID: PMC10788666 DOI: 10.2337/cd23-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Manufacturers continue to improve performance and usability of continuous glucose monitoring (CGM) systems. As CGM becomes a standard of care, especially for people on insulin therapy, it is important to routinely gauge how satisfied people with diabetes are with this technology. This article describes survey feedback from a large cohort of people with diabetes using older and current CGM systems and highlights areas of current satisfaction, concern, and future system improvement.
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Litvinova O, Eitenberger M, Bilir A, Yeung AWK, Parvanov ED, MohanaSundaram A, Horbańczuk JO, Atanasov AG, Willschke H. Patent analysis of digital sensors for continuous glucose monitoring. Front Public Health 2023; 11:1205903. [PMID: 37621612 PMCID: PMC10445130 DOI: 10.3389/fpubh.2023.1205903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
The high need for optimal diabetes management among an ever-increasing number of patients dictates the development and implementation of new digital sensors for continuous glucose monitoring. The purpose of this work is to systematize the global patenting trends of digital sensors for continuous glucose monitoring and analyze their effectiveness in controlling the treatment of diabetes patients of different ages and risk groups. The Lens database was used to build the patent landscape of sensors for continuous glucose monitoring. Retrospective analysis showed that the patenting of sensors for continuous glucose monitoring had positive trend over the analyzed period (2000-2022). Leading development companies are Dexcom Inc., Abbott Diabetes Care Inc., Medtronic Minimed Inc., Roche Diabetes Care Inc., Roche Diagnostics Operations Inc., Roche Diabetes Care Gmbh, and Ascensia Diabetes Care Holdings Ag, among others. Since 2006, a new approach has emerged where digital sensors are used for continuous glucose monitoring, and smartphones act as receivers for the data. Additionally, telemedicine communication is employed to facilitate this process. This opens up new opportunities for assessing the glycemic profile (glycemic curve information, quantitative assessment of the duration and amplitude of glucose fluctuations, and so on), which may contribute to improved diabetes management. A number of digital sensors for minimally invasive glucose monitoring are patented, have received FDA approval, and have been on the market for over 10 years. Their effectiveness in the clinic has been proven, and advantages and disadvantages have been clarified. Digital sensors offer a non-invasive option for monitoring blood glucose levels, providing an alternative to traditional invasive methods. This is particularly useful for patients with diabetes who require frequent monitoring, including before and after meals, during and after exercise, and in other scenarios where glucose levels can fluctuate. However, non-invasive glucose measurements can also benefit patients without diabetes, such as those following a dietary treatment plan, pregnant women, and individuals during fasting periods like Ramadan. The availability of non-invasive monitoring is especially valuable for patients in high-risk groups and across different age ranges. New world trends have been identified in the patenting of digital sensors for non-invasive glucose monitoring in interstitial skin fluid, saliva, sweat, tear fluid, and exhaled air. A number of non-invasive devices have received the CE mark approval, which confirms that the items meet European health, safety, and environmental protection standards (TensorTip Combo-Glucometer, Cnoga Medical Ltd.; SugarBEAT, Nemaura Medical; GlucoTrack, GlucoTrack Inc.), but are not FDA-approved yet. The above-mentioned sensors have characteristics that make them popular in the treatment of diabetes: they do not require implantation, do not cause an organism reaction to a foreign body, and are convenient to use. In the EU, in order to increase clinical safety and the level of transparency about medical devices, manufacturers must obtain certificates in accordance with Regulation (EU) 2017/745, taking into account the transition period. The development of systems, which include digital sensors for continuous glucose monitoring, mobile applications, and web platforms for professional analysis of glycemic control and implementation of unified glycemic assessment principles in mobile healthcare, represent promising approaches for controlling glycaemia in patients.
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Affiliation(s)
- Olena Litvinova
- Department of Management and Quality Assurance in Pharmacy, National University of Pharmacy of the Ministry of Health of Ukraine, Kharkiv, Ukraine
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Magdalena Eitenberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Aylin Bilir
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Andy Wai Kan Yeung
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Division of Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Emil D. Parvanov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria
| | | | - Jarosław Olav Horbańczuk
- Department of Biotechnology and Nutrigenomics, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Biotechnology and Nutrigenomics, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
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Khadem H, Nemat H, Elliott J, Benaissa M. Blood Glucose Level Time Series Forecasting: Nested Deep Ensemble Learning Lag Fusion. Bioengineering (Basel) 2023; 10:bioengineering10040487. [PMID: 37106674 PMCID: PMC10135844 DOI: 10.3390/bioengineering10040487] [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: 03/21/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Blood glucose level prediction is a critical aspect of diabetes management. It enables individuals to make informed decisions about their insulin dosing, diet, and physical activity. This, in turn, improves their quality of life and reduces the risk of chronic and acute complications. One conundrum in developing time-series forecasting models for blood glucose level prediction is to determine an appropriate length for look-back windows. On the one hand, studying short histories foists the risk of information incompletion. On the other hand, analysing long histories might induce information redundancy due to the data shift phenomenon. Additionally, optimal lag lengths are inconsistent across individuals because of the domain shift occurrence. Therefore, in bespoke analysis, either optimal lag values should be found for each individual separately or a globally suboptimal lag value should be used for all. The former approach degenerates the analysis's congruency and imposes extra perplexity. With the latter, the fine-tunned lag is not necessarily the optimum option for all individuals. To cope with this challenge, this work suggests an interconnected lag fusion framework based on nested meta-learning analysis that improves the accuracy and precision of predictions for personalised blood glucose level forecasting. The proposed framework is leveraged to generate blood glucose prediction models for patients with type 1 diabetes by scrutinising two well-established publicly available Ohio type 1 diabetes datasets. The models developed undergo vigorous evaluation and statistical analysis from mathematical and clinical perspectives. The results achieved underpin the efficacy of the proposed method in blood glucose level time-series prediction analysis.
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Affiliation(s)
- Heydar Khadem
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield S10 2TN, UK
| | - Hoda Nemat
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield S10 2TN, UK
| | - Jackie Elliott
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2TN, UK
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK
| | - Mohammed Benaissa
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield S10 2TN, UK
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Menzen M. [It's a new world: Improvement of diabetes therapy through digital and technical innovations]. Dtsch Med Wochenschr 2023; 148:288-293. [PMID: 36878226 DOI: 10.1055/a-1911-2926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Medical progress is increasingly characterized by digital and technical solutions that improve and facilitate treatment of our patients. Especially diabetes therapy is an ideal field for digital and technical solutions. The complexity of insulin therapy with the need to take multiple variables into account is a brilliant example for the use of digital support processes. This article gives an overview of the current state of telemedicine during corona pandemic and diabetes Apps to improve mental health and self support in people with diabetes as well as to simplify documentation. In the field of technical solutions at first continuous glucose monitoring and smart pen technology will be presented with their potential to increase time in range, reduce the frequency of hypoglycemia and improve glycemic management. As next topic automated insulin delivery as current gold standard and possibilities to further improve glycemic control in future. Last wearables in the diabetes field to improve diabetes therapy as well as the management of diabetes complications. All these aspects show the importance of technical and digital supported therapies for treatment and glycemic management in people with diabetes in Germany.
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Affiliation(s)
- Markus Menzen
- Abteilung für Innere Medizin, Diabetologie, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
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Zhang G, Romo-Anselmo E, Kwa T, Cohen O, Vigersky R, Chattaraj S. Advances in Insulin Infusion Set in the New Era of Automated Insulin Delivery: A Systematic Review. J Diabetes Sci Technol 2023; 17:302-313. [PMID: 36562593 PMCID: PMC10012377 DOI: 10.1177/19322968221145731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Automated insulin delivery (AID) has become a well-known research topic devoted to achieving better glycemic outcomes. AID systems consist primarily of three components: the continuous glucose monitoring system, the insulin delivery system, either tethered or patch pump, and the control system (algorithm). A key component in the tethered pump AID system is the insulin infusion set (IIS). This Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) study was conducted to evaluate the IIS evolution in the era of AID and to provide future perspectives of IIS clinical use. METHODS Literature searches for articles published from January 2016 to July 2022 were performed in Embase/Medline and PubMed. Data were extracted following PRISMA guidelines. Primary meta-analysis outcomes were IIS wear duration, total daily dose of insulin, and IIS failure reasons/modes. RESULTS We identified 387 publications, of which 15 eligible studies compared various IISs comprising over 1400 participants and >53 000 wears. Half of the studies published in 2022 were focused on extended IISs designed for wear durations of seven days or more. Three clinical trials have demonstrated the safe use of extended IISs to seven days of wear in individuals with type 1 diabetes, and two also demonstrated good glycemic control throughout the seven-day use. CONCLUSIONS Research in insulin infusion technology has increased in the last six years, and extended IISs have demonstrated improved overall performance, particularly in duration of wear. Paths for future products are discussed with an emphasis on understanding the existing barriers related to both technical and nontechnical issues.
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Affiliation(s)
| | | | - Tim Kwa
- Medtronic Diabetes, Northridge, CA,
USA
| | - Ohad Cohen
- Medtronic Diabetes, Northridge, CA,
USA
- Medtronic International Trading Sàrl,
Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Hamdy O, Al Sifri S, Hassanein M, Al Dawish M, Al-Dahash RA, Alawadi F, Jarrah N, Ballout H, Hegazi R, Amin A, Mechanick JI. The Transcultural Diabetes Nutrition Algorithm: A Middle Eastern Version. Front Nutr 2022; 9:899393. [PMID: 35769383 PMCID: PMC9235861 DOI: 10.3389/fnut.2022.899393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/04/2022] [Indexed: 12/02/2022] Open
Abstract
Diabetes prevalence is on the rise in the Middle East. In countries of the Gulf region-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates-prevalence rates are among the highest in the world. Further, Egypt now ranks as one of the top 10 countries in the world for high number of people with diabetes. Medical nutrition therapy is key to optimal management of diabetes. Patient adherence to nutritional guidance depends on advice that is tailored to regional foods and cultural practices. In 2012, international experts created a transcultural Diabetes Nutrition Algorithm (tDNA) for broad applicability. The objective of this current project was to adapt the algorithm and supportive materials to the Middle East region. A Task Force of regional and global experts in the fields of diabetes, obesity, and metabolic disorders met to achieve consensus on Middle East-specific adaptations to the tDNA. Recommendations, position statements, figures, and tables are presented here, representing conclusions of the tDNA-Middle Eastern (tDNA-ME) Task Force. Educational materials can be used to help healthcare professionals optimize nutritional care for patients with type 2 diabetes. The tDNA-ME version provides evidence-based guidance on how to meet patients' nutritional needs while following customs of people living in the Middle Eastern region.
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Affiliation(s)
- Osama Hamdy
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, United States
| | | | | | | | - Raed A. Al-Dahash
- Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz for Health Science, Riyadh, Saudi Arabia
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | | | - Refaat Hegazi
- Abbott Laboratories, Nutrition Division, Research & Development Department, Columbus, OH, United States
| | - Ahmed Amin
- Abbott Laboratories, Dubai, United Arab Emirates
| | - Jeffrey I. Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, NY, United States
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