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Thomas A, Haak T, Tombek A, Kulzer B, Ehrmann D, Kordonouri O, Kröger J, Schubert-Olesen O, Kolassa R, Siegmund T, Haller N, Heinemann L. How to Use Continuous Glucose Monitoring Efficiently in Diabetes Management: Opinions and Recommendations by German Experts on the Status and Open Questions. J Diabetes Sci Technol 2024:19322968241267768. [PMID: 39129243 DOI: 10.1177/19322968241267768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Today, continuous glucose monitoring (CGM) is a standard diagnostic option for patients with diabetes, at least for those with type 1 diabetes and those with type 2 diabetes on insulin therapy, according to international guidelines. The switch from spot capillary blood glucose measurement to CGM was driven by the extensive and immediate support and facilitation of diabetes management CGM offers. In patients not using insulin, the benefits of CGM are not so well studied/obvious. In such patients, factors like well-being and biofeedback are driving CGM uptake and outcome. Apps can combine CGM data with data about physical activity and meal consumption for therapy adjustments. Personalized data management and coaching is also more feasible with CGM data. The same holds true for digitalization and telemedicine intervention ("virtual diabetes clinic"). Combining CGM data with Smart Pens ("patient decision support") helps to avoid missing insulin boluses or insulin miscalculation. Continuous glucose monitoring is a major pillar of all automated insulin delivery systems, which helps substantially to avoid acute complications and achieve more time in the glycemic target range. These options were discussed by a group of German experts to identify concrete gaps in the care structure, with a view to the necessary structural adjustments of the health care system.
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Affiliation(s)
| | - Thomas Haak
- Diabetes consulting, Mergentheim Diabetes Center, Bad Mergentheim, Germany
| | - Astrid Tombek
- Diabetes consulting, Mergentheim Diabetes Center, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Diabetes consulting, Mergentheim Diabetes Center, Bad Mergentheim, Germany
- FIDAM, Forschungsinstitut Diabetes-Akademie Mergentheim (Diabetes Academy Mergentheim Research Institute), Bad Mergentheim, Germany
| | - Dominic Ehrmann
- FIDAM, Forschungsinstitut Diabetes-Akademie Mergentheim (Diabetes Academy Mergentheim Research Institute), Bad Mergentheim, Germany
| | - Olga Kordonouri
- AUF DER BULT Hospital, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Jens Kröger
- Diabetes, Hamburg City Diabetes Center, Hamburg, Germany
| | | | - Ralf Kolassa
- Diabetes, Diabetes Focus Practice Bergheim/Erft, Bergheim/Erft, Germany
| | | | - Nicola Haller
- Diabetes, Diabetes & Metabolic Center Starnberg, Starnberg, Germany
| | - Lutz Heinemann
- Science Consulting in Diabetes GmbH, Düsseldorf, Germany
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Tidemand KG, Laugesen C, Ranjan AG, Skovhus LB, Nørgaard K. Frequency of Rebound Hyperglycemia in Adults with Type 1 Diabetes Treated with Different Insulin Delivery Modalities. Diabetes Technol Ther 2024. [PMID: 39052322 DOI: 10.1089/dia.2024.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: For people with type 1 diabetes (T1D), ensuring fast and effective recovery from hypoglycemia while avoiding posthypoglycemic hyperglycemia (rebound hyperglycemia, RH) can be challenging. The objective of this study was to investigate the frequency of RH across different treatment modalities and its impact on glycemic control. Methods: This cross-sectional real-world study included adults with T1D using continuous glucose monitoring and attending the outpatient clinic at Steno Diabetes Center Copenhagen. RH was defined as ≥1 sensor glucose value (SG) >10.0 mmol/L (180 mg/dL) starting within 2 h of an antecedent SG <3.9 mmol/L (70 mg/dL). The severity of the RH events was calculated as area under the curve (AUC) and separately for users of multiple daily injections (MDIs), unintegrated insulin pumps, sensor augmented pumps (SAPs), and automated insulin delivery (AID), respectively. Results: Across the four groups, SAP and AID users had the highest incidence of RH (2.06 ± 1.65 and 2.08 ± 1.49 events per week, respectively) and a similar percentage of hypoglycemic events leading to RH events (41.3 ± 22.8% and 39.6 ± 20.1%, respectively). The AID users with RH events were significantly shorter compared with MDI users (122 ± 72 vs. 185 ± 135 min; P < 0.0001). Overall, severity of RH was inversely associated with more advanced technology (P < 0.001) and inversely associated (P < 0.001) with time in target range (TIR). Conclusions: Groups with insulin suspension features experienced the highest frequency of RH; however, AID users tended to experience shorter and less severe RH events. The association between the severity of RH events and TIR suggests that RH should be assessed and used in the guidance of hypoglycemia management.
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Affiliation(s)
| | - Christian Laugesen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | | | | | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
- Departement of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ortiz-Zúñiga A, Amigó J, Sánchez M, Abad M, Simó R, Hernández C, Simó-Servat O. Impact in real-world of intermittent-scanned continuous glucose monitoring with alarms on hypoglycemia and its recognition in type 1 diabetes. Diabetes Res Clin Pract 2024; 214:111786. [PMID: 39029746 DOI: 10.1016/j.diabres.2024.111786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Recent studies have demonstrated that real-time CGM use reduce the incidence severe hypoglycemic events and impaired awareness of hypoglycemia (IAH) However, there are few real-world studies evaluating the effect of intermittently scanned continuous glucose monitoring (isCGM) on hypoglycemic episodes and hypoglycemia unawareness (IAH). The present study was designed to cover this research-practice gap. METHODS This is a real-world, observational, prospective cohort study with 2 years of follow-up in which 60 subjects with T1D who experienced frequent hypoglycemic events were included. All the patients were invited to use isCGM type Abbott FreeStyle Libre 2® on a continuous basis for 2 years. Glucometric parameters were obtained during the initial 2 weeks using isCGM and compared with data collected for the same period at 1 year and at the end of follow-up. The IAH was evaluated using the Clarke questionnaire, and to assess psychological aspects related to hypoglycemia the Hypoglycemia Fear Survey (HFS) was used. RESULTS After 2-years of follow-up using isCGM, we observed a decrease in glucose variability (40.3 ± 0.8 % vs. 37.1 ± 0.9 %, p = 0.003), time in low glucose range (54-69 mg/dL) (5.2 ± 0.4 % vs. 3.6 ± 0.3 %, p = 0.001), time in very low glucose range (<54 mg/dL) (3.2 ± 0.5 % vs. 0.8 ± 0.2 %, p < 0.001), less events related to low glucose levels (10.6 ± 1.1 vs 8.0 ± 1.0, p = 0.042) and a short duration of hypoglycemia episodes (106.1 ± 5.9 min vs. 85.7 ± 5.7 min, p = 0.008). In addition, participants presented a reduction of 47 % in the frequency of IAH, assessed by the Clarke questionnaire scores (24.6 % vs. 11.6 %, p = 0.034), as well as hypoglycemia fear (77.8 ± 2.4 vs 68.2 ± 2.1, p < 0.001). Furthermore, a reduction in total insulin dose was also observed (0.64 ± 0.30 UI/Kg/day vs 0.56 ± 0.11 UI/Kg/day, p = 0.018). CONCLUSIONS In the real-world, long-term use of isCGM could reduce both hypoglycemic episodes and IAH in people with T1D.
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Affiliation(s)
- A Ortiz-Zúñiga
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
| | - J Amigó
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
| | - M Sánchez
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain.
| | - M Abad
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain.
| | - R Simó
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
| | - C Hernández
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
| | - O Simó-Servat
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
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Yoo JH, Moon SJ, Park CY, Kim JH. Differences Between Glycated Hemoglobin and Glucose Management Indicator in Real-Time and Intermittent Scanning Continuous Glucose Monitoring in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241262106. [PMID: 39075889 DOI: 10.1177/19322968241262106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND This study demonstrates the difference between glucose management indicator (GMI) and glycated hemoglobin (HbA1c) according to sensor mean glucose and HbA1c status using 2 continuous glucose monitoring (CGM) sensors in people with type 1 diabetes. METHODS A total of 275 subjects (117 Dexcom G6 [G6] and 158 FreeStyle Libre 1 [FL]) with type 1 diabetes was included. The G6 and FL sensors were used, respectively, over 90 days to analyze 682 and 515 glycemic profiles that coincide with HbA1c. RESULTS The mean HbA1c was 6.6% in Dexcom G6 and 7.2% in FL profiles. In G6 profiles, GMI was significantly higher than HbA1c irrespective of mean glucose (all P < .001, mean difference: 0.58% ± 0.49%). The GMI was significantly higher than the given HbA1c when HbA1c was below 8.0% (all P < .001). The discordance was the highest at 0.9% for lower HbA1c values (5.0%-5.9%). The proportion of discordance >0.5% improved from 60.1% to 30.9% when using the revised GMI equation in G6 profiles. In FL profile, the overall mean difference between GMI and HbA1c was 0 (P = .966). The GMI was significantly lower by 0.9% than HbA1c of 9.0% to 9.9% and higher by 0.5% in HbA1c of 5.0% to 5.9% (all P < .001). CONCLUSIONS The GMI is overestimated in G6 users, particularly those with well-controlled diabetes, but the GMI and HbA1c discordance improved with a revised equation from the observed data. The FL profile showed greater discordance for lower HbA1c levels or higher HbA1c levels.
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Affiliation(s)
- Jee Hee Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sun Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Mameli C, Smylie GM, Marigliano M, Zagaroli L, Mancioppi V, Maffeis C, Salpietro V, Zuccotti G, Delvecchio M. Safety and Psychological Outcomes of Tandem t:Slim X2 Insulin Pump with Control-IQ Technology in Children, Adolescents, and Young Adults with Type 1 Diabetes: A Systematic Review. Diabetes Ther 2024:10.1007/s13300-024-01618-2. [PMID: 39008237 DOI: 10.1007/s13300-024-01618-2] [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: 05/31/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
The Tandem t:slim X2 insulin pump is a second-generation automated insulin delivery system with Control-IQ technology. It consists of an X2 insulin pump, an integrated Dexcom sensor, and an embedded 'Control-IQ' algorithm, which predicts glucose levels 30 min in the future, adapting the programmed basal insulin rates to get glucose levels between 112.5 and 160 mg/dl (8.9 mmol/l). The system delivers automatic correction boluses of insulin when glucose levels are predicted to rise > 180 mg/dl (10 mmol/l). It has been commercially available since 2016. We reviewed the current evidence about the psychological, safety, and exercise-related outcomes of this device in children, adolescents, and young adults living with type 1 diabetes. We screened 552 papers, but only 21 manuscripts were included in this review. Fear of hypoglycemia is significantly reduced in young people with diabetes and their parents. Interestingly, diabetes-related distress is decreased; thus, the system is well accepted by the users. The sleeping quality of subjects living with diabetes and their caregivers is improved to a lesser extent as well. Despite the small number of data, this system is associated with a low rate of exercise-related hypoglycemia. Finally, evidence from the literature shows that this system is safe and effective in improving psychological personal outcomes. Even if further steps toward the fully closed loop are still mandatory, this second-generation automated insulin delivery system reduces the burden of diabetes. It properly addresses most psychological issues in children, adolescents, and young adults with type 1 diabetes mellitus; thus, it appears to be well accepted.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Università Di Milano, Milan, Italy
| | | | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics, and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - Luca Zagaroli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valentina Mancioppi
- Department of Surgery, Dentistry, Pediatrics, and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics, and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Università Di Milano, Milan, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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Miller E, Chuang JS, Roberts GJ, Nabutovsky Y, Virdi N, Wright EE. Association of Changes in A1C Following Continuous Glucose Monitoring Acquisition in People with Sub-Optimally Treated Type 2 Diabetes Taking GLP-1 RA Therapy. Diabetes Ther 2024:10.1007/s13300-024-01619-1. [PMID: 39008235 DOI: 10.1007/s13300-024-01619-1] [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: 04/26/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Both glucagon-like peptide-1 receptor agonists (GLP-1 RA) and continuous glucose monitoring (CGM) improve glycemia in patients with type 2 diabetes (T2D). However, it is unknown whether adding CGM to GLP-1 RA therapy further improves A1c. We evaluated changes in A1c levels 6 months after initiation of FreeStyle Libre (FSL) in adults with sub-optimally controlled T2D already on GLP-1 RA therapy. METHODS This retrospective, observational study used Optum's de-identified Market Clarity Data, a linked electronic health record-claims database to assess changes in A1c after FSL acquisition. Inclusion criteria were T2D diagnosis, ≥ 18 years, baseline A1c ≥ 8%, with the first FSL acquisition between 2018 and 2022. Patients were required to be on GLP-1 RA prior to FSL with at least one GLP-1 RA prescription within 90 days of FSL acquisition. GLP-1 RA initiation was defined as the earliest GLP-1 RA prescription from 2017 onwards. Paired changes in A1c were assessed at 6 months after initial FSL acquisition. RESULTS The study cohort included 1454 adults with T2D (age 55 ± 10 years, 52% male, 38% with intensive insulin therapy, median 471 days from GLP-1 RA initiation to FSL, and baseline A1c 9.8 ± 1.5%). After FSL acquisition, patients experienced an A1c decrease of 1.5 ± 1.9% (p < 0.001). Patients with a baseline A1c > 10% had the largest reduction (n = 497, - 2.7 ± 2.2%, p < 0.001). Significant improvements were observed in subgroups based on insulin therapy and GLP-1 RA formulation. Those initiating GLP-1 RA therapy > 24 months before FSL acquisition also showed improvements in A1c (n = 478; - 1.3 ± 1.7%, p < 0.001). CONCLUSIONS In a large, real-world study of adults with T2D, those on prior GLP-1 RA therapy experienced significant A1c improvements after acquiring FSL, irrespective of GLP-1 RA duration, GLP-1 RA formulation, or insulin therapy type. These findings support the use of FSL in adults with T2D treated with GLP-1 RA.
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Affiliation(s)
- Eden Miller
- Diabetes and Obesity Care LLC, Bend, OR, 97702, USA
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Kim JY, Jin SM, Sim KH, Kim BY, Cho JH, Moon JS, Lim S, Kang ES, Park CY, Kim SG, Kim JH. Continuous glucose monitoring with structured education in adults with type 2 diabetes managed by multiple daily insulin injections: a multicentre randomised controlled trial. Diabetologia 2024; 67:1223-1234. [PMID: 38639876 DOI: 10.1007/s00125-024-06152-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
AIMS/HYPOTHESIS The aim of this study was to compare the effectiveness of stand-alone intermittently scanned continuous glucose monitoring (isCGM) with or without a structured education programme and blood glucose monitoring (BGM) in adults with type 2 diabetes on multiple daily insulin injections (MDI). METHODS In this 24 week randomised open-label multicentre trial, adults with type 2 diabetes on intensive insulin therapy with HbA1c levels of 58-108 mmol/mol (7.5-12.0%) were randomly assigned in a 1:1:1 ratio to isCGM with a structured education programme on adjusting insulin dose and timing according to graphical patterns in CGM (intervention group), isCGM with conventional education (control group 1) or BGM with conventional education (control group 2). Block randomisation was conducted by an independent statistician. Due to the nature of the intervention, blinding of participants and investigators was not possible. The primary outcome was change in HbA1c from baseline at 24 weeks, assessed using ANCOVA with the baseline value as a covariate. RESULTS A total of 159 individuals were randomised (n=53 for each group); 148 were included in the full analysis set, with 52 in the intervention group, 49 in control group 1 and 47 in control group 2. The mean (± SD) HbA1c level at baseline was 68.19±10.94 mmol/mol (8.39±1.00%). The least squares mean change (± SEM) from baseline HbA1c at 24 weeks was -10.96±1.35 mmol/mol (-1.00±0.12%) in the intervention group, -6.87±1.39 mmol/mol (-0.63±0.13%) in control group 1 (p=0.0367 vs intervention group) and -6.32±1.42 mmol/mol (-0.58±0.13%) in control group 2 (p=0.0193 vs intervention group). Adverse events occurred in 28.85% (15/52) of individuals in the intervention group, 26.42% (14/53) in control group 1 and 48.08% (25/52) in control group 2. CONCLUSIONS/INTERPRETATION Stand-alone isCGM offers a greater reduction in HbA1c in adults with type 2 diabetes on MDI when education on the interpretation of graphical patterns in CGM is provided. TRIAL REGISTRATION ClinicalTrials.gov NCT04926623. FUNDING This study was supported by Daewoong Pharmaceutical Co., Ltd.
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Affiliation(s)
- Ji Yoon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kang Hee Sim
- Diabetes Education Unit, Diabetes Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Galindo RJ, Aleppo G, Parkin CG, Baidal DA, Carlson AL, Cengiz E, Forlenza GP, Kruger DF, Levy C, McGill JB, Umpierrez GE. Increase Access, Reduce Disparities: Recommendations for Modifying Medicaid CGM Coverage Eligibility Criteria. J Diabetes Sci Technol 2024; 18:974-987. [PMID: 36524477 PMCID: PMC11307217 DOI: 10.1177/19322968221144052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Numerous studies have demonstrated the clinical value of continuous glucose monitoring (CGM) in type 1 diabetes (T1D) and type 2 diabetes (T2D) populations. However, the eligibility criteria for CGM coverage required by the Centers for Medicare & Medicaid Services (CMS) ignore the conclusive evidence that supports CGM use in various diabetes populations that are currently deemed ineligible. In an earlier article, we discussed the limitations and inconsistencies of the agency's CGM eligibility criteria relative to current scientific evidence and proposed practice solutions to address this issue and improve the safety and care of Medicare beneficiaries with diabetes. Although Medicaid is administered through CMS, there is no consistent Medicaid policy for CGM coverage in the United States. This article presents a rationale for modifying and standardizing Medicaid CGM coverage eligibility across the United States.
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Affiliation(s)
- Rodolfo J. Galindo
- Emory University School of Medicine, Atlanta, GA, USA
- Center for Diabetes Metabolism Research, Emory University Hospital Midtown, Atlanta, GA, USA
- Hospital Diabetes Taskforce, Emory Healthcare System, Atlanta, GA, USA
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - David A. Baidal
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anders L. Carlson
- International Diabetes Center, Minneapolis, MN, USA
- Regions Hospital & HealthPartners Clinics, St. Paul, MN, USA
- Diabetes Education Programs, HealthPartners and Stillwater Medical Group, Stillwater, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eda Cengiz
- Pediatric Diabetes Program, Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory P. Forlenza
- Barbara Davis Center, Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Denver, Denver, CO, USA
| | - Davida F. Kruger
- Division of Endocrinology, Diabetes, Bone & Mineral, Henry Ford Health System, Detroit, MI, USA
| | - Carol Levy
- Division of Endocrinology, Diabetes, and Metabolism, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Diabetes Center and T1D Clinical Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janet B. McGill
- Division of Endocrinology, Metabolism & Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Guillermo E. Umpierrez
- Division of Endocrinology, Metabolism, Emory University School of Medicine, Atlanta, GA, USA
- Diabetes and Endocrinology, Grady Memorial Hospital, Atlanta, GA, USA
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Xu Y, Dunn TC, Bergenstal RM, Cheng A, Dabiri Y, Ajjan RA. Time in Range, Time in Tight Range, and Average Glucose Relationships Are Modulated by Glycemic Variability: Identification of a Glucose Distribution Model Connecting Glycemic Parameters Using Real-World Data. Diabetes Technol Ther 2024; 26:467-477. [PMID: 38315505 DOI: 10.1089/dia.2023.0564] [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: 02/07/2024]
Abstract
Background: Time in range (TIR), time in tight range (TITR), and average glucose (AG) are used to adjust glycemic therapies in diabetes. However, TIR/TITR and AG can show a disconnect, which may create management difficulties. We aimed to understand the factors influencing the relationships between these glycemic markers. Materials and Methods: Real-world glucose data were collected from self-identified diabetes type 1 and type 2 diabetes (T1D and T2D) individuals using flash continuous glucose monitoring (FCGM). The effects of glycemic variability, assessed as glucose coefficient of variation (CV), on the relationship between AG and TIR/TITR were investigated together with the best-fit glucose distribution model that addresses these relationships. Results: Of 29,164 FCGM users (16,367 T1D, 11,061 T2D, and 1736 others), 38,259 glucose readings/individual were available. Comparing low and high CV tertiles, TIR at AG of 150 mg/dL varied from 80% ± 5.6% to 62% ± 6.8%, respectively (P < 0.001), while TITR at AG of 130 mg/dL varied from 65% ± 7.5% to 49% ± 7.0%, respectively (P < 0.001). In contrast, higher CV was associated with increased TIR and TITR at AG levels outside the upper limit of these ranges. Gamma distribution was superior to six other models at explaining AG and TIR/TITR interactions and demonstrated nonlinear interplay between these metrics. Conclusions: The gamma model accurately predicts interactions between CGM-derived glycemic metrics and reveals that glycemic variability can significantly influence the relationship between AG and TIR with opposing effects according to AG levels. Our findings potentially help with clinical diabetes management, particularly when AG and TIR appear mismatched.
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Affiliation(s)
- Yongjin Xu
- Abbott Diabetes Care, Alameda, California, USA
| | | | - Richard M Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Alan Cheng
- Abbott Diabetes Care, Alameda, California, USA
| | | | - Ramzi A Ajjan
- The LIGHT Laboratories, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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10
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Moon JS, Kang S, Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, Seo JA, Kim MK, Lim JH, Song YJ, Yang YS, Kim JH, Lee YB, Noh J, Hur KY, Park JS, Rhee SY, Kim HJ, Kim HM, Ko JH, Kim NH, Kim CH, Ahn J, Oh TJ, Kim SK, Kim J, Han E, Jin SM, Bae J, Jeon E, Kim JM, Kang SM, Park JH, Yun JS, Cha BS, Moon MK, Lee BW. 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association. Diabetes Metab J 2024; 48:546-708. [PMID: 39091005 PMCID: PMC11307112 DOI: 10.4093/dmj.2024.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Jun Sung Moon
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Shinae Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Yoon Ju Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Ye Seul Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Suk Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Hae Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soo-Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eugene Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehyun Bae
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Eonju Jeon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seon Mee Kang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Hwan Park
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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11
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Rahim E, Rahim FO, Anzaar HF, Lalwani P, Jain B, Desai A, Palakodeti S. Culturally Tailored Strategies to Enhance Type 2 Diabetes Care for South Asians in the United States. J Gen Intern Med 2024:10.1007/s11606-024-08902-8. [PMID: 38943015 DOI: 10.1007/s11606-024-08902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 06/30/2024]
Abstract
South Asian immigrants in the United States face an elevated risk of developing type 2 diabetes (T2DM). This phenomenon has been linked to lifestyle factors and social determinants of health (SDOH) such as high-carbohydrate diet, limited physical activity, and stress from assimilation and other life challenges. Unfortunately, barriers stemming from language discordance, low health literacy, and certain cultural practices can hinder effective clinical management of T2DM among South Asian immigrants. In this perspective, we address these sociocultural barriers and propose culturally informed recommendations to improve healthcare delivery for South Asian groups and empower South Asian patients to self-manage T2DM. Our recommendations include (1) considerations and support for SDOH in South Asian communities, (2) culturally tailored healthcare delivery for South Asians, (3) mHealth technologies for T2DM education and self-management; and (4) enhanced epidemiological and South Asian-centric research.
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Affiliation(s)
| | | | | | | | - Bhav Jain
- Stanford University School of Medicine, Stanford, CA, USA
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12
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Lazar D, Tao M, Matievich W, Kastanos K, Dunn TC. Accuracy and Functionality of Select Continuous Glucose Monitoring Systems Are Not Impacted by Implantable Cardioverter Defibrillator Devices. J Diabetes Sci Technol 2024:19322968241260038. [PMID: 38907649 DOI: 10.1177/19322968241260038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
BACKGROUND Increasing numbers of individuals with diabetes are adopting use of continuous glucose monitoring (CGM) in their daily self-management. Many of these individuals have advanced heart disease. Implantable cardioverter defibrillator (ICD) devices can effectively reduce arrhythmic death and all-cause mortality in individuals with advanced heart disease. However, the potential impact of ICD devices on CGM system accuracy and functionality has not been well studied. METHODS This evaluation assessed whether FreeStyle Libre (FL) CGM systems can coexist and function within the same patient in the presence of wireless interference devices, including current ICD devices. Interferer sources included Wi-Fi devices, Bluetooth devices, cellular mobile devices, implantable medical devices, Bluetooth Low-Energy (BLE) devices, BLE accessory devices and BLE mobile devices, and ICD-programmer interferers. Five testing methodologies were used to evaluate the accuracy and functionality of the CGM systems when exposed to ICD functions: high-energy emergency shocking, pacing modes, anti-tachycardia pacing mode (ATP), and DC Fibber mode. RESULTS All acceptance criteria and testing requirements were met for the CGM and ICD system for wireless coexistence evaluation. CONCLUSIONS Our findings demonstrated that coexisting ICD devices and FL CGM systems provide safe and effective wireless communications with functional and accurate transfer of data during scenarios expected in clinical use.
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Affiliation(s)
- Dylan Lazar
- Cardiac Rhythm Management, Abbott, Sylmar, CA, USA
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13
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Plebani M, Nichols JH, Luppa PB, Greene D, Sciacovelli L, Shaw J, Khan AI, Carraro P, Freckmann G, Dimech W, Zaninotto M, Spannagl M, Huggett J, Kost GJ, Trenti T, Padoan A, Thomas A, Banfi G, Lippi G. Point-of-care testing: state-of-the art and perspectives. Clin Chem Lab Med 2024; 0:cclm-2024-0675. [PMID: 38880779 DOI: 10.1515/cclm-2024-0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
Point-of-care testing (POCT) is becoming an increasingly popular way to perform laboratory tests closer to the patient. This option has several recognized advantages, such as accessibility, portability, speed, convenience, ease of use, ever-growing test panels, lower cumulative healthcare costs when used within appropriate clinical pathways, better patient empowerment and engagement, and reduction of certain pre-analytical errors, especially those related to specimen transportation. On the other hand, POCT also poses some limitations and risks, namely the risk of lower accuracy and reliability compared to traditional laboratory tests, quality control and connectivity issues, high dependence on operators (with varying levels of expertise or training), challenges related to patient data management, higher costs per individual test, regulatory and compliance issues such as the need for appropriate validation prior to clinical use (especially for rapid diagnostic tests; RDTs), as well as additional preanalytical sources of error that may remain undetected in this type of testing, which is usually based on whole blood samples (i.e., presence of interfering substances, clotting, hemolysis, etc.). There is no doubt that POCT is a breakthrough innovation in laboratory medicine, but the discussion on its appropriate use requires further debate and initiatives. This collective opinion paper, composed of abstracts of the lectures presented at the two-day expert meeting "Point-Of-Care-Testing: State of the Art and Perspective" (Venice, April 4-5, 2024), aims to provide a thoughtful overview of the state-of-the-art in POCT, its current applications, advantages and potential limitations, as well as some interesting reflections on the future perspectives of this particular field of laboratory medicine.
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Affiliation(s)
- Mario Plebani
- Department of Medicine, University of Padova, Padova, Italy
| | - James H Nichols
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter B Luppa
- Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Dina Greene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Laura Sciacovelli
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Julie Shaw
- Eastern Ontario Regional Laboratories Association (EORLA), Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Adil I Khan
- Department of Pathology & Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Paolo Carraro
- Department of Laboratory Medicine, Venice Hospital, Venice, Italy
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Wayne Dimech
- National Serology Reference Laboratory, Melbourne, Australia
| | | | - Michael Spannagl
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jim Huggett
- National Measurement Laboratory, LGC, Teddington, UK
| | - Gerald J Kost
- POCT - CTR, Pathology and Laboratory Medicine, School of Medicine, University of California, CA, USA
| | - Tommaso Trenti
- Laboratory Medicine and Pathology Department AUSL e AOU Modena, Modena, Italy
| | - Andrea Padoan
- Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - Annette Thomas
- National PoCT Clinical Lead, National Pathology Programme, NHS Wales Executive, Cardiff, Wales, UK
| | - Giuseppe Banfi
- IRCCS Galeazzi-Sant'Ambrogio and Università Vita e Salute San Raffaele, Milan, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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14
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Selvin E. The Glucose Management Indicator: Time to Change Course? Diabetes Care 2024; 47:906-914. [PMID: 38295402 PMCID: PMC11116920 DOI: 10.2337/dci23-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/01/2023] [Indexed: 02/02/2024]
Abstract
Laboratory measurement of hemoglobin A1c (HbA1c) has, for decades, been the standard approach to monitoring glucose control in people with diabetes. Continuous glucose monitoring (CGM) is a revolutionary technology that can also aid in the monitoring of glucose control. However, there is uncertainty in how best to use CGM technology and its resulting data to improve control of glucose and prevent complications of diabetes. The glucose management indicator, or GMI, is an equation used to estimate HbA1c based on CGM mean glucose. GMI was originally proposed to simplify and aid in the interpretation of CGM data and is now provided on all standard summary reports (i.e., average glucose profiles) produced by different CGM manufacturers. This Perspective demonstrates that GMI performs poorly as an estimate of HbA1c and suggests that GMI is a concept that has outlived its usefulness, and it argues that it is preferable to use CGM mean glucose rather than converting glucose to GMI or an estimate of HbA1c. Leaving mean glucose in its raw form is simple and reinforces that glucose and HbA1c are distinct. To reduce patient and provider confusion and optimize glycemic management, mean CGM glucose, not GMI, should be used as a complement to laboratory HbA1c testing in patients using CGM systems.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD
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15
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Wright EE, Roberts GJ, Chuang JS, Nabutovsky Y, Virdi N, Miller E. Initiating GLP-1 Therapy in Combination with FreeStyle Libre Provides Greater Benefit Compared with GLP-1 Therapy Alone. Diabetes Technol Ther 2024. [PMID: 38669474 DOI: 10.1089/dia.2024.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background and Aim: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) therapy provides glycemic benefits to individuals with type 2 diabetes (T2D). However, the effects of GLP-1 RA therapy in combination with FreeStyle Libre systems (FSL) are unknown. This study aimed to compare changes in hemoglobin A1c (HbA1c) between people acquiring GLP-1 with FSL (GLP-1+FSL) versus GLP-1 without FSL (GLP-1). Methods: This real-world study used Optum's de-identified Market Clarity Data, a linked electronic health records (EHR)-claims database, and included adults with T2D and HbA1c ≥8% who acquired their first GLP-1 RA medication between 2018 and 2022. GLP-1+FSL subjects acquired their first FSL within ±30 days of their first GLP-1 acquisition. Cohorts were matched 1:5 on baseline insulin therapy, age, sex, baseline HbA1c, and GLP-1 type. Paired changes in HbA1c were compared between unmatched and matched groups at 6 months. Results: The study included 24,724 adults in the unmatched cohort (GLP-1+FSL, n = 478; GLP-1, n = 24,246). The matched cohort included 478 GLP-1+FSL users and 2,390 GLP-1 users: mean age 53.5 ± 11.8 and 53.5 ± 11.3 years, HbA1c 10.25 ± 1.68% and 10.22 ± 1.69%, respectively. HbA1c reduction was greater in the GLP-1+FSL group compared with the GLP-1 group in the unmatched cohort (-2.43% vs. -1.73%, difference 0.70%, P < 0.001, respectively) and in the matched cohort (-2.43% vs. -2.06%, difference 0.37%, P < 0.001). GLP-1+FSL vs. GLP-1 treatment was associated with greater HbA1c reduction in the intensive insulin (-2.32% vs. -1.50%), nonintensive insulin (-2.50% vs. -1.74%), and noninsulin group (-2.46% vs. -1.78%), as well as in patients using semaglutide (-2.73% vs. -1.92%) and dulaglutide (-2.45% vs. -1.71%) GLP-1 RA, all P < 0.001. Conclusions: Adults with suboptimally controlled T2D, initiating GLP-1 RA with FreeStyle Libre, had greater improvement in HbA1c compared with those treated with GLP-1 RA only. These results suggest an additional glycemic benefit of FSL when used with a GLP-1 RA in T2D treatment.
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Affiliation(s)
| | | | | | | | | | - Eden Miller
- Diabetes and Obesity Care LLC, Bend, Oregon, USA
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16
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Rosenstock J, Bajaj HS, Lingvay I, Heller SR. Clinical perspectives on the frequency of hypoglycemia in treat-to-target randomized controlled trials comparing basal insulin analogs in type 2 diabetes: a narrative review. BMJ Open Diabetes Res Care 2024; 12:e003930. [PMID: 38749508 PMCID: PMC11097869 DOI: 10.1136/bmjdrc-2023-003930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
The objective of this review was to comprehensively present and summarize trends in reported rates of hypoglycemia with one or two times per day basal insulin analogs in individuals with type 2 diabetes to help address and contextualize the emerging theoretical concern of increased hypoglycemic risk with once-weekly basal insulins.Hypoglycemia data were extracted from treat-to-target randomized clinical trials conducted during 2000-2022. Published articles were identified on PubMed or within the US Food and Drug Administration submission documents. Overall, 57 articles were identified: 44 assessed hypoglycemic outcomes in participants receiving basal-only therapy (33 in insulin-naive participants; 11 in insulin-experienced participants), 4 in a mixed population (insulin-naive and insulin-experienced participants) and 9 in participants receiving basal-bolus therapy. For the analysis, emphasis was placed on level 2 (blood glucose <3.0 mmol/L (<54 mg/dL)) and level 3 (or severe) hypoglycemia.Overall, event rates for level 2 or level 3 hypoglycemia across most studies ranged from 0.06 to 7.10 events/person-year of exposure (PYE) for participants receiving a basal-only insulin regimen; the rate for basal-bolus regimens ranged from 2.4 to 13.6 events/PYE. Rates were generally lower with second-generation basal insulins (insulin degludec or insulin glargine U300) than with neutral protamine Hagedorn insulin or first-generation basal insulins (insulin detemir or insulin glargine U100). Subgroup categorization by sulfonylurea usage, end-of-treatment insulin dose or glycated hemoglobin reduction did not show consistent trends on overall hypoglycemia rates. Hypoglycemia rates reported so far for once-weekly basal insulins are consistent with or lower than those reported for daily-administered basal insulin analogs.
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Affiliation(s)
| | | | - Ildiko Lingvay
- Endocrinology Division, Department of Internal Medicine and Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Simon R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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17
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González-Vidal T, Rivas-Otero D, Agüeria-Cabal P, Ramos-Ruiz G, Delgado E, Menéndez-Torre E. Continuous Glucose Monitoring Alarms in Adults with Type 1 Diabetes: User Characteristics and the Impact of Hypoglycemia and Hyperglycemia Alarm Thresholds on Glycemic Control. Diabetes Technol Ther 2024; 26:313-323. [PMID: 38156962 DOI: 10.1089/dia.2023.0460] [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: 01/03/2024]
Abstract
Background: Few studies have evaluated the implications of the alarm thresholds of continuous glucose monitoring (CGM) systems for individuals with diabetes. The present study aimed to investigate the influence of hypoglycemia and hyperglycemia alarm thresholds on glycemic control in adults with type 1 diabetes (T1DM) and the characteristics of patients who use these alarms more frequently. Methods: This observational cross-sectional study included 873 users of the FreeStyle Libre 2 system (501 men, median age 48 years, range 18-90 years) with T1DM from a single center. We investigated the role of demographic and metabolic factors on the use of alarms and the impact of hypoglycemia and hyperglycemia alarms and their thresholds on glycemic control. Results: Alarm users were older than nonusers (median age 49 vs. 43 years, respectively; P < 0.001). The hypoglycemia alarms were set by 76.1% of women and by 69.1% of men (P = 0.022). The hypoglycemia alarms reduced hypoglycemia features and glucose variability, although at the expense of shorter time in range. The higher the hypoglycemia alarm threshold, the greater these effects. The hyperglycemia alarms were effective in reducing hyperglycemia and lowering the glucose management indicator, although at the expense of a greater tendency to hypoglycemia. The lower the hyperglycemia alarm threshold, the greater these effects. Conclusions: CGM alarms contribute to better glycemic control. However, hypoglycemia and hyperglycemia alarms have advantages and disadvantages. Adults with T1DM should explore, under medical supervision, which alarm thresholds will best help them achieve their individual glycemic goals.
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Affiliation(s)
- Tomás González-Vidal
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Diego Rivas-Otero
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
| | - Pablo Agüeria-Cabal
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
| | - Guillermo Ramos-Ruiz
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
| | - Elías Delgado
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Edelmiro Menéndez-Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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18
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Gardner D, Lakkad M, Qiu Z, Inoue Y, Rama Chandran S, Wherry K. The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System Compared to Standard Management of Type 1 Diabetes in a Singapore Setting. Diabetes Technol Ther 2024; 26:324-334. [PMID: 38215206 PMCID: PMC11058413 DOI: 10.1089/dia.2023.0455] [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: 01/14/2024]
Abstract
Background: Despite advances in technology, glycemic outcomes in people with type 1 diabetes (T1D) remain suboptimal. The MiniMed 780G (MM780G) advanced hybrid closed-loop (AHCL) system is the latest technology for T1D management with established safety and efficacy. This study explores the cost-effectiveness of MM780G AHCL compared against multiple daily injections (MDI) plus intermittently scanned continuous glucose monitor (isCGM). Methods: A cost-utility analysis was conducted, simulating lifetime outcomes for 1000 T1D individuals, with baseline hemoglobin A1c of 8.4%, using the IQVIA Core Diabetes Model (CDM) v9.5. A Singapore health care payer perspective was taken with 2023 costs applied. Treatment effects were taken from the ADAPT study and treatment-related events from a combination of sources. T1D complication costs were derived from local literature, and health state utilities and disutilities from published literature. Scenario analyses and probabilistic sensitivity analyses (PSAs) explored uncertainty. Cost-effectiveness was assessed based on willingness-to-pay (WTP) thresholds set to Singapore Dollars (SGD) 45,000 (United States Dollars [USD] 33,087) per quality-adjusted life year (QALY) and Singapore's gross domestic product (GDP) per capita of SGD 114,165 (USD 83,941) per QALY. Results: A switch from MDI plus isCGM to MM780G resulted in expected gains in life-years (+0.78) and QALYs (+1.45). Cost savings through reduction in T1D complications (SGD 25,465; USD 18,723) partially offset the higher treatment costs in the AHCL arm (+SGD 74,538; +USD 54,805), resulting in an estimated incremental cost-effectiveness ratio of SGD 33,797 (USD 24,850) per QALY gained. Findings were robust, with PSA outputs indicating 81% and 99% probabilities of cost-effectiveness at the stated WTP thresholds. Conclusion: MM780G is a cost-effective option for people with T1D managed in a Singapore setting.
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Affiliation(s)
- Daphne Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | | | - Zhiyu Qiu
- Medtronic Singapore, Singapore, Singapore
| | - Yuta Inoue
- Medtronic Diabetes, Northridge, California, USA
| | | | - Kael Wherry
- Medtronic Diabetes, Northridge, California, USA
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19
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Yoo JH, Yang SH, Jin SM, Kim JH. Optimal Coefficient of Variance Threshold to Minimize Hypoglycemia Risk in Individuals with Well-Controlled Type 1 Diabetes Mellitus. Diabetes Metab J 2024; 48:429-439. [PMID: 38476023 PMCID: PMC11140403 DOI: 10.4093/dmj.2023.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/12/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGRUOUND This study investigated the optimal coefficient of variance (%CV) for preventing hypoglycemia based on real-time continuous glucose monitoring (rt-CGM) data in people with type 1 diabetes mellitus (T1DM) already achieving their mean glucose (MG) target. METHODS Data from 172 subjects who underwent rt-CGM for at least 90 days and for whom 439 90-day glycemic profiles were available were analyzed. Receiver operator characteristic analysis was conducted to determine the cut-off value of %CV to achieve time below range (%TBR)<54 mg/dL <1 and =0. RESULTS Overall mean glycosylated hemoglobin was 6.8% and median %TBR<54 mg/dL was 0.2%. MG was significantly higher and %CV significantly lower in profiles achieving %TBR<54 mg/dL <1 compared to %TBR<54 mg/dL ≥1 (all P<0.001). The cut-off value of %CV for achieving %TBR<54 mg/dL <1 was 37.5%, 37.3%, and 31.0%, in the whole population, MG >135 mg/dL, and ≤135 mg/dL, respectively. The cut-off value for %TBR<54 mg/dL=0% was 29.2% in MG ≤135 mg/dL. In profiles with MG ≤135 mg/dL, 94.2% of profiles with a %CV <31 achieved the target of %TBR<54 mg/dL <1, and 97.3% with a %CV <29.2 achieved the target of %TBR<54 mg/ dL=0%. When MG was >135 mg/dL, 99.4% of profiles with a %CV <37.3 achieved %TBR<54 mg/dL <1. CONCLUSION In well-controlled T1DM with MG ≤135 mg/dL, we suggest a %CV <31% to achieve the %TBR<54 mg/dL <1 target. Furthermore, we suggest a %CV <29.2% to achieve the target of %TBR<54 mg/dL =0 for people at high risk of hypoglycemia.
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Affiliation(s)
- Jee Hee Yoo
- Division of Endocrinology and Metabolism, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Seung Hee Yang
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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20
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Visser MM, Charleer S, Fieuws S, De Block C, Hilbrands R, Van Huffel L, Maes T, Vanhaverbeke G, Dirinck E, Myngheer N, Vercammen C, Nobels F, Keymeulen B, Mathieu C, Gillard P. The Impact of Baseline User Characteristics on the Benefits of Real-Time Versus Intermittently Scanned Continuous Glucose Monitoring in Adults With Type 1 Diabetes: Moderator Analyses of the ALERTT1 Trial. J Diabetes Sci Technol 2024; 18:660-666. [PMID: 36172693 PMCID: PMC11089880 DOI: 10.1177/19322968221128315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND ALERTT1 showed that switching from intermittently scanned continuous glucose monitoring (isCGM) without alerts to real-time CGM (rtCGM) with alert functionality improved time in range (TIR; 70-180 mg/dL), glycated hemoglobin (HbA1c), time <54 mg/dL, and Hypoglycemia Fear Survey version II worry subscale (HFS-worry) score after six months in adults with type 1 diabetes (T1D). Moderator analyses aimed to identify certain subgroups that would benefit more from switching to rtCGM than others. METHODS Post hoc analyses of ALERTT1 evaluated the impact of 14 baseline characteristics on the difference (delta) in mean TIR, HbA1c, time <54 mg/dL, and HFS-worry score at six months between rtCGM and isCGM. Therefore, the delta was allowed to depend on each of these variables by including interactions in the moderator analysis model. Analyses were performed separately for each variable; variables with P < .10 in the univariable analysis were combined into a single model. RESULTS Univariable analyses showed no dependency of delta TIR, HbA1c, or time <54 mg/dL on variables other than CGM type. Only delta HFS-worry score depended on baseline HbA1c (P = .0059), indicating less worries with rtCGM in people with baseline HbA1c <6.5% or ≥8%. Given P < .10 for dependency of delta TIR on insulin therapy type (favoring multiple daily injections), baseline HbA1c, and baseline TIR, these variables were combined into a multivariable analysis; interactions were not statistically significant. CONCLUSIONS Except for HFS-worry score, no interactions between 14 baseline characteristics and the six-month intervention effect of rtCGM on TIR, HbA1c, or time <54 mg/dL were observed, supporting the conclusion of ALERTT1 that switching from isCGM without alerts to rtCGM with alert functionality is beneficial for a wide range of people with T1D.
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Affiliation(s)
| | - Sara Charleer
- Department of Endocrinology, University Hospitals Leuven – KU Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and University of Hasselt, Leuven, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, University Hospital Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Robert Hilbrands
- Academic Hospital and Diabetes Research Centre, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Toon Maes
- Department of Endocrinology, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium
| | | | - Eveline Dirinck
- Department of Endocrinology-Diabetology-Metabolism, University Hospital Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nele Myngheer
- Department of Endocrinology, AZ Groeninge, Kortrijk, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium
| | - Frank Nobels
- Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium
| | - Bart Keymeulen
- Academic Hospital and Diabetes Research Centre, Vrije Universiteit Brussel, Brussels, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven – KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven – KU Leuven, Leuven, Belgium
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21
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Lee MH, Gooley J, Obeyesekere V, Lu J, Paldus B, Hendrieckx C, MacIsaac RJ, McAuley SA, Speight J, Vogrin S, Jenkins AJ, Holmes-Walker DJ, O'Neal DN, Ward GM. Hybrid Closed Loop in Adults With Type 1 Diabetes and Severely Impaired Hypoglycemia Awareness. J Diabetes Sci Technol 2024:19322968241245627. [PMID: 38613225 DOI: 10.1177/19322968241245627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Benefits of hybrid closed-loop (HCL) systems in a high-risk group with type 1 diabetes and impaired awareness of hypoglycemia (IAH) have not been well-explored. METHODS Adults with Edmonton HYPO scores ≥1047 were randomized to 26-weeks HCL (MiniMed™ 670G) vs standard therapy (multiple daily injections or insulin pump) without continuous glucose monitoring (CGM) (control). Primary outcome was percentage CGM time-in-range (TIR; 70-180 mg/dL) at 23 to 26 weeks post-randomization. Major secondary endpoints included magnitude of change in counter-regulatory hormones and autonomic symptom responses to hypoglycemia at 26-weeks post-randomization. A post hoc analysis evaluated glycemia risk index (GRI) comparing HCL with control groups at 26 weeks post-randomization. RESULTS Nine participants (median [interquartile range (IQR)] age 51 [41, 59] years; 44% male; enrolment HYPO score 1183 [1058, 1308]; Clarke score 6 [6, 6]; n = 5 [HCL]; n = 4 [control]) completed the study. Time-in-range was higher using HCL vs control (70% [68, 74%] vs 48% [44, 50%], P = .014). Time <70 mg/dL did not differ (HCL 3.8% [2.7, 3.9] vs control 6.5% [4.3, 8.6], P = .14) although hypoglycemia episode duration was shorter (30 vs 50 minutes, P < .001) with HCL. Glycemia risk index was lower with HCL vs control (38.1 [30.0, 39.2] vs 70.8 [58.5, 72.4], P = .014). Following 6 months of HCL use, greater dopamine (24.0 [12.3, 27.6] vs -18.5 [-36.5, -4.8], P = .014), and growth hormone (6.3 [4.6, 16.8] vs 0.5 [-0.8, 3.0], P = .050) responses to hypoglycemia were observed. CONCLUSIONS Six months of HCL use in high-risk adults with severe IAH increased glucose TIR and improved GRI without increased hypoglycemia, and partially restored counter-regulatory responses. CLINICAL TRIAL REGISTRATION ACTRN12617000520336.
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Affiliation(s)
- Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Judith Gooley
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Varuni Obeyesekere
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Jean Lu
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Barbora Paldus
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Sybil A McAuley
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology & Diabetes, The Alfred, Melbourne, VIC, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Alicia J Jenkins
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - D Jane Holmes-Walker
- Department of Endocrinology, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Clinical Biochemistry, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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22
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Gupta A, Mukherjee S, Kumar Bhadada S, Ram S, Pal R, Sachdeva N, Dutta P. Impact of short-term application of continuous glucose monitoring system(CGMS) on long-term glycemic profile in adolescents and adults with type 1 diabetes mellitus: An open-label randomized control cross over study. Diabetes Res Clin Pract 2024; 210:111610. [PMID: 38484983 DOI: 10.1016/j.diabres.2024.111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/27/2024] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
AIMS The use of Continuous Glucose Monitoring System (CGMS) improves glycemic parameters in Type 1 Diabetes Mellitus (T1D), but the cost is prohibitive. Here, we investigated the effect of short-term application of real-time and intermittently-scanned CGMS (rt and is-CGMS) in T1D individuals on change in HbA1c at the end of 3 months. METHODS T1D individuals were randomized into three groups in a ratio of 1:1:2 - Group A (rt-CGMS for 2 weeks initially, followed by is-CGMS for 2 weeks at 3 months), Group B (is-CGMS for 2 weeks initially followed by rt-CGMS for 2 weeks at 3 months) and Group C (only self-monitoring of blood glucose), respectively. HbA1c at baseline, 3, and 6 months were compared. RESULTS Out of a total 68 T1D patients, HbA1c decreased significantly in groups A and B at 6 months compared to the baseline, but not in group C. HbA1c was significantly lower in Group A compared to Group C at 3 and 6 months. Fructosamine levels significantly decreased in Group B before and after cross-over. Glycemic variability indices improved significantly after cross-over from is-CGMS to rt-CGMS. CONCLUSION Intermittent application of CGMS for 2 weeks improves short- and long-term blood glucose control in T1D.
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Affiliation(s)
- Ashish Gupta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Soham Mukherjee
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sant Ram
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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23
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Zhu T, Kuang L, Piao C, Zeng J, Li K, Georgiou P. Population-Specific Glucose Prediction in Diabetes Care With Transformer-Based Deep Learning on the Edge. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2024; 18:236-246. [PMID: 38163299 DOI: 10.1109/tbcas.2023.3348844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Leveraging continuous glucose monitoring (CGM) systems, real-time blood glucose (BG) forecasting is essential for proactive interventions, playing a crucial role in enhancing the management of type 1 diabetes (T1D) and type 2 diabetes (T2D). However, developing a model generalized to a population and subsequently embedding it within a microchip of a wearable device presents significant technical challenges. Furthermore, the domain of BG prediction in T2D remains under-explored in the literature. In light of this, we propose a population-specific BG prediction model, leveraging the capabilities of the temporal fusion Transformer (TFT) to adjust predictions based on personal demographic data. Then the trained model is embedded within a system-on-chip, integral to our low-power and low-cost customized wearable device. This device seamlessly communicates with CGM systems through Bluetooth and provides timely BG predictions using edge computing. When evaluated on two publicly available clinical datasets with a total of 124 participants with T1D or T2D, the embedded TFT model consistently demonstrated superior performance, achieving the lowest prediction errors when compared with a range of machine learning baseline methods. Executing the TFT model on our wearable device requires minimal memory and power consumption, enabling continuous decision support for more than 51 days on a single Li-Poly battery charge. These findings demonstrate the significant potential of the proposed TFT model and wearable device in enhancing the quality of life for people with diabetes and effectively addressing real-world challenges.
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24
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Hannah KL, Nemlekar PM, Johnson ML, Cherñavvsky DR, Norman GJ. Continuous Glucose Monitoring and Reduced Diabetes-Related Hospitalizations in Patients with Type 2 Diabetes and CKD. KIDNEY360 2024; 5:515-521. [PMID: 38356161 PMCID: PMC11093542 DOI: 10.34067/kid.0000000000000396] [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: 11/15/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
Key Points Patients with diabetes and CKD have a heightened risk of glycemic variability, which can lead to severe hypoglycemic or hyperglycemic events, potentially resulting in hospitalization. This study describes the results of a retrospective claims analysis of people with insulin-requiring type 2 diabetes and stage 3–5 CKD who initiated continuous glucose monitoring. Continuous glucose monitoring could help patients with type 2 diabetes and CKD control their glucose and avoid potentially dangerous glycemic events. Background There is a heightened risk of glycemic variability in patients with diabetes and CKD. This glycemic variability could lead to hypoglycemic or hyperglycemic crises. We hypothesized that initiation of continuous glucose monitoring (CGM), which provides a glucose measurement every 1–5 minutes, could reduce the incidence of hospitalizations for patients with type 2 diabetes (T2D) and CKD. Methods A retrospective analysis of US administrative claims data from the Optum Clinformatics database was conducted. People with T2D, using insulin, not receiving dialysis, and living with stage 3–5 CKD who initiated CGM between January 1, 2016, and March 31, 2022, were identified. National Drug Codes and Healthcare Common Coding Procedure System codes were used to identify CGM device use, and International Classification of Diseases 10th revision codes were used to identify CKD diagnosis and categorize health care encounters. Rates of diabetes-related hospitalizations were obtained, and multivariable logistic regression analyses revealed predictors of hypoglycemic and hyperglycemic encounters. Results A total of 8,959 insulin-using patients with T2D and CKD were identified. Most were White (72.3%), had Medicare insurance coverage (82.2%), were using intensive insulin (91.3%), and had stage 3 CKD (86.0%). After CGM initiation, rates of hospitalizations for hyperglycemia or hypoglycemia decreased by 18.2% and 17.0%, respectively (P < 0.0001 for both). The proportion hospitalized with at least one hypoglycemic or hyperglycemic event also significantly decreased after CGM initiation. Significant predictors of both hypoglycemic and hyperglycemic encounters included a previous encounter of that type, age 30–59 years and depression (for hypoglycemia), and age 30–49 years and neuropathy (for hyperglycemia). Use of CGM or glucagon-like peptide-1 receptor agonists was significantly protective against hypoglycemic encounters. Conclusions Initiation of CGM was associated with significant reductions in diabetes-related hospitalizations among insulin-using individuals with T2D and moderate-to-severe CKD. CGM could help patients with T2D and CKD control their glucose and avoid potentially dangerous glycemic events.
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25
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Miller E, Miller K. Detection and Intervention: Use of Continuous Glucose Monitoring in the Early Stages of Type 2 Diabetes. Clin Diabetes 2024; 42:398-407. [PMID: 39015167 PMCID: PMC11247044 DOI: 10.2337/cd23-0077] [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: 07/18/2024]
Abstract
The term "prediabetes" has been used to identify the state of abnormal glucose homeostasis (dysglycemia) that often leads to the development of clinical type 2 diabetes. However, this term does not describe the cellular changes that are already taking place in individuals with elevated glucose levels. This article describes our approach to detecting early dysglycemia using continuous glucose monitoring and explains how this approach can be integrated into clinical practice settings.
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26
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Been RA, Lameijer A, Gans ROB, van Beek AP, Kingsnorth AP, Choudhary P, van Dijk PR. The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review. Ther Adv Endocrinol Metab 2024; 15:20420188241236289. [PMID: 38476216 PMCID: PMC10929059 DOI: 10.1177/20420188241236289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Continuous glucose monitoring (CGM) usage has been shown to improve disease outcomes in people living with diabetes by facilitating better glycemic management. However, previous research has suggested that access to these devices can be influenced by nonmedical factors such as socioeconomic status and ethnicity. It is critical that equitable access to CGM devices is ensured as people from those groups experience poorer diabetes-related health outcomes. In this narrative review, we provide an overview of the various healthcare systems worldwide and how socioeconomic status, social context, and ethnicity shape device usage and the associated health outcomes. In general, we found that having a lower socioeconomic status and belonging to an ethnic minority group negatively impact CGM usage. While financial means proved to be an important mediator in this process, it was not the sole driver as disparities persisted even after adjustment for factors such as income and insurance status. Recommendations to increase CGM usage for people of a lower socioeconomic status and ethnic minorities include increasing the availability of financial, administrative, and educational support, for both patients and healthcare providers. However, recommendations will vary due to local country-specific circumstances, such as reimbursement criteria and healthcare ecosystems.
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Affiliation(s)
- Riemer A. Been
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Reinold O. B. Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - André P. van Beek
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Andrew P. Kingsnorth
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Pratik Choudhary
- University of Leicester, Leicester General Hospital, Leicester, Leicester Diabetes Centre – Bloom, UK
| | - Peter R. van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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27
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Hermanns N, Kulzer B, Ehrmann D. Person-reported outcomes in diabetes care: What are they and why are they so important? Diabetes Obes Metab 2024; 26 Suppl 1:30-45. [PMID: 38311448 DOI: 10.1111/dom.15471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/06/2024]
Abstract
In this review, we aim to show how person-reported outcomes (PROs) and person-reported experiences (PREs) can significantly contribute to the way diabetes care is delivered, the involvement of people with diabetes in diabetes care, and the collaboration between health care professionals and people with diabetes. This review focuses on the definition and measurement of PROs and PREs, the importance of PROs and PREs for person-centred diabetes care, and integrating the perspectives of people with diabetes in the evaluation of medical, psychological and technological interventions. PROs have been increasingly accepted by Health Technology Assessment bodies and are therefore valued in the context of reimbursement decisions and consequently by regulators and other health care stakeholders for the allocation of health care resources. Furthermore, the review identified current challenges to the assessment and use of PROs and PREs in clinical care and research. These challenges relate to the combination of questionnaires and ecological momentary assessment for measuring PROs and PREs, lack of consensus on a core outcome set, limited sensitivity to change within many measures and insufficient standardization of what can be considered a minimal clinically important difference. Another issue that has not been sufficiently addressed is the involvement of people with diabetes in the design and development of measures to assess PROs and PREs.
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
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28
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Gruson D, Cobbaert C, Dabla PK, Stankovic S, Homsak E, Kotani K, Khali R, Nichols JH, Gouget B. Validation and verification framework and data integration of biosensors and in vitro diagnostic devices: a position statement of the IFCC Committee on Mobile Health and Bioengineering in Laboratory Medicine (C-MBHLM) and the IFCC Scientific Division. Clin Chem Lab Med 2024; 0:cclm-2023-1455. [PMID: 38379410 DOI: 10.1515/cclm-2023-1455] [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: 12/17/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
Advances in technology have transformed healthcare and laboratory medicine. Biosensors have emerged as a promising technology in healthcare, providing a way to monitor human physiological parameters in a continuous, real-time, and non-intrusive manner and offering value and benefits in a wide range of applications. This position statement aims to present the current situation around biosensors, their perspectives and importantly the need to set the framework for their validation and safe use. The development of a qualification framework for biosensors should be conceptually adopted and extended to cover digitally measured biomarkers from biosensors for advancing healthcare and achieving more individualized patient management and better patient outcome.
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Affiliation(s)
- Damien Gruson
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
- Emerging Technologies Division and MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC), Milan, Italy
| | - Christa Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre (LUMC), Leiden, Netherlands
- International Federation of Clinical Chemistry (IFCC) Scientific Division, Milan, Italy
| | - Pradeep Kumar Dabla
- Emerging Technologies Division and MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC), Milan, Italy
- Department of Biochemistry, G.B. Pant Institute of Postgraduate Medical Education & Research, Associated Maulana Azad Medical College, New Delhi, India
| | - Sanja Stankovic
- Emerging Technologies Division and MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC), Milan, Italy
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Evgenija Homsak
- Emerging Technologies Division and MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC), Milan, Italy
- Department for Laboratory Diagnostics, University Clinical Center Maribor, Maribor, Slovenia
| | - Kazuhiko Kotani
- Emerging Technologies Division and MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC), Milan, Italy
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Japan
| | - Ramy Khali
- Emerging Technologies Division and MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC), Milan, Italy
- Egyptian Association of Healthcare Quality and Patient Safety, Alexandria, Egypt
| | - James H Nichols
- Emerging Technologies Division and MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC), Milan, Italy
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bernard Gouget
- Emerging Technologies Division and MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC), Milan, Italy
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Farrell CM, McNeilly AD, Hapca S, Fournier PA, Jones TW, Facchinetti A, Cappon G, West DJ, McCrimmon RJ. High intensity interval training as a novel treatment for impaired awareness of hypoglycaemia in people with type 1 diabetes (HIT4HYPOS): a randomised parallel-group study. Diabetologia 2024; 67:392-402. [PMID: 38010533 PMCID: PMC10789679 DOI: 10.1007/s00125-023-06051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023]
Abstract
AIMS/HYPOTHESIS Impaired awareness of hypoglycaemia (IAH) in type 1 diabetes may develop through a process referred to as habituation. Consistent with this, a single bout of high intensity interval exercise as a novel stress stimulus improves counterregulatory responses (CRR) to next-day hypoglycaemia, referred to as dishabituation. This longitudinal pilot study investigated whether 4 weeks of high intensity interval training (HIIT) has sustained effects on counterregulatory and symptom responses to hypoglycaemia in adults with type 1 diabetes and IAH. METHODS HIT4HYPOS was a single-centre, randomised, parallel-group study. Participants were identified using the Scottish Diabetes Research Network (SDRN) and from diabetes outpatient clinics in NHS Tayside, UK. The study took place at the Clinical Research Centre, Ninewells Hospital and Medical School, Dundee, UK. Participants were aged 18-55 years with type 1 diabetes of at least 5 years' duration and HbA1c levels <75 mmol/mol (<9%). They had IAH confirmed by a Gold score ≥4, modified Clarke score ≥4 or Dose Adjustment For Normal Eating [DAFNE] hypoglycaemia awareness rating of 2 or 3, and/or evidence of recurrent hypoglycaemia on flash glucose monitoring. Participants were randomly allocated using a web-based system to either 4 weeks of real-time continuous glucose monitoring (RT-CGM) or RT-CGM+HIIT. Participants and investigators were not masked to group assignment. The HIIT programme was performed for 20 min on a stationary exercise bike three times a week. Hyperinsulinaemic-hypoglycaemic (2.5 mmol/l) clamp studies with assessment of symptoms, hormones and cognitive function were performed at baseline and after 4 weeks of the study intervention. The predefined primary outcome was the difference in hypoglycaemia-induced adrenaline (epinephrine) responses from baseline following RT-CGM or RT-CGM+HIIT. RESULTS Eighteen participants (nine men and nine women) with type 1 diabetes (median [IQR] duration 27 [18.75-32] years) and IAH were included, with nine participants randomised to each group. Data from all study participants were included in the analysis. During the 4 week intervention there were no significant mean (SEM) differences between RT-CGM and RT-CGM+HIIT in exposure to level 1 (28 [7] vs 22 [4] episodes, p=0.45) or level 2 (9 [3] vs 4 [1] episodes, p=0.29) hypoglycaemia. The CGM-derived mean glucose level, SD of glucose and glucose management indicator (GMI) did not differ between groups. During the hyperinsulinaemic-hypoglycaemic clamp studies, mean (SEM) change from baseline was greater for the noradrenergic responses (RT-CGM vs RT-CGM+HIIT: -988 [447] vs 514 [732] pmol/l, p=0.02) but not the adrenergic responses (-298 [687] vs 1130 [747] pmol/l, p=0.11) in those participants who had undergone RT-CGM+HIIT. There was a benefit of RT-CGM+HIIT for mean (SEM) change from baseline in the glucagon CRR to hypoglycaemia (RT-CGM vs RT-CGM+HIIT: 1 [4] vs 16 [6] ng/l, p=0.01). Consistent with the hormone response, the mean (SEM) symptomatic response to hypoglycaemia (adjusted for baseline) was greater following RT-CGM+HIIT (RT-CGM vs RT-CGM+HIIT: -4 [2] vs 0 [2], p<0.05). CONCLUSIONS/INTERPRETATION In this pilot clinical trial in people with type 1 diabetes and IAH, we found continuing benefits of HIIT for overall hormonal and symptomatic CRR to subsequent hypoglycaemia. Our findings also suggest that HIIT may improve the glucagon response to insulin-induced hypoglycaemia. TRIAL REGISTRATION ISRCTN15373978. FUNDING Sir George Alberti Fellowship from Diabetes UK (CMF) and the Juvenile Diabetes Research Foundation.
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Affiliation(s)
- Catriona M Farrell
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Alison D McNeilly
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Simona Hapca
- Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | | | | | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giacomo Cappon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Daniel J West
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
| | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK.
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McKechnie V, Oliver N, Amiel SA, Fox JRE. Hyperglycaemia aversion in type 1 diabetes: A grounded theory study. Br J Health Psychol 2024; 29:254-271. [PMID: 37806779 DOI: 10.1111/bjhp.12697] [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: 12/08/2022] [Revised: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Very little is known about the circumstances under which hyperglycaemia aversion develops and is maintained. The present study aimed to identify psychological factors involved in the process of hyperglycaemia aversion and to understand how it affects people's self-management of type 1 diabetes. DESIGN Qualitative, in-depth interviews were used. METHODS A constructivist grounded theory study, using semi-structured participant interviews, was undertaken to build a theoretical model of the process of hyperglycaemia aversion. RESULTS Eighteen participants were interviewed. Fifteen were considered hyperglycaemia averse and included in the analysis. A theoretical model was developed to describe and explain processes involved in hyperglycaemia aversion. Many participants held very high standards for themselves and often had a strong preference for control. While some participants described anxiety associated with higher blood glucose, the most proximal driver of their approach was self-criticism and frustration associated with not meeting their own high standards for blood glucose. A number of attentional processes and beliefs, mostly related to hypoglycaemia, maintained and reinforced their blood glucose preference. Diabetes technology served as an enabler, raiser of standards, and additional critical judge of participants' hyperglycaemia aversion. CONCLUSIONS The trans-diagnostic concept of emotional over-control is used to understand the proposed model of processes of hyperglycaemia aversion. The present study offers new insight which will aid clinicians in identifying and supporting those who may be at risk of psychological distress and harm associated with a preference for avoidance of higher blood glucose levels.
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Affiliation(s)
- Vicky McKechnie
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Clinical Health Psychology and Neuropsychology, Imperial College Healthcare NHS Trust and West London NHS Trust, London, UK
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Stephanie A Amiel
- Department of Diabetes, Faculty of Life Sciences, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - John R E Fox
- School of Psychology, Cardiff University, Cardiff, UK
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Subramanian S, Khan F, Hirsch IB. New advances in type 1 diabetes. BMJ 2024; 384:e075681. [PMID: 38278529 DOI: 10.1136/bmj-2023-075681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Type 1 diabetes is an autoimmune condition resulting in insulin deficiency and eventual loss of pancreatic β cell function requiring lifelong insulin therapy. Since the discovery of insulin more than 100 years ago, vast advances in treatments have improved care for many people with type 1 diabetes. Ongoing research on the genetics and immunology of type 1 diabetes and on interventions to modify disease course and preserve β cell function have expanded our broad understanding of this condition. Biomarkers of type 1 diabetes are detectable months to years before development of overt disease, and three stages of diabetes are now recognized. The advent of continuous glucose monitoring and the newer automated insulin delivery systems have changed the landscape of type 1 diabetes management and are associated with improved glycated hemoglobin and decreased hypoglycemia. Adjunctive therapies such as sodium glucose cotransporter-1 inhibitors and glucagon-like peptide 1 receptor agonists may find use in management in the future. Despite these rapid advances in the field, people living in under-resourced parts of the world struggle to obtain necessities such as insulin, syringes, and blood glucose monitoring essential for managing this condition. This review covers recent developments in diagnosis and treatment and future directions in the broad field of type 1 diabetes.
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Affiliation(s)
- Savitha Subramanian
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Farah Khan
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Irl B Hirsch
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
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Lacy ME, Lee KE, Atac O, Heier K, Fowlkes J, Kucharska-Newton A, Moga DC. Patterns and Trends in Continuous Glucose Monitoring Utilization Among Commercially Insured Individuals With Type 1 Diabetes: 2010-2013 to 2016-2019. Clin Diabetes 2024; 42:388-397. [PMID: 39015169 PMCID: PMC11247039 DOI: 10.2337/cd23-0051] [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: 07/18/2024]
Abstract
Prior studies suggest that only ∼30% of patients with type 1 diabetes use continuous glucose monitoring (CGM), but most studies to date focused on children and young adults seen by endocrinologists or in academic centers. This study examined national trends in CGM utilization among commercially insured children and adults with type 1 diabetes. Overall, CGM utilization was 20.12% in 2010-2013 and 49.78% in 2016-2019, reflecting a 2.5-fold increase in utilization within a period of <10 years. Identifying populations with low CGM use is a necessary first step in developing targeted interventions to increase CGM uptake.
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Affiliation(s)
- Mary E. Lacy
- College of Public Health, University of Kentucky, Lexington, KY
| | | | - Omer Atac
- College of Public Health, University of Kentucky, Lexington, KY
- Department of Public Health, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Kory Heier
- College of Public Health, University of Kentucky, Lexington, KY
| | - John Fowlkes
- College of Medicine, University of Kentucky, Lexington, KY
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Hoffman EG, D’Souza NC, Liggins RT, Riddell MC. Pharmacologic inhibition of somatostatin receptor 2 to restore glucagon counterregulation in diabetes. Front Pharmacol 2024; 14:1295639. [PMID: 38298268 PMCID: PMC10829877 DOI: 10.3389/fphar.2023.1295639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
Glucose homeostasis is primarily maintained by pancreatic hormones, insulin and glucagon, with an emerging role for a third islet hormone, somatostatin, in regulating insulin and glucagon responses. Under healthy conditions, somatostatin secreted from pancreatic islet δ-cells inhibits both insulin and glucagon release through somatostatin receptor- induced cAMP-mediated downregulation and paracrine inhibition of β- and α-cells, respectively. Since glucagon is the body's most important anti-hypoglycemic hormone, and because glucagon counterregulation to hypoglycemia is lost in diabetes, the study of somatostatin biology has led to new investigational medications now in development that may help to restore glucagon counterregulation in type 1 diabetes. This review highlights the normal regulatory role of pancreatic somatostatin signaling in healthy islet function and how the inhibition of somatostatin receptor signaling in pancreatic α-cells may restore normal glucagon counterregulation in diabetes mellitus.
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Affiliation(s)
- Emily G. Hoffman
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada
| | - Ninoschka C. D’Souza
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada
| | | | - Michael C. Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada
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Sharma K, Puranik N, Yadav D. Neural Stem Cell-based Regenerative Therapy: A New Approach to Diabetes Treatment. Endocr Metab Immune Disord Drug Targets 2024; 24:531-540. [PMID: 37183465 DOI: 10.2174/1871530323666230512121416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 05/16/2023]
Abstract
Diabetes mellitus (DM) is the most common metabolic disorder that occurs due to the loss, or impaired function of insulin-secreting pancreatic beta cells, which are of two types - type 1 (T1D) and type 2 (T2D). To cure DM, the replacement of the destroyed pancreatic beta cells of islet of Langerhans is the most widely practiced treatment. For this, isolating neuronal stem cells and cultivating them as a source of renewable beta cells is a significant breakthrough in medicine. The functions, growth, and gene expression of insulin-producing pancreatic beta cells and neurons are very similar in many ways. A diabetic patient's neural stem cells (obtained from the hippocampus and olfactory bulb) can be used as a replacement source of beta cells for regenerative therapy to treat diabetes. The same protocol used to create functional neurons from progenitor cells can be used to create beta cells. Recent research suggests that replacing lost pancreatic beta cells with autologous transplantation of insulin-producing neural progenitor cells may be a perfect therapeutic strategy for diabetes, allowing for a safe and normal restoration of function and a reduction in potential risks and a long-term cure.
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Affiliation(s)
- Kajal Sharma
- School of Sciences in Biotechnology, Jiwaji University, Gwalior, 474011, Madhya Pradesh, India
| | - Nidhi Puranik
- Department of Bio-logical Sciences, Bharathiar University, Tamil Nadu, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan, 38541, Korea
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S126-S144. [PMID: 38078575 PMCID: PMC10725813 DOI: 10.2337/dc24-s007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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36
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Welsh JB, Psavko S, Zhang X, Gao P, Balo AK. Comparisons of Fifth-, Sixth-, and Seventh-Generation Continuous Glucose Monitoring Systems. J Diabetes Sci Technol 2024; 18:143-147. [PMID: 35695305 PMCID: PMC10899839 DOI: 10.1177/19322968221099879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Between-system differences for continuous glucose monitoring (CGM) devices have important clinical consequences. PURPOSE Here we review attributes of Dexcom's fifth-, sixth-, and seventh-generation (G5, G6, and G7) CGM systems. METHODS Accuracy metrics were derived from preapproval trials of the three systems and compared after propensity score adjustments were used to balance baseline demographic characteristics. Metrics included mean absolute relative differences (MARD) between CGM and YSI values and the proportion of CGM values within 20% or 20 mg/dL of the YSI values ("%20/20"). Ease-of-use was evaluated by formal task analysis. CONCLUSIONS Adjusted MARD and %20/20 agreement rates were 9.0%/93.1% (abdomen-placed G5), 9.9%/92.3% (abdomen-placed G6), 9.1%/93.2% (abdomen-placed G7), and 8.2%/95.3% (arm-placed G7). Task analysis favored G7 over earlier systems. Favorable clinical outcomes such as hemoglobin A1c reduction and hypoglycemia avoidance seen with G5 and G6 are anticipated with G7 use.
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Pangrace M, Dolan S, Grace T, Greene E, Long E, McClelland S, Moore J, Morgan DE, Mullins H, Wescott S. AMCP Market Insights Health Plan Best Practice: Implementing continuous glucose monitoring to improve patient outcomes in diabetes. J Manag Care Spec Pharm 2024; 30:S1-S15. [PMID: 38190244 DOI: 10.18553/jmcp.2024.30.1-a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Diabetes is a complex chronic condition that affects the body's ability to produce or use insulin effectively, resulting in elevated blood glucose levels. It is associated with various complications and comorbidities, significantly impacting both individuals and the health care system. Effective management involves a combination of lifestyle adjustments, medication adherence, monitoring, education, and support. The expanding use of continuous glucose monitoring (CGM) has been transformative in diabetes care, providing valuable real-time data and insights for better management. To understand the opportunity for health plans to support improved patient outcomes with CGM, AMCP sponsored a multifaceted approach to identify best practices consisting of expert interviews, a national payer survey, an expert panel workshop with clinical experts and managed care stakeholders, and a national webcast to communicate the program findings. This article summarizes current evidence for CGM to support managed care and payer professionals in making collaborative, evidence-based decisions to optimize outcomes among patients with diabetes. In addition, this review also presents the findings of a national payer survey and describes expert-supported health plan best practices around coverage and access to CGM.
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Affiliation(s)
| | - Sheri Dolan
- Bureau of Professional and Ancillary Services, University of Illinois at Chicago
| | | | | | | | | | - Josh Moore
- MO HealthNet Division, Missouri Department of Social Services, Columbia
| | - Diane E Morgan
- Government Programs Pharmacy, UnitedHealthcare, Severn, MD
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Oraibi O, Alameer A, Dalak M, Alsharif S, Hakami SA, Sumayli M, Shami A, Mohrag M, Madkhali MA, Madkhali MA, Alhazmi L, Darraj M. Impaired Awareness of Hypoglycemia and its Risk Factors among Diabetic Patients in Jazan, Saudi Arabia: A Cross-Sectional Study. Curr Diabetes Rev 2024; 20:124-137. [PMID: 38243952 DOI: 10.2174/0115733998288242240104054438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Impaired awareness of hypoglycemia (IAH) is related to a three- to sixfold increase in the risk of severe hypoglycemia in adults with type 1 diabetes mellitus (T1D). This study aimed to assess the prevalence of IAH and its risk factors and determine the frequency of hypoglycemic symptoms. OBJECTIVE This study aimed to assess the prevalence of IAH and its risk factors and determine the frequency of hypoglycemic symptoms. METHODOLOGY A cross-sectional study was conducted among T1D patients attending Jazan Endocrine and Diabetes Center in Jazan province, Saudi Arabia. A total of 151 patients participated, using the interview-based Clarke questionnaire, a validated eight-item questionnaire to evaluate IAH. Scoring four or more answers as reduced awareness categorizes the participant as having IAH. RESULTS The prevalence of IAH was 25.2% among the T1D patients. IAH was significantly associated with body mass index (BMI; p = 0.034), occupation (p = 0.014), and blood glucose monitoring methods (p = 0.027). Shaking and sweating were the most commonly reported symptoms of hypoglycemia. A BMI of <25 kg/m2 was higher linked to hunger and speech difficulty compared to a BMI of ≥25 kg/m2 (p < 0.05). Changing the insulin injection site was associated with confusion, odd behavior, and speech difficulty (p < 0.05). Monitoring blood glucose four times daily was associated with sweating, odd behavior, and incoordination (p = 0.024) compared to monitoring less than four times daily (p < 0.05). A hemoglobin A1c (HbA1c) reading of ≥7 was linked to odd behavior compared to an HbA1c reading of <7 (p = 0.032). Patients committed to insulin injections were more likely to experience palpitations than non-committed patients (p = 0.038). Each one-unit increase in age, monitoring blood glucose, and income was associated with a decrease in the odds of IAH (OR of Age = 0.89, 95% CI: 0.83-0.95) (OR of income = 0.10, 95% CI: 0.01-0.55). Moreover, individuals with a Body Mass Index (BMI) greater than or equal to 25 (OR = 2.99, 95% CI: 1.13-8.25), employed individuals (OR = 18.2, 95% CI: 3.75-105), and diabetes duration of more than ten years (OR = 3.96, 95% CI: 1.31- 13.2) exhibited an increase in the higher risk of IAH. CONCLUSION IAH was prevalent among T1D patients attending Jazan Endocrine and Diabetes Center. The main associated factors included BMI, blood glucose monitoring method, and occupation. Future research should investigate the underlying causes of the observed associations and explore strategies to enhance the awareness of hypoglycemia.
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Affiliation(s)
- Omar Oraibi
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Abdulelah Alameer
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Dalak
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Sawsan Alsharif
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Shatha A Hakami
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Sumayli
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ayman Shami
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mostafa Mohrag
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Luai Alhazmi
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Majid Darraj
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Selvin E, Stanton RC, Gabbay RA. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S111-S125. [PMID: 38078586 PMCID: PMC10725808 DOI: 10.2337/dc24-s006] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Courtney A, Smith D, Forde H. Real-world outcomes of continuous glucose monitoring in adults with diabetes mellitus attending an Irish tertiary hospital. Ir J Med Sci 2023; 192:2763-2768. [PMID: 36940009 PMCID: PMC10025786 DOI: 10.1007/s11845-023-03322-9] [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] [Received: 09/19/2022] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUNDS AND AIMS The American Diabetes Association/European Association for the Study of Diabetes recently recommend the preferential use of continuous glucose monitoring(CGM) over self-monitoring of blood glucose for the management of type 1 diabetes (T1DM). For most adults with T1DM, the recommended target time in range is > 70% with < 4% time below range. In Ireland, CGM use has become increasingly popular since 2021. We aimed to audit adult CGM use and analyse CGM metrics in our cohort of adults with diabetes attending a tertiary diabetes centre. METHODS People with diabetes who were using DEXCOM G6 CGM devices, and sharing their data with the healthcare team on the DEXCOM CLARITY for healthcare professionals platform were included in the audit. Clinical information, glycated haemoglobin (HbA1c) and CGM metrics were gathered retrospectively from medical records and the DEXCOM CLARITY platform. RESULTS Data were available for 119 CGM users, 96.9% with T1DM, median age 36 years (IQR = 20) and median diabetes duration 17 years (IQR = 20). Fifty-three per cent of the cohort was male. Mean time in range was 56.2% (SD = 19.2) and mean time below range was 2.3% (SD = 2.6). Mean HbA1c in CGM users was 56.7 mmol/mol (SD = 13.1). This represented a decrease of 6.7 mmol/mol compared to the last HbA1c measurements available pre-commencement of CGM (p ≤ 0.0001, CI 4.4-8.9). The percentage of people in this cohort with a HbA1c < 53 mmol/mol was 40.6% (n = 39/96), compared to 17.5% (n = 18/103) pre-commencement of CGM. CONCLUSIONS Our study highlights the challenges in optimising the use of CGM. Our team aims to focus on providing additional education to CGM users, more frequent touch-base virtual reviews and increasing access to hybrid closed-loop insulin pump therapy.
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Affiliation(s)
- Aoife Courtney
- Department of Endocrinology and Diabetes Mellitus, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
| | - Diarmuid Smith
- Department of Endocrinology and Diabetes Mellitus, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Hannah Forde
- Department of Endocrinology and Diabetes Mellitus, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
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Ratzki-Leewing A, Black JE, Kahkoska AR, Ryan BL, Zou G, Klar N, Timcevska K, Harris SB. Severe (level 3) hypoglycaemia occurrence in a real-world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States). Diabetes Obes Metab 2023; 25:3736-3747. [PMID: 37700692 PMCID: PMC10958739 DOI: 10.1111/dom.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
AIMS Among adults with insulin- and/or secretagogue-treated diabetes in the United States, very little is known about the real-world descriptive epidemiology of iatrogenic severe (level 3) hypoglycaemia. Addressing this gap, we collected primary, longitudinal data to quantify the absolute frequency of events as well as incidence rates and proportions. MATERIALS AND METHODS iNPHORM is a US-wide, 12-month ambidirectional panel survey (2020-2021). Adults with type 1 diabetes mellitus (T1DM) or insulin- and/or secretagogue-treated type 2 diabetes mellitus (T2DM) were recruited from a probability-based internet panel. Participants completing ≥1 follow-up questionnaire(s) were analysed. RESULTS Among 978 respondents [T1DM 17%; mean age 51 (SD 14.3) years; male: 49.6%], 63% of level 3 events were treated outside the health care system (e.g. by family/friend/colleague), and <5% required hospitalization. Following the 12-month prospective period, one-third of individuals reported ≥1 event(s) [T1DM 44.2% (95% CI 36.8%-51.8%); T2DM 30.8% (95% CI 28.7%-35.1%), p = .0404, α = 0.0007]; and the incidence rate was 5.01 (95% CI 4.15-6.05) events per person-year (EPPY) [T1DM 3.57 (95% CI 2.49-5.11) EPPY; T2DM 5.29 (95% CI 4.26-6.57) EPPY, p = .1352, α = 0.0007]. Level 3 hypoglycaemia requiring non-transport emergency medical services was more common in T2DM than T1DM (p < .0001, α = 0.0016). In total, >90% of events were experienced by <15% of participants. CONCLUSIONS iNPHORM is one of the first long-term, prospective US-based investigations on level 3 hypoglycaemia epidemiology. Our results underscore the importance of participant-reported data to ascertain its burden. Events were alarmingly frequent, irrespective of diabetes type, and concentrated in a small subsample.
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Affiliation(s)
- Alexandria Ratzki-Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jason E. Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anna R. Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kristina Timcevska
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart B. Harris
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine/Division of Endocrinology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Borenstein JT, Cummins G, Dutta A, Hamad E, Hughes MP, Jiang X, Lee HH, Lei KF, Tang XS, Zheng Y, Chen J. Bionanotechnology and bioMEMS (BNM): state-of-the-art applications, opportunities, and challenges. LAB ON A CHIP 2023; 23:4928-4949. [PMID: 37916434 DOI: 10.1039/d3lc00296a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
The development of micro- and nanotechnology for biomedical applications has defined the cutting edge of medical technology for over three decades, as advancements in fabrication technology developed originally in the semiconductor industry have been applied to solving ever-more complex problems in medicine and biology. These technologies are ideally suited to interfacing with life sciences, since they are on the scale lengths as cells (microns) and biomacromolecules (nanometers). In this paper, we review the state of the art in bionanotechnology and bioMEMS (collectively BNM), including developments and challenges in the areas of BNM, such as microfluidic organ-on-chip devices, oral drug delivery, emerging technologies for managing infectious diseases, 3D printed microfluidic devices, AC electrokinetics, flexible MEMS devices, implantable microdevices, paper-based microfluidic platforms for cellular analysis, and wearable sensors for point-of-care testing.
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Affiliation(s)
| | - Gerard Cummins
- School of Engineering, University of Birmingham, Edgbaston, B15 2TT, UK.
| | - Abhishek Dutta
- Department of Electrical & Computer Engineering, University of Connecticut, USA.
| | - Eyad Hamad
- Biomedical Engineering Department, School of Applied Medical Sciences, German Jordanian University, Amman, Jordan.
| | - Michael Pycraft Hughes
- Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates.
| | - Xingyu Jiang
- Department of Biomedical Engineering, Southern University of Science and Technology, China.
| | - Hyowon Hugh Lee
- Weldon School of Biomedical Engineering, Center for Implantable Devices, Purdue University, West Lafayette, IN, USA.
| | | | | | | | - Jie Chen
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB T6G 2R3, Canada.
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43
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Maiorino MI, Buzzetti R, Irace C, Laviola L, Napoli N, Pitocco D, Esposito K. An updated algorithm for an effective choice of continuous glucose monitoring for people with insulin-treated diabetes. Endocrine 2023; 82:215-225. [PMID: 37676398 PMCID: PMC10543826 DOI: 10.1007/s12020-023-03473-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Continuous Glucose Monitoring (CGM) is a key tool for insulin-treated people with diabetes (PwD). CGM devices include both real-time CGM (rtCGM) and intermittently scanned CGM (isCGM), which are associated with an improvement of glucose control and less hypoglycemia in clinical trials of people with type 1 and type 2 diabetes. METHODS This is an expert position to update a previous algorithm on the most suitable choice of CGM for insulin-treated PwD in light of the recent evidence and clinical practice. RESULTS We identified six different clinical scenarios, including type 1 diabetes, type 2 diabetes, pregnancy on intensive insulin therapy, regular physical exercise, new onset of diabetes, and frailty. The use of rtCGM or isCGM is suggested, on the basis of the predominant clinical issue, as suboptimal glucose control or disabling hypoglycemia, regardless of baseline HbA1c or individualized HbA1c target. CONCLUSION The present algorithm may help to select the best CGM device based on patients' clinical characteristics, needs and clinical context, offering a further opportunity of a "tailored" therapy for people with insulin-treated diabetes.
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Affiliation(s)
- Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, University Hospital Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy.
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Naples, Italy.
| | - Raffaella Buzzetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Viale Europa, 88100, Catanzaro, Italy
| | - Luigi Laviola
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Napoli
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Endocrinology and Diabetes, Department of Medicine and Surgery, Università Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, University Hospital Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Naples, Italy
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Battelino T, Brosius F, Ceriello A, Cosentino F, Green J, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Rydén L, Rodbard HW, Ji L, Sheu WHH, Standl E, Parkin CG, Schnell O. Guideline Development for Medical Device Technology: Issues for Consideration. J Diabetes Sci Technol 2023; 17:1698-1710. [PMID: 35531901 PMCID: PMC10658688 DOI: 10.1177/19322968221093355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advances in the development of innovative medical devices and telehealth technologies create the potential to improve the quality and efficiency of diabetes care through collecting, aggregating, and interpreting relevant health data in ways that facilitate more informed decisions among all stakeholder groups. Although many medical societies publish guidelines for utilizing these technologies in clinical practice, we believe that the methodologies used for the selection and grading of the evidence should be revised. In this article, we discuss the strengths and limitations of the various types of research commonly used for evidence selection and grading and present recommendations for modifying the process to more effectively address the rapid pace of device and technology innovation and new product development.
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Affiliation(s)
- Tadej Battelino
- University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine–Tucson, AZ, USA
| | | | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Mikhail Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | | | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Linong Ji
- Peking University People’s Hospital, Beijing, China
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City
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Gupta R, Edupuganti S, Zamir I, Singh A, Thawani HT. Latent Autoimmune Diabetes in Adults and a Continuous Glucose Monitoring Device: An Unfortunate Outcome. Cureus 2023; 15:e49141. [PMID: 38130540 PMCID: PMC10733160 DOI: 10.7759/cureus.49141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Latent autoimmune diabetes in adults (LADA) is a slow-progressing form of autoimmune diabetes. A 44-year-old man with a four-year history of diabetes mellitus (DM), obsessive-compulsive disorder (OCD), and panic disorder was admitted to the hospital for diabetic ketoacidosis. LADA was confirmed with positive GAD-65 antibody. His occupation involved random working days with several weeks off in between projects. During workdays, his insulin dosage required frequent adjustments due to lower blood glucose (BG) readings. Owing to the variable work schedule and constantly changing insulin needs, he was recommended a continuous glucose monitoring (CGM) device. Few days after starting on the CGM device, he was seen in the emergency department because of elevated BG. His home BG readings ranged from 80 to 408 mg/dL. He was getting frustrated with the fluctuating BG readings. At home, he remained agitated and endlessly checked his CGM device. After discharge, he would repeatedly call the endocrinology office with his BG readings with the insulin dose being adjusted accordingly. Few weeks later, the office received a call from his wife informing us that the patient had shot himself in the head. According to his wife, lately he had trouble sleeping, was very anxious, and often had panic attacks. He seemed to struggle with ever-fluctuating BG readings and was obsessed with incessantly changing numbers on his CGM device. Patients with Type 1 DM are at increased risk of mental health disorders and suicide forms a sizeable proportion of deaths in these patients. This case highlights the importance of mental health, especially underlying OCD as a prognostic factor in the management of diabetes with CGM devices.
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Affiliation(s)
- Rohit Gupta
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Srujan Edupuganti
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Irma Zamir
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Adiraj Singh
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Hemant T Thawani
- Endocrinology, Diabetes and Metabolism, Hurley Medical Center, Michigan State University, Flint, USA
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46
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Gaulke AP, Giordano J, Grossman DS. Association of Continuous Glucose Monitor Receipt and Diabetes Care Provider Type: A Cohort Study of West Virginia Medicaid Beneficiaries With Type 1 Diabetes. Med Care 2023; 61:760-764. [PMID: 37737739 DOI: 10.1097/mlr.0000000000001917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To compare the prevalence of West Virginia Medicaid (WVM) beneficiaries with type 1 diabetes (T1D) with a WVM administrative claim for continuous glucose monitoring (CGM) supplies by whether they received medical care from a board-certified endocrinologist. METHODS A total of 1494 WVM beneficiaries aged 20-64 with T1D were retrospectively followed from May 2018 to April 2020. The sample consisted of 2 groups: those receiving medical care from board-certified endocrinologists and those receiving medical care from other providers. CGM prevalence is compared before and after WVM started providing insurance coverage for beneficiaries with T1D to use CGM systems in May 2019 using linear regression with and without adjustments for patient characteristics. RESULTS Thirty-five percent of beneficiaries received care from a board-certified endocrinologist at any point during the sample period. Post-May 2019, the prevalence of WVM administrative claims for CGM supplies was significantly higher among beneficiaries receiving care from an endocrinologist compared with other providers. CONCLUSIONS Receiving diabetes care from a board-certified endocrinologist is positively associated with having administrative claims for CGM supplies.
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Affiliation(s)
- Amanda P Gaulke
- Department of Economics, Kansas State University, Manhattan, KS
| | - Jennifer Giordano
- Section of Endocrinology within the School of Medicine, West Virginia University
| | - Daniel S Grossman
- Department of Economics, John Chambers College of Business and Economics, West Virginia University, Morgantown, WV
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47
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Macon EL, Devore MH, Lin YK, Music MB, Wooten M, McMullen CA, Woodcox AM, Marksbury AR, Beckner Z, Patel BV, Schoeder LA, Iles AN, Fisher SJ. Current and future therapies to treat impaired awareness of hypoglycemia. Front Pharmacol 2023; 14:1271814. [PMID: 37942482 PMCID: PMC10628050 DOI: 10.3389/fphar.2023.1271814] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
In order to achieve optimal glycemic control, intensive insulin regimes are needed for individuals with Type 1 Diabetes (T1D) and insulin-dependent Type 2 Diabetes (T2D). Unfortunately, intensive glycemic control often results in insulin-induced hypoglycemia. Moreover, recurrent episodes of hypoglycemia result in both the loss of the characteristic warning symptoms associated with hypoglycemia and an attenuated counterregulatory hormone responses. The blunting of warning symptoms is known as impaired awareness of hypoglycemia (IAH). Together, IAH and the loss of the hormonal response is termed hypoglycemia associated autonomic failure (HAAF). IAH is prevalent in up to 25% in people with T1D and up to 10% in people with T2D. IAH and HAAF increase the risk of severe hypoglycemia 6-fold and 25-fold, respectively. To reduce this risk for severe hypoglycemia, multiple different therapeutic approaches are being explored that could improve awareness of hypoglycemia. Current therapies to improve awareness of hypoglycemia include patient education and psychoeducation, the use of novel glycemic control technology, pancreas/islet transplantation, and drug therapy. This review examines both existing therapies and potential therapies that are in pre-clinical testing. Novel treatments that improve awareness of hypoglycemia, via improving the counterregulatory hormone responses or improving hypoglycemic symptom recognition, would also shed light on the possible neurological mechanisms that lead to the development of IAH. To reduce the risk of severe hypoglycemia in people with diabetes, elucidating the mechanism behind IAH, as well as developing targeted therapies is currently an unmet need for those that suffer from IAH.
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Affiliation(s)
- Erica L. Macon
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Micah H. Devore
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Yu Kuei Lin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Megan B. Music
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Mason Wooten
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Colleen A. McMullen
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Andrea M. Woodcox
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Ashlee R. Marksbury
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Zachary Beckner
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Bansi V. Patel
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Lily A. Schoeder
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Ashley N. Iles
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Simon J. Fisher
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
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Jacobsen LM, Sherr JL, Considine E, Chen A, Peeling SM, Hulsmans M, Charleer S, Urazbayeva M, Tosur M, Alamarie S, Redondo MJ, Hood KK, Gottlieb PA, Gillard P, Wong JJ, Hirsch IB, Pratley RE, Laffel LM, Mathieu C. Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:132. [PMID: 37794113 PMCID: PMC10550996 DOI: 10.1038/s43856-023-00358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The greatest change in the treatment of people living with type 1 diabetes in the last decade has been the explosion of technology assisting in all aspects of diabetes therapy, from glucose monitoring to insulin delivery and decision making. As such, the aim of our systematic review was to assess the utility of these technologies as well as identify any precision medicine-directed findings to personalize care. METHODS Screening of 835 peer-reviewed articles was followed by systematic review of 70 of them (focusing on randomized trials and extension studies with ≥50 participants from the past 10 years). RESULTS We find that novel technologies, ranging from continuous glucose monitoring systems, insulin pumps and decision support tools to the most advanced hybrid closed loop systems, improve important measures like HbA1c, time in range, and glycemic variability, while reducing hypoglycemia risk. Several studies included person-reported outcomes, allowing assessment of the burden or benefit of the technology in the lives of those with type 1 diabetes, demonstrating positive results or, at a minimum, no increase in self-care burden compared with standard care. Important limitations of the trials to date are their small size, the scarcity of pre-planned or powered analyses in sub-populations such as children, racial/ethnic minorities, people with advanced complications, and variations in baseline glycemic levels. In addition, confounders including education with device initiation, concomitant behavioral modifications, and frequent contact with the healthcare team are rarely described in enough detail to assess their impact. CONCLUSIONS Our review highlights the potential of technology in the treatment of people living with type 1 diabetes and provides suggestions for optimization of outcomes and areas of further study for precision medicine-directed technology use in type 1 diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mustafa Tosur
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Selma Alamarie
- Stanford University School of Medicine, Stanford, CA, USA
| | - Maria J Redondo
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Korey K Hood
- Stanford University School of Medicine, Stanford, CA, USA
| | - Peter A Gottlieb
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Jessie J Wong
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Irl B Hirsch
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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49
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Oudin A, Maatoug R, Bourla A, Ferreri F, Bonnot O, Millet B, Schoeller F, Mouchabac S, Adrien V. Digital Phenotyping: Data-Driven Psychiatry to Redefine Mental Health. J Med Internet Res 2023; 25:e44502. [PMID: 37792430 PMCID: PMC10585447 DOI: 10.2196/44502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/10/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
The term "digital phenotype" refers to the digital footprint left by patient-environment interactions. It has potential for both research and clinical applications but challenges our conception of health care by opposing 2 distinct approaches to medicine: one centered on illness with the aim of classifying and curing disease, and the other centered on patients, their personal distress, and their lived experiences. In the context of mental health and psychiatry, the potential benefits of digital phenotyping include creating new avenues for treatment and enabling patients to take control of their own well-being. However, this comes at the cost of sacrificing the fundamental human element of psychotherapy, which is crucial to addressing patients' distress. In this viewpoint paper, we discuss the advances rendered possible by digital phenotyping and highlight the risk that this technology may pose by partially excluding health care professionals from the diagnosis and therapeutic process, thereby foregoing an essential dimension of care. We conclude by setting out concrete recommendations on how to improve current digital phenotyping technology so that it can be harnessed to redefine mental health by empowering patients without alienating them.
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Affiliation(s)
- Antoine Oudin
- Infrastructure for Clinical Research in Neurosciences, Paris Brain Institute, Sorbonne University- Institut national de la santé et de la recherche médicale - Centre national de la recherche scientifique, Paris, France
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Public Hospitals of Sorbonne University, Paris, France
| | - Redwan Maatoug
- Infrastructure for Clinical Research in Neurosciences, Paris Brain Institute, Sorbonne University- Institut national de la santé et de la recherche médicale - Centre national de la recherche scientifique, Paris, France
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Public Hospitals of Sorbonne University, Paris, France
| | - Alexis Bourla
- Infrastructure for Clinical Research in Neurosciences, Paris Brain Institute, Sorbonne University- Institut national de la santé et de la recherche médicale - Centre national de la recherche scientifique, Paris, France
- Department of Psychiatry, Saint-Antoine Hospital, Public Hospitals of Sorbonne University, Paris, France
- Medical Strategy and Innovation Department, Clariane, Paris, France
- NeuroStim Psychiatry Practice, Paris, France
| | - Florian Ferreri
- Infrastructure for Clinical Research in Neurosciences, Paris Brain Institute, Sorbonne University- Institut national de la santé et de la recherche médicale - Centre national de la recherche scientifique, Paris, France
- Department of Psychiatry, Saint-Antoine Hospital, Public Hospitals of Sorbonne University, Paris, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, Nantes University Hospital, Nantes, France
- Pays de la Loire Psychology Laboratory, Nantes University, Nantes, France
| | - Bruno Millet
- Infrastructure for Clinical Research in Neurosciences, Paris Brain Institute, Sorbonne University- Institut national de la santé et de la recherche médicale - Centre national de la recherche scientifique, Paris, France
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Public Hospitals of Sorbonne University, Paris, France
| | - Félix Schoeller
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Stéphane Mouchabac
- Infrastructure for Clinical Research in Neurosciences, Paris Brain Institute, Sorbonne University- Institut national de la santé et de la recherche médicale - Centre national de la recherche scientifique, Paris, France
- Department of Psychiatry, Saint-Antoine Hospital, Public Hospitals of Sorbonne University, Paris, France
| | - Vladimir Adrien
- Infrastructure for Clinical Research in Neurosciences, Paris Brain Institute, Sorbonne University- Institut national de la santé et de la recherche médicale - Centre national de la recherche scientifique, Paris, France
- Department of Psychiatry, Saint-Antoine Hospital, Public Hospitals of Sorbonne University, Paris, France
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50
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Song SH, Frier BM. Does sensor technology lower the prevalence of impaired hypoglycaemia awareness in type 1 diabetes? Diabet Med 2023; 40:e15185. [PMID: 37470747 DOI: 10.1111/dme.15185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Soon H Song
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian M Frier
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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