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Resmini E, Zarra E, Dotti S, Rotondi G, Cornaghi AV, Madaschi S, Cimino E, Massari G, Pezzaioli LC, Buoso C, Sandri M, Girelli A. Impact on Glycemia Risk Index and other metrics in type 1 adult patients switching to Advanced Hybrid Closed-Loop systems: a one-year real-life experience. Eur J Med Res 2024; 29:365. [PMID: 39004734 PMCID: PMC11247841 DOI: 10.1186/s40001-024-01946-w] [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: 04/12/2024] [Accepted: 06/23/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Advanced Hybrid Closed-Loop system (AHCL) has profoundly changed type 1 diabetes therapy. This study primarily aimed to assess the impact on Glycemia Risk Index (GRI) and other continuous glucose monitoring (CGM) metrics when switching from one of four insulin strategies to AHCL in type 1 adult patients. METHODS A single-center, retrospective pre/post observational study; 198 patients (age 44.4 ± 12.7 years, 115 females/83 males, diabetes duration 24.7 ± 11.6 years, HbA1c 7.4 ± 1%), treated with different insulin therapies (MDI, CSII, SAP with PLGS, HCL) were assessed before and after switching to an AHCL (MiniMed 780G, Diabeloop Roche, Tandem Control-IQ) at 1, 3, 6, and 12 months. Mixed-effects multivariable regression models were used to estimate the mean pre/post variations at different time points, adjusted for potential confounders. RESULTS A month after the switch, there was an improvement in CGM metrics and HbA1c for all patients: GRI -10.7, GMI -0.27%, CV -2.1%, TAR>250 -3.7%, TAR180-250 -5.6%, TIR + 9.7%, HbA1c -0.54% (all p < 0.001). This improvement was maintained throughout the observational period (at 3, 6, and 12 months, with all p-values < 0.001). When improvements across the 780, Diabeloop, and Tandem CIQ devices were compared: Diabeloop demonstrated significantly better performance in terms of GRI, GMI, CV, TAR>250 at T1 (for all p < 0.01); 780 recorded highest average decrease in TAR180-250 (p = 0.020), while Tandem achieved the most significant reduction in TBR54-69 (p = 0.004). CONCLUSIONS Adopting an AHCL leads to a rapid and sustained improvement in GRI and other parameters of metabolic control for up to a year, regardless of prior insulin therapies, baseline conditions or brands.
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Affiliation(s)
- Eugenia Resmini
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy.
| | - Emanuela Zarra
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Silvia Dotti
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Giulia Rotondi
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Angelo Vincenzo Cornaghi
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Sara Madaschi
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Elena Cimino
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Giulia Massari
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Letizia Chiara Pezzaioli
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Caterina Buoso
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Marco Sandri
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
| | - Angela Girelli
- Medicina Generale Diabetologia, Dipartimento di Continuità di Cura e Fragilità, ASST Spedali Civili, Brescia, Italy
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Schmidt S, Madsen KP, Pedersen-Bjergaard U, Rytter K, Hommel E, Cleal B, Willaing I, Andersen HU, Nørgaard K. Associations between clinical and psychosocial factors and HbA1c in adult insulin pump users with type 1 diabetes. Acta Diabetol 2023; 60:1089-1097. [PMID: 37160785 PMCID: PMC10289904 DOI: 10.1007/s00592-023-02081-4] [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] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 05/11/2023]
Abstract
AIMS Many adults with type 1 diabetes do not achieve recommended glycemic goals despite intensive insulin therapy using insulin pumps. The aim of this study was to explore associations between clinical and psychosocial factors and HbA1c in insulin pump users to identify and prioritize areas for potential intervention. METHODS A questionnaire-based survey covering clinical and psychosocial aspects of life with type 1 diabetes was distributed to all adult (≥ 18 years) insulin pump users in the Capital Region of Denmark. Responses were combined with data from medical records and national registries. Associations with HbA1c were modeled using regression-based machine learning. RESULTS Of 1,591 invited individuals, 770 (48.4%) responded to the survey. Mean HbA1c among responders was 7.3% (56 mmol/mmol), and 35.6% had an HbA1c < 7.0% (53 mmol/mol). Six factors were significantly associated with HbA1c: diabetes duration (0.006% (0.1 mmol/mol) lower HbA1c per 1-year increase in diabetes duration); education (0.4% (4.3 mmol/mol) lower HbA1c with long higher education vs. primary school); insulin type (0.2% (2.2 mmol/mol) lower HbA1c with ultra-rapid-acting insulin vs. rapid-acting insulin); hypoglycemia awareness status (0.2% (2.2 mmol/mol) lower HbA1c with complete unawareness vs. full awareness); insulin device satisfaction (0.2% (2.7 mmol/mol) lower HbA1c per 1-point increase in Insulin Device Satisfaction Survey score); and diabetes distress (0.3% (3.1 mmol/mol) higher HbA1c per 1-point increase in Type 1 Diabetes Distress Scale score). CONCLUSIONS This study identified several associations between clinical and psychosocial factors and HbA1c that may be considered when developing interventions targeted people with type 1 diabetes.
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Affiliation(s)
- Signe Schmidt
- Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kristoffer Panduro Madsen
- Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karen Rytter
- Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
| | - Eva Hommel
- Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Bryan Cleal
- Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Ingrid Willaing
- Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Ullits Andersen
- Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Kirsten Nørgaard
- Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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3
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Pitocco D, Laurenzi A, Tomaselli L, Assaloni R, Consoli A, Di Bartolo P, Guardasole V, Lombardo F, Maffeis C, Rossi A, Gesuita R, Di Molfetta S, Rigamonti A, Scaramuzza A, Irace C, Cherubini V. Health care organization and use of technological devices in people with diabetes in Italy: Results from a survey of the Working Group on Diabetes and Technology. Nutr Metab Cardiovasc Dis 2022; 32:2392-2398. [PMID: 35970683 DOI: 10.1016/j.numecd.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIM The use of technology offers recognized benefits to persons with diabetes. The aim of this study was to evaluate the organization of healthcare facilities, the composition of the diabetes team, and the use of Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in Italy. METHODS AND RESULTS Diabetes care centers were asked to complete a web survey based on information collected in 2018. Sixty-one pediatric and 243 adult centers participated in the survey, accounting for 507,386 patients, mostly with type 2 diabetes (86.4%). Fifty-three percent of pediatric centers and 11% of adult centers reported a team composed of diabetologists, nurses, and psychologists. Overall, 13,204 patients (2.6%) were using CSII (95% with type 1 diabetes), and 28,936 (5.7%), were using CGM (74% with type 1 diabetes). When stratifying for the type of diabetes, 24% and 40.8% of patients with type 1 were using CSII and CGM, respectively, whereas low use of technology was reported for patients with type 2 and women with gestational diabetes. The percentage of adult and pediatric patients with type 1 diabetes on CSII and CGM was respectively 21% and 32%, and 35% and 57%. CONCLUSIONS The spread of CGM and CSII increased in Italy between 2013 and 2018. However, the percentage of users is still lower than what is expected based on clinical indications for use of technology. The inadequate number of professionals in the diabetes care team and insufficient economic resources are relevant barriers to disseminating technology for diabetes management.
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Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, UOSD Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone [GO], Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Rigamonti
- Division of Pediatrics, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy.
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
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Sastre J, Pinés PJ, del Val F, Moreno-Fernandez J, Gonzalez López J, Quiroga I, Herranz S, López Gallardo G, Calderón D, López López J. Control metabólico y pautas de tratamiento en pacientes con diabetes tipo 1 en Castilla-La Mancha, 10 años después. Estudio DIACAM1 2020. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sastre J, Pinés PJ, Del Val F, Moreno-Fernandez J, Gonzalez López J, Quiroga I, Herranz S, López Gallardo G, Calderón D, López López J. Metabolic control and treatment regimens in patients with type 1 diabetes in Castilla-La Mancha, 10 years later: The 2020 DIACAM1 study. ENDOCRINOL DIAB NUTR 2022; 69:483-492. [PMID: 36008243 DOI: 10.1016/j.endien.2022.07.006] [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: 05/03/2021] [Accepted: 10/05/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate degree of metabolic control and treatment regimens in patients with type 1 diabetes mellitus (T1DM) enrolled in the DIACAM1 study, after 10 years of follow-up under routine clinical practice conditions. PATIENTS AND METHODS A total of 1,465 patients enrolled in the DIACAM1 study, a multicentre, cross-sectional study conducted in Castilla-La Mancha in 2010, were analysed. Of these patients, 58 (4%) died during the 10-year follow-up period. Anthropometric, clinical, laboratory and treatment data were reviewed for 1,121 (76.5%) patients in active follow-up. RESULTS Mean glycosylated haemoglobin (HbA1c) levels were 7.66% lower than in 2010 (p<0.001), 26% of patients achieved HbA1c levels <7%, 24.4% were obese, 51.7% had dyslipidaemia and 33.6% had hypertension. The following were found to be predictive factors for good glycaemic control (HbA1c<7%): good glycaemic control in 2010 (odds ratio [OR] 4.8); the use of intensified insulin regimens, including the Institute for Clinical Systems Improvement (ICSI) guideline and glucose monitoring (OR 2.8); no hyperlipidaemia (OR 1.97); and higher levels of education (OR 1.4). The recommended targets for lipid and blood pressure control were met by 76% of patients; 40% of the patients enrolled required drug treatment. CONCLUSIONS Glycaemic control in patients with T1DM in Castilla-La Mancha improved after 10 years of follow-up. The use of intensified insulin regimens and technology applied to diabetes care appear to be determining factors in achieving this improvement. Despite the increase in the prevalence of cardiovascular risk factors, the majority of the patients achieved good lipid and blood pressure control.
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Affiliation(s)
- Julia Sastre
- Servicio de Endocrinología, Hospital Universitario de Toledo, Toledo, Spain.
| | - Pedro José Pinés
- Servicio de Endocrinología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Florentino Del Val
- Sección de Endocrinología, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | - Iván Quiroga
- Sección de Endocrinología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - Sandra Herranz
- Sección de Endocrinología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Gema López Gallardo
- Unidad de Endocrinología, Hospital Santa Bárbara, Puertollano, Ciudad Real, Spain
| | - Dulce Calderón
- Sección de Endocrinología, Hospital Virgen de la Luz, Cuenca, Spain
| | - José López López
- Servicio de Endocrinología, Hospital Universitario de Toledo, Toledo, Spain
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Gómez-Peralta F, Menéndez E, Conde S, Conget I, Novials A. Clinical characteristics and management of type 1 diabetes in Spain. The SED1 study. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:642-653. [PMID: 34906345 DOI: 10.1016/j.endien.2021.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/30/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the sociodemographic and clinical profile of a representative sample of people with type 1 diabetes mellitus (DM1) in Spain and identify factors associated with glycemic control. MATERIAL AND METHODS A cross-sectional observational study was carried out in adults and children with DM1 treated in 75 Spanish public hospitals, geographically distributed in order to be representative of the Spanish population. Within each center, the patients were included on a consecutive basis as they visited the clinic. They were interviewed, and their clinical histories were reviewed. A descriptive statistical analysis was made, and factors associated with HbA1c were analysed using multivariate linear regression analysis. RESULTS A total of 647 patients were included: 55.3% females, aged 36.6 ± 14.4 years, 97.2% Caucasians, BMI 24.7 ± 4.4 kg/m2 (12.1% ≥ 30 kg/m2), and 74.0% had secondary / university education. A total of 20.2% were active smokers. The mean time from the diagnosis of DM1 was 17.9 ± 12.0 years. A total of 48.7% presented comorbidities: 19.3% retinopathy and 16.4% hypothyroidism. As regards treatment for DM1, 76.5% received basal-bolus insulin therapy and 20.7% continuous subcutaneous insulin infusion (CSII); 51.0% of the patients used an insulin/carbohydrate ratio (ICR), with 4.6 ± 1.6 self-monitored capillary blood glucose (SMCBG) measurements a day, and 24.8% used continuous glucose monitoring (CGM). The mean HbA1c value was 7.6 ± 1.1% (30% below 7%). Metabolic control improved (lower HbA1c) with more daily SMCBG (B = -0.053; p = 0.009), a higher educational level (B = 0.461; P < 0.001), greater number of hypoglycemia episodes (B = -0.253; P = 0.018) and carbohydrate counting (B = -0.190; P = 0.048), and worsened the longer the duration of the disease (B = 0.010; P = 0.010), higher total dose of insulin (B = 0.010; P < 0.0001), poorer adherence to diet (B = 0.650; P < 0.0001) and a family history of DM (B = -0.233; P = 0.007). CONCLUSIONS The management of patients with DM1 in Spain, as well as the treatment they receive, is similar to that seen in other Western countries. Blood glucose control is associated with educational level, disease duration, and the characteristics of treatment and self-care.
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Affiliation(s)
| | - Edelmiro Menéndez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central Asturias, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | | | - Ignacio Conget
- Unidad de Endocrinología y Nutrición, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones Biomédicas en Red sobre Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - Anna Novials
- Unidad de Endocrinología y Nutrición, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Braune K, Boss K, Schmidt-Herzel J, Gajewska KA, Thieffry A, Schulze L, Posern B, Raile K. Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic via Service Design: Prospective, Longitudinal, Open-label Feasibility Trial. JMIR Mhealth Uhealth 2021; 9:e24374. [PMID: 33571104 PMCID: PMC8023381 DOI: 10.2196/24374] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/28/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic poses new challenges to health care providers and the delivery of continuous care. Although many diabetes technologies, such as insulin pumps and continuous glucose monitors, have been established, the data from these devices are rarely assessed. Furthermore, telemedicine has not been sufficiently integrated into clinical workflows. OBJECTIVE We sought to remotely support children with type 1 diabetes and their caregivers, enhance the clinical outcomes and quality of life of children with diabetes, increase multiple stakeholders' engagement with digital care via a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze the success factors and barriers of transitioning from conventional care to digital care. METHODS Service design methods were used to adapt clinical workflows. Remote consultations were performed on a monthly and on-demand basis. Diabetes device data were uploaded from patients' homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during, and after the COVID-19 lockdown period in Germany. RESULTS A total of 28 children with type 1 diabetes and their caregivers enrolled in this study and completed 6 months of remote visits. Of these 28 participants, 16 (57%) also opted to attend at least one of their regular visits remotely. After 3 months of remote visits, participants' time in range (P=.001) and time in hyperglycemia (P=.004) significantly improved, and their time in hypoglycemia did not increase. These improvements were maintained during the COVID-19 lockdown period (ie, between months 3 and 6 of this study). Participants' psychosocial health improved after 6 months. CONCLUSIONS Remote consultations and commonly shared data access can improve the clinical outcomes and quality of life of children with type 1 diabetes, even during challenging circumstances. A service design approach helped with the delivery of comprehensive and holistic solutions that accounted for the needs of multiple stakeholders. Our findings can inform the future integration of digital tools into clinical care during and beyond the pandemic. TRIAL REGISTRATION German Clinical Trials Register DRKS00016170; https://tinyurl.com/skz4wdk5.
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Affiliation(s)
- Katarina Braune
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Karina Boss
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany
| | - Jessica Schmidt-Herzel
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany
| | | | - Axel Thieffry
- Novo Nordisk Center for Biosustainability, Technical University of Denmark, Copenhagen, Denmark
| | | | | | - Klemens Raile
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany
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Gómez-Peralta F, Menéndez E, Conde S, Conget I, Novials A. Clinical characteristics and management of type 1 diabetes in Spain. The SED1 study. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00003-3. [PMID: 33664001 DOI: 10.1016/j.endinu.2020.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine the sociodemographic and clinical profile of a representative sample of people with type 1 diabetes mellitus (DM1) in Spain and identify factors associated with glycemic control. MATERIAL AND METHODS A cross-sectional observational study was carried out in adults and children with DM1 treated in 75 Spanish public hospitals, geographically distributed in order to be representative of the Spanish population. Within each center, the patients were included on a consecutive basis as they visited the clinic. They were interviewed, and their clinical histories were reviewed. A descriptive statistical analysis was made, and factors associated with HbA1c were analyzed using multivariate linear regression analysis. RESULTS A total of 647 patients were included: 55.3% females, aged 36.6±14.4 years, 97.2% Caucasians, BMI 24.7±4.4kg/m2 (12.1% ≥30kg/m2), and 74.0% had secondary / university education. A total of 20.2% were active smokers. The mean time from the diagnosis of DM1 was 17.9±12.0 years. A total of 48.7% presented comorbidities: 19.3% retinopathy and 16.4% hypothyroidism. As regards treatment for DM1, 76.5% received basal-bolus insulin therapy and 20.7% continuous subcutaneous insulin infusion (CSII); 51.0% of the patients used an insulin/carbohydrate ratio (ICR), with 4.6±1.6 self-monitored capillary blood glucose (SMCBG) measurements a day, and 24.8% used continuous glucose monitoring (CGM). The mean HbA1c value was 7.6±1.1% (30% below 7%). Metabolic control improved (lower HbA1c) with more daily SMCBG (B=-0.053; p=0.009), a higher educational level (B=0.461; P<0.001), greater number of hypoglycemia episodes (B=-0.253; P=0.018) and carbohydrate counting (B=-0.190; P=0.048), and worsened the longer the duration of the disease (B=0.010; P=0.010), higher total dose of insulin (B=0.010; P<0.0001), poorer adherence to diet (B=0.650; P<0.0001) and a family history of DM (B=-0.233; P=0.007). CONCLUSIONS The management of patients with DM1 in Spain, as well as the treatment they receive, is similar to that seen in other Western countries. Blood glucose control is associated with educational level, disease duration, and the characteristics of treatment and self-care.
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Affiliation(s)
| | - Edelmiro Menéndez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central Asturias, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, España
| | | | - Ignacio Conget
- Unidad de Endocrinología y Nutrición, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, España; Centro de Investigaciones Biomédicas en Red sobre Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, España
| | - Anna Novials
- Unidad de Endocrinología y Nutrición, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, España
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9
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Casaño MÁ, Del Mar Alonso Montejo M, Gea IL, Manuel Jiménez Hinojosa J, Mata MÁS, Macías F, Del Mar Romero Pérez M, de Toro M, Martínez G, Munguira P, Vivas G, Siguero JPL. Study of the quality of life and adherence to treatment in patients from 2 to 16 years-old with type 1 diabetes mellitus in Andalusia, Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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10
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Gajewska KA, Biesma R, Bennett K, Sreenan S. Barriers and facilitators to accessing insulin pump therapy by adults with type 1 diabetes mellitus: a qualitative study. Acta Diabetol 2021; 58:93-105. [PMID: 32862261 DOI: 10.1007/s00592-020-01595-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/09/2020] [Indexed: 12/31/2022]
Abstract
AIMS Uptake of continuous subcutaneous insulin infusion (CSII) by people with diabetes (PwD) in Ireland is low and exhibits regional variation. This study explores barriers and facilitators to accessing CSII by adults with Type 1 diabetes mellitus. RESEARCH DESIGN AND METHODS A qualitative study employing focus groups with adults with Type 1 diabetes mellitus (n = 26) and semi-structured interviews with health care professionals (HCP) and other key stakeholders (n = 21) was conducted. Reflexive thematic analysis was used to analyze data, using NVivo. RESULTS Four main themes comprising barriers to or facilitators of CSII uptake were identified. These included: (1) awareness of CSII and its benefits, (2) the structure of diabetes services, (3) the capacity of the diabetes service to deliver the CSII service, and (4) the impact of individuals' attitudes and personal characteristics-both PwD, and HCP. Each of these themes was associated with a number of categories, of which 18 were identified and explored. If the structure of the health-service is insufficient and capacity is poor (e.g., under-resourced clinics), CSII uptake appears to be impacted by individuals': interest, attitude, willingness and motivation, which may intensify the regional inequality in accessing CSII. CONCLUSIONS This study identified factors that contribute to gaps in the delivery of diabetes care that policy-makers may use to improve access to CSII for adult PwD.
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Affiliation(s)
- Katarzyna A Gajewska
- Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland.
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kathleen Bennett
- Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland
| | - Seamus Sreenan
- 3U Diabetes, RCSI: University of Medicine and Health Sciences, Dublin, Ireland
- Department of Diabetes and Endocrinology, RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland
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11
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Benioudakis ES, Georgiou ED, Barouxi ED, Armagos AM, Koutsoumani V, Anastasiou-Veneti F, Koutsoumani E, Brokalaki M. The diabetes quality of life brief clinical inventory in combination with the management strategies in type 1 diabetes mellitus with or without the use of insulin pump. Diabetol Int 2020; 12:217-228. [PMID: 33786276 DOI: 10.1007/s13340-020-00477-z] [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: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
Aims The aims of this study are to evaluate any differences in the Quality of life among Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Dose Injection (MDI) insulin delivery, applying the Diabetes Quality of life Brief Clinical Inventory (DQoL-BCI) questionnaire, and assess the diabetes management strategies between the two groups. Methods One hundred and ten adult participants (male/female ratio 1:2.7) with type 1 diabetes were recruited in this online survey. Forty-eight of them were using CSII and the rest 62 (were using) MDI insulin delivery. A 23-item socio-demographic/diabetes management strategies questionnaire and the 15-item DQoL-BCI were administered. Results CSII users scored statistically, significantly better at the satisfaction treatment subscale (p = 0.032) of the DQoL-BCI and emerged that they were implemented more management strategies such as dietician guidance services (p = 0.002), carbohydrate education seminars (p = 0.03). Predictive factors were also detected regarding the HbA1c < 7% (53 mmol/mol) and β-coefficients in relation to DQoL-BCI questionnaire with the subscales of a negative impact and satisfaction treatment. Conclusion Diabetes self-management education plays a key role to a better compliance with the treatment. Client-centered multidisciplinary centers in T1DM education are essential so that they be applicable for all T1DM patients irrespective of the type of insulin delivery they used.
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Affiliation(s)
- Emmanouil S Benioudakis
- Department of Psychology, University of Crete, Rethimno, Greece.,Psychiatric Clinic, General Hospital of Chania, Chania, Greece
| | - Evangelos D Georgiou
- Statistical Methods in Medicine and Pharmacy, Athens University of Economics and Business, Athens, Greece.,Department of Psychology, University of Cyprus Centre for Field Studies, University of Cyprus, Nicosia, Cyprus
| | | | - Athanasios M Armagos
- Health Psychology, University of Crete, Rethimno, Greece.,Psychiatric Clinic, Naval Hospital of Athens (NNA), Athens, Greece
| | | | | | | | - Maria Brokalaki
- Nutrition and Dietetics, Technological Educational Institute of Crete, Sitia, Greece
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12
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Gajewska KA, Biesma R, Bennett K, Sreenan S. Availability of and access to continuous subcutaneous insulin infusion therapy for adults with type 1 diabetes in Ireland. Acta Diabetol 2020; 57:875-882. [PMID: 32124077 DOI: 10.1007/s00592-020-01497-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022]
Abstract
AIMS The uptake of continuous subcutaneous insulin infusion (CSII) is low in adults with type 1 diabetes mellitus (T1DM) in Ireland, compared to other countries where CSII is reimbursed. To explore the reasons for the low uptake, this study aims to investigate the availability of CSII in adult diabetes clinics in Ireland. METHODS A national survey of all adult diabetes clinics (public and private) in Ireland was conducted and completed anonymously by the lead physician/diabetes nurse specialist in each clinic. Descriptive statistics and comparisons between clinics offering different levels of care for CSII are presented. RESULTS Of 50 diabetes clinics invited, 47 (94%) participated in the study. Fifteen clinics (32%) offered no support for CSII, while 21 (45%) reported offering both training to commence CSII and ongoing support. Based on the survey findings, access to CSII was unavailable for 2426 (11%) of those with T1DM. The majority (n = 15,831, 71% of 22,321 T1DM population) received diabetes care from clinics offering CSII training, but only 2165 were using CSII (10% of T1DM population). Uptake of CSII was higher in clinics offering training than in those offering follow-up care for CSII only (12% vs. 5%, p < 0.001). Clinics offering all CSII services had more specialists (p = 0.005 for endocrinologists and p < 0.001 for dietitians). Reasons for not offering CSII services included staff shortages and heavy workload. CONCLUSIONS This study highlights the low uptake of CSII in Ireland and demonstrates that, even when reimbursed, other barriers to uptake of CSII can limit its use.
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Affiliation(s)
- Katarzyna Anna Gajewska
- Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland.
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Centre, Groningen, The Netherlands
| | - Kathleen Bennett
- Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland
| | - Seamus Sreenan
- 3U Diabetes, RCSI: University of Medicine and Health Sciences, Dublin, Ireland
- Department of Diabetes and Endocrinology, RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland
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13
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Gajewska KA, Bennett K, Biesma R, Sreenan S. Low uptake of continuous subcutaneous insulin infusion therapy in people with type 1 diabetes in Ireland: a retrospective cross-sectional study. BMC Endocr Disord 2020; 20:92. [PMID: 32576284 PMCID: PMC7310521 DOI: 10.1186/s12902-020-00573-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The uptake of continuous subcutaneous insulin infusion (CSII) therapy in those with type 1 diabetes varies internationally and is mainly determined by the national healthcare reimbursement systems. The aim of this study is to estimate national and regional uptake of CSII therapy in children, adolescents and adults with type 1 diabetes in Ireland. METHODS A retrospective cross-sectional study was conducted utilizing the national pharmacy claims database in 2016. Individuals using CSII were identified by dispensing of infusion sets. The uptake of CSII was calculated as the percentage of people with type 1 diabetes claiming CSII sets in 2016, both in children and adolescent (age < 18 years) and adult populations (≥ 18 years). Descriptive statistics including percentages with 95% confidence intervals (CIs) are presented, stratified by age-groups and geographical regions, and chi-square tests used for comparisons. RESULTS Of 20,081 people with type 1 diabetes, 2111 (10.5, 95% CI: 10.1-10.9%) were using CSII in 2016. Uptake was five-fold higher in children and adolescents at 34.7% (95% CI: 32.9-36.5%) than in adults at 6.8% (95% CI: 6.4-7.2%). Significant geographical heterogeneity in CSII uptake was found, from 12.6 to 53.7% in children and adolescents (p < 0.001), and 2 to 9.6% in adults (p < 0.001). CONCLUSIONS Uptake of CSII in people with type 1 diabetes is low in Ireland, particularly in those ≥18 years. Identification of barriers to uptake, particularly in this group, is required.
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Affiliation(s)
- Katarzyna Anna Gajewska
- Division of Population Health Scineces, RCSI: University of Medicine and Health Sciences, Dublin, Ireland.
| | - Kathleen Bennett
- Division of Population Health Scineces, RCSI: University of Medicine and Health Sciences, Dublin, Ireland
| | - Regien Biesma
- Department of Health Sciences, Global Health, Univeristy Medical Centre Groningen, Groningen, the Netherlands
| | - Seamus Sreenan
- 3U Diabetes, RCSI: University of Medicine and Health Scineces, Dublin, Ireland
- Diabetes and Endocrinology. RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland
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14
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Álvarez Casaño M, Alonso Montejo MDM, Leiva Gea I, Jiménez Hinojosa JM, Santos Mata MÁ, Macías F, Romero Pérez MDM, de Toro M, Martínez G, Munguira P, Vivas G, López Siguero JP. [Study of the quality of life and adherence to treatment in patients from 2 to 16 years-old with type 1 diabetes mellitus in Andalusia, Spain]. An Pediatr (Barc) 2020; 94:75-81. [PMID: 32540137 DOI: 10.1016/j.anpedi.2020.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Diabetes mellitus 1 is the second most frequent chronic disease, and the most frequent endocrine-metabolic disorder in childhood. The estimated prevalence is between 1.1 and 1.4 / 1000 children under 15 years years-old. In Andalusia the prevalence is higher (1.7 per thousand). The objective of the study is to evaluate health-related quality of life (HRQoL) and adherence to treatment, specifically in the paediatric population of Andalusia. METHODS A multicentre cross-sectional observational analytical study was conducted on a sample of 178 patients from six hospitals with a Paediatric Endocrinology Unit. Each patient received two questionnaires; quality of life (PedsQL version 3.0) and adherence to the self-care recommendations (SCI-R) treatment. The demographic, clinical, metabolic control data, and possible complications were also collected. RESULTS High levels were obtained in both adherence and health-related quality of life (HRQoL). Adherence was inversely related to age and HbA1c. The health-related quality of life (HRQoL) was associated with the use of a continuous real-time glucose monitoring system (MCG-TR) combined with continuous subcutaneous insulin infusion (CSII), as well as with a lower number of severe hypoglycaemia and renal complications. The mean HbA1c was 7.1%. 12,9% of patients used ISCI. 83.2% used capillary glycemia exclusively, while 16.8% used some interstitial glucose monitoring device. CONCLUSIONS This is the first study in Andalusia that analyzes the health-related quality of life (HRQoL) of pediatric patients. The results show high levels of adherence and health-related quality of life (HRQoL), as well as good metabolic control.
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Affiliation(s)
- María Álvarez Casaño
- Unidad de Endocrinología Pediátrica, Hospital Materno Infantil de Málaga, Málaga, España.
| | | | - Isabel Leiva Gea
- Unidad de Endocrinología Pediátrica, Hospital Materno Infantil de Málaga, Málaga, España
| | | | | | - Francisco Macías
- Unidad de Endocrinología Pediátrica, Hospital Materno Infantil de Jerez , Cádiz, España
| | | | - Marta de Toro
- Unidad de Endocrinología Pediátrica, Hospital Materno Infantil de Jaén, Jaén, España
| | - Gabriela Martínez
- Unidad de Endocrinología Pediátrica, Hospital Materno Infantil de Jaén, Jaén, España
| | - Pilar Munguira
- Unidad de Endocrinología Pediátrica, Hospital General San Agustín de Linares, Jaén, España
| | - Gustavo Vivas
- Unidad de Endocrinología Pediátrica, Hospital Serranía de Ronda , Jaén, España
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Muñoz-Velandia O, Guyatt G, Devji T, Zhang Y, Li SA, Alexander PE, Henao D, Gomez AM, Ruiz-Morales Á. Patient Values and Preferences Regarding Continuous Subcutaneous Insulin Infusion and Artificial Pancreas in Adults with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Data. Diabetes Technol Ther 2019; 21:183-200. [PMID: 30839227 DOI: 10.1089/dia.2018.0346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We produced, through a systematic review of quantitative and qualitative evidence, a synthesis of the issues of importance (values and preferences) to adult patients with type 1 diabetes regarding treatment with automated insulin delivery systems. METHODS We searched MEDLINE, CINAHL, EMBASE, and PsycINFO from the inception of each database through September 2018. We included studies examining patient values and preferences for outcomes related to continuous subcutaneous insulin infusion or artificial pancreas treatment. We compiled structured summaries of the results and assessed the relative importance of each outcome. GRADE (Grading of Recommendations, Assessment Development, and Evaluation) and CERQual (Confidence in Evidence from Reviews of Qualitative research) approaches provided the structure for the evaluation of the quality of evidence and confidence in the findings. A mixed-methods result-based convergent design provided the structure for integration and presentation of results. RESULTS We reviewed 1665 unique citations; 19 studies (8 quantitative and 11 qualitative) proved eligible. Glycemic control is the key attribute that drives patients' preference. Reduction of glycemic variability and decreased incidence of hypoglycemia and chronic complications proved of intermediate importance and were ranked similarly to components of treatment burden, including the size and appearance of devices, cost, ease of use, and the embarrassment of public use. CONCLUSIONS Clinician guidance may play a crucial role in determining patient values and preferences (for instance, patients' priority in glucose control rather than avoiding diabetic complications). Our results provide guidance for clinicians in discussing preferred insulin delivery systems with patients with type 1 diabetes.
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Affiliation(s)
- Oscar Muñoz-Velandia
- 1 Department of Internal Medicine and Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
- 2 Department of Clinical Epidemiology and Biostatistics, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Gordon Guyatt
- 3 Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Tahira Devji
- 3 Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Yuan Zhang
- 3 Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Shelly-Anne Li
- 4 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Paul Elías Alexander
- 3 Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Diana Henao
- 5 Endocrinology Unit, Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana-María Gomez
- 5 Endocrinology Unit, Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Álvaro Ruiz-Morales
- 1 Department of Internal Medicine and Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
- 2 Department of Clinical Epidemiology and Biostatistics, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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16
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Tomé Pérez Y, Barroso Martínez V, Félix-Redondo FJ, Tobajas Belvis L, Cordón Arroyo AM. Needs of schoolchildren with type 1 diabetes in Extremadura: Family perceptions. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Yamamoto Y, Kikuchi T, Urakami T, Goto M, Tsubouchi K, Sasaki G, Mizuno H, Abe Y, Kitsuda K, Amemiya S, Sugihara S. Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control: comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2019; 32:1-9. [PMID: 30517078 DOI: 10.1515/jpem-2018-0329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/08/2018] [Indexed: 11/15/2022]
Abstract
Background Treatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients. Methods The registration data including hemoglobin A1c (HbA1c), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort). Results The proportion of subjects with multiple daily insulin injection therapy (MDI) and CSII significantly increased (p<0.0001) from 67.4% and 9.7% to 71.8% and 23.4%, respectively. In the 2013 cohort, almost all patients were treated with basal-bolus treatment using insulin analogs. The use of CSII increased in all age groups, especially in the age group 0-5 years. The rates of overall, moderate and severe hypoglycemia significantly declined from 10.24, 10.18 and 0.056 events/100 persons/period in the 2008 cohort to 0.66, 0.62 and 0.033 in the 2013 cohort (p<0.0001, <0.0001, 0.04), respectively. Contrarily, there were no significant changes in HbA1c values between the two cohorts. Conclusions The popularization of the basal-bolus treatment using insulin analogs hascontributed to a significant decrease in hypoglycemia. In contrast, the intensive insulin treatment may not be enough for the satisfactory improvement of glycemic control in Japanese children and adolescents with T1DM. Considerable points remain, such as diabetic education and support to motivate patients.
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Affiliation(s)
- Yukiyo Yamamoto
- Director of Medical Education, Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu City 807-8555, Japan.,The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Toru Kikuchi
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Tatsuhiko Urakami
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Motohide Goto
- Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Kohji Tsubouchi
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Chuno Kosei Hospital, Gifu, Japan
| | - Goro Sasaki
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Haruo Mizuno
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Departments of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuki Abe
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Kazuteru Kitsuda
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Kitasato University, Kanagawa, Japan
| | - Shin Amemiya
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Shigetaka Sugihara
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Tomé Pérez Y, Barroso Martínez V, Félix-Redondo FJ, Tobajas Belvis L, Cordón Arroyo AM. [Needs of schoolchildren with type 1 diabetes in Extremadura: Family perceptions]. An Pediatr (Barc) 2018; 90:173-179. [PMID: 30193798 DOI: 10.1016/j.anpedi.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION School-aged children with type 1 diabetes (DM1) require access to appropriate and safe care for their disease during their stay in the educational centre. OBJECTIVE To identify the needs perceived by families of schoolchildren with DM1 that affect their educational integration, safety, and well-being during the school day. METHODOLOGY A descriptive and cross-sectional study was conducted using a questionnaire based on information and opinions provided by families of 362 schoolchildren between 3 and 16 years old with DM1 registered in their health history in the Public Health System of Extremadura. RESULTS The response rate was 56.9% (206). It was shown that 35% of schoolchildren with DM1 were treated with continuous subcutaneous insulin infusion therapy. Almost all of them (95.1%) required glucose monitoring, and 57.8% required insulin administration during the school day. Most (88%) children had adjusted well to school and did not describe any type of discriminatory treatment (87.4%). Glucagon is available in 82% of educational centres, in which 43.7% had a trained adult person to administer it. That teachers could recognise a hypoglycaemia was expressed by 21.4% of the families, and 29.1% were unaware of the existence of coordination protocols in the school. More than half (58.7%) claimed that the information available in schools about diabetes was low, and 77.2% stated that the control of the disease would improve if more training was provided to teachers. CONCLUSIONS There are aspects optimally covered in the care of schoolchildren with DM1 in the schools of Extremadura. Among situations identified with potential room for improvement were adherence to the coordination protocol, information about diabetes, and training of adults to deal with emergency situations.
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Affiliation(s)
- Yolanda Tomé Pérez
- Dirección General de Planificación, Formación y Calidad Sanitarias y Sociosanitarias, Consejería de Sanidad y Políticas Sociales, Junta de Extremadura, Mérida, Badajoz, España.
| | - Victoria Barroso Martínez
- Dirección General de Planificación, Formación y Calidad Sanitarias y Sociosanitarias, Consejería de Sanidad y Políticas Sociales, Junta de Extremadura, Mérida, Badajoz, España
| | - F Javier Félix-Redondo
- Dirección General de Asistencia Sanitaria, Servicio Extremeño de Salud, Mérida, Badajoz, España
| | - Luis Tobajas Belvis
- Dirección General de Planificación, Formación y Calidad Sanitarias y Sociosanitarias, Consejería de Sanidad y Políticas Sociales, Junta de Extremadura, Mérida, Badajoz, España
| | - Ana María Cordón Arroyo
- Dirección General de Planificación, Formación y Calidad Sanitarias y Sociosanitarias, Consejería de Sanidad y Políticas Sociales, Junta de Extremadura, Mérida, Badajoz, España
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López Siguero JP, Pérez González O, Gómez Gila AL, Leiva Gea I. Situación de la diabetes mellitus tipo 1 en Andalucía. Datos asistenciales, uso de terapias avanzadas y recursos humanos. An Pediatr (Barc) 2018; 89:111-116. [DOI: 10.1016/j.anpedi.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/16/2017] [Accepted: 09/22/2017] [Indexed: 01/09/2023] Open
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Tauschmann M, Hovorka R. Technology in the management of type 1 diabetes mellitus - current status and future prospects. Nat Rev Endocrinol 2018; 14:464-475. [PMID: 29946127 DOI: 10.1038/s41574-018-0044-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Type 1 diabetes mellitus (T1DM) represents 5-10% of diabetes cases worldwide. The incidence of T1DM is increasing, and there is no immediate prospect of a cure. As such, lifelong management is required, the burden of which is being eased by novel treatment modalities, particularly from the field of diabetes technologies. Continuous glucose monitoring has become the standard of care and includes factory-calibrated subcutaneous glucose monitoring and long-term implantable glucose sensing. In addition, considerable progress has been made in technology-enabled glucose-responsive insulin delivery. The first hybrid insulin-only closed-loop system has been commercialized, and other closed-loop systems are under development, including dual-hormone glucose control systems. This Review focuses on well-established diabetes technologies, including glucose sensing, pen-based insulin delivery, data management and data analytics. We also cover insulin pump therapy, threshold-based suspend, predictive low-glucose suspend and single-hormone and dual-hormone closed-loop systems. Clinical practice recommendations for insulin pump therapy and continuous glucose monitoring are presented, and ongoing research and future prospects are highlighted. We conclude that the management of T1DM is improved by diabetes technology for the benefit of the majority of people with T1DM, their caregivers and guardians and health-care professionals treating patients with T1DM.
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Affiliation(s)
- Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
- Department of Paediatrics, University of Cambridge, Cambridge, UK.
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The situation as regards diabetes mellitus type 1 in Andalusia. Care data, use of advanced therapies and human resources. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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22
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Kampmann U, Madsen LR, Bjerg L, Witte DR, Hasselstrøm K, Østergård T, Alstrup K, Møller MK, Dylmer D, Hansen KW. Prevalence and geographical distribution of insulin pump therapy in the Central Denmark Region and its association with metabolic parameters. Diabetes Res Clin Pract 2018; 141:148-155. [PMID: 29733870 DOI: 10.1016/j.diabres.2018.04.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
AIMS Insulin treatment in type 1 diabetes encompasses multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion (CSII). Both population-based studies and comparative studies regarding CSII use are sparse. The aim of the current study was to describe the prevalence and distribution of CSII use among adults with type 1 diabetes in the Central Denmark Region and to compare metabolic control in CSII-treated patients to those treated with MDI. METHODS A database was constructed using the Danish Adult Diabetes Registry in 2014/2015 in combination with an audit of the patients' medical records. RESULTS 3909 adults with type 1 diabetes patients were included. The proportion of patients treated with CSII differed significantly between the 8 regional hospitals from 12.0% to 31.1%. CSII users had a significantly lower HbA1c compared to MDI treated patients (7.6% (60 mmol/mol) versus 8.0% (64 mmol/mol)) in unadjusted analyses. After adjustment for clinically relevant characteristics the difference between CSII and MDI-treated patients was attenuated, but remained statistically significant. CONCLUSION The distribution of CSII differed markedly between hospitals and CSII users had better glycemic control, even after adjustment for sex, age, BMI, diabetes duration, smoking, use of lipid-lowering and blood pressure-lowering medication.
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Affiliation(s)
- Ulla Kampmann
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark.
| | - Lene Ring Madsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - Lasse Bjerg
- Department of Public Health, Section of General Practice, Aarhus University, Denmark; Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Daniel R Witte
- Department of Public Health, Section of General Practice, Aarhus University, Denmark; Danish Diabetes Academy, Odense, Denmark
| | | | - Torben Østergård
- Department of Internal Medicine, Viborg Regional Hospital, Denmark
| | - Kirsten Alstrup
- Department of Internal Medicine, Randers Regional Hospital, Denmark
| | | | - Dorrit Dylmer
- Department of Internal Medicine, Holstebro Regional Hospital, Denmark
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23
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Beato-Víbora P, Chico-Ballesteros A, Giménez M, Guerrero-Vázquez R, Barrio-Castellanos R, Goñi-Iriarte MJ, Díaz-Soto G, Merino-Torres JF, Moreno-Fernández J, Martínez-Brocca MA. A national survey on the efficacy and safety of continuous subcutaneous insulin infusion in patients with type 1 diabetes in Spain. Diabetes Res Clin Pract 2018; 137:56-63. [PMID: 29278712 DOI: 10.1016/j.diabres.2017.12.009] [Citation(s) in RCA: 12] [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] [Received: 09/02/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 11/15/2022]
Abstract
AIMS To assess safety and benefits of continuous subcutaneous insulin infusion (CSII) therapy in a cohort of type 1 diabetes patients in Spain. METHODS A web-based national registry was created by the Working Group of the Spanish Diabetes Association. All patients on CSII being followed at selected referral centers were included. A cross-sectional analysis was performed. RESULTS A total of 1275 patients were included. Data completion for patients on CSII was 67 ± 32%. Indications for treatment were suboptimal glycemic control (32%), high glucose variability (24%), preconception care (14%) and hypoglycemia (11%). In the patients on CSII for ≥1 year (n = 843, mean CSII duration of 5 years), HbA1c decreased by 5 mmol/mol (0.5%) in the whole population and by 8 mmol/mol (0.7%) in subjects with suboptimal glycemic control as CSII indication. Percentage of patients achieving HbA1c ≤ 53 mmol/mol (7%) increased from 20% before CSII to 34% at the end of follow-up. Severe hypoglycemia decreased from 29% to 5%. The rate of discontinuation was 9.5%. HbA1c was lower in patients using bolus advisor and temporary basal rates. CONCLUSIONS CSII was associated with a sustained improvement in glycemic control and a reduction in severe hypoglycemia. The use of advanced CSII settings was related to better glycemic control.
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24
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Abstract
To date, the use of technology for the management of diabetes represents a promising area of innovation that can dramatically change diabetics' lives. In the past decade, the use of diabetes devices has widely grown and looks to have partially improved diabetes management. The combination of cloud technology with real-expert intervention saves time and improves efficiency, as well as empowering the patient. The application of mathematical models applied to diabetes therapy could lead to significant improvement in life quality and challenge the burden of hypoglycaemia. Events where an individual needs support are instantly achieved, triggering outreach alerts via cloud and wireless connectivity, thereby improving patient compliance and reducing disease costs.
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Affiliation(s)
- A R Maurizi
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Piemonte
- Faculty of Bioengineering, Campus Bio-Medico University of Rome, Rome, Italy
| | - P Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
- Centre of Immunobiology, Blizard Instiute, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
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25
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Visekruna S, McGillis Hall L, Parry M, Spalding K. Intersecting Health Policy and the Social Determinants of Health in Pediatric Type 1 Diabetes Management and Care. J Pediatr Nurs 2017; 37:62-69. [PMID: 28683888 DOI: 10.1016/j.pedn.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 06/03/2017] [Indexed: 12/20/2022]
Abstract
THEORETICAL PRINCIPLES Type 1 diabetes health technologies are evolving. This is an expensive chronic condition to manage, hence a combination of public and private healthcare funding sources, as well as out-of-pocket payments support disease management. The aim of this paper is to describe two conceptual underpinnings, which can appropriately position the health policy and clinical context of pediatric type 1 diabetes management and care. PHENOMENA ADDRESSED: "The Main Determinants of Health" framework is used to position pediatric T1D management and care within the model's four interconnected layers: the structural environment, social and material conditions, support systems and individual health behaviors. A health policy in Ontario, Canada, the Assistive Devices Program for insulin pump therapy is also discussed relative to the model's outermost layer: the structural environment. Four dimensions of control, which characterize the "street-level bureaucrat" role including "distributing benefits and sanctions; structuring the context; teaching the client role; and, psychological benefits and sanctions" then position the policy context of the diabetes nurse educator role relative to the Assistive Devices Program policy. RESEARCH LINKAGES These conceptual underpinnings could extend beyond the pediatric T1D landscape to position global research in other nursing practice areas, as well as with other patient populations and professional disciplines such as social work and medicine.
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Affiliation(s)
- Sanja Visekruna
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Linda McGillis Hall
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Karen Spalding
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada.
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26
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Naranjo D, Suttiratana SC, Iturralde E, Barnard KD, Weissberg-Benchell J, Laffel L, Hood KK. What End Users and Stakeholders Want From Automated Insulin Delivery Systems. Diabetes Care 2017; 40:1453-1461. [PMID: 28842523 PMCID: PMC5864142 DOI: 10.2337/dc17-0400] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/23/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to rigorously explore psychosocial factors associated with automated insulin delivery systems among people living with type 1 diabetes. RESEARCH DESIGN AND METHODS Across four sites in the U.S. and U.K., 284 participants completed structured interviews or focus groups on expectations, desired features, potential benefits, and perceived burdens of automated insulin delivery systems. Recorded audio files were transcribed and analyzed using NVivo. RESULTS Three themes were identified as critical for uptake of automated insulin delivery: considerations of trust and control, system features, and concerns and barriers to adoption. Children and adolescents with type 1 diabetes primarily identified needs specific to their life stage and social contexts (e.g., school). Adults with type 1 diabetes, parents of youth with type 1 diabetes, and partners of adults with type 1 diabetes were most concerned about the accuracy, adaptability, and algorithm quality alongside expectations that systems stabilize glucose levels and reduce risk for long-term complications. CONCLUSIONS Incorporating stakeholder perspectives on use of automated insulin delivery systems will improve the adoption of devices, quality of life, and likelihood of optimal health. Efforts to build trust in systems, optimize user-system interactions, and provide clear guidance about device capabilities and limitations may help potential users achieve optimal glycemic outcomes.
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Affiliation(s)
- Diana Naranjo
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Sakinah C Suttiratana
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.,Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Esti Iturralde
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | | | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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27
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Leelarathna L, Roberts SA, Hindle A, Markakis K, Alam T, Chapman A, Morris J, Urwin A, Jinadev P, Rutter MK. Comparison of different insulin pump makes under routine care conditions in adults with Type 1 diabetes. Diabet Med 2017. [PMID: 28636773 DOI: 10.1111/dme.13412] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS To compare long-term HbA1c changes associated with different insulin pumps during routine care in a large cohort of adults with Type 1 diabetes representative of other clinic populations. METHODS Observational, retrospective study of 508 individuals starting pump therapy between 1999 and 2014 (mean age, 40 years; 55% women; diabetes duration, 20 years; 94% Type 1 diabetes; median follow-up, 3.7 years). Mixed linear models compared covariate-adjusted HbA1c changes associated with different pump makes. RESULTS The pumps compared were: 50% Medtronic, 24% Omnipod, 14% Roche and 12% Animas. Overall HbA1c levels improved and improvements were maintained during a follow-up extending to 10 years (HbA1c : pre-continuous subcutaneous insulin infusion (pre-CSII) vs. 12 months post CSII, 71 (61, 82) vs. 66 (56, 74) mmol/mol; 8.7 (7.7, 9.6) vs. 8.2 (7.3, 8.9)%; P < 0.0001). The percentage of individuals with HbA1c ≥ 64 mmol/mol (8.0%) reduced from a pre-CSII level of 68% to 55%. After adjusting for baseline confounders, there were no between-pump differences in HbA1c lowering (P = 0.44), including a comparison of patch pumps with traditional catheter pumps (P = 0.63). There were no significant (P < 0.05) between-pump differences in HbA1c lowering in pre-specified subgroups stratified by pre-pump HbA1c , age or diabetes duration. HbA1c lowering was positively related to baseline HbA1c (P < 0.001) and diabetes duration (P = 0.017), and negatively related to the number of years of CSII use (P = 0.024). CONCLUSIONS Under routine care conditions, there were no covariate-adjusted differences in HbA1c lowering when comparing different pump makes, including a comparison of patch pumps vs. traditional catheter pumps. Therefore, the choice of CSII make should not be influenced by the desired degree of HbA1c lowering.
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Affiliation(s)
- L Leelarathna
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - S A Roberts
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - A Hindle
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - K Markakis
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - T Alam
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - A Chapman
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - J Morris
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - A Urwin
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - P Jinadev
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - M K Rutter
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
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28
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Anyanwagu U, Olaoye H, Jennings P, Ashton-Cleary S, Sugunendran S, Hughes D, Idris I, Wilmot EG. Continuous subcutaneous insulin infusion (CSII) therapy at Derby Teaching Hospitals: sustained benefits in glucose control. Diabet Med 2017; 34:1154-1157. [PMID: 28430381 DOI: 10.1111/dme.13367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/12/2022]
Abstract
AIM In the short term, continuous subcutaneous insulin infusion (CSII) has been associated with improved glycaemic control, reduced hypoglycaemia and improved quality of life (QOL). However, limited data are available on its long-term benefits, particularly in the UK. We aimed to assess the impact of CSII on longer term outcomes. METHOD Patient-level data were obtained for CSII users at Derby Teaching Hospitals, UK. Patient confidence and satisfaction questionnaires using the Likert scale were used to assess confidence in self-management. Comparative statistics were conducted using Pearson's chi-square and Student's t-tests. RESULTS Some 258 CSII users were identified (60.1% female, mean age 43.9 ± 13.4 years). Overall, there was significant decrease in HbA1c from 78 mmol/mol (9.3 ± 2.0%) at baseline, to 69 mmol/mol (8.5 ± 1.3%) at 6 months [mean difference (md): -0.64; 95% confidence interval (95% CI): -0.91 to -0.37; P < 0.0001]; which was sustained at 6 years of follow-up (HbA1c : 66 mmol/mol, 8.2 ± 1.3%; md: -1.07%; 95% CI: -1.45 to -0.69; P < 0.0001). One hundred and twenty-one patients (47%) responded to the survey, of whom 95 (78.5%) reported a reduction in the frequency of hypoglycaemia; 102 (84.3%) were satisfied with the quality of care received in the insulin pump service. CONCLUSION CSII therapy led to a sustained long-term improvement in glycaemic control in addition to a reduction in self-reported hypoglycaemia.
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Affiliation(s)
- U Anyanwagu
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham
| | - H Olaoye
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham
| | - P Jennings
- Diabetes Unit, Royal Derby Hospital, Derby, UK
| | | | | | - D Hughes
- Diabetes Unit, Royal Derby Hospital, Derby, UK
| | - I Idris
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham
- Diabetes Unit, Royal Derby Hospital, Derby, UK
| | - E G Wilmot
- Diabetes Unit, Royal Derby Hospital, Derby, UK
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29
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Shulman R, Stukel TA, Miller FA, Newman A, Daneman D, Guttmann A. Insulin pump use and discontinuation in children and teens: a population-based cohort study in Ontario, Canada. Pediatr Diabetes 2017; 18:33-44. [PMID: 26748950 DOI: 10.1111/pedi.12353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/04/2015] [Accepted: 12/12/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe insulin pump use by youth since introduction of universal funding in Ontario, Canada and to explore the relationship between pump use and pediatric diabetes center characteristics and the relationship between discontinuation and center and patient characteristics. RESEARCH DESIGN AND METHODS Observational, population-based cohort study of youth with type 1 diabetes (<19 yr) who received pump funding from 2006 to 2013 (n = 3700). We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. We tested the relationship between center-level pump uptake and center characteristics (center type, physician model, and availability of 24-h support) using an adjusted negative binomial model; we studied center- and patient-level factors (socioeconomic status and baseline glycemic control) associated with discontinuation using a Cox proportional hazards model with generalized estimating equations. RESULTS Pump users were more likely to be in the highest income quintile than non-pump users (29.6 vs. 19.1%, p < 0.0001). In 2012, mean percent pump use was 38.0% with variability across centers. There was no association between uptake and center characteristics. Discontinuation was low (0.42/100 person-yr) and was associated with being followed at a small community center [hazard ratio (HR): 2.24 (1.05-4.76)] and being more deprived [HR: 2.36 (1.14-1.48)]. Older age was associated with a lower rate of discontinuation [HR: 0.31 (0.14-0.66)]. CONCLUSIONS Rates of pump use have increased since 2006 and discontinuation is rare. Large variation in uptake across centers was not explained by the factors we examined but may reflect variation in patient populations or practice patterns, and should be further explored.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Therese A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada
| | - Alice Newman
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
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30
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Szypowska A, Schwandt A, Svensson J, Shalitin S, Cardona-Hernandez R, Forsander G, Sundberg F, De Beaufort C, Maahs D, Maffeis C, O'Riordan SMP, Krisane ID, Scharf M, Castro S, Konstantinova M, Obermannova B, Casteels K, Gökşen D, Galhardo J, Kanaka-Gantenbein C, Rami-Merhar B, Madacsy L. Insulin pump therapy in children with type 1 diabetes: analysis of data from the SWEET registry. Pediatr Diabetes 2016; 17 Suppl 23:38-45. [PMID: 27417128 DOI: 10.1111/pedi.12416] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control. OBJECTIVE To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI. METHODS This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out. RESULTS Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47-1.55), P < .0001) and the diabetes-related expenditure per capita [odd ratio 1.55 (1.49-1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001). CONCLUSIONS Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.
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Affiliation(s)
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Jannet Svensson
- Pediatric Department, Copenhagen University Hospital, Herlev, Denmark
| | - Shlomit Shalitin
- The Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Gun Forsander
- Institute for Clinical Sciences, Sahlgrenska Achademy, University of Gothenburg, Gothenburg, Sweden.,The Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frida Sundberg
- The Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carine De Beaufort
- DCCP-Clinique pédiatrique de Luxembourg, Luxembourg, Luxembourg.,Department of Pediatric Endocrinology, UZBrussels, Brussels, Belgium
| | - David Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver Aurora, Colorado, USA
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit & Regional Center for Pediatric Diabetes, University Hospital, University of Verona, Verona, Italy
| | - Stephen M P O'Riordan
- Paediatrics Diabetes & Endocrine Unit, Department of Paediatrics & Child Health, Cork University Hospital, University College Cork, Cork, Ireland
| | - Iveta Dzivite Krisane
- Children's University Hospital Children's Endocrinology Centre, Riga Stradins University, Riga, Latvia
| | - Mauro Scharf
- Pediatric Endocrinology, Hospital Nossa Senhora Das Graças, Brazil
| | - Sofia Castro
- Child and Young Department, APDP-Diabetes, Lisbon, Portugal
| | - Maia Konstantinova
- Medical University-Clinic of Endocrinology, Diabetes and Genetics, Sofia University Pediatric Hospital, Sofia, Bulgaria
| | - Barbora Obermannova
- Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Belgium
| | - Damla Gökşen
- Faculty of Medicine Pediatric Endocrinology and Diabetes, Ege University, İzmir, Turkey
| | - Júlia Galhardo
- Unit of Pediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal
| | - Christina Kanaka-Gantenbein
- Diabetes Center, Division of Endocrinology, Diabetes and Metabolism First Department of Pediatrics, Medical School National and Kapodistrian University of Athens-Greece "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine of Medical University of Vienna, Vienna, Austria
| | - Laszlo Madacsy
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
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31
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Deiss D, Adolfsson P, Alkemade-van Zomeren M, Bolli GB, Charpentier G, Cobelli C, Danne T, Girelli A, Mueller H, Verderese CA, Renard E. Insulin Infusion Set Use: European Perspectives and Recommendations. Diabetes Technol Ther 2016; 18:517-24. [PMID: 27526329 PMCID: PMC5040072 DOI: 10.1089/dia.2016.07281.sf] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Insulin pump users worldwide depend on insulin infusion sets (IISs) for predictable delivery of insulin to the subcutaneous tissue. Yet emerging data indicates that IISs are associated with many pump-related adverse events and may contribute to potentially life-threatening problem of unexplained hyperglycemia. The relative scarcity of published research on IISs to date, the heterogeneity of regional IIS practices, and the increasing demand for international standards guiding their use prompted convening of a panel of diabetologists and diabetes nurse educators last February, in Milan, Italy, to discuss a framework for optimizing IIS practice in Europe. The multinational panel was tasked, first, with identifying the often-overlooked IIS issues that can affect patients' experience of pump therapy-e.g., partial or complete blockage of the cannula, skin pathologies, unpredictable variations in insulin absorption, dislodgment, and the demands of site rotation and set changes-and, second, with establishing direction for developing cohesive protocols to assure long-term success. As reported in this article, the panel examined IIS-related complications of pump therapy encountered in clinical practice, considered country-wide policies to prevent and mitigate such complications, and updated priorities for improving IIS education on issues of device selection, skin care, and troubleshooting unexplained hyperglycemia. These recommendations may be more relevant with the possibility of closed-loop systems available in the near future.
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Affiliation(s)
- Dorothee Deiss
- Medicover Berlin-Mitte, Clinic for Endocrinology and Diabetology, Berlin, Germany
| | - Peter Adolfsson
- Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Geremia B. Bolli
- Department of Medicine, Perugia University School of Medicine, Perugia, Italy
| | - Guillaume Charpentier
- Department of Diabetes and Endocrinology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Thomas Danne
- Diabetes Center for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Angela Girelli
- Diabetes Care Unit, A.S.S.T. of Spedali Civili, Brescia, Italy
| | - Heiko Mueller
- German Clinic for Diagnosis, Section for Pediatric Diabetes Therapy, DKD HELIOS Klinik, Weisbaden, Germany
| | | | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital; Institute of Functional Genomics, UMR CNRS 5203/INSERM U1191, University of Montpellier, Montpellier, France
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32
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King AB, Kuroda A, Matsuhisa M, Hobbs T. A Review of Insulin-Dosing Formulas for Continuous Subcutaneous Insulin Infusion (CSII) for Adults with Type 1 Diabetes. Curr Diab Rep 2016; 16:83. [PMID: 27457238 PMCID: PMC4960276 DOI: 10.1007/s11892-016-0772-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Dosing guidelines for patients with type 1 diabetes using continuous subcutaneous insulin infusion (CSII), which are historically based on clinical experience and retrospective studies of patients consuming an American diet, recommend that basal insulin should represent approximately 50 % of the total daily dose (TDD). Recent prospective studies in the USA and Japan conclude that the more appropriate proportion is closer to 30-40 % of TDD. In addition, currently used formulas for calculating the carbohydrate-to-insulin ratio (CIR) and correction factor (CF) may lead to underdosing of bolus insulin by as much as 12.8-50 % for a hypothetical patient. The discrepancies between traditional formulas and data from newer studies can be accounted for by the more rigorous design of the newer studies (e.g., prospective design, controlled diets, meal omission, and frequent glucose monitoring). International differences in diet composition may also be important to consider when developing dosing recommendations for CSII.
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Affiliation(s)
- Allen B. King
- Diabetes Care Center, 1260 S. Main Street, Salinas, CA 93901 USA
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute for Advanced Enzyme Research, Tokushima University, 3-18-15, Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute for Advanced Enzyme Research, Tokushima University, 3-18-15, Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Todd Hobbs
- Novo Nordisk, Inc., 100 College Rd W, Princeton, NJ 08540-6604 USA
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Naranjo D, Tanenbaum ML, Iturralde E, Hood KK. Diabetes Technology: Uptake, Outcomes, Barriers, and the Intersection With Distress. J Diabetes Sci Technol 2016; 10:852-8. [PMID: 27234809 PMCID: PMC4928242 DOI: 10.1177/1932296816650900] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Patients managing type 1 diabetes have access to new technologies to assist in management. This manuscript has two aims: 1) to briefly review the literature on diabetes technology use and how this relates to psychological factors and 2) to present an example of human factors research using our data to examine psychological factors associated with technology use. Device/technology uptake and use has increased over the years and at present day is a common clinical practice. There are mixed results in terms of health and psychosocial outcomes, with specific subgroups doing better than others with technology. Our data demonstrated that patients have moderately elevated diabetes distress across differing types of technology used, from low-tech to high-tech options, possibly meaning that technology does not add or take away distress. In addition, users on multiple daily injections compared to all other technology groups have less positive attitudes about technology. Finally, we discuss implications for clinical practice and future research.
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Affiliation(s)
- Diana Naranjo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, CA, USA
| | - Esti Iturralde
- Department of Pediatrics, Stanford University School of Medicine, CA, USA
| | - Korey K Hood
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA Department of Pediatrics, Stanford University School of Medicine, CA, USA
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Bonfanti R, Lepore G, Bozzetto L, Corsi A, Di Blasi V, Girelli A, Grassi G, Iafusco D, Rabbone I, Schiaffini R, Laviola L, Bruttomesso D. Survey on the use of insulin pumps in Italy: comparison between pediatric and adult age groups (IMITA study). Acta Diabetol 2016; 53:403-12. [PMID: 26429560 DOI: 10.1007/s00592-015-0810-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/14/2015] [Indexed: 01/22/2023]
Abstract
AIMS The aim of the study was to evaluate and compare continuous subcutaneous insulin infusion (CSII) use in pediatric and adult age groups. METHODS Data were collected with a questionnaire sent by e-mail to CSII-experienced Diabetes Centers. The questionnaire assessed: (1) number of CSII-treated patients; (2) patient demographic data and characteristics; (3) structure and organization of Diabetes Centers providing CSII therapy; (4) pump characteristics (conventional pump, sensor-augmented pump); and (5) CSII dropouts. RESULTS A total of 217 out of 1093 Italian centers participated: 51 pediatric (23.5 %) and 166 (76.5 %) adult centers (AP). Compared to a survey performed in 2005, there was a significant increase in the number of pediatric units when compared to adult units (112 vs 37 %, respectively, p < 0.05). Pediatric age is characterized by a greater concern for quality of life and injections, and a higher dropout rate (10.6 vs 8.9 %) mainly related to pump wearability and site reactions. A complete diabetes-care team is associated with a superior use of technology (fewer dropouts, increased CGM and advanced bolus use) which is, however, still used in a small percentage of patients. CONCLUSIONS In Italy, the number of CSII-treated pediatric patients (PP) is growing more significantly when compared to adults. Only 60 % of all patients are using advanced functions and 20 % are using CGMs continuously. This confirms the great interest in diabetes technology that is growing in pediatric diabetologists. However, much improvement is warranted in the organization and specialized training of pediatric, adult and transitional facilities.
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Affiliation(s)
- R Bonfanti
- Pediatric Department and Diabetes Research Institute (OSR-DRI), IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - G Lepore
- Unit of Endocrine Disease and Diabetology, A.O Papa Giovanni XXIII, Bergamo, Italy
| | - L Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - A Corsi
- Unit of Diabetology and Endocrinology, P.O. Metropolitano, ASL 3, Genoa, Italy
| | - V Di Blasi
- Department of Endocrinology and Diabetology, ASL Salerno, Salerno, Italy
| | - A Girelli
- Unit of Diabetology, A.O. Spedali Civili, Brescia, Italy
| | - G Grassi
- Division of Endocrinology, Diabetology and Metabolism, A.O Città della Salute e della Scienza, Turin, Italy
| | - D Iafusco
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - I Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - R Schiaffini
- Unit of Endocrinology and Diabetes, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Aldo Moro, Bari, Italy
| | - D Bruttomesso
- Department of Medicine, DIMED, Metabolic Diseases, University of Padua, Padua, Italy
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Affiliation(s)
- Darrell M Wilson
- Department of Pediatrics, Stanford University , Stanford, California
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Benefits of continuous subcutaneous insulin infusion in type 1 diabetes. Is there any doubt? ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2016; 63:103-5. [PMID: 26775015 DOI: 10.1016/j.endonu.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/26/2015] [Accepted: 11/28/2015] [Indexed: 11/21/2022]
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Pozzilli P, Battelino T, Danne T, Hovorka R, Jarosz‐Chobot P, Renard E. Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics. Diabetes Metab Res Rev 2016; 32:21-39. [PMID: 25865292 PMCID: PMC5033023 DOI: 10.1002/dmrr.2653] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/27/2015] [Indexed: 01/01/2023]
Abstract
The level of glycaemic control necessary to achieve optimal short-term and long-term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid-acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid-acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost-effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid-acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin infusion on patients' health-related quality of life; reviews relevant pharmacoeconomic data; and discusses recent advances in pump technology, including the development of closed-loop 'artificial pancreas' systems. © 2015 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Paolo Pozzilli
- Area of Endocrinology and DiabetesUniversity Campus Bio‐MedicoRomeItaly
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic DiseasesUniversity Children's Hospital LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Thomas Danne
- Diabetes Centre for Children and AdolescentsAUF DER BULT, Kinder‐ und JugendkrankenhausHannoverGermany
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
| | - Przemyslawa Jarosz‐Chobot
- Department of Pediatrics, Endocrinology and Diabetes School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition and CIC INSERM 1411Montpellier University HospitalMontpellierFrance
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Arranz Martín A, Calle Pascual A, del Cañizo Gómez FJ, González Albarrán O, Lisbona Gil A, Botella Serrano M, Pallardo Sánchez LF. Estado actual de los sistemas de infusión subcutánea continua de insulina y monitorización continua de glucosa en la Comunidad de Madrid. ACTA ACUST UNITED AC 2015; 62:171-9. [DOI: 10.1016/j.endonu.2015.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/19/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
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Bruttomesso D, Laviola L, Lepore G, Bonfanti R, Bozzetto L, Corsi A, Di Blasi V, Girelli A, Grassi G, Iafusco D, Rabbone I, Schiaffini R. Continuous subcutaneous insulin infusion in Italy: third national survey. Diabetes Technol Ther 2015; 17:96-104. [PMID: 25479035 DOI: 10.1089/dia.2014.0242] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) is increasing worldwide, mostly because of improved technology. The aim of this study was to evaluate the current status of CSII in Italy. MATERIALS AND METHODS Physicians from 272 diabetes centers received a questionnaire investigating clinical features, pump technology, and management of patients on CSII. RESULTS Two hundred seventeen centers (79.8%) joined the study and, by the end of April 2013, gave information about 10,152 patients treated with CSII: 98.2% with type 1 diabetes mellitus, 81.4% adults, 57% female, and 61% with a conventional pump versus 39% with a sensor-augmented pump. CSII advanced functions were used by 68% of patients, and glucose sensors were used 12 days per month on average. Fifty-eight percent of diabetes centers had more than 20 patients on CSII, but there were differences among centers and among regions. The main indication for CSII was poor glucose control. Dropout was mainly due to pump wearability or nonoptimal glycemic control. Twenty-four hour assistance was guaranteed in 81% of centers. A full diabetes team (physician+nurse+dietician+psychologist) was available in 23% of adult-care diabetes centers and in 53% of pediatric diabetes units. CONCLUSIONS CSII keeps increasing in Italy. More work is needed to ensure uniform treatment strategies throughout the country and to improve pump use.
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Affiliation(s)
- Daniela Bruttomesso
- 1 Metabolic Diseases, Department of Medicine-DIMED, University of Padua , Padua, Italy
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Assessment of Insulin Administration Methods: Perceptions by Patients and Significant Others Instrument Development. J Nurs Meas 2015; 23:336-49. [DOI: 10.1891/1061-3749.23.2.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: To develop, test, and establish the validity and reliability of 4 instruments to evaluate perceptions of paired patients and patient-identified significant others to assess the impact of continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDII) on diabetes management and lifestyle. Methods: Sociotechnical systems theory and the life patterns model framed the study. Four parallel survey instruments (patient CSII and MDII and significant other CSII and MDII) were developed to elicit demographic information and perceptions concerning CSII and MDII. Results: Validity and reliability were established. Conclusions: The instruments developed for this study could be adapted or used as templates in management approach impact studies of other chronic diseases. The study should be replicated with a different geographic sample.
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Martín-Vaquero P, Martínez-Brocca MA, García-López JM. Documento de posicionamiento sobre la eficiencia de las tecnologías aplicadas al manejo de la diabetes. ACTA ACUST UNITED AC 2014; 61:e45-63. [DOI: 10.1016/j.endonu.2014.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/28/2014] [Indexed: 12/17/2022]
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Dovc K, Telic SS, Lusa L, Bratanic N, Zerjav-Tansek M, Kotnik P, Stefanija MA, Battelino T, Bratina N. Improved metabolic control in pediatric patients with type 1 diabetes: a nationwide prospective 12-year time trends analysis. Diabetes Technol Ther 2014; 16:33-40. [PMID: 24131373 PMCID: PMC3887404 DOI: 10.1089/dia.2013.0182] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study estimated temporal trends of metabolic control over 12 years in a national cohort of childhood-onset type 1 diabetes. SUBJECTS AND METHODS Data from the prospective childhood-onset diabetes register, which included 886 case subjects from 0 to 17.99 years of age at diagnosis and at least 1 year of follow-up until the age of 22.99 years, were analyzed using multivariable linear and logistic regression models in the observational period between 2000 and 2011. RESULTS Hemoglobin A1c (HbA1c) significantly decreased over 12 years, from 78 mmol/mol (interquartile range [IQR], 68-88 mmol/mol) (9.26% [IQR, 8.41-10.24%]) in the year 2000 to 61 mmol/mol (IQR, 55-67 mmol/mol) (7.75% [IQR, 7.20-8.30%]) in the year 2011 (P<0.001). HbA1c was significantly associated with age, treatment modality, and duration of diabetes (P<0.001), with females having on average 1.02% higher HbA1c (P=0.01; 95% confidence interval [CI] 1.005-1.035). The overall use of insulin pumps was 74%. The incidence rate of severe acute complications was low: 1.07 per 100 patient-years for severe diabetic ketoacidosis (95% CI 0.81-1.40) and 1.21 per 100 patient-years for severe (requiring intravenous or intramuscular therapy) hypoglycemia (95% CI 0.81-1.40). CONCLUSIONS The metabolic control of the entire nationwide pediatric type 1 diabetes population significantly improved during the 12-year observational period with a low rate of severe acute complications events. The improvement was associated with the treatment modality. Additional efforts and solutions are necessary to further improve metabolic control and the quality of life of young people with type 1 diabetes.
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Affiliation(s)
- Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center-University Children's Hospital, Ljubljana, Slovenia
| | - Sasa Starc Telic
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center-University Children's Hospital, Ljubljana, Slovenia
| | - Lara Lusa
- Institute for Biostatistics and Medical Informatics, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Bratanic
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center-University Children's Hospital, Ljubljana, Slovenia
| | - Mojca Zerjav-Tansek
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center-University Children's Hospital, Ljubljana, Slovenia
| | - Primoz Kotnik
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center-University Children's Hospital, Ljubljana, Slovenia
| | - Magdalena Avbelj Stefanija
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center-University Children's Hospital, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center-University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Natasa Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center-University Children's Hospital, Ljubljana, Slovenia
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Ziegler R, Tubili C, Chico A, Guerci B, Lundberg E, Borchert M, Löffler A, Bloethner S, Weissmann J, Pfützner A. ProAct study: new features of insulin pumps improve diabetes management and glycemic control in patients after transition of continuous subcutaneous insulin infusion systems. Diabetes Technol Ther 2013; 15:738-43. [PMID: 23931739 DOI: 10.1089/dia.2013.0090] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) patients experience switches of pump systems on a regular basis. We investigated the impact of transition from older pumps to the Accu-Chek(®) Combo system (Roche Diagnostics Deutschland GmbH, Mannheim, Germany) on a patient's glycemic control and diabetes management. PATIENTS AND METHODS In total, 299 patients (172 female, 127 male; mean±SD age, 39.4±15.2 years; CSII duration, 7.0±5.2 years) were enrolled by 61 European sites into this uncontrolled prospective trial. Glycemic control, safety, and diabetes management parameters were measured at baseline and after 3 and 6 months. Changes from baseline were analyzed. RESULTS After transition to the new insulin pump, mean±SD hemoglobin A1c (HbA1c) values decreased from 7.8±1.1% (baseline) to 7.7±1.1% (end point). The proportion of patients with HbA1c <7.0% was slightly higher at the end of the study (29.6%) than at baseline (25.2%), whereas the proportion of patients with HbA1c >8.0% decreased (baseline, 36.2%; end point, 32.7%; P<0.05). The number of hypoglycemic episodes (blood glucose<70 mg/dL) improved slightly during the study (baseline, 40.4±34.0 events/quarter; end point, 39.2±33.9 events/quarter). Glycemic control improved significantly in the group with an initial HbA1c >8.0% (-0.46%; P<0.001) and remained solidly stable in the group with an initial HbA1c <7% (+0.04%; not significant). Short-term (<3 years) pump users (n=48) had a larger HbA1c decrease (-0.40%) than long-term (≥3 years) users (n=251) (-0.07%; P<0.05). The number of blood glucose measurements increased (3.7±1.9/day vs. 4.4±1.8/day; P<0.05), whereas the number of insulin boluses decreased (5.1±1.9/day vs. 4.6±1.5/day; P<0.05) during the study. CONCLUSIONS Transition from older pump systems to the Accu-Chek Combo system in a large patient population resulted in stable glycemic control with significant improvements in HbA1c in patients with unsatisfactory baseline HbA1c and shorter pump use. Increased frequency of self-monitoring of blood glucose and decrease of bolus frequency could suggest a more confident diabetes management and a reduced need for correction boluses.
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Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
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La pompe à insuline améliore-t-elle la qualité de vie et la satisfaction des enfants et adolescents diabétiques de type 1 ? Arch Pediatr 2013; 20:248-56. [DOI: 10.1016/j.arcped.2012.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 11/05/2012] [Accepted: 12/12/2012] [Indexed: 11/15/2022]
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Naik S, Kerr D, Begley J, Morton J. Influence of local skin temperature and choice of insulin analog on catheter occlusion rates during continuous insulin infusion: an exploratory study. Diabetes Technol Ther 2012; 14:1018-22. [PMID: 23101952 DOI: 10.1089/dia.2012.0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS The aim of this study was to determine whether changes in local skin temperature over which the infusion catheters pass when using insulin pump therapy and the choice of rapid-acting insulin analog influence the risk of catheter occlusion. SUBJECTS AND METHODS Twenty healthy volunteers were assigned to wear insulin pumps primed with insulin glulisine and insulin aspart in a randomized order each for a duration of 5 days and a temperature probe (taped to the skin near the insulin catheter). To reproduce the effect of subcutaneous infusion, the insulin catheter was inserted into an absorbent sponge in a plastic bag strapped to the subject's abdomen. Basal infusion rates were programmed at 0.2 IU/h, and 2-IU boluses were given three times a day with meals. RESULTS Average skin temperature ranged between 33.5°C and 36.68°C for insulin glulisine and 32.35°C and 35.28°C for insulin aspart, with no difference in skin temperature between treatments or between the first and second week of the study. Nine occlusions were seen in eight subjects with an overall rate of occlusion of 22.5% (95% confidence interval, 21.9-61.3%) and were more likely to occur in the second week. On an individual level the risk of occlusion was similar for insulin glulisine and insulin aspart (odds ratio, 0.87%; P=0.6). CONCLUSIONS Overall, in this small study simulating subcutaneous insulin infusion, the rate of catheter occlusion was low and unaffected by local fluctuations in ambient skin temperature. There was no significant difference between the two rapid-acting insulin analogs tested. Where occlusions occurred, they were more likely to happen beyond the manufacturer's recommended 72-h limit for catheter use.
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Affiliation(s)
- Sarita Naik
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
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Penfornis A, Personeni E, Tiv M, Monnier C, Meillet L, Combes J, Mouret C, Picard S. Quality of care of patients with type 1 diabetes: population-based results in a French region. DIABETES & METABOLISM 2012; 38:436-43. [PMID: 22749623 DOI: 10.1016/j.diabet.2012.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 04/22/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
AIM Although the incidence of type 1 diabetes (T1D) has been increasing, little is known of its quality of care. Thus, our survey was designed to retrospectively evaluate this issue in French patients. METHODS Patients with T1D living in northeastern France were identified thanks to the healthcare system (CPAM) database, and the resulting list reviewed by local diabetes specialists. All of the listed patients and their primary physicians were asked to fill in a questionnaire including clinical data, laboratory results and follow-up habits. The 'optimized results' included CPAM-based results plus any specialized care provided during hospitalizations in diabetes and non-diabetes units, according to questionnaire data. RESULTS A total of 227 individuals, for whom CPAM data were available, were identified as having T1D. From these patients, 174 questionnaires were answered, and optimized results (having both CPAM data and a completely filled-in questionnaire) were available for 149 patients. Of the 169 patients who responded, 71.3% reported at least a yearly visit with a diabetologist. This number reached 77.9% when optimized results were considered. Patients who received specialized care were younger, underwent HbA(1c) tests more often and were more frequently on optimal treatment; however, there was no difference in HbA(1c) values or in the prevalence of complications. Eye examinations and kidney tests had been performed at least once over the 2-year period in more than 87% of the patients, whereas around 30%, 21% and 23% had an eye exam, creatinine test and urinary albumin excretion measurement, respectively, only once over the same time period. CONCLUSION This is the first large-scale study of the quality of care in patients with T1DM in France, and it could serve as a preliminary survey for a national study. Although the follow-up was better than previously reported, there is still considerable room for improvement.
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Affiliation(s)
- A Penfornis
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, EA 3920, University of Franche-Comté, 25030 Besançon cedex, France.
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Matsuda E, Brennan P. The effectiveness of continuous subcutaneous insulin pumps with continuous glucose monitoring in outpatient adolescents with type 1 diabetes: A systematic review. ACTA ACUST UNITED AC 2012; 10:1-10. [DOI: 10.11124/jbisrir-2012-170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kirchsteiger H, Estrada GC, Pölzer S, Renard E, del Re L. Estimating Interval Process Models for Type 1 Diabetes for Robust Control Design. ACTA ACUST UNITED AC 2011. [DOI: 10.3182/20110828-6-it-1002.03770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kerr D, Hoogma RPLM, Buhr A, Petersen B, Storms FEMG. Multicenter user evaluation of ACCU-CHEK® Combo, an integrated system for continuous subcutaneous insulin infusion. J Diabetes Sci Technol 2010; 4:1400-7. [PMID: 21129336 PMCID: PMC3005051 DOI: 10.1177/193229681000400615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate a newly developed system for insulin delivery incorporating a multifunctional blood glucose meter and a remotely controlled insulin pump (ACCU-CHEK® Combo system) in established pump users with type 1 diabetes. The technology was assessed both from device performance and subject usability perspectives. METHOD A multicenter, prospective, single group study was carried out in five centers in the Netherlands and four centers in the United Kingdom for more than 6 months. The study was divided into two phases: Phase 1 (4 weeks) for device validation purposes and phase 2 (22 weeks) to observe the impact of the system on metabolic control, patient satisfaction [using the Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and device safety. RESULTS Eighty subjects completed the planned study period. There were no unexpected device errors. Treatment satisfaction was high at baseline and further increased to study end (DTSQ change version: sum score, 10.6±7.2; scale score range, -18 to +18, p<0.0001). Hemoglobin A1c improved continuously over time, from 7.9% (±0.9%) to 7.7% (±0.8%) at month 3 (p<0.001) and 7.6% (±0.8%) at month 6 (p<0.0001). The frequency of severe hypoglycemia was 0.08 per patient years. There was no case of ketoacidosis. CONCLUSIONS The new system was evaluated by experienced continuous subcutaneous insulin infusion users as safe in daily practice and associated with favorable treatment satisfaction and a modest improvement in glycemic control.
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Affiliation(s)
- David Kerr
- Centre of Postgraduate Medical Research and Education, School of Health and Social Care, Bournemouth University, Dorset, United Kingdom.
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