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De Ridder F, Charleer S, Jacobs S, Bolsens N, Ledeganck KJ, Van Aken S, Vanbesien J, Gies I, Casteels K, Massa G, Lysy PA, Logghe K, Lebrethon MC, Depoorter S, Gillard P, De Block C, den Brinker M. Effect of nationwide reimbursement of real-time continuous glucose monitoring on HbA1c, hypoglycemia and quality of life in a pediatric type 1 diabetes population: The RESCUE-pediatrics study. Front Pediatr 2022; 10:991633. [PMID: 36275049 PMCID: PMC9582657 DOI: 10.3389/fped.2022.991633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Real-time continuous glucose monitoring (RT-CGM) can improve metabolic control and quality of life (QoL), but long-term real-world data in children with type 1 diabetes (T1D) are scarce. Over a period of 24 months, we assessed the impact of RT-CGM reimbursement on glycemic control and QoL in children/adolescents with T1D treated with insulin pumps. RESEARCH DESIGN AND METHODS We conducted a multicenter prospective observational study. Primary endpoint was the change in HbA1c. Secondary endpoints included change in time in hypoglycemia, QoL, hospitalizations for hypoglycemia and/or ketoacidosis and absenteeism (school for children, work for parents). RESULTS Between December 2014 and February 2019, 75 children/adolescents were followed for 12 (n = 62) and 24 months (n = 50). Baseline HbA1c was 7.2 ± 0.7% (55 ± 8mmol/mol) compared to 7.1 ± 0.8% (54 ± 9mmol/mol) at 24 months (p = 1.0). Participants with a baseline HbA1c ≥ 7.5% (n = 27, mean 8.0 ± 0.3%; 64 ± 3mmol/mol) showed an improvement at 4 months (7.6 ± 0.7%; 60 ± 8mmol/mol; p = 0.009) and at 8 months (7.5 ± 0.6%; 58 ± 7mmol/mol; p = 0.006), but not anymore thereafter (endpoint 24 months: 7.7 ± 0.9%; 61 ± 10mmol/mol; p = 0.2). Time in hypoglycemia did not change over time. QoL for parents and children remained stable. Need for assistance by ambulance due to hypoglycemia reduced from 8 to zero times per 100 patient-years (p = 0.02) and work absenteeism for parents decreased from 411 to 214 days per 100 patient-years (p = 0.03), after 24 months. CONCLUSION RT-CGM in pump-treated children/adolescents with T1D showed a temporary improvement in HbA1c in participants with a baseline HbA1c ≥ 7.5%, without increasing time in hypoglycemia. QoL was not affected. Importantly, RT-CGM reduced the need for assistance by ambulance due to hypoglycemia and reduced work absenteeism for parents after 24 months. CLINICAL TRIAL REGISTRATION [ClinicalTrials.gov], identifier [NCT02601729].
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Affiliation(s)
- Francesca De Ridder
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium.,Fund for Scientific Research (FWO), Brussels, Belgium
| | - Sara Charleer
- Department of Endocrinology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - Seppe Jacobs
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Nancy Bolsens
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Sara Van Aken
- Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Jesse Vanbesien
- Department of Pediatrics, University Hospital Brussels, Free University of Brussels (VUB), Brussels, Belgium
| | - Inge Gies
- Department of Pediatrics, University Hospital Brussels, Free University of Brussels (VUB), Brussels, Belgium
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Guy Massa
- Department of Pediatrics, Jessa Hospital, Hasselt, Belgium
| | - Philippe A Lysy
- Department of Pediatrics, University Hospital Saint-Luc, Brussels, Belgium
| | - Karl Logghe
- Department of Pediatrics, General Hospital Delta, Roeselare, Belgium
| | | | - Sylvia Depoorter
- Department of Pediatrics, General Hospital Sint-Jan Bruges, Bruges, Belgium
| | - Pieter Gillard
- Fund for Scientific Research (FWO), Brussels, Belgium.,Department of Endocrinology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - Christophe De Block
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Marieke den Brinker
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital (UZA), Antwerp, Belgium
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2
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Desrochers HR, Schultz AT, Laffel LM. Use of Diabetes Technology in Children: Role of Structured Education for Young People with Diabetes and Families. Endocrinol Metab Clin North Am 2020; 49:19-35. [PMID: 31980118 PMCID: PMC7140592 DOI: 10.1016/j.ecl.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The current era has witnessed an explosion of advanced diabetes technologies. Young people with diabetes and their families require detailed, structured diabetes education in order to optimize use of such devices. There is need for youth and their families to participate in the selection of particular devices for personal use and comprehensive education regarding the safe and effective use of such technologies. The education process should ensure that youth and their families receive realistic expectations of what the advanced technologies can and cannot do to avoid disappointment and the premature discontinuation of such systems.
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Affiliation(s)
- Hannah R Desrochers
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA
| | - Alan T Schultz
- Emergency Department, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY 10467, USA
| | - Lori M Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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McGill DE, Volkening LK, Butler DA, Harrington KR, Katz ML, Laffel LM. Baseline Psychosocial Characteristics Predict Frequency of Continuous Glucose Monitoring in Youth with Type 1 Diabetes. Diabetes Technol Ther 2018; 20:434-439. [PMID: 29727245 PMCID: PMC6014048 DOI: 10.1089/dia.2018.0037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Consistent use of continuous glucose monitoring (CGM) has been associated with improved glycemic control in youth with type 1 diabetes (T1D). There are many barriers to device uptake and continued use. There is a need to understand patient-specific characteristics when considering CGM. We evaluated patterns of CGM use and associations between baseline psychosocial measures and frequency of CGM use over 1 year. METHODS Youth with T1D (n = 120), ages 8-18 years, completed questionnaires at CGM initiation and after 6 and 12 months assessing depressive symptoms, diabetes burden, and diabetes-specific and generic quality of life (QOL). RESULTS Youth (51% male and 95% white) had mean age 12.7 ± 2.7 years, diabetes duration 6.1 ± 3.6 years, and glycated hemoglobin (HbA1c) 8.0 ± 0.8%. Over 1 year, 35% of youth used CGM 6 to 7 days per week, 45% used CGM 3-5 days per week, and 20% used CGM only 0-2 days per week. Youth who used CGM 3-7 days per week over 12 months had lower HbA1c at months 9 and 12 than youth who used CGM 0-2 days per week (9 months: 7.9 ± 0.9% vs. 8.5 ± 1.1%, P = 0.006 and 12 months: 8.0 ± 0.9% vs. 8.5 ± 1.1%, P = 0.02). Those using CGM 0-2 days per week had greater endorsement of depressive symptoms and diabetes burden and reported lower QOL at baseline compared with those using CGM 3-7 days per week. CONCLUSIONS CGM use for 3 or more days per week over 12 months had a protective effect on HbA1c. Providers should consider addressing psychosocial parameters when initiating CGM to maximize uptake and promote continued use in youth with T1D.
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Affiliation(s)
- Dayna E McGill
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
| | - Lisa K Volkening
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
| | - Deborah A Butler
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
| | - Kara R Harrington
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
| | - Michelle L Katz
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
| | - Lori M Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
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4
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Ramirez-Rincon A, Hincapie-García J, Arango CM, Aristizabal N, Castillo E, Hincapie G, Zapata E, Cuesta DP, Delgado M, Abad V, Torres JL, Palacio A, Botero JF. Clinical Outcomes After 1 Year of Augmented Insulin Pump Therapy in Patients with Diabetes in a Specialized Diabetes Center in Medellín, Colombia. Diabetes Technol Ther 2016; 18:713-718. [PMID: 27860498 DOI: 10.1089/dia.2016.0166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Type 1 diabetes can be difficult to control. Augmented pump therapy (CSII-rtCGM) has become an important tool for controlling blood glucose and decreasing hypoglycemia. METHODS Describe the results 1 year after starting CSII-rtCGM in patients with diabetes in Medellín, Colombia. This is an observational, retrospective study. Patients with type 1 and type 2 diabetes started on CSII-rtCGM between January 2008 and June 2015 were included. Qualitative variables were analyzed as absolute or relative frequencies. Quantitative variables were obtained through central tendency and dispersion according to the normal distribution of the analyzed variable using Kolmogorov-Smirnov. SPSS 19 from IBM was used. RESULTS Two hundred forty-seven patients were identified, of those 183 were included. The starting HbA1C was 8.7% ± 1.7% and 7.4% ± 0.8% (P < 0.05) 1 year later. 16.5% of patients had been admitted to the hospital before starting CSII-rtCGM, after 1 year the admission rate was 6.0% (P < 0.05). The incidence of severe hypoglycemia at the beginning was 32%, 1 year later it was 7.1%. CONCLUSION CSII-rtCGM therapy improves glucose control and decreases severe hypoglycemic events and hospital admission rate.
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Affiliation(s)
- Alex Ramirez-Rincon
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
- 6 Grupo de Investigación de Medicina Interna y Endocrinología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Jaime Hincapie-García
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
- 6 Grupo de Investigación de Medicina Interna y Endocrinología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Claudia Monsalve Arango
- 2 Clinica Universitaria Bolivariana , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
- 6 Grupo de Investigación de Medicina Interna y Endocrinología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Natalia Aristizabal
- 2 Clinica Universitaria Bolivariana , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
- 6 Grupo de Investigación de Medicina Interna y Endocrinología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | | | - Eliana Zapata
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
| | | | - Maria Delgado
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
| | - Veronica Abad
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
| | - Jose Luis Torres
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 4 Clinica Las Américas, Medellín, Colombia
| | - Andres Palacio
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
| | - José Fernando Botero
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
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5
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Barnard K, Crabtree V, Adolfsson P, Davies M, Kerr D, Kraus A, Gianferante D, Bevilacqua E, Serbedzija G. Impact of Type 1 Diabetes Technology on Family Members/Significant Others of People With Diabetes. J Diabetes Sci Technol 2016; 10:824-30. [PMID: 27118728 PMCID: PMC4928241 DOI: 10.1177/1932296816645365] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim was to explore the impact of diabetes-related technology to ensure that such devices are used in a way that returns maximum benefit from a medical and psychological perspective. METHOD Spouses and caregivers of people with type 1 diabetes were invited to complete an online questionnaire about their experiences with diabetes technologies used by their family members. Participants were recruited via the Glu online community website. Questions explored impact on daily living, frequency and severity of hypoglycemia, and diabetes-related distress. RESULTS In all, 100 parents/caregivers and 74 partners participated in this survey. Average (mean) duration of living with a person with type 1 diabetes was 16 years (SD = 13) for partners, with duration of diabetes for children being 4.2 ± 3.2 years. Average duration of current therapy was 8.3 ± 7.3 years for adults and 3.4 ± 2.9 years for children. Of the participants, 86% partners and 82% parents/caregivers reported diabetes technology had made it easier for their family members to achieve blood glucose targets. Compared to partners, parents/caregivers reported more negative emotions (P < .001) and decreased well-being (P < .001) related to their family members type 1 diabetes. Diabetes-related distress was common, as was sleep disturbance associated with device alarms and fear of hypoglycemia. Reduced frequency and severity of hypoglycemia related to device use was reported by approximately half of participants. CONCLUSION There is little doubt about the medical benefit of diabetes technologies and their uptake is increasing but some downsides were reported. Barriers to uptake of technologies lie beyond the mechanics of diabetes management. Supporting users in using diabetes technology to achieve the best possible glycemic control, in the context of their own life, is crucial. Furthermore, understanding these issues with input from the type 1 diabetes community including family members and caregivers will help innovation and design of new technology.
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Affiliation(s)
- Katharine Barnard
- Faculty of Health & Social Science, Bournemouth University, Bournemouth, UK
| | | | - Peter Adolfsson
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Hospital of Halland, Kungsbacka, Sweden
| | | | - David Kerr
- William Sansum Diabetes Center, Santa Barbara, CA, USA
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6
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Wen W, Frampton R, Wright K, Fattore S, Shadbolt B, Perampalam S. A pilot study of factors associated with glycaemic control in adults with Type 1 diabetes mellitus on insulin pump therapy. Diabet Med 2016; 33:231-4. [PMID: 26484625 DOI: 10.1111/dme.13001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
AIMS To identify the knowledge and management factors associated with glycaemic control among adults with Type 1 diabetes mellitus treated with insulin pump therapy. METHODS A cross-sectional study of adults with Type 1 diabetes mellitus on insulin pump therapy for at least 12 months (n = 50, 18-70 years old) was undertaken between December 2013 and May 2014. A new questionnaire was developed to evaluate participants' knowledge and management related to insulin pump therapy, and were correlated with insulin pump data, HbA1c and frequency of hypoglycaemia. RESULTS Participants who changed their insulin pump settings when indicated had significantly better glycaemic control than those who did not (P = 0.04). Multivariate logistic regression analysis found that better overall insulin pump therapy management was a significant predictor of better glycaemic control (odds ratio 4.45, 95% confidence interval 1.61-12.3; P = 0.004) after adjusting for potential confounders including age, gender, duration of diabetes and insulin pump therapy. However, overall insulin pump therapy knowledge was not a significant predictor of glycaemic control (P = 0.058). There was no significant association between frequency of hypoglycaemia and insulin pump therapy knowledge or management. CONCLUSIONS We identified some key knowledge and management factors associated with glycaemic control in adults with Type 1 diabetes mellitus on insulin pump therapy using a newly designed questionnaire. The pilot study assessed the clinical utility of this evaluation tool, which may facilitate provision of targeted education to insulin pump therapy users to achieve optimal glycaemic control.
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Affiliation(s)
- W Wen
- Department of Endocrinology, Eastern Health, Victoria, Australia
| | - R Frampton
- Department of Medicine, Canberra Hospital, Australian Capital Territory, Australia
| | - K Wright
- Department of Endocrinology and Diabetes, Canberra Hospital, Australian Capital Territory, Australia
| | - S Fattore
- Department of Endocrinology and Diabetes, Canberra Hospital, Australian Capital Territory, Australia
| | - B Shadbolt
- Department of Epidemiology, Canberra Hospital, Australian Capital Territory, Australia
- Medical School, Australian National University, Australian Capital Territory, Australia
| | - S Perampalam
- Department of Endocrinology and Diabetes, Canberra Hospital, Australian Capital Territory, Australia
- Medical School, Australian National University, Australian Capital Territory, Australia
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Czech M, Rdzanek E, Pawęska J, Adamowicz-Sidor O, Niewada M, Jakubczyk M. Drug-related risk of severe hypoglycaemia in observational studies: a systematic review and meta-analysis. BMC Endocr Disord 2015; 15:57. [PMID: 26458540 PMCID: PMC4603823 DOI: 10.1186/s12902-015-0052-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/30/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) leads to multiple complications, including severe hypoglycaemia events (SHEs). SHEs can impact a patient's quality of life and compliance and may directly result in additional costs to the health care system. The aim of this review was to evaluate the risk of severe hypoglycaemia in patients with type 1 (T1) and 2 (T2) DM as observed in everyday clinical practice for various drug regimens. METHODS We conducted a systematic review of observational (retrospective or prospective) studies in the MEDLINE, Embase, and Cochrane Library databases that covered at least 100 children or adults with T1/T2 DM. In T1 DM, basal-bolus/pre-mix insulin (human or analogue) and insulin pump were reviewed, and in T2 DM, basal-bolus/pre-mix insulin (human or analogue), oral antidiabetic drugs supported with basal insulin (human or analogue), sulfonylureas in monotherapy, and combined oral treatment were reviewed. In order to estimate SHE rates, we extracted data on the time horizon of the study, number of patients, number of SHEs, and number of patients experiencing at least one SHE. We used a random effects model to estimate the annual SHE rate. We considered the risk for other antidiabetic medications in T2 DM to be negligible and the results of our main review yielded no observational data for premixes in T1 DM so they were assessed based on relative rates taken from additional systematic reviews. The study, being a desk research, did not involve any human subjects (including human material or human data) and no ethical committee approval was asked for. For the same reason there was no need to collect informed consent for participation in the study. RESULTS We identified 76 observational studies encompassing 707,722.30 patient-years. The estimated annual SHE rate varied from 0.168 (95 % CI 0.123-0.237) for insulin pump up to 1.628 for biphasic human insulin in T1 DM patients, and from 0.0035 for oral antidiabetic drugs up to 0.554 (95 % CI 0.157-7.534) for basal-bolus with human insulin in T2 DM patients. CONCLUSIONS Our review indicates that SHE rates differ between patients depending on treatment regimen. However, SHEs are also driven by other factors. Proper modelling techniques are needed to use various types of information in published studies.
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Affiliation(s)
- Marcin Czech
- Novo Nordisk Pharma sp. z o.o, Warsaw, Poland.
- Department of Pharmacoeconomics, Medical University of Warsaw, Warsaw, Poland.
- Business School, Warsaw University of Technology, Warsaw, Poland.
| | - Elżbieta Rdzanek
- HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K, Warsaw, Poland.
| | - Justyna Pawęska
- HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K, Warsaw, Poland.
| | | | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
| | - Michał Jakubczyk
- Decision Analysis and Support Unit, Warsaw School of Economics, Al. Niepodległości 162, 02-554, Warsaw, Poland.
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8
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Affiliation(s)
- Tadej Battelino
- University Medical Centre University Children's Hospital, Medical Faculty, University of Ljubljana, Slovenia Atlanta Diabetes Associates, Atlanta, GA, USA
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9
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Matejko B, Skupien J, Mrozińska S, Grzanka M, Cyganek K, Kiec-Wilk B, Malecki MT, Klupa T. Factors associated with glycemic control in adult type 1 diabetes patients treated with insulin pump therapy. Endocrine 2015; 48:164-9. [PMID: 24798448 DOI: 10.1007/s12020-014-0274-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
Continuous subcutaneous insulin infusion (CSII) by insulin pump seems to improve glycemia and quality of life as compared to conventional insulin therapy in type 1 diabetes (T1DM). However, while many T1DM subjects achieve excellent glycemic control, some others cannot reach recommended goals. In a retrospective analysis, we searched for factors associated with glycemic control in T1DM patients treated with insulin pump therapy. Data from 192 patients (133 women and 59 men) treated with personal insulin pumps at the Department of Metabolic Diseases, University Hospital, Krakow, Poland were analyzed. Sources of information included medical records, memory read-outs from insulin pumps and data from glucose meters. Univariate, multivariate linear and logistic regression analysis for the association with hemoglobin A1c (HbA1c) level were performed. The mean age of the subjects was 28.9 (±11.2) years, the mean duration of T1DM-14.6 (±7.6) years, mean body mass index-23.5 (±3.1) kg/m2. The mean HbA1c level in the entire study group was 7.4% (57 mmol/mol). In the multivariate linear regression analysis, HbA1c correlated with the mean number of daily blood glucose measurements, number of hypoglycemic episodes per 100 blood glucose measurements, age at the examination, and continuous glucose monitoring system use. Multivariate logistic regression analysis for reaching the therapeutic target of HbA1c<7.0% (53 mmol/mol) showed that the independent predictors of achieving this goal included the same four variables. In a large clinical observation, we identified that patient-related and technological factors associated with glycemic control in adult pump-treated T1DM subjects.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Jagiellonian University, 15 Kopernika Street, 31-501, Kraków, Poland
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Scaramuzza A, Cherubini V, Tumini S, Bonfanti R, Buono P, Cardella F, d'Annunzio G, Frongia AP, Lombardo F, Monciotti ACM, Rabbone I, Schiaffini R, Toni S, Zucchini S, Frontino G, Iafusco D. Recommendations for self-monitoring in pediatric diabetes: a consensus statement by the ISPED. Acta Diabetol 2014; 51:173-84. [PMID: 24162715 DOI: 10.1007/s00592-013-0521-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 10/01/2013] [Indexed: 11/29/2022]
Abstract
A panel of experts of the Italian Society of Pediatric Endocrinology and Diabetology comprehensively discussed and approved the Italian recommendations regarding self-monitoring of blood glucose, continuous glucose monitoring and other measures of glycemic control in children and adolescents with type 1 diabetes. After an extensive review of the literature, we took these issues into account: self-monitoring blood glucose, continuous glucose monitoring, glycemic variability, glycosuria, ketonuria, ketonemia, glycated hemoglobin, fructosamine and glycated albumin, logbook, data downloading, lancing devices, carbohydrate counting, and glycemic measurements at school. We concluded that clinical guidelines on self-management should be developed in every country with faithful adaptation to local languages and taking into account specific contexts and local peculiarities, without any substantial modifications to the international recommendations. We believe that the National Health Service should provide all necessary resources to ensure self-monitoring of blood glucose and possibly continuous glucose monitoring of all children and adolescents with type 1 diabetes, according to the standards of care provided by these recommendations and internationally.
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Affiliation(s)
- Andrea Scaramuzza
- Department of Pediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco," via G.B. Grassi 74, 20157, Milan, Italy,
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11
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Nørgaard K, Scaramuzza A, Bratina N, Lalić NM, Jarosz-Chobot P, Kocsis G, Jasinskiene E, De Block C, Carrette O, Castañeda J, Cohen O. Routine sensor-augmented pump therapy in type 1 diabetes: the INTERPRET study. Diabetes Technol Ther 2013; 15:273-80. [PMID: 23438304 PMCID: PMC3696941 DOI: 10.1089/dia.2012.0288] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sensor-augmented pump (SAP) therapy can improve glycemic control, compared with multiple daily insulin injections or with insulin pump therapy alone, without increasing the risk of hypoglycemia. SUBJECTS AND METHODS A 12-month observational study in patients with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII), upon the introduction of continuous glucose monitoring (CGM), was conducted in 15 countries (in Europe and in Israel) to document the real-life use of SAP and assess which variables are associated with improvement in type 1 diabetes management. RESULTS Data from 263 patients (38% male; mean age, 28.0 ± 15.7 years [range, 1-69 years]; body mass index, 23.3 ± 4.9 kg/m(2); diabetes duration, 13.9 ± 10.7 years; CSII duration, 2.6 ± 3 years) were collected. Baseline mean glycated hemoglobin A1c (HbA1c) was 8.1 ± 1.4%; 82% had suboptimal HbA1c (≥ 7%). The average sensor use for 12 months was 30% (range, 0-94%), and sensor use decreased with time (first 3 months, 37%; last 3 months, 27%). Factors associated with improvement in HbA1c after 12 months in patients with baseline HbA1c ≥ 7% were high baseline HbA1c (P<0.001), older age group (P<0.001), and more frequent sensor use (P = 0.047). Significantly less hospitalization, increased treatment satisfaction, and reduced fear of hypoglycemia were reported after 12 months of SAP. CONCLUSIONS This is the largest and longest multicenter prospective observational study providing real-life data on SAP. These results are consistent with those of controlled trials showing the effectiveness of CGM in pump users.
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The role of continuous glucose monitoring in the care of children with type 1 diabetes. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2013; 2013:8. [PMID: 23531400 PMCID: PMC3630059 DOI: 10.1186/1687-9856-2013-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/20/2013] [Indexed: 11/10/2022]
Abstract
Continuous glucose monitoring (CGM), while a relatively new technology, has the potential to transform care for children with type 1 diabetes. Some, but not all studies, have shown that CGM can significantly improve hemoglobin A1c levels and reduce time spent in the hypoglycemic range in children, particularly when used as part of sensor-augmented pump (SAP) therapy. Despite the publication of recent clinical practice guidelines suggesting CGM be offered to all children 8 years of age or older who are likely to benefit, and studies showing that younger children can also benefit, this technology is not yet commonly used by children with type 1 diabetes. Effects of CGM are enhanced when used on a near-daily basis (a use-dependent effect) and with insulin pump therapy. Therefore, coordinated strategies are needed to help children and their families initiate and continue to use this resource for diabetes care. This review introduces CGM to pediatric endocrinologists who are not yet familiar with the finer details of this technology, summarizes current data showing the benefits and limitations of CGM use in children, reviews specific case examples demonstrating when CGM can be helpful, and shows the value of both retrospective and real-time CGM. It is hoped that this information leads to discussion of this technology in pediatric endocrinology clinics as an important next step in improving the care of children with type 1 diabetes.
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Mauras N, Fox L, Englert K, Beck RW. Continuous glucose monitoring in type 1 diabetes. Endocrine 2013; 43:41-50. [PMID: 22926738 DOI: 10.1007/s12020-012-9765-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 07/19/2012] [Indexed: 01/13/2023]
Abstract
Continuous glucose monitors (CGM), devices that can measure interstitial glucose in "real time," have become widely available particularly for use in patients with diabetes, and their accuracy and ease of use have greatly improved over the last decade. A number of large and well-controlled clinical trials have firmly established their usefulness in improving metabolic control (as measured by HbA1C) and decreasing time spent in hypoglycemia in adults; however, data have been less robust proving benefit in children and adolescents. Benefits are clearly linked to near-continuous wear. Insulin dosing algorithms based on CGM glucose trends have proven useful in dissecting the large volume of data generated daily by these devices, although these are imperfect tools, particularly in children. The technology is likely to be most useful when integrated with insulin pump delivery systems (sensor augmented). In this review, we concentrate on the analysis of published results of the largest trials in adults and children, including the very young, with diabetes.
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Affiliation(s)
- Nelly Mauras
- Nemours Children's Clinic, 807 Children's Way, Jacksonville, FL 32207, USA.
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Hoey H, Mlinac A, Tran CT, Schlaeger C. 5(th) Annual Symposium on Self-Monitoring of Blood Glucose (SMBG) applications and beyond, May 3-5, 2012, Dublin, Ireland. Diabetes Technol Ther 2012; 14:1155-73. [PMID: 23216339 PMCID: PMC3696943 DOI: 10.1089/dia.2012.0230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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15
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Hammond P. Continuous glucose monitoring: the clinical picture. How to interpret and use the data. PRACTICAL DIABETES 2012. [DOI: 10.1002/pdi.1723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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16
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Frontino G, Bonfanti R, Scaramuzza A, Rabbone I, Meschi F, Rigamonti A, Battaglino R, Favalli V, Bonura C, Sicignano S, Gioia E, Zuccotti GV, Cerutti F, Chiumello G. Sensor-augmented pump therapy in very young children with type 1 diabetes: an efficacy and feasibility observational study. Diabetes Technol Ther 2012; 14:762-4. [PMID: 22694194 DOI: 10.1089/dia.2012.0044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Efficacy and feasibility of sensor-augmented pump (SAP) therapy were evaluated in very young children with type 1 diabetes (T1D). SUBJECTS AND METHODS SAP (Dexcom [San Diego, CA] Seven Plus™ usage combined with insulin pump) therapy was retrospectively evaluated in 28 children (15 boys) younger than 7 years (mean age, 5.8 ± 1.2 years; range, 3-7 years), with T1D. Glycosylated hemoglobin (HbA1c) was evaluated at baseline and at the end of the study, as were efficacy and feasibility of the system, using a rating scale (with 3 being the most positive). RESULTS SAP has been used for at least 6 months by 85% of patients, with an overall good satisfaction (92%). The greatest perceived benefit was the reduced fear of hypoglycemia (score of 3, 81%). HbA1c significantly improved only in patients with baseline HbA1c >7.5% (P = 0.026). CONCLUSIONS SAP therapy is effective and feasible in preschool children with T1D. In patients with high HbA1c at baseline it provide a 0.9% decrease, sustained for at least 6 months.
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Affiliation(s)
- Giulio Frontino
- Department of Pediatrics, Endocrine Unit, Scientific Institute Hospital San Raffaele, Vita-Salute University, Milan, Italy.
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Bratlie KM, York RL, Invernale MA, Langer R, Anderson DG. Materials for diabetes therapeutics. Adv Healthc Mater 2012; 1:267-84. [PMID: 23184741 PMCID: PMC3899887 DOI: 10.1002/adhm.201200037] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Indexed: 11/10/2022]
Abstract
This review is focused on the materials and methods used to fabricate closed-loop systems for type 1 diabetes therapy. Herein, we give a brief overview of current methods used for patient care and discuss two types of possible treatments and the materials used for these therapies-(i) artificial pancreases, comprised of insulin producing cells embedded in a polymeric biomaterial, and (ii) totally synthetic pancreases formulated by integrating continuous glucose monitors with controlled insulin release through degradable polymers and glucose-responsive polymer systems. Both the artificial and the completely synthetic pancreas have two major design requirements: the device must be both biocompatible and be permeable to small molecules and proteins, such as insulin. Several polymers and fabrication methods of artificial pancreases are discussed: microencapsulation, conformal coatings, and planar sheets. We also review the two components of a completely synthetic pancreas. Several types of glucose sensing systems (including materials used for electrochemical, optical, and chemical sensing platforms) are discussed, in addition to various polymer-based release systems (including ethylene-vinyl acetate, polyanhydrides, and phenylboronic acid containing hydrogels).
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Affiliation(s)
- Kaitlin M. Bratlie
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA 02142, USA
- Department of Anesthesiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Roger L. York
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA 02142, USA
- Department of Anesthesiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Michael A. Invernale
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA 02142, USA
- Department of Anesthesiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Robert Langer
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA 02142, USA
- Department of Anesthesiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
- Harvard-MIT Division of Health Science Technology, Massachusetts Institute of Technology, 45 Carleton Street, Building E25-342, Cambridge, MA 02142, USA
| | - Daniel G. Anderson
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA 02142, USA
- Department of Anesthesiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
- Harvard-MIT Division of Health Science Technology, Massachusetts Institute of Technology, 45 Carleton Street, Building E25-342, Cambridge, MA 02142, USA
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Phillip M, Danne T, Shalitin S, Buckingham B, Laffel L, Tamborlane W, Battelino T. Use of continuous glucose monitoring in children and adolescents (*). Pediatr Diabetes 2012; 13:215-28. [PMID: 22284160 DOI: 10.1111/j.1399-5448.2011.00849.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Abstract
Hypoglycemia is the most important and common side effect of insulin therapy. It is also the rate limiting factor in safely achieving excellent glycemic control. A three-fold increased risk of severe hypoglycemia occurs in both type 1 and type 2 diabetes with tight glucose control. This dictates a need to individualize therapy and glycemia goals to minimize this risk. Several ways to reduce hypoglycemia risk are recognized and discussed. They include frequent monitoring of blood sugars with home blood glucose tests and sometimes continuous glucose monitoring (CGM) in order to identify hypoglycemia particularly in hypoglycemia unawareness. Considerations include prompt measured hypoglycemia treatment, attempts to reduce glycemic variability, balancing basal and meal insulin therapy, a pattern therapy approach and use of a physiological mimicry with insulin analogues in a flexible manner. Methods to achieve adequate control while focusing on minimizing the risk of hypoglycemia are delineated in this article.
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Affiliation(s)
- Anthony L McCall
- Division of Endocrinology, University of Virginia School of Medicine, 450 Ray C. Hunt Drive, Charlottesville, VA 22903, USA.
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Gonder-Frederick L, Shepard J, Peterson N. Closed-loop glucose control: psychological and behavioral considerations. J Diabetes Sci Technol 2011; 5:1387-95. [PMID: 22226256 PMCID: PMC3262705 DOI: 10.1177/193229681100500610] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Since 2000, the diabetes community has witnessed tremendous technological advances that have revolutionized diabetes management. Currently, closed-loop glucose control (CLC) systems, which link continuous subcutaneous insulin infusion and continuous glucose monitoring, are the newest, cutting edge technology aimed at reducing glycemic variability and improving daily management of diabetes. Although advances in knowledge and technology in the treatment of diabetes have improved exponentially, adherence to diabetes regimens remains complex and often difficult to predict. Human factors, such as patient perceptions and behavioral self-regulation, are central to adherence to prescribed regimens, as well as to adoption and utilization of diabetes technology, and they will continue to be crucial as diabetes management evolves. Thus, the aims of this article are three-fold: (1) to review psychological and behavioral factors that have influenced adoption and utilization of past technologies, (2) to examine three theoretical frameworks that may help in conceptualizing relevant patient factors in diabetes management, and (3) to propose patient-selection factors that will likely affect future CLC systems.
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Affiliation(s)
- Linda Gonder-Frederick
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia 22908 , USA.
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