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Bellido V, Aguilera E, Cardona-Hernandez R, Diaz-Soto G, González Pérez de Villar N, Picón-César MJ, Ampudia-Blasco FJ. Expert Recommendations for Using Time-in-Range and Other Continuous Glucose Monitoring Metrics to Achieve Patient-Centered Glycemic Control in People With Diabetes. J Diabetes Sci Technol 2023; 17:1326-1336. [PMID: 35470692 PMCID: PMC10563535 DOI: 10.1177/19322968221088601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
New metrics for assessing glycemic control beyond HbA1c have recently emerged due to the increasing use of continuous glucose monitoring (CGM) in diabetes clinical practice. Among them, time in range (TIR) has appeared as a simple and intuitive metric that correlates inversely with HbA1c and has also been newly linked to the risk of long-term diabetes complications. The International Consensus on Time in Range established a series of target glucose ranges (TIR, time below range and time above range) and recommendations for time spent within these ranges for different diabetes populations. These parameters should be evaluated together with the ambulatory glucose profile (AGP). Using standardized visual reporting may help people with diabetes and healthcare professionals in the evaluation of glucose control in frequent clinical situations. The objective of the present review is to provide practical insights to quick interpretation of patient-centered metrics based on flash glucose monitoring data, as well as showing some visual examples of common clinical situations and giving practical recommendations for their management.
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Affiliation(s)
- Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Aguilera
- Endocrinology and Nutrition Department, Health Sciences Research Institute and University, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Gonzalo Diaz-Soto
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
| | | | - María J. Picón-César
- Endocrinology and Nutrition Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Javier Ampudia-Blasco
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Research Foundation, Valencia, Spain
- CIBERDEM, Madrid, Spain
- Universitat de Valencia, Valencia, Spain
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Kaku K, Nakayama Y, Yabuuchi J, Naito Y, Kanasaki K. Safety and effectiveness of empagliflozin in clinical practice as monotherapy or with other glucose-lowering drugs in Japanese patients with type 2 diabetes: subgroup analysis of a 3-year post-marketing surveillance study. Expert Opin Drug Saf 2023; 22:819-832. [PMID: 37194266 DOI: 10.1080/14740338.2023.2213477] [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: 04/04/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors such as empagliflozin are increasingly prescribed as initial glucose-lowering drugs for type 2 diabetes (T2D), based on their cardiorenal benefits. However, information regarding the safety and the effectiveness of monotherapy with SGLT2 inhibitors in routine clinical practice is limited. RESEARCH DESIGN AND METHODS We analyzed data from a prospective, 3-year, post-marketing surveillance study of empagliflozin in Japan. We evaluated adverse drug reactions (ADRs) (the primary endpoint) and glycemic effectiveness with or without other glucose-lowering drugs. RESULTS 7931 T2D patients were treated with empagliflozin. At baseline, mean age was 58.7 years, 63.0% were male, and 1835 (23.14%) were not receiving other glucose-lowering drugs. ADRs occurred in 141 (7.68%) and 875 (14.62%) patients initiating empagliflozin as monotherapy or combination therapy, respectively. The most frequent ADRs of special interest with empagliflozin as monotherapy or combination therapy were urinary tract infections (0.82% and 1.14% of patients, respectively) and excessive/frequent urination (0.65%, 1.50%). At last observation, glycated hemoglobin level was reduced by a mean of 0.78% with empagliflozin monotherapy (from baseline mean of 7.55%) and 0.74% with combination therapy (baseline 8.16%). CONCLUSIONS Empagliflozin is well tolerated and effective in clinical practice in Japan when initiated as monotherapy or combination therapy.
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Affiliation(s)
- Kohei Kaku
- Department of Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yayoi Nakayama
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Junko Yabuuchi
- Medicines Development Unit Japan and Medical Affairs, Eli Lilly Japan K.K, Kobe, Japan
| | - Yusuke Naito
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Keizo Kanasaki
- Department of Internal Medicine 1, Faculty of Medicine, Shimane University, Izumo, Japan
- Division of Anticipatory Molecular Food Science and Technology, Medical Research Institute, Kanazawa Medical University, Kahoku-gun, Japan
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Baliga BS, Tillman JB, Olson B, Vaughan S, Sheikh FN, Malone JK. First Real-World Experience With Bigfoot Unity: A 6-Month Retrospective Analysis. Clin Diabetes 2023; 41:539-548. [PMID: 37849519 PMCID: PMC10577513 DOI: 10.2337/cd22-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The Bigfoot Unity Diabetes Management System, a smart pen cap system cleared by the U.S. Food and Drug Administration in May 2021, incorporates continuous glucose monitoring data, real-time glycemic alerts, and clinician-directed dose recommendations. This study analyzed real-world clinical outcomes data for an initial cohort (n = 58, from 13 clinics) managing multiple daily injection insulin therapy using the pen cap system for 6 months. We examined glycemic control, including hypoglycemia events and interaction with and use of the pen cap system. In a cohort mainly consisting of adults with type 2 diabetes and an average age of 62 years, the results demonstrate close adherence to established glycemic targets, including a relatively short amount of time spent in the hypoglycemic range.
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Sethi B, Al-Rubeaan K, Unubol M, Mabunay MA, Berthou B, Pilorget V, Vethakkan SR, Frechtel G. Efficacy and Safety of Insulin Glargine 300 U/mL in People with Type 2 Diabetes Uncontrolled on Basal Insulin: The 26-Week Interventional, Single-Arm ARTEMIS-DM Study. Diabetes Ther 2022; 13:1-14. [PMID: 35713873 PMCID: PMC9205141 DOI: 10.1007/s13300-022-01271-7] [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: 03/05/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The efficacy and safety of switching to insulin glargine 300 U/mL (Gla-300) in type 2 diabetes mellitus (T2DM) uncontrolled on basal insulin (BI) has been demonstrated in the North American and Western European populations; however, there is limited data from other geographical regions with different ethnicities. The ARTEMIS-DM study aimed to evaluate the efficacy and safety of Gla-300 in people with T2DM uncontrolled on BI from Asia, Latin America and Middle East Africa. METHODS The ARTEMIS-DM was a 26-week, prospective, interventional, single-arm, phase IV study (NCT03760991). Adults with T2DM previously uncontrolled (glycated haemoglobin [HbA1c] 7.5-10%) on BI were switched to Gla-300. The primary endpoint was change in HbA1c from baseline to 26 weeks. Key secondary endpoints were changes in HbA1c (week 12), fasting plasma glucose (FPG), self-monitored plasma glucose (SMPG) and BI dose from baseline to week 26. The safety and tolerability of Gla-300 were also assessed. RESULTS A total of 372 (50% male) participants were included, with mean (standard deviation [SD]) age 60.9 (10.0) years, duration of diabetes 13.11 (7.48) years and baseline HbA1c 8.67 (0.77)% (71.22 [8.44] mmol/mol). A total of 222 (59.7%) participants were using insulin glargine 100 U/mL and 107 (28.8%) were using neutral protamine Hagedorn insulin as previous BI. There were clinically significant reductions in mean HbA1c (- 0.82%; primary endpoint), FPG and SMPG levels at week 26. With a pre-defined titration algorithm, mean Gla-300 dose increased from 27.48 U (0.35 U/kg) at baseline to 39.01 U (0.50 U/kg) at week 26. Hypoglycaemia events occurred in 20.4% of the participants; 1 (0.3%) participant had a severe hypoglycaemia event. CONCLUSION In people with T2DM uncontrolled on previous BI, switching to Gla-300 with optimal titration guided by an algorithm was associated with improved glycaemic control and low incidence of hypoglycaemia across multiple geographic regions. GOV IDENTIFIER NCT03760991.
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Affiliation(s)
| | - Khalid Al-Rubeaan
- Research and Scientific Center Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
| | - Mustafa Unubol
- Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | | | | | | | | | - Gustavo Frechtel
- Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
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Davis G, Bailey R, Calhoun P, Price D, Beck RW. Magnitude of Glycemic Improvement in Patients with Type 2 Diabetes Treated with Basal Insulin: Subgroup Analyses from the MOBILE Study. Diabetes Technol Ther 2022; 24:324-331. [PMID: 34962151 PMCID: PMC9127836 DOI: 10.1089/dia.2021.0489] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective: To determine if type 2 diabetes patients using basal insulin without prandial insulin with worse glycemic control at baseline would have the greatest benefit from using real-time continuous glucose monitoring (CGM). Methods: We conducted a post hoc analysis of the MOBILE Study, a multicenter trial examining the impact of CGM versus self-monitoring with a blood glucose meter (BGM) in patients with type 2 diabetes treated with basal insulin without prandial insulin. Participants were divided into subgroups based on baseline hemoglobin A1c (HbA1c) and baseline time-in-range 70-180 mg/dL (TIR). Change in TIR from baseline was calculated within each subgroup. Results: In subgroups based on baseline HbA1c, compared with the BGM group, the CGM group had 14% greater increase in TIR for participants with baseline HbA1c ≥8.5%, 14% greater increase for baseline HbA1c ≥9.0%, 22% greater increase for baseline HbA1c ≥9.5%, and 32% greater increase for baseline HbA1c ≥10.0% (P-value for interaction = 0.27). The time spent with glucose >250 mg/dL was significantly lower with CGM compared with BGM among participants with higher HbA1c values (P for interaction = 0.004). Results in subgroups based on baseline TIR paralleled the results in subgroups based on baseline HbA1c. Conclusion: While the benefit of CGM on TIR among patients with type 2 diabetes treated with basal insulin is apparent across the range of baseline glycemic control, the greatest impact of CGM is in those with the worst baseline glycemic control, particularly among those with HbA1c ≥10%. Clinical Trial Registration number: NCT03566693.
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Affiliation(s)
- Georgia Davis
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, GA
| | - Ryan Bailey
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
- Address correspondence to: Peter Calhoun, PhD, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647, USA
| | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida, USA
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Beck SE, Kelly C, Price DA. Non-adjunctive continuous glucose monitoring for control of hypoglycaemia (COACH): Results of a post-approval observational study. Diabet Med 2022; 39:e14739. [PMID: 34758142 PMCID: PMC9299719 DOI: 10.1111/dme.14739] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Prior to the Continuous Monitoring and Control of Hypoglycaemia (COACH) study described herein, no study had been powered to evaluate the impact of non-adjunctive RT-CGM use on the rate of debilitating moderate or severe hypoglycaemic events. RESEARCH DESIGN AND METHODS In this 12-month observational study, adults with insulin-requiring diabetes who were new to RT-CGM participated in a 6-month control phase where insulin dosing decisions were based on self monitoring of blood glucose values, followed by a 6-month phase where decisions were based on RT-CGM data (i.e. non-adjunctive RT-CGM use); recommendations for RT-CGM use were made according to sites' usual care. The primary outcome was change in debilitating moderate (requiring second-party assistance) and severe (resulting in seizures or loss of consciousness) hypoglycaemic event frequency. Secondary outcomes included changes in HbA1c and diabetic ketoacidosis (DKA) frequency. RESULTS A total of 519 participants with mean (SD) age 50.3 (16.1) years and baseline HbA1c 8.0% (1.4%) completed the study, of whom 32.8% had impaired hypoglycaemia awareness and 33.5% had type 2 diabetes (T2D). The mean (SE) per-patient frequency of hypoglycaemic events decreased by 63% from 0.08 (0.016) during the SMBG phase to 0.03 (0.010) during the RT-CGM phase (p = 0.005). HbA1c decreased during the RT-CGM phase both for participants with type 1 diabetes (T1D) and T2D and there was a trend towards larger reductions among individuals with higher baseline HbA1c. CONCLUSIONS Among adults with insulin-requiring diabetes, non-adjunctive use of RT-CGM data is safe, resulting in significantly fewer debilitating hypoglycaemic events than management using SMBG.
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Bode B, King A, Russell-Jones D, Billings LK. Leveraging advances in diabetes technologies in primary care: a narrative review. Ann Med 2021; 53:805-816. [PMID: 34184589 PMCID: PMC8245065 DOI: 10.1080/07853890.2021.1931427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022] Open
Abstract
Primary care providers (PCPs) play an important role in providing medical care for patients with type 2 diabetes. Advancements in diabetes technologies can assist PCPs in providing personalised care that addresses each patient's individual needs. Diabetes technologies fall into two major categories: devices for glycaemic self-monitoring and insulin delivery systems. Monitoring technologies encompass self-measured blood glucose (SMBG), where blood glucose is intermittently measured by a finger prick blood sample, and continuous glucose monitoring (CGM) devices, which use an interstitial sensor and are capable of giving real-time information. Studies show people using real-time CGM have better glucose control compared to SMBG. CGM allows for new parameters including time in range (the time spent within the desired target glucose range), which is an increasingly relevant real-time metric of glycaemic control. Insulin pens have increased the ease of administration of insulin and connected pens that can calculate and capture data on dosing are becoming available. There are a number of websites, software programs, and applications that can help PCPs and patients to integrate diabetes technology into their diabetes management schedules. In this article, we summarise these technologies and provide practical information to inform PCPs about utility in their clinical practice. The guiding principle is that use of technology should be individualised based on a patient's needs, desires, and availability of devices. Diabetes technology can help patients improve their clinical outcomes and achieve the quality of life they desire by decreasing disease burden.KEY MESSAGESIt is important to understand the role that diabetes technologies can play in primary care to help deliver high-quality care, taking into account patient and community resources. Diabetes technologies fall into two major categories: devices for glycaemic self-monitoring and insulin delivery systems. Modern self-measured blood glucose devices are simple to use and can help guide decision making for self-management plans to improve clinical outcomes, but cannot provide "live" data and may under- or overestimate blood glucose; patients' monitoring technique and compliance should be reviewed regularly. Importantly, before a patient is provided with monitoring technology, they must receive suitably structured education in its use and interpretation.Continuous glucose monitoring (CGM) is now standard of care for people with type 1 diabetes and people with type 2 diabetes on meal-time (prandial) insulin. Real-time CGM can tell both the patient and the healthcare provider when glucose is in the normal range, and when they are experiencing hyper- or hypoglycaemia. Using CGM data, changes in lifestyle, eating habits, and medications, including insulin, can help the patient to stay in a normal glycaemic range (70-180 mg/dL). Real-time CGM allows for creation of an ambulatory glucose profile and monitoring of time in range (the time spent within target blood glucose of 70-180 mg/dL), which ideally should be at least 70%; avoiding time above range (>180 mg/dL) is associated with reduced diabetes complications and avoiding time below range (<70 mg/dL) will prevent hypoglycaemia. Insulin pens are simpler to use than syringes, and connected pens capture information on insulin dose and injection timing.There are a number of websites, software programs and applications that can help primary care providers and patients to integrate diabetes technology into their diabetes management schedules. The guiding principle is that use of technology should be individualised based on a patient's needs, desires, skill level, and availability of devices.
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Affiliation(s)
- Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA, USA
| | - Aaron King
- HealthTexas at Stone Oak, San Antonio, TX, USA
| | | | - Liana K. Billings
- NorthShore University HealthSystem/University of Chicago Pritzker School of Medicine, Skokie, IL, USA
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Joaqui VB, Gómez NB, Ortiz RC, Toro LMO, Lombo JPM, Cifuentes CAS, García MAM, Lomba AA. Effectiveness of triple therapy with dapagliflozin add-on to dual therapy over 52 weeks in patients with uncontrolled type 2 diabetes mellitus in a centre of high complexity, Cali-Colombia. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:49-59. [PMID: 33444492 PMCID: PMC10528692 DOI: 10.20945/2359-3997000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of adding dapagliflozin as an intensification strategy for the treatment of patients with uncontrolled type 2 diabetes mellitus (T2DM). METHODS A historical cohort study was conducted in 123 adult patients over 18 years old who were diagnosed with uncontrolled T2DM, who received dapagliflozin add-on to their dual base treatment: metformin plus glibenclamide (n = 32), metformin plus saxagliptin (n = 29), metformin plus exenatide (n = 28), or metformin plus insulin (n = 34). The endpoints were evaluated using analysis of variance. RESULTS All the patients completed a 52-week follow-up. Overall, 52.85% of patients were female, the Hispanic population represented the largest proportion of patients in all groups (60.98%), and the mean ± SD patient age and body weight were 55.05 ± 7.58 years and 83.55 ± 9.65 kg, respectively. The mean ± SD duration of T2DM, glycated hemoglobin (HbA1c), and fasting plasma glucose (FPG) were 5.93 ± 2.98 years, 8.1 ± 0.53%, and 166.03 ± 26.80 mg/dL, respectively. The grand mean changes of HbA1c, FPG, body weight and blood pressure showed a decreasing trend during the study period and it was statistically significant in all groups (p-value = <0.001). The proportion of patients achieving HbA1c target (<7%) was highest in the group that used a dapagliflozin add-on to metformin plus saxagliptin. CONCLUSION The addition of dapagliflozin as an alternative for intensification of dual therapy consistently improved, not only FPG and HbA1c, but also body weight and blood pressure, with statistically significant results.
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Affiliation(s)
- Vanessa Bedoya Joaqui
- Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia
| | - Nathalia Buitrago Gómez
- Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia
| | - Reinaldo Carvajal Ortiz
- Centro Médico Imbanaco S.A., Cali, Colombia; Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia
| | | | - Jenny Patricia Muñoz Lombo
- Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia
| | | | | | - Alín Abreu Lomba
- Centro Médico Imbanaco S.A., Cali, Colombia; Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia,
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Nkhoma DE, Soko CJ, Bowrin P, Manga YB, Greenfield D, Househ M, Li Jack YC, Iqbal U. Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 210:106370. [PMID: 34492544 DOI: 10.1016/j.cmpb.2021.106370] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe and assess digital health-led diabetes self-management education and support (DSMES) effectiveness in improving glycosylated hemoglobin, diabetes knowledge, and health-related quality of life (HrQoL) of Type 1 and 2 Diabetes in the past 10 years. DESIGN Systematic Review and Meta-Analysis. The protocol was registered on PROSPERO registration number CRD42019139884. DATA SOURCES PubMed, EMBASE, Cochrane library, Web of Science, and Scopus between January 2010 and August 2019. Study Selection and Appraisal: Randomized control trials of digital health-led DSMES for Type 1 (T1DM) or 2 (T2DM) diabetes compared to usual care were included. Outcomes were change in HbA1c, diabetes knowledge, and HrQoL. Cochrane Risk of Bias 2.0 tool was used to assess bias and GRADEpro for overall quality. The analysis involved narrative synthesis, subgroup and pooled meta-analyses. RESULTS From 4286 articles, 39 studies (6861 participants) were included. Mean age was 51.62 years, range (13-70). Meta-analysis revealed intervention effects on HbA1c for T2DM with difference in means (MD) from baseline -0.480% (-0.661, -0.299), I275% (6 months), -0.457% (-0.761, -0.151), I2 81% (12 months), and for T1DM -0.41% (-1.022, 0.208) I2 83% (6 months), -0.03% (-0.210, 0.142) I2 0% (12 months). Few reported HrQoL with Hedges' g 0.183 (-0.039, 0.405), I2 0% (6 months), 0.153 (-0.060, 0.366), I2 0% (12 months) and diabetes knowledge with Hedges' g 1.003 (0.068, 1.938), I2 87% (3 months). CONCLUSION Digital health-led DSMES are effective in improving HbA1c and diabetes knowledge, notably for T2DM. Research shows non-significant changes in HrQoL. Intervention effect on HbA1c was more impressive if delivered through mobile apps or patient portals. Further research is needed on the impact of DSMES on these outcomes, especially for newly diagnosed diabetes patients.
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Affiliation(s)
- Dumisani Enricho Nkhoma
- Master Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Nkhata Bay District Hospital, Nkhata Bay District Health Office, Nkhata Bay, Mkondezi, Malawi
| | - Charles Jenya Soko
- Master Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei City, Taiwan
| | - Pierre Bowrin
- PhD Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei City, Taiwan
| | - Yankuba B Manga
- Graduate Institute of Biomedical Materials and Tissue Engineering and School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City, Taiwan
| | - David Greenfield
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales (UNSW) Medicine, Sydney, Australia
| | - Mowafa Househ
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Yu-Chuan Li Jack
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei City, Taiwan; Graduate Insitute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei City, Taiwan; Dermatology Department, Wan-Fang Hospital, Taipei City, Taiwan; International Medical Informatics Association (IMIA), Switzerland
| | - Usman Iqbal
- Master Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei City, Taiwan; PhD Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei City, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei City, Taiwan.
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Maegawa H, Tobe K, Nakamura I, Uno S. Real-world evidence for long-term safety and effectiveness of ipragliflozin in treatment-naïve versus non-naïve Japanese patients with type 2 diabetes mellitus: subgroup analysis of a 3-year post-marketing surveillance study (STELLA-LONG TERM). Diabetol Int 2021; 12:430-444. [PMID: 34567926 DOI: 10.1007/s13340-021-00501-w] [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: 12/07/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Background STELLA-LONG TERM was a 3-year post-marketing surveillance study that evaluated the long-term safety and effectiveness of ipragliflozin in Japanese patients with type 2 diabetes mellitus (T2DM). This subgroup analysis examined the safety and effectiveness of ipragliflozin in treatment-naïve and non-naïve patients. Materials and methods Patients were stratified into two subgroups: treatment-naïve (patients who had not received any antidiabetic drugs before starting ipragliflozin monotherapy) and non-naïve (all other patients). Patients who had added or switched antidiabetic drugs during follow-up were excluded from the analysis from that point. The incidence of adverse drug reactions (ADRs) and changes from baseline in glycosylated hemoglobin (HbA1c), body weight, fasting plasma glucose (FPG) and laboratory parameters were assessed. Results Of the 11,051 patients in the safety analysis set, 1980 patients (17.92%) were treatment-naïve and 9071 (82.08%) were non-naïve. In the safety analysis set, treatment-naïve patients reported significantly lower incidences of ADRs (10.81% vs 20.87%; p < 0.001) and serious ADRs (0.86% vs 2.09%; p < 0.001) compared with non-naïve patients, as well as significantly lower incidences of polyuria/pollakiuria, volume depletion-related events, skin complications and renal disorders. In the effectiveness analysis, sustained and significant reductions from baseline to 36 months were observed in HbA1c, FPG and body weight in both treatment-naïve and non-naïve patients (all p < 0.001 vs baseline). Conclusions Over 3 years, ipragliflozin was better tolerated in treatment-naive than in non-naive Japanese patients with T2DM and had similar efficacy in these populations. Therefore, ipragliflozin is a useful first-line treatment option for patients with T2DM. Clinical trial registration ClinicalTrials.gov: NCT02479399. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-021-00501-w.
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Affiliation(s)
- Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan
| | - Ichiro Nakamura
- Operational Excellence, Medical Affairs Japan, Astellas Pharma Inc., Tokyo, Japan
| | - Satoshi Uno
- Data Science, Development, Astellas Pharma Inc., Tokyo, Japan
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Roze S, Isitt JJ, Smith-Palmer J, Lynch P. Evaluation of the Long-Term Cost-Effectiveness of the Dexcom G6 Continuous Glucose Monitor versus Self-Monitoring of Blood Glucose in People with Type 1 Diabetes in Canada. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:717-725. [PMID: 34408456 PMCID: PMC8366033 DOI: 10.2147/ceor.s304395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Dexcom G6 real-time continuous glucose monitoring (RT-CGM) system is one of the most sophisticated RT-CGM systems developed to date and became available in Canada in 2019. A health economic analysis was performed to determine the long-term cost-effectiveness of the Dexcom G6 RT-CGM system versus SMBG in adults with type 1 diabetes (T1D) in Canada. METHODS The analysis was performed using the IQVIA Core Diabetes Model. Based on clinical trial data, patients with mean baseline HbA1c of 8.6% were assumed to have a HbA1c reduction of 1.0% with RT-CGM versus 0.4% reduction with SMBG. RT-CGM was also associated with a quality of life (QoL) benefit owing to reduced incidence of hypoglycemia, reduced fear of hypoglycemia (FoH) and elimination of fingerstick testing. Direct medical costs were sourced from published literature, and inflated to 2019 Canadian dollars (CAD). RESULTS Dexcom G6 RT-CGM was projected to improve mean quality-adjusted life expectancy by 2.09 quality-adjusted life years (QALYs) relative to SMBG (15.52 versus 13.43 QALYs) but mean total lifetime cots were CAD 35,353 higher with RT-CGM (CAD 227,357 versus CAD 192,004) resulting in an incremental cost-effectiveness ratio (ICER) of CAD 16,931 per QALY gained. Sensitivity analyses revealed that assumptions relating to the QoL benefit associated with reduced FoH and the elimination of fingerstick testing with RT-CGM as well as SMBG usage and change in HbA1c were the key drivers of cost-effectiveness. CONCLUSION For adults with T1D in Canada, RT-CGM is associated with improved glycemic control and QoL benefits owing to a reduced FoH and elimination of the requirement for fingerstick testing and over a lifetime time horizon is cost-effective relative to SMBG.
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Préau Y, Armand M, Galie S, Schaepelynck P, Raccah D. Impact of Switching from Intermittently Scanned to Real-Time Continuous Glucose Monitoring Systems in a Type 1 Diabetes Patient French Cohort: An Observational Study of Clinical Practices. Diabetes Technol Ther 2021; 23:259-267. [PMID: 33136439 PMCID: PMC7994425 DOI: 10.1089/dia.2020.0515] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aim: Assess the impact of switching from intermittently scanned (FreeStyle Libre [FSL]) to real-time (Dexcom G4 platinum [DG4]) continuous glucose monitoring systems on glycemia control in type 1 diabetes (T1D) patients with high risk of hypoglycemia and/or elevated glycated hemoglobin (HbA1c). Methods: We conducted an observational study in 18 T1D adults with poor glycemic control on FSL. Ambulatory glucose profile data were collected during the last 3 months of FSL use before inclusion (M0 period), during the first 3 months (M3 period) and the last 3 months (M6 period) of DG4 use. Data were then expressed as 24-h averages. Biological HbA1c was measured for all three periods. Patients were their own-controls and statistics were performed using paired t-test or Wilcoxon for matched-pairs. Results: The switch to DG4 at M3 resulted in a higher time-in-range (TIR) 70-180 mg/dL (median [Q1;Q3], 53.1 [44.5;67.3] vs. 41.5 [28.5;62.0], P = 0.0008), and a lower time-below-range <70 mg/dL (TBR mean ± standard deviation (SD), 5.4 ± 3.7 vs. 10.9 ± 7.1, P = 0.0009) and in the glucose % coefficient of variation (%CV mean ± SD, 40.1 vs. 46.9, P = 0.0001). Mean (SD) changes were +10.3 (8.0) percentage points for TIR, -5.5 (5.8) percentage points for TBR, and -6.8 (5.8) percentage points for %CV. These results were confirmed at the M6 period. Conclusions: Switching from FSL to DG4 appears to provide a beneficial therapeutic option without changing insulin delivery systems, regardless of the origin of the patient's initial glycemic issue.
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Affiliation(s)
- Yannis Préau
- APHM, University Hospital Sainte Marguerite, Department of Nutrition & Diabetes, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- Address correspondence to: Yannis Préau, MD, University Hospital Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard Sainte Marguerite, 13385 Marseille Cedex 09, France
| | | | - Sébastien Galie
- APHM, University Hospital Sainte Marguerite, Department of Nutrition & Diabetes, Marseille, France
| | - Pauline Schaepelynck
- APHM, University Hospital Sainte Marguerite, Department of Nutrition & Diabetes, Marseille, France
| | - Denis Raccah
- APHM, University Hospital Sainte Marguerite, Department of Nutrition & Diabetes, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
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13
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Gilbert TR, Noar A, Blalock O, Polonsky WH. Change in Hemoglobin A1c and Quality of Life with Real-Time Continuous Glucose Monitoring Use by People with Insulin-Treated Diabetes in the Landmark Study. Diabetes Technol Ther 2021; 23:S35-S39. [PMID: 33470882 PMCID: PMC7957368 DOI: 10.1089/dia.2020.0666] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Initiating continuous glucose monitoring (CGM) can affect hemoglobin A1c (HbA1c) levels and patients' relationship with their diabetes. We used real-world HbA1c data to quantify short-term changes in glycemia and validated psychosocial questionnaires to assess changes in quality-of-life indicators in people during their first few months of CGM use. Methods: Eligibility was assessed during calls to Dexcom sales regarding its G6 CGM System. Eligibility criteria included ages 25-65 years, type 1 (T1D) or type 2 diabetes (T2D) on intensive insulin therapy (IIT), and no prior CGM use. Participants used a web-based portal to complete the 17-item Diabetes Distress Scale (DDS) and the 14-item Hypoglycemia Attitudes and Behavior Scale (HABS); provided validated HbA1c measurements; and shared their CGM data pre- and 3-5 months post-CGM initiation. Satisfaction and ease of use with the G6 System were also assessed. Results: Data were available from 248 patients (182 with T1D, 66 with T2D; 57% male, 88% non-Hispanic white). Mean (standard deviation) HbA1c fell significantly from 8.2% (1.9%) at baseline to 7.1% (1.1%) at the end of the study (P < 0.001); more than half (54.4%) of those with initial HbA1c values >7% experienced absolute HbA1c reductions of >1%. Significant reductions in diabetes distress (DDS) and hypoglycemic concerns (HABS) were observed (P < 0.001). Most (93%) participants were satisfied or very satisfied with the G6 System and 73% found it very easy to use. Conclusions: The first 3 months of CGM use was correlated with improvements in psychosocial outcomes and improved HbA1c levels for people with T1D or T2D who use IIT.
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Affiliation(s)
- Timothy R. Gilbert
- Endocrinology Center of Southwest Louisiana, Lake Charles, Louisiana, USA
| | - Adam Noar
- Dexcom, Inc., San Diego, California, USA
- Address correspondence to: Adam Noar, BA, Dexcom, Inc., 6340 Sequence Drive, San Diego, CA 92121, USA
| | - Olivia Blalock
- Endocrinology Center of Southwest Louisiana, Lake Charles, Louisiana, USA
| | - William H. Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- Department of Medicine, University of California, San Diego, California, USA
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Calhoun P, Price D, Beck RW. Glycemic Improvement Using Continuous Glucose Monitoring by Baseline Time in Range: Subgroup Analyses from the DIAMOND Type 1 Diabetes Study. Diabetes Technol Ther 2021; 23:230-233. [PMID: 33006904 PMCID: PMC7906860 DOI: 10.1089/dia.2020.0471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The DIAMOND study demonstrated that real-time continuous glucose monitors (rtCGMs) improve glycemia for adults with type 1 diabetes using multiple daily injections. This analysis explores the relationship between baseline time in range (TIR) and improvement in TIR using rtCGMs or self-monitoring of blood glucose (SMBG). Baseline TIR was divided into three categories: <40% (9.6 h per day), <50% (12 h per day), and <60% (14.4 h per day). Compared with SMBG, use of rtCGMs increased mean TIR by an additional 16 min per day for participants with a baseline TIR <40%, 77 min per day for baseline TIR <50%, and 88 min per day for baseline TIR <60%. A greater percentage of participants increased TIR by >4 h per day using rtCGMs within the three baseline TIR groups. For participants with a baseline TIR <50%, 29% of rtCGM users improved their TIR by >4 h per day compared with no SMBG users (P < 0.001). Similar trends were found for improvement in mean glucose and time spent in hyper- and hypoglycemic ranges.
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Affiliation(s)
- Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
- Address correspondence to: Peter Calhoun, PhD, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647, USA
| | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida, USA
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Ólafsdóttir AF, Bolinder J, Heise T, Polonsky W, Ekelund M, Wijkman M, Pivodic A, Ahlén E, Schwarcz E, Nyström T, Hellman J, Hirsch IB, Lind M. The majority of people with type 1 diabetes and multiple daily insulin injections benefit from using continuous glucose monitoring: An analysis based on the GOLD randomized trial (GOLD-5). Diabetes Obes Metab 2021; 23:619-630. [PMID: 33200487 PMCID: PMC7839699 DOI: 10.1111/dom.14257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Abstract
AIM To identify responders to continuous glucose monitoring (CGM) in relation to reductions in HbA1c and percentage of time spent in hypoglycaemia after initiation of CGM for individuals with type 1 diabetes treated with multiple daily insulin injections. MATERIALS AND METHODS We analysed data from 142 participants in the GOLD randomized clinical trial. We evaluated how many lowered their HbA1c by more than 0.4% (>4.7 mmol/mol) or decreased the time spent in hypoglycaemia over 24 hours by more than 20 or 30 minutes, and which baseline variables were associated with those improvements. RESULTS Lower reduction of HbA1c was associated with greater reduction of hypoglycaemia (r = -0.52; P < .0001). During CGM, 47% of participants lowered their HbA1c values by more than 0.4% (>4.7 mmol/mol) than with self-measurement of blood glucose, and 47% decreased the time spent in hypoglycaemia by more than 20 minutes over 24 hours. Overall, 78% either reduced their HbA1c by more than 0.4% (>4.7 mmol/mol) or the time spent in hypoglycaemia by more than 20 minutes over 24 hours, but only 14% improved both. Higher HbA1c, a lower percentage of time at less than 3.0 or 3.9 mmol/L, a lower coefficient of variation (CV) and a higher percentage of time above 13.9 mmol/L (P = .016) were associated with greater HbA1c reduction during CGM. The variables associated with a greater reduction of time in hypoglycaemia were female sex, greater time with glucose levels at less than 3.0 mmol/L, higher CV, and higher hypoglycaemia confidence as evaluated by a hypoglycaemic confidence questionnaire. CONCLUSION The majority of people with type 1 diabetes managed by multiple daily insulin injections benefit from CGM; some experienced reduced HbA1c while others reduced the time spent in hypoglycaemia. These factors need to be considered by healthcare professionals and decision-makers for reimbursement and diabetes guidelines.
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Affiliation(s)
- Arndís F. Ólafsdóttir
- Department of MedicineNU‐Hospital GroupUddevallaSweden
- Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
| | - Jan Bolinder
- Department of MedicineKarolinska University Hospital Huddinge, Karolinska InstitutetStockholmSweden
| | | | - William Polonsky
- Behavioral Diabetes InstituteSan DiegoCaliforna
- Department of MedicineUniversity of CaliforniaSan DiegoCalifornia
| | - Magnus Ekelund
- Department of Clinical SciencesLund UniversityLundSweden
| | - Magnus Wijkman
- Department of Internal Medicine and Department of Health, Medicine and Caring SciencesLinköping UniversityNorrköpingSweden
| | - Aldina Pivodic
- Statistiska KonsultgruppenGothenburgSweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Elsa Ahlén
- Department of MedicineNU‐Hospital GroupUddevallaSweden
- Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
| | - Erik Schwarcz
- Department of Internal Medicine, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Thomas Nyström
- Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden
| | - Jarl Hellman
- Department of Medical Sciences, Clinical Diabetes and MetabolismUppsala UniversityUppsalaSweden
| | - Irl B. Hirsch
- School of MedicineUniversity of WashingtonSeattleWashington
| | - Marcus Lind
- Department of MedicineNU‐Hospital GroupUddevallaSweden
- Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
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Roze S, Isitt JJ, Smith-Palmer J, Lynch P, Klinkenbijl B, Zammit G, Benhamou PY. Long-Term Cost-Effectiveness the Dexcom G6 Real-Time Continuous Glucose Monitoring System Compared with Self-Monitoring of Blood Glucose in People with Type 1 Diabetes in France. Diabetes Ther 2021; 12:235-246. [PMID: 33165838 PMCID: PMC7651823 DOI: 10.1007/s13300-020-00959-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The aim was to determine the long-term cost-effectiveness of the Dexcom G6 real-time continuous glucose monitoring (RT-CGM) system versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes (T1D) in France. METHODS The analysis was performed using the IQVIA Core Diabetes Model and utilized clinical input data from the DIAMOND clinical trial in adults with T1D. Simulated patients were assumed to have a mean baseline HbA1c of 8.6%, and those in the RT-CGM arm were assumed to have a HbA1c reduction of 1.0% compared with 0.4% in the SMBG arm. A quality of life (QoL) benefit associated with a reduced fear of hypoglycemia (FoH) and elimination of the requirement for fingerstick testing in the RT-CGM arm was also applied. RESULTS The G6 RT-CGM system was associated with an incremental gain in quality-adjusted life expectancy of 1.38 quality-adjusted life years (QALYs) compared with SMBG (10.64 QALYs versus 9.23 QALYs). Total mean lifetime costs were 21,087 euros higher with RT-CGM (148,077 euros versus 126,990 euros), resulting in an incremental cost-effectiveness ratio of 15,285 euros per QALY gained. CONCLUSIONS In France, based on a willingness-to-pay threshold of 50,000 euros per QALY gained, the use of the G6 RT-CGM system is cost-effective relative to SMBG for adults with long-standing T1D, driven primarily by improved glycemic control and the QoL benefit associated with reduced FoH and elimination of the requirement for fingerstick testing.
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Affiliation(s)
| | | | | | | | | | | | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble Alpes University Hospital, Grenoble, France
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17
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Roze S, Isitt J, Smith-Palmer J, Javanbakht M, Lynch P. Long-term Cost-Effectiveness of Dexcom G6 Real-time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K. Diabetes Care 2020; 43:2411-2417. [PMID: 32647050 DOI: 10.2337/dc19-2213] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A long-term health economic analysis was performed to establish the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) (Dexcom G6) versus self-monitoring of blood glucose (SMBG) alone in U.K.-based patients with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS The analysis used the IQVIA CORE Diabetes Model. Clinical input data were sourced from the DIAMOND trial in adults with T1D. Simulations were performed separately in the overall population of patients with baseline HbA1c ≥7.5% (58 mmol/mol), and a secondary analysis was performed in patients with baseline HbA1c ≥8.5% (69 mmol/mol). The analysis was performed from the National Health Service health care payer perspective over a lifetime time horizon. RESULTS In the overall population, G6 RT-CGM was associated with a mean incremental gain in quality-adjusted life expectancy of 1.49 quality-adjusted life years (QALYs) versus SMBG (mean [SD] 11.47 [2.04] QALYs versus 9.99 [1.84] QALYs). Total mean (SD) lifetime costs were also pounds sterling (GBP) 14,234 higher with RT-CGM (GBP 102,468 [35,681] versus GBP 88,234 [39,027]) resulting in an incremental cost-effectiveness ratio of GBP 9,558 per QALY gained. Sensitivity analyses revealed that the findings were sensitive to changes in the quality-of-life benefit associated with reduced fear of hypoglycemia and avoidance of fingerstick testing as well as the HbA1c benefit associated with RT-CGM use. CONCLUSIONS For U.K.-based T1D patients, the G6 RT-CGM device is associated with significant improvements in clinical outcomes and, over patient lifetimes, is a cost-effective disease management option relative to SMBG on the basis of a willingness-to-pay threshold of GBP 20,000 per QALY gained.
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18
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Hernández-Muñoz JJ, De Santiago AC, Cedrone SZ, Verduzco RA, Bazan DZ. Impact of Pharmacist-Led Drug Therapy Management Services on HbA 1c Values in a Predominantly Hispanic Population Visiting an Outpatient Endocrinology Clinic. J Pharm Pract 2020; 34:857-863. [PMID: 32495714 DOI: 10.1177/0897190020927863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To assess the impact pharmacists have on improving glycemic control among predominantly Hispanic diabetic patients visiting an endocrinology clinic in South Texas. Pharmacists were recently integrated into this clinic to be part of a collaborative team. METHODS This study follows a retrospective cohort design. All patients received diabetic care from endocrinologists, and some received pharmacist-led drug therapy management (PDTM). Patients with ≥1 PDTM were categorized as the intervention group and those without PDTM as the standard of care (SOC) group. The outcome variables were the mean absolute change in glycosylated hemoglobin (HbA1c) from baseline and the proportion of patients at goal HbA1c (<7%) postintervention. RESULTS Data were collected from 222 patients (n = 120 SOC patients, n = 102 PDTM patients). The mean age was 61 ± 14 years, 136 (61%) were female, and 197 (89%) were Hispanic. The mean absolute change in HbA1c was -1.3%. In the adjusted model, the mean absolute change in HbA1c in the PDTM compared to the SOC group was not significant (-0.1% ± 0.2%; P < .74), and concurrent interventions from registered dieticians (RDs) and licensed professional counselors (LPC) were identified as effect modifiers of the association. The stratum specific analysis identified the greatest decrease in HbA1c when the three interventions (ie, PDTM, RD, and LPC) coincided (-1.0% ± 0.3%; P < .01). Postintervention, 25% of those who received PDTM achieved an HbA1c<7% as compared to 19% in the SOC group. CONCLUSION The clinical importance of pharmacists is enhanced when integrated with behavioral modifying programs to achieve additional improvement in HbA1c.
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Affiliation(s)
- José J Hernández-Muñoz
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, College Station, TX, USA
| | - Annette C De Santiago
- DHR Health, Edinburg, TX, USA.,Department of Pharmacy Practice, Texas A&M Irma Lerma Rangel College of Pharmacy, Kingsville, TX, USA
| | | | - Rene A Verduzco
- DHR Health, Edinburg, TX, USA.,Department of Pharmacy Practice, Texas A&M Irma Lerma Rangel College of Pharmacy, Kingsville, TX, USA
| | - Daniela Z Bazan
- DHR Health, Edinburg, TX, USA.,Department of Pharmacy Practice, Texas A&M Irma Lerma Rangel College of Pharmacy, Kingsville, TX, USA
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Gordon I, Rutherford C, Makarounas-Kirchmann K, Kirchmann M. Meta-analysis of average change in laboratory-measured HbA1c among people with type 1 diabetes mellitus using the 14 day Flash Glucose Monitoring System. Diabetes Res Clin Pract 2020; 164:108158. [PMID: 32333970 DOI: 10.1016/j.diabres.2020.108158] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/01/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023]
Abstract
AIM FreeStyle Libre™ Flash Glucose Monitoring System (Flash GM), a novel, sensor-based, factory-calibrated system has been compared with self-monitoring of blood glucose in a well-controlled adult type 1 diabetes mellitus (T1D) population (HbA1c ≤ 7.5%, 58 mmol/mol), in a randomized controlled trial (RCT). The need for RCTs to recruit homogenous patients and for a well-controlled environment may not necessarily reflect use of a new technology in real clinical practice. METHODS A random effects meta-analysis of all identified studies in T1D was performed to investigate changes in laboratory-measured HbA1c following introduction of Flash GM. RESULTS Flash GM introduction showed a mean change from baseline to longest follow-up timepoint of -0.41% ([95% CI -0.51%, -0.31%]; P < 0.001; -4.5 [95% CI -5.6, -3.3] mmol/mol) in HbA1c in the random effects meta-analysis (34 studies comprising 5,466 participants). When the Flash GM arms of the two RCTs were excluded, there was a similar change in HbA1c of -0.41% ([95% CI -0.50%, -0.32%], P < 0.001; -4.5 [95% CI -5.4, -3.5] mmol/mol) in the 32 uncontrolled studies. Considerable heterogeneity was shown in all meta-analyses (I2 values > 85%), likely due to the inclusion of diverse populations and variations in study protocols, meaning random effects meta-analyses should be strongly preferred. CONCLUSIONS In people with T1D, use of Flash GM for 2 to 24 months was associated with an estimated HbA1c reduction from baseline of 0.4%. A similar reduction occurred in uncontrolled studies where baseline HbA1c was generally higher compared with Flash GM arms of well-controlled studies.
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Affiliation(s)
- Ian Gordon
- Statistical Consulting Centre, School of Mathematics and Statistics, University of Melbourne, Victoria 3010, Australia.
| | - Carolyn Rutherford
- KMC Health Care, 45 Alicudi Avenue, Frankston South, Victoria 3199, Australia.
| | | | - Matt Kirchmann
- KMC Health Care, 45 Alicudi Avenue, Frankston South, Victoria 3199, Australia.
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Cowart K, Updike W, Bullers K. Systematic Review of Randomized Controlled Trials Evaluating Glycemic Efficacy and Patient Satisfaction of Intermittent-Scanned Continuous Glucose Monitoring in Patients with Diabetes. Diabetes Technol Ther 2020; 22:337-345. [PMID: 31859531 DOI: 10.1089/dia.2019.0345] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Intermittent-scanned continuous glucose monitoring (isCGM) has the ability to allow for greater personalization of diabetes self-management. The purpose of this systematic review is to provide an updated analysis of the efficacy and patient satisfaction of isCGM in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Methods: A research librarian searched PubMed, EMBASE, and Cochrane Library using keywords and subject headings to identify studies assessing efficacy and use of isCGMs in patients with T1DM and T2DM. Results: Nine randomized controlled trials (RCTs) involving patients with T1DM and T2DM using isCGM were included. Based on available RCT evidence investigating isCGM in patients with diabetes, isCGM may lead to a small decrease hemoglobin A1c (HbA1c) in certain subgroups of patients with uncontrolled T2DM (those using multiple daily insulin injections and aged 65 years or younger). Patients with uncontrolled T1DM using insulin may also benefit from isCGM, when combined with a structured diabetes education program. Evidence is mixed regarding isCGM impact on improving time in glycemic range, glycemic variability, and hypoglycemia. isCGM has demonstrated greater patient satisfaction and lower diabetes distress compared with usual care. Conclusions: isCGM may lead to improvements in HbA1c in certain subgroups of patients. Additional benefit with isCGM on time in glycemic range, glycemic variability, and hypoglycemia is unclear at this time. Future clinical trials are warranted to investigate the role of isCGM in patients with uncontrolled T2DM using insulin and oral antidiabetic drugs.
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Affiliation(s)
- Kevin Cowart
- Department of Pharmacotherapeutics & Clinical Research, College of Pharmacy, University of South Florida, Tampa, Florida
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Wendy Updike
- Department of Pharmacotherapeutics & Clinical Research, College of Pharmacy, University of South Florida, Tampa, Florida
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Krystal Bullers
- Taneja College of Pharmacy Liaison, Research & Education, University of South Florida, Tampa, Florida
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21
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Relationship between HbA1c and capillary blood glucose self-monitoring in type 2 diabetics. ACTA ACUST UNITED AC 2020; 57:125-132. [PMID: 30864405 DOI: 10.2478/rjim-2018-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Diabetes Control and Complications Trial has established the importance of glycemic control in reducing the progression of retinopathy, nephropathy, and neuropathy in type 1 diabetics. There is little literature linking the frequency of glycemic monitoring with glycated hemoglobin A (HbA1c) in type 2 diabetics. The objectives were to assess the influence of glycemic self-monitoring on HbA1c in three groups of patients with type 2 diabetes (with insulin, with oral antidiabetics and with combination therapy). METHODS The glucometer capillary surveys of 117 patients were counted in the 30 days prior to the visit to the Integrated Diabetes Unit at Centro Hospitalar Tondela-Viseu. In the three groups considered, sociodemographic characteristics (age, gender, area of residence, household and schooling) were evaluated and compared. RESULTS There was no statistically significant association between HbA1c and the frequency of capillary glucose in any of the groups. In the evaluation of sociodemographic data, contrary to what was expected, the area of residence and schooling did not influence the value of HbA1c. CONCLUSION These results question the role of glycemic monitoring in the metabolic control of type 2 diabetics, highlighting the need to implement therapeutic education programs so that these patients can adequately intervene in the therapeutic adjustment as a function of the information obtained by capillary glycemia.
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22
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Metwally AM, Soliman M, Abdelmohsen AM, Kandeel WA, Saber M, Elmosalami DM, Asem N, Fathy AM. Effect of Counteracting Lifestyle Barriers through Health Education in Egyptian Type 2 Diabetic Patients. Open Access Maced J Med Sci 2019; 7:2886-2894. [PMID: 31844454 PMCID: PMC6901843 DOI: 10.3889/oamjms.2019.624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle. AIM This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviours, physical activity, medication compliance, and blood glucose monitoring. METHODS A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviours and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention assessment to evaluate the effect of the health education sessions. Statistical analysis was done to identify any statistically significant difference before and after the health education intervention. RESULTS There was a significant improvement of the post-education mean scores of the studied behaviours when compared with the pre-education scores of the participants' behaviours (p < 0.001). There was also a significant reduction in the barriers facing patients to diabetes self-management including nutritional barriers (P < 0.001), medication compliance barriers (P < 0.001) with a percent change (43%), physical activity barriers (p < 0.001), and blood glucose monitoring (p < 0.001) with a percent change (44%).There was a statistically significant positive correlation between improvement of medication compliance (P = 0.027), blood glucose monitoring(P = 0.045), and glycated haemoglobin of the study participants. CONCLUSION lifestyle modification education of type 2 diabetic patients can overcome the main barriers of following a healthy lifestyle and improve their anthropometric measures and blood glucose level.
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Affiliation(s)
- Ammal Mokhtar Metwally
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Mona Soliman
- Department of Public Health & Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Aida M. Abdelmohsen
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Wafaa A. Kandeel
- Biological Anthropology Department, Medical Division, National Research Centre, Giza, Egypt
- Theodor Bilharz Research Institute, Giza, Egypt
| | - Maha Saber
- Department of Complementary Medicine Research, Medical Division, National Research Centre, Giza, Egypt
- Medical Research Centre of Excellence (MRCE), Giza, Egypt
| | - Dalia Mohamed Elmosalami
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Noha Asem
- Department of Public Health & Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Asmaa Mohamed Fathy
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
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Kruger DF, Edelman SV, Hinnen DA, Parkin CG. Reference Guide for Integrating Continuous Glucose Monitoring Into Clinical Practice. DIABETES EDUCATOR 2018; 45:3S-20S. [PMID: 30541402 DOI: 10.1177/0145721718818066] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Large randomized trials have demonstrated the efficacy of continuous glucose monitoring (CGM) in persons with type 1 diabetes and insulin-treated type 2 diabetes. The purpose of this article is to provide basic knowledge about CGM technology, discuss the use of CGM data in clinical practice, and direct clinicians to online resources that provide comprehensive information and tools relevant to patient selection, education/training, and reimbursement. CONCLUSIONS Effective use of CGM requires all members of the health care team to become knowledgeable and skilled in integrating CGM into their practices and in teaching their patients how to safely incorporate CGM use into their daily diabetes self-management.
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Affiliation(s)
- Davida F Kruger
- Henry Ford Health System, Division of Endocrinology, Diabetes and Bone & Mineral, Detroit, Michigan
| | - Steve V Edelman
- University of California San Diego and Taking Control of Your Diabetes 501c3, San Diego, California
| | - Deborah A Hinnen
- Memorial Hospital Diabetes Center, University of Colorado Health, Colorado Springs, Colorado
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24
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Edelman SV, Argento NB, Pettus J, Hirsch IB. Clinical Implications of Real-time and Intermittently Scanned Continuous Glucose Monitoring. Diabetes Care 2018; 41:2265-2274. [PMID: 30348844 DOI: 10.2337/dc18-1150] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/14/2018] [Indexed: 02/03/2023]
Abstract
Two types of continuous glucose monitoring (CGM) systems are now available: real-time CGM (rtCGM) and intermittently scanned (isCGM). Current rtCGM systems automatically transmit a continuous stream of glucose data to the user, provide alerts and active alarms, and transmit glucose data (trend and numerical) in real time to a receiver, smart watch, or smartphone. The current isCGM system provides the same type of glucose data but requires the user to purposely scan the sensor to obtain information, and it does not have alerts and alarms. Both CGM technologies have significant advantages over self-monitoring of blood glucose; however, differences in the features and capabilities of the two approaches must be considered when guiding patient selection of the system that meets their individual needs.
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Affiliation(s)
- Steven V Edelman
- University of California, San Diego, and Taking Control of Your Diabetes, San Diego, CA
| | | | - Jeremy Pettus
- Clinical and Translational Research Institute and University of California, San Diego, San Diego, CA
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25
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Parkin CG. Response to Yu et al. Article "Healthcare Resource Waste Associated with Patient Nonadherence and Early Discontinuation of Traditional Continuous Glucose Monitoring in Real-World Settings: A Multicountry Analysis". Diabetes Technol Ther 2018; 20:635-637. [PMID: 30106604 DOI: 10.1089/dia.2018.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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