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Kubilay E, Trawley S, Ward GM, Fourlanos S, Grills CA, Lee MH, MacIsaac RJ, O'Neal DN, O'Regan NA, Sundararajan V, Vogrin S, Colman PG, McAuley SA. Lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery in a randomised trial. Diabet Med 2023; 40:e15020. [PMID: 36468784 DOI: 10.1111/dme.15020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
AIM To explore the lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery, an area previously receiving minimal attention. METHODS Semi-structured interviews were conducted with adults aged 60 years or older with long-duration type 1 diabetes who participated in a randomised, open-label, two-stage crossover trial comparing first-generation closed-loop therapy (MiniMed 670G) versus sensor-augmented pump therapy. Interview recordings were transcribed, thematically analysed and assessed. RESULTS Twenty-one older adults participated in interviews after using closed-loop therapy. Twenty were functionally independent, without frailty or major cognitive impairment; one was dependent on caregiver assistance, including for diabetes management. Quality of life benefits were identified, including improved sleep and reduced diabetes-related psychological burden, in the context of experiencing improved glucose levels. Gaps between expectations and reality of closed-loop therapy were also experienced, encountering disappointment amongst some participants. The cost was perceived as a barrier to continued closed-loop access post-trial. Usability issues were identified, such as disruptive overnight alarms and sensor inaccuracy. CONCLUSIONS The lived experience of older adults without frailty or major cognitive impairment using first-generation closed-loop therapy was mainly positive and concordant with glycaemic benefits found in the trial. Older adults' lived experience using automated insulin delivery beyond trial environments requires exploration; moreover, the usability needs of older adults should be considered during future device development.
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Affiliation(s)
- Erin Kubilay
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
| | - Steven Trawley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Australia
| | - Charlotte A Grills
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Niamh A O'Regan
- Department of Geriatric Medicine, Waterford Integrated Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - Vijaya Sundararajan
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
| | - Sybil A McAuley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
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Jung H, Tittel SR, Schloot NC, Heitmann E, Otto T, Lebrec J, Pavel M, Lanzinger S. Clinical characteristics, treatment patterns, and persistence in individuals with type 2 diabetes initiating a glucagon-like peptide-1 receptor agonist: A retrospective analysis of the Diabetes Prospective Follow-Up Registry. Diabetes Obes Metab 2023. [PMID: 36855221 DOI: 10.1111/dom.15038] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
AIMS To describe clinical characteristics, treatment patterns and glucagon-like peptide-1 receptor agonist (GLP-1 RA) persistence in individuals with type 2 diabetes (T2D) initiating their first GLP-1 RA. MATERIALS AND METHODS A real-world analysis of adults with T2D initiating GLP-1 RA therapy between 2007 and June 2020 from the multicentre Diabetes Prospective Follow-Up (DPV) Registry, stratified by antidiabetes therapy at the time of GLP-1 RA initiation: oral antidiabetic drugs (OAD), insulin ± OAD or lifestyle modification (LM). GLP-1 RA treatment persistence in individuals with ≥12 months follow-up was determined by Kaplan-Meier analysis. RESULTS Overall, 15 111 individuals with T2D initiating GLP-1 RA therapy (55% men) were identified; median [interquartile range (IQR)] age [58.7 (50.6-66.7) years], diabetes duration [8.5 (3.6-14.7) years], glycated haemoglobin [HbA1c; 8.2 (7.1-9.8)%]. Median (95% confidence interval) GLP-1 RA persistence in eligible individuals (n = 5189) was 11 (10-12) months; OAD 12 (11-14) months (n = 2453); insulin ± OAD 11 (9-12) months (n = 2204); and LM 7 (5-9) months (n = 532). Median treatment persistence tended to increase from 2007-2012 to 2017-2020. Median (IQR) HbA1c decreased from baseline [8.2 (7.1-9.8)%] to discontinuation [7.5 (6.6-8.7)%], with a greater decrease observed in individuals with persistence >12 months versus ≤12 months. Individuals who discontinued GLP-1 RA therapy predominantly switched to insulin (if not already using) or dipeptidyl peptidase-4 inhibitors. CONCLUSION Real-world registry data revealed improved outcomes with longer median GLP-1 RA persistence; ~50% of patients overall achieved HbA1c <7% at 12 months. Persistence was highest with baseline OAD and/or insulin, and tended to increase over the period 2007-2020.
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Affiliation(s)
- Heike Jung
- Lilly Deutschland GmbH, Bad Homburg, Germany
| | - Sascha R Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | | | | | | | | | | | - Stefanie Lanzinger
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
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Sen CK, Roy S, Khanna S. Diabetic Peripheral Neuropathy Associated with Foot Ulcer: One of a Kind. Antioxid Redox Signal 2023. [PMID: 35850520 DOI: 10.1089/ars.2022.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Significance: Diabetic peripheral neuropathy (DPN) associated with a diabetic foot ulcer (DFU) is likely to be complicated with critical factors such as biofilm infection and compromised skin barrier function of the diabetic skin. Repaired skin with a history of biofilm infection is known to be compromised in barrier function. Loss of barrier function is also observed in the oxidative stress affected diabetic and aged skin. Recent Advances: Loss of barrier function makes the skin prone to biofilm infection and cellulitis, which contributes to chronic inflammation and vasculopathy. Hyperglycemia favors biofilm formation as glucose lowering led to reduction in biofilm development. While vasculopathy limits oxygen supply, the O2 cost of inflammation is high increasing hypoxia severity. Critical Issues: The host nervous system can be inhabited by bacteria. Because electrical impulses are a part of microbial physiology, polymicrobial colonization of the host's neural circuit is likely to influence transmission of action potential. The identification of perineural apatite in diabetic patients with peripheral neuropathy suggests bacterial involvement. DPN starts in both feet at the same time. Future Directions: Pair-matched studies of DPN in the foot affected with DFU (i.e., DFU-DPN) compared with DPN in the without ulcer, and intact skin barrier function, are likely to provide critical insight that would help inform effective care strategies. This review characterizes DFU-DPN from a translational science point of view presenting a new paradigm that recognizes the current literature in the context of factors that are unique to DFU-DPN.
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Affiliation(s)
- Chandan K Sen
- Indiana Center for Regenerative Medicine & Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sashwati Roy
- Indiana Center for Regenerative Medicine & Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Savita Khanna
- Indiana Center for Regenerative Medicine & Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Phan LMT, Vo TAT, Hoang TX, Selvam SP, Pham HL, Kim JY, Cho S. Trending Technology of Glucose Monitoring during COVID-19 Pandemic: Challenges in Personalized Healthcare. ADVANCED MATERIALS TECHNOLOGIES 2021; 6:2100020. [PMID: 34179343 PMCID: PMC8212092 DOI: 10.1002/admt.202100020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/18/2021] [Indexed: 05/11/2023]
Abstract
The COVID-19 pandemic has continued to spread rapidly, and patients with diabetes are at risk of experiencing rapid progression and poor prognosis for appropriate treatment. Continuous glucose monitoring (CGM), which includes accurately tracking fluctuations in glucose levels without raising the risk of coronavirus exposure, becomes an important strategy for the self-management of diabetes during this pandemic, efficiently contributing to the diabetes care and the fight against COVID-19. Despite being less accurate than direct blood glucose monitoring, wearable noninvasive systems can encourage patient adherence by guaranteeing reliable results through high correlation between blood glucose levels and glucose concentrations in various other biofluids. This review highlights the trending technologies of glucose sensors during the ongoing COVID-19 pandemic (2019-2020) that have been developed to make a significant contribution to effective management of diabetes and prevention of coronavirus spread, from off-body systems to wearable on-body CGM devices, including nanostructure and sensor performance in various biofluids. The advantages and disadvantages of various human biofluids for use in glucose sensors are also discussed. Furthermore, the challenges faced by wearable CGM sensors with respect to personalized healthcare during and after the pandemic are deliberated to emphasize the potential future directions of CGM devices for diabetes management.
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Affiliation(s)
- Le Minh Tu Phan
- Department of Electronic EngineeringGachon UniversitySeongnam‐siGyeonggi‐do13120Republic of Korea
- School of Medicine and PharmacyThe University of DanangDanang550000Vietnam
| | - Thuy Anh Thu Vo
- Department of Life ScienceGachon UniversitySeongnam‐siGyeonggi‐do461‐701Republic of Korea
| | - Thi Xoan Hoang
- Department of Life ScienceGachon UniversitySeongnam‐siGyeonggi‐do461‐701Republic of Korea
| | - Sathish Panneer Selvam
- Department of Electronic EngineeringGachon UniversitySeongnam‐siGyeonggi‐do13120Republic of Korea
| | - Hoang Lan Pham
- Department of Life ScienceGachon UniversitySeongnam‐siGyeonggi‐do461‐701Republic of Korea
| | - Jae Young Kim
- Department of Life ScienceGachon UniversitySeongnam‐siGyeonggi‐do461‐701Republic of Korea
| | - Sungbo Cho
- Department of Electronic EngineeringGachon UniversitySeongnam‐siGyeonggi‐do13120Republic of Korea
- Department of Health Sciences and TechnologyGAIHSTGachon UniversityIncheon21999Republic of Korea
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Kordonouri O, Kerner W. [Type 1 diabetes: an update]. Internist (Berl) 2021; 62:627-637. [PMID: 33825933 PMCID: PMC8024935 DOI: 10.1007/s00108-021-01009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/02/2022]
Abstract
Die Inzidenz des Diabetes mellitus Typ 1 (T1D) steigt seit 30 Jahren stetig an, insbesondere bei Kindern und Jugendlichen, sodass es alle 20 Jahre zu einer Verdoppelung der Fallzahlen in dieser Altersgruppe kommt. Die verspätete Diagnose oder falsche Interpretation der Symptome führt zur lebensgefährlichen diabetischen Ketoazidose, an der jedes dritte Kind in Deutschland bei Manifestation des T1D leidet. In der Insulintherapie des T1D bei Kindern, Jugendlichen und Erwachsenen gibt es keine prinzipiellen Unterschiede. Die Anwendung einer Insulinpumpentherapie und kontinuierlichen Glukosemessung nimmt stetig zu. Hiermit sollen hypo- und hyperglykämische Episoden reduziert, die Zeit im Zielbereich erhöht und das Hämoglobin‑A1c-Therapieziel unter 7 % erreicht werden. Neben der Vermeidung diabetesbedingter mikrovaskulärer Langzeitkomplikationen ist die rechtzeitige Erkennung und Behandlung kardiovaskulärer Risikofaktoren auch bei jungen Menschen mit T1D von außerordentlicher Bedeutung.
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Affiliation(s)
- Olga Kordonouri
- Allgemeinpädiatrie, Diabetologie, Endokrinologie, Gastroenterologie und Klinische Forschung, Kinder- und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Deutschland.
| | - Wolfgang Kerner
- Klinik für Diabetes und Stoffwechselerkrankungen, Klinikum Karlsburg, Karlsburg, Deutschland
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Hodeck K, Tittel SR, Dreyhaupt I, Beer R, Petermann S, Risse A, Weyer M, Hake K, Schiel R, Holl RW. Charakteristika von Diabetespatienten mit und ohne Pflegebedürftigkeit. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1207-9645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ZusammenfassungIm Rahmen der vorliegenden multizentrischen Auswertung mit 6.424 Pflegepatienten unter 500.973 Menschen mit Diabetes aus dem DPV-Register wird die Erkrankungssituation der Pflegebedürftigen im Vergleich zu Patienten ohne Pflegebedürftigkeit, differenziert nach Altersgruppen und Diabetestyp, dargestellt.15 % der Pflegebedürftigen haben einen Typ-1-Diabetes, darunter fallen 99,0 % der Kinder, 9,5 % der 18- bis 75-Jährigen und 2,4 % der über 75-Jährigen. Pflegebedürftigkeit ist bei Erwachsenen und Senioren insbesondere mit den Krankheitsbildern Demenz, Depression, Herzinsuffizienz, Durchblutungsstörungen der Hirngefäße/Schlaganfall sowie mit dem diabetischen Fußsyndrom/Amputationen assoziiert. In der diabetologischen Therapie des Typ-2-DM wird bei 77 % der Pflegebedürftigen und damit deutlich häufiger als in der Vergleichsgruppe mit 55 % Insulin eingesetzt. Trotz höherer HbA1c-Werte und höherer Nüchternglukose als bei Typ-2-Patienten ohne Pflege treten unter Pflegebedürftigen gleichzeitig signifikant häufiger Hypoglykämien mit und ohne Koma auf. Stoffwechselbedingte Entgleisungen führten bei 15 % der Pflegepatienten mit Typ-2-DM gegenüber nur 6 % der Menschen mit Typ-2-DM ohne Pflegebedarf zu Klinikaufnahmen.Im Rahmen der Versorgung sollte verstärkt auf die Vermeidung von Stoffwechselentgleisungen geachtet und präventiv auf einen späteren Eintritt der assoziierten Krankheitsbilder hingewirkt werden. Die Versorgungsstrukturen sollten regional auf die Begleitung der Betroffenen spezialisiert werden. In der Aus- und Weiterbildung von Pflegepersonal und Ärzten sollten die Besonderheiten von jungen und alten Menschen mit Typ-1- und Typ-2-Diabetes stärker beachtet werden.
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Affiliation(s)
- Katja Hodeck
- Institut für Innovatives Gesundheitsmanagement GmbH, Berlin
| | - Sascha R. Tittel
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm und Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg
| | - Ines Dreyhaupt
- Kreisklinik Trostberg, Kliniken Südostbayern AG, Traunstein
| | - Renate Beer
- Diabetesberatung, HELIOS Klinikum Hildesheim
| | | | | | - Marc Weyer
- Innere Medizin, DRK Kamillus Klinik, Asbach
| | - Kathrin Hake
- Klinik für Kinder- und Jugendmedizin, MediClin Müritz-Klinikum, Waren
| | - Ralf Schiel
- MEDIGREIF Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Haus Gothensee, Ostseebad Heringsdorf
| | - Reinhard W. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm und Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg
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Grammes J, Küstner E, Dapp A, Hummel M, Kämmer JC, Kubiak T, Schütz-Fuhrmann I, Zimny S, Bollow E, Holl RW. Comment on: Comparative characteristics of older people with type 1 diabetes treated with continuous subcutaneous insulin infusion or insulin injection therapy: data from the German/Austrian DPV registry. Reply to Rigalleau et al. Diabet Med 2020; 37:1209-1210. [PMID: 32319106 DOI: 10.1111/dme.14311] [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] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- J Grammes
- Health Psychology, Johannes Gutenberg University, Mainz
| | - E Küstner
- Health Psychology, Johannes Gutenberg University, Mainz
| | - A Dapp
- Medical Center, Spaichingen
| | - M Hummel
- Diabetology Outpatient Clinic, Rosenheim
| | - J-C Kämmer
- Department of Gastroenterology, Cardiology, Diabetology, and Geriatrics, Vivantes Klinikum Berlin, Berlin
| | - T Kubiak
- Health Psychology, Johannes Gutenberg University, Mainz
| | - I Schütz-Fuhrmann
- Department of Internal Medicine, Krankenhaus Hietzing, Vienna, Austria
| | - S Zimny
- Department of Internal Medicine, Endocrinology and Diabetology, Helios Kliniken, Schwerin
| | - E Bollow
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm
- German Center for Diabetes Research (DZD), Munich, Germany
| | - R W Holl
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm
- German Center for Diabetes Research (DZD), Munich, Germany
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